E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 108 CONGRESS, FIRST SESSION
Vol. 149 WASHINGTON, THURSDAY, JUNE 26, 2003 No. 96 House of Representatives The House met at 10 a.m. PLEDGE OF ALLEGIANCE North Carolina, as the ‘‘General Charles Ga- briel Post Office’’. Rabbi Milton Balkany, Dean, Bais The SPEAKER. Will the gentleman Yaakov of Brooklyn, New York, offered H.R. 1596. An act to designate the facility from Tennessee (Mr. COOPER) come for- of the United States Postal Service located the following prayer: ward and lead the House in the Pledge at 2318 Woodson Road in St. Louis, Missouri, Our Father in Heaven, the majestic of Allegiance. as the ‘‘Timothy Michael Gaffney Post Office sequoias tower over the Alpine ex- Mr. COOPER led the Pledge of Alle- Building’’. panses, and yet they continue to giance as follows: H.R. 1609. An act to redesignate the facility of the United States Postal Service located stretch upward toward the Sun. The I pledge allegiance to the Flag of the mighty Colorado River carved the awe- at 201 West Boston Street in Brookfield, Mis- United States of America, and to the Repub- souri, as the ‘‘Admiral Donald Davis Post Of- some grandeur of the Grand Canyon lic for which it stands, one nation under God, fice Building’’. eons ago, yet it continues to surge ever indivisible, with liberty and justice for all. H.R. 1740. An act to designate the facility onward. The thrashing tide of the At- f of the United States Postal Service located lantic has brought innumerable ships at 1502 East Kiest Boulevard in Dallas, MESSAGE FROM THE SENATE to port, and yet the waves ebb and flow Texas, as the ‘‘Dr. Caesar A.W. Clark, Sr. without cease. I stand here today A message from the Senate by Mr. Post Office Building’’. H.R. 2030. An act to designate the facility among the jewels of our Nation, among Monahan, one of its clerks, announced that the Senate has passed without of the United States Postal Service located men and women who are precious, who at 120 Baldwin Avenue in Paia, Maui, Hawaii, radiate dedication, and they have been amendment bills of the House of the as the ‘‘Patsy Takemoto Mink Post Office selected as the leaders of our land. And following titles: Building’’. I pray to You, O Lord, that they too re- H.R. 825. An act to redesignate the facility The message also announced that the main unsatisfied with yesterday. Let of the United States Postal Service located Senate has passed bills of the following them grow with insight and turn the at 7401 West 100th Place in Bridgeview, Illi- titles in which the concurrence of the tide for our land, for we need them, nois, as the ‘‘Michael J. Healy Post Office Building’’. House is requested: their wisdom, devotion and energy, H.R. 917. An act to designate the facility of S. 163. An act to reauthorize the United now more than ever. Amen. the United States Postal Service located at States Institute for Environmental Conflict 1830 South Lake Drive in Lexington, South Resolution, and for other purposes. f Carolina, as the ‘‘Floyd Spence Post Office S. 498. An act to authorize the President to Building’’. posthumously award a gold medal on behalf THE JOURNAL H.R. 925. An act to redesignate the facility of Congress to Joseph A. De Laine, in rec- The SPEAKER. The Chair has exam- of the United States Postal Service located ognition of his contributions to the Nation. at 1859 South Ashland Avenue in Chicago, Il- S. 867. An act to designate the facility of ined the Journal of the last day’s pro- the United States Postal Service located at ceedings and announces to the House linois, as the ‘‘Cesar Chavez Post Office’’. H.R. 981. An act to designate the facility of 710 Wicks Lane in Billings, Montana, as the his approval thereof. the United States Postal Service located at ‘‘Ronald Reagan Post Office Building’’. Pursuant to clause 1, rule I, the Jour- 141 Erie Street in Linesville, Pennsylvania, S. 1207. An act to redesignate the facility nal stands approved. as the ‘‘James R. Merry Post Office’’. of the United States Postal Service located Mr. MCNULTY. Mr. Speaker, pursu- H.R. 985. An act to designate the facility of at 120 East Ritchie Avenue in Marceline, ant to clause 1, rule I, I demand a vote the United States Postal Service located at Missouri, as the ‘‘Walt Disney Post Office Building’’. on agreeing to the Speaker’s approval 111 West Washington Street in Bowling of the Journal. Green, Ohio, as the ‘‘Delbert L. Latta Post f Office Building’’. ANNOUNCEMENT BY THE SPEAKER The SPEAKER. The question is on H.R. 1055. An act to designate the facility the Speaker’s approval of the Journal. of the United States Postal Service located The SPEAKER. The gentlewoman The question was taken; and the at 1901 West Evans Street in Florence, South from New York (Mrs. KELLY) will be Speaker announced that the ayes ap- Carolina, as the ‘‘Dr. Roswell N. Beck Post recognized for 1 minute, followed by 5 peared to have it. Office Building’’. one-minutes on each side. Mr. MCNULTY. Mr. Speaker, on that H.R. 1368. An act to designate the facility f I demand the yeas and nays. of the United States Postal Service located The yeas and nays were ordered. at 7554 Pacific Avenue in Stockton, Cali- WELCOMING RABBI MILTON fornia, as the ‘‘Norman D. Shumway Post Of- BALKANY The SPEAKER. Pursuant to clause 8, fice Building’’. rule XX, further proceedings on this H.R. 1465. An act to designate the facility (Mrs. KELLY asked and was given question are postponed until later of the United States Postal Service located permission to address the House for 1 today. at 4832 East Highway 27 in Iron Station, minute.)
b This symbol represents the time of day during the House proceedings, e.g., b 1407 is 2:07 p.m. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor.
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VerDate Jan 31 2003 01:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00001 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.000 H26PT1 H5942 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Mrs. KELLY. Mr. Speaker, Rabbi tions. I firmly belief that no senior neral for a great statesman from Ari- Milton Balkany, Dean of Bais Yaakov should be forced to choose between put- zona, former House Armed Services in Brooklyn, New York, is an acquaint- ting food on the table or buying the Chairman Bob Stump. I was reminded ance of mine. He has been an active medicines they need. The Prescription of another late Arizona statesman, participant and leader in the Jewish Drug and Medicare Modernization Act Senator Barry Goldwater. In fact, next community in New York City for would build on the strengths and suc- week marks the 40th anniversary of his many, many years. Rabbi Balkany has cesses of the current Medicare system significant step in the historic presi- worked hard to bring the community while guaranteeing that all seniors will dential campaign he waged in 1964. On together in order to continue tradi- have access to a prescription drug ben- July 4, 1963, the National Draft Gold- tional religious and cultural values. efit. water Rally was held at the Wash- Not only does he help younger genera- Just the other day the Secretary of ington National Guard Armory. I was tions understand the intrinsic and ex- Health and Human Services released a honored as a young teenager to come traordinary Jewish culture to which study which says that seniors will get on a bus from South Carolina with they belong, but he also welcomes oth- an up-front drug discount of 25 percent. some of the founders of the modern Re- ers of all religions to engage in prayer, That is a significant savings for many publican Party, Drake Edens, Floyd meditation and community. of the seniors in my district. The re- Spence and Rusty DePass. This failed I applaud you, Rabbi, on this special forms in this legislation will put pa- presidential campaign actually was occasion and welcome you as the guest tients before paperwork and ensure spectacularly successful in launching a chaplain of the House of Representa- that doctors will continue to serve sen- political revolution for limited govern- tives. iors through Medicare. The House has ment and expanded freedom. Especially acted in the past and will work with f in the South, Republican conservatism the Senate to provide affordable, vol- has risen from virtual nonexistence to REGARDING AMENDMENT TO untary coverage for every senior imme- majority status on the local, State and INTELLIGENCE BILL diately. Let us pass this important leg- Federal level. (Mr. KUCINICH asked and was given islation. Our seniors have waited too I am grateful for the lasting influ- permission to address the House for 1 long for this much-needed relief. ence of Barry Goldwater, who inspired minute and to revise and extend his re- f victory over communism, achieved by marks.) MEDICARE MODERNIZATION Ronald Reagan, and an emphasis on ex- Mr. KUCINICH. Madam Speaker, yes- panding freedom by reducing taxation, (Mr. DEFAZIO ASKED AND WAS GIVEN terday in debate over H.R. 2417, the in- promoted by George W. Bush. PERMISSION TO ADDRESS THE HOUSE FOR telligence bill, the chairman of the In conclusion, God bless our troops. committee refused to commit to an In- 1 MINUTE.) Mr. DEFAZIO. Madam Speaker, the f telligence Committee audit of all tele- Republican Medicare prescription drug phone and electronic communications MEDICARE PRESCRIPTION DRUG bill will provide unprecedented benefits between the Central Intelligence Agen- BENEFIT and protection. Unfortunately, the ben- cy and the Vice President to determine efits and protection under this perverse (Mr. COOPER asked and was given whether or not the Vice President in- legislation will all flow to the pharma- permission to address the House for 1 fluenced intelligence produced by the ceutical and insurance industries, not minute and to revise and extend his re- CIA on Iraq’s alleged weapons of mass the seniors who need help paying their marks.) destruction, the cause of war. First, prescription drug bills. That is right. Mr. COOPER. Madam Speaker, today the chairman said the material may be The biggest beneficiaries are the wildly is the day that our seniors have been classified and, second, working docu- profitable pharmaceutical industry and waiting for for many, many years, the ments of the executive are respected the anticompetitive insurance indus- day that we will pass a Medicare pre- and privileged. Some Members want try. You cannot provide a meaningful scription drug benefit. Unfortunately, the Permanent Select Committee on benefit unless you deal with the ob- the real debate took place last night Intelligence to have jurisdiction over scene price of prescription drugs. And upstairs in an attic room in this build- the issue which top committee mem- this bill does nothing, not reasonable ing in the dark of night, literally start- bers clearly do not want to investigate. pricing, not reimportation, not nego- ing after midnight, from 1 to 4 a.m., If an executive official pressured or tiated lowering of prices, nothing, be- burglar hours, not lawmaker hours. In manipulated CIA analysts to dissemi- cause that would hurt the profits of the that debate, they foreclosed real debate nate false, raw, unreliable information pharmaceutical industry. The insur- on this floor today. They allowed only to justify a war, that matter should be ance industry, they will get a subsidy two bills to be considered, the Repub- neither classified nor shielded nor priv- under this bill to offer some sort of lican plan which is deeply flawed, ileged. My amendment to the intel- benefit without any requirement what which will end Medicare as we know it, ligence bill would direct the Inspector those benefits might be, without any and another plan which is too large to General of the CIA to audit all elec- limit on the premiums they might fit within the budget window. I sup- tronic communications between the Of- charge, without any requirement who ported the Dooley alternative, a much fice of the Vice President and CIA to they might provide coverage to or ex- more sensible piece of legislation. Our get to the bottom of numerous public clude, all beginning in 2006. seniors deserve better, much better reports which raise questions as to We just heard about the great afford- than will be done for them on this whether or not the Vice President able plan we are going to offer today. House floor today. played a role in making false informa- This begins in the year 2006 and seniors f tion to become the public reason the who pay $4,500 a year for drugs will get President went to war in Iraq. $3,500 out of their pocket and a thou- b 1015 f sand from this bill. This is the pharma- PRESCRIPTION DRUG MEDICARE MODERNIZATION ceutical industry and insurance indus- LEGISLATION try protection legislation. (Mr. FORBES asked and was given (Mr. PENCE asked and was given per- f permission to address the House for 1 mission to address the House for 1 minute and to revise and extend his re- HONORING THE 40TH ANNIVER- minute and to revise and extend his re- marks.) SARY OF THE NATIONAL DRAFT marks.) Mr. FORBES. Madam Speaker, I rise GOLDWATER RALLY Mr. PENCE. Madam Speaker, as Con- today in support of a comprehensive (Mr. WILSON of South Carolina gress considers the prescription drug prescription drug benefit for all sen- asked and was given permission to ad- legislation today, I think it is impor- iors. The Prescription Drug and Medi- dress the House for 1 minute and to re- tant for the American people to re- care Modernization Act of 2003 will vise and extend his remarks.) member a few simple facts. This would guarantee prescription drug coverage Mr. WILSON of South Carolina. be the biggest new Federal entitlement to all our seniors and future genera- Madam Speaker, yesterday was the fu- since 1965 when Medicare was created.
VerDate Jan 31 2003 01:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00002 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.002 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5943 Medicare currently costs seven and a tribute to an Army sergeant that AMENDMENT NO. 4 OFFERED BY HASTINGS OF half times what this Congress said it meant a great deal to Kansas and our FLORIDA would cost when they invented it. country. Sergeant Jacob Butler, from The CHAIRMAN pro tempore. The Seventy-six percent of seniors in Wellsville, Kansas, joined the Army as unfinished business is the demand for a America today already have prescrip- a private at the young age of 19. He recorded vote on the amendment of- tion drug coverage and according to later rose to the rank of sergeant and fered by the gentleman from Florida the CBO under some versions of this accepted the demanding task of a (Mr. HASTINGS) on which further pro- legislation more than a third of those scout. Unfortunately, Jacob Butler was ceedings were postponed and on which Americans who enjoy coverage from a killed April 1 when a rocket propelled the ayes prevailed by voice vote. private employer from whom they have grenade hit his vehicle in Iraq. It was The Clerk will redesignate the amendment. retired could lose that coverage. an honor to attend Jacob’s memorial If the foundations be destroyed, what The text of the amendment is as fol- service and funeral with his parents, lows: can the righteous do? Let us not in this Jim and Cindy, his friends, his family, Amendment No. 4 offered by Mr. HASTINGS Congress today sow the seeds to de- and his fellow soldiers. The ceremony stroy the foundation of a free market of Florida: reminded me once again that great sac- At the end of subtitle D of title III, insert system by creating a universal drug rifices for the causes of freedom did not the following new section: benefit in Medicare. The answer is the end on July 4, 1776. Sacrifices continue SEC. 337. IMPROVEMENT OF RECRUITMENT, HIR- reforms the President called for giving today. ING AND RETENTION OF ETHNIC Americans the same choices that the AND CULTURAL MINORITIES IN THE Jacob is no longer only a blessing to INTELLIGENCE COMMUNITY. Members of Congress have. It is not to his friends and family, he is now a create a massive new Federal entitle- (a) PILOT PROJECT TO IMPROVE DIVERSITY blessing to an entire Nation. On behalf THROUGHOUT THE INTELLIGENCE COMMUNITY ment. of the people of Kansas and this grate- USING INNOVATIVE METHODOLOGIES FOR THE f ful Nation, I ask that we remember RECRUITMENT, HIRING AND RETENTION OF ETH- NIC AND CULTURAL MINORITIES AND WOMEN REPUBLICAN MEDICARE BILL Sergeant Jacob Butler as a son, a friend, a soldier, and a patriot. WITH THE DIVERSITY OF SKILLS, LANGUAGES (Ms. LORETTA SANCHEZ of Cali- AND EXPERTISE REFLECTIVE OF THE CURRENT fornia asked and was given permission f MISSION.—The Director of Central Intel- to address the House for 1 minute.) INTELLIGENCE AUTHORIZATION ligence shall carry out a pilot project under this section to test and evaluate alternative, Ms. LORETTA SANCHEZ of Cali- ACT FOR FISCAL YEAR 2004 fornia. Madam Speaker, I heard a innovative methods to recruit and hire for The SPEAKER pro tempore (Mr. the intelligence community women and mi- strange rumor last night that the Re- norities with diverse ethnic and cultural publican Party was going to change its PENCE). Pursuant to House Resolution 295 and rule XVIII, the Chair declares backgrounds, skills, language proficiency, mascot from the elephant to the night and expertise. the House in the Committee of the owl. This would be fitting since most (b) METHODS.—In carrying out the pilot legislation these days is being dis- Whole House on the State of the Union project, the Director shall employ methods cussed by Republicans in the dark of for the further consideration of the such as advertising in foreign language news- bill, H.R. 2417. papers in the United States, site visits to in- night behind closed doors without giv- stitutions with a high percentage of students ing Democrats a fair chance to debate b 1020 who study English as a second language, and it here on the House floor. IN THE COMMITTEE OF THE WHOLE other methods that are not used by the Di- Today we are going to vote on legis- Accordingly, the House resolved rector under the DCI Diversity Strategic lation that will provide the most sig- Plan to increase diversity of officers and em- itself into the Committee of the Whole nificant reform in Medicare since its ployees in the intelligence community. House on the State of the Union for the creation in 1965. This legislation will (c) DURATION OF PROJECT.—The Director further consideration of the bill (H.R. shall carry out the project under this section impact millions of seniors across the 2417) to authorize appropriations for for a 3-year period. Nation, yet many of the Representa- fiscal year 2004 for intelligence and in- (d) REPORT.—Not later than 2 years after tives in Congress will not have seen the date the Director implements the pilot telligence-related activities of the this legislation until today. Would project under this section, the Director shall United States Government, the Com- someone sign their name on a long- submit to Congress a report on the project. munity Management Account, and the term mortgage for their home if they The report shall include— Central Intelligence Agency Retire- (1) an assessment of the effectiveness of had never stepped inside that house? ment and Disability System, and for the project; and Moreover, many well thought out (2) recommendations on the continuation other purposes, with Mrs. BIGGERT amendments today will not be debated. of the project as well as for improving the ef- For example, my simple, cost effective (Chairman pro tempore) in the chair. fectiveness of the project in meeting the proposal for a Medicare prescription The Clerk read the title of the bill. goals of increasing the recruiting and hiring drug benefit, they did not allow us to The CHAIRMAN pro tempore. When of women and minorities within the intel- bring it to the floor to discuss it. The the Committee of the Whole rose on ligence community. Wednesday, June 25, 2003, a request for (e) DIVERSITY PLAN.—(1) Not later than night owls have yet again ruined a per- February 15, 2004, the Director of Central In- fect opportunity on what should really a recorded vote on amendment No. 6 printed in House report 108–176 by the telligence shall submit to Congress a report be bipartisan legislation. Ain’t that a which describes the plan of the Director, en- hoot. gentlewoman from California (Ms. LEE) titled the ‘‘DCI Diversity Strategic Plan’’, had been postponed. and any subsequent revision to that plan, to f SEQUENTIAL VOTES POSTPONED IN COMMITTEE increase diversity of officers and employees HONORING SERGEANT JACOB OF THE WHOLE in the intelligence community, including the BUTLER The CHAIRMAN pro tempore. Pursu- short- and long-term goals of the plan. The (Mr. RYUN of Kansas asked and was ant to clause 6 of rule XVIII, pro- report shall also provide a detailed descrip- ceedings will now resume on those tion of the progress that has been made by given permission to address the House each element of the intelligence community for 1 minute and to revise and extend amendments on which further pro- in implementing the plan. his remarks.) ceedings were postponed in the fol- (2) In implementing the plan, the Director Mr. RYUN of Kansas. Mr. Speaker, I lowing order: shall incorporate innovative methods for the rise today on behalf of a true patriot. Amendment No. 4 offered by the gen- recruitment and hiring of women and mi- It will soon be July 4, a date etched in tleman from Florida (Mr. HASTINGS); norities that the Director has determined to America’s heart. A day that serves as a amendment No. 5 offered by the gen- be effective from the pilot project carried out under this section. time of reflection and celebration in tleman from Ohio (Mr. KUCINICH); (f) DEFINITION.—In this section, the term the memory of sacrifices made; sac- amendment No. 6 by the gentlewoman ‘‘intelligence community’’ has the meaning rifices made throughout history that from California (Ms. LEE). given that term in section 3(4) of the Na- granted us the freedoms that we enjoy The first electronic vote, if ordered, tional Security Act of 1947 (50 U.S.C. 401(4))). today. will be conducted as a 15-minute vote. RECORDED VOTE As our Nation celebrates our inde- Remaining electronic votes will be con- The CHAIRMAN pro tempore. A re- pendence, it seems appropriate to pay ducted as 5-minute votes. corded vote has been demanded.
VerDate Jan 31 2003 01:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00003 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.005 H26PT1 H5944 CONGRESSIONAL RECORD — HOUSE June 26, 2003 A recorded vote was ordered. Myrick Rodriguez Strickland SEC. 345. REPORT ON COMMUNICATIONS BE- Nadler Rogers (AL) Stupak TWEEN THE CENTRAL INTEL- The vote was taken by electronic de- Napolitano Rogers (KY) Sullivan LIGENCE AGENCY AND THE OFFICE vice, and there were—ayes 418, noes 0, Neal (MA) Rogers (MI) Sweeney OF THE VICE PRESIDENT ON WEAP- not voting 16, as follows: Nethercutt Rohrabacher Tancredo ONS OF MASS DESTRUCTION IN Neugebauer Ros-Lehtinen IRAQ. [Roll No. 318] Tanner Ney Ross Tauscher (a) AUDIT.—The Inspector General of the AYES—418 Northup Rothman Tauzin Central Intelligence Agency shall conduct an Norwood Roybal-Allard Abercrombie Deal (GA) Issa Taylor (MS) audit of all telephone and electronic commu- Nunes Royce Taylor (NC) Ackerman DeFazio Istook Nussle Ruppersberger nications between the Central Intelligence Terry Aderholt DeGette Jackson (IL) Oberstar Rush Agency and the Office of the Vice President Thomas Akin Delahunt Jackson-Lee Obey Ryan (OH) that relate to weapons of mass destruction Thompson (CA) Alexander DeLauro (TX) Olver Ryan (WI) Thompson (MS) obtained or developed by Iraq preceding Op- Allen DeLay Janklow Ortiz Ryun (KS) Andrews DeMint Jenkins Thornberry eration Iraqi Freedom on or after September Osborne Sabo 11, 2001. Baca Deutsch John Ose Sanchez, Linda Tiahrt Bachus Diaz-Balart, L. Johnson (CT) Otter T. Tiberi (b) REPORT.—Not later than 1 year after Baird Diaz-Balart, M. Johnson (IL) Owens Sanchez, Loretta Tierney the date of the enactment of this Act, the In- Baker Dicks Johnson, E. B. Oxley Sanders Toomey spector General shall submit to Congress a Baldwin Dingell Johnson, Sam Pallone Sandlin Towns report on the audit conducted under sub-sec- Ballance Doggett Jones (NC) Pascrell Saxton Turner (OH) tion (a). The report shall be submitted in un- Ballenger Dooley (CA) Jones (OH) Pastor Schakowsky Turner (TX) Barrett (SC) Doolittle Kanjorski classified form, but may contain a classified Paul Schiff Udall (CO) annex. Bartlett (MD) Doyle Keller Payne Schrock Udall (NM) Barton (TX) Dreier Kelly Pearce Scott (GA) Upton RECORDED VOTE Bass Duncan Kennedy (MN) Pelosi Scott (VA) Van Hollen The CHAIRMAN pro tempore. A re- Beauprez Dunn Kennedy (RI) Pence Sensenbrenner Velazquez Becerra Edwards Kildee corded vote has been demanded. Peterson (MN) Serrano Visclosky Bell Ehlers Kilpatrick Peterson (PA) Shadegg Vitter A recorded vote was ordered. Bereuter Emanuel Kind Petri Shaw Walden (OR) The CHAIRMAN pro tempore. This Berkley Emerson King (IA) Pickering Shays Berman English King (NY) Walsh will be a 5-minute vote. Pitts Sherman Wamp Berry Eshoo Kingston Platts Sherwood The vote was taken by electronic de- Biggert Etheridge Kirk Waters Pombo Shimkus Watson vice, and there were—ayes 76, noes 347, Bilirakis Evans Kline Pomeroy Shuster Watt not voting 11, as follows: Bishop (GA) Everett Knollenberg Porter Simmons Waxman Bishop (NY) Farr Kolbe Portman Simpson [Roll No. 319] Weiner Bishop (UT) Feeney Kucinich Price (NC) Skelton AYES—76 Blackburn Ferguson LaHood Pryce (OH) Slaughter Weldon (FL) Allen Jackson-Lee Rahall Blumenauer Filner Lampson Putnam Smith (MI) Weller Baldwin (TX) Blunt Flake Langevin Quinn Smith (NJ) Wexler Rush Becerra Johnson, E. B. Boehlert Fletcher Lantos Radanovich Smith (TX) Whitfield Ryan (OH) Berkley Jones (OH) Boehner Foley Larsen (WA) Rahall Snyder Wicker Sanders Blumenauer Kleczka Bonilla Forbes Larson (CT) Ramstad Solis Wilson (NM) Schakowsky Brown (OH) Kucinich Bonner Ford Latham Regula Souder Wilson (SC) Scott (VA) Brown, Corrine Lee Bono Fossella LaTourette Rehberg Spratt Wolf Serrano Capps Lewis (GA) Boozman Frank (MA) Leach Renzi Stark Woolsey Slaughter Capuano Lofgren Boswell Franks (AZ) Lee Reyes Stearns Wu Solis Carson (IN) Maloney Boucher Frelinghuysen Levin Reynolds Stenholm Young (FL) Stark Clay Markey Boyd Frost Lewis (CA) Strickland Clyburn McDermott Bradley (NH) Gallegly Lewis (GA) NOT VOTING—16 Thompson (MS) Brady (PA) Garrett (NJ) Lewis (KY) Davis (IL) McGovern Brown-Waite, Gephardt Sessions Tierney Brady (TX) Gerlach Linder DeFazio Meehan Ginny Hulshof Towns Brown (OH) Gibbons Lipinski Smith (WA) Delahunt Meeks (NY) Conyers Jefferson Udall (CO) Brown (SC) Gilchrest LoBiondo Weldon (PA) Dingell Miller, George Cubin Kaptur Udall (NM) Brown, Corrine Gillmor Lofgren Wynn Doggett Moran (VA) Engel Kleczka Van Hollen Burgess Gingrey Lowey Young (AK) Farr Nadler Fattah Rangel Burns Gonzalez Lucas (KY) Filner Napolitano Velazquez Burr Goode Lucas (OK) Frank (MA) Neal (MA) Waters ANNOUNCEMENT BY THE CHAIRMAN PRO Burton (IN) Goodlatte Lynch Grijalva Oberstar Watson Buyer Gordon Majette TEMPORE Gutierrez Olver Watt Calvert Goss Maloney The CHAIRMAN pro tempore (Mrs. Hinchey Owens Waxman Honda Pastor Weiner Camp Granger Manzullo BIGGERT) (during the vote). Members Cannon Graves Markey Inslee Paul Wexler Cantor Green (TX) Marshall are reminded there are 2 minutes re- Jackson (IL) Payne Woolsey Capito Green (WI) Matheson maining on this vote. Capps Greenwood Matsui NOES—347 Capuano Grijalva McCarthy (MO) Abercrombie Bono Cox Cardin Gutierrez McCarthy (NY) b 1042 Ackerman Boozman Cramer Cardoza Gutknecht McCollum Aderholt Boswell Crane Carson (IN) Hall McCotter Messrs. TANCREDO, SIMPSON, Akin Boucher Crenshaw Carson (OK) Harman McCrery CANTOR, GARY G. MILLER of Cali- Alexander Boyd Crowley Carter Harris McDermott fornia, and FLAKE changed their vote Andrews Bradley (NH) Culberson Case Hart McGovern Baca Brady (PA) Cummings Castle Hastings (FL) McHugh from ‘‘no’’ to ‘‘aye.’’ Bachus Brady (TX) Cunningham Chabot Hastings (WA) McInnis So the amendment was agreed to. Baird Brown (SC) Davis (AL) Chocola Hayes McIntyre The result of the vote was announced Baker Burgess Davis (CA) Clay Hayworth McKeon Ballance Burns Davis (FL) Clyburn Hefley McNulty as above recorded. Ballenger Burr Davis (TN) Coble Hensarling Meehan AMENDMENT NO. 5 OFFERED BY MR. KUCINICH Barrett (SC) Burton (IN) Davis, Jo Ann Cole Herger Meek (FL) Bartlett (MD) Buyer Davis, Tom Collins Hill Meeks (NY) The CHAIRMAN pro tempore. The Barton (TX) Calvert Deal (GA) Cooper Hinchey Menendez unfinished business is the demand for a Bass Camp DeGette Costello Hinojosa Mica recorded vote on Amendment No. 5 of- Beauprez Cannon DeLauro Cox Hobson Michaud Bell Cantor DeLay Cramer Hoeffel Millender- fered by the gentleman from Ohio (Mr. Bereuter Capito DeMint Crane Hoekstra McDonald KUCINICH) on which further proceedings Berman Cardin Deutsch Crenshaw Holden Miller (FL) were postponed and on which the noes Berry Cardoza Diaz-Balart, L. Crowley Holt Miller (MI) Biggert Carson (OK) Diaz-Balart, M. Culberson Honda Miller (NC) prevailed by voice vote. Bilirakis Carter Dicks Cummings Hooley (OR) Miller, Gary The Clerk will redesignate the Bishop (GA) Case Dooley (CA) Cunningham Hostettler Miller, George amendment. Bishop (NY) Castle Doolittle Davis (AL) Houghton Mollohan Bishop (UT) Chabot Doyle Davis (CA) Hoyer Moore The text of the amendment is as fol- Blackburn Chocola Dreier Davis (FL) Hunter Moran (KS) lows: Blunt Coble Duncan Davis (IL) Hyde Moran (VA) Boehlert Cole Dunn Davis (TN) Inslee Murphy Amendment No. 5 offered by Mr. KUCINICH: Boehner Collins Edwards Davis, Jo Ann Isakson Murtha At the end of title III, add the following Bonilla Cooper Ehlers Davis, Tom Israel Musgrave new section: Bonner Costello Emanuel
VerDate Jan 31 2003 01:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00004 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.007 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5945 Emerson Kline Quinn b 1051 [Roll No. 320] Engel Knollenberg Radanovich English Kolbe Ramstad Ms. DELAURO and Mr. REYNOLDS AYES—185 Eshoo LaHood Regula changed their vote from ‘‘aye’’ to ‘‘no.’’ Abercrombie Gutierrez Obey Etheridge Lampson Rehberg Ackerman Harman Olver Evans Langevin Renzi So the amendment was rejected. Allen Hastings (FL) Ortiz Everett Lantos Reyes The result of the vote was announced Andrews Hill Owens Fattah Larsen (WA) Reynolds Baca Hinchey Pallone Feeney Larson (CT) as above recorded. Rodriguez Baird Hinojosa Pascrell Ferguson Latham Rogers (AL) AMENDMENT NO. 6 OFFERED BY MS. LEE Baldwin Hoeffel Pastor Flake LaTourette Rogers (KY) Ballance Holt Paul Fletcher Leach The CHAIRMAN pro tempore. The Rogers (MI) Becerra Honda Payne Foley Levin Rohrabacher unfinished business is the demand for a Bell Hooley (OR) Pelosi Forbes Lewis (CA) Ros-Lehtinen recorded vote on amendment No. 6 of- Berkley Hoyer Pomeroy Ford Lewis (KY) Ross Berman Inslee Fossella Linder fered by the gentlewoman from Cali- Price (NC) Rothman Berry Israel Franks (AZ) Lipinski EE Rahall Roybal-Allard fornia (Ms. L ) on which further pro- Bishop (GA) Jackson (IL) Frelinghuysen LoBiondo Reyes Royce ceedings were postponed and on which Bishop (NY) Jackson-Lee Frost Lowey Rodriguez Ruppersberger Blumenauer (TX) Gallegly Lucas (KY) the noes prevailed by voice vote. Ross Ryan (WI) Boswell Jefferson Garrett (NJ) Lucas (OK) The Clerk will redesignate the Rothman Ryun (KS) Boucher Johnson, E. B. Roybal-Allard Gerlach Lynch amendment. Boyd Jones (OH) Gibbons Majette Sabo Rush Sanchez, Linda The text of the amendment is as fol- Brady (PA) Kanjorski Ryan (OH) Gilchrest Manzullo Brown (OH) Kaptur T. Sabo Gillmor Marshall lows: Brown, Corrine Kennedy (RI) Sanchez, Loretta Sanchez, Linda Gingrey Matheson Capps Kildee Sandlin Amendment No. 6 offered by Ms. LEE: T. Gonzalez Matsui Capuano Kilpatrick Saxton Sanchez, Loretta Goode McCarthy (MO) At the end of title III, add the following Cardin Kind Schiff Sanders Goodlatte McCarthy (NY) new section: Carson (IN) Kleczka Schrock Sandlin Gordon McCollum Carson (OK) Kucinich Scott (GA) SEC. 345. REPORT ON INTELLIGENCE SHARING Schakowsky Goss McCotter Case Lampson Sensenbrenner WITH UNITED NATIONS WEAPONS Schiff Granger McCrery Clay Langevin INSPECTORS SEARCHING FOR WEAP- Scott (GA) Graves McHugh Shadegg Clyburn Larsen (WA) ONS OF MASS DESTRUCTION IN Scott (VA) Green (TX) McInnis Shaw Costello Larson (CT) IRAQ. Serrano Green (WI) McIntyre Shays Crowley Lee Greenwood McKeon Sherman (a) IN GENERAL.—The Comptroller General Cummings Levin Sherman Gutknecht McNulty Sherwood of the United States shall conduct a study to Davis (AL) Lewis (GA) Skelton Hall Meek (FL) Shimkus determine the extent to which intelligence Davis (CA) Lipinski Slaughter Snyder Harman Menendez Shuster developed by the Department of Defense and Davis (FL) Lofgren Harris Mica Solis Simmons by the intelligence community with respect Davis (IL) Lowey Hart Michaud Simpson Spratt to weapons of mass destruction obtained or Davis (TN) Majette Hastings (FL) Millender- Skelton DeFazio Maloney Stark Hastings (WA) McDonald Smith (MI) developed by Iraq preceding Operation Iraqi DeGette Markey Stenholm Hayes Miller (FL) Smith (NJ) Freedom was made available to the United Delahunt Matheson Strickland Hayworth Miller (MI) Smith (TX) Nations weapons inspectors and the quantity DeLauro Matsui Stupak Hefley Miller (NC) Snyder and quality of the information that was pro- Deutsch McCarthy (MO) Tanner Hensarling Miller, Gary Souder vided (if any). Dicks McCarthy (NY) Tauscher Herger Mollohan Spratt Dingell McCollum Taylor (MS) (b) SPECIFIC MATTER STUDIED.—The study Hill Moore Stearns Doggett McDermott Thompson (CA) Hinojosa Moran (KS) Stenholm shall provide for an analysis of the suffi- Dooley (CA) McGovern Thompson (MS) Hobson Murphy Stupak ciency of the intelligence provided by the Di- Doyle McIntyre Tierney Hoeffel Murtha Sullivan rector of Central Intelligence to those weap- Edwards Meehan Towns Hoekstra Musgrave Sweeney ons inspectors, and whether the information Emanuel Meek (FL) Turner (TX) Holden Myrick Tancredo was provided in a timely manner and in a Engel Meeks (NY) Udall (CO) Holt Nethercutt Tanner Eshoo Menendez Udall (NM) Hooley (OR) Neugebauer sufficient quantity and quality to enable the Tauscher Etheridge Michaud Van Hollen Hostettler Ney inspectors to locate, visit, and conduct in- Tauzin Evans Millender- Velazquez Houghton Northup vestigations on all high and medium value Farr McDonald Visclosky Hoyer Norwood Taylor (MS) suspected sites of weapons of mass destruc- Taylor (NC) Fattah Miller (NC) Waters Hulshof Nunes Watson Terry tion. Filner Miller, George Hunter Nussle Watt Thomas (c) ACCESS TO INFORMATION.—(1) Subject to Ford Moore Hyde Obey Waxman Thompson (CA) paragraph (2), the Comptroller General may Frank (MA) Moran (VA) Isakson Ortiz Weiner Thornberry secure directly from any agency or depart- Frost Nadler Israel Osborne Gonzalez Napolitano Wexler Tiahrt Issa Ose ment of the United States information nec- Green (TX) Neal (MA) Woolsey Tiberi Istook Otter essary to carry out the study under sub- Grijalva Oberstar Wu Janklow Oxley Toomey section (a). Turner (OH) Jenkins Pallone (2) The appropriate Federal agencies or de- NOES—239 John Pascrell Turner (TX) Johnson (CT) Pearce Upton partments shall cooperate with the Comp- Aderholt Calvert Ehlers Johnson (IL) Pelosi Visclosky troller General in expeditiously providing Akin Camp Emerson Johnson, Sam Pence Vitter appropriate security clearance to individuals Alexander Cannon English Jones (NC) Peterson (MN) Walden (OR) carrying out the study to the extent possible Bachus Cantor Everett Kanjorski Peterson (PA) Walsh pursuant to existing procedures and require- Baker Capito Feeney Ballenger Cardoza Ferguson Keller Petri Wamp ments, except that no person shall be pro- Weldon (FL) Barrett (SC) Carter Flake Kelly Pickering vided with access to classified information Kennedy (MN) Pitts Weldon (PA) Bartlett (MD) Castle Fletcher Kennedy (RI) Platts Weller under this section without the appropriate Barton (TX) Chabot Foley Kildee Pombo Whitfield security clearances. Bass Chocola Forbes Beauprez Coble Fossella Kilpatrick Pomeroy Wicker (d) REPORT.—Not later than 12 months Kind Porter Wilson (NM) Bereuter Cole Franks (AZ) after the date of the enactment of this Act, Biggert Collins Frelinghuysen King (IA) Portman Wilson (SC) the Comptroller General shall submit to King (NY) Price (NC) Wolf Bilirakis Cooper Gallegly Kingston Pryce (OH) Wu Congress a report on the study conducted Bishop (UT) Cox Garrett (NJ) Kirk Putnam Young (FL) under subsection (a). The report shall be sub- Blackburn Cramer Gerlach mitted in unclassified form, but may contain Blunt Crane Gibbons NOT VOTING—11 a classified annex. Boehlert Crenshaw Gilchrest Boehner Culberson Gillmor Brown-Waite, Gephardt Sessions RECORDED VOTE Bonilla Cunningham Gingrey Ginny Jefferson Smith (WA) Bonner Davis, Jo Ann Goode Conyers Kaptur Wynn The CHAIRMAN pro tempore. A re- Bono Davis, Tom Goodlatte Cubin Rangel Young (AK) corded vote has been demanded. Boozman Deal (GA) Gordon Bradley (NH) DeLay Goss ANNOUNCEMENT BY THE CHAIRMAN PRO A recorded vote was ordered. Brady (TX) DeMint Granger TEMPORE The CHAIRMAN pro tempore. This Brown (SC) Diaz-Balart, L. Graves The CHAIRMAN pro tempore (Mrs. will be a 5-minute vote. Burgess Diaz-Balart, M. Green (WI) BIGGERT) (during the vote). Members The vote was taken by electronic de- Burns Doolittle Greenwood Burr Dreier Gutknecht are reminded that there are 2 minutes vice, and there were—ayes 185, noes 239, Burton (IN) Duncan Hall remaining in this vote. not voting 10, as follows: Buyer Dunn Harris
VerDate Jan 31 2003 01:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00005 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.006 H26PT1 H5946 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Hart McCrery Rohrabacher ligence Agency Retirement and Dis- GENERAL LEAVE Hastings (WA) McHugh Ros-Lehtinen ability System, and for other purposes, Hayes McInnis Royce Mr. GOSS. Mr. Speaker, I ask unani- Hayworth McKeon Ruppersberger pursuant to House Resolution 295, she mous consent that all Members may Hefley McNulty Ryan (WI) reported the bill back to the House have 5 legislative days to revise and ex- Hensarling Mica Ryun (KS) with an amendment adopted by the Herger Miller (FL) tend their remarks and include extra- Saxton Committee of the Whole. Hobson Miller (MI) Schrock neous material on H.R. 2417. Hoekstra Miller, Gary Sensenbrenner The SPEAKER pro tempore. Under The SPEAKER pro tempore. Is there Holden Mollohan Shadegg the rule, the previous question is or- Hostettler objection to the request of the gen- Moran (KS) Shaw dered. Houghton Murphy Shays tleman from Florida? Hulshof Murtha Sherwood Is a separate vote demanded on any There was no objection. Hunter Musgrave Shimkus amendment to the committee amend- f Hyde Myrick Shuster Isakson Nethercutt ment in the nature of a substitute Simmons PROVIDING FOR CONSIDERATION Issa Neugebauer adopted by the Committee of the Simpson Istook Ney OF MOTIONS TO SUSPEND THE Smith (MI) Whole? If not, the question is on the Janklow Northup RULES Smith (NJ) amendment. Jenkins Norwood Smith (TX) John Nunes The amendment was agreed to. Mr. LINDER. Madam Speaker, by di- Souder Johnson (CT) Nussle The SPEAKER pro tempore. The rection of the Committee on Rules, I Johnson (IL) Osborne Stearns call up House Resolution 297 and ask Johnson, Sam Ose Sullivan question is on the engrossment and Sweeney third reading of the bill. for its immediate consideration. Jones (NC) Otter The Clerk read the resolution, as fol- Keller Oxley Tancredo The bill was ordered to be engrossed Kelly Pearce Tauzin lows: Taylor (NC) and read a third time, and was read the Kennedy (MN) Pence H. RES. 297 King (IA) Peterson (MN) Terry third time. Resolved, That during the remainder of the King (NY) Peterson (PA) Thomas (By unanimous consent, Mrs. HAR- Thornberry One Hundred Eighth Congress, the Speaker Kingston Petri MAN was allowed to speak out of order.) Kirk Pickering Tiahrt may entertain motions that the House sus- Kline Pitts Tiberi THANKING MEMBERS AND STAFF pend the rules on Wednesdays as though Knollenberg Platts Toomey Ms. HARMAN. Mr. Speaker, now that under clause 1 of rule XV. Kolbe Pombo Turner (OH) LaHood Porter Upton we have completed debate on our intel- The SPEAKER pro tempore (Mrs. Lantos Portman Vitter ligence authorization bill for 2004, I BIGGERT). The gentleman from Georgia Latham Pryce (OH) Walden (OR) just wanted to thank our chairman (Mr. LINDER) is recognized for 1 hour. LaTourette Putnam Walsh Mr. LINDER. Madam Speaker, for Leach Quinn Wamp who is graceful, collaborative and bi- Lewis (CA) Radanovich Weldon (FL) partisan and the members and staff on the purpose of debate only, I yield the Lewis (KY) Ramstad Weldon (PA) the majority side and to thank the customary 30 minutes to the gen- Linder Regula Weller strong team we have on the Demo- tleman from Massachusetts (Mr. LoBiondo Rehberg Whitfield Lucas (KY) Renzi Wicker cratic side and especially our staff. By MCGOVERN), pending which I yield my- Lucas (OK) Reynolds Wilson (NM) name: Christine Healey, John Keefe, self such time as I may consume. Dur- Manzullo Rogers (AL) Wilson (SC) Marcel Lettre, Wyndee Parker, Beth ing consideration of this resolution, all Marshall Rogers (KY) Wolf time yielded is for the purpose of de- McCotter Rogers (MI) Young (FL) Larson, Kirk McConnell, Bob Emmett and Ilene Romack; and also David bate only. NOT VOTING—10 Flanders of my personal staff for all Madam Speaker, H. Res. 297 is a sim- Brown-Waite, Gephardt Smith (WA) the effort they put into yesterday’s ple, straightforward measure that au- Ginny Lynch Wynn very thorough and, I thought, out- thorizes the Speaker to entertain mo- Conyers Rangel Young (AK) Cubin Sessions standing debate. tions to suspend the rules on Wednes- OSS days for the remainder of the 108th ANNOUNCEMENT BY THE CHAIRMAN PRO (By unanimous consent, Mr. G Congress. I strongly supported this pro- TEMPORE was allowed to speak out of order.) posal and urge all of my colleagues in The CHAIRMAN pro tempore (during THANKING MEMBERS AND STAFF the House to join with me in approving the vote). Members are reminded that Mr. GOSS. Mr. Speaker, I too would this measure. there are 2 minutes remaining in this like to congratulate my ranking mem- This past Monday, the Rules Sub- vote. ber and the members of the staff on committee on Technology and the b 1059 both sides of the aisle. Normally I House, which I chair, held a hearing to would name all those staff. This year I So the amendment was rejected. consider this very proposal. The chair- am just going to point to one indi- man of the Committee on Rules testi- The result of the vote was announced vidual who really was the architect of as above recorded. fied on this proposal, and the sub- the bill for the majority, put it to- committee gathered testimony from b 1100 gether, did the hard work as he always the minority whip, the gentleman from does. He does the budget number and The CHAIRMAN pro tempore (Mrs. Maryland (Mr. HOYER), and the gen- he understands the programs. His name BIGGERT). The question is on the com- tleman from Massachusetts (Mr. is Mike Meermans. In addition to the mittee amendment in the nature of a FRANK) as well. substitute, as amended. spectacular work he did for us in a bi- During the debate on H. Res. 297, I The committee amendment in the partisan and a thoroughly professional urge my colleagues to keep their re- nature of a substitute, as amended, was way, Mr. Meermans and his family had marks to the underlying measure, agreed to. a sudden and significant illness in the rather than use this modest proposal as The CHAIRMAN pro tempore. Under family. We wish his family well and we an excuse to debate other matters. Ex- the rule, the Committee rises. wish his son Godspeed, full and com- tending the Speaker’s ability to enter- Accordingly, the Committee rose; plete recovery. tain motions to suspend the rules on and the Speaker pro tempore (Mr. The SPEAKER pro tempore. The Wednesdays provides the House leader- SHIMKUS) having assumed the chair, question is on the passage of the bill. ship with another tool that can be used Mrs. BIGGERT, Chairman pro tempore The question was taken; and the to easily move noncontroversial legis- of the Committee of the Whole House Speaker pro tempore announced that lation through the Chamber. on the State of the Union, reported the ayes appeared to have it. By way of background, when the that that Committee, having had under Mr. GOSS. Mr. Speaker, on that I de- House convened on January 7, 2003, we consideration the bill (H.R. 2417) to au- mand the yeas and nays. adopted H. Res. 5, the House rules for thorize appropriations for fiscal year The yeas and nays were ordered. the 108th Congress. Specifically, clause 2004 for intelligence and intelligence- The SPEAKER pro tempore. Pursu- 1 of rule XV provides that it is in order related activities of the United States ant to clause 8 of rule XX, further pro- for the House to entertain a motion to Government, the Community Manage- ceedings on this question will be post- suspend the rules on Mondays, Tues- ment Account, and the Central Intel- poned. days, and in the last 6 days of session
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00006 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.005 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5947 of Congress. That very same day, the ated 38 years ago. Two days ago, I weapon that stifles debate, that shuts House also approved a standing order asked the chairman of the Committee Members and their constituents out of that authorized the Speaker to enter- on Rules when as a Member of the the legislative process, destroys the tain motions to suspend the rules on House I could examine this hugely im- committee process and harms the pub- Wednesdays, through the second portant bill, and I was told emphati- lic interest, all behind closed doors and Wednesday in April. On April 30, 2003, cally that it would be available online often in the middle of the night. the House adopted a unanimous con- yesterday morning. So I got up early As Members know, and the American sent agreement that extended the au- yesterday morning, and I logged on at people are noticing, the Committee on thority of the Speaker to entertain mo- home; but there was no bill. I checked Rules is where the sausage gets made tions to suspend the rules through yes- again during the day, but again no bill. and it is not pretty. Finally at 11:50 p.m. last night, we terday, June 25. There have been a b 1115 total of 16 Wednesdays this year on were given a copy of the bill and told which the House could have considered the Committee on Rules would hold an The facts speak for themselves. Two legislation under suspension of the emergency meeting an hour later to thirds of the rules reported by this rules. Through yesterday, this author- consider this bill, and we reported the committee in the 106th Congress were ity was exercised 13 times. rule at 5 a.m. this morning. closed or restricted. That increased al- Entertaining motions to suspend the Why the rush to do this bill in the most three-fourths in the 107th Con- rules on Wednesdays has been a valu- middle of the night? Is this bill so im- gress. In fact, less than 30 percent of able and helpful tool for the House portant, so time sensitive that the Re- the rules reported by this committee in leadership. In fact, just a few weeks publicans need to force it through the the 107th Congress were open. And so ago, the minority showed how much Committee on Rules in the dead of far this year of the 52 rules reported by clout they can have actually in defeat- night? When I asked the distinguished the Committee on Rules six have been ing these suspensions when they op- chairman of the Committee on Rules open rules, six of 52. posed two Senate-passed public lands why it was considered an emergency All of this may sound like Inside bills and both measures failed under hearing, all he could tell me was that Baseball to most Americans, but as we suspension of the rules. Eventually, we he called the emergency hearing be- can see with the prescription drug bill brought both measures back to the cause it is his prerogative as chairman this stuff matters. In the House of Rep- floor where they were overwhelmingly of the committee and he wanted to do resentatives process determines a great approved. There is simply no evidence it this way. We had only an hour to deal, and lately, Madam Speaker, the to support any claim that permitting look at this final bill, a bill that is process around here has been lousy. the Speaker to entertain motions to close to 700 pages long. When they were in the minority, Re- suspend the rules on Wednesdays limits This process, Madam Speaker, is dis- publicans consistently complained or infringes on the rights of the minor- graceful. It demeans this body, and it about their treatment by the then ity. insults the American people who rely Democratic majority. So if this is pay- Madam Speaker, approving this reso- on us to read, to debate, and to vote back for the way Democrats ran the lution is the right thing to do. knowledgeably on legislation. It is House, then call it payback, but please Madam Speaker, I reserve the bal- clear that the Republican leadership do not claim that this is fair and bal- ance of my time. wants to rush this bill through this anced when it is clearly not. Americans Mr. MCGOVERN. Madam Speaker, I body as quickly as possible. The other are better served with an open demo- thank the gentleman from Georgia for body has already spent 2 weeks debat- cratic process. It is in the public inter- yielding me this time, and I yield my- ing this bill. They will consider over 70 est to allow the full and free debate self 51⁄2 minutes. amendments before they are done. Re- and to have many people and many dif- This resolution is simple. It allows publicans and Democrats alike have ferent points of view heard and consid- the Republican leadership to consider been able to bring their amendments to ered by Members of the people’s House. suspension bills on Wednesdays. Cur- the floor in the other body and to be In 1994, while still in the minority, rent rules allow this body to consider heard and to debate these issues. Fifty- Chairman DREIER gave a speech about suspension bills on Mondays and Tues- eight amendments on the Medicare bill the undemocratic nature of the Com- days. A special provision in the rules were brought to the Committee on mittee on Rules. In that speech he said allows the majority to place items Rules this morning. Only one sub- that ‘‘the arrogance of power with under the suspension of the rules on stitute was made in order. Everything which they prevent Members, rank- Wednesday as well. That special provi- else, including some very thoughtful and-file Democrats and Republicans, sion expires soon, and it is my under- amendments offered by Republicans, from being able to offer amendments, standing that the majority would like was denied. We will have a grand total that is what really creates the outrage to extend it through the 108th Con- of 4 hours to discuss a bill that will here.’’ The wisdom of his words still gress. fundamentally change the way 40 mil- apply today. The arrogance of power is Madam Speaker, I am rising today to lion Americans pay for the medicines indeed a dangerous thing. strongly oppose this resolution, and I that they need. Madam Speaker, I reserve the bal- urge my colleagues to vote ‘‘no’’ and This process is awful, Madam Speak- ance of my time. defeat the resolution. I have serious er; and this resolution will make it Mr. LINDER. Madam Speaker, I re- concerns about not only the suspension worse. The question is quite simple. serve the balance of my time. process but about the way this House is Rather than naming more post offices Mr. MCGOVERN. Madam Speaker, I being managed. Suspensions should be on Wednesdays, why do we not have yield 5 minutes to the distinguished reserved for noncontroversial items more debate? What is wrong, for exam- gentleman from Texas (Mr. FROST), the that do not require lengthy debate by ple, with this House spending a few ranking member on the House Com- the full House. Controversial issues or days or even a week on the Medicare mittee on Rules. substantive issues should not be prescription drug bill? Why not let (Mr. FROST asked and was given per- brought to the House floor under the more Members, Democrats and Repub- mission to revise and extend his re- suspension process, a process that al- licans alike, have an opportunity to be marks.) lows little debate and no amendments. heard? We obviously have the time; Mr. FROST. Madam Speaker, I thank But, Madam Speaker, this House is otherwise you would not be here asking the gentleman for yielding me this becoming a place where trivial issues for more suspensions to be scheduled. I time. get debated passionately and impor- understand that the majority has a re- Let us be very clear about what is tant ones not at all. The majority of sponsibility to run the House, to move happening on the floor today. The this House already allows far too little legislation through this process. The United States Senate has a procedure debate on critical issues facing the Committee on Rules can be a tool in called a filibuster where Members can American people. Later today, we will that effort; but under this Republican get up and talk and fill time. Up until debate the most sweeping changes to leadership, the Committee on Rules today the House does not have a fili- Medicare since the program was cre- has become not a tool but a weapon, a buster. What we are doing is to pass a
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00007 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.017 H26PT1 H5948 CONGRESSIONAL RECORD — HOUSE June 26, 2003 bill, a change in our rules, that would Mr. LINDER. Madam Speaker, I re- tleman from Massachusetts (Mr. create a filibuster on the floor of the serve the balance of my time. FRANK) will speak to that a little later House and prevent Members from hav- Mr. MCGOVERN. Madam Speaker, I and tell us how tricky that is when ing the opportunity to debate sub- yield 31⁄2 minutes to the distinguished they put matters on and Members can- stantive matters. gentleman from Florida (Mr. not, for example, make a distinction Why do I say that? We are going to HASTINGS), another member of the between whether they want to vote yes add an extra day of suspensions. Why Committee on Rules. or no and when many times they will do the Republicans want to add an Mr. HASTINGS of Florida. Madam want to vote no and find themselves in extra day of suspensions? They want to Speaker, I thank the gentleman from a box. I believe the gentleman from use our valuable floor time for minor Massachusetts (Mr. MCGOVERN) for Massachusetts (Mr. FRANK) will be able noncontroversial matters. Why do they yielding me this time. And the gen- to explain it better than I. want to use our valuable floor time for tleman from Texas (Mr. FROST), the The gentleman’s chairman and mine, minor noncontroversial matters? Be- ranking member who is a most distin- the gentleman’s good friend and mine, cause they do not want to provide full guished member of the Committee on Gerald Solomon, said the following: debate on matters like changing Medi- Rules, is very generous to my col- Every time we deny an open amend- care and the new prescription drug leagues on other side when he says ment process on an important piece of plan. Why do they not want to provide they will bring up nonsubstantive mat- legislation, we are disenfranchising the full debate on Medicare and prescrip- ters on the suspension calendar under people and their representatives from tion drugs? They do not have enough the rule that is proposed now, to add a the legislative process. The people and time. There is not enough time for us day where suspension matters of the their representatives are not being to do this. Why do not we have enough rules can be brought to our attention. even treated as second class citizens. time? Because they are bringing more I am not that generous because And what I said to the chairman is that noncontroversial bills to the floor. among the things that I believe that roughly 48.9 percent of the people in It is very interesting. This is of are likely to happen is that we are this country are represented by Demo- course the oft remarked case of the going to see substantive legislation crats. young person who killed his parents here on the floor of the House under Let me end by saying what Gerald and throws himself on the mercy of the the suspension calendar. And when Solomon said: The people are sick and court because he is an orphan. that happens that means it did not tired of this political gamesmanship. Let us be very clear what the Repub- come to the Committee on Rules. They want back into their House, and licans are doing. They do not want to Members did not have an opportunity they do want it open and democratic, debate the key substantive issues that to amend it. When it is here on the not closed and dictatorial. face this country. What did they do in House floor they each have 20 minutes Anybody that believes that this the rule last night, this morning? We per side and one can bring the most measure is going to help this House of were here until 5:15 a.m. this morning. major matter; for example, we were up Representatives is participating in Why were we here until 5:15 a.m. this last night, as has been pointed out, what Gerald Solomon described as a morning in the Committee on Rules? from 12:50 until 5:15 this morning in the closed and dictatorial body, and time Because our meeting did not start until Committee on Rules. That is all right, will tell. 12:50 a.m. this morning. Why did it not but would the Members believe that Mr. LINDER. Madam Speaker, I re- start until 12:50 this morning? Because under this particular rule that is com- serve the balance of my time. Mr. MCGOVERN. Madam Speaker, I the Republicans did not want a meet- ing in the middle of a session that what yield 2 minutes to the gentlewoman ing that would be widely covered by we could also do is bring this same from Ohio (Ms. KAPTUR). the press and it would be easily acces- Medicare measure up if we wanted to under the majority provision? Ms. KAPTUR. Madam Speaker, I sible to our Members to come and tes- thank the gentleman for yielding me tify. A lot of very good Members, a lot I cannot say it too well, but I said to the chairman of the committee, why this time and rise in strong opposition of conscientious Members on both sides are we doing this in the middle of the to this rule today. Imagine, a bill that of the aisle stayed up. They were there night? It would seem to me that what will affect over 40 million people. But at 12:50 a.m. and they testified until 5 we can do is work 9 to 5 Monday not until 2006 they tell us, which is a.m. this morning, and what did the through Friday rather than having to very interesting, and we do not even Republicans on the Committee on have this lack of time. The American get a chance to read the bill before we Rules do? They told them thanks for people send us up here to work. They vote on it. Last night, I was one of coming but no thanks, they are not do not send us up here to avoid time. those people that managed to stay in going to give them any time on the Mr. DREIER. Madam Speaker, will the Committee on Rules until 5 a.m. floor, they will not give them an the gentleman yield? this morning trying to amend this bill. amendment. They did this to some of Mr. HASTINGS of Florida. I yield to I thought: ‘‘What a punitive process.’’ their own Members as well as to Demo- the gentleman from California. Yet this is how they are treating the crats. Why are they doing that? Be- Mr. DREIER. Madam Speaker, I American people, too. It will be harder cause they do not want their own Mem- thank my friend for yielding. And let on them than it was obviously on us bers to have to vote on things that me begin by expressing my apprecia- staying up all night on this measure might be embarrassing for them when tion to him for the hard work that he that is so vastly important to grand- they go back to the next election. put into the Committee on Rules meet- mothers, grandfathers, to older citizens So that brings us to where we are ing last night. across this country. today. We are going to create a fili- My friend just mentioned the fact They want to privatize Medicare. buster rule in the House. We are going that measures that are considered They want to take this prescription to permit the Republican leadership to under suspension of the rules are non- drug benefit and put our seniors into filibuster, to use our time, our valuable substantive and his concern is the fact Medicare HMOs. Try to find one that floor time, by bringing noncontrover- that we may bring up substantive still exists in your area. And they de- sial bills commending people for things measures under suspension of the rules. nied me the opportunity to offer my they have done, naming facilities, all The fact of the matter is major sub- amendment to permit the Secretary of kinds of things. We used to just do stantive pieces of legislation should Health and Human Services to have ne- those in a day or two. Now we are come up under suspension of the rules. gotiated prices for prescription drugs. going to have 3 days of those bills and They can only pass if there is a two- Everybody knows bulk buying gets one now, ‘‘Oh, by the way, we will not have thirds vote. The only requirement is a better price. They denied me that any time for you to offer your amend- that in fact 61 Democrats joined with ability, and not only that but in the ment on Medicare, we will not have every Republican to pass the measure. base bill in section 8–1800 they forbid any time for you to offer your amend- I thank my friend for yielding. I just the Secretary of Health and Human ment on prescription drugs. We have wanted to make that clear. Services to have negotiated prices to used up all our time. We have created Mr. HASTINGS of Florida. Madam get people the best price for prescrip- another suspension day.’’ Speaker, reclaiming my time, the gen- tion drugs, moreover, in their bill, if a
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00008 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.019 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5949 person’s drugs cost over $2,000 a year, sequences later that 12 million chil- one of the most important issues this well, it’s just too bad. Seniors will have dren, American children, have been left Congress will consider this year, this to pay between $2,000 and $4,000 for on the editing room floor because they prescription drug package for our sen- what they cannot afford. How many did not have a lobbyist in the con- ior citizens. seniors earning $8,000 a year on Social ference room. And we did not know The Committee on Energy and Com- Security can afford that? this fact because we had to debate this merce marked up this legislation for 3 What is the matter with you people? bill and move it immediately within 1 days last week, the Democratic side of- What is the matter with you? hour. Six and one half million working fered dozens of amendments that would And then they try to limit the families who make $12,000 a year, equal significantly improve the legislation. amount of time for debate on the floor to what a Member of Congress earns in Several of these amendments were very here. Let’s look at negotiated prices on 1 month, yet General Musharraf of close or tie votes, including one this accompanying chart, which I am Pakistan walked out in 24 hours with amendment that I offered to close that trying to get in this bill, take this that check, equal amount. gap in coverage that is part of the so- medicine for high blood pressure, for That is a consequence. It is a real called prescription drug benefit plan. example, in Canada that costs about consequence about whether we have That would close that doughnut hole $152. In our country it costs about $182 time on the floor to debate these that our seniors are going to fall into if one goes to the regular drugstore. issues, give voice to our values and under the majority Republican plan. And if one has a negotiated price like principles. Whether they are Demo- But the Committee on Rules would not the Department of Veterans Affairs crats or Republicans, there are com- let us offer these same amendments, has, you can get it for $102. The con- mon values, common principles we can amendments which should have been sumer saves all that money. find. offered and may have passed on this All my amendment tries to do is to b 1130 floor. use what the Department of Veterans One amendment was discussed by my Affairs does to have bulk buying, to Now, if we want to have non- colleague, the gentlewoman from Ohio, have negotiated prices, and apply it to controversial time on the floor, that is regarding a provision in this bill that this program so we use the power of fine. But find in your heart, in your prohibits the Health and Human Serv- the people, the consumer power of the mind, that same sense of justice for ices Secretary from negotiating for people, to get them the best price for controversial issues to debate. Respect cheaper prices for our seniors. That is prescription drugs. They will not allow the public that we are here to give just wrong. We do not prohibit the VA my amendment on this floor today. voice to their values, that we should from doing it. We do not prohibit our I should at least have the right to debate those issues. That is just one States from doing it. In fact, the Com- offer my amendment. You can vote no consequence. mittee on Energy and Commerce bill on it, but you have no right to do this I had a bipartisan amendment on the that passed allowed States to do that; to the senior citizens of our country. I prescription drug bill that would allow yet we are saying that the Federal urge my colleagues to vote no on this generics to come to market to compete Government cannot get cheaper prices rule. with name brands to reduce prices. It for our seniors. That amendment Mr. LINDER. Madam Speaker, on my would also allow us to import drugs should be on this floor. time, I would like to ask the Clerk to from American-made drugs that are Madam Speaker, it is far too impor- reread the rule. sold in Canada, Germany, and England tant for us to rush a debate on a pre- The SPEAKER pro tempore (Mrs. at cheaper prices, that would bring scription drug benefit for seniors and BIGGERT). Without objection, the Clerk market forces to bear, bring real com- only have 1 day. The Senate has been will reread the resolution. petition, make drugs affordable, would debating this bill for the past 2 weeks, There was no objection. save close to a half of $1 trillion. There The Clerk reread the resolution. but in the House we are going to do Mr. LINDER. Madam Speaker, I was no room for this debate on pre- this and rush it through in one after- thought I was correct. This is a rule on scription drugs for that amendment. noon. That is not the way our fore- So whether we want noncontrover- suspensions, not on Medicare. fathers designed this House to legis- Madam Speaker, I continue to re- sial, it is not controversial to me, but late. serve the balance of my time. whether we have real issues debated I urge my colleagues to oppose the Mr. MCGOVERN. Madam Speaker, I here on this floor, so people can vote rule when it comes up and obviously to yield 21⁄2 minutes to the gentleman and be held accountable, that, to me, is oppose the underlying bill. from Illinois (Mr. EMANUEL). significant. Let us have time to bring Mr. LINDER. Madam Speaker, I re- Mr. EMANUEL. Madam Speaker, I our common values and common prin- serve the balance of my time. thank the gentleman from Massachu- ciples, to debate them, and stand up in Mr. MCGOVERN. Madam Speaker, I setts (Mr. MCGOVERN) for yielding me front of our public to let them know yield 51⁄2 minutes to the gentleman this time. where we stand. from Massachusetts (Mr. FRANK). What are the consequences of what Mr. LINDER. Madam Speaker, I re- Mr. FRANK of Massachusetts. we are talking about? I will give an ex- serve the balance of my time. Madam Speaker, the disrespect that ample. When we were debating the tax Mr. MCGOVERN. Madam Speaker, I the majority has for the democratic bill a couple weeks ago, we found out yield 2 minutes to the gentleman from process is evident today. after the fact because we only had an Texas (Mr. GREEN). The majority brings this to the floor, hour to debate this major tax bill that Mr. GREEN of Texas. Madam Speak- does not deign to discuss it. Perhaps 12 million children of working parents, er, I thank my colleague from Massa- they are going to wait until they have 61⁄2 million families, were left on the chusetts for allowing me to talk on the very last word, which they are en- editing room floor not getting a tax this rule, but mainly talk about a rule titled to under the rule; but I do not cut that they were promised, a $1,000 that will come up in a few minutes. understand why they should think it is tax cut. It costs us $3.5 billion to make Madam Speaker, a critical part of not worth their time and energy to dis- those children whole while millionaires the legislative process is to be able to cuss the issues we are trying to solve. were getting their tax cut. amend legislation so that we can im- Mr. LINDER. Madam Speaker, will General Musharraf of Pakistan came prove it. The rule on Medicare pre- the gentleman yield? to the White House the other day, scription drugs does not allow us to do Mr. FRANK of Massachusetts. I will walked out in 24 hours with a $3.5 bil- that. The continued efforts by the lead- yield to the gentleman from Georgia on lion check, equal to the amount it ership of the House to stifle debate on his time. would be to keep the children, 12 mil- this issue can no longer be tolerated. Mr. LINDER. Madam Speaker, I am lion children, 61⁄2 million families, the Although the rule does allow a sub- happy to give the gentleman 2 minutes. same amount of money to give them a stitute, which is better than last year, Mr. FRANK of Massachusetts. full $1,000 child tax credit. which I appreciate, there are so many Madam Speaker, I am happy to yield. They do not have time to debate other important amendments that Mr. LINDER. Madam Speaker, I have these things. They learn the con- should be debated on the floor on this, explained this rule, and the Clerk has
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00009 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.021 H26PT1 H5950 CONGRESSIONAL RECORD — HOUSE June 26, 2003 read it twice. I do not know what the final bill. This is where you go on sus- percent, we are not going to let you try gentleman does not understand about pension. It is a terrible abuse of the and change or modify the 10 percent, it or what needs to be discussed about democratic process to take a complex because then we will say, oh, you are it. This was a rule that was passed in issue like we had on Israel yesterday, not patriotic, you are not a supporter April under unanimous consent. If the and I voted for it, but I would have of the State of Israel, you are not a gentleman wants to discuss the rule, I liked to have voted for some amend- supporter of the American economy. will be delighted to engage him. But if ments. I would like to be able to affirm That is an abuse of the process, be- the gentleman wants to discuss some- that Israel has a right of self-defense, cause democracy does not simply thing else, he is all on his own. but ought to consider as a matter of means the end result. It means an open Mr. FRANK of Massachusetts. prudence and as a matter of their own process of debate. It means letting peo- Madam Speaker, reclaiming my time, I self-interests whether or not they ple try to change each other’s minds. It thank the gentleman for confirming should use it as often as they are enti- means letting the American people my point. He said the Clerk has read it tled to. But it comes up on suspension. through the media understand what is twice. Okay, America. You have heard And the important questions are going on. What we have is a systemic specifically the language read twice. often not ‘‘yes’’ or ‘‘no,’’ but ‘‘yes, process here not to allow that. You should be grateful for that. but,’’ and ‘‘no, except.’’ You do not Madam Speaker, it is not a matter of There are philosophical implications allow that. You bring them up under time. We are told we do not have here. We have been meeting only on an suspension because this is your view, enough time. By the way, when I came here and average of 21⁄2 days a week. You are only the end result counts. If you can was told by the majority, well, that is now going to make 3 out of 21⁄2 days eli- get a majority for the end result, the gible for suspensions. debate process gets collapsed; and the way it used to be. No, it was not. The chairman of the Committee on whether or not there are amendments, By the way, to the extent that there Rules said previously, 25 years ago the whether or not there is any modifica- were abuses in the past, I objected. Democrats went from 1 day to 2. That tion, that is not allowed. When I was in the majority, I helped was 2 days out of 4 days. You have Here is why: there are people on the lead a change in the rules because too shrunk the time we are in session and Republican side who campaign in their often, both sides in a conference report increased the amount for suspensions. own districts on one set of principles took the same position. And I fought The refusal to discuss this announce- and then come here and enable exactly for the rights of minorities to take 20 ment, arrogantly, Hey, I read the rule, the opposite to become the law of the minutes on the conference report. what more do you want, is what we are land. And here is how they do it. They Madam Speaker, when I came here, getting at. say to people, oh, I would not vote on we had something called the 5-minute What we have here is what political that. We are going to vote next week rule. We debated. We yielded to each philosophers have called authoritarian on whether or not, or 2 weeks, whether other. We debated defense bills for 3, 4, democracy. It is a view that as long as or not you should be allowed to receive and 5 days. The majority, in the interests of ultimately a majority ratifies a result, Federal money for secular purposes, making sure that it gets its Members that is all that counts. Well, that is a and then deny employment to people to do whatever they are told to do very unfortunate view of democracy. It because you do not like their religion. without being embarrassed on subordi- is not the view of democracy of the That is what is going to be up. And we nate issues, has beaten down democ- U.S. Constitution, of the Rules of the are not going to get to vote on this if racy. They have collapsed democracy House of Representatives, or any self- past practice is any guide, because we into meaning simply the end product. respecting parliamentary democracy. have twice asked to vote on that spe- What we want to have is debate. And debates on amendments and public cific issue; and the Republicans said, discussion, as evidenced by this today, What we want to have is to air for the no, no, we do not want you to vote on public. We are here as the representa- hey, I read the rule; what do you need? that. Well, democracy needs debate, discus- tive body for a great democracy. What The reason is that if their Members sion. It needs a joinder of the issues, is important is not simply the result, had to vote individually on that, many and we do not get that. And we do not not simply your ability, which I envy, of them would have to vote not to get it, as I said, primarily to protect; to get your Members to vote in a ma- allow that discrimination because that and we have Members who are not as jority for things that they do not like. is what they told people they stand for. conservative as the center of gravity You are going to produce a majority So what the Republicans will do will be on the Republican Party, and I apolo- today for a prescription drug bill for to bring forward what we call a rule. It gize to some in the Republican Party which most of your Members are going is a procedure which will prevent peo- for saying ‘‘center of gravity,’’ because to go home and take a prescription ple from voting on the very issue that I know to many of them ‘‘center’’ is a drug to cure the headache and the they claim to support. And then having dirty word. stomach ache and the backache and voted to prevent themselves from vot- So there are moderate Republicans, the twisted arms that they are going to ing, they will go to their own constitu- so-called, who do not agree with their get either from voting for it or after ents and say, you know, I agree; but I party’s positions. What they are now voting for it. But you can get them to was not given a chance to vote. That is doing is voting with their party on a do it. what we are dealing with. series of procedures that disallow de- Well, here is what happens. In fact, That is what happens when you have mocracy, disallow debate, disallow the chairman of the Committee on more suspensions, and this is very rel- amendments, and that allows them Rules said as we debated this in the evant to this rule. You take things like then to appear to be for certain posi- Committee on Rules, it is partly be- the Israel resolution and resolutions on tions when they have voted to collapse cause there is such a narrow majority the war and on the troops and on ge- them. That is why this rule is a great that you have to go to these tactics. netically modified foods, all of those disservice to democracy. That is backwards. The narrower the were resolutions which I supported, but Mr. LINDER. Madam Speaker, I re- majority in the House, the more re- with which I had some subordinate serve the balance of my time. spect there ought to be for the proce- cause differences. I would have liked to Mr. MCGOVERN. Madam Speaker, I dural forums that allow things not to have been able to participate in a yield myself the balance of my time. be forced. democratic process to try to amend First of all, let me echo a point that Here is what we have: an ideologi- them, I think, to strengthen them. was made by my colleague from Massa- cally driven majority on the Repub- You were afraid, you in the majority, chusetts about the importance of the lican side, very much controlled on key Madam Speaker, to allow that to hap- amendment process and how it pro- issues by their most extreme ideolog- pen. You wanted to make some polit- motes congressional accountability. ical cohort, and they are determined to ical points, so you bring these forward Let me read my colleagues a quote: put legislation through that many of in an unamendable form and you say to ‘‘What does the ability to offer an their Members do not like. And the people, you are going to have to vote amendment have to do with account- key, by the way, is not yes or no on the for it. Even if you only agree with 90 ability? If a Member has the power to
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00010 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.025 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5951 offer an amendment, he can no longer This is too important; and for some frastructure and bioterrorism readiness clearly claim to support one thing, but then of us who worry that they are trying to deserve’s priority over non-substantive mat- say that he was blocked in his effort to privatize and weaken Medicare, it is ters. We have a moral duty not to take lightly make a change in the law. In addition, appalling that we do not have an op- the lives of our children and grandchildren. with more floor votes and more clear portunity to have amendments on this Quite frankly, this bill appears to be somewhat issues, Members will be forced to take floor to protect Medicare, to make sure of a mockery to our democratic process. clear positions with their votes. That that it does not wither on the vine, to In the years leading up to the election of is exactly what the American people make sure that it is there for future 1994, the Republican Party in the House of want: fewer excuses and more elected generations. Representatives complained loudly and vocif- officials who actually stand for some- That is what is at stake here. That is erously that the then-Democratic majority ruled thing.’’ what we are talking about is so impor- the House with an autocratic iron fist. The That quote, Madam Speaker, was tant. Members of the Rules Committee heard this made by the distinguished chairman of I want to close by making an appeal complaint on a daily basis. Democrats were the Committee on Rules, the gen- to some of my Republican colleagues accused of stifling debate and gagging the tleman from California (Mr. DREIER). I who routinely come before the Com- House. agree with that quote. mittee on Rules and, like many Demo- After eight and a half years of a Republican- The gentleman from Georgia (Mr. crats, get routinely shut out of the controlled House, the Democratic Members of LINDER), my friend, seems confused as process. Many of them were there last the Rules Committee can report that the to why we are having this debate. He night, early this morning, at 2:00, 3:00, House of Representatives is less democratic has asked for the amendment resolu- 4:00 in the morning trying to get their and more autocratic than ever before. Instead tion to be read over and over, so let me amendments made in order, very of reforming the House, the Republican major- try to clear something up. The reason thoughtful amendments. They were ity has taken filibuster and gagging the House why we are having this debate today is shut out of the process. I want to speak to new heights. The Democratic Members of because we believe that this House is to them just for one second and urge the Rules Committee, as do the other Mem- becoming a place where trivial issues them to join with us in voting against bers of the Democratic Caucus, believe that get debated passionately, and impor- this resolution. Send a message to your the Republican majority has, in the years tant ones, not at all. The fact that leadership that everybody in this Con- since it took control of this institution, made a what they are asking for is an addi- gress deserves respect and everybody concerted effort to shut down debate and stifle tional day to debate essentially non- should be heard, that the constituents the deserving advocates of this legislative in- consequential, trivial issues bothers us that I represent are as important as stitution. We believe this effort by the Republic because we are constantly being told the constituents that you represent, leadership goes against the public interest and by the majority that we do not have are as important as the constituents the pledges made by a host of Republican enough time to make everybody’s that are represented by the Speaker of Members in the years leading up to the 1994 amendments in order. We do not have the House and the majority leader of election. Furthermore, the ‘‘substance’’ of this enough time to allow this House to de- this Chamber. bill, if you will, completely obliterates legitimate liberate. We do not have enough time So this is an important vote, and the legislative order. to make sure that the democratic proc- debate we are having today is very rel- Mr. Speaker, I point that our children and ess works, and that all Members, evant and very relevant to the topic at grandchildren deserve better. The first re- Democrats and Republicans, have an hand. So I urge my colleagues on both sponders on the front line awaiting the nec- opportunity to have their constituents’ sides of the aisle to vote ‘‘no’’ on this. essary funds to staff the ports and the posts voices be heard on this House floor. So We are spending too much time naming against the threat of terrorist attack deserve that is why we are having this debate. post offices and not enough time debat- better. Our brothers in Liberia who have been We are having it in a particularly ing the issues that real people care displaced because of civil and political strife passionate way today because of what about. So I urge a ‘‘no’’ vote. deserve better. The seniors citizens whose went on earlier this morning in the Madam Speaker, I yield back the re- ability to obtain prescription drugs in a reason- Committee on Rules. The prescription mainder of my time. able fashion deserve better. We, as Member drug bill, perhaps one of the most im- Mr. LINDER. Madam Speaker, I yield of the House of Representatives are charged portant pieces of legislation that we myself such time as I may consume. to do better. will deal with, an issue that impacts 40 I do not agree with my Massachu- For the foregoing reasons, I oppose H. Res. million of our senior citizens in this setts colleague who said it is dumbing 297. country, this bill was brought to the down democracy to do suspensions and Mr. LINDER. Madam Speaker, I yield Committee on Rules in the middle of not have amendments. To get to a con- back the balance of my time, and I the night, and virtually every amend- clusion at many times is good for the move the previous question on the res- ment and all of the substitutes except process, good for the country. olution. one were ruled out of order, were de- Ms. JACKSON-LEE of Texas. Mr. Speaker, The previous question was ordered. nied. So these people will not have an I rise in opposition to H. Res. 297 which pro- The SPEAKER pro tempore (Mrs. opportunity to be heard on the floor vides for the Speaker the option to entertain BIGGERT). The question is on the reso- today. motions to suspend the rules on Wednesdays lution. during the remainder of the One Hundred The question was taken; and the b 1145 Eighth Congress. Functionally, this proposal Speaker pro tempore announced that I mean, we are stunned. We are hinders the legislative business of the House. the ayes appeared to have it. shocked. We are appalled that on a bill Furthermore, by implication, this bill appears Mr. MCGOVERN. Madam Speaker, I this important that they are rushing it to be nothing more than an another attempt by object to the vote on the ground that a to the floor under an extremely restric- the Majority to diminish the opportunity of the quorum is not present and make the tive process, limiting debate so that we Minority to debate more substantive issues on point of order that a quorum is not are not going to have much of a debate this floor. present. here on this House floor. The purpose for allocating time for these The SPEAKER pro tempore. Pursu- In the other body they have been de- items is to expedite their adoption and entry ant to clause 8, rule XX and the Chair’s bating it for 2 weeks, over 70 amend- into the records because they are not con- prior announcement, further pro- ments, and they are still debating it; troversial. To slow down the legislative cal- ceedings on this motion will be post- but here in the people’s House, we are ender with three days, instead of two, of non- poned. supposed to represent the people. We controversial items is patently wasteful. Pass- The point of no quorum is considered are supposed to be the body of govern- ing legislation to commemorate great citizens withdrawn. ment closest to the people. We are and to instill widely-held moral values is quite f being told that we have to do it in a important but should yield to the simple prin- matter of a few hours, let us do it ciple of prioritization. An appropriations bill for RECESS quickly, no amendments and get out of projects queued by the Department of Home- The SPEAKER pro tempore. Pursu- here. That is not the way to do it. land Security to protect our Nation’s critical in- ant to clause 12(a) of rule I, the Chair
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00011 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.027 H26PT1 H5952 CONGRESSIONAL RECORD — HOUSE June 26, 2003 declares the House in recess subject to (2) conform the title of H.R. 1 to reflect the b 1300 the call of the Chair. addition of the text of H.R. 2596 to the en- I would like to take a moment to Accordingly (at 11 o’clock and 48 grossment; (3) assign appropriate designations to pro- clarify for my colleagues that upon minutes a.m.), the House stood in re- visions within the engrossment; and passage of both pieces of legislation, cess subject to the call of the Chair. (4) conform provisions for short titles with- the text of H.R. 2596 shall be added as f in the engrossment. a new matter at the end of H.R. 1. In (c) Upon the addition of the text of H.R. simple terms, these two bills will be- b 1253 2596 to the engrossment of H.R. 1, H.R. 2596 come one. However, this bill does not AFTER RECESS shall be laid on the table. SEC. 4. During consideration of H.R. 1 and preclude either bill from moving for- The recess having expired, the House H.R. 2596 pursuant to this resolution, not- ward independently. was called to order by the Speaker pro withstanding the operation of the previous Finally, the remaining sections of tempore (Mr. LATOURETTE) at 12 question, the Chair may postpone further this rule provide for some house- o’clock and 53 minutes p.m. consideration of either bill to a time des- keeping provisions and provisions ignated by the Speaker. f which will allow this body to move for- SEC. 5. Upon the adoption of this resolution ward in the appropriations process. PROVIDING FOR CONSIDERATION it shall be in order, any rule of the House to the contrary notwithstanding, to consider Mr. Speaker, today is a historic day. OF H.R. 1, MEDICARE PRESCRIP- For years now, seniors across this TION DRUG AND MODERNIZA- concurrent resolutions providing for ad- journment of the House and Senate during country have consistently voiced to TION ACT OF 2003, AND H.R. 2596, the month of July. Congress the same major concerns: the HEALTH SAVINGS AND AFFORD- SEC. 6. The Committee on Appropriations skyrocketing costs of prescription ABILITY ACT OF 2003 may have until midnight on Thursday, July drugs. Their concerns are not per- Ms. PRYCE of Ohio. Mr. Speaker, by 3, 2003, to file a report to accompany a bill ceived; they are very, very real. Each making appropriations for the Department direction of the Committee on Rules, I of defense for the fiscal year ending Sep- year, a typical senior pays approxi- call up House Resolution 299 and ask tember 30, 2004, and for other purposes. mately $1,300 on prescription drugs, for its immediate consideration. The SPEAKER pro tempore. The gen- filling about 22 prescriptions on aver- The Clerk read the resolution, as fol- tlewoman from Ohio is recognized for 1 age. Today, the House will consider a lows: hour. plan to give all seniors a prescription H. RES. 299 Ms. PRYCE of Ohio. Mr. Speaker, for drug benefit through Medicare. Resloved, That upon the adoption of this purposes of debate only, I yield the cus- In passing this bill, as I believe we resolution it shall be in order without inter- tomary 30 minutes to the gentlewoman will do before this day is over, we will vention of any point of order to consider in from New York (Ms. SLAUGHTER), pend- renew America’s promise to our sen- the House the bill (H.R. 1) to amend title ing which I yield myself such time as I iors, reduce the cost of prescription XVIII of the Social Security Act to provide drugs, and revolutionize medicine in for a voluntary program for prescription may consume. During consideration of this resolution, all time yielded is for the 21st century. drug coverage under the Medicare Program, I would like to thank the gentleman to modernize the Medicare Program, and for the purposes of debate only. other purposes. The bill shall be considered Mr. Speaker, House Resolution 299 is from California (Chairman THOMAS) as a read for amendment. The previous ques- a multi-part rule providing for the con- and the gentleman from Louisiana tion shall be considered as ordered on the sideration of H.R. 1, the Medicare Pre- (Chairman TAUZIN) for their exemplary bill and on any amendment thereto to final scription Drug and Modernization Act cooperation, their remarkable leader- passage without intervening motion except: of 2003, and H.R. 2596, the Health Sav- ship, and inspiring vision they have (1) three hours of debate on the bill equally ings and Affordability Act of 2003. provided on this complex, yet very divided among and controlled by the chair- This rule provides for consideration much-needed legislation. I would like men and ranking minority members of the to take a moment just to give special Committee on Energy and Commerce and the of H.R. 1 under a modified closed rule, Committee on Ways and Means; (2) the an appropriate rule for such a delicate, thanks to them for working so closely amendment printed in the report of the Com- complex, and historic piece of legisla- with me on a couple of provisions that mittee on Rules accompanying this resolu- tion. The rule provides for 3 hours of will greatly benefit cancer patients and tion, if offered by Representative Rangel of general debate equally divided between hospitals across the country. Included New York or his designee, which shall be in the chairmen and ranking minority in this legislation is immediate Medi- order without intervention of any point of members of the Committee on Energy care coverage for oral anticancer drugs order, shall be considered as read, and shall and Commerce and the Committee on through a demonstration project that be considered as read, and shall be separately Ways and Means. The rule waives all will offer extraordinary support to sen- debatable for one hour equally divided and controlled by the proponent and an oppo- points of order against consideration of iors who are fighting cancer. It will en- nent; and (3) one motion to recommit with or H.R. 1. able them to afford the newest life- without instructions. After general debate it will be in saving medicines in the comfort of SEC. 2. Upon the adoption of this resolution order to consider an amendment print- their own homes, rather than be it shall be in order on the legislative day of ed in the report accompanying this res- hooked up to chemotherapies by infu- June 26 or June 27, 2003, without interven- olution, if offered, by the gentleman sions in a hospital or clinical setting. tion of any point of order to consider in the from New York (Mr. RANGEL) or his I also commend the chairmen’s inter- House the bill (H.R. 2596) to amend the Inter- designee and debatable for 1 hour. All est and support in assisting hospitals nal Revenue Code of 1986 to allow a deduc- tion to individuals for amounts contributed points of order are waived against the who serve a disproportionate number of to health savings security accounts and amendment. Finally, the rule permits uninsured and indigent populations. health savings accounts, to provide for the the minority to offer a motion to re- Hospitals across this country, includ- disposition of unused health benefits in cafe- commit to H.R. 1 with or without in- ing many of our Nation’s children’s teria plans and flexible spending arrange- structions. hospitals, will be better able to serve ments, and for other purposes. The bill shall Section 2 of this rule provides for the their patients with over $3 billion in be considered as read for amendment. The consideration of H.R. 2596, the Health additional funding. Finally, rural hos- previous question shall be considered as or- Savings and Affordability Act of 2003, pitals are finally getting their fair dered on the bill to final passage without in- either today, the legislative day of tervening motion except: (1) one hour of de- share: $27.2 billion. bate on the bill equally divided and con- June 26, or tomorrow, June 27, under a Since 1965, Medicare has provided a trolled by the chairman and ranking minor- closed rule. The rule provides 1 hour of guarantee of health care coverage for ity member of the Committee on Ways and general debate in the House equally di- more than 40 million seniors. Today, Means; and (2) one motion to recommit. vided and controlled by the chairman our seniors are counting on the sta- SEC. 3. (a) In the engrossment of H.R. 1, the and ranking minority member of the bility, longevity, and integrity of this Clerk shall await the disposition of H.R. 2596 Committee on Ways and Means. All program for their secure retirement. under section 2. (b) If H.R. 2596 is passed by the House, the points of order against the consider- But if we do not act and pass this bill Clerk shall— ation of H.R. 2596 are waived. Finally, before us today, the future of Medicare (1) add the text of H.R. 2596 as new matter the rule provides for one motion to re- will be certain: certain bankruptcy. at the end of H.R. 1; commit with or without instructions. Our inaction will have sealed the fate
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00012 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.029 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5953 for one of our Nation’s most trusted Now, some of my colleagues will no they could use to strengthen the bill, I programs. doubt put forth $1 trillion, pie-in-the- apologize to you that there is no possi- So today, we will do two long-over- sky plans. These packages would bust bility in the world that you could do it. due things. First, we will modernize any budget, Republican, Democrat, or I hope that you did not hate yourself Medicare to save it for future seniors; otherwise. As a matter of fact, the this morning for all the sleep that you and, second, we will provide the much- Democrat substitute actually is larger lost for nothing. needed prescription drug coverage. than the sum of two budgets. The Dem- Mr. Speaker, this rule is an affront to The prescription drug package the ocrat Spratt budget had $528 billion for the democratic process. The underlying House is considering here today will Medicare, and the Democrat Blue Dog bill will harm every single one of the 40 provide the same universal guaranteed budget had $400 billion dedicated to million Americans served by Medicare. Medicare health services as those that Medicare. That is a total of $920 billion. At 1 a.m. this morning, with absolutely currently exist. If you are 65 or older, But the Democrat substitute that they no meaningful opportunity to review you qualify for Medicare, and you qual- are offering today is over $1 trillion, the almost 700-page prescription drug ify for this benefit. It is that simple. more than the combination of those legislation, the Committee on Rules And we provide significant and imme- two Democrat budgets. Mr. Speaker, met to consider the resolution now be- diate savings for seniors on their medi- that is unacceptable. fore us. By now I should be used to it, cines. Specifically, this plan provides Mr. Speaker, the lack of prescription but we cannot tolerate these continual Medicare beneficiaries with a prescrip- drug coverage under Medicare is ex- attacks on democracy. When you tion drug discount card offering over 25 actly what age discrimination looks refuse to allow half this House to speak percent in savings, catastrophic protec- like in 2003. Seniors are the last group and to give their amendments, you are tions, giving seniors 100 percent cov- of people who are forced to pay retail cutting out half of the population of erage for out-of-control drug costs be- costs for their medications and, Mr. the United States from any participa- yond $3,500 year, and full assistance for Speaker, that should be enough of a tion in the legislation that goes on our neediest citizens. violation of civil rights to get even the here. It defies reason and it defies com- Equally important, this rule makes ACLU involved. mon sense that political expediency in order a provision establishing health I said just a moment ago that today and newspaper headlines could force savings accounts, a revolutionary tool, is a historic day, and it is. Today we this monumental legislation, probably so that every American, not just sen- apply a little common sense by recog- the most monumental that any of us iors, can set aside savings now for their nizing that health care is simply not will do in our tenure in the Congress of medical expenses, tax-free. With over what it was 30 years ago, and that the United States, to force it through 40 million uninsured, this is so impor- Medicare is not what it was 30 years the Chamber with little more than cur- tant, and the plan provides for a catch- ago. It must change to keep up. Today, sory consideration. up provision so that seniors can take we will take the first steps in creating The other body, on the other hand, advantage and set aside more money the next generation of quality health has spent over 2 weeks debating similar more quickly. care, a new era where prescription legislation. In stark contrast, we meet Mr. Speaker, this is a remedy for drugs make regular doctor visits less when nobody is around, up in the attic, what ails America’s uninsured. Our frequent, where cutting-edge treat- as someone said today, and are per- plan is designed for those people who ments make hospital stays nearly ob- mitted only 3 hours to discuss the larg- might be shut out of work-based cov- solete in the future, and where life- est overhaul of Medicare in its history. erage and offers all Americans, regard- saving medications reduce formerly The people we represent would be dis- less of their income or age, access to deadly diseases to mere manageable gusted if they understood how this health coverage with no bureaucracy symptoms within longer and healthier issue is being handled. or costly mandates. lives. We are not naming a post office here. Finally, this package includes chron- Today I urge my colleagues to be We are considering, as I said, the most ic care management for all Medicare bold, to be courageous, to show leader- important change to Medicare since its beneficiaries. ship, and to take America’s health care creation. This decision will affect so Mr. Speaker, one-third of Medicare system into a new frontier, a place many people. It is no simple under- beneficiaries have one or more chronic where it has needed to go for far too taking, and it certainly deserves more illnesses. This provision will help bet- long now. Time is precious and so are debate than allowed by this rule. ter manage diseases, reduce health care our seniors. I urge this Congress to To add even more confusion to the costs, and enhance health and quality pass the underlying rule and approve messy process, the Committee on Rules of life. H.R. 1, the Medicare Improvement and incorporated the so-called Health Sav- So here we are at a major crossroad. Prescription Drug Act of 2003. ings Account bill into the rule for the Seniors continue to tell us that adding Mr. Speaker, I reserve the balance of Medicare overhaul legislation, so what a prescription drug benefit to Medicare my time. we are doing here are two rules. So- is not some pie-in-the-sky policy that Ms. SLAUGHTER. Mr. Speaker, I called health savings accounts would they would merely prefer become law. thank the gentlewoman from Ohio for create a new tax advantage, personal No. The majority of seniors are telling yielding me the customary 30 minutes, savings accounts, used to pay the out- us that they cannot go another year and I yield myself such time as I may of-pocket medical expenses. At first without help, without any assistance, consume. glance, perhaps it sounds innocuous. without any help with their drug costs, (Ms. SLAUGHTER asked and was But when you look at the fine print, and without access to higher-quality given permission to revise and extend you see that it basically amounts to a health care. her remarks.) $72 billion tax cut over the next 10 Therefore, some questions need to be Ms. SLAUGHTER. Mr. Speaker, this years while the Federal deficit con- asked for those who will come forward is a very sad day for most of us. A pro- tinues to grow out of control. Even in the next few hours and oppose this gram that has served America well and worse, it is a tax break with a destruc- package. Ask them: How is this pack- has given peace of mind and good tive purpose: to threaten the tradi- age not an improvement for our seniors health care to seniors for over 40 years tional employer-based health care by who have no coverage and are strug- is under threat today; and actually, actually encouraging companies to re- gling to pay for their medications? And what we know is going to be before us duce their employees’ health coverage. ask them: How is the huge prescription is the death of Medicare. Mr. Speaker, perhaps the most egre- drug savings that will result from this One of the saddest parts about this gious problem with the legislation be- plan not useful to seniors? Ask them: bill today is that the Democrats have fore us is it does nothing to address the How is bringing Medicare into the 21st no role in it. To all of my colleagues skyrocketing prices of prescription century and saving it for future gen- who showed up last night at the Com- drugs. Oh, sure, they will tell us that erations not wise for our children, our mittee on Rules, or this morning, actu- we can import drugs from Canada, but grandchildren, and our great grand- ally, at the Committee on Rules with the fact of the matter is that an children? amendments that they thought that amendment inserted into the Senate
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00013 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.032 H26PT1 H5954 CONGRESSIONAL RECORD — HOUSE June 26, 2003 bill by one of our Senators says that it away what is probably the most impor- pact our mothers, grandmothers, sisters, and cannot be done unless it is certified by tant issue to senior citizens, will they aunts. Women are living longer than ever, and the Secretary of HHS, who has stated be able to get health care. longer than men—this is good news. However, already that he will not do it. There- b 1315 the poverty that many women experience dur- fore, any debate today about being able ing their final years is certainly not good news. to import drugs is absolutely a farce. Don Young, who is the President of There are several reasons women’s ‘‘golden The consumer price index on which the Health Insurance Association of years’’ are not so golden. While most women Social Security cost-of-living adjust- Americans, quoted here often, has said, have worked their entire lives, a good portion ments are based rose 98 percent, and ‘‘We caution Congress against relying of this work was not in the paid workforce. the prescription drug costs that are on drug only insurance as a mechanism You don’t earn a pension for time spent caring crippling older Americans rose even to deliver a benefit.’’ for children or elderly parents. higher. Seniors on Medicare are ex- Ira Loss, an analyst with Washington When many of our mothers and grand- pected to spend $1.8 trillion on pre- Analysis, said, ‘‘The private sector mothers were in the workforce, they were de- scription drugs over the next decade. that is supposed to be excited about nied equal pay for equal work. Some worked Today’s Washington Post tells a this isn’t. It creates a new benefit pro- only part time, trying to balance the respon- story of Marie Urban of Cleveland. gram built around insurance products sibilities of their jobs and their families. As a After her housing and Medicare pay- that do not exist and are likely to result, they’ve made less over their lifetimes— ment, she has $459 a month for utili- never exist.’’ and now their monthly Social Security benefit ties, food, car insurance, taxes, and Mr. Speaker, this proposal would re- is smaller. These women deserve financial medication. She told The Post that place Medicare’s guaranteed coverage stability, and still, the Republican prescription some months she has 87 cents left over. with what is essentially a voucher pro- drug proposal denies them the security that This is wrong. She deserves better. A gram to purchase private insurance, as- comes with knowing that can afford to pay for few years ago, as a temporary Band- suming that there is an insurer willing their medical care. Aid, I organized a bus load of seniors to to sell it to you. But those who want No one needs a drug benefit more than el- travel to Canada to purchase medica- the traditional fee-for-service Medicare derly women. But instead of a real prescription tions at fractions of the prices charged will be forced to pay higher premiums. drug benefit, all they are getting from the ma- in the American market. We had doz- We have no idea, for example, what jority are empty promises, a ‘‘donut hole’’ cov- ens more people interested than we Part B would cost because it is not in erage gap, and increased premiums for the could accommodate, but those who the bill, which is intended to force the services they already enjoy. Our mothers and went saved anywhere from $100 to $650 beneficiaries out of traditional Medi- grandmothers deserve better. We can and we on a 3-month supply of medication. care and into private insurance. must do better. Oppose this sham Republican We are fortunate to live in an age Mr. Speaker, senior citizens do not plan, and support the Democratic alternative. when science provides the medications want this legislation. We have all re- Ms. SLAUGHTER. Mr. Speaker, I that cure illness and improve the qual- ceived call after call and letter after yield such time as she may consume to ity of life and extend life. But the letter beseeching us to oppose this the gentlewoman from California (Ms. plan. They did not contact me because LINDA T. SA´ NCHEZ.) promise of the wonder drug is meaning- ´ less if you cannot afford to buy it. The they need prescription drug coverage. (Ms. LINDA T. SANCHEZ of Cali- skyrocketing price of prescription They called and wrote me because they fornia asked and was given permission drugs is the number one concern of know this bill will not provide them to revise and extend her remarks.) Ms. LINDA T. SA´ NCHEZ of Cali- American seniors and, indeed, most with the help they desperately need. fornia. Mr. Speaker, this sham Repub- Americans. H.R. 1 does nothing to According to the Consumers Union, lican prescription bill provides elderly freeze or reduce the exorbitant cost of the average Medicare user spends $2,318 women with nothing more than a false prescription drugs. In fact, again, the for prescription medicine. Under this plan, the out-of-pocket drugs would sense of security. idea of going to Canada and handing it Ms. SLAUGHTER. Mr. Speaker, I rise to $2,954 for the average senior on out with one hand and taking it away yield such time as she may consume to Medicare. So this program is a placebo, with the other is something that the the gentlewoman from California (Ms. drug companies will be very happy not a cure, legislation crafted to pro- SOLIS). vide political cover for the majority, about, because they have fought in (Ms. SOLIS asked and was given per- not provide prescription drug coverage every possible venue to keep the re- mission to revise and extend her re- for seniors. Some may argue that this importation of drugs. marks.) At the same time, we hoped that we is something better than nothing, but Ms. SOLIS. Mr. Speaker, this bill is a might do what the Veterans Adminis- it is only a start and, frankly, what we sham. It does not provide adequate pre- tration has done with great success. By have in Medicare has not been that scription drug benefit. negotiating for the people that they bad. But as many of our constituents Este projecto de ley no ayudara a los represent with the drug companies, say, a bad bill is worse than no bill. ancionos. No ayudara ni a nuestras they have been able to save many of Mr. Speaker, this bill that will raise madres ni a nuestras abuelitas. their veterans a great deal of money. premiums and reduce their choices and (English translation of the above Seniors fear this bill is a rush to pri- dismantle Medicare is a very bad bill. I statement is as follows:) vatize Medicare. We saw the flop of urge my colleagues to oppose the rule. It will not help our mothers, nor our Medicare+Choice when many, many Mr. Speaker, I yield such time as she grandmothers. private insurance companies pulled out may consume to the gentlewoman from Mr. Speaker, I rise to call attention to the completely on senior citizens, leaving California (Ms. WOOLSEY). American women who will be disproportion- many of them in parts of the United (Ms. WOOLSEY asked and was given ately impacted by Medicare reform. The reality States completely uncovered. Indeed, permission to revise and extend her re- we must confront is that women simply live they have told us again, they do not marks.) longer than men—about 19 years into retire- want to cover a prescription drug pro- Ms. WOOLSEY. Mr. Speaker, this ment, while men can expect to live 15 years. gram. One hundred percent of the peo- sham Republican bill fails to provide So although this means we have longer to ple they cover will buy medicine. This women with the real prescription drug cherish our mothers and grandmothers, it also is not what they consider a good busi- coverage they need and they deserve. means that women are more susceptible to ness proposition. Here we are, again, discussing ways to help multiple and chronic illness, and require more Forty years ago, Congress created seniors afford the prescription drugs that they long-term care needs. the Medicare program because private need. And once again, the majority insists on It is no surprise then that women comprise industry would not offer health insur- a sham proposal that gives seniors nothing the majority of Medicare. In fact, we constitute ance to older people. Companies saw more than a false sense of security. 58 percent of the Medicare population at 65, the older people as a threat to their My female colleagues and I would like to re- and 71 percent at the age of 85. Yet even profits. We should have learned this mind everyone that as we debate proposals to more crucial is the fact that four out of five of lesson in the 1960s, because nothing has add a prescription drug benefit to Medicare, America’s elderly women are widowed and al- changed; and now we are today taking the decisions we make will overwhelmingly im- most half live out their days alone. Compound
VerDate Jan 31 2003 02:39 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00014 Fmt 7634 Sfmt 9920 E:\CR\FM\K26JN7.034 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5955 this misfortune with the reality that these wid- Mr. Speaker, I urge my colleagues to vote all 40 million Medicare beneficiaries to nego- owed women are four times more likely, and against this sham of a bill. It seeks to privatize tiate drug prices. The savings would then be a single or divorced woman are five times Medicare and does not provide a real, guaran- passed on to seniors. In addition, the Demo- more likely, to live in poverty after retirement teed, affordable drug benefit that our seniors cratic proposal makes drugs more affordable than a married man. desperately need. by allowing the safe reimportation of drugs America’s elderly women, many of whom When I am home in Wisconsin, one of the from Canada and makes lower cost generic live alone and in poverty, have higher out-of- issues I hear most about, in the grocery store, drugs available more quickly. Unlike the Re- pocket health care costs and are now being on the street, at the airport baggage claim, or publican bill, there are no gaps in coverage in denied access to a secure and responsible in meetings from Monroe to Baraboo, is that the Democratic proposal. Coverage is pro- Medicare prescription drug plan under the Re- seniors cannot afford to pay their prescription vided for any drug a senior’s doctor provides. publican Plan. Almost 8 out of 10 women on drug coverage. Seniors send me receipts for Seniors would be able to choose where to fill Medicare use prescription drugs regularly, their drug bills and ask me how they are sup- their prescriptions and would not have to join though most pay for these medications out-of- posed to afford their rising drug costs on a an HMO or private insurance plan to get drug pocket. Now we are telling these women, who fixed budget. coverage. This is the proposal seniors have already spend 20 percent more on prescription The Republican drug bill on the floor today been asking for, not one full of complexities drugs than their male counterparts, that they is not going to provide seniors with the relief and gaps in coverage like the Republican plan must navigate the privatized ropes, and we they deserve. Instead of providing a real, af- we will vote on shortly. can only hope, not guarantee, that they will fordable prescription drug benefit, this bill Today we are voting on a bill that is a have affordable coverage and monthly pre- seeks to privatize the Medicare program. It is sham. It is a sad mockery of what seniors in miums. Even middle-class women who have my belief that privatization of Medicare is un- our country deserve. Instead of providing a made wise financial planning decisions will warranted. Medicare has been a vital compo- comprehensive Medicare prescription drug quickly find that high drug costs may under- nent of our Nation’s health care system since benefit for America’s seniors, the Republicans mine any retirement security they have worked its creation in 1965. In fact, Medicare was have decided to make sure this bill suits the hard to establish. originally created because private insurance big drug companies and leads down the road My district, which is predominately Latino, plans were simply not providing health insur- of privatizing Medicare. This is just plain will be one of the hardest hit by this new legis- ance to seniors and people with disabilities. wrong for the retirees of the greatest genera- lation. Latina women make up the largest mi- For nearly 40 years, Medicare has done the tion, who worked hard, lived through the de- nority percentage (58 percent) on Medicare job that private insurers would not—or could pression, won a war, and raised their families. with incomes less than $10,000. These minor- not—do. Seniors need a comprehensive prescription ity women historically rely on public, rather Why then, would we rely on private insurers drug benefit that is affordable and dependable than private, health insurance. Now, we are to provide a Medicare prescription drug benefit for all—with no gaps or gimmicks in coverage. stripping their only health coverage security to our Nation’s seniors? This bill relies on pri- The Republican proposal fails on all these and implementing a new, privatized and com- vate insurers to provide a prescription drug counts, and I urge my colleagues to vote pletely unmapable plan! benefit. Seniors would have to join HMOs and against it. Have we not learned our lessons from private insurance plans to get the benefit. The Ms. SLAUGHTER. Mr. Speaker, I Medicare+Choice that private plans do not prices and benefits under this private cov- yield such time as she may consume to participate in many regions, that their pre- erage would vary from region to region, so the gentlewoman from California (Mrs. miums and benefits vary greatly by geographic that a senior in Wisconsin would have to pay CAPPS). are, that participation by Medicare HMO’s has a different premium than a senior in Florida. (Mrs. CAPPS asked and was given been unstable, and that private plans are not These geographic disparities are simply unac- permission to revise and extend her re- less costly than traditional Medicare? ceptable. marks.) By 2025, Latinos are expected to comprise There are no assurances in this bill that pre- Mrs. CAPPS. Mr. Speaker, I oppose 18 percent of the elderly population and they scription drugs would be affordable. In fact, this Republican prescription bill be- are continually encountering strategically this bill takes no steps to stop or slow the sky- cause it provides elderly women with placed barriers that hinder their equal right to rocketing cost of prescription drugs. Instead, nothing more than a false sense of se- quality health care. Let’s not forget all the mothers, grand- this bill provides partial coverage of drug curity. mothers, and sisters now and in the future for spending until $2,000 and then leaves seniors Ms. SLAUGHTER. Mr. Speaker, I whom Medicare represents a lifeline to a high and dry. There is a huge gap in coverage yield such time as she may consume to healthy retirement. Who wants to tell the mil- where seniors may pay 100 percent out of the gentlewoman from California (Ms. lions of hard working women who take care of pocket and continue paying premiums, until WATSON). their families that once again, because of irre- they reach a high out-of-pocket cap. Half of all (Ms. WATSON asked and was given sponsible and unbalanced tax cuts, their seniors will fall into this gaping hole. I believe permission to revise and extend her re- health care and prescription drug needs will seniors deserve affordable drug coverage, and marks.) Ms. WATSON. Mr. Speaker, I rise in be sacrificed? we should not help some seniors cover their Ms. SLAUGHTER. Mr. Speaker, I drug costs while leaving others out in the cold. opposition to this sham Republican yield such time as she may consume to Lastly, the Republican drug plan does not Medicare bill. That is why I wear my the gentlewoman from California (Ms. offer the same benefit to everyone on Medi- black arm band because it is the death HARMAN). care. This plan calls for ‘‘means-testing’’ for of Medicare and it does not provide the (Ms. HARMAN asked and was given Medicare benefits, meaning seniors with high- adequate prescription drug coverage permission to revise and extend her re- er incomes would have to pay more money our mothers, grandmothers, sisters, marks.) out-of-pocket before they reach the cata- and nieces deserve. Ms. HARMAN. Mr. Speaker, I rise in strophic limit. This provision would fundamen- Ms. SLAUGHTER. Mr. Speaker, I opposition to the bill to end Medicare tally change the Medicare program. Since its yield such time as she may consume to as we know it, which will hurt our sis- inception in 1965, the central promise of Medi- the gentlewoman from California (Mrs. ters, mothers, and grandmothers. care was that it would provide a consistent DAVIS). Ms. SLAUGHTER. Mr. Speaker, I benefit for everyone, and means-testing would (Mrs. DAVIS of California asked and yield such time as she may consume to violate this promise. was given permission to revise and ex- the gentlewoman from Wisconsin (Ms. I support the Democratic proposal that will tend her remarks.) BALDWIN). be offered as an amendment today. This pro- Mrs. DAVIS of California. Mr. Speak- (Ms. BALDWIN asked and was given posal would add a new Part D in Medicare to er, I oppose this unacceptable bill that permission to revise and extend her re- provide voluntary prescription drug coverage is particularly harmful to senior marks.) for all Medicare beneficiaries. This proposal women. Ms. BALDWIN. Mr. Speaker, I rise in would provide the same benefits, premiums, Mr. Speaker, I rise to talk about older opposition to this bill which fails to and cost sharing for all beneficiaries no matter women and their need for a real prescription provide women with the affordable and where they live. It would guarantee fair drug drug benefit. The legislation we have before reliable Medicare prescription drug prices by giving the Secretary of the Depart- us represents a hollow substitute for a bona coverage that they desperately need ment of Health and Human Services the au- fide Medicare prescription drug benefit. Some and deserve. thority to use the collective bargaining clout of will claim that the Republican Medicare reform
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00015 Fmt 7634 Sfmt 9920 E:\CR\FM\A26JN7.012 H26PT1 H5956 CONGRESSIONAL RECORD — HOUSE June 26, 2003 legislation provides a prescription drug benefit cause it does not provide the adequate pies can be substituted for more costly treat- and declare success. Well, Mr. Speaker, we prescription drug coverage that our ments like hospitalization and surgery. But aren’t fooling anyone. mothers and grandmothers absolutely what seniors—men and women—need and We aren’t fooling Donna Koski, from San deserve. want is help that they can understand and can Diego, who cannot afford her medication. She Ms. SLAUGHTER. Mr. Speaker, I rely on, not the ‘‘bait and switch’’ of the Re- wrote to tell me, ‘‘HMOs are no longer helping yield such time as she may consume to publican plan. us with the cost [of drugs]. I worked and paid the gentlewoman from New York (Mrs. Ms. SLAUGHTER. Mr. Speaker, I taxes all my life, raised five kids in California MALONEY). yield such time as she may consume to and now have five grandkids. I can’t afford (Mrs. MALONEY asked and was given the gentlewoman from Connecticut rent or so many things that I once took for permission to revise and extend her re- (Ms. DELAURO). granted would be there when I retired. What is marks.) (Ms. DeLAURO asked and was given to become of senior citizens [like me]?’’ We Mrs. MALONEY. Mr. Speaker, I op- permission to revise and extend her re- aren’t fooling Sidney and Edith Horwitz, from pose this Republican Medicare bill, and marks.) La Jolla, who told me. ‘‘Figure out a way to I urge every woman, man, every Amer- Ms. DELAURO. Mr. Speaker, the Re- give us drug benefits without joining a HMO. ican to read the fine print. There are publican Medicare bill fails to provide Deregulation and outsourcing to private com- gaping holes. There are problems. I will Americans with real prescription drug panies has been a travesty to consumers.’’ put this into the RECORD and I am to- coverage, that which they need and Mr. Speaker, my constituents want an af- tally opposed to this bill. that which they deserve. fordable prescription drug benefit that will be Mr. Speaker, the health of America’s older Ms. SLAUGHTER. Mr. Speaker, I there when they need it. They do not want to women is at serious risk. Whatever Medicare yield such time as she may consume to privatize Medicare. However, the bill we will Prescription Drug bill we pass will have an the gentlewoman from Illinois (Ms. discuss dismantles Medicare and does nothing enormous impact on older women, both now SCHAKOWSKY). to lower prescription drug prices. This pro- and in the future, and women are concerned. (Ms. SCHAKOWSKY asked and was posal eliminates the security of traditional More than half of Medicare recipients age given permission to revise and extend Medicare by requiring it to compete with pri- 65 are women; by age 85, 71 percent are her remarks.) vate plans in 2010. It would transform Medi- women. And most older women live on fixed Ms. SCHAKOWSKY. Mr. Speaker, I care from a defined benefit to a defined con- incomes. Older women tend to have more rise against the Republican bill that tribution program and ultimately eliminate chronic health conditions than men, and eight kills Medicare and fails to provide af- Medicare as we know it. Because, private of ten women on Medicare use prescription fordable prescription coverage to the Medicare plans tend to aggressively recruit drugs regularly. elderly and people with disabilities. younger and healthier seniors, open competi- In the face of these facts, the ‘‘bait and Ms. SLAUGHTER. Mr. Speaker, I tion will mean rising out-of-pocket costs for the switch’’ tactics of the Republican Medicare yield such time as she may consume to vast majority who would choose the stable Prescription Drug bill are simply outrageous. the gentlewoman from California (Ms. benefits and premiums of traditional Medicare. Seniors think we’re giving them help with high LEE). (Ms. LEE asked and was given per- The result of open competition will be the cost drugs. They think we’re offering them mission to revise and extend her re- transformation of today’s universal, national supplemental insurance—guaranteed, cheaper risk pool into a multitude of regional pools marks.) and permanent—to ease their burden of sky- Ms. LEE. Mr. Speaker, this bogus Re- segmented by age, income, residence and rocketing drug costs on fixed incomes. But the health status. To many, this transformation publican prescription drug bill will ef- Republican bill is a cruel trick. Seniors who fectively dismantle and kill Medicare sounds more like a scheme than meaningful are sickest and taking expensive medica- reform. and leave millions of seniors, espe- tions—mostly women on fixed incomes—get a cially our women, our mothers, our Our seniors need more stability and cer- little bit of help with the first 2000 bucks of tainty than this—especially older women who grandmothers behind. drug expenses. But then they get the ‘‘donut Ms. SLAUGHTER. Mr. Speaker, I are counting on Congress to provide a real so- hole’’—a big fat zero until they pay a $3000 lution to the rising cost of prescription drugs. yield such time as she may consume to ransom to get more help with their drug bills. the gentlewoman from Minnesota (Ms. Women, literally, are the face of Medicare. The fiscal irresponsibility of the Republican They constitute 58 percent of the Medicare MCCOLLUM). bill is stunning and illogical. Instead of putting (Ms. McCOLLUM asked and was population at 65. They constitute 71 percent of the purchasing power of America’s seniors to the Medicare population at 85. Women have a given permission to revise and extend work as a huge bargaining chip to lower pre- greater rate of health problems since they live her remarks.) scription drug costs, the Republicans prohibit longer. They have lower incomes, which make Ms. MCCOLLUM. Mr. Speaker, this the Secretary of HHS from negotiating for access to affordable prescription drugs more Medicare bill fails to provide women lower drug prices on behalf of seniors. The difficult. More than 1 in 3 women on Medicare with real prescription drug coverage Democrats believe prescription drugs should (nearly 7 million) lack prescription drug cov- they need and deserve. be affordable for seniors—but our amend- erage. Ms. SLAUGHTER. Mr. Speaker, I re- The Republication Medicare reform plan will ments to have the Secretary negotiate on sen- serve the balance of my time. only perpetuate these health care disparities. iors’ behalf were defeated. Ms. PRYCE of Ohio. Mr. Speaker, I Where is the benefit for our seniors who are The height of hypocrisy in the Republican yield 3 minutes to the gentleman from living on a fixed income and cannot afford to bill is the fact that it actually discourages em- Kentucky (Mr. FLETCHER) for some pay out-of-pocket during the coverage gap? ployers from continuing to offer drug coverage substantive remarks. Dr. Fletcher is a Where is the benefit for the women who, be- for retired seniors who have already paid member of the Committee on Energy cause they were stay-at-home mothers and health insurance premiums throughout their and Commerce and also a member of did not earn a pension, cannot afford the pre- working lives. The Congressional Budget Of- the medical profession, and we look scription drugs they desperately need? fice estimates that a third of employers will forward to what he has to add to this For my constituents, the Republican pro- drop retiree drug benefit coverage if the Re- debate. posal is not good enough. I cannot support public bill becomes law. Mr. FLETCHER. Mr. Speaker, let me this legislation when I know we can do better. Frankly, the Republican Medicare Prescrip- thank the gentlewoman from Ohio (Ms. We are doing more than providing prescription tion Drug bill is cruel. This is not compas- PRYCE) for her leadership in chairing drugs, we are legislating the future of Medi- sionate conservatism. It is blatant bias against our majority conference as well as her care. elderly, against women, and against the poor. leadership on this issue and this rule. Ms. SLAUGHTER. Mr. Speaker, I It is the first step in doing away with Medicare Mr. Speaker, I find it interesting to yield such time as she may consume to as an entitlement and it is the first step toward see and observe the number of people the gentlewoman from Georgia (Ms. dividing our elderly into the needy and those that have stood in line here to talk MAJETTE). who can afford to ‘‘buy out’’. The purpose of about this bill, even though CBO esti- (Ms. MAJETTE asked and was given Medicare was to help the elderly with needed mates that 93 percent of our seniors permission to revise and extend her re- care as they age, and to do it with dignity and will take advantage of this bill. That marks.) not on the basis of ability to pay. means many of the sisters, mothers Ms. MAJETTE. Mr. Speaker, I oppose Prescription drug coverage would save and family members that these Mem- this sham Republican Medicare bill be- money in the long term because drug thera- bers have just spoken about will take
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00016 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.014 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5957 advantage of this legislation. As a mat- Ms. SLAUGHTER. Mr. Speaker, we Mr. BRADLEY of New Hampshire. ter of fact, I would imagine if we asked have so little time to try to make any Mr. Speaker, I rise today in support of these Members how many of them take points here. H.R. 1 and the rule that accompanies advantage of the Federal Health Ben- Mr. Speaker, I yield 2 minutes to the this important legislation, for today efit Plan, that probably the majority of gentleman from Massachusetts (Mr. we will begin to finally provide for a them, if not all of them, choose to par- MCGOVERN), a member of Committee prescription drug benefit under Medi- ticipate in that. on Rules. care for America’s senior citizens. Now, we offer something here in this Mr. MCGOVERN. Mr. Speaker, this is H.R. 1 will ease the financial burden prescription drug bill that gives them a a sad day for this House and, more im- placed on America’s seniors, improve similar choice, and yet for some reason portantly, it is a sad day for America’s access to the medications they need, they seem to deride what we are doing. senior citizens. and introduce market measures that This is the single most pressing This bill is a complex and controver- will curb future cost increases. health care issue facing our country: sial $400 billion Medicare privatization According to a recent study, the providing prescription drugs for our plan that will affect the lives of 40 mil- House plan, our plan, would reduce the seniors. This bill does several things. lion senior citizens. For 38 years Medi- average overall cost of prescription One, it is a voluntary program. Two, it care has been there for our parents and drugs by 25 percent through aggre- provides something that is affordable, our grandparents, helping them live gating the purchasing power of seniors. not only affordable for seniors but af- longer, more healthy lives. It is a sa- In addition to these overall savings, fordable for taxpayers, and it is some- cred promise with the elderly of this the plan provides significant and im- thing that far exceeds anything that country and this House is about to mediate savings for seniors through has been looked at or has had a reason- radically and fundamentally break provisions, including a prescription able opportunity of being passed that that promise. drug discount card which would pro- this Congress has ever put forth. It is If that were not bad enough, the Re- vide a 10 to 15 percent savings; signifi- flexible. It provides choice and secu- publican leadership blocks out all cant front-end coverage with a cost rity. It provides a modernization of amendments and all but one substitute sharing agreement that has seniors Medicare that will address the con- to this bill. For example, this bill man- paying 20 percent on the first $2,000 of cerns of prevention and chronic disease dates for the first time a co-payment drug costs after they pay a deductible management which are so needed in for senior citizens who receive Medi- and a monthly membership fee. Beyond this country. care home health care. I have been that it involves catastrophic protec- It also prevents a catastrophic illness fighting for years to protect home tion providing 100 percent coverage for from bankrupting a family. Often a health care from cuts, so I had an out of control drug costs beyond $3,500. catastrophic illness can bankrupt a amendment before the Committee on And, lastly, and perhaps most impor- family, and we know of families that Rules around 4:30 this morning to tantly, assistance for low income sen- have saved money their entire life and eliminate that co-pay because I think then one illness in the family has iors, enabling those Medicare bene- it is unfair and I think we should help ficiaries that have income of 135 per- bankrupted them. This bill absolutely seniors who use home health care, not prevents that from happening due to cent of the poverty line to receive full charge them more money. But like coverage on their prescription drugs. the cost of prescription drugs. every single other amendment, Demo- We also find that it helps a number of Mr. Speaker, the advancement of crat or Republican, my amendment low income seniors, particularly medical research and technology has was not made in order. women, and I am shocked that these led to the development of new drugs The other body has spent the last 2 Members would not stand up and sup- that can dramatically reduce the need weeks, Mr. Speaker, debating, dis- port this bill, because women are par- for surgery, for hospitalization and for cussing and amending their prescrip- ticularly affected. Many women live on nursing home care. tion drug bill. They seem to recognize fixed incomes of Social Security and that this is a big deal. So how much b 1330 are having to choose between food and time do we give our seniors in this It is high time that we provide Amer- medicine. I saw them as a physician. I House? Not 2 weeks, not even 2 days. ica’s senior citizens with improved ac- saw them as patients of mine. In Ken- cess to these drugs at prices they can tucky nearly 35 percent of Medicare Three hours. What a terrible disservice afford. I urge my colleagues to support beneficiaries will qualify for low in- to the people I represent, the people we the rule and to support the legislation. come assistance under this bill. all represent. Ms. SLAUGHTER. Mr. Speaker, I Mr. Speaker, not only that but in This bill ends Medicare as we know it Kentucky, Medicare recipients are and turns it into a convoluted, com- yield 2 minutes to the gentleman from spending 67 percent of their total pre- plicated voucher program of HMOs and Ohio (Mr. BROWN). scription drug costs out-of-pocket, PPOs and shifting coverage. It is a bill Mr. BROWN of Ohio. Mr. Speaker, I which is the highest in the Nation. that leaves a huge gap in coverage, pe- thank my friend from New York for Additionally, with this bill, they nalizing people for getting sick. It is a yielding me the time. were talking about Democrats not hav- bill that moves us towards privatizing Mr. Speaker, we should reject this ing input, but we had 30 hours of debate Medicare and leaves our seniors at the rule because H.R. 1 offers the wrong vi- in the Committee on Energy and Com- mercy of the insurance industry and sion for Medicare. H.R. 1 asks every merce. As a matter of fact, a Demo- the big drug companies. It is a bill that Member a fundamental question, what cratic colleague of mine, the gen- only a CEO could love. Senior citizens do you want Medicare to be? If you tleman from Texas (Mr. GREEN) and I deserve a drug benefit within Medicare. want Medicare coverage that is guaran- put forward an amendment for diabetes They should not be left at the mercy of teed, dependable, universal and fair, screening. We passed that. It is part of the HMO accountants who are more you will vote against H.R. 1. If you this bill. concerned with the bottom line and want Medicare to cover every senior So I think this is a tremendously im- profit margins than with adequate everywhere, you will vote against H.R. portant piece of legislation. Every sen- health care. 1. If you want Medicare to offer the ior will have reduced costs in the pre- Our substitute works like the rest of same coverage to seniors on Park Ave- scription drug expenses that they pay Medicare. It tackles the high cost of nue as seniors in Appalachian, Ohio, because the Federal Government will drugs and it guarantees our seniors you will vote against H.R. 1. negotiate a lower price for these drugs. meaningful, consistent prescription But Mr. Speaker, if you want Medi- What we see here is an opportunity. We drug coverage. That is what our seniors care to offer unreliable, selective, dis- will negotiate a lower price for the pre- deserve. I urge my colleagues to vote criminatory coverage, you will support scription drugs. no on the rule and yes on the Demo- H.R. 1. If you want Medicare to offer Mr. Speaker, I would hope Members cratic substitute. seniors in Appalachian, Ohio, less cov- would support this rule and that Mem- Ms. PRYCE of Ohio. Mr. Speaker, I erage than seniors on Park Avenue or bers would support this prescription yield 2 minutes to the gentleman from no coverage at all, you will vote for drug bill. New Hampshire (Mr. BRADLEY). H.R. 1. If you want Medicare to offer
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00017 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.042 H26PT1 H5958 CONGRESSIONAL RECORD — HOUSE June 26, 2003 rural seniors coverage, but at three or I also want to thank leadership for their work presentation before the Committee on four times the price, then you will vote to ensure stable funding in the Medicaid dis- Rules, over a 90-minute period, to deal for H.R. 1. If you want a plan written proportionate share hospital (DSH) program. with virtually every question that by the drug companies and by the in- H.R. 1 provides all states with a one time 20% came forward; and, Mr. Speaker, it was surance companies because of their increase in their DSH allotments. This 20% in- so apparent that her grasp of this issue, huge contributions to the Republican crease means an additional $184 million in coupled with her commitment to en- Party, if you want that, then you will Fiscal Year 2004 for California’s safety net sure that our senior citizens finally vote for H.R. 1; and if you want a bill hospitals. This additional funding will help en- have the opportunity for the first time that will force people who now have sure that services to the most vulnerable pop- under the structure put in place for prescription drug coverage, a bill that ulations remain available. Medicare have access to affordable pre- will force seniors who now have pre- I believe that we must bring Medicare into scription drugs; and, Mr. Speaker, it scription drug coverage to drop that the 21st century and that no American should was very interesting to note that while coverage, then you will vote for H.R. 1. be denied needed prescription drugs because there was bipartisan praise for the gen- The gentleman from New York (Mr. he or she cannot afford them. I recognize that tlewoman from Connecticut (Mrs. RANGEL) and the gentleman from the lack of a prescription drug benefit for our JOHNSON) as this hearing began at 12:50 Michigan (Mr. DINGELL) will offer a seniors signifies the fact that Medicare has this morning, the final panel that came substitute amendment with a different fallen behind the times. H.R. 1 is the best pre- before us at probably about 4:30 or so, version of Medicare. The Rangel-Din- scription drug benefit plan for America and I I cannot remember exactly what time gell substitute strengthens Medicare urge my colleagues to support its passage. it was, maybe 4:15 this morning, had a by adding a prescription drug benefit, Ms. PRYCE of Ohio. Mr. Speaker, I Democrat on the final panel praising no unaffordable cost sharing, no gaps am pleased to yield such time as he the gentlewoman from Connecticut in coverage. The Rangel-Dingell sub- may consume to the gentleman from (Mrs. JOHNSON), not necessarily agree- ing with everything that she said, but stitute would maintain Medicare’s California (Mr. DREIER), my distin- praising her for the fine work that she guaranteed coverage, remaining faith- guished colleague, the chairman of the Committee on Rules, who led us has involved herself in on this issue. ful to the trust Medicare has earned I believe that as we look at what it is through our hearing on this last night from America’s seniors. that we are trying to do here there are The Rangel-Dingell substitute har- to the historic conclusion today on the so many very important and positive nesses seniors’ purchasing power to de- floor. developments that have taken place. I (Mr. DREIER asked and was given mand better prices from the drug in- know my friend from Ohio has just dustry. My friend from Kentucky had permission to revise and extend his re- mentioned the very important issue of it all wrong when he said the Repub- marks.) the disproportionate share of hospitals lican plan does that. The Republican Mr. DREIER. Mr. Speaker, the first that provide assistance under Med- plan, because it was written by the revision I would like to make to my icaid. Increasing the level of funding drug companies, does nothing to bring very good friend and the role that I for those hospitals that are shouldering prices down. play was leading us through this morn- that responsibility has been one of the Vote ‘‘no’’ on the rule. Vote ‘‘no’’ on ing as we did, in fact, as has been challenges that the Los Angeles area, H.R. 1. Vote ‘‘yes’’ on the Rangel-Din- pointed out, beginning late at night. which I am honored to represent, has gell substitute. We began late at night because we were faced; and we, I believe, are going to be Ms. PRYCE of Ohio. Mr. Speaker, I all working together to fashion a bill able to help deal with that. am pleased to yield such time as he which I am convinced that at the end At the same time, I have to say that may consume to the gentleman from of the day will enjoy bipartisan support in looking at some of the things that California (Mr. ISSA), my distinguished in this House of Representatives. have been said that were critical of colleague. It has been the gentleman from Illi- this rule and of the measure, first on (Mr. ISSA asked and was given per- nois (Mr. HASTERT), the Speaker, who, the rule, Mr. Speaker, we have put into mission to revise and extend his re- as the author of this legislation, has place what I believe is a very fair rule. marks.) been in the lead on not only the issue In the 107th Congress we all know that Mr. ISSA. Mr. Speaker, I support this of bringing about measures to we dealt with this issue, and there was bipartisan, Republican-led, legendary, strengthen and protect and improve no substitute made in order. So in this historic event that we are partici- Medicare but also to put into place a Congress we have done that, but in pating in here today. very important expansion of medical bringing the health savings accounts, Mr. Speaker, I rise today to comment Chair- savings accounts, which I joined him in which are a very important item, de- man THOMAS, Chairman TAUZIN, and the championing for many, many years. signed to provide incentives for people House Republican leadership for their work on This is a historic day, as many as to make choices and plan for their H.R. 1. have said; and my colleague, the gen- long-term health care needs by bring- This landmark legislation will provide Amer- tlewoman from Ohio (Ms. PRYCE), has ing this measure in with our very im- ica’s seniors with a lifetime prescription drug been working diligently over the last portant Medicare package, what we benefit through Medicare. This new benefit will several days and weeks and months to have done is we have provided the mi- mean permanent prescription drug access, get us here. nority with three opportunities, the lower drug costs and a limit on catastrophic I mentioned the gentleman from Illi- substitute and two opportunities to drug expenses for all beneficiaries. nois (Speaker HASTERT). There are lots offer motions to recommit, and there I am especially pleased to see that this bill of other people, the gentleman from was no substitute offered on the other enacts meaningful Medicare reforms that spe- California (Mr. THOMAS), the chairman and I suspect we would have made that. cifically affect California and my constituents in of the Committee on Ways and Means; We conceivably could have had four op- the 49th Congressional District. the gentleman from Louisiana (Mr. portunities for the minority, if they H.R. 1 includes language that allows the TAUZIN), the chairman of the Com- had submitted those to us, that would Secretary of Health and Human Services to mittee on Energy and Commerce; but I have been made in order; and we, as the designate plans that serve special needs would like to talk about the Represent- majority, have basically one oppor- beneficiaries as Specialized Medicare Advan- atives who did at 12:50 this morning ap- tunity and that is our bill. tage plans. This provision enhances the devel- pear before the Committee on Rules. I acknowledge that as members of opment of more effective approaches to The gentleman from Oregon (Mr. the majority we have been able under chronic illness care by providing an oppor- WALDEN) represented the Committee Speaker HASTERT’s leadership to put tunity for additional frail elderly demonstrations on Energy and Commerce and did a this package together; but anyone who to move into mainstream Medicare. One ex- wonderful job; but no one has been claims that we are not giving an oppor- ample of this type of demonstration is the more intimately involved in dealing tunity to the minority for their pro- SCAN program, which currently serves over with health care issues than the gen- posals to be considered is really wrong, 50,000 Southern Californians—including tlewoman from Connecticut (Mrs. and we have provided the proposal 10,000 who live inside the 49th Congressional JOHNSON), and I was very impressed which was submitted to us by the rank- District. with the fact that she was able, in her ing minority member of the Committee
VerDate Jan 31 2003 02:39 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00018 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.044 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5959 on Ways and Means and ranking minor- Ms. SLAUGHTER. Mr. Speaker, I creases oncology practice expenses by ity member on the Committee on En- yield such time as she may consume to $190 million. That is 83 percent over ergy and Commerce. So I believe we the gentlewoman from California (Mrs. their current payment, and it is 50 per- are going to, as this debate proceeds, NAPOLITANO). cent higher than any other specialty. find that there are Democrats who will (Mrs. NAPOLITANO asked and was It also includes an average sales price want to join with us; and I congratu- given permission to revise and extend plus 12 percent for 2 years. Now, that is late them for understanding the fact her remarks.) $240 to $250 million on top of a $190 mil- that this is going to be the first oppor- Mrs. NAPOLITANO. Mr. Speaker, I lion increase in practice expenses. tunity to truly provide access to af- think this is an unfinished Republican In addition to that, we have provided fordable prescription drugs to our sen- Medicare bill because it does not pro- for oral cancer therapies, the new, up- ior citizens. vide the simple, adequate prescription coming way to treat cancer, so that I will tell my colleagues, Mr. Speak- drug coverage for all our mothers, our chemotherapies are not the only treat- er, in voting ‘‘no’’ on this package, at sisters, and our grandmothers. ment that seniors can get. They can the end of the day we will see Members Ms. SLAUGHTER. Mr. Speaker, I stay home and take a pill in their own saying no to our attempt to put into yield 2 minutes to the gentlewoman surroundings rather than go be hooked place a program that will meet that from California (Mrs. CAPPS). up to some infusion device. very important need. So I just want to (Mrs. CAPPS asked and was given These are wonderful steps forward for say that I know there a lot of staff peo- permission to revise and extend her re- the cancer community. ple who have been involved in this, and marks.) Mrs. CAPPS. Mr. Speaker, will the Mrs. CAPPS. Mr. Speaker, I thank I particularly want to express my ap- gentlewoman yield? preciation to the members of the Com- my colleague for yielding me the time. Mr. Speaker, I rise in opposition to Ms. PRYCE of Ohio. I yield to the mittee on Rules, very ably led staff on gentlewoman from California. our side by my friend Billy Pitts, and this rule and to the Medicare bill. The Mrs. CAPPS. Mr. Speaker, I thank we on this committee had members on rule is unfair. The bill is unacceptable. my colleague for yielding, and we do both the Democratic and the Repub- It provides spotty coverage that will share a very strong interest in this lican side who did meet from 12:50 this not help seniors with their expensive issue, and we both also know that on- morning until our filing of the rule by medications, and it reneges on a prom- cology services involve more than the the gentlewoman from Ohio (Ms. ise we have made to America’s seniors oncologist, and, yes, this bill does raise PRYCE) and I at 6:20 this morning. and those with disabilities by ending And the reason we did it is that this Medicare as we have known it. from the terrible low cut that was is such an important issue. The reason I want to speak about a provision in originally in it some 12 percent; but it we did it is that we want to make sure the bill that still cuts, even with yes- still leaves a huge vacuum for the serv- that we get this done for the American terday’s revisions, hundreds of millions ices that are provided by oncology people, and I am convinced that our of dollars for cancer care. A cut like nurses, the whole panoply of out- chance to come together has been made this will be devastating to seniors with patient and clinic setting services that possible by all those who were involved cancer. patients who are receiving chemo- in this, and I thank my friend for yield- If this bill is passed, cancer centers therapy, which is such a devastating ing me the time. will close, especially satellite centers treatment to go through, need in order Ms. SLAUGHTER. Mr. Speaker, I am that are located close to where seniors to maintain. pleased to yield such time as she may live. Those that remain open will It is really a life-and-death situation consume to the gentlewoman from admit fewer patients and lay off oncol- for people who receive a diagnosis of California (Ms. PELOSI), the minority ogy nurses. cancer and then find out that they leader. Medicare beneficiaries do pay too have to go to the doctor and get their (Ms. PELOSI asked and was given much for their oncology medications. medication, and then they have to find permission to revise and extend her re- We all agree that we must fix this, but some way to have the services deliv- marks.) Medicare also pays way too little for ered because Medicare will not cover Ms. PELOSI. Mr. Speaker, I thank essential oncology services. The over- this wide comprehensive care in a can- the gentlewoman for yielding me the payments for oncology drugs has been cer center, and that is what we need to time. I think this is a sham Republican used to pay for treatments oncologists have a full debate upon. Medicare bill which fails to provide provide to cancer patients. So we must Ms. PRYCE of Ohio. Reclaiming my women with a real prescription drug fix both parts of this problem. time, I disagree with the gentle- benefit which they need and they de- The bill fixes overpayment of drugs, woman’s analysis of how it works. serve. but still cuts some $300 million from There is a provision that will allow Ms. SLAUGHTER. Mr. Speaker, I cancer care to do it. The quality of physicians to stockpile, if they prefer. yield such time as she may consume to cancer care will suffer. the gentlewoman from New York (Ms. The gentleman from Georgia (Mr. b 1345 VELA´ ZQUEZ). NORWOOD) and I submitted amendments (Ms. VELA´ ZQUEZ asked and was last night to fix both parts of this prob- But on to another issue, Mr. Speaker. given permission to revise and extend lem and protect the quality of cancer There were statements made earlier her remarks.) care for all Americans, but these that there were no cost savings in this Ms. VELA´ ZQUEZ. Mr. Speaker, I amendments were not made in order; bill, by a former speaker. There are think the sham Republican Medicare and now seniors will not only not get cost savings. There is group purchasing bill fails to provide women with the sufficient prescription drug coverage and insurance benefits, a 25 to 30 per- real prescription drug coverage that but those with cancer, seniors with cent savings. There is a discount card, they need and deserve. cancer, will see their treatments jeop- 15 to 20 percent savings. There is a Ms. SLAUGHTER. Mr. Speaker, I ardized, thwarted, cut off. What will Medicare best price, $18 billion in sav- yield such time as she may consume to seniors with cancer do? ings. Average wholesale price reform, the gentlewoman from California (Ms. I urge my colleagues to vote against $15 billion in savings. There is Hatch- WATERS). the rule and against this bill. Waxman reforms and reimportation re- (Ms. WATERS asked and was given Ms. PRYCE of Ohio. Mr. Speaker, I forms, all generating savings. And that permission to revise and extend her re- yield myself such time as I may con- is how we are able to expand and gen- marks.) sume. erate better treatment for seniors Ms. WATERS. Mr. Speaker, I think In response to the gentlewoman from through the upcoming years. this is a sham Republican prescription California (Mrs. CAPPS), who we both Mr. Speaker, I reserve the balance of bill because elderly women are dying share an abiding concern about cancer my time. from preventable diseases. This is patients and their treatment, I would Ms. SLAUGHTER. Mr. Speaker, I nothing more than a false sense of se- just like to set the record straight in yield 1 minute to the gentleman from curity. that the bill on the floor today in- Rhode Island (Mr. LANGEVIN).
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00019 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.046 H26PT1 H5960 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Mr. LANGEVIN. Mr. Speaker, I rise provide a greater benefit than the puny nothing to hold down the excessive in opposition to the proposed rule pro- benefits in this bill. Here are three profiteering of the pharmaceutical viding for consideration of the Medi- drugs: Tamoxifen. If we could just re- companies, when they find out that care Prescription Drug and Moderniza- import, if Americans could just buy the their coverage essentially stops during tion Act. drug by mail from Canada, they would midsummer while they still have to This rule restricts the House to 3 save 90 percent. But a couple with a pay the premiums, they are going to hours of debate on the largest ever $4,500 a year drug bill will get a 22 per- feel betrayed. And they are being be- overhaul of a program that has been cent benefit under this legislation. For trayed. critical to the health of our Nation’s Vioxx, for arthritis, 52 percent if you If we allow this bill to become law, seniors for 38 years. Furthermore, the could just buy it in Canada and bring it we would be saying that guaranteed rule blocked dozens of amendments, in- back into this country. Under this bill, health care for our seniors is no longer cluding one of my own, which could a 22 percent reduction for seniors who the obligation or the responsibility of have resulted in tremendous savings pay $4,500 a year for drugs. And then this government. I did not come to the for seniors by opening the door for the Xalatan, for glaucoma, a little closer, Congress to preside over the disman- Health and Human Services Depart- 33 percent from Canada, 22 percent tling of Medicare. Our social contract ment to use the bulk purchasing power under this bill. with our seniors must be honored, and of America’s 40 million Medicare bene- So without any cost, without spend- I urge my colleagues to support a plan ficiaries to negotiate lower medication ing $400 billion and without spending a that does that and not this Republican prices for them. penny, but impinging on the profits of sham. Oppose the rule and oppose the As a result, Members are denied the the pharmaceutical industry, we could bill. opportunity to address many dis- provide much better benefits by negoti- Ms. SLAUGHTER. Mr. Speaker, I turbing provisions in this bill. To men- ating or allowing reimportation. yield 2 minutes to the gentleman from tion just a few, the failure to address But it does not stop there. It also Tennessee (Mr. COOPER). the rapidly rising cost of prescription benefits the insurance industry. It is (Mr. COOPER asked and was given drugs that will soon render this benefit going to drive seniors from Medicare permission to revise and extend his re- meaningless; the tremendous gaps in into private insurance, provide sub- marks.) coverage that will result in less help sidies to private insurance to provide Mr. COOPER. Mr. Speaker, I thank for those who need it most; and the unspecified benefits at a cost to be de- the gentlewoman for yielding me this provisions that fundamentally alter termined in the future when those ben- time. the structure and entitlement of Medi- efits might become available in the Mr. Speaker, this should be a great care by requiring the program to com- year 2006, and they can be withdrawn day for this country. We should be on pete with private plans beginning in at any time by those industries. the verge of passing a real Medicare 2010. This is not the security our seniors prescription drug benefit for our sen- Mr. Speaker, the list of Members’ deserve and it is outrageous that this iors. But, unfortunately, we are not. concerns with this bill goes on and on should be offered without any amend- The Republican majority is rushing and on. The other Chamber has been ments being allowed to this party. through a sham bill in this House in debating this bill for 2 weeks, mean- Ms. PRYCE of Ohio. Mr. Speaker, I barely 24 hours. They would not let while the United States House of Rep- continue to reserve the balance of my anybody see a copy of this bill until resentatives will have a mere 3 hours of time. 11:50 p.m. last night. The Committee on debate on this bill that we are pre- Ms. SLAUGHTER. Mr. Speaker, I Rules’ deliberations began at 12:50 a.m. sented with. This is an affront to de- yield 2 minutes to the gentlewoman last night and lasted, as has been men- mocracy. from Connecticut (Ms. DELAURO). tioned, until 4 a.m. Ms. PRYCE of Ohio. Mr. Speaker, I Ms. DELAURO. Mr. Speaker, this What are they afraid of? What are continue to reserve the balance of my House has sometimes risen to the occa- they hiding? And why would they not time. sion on matters of great national im- allow amendments like the Dooley Ms. SLAUGHTER. Mr. Speaker, I portance; the first Gulf War, Sep- amendment to be offered on this floor? yield 2 minutes to the gentleman from tember 11, when we came together to It is my understanding in the other Oregon (Mr. DEFAZIO). bind the Nation’s wounds and provide body that Senators HAGEL, ENSIGN, and Mr. DEFAZIO. Mr. Speaker, I thank for the national security of the Nation. CLINTON will be offering the Dooley ap- the gentlewoman for yielding me this Unfortunately, this legislation does proach as a substitute to that legisla- time. not rise to the occasion. It does not de- tion. The other body has deliberated on We have heard a lot about the new liver an adequate prescription drug this matter for some 2 weeks in the full benefits and protections that will be af- benefit or hold down the cost of drugs. light of day so that all senior citizens forded by this bill. Unfortunately, most What it does do is open the door to the around this country, all families of the benefits and protections will not privatization of Medicare. It turns it around this country, could pay atten- go to seniors in need, they will go to over to the HMOs, to the private insur- tion to the details of this legislation the pharmaceutical and the insurance ance market which has dropped over and judge for themselves whether it is industry. This bill will do a good job of half of the Medicare enrollees in my good medicine for the American people protecting the monopoly profits and State of Connecticut over the last 4 or not. price gouging by the pharmaceutical years. And seniors have not forgotten. But not only is the Republican ma- industry. This bill does nothing to contain jority hiding the real substance of this Perhaps the gentleman from Ken- costs. It prohibits the Secretary of bill, they have failed to learn the les- tucky has not read or at least he Health and Human Services from even sons of past efforts of this House to re- doesn’t understand the bill. Section engaging in negotiations with the drug form the health care system. Number 1801 prohibits the Federal Government, companies to lower prices. As a result, one, health care legislation that works Medicare, from negotiating lower many seniors will pay more than they must not be partisan. This bill is al- prices from the pharmaceutical indus- do now and their premiums will rise as most an entirely Republican-only bill. try, a provision inserted at the behest the cost of drugs rises. That dooms it to failure from the start. of the pharmaceutical industry to pro- Throughout my time in Congress, the Second, real health care reform must tect their profits. The VA negotiates single most common concern I have not be overly complex. This is one of very successfully, and that would lower heard from seniors at the local stop- the most complex bills that seniors the cost of drugs much more than the and-shops where I meet with them could ever imagine facing. The red tape puny benefits in this bill at a cost of every weekend is how expensive their is incredible. And, third, this bill $400 billion. But, no, that is prohibited prescription drug bills are. Seniors should not be overly burdensome to in this legislation. know that they are being taken advan- seniors, but it is. Watch out when your The bill does not allow the re- tage of. They know they can get drugs seniors back home realize they have to importation of U.S. manufactured cheaper in Canada and overseas. And pay $35 a month for a very questionable drugs from Canada because that would when seniors find out that we are doing benefit.
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00020 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.049 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5961 There is a donut hole in coverage, saying, once again, we do not want to b 1400 and that is almost too complex to ex- do it. We do not want your money. Mr. KIND. Mr. Speaker, I rise in op- plain in the 2 minutes I am allowed There are not many people here in position to the rule, and encourage my here, but this bill is so inferior to the Washington who tell the government colleagues to vote ‘‘no’’ on the previous Dooley bill, which solves these prob- we do not want your money. These pri- question so we can have a real and hon- lems in a simple, clear and fair fashion. vate insurance companies do not want est debate today, and make in order Under the Dooley bill, there is a zero to write this drug benefit. This bill is a the Dooley substitute. monthly premium. sham. I, along with others in the New Mr. Speaker, I urge a ‘‘no’’ vote on The bill sets no details on premium, Democratic Coalition, have worked the previous question. no details on the scope of the coverage. long and hard to offer a viable alter- Ms. SLAUGHTER. Mr. Speaker, I What are seniors getting under this native to the base bill. The bill before yield 1 minute to the gentleman from bill? They do not know because we hon- us, unfortunately, will jeopardize the Illinois (Mr. EMANUEL). estly do not know. The Dooley bill de- very sanctity of the Medicare program. (Mr. EMANUEL asked and was given serves a debate here today. It rep- The Dooley bill, on the other hand, is permission to revise and extend his re- resents a compromise between what simple, progressive and affordable. It marks.) the Senate and the House is trying to helps those seniors who needs the most Mr. EMANUEL. Mr. Speaker, like the do here and what the Democrats are assistance, the low-income and those preceding speaker before me from Ten- proposing in the substitute. We deserve with high drug costs. It offers zero pre- nessee, my good friend, the Dooley- to have a debate on the Dooley bill. mium payments; it is Medicare as sen- Tauscher bill, I think, addresses the Mr. Speaker, the rule should be de- iors know it. The benefits are inte- right priorities, the right common val- feated, the motion should be defeated, grated into Medicare part B, and every ues we have. It does not try to end and we should debate the Dooley bill. beneficiary gets a guaranteed benefit Medicare as we know it. It keeps Medi- Ms. PRYCE of Ohio. Mr. Speaker, I for no additional premium. care, that has done so well over 40 reserve the balance of my time. Unlike the House and Senate Repub- years, intact. And unlike the other Ms. SLAUGHTER. Mr. Speaker, I lican bills, this bill has no gap in cov- bills, it lives within the $400 billion yield such time as he may consume to erage, and it is fiscally responsible. It frame. It is true to the principles that the gentleman from Massachusetts fits within the budget resolution that have held Medicare true. It relies on (Mr. TIERNEY). was passed earlier this year. part B of Medicare to deliver the ben- (Mr. TIERNEY asked and was given Later today, it is my understanding efit. It does not try to privatize that permission to revise and extend his re- that Senators HAGEL and CLINTON and benefit. It is a low-income benefit for marks.) ENSIGN will be offering the same exact our seniors. But, most importantly, it Mr. TIERNEY. Mr. Speaker, I rise in Dooley substitute on the Senate floor. is universal in its benefit. Everybody opposition to this bill, which is not We should be allowed to debate the would get it. There would be a min- modernization of Medicare. It ends it, same measure today. I urge a ‘‘no’’ imum of a 25 to 30 percent discount on it does not mend it. And there is no vote on the previous question. drugs. choice here for doctors, only for insur- Ms. SLAUGHTER. Mr. Speaker, I One of the biggest debates here is not ance companies. It is going to put a lot yield 1 minute to the gentleman from only a benefit under Medicare of pre- of seniors who have good retirement California (Mr. THOMPSON). scription drugs, but it is making the plans back into the Medicare system (Mr. THOMPSON of California asked drugs that our elderly need every day without the care and the prescription and was given permission to revise and when they go to the drugstore or their drugs they need. extend his remarks.) local pharmacy, making those medica- Mr. THOMPSON of California. Mr. ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE tions affordable. The benefit accounts Speaker, I rise today against this rule. for all drug spending. That is the core The SPEAKER pro tempore (Mr. Members should have an opportunity principle here. It is a universal benefit. LATOURETTE). The Chair has an an- to vote on an enhanced version of the So this is the right type of approach. nouncement. As indicated by previous bipartisan Senate bill. That is the Blue The other day the Washington Post en- occupants of the Chair on June 27, 2002, Dog prescription drug benefit bill. Un- dorsed it. And, today, in the other and on March 24, 1995, although a unan- fortunately for seniors across this body, a bipartisan group of Senators imous consent request to insert re- country, our friends across the aisle will be introducing it. I think it ex- marks in debate may comprise a sim- have disallowed a debate on this better presses our common values and our ple declarative statement of the Mem- bill. It is better because it has a guar- common principles of what is true to ber’s attitude toward the pending anteed fall-back, which means if sen- our vision of what Medicare should be, measure, it is improper for a Member iors cannot get a PPO, they will have not what it should not be. to embellish such a request with other Medicare. It is better because there are Ms. SLAUGHTER. Mr. Speaker, I oratory, and it can become an imposi- no premium supports, which means yield 1 minute to the gentleman from tion on the time of the Member who seniors are not going to be penalize for Florida (Mr. DAVIS). has yielded for that purpose. staying in Medicare; and it is better be- Mr. DAVIS of Florida. Mr. Speaker, Ms. SLAUGHTER. Mr. Speaker, we cause it does not privatize Medicare. one of the things that we can all agree will pay attention to that. Medicare is an important program that upon here today is that there ought to Mr. Speaker, I yield such time as she has saved the lives of many seniors, be an open and honest debate in our may consume to the gentlewoman from and an inclusion of a prescription drug country and with our seniors as to ex- Indiana (Ms. CARSON). benefit deserves an open debate. actly how to accomplish writing a pre- (Ms. CARSON of Indiana asked and Mr. Speaker, I urge opposition to this scription drug benefit. There are Demo- was given permission to revise and ex- rule so the Blue Dog proposal can be crats here who recognize that we have tend her remarks.) debated and seniors can have the best to live within the budget constraints Ms. CARSON of Indiana. Mr. Speak- coverage that we can afford at this that have been forced upon us, and we er, I will be brief, and I appreciate the time. are ready to take the first step, even opportunity to speak about how the Mr. Speaker, today I rise in opposition to the though it would not be the final step Medicare bill fails to provide women rule of the Republican Medicare Prescription we would take. We are ready to work with the real prescription drug cov- Drug Bill, H.R. 1. It serves only one purpose— with Republicans. erage that they need, especially to sen- ensuring that the voices of several in the This bill that is being forced on the ior women of this Nation. Democratic Party are never heard on this crit- House of Representatives today with a Ms. SLAUGHTER. Mr. Speaker, I ical issue. minimum amount of debate is a sham. yield 1 minute to the gentleman from I stand here on behalf of the Blue Dog Coa- There are many ways to illustrate the Wisconsin (Mr. KIND). lition—a group which engaged in this debate point. Probably the best is the private (Mr. KIND asked and was given per- by crafting a moderate, affordable prescription insurance companies who are being mission to revise and extend his re- drug alternative that would have appealed to asked to provide this drug benefit are marks.) Members on both sides of the aisle. But this
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00021 Fmt 7634 Sfmt 9920 E:\CR\FM\K26JN7.050 H26PT1 H5962 CONGRESSIONAL RECORD — HOUSE June 26, 2003 body will never consider the Blue Dog sub- Senate bill were based upon Senate amend- It is clear that the status quo is not stitute, because the Rules Committee denied ments that have either been introduced and working to make prescription drugs af- us the opportunity to debate our proposal and passed or are pending introduction. As such, fordable for seniors. It is also clear have a vote on the House floor. they have all been scored by CBO for their that our country’s economic situation As you know, the Blue Dogs are a group of sponsoring offices. The availability of that in- does not give Congress a lot of options fiscally conservative Democrats, who are com- formation has allowed the Blue Dogs to say for solving this growing problem. mitted—as a coalition—to the passage of a with certainty that this legislation fits within the Under the Dooley-Tauscher plan, sen- prescription drug benefit that fits within our $400 billion budget window. iors do not have to pay a premium, and $400 billion budget window. On Tuesday But, Members with questions about the Blue the generous low-income benefit far ex- evening, the Coalition formally endorsed legis- Dog substitute will never have the opportunity ceeds the one offered by the majority. lation based upon the bipartisan Senate Medi- to pose them because the rule has prevented For seniors whose income is 150 percent care bill (S. 1). all debate on this alternative. Medicare is a of the Federal poverty level, roughly The Senate has come together to develop a complex program and the debate on the addi- equal to $13,400, they will only have a strong bipartisan benefit. It is not perfect. But, tion of a new prescription drug benefit cannot 10 percent cost share. in recent years, the perfect has become the be a simple one. Voices should be heard, de- Furthermore, any prescription drug enemy of the good and, unfortunately, the per- bate should be had, and all options should be plan needs to be part of Medicare, fect is out of our price range. The Senate of- fully explored before one course of action is which seniors like and trust. Our plan fers America’s seniors a good benefit. It car- decided upon. Unfortunately—to the detriment is managed by Medicare. The benefit is ries a monthly premium of $35. A deductible of this body and America’s seniors—that is not integrated into Medicare part B, and of $275. A 50 percent cost-share through the happening. every beneficiary gets a guaranteed first $4500 of drug spending. And, it offers a I urge my colleagues to oppose this rule, benefit at no additional cost. By catastrophic benefit that kicks in after bene- and in doing so allow the House of Represent- leveraging the buying power of all sen- ficiaries have spent $3700 out of pocket. Fur- atives to give this critical issue the open and iors, our plan allows every single per- ther, it corrects a variety of inadequacies in deliberate debate that it fully deserves. son on Medicare to benefit from imme- Ms. PRYCE of Ohio. Mr. Speaker, I our Medicare reimbursement system for rural diate drug savings regardless of how yield 2 minutes to the gentleman from providers. And, it does all of this without put- many prescriptions they are filling a Georgia (Mr. GINGREY), another physi- ting Medicare on the path to privatization. But, month. cian in our conference. with a score of $389 billion, there was some Finally, Mr. Speaker, our seniors Mr. GINGREY. Mr. Speaker, I thank need to be protected from catastrophic room for improvements. And, that is just what the gentlewoman from Ohio (Ms. the Blue Dog Coalition has done. drug costs. Seniors who have high drug PRYCE) for giving me an opportunity to costs will be able to access the full ben- We have strengthened the rural provider speak on this issue. I rise in favor of package by accelerating the start dates to efit sooner because our plan focuses on the rule and in favor of this bill. the total cost of the drug, not dis- 2004. And, we have improved the adjustments I have delivered probably 5,000 or made to the wage index labor share—drop- counted price paid out of pocket. Our more babies over a 30-year medical ca- plan has an extra safety net for those ping the labor share to 62 percent. reer; but I will be prouder today of this who really need it, people with total We have built upon the Senate’s critically delivery that we are giving to our sen- important fall-back provisions. The fall-back drug costs of $4,000 a year. iors, that we have promised them for Under our bill, companies that cur- means that seniors—such as those living in the last 2 years. Finally today that de- rently provide prescription drug cov- rural areas without two or more plans pro- livery will occur. This will be the best erage to their retirees will have the in- viding service—will always have access to a delivery that I have ever given because centive to continue doing so because drug benefit. We have provided an additional what we are talking about is not just a the Federal Government will assume layer of stability for those seniors, by requiring prescription drug benefit; we are also the risk of drug coverage once bene- the fall-back plans to contract for two years as talking about modernizing Medicare so ficiaries reach their deductible. opposed to one. that it will not be going bankrupt by We need to be smart and realistic We have included the Senate Generic drug the year 2030. about how we can provide every Amer- amendment, which has been scored by CBO With a prescription drug benefit, we ican senior with prescription drug cov- as a cost-saver because it streamlines and will have an opportunity for our sen- erage. Given the current economic sit- clarifies the process by which generic medica- iors to avoid prolonged hospital stays uation, our plan is the one that pro- tions can be brought to market. This will in- and prolonged nursing home stays, dif- vides this coverage and is fiscally crease the amount of affordable medications ficult expensive surgery. Let them take achievable. I urge my colleagues to de- available to all of our seniors. those medications early in the disease feat the previous question and support We have incorporated disclosure require- process so that high blood pressure the Dooley-Tauscher substitute. ments, to ensure that our plans are fully dem- does not result in a stroke or heart at- Ms. SLAUGHTER. Mr. Speaker, I onstrating how savings are passed on to our tack or so the diabetes they are suf- yield such time as she may consume to beneficiaries. fering with does not end up in them the gentlewoman from the Virgin Is- We allow the Secretary to negotiate on be- being a dialysis patient. lands (Mrs. CHRISTENSEN). half of all Medicare beneficiaries for the best This is a good bill. This is a bill that (Mrs. CHRISTENSEN asked and was prices possible. our leadership is finally going to give given permission to revise and extend We permit the re-importation of medications to our seniors; and I tell Members this her remarks.) from Canada, provided that the Secretary cer- is the day to do it, and this is the finest Mrs. CHRISTENSEN. Mr. Speaker, I tifies that such action would not jeopardize the delivery we can offer to our seniors. rise in opposition to the sham Repub- health and safety of the American public. Ms. SLAUGHTER. Mr. Speaker, I lican Medicare bill which fails to pro- We allow Medicare to operate as the pri- yield myself such time as I may con- vide women with the real prescription mary payor for all dually eligible beneficiaries, sume. drug coverage that they need and de- lifting some of the financial burden off of the Mr. Speaker, I am sure the gen- serve, and undermines the entire pro- shoulders of our states. tleman from Georgia (Mr. GINGREY) is gram. We allow a portion of employer contributions pleased that the Democrats tried to Ms. SLAUGHTER. Mr. Speaker, I to be counted towards the beneficiary out of make the gentleman’s amendment in yield 2 minutes to the gentleman from pocket limits, encouraging our employers to order last night. California (Mr. DOOLEY). continue sponsoring retiree health plans. Mr. Speaker, I yield 2 minutes to the Mr. DOOLEY of California. Mr. And we are able to make these improve- gentlewoman from California (Mrs. Speaker, I rise to ask that the previous ments within the confines of the $400 billion TAUSCHER). question be defeated so we can offer a budget allocation. Mrs. TAUSCHER. Mr. Speaker, I rise real prescription drug benefit to sen- Unfortunately, the Congressional Budget Of- today to strongly urge my colleagues iors. It is unfortunate that the bill fice was not able to complete a score on our to vote against the rule and to defeat being offered by our Republican col- legislation prior to the convening of the Rules the previous question. This will allow leagues is one that seniors are going to Committee. However, the majority of the us to debate a much more realistic and find is so complex that it is going to re- changes we have made to the already-scored fiscally responsible Medicare bill. sult in taxpayers displacing a lot of
VerDate Jan 31 2003 02:09 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00022 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.020 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5963 private sector contributions which are at 135 percent of the poverty level and prior to the vote on the previous ques- already providing prescription drug below. The only thing they will be ex- tion. benefits. pected to pay is a small $2 copay for ge- The SPEAKER pro tempore (Mr. Why in the world would we design a neric drugs and a small $5 copay for LATOURETTE). Is there objection to the drug benefit program where we are ac- name-brand drugs. request of the gentlewoman from New tually going to be trading taxpayer I have heard a lot of comments today York? dollars for dollars that are already about private insurance companies are There was no objection. being spent by corporations for their going to be involved in administering Ms. SLAUGHTER. Mr. Speaker, I retirees? this plan. I think it is important to yield back the balance of my time. There is a better alternative, and recognize that today’s Medicare plan Ms. PRYCE of Ohio. Mr. Speaker, I that is the bill we would like to offer, uses private insurance companies to yield myself such time as I may con- that is, we take the $400 billion that handle all of the reimbursement sume. President Bush has talked about, roll charges for Medicare. So we are not Mr. Speaker, passing this plan is the it into Medicare part B, and use a drug doing anything dramatically different right thing to do. It makes the kind of card much like President Bush has in this bill than what is being done commonsense changes to the health talked about which ensures that every today. care system in this country that the senior will have access to negotiated I would also say the fact that this American public needs. Adding this prices which ensures that they have 10 bill would provide catastrophic cov- Medicare benefit will renew our prom- to 20 percent savings. We do this with- erage for seniors is going to be a tre- ise to our seniors. It will reduce the out an increase in premiums. We also mendous benefit. It will give them the cost of prescription drugs, and it will target seniors facing catastrophic peace of mind to know that no matter revolutionize medicine for the 21st cen- health care costs by ensuring that how high their drug costs may be, at tury. Seniors deserve this assistance after they have purchased drugs that some point the Federal Government now. They deserved it yesterday. They cost $4,000, that the Federal Govern- will pay for all of it, the taxpayers will deserved it last week; and actually, ment will be there to pick up the vast pay for all of it. I would also say that they deserved it last year. It is time for majority of their drug costs from that this bill provides an important rural this body to act. I urge my colleagues point on. health benefit package that is going to to support this fair rule and pass the We also recognize that there are a lot benefit all of rural America. It also needed reform today. of seniors in this country that cannot provides additional monies, important b 1415 afford the $4,000, so we provide a low- monies that are needed for dispropor- income benefit that provides signifi- tionate share hospitals. It will benefit The material previously referred to cant assistance to all those seniors who every children’s hospital in America by Ms. SLAUGHTER is as follows: have incomes less than 200 percent of today. All those hospitals that provide PREVIOUS QUESTION FOR H. RES. 299—RULE ON poverty. This would ensure that 50 per- care for people on Medicaid will receive H.R. 1 AND H.R. 2596 MEDICARE PRESCRIP- TION DRUG AND MODERNIZATION ACT AND cent of the seniors on Medicare today additional funds. I think this is an im- HEALTH SAVINGS AND AFFORDABILITY ACT would have a subsidized low-income portant bill, and I urge Members to In the first section of the resolution strike benefit that would help provide them vote for the previous question and to ‘‘and (3)’’ and insert the following: access to much-needed prescription adopt this new prescription drug ben- ‘‘(3) the further amendment in the nature drugs. efit for Medicare beneficiaries. of a substitute specified in section 7 of this It is time for this Congress to come Ms. SLAUGHTER. Mr. Speaker, I resolution if offered by Representative Doley together and say, if seniors have a lim- yield myself the balance of my time. of California or a designee, which shall be in ited amount of resources, let us target Today, the House votes on the big- order without intervention of any point of those resources of those seniors that gest change in Medicare in its 40-year order, shall be considered as read, and shall are in greatest need. Those are the sen- history, a change that will affect 40 be separately debatable for 60 minutes equal- ly divided and controlled by the proponent iors with very high drug costs and million Americans; but the Republican and an opponent; and (4)’’ those seniors with the least ability to leaders have rigged the rules to prevent At the end of the resolution add the fol- pay, and the system should be simple. the House from voting on serious alter- lowing new section: The Republican plan that we are natives offered by Republicans and ‘‘Sec. 7. The further amendment in the na- going to be considering on the floor Democrats alike. ture of a substitute referred to in the first today provides seniors the benefit if Mr. Speaker, I will call for a ‘‘no’’ section of this resolution is as follows:’’ they are low-income, but not if they vote on the previous question in the Strike all after the enacting clause and in- sert the following: have $6,000 in assets or a car that is too hope that the House gets the chance to valuable. We need a plan that seniors consider an additional alternative that SECTION 1. SHORT TITLE; TABLE OF CONTENTS. can understand, that they do not need the Republican leaders fear. If the pre- (a) SHORT TITLE.—This Act may be cited as vious question is defeated, I will offer the ‘‘Medicare Rx Now Act of 2003’’. to be an accountant to figure out; and (b) AMENDMENTS TO SOCIAL SECURITY that is what our alternative would pro- an amendment to the rule that will ACT.—Except as otherwise specifically pro- vide. make in order the Dooley prescription vided, whenever in this Act an amendment is Ms. PRYCE of Ohio. Mr. Speaker, I drug alternative substitute. It makes expressed in terms of an amendment to or re- yield 2 minutes to the gentleman from all senior citizens enrolled in Medicare peal of a section or other provision, the ref- Kentucky (Mr. WHITFIELD), a member part B eligible for prescription drug as- erence shall be considered to be made to that of the Committee on Energy and Com- sistance without increasing their pre- section or other provision of the Social Secu- merce. miums. Unlike the Republican bill, it rity Act. (c) TABLE OF CONTENTS.—The table of con- Mr. WHITFIELD. Mr. Speaker, today has no sickness penalty or doughnut tents of this Act is as follows: represents the culmination of 4 to 5 hole that seniors can fall through. Un- Sec. 1. Short title; table of contents. years of Congress’ efforts to provide a like the Republican bill, it does not en- TITLE I—MEDICARE RX NOW prescription drug benefit for senior courage companies to drop seniors’ ex- citizens on Medicare. Two years ago, isting drug plans. Sec. 100. Purpose. the House of Representatives passed a Let me make it clear that a ‘‘no’’ Subtitle A—Part B Drug Benefit with High prescription drug benefit for senior vote on the previous question will not Deductible and No Premium citizens. Last year we did the same. stop the consideration of H.R. 1. It will Sec. 101. Inclusion of high-deductible out- patient prescription drug ben- The Senate did not do it the year be- simply allow the House to vote on the efit under part B. fore, nor did they do it last year; but Dooley substitute. However, a ‘‘yes’’ Sec. 102. Provision of benefits through medi- this year both the House and the Sen- vote on the previous question will pre- care approved prescription drug ate will pass a prescription drug ben- vent the House from voting. I urge a plans. efit. ‘‘no’’ vote. Subtitle B—Benefits for Low-income This is a meaningful plan. It is going Mr. Speaker, I ask unanimous con- Beneficiaries to provide basically free medicines for sent that the text of the amendment be Sec. 111. Benefits for low-income bene- any senior citizen on Medicare who is printed in the RECORD immediately ficiaries.
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00023 Fmt 7634 Sfmt 0655 E:\CR\FM\K26JN7.056 H26PT1 H5964 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Sec. 112. Improving enrollment process drugs both while the annual deductible is retary for the 12-month period ending in under medicaid. being satisfied and after it is satisfied. July of the previous year. TITLE II—RURAL HEALTH CARE (4) To assure access to medicare-approved ‘‘(3) COST-SHARING.— IMPROVEMENTS prescription drug plans for all medicare ‘‘(A) THREE-TIERED COPAYMENT STRUC- TURE.—Subject to the succeeding provisions Sec. 201. Fairness in the medicare dispropor- beneficiaries, the Secretary will solicit bids of this paragraph , in the case of a covered tionate share hospital (DSH) for prescription drug discount plans that will outpatient drug that is dispensed in a year to adjustment for rural hospitals. be available in all geographic regions to all an eligible individual, the individual shall be Sec. 202. Immediate establishment of uni- medicare beneficiaries. responsible for a copayment for the drug in form standardized amount in (5) All pharmacies that comply with elec- an amount equal to the following (or, if less, rural and small urban areas. tronic claims processing standards may pro- Sec. 203. Establishment of essential rural vide drugs under the program. the price for the drug negotiated pursuant to hospital classification. (6) This title also provides for the avail- subsection (c)(5)): Sec. 204. More frequent update in weights ability of additional benefits in the form of ‘‘(i) GENERIC DRUGS.—In the case of a ge- used in hospital market basket. a waiver of the annual deductible and re- neric covered outpatient drug, the base co- Sec. 205. Improvements to critical access duced copayments, thereby providing imme- payment amount specified in accordance hospital program. diate entitlement to prescription drug bene- with subparagraph (B) for each prescription Sec. 206. Redistribution of unused resident fits, for medicare beneficiaries who have in- (as defined by the Secretary) of such drug. positions. comes under 200 percent of the poverty line ‘‘(ii) PREFERRED BRAND NAME DRUGS.—In Sec. 207. Two-year extension of hold harm- and who are not eligible for medicaid pre- the case of a preferred brand name covered less provisions for small rural scription drug benefits. outpatient drug, 4 times the copayment hospitals and sole community amount applied under clause (i) for each pre- Subtitle A—Part B Drug Benefit with High scription (as so defined) of such drug. hospitals under prospective Deductible and No Premium payment system for hospital ‘‘(iii) NONPREFERRED BRAND NAME DRUG.— SEC. 101. INCLUSION OF HIGH-DEDUCTIBLE OUT- outpatient department services. In the case of a nonpreferred brand name PATIENT PRESCRIPTION DRUG BEN- covered outpatient drug, 150 percent of the Sec. 208. Exclusion of certain rural health EFIT UNDER PART B. clinic and Federally qualified copayment amount applied under clause (ii) (a) COVERAGE.—Section 1832(a) (42 U.S.C. for each prescription (as so defined) of such health center services from the 1395k(a)) is amended— prospective payment system for drug. (1) by striking ‘‘and’’ at the end of para- ‘‘(B) ESTABLISHMENT OF BASE COPAYMENT skilled nursing facilities. graph (1); Sec. 209. Recognition of attending nurse AMOUNT CONSISTENT WITH 80:20 BENEFIT (2) by striking the period at the end of RATIO.—For each year beginning with 2006 practitioners as attending phy- paragraph (2) and inserting ‘‘; and’’; and sicians to serve hospice pa- the Secretary shall establish a base copay- (3) by adding at the end the following new ment amount in a manner consistent with tients. paragraph: Sec. 210. Improvement in payments to retain the principle (subject to reasonable rounding ‘‘(3) entitlement to have access to a pre- emergency capacity for ambu- rules) that the ratio of the aggregate amount scription drug plan that provides discounts of benefits provided under this section to the lance services in rural areas. on purchases for outpatient prescription Sec. 211. Three-year increase for home aggregate copayments under this paragraph drugs and, effective beginning with 2006, for health services furnished in a for each year should be approximately equal payment made on his behalf (subject to the to 80 to 20. rural area. provisions of this part) for high-deductible Sec. 212. Providing safe harbor for certain ‘‘(C) DISCOUNTS ALLOWED FOR NETWORK outpatient prescription drug coverage under collaborative efforts that ben- PHARMACIES.—A medicare-approved prescrip- section 1845.’’. tion drug plan may reduce copayments for efit medically underserved pop- (b) DESCRIPTION OF HIGH-DEDUCTIBLE PRE- its designees below the level otherwise pro- ulations. Sec. 213. GAO study of geographic dif- SCRIPTION DRUG BENEFIT.—Title XVIII is vided under this paragraph, but in no case shall such a reduction result in an increase ferences in payments for physi- amended by inserting after section 1844 the in payments made by the Secretary under cians’ services. following new section: Sec. 214. Treatment of missing cost report- ‘‘OUTPATIENT PRESCRIPTION DRUG COVERAGE this section to a plan. ‘‘(D) TREATMENT OF MEDICALLY NECESSARY ing periods for sole community ‘‘SEC. 1845. (a) HIGH-DEDUCTIBLE OUT- NONPREFERRED DRUGS.—A nonpreferred brand hospitals. PATIENT PRESCRIPTION DRUG COVERAGE DE- Sec. 215. Extension of telemedicine dem- name drug shall be treated as a preferred FINED.— brand name drug under this paragraph if onstration project. ‘‘(1) IN GENERAL.—For purposes of this such nonpreferred drug is determined (pursu- Sec. 216. Adjustment to the medicare inpa- part, the term ‘high-deductible outpatient tient hospital PPS wage index ant to procedures established under sub- prescription drug coverage’ means payment section (c)(6)) to be medically necessary. to revise the labor-related of— ‘‘(E) REQUIREMENT FOR DESIGNATION OF PRE- share of such index. ‘‘(A) expenses for covered outpatient pre- Sec. 217. Establishment of floor on geo- FERRED BRAND NAME DRUGS.—Within each scription drugs incurred in a year after the category of therapeutic-equivalent covered graphic adjustments of pay- individual has incurred expenses for such outpatient prescription drugs (as defined by ments for physicians’ services. drugs in the year of an amount equal to the the Secretary, in consultation with the TITLE I—MEDICARE RX NOW annual deductible specified in paragraph (2); Medicare Payment Advisory Commission, SEC. 100. PURPOSE. reduced by each medicare-approved prescription drug The purpose of this title is to provide for ‘‘(B) cost-sharing described in paragraph plan shall provide for the designation of at outpatient prescription drug benefits to (3). least one preferred brand name covered out- medicare beneficiaries in the following man- For periods before 2006, such coverage shall patient drug. ner: consist of access to discounts for prescrip- ‘‘(4) PAYMENT OF BENEFITS BEYOND DEDUCT- (1) Medicare beneficiaries enrolled under tion drugs under a medicare-approved pre- IBLE.— medicare part B qualify for outpatient pre- scription drug plan. ‘‘(A) IN GENERAL.—There shall be paid from scription drug benefits after an annual de- ‘‘(2) ANNUAL DEDUCTIBLE.— the Federal Supplementary Medical Insur- ductible (initially set at $4,000) has been met. ‘‘(A) IN GENERAL.—The annual deductible ance Trust Fund, in the case of each indi- This benefit is available without any addi- under this paragraph— vidual who is covered under the insurance tional premium. ‘‘(i) for 2006 is equal to $4,000; and program established by this part and incurs (2) There are fixed dollar copayments for ‘‘(ii) for a subsequent year is equal to the expenses for covered outpatient prescription this coverage, with the average of such co- amount specified in subparagraph (B) for drugs with respect to which benefits are pay- payments equal to 20 percent of the benefits that year, except that, if the amount speci- able under this section, amounts equal to the and the amount of the copayments varying fied in such subparagraph is not a multiple amounts provided under paragraph (1). depending upon whether the drugs are ge- of $10, it shall be rounded to the nearest mul- ‘‘(B) COUNTING OF INCURRED EXPENSES.—Ex- neric, preferred brand-name, or non-pre- tiple of $10. penses with respect to covered outpatient ferred brand-name drugs. ‘‘(B) INFLATIONARY ADJUSTMENT.—The prescription drugs under this section shall— (3) The benefits are provided through medi- amount specified in this subparagraph— ‘‘(i) be treated as incurred regardless of care-approved prescription drug plans. These ‘‘(i) for 2006, is $4,000; or whether they are reimbursed by a third- plans may be current plans, such as ‘‘(ii) the amount specified in this subpara- party payor; Medicare+Choice plans, employer-based re- graph for a subsequent year is the amount ‘‘(ii) not be treated as incurred unless the tiree coverage, medigap plans, State assist- specified in this subparagraph for the pre- expenses were incurred during a period in ance programs, medicaid, drug discount card vious year increased by the annual percent- which the individual was covered under this plans, and other qualified plans (as deter- age increase in average per capita aggregate part; and mined by the Secretary). All of these plans expenditures for covered outpatient prescrip- ‘‘(iii) not be treated as incurred unless in- must offer, in addition to the high-deduct- tion drugs in the United States for medicare formation concerning the transaction giving ible coverage, discounts for prescription beneficiaries, as determined by the Sec- rise to such expenses has been electronically
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00024 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.022 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5965 transmitted by the pharmacy or other entity proved prescription drug plan are the fol- ficiaries, pharmacy benefit managers, indi- dispensing the covered outpatient prescrip- lowing: viduals with expertise in information tech- tion drugs to the medicare-approved pre- ‘‘(A) A Medicare+Choice plan. nology, and pharmacy benefit experts of the scription drug plan consistent with elec- ‘‘(B) A group health plan, including a re- Departments of Veterans Affairs and Defense tronic claims standards established under tirement health benefits plan, that provides and other appropriate Federal agencies to subsection (c)(3).’’. prescription drug coverage. provide recommendations to the Adminis- SEC. 102. PROVISION OF BENEFITS THROUGH ‘‘(C) A State plan under title XIX. trator on such standards, including rec- MEDICARE APPROVED PRESCRIP- ‘‘(D) A health benefits plan under the Fed- ommendations relating to the following: TION DRUG PLANS. eral employees’ health benefits program ‘‘(I) The range of available computerized (a) IN GENERAL.—Section 1845 of the Social under chapter 89 of title 5, United States prescribing software and hardware and their Security Act, as inserted by section 101(a), is Code. further amended by adding at the end the costs to develop and implement. ‘‘(E) A medicare supplemental policy. ‘‘(II) The extent to which such standards following: ‘‘(F) State pharmaceutical assistance pro- and systems reduce medication errors and ‘‘(b) PROVISION OF BENEFITS THROUGH A gram. can be readily implemented by physicians, MEDICARE APPROVED PRESCRIPTION DRUG ‘‘(G) A prescription drug discount card pharmacies, and hospitals. PLAN.— plan (described in subsection (d)). ‘‘(1) IN GENERAL.—In the case of an indi- ‘‘(H) Any other prescription drug plan that ‘‘(III) Efforts to develop uniform standards vidual entitled to benefits for high-deduct- is determined to meet such requirements as and a common software platform for the se- ible outpatient prescription drug coverage the Secretary establishes. cure electronic communication of medica- under this section, the individual shall ob- ‘‘(3) ADMINISTRATION THROUGH CARD-BASED tion history, eligibility, benefit, and pre- tain such benefits through a medicare-ap- ELECTRONIC MECHANISM.— scription information. proved prescription drug plan that is des- ‘‘(A) USE OF MEDICARE PRESCRIPTION DRUG ‘‘(IV) Efforts to develop and promote uni- ignated under this subsection. CARD.—Claims for benefits under this section versal connectivity and interoperability for ‘‘(2) DESIGNATION PROCESS.—The Secretary under a medicare-approved prescription drug the secure electronic exchange of such infor- shall provide for a process for designation of plan may only be made electronically mation. medicare-approved prescription drug plans through the use of an electronic prescription ‘‘(V) The cost of implementing such sys- consistent with the following: card system (in this paragraph referred to as tems in the range of hospital and physician ‘‘(A) FREQUENCY OF DESIGNATIONS.—The the ‘system’). office settings and pharmacies, including Secretary shall permit individuals, on an an- ‘‘(B) STANDARDS FOR ELECTRONIC PRESCRIP- hardware, software, and training costs. nual basis and at such other times during a TION CARD SYSTEM.—The Secretary shall es- ‘‘(VI) Implementation issues as they relate year as the Secretary may specify, to change tablish standards for the system, including to part C of title XI, and current Federal and the plan designated. the following: State prescribing laws and regulations and ‘‘(B) DISSEMINATION OF INFORMATION.—The ‘‘(i) CARDS.—Standards for claims cards to their impact on implementation of comput- Secretary shall provide for the dissemina- be used by designees under the system. erized prescribing. tion of information on designation of plans ‘‘(ii) COORDINATION OF ELECTRONIC INFORMA- ‘‘(iii) DEADLINES.— under this subsection. Such dissemination TION.—Standards for the real-time trans- ‘‘(I) The Secretary shall constitute the may be coordinated with the dissemination mittal among pharmacies, medicare-ap- task force under clause (ii) by not later than of information on Medicare+Choice plan se- proved prescription drug plans, and the Sec- April 1, 2004. lection under part C. retary (including an appropriate data clear- ‘‘(II) Such task force shall submit rec- ‘‘(C) DEFAULT ASSIGNMENT.—In the case of inghouse operated by or under contract with ommendations to the Secretary by not later an individual who is enrolled under this part the Secretary) of information on expenses in- than January 1, 2005. who has not otherwise designated a medi- curred for covered outpatient prescription ‘‘(III) The Secretary shall provide for the care-approved prescription drug plan, the drugs by designees. development and promulgation, by not later Secretary shall assign the individual to an ‘‘(iii) CONFIDENTIALITY.—Standards that as- than January 1, 2006, of national standards appropriate prescription drug discount card sure the confidentiality of individually iden- relating to the electronic prescription drug plan serving the area in which the individual tifiable information of designees and that program described in clause (ii). Such stand- resides. are consistent with the regulations promul- ards shall be issued by a standards organiza- ‘‘(D) DEEMED DESIGNATION.—The Secretary gated under section 264(c) of the Health In- tion accredited by the American National may deem an individual who is enrolled in a surance Portability and Accountability Act Standards Institute (ANSI) and shall be com- medicare-approved prescription drug plan de- of 1996. patible with standards established under scribed in subparagraph (A) through (E) of ‘‘(iv) ELECTRONIC TRANSMITTAL OF PRE- part C of title XI. subsection (c)(2) as having designated such SCRIPTIONS.—Prescriptions must be written ‘‘(4) ACCEPTANCE OF CLAIMS THROUGH ALL plan, but shall permit the individual to des- and transmitted electronically (other than QUALIFYING PHARMACIES.—A medicare-ap- ignate a prescription drug discount card plan by facsimile), except in emergency cases and proved prescription drug plan shall— instead. The Secretary shall establish rules other exceptional circumstances recognized ‘‘(A) permit the participation of any phar- in cases where an individual is enrolled in by the Secretary. macy that meets terms and conditions that more than one such plan. ‘‘(v) PROVISION OF INFORMATION TO PRE- the plan has established; ‘‘(3) DESIGNEE DEFINED.—In this section, SCRIBING HEALTH CARE PROFESSIONAL.—The ‘‘(B) provide for acceptance and process of the term ‘designee’ means such an individual program provides for the electronic trans- claims for designees from any pharmacy that who makes such a designation and, with re- mittal to the prescribing health care profes- meets standards the Secretary has estab- spect to a plan, an individual who has des- sional of information that includes— lished under paragraph (3) to carry out real- ignated that plan under this subsection. ‘‘(I) information (to the extent available ‘‘(c) MEDICARE-APPROVED PRESCRIPTION and feasible) on the drug or drugs being pre- time transmittal of claims to such plans and DRUG PLANS.— scribed for that patient and other informa- that provides for disclosure, in the case of ‘‘(1) IN GENERAL.—For purposes of this tion relating to the medical history or condi- dispensing of a brand name drug to a des- part, the term ‘medicare-approved prescrip- tion of the patient that may be relevant to ignee, of information on the availability of tion drug plan’ means a health plan or pro- the appropriate prescription for that patient; generic equivalents at reduced cost to the gram described in paragraph (2) that— ‘‘(II) cost-effective alternatives (if any) for designee; and ‘‘(A) beginning with 2006, provides at least the use of the drug prescribed; and ‘‘(C) permit enrollees to receive benefits high-deductible outpatient prescription drug ‘‘(III) information on the drugs included in (which may include a 90-day supply of drugs coverage to designees of that plan or pro- the applicable formulary. or biologicals) through a community phar- gram; To the extent feasible, such program shall macy, rather than through mail order, with ‘‘(B) meets the applicable requirements of permit the prescribing health care profes- any differential in cost paid by such enroll- paragraph (3) and succeeding paragraphs of sional to provide (and be provided) related ees. this subsection with respect to such des- information on an interactive, real-time ‘‘(5) REQUIREMENT TO NEGOTIATE DISCOUNTS ignees; basis. AND GENERIC EQUIVALENTS.—A medicare-ap- ‘‘(C) has entered into an agreement with ‘‘(C) STANDARDS.— proved prescription drug plan shall provide the Secretary to provide and exchange elec- ‘‘(i) DEVELOPMENT.—The Secretary shall designees of the plan with the following: tronically such information as the Secretary provide for the development of uniform ‘‘(A) NEGOTIATED PRICES.—Access to nego- may require for the administration of the standards relating to the electronic prescrip- tiated prices (including applicable discounts) program of benefits under this section; and tion drug program described in subparagraph used for payment for covered outpatient ‘‘(D) meets such additional requirements (B). Such standards shall be compatible with drugs, regardless of the fact that no benefits as the Secretary may specify, including re- standards established under part C of title or only partial benefits may be payable with quiring the provision of appropriate periodic XI. respect to such drugs because of the applica- audits. ‘‘(ii) ADVISORY TASK FORCE.—In developing tion of the deductible under subsection (a)(2) ‘‘(2) TYPES OF PLANS AND PROGRAMS THAT such standards the Secretary shall establish or copayment under subsection (a)(3) or be- MAY QUALIFY.—The types of plans and pro- a task force that includes representatives of cause the drugs are procured before January grams that may qualify as a medicare-ap- physicians, hospitals, pharmacies, bene- 1, 2006.
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‘‘(B) GENERIC EQUIVALENTS.—Information scription drug discount card plans to individ- (1) IN GENERAL.—Section 1839(a) (42 U.S.C. on the availability of generic equivalents at uals enrolled under this part either nation- 1395r(a)) is amended by adding at the end the reduced cost to such designees. wide or in large geographic areas. The Sec- following new paragraph: ‘‘(6) TREATMENT OF NONPREFERRED BRAND retary shall award bids in a manner so that ‘‘(5) Notwithstanding the previous provi- NAME DRUGS.— such plans are offered in all areas of the sions of this subsection, in computing actu- ‘‘(A) PROCEDURES REGARDING THE DETER- United States. The Secretary may not award arial rates there shall not be taken into ac- MINATION OF DRUGS THAT ARE MEDICALLY NEC- a contract based on such a bid to an entity count benefits and administrative costs that ESSARY.— with respect to a plan unless the entity and are attributable to the prescription drug cov- ‘‘(i) IN GENERAL.—A medicare-approved plan meet the applicable requirements to be erage provided under section 1845.’’. prescription drug plan shall have in place a medicare-approved prescription drug plan (2) SPECIAL ENROLLMENT PERIOD; WAIVER OF procedures on a case-by-case basis to treat a under this section. LATE ENROLLMENT PENALTY.— nonpreferred brand name drug as a preferred ‘‘(2) LIMITATION ON BENEFITS.—The entity (A) Section 1837 (42 U.S.C. 1395p) is amend- brand name drug for purposes of subsection offering a prescription drug discount card ed by adding at the end the following new (a) if the nonpreferred brand name drug is plan shall not offer (or charge for) benefits to subsection: determined— designees of the plan in addition to high-de- ‘‘(k) There shall also be a general enroll- ‘‘(I) to be not as effective for the designee ductible prescription drug coverage, access ment period during the period beginning on in preventing or slowing the deterioration of, to negotiated prices, and other benefits re- July 1, 2005, and ending on November 30, or improving or maintaining, the health of quired under this section and, in the case of 2005.’’. the individual; or subsidy eligible individuals, benefits under (B) Section 1838(a) (42 U.S.C. 1395q(a)) is ‘‘(II) to have a significant adverse effect on subsection (h). amended— the individual. (i) by striking ‘‘or’’ at the end of paragraph ‘‘(e) PAYMENT OF PLANS.— ‘‘(ii) REQUIREMENT.—The procedures under (2); ‘‘(1) IN GENERAL.—The Secretary shall pro- clause (i) shall require that determinations (ii) by striking the period at the end of vide, in the contract entered into between under such clause are based on professional paragraph (3) and inserting ‘‘, or’’; and the Secretary and entities that offer medi- medical judgment, the medical condition of (iii) by adding at the end the following new care-approved prescription drug plans, for the enrollee, and other medical evidence. paragraph: payment to the plans for high-deductible ‘‘(B) PROCEDURES REGARDING APPEAL ‘‘(4) in the case of an individual who en- prescription drug coverage offered through RIGHTS WITH RESPECT TO DENIALS OF CARE.— rolls pursuant to subsection (k) of section the plan, including expanded coverage for Such a plan shall have in place procedures to 1837, January 1, 2006.’’. low-income individuals under subsection (g) ensure a timely internal review (and timely (C) Section 1839(b) (42 U.S.C. 1395r(b)) is and taking into account performance incen- independent external review) for resolution amended by inserting ‘‘or a general enroll- tives described in paragraph (2). In addition, of denials of coverage in accordance with the ment period under section 1837(k)’’ after in the case of prescription drug discount card medical exigencies of the case in accordance ‘‘not pursuant to a special enrollment period plans, the Secretary shall provide for pay- with requirements established by the Sec- under section 1837(i)(4)’’. ment of administrative costs in carrying out retary that are comparable to such require- (3) GOVERNMENT CONTRIBUTION.—Section the contract (taking into account the per- ments for Medicare+Choice organizations 1844(a)(1) (42 U.S.C. 1395w(a)(1)) is amended— formance incentives described in paragraph under part C and to ensure notice to des- (A) by striking ‘‘plus’’ at the end of sub- (2)), based on rates negotiated between the ignees regarding such procedures. A designee paragraph (A); Secretary and the entity in the solicitation shall have the further right to an appeal of (B) by striking ‘‘; plus’’ at the end of sub- process under subsection (d). such a denial of coverage in the same man- paragraph (B) and inserting ‘‘, plus’’; and ‘‘(2) INCENTIVES FOR COST AND UTILIZATION ner as is provided under section 1852(g)(5) in (C) by adding at the end the following new MANAGEMENT AND QUALITY IMPROVEMENT.— the case of a failure to receive health serv- subparagraph: ices under a Medicare+Choice plan. The Secretary shall include in the contract ‘‘(C) a Government contribution equal to ‘‘(7) PROMPT PAYMENT OF PHARMACIES FOR such financial or other performance incen- the aggregate amounts expended from the COVERED BENEFITS.—Medicare-approved pre- tives for cost and utilization management Trust Fund for benefits and administrative scription drug plans shall provide for pay- and quality improvement as the Secretary expenses attributable to the prescription ment to qualifying pharmacies of benefits may deem appropriate. drug coverage provided under section 1845; under subsection (a)(4) promptly in accord- ‘‘(f) COVERED OUTPATIENT PRESCRIPTION plus’’. ance with rules no less generous than the DRUGS DEFINED.— (c) MEDICARE AS PRIMARY PAYOR.—Section rules applicable under section 1842(c)(2)(B). ‘‘(1) IN GENERAL.—Except as provided in 1862(b) (42 U.S.C. 1395y(b)) is amended by add- ‘‘(8) EDUCATION.—Medicare-approved pre- this subsection, for purposes of this section, ing at the end the following new paragraph: scription drug plans shall apply methods to the term ‘covered outpatient prescription ‘‘(7) EXCEPTION FOR OUTPATIENT PRESCRIP- identify and educate providers, pharmacists, drug’ means— TION DRUG BENEFIT.—The previous provisions and designees regarding— ‘‘(A) a drug that may be dispensed only of this subsection shall not apply to benefits ‘‘(A) instances or patterns concerning the upon a prescription and that is described in provided under section 1845.’’. unnecessary or inappropriate prescribing or subparagraph (A)(i) or (A)(ii) of section dispensing of covered outpatient prescription Subtitle B—Benefits for Low-income 1927(k)(2); or drugs; Beneficiaries ‘‘(B) a biological product described in ‘‘(B) instances or patterns of substandard SEC. 111. BENEFITS FOR LOW-INCOME BENE- clauses (i) through (iii) of subparagraph (B) care; FICIARIES. of such section or insulin described in sub- ‘‘(C) potential adverse reactions to covered (a) IN GENERAL.— paragraph (C) of such section, outpatient prescription drugs; (1) FIRST DOLLAR COVERAGE.—Section 1845, and such term includes a vaccine licensed ‘‘(D) inappropriate use of antibiotics; as inserted by section 101(b), is amended by under section 351 of the Public Health Serv- ‘‘(E) appropriate use of generic products; adding at the end the following new sub- ice Act and any use of a covered outpatient and section: drug for a medically accepted indication (as ‘‘(F) the importance of using covered out- ‘‘(g) FIRST DOLLAR COVERAGE FOR CERTAIN defined in section 1927(k)(6)). patient prescription drugs in accordance LOW-INCOME INDIVIDUALS.— ‘‘(2) EXCLUSIONS.— with the instruction of prescribing providers. ‘‘(1) IN GENERAL.—In the case of a subsidy ‘‘(A) IN GENERAL.—Such term does not in- ‘‘(9) NOT AT FINANCIAL RISK.—The entity of- eligible individual (as defined in paragraph clude drugs or classes of drugs, or their med- fering a medicare-approved prescription drug (2)), this section shall be applied as if the an- ical uses, which may be excluded from cov- plan shall not be at financial risk for the nual deductible were equal to zero but, with erage or otherwise restricted under section provision of high-deductible prescription respect to costs incurred before the amount 1927(d)(2), other than subparagraph (E) there- drug coverage under the plan to designees, of the annual deductible otherwise applica- of (relating to smoking cessation agents), or but there shall be performance incentives ble, the following copayment amounts shall under section 1927(d)(3), as the Secretary (based on risk corridors negotiated between apply: may specify and does not include such other the entity and the Secretary and subject to ‘‘(A) 10 PERCENT COPAYMENT FOR INDIVID- medicines, classes, and uses as the Secretary audit) in relation to the administration of UALS WITH INCOMES UP TO 150 PERCENT OF POV- may specify consistent with the goals of pro- the contract and the entity’s ability to re- ERTY.—For subsidy eligible individuals with viding quality care and containing costs duce costs through appropriate incentive income that does not exceed 150 percent of under this section. mechanisms. the poverty line, the copayment amounts ‘‘(B) AVOIDANCE OF DUPLICATE COVERAGE.— ‘‘(10) PROVISION OF DATA.—The entity offer- shall be the copayments amounts specified A drug prescribed for an individual that ing such a plan shall provide the Secretary in subsection (a)(3), which reflects an aver- would otherwise be a covered outpatient pre- with such information as is required to make age benefit percentage of 90 percent. scription drug under this section shall not be payments to the entity under this section. ‘‘(B) 50 PERCENT COPAYMENT FOR INDIVID- so considered if payment for such drug is ‘‘(d) PRESCRIPTION DRUG DISCOUNT CARD UALS WITH INCOMES ABOVE 150 PERCENT OF POV- available under part A or under this part PLANS.— ERTY.—For subsidy eligible individuals with (other than under this section).’’. ‘‘(1) SOLICITATION OF BIDS.—The Secretary income that exceeds 150 percent of the pov- shall solicit bids from entities to offer pre- (b) NO EFFECT ON PART B PREMIUM.— erty line, the copayment amounts shall be
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the copayments amounts specified in sub- ‘‘(4) RELATION TO MEDICAID PROGRAM.— bursable under the appropriate paragraph of section (a)(3) increased by 150 percent, which ‘‘(A) IN GENERAL.—For provisions providing section 1903(a); except that, notwithstanding reflects an average benefit percentage of 50 for eligibility determinations, and additional any other provision of such section, the ap- percent, but in no case shall such copayment financing, under the medicaid program, see plicable Federal matching rates with respect amount exceed the price negotiated for the section 1935. to such expenditures under such section drug involved. ‘‘(B) COORDINATION.—The Secretary shall shall be increased as follows (but in no case ‘‘(2) DETERMINATION OF ELIGIBILITY.— develop and implement a plan for the coordi- shall the rate as so increased exceed 100 per- ‘‘(A) SUBSIDY ELIGIBLE INDIVIDUAL DE- nation of prescription drug benefits under cent): FINED.—For purposes of this section, subject this part with the benefits provided under ‘‘(A) For expenditures attributable to costs to subparagraph (D), the term ‘subsidy eligi- the medicaid program under title XIX, with incurred during 2006, the otherwise applica- ble individual’ means an individual who— particular attention to insuring coordination ble Federal matching rate shall be increased ‘‘(i) is enrolled under this part; of payments and prevention of fraud and by 10 percent of the percentage otherwise ‘‘(ii) has income below 150 percent (or such abuse. In developing and implementing such payable (but for this subsection) by the higher percent, not to exceed 200 percent, as plan, the Secretary shall involve the States, State. a State may specify under subparagraph (B)) the data processing industry, pharmacists, ‘‘(B)(i) For expenditures attributable to of the Federal poverty line; and and pharmaceutical manufacturers, and costs incurred during 2007 and each subse- ‘‘(iii) is not eligible for medical assistance other experts and representatives of low-in- quent year through 2013, the otherwise appli- with respect to prescription drugs under title come medicare beneficiaries.’’. cable Federal matching rate shall be in- XIX. (2) REDUCTION IN CATASTROPHIC COPAY- creased by the applicable percent (as defined For purposes of this section, an individual MENTS FOR LOW INCOME INDIVIDUALS.—Section in clause (ii)) of the percentage otherwise shall not be treated as eligible for medical 1845(a), as inserted by section 101(b), is payable (but for this subsection) by the assistance with respect to prescription drugs amended— State. under title XIX (including under a waiver (A) in paragraph (3)(A), by inserting ‘‘and ‘‘(ii) For purposes of clause (i), the ‘appli- under section 1115) only if, with respect to paragraph (5)’’ after ‘‘Subject to the suc- cable percent’ for— such assistance, the individual is charged a ceeding provisions of this paragraph’’; and ‘‘(I) 2007 is 20 percent; or copayment greater than a nominal amount (B) by adding at the end the following new ‘‘(II) a subsequent year is the applicable (as described in section 1916(a)(3)) and there paragraph: percent under this clause for the previous is no monthly or similar dollar limit estab- ‘‘(5) REDUCTION IN COPAYMENTS FOR LOW-IN- year increased by 10 percentage points. lished for the amount of such assistance over COME INDIVIDUALS TO 10 PERCENT.—In the case ‘‘(C) For expenditures attributable to costs any period of time. of a subsidy eligible individual with income incurred after 2013, the otherwise applicable ‘‘(B) COVERAGE OF INDIVIDUALS WITH INCOME that does not exceed 150 percent of the pov- Federal matching rate shall be increased to UP TO 200 PERCENT OF POVERTY AT STATE OP- erty line (as defined for purposes of sub- 100 percent. TION.—One of the 50 States or the District of section (g)), the copayment otherwise appli- ‘‘(2) COORDINATION.—The State shall pro- Columbia may, at its option and subject to cable under paragraph (3) shall be 1⁄2 of the vide the Secretary with such information as section 1935(c), specify a percent of income, copayment amount otherwise applicable.’’. may be necessary to properly allocate ad- that exceeds 150 percent but does not exceed (b) MEDICAID AMENDMENTS.— ministrative expenditures described in para- 200 percent, that will apply for purposes of (1) DETERMINATIONS OF ELIGIBILITY FOR graph (1) that may otherwise be made for this subsection to individuals residing in the LOW-INCOME SUBSIDIES.— similar eligibility determinations. State. (A) REQUIREMENT.—Section 1902(a) (42 ‘‘(c) STATE CONTRIBUTION AT SCHIP MATCH- ‘‘(C) DETERMINATIONS.—The determination U.S.C. 1396a(a)) is amended— ING RATE TOWARDS ADDITIONAL LOW-INCOME of whether an individual residing in a State (i) by striking ‘‘and’’ at the end of para- SUBSIDIES FOR OPTIONAL SUBSIDY ELIGIBLE is a subsidy eligible individual shall be deter- graph (64); INDIVIDUALS COVERED UNDER STATE OP- mined under the State medicaid plan for the (ii) by striking the period at the end of TION.—In the case of a State that specifies a State under section 1935(a) or by the Social paragraph (65) and inserting ‘‘; and’’; and percent of income under section 1845(g)(2)(B) Security Administration. There are author- (iii) by inserting after paragraph (65) the for a quarter, the amount of payment made ized to be appropriated to the Social Secu- following new paragraph: to the State under section 1903(a)(1) for the rity Administration such sums as may be ‘‘(66) provide for making eligibility deter- quarter shall be reduced by the product of— necessary for the determination of eligibility minations under sections 1845(a)(5), 1845(g), ‘‘(1) 100 percent less the enhanced FMAP under this subparagraph. and 1935(a).’’. described in section 2105(b) for that State ‘‘(D) INCOME DETERMINATIONS.—For pur- (2) NEW SECTION.—Title XIX of such Act is and quarter; and poses of applying this subsection— further amended— ‘‘(2) the additional amount of payment ‘‘(i) income shall be determined in the (A) by redesignating section 1935 as section made under section 1845 because of the appli- manner no less restrictive than the manner 1936; and cation of such specification.’’. (b) PHASED-IN FEDERAL ASSUMPTION OF described in section 1905(p)(1)(B); and (B) by inserting after section 1934 the fol- MEDICAID RESPONSIBILITY FOR COST-SHARING ‘‘(ii) the term ‘Federal poverty line’ means lowing new section: the official poverty line (as defined by the SUBSIDIES FOR DUALLY ELIGIBLE INDIVID- Office of Management and Budget, and re- ‘‘SPECIAL PROVISIONS RELATING TO MEDICARE UALS.— vised annually in accordance with section PRESCRIPTION DRUG BENEFIT (1) IN GENERAL.—Section 1903(a)(1) (42 673(2) of the Omnibus Budget Reconciliation ‘‘SEC. 1935. (a) REQUIREMENT FOR MAKING U.S.C. 1396b(a)(1)) is amended by inserting Act of 1981) applicable to a family of the size ELIGIBILITY DETERMINATIONS FOR LOW-IN- before the semicolon the following: ‘‘, re- involved. COME SUBSIDY.— duced by the amount computed under sec- ‘‘(E) TREATMENT OF TERRITORIAL RESI- ‘‘(1) IN GENERAL.—As a condition of its tion 1935(d)(1) for the State and the quarter’’. DENTS.—In the case of an individual who is State plan under this title under section (2) AMOUNT DESCRIBED.—Section 1935, as in- not a resident of the 50 States or the District 1902(a)(66) and receipt of any Federal finan- serted by subsection (a)(2), is amended by of Columbia, the individual is not eligible to cial assistance under section 1903(a), a State adding at the end the following new sub- be a subsidy eligible individual but may be shall— section: eligible for financial assistance with pre- ‘‘(A) make determinations of eligibility for ‘‘(d) FEDERAL ASSUMPTION OF MEDICAID scription drug expenses under section 1935(f). subsidies under (and in accordance with) sec- PRESCRIPTION DRUG COSTS FOR DUALLY-ELI- ‘‘(3) ADMINISTRATION OF SUBSIDY PRO- tions 1845(g) and 1845(a)(5); GIBLE BENEFICIARIES.— GRAM.—The Secretary shall provide a process ‘‘(B) inform the Secretary of such deter- ‘‘(1) IN GENERAL.—For purposes of section whereby, in the case of an individual who is minations in cases in which such eligibility 1903(a)(1), for a State that is one of the 50 determined to be a subsidy eligible indi- is established; and States or the District of Columbia for a cal- vidual and who is enrolled in a medicare-ap- ‘‘(C) otherwise provide the Secretary with endar quarter in a year (beginning with 2006) proved prescription drug plan— such information as may be required to the amount computed under this subsection ‘‘(A) the Secretary provides for a notifica- carry out section 1845. is equal to the sum of the product described tion of the entity offering the plan that the ‘‘(2) STATE OPTION FOR COVERAGE OF ADDI- in paragraph (3) plus the product of the fol- individual is eligible for a subsidy under TIONAL LOW-INCOME INDIVIDUALS.—A State lowing: paragraph (1); may elect under paragraph (2)(B) of section ‘‘(A) MEDICARE BENEFITS FOR MEDICAID ELI- ‘‘(B) such entity adjusts the benefits for 1845(g) to cover additional low-income medi- GIBLES.—The total amount of payments prescription drug coverage accordingly and care beneficiaries under the prescription made in the quarter because of the operation submits to the Secretary information on the drug subsidy program provided under such of section 1845 that are attributable to indi- amount of such benefits provided; and subsection, subject to contribution under viduals who are residents of the State and ‘‘(C) the Secretary periodically and on a subsection (c). are eligible for medical assistance with re- timely basis reimburses the entity for the ‘‘(b) PAYMENTS FOR ADDITIONAL ADMINIS- spect to prescription drugs under this title. amount of such benefits (including reason- TRATIVE COSTS.— For purposes of this subparagraph, an indi- able related administrative costs) that are ‘‘(1) IN GENERAL.—The amounts expended vidual shall not be treated as eligible for provided only because of the application of by a State in carrying out subsection (a) are, medical assistance with respect to prescrip- this subsection. subject to paragraph (2), expenditures reim- tion drugs under title XIX (including under a
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00027 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.022 H26PT1 H5968 CONGRESSIONAL RECORD — HOUSE June 26, 2003
waiver under section 1115) only if, with re- ‘‘(2) PLAN.—The plan described in this (b) USE OF SIMPLIFIED APPLICATION PROC- spect to such assistance, the individual is paragraph is a plan that— ESS.—Such section 1905(p) is further amended charged a copayment greater than a nominal ‘‘(A) provides medical assistance under sec- by adding at the end the following new para- amount (as described in section 1916(a)(3)) tion 1845(g) with respect to the provision of graph: and there is no monthly or similar dollar covered outpatient drugs to low-income ‘‘(7) A State shall permit individuals to limit established for the amount of such as- medicare beneficiaries whose income does apply to qualify as a qualified medicare ben- sistance over any period of time. not exceed an income level specified under eficiary or for benefits under section ‘‘(B) STATE MATCHING RATE.—A proportion the plan; and 1902(a)(10)(E)(iii) through the use of the sim- computed by subtracting from 100 percent ‘‘(B) assures that additional amounts re- plified application form developed under sec- the Federal medical assistance percentage ceived by the State that are attributable to tion 1905(p)(5)(A) and shall permit such an (as defined in section 1905(b)) applicable to the operation of this subsection are used application to be made over the telephone, the State and the quarter. only for such assistance. the Internet, or by mail, without the need ‘‘(C) PHASE-OUT PROPORTION.—The phase- ‘‘(3) INCREASED AMOUNT.— for an interview in person by the applicant out proportion (as defined in paragraph (2)) ‘‘(A) IN GENERAL.—The amount specified in or a representative of the applicant.’’. for the quarter. this paragraph for a State for a year is equal (c) ROLE OF SOCIAL SECURITY OFFICES.— ‘‘(2) PHASE-OUT PROPORTION.—For purposes to the product of— (1) ENROLLMENT AND PROVISION OF INFORMA- of paragraph (1)(C), the ‘phase-out propor- ‘‘(i) the aggregate amount specified in sub- TION AT SOCIAL SECURITY OFFICES.—Such sec- tion’ for a calendar quarter in— paragraph (B); and tion is further amended by adding at the end ‘‘(A) 2006 is 90 percent; ‘‘(ii) the amount specified in section the following new paragraph: ‘‘(B) a subsequent year before 2014, is the 1108(g)(1) for that State, divided by the sum ‘‘(8) The Commissioner of Social Security phase-out proportion for calendar quarters in of the amounts specified in such section for shall provide, through local offices of the So- the previous year decreased by 10 percentage all such States. cial Security Administration— points; or ‘‘(B) AGGREGATE AMOUNT.—The aggregate ‘‘(A) for the enrollment under State plans ‘‘(C) a year after 2013 is 0 percent. amount specified in this subparagraph for— under this title for appropriate medicare ‘‘(3) PRODUCT.—The product described in ‘‘(i) 2006, is equal to $25,000,000; or cost-sharing benefits for individuals who this paragraph for a State for a calendar ‘‘(ii) a subsequent year, is equal to the ag- qualify as a qualified medicare beneficiary or quarter is the State matching rate described gregate amount specified in this subpara- for benefits under section 1902(a)(10)(E)(iii); in paragraph (1)(B) for that State and quar- graph for the previous year increased by an- and ter multiplied by the additional expenditures nual percentage increase specified in section ‘‘(B) for providing oral and written notice made under section 1845 as a result of the fol- 1845(a)(2)(B) for the year involved. of the availability of such benefits.’’. ‘‘(4) REPORT.—The Secretary shall submit lowing: (2) CLARIFYING AMENDMENT.—Section ‘‘(A) REDUCTIONS IN CATASTROPHIC COPAY- to Congress a report on the application of 1902(a)(5) (42 U.S.C. 1396a(a)(5)) is amended by MENTS.—The application of subsection (a)(5) this subsection and may include in the re- inserting ‘‘as provided in section 1905(p)(10)’’ thereof. port such recommendations as the Secretary before ‘‘except’’. deems appropriate.’’. ‘‘(B) FIRST DOLLAR COVERAGE.—The appli- (d) OUTSTATIONING OF STATE ELIGIBILITY (2) CONFORMING AMENDMENT.—Section cation under subsection (g) of reduced copay- WORKERS AT SSA FIELD OFFICES.—Section 1108(f) (42 U.S.C. 1308(f)) is amended by in- ments amounts insofar as such amounts are 1902(a)(55) (42 U.S.C. 1396a(a)(55)) is amend- serting ‘‘and section 1935(f)(1)(B)’’ after less than 25 percent of the amount of the ed— ‘‘Subject to subsection (g)’’. price otherwise negotiated for the drug in- (1) by striking ‘‘subsection (a)(10)(A)(i)(IV), (e) MEDICAID REDUCTION OF COPAYMENTS volved. (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or (3) MEDICAID PROVIDING WRAP-AROUND BENE- FOR QMBS.—Section 1905(p)(3) (42 U.S.C. 1396d(p)(3)) is amended by adding at the end (a)(10)(A)(ii)(IX)’’ and inserting ‘‘paragraph FITS.—Section 1935, as so inserted and (10)(A)(i)(IV), (10)(A)(i)(VI), (10)(A)(i)(VII), amended, is further amended by adding at the following new subparagraph: ‘‘(E) The difference between the copayment (10)(A)(ii)(IX), or (10)(E)’’; and the end the following new subsection: (2) in subparagraph (A), by inserting ‘‘and ‘‘(e) MEDICAID AS SECONDARY PAYOR.—In amounts established under sections 1845(g)(1)(A) and 1845(a)(5) for covered out- in the case of applications of individuals for the case of an individual who is entitled to medical assistance under paragraph (10)(E), benefits under part B of title XVIII and is el- patient drugs and the nominal copayment amounts that would apply to such drugs if at locations that include field offices of the igible for medical assistance with respect to Social Security Administration’’. prescribed drugs under this title, medical as- covered under this title, pursuant to section sistance shall continue to be provided under 1916(a).’’. TITLE II—RURAL HEALTH CARE this title for prescribed drugs to the extent (f) RENEGOTIATION OF PHARMACY PLUS IMPROVEMENTS WAIVERS.—In the case of States which as of payment is not made under such part B, SEC. 201. FAIRNESS IN THE MEDICARE DIS- without regard to section 1902(n)(2).’’. the date of the enactment of this Act have PROPORTIONATE SHARE HOSPITAL (4) CLARIFYING AMENDMENTS.—Section entered into demonstration projects (popu- (DSH) ADJUSTMENT FOR RURAL 1905(p)(3) (42 U.S.C. 1396d(p)(3)) is amended— larly known as pharmacy plus waivers) HOSPITALS. (A) in subparagraph (B), by inserting ‘‘, but under section 1115 of the Social Security Act (a) EQUALIZING DSH PAYMENT AMOUNTS.— under which the State is provided flexibility not including any copayments under section (1) IN GENERAL.—Section 1886(d)(5)(F)(vii) to offer medical assistance for prescription 1845’’ after ‘‘section 1813’’; and (42 U.S.C. 1395ww(d)(5)(F)(vii)) is amended by drug coverage in return for limitations on (B) in subparagraph (C), by inserting ‘‘, but inserting ‘‘, and, after October 1, 2003, for any payments for certain optional populations, not including any deductible under section other hospital described in clause (iv),’’ after the Secretary of Health and Human Services ‘‘clause (iv)(I)’’ in the matter preceding sub- 1845’’ after ‘‘section 1833(b)’’.. shall renegotiate such projects in order to (d) TREATMENT OF TERRITORIES.— clause (I). account for the additional prescription drug (1) IN GENERAL.—Section 1935 of such Act, (2) CONFORMING AMENDMENTS.—Section benefits made available under the amend- as so inserted and amended, is further 1886(d)(5)(F) (42 U.S.C. 1395ww(d)(5)(F)) is ments made by this title. amended— amended— SEC. 112. IMPROVING ENROLLMENT PROCESS (A) in clause (iv)— (A) in subsection (a) in the matter pre- UNDER MEDICAID. ceding paragraph (1), by inserting ‘‘subject (i) in subclause (II)— (a) AUTOMATIC REENROLLMENT WITHOUT (I) by inserting ‘‘and before October 1, to subsection (f)’’ after ‘‘section 1903(a)’’; NEED TO REAPPLY.— 2003,’’ after ‘‘April 1, 2001,’’; and (B) in subsection (c)(1), by inserting ‘‘sub- (1) IN GENERAL.—Section 1905(p) (42 U.S.C. ject to subsection (f)’’ after ‘‘1903(a)(1)’’; and 1396d(p)) is amended— (II) by inserting ‘‘or, for discharges occur- (C) by adding at the end the following new (A) by redesignating paragraph (6) as para- ring on or after October 1, 2003, is equal to subsection: graph (9); and the percent determined in accordance with ‘‘(f) TREATMENT OF TERRITORIES.— (B) by inserting after paragraph (5), the the applicable formula described in clause ‘‘(1) IN GENERAL.—In the case of a State, following new paragraph: (vii)’’ after ‘‘clause (xiii)’’; other than the 50 States and the District of ‘‘(6) In the case of an individual who has (ii) in subclause (III)— Columbia— been determined to qualify as a qualified (I) by inserting ‘‘and before October 1, ‘‘(A) the previous provisions of this section medicare beneficiary or to be eligible for 2003,’’ after ‘‘April 1, 2001,’’; and shall not apply to residents of such State; benefits under section 1902(a)(10)(E)(iii), the (II) by inserting ‘‘or, for discharges occur- and individual shall be deemed to continue to be ring on or after October 1, 2003, is equal to ‘‘(B) if the State establishes a plan de- so qualified or eligible without the need for the percent determined in accordance with scribed in paragraph (2) (for providing med- any annual or periodic application unless the applicable formula described in clause ical assistance with respect to the provision and until the individual notifies the State (vii)’’ after ‘‘clause (xii)’’; of prescription drugs to medicare bene- that the individual’s eligibility conditions (iii) in subclause (IV)— ficiaries under section 1845(g)), the amount have changed so that the individual is no (I) by inserting ‘‘and before October 1, otherwise determined under section 1108(f) longer so qualified or eligible.’’. 2003,’’ after ‘‘April 1, 2001,’’; and (as increased under section 1108(g)) for the (2) CONFORMING AMENDMENT.—Section (II) by inserting ‘‘or, for discharges occur- State shall be increased by the amount spec- 1902(e)(8) (42 U.S.C. 1396a(e)(8)) is amended by ring on or after October 1, 2003, is equal to ified in paragraph (3). striking the second sentence. the percent determined in accordance with
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00028 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.022 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5969 the applicable formula described in clause (B) in subparagraph (D), in the matter pre- trol peer review organization under part B of (vii)’’ after ‘‘clause (x) or (xi)’’; ceding clause (i), by inserting ‘‘, for fiscal title XI or other quality standards recog- (iv) in subclause (V)— years before fiscal year 1997,’’ before ‘‘a re- nized by the Secretary. (I) by inserting ‘‘and before October 1, gional DRG prospective payment rate for A hospital classified as an essential rural 2003,’’ after ‘‘April 1, 2001,’’; and each region,’’. hospital may not change such classification (II) by inserting ‘‘or, for discharges occur- SEC. 203. ESTABLISHMENT OF ESSENTIAL RURAL and a hospital so classified shall not be ring on or after October 1, 2003, is equal to HOSPITAL CLASSIFICATION. treated as a sole community hospital, medi- the percent determined in accordance with (a) CLASSIFICATION.—Section 1861(mm) (42 care dependent hospital, or rural referral the applicable formula described in clause U.S.C. 1395x(mm)) is amended— center for purposes of section 1886.’’. (vii)’’ after ‘‘clause (xi)’’; and (1) in the heading by adding ‘‘ESSENTIAL (b) PAYMENT BASED ON 102 PERCENT OF AL- (v) in subclause (VI)— RURAL HOSPITALS’’ at the end; and LOWED COSTS.— (I) by inserting ‘‘and before October 1, (2) by adding at the end the following new (1) INPATIENT HOSPITAL SERVICES.—Section 2003,’’ after ‘‘April 1, 2001,’’; and paragraphs: 1886(d) (42 U.S.C. 1395ww(d)) is amended by (II) by inserting ‘‘or, for discharges occur- ‘‘(4)(A) The term ‘essential rural hospital’ adding at the end the following: ring on or after October 1, 2003, is equal to means a subsection (d) hospital (as defined in ‘‘(11) In the case of a hospital classified as the percent determined in accordance with section 1886(d)(1)(B)) that is located in a an essential rural hospital under section the applicable formula described in clause rural area (as defined for purposes of section 1861(mm)(4) for a cost reporting period, the (vii)’’ after ‘‘clause (x)’’; 1886(d)), has more than 25 licensed acute care payment under this subsection for inpatient (B) in clause (viii), by striking ‘‘The for- inpatient beds, has applied to the Secretary hospital services for discharges occurring mula’’ and inserting ‘‘For discharges occur- for classification as such a hospital, and with during the period shall be based on 102 per- ring before October 1, 2003, the formula’’; and respect to which the Secretary has deter- cent of the reasonable costs for such serv- (C) in each of clauses (x), (xi), (xii), and mined that the closure of the hospital would ices. Nothing in this paragraph shall be con- (xiii), by striking ‘‘For purposes’’ and insert- significantly diminish the ability of medi- strued as affecting the application or care beneficiaries to obtain essential health ing ‘‘With respect to discharges occurring be- amount of deductibles or copayments other- care services. wise applicable to such services under part A fore October 1, 2003, for purposes’’. ‘‘(B) The determination under subpara- (b) EFFECTIVE DATE.—The amendments or as waiving any requirement for billing for graph (A) shall be based on the following cri- such services.’’. made by this section shall apply to dis- teria: (2) HOSPITAL OUTPATIENT SERVICES.—Sec- charges occurring on or after October 1, 2003. ‘‘(i) HIGH PROPORTION OF MEDICARE BENE- tion 1833(t)(13) (42 U.S.C. 1395l(t)(13)) is SEC. 202. IMMEDIATE ESTABLISHMENT OF UNI- FICIARIES RECEIVING CARE FROM HOSPITAL.—(I) amended by adding at the end the following FORM STANDARDIZED AMOUNT IN A high percentage of such beneficiaries re- new subparagraph: RURAL AND SMALL URBAN AREAS. siding in the area of the hospital who are ‘‘(B) SPECIAL RULE FOR ESSENTIAL RURAL (a) IN GENERAL.—Section 1886(d)(3)(A) (42 hospitalized (during the most recent year for HOSPITALS.—In the case of a hospital classi- U.S.C. 1395ww(d)(3)(A)) is amended— which complete data are available) receive fied as an essential rural hospital under sec- (1) in clause (iv), by inserting ‘‘and ending basic inpatient medical care at the hospital. tion 1861(mm)(4) for a cost reporting period, on or before September 30, 2003,’’ after ‘‘Oc- ‘‘(II) For a hospital with more than 200 li- the payment under this subsection for cov- tober 1, 1995,’’; and censed beds, a high percentage of such bene- ered OPD services during the period shall be (2) by redesignating clauses (v) and (vi) as ficiaries residing in such area who are hos- based on 102 percent of the reasonable costs clauses (vii) and (viii), respectively, and in- pitalized (during such recent year) receive for such services. Nothing in this subpara- serting after clause (iv) the following new specialized surgical inpatient care at the graph shall be construed as affecting the ap- clauses: hospital. plication or amount of deductibles or copay- ‘‘(v) For discharges occurring in the fiscal ‘‘(III) Almost all physicians described in ments otherwise applicable to such services year beginning on October 1, 2003, the aver- section 1861(r)(1) in such area have privileges under this part or as waiving any require- age standardized amount for hospitals lo- at the hospital and provide their inpatient cated in areas other than a large urban area ment for billing for such services.’’. services primarily at the hospital. (c) EFFECTIVE DATE.—The amendments shall be equal to the average standardized ‘‘(ii) SIGNIFICANT ADVERSE IMPACT IN AB- made by this section shall apply to cost re- amount for hospitals located in a large urban SENCE OF HOSPITAL.—If the hospital were to porting periods beginning on or after October area.’’. close— 1, 2004. (b) CONFORMING AMENDMENTS.— ‘‘(I) there would be a significant amount of SEC. 204. MORE FREQUENT UPDATE IN WEIGHTS (1) COMPUTING DRG-SPECIFIC RATES.—Sec- time needed for residents to reach emer- USED IN HOSPITAL MARKET BAS- tion 1886(d)(3)(D) (42 U.S.C. 1395ww(d)(3)(D)) gency treatment, resulting in a potential KET. is amended— significant harm to beneficiaries with crit- (a) MORE FREQUENT UPDATES IN WEIGHTS.— (A) in the heading, by striking ‘‘IN DIF- ical illnesses or injuries; After revising the weights used in the hos- FERENT AREAS’’; ‘‘(II) there would be an inability in the pital market basket under section (B) in the matter preceding clause (i), by community to stablize emergency cases for 1886(b)(3)(B)(iii) of the Social Security Act striking ‘‘, each of’’; transfers to another acute care setting, re- (42 U.S.C. 1395ww(b)(3)(B)(iii)) to reflect the (C) in clause (i)— sulting in a potential for significant harm to most current data available, the Secretary (i) in the matter preceding subclause (I), by medicare beneficiaries; and shall establish a frequency for revising such inserting ‘‘for fiscal years before fiscal year ‘‘(III) any other nearby hospital lacks the weights, including the labor share, in such 2004,’’ before ‘‘for hospitals’’; and physical and clinical capacity to take over market basket to reflect the most current (ii) in subclause (II), by striking ‘‘and’’ the hospital’s typical admissions. data available more frequently than once after the semicolon at the end; ‘‘(C) In making such determination, the every 5 years. (D) in clause (ii)— Secretary may also consider the following: (b) REPORT.—Not later than October 1, 2004, (i) in the matter preceding subclause (I), by ‘‘(i) Free-standing ambulatory surgery cen- the Secretary shall submit a report to Con- inserting ‘‘for fiscal years before fiscal year ters, office-based oncology care, and imaging gress on the frequency established under sub- 2004,’’ before ‘‘for hospitals’’; and center services are insufficient in the hos- section (a), including an explanation of the (ii) in subclause (II), by striking the period pital’s area to handle the outpatient care of reasons for, and options considered, in deter- at the end and inserting ‘‘; and’’; and the hospital. mining such frequency. (E) by adding at the end the following new ‘‘(ii) Beneficiaries in nearby areas would be SEC. 205. IMPROVEMENTS TO CRITICAL ACCESS clause: adversely affected if the hospital were to HOSPITAL PROGRAM. ‘‘(iii) for a fiscal year beginning after fiscal close as the hospital provides specialized (a) INCREASE IN PAYMENT AMOUNTS.— year 2003, for hospitals located in all areas, knowledge and services to a network of (1) IN GENERAL.—Sections 1814(l), 1834(g)(1), to the product of— smaller hospitals and critical access hos- and 1883(a)(3) (42 U.S.C. 1395f(l); 1395m(g)(1); ‘‘(I) the applicable standardized amount pitals. 42 U.S.C. 1395tt(a)(3)) are each amended by (computed under subparagraph (A)), reduced ‘‘(iii) Medicare beneficiaries would have inserting ‘‘equal to 102 percent of’’ before under subparagraph (B), and adjusted or re- difficulty in accessing care if the hospital ‘‘the reasonable costs’’. duced under subparagraph (C) for the fiscal were to close as the hospital provides signifi- (2) EFFECTIVE DATE.—The amendments year; and cant subsidies to support ambulatory care in made by paragraph (1) shall apply to pay- ‘‘(II) the weighting factor (determined local clinics, including mental health clinics ments for services furnished during cost re- under paragraph (4)(B)) for that diagnosis-re- and to support post acute care. porting periods beginning on or after October lated group.’’. ‘‘(iv) The hospital has a committment to 1, 2003. (2) TECHNICAL CONFORMING SUNSET.—Sec- provide graduate medical education in a (b) COVERAGE OF COSTS FOR CERTAIN EMER- tion 1886(d)(3) (42 U.S.C. 1395ww(d)(3)) is rural area. GENCY ROOM ON-CALL PROVIDERS.— amended— ‘‘(C) QUALITY CARE.—The hospital inpatient (1) IN GENERAL.—Section 1834(g)(5) (42 (A) in the matter preceding subparagraph score for quality of care is not less than the U.S.C. 1395m(g)(5)) is amended— (A), by inserting ‘‘, for fiscal years before fis- median hospital score for qualify of care for (A) in the heading— cal year 1997,’’ before ‘‘a regional adjusted hospitals in the State, as established under (i) by inserting ‘‘CERTAIN’’ before ‘‘EMER- DRG prospective payment rate’’; and standards of the utilization and quality con- GENCY’’; and
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00029 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.022 H26PT1 H5970 CONGRESSIONAL RECORD — HOUSE June 26, 2003
(ii) by striking ‘‘PHYSICIANS’’ and inserting (1) IN GENERAL.—Section 1820(c)(2)(B)(iii) this section shall be applied with respect to ‘‘PROVIDERS’’; (42 U.S.C. 1395i–4(c)(2)(B)(iii)) is amended to such an affiliated group by deeming the af- (B) by striking ‘‘emergency room physi- read as follows: filiated group to be a single hospital. cians who are on-call (as defined by the Sec- ‘‘(iii) provides not more than a total of 25 ‘‘(ii) REDISTRIBUTION.— retary)’’ and inserting ‘‘physicians, physi- extended care service beds (pursuant to an ‘‘(I) IN GENERAL.—The Secretary is author- cian assistants, nurse practitioners, and clin- agreement under subsection (f)) and acute ized to increase the otherwise applicable ical nurse specialists who are on-call (as de- care inpatient beds (meeting such standards resident limits for hospitals by an aggregate fined by the Secretary) to provide emergency as the Secretary may establish) for providing number estimated by the Secretary that services’’; and inpatient care for a period that does not ex- does not exceed the aggregate reduction in (C) by striking ‘‘physicians’ services’’ and ceed, as determined on an annual, average such limits attributable to clause (i) (with- inserting ‘‘services covered under this title’’. basis, 96 hours per patient;’’. out taking into account any adjustment (2) EFFECTIVE DATE.—The amendment (2) CONFORMING AMENDMENT.—Section under subclause (IV) of such clause). made by paragraph (1) shall apply with re- 1820(f) (42 U.S.C. 1395i–4(f)) is amended by ‘‘(II) EFFECTIVE DATE.—No increase under spect to costs incurred for services provided striking ‘‘and the number of beds used at any subclause (I) shall be permitted or taken into on or after January 1, 2004. time for acute care inpatient services does account for a hospital for any portion of a (c) MODIFICATION OF THE ISOLATION TEST not exceed 15 beds’’. cost reporting period that occurs before July FOR COST-BASED CAH AMBULANCE SERV- (3) EFFECTIVE DATE.—The amendments 1, 2004, or before the date of the hospital’s ap- ICES.— made by this subsection shall with respect to plication for an increase under this clause. (1) IN GENERAL.—Section 1834(l)(8) (42 designations made on or after October 1, No such increase shall be permitted for a U.S.C. 1395m(l)), as added by section 205(a) of 2004. hospital unless the hospital has applied to BIPA (114 Stat. 2763A–482), is amended by (g) ADDITIONAL 5-YEAR PERIOD OF FUNDING the Secretary for such increase by December adding at the end the following: ‘‘The limita- FOR GRANT PROGRAM.— 31, 2005. (1) IN GENERAL.—Section 1820(g) (42 U.S.C. tion described in the matter following sub- ‘‘(III) CONSIDERATIONS IN REDISTRIBUTION.— paragraph (B) in the previous sentence shall 1395i–4(g)) is amended by adding at the end In determining for which hospitals the in- not apply if the ambulance services are fur- the following new paragraph: crease in the otherwise applicable resident nished by such a provider or supplier of am- ‘‘(4) FUNDING.— limit is provided under subclause (I), the bulance services who is a first responder to ‘‘(A) IN GENERAL.—Subject to subparagraph Secretary shall take into account the need (B), payment for grants made under this sub- emergencies (as determined by the Sec- for such an increase by specialty and loca- section during fiscal years 2004 through 2008 retary).’’. tion involved, consistent with subclause (IV). shall be made from the Federal Hospital In- (2) EFFECTIVE DATE.—The amendment ‘‘(IV) PRIORITY FOR RURAL AND SMALL surance Trust Fund. made by paragraph (1) shall apply to ambu- URBAN AREAS.—In determining for which hos- ‘‘(B) ANNUAL AGGREGATE LIMITATION.—In no lances services furnished on or after the first pitals and residency training programs an in- case may the amount of payment provided cost reporting period that begins after the crease in the otherwise applicable resident for under subparagraph (A) for a fiscal year date of the enactment of this Act. limit is provided under subclause (I), the exceed $25,000,000.’’. (d) REINSTATEMENT OF PERIODIC INTERIM Secretary shall first distribute the increase (2) CONFORMING AMENDMENT.—Section 1820 PAYMENT (PIP).— to programs of hospitals located in rural (42 U.S.C. 1395i–4) is amended by striking (1) IN GENERAL.—Section 1815(e)(2) (42 subsection (j). areas or in urban areas that are not large U.S.C. 1395g(e)(2)) is amended— urban areas (as defined for purposes of sub- SEC. 206. REDISTRIBUTION OF UNUSED RESI- (A) in the matter before subparagraph (A), DENT POSITIONS. section (d)) on a first-come-first-served basis by inserting ‘‘, in the cases described in sub- (a) IN GENERAL.—Section 1886(h)(4) (42 (as determined by the Secretary) based on a paragraphs (A) through (D)’’ after ‘‘1986’’; U.S.C. 1395ww(h)(4)) is amended— demonstration that the hospital will fill the and (1) in subparagraph (F)(i), by inserting positions made available under this clause (B) by striking ‘‘and’’ at the end of sub- ‘‘subject to subparagraph (I),’’ after ‘‘October and not to exceed an increase of 25 full-time paragraph (C); 1, 1997,’’; equivalent positions with respect to any hos- (C) by adding ‘‘and’’ at the end of subpara- (2) in subparagraph (H)(i), by inserting pital. graph (D); and ‘‘subject to subparagraph (I),’’ after ‘‘sub- ‘‘(V) APPLICATION OF LOCALITY ADJUSTED (D) by inserting after subparagraph (D) the paragraphs (F) and (G),’’; and NATIONAL AVERAGE PER RESIDENT AMOUNT.— following new subparagraph: (3) by adding at the end the following new With respect to additional residency posi- ‘‘(E) inpatient critical access hospital serv- subparagraph: tions in a hospital attributable to the in- ices;’’. ‘‘(I) REDISTRIBUTION OF UNUSED RESIDENT crease provided under this clause, notwith- (2) DEVELOPMENT OF ALTERNATIVE METHODS POSITIONS.— standing any other provision of this sub- OF PERIODIC INTERIM PAYMENTS.—With re- ‘‘(i) REDUCTION IN LIMIT BASED ON UNUSED section, the approved FTE resident amount spect to periodic interim payments to crit- POSITIONS.— is deemed to be equal to the locality ad- ical access hospitals for inpatient critical ac- ‘‘(I) IN GENERAL.—If a hospital’s resident justed national average per resident amount cess hospital services under section level (as defined in clause (iii)(I)) is less than computed under subparagraph (E) for that 1815(e)(2)(E) of the Social Security Act, as the otherwise applicable resident limit (as hospital. added by paragraph (1), the Secretary shall defined in clause (iii)(II)) for each of the ref- ‘‘(VI) CONSTRUCTION.—Nothing in this develop alternative methods for such pay- erence periods (as defined in subclause (II)), clause shall be construed as permitting the ments that are based on expenditures of the effective for cost reporting periods beginning redistribution of reductions in residency po- hospital. on or after January 1, 2004, the otherwise ap- sitions attributable to voluntary reduction (3) REINSTATEMENT OF PIP.—The amend- plicable resident limit shall be reduced by 75 programs under paragraph (6) or as affecting ments made by paragraph (1) shall apply to percent of the difference between such limit the ability of a hospital to establish new payments made on or after January 1, 2004. and the reference resident level specified in medical residency training programs under (e) CONDITION FOR APPLICATION OF SPECIAL subclause (III) (or subclause (IV) if applica- subparagraph (H). PHYSICIAN PAYMENT ADJUSTMENT.— ble). ‘‘(iii) RESIDENT LEVEL AND LIMIT DEFINED.— (1) IN GENERAL.—Section 1834(g)(2) (42 ‘‘(II) REFERENCE PERIODS DEFINED.—In this In this subparagraph: U.S.C. 1395m(g)(2)) is amended by adding clause, the term ‘reference periods’ means, ‘‘(I) RESIDENT LEVEL.—The term ‘resident after and below subparagraph (B) the fol- for a hospital, the 3 most recent consecutive level’ means, with respect to a hospital, the lowing: cost reporting periods of the hospital for total number of full-time equivalent resi- ‘‘The Secretary may not require, as a condi- which cost reports have been settled (or, if dents, before the application of weighting tion for applying subparagraph (B) with re- not, submitted) on or before September 30, factors (as determined under this paragraph), spect to a critical access hospital, that each 2002. in the fields of allopathic and osteopathic physician providing professional services in ‘‘(III) REFERENCE RESIDENT LEVEL.—Subject medicine for the hospital. the hospital must assign billing rights with to subclause (IV), the reference resident ‘‘(II) OTHERWISE APPLICABLE RESIDENT respect to such services, except that such level specified in this subclause for a hos- LIMIT.—The term ‘otherwise applicable resi- subparagraph shall not apply to those physi- pital is the highest resident level for the hos- dent limit’ means, with respect to a hospital, cians who have not assigned such billing pital during any of the reference periods. the limit otherwise applicable under sub- rights.’’. ‘‘(IV) ADJUSTMENT PROCESS.—Upon the paragraphs (F)(i) and (H) on the resident (2) EFFECTIVE DATE.—The amendment timely request of a hospital, the Secretary level for the hospital determined without re- made by paragraph (1) shall be effective as if may adjust the reference resident level for a gard to this subparagraph.’’. included in the enactment of section 403(d) of hospital to be the resident level for the hos- (b) CONFORMING AMENDMENT TO IME.—Sec- the Medicare, Medicaid, and SCHIP Balanced pital for the cost reporting period that in- tion 1886(d)(5)(B)(v) (42 U.S.C. Budget Refinement Act of 1999 (113 Stat. cludes July 1, 2003. 1395ww(d)(5)(B)(v)) is amended by adding at 1501A–371). ‘‘(V) AFFILIATION.—With respect to hos- the end the following: ‘‘The provisions of (f) PERMITTING CAHS TO ALLOCATE SWING pitals which are members of the same affili- subparagraph (I) of subsection (h)(4) shall BEDS AND ACUTE CARE INPATIENT BEDS SUB- ated group (as defined by the Secretary apply with respect to the first sentece of this JECT TO A TOTAL LIMIT OF 25 BEDS.— under subparagraph (H)(ii)), the provisions of clause in the same manner as it applies with
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00030 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.022 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5971 respect to subparagraph (F) of such sub- 1888(e)(2)(A)(ii)’’ and inserting ‘‘clauses (ii), ‘‘(H) any remuneration between a public or section.’’. (iii), and (iv) of section 1888(e)(2)(A)’’. nonprofit private health center entity de- (c) REPORT ON EXTENSION OF APPLICATIONS (d) EFFECTIVE DATE.—The amendments scribed under clause (i) or (ii) of section UNDER REDISTRIBUTION PROGRAM.—Not later made by subsection (a) shall apply to serv- 1905(l)(2)(B) and any individual or entity pro- than July 1, 2005, the Secretary shall submit ices furnished on or after January 1, 2004. viding goods, items, services, donations or to Congress a report containing rec- SEC. 209. RECOGNITION OF ATTENDING NURSE loans, or a combination thereof, to such ommendations regarding whether to extend PRACTITIONERS AS ATTENDING health center entity pursuant to a contract, the deadline for applications for an increase PHYSICIANS TO SERVE HOSPICE PA- lease, grant, loan, or other agreement, if in resident limits under section TIENTS. such agreement contributes to the ability of 1886(h)(4)(I)(ii)(II) of the Social Security Act (a) IN GENERAL.—Section 1861(dd)(3)(B) (42 the health center entity to maintain or in- (as added by subsection (a)). U.S.C. 1395x(dd)(3)(B)) is amended by insert- crease the availability, or enhance the qual- SEC. 207. TWO-YEAR EXTENSION OF HOLD HARM- ing ‘‘or nurse practitioner (as defined in sub- ity, of services provided to a medically un- LESS PROVISIONS FOR SMALL section (aa)(5))’’ after ‘‘the physician (as de- derserved population served by the health RURAL HOSPITALS AND SOLE COM- fined in subsection (r)(1))’’. center entity.’’. MUNITY HOSPITALS UNDER PRO- (b) PROHIBITION ON NURSE PRACTITIONER (b) RULEMAKING FOR EXCEPTION FOR SPECTIVE PAYMENT SYSTEM FOR CERTIFYING NEED FOR HOSPICE.—Section HEALTH CENTER ENTITY ARRANGEMENTS.— HOSPITAL OUTPATIENT DEPART- 1814(a)(7)(A)(i)(I) (42 U.S.C. 1395f(a)(7)(A)(i)(I)) MENT SERVICES. (1) ESTABLISHMENT.— is amended by inserting ‘‘(which for purposes (A) IN GENERAL.—The Secretary of Health (a) HOLD HARMLESS PROVISIONS.— of this subparagraph does not include a nurse and Human Services (in this subsection re- (1) IN GENERAL.—Section 1833(t)(7)(D)(i) (42 practitioner)’’ after ‘‘attending physician (as U.S.C. 1395l(t)(7)(D)(i)) is amended— ferred to as the ‘‘Secretary’’) shall establish, defined in section 1861(dd)(3)(B))’’. on an expedited basis, standards relating to (A) in the heading, by striking ‘‘SMALL’’ SEC. 210. IMPROVEMENT IN PAYMENTS TO RE- the exception described in section and inserting ‘‘CERTAIN’’; TAIN EMERGENCY CAPACITY FOR (B) by inserting ‘‘or a sole community hos- 1128B(b)(3)(H) of the Social Security Act, as AMBULANCE SERVICES IN RURAL added by subsection (a), for health center en- pital (as defined in section 1886(d)(5)(D)(iii)) AREAS. tity arrangements to the antikickback pen- located in a rural area’’ after ‘‘100 beds’’; and Section 1834(l) (42 U.S.C. 1395m(l)) is alties. (C) by striking ‘‘2004’’ and inserting ‘‘2006’’. amended— (B) FACTORS TO CONSIDER.—The Secretary (2) EFFECTIVE DATE.—The amendment (1) by redesignating paragraph (8), as added shall consider the following factors, among made by subsection (a)(2) shall apply with re- by section 221(a) of BIPA (114 Stat. 2763A– others, in establishing standards relating to spect to payment for OPD services furnished 486), as paragraph (9); and the exception for health center entity ar- on and after January 1, 2004. (2) by adding at the end the following new rangements under subparagraph (A): (b) STUDY; ADJUSTMENT.— paragraph: (i) Whether the arrangement between the (1) STUDY.—The Secretary shall conduct a ‘‘(10) ASSISTANCE FOR RURAL PROVIDERS health center entity and the other party re- study to determine if, under the prospective FURNISHING SERVICES IN LOW MEDICARE POPU- sults in savings of Federal grant funds or in- payment system for hospital outpatient de- LATION DENSITY AREAS.— creased revenues to the health center entity. partment services under section 1833(t) of the ‘‘(A) IN GENERAL.—In the case of ground (ii) Whether the arrangement between the Social Security Act (42 U.S.C. 1395l(t)), costs ambulance services furnished on or after health center entity and the other party re- incurred by rural providers of services by January 1, 2004, for which the transportation stricts or limits a patient’s freedom of ambulatory payment classification groups originates in a qualified rural area (as de- choice. (APCs) exceed those costs incurred by urban fined in subparagraph (B)), the Secretary (iii) Whether the arrangement between the providers of services. shall provide for an increase in the base rate health center entity and the other party pro- (2) ADJUSTMENT.—Insofar as the Secretary of the fee schedule for mileage for a trip es- tects a health care professional’s inde- determines under paragraph (1) that costs in- tablished under this subsection. In estab- pendent medical judgment regarding medi- curred by rural providers exceed those costs lishing such increase, the Secretary shall, cally appropriate treatment. incurred by urban providers of services, the based on the relationship of cost and volume, Secretary shall provide for an appropriate estimate the average increase in cost per The Secretary may also include other stand- adjustment under such section 1833(t) to re- trip for such services as compared with the ards and criteria that are consistent with flect those higher costs by January 1, 2005. cost per trip for the average ambulance serv- the intent of Congress in enacting the excep- SEC. 208. EXCLUSION OF CERTAIN RURAL ice. tion established under this section. HEALTH CLINIC AND FEDERALLY ‘‘(B) QUALIFIED RURAL AREA DEFINED.—For (2) INTERIM FINAL EFFECT.—No later than QUALIFIED HEALTH CENTER SERV- purposes of subparagraph (A), the term 180 days after the date of enactment of this ICES FROM THE PROSPECTIVE PAY- ‘qualified rural area’ is a rural area (as de- Act, the Secretary shall publish a rule in the MENT SYSTEM FOR SKILLED NURS- fined in section 1886(d)(2)(D)) with a popu- Federal Register consistent with the factors ING FACILITIES. lation density of medicare beneficiaries re- under paragraph (1)(B). Such rule shall be ef- (a) IN GENERAL.—Section 1888(e)(2)(A) (42 siding in the area that is in the lowest three fective and final immediately on an interim U.S.C. 1395yy(e)(2)(A)) is amended— quartiles of all rural county populations.’’. basis, subject to such change and revision, (1) in clause (i)(II), by striking ‘‘clauses (ii) after public notice and opportunity (for a pe- and (iii)’’ and inserting ‘‘clauses (ii), (iii), SEC. 211. THREE-YEAR INCREASE FOR HOME HEALTH SERVICES FURNISHED IN A riod of not more than 60 days) for public and (iv)’’; and RURAL AREA. comment, as is consistent with this sub- (2) by adding at the end the following new (a) IN GENERAL.—In the case of home section. clause: health services furnished in a rural area (as SEC. 213. GAO STUDY OF GEOGRAPHIC DIF- ‘‘(iv) EXCLUSION OF CERTAIN RURAL HEALTH defined in section 1886(d)(2)(D) of the Social FERENCES IN PAYMENTS FOR PHY- CLINIC AND FEDERALLY QUALIFIED HEALTH CEN- Security Act (42 U.S.C. 1395ww(d)(2)(D))) dur- SICIANS’ SERVICES. TER SERVICES.—Services described in this ing 2004, 2005, and 2006, the Secretary shall (a) STUDY.—The Comptroller General of clause are— increase the payment amount otherwise the United States shall conduct a study of ‘‘(I) rural health clinic services (as defined made under section 1895 of such Act (42 differences in payment amounts under the in paragraph (1) of section 1861(aa)); and U.S.C. 1395fff ) for such services by 5 percent. physician fee schedule under section 1848 of ‘‘(II) Federally qualified health center (b) WAIVING BUDGET NEUTRALITY.—The the Social Security Act (42 U.S.C. 1395w–4) services (as defined in paragraph (3) of such Secretary shall not reduce the standard pro- for physicians’ services in different geo- section); spective payment amount (or amounts) graphic areas. Such study shall include— that would be described in clause (ii) if such under section 1895 of the Social Security Act (1) an assessment of the validity of the geo- services were not furnished by an individual (42 U.S.C. 1395fff ) applicable to home health graphic adjustment factors used for each affiliated with a rural health clinic or a Fed- services furnished during a period to offset component of the fee schedule; erally qualified health center.’’. the increase in payments resulting from the (2) an evaluation of the measures used for (b) CERTAIN SERVICES FURNISHED BY AN EN- application of subsection (a). such adjustment, including the frequency of TITY JOINTLY OWNED BY HOSPITALS AND CRIT- SEC. 212. PROVIDING SAFE HARBOR FOR CER- revisions; and ICAL ACCESS HOSPITALS.—For purposes of ap- TAIN COLLABORATIVE EFFORTS (3) an evaluation of the methods used to plying section 411.15(p)–(3)(iii) of title 42 of THAT BENEFIT MEDICALLY UNDER- determine professional liability insurance the Code of Federal Regulations, the Sec- SERVED POPULATIONS. costs used in computing the malpractice retary shall treat an entity that is 100 per- (a) IN GENERAL.—Section 1128B(b)(3) (42 component, including a review of increases cent owned as a joint venture by 2 Medicare- U.S.C. 1320a–7(b)(3)), as amended by section in professional liability insurance premiums participating hospitals or critical access hos- 101(b)(2), is amended— and variation in such increases by State and pitals as a Medicare-participating hospital (1) in subparagraph (F), by striking ‘‘and’’ physician specialty and methods used to up- or a critical access hospital. after the semicolon at the end; date the geographic cost of practice index (c) TECHNICAL AMENDMENTS.—Sections (2) in subparagraph (G), by striking the pe- and relative weights for the malpractice 1842(b)(6)(E) and 1866(a)(1)(H)(ii) (42 U.S.C. riod at the end and inserting ‘‘; and’’; and component. 1395u(b)(6)(E); 1395cc(a)(1)(H)(ii)) are each (3) by adding at the end the following new (b) REPORT.—Not later than 1 year after amended by striking ‘‘section subparagraph: the date of the enactment of this Act, the
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00031 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.022 H26PT1 H5972 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Comptroller General shall submit to Con- work floor index for any locality for which Johnson, Sam Nussle Shays gress a report on the study conducted under such geographic index is less than the work Jones (NC) Osborne Sherwood subsection (a). The report shall include rec- floor index. Keller Ose Shimkus Kelly Otter ommendations regarding the use of more ‘‘(ii) WORK FLOOR INDEX.—For purposes of Shuster Kennedy (MN) Oxley current data in computing geographic cost of clause (i), the term ‘applicable floor index’ Simmons King (IA) Paul Simpson practice indices as well as the use of data di- means— King (NY) Pearce Smith (MI) rectly representative of physicians’ costs ‘‘(I) 0.980 with respect to services furnished Kingston Pence Smith (NJ) (rather than proxy measures of such costs). during 2004; and Kirk Peterson (MN) Smith (TX) Kline Peterson (PA) SEC. 214. TREATMENT OF MISSING COST REPORT- ‘‘(II) 1.000 for services furnished during Souder Knollenberg Petri ING PERIODS FOR SOLE COMMU- 2005, 2006, and 2007. Stearns Kolbe Pickering NITY HOSPITALS. ‘‘(F) FLOOR FOR PRACTICE EXPENSE AND LaHood Pitts Sullivan (a) IN GENERAL.—Section 1886(b)(3)(I) (42 MALPRACTICE GEOGRAPHIC INDICES.—For pur- Latham Platts Sweeney U.S.C. 1395ww(b)(3)(I)) is amended by adding poses of payment for services furnished on or LaTourette Pombo Tancredo at the end the following new clause: after January 1, 2005, and before January 1, Leach Porter Tauzin ‘‘(iii) In no case shall a hospital be denied 2008, after calculating the practice expense Lewis (CA) Portman Taylor (NC) treatment as a sole community hospital or and malpractice indices in clauses (i) and (ii) Lewis (KY) Pryce (OH) Terry payment (on the basis of a target rate as of subparagraph (A) and in subparagraph (B), Linder Putnam Thomas such as a hospital) because data are unavail- the Secretary shall increase any such index LoBiondo Quinn Thornberry Lucas (OK) Radanovich Tiahrt able for any cost reporting period due to to 1.00 for any locality for which such index changes in ownership, changes in fiscal Manzullo Ramstad Tiberi is less than 1.00.’’. McCotter Regula intermediaries, or other extraordinary cir- Toomey McCrery Rehberg Turner (OH) cumstances, so long as data for at least one Ms. PRYCE of Ohio. Mr. Speaker, I yield back the balance of my time, and McHugh Renzi Upton applicable base cost reporting period is McKeon Reynolds Vitter available.’’. I move the previous question on the Mica Rogers (AL) Walden (OR) Miller (FL) (b) EFFECTIVE DATE.—The amendment resolution. Rogers (KY) Walsh Miller (MI) Rogers (MI) made by subsection (a) shall apply to cost re- The SPEAKER pro tempore (Mr. Wamp Miller, Gary Rohrabacher porting periods beginning on or after Janu- Weldon (FL) LATOURETTE). The question is on order- Moran (KS) Ros-Lehtinen ary 1, 2004. Weldon (PA) ing the previous question. Murphy Royce Weller SEC. 215. EXTENSION OF TELEMEDICINE DEM- The question was taken; and the Musgrave Ryan (WI) ONSTRATION PROJECT. Myrick Ryun (KS) Whitfield Section 4207 of Balanced Budget Act of 1997 Speaker pro tempore announced that Nethercutt Saxton Wicker (Public Law 105–33) is amended— the ayes appeared to have it. Neugebauer Schrock Wilson (NM) (1) in subsection (a)(4), by striking ‘‘4- Ms. SLAUGHTER. Mr. Speaker, I ob- Ney Sensenbrenner Wilson (SC) year’’ and inserting ‘‘8-year’’; and ject to the vote on the ground that a Northup Sessions Wolf Norwood Shadegg Young (AK) (2) in subsection (d)(3), by striking quorum is not present and make the Nunes Shaw Young (FL) ‘‘$30,000,000’’ and inserting ‘‘$60,000,000’’. point of order that a quorum is not SEC. 216. ADJUSTMENT TO THE MEDICARE INPA- present. NAYS—203 TIENT HOSPITAL PPS WAGE INDEX TO REVISE THE LABOR-RELATED The SPEAKER pro tempore. Evi- Abercrombie Etheridge Markey SHARE OF SUCH INDEX. dently a quorum is not present. Ackerman Evans Marshall Alexander Farr Matheson (a) IN GENERAL.—Section 1886(d)(3)(E) (42 The Sergeant at Arms will notify ab- Allen Fattah Matsui U.S.C. 1395ww(d)(3)(E)) is amended— sent Members. Andrews Filner McCarthy (MO) (1) by striking ‘‘WAGE LEVELS.—The Sec- Pursuant to clauses 8 and 9 of rule Baca Ford McCarthy (NY) retary’’ and inserting ‘‘WAGE LEVELS.— XX, this 15-minute vote on ordering Baird Frank (MA) McCollum ‘‘(i) IN GENERAL.—Except as provided in Baldwin Frost McDermott clause (ii), the Secretary’’; and the previous question will be followed Ballance Gonzalez McGovern (2) by adding at the end the following new by 5-minute votes on adopting the reso- Becerra Gordon McIntyre clause: lution, if ordered, and on adopting Bell Green (TX) McNulty Berkley Grijalva Meehan ‘‘(ii) ALTERNATIVE PROPORTION TO BE AD- House Resolution 297 which was de- Berman Gutierrez Meek (FL) JUSTED BEGINNING IN FISCAL YEAR 2004.— bated earlier today. Berry Hall Meeks (NY) ‘‘(I) IN GENERAL.—Except as provided in The vote was taken by electronic de- Bishop (GA) Harman Menendez subclause (II), for discharges occurring on or vice, and there were—yeas 226, nays Bishop (NY) Hastings (FL) Michaud Blumenauer Hill Millender- after October 1, 2003, the Secretary shall sub- 203, not voting 6, as follows: stitute the ‘62 percent’ for the proportion de- Boswell Hinchey McDonald scribed in the first sentence of clause (i). [Roll No. 321] Boucher Hinojosa Miller (NC) Boyd Hoeffel Miller, George ‘‘(II) HOLD HARMLESS FOR CERTAIN HOS- YEAS—226 Brady (PA) Holden Mollohan PITALS.—If the application of subclause (I) Aderholt Castle Garrett (NJ) Brown (OH) Holt Moore would result in lower payments to a hospital Akin Chabot Gerlach Brown, Corrine Honda Moran (VA) than would otherwise be made, then this sub- Bachus Chocola Gibbons Capps Hooley (OR) Murtha paragraph shall be applied as if this clause Baker Coble Gilchrest Capuano Hoyer Nadler had not been enacted.’’. Ballenger Cole Gillmor Cardin Inslee Napolitano Barrett (SC) Collins Gingrey Cardoza Israel Neal (MA) (b) WAIVING BUDGET NEUTRALITY.—Section Bartlett (MD) Cox Goode Carson (IN) Jackson (IL) Oberstar 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)), as Barton (TX) Crane Goodlatte Carson (OK) Jackson-Lee Obey amended by subsection (a), is amended by Bass Crenshaw Goss Case (TX) Olver adding at the end of clause (i) the following Beauprez Cubin Granger Clay Jefferson Ortiz new sentence: ‘‘The Secretary shall apply Bereuter Culberson Graves Clyburn John Owens the previous sentence for any period as if the Biggert Cunningham Green (WI) Conyers Johnson, E. B. Pallone amendments made by section 202(a) of the Bilirakis Davis, Jo Ann Greenwood Cooper Jones (OH) Pascrell Medicare Rx Now Act of 2003 had not been Bishop (UT) Davis, Tom Gutknecht Costello Kanjorski Pastor Blackburn Deal (GA) Harris Cramer Kaptur Payne enacted.’’. Blunt DeLay Hart Crowley Kennedy (RI) Pelosi SEC. 217. ESTABLISHMENT OF FLOOR ON GEO- Boehlert DeMint Hastert Davis (AL) Kildee Pomeroy GRAPHIC ADJUSTMENTS OF PAY- Boehner Diaz-Balart, L. Hastings (WA) Davis (CA) Kilpatrick Price (NC) MENTS FOR PHYSICIANS’ SERVICES. Bonilla Diaz-Balart, M. Hayes Davis (FL) Kind Rahall Section 1848(e)(1) (42 U.S.C. 1395w–4(e)(1)) is Bonner Doolittle Hayworth Davis (IL) Kleczka Rangel amended— Bono Dreier Hefley Davis (TN) Kucinich Reyes (1) in subparagraph (A), by striking ‘‘sub- Boozman Duncan Hensarling DeFazio Lampson Rodriguez paragraphs (B) and (C)’’ and inserting ‘‘sub- Bradley (NH) Dunn Herger DeGette Langevin Ross Brady (TX) Ehlers Hobson Delahunt Lantos Rothman paragraphs (B), (C), (E), and (F)’’; and Brown (SC) English Hoekstra DeLauro Larsen (WA) Roybal-Allard (2) by adding at the end the following new Burgess Everett Hostettler Deutsch Larson (CT) Ruppersberger subparagraphs: Burns Feeney Houghton Dicks Lee Rush ‘‘(E) FLOOR FOR WORK GEOGRAPHIC INDI- Burr Ferguson Hulshof Dingell Levin Ryan (OH) CES.— Burton (IN) Flake Hunter Doggett Lewis (GA) Sabo ‘‘(i) IN GENERAL.—For purposes of payment Buyer Fletcher Hyde Dooley (CA) Lipinski Sanchez, Linda for services furnished on or after January 1, Calvert Foley Isakson Doyle Lofgren T. Camp Forbes Issa Edwards Lowey Sanchez, Loretta 2004, and before January 1, 2008, after calcu- Cannon Fossella Istook Emanuel Lucas (KY) Sanders lating the work geographic indices in sub- Cantor Franks (AZ) Janklow Emerson Lynch Sandlin paragraph (A)(iii), the Secretary shall in- Capito Frelinghuysen Jenkins Engel Majette Schakowsky crease the work geographic index to the Carter Gallegly Johnson (IL) Eshoo Maloney Schiff
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00032 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.022 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5973 Scott (GA) Stupak Velazquez LaTourette Peterson (MN) Shimkus Tierney Van Hollen Weiner Scott (VA) Tanner Visclosky Leach Peterson (PA) Shuster Toomey Velazquez Wexler Serrano Tauscher Waters Lewis (CA) Petri Simmons Towns Visclosky Woolsey Sherman Taylor (MS) Watson Lewis (KY) Pickering Simpson Turner (TX) Waters Wu Skelton Thompson (CA) Watt Linder Pitts Smith (MI) Udall (CO) Watt Wynn Slaughter Thompson (MS) Waxman LoBiondo Platts Smith (NJ) Udall (NM) Waxman Snyder Tierney Lucas (OK) Pombo Smith (TX) Weiner NOT VOTING—11 Solis Towns Wexler Manzullo Porter Souder Spratt Turner (TX) Woolsey McCotter Portman Stearns Carter Jones (NC) Smith (WA) Stark Udall (CO) McCrery Pryce (OH) Sullivan Wu Gephardt Matsui Watson Stenholm Udall (NM) McHugh Putnam Sweeney Gutknecht McInnis Wynn Wolf Strickland Van Hollen McKeon Quinn Tancredo Istook Rush Mica Radanovich Tauzin NOT VOTING—6 Miller (FL) Ramstad Taylor (NC) ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE Brown-Waite, Gephardt Smith (WA) Miller (MI) Regula Terry The SPEAKER pro tempore (during Ginny Johnson (CT) Miller, Gary Rehberg Thomas the vote). Members are advised there Cummings McInnis Moran (KS) Renzi Thornberry Murphy Reynolds Tiahrt are 2 minutes remaining in this vote. ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE Musgrave Rogers (AL) Tiberi The SPEAKER pro tempore (during Myrick Rogers (KY) Turner (OH) b 1444 the vote). Members are advised that 2 Nethercutt Rogers (MI) Upton Neugebauer Rohrabacher Vitter So the resolution was agreed to. minutes remain in this vote. Ney Ros-Lehtinen Walden (OR) The result of the vote was announced Northup Royce Walsh as above recorded. b 1436 Norwood Ryan (WI) Wamp Nunes Ryun (KS) Weldon (FL) A motion to reconsider was laid on Mr. SANDLIN and Mr. TURNER of Nussle Saxton Weldon (PA) the table. Texas changed their vote from ‘‘yea’’ Osborne Schrock Weller The SPEAKER pro tempore. Pursu- to ‘‘nay.’’ Ose Sensenbrenner Whitfield ant to section 6 of House Resolution 299 So the previous question was ordered. Otter Sessions Wicker Oxley Shadegg Wilson (NM) and clause 1 of rule XXI, all points of The result of the vote was announced Paul Shaw Wilson (SC) order are reserved against provisions as above recorded. Pearce Shays Young (AK) contained in the bill making appropria- The SPEAKER pro tempore (Mr. Pence Sherwood Young (FL) tions for the Department of Defense for LATOURETTE). The question is on the NOES—203 the fiscal year ending September 30, resolution. 2004, and for other purposes. The question was taken; and the Abercrombie Flake Meehan Ackerman Ford Meek (FL) f Speaker pro tempore announced that Alexander Frank (MA) Meeks (NY) the ayes appeared to have it. Allen Frost Menendez Andrews Gonzalez Michaud PROVIDING FOR CONSIDERATION RECORDED VOTE Baca Gordon Millender- OF MOTIONS TO SUSPEND THE Ms. SLAUGHTER. Mr. Speaker, I de- Baird Green (TX) McDonald RULES mand a recorded vote. Baldwin Grijalva Miller (NC) A recorded vote was ordered. Ballance Gutierrez Miller, George The SPEAKER pro tempore. The Bartlett (MD) Harman Mollohan pending business is the question of The SPEAKER pro tempore. This Becerra Hastings (FL) Moore will be a 5-minute vote, followed by a Bell Hefley Moran (VA) agreeing to the resolution, House Reso- second 5-minute vote on the question Berkley Hill Murtha lution 297. of adoption of House Resolution 297 de- Berman Hinchey Nadler The Clerk read the title of the resolu- Berry Hinojosa Napolitano tion. bated earlier today. Bishop (GA) Hoeffel Neal (MA) The vote was taken by electronic de- Bishop (NY) Holden Oberstar The SPEAKER pro tempore. The vice, and there were—ayes 221, noes 203, Blumenauer Holt Obey question is on the resolution. Boswell Honda Olver not voting 11, as follows: The question was taken; and the Boucher Hooley (OR) Ortiz Speaker pro tempore announced that [Roll No. 322] Boyd Hoyer Owens Brady (PA) Inslee Pallone the ayes appeared to have it. AYES—221 Brown (OH) Israel Pascrell RECORDED VOTE Aderholt Cole Goss Brown, Corrine Jackson (IL) Pastor Akin Collins Granger Capps Jackson-Lee Payne Mr. MCGOVERN. Mr. Speaker, I de- Bachus Cox Graves Capuano (TX) Pelosi mand a recorded vote. Baker Crane Green (WI) Cardin Jefferson Pomeroy A recorded vote was ordered. Ballenger Crenshaw Greenwood Cardoza John Price (NC) Barrett (SC) Cubin Hall Carson (IN) Johnson, E. B. Rahall The SPEAKER pro tempore. This Barton (TX) Culberson Harris Carson (OK) Jones (OH) Rangel will be a 5-minute vote. Bass Cunningham Hart Case Kanjorski Reyes The vote was taken by electronic de- Beauprez Davis, Jo Ann Hastert Clay Kaptur Rodriguez vice, and there were—ayes 226, noes 203, Bereuter Davis, Tom Hastings (WA) Clyburn Kennedy (RI) Ross Biggert Deal (GA) Hayes Conyers Kildee Rothman not voting 5, as follows: Bilirakis DeLay Hayworth Cooper Kilpatrick Roybal-Allard [Roll No. 323] Bishop (UT) DeMint Hensarling Costello Kind Ruppersberger Blackburn Diaz-Balart, L. Herger Cramer Kleczka Ryan (OH) AYES—226 Blunt Diaz-Balart, M. Hobson Crowley Kucinich Sabo Aderholt Brown-Waite, DeLay Boehlert Doolittle Hoekstra Cummings Lampson Sanchez, Linda Akin Ginny DeMint Boehner Dreier Hostettler Davis (AL) Langevin T. Bachus Burgess Diaz-Balart, L. Bonilla Duncan Houghton Davis (CA) Lantos Sanchez, Loretta Baker Burns Diaz-Balart, M. Bonner Dunn Hulshof Davis (FL) Larsen (WA) Sanders Ballenger Burr Doolittle Bono Ehlers Hunter Davis (IL) Larson (CT) Sandlin Barrett (SC) Burton (IN) Dreier Boozman Emerson Hyde Davis (TN) Lee Schakowsky Bartlett (MD) Buyer Duncan Bradley (NH) English Isakson DeFazio Levin Schiff Barton (TX) Calvert Dunn Brady (TX) Everett Issa DeGette Lewis (GA) Scott (GA) Bass Camp Ehlers Brown (SC) Feeney Janklow Delahunt Lipinski Scott (VA) Beauprez Cannon Emerson Brown-Waite, Ferguson Jenkins DeLauro Lofgren Serrano Bereuter Cantor English Ginny Fletcher Johnson (CT) Deutsch Lowey Sherman Capito Everett Biggert Burgess Foley Johnson (IL) Dicks Lucas (KY) Skelton Carter Feeney Bilirakis Burns Forbes Johnson, Sam Dingell Lynch Slaughter Castle Ferguson Bishop (UT) Burr Fossella Keller Doggett Majette Snyder Chabot Flake Burton (IN) Franks (AZ) Kelly Dooley (CA) Maloney Solis Blackburn Chocola Fletcher Buyer Frelinghuysen Kennedy (MN) Doyle Markey Spratt Blunt Coble Foley Calvert Gallegly King (IA) Edwards Marshall Stark Boehlert Cole Forbes Camp Garrett (NJ) King (NY) Emanuel Matheson Stenholm Boehner Collins Fossella Cannon Gerlach Kingston Engel McCarthy (MO) Strickland Bonilla Crane Franks (AZ) Cantor Gibbons Kirk Eshoo McCarthy (NY) Stupak Bonner Crenshaw Frelinghuysen Capito Gilchrest Kline Etheridge McCollum Tanner Bono Culberson Gallegly Castle Gillmor Knollenberg Evans McDermott Tauscher Boozman Cunningham Garrett (NJ) Chabot Gingrey Kolbe Farr McGovern Taylor (MS) Bradley (NH) Davis, Jo Ann Gerlach Chocola Goode LaHood Fattah McIntyre Thompson (CA) Brady (TX) Davis, Tom Gibbons Coble Goodlatte Latham Filner McNulty Thompson (MS) Brown (SC) Deal (GA) Gilchrest
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00033 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.016 H26PT1 H5974 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Gillmor Lewis (KY) Rogers (MI) Oberstar Ryan (OH) Tauscher port the bill to the House with such amend- Gingrey Linder Rohrabacher Obey Sabo Taylor (MS) ments as may have been adopted. The pre- Goode LoBiondo Ros-Lehtinen Olver Sanchez, Linda Thompson (CA) vious question shall be considered as ordered Ortiz T. Goodlatte Lucas (OK) Royce Thompson (MS) on the bill and amendments thereto the final Goss Manzullo Ryan (WI) Owens Sanchez, Loretta Tierney passage without intervening motion except Granger McCotter Ryun (KS) Pallone Sanders Towns one motion to recommit with or without in- Graves McCrery Saxton Pascrell Sandlin Turner (TX) Green (WI) McHugh Schrock Pastor Schakowsky Udall (CO) structions. Payne Schiff Greenwood McKeon Sensenbrenner Udall (NM) The SPEAKER pro tempore. The gen- Gutknecht Mica Sessions Pelosi Scott (GA) Van Hollen Hall Miller (FL) Shadegg Peterson (MN) Scott (VA) tlewoman from North Carolina (Mrs. Velazquez Harris Miller (MI) Shaw Pomeroy Serrano MYRICK) is recognized for 1 hour. Visclosky Hart Miller, Gary Shays Price (NC) Sherman Waters Mrs. MYRICK. Mr. Speaker, for the Hastings (WA) Moran (KS) Sherwood Rahall Skelton purpose of debate only, I yield the cus- Hayes Murphy Shimkus Rangel Snyder Watson Hayworth Musgrave Shuster Reyes Solis Watt tomary 30 minutes to the gentleman Hefley Myrick Simmons Rodriguez Spratt Waxman from Massachusetts (Mr. MCGOVERN), Hensarling Nethercutt Simpson Ross Stark Weiner pending which I yield myself such time Herger Neugebauer Smith (MI) Rothman Stenholm Wexler Hobson Ney Smith (NJ) Roybal-Allard Strickland Woolsey as I may consume. During consider- Hoekstra Northup Smith (TX) Ruppersberger Stupak Wu ation of this resolution, all time yield- Hostettler Norwood Souder Rush Tanner Wynn ed is for the purpose of debate only. Houghton Nunes Stearns Last night, the Committee on Rules Hulshof Nussle Sullivan NOT VOTING—5 Hunter Osborne Sweeney Cox McInnis Smith (WA) met and granted an open rule for H.R. Hyde Ose Tancredo Gephardt Slaughter 2559, the Fiscal Year 2004 Military Con- Isakson Otter Tauzin struction Appropriations Act. Issa Oxley Taylor (NC) ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE The United States military is clearly Istook Paul Terry The SPEAKER pro tempore (Mr. Janklow Pearce Thomas the best in the world. The young men LATOURETTE) (during the vote). Mem- Jenkins Pence Thornberry and women in our Army, Navy, Air Johnson (CT) Peterson (PA) Tiahrt bers are reminded there are 2 minutes Force, Marines, and Coast Guard are Johnson (IL) Petri Tiberi remaining on this vote. Johnson, Sam Pickering Toomey thoroughly dedicated and patriotic pro- Jones (NC) Pitts Turner (OH) b 1453 fessionals, the best our Nation has to Keller Platts Upton offer. We are asking a lot from our So the resolution was agreed to. Kelly Pombo Vitter military today. Our personnel on ac- Kennedy (MN) Porter Walden (OR) The result of the vote was announced tive duty know that they may well be King (IA) Portman Walsh as above recorded. King (NY) Pryce (OH) Wamp deployed overseas and, perhaps, on dan- A motion to reconsider was laid on Kingston Putnam Weldon (FL) gerous missions. So we want to provide the table. Kirk Quinn Weldon (PA) them a quality of life for themselves Kline Radanovich Weller Stated against: and their families that will allow them Knollenberg Ramstad Whitfield Mr. MATSUI. Mr. Speaker, on rollcall No. Kolbe Regula Wicker to serve, knowing that their families 322, had I been present, I would have voted LaHood Rehberg Wilson (NM) will be taken care of with good housing Latham Renzi Wilson (SC) ‘‘no.’’ LaTourette Reynolds Wolf and good health care. Leach Rogers (AL) Young (AK) f Mr. Speaker, H.R. 2559 recognizes the Lewis (CA) Rogers (KY) Young (FL) PROVIDING FOR CONSIDERATION dedication and commitment of our troops by providing for their most NOES—203 OF H.R. 2559, MILITARY CON- STRUCTION APPROPRIATIONS basic needs: improved military facili- Abercrombie DeLauro Kildee ACT, 2004 ties, including the previously men- Ackerman Deutsch Kilpatrick tioned housing and medical facilities. Alexander Dicks Kind Mrs. MYRICK. Mr. Speaker, by direc- Allen Dingell Kleczka b 1500 Andrews Doggett Kucinich tion of the Committee on Rules, I call Baca Dooley (CA) Lampson up House Resolution 298 and ask for its Mr. Speaker, we must honor the most Baird Doyle Langevin immediate consideration. basic commitments we have made to Baldwin Edwards Lantos Ballance Emanuel Larsen (WA) The Clerk read the resolution, as fol- the men and women of our Armed Serv- Becerra Engel Larson (CT) lows: ices. We must ensure a reasonable qual- Bell Eshoo Lee H. RES. 298 ity of life to recruit and retain the best Berkley Etheridge Levin and brightest for America’s fighting Berman Evans Lewis (GA) Resolved, That at any time after the adop- Berry Farr Lipinski tion of this resolution the Speaker may, pur- forces. Most importantly, we must do Bishop (GA) Fattah Lofgren suant to clause 2(b) of rule XVIII, declare the it all, everything in our power to en- Bishop (NY) Filner Lowey House resolved into the Committee of the sure a strong, able, dedicated American Blumenauer Ford Lucas (KY) Whole House on the state of the Union for military so this Nation will be ever Boswell Frank (MA) Lynch consideration of the bill (H.R. 2559) making Boucher Frost Majette vigilant, ever prepared, so much more appropriations for military construction, Boyd Gonzalez Maloney important now than it has been in the family housing, and base realignment and Brady (PA) Gordon Markey past. Brown (OH) Green (TX) Marshall closure for the Department of Defense for Brown, Corrine Grijalva Matheson the fiscal year ending September 30, 2004, and This bill provides nearly $1.2 billion Capps Gutierrez Matsui for other purposes. The first reading of the for barracks, and $176 million for hos- Capuano Harman McCarthy (MO) bills shall be dispensed with. General debate pitals and medical facilities for our Cardin Hastings (FL) McCarthy (NY) shall be confined to the bill and shall not ex- troops and their families. It also pro- Cardoza Hill McCollum Carson (IN) Hinchey McDermott ceed one hour equally divided and controlled vides $2.7 billion to operate and main- Carson (OK) Hinojosa McGovern by the chairman and ranking minority mem- tain existing housing units, and $1.2 Case Hoeffel McIntyre ber of the Committee on Appropriations. billion for new housing units, much, Clay Holden McNulty After general debate the bill shall be consid- Clyburn Holt Meehan ered for amendment under the five-minute much needed. Conyers Honda Meek (FL) rule. Points of order against provisions in Military families also have a tremen- Cooper Hooley (OR) Meeks (NY) the bill for failure to comply with clause 2 of dous need for quality child care, espe- Costello Hoyer Menendez cially single parents and families in Cramer Inslee Michaud rule XXI are waived. During consideration of Crowley Israel Millender- the bill for amendment, the Chairman of the which one or both parents may face Cubin Jackson (IL) McDonald Committee of the Whole may accord priority lengthy deployment. To help meet this Cummings Jackson-Lee Miller (NC) in recognition on the basis of whether the need, the bill provides $16 million for Davis (AL) (TX) Miller, George Member offering an amendment has caused child development centers. H.R. 2559 is Davis (CA) Jefferson Mollohan it to be printed in the portion of the CON- Davis (FL) John Moore more than just a signal to our soldiers, GRESSIONAL RECORD designated for that pur- Davis (IL) Johnson, E. B. Moran (VA) pose in clause 8 of rule XVIII. Amendments sailors, airmen and Marines that this Davis (TN) Jones (OH) Murtha Nation recognizes their services and DeFazio Kanjorski Nadler so printed shall be considered as read. At the DeGette Kaptur Napolitano conclusion of consideration of the bill for their sacrifice. It is a means by which Delahunt Kennedy (RI) Neal (MA) amendment the Committee shall rise and re- we meet our commitment to providing
VerDate Jan 31 2003 03:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00034 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.018 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5975 them a decent quality of life so as to Mr. Speaker, I would ask my col- fects every branch of our Armed sustain the commitment and profes- leagues what in the world are we Forces. And if base closure is somehow sionalism of America’s all voluntary doing? How can we stand on this House magically supposed to balance the armed services and the families that floor day after day, week after week ledgers, then why are we in such a support them. and declare how much we support our housing and construction crisis right While our men and women in uniform uniformed men and women when the now? have swiftly dispatched our enemies funding provided for family housing in It does not have to be this way, Mr. abroad, they face increasingly complex this bill is $270 million less than last Speaker, and there is a remedy. The personal and professional challenges year? How can we stand on the floor of ranking member of the Committee on here at home. We must do more to take this House day after day, week after Appropriations, the gentleman from care of those who are putting their week and say that we are engaged in a Wisconsin (Mr. OBEY), tried to provide lives on the line to defend our free- long-term struggle against a global an extra $958 million above the alloca- doms, and for the families who support enemy when funding for military con- tion level for military construction and them in their efforts. And I am really struction in this bill is $1 billion less housing. His solution is not hard to ac- glad we are getting this done before we than last year? cept. This House would simply scale head home for the July 4th work break. Mr. Speaker, poor facility conditions back 5 percent of the scheduled tax cut Mr. Speaker, I urge my colleagues to are not only unsafe, they hamper readi- for people with adjusted gross incomes support the rule and to support the ness and decrease troop retention. Ac- of over $1 million for 1 year. This would conference report. cording to the Pentagon, 180,000 of the mean that the tax refund for these in- Mr. Speaker, I reserve the balance of 300,000 units of military housing are dividuals would be reduced from about my time. substandard. According to the Pen- $88,000 to $83,000. Mr. MCGOVERN. Mr. Speaker, I yield tagon, 68 percent of the Department’s Now, Mr. Speaker, according to the myself 61⁄2 minutes. facilities have deficiencies so serious most recent census, there are more Mr. Speaker, I thank the gentle- than 280 million people in the United woman from North Carolina (Mrs. that they might impede mission readi- ness or they are so deteriorated that States. This modest change in the tax MYRICK) for yielding me the customary cut would affect about 200,000 individ- 30 minutes. they cannot support mission require- ments. The current reductions in fund- uals, or less than one-tenth of 1 percent Mr. Speaker, the rule under consider- of all taxpayers. Such a small adjust- ation for H.R. 2559, the Fiscal Year 2004 ing for construction in these facility categories means that the rate at ment, however, would provide nearly a Military Construction Appropriations billion dollars to help ensure that more Act, is an open rule. It provides for one which buildings are renovated or re- placed has just increased from 83 years than 1.4 million men and women who hour of general debate, waives all serve our country on active duty have points of order against consideration of to 150 years. This is a national scandal. And let us decent housing and workplaces for the bill, allows for germane amend- themselves and their families. But the ments and provides for one motion to be clear, this bill is not only about new housing, it is about the operation and Republicans on the Committee on Ap- recommit with or without instructions. propriations rejected the gentleman Mr. Speaker, I would like to express maintenance of existing family hous- ing. One of the few increases in family from Wisconsin’s (Mr. OBEY) proposal, my appreciation for the work of the and last night the Republicans on the gentleman from Michigan (Chairman housing in this bill is for the Army. It receives an $81 million increase. Unfor- Committee on Rules refused to allow KNOLLENBERG) and the ranking mem- the gentleman from Wisconsin’s (Mr. ber, the gentleman from Texas (Mr. ED- tunately, funding for the operation and OBEY) amendment to even be debated WARDS) of the Subcommittee on Mili- maintenance of existing Army family housing is cut by $63 million, allowing and voted on in this House. tary Construction along with the So we are faced with the results of more and more current housing units chairman of the Committee on Appro- what happens when we rob our Nation to deteriorate and fall into substandard priations, the gentleman from Florida of the most basic revenue needed to (Chairman YOUNG) and the ranking condition. Talk about robbing Peter to adequately fund our Nation’s prior- member, the gentleman from Wis- pay Paul. ities. We rob our valiant military per- Mr. Speaker, I keep hearing that consin (Mr. OBEY) for continuing the sonnel of decent homes and facilities. since the events of September 11 we tradition of bipartisan action on this We rob our veterans of their basic ben- live in a changed world. I keep on hear- bill and for doing the best with a ter- efits. We cut back funding for schools ing how much we appreciate our Armed rible allocation. and child care for military families. Forces, how much we appreciate their Mr. Speaker, I have a terrible feeling And we are faced with passing this sacrifice and service. Then why do we of deja vu. Almost exactly 1 year ago, woefully inadequate bill, a bill I be- on June 27 of 2002, I stood on this House keep cutting and cutting and cutting lieve that for all the hard work of the floor as the minority manager of the the military construction appropria- gentleman from Michigan (Chairman rule on the fiscal year 2003 military tions bill? We obviously do not appre- KNOLLENBERG) and the ranking mem- construction bill. Along with the then- ciate them enough to give them decent ber, the gentleman from Texas (Mr. ED- chairman, the gentleman from Ohio housing. We obviously do not admire WARDS), can only be viewed as a shame- (Mr. HOBSON) and the ranking member, them enough to give them quality fa- ful scandal on the part of this House. the gentleman from Massachusetts cilities. Are we going to be on the floor Mr. Speaker, I reserve the balance of (Mr. OLVER), we all bemoaned the inad- of this House next year expressing our my time. equacy of that bill. We all pledged to disappointment over how inadequate Mrs. MYRICK. Mr. Speaker, I reserve do better next year and called upon the military construction appropria- the balance of my time. President Bush to increase the budget tions bill is again? Mr. MCGOVERN. Mr. Speaker, I yield for desperately needed military con- Now, I have been told that we should 9 minutes to the distinguished gen- struction, housing, base realignment just wait until the 2005 round of base tleman from Wisconsin (Mr. OBEY), the and base closure. closings, then we will see some modest ranking Democrat on the Committee Well, 1 year later none of that has increases for housing at the bases that on Appropriations. happened. In fact, this year is even survive the next round of closures. (Mr. OBEY asked and was given per- worse. If last year’s appropriations bill That is as cynical a rationalization as mission to revise and extend his re- was inadequate, this one is woefully in- I have ever heard. Do we honestly be- marks, and include extraneous mate- adequate, to quote the gentleman from lieve that inadequate housing and fa- rial.) Michigan (Chairman KNOLLENBERG). In cilities exist only on bases likely to be Mr. OBEY. Mr. Speaker, it would be fact, the fiscal year 2004 bill is $1.5 bil- closed down? so nice if the force of our rhetoric is lion less than last year’s bill. Let me Mr. Speaker, this crisis in funding for matched by the force of our deeds. repeat that. This bill is $1.5 billion less family housing and military construc- That certainly is not the case with this than the fiscal year 2003 funding levels. tion is nationwide. It exists at nearly bill. It is even $41 million less than the every single base and installation Just a few months ago this House chairman’s request. across the land and overseas, and it af- passed this resolution and it said,
VerDate Jan 31 2003 06:17 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00035 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.070 H26PT1 H5976 CONGRESSIONAL RECORD — HOUSE June 26, 2003 among other things, ‘‘Resolved by the an amendment to correct the problem. simply saying shave them back by 5 House of Representatives, the Senate My amendment would reinstate the percent. concurring, that the Congress express $160 million in cuts from the Presi- Our problem is, we will not even be the unequivocal support and apprecia- dent’s budget. I would like to restore able to offer this amendment on the tion of the Nation to the members of all of them. I think the White House is floor today because the Committee on the United States Armed Forces serv- right. We need them. I would also add Rules said, ‘‘No way, baby.’’ So that ing in Operation Iraqi Freedom who are $480 million for family housing. That means that once again, the Republican carrying out their missions with excel- would help at least 2,500 military fami- majority is able to hide behind its lence, patriotism and bravery and also lies. That would be a useful first step budget resolution which did not specify to their families.’’ in replacing the 134,000 inadequate where the cuts would come from in Well, the sad news, unfortunately, is units that service members and their order to pay for the tax cuts. that the check is not in the mail. We families are forced to live in today. We have a serious problem in this have given them a resolution but we Finally, the amendment would pro- House. The budget process is supposed are short-sheeting them in terms of vide $318 million for new barracks that to force the Congress to make choices, things that military families need in would help 5,300 single service members to recognize trade-offs, and explicitly order to make their life better. I do not into decent housing. The Pentagon make those choices in full view of the understand why we are doing that. This says we need over 83,000 units, so even country. Instead, the budget process is bill shows the House’s ‘‘support and ap- this amendment goes just an inch. My being used in conjunction with the preciation’’ by providing $1.5 billion amendment is an opportunity to re- rules out of the Committee on Rules to less than we appropriated last year to store the projects the President said deny the public the understanding of provide the military with decent hous- were needed, to help about 8,000 service what the costs are from those tax cuts. ing and work places. members and their families, and it So they get to think that they are The bill also thanks the military sup- would help Congress to keep its prom- cost-free. posedly by cutting the President’s own ise to the troops. They do not know, for instance, that request for the Pentagon by $180 mil- Now, as the gentleman from Massa- they will cost the public an extra $27 lion. This is for hangers, offices, fitness chusetts has indicated, I would pay for billion in interest payments next year. centers and teaching facilities that it by changing the tax package that If we could take just $10 billion of that even OMB and the administration said was just passed by this Congress. What extra interest payment, we could take the military needed. But this bill cuts I would say is that for persons with ad- care of the shortcomings in education, them out. justed gross incomes of more than $1 in health care, in military housing, and Many Members of this House have million, instead of their getting the every other appropriation bill that seen the problems for themselves. The $88,000 tax cut they will get next year, comes before us. That is what we would Pentagon itself rates the readiness of we would cut that to $83,000. That is do if we had any sense of common most military facilities as marginal or hardly starvation wages. Now, these sense. That is what we would do if we worse. Over 225,000 service members are not just millionaires. These are had any sense of justice. and their families cannot get decent people with adjusted gross incomes of I urge you to vote against the pre- barracks or decent housing. This bill is more than $1 million each year, about vious question on the rule so that we not up to the job and we all know why. 200,000 people in this society. And I bet can offer the amendment that I have It is not the fault of the subcommittee if you asked them, they would say they just described. chairman. It is the fault of every single would happily take that reduction in [From the Army Times, June 30, 2003] Member of this House who voted for order to provide a real improvement in NOTHING BUT LIP SERVICE the budget resolution which said that the quality of life for our troops. In recent months, President Bush and the the only priorities for this year was b 1515 Republican-controlled Congress have missed going to be tax cuts. And as you know, no opportunity to heap richly deserved the lion’s share of the tax cuts went We are saying let them keep 95 per- praise on the military. But talk is cheap— into the pockets of the most wealthy 1 cent of their tax cut but use that $5,000 and getting cheaper by the day, judging from percent of people in this country. difference to give people who are put- the nickel-and-dime treatment the troops So as a result of that decision by the ting their lives on the line for this are getting lately. Republican leadership to put tax cuts country better living conditions. For example, the White House griped that I do not know if you saw the article various pay-and-benefits incentives added to as the primary goal of this Congress, the 2004 defense budget by Congress are the budget resolution, for instance, in the ‘‘Army Times’’ June 30, 2003. Mr. wasteful and unnecessary—including a mod- that was passed is on track to cut $28 Speaker, I will insert this article in the est proposal to double the $6,000 gratuity billion from veterans benefits. There RECORD immediately after my re- paid to families of troops who die on active would be, under the White House budg- marks. duty. This comes at a time when Americans et, $200 million in cuts to impact aid to I would also like to read you two continue to die in Iraq at a rate of about one the school districts that educate the paragraphs from a news story today a day. children of military families. As many out of The New York Times. It reads as Similarly, the administration announced follows: ‘‘The 400 wealthiest taxpayers that on Oct. 1 it wants to roll back recent as 230,000 military families have been modest increases in monthly imminent-dan- cut out of the low income child tax who accounted for more than 1 percent ger pay (from $225 to $150) and family-separa- provision. of all income in the United States in tion allowance (from $250 to $100) for troops We are taking millionaires off the the year 2000 more than doubled their getting shot at in combat zones. tax roll, but we are not giving the peo- share from 8 years earlier, but their Then there’s military tax relief—or the ple who need the help the most any- tax burden plummeted over that same lack thereof. As Bush and Republican leaders thing but table scraps on the tax side. period of time.’’ in Congress preach the mantra of tax cuts, The defense bill, which was marked The article then goes on to say why, they can’t seem to find time to make up this morning in full committee, will and then it says that ‘‘had President progress on minor tax provisions that would be a boon to military homeowners, reservists cut raises for the most junior enlisted Bush’s latest tax cuts been in effect in who travel long distances for training and and officer personnel from the 4.1 per- 2000, the average tax bill for the top 400 parents deployed to combat zones, among cent they have been expecting to just 2 earners in the country would have been others. percent. I want to see how many of you about $30.4 million, a savings of $8.3 Incredibly, one of those tax provisions— who have cried about the fact that you million, or more than a fifth.’’ easing residency rules for service members have Army personnel on food stamps, I Now, when we are in tough times, we to qualify for capital-gains exemptions when want to see how many of you vote to have to ask, in my judgment, who selling a home—has been a homeless orphan cut that. I want to watch that. needs help the most. I think that de- in the corridors of power for more than five years now. A realistic budget resolution has cent military housing ought to come The chintz even extends to basic pay. been beyond the reach of the Congress, before $88,000 tax cuts for the most While Bush’s proposed 2004 defense budget and this is the result as we are seeing comfortable people in this society. We would continue higher targeted raises for today. Now, I want to be able to offer are not saying cut them out. We are some ranks, he also proposed capping raises
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00036 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.186 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5977 for E–1s, E–2s and O–1s at 2 percent, well that while we honor you with our equate barracks that do not even meet below the average raise of 4.1 percent. words, we cut your quality of life pro- the lowest Department of Defense The Senate version of the defense bill re- grams with our deeds and with our standards. The truth is that there are jects that idea, and would provide minimum votes. Yes, it is more than a signal. 128,860 military families, people that on 3.7 percent raises for all and higher targeted hikes for some. But the House version of the This bill is a slap in the face to every this floor just a few minutes ago were bill goes along with Bush, making this an serviceman and -woman, every mili- called professional, the best, clearly issue still to be hashed out in upcoming tary child in America who this year dedicated, 128,000 of those families are negotiations. and in years past has made tremendous now living in housing that does not All of which brings us to the latest indig- sacrifices, including the sacrifice of meet very low DOD standards. nity—Bush’s $9.2 billion military construc- life, to defend our country and our way By the way, just for the record, let tion request for 2004, which was set a full $1.5 of life. me point out what is defined as meet- billion below this year’s budget on the expec- The dollar figures in this bill are not ing the quality standard required by tation that Congress, as has become tradi- tion in recent years, would add funding as it the fault of the gentleman from Michi- the Department of Defense. In the drafted the construction appropriations bill. gan (Mr. KNOLLENBERG), the great Navy that means that $15,000 could fix But Bush’s tax cuts have left little elbow chairman of this subcommittee, of up your house where it could meet room in the 2004 federal budget that is tak- which I am the ranking member. He those lowest minimum DOD standards ing shape, and the squeeze is on across the did the very best any human could do and you are living in adequate housing. board. to fairly put together the highest list Forget the fact that you may never get The result: Not only has the House Appro- of priorities given the woefully inad- that $15,000 to fix your leaky roof or to priations military construction panel ac- equate funding in this bill; but let us fix the washer and dryer that are not cepted Bush’s proposed $1.5 billion cut, it voted to reduce construction spending by an tell the American people, Mr. Speaker, working or to repair the damage to the additional $41 million next year. like it is. They deserve the truth and structure of the house. If $15,000 would Rep. David Obey, D-Wis., senior Democrat so do our servicemen and -women. fix it, even if you never get that money on the House Appropriations Committee, What this Republican leadership in to fix that house, you are living in ade- took a stab at restoring $1 billion of the $1.5 Congress this year has said is that it is quate housing. billion cut in Bush’s construction budget. He more important to give a person mak- The truth is, as the gentlewoman proposed to cover that cost by trimming re- ing more than $1 million dollar a year from North Carolina said, we ask a lot cent tax cuts for the roughly 200,000 Ameri- an $88,000 tax cut rather than an $83,000 from our servicemen and -women; and I cans who earn more than $1 million a year. tax cut. It is more important to do Instead of a tax break of $88,300, they would stand in this House today to say that receive $83,500. that than it is to provide adequate this bill, despite the tremendous, val- The Republican majority on the construc- housing and day care and health clinics iant efforts of the gentleman from tion appropriations panel quickly shot Obey and training ranges for our brave serv- Michigan (Mr. KNOLLENBERG) who did down. And so the outlook for making icemen and -women, many of whom are the best anybody could with the progress next year in tackling the huge serving in Iraq today. amount of money given to him, this backlog of work that needs to be done on Let us be clear. What this House bill is a slap in the face to our service- crumbling military housing and other facili- leadership is saying is that while we men and -women; and just as the ties is bleak at best. salute our troops as they get on the Taken piecemeal, all these corner-cutting ‘‘Army Times’’ in its editorial recently moves might be viewed as mere flesh airplane to fly to Iraq or Afghanistan said that our soldiers are in effect get- wounds. But even flesh wounds are fatal if and risk their lives for us, we are hand- ting tired of lip service from Congress, you suffer enough of them. It adds up to a ing them a slip saying the administra- this bill salutes them by insulting troubling pattern that eventually will hurt tion wants to cut their children’s edu- them. morale—especially if the current breakneck cation funding and the IMPACT aid It defines our rhetoric of apprecia- operations tempo also rolls on unchecked program; and on the very night of tion with the reality of a $1.5 billion and the tense situations in Iraq and Afghani- March 21 when we voted to salute our cut in important programs that would stan do not ease. troops in Iraq, 8 minutes later the have meant a better quality of life, bet- Rep. Chet Edwards, D-Texas, who notes that the House passed a resolution in March House Republican majority voted to ter training so that many of our troops pledging ‘‘unequivocal support’’ to service cut those troops’ future veterans bene- might come home safely to the hugs of members and their families, puts it this way: fits by $28 billion. There is a clear their families rather than in body bags. ‘‘American military men and women don’t record here; and, yes, it is a clear sig- What this House is saying, despite all deserve to be saluted with our words and in- nal to our servicemen and -women. the intentions that one might have, sulted by our actions.’’ It is that we are going to cut your good or bad, what this House is saying Translation: Money talks—and we all benefits, your housing, your children’s with our votes is that we value more an know what walks. education, your day care clinics, your $88,000 tax cut for millionaires, those Mr. MCGOVERN. Mr. Speaker, I yield health facilities in order to pay for the making more than $1 million, more 6 minutes to the distinguished gen- promise of the gentleman from Texas than them getting an $83,000 tax cut, tleman from Texas (Mr. EDWARDS), who (Mr. DELAY), who said that in time of we value that more than treating with has worked very hard on this bill. war, nothing is more important than respect our servicemen and -women. Mr. EDWARDS. Mr. Speaker, several tax cuts. We should oppose this rule, support weeks ago, the gentleman from Texas Unfortunately, the vast majority of the Obey amendment, and back up our (Mr. DELAY), the majority leader of the 44,000 Army soldiers that I have the rhetoric with our actions. this House, said that in time of war privilege to represent at Fort Hood in Mr. MCGOVERN. Mr. Speaker, I yield nothing is more important than tax Texas will not get anything or very lit- myself such time as I may consume, cuts. Well, this bill proves it. Because tle at all out of those tax cuts, while and I will close for our side. of the tax cuts, including dividend tax the millionaires will average, not the Mr. Speaker, first I want to thank cuts for the wealthiest Americans, be- millionaires but the people making the gentleman from Texas (Mr. ED- cause of the $88,000 tax cut that every over $1 million a year will average WARDS) and the gentleman from Wis- American on average making over $1 more than $88,000 in tax cuts. consin (Mr. OBEY) for their eloquent million a year will receive, we now How serious is the housing problem and powerful words and for reminding bring a bill to this House that should for our servicemen and -women? Maybe us all how we are not living up to our be an embarrassment to the Members they already have quality housing. promise to our uniformed men and of Congress who stood on this floor and Perhaps there is some Member of this women, and it is something that every said we should honor our servicemen House or some member of the public, single Member in this House should lis- and -women. Mr. Speaker, that has not visited our ten to very carefully; and we now have I noted the gentlewoman from North military installations recently. Maybe an opportunity to be able to do some- Carolina (Mrs. MYRICK) a few minutes they think they live in the lap of lux- thing about that. ago said this bill is more than a signal ury. Let me present the facts. Mr. Speaker, I will ask for a recorded to our servicemen and -women. Well, I The fact is that there are 83,000 serv- vote on the previous question, and I agree. It is a flashing red light. It says icemen and -women living in inad- will urge Members to vote ‘‘no’’ on the
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00037 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.040 H26PT1 H5978 CONGRESSIONAL RECORD — HOUSE June 26, 2003 previous question. If the previous ques- except for pro forma amendments or to a de- Coble Isakson Pryce (OH) tion is defeated, I will offer an amend- mand for a division of the question in the Cole Issa Putnam committee of the whole or in the House. Collins Istook Quinn ment to the rule that will make in Cox Janklow Radanovich ‘‘SEC. 3. The amendment referred to in sec- order the Obey amendment to restore Crane Jenkins Ramstad tion 2 is as follows: Crenshaw Johnson (CT) Regula funding for military construction pro- On page 2, line 13, under the heading ‘‘Mili- grams. This amendment was submitted Culberson Johnson (IL) Rehberg tary Construction, Army’’, delete the dollar Cunningham Johnson, Sam Renzi to the Committee on Rules and re- amount and insert $1,726,660,000; Davis, Jo Ann Jones (NC) Reynolds jected by the Republican majority. On page 3, line 13, under the heading ‘‘Mili- Davis, Tom Keller Rogers (AL) The bill provides $9.2 billion for mili- tary Construction, Navy’’, delete the dollar Deal (GA) Kelly Rogers (KY) DeLay Kennedy (MN) Rogers (MI) tary construction spending. That is $41 amount and insert $1,311,907,000; DeMint King (IA) Rohrabacher million below the level requested by On page 4, line 5, under the heading ‘‘Mili- Diaz-Balart, L. King (NY) Ros-Lehtinen tary Construction, Air Force’’, delete the Diaz-Balart, M. Kingston the President, and $1.5 billion less than Royce dollar amount and insert $968,509,000; Doolittle Kirk last year. As we have said over and Ryan (WI) On page 4, line 21, under the heading ‘‘Mili- Dreier Kline over, even the gentleman from Michi- Duncan Knollenberg Ryun (KS) tary Construction, Defense-Wide’’, delete the Saxton gan (Mr. KNOLLENBERG), the distin- Dunn Kolbe dollar amount and insert $872,110,000; Schrock guished chairman of the subcommittee, Ehlers LaHood On page 5, line 20, under the heading ‘‘Mili- Emerson Latham Sensenbrenner called the bill woefully underfunded. tary Construction, Army National Guard, de- English LaTourette Sessions This amendment will help restore lete the dollar amount and insert $231,860,000; Everett Leach Shadegg some of these desperately needed addi- On page 6, line 3, under the heading ‘‘Mili- Feeney Lewis (KY) Shaw tional funds. It will provide an addi- tary Construction Air National Guard’’, de- Ferguson Linder Shays lete the dollar amount and insert $95,605,000; Flake LoBiondo Sherwood tional $958 million above the sub- Fletcher Lucas (OK) Shimkus On page 7, line 19, under the heading committee’s allocation. This would be Foley Manzullo Shuster ‘‘Family Housing Construction, Army’’, de- offset by reducing the 2004 tax cut for Forbes McCotter Simmons lete the dollar amount and insert $601,191,000; Fossella McCrery 200,000 millionaires from $88,000 to Simpson On page 8, line 13, under the heading Franks (AZ) McHugh Smith (MI) $83,000. That is it. ‘‘Family Housing Construction, Navy and Frelinghuysen McKeon Smith (NJ) Mr. Speaker, whether or not Mem- Marine Corps’’, delete the dollar amount and Gallegly Mica Smith (TX) bers are Republicans or Democrats, insert $288,193,000; Garrett (NJ) Miller (FL) Souder Gerlach Miller (MI) Sullivan they should be extremely concerned, in And on page 9, line 6, under the heading Gibbons Miller, Gary ‘‘Family Housing Construction, Air Force’’, Sweeney fact outraged, about the lack of ade- Gilchrest Moran (KS) Tancredo delete the dollar amount and insert quate funding for the programs that Gillmor Murphy Tauzin $841,065,000. Gingrey Musgrave Taylor (NC) help our men and women in the mili- Goode Myrick At the end of the bill, add the following: Terry tary. The Obey amendment would help Goodlatte Nethercutt Section . In the case of taxpayers with ad- Thomas Goss Neugebauer fix that and do so with no additional justed gross income tax excess of $1,000,000 Thornberry Granger Ney cost to the deficit. Tiahrt for the tax year beginning in 2003, the Graves Northup Tiberi Our rhetoric is simply not enough, amount of tax reduction resulting from en- Green (WI) Norwood Mr. Speaker. If we want to honor our actment of the Jobs and Growth Tax Relief Greenwood Nunes Toomey Reconciliation Act of 2003 shall be reduced Gutknecht Nussle Turner (OH) uniformed men and women then we Upton by five percent. Harris Osborne should not be cutting their benefits Hart Ose Vitter and their programs. We should be pro- Mrs. MYRICK. Mr. Speaker, I yield Hastings (WA) Otter Walden (OR) viding them what they need. back the balance of my time, and I Hayes Oxley Walsh So I will urge Members on both sides move the previous question on the res- Hayworth Pearce Wamp Hefley Pence Weldon (FL) of the aisle to vote ‘‘no’’ on the pre- olution. Hensarling Peterson (PA) Weldon (PA) vious question. Let me emphasize that The SPEAKER pro tempore. The Hobson Petri Weller a ‘‘no’’ vote will not stop the House question is on ordering the previous Hoekstra Pickering Whitfield from taking up the military construc- Hostettler Pitts Wicker question. Houghton Platts Wilson (NM) tion appropriations bill. However, a The question was taken; and the Hulshof Pombo Wilson (SC) ‘‘yes’’ vote will prevent the House from Speaker pro tempore announced that Hunter Porter Wolf considering the Obey amendment to the ayes appeared to have it. Hyde Portman Young (FL) help restore funding for this important Mr. MCGOVERN. Mr. Speaker, I ob- NAYS—200 legislation. ject to the vote on the ground that a Mr. Speaker, I ask unanimous con- Abercrombie Crowley Hinchey quorum is not present and make the Ackerman Cummings Hinojosa sent to insert the text of the amend- point of order that a quorum is not Alexander Davis (AL) Hoeffel ment and extraneous materials imme- present. Allen Davis (CA) Holden diately prior to the vote on the pre- The SPEAKER pro tempore. Evi- Andrews Davis (FL) Holt Baca Davis (IL) Honda vious question. dently a quorum is not present. Baird Davis (TN) Hooley (OR) The SPEAKER pro tempore (Mr. The Sergeant at Arms will notify ab- Baldwin DeFazio Hoyer LATOURETTE). Is there objection to the sent Members. Ballance DeGette Inslee request of the gentleman from Massa- Becerra Delahunt Israel Pursuant to clause 9 of rule XX, the Bell DeLauro Jackson (IL) chusetts? Chair will reduce to 5 minutes the min- Berkley Deutsch Jackson-Lee There was no objection. imum time for electronic voting, if or- Berman Dicks (TX) Mr. MCGOVERN. Mr. Speaker, again, dered, on the question of adoption of Berry Dingell John I urge my colleagues to vote ‘‘no’’ on Bishop (GA) Doggett Johnson, E. B. the resolution. Bishop (NY) Doyle Jones (OH) the previous question, and I yield back The vote was taken by electronic de- Blumenauer Edwards Kanjorski the balance of my time. vice, and there were—yeas 220, nays Boswell Emanuel Kaptur Boucher Engel Kennedy (RI) The material previously referred to 200, not voting 14, as follows: by the gentleman from Massachusetts Boyd Eshoo Kildee [Roll No. 324] Brady (PA) Etheridge Kilpatrick is as follows: Brown (OH) Farr Kind YEAS—220 PREVIOUS QUESTION FOR H. RES. 298—RULE ON Brown, Corrine Fattah Kleczka H.R. 2559 FISCAL YEAR 2004 MILITARY CON- Aderholt Bishop (UT) Burns Capps Filner Kucinich Akin Blackburn Burr Capuano Ford Lampson STRUCTION APPROPRIATIONS Bachus Blunt Burton (IN) Cardin Frank (MA) Langevin At the end of the resolution, add the fol- Baker Boehlert Buyer Cardoza Frost Lantos lowing: Ballenger Boehner Calvert Carson (IN) Gonzalez Larsen (WA) ‘‘SEC. 2. Notwithstanding any other provi- Barrett (SC) Bonilla Camp Carson (OK) Gordon Larson (CT) sion of this resolution, the amendment print- Bartlett (MD) Bonner Cannon Case Green (TX) Lee ed in section 3 shall be in order without Barton (TX) Bono Cantor Clay Grijalva Levin Bass Boozman Capito Clyburn Gutierrez Lewis (GA) intervention of any point of order and before Beauprez Bradley (NH) Carter Conyers Hall Lipinski any other amendment if offered by Rep- Bereuter Brady (TX) Castle Cooper Harman Lofgren resentative Obey of Wisconsin or a designee. Biggert Brown (SC) Chabot Costello Hastings (FL) Lowey The amendment is not subject to amendment Bilirakis Burgess Chocola Cramer Hill Lucas (KY)
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00038 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.073 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5979 Lynch Olver Sherman marks, and that I be permitted to in- The bill presented today totals $9.196 Majette Ortiz Skelton clude tabular and extraneous material billion, which complies with the 302(b) Maloney Owens Slaughter Markey Pallone Snyder on the bill, H.R. 2559. allocation for both budget authority Marshall Pascrell Solis The SPEAKER pro tempore. Is there and outlays. This recommendation is, Matheson Pastor Spratt objection to the request of the gen- however, $41 million below the Presi- Matsui Payne Stark tleman from Michigan? dent’s request, a reduction of less than McCarthy (MO) Pelosi Stenholm There was no objection. 1⁄2 of 1 percent. Excluding funds pro- McCarthy (NY) Peterson (MN) Strickland McCollum Pomeroy Stupak f vided in response to the global war on McDermott Price (NC) Tanner terrorism and Operation Iraqi Free- McGovern Rahall Tauscher MILITARY CONSTRUCTION McIntyre Rangel dom, the bill is $605 million or 6 per- Taylor (MS) APPROPRIATIONS ACT, 2004 McNulty Reyes cent below fiscal year 2003 enacted lev- Thompson (CA) Meehan Rodriguez The SPEAKER pro tempore. Pursu- Thompson (MS) els. Meek (FL) Ross Tierney ant to House Resolution 298 and rule For the first time in recent memory, Meeks (NY) Rothman XVIII, the Chair declares the House in Menendez Roybal-Allard Towns this subcommittee has produced a rec- Michaud Ruppersberger Turner (TX) the Committee of the Whole House on ommendation that is below the Presi- Millender- Rush Udall (CO) the State of the Union for the consider- dent’s request. This is the hand that we Udall (NM) McDonald Ryan (OH) ation of the bill, H.R. 2559. were dealt under current budgetary Miller (NC) Sabo Van Hollen Miller, George Sanchez, Linda Velazquez b 1553 constraints, and we have tried to deal Mollohan T. Visclosky with it in as fair a manner as possible. Moore Sanchez, Loretta Waters IN THE COMMITTEE OF THE WHOLE I assure Members the committee did Moran (VA) Sanders Watt Accordingly, the House resolved due diligence to find as much savings Murtha Sandlin Waxman itself into the Committee of the Whole Nadler Schakowsky Weiner as possible for the bill, and I believe we Napolitano Schiff Wexler House on the State of the Union for the left no stone unturned in this process. Neal (MA) Scott (GA) Woolsey consideration of the bill (H.R. 2559) This bill continues the subcommittee’s Oberstar Scott (VA) Wu making appropriations for military Obey Serrano Wynn bipartisan tradition of quality of life construction, family housing, and base first for our service men and women. NOT VOTING—14 realignment and closure for the De- This is our paramount goal, and I be- Brown-Waite, Gephardt Paul partment of Defense for the fiscal year lieve we have reached it. Ginny Herger Smith (WA) ending September 30, 2004, and for As many Members are aware, the De- Cubin Jefferson Stearns other purposes, with Mr. BASS in the Dooley (CA) Lewis (CA) Watson partment of Defense is undertaking a Evans McInnis Young (AK) chair. privatization effort for military hous- The Clerk read the title of the bill. ing. For those of us who have seen the ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE The CHAIRMAN. Pursuant to the results thus far, this is an exciting de- The SPEAKER pro tempore (Mr. rule, the bill is considered as having velopment. What it means for the fam- LATOURETTE) (during the vote). Mem- been read the first time. ily housing account of this bill is that bers are advised 2 minutes remain in Under the rule, the gentleman from less money does not mean less housing. this vote. Michigan (Mr. KNOLLENBERG) and the It means that we are getting more b 1551 gentleman from Texas (Mr. EDWARDS) bang for our buck. For example, take each will control 30 minutes. Mr. GORDON changed his vote from the Residential Communities Initiative The Chair recognizes the gentleman at the Presidio of Monterey. Using only ‘‘yea’’ to ‘‘nay.’’ from Michigan (Mr. KNOLLENBERG). So the previous question was ordered. the basic allowance for housing, the Mr. KNOLLENBERG. Mr. Chairman, BAH, 2,168 new homes will be built and The result of the vote was announced I yield myself such time as I may con- as above recorded. 41 historic units will be renovated. In sume. addition, the private contractor will The SPEAKER pro tempore. The (Mr. KNOLLENBERG asked and was build wider roads, playgrounds, amen- question is on the resolution. given permission to revise and extend The resolution was agreed to. ities such as community centers and his remarks.) swimming pools, and so on. What had A motion to reconsider was laid on Mr. KNOLLENBERG. Mr. Chairman, been substandard housing will become the table. it is my pleasure to present to the an enviable community for our mili- House H.R. 2559, the fiscal year 2004 f tary families, and it will come at no military construction appropriations PERMISSION FOR COMMITTEE ON cost, no cost to the family housing ac- bill. This legislation provides funds for APPROPRIATIONS TO HAVE count in this bill. all types of construction projects on UNTIL MIDNIGHT, JULY 3, 2003, The bottom line is that the funding military installations here in the U.S. TO FILE PRIVILEGED REPORT in this bill does not slow down the ef- and abroad. Projects range from bar- ON LEGISLATIVE BRANCH AP- fort to revitalize our military family racks and housing to training ranges PROPRIATIONS ACT, 2004 housing. In fact, that effort is accel- and runways. erating because of this privatization Mr. KINGSTON. Mr. Speaker, I ask I would like to thank my ranking initiative. unanimous consent that the Com- member, the gentleman from Texas I would like to take a moment to mittee on Appropriations have until (Mr. EDWARDS), for his advice and sup- highlight some key areas in the bill. midnight, July 3, 2003, to file a privi- port and cooperation in producing this First, $1.24 billion is provided for troop leged report, making appropriations for recommendation. He has been a good barracks. This is a $62 million increase the Legislative Branch for the fiscal partner, and I appreciate having the from last year’s level. This sends a year ending September 30, 2004, and for gentleman there to work together on positive message to our unaccompanied other purposes. this bill. personnel stationed all around the The SPEAKER pro tempore. Is there I would also like to express my ap- world that their quality of life is a pri- objection to the request of the gen- preciation to all members of the sub- ority. tleman from Georgia? committee for their help in putting to- The bill includes $194 million for hos- There was no objection. gether this year’s bill. I commend the pital and medical facilities, an increase The SPEAKER pro tempore. Pursu- good work done by the subcommittee of $25 million above last year’s level. ant to clause 1 of rule XXI, all points of staff, Tom Forhan, Brian Potts, Mary This is another positive quality-of-life order are reserved on the bill. Arnold, Kim Reath, and Valerie Bald- message, one intended for all service f win. This has made my transition to members as well as their families. chairman an easy one. I want to thank $274 million is provided for commu- GENERAL LEAVE my personal staff, Jeff Onizuk and nity facilities, an increase of $45 mil- Mr. KNOLLENBERG. Mr. Speaker, I Lieutenant Commander Scott Gray. I lion above the President’s request. ask unanimous consent that all Mem- appreciate the long hours they have These facilities include child develop- bers may have 5 legislative days within put in making this the best bill pos- ment centers, fire stations, schools, which to revise and extend their re- sible. and physical fitness centers.
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00039 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.019 H26PT1 H5980 CONGRESSIONAL RECORD — HOUSE June 26, 2003 $465 million is provided for the Guard struction requirements by $327 million. In conclusion, we have focused our ef- and Reserve components, an increase of Of these reductions, $279 million has forts on programs that directly support $95 million above the President’s re- been applied to construction require- the men and women in our Armed quest. ments in the United States. It is my Forces. We would like to do more. We The bill fully funds the President’s opinion additional cuts will adversely always have and always will. But in my request of $1.2 billion for new family impact the quality of life and mission opinion, the recommendations in this housing units and improvements to ex- readiness of our troops living overseas, bill are solid and fully fund projects isting units, and $2.7 billion is provided including those who are fighting the that are vital to the security of the for the operation and maintenance of war against terrorism and also in Oper- United States. The bottom line is this: existing family housing units. ation Iraqi Freedom. Therefore, I can- with this bill, we meet the military’s b 1600 not recommend additional cuts in this mission critical infrastructure needs I would like to highlight the overseas area to my colleagues. and enable its efforts to improve the military construction program for just We have worked closely with the au- quality of life for our men and women one moment. In support of a global thorization committee in producing in the Armed Forces. This is a fair bill. repositioning effort, the President’s this legislation. I would like to take I encourage all my colleagues to sup- amended budget submission and the this opportunity to thank the gen- port it. recommendation before Members today tleman from Colorado (Mr. HEFLEY) Mr. Chairman, I include the following rescinds and/or reduces overseas con- and his staff for their assistance. tabular material for the RECORD:
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00040 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.078 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5981
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00041 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.079 H26PT1 Insert offset folio 401/1 here EH26JN03.001 H5982 CONGRESSIONAL RECORD — HOUSE June 26, 2003
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00042 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.079 H26PT1 Insert offset folio 401/2 here EH26JN03.002 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5983 Mr. Chairman, I reserve the balance at Fort Hood, 20,000 of whom are over- leagues, Mr. Chairman, we should be of my time. seas in Iraq today. ashamed that we are asking our serv- Mr. EDWARDS. Mr. Chairman, I I believe it adds insult to injury to icemen and -women to have their hous- yield myself such time as I may con- make these cuts in military quality-of- ing, their quality of life, their day care, sume. life programs to help pay for an $88,000 their health clinics, their training fa- Mr. Chairman, I am going to vote for tax cut for people in America living cility programs cut by $1.5 billion in this military construction bill for one here safely, comfortably at home, not time of war. We should salute our serv- reason and for one reason alone. I be- fighting in war, people making over $1 icemen and -women and their families lieve the gentleman from Michigan, million a year. It is not just wrong; it with our deeds, not just with our the chairman of our committee, has is outrageous. As public officials, our words. worked very hard and in a fair and bi- spending priorities are a better reflec- Mr. Chairman, I reserve the balance partisan manner from day one on this tion of our values than our speeches of my time. bill. He and his capable staff have and our rhetoric. What does it say Mr. KNOLLENBERG. Mr. Chairman, worked diligently and professionally to about our values in Congress when we it is a pleasure for me to yield 3 min- deal with a $1.5 billion military con- ask Americans to go into combat in utes to the gentleman from Florida struction cut. This grossly inadequate Iraq and then the administration is (Mr. YOUNG), the chairman of the Com- funding level was not the decision of trying to cut those very servicemen’s mittee on Appropriations. the gentleman from Michigan or my- and -women’s children’s education Mr. YOUNG of Florida. Mr. Chair- self. The gentleman from Michigan has funding by 14 percent? What does it say man, I thank the gentleman for yield- a deep and genuine commitment to about our values when a person making ing me this time, and I rise for two supporting a high quality of life for our $1 million in dividend income this year purposes: one, to express strong sup- servicemen and -women and their fami- just received a $200,000 tax cut while a port for the bill and to compliment lies. I know that firsthand. This deci- soldier in Iraq must read that the Chairman KNOLLENBERG and Ranking sion was made above his pay grade and House has voted to cut military hous- Member EDWARDS for producing as above mine. As the chairman and the ing, quality-of-life and training facility good a bill as they could with what they had to work with. We have heard ranking member of the Subcommittee projects by $1.5 billion? By the way, today as we heard during the Homeland on Military Construction, our responsi- the House has voted to cut their future Security appropriations bill earlier and bility is to take whatever funding level veterans benefits by $28 billion, a vote I predict, Mr. Chairman, we will hear it is given to us and invest those re- cast on March 21 just 8 minutes after from the other 11 appropriations bills, sources in a way that will fund the we had overwhelmingly voted for a res- that they need more money, that they highest possible military construction olution saluting the service of our serv- did not get enough money; that, as in priorities. I believe that is what the icemen and -women in Iraq. gentleman from Michigan, our sub- Mr. Chairman, in my opinion that this particular case, the bill is below the President’s budget request. committee, and I have done; and that type of priority makes a mockery of Mr. Chairman, the budget resolution is why I will vote for this bill. the American ideals of fairness and that this committee is required to deal However, Mr. Chairman, I would be shared sacrifice during time of war. with was below the President’s budget remiss and I believe it would be the What do these cuts mean? It means request. Somebody tell me how we can height of irresponsibility for me not to that tens and tens of thousands of serv- go above the President’s budget re- speak honestly to our colleagues about icemen and -women living in inad- quest with a budget resolution that is what I consider to be the serious impli- equate housing will have to continue to below the President’s budget request. cations of cutting military construc- do so. We have 83,000 new barracks that That would take a little magic. The tion funding by $1.5 billion. By the are needed to meet minimum DOD gentleman from Wisconsin and I have way, that is before the consideration of standards for our single servicemen sat together many times trying to fig- inflation. In my opinion, cutting mili- and -women. We have a need for 128,860 ure out that magic. We have not found tary quality of life and military train- new housing units for military families the right magic wand yet. But the com- ing investments during a time of war who sacrifice so much for our country. mittees and the subcommittees are breaks faith with America’s service- This bill does not meet those needs. doing the best they can with what they men and -women and their families. I Why? Not because of the values or pri- have to work with, and they are pro- am deeply disappointed that the ad- orities of the gentleman from Michi- ducing good bills. ministration and the House leadership gan, but because the top leadership of The second part of my interest today would say in effect that it is okay to this House and the administration de- is to say to our colleagues that, al- salute our troops with our words while cided that we must cut military con- though there was a substantial delay in cutting critical military quality-of-life struction by $1.5 billion to help pay for getting past some budgetary issues programs with our deeds. I believe it is that massive tax cut that we have al- that were above the jurisdiction of the wrong to salute our servicemen and ready signed into law. Committee on Appropriations, that 2 -women with words while insulting There is a lot of good in this bill, and weeks ago when those issues were fi- them with our deeds. It is wrong in a the committee should be proud of its nally settled, your Committee on Ap- time of war in Afghanistan for the ad- work. There are a lot of important pri- propriations has responded well. The ministration in a separate bill to want ority programs funded. I salute the Homeland Security bill was marked up, to cut military education funds for chairman and his very professional sent to the House, and it has gone on to military children by $173 million and to staff for, under very difficult cir- the Senate. The military construction cut funds for military family housing, cumstances, having to cut out impor- bill has been marked up, sent to the health care, day care and training in tant programs in order to adequately House and will go to the Senate today. this bill by $1.5 billion. fund the highest-priority programs. I The defense appropriations bill has Mr. Chairman, we are starting to see salute the gentleman from Michigan, been marked up. The labor, health and a pattern of respect to our servicemen his staff and the professional staff on human services bill has been marked and -women in time of war with our both sides. This bill was put together up. The interior appropriations bill has rhetoric and disrespect with our prior- without partisanship. It was put to- been marked up. The agriculture ap- ities and our actions. Frankly, in my gether under trying circumstances, propriations bill has been marked up, opinion, we are reflecting the values of with a last-minute decision by some- and the legislative branch bill has been the majority leader of the House, the one, I do not know and I do not know marked up. So in that 2-week period, gentleman from Texas (Mr. DELAY), how, someone who said, we are going to your committee has produced seven of who said during the Iraqi war that in have to cut our spending by $560 mil- the 13 bills. That is in addition to hav- time of war, nothing is more important lion below the amount authorized just ing completed 11 of last year’s bills than cutting taxes. I would like to in- a few weeks ago. during this calendar year and one vite the majority leader to my district I support this bill for the many good major wartime supplemental. to explain that statement and that things in it and the good work that was I am very proud of the Committee on value to the 44,000 soldiers I represent done to produce it; but I say to my col- Appropriations on both sides. I am
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00043 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.080 H26PT1 H5984 CONGRESSIONAL RECORD — HOUSE June 26, 2003 proud of the subcommittees and their Mr. Chairman, that is a statement tration. In fact, we have lost almost 3 leadership. But you cannot have more not from a Democrat or Republican in million jobs since President Bush took money to spend than the budget resolu- this House, but from the ‘‘Army office. Part of that is not his responsi- tion provides, whether it is with the Times’’ editorial. I think we should lis- bility; part of it in my view is, and the President’s number, above the Presi- ten to the words and spirit of that edi- Congress’s as well. My point is that dent’s number, or below the President’s torial. I do not think our servicemen when conditions change one would number. We are given that number, and and -women are going to accept lip think that their approach and their that is what we have to deal with. service. They give us dedicated service, remedies change, but they have not. Mr. EDWARDS. Mr. Chairman, I including the risking of their lives. It We have gotten only one answer out of yield myself 3 minutes. is time for us to give them more than the administration in terms of dealing Mr. Chairman, I want to thank the lip service when it comes to commit- with the economy: Tax cuts, tax cuts, gentleman from Florida (Mr. YOUNG) ting to making tough choices, commit- tax cuts, no matter how badly they are for his comments. There is no Member ting to ensure that they can have a skewed to the upper reaches of the in- of this House, Democrat or Republican, better quality of life, live in decent come ladders and no matter what they over the years who has been more com- housing, have day care for their chil- cost to the other people in this society. mitted to our servicemen and -women. dren and quality schools for their fami- And this bill is one of the examples of As critical as I am of the funding level lies. what it costs. in this bill, I know if anyone will work When this House passes these tax hard to see if we can find more money b 1615 cuts, it pretends that there is no cost to more adequately show our respect to Mr. KNOLLENBERG. Mr. Chairman, to anyone else. Let me just spell out our servicemen and -women with our I have no further requests for time, and what some of the costs are. Those tax dollars in military construction, the I reserve the balance of my time. cuts mean that we will be paying $23 gentleman from Florida will be the Mr. EDWARDS. Mr. Chairman, I billion more in interest payments next person to fight that fight and to lead yield 6 minutes to the distinguished year than we would otherwise be pay- that fight. gentleman from Wisconsin (Mr. OBEY), ing. Before these tax cuts play out we Mr. Chairman, I want to say to my the ranking Democrat on the full Com- will be spending more on interest pay- colleagues that my comments, my crit- mittee on Appropriations who made an ments in the Federal budget than we ical comments about the funding level effort earlier this day to offer an will be spending on all domestic appro- of this bill, not the way it was put to- amendment that was closed off by the priation items reported by this com- gether because the gentleman from Republican leadership to add nearly $1 mittee, and it will be a gargantuan Michigan did an excellent job and a billion of commitment to our service- share of the Federal budget. We ought fair job in doing that, but I want people men and women’s quality of life pro- to be able to make better judgments to know this criticism does not just grams. than that. come from one Member of Congress. I Mr. OBEY. Mr. Chairman, I thank would like to read an editorial dated the gentleman for yielding me this But there are other costs as well. We June 30 of the ‘‘Army Times.’’ It says, time. passed the ‘‘No Child Left Behind Act’’ ‘‘Nothing But Lip Service.’’ I want to express my agreement with for education, sent mandates out to the ‘‘In recent months, President Bush the comments made by the gentleman States and said we would send cash out and the Republican-controlled Con- from Florida (Mr. YOUNG), the distin- to help pay for those mandates. I’ve gress have missed no opportunity to guished chairman of this committee. news for you, the appropriations bill heap richly deserved praise on the mili- And then I want to say this: Budgets that is going to come out will short tary. But talk is cheap and getting are not just presentations of numbers. sheet those education programs by $8 cheaper by the day, judging from the Budgets really reflect and define and billion. Nobody knows that, but that is nickel-and-dime treatment the troops exhibit our priorities and our values. what is going to happen. And this is are getting lately.’’ And that is why this bill is such a sad happening at a time when budget It goes on to say this: commentary on the nature of this crunches all over the country are going ‘‘All of which brings us to the latest to be squeezing States and squeezing indignity, Bush’s $9.2 billion military House. When President Bush came into of- schools. We are also having to squeeze construction request for 2004, which down on what we provide in health was set a full $1.5 billion below this fice, thanks to the fiscal discipline demonstrated by the previous adminis- care. There are thousands and thou- year’s budget on the expectation that sands of families being pushed off Congress, as has become tradition in tration, we expected to see at least $6 trillion worth of surpluses over the health care in many States in the recent years, would add funding as it Union. And this bill represents what is drafted the construction appropria- next decade. We were in the best shape that we had been fiscally in more than going to happen to military families, tions bill. because we are cutting $1.5 billion ‘‘But Bush’s tax cuts have left little a generation. So the President decided below the deliverable amount in the elbow room in the 2004 Federal budget that we could afford to provide very previous year’s budget for military that is taking shape, and the squeeze is large tax cuts, and he estimated we families under military construction. on across the board. would still have billions left over for ‘‘The result: not only has the House other purposes, and the House passed And we wind up making only token appropriations military construction those tax cuts. progress in improving the housing for panel accepted Bush’s proposed $1.5 bil- My point is that then something hap- military families and for single en- lion cut, it voted to reduce construc- pened that was totally unexpected. We listed people. tion spending by an additional $41 mil- got hit by 9/11 and the economic down- The cost of the estate tax elimi- lion next year.’’ turn that followed that. Any person of nation, which this House just passed: The editorial goes on after com- prudence in my view, having seen such For the cost of that money it took to mending the gentleman from Wis- a shocking change, would have been take millionaires off the tax roll when consin for his amendment to try to add careful about the next step that they we passed that estate tax change—that nearly $1 billion to this bill to say this: took, but this Congress and this White is going to cost $800 billion—for that ‘‘Taken piecemeal, all these corner- House, alas, was not. So despite the $800 billion, we could close one-third of cutting moves might be viewed as mere fact that the bottom was falling out of the gap in financing that will be exist- flesh wounds. But even flesh wounds the economy and the bottom was fall- ing in the Social Security system. We are fatal if you suffer enough of them. ing out of Government revenues, the should have done that first. But we did It adds up to a troubling pattern that White House and this Congress decided not. We passed another huge tax cut eventually will hurt morale, especially they were going to push on with even for the high rollers. if the current breakneck operations larger tax cuts. They said that we So there are consequences, and there tempo also rolls on unchecked and the needed to do it in order to create jobs. are costs to those tax cuts. The gen- tense situations in Iraq and Afghani- But, not a single job has been created tleman from Florida (Mr. YOUNG) is stan do not ease.’’ during the tenure of the Bush adminis- right. He cannot perform a miracle.
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00044 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.083 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5985 Neither can the gentleman from Michi- House, and that is our servicemen and capitalization rate for the active Air Force will gan (Mr. KNOLLENBERG). Appropria- women overseas, because I know there increase to 183 years. The Navy recapitaliza- tions are the table scraps that are left was an effort made to make additional tion rate will increase to 140 years. The re- over after this House has decided to cuts in some of those facilities. There capitalization rate for the Marines actually plunge ahead, promising all of these is not much to be gained personally or goes down, but is still an unacceptable 88 out-sized tax cuts to the American peo- politically by defending quality of life years. And the Army recapitalization rate in ple with a huge share of those tax cuts commitments overseas because those this budget increases to 144 years. The DOD going to the most well off, and then we folks are not living in our districts at goal is 67 years. I strongly support the effort see what happens to the rest. the time. The gentleman from Michi- by Mr. OBEY to increase funding for Military So that is why I am not pleased with gan (Mr. KNOLLENBERG) said no to that Construction and Family Housing in this bill by this bill, not because of the work of the kind of cut because he knew that would $1 billion. This funding, and much more, is gentleman from Michigan (Mr. have been the wrong thing to do. I sa- sorely needed. KNOLLENBERG) or the staff but because lute him and I hope with his dedication I would like to thank the Chairman and this House made a basic bad judgment and the gentleman from Florida’s (Mr. Ranking Member for working with me on the to begin with and it is being com- YOUNG) and the gentleman from Wis- vital installations in Washington state. We will pounded and illustrated and dem- consin’s (Mr. OBEY) and other Members make a start in this bill on fixing a Navy pier onstrated with every other bill we of this House’s dedication, we will see at Puget Sound Naval Shipyard which today is bring to the floor. before this year ends we can pass a not up to Navy standards for performing its That is the problem. There are con- military construction bill that we can mission, which is mooring nuclear powered sequences. The budget process is being look our servicemen and women in the aircraft carriers. And the bill includes several handled in this House to try to hide eye and say we are proud of them and important projects to build barracks at Ft. those consequences. It is our responsi- we do salute them with more than just Lewis, refurbish the Mission Support Center at bility to try to lay out what those con- words. McChord Air Force Base, and rebuild the serv- sequences are, and that is why we have So I ask my colleagues, despite my ice pier at Subase Bangor. Also, this bill con- gone through this operation this after- reservations, to support the tremen- tinues to support the privatization of family noon. dous effort and work of the gentleman housing at Ft. Lewis, WA. Mr. Chairman, Mr. KNOLLENBERG. Mr. Chairman, from Michigan (Mr. KNOLLENBERG) and beautiful new houses have been built and are I continue to reserve the balance of my our subcommittee. under construction there, and this Congress time. Mr. ORTIZ. Mr. Chairman, I rise this can be proud about the new houses being Mr. EDWARDS. Mr. Chairman, I do evening in support of our men and women in built for military families through this innovative not think there are any other speakers the Armed Services. For many weeks now, we program. on this side. I yield myself 3 minutes. have all declared our gratefulness to these I hope as this bill proceeds through the Mr. Chairman, I never thought I in warriors and their families of the sacrifices Congressional process, that additional funds my 12 years in this House would come they have made on behalf of our Nation. can be found to make this a truly responsible to the floor and speak out in favor of a Besides their incredible efforts in fighting the piece of legislation. Having voiced my deep military construction bill that cuts War on Terrorism, these patriots and their concerns, I will vote today in support of this quality of life and training investments families have had to learn to live without their bill in order to ensure that those important for servicemen and women even in time fathers or mothers or spouses present on a projects which do receive funding here are al- of war by $1.5 billion. I never thought I daily basis because of numerous, long, and lowed to move forward. would ask my colleagues to vote for a dangerous deployments, or even worse, if Mr. SCHROCK. Mr. Chairman, America is bill that decreases Navy and Marine their loved one has paid the ultimate sacrifice. indebted to the men and women of the armed Corps family housing construction in- I, myself, have had more than my share of forces. Their success in Iraq, Afghanistan and vestment by $193 million compared to families in my district that have paid this price. around the world give witness to their bravery last year. I never thought I would ask I have traveled extensively to our military fa- and commitment. In order to maintain this my colleagues to vote for a bill that de- cilities and have observed the substandard dedicated, all-volunteer force and to ensure its creases family Air Force construction housing we force our military personnel and readiness, we must be proactive in providing housing by $48 million compared to last families to live in. We must address this situa- them adequate quality of life and training facili- year. tion. ties. But I do ask my colleagues to vote We are all grateful for these sacrifices, but The reality is that we are still correcting the for this bill because we had to do the how will we show this gratefulness? Will we spending deficiencies of the past. Even after best we could with the allocation given support the Ranking Member in his effort to years of funding plus-ups to the Department’s to us. Because of the needs, the impor- scale back the tax cuts by a mere 5 percent military construction budget, service men and tant needs, military family needs that for those who make over a million dollars a women continue to live and work in aging and this bill meets, I will vote for it. Be- year, so we can restore funding and ade- inferior facilities. In fact, more than two-thirds cause of the needs that will remain quately house our forces? of the services’ current facilities are classified unmet, I will not be proud that this Even though we are cutting military con- at ‘‘C–3’’ or ‘‘C–4’’ readiness levels. This sig- House will go on record as saying in struction spending by $1.5 billion from last nifies that their ability to carry out missions time of war to our servicemen and year’s funding, we can still do the right thing has been appreciably degraded. women thanks for risking their lives, at this time by voting for the Previous Ques- I am glad that we are able to work across thanks for fighting in Iraq, thanks for tion. We must support the Ranking Member’s party lines to ensure that military construction taking care of their children at home efforts and truly show our gratitude to our is funded at the highest levels possible. while they are wondering if their loved troops. H.R. 2559 addresses many of the pressing one will ever come home alive, while at Mr. DICKS. Mr. Chairman, I would like to construction and family housing needs facing the same time cutting their quality of commend Chairman KNOLLENBERG and Rank- the services. The bill would provide $1.2 billion life programs by $1.5 billion. I guess it ing Member EDWARDS for their work on this for barracks, $16 million for child development is a testament to my respect for the bill. They have done their best with an unrea- centers, and $1.2 billion for new family hous- gentleman from Michigan (Mr. sonable and unacceptable allocation. I know ing units and improvements to existing ones. KNOLLENBERG), his fairness, his dedica- they share my deep disappointment over this I urge my colleagues to support H.R. 2559, tion to our servicemen and women, his level of funding, which is $1.5 billion less than because these new and improved facilities will commitment to working as hard as any was appropriated for Military Construction & enhance the quality of life for our service human could to see that we make the Family Housing last year. members while they are doing their jobs and best with an unfair, horrible situation Unfortunately this cut makes a bad situation training to defend America. in this funding level, that I will vote worse. When the Bush administration came We must never let our military deteriorate as for this bill. And I do want to pay a into office, they found a Department of De- we have seen in the past, because, as recent special thanks to the gentleman from fense where the recapitalization rates for facili- events have demonstrated, we will never know Michigan (Mr. KNOLLENBERG) for stand- ties varied from 80 to over 100 years in the when our nation’s security will be challenged. ing up for people who often do not have various services. They rightly condemned this Mr. NUSSLE. Mr. Chairman, I rise today in someone speaking for them in this situation. However, under this budget, the re- support of H.R. 2559, the Military Construction
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00045 Fmt 7634 Sfmt 9920 E:\CR\FM\K26JN7.125 H26PT1 H5986 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Appropriations Act for Fiscal Year 2004. It is cally important. If we are asking these brave Pursuant to the rule, the bill shall be the second bill we are considering pursuant to men and women to protect our national secu- considered for amendment under the 5- the 302(b) allocations adopted by the Appro- rity, then we must ensure that they have the minute rule. During consideration of priations Committee on June 17th. I am tools and the facilities to protect themselves. the bill for amendment, the Chair may pleased to report that it is consistent with the America’s armed forces have been charged accord priority in recognition to a levels established in H. Con. Res. 95, the with developing the capabilities to fight jointly Member offering an amendment that House concurrent resolution on the budget for and with coalition partners to secure victory has been printed in the designated fiscal year 2004, which Congress adopted on across the full spectrum of warfare while con- place in the CONGRESSIONAL RECORD. April 10. The budget resolution provided tinuing the transition to a more flexible, more Those amendments will be considered $400.1 billion in discretionary budget authority agile, lighter and more lethal force. read. for national defense. This bill funds the military In this context, I am pleased the Committee The Clerk will read. construction and family housing portion of that has included funding for a state-of-the-art ex- The Clerk read as follows: commitment to our men and women in uni- plosives loading facility at the Army’s ‘‘Home H.R. 2559 form. of Lethality’’—Picatinny Arsenal in New Jer- Be it enacted by the Senate and House of Rep- H.R. 2559 provides $9.196 billion in new sey. resentatives of the United States of America in budget authority and $10.282 billion in outlays In Afghanistan and Iraq, the achievements Congress assembled, That the following sums for fiscal year 2004. It is therefore identical to of our young men and women in uniform are are appropriated, out of any money in the due in part to the incredible technological ad- Treasury not otherwise appropriated for its 302(b) allocation to the House Sub- military construction, family housing, and committee on Military Construction Appropria- vances employed by our military, much of base realignment and closure functions ad- tions. It does not contain emergency-des- which has been researched and developed by ministered by the Department of Defense, for ignated new BA. It does include $340.5 million Picatinny Arsenal—the only Army-owned, the fiscal year ending September 30, 2004, and in rescissions of previously enacted BA. Al- Army-operated facilities for the research and for other purposes, namely: though budget authority in the bill declines by development of energetics materials (mines, MILITARY CONSTRUCTION, ARMY 12.8 percent from the previous year, it is $81 armor, warheads, artillery, etc.) in the nation. (INCLUDING RESCISSIONS) million above the President’s request. This The new facility will mark a substantial up- For acquisition, construction, installation, mainly because H.R. 2559 contains a procure- grade in safety, environmental protection and and equipment of temporary or permanent ment appropriation of $120 million that, ac- process controls that will benefit the other public works, military installations, facili- cording to CBO, was part of the administra- branches of the military that rely on Army re- ties, and real property for the Army as cur- tion’s request for the Defense appropriation bill search and development expertise. rently authorized by law, including per- Mr. Chairman, once again I commend Mr. sonnel in the Army Corps of Engineers and rather than this bill. other personal services necessary for the The bill complies with section 302(f) of the KNOLLENBERG and Mr. YOUNG and I urge sup- purposes of this appropriation, and for con- Budget Act, which prohibits consideration of port for this bill. struction and operation of facilities in sup- bills in excess of an appropriations sub- Mr. FRANKS of Arizona. Mr. Chairman, port of the functions of the Commander in committee’s 302(b) allocation of budget au- today I urge your consideration of the author- Chief, $1,533,660,000, to remain available until thority and outlays established in the budget ization of $14.3 million for land acquisition to September 30, 2008: Provided, That of this resolution. preserve access to the Barry M. Goldwater amount, not to exceed $122,710,000 shall be H.R. 2559 represents this House’s solemn Range. This land acquisition would serve to available for study, planning, design, archi- commitment to the quality of life of those who prevent incompatible land uses and encroach- tect and engineer services, and host nation ment, and to increase the margin of safety in support, as authorized by law, unless the put their lives on the line for freedom. It not Secretary of Defense determines that addi- only addresses the long-term infrastructure the Live Ordnance Departure Area located tional obligations are necessary for such pur- problems at military bases, it sustains bar- southwest of Luke Air Force Base. poses and notifies the Committees on Appro- racks, family housing, medical facilities, and The Barry M. Goldwater Range, a 2.7 mil- priations of both Houses of Congress of his child support centers across the country and lion acre land and airspace area in southwest determination and the reasons therefor: Pro- overseas. It also provides infrastructure fund- Arizona, is the crown jewel of all flight ranges, vided further, That of the funds appropriated ing for National Guard and Reserve troops providing the Air Force with the space nec- for ‘‘Military Construction, Army’’ under who now find themselves on the front lines of essary to conduct live-fire training and simu- Public Law 107–249, $142,200,000 are rescinded: lating realistically the dimensions of a modern Provided further, That of the funds appro- the war against terrorism. Finally, it incor- priated for ‘‘Military Construction, Army’’ porates the results of real-world national secu- battlefield. under Public Law 107–64, $24,000,000 are re- rity policy changes: The redeployment south of Luke Air Force Base-with its year-round idyl- scinded: Provided further, That of the funds U.S. military forces away from the North Ko- lic weather-is the training home to the F–16 appropriated for ‘‘Military Construction, rean border to better-protected bases, and the Fighting Falcon. With an average of 170 sor- Army’’ under Public Law 106–246, $17,415,000 gradual drawdown of troops from some Cen- ties flown each day, access to the Barry M. are rescinded. tral European bases. Goldwater Range is an essential part of the AMENDMENT OFFERED BY MR. OBEY In conclusion, I express my support for H.R. advanced training and practice required of the Mr. OBEY. Mr. Chairman, I offer an 2559. Air Force fighter pilots. The southern depar- amendment. Mr. FRELINGHUYSEN. Mr. Chairman, I rise ture corridor from Luke Air Force Base is the The Clerk read as follows: in strong support of H.R. 2559, making appro- only air corridor where live ordnance can be Amendment offered by Mr. OBEY: priations for military construction for fiscal carried out by F–16 Fighters. The threat of ad- On page 2, line 13, under the heading ‘‘Mili- 2004. This legislation is a strong product for vancement and increased pressure of residen- tary Construction, Army’’, delete the dollar tough times and I want to commend the Sub- tial development from what has traditionally amount and insert $1,726,660,000; On page 3, line 13, under the heading ‘‘Mili- committee Chairman, the gentleman from been isolated farmland places the mission and tary Construction, Navy’’, delete the dollar Michigan, Mr. KNOLLENBERG, and the Gen- the future of Luke Air Force Base at risk. amount and insert $1,311,907,000; tleman from Texas, Mr. EDWARDS. The Air Force has also made this $14.3 mil- On page 4, line 5, under the heading ‘‘Mili- This legislation provides $9.2 billion in fund- lion request stating, ‘‘Continued residential de- tary Construction, Air Force’’, delete the ing for military construction and family housing velopment of the departure corridors could im- dollar amount and insert $968,509,000; projects across the country. pair Luke [Air Force Base’s] ability to support On page 4, line 21, under the heading ‘‘Mili- While no one is satisfied with the bottom sorties carrying live ordnance and to fully uti- tary Construction, Defense-Wide’’, delete the dollar amount and insert $872,110,000; line on this bill and we all wish that we could lize the [Barry M. Goldwater Range] . . . [and] On page 5, line 20, under the heading ‘‘Mili- not do more, this is a solid product. It satisfies further encumbering Luke [Air Force Base’s] tary Construction, Army National Guard’’, our obligation to ensure that our men and access to the [Barry M. Goldwater Range] delete the dollar amount and insert women in uniform live in, train at, and deploy may adversely impact Luke’s mission and re- $231,860,000; from adequate facilities. This bill shows our sult in a degradation to the national security.’’ On page 6, line 3, under the heading ‘‘Mili- commitment to our service members by con- Mr. EDWARDS. Chairman, I yield tary Construction, Air National Guard’’, de- structing and upgrading military installations, back the balance of my time. lete the dollar amount and insert $95,605,000; On page 7, line 19, under the heading and military family housing in the United Mr. KNOLLENBERG. Mr. Chairman, ‘‘Family Housing Construction, Army’’, de- States and overseas. I yield back the balance of my time. lete the dollar amount and insert $601,191,000; Improving the quality of life for our men and The CHAIRMAN. All time for general On page 8, line 13, under the heading women in uniform throughout the world is criti- debate has expired. ‘‘Family Housing Construction, Navy and
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00046 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.047 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5987 Marine Corps’’, delete the dollar amount and majority but denying those same waiv- until September 30, 2008: Provided, That such insert $288,193,000; ers to the minority. That puts us in an amounts of this appropriation as may be de- And on page 9, line 6, under the heading uneven position on the House floor. We termined by the Secretary of Defense may be ‘‘Family Housing Construction, Air Force’’, are in that kind of position on this transferred to such appropriations of the De- delete the dollar amount and insert partment of Defense available for military $841,065,000. amendment. I want to simply say in construction or family housing as he may At the end of the bill, add the following: conceding the point of order that I will designate, to be merged with and to be avail- Section lll. In the case of taxpayers continue to make this motion on this able for the same purposes, and for the same with adjusted gross income in excess of bill. I will have it in my motion to re- time period, as the appropriation or fund to $1,000,000 for the tax beginning in 2003, the commit. I will try at every stage of the which transferred: Provided further, That of amount of tax reduction resulting from en- process to get this matter before the the amount appropriated, not to exceed actment of the Jobs and Growth Tax Relief House so we can make these priority $63,884,000 shall be available for study, plan- Reconciliation Act of 2003 shall be reduced judgments, and it is up to the majority ning, design, architect and engineer services, by five percent. as authorized by law, unless the Secretary of whether it wants to knock them off the Mr. OBEY (during the reading). Mr. Defense determines that additional obliga- floor or not. tions are necessary for such purposes and no- Chairman, I ask unanimous consent The CHAIRMAN. The gentleman’s that the amendment be considered as tifies the Committees on Appropriations of point of order is conceded and sus- both Houses of Congress of his determination read and printed in the RECORD. tained. and the reasons therefor: Provided further, The CHAIRMAN. Is there objection The Clerk will read. That of the funds appropriated for ‘‘Military to the request of the gentleman from Mr. KNOLLENBERG. Mr. Chairman, Construction, Defense-wide’’ under Public Wisconsin? I ask unanimous consent that the re- Law 107–249, $32,680,000 are rescinded. There was no objection. mainder of the bill, through page 19, MILITARY CONSTRUCTION, ARMY NATIONAL Mr. KNOLLENBERG. Mr. Chairman, line 19 be considered as read, printed in GUARD I reserve a point of order. the RECORD and open to amendment at For construction, acquisition, expansion, The CHAIRMAN. The point of order any point. rehabilitation, and conversion of facilities is reserved. The CHAIRMAN. Is there objection for the training and administration of the Mr. OBEY. Mr. Chairman, I have al- to the gentleman from Michigan? Army National Guard, and contributions ready explained to the House what the There was no objection. therefor, as authorized by chapter 1803 of intention of this amendment is. This title 10, United States Code, and Military The text of the remainder of the bill, Construction Authorization Acts, amendment would reinstate the $160 from page 3, line 5, though page 19, line million in cuts from the President’s $208,033,000, to remain available until Sep- 19 is as follows: tember 30, 2008. budget for hangers, maintenance shops, MILITARY CONSTRUCTION, NAVY office space, physical fitness facilities MILITARY CONSTRUCTION, AIR NATIONAL (INCLUDING RESCISSIONS) for the military that even the White GUARD House thought were crucial. It adds For acquisition, construction, installation, For construction, acquisition, expansion, and equipment of temporary or permanent $480 million for family housing to help rehabilitation, and conversion of facilities public works, naval installations, facilities, for the training and administration of the at least 2,500 military families. There and real property for the Navy as currently Air National Guard, and contributions there- are 134,000 inadequate units that serv- authorized by law, including personnel in the for, as authorized by chapter 1803 of title 10, ice those families to date. It would add Naval Facilities Engineering Command and United States Code, and Military Construc- $318 million for new barracks. It would other personal services necessary for the tion Authorization Acts, $77,105,000, to re- help get 5,300 single service personnel purposes of this appropriation, $1,211,077,000, main available until September 30, 2008. to remain available until September 30, 2008: into decent housing. The Pentagon MILITARY CONSTRUCTION, ARMY RESERVE says there is a need for over 83,000 unit Provided, That of this amount, not to exceed $65,612,000 shall be available for study, plan- For construction, acquisition, expansion, fix-ups. And it would pay for that by ning, design, architect and engineer services, rehabilitation, and conversion of facilities reducing the expected tax cut for those as authorized by law, unless the Secretary of for the training and administration of the with adjusted gross incomes of more Defense determines that additional obliga- Army Reserve as authorized by chapter 1803 than $1 million dollars annually. We tions are necessary for such purposes and no- of title 10, United States Code, and Military would adjust their tax cuts from $88,000 tifies the Committees on Appropriations of Construction Authorization Acts, $84,569,000, to $83,000, thus enabling them to keep both Houses of Congress of his determination to remain available until September 30, 2008. 95 percent of their tax cut. That would and the reasons therefor: Provided further, MILITARY CONSTRUCTION, NAVAL RESERVE That of the funds appropriated for ‘‘Military free up enough money to meet these For construction, acquisition, expansion, Construction, Navy’’ under Public Law 107– rehabilitation, and conversion of facilities military needs, and I would urge the 249, $27,213,000 are rescinded: Provided further, for the training and administration of the re- House, despite the action of the Com- That of the funds appropriated for ‘‘Military serve components of the Navy and Marine mittee on Rules, to allow this amend- Construction, Navy’’ under Public Law 107– Corps as authorized by chapter 1803 of title ment to go forward. 64, $12,109,000 are rescinded. 10, United States Code, and Military Con- POINT OF ORDER MILITARY CONSTRUCTION, AIR FORCE struction Authorization Acts, $38,992,000, to The CHAIRMAN. Does the gentleman For acquisition, construction, installation, remain available until September 30, 2008. from Michigan (Mr. KNOLLENBERG) in- and equipment of temporary or permanent MILITARY CONSTRUCTION, AIR FORCE RESERVE sist on his point of order? public works, military installations, facili- ties, and real property for the Air Force as For construction, acquisition, expansion, Mr. KNOLLENBERG. Mr. Chairman, rehabilitation, and conversion of facilities I do. I make a point of order against currently authorized by law, $896,136,000, to remain available until September 30, 2008: for the training and administration of the the amendment because it proposes to Provided, That of this amount, not to exceed Air Force Reserve as authorized by chapter change existing law and constitutes $80,543,000 shall be available for study, plan- 1803 of title 10, United States Code, and Mili- legislation in an appropriations bill ning, design, architect and engineer services, tary Construction Authorization Acts, and therefore violates clause 2 of rule as authorized by law, unless the Secretary of $56,212,000, to remain available until Sep- XXI, which states in part ‘‘An amend- Defense determines that additional obliga- tember 30, 2008. ment to a general appropriations bill tions are necessary for such purposes and no- NORTH ATLANTIC TREATY ORGANIZATION shall not be in order if changing exist- tifies the Committees on Appropriations of SECURITY INVESTMENT PROGRAM ing law.’’ both Houses of Congress of his determination and the reasons therefor. For the United States share of the cost of At this time I ask for a ruling from the North Atlantic Treaty Organization Se- MILITARY CONSTRUCTION, DEFENSE-WIDE the Chair. curity Investment Program for the acquisi- Mr. OBEY. Mr. Chairman, I would (INCLUDING RESCISSION AND TRANSFER OF tion and construction of military facilities like to be heard on the point of order. FUNDS) and installations (including international The CHAIRMAN. The gentleman For acquisition, construction, installation, military headquarters) and for related ex- from Wisconsin is recognized. and equipment of temporary or permanent penses for the collective defense of the North public works, installations, facilities, and Atlantic Treaty Area as authorized in Mili- Mr. OBEY. Mr. Chairman, what has real property for activities and agencies of tary Construction Authorization Acts and been happening in this House is that the Department of Defense (other than the section 2806 of title 10, United States Code, the Committee on Rules has routinely military departments), as currently author- $169,300,000, to remain available until ex- been waiving points of orders for the ized by law, $813,613,000, to remain available pended.
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FAMILY HOUSING CONSTRUCTION, ARMY main available until expended, for family may be obligated for architect and engineer (INCLUDING RESCISSION) housing initiatives undertaken pursuant to contracts estimated by the Government to For expenses of family housing for the section 2883 of title 10, United States Code, exceed $500,000 for projects to be accom- Army for construction, including acquisi- providing alternative means of acquiring and plished in Japan, in any NATO member tion, replacement, addition, expansion, ex- improving military family housing and sup- country, or in countries bordering the Ara- tension and alteration, as authorized by law, porting facilities. bian Sea, unless such contracts are awarded $409,191,000, to remain available until Sep- BASE REALIGNMENT AND CLOSURE ACCOUNT to United States firms or United States tember 30, 2008: Provided, That of the funds For deposit into the Department of De- firms in joint venture with host nation appropriated for ‘‘Family Housing Construc- fense Base Closure Account 1990 established firms. tion, Army’’ under Public Law 107–249, by section 2906(a)(1) of the Department of De- SEC. 112. None of the funds appropriated in $52,300,000 are rescinded. fense Authorization Act, 1991 (Public Law Military Construction Appropriations Acts 101–510), $370,427,000, to remain available for military construction in the United FAMILY HOUSING OPERATION AND States territories and possessions in the Pa- MAINTENANCE, ARMY until expended. GENERAL PROVISIONS cific and on Kwajalein Atoll, or in countries For expenses of family housing for the bordering the Arabian Sea, may be used to SEC. 101. None of the funds appropriated in Army for operation and maintenance, includ- award any contract estimated by the Gov- Military Construction Appropriations Acts ing debt payment, leasing, minor construc- ernment to exceed $1,000,000 to a foreign con- shall be expended for payments under a cost- tion, principal and interest charges, and in- tractor: Provided, That this section shall not plus-a-fixed-fee contract for construction, surance premiums, as authorized by law, be applicable to contract awards for which where cost estimates exceed $25,000, to be $1,043,026,000. the lowest responsive and responsible bid of performed within the United States, except FAMILY HOUSING CONSTRUCTION, NAVY AND a United States contractor exceeds the low- Alaska, without the specific approval in MARINE CORPS est responsive and responsible bid of a for- writing of the Secretary of Defense setting eign contractor by greater than 20 percent: (INCLUDING RESCISSION) forth the reasons therefor. For expenses of family housing for the SEC. 102. Funds appropriated to the Depart- Provided further, That this section shall not Navy and Marine Corps for construction, in- ment of Defense for construction shall be apply to contract awards for military con- cluding acquisition, replacement, addition, available for hire of passenger motor vehi- struction on Kwajalein Atoll for which the expansion, extension and alteration, as au- cles. lowest responsive and responsible bid is sub- thorized by law, $184,193,000, to remain avail- SEC. 103. Funds appropriated to the Depart- mitted by a Marshallese contractor. able until September 30, 2008: Provided, That ment of Defense for construction may be SEC. 113. The Secretary of Defense is to in- of the funds appropriated for ‘‘Family Hous- used for advances to the Federal Highway form the appropriate committees of Con- ing Construction, Navy and Marine Corps’’ Administration, Department of Transpor- gress, including the Committees on Appro- under Public Law 107–249, $3,585,000 are re- tation, for the construction of access roads priations, of the plans and scope of any pro- scinded. as authorized by section 210 of title 23, posed military exercise involving United States personnel 30 days prior to its occur- FAMILY HOUSING OPERATION AND United States Code, when projects author- ring, if amounts expended for construction, MAINTENANCE, NAVY AND MARINE CORPS ized therein are certified as important to the either temporary or permanent, are antici- For expenses of family housing for the national defense by the Secretary of Defense. SEC. 104. None of the funds appropriated in pated to exceed $100,000. Navy and Marine Corps for operation and this Act may be used to begin construction SEC. 114. Not more than 20 percent of the maintenance, including debt payment, leas- of new bases inside the continental United appropriations in Military Construction Ap- ing, minor construction, principal and inter- States for which specific appropriations have propriations Acts which are limited for obli- est charges, and insurance premiums, as au- not been made. gation during the current fiscal year shall be thorized by law, $852,778,000. SEC. 105. No part of the funds provided in obligated during the last 2 months of the fis- FAMILY HOUSING CONSTRUCTION, AIR FORCE Military Construction Appropriations Acts cal year. (INCLUDING RESCISSIONS) shall be used for purchase of land or land (TRANSFER OF FUNDS) For expenses of family housing for the Air easements in excess of 100 percent of the SEC. 115. Funds appropriated to the Depart- Force for construction, including acquisi- value as determined by the Army Corps of ment of Defense for construction in prior tion, replacement, addition, expansion, ex- Engineers or the Naval Facilities Engineer- years shall be available for construction au- tension and alteration, as authorized by law, ing Command, except: (1) where there is a de- thorized for each such military department $657,065,000, to remain available until Sep- termination of value by a Federal court; (2) by the authorizations enacted into law dur- tember 30, 2008: Provided, That of the funds purchases negotiated by the Attorney Gen- ing the current session of Congress. appropriated for ‘‘Family Housing Construc- eral or his designee; (3) where the estimated SEC. 116. For military construction or fam- tion, Air Force’’ under Public Law 107–249, value is less than $25,000; or (4) as otherwise ily housing projects that are being com- $19,347,000 are rescinded: Provided further, determined by the Secretary of Defense to be pleted with funds otherwise expired or lapsed That of the funds appropriated for ‘‘Family in the public interest. for obligation, expired or lapsed funds may Housing Construction, Air Force’’ under SEC. 106. None of the funds appropriated in be used to pay the cost of associated super- Public Law 105–237, $9,692,000 are rescinded. Military Construction Appropriations Acts vision, inspection, overhead, engineering and FAMILY HOUSING OPERATION AND shall be used to: (1) acquire land; (2) provide design on those projects and on subsequent MAINTENANCE, AIR FORCE for site preparation; or (3) install utilities for claims, if any. any family housing, except housing for For expenses of family housing for the Air SEC. 117. Notwithstanding any other provi- which funds have been made available in an- Force for operation and maintenance, in- sion of law, any funds appropriated to a mili- nual Military Construction Appropriations cluding debt payment, leasing, minor con- tary department or defense agency for the Acts. struction, principal and interest charges, and construction of military projects may be ob- SEC. 107. None of the funds appropriated in ligated for a military construction project or insurance premiums, as authorized by law, Military Construction Appropriations Acts $826,074,000. contract, or for any portion of such a project for minor construction may be used to trans- or contract, at any time before the end of FAMILY HOUSING CONSTRUCTION, DEFENSE- fer or relocate any activity from one base or the fourth fiscal year after the fiscal year for WIDE installation to another, without prior notifi- which funds for such project were appro- For expenses of family housing for the ac- cation to the Committees on Appropriations. priated if the funds obligated for such tivities and agencies of the Department of SEC. 108. No part of the funds appropriated project: (1) are obligated from funds avail- Defense (other than the military depart- in Military Construction Appropriations able for military construction projects; and ments) for construction, including acquisi- Acts may be used for the procurement of (2) do not exceed the amount appropriated tion, replacement, addition, expansion, ex- steel for any construction project or activity for such project, plus any amount by which tension and alteration, as authorized by law, for which American steel producers, fabrica- the cost of such project is increased pursuant $350,000, to remain available until September tors, and manufacturers have been denied to law. 30, 2008. the opportunity to compete for such steel (TRANSFER OF FUNDS) FAMILY HOUSING OPERATION AND procurement. SEC. 118. During the 5-year period after ap- MAINTENANCE, DEFENSE-WIDE SEC. 109. None of the funds available to the Department of Defense for military con- propriations available to the Department of For expenses of family housing for the ac- struction or family housing during the cur- Defense for military construction and family tivities and agencies of the Department of rent fiscal year may be used to pay real housing operation and maintenance and con- Defense (other than the military depart- property taxes in any foreign nation. struction have expired for obligation, upon a ments) for operation and maintenance, leas- SEC. 110. None of the funds appropriated in determination that such appropriations will ing, and minor construction, as authorized Military Construction Appropriations Acts not be necessary for the liquidation of obli- by law, $49,440,000. may be used to initiate a new installation gations or for making authorized adjust- DEPARTMENT OF DEFENSE FAMILY HOUSING overseas without prior notification to the ments to such appropriations for obligations IMPROVEMENT FUND Committees on Appropriations. incurred during the period of availability of For the Department of Defense Family SEC. 111. None of the funds appropriated in such appropriations, unobligated balances of Housing Improvement Fund, $300,000, to re- Military Construction Appropriations Acts such appropriations may be transferred into
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00048 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.029 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5989 the appropriation ‘‘Foreign Currency Fluc- nance and repair of any general or flag offi- The Clerk will report the motion to tuations, Construction, Defense’’ to be cer quarters without 30 days advance prior recommit. merged with and to be available for the same notification to the appropriate committees The Clerk read as follows: time period and for the same purposes as the of Congress, except that an after-the-fact no- Mr. OBEY moves to recommit the bill, H.R. appropriation to which transferred. tification shall be submitted if the limita- 2559, to the Committee on Appropriation SEC. 119. The Secretary of Defense is to tion is exceeded solely due to costs associ- with instructions to report the same forth- provide the Committees on Appropriations of ated with environmental remediation that with with the following amendment: the Senate and the House of Representatives could not be reasonably anticipated at the On page 2, line 13, under the heading ‘‘Mili- with an annual report by February 15, con- time of the budget submission: Provided fur- tary Construction, Army’’, delete the dollar taining details of the specific actions pro- ther, That the Under Secretary of Defense amount and insert $1,726,660,000; posed to be taken by the Department of De- (Comptroller) is to report annually to the On page 3, line 13, under the heading ‘‘Mili- fense during the current fiscal year to en- Committees on Appropriations all operations tary Construction, Navy’’, delete the dollar courage other member nations of the North and maintenance expenditures for each indi- amount and insert $1,311,907,000; Atlantic Treaty Organization, Japan, Korea, vidual general or flag officer quarters for the On page 4, line 5, under the heading ‘‘Mili- and United States allies bordering the Ara- prior fiscal year. tary Construction, Air Force’’, delete the bian Sea to assume a greater share of the SEC. 125. None of the funds made available dollar amount and insert $968,509,000; common defense burden of such nations and in this Act may be transferred to any depart- On page 4, line 21, under the heading ‘‘Mili- the United States. ment, agency, or instrumentality of the tary Construction, Defense-Wide’’, delete the (TRANSFER OF FUNDS) United States Government, except pursuant dollar amount and insert $872,110,000; to a transfer made by, or transfer authority On page 5, line 20, under the heading ‘‘Mili- SEC. 120. During the current fiscal year, in provided in, this Act or any other appropria- tary Construction, Army National Guard, de- addition to any other transfer authority tion Act. lete the dollar amount and insert $231,860,000; available to the Department of Defense, pro- SEC. 126. None of the funds appropriated in On page 6, line 3, under the heading ‘‘Mili- ceeds deposited to the Department of De- this Act for the Department of the Army for tary Construction, Air National Guard’’, de- fense Base Closure Account established by military construction projects in the Repub- lete the dollar amount and insert $95,605,000; section 207(a)(1) of the Defense Authorization lic of Korea may be obligated or expended for On page 7, line 19, under the heading Amendments and Base Closure and Realign- projects at Camp Humphreys in the Republic ‘‘Family Housing Construction, Army’’, de- ment Act (Public Law 100–526) pursuant to of Korea until the Secretary of Defense cer- lete the dollar amount and insert $601,191,000; section 207(a)(2)(C) of such Act, may be tifies and reports to the appropriate commit- On page 8, line 13, under the heading transferred to the account established by tees of Congress that the United States and ‘‘Family Housing Construction, Navy and Marine Corps’’, delete the dollar amount and section 2906(a)(1) of the Department of De- the Republic of Korea have entered into an insert $288,193,000; fense Authorization Act, 1991, to be merged agreement on the availability and use of with, and to be available for the same pur- And on page 9, line 6, under the heading land sufficient for such projects. The certifi- ‘‘Family Housing Construction, Air Force’’, poses and the same time period as that ac- cation must be presented to the committees count. delete the dollar amount and insert no later than September 30, 2004, or the funds $841,065,000. (TRANSFER OF FUNDS) expire. At the end of the bill, add the following: SEC. 121. Subject to 30 days prior notifica- b 1630 SECTION ll. In the case of taxpayers with tion to the Committees on Appropriations, adjusted gross income in excess of $1,000,000 such additional amounts as may be deter- The CHAIRMAN. Are there any for the tax year beginning in 2003, the mined by the Secretary of Defense may be amendments? amount of tax reduction resulting from en- transferred to the Department of Defense If not, the Clerk will read. actment of the Jobs and Growth Tax Relief Family Housing Improvement Fund from The Clerk read as follows: Reconciliation Act of 2003 shall be reduced amounts appropriated for construction in This Act may be cited as the ‘‘Military by five percent. ‘‘Family Housing’’ accounts, to be merged Construction Appropriations Act, 2004’’. Mr. OBEY (during the reading). Mr. with and to be available for the same pur- The CHAIRMAN. Are there further Speaker, I ask unanimous consent that poses and for the same period of time as amendments? the motion be considered as read and amounts appropriated directly to the Fund: If not, under the rule, the Committee Provided, That appropriations made available printed in the RECORD. to the Fund shall be available to cover the rises. The SPEAKER pro tempore. Is there costs, as defined in section 502(5) of the Con- Accordingly, the Committee rose; objection to the request of the gen- gressional Budget Act of 1974, of direct loans and the Speaker pro tempore, Mr. tleman from Wisconsin? or loan guarantees issued by the Department THORNBERRY, having assumed the There was no objection. of Defense pursuant to the provisions of sub- chair, Mr. BASS, Chairman of the Com- The SPEAKER pro tempore. The chapter IV of chapter 169, title 10, United mittee of the Whole House on the State Chair recognizes the gentleman from States Code, pertaining to alternative means of the Union, reported that that Com- Wisconsin (Mr. OBEY) on his motion to of acquiring and improving military family mittee, having had under consideration recommit. housing and supporting facilities. the bill (H.R. 2559) making appropria- Mr. OBEY. Mr. Speaker, I will not SEC. 122. None of the funds appropriated or take the 5 minutes. This is simply the made available by this Act may be obligated tions for military construction, family for Partnership for Peace Programs in the housing, and base realignment and clo- same motion I offered before. If this New Independent States of the former Soviet sure for the Department of Defense for House were operating on the basis of Union. the fiscal year ending September 30, any degree of fairness today, it would (TRANSFER OF FUNDS) 2004, and for other purposes, pursuant be before the House, and I would sim- SEC. 123. During the current fiscal year, in to House Resolution 298, he reported ply ask that the majority refrain from addition to any other transfer authority the bill back to the House. offering the point of order against it. I available to the Department of Defense, The SPEAKER pro tempore. Under know they have their marching orders. amounts may be transferred from the ac- the rule, the previous question is or- They have to do what they have to do, count established by section 2906(a)(1) of the dered. and I have to do what I have to do. Department of Defense Authorization Act, The question is on the engrossment POINT OF ORDER 1991, to the fund established by section and third reading of the bill. Mr. KNOLLENBERG. Mr. Chairman, 1013(d) of the Demonstration Cities and Met- The bill was ordered to be engrossed I make a point of order against the mo- ropolitan Development Act of 1966 (42 U.S.C. 3374) to pay for expenses associated with the and read a third time, and was read the tion to recommit because it proposes Homeowners Assistance Program. Any third time. to change existing law and constitutes amounts transferred shall be merged with MOTION TO RECOMMIT OFFERED BY MR. OBEY legislation in an appropriations bill, and be available for the same purposes and Mr. OBEY. Mr. Speaker, I offer a mo- and, therefore, violates clause 2 of rule for the same time period as the fund to tion to recommit. XXI. which transferred. The SPEAKER pro tempore. Is the The rule states, in pertinent part, SEC. 124. Notwithstanding this or any other gentleman opposed to the bill? ‘‘An amendment to a general appro- provision of law, funds appropriated in Mili- Mr. OBEY. Without the motion to re- priation bill shall not be in order if tary Construction Appropriations Acts for commit, yes. operations and maintenance of family hous- changing existing law.’’ ing shall be the exclusive source of funds for Mr. KNOLLENBERG. Mr. Speaker, I The amendment proposes to alter the repair and maintenance of all family housing reserve a point of order against the mo- application of existing law. units, including general or flag officer quar- tion to recommit. The SPEAKER pro tempore. Does the ters: Provided, That not more than $35,000 per The SPEAKER pro tempore. A point gentleman from Wisconsin wish to be unit may be spent annually for the mainte- of order is reserved. heard on the point of order?
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00049 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.029 H26PT1 H5990 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Mr. OBEY. Yes, I do, Mr. Speaker. DeLauro Johnson (CT) Osborne Thompson (MS) Velazquez Weller As I said earlier, this is the same mo- DeLay Johnson (IL) Ose Thornberry Visclosky Wexler DeMint Johnson, E. B. Otter Tiahrt Vitter Whitfield tion I made before. What is happening Deutsch Johnson, Sam Owens Tiberi Walden (OR) Wicker here is that because of a technical dif- Diaz-Balart, L. Jones (NC) Oxley Tierney Walsh Wilson (NM) ference in the way the rules are being Diaz-Balart, M. Jones (OH) Pallone Toomey Wamp Wilson (SC) Dicks Kanjorski Pascrell Towns Waters applied to the majority and the minor- Wolf Dingell Kaptur Pastor Turner (OH) Watson Woolsey Turner (TX) Watt ity, we are being prevented from offer- Doggett Keller Payne Wu Udall (CO) Waxman ing a motion which would strike a Dooley (CA) Kelly Pearce Wynn Doolittle Kennedy (MN) Pelosi Udall (NM) Weiner much better balance between the needs Young (AK) Doyle Kennedy (RI) Pence Upton Weldon (FL) Young (FL) of our military and the needs of the Dreier Kildee Peterson (MN) Van Hollen Weldon (PA) most well-off people in this society. Duncan Kilpatrick Peterson (PA) NOT VOTING—6 With that, I concede the point of Dunn Kind Petri Edwards King (IA) Pickering Brown-Waite, Gephardt Smith (WA) order. Ehlers King (NY) Pitts Ginny McInnis The SPEAKER pro tempore. The gen- Emanuel Kingston Platts Cox Paul Emerson Kirk Pombo tleman from Wisconsin concedes the ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE point of order. The point of order is Engel Kleczka Pomeroy English Kline Porter The SPEAKER pro tempore (Mr. sustained. Eshoo Knollenberg Portman THORNBERRY) (during the vote). Mem- MOTION TO RECOMMIT OFFERED BY MR. OBEY Etheridge Kolbe Price (NC) bers are reminded less than 2 minutes Evans Kucinich Pryce (OH) Mr. OBEY. Mr. Chairman, I offer a Everett LaHood Putnam remain in this vote. motion to recommit. Farr Lampson Quinn The SPEAKER pro tempore. Is the Fattah Langevin Radanovich b 1654 gentleman opposed to the bill? Feeney Lantos Rahall Ferguson Larsen (WA) Ramstad Mr. ACKERMAN changed his vote Mr. OBEY. I am, Mr. Speaker. Filner Larson (CT) Rangel from ‘‘nay’’ to ‘‘yea’’. The SPEAKER pro tempore. The Flake Latham Regula So the bill was passed. Clerk will report the motion to recom- Fletcher LaTourette Rehberg The result of the vote was announced Foley Leach Renzi mit. Forbes Lee Reyes as above recorded. The Clerk read as follows: Ford Levin Reynolds A motion to reconsider was laid on Mr. OBEY moves to recommit the bill, H.R. Fossella Lewis (CA) Rodriguez the table. 2559, to the Committee on Appropriations. Frank (MA) Lewis (GA) Rogers (AL) Franks (AZ) Lewis (KY) Rogers (KY) f The SPEAKER pro tempore. The mo- Frelinghuysen Linder Rogers (MI) tion is not debatable. Frost Lipinski Rohrabacher EXPRESSING SUPPORT FOR Gallegly LoBiondo Ros-Lehtinen The question is on the motion to re- Garrett (NJ) Lofgren Ross FREEDOM IN HONG KONG commit offered by the gentleman from Gerlach Lowey Rothman The SPEAKER pro tempore. The un- Wisconsin (Mr. OBEY). Gibbons Lucas (KY) Roybal-Allard finished business is the question of sus- The motion was rejected. Gilchrest Lucas (OK) Royce Gillmor Lynch Ruppersberger pending the rules and agreeing to the The SPEAKER pro tempore. The Gingrey Majette Rush resolution, H. Res. 277. question is on the passage of the bill. Gonzalez Maloney Ryan (OH) The Clerk read the title of the resolu- Under clause 10 of rule XX, the yeas Goode Manzullo Ryan (WI) Goodlatte Markey Ryun (KS) tion. and nays are ordered. Gordon Marshall Sabo The SPEAKER pro tempore. The Pursuant to clauses 8 and 9 of rule Goss Matheson Sanchez, Linda question is on the motion offered by XX, this 15-minute vote on passage of Granger Matsui T. the gentleman from New Jersey (Mr. Graves McCarthy (MO) Sanchez, Loretta H.R. 2559 will be followed by 5-minute Green (TX) McCarthy (NY) Sanders SMITH) that the House suspend the votes on suspending the rules and Green (WI) McCollum Sandlin rules and agree to the resolution, H. adopting House Resolution 277 and on Greenwood McCotter Saxton Res. 277, on which the yeas and nays agreeing to the Speaker’s approval of Grijalva McCrery Schakowsky Gutierrez McDermott Schiff are ordered. the Journal. Gutknecht McGovern Schrock This is a 5-minute vote. The vote was taken by electronic de- Hall McHugh Scott (GA) The vote was taken by electronic de- vice, and there were—yeas 428, nays 0, Harman McIntyre Scott (VA) vice, and there were—yeas 426, nays 1, Harris McKeon Sensenbrenner not voting 6, as follows: Hart McNulty Serrano not voting 7, as follows: [Roll No. 325] Hastings (FL) Meehan Sessions [Roll No. 326] Hastings (WA) Meek (FL) Shadegg YEAS—428 Hayes Meeks (NY) Shaw YEAS—426 Abercrombie Blunt Carter Hayworth Menendez Shays Abercrombie Blunt Carter Ackerman Boehlert Case Hefley Mica Sherman Ackerman Boehlert Case Aderholt Boehner Castle Hensarling Michaud Sherwood Aderholt Boehner Castle Akin Bonilla Chabot Herger Millender- Shimkus Akin Bonilla Chabot Alexander Bonner Chocola Hill McDonald Shuster Alexander Bonner Chocola Allen Bono Clay Hinchey Miller (FL) Simmons Allen Bono Clay Andrews Boozman Clyburn Hinojosa Miller (MI) Simpson Andrews Boozman Clyburn Baca Boswell Coble Hobson Miller (NC) Skelton Baca Boswell Coble Bachus Boucher Cole Hoeffel Miller, Gary Slaughter Bachus Boucher Cole Baird Boyd Collins Hoekstra Miller, George Smith (MI) Baird Boyd Collins Baker Bradley (NH) Conyers Holden Mollohan Smith (NJ) Baker Bradley (NH) Conyers Baldwin Brady (PA) Cooper Holt Moore Smith (TX) Baldwin Brady (PA) Cooper Ballance Brady (TX) Costello Honda Moran (KS) Snyder Ballance Brady (TX) Costello Ballenger Brown (OH) Cramer Hooley (OR) Moran (VA) Solis Ballenger Brown (OH) Cox Barrett (SC) Brown (SC) Crane Hostettler Murphy Souder Barrett (SC) Brown (SC) Cramer Bartlett (MD) Brown, Corrine Crenshaw Houghton Murtha Spratt Bartlett (MD) Brown, Corrine Crane Barton (TX) Burgess Crowley Hoyer Musgrave Stark Barton (TX) Burgess Crenshaw Bass Burns Cubin Hulshof Myrick Stearns Bass Burns Crowley Beauprez Burr Culberson Hunter Nadler Stenholm Beauprez Burr Cubin Becerra Burton (IN) Cummings Hyde Napolitano Strickland Becerra Burton (IN) Culberson Bell Buyer Cunningham Inslee Neal (MA) Stupak Bell Buyer Cummings Bereuter Calvert Davis (AL) Isakson Nethercutt Sullivan Bereuter Calvert Cunningham Berkley Camp Davis (CA) Israel Neugebauer Sweeney Berkley Camp Davis (AL) Berman Cannon Davis (FL) Issa Ney Tancredo Berman Cannon Davis (CA) Berry Cantor Davis (IL) Istook Northup Tanner Berry Cantor Davis (FL) Biggert Capito Davis (TN) Jackson (IL) Norwood Tauscher Biggert Capito Davis (IL) Bilirakis Capps Davis, Jo Ann Jackson-Lee Nunes Tauzin Bilirakis Capps Davis (TN) Bishop (GA) Capuano Davis, Tom (TX) Nussle Taylor (MS) Bishop (GA) Capuano Davis, Jo Ann Bishop (NY) Cardin Deal (GA) Janklow Oberstar Taylor (NC) Bishop (NY) Cardin Davis, Tom Bishop (UT) Cardoza DeFazio Jefferson Obey Terry Bishop (UT) Cardoza Deal (GA) Blackburn Carson (IN) DeGette Jenkins Olver Thomas Blackburn Carson (IN) DeFazio Blumenauer Carson (OK) Delahunt John Ortiz Thompson (CA) Blumenauer Carson (OK) DeGette
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00050 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.101 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5991 Delahunt Johnson, E. B. Otter Tiahrt Visclosky Weller Franks (AZ) Leach Reyes DeLauro Johnson, Sam Owens Tiberi Vitter Wexler Frelinghuysen Lee Reynolds DeLay Jones (NC) Oxley Tierney Walden (OR) Whitfield Frost Lewis (CA) Rodriguez DeMint Jones (OH) Pallone Toomey Walsh Wicker Gallegly Lewis (KY) Rogers (AL) Deutsch Kanjorski Pascrell Towns Wamp Wilson (NM) Garrett (NJ) Linder Rogers (KY) Diaz-Balart, L. Kaptur Pastor Turner (OH) Waters Wilson (SC) Gerlach Lipinski Rogers (MI) Diaz-Balart, M. Keller Payne Turner (TX) Watson Wolf Gibbons Lofgren Rohrabacher Dicks Kelly Pearce Udall (CO) Watt Woolsey Gilchrest Lowey Ros-Lehtinen Dingell Kennedy (MN) Pelosi Udall (NM) Waxman Wu Gingrey Lucas (KY) Ross Doggett Kennedy (RI) Pence Upton Weiner Wynn Goode Lucas (OK) Rothman Dooley (CA) Kildee Peterson (MN) Van Hollen Weldon (FL) Young (AK) Goodlatte Lynch Roybal-Allard Doolittle Kilpatrick Peterson (PA) Velazquez Weldon (PA) Young (FL) Gordon Majette Royce Goss Maloney Doyle Kind Petri NAYS—1 Ruppersberger Dreier King (IA) Pickering Granger Manzullo Rush Duncan King (NY) Pitts Paul Graves Matsui Ryan (OH) Dunn Kingston Platts Green (TX) McCarthy (MO) Ryan (WI) Ehlers Kirk Pombo NOT VOTING—7 Green (WI) McCarthy (NY) Ryun (KS) Emanuel Kleczka Pomeroy Brown-Waite, Gephardt McInnis Greenwood McCollum Sanchez, Loretta Emerson Kline Porter Ginny Herger Smith (WA) Grijalva McCotter Sanders Engel Knollenberg Portman Edwards Jefferson Gutierrez McCrery Sandlin English Kolbe Price (NC) Hall McHugh Saxton Eshoo Kucinich Pryce (OH) ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE Harman McIntyre Schiff Etheridge LaHood Putnam The SPEAKER pro tempore (during Harris McKeon Schrock Evans Lampson Quinn the vote). Members are advised that 2 Hart Meehan Scott (GA) Everett Langevin Radanovich Hastings (WA) Meek (FL) Scott (VA) Farr Lantos Rahall minutes remain in the vote. Hayes Meeks (NY) Sensenbrenner Fattah Larsen (WA) Ramstad Hayworth Menendez Serrano Feeney Larson (CT) Rangel b 1703 Hensarling Mica Sessions Herger Michaud Ferguson Latham Regula So (two-thirds having voted in favor Shaw Filner LaTourette Rehberg Hill Millender- Shays Flake Leach Renzi thereof) the rules were suspended and Hinojosa McDonald Sherman Fletcher Lee Reyes the resolution was agreed to. Hobson Miller (FL) Sherwood Foley Levin Reynolds The result of the vote was announced Hoeffel Miller (MI) Shimkus Forbes Lewis (CA) Rodriguez Hoekstra Miller (NC) Shuster as above recorded. Holden Miller, Gary Ford Lewis (GA) Rogers (AL) Simmons Holt Mollohan Fossella Lewis (KY) Rogers (KY) A motion to reconsider was laid on Simpson Honda Moran (KS) Frank (MA) Linder Rogers (MI) the table. Skelton Hooley (OR) Moran (VA) Franks (AZ) Lipinski Rohrabacher Smith (NJ) Hostettler Murphy Frelinghuysen LoBiondo Ros-Lehtinen f Smith (TX) Houghton Murtha Frost Lofgren Ross Snyder Hoyer Musgrave Gallegly Lowey Rothman THE JOURNAL Solis Hunter Myrick Garrett (NJ) Lucas (KY) Roybal-Allard Souder Hyde Nadler Gerlach Lucas (OK) Royce The SPEAKER pro tempore (Mr. Spratt Inslee Napolitano Gibbons Lynch Ruppersberger SWEENEY). Pursuant to clause 8 of rule Stearns Isakson Nethercutt Gilchrest Majette Rush Sullivan XX, the pending business is the ques- Israel Neugebauer Gillmor Maloney Ryan (OH) tion of the Speaker’s approval of the Issa Ney Tancredo Gingrey Manzullo Ryan (WI) Tanner Journal of the last day’s proceedings. Istook Northup Gonzalez Markey Ryun (KS) Jackson (IL) Norwood Tauscher Goode Marshall Sabo The question is on the Speaker’s ap- Jackson-Lee Nunes Tauzin Goodlatte Matheson Sanchez, Linda proval of the Journal, on which the (TX) Nussle Taylor (NC) Gordon Matsui T. Janklow Ortiz Terry Goss McCarthy (MO) Sanchez, Loretta yeas and nays are ordered. Thomas This is a 5-minute vote. Jenkins Osborne Granger McCarthy (NY) Sanders John Ose Thornberry Graves McCollum Sandlin The vote was taken by electronic de- Johnson (CT) Owens Tiahrt Green (TX) McCotter Saxton vice, and there were—yeas 357, nays 68, Johnson (IL) Oxley Tiberi Green (WI) McCrery Schakowsky not voting 9, as follows: Johnson, Sam Pallone Tierney Greenwood McDermott Schiff Jones (NC) Pascrell Turner (OH) Grijalva McGovern Schrock [Roll No. 327] Jones (OH) Paul Turner (TX) Gutierrez McHugh Scott (GA) YEAS—357 Kanjorski Payne Udall (CO) Gutknecht McIntyre Scott (VA) Kaptur Pearce Upton Hall McKeon Sensenbrenner Abercrombie Burgess Davis (TN) Keller Pelosi Van Hollen Harman McNulty Serrano Ackerman Burns Davis, Jo Ann Kelly Pence Velazquez Harris Meehan Sessions Akin Burr Davis, Tom Kildee Peterson (PA) Vitter Hart Meek (FL) Shadegg Alexander Burton (IN) Deal (GA) Kilpatrick Pickering Walden (OR) Hastings (FL) Meeks (NY) Shaw Andrews Buyer DeGette Kind Pitts Walsh Hastings (WA) Menendez Shays Baca Calvert Delahunt King (IA) Platts Wamp Hayes Mica Sherman Bachus Camp DeLauro King (NY) Pombo Watson Hayworth Michaud Sherwood Baker Cannon DeLay Kingston Pomeroy Watt Hefley Millender- Shimkus Ballance Cantor DeMint Kirk Porter Waxman Hensarling McDonald Shuster Ballenger Capito Deutsch Kleczka Portman Weiner Hill Miller (FL) Simmons Barrett (SC) Capps Diaz-Balart, L. Kline Price (NC) Weldon (FL) Hinchey Miller (MI) Simpson Bartlett (MD) Cardin Diaz-Balart, M. Knollenberg Pryce (OH) Weldon (PA) Hinojosa Miller (NC) Skelton Barton (TX) Cardoza Dicks Kolbe Putnam Wexler Hobson Miller, Gary Slaughter Bass Carson (IN) Dingell LaHood Quinn Whitfield Hoeffel Miller, George Smith (MI) Beauprez Carson (OK) Doggett Lampson Radanovich Wilson (NM) Hoekstra Mollohan Smith (NJ) Becerra Carter Dooley (CA) Langevin Rahall Wilson (SC) Holden Moore Smith (TX) Bereuter Case Doolittle Lantos Rangel Wolf Holt Moran (KS) Snyder Berkley Castle Doyle Larson (CT) Regula Woolsey Honda Moran (VA) Solis Berman Chabot Dreier Latham Rehberg Young (AK) Hooley (OR) Murphy Souder Biggert Chocola Duncan LaTourette Renzi Young (FL) Hostettler Murtha Spratt Bilirakis Clay Dunn Houghton Musgrave Stark Bishop (GA) Clyburn Ehlers NAYS—68 Hoyer Myrick Stearns Bishop (NY) Coble Emanuel Hulshof Nadler Stenholm Bishop (UT) Cole Emerson Aderholt Gillmor Matheson Hunter Napolitano Strickland Blackburn Collins Engel Allen Gutknecht McDermott Hyde Neal (MA) Stupak Blumenauer Conyers Eshoo Baird Hastings (FL) McGovern Inslee Nethercutt Sullivan Blunt Cooper Etheridge Baldwin Hefley McNulty Isakson Neugebauer Sweeney Boehlert Cox Evans Bell Hinchey Miller, George Israel Ney Tancredo Boehner Cramer Everett Berry Hulshof Moore Issa Northup Tanner Bonilla Crenshaw Farr Brady (PA) Johnson, E. B. Neal (MA) Istook Norwood Tauscher Bonner Crowley Fattah Brown (OH) Kennedy (MN) Oberstar Jackson (IL) Nunes Tauzin Bono Cubin Feeney Brown, Corrine Kennedy (RI) Obey Jackson-Lee Nussle Taylor (MS) Boozman Culberson Ferguson Capuano Kucinich Olver (TX) Oberstar Taylor (NC) Boswell Cummings Flake Costello Larsen (WA) Otter Janklow Obey Terry Boucher Cunningham Fletcher Crane Levin Jenkins Olver Thomas Boyd Davis (AL) Foley DeFazio Lewis (GA) Pastor John Ortiz Thompson (CA) Bradley (NH) Davis (CA) Forbes English LoBiondo Peterson (MN) Johnson (CT) Osborne Thompson (MS) Brady (TX) Davis (FL) Fossella Filner Markey Ramstad Johnson (IL) Ose Thornberry Brown (SC) Davis (IL) Frank (MA) Ford Marshall Sabo
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00051 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.033 H26PT1 H5992 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Sanchez, Linda Strickland Udall (NM) clause 8 of rule XVIII. Amendments so ‘‘(ii) is uninsured as of the first day of such T. Stupak Visclosky printed shall be considered as read. month and, with respect to the taxable year Schakowsky Sweeney Waters which includes such month— Shadegg Taylor (MS) At the conclusion of consideration of Weller ‘‘(I) is entitled to a deduction for a depend- Slaughter Thompson (CA) the bill for amendment, the Committee Wicker ent under section 151(c) (or would be so enti- Smith (MI) Thompson (MS) Wu shall rise and report the bill to the Stark Toomey tled but for paragraph (2) or (4) of section Stenholm Towns House with such amendments as may 152(e)), or have been adopted. The previous ques- ‘‘(II) files a joint return, and NOT VOTING—9 tion shall be considered as ordered on ‘‘(C) zero in any other case. Brown-Waite, Gonzalez Smith (WA) the bill and amendments thereto to ‘‘(3) ADDITIONAL CONTRIBUTIONS FOR INDI- Ginny Jefferson Wynn VIDUALS 55 OR OLDER.— Edwards McInnis final passage without intervening mo- Gephardt Petri tion except one motion to recommit ‘‘(A) IN GENERAL.—In the case of an indi- with or without instructions. vidual who has attained the age of 55 before ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE The SPEAKER pro tempore. Is there the close of the taxable year, paragraph (2) The SPEAKER pro tempore (during shall be applied by increasing the $2,000 objection to the request of the gen- the vote). Members are advised there amount in paragraph (2)(A) and the $4,000 tleman from California? are 2 minutes remaining. amount in paragraph (2)(B) by the additional There was no objection. contribution amount. b 1711 f ‘‘(B) ADDITIONAL CONTRIBUTION AMOUNT.— So the Journal was approved. For purposes of this section, the additional HEALTH SAVINGS AND contribution amount is the amount deter- The result of the vote was announced AFFORDABILITY ACT OF 2003 mined in accordance with the following as above recorded. Mr. THOMAS. Mr. Speaker, pursuant table: f to House Resolution 299, I call up the ‘‘For taxable years The additional FURTHER MESSAGE FROM THE bill (H.R. 2596) to amend the Internal beginning in: contribution amount SENATE Revenue Code of 1986 to allow a deduc- is: 2004 ...... $500 A further message from the Senate tion to individuals for amounts con- 2005 ...... $600 by Mr. Monahan, one of its clerks, an- tributed to health savings security ac- 2006 ...... $700 nounced that the Senate has passed a counts and health savings accounts, to 2007 ...... $800 bill of the following title in which the provide for the disposition of unused 2008 ...... $900 2009 and thereafter ...... $1,000. concurrence of the House is requested: health benefits in cafeteria plans and flexible spending arrangements, and for ‘‘(4) LIMITATION BASED ON ADJUSTED GROSS S. 312. An act to amend title XXI of the So- INCOME.— cial Security Act to extend the availability other purposes, and ask for its imme- diate consideration. ‘‘(A) SELF-ONLY COVERAGE.—The dollar of allotments for fiscal years 1998 through amount in paragraph (2)(A) (as increased 2001 under the State Children’s Health Insur- The Clerk read the title of the bill. The text of H.R. 2596 is as follows: under paragraph (3)) shall be reduced (but ance Program. not below zero) by an amount which bears f H.R. 2596 the same ratio to such dollar amount as— Be it enacted by the Senate and House of Rep- MAKING IN ORDER ON TUESDAY, ‘‘(i) the amount (if any) by which the tax- resentatives of the United States of America in payer’s adjusted gross income for such tax- JULY 8, 2003, CONSIDERATION OF Congress assembled, able year exceeds $75,000 ($150,000 in the case DEPARTMENT OF DEFENSE AP- SECTION 1. SHORT TITLE. of a joint return), bears to PROPRIATIONS ACT, 2004 This Act may be cited as the ‘‘Health Sav- ‘‘(ii) $10,000 ($20,000 in the case of a joint re- Mr. LEWIS of California. Mr. Speak- ings and Affordability Act of 2003’’. turn). er, I ask unanimous consent that it be SEC. 2. HEALTH SAVINGS SECURITY ACCOUNTS ‘‘(B) FAMILY COVERAGE.—The dollar AND HEALTH SAVINGS ACCOUNTS. amount in paragraph (2)(B) (as increased in order on Tuesday, July 8, 2003, for (a) IN GENERAL.—Part VII of subchapter B under paragraph (3)) shall be reduced (but the Speaker, as though pursuant to of chapter 1 of the Internal Revenue Code of not below zero) by an amount which bears clause 2(b) of rule XVIII, to declare the 1986 (relating to additional itemized deduc- the same ratio to such dollar amount as— House resolved into the Committee of tions for individuals) is amended by redesig- ‘‘(i) the amount (if any) by which the tax- the Whole House on the State of the nating section 223 as section 225 and by in- payer’s adjusted gross income for such tax- Union for consideration of a bill re- serting after section 222 the following new able year exceeds $150,000, bears to ported pursuant to section 6 of House sections: ‘‘(ii) $20,000. Resolution 299 making appropriations ‘‘SEC. 223. HEALTH SAVINGS SECURITY AC- ‘‘(C) NO REDUCTION BELOW $200 UNTIL COM- COUNTS. PLETE PHASE-OUT.—No dollar amount shall be for the Department of Defense for the ‘‘(a) DEDUCTION ALLOWED.—In the case of reduced below $200 under subparagraph (A) or fiscal year ending September 30, 2004, an individual who is an eligible individual (B) unless (without regard to this subpara- and for other purposes, which shall pro- for any month during the taxable year, there graph) such limitation is reduced to zero. ceed according to the following order: shall be allowed as a deduction for the tax- ‘‘(D) ROUNDING.—Any amount determined The first reading of the bill shall be able year an amount equal to the aggregate under this paragraph which is not a multiple dispensed with. amount paid in cash during such taxable of $10 shall be rounded to the next lowest $10. All points of order against consider- year by such individual to a health savings ‘‘(E) ADJUSTED GROSS INCOME.—For pur- ation of the bill are waived. security account of such individual. poses of this paragraph, adjusted gross in- ‘‘(b) LIMITATIONS.— come shall be determined— General debate shall be confined to ‘‘(1) IN GENERAL.—The amount allowable as ‘‘(i) without regard to this section or sec- the bill and shall not exceed 1 hour a deduction under subsection (a) to an indi- tion 911, and equally divided and controlled by the vidual for the taxable year shall not exceed ‘‘(ii) after application of sections 86, 135, chairman and ranking minority mem- the sum of the monthly limitations for 137, 219, 221, 222, and 469. ber of the Committee on Appropria- months during such taxable year that the in- ‘‘(5) COORDINATION WITH OTHER CONTRIBU- tions. dividual is an eligible individual. TIONS.—The limitation which would (but for After general debate, the bill shall be ‘‘(2) MONTHLY LIMITATION.—The monthly this paragraph) apply under this subsection 1 considered for amendment under the 5- limitation for any month is ⁄12 of— to the taxpayer for any taxable year shall be ‘‘(A) $2,000, in the case of an eligible indi- reduced (but not below zero) by the sum of— minute rule. vidual who— ‘‘(A) the aggregate amount paid during Points of order against provisions in ‘‘(i) has self-only coverage under a min- such taxable year to Archer MSAs of such in- the bill for failure to comply with imum deductible plan as of the first day of dividual, clause 2 of rule XXI are waived. such month, or ‘‘(B) the aggregate amount paid during During consideration of the bill for ‘‘(ii) is uninsured as of the first day of such such taxable year to health savings accounts amendment, the Chairman of the Com- month and is not described in subparagraph of such individual, and mittee of the Whole may accord pri- (B)(ii) with respect to the taxable year which ‘‘(C) the aggregate amount paid during ority in recognition on the basis of includes such month, such taxable year to health savings security ‘‘(B) $4,000, in the case of an eligible indi- accounts of such individual by persons other whether the Member offering an vidual who— than such individual. amendment has caused it to be printed ‘‘(i) has family coverage under a minimum ‘‘(6) SPECIAL RULES FOR MARRIED INDIVID- in the portion of the CONGRESSIONAL deductible plan as of the first day of such UALS, DEPENDENTS, AND MEDICARE ELIGIBLE RECORD designated for that purpose in month, or INDIVIDUALS.—Rules similar to the rules of
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00052 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.035 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5993 paragraphs (3), (6), and (7) of section 220(b) ‘‘(i) unless it is in cash and is contributed tion 408(e) shall apply to health savings secu- shall apply for purposes of this section. by— rity accounts, and any amount treated as ‘‘(c) DEFINITIONS.—For purposes of this sec- ‘‘(I) the account beneficiary, distributed under such similar rules shall be tion— ‘‘(II) a member of the family of the account treated as not used to pay qualified medical ‘‘(1) ELIGIBLE INDIVIDUAL.— beneficiary, or expenses. ‘‘(A) IN GENERAL.—The term ‘eligible indi- ‘‘(III) an employer of the account bene- ‘‘(f) TAX TREATMENT OF DISTRIBUTIONS.— vidual’ means, with respect to any month, ficiary, and ‘‘(1) AMOUNTS USED FOR QUALIFIED MEDICAL any individual unless such individual is cov- ‘‘(ii) to the extent such contribution, when EXPENSES.—Any amount paid or distributed ered, as of the first day of such month, under added to previous contributions to the trust out of a health savings security account any health plan which is not a minimum de- for the calendar year, exceeds the highest which is used exclusively to pay qualified ductible plan. annual limitation which could apply to an medical expenses of any account beneficiary ‘‘(B) CERTAIN COVERAGE DISREGARDED.— individual under subsection (b) for a taxable shall not be includible in gross income. Subparagraph (A) shall be applied without year beginning in such calendar year. ‘‘(2) INCLUSION OF AMOUNTS NOT USED FOR regard to— ‘‘(B) The trustee is a bank (as defined in QUALIFIED MEDICAL EXPENSES.— ‘‘(i) coverage for any benefit provided by section 408(n)), an insurance company (as de- ‘‘(A) IN GENERAL.—Any amount paid or dis- permitted insurance, and fined in section 816), or another person who tributed out of a health savings security ac- ‘‘(ii) coverage (whether through insurance demonstrates to the satisfaction of the Sec- count which is not used exclusively to pay or otherwise) for accidents, disability, dental retary that the manner in which such person the qualified medical expenses of the ac- care, vision care, or long-term care. will administer the trust will be consistent count beneficiary shall be included in the ‘‘(2) MINIMUM DEDUCTIBLE PLAN.— with the requirements of this section. gross income of such beneficiary in the man- ‘‘(A) IN GENERAL.—The term ‘minimum de- ‘‘(C) No part of the trust assets will be in- ner provided under section 72. ductible plan’ means a health plan— vested in life insurance contracts. ‘‘(B) SPECIAL RULES FOR APPLYING SECTION ‘‘(i) in the case of self-only coverage, which ‘‘(D) The assets of the trust will not be 72.—For purposes of applying section 72 to has an annual deductible which is not less commingled with other property except in a any amount described in subparagraph (A)— than $500, and common trust fund or common investment ‘‘(i) all health savings security accounts ‘‘(ii) in the case of family coverage, which fund. shall be treated as 1 contract, has an annual deductible which is not less ‘‘(E) The interest of an individual in the ‘‘(ii) all distributions during any taxable than twice the dollar amount in clause (i) (as balance in his account is nonforfeitable. year shall be treated as 1 distribution, increased under subparagraph (B)). ‘‘(2) MEMBER OF THE FAMILY.—The term ‘‘(iii) the value of the contract, income on ‘‘(B) COST-OF-LIVING ADJUSTMENT FOR AN- ‘member of the family’ has the meaning the contract, and investment in the contract NUAL DEDUCTIBLES.— given such term in section 2032A(e)(2). shall be computed as of the close of the cal- ‘‘(i) IN GENERAL.—In the case of any tax- ‘‘(3) QUALIFIED MEDICAL EXPENSES.—The endar year in which the taxable year begins, able year beginning in a calendar year after term ‘qualified medical expenses’ has the and 2004, the $500 amount in subparagraph (A)(i) meaning given such term in section 220(d)(2), ‘‘(iv) such distributions shall be treated as shall be increased by an amount equal to— except that— made from contributions from members of ‘‘(I) such dollar amount, multiplied by ‘‘(A) subparagraph (B)(i) thereof shall not the family of the account beneficiary to the ‘‘(II) the cost-of-living adjustment deter- apply to— extent that such distribution, when added to mined under section 1(f)(3) for the calendar ‘‘(i) insurance which constitutes a min- all previous distributions from the health year in which such taxable year begins by imum deductible plan if no portion of the savings security account taken into account substituting ‘calendar year 2003’ for ‘cal- cost of such insurance is paid by an employer under this clause, do not exceed the aggre- endar year 1992’ in subparagraph (B) thereof. or former employer of the account bene- gate contributions from members of such ‘‘(ii) ROUNDING.—If any increase under ficiary or the spouse of such beneficiary, and family. clause (i) is not a multiple of $50, such in- ‘‘(ii) any health insurance (other than ‘‘(3) EXCESS CONTRIBUTIONS RETURNED BE- crease shall be rounded to the nearest mul- health insurance substantially all of its cov- FORE DUE DATE OF RETURN.— tiple of $50. erage is coverage described in subsection ‘‘(A) IN GENERAL.—If any excess contribu- ‘‘(C) SPECIAL RULES.— (c)(1)(B)) if the account beneficiary has at- tion is contributed for a taxable year to any ‘‘(i) EXCLUSION OF CERTAIN PLANS.—Such tained age 65, and health savings security account of an indi- term does not include a health plan if sub- ‘‘(B) subparagraph (C) thereof shall not vidual, paragraph (2) shall not apply to dis- stantially all of its coverage is coverage de- apply for purposes of this section. tributions from the health savings security scribed in paragraph (1)(B). ‘‘(4) ACCOUNT BENEFICIARY.—The term ‘ac- accounts of such individual (to the extent ‘‘(ii) SAFE HARBOR FOR ABSENCE OF PREVEN- count beneficiary’ means the individual on such distributions do not exceed the aggre- TIVE CARE DEDUCTIBLE.—A plan shall not fail whose behalf the health savings security ac- gate excess contributions to all such ac- to be treated as a minimum deductible plan count was established. counts of such individual for such year) if— by reason of failing to have a deductible for ‘‘(5) CERTAIN RULES TO APPLY.—Rules simi- ‘‘(i) such distribution is made on or before preventive care. lar to the following rules shall apply for pur- the last day prescribed by law (including ex- ‘‘(3) UNINSURED.—An individual shall be poses of this section: tensions of time) for filing the account bene- treated as uninsured if such individual is not ‘‘(A) Section 219(d)(2) (relating to no deduc- ficiary’s return for such taxable year, covered by insurance which constitutes med- tion for rollovers). ‘‘(ii) no deduction is allowed under this ical care. The preceding sentence shall be ap- ‘‘(B) Section 219(f)(3) (relating to time section with respect to such contribution, plied without regard to the coverage de- when contributions deemed made). ‘‘(iii) such distribution is accompanied by scribed in paragraph (1)(B). ‘‘(C) Except as provided in section 106(d), the amount of net income attributable to ‘‘(4) PERMITTED INSURANCE.—The term ‘per- section 219(f)(5) (relating to employer pay- such excess contribution, and mitted insurance’ has the meaning given ments). ‘‘(iv) such distribution satisfies the re- such term in section 220(c)(3). ‘‘(D) Section 408(g) (relating to community quirements of subparagraph (B). ‘‘(5) FAMILY COVERAGE.—The term ‘family property laws). ‘‘(B) RULES RELATED TO ORDERING.— coverage’ has the meaning given such term ‘‘(E) Section 408(h) (relating to custodial ‘‘(i) DISTRIBUTIONS LIMITED TO CONTRIBU- in section 220(c)(5). accounts). TIONS.—Subparagraph (A) shall apply to dis- ‘‘(6) ARCHER MSA.—The term ‘Archer MSA’ ‘‘(6) CONTRIBUTIONS FROM FLEXIBLE SPEND- tributions to a person only to the extent of has the meaning given such term in section ING ACCOUNTS TREATED AS MADE BY THE EM- the contributions of such person to such ac- 220(d). PLOYER.—Any contribution from a flexible counts during such taxable year. ‘‘(7) HEALTH SAVINGS ACCOUNT.—The term spending account to a health savings secu- ‘‘(ii) CLASSES OF CONTRIBUTORS.—Subpara- ‘health savings account’ has the meaning rity account which is not includible in the graph (A) shall apply only to distributions of given such term in section 224(d). gross income of the employee by reason of such contributions which are made in the ‘‘(d) HEALTH SAVINGS SECURITY ACCOUNT.— section 125(h) shall be treated as a contribu- following order: For purposes of this section— tion made by the employer for purposes of ‘‘(I) first, to members of the family of the ‘‘(1) IN GENERAL.—The term ‘health savings this section. account beneficiary, security account’ means a trust created or ‘‘(e) TAX TREATMENT OF ACCOUNTS.— ‘‘(II) second, to the account beneficiary, organized in the United States as a health ‘‘(1) IN GENERAL.—A health savings secu- ‘‘(III) third, to employers of the account savings security account exclusively for the rity account is exempt from taxation under beneficiary with respect to contributions purpose of paying the qualified medical ex- this subtitle unless such account has ceased under section 125(h), and penses of the account beneficiary, but only if to be a health savings security account. Not- ‘‘(IV) fourth, to employers of the account the written governing instrument creating withstanding the preceding sentence, any beneficiary with respect to contributions the trust meets the following requirements: such account is subject to the taxes imposed under section 106(d). ‘‘(A) Except in the case of a rollover con- by section 511 (relating to imposition of tax ‘‘(iii) LAST-IN FIRST-OUT.—If distributions tribution from an Archer MSA, or a health on unrelated business income of charitable, could be made to more than one person savings security account, which is not in- etc. organizations). under any subclause of clause (ii), subpara- cludible in gross income, no contribution ‘‘(2) ACCOUNT TERMINATIONS.—Rules similar graph (A) shall not apply to any such dis- will be accepted— to the rules of paragraphs (2) and (4) of sec- tribution unless such distribution is of the
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00053 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.037 H26PT1 H5994 CONGRESSIONAL RECORD — HOUSE June 26, 2003 most recent excess contribution which has ‘‘SEC. 224. HEALTH SAVINGS ACCOUNTS. ‘‘(II) the cost-of-living adjustment deter- not been distributed to the contributor. ‘‘(a) DEDUCTION ALLOWED.—In the case of mined under section 1(f)(3) for the calendar ‘‘(C) TREATMENT OF NET INCOME.—Any net an individual who is an eligible individual year in which such taxable year begins by income described in subparagraph (A)(iii) for any month during the taxable year, there substituting ‘calendar year 1997’ for ‘cal- shall be included in the gross income of the shall be allowed as a deduction for the tax- endar year 1992’ in subparagraph (B) thereof. person receiving the distribution for the tax- able year an amount equal to the aggregate ‘‘(ii) SPECIAL RULES.—In the case of the able year in which received. amount paid in cash during such taxable $1,000 amount in subparagraph (A)(i) and the ‘‘(D) EXCESS CONTRIBUTION.—For purposes year by such individual to a health savings $2,000 amount in subparagraph (A)(ii), sub- account of such individual. of subparagraph (A), the term ‘excess con- clause (i)(II) shall be applied by substituting ‘‘(b) LIMITATIONS.— tribution’ means any contribution (other ‘calendar year 2002’ for ‘calendar year 1997’. ‘‘(1) IN GENERAL.—The amount allowable as than a rollover contribution from another ‘‘(iii) ROUNDING.—If any increase under health savings security account, or from an a deduction under subsection (a) to an indi- vidual for the taxable year shall not exceed clause (i) or (ii) is not a multiple of $50, such Archer MSA, which is not includible in gross increase shall be rounded to the nearest mul- income) to the extent such contribution re- the sum of the monthly limitations for months during such taxable year that the in- tiple of $50. sults in the aggregate contributions to dividual is an eligible individual. ‘‘(C) SPECIAL RULES.— health savings security accounts of the ac- ‘‘(2) MONTHLY LIMITATION.—The monthly ‘‘(i) EXCLUSION OF CERTAIN PLANS.—Such count beneficiary for the taxable year to be limitation for any month is the amount term does not include a health plan if sub- in excess of the limitation under subsection equal to 1⁄12 of the annual deductible (as of stantially all of its coverage is coverage de- (b) (determined without regard to paragraph the first day of such month) of the individ- scribed in paragraph (1)(B). (5)(C) thereof) which applies to such bene- ual’s coverage under the high deductible ‘‘(ii) SAFE HARBOR FOR ABSENCE OF PREVEN- ficiary for such year. health plan. TIVE CARE DEDUCTIBLE.— A plan shall not fail ‘‘(4) ADDITIONAL TAX ON DISTRIBUTIONS NOT ‘‘(3) COORDINATION WITH OTHER CONTRIBU- to be treated as a high deductible health USED FOR QUALIFIED MEDICAL EXPENSES.— TIONS.—The limitation which would (but for plan by reason of failing to have a deductible N GENERAL.—The tax imposed by this ‘‘(A) I this paragraph) apply under this subsection chapter on the account beneficiary for any for preventive care. to the taxpayer for any taxable year shall be ‘‘(D) TREATMENT OF NETWORK SERVICES.— taxable year in which there is a payment or reduced (but not below zero) by the sum of— distribution from a health savings security ‘‘(i) IN GENERAL.—In the case of a health ‘‘(A) the aggregate amount paid during plan which is a preferred provider organiza- account of such beneficiary which is includ- such taxable year to Archer MSAs of such in- ible in gross income under paragraph (2) tion plan and which would (without regard dividual, to services provided outside such organiza- shall be increased by 15 percent of the ‘‘(B) the aggregate amount paid during amount which is so includible. tion’s network of providers described in such taxable year to health savings security clause (iii)(I)) be a high deductible health ‘‘(B) EXCEPTION FOR DISABILITY OR DEATH.— accounts of such individual, and Subparagraph (A) shall not apply if the pay- plan, such plan shall not fail to be a high de- ‘‘(C) the aggregate amount paid during ductible health plan because— ment or distribution is made after the ac- such taxable year to health savings accounts ‘‘(I) the annual deductible for services pro- count beneficiary becomes disabled within of such individual by persons other than vided outside such network exceeds the ap- the meaning of section 72(m)(7) or dies. such individual. ‘‘(C) EXCEPTION FOR DISTRIBUTIONS AFTER plicable maximum dollar amount in clause ‘‘(4) SPECIAL RULES FOR MARRIED INDIVID- MEDICARE ELIGIBILITY.—Subparagraph (A) (i) or (ii) of subparagraph (A), or UALS, DEPENDENTS, AND MEDICARE ELIGIBLE shall not apply to any payment or distribu- ‘‘(II) the annual out-of-pocket expenses re- INDIVIDUALS.—Rules similar to the rules of tion after the date on which the account ben- paragraphs (3), (6), and (7) of section 220(b) quired to be paid for services provided out- eficiary attains the age specified in section shall apply for purposes of this section. side such network exceeds the applicable dol- 1811 of the Social Security Act. ‘‘(c) DEFINITIONS.—For purposes of this sec- lar amount in subparagraph (A)(iii). ‘‘(5) ROLLOVER CONTRIBUTION.— tion— ‘‘(ii) ANNUAL DEDUCTIBLE.—The annual de- ‘‘(A) IN GENERAL.—Paragraph (2) shall not ‘‘(1) ELIGIBLE INDIVIDUAL.— ductible taken into account under subsection apply to any amount paid or distributed ‘‘(A) IN GENERAL.—The term ‘eligible indi- (b)(2) with respect to a plan which is a high from a health savings security account to vidual’ means, with respect to any month, deductible health plan by reason of clause (i) the account beneficiary to the extent the any individual if— shall be the annual deductible for services amount received is paid into a health savings ‘‘(i) such individual is covered under a high provided within such network. security account, or a health savings ac- deductible health plan as of the 1st day of ‘‘(iii) PREFERRED PROVIDER ORGANIZATION count, for the benefit of such beneficiary not such month, and PLAN DEFINED.—In this subparagraph, the later than the 60th day after the day on ‘‘(ii) such individual is not, while covered term ‘preferred provider organization plan’ which the beneficiary receives the payment under a high deductible health plan, covered means a health plan that— or distribution. under any health plan— ‘‘(I) has a network of providers that have ‘‘(B) LIMITATION.—This paragraph shall not ‘‘(I) which is not a high deductible health agreed to a contractually specified reim- apply to any amount described in subpara- plan, and bursement for covered benefits with the or- graph (A) received by an individual from a ‘‘(II) which provides coverage for any ben- ganization offering the plan, health savings security account if, at any efit which is covered under the high deduct- ‘‘(II) provides for reimbursement for all time during the 1-year period ending on the ible health plan. covered benefits regardless of whether such day of such receipt, such individual received ‘‘(B) CERTAIN COVERAGE DISREGARDED.— benefits are provided within such network of any other amount described in subparagraph Subparagraph (A)(ii) shall be applied without providers, and (A) from a health savings security account regard to— ‘‘(III) is offered by an organization that is which was not includible in the individual’s ‘‘(i) coverage for any benefit provided by not licensed or organized under State law as gross income because of the application of permitted insurance, and a health maintenance organization. this paragraph. ‘‘(ii) coverage (whether through insurance ‘‘(3) PERMITTED INSURANCE.—The term ‘per- ‘‘(6) SPECIAL RULES.—Rules similar to the or otherwise) for accidents, disability, dental mitted insurance’ has the meaning given rules of paragraphs (6), (7), and (8) of section care, vision care, or long-term care. such term in section 220(c)(3). 220(f) shall apply for purposes of this section. ‘‘(2) HIGH DEDUCTIBLE HEALTH PLAN.— ‘‘(4) FAMILY COVERAGE.—The term ‘family ‘‘(g) REPORTS.—The Secretary may require ‘‘(A) IN GENERAL.—The term ‘high deduct- coverage’ has the meaning given such term the trustee of a health savings security ac- ible health plan’ means a health plan— in section 220(c)(5). count to make such reports regarding such ‘‘(i) in the case of self-only coverage, which ‘‘(5) ARCHER MSA.—The term ‘Archer MSA’ account to the Secretary and to the account has an annual deductible which is not less has the meaning given such term in section beneficiary with respect to contributions, than $1,000 and not more than $2,250, 220(d). distributions, and such other matters as the ‘‘(ii) in the case of family coverage, which ‘‘(6) HEALTH SAVINGS SECURITY ACCOUNT.— Secretary determines appropriate. The re- has an annual deductible which is not less The term ‘health savings security account’ ports required by this subsection shall be than $2,000 and not more than $4,500, and has the meaning given such term in section filed at such time and in such manner and ‘‘(iii) the annual out-of-pocket expenses re- 223(d). furnished to such individuals at such time quired to be paid under the plan (other than ‘‘(d) HEALTH SAVINGS ACCOUNT.—For pur- and in such manner as may be required by for premiums) for covered benefits does not exceed— poses of this section— the Secretary. ‘‘(I) $3,000 for self-only coverage, and ‘‘(1) IN GENERAL.—The term ‘health savings ‘‘(h) REGULATIONS.—The Secretary may ‘‘(II) $5,500 for family coverage. account’ means a trust created or organized issue regulations to carry out the purposes ‘‘(B) COST-OF-LIVING ADJUSTMENT.— in the United States as a health savings ac- of this section, including regulations regard- ‘‘(i) IN GENERAL.—In the case of any tax- count exclusively for the purpose of paying ing the proper treatment of distributions de- able year beginning in a calendar year after the qualified medical expenses of the ac- scribed in subsection (f)(3) and nondeductible 1998, each dollar amount in subparagraph (A) count beneficiary, but only if the written contributions by members of the family of shall be increased by an amount equal to— governing instrument creating the trust the account beneficiary. ‘‘(I) such dollar amount, multiplied by meets the following requirements:
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00054 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.037 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5995 ‘‘(A) Except in the case of a rollover con- the qualified medical expenses of the ac- eficiary attains the age specified in section tribution from an Archer MSA, a health sav- count beneficiary shall be included in the 1811 of the Social Security Act. ings security account, or a health savings ac- gross income of such beneficiary. ‘‘(5) ROLLOVER CONTRIBUTION.— count, which is not includible in gross in- ‘‘(3) EXCESS CONTRIBUTIONS RETURNED BE- ‘‘(A) IN GENERAL.—Paragraph (2) shall not come, no contribution will be accepted— FORE DUE DATE OF RETURN.— apply to any amount paid or distributed ‘‘(i) unless it is in cash and is contributed ‘‘(A) IN GENERAL.—If any excess contribu- from a health savings account to the account by— tion is contributed for a taxable year to any beneficiary to the extent the amount re- ‘‘(I) the account beneficiary, or health savings account of an individual, ceived is paid into a health savings account ‘‘(II) an employer of the account bene- paragraph (2) shall not apply to distributions for the benefit of such beneficiary not later ficiary, and from the health savings accounts of such in- than the 60th day after the day on which the ‘‘(ii) to the extent such contribution, when dividual (to the extent such distributions do beneficiary receives the payment or distribu- added to previous contributions to the trust not exceed the aggregate excess contribu- tion. for the calendar year, exceeds the highest tions to all such accounts of such individual ‘‘(B) LIMITATION.—This paragraph shall not annual limitation which could apply to an for such year) if— apply to any amount described in subpara- individual under subsection (b) for a taxable ‘‘(i) such distribution is made on or before graph (A) received by an individual from a year beginning in such calendar year. the last day prescribed by law (including ex- health savings account if, at any time during ‘‘(B) The trustee is a bank (as defined in tensions of time) for filing the account bene- the 1-year period ending on the day of such section 408(n)), an insurance company (as de- ficiary’s return for such taxable year, receipt, such individual received any other fined in section 816), or another person who ‘‘(ii) no deduction is allowed under this amount described in subparagraph (A) from a demonstrates to the satisfaction of the Sec- section with respect to such contribution, health savings account which was not in- retary that the manner in which such person ‘‘(iii) such distribution is accompanied by cludible in the individual’s gross income be- will administer the trust will be consistent the amount of net income attributable to cause of the application of this paragraph. with the requirements of this section. such excess contribution, and ‘‘(6) SPECIAL RULES.—Rules similar to the ‘‘(C) No part of the trust assets will be in- ‘‘(iv) such distribution satisfies the re- rules of paragraphs (6), (7), and (8) of section vested in life insurance contracts. quirements of subparagraph (B). 220(f) shall apply for purposes of this section. ‘‘(D) The assets of the trust will not be ‘‘(B) RULES RELATED TO ORDERING.— ‘‘(g) REPORTS.—The Secretary may require commingled with other property except in a ‘‘(i) DISTRIBUTIONS LIMITED TO CONTRIBU- the trustee of a health savings account to common trust fund or common investment TIONS.—Subparagraph (A) shall apply to dis- make such reports regarding such account to fund. tributions to a person only to the extent of the Secretary and to the account beneficiary ‘‘(E) The interest of an individual in the the contributions of such person to such ac- with respect to contributions, distributions, balance in his account is nonforfeitable. counts during such taxable year. and such other matters as the Secretary de- ‘‘(2) QUALIFIED MEDICAL EXPENSES.—The ‘‘(ii) CLASSES OF CONTRIBUTORS.—Subpara- termines appropriate. The reports required term ‘qualified medical expenses’ has the graph (A) shall apply only to distributions of by this subsection shall be filed at such time meaning given such term in section 220(d)(2). such contributions which are made in the and in such manner and furnished to such in- ‘‘(3) ACCOUNT BENEFICIARY.—The term ‘ac- following order: dividuals at such time and in such manner as count beneficiary’ means the individual on ‘‘(I) first, to the account beneficiary, may be required by the Secretary.’’. whose behalf the health savings account was ‘‘(II) second, to employers of the account (b) DEDUCTION ALLOWED WHETHER OR NOT established. beneficiary with respect to contributions INDIVIDUAL ITEMIZES OTHER DEDUCTIONS.— ‘‘(4) CERTAIN RULES TO APPLY.—Rules simi- under section 125(h), and Subsection (a) of section 62 of such Code is lar to the following rules shall apply for pur- ‘‘(III) third, to employers of the account amended by inserting after paragraph (18) poses of this section: beneficiary with respect to contributions the following new paragraphs: ‘‘(A) Section 219(d)(2) (relating to no deduc- under section 106(d). ‘‘(19) HEALTH SAVINGS SECURITY AC- tion for rollovers). ‘‘(iii) LAST-IN FIRST-OUT.—If distributions COUNTS.—The deduction allowed by section ‘‘(B) Section 219(f)(3) (relating to time could be made to more than one person 223. when contributions deemed made). under any subclause of clause (ii), subpara- ‘‘(20) HEALTH SAVINGS ACCOUNTS.—The de- ‘‘(C) Except as provided in section 106(d), graph (A) shall not apply to any such dis- duction allowed by section 224.’’. section 219(f)(5) (relating to employer pay- tribution unless such distribution is of the (c) COORDINATION WITH ARCHER MSAS.— ments). most recent excess contribution which has (1) ROLLOVERS FROM ARCHER MSAS PER- ‘‘(D) Section 408(g) (relating to community not been distributed to the contributor. MITTED.—Subparagraph (A) of section property laws). ‘‘(C) TREATMENT OF NET INCOME.—Any net 220(f)(5) of such Code (relating to rollover ‘‘(E) Section 408(h) (relating to custodial income described in subparagraph (A)(iii) contribution) is amended by inserting ‘‘, a accounts). shall be included in the gross income of the health savings security account (as defined ‘‘(6) CONTRIBUTIONS FROM FLEXIBLE SPEND- person receiving the distribution for the tax- in section 223(d)), or a health savings ac- ING ACCOUNTS TREATED AS MADE BY THE EM- able year in which received. count (as defined in section 224(d)),’’ after PLOYER.—Any contribution from a flexible ‘‘(D) EXCESS CONTRIBUTION.—For purposes ‘‘paid into an Archer MSA’’. spending account to a health savings ac- of subparagraph (A), the term ‘excess con- (2) REDUCTION IN ARCHER MSA LIMITATION count which is not includible in the gross in- tribution’ means any contribution (other FOR CONTRIBUTIONS TO HEALTH SAVINGS SECU- come of the employee by reason of section than a rollover contribution from another RITY ACCOUNTS AND HEALTH SAVINGS AC- 125(h) shall be treated as a contribution health savings account, from a health sav- COUNTS.—Subsection (b) of section 220 of such made by the employer for purposes of this ings security account, or from an Archer Code (relating to limitations) is amended by section. MSA, which is not includible in gross in- adding at the end the following new para- ‘‘(e) TAX TREATMENT OF ACCOUNTS.— come) to the extent such contribution re- graph: ‘‘(1) IN GENERAL.—A health savings account sults in the aggregate contributions to ‘‘(8) COORDINATION WITH HEALTH SAVINGS SE- is exempt from taxation under this subtitle health savings accounts of the account bene- CURITY ACCOUNTS AND HEALTH SAVINGS AC- unless such account has ceased to be a ficiary for the taxable year to be in excess of COUNTS.—The limitation which would (but health savings account. Notwithstanding the the limitation under subsection (b) (deter- for this paragraph) apply under this sub- preceding sentence, any such account is sub- mined without regard to paragraph (3)(C) section to the taxpayer for any taxable year ject to the taxes imposed by section 511 (re- thereof) which applies to such beneficiary for shall be reduced (but not below zero) by the lating to imposition of tax on unrelated busi- such year. sum of— ness income of charitable, etc. organiza- ‘‘(4) ADDITIONAL TAX ON DISTRIBUTIONS NOT ‘‘(A) the aggregate amount paid during tions). USED FOR QUALIFIED MEDICAL EXPENSES.— such taxable year to health savings security ‘‘(2) ACCOUNT TERMINATIONS.—Rules similar ‘‘(A) IN GENERAL.—The tax imposed by this accounts of such individual, and to the rules of paragraphs (2) and (4) of sec- chapter on the account beneficiary for any ‘‘(B) the aggregate amount paid during tion 408(e) shall apply to health savings ac- taxable year in which there is a payment or such taxable year to health savings accounts counts, and any amount treated as distrib- distribution from a health savings account of of such individual.’’. uted under such rules shall be treated as not such beneficiary which is includible in gross (d) EXCLUSIONS FOR EMPLOYER CONTRIBU- used to pay qualified medical expenses. income under paragraph (2) shall be in- TIONS TO HEALTH SAVINGS SECURITY AC- ‘‘(f) TAX TREATMENT OF DISTRIBUTIONS.— creased by 15 percent of the amount which is COUNTS AND HEALTH SAVINGS ACCOUNTS.— ‘‘(1) AMOUNTS USED FOR QUALIFIED MEDICAL so includible. (1) EXCLUSION FROM INCOME TAX.—Section EXPENSES.—Any amount paid or distributed ‘‘(B) EXCEPTION FOR DISABILITY OR DEATH.— 106 of such Code (relating to contributions by out of a health savings account which is used Subparagraph (A) shall not apply if the pay- employer to accident and health plans) is exclusively to pay qualified medical expenses ment or distribution is made after the ac- amended by adding at the end the following of any account beneficiary shall not be in- count beneficiary becomes disabled within new subsections: cludible in gross income. the meaning of section 72(m)(7) or dies. ‘‘(d) CONTRIBUTIONS TO HEALTH SAVINGS SE- ‘‘(2) INCLUSION OF AMOUNTS NOT USED FOR ‘‘(C) EXCEPTION FOR DISTRIBUTIONS AFTER CURITY ACCOUNTS.— QUALIFIED MEDICAL EXPENSES.—Any amount MEDICARE ELIGIBILITY.—Subparagraph (A) ‘‘(1) IN GENERAL.—In the case of an em- paid or distributed out of a health savings shall not apply to any payment or distribu- ployee who is an eligible individual, amounts account which is not used exclusively to pay tion after the date on which the account ben- contributed by such employee’s employer to
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00055 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.037 H26PT1 H5996 CONGRESSIONAL RECORD — HOUSE June 26, 2003 any health savings security account of such ment from income under subsection (d) or (e) ‘‘(A) the distributions out of the accounts employee shall be treated as employer-pro- of section 106.’’ which were included in gross income under vided coverage for medical expenses under an (3) EMPLOYER CONTRIBUTIONS REQUIRED TO section 223(f)(2), and accident or health plan to the extent such BE SHOWN ON W–2.—Subsection (a) of section ‘‘(B) the excess (if any) of— amounts do not exceed the limitation under 6051 of such Code is amended by striking ‘‘(i) the sum of limitations described in section 223(b) (determined without regard to ‘‘and’’ at the end of paragraph (10), by strik- paragraph (1), over this subsection) which is applicable to such ing the period at the end of paragraph (11) ‘‘(ii) the amount contributed to the ac- employee for such taxable year. and inserting a comma, and by inserting counts for the taxable year. ‘‘(2) SPECIAL RULES.—Rules similar to the after paragraph (11) the following new para- For purposes of this subsection, any con- rules of paragraphs (2), (3), (4), and (5) of sub- graphs: tribution which is distributed out of the section (b) shall apply for purposes of this ‘‘(12) the amount contributed to any health health savings security account in a dis- subsection. savings security account (as defined in sec- tribution to which section 223(f)(3) applies ‘‘(3) DEFINITIONS.—For purposes of this sub- tion 223(d)) of such employee or such employ- shall be treated as an amount not contrib- section, the terms ‘eligible individual’ and ee’s spouse, and uted. ‘health savings security account’ have the ‘‘(13) the amount contributed to any health ‘‘(h) EXCESS CONTRIBUTIONS TO HEALTH respective meanings given to such terms by savings account (as defined in section 224(d)) SAVINGS ACCOUNTS.—For purposes of this section 223. of such employee or such employee’s section, in the case of health savings ac- ‘‘(4) CROSS REFERENCE.— spouse.’’. counts (within the meaning of section (4) PENALTY FOR FAILURE OF EMPLOYER TO ‘‘For penalty on failure by employer to 224(d)), the term ‘excess contributions’ MAKE COMPARABLE HEALTH SAVINGS ACCOUNT make comparable contributions to the health means the sum of— CONTRIBUTIONS.— savings security accounts of comparable em- ‘‘(1) the aggregate amount contributed for (A) IN GENERAL.—Chapter 43 of such Code is ployees, see section 4980G. the taxable year to the accounts (other than amended by adding after section 4980F the a rollover contribution from another health ‘‘(e) CONTRIBUTIONS TO HEALTH SAVINGS AC- following new section: COUNTS.— savings account, a health savings security ‘‘SEC. 4980G. FAILURE OF EMPLOYER TO MAKE account, or from an Archer MSA, which is ‘‘(1) IN GENERAL.—In the case of an em- COMPARABLE HEALTH SAVINGS AC- ployee who is an eligible individual, amounts COUNT CONTRIBUTIONS. not includible in gross income) which is in excess of the limitation under section 224(b) contributed by such employee’s employer to ‘‘(a) GENERAL RULE.—In the case of an em- any health savings account of such employee ployer who makes a contribution to the (determined without regard to paragraph shall be treated as employer-provided cov- health savings security account or the (3)(C) thereof), and erage for medical expenses under an accident health savings account of any employee dur- ‘‘(2) the amount determined under this sub- or health plan to the extent such amounts do ing a calendar year, there is hereby imposed section for the preceding taxable year, re- not exceed the limitation under section a tax on the failure of such employer to meet duced by the sum of— 224(b) (determined without regard to this the requirements of subsection (b) for such ‘‘(A) the distributions out of the accounts subsection) which is applicable to such em- calendar year. which were included in gross income under ployee for such taxable year. ‘‘(b) RULES AND REQUIREMENTS.—Rules and section 224(f)(2), and ‘‘(2) SPECIAL RULES.—Rules similar to the requirements similar to the rules and re- ‘‘(B) the excess (if any) of— rules of paragraphs (2), (3), (4), and (5) of sub- quirements of section 4980E shall apply for ‘‘(i) the sum of limitations described in section (b) shall apply for purposes of this purposes of this section. paragraph (1), over subsection. ‘‘(c) REGULATIONS.—The Secretary shall ‘‘(ii) the amount contributed to the ac- ‘‘(3) DEFINITIONS.—For purposes of this sub- issue regulations to carry out the purposes counts for the taxable year. section, the terms ‘eligible individual’ and of this section, including regulations pro- For purposes of this subsection, any con- ‘health savings account’ have the respective viding special rules for employers who make tribution which is distributed out of the meanings given to such terms by section 224. contributions to more than one of the fol- health savings account in a distribution to ‘‘(4) CROSS REFERENCE.— lowing types of accounts during the calendar which section 224(f)(3) applies shall be treat- ‘‘For penalty on failure by employer to year: ed as an amount not contributed.’’. make comparable contributions to the health ‘‘(1) An Archer MSA. (f) TAX ON PROHIBITED TRANSACTIONS.— savings accounts of comparable employees, ‘‘(2) A health savings security account. (1) Section 4975 of such Code (relating to see section 4980G.’’. ‘‘(3) A health savings account.’’. tax on prohibited transactions) is amended (B) CLERICAL AMENDMENT.—The table of (2) EXCLUSION FROM EMPLOYMENT TAXES.— by adding at the end of subsection (c) the fol- sections for chapter 43 of such Code is (A) RAILROAD RETIREMENT TAX.—Sub- lowing new paragraphs: section (e) of section 3231 of such Code is amended by adding after the item relating to ‘‘(6) SPECIAL RULE FOR HEALTH SAVINGS SE- amended by adding at the end the following section 4980F the following new item: CURITY ACCOUNTS.—An individual for whose new paragraph: ‘‘Sec. 4980G. Failure of employer to make benefit a health savings security account ‘‘(11) HEALTH SAVINGS SECURITY ACCOUNT comparable health savings ac- (within the meaning of section 223(d)) is es- AND HEALTH SAVINGS ACCOUNT CONTRIBU- count contributions.’’. tablished shall be exempt from the tax im- TIONS.—The term ‘compensation’ shall not (e) TAX ON EXCESS CONTRIBUTIONS.—Sec- posed by this section with respect to any include any payment made to or for the ben- tion 4973 of such Code (relating to tax on ex- transaction concerning such account (which efit of an employee if at the time of such cess contributions to certain tax-favored ac- would otherwise be taxable under this sec- payment it is reasonable to believe that the counts and annuities) is amended— tion) if, with respect to such transaction, the employee will be able to exclude such pay- (1) by striking ‘‘or’’ at the end of paragraph account ceases to be a health savings secu- ment from income under subsection (d) or (e) (3) of subsection (a), rity account by reason of the application of of section 106.’’. (2) by inserting after paragraph (4) of sub- section 223(e)(2) to such account. (B) UNEMPLOYMENT TAX.—Subsection (b) of section (a) the following new paragraphs: ‘‘(7) SPECIAL RULE FOR HEALTH SAVINGS AC- section 3306 of such Code is amended by ‘‘(5) a health savings security account COUNTS.—An individual for whose benefit a striking ‘‘or’’ at the end of paragraph (16), by (within the meaning of section 223(d)), or health savings account (within the meaning striking the period at the end of paragraph ‘‘(6) a health savings account (within the of section 224(d)) is established shall be ex- (17) and inserting ‘‘; or’’, and by inserting meaning of section 224(d))’’, and empt from the tax imposed by this section after paragraph (17) the following new para- (4) by adding at the end the following new with respect to any transaction concerning graph: subsections: such account (which would otherwise be tax- ‘‘(18) any payment made to or for the ben- ‘‘(g) EXCESS CONTRIBUTIONS TO HEALTH able under this section) if, with respect to efit of an employee if at the time of such SAVINGS SECURITY ACCOUNTS.—For purposes such transaction, the account ceases to be a payment it is reasonable to believe that the of this section, in the case of health savings health savings account by reason of the ap- employee will be able to exclude such pay- security accounts (within the meaning of plication of section 224(e)(2) to such ac- ment from income under subsection (d) or (e) section 223(d)), the term ‘excess contribu- count.’’. of section 106.’’. tions’ means the sum of— (2) Paragraph (1) of section 4975(e) of such (C) WITHHOLDING TAX.—Subsection (a) of ‘‘(1) the aggregate amount contributed for Code is amended by redesignating subpara- section 3401 of such Code is amended by the taxable year to the accounts (other than graphs (E) and (F) as subparagraphs (G) and striking ‘‘or’’ at the end of paragraph (20), by a rollover contribution from another health (H), respectively, and by inserting after sub- striking the period at the end of paragraph savings security account, or from an Archer paragraph (D) the following new subpara- (21) and inserting ‘‘; or’’, and by inserting MSA, which is not includible in gross in- graphs: after paragraph (21) the following new para- come) which is in excess of the limitation ‘‘(E) a health savings security account de- graph: under section 223(b) (determined without re- scribed in section 223(d), ‘‘(22) any payment made to or for the ben- gard to paragraph (5)(C) thereof), and ‘‘(F) a health savings account described in efit of an employee if at the time of such ‘‘(2) the amount determined under this sub- section 224(d),’’. payment it is reasonable to believe that the section for the preceding taxable year, re- (g) FAILURE TO PROVIDE REPORTS ON employee will be able to exclude such pay- duced by the sum of— HEALTH SAVINGS ACCOUNTS.—Paragraph (2)
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00056 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.037 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5997 of section 6693(a) of such Code (relating to re- are each amended by inserting ‘‘223,’’ after tion 213(d)(1) (without regard to subpara- ports) is amended by redesignating subpara- ‘‘222,’’. graphs (C) and (D) thereof). graphs (C) and (D) as subparagraphs (E) and (B) Section 222(b)(2)(C)(i) is amended by in- ‘‘(4) UNUSED HEALTH BENEFITS.—For pur- (F), respectively, and by inserting after sub- serting ‘‘223,’’ before ‘‘911’’. poses of this subsection, with respect to an paragraph (B) the following new subpara- (C) Section 469(i)(3)(F)(iii) is amended by employee, the term ‘unused health benefits’ graphs: striking ‘‘and 222’’ and inserting ‘‘222, and means the excess of— ‘‘(C) section 223(g) (relating to health sav- 223’’. ‘‘(A) the maximum amount of reimburse- ings security accounts), (l) EFFECTIVE DATE.—The amendments ment allowable to the employee during a ‘‘(D) section 224(g) (relating to health sav- made by this section shall apply to taxable plan year under a health flexible spending ings accounts),’’. years beginning after December 31, 2003. arrangement, taking into account any elec- (h) EXCEPTION FROM CAPITALIZATION OF SEC. 3. DISPOSITION OF UNUSED HEALTH BENE- tion by the employee, over POLICY ACQUISITION EXPENSES.—Subpara- FITS IN CAFETERIA PLANS AND ‘‘(B) the actual amount of reimbursement graph (B) of section 848(e)(1) of such Code FLEXIBLE SPENDING ARRANGE- during such year under such arrangement.’’. (defining specified insurance contract) is MENTS. (b) EFFECTIVE DATE.—The amendment amended by striking ‘‘and’’ at the end of (a) IN GENERAL.—Section 125 of the Inter- made by subsection (a) shall apply to taxable clause (iii), by striking the period at the end nal Revenue Code of 1986 (relating to cafe- years beginning after December 31, 2003. of clause (iv) and inserting a comma, and by teria plans) is amended by redesignating sub- adding at the end the following new clauses: SEC. 4. EXCEPTION TO INFORMATION REPORT- sections (h) and (i) as subsections (i) and (j), ING REQUIREMENTS RELATED TO ‘‘(v) any contract which is a health savings respectively, and by inserting after sub- CERTAIN HEALTH ARRANGEMENTS. security account (as defined in section section (g) the following: (a) IN GENERAL.—Section 6041 (relating to 223(d)), and’’. ‘‘(h) CONTRIBUTIONS OF CERTAIN UNUSED information at source) is amended by adding ‘‘(vi) any contract which is a health sav- HEALTH BENEFITS.— at the end the following new subsection: ings account (as defined in section 224(d)).’’. ‘‘(1) IN GENERAL.—For purposes of this (i) HEALTH SAVINGS SECURITY ACCOUNTS ‘‘(f) SECTION DOES NOT APPLY TO CERTAIN title, a plan or other arrangement shall not AND HEALTH SAVINGS ACCOUNTS MAY BE OF- HEALTH ARRANGEMENTS.—This section shall fail to be treated as a cafeteria plan solely FERED UNDER CAFETERIA PLANS.—Paragraph not apply to any payment for medical care (2) of section 125(d) (relating to cafeteria because qualified benefits under such plan (as defined in section 213(d)) made under— plan defined) is amended by adding at the include a health flexible spending arrange- ‘‘(1) a flexible spending arrangement (as end the following new subparagraph: ment under which not more than $500 of un- defined in section 106(c)(2)), or ‘‘(D) EXCEPTION FOR HEALTH SAVINGS AC- used health benefits may be— ‘‘(2) a health reimbursement arrangement COUNTS.—Subparagraph (A) shall not apply ‘‘(A) carried forward to the succeeding plan which is treated as employer-provided cov- to a plan to the extent of amounts which a year of such health flexible spending ar- erage under an accident or health plan for covered employee may elect to have the em- rangement, purposes of section 106.’’. ployer pay as contributions to a health sav- ‘‘(B) to the extent permitted by sections (b) EFFECTIVE DATE.—The amendment ings security account, or a health savings ac- 223 and 224, contributed on behalf of the em- made by this section shall apply to payments count, established on behalf of the em- ployee to a health savings security account made after December 31, 2002. ployee.’’. (as defined in section 223(d)), or a health sav- ings account (as defined in section 224(d)), (j) INFORMATION REPORTING BY PROVIDERS b 1715 OF HEALTH INSURANCE.—Subpart B of part III maintained for the benefit of such employee, of subchapter A of chapter 61 of such Code is or The SPEAKER pro tempore (Mr. ‘‘(C) contributed to a qualified retirement amended by adding at the end the following SWEENEY). Pursuant to House Resolu- plan (as defined in section 4974(c)), or an eli- new section: tion 299, the gentleman from California ‘‘SEC. 6050U. RETURNS RELATING TO PROVIDERS gible deferred compensation plan (as defined (Mr. THOMAS) and the gentleman from OF HEALTH INSURANCE. in section 457(b)) of an eligible employer de- ‘‘(a) REQUIREMENT OF REPORTING.—Under scribed in section 457(e)(1)(A), but only to the New York (Mr. RANGEL) each will con- regulations prescribed by the Secretary, extent such amount would not be allowed as trol 30 minutes. every person who provides any individual a deduction under— The Chair recognizes the gentleman with coverage under a plan which con- ‘‘(i) section 223 if made directly by the em- from California (Mr. THOMAS). stitutes medical care shall, at such time as ployee to a health savings security account Mr. THOMAS. Mr. Speaker, I yield the Secretary may prescribe, make the re- of the employee (determined without regard turn described in subsection (b) with respect to any other contributions made by the em- myself such time as I may consume. to such individual. ployee), and This is an important day regarding ‘‘(b) FORM AND MANNER OF RETURNS.—A re- ‘‘(ii) section 224 if made directly by the em- all Americans’ health care needs. Most turn is described in this subsection if such ployee to a health savings account of the em- people are focused on our seniors and return— ployee (determined without regard to any the Medicare legislation, which will be ‘‘(1) is in such form as the Secretary may other contributions made by the employee). before us shortly. We have before us prescribe, and ‘‘(2) SPECIAL RULES FOR TREATMENT OF CON- now the Health Savings and Afford- ‘‘(2) contains such information as the Sec- TRIBUTIONS TO RETIREMENT PLANS.—For pur- retary prescribes. poses of this title, contributions under para- ability Act, and I first want to thank ‘‘(c) STATEMENTS TO BE FURNISHED TO INDI- graph (1)(C)— my colleague, the gentleman from Illi- VIDUALS WITH RESPECT TO WHOM INFORMA- ‘‘(A) shall be treated as elective deferrals nois (Mr. LIPINSKI), for working with us TION IS REQUIRED.—Every person required to (as defined in section 402(g)(3)) in the case of in producing a bipartisan piece of legis- make a return under subsection (a) shall fur- contributions to a qualified cash or deferred lation, which is extremely important nish to each individual whose name is re- arrangement (as defined in section 401(k)) or to seniors accompanying the Medicare quired to be set forth in such return a writ- to an annuity contract described in section ten statement showing— legislation, but really to all Ameri- 403(b), cans, and especially those Americans ‘‘(1) the name and address of the person re- ‘‘(B) shall be treated as employer contribu- quired to make such return and the phone tions to which the employee has a non- who, through no fault of their own, number of the information contact for such forfeitable right in the case of a plan (other today have no health insurance avail- person, and than a plan described in subparagraph (A)) able to them. ‘‘(2) the information required to be shown which is described in section 401(a) which in- This legislation creates two new sav- on the return with respect to such indi- cludes a trust exempt from tax under section ings accounts, a health savings account vidual. 501(a), and a health savings security account. The written statement required under the ‘‘(C) shall be treated as deferred compensa- The basic idea is that people ought to preceding sentence shall be furnished on or tion in the case of contributions to an eligi- before January 31 of the year following the ble deferred compensation plan (as defined in be able to put their own money away, calendar year for which the return under section 457(b)), and individuals, relatives, or otherwise who subsection (a) is required to be made.’’. ‘‘(D) shall be treated in the manner des- wish to help them put money away, (k) CONFORMING AMENDMENTS.— ignated for purposes of section 408 or 408A in and in particular instances, employers (1) The table of sections for part VII of sub- the case of contributions to an individual re- who adopt particular kinds of health chapter B of chapter 1 of such Code is amend- tirement plan. care plans for their employees assist in ed by striking the last item and inserting ‘‘(3) HEALTH FLEXIBLE SPENDING ARRANGE- putting money away for health care the following: MENT.—For purposes of this subsection, the needs. These accounts will accumulate ‘‘Sec. 223. Health savings security accounts. term ‘health flexible spending arrangement’ ‘‘Sec. 224. Health savings accounts. means a flexible spending arrangement (as tax free and can be expended for any ‘‘Sec. 225. Cross reference.’’. defined in section 106(c)) that is a qualified health needs. (2)(A) Sections 86(b)(2)(A), 135(c)(4)(A), benefit and only permits reimbursement for Here is the really exciting and impor- 137(b)(3)(A), 219(g)(3)(A)(ii), and 221(b)(2)(C)(i) expenses for medical care (as defined in sec- tant new twist. There is no age limit at
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00057 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.037 H26PT1 H5998 CONGRESSIONAL RECORD — HOUSE June 26, 2003 which you have to make all of the con- There was no objection. ance. And, of course, you make the tributions paid out of the health sav- Mr. RYAN of Wisconsin. Mr. Speaker, killing on your savings by not paying ings account. It is literally lifetime as- I reserve the balance of my time. taxes. And so once he does you this sistance. Why is that important? Be- Mr. RANGEL. Mr. Speaker, I yield favor, he has to do it for the lesser-in- cause today, as we pass the new Medi- myself such time as I may consume. come people, and lo and behold, we will care modernization with prescription The chairman of the Committee on find that those who cannot afford to drug program, we will add tremendous Ways and Means connected this bill stash away this money, because they new benefits, but there are other costs with senior citizens’ inability to plan do not have disposable income, end up associated with the bill, both in acquir- for their future. Well, I am glad he is with no insurance and no savings ac- ing prescription drugs and in making sending them a signal, because after count. sure that seniors can pay for those ad- what they intend to do with seniors Oh, one might say this is cruel, but ditional costs. with the Medicare bill, somebody sensitivity never bothered the majority It is not right to say that every addi- might have planned for their futures. party, because at the end of the game tional benefit provided to seniors I remember in the good old days they want to know how much of the should be paid for by taxpayers. We are when Republicans used to say that people’s money did you leave with already in the midst of the greatest they were going to travel around the them. Or to put it another way, how intergenerational transfer of wealth in country and pull the Tax Code up by much did you take away from the Fed- the history of the world. But it is also the roots. That meant they were going eral Government so that we cannot not fair to say to hardworking Ameri- to close loopholes, get rid of shelters, provide basic services. cans that when they retire they should and to have a system that people did So the gentleman from California pay out of their own pockets if we have not have to hire accountants and law- (Mr. STARK) need not worry. This sav- not provided an easily affordable meth- yers in order to know what their tax li- ings account has nothing to do with od to accumulate those dollars. ability would be. I even volunteered to health. It has everything to do with That is exactly what we have in front drive around with them on these buses shelter. of us today: A health savings account to see just how they intended to put Mr. Speaker, I ask unanimous con- that has a multiple number of ways in back a Code that was more equitable sent that the balance of my time be which money can be placed in to be and fair and one could understand. turned over to the gentleman from paid for health needs not only while But while the gentleman from Cali- California (Mr. STARK) and that he be you are working but when you retire. fornia (Mr. STARK) still thinks that given the authority to allocate time. There is no absolute payout. And if some of them are on the level as re- The SPEAKER pro tempore. Is there there is money in it when the senior lates to health, I asked for the oppor- objection to the request of the gen- passes, then it becomes part of an es- tunity to at least open up this debate tleman from New York? tate and that money, in its transfer, is There was no objection. just so that people who are not on the The SPEAKER pro tempore. The gen- taxable. There is no possibility of floor would understand that this has gimmicking the system. tleman from California (Mr. STARK) re- nothing to do with health. It has a serves the balance of his time. The real concern is that we have told heck of a lot to do with wealth and Americans oftentimes that they have Mr. RYAN of Wisconsin. Mr. Speaker, more to do with shelter. They have to I yield myself such time as I may con- to pay for particular costs, and yet we find ways to make certain that the def- do not provide an easy and affordable sume. icit gets larger and that there is no Mr. Speaker, I just heard the ranking way for them to do so. One of the big money in the Treasury to take care of concerns we have today is chronic or member say this is not a health bill, the problems that we used to say was a that this is a tax shelter. I beg to dif- long-term care costs for seniors. Time Federal responsibility. How do you do value of money is the best way to ad- fer. Number one, what we are talking it? Just being creative. dress a problem that is going to face about here is really novel and revolu- Why, they do not even need a chair- tionary. We are saying that employers most Americans. That is exactly what man of a Committee on the Budget be- health savings accounts allow you to and employees can together contribute cause there are no budget restrictions. to their own savings account with pre- do. It is clearly an affordable health Last night, this bill was supposed to be care cost if you have planned for it. tax dollars, with tax- deductible dollars going over to the Committee on Rules Unfortunately, too often today’s sen- to purchase health care spending and at a cost of $71 billion over 10 years. iors did not plan. There was not a pro- to have a catastrophic plan. gram convenient and easy for them to What imagination. What creativity, The gentleman from New York said, plan. This allows them, in a prudent when just overnight they found out what about the people who do not have way, to put money away. Oftentimes that the bill really costs $171 billion. $4,000 to put in their health security we may want to help our parents, sen- How can Republicans be so smart that savings account? Well, their employer ior children. This is a way, through a just overnight, without hearings, with- can put $4,000 into their account. The health savings account, that they can out checking with Treasury, without purpose of this reform, Mr. Speaker, is place money available for seniors to be talking with OMB they can find $100 to get at some of the big issues that readily used for health savings ac- billion? are really hurting this country, and counts that provide a positive, tax-free Now, what is the cost of $171 billion? that is the cost of health insurance, environment for accumulating those It is simple: It means that people who the affordability, and the accessibility dollars. make up to $150,000 and are well do not of health insurance. In so many ways, Mr. Speaker, this have to pay taxes on storing away So what this reform does is it equips particular program will blend not only $4,000 in a tax shelter. So if you are the individual in the family with the with the Medicare changes that we are working for someone and you make up ability to go out into the health care going to be making but in terms of to $150,000, you never have to pay taxes marketplace with tax-deductible dol- meeting the needs of today’s workers on the money, whether you are sick or lars to act like good consumers and as well. It is completely portable, it is whether or not you retire with the buy their health insurance. It gives in- a fund that accumulates tax free, and money. This is really just a tax-free centives. It actually requires, on it belongs to the individual. They can grant to some of the people who are health savings accounts, that employ- take it with them wherever they may friendly to people on the other side. ers provide catastrophic health insur- want to work. But what about the people that do ance, or individuals who have their Mr. Speaker, I ask unanimous con- not have the $4,000? Now, that is the own health savings accounts have cata- sent that the control of the balance of problem, because you are not eligible strophic health insurance. So it makes my time be by the gentleman from for this unless you do not have ex- sure that people have health insurance Wisconsin (Mr. RYAN). penses that will be paid for for $1,000. if they really run into problems. But it The SPEAKER pro tempore. Without So if an employer really cares for you allows people to manage their health objection, the gentleman from Wis- and wants to have you eligible for this care expenditures themselves. consin (Mr. RYAN) will control the bal- tax shelter, the best favor he can do for You know, it is often said that we ance of the time. you is to take away your health insur- spend more time shopping for cars or
VerDate Jan 31 2003 04:37 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00058 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.130 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H5999 computers than we do for our own of the uninsured have incomes too low count. That amount will grow to $1,000 health insurance. Well, the reforms in to be eligible for any tax benefits con- in 2009, and I think it is a very sensi- this bipartisan Thomas-Lipinski bill tained in H.R. 2596. And as was stated tively written provision to help folks give us those incentives to act like earlier, few, if any, have the $4,000 a who have been away from the work- good consumers so we can watch our year in additional savings required to force or need this additional provision. health care dollars. Health care infla- utilize the benefits contained. There is Mr. STARK. Mr. Speaker, I yield 3 tion is out of control. Health care nothing in this bill that requires the minutes to the gentleman from Michi- spending is out of control. Premium in- employers to give the employees any gan (Mr. LEVIN), a member of the Com- creases facing small businesses and in- money to make up for that gap that mittee on Ways and Means who under- dividuals are out of control. We need to will be created by the higher stands that with this $174 billion that give consumers the ability to get it deductibles. It merely gives them the we are wasting in this bill, we could under control. That is what this legis- opportunity, if they have any money, help States maintain Medicaid cov- lation does. to add to savings accounts. erage as they weather their fiscal cri- I am also interested in the argument Not surprisingly, the same 6 million sis. that this is somehow fiscally irrespon- families who were deliberately ex- Mr. LEVIN. Mr. Speaker, this came sible. I find that kind of a unique argu- cluded by the Republicans from the re- out of the wee hours of this morning, ment, given the fact that the gen- cent tax bill for child tax credit are the but I want Members to realize how rad- tleman from New York is about to same families that they are excluding ical a move this is. We are going to bring a prescription drug substitute from benefiting in this bill. So for fam- have later today a radical effort to dis- amendment to the floor that spends ilies with insurance, it provides tax mantle Medicare. What this is is a rad- $600 billion more than the Republican benefits only if the insurance requires ical effort to dismantle our employer- plan does; a trillion dollar bill that them to pay the first thousand dollars; based system in this country. So now spends a trillion dollars on his pre- and employers will be encouraged by we are going to take a step toward a scription drug bill versus the $400 bil- this nonsense to increase health insur- kind of voucher for health insurance in lion that was paid for in the House ance deductibles, which lowers their the form of a tax credit. That is what budget resolution, as is this health sav- costs and lowers the benefits for most we are going to do. ings account legislation. Those who can afford to use the tax Mr. Speaker, I reserve the balance of of their employees’ health insurance. credit will have that voucher, and they my time so that the other side can Mr. RYAN of Wisconsin. Mr. Speaker, yield time. I yield 2 minutes to the gentlewoman will go out into the marketplace. The Mr. STARK. Mr. Speaker, I yield my- from Washington (Ms. DUNN), a mem- consumer, each individual one, is going self 3 minutes. ber of the Committee on Ways and to try to swim as best as they can. But (Mr. STARK asked and was given Means. for those who do not have the money to permission to revise and extend his re- Ms. DUNN. Mr. Speaker, I am very put in this account, who have no ben- marks.) happy that we have this bill on the efit from the tax credit, they are going Mr. STARK. Mr. Speaker, I will start floor finally. I think it serves a real to continue not to swim as an indi- with an apology to all my Republican need, and it provides total flexibility vidual consumer, but to sink. That is colleagues. For, oh, at least the 30 to people who want to provide for the what is going to happen. That is why years or so I have been here, I have coverage of their health care expenses. this is so radical. been accusing the Republicans of not One particular provision that appeals Now, the other side of the aisle said being inclusive, just dealing with the to me is one that we used to refer to as we want to add money into Medicare in rich and forgetting about the minori- a catch-up health savings account con- the prescription drug proposal. They ties and the working people in this tribution. We now call it a health sav- are darn right. We did not create this country. With this bill they have be- ings security account, and these are ac- deep deficit. Their answer to a deficit come broadly inclusive. Later on to- counts that are designed particularly that is deep is to dig it deeper. In the night, they are going to take the first for people who are age 55 or older. It middle of the night or early morning, step in destroying health care for sen- gives them the right to contribute ad- you add $100 billion to the deficit; and iors, and then, because they are being ditional dollars every year into their I want to quickly read what this looks so inclusive with this bill, they are health savings accounts because of par- like. going to screw everybody. They are ticular situations they might have We were supposed to have with the going to destroy health care for the faced in the past. March baseline a deficit of $377 billion. employees who get their health insur- The flexibility of HSAs is widely We added $484 billion through what was ance from employers. known. These dollars can be used for called a technical reestimate. Then As the distinguished ranking member any health-related expense as long as it through legislation, we added what was of our committee pointed out, $100 bil- is not reimbursed. For example, they it, 700 to $800 billion. Now the projected lion was added to this in the middle of can be used to pay for long-term care deficit, $1.5 trillion, four times what the night, and the bill will be funded by or for health coverage policy or doc- was projected a few months ago, and borrowing, by increasing the national tors’ bills or for prescription drugs; but this does not include the bill that is debt and worsening deficits. And all it what is special about the health sav- going to be brought up later or addi- really does, if you cut through all the ings security accounts is in the way it tional military expenditures. It does Mickey Mouse that they have talked applies to people like me. Many people, not include this $100 billion. I tell the about, high-deductible insurance, is particularly women, during their child- gentleman from Wisconsin (Mr. RYAN), that it creates some new tax-exempt raising years took time away from the this is fiscally irresponsible. You Re- savings accounts. Tax shelters for the workplace and often did not add money publicans have zero fiscal responsi- wealthy and the healthy. And it ad- into accounts like IRAs, or actually bility in your political veins. Zero. vances the objective of undercutting Social Security accounts, and ended up This is radical because it is going to employer-provided health coverage. It is no secret that the distinguished with big goose eggs when the time dismantle the employer-based system. chairman of the Committee on Ways came to calculate their benefits. PARLIAMENTARY INQUIRY In this case, the health savings ac- and Means has expressed his desire to Mr. HAYWORTH. Parliamentary in- counts provide for folks who took time dismantle the employment-linked quiry, Mr. Speaker. health insurance system, and he has off during their child-raising years, or The SPEAKER pro tempore (Mr. noted that he believes it encourages to look after an ill parent; and it al- SWEENEY). Does the gentleman from overutilization of health care because lows them to add up to 25 percent in Michigan (Mr. LEVIN) yield for a par- individuals are shielded from knowing additional dollars each year to their liamentary inquiry? the true cost. health savings accounts. This will Mr. LEVIN. No, Mr. Speaker, I will begin in operation as soon as this bill not yield for a parliamentary inquiry. b 1730 is enacted. An individual age 55 or Mr. Speaker, as I was saying, you are Now, the argument that the bill will older can contribute $500 a year in ad- not only going to dismantle Medicare assist the uninsured is not true. Most dition to the total health savings ac- later as a first step, and now
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00059 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.113 H26PT1 H6000 CONGRESSIONAL RECORD — HOUSE June 26, 2003 try to dismantle the employer-based Medicaid, but those who are working they could say let us stop giving insur- health care system in this country; but people who do not have insurance, this ance to the teachers, let us just give what you are doing is digging a deeper, provides an option to those people to them a $10,000 deductible policy, put deeper hole of debt in this country. embrace insurance. To realize savings, $500 in their savings account and say to This is a radical proposal on all ac- yes, does require a modicum of per- the $30,000-a-year teacher, they can counts, and it should be rejected. sonal responsibility, undoubtedly. come up with $3,500 to put into their PARLIAMENTARY INQUIRY But, Mr. Speaker, certainly we have account. Mr. HAYWORTH. Mr. Speaker, par- not degenerated to the point where we liamentary inquiry. absolutely forsake a notion of personal b 1745 The SPEAKER pro tempore. The gen- responsibility in savings. What we do is I love to hear people who make tleman will state it. offer options that will supplement $150,000 talk about what it is like to be Mr. HAYWORTH. Mr. Speaker, is it health care; and despite the cat calls in this country making $30,000, which is appropriate for a Member to address and poisonous partisan rhetoric, it is the average pay. Or the people making his comments directly to another worth noting that this is bipartisan $18,000. They work every day. They Member, or should those comments be legislation. have no insurance. Do you think they directed through the Chair addressing So again a cautionary note to my have $3,500 to put into a savings ac- the Member? friends on the left. If you believe you The SPEAKER pro tempore. All re- are indicting one party, stop and think; count? marks should be directed through the many of your colleagues who share This is for rich people. That is why it Chair. both the party label and broad-based went up $100 billion miraculously be- Mr. HAYWORTH. Was it true that philosophy, as my friends on the left tween a $65,000 income limit and the preceding gentleman addressed a share in many different areas, join $150,000. It only cost 74 for all the peo- Member directly? with us in this legislation because they ple at the bottom, but it cost 100 for us. The SPEAKER pro tempore. All re- understand it opens opportunity for This is a bad bill. marks in debate should be directed to health insurance, it opens opportunity What it does, also, it says people are the Chair. for individuals, it opens opportunity going to get out of the pool. People Mr. RYAN of Wisconsin. Mr. Speaker, for employers, and it will lead to more who are rich and healthy are going to I yield myself 30 seconds. people seeking the insurance we all get out of the pool, and they are going Mr. Speaker, to respond to a couple want to see them have. Vote ‘‘yes’’ on to leave the sick and the poor in the of comments from the last speaker, I this legislation. pool. And what happens to the pre- would say, number one, we are going to Mr. STARK. Mr. Speaker, I yield 3 miums for the average person? They go keep hearing this rhetoric, that this minutes to the gentleman from Wash- up. The idea of insurance is to spread undermines or destroys employer-spon- ington (Mr. MCDERMOTT) who realizes the risk, and you are letting the sored health care. Actually, it is far that with this $176 billion we could in- wealthy and healthy get out of the from that. It is the opposite of that. sure every one of the 9 million unin- pool. This makes it easier for employers to sured children in this country. Mr. RYAN of Wisconsin. Mr. Speaker, offer health care to their employees. (Mr. MCDERMOT asked and was I yield myself 15 seconds to respond What this does is it makes it easier be- given permission to revise and extend just briefly only to say that health cause employers can offer less-costly his remarks.) care is voluntary by businesses. Mr. catastrophic coverage and give their Mr. MCDERMOTT. Mr. Speaker, I Speaker, Boeing could drop their employees money, pretax money in think it is important to realize that health care right now, today, to their their accounts, to purchase health last night a miracle occurred in this employees. And, Mr. Speaker, that is care. This will lower the cost of health body, a bill that left the committee what is happening today. Millions of insurance and make it cheaper for em- costing $73 billion sometime after mid- businesses are making those kinds of ployers to offer health care. night suddenly became $173 billion. An decisions to drop health care. We are Mr. Speaker, I yield 21⁄2 minutes to actual miracle in the Committee on trying to make it more affordable. We the gentleman from Arizona (Mr. Rules. are trying to keep it so that businesses HAYWORTH), an esteemed member of The fact is Members have to under- can still offer health insurance at an the Committee on Ways and Means. stand why that happened. All Members affordable price to their employees. Mr. HAYWORTH. Mr. Speaker, again, make $150,000 a year. They were not Mr. Speaker, I yield 2 minutes to the as we come to the well this evening, we covered by this bill. It only went up to gentleman from California (Mr. see a very vast difference in our visions $65,000; but in the Committee on Rules ROYCE). of health care and visions of America. they said, let us put ourselves in this Mr. ROYCE. Mr. Speaker, I thank the Our friends on the left who later to- bill, so they raised it up to $150,000 so gentleman for yielding me this time. night will offer a $1 trillion govern- that we could take benefit of this. Now This measure will make it easier for ment command-and-control approach that was a thoughtful thing for them employers to offer health care to their to prescription drugs now take strong to be doing, but did they think about employees. It is also going to help objection, to put it diplomatically, the people in your district? Americans save for their medical ex- about a plan that, yes, initially is ex- My employees at Boeing, they get penses, to gain greater access to qual- pensive. I would grant Members that $65,000 a year. It is a pretty good pay- ity health care. I particularly support billions are real dollars here, but it ing job, and they get good benefits the provision in this bill that would substantially supplements and expands from their company. What is to stop prevent a portion of the unused bal- the ability of people to have health in- their company tomorrow from saying, ances and flexible spending arrange- surance. We are going to give you a $10,000 de- ments from being forfeited at the end As the gentleman from Wisconsin ductible policy, and we will put $500 of the year. Right now there is a use-it- (Mr. RYAN) mentioned, it gives employ- into your account, you put $3,500 in, or-lose-it provision that applies to ers more options to provide that type and you will have it all for yourself? workers. I have been working for sev- of insurance by embracing catastrophic They can do that. They can end a de- eral years to allow individuals to accu- plans and freeing up dollars to go to fined benefit package at Boeing tomor- mulate unused balances from their employees, and as we see in the case of row and give a defined contribution. flexible spending arrangements to save health savings security accounts, and Give employees a voucher, and say for health care expenses. In this Con- this is the key, and I would urge my they are on their own. Do Members gress I introduced H.R. 176 to allow in- colleagues to understand this, as so want them to strike over that? dividuals to accumulate $2,000 annually many have come to the well of this Mr. Speaker, how about the woman from these FSAs, as we call them. House on both sides of the aisle and la- making $30,000 teaching school. We all Right now we have over 30 million mented the numbers of uninsured know those school teachers are rich workers in the United States that have Americans, not the medically indigent people. You end the school program, these FSAs available to them. Employ- with whom we try to deal through the State governments are in trouble, ees and employers can set aside pretax
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00060 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.117 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6001 money which can be used to pay for Furthermore, those workers and other in- mitment to this issue and to reducing the out-of-pocket health care expenses and sured individuals who have traditional, more number of uninsured Americans. copayments and deductibles. Under the comprehensive coverage will see their pre- Sincerely, current system, unfortunately, em- miums rise. Younger, healthier workers will RONALD E. POLLACK, likely choose the less-comprehensive cov- Executive Director. ployees forfeit money not used at the erage, leaving older and sicker workers and end of the year. Currently, this encour- Mr. STARK. Mr. Speaker, I yield 3 those who earn too little to pay taxes in tra- minutes to the distinguished gen- ages wasteful health care spending be- ditional coverage. As a result, costs for this cause employees, knowing that they coverage will rise, leaving workers with no tleman from Wisconsin (Mr. KLECZKA). will forfeit unused account balances, choice but to enroll in the high-deductible Mr. KLECZKA. Mr. Speaker, let me engage in end-of-the-year spending coverage this bill seeks to promote. thank the gentleman from California sprees on services they may not need This legislation was slipped through the for yielding me this time. like extra eyeglasses, shades or unnec- Ways and Means committee last week, and Mr. Speaker, I really do not know essary exams. So eliminating the use- made worst late last night in the Rules Com- where to start, to start answering some it-or-lose-it provision solves this prob- mittee. Among the changes made in Rules, of the critics and the proponents of lem because then the employee will be the income threshold has been raised to this legislation. This bill started out able to roll over the balance from year $175,000 for joint filers. The cost of the re- about a week ago or so in the Com- vised bill is estimated to be $174 over ten to year. That is the attempt in this bill mittee on Ways and Means, which I years—more than twice the estimated cost of serve on, and the cost was $14 billion. on that provision. the bill that passed Ways and Means last Preventing some forfeiture also in- week—and makes clear that this legislation Then the day the bill came up, the cost creases the savings rate by increasing is first and foremost another tax shelter, not rose to $72 billion. And then last night the disposable income of those employ- a bill to cover the uninsured. the cost went to $173 billion. Mr. ees in the program, and it also empow- H.R. 2351 was raised just last week with lit- Speaker, let us pass this bill quickly, ers them to make their own health tle notice and certainly without any hear- because I am afraid it is going to con- care decisions. I urge my colleagues to ings, despite the bill’s far-reaching implica- tinue to grow. But that does not make pass this legislation. tions and significant cost. And now the it a good bill. Mr. STARK. Mr. Speaker, I yield my- House leadership has called for it to be What is going on here, my friends, is self 30 seconds. I have a couple of let- joined with the Medicare prescription drug this is the demise of the employer- ters, one from the AFL-CIO which sug- legislation before the House. I urge you to sponsored health care system in this gests that this legislation would estab- vote against H.R. 2351. country. The employers do not like it. Sincerely, lish an enormous tax shelter for WILLIAM SAMUEL, They want to get out of it. Members of wealthy individuals and at the same Director, Department of Legislation. the committee, including the chair- time undermine employer-based health man, have indicated that their desire is coverage and shift costs onto workers. FAMILIES USA to dismantle the employer-based I have a letter from Families USA Washington, DC, June 26, 2003. health care system. This bill does it. which, among other things, says that Hon. CHARLES RANGEL, How does it do it? It gives the em- this bill also threatens the employer- Rayburn House Office Building, ployer an option. It says, Mr. and Mrs. provided health insurance system par- Washington, DC. Employee, we are changing your health ticularly among smaller employers DEAR REPRESENTATIVE RANGEL, On behalf policy. I am going to give you one who will be able to take deductions in of Families USA, the national advocacy starting next month that will provide the top brackets and who will then no group for health care consumers, I am writ- for a $2,000 deduction on your health longer be interested in providing cov- ing to oppose the Health Savings and Afford- care costs. Start saving, because the erage for their employees. ability act of 2003 (H.R. 2596). Implementa- Congress passed a bill where you can tion of the Health Savings Accounts (HSAs) Mr. Speaker, I include both letters save and then you pay the first $2,000. for the RECORD. and Health Savings Security Accounts (HSSAs) will do little to expand health in- It sounds fine in principle, but here is AMERICAN FEDERATION OF LABOR surance coverage to the 41 million Ameri- the problem, my friends. Working fam- AND CONGRESS OF INDUSTRIAL OR- cans who are uninsured. ilies in this country have to first of all GANIZATIONS, pay the mortgage so they do not lose Washington, DC, June 26, 2003. This bill creates two programs loosely DEAR REPRESENTATIVE: The AFL–CIO op- modeled after existing Archer Medical Sav- the home, pay for the car so he can get poses H.R. 2351, the Health Savings Account ings Accounts (MSAs). Rather than tar- to work, feed the kids and clothe them Availability Act. This legislation would es- geting limited federal funds to provide help and send them to school, and then this tablish an enormous tax shelter for wealthy for the lowest-income uninsured, this bill Congress has already told you that the individuals and at the same time undermine creates tax-free accounts, the HSSA’s, which past generation has been irresponsible, employer-based health coverage and shift can be accessed by families with incomes up they did not plan for their future and to $150,000 before starting to phase-out. The more cost onto workers. Despite proponents’ you better. So put money away for claims, this bill would fail to expand cov- total cost of this bill is over $169 billion over erage to the uninsured and would be espe- ten years—a huge federal investment that your retirement in an IRA and a 401(k). cially harmful to those low-income, older will do little or nothing to cover the low-in- And you say, yes, because Social Secu- and sicker workers who now have com- come uninsured. The people who deserved to rity probably will not be enough, I will prehensive coverage. be helped in any health legislation are being do that. Then this Congress said, col- Under H.R. 2351, employers could offer ignored by this legislation. If this huge com- lege education is going up, mom and Health Savings Accounts as long as they are mitment of resources were applied to an ex- dad, start saving for your kids’ edu- provided in conjunction with high-deductible pansion of the Children’s Health Insurance cation. And so you say, yeah, I will put health insurance policies, defined as at least Program or to Medicaid, we could cover $500 for an individual policy and $1,000 for a every uninsured child in America (about 8.5 a couple of thousand away a year for family plan. This will encourage employers million) with excellent care and have money Johnny’s and Sally’s education. to abandon more generous coverage and offer left over to help their mothers! To casually, Now we are saying to you, after all instead less comprehensive policies that and with so little debate, spend these huge this, we have got another one, start shift significant costs onto workers. The resources on so many higher-income individ- saving for your health care. Then you Joint Committee on Taxation has estimated uals is a travesty of the legislative process. say, Mr. Republican Congressman, I am that 30 million such accounts would be es- This bill also threatens the employer-pro- out of money. I do not make that tablished by 2013 and the majority of em- vided health insurance system, particularly ployers would modify their health plans to much. I do not have any more dispos- among smaller employers who will be able to meet the high-deductible guidelines of the able income. And so when your em- take deductions in the top brackets for their legislation. ployer changes your health plan and personal insurance and who will then no In addition, this shift in coverage would you do not put the $2,000 or $4,000 away harm most those workers who need health longer be interested in providing coverage for their employees. when you get sick, you are out of luck. care. Low-income workers who are the in- That is what is going on here. Make no tended beneficiaries of these plans’ preferred We look forward to working under your tax treatment are not likely to get back leadership to reject this bill, and instead to mistake about it. enough in taxes to offset the greater out-of- work for real and meaningful mechanisms to Mr. STARK. Mr. Speaker, I yield 4 pocket costs they are likely to incur with expand coverage to the uninsured in this minutes to the distinguished gen- these high-deductible plans. country. Thank you for your continued com- tleman from Texas (Mr. DOGGETT), a
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00061 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.120 H26PT1 H6002 CONGRESSIONAL RECORD — HOUSE June 26, 2003 member of the Committee on Ways and millions of Americans that it has Second, insured workers with high- Means. served since 1965, and we want to deductible plans will also see similar Mr. DOGGETT. Mr. Speaker, once strengthen it, not see it undermined incentives. Both savings vehicles give again Republicans insist on a fiscally through into privatization. individuals a potent incentive to save irresponsible bill that will benefit the The bill before us this afternoon does for health care costs that do not fit wealthiest and in this case the health- something very similar to what the within their deductible, giving them iest at the cost of at least $174 billion later bill proposes to do to Medicare another option and perhaps some peace added to our already soaring national and, that is, to weaken, at great cost to of mind about unanticipated medical debt. our Treasury, our employer-based expenses. The medical expenses that Mr. Speaker, despite the bright sun- health care system. By totally exclud- qualify for tax-free distributions are shine outside, it really is a dark day ing employees unless they are in plans very far reaching and include expenses for so many Americans who are work- that deny any assistance on at least from preventive care to long-term care. ing hard just to make ends meet. This the first $1,000 or $2,000 in medical bill When individuals use their own hard- bill is the natural companion to a coverage, this bill will encourage even earned dollars for health care, they measure written by the same folks that higher deductibles. And it will be a will ask more questions, further inform are presenting this bill, which pre- struggle for a cafeteria worker to pay themselves, and become better con- viously denied a child tax credit to their first $1,000 or their first $2,000 or sumers of health care products. This poor working folks. Tax cuts, no mat- more-thousand under these new high- bill undoubtedly promotes an educated ter what the economic conditions, no deductible plans. and wise consumer of health care serv- matter how pressing are the other pri- The same plans will encourage more ices and will result in all-around better orities we have in our country, such as small employers to stop providing cov- health care decisions. protecting our families from terrorism, erage at all and to protect themselves Our current Tax Code puts a punitive tax cuts, we are always told, can cure individually through these MSAs and burden on working families who save any ill in our society, unless of course to terminate costly health insurance their own money for medical and other you are poor and working, in which for their other employees. It will en- expenses. The health savings accounts case your kids are not worthy of a courage group health plans to reduce ease that burden by providing two sim- child tax credit. covered services, increase copayments. ple and flexible savings mechanisms for Thanks to the intransigence of the In short, through these three bills, working families. House Republican leadership, there are we see Republican indifference from b 1800 now 6 million working American fami- cradle to grave for children, for work- This is commonsense legislation that lies, they are folks like cafeteria work- ers, for seniors. makes health insurance and health ers and teachers’ aides, nursing home Mr. RYAN of Wisconsin. Mr. Speaker, care more affordable and tax advan- employees, those working at our hos- I yield 3 minutes to the gentleman taged for Americans. It does not de- pitals doing the tough work, they will from Pennsylvania (Mr. ENGLISH) to stroy our health care system and it receive no check for their children this talk about this legislation that we are does not dismantle Medicare. Accord- year like other Americans. Their bid to debating, health savings accounts. ingly, I urge my colleagues to give gain a little economic independence, to Mr. ENGLISH. Mr. Speaker, I really workers control of their own health share in the economic benefits of the wish more of the American public were care and vote for the creation of health American Dream, it will come and go watching this debate because they on July 4 unfulfilled because of the re- savings accounts. would be able to fully appreciate how The SPEAKER pro tempore (Mr. fusal of this House Republican leader- marginal the left has become to any se- ship and their desire to go on recess SWEENEY). The Chair advises Members rious debate about the problems facing that the gentleman from California not only for July 4 but to continue this country. What we are going to be (Mr. STARK) has 9 minutes remaining their recess from reality. doing tonight is not voting to repeal For these same families that were de- and the gentleman from Wisconsin (Mr. Medicare, but instead voting to pass liberately excluded from the recent tax RYAN) has 121⁄4 minutes remaining. this bill, which is a bill that would pro- cut as well as for many other working Mr. STARK. Mr. Speaker, I yield 2 vide more medical security for unin- families, House Republicans add more minutes to the distinguished gen- sured Americans as well as many low- insult to injury by encouraging em- tleman from New Jersey (Mr. and middle-income workers. PALLONE), who understands that we ployers to terminate or to weaken any This legislation actually creates two group health insurance coverage could cover the parents of low-income new instruments to meet health care through which some of these employees children who are eligible for Medicaid needs by rewarding Americans who may be covered. This bill is also the and CHIP with the same amount of open either type of account with tax natural companion to the next bill that money. advantages and maximum flexibility, we are about to take up, the bill to re- Mr. PALLONE. Mr. Speaker, I just do so as the other side has noted, even the peal Medicare as we have known it, not know how many tricks or hoaxes healthy can have a greater role in man- since President Lyndon B. Johnson the Republican leadership is going to aging their own health care. Encour- signed it into law. We know this is not play on us tonight and on the Amer- aging individuals to enroll in these new new. They have opposed Medicare since ican people. It is unbelievable. I lis- savings vehicles has multiple benefits. before President Johnson wrote his sig- tened to the gentleman from Pennsyl- nature to make it a reality. Newt Ging- First, this is a big step to make health vania. He said there is going to be rich wanted it to wither on the vine. insurance more affordable and help re- Medicare reform tonight. There is not Earlier this month, Mr. Gingrich de- duce the growing number of Americans going to be Medicare reform. It is just clared, much as our colleagues are here without health insurance. The tax-pre- going to be an effort to kill Medicare today, using the very same words that ferred nature of the health savings se- and destroy Medicare. And then they they got from Newt Gingrich, that it curity accounts offers a powerful in- say they are going to bring up a pre- was an ‘‘obsolete government monop- centive for uninsured workers to take scription drug benefit tonight that oly.’’ advantage of these accounts. The con- really is not any meaningful benefit Only yesterday we heard the same tributions to the accounts are deduct- that forces one into HMOs, that denies language from the sponsor of this ible; the investment earnings within them of choices of doctors and hos- measure: ‘‘To those who say that the the accounts tax-free; and the distribu- pitals. And now this one, the ultimate bill would end Medicare as we know it, tions are also tax-free when used for trick, which I guess we did not really our answer is, ‘We certainly hope so.’ ’’ health insurance. Many, including the even know about until today, that ba- ‘‘Old-fashioned Medicare isn’t very self-employed, would find this enor- sically tries to undercut employer- good,’’ said Bill Thomas, the sponsor of mously valuable. This results in sig- based health insurance. this legislation and the companion nificant savings on health insurance, When does it end? When are the Re- measure to repeal Medicare tonight. an economic benefit that is certain to publicans going to end what they are Some of us think old-fashioned Medi- encourage many uninsured Americans trying to do to destroy the health care care has worked pretty well for the to utilize these accounts. system?
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00062 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.122 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6003 Mr. Speaker, although we would like tail-end, there are a few others that are from Louisiana (Mr. MCCRERY), from to provide health coverage for those nearing their entry into Medicare, but the committee. who are uninsured, this bill does little we are facing a crisis too. Our parents Mr. MCCRERY. Mr. Speaker, the im- or nothing to help the low-income un- need help in today’s world. At the same mediate preceding speaker, the gen- insured. Individuals eligible for the tax time that we worry about our parents’ tleman from Illinois (Mr. EMANUEL), credit under the Thomas bill would health and their futures and what our spoke about the free market and let- have to be uninsured or in high deduct- role is as their children will be in help- ting free market forces work with re- ible plans, but according to the bill, ing them in their golden years, we are spect to prescription drugs, and his so- starting in 2004, those individuals could also raising our children, trying to lution is either import drugs from set aside up to $2,000 tax free into a save for their college and their future. other countries and sell them here of new health savings account to sup- This is one pro-family tax item. It al- course at lower prices or let us adopt posedly help pay for health insurance. lows me, as the child of a father who the prices that are paid in those other But the argument that the bill will as- had a stroke last October, to help my countries here in our country, and he sist the uninsured is simply not true. parents with their health care costs. So calls that the free market. Most uninsured have incomes that are this is one great pro-family tax meas- What he failed to point out is those too low to owe Federal income tax li- ure, and I urge my colleagues to sup- drugs and those prices that he would be ability, let alone have $2,000 to set port it. importing or adopting the prices out aside for this purpose. In addition, self- Mr. STARK. Mr. Speaker, I yield 11⁄2 here are set by government price con- employed individuals, the other large minutes to the gentleman from Illinois trols, not the free market. segment of the uninsured, may already (Mr. EMANUEL). Mr. EMANUEL. Mr. Speaker, will the deduct 100 percent of the health insur- Mr. EMANUEL. Mr. Speaker, I thank gentleman yield? ance costs. my colleague from California for yield- Mr. MCCRERY. I yield to the gen- The only consequence of this bill is ing me this time. tleman from Illinois. to undercut the provision of employer- Earlier the speaker before me talked Mr. EMANUEL. Mr. Speaker, the fact sponsored health care coverage by en- about choice. In the prescription drug is we would have competition. It is a couraging employers to raise debate we are having, I have talked Gutknecht-Emanuel bill with a number deductibles or potentially drop their about choice and I have an amendment, of the gentleman’s colleagues on his coverage and raise the cost of health a bipartisan amendment, to offer peo- side and a number of colleagues on my care for low income, older and sick ple choice between generic versus name side. The three provisions to this bill, workers with higher co-payments and brand drugs that would reduce prices A, allow generics to come to market premiums. so people could pick cheaper drugs. quicker so name brand pharmaceutical And, lastly, as many of the speakers Also part of the provision allows indi- companies could not be involved in on our side have said, this legislation viduals, government, private sector, to frivolous lawsuits. will cost the government over $173 bil- buy medications anywhere in the G–8 Mr. MCCRERY. Mr. Speaker, re- lion, another in a series of fiscally irre- countries and have competition so they claiming my time, the issue of generics sponsible tax cuts passed by the House. can get drugs cheaper in Germany or is addressed in the underlying bill that The entire cost of the bill will be fund- France or Canada or Italy. That would we will be debating later tonight, but ed by borrowing, increasing the na- drive prices down. the gentleman spoke about bringing tional debt. I too agree with competition. The drugs in from other countries and sell- Where does this end? We have a na- free market would drive prices down. ing them at prices that have been im- tional debt 4-, $500 billion. Where is it So those of us who embrace the free posed by governments, not by the free going to end? market wonder why sometimes our col- Mr. RYAN of Wisconsin. Mr. Speaker, market. Mr. STARK. Mr. Speaker, I reserve I yield 2 minutes to the gentleman leagues on the other side are so scared of the free market. I have seen that the the balance of my time. from Nebraska (Mr. TERRY). (Mr. TERRY asked and was given benefits of the free market work. I Mr. RYAN of Wisconsin. Mr. Speaker, permission to revise and extend his re- would like to see it come to the discus- I yield 2 minutes to the gentleman marks.) sion we have on a prescription drug bill from Texas (Mr. BURGESS). Mr. TERRY. Mr. Speaker, when will because if we bring that competition of Mr. BURGESS. Mr. Speaker, I thank it end? I am saddened by the argu- the free market to the debate about the gentleman from Wisconsin for ments from the left that fail to recog- prescription drugs, we will make medi- yielding me this time. nize that there are more people in cations more affordable to all Ameri- H.R. 2596 will increase access to con- America that want to have choices. cans of all ages. sumer-based health coverage to all They do not want just the offering of a The interesting thing is there are Americans regardless of income. Under government program one size fits all. two issues that are driving health care H.R. 2596 the availability of health sav- Not everyone thinks that the govern- inflation at 25, 30 percent for the pub- ings accounts will assist those that live ment is the answer to everything. So I lic. One is the cost of prescription without health coverage and give am proud to support bills that allow drugs. Two is the 42 million uninsured Americans more options when it comes the market to provide opportunities who show up in our emergency rooms, to their health. Health savings ac- and choices, and that is what tonight is driving up hospital costs which insur- counts will promote savings and more about. I am wondering sitting here lis- ance companies pass on to employers direct health purchasing. tening to the debate what some of our and employers pass on to employees. The character of these accounts will Founding Fathers would think of to- And if we wanted to insure the unin- also simplify the doctor-patient rela- day’s debate. Think about the people sured, we can do it for a lot less money tionship. As a physician, I know first- that started this country that left than this. Expand Kid Care. In Illinois hand the difficulty some patients have their countries to set sail on a venture we have a program known as Kid Care, working through their insurance com- unknown to come to a new land for insurance for the children of working panies and trying to figure out what what? Freedom. Trying to escape the parents, that expands the kid care to services are covered by their policies. government powers that were control- family care. With a health savings account, pa- ling their lives. And now 200 or 300 What is most interesting about this tients can focus their attention on years later from those first people that debate is that we have a prescription their medical care. They can discuss landed on our shores, our debate is how drug bill coverage for Members of Con- their needs with their doctors frankly far government is going to control gress that is far more generous than and honestly, and they can proceed their health and their lives. Not every- the one that we are about to provide with appropriate medical treatments body wants bureaucrats running their for our elderly. Those are the wrong that they need. health care. So I am proud to stand in values. Those are not the values that My colleagues on the other side of favor of the HSAs. we came here to represent. the aisle are more prepared to force Mr. Speaker, in today’s world us Mr. RYAN of Wisconsin. Mr. Speaker, people into a one-size-fits-all solution baby boomers, and, yes, I am on the I yield 30 seconds to the gentleman instead of giving individuals the choice
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00063 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.126 H26PT1 H6004 CONGRESSIONAL RECORD — HOUSE June 26, 2003 or the purchasing power to make deci- Mr. RYAN of Wisconsin. Mr. Speaker, that have enabled middle-class individ- sions for themselves. I yield 2 minutes to the gentlewoman uals to have some health security, to I myself have had a medical saving from Florida (Ms. HARRIS). have some access to prescription drugs, account since 1997, that is, until I came (Ms. HARRIS asked and was given to have access to the health care that to Congress, and it was coverage that I permission to revise and extend her re- they and their families need, will come made available to everyone in my prac- marks.) under assault. It begins with this legis- tice as a choice. It was not a require- Ms. HARRIS. Mr. Speaker, today the lation, medical savings accounts, ment. If someone wanted the chance to House of Representative stands at the where millions of Americans who now be in charge of their medical decisions threshold of passing landmark legisla- have good health care plans, where and a chance to build wealth in one of tion that protects and improves Medi- they share the payment of those plans these accounts for future medical ex- care while providing our seniors with a with their employers, between employ- penses, I thought it was only prudent real prescription drug benefit. While ers and employees, will find out that as an employer to provide that oppor- the debate remains properly focused those plans are going to be substituted tunity. upon this moral obligation to our sen- by high-threshold, high-cost, high-de- Mr. Speaker, we talk about the evils iors, I wish to highlight another excit- ductible plans, and the theory is that of HMOs, and the Members on the ing component of health care reform they can pay for that out of their med- other side of the aisle are frequently that we will address today. ical savings accounts. mentioning the evils of HMOs, but this H.R. 2596, the Health Savings and Af- Millions of Americans are going to is the anti-HMO. Put the purchasing fordability Act of 2003, authorizes the wake up and find out that the health power back in the hand of the patient. creation of health savings accounts care plans that they have available to These plans are centered on the con- which will enable every American to them today will not be available to cept of personal choice. These accounts pay their basic medical expenses from them tomorrow. make more money available to pur- tax-free money. In almost every pur- Just as with the passage of the Medi- chase health coverage. We need to be chase of goods and services except care bill, the prescription drug bill that serious about the solutions when ad- health care, individuals bargain di- we will do later tonight, some 30 per- dressing the problems of the uninsured rectly with vendors and providers. cent of the people who have prescrip- in this country. An individual will tion drug benefits will wake up and b 1815 make rational decisions when they find out that they will get a lesser ben- have the ability to spend their own Assuming an adequately competitive efit under the Medicare prescription money on their health services. market, suppliers will not charge more drug benefit than they are currently I ask my colleagues, I implore my than buyers are willing and able to pay getting today. Millions of senior citi- colleagues, not to stand in the way. for very long. zens will discover that they have lost Give Americans the freedom to make The structure of our current health their prescription drug benefit as they this decision. care system pushes consumers to the know it, and they will have to accept Mr. STARK. Mr. Speaker, I yield 2 sidelines. Big insurance companies ne- minutes to the gentleman from Wash- something much less than that. gotiate prices with big health care con- When we come back from the Fourth ington (Mr. INSLEE). glomerates, producing a distorted mar- (Mr. INSLEE asked and was given of July break, we will complete this ket and more expensive health care, permission to revise and extend his re- trifecta assault on middle-class health prescription drugs, and health insur- marks.) care plans when the Committee on Mr. INSLEE. Mr. Speaker, in regard ance premiums for the uninsured and Education and the Workforce reports to the Medicare bill we will be consid- self-employed. out the Association Health Care Plan ering this evening, I thought about H.R. 2596 allows Americans, particu- proposal. Because the CBO, the Con- coming down to the House and assert- larly Medicare-eligible seniors, to use gressional Budget Office tells us that ing that this bill was a Trojan horse, health care savings accounts to pay for over 8 million Americans will lose the but I think it is worse than a Trojan medical expenses, prescription drug health care they have today, and what horse. I do not think it would be fair to costs, retiree health insurance ex- will be substituted will be a health care the Trojan horse metaphor to call this penses, long-term care service, and plan that is much less comprehensive a Trojan horse. And the reason is, is COBRA coverage. It permits family than they have today. Mr. Speaker, 8 when the Athenians sent the horse to members and employers to make tax- million Americans, 8 million middle- the Trojans, they did not announce in free contributions to these accounts. class Americans. And the answer that advance that the horse was full of sol- The nature and uncertainty of health the Republicans suggest to us is we can diers that were going to attack the care expenses will always require crit- all just save and pay for that ourselves. city. They kind of kept that a secret. ical programs such as Medicare and an Well, if we look who is paying into But the Republicans have not kept any efficiently-operating insurance indus- 401(k)s, we know that most Americans secrets about this horse at all because try. That is why the reforms that we do not have that disposable income. if we look at what the gentleman from will adopt in H.R. 1 are so vital. That is why they have employer-based California (Mr. THOMAS) said, ‘‘To Nevertheless, through the magic of health care systems. those who say that the Medicare bill the free market, H.R. 2596 will reduce But starting tonight, that employer- would end Medicare as we know it, our costs that many Americans pay for the based health care system, that system answer is we certainly hope so.’’ most basic health care needs, while that has done so much to keep people If the Athenians had announced that forcing our entire health care system healthy, to keep people out of poverty, the gift, the alleged gift, they were to become more efficient. to keep them from losing their homes, sending was going to destroy the city Mr. STARK. Mr. Speaker, I am de- is about to be shredded; and the assault they were attacking, no one would lighted to yield the balance of our time is complete and its comprehensive, and have bought that old nag. And it the to the distinguished gentleman from it runs from the seniors to new and same situation here. We should not buy California (Mr. GEORGE MILLER), the young families trying to raise children. this old nag of a bill with the expressed ranking member of the Committee on All of these people will find out. If my intent of destroying Medicare over the Education and the Workforce. colleagues do not think it is going to next 10 years. And, yes, it is com- Mr. GEORGE MILLER of California. happen, just look at the employers who plicated on how that is going to hap- Mr. Speaker, I thank the gentleman for are announcing that these cutbacks are pen. And, yes, it is a little bit chaotic yielding me this time. going to come who are supporting the in explaining it. But the Members can Mr. Speaker, in the next few hours, association health care plans, who are rest assured that America’s senior citi- the Republicans in the Congress will supporting medical savings accounts, zens are going to figure this out. They engage in the greatest raid and dimin- these health savings accounts tonight, are going to figure out this is worse ishment on middle-class health care and who are supporting prescription than a Trojan horse because they see it benefits in the history of this country. drugs. Because they are lining up to coming. We should reject this and Benefits that have been built up over get rid of their obligations for prescrip- adopt the Democratic substitute. the last 50 or 60 years in this country tion drugs, for health care for young
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00064 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.128 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6005 families, health care for older families, more choices. They want to restrict makes a mess of a system that needs to be all in the name of their cost savings. those choices. fine-tuned, not destroyed. The majority of But that will dramatically change the This does not take anything away Americans now receive health insurance middle class in this country and what from anybody, Mr. Speaker. This gives through employers. This bill will offer a tax they have come to know as health care people more choices. This says to peo- break to people who do not have health insur- security. ple, if you are having a hard time sav- ance coverage, and those whose coverage But for the elderly it is going to be ing for your health care, we are going has a deductible of over $1,000. It sounds even more dramatic. When we look at to make it easier for you to do that. If good, until you think about it. This bill will the prescription drug benefit, it is in- you are a small business and you can- serve to encourage businesses to cut their teresting that the largest elderly group not afford health care for your employ- health insurance programs, or raise in the country, AARP, everything that ees right now, we are giving you a new deductibles on their employees. Low- to mod- they say is essential to protect senior option to do just that. erate-income employees and those who are citizens, and a prescription drug ben- We are going to give employers the uninsured pay all kinds of taxes: payroll taxes, efit is not in this bill. Read their let- ability to say, look, you can put money sales taxes, property taxes. However, they ter. It is not in this bill. They wish it in an account that you can deduct it tend to not pay enough income taxes to take was, they hope it will be, but it is not from in your employee’s name. Your advantage of this new Republican-give-to-the- here tonight. employees contribute to this account. rich scheme. So the exact people who are not Mr. RYAN of Wisconsin. Mr. Speaker, If you do it, you have to buy cata- being left out of our healthcare system, and I yield myself the remaining time. strophic health care coverage for them. who need relief, are being left out of this bill. I would like to begin my closing by So we are making sure with health The underlying goal of this bill is to dis- saying that the gentleman from Cali- care savings accounts that there is mantle the employer-based health insurance fornia is a person who has worked in health insurance. And the beautiful system that the Chairman of the Ways and health care for many, many years; and part of this proposal, Mr. Speaker, is Means Committee hates. He has stated that I know that he is sincere in trying to that this is the employee’s money; it is he does not like employer-based health insur- do what he thinks is best to give access their money that is at stake when they ance because it shields people from the cost to people who need health care. I be- go out and buy health care. They are of healthcare and thus enables people to use lieve everyone who came to the floor going to act like real consumers. They healthcare too much. I don’t see that Ameri- and into the well who spoke on this bill can take this money with them when cans have made themselves too healthy. I today cares about health care. they leave their job and go to another want to increase access to care not decrease Mr. Speaker, I am relatively new to job. They can take this money with it, so I will vote against this bill. this body; but one thing I have learned them into retirement throughout the Not only is this a bad bill, it is an expensive is that if you are running out of argu- rest of their life; and when they die, one. It will cost $71 billion over the next ten ments, the oldest trick in the book is this money can go to their spouse. This years—all money borrowed from our children to impugn the other person’s motives. money becomes the individual’s and grandchildren. In the later years of the Tell them that all we want to do is money. budget window, this bill will cost in excess of help the rich and hurt the poor, that One of the big problems we have in $10 billion per year, and will accelerate just at what we are trying to do is destroy em- health care today is we do not act like the time when the baby boom generation re- ployer-sponsored health care. consumers. We have third-party payers tires, denying resources to meet our commit- Well, Mr. Speaker, two of the Na- paying the bills, and so when we go and ments to the Social Security and Medicare tion’s leading organizations who rep- pay for health care, someone else is systems. resent small employers, the people who paying the bills, so we really do not Again, it seems this bill was crafted to spe- are really facing these high premium care how much it costs. That is one of cifically target and destroy the elements of our hikes, the National Association of the reasons why the costs of health healthcare system that people know and trust: Manufacturers, the National Federa- care are going up through the roof. Medicare and Employer-sponsored cov- tion of Independent Businesses, this is This puts in place 280 million brains erage—and use the savings to give to CEOs, one of their key priorities. They en- on behalf of bringing down health care the healthy, and the wealthy. It is not sur- dorse this bill. costs and 280 million sets of eye balls prising to find that due to the structure of this What this does, Mr. Speaker, is it watching this industry to make sure bill, the same people whose children were de- makes it easier for employers to offer that doctors are charging the right nied the benefits of a child tax credit, will also health care to their employees. It helps kinds of prices, that hospitals are not not receive any benefits from this bill. us continue employer-sponsored health overcharging, and that they are get- Of course they will be allowed to help pay care. ting the best quality for their dollar. the interest on the booming debt that it adds Another thing that we have been Mr. Speaker, it is about giving power to. hearing, that this is fiscally irrespon- to consumers versus giving power to I will oppose this bill and encourage my col- sible and adds to the deficit. bureaucrats in Washington. Let us give leagues to do the same. Mr. Speaker, what is fiscally irre- Americans more freedom, let us give Mr. RYAN of Wisconsin. Mr. Speaker, sponsible is the substitute prescription consumers more power, and let us help I yield back the balance of my time. drug bill that the minority is bringing bring down health care costs. The SPEAKER pro tempore (Mr. to the floor which costs $600 billion Mr. Speaker, I urge passage of this SWEENEY). All time for debate has ex- more than the budget resolution al- bill. pired. lows. The budget resolution that Ms. JACKSON-LEE of Texas. Mr. Speaker, Pursuant to House Resolution 299, passed this House balances the budget it used to be that the most challenging part of the bill is considered read for amend- within the term of the budget resolu- my job here was finding meaningful ways of ment and the previous question is or- tion, within 10 years. And this is paid improving quality of life for the people in my dered. for and budgeted for in the budget reso- district. Now it seems the most challenging The question is on the engrossment lution. part is trying to figure out how the Republican and third reading of the bill. Mr. Speaker, at the end of the day, leadership will next try to deny those same The bill was ordered to be engrossed after we have heard all of these argu- people the lives they and their families de- and read a third time, and was read the ments, it kind of comes down to two serve. Today’s bill is one of the more creative third time. things, two different philosophies: so- approaches I have seen by the Republicans to The SPEAKER pro tempore. The cialism versus consumerism. They advance their goals of giving their rich political question is on the passage of the bill. want socialized medicine. They want donors big tax cuts, and denying the poor and The question was taken; and the power to go to Washington where middle classes healthcare and the services Speaker pro tempore announced that Washington can allocate the benefits, they need. the ayes appeared to have it. where Washington can ration the This bill serves no one that really needs it, Mr. STARK. Mr. Speaker, I object to health care. We want power to go to and will actually undermine the health insur- the vote on the ground that a quorum the people. We want power to go to the ance benefits received by millions of Ameri- is not present and make the point of consumers. We want people to have cans now. It is confusing and complex, and order that a quorum is not present.
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00065 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.131 H26PT1 H6006 CONGRESSIONAL RECORD — HOUSE June 26, 2003 The SPEAKER pro tempore. Evi- Brown, Corrine Jackson-Lee Pallone the availability of allotments for fiscal dently a quorum is not present. Capps (TX) Pascrell years 1998 through 2001 under the State Capuano Jefferson Pastor The Sergeant at Arms will notify ab- Cardin John Payne Children’s Health Insurance Program sent Members. Carson (IN) Johnson, E. B. Pelosi (SCHIP), and ask for its immediate The vote was taken by electronic de- Carson (OK) Jones (OH) Pomeroy consideration in the House. Castle Kanjorski Price (NC) The Clerk read the title of the bill. vice, and there were—yeas 237, nays Clay Kaptur Rahall 191, not voting 7, as follows: Clyburn Kennedy (RI) Rangel The SPEAKER pro tempore (Mr. Kildee Reyes [Roll No. 328] Conyers SWEENEY). Is there objection to the re- Cooper Kilpatrick Rodriguez quest of the gentleman from Lou- YEAS—237 Costello Kind Ross Kleczka Rothman isiana? Aderholt Frelinghuysen Northup Cramer Kucinich Roybal-Allard There was no objection. Akin Gallegly Norwood Crowley Lampson Ruppersberger Alexander Garrett (NJ) Nunes Cummings The Clerk read the bill, as follows: Langevin Rush Bachus Gerlach Nussle Davis (AL) Be it enacted by the Senate and House of Rep- Lantos Ryan (OH) Baker Gibbons Osborne Davis (CA) Larsen (WA) Sabo resentatives of the United States of America in Ballenger Gilchrest Ose Davis (FL) Larson (CT) Sanchez, Linda Congress assembled, Barrett (SC) Gillmor Otter Davis (IL) Lee T. SECTION 1. EXTENDING AVAILABILITY OF SCHIP Bartlett (MD) Gingrey Oxley DeFazio Levin Sanchez, Loretta ALLOTMENTS FOR FISCAL YEARS Barton (TX) Goode Paul DeGette Lewis (GA) Sanders 1998 THROUGH 2001. Bass Goodlatte Pearce Delahunt Lofgren Sandlin Beauprez Goss Pence DeLauro (a) RETAINED AND REDISTRIBUTED ALLOT- Lowey Schakowsky Bereuter Granger Peterson (MN) Dicks MENTS FOR FISCAL YEARS 1998 AND 1999.— Lynch Schiff Berkley Graves Peterson (PA) Dingell Paragraphs (2)(A)(i) and (2)(A)(ii) of section Majette Scott (VA) Biggert Green (WI) Petri Doggett Maloney Serrano 2104(g) of the Social Security Act (42 U.S.C. Bilirakis Greenwood Pickering Doyle Markey Sherman 1397dd(g)) are each amended by striking ‘‘fis- Bishop (GA) Gutknecht Pitts Edwards Marshall Skelton cal year 2002’’ and inserting ‘‘fiscal year Bishop (UT) Hall Platts Emanuel Matheson Slaughter Blackburn Harris Pombo 2004’’. Engel Matsui Snyder Blunt Hart Porter (b) EXTENSION AND REVISION OF RETAINED Eshoo McCarthy (MO) Solis Boehlert Hastert Portman AND REDISTRIBUTED ALLOTMENTS FOR FISCAL Etheridge McCarthy (NY) Spratt Boehner Hastings (WA) Pryce (OH) YEAR 2000.— Evans McCollum Stark Bonilla Hayes Putnam Farr McDermott Stenholm (1) PERMITTING AND EXTENDING RETENTION Bonner Hayworth Quinn Fattah McGovern Strickland OF PORTION OF FISCAL YEAR 2000 ALLOTMENT.— Bono Hefley Radanovich Filner McIntyre Stupak Paragraph (2) of such section 2104(g) is Boozman Hensarling Ramstad Ford McNulty Tanner amended— Boyd Herger Regula Frank (MA) Meehan Tauscher Bradley (NH) Hobson Rehberg (A) in the heading, by striking ‘‘AND 1999’’ Frost Meek (FL) Taylor (MS) Brady (TX) Hoekstra Renzi and inserting ‘‘THROUGH 2000’’; and Gonzalez Meeks (NY) Thompson (CA) Brown (SC) Hooley (OR) Reynolds (B) by adding at the end of subparagraph Gordon Menendez Thompson (MS) Burgess Hostettler Rogers (AL) Green (TX) Michaud Tierney (A) the following: Burns Hulshof Rogers (KY) Grijalva Millender- Towns ‘‘(iii) FISCAL YEAR 2000 ALLOTMENT.—Of the Burr Hunter Rogers (MI) Gutierrez McDonald Turner (TX) amounts allotted to a State pursuant to this Burton (IN) Hyde Rohrabacher Harman Miller (NC) Udall (CO) section for fiscal year 2000 that were not ex- Buyer Isakson Royce Hastings (FL) Miller, George Udall (NM) Calvert Issa Ryan (WI) pended by the State by the end of fiscal year Hill Mollohan Van Hollen Camp Istook Ryun (KS) 2002, 50 percent of that amount shall remain Hinchey Moore Velazquez Cannon Janklow Saxton available for expenditure by the State Hinojosa Moran (VA) Visclosky Cantor Jenkins Schrock Hoeffel Murtha Waters through the end of fiscal year 2004.’’. Capito Johnson (CT) Scott (GA) Holden Nadler Watson (2) REDISTRIBUTED ALLOTMENTS.—Para- Cardoza Johnson (IL) Sensenbrenner Holt Napolitano Watt graph (1) of such section 2104(g) is amended— Carter Johnson, Sam Sessions Honda Neal (MA) Waxman (A) in subparagraph (A), by inserting ‘‘or Case Jones (NC) Shadegg Houghton Oberstar Weiner Chabot Keller Shaw for fiscal year 2000 by the end of fiscal year Hoyer Obey Wexler Chocola Kelly Shays 2002,’’ after ‘‘fiscal year 2001,’’; Inslee Olver Woolsey Coble Kennedy (MN) Sherwood (B) in subparagraph (A), by striking ‘‘1998 Israel Ortiz Wu Cole King (IA) Shimkus Jackson (IL) Owens Wynn or 1999’’ and inserting ‘‘1998, 1999, or 2000’’; Collins King (NY) Shuster (C) in subparagraph (A)(i)— Cox Kingston Simmons NOT VOTING—7 (i) by striking ‘‘or’’ at the end of subclause Crane Kirk Simpson Brown-Waite, McInnis Vitter (I), Crenshaw Kline Smith (MI) Ginny Ros-Lehtinen Cubin Knollenberg Smith (NJ) Young (FL) (ii) by striking the period at the end of Gephardt Smith (WA) Culberson Kolbe Smith (TX) subclause (II) and inserting ‘‘; or’’; and Cunningham LaHood Souder ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE (iii) by adding at the end the following new Davis (TN) Latham Stearns The SPEAKER pro tempore (Mr. subclause: Davis, Jo Ann LaTourette Sullivan ‘‘(III) the fiscal year 2000 allotment, the Davis, Tom Leach Sweeney SWEENEY) (during the vote). Members amount specified in subparagraph (C)(i) (less Deal (GA) Lewis (CA) Tancredo are advised that there are 2 minutes re- the total of the amounts under clause (ii) for DeLay Lewis (KY) Tauzin maining in this vote. DeMint Linder Taylor (NC) such fiscal year), multiplied by the ratio of Deutsch Lipinski Terry b 1855 the amount specified in subparagraph (C)(ii) Diaz-Balart, L. LoBiondo Thomas for the State to the amount specified in sub- Diaz-Balart, M. Lucas (KY) Thornberry Mr. STRICKLAND and Mr. GUTIER- paragraph (C)(iii).’’; Dooley (CA) Lucas (OK) Tiahrt REZ changed their vote from ‘‘yea’’ to (D) in subparagraph (A)(ii), by striking ‘‘or Doolittle Manzullo Tiberi ‘‘nay.’’ 1999’’ and inserting ‘‘, 1999, or 2000’’; Dreier McCotter Toomey (E) in subparagraph (B), by striking ‘‘with Duncan McCrery Turner (OH) Mr. BISHOP of Georgia changed his Dunn McHugh Upton vote from ‘‘nay’’ to ‘‘yea.’’ respect to fiscal year 1998 or 1999’’; Ehlers McKeon Walden (OR) So the bill was passed. (F) in subparagraph (B)(ii)— Emerson Mica Walsh The result of the vote was announced (i) by inserting ‘‘with respect to fiscal year English Miller (FL) Wamp 1998, 1999, or 2000,’’ after ‘‘subsection (e),’’; Everett Miller (MI) Weldon (FL) as above recorded. and Feeney Miller, Gary Weldon (PA) A motion to reconsider was laid on (ii) by striking ‘‘2002’’ and inserting ‘‘2004’’; Ferguson Moran (KS) Weller the table. and Flake Murphy Whitfield Fletcher Musgrave Wicker f (G) by adding at the end the following new subparagraph: Foley Myrick Wilson (NM) EXTENDING AVAILABILITY OF Forbes Nethercutt Wilson (SC) ‘‘(C) AMOUNTS USED IN COMPUTING REDIS- Fossella Neugebauer Wolf SCHIP ALLOTMENTS FOR FISCAL TRIBUTIONS FOR FISCAL YEAR 2000.—For pur- Franks (AZ) Ney Young (AK) YEARS 1998 THROUGH 2001 poses of subparagraph (A)(i)(III)— NAYS—191 Mr. TAUZIN. Mr. Speaker, I ask ‘‘(i) the amount specified in this clause is unanimous consent that the Com- the amount specified in paragraph (2)(B)(i)(I) Abercrombie Baldwin Bishop (NY) for fiscal year 2000, less the total amount re- Ackerman Ballance Blumenauer mittee on Energy and Commerce be maining available pursuant to paragraph Allen Becerra Boswell discharged from further consideration Andrews Bell Boucher (2)(A)(iii); Baca Berman Brady (PA) of the bill (H.R. 531) to amend title XXI ‘‘(ii) the amount specified in this clause for Baird Berry Brown (OH) of the Social Security Act to extend a State is the amount by which the State’s
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00066 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.133 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6007
expenditures under this title in fiscal years ment for fiscal year 2001 under subsection (c) BIPA; SECRETARY.—In this Act: 2000, 2001, and 2002 exceed the State’s allot- (b); and (1) BIPA.—The term ‘‘BIPA’’ means the ment for fiscal year 2000 under subsection ‘‘(iii) the amount specified in this clause is Medicare, Medicaid, and SCHIP Benefits Im- (b); and the sum, for all States entitled to a redis- provement and Protection Act of 2000, as en- ‘‘(iii) the amount specified in this clause is tribution under subparagraph (A) from the acted into law by section 1(a)(6) of Public the sum, for all States entitled to a redis- allotments for fiscal year 2001, of the Law 106–554. tribution under subparagraph (A) from the amounts specified in clause (ii).’’. (2) SECRETARY.—The term ‘‘Secretary’’ allotments for fiscal year 2000, of the (3) CONFORMING AMENDMENTS.—Such sec- means the Secretary of Health and Human amounts specified in clause (ii).’’. tion 2104(g) is further amended— Services. (3) CONFORMING AMENDMENTS.—Such sec- (A) in its heading, by striking ‘‘AND 2000’’ (d) TABLE OF CONTENTS.—The table of con- tion 2104(g) is further amended— and inserting ‘‘2000, AND 2001’’; and tents of this Act is as follows: (A) in its heading, by striking ‘‘AND 1999’’ (B) in paragraph (3)— Sec. 1. Short title; amendments to Social and inserting ‘‘, 1999, AND 2000’’; and (i) by striking ‘‘or fiscal year 2000’’ and in- Security Act; references to (B) in paragraph (3)— serting ‘‘fiscal year 2000, or fiscal year 2001’’; BIPA and Secretary; table of (i) by striking ‘‘or fiscal year 1999’’ and in- and contents. serting ‘‘, fiscal year 1999, or fiscal year (ii) by striking ‘‘or November 30, 2002,’’ and TITLE I—MEDICARE PRESCRIPTION 2000’’; and inserting ‘‘November 30, 2002, or November DRUG BENEFIT (ii) by striking ‘‘or November 30, 2001’’ and 30, 2003,’’, respectively. Sec. 101. Establishment of a medicare pre- inserting ‘‘November 30, 2001, or November (d) EFFECTIVE DATE.—This section, and the scription drug benefit. 30, 2002’’, respectively. amendments made by this section, shall be (c) EXTENSION AND REVISION OF RETAINED effective as if this section had been enacted ‘‘PART D—VOLUNTARY PRESCRIPTION DRUG AND REDISTRIBUTED ALLOTMENTS FOR FISCAL on September 30, 2002, and amounts under BENEFIT PROGRAM YEAR 2001.— title XXI of the Social Security Act (42 ‘‘Sec. 1860D–1. Benefits; eligibility; en- (1) PERMITTING AND EXTENDING RETENTION U.S.C. 1397aa et seq.) from allotments for fis- rollment; and coverage period. OF PORTION OF FISCAL YEAR 2001 ALLOTMENT.— cal years 1998 through 2000 are available for ‘‘Sec. 1860D–2. Requirements for quali- Paragraph (2) of such section 2104(g), as expenditure on and after October 1, 2002, fied prescription drug coverage. amended in subsection (b)(1)(B), is further under the amendments made by this section ‘‘Sec. 1860D–3. Beneficiary protections amended— as if this section had been enacted on Sep- for qualified prescription drug (A) in the heading, by striking ‘‘2000’’ and tember 30, 2002. coverage. inserting ‘‘2001’’; and ‘‘Sec. 1860D–4. Requirements for and (B) by adding at the end of subparagraph The bill was ordered to be engrossed contracts with prescription (A) the following: and read a third time, was read the drug plan (PDP) sponsors. ‘‘(iv) FISCAL YEAR 2001 ALLOTMENT.—Of the third time, and passed, and a motion to ‘‘Sec. 1860D–5. Process for beneficiaries amounts allotted to a State pursuant to this reconsider was laid on the table. to select qualified prescription section for fiscal year 2001 that were not ex- f drug coverage. pended by the State by the end of fiscal year ‘‘Sec. 1860D–6. Submission of bids and 2003, 50 percent of that amount shall remain GENERAL LEAVE premiums. available for expenditure by the State ‘‘Sec. 1860D–7. Premium and cost-shar- through the end of fiscal year 2005.’’. Mr. TAUZIN. Mr. Speaker, I ask unanimous consent that all Members ing subsidies for low-income in- (2) REDISTRIBUTED ALLOTMENTS.—Para- dividuals. graph (1) of such section 2104(g), as amended may have 5 legislative days within ‘‘Sec. 1860D–8. Subsidies for all medicare in subsection (b)(2), is further amended— which to revise and extend their re- beneficiaries for qualified pre- (A) in subparagraph (A), by inserting ‘‘or marks on H.R. 531, the bill just passed. scription drug coverage. for fiscal year 2001 by the end of fiscal year The SPEAKER pro tempore. Is there ‘‘Sec. 1860D–9. Medicare Prescription 2003,’’ after ‘‘fiscal year 2002,’’; objection to the request of the gen- Drug Trust Fund. (B) in subparagraph (A), by striking ‘‘1999, tleman from Louisiana? ‘‘Sec. 1860D–10. Definitions; application or 2000’’ and inserting ‘‘1999, 2000, or 2001’’; There was no objection. to medicare advantage and (C) in subparagraph (A)(i)— EFFS programs; treatment of (i) by striking ‘‘or’’ at the end of subclause f references to provisions in part (II), MEDICARE PRESCRIPTION DRUG C. (ii) by striking the period at the end of AND MODERNIZATION ACT OF 2003 Sec. 102. Offering of qualified prescription subclause (III) and inserting ‘‘; or’’; and drug coverage under Medicare (iii) by adding at the end the following new Mr. THOMAS. Mr. Speaker, pursuant Advantage and enhanced fee- subclause: to House Resolution 299, I call up the for-service (EFFS) program. ‘‘(IV) the fiscal year 2001 allotment, the bill (H.R. 1) to amend title XVIII of the Sec. 103. Medicaid amendments. amount specified in subparagraph (D)(i) (less Social Security Act to provide for a Sec. 104. Medigap transition. the total of the amounts under clause (ii) for Sec. 105. Medicare prescription drug dis- such fiscal year), multiplied by the ratio of voluntary program for prescription count card and assistance pro- the amount specified in subparagraph (D)(ii) drug coverage under the Medicare Pro- gram. for the State to the amount specified in sub- gram, to modernize the Medicare Pro- Sec. 106. Disclosure of return information paragraph (D)(iii).’’; gram, and for other purposes, and ask for purposes of carrying out (D) in subparagraph (A)(ii), by striking ‘‘or for its immediate consideration. medicare catastrophic prescrip- 2000’’ and inserting ‘‘2000, or 2001’’; The Clerk read the title of the bill. tion drug program. (E) in subparagraph (B)— The SPEAKER pro tempore (Mr. Sec. 107. State Pharmaceutical Assistance (i) by striking ‘‘and’’ at the end of clause Transition Commission. LAHOOD). Pursuant to House Resolu- Sec. 108. Additional requirements for annual (ii); tion 299, the bill is considered read for (ii) by redesignating clause (iii) as clause financial report and oversight (iv); and amendment. on medicare program, including (iii) by inserting after clause (ii) the fol- The text of H.R. 1 is as follows: prescription drug spending. lowing new clause: H.R. 1 TITLE II—MEDICARE ENHANCED FEE- ‘‘(iii) notwithstanding subsection (e), with Be it enacted by the Senate and House of Rep- FOR-SERVICE AND MEDICARE ADVAN- respect to fiscal year 2001, shall remain resentatives of the United States of America in TAGE PROGRAMS; MEDICARE COM- available for expenditure by the State Congress assembled, PETITION through the end of fiscal year 2005; and’’; and SECTION 1. SHORT TITLE; AMENDMENTS TO SO- Sec. 200. Medicare modernization and revi- (F) by adding at the end the following new CIAL SECURITY ACT; REFERENCES talization. subparagraph: TO BIPA AND SECRETARY; TABLE OF Subtitle A—Medicare Enhanced Fee-for- ‘‘(D) AMOUNTS USED IN COMPUTING REDIS- CONTENTS. Service Program TRIBUTIONS FOR FISCAL YEAR 2001.—For pur- (a) SHORT TITLE.—This Act may be cited as poses of subparagraph (A)(i)(IV)— the ‘‘Medicare Prescription Drug and Mod- Sec. 201. Establishment of enhanced fee-for- ‘‘(i) the amount specified in this clause is ernization Act of 2003’’. service (EFFS) program under the amount specified in paragraph (2)(B)(i)(I) (b) AMENDMENTS TO SOCIAL SECURITY medicare. for fiscal year 2001, less the total amount re- ACT.—Except as otherwise specifically pro- ‘‘PART E—ENHANCED FEE-FOR-SERVICE maining available pursuant to paragraph vided, whenever in this Act an amendment is PROGRAM (2)(A)(iv); expressed in terms of an amendment to or re- ‘‘Sec. 1860E–1. Offering of enhanced fee- ‘‘(ii) the amount specified in this clause for peal of a section or other provision, the ref- for-service plans throughout a State is the amount by which the State’s erence shall be considered to be made to that the United States. expenditures under this title in fiscal years section or other provision of the Social Secu- ‘‘Sec. 1860E–2. Offering of enhanced fee- 2001, 2002, and 2003 exceed the State’s allot- rity Act. for-service (EFFS) plans.
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00067 Fmt 7634 Sfmt 0655 E:\CR\FM\A26JN7.074 H26PT1 H6008 CONGRESSIONAL RECORD — HOUSE June 26, 2003 ‘‘Sec. 1860E–3. Submission of bids; bene- Sec. 411. Two-year increase for home health Sec. 628. Part B deductible. ficiary savings; payment of services furnished in a rural Sec. 629. Extension of coverage of intra- plans. area. venous immune globulin (IVIG) ‘‘Sec. 1860E–4. Premiums; organizational Sec. 412. Providing safe harbor for certain for the treatment of primary and financial requirements; es- collaborative efforts that ben- immune deficiency diseases in tablishment of standards; con- efit medically underserved pop- the home. tracts with EFFS organiza- ulations. Sec. 630. Medicare coverage of diabetes lab- tions. Sec. 413. GAO study of geographic dif- oratory diagnostic tests. Subtitle B—Medicare Advantage Program ferences in payments for physi- Sec. 631. Demonstration project for coverage cians’ services. of certain prescription drugs CHAPTER 1—IMPLEMENTATION OF PROGRAM Sec. 414. Treatment of missing cost report- and biologics. Sec. 211. Implementation of medicare advan- ing periods for sole community tage program. TITLE VII—PROVISIONS RELATING TO hospitals. PARTS A AND B Sec. 212. Medicare advantage improvements. Sec. 415. Extension of telemedicine dem- Subtitle A—Home Health Services CHAPTER 2—IMPLEMENTATION OF COMPETITION onstration project. PROGRAM Sec. 416. Adjustment to the medicare inpa- Sec. 701. Update in home health services. Sec. 221. Competition program beginning in tient hospital PPS wage index Sec. 702. Establishment of reduced copay- 2006. to revise the labor-related ment for a home health service episode of care for certain bene- CHAPTER 3—ADDITIONAL REFORMS share of such index. Sec. 417. Medicare incentive payment pro- ficiaries. Sec. 231. Making permanent change in medi- gram improvements for physi- Sec. 703. MedPAC study on medicare mar- care advantage reporting dead- cian scarcity. gins of home health agencies. lines and annual, coordinated Sec. 418. Rural hospice demonstration Sec. 704. Demonstration project to clarify election period. project. the definition of homebound. Sec. 232. Avoiding duplicative State regula- Subtitle B—Direct Graduate Medical tion. TITLE V—PROVISIONS RELATING TO Education Sec. 233. Specialized medicare advantage PART A plans for special needs bene- Subtitle A—Inpatient Hospital Services Sec. 711. Extension of update limitation on ficiaries. Sec. 501. Revision of acute care hospital pay- high cost programs. Sec. 234. Medicare MSAs. ment updates. Subtitle C—Chronic Care Improvement Sec. 235. Extension of reasonable cost con- Sec. 502. Recognition of new medical tech- Sec. 721. Voluntary chronic care improve- tracts. nologies under inpatient hos- ment under traditional fee-for- Sec. 236. Extension of municipal health serv- pital PPS. service. ice demonstration projects. Sec. 503. Increase in Federal rate for hos- Sec. 722. Chronic care improvement under Sec. 237. Study of performance-based pay- pitals in Puerto Rico. medicare advantage and en- ment systems. Sec. 504. Wage index adjustment reclassi- hanced fee-for-service pro- Subtitle C—Application of FEHBP-Style fication reform . grams. Competitive Reforms Sec. 505. MedPAC report on specialty hos- Sec. 723. Institute of Medicine report. Sec. 241. Application of FEHBP-style com- pitals. Sec. 724. MedPAC report. petitive reform beginning in Subtitle B—Other Provisions Subtitle D—Other Provisions 2010. Sec. 511. Payment for covered skilled nurs- Sec. 731. Modifications to medicare payment TITLE III—COMBATTING WASTE, FRAUD, ing facility services. advisory commission AND ABUSE Sec. 512. Coverage of hospice consultation (MedPAC). Sec. 301. Medicare secondary payor (MSP) services. Sec. 732. Demonstration project for medical provisions. Sec. 513. Correction of Trust Fund holdings. adult day care services. Sec. 302. Competitive acquisition of certain TITLE VI—PROVISIONS RELATING TO Sec. 733. Improvements in national and local items and services. PART B coverage determination process Sec. 303. Competitive acquisition of covered Subtitle A—Physicians’ Services to respond to changes in tech- nology. outpatient drugs and Sec. 601. Revision of updates for physicians’ Sec. 734. Treatment of certain physician pa- biologicals. services. thology services. Sec. 304. Demonstration project for use of Sec. 602. Studies on access to physicians’ Sec. 735. Clinical investigation of medicare recovery audit contractors. services. TITLE IV—RURAL HEALTH CARE Sec. 603. MedPAC report on payment for pancreatic islet cell trans- IMPROVEMENTS physicians’ services. plants. Sec. 736. Demonstration project for con- Sec. 401. Enhanced disproportionate share Sec. 604. Inclusion of podiatrists and den- sumer-directed chronic out- hospital (DSH) treatment for tists under private contracting patient services. rural hospitals and urban hos- authority. pitals with fewer than 100 beds. Sec. 605. Establishment of floor on work ge- TITLE VIII—MEDICARE BENEFITS Sec. 402. Immediate establishment of uni- ographic adjustment. ADMINISTRATION form standardized amount in Subtitle B—Preventive Services Sec. 801. Establishment of Medicare Benefits rural and small urban areas. Sec. 611. Coverage of an initial preventive Administration. Sec. 403. Establishment of essential rural physical examination. TITLE IX—REGULATORY REDUCTION hospital classification. Sec. 612. Coverage of cholesterol and blood AND CONTRACTING REFORM Sec. 404. More frequent update in weights lipid screening. used in hospital market basket. Subtitle A—Regulatory Reform Sec. 613. Waiver of deductible for colorectal Sec. 405. Improvements to critical access Sec. 901. Construction; definition of sup- cancer screening tests. hospital program. plier. Sec. 614. Improved payment for certain Sec. 406. Redistribution of unused resident Sec. 902. Issuance of regulations. mammography services. positions. Sec. 903. Compliance with changes in regula- Sec. 407. Two-year extension of hold harm- Subtitle C—Other Services tions and policies. less provisions for small rural Sec. 621. Hospital outpatient department Sec. 904. Reports and studies relating to reg- hospitals and sole community (HOPD) payment reform. ulatory reform. hospitals under prospective Sec. 622. Payment for ambulance services. Subtitle B—Contracting Reform Sec. 623. Renal dialysis services. payment system for hospital Sec. 911. Increased flexibility in medicare Sec. 624. One-year moratorium on therapy outpatient department services. administration. Sec. 408. Exclusion of certain rural health caps; provisions relating to re- Sec. 912. Requirements for information secu- clinic and federally qualified ports. rity for medicare administra- health center services from the Sec. 625. Adjustment to payments for serv- tive contractors. prospective payment system for ices furnished in ambulatory skilled nursing facilities. surgical centers. Subtitle C—Education and Outreach Sec. 409. Recognition of attending nurse Sec. 626. Payment for certain shoes and in- Sec. 921. Provider education and technical practitioners as attending phy- serts under the fee schedule for assistance. sicians to serve hospice pa- orthotics and prosthetics. Sec. 922. Small provider technical assistance tients. Sec. 627. Waiver of part B late enrollment demonstration program. Sec. 410. Improvement in payments to retain penalty for certain military re- Sec. 923. Medicare Provider Ombudsman; emergency capacity for ambu- tirees; special enrollment pe- Medicare Beneficiary Ombuds- lance services in rural areas. riod. man.
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00068 Fmt 7634 Sfmt 0655 E:\CR\FM\A26JN7.055 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6009 Sec. 924. Beneficiary outreach demonstra- Sec. 1115. Enforcement. qualified prescription drug coverage at the tion program. Sec. 1116. Rulemaking. time of such first enrollment, the individual Sec. 925. Inclusion of additional information Sec. 1117. Savings clause. shall be permitted to enroll in a prescription in notices to beneficiaries Sec. 1118. Effective date. drug plan under this part at the time of the about skilled nursing facility Subtitle C—Importation of Prescription election of coverage under the original fee- benefits. Drugs for-service plan. Sec. 926. Information on medicare-certified Sec. 1121. Importation of prescription drugs. ‘‘(B) INITIAL ELECTION PERIODS.— skilled nursing facilities in hos- TITLE I—MEDICARE PRESCRIPTION DRUG ‘‘(i) INDIVIDUALS CURRENTLY COVERED.—In pital discharge plans. BENEFIT the case of an individual who is entitled to benefits under part A or enrolled under part Subtitle D—Appeals and Recovery SEC. 101. ESTABLISHMENT OF A MEDICARE PRE- Sec. 931. Transfer of responsibility for medi- SCRIPTION DRUG BENEFIT. B as of October 1, 2005, there shall be an ini- care appeals. (a) IN GENERAL.—Title XVIII is amended— tial election period of 6 months beginning on Sec. 932. Process for expedited access to re- (1) by redesignating part D as part F; and that date. view. (2) by inserting after part C the following ‘‘(ii) INDIVIDUAL COVERED IN FUTURE.—In Sec. 933. Revisions to medicare appeals proc- new part: the case of an individual who is first entitled to benefits under part A or enrolled under ess. ‘‘PART D—VOLUNTARY PRESCRIPTION DRUG part B after such date, there shall be an ini- Sec. 934. Prepayment review. BENEFIT PROGRAM Sec. 935. Recovery of overpayments. tial election period which is the same as the Sec. 936. Provider enrollment process; right ‘‘SEC. 1860D–1. BENEFITS; ELIGIBILITY; ENROLL- initial enrollment period under section MENT; AND COVERAGE PERIOD. of appeal. 1837(d). ‘‘(a) PROVISION OF QUALIFIED PRESCRIPTION Sec. 937. Process for correction of minor er- ‘‘(C) ADDITIONAL SPECIAL ELECTION PERI- DRUG COVERAGE THROUGH ENROLLMENT IN rors and omissions without pur- ODS.—The Administrator shall establish spe- PLANS.—Subject to the succeeding provisions suing appeals process. cial election periods— of this part, each individual who is entitled Sec. 938. Prior determination process for ‘‘(i) in cases of individuals who have and to benefits under part A or is enrolled under certain items and services; ad- involuntarily lose prescription drug coverage part B is entitled to obtain qualified pre- vance beneficiary notices. described in subsection (c)(2)(C); scription drug coverage (described in section ‘‘(ii) in cases described in section 1837(h) Subtitle V—Miscellaneous Provisions 1860D–2(a)) as follows: (relating to errors in enrollment), in the Sec. 941. Policy development regarding eval- ‘‘(1) MEDICARE-RELATED PLANS.— same manner as such section applies to part uation and management (E & ‘‘(A) MEDICARE ADVANTAGE.—If the indi- B; M) documentation guidelines. vidual is eligible to enroll in a Medicare Ad- ‘‘(iii) in the case of an individual who Sec. 942. Improvement in oversight of tech- vantage plan that provides qualified pre- meets such exceptional conditions (including nology and coverage. scription drug coverage under section 1851(j), conditions provided under section Sec. 943. Treatment of hospitals for certain the individual may enroll in such plan and 1851(e)(4)(D)) as the Administrator may pro- services under medicare sec- obtain coverage through such plan. vide; and ondary payor (MSP) provisions. ‘‘(B) EFFS PLANS.—If the individual is eli- Sec. 944. EMTALA improvements. gible to enroll in an EFFS plan that provides ‘‘(iv) in cases of individuals (as determined Sec. 945. Emergency Medical Treatment and qualified prescription drug coverage under by the Administrator) who become eligible Active Labor Act (EMTALA) part E under section 1860E–2(d), the indi- for prescription drug assistance under title technical advisory group. vidual may enroll in such plan and obtain XIX under section 1935(d). Sec. 946. Authorizing use of arrangements to coverage through such plan. ‘‘(3) INFORMATION ON PLANS.—Information provide core hospice services in ‘‘(C) MA-EFFS PLAN; MA-EFFS RX PLAN.— described in section 1860D–3(b)(1) on prescrip- certain circumstances. For purposes of this part, the term ‘MA- tion drug plans and MA-EFFS Rx plans shall Sec. 947. Application of OSHA bloodborne EFFS plan’ means a Medicare Advantage be made available during election periods. pathogens standard to certain plan under part C and an EFFS plan under ‘‘(4) ADDITIONAL INFORMATION.—In order to hospitals. part E and the term ‘MA-EFFS Rx plan’ promote the efficient marketing of prescrip- Sec. 948. BIPA-related technical amend- means a MA-EFFS plan insofar as such plan tion drug plans and MA-EFFS plans, the Ad- ments and corrections. provides qualified prescription drug cov- ministrator may provide information to the Sec. 949. Conforming authority to waive a erage. sponsors and organizations offering such program exclusion. ‘‘(2) PRESCRIPTION DRUG PLAN.—If the indi- plans about individuals eligible to enroll in Sec. 950. Treatment of certain dental vidual is not enrolled in a MA-EFFS plan, such plans. claims. the individual may enroll under this part in ‘‘(c) GUARANTEED ISSUE; COMMUNITY RAT- Sec. 951. Furnishing hospitals with informa- a prescription drug plan (as defined in sec- ING; AND NONDISCRIMINATION.— tion to compute dsh formula. tion 1860D–10(a)(5)). ‘‘(1) GUARANTEED ISSUE.— Sec. 952. Revisions to reassignment provi- Such individuals shall have a choice of such ‘‘(A) IN GENERAL.—An eligible individual sions. plans under section 1860D–5(d). who is eligible to elect qualified prescription Sec. 953. Other provisions. ‘‘(b) GENERAL ELECTION PROCEDURES.— drug coverage under a prescription drug plan Sec. 954. Temporary suspension of OASIS re- ‘‘(1) IN GENERAL.—An individual eligible to or MA-EFFS Rx plan at a time during which quirement for collection of data make an election under subsection (a) may elections are accepted under this part with on non-medicare and non-med- elect to enroll in a prescription drug plan respect to the plan shall not be denied en- icaid patients. under this part, or elect the option of quali- rollment based on any health status-related TITLE X—MEDICAID fied prescription drug coverage under a MA- factor (described in section 2702(a)(1) of the Sec. 1001. Medicaid disproportionate share EFFS Rx plan under part C or part E, and to Public Health Service Act) or any other fac- hospital (DSH) payments. change such election only in such manner tor. Sec. 1002. Clarification of inclusion of inpa- and form as may be prescribed by regula- ‘‘(B) MEDICARE ADVANTAGE LIMITATIONS tient drug prices charged to tions of the Administrator of the Medicare PERMITTED.—The provisions of paragraphs (2) certain public hospitals in the Benefits Administration (appointed under and (3) (other than subparagraph (C)(i), relat- best price exemptions for the section 1809(b)) (in this part referred to as ing to default enrollment) of section 1851(g) medicaid drug rebate program. the ‘Medicare Benefits Administrator’) and (relating to priority and limitation on termi- TITLE XI—ACCESS TO AFFORDABLE only during an election period prescribed in nation of election) shall apply to PDP spon- PHARMACEUTICALS or under this subsection. sors under this subsection. ‘‘(2) ELECTION PERIODS.— Subtitle A—Access to Affordable ‘‘(2) COMMUNITY-RATED PREMIUM.— ‘‘(A) IN GENERAL.—Except as provided in Pharmaceuticals ‘‘(A) IN GENERAL.—In the case of an indi- this paragraph, the election periods under vidual who enrolls under a prescription drug Sec. 1101. 30-month stay-of-effectiveness pe- this subsection shall be the same as the cov- plan or in a MA-EFFS Rx plan during the in- riod. erage election periods under the Medicare dividual’s initial enrollment period under Sec. 1102. Forfeiture of 180-day exclusivity Advantage and EFFS programs under sec- this part or maintains (as determined under period. tion 1851(e), including— subparagraph (C)) continuous prescription Sec. 1103. Bioavailability and bioequiva- ‘‘(i) annual coordinated election periods; drug coverage since the date the individual lence. and first qualifies to elect prescription drug cov- Sec. 1104. Conforming amendments. ‘‘(ii) special election periods. erage under this part, a PDP sponsor or enti- Subtitle B—Ability of Federal Trade In applying the last sentence of section ty offering a prescription drug plan or MA- Commission to Enforce Antitrust Laws 1851(e)(4) (relating to discontinuance of an EFFS Rx plan and in which the individual is Sec. 1111. Definitions. election during the first year of eligibility) enrolled may not deny, limit, or condition Sec. 1112. Notification of agreements. under this subparagraph, in the case of an the coverage or provision of covered pre- Sec. 1113. Filing deadlines. election described in such section in which scription drug benefits or vary or increase Sec. 1114. Disclosure exemption. the individual had elected or is provided the premium under the plan based on any
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00069 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.055 H26PT1 H6010 CONGRESSIONAL RECORD — HOUSE June 26, 2003 health status-related factor described in sec- graph (E)(ii)) the coverage provides benefits as preventing qualified prescription drug tion 2702(a)(1) of the Public Health Service at least equivalent to the benefits under a coverage from including coverage of covered Act or any other factor. qualified prescription drug plan. outpatient drugs that exceeds the coverage ‘‘(B) LATE ENROLLMENT PENALTY.—In the ‘‘(D) CERTIFICATION.—For purposes of car- required under paragraph (1), but any such case of an individual who does not maintain rying out this paragraph, the certifications additional coverage shall be limited to cov- such continuous prescription drug coverage of the type described in sections 2701(e) of erage of covered outpatient drugs. (as described in subparagraph (C)), a PDP the Public Health Service Act and in section ‘‘(B) DISAPPROVAL AUTHORITY.—The Admin- sponsor or an entity offering a MA-EFFS Rx 9801(e) of the Internal Revenue Code shall istrator shall review the offering of qualified plan may (notwithstanding any provision in also include a statement for the period of prescription drug coverage under this part or this title) adjust the premium otherwise ap- coverage of whether the individual involved part C or E. If the Administrator finds, in plicable with respect to qualified prescrip- had prescription drug coverage described in the case of a qualified prescription drug cov- tion drug coverage in a manner that reflects subparagraph (C). erage under a prescription drug plan or a additional actuarial risk involved. Such a ‘‘(E) DISCLOSURE.— MA-EFFS Rx plan, that the organization or risk shall be established through an appro- ‘‘(i) IN GENERAL.—Each entity that offers sponsor offering the coverage is engaged in priate actuarial opinion of the type de- coverage of the type described in clause (iii), activities intended to discourage enrollment scribed in subparagraphs (A) through (C) of (iv), (v), or (vi) of subparagraph (C) shall pro- of classes of eligible medicare beneficiaries section 2103(c)(4). The Administrator shall vide for disclosure, consistent with standards obtaining coverage through the plan on the provide a mechanism for assisting such spon- established by the Administrator, of whether basis of their higher likelihood of utilizing sors and entities in identifying eligible indi- such coverage provides benefits at least prescription drug coverage, the Adminis- viduals who have (or have not) maintained equivalent to the benefits under a qualified trator may terminate the contract with the such continuous prescription drug coverage. prescription drug plan. sponsor or organization under this part or ‘‘(C) CONTINUOUS PRESCRIPTION DRUG COV- ‘‘(ii) WAIVER OF LIMITATIONS.—An indi- part C or E. ERAGE.—An individual is considered for pur- vidual may apply to the Administrator to ‘‘(3) APPLICATION OF SECONDARY PAYOR PRO- poses of this part to be maintaining contin- waive the requirement that coverage of such VISIONS.—The provisions of section 1852(a)(4) uous prescription drug coverage on and after type provide benefits at least equivalent to shall apply under this part in the same man- the date the individual first qualifies to elect the benefits under a qualified prescription ner as they apply under part C. prescription drug coverage under this part if drug plan, if the individual establishes that ‘‘(b) STANDARD COVERAGE.—For purposes of the individual establishes that as of such the individual was not adequately informed this part, the ‘standard coverage’ is coverage date the individual is covered under any of that such coverage did not provide such level of covered outpatient drugs (as defined in the following prescription drug coverage and of benefits. subsection (f)) that meets the following re- before the date that is the last day of the 63- ‘‘(F) CONSTRUCTION.—Nothing in this sec- quirements: day period that begins on the date of termi- tion shall be construed as preventing the ‘‘(1) DEDUCTIBLE.—The coverage has an an- nation of the particular prescription drug disenrollment of an individual from a pre- nual deductible— coverage involved (regardless of whether the scription drug plan or a MA-EFFS Rx plan ‘‘(A) for 2006, that is equal to $250; or individual subsequently obtains any of the based on the termination of an election de- ‘‘(B) for a subsequent year, that is equal to following prescription drug coverage): scribed in section 1851(g)(3), including for the amount specified under this paragraph ‘‘(i) COVERAGE UNDER PRESCRIPTION DRUG non-payment of premiums or for other rea- for the previous year increased by the per- PLAN OR MA-EFFS RX PLAN.—Qualified pre- sons specified in subsection (d)(3), which centage specified in paragraph (5) for the scription drug coverage under a prescription takes into account a grace period described year involved. drug plan or under a MA-EFFS Rx plan. in section 1851(g)(3)(B)(i). Any amount determined under subparagraph ‘‘(ii) MEDICAID PRESCRIPTION DRUG COV- ‘‘(3) NONDISCRIMINATION.—A PDP sponsor (B) that is not a multiple of $10 shall be ERAGE.—Prescription drug coverage under a that offers a prescription drug plan in an rounded to the nearest multiple of $10. medicaid plan under title XIX, including area designated under section 1860D–4(b)(5) ‘‘(2) 80:20 BENEFIT STRUCTURE.— through the Program of All-inclusive Care shall make such plan available to all eligible ‘‘(A) 20 PERCENT COINSURANCE.—The cov- for the Elderly (PACE) under section 1934, or individuals residing in the area without re- erage has cost-sharing (for costs above the through a demonstration project under part gard to their health or economic status or C that demonstrates the application of capi- their place of residence within the area. annual deductible specified in paragraph (1) tation payment rates for frail elderly medi- ‘‘(d) EFFECTIVE DATE OF ELECTIONS.— and up to the initial coverage limit under care beneficiaries through the use of an ‘‘(1) IN GENERAL.—Except as provided in paragraph (3)) that is— interdisciplinary team and through the pro- this section, the Administrator shall provide ‘‘(i) equal to 20 percent; or vision of primary care services to such bene- that elections under subsection (b) take ef- ‘‘(ii) is actuarially equivalent (using proc- ficiaries by means of such a team at the fect at the same time as the Administrator esses established under subsection (e)) to an nursing facility involved. provides that similar elections under section average expected payment of 20 percent of ‘‘(iii) PRESCRIPTION DRUG COVERAGE UNDER 1851(e) take effect under section 1851(f). such costs. GROUP HEALTH PLAN.—Any outpatient pre- ‘‘(2) NO ELECTION EFFECTIVE BEFORE 2006.—In ‘‘(B) USE OF TIERS.—Nothing in this part scription drug coverage under a group health no case shall any election take effect before shall be construed as preventing a PDP spon- plan, including a health benefits plan under January 1, 2006. sor from applying tiered copayments, so long the Federal Employees Health Benefit Plan ‘‘(3) TERMINATION.—The Administrator as such tiered copayments are consistent under chapter 89 of title 5, United States shall provide for the termination of an elec- with subparagraph (A). Code, and a qualified retiree prescription tion in the case of— ‘‘(3) INITIAL COVERAGE LIMIT.—Subject to drug plan as defined in section 1860D–8(f)(1), ‘‘(A) termination of coverage under both paragraph (4), the coverage has an initial but only if (subject to subparagraph (E)(ii)) part A and part B; and coverage limit on the maximum costs that the coverage provides benefits at least equiv- ‘‘(B) termination of elections described in may be recognized for payment purposes— alent to the benefits under a qualified pre- section 1851(g)(3) (including failure to pay re- ‘‘(A) for 2006, that is equal to $2,000; or scription drug plan. quired premiums). ‘‘(B) for a subsequent year, that is equal to ‘‘(iv) PRESCRIPTION DRUG COVERAGE UNDER ‘‘SEC. 1860D–2. REQUIREMENTS FOR QUALIFIED the amount specified in this paragraph for CERTAIN MEDIGAP POLICIES.—Coverage under PRESCRIPTION DRUG COVERAGE. the previous year, increased by the annual a medicare supplemental policy under sec- ‘‘(a) REQUIREMENTS.— percentage increase described in paragraph tion 1882 that provides benefits for prescrip- ‘‘(1) IN GENERAL.—For purposes of this part (5) for the year involved. tion drugs (whether or not such coverage and part C and part E, the term ‘qualified Any amount determined under subparagraph conforms to the standards for packages of prescription drug coverage’ means either of (B) that is not a multiple of $25 shall be benefits under section 1882(p)(1)), but only if the following: rounded to the nearest multiple of $25. the policy was in effect on January 1, 2006, ‘‘(A) STANDARD COVERAGE WITH ACCESS TO ‘‘(4) CATASTROPHIC PROTECTION.— and if (subject to subparagraph (E)(ii)) the NEGOTIATED PRICES.—Standard coverage (as ‘‘(A) IN GENERAL.—Notwithstanding para- coverage provides benefits at least equiva- defined in subsection (b)) and access to nego- graph (3), the coverage provides benefits with lent to the benefits under a qualified pre- tiated prices under subsection (d). no cost-sharing after the individual has in- scription drug plan. ‘‘(B) ACTUARIALLY EQUIVALENT COVERAGE curred costs (as described in subparagraph ‘‘(v) STATE PHARMACEUTICAL ASSISTANCE WITH ACCESS TO NEGOTIATED PRICES.—Cov- (C)) for covered outpatient drugs in a year PROGRAM.—Coverage of prescription drugs erage of covered outpatient drugs which equal to the annual out-of-pocket threshold under a State pharmaceutical assistance pro- meets the alternative coverage requirements specified in subparagraph (B). gram, but only if (subject to subparagraph of subsection (c) and access to negotiated ‘‘(B) ANNUAL OUT-OF-POCKET THRESHOLD.— (E)(ii)) the coverage provides benefits at prices under subsection (d), but only if it is ‘‘(i) IN GENERAL.—For purposes of this part, least equivalent to the benefits under a approved by the Administrator, as provided the ‘annual out-of-pocket threshold’ speci- qualified prescription drug plan. under subsection (c). fied in this subparagraph is equal to $3,500 ‘‘(vi) VETERANS’ COVERAGE OF PRESCRIPTION ‘‘(2) PERMITTING ADDITIONAL OUTPATIENT (subject to adjustment under clause (ii) and DRUGS.—Coverage of prescription drugs for PRESCRIPTION DRUG COVERAGE.— subparagraph (D)). veterans under chapter 17 of title 38, United ‘‘(A) IN GENERAL.—Subject to subparagraph ‘‘(ii) INFLATION INCREASE.—For a year after States Code, but only if (subject to subpara- (B), nothing in this part shall be construed 2006, the dollar amount specified in clause (i)
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shall be increased by the annual percentage ‘‘(v) INDIVIDUAL ELECTION TO PRESENT MOST drug plan or in an MA-EFFS Rx plan or an increase described in paragraph (5) for the RECENT INFORMATION REGARDING INCOME.— individual who makes an election under sub- year involved. Any amount determined The Secretary shall provide, in coordination paragraph (D)(vii), the Secretary shall dis- under the previous sentence that is not a with the Secretary of the Treasury, a proce- close to the entity that offers the plan the multiple of $100 shall be rounded to the near- dure under which, for purposes of applying annual out-of-pocket threshold applicable to est multiple of $100. this subparagraph for a calendar year, in- such individual under subparagraph (D). ‘‘(C) APPLICATION.—In applying subpara- stead of using the information described in ‘‘(F) MAINTAINING CONFIDENTIALITY OF IN- graph (A)— clause (iv), an enrollee may elect to use FORMATION.— ‘‘(i) incurred costs shall only include costs more recent information, including informa- ‘‘(i) IN GENERAL.—The amount of any in- incurred for the annual deductible (described tion with respect to a taxable year ending in crease in an annual out-of-pocket threshold in paragraph (1)), cost-sharing (described in such calendar year. Such process shall— under subparagraph (D) may not be disclosed paragraph (2)), and amounts for which bene- ‘‘(I) require the enrollee to provide the by the Secretary except to a PDP sponsor or fits are not provided because of the applica- Secretary with a copy of the relevant por- entity that offers a MA-EFFS Rx plan to the tion of the initial coverage limit described in tion of the more recent return to be used extent necessary to carry out this part. paragraph (3); and under this clause; ‘‘(ii) CRIMINAL AND CIVIL PENALTIES FOR UN- ‘‘(ii) such costs shall be treated as incurred ‘‘(II) provide for the Medicare Beneficiary AUTHORIZED DISCLOSURE.—A person who only if they are paid by the individual (or by Ombudsman (under section 1810) offering as- makes an unauthorized disclosure of infor- another individual, such as a family member, sistance to such enrollees in presenting such mation disclosed under section 6103(l)(19) of on behalf of the individual), under section information and the toll-free number under the Internal Revenue Code of 1986 (including 1860D–7, under title XIX, or under a State such section being a point of contact for disclosure of any increase in an annual out- pharmaceutical assistance program and the beneficiaries to inquire as to how to present of-pocket threshold under subparagraph (D)) individual (or other individual) is not reim- such information; shall be subject to penalty to the extent pro- bursed through insurance or otherwise, a ‘‘(III) provide for the verification of the in- vided under— group health plan, or other third-party pay- formation in such return by the Secretary of ‘‘(I) section 7213 of such Code (relating to ment arrangement (other than under such the Treasury under section 6103(l)(19) of the criminal penalty for unauthorized disclosure title or such program) for such costs. Internal Revenue Code of 1986; and of information); ‘‘(D) ADJUSTMENT OF ANNUAL OUT-OF-POCK- ‘‘(IV) provide for the payment by the Sec- ‘‘(II) section 7213A of such Code (relating to ET THRESHOLDS.— retary (in a manner specified by the Sec- criminal penalty for unauthorized inspection ‘‘(i) IN GENERAL.—Subject to clause (vii), retary) to the enrollee of an amount equal to of returns or return information); for each enrollee in a prescription drug plan the excess of the benefit payments that ‘‘(III) section 7431 of such Code (relating to or in a MA-EFFS Rx plan whose adjusted would have been payable under the plan if civil damages for unauthorized inspection or gross income exceeds the income threshold the more recent return information were disclosure of returns and return informa- as defined in clause (ii) for a year, the annual used, over the benefit payments that were tion); out-of-pocket threshold otherwise deter- made under the plan. ‘‘(IV) any other provision of the Internal mined under subparagraph (B) for such year Revenue Code of 1986; or In the case of a payment under subclause shall be increased by an amount equal to the ‘‘(V) any other provision of law. (III) for an enrollee under a prescription drug percentage specified in clause (iii), multi- ‘‘(iii) APPLICATION OF ADDITIONAL CIVIL plan, the PDP sponsor of the plan shall pay plied by the lesser of— MONETARY PENALTY FOR UNAUTHORIZED DIS- to the Secretary the amount so paid, less the ‘‘(I) the amount of such excess; or CLOSURES.—In addition to any penalty other- applicable reinsurance amount that would ‘‘(II) the amount by which the income wise provided under law, any person who have applied under section 1860D–8(c)(1)(B) if threshold limit exceeds the income thresh- makes an unauthorized disclosure of such in- such payment had been treated as an allow- old. formation shall be subject to a civil mone- able cost under such section. Such plan pay- tary penalty of not to exceed $10,000 for each Any amount determined under the previous ment shall be deposited in the Treasury to such unauthorized disclosure. The provisions sentence that is not a multiple of $100 shall the credit of the Medicare Prescription Drug of section 1128A (other than subsections (a) be rounded to the nearest multiple of $100. Account in the Federal Supplementary Med- and (b)) shall apply to civil money penalties ‘‘(ii) INCOME THRESHOLD.—For purposes of ical Insurance Trust Fund (under section under this subparagraph in the same manner clause (i)— 1841). as they apply to a penalty or proceeding ‘‘(I) IN GENERAL.—Subject to subclause (II), ‘‘(vi) DISSEMINATION OF INFORMATION ON under section 1128A(a). the term ‘income threshold’ means $60,000 PROCESS.—The Secretary shall provide, ‘‘(G) INFORMATION REGARDING THIRD-PARTY and the term ‘income threshold limit’ means through the annual medicare handbook REIMBURSEMENT.—In order to ensure compli- $200,000. under section 1804(a), for a general descrip- ance with the requirements of subparagraph ‘‘(II) INCOME INFLATION ADJUSTMENT.—In tion of the adjustment of annual out-of- (C)(ii), the Administrator is authorized to es- the case of a year beginning after 2006, each pocket thresholds provided under this sub- tablish procedures, in coordination with the of the dollar amounts in subclause (I) shall paragraph, including the process for adjust- Secretary of Treasury and the Secretary of be increased by an amount equal to such dol- ment based upon more recent information Labor, for determining whether costs for in- lar amount multiplied by the cost-of-living and the confidentiality provisions of sub- dividuals are being reimbursed through in- adjustment determined under section 1(f)(3) paragraph (F), and shall provide for dissemi- surance or otherwise, a group health plan, or of the Internal Revenue Code of 1986 for such nation of a table for each year that sets other third-party payment arrangement, and year, determined by substituting ‘calendar forth the amount of the adjustment that is for alerting the sponsors and organization year 2005’ for ‘calendar year 1992’. If any made under clause (i) based on the amount of that offer the plans in which such individ- amount increased under the previous sen- an enrollee’s adjusted gross income. uals are enrolled about such reimbursement tence is not a multiple of $100, such amount ‘‘(vii) ENROLLEE OPT-OUT.—The Secretary arrangements. A PDP sponsor or Medicare shall be rounded to the nearest multiple of shall provide a procedure whereby, if an en- Advantage or EFFS organization may also $100. rollee elects to have the maximum annual periodically ask individuals enrolled in a ‘‘(iii) PERCENTAGE.—The percentage speci- out-of-pocket threshold applied under this prescription drug plan or MA-EFFS Rx plan fied in this clause for a year is a fraction (ex- subparagraph for a year, the Secretary shall offered by the sponsor or organization pressed as a percentage) equal to— not request any information regarding the whether the individuals have or expect to re- ‘‘(I) the annual out-of-pocket threshold for enrollee under subparagraph (E) for that ceive such third-party reimbursement. A ma- a year under subparagraph (B) (determined year. terial misrepresentation of the information without regard to this subparagraph), di- ‘‘(E) REQUESTING INFORMATION ON ENROLL- described in the preceding sentence by an in- vided by EES.— dividual (as defined in standards set by the ‘‘(II) the income threshold under clause (ii) ‘‘(i) IN GENERAL.—The Secretary shall, pe- Administrator and determined through a for that year. riodically as required to carry out subpara- process established by the Administrator) If any percentage determined under the pre- graph (D), transmit to the Secretary of the shall constitute grounds for termination of vious sentence that is not a multiple of 1⁄10th Treasury a list of the names and TINs of en- enrollment under section 1860D–1(d)(3). of 1 percentage point, such percentage shall rollees in prescription drug plans (or in MA- ‘‘(5) ANNUAL PERCENTAGE INCREASE.—For be rounded to the nearest multiple of 1⁄10th of EFFS Rx plans) and request that such Sec- purposes of this part, the annual percentage 1 percentage point. retary disclose to the Secretary information increase specified in this paragraph for a ‘‘(iv) USE OF MOST RECENT RETURN INFORMA- under subparagraph (A) of section 6103(l)(19) year is equal to the annual percentage in- TION.—For purposes of clause (i) for an en- of the Internal Revenue Code of 1986 with re- crease in average per capita aggregate ex- rollee for a year, except as provided in clause spect to those enrollees for a specified tax- penditures for covered outpatient drugs in (v), the adjusted gross income of an indi- able year for application in a particular cal- the United States for medicare beneficiaries, vidual shall be based on the most recent in- endar year. as determined by the Administrator for the formation disclosed to the Secretary under ‘‘(ii) DISCLOSURE TO PLAN SPONSORS.—In the 12-month period ending in July of the pre- section 6109(l)(19) of the Internal Revenue case of a specified taxpayer (as defined in vious year. Code of 1986 before the beginning of that section 6103(l)(19)(B) of the Internal Revenue ‘‘(c) ALTERNATIVE COVERAGE REQUIRE- year. Code of 1986) who is enrolled in a prescription MENTS.—A prescription drug plan or MA-
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The provisions of section drug under this part shall not be so consid- scription drug benefit design from the stand- 1927(b)(3)(D) shall apply to information dis- ered under a plan if the plan excludes the ard coverage described in subsection (b) so closed to the Administrator under this para- drug under a formulary and such exclusion is long as the Administrator determines (based graph in the same manner as such provisions not successfully appealed under section on an actuarial analysis approved by the Ad- apply to information disclosed under such 1860D–3(f)(2). ministrator) that the following requirements section. ‘‘(4) APPLICATION OF GENERAL EXCLUSION are met and the plan applies for, and re- ‘‘(3) AUDITS AND REPORTS.—To protect PROVISIONS.—A prescription drug plan or ceives, the approval of the Administrator for against fraud and abuse and to ensure proper MA-EFFS Rx plan may exclude from quali- such benefit design: disclosures and accounting under this part, fied prescription drug coverage any covered ‘‘(1) ASSURING AT LEAST ACTUARIALLY in addition to any protections against fraud outpatient drug— EQUIVALENT COVERAGE.— and abuse provided under section 1860D– ‘‘(A) for which payment would not be made ‘‘(A) ASSURING EQUIVALENT VALUE OF TOTAL 4(b)(3)(C), the Administrator may periodi- if section 1862(a) applied to part D; or COVERAGE.—The actuarial value of the total cally audit the financial statements and ‘‘(B) which are not prescribed in accord- coverage (as determined under subsection records of PDP sponsor or entities offering a ance with the plan or this part. (e)) is at least equal to the actuarial value MA-EFFS Rx plan. Such exclusions are determinations subject (as so determined) of standard coverage. ‘‘(e) ACTUARIAL VALUATION; DETERMINATION to reconsideration and appeal pursuant to ‘‘(B) ASSURING EQUIVALENT UNSUBSIDIZED OF ANNUAL PERCENTAGE INCREASES.— section 1860D–3(f). VALUE OF COVERAGE.—The unsubsidized value ‘‘(1) PROCESSES.—For purposes of this sec- ‘‘SEC. 1860D–3. BENEFICIARY PROTECTIONS FOR of the coverage is at least equal to the un- tion, the Administrator shall establish proc- subsidized value of standard coverage. For QUALIFIED PRESCRIPTION DRUG esses and methods— COVERAGE. purposes of this subparagraph, the unsub- ‘‘(A) for determining the actuarial valu- ‘‘(a) GUARANTEED ISSUE, COMMUNITY-RATED sidized value of coverage is the amount by ation of prescription drug coverage, includ- PREMIUMS, ACCESS TO NEGOTIATED PRICES, which the actuarial value of the coverage (as ing— AND NONDISCRIMINATION.—For provisions re- determined under subsection (e)) exceeds the ‘‘(i) an actuarial valuation of standard cov- quiring guaranteed issue, community-rated actuarial value of the subsidy payments erage and of the reinsurance subsidy pay- premiums, access to negotiated prices, and under section 1860D–8 with respect to such ments under section 1860D–8; nondiscrimination, see sections 1860D–1(c)(1), coverage. ‘‘(ii) the use of generally accepted actu- 1860D–1(c)(2), 1860D–2(d), and 1860D–6(b), re- ‘‘(C) ASSURING STANDARD PAYMENT FOR arial principles and methodologies; and spectively. COSTS AT INITIAL COVERAGE LIMIT.—The cov- ‘‘(iii) applying the same methodology for ‘‘(b) DISSEMINATION OF INFORMATION.— erage is designed, based upon an actuarially determinations of alternative coverage ‘‘(1) GENERAL INFORMATION.—A PDP spon- representative pattern of utilization (as de- under subsection (c) as is used with respect sor shall disclose, in a clear, accurate, and termined under subsection (e)), to provide to determinations of standard coverage standardized form to each enrollee with a for the payment, with respect to costs in- under subsection (b); and curred that are equal to the initial coverage prescription drug plan offered by the sponsor ‘‘(B) for determining annual percentage in- under this part at the time of enrollment limit under subsection (b)(3), of an amount creases described in subsection (b)(5). equal to at least the product of— and at least annually thereafter, the infor- ‘‘(i) the amount by which the initial cov- Such methods for determining actuarial mation described in section 1852(c)(1) relat- erage limit described in subsection (b)(3) ex- valuation shall take into account effects of ing to such plan. Such information includes ceeds the deductible described in subsection alternative coverage on drug utilization. the following: (b)(1); and ‘‘(2) USE OF OUTSIDE ACTUARIES.—Under the ‘‘(A) Access to specific covered outpatient ‘‘(ii) 100 percent minus the cost-sharing processes under paragraph (1)(A), PDP spon- drugs, including access through pharmacy percentage specified in subsection sors and entities offering MA-EFFS Rx plans networks. (b)(2)(A)(i). may use actuarial opinions certified by inde- ‘‘(B) How any formulary used by the spon- ‘‘(2) CATASTROPHIC PROTECTION.—The cov- pendent, qualified actuaries to establish ac- sor functions, including the drugs included erage provides for beneficiaries the cata- tuarial values, but the Administrator shall in the formulary. strophic protection described in subsection determine whether such actuarial values ‘‘(C) Co-payments and deductible require- (b)(4). meet the requirements under subsection ments, including the identification of the ‘‘(d) ACCESS TO NEGOTIATED PRICES.— (c)(1). tiered or other co-payment level applicable ‘‘(1) IN GENERAL.—Under qualified prescrip- ‘‘(f) COVERED OUTPATIENT DRUGS DE- to each drug (or class of drugs). tion drug coverage offered by a PDP sponsor FINED.— ‘‘(D) Grievance and appeals procedures. or an entity offering a MA-EFFS Rx plan, ‘‘(1) IN GENERAL.—Except as provided in Such information shall also be made avail- the sponsor or entity shall provide bene- this subsection, for purposes of this part, the able upon request to prospective enrollees. ficiaries with access to negotiated prices (in- term ‘covered outpatient drug’ means— ‘‘(2) DISCLOSURE UPON REQUEST OF GENERAL cluding applicable discounts) used for pay- ‘‘(A) a drug that may be dispensed only COVERAGE, UTILIZATION, AND GRIEVANCE IN- ment for covered outpatient drugs, regard- upon a prescription and that is described in FORMATION.—Upon request of an individual less of the fact that no benefits may be pay- subparagraph (A)(i) or (A)(ii) of section eligible to enroll under a prescription drug able under the coverage with respect to such 1927(k)(2); or plan, the PDP sponsor shall provide the in- drugs because of the application of cost-shar- ‘‘(B) a biological product described in formation described in section 1852(c)(2) ing or an initial coverage limit (described in clauses (i) through (iii) of subparagraph (B) (other than subparagraph (D)) to such indi- subsection (b)(3)). Insofar as a State elects to of such section or insulin described in sub- vidual. provide medical assistance under title XIX paragraph (C) of such section and medical ‘‘(3) RESPONSE TO BENEFICIARY QUESTIONS.— to a beneficiary enrolled under such title and supplies associated with the injection of in- Each PDP sponsor offering a prescription under a prescription drug plan or MA-EFFS sulin (as defined in regulations of the Sec- drug plan shall have a mechanism for pro- Rx plan for a drug based on the prices nego- retary) viding specific information to enrollees upon tiated by a prescription drug plan or MA- and such term includes a vaccine licensed request. The sponsor shall make available on EFFS Rx plan under this part, the require- under section 351 of the Public Health Serv- a timely basis, through an Internet website ments of section 1927 shall not apply to such ice Act and any use of a covered outpatient and in writing upon request, information on drugs. The prices negotiated by a prescrip- drug for a medically accepted indication (as specific changes in its formulary. tion drug plan under this part, by a MA- defined in section 1927(k)(6)). ‘‘(4) CLAIMS INFORMATION.—Each PDP spon- EFFS Rx plan with respect to covered out- ‘‘(2) EXCLUSIONS.— sor offering a prescription drug plan must patient drugs, or by a qualified retiree pre- ‘‘(A) IN GENERAL.—Such term does not in- furnish to each enrollee in a form easily un- scription drug plan (as defined in section clude drugs or classes of drugs, or their med- derstandable to such enrollees an expla- 1860D–8(f)(1)) with respect to such drugs on ical uses, which may be excluded from cov- nation of benefits (in accordance with sec- behalf of individuals entitled to benefits erage or otherwise restricted under section tion 1806(a) or in a comparable manner) and under part A or enrolled under part B, shall 1927(d)(2), other than subparagraph (E) there- a notice of the benefits in relation to initial (notwithstanding any other provision of law) of (relating to smoking cessation agents), or coverage limit and the annual out-of-pocket not be taken into account for the purposes of under section 1927(d)(3). threshold applicable to such enrollee for the establishing the best price under section ‘‘(B) AVOIDANCE OF DUPLICATE COVERAGE.— current year, whenever prescription drug 1927(c)(1)(C). A drug prescribed for an individual that benefits are provided under this part (except ‘‘(2) DISCLOSURE.—The PDP sponsor or en- would otherwise be a covered outpatient that such notice need not be provided more tity offering a MA-EFFS Rx plan shall dis- drug under this part shall not be so consid- often than monthly). close to the Administrator (in a manner ered if payment for such drug is available ‘‘(c) ACCESS TO COVERED BENEFITS.— specified by the Administrator) the extent to under part A or B for an individual entitled ‘‘(1) ASSURING PHARMACY ACCESS.— which discounts or rebates or other remu- to benefits under part A and enrolled under ‘‘(A) PARTICIPATION OF ANY WILLING PHAR- neration or price concessions made available part B. MACY.—A PDP sponsor and an entity offering to the sponsor or organization by a manufac- ‘‘(3) APPLICATION OF FORMULARY RESTRIC- a MA-EFFS Rx plan shall permit the partici- turer are passed through to enrollees TIONS.—A drug prescribed for an individual pation of any pharmacy that meets terms through pharmacies and other dispensers or that would otherwise be a covered outpatient and conditions that the plan has established.
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‘‘(B) DISCOUNTS ALLOWED FOR NETWORK ‘‘(i) base clinical decisions on the strength tes, asthma, hypertension, and congestive PHARMACIES.—A prescription drug plan and a of scientific evidence and standards of prac- heart failure) or multiple prescriptions, that MA-EFFS Rx plan may, notwithstanding tice, including assessing peer-reviewed med- covered outpatient drugs under the prescrip- subparagraph (A), reduce coinsurance or co- ical literature, such as randomized clinical tion drug plan are appropriately used to op- payments for its enrolled beneficiaries below trials, pharmacoeconomic studies, outcomes timize therapeutic outcomes through im- the level otherwise provided for covered out- research data, and on such other information proved medication use and reduce the risk of patient drugs dispensed through in-network as the committee determines to be appro- adverse events, including adverse drug inter- pharmacies, but in no case shall such a re- priate; and actions. Such programs may distinguish be- duction result in an increase in payments ‘‘(ii) shall take into account whether in- tween services in ambulatory and institu- made by the Administrator under section cluding in the formulary particular covered tional settings. 1860D–8 to a plan. outpatient drugs has therapeutic advantages ‘‘(B) ELEMENTS.—Such program may in- ‘‘(C) CONVENIENT ACCESS FOR NETWORK in terms of safety and efficacy. clude— PHARMACIES.—The PDP sponsor of the pre- ‘‘(C) INCLUSION OF DRUGS IN ALL THERA- ‘‘(i) enhanced beneficiary understanding to scription drug plan and the entity offering a PEUTIC CATEGORIES.—The formulary must in- promote the appropriate use of medications MA-EFFS Rx plan shall secure the participa- clude drugs within each therapeutic category by beneficiaries and to reduce the risk of po- tion in its network of a sufficient number of and class of covered outpatient drugs (al- tential adverse events associated with medi- pharmacies that dispense (other than by though not necessarily for all drugs within cations, through beneficiary education, mail order) drugs directly to patients to en- such categories and classes). In establishing counseling, case management, disease state sure convenient access (consistent with rules such classes, the committee shall take into management programs, and other appro- of the Administrator). The Administrator account the standards published in the priate means; shall establish convenient access rules under United States Pharmacopeia-Drug Informa- ‘‘(ii) increased beneficiary adherence with this subparagraph that are no less favorable tion. The committee shall make available to prescription medication regimens through to enrollees than the rules for convenient ac- the enrollees under the plan through the medication refill reminders, special pack- cess to pharmacies of the Secretary of De- Internet or otherwise the bases for the exclu- aging, and other compliance programs and fense established as of June 1, 2003, for pur- sion of coverage of any drug from the for- other appropriate means; and poses of the TRICARE Retail Pharmacy mulary. ‘‘(iii) detection of patterns of overuse and (TRRx) program. Such rules shall include ‘‘(D) PROVIDER AND PATIENT EDUCATION.— underuse of prescription drugs. adequate emergency access for enrolled The committee shall establish policies and ‘‘(C) DEVELOPMENT OF PROGRAM IN COOPERA- beneficiaries. procedures to educate and inform health care TION WITH LICENSED PHARMACISTS.—The pro- ‘‘(D) LEVEL PLAYING FIELD.—Such a spon- providers and enrollees concerning the for- gram shall be developed in cooperation with sor shall permit enrollees to receive benefits mulary. licensed and practicing pharmacists and phy- (which may include a 90-day supply of drugs sicians. ‘‘(E) NOTICE BEFORE REMOVING DRUG FROM or biologicals) through a community phar- ‘‘(D) CONSIDERATIONS IN PHARMACY FEES.— FORMULARY FOR CHANGING PREFERRED OR TIER macy, rather than through mail order, with The PDP sponsor of a prescription drug pro- STATUS OF DRUG.—Any removal of a covered any differential in charge paid by such en- outpatient drug from a formulary and any gram and an entity offering a MA-EFFS Rx rollees. change in the preferred or tier cost-sharing plan shall take into account, in establishing ‘‘(E) NOT REQUIRED TO ACCEPT INSURANCE fees for pharmacists and others providing status of such a drug shall take effect only RISK.—The terms and conditions under sub- services under the medication therapy man- after appropriate notice is made available to paragraph (A) may not require participating agement program, the resources and time beneficiaries and physicians. pharmacies to accept insurance risk as a used in implementing the program. Each ‘‘(F) PERIODIC EVALUATION OF PROTOCOLS.— condition of participation. such sponsor or entity shall disclose to the In connection with the formulary, a prescrip- ‘‘(2) USE OF STANDARDIZED TECHNOLOGY.— Administrator upon request the amount of tion drug plan shall provide for the periodic ‘‘(A) IN GENERAL.—The PDP sponsor of a any such management or dispensing fees and evaluation and analysis of treatment proto- prescription drug plan and an entity offering such fees shall be confidential in the same cols and procedures. a MA-EFFS Rx plan shall issue (and reissue, manner as provided under section ‘‘(G) GRIEVANCES AND APPEALS RELATING TO as appropriate) such a card (or other tech- 1927(b)(3)(D) for information disclosed under nology) that may be used by an enrollee to APPLICATION OF FORMULARIES.—For provi- section 1927(b)(3)(A). sions relating to grievances and appeals of assure access to negotiated prices under sec- ‘‘(3) ELECTRONIC PRESCRIPTION PROGRAM.— coverage, see subsections (e) and (f). tion 1860D–2(d) for the purchase of prescrip- ‘‘(A) IN GENERAL.—An electronic prescrip- tion drugs for which coverage is not other- ‘‘(d) COST AND UTILIZATION MANAGEMENT; tion drug program described in this para- wise provided under the plan. QUALITY ASSURANCE; MEDICATION THERAPY graph is a program that includes at least the ANAGEMENT ROGRAM ‘‘(B) STANDARDS.— M P .— following components, consistent with uni- ‘‘(i) DEVELOPMENT.—The Administrator ‘‘(1) IN GENERAL.—The PDP sponsor or enti- form standards established under subpara- shall provide for the development or utiliza- ty offering a MA-EFFS Rx plan shall have in graph (B): tion of uniform standards relating to a place, directly or through appropriate ar- ‘‘(i) ELECTRONIC TRANSMITTAL OF PRESCRIP- standardized format for the card or other rangements, with respect to covered out- TIONS.—Prescriptions must be written and technology referred to in subparagraph (A). patient drugs— transmitted electronically (other than by Such standards shall be compatible with ‘‘(A) an effective cost and drug utilization facsimile), except in emergency cases and standards established under part C of title management program, including medically other exceptional circumstances recognized XI. appropriate incentives to use generic drugs by the Administrator. ‘‘(ii) APPLICATION OF ADVISORY TASK and therapeutic interchange, when appro- ‘‘(ii) PROVISION OF INFORMATION TO PRE- FORCE.—The advisory task force established priate; SCRIBING HEALTH CARE PROFESSIONAL.—The under subsection (d)(3)(B)(ii) shall provide ‘‘(B) quality assurance measures and sys- program provides for the electronic trans- recommendations to the Administrator tems to reduce medical errors and adverse mittal to the prescribing health care profes- under such subsection regarding the stand- drug interactions, including side-effects, and sional of information that includes— ards developed under clause (i). improve medication use, including a medica- ‘‘(I) information (to the extent available ‘‘(3) REQUIREMENTS ON DEVELOPMENT AND tion therapy management program described and feasible) on the drug or drugs being pre- APPLICATION OF FORMULARIES.—If a PDP in paragraph (2) and for years beginning with scribed for that patient and other informa- sponsor of a prescription drug plan or an en- 2007, an electronic prescription program de- tion relating to the medical history or condi- tity offering a MA-EFFS Rx plan uses a for- scribed in paragraph (3); and tion of the patient that may be relevant to mulary, the following requirements must be ‘‘(C) a program to control fraud, abuse, and the appropriate prescription for that patient; met: waste. ‘‘(II) cost-effective alternatives (if any) for ‘‘(A) PHARMACY AND THERAPEUTIC (P&T) Nothing in this section shall be construed as the use of the drug prescribed; and COMMITTEE.—The sponsor or entity must es- impairing a PDP sponsor or entity from uti- ‘‘(III) information on the drugs included in tablish a pharmacy and therapeutic com- lizing cost management tools (including dif- the applicable formulary. mittee that develops and reviews the for- ferential payments) under all methods of op- To the extent feasible, such program shall mulary. Such committee shall include at eration. permit the prescribing health care profes- least one practicing physician and at least ‘‘(2) MEDICATION THERAPY MANAGEMENT sional to provide (and be provided) related one practicing pharmacist independent and PROGRAM.— information on an interactive, real-time free of conflict with respect to the com- ‘‘(A) IN GENERAL.—A medication therapy basis. mittee both with expertise in the care of el- management program described in this para- ‘‘(B) STANDARDS.— derly or disabled persons and a majority of graph is a program of drug therapy manage- ‘‘(i) DEVELOPMENT.—The Administrator its members shall consist of individuals who ment and medication administration that shall provide for the development of uniform are practicing physicians or practicing phar- may be furnished by a pharmacy provider standards relating to the electronic prescrip- macists (or both). and that is designed to assure, with respect tion drug program described in subparagraph ‘‘(B) FORMULARY DEVELOPMENT.—In devel- to beneficiaries at risk for potential medica- (A). Such standards shall be compatible with oping and reviewing the formulary, the com- tion problems, such as beneficiaries with standards established under part C of title mittee shall— complex or chronic diseases (such as diabe- XI.
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‘‘(ii) ADVISORY TASK FORCE.—In developing zation (including any entity or individual ‘‘(B) REINSURANCE PERMITTED.—The entity such standards and the standards described through which the sponsor provides covered may obtain insurance or make other ar- in subsection (c)(2)(B)(i) the Administrator benefits) and enrollees with prescription rangements for the cost of coverage provided shall establish a task force that includes rep- drug plans of the sponsor under this part in to any enrollee. resentatives of physicians, hospitals, phar- accordance with section 1852(f). ‘‘(3) SOLVENCY FOR UNLICENSED SPONSORS.— macies, beneficiaries, pharmacy benefit man- ‘‘(2) APPLICATION OF COVERAGE DETERMINA- In the case of a sponsor that is not described agers, individuals with expertise in informa- TION AND RECONSIDERATION PROVISIONS.—A in paragraph (1), the sponsor shall meet sol- tion technology, and pharmacy benefit ex- PDP sponsor shall meet the requirements of vency standards established by the Adminis- perts of the Departments of Veterans Affairs paragraphs (1) through (3) of section 1852(g) trator under subsection (d). and Defense and other appropriate Federal with respect to covered benefits under the ‘‘(b) CONTRACT REQUIREMENTS.— agencies to provide recommendations to the prescription drug plan it offers under this ‘‘(1) IN GENERAL.—The Administrator shall Administrator on such standards, including part in the same manner as such require- not permit the election under section 1860D– recommendations relating to the following: ments apply to an organization with respect 1 of a prescription drug plan offered by a ‘‘(I) The range of available computerized to benefits it offers under a plan under part PDP sponsor under this part, and the sponsor prescribing software and hardware and their C. shall not be eligible for payments under sec- costs to develop and implement. ‘‘(3) REQUEST FOR REVIEW OF TIERED FOR- tion 1860D–7 or 1860D–8, unless the Adminis- ‘‘(II) The extent to which such standards MULARY DETERMINATIONS.—In the case of a trator has entered into a contract under this and systems reduce medication errors and prescription drug plan offered by a PDP subsection with the sponsor with respect to can be readily implemented by physicians, sponsor or a MA-EFFS Rx plan that provides the offering of such plan. Such a contract pharmacies, and hospitals. for tiered cost-sharing for drugs included with a sponsor may cover more than one pre- ‘‘(III) Efforts to develop uniform standards within a formulary and provides lower cost- scription drug plan. Such contract shall pro- and a common software platform for the se- sharing for preferred drugs included within vide that the sponsor agrees to comply with cure electronic communication of medica- the formulary, an individual who is enrolled the applicable requirements and standards of tion history, eligibility, benefit, and pre- in the plan may request coverage of a non- this part and the terms and conditions of scription information. preferred drug under the terms applicable for payment as provided for in this part. ‘‘(IV) Efforts to develop and promote uni- preferred drugs if the prescribing physician ‘‘(2) NEGOTIATION REGARDING TERMS AND versal connectivity and interoperability for determines that the preferred drug for treat- CONDITIONS.—The Administrator shall have the secure electronic exchange of such infor- ment of the same condition either would not the same authority to negotiate the terms and conditions of prescription drug plans mation. be as effective for the individual or would under this part as the Director of the Office ‘‘(V) The cost of implementing such sys- have adverse effects for the individual or of Personnel Management has with respect tems in the range of hospital and physician both. to health benefits plans under chapter 89 of office settings and pharmacies, including ‘‘(f) APPEALS.— title 5, United States Code. In negotiating hardware, software, and training costs. ‘‘(1) IN GENERAL.—Subject to paragraph (2), ‘‘(VI) Implementation issues as they relate a PDP sponsor shall meet the requirements the terms and conditions regarding pre- to part C of title XI, and current Federal and of paragraphs (4) and (5) of section 1852(g) miums for which information is submitted State prescribing laws and regulations and with respect to drugs (including a determina- under section 1860D–6(a)(2), the Adminis- their impact on implementation of comput- tion related to the application of tiered cost- trator shall take into account the subsidy payments under section 1860D–8. erized prescribing. sharing described in subsection (e)(3)) in the ‘‘(3) INCORPORATION OF CERTAIN MEDICARE ‘‘(iii) DEADLINES.— same manner as such requirements apply to ADVANTAGE CONTRACT REQUIREMENTS.—The ‘‘(I) The Administrator shall constitute the an organization with respect to benefits it following provisions of section 1857 shall task force under clause (ii) by not later than offers under a plan under part C. April 1, 2004. apply, subject to subsection (c)(5), to con- ‘‘(2) FORMULARY DETERMINATIONS.—An indi- tracts under this section in the same manner ‘‘(II) Such task force shall submit rec- vidual who is enrolled in a prescription drug as they apply to contracts under section ommendations to Administrator by not later plan offered by a PDP sponsor or in a MA- than January 1, 2005. 1857(a): EFFS Rx plan may appeal to obtain coverage ‘‘(III) The Administrator shall provide for ‘‘(A) MINIMUM ENROLLMENT.—Paragraphs for a covered outpatient drug that is not on the development and promulgation, by not (1) and (3) of section 1857(b), except that the a formulary of the sponsor or entity offering later than January 1, 2006, of national stand- requirement of such paragraph (1) shall be the plan if the prescribing physician deter- ards relating to the electronic prescription waived during the first contract year with mines that the formulary drug for treatment drug program described in clause (ii). Such respect to an organization in a region. of the same condition either would not be as standards shall be issued by a standards or- ‘‘(B) CONTRACT PERIOD AND EFFECTIVE- effective for the individual or would have ad- ganization accredited by the American Na- NESS.—Paragraphs (1) through (3) and (5) of verse effects for the individual or both. tional Standards Institute (ANSI) and shall section 1857(c). ‘‘(g) CONFIDENTIALITY AND ACCURACY OF EN- be compatible with standards established ‘‘(C) PROTECTIONS AGAINST FRAUD AND BEN- ROLLEE RECORDS.—A PDP sponsor that offers EFICIARY PROTECTIONS.—Section 1857(d). under part C of title XI. a prescription drug plan shall meet the re- ‘‘(D) ADDITIONAL CONTRACT TERMS.—Sec- ‘‘(4) TREATMENT OF ACCREDITATION.—Sec- quirements of section 1852(h) with respect to tion 1857(e); except that in applying section tion 1852(e)(4) (relating to treatment of ac- enrollees under the plan in the same manner creditation) shall apply to prescription drug as such requirements apply to an organiza- 1857(e)(2) under this part— plans under this part with respect to the fol- tion with respect to enrollees under part C. ‘‘(i) such section shall be applied sepa- lowing requirements, in the same manner as A PDP sponsor shall be treated as a business rately to costs relating to this part (from they apply to plans under part C with respect associate for purposes of the provisions of costs under part C and part E); to the requirements described in a clause of subpart E of part 164 of title 45, Code of Fed- ‘‘(ii) in no case shall the amount of the fee section 1852(e)(4)(B): eral Regulations, adopted pursuant to the established under this subparagraph for a ‘‘(A) Paragraph (1) (including quality as- authority of the Secretary under section plan exceed 20 percent of the maximum surance), including medication therapy man- 264(c) of the Health Insurance Portability amount of the fee that may be established agement program under paragraph (2). and Accountability Act of 1996 (42 U.S. C. under subparagraph (B) of such section; and ‘‘(B) Subsection (c)(1) (relating to access to 1320d-2 note). ‘‘(iii) no fees shall be applied under this covered benefits). ‘‘SEC. 1860D–4. REQUIREMENTS FOR AND CON- subparagraph with respect to MA-EFFS Rx ‘‘(C) Subsection (g) (relating to confiden- TRACTS WITH PRESCRIPTION DRUG plans. tiality and accuracy of enrollee records). PLAN (PDP) SPONSORS. ‘‘(E) INTERMEDIATE SANCTIONS.—Section ‘‘(5) PUBLIC DISCLOSURE OF PHARMACEUTICAL ‘‘(a) GENERAL REQUIREMENTS.—Each PDP 1857(g). PRICES FOR EQUIVALENT DRUGS.—Each PDP sponsor of a prescription drug plan shall ‘‘(F) PROCEDURES FOR TERMINATION.—Sec- sponsor and each entity offering a MA-EFFS meet the following requirements: tion 1857(h). Rx plan shall provide that each pharmacy or ‘‘(1) LICENSURE.—Subject to subsection (c), ‘‘(4) RULES OF APPLICATION FOR INTER- other dispenser that arranges for the dis- the sponsor is organized and licensed under MEDIATE SANCTIONS.—In applying paragraph pensing of a covered outpatient drug shall State law as a risk-bearing entity eligible to (3)(E)— inform the beneficiary at the time of pur- offer health insurance or health benefits cov- ‘‘(A) the reference in section 1857(g)(1)(B) chase of the drug of any differential between erage in each State in which it offers a pre- to section 1854 is deemed a reference to this the price of the prescribed drug to the en- scription drug plan. part; and rollee and the price of the lowest cost avail- ‘‘(2) ASSUMPTION OF FINANCIAL RISK FOR UN- ‘‘(B) the reference in section 1857(g)(1)(F) able generic drug covered under the plan SUBSIDIZED COVERAGE.— to section 1852(k)(2)(A)(ii) shall not be ap- that is therapeutically equivalent and bio- ‘‘(A) IN GENERAL.—Subject to subparagraph plied. equivalent. (B) and section 1860D–5(d)(2), the entity as- ‘‘(5) SERVICE AREA REQUIREMENT.—For pur- ‘‘(e) GRIEVANCE MECHANISM, COVERAGE DE- sumes full financial risk on a prospective poses of this part, the Administrator shall TERMINATIONS, AND RECONSIDERATIONS.— basis for qualified prescription drug coverage designate at least 10 areas covering the en- ‘‘(1) IN GENERAL.—Each PDP sponsor shall that it offers under a prescription drug plan tire United States and to the extent prac- provide meaningful procedures for hearing and that is not covered under section 1860D– ticable shall be consistent with EFFS re- and resolving grievances between the organi- 8. gions established under section 1860E–1(a)(2).
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‘‘(c) WAIVER OF CERTAIN REQUIREMENTS TO ‘‘(1) Annual, coordinated election periods, ‘‘(1) IN GENERAL.—Each PDP sponsor shall EXPAND CHOICE.— in which such individuals can change the submit to the Administrator the information ‘‘(1) IN GENERAL.—In the case of an entity qualifying plans through which they obtain described in paragraph (2) in the same man- that seeks to offer a prescription drug plan coverage, in accordance with section 1860D– ner as information is submitted by an orga- in a State, the Administrator shall waive the 1(b)(2). nization under section 1854(a)(1). requirement of subsection (a)(1) that the en- ‘‘(2) Active dissemination of information ‘‘(2) INFORMATION SUBMITTED.—The infor- tity be licensed in that State if the Adminis- to promote an informed selection among mation described in this paragraph is the fol- trator determines, based on the application qualifying plans based upon price, quality, lowing: and other evidence presented to the Adminis- and other features, in the manner described ‘‘(A) COVERAGE PROVIDED.—Information on trator, that any of the grounds for approval in (and in coordination with) section 1851(d), the qualified prescription drug coverage to of the application described in paragraph (2) including the provision of annual compara- be provided. have been met. tive information, maintenance of a toll-free ‘‘(B) ACTUARIAL VALUE.—Information on ‘‘(2) GROUNDS FOR APPROVAL.—The grounds hotline, and the use of non-Federal entities. the actuarial value of the coverage. for approval under this paragraph are the ‘‘(3) Coordination of elections through fil- ‘‘(C) BID AND PREMIUM.—Information on the grounds for approval described in subpara- ing with the entity offering a MA-EFFS Rx bid and the premium for the coverage, in- graph (B), (C), and (D) of section 1855(a)(2), plan or a PDP sponsor, in the manner de- cluding an actuarial certification of— and also include the application by a State scribed in (and in coordination with) section ‘‘(i) the actuarial basis for such bid and of any grounds other than those required 1851(c)(2). premium; under Federal law. ‘‘(4) Informing each enrollee before the be- ‘‘(ii) the portion of such bid and premium ‘‘(3) APPLICATION OF WAIVER PROCEDURES.— ginning of each year of the annual out-of- attributable to benefits in excess of standard With respect to an application for a waiver pocket threshold applicable to the enrollee coverage; (or a waiver granted) under this subsection, for that year under section 1860D–2(b)(4) at ‘‘(iii) the reduction in such bid resulting the provisions of subparagraphs (E), (F), and such time. from the reinsurance subsidy payments pro- (G) of section 1855(a)(2) shall apply. ‘‘(c) MA-EFFS RX ENROLLEE MAY ONLY OB- vided under section 1860D–8(a)(2); and ‘‘(4) LICENSURE DOES NOT SUBSTITUTE FOR TAIN BENEFITS THROUGH THE PLAN.—An indi- ‘‘(iv) the reduction in such premium result- OR CONSTITUTE CERTIFICATION.—The fact that vidual who is enrolled under a MA-EFFS Rx ing from the direct and reinsurance subsidy an entity is licensed in accordance with sub- plan may only elect to receive qualified pre- payments provided under section 1860D–8. section (a)(1) does not deem the entity to scription drug coverage under this part ‘‘(D) ADDITIONAL INFORMATION.—Such other meet other requirements imposed under this through such plan. information as the Administrator may re- quire to carry out this part. part for a PDP sponsor. ‘‘(d) ASSURING ACCESS TO A CHOICE OF ‘‘(3) REVIEW OF INFORMATION; NEGOTIATION ‘‘(5) REFERENCES TO CERTAIN PROVISIONS.— QUALIFIED PRESCRIPTION DRUG COVERAGE.— AND APPROVAL OF PREMIUMS.— For purposes of this subsection, in applying ‘‘(1) CHOICE OF AT LEAST TWO PLANS IN EACH ‘‘(A) IN GENERAL.—Subject to subparagraph provisions of section 1855(a)(2) under this AREA.— (B), the Administrator shall review the infor- subsection to prescription drug plans and ‘‘(A) IN GENERAL.—The Administrator shall mation filed under paragraph (2) for the pur- PDP sponsors— assure that each individual who is entitled pose of conducting negotiations under sec- ‘‘(A) any reference to a waiver application to benefits under part A or enrolled under tion 1860D–4(b)(2) (relating to using OPM-like under section 1855 shall be treated as a ref- part B and who is residing in an area in the authority under the FEHBP). The Adminis- erence to a waiver application under para- United States has available, consistent with graph (1); and trator, using the information provided (in- subparagraph (B), a choice of enrollment in cluding the actuarial certification under ‘‘(B) any reference to solvency standards at least two qualifying plans (as defined in shall be treated as a reference to solvency paragraph (2)(C)) shall approve the premium paragraph (5)) in the area in which the indi- submitted under this subsection only if the standards established under subsection (d). vidual resides, at least one of which is a pre- ‘‘(d) SOLVENCY STANDARDS FOR NON-LI- premium accurately reflects both (i) the ac- scription drug plan. tuarial value of the benefits provided, and CENSED SPONSORS.— ‘‘(B) REQUIREMENT FOR DIFFERENT PLAN ‘‘(1) ESTABLISHMENT.—The Administrator (ii) the 73 percent average subsidy provided SPONSORS.—The requirement in subpara- under section 1860D–8 for the standard ben- shall establish, by not later than October 1, graph (A) is not satisfied with respect to an 2004, financial solvency and capital adequacy efit. The Administrator shall apply actuarial area if only one PDP sponsor or one entity principles to approval of a premium under standards that an entity that does not meet that offers a MA-EFFS Rx plan offers all the the requirements of subsection (a)(1) must this part in a manner similar to the manner qualifying plans in the area. in which those principles are applied in es- meet to qualify as a PDP sponsor under this ‘‘(2) GUARANTEEING ACCESS TO COVERAGE.— part. tablishing the monthly part B premium In order to assure access under paragraph (1) under section 1839. ‘‘(2) COMPLIANCE WITH STANDARDS.—Each and consistent with paragraph (3), the Ad- ‘‘(B) EXCEPTION.—In the case of a plan de- PDP sponsor that is not licensed by a State ministrator may provide partial under- under subsection (a)(1) and for which a waiv- scribed in section 1851(a)(2)(C), the provisions writing of risk for a PDP sponsor to expand of subparagraph (A) shall not apply and the er application has been approved under sub- the service area under an existing prescrip- section (c) shall meet solvency and capital provisions of paragraph (5)(B) of section tion drug plan to adjoining or additional 1854(a), prohibiting the review, approval, or adequacy standards established under para- areas or to establish such a plan (including graph (1). The Administrator shall establish disapproval of amounts described in such offering such a plan on a regional or nation- paragraph, shall apply to the negotiation certification procedures for such PDP spon- wide basis), but only so long as (and to the sors with respect to such solvency standards and rejection of the monthly bid amounts extent) necessary to assure the access guar- and proportion referred to in subparagraph in the manner described in section 1855(c)(2). anteed under paragraph (1). ‘‘(e) RELATION TO STATE LAWS.— (A). ‘‘(3) LIMITATION ON AUTHORITY.—In exer- ‘‘(1) IN GENERAL.—The standards estab- ‘‘(b) UNIFORM BID AND PREMIUM.— cising authority under this subsection, the ‘‘(1) IN GENERAL.—The bid and premium for lished under this part shall supersede any Administrator— State law or regulation (other than State li- a prescription drug plan under this section ‘‘(A) shall not provide for the full under- may not vary among enrollees in the plan in censing laws or State laws relating to plan writing of financial risk for any PDP spon- solvency, except as provided in subsection the same service area. sor; and ‘‘(2) CONSTRUCTION.—Nothing in paragraph (d)) with respect to prescription drug plans ‘‘(B) shall seek to maximize the assump- which are offered by PDP sponsors under (1) shall be construed as preventing the im- tion of financial risk by PDP sponsors or en- position of a late enrollment penalty under this part. tities offering a MA-EFFS Rx plan. ‘‘(2) PROHIBITION OF STATE IMPOSITION OF section 1860D–1(c)(2)(B). ‘‘(4) REPORTS.—The Administrator shall, in ‘‘(c) COLLECTION.— PREMIUM TAXES.—No State may impose a each annual report to Congress under section ‘‘(1) BENEFICIARY’S OPTION OF PAYMENT premium tax or similar tax with respect to 1809(f), include information on the exercise THROUGH WITHHOLDING FROM SOCIAL SECURITY premiums paid to PDP sponsors for prescrip- of authority under this subsection. The Ad- PAYMENT OR USE OF ELECTRONIC FUNDS TRANS- tion drug plans under this part, or with re- ministrator also shall include such rec- FER MECHANISM.—In accordance with regula- spect to any payments made to such a spon- ommendations as may be appropriate to tions, a PDP sponsor shall permit each en- sor by the Administrator under this part. minimize the exercise of such authority, in- rollee, at the enrollee’s option, to make pay- ‘‘SEC. 1860D–5. PROCESS FOR BENEFICIARIES TO cluding minimizing the assumption of finan- ment of premiums under this part to the SELECT QUALIFIED PRESCRIPTION cial risk. DRUG COVERAGE. sponsor through withholding from benefit ‘‘(5) QUALIFYING PLAN DEFINED.—For pur- ‘‘(a) IN GENERAL.—The Administrator shall payments in the manner provided under sec- establish a process for the selection of the poses of this subsection, the term ‘qualifying tion 1840 with respect to monthly premiums prescription drug plan or MA-EFFS Rx plan plan’ means a prescription drug plan or a under section 1839 or through an electronic through which eligible individuals elect MA-EFFS Rx plan. funds transfer mechanism (such as auto- qualified prescription drug coverage under ‘‘SEC. 1860D–6. SUBMISSION OF BIDS AND PRE- matic charges of an account at a financial this part. MIUMS. institution or a credit or debit card account) ‘‘(b) ELEMENTS.—Such process shall include ‘‘(a) SUBMISSION OF BIDS, PREMIUMS, AND or otherwise. All premium payments that the following: RELATED INFORMATION.— are withheld under this paragraph shall be
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00075 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.056 H26PT1 H6016 CONGRESSIONAL RECORD — HOUSE June 26, 2003 credited to the Medicare Prescription Drug source or generic drug (as described in sec- eligible for financial assistance with pre- Trust Fund and shall be paid to the PDP tion 1927(k)(7)(A)) and $5 for a non-preferred scription drug expenses under section 1935(e). sponsor involved. drug. ‘‘(F) TREATMENT OF CONFORMING MEDIGAP ‘‘(2) OFFSETTING.—Reductions in premiums ‘‘(2) SLIDING SCALE PREMIUM SUBSIDY FOR POLICIES.—For purposes of this section, the for coverage under parts A and B as a result INDIVIDUALS WITH INCOME ABOVE 135, BUT term ‘qualified prescription drug coverage’ of a selection of a MA-EFFS Rx plan may be BELOW 150 PERCENT, OF FEDERAL POVERTY includes a medicare supplemental policy de- used to reduce the premium otherwise im- LEVEL.—In the case of a subsidy eligible indi- scribed in section 1860D–8(b)(4). posed under paragraph (1). vidual who is determined to have income ‘‘(5) INDEXING DOLLAR AMOUNTS.— ‘‘(d) ACCEPTANCE OF REFERENCE PREMIUM that exceeds 135 percent, but does not exceed ‘‘(A) FOR 2007.—The dollar amounts applied AMOUNT AS FULL PREMIUM FOR SUBSIDIZED 150 percent, of the Federal poverty level, the under paragraphs (1)(B) for 2007 shall be the LOW-INCOME INDIVIDUALS IF NO STANDARD (OR individual is entitled under this section to dollar amounts specified in such paragraph EQUIVALENT) COVERAGE IN AN AREA.— an income-related premium subsidy deter- increased by the annual percentage increase ‘‘(1) IN GENERAL.—If there is no standard mined on a linear sliding scale ranging from described in section 1860D–2(b)(5) for 2007. prescription drug coverage (as defined in 100 percent of the amount described in sub- ‘‘(B) FOR SUBSEQUENT YEARS.—The dollar paragraph (2)) offered in an area, in the case section (b)(1) for individuals with incomes at amounts applied under paragraph (1)(B) for a of an individual who is eligible for a pre- 135 percent of such level to 0 percent of such year after 2007 shall be the amounts (under mium subsidy under section 1860D–7 and re- amount for individuals with incomes at 150 this paragraph) applied under paragraph sides in the area, the PDP sponsor of any percent of such level. (1)(B) for the preceding year increased by the prescription drug plan offered in the area ‘‘(3) CONSTRUCTION.—Nothing in this sec- annual percentage increase described in sec- (and any entity offering a MA-EFFS Rx plan tion shall be construed as preventing a PDP tion 1860D–2(b)(5) (relating to growth in in the area) shall accept the reference pre- sponsor or entity offering a MA-EFFS Rx medicare prescription drug costs per bene- mium amount (under paragraph (3)) as pay- plan from reducing to 0 the cost-sharing oth- ficiary) for the year involved. ment in full for the premium charge for erwise applicable to generic drugs. ‘‘(b) PREMIUM SUBSIDY AMOUNT.— ‘‘(1) IN GENERAL.—The premium subsidy qualified prescription drug coverage. ‘‘(4) DETERMINATION OF ELIGIBILITY.— amount described in this subsection for an ‘‘(2) STANDARD PRESCRIPTION DRUG COV- ‘‘(A) SUBSIDY ELIGIBLE INDIVIDUAL DE- individual residing in an area is the bench- ERAGE DEFINED.—For purposes of this sub- FINED.—For purposes of this section, subject section, the term ‘standard prescription drug to subparagraph (D), the term ‘subsidy eligi- mark premium amount (as defined in para- coverage’ means qualified prescription drug ble individual’ means an individual who— graph (2)) for qualified prescription drug cov- coverage that is standard coverage or that ‘‘(i) is eligible to elect, and has elected, to erage offered by the prescription drug plan has an actuarial value equivalent to the ac- obtain qualified prescription drug coverage or the MA-EFFS Rx plan in which the indi- tuarial value for standard coverage. under this part; vidual is enrolled. ‘‘(2) BENCHMARK PREMIUM AMOUNT DE- ‘‘(3) REFERENCE PREMIUM AMOUNT DE- ‘‘(ii) has income below 150 percent of the FINED.—For purposes of this subsection, the FINED.—For purposes of this subsection, the Federal poverty line; and term ‘reference premium amount’ means, ‘‘(iii) meets the resources requirement de- term ‘benchmark premium amount’ means, with respect to qualified prescription drug scribed in subparagraph (D). with respect to qualified prescription drug coverage offered under— coverage offered under— ‘‘(B) DETERMINATIONS.—The determination ‘‘(A) a prescription drug plan that— of whether an individual residing in a State ‘‘(A) a prescription drug plan that— ‘‘(i) provides standard coverage (or alter- is a subsidy eligible individual and the ‘‘(i) provides standard coverage (or alter- native prescription drug coverage the actu- amount of such individual’s income shall be native prescription drug coverage the actu- arial value is equivalent to that of standard determined under the State medicaid plan arial value of which is equivalent to that of coverage), the plan’s PDP premium; or for the State under section 1935(a) or by the standard coverage), the premium amount for ‘‘(ii) provides alternative prescription drug Social Security Administration. In the case enrollment under the plan under this part coverage the actuarial value of which is of a State that does not operate such a med- (determined without regard to any subsidy greater than that of standard coverage, the icaid plan (either under title XIX or under a under this section or any late enrollment plan’s PDP premium multiplied by the ratio statewide waiver granted under section 1115), penalty under section 1860D–1(c)(2)(B)); or of (I) the actuarial value of standard cov- such determination shall be made under ar- ‘‘(ii) provides alternative prescription drug erage, to (II) the actuarial value of the alter- rangements made by the Administrator. coverage the actuarial value of which is native coverage; There are authorized to be appropriated to greater than that of standard coverage, the ‘‘(B) an EFFS plan, the EFFS monthly pre- the Social Security Administration such premium amount described in clause (i) mul- scription drug beneficiary premium (as de- sums as may be necessary for the determina- tiplied by the ratio of (I) the actuarial value fined in section 1860E–4(a)(3)(B)); or tion of eligibility under this subparagraph. of standard coverage, to (II) the actuarial value of the alternative coverage; or ‘‘(C) a Medicare Advantage, the Medicare ‘‘(C) INCOME DETERMINATIONS.—For pur- Advantage monthly prescription drug bene- poses of applying this section— ‘‘(B) a MA-EFFS Rx plan, the portion of ficiary premium (as defined in section ‘‘(i) income shall be determined in the the premium amount that is attributable to 1854(b)(2)(B)). manner described in section 1905(p)(1)(B); and statutory drug benefits (described in section ‘‘(ii) the term ‘Federal poverty line’ means 1853(a)(1)(A)(ii)(II)). For purposes of subparagraph (A), the term ‘‘(c) RULES IN APPLYING COST-SHARING SUB- the official poverty line (as defined by the ‘PDP premium’ means, with respect to a pre- SIDIES.— Office of Management and Budget, and re- scription drug plan, the premium amount for ‘‘(1) IN GENERAL.—In applying subsection vised annually in accordance with section enrollment under the plan under this part (a)(1)(B), nothing in this part shall be con- 673(2) of the Omnibus Budget Reconciliation (determined without regard to any low-in- strued as preventing a plan or provider from Act of 1981) applicable to a family of the size come subsidy under section 1860D–7 or any waiving or reducing the amount of cost-shar- involved. late enrollment penalty under section 1860D– ing otherwise applicable. ‘‘(D) RESOURCE STANDARD APPLIED TO BE 1(c)(2)(B)). ‘‘(2) LIMITATION ON CHARGES.—In the case of BASED ON THREE TIMES SSI RESOURCE STAND- ‘‘SEC. 1860D–7. PREMIUM AND COST-SHARING an individual receiving cost-sharing sub- ARD.—The resource requirement of this sub- SUBSIDIES FOR LOW-INCOME INDI- sidies under subsection (a)(1)(B), the PDP paragraph is that an individual’s resources VIDUALS. sponsor or entity offering a MA-EFFS Rx (as determined under section 1613 for pur- ‘‘(a) INCOME-RELATED SUBSIDIES FOR INDI- plan may not charge more than $5 per pre- poses of the supplemental security income VIDUALS WITH INCOME BELOW 150 PERCENT OF scription. program) do not exceed— FEDERAL POVERTY LEVEL.— ‘‘(3) APPLICATION OF INDEXING RULES.—The ‘‘(i) for 2006 three times the maximum ‘‘(1) FULL PREMIUM SUBSIDY AND REDUCTION provisions of subsection (a)(5) shall apply to amount of resources that an individual may OF COST-SHARING FOR INDIVIDUALS WITH IN- the dollar amount specified in paragraph (2) have and obtain benefits under that pro- COME BELOW 135 PERCENT OF FEDERAL POVERTY in the same manner as they apply to the dol- gram; and LEVEL.—In the case of a subsidy eligible indi- lar amounts specified in subsections ‘‘(ii) for a subsequent year the resource vidual (as defined in paragraph (4)) who is de- (a)(1)(B). limitation established under this clause for termined to have income that does not ex- ‘‘(d) ADMINISTRATION OF SUBSIDY PRO- the previous year increased by the annual ceed 135 percent of the Federal poverty level, GRAM.—The Administrator shall provide a the individual is entitled under this sec- percentage increase in the consumer price process whereby, in the case of an individual tion— index (all items; U.S. city average) as of Sep- who is determined to be a subsidy eligible in- ‘‘(A) to an income-related premium sub- tember of such previous year. dividual and who is enrolled in prescription sidy equal to 100 percent of the amount de- Any resource limitation established under drug plan or is enrolled in a MA-EFFS Rx scribed in subsection (b)(1); and clause (ii) that is not a multiple of $10 shall plan— ‘‘(B) subject to subsection (c), to the sub- be rounded to the nearest multiple of $10. ‘‘(1) the Administrator provides for a noti- stitution for the beneficiary cost-sharing de- ‘‘(E) TREATMENT OF TERRITORIAL RESI- fication of the PDP sponsor or the entity of- scribed in paragraphs (1) and (2) of section DENTS.—In the case of an individual who is fering the MA-EFFS Rx plan involved that 1860D–2(b) (up to the initial coverage limit not a resident of the 50 States or the District the individual is eligible for a subsidy and specified in paragraph (3) of such section) of of Columbia, the individual is not eligible to the amount of the subsidy under subsection amounts that do not exceed $2 for a multiple be a subsidy eligible individual but may be (a);
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‘‘(2) the sponsor or entity involved reduces tity’ means any of the following that has en- ‘‘(1) ADJUSTMENT OF REINSURANCE PAY- the premiums or cost-sharing otherwise im- tered into an agreement with the Adminis- MENTS TO ASSURE 30 PERCENT LEVEL OF SUB- posed by the amount of the applicable sub- trator to provide the Administrator with SIDY THROUGH REINSURANCE.— sidy and submits to the Administrator infor- such information as may be required to ‘‘(A) ESTIMATION OF PAYMENTS.—The Ad- mation on the amount of such reduction; and carry out this section: ministrator shall estimate— ‘‘(3) the Administrator periodically and on ‘‘(1) A PDP sponsor offering a prescription ‘‘(i) the total payments to be made (with- a timely basis reimburses the sponsor or en- drug plan under this part. out regard to this subsection) during a year tity for the amount of such reductions. ‘‘(2) An entity that offers a MA-EFFS Rx under subsections (a)(2) and (c); and The reimbursement under paragraph (3) with plan. ‘‘(ii) the total payments to be made by respect to cost-sharing subsidies may be ‘‘(3) The sponsor of a qualified retiree pre- qualifying entities for standard coverage computed on a capitated basis, taking into scription drug plan (as defined in subsection under plans described in subsection (b) dur- account the actuarial value of the subsidies (f)). ing the year. and with appropriate adjustments to reflect ‘‘(c) REINSURANCE PAYMENT AMOUNT.— ‘‘(B) ADJUSTMENT.—The Administrator differences in the risks actually involved. ‘‘(1) IN GENERAL.—Subject to subsection shall proportionally adjust the payments ‘‘(e) RELATION TO MEDICAID PROGRAM.— (d)(1)(B) and paragraph (4), the reinsurance made under subsections (a)(2) and (c) for a ‘‘(1) IN GENERAL.—For provisions providing payment amount under this subsection for a coverage year in such manner so that the for eligibility determinations, and additional qualifying covered individual (as defined in total of the payments made under such sub- financing, under the medicaid program, see paragraph (5)) for a coverage year (as defined sections for the year is equal to 30 percent of section 1935. in subsection (h)(2)) is equal to the sum of the total payments described in subpara- ‘‘(2) MEDICAID PROVIDING WRAP AROUND BEN- the following: graph (A)(ii). EFITS.—The coverage provided under this ‘‘(A) REINSURANCE BETWEEN INITIAL REIN- ‘‘(2) RISK ADJUSTMENT FOR DIRECT SUB- part is primary payor to benefits for pre- SURANCE THRESHOLD AND THE INITIAL COV- SIDIES.—To the extent the Administrator de- scribed drugs provided under the medicaid ERAGE LIMIT.—For the portion of the individ- termines it appropriate to avoid risk selec- program under title XIX consistent with sec- ual’s gross covered prescription drug costs tion, the payments made for direct subsidies tion 1935(d)(1). (as defined in paragraph (3)) for the year that under subsection (a)(1) are subject to adjust- ‘‘(3) COORDINATION.—The Administrator exceeds the initial reinsurance threshold ment based upon risk factors specified by the shall develop and implement a plan for the specified in paragraph (4), but does not ex- Administrator. Any such risk adjustment coordination of prescription drug benefits ceed the initial coverage limit specified in shall be designed in a manner as to not re- under this part with the benefits provided section 1860D–2(b)(3), an amount equal to 20 sult in a change in the aggregate payments under the medicaid program under title XIX, percent of the allowable costs (as defined in made under such subsection. with particular attention to insuring coordi- paragraph (2)) attributable to such gross cov- ‘‘(e) PAYMENT METHODS.— nation of payments and prevention of fraud ered prescription drug costs. ‘‘(1) IN GENERAL.—Payments under this sec- and abuse. In developing and implementing ‘‘(B) REINSURANCE ABOVE ANNUAL OUT-OF- tion shall be based on such a method as the such plan, the Administrator shall involve POCKET THRESHOLD.—For the portion of the Administrator determines. The Adminis- the Secretary, the States, the data proc- individual’s gross covered prescription drug trator may establish a payment method by essing industry, pharmacists, and pharma- costs for the year that exceeds the annual which interim payments of amounts under ceutical manufacturers, and other experts. out-of-pocket threshold specified in 1860D– this section are made during a year based on ‘‘SEC. 1860D–8. SUBSIDIES FOR ALL MEDICARE 2(b)(4)(B), an amount equal to 80 percent of the Administrator’s best estimate of BENEFICIARIES FOR QUALIFIED the allowable costs attributable to such amounts that will be payable after obtaining PRESCRIPTION DRUG COVERAGE. gross covered prescription drug costs. all of the information. ‘‘(a) SUBSIDY PAYMENT.—In order to reduce ‘‘(2) ALLOWABLE COSTS.—For purposes of ‘‘(2) SOURCE OF PAYMENTS.—Payments premium levels applicable to qualified pre- this section, the term ‘allowable costs’ under this section shall be made from the scription drug coverage for all medicare means, with respect to gross covered pre- Medicare Prescription Drug Trust Fund. beneficiaries consistent with an overall sub- scription drug costs under a plan described ‘‘(f) RULES RELATING TO QUALIFIED RETIREE sidy level of 73 percent, to reduce adverse se- in subsection (b) offered by a qualifying enti- PRESCRIPTION DRUG PLAN.— lection among prescription drug plans and ty, the part of such costs that are actually ‘‘(1) DEFINITION.—For purposes of this sec- MA-EFFS Rx plans, and to promote the par- paid (net of discounts, chargebacks, and av- tion, the term ‘qualified retiree prescription ticipation of PDP sponsors under this part, erage percentage rebates) under the plan, but drug plan’ means employment-based retiree the Administrator shall provide in accord- in no case more than the part of such costs health coverage (as defined in paragraph ance with this section for payment to a that would have been paid under the plan if (4)(A)) if, with respect to an individual who qualifying entity (as defined in subsection the prescription drug coverage under the is a participant or beneficiary under such (b)) of the following subsidies: plan were standard coverage. coverage and is eligible to be enrolled in a ‘‘(1) DIRECT SUBSIDY.—In the case of an en- ‘‘(3) GROSS COVERED PRESCRIPTION DRUG prescription drug plan or a MA-EFFS Rx rollee enrolled for a month in a prescription COSTS.—For purposes of this section, the plan under this part, the following require- drug plan or a MA-EFFS Rx plan, a direct term ‘gross covered prescription drug costs’ ments are met: subsidy equal to 43 percent of the national means, with respect to an enrollee with a ‘‘(A) ACTUARIAL EQUIVALENCE TO STANDARD average monthly bid amount (computed qualifying entity under a plan described in COVERAGE.—The Administrator determines under subsection (g)) for that month. subsection (b) during a coverage year, the (based on an actuarial analysis approved by ‘‘(2) SUBSIDY THROUGH REINSURANCE.—In costs incurred under the plan (including the Administrator) that coverage provides at the case of an enrollee enrolled for a month costs attributable to administrative costs) least the same actuarial value as standard in a prescription drug plan or a MA-EFFS Rx for covered prescription drugs dispensed dur- coverage. Such determination may be made plan, the reinsurance payment amount (as ing the year, including costs relating to the on an annual basis. defined in subsection (c)), which in the ag- deductible, whether paid by the enrollee or ‘‘(B) AUDITS.—The sponsor (or the adminis- gregate is 30 percent of the total payments under the plan, regardless of whether the trator, if designated by the sponsor) and the made by qualifying entities for standard cov- coverage under the plan exceeds standard plan shall maintain, and afford the Adminis- erage under the respective plan, for excess coverage and regardless of when the payment trator access to, such records as the Admin- costs incurred in providing qualified pre- for such drugs is made. istrator may require for purposes of audits scription drug coverage— ‘‘(4) INITIAL REINSURANCE THRESHOLD.—The and other oversight activities necessary to ‘‘(A) for enrollees with a prescription drug initial reinsurance threshold specified in this ensure the adequacy of prescription drug plan under this part; and paragraph— coverage and the accuracy of payments ‘‘(B) for enrollees with a MA-EFFS Rx ‘‘(A) for 2006, is equal to $1,000; or made. plan. ‘‘(B) for a subsequent year, is equal to the ‘‘(C) PROVISION OF CERTIFICATION OF PRE- ‘‘(3) EMPLOYER AND UNION FLEXIBILITY.—In payment threshold specified in this para- SCRIPTION DRUG COVERAGE.—The sponsor of the case of an individual who is a participant graph for the previous year, increased by the the plan shall provide for issuance of certifi- or beneficiary in a qualified retiree prescrip- annual percentage increase described in sec- cations of the type described in section tion drug plan (as defined in subsection tion 1860D–2(b)(5) for the year involved. 1860D–1(c)(2)(D). (f)(1)) and who is not enrolled in a prescrip- Any amount determined under subparagraph ‘‘(2) LIMITATION ON BENEFIT ELIGIBILITY.— tion drug plan or in a MA-EFFS Rx plan, the (B) that is not a multiple of $10 shall be No payment shall be provided under this sec- special subsidy payments under subsection rounded to the nearest multiple of $10. tion with respect to a participant or bene- (f)(3). ‘‘(5) QUALIFYING COVERED INDIVIDUAL DE- ficiary in a qualified retiree prescription This section constitutes budget authority in FINED.—For purposes of this subsection, the drug plan unless the individual is— advance of appropriations Acts and rep- term ‘qualifying covered individual’ means ‘‘(A) is covered under the plan; and resents the obligation of the Administrator an individual who— ‘‘(B) is eligible to obtain qualified prescrip- to provide for the payment of amounts pro- ‘‘(A) is enrolled with a prescription drug tion drug coverage under section 1860D–1 but vided under this section. plan under this part; or did not elect such coverage under this part ‘‘(b) QUALIFYING ENTITY DEFINED.—For pur- ‘‘(B) is enrolled with a MA-EFFS Rx plan. (either through a prescription drug plan or poses of this section, the term ‘qualifying en- ‘‘(d) ADJUSTMENT OF PAYMENTS.— through a MA-EFFS Rx plan).
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‘‘(3) EMPLOYER AND UNION SPECIAL SUBSIDY any such supplemental coverage (not includ- vided in this part. Except as otherwise pro- AMOUNTS.— ing payment of any premium referred to in vided in this section, the provisions of sub- ‘‘(A) IN GENERAL.—For purposes of sub- subparagraph (B)) shall be treated as pri- sections (b) through (i) of section 1841 shall section (a), the special subsidy payment mary coverage to which section apply to the Trust Fund in the same manner amount under this paragraph for a quali- 1862(b)(2)(A)(i) is deemed to apply. as they apply to the Federal Supplementary fying covered retiree(as defined in paragraph ‘‘(g) COMPUTATION OF NATIONAL AVERAGE Medical Insurance Trust Fund under such (6)) for a coverage year (as defined in sub- MONTHLY BID AMOUNT.— section. section (h)) enrolled in a qualifying entity ‘‘(1) IN GENERAL.—For each year (beginning ‘‘(b) PAYMENTS FROM TRUST FUND.— described in subsection (b)(3) under a quali- with 2006) the Administrator shall compute a ‘‘(1) IN GENERAL.—The Managing Trustee fied retiree prescription drug plan is, for the national average monthly bid amount equal shall pay from time to time from the Trust portion of the individual’s gross covered pre- to the average of the benchmark bid Fund such amounts as the Administrator scription drug costs for the year that exceeds amounts for each prescription drug plan and certifies are necessary to make— the deductible amount specified in subpara- for each MA-EFFS Rx plan (as computed ‘‘(A) payments under section 1860D–7 (re- graph (B), an amount equal to, subject to under paragraph (2), but excluding plans de- lating to low-income subsidy payments); subparagraph (D), 28 percent of the allowable scribed in section 1851(a)(2)(C))) adjusted ‘‘(B) payments under section 1860D–8 (re- costs attributable to such gross covered pre- under paragraph (4) to take into account re- lating to subsidy payments); and scription drug costs, but only to the extent insurance payments. ‘‘(C) payments with respect to administra- such costs exceed the deductible under sub- ‘‘(2) BENCHMARK BID AMOUNT DEFINED.—For tive expenses under this part in accordance paragraph (B) and do not exceed the cost purposes of this subsection, the term ‘bench- with section 201(g). limit under such subparagraph in the case of mark bid amount’ means, with respect to ‘‘(2) TRANSFERS TO MEDICAID ACCOUNT FOR any such individual for the plan year. qualified prescription drug coverage offered INCREASED ADMINISTRATIVE COSTS.—The Man- ‘‘(B) DEDUCTIBLE AND COST LIMIT APPLICA- under— aging Trustee shall transfer from time to BLE.—Subject to subparagraph (C)— ‘‘(A) a prescription drug plan that— time from the Trust Fund to the Grants to ‘‘(i) the deductible under this subparagraph ‘‘(i) provides standard coverage (or alter- States for Medicaid account amounts the Ad- is equal to $250 for plan years that end in native prescription drug coverage the actu- ministrator certifies are attributable to in- 2006; and arial value of which is equivalent to that of creases in payment resulting from the appli- ‘‘(ii) the cost limit under this subpara- standard coverage), the PDP bid; or cation of a higher Federal matching percent- graph is equal to $5,000 for plan years that ‘‘(ii) provides alternative prescription drug age under section 1935(b). end in 2006. coverage the actuarial value of which is ‘‘(c) DEPOSITS INTO TRUST FUND.— ‘‘(C) INDEXING.—The deductible and cost greater than that of standard coverage, the ‘‘(1) LOW-INCOME TRANSFER.—There is here- limit amounts specified in subparagraphs (B) PDP bid multiplied by the ratio of (I) the ac- by transferred to the Trust Fund, from for a plan year that ends after 2006 shall be tuarial value of standard coverage, to (II) the amounts appropriated for Grants to States adjusted in the same manner as the annual actuarial value of the alternative coverage; for Medicaid, amounts equivalent to the ag- deductible under section 1860D–2(b)(1) is an- or gregate amount of the reductions in pay- nually adjusted under such section. ‘‘(B) a MA-EFFS Rx plan, the portion of ments under section 1903(a)(1) attributable to ‘‘(4) RELATED DEFINITIONS.—As used in this the bid amount that is attributable to statu- the application of section 1935(c). section: tory drug benefits (described in section ‘‘(2) APPROPRIATIONS TO COVER GOVERNMENT ‘‘(A) EMPLOYMENT-BASED RETIREE HEALTH 1853(a)(1)(A)(ii)(II)). CONTRIBUTIONS.—There are authorized to be COVERAGE.—The term ‘employment-based re- For purposes of subparagraph (A), the term appropriated from time to time, out of any tiree health coverage’ means health insur- moneys in the Treasury not otherwise appro- ance or other coverage of health care costs ‘PDP bid’ means, with respect to a prescrip- tion drug plan, the bid amount for enroll- priated, to the Trust Fund, an amount equiv- for individuals eligible to enroll in a pre- alent to the amount of payments made from scription drug plan or MA-EFFS Rx plan ment under the plan under this part (deter- mined without regard to any low-income the Trust Fund under subsection (b), reduced under this part (or for such individuals and by the amount transferred to the Trust Fund their spouses and dependents) under a group subsidy under section 1860D–7 or any late en- rollment penalty under section 1860D– under paragraph (1). health plan (including such a plan that is es- ‘‘(d) RELATION TO SOLVENCY REQUIRE- 1(c)(2)(B)). tablished or maintained under or pursuant to MENTS.—Any provision of law that relates to ‘‘(3) WEIGHTED AVERAGE.— one or more collective bargaining agree- the solvency of the Trust Fund under this ‘‘(A) IN GENERAL.—The monthly national ments or that is offered under chapter 89 of part shall take into account the Trust Fund average monthly bid amount computed title 5, United States Code) based on their and amounts receivable by, or payable from, under paragraph (1) shall be a weighted aver- status as retired participants in such plan. the Trust Fund. ‘‘(B) QUALIFYING COVERED RETIREE.—The age, with the weight for each plan being equal to the average number of beneficiaries ‘‘SEC. 1860D–10. DEFINITIONS; APPLICATION TO term ‘qualifying covered retiree’ means an MEDICARE ADVANTAGE AND EFFS individual who is eligible to obtain qualified enrolled under such plan in the previous PROGRAMS; TREATMENT OF REF- prescription drug coverage under section year. ERENCES TO PROVISIONS IN PART 1860D–1 but did not elect such coverage under ‘‘(B) SPECIAL RULE FOR 2006.—For purposes C. this part (either through a prescription drug of applying this subsection for 2006, the Ad- ‘‘(a) DEFINITIONS.—For purposes of this plan or through a MA-EFFS Rx plan) but is ministrator shall establish procedures for de- part: covered under a qualified retiree prescription termining the weighted average under sub- ‘‘(1) COVERED OUTPATIENT DRUGS.—The drug plan. paragraph (A) for 2005. term ‘covered outpatient drugs’ is defined in ‘‘(C) SPONSOR.—The term ‘sponsor’ means a ‘‘(4) ADJUSTMENT TO ADD BACK IN VALUE OF section 1860D–2(f). plan sponsor, as defined in section 3(16)(B) of REINSURANCE SUBSIDIES.—The adjustment ‘‘(2) INITIAL COVERAGE LIMIT.—The term the Employee Retirement Income Security under this paragraph, to take into account ‘initial coverage limit’ means such limit as Act of 1974. reinsurance payments under subsection (c) established under section 1860D–2(b)(3), or, in ‘‘(5) CONSTRUCTION.—Nothing in this sub- making up 30 percent of total payments, is the case of coverage that is not standard section shall be construed as— such an adjustment as will make the na- coverage, the comparable limit (if any) es- ‘‘(A) precluding an individual who is cov- tional average monthly bid amount rep- tablished under the coverage. ered under employment-based retiree health resent represent 100 percent, instead of rep- ‘‘(3) MEDICARE PRESCRIPTION DRUG TRUST coverage from enrolling in a prescription resenting 70 percent, of average payments FUND.—The term ‘Medicare Prescription drug plan or in a MA-EFFS plan; under this part. Drug Trust Fund’ means the Trust Fund cre- ‘‘(B) precluding such employment-based re- ‘‘(h) COVERAGE YEAR DEFINED.—For pur- ated under section 1860D–9(a). tiree health coverage or an employer or poses of this section, the term ‘coverage ‘‘(4) PDP SPONSOR.—The term ‘PDP spon- other person from paying all or any portion year’ means a calendar year in which cov- sor’ means an entity that is certified under of any premium required for coverage under ered outpatient drugs are dispensed if a this part as meeting the requirements and such a prescription drug plan or MA-EFFS claim for payment is made under the plan for standards of this part for such a sponsor. plan on behalf of such an individual; or such drugs, regardless of when the claim is ‘‘(5) PRESCRIPTION DRUG PLAN.—The term ‘‘(C) preventing such employment-based re- paid. ‘prescription drug plan’ means health bene- tiree health coverage from providing cov- ‘‘SEC. 1860D–9. MEDICARE PRESCRIPTION DRUG fits coverage that— erage for retirees— TRUST FUND. ‘‘(A) is offered under a policy, contract, or ‘‘(i) who are covered under a qualified re- ‘‘(a) IN GENERAL.—There is created on the plan by a PDP sponsor pursuant to, and in tiree prescription plan that is better than books of the Treasury of the United States a accordance with, a contract between the Ad- standard coverage; or trust fund to be known as the ‘Medicare Pre- ministrator and the sponsor under section ‘‘(ii) who are not covered under a qualified scription Drug Trust Fund’ (in this section 1860D–4(b); retiree prescription plan but who are en- referred to as the ‘Trust Fund’). The Trust ‘‘(B) provides qualified prescription drug rolled in a prescription drug plan or a MA- Fund shall consist of such gifts and bequests coverage; and EFFS Rx plan, that is supplemental to the as may be made as provided in section ‘‘(C) meets the applicable requirements of benefits provided under such prescription 201(i)(1), and such amounts as may be depos- the section 1860D–3 for a prescription drug drug plan or MA-EFFS Rx plan, except that ited in, or appropriated to, such fund as pro- plan.
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‘‘(6) QUALIFIED PRESCRIPTION DRUG COV- fore the date of the enactment of this Act) to ‘‘(4) AVAILABILITY OF PREMIUM AND COST- ERAGE.—The term ‘qualified prescription part D of title XVIII of the Social Security SHARING SUBSIDIES.—In the case of low-in- drug coverage’ is defined in section 1860D– Act is deemed a reference to part F of such come individuals who are enrolled in a Medi- 2(a). title (as in effect after such date). care Advantage plan that provides qualified ‘‘(7) STANDARD COVERAGE.—The term (2) CONFORMING AMENDMENT PERMITTING prescription drug coverage, premium and ‘standard coverage’ is defined in section WAIVER OF COST-SHARING.—Section 1128B(b)(3) cost-sharing subsidies are provided for such 1860D–2(b). (42 U.S.C. 1320a–7b(b)(3)) is amended— coverage under section 1860D–7. ‘‘(8) INSURANCE RISK.—The term ‘insurance (A) by striking ‘‘and’’ at the end of sub- ‘‘(5) AVAILABILITY OF DIRECT AND REINSUR- risk’ means, with respect to a participating paragraph (E); ANCE SUBSIDIES TO REDUCE BIDS AND PRE- pharmacy, risk of the type commonly as- (B) by striking the period at the end of MIUMS.—Medicare Advantage organizations sumed only by insurers licensed by a State subparagraph (F) and inserting ‘‘; and’’; and are provided direct and reinsurance subsidy and does not include payment variations de- (C) by adding at the end the following new payments for providing qualified prescrip- signed to reflect performance-based meas- subparagraph: tion drug coverage under this part under sec- ures of activities within the control of the ‘‘(G) the waiver or reduction of any cost- tion 1860D–8. pharmacy, such as formulary compliance and sharing imposed under part D of title ‘‘(6) CONSOLIDATION OF DRUG AND NON-DRUG generic drug substitution. XVIII.’’. PREMIUMS.—In the case of a Medicare Advan- ‘‘(b) OFFER OF QUALIFIED PRESCRIPTION (3) SUBMISSION OF LEGISLATIVE PROPOSAL.— tage plan that includes qualified prescription DRUG COVERAGE UNDER MEDICARE ADVAN- Not later than 6 months after the date of the drug coverage, with respect to an enrollee in TAGE AND EFFS PROGRAMS.— enactment of this Act, the Secretary of such plan there shall be a single premium for ‘‘(1) AS PART OF MEDICARE ADVANTAGE Health and Human Services shall submit to both drug and non-drug coverage provided PLAN.—Medicare Advantage organizations the appropriate committees of Congress a under the plan. are required to offer Medicare Advantage legislative proposal providing for such tech- ‘‘(7) TRANSITION IN INITIAL ENROLLMENT PE- plans that include qualified prescription nical and conforming amendments in the law RIOD.—Notwithstanding any other provision drug coverage under part C pursuant to sec- as are required by the provisions of this sub- of this part, the annual, coordinated election tion 1851(j). title. period under subsection (e)(3)(B) for 2006 ‘‘(2) AS PART OF EFFS PLAN.—EFFS organi- (c) STUDY ON TRANSITIONING PART B PRE- shall be the 6-month period beginning with zations are required to offer EFFS plans that SCRIPTION DRUG COVERAGE.—Not later than November 2005. include qualified prescription drug coverage January 1, 2005, the Medicare Benefits Ad- ‘‘(8) QUALIFIED PRESCRIPTION DRUG COV- under part E pursuant to section 1860E–2(d). ministrator shall submit a report to Con- ERAGE; STANDARD COVERAGE.—For purposes ‘‘(c) APPLICATION OF PART C PROVISIONS gress that makes recommendations regard- of this part, the terms ‘qualified prescription UNDER THIS PART.—For purposes of applying ing methods for providing benefits under drug coverage’ and ‘standard coverage’ have provisions of part C under this part with re- part D of title XVIII of the Social Security the meanings given such terms in section spect to a prescription drug plan and a PDP Act for outpatient prescription drugs for 1860D–2. sponsor, unless otherwise provided in this which benefits are provided under part B of ‘‘(9) SPECIAL RULES FOR PRIVATE FEE-FOR- part such provisions shall be applied as if— such title. SERVICE PLANS.— With respect to a Medicare ‘‘(1) any reference to a Medicare Advantage SEC. 102. OFFERING OF QUALIFIED PRESCRIP- Advantage plan described in section or other plan included a reference to a pre- TION DRUG COVERAGE UNDER 1851(a)(2)(C) that offers qualified prescription scription drug plan; MEDICARE ADVANTAGE AND EN- drug coverage— ‘‘(2) any reference to a provider-sponsored HANCED FEE-FOR-SERVICE (EFFS) ‘‘(A) REQUIREMENTS REGARDING NEGOTIATED organization included a reference to a PDP PROGRAM. PRICES.—Subsections (a)(1) and (d)(1) of sec- sponsor; (a) MEDICARE ADVANTAGE.—Section 1851 (42 tion 1860D–2 shall not be construed to require ‘‘(3) any reference to a contract under sec- U.S.C. 1395w–21) is amended by adding at the the plan to negotiate prices or discounts but tion 1857 included a reference to a contract end the following new subsection: shall apply to the extent the plan does so. under section 1860D–4(b); and ‘‘(j) AVAILABILITY OF PRESCRIPTION DRUG ‘‘(B) MODIFICATION OF PHARMACY PARTICIPA- ‘‘(4) any reference to part C included a ref- BENEFITS AND SUBSIDIES.— TION REQUIREMENT.—If the plan provides ac- erence to this part. ‘‘(1) OFFERING OF QUALIFIED PRESCRIPTION cess, without charging additional copay- ‘‘(d) REPORT ON PHARMACY SERVICES PRO- DRUG COVERAGE.—A Medicare Advantage or- ments, to all pharmacies without regard to VIDED TO LONG-TERM CARE FACILITY PA- ganization on and after January 1, 2006— TIENTS.— ‘‘(A) may not offer a Medicare Advantage whether they are participating pharmacies ‘‘(1) REVIEW.—Within 6 months after the plan described in section 1851(a)(2)(A) in an in a network, section 1860D-3(c)(1)(A)(iii) date of the enactment of this section, the area unless either that plan (or another shall not apply to the plan. Secretary shall review the current standards Medicare Advantage plan offered by the or- ‘‘(C) DRUG UTILIZATION MANAGEMENT PRO- of practice for pharmacy services provided to ganization in that area) includes qualified GRAM NOT REQUIRED.—The requirements of patients in nursing facilities and other long- prescription drug coverage; and section 1860D-3(d)(1)(A) shall not apply to the term care facilities. ‘‘(B) may not offer the prescription drug plan. ‘‘(2) EVALUATIONS AND RECOMMENDATIONS.— coverage (other than that required under ‘‘(D) NON-PARTICIPATING PHARMACY DISCLO- Specifically in the review under paragraph parts A and B) to an enrollee under a Medi- SURE EXCEPTION.—If the plan provides cov- (1), the Secretary shall— care Advantage plan, unless such drug cov- erage for drugs purchased from all phar- ‘‘(A) assess the current standards of prac- erage is at least qualified prescription drug macies, without entering into contracts or tice, clinical services, and other service re- coverage and unless the requirements of this agreements with pharmacies to provide quirements generally utilized for pharmacy subsection with respect to such coverage are drugs to enrollees covered by the plan, sec- services in the long-term care setting; met. tion 1860D-3(d)(5) shall not apply to the ‘‘(B) evaluate the impact of those stand- ‘‘(2) REQUIREMENT FOR ELECTION OF PART D plan.’’. ards with respect to patient safety, reduc- COVERAGE TO OBTAIN QUALIFIED PRESCRIPTION (b) APPLICATION TO EFFS PLANS.—Sub- tion of medication errors and quality of care; DRUG COVERAGE.—For purposes of this part, section (d) of section 1860E–2, as added by and an individual who has not elected qualified section 201(a), is amended to read as follows: ‘‘(C) recommend (in the Secretary’s report prescription drug coverage under section ‘‘(d) AVAILABILITY OF PRESCRIPTION DRUG under paragraph (3)) necessary actions and 1860D–1(b) shall be treated as being ineligible BENEFITS AND SUBSIDIES.— appropriate reimbursement to ensure the to enroll in a Medicare Advantage plan under ‘‘(1) OFFERING OF QUALIFIED PRESCRIPTION provision of prescription drugs to medicare this part that offers such coverage. DRUG COVERAGE.—An EFFS organization— beneficiaries residing in nursing facilities ‘‘(3) COMPLIANCE WITH CERTAIN ADDITIONAL ‘‘(A) may not offer an EFFS plan in an and other long-term care facilities in a man- BENEFICIARY PROTECTIONS FOR PRESCRIPTION area unless either that plan (or another ner consistent with existing patient safety DRUG COVERAGE.—With respect to the offer- EFFS plan offered by the organization in and quality of care standards under applica- ing of qualified prescription drug coverage that area) includes qualified prescription ble State and Federal laws. by a Medicare Advantage organization under drug coverage; and ‘‘(3) REPORT.—The Secretary shall submit this part on and after January 1, 2006, the or- ‘‘(B) may not offer the prescription drug a report to the Congress on the Secretary’s ganization and plan shall meet the require- coverage (other than that required under findings and recommendations under this ments of subsections (a) through (d) of sec- parts A and B) to an enrollee under an EFFS subsection, including a detailed description tion 1860D–3 in the same manner as they plan, unless such drug coverage is at least of the Secretary’s plans to implement this apply to a PDP sponsor and a prescription qualified prescription drug coverage and un- part in a manner consistent with applicable drug plan under part D and shall submit to less the requirements of this subsection with State and Federal laws designed to protect the Administrator the information described respect to such coverage are met. the safety and quality of care of patients of in section 1860D–6(a)(2). The Administrator ‘‘(2) REQUIREMENT FOR ELECTION OF PART D nursing facilities and other long-term care shall waive such requirements to the extent COVERAGE TO OBTAIN QUALIFIED PRESCRIPTION facilities.’’. the Administrator determines that such re- DRUG COVERAGE.—For purposes of this part, (b) ADDITIONAL CONFORMING CHANGES.— quirements duplicate requirements other- an individual who has not elected qualified (1) CONFORMING REFERENCES TO PREVIOUS wise applicable to the organization or plan prescription drug coverage under section PART D.—Any reference in law (in effect be- under this part. 1860D–1(b) shall be treated as being ineligible
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to enroll in an EFFS plan under this part COME SUBSIDIES.—As a condition of its State the State plan under this title (including that offers such coverage. plan under this title under section 1902(a)(66) such a plan operating under a waiver under ‘‘(3) COMPLIANCE WITH CERTAIN ADDITIONAL and receipt of any Federal financial assist- section 1115). BENEFICIARY PROTECTIONS FOR PRESCRIPTION ance under section 1903(a), a State shall— ‘‘(B) STATE MATCHING RATE.—A proportion DRUG COVERAGE.—With respect to the offer- ‘‘(1) make determinations of eligibility for computed by subtracting from 100 percent ing of qualified prescription drug coverage premium and cost-sharing subsidies under the Federal medical assistance percentage by an EFFS organization under this part, the (and in accordance with) section 1860D–7; (as defined in section 1905(b)) applicable to organization and plan shall meet the require- ‘‘(2) inform the Administrator of the Medi- the State and the quarter. ments of subsections (a) through (d) of sec- care Benefits Administration of such deter- ‘‘(C) PHASE-OUT PROPORTION.—The phase- tion 1860D–3 in the same manner as they minations in cases in which such eligibility out proportion (as defined in paragraph (2)) apply to a PDP sponsor and a prescription is established; and for the quarter. drug plan under part D and shall submit to ‘‘(3) otherwise provide such Administrator ‘‘(2) PHASE-OUT PROPORTION.—For purposes the Administrator the information described with such information as may be required to of paragraph (1)(C), the ‘phase-out propor- in section 1860D–6(a)(2). The Administrator carry out part D of title XVIII (including tion’ for a calendar quarter in— shall waive such requirements to the extent section 1860D–7). ‘‘(A) 2006 is 931⁄3 percent; the Administrator determines that such re- ‘‘(b) PAYMENTS FOR ADDITIONAL ADMINIS- ‘‘(B) a subsequent year before 2021, is the quirements duplicate requirements other- TRATIVE COSTS.— phase-out proportion for calendar quarters in wise applicable to the organization or plan ‘‘(1) IN GENERAL.—The amounts expended the previous year decreased by 6-2⁄3 percent- under this part. by a State in carrying out subsection (a) are, age points; or subject to paragraph (2), expenditures reim- ‘‘(4) AVAILABILITY OF PREMIUM AND COST- ‘‘(C) a year after 2020 is 0 percent.’’. bursable under the appropriate paragraph of SHARING SUBSIDIES.—In the case of low-in- (c) MEDICAID PROVIDING WRAP-AROUND come individuals who are enrolled in an section 1903(a); except that, notwithstanding BENEFITS.—Section 1935, as so inserted and EFFS plan that provides qualified prescrip- any other provision of such section, the ap- amended, is further amended by adding at tion drug coverage, premium and cost-shar- plicable Federal matching rates with respect the end the following new subsection: ‘‘(d) ADDITIONAL PROVISIONS.— ing subsidies are provided for such coverage to such expenditures under such section ‘‘(1) MEDICAID AS SECONDARY PAYOR.—In the under section 1860D–7. shall be increased as follows (but in no case shall the rate as so increased exceed 100 per- case of an individual who is entitled to quali- ‘‘(5) AVAILABILITY OF DIRECT AND REINSUR- cent): fied prescription drug coverage under a pre- ANCE SUBSIDIES TO REDUCE BIDS AND PRE- ‘‘(A) For expenditures attributable to costs scription drug plan under part D of title MIUMS.—EFFS organizations are provided di- XVIII (or under a MA-EFFS Rx plan under rect and reinsurance subsidy payments for incurred during 2005, the otherwise applica- part C or E of such title) and medical assist- providing qualified prescription drug cov- ble Federal matching rate shall be increased 2 ance for prescribed drugs under this title, erage under this part under section 1860D–8. by 6- ⁄3 percent of the percentage otherwise payable (but for this subsection) by the medical assistance shall continue to be pro- ‘‘(6) CONSOLIDATION OF DRUG AND NON-DRUG State. vided under this title (other than for copay- PREMIUMS.—In the case of an EFFS plan that ment amounts specified in section 1860D– includes qualified prescription drug cov- ‘‘(B)(i) For expenditures attributable to 7(a)(1)(B), notwithstanding section 1916) for erage, with respect to an enrollee in such costs incurred during 2006 and each subse- prescribed drugs to the extent payment is plan there shall be a single premium for both quent year through 2018, the otherwise appli- not made under the prescription drug plan or drug and non-drug coverage provided under cable Federal matching rate shall be in- MA-EFFS Rx plan selected by the individual. the plan. creased by the applicable percent (as defined in clause (ii)) of the percentage otherwise ‘‘(2) CONDITION.—A State may require, as a ‘‘(7) QUALIFIED PRESCRIPTION DRUG COV- payable (but for this subsection) by the condition for the receipt of medical assist- ERAGE; STANDARD COVERAGE.—For purposes ance under this title with respect to pre- of this part, the terms ‘qualified prescription State. scription drug benefits for an individual eli- drug coverage’ and ‘standard coverage’ have ‘‘(ii) For purposes of clause (i), the ‘appli- gible to obtain qualified prescription drug the meanings given such terms in section cable percent’ for— 1 coverage described in paragraph (1), that the 1860D–2.’’. ‘‘(I) 2006 is 13- ⁄3 percent; or individual elect qualified prescription drug (c) CONFORMING AMENDMENTS.—Section ‘‘(II) a subsequent year is the applicable coverage under section 1860D–1.’’. 1851 (42 U.S.C. 1395w–21) is amended— percent under this clause for the previous 2 (d) TREATMENT OF TERRITORIES.— (1) in subsection (a)(1)— year increased by 6- ⁄3 percentage points. ‘‘(C) For expenditures attributable to costs (1) IN GENERAL.—Section 1935, as so in- (A) by inserting ‘‘(other than qualified pre- serted and amended, is further amended— scription drug benefits)’’ after ‘‘benefits’’; incurred after 2018, the otherwise applicable Federal matching rate shall be increased to (A) in subsection (a) in the matter pre- (B) by striking the period at the end of ceding paragraph (1), by inserting ‘‘subject subparagraph (B) and inserting a comma; 100 percent. ‘‘(2) COORDINATION.—The State shall pro- to subsection (e)’’ after ‘‘section 1903(a)’’; and (B) in subsection (c)(1), by inserting ‘‘sub- (C) by adding after and below subparagraph vide the Administrator with such informa- tion as may be necessary to properly allo- ject to subsection (e)’’ after ‘‘1903(a)(1)’’; and (B) the following: (C) by adding at the end the following new ‘‘and may elect qualified prescription drug cate administrative expenditures described in paragraph (1) that may otherwise be made subsection: coverage in accordance with section 1860D– ‘‘(e) TREATMENT OF TERRITORIES.— 1.’’; and for similar eligibility determinations.’’. (b) PHASED-IN FEDERAL ASSUMPTION OF ‘‘(1) IN GENERAL.—In the case of a State, (2) in subsection (g)(1), by inserting ‘‘and MEDICAID RESPONSIBILITY FOR PREMIUM AND other than the 50 States and the District of section 1860D–1(c)(2)(B)’’ after ‘‘in this sub- COST-SHARING SUBSIDIES FOR DUALLY ELIGI- Columbia— section’’. BLE INDIVIDUALS.— ‘‘(A) the previous provisions of this section (d) EFFECTIVE DATE.—The amendments (1) IN GENERAL.—Section 1903(a)(1) (42 shall not apply to residents of such State; made by this section apply to coverage pro- and vided on or after January 1, 2006. U.S.C. 1396b(a)(1)) is amended by inserting before the semicolon the following: ‘‘, re- ‘‘(B) if the State establishes a plan de- SEC. 103. MEDICAID AMENDMENTS. duced by the amount computed under sec- scribed in paragraph (2) (for providing med- (a) DETERMINATIONS OF ELIGIBILITY FOR tion 1935(c)(1) for the State and the quarter’’. ical assistance with respect to the provision LOW-INCOME SUBSIDIES.— (2) AMOUNT DESCRIBED.—Section 1935, as in- of prescription drugs to medicare bene- (1) REQUIREMENT.—Section 1902(a) (42 serted by subsection (a)(2), is amended by ficiaries), the amount otherwise determined U.S.C. 1396a(a)) is amended— adding at the end the following new sub- under section 1108(f) (as increased under sec- (A) by striking ‘‘and’’ at the end of para- section: tion 1108(g)) for the State shall be increased graph (64); ‘‘(c) FEDERAL ASSUMPTION OF MEDICAID by the amount specified in paragraph (3). (B) by striking the period at the end of PRESCRIPTION DRUG COSTS FOR DUALLY-ELI- ‘‘(2) PLAN.—The plan described in this paragraph (65) and inserting ‘‘; and’’; and GIBLE BENEFICIARIES.— paragraph is a plan that— (C) by inserting after paragraph (65) the ‘‘(1) IN GENERAL.—For purposes of section ‘‘(A) provides medical assistance with re- following new paragraph: 1903(a)(1), for a State that is one of the 50 spect to the provision of covered outpatient ‘‘(66) provide for making eligibility deter- States or the District of Columbia for a cal- drugs (as defined in section 1860D–2(f)) to minations under section 1935(a).’’. endar quarter in a year (beginning with 2005) low-income medicare beneficiaries; and (2) NEW SECTION.—Title XIX is further the amount computed under this subsection ‘‘(B) assures that additional amounts re- amended— is equal to the product of the following: ceived by the State that are attributable to (A) by redesignating section 1935 as section ‘‘(A) MEDICARE SUBSIDIES.—The total the operation of this subsection are used 1936; and amount of payments made in the quarter only for such assistance. (B) by inserting after section 1934 the fol- under section 1860D–7 (relating to premium ‘‘(3) INCREASED AMOUNT.— lowing new section: and cost-sharing prescription drug subsidies ‘‘(A) IN GENERAL.—The amount specified in ‘‘SPECIAL PROVISIONS RELATING TO MEDICARE for low-income medicare beneficiaries) that this paragraph for a State for a year is equal PRESCRIPTION DRUG BENEFIT are attributable to individuals who are resi- to the product of— ‘‘SEC. 1935. (a) REQUIREMENT FOR MAKING dents of the State and are entitled to bene- ‘‘(i) the aggregate amount specified in sub- ELIGIBILITY DETERMINATIONS FOR LOW-IN- fits with respect to prescribed drugs under paragraph (B); and
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‘‘(ii) the amount specified in section ‘‘(B) INDIVIDUAL COVERED.—An individual ‘‘MEDICARE PRESCRIPTION DRUG DISCOUNT CARD 1108(g)(1) for that State, divided by the sum described in this subparagraph is an indi- ENDORSEMENT AND ASSISTANCE PROGRAM of the amounts specified in such section for vidual who— ‘‘SEC. 1807. (a) ESTABLISHMENT OF PRO- all such States. ‘‘(i) enrolls in a prescription drug plan GRAM.— ‘‘(B) AGGREGATE AMOUNT.—The aggregate under part D; and ‘‘(1) IN GENERAL.—The Secretary shall es- amount specified in this subparagraph for— ‘‘(ii) at the time of such enrollment was tablish a program— ‘‘(i) 2006, is equal to $25,000,000; or enrolled and terminates enrollment in a ‘‘(A) to endorse prescription drug discount ‘‘(ii) a subsequent year, is equal to the ag- medicare supplemental policy which has a card programs (each such program referred gregate amount specified in this subpara- benefit package classified as ‘H’, ‘I’, or ‘J’ to as an ‘endorsed program’) that meet the graph for the previous year increased by an- under the standards referred to in subpara- requirements of this section in order to pro- nual percentage increase specified in section graph (A)(i) or terminates enrollment in a vide access to prescription drug discounts 1860D–2(b)(5) for the year involved. policy to which such standards do not apply through eligible entities for medicare bene- ‘‘(4) REPORT.—The Administrator shall sub- but which provides benefits for prescription ficiaries throughout the United States; and mit to Congress a report on the application drugs. ‘‘(B) to provide for prescription drug ac- of this subsection and may include in the re- ‘‘(C) ENFORCEMENT.—The provisions of counts and public contributions into such ac- port such recommendations as the Adminis- paragraph (4) of subsection (s) shall apply counts. trator deems appropriate.’’. with respect to the requirements of this The Secretary shall make available to medi- (2) CONFORMING AMENDMENT.—Section paragraph in the same manner as they apply care beneficiaries information regarding en- 1108(f) (42 U.S.C. 1308(f)) is amended by in- to the requirements of such subsection. dorsed programs and accounts under this serting ‘‘and section 1935(e)(1)(B)’’ after ‘‘(3) NEW STANDARDS.—In applying sub- section. ‘‘Subject to subsection (g)’’. section (p)(1)(E) (including permitting the ‘‘(2) LIMITED PERIOD OF OPERATION.—The (e) AMENDMENT TO BEST PRICE.—Section NAIC to revise its model regulations in re- Secretary shall begin— 1927(c)(1)(C)(i) (42 U.S.C. 1396r–8(c)(1)(C)(i)) is sponse to changes in law) with respect to the ‘‘(A) the card endorsement part of the pro- amended— change in benefits resulting from title I of gram under paragraph (1)(A) as soon as pos- (1) by striking ‘‘and’’ at the end of sub- the Medicare Prescription Drug and Mod- sible, but in no case later than 90 days after clause (III); ernization Act of 2003, with respect to poli- the date of the enactment of this section; (2) by striking the period at the end of sub- cies issued to individuals who are enrolled in and clause (IV) and inserting ‘‘; and’’; and a plan under part D, the changes in stand- ‘‘(B) the prescription drug account part of (3) by adding at the end the following new ards shall only provide for substituting (for the program under paragraph (1)(B) as soon subclause: the benefit packages described in paragraph as possible, but in no case later than Sep- ‘‘(V) any prices charged which are nego- (2)(B)(ii) that included coverage for prescrip- tember 2004. tiated by a prescription drug plan under part tion drugs) two benefit packages that may ‘‘(3) TRANSITION.—The program under this D of title XVIII, by a MA-EFFS Rx plan provide for coverage of cost-sharing (other section shall continue through 2005 through- under part C or E of such title with respect than the prescription drug deductible) with out the United States. The Secretary shall to covered outpatient drugs, or by a qualified respect to qualified prescription drug cov- provide for an appropriate transition and retiree prescription drug plan (as defined in termination of such program on January 1, section 1860D–8(f)(1)) with respect to such erage under such part. The two benefit pack- 2006. drugs on behalf of individuals entitled to ages shall be consistent with the following: ‘‘(4) VOLUNTARY NATURE OF PROGRAM.— benefits under part A or enrolled under part ‘‘(A) FIRST NEW POLICY.—The policy de- Nothing in this section shall be construed as B of such title.’’. scribed in this subparagraph has the fol- lowing benefits, notwithstanding any other requiring an eligible beneficiary to enroll in SEC. 104. MEDIGAP TRANSITION. provision of this section relating to a core the program under this section. (a) IN GENERAL.—Section 1882 (42 U.S.C. ‘‘(b) ELIGIBLE BENEFICIARY; ELIGIBLE ENTI- 1395ss) is amended by adding at the end the benefit package: ‘‘(i) Coverage of 50 percent of the cost-shar- TY; PRESCRIPTION DRUG ACCOUNT.—For pur- following new subsection: poses of this section: ‘‘(v) COVERAGE OF PRESCRIPTION DRUGS.— ing otherwise applicable under parts A and ‘‘(1) ELIGIBLE BENEFICIARY.—The term ‘eli- N GENERAL.—Notwithstanding any B, except coverage of 100 percent of any cost- ‘‘(1) I gible beneficiary’ means an individual who is other provision of law, except as provided in sharing otherwise applicable for preventive benefits. eligible for benefits under part A or enrolled paragraph (3) no new medicare supplemental under part B and who is not enrolled in a policy that provides coverage of expenses for ‘‘(ii) No coverage of the part B deductible. ‘‘(iii) Coverage for all hospital coinsurance Medicare Advantage plan that offers quali- prescription drugs may be issued under this fied prescription drug coverage. section on or after January 1, 2006, to an in- for long stays (as in the current core benefit package). ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible dividual unless it replaces a medicare supple- entity’ means any entity that the Secretary mental policy that was issued to that indi- ‘‘(iv) A limitation on annual out-of-pocket expenditures under parts A and B to $4,000 in determines to be appropriate to provide the vidual and that provided some coverage of benefits under this section, including— expenses for prescription drugs. Nothing in 2005 (or, in a subsequent year, to such limita- tion for the previous year increased by an ‘‘(A) pharmaceutical benefit management this subsection shall be construed as pre- companies; venting the policy holder of a medicare sup- appropriate inflation adjustment specified by the Secretary). ‘‘(B) wholesale and retail pharmacy deliv- plemental policy issued before January 1, ery systems; 2006, from continuing to receive benefits ‘‘(B) SECOND NEW POLICY.—The policy de- scribed in this subparagraph has the same ‘‘(C) insurers; under such policy on and after such date. ‘‘(D) Medicare Advantage organizations; benefits as the policy described in subpara- ‘‘(2) ISSUANCE OF SUBSTITUTE POLICIES FOR ‘‘(E) other entities; or graph (A), except as follows: BENEFICIARIES ENROLLED WITH A PLAN UNDER ‘‘(F) any combination of the entities de- ‘‘(i) Substitute ‘75 percent’ for ‘50 percent’ PART D.— scribed in subparagraphs (A) through (E). in clause (i) of such subparagraph. ‘‘(A) IN GENERAL.—The issuer of a medicare ‘‘(3) PRESCRIPTION DRUG ACCOUNT.—The ‘‘(ii) Substitute ‘$2,000’ for ‘$4,000’ in clause supplemental policy— term ‘prescription drug account’ means, with (iv) of such subparagraph. ‘‘(i) may not deny or condition the respect to an eligible beneficiary, an account ‘‘(4) CONSTRUCTION.—Any provision in this issuance or effectiveness of a medicare sup- established for the benefit of that bene- section or in a medicare supplemental policy plemental policy that has a benefit package ficiary under section 1807A. classified as ‘A’, ‘B’, ‘C’, ‘D’, ‘E’, ‘F’, or ‘G’ relating to guaranteed renewability of cov- ‘‘(c) ENROLLMENT IN ENDORSED PLAN.— (under the standards established under sub- erage shall be deemed to have been met ‘‘(1) ESTABLISHMENT OF PROCESS.— section (p)(2)) and that is offered and is through the offering of other coverage under ‘‘(A) IN GENERAL.—The Secretary shall es- available for issuance to new enrollees by this subsection.’’. tablish a process through which an eligible such issuer; (b) NAIC REPORT TO CONGRESS ON MEDIGAP beneficiary may make an election to enroll ‘‘(ii) may not discriminate in the pricing of MODERNIZATION.—The Secretary shall re- under this section with an endorsed program. such policy, because of health status, claims quest the National Association of Insurance ‘‘(B) REQUIREMENT OF ENROLLMENT.—An el- experience, receipt of health care, or medical Commissioners to submit to Congress, not igible beneficiary must enroll under this sec- condition; and later than 18 months after the date of the en- tion for a year in order to be eligible to re- ‘‘(iii) may not impose an exclusion of bene- actment of this Act, a report that includes ceive the benefits under this section for that fits based on a pre-existing condition under recommendations on the modernization of year. such policy, coverage under the medigap program under ‘‘(C) LIMITATION ON ENROLLMENT.— in the case of an individual described in sub- section 1882 of the Social Security Act (42 ‘‘(i) IN GENERAL.—Except as provided under paragraph (B) who seeks to enroll under the U.S.C. 1395ss). this subparagraph and under such excep- policy not later than 63 days after the date of SEC. 105. MEDICARE PRESCRIPTION DRUG DIS- tional circumstances as the Secretary may the termination of enrollment described in COUNT CARD AND ASSISTANCE PRO- provide, an eligible individual shall have the such paragraph and who submits evidence of GRAM. opportunity to enroll under this section dur- the date of termination or disenrollment (a) IN GENERAL.—Title XVIII is amended by ing an initial, general enrollment period as along with the application for such medicare inserting after section 1806 the following new soon as possible after the date of the enact- supplemental policy. sections: ment of this section and annually thereafter.
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00081 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.057 H26PT1 H6022 CONGRESSIONAL RECORD — HOUSE June 26, 2003 The Secretary shall specify the form, man- tion shall select any eligible entity, that has tures for purposes of Federal matching pay- ner, and timing of such election but shall been awarded a contract under this section ments under titles XIX and XXI insofar as permit the exercise of such election at the and serves the State in which the beneficiary such expenditures are for an enrollment fee time the individual is eligible to enroll. The resides, to provide access to negotiated under this subsection. annual open enrollment periods shall be co- prices under subsection (i). ‘‘(4) DISTRIBUTION OF PORTION OF ENROLL- ordinated with those provided under the ‘‘(B) RULES.—In establishing the process MENT FEE.—Of the enrollment fee collected Medicare Advantage program under part C. under subparagraph (A), the Secretary shall by the Secretary under this subsection with ‘‘(ii) REELECTION AFTER TERMINATION OF EN- use rules similar to the rules for enrollment respect to a beneficiary, 2⁄3 of that fee shall ROLLMENT IN A MEDICARE ADVANTAGE PLAN.— and disenrollment with a Medicare Advan- be made available to the eligible entity se- In the case of an individual who is enrolled tage plan under section 1851 (including the lected by the eligible beneficiary. under this section and who subsequently en- special election periods under subsection ‘‘(g) ISSUANCE OF CARD AND COORDINA- rolls in a Medicare Advantage plan that pro- (e)(4) of such section), including that— TION.—Each eligible entity shall— vides qualified prescription drug coverage ‘‘(i) an individual may not select more ‘‘(1) issue, in a uniform standard format under part C, the individual shall be given than one eligible entity at any time; and specified by the Secretary, to each enrolled the opportunity to reenroll under this sec- ‘‘(ii) an individual shall only be permitted beneficiary a card and an enrollment number tion at the time the individual discontinues (except for unusual circumstances) to change that establishes proof of enrollment and that the enrollment under such part. the selection of the entity once a year. can be used in a coordinated manner— ‘‘(iii) LATE ENROLLMENT.—The Secretary In carrying out clause (ii), the Secretary ‘‘(A) to identify the eligible entity selected shall permit individuals to elect to enroll may consider a change in residential setting to provide access to negotiated prices under under this section at times other than as (such as placement in a nursing facility) to subsection (i); and permitted under the previous provisions of be an unusual circumstance. ‘‘(B) to make deposits to and withdrawals this paragraph. ‘‘(C) DEFAULT SELECTION.—In establishing from a prescription drug account under sec- ‘‘(D) TERMINATION OF ENROLLMENT.—An en- such process, the Secretary shall provide an tion 1807A; and rollee under this section shall be equitable method for selecting an eligible en- ‘‘(2) provide for electronic methods to co- disenrolled— tity for individuals who enroll under this ordinate with the accounts established under ‘‘(i) upon enrollment in a Medicare Advan- section and fail to make such a selection. section 1807A. tage plan under part C that provides quali- ‘‘(2) COMPETITION.—Eligible entities with a ‘‘(h) ENROLLEE PROTECTIONS.— fied prescription drug coverage; contract under this section shall compete for ‘‘(1) GUARANTEED ISSUE AND NONDISCRIMINA- ‘‘(ii) upon failure to pay the applicable en- beneficiaries on the basis of discounts, TION.— rollment fee under subsection (f); formularies, pharmacy networks, and other ‘‘(A) GUARANTEED ISSUE.— ‘‘(iii) upon termination of coverage under services provided for under the contract. ‘‘(i) IN GENERAL.—An eligible beneficiary part A or part B; or ‘‘(e) PROVIDING ENROLLMENT, SELECTION, who is eligible to select an eligible entity ‘‘(iv) upon notice submitted to the Sec- AND COVERAGE INFORMATION TO BENE- under subsection (b) for prescription drug retary in such form, manner, and time as the FICIARIES.— coverage under this section at a time during Secretary shall provide. ‘‘(1) ACTIVITIES.—The Secretary shall pro- which selections are accepted under this sec- Terminations of enrollment under this sub- vide for activities under this section to tion with respect to the coverage shall not paragraph shall be effective as specified by broadly disseminate information to eligible be denied selection based on any health sta- the Secretary in regulations. beneficiaries (and prospective eligible bene- tus-related factor (described in section ‘‘(2) ENROLLMENT PERIODS.— ficiaries) regarding enrollment under this 2702(a)(1) of the Public Health Service Act) ‘‘(A) IN GENERAL.—Except as provided section, the selection of eligible entities, and or any other factor and may not be charged under this paragraph, an eligible beneficiary the prescription drug coverage made avail- any selection or other fee as a condition of may not enroll in the program under this able by eligible entities with a contract such acceptance. part during any period after the beneficiary’s under this section. ‘‘(ii) MEDICARE ADVANTAGE LIMITATIONS initial enrollment period under part B (as de- ‘‘(2) SPECIAL RULE FOR FIRST ENROLLMENT PERMITTED.—The provisions of paragraphs (2) termined under section 1837). UNDER THE PROGRAM.—To the extent prac- and (3) (other than subparagraph (C)(i), relat- ‘‘(B) OPEN ENROLLMENT PERIOD FOR CUR- ticable, the activities described in paragraph ing to default enrollment) of section 1851(g) RENT BENEFICIARIES.—The Secretary shall es- (1) shall ensure that eligible beneficiaries are (relating to priority and limitation on termi- tablish a period, which shall begin on the provided with such information at least 60 nation of election) shall apply to selection of date on which the Secretary first begins to days prior to the first enrollment period de- eligible entities under this paragraph. accept elections for enrollment under this scribed in subsection (c). ‘‘(B) NONDISCRIMINATION.—An eligible enti- section and shall end not earlier than 3 ‘‘(f) ENROLLMENT FEE.— ty offering prescription drug coverage under months later, during which any eligible ben- ‘‘(1) AMOUNT.—Except as provided in para- this section shall not establish a service area eficiary may enroll under this section. graph (3), enrollment under the program in a manner that would discriminate based ‘‘(C) SPECIAL ENROLLMENT PERIOD IN CASE under this section is conditioned upon pay- on health or economic status of potential en- OF TERMINATION OF COVERAGE UNDER A GROUP ment of an annual enrollment fee of $30. rollees. HEALTH PLAN.—The Secretary shall provide Such fee for 2004 shall include any portion of ‘‘(C) COVERAGE OF ALL PORTIONS OF A for a special enrollment period under this 2003 in which the program is implemented STATE.—If an eligible entity with a contract section in the same manner as is provided under this section. under this section serves any part of a State under section 1837(i) with respect to part B, ‘‘(2) COLLECTION OF ENROLLMENT FEE.—The it shall serve the entire State. except that for purposes of this subparagraph annual enrollment fee shall be collected and ‘‘(2) DISSEMINATION OF INFORMATION.— any reference to ‘by reason of the individ- credited to the Federal Supplementary Med- ‘‘(A) GENERAL INFORMATION.—An eligible ual’s (or the individual’s spouse’s) current ical Insurance Trust Fund in the same man- entity with a contract under this section employment status’ shall be treated as being ner as the monthly premium determined shall disclose, in a clear, accurate, and deleted. under section 1839 is collected and credited standardized form to each eligible bene- ‘‘(3) PERIOD OF COVERAGE.— to such Trust Fund under section 1840, ex- ficiary who has selected the entity to pro- ‘‘(A) IN GENERAL.—Except as provided in cept that it shall be collected only 1 time per vide access to negotiated prices under this subparagraph (B) and subject to subpara- year. section at the time of selection and at least graph (C), an eligible beneficiary’s coverage ‘‘(3) PAYMENT OF ENROLLMENT FEE BY STATE annually thereafter, the information de- under the program under this section shall FOR CERTAIN BENEFICIARIES.— scribed in section 1852(c)(1) relating to such be effective for the period provided under ‘‘(A) IN GENERAL.—The Secretary shall es- prescription drug coverage. Such informa- section 1838, as if that section applied to the tablish an arrangement under which a State tion includes the following (in a manner de- program under this section. may provide for payment of some or all of signed to permit and promote competition ‘‘(B) ENROLLMENT DURING OPEN AND SPECIAL the enrollment fee for some or all low in- among eligible entities): ENROLLMENT.—Subject to subparagraph (C), come enrollees in the State, as specified by ‘‘(i) Summary information regarding nego- an eligible beneficiary who enrolls under the the State under the arrangement. Insofar as tiated prices (including discounts) for cov- program under this section under subpara- such a payment arrangement is made with ered outpatient drugs. graph (B) or (C) of paragraph (2) shall be en- respect to an enrollee, the amount of the en- ‘‘(ii) Access to such prices through phar- titled to the benefits under this section be- rollment fee shall be paid directly by the macy networks. ginning on the first day of the month fol- State and shall not be collected under para- ‘‘(iii) How any formulary used by the eligi- lowing the month in which such enrollment graph (2). In carrying out this paragraph, the ble entity functions. occurs. Secretary may apply procedures similar to ‘‘(B) DISCLOSURE UPON REQUEST OF GENERAL ‘‘(d) SELECTION OF AN ELIGIBLE ENTITY FOR that applied under state agreements under COVERAGE, UTILIZATION, AND GRIEVANCE IN- ACCESS TO NEGOTIATED PRICES.— section 1843. FORMATION.—Upon request of an eligible ben- ‘‘(1) PROCESS.— ‘‘(B) NO FEDERAL MATCHING AVAILABLE eficiary, the eligible entity shall provide the ‘‘(A) IN GENERAL.—The Secretary shall es- UNDER MEDICAID OR SCHIP.—Expenditures information described in section 1852(c)(2) tablish a process through which an eligible made by a State described in subparagraph (other than subparagraph (D)) to such bene- beneficiary who is enrolled under this sec- (A) shall not be treated as State expendi- ficiary.
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‘‘(C) RESPONSE TO BENEFICIARY QUES- ‘‘(8) CONFIDENTIALITY AND ACCURACY OF EN- in the same manner as such provisions apply TIONS.—Each eligible entity offering pre- ROLLEE RECORDS.—An eligible entity shall to information disclosed under such section. scription drug coverage under this section meet the requirements of section 1852(h) ‘‘(6) PUBLIC DISCLOSURE OF PHARMACEUTICAL shall have a mechanism (including a toll-free with respect to enrollees under this section PRICES FOR EQUIVALENT DRUGS.—Each eligible telephone number) for providing upon re- in the same manner as such requirements entity shall provide that each pharmacy or quest specific information (such as nego- apply to a Medicare Advantage organization other dispenser that arranges for the dis- tiated prices, including discounts) to individ- with respect to enrollees under part C. The pensing of a covered outpatient drug in con- uals who have selected the entity. The entity eligible entity shall implement policies and nection with its endorsed program shall in- shall make available, through an Internet procedures to safeguard the use and disclo- form the enrollee in that program at the website and in writing upon request, infor- sure of enrollees’ individually identifiable time of purchase of the drug of any differen- mation on specific changes in its formulary. health information in a manner consistent tial between the price of the prescribed drug ‘‘(D) COORDINATION WITH PRESCRIPTION DRUG with the Federal regulations (concerning the to the enrollee and the price of the lowest ACCOUNT BENEFITS.—Each such eligible enti- privacy of individually identifiable health cost available generic drug covered under ty shall provide for coordination of such in- information) promulgated under section the program that is therapeutically equiva- formation as the Secretary may specify to 264(c) of the Health Insurance Portability lent and bioequivalent. ‘‘(j) CONTRIBUTION INTO PRESCRIPTION DRUG carry out section 1807A. and Accountability Act of 1996. The eligible entity shall be treated as a covered entity ACCOUNT.— ‘‘(3) ACCESS TO COVERED BENEFITS.— for purposes of the provisions of subpart E of ‘‘(1) IN GENERAL.—In the case of an indi- ‘‘(A) ENSURING PHARMACY ACCESS.—The part 164 of title 45, Code of Federal Regula- vidual enrolled under this section, the Sec- provisions of subsection (c)(1) of section tions, adopted pursuant to the authority of retary shall— 1860D–3 (other than payment provisions the Secretary under section 264(c) of the ‘‘(A) establish a prescription drug account under section 1860D–8 with respect to spon- Health Insurance Portability and Account- for the individual under section 1807A; and sors under such subsection) shall apply to an ability Act of 1996 (42 U.S. C. 1320d-2 note). ‘‘(B) subject to paragraph (5), deposit into eligible entity under this section in the same ‘‘(9) PERIODIC REPORTS AND OVERSIGHT.— such account on a monthly or other periodic manner as they apply to a PDP sponsor The eligible entity shall submit to the Sec- basis an amount that, on an annual basis, is under such section. retary periodic reports on performance, uti- equivalent to the annual Federal contribu- ‘‘(B) ACCESS TO NEGOTIATED PRICES FOR lization, finances, and such other matters as tion amount specified in paragraph (2) for PRESCRIPTION DRUGS.—For requirements re- the Secretary may specify. The Secretary the enrollee involved. lating to the access of an eligible beneficiary shall provide appropriate oversight to ensure ‘‘(2) ANNUAL FEDERAL CONTRIBUTION to negotiated prices (including applicable compliance of eligible entities with the re- AMOUNT.—Subject to paragraph (3), in the discounts), see subsection (i). quirements of this subsection, including case of an accountholder whose income is— ‘‘(C) REQUIREMENTS ON DEVELOPMENT AND verification of the discounts and services ‘‘(A) not more than 135 percent of the pov- APPLICATION OF FORMULARIES.—Insofar as an provided. erty line, the annual Federal contribution eligible entity with a contract under this ‘‘(10) ADDITIONAL BENEFICIARY PROTEC- amount for a year is $800; part uses a formulary, the entity shall com- TIONS.—The eligible entity meets such addi- ‘‘(B) more than 135 percent, but not more ply with the requirements of section 1860D– tional requirements as the Secretary identi- than 150 percent, of the poverty line, the an- 3(c)(3), insofar as the Secretary determines fies to protect and promote the interest of nual Federal contribution amount for a year that such requirements can be implemented enrollees, including requirements that en- is $500; or on a timely basis. sure that enrollees are not charged more ‘‘(C) more than 150 percent of the poverty ‘‘(4) COST AND UTILIZATION MANAGEMENT; than the lower of the negotiated retail price line, the annual Federal contribution QUALITY ASSURANCE; MEDICATION THERAPY or the usual and customary price. amount for a year is $100. MANAGEMENT PROGRAM.— ‘‘(i) BENEFITS UNDER THE PROGRAM ‘‘(3) INCOME ELIGIBILITY DETERMINATIONS.— ‘‘(A) IN GENERAL.—For purposes of pro- THROUGH SAVINGS TO ENROLLEES THROUGH The determination of whether an individual viding access to negotiated benefits under NEGOTIATED PRICES.— residing in a State is a eligible for a con- subsection (i), the eligible entity shall have ‘‘(1) IN GENERAL.—Subject to paragraph (2), tribution under paragraph (1) shall be deter- in place the programs and measure described each eligible entity with a contract under mined under the State medicaid plan for the in section 1860D–3(d), including an effective this section shall provide each eligible bene- State under section 1935(a) or by the Social cost and drug utilization management pro- ficiary enrolled with the entity with access Security Administration. In the case of a gram, quality assurance measures and sys- to negotiated prices (including applicable State that does not operate such a medicaid tems, and a program to control fraud, abuse, discounts). For purposes of this paragraph, plan (either under title XIX or under a state- and waste, insofar as the Secretary deter- the term ‘prescription drugs’ is not limited wide waiver granted under section 1115), such mines that such provisions can be imple- to covered outpatient drugs, but does not in- determination shall be made under arrange- mented on a timely basis. clude any over-the-counter drug that is not a ments made by the Secretary. There are au- ‘‘(B) TREATMENT OF ACCREDITATION.—Sec- covered outpatient drug. The prices nego- thorized to be appropriated to the Social Se- tion 1852(e)(4) (relating to treatment of ac- tiated by an eligible entity under this para- curity Administration such sums as may be creditation) shall apply to the requirements graph shall (notwithstanding any other pro- necessary for the determination of eligibility for an endorsed program under this section vision of law) not be taken into account for under this paragraph. with respect to the following requirements, the purposes of establishing the best price ‘‘(4) PARTIAL YEAR.—Insofar as the provi- in the same manner as they apply to Medi- under section 1927(c)(1)(C). sions of this subsection and section 1807A are care Advantage plans under part C with re- ‘‘(2) FORMULARY RESTRICTIONS.—Insofar as not implemented for all months in 2004, the spect to the requirements described in a an eligible entity with a contract under this annual contribution amount under this sub- clause of section 1852(e)(4)(B): part uses a formulary, the negotiated prices section for 2004 shall be prorated to reflect ‘‘(i) Paragraph (3)(A) (relating to access to (including applicable discounts) for prescrip- the portion of that year in which such provi- covered benefits). tion drugs shall only be available for drugs sions are in effect. ‘‘(ii) Paragraph (7) (relating to confiden- included in such formulary. ‘‘(5) RESTRICTION ON CONTRIBUTIONS.—There tiality and accuracy of enrollee records). ‘‘(3) PROHIBITION ON APPLICATION ONLY TO shall only be an annual Federal contribution ‘‘(5) GRIEVANCE MECHANISM.—Each eligible MAIL ORDER.—The negotiated prices under under paragraph (1) for an individual if the entity shall provide meaningful procedures this subsection shall apply to prescription individual is not eligible for coverage of, or for hearing and resolving grievances between drugs that are available other than solely assistance for, outpatient prescription drugs the organization consistent with the require- through mail order. under any of the following: ments of section 1860D–3(e) insofar as they ‘‘(4) PROHIBITION ON CHARGES FOR REQUIRED ‘‘(A) A medicaid plan under title XIX (in- relate to PDP sponsors of prescription drug SERVICES.—An eligible entity (and any phar- cluding under any waiver approved under plans. macy contracting with such entity for the section 1115). ‘‘(6) BENEFICIARY SERVICES.—An eligible en- provision of a discount under this section) ‘‘(B) Enrollment under a group health plan tity shall provide for its enrollees pharma- may not charge a beneficiary any amount for or health insurance coverage. ceutical support services, such as education any services required to be provided by the ‘‘(C) Enrollment under a medicare supple- and counseling, and services to prevent ad- entity under this section. mental insurance policy. verse drug interactions. ‘‘(5) DISCLOSURE.—The eligible entity offer- ‘‘(D) Chapter 55 of title 10, United States ‘‘(7) COVERAGE DETERMINATIONS AND RECON- ing the endorsed program shall disclose to Code (relating to medical and dental care for SIDERATIONS.—An eligible entity shall meet the Secretary (in a manner specified by the members of the uniformed services). the requirements of paragraphs (1) through Secretary) the extent to which discounts or ‘‘(E) Chapter 17 of title 38, United States (3) of section 1852(g) with respect to covered rebates or other remuneration or price con- Code (relating to Veterans’ medical care). benefits under the prescription drug cov- cessions made available to the entity by a ‘‘(F) Enrollment under a plan under chap- erage it offers under this section in the same manufacturer are passed through to enroll- ter 89 of title 5, United States Code (relating manner as such requirements apply to a ees through pharmacies and other dispensers to the Federal employees’ health benefits Medicare Advantage organization with re- or otherwise. The provisions of section program). spect to benefits it offers under a Medicare 1927(b)(3)(D) shall apply to information dis- ‘‘(G) The Indian Health Care Improvement Advantage plan under part C. closed to the Secretary under this paragraph Act (25 U.S.C. 1601 et seq.).
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‘‘(6) APPROPRIATION TO COVER NET PROGRAM ‘‘PRESCRIPTION DRUG ACCOUNTS ‘‘(I) SURVIVING SPOUSE.—If the EXPENDITURES.—There are authorized to be ‘‘SEC. 1807A. ‘‘(a) ESTABLISHMENT OF AC- accountholder was married at the time of appropriated from time to time, out of any COUNTS.— death, the remainder shall be credited to an moneys in the Treasury not otherwise appro- ‘‘(1) IN GENERAL.—The Secretary shall es- account (including a reserve account) of the priated, to the Federal Supplementary Med- tablish and maintain for each eligible bene- accountholder’s surviving spouse. ical Insurance Trust Fund established under ficiary who is enrolled under section 1807 at ‘‘(II) NO SURVIVING SPOUSE.—If the section 1841, an amount equal to the amount the time of enrollment a prescription drug accountholder was not so married, the re- by which the benefits and administrative account (in this section and section 1807 re- mainder shall be distributed to the estate of costs of providing the benefits under this ferred to as an ‘account’). the accountholder and distributed as pro- section exceed the sum of the portion of the ‘‘(2) RESERVE ACCOUNTS.—In cases de- vided by law. enrollment fees retained by the Secretary. scribed in subsections (b)(3)(A), (b)(3)(B)(i), ‘‘(4) USE OF ACCOUNT FOR PREMIUMS FOR EN- ‘‘(k) DEFINITIONS.—In this part and section and (b)(3)(B)(ii)(I), the Secretary shall estab- ROLLMENT IN A MEDICARE ADVANTAGE PLAN.— 1807A: lish and maintain for each surviving spouse During any period in which an accountholder ‘‘(1) COVERED OUTPATIENT DRUG.— who is not enrolled under section 1807 a re- is enrolled in a Medicare Advantage plan ‘‘(A) IN GENERAL.—Except as provided in serve prescription drug account (in this sec- under part C, the balance in the account may this paragraph, for purposes of this section, tion referred to as an ‘reserve account’). be used and applied only to reimburse the the term ‘covered outpatient drug’ means— ‘‘(3) ACCOUNTHOLDER DEFINED.—In this sec- amount of the premium (if any) established ‘‘(i) a drug that may be dispensed only tion and section 1807A, the term for enrollment under the plan. upon a prescription and that is described in ‘accountholder’ means an individual for ‘‘(5) APPLICATION TO MEDICAID EXPENSES IN subparagraph (A)(i) or (A)(ii) of section whom an account or reserve account has CERTAIN CASES.— 1927(k)(2); or been established under this section. ‘‘(A) IN GENERAL.—Except as provided in ‘‘(ii) a biological product described in ‘‘(4) EXPENDITURES FROM ACCOUNT.—Noth- this paragraph, an account shall be treated clauses (i) through (iii) of subparagraph (B) ing in this section shall be construed as re- as an asset for purposes of establishing eligi- of such section or insulin described in sub- quiring the Federal Government to obligate bility for medical assistance under title XIX. paragraph (C) of such section and medical funds for amounts in any account until such ‘‘(B) APPLICATION TOWARDS SPENDDOWN.—In supplies associated with the injection of in- time as a withdrawal from such account is the case of an accountholder who is applying sulin (as defined in regulations of the Sec- authorized under this section. for such medical assistance and who would, retary), ‘‘(b) USE OF ACCOUNTS.— but for the application of subparagraph (A), ‘‘(1) APPLICATION OF ACCOUNT.—Except as be eligible for such assistance— and such term includes a vaccine licensed provided in this subsection, amounts cred- ‘‘(i) subparagraph (A) shall not apply; and under section 351 of the Public Health Serv- ited to an account shall only be used for the ‘‘(ii) the account shall be available (in ac- ice Act and any use of a covered outpatient purchase of covered outpatient drugs for the cordance with a procedure established by the drug for a medically accepted indication (as accountholder. Any amounts remaining at Secretary) to the State to reimburse the defined in section 1927(k)(6)). the end of a year remain available for ex- State for any expenditures made under the ‘‘(B) EXCLUSIONS.— penditures in succeeding years. plan for such medical assistance. ‘‘(i) IN GENERAL.—Such term does not in- ‘‘(2) ACCOUNT RULES FOR PUBLIC AND PRI- ‘‘(c) AMOUNTS CREDITED IN ACCOUNT.—The clude drugs or classes of drugs, or their med- VATE CONTRIBUTIONS.—The Secretary shall Secretary shall credit to a prescription drug ical uses, which may be excluded from cov- establish a ongoing process for the deter- account of an eligible beneficiary the fol- erage or otherwise restricted under section mination of the amount in each account that lowing amounts: 1927(d)(2), other than subparagraph (E) there- is attributable to public and private con- ‘‘(1) PUBLIC CONTRIBUTIONS.—The following of (relating to smoking cessation agents), or tributions (including spousal rollover con- contributions (each referred to in this sec- under section 1927(d)(3). tributions) based on the following rules: tion as a ‘public contribution’): ‘‘(ii) AVOIDANCE OF DUPLICATE COVERAGE.— ‘‘(A) TREATMENT OF EXPENDITURES.—Ex- ‘‘(A) FEDERAL CONTRIBUTIONS.—Federal A drug prescribed for an individual that penditures from the account shall— contributions provided under subsection (d). would otherwise be a covered outpatient ‘‘(i) first be counted against any public ‘‘(B) STATE CONTRIBUTIONS.—Contributions drug under this section shall not be so con- contribution; and made by a State under subsection (f). sidered if payment for such drug is available ‘‘(ii) next be counted against private con- ‘‘(2) SPOUSAL ROLLOVER CONTRIBUTION.—A under part A or B for an individual entitled tributions. distribution from a deceased spouse under to benefits under part A and enrolled under ‘‘(B) TREATMENT OF SPOUSAL ROLLOVER CON- subsection (b)(3) (referred to in this section part B. TRIBUTIONS.—With respect to any spousal as a ‘spousal rollover contribution’). ‘‘(C) APPLICATION OF FORMULARY RESTRIC- rollover contribution, the portions of such ‘‘(3) PRIVATE CONTRIBUTIONS.—The fol- TIONS.—A drug prescribed for an individual contribution that were attributable to public lowing contributions (each referred to in this that would otherwise be a covered outpatient and private contributions at the time of its section as a ‘private contribution’): drug under this section shall not be so con- distribution under subsection (b)(3) shall be ‘‘(A) EMPLOYER AND INDIVIDUAL CONTRIBU- sidered under an endorsed program if the eli- treated under this paragraph as if it were a TIONS.—Contributions made under subsection gible entity offering the program excludes direct public or private contribution, respec- (e). the drug under a formulary and a review of tively, into the account of the spouse. ‘‘(B) OTHER INDIVIDUAL CONTRIBUTIONS.— such exclusion is not successfully resolved ‘‘(3) DEATH OF ACCOUNTHOLDER.—In the case Contributions made by accountholder other under subsection (h)(5). of the death of an accountholder, the balance than under subsection (e). ‘‘(D) APPLICATION OF GENERAL EXCLUSION in any account (taking into account liabil- ‘‘(C) CONTRIBUTIONS BY NONPROFIT ORGANI- PROVISIONS.—An eligible entity offering an ities accrued before the time of death) shall ZATIONS.—Contributions made by a chari- endorsed program may exclude from quali- be distributed as follows: table, not-for-profit organization (that may fied prescription drug coverage any covered ‘‘(A) TREATMENT OF PUBLIC CONTRIBU- be a religious organization). outpatient drug— TIONS.—If the accountholder is married at Except as provided in this subsection, no ‘‘(i) for which payment would not be made the time of death, the amount in the account amounts may be contributed to, or credited if section 1862(a) applied to part D; or that is attributable to public contributions to, a prescription drug account. ‘‘(ii) which are not prescribed in accord- shall be credited to the account (if any) of ‘‘(d) FEDERAL CONTRIBUTION.—For Federal ance with the program or this section. the surviving spouse of the accountholder contributions in the case of accountholders, Such exclusions are determinations subject (or, if the surviving spouse is not an eligible see section 1807(j). to review pursuant to subsection (h)(5). beneficiary, into a reserve account to be held ‘‘(e) EMPLOYER AND INDIVIDUAL CONTRIBU- ‘‘(2) POVERTY LINE.—The term ‘poverty for when that spouse becomes an eligible TIONS.— line’ means the income official poverty line beneficiary). ‘‘(1) EMPLOYMENT-RELATED CONTRIBUTION.— (as defined by the Office of Management and ‘‘(B) TREATMENT OF PRIVATE CONTRIBU- ‘‘(A) IN GENERAL.—In the case of any Budget, and revised annually in accordance TIONS.—The amount in the account that is accountholder who is a beneficiary or partic- with section 673(2) of the Omnibus Budget attributable to private contributions shall be ipant in a group health plan (including a Reconciliation Act of 1981) applicable to a distributed as follows: multi-employer plan), whether as an em- family of the size involved. ‘‘(i) DESIGNATION OF DISTRIBUTEE.—If the ployee, former employee or otherwise, in- ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.— accountholder has made a designation, in a cluding as a dependent of an employee or There are authorized to be appropriated such form and manner specified by the Secretary, former employee, the plan may make a con- sums as may be necessary to carry out this for the distribution of some or all of such tribution into the accountholder’s account section and section 1807A. amount, such amount shall be distributed in (but not into a reserve account of the ‘‘(e) INTERIM, FINAL REGULATORY AUTHOR- accordance with the designation. Such des- accountholder). ITY.—In order to carry out this section and ignation may provide for the distribution ‘‘(B) LIMITATION.—The total amount that section 1807A in a timely manner, the Sec- into an account (including a reserve account) may be contributed under subparagraph (A) retary may promulgate regulations that of a surviving spouse. under a plan to an account during any year take effect on an interim basis, after notice ‘‘(ii) ABSENCE OF DESIGNATION.—Insofar as may not exceed $5,000. and pending opportunity for public com- the accountholder has not made such a des- ‘‘(C) CONDITION.—A group health plan may ment. ignation— condition a contribution with respect to an
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00084 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.057 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6025 accountholder under this paragraph on the disclose to officers and employees of the De- implementation of the medicare prescription accountholder’s enrollment under section partment of Health and Human Services drug program under part D of title XVIII of 1807 with an eligible entity that is recognized with respect to a specified taxpayer for the the Social Security Act. or approved by that plan. taxable year specified by the Secretary of (2) DEFINITIONS.—For purposes of this sec- ‘‘(2) OTHER INDIVIDUALS.— Health and Human Services in such re- tion: ‘‘(A) IN GENERAL.—Any individual may also quest— (A) STATE PHARMACEUTICAL ASSISTANCE contribute to the account of that individual ‘‘(i) the taxpayer identity information with PROGRAM DEFINED.—The term ‘‘State phar- or the account of any other individual under respect to such taxpayer, and maceutical assistance program’’ means a this subsection. ‘‘(ii) the adjusted gross income of such tax- program (other than the medicaid program) ‘‘(B) LIMITATION.—The total amount that payer for the taxable year (or, if less, the in- operated by a State (or under contract with may be contributed to an account under sub- come threshold limit specified in section a State) that provides as of the date of the paragraph (A) during any year may not ex- 1860D–2(b)(4)(D)(ii) for the calendar year enactment of this Act assistance to low-in- ceed $5,000, regardless of who makes such specified by such Secretary in such request). come medicare beneficiaries for the purchase contribution. ‘‘(B) SPECIFIED TAXPAYER.—For purposes of of prescription drugs. ‘‘(3) NO CONTRIBUTION PERMITTED TO RE- this paragraph, the term ‘specified taxpayer’ (B) PROGRAM PARTICIPANT.—The term ‘‘pro- SERVE ACCOUNT.—No contribution may be means any taxpayer who— gram participant’’ means a low-income made under this subsection to a reserve ac- ‘‘(i) is identified by the Secretary of Health medicare beneficiary who is a participant in count. and Human Services in the request referred a State pharmaceutical assistance program. ‘‘(4) FORM AND MANNER OF CONTRIBUTION.— to in subparagraph (A), and (b) COMPOSITION.—The Commission shall The Secretary shall specify the form and ‘‘(ii) either— include the following: manner of contributions under this sub- ‘‘(I) has an adjusted gross income for the (1) A representative of each governor of section. taxable year referred to in subparagraph (A) each State that the Secretary identifies as ‘‘(f) STATE CONTRIBUTIONS.— in excess of the income threshold specified in operating on a statewide basis a State phar- ‘‘(1) IN GENERAL.—A State may enter into section 1860D–2(b)(4)(D)(ii) of such Act for maceutical assistance program that provides arrangements with the Secretary for the the calendar year referred to in such sub- for eligibility and benefits that are com- crediting of amounts for accountholders. paragraph, or parable or more generous than the low-in- ‘‘(2) FORM AND MANNER OF CONTRIBUTION.— ‘‘(II) is identified by such Secretary under come assistance eligibility and benefits of- The Secretary shall specify the form and subparagraph (A) as being an individual who fered under part D of title XVIII of the So- manner of contributions under this sub- elected to use more recent information cial Security Act. section. under section 1860D–2(b)(4)(D)(v) of such Act. (2) Representatives from other States that ‘‘(3) MEDICAID TREATMENT.—Amounts cred- ‘‘(C) JOINT RETURNS.—In the case of a joint the Secretary identifies have in operation ited under this subsection shall not be treat- return, the Secretary shall, for purposes of other State pharmaceutical assistance pro- ed as medical assistance for purposes of title applying this paragraph, treat each spouse as grams, as appointed by the Secretary. XIX or child health assistance for purposes a separate taxpayer having an adjusted gross (3) Representatives of organizations that of title XXI for individuals who are not income equal to one-half of the adjusted have an inherent interest in program partici- qualifying low income enrollees.’’. gross income determined with respect to pants or the program itself, as appointed by (b) EXCLUSION OF COSTS FROM DETERMINA- such return. the Secretary but not to exceed the number TION OF PART B MONTHLY PREMIUM.—Section ‘‘(D) RESTRICTION ON USE OF DISCLOSED IN- of representatives under paragraphs (1) and 1839(g) (42 U.S.C. 1395r(g)) is amended— FORMATION.—Return information disclosed (2). (1) by striking ‘‘attributable to the appli- under subparagraph (A) may be used by offi- (4) Representatives of Medicare Advantage cation of section’’ and inserting ‘‘attrib- cers and employees of the Department of organizations and other private health insur- utable to— Health and Human Services only for the pur- ance plans, as appointed by the Secretary. ‘‘(1) the application of section’’; pose of administering the prescription drug (5) The Secretary (or the Secretary’s des- (2) by striking the period and inserting ‘‘; benefit under title XVIII of the Social Secu- ignee) and such other members as the Sec- and’’; and rity Act. Such officers and employees may retary may specify (3) by adding at the end the following new disclose the annual out-of-pocket threshold The Secretary shall designate a member to paragraph: which applies to an individual under such serve as chair of the Commission and the ‘‘(2) the Voluntary Medicare Outpatient part to the entity that offers the plan re- Commission shall meet at the call of the Prescription Drug Discount and Security ferred to in section 1860D–2(b)(4)(E)(ii) of chair. Program under sections 1807 and 1807A.’’. such Act in which such individual is en- (c) DEVELOPMENT OF PROPOSAL.—The Com- (c) STATE ELIGIBILITY DETERMINATIONS.— rolled. Such sponsor may use such informa- mission shall develop the proposal described Section 1935, as added by section 103(a)(2), is tion only for purposes of administering such in subsection (a) in a manner consistent with amended— benefit.’’. the following principles: (1) in subsection (a)(1), by inserting ‘‘and of (2) JOINT RETURN PERMITTED IN CASE OF (1) Protection of the interests of program eligibility for an annual Federal contribu- SURVIVING SPOUSES.—Under section 6103(a)(3) participants in a manner that is the least tion amount under section 1807A(j)(2)’’ before of the Internal Revenue Code of 1986, a sur- disruptive to such participants and that in- the semicolon; and viving spouse may file a joint return for the cludes a single point of contact for enroll- (2) in subsection (a)(3), by inserting ‘‘and taxable year in which one spouse dies. ment and processing of benefits. sections 1807 and 1807A’’ after ‘‘1860D–7)’’. (b) CONFIDENTIALITY.—Paragraph (3) of sec- (2) Protection of the financial and flexi- (d) REPORT ON PROGRESS IN IMPLEMENTA- tion 6103(a) of such Code is amended by strik- bility interests of States so that States are TION OF PRESCRIPTION DRUG BENEFIT.—Not ing ‘‘or (16)’’ and inserting ‘‘(16), or (19)’’. not financially worse off as a result of the later than March 1, 2005, the Administrator (c) PROCEDURES AND RECORDKEEPING RE- enactment of this title. shall submit a report to Congress on the LATED TO DISCLOSURES.—Subsection (p)(4) of (3) Principles of medicare modernization progress that has been made in imple- section 6103 of such Code is amended by provided under title II of this Act. menting the prescription drug benefit under striking ‘‘any other person described in sub- (d) REPORT.—By not later than January 1, this title. The Administrator shall include in section (l)(16) or (17)’’ each place it appears 2005, the Commission shall submit to the the report specific steps that have been and inserting ‘‘any other person described in President and the Congress a report that taken, and that need to be taken, to ensure subsection (l)(16), (17), or (19)’’. contains a detailed proposal (including spe- a timely start of the program on January 1, (d) UNAUTHORIZED DISCLOSURE.—Paragraph cific legislative or administrative rec- 2006. (2) of section 7213(a) of such Code is amended ommendations, if any) and such other rec- SEC. 106. DISCLOSURE OF RETURN INFORMA- by striking ‘‘or (16)’’ and inserting ‘‘(16), or ommendations as the Commission deems ap- TION FOR PURPOSES OF CARRYING (19)’’. propriate. OUT MEDICARE CATASTROPHIC (e) UNAUTHORIZED INSPECTION.—Subpara- (e) SUPPORT.—The Secretary shall provide PRESCRIPTION DRUG PROGRAM. graph (B) of section 7213A(a)(1) of such Code the Commission with the administrative sup- (a) DISCLOSURE.— is amended by inserting ‘‘or (19)’’ after ‘‘sub- port services necessary for the Commission (1) IN GENERAL.—Subsection (l) of section section (l)(18)’’. to carry out its responsibilities under this 6103 of the Internal Revenue Code of 1986 (re- SEC. 107. STATE PHARMACEUTICAL ASSISTANCE section. lating to disclosure of returns and return in- TRANSITION COMMISSION. (f) TERMINATION.—The Commission shall formation for purposes other than tax ad- (a) ESTABLISHMENT.— terminate 30 days after the date of submis- ministration) is amended by adding at the (1) IN GENERAL.—There is established, as of sion of the report under subsection (d). end the following new paragraph: the first day of the third month beginning SEC. 108. ADDITIONAL REQUIREMENTS FOR AN- ‘‘(19) DISCLOSURE OF RETURN INFORMATION after the date of the enactment of this Act, NUAL FINANCIAL REPORT AND FOR PURPOSES OF CARRYING OUT MEDICARE a State Pharmaceutical Assistance Transi- OVERSIGHT ON MEDICARE PRO- CATASTROPHIC PRESCRIPTION DRUG PROGRAM.— tion Commission (in this section referred to GRAM, INCLUDING PRESCRIPTION ‘‘(A) IN GENERAL.—The Secretary may, as the ‘‘Commission’’) to develop a proposal DRUG SPENDING. upon written request from the Secretary of for addressing the unique transitional issues (a) IN GENERAL.—Section 1817 (42 U.S.C. Health and Human Services under section facing State pharmaceutical assistance pro- 1395i) is amended by adding at the end the 1860D–2(b)(4)(E)(i) of the Social Security Act, grams, and program participants, due to the following new subsection:
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‘‘(l) COMBINED REPORT ON OPERATION AND (2) by inserting after part D the following ‘‘OFFERING OF ENHANCED FEE-FOR-SERVICE STATUS OF THE TRUST FUND, THE FEDERAL new part: (EFFS) PLANS SUPPLEMENTARY MEDICAL INSURANCE TRUST ‘‘SEC. 1860E–2. (a) PLAN REQUIREMENTS.—No ‘‘PART E—ENHANCED FEE-FOR-SERVICE FUND, AND MEDICARE PRESCRIPTION DRUG EFFS plan may be offered under this part in PROGRAM TRUST FUND.— an EFFS region unless the requirements of ‘‘(1) IN GENERAL.—In addition to the duty ‘‘OFFERING OF ENHANCED FEE-FOR-SERVICE this part are met with respect to the plan of the Board of Trustees to report to Con- PLANS THROUGHOUT THE UNITED STATES and EFFS organization offering the plan. gress under subsection (b), on the date the ‘‘(b) AVAILABLE TO ALL EFFS BENE- Board submits the report required under sub- ‘‘SEC. 1860E–1. (a) ESTABLISHMENT OF PRO- FICIARIES IN THE ENTIRE REGION.—With re- section (b)(2), the Board shall submit to Con- GRAM.— spect to an EFFS plan offered in an EFFS re- gress a report on the operation and status of ‘‘(1) IN GENERAL.—The Administrator shall gion— the Trust Fund, the Federal Supplementary establish under this part beginning January ‘‘(1) IN GENERAL.—The plan must be offered Medical Insurance Trust Fund established 1, 2006, an enhanced fee-for-service program to all EFFS-eligible individuals residing in under section 1841, and the Medicare Pre- under which enhanced fee-for-service plans the region. scription Drug Trust Fund under section (as defined in subsection (b)) are offered to ‘‘(2) ASSURING ACCESS TO SERVICES.—The 1860D–9(a) (in this subsection collectively re- EFFS-eligible individuals (as so defined) in plan shall comply with the requirements of ferred to as the ‘Trust Funds’). Such report EFFS regions throughout the United States. section 1852(d)(4). shall included the following information: ‘‘(2) EFFS REGIONS.—For purposes of this ‘‘(c) BENEFITS.— ‘‘(A) OVERALL SPENDING FROM THE GENERAL part the Administrator shall establish EFFS ‘‘(1) IN GENERAL.—Each EFFS plan shall FUND OF THE TREASURY.—A statement of regions throughout the United States by di- provide to members enrolled in the plan total amounts obligated during the pre- viding the entire United States into at least under this part benefits, through providers ceding fiscal year from the General Revenues 10 such regions. Before establishing such re- and other persons that meet the applicable of the Treasury to the Trust Funds for pay- gions, the Administrator shall conduct a requirements of this title and part A of title ment for benefits covered under this title, market survey and analysis, including an ex- XI— stated in terms of the total amount and in amination of current insurance markets, to ‘‘(A) for the items and services described in terms of the percentage such amount bears determine how the regions should be estab- section 1852(a)(1); to all other amounts obligated from such lished. The regions shall be established in a ‘‘(B) that are uniform for the plan for all General Revenues during such fiscal year. manner to take into consideration maxi- EFFS eligible individuals residing in the ‘‘(B) HISTORICAL OVERVIEW OF SPENDING.— mizing full access for all EFFS-eligible indi- same EFFS region; From the date of the inception of the pro- viduals, especially those residing in rural ‘‘(C) that include a single deductible appli- gram of insurance under this title through areas. cable to benefits under parts A and B and in- the fiscal year involved, a statement of the clude a catastrophic limit on out-of-pocket ‘‘(b) DEFINITIONS.—For purposes of this total amounts referred to in subparagraph expenditures for such covered benefits; and part: (A). ‘‘(D) that include benefits for prescription ‘‘(1) EFFS ORGANIZATION.—The ‘EFFS orga- ‘‘(C) 10-YEAR AND 75-YEAR PROJECTIONS.—An drug coverage for each enrollee who elects nization’ means an entity that the Adminis- estimate of total amounts referred to in sub- under part D to be provided qualified pre- trator certifies as meeting the requirements paragraph (A) required to be obligated for scription drug coverage through the plan. and standards applicable to such organiza- payment for benefits covered under this title ‘‘(2) DISAPPROVAL AUTHORITY.—The Admin- tion under this part. for each of the 10 fiscal years succeeding the istrator shall not approve a plan of an EFFS ‘‘(2) ENHANCED FEE-FOR-SERVICE PLAN; EFFS fiscal year involved and for the 75-year pe- organization if the Administrator deter- PLAN.—The terms ‘enhanced fee-for-service riod beginning with the succeeding fiscal mines (pursuant to the last sentence of sec- plan’ and ‘EFFS plan’ mean health benefits year. tion 1852(b)(1)(A)) that the benefits are de- coverage offered under a policy, contract, or ‘‘(D) RELATION TO GDP GROWTH.—A com- signed to substantially discourage enroll- plan by an EFFS organization pursuant to parison of the rate of growth of the total ment by certain EFFS eligible individuals and in accordance with a contract pursuant amounts referred to in subparagraph (A) to with the organization. to section 1860E–4(c), but only if the plan the rate of growth in the gross domestic ‘‘(d) OUTPATIENT PRESCRIPTION DRUG COV- provides either fee-for-service coverage de- product for the same period. ERAGE.—For rules concerning the offering of scribed in the following subparagraph (A) or ‘‘(2) PUBLICATION.—Each report submitted prescription drug coverage under EFFS preferred provider coverage described in the under paragraph (1) shall be published joint- plans, see the amendment made by section following subparagraph (B): ly by the Committee on Ways and Means and 102(b) of the Medicare Prescription Drug and ‘‘(A) FEE-FOR-SERVICE COVERAGE.—The the Committee on Energy and Commerce as Modernization Act of 2003. plan— a public document and shall be made avail- ‘‘(e) OTHER ADDITIONAL PROVISIONS.—The ‘‘(i) reimburses hospitals, physicians, and able by such Committees on the Internet.’’. provisions of section 1852 (other than sub- other providers at a rate determined by the (b) EFFECTIVE DATE.—The amendment section (a)(1)) shall apply under this part to made by subsection (a) shall apply with re- plan on a fee-for-service basis without plac- EFFS plans. For the application of chronic spect to fiscal years beginning on or after ing the provider at financial risk; care improvement provisions, see the amend- the date of the enactment of this Act. ‘‘(ii) does not vary such rates for such a ment made by section 722(b). provider based on utilization relating to such TITLE II—MEDICARE ENHANCED FEE- provider; and ‘‘SUBMISSION OF BIDS; BENEFICIARY SAVINGS; FOR-SERVICE AND MEDICARE ADVAN- ‘‘(iii) does not restrict the selection of pro- PAYMENT OF PLANS TAGE PROGRAMS; MEDICARE COMPETI- viders among those who are lawfully author- ‘‘SEC. 1860E–3. (a) SUBMISSION OF BIDS.— TION ized to provide the covered services and ‘‘(1) REQUIREMENT.— SEC. 200. MEDICARE MODERNIZATION AND REVI- agree to accept the terms and conditions of ‘‘(A) EFFS MONTHLY BID AMOUNT.—For TALIZATION. payment established by the plan. each year (beginning with 2006), an EFFS or- This title provides for— ‘‘(B) PREFERRED PROVIDER COVERAGE.—The ganization shall submit to the Administrator (1) establishment of the medicare enhanced plan— an EFFS monthly bid amount for each EFFS fee-for-service (EFFS) program under which ‘‘(i) has a network of providers that have plan offered in each region. Each such bid is medicare beneficiaries are provided access to agreed to a contractually specified reim- referred to in this section as the ‘EFFS a range of enhanced fee-for-service (EFFS) bursement for covered benefits with the or- monthly bid amount’. plans that may use preferred provider net- ganization offering the plan; and ‘‘(B) FORM.—Such bid amounts shall be works to offer an enhanced range of benefits; ‘‘(ii) provides for reimbursement for all submitted for each such plan and region in a (2) establishment of a Medicare Advantage covered benefits regardless of whether such form and manner and time specified by the program that offers improved managed care benefits are provided within such network of Administrator, and shall include information plans with coordinated care; and providers. described in paragraph (3)(A). (3) competitive bidding, in the style of the ‘‘(3) EFFS ELIGIBLE INDIVIDUAL.—The term ‘‘(2) UNIFORM BID AMOUNTS.—Each EFFS Federal Employees Health Benefits program ‘EFFS eligible individual’ means an eligible monthly bid amount submitted under para- (FEHBP), among enhanced fee-for-service individual described in section 1851(a)(3). graph (1) by an EFFS organization under plans and Medicare Advantage plans in order ‘‘(4) EFFS REGION.—The term ‘EFFS re- this part for an EFFS plan in an EFFS re- to promote greater efficiency and respon- gion’ means a region established under sub- gion may not vary among EFFS eligible in- siveness to medicare beneficiaries. section (a)(2). dividuals residing in the EFFS region in- Subtitle A—Medicare Enhanced Fee-for- volved. ‘‘(c) APPLICATION OF CERTAIN ELIGIBILITY, Service Program ‘‘(3) SUBMISSION OF BID AMOUNT INFORMA- ENROLLMENT, ETC. REQUIREMENTS.—The pro- SEC. 201. ESTABLISHMENT OF ENHANCED FEE- TION BY EFFS ORGANIZATIONS.— FOR-SERVICE (EFFS) PROGRAM visions of section 1851 (other than subsection ‘‘(A) INFORMATION TO BE SUBMITTED.—The UNDER MEDICARE. (h)(4)(A)) shall apply to EFFS plans offered information described in this subparagraph (a) IN GENERAL.—Title XVIII, as amended by an EFFS organization in an EFFS region, is as follows: by section 101(a), is amended— including subsection (g) (relating to guaran- ‘‘(i) The EFFS monthly bid amount for (1) by redesignating part E as part F; and teed issue and renewal). provision of all items and services under this
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part, which amount shall be based on aver- that region. In the case of an EFFS region in ‘‘(3) DEMOGRAPHIC RISK ADJUSTMENT, IN- age costs for a typical beneficiary residing in which an EFFS plan was offered in the pre- CLUDING ADJUSTMENT FOR HEALTH STATUS.— the region, and the actuarial basis for deter- vious year, the Administrator may compute The Administrator shall adjust under para- mining such amount. such average based upon risk adjustment graph (1)(A) the unadjusted EFFS statutory ‘‘(ii) The proportions of such bid amount factors applied under subsection (c)(3) in non-drug monthly bid amount and under that are attributable to— that region in a previous year. paragraph (1)(B) the EFFS region-specific ‘‘(I) the provision of statutory non-drug ‘‘(ii) TREATMENT OF NEW REGIONS.—In the non-drug monthly benchmark amount for benefits (such portion referred to in this part case of a region in which no EFFS plan was such risk factors as age, disability status, as the ‘unadjusted EFFS statutory non-drug offered in the previous year, the Adminis- gender, institutional status, and such other monthly bid amount’); trator shall estimate such average. In mak- factors as the Administrator determines to ‘‘(II) the provision of statutory prescrip- ing such estimate, the Administrator may be appropriate, including adjustment for tion drug benefits; and use average risk adjustment factors applied health status under section 1853(a)(3) (as ap- ‘‘(III) the provision of non-statutory bene- to comparable EFFS regions or applied on a plied under subsection (d)), so as to ensure fits; national basis. actuarial equivalence. The Administrator and the actuarial basis for determining such ‘‘(B) DETERMINATION OF RISK ADJUSTED may add to, modify, or substitute for such BENCHMARK AND RISK-ADJUSTED BID.—For adjustment factors if such changes will im- proportions. each EFFS plan offered in an EFFS region, prove the determination of actuarial equiva- ‘‘(iii) Such additional information as the the Administrator shall— lence. Administrator may require to verify the ac- ‘‘(i) adjust the EFFS region-specific non- ‘‘(4) ADJUSTMENT FOR INTRA-REGIONAL GEO- tuarial bases described in clauses (i) and (ii). drug monthly benchmark amount (as defined GRAPHIC VARIATIONS.—The Administrator ‘‘(B) STATUTORY BENEFITS DEFINED.—For in paragraph (3)) by the applicable average shall also adjust such amounts in a manner purposes of this part: risk adjustment factor computed under sub- to take into account variations in payments ‘‘(i) The term ‘statutory non-drug benefits’ paragraph (A); and rates under part C among the different pay- means benefits under section 1852(a)(1). ‘‘(ii) adjust the unadjusted EFFS statutory ment areas under such part included in each ‘‘(ii) The term ‘statutory prescription drug non-drug monthly bid amount by such appli- EFFS region. benefits’ means benefits under part D. cable average risk adjustment factor. ‘‘(d) APPLICATION OF ADDITIONAL PAYMENT ‘‘(iii) The term ‘statutory benefits’ means ‘‘(C) DETERMINATION OF AVERAGE PER CAP- RULES.—The provisions of section 1853 (other statutory prescription drug benefits and ITA MONTHLY SAVINGS.—The average per cap- than subsections (a)(1)(A), (d), and (e)) shall statutory non-drug benefits. ita monthly savings described in this sub- apply to an EFFS plan under this part, ex- ‘‘(C) ACCEPTANCE AND NEGOTIATION OF BID paragraph is equal to the amount (if any) by cept as otherwise provided in this section. AMOUNTS.—The Administrator has the au- which— ‘‘PREMIUMS; ORGANIZATIONAL AND FINANCIAL thority to negotiate regarding monthly bid ‘‘(i) the risk-adjusted benchmark amount REQUIREMENTS; ESTABLISHMENT OF STAND- amounts submitted under subparagraph (A) computed under subparagraph (B)(i), exceeds ARDS; CONTRACTS WITH EFFS ORGANIZATIONS (and the proportion described in subpara- ‘‘(ii) the risk-adjusted bid computed under ‘‘SEC. 1860E–4. (a) PREMIUMS.— graph (A)(ii)), and for such purpose, the Ad- subparagraph (B)(ii). ‘‘(1) IN GENERAL.—The provisions of section ministrator has negotiation authority that ‘‘(3) COMPUTATION OF EFFS REGION-SPECIFIC 1854 (other than subsections (a)(6)(C) and the Director of the Office of Personnel Man- NON-DRUG MONTHLY BENCHMARK AMOUNT.—For (h)), including subsection (b)(5) relating to agement has with respect to health benefits purposes of this part, the term ‘EFFS region- the consolidation of drug and non-drug bene- plans under chapter 89 of title 5, United specific non-drug monthly benchmark ficiary premiums and subsection (c) relating States Code. The Administrator may reject amount’ means, with respect to an EFFS re- to uniform bids and premiums, shall apply to such a bid amount or proportion if the Ad- gion for a month in a year, an amount equal an EFFS plan under this part, subject to ministrator determines that such amount or 1 to ⁄12 of the average (weighted by number of paragraph (2). proportion is not supported by the actuarial EFFS eligible individuals in each payment ‘‘(2) CROSS-WALK.—In applying paragraph bases provided under subparagraph (A). area described in section 1853(d)) of the an- (1), any reference in section 1854(b)(1)(A) or ‘‘(D) CONTRACT AUTHORITY.—The Adminis- nual capitation rate as calculated under sec- 1854(d) to— trator may, taking into account the tion 1853(c)(1) for that area. ‘‘(A) a Medicare Advantage monthly basic unadjusted EFFS statutory non-drug month- ‘‘(c) PAYMENT OF PLANS BASED ON BID beneficiary premium is deemed a reference ly bid amounts accepted under subparagraph AMOUNTS.— to the EFFS monthly basic beneficiary pre- (C), enter into contracts for the offering of ‘‘(1) NON-DRUG BENEFITS.—Under a contract mium (as defined in paragraph (3)(A)); EFFS plans by up to 3 EFFS organizations in under section 1860E–4(c) and subject to sec- ‘‘(B) a Medicare Advantage monthly pre- any region. tion 1853(g) (as made applicable under sub- scription drug beneficiary premium is ‘‘(b) PROVISION OF BENEFICIARY SAVINGS section (d)), the Administrator shall make deemed a reference to the EFFS monthly FOR CERTAIN PLANS.— monthly payments under this subsection in prescription drug beneficiary premium (as ‘‘(1) BENEFICIARY REBATE RULE.— advance to each EFFS organization, with re- defined in paragraph (3)(B)); and ‘‘(A) REQUIREMENT.—The EFFS plan shall spect to coverage of an individual under this ‘‘(C) a Medicare Advantage monthly sup- provide to the enrollee a monthly rebate part in an EFFS region for a month, in an plemental beneficiary premium is deemed a equal to 75 percent of the average per capita amount determined as follows: reference to the EFFS monthly supple- savings (if any) described in paragraph (2) ap- ‘‘(A) PLANS WITH BIDS BELOW BENCHMARK.— mental beneficiary premium (as defined in plicable to the plan and year involved. In the case of a plan for which there are av- paragraph (3)(C)). ‘‘(B) FORM OF REBATE.—A rebate required erage per capita monthly savings described ‘‘(3) DEFINITIONS.—For purposes of this under this paragraph shall be provided— in subsection (b)(2)(C), the payment under part: ‘‘(i) through the crediting of the amount of this subsection is equal to the unadjusted ‘‘(A) EFFS MONTHLY BASIC BENEFICIARY the rebate towards the EFFS monthly pre- EFFS statutory non-drug monthly bid PREMIUM.—The term ‘EFFS monthly basic scription drug beneficiary premium (as de- amount, adjusted under paragraphs (3) and beneficiary premium’ means, with respect to fined in section 1860E–4(a)(3)(B)) and the (4), plus the amount of the monthly rebate an EFFS plan— EFFS monthly supplemental beneficiary computed under subsection (b)(1)(A) for that ‘‘(i) described in section 1860E–3(c)(1)(A) premium (as defined in section 1860E– plan and year. (relating to plans providing rebates), zero; or 4(a)(3)(C)); ‘‘(B) PLANS WITH BIDS AT OR ABOVE BENCH- ‘‘(ii) described in section 1860E–3(c)(1)(B), ‘‘(ii) through a direct monthly payment MARK.—In the case of a plan for which there the amount (if any) by which the unadjusted (through electronic funds transfer or other- are no average per capita monthly savings EFFS statutory non-drug monthly bid wise); or described in subsection (b)(2)(C), the pay- amount exceeds the EFFS region-specific ‘‘(iii) through other means approved by the ment amount under this subsection is equal non-drug monthly benchmark amount (as de- Medicare Benefits Administrator, to the EFFS region-specific non-drug month- fined in section 1860E–3(b)(3)). or any combination thereof. ly benchmark amount, adjusted under para- ‘‘(B) EFFS MONTHLY PRESCRIPTION DRUG ‘‘(2) COMPUTATION OF AVERAGE PER CAPITA graphs (3) and (4). BENEFICIARY PREMIUM.—The term ‘EFFS MONTHLY SAVINGS.—For purposes of para- ‘‘(2) FOR FEDERAL DRUG SUBSIDIES.—In the monthly prescription drug beneficiary pre- graph (1)(A), the average per capita monthly case in which an enrollee who elects under mium’ means, with respect to an EFFS plan, savings referred to in such paragraph for an part D to be provided qualified prescription the portion of the aggregate monthly bid EFFS plan and year is computed as follows: drug coverage through the plan, the EFFS amount submitted under clause (i) of section ‘‘(A) DETERMINATION OF REGION-WIDE AVER- organization offering such plan also is enti- 1860E–3(a)(3)(A) for the year that is attrib- AGE RISK ADJUSTMENT.— tled— utable under such section to the provision of ‘‘(i) IN GENERAL.—The Medicare Benefits ‘‘(A) to direct subsidy payment under sec- statutory prescription drug benefits. Administrator shall determine, at the same tion 1860D–8(a)(1); ‘‘(C) EFFS MONTHLY SUPPLEMENTAL BENE- time rates are promulgated under section ‘‘(B) to reinsurance subsidy payments FICIARY PREMIUM.—The term ‘EFFS monthly 1853(b)(1) (beginning with 2006), for each under section 1860D–8(a)(2); and supplemental beneficiary premium’ means, EFFS region the average of the risk adjust- ‘‘(C) to reimbursement for premium and with respect to an EFFS plan, the portion of ment factors described in subsection (c)(3) to cost-sharing reductions for low-income indi- the aggregate monthly bid amount sub- be applied to enrollees under this part in viduals under section 1860D–7(c)(3). mitted under clause (i) of section 1860E–
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00087 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.058 H26PT1 H6028 CONGRESSIONAL RECORD — HOUSE June 26, 2003 3(a)(3)(A) for the year that is attributable (2) in paragraph (5), by inserting ‘‘(other amended by subsection (a)). Such study shall under such section to the provision of non- than 2004)’’ after ‘‘for each year’’. include an examination of— statutory benefits. (c) INCREASING MINIMUM PERCENTAGE IN- (A) the bases for variation in such costs be- ‘‘(b) ORGANIZATIONAL AND FINANCIAL RE- CREASE TO NATIONAL GROWTH RATE.— tween different areas, including differences QUIREMENTS.—The provisions of section 1855 (1) IN GENERAL.—Section 1853(c)(1) (42 in input prices, utilization, and practice pat- shall apply to an EFFS plan offered by an U.S.C. 1395w–23(c)(1)) is amended— terns; EFFS organization under this part. (A) in subparagraph (A), by striking ‘‘The (B) the appropriate geographic area for ‘‘(c) STANDARDS.—The provisions of para- sum’’ and inserting ‘‘For a year before 2005, payment under the Medicare Advantage pro- graphs (1), (3), and (4) of section 1856(b) shall the sum’’; gram under part C of title XVIII of such Act; apply to an EFFS plan offered by an EFFS (B) in subparagraph (B)(iv), by striking and organization under this part. ‘‘and each succeeding year’’ and inserting ‘‘, (C) the accuracy of risk adjustment meth- ONTRACTS WITH EFFS ORGANIZA- ‘‘(d) C 2003, and 2004’’; ods in reflecting differences in costs of pro- TIONS.—The provisions of section 1857 shall (C) in subparagraph (C)(iv), by striking viding care to different groups of bene- apply to an EFFS plan offered by an EFFS ‘‘and each succeeding year’’ and inserting ficiaries served under such program. organization under this part, except that any ‘‘and 2003’’; and (2) REPORT.—Not later than 18 months reference in such section to part C is deemed (D) by adding at the end of subparagraph after the date of the enactment of this Act, a reference to this part.’’. (C) the following new clause: the Commission shall submit to Congress a (b) APPLICATION OF MEDIGAP PROVISIONS TO ‘‘(v) For 2004 and each succeeding year, the report on the study conducted under para- EFFS PLANS.—Section 1882 of the Social Se- curity Act (42 U.S.C. 1395ss) shall be adminis- greater of— graph (1). tered as if any reference to a ‘‘(I) 102 percent of the annual Medicare Ad- (g) REPORT ON IMPACT OF INCREASED FINAN- Medicare+Choice organization offering a vantage capitation rate under this paragraph CIAL ASSISTANCE TO MEDICARE ADVANTAGE Medicare+Choice plan under part C of title for the area for the previous year; or PLANS.—Not later than July 1, 2006, the XVIII of such Act were a reference both to a ‘‘(II) the annual Medicare Advantage capi- Medicare Benefits Administrator shall sub- Medicare Advantage organization offering a tation rate under this paragraph for the area mit to Congress a report that describes the Medicare Advantage plan under such part for the previous year increased by the na- impact of additional financing provided and an EFFS organization offering an EFFS tional per capita Medicare Advantage growth under this Act and other Acts (including the plan under part E of such title. percentage, described in paragraph (6) for Medicare, Medicaid, and SCHIP Balanced that succeeding year, but not taking into ac- Subtitle B—Medicare Advantage Program Budget Refinement Act of 1999 and BIPA) on count any adjustment under paragraph (6)(C) the availability of Medicare Advantage plans CHAPTER 1—IMPLEMENTATION OF for a year before 2004.’’. in different areas and its impact on lowering PROGRAM (2) CONFORMING AMENDMENT.—Section premiums and increasing benefits under such SEC. 211. IMPLEMENTATION OF MEDICARE AD- 1853(c)(6)(C) (42 U.S.C. 1395w–23(c)(6)(C)) is plans. VANTAGE PROGRAM. amended by inserting before the period at (a) IN GENERAL.—There is hereby estab- (h) ANNOUNCEMENT OF REVISED MEDICARE the end the following: ‘‘, except that for pur- ADVANTAGE PAYMENT RATES.—Within 6 lished the Medicare Advantage program. The poses of paragraph (1)(C)(v)(II), no such ad- Medicare Advantage program shall consist of weeks after the date of the enactment of this justment shall be made for a year before Act, the Secretary shall determine, and shall the program under part C of title XVIII of 2004’’. the Social Security Act, as amended by this announce (in a manner intended to provide (d) INCLUSION OF COSTS OF DOD AND VA title. notice to interested parties) Medicare Ad- MILITARY FACILITY SERVICES TO MEDICARE- (b) REFERENCES.—Any reference to the pro- vantage capitation rates under section 1853 gram under part C of title XVIII of the So- ELIGIBLE BENEFICIARIES IN CALCULATION OF of the Social Security Act (42 U.S.C. 1395w– cial Security Act shall be deemed a reference MEDICARE+CHOICE PAYMENT RATES.—Section 23) for 2004, revised in accordance with the to the Medicare Advantage program and, 1853(c)(3) (42 U.S.C. 1395w–23(c)(3)) is amend- provisions of this section. with respect to such part, any reference to ed— (1) in subparagraph (A), by striking ‘‘sub- CHAPTER 2—IMPLEMENTATION OF ‘‘Medicare+Choice’’ is deemed a reference to COMPETITION PROGRAM ‘‘Medicare Advantage’’. paragraph (B)’’ and inserting ‘‘subparagraphs SEC. 212. MEDICARE ADVANTAGE IMPROVE- (B) and (E)’’, and SEC. 221. COMPETITION PROGRAM BEGINNING IN MENTS. (2) by adding at the end the following new 2006. (a) EQUALIZING PAYMENTS WITH FEE-FOR- subparagraph: (a) SUBMISSION OF EFFS-LIKE BIDDING IN- SERVICE.— ‘‘(E) INCLUSION OF COSTS OF DOD AND VA FORMATION BEGINNING IN 2006.—Section 1854 (1) IN GENERAL.—Section 1853(c)(1) (42 MILITARY FACILITY SERVICES TO MEDICARE-ELI- (42 U.S.C. 1395w–24) is amended— U.S.C. 1395w–23(c)(1)) is amended by adding GIBLE BENEFICIARIES.—In determining the (1) by amending the section heading to at the end the following: area-specific Medicare+Choice capitation read as follows: ‘‘(D) BASED ON 100 PERCENT OF FEE-FOR- rate under subparagraph (A) for a year (be- ‘‘PREMIUMS AND BID AMOUNT’’; SERVICE COSTS.— ginning with 2004), the annual per capita rate ‘‘(i) IN GENERAL.—For 2004, the adjusted av- of payment for 1997 determined under section (2) in subsection (a)(1)(A)— erage per capita cost for the year involved, 1876(a)(1)(C) shall be adjusted to include in (A) by striking ‘‘(A)’’ and inserting ‘‘(A)(i) determined under section 1876(a)(4) for the the rate the Secretary’s estimate, on a per if the following year is before 2006,’’; and Medicare Advantage payment area for serv- capita basis, of the amount of additional (B) by inserting before the semicolon at ices covered under parts A and B for individ- payments that would have been made in the the end the following: ‘‘or (ii) if the following uals entitled to benefits under part A and en- area involved under this title if individuals year is 2006 or later, the information de- rolled under part B who are not enrolled in entitled to benefits under this title had not scribed in paragraph (3) or (6)(A) for the type a Medicare Advantage under this part for the received services from facilities of the De- of plan involved’’; and year, but adjusted to exclude costs attrib- partment of Defense or the Department of (3) by adding at the end of subsection (a) utable to payments under section 1886(h). Veterans Affairs.’’. the following: UBMISSION OF BID AMOUNTS BY MEDI ‘‘(ii) INCLUSION OF COSTS OF VA AND DOD (e) EXTENDING SPECIAL RULE FOR CERTAIN ‘‘(6) S - CARE ADVANTAGE ORGANIZATIONS MILITARY FACILITY SERVICES TO MEDICARE-ELI- INPATIENT HOSPITAL STAYS TO REHABILITA- .— NFORMATION TO BE SUBMITTED GIBLE BENEFICIARIES.—In determining the ad- TION HOSPITALS.— ‘‘(A) I .—The justed average per capita cost under clause (1) IN GENERAL.—Section 1853(g) (42 U.S.C. information described in this subparagraph (i) for a year, such cost shall be adjusted to 1395w–23(g)) is amended— is as follows: include the Secretary’s estimate, on a per (A) by inserting ‘‘or from a rehabilitation ‘‘(i) The monthly aggregate bid amount for capita basis, of the amount of additional facility (as defined in section 1886(j)(1)(A))’’ provision of all items and services under this payments that would have been made in the after ‘‘1886(d)(1)(B))’’; and part, which amount shall be based on aver- area involved under this title if individuals (B) in paragraph (2)(B), by inserting ‘‘or age costs for a typical beneficiary residing in entitled to benefits under this title had not section 1886(j), as the case may be,’’ after the area, and the actuarial basis for deter- received services from facilities of the De- ‘‘1886(d)’’. mining such amount. partment of Veterans Affairs or the Depart- (2) EFFECTIVE DATE.—The amendments ‘‘(ii) The proportions of such bid amount ment of Defense.’’. made by paragraph (1) shall apply to con- that are attributable to— (2) CONFORMING AMENDMENT.—Such section tract years beginning on or after January 1, ‘‘(I) the provision of statutory non-drug is further amended, in the matter before sub- 2004. benefits (such portion referred to in this part paragraph (A), by striking ‘‘or (C)’’ and in- (f) MEDPAC STUDY OF AAPCC.— as the ‘unadjusted Medicare Advantage stat- serting ‘‘(C), or (D)’’. (1) STUDY.—The Medicare Payment Advi- utory non-drug monthly bid amount’); (b) CHANGE IN BUDGET NEUTRALITY FOR sory Commission shall conduct a study that ‘‘(II) the provision of statutory prescrip- BLEND.—Section 1853(c) (42 U.S.C. 1395w– assesses the method used for determining the tion drug benefits; and 23(c)) is amended— adjusted average per capita cost (AAPCC) ‘‘(III) the provision of non-statutory bene- (1) in paragraph (1)(A), by inserting ‘‘(for a under section 1876(a)(4) of the Social Secu- fits; year other than 2004)’’ after ‘‘multiplied’’; rity Act (42 U.S.C. 1395mm(a)(4)) as applied and the actuarial basis for determining such and under section 1853(c)(1)(A) of such Act (as proportions.
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‘‘(iii) Such additional information as the ‘‘(ii) TREATMENT OF NEW STATES.—In the (1) IN GENERAL.—Section 1853(a)(1)(A) (42 Administrator may require to verify the ac- case of a State in which no Medicare Advan- U.S.C. 1395w–23) is amended by striking ‘‘in tuarial bases described in clauses (i) and (ii). tage plan was offered in the previous year, an amount’’ and all that follows and insert- ‘‘(B) STATUTORY BENEFITS DEFINED.—For the Administrator shall estimate such aver- ing the following: ‘‘in an amount determined purposes of this part: age. In making such estimate, the Adminis- as follows: ‘‘(i) The term ‘statutory non-drug benefits’ trator may use average risk adjustment fac- ‘‘(i) PAYMENT BEFORE 2006.—For years be- means benefits under section 1852(a)(1). tors applied to comparable States or applied fore 2006, the payment amount shall be equal ‘‘(ii) The term ‘statutory prescription drug on a national basis. to 1⁄12 of the annual Medicare Advantage benefits’ means benefits under part D. ‘‘(B) DETERMINATION OF RISK ADJUSTED capitation rate (as calculated under sub- ‘‘(iii) The term ‘statutory benefits’ means BENCHMARK AND RISK-ADJUSTED BID.—For section (c)(1)) with respect to that individual statutory prescription drug benefits and each Medicare Advantage plan offered in a for that area, reduced by the amount of any statutory non-drug benefits. State, the Administrator shall— reduction elected under section 1854(f )(1)(E) ‘‘(C) ACCEPTANCE AND NEGOTIATION OF BID ‘‘(i) adjust the Medicare Advantage area- and adjusted under clause (iv). AMOUNTS.— specific non-drug monthly benchmark ‘‘(ii) PAYMENT FOR STATUTORY NON-DRUG ‘‘(i) IN GENERAL.—Subject to clause (ii)— amount (as defined in subsection (j)) by the BENEFITS BEGINNING WITH 2006.—For years be- ‘‘(I) the Administrator has the authority to applicable average risk adjustment factor ginning with 2006— negotiate regarding monthly bid amounts computed under subparagraph (A); and ‘‘(I) PLANS WITH BIDS BELOW BENCHMARK.— submitted under subparagraph (A) (and the ‘‘(ii) adjust the unadjusted Medicare Ad- In the case of a plan for which there are av- proportion described in subparagraph vantage statutory non-drug monthly bid erage per capita monthly savings described (A)(ii)), and for such purpose and subject to amount by such applicable average risk ad- in section 1854(b)(3)(C), the payment under such clause, the Administrator has negotia- justment factor. this subsection is equal to the unadjusted tion authority that the Director of the Office ‘‘(C) DETERMINATION OF AVERAGE PER CAP- Medicare Advantage statutory non-drug of Personnel Management has with respect ITA MONTHLY SAVINGS.—The average per cap- monthly bid amount, adjusted under clause to health benefits plans under chapter 89 of ita monthly savings described in this sub- (iv), plus the amount of the monthly rebate title 5, United States Code; and paragraph is equal to the amount (if any) by computed under section 1854(b)(1)(C)(i) for ‘‘(II) the Administrator may reject such a which— that plan and year. bid amount or proportion if the Adminis- ‘‘(i) the risk-adjusted benchmark amount ‘‘(II) PLANS WITH BIDS AT OR ABOVE BENCH- trator determines that such amount or pro- computed under subparagraph (B)(i), exceeds MARK.—In the case of a plan for which there portion is not supported by the actuarial ‘‘(ii) the risk-adjusted bid computed under are no average per capita monthly savings bases provided under subparagraph (A). subparagraph (B)(ii). described in section 1854(b)(3)(C), the pay- ment amount under this subsection is equal ‘‘(ii) EXCEPTION.—In the case of a plan de- ‘‘(D) AUTHORITY TO DETERMINE RISK ADJUST- scribed in section 1851(a)(2)(C), the provisions MENT FOR AREAS OTHER THAN STATES.—The to the Medicare Advantage area-specific non- of clause (i) shall not apply and the provi- Administrator may provide for the deter- drug monthly benchmark amount, adjusted sions of paragraph (5)(B), prohibiting the re- mination and application of risk adjustment under clause (iv). view, approval, or disapproval of amounts de- factors under this paragraph on the basis of ‘‘(iii) FOR FEDERAL DRUG SUBSIDIES.—In the case in which an enrollee who elects under scribed in such paragraph, shall apply to the areas other than States. part D to be provided qualified prescription negotiation and rejection of the monthly bid ‘‘(4) BENEFICIARY’S OPTION OF PAYMENT drug coverage through the plan, the Medi- amounts and proportion referred to in sub- THROUGH WITHHOLDING FROM SOCIAL SECURITY care Advantage organization offering such paragraph (A).’’. PAYMENT OR USE OF ELECTRONIC FUNDS TRANS- plan also is entitled— (b) PROVIDING FOR BENEFICIARY SAVINGS FER MECHANISM.—In accordance with regula- ‘‘(I) to direct subsidy payment under sec- FOR CERTAIN PLANS.— tions, a Medicare Advantage organization tion 1860D–8(a)(1); (1) IN GENERAL.—Section 1854(b) (42 U.S.C. shall permit each enrollee, at the enrollee’s ‘‘(II) to reinsurance subsidy payments 1395w–24(b)) is amended— option, to make payment of premiums under under section 1860D–8(a)(2); and (A) by adding at the end of paragraph (1) this part to the organization indirectly ‘‘(III) to reimbursement for premium and the following new subparagraph: through withholding from benefit payments in the manner provided under section 1840 cost-sharing reductions for low-income indi- ‘‘(C) BENEFICIARY REBATE RULE.— viduals under section 1860D–7(c)(3). ‘‘(i) REQUIREMENT.—The Medicare Advan- with respect to monthly premiums under ‘‘(iv) DEMOGRAPHIC ADJUSTMENT, INCLUDING tage plan shall provide to the enrollee a section 1839 or through an electronic funds transfer mechanism (such as automatic ADJUSTMENT FOR HEALTH STATUS.—The Ad- monthly rebate equal to 75 percent of the av- ministrator shall adjust the payment erage per capita savings (if any) described in charges of an account at a financial institu- tion or a credit or debit card account) or oth- amount under clause (i), the unadjusted paragraph (3) applicable to the plan and year Medicare Advantage statutory non-drug involved. erwise. All premium payments that are with- held under this paragraph that are credited monthly bid amount under clause (ii)(I), and ‘‘(iii) FORM OF REBATE.—A rebate required the Medicare Advantage area-specific non- under this subparagraph shall be provided— to the Federal Supplementary Medical Insur- ance Drug Trust Fund shall be paid to the drug monthly benchmark amount under ‘‘(I) through the crediting of the amount of clause (ii)(II) for such risk factors as age, the rebate towards the Medicare Advantage Medicare Advantage organization involved.’’. (2) PROVISION OF SINGLE CONSOLIDATED PRE- disability status, gender, institutional sta- monthly supplementary beneficiary pre- tus, and such other factors as the Adminis- mium or the premium imposed for prescrip- MIUM.—Section 1854(b) (42 U.S.C. 1395w–24(b)), as amended by paragraph (1), is further trator determines to be appropriate, includ- tion drug coverage under part D; ing adjustment for health status under para- ‘‘(II) through a direct monthly payment amended by adding at the end the following new paragraph: graph (3), so as to ensure actuarial equiva- (through electronic funds transfer or other- lence. The Administrator may add to, mod- wise); or ‘‘(5) SINGLE CONSOLIDATED PREMIUM.—In the case of an enrollee in a Medicare Advantage ify, or substitute for such adjustment factors ‘‘(III) through other means approved by the if such changes will improve the determina- Medicare Benefits Administrator, plan who elects under part D to be provided qualified prescription drug coverage through tion of actuarial equivalence.’’. or any combination thereof.’’; and (d) CONFORMING AMENDMENTS.— the plan, the Administrator shall provide a (B) by adding at the end the following new (1) PROTECTION AGAINST BENEFICIARY SELEC- mechanism for the consolidation of the bene- paragraphs: TION.—Section 1852(b)(1)(A) (42 U.S.C. 1395w– ficiary premium amount for non-drug bene- ‘‘(3) COMPUTATION OF AVERAGE PER CAPITA 22(b)(1)(A)) is amended by adding at the end fits under this part with the premium MONTHLY SAVINGS.—For purposes of para- the following: ‘‘The Administrator shall not amount for prescription drug coverage under graph (1)(C)(i), the average per capita month- approve a plan of an organization if the Ad- part D provided through the plan.’’. ly savings referred to in such paragraph for ministrator determines that the benefits are (3) COMPUTATION OF MEDICARE ADVANTAGE a Medicare Advantage plan and year is com- designed to substantially discourage enroll- AREA-SPECIFIC NON-DRUG BENCHMARK.—Sec- puted as follows: ment by certain Medicare Advantage eligible tion 1853 (42 U.S.C. 1395w–23) is amended by ‘‘(A) DETERMINATION OF STATE-WIDE AVER- individuals with the organization.’’. adding at the end the following new sub- AGE RISK ADJUSTMENT.— (2) CONFORMING AMENDMENT TO PREMIUM section: ‘‘(i) IN GENERAL.—The Medicare Benefits ‘‘(j) COMPUTATION OF MEDICARE ADVANTAGE TERMINOLOGY.—Section 1854(b)(2) (42 U.S.C. Administrator shall determine, at the same AREA-SPECIFIC NON-DRUG MONTHLY BENCH- 1395w–24(b)(2)) is amended by redesignating time rates are promulgated under section MARK AMOUNT.—For purposes of this part, subparagraph (C) as subparagraph (D) and by 1853(b)(1) (beginning with 2006), for each the term ‘Medicare Advantage area-specific striking subparagraphs (A) and (B) and in- State the average of the risk adjustment fac- non-drug monthly benchmark amount’ serting the following: tors to be applied under section 1853(a)(1)(A) means, with respect to a Medicare Advan- ‘‘(A) MEDICARE ADVANTAGE MONTHLY BASIC to payment for enrollees in that State. In tage payment area for a month in a year, an BENEFICIARY PREMIUM.—The term ‘Medicare the case of a State in which a Medicare Ad- amount equal to 1⁄12 of the annual Medicare Advantage monthly basic beneficiary pre- vantage plan was offered in the previous Advantage capitation rate under section mium’ means, with respect to a Medicare Ad- year, the Administrator may compute such 1853(c)(1) for the area for the year.’’. vantage plan— average based upon risk adjustment factors (c) PAYMENT OF PLANS BASED ON BID ‘‘(i) described in section 1853(a)(1)(A)(ii)(I) applied in that State in a previous year. AMOUNTS.— (relating to plans providing rebates), zero; or
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00089 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.058 H26PT1 H6030 CONGRESSIONAL RECORD — HOUSE June 26, 2003 ‘‘(ii) described in section section 1853(a)(3) (relating to health status supersede any State law or regulation (other 1853(a)(1)(A)(ii)(II), the amount (if any) by adjustment).’’. than State licensing laws or State laws re- which the unadjusted Medicare Advantage (2) REPEAL OF PROVISIONS RELATING TO AD- lating to plan solvency) with respect to statutory non-drug monthly bid amount ex- JUSTED COMMUNITY RATE (ACR).— Medicare Advantage plans which are offered ceeds the Medicare Advantage area-specific (A) IN GENERAL.—Subsections (e) and (f) of by Medicare Advantage organizations under non-drug monthly benchmark amount. section 1854 (42 U.S.C. 1395w–24) are repealed. this part.’’. ‘‘(B) MEDICARE ADVANTAGE MONTHLY PRE- (B) CONFORMING AMENDMENTS.—(i) Section (b) EFFECTIVE DATE.—The amendment SCRIPTION DRUG BENEFICIARY PREMIUM.—The 1839(a)(2) (42 U.S.C. 1395r(a)(2)) is amended by made by subsection (a) shall take effect on term ‘Medicare Advantage monthly prescrip- striking ‘‘, and to reflect’’ and all that fol- the date of the enactment of this Act. tion drug beneficiary premium’ means, with lows and inserting a period. SEC. 233. SPECIALIZED MEDICARE ADVANTAGE respect to a Medicare Advantage plan, that (ii) Section 1852(a)(1) (42 U.S.C. 1395w– PLANS FOR SPECIAL NEEDS BENE- portion of the bid amount submitted under 22(a)(1)) is amended by striking ‘‘title XI’’ FICIARIES. clause (i) of subsection (a)(6)(A) for the year and all that follows and inserting the fol- (a) TREATMENT AS COORDINATED CARE that is attributable under such section to lowing: ‘‘title XI those items and services PLAN.—Section 1851(a)(2)(A) (42 U.S.C. 1395w– the provision of statutory prescription drug (other than hospice care) for which benefits 21(a)(2)(A)) is amended by adding at the end benefits. are available under parts A and B to individ- the following new sentence: ‘‘Specialized ‘‘(C) MEDICARE ADVANTAGE MONTHLY SUP- uals residing in the area served by the Medicare Advantage plans for special needs PLEMENTAL BENEFICIARY PREMIUM.—The term plan.’’. beneficiaries (as defined in section 1859(b)(4)) ‘Medicare Advantage monthly supplemental (iii) Section 1857(d)(1) (42 U.S.C. 1395w– may be any type of coordinated care plan.’’. beneficiary premium’ means, with respect to 27(d)(1)) is amended by striking ‘‘, costs, and (b) SPECIALIZED MEDICARE ADVANTAGE a Medicare Advantage plan, the portion of computation of the adjusted community PLAN FOR SPECIAL NEEDS BENEFICIARIES DE- the aggregate monthly bid amount sub- rate’’ and inserting ‘‘and costs’’. FINED.—Section 1859(b) (42 U.S.C. 1395w–29(b)) mitted under clause (i) of subsection (a)(6)(A) (f) REFERENCES UNDER PART E.—Section is amended by adding at the end the fol- for the year that is attributable under such 1859 (42 U.S.C. 1395w–29) is amended by add- lowing new paragraph: section to the provision of nonstatutory ben- ing at the end the following new subsection: ‘‘(4) SPECIALIZED MEDICARE ADVANTAGE efits.’’. ‘‘(f) APPLICATION UNDER PART E.—In the PLANS FOR SPECIAL NEEDS BENEFICIARIES.— (3) REQUIREMENT FOR UNIFORM PREMIUM AND case of any reference under part E to a re- ‘‘(A) IN GENERAL.—The term ‘specialized BID AMOUNTS.—Section 1854(c) (42 U.S.C. quirement or provision of this part in the re- Medicare Advantage plan for special needs 1395w–24(c)) is amended to read as follows: lation to an EFFS plan or organization beneficiaries’ means a Medicare Advantage plan that exclusively serves special needs ‘‘(c) UNIFORM PREMIUM AND BID AMOUNTS.— under such part, except as otherwise speci- beneficiaries (as defined in subparagraph The Medicare Advantage monthly bid fied any such requirement or provision shall (B)). amount submitted under subsection (a)(6), be applied to such organization or plan in ‘‘(B) SPECIAL NEEDS BENEFICIARY.—The the Medicare Advantage monthly basic, pre- the same manner as such requirement or term ‘special needs beneficiary’ means a scription drug, and supplemental beneficiary provision applies to a Medicare Advantage Medicare Advantage eligible individual premiums, and the Medicare Advantage private fee-for-service plan (and the Medi- who— monthly MSA premium charged under sub- care Advantage organization that offers such ‘‘(i) is institutionalized (as defined by the section (b) of a Medicare Advantage organi- plan) under this part.’’. Secretary); zation under this part may not vary among (g) EFFECTIVE DATE.—The amendments ‘‘(ii) is entitled to medical assistance individuals enrolled in the plan.’’. made by this section shall apply to payments under a State plan under title XIX; or (4) PERMITTING BENEFICIARY REBATES.— and premiums for months beginning with ‘‘(iii) meets such requirements as the Sec- (A) Section 1851(h)(4)(A) (42 U.S.C. 1395w– January 2006. retary may determine would benefit from en- 21(h)(4)(A)) is amended by inserting ‘‘except CHAPTER 3—ADDITIONAL REFORMS rollment in such a specialized Medicare Ad- as provided under section 1854(b)(1)(C)’’ after SEC. 231. MAKING PERMANENT CHANGE IN MEDI- vantage plan described in subparagraph (A) ‘‘or otherwise’’. CARE ADVANTAGE REPORTING for individuals with severe or disabling (B) Section 1854(d) (42 U.S.C. 1395w–24(d)) is DEADLINES AND ANNUAL, COORDI- chronic conditions.’’. amended by inserting ‘‘, except as provided NATED ELECTION PERIOD. (c) RESTRICTION ON ENROLLMENT PER- under subsection (b)(1)(C),’’ after ‘‘and may (a) CHANGE IN REPORTING DEADLINE.—Sec- MITTED.—Section 1859 (42 U.S.C. 1395w–29) is not provide’’. tion 1854(a)(1) (42 U.S.C. 1395w–24(a)(1)), as amended by adding at the end the following THER CONFORMING AMENDMENTS RELAT- (5) O amended by section 532(b)(1) of the Public new subsection: ING TO BIDS.—Section 1854 (42 U.S.C. 1395w–24) Health Security and Bioterrorism Prepared- ‘‘(f) RESTRICTION ON ENROLLMENT FOR SPE- is amended— ness and Response Act of 2002, is amended by CIALIZED MEDICARE ADVANTAGE PLANS FOR (A) in the heading of subsection (a), by in- striking ‘‘2002, 2003, and 2004 (or July 1 of SPECIAL NEEDS BENEFICIARIES.—In the case serting ‘‘AND BID AMOUNTS’’ after ‘‘PRE- each other year)’’ and inserting ‘‘2002 and of a specialized Medicare Advantage plan (as MIUMS’’; and each subsequent year’’. defined in subsection (b)(4)), notwithstanding (B) in subsection (a)(5)(A), by inserting (b) DELAY IN ANNUAL, COORDINATED ELEC- any other provision of this part and in ac- ‘‘paragraphs (2), (3), and (4) of’’ after ‘‘filed TION PERIOD.—Section 1851(e)(3)(B) (42 U.S.C. cordance with regulations of the Secretary under’’. 1395w–21(e)(3)(B)), as amended by section and for periods before January 1, 2007, the (e) ADDITIONAL CONFORMING AMEND- 532(c)(1)(A) of the Public Health Security and plan may restrict the enrollment of individ- MENTS.— Bioterrorism Preparedness and Response Act uals under the plan to individuals who are (1) ANNUAL DETERMINATION AND ANNOUNCE- of 2002, is amended— within one or more classes of special needs MENT OF CERTAIN FACTORS.—Section 1853(b)(1) (1) by striking ‘‘and after 2005’’; and beneficiaries.’’. (42 U.S.C. 1395w–23(b)(1)) is amended by strik- (2) by striking ‘‘, 2004, and 2005’’ and insert- (d) AUTHORITY TO DESIGNATE OTHER PLANS ing ‘‘the respective calendar year’’ and all ing ‘‘and any subsequent year’’. AS SPECIALIZED MEDICARE ADVANTAGE that follows and inserting the following: (c) ANNUAL ANNOUNCEMENT OF PAYMENT PLANS.—In promulgating regulations to ‘‘the calendar year concerned with respect to RATES.—Section 1853(b)(1) (42 U.S.C. 1395w– carry out the last sentence of section each Medicare Advantage payment area, the 23(b)(1)), as amended by section 532(d)(1) of 1851(a)(2)(A) of the Social Security Act (as following: the Public Health Security and Bioterrorism added by subsection (a)) and section ‘‘(A) PRE-COMPETITION INFORMATION.—For Preparedness and Response Act of 2002, is 1859(b)(4) of such Act (as added by subsection years before 2006, the following: amended— (b)), the Secretary may provide (notwith- ‘‘(i) MEDICARE ADVANTAGE CAPITATION (1) by striking ‘‘and after 2005’’; and standing section 1859(b)(4)(A) of such Act) for RATES.—The annual Medicare Advantage (2) by striking ‘‘and 2005’’ and inserting the offering of specialized Medicare Advan- capitation rate for each Medicare Advantage ‘‘and each subsequent year’’. tage plans by Medicare Advantage plans that payment area for the year. (d) REQUIRING PROVISION OF AVAILABLE IN- disproportionately serve special needs bene- ‘‘(ii) ADJUSTMENT FACTORS.—The risk and FORMATION COMPARING PLAN OPTIONS.—The ficiaries who are frail, elderly medicare other factors to be used in adjusting such first sentence of section 1851(d)(2)(A)(ii) (42 beneficiaries. rates under subsection (a)(1)(A) for payments U.S.C. 1395w–21(d)(2)(A)(ii)) is amended by in- (e) REPORT TO CONGRESS.—Not later than for months in that year. serting before the period the following: ‘‘to December 31, 2005, the Medicare Benefits Ad- ‘‘(B) COMPETITION INFORMATION.—For years the extent such information is available at ministrator shall submit to Congress a re- beginning with 2006, the following: the time of preparation of materials for the port that assesses the impact of specialized ‘‘(i) BENCHMARK.—The Medicare Advantage mailing’’. Medicare Advantage plans for special needs area-specific non-drug benchmark under sec- SEC. 232. AVOIDING DUPLICATIVE STATE REGU- beneficiaries on the cost and quality of serv- tion 1853(j). LATION. ices provided to enrollees. Such report shall ‘‘(ii) ADJUSTMENT FACTORS.—The adjust- (a) IN GENERAL.—Section 1856(b)(3) (42 include an assessment of the costs and sav- ment factors applied under section U.S.C. 1395w–26(b)(3)) is amended to read as ings to the medicare program as a result of 1853(a)(1)(A)(iv) (relating to demographic ad- follows: amendments made by subsections (a), (b), justment), section 1853(a)(1)(B) (relating to ‘‘(3) RELATION TO STATE LAWS.—The stand- and (c). adjustment for end-stage renal disease), and ards established under this subsection shall (f) EFFECTIVE DATES.—
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00090 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.058 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6031
(1) IN GENERAL.—The amendments made by ed by striking ‘‘December 31, 2004’’ and in- ble individuals in the United States who are subsections (a), (b), and (c) shall take effect serting ‘‘December 31, 2009’’. enrolled in Medicare Advantage plans during upon the date of the enactment of this Act. SEC. 237. STUDY OF PERFORMANCE-BASED PAY- March of the previous year. (2) DEADLINE FOR ISSUANCE OF REQUIRE- MENT SYSTEMS. ‘‘(ii) EXCEPTION.—In the case of an EFFS MENTS FOR SPECIAL NEEDS BENEFICIARIES; (a) IN GENERAL.—The Secretary shall re- region that was a competitive EFFS region TRANSITION.—No later than 6 months after quest the Institute of Medicine of the Na- for the previous year, the Medicare Benefits the date of the enactment of this Act, the tional Academy of Sciences to— Administrator may continue to treat the re- Secretary shall issue interim final regula- (1) conduct a study that reviews and evalu- gion as meeting the requirement of subpara- tions to establish requirements for special ates public and private sector experiences in graph (A)(ii) if the region would meet such needs beneficiaries under section establishing performance measures and pay- requirement but for a de minimis reduction 1859(b)(4)(B)(iii) of the Social Security Act, ment incentives under the medicare program below the percentage specified in clause (i). as added by subsection (b). and linking performance to payment; and ‘‘(2) COMPETITIVE EFFS NON-DRUG MONTHLY SEC. 234. MEDICARE MSAS. (2) submit a report to the Secretary and BENCHMARK AMOUNT.—For purposes of this part, the term ‘competitive EFFS non-drug (a) EXEMPTION FROM REPORTING ENROLLEE Congress, not later than 18 months after the monthly benchmark amount’ means, with ENCOUNTER DATA.— date of the enactment of this Act, regarding respect to an EFFS region for a month in a (1) IN GENERAL.—Section 1852(e)(1) (42 such study. U.S.C. 1395w–22(e)(1)) is amended by inserting (b) STUDY.—The study under subsection year and subject to paragraph (8), the sum of ‘‘(other than MSA plans)’’ after ‘‘plans’’. (a)(1) shall— the 2 components described in paragraph (3) for the region and year. The Administrator (2) CONFORMING AMENDMENTS.—Section 1852 (1) include a review and evaluation of in- shall compute such benchmark amount for (42 U.S.C. 1395w–22) is amended— centives that have been or could be used to each competitive EFFS region before the be- (A) in subsection (c)(1)(I), by inserting be- encourage quality performance, including ginning of each annual, coordinated election fore the period at the end the following: ‘‘if those aimed at health plans and their enroll- period under section 1851(e)(3)(B) for each required under such section’’; and ees, providers and their patients, and other year (beginning with 2010) in which it is des- (B) in subparagraphs (A) and (B) of sub- incentives that encourage quality-based ignated as such a region. section (e)(2), by striking ‘‘, a non-network health care purchasing and collaborative ef- ‘‘(3) 2 COMPONENTS.—For purposes of para- MSA plan,’’ and ‘‘, NON-NETWORK MSA PLANS,’’ forts to improve performance; and graph (2), the 2 components described in this each place it appears. (2) examine how these measures and incen- paragraph for an EFFS region and a year are (b) MAKING PROGRAM PERMANENT AND tives might be applied in the Medicare Ad- the following: ELIMINATING CAP.—Section 1851(b)(4) (42 vantage program, the Enhanced Fee-For- Service (EFFS) program, and traditional fee- ‘‘(A) EFFS COMPONENT.—The product of U.S.C. 1395w–21(b)(4)) is amended— the following: (1) in the heading, by striking ‘‘ON A DEM- for-service programs. ‘‘(i) WEIGHTED AVERAGE OF PLAN BIDS IN RE- ONSTRATION BASIS’’; (c) REPORT RECOMMENDATIONS.—The report under subsection (a)(2) shall— GION.—The weighted average of the EFFS (2) by striking the first sentence of sub- plan bids for the region and year (as deter- paragraph (A); and (1) include recommendations regarding ap- propriate performance measures for use in mined under paragraph (4)(A)). (3) by striking the second sentence of sub- ‘‘(ii) NON-FFS MARKET SHARE.—1 minus the paragraph (C). assessing and paying for quality; and (2) identify options for updating perform- fee-for-service market share percentage de- (c) APPLYING LIMITATIONS ON BALANCE termined under paragraph (5) for the region ance measures. BILLING.—Section 1852(k)(1) (42 U.S.C. 1395w– and the year. 22(k)(1)) is amended by inserting ‘‘or with an Subtitle C—Application of FEHBP-Style ‘‘(B) FEE-FOR-SERVICE COMPONENT.—The organization offering a MSA plan’’ after Competitive Reforms product of the following: ‘‘section 1851(a)(2)(A)’’. SEC. 241. APPLICATION OF FEHBP-STYLE COM- ‘‘(i) FEE-FOR-SERVICE REGION-SPECIFIC NON- (d) ADDITIONAL AMENDMENT.—Section PETITIVE REFORM BEGINNING IN DRUG AMOUNT.—The fee-for-service region- 1851(e)(5)(A) (42 U.S.C. 1395w–21(e)(5)(A)) is 2010. specific non-drug amount (as defined in para- amended— (a) IDENTIFICATION OF COMPETITIVE EFFS graph (6)) for the region and year. (1) by adding ‘‘or’’ at the end of clause (i); REGIONS; COMPUTATION OF COMPETITIVE ‘‘(ii) FEE-FOR-SERVICE MARKET SHARE.—The (2) by striking ‘‘, or’’ at the end of clause EFFS NON-DRUG BENCHMARKS UNDER EFFS fee-for-service market share percentage (de- (ii) and inserting a semicolon; and PROGRAM.— termined under paragraph (5)) for the region (3) by striking clause (iii). (1) IN GENERAL.—Section 1860E–3, as added and the year. SEC. 235. EXTENSION OF REASONABLE COST by section 201(a), is amended by adding at ‘‘(4) DETERMINATION OF WEIGHTED AVERAGE CONTRACTS. the end the following new subsection: EFFS PLAN BIDS FOR A REGION.— Subparagraph (C) of section 1876(h)(5) (42 ‘‘(e) APPLICATION OF COMPETITION.— ‘‘(A) IN GENERAL.—For purposes of para- U.S.C. 1395mm(h)(5)) is amended to read as ‘‘(1) DETERMINATION OF COMPETITIVE EFFS graph (3)(A)(i), the weighted average of follows: REGIONS.— EFFS plan bids for an EFFS region and a ‘‘(C)(i) Subject to clause (ii), may be ex- ‘‘(A) IN GENERAL.—For purposes of this year is the sum of the following products for tended or renewed under this subsection in- part, the term ‘competitive EFFS region’ EFFS plans described in subparagraph (C) in definitely. means, for a year beginning with 2010, an the region and year: ‘‘(ii) For any period beginning on or after EFFS region that the Administrator finds— ‘‘(i) UNADJUSTED EFFS STATUTORY NON-DRUG January 1, 2008, a reasonable cost reimburse- ‘‘(i) there will be offered in the region dur- MONTHLY BID AMOUNT.—The unadjusted EFFS ment contract under this subsection may not ing the annual, coordinated election period statutory non-drug monthly bid amount (as be extended or renewed for a service area in- under section 1851(e)(3)(B) (as applied under defined in subsection (a)(3)(A)(ii)(I)) for the sofar as such area, during the entire previous section 1860E–1(c)) before the beginning of region and year. year, was within the service area of 2 or the year at least 2 EFFS plans (in addition ‘‘(ii) PLAN’S SHARE OF EFFS ENROLLMENT IN more plans which were coordinated care to the fee-for-service program under parts A REGION.—The number of individuals de- Medicare Advantage plans under part C or 2 and B), each offered by a different EFFS or- scribed in subparagraph (B), divided by the or more enhanced fee-for-service plans under ganization and each of which met the min- total number of such individuals for all part E and each of which plan for that pre- imum enrollment requirements of paragraph EFFS plans described in subparagraph (C) for vious year for the area involved meets the (1) of section 1857(b) (as applied without re- that region and year. following minimum enrollment require- gard to paragraph (3) thereof) as of March of ‘‘(B) COUNTING OF INDIVIDUALS.—The Ad- ments: the previous year; and ministrator shall count, for each EFFS plan ‘‘(I) With respect to any portion of the area ‘‘(ii) during March of the previous year at described in subparagraph (C) for an EFFS involved that is within a Metropolitan Sta- least the percentage specified in subpara- region and year, the number of individuals tistical Area with a population of more than graph (C) of the number of EFFS eligible in- who reside in the region and who were en- 250,000 and counties contiguous to such Met- dividuals who reside in the region were en- rolled under such plan under this part during ropolitan Statistical Area, 5,000 individuals. rolled in an EFFS plan. March of the previous year. ‘‘(II) With respect to any other portion of ‘‘(B) PERCENTAGE SPECIFIED.— ‘‘(C) EXCLUSION OF PLANS NOT OFFERED IN such area, 1,500 individuals.’’. ‘‘(i) IN GENERAL.—For purposes of subpara- PREVIOUS YEAR.—For an EFFS region and SEC. 236. EXTENSION OF MUNICIPAL HEALTH graph (A), subject to clause (ii), the percent- year, the EFFS plans described in this sub- SERVICE DEMONSTRATION age specified in this subparagraph for a year paragraph are plans that are offered in the PROJECTS. is equal the lesser of 20 percent or to the sum region and year and were offered in the re- Section 9215(a) of the Consolidated Omni- of— gion in March of the previous year. bus Budget Reconciliation Act of 1985 (42 ‘‘(I) the percentage, as estimated by the ‘‘(5) COMPUTATION OF FEE-FOR-SERVICE MAR- U.S.C. 1395b–1 note), as amended by section Administrator, of EFFS eligible individuals KET SHARE PERCENTAGE.—The Administrator 6135 of the Omnibus Budget Reconciliation in the United States who are enrolled in shall determine, for a year and an EFFS re- Act of 1989, section 13557 of the Omnibus EFFS plans during March of the previous gion, the proportion (in this subsection re- Budget Reconciliation Act of 1993, section year; and ferred to as the ‘fee-for-service market share 4017 of BBA, section 534 of BBRA (113 Stat. ‘‘(II) the percentage, as estimated by the percentage’) of the EFFS eligible individuals 1501A–390), and section 633 of BIPA, is amend- Administrator, of Medicare Advantage eligi- who are residents of the region during March
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00091 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.058 H26PT1 H6032 CONGRESSIONAL RECORD — HOUSE June 26, 2003 of the previous year, of such individuals who previous year, the weighted average phase-in for a de minimis reduction below the per- were not enrolled in an EFFS plan or in a proportion for the region for the year is centage specified in clause (i). Medicare Advantage plan (or, if greater, such equal to 1⁄5. ‘‘(2) COMPETITIVE MEDICARE ADVANTAGE proportion determined for individuals na- ‘‘(ii) COMPETITIVE REGION IN PREVIOUS NON-DRUG MONTHLY BENCHMARK AMOUNT.—For tionally). YEAR.—If the region was a competitive EFFS purposes of this part, the term ‘competitive ‘‘(6) FEE-FOR-SERVICE REGION-SPECIFIC NON- region in the previous year, the weighted av- Medicare Advantage non-drug monthly DRUG AMOUNT.— erage phase-in proportion for the region for benchmark amount’ means, with respect to a ‘‘(A) IN GENERAL.—For purposes of para- the year is equal to the weighted average competitive Medicare Advantage area for a graph (3)(B)(i) and section 1839(h)(2)(A), sub- phase-in proportion determined under this month in a year subject to paragraph (8), the ject to subparagraph (C), the term ‘fee-for- subparagraph for the region for the previous sum of the 2 components described in para- service region-specific non-drug amount’ year plus 1⁄5, but in no case more than 1.’’. graph (3) for the area and year. The Adminis- means, for a competitive EFFS region and a (2) CONFORMING AMENDMENTS.— trator shall compute such benchmark year, the adjusted average per capita cost for (A) Such section 1860E–3 is further amend- amount for each competitive Medicare Ad- the year involved, determined under section ed— vantage area before the beginning of each 1876(a)(4) for such region for services covered (i) in subsection (b), by adding at the end annual, coordinated election period under under parts A and B for individuals entitled the following new paragraph: section 1851(e)(3)(B) for each year (beginning to benefits under part A and enrolled under ‘‘(4) APPLICATION IN COMPETITIVE REGIONS.— with 2010) in which it is designated as such this part who are not enrolled in an EFFS For special rules applying this subsection in an area. plan under part E or a Medicare Advantage competitive EFFS regions, see subsection ‘‘(3) 2 COMPONENTS.—For purposes of para- plan under part C for the year, but adjusted (e)(7).’’; graph (2), the 2 components described in this to exclude costs attributable to payments (ii) in subsection (c)(1), by inserting ‘‘and paragraph for a competitive Medicare Ad- under section 1886(h). subsection (e)(7)’’ after ‘‘(as made applicable vantage area and a year are the following: ‘‘(B) USE OF FULL RISK ADJUSTMENT TO under subsection (d))’’; and ‘‘(A) MEDICARE ADVANTAGE COMPONENT.— STANDARDIZE FEE-FOR-SERVICE COSTS TO TYP- (iii) in subsection (d) , by striking ‘‘and The product of the following: ICAL BENEFICIARY.—In determining the ad- (e)’’ and inserting ‘‘(e), and (k) ’’. ‘‘(i) WEIGHTED AVERAGE OF MEDICARE AD- justed average per capita cost for a region (B) Section 1860E–4(a)(1), as inserted by and year under subparagraph (A), such costs section 201(a)(2), is amended by inserting ‘‘, VANTAGE PLAN BIDS IN AREA.—The weighted shall be adjusted to fully take into account except as provided in section 1860E–3(e)(7)’’ average of the plan bids for the area and year the demographic and health status risk fac- after ‘‘paragraph (2)’’. (as determined under paragraph (4)(A)). tors established under subsection (c)(3) so (b) IDENTIFICATION OF COMPETITIVE MEDI- ‘‘(ii) NON-FFS MARKET SHARE.—1 minus the that such per capita costs reflect the average CARE ADVANTAGE AREAS; APPLICATION OF fee-for-service market share percentage, de- costs for a typical beneficiary residing in the COMPETITIVE MEDICARE ADVANTAGE NON- termined under paragraph (5) for the area region. DRUG BENCHMARKS UNDER MEDICARE ADVAN- and year. ‘‘(C) INCLUSION OF COSTS OF VA AND DOD TAGE PROGRAM.— ‘‘(B) FEE-FOR-SERVICE COMPONENT.—The MILITARY FACILITY SERVICES TO MEDICARE-ELI- (1) IN GENERAL.—Section 1853, as amended product of the following: GIBLE BENEFICIARIES.—In determining the ad- by section 221(b)(3), is amended by adding at ‘‘(i) FEE-FOR-SERVICE AREA-SPECIFIC NON- justed average per capita cost under subpara- the end the following new subsection: DRUG AMOUNT.—The fee-for-service area-spe- graph (A) for a year, such cost shall be ad- ‘‘(k) APPLICATION OF COMPETITION.— cific non-drug amount (as defined in para- justed to include the Administrator’s esti- ‘‘(1) DETERMINATION OF COMPETITIVE MEDI- graph (6)) for the area and year. mate, on a per capita basis, of the amount of CARE ADVANTAGE AREAS.— ‘‘(ii) FEE-FOR-SERVICE MARKET SHARE.—The additional payments that would have been ‘‘(A) IN GENERAL.—For purposes of this fee-for-service market share percentage, de- made in the region involved under this title part, the terms ‘competitive Medicare Ad- termined under paragraph (5) for the area if individuals entitled to benefits under this vantage area’ and ‘CMA area’ mean, for a and year. title had not received services from facilities year beginning with 2010, an area (which is a ‘‘(4) DETERMINATION OF WEIGHTED AVERAGE of the Department of Veterans Affairs or the metropolitan statistical area or other area MEDICARE ADVANTAGE BIDS FOR AN AREA.— Department of Defense. with a substantial number of Medicare Ad- ‘‘(A) IN GENERAL.—For purposes of para- ‘‘(7) APPLICATION OF COMPETITION.—In the vantage enrollees) that the Administrator graph (3)(A)(i), the weighted average of plan case of an EFFS region that is a competitive finds— bids for an area and a year is the sum of the EFFS region for a year, for purposes of ap- ‘‘(i) there will be offered during the annual, following products for Medicare Advantage plying subsections (b) and (c)(1) and section coordinated election period under section plans described in subparagraph (C) in the 1860E–4(a), any reference to an EFFS region- 1851(e)(3)(B) under this part before the begin- area and year: specific non-drug monthly benchmark ning of the year at least 2 Medicare Advan- ‘‘(i) MONTHLY MEDICARE ADVANTAGE STATU- amount shall be treated as a reference to the tage plans (in addition to the fee-for-service TORY NON-DRUG BID AMOUNT.—The unadjusted competitive EFFS non-drug monthly bench- program under parts A and B), each offered Medicare Advantage statutory non-drug mark amount under paragraph (2) for the re- by a different Medicare Advantage organiza- monthly bid amount. gion and year. tion and each of which met the minimum en- ‘‘(ii) PLAN’S SHARE OF MEDICARE ADVANTAGE ‘‘(8) PHASE-IN OF BENCHMARK FOR EACH RE- rollment requirements of paragraph (1) of ENROLLMENT IN AREA.—The number of indi- GION.— section 1857(b) (as applied without regard to viduals described in subparagraph (B), di- ‘‘(A) USE OF BLENDED BENCHMARK.—In the paragraph (3) thereof) as of March of the pre- vided by the total number of such individ- case of a region that has not been a competi- vious year with respect to the area; and uals for all Medicare Advantage plans de- tive EFFS region for each of the previous 4 ‘‘(ii) during March of the previous year at scribed in subparagraph (C) for that area and years, the competitive EFFS non-drug least the percentage specified in subpara- year. monthly benchmark amount shall be equal graph (B) of the number of Medicare Advan- ‘‘(B) COUNTING OF INDIVIDUALS.—The Ad- to the sum of the following: tage eligible individuals who reside in the ministrator shall count, for each Medicare ‘‘(i) NEW COMPETITIVE COMPONENT.—The area were enrolled in a Medicare Advantage Advantage plan described in subparagraph product of— plan. (C) for an area and year, the number of indi- ‘‘(I) the weighted average phase-in propor- ‘‘(B) PERCENTAGE SPECIFIED.— viduals who reside in the area and who were tion for that area and year, as specified in ‘‘(i) IN GENERAL.—For purposes of subpara- enrolled under such plan under this part dur- subparagraph (B); and graph (A), subject to clause (ii), the percent- ing March of the previous year. ‘‘(II) the competitive EFFS non-drug age specified in this subparagraph for a year ‘‘(C) EXCLUSION OF PLANS NOT OFFERED IN monthly benchmark amount for the region is equal the lesser of 20 percent or to the sum PREVIOUS YEAR.—For an area and year, the and year, determined under paragraph (2) of— Medicare Advantage plans described in this without regard to this paragraph. ‘‘(I) the percentage, as estimated by the subparagraph are plans described in the first ‘‘(ii) OLD COMPETITIVE COMPONENT.—The Administrator, of EFFS eligible individuals sentence of section 1851(a)(2)(A) that are of- product of— in the United States who are enrolled in fered in the area and year and were offered in ‘‘(I) 1 minus the weighted average phase-in EFFS plans during March of the previous the area in March of the previous year. proportion for that region and year; and year; and ‘‘(5) COMPUTATION OF FEE-FOR-SERVICE MAR- ‘‘(II) the EFFS region-specific non-drug ‘‘(II) the percentage, as estimated by the KET SHARE PERCENTAGE.—The Administrator benchmark amount for the region and the Administrator, of Medicare Advantage eligi- shall determine, for a year and a competitive year. ble individuals in the United States who are Medicare Advantage area, the proportion (in ‘‘(B) COMPUTATION OF WEIGHTED AVERAGE enrolled in Medicare Advantage plans during this subsection referred to as the ‘fee-for- PHASE-IN PROPORTION.—For purposes of this March of the previous year. service market share percentage’) of Medi- paragraph, the ‘weighted average phase-in ‘‘(ii) EXCEPTION.—In the case of an area care Advantage eligible individuals residing proportion’ for an EFFS region for a year that was a competitive area for the previous in the area who during March of the previous shall be determined as follows: year, the Medicare Benefits Administrator year were not enrolled in a Medicare Advan- ‘‘(i) FIRST YEAR (AND REGION NOT COMPETI- may continue to treat the area as meeting tage plan or in an EFFS plan (or, if greater, TIVE REGION IN PREVIOUS YEAR).—If the area the requirement of subparagraph (A)(ii) if such proportion determined for individuals was not a competitive EFFS region in the the area would meet such requirement but nationally).
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‘‘(6) FEE-FOR-SERVICE AREA-SPECIFIC NON- phase-in proportion for the area for the year ‘‘(i) BENCHMARKS.—The Medicare Advan- DRUG AMOUNT.— is equal to 1⁄5. tage area-specific non-drug benchmark under ‘‘(A) IN GENERAL.—For purposes of para- ‘‘(ii) COMPETITIVE AREA IN PREVIOUS YEAR.— section 1853(j) and, if applicable, the com- graph (3)(B)(i) and section 1839(h)(1)(A), sub- If the area was a competitive Medicare Ad- petitive Medicare Advantage non-drug ject to subparagraph (C), the term ‘fee-for- vantage area in the previous year, the benchmark under section 1853(k)(2), for the service area-specific non-drug amount’ weighted average phase-in proportion for the year and competitive Medicare Advantage means, for a competitive Medicare Advan- area for the year is equal to the weighted av- area involved and the national fee-for-serv- tage area and a year, the adjusted average erage phase-in proportion determined under ice market share percentage for the area and per capita cost for the year involved, deter- this subparagraph for the area for the pre- year. mined under section 1876(a)(4) for such area vious year plus 1⁄5, but in no case more than ‘‘(ii) ADJUSTMENT FACTORS.—The adjust- for services covered under parts A and B for 1. ment factors applied under section individuals entitled to benefits under part A ‘‘(C) MEDICARE ADVANTAGE AREA-WIDE NON- 1853(a)(1)(A)(iv) (relating to demographic ad- and enrolled under this part who are not en- DRUG BENCHMARK AMOUNT.—For purposes of justment), section 1853(a)(1)(B) (relating to rolled in a Medicare Advantage plan under subparagraph (A)(ii)(II), the term ‘Medicare adjustment for end-stage renal disease), and part C or an EFFS plan under part E for the Advantage area-wide non-drug benchmark section 1853(a)(3) (relating to health status year, but adjusted to exclude costs attrib- amount’ means, for an area and year, the adjustment). utable to payments under section 1886(h). weighted average of the amounts described ‘‘(iii) CERTAIN BENCHMARKS AND AMOUNTS.— ‘‘(B) USE OF FULL RISK ADJUSTMENT TO in section 1853(j) for Medicare Advantage In the case of a competitive Medicare Advan- STANDARDIZE FEE-FOR-SERVICE COSTS TO TYP- payment area or areas included in the area tage area, the Medicare Advantage area-wide ICAL BENEFICIARY.—In determining the ad- (based on the number of traditional fee-for- non-drug benchmark amount (as defined in justed average per capita cost for an area service enrollees in such payment area or subsection (k)(8)(C)) and the fee-for-service and year under subparagraph (A), such costs areas) and year.’’. area-specific non-drug amount (as defined in shall be adjusted to fully take into account (2) APPLICATION.—Section 1854 (42 U.S.C. section 1853(k)(6)) for the area. the demographic and health status risk fac- 1395w–24) is amended— ‘‘(iv) INDIVIDUALS.—The number of individ- tors established under subsection (A) in subsection (b)(1)(C)(i), as added by uals counted under subsection (k)(4)(B) and (a)(1)(A)(iv) so that such per capita costs re- section 221(b)(1)(A), by striking ‘‘(i) REQUIRE- enrolled in each Medicare Advantage plan in flect the average costs for a typical bene- MENT.—The’’ and inserting ‘‘(i) REQUIREMENT the area.’’. ficiary residing in the area. FOR NON-COMPETITIVE AREAS.—In the case of (C) DEFINITION OF MONTHLY BASIC PRE- ‘‘(C) INCLUSION OF COSTS OF VA AND DOD a Medicare Advantage payment area that is MIUM.—Section 1854(b)(2)(A)(ii), as amended MILITARY FACILITY SERVICES TO MEDICARE-ELI- not a competitive Medicare Advantage area by section 221(d)(2), is amended by inserting GIBLE BENEFICIARIES.—In determining the ad- designated under section 1853(k)(1), the’’; ‘‘(or, in the case of a competitive Medicare justed average per capita cost under subpara- (B) in subsection (b)(1)(C), as so added, by Advantage area, the competitive Medicare graph (A) for a year, such cost shall be ad- inserting after clause (i) the following new Advantage non-drug monthly benchmark justed to include the Administrator’s esti- clause: amount or, in applying this paragraph under mate, on a per capita basis, of the amount of ‘‘(ii) REQUIREMENT FOR COMPETITIVE MEDI- part E in the case of a competitive EFFS re- additional payments that would have been CARE ADVANTAGE AREAS.—In the case of a gion, the competitive EFFS non-drug month- made in the area involved under this title if Medicare Advantage payment area that is ly benchmark amount)’’ after ‘‘benchmark individuals entitled to benefits under this designated as a competitive Medicare Advan- amount’’. title had not received services from facilities tage area under section 1853(k)(1), if there (c) PREMIUM ADJUSTMENT.— of the Department of Veterans Affairs or the are average per capita monthly savings de- (1) IN GENERAL.—Section 1839 (42 U.S.C. Department of Defense. scribed in paragraph (6) for a Medicare Ad- 1395r) is amended by adding at the end the ‘‘(7) APPLICATION OF COMPETITION.—In the vantage plan and year, the Medicare Advan- following new subsection: case of an area that is a competitive Medi- tage plan shall provide to the enrollee a ‘‘(h)(1)(A) In the case of an individual who care Advantage area for a year, for purposes monthly rebate equal to 75 percent of such resides in a competitive Medicare Advantage of applying subsection (a)(1)(A)(ii) and sec- savings.’’; and area under section 1853(k)(1) (regardless of tions 1854(b)(2)(A)(ii) and 1854(b)(3)(B)(i), any (C) by adding at the end of subsection (b), whether such area is in a competitive EFFS reference to a Medicare Advantage area-spe- as amended by sections 221(b)(1)(B) and region under section 1860E–3(e)) and who is cific non-drug monthly benchmark amount 221(b)(2), the following new paragraph: not enrolled in a Medicare Advantage plan shall be treated as a reference to the com- ‘‘(6) COMPUTATION OF AVERAGE PER CAPITA under part C or in an EFFS plan under part petitive Medicare Advantage non-drug MONTHLY SAVINGS FOR COMPETITIVE MEDICARE E, the monthly premium otherwise applied monthly benchmark amount under para- ADVANTAGE AREAS.—For purposes of para- under this part (determined without regard graph (2) for the area and year. graph (1)(C)(ii), the average per capita to subsections (b) and (f) or any adjustment ‘‘(8) PHASE-IN OF BENCHMARK FOR EACH monthly savings referred to in such para- under this subsection) shall be adjusted as AREA.— graph for a Medicare Advantage plan and follows: If the fee-for-service area-specific ‘‘(A) USE OF BLENDED BENCHMARK.—In the year shall be computed in the same manner non-drug amount (as defined in section case of an area that has not been a competi- as the average per capita monthly savings is 1853(k)(6)) for the competitive Medicare Ad- tive Medicare Advantage area for each of the computed under paragraph (3) except that vantage area in which the individual resides previous 4 years, the competitive Medicare the reference to the Medicare Advantage for a month— Advantage non-drug monthly benchmark area-specific non-drug monthly benchmark ‘‘(i) does not exceed the competitive Medi- amount shall be equal to the sum of the fol- amount in paragraph (3)(B)(i) (or to the care Advantage non-drug benchmark (as de- lowing: benchmark amount as adjusted under para- termined under paragraph (2) of section ‘‘(i) NEW COMPETITIVE COMPONENT.—The graph (3)(C)(i)) is deemed to be a reference to 1853(k), without regard to paragraph (8) product of— the competitive Medicare Advantage non- thereof) for such area, the amount of the pre- ‘‘(I) the weighted average phase-in propor- drug monthly benchmark amount (or such mium for the individual for the month shall tion for that area and year, as specified in amount as adjusted in the manner described be reduced by an amount equal to the prod- subparagraph (B); and in paragraph (3)(B)(i)).’’. uct of the adjustment factor under subpara- ‘‘(II) the competitive Medicare Advantage (3) ADDITIONAL CONFORMING AMENDMENTS.— graph (C) and 75 percent of the amount by non-drug monthly benchmark amount for (A) PAYMENT OF PLANS.—Section which such competitive benchmark exceeds the area and year, determined under para- 1853(a)(1)(A)(ii), as amended by section such fee-for-service area-specific non-drug graph (2) without regard to this paragraph. 221(c)(1), is amended— amount; or ‘‘(ii) OLD COMPETITIVE COMPONENT.—The (i) in subclauses (I) and (II), by inserting ‘‘(ii) exceeds such competitive Medicare product of— ‘‘(or, insofar as such payment area is a com- Advantage non-drug benchmark, the amount ‘‘(I) 1 minus the weighted average phase-in petitive Medicare Advantage area, described of the premium for the individual for the proportion for that area and year; and in section 1854(b)(6))’’ after ‘‘section month shall be adjusted to ensure, subject to ‘‘(II) the Medicare Advantage area-wide 1854(b)(3)(C)’’; and subparagraph (B), that— non-drug benchmark amount for the area (ii) in subclause (II), by inserting ‘‘(or, in- ‘‘(I) the sum of the amount of the adjusted and the year. sofar as such payment area is a competitive premium and the competitive Medicare Ad- ‘‘(B) COMPUTATION OF WEIGHTED AVERAGE Medicare Advantage area, the competitive vantage non-drug benchmark for the area, is PHASE-IN PROPORTION.—For purposes of this Medicare Advantage non-drug monthly equal to paragraph, the ‘weighted average phase-in benchmark amount)’’ after ‘‘Medicare Ad- ‘‘(II) the sum of the unadjusted premium proportion’ for a Medicare Advantage pay- vantage area-specific non-drug monthly plus amount of the fee-for-service area-spe- ment area for a year shall be determined as benchmark amount’’; and cific non-drug amount for the area. follows: (B) DISCLOSURE OF INFORMATION.—Section ‘‘(B) In no case shall the actual amount of ‘‘(i) FIRST YEAR (AND AREA NOT COMPETITIVE 1853(b)(1)(B), as amended by section 221(e)(1), an adjustment under subparagraph (A)(ii) ex- AREA IN PREVIOUS YEAR).—If the area was not is amended to read as follows: ceed the product of the adjustment factor a Medicare Advantage competitive area in ‘‘(B) COMPETITION INFORMATION.—For years under subparagraph (C) and the amount of the previous year, the weighted average beginning with 2006, the following: the adjustment otherwise computed under
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00093 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.058 H26PT1 H6034 CONGRESSIONAL RECORD — HOUSE June 26, 2003 subparagraph (A)(ii) without regard to this viously transmitted under this paragraph for received’’ and inserting ‘‘on the date notice subparagraph. the year.’’. of, or information related to, a primary ‘‘(C) The adjustment factor under this sub- (2) NO CHANGE IN MEDICARE’S DEFINED BEN- plan’s responsibility for such payment or paragraph for an area for a year is equal to— EFIT PACKAGE.—Nothing in this part (or the other information is received’’; and ‘‘(i) the number of consecutive years (in amendments made by this part) shall be con- (3) in subparagraph (B)(iii), , as redesig- the 5-year period ending with the year in- strued as changing the entitlement to de- nated by subsection (a)(2)(B), by striking the volved) in which such area was a competitive fined benefits under parts A and B of title first sentence and inserting the following: Medicare Advantage area; divided by XVIII of the Social Security Act. ‘‘In order to recover payment made under ‘‘(ii) 5. (3) CONFORMING AMENDMENT.—Section this title for an item or service, the United ‘‘(2)(A) In the case of an individual who re- 1844(c) (42 U.S.C. 1395w(c)) is amended by in- States may bring an action against any or sides in an area that is within a competitive serting ‘‘and without regard to any premium all entities that are or were required or re- EFFS region under section 1860E–3(e) but is adjustment effected under section 1839(h)’’ sponsible (directly, as an insurer or self-in- not within a competitive Medicare Advan- before the period at the end. surer, as a third-party administrator, as an tage area under section 1853(k)(1) and who is (d) EFFECTIVE DATE.—The amendments employer that sponsors or contributes to a not enrolled in a Medicare Advantage plan made by this section shall take effect on group health plan, or large group health under part C or in an EFFS plan under part January 1, 2010. plan, or otherwise) to make payment with E, the monthly premium otherwise applied TITLE III—COMBATTING WASTE, FRAUD, respect to the same item or service (or any under this part (determined without regard AND ABUSE portion thereof) under a primary plan. The to subsections (b) and (f) or any adjustment SEC. 301. MEDICARE SECONDARY PAYOR (MSP) United States may, in accordance with para- under this subsection) shall be adjusted as PROVISIONS. graph (3)(A) collect double damages against follows: If the fee-for-service region-specific (a) TECHNICAL AMENDMENT CONCERNING any such entity. In addition, the United non-drug amount (as defined in section SECRETARY’S AUTHORITY TO MAKE CONDI- States may recover under this clause from 1860E–3(e)(6)) for a region for a month— TIONAL PAYMENT WHEN CERTAIN PRIMARY any entity that has received payment from a ‘‘(i) does not exceed the competitive EFFS PLANS DO NOT PAY PROMPTLY.— primary plan or from the proceeds of a pri- non-drug monthly benchmark amount (as de- (1) IN GENERAL.—Section 1862(b)(2) (42 mary plan’s payment to any entity.’’. termined under paragraph (2) of section U.S.C. 1395y(b)(2)) is amended— (c) CLERICAL AMENDMENTS.—Section 1862(b) 1860E–3(e), without regard to paragraph (8) (A) in subparagraph (A)(ii), by striking (42 U.S.C. 1395y(b)) is amended— thereof) for such region, the amount of the ‘‘promptly (as determined in accordance (1) in paragraph (1)(A), by moving the in- premium for the individual for the month with regulations)’’; dentation of clauses (ii) through (v) 2 ems to shall be reduced by an amount equal to the (B) in subparagraph (B)— the left; and product of the adjustment factor under sub- (i) by redesignating clauses (i) through (iii) (2) in paragraph (3)(A), by striking ‘‘such’’ paragraph (C) and 75 percent of the amount as clauses (ii) through (iv), respectively; and before ‘‘paragraphs’’. by which such competitive benchmark (ii) by inserting before clause (ii), as so re- SEC. 302. COMPETITIVE ACQUISITION OF CER- amount exceeds such fee-for-service region- designated, the following new clause: TAIN ITEMS AND SERVICES. specific non-drug benchmark amount; or ‘‘(i) AUTHORITY TO MAKE CONDITIONAL PAY- (a) IN GENERAL.—Section 1847 (42 U.S.C. ‘‘(ii) exceeds such competitive EFFS non- MENT.—The Secretary may make payment 1395w–3) is amended to read as follows: drug monthly benchmark amount, the under this title with respect to an item or ‘‘COMPETITIVE ACQUISITION OF CERTAIN ITEMS amount of the premium for the individual for service if a primary plan described in sub- AND SERVICES the month shall be adjusted to ensure, sub- paragraph (A)(ii) has not made or cannot ‘‘SEC. 1847. (a) ESTABLISHMENT OF COMPETI- ject to subparagraph (B), that— reasonably be expected to make payment TIVE ACQUISITION PROGRAMS.— ‘‘(I) the sum of the amount of the adjusted with respect to such item or service prompt- ‘‘(1) IMPLEMENTATION OF PROGRAMS.— premium and the competitive EFFS non- ly (as determined in accordance with regula- ‘‘(A) IN GENERAL.—The Secretary shall es- drug monthly benchmark amount for the re- tions). Any such payment by the Secretary tablish and implement programs under gion, is equal to shall be conditioned on reimbursement to which competitive acquisition areas are es- ‘‘(II) the sum of the unadjusted premium the appropriate Trust Fund in accordance tablished throughout the United States for plus the amount of the EFFS region-specific with the succeeding provisions of this sub- contract award purposes for the furnishing non-drug monthly bidfor the region. section.’’. under this part of competitively priced items ‘‘(B) In no case shall the actual amount of (2) EFFECTIVE DATE.—The amendments and services (described in paragraph (2)) for an adjustment under subparagraph (A)(ii) ex- made by paragraph (1) shall be effective as if which payment is made under this part. ceed the product of the adjustment factor included in the enactment of title III of the Such areas may differ for different items and under subparagraph (C) and the amount of Medicare and Medicaid Budget Reconcili- services. the adjustment otherwise computed under ation Amendments of 1984 (Public Law 98- ‘‘(B) PHASED-IN IMPLEMENTATION.—The pro- subparagraph (A)(ii) without regard to this 369). grams shall be phased-in— subparagraph. (b) CLARIFYING AMENDMENTS TO CONDI- ‘‘(i) among competitive acquisition areas ‘‘(C) The adjustment factor under this sub- TIONAL PAYMENT PROVISIONS.—Section over a period of not longer than 3 years in a paragraph for an EFFS region for a year is 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further manner so that the competition under the equal to— amended— programs occurs in— ‘‘(i) the number of consecutive years (in (1) in subparagraph (A), in the matter fol- ‘‘(I) at least 1⁄3 of such areas in 2005; and the 5-year period ending with the year in- lowing clause (ii), by inserting the following ‘‘(II) at least 2⁄3 of such areas in 2006; and volved) in which such region was a competi- sentence at the end: ‘‘An entity that engages ‘‘(ii) among items and services in a manner tive EFFS region; divided by in a business, trade, or profession shall be such that the programs apply to the highest ‘‘(ii) 5. deemed to have a self-insured plan if it car- cost and highest volume items and services ‘‘(3) Nothing in this subsection shall be ries its own risk (whether by a failure to ob- first. construed as preventing a reduction under tain insurance, or otherwise) in whole or in ‘‘(C) WAIVER OF CERTAIN PROVISIONS.—In paragraph (1)(A) or paragraph (2)(A) in the part.’’; carrying out the programs, the Secretary premium otherwise applicable under this (2) in subparagraph (B)(ii), as redesignated may waive such provisions of the Federal Ac- part to zero or from requiring the provision by subsection (a)(2)(B)— quisition Regulation as are necessary for the of a rebate to the extent such premium (A) by striking the first sentence and in- efficient implementation of this section, would otherwise be required to be less than serting the following: ‘‘A primary plan, and other than provisions relating to confiden- zero. an entity that receives payment from a pri- tiality of information and such other provi- ‘‘(4) The adjustment in the premium under mary plan, shall reimburse the appropriate sions as the Secretary determines appro- this subsection shall be effected in such man- Trust Fund for any payment made by the priate. ner as the Medicare Benefits Administrator Secretary under this title with respect to an ‘‘(2) ITEMS AND SERVICES DESCRIBED.—The determines appropriate. item or service if it is demonstrated that items and services referred to in paragraph ‘‘(5) In order to carry out this subsection such primary plan has or had a responsi- (1) are the following: (insofar as it is effected through the manner bility to make payment with respect to such ‘‘(A) DURABLE MEDICAL EQUIPMENT AND of collection of premiums under 1840(a)), the item or service. A primary plan’s responsi- MEDICAL SUPPLIES.—Covered items (as de- Medicare Benefits Administrator shall trans- bility for such payment may be dem- fined in section 1834(a)(13)) for which pay- mit to the Commissioner of Social Secu- onstrated by a judgment, a payment condi- ment is otherwise made under section rity— tioned upon the recipient’s compromise, 1834(a), including items used in infusion and ‘‘(A) at the beginning of each year, the waiver, or release (whether or not there is a drugs and supplies used in conjunction with name, social security account number, and determination or admission of liability) of durable medical equipment, but excluding the amount of the adjustment (if any) under payment for items or services included in a class III devices under the Federal Food, this subsection for each individual enrolled claim against the primary plan or the pri- Drug, and Cosmetic Act. under this part for each month during the mary plan’s insured, or by other means.’’; ‘‘(B) OTHER EQUIPMENT AND SUPPLIES.— year; and and Items, equipment, and supplies (as described ‘‘(B) periodically throughout the year, in- (B) in the final sentence, by striking ‘‘on in section 1842(s)(2)(D) other than enteral nu- formation to update the information pre- the date such notice or other information is trients).
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‘‘(C) OFF-THE-SHELF ORTHOTICS.—Orthotics retary shall establish new quality standards ‘‘(1) ESTABLISHMENT.—There is established (described in section 1861(s)(9)) for which for products subject to competitive acquisi- a Program Advisory and Oversight Com- payment is otherwise made under section tion under this section. Such standards shall mittee (hereinafter in this section referred 1834(h) which require minimal self-adjust- be applied prospectively and shall be pub- to as the ‘Committee’). ment for appropriate use and does not re- lished on the website of the Department of ‘‘(2) MEMBERSHIP; TERMS.—The Committee quire expertise in trimming, bending, mold- Health and Human Services. shall consist of such members as the Sec- ing, assembling, or customizing to fit to the ‘‘(ii) CONSULTATION WITH PROGRAM ADVI- retary may appoint who shall serve for such patient. SORY AND OVERSIGHT COMMITTEE.—The Sec- term as the Secretary may specify. ‘‘(3) EXCEPTION AUTHORITY.—In carrying retary shall consult with the Program Advi- ‘‘(3) DUTIES.— out the programs under this section, the Sec- sory and Oversight Committee (established ‘‘(A) TECHNICAL ASSISTANCE.—The Com- retary may exempt— under subsection (c)) to review (and advise mittee shall provide advice and technical as- ‘‘(A) rural areas and areas with low popu- the Secretary concerning) the quality stand- sistance to the Secretary with respect to the lation density within urban areas that are ards referred to in clause (i). following functions: not competitive, unless there is a significant ‘‘(iii) CONSTRUCTION.—Nothing in this sub- ‘‘(i) The implementation of the program national market through mail order for a paragraph shall be construed as delaying the under this section. particular item or service; and effective date of the implementation of the ‘‘(ii) The establishment of requirements for ‘‘(B) items and services for which the appli- competitive acquisition program under this collection of data. cation of competitive acquisition is not like- section. ‘‘(iii) The development of proposals for effi- ly to result in significant savings. ‘‘(3) CONTENTS OF CONTRACT.— cient interaction among manufacturers and ‘‘(4) SPECIAL RULE FOR CERTAIN RENTED ‘‘(A) IN GENERAL.—A contract entered into distributors of the items and services and ITEMS OF DURABLE MEDICAL EQUIPMENT.—In with an entity under the competition con- providers and beneficiaries. the case of a covered item for which payment ducted pursuant to paragraph (1) is subject ‘‘(B) ADDITIONAL DUTIES.—The Committee is made on a rental basis under section to terms and conditions that the Secretary shall perform such additional functions to 1834(a), the Secretary shall establish a proc- may specify. assist the Secretary in carrying out this sec- ess by which rental agreements for the cov- ‘‘(B) TERM OF CONTRACTS.—The Secretary tion as the Secretary may specify. ered items entered into before the applica- shall recompete contracts under this section ‘‘(4) INAPPLICABILITY OF FACA.—The provi- tion of the competitive acquisition program not less often than once every 3 years. sions of the Federal Advisory Committee Act under this section for the item may be con- ‘‘(4) LIMIT ON NUMBER OF CONTRACTORS.— (5 U.S.C. App.) shall not apply. ‘‘(d) ANNUAL REPORTS.—The Secretary tinued notwithstanding this section. In the ‘‘(A) IN GENERAL.—The Secretary may case of any such continuation, the supplier limit the number of contractors in a com- shall submit to Congress an annual manage- involved shall provide for appropriate serv- petitive acquisition area to the number ment report on the programs under this sec- tion. Each such report shall include informa- icing and replacement, as required under sec- needed to meet projected demand for items tion on savings, reductions in beneficiary tion 1834(a). and services covered under the contracts. In cost-sharing, access to and quality of items ‘‘(5) PHYSICIAN AUTHORIZATION.—The Sec- awarding contracts, the Secretary shall take and services, and beneficiary satisfaction. retary may establish a process under which a into account the ability of bidding entities physician may prescribe a particular brand ‘‘(e) DEMONSTRATION PROJECT FOR CLINICAL to furnish items or services in sufficient or mode of delivery of an item or service if LABORATORY SERVICES.— quantities to meet the anticipated needs of the item or service involved is clinically ‘‘(1) IN GENERAL.—The Secretary shall con- beneficiaries for such items or services in more appropriate than other similar items or duct a demonstration project on the applica- the geographic area covered under the con- services. tion of competitive acquisition under this tract on a timely basis. ‘‘(6) APPLICATION.—For each competitive section to clinical diagnostic laboratory ‘‘(B) MULTIPLE WINNERS.—The Secretary acquisition area in which the program is im- tests— shall award contracts to multiple entities plemented under this subsection with respect ‘‘(A) for which payment is otherwise made submitting bids in each area for an item or to items and services, the payment basis de- under section 1833(h) or 1834(d)(1) (relating to service. termined under the competition conducted colorectal cancer screening tests); and AYMENT.—Payment under this part under subsection (b) shall be substituted for ‘‘(5) P ‘‘(B) which are furnished by entities that the payment basis otherwise applied under for competitively priced items and services did not have a face-to-face encounter with section 1834(a). described in subsection (a)(2) shall be based the individual. ‘‘(b) PROGRAM REQUIREMENTS.— on the bids submitted and accepted under ‘‘(2) TERMS AND CONDITIONS.—Such project ‘‘(1) IN GENERAL.—The Secretary shall con- this section for such items and services. shall be under the same conditions as are ap- duct a competition among entities supplying ‘‘(6) PARTICIPATING CONTRACTORS.—Pay- plicable to items and services described in items and services described in subsection ment shall not be made for items and serv- subsection (a)(2). (a)(2) for each competitive acquisition area ices described in subsection (a)(2) furnished ‘‘(3) REPORT.—The Secretary shall submit in which the program is implemented under by a contractor and for which competition is to Congress— subsection (a) with respect to such items and conducted under this section unless— ‘‘(A) an initial report on the project not services. ‘‘(A) the contractor has submitted a bid for later than December 31, 2005; and ‘‘(2) CONDITIONS FOR AWARDING CONTRACT.— such items and services under this section; ‘‘(B) such progress and final reports on the ‘‘(A) IN GENERAL.—The Secretary may not and project after such date as the Secretary de- award a contract to any entity under the ‘‘(B) the Secretary has awarded a contract termines appropriate.’’. competition conducted in an competitive ac- to the contractor for such items and services (b) CONFORMING AMENDMENTS.— quisition area pursuant to paragraph (1) to under this section. (1) DURABLE MEDICAL EQUIPMENT; ELIMI- furnish such items or services unless the In this section, the term ‘bid’ means a re- NATION OF INHERENT REASONABLENESS AU- Secretary finds all of the following: quest for a proposal for an item or service THORITY.—Section 1834(a) (42 U.S.C. 1395m(a)) ‘‘(i) The entity meets quality and financial that includes the cost of the item or service, is amended— standards specified by the Secretary or de- and where appropriate, any services that are (A) in paragraph (1)(B), by striking ‘‘The veloped by the Program Advisory and Over- attendant to the provision of the item or payment basis’’ and inserting ‘‘Subject to sight Committee established under sub- service. subparagraph (E)(i), the payment basis’’; section (c). ‘‘(7) CONSIDERATION IN DETERMINING CAT- (B) in paragraph (1)(C), by striking ‘‘This ‘‘(ii) The total amounts to be paid under EGORIES FOR BIDS.—The Secretary shall con- subsection’’ and inserting ‘‘Subject to sub- the contract (including costs associated with sider the similarity of the clinical efficiency paragraph (E)(ii), this subsection’’; the administration of the contract) are ex- and value of specific codes and products, in- (C) by adding at the end of paragraph (1) pected to be less than the total amounts that cluding products that may provide a thera- the following new subparagraph: would otherwise be paid. peutic advantage to beneficiaries, before de- ‘‘(E) APPLICATION OF COMPETITIVE ACQUISI- ‘‘(iii) Beneficiary access to a choice of mul- lineating the categories and products that TION; ELIMINATION OF INHERENT REASONABLE- tiple suppliers in the area is maintained. will be subject to bidding. NESS AUTHORITY.—In the case of covered ‘‘(iv) Beneficiary liability is limited to 20 ‘‘(8) AUTHORITY TO CONTRACT FOR EDU- items and services that are included in a percent of the applicable contract award CATION, MONITORING, OUTREACH AND COM- competitive acquisition program in a com- price, except in such cases where a supplier PLAINT SERVICES.—The Secretary may enter petitive acquisition area under section has furnished an upgraded item and has exe- into a contract with an appropriate entity to 1847(a)— cuted an advanced beneficiary notice. address complaints from beneficiaries who ‘‘(i) the payment basis under this sub- ‘‘(B) DEVELOPMENT OF QUALITY STANDARDS receive items and services from an entity section for such items and services furnished FOR DME PRODUCTS.— with a contract under this section and to in such area shall be the payment basis de- ‘‘(i) IN GENERAL.—The quality standards conduct appropriate education of and out- termined under such competitive acquisition specified under subparagraph (A)(i) shall not reach to such beneficiaries and monitoring program; and be less than the quality standards that would quality of services with respect to the pro- ‘‘(ii) the Secretary may use information on otherwise apply if this section did not apply gram. the payment determined under such com- and shall include consumer services stand- ‘‘(c) PROGRAM ADVISORY AND OVERSIGHT petitive acquisition programs to adjust the ards. Not later than July 1, 2004, the Sec- COMMITTEE.— payment amount otherwise recognized under
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subparagraph (B)(ii) for an area that is not a ‘‘(iv) EXCEPTION TO BUDGET NEUTRALITY.— (3) TREATMENT OF OTHER SERVICES CUR- competitive acquisition area under section The additional expenditures attributable to RENTLY IN THE NON-PHYSICIAN WORK POOL.— 1847 and in the case of such adjustment, clauses (ii) and (iii) of subparagraph (H) shall The Secretary shall make adjustments to paragraph (10)(B) shall not be applied.’’; and not be taken into account in applying clause the non-physician work pool methodology (D) in paragraph (10)(B), by inserting ‘‘in (ii)(II) for 2005.’’; and (as such term is used in the regulations pro- an area and with respect to covered items (B) by adding at the end the following new mulgated by the Secretary in the Federal and services for which the Secretary does subparagraph: Register as of December 31, 2002) for deter- not make a payment amount adjustment ‘‘(H) ADJUSTMENTS IN PRACTICE EXPENSE mination of practice expense relative value under paragraph (1)(E)’’ after ‘‘under this RELATIVE VALUE UNITS FOR 2005.— units under the physician fee schedule de- subsection’’. ‘‘(i) IN GENERAL.—As part of the annual scribed in section 1848(c)(2)(C)(ii) of the So- (2) OFF-THE-SHELF ORTHOTICS; ELIMINATION process of establishing the physician fee cial Security Act so that the practice ex- OF INHERENT REASONABLENESS AUTHORITY.— schedule under subsection (b) for 2005, the pense relative value units for services deter- Section 1834(h) (42 U.S.C. 1395m(h)) is amend- Secretary shall increase the practice expense mined under such methodology are not af- ed— relative value units for 2005 consistent with fected relative to the practice expense rel- (A) in paragraph (1)(B), by striking ‘‘and clauses (ii) and (iii). ative value units of other services not deter- (E)’’ and inserting ‘‘, (E) , and (H)(i)’’; ‘‘(ii) USE OF SUPPLEMENTAL SURVEY DATA.— mined under such non-physician work pool (B) in paragraph (1)(D), by striking ‘‘This For 2005 for any specialty that submitted methodology, as the result of amendments subsection’’ and inserting ‘‘Subject to sub- survey data that included expenses for the made by paragraph (1). paragraph (H)(ii), this subsection’’; administration of drugs and biologicals for (b) PAYMENT BASED ON COMPETITION.—Title XVIII is amended by inserting after section (C) by adding at the end of paragraph (1) which payment is made under section 1842(o) 1847 (42 U.S.C. 1395w–3), as amended by sec- the following new subparagraph: (or section 1847A), the Secretary shall use tion 302, the following new sections: ‘‘(H) APPLICATION OF COMPETITIVE ACQUISI- such supplemental survey data in carrying TION TO ORTHOTICS; ELIMINATION OF INHERENT out this subparagraph insofar as they are ‘‘COMPETITIVE ACQUISITION OF COVERED REASONABLENESS AUTHORITY.—In the case of collected and provided by entities and orga- OUTPATIENT DRUGS AND BIOLOGICALS orthotics described in paragraph (2)(B) of nizations consistent with the criteria estab- ‘‘SEC. 1847A. (a) IMPLEMENTATION OF COM- section 1847(a) that are included in a com- lished by the Secretary pursuant to section PETITIVE ACQUISITION.— petitive acquisition program in a competi- 212(a) of the Medicare, Medicaid, and SCHIP ‘‘(1) IMPLEMENTATION OF PROGRAM.— tive acquisition area under such section— Balanced Budget Refinement Act of 1999 and ‘‘(A) IN GENERAL.—The Secretary shall es- ‘‘(i) the payment basis under this sub- insofar as such data are submitted to the tablish and implement a competitive acqui- section for such orthotics furnished in such Secretary by December 31, 2004. sition program under which— area shall be the payment basis determined ‘‘(iii) PROVISIONS FOR APPROPRIATE REPORT- ‘‘(i) competitive acquisition areas are es- under such competitive acquisition program; ING AND BILLING FOR PHYSICIANS’ SERVICES AS- tablished throughout the United States for and SOCIATED WITH THE ADMINISTRATION OF COV- contract award purposes for acquisition of ‘‘(ii) the Secretary may use information on ERED OUTPATIENT DRUGS AND BIOLOGICALS.— and payment for categories of covered out- the payment determined under such com- ‘‘(I) EVALUATION OF CODES.—The Secretary patient drugs and biologicals (as defined in petitive acquisition programs to adjust the shall promptly evaluate existing codes for paragraph (2)) under this part; payment amount otherwise recognized under physicians’ services associated with the ad- ‘‘(ii) each physician is given the oppor- subparagraph (B)(ii) for an area that is not a ministration of covered outpatient drugs and tunity annually to elect to obtain drugs and competitive acquisition area under section biologicals (as defined in section biologicals under the program or under sec- 1847, and in the case of such adjustment, 1847A(a)(2)(A)) to ensure accurate reporting tion 1847B; and paragraphs (8) and (9) of section 1842(b) shall and billing for such services. ‘‘(iii) each physician who elects to obtain not be applied.’’. ‘‘(II) USE OF EXISTING PROCESSES.—In car- drugs and biologicals under the program (c) REPORT ON ACTIVITIES OF SUPPLIERS.— rying out subclause (I), the Secretary shall makes an annual selection under paragraph The Secretary shall conduct a study to de- use existing processes for the consideration (5) of the contractor through which drugs termine the extent to which (if any) sup- of coding changes and, to the extent coding and biologicals within a category of drugs pliers of covered items of durable medical changes are made, shall use such processes in and biologicals will be acquired and deliv- equipment that are subject to the competi- establishing relative values for such serv- ered to the physician under this part. tive acquisition program under section 1847 ices. ‘‘(B) IMPLEMENTATION.—The Secretary of the Social Security Act, as amended by ‘‘(III) IMPLEMENTATION.—In carrying out shall implement the program so that the subsection (a), are soliciting physicians to program applies to— prescribe certain brands or modes of delivery subclause (I), the Secretary shall consult with representatives of physician specialties ‘‘(i) the oncology category beginning in of covered items based on profitability. 2005; and (d) GAO STUDY ON SAFE AND EFFECTIVE affected by the implementation of section ‘‘(ii) the non-oncology category beginning HOME INFUSION AND INHALATION THERAPY; 1847A or section 1847B, and shall take such in 2006. STANDARDS.— steps within the Secretary’s authority to ex- (1) STUDY.—The Comptroller General of the pedite such considerations under subclause This section shall not apply in the case of a United States shall conduct a study of the (II). physician who elects section 1847B to apply. standards, professional services, and related ‘‘(iv) SUBSEQUENT, BUDGET NEUTRAL AD- ‘‘(C) WAIVER OF CERTAIN PROVISIONS.—In functions necessary for the provision of safe JUSTMENTS PERMITTED.—Nothing in this sub- order to promote competition, efficient serv- and effective home infusion therapy and paragraph shall be construed as preventing ice, and product quality, in carrying out the home inhalation therapy. the Secretary from providing for adjust- program the Secretary may waive such pro- (2) REPORT.—Not later than May 1, 2004, ments in practice expense relative value visions of the Federal Acquisition Regula- the Comptroller General shall submit to units under (and consistent with) subpara- tion as are necessary for the efficient imple- Congress a report on the study conducted graph (B) for years after 2005. mentation of this section, other than provi- under paragraph (1). ‘‘(v) CONSULTATION.—Before publishing the sions relating to confidentiality of informa- (3) USE OF FINDINGS IN DEVELOPING STAND- notice of proposed rulemaking to carry out tion and such other provisions as the Sec- ARDS.—In promulgating regulations to carry this subparagraph, the Secretary shall con- retary determines appropriate. out section 1847 of the Social Security Act, sult with the Comptroller General of the ‘‘(D) EXCLUSION AUTHORITY.—The Secretary as amended by subsection (a), the Secretary United States and with groups representing may exclude covered outpatient drugs and shall ensure that quality standards devel- the physician specialties involved. biologicals (including a class of such drugs oped under subsection (b)(2)(B) of such sec- ‘‘(vi) TREATMENT AS CHANGE IN LAW AND and biologicals) from the competitive bid- tion reflect the findings of the Comptroller REGULATION IN SUSTAINABLE GROWTH RATE DE- ding system under this section if the drugs General set forth in the report under para- TERMINATION.—The enactment of subpara- or biologicals (or class) are not appropriate graph (2). graph (B)(iv) and this subparagraph shall be for competitive bidding due to low volume of SEC. 303. COMPETITIVE ACQUISITION OF COV- treated as a change in law for purposes of ap- utilization by beneficiaries under this part ERED OUTPATIENT DRUGS AND plying subsection (f)(2)(D).’’. or a unique mode or method of delivery or BIOLOGICALS. (2) PROHIBITION OF ADMINISTRATIVE AND JU- similar reasons. (a) ADJUSTMENT TO PHYSICIAN FEE SCHED- DICIAL REVIEW.—Section 1848(i)(1) (42 U.S.C. ‘‘(2) COVERED OUTPATIENT DRUGS AND ULE.— 1395w–4(i)(1)) is amended— BIOLOGICALS, CATEGORIES, PROGRAM DE- (1) ADJUSTMENT IN PRACTICE EXPENSE REL- (A) by striking ‘‘and’’ at the end of sub- FINED.—For purposes of this section— ATIVE VALUE UNITS.—Section 1848(c)(2) (42 paragraph (D); ‘‘(A) COVERED OUTPATIENT DRUGS AND U.S.C. 1395w–4(c)(2)) is amended— (B) by striking the period at the end of BIOLOGICALS DEFINED.—The term ‘covered (A) in subparagraph (B)— subparagraph (E) and inserting ‘‘, and’’; and outpatient drugs and biologicals’ means (i) in clause (ii)(II), by striking ‘‘The ad- (C) by adding at the end the following new drugs and biologicals to which section 1842(o) justments’’ and inserting ‘‘Subject to clause subparagraph: applies and which are not covered under sec- (iv), the adjustments’’; and ‘‘(F) adjustments in practice expense rel- tion 1847 (relating to competitive acquisition (ii) by adding at the end of subparagraph ative value units for 2005 under subsection for items of durable medical equipment). (B), the following new clause: (c)(2)(H).’’. Such term does not include the following:
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‘‘(i) Blood clotting factors. ‘‘(5) CONTRACTOR SELECTION PROCESS.— program-wide Medicare Provider Ombuds- ‘‘(ii) Drugs and biologicals furnished to in- ‘‘(A) IN GENERAL.—The Secretary shall pro- man to review complaints, see section dividuals in connection with the treatment vide a process for the selection of a con- 1868(b), as added by section 923 of the Medi- of end stage renal disease. tractor, on an annual basis and in such exi- care Prescription Drug and Modernization ‘‘(iii) Radiopharmaceuticals. gent circumstances as the Secretary may Act of 2003. ‘‘(iv) Vaccines. provide and with respect to each category of ‘‘(3) AWARDING MULTIPLE CONTRACTS FOR A ‘‘(B) 2 CATEGORIES.—Each of the following covered outpatient drugs and biologicals for CATEGORY AND AREA.—In order to provide a shall be a separate category of covered out- an area, by physicians prescribing such drugs choice of at least 2 contractors in each com- patient drugs and biologicals, as identified and biologicals in the area of the contractor petitive acquisition area for a category of by the Secretary: under this section that will supply the drugs drugs and biologicals, the Secretary may ‘‘(i) ONCOLOGY CATEGORY.—A category (in and biologicals within that category and limit (but not below 2) the number of quali- this section referred to as the ‘oncology cat- area. Such selection shall also include the fied entities that are awarded such contracts egory’) consisting of those covered out- election described in section 1847B(a). for any category and area. The Secretary patient drugs and biologicals that, as deter- ‘‘(B) INFORMATION ON CONTRACTORS.—The shall select among qualified entities based mined by the Secretary, are typically pri- Secretary shall make available to physicians on the following: marily billed by oncologists or are otherwise on an ongoing basis, through a directory ‘‘(A) The bid prices for covered outpatient used to treat cancer. posted on the Department’s Internet website drugs and biologicals within the category ‘‘(ii) NON-ONCOLOGY CATEGORIES.—Such or otherwise and upon request, a list of the and area. contractors under this section in the dif- numbers of categories (in this section re- ‘‘(B) Bid price for distribution of such ferent competitive acquisition areas. ferred to as the ‘non-oncology categories’) drugs and biologicals. ‘‘(C) SELECTING PHYSICIAN DEFINED.—For consisting of covered outpatient drugs and ‘‘(C) Ability to ensure product integrity. purposes of this section, the term ‘selecting biologicals not described in clause (i), and ‘‘(D) Customer service. physician’ means, with respect to a con- appropriate subcategories of such drugs and ‘‘(E) Past experience in the distribution of tractor and category and competitive acqui- biologicals as the Secretary may specify. drugs and biologicals, including controlled sition area, a physician who has not elected ‘‘(C) PROGRAM.—The term ‘program’ means substances. the competitive acquisition program under section 1847B to apply and has selected to apply under this section such contractor for ‘‘(F) Such other factors as the Secretary this section. may specify. ‘‘(D) COMPETITIVE ACQUISITION AREA; such category and area. ‘‘(b) PROGRAM REQUIREMENTS.— ‘‘(4) TERMS OF CONTRACTS.— AREA.—The terms ‘competitive acquisition ‘‘(1) CONTRACT FOR COVERED OUTPATIENT ‘‘(A) IN GENERAL.—A contract entered into area’ and ‘area’ mean an appropriate geo- DRUGS AND BIOLOGICALS.—The Secretary with an entity under the competition con- graphic region established by the Secretary shall conduct a competition among entities ducted pursuant to paragraph (1) is subject under the program. for the acquisition of a covered outpatient to terms and conditions that the Secretary ‘‘(E) CONTRACTOR.—The term ‘contractor’ drug or biological within each HCPCS code may specify consistent with this section. means an entity that has entered into a con- within each category for each competitive ‘‘(B) PERIOD OF CONTRACTS.—A contract tract with the Secretary under this section. acquisition area. under this section shall be for a term of 2 ‘‘(3) APPLICATION OF PROGRAM PAYMENT ‘‘(2) CONDITIONS FOR AWARDING CONTRACT.— years, but may be terminated by the Sec- METHODOLOGY.—With respect to covered out- ‘‘(A) IN GENERAL.—The Secretary may not retary or the entity with appropriate, ad- patient drugs and biologicals which are sup- award a contract to any entity under the vance notice. plied under the program in an area and competition conducted in a competitive ac- ‘‘(C) INTEGRITY OF DRUG AND BIOLOGICAL which are prescribed by a physician who has quisition area pursuant to paragraph (1) with DISTRIBUTION SYSTEM.—The Secretary— not elected section 1847B to apply— respect to the acquisition of covered out- ‘‘(i) shall require that for all drug and bio- ‘‘(A) the claim for such drugs and patient drugs and biologicals within a cat- logical products distributed by a contractor biologicals shall be submitted by the con- egory unless the Secretary finds that the en- under this section be acquired directly from tractor that supplied the drugs and tity meets all of the following with respect the manufacturer or from a distributor that biologicals; to the contract period involved: has acquired the products directly from the ‘‘(B) collection of amounts of any deduct- ‘‘(i) CAPACITY TO SUPPLY COVERED OUT- manufacturer; and ible and coinsurance applicable with respect PATIENT DRUG OR BIOLOGICAL WITHIN CAT- ‘‘(ii) may require, in the case of such prod- to such drugs and biologicals shall be the re- EGORY.— ucts that are particularly susceptible to sponsibility of such contractor and shall not ‘‘(I) IN GENERAL.—The entity has sufficient counterfeit or diversion, that the contractor be collected unless the drug or biological is arrangements to acquire and to deliver cov- comply with such additional product integ- administered to the beneficiary involved; ered outpatient drugs and biologicals within rity safeguards as may be determined to be and such category in the area specified in the necessary. ‘‘(C) the payment under this section (and contract at the bid price specified in the con- ‘‘(D) IMPLEMENTATION OF ANTI-COUNTER- related coinsurance amounts) for such drugs tract for all physicians that may elect such FEITING, QUALITY, SAFETY, AND RECORD KEEP- and biologicals— entity. ING REQUIREMENTS.—The Secretary shall re- ‘‘(i) shall be made only to such contractor; ‘‘(II) SHIPMENT METHODOLOGY.—The entity quire each contractor to implement (through ‘‘(ii) shall be conditioned upon the admin- has arrangements in effect for the shipment its officers, agents, representatives, and em- istration of such drugs and biologicals; and at least 5 days each week of covered out- ployees) requirements relating to the storage ‘‘(iii) shall be based on the average of the patient drugs and biologicals under the con- and handling of covered outpatient drugs and bid prices for such drugs and biologicals in tract and for the timely delivery (including biologicals and for the establishment and the area, as computed under subsection (d). for emergency situations) of such drugs and maintenance of distribution records for such The Secretary shall provide a process for biologicals in the area under the contract. drugs and biologicals. A contract under this recoupment in the case in which payment is ‘‘(ii) QUALITY, SERVICE, FINANCIAL PERFORM- section may include requirements relating made for drugs and biologicals which were ANCE AND SOLVENCY STANDARDS.—The entity to the following: billed at the time of dispensing but which meets quality, service, financial perform- ‘‘(i) Secure facilities. were not actually administered. ance, and solvency standards specified by the ‘‘(ii) Safe and appropriate storage of drugs ‘‘(4) CONTRACT REQUIRED.— Secretary, including— and biologicals. ‘‘(A) IN GENERAL.—Payment may not be ‘‘(I) the establishment of procedures for ‘‘(iii) Examination of drugs and biologicals made under this part for covered outpatient the prompt response and resolution of physi- received and dispensed. drugs and biologicals prescribed by a physi- cian and beneficiary complaints and inquir- ‘‘(iv) Disposition of damaged and outdated cian who has not elected section 1847B to ies regarding the shipment of covered out- drugs and biologicals. apply within a category and a competitive patient drugs and biologicals; and ‘‘(v) Record keeping and written policies acquisition area with respect to which the ‘‘(II) a grievance process for the resolution and procedures. program applies unless— of disputes. ‘‘(vi) Compliance personnel. ‘‘(i) the drugs or biologicals are supplied by ‘‘(B) ADDITIONAL CONSIDERATIONS.—The ‘‘(E) COMPLIANCE WITH CODE OF CONDUCT a contractor with a contract under this sec- Secretary may refuse to award a contract AND FRAUD AND ABUSE RULES.—Under the tion for such category of drugs and under this section, and may terminate such contract— biologicals and area; and a contract, with an entity based upon— ‘‘(i) the contractor shall comply with a ‘‘(ii) the physician has elected such con- ‘‘(i) the suspension or revocation, by the code of conduct, specified or recognized by tractor under paragraph (5) for such category Federal Government or a State government, the Secretary, that includes standards relat- and area. of the entity’s license for the distribution of ing to conflicts of interest; and ‘‘(B) PHYSICIAN CHOICE.—Subparagraph (A) drugs or biologicals (including controlled ‘‘(ii) the contractor shall comply with all shall not apply for a category of drugs for an substances); or applicable provisions relating to prevention area if the physician prescribing the covered ‘‘(ii) the exclusion of the entity under sec- of fraud and abuse, including compliance outpatient drug in such category and area tion 1128 from participation under this title. with applicable guidelines of the Department has elected to apply section 1847B instead of ‘‘(C) APPLICATION OF MEDICARE PROVIDER of Justice and the Inspector General of the this section. OMBUDSMAN.—For provision providing for a Department of Health and Human Services.
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‘‘(F) DIRECT DELIVERY OF DRUGS AND under such section, except that any ref- such drugs and biologicals (or class) using BIOLOGICALS TO PHYSICIANS.—Under the con- erence— the payment methodology under section tract the contractor shall only supply cov- ‘‘(A) in that subparagraph to a ‘manufac- 1847B. ered outpatient drugs and biologicals di- turer or wholesaler’ is deemed a reference to ‘‘(3) COORDINATION RULES.—The provisions rectly to the selecting physicians and not di- a ‘bidder’ under this section; of section 1842(h)(3) shall apply to a con- rectly to beneficiaries, except under cir- ‘‘(B) in that section to ‘prices charged for tractor with respect to covered outpatients cumstances and settings where a beneficiary drugs’ is deemed a reference to a ‘bid’ sub- drugs and biologicals supplied by that con- currently receives a drug or biological in the mitted under this section; and tractor in the same manner as they apply to beneficiary’s home or other non-physician ‘‘(C) in clause (i) of that section to ‘this a participating supplier. In order to admin- office setting as the Secretary may provide. section’, is deemed a reference to ‘part B of ister this section, the Secretary may condi- The contractor shall not deliver drugs and title XVIII’. tion payment under this part to a person for biologicals to a selecting physician except ‘‘(7) INCLUSION OF COSTS.—The bid price the administration of a drug or biological upon receipt of a prescription for such drugs submitted in a contract offer for a covered supplied under this section upon person’s and biologicals, and such necessary data as outpatient drug or biological shall— provision of information on such administra- may be required by the Secretary to carry ‘‘(A) include all costs related to the deliv- tion. out this section. This section does not— ery of the drug or biological to the selecting ‘‘(4) APPLICATION OF REQUIREMENT FOR AS- ‘‘(i) require a physician to submit a pre- physician (or other point of delivery); and SIGNMENT.—For provision requiring assign- scription for each individual treatment; or ‘‘(B) include the costs of dispensing (in- ment of claims for covered outpatient drugs ‘‘(ii) change a physician’s flexibility in cluding shipping) of such drug or biological and biologicals, see section 1842(o)(3). terms of writing a prescription for drugs for and management fees, but shall not include ‘‘(5) PROTECTION FOR BENEFICIARY IN CASE a single treatment or a course of treatment. any costs related to the administration of OF MEDICAL NECESSITY DENIAL.—For protec- ‘‘(5) PERMITTING ACCESS TO DRUGS AND the drug or biological, or wastage, spillage, tion of beneficiaries against liability in the BIOLOGICALS.—The Secretary shall establish or spoilage. case of medical necessity determinations, rules under this section under which drugs ‘‘(8) PRICE ADJUSTMENTS DURING CONTRACT see section 1842(b)(3)(B)(ii)(III). and biologicals which are acquired through a PERIOD; DISCLOSURE OF COSTS.—Each contract ‘‘(6) PHYSICIAN ROLE IN APPEALS PROCESS.— contractor under this section may be used to awarded shall provide for— The Secretary shall establish a procedure resupply inventories of such drugs and ‘‘(A) disclosure to the Secretary the con- under which a physician who prescribes a biologicals which are administered con- tractor’s reasonable, net acquisition costs drug or biological for which payment is made sistent with safe drug practices and with for periods specified by the Secretary, not under this section has appeal rights that are adequate safeguards against fraud and abuse. more often than quarterly, of the contract; similar to those provided to a physician who The previous sentence shall apply if the phy- and prescribes durable medical equipment or a sicians can demonstrate to the Secretary all ‘‘(B) appropriate price adjustments over laboratory test. of the following: the period of the contract to reflect signifi- ‘‘(g) ADVISORY COMMITTEE.—The Secretary ‘‘(A) The drugs or biologicals are required cant increases or decreases in a contractor’s shall establish an advisory committee that immediately. reasonable, net acquisition costs, as so dis- includes representatives of parties affected ‘‘(B) The physician could not have reason- closed. by the program under this section, including ably anticipated the immediate requirement ‘‘(d) COMPUTATION OF AVERAGE BID PRICES physicians, specialty pharmacies, distribu- for the drugs or biologicals. FOR A CATEGORY AND AREA.— tors, manufacturers, and beneficiaries. The ‘‘(C) The contractor could not deliver to ‘‘(1) IN GENERAL.—For each year or other committee shall advise the Secretary on the physician the drugs or biologicals in a contract period for each covered outpatient issues relating to the effective implementa- timely manner. drug or biological and area with respect to tion of this section. ‘‘(D) The drugs or biologicals were admin- which a competition is conducted under the ‘‘(h) ANNUAL REPORTS.—The Secretary istered in an emergency situation. program, the Secretary shall compute an shall submit to Congress an annual report in ‘‘(6) CONSTRUCTION.—Nothing in this sec- area average of the bid prices submitted, in each of 2005, 2006, and 2007, on the program. tion shall be construed as waiving applicable contract offers accepted for the category and Each such report shall include information State requirements relating to licensing of area, for that year or other contract period. on savings, reductions in cost-sharing, access pharmacies. ‘‘(2) SPECIAL RULES.—The Secretary shall to covered outpatient drugs and biologicals, ‘‘(c) BIDDING PROCESS.— establish rules regarding the use under this the range of choices of contractors available ‘‘(1) IN GENERAL.—In awarding a contract section of the alternative payment amount to providers, and beneficiary and provider for a category of drugs and biologicals in an provided under section 1847B to the use of a satisfaction. area under the program, the Secretary shall price for specific covered outpatient drugs ‘‘OPTIONAL USE OF AVERAGE SALES PRICE consider with respect to each entity seeking and biologicals in the following cases: PAYMENT METHODOLOGY to be awarded a contract the prices bid to ac- ‘‘(A) NEW DRUGS AND BIOLOGICALS.—A cov- ‘‘SEC. 1847B. (a) IN GENERAL.— quire and supply the covered outpatient ered outpatient drug or biological for which ‘‘(1) ELECTION.—In connection with the an- drugs and biologicals for that category and an average bid price has not been previously nual election made by a physician under sec- area and the other factors referred to in sub- determined. tion 1847A(a)(5), the physician may elect to section (b)(3). ‘‘(B) OTHER CASES.—Such other exceptional apply this section to the payment for cov- ‘‘(2) PRICES BID.—The prices bid by an enti- cases as the Secretary may specify in regula- ered outpatient drugs and biologicals instead ty under paragraph (1) shall be the prices in tions, such as oral drugs under section of the payment methodology under section effect and available for the supply of con- 1861(s)(2)(Q) and immmunosuppressives under 1847A. tracted drugs and biologicals in the area section 1861(s)(2)(J). ‘‘(2) IMPLEMENTATION.—This section shall through the entity for the contract period. ‘‘(e) COINSURANCE.— be implemented with respect to categories of ‘‘(3) REJECTION OF CONTRACT OFFER.—The ‘‘(1) IN GENERAL.—Coinsurance under this covered outpatient drugs and biologicals de- Secretary shall reject the contract offer of part with respect to a covered outpatient scribed in section 1847A(a)(2)(B). an entity with respect to a category of drugs drug or biological for which payment is pay- ‘‘(3) COVERED OUTPATIENT DRUGS AND and biologicals for an area if the Secretary able under this section shall be based on 20 BIOLOGICALS DEFINED.—For purposes of this estimates that the prices bid, in the aggre- percent of the payment basis under this sec- section, the term ‘covered outpatient drugs gate on average, would exceed 100 percent of tion. and biologicals’ has the meaning given such the average sales price (as determined under ‘‘(2) COLLECTION.—Such coinsurance shall term in section 1847A(a)(2)(A). section 1847B). be collected by the contractor that supplies ‘‘(b) COMPUTATION OF PAYMENT AMOUNT.— ‘‘(4) BIDDING ON A NATIONAL OR REGIONAL the drug or biological involved and, subject ‘‘(1) IN GENERAL.—If this section applies BASIS.—Nothing in this section shall be con- to subsection (a)(3)(B), in the same manner with respect to a covered outpatient drug or strued as precluding a bidder from bidding as coinsurance is collected for durable med- biological, the amount payable for the drug for contracts in all areas of the United ical equipment under this part. or biological (based on a minimum dosage States or as requiring a bidder to submit a ‘‘(f) SPECIAL PAYMENT RULES.— unit) is, subject to applicable deductible and bid for all areas of the United States. ‘‘(1) IN GENERAL.—The Secretary may not coinsurance— ‘‘(5) UNIFORMITY OF BIDS WITHIN AREA.—The provide for an adjustment to reimbursement ‘‘(A) in the case of a multiple source drug amount of the bid submitted under a con- for covered outpatient drugs and biologicals (as defined in subsection (c)(6)(C)), 100 per- tract offer for any covered outpatient drug unless adjustments to the practice expense cent (or in the case of covered outpatient or biological for an area shall be the same payment adjustment are made on the basis drugs and biologicals furnished during 2005 for that drug or biological for all portions of of supplemental surveys under section and 2006, 112 percent) of the amount deter- that area. 1848(c)(2)(H)(ii) of the Social Security Act, as mined under paragraph (3); or ‘‘(6) CONFIDENTIALITY OF BIDS.—The provi- added by subsection (a)(1)(B). ‘‘(B) in the case of a single source drug (as sions of subparagraph (D) of section 1927(b)(3) ‘‘(2) USE IN EXCLUSION CASES.—If the Sec- defined in subsection (c)(6)(D)), 100 percent shall apply to a bid submitted in a contract retary excludes a drug or biological (or class (or in the case of covered outpatient drugs offer for a covered outpatient drug or bio- of drugs or biologicals) under subsection and biologicals furnished during 2005 and logical under this section in the same man- (a)(1)(D), the Secretary may provide for re- 2006, 112 percent) of the amount determined ner as it applies to information disclosed imbursement to be made under this part for under paragraph (4).
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‘‘(2) SPECIFICATION OF UNIT.— discounts, prompt pay discounts, cash dis- ‘‘(iii) are sold or marketed in the United ‘‘(A) SPECIFICATION BY MANUFACTURER.— counts, the free goods that are contingent on States during the quarter. The manufacturer of a covered outpatient any purchase requirement, chargebacks, and ‘‘(D) SINGLE SOURCE DRUG.—The term ‘sin- drug shall specify the unit associated with rebates (other than rebates under section gle source drug’ means a covered outpatient each National Drug Code as part of the sub- 1927), that result in a reduction of the cost to drug which is not a multiple source drug and mission of data under section the purchaser. A rebate to a payor or other which is produced or distributed under an 1927(b)(3)(A)(iii). entity that does not take title to a covered original new drug application approved by ‘‘(B) UNIT DEFINED.—In this section, the outpatient drug shall not be taken into ac- the Food and Drug Administration, includ- term ‘unit’ means, with respect to a covered count in determining such price unless the ing a drug product marketed by any cross-li- outpatient drug, the lowest identifiable manufacturer has an agreement with the censed producers or distributors operating quantity (such as a capsule or tablet, milli- payor or other entity under which the pur- under the new drug application, or which is gram of molecules, or grams) of the drug chaser’s price for the drug is reduced as a a biological. that is dispensed, exclusive of any diluent consequence of such rebate. ‘‘(E) EXCEPTION FROM PHARMACEUTICAL without reference to volume measures per- ‘‘(4) AUTHORITY TO DISREGARD AVERAGE EQUIVALENCE AND BIOEQUIVALENCE REQUIRE- taining to liquids. SALES PRICE DURING FIRST QUARTER OF MENT.—Subparagraph (C)(ii) shall not apply ‘‘(3) MULTIPLE SOURCE DRUG.—For all drug SALES.—In the case of a covered outpatient if the Food and Drug Administration products included within the same multiple drug during an initial period (not to exceed changes by regulation the requirement that, source drug, the amount specified in this a full calendar quarter) in which data on the for purposes of the publication described in paragraph is the volume-weighted average of prices for sales for the drug is not suffi- subparagraph (C)(i), in order for drug prod- the average sales prices reported under sec- ciently available from the manufacturer to ucts to be rated as therapeutically equiva- tion 1927(b)(3)(A)(iii) computed as follows: compute an average sales price for the drug, lent, they must be pharmaceutically equiva- ‘‘(A) Compute the sum of the products (for the Secretary may determine the amount lent and bioequivalent, as defined in sub- each national drug code assigned to such payable under this section for the drug with- paragraph (F). drug products) of— out considering the manufacturer’s average ‘‘(F) DETERMINATION OF PHARMACEUTICAL ‘‘(i) the manufacturer’s average sales price sales price of that manufacturer for that EQUIVALENCE AND BIOEQUIVALENCE.—For pur- (as defined in subsection (c)); and drug. poses of this paragraph— ‘‘(ii) the total number of units specified ‘‘(i) drug products are pharmaceutically under paragraph (2) sold, as reported under ‘‘(5) FREQUENCY OF DETERMINATIONS.— ‘‘(A) IN GENERAL ON A QUARTERLY BASIS.— equivalent if the products contain identical section 1927(b)(3)(A)(iii). amounts of the same active drug ingredient ‘‘(B) Divide the sum computed under sub- The manufacturer’s average sales price, for a covered outpatient drug of a manufacturer, in the same dosage form and meet paragraph (A) by the sum of the total num- compendial or other applicable standards of ber of units under subparagraph (A)(ii) for all shall be determined by such manufacturer under this subsection on a quarterly basis. In strength, quality, purity, and identity; and national drug codes assigned to such drug ‘‘(ii) drugs are bioequivalent if they do not products. making such determination insofar as there is a lag in the reporting of the information present a known or potential bioequivalence ‘‘(4) SINGLE SOURCE DRUG.—The amount problem, or, if they do present such a prob- specified in this paragraph for a single on rebates and chargebacks under paragraph lem, they are shown to meet an appropriate source drug is the lesser of the following: (3) so that adequate data are not available on standard of bioequivalence. ‘‘(A) MANUFACTURER’S AVERAGE SALES a timely basis, the manufacturer shall apply ‘‘(G) INCLUSION OF VACCINES.—In applying PRICE.—The manufacturer’s average sales a methodology established by the Secretary provisions of section 1927 under this section, price for a national drug code, as computed based on a 12-month rolling average for the ‘other than a vaccine’ is deemed deleted using the methodology applied under para- manufacturer to estimate costs attributable from section 1927(k)(2)(B). graph (3). to rebates and chargebacks. ‘‘(B) WHOLESALE ACQUISITION COST (WAC).— ‘‘(B) UPDATES IN RATES.—The payment ‘‘(d) AUTHORITY TO USE ALTERNATIVE PAY- The wholesale acquisition cost (as defined in rates under subsection (b)(1) and (b)(2)(A) MENT IN RESPONSE TO PUBLIC HEALTH EMER- subsection (c)(6)(B)) reported for the single shall be updated by the Secretary on a quar- GENCY.—In the case of a public health emer- source drug. terly basis and shall be applied based upon gency under section 319 of the Public Health ‘‘(5) BASIS FOR DETERMINATION.—The pay- the manufacturer’s average sales price deter- Service Act in which there is a documented ment amount shall be determined under this mined for the most recent calendar quarter. inability to access covered outpatient drugs subsection based on information reported ‘‘(C) USE OF CONTRACTORS; IMPLEMENTA- and biologicals, and a concomitant increase under subsection (e) and without regard to TION.—The Secretary may use a carrier, fis- in the price, of a drug or biological which is any special packaging, labeling, or identi- cal intermediary, or other contractor to de- not reflected in the manufacturer’s average fiers on the dosage form or product or pack- termine the payment amount under sub- sales price for one or more quarters, the Sec- age. section (b). Notwithstanding any other pro- retary may use the wholesale acquisition ‘‘(c) MANUFACTURER’S AVERAGE SALES vision of law, the Secretary may implement, cost (or other reasonable measure of drug PRICE.— by program memorandum or otherwise, any price) instead of the manufacturer’s average ‘‘(1) IN GENERAL.—For purposes of this sub- of the provisions of this section. sales price for such quarters and for subse- section, subject to paragraphs (2) and (3), the ‘‘(6) DEFINITIONS AND OTHER RULES.—In this quent quarters until the price and avail- manufacturer’s ‘average sales price’ means, section: ability of the drug or biological has sta- of a covered outpatient drug for a NDC code ‘‘(A) MANUFACTURER.—The term ‘manufac- bilized and is substantially reflected in the for a calendar quarter for a manufacturer for turer’ means, with respect to a covered out- applicable manufacturer’s average sales a unit— patient drug, the manufacturer (as defined in price. ‘‘(A) the manufacturer’s total sales (as de- section 1927(k)(5)) whose national drug code ‘‘(e) REPORTS.— fined by the Secretary in regulations for pur- appears on such drug. ‘‘(1) QUARTERLY REPORT ON AVERAGE SALES poses of section 1927(c)(1)) in the United ‘‘(B) WHOLESALE ACQUISITION COST.—The PRICE.—For requirements for reporting the States for such drug in the calendar quarter; term ‘wholesale acquisition cost’ means, manufacturer’s average sales price (and, if divided by with respect to a covered outpatient drug, required to make payment, the manufactur- ‘‘(B) the total number of such units of such the manufacturer’s list price for the drug to er’s wholesale acquisition cost) for the cov- drug sold by the manufacturer in such quar- wholesalers or direct purchasers in the ered outpatient drug or biological, see sec- ter. United States, not including prompt pay or tion 1927(b)(3). ‘‘(2) CERTAIN SALES EXEMPTED FROM COM- other discounts, rebates or reductions in ‘‘(2) ANNUAL REPORT TO CONGRESS.—The PUTATION.—In calculating the manufactur- price, for the most recent month for which Secretary shall submit to the Committees on er’s average sales price under this sub- the information is available, as reported in Energy and Commerce and Ways and Means section, the following sales shall be ex- wholesale price guides or other publications of the House of Representatives and the cluded: of drug pricing data. Committee on Finance of the Senate an an- ‘‘(A) SALES EXEMPT FROM BEST PRICE.— ‘‘(C) MULTIPLE SOURCE DRUG.—The term nual report on the operation of this section. Sales exempt from the inclusion in the de- ‘multiple source drug’ means, for a calendar Such report shall include information on the termination of ‘best price’ under section quarter, a covered outpatient drug for which following: 1927(c)(1)(C)(i). there are 2 or more drug products which— ‘‘(A) Trends in average sales price under ‘‘(B) SALES AT NOMINAL CHARGE.—Such ‘‘(i) are rated as therapeutically equivalent subsection (b). other sales as the Secretary identifies by (under the Food and Drug Administration’s ‘‘(B) Administrative costs associated with regulation as sales to an entity that are most recent publication of ‘Approved Drug compliance with this section. nominal in price or do not reflect a market Products with Therapeutic Equivalence ‘‘(C) Total value of payments made under price paid by an entity to which payment is Evaluations’), this section. made under this section. ‘‘(ii) except as provided in subparagraph ‘‘(D) Comparison of the average manufac- ‘‘(3) SALE PRICE NET OF DISCOUNTS.—In cal- (E), are pharmaceutically equivalent and turer price as applied under section 1927 for culating the manufacturer’s average sales bioequivalent, as determined under subpara- a covered outpatient drug or biological with price under this subsection, such price shall graph (F) and as determined by the Food and the manufacturer’s average sales price for be determined taking into account volume Drug Administration, and the drug or biological under this section.
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‘‘(f) RESTRICTION ON ADMINISTRATIVE AND part B of title XVIII of the Social Security (d) QUALIFICATIONS OF CONTRACTORS.— JUDICIAL REVIEW.—There shall be no adminis- Act; and (1) IN GENERAL.—The Secretary shall enter trative or judicial review under section 1869, (B) the site of delivery of such services. into a recovery audit contract under this section 1878, or otherwise, of determinations (2) REPORT.—Not later than 2 years after section with an entity only if the entity has of manufacturer’s average sales price under the year in which the amendment made by staff that has the appropriate clinical knowl- subsection (c).’’. subsection (a)(1) first takes effect, the Comp- edge of and experience with the payment (c) CONTINUATION OF PAYMENT METHOD- troller General shall submit to Congress a rules and regulations under the medicare OLOGY FOR RADIOPHARMACEUTICALS.—Nothing report on the study conducted under para- program or the entity has or will contract in the amendments made by this section graph (1). with another entity that has such knowl- shall be construed as changing the payment (f) MEDPAC RECOMMENDATIONS ON BLOOD edgeable and experienced staff. methodology under part B of title XVIII of CLOTTING FACTORS.—The Medicare Payment (2) INELIGIBILITY OF CERTAIN CONTRAC- the Social Security Act for radiopharma- Advisory Commission shall submit to Con- TORS.—The Secretary may not enter into a ceuticals, including the use by carriers of in- gress, in its annual report in 2004, specific recovery audit contract under this section voice pricing methodology. recommendations regarding a payment with an entity to the extent that the entity (d) CONFORMING AMENDMENTS.— amount (or amounts) for blood clotting fac- is a fiscal intermediary under section 1816 of (1) IN GENERAL.—Section 1842(o) (42 U.S.C. tors and its administration under the medi- the Social Security Act (42 U.S.C. 1395h), a 1395u(o)) is amended— care program. carrier under section 1842 of such Act (42 (g) ESTABLISHMENT OF PHARMACEUTICAL (A) in paragraph (1), by inserting ‘‘, subject U.S.C. 1395u), or a Medicare Administrative MANAGEMENT FEE WHERE DRUGS PROVIDED to section 1847A and 1847B,’’ before ‘‘the Contractor under section 1874A of such Act. THROUGH A CONTRACTOR.—Section 1848(a) (42 amount payable for the drug or biological’’; (3) PREFERENCE FOR ENTITIES WITH DEM- U.S.C. 1395w–4(a)) is amended by adding at and the end the following new paragraph: ONSTRATED PROFICIENCY.—In awarding con- (B) by adding at the end of paragraph (2) tracts to recovery audit contractors under ‘‘(5) RECOGNITION OF PHARMACEUTICAL MAN- the following: ‘‘This paragraph shall not this section, the Secretary shall give pref- AGEMENT FEE IN CERTAIN CASES.—In estab- apply in the case of payment under section lishing the fee schedule under this section, erence to those risk entities that the Sec- 1847A or 1847B.’’. the Secretary shall provide for a separate retary determines have demonstrated more (2) NO CHANGE IN COVERAGE BASIS.—Section payment with respect to physicians’ services than 3 years direct management experience 1861(s)(2)(A) (42 U.S.C. 1395x(s)(2)(A)) is consisting of the unique administrative and and a proficiency for cost control or recovery amended by inserting ‘‘(or would have been management costs associated with covered audits with private insurers, health care pro- so included but for the application of section drugs and biologicals which are furnished to viders, health plans, or under the medicaid 1847A or 1847B)’’ after ‘‘included in the physi- physicians through a contractor under sec- program under title XIX of the Social Secu- cians’ bills’’. tion 1847A (compared with such costs if such rity Act. (3) PAYMENT.—Section 1833(a)(1)(S) (42 drugs and biologicals were acquired directly (e) CONSTRUCTION RELATING TO CONDUCT OF U.S.C. 1395l(a)(1)(S)) is amended by inserting by such physicians).’’. INVESTIGATION OF FRAUD.—A recovery of an ‘‘(or, if applicable, under section 1847A or (h) STUDY ON CODES FOR NON-ONCOLOGY overpayment to a provider by a recovery 1847B)’’ after ‘‘1842(o)’’. CODES.— audit contractor shall not be construed to (4) CONSOLIDATED REPORTING OF PRICING IN- (1) STUDY.—The Secretary shall conduct a prohibit the Secretary or the Attorney Gen- FORMATION.—Section 1927 (42 U.S.C. 1396r–8) study to determine the appropriateness of es- eral from investigating and prosecuting, if is amended— tablishing and implementing separate codes appropriate, allegations of fraud or abuse (A) in subsection (a)(1), by inserting ‘‘or for non-oncology infusions that are based on arising from such overpayment. under part B of title XVIII’’ after ‘‘section the level of complexity of the administration (f) REPORT.—The Secretary of Health and 1903(a)’’; and resource consumption. Human Services shall submit to Congress a report on the project not later than 6 months (B) in subsection (b)(3)(A)— (2) REPORT.—Not later than 1 year after (i) in clause (i), by striking ‘‘and’’ at the the date of the enactment of this Act, the after the date of its completion. Such reports end; Secretary shall submit a report to Congress shall include information on the impact of (ii) in clause (ii), by striking the period and on the study. To the extent the Secretary de- the project on savings to the medicare pro- inserting ‘‘; and’’; and termines it to be appropriate, the Secretary gram and recommendations on the cost-ef- (iii) by adding at the end the following new may implement appropriate changes in the fectiveness of extending or expanding the clause: payment methodology for such codes. project. ‘‘(iii) for calendar quarters beginning on or SEC. 304. DEMONSTRATION PROJECT FOR USE OF TITLE IV—RURAL HEALTH CARE after April 1, 2004, in conjunction with re- RECOVERY AUDIT CONTRACTORS. IMPROVEMENTS porting required under clause (i) and by na- (a) IN GENERAL.—The Secretary of Health SEC. 401. ENHANCED DISPROPORTIONATE SHARE tional drug code (NDC)— and Human Services shall conduct a dem- HOSPITAL (DSH) TREATMENT FOR ‘‘(I) the manufacturer’s average sales price onstration project under this section (in this RURAL HOSPITALS AND URBAN HOS- (as defined in section 1847B(c)) and the total section referred to as the ‘‘project’’) to dem- PITALS WITH FEWER THAN 100 BEDS. (a) DOUBLING THE CAP.— number of units specified under section onstrate the use of recovery audit contrac- (1) IN GENERAL.—Section 1886(d)(5)(F) (42 1847B(b)(2)(A); tors under the Medicare Integrity Program U.S.C. 1395ww(d)(5)(F)) is amended by adding ‘‘(II) if required to make payment under in identifying underpayments and overpay- at the end the following new clause: section 1847B, the manufacturer’s wholesale ments and recouping overpayments under ‘‘(xiv)(I) In the case of discharges in a fis- acquisition cost, as defined in subsection the medicare program for services for which cal year beginning on or after October 1, (c)(6) of such section; and payment is made under part A or part B of 2003, subject to subclause (II), there shall be ‘‘(III) information on those sales that were title XVIII of the Social Security Act. Under substituted for the disproportionate share made at a nominal price or otherwise de- the project— adjustment percentage otherwise determined scribed in section 1847B(c)(2)(B), which infor- (1) payment may be made to such a con- under clause (iv) (other than subclause (I)) or mation is subject to audit by the Inspector tractor on a contingent basis; under clause (viii), (x), (xi), (xii), or (xiii), General of the Department of Health and (2) a percentage of the amount recovered the disproportionate share adjustment per- Human Services; may be retained by the Secretary and shall be available to the program management ac- centage determined under clause (vii) (relat- for a covered outpatient drug or biological count of the Centers for Medicare & Med- ing to large, urban hospitals). for which payment is made under section icaid Services; and ‘‘(II) Under subclause (I), the dispropor- 1847B.’’; (3) the Secretary shall examine the effi- tionate share adjustment percentage shall (C) in subsection (b)(3)(B)— cacy of such use with respect to duplicative not exceed 10 percent for a hospital that is (i) in the heading, by inserting ‘‘AND MANU- payments, accuracy of coding, and other not classified as a rural referral center under FACTURER’S AVERAGE SALES PRICE’’ after payment policies in which inaccurate pay- subparagraph (C).’’. ‘‘PRICE’’; and ments arise. (2) CONFORMING AMENDMENTS.—Section (ii) by inserting ‘‘and manufacturer’s aver- (b) SCOPE AND DURATION.— 1886(d)(5)(F) (42 U.S.C. 1395ww(d)(5)(F)) is age sales prices (including wholesale acquisi- (1) SCOPE.—The project shall cover at least amended— tion cost) if required to make payment’’ 2 States that are among the States with— (A) in each of subclauses (II), (III), (IV), after ‘‘manufacturer prices’’; and (A) the highest per capita utilization rates (V), and (VI) of clause (iv), by inserting ‘‘sub- (D) in subsection (b)(3)(D)(i), by inserting of medicare services, and ject to clause (xiv) and’’ before ‘‘for dis- ‘‘and section 1847B’’ after ‘‘this section’’. (B) at least 3 contractors. charges occurring’’; (e) GAO STUDY.— (2) DURATION.—The project shall last for (B) in clause (viii), by striking ‘‘The for- (1) STUDY.—The Comptroller General of the not longer than 3 years. mula’’ and inserting ‘‘Subject to clause (xiv), United States shall conduct a study to assess (c) WAIVER.—The Secretary of Health and the formula’’; and the impact of the amendments made by this Human Services shall waive such provisions (C) in each of clauses (x), (xi), (xii), and section on the delivery of services, including of title XVIII of the Social Security Act as (xiii), by striking ‘‘For purposes’’ and insert- their impact on— may be necessary to provide for payment for ing ‘‘Subject to clause (xiv), for purposes’’. (A) beneficiary access to drugs and services under the project in accordance with (b) EFFECTIVE DATE.—The amendments biologicals for which payment is made under subsection (a). made by this section shall apply with respect
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00100 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.060 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6041
to discharges occurring on or after October 1, ‘‘(i) HIGH PROPORTION OF MEDICARE BENE- (2) HOSPITAL OUTPATIENT SERVICES.—Sec- 2003. FICIARIES RECEIVING CARE FROM HOSPITAL.—(I) tion 1833(t)(13) (42 U.S.C. 1395l(t)(13)) is SEC. 402. IMMEDIATE ESTABLISHMENT OF UNI- A high percentage of such beneficiaries re- amended by adding at the end the following FORM STANDARDIZED AMOUNT IN siding in the area of the hospital who are new subparagraph: RURAL AND SMALL URBAN AREAS. hospitalized (during the most recent year for ‘‘(B) SPECIAL RULE FOR ESSENTIAL RURAL (a) IN GENERAL.—Section 1886(d)(3)(A) (42 which complete data are available) receive HOSPITALS.—In the case of a hospital classi- U.S.C. 1395ww(d)(3)(A)) is amended— basic inpatient medical care at the hospital. fied as an essential rural hospital under sec- (1) in clause (iv), by inserting ‘‘and ending ‘‘(II) For a hospital with more than 200 li- tion 1861(mm)(4) for a cost reporting period, on or before September 30, 2003,’’ after ‘‘Oc- censed beds, a high percentage of such bene- the payment under this subsection for cov- tober 1, 1995,’’; and ficiaries residing in such area who are hos- ered OPD services during the period shall be (2) by redesignating clauses (v) and (vi) as pitalized (during such recent year) receive based on 102 percent of the reasonable costs clauses (vii) and (viii), respectively, and in- specialized surgical inpatient care at the for such services. Nothing in this subpara- serting after clause (iv) the following new hospital. graph shall be construed as affecting the ap- clauses: ‘‘(III) Almost all physicians described in plication or amount of deductibles or copay- ‘‘(v) For discharges occurring in the fiscal section 1861(r)(1) in such area have privileges ments otherwise applicable to such services year beginning on October 1, 2003, the aver- at the hospital and provide their inpatient under this part or as waiving any require- age standardized amount for hospitals lo- services primarily at the hospital. ment for billing for such services.’’. cated in areas other than a large urban area ‘‘(IV) The hospital inpatient score for qual- (c) EFFECTIVE DATE.—The amendments shall be equal to the average standardized ity of care is not less than the median hos- made by this section shall apply to cost re- amount for hospitals located in a large urban pital score for qualify of care for hospitals in porting periods beginning on or after October area.’’. the State, as established under standards of 1, 2004. (b) CONFORMING AMENDMENTS.— the utilization and quality control peer re- SEC. 404. MORE FREQUENT UPDATE IN WEIGHTS (1) COMPUTING DRG-SPECIFIC RATES.—Sec- view organization under part B of title XI or USED IN HOSPITAL MARKET BAS- tion 1886(d)(3)(D) (42 U.S.C. 1395ww(d)(3)(D)) KET. is amended— other quality standards recognized by the Secretary. (a) MORE FREQUENT UPDATES IN WEIGHTS.— (A) in the heading, by striking ‘‘IN DIF- ‘‘(ii) SIGNIFICANT ADVERSE IMPACT IN AB- After revising the weights used in the hos- FERENT AREAS’’; SENCE OF HOSPITAL.—If the hospital were to pital market basket under section (B) in the matter preceding clause (i), by 1886(b)(3)(B)(iii) of the Social Security Act striking ‘‘, each of’’; close— ‘‘(I) there would be a significant amount of (42 U.S.C. 1395ww(b)(3)(B)(iii)) to reflect the (C) in clause (i)— most current data available, the Secretary (i) in the matter preceding subclause (I), by time needed for residents to reach emer- gency treatment, resulting in a potential shall establish a frequency for revising such inserting ‘‘for fiscal years before fiscal year weights, including the labor share, in such 2004,’’ before ‘‘for hospitals’’; and significant harm to beneficiaries with crit- ical illnesses or injuries; market basket to reflect the most current (ii) in subclause (II), by striking ‘‘and’’ data available more frequently than once after the semicolon at the end; ‘‘(II) there would be an inability in the community to stablize emergency cases for every 5 years. (D) in clause (ii)— (b) REPORT.—Not later than October 1, 2004, transfers to another acute care setting, re- (i) in the matter preceding subclause (I), by the Secretary shall submit a report to Con- sulting in a potential for significant harm to inserting ‘‘for fiscal years before fiscal year gress on the frequency established under sub- medicare beneficiaries; and 2004,’’ before ‘‘for hospitals’’; and section (a), including an explanation of the ‘‘(III) any other nearby hospital lacks the (ii) in subclause (II), by striking the period reasons for, and options considered, in deter- physical and clinical capacity to take over at the end and inserting ‘‘; and’’; and mining such frequency. (E) by adding at the end the following new the hospital’s typical admissions. ‘‘(C) In making such determination, the SEC. 405. IMPROVEMENTS TO CRITICAL ACCESS clause: HOSPITAL PROGRAM. Secretary may also consider the following: ‘‘(iii) for a fiscal year beginning after fiscal (a) INCREASE IN PAYMENT AMOUNTS.— ‘‘(i) Free-standing ambulatory surgery cen- year 2003, for hospitals located in all areas, (1) IN GENERAL.—Sections 1814(l), 1834(g)(1), ters, office-based oncology care, and imaging to the product of— and 1883(a)(3) (42 U.S.C. 1395f(l); 1395m(g)(1); center services are insufficient in the hos- ‘‘(I) the applicable standardized amount 42 U.S.C. 1395tt(a)(3)) are each amended by pital’s area to handle the outpatient care of (computed under subparagraph (A)), reduced inserting ‘‘equal to 102 percent of’’ before the hospital. under subparagraph (B), and adjusted or re- ‘‘the reasonable costs’’. ‘‘(ii) Beneficiaries in nearby areas would be duced under subparagraph (C) for the fiscal (2) EFFECTIVE DATE.—The amendments adversely affected if the hospital were to year; and made by paragraph (1) shall apply to pay- close as the hospital provides specialized ‘‘(II) the weighting factor (determined ments for services furnished during cost re- knowledge and services to a network of under paragraph (4)(B)) for that diagnosis-re- porting periods beginning on or after October smaller hospitals and critical access hos- lated group.’’. 1, 2003. (2) TECHNICAL CONFORMING SUNSET.—Sec- pitals. (b) COVERAGE OF COSTS FOR CERTAIN EMER- tion 1886(d)(3) (42 U.S.C. 1395ww(d)(3)) is ‘‘(iii) Medicare beneficiaries would have GENCY ROOM ON-CALL PROVIDERS.— amended— difficulty in accessing care if the hospital (1) IN GENERAL.—Section 1834(g)(5) (42 (A) in the matter preceding subparagraph were to close as the hospital provides signifi- U.S.C. 1395m(g)(5)) is amended— (A), by inserting ‘‘, for fiscal years before fis- cant subsidies to support ambulatory care in (A) in the heading— cal year 1997,’’ before ‘‘a regional adjusted local clinics, including mental health clinics (i) by inserting ‘‘CERTAIN’’ before ‘‘EMER- DRG prospective payment rate’’; and and to support post acute care. GENCY’’; and (B) in subparagraph (D), in the matter pre- ‘‘(iv) The hospital has a committment to (ii) by striking ‘‘PHYSICIANS’’ and inserting ceding clause (i), by inserting ‘‘, for fiscal provide graduate medical education in a ‘‘PROVIDERS’’; years before fiscal year 1997,’’ before ‘‘a re- rural area. (B) by striking ‘‘emergency room physi- gional DRG prospective payment rate for A hospital classified as an essential rural cians who are on-call (as defined by the Sec- each region,’’. hospital may not change such classification retary)’’ and inserting ‘‘physicians, physi- SEC. 403. ESTABLISHMENT OF ESSENTIAL RURAL and a hospital so classified shall not be cian assistants, nurse practitioners, and clin- HOSPITAL CLASSIFICATION. treated as a sole community hospital, medi- ical nurse specialists who are on-call (as de- (a) CLASSIFICATION.—Section 1861(mm) (42 care dependent hospital, or rural referral U.S.C. 1395x(mm)) is amended— fined by the Secretary) to provide emergency center for purposes of section 1886.’’. services’’; and (1) in the heading by adding ‘‘ESSENTIAL (b) PAYMENT BASED ON 102 PERCENT OF AL- (C) by striking ‘‘physicians’ services’’ and RURAL HOSPITALS’’ at the end; and LOWED COSTS.— (2) by adding at the end the following new inserting ‘‘services covered under this title’’. (1) INPATIENT HOSPITAL SERVICES.—Section paragraphs: (2) EFFECTIVE DATE.—The amendment ‘‘(4)(A) The term ‘essential rural hospital’ 1886(d) (42 U.S.C. 1395ww(d)) is amended by made by paragraph (1) shall apply with re- means a subsection (d) hospital (as defined in adding at the end the following: spect to costs incurred for services provided section 1886(d)(1)(B)) that is located in a ‘‘(11) In the case of a hospital classified as on or after January 1, 2004. rural area (as defined for purposes of section an essential rural hospital under section (c) MODIFICATION OF THE ISOLATION TEST 1886(d)), has more than 25 licensed acute care 1861(mm)(4) for a cost reporting period, the FOR COST-BASED CAH AMBULANCE SERV- inpatient beds, has applied to the Secretary payment under this subsection for inpatient ICES.— for classification as such a hospital, and with hospital services for discharges occurring (1) IN GENERAL.—Section 1834(l)(8) (42 respect to which the Secretary has deter- during the period shall be based on 102 per- U.S.C. 1395m(l)), as added by section 205(a) of mined that the closure of the hospital would cent of the reasonable costs for such serv- BIPA (114 Stat. 2763A–482), is amended by significantly diminish the ability of medi- ices. Nothing in this paragraph shall be con- adding at the end the following: ‘‘The limita- care beneficiaries to obtain essential health strued as affecting the application or tion described in the matter following sub- care services. amount of deductibles or copayments other- paragraph (B) in the previous sentence shall ‘‘(B) The determination under subpara- wise applicable to such services under part A not apply if the ambulance services are fur- graph (A) shall be based on the following cri- or as waiving any requirement for billing for nished by such a provider or supplier of am- teria: such services.’’. bulance services who is a first responder to
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00101 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.060 H26PT1 H6042 CONGRESSIONAL RECORD — HOUSE June 26, 2003 emergencies in accordance with local proto- reference to ‘25 beds’, but only if no more resident limits for hospitals by an aggregate cols (as determined by the Secretary).’’. than 10 beds in the hospital are at any time number estimated by the Secretary that (2) EFFECTIVE DATE.—The amendment used for non-acute care services. A hospital does not exceed the aggregate reduction in made by paragraph (1) shall apply to ambu- that makes such an election is not eligible such limits attributable to clause (i) (with- lances services furnished on or after the first for the increase provided under subsection out taking into account any adjustment cost reporting period that begins after the (c)(3)(A). under subclause (IV) of such clause). date of the enactment of this Act. ‘‘(B) The limitations in numbers of beds ‘‘(II) EFFECTIVE DATE.—No increase under (d) REINSTATEMENT OF PERIODIC INTERIM under the first sentence of paragraph (1) are subclause (I) shall be permitted or taken into PAYMENT (PIP).— subject to adjustment under subsection account for a hospital for any portion of a (1) IN GENERAL.—Section 1815(e)(2) (42 (c)(3).’’. cost reporting period that occurs before July U.S.C. 1395g(e)(2)) is amended— (4) EFFECTIVE DATE.—The amendments 1, 2004, or before the date of the hospital’s ap- (A) in the matter before subparagraph (A), made by this subsection shall apply to des- plication for an increase under this clause. by inserting ‘‘, in the cases described in sub- ignations made before, on, or after January No such increase shall be permitted for a paragraphs (A) through (D)’’ after ‘‘1986’’; 1, 2004. hospital unless the hospital has applied to and (g) ADDITIONAL 5-YEAR PERIOD OF FUNDING the Secretary for such increase by December (B) by striking ‘‘and’’ at the end of sub- FOR GRANT PROGRAM.— 31, 2005. paragraph (C); (1) IN GENERAL.—Section 1820(g) (42 U.S.C. ‘‘(III) CONSIDERATIONS IN REDISTRIBUTION.— (C) by adding ‘‘and’’ at the end of subpara- 1395i–4(g)) is amended by adding at the end In determining for which hospitals the in- graph (D); and the following new paragraph: crease in the otherwise applicable resident (D) by inserting after subparagraph (D) the ‘‘(4) FUNDING.— limit is provided under subclause (I), the following new subparagraph: ‘‘(A) IN GENERAL.—Subject to subparagraph Secretary shall take into account the need ‘‘(E) inpatient critical access hospital serv- (B), payment for grants made under this sub- for such an increase by specialty and loca- ices;’’. section during fiscal years 2004 through 2008 tion involved, consistent with subclause (IV). (2) DEVELOPMENT OF ALTERNATIVE METHODS shall be made from the Federal Hospital In- ‘‘(IV) PRIORITY FOR RURAL AND SMALL OF PERIODIC INTERIM PAYMENTS.—With re- surance Trust Fund. URBAN AREAS.—In determining for which hos- spect to periodic interim payments to crit- ‘‘(B) ANNUAL AGGREGATE LIMITATION.—In no pitals and residency training programs an in- ical access hospitals for inpatient critical ac- case may the amount of payment provided crease in the otherwise applicable resident cess hospital services under section for under subparagraph (A) for a fiscal year limit is provided under subclause (I), the 1815(e)(2)(E) of the Social Security Act, as exceed $25,000,000.’’. Secretary shall first distribute the increase added by paragraph (1), the Secretary shall (2) CONFORMING AMENDMENT.—Section 1820 to programs of hospitals located in rural develop alternative methods for such pay- (42 U.S.C. 1395i–4) is amended by striking areas or in urban areas that are not large ments that are based on expenditures of the subsection (j). urban areas (as defined for purposes of sub- hospital. SEC. 406. REDISTRIBUTION OF UNUSED RESI- section (d)) on a first-come-first-served basis DENT POSITIONS. (3) REINSTATEMENT OF PIP.—The amend- (as determined by the Secretary) based on a (a) IN GENERAL.—Section 1886(h)(4) (42 ments made by paragraph (1) shall apply to demonstration that the hospital will fill the U.S.C. 1395ww(h)(4)) is amended— payments made on or after January 1, 2004. positions made available under this clause (1) in subparagraph (F)(i), by inserting (e) CONDITION FOR APPLICATION OF SPECIAL and not to exceed an increase of 25 full-time ‘‘subject to subparagraph (I),’’ after ‘‘October PHYSICIAN PAYMENT ADJUSTMENT.— equivalent positions with respect to any hos- 1, 1997,’’; (1) IN GENERAL.—Section 1834(g)(2) (42 pital. (2) in subparagraph (H)(i), by inserting U.S.C. 1395m(g)(2)) is amended by adding ‘‘(V) APPLICATION OF LOCALITY ADJUSTED ‘‘subject to subparagraph (I),’’ after ‘‘sub- after and below subparagraph (B) the fol- NATIONAL AVERAGE PER RESIDENT AMOUNT.— paragraphs (F) and (G),’’; and lowing: With respect to additional residency posi- (3) by adding at the end the following new ‘‘The Secretary may not require, as a condi- tions in a hospital attributable to the in- subparagraph: tion for applying subparagraph (B) with re- crease provided under this clause, notwith- ‘‘(I) REDISTRIBUTION OF UNUSED RESIDENT spect to a critical access hospital, that each standing any other provision of this sub- POSITIONS.— physician providing professional services in section, the approved FTE resident amount ‘‘(i) REDUCTION IN LIMIT BASED ON UNUSED the hospital must assign billing rights with is deemed to be equal to the locality ad- POSITIONS.— respect to such services, except that such justed national average per resident amount ‘‘(I) IN GENERAL.—If a hospital’s resident subparagraph shall not apply to those physi- computed under subparagraph (E) for that level (as defined in clause (iii)(I)) is less than cians who have not assigned such billing hospital. the otherwise applicable resident limit (as rights.’’. ‘‘(VI) CONSTRUCTION.—Nothing in this defined in clause (iii)(II)) for each of the ref- (2) EFFECTIVE DATE.—The amendment clause shall be construed as permitting the erence periods (as defined in subclause (II)), made by paragraph (1) shall be effective as if redistribution of reductions in residency po- effective for cost reporting periods beginning included in the enactment of section 403(d) of sitions attributable to voluntary reduction on or after January 1, 2004, the otherwise ap- the Medicare, Medicaid, and SCHIP Balanced programs under paragraph (6) or as affecting plicable resident limit shall be reduced by 75 Budget Refinement Act of 1999 (113 Stat. the ability of a hospital to establish new percent of the difference between such limit 1501A–371). medical residency training programs under and the reference resident level specified in (f) FLEXIBILITY IN BED LIMITATION FOR HOS- subparagraph (H). subclause (III) (or subclause (IV) if applica- PITALS.—Section 1820 (42 U.S.C. 1395i–4) is ‘‘(iii) RESIDENT LEVEL AND LIMIT DEFINED.— ble). amended— In this subparagraph: (1) in subsection (c)(2)(B)(iii), by inserting ‘‘(II) REFERENCE PERIODS DEFINED.—In this ‘‘(I) RESIDENT LEVEL.—The term ‘resident clause, the term ‘reference periods’ means, ‘‘subject to paragraph (3)’’ after ‘‘(iii) pro- level’ means, with respect to a hospital, the for a hospital, the 3 most recent consecutive vides’’; total number of full-time equivalent resi- cost reporting periods of the hospital for (2) by adding at the end of subsection (c) dents, before the application of weighting which cost reports have been settled (or, if the following new paragraph: factors (as determined under this paragraph), not, submitted) on or before September 30, ‘‘(3) INCREASE IN MAXIMUM NUMBER OF BEDS in the fields of allopathic and osteopathic 2002. FOR HOSPITALS WITH STRONG SEASONAL CENSUS medicine for the hospital. FLUCTUATIONS.— ‘‘(III) REFERENCE RESIDENT LEVEL.—Subject ‘‘(II) OTHERWISE APPLICABLE RESIDENT ‘‘(A) IN GENERAL.—Subject to subparagraph to subclause (IV), the reference resident LIMIT.—The term ‘otherwise applicable resi- level specified in this subclause for a hos- (C), in the case of a hospital that dem- dent limit’ means, with respect to a hospital, pital is the highest resident level for the hos- onstrates that it meets the standards estab- the limit otherwise applicable under sub- pital during any of the reference periods. lished under subparagraph (B) and has not paragraphs (F)(i) and (H) on the resident ‘‘(IV) ADJUSTMENT PROCESS.—Upon the made the election described in subsection level for the hospital determined without re- timely request of a hospital, the Secretary (f)(2)(A), the bed limitations otherwise appli- gard to this subparagraph.’’. shall adjust (subject to audit) the reference cable under paragraph (2)(B)(iii) and sub- (b) CONFORMING AMENDMENT TO IME.—Sec- section (f) shall be increased by 5 beds. resident level for a hospital to be the resi- tion 1886(d)(5)(B)(v) (42 U.S.C. ‘‘(B) STANDARDS.—The Secretary shall dent level for the hospital for the cost re- 1395ww(d)(5)(B)(v)) is amended by adding at specify standards for determining whether a porting period that includes July 1, 2003. the end the following: ‘‘The provisions of critical access hospital has sufficiently ‘‘(V) AFFILIATION.—With respect to hos- subparagraph (I) of subsection (h)(4) shall strong seasonal variations in patient admis- pitals which are members of the same affili- apply with respect to the first sentece of this sions to justify the increase in bed limita- ated group (as defined by the Secretary clause in the same manner as it applies with tion provided under subparagraph (A).’’; and under subparagraph (H)(ii)), the provisions of respect to subparagraph (F) of such sub- (3) in subsection (f)— this section shall be applied with respect to section.’’. (A) by inserting ‘‘(1)’’ after ‘‘(f)’’; and such an affiliated group by deeming the af- (c) REPORT ON EXTENSION OF APPLICATIONS (B) by adding at the end the following new filiated group to be a single hospital. UNDER REDISTRIBUTION PROGRAM.—Not later paragraph: ‘‘(ii) REDISTRIBUTION.— than July 1, 2005, the Secretary shall submit ‘‘(2)(A) A hospital may elect to treat the ‘‘(I) IN GENERAL.—The Secretary is author- to Congress a report containing rec- reference in paragraph (1) to ‘15 beds’ as a ized to increase the otherwise applicable ommendations regarding whether to extend
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00102 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.060 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6043 the deadline for applications for an increase SEC. 410. IMPROVEMENT IN PAYMENTS TO RE- the exception described in section in resident limits under section TAIN EMERGENCY CAPACITY FOR 1128B(b)(3)(H) of the Social Security Act, as 1886(h)(4)(I)(ii)(II) of the Social Security Act AMBULANCE SERVICES IN RURAL added by subsection (a), for health center en- (as added by subsection (a)). AREAS. tity arrangements to the antikickback pen- Section 1834(l) (42 U.S.C. 1395m(l)) is alties. SEC. 407. TWO-YEAR EXTENSION OF HOLD HARM- amended— LESS PROVISIONS FOR SMALL (B) FACTORS TO CONSIDER.—The Secretary (1) by redesignating paragraph (8), as added shall consider the following factors, among RURAL HOSPITALS AND SOLE COM- by section 221(a) of BIPA (114 Stat. 2763A– MUNITY HOSPITALS UNDER PRO- others, in establishing standards relating to SPECTIVE PAYMENT SYSTEM FOR 486), as paragraph (9); and the exception for health center entity ar- HOSPITAL OUTPATIENT DEPART- (2) by adding at the end the following new rangements under subparagraph (A): MENT SERVICES. paragraph: (i) Whether the arrangement between the ‘‘(10) ASSISTANCE FOR RURAL PROVIDERS (a) HOLD HARMLESS PROVISIONS.— health center entity and the other party re- FURNISHING SERVICES IN LOW MEDICARE POPU- (1) IN GENERAL.—Section 1833(t)(7)(D)(i) (42 sults in savings of Federal grant funds or in- U.S.C. 1395l(t)(7)(D)(i)) is amended— LATION DENSITY AREAS.— creased revenues to the health center entity. ‘‘(A) IN GENERAL.—In the case of ground (A) in the heading, by striking ‘‘SMALL’’ (ii) Whether the arrangement between the ambulance services furnished on or after and inserting ‘‘CERTAIN’’; health center entity and the other party re- (B) by inserting ‘‘or a sole community hos- January 1, 2004, for which the transportation stricts or limits a patient’s freedom of pital (as defined in section 1886(d)(5)(D)(iii)) originates in a qualified rural area (as de- choice. located in a rural area’’ after ‘‘100 beds’’; and fined in subparagraph (B)), the Secretary (iii) Whether the arrangement between the (C) by striking ‘‘2004’’ and inserting ‘‘2006’’. shall provide for a percent increase in the health center entity and the other party pro- base rate of the fee schedule for a trip estab- (2) EFFECTIVE DATE.—The amendment tects a health care professional’s inde- made by subsection (a)(2) shall apply with re- lished under this subsection. In establishing pendent medical judgment regarding medi- spect to payment for OPD services furnished such percent increase, the Secretary shall es- cally appropriate treatment. on and after January 1, 2004. timate the average cost per trip for the base rate in the lowest quartile as compared to The Secretary may also include other stand- (b) STUDY; ADJUSTMENT.— the average cost for the base rate for such ards and criteria that are consistent with (1) STUDY.—The Secretary shall conduct a services that is in the highest quartile of all the intent of Congress in enacting the excep- study to determine if, under the prospective rural county populations. tion established under this section. payment system for hospital outpatient de- ‘‘(B) QUALIFIED RURAL AREA DEFINED.—For (2) INTERIM FINAL EFFECT.—No later than partment services under section 1833(t) of the purposes of subparagraph (A), the term 180 days after the date of enactment of this Social Security Act (42 U.S.C. 1395l(t)), costs ‘qualified rural area’ is a rural area (as de- Act, the Secretary shall publish a rule in the incurred by rural providers of services by fined in section 1886(d)(2)(D)) with a popu- Federal Register consistent with the factors ambulatory payment classification groups lation density of medicare beneficiaries re- under paragraph (1)(B). Such rule shall be ef- (APCs) exceed those costs incurred by urban siding in the area that is in the lowest quar- fective and final immediately on an interim providers of services. tile of all rural county populations.’’. basis, subject to such change and revision, (2) ADJUSTMENT.—Insofar as the Secretary after public notice and opportunity (for a pe- determines under paragraph (1) that costs in- SEC. 411. TWO-YEAR INCREASE FOR HOME HEALTH SERVICES FURNISHED IN A riod of not more than 60 days) for public curred by rural providers exceed those costs RURAL AREA. comment, as is consistent with this sub- incurred by urban providers of services, the (a) IN GENERAL.—In the case of home section. Secretary shall provide for an appropriate health services furnished in a rural area (as SEC. 413. GAO STUDY OF GEOGRAPHIC DIF- adjustment under such section 1833(t) to re- defined in section 1886(d)(2)(D) of the Social FERENCES IN PAYMENTS FOR PHY- flect those higher costs by January 1, 2005. Security Act (42 U.S.C. 1395ww(d)(2)(D))) dur- SICIANS’ SERVICES. (a) STUDY.—The Comptroller General of ing 2004 and 2005, the Secretary shall in- SEC. 408. EXCLUSION OF CERTAIN RURAL the United States shall conduct a study of HEALTH CLINIC AND FEDERALLY crease the payment amount otherwise made differences in payment amounts under the QUALIFIED HEALTH CENTER SERV- under section 1895 of such Act (42 U.S.C. physician fee schedule under section 1848 of ICES FROM THE PROSPECTIVE PAY- 1395fff ) for such services by 5 percent. MENT SYSTEM FOR SKILLED NURS- the Social Security Act (42 U.S.C. 1395w–4) (b) WAIVING BUDGET NEUTRALITY.—The ING FACILITIES. for physicians’ services in different geo- Secretary shall not reduce the standard pro- graphic areas. Such study shall include— (a) IN GENERAL.—Section 1888(e)(2)(A) (42 spective payment amount (or amounts) U.S.C. 1395yy(e)(2)(A)) is amended— (1) an assessment of the validity of the geo- under section 1895 of the Social Security Act graphic adjustment factors used for each (1) in clause (i)(II), by striking ‘‘clauses (ii) (42 U.S.C. 1395fff ) applicable to home health and (iii)’’ and inserting ‘‘clauses (ii), (iii), component of the fee schedule; services furnished during a period to offset (2) an evaluation of the measures used for and (iv)’’; and the increase in payments resulting from the (2) by adding at the end the following new such adjustment, including the frequency of application of subsection (a). revisions; and clause: SEC. 412. PROVIDING SAFE HARBOR FOR CER- ‘‘(iv) EXCLUSION OF CERTAIN RURAL HEALTH (3) an evaluation of the methods used to TAIN COLLABORATIVE EFFORTS determine professional liability insurance CLINIC AND FEDERALLY QUALIFIED HEALTH CEN- THAT BENEFIT MEDICALLY UNDER- TER SERVICES.—Services described in this SERVED POPULATIONS. costs used in computing the malpractice component, including a review of increases clause are— (a) IN GENERAL.—Section 1128B(b)(3) (42 ‘‘(I) rural health clinic services (as defined U.S.C. 1320a–7(b)(3)), as amended by section in professional liability insurance premiums in paragraph (1) of section 1861(aa)); and 101(b)(2), is amended— and variation in such increases by State and ‘‘(II) Federally qualified health center (1) in subparagraph (F), by striking ‘‘and’’ physician specialty and methods used to up- services (as defined in paragraph (3) of such after the semicolon at the end; date the geographic cost of practice index section); (2) in subparagraph (G), by striking the pe- and relative weights for the malpractice riod at the end and inserting ‘‘; and’’; and component. that would be described in clause (ii) if such (b) REPORT.—Not later than 1 year after (3) by adding at the end the following new services were not furnished by an individual the date of the enactment of this Act, the subparagraph: affiliated with a rural health clinic or a Fed- Comptroller General shall submit to Con- ‘‘(H) any remuneration between a public or erally qualified health center.’’. gress a report on the study conducted under nonprofit private health center entity de- (b) EFFECTIVE DATE.—The amendments subsection (a). The report shall include rec- scribed under clause (i) or (ii) of section made by subsection (a) shall apply to serv- ommendations regarding the use of more 1905(l)(2)(B) and any individual or entity pro- ices furnished on or after January 1, 2004. current data in computing geographic cost of viding goods, items, services, donations or practice indices as well as the use of data di- SEC. 409. RECOGNITION OF ATTENDING NURSE loans, or a combination thereof, to such PRACTITIONERS AS ATTENDING rectly representative of physicians’ costs health center entity pursuant to a contract, (rather than proxy measures of such costs). PHYSICIANS TO SERVE HOSPICE PA- lease, grant, loan, or other agreement, if TIENTS. SEC. 414. TREATMENT OF MISSING COST REPORT- such agreement contributes to the ability of ING PERIODS FOR SOLE COMMU- (a) IN GENERAL.—Section 1861(dd)(3)(B) (42 the health center entity to maintain or in- NITY HOSPITALS. U.S.C. 1395x(dd)(3)(B)) is amended by insert- crease the availability, or enhance the qual- (a) IN GENERAL.—Section 1886(b)(3)(I) (42 ing ‘‘or nurse practitioner (as defined in sub- ity, of services provided to a medically un- U.S.C. 1395ww(b)(3)(I)) is amended by adding section (aa)(5))’’ after ‘‘the physician (as de- derserved population served by the health at the end the following new clause: fined in subsection (r)(1))’’. center entity.’’. ‘‘(iii) In no case shall a hospital be denied (b) CLARIFICATION OF HOSPICE ROLE OF (b) RULEMAKING FOR EXCEPTION FOR treatment as a sole community hospital or NURSE PRACTITIONERS.—Section HEALTH CENTER ENTITY ARRANGEMENTS.— payment (on the basis of a target rate as 1814(a)(7)(A)(i)(I) (42 U.S.C. 1395f(a)(7)(A)(i)(I)) (1) ESTABLISHMENT.— such as a hospital) because data are unavail- is amended by inserting ‘‘(which for purposes (A) IN GENERAL.—The Secretary of Health able for any cost reporting period due to of this subparagraph does not include a nurse and Human Services (in this subsection re- changes in ownership, changes in fiscal practitioner)’’ after ‘‘attending physician (as ferred to as the ‘‘Secretary’’) shall establish, intermediaries, or other extraordinary cir- defined in section 1861(dd)(3)(B))’’. on an expedited basis, standards relating to cumstances, so long as data for at least one
VerDate Jan 31 2003 05:21 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00103 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.060 H26PT1 H6044 CONGRESSIONAL RECORD — HOUSE June 26, 2003 applicable base cost reporting period is ‘‘(i) primary care physicians; or ‘‘(2) The Secretary shall establish proce- available.’’. ‘‘(ii) physicians who are not primary care dures under which the Secretary, and not the (b) EFFECTIVE DATE.—The amendment physicians. physician furnishing the service, is respon- made by subsection (a) shall apply to cost re- ‘‘(B) NUMBER OF MEDICARE BENEFICIARIES sible for determining when a payment is re- porting periods beginning on or after Janu- RESIDING IN THE AREA.—The number of indi- quired to be made under paragraph (1). ary 1, 2004. viduals who are residing in the county and ‘‘(3) In carrying out paragraph (1) for a SEC. 415. EXTENSION OF TELEMEDICINE DEM- are entitled to benefits under part A or en- year, the Secretary shall include, as part of ONSTRATION PROJECT. rolled under this part, or both. the proposed and final rule to implement the Section 4207 of Balanced Budget Act of 1997 ‘‘(C) DETERMINATION OF RATIOS.— physician fee schedule under section 1848 for (Public Law 105–33) is amended— ‘‘(i) PRIMARY CARE RATIO.—The ratio (in the year, a list of all areas which will qualify as a health professional shortage area under (1) in subsection (a)(4), by striking ‘‘4- this paragraph referred to as the ‘primary paragraph (1) for the year involved.’’. year’’ and inserting ‘‘8-year’’; and care ratio’) of the number of primary care (2) EFFECTIVE DATE.—The amendments (2) in subsection (d)(3), by striking physicians (determined under subparagraph made by paragraph (1) shall apply to physi- ‘‘$30,000,000’’ and inserting ‘‘$60,000,000’’. (A)(i)), to number of medicare beneficiaries determined under subparagraph (B). cians’ services furnished or after January 1, SEC. 416. ADJUSTMENT TO THE MEDICARE INPA- 2004. TIENT HOSPITAL PPS WAGE INDEX ‘‘(ii) SPECIALIST CARE RATIO.—The ratio (in SEC. 418. RURAL HOSPICE DEMONSTRATION TO REVISE THE LABOR-RELATED this paragraph referred to as the ‘specialist PROJECT. SHARE OF SUCH INDEX. care ratio’) of the number of other physi- (a) IN GENERAL.—The Secretary shall con- (a) IN GENERAL.—Section 1886(d)(3)(E) (42 cians (determined under subparagraph duct a demonstration project for the delivery U.S.C. 1395ww(d)(3)(E)) is amended— (A)(ii)), to number of medicare beneficiaries of hospice care to medicare beneficiaries in WAGE LEVELS.—The Sec- (1) by striking ‘‘ determined under subparagraph (B). rural areas. Under the project medicare retary’’ and inserting ‘‘WAGE LEVELS.— ‘‘(3) RANKING OF COUNTIES.—The Secretary beneficiaries who are unable to receive hos- ‘‘(i) IN GENERAL.—Except as provided in shall rank each such county or area based pice care in the home for lack of an appro- clause (ii), the Secretary’’; and separately on its primary care ratio and its priate caregiver are provided such care in a (2) by adding at the end the following new specialist care ratio. facility of 20 or fewer beds which offers, clause: ‘‘(4) IDENTIFICATION OF COUNTIES.—The Sec- within its walls, the full range of services ‘‘(ii) ALTERNATIVE PROPORTION TO BE AD- retary shall identify— provided by hospice programs under section JUSTED BEGINNING IN FISCAL YEAR 2004.— ‘‘(A) those counties and areas (in this para- 1861(dd) of the Social Security Act (42 U.S.C. ‘‘(I) IN GENERAL.—Except as provided in graph referred to as ‘primary care scarcity 1395x(dd)). subclause (II), for discharges occurring on or counties’) with the lowest primary care ra- (b) SCOPE OF PROJECT.—The Secretary after October 1, 2003, the Secretary shall sub- tios that represent, if each such county or shall conduct the project under this section stitute the ‘62 percent’ for the proportion de- area were weighted by the number of medi- with respect to no more than 3 hospice pro- scribed in the first sentence of clause (i). care beneficiaries determined under para- grams over a period of not longer than 5 ‘‘(II) HOLD HARMLESS FOR CERTAIN HOS- graph (2)(B), an aggregate total of 20 percent years each. PITALS.—If the application of subclause (I) of the total of the medicare beneficiaries de- (c) COMPLIANCE WITH CONDITIONS.—Under would result in lower payments to a hospital termined under such paragraph; and the demonstration project— than would otherwise be made, then this sub- ‘‘(B) those counties and areas (in this sub- (1) the hospice program shall comply with paragraph shall be applied as if this clause section referred to as ‘specialist care scar- otherwise applicable requirements, except had not been enacted.’’. city counties’) with the lowest specialist that it shall not be required to offer services (b) WAIVING BUDGET NEUTRALITY.—Section care ratios that represent, if each such coun- outside of the home or to meet the require- 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)), as ty or area were weighted by the number of ments of section 1861(dd)(2)(A)(iii) of the So- amended by subsection (a), is amended by medicare beneficiaries determined under cial Security Act; and adding at the end of clause (i) the following paragraph (2)(B), an aggregate total of 20 (2) payments for hospice care shall be made new sentence: ‘‘The Secretary shall apply percent of the total of the medicare bene- at the rates otherwise applicable to such the previous sentence for any period as if the ficiaries determined under such paragraph. care under title XVIII of such Act. amendments made by section 402(a) of the There is no administrative or judicial review The Secretary may require the program to Medicare Prescription Drug and Moderniza- respecting the identification of a county or comply with such additional quality assur- tion Act of 2003 had not been enacted.’’. area or the assignment of a specialty of any ance standards for its provision of services in SEC. 417. MEDICARE INCENTIVE PAYMENT PRO- physician under this paragraph. its facility as the Secretary deems appro- priate. GRAM IMPROVEMENTS FOR PHYSI- ‘‘(5) RURAL CENSUS TRACKS.—To the extent (d) REPORT.—Upon completion of the CIAN SCARCITY. feasible, the Secretary shall treat a rural project, the Secretary shall submit a report (a) ADDITIONAL BONUS PAYMENT FOR CER- census tract of a metropolitan statistical TAIN PHYSICIAN SCARCITY AREAS.— to Congress on the project and shall include area (as determined under the most recent in the report recommendations regarding ex- (1) IN GENERAL.—Section 1833 (42 U.S.C. modification of the Goldsmith Modification, 1395l) is amended by adding at the end the tension of such project to hospice programs originally published in the Federal Register serving rural areas. following new subsection: on February 27, 1992 (57 Fed. Reg. 6725) as an ‘‘(u) INCENTIVE PAYMENTS FOR PHYSICIAN equivalent area for purposes of qualifying as TITLE V—PROVISIONS RELATING TO PART A SCARCITY AREAS.— a primary care scarcity county or specialist ‘‘(1) IN GENERAL.—In the case of physicians’ care scarcity county under this subsection. Subtitle A—Inpatient Hospital Services services furnished in a year— ‘‘(6) PHYSICIAN DEFINED.—For purposes of SEC. 501. REVISION OF ACUTE CARE HOSPITAL ‘‘(A) by a primary care physician in a pri- this paragraph, the term ‘physician’ means a PAYMENT UPDATES. mary care scarcity county (identified under physician described in section 1861(r)(1) and Section 1886(b)(3)(B)(i) (42 U.S.C. paragraph (4)); or the term ‘primary care physician’ means a 1395ww(b)(3)(B)(i)) is amended— ‘‘(B) by a physician who is not a primary physician who is identified in the available (1) by striking ‘‘and’’ at the end of sub- care physician in a specialist care scarcity data as a general practitioner, family prac- clause (XVIII); county (as so identified), tice practitioner, general internist, or obste- (2) by striking subclause (XIX); and in addition to the amount of payment that trician or gynecologist. (3) by inserting after subclause (XVIII) the following new subclauses: would otherwise be made for such services ‘‘(7) PUBLICATION OF LIST OF COUNTIES.—In under this part, there also shall be paid an carrying out this subsection for a year, the ‘‘(XIX) for each of fiscal years 2004 through amount equal to 5 percent of the payment Secretary shall include, as part of the pro- 2006, the market basket percentage increase amount for the service under this part. posed and final rule to implement the physi- minus 0.4 percentage points for hospitals in all areas; and ‘‘(2) DETERMINATION OF RATIOS OF PHYSI- cian fee schedule under section 1848 for the ‘‘(XX) for fiscal year 2007 and each subse- CIANS TO MEDICARE BENEFICIARIES IN AREA.— year, a list of all areas which will qualify as quent fiscal year, the market basket per- Based upon available data, the Secretary a primary care scarcity county or specialist centage increase for hospitals in all areas.’’. shall periodically determine, for each county care scarcity county under this subsection or equivalent area in the United States, the for the year involved.’’. SEC. 502. RECOGNITION OF NEW MEDICAL TECH- NOLOGIES UNDER INPATIENT HOS- following: (2) EFFECTIVE DATE.—The amendments PITAL PPS. ‘‘(A) NUMBER OF PHYSICIANS PRACTICING IN made by subsection (a) shall apply to physi- (a) IMPROVING TIMELINESS OF DATA COLLEC- THE AREA.—The number of physicians who cians’ services furnished or after January 1, TION.—Section 1886(d)(5)(K) (42 U.S.C. furnish physicians’ services in the active 2004. 1395ww(d)(5)(K)) is amended by adding at the practice of medicine or osteopathy in that (b) IMPROVEMENT TO MEDICARE INCENTIVE end the following new clause: county or area, other than physicians whose PAYMENT PROGRAM.— ‘‘(vii) Under the mechanism under this sub- practice is exclusively for the Federal Gov- (1) IN GENERAL.—Section 1833(m) (42 U.S.C. paragraph, the Secretary shall provide for ernment, physicians who are retired, or phy- 1395l(m)) is amended— the addition of new diagnosis and procedure sicians who only provide administrative (A) by inserting ‘‘(1)’’ after ‘‘(m)’’; and codes in April 1 of each year, but the addi- services. Of such number, the number of such (B) by adding at the end the following new tion of such codes shall not require the Sec- physicians who are— paragraphs: retary to adjust the payment (or diagnosis-
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00104 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.060 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6045 related group classification) under this sub- ‘‘(II) The Secretary shall accept comments, on or after October 1, 1997, 50 percent (and for section until the fiscal year that begins after recommendations, and data from the public discharges between October 1, 1987, and Sep- such date.’’. regarding whether the service or technology tember 30, 1997, 25 percent)’’ and inserting (b) ELIGIBILITY STANDARD FOR TECHNOLOGY represents a substantial improvement. ‘‘the applicable Federal percentage (specified OUTLIERS.— ‘‘(III) The Secretary shall provide for a in subparagraph (E))’’; and (1) MINIMUM PERIOD FOR RECOGNITION OF meeting at which organizations representing (2) by adding at the end the following new NEW TECHNOLOGIES.—Section 1886(d)(5)(K)(vi) hospitals, physicians, medicare beneficiaries, subparagraph: (42 U.S.C. 1395ww(d)(5)(K)(vi)) is amended— manufacturers, and any other interested ‘‘(E) For purposes of subparagraph (A), for (A) by inserting ‘‘(I)’’ after ‘‘(vi)’’; and party may present comments, recommenda- discharges occurring— (B) by adding at the end the following new tions, and data to the clinical staff of the ‘‘(i) on or after October 1, 1987, and before subclause: Centers for Medicare & Medicaid Services be- October 1, 1997, the applicable Puerto Rico ‘‘(II) Under such criteria, a service or tech- fore publication of a notice of proposed rule- percentage is 75 percent and the applicable nology shall not be denied treatment as a making regarding whether service or tech- Federal percentage is 25 percent; new service or technology on the basis of the nology represents a substantial improve- ‘‘(ii) on or after October 1, 1997, and before period of time in which the service or tech- ment.’’. October 1, 2003, the applicable Puerto Rico nology has been in use if such period ends be- (c) PREFERENCE FOR USE OF DRG ADJUST- percentage is 50 percent and the applicable fore the end of the 2-to-3-year period that be- MENT.—Section 1886(d)(5)(K) (42 U.S.C. Federal percentage is 50 percent; gins on the effective date of implementation 1395ww(d)(5)(K)) is further amended by add- ‘‘(iii) during fiscal year 2004, the applicable of a code under ICD–9–CM (or a successor ing at the end the following new clause: Puerto Rico percentage is 41 percent and the coding methodology) that enables the identi- ‘‘(ix) Before establishing any add-on pay- applicable Federal percentage is 59 percent; fication of specific discharges in which the ment under this subparagraph with respect ‘‘(iv) during fiscal year 2005, the applicable service or technology has been used.’’. to a new technology, the Secretary shall Puerto Rico percentage is 33 percent and the (2) ADJUSTMENT OF THRESHOLD.—Section seek to identify one or more diagnosis-re- applicable Federal percentage is 67 percent; 1886(d)(5)(K)(ii)(I) (42 U.S.C. lated groups associated with such tech- and 1395ww(d)(5)(K)(ii)(I)) is amended by insert- nology, based on similar clinical or anatom- ‘‘(v) on or after October 1, 2005, the applica- ing ‘‘(applying a threshold specified by the ical characteristics and the cost of the tech- ble Puerto Rico percentage is 25 percent and Secretary that is the lesser of 75 percent of nology. Within such groups the Secretary the standardized amount (increased to re- shall assign an eligible new technology into the applicable Federal percentage is 75 per- flect the difference between cost and a diagnosis-related group where the average cent.’’. charges) or 75 percent of one standard devi- costs of care most closely approximate the SEC. 504. WAGE INDEX ADJUSTMENT RECLASSI- FICATION REFORM . ation for the diagnosis-related group in- costs of care of using the new technology. No (a) IN GENERAL.—Section 1886(d) (42 U.S.C. volved)’’ after ‘‘is inadequate’’. add-on payment under this subparagraph 1395ww(d)) is amended by adding at the end (3) CRITERION FOR SUBSTANTIAL IMPROVE- shall be made with respect to such new tech- the following: MENT.—Section 1886(d)(5)(K)(vi) (42 U.S.C. nology and this clause shall not affect the application of paragraph (4)(C)(iii).’’. ‘‘(11)(A) In order to recognize commuting 1395ww(d)(5)(K)(vi)), as amended by para- patterns among Metropolitan Statistical graph (1), is further amended by adding at (d) IMPROVEMENT IN PAYMENT FOR NEW TECHNOLOGY.—Section 1886(d)(5)(K)(ii)(III) (42 Areas and between such Areas and rural the end the following subclause: areas, the Secretary shall establish a proc- ‘‘(III) The Secretary shall by regulation U.S.C. 1395ww(d)(5)(K)(ii)(III)) is amended by ess, upon application of a subsection (d) hos- provide for further clarification of the cri- inserting after ‘‘the estimated average cost teria applied to determine whether a new of such service or technology’’ the following: pital that establishes that it is a qualifying service or technology represents an advance ‘‘(based on the marginal rate applied to costs hospital described in subparagraph (B), for in medical technology that substantially im- under subparagraph (A))’’. an increase of the wage index applied under proves the diagnosis or treatment of bene- (e) ESTABLISHMENT OF NEW FUNDING FOR paragraph (3)(E) for the hospital in the ficiaries. Under such criteria, in determining HOSPITAL INPATIENT TECHNOLOGY.— amount computed under subparagraph (D). whether a new service or technology rep- (1) IN GENERAL.—Section ‘‘(B) A qualifying hospital described in this resents an advance in medical technology 1886(d)(5)(K)(ii)(III) (42 U.S.C. subparagraph is a subsection (d) hospital— that substantially improves the diagnosis or 1395ww(d)(5)(K)(ii)(III)) is amended by strik- ‘‘(i) the average wages of which exceed the treatment of beneficiaries, the Secretary ing ‘‘subject to paragraph (4)(C)(iii),’’. average wages for the area in which the hos- shall deem a service or technology as meet- (2) NOT BUDGET NEUTRAL.—There shall be pital is located; and ing such requirement if the service or tech- no reduction or other adjustment in pay- ‘‘(ii) which has at least 10 percent of its nology is a drug or biological that is des- ments under section 1886 of the Social Secu- employees who reside in one or more higher ignated under section 506 of the Federal rity Act because an additional payment is wage index areas. Food, Drug, and Cosmetic Act, approved provided under subsection (d)(5)(K)(ii)(III) of ‘‘(C) For purposes of this paragraph, the under section 314.510 or 601.41 of title 21, Code such section. term ‘higher wage index area’ means, with of Federal Regulations, or designated for pri- (f) EFFECTIVE DATE.— respect to a hospital, an area with a wage ority review when the marketing application (1) IN GENERAL.—The Secretary shall im- index that exceeds that of the area in which for such drug or biological was filed or is a plement the amendments made by this sec- the hospital is located. medical device for which an exemption has tion so that they apply to classification for ‘‘(D) The increase in the wage index under been granted under section 520(m) of such fiscal years beginning with fiscal year 2005. subparagraph (A) for a hospital shall be Act, or for which priority review has been (2) RECONSIDERATIONS OF APPLICATIONS FOR equal to the percentage of the employees of provided under section 515(d)(5) of such Act. FISCAL YEAR 2004 THAT ARE DENIED.—In the the hospital that resides in any higher wage Nothing in this subclause shall be construed case of an application for a classification of index area multiplied by the sum of the prod- as effecting the authority of the Secretary to a medical service or technology as a new ucts, for each higher wage index area of— determine whether items and services are medical service or technology under section ‘‘(i) the difference between (I) the wage medically necessary and appropriate under 1886(d)(5)(K) of the Social Security Act (42 index for such area, and (II) the wage index section 1862(a)(1).’’. U.S.C. 1395ww(d)(5)(K)) that was filed for fis- of the area in which the hospital is located (4) PROCESS FOR PUBLIC INPUT.—Section cal year 2004 and that is denied— (before the application of this paragraph); 1886(d)(5)(K) (42 U.S.C. 1395ww(d)(5)(K)), as (A) the Secretary shall automatically re- and amended by paragraph (1), is amended— consider the application as an application ‘‘(ii) the number of employees of the hos- (A) in clause (i), by adding at the end the for fiscal year 2005 under the amendments pital that reside in such higher wage index following: ‘‘Such mechanism shall be modi- made by this section; and area divided by the total number of such em- fied to meet the requirements of clause (B) the maximum time period otherwise ployees that reside in all high wage index (viii).’’; and permitted for such classification of the serv- areas. (B) by adding at the end the following new ice or technology shall be extended by 12 ‘‘(E) The process under this paragraph clause: months. shall be based upon the process used by the ‘‘(viii) The mechanism established pursu- SEC. 503. INCREASE IN FEDERAL RATE FOR HOS- Medicare Geographic Classification Review ant to clause (i) shall be adjusted to provide, PITALS IN PUERTO RICO. Board under paragraph (10) with respect to before publication of a proposed rule, for Section 1886(d)(9) (42 U.S.C. 1395ww(d)(9)) is data submitted by hospitals to the Board on public input regarding whether a new service amended— the location of residence of hospital employ- or technology not described in the second (1) in subparagraph (A)— ees and wages under the applicable schedule sentence of clause (vi)(III) represents an ad- (A) in clause (i), by striking ‘‘for dis- established for geographic reclassification. vance in medical technology that substan- charges beginning on or after October 1, 1997, ‘‘(F) A reclassification under this para- tially improves the diagnosis or treatment of 50 percent (and for discharges between Octo- graph shall be effective for a period of 3 fis- beneficiaries as follows: ber 1, 1987, and September 30, 1997, 75 per- cal years, except that the Secretary shall es- ‘‘(I) The Secretary shall make public and cent)’’ and inserting ‘‘the applicable Puerto tablish procedures under which a subsection periodically update a list of all the services Rico percentage (specified in subparagraph (d) hospital may elect to terminate such re- and technologies for which an application for (E))’’; and classification before the end of such period. additional payment under this subparagraph (B) in clause (ii), by striking ‘‘for dis- ‘‘(G) A hospital that is reclassified under is pending. charges beginning in a fiscal year beginning this paragraph for a period is not eligible for
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reclassification under paragraphs (8) or (10) ‘‘(C) advising the individual regarding ad- (2) CONFORMING AMENDMENT.—Paragraph during that period. vanced care planning.’’. (4)(B) of such section is amended, in the mat- ‘‘(H) Any increase in a wage index under (b) PAYMENT.—Section 1814(i) (42 U.S.C. ter before clause (i), by inserting ‘‘and para- this paragraph for a hospital shall not be l395f(i)) is amended by adding at the end the graph (5)’’ after ‘‘subparagraph (D)’’. taken into account for purposes of— following new paragraph: (3) NOT TREATED AS CHANGE IN LAW AND ‘‘(i) computing the wage index for the area ‘‘(4) The amount paid to a hospice program REGULATION IN SUSTAINABLE GROWTH RATE DE- in which the hospital is located or any other with respect to the services under section TERMINATION.—The amendments made by area; or 1812(a)(5) for which payment may be made this subsection shall not be treated as a ‘‘(ii) applying any budget neutrality ad- under this part shall be equal to an amount change in law for purposes of applying sec- justment with respect to such index under equivalent to the amount established for an tion 1848(f)(2)(D) of the Social Security Act paragraph (8)(D).’’. office or other outpatient visit for evalua- (42 U.S.C. 1395w–4(f)(2)(D)). (b) EFFECTIVE DATE.—The amendment tion and management associated with pre- made by subsection (a) shall first apply to senting problems of moderate severity under (b) USE OF 10-YEAR ROLLING AVERAGE IN the wage index for discharges occurring on the fee schedule established under section COMPUTING GROSS DOMESTIC PRODUCT.— or after October 1, 2004. 1848(b), other than the portion of such (1) IN GENERAL.—Section 1848(f)(2)(C) (42 SEC. 505. MEDPAC REPORT ON SPECIALTY HOS- amount attributable to the practice expense U.S.C. 1395w–4(f)(2)(C)) is amended— PITALS. component.’’. (A) by striking ‘‘projected’’ and inserting (a) MEDPAC STUDY.—The Medicare Pay- (c) CONFORMING AMENDMENT.—Section ‘‘annual average’’; and ment Advisory Commission shall conduct a 1861(dd)(2)(A)(i) (42 U.S.C. 1395x(dd)(2)(A)(i)) (B) by striking ‘‘from the previous applica- study of specialty hospitals compared with is amended by inserting before the comma at ble period to the applicable period involved’’ other similar general acute care hospitals the end the following: ‘‘and services de- and inserting ‘‘during the 10-year period end- under the medicare program. Such study scribed in section 1812(a)(5)’’. ing with the applicable period involved’’. shall examine— (d) EFFECTIVE DATE.—The amendments (2) EFFECTIVE DATE.—The amendment (1) whether there are excessive self-refer- made by this section shall apply to services made by paragraph (1) shall apply to com- rals; provided by a hospice program on or after putations of the sustainable growth rate for (2) quality of care furnished; January 1, 2004. years beginning with 2003. (3) the impact of specialty hospitals on SEC. 513. CORRECTION OF TRUST FUND HOLD- SEC. 602. STUDIES ON ACCESS TO PHYSICIANS’ INGS. such general acute care hospitals; and SERVICES. (4) differences in the scope of services, (a) IN GENERAL.—Within 120 days after the medicaid utilization, and uncompensated effective date of this section, the Secretary (a) GAO STUDY ON BENEFICIARY ACCESS TO care furnished. of the Treasury shall take the actions de- PHYSICIANS’ SERVICES.— (b) REPORT.—Not later than 1 year after scribed in subsection (b) with respect to the (1) STUDY.—The Comptroller General of the the date of the enactment of this Act, the Federal Hospital Insurance Trust Fund (in United States shall conduct a study on ac- Secretary shall submit to Congress a report this section referred to as the ‘‘Trust Fund’’) cess of medicare beneficiaries to physicians’ on the study conducted under subsection (a), with the goal being that, after the actions services under the medicare program. The and shall include any recommendations for are taken, the holdings of the Trust Fund study shall include— legislation or administrative change as the will replicate, to the extent practicable in (A) an assessment of the use by bene- Secretary determines appropriate. the judgment of the Secretary of the Treas- ficiaries of such services through an analysis Subtitle B—Other Provisions ury, in consultation with the Secretary, the of claims submitted by physicians for such obligations that would have been held by the SEC. 511. PAYMENT FOR COVERED SKILLED services under part B of the medicare pro- NURSING FACILITY SERVICES. trust fund if the clerical error had not oc- gram; curred. (a) ADJUSTMENT TO RUGS FOR AIDS RESI- (B) an examination of changes in the use (b) OBLIGATIONS ISSUED AND REDEEMED.— DENTS.—Paragraph (12) of section 1888(e) (42 by beneficiaries of physicians’ services over The Secretary of the Treasury shall— U.S.C. 1395yy(e)) is amended to read as fol- time; (1) issue to the Trust Fund obligations lows: (C) an examination of the extent to which under chapter 31 of title 31, United States ‘‘(12) ADJUSTMENT FOR RESIDENTS WITH physicians are not accepting new medicare Code, that bear issue dates, interest rates, AIDS.— beneficiaries as patients. and maturity dates as the obligations that— ‘‘(A) IN GENERAL.—Subject to subparagraph (2) REPORT.—Not later than 18 months (A) would have been issued to the Trust (B), in the case of a resident of a skilled after the date of the enactment of this Act, Fund if the clerical error had not occurred; nursing facility who is afflicted with ac- the Comptroller General shall submit to or quired immune deficiency syndrome (AIDS), Congress a report on the study conducted (B) were issued to the Trust Fund and were the per diem amount of payment otherwise under paragraph (1). The report shall include redeemed by reason of the clerical error; and applicable shall be increased by 128 percent a determination whether— (2) redeem from the Trust Fund obligations to reflect increased costs associated with (A) data from claims submitted by physi- that would have been redeemed from the such residents. cians under part B of the medicare program Trust Fund if the clerical error had not oc- ‘‘(B) SUNSET.—Subparagraph (A) shall not indicate potential access problems for medi- curred. apply on and after such date as the Sec- care beneficiaries in certain geographic (c) APPROPRIATION TO TRUST FUND.—Within retary certifies that there is an appropriate areas; and 120 days after the effective date of this sec- adjustment in the case mix under paragraph (B) access by medicare beneficiaries to tion, there is hereby appropriated to the (4)(G)(i) to compensate for the increased physicians’ services may have improved, re- Trust Fund, out of any money in the Treas- costs associated with residents described in mained constant, or deteriorated over time. ury not otherwise appropriated, an amount such subparagraph.’’. determined by the Secretary of the Treas- (b) STUDY AND REPORT ON SUPPLY OF PHYSI- (b) EFFECTIVE DATE.—The amendment ury, in consultation with the Secretary of CIANS.— made by paragraph (1) shall apply to services Health and Human Services, to be equal to (1) STUDY.—The Secretary shall request furnished on or after October 1, 2003. the interest income lost by the trust fund the Institute of Medicine of the National SEC. 512. COVERAGE OF HOSPICE CONSULTA- through the date of credit by reason of the Academy of Sciences to conduct a study on TION SERVICES. clerical error. the adequacy of the supply of physicians (in- (a) COVERAGE OF HOSPICE CONSULTATION (d) CLERICAL ERROR DEFINED.—For pur- cluding specialists) in the United States and SERVICES.—Section 1812(a) (42 U.S.C. poses of this section, the term ‘‘clerical the factors that affect such supply. 1395d(a)) is amended— error’’ means the failure to have transferred (2) REPORT TO CONGRESS.—Not later than 2 (1) by striking ‘‘and’’ at the end of para- the correct amount from the general fund to years after the date of enactment of this sec- graph (3); the Trust Fund, which failure occurred on tion, the Secretary shall submit to Congress (2) by striking the period at the end of April 15, 2001. a report on the results of the study described paragraph (4) and inserting ‘‘; and’’; and in paragraph (1), including any recommenda- (3) by inserting after paragraph (4) the fol- TITLE VI—PROVISIONS RELATING TO tions for legislation. lowing new paragraph: PART B ‘‘(5) for individuals who are terminally ill, Subtitle A—Physicians’ Services (c) GAO STUDY OF MEDICARE PAYMENT FOR have not made an election under subsection SEC. 601. REVISION OF UPDATES FOR PHYSI- INHALATION THERAPY.— (d)(1), and have not previously received serv- CIANS’ SERVICES. (1) STUDY.—The Comptroller General of the ices under this paragraph, services that are (a) UPDATE FOR 2004 AND 2005.— United States shall conduct a study to exam- furnished by a physician who is either the (1) IN GENERAL.—Section 1848(d) (42 U.S.C. ine the adequacy of current reimbursements medical director or an employee of a hospice 1395w–4(d)) is amended by adding at the end for inhalation therapy under the medicare program and that consist of— the following new paragraph: program. ‘‘(A) an evaluation of the individual’s need ‘‘(5) UPDATE FOR 2004 AND 2005.—The update (2) REPORT.—Not later than May 1, 2004, for pain and symptom management; to the single conversion factor established in the Comptroller General shall submit to ‘‘(B) counseling the individual with respect paragraph (1)(C) for each of 2004 and 2005 Congress a report on the study conducted to end-of-life issues and care options; and shall be not less than 1.5 percent.’’. under paragraph (1).
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00106 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.061 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6047 SEC. 603. MEDPAC REPORT ON PAYMENT FOR Secretary determines, taking into account (A) by striking ‘‘and’’ at the end of sub- PHYSICIANS’ SERVICES. the report of the Comptroller General under paragraph (H); (a) PRACTICE EXPENSE COMPONENT.—Not section 605(b)(2) of the Medicare Prescription (B) by striking the semicolon at the end of later than 1 year after the date of the enact- Drug and Modernization Act of 2003, that subparagraph (I) and inserting ‘‘, and’’; and ment of this Act, the Medicare Payment Ad- there is no sound economic rationale for the (C) by adding at the end the following new visory Commission shall submit to Congress implementation of that clause.’’. subparagraph: a report on the effect of refinements to the (b) GAO REPORT.— ‘‘(J) in the case of an initial preventive practice expense component of payments for (1) EVALUATION.—As part of the study on physical examination, which is performed physicians’ services, after the transition to a geographic differences in payments for phy- not later than 6 months after the date the in- full resource-based payment system in 2002, sicians’ services conducted under section 413, dividual’s first coverage period begins under under section 1848 of the Social Security Act the Comptroller General of the United States part B;’’; and (42 U.S.C. 1395w–4). Such report shall exam- shall evaluate the following: (2) in paragraph (7), by striking ‘‘or (H)’’ ine the following matters by physician spe- (A) Whether there is a sound economic and inserting ‘‘(H), or (J)’’. cialty: basis for the implementation of the adjust- (f) EFFECTIVE DATE.—The amendments (1) The effect of such refinements on pay- ment of the work geographic index under made by this section shall apply to services ment for physicians’ services. section 1848(e)(1) of the Social Security Act furnished on or after January 1, 2004, but (2) The interaction of the practice expense under subsection (a) in those areas in which only for individuals whose coverage period component with other components of and ad- the adjustment applies. begins on or after such date. justments to payment for physicians’ serv- (B) The effect of such adjustment on physi- SEC. 612. COVERAGE OF CHOLESTEROL AND ices under such section. cian location and retention in areas affected BLOOD LIPID SCREENING. (3) The appropriateness of the amount of by such adjustment, taking into account— (a) COVERAGE.—Section 1861(s)(2) (42 U.S.C. compensation by reason of such refinements. (i) differences in recruitment costs and re- 1395x(s)(2)), as amended by section 611(a), is (4) The effect of such refinements on access tention rates for physicians, including spe- amended— to care by medicare beneficiaries to physi- cialists, between large urban areas and other (1) in subparagraph (V), by striking ‘‘and’’ cians’ services. areas; and at the end; (5) The effect of such refinements on physi- (ii) the mobility of physicians, including (2) in subparagraph (W), by inserting ‘‘and’’ cian participation under the medicare pro- specialists, over the last decade. at the end; and gram. (C) The appropriateness of establishing a (3) by adding at the end the following new (b) VOLUME OF PHYSICIAN SERVICES.—The floor of 1.0 for the work geographic index. subparagraph: Medicare Payment Advisory Commission (2) REPORT.—By not later than September ‘‘(X) cholesterol and other blood lipid shall submit to Congress a report on the ex- 1, 2004, the Comptroller General shall submit screening tests (as defined in subsection tent to which increases in the volume of phy- to Congress and to the Secretary a report on (XX));’’. sicians’ services under part B of the medi- the evaluation conducted under paragraph (b) SERVICES DESCRIBED.—Section 1861 (42 care program are a result of care that im- (1). U.S.C. 1395x), as amended by section 611(b), is proves the health and well-being of medicare amended by adding at the end the following Subtitle B—Preventive Services beneficiaries. The study shall include the fol- new subsection: lowing: SEC. 611. COVERAGE OF AN INITIAL PREVENTIVE PHYSICAL EXAMINATION. ‘‘Cholesterol and Other Blood Lipid (1) An analysis of recent and historic Screening Test (a) COVERAGE.—Section 1861(s)(2) (42 U.S.C. growth in the components that the Sec- ‘‘(xx)(1) The term ‘cholesterol and other retary includes under the sustainable growth 1395x(s)(2)) is amended— (1) in subparagraph (U), by striking ‘‘and’’ blood lipid screening test’ means diagnostic rate (under section 1848(f) of the Social Secu- testing of cholesterol and other lipid levels rity Act). at the end; (2) in subparagraph (V), by inserting ‘‘and’’ of the blood for the purpose of early detec- (2) An examination of the relative growth tion of abnormal cholesterol and other lipid of volume in physician services between at the end; and (3) by adding at the end the following new levels. medicare beneficiaries and other popu- ‘‘(2) The Secretary shall establish stand- lations. subparagraph: ‘‘(W) an initial preventive physical exam- ards, in consultation with appropriate orga- (3) An analysis of the degree to which new nizations, regarding the frequency and type technology, including coverage determina- ination (as defined in subsection (ww));’’. (b) SERVICES DESCRIBED.—Section 1861 (42 of cholesterol and other blood lipid screening tions of the Centers for Medicare & Medicaid tests, except that such frequency may not be Services, has affected the volume of physi- U.S.C. 1395x) is amended by adding at the end the following new subsection: more often than once every 2 years.’’. cians’ services. (c) FREQUENCY.—Section 1862(a)(1) (42 ‘‘Initial Preventive Physical Examination (4) An examination of the impact on vol- U.S.C. 1395y(a)(1)), as amended by section ume of demographic changes. ‘‘(ww) The term ‘initial preventive phys- 611(e), is amended— (5) An examination of shifts in the site of ical examination’ means physicians’ services (1) by striking ‘‘and’’ at the end of subpara- service of services that influence the number consisting of a physical examination with graph (I); and intensity of services furnished in physi- the goal of health promotion and disease de- (2) by striking the semicolon at the end of cians’ offices and the extent to which tection and includes items and services (ex- subparagraph (J) and inserting ‘‘; and’’; and changes in reimbursement rates to other cluding clinical laboratory tests), as deter- (3) by adding at the end the following new providers have affected these changes. mined by the Secretary, consistent with the subparagraph: (6) An evaluation of the extent to which recommendations of the United States Pre- ‘‘(K) in the case of a cholesterol and other the Centers for Medicare & Medicaid Serv- ventive Services Task Force.’’. blood lipid screening test (as defined in sec- ices takes into account the impact of law (c) WAIVER OF DEDUCTIBLE AND COINSUR- tion 1861(xx)(1)), which is performed more and regulations on the sustainable growth ANCE.— frequently than is covered under section rate. (1) DEDUCTIBLE.—The first sentence of sec- 1861(xx)(2).’’. SEC. 604. INCLUSION OF PODIATRISTS AND DEN- tion 1833(b) (42 U.S.C. 1395l(b)) is amended— (d) EFFECTIVE DATE.—The amendments TISTS UNDER PRIVATE CON- (A) by striking ‘‘and’’ before ‘‘(6)’’, and made by this section shall apply to tests fur- TRACTING AUTHORITY. (B) by inserting before the period at the nished on or after January 1, 2005. Section 1802(b)(5)(B) (42 U.S.C. end the following: ‘‘, and (7) such deductible SEC. 613. WAIVER OF DEDUCTIBLE FOR 1395a(b)(5)(B)) is amended by striking ‘‘sec- shall not apply with respect to an initial pre- COLORECTAL CANCER SCREENING tion 1861(r)(1)’’ and inserting ‘‘paragraphs (1), ventive physical examination (as defined in TESTS. (2), and (3) of section 1861(r)’’. section 1861(ww))’’. (a) IN GENERAL.—The first sentence of sec- SEC. 605. ESTABLISHMENT OF FLOOR ON WORK (2) COINSURANCE.—Section 1833(a)(1) (42 tion 1833(b) (42 U.S.C. 1395l(b)), as amended GEOGRAPHIC ADJUSTMENT. U.S.C. 1395l(a)(1)) is amended— by section 611(c)(1), is amended— (a) MINIMUM INDEX.—Section 1848(e)(1) (42 (A) in clause (N), by inserting ‘‘(or 100 per- (1) by striking ‘‘and’’ before ‘‘(7)’’; and U.S.C. 1395w–4(e)(1)) is amended by adding at cent in the case of an initial preventive (2) by inserting before the period at the end the end the following new subparagraph: physical examination, as defined in section the following: ‘‘, and (8) such deductible shall ‘‘(E) FLOOR AT 1.0 ON WORK GEOGRAPHIC 1861(ww))’’ after ‘‘80 percent’’; and not apply with respect to colorectal cancer INDEX.— (B) in clause (O), by inserting ‘‘(or 100 per- screening tests (as described in section ‘‘(i) IN GENERAL.—Subject to clause (ii), cent in the case of an initial preventive 1861(pp)(1))’’. after calculating the work geographic index physical examination, as defined in section (b) CONFORMING AMENDMENTS.—Paragraphs in subparagraph (A)(iii), for purposes of pay- 1861(ww))’’ after ‘‘80 percent’’. (2)(C)(ii) and (3)(C)(ii) of section 1834(d) (42 ment for services furnished on or after Janu- (d) PAYMENT AS PHYSICIANS’ SERVICES.— U.S.C. 1395m(d)) are each amended— ary 1, 2004, and before January 1, 2006, the Section 1848(j)(3) (42 U.S.C. 1395w–4(j)(3)) is (1) by striking ‘‘DEDUCTIBLE AND’’ in the Secretary shall increase the work geographic amended by inserting ‘‘(2)(W),’’ after heading; and index to 1.00 for any locality for which such ‘‘(2)(S),’’. (2) in subclause (I), by striking ‘‘deductible work geographic index is less than 1.00. (e) OTHER CONFORMING AMENDMENTS.—Sec- or’’ each place it appears. ‘‘(ii) SECRETARIAL DISCRETION.—Clause (i) tion 1862(a) (42 U.S.C. 1395y(a)) is amended— (c) EFFECTIVE DATE.—The amendment shall have no force or effect in law if the (1) in paragraph (1)— made by this section shall apply to items
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00107 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.061 H26PT1 H6048 CONGRESSIONAL RECORD — HOUSE June 26, 2003 and services furnished on or after Janaury 1, under the payment system under this sub- that classify such devices separately from 2004. section shall be equal to 95 percent of the av- the other services (or group of services) paid SEC. 614. IMPROVED PAYMENT FOR CERTAIN erage wholesale price for the drug. for under this subsection in a manner re- MAMMOGRAPHY SERVICES. ‘‘(E) CLASSES OF DRUGS.—For purposes of flecting the number, isotope, and radioactive (a) EXCLUSION FROM OPD FEE SCHEDULE.— this paragraph, each of the following shall be intensity of such devices furnished, including Section 1833(t)(1)(B)(iv) (42 U.S.C. treated as a separate class of drugs: separate groups for palladium-103 and iodine- 1395l(t)(1)(B)(iv)) is amended by inserting be- ‘‘(i) SOLE SOURCE DRUGS.—A sole source 125 devices.’’. fore the period at the end the following: ‘‘and drug which for purposes of this paragraph (3) GAO REPORT.—The Comptroller General does not include screening mammography means a drug or biological that is not a mul- of the United States shall conduct a study to (as defined in section 1861(jj)) and unilateral tiple source drug (as defined in subclauses (I) determine appropriate payment amounts and bilateral diagnostic mammography’’. and (II) of section 1927(k)(7)(A)(i)) and is not under section 1833(t)(13)(B) of the Social Se- (b) EFFECTIVE DATE.—The amendment a drug approved under an abbreviated new curity Act, as added by paragraph (1), for de- made by subsection (a) shall apply to mam- drug application under section 355(j) of the vices of brachytherapy. Not later than Janu- mography performed on or after January 1, Federal Food, Drug, and Cosmetic Act. ary 1, 2005, the Comptroller General shall 2004. ‘‘(ii) INNOVATOR MULTIPLE SOURCE DRUGS.— submit to Congress and the Secretary a re- Subtitle C—Other Services Innovator multiple source drugs (as defined port on the study conducted under this para- SEC. 621. HOSPITAL OUTPATIENT DEPARTMENT in section 1927(k)(7)(A)(ii)). graph, and shall include specific rec- (HOPD) PAYMENT REFORM. ‘‘(iii) NONINNOVATOR MULTIPLE SOURCE ommendations for appropriate payments for (a) PAYMENT FOR DRUGS.— DRUGS.—Noninnovator multiple source drugs such devices. (1) MODIFICATION OF AMBULATORY PAYMENT (as defined in section 1927(k)(7)(A)(iii)). (c) APPLICATION OF FUNCTIONAL EQUIVA- CLASSIFICATION (APC) GROUPS.—Section 1833(t) ‘‘(F) INAPPLICABILITY OF EXPENDITURES IN LENCE TEST.— (42 U.S.C. 1395l(t)) is amended— DETERMINING CONVERSION FACTORS.—Addi- (1) IN GENERAL.—Section 1833(t)(6) (42 (A) by redesignating paragraph (13) as tional expenditures resulting from this para- U.S.C. 1395l(t)(6)) is amended by adding at paragraph (14); and graph and paragraph (14)(C) in a year shall the end the following new subparagraph: (B) by inserting after paragraph (12) the not be taken into account in establishing the ‘‘(F) LIMITATION ON APPLICATION OF FUNC- following new paragraph: conversion factor for that year.’’. TIONAL EQUIVALENCE STANDARD.—The Sec- ‘‘(13) DRUG APC PAYMENT RATES.— (2) REDUCTION IN THRESHOLD FOR SEPARATE retary may not apply a ‘functional equiva- ‘‘(A) IN GENERAL.—With respect to pay- APCS FOR DRUGS.—Section 1833(t)(14), as re- lence’ payment standard (including such ment for covered OPD services that includes designated by paragraph (1)(A), is amended standard promulgated on November 1, 2002) a specified covered outpatient drug (defined by adding at the end the following new sub- or any other similar standard in order to in subparagraph (B)), the amount provided paragraph: deem a particular product to be functionally for payment for such drug under the pay- ‘‘(B) THRESHOLD FOR ESTABLISHMENT OF equivalent (or a similar standard) unless the ment system under this subsection for serv- SEPARATE APCS FOR DRUGS.—The Secretary Commissioner of Food and Drugs establishes ices furnished in— shall reduce the threshold for the establish- a functional equivalence standard and cer- ‘‘(i) 2004, 2005, or 2006, shall in no case— ment of separate ambulatory payment clas- tifies, under such standards, that the two sification groups (APCs) with respect to ‘‘(I) exceed 95 percent of the average whole- products are functionally equivalent. If the drugs to $50 per administration.’’. sale price for the drug; or Commissioner makes such a certification (3) EXCLUSION OF SEPARATE DRUG APCS FROM ‘‘(II) be less than the transition percentage with respect to two or more products, the OUTLIER PAYMENTS.—Section 1833(t)(5) is (under subparagraph (C)) of the average Secretary may, after complying with appli- amended by adding at the end the following wholesale price for the drug; or cable rulemaking requirements, implement new subparagraph: ‘‘(ii) a subsequent year, shall be equal to such standard with respect to such products ‘‘(E) EXCLUSION OF SEPARATE DRUG APCS the average price for the drug for that area under this subsection.’’. FROM OUTLIER PAYMENTS.—No additional pay- and year established under the competitive (2) EFFECTIVE DATE.—The amendment ment shall be made under subparagraph (A) acquisition program under section 1847A as made by paragraph (1) shall apply to the ap- calculated and applied by the Secretary for in the case of ambulatory procedure codes established separately for drugs.’’. plication of a functional equivalence stand- purposes of this paragraph. ard to a drug or biological on or after the (4) PAYMENT FOR PASS THROUGH DRUGS.— ‘‘(B) SPECIFIED COVERED OUTPATIENT DRUG date of the enactment of this Act, unless DEFINED.— Clause (i) of section 1833(t)(6)(D) (42 U.S.C. 1395l(t)(6)(D)) is amended by inserting after such application was being made to such ‘‘(i) IN GENERAL.—In this paragraph, the drug or biological prior to June 13, 2003. term ‘specified covered outpatient drug’ ‘‘under section 1842(o)’’ the following: ‘‘(or if the drug is covered under a competitive ac- (d) HOSPITAL ACQUISITION COST STUDY.— means, subject to clause (ii), a covered out- (1) IN GENERAL.—The Secretary shall con- patient drug (as defined in 1927(k)(2), that quisition contract under section 1847A for an area, an amount determined by the Sec- duct a study on the costs incurred by hos- is— pitals in acquiring covered outpatient drugs ‘‘(I) a radiopharmaceutical; or retary equal to the average price for the drug for that area and year established under for which payment is made under section ‘‘(II) a drug or biological for which pay- 1833(t) of the Social Security Act (42 U.S.C. ment was made under paragraph (6) (relating such section as calculated and applied by the Secretary for purposes of this paragraph)’’. 1395l(t)). to pass-through payments) on or before De- (2) DRUGS COVERED.—The study in para- cember 31, 2002. (5) EFFECTIVE DATE.—The amendments made by this subsection shall apply to serv- graph (1) shall not include those drugs for ‘‘(ii) EXCEPTION.—Such term does not in- which the acquisition costs is less than $50 clude— ices furnished on or after January 1, 2004. (b) SPECIAL PAYMENT FOR per administration. ‘‘(I) a drug for which payment is first made BRACHYTHERAPY.— (3) REPRESENTATIVE SAMPLE OF HOS- on or after January 1, 2003, under paragraph (1) IN GENERAL.—Section 1833(t)(14), as so PITALS.—In conducting the study under para- (6); or redesignated and amended by subsection graph (1), the Secretary shall collect data ‘‘(II) a drug for a which a temporary (a)(2), is amended by adding at the end the from a statistically valid sample of hospitals HCPCS code has not been assigned. following new subparagraph: with an urban/rural stratification. ‘‘(C) TRANSITION TOWARDS HISTORICAL AVER- ‘‘(C) PAYMENT FOR DEVICES OF (4) REPORT.—Not later than January 1, AGE ACQUISITION COST.—The transition per- BRACHYTHERAPY AT CHARGES ADJUSTED TO 2006, the Secretary shall submit to Congress centage under this subparagraph for drugs COST.—Notwithstanding the preceding provi- a report on the study conducted under para- furnished in a year is determined in accord- sions of this subsection, for a device of graph (1), and shall include recommenda- ance with the following table: brachytherapy furnished on or after January tions with respect to the following: The transition percent- (A) Whether the study should be repeated, age for— 1, 2004, and before January 1, 2007, the pay- ment basis for the device under this sub- and if so, how frequently. Inno- section shall be equal to the hospital’s (B) Whether the study produced useful data For the year— Single vator Ge- on hospital acquisition cost. source multiple neric charges for each device furnished, adjusted drugs source drugs to cost.’’. (C) Whether data produced in the study is are— drugs are— (2) SPECIFICATION OF GROUPS FOR appropriate for use in making adjustments are— BRACHYTHERAPY DEVICES.—Section 1833(t)(2) to payments for drugs and biologicals under 2004 ...... 83% 81.5% 46% (42 U.S.C. 1395l(t)(2) is amended— section 1847A of the Social Security Act. 2005 ...... 77% 75% 46% (A) in subparagraph (F), by striking ‘‘and’’ (D) Whether separate estimates can be 2006 ...... 71% 68% 46% at the end; made of overhead costs, including handing ‘‘(D) PAYMENT FOR NEW DRUGS UNTIL TEM- (B) in subparagraph (G), by striking the pe- and administering costs for drugs. PORARY HCPCS CODE ASSIGNED.—With re- riod at the end and inserting ‘‘; and’’; and SEC. 622. PAYMENT FOR AMBULANCE SERVICES. spect to payment for covered OPD services (C) by adding at the end the following new (a) PHASE-IN PROVIDING FLOOR USING that includes a covered outpatient drug (as subparagraph: BLEND OF FEE SCHEDULE AND REGIONAL FEE defined in 1927(k)) for a which a temporary ‘‘(H) with respect to devices of SCHEDULES.—Section 1834(l) (42 U.S.C. HCPCS code has not been assigned, the brachytherapy, the Secretary shall create 1395m(l)), as amended by section 410(a), is amount provided for payment for such drug additional groups of covered OPD services amended—
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00108 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.061 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6049 (1) in paragraph (2)(E), by inserting ‘‘con- models (as published in the Federal Register or diseases that should justify conducting an sistent with paragraph (11)’’ after ‘‘in an effi- of June 4, 2003), the Secretary shall establish assessment of the need to waive the therapy cient and fair manner’’; and an advisory board comprised of representa- caps under section 1833(g)(4) of the Social Se- (2) by adding at the end the following new tives described in paragraph (2) to provide curity Act (42 U.S.C. 1395l(g)(4)). paragraph: advice and recommendations with respect to (2) REPORTS TO CONGRESS.— ‘‘(11) PHASE-IN PROVIDING FLOOR USING the establishment and operation of such (A) PRELIMINARY REPORT.—Not later than BLEND OF FEE SCHEDULE AND REGIONAL FEE demonstration project. July 1, 2004, the Secretary shall submit to SCHEDULES.—In carrying out the phase-in (2) REPRESENTATIVES.—Representatives re- Congress a preliminary report on the condi- under paragraph (2)(E) for each level of serv- ferred to in paragraph (1) include representa- tions and diseases identified under paragraph ice furnished in a year, the portion of the tives of the following: (1). payment amount that is based on the fee (A) Patient organizations. (B) FINAL REPORT.—Not later than Sep- schedule shall be the greater of the amount (B) Clinicians. tember 1, 2004, the Secretary shall submit to determined under such fee schedule (without (C) The medicare payment advisory com- Congress a final report on such conditions regard to this paragraph) or the following mission, established under section 1805 of the and diseases. blended rate of the fee schedule under para- Social Security Act (42 U.S.C. 1395b–6). (C) RECOMMENDATIONS.—Not later than Oc- graph (1) and of a regional fee schedule for (D) The National Kidney Foundation. tober 1, 2004, the Secretary shall submit to the region involved: (E) The National Institute of Diabetes and Congress a recommendation of criteria, with ‘‘(A) For 2004, the blended rate shall be Digestive and Kidney Diseases of National respect to such conditions and disease, under based 20 percent on the fee schedule under Institutes of Health. which a waiver of the therapy caps would paragraph (1) and 80 percent on the regional (F) End-stage renal disease networks. apply. fee schedule. (G) Medicare contractors to monitor qual- (d) GAO STUDY OF PATIENT ACCESS TO ‘‘(B) For 2005, the blended rate shall be ity of care. PHYSICAL THERAPIST SERVICES.— based 40 percent on the fee schedule under (I) providers of services and renal dialysis (1) STUDY.—The Comptroller General of the paragraph (1) and 60 percent on the regional facilities furnishing end-stage renal disease United States shall conduct a study on ac- fee schedule. services. cess to physical therapist services in States ‘‘(C) For 2006, the blended rate shall be (J) Economists. authorizing such services without a physi- based 60 percent on the fee schedule under (K) Researchers. cian referral and in States that require such paragraph (1) and 40 percent on the regional (b) RESTORING COMPOSITE RATE EXCEPTIONS a physician referral. The study shall— fee schedule. FOR PEDIATRIC FACILITIES.— (A) examine the use of and referral pat- ‘‘(D) For 2007, 2008, and 2009, the blended (1) IN GENERAL.—Section 422(a)(2) of BIPA terns for physical therapist services for pa- rate shall be based 80 percent on the fee is amended— tients age 50 and older in States that author- schedule under paragraph (1) and 20 percent (A) in subparagraph (A), by striking ‘‘and ize such services without a physician referral on the regional fee schedule. (C)’’ and inserting ‘‘, (C), and (D)’’; and in States that require such a physician ‘‘(E) For 2010 and each succeeding year, the (B) in subparagraph (B), by striking ‘‘In referral; blended rate shall be based 100 percent on the the case’’ and inserting ‘‘Subject to subpara- (B) examine the use of and referral pat- fee schedule under paragraph (1). graph (D), in the case’’; and terns for physical therapist services for pa- For purposes of this paragraph, the Sec- (C) by adding at the end the following new tients who are medicare beneficiaries; retary shall establish a regional fee schedule subparagraph: (C) examine the potential effect of prohib- for each of the 9 Census divisions using the ‘‘(D) INAPPLICABILITY TO PEDIATRIC FACILI- iting a physician from referring patients to methodology (used in establishing the fee TIES.—Subparagraphs (A) and (B) shall not physical therapy services owned by the phy- schedule under paragraph (1)) to calculate a apply, as of October 1, 2002, to pediatric fa- sician and provided in the physician’s office; regional conversion factor and a regional cilities that do not have an exception rate (D) examine the delivery of physical thera- mileage payment rate and using the same described in subparagraph (C) in effect on pists’ services within the facilities of Depart- payment adjustments and the same relative such date. For purposes of this subpara- ment of Defense; and value units as used in the fee schedule under graph, the term ‘pediatric facility’ means a (E) analyze the potential impact on medi- such paragraph.’’. renal facility at least 50 percent of whose pa- care beneficiaries and on expenditures under (b) ADJUSTMENT IN PAYMENT FOR CERTAIN tients are individuals under 18 years of age.’’. the medicare program of eliminating the LONG TRIPS.—Section 1834(l), as amended by (2) CONFORMING AMENDMENT.—The fourth need for a physician referral and physician subsection (a), is further amended by adding sentence of section 1881(b)(7) (42 U.S.C. certification for physical therapist services at the end the following new paragraph: 1395rr(b)(7)), as amended by subsection (b), is under the medicare program. ‘‘(12) ADJUSTMENT IN PAYMENT FOR CERTAIN further amended by striking ‘‘Until’’ and in- (2) REPORT.—The Comptroller General LONG TRIPS.—In the case of ground ambu- serting ‘‘Subject to section 422(a)(2) of the shall submit to Congress a report on the lance services furnished on or after January Medicare, Medicaid, and SCHIP Benefits Im- study conducted under paragraph (1) by not 1, 2004, and before January 1, 2009, regardless provement and Protection Act of 2000, and later than 1 year after the date of the enact- of where the transportation originates, the until’’. ment of this Act. fee schedule established under this sub- (c) INCREASE IN RENAL DIALYSIS COMPOSITE SEC. 625. ADJUSTMENT TO PAYMENTS FOR SERV- section shall provide that, with respect to RATE FOR SERVICES FURNISHED IN 2004.—Not- ICES FURNISHED IN AMBULATORY the payment rate for mileage for a trip above withstanding any other provision of law, SURGICAL CENTERS. 50 miles the per mile rate otherwise estab- with respect to payment under part B of title Section 1833(i)(2)(C) (42 U.S.C. 1395l(i)(2)(C)) is amended in the last sentence by inserting lished shall be increased by 1⁄4 of the pay- XVIII of the Social Security Act for renal di- ment per mile otherwise applicable to such alysis services furnished in 2004, the com- ‘‘and each of fiscal years 2004 through 2008’’ miles.’’. posite payment rate otherwise established after ‘‘In each of the fiscal years 1998 (c) GAO REPORT ON COSTS AND ACCESS.— under section 1881(b)(7) of such Act (42 U.S.C. through 2002’’. Not later than December 31, 2005, the Comp- 1395rr(b)(7)) shall be increased by 1.6 percent. SEC. 626. PAYMENT FOR CERTAIN SHOES AND IN- troller General of the United States shall SEC. 624. ONE-YEAR MORATORIUM ON THERAPY SERTS UNDER THE FEE SCHEDULE FOR ORTHOTICS AND PROSTHETICS. submit to Congress an initial report on how CAPS; PROVISIONS RELATING TO RE- PORTS. (a) IN GENERAL.—Section 1833(o) (42 U.S.C. costs differ among the types of ambulance (a) 1-YEAR MORATORIUM ON THERAPY 1395l(o)) is amended— providers and on access, supply, and quality CAPS.—Section 1833(g)(4) (42 U.S.C. (1) in paragraph (1), by striking ‘‘no more of ambulance services in those regions and 1395l(g)(4)) is amended by striking ‘‘and 2002’’ than the limits established under paragraph States that have a reduction in payment and inserting ‘‘2002, and 2004’’. (2)’’ and inserting ‘‘no more than the amount under the medicare ambulance fee schedule (b) PROMPT SUBMISSION OF OVERDUE RE- of payment applicable under paragraph (2)’’; (under section 1834(l) of the Social Security PORTS ON PAYMENT AND UTILIZATION OF OUT- and Act, as amended by this section). Not later PATIENT THERAPY SERVICES.—Not later than (2) in paragraph (2), to read as follows: than December 31, 2007, the Comptroller Gen- December 31, 2003, the Secretary shall sub- ‘‘(2)(A) Except as provided by the Sec- eral shall submit to Congress a final report mit to Congress the reports required under retary under subparagraphs (B) and (C), the on such access and supply. section 4541(d)(2) of the Balanced Budget Act amount of payment under this paragraph for (d) EFFECTIVE DATE.—The amendments of 1997 (relating to alternatives to a single custom molded shoes, extra depth shoes, and made by this section shall apply to ambu- annual dollar cap on outpatient therapy) and inserts shall be the amount determined for lance services furnished on or after January under section 221(d) of the Medicare, Med- such items by the Secretary under section 1, 2004. icaid, and SCHIP Balanced Budget Refine- 1834(h). SEC. 623. RENAL DIALYSIS SERVICES. ment Act of 1999 (relating to utilization pat- ‘‘(B) The Secretary or a carrier may estab- (a) DEMONSTRATION OF ALTERNATIVE DELIV- terns for outpatient therapy). lish payment amounts for shoes and inserts ERY MODELS.— (c) IDENTIFICATION OF CONDITIONS AND DIS- that are lower than the amount established (1) USE OF ADVISORY BOARD.—In carrying EASES JUSTIFYING WAIVER OF THERAPY CAP.— under section 1834(h) if the Secretary finds out the demonstration project relating to (1) STUDY.—The Secretary shall request that shoes and inserts of an appropriate improving care for people with end-stage the Institute of Medicine of the National quality are readily available at or below the renal disease through alternative delivery Academy of Sciences to identify conditions amount established under such section.
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00109 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.061 H26PT1 H6050 CONGRESSIONAL RECORD — HOUSE June 26, 2003 ‘‘(C) In accordance with procedures estab- section 1839(a)(1) ending with such subse- ‘‘(G) Hypertension. lished by the Secretary, an individual enti- quent year (rounded to the nearest $1)’’. ‘‘(H) Dyslipidemia. tled to benefits with respect to shoes de- SEC. 629. EXTENSION OF COVERAGE OF INTRA- ‘‘(I) History of gestational diabetes scribed in section 1861(s)(12) may substitute VENOUS IMMUNE GLOBULIN (IVIG) mellitus or delivery of a baby weighing modification of such shoes instead of obtain- FOR THE TREATMENT OF PRIMARY greater than 9 pounds. ing one (or more, as specified by the Sec- IMMUNE DEFICIENCY DISEASES IN ‘‘(J) Polycystic ovary syndrome. retary) pair of inserts (other than the origi- THE HOME. ‘‘(3) The Secretary shall establish stand- nal pair of inserts with respect to such (a) IN GENERAL.—Section 1861 (42 U.S.C. ards, in consultation with appropriate orga- shoes). In such case, the Secretary shall sub- 1395x), as amended by sections 611(a) and nizations, regarding the frequency of diabe- stitute, for the payment amount established 612(a) is amended— tes screening tests, except that such fre- under section 1834(h), a payment amount (1) in subsection (s)(2)— quency may not be more often than twice that the Secretary estimates will assure that (A) by striking ‘‘and’’ at the end of sub- within the 12-month period following the there is no net increase in expenditures paragraph (W); date of the most recent diabetes screening under this subsection as a result of this sub- (B) by adding ‘‘and’’ at the end of subpara- test of that individual.’’. paragraph.’’. graph (X); and (c) FREQUENCY.—Section 1862(a)(1) (42 (b) CONFORMING AMENDMENTS.—(1) Section (C) by adding at the end the following new U.S.C. 1395y(a)(1)), as amended by sections 1834(h)(4)(C) (42 U.S.C. 1395m(h)(4)(C)) is subparagraph: 611 and 612, is amended— amended by inserting ‘‘(and includes shoes ‘‘(Y) intravenous immune globulin for the (1) by striking ‘‘and’’ at the end of subpara- described in section 1861(s)(12))’’ after ‘‘in treatment of primary immune deficiency dis- graph (J); section 1861(s)(9)’’. eases in the home (as defined in subsection (2) by striking the semicolon at the end of (2) Section 1842(s)(2) (42 U.S.C. 1395u(s)(2)) (yy));’’; and subparagraph (K) and inserting ‘‘; and’’; and is amended by striking subparagraph (C). (2) by adding at the end the following new (3) by adding at the end the following new (c) EFFECTIVE DATE.—The amendments subsection: subparagraph: made by this section shall apply to items ‘‘Intravenous Immune Globulin ‘‘(L) in the case of a diabetes screening tests or service (as defined in section furnished on or after January 1, 2004. ‘‘(yy) The term ‘intravenous immune glob- SEC. 627. WAIVER OF PART B LATE ENROLLMENT 1861(yy)(1)), which is performed more fre- ulin’ means an approved pooled plasma de- quently than is covered under section PENALTY FOR CERTAIN MILITARY rivative for the treatment in the patient’s RETIREES; SPECIAL ENROLLMENT 1861(yy)(3).’’. PERIOD. home of a patient with a diagnosed primary (d) EFFECTIVE DATE.—The amendments (a) WAIVER OF PENALTY.— immune deficiency disease, but not including made by this section shall apply to tests fur- (1) IN GENERAL.—Section 1839(b) (42 U.S.C. items or services related to the administra- nished on or after the date that is 90 days 1395r(b)) is amended by adding at the end the tion of the derivative, if a physician deter- after the date of enactment of this Act. following new sentence: ‘‘No increase in the mines administration of the derivative in SEC. 631. DEMONSTRATION PROJECT FOR COV- premium shall be effected for a month in the the patient’s home is medically appro- ERAGE OF CERTAIN PRESCRIPTION case of an individual who is 65 years of age priate.’’. DRUGS AND BIOLOGICS. or older, who enrolls under this part during (b) PAYMENT AS A DRUG OR BIOLOGICAL.— (a) DEMONSTRATION PROJECT.—The Sec- 2001, 2002, 2003, or 2004 and who demonstrates Section 1833(a)(1)(S) (42 U.S.C. 1395l(a)(1)(S)) retary shall conduct a demonstration project to the Secretary before December 31, 2004, is amended by inserting ‘‘(including intra- under part B of title XVIII of the Social Se- that the individual is a covered beneficiary venous immune globulin (as defined in sec- curity Act under which payment is made for (as defined in section 1072(5) of title 10, tion 1861(yy)))’’ after ‘‘with respect to drugs drugs or biologics that are prescribed as re- placements for drugs and biologicals de- United States Code). The Secretary of Health and biologicals’’. scribed in section 1861(s)(2)(A) or 1861(s)(2)(Q) and Human Services shall consult with the (c) EFFECTIVE DATE.—The amendments of such Act (42 U.S.C. 1395x(s)(2)(A), Secretary of Defense in identifying individ- made by this section shall apply to items 1395x(s)(2)(Q))), or both, for which payment is uals described in the previous sentence.’’. furnished administered on or after January 1, 2004. made under such part. (2) EFFECTIVE DATE.—The amendment (b) DEMONSTRATION PROJECT SITES.—The made by paragraph (1) shall apply to pre- SEC. 630. MEDICARE COVERAGE OF DIABETES LABORATORY DIAGNOSTIC TESTS. project established under this section shall miums for months beginning with January be conducted in 3 States selected by the Sec- 2004. The Secretary of Health and Human (a) COVERAGE.—Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)), as amended by sections 611 and retary. Services shall establish a method for pro- (c) DURATION.—The Secretary shall con- 612, is amended— viding rebates of premium penalties paid for duct the demonstration project for the 2- (1) in subparagraph (W), by striking ‘‘and’’ months on or after January 2004 for which a year period beginning on the date that is 90 at the end; penalty does not apply under such amend- days after the date of the enactment of this ment but for which a penalty was previously (2) in subparagraph (X), by adding ‘‘and’’ at Act, but in no case may the project extend collected. the end; and beyond December 31, 2005. (b) MEDICARE PART B SPECIAL ENROLLMENT (3) by adding at the end the following new (d) LIMITATION.—Under the demonstration PERIOD.— subparagraph: project over the duration of the project, the (1) IN GENERAL.—In the case of any indi- ‘‘(Y) diabetes screening tests and services Secretary may not provide— vidual who, as of the date of the enactment (as defined in subsection (yy));’’. (1) coverage for more than 10,000 patients; of this Act, is 65 years of age or older, is eli- (b) SERVICES DESCRIBED.—Section 1861 (42 and gible to enroll but is not enrolled under part U.S.C. 1395x), as amended by sections 611 and (2) more than $100,000,000 in funding. B of title XVIII of the Social Security Act, 612, is further amended by adding at the end (e) REPORT.—Not later than January 1, and is a covered beneficiary (as defined in the following new subsection: 2006, the Secretary shall submit to Congress section 1072(5) of title 10, United States ‘‘Diabetes Screening Tests and Services a report on the project. The report shall in- Code), the Secretary of Health and Human ‘‘(yy)(1) The term ‘diabetes screening tests’ clude an evaluation of patient access to care Services shall provide for a special enroll- means diagnostic testing furnished to an in- and patient outcomes under the project, as ment period during which the individual may dividual at risk for diabetes (as defined in well as an analysis of the cost effectiveness enroll under such part. Such period shall paragraph (2)) for the purpose of early detec- of the project, including an evaluation of the begin as soon as possible after the date of the tion of diabetes, including— costs savings (if any) to the medicare pro- gram attributable to reduced physicians’ enactment of this Act and shall end on De- ‘‘(A) a fasting plasma glucose test; and services and hospital outpatient departments cember 31, 2004. ‘‘(B) such other tests, and modifications to services for administration of the biological. (2) COVERAGE PERIOD.—In the case of an in- tests, as the Secretary determines appro- dividual who enrolls during the special en- priate, in consultation with appropriate or- TITLE VII—PROVISIONS RELATING TO rollment period provided under paragraph ganizations. PARTS A AND B (1), the coverage period under part B of title ‘‘(2) For purposes of paragraph (1), the Subtitle A—Home Health Services XVIII of the Social Security Act shall begin term ‘individual at risk for diabetes’ means SEC. 701. UPDATE IN HOME HEALTH SERVICES. on the first day of the month following the an individual who has any, a combination of, (a) CHANGE TO CALENDER YEAR UPDATE.— month in which the individual enrolls. or all of the following risk factors for diabe- (1) IN GENERAL.—Section 1895(b) (42 U.S.C. SEC. 628. PART B DEDUCTIBLE. tes: 1395fff(b)(3)) is amended— Section 1833(b) (42 U.S.C. 1395l(b)) is ‘‘(A) A family history of diabetes. (A) in paragraph (3)(B)(i)— amended— ‘‘(B) Overweight defined as a body mass (i) by striking ‘‘each fiscal year (beginning (1) by striking ‘‘1991 and’’ and inserting index greater than or equal to 25 kg/m2. with fiscal year 2002)’’ and inserting ‘‘fiscal ‘‘1991,’’; and ‘‘(C) Habitual physical inactivity. year 2002 and for fiscal year 2003 and for each (2) by striking ‘‘and subsequent years’’ and ‘‘(D) Belonging to a high-risk ethnic or ra- subsequent year (beginning with 2004)’’; and inserting ‘‘and each subsequent year through cial group. (ii) by inserting ‘‘or year’’ after ‘‘the fiscal 2003, and for a subsequent year after 2003 the ‘‘(E) Previous identification of an elevated year’’; amount of such deductible for the previous impaired fasting glucose. (B) in paragraph (3)(B)(ii)(II), by striking year increased by the annual percentage in- ‘‘(F) Identification of impaired glucose tol- ‘‘any subsequent fiscal year’’ and inserting crease in the monthly actuarial rate under erance. ‘‘2004 and any subsequent year’’;
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00110 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.061 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6051 (C) in paragraph (3)(B)(iii), by inserting ‘‘or (A) by striking ‘‘or coinsurance’’ and in- (A) adversely effects the provision of home year’’ after ‘‘fiscal year’’ each place it ap- serting ‘‘, coinsurance, or copayment’’; and health services under the medicare program; pears; (B) by striking ‘‘or (a)(4)’’ and inserting or (D) in paragraph (3)(B)(iv)— ‘‘(a)(4), or (a)(5)’’. (B) directly causes an unreasonable in- (i) by inserting ‘‘or year’’ after ‘‘fiscal SEC. 703. MEDPAC STUDY ON MEDICARE MAR- crease of expenditures under the medicare year’’ each place it appears; and GINS OF HOME HEALTH AGENCIES. program for the provision of such services (ii) by inserting ‘‘or years’’ after ‘‘fiscal (a) STUDY.—The Medicare Payment Advi- that is directly attributable to such clari- years’’; and sory Commission shall conduct a study of fication; (E) in paragraph (5), by inserting ‘‘or year’’ payment margins of home health agencies (2) the specific data evidencing the amount after ‘‘fiscal year’’. under the home health prospective payment of any increase in expenditures that is a di- (2) TRANSITION RULE.—The standard pro- system under section 1895 of the Social Secu- rectly attributable to the demonstration spective payment amount (or amounts) rity Act (42 U.S.C. 1395fff). Such study shall project (expressed both in absolute dollar under section 1895(b)(3) of the Social Secu- examine whether systematic differences in terms and as a percentage) above expendi- rity Act for the calendar quarter beginning payment margins are related to differences tures that would otherwise have been in- on October 1, 2003, shall be such amount (or in case mix (as measured by home health re- curred for home health services under the amounts) for the previous calendar quarter. source groups (HHRGs)) among such agen- medicare program; and (b) CHANGES IN UPDATES FOR 2004, 2005, AND cies. The study shall use the partial or full- (3) specific recommendations to exempt 2006.—Section 1895(b)(3)(B)(ii) (42 U.S.C. year cost reports filed by home health agen- permanently and severely disabled home- 1395fff(b)(3)(B)(ii)), as amended by subsection cies. bound beneficiaries from restrictions on the (a)(1)(B), is amended— (b) REPORT.—Not later than 2 years after length, frequency and purpose of their ab- (1) by striking ‘‘or’’ at the end of subclause the date of the enactment of this Act, the sences from the home to qualify for home (I); Commission shall submit to Congress a re- health services without incurring additional (2) by redesignating subclause (II) as sub- port on the study under subsection (a). unreasonable costs to the medicare program. clause (III); SEC. 704. DEMONSTRATION PROJECT TO CLARIFY (g) WAIVER AUTHORITY.—The Secretary (3) in subclause (III), as so redesignated, by THE DEFINITION OF HOMEBOUND. shall waive compliance with the require- striking ‘‘2004’’ and inserting ‘‘2007’’; and (a) DEMONSTRATION PROJECT.—Not later ments of title XVIII of the Social Security (4) by inserting after subclause (I) the fol- than 180 days after the date of the enactment Act (42 U.S.C. 1395 et seq.) to such extent and lowing new subclause: of this Act, the Secretary shall conduct a for such period as the Secretary determines ‘‘(II) each of 2004, 2005, and 2006 the home two-year demonstration project under part B is necessary to conduct demonstration health market basket percentage increase of title XVIII of the Social Security Act projects. minus 0.4 percentage points; or’’. under which medicare beneficiaries with (h) CONSTRUCTION.—Nothing in this section shall be construed as waiving any applicable SEC. 702. ESTABLISHMENT OF REDUCED COPAY- chronic conditions described in subsection MENT FOR A HOME HEALTH SERV- (b) are deemed to be homebound for purposes civil monetary penalty, criminal penalty, or other remedy available to the Secretary ICE EPISODE OF CARE FOR CERTAIN of receiving home health services under the under title XI or title XVIII of the Social Se- BENEFICIARIES. medicare program. curity Act for acts prohibited under such ti- (a) PART A.— (b) MEDICARE BENEFICIARY DESCRIBED.—For (1) IN GENERAL.—Section 1813(a) (42 U.S.C. purposes of subsection (a), a medicare bene- tles, including penalties for false certifi- cations for purposes of receipt of items or 1395e(a)) is amended by adding at the end the ficiary is eligible to be deemed to be home- services under the medicare program. following new paragraph: bound, without regard to the purpose, fre- ‘‘(5)(A)(i) Subject to clause (ii), the amount (i) AUTHORIZATION OF APPROPRIATIONS.— quency, or duration of absences from the Payments for the costs of carrying out the payable for home health services furnished home, if— to the individual under this title for each demonstration project under this section (1) the beneficiary has been certified by episode of care beginning in a year (begin- shall be made from the Federal Supple- one physician as an individual who has a per- ning with 2004) shall be reduced by a copay- mentary Insurance Trust Fund under section manent and severe condition that will not ment equal to the copayment amount speci- 1841 of such Act (42 U.S.C. 1395t). improve; fied in subparagraph (B)(ii) for such year. (j) DEFINITIONS.—In this section: ‘‘(ii) The copayment under clause (i) shall (2) the beneficiary requires the individual (1) MEDICARE BENEFICIARY.—The term not apply— to receive assistance from another individual ‘‘medicare beneficiary’’ means an individual ‘‘(I) in the case of an individual who has with at least 3 out of the 5 activities of daily who is enrolled under part B of title XVIII of been determined to be entitled to medical as- living for the rest of the individual’s life; the Social Security Act. sistance under section 1902(a)(10)(A) or (3) the beneficiary requires skilled nursing (2) HOME HEALTH SERVICES.—The term 1902(a)(10)(C) or to be a qualified medicare services on a permanent basis and the skilled ‘‘home health services’’ has the meaning beneficiary (as defined in section 1905(p)(1)), nursing is more than medication manage- given such term in section 1861(m) of the So- a specified low-income medicare beneficiary ment; cial Security Act (42 U.S.C. 1395x(m)). described in section 1902(a)(10)(E)(iii), or a (4) either (A) an attendant is needed during (3) ACTIVITIES OF DAILY LIVING DEFINED.— qualifying individual described in section the day to monitor and treat the bene- The term ‘‘activities of daily living’’ means 1902(a)(10)(E)(iv)(I); and ficiary’s medical condition, or (B) the bene- eating, toileting, transferring, bathing, and ‘‘(II) in the case of an episode of care which ficiary needs daily skilled nursing on a per- dressing. consists of 4 or fewer visits. manent basis and the skilled nursing is more (4) SECRETARY.—The term ‘‘Secretary’’ ‘‘(B)(i) The Secretary shall estimate, be- than medication management; and means the Secretary of Health and Human fore the beginning of each year (beginning (5) the beneficiary requires technological Services. with 2004), the national average payment assistance or the assistance of another per- Subtitle B—Direct Graduate Medical under this title per episode for home health son to leave the home. Education services projected for the year involved. (c) DEMONSTRATION PROJECT SITES.—The demonstration project established under this SEC. 711. EXTENSION OF UPDATE LIMITATION ON ‘‘(ii) For each year the copayment amount HIGH COST PROGRAMS. under this clause is equal to 1.5 percent of section shall be conducted in 3 States se- Section 1886(h)(2)(D)(iv) (42 U.S.C. the national average payment estimated for lected by the Secretary to represent the 1395ww(h)(2)(D)(iv)) is amended— the year involved under clause (i). Any Northeast, Midwest, and Western regions of (1) in subclause (I)— the United States. amount determined under the preceding sen- (A) by inserting ‘‘AND 2004 THROUGH 2013’’ tence which is not a multiple of $5 shall be (d) LIMITATION ON NUMBER OF PARTICI- after ‘‘AND 2002’’; and PANTS.—The aggregate number of such bene- rounded to the nearest multiple of $5. (B) by inserting ‘‘or during the period be- ‘‘(iii) There shall be no administrative or ficiaries that may participate in the project ginning with fiscal year 2004 and ending with judicial review under section 1869, 1878, or may not exceed 15,000. fiscal year 2013’’ after ‘‘during fiscal year otherwise of the estimation of average pay- (e) DATA.—The Secretary shall collect such ment under clause (i).’’. data on the demonstration project with re- 2001 or fiscal year 2002’’; and (2) in subclause (II)— (2) TIMELY IMPLEMENTATION.—Unless the spect to the provision of home health serv- Secretary of Health and Human Services ices to medicare beneficiaries that relates to (A) by striking ‘‘fiscal year 2004, or fiscal otherwise provides on a timely basis, the co- quality of care, patient outcomes, and addi- year 2005,’’ and payment amount specified under section tional costs, if any, to the medicare pro- (B) by striking ‘‘For a’’ and inserting ‘‘For 1813(a)(5)(B)(ii) of the Social Security Act (as gram. the’’. added by paragraph (1)) for 2004 shall be (f) REPORT TO CONGRESS.—Not later than 1 Subtitle C—Chronic Care Improvement deemed to be $40. year after the date of the completion of the SEC. 721. VOLUNTARY CHRONIC CARE IMPROVE- (b) CONFORMING PROVISIONS.— demonstration project under this section, MENT UNDER TRADITIONAL FEE- (1) Section 1833(a)(2)(A) (42 U.S.C. the Secretary shall submit to Congress a re- FOR-SERVICE. 1395l(a)(2)(A)) is amended by inserting ‘‘less port on the project using the data collected Title XVIII, as amended by section 105(a), the copayment amount applicable under sec- under subsection (e) and shall include— is amended by inserting after section 1807 tion 1813(a)(5)’’ after ‘‘1895’’. (1) an examination of whether the provi- the following new section: (2) Section 1866(a)(2)(A)(i) (42 U.S.C. sion of home health services to medicare ‘‘CHRONIC CARE IMPROVEMENT 1395cc(a)(2)(A)(i)) is amended— beneficiaries under the project— ‘‘SEC. 1808. (a) IN GENERAL.—
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00111 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.062 H26PT1 H6052 CONGRESSIONAL RECORD — HOUSE June 26, 2003
‘‘(1) IN GENERAL.—The Secretary shall es- ‘‘(B) Notification that the contractor offer- ‘‘(3) BUDGET NEUTRAL PAYMENT CONDI- tablish a process for providing chronic care ing a program may contact the beneficiary TION.—In entering into a contract with an improvement programs in each CCIA region directly concerning such participation. entity under this subsection, the Secretary for medicare beneficiaries who are not en- ‘‘(C) Notification that participation in a shall establish payment rates that assure rolled under part C or E and who have cer- program is voluntary. that there will be no net aggregate increase tain chronic conditions, such as congestive ‘‘(D) A description of the method for the in payments under this title over any period heart failure, diabetes, chronic obstructive beneficiary to select the single program in of 3 years or longer, as agreed to by the Sec- pulmonary disease (COPD), stroke, prostate which the beneficiary wishes to participate retary. Under this section, the Secretary and colon cancer, hypertension, or other dis- and for declining to participate and a meth- shall assure that medicare program outlays ease as identified by the Secretary as appro- od for obtaining additional information con- plus administrative expenses (that would not priate for chronic care improvement. Such a cerning such participation. have been paid under this title without im- process shall begin to be implemented no ‘‘(4) PARTICIPATION.—A medicare bene- plementation of this section), including con- later than 1 year after the date of the enact- ficiary may participate in only one program tractor fees, shall not exceed the expendi- ment of this section. under this section and may terminate par- tures that would have been incurred under ‘‘(2) TERMINOLOGY.—For purposes of this ticipation at any time in a manner specified this title for a comparable population in the section: by the Secretary. absence of the program under this section for ‘‘(A) CCIA REGION.—The term ‘CCIA region’ ‘‘(5) INDIVIDUAL CHRONIC CARE IMPROVEMENT the 3-year contract period. means a chronic care improvement adminis- PLANS.— ‘‘(4) AT RISK RELATIONSHIP.—For purposes trative region delineated under subsection ‘‘(A) IN GENERAL.—For each beneficiary of section 1128B(b)(3)(F), a contract under (b)(2). participating in a program of a contractor this section shall be treated as a risk-sharing ‘‘(B) CHRONIC CARE IMPROVEMENT PRO- under this section, the contractor shall de- arrangement referred to in such section. GRAM.—The terms ‘chronic care improve- velop with the beneficiary an individualized, ‘‘(5) PERFORMANCE STANDARDS.—Payment ment program’ and ‘program’ means such a goal-oriented chronic care improvement to contractors under this section shall be program provided by a contractor under this plan. subject to the contractor’s meeting of clin- section. ‘‘(B) ELEMENTS OF INDIVIDUAL PLAN.—Each ical and financial performance standards set ‘‘(C) CONTRACTOR.—The term ‘contractor’ individual plan developed under subpara- by the Secretary. means an entity with a contract to provide a graph (A) shall include a single point of con- ‘‘(6) CONTRACTOR OUTCOMES REPORT.—Each chronic care improvement program in a tact to coordinate care and the following, as contractor offering a program shall monitor CCIA region under this section. appropriate: and report to the Secretary, in a manner ‘‘(D) INDIVIDUAL PLAN.—The term ‘indi- ‘‘(i) Self-improvement education for the specified by the Secretary, the quality of vidual plan’ means a chronic care improve- beneficiary (such as education for disease care and efficacy of such program in terms ment plan established under subsection (c)(5) management through medical nutrition of— for an individual. therapy) and support education for health ‘‘(A) process measures, such as reductions ‘‘(3) CONSTRUCTION.—Nothing in this sec- care providers, primary caregivers, and fam- in errors of treatment and rehospitalization tion shall be construed as expanding the ily members. rates; amount, duration, or scope of benefits under ‘‘(ii) Coordination of health care services, ‘‘(B) beneficiary and provider satisfaction; this title. such as application of a prescription drug ‘‘(C) health outcomes; and ‘‘(D) financial outcomes. ‘‘(b) COMPETITIVE BIDDING PROCESS.— regimen and home health services. ‘‘(7) PHASED IN IMPLEMENTATION.—Nothing ‘‘(1) IN GENERAL.—Under this section the ‘‘(iii) Collaboration with physicians and in this section shall be construed as pre- Secretary shall award contracts to qualified other providers to enhance communication venting the Secretary from phasing in the entities for chronic care improvement pro- of relevant clinical information. implementation of programs. grams for each CCIA region under this sec- ‘‘(iv) The use of monitoring technologies ‘‘(d) BIANNUAL OUTCOMES REPORTS.—The that enable patient guidance through the ex- tion through a competitive bidding process. Secretary shall submit to the Congress bian- change of pertinent clinical information, ‘‘(2) PROCESS.—Under such process— nual reports on the implementation of this such as vital signs, symptomatic informa- ‘‘(A) the Secretary shall delineate the section. Each such report shall include infor- tion, and health self-assessment. United States into multiple chronic care im- mation on— ‘‘(v) The provision of information about provement administrative regions; and ‘‘(1) the scope of implementation (in terms hospice care, pain and palliative care, and ‘‘(B) the Secretary shall select at least 2 of both regions and chronic conditions); end-of-life care. winning bidders in each CCIA region on the ‘‘(2) program design; and ‘‘(C) CONTRACTOR RESPONSIBILITIES.—In es- basis of the ability of each bidder to carry ‘‘(3) improvements in health outcomes and tablishing and carrying out individual plans out a chronic care improvement program in financial efficiencies that result from such under a program, a contractor shall, directly accordance with this section, in order to implementation. achieve improved health and financial out- or through subcontractors— ‘‘(e) CLINICAL TRIALS.—The Secretary shall comes. ‘‘(i) guide participants in managing their conduct randomized clinical trials, that ‘‘(3) ELIGIBLE CONTRACTOR.—A contractor health, including all their co-morbidities, compare program participants with medicare may be a disease improvement organization, and in performing activities as specified beneficiaries who are offered, but decline, to health insurer, provider organization, a under the elements of the plan; participate, in order to assess the potential group of physicians, or any other legal enti- ‘‘(ii) use decision support tools such as evi- of programs to— ty that the Secretary determines appro- dence-based practice guidelines or other cri- ‘‘(1) reduce costs under this title; and priate. teria as determined by the Secretary; and ‘‘(2) improve health outcomes under this ‘‘(c) CHRONIC CARE IMPROVEMENT PRO- ‘‘(iii) develop a clinical information data- title. GRAMS.— base to track and monitor each participant ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— ‘‘(1) IN GENERAL.—Each contract under this across settings and to evaluate outcomes. There are authorized to be appropriated to section shall provide for the operation of a ‘‘(6) ADDITIONAL REQUIREMENTS.—The Sec- the Secretary, in appropriate part from the chronic care improvement program by a con- retary may establish additional require- Hospital Insurance Trust Fund and the Sup- tractor in a CCIA region consistent with this ments for programs and contractors under plementary Medical Insurance Trust Fund, subsection. this section. such sums as may be necessary to provide for ‘‘(2) IDENTIFICATION OF PROSPECTIVE PRO- ‘‘(7) ACCREDITATION.—The Secretary may contracts with chronic care improvement GRAM PARTICIPANTS.—Each contractor shall provide that programs that are accredited by programs under this section. have a method for identifying medicare qualified organizations may be deemed to ‘‘(g) LIMITATION ON FUNDING.—In no case beneficiaries in the region to whom it will meet such requirements under this section shall the funding under this section exceed $100,000,000 over a period of 3 years.’’. offer services under its program. The con- as the Secretary may specify. SEC. 722. CHRONIC CARE IMPROVEMENT UNDER tractor shall identify such beneficiaries ‘‘(c) CONTRACT TERMS.— MEDICARE ADVANTAGE AND EN- through claims or other data and other ‘‘(1) IN GENERAL.—A contract under this HANCED FEE-FOR-SERVICE PRO- means permitted consistent with applicable section shall contain such terms and condi- GRAMS. disclosure provisions. tions as the Secretary may specify con- (a) UNDER MEDICARE ADVANTAGE PRO- ‘‘(3) INITIAL CONTACT BY SECRETARY.—The sistent with this section. The Secretary may GRAM.—Section 1852 (42 U.S.C. 1395w–22) is Secretary shall communicate with each ben- not enter into a contract with an entity amended— eficiary identified under paragraph (2) as a under this section unless the entity meets (1) by amending subsection (e) to read as prospective participant in one or more pro- such clinical, quality improvement, finan- follows: grams concerning participation in a pro- cial, and other requirements as the Sec- ‘‘(e) IMPLEMENTATION OF CHRONIC CARE IM- gram. Such communication may be made by retary deems to be appropriate for the popu- PROVEMENT PROGRAMS FOR BENEFICIARIES the Secretary (or on behalf of the Secretary) lation to be served. WITH MULTIPLE OR SUFFICIENTLY SEVERE and shall include information on the fol- ‘‘(2) USE OF SUBCONTRACTORS PERMITTED.— CHRONIC CONDITIONS.— lowing: A contractor may carry out a program di- ‘‘(1) IN GENERAL.—Each Medicare Advan- ‘‘(A) A description of the advantages to the rectly or through contracts with subcontrac- tage organization with respect to each Medi- beneficiary in participating in a program. tors. care Advantage plan it offers shall have in
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effect, for enrollees with multiple or suffi- ‘‘(5) OUTCOMES REPORT.—Each Medicare 6(b)) is amended by adding at the end the fol- ciently severe chronic conditions, a chronic Advantage organization with respect to its lowing new paragraph: care improvement program that is designed chronic care improvement program under ‘‘(8) EXAMINATION OF BUDGET CON- to manage the needs of such enrollees and this subsection shall monitor and report to SEQUENCES.—Before making any rec- that meets the requirements of this sub- the Secretary information on the quality of ommendations, the Commission shall exam- section. care and efficacy of such program as the Sec- ine the budget consequences of such rec- ‘‘(2) ENROLLEE WITH MULTIPLE OR SUFFI- retary may require.’’; and ommendations, directly or through consulta- CIENTLY SEVERE CHRONIC CONDITIONS.—For (2) by amending subparagraph (I) of sub- tion with appropriate expert entities.’’. purposes of this subsection, the term ‘en- section (c)(1) to read as follows: (b) CONSIDERATION OF EFFICIENT PROVISION rollee with multiple or sufficiently severe ‘‘(I) CHRONIC CARE IMPROVEMENT PRO- OF SERVICES.—Section 1805(b)(2)(B)(i) (42 chronic conditions’ means, with respect to GRAM.—A description of the organization’s U.S.C. 1395b–6(b)(2)(B)(i)) is amended by in- an enrollee in a Medicare Advantage plan of chronic care improvement program under serting ‘‘the efficient provision of’’ after ‘‘ex- a Medicare Advantage organization, an en- subsection (e).’’. penditures for’’. rollee in the plan who has one or more (b) APPLICATION UNDER ENHANCED FEE-FOR- (c) APPLICATION OF DISCLOSURE REQUIRE- chronic conditions, such as congestive heart SERVICE PROGRAM.—Section 1860E–2(c)(3), as MENTS.— failure, diabetes, COPD, stroke, prostate and inserted by section 201(a), is amended by in- (1) IN GENERAL.—Section 1805(c)(2)(D) (42 colon cancer, hypertension, or other disease serting ‘‘, including subsection (e) (relating U.S.C. 1395b–6(c)(2)(D)) is amended by adding as identified by the organization as appro- to implementation of chronic care improve- at the end the following: ‘‘Members of the priate for chronic care improvement. ment programs)’’ after ‘‘The provisions of Commission shall be treated as employees of ‘‘(3) GENERAL REQUIREMENTS.— section 1852’’. the Congress for purposes of applying title I ‘‘(A) IN GENERAL.—Each chronic care im- (c) EFFECTIVE DATE.—The amendments of the Ethics in Government Act of 1978 provement program under this subsection made by this section shall apply for contract (Public Law 95-521).’’. shall be conducted consistent with this sub- years beginning on or after 1 year after the (2) EFFECTIVE DATE.—The amendment section. date of the enactment of this Act. made by paragraph (1) shall take effect on ‘‘(B) IDENTIFICATION OF ENROLLEES.—Each SEC. 723. INSTITUTE OF MEDICINE REPORT. January 1, 2004. (d) ADDITIONAL REPORTS.— such program shall have a method for moni- (a) STUDY.— (1) DATA NEEDS AND SOURCES.—The Medi- toring and identifying enrollees with mul- (1) IN GENERAL.—The Secretary of Health tiple or sufficiently severe chronic condi- and Human Services shall contract with the care Payment Advisory Commission shall tions that meet the organization’s criteria Institute of Medicine of the National Acad- conduct a study, and submit a report to Con- for participation under the program. emy of Sciences to conduct a study of the gress by not later than June 1, 2004, on the ‘‘(C) DEVELOPMENT OF PLANS.—For an en- barriers to effective integrated care improve- need for current data, and sources of current rollee identified under subparagraph (B) for ment for medicare beneficiaries with mul- data available, to determine the solvency participation in a program, the program tiple or severe chronic conditions across set- and financial circumstances of hospitals and shall develop, with the enrollee’s consent, an tings and over time and to submit a report other medicare providers of services. The individualized, goal-oriented chronic care under subsection (b). Commission shall examine data on uncom- improvement plan for chronic care improve- pensated care, as well as the share of uncom- (2) SPECIFIC ITEMS.—The study shall exam- ment. ine the statutory and regulatory barriers to pensated care accounted for by the expenses ‘‘(D) ELEMENTS OF PLANS.—Each chronic coordinating care across settings for medi- for treating illegal aliens. care improvement plan developed under sub- care beneficiaries in transition from one set- (2) USE OF TAX-RELATED RETURNS.—Using paragraph (C) shall include a single point of ting to another (such as between hospital, return information provided under Form 990 contact to coordinate care and the following, nursing facility, home health, hospice, and of the Internal Revenue Service, the Com- as appropriate: home). The study shall specifically identify mission shall submit to Congress, by not ‘‘(i) Self-improvement education for the the following: later than June 1, 2004, a report on the fol- enrollee (such as education for disease man- (A) Clinical, financial, or administrative lowing: agement through medical nutrition therapy) requirements in the medicare program that (A) Investments, endowments, and fund- and support education for health care pro- raising of hospitals participating under the viders, primary caregivers, and family mem- present barriers to effective, seamless transi- tions across care settings. medicare program and related foundations. bers. (B) Access to capital financing for private ‘‘(ii) Coordination of health care services, (B) Policies that impede the establishment of administrative and clinical information and for not-for-profit hospitals. such as application of a prescription drug SEC. 732. DEMONSTRATION PROJECT FOR MED- regimen and home health services. systems to track health status, utilization, cost, and quality data across settings. ICAL ADULT DAY CARE SERVICES. ‘‘(iii) Collaboration with physicians and (a) ESTABLISHMENT.—Subject to the suc- (C) State-level requirements that may other providers to enhance communication ceeding provisions of this section, the Sec- present barriers to better care for medicare of relevant clinical information. retary of Health and Human Services shall beneficiaries. ‘‘(iv) The use of monitoring technologies establish a demonstration project (in this (3) CONSULTATION.—The study under this that enable patient guidance through the ex- section referred to as the ‘‘demonstration subsection shall be conducted in consulta- change of pertinent clinical information, project’’) under which the Secretary shall, as tion with experts in the field of chronic care, such as vital signs, symptomatic informa- part of a plan of an episode of care for home consumers, and family caregivers, working tion, and health self-assessment. health services established for a medicare ‘‘(v) The provision of information about to integrate care delivery and create more beneficiary, permit a home health agency, hospice care, pain and palliative care, and seamless transitions across settings and over directly or under arrangements with a med- end-of-life care. time. ical adult day care facility, to provide med- (b) REPORT.—The report under this sub- ‘‘(E) ORGANIZATION RESPONSIBILITIES.—In ical adult day care services as a substitute section shall be submitted to the Secretary establishing and carrying out chronic care for a portion of home health services that improvement plans for participants under and Congress not later than 18 months after would otherwise be provided in the bene- this paragraph, a Medicare Advantage orga- the date of the enactment of this Act. ficiary’s home. nization shall, directly or through sub- SEC. 724. MEDPAC REPORT. (b) PAYMENT.— contractors— (a) EVALUATION.—shall conduct an evalua- (1) IN GENERAL.—The amount of payment ‘‘(i) guide participants in managing their tion that includes a description of the status for an episode of care for home health serv- health, including all their co-morbidities, of the implementation of chronic care im- ices, a portion of which consists of substitute and in performing the activities as specified provement programs under section 1808 of medical adult day care services, under the under the elements of the plan; the Social Security Act, the quality of demonstration project shall be made at a ‘‘(ii) use decision support tools such as evi- health care services provided to individuals rate equal to 95 percent of the amount that dence-based practice guidelines or other cri- in such program, the health status of the would otherwise apply for such home health teria as determined by the Secretary; and participants of such program, and the cost services under section 1895 of the Social Se- ‘‘(iii) develop a clinical information data- savings attributed to implementation of curity Act (42 u.s.c. 1395fff). In no case may base to track and monitor each participant such program. a home health agency, or a medical adult across settings and to evaluate outcomes. (b) REPORT.—Not later than 2 years after day care facility under arrangements with a ‘‘(3) ADDITIONAL REQUIREMENTS.—The Sec- the date of implementation of such chronic home health agency, separately charge a retary may establish additional require- care improvement programs, the Commis- beneficiary for medical adult day care serv- ments for chronic care improvement pro- sion shall submit a report on such evalua- ices furnished under the plan of care. grams under this section. tion. (2) BUDGET NEUTRALITY FOR DEMONSTRATION ‘‘(4) ACCREDITATION.—The Secretary may Subtitle D—Other Provisions PROJECT.—Notwithstanding any other provi- provide that chronic care improvement pro- SEC. 731. MODIFICATIONS TO MEDICARE PAY- sion of law, the Secretary shall provide for grams that are accredited by qualified orga- MENT ADVISORY COMMISSION an appropriate reduction in the aggregate nizations may be deemed to meet such re- (MEDPAC). amount of additional payments made under quirements under this subsection as the Sec- (a) EXAMINATION OF BUDGET CON- section 1895 of the Social Security Act (42 retary may specify. SEQUENCES.—Section 1805(b) (42 U.S.C. 1395b– U.S.C. 1395fff) to reflect any increase in
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amounts expended from the Trust Funds as a (ii) is designed to promote physical and ‘‘(5) LOCAL COVERAGE DETERMINATION PROC- result of the demonstration project con- mental health of the individuals; and ESS.—With respect to local coverage deter- ducted under this section. (C) such other services as the Secretary minations made on or after January 1, 2004— (c) DEMONSTRATION PROJECT SITES.—The may specify. ‘‘(A) PLAN TO PROMOTE CONSISTENCY OF COV- project established under this section shall (4) MEDICARE BENEFICIARY.—The term ERAGE DETERMINATIONS.—The Secretary shall be conducted in not more than 5 States se- ‘‘medicare beneficiary’’ means an individual develop a plan to evaluate new local cov- lected by the Secretary that license or cer- entitled to benefits under part A of this title, erage determinations to determine which de- tify providers of services that furnish med- enrolled under part B of this title, or both. terminations should be adopted nationally ical adult day care services. SEC. 733. IMPROVEMENTS IN NATIONAL AND and to what extent greater consistency can (d) DURATION.—The Secretary shall con- LOCAL COVERAGE DETERMINATION be achieved among local coverage determina- duct the demonstration project for a period PROCESS TO RESPOND TO CHANGES tions. of 3 years. IN TECHNOLOGY. ‘‘(B) CONSULTATION.—The Secretary shall (e) VOLUNTARY PARTICIPATION.—Participa- (a) NATIONAL AND LOCAL COVERAGE DETER- require the fiscal intermediaries or carriers tion of medicare beneficiaries in the dem- MINATION PROCESS.— providing services within the same area to onstration project shall be voluntary. The (1) IN GENERAL.—Section 1862 (42 U.S.C. consult on all new local coverage determina- total number of such beneficiaries that may 1395y) is amended— tions within the area. participate in the project at any given time (A) in the third sentence of subsection (a) ‘‘(C) DISSEMINATION OF INFORMATION.—The may not exceed 15,000. by inserting ‘‘consistent with subsection Secretary should serve as a center to dis- (f) PREFERENCE IN SELECTING AGENCIES.—In (k)’’ after ‘‘the Secretary shall ensure’’; and seminate information on local coverage de- selecting home health agencies to partici- terminations among fiscal intermediaries pate under the demonstration project, the (B) by adding at the end the following new subsection: and carriers to reduce duplication of effort. Secretary shall give preference to those ‘‘(6) NATIONAL AND LOCAL COVERAGE DETER- ‘‘(k) NATIONAL AND LOCAL COVERAGE DE- agencies that are currently licensed or cer- MINATION DEFINED.—For purposes of this sub- TERMINATION PROCESS.— tified through common ownership and con- section, the terms ‘national coverage deter- ‘‘(1) FACTORS AND EVIDENCE USED IN MAKING trol to furnish medical adult day care serv- mination’ and ‘local coverage determination’ NATIONAL COVERAGE DETERMINATIONS.—The ices. have the meaning given such terms in para- Secretary shall make available to the public (g) WAIVER AUTHORITY.—The Secretary graphs (1)(B) and (2)(B), respectively, of sec- the factors considered in making national may waive such requirements of title XVIII tion 1869(f).’’. coverage determinations of whether an item of the Social Security Act as may be nec- (2) EFFECTIVE DATE.—The amendments or service is reasonable and necessary. The essary for the purposes of carrying out the made by paragraph (1) shall apply to na- Secretary shall develop guidance documents demonstration project, other than waiving tional and local coverage determinations as to carry out this paragraph in a manner the requirement that an individual be home- of January 1, 2004. similar to the development of guidance docu- bound in order to be eligible for benefits for (b) MEDICARE COVERAGE OF ROUTINE COSTS ments under section 701(h) of the Federal home health services. ASSOCIATED WITH CERTAIN CLINICAL (h) EVALUATION AND REPORT.—The Sec- Food, Drug, and Cosmetic Act (21 U.S.C. TRIALS.— retary shall conduct an evaluation of the 371(h)). (1) IN GENERAL.—With respect to the cov- clinical and cost effectiveness of the dem- ‘‘(2) TIMEFRAME FOR DECISIONS ON REQUESTS erage of routine costs of care for bene- onstration project. Not later 30 months after FOR NATIONAL COVERAGE DETERMINATIONS.—In ficiaries participating in a qualifying clin- the commencement of the project, the Sec- the case of a request for a national coverage ical trial, as set forth on the date of the en- retary shall submit to Congress a report on determination that— actment of this Act in National Coverage De- the evaluation, and shall include in the re- ‘‘(A) does not require a technology assess- termination 30-1 of the Medicare Coverage port the following: ment from an outside entity or deliberation Issues Manual, the Secretary shall deem (1) An analysis of the patient outcomes and from the Medicare Coverage Advisory Com- clinical trials conducted in accordance with costs of furnishing care to the medicare mittee, the decision on the request shall be an investigational device exemption ap- beneficiaries participating in the project as made not later than 6 months after the date proved under section 520(g) of the Federal compared to such outcomes and costs to of the request; or Food, Drug, and Cosmetic Act (42 U.S.C. beneficiaries receiving only home health ‘‘(B) requires such an assessment or delib- 360j(g)) to be automatically qualified for services for the same health conditions. eration and in which a clinical trial is not such coverage. (2) Such recommendations regarding the requested, the decision on the request shall (2) RULE OF CONSTRUCTION.—Nothing in this extension, expansion, or termination of the be made not later than 9 months after the subsection shall be construed as authorizing project as the Secretary determines appro- date of the request. or requiring the Secretary to modify the reg- priate. ‘‘(3) PROCESS FOR PUBLIC COMMENT IN NA- ulations set forth on the date of the enact- (i) DEFINITIONS.—In this section: TIONAL COVERAGE DETERMINATIONS.—At the ment of this Act at subpart B of part 405 of (1) HOME HEALTH AGENCY.—The term ‘‘home end of the 6-month period (or 9-month period title 42, Code of Federal Regulations, or sub- health agency’’ has the meaning given such for requests described in paragraph (2)(B)) part A of part 411 of such title, relating to term in section 1861(o) of the Social Security that begins on the date a request for a na- coverage of, and payment for, a medical de- Act (42 U.S.C. 1395x(o)). tional coverage determination is made, the vice that is the subject of an investigational (2) MEDICAL ADULT DAY CARE FACILITY.— Secretary shall— device exemption by the Food and Drug Ad- The term ‘‘medical adult day care facility’’ ‘‘(A) make a draft of proposed decision on ministration (except as may be necessary to means a facility that— the request available to the public through implement paragraph (1)). (A) has been licensed or certified by a the Medicare Internet site of the Department (3) EFFECTIVE DATE.—This subsection shall State to furnish medical adult day care serv- of Health and Human Services or other ap- apply to clinical trials begun before, on, or ices in the State for a continuous 2-year pe- propriate means; after the date of the enactment of this Act riod; ‘‘(B) provide a 30-day period for public com- and to items and services furnished on or (B) is engaged in providing skilled nursing ment on such draft; after such date. services and other therapeutic services di- ‘‘(C) make a final decision on the request (c) ISSUANCE OF TEMPORARY NATIONAL rectly or under arrangement with a home within 60 days of the conclusion of the 30-day CODES.—Not later than January 1, 2004, the health agency; period referred to under subparagraph (B); Secretary shall implement revised proce- (C) meets such standards established by ‘‘(D) include in such final decision sum- dures for the issuance of temporary national the Secretary to assure quality of care and maries of the public comments received and HCPCS codes under part B of title XVIII of such other requirements as the Secretary responses thereto; the Social Security Act. finds necessary in the interest of the health ‘‘(E) make available to the public the clin- SEC. 734. TREATMENT OF CERTAIN PHYSICIAN and safety of individuals who are furnished ical evidence and other data used in making PATHOLOGY SERVICES. services in the facility; and such a decision when the decision differs (a) IN GENERAL.—Section 1848(i) (42 U.S.C. (D) provides medical adult day care serv- from the recommendations of the Medicare 1395w–4(i)) is amended by adding at the end ices. Coverage Advisory Committee; and the following new paragraph: (3) MEDICAL ADULT DAY CARE SERVICES.— ‘‘(F) in the case of a decision to grant the ‘‘(4) TREATMENT OF CERTAIN INPATIENT PHY- The term ‘‘medical adult day care services’’ coverage determination, assign a temporary SICIAN PATHOLOGY SERVICES.— means— or permanent code and implement the coding ‘‘(A) IN GENERAL.—With respect to services (A) home health service items and services change. furnished on or after January 1, 2004, and be- described in paragraphs (1) through (7) of sec- ‘‘(4) CONSULTATION WITH OUTSIDE EXPERTS fore January 1, 2009, if an independent lab- tion 1861(m) furnished in a medical adult day IN CERTAIN NATIONAL COVERAGE DETERMINA- oratory furnishes the technical component of care facility; TIONS.—With respect to a request for a na- a physician pathology service to a fee-for- (B) a program of supervised activities fur- tional coverage determination for which service medicare beneficiary who is an inpa- nished in a group setting in the facility there is not a review by the Medicare Cov- tient or outpatient of a covered hospital, the that— erage Advisory Committee, the Secretary Secretary shall treat such component as a (i) meet such criteria as the Secretary de- shall consult with appropriate outside clin- service for which payment shall be made to termines appropriate; and ical experts. the laboratory under this section and not as
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an inpatient hospital service for which pay- Social Security Act, and enrolled under part ‘‘(C) TERM OF OFFICE.—The Administrator ment is made to the hospital under section B of such title, but who is not enrolled under shall be appointed for a term of 4 years. In 1886(d) or as a hospital outpatient service for part C of such title who is diagnosed as hav- any case in which a successor does not take which payment is made to the hospital under ing one or more chronic conditions (as de- office at the end of an Administrator’s term section 1833(t). fined by the Secretary), such as diabetes. of office, that Administrator may continue ‘‘(B) DEFINITIONS.—In this paragraph: (b) DESIGN OF PROJECTS.— in office until the entry upon office of such ‘‘(i) COVERED HOSPITAL.— (1) IN GENERAL.—In establishing the dem- a successor. An Administrator appointed to a ‘‘(I) IN GENERAL.—The term ‘covered hos- onstration projects under this section, the term of office after the commencement of pital’ means, with respect to an inpatient or Secretary shall evaluate practices employed such term may serve under such appoint- outpatient, a hospital that had an arrange- by group health plans and practices under ment only for the remainder of such term. ment with an independent laboratory that State plans for medical assistance under the ‘‘(D) GENERAL AUTHORITY.—The Adminis- was in effect as of July 22, 1999, under which medicaid program under title XIX of the So- trator shall be responsible for the exercise of a laboratory furnished the technical compo- cial Security Act that permit patients to all powers and the discharge of all duties of nent of physician pathology services to fee- self-direct the provision of personal care the Administration, and shall have authority for-service medicare beneficiaries who were services. and control over all personnel and activities hospital inpatients or outpatients, respec- (2) SCOPE OF SERVICES.—The Secretary thereof. tively, and submitted claims for payment for shall determine the appropriate scope of per- ‘‘(E) RULEMAKING AUTHORITY.—The Admin- such component to a carrier with a contract sonal care services that would apply under istrator may prescribe such rules and regula- under section 1842 and not to the hospital. the demonstration projects. tions as the Administrator determines nec- ‘‘(II) CHANGE IN OWNERSHIP DOES NOT AF- (c) VOLUNTARY PARTICIPATION.—Participa- essary or appropriate to carry out the func- FECT DETERMINATION.—A change in owner- tion of medicare beneficiaries in the dem- tions of the Administration. The regulations ship with respect to a hospital on or after onstration projects shall be voluntary. prescribed by the Administrator shall be sub- the date referred to in subclause (I) shall not (d) DEMONSTRATION PROJECTS SITES.—Not ject to the rulemaking procedures estab- affect the determination of whether such later than 2 years after the date of the enact- lished under section 553 of title 5, United hospital is a covered hospital for purposes of ment of this Act, the Secretary shall con- States Code. The Administrator shall pro- such subclause. duct no fewer than 3 demonstration projects vide for the issuance of new regulations to ‘‘(ii) FEE-FOR-SERVICE MEDICARE BENE- established under this section. Of those dem- carry out parts C, D, and E. FICIARY.—The term ‘fee-for-service medicare onstration projects, the Secretary shall con- ‘‘(F) AUTHORITY TO ESTABLISH ORGANIZA- beneficiary’ means an individual who is enti- duct at least one in each of the following TIONAL UNITS.—The Administrator may es- tled to benefits under part A, or enrolled areas: tablish, alter, consolidate, or discontinue under this part, or both, but is not enrolled (1) An urban area. such organizational units or components in any of the following: (2) A rural area. within the Administration as the Adminis- ‘‘(I) A Medicare+Choice plan under part C. (3) An area that the Secretary determines trator considers necessary or appropriate, ‘‘(II) A plan offered by an eligible organiza- has a medicare population with rate of inci- except as specified in this section. tion under section 1876. dence of diabetes that significantly exceeds ‘‘(G) AUTHORITY TO DELEGATE.—The Admin- istrator may assign duties, and delegate, or ‘‘(III) A program of all-inclusive care for the national average rate of all areas. authorize successive redelegations of, au- the elderly (PACE) under section 1894. (e) EVALUATION AND REPORT.— thority to act and to render decisions, to ‘‘(IV) A social health maintenance organi- (1) EVALUATIONS.—The Secretary shall con- such officers and employees of the Adminis- zation (SHMO) demonstration project estab- duct evaluations of the clinical and cost ef- tration as the Administrator may find nec- lished under section 4018(b) of the Omnibus fectiveness of the demonstration projects. essary. Within the limitations of such dele- Budget Reconciliation Act of 1987 (Public (2) REPORTS.—Not later than 2 years after gations, redelegations, or assignments, all Law 100–203).’’. the commencement of the demonstration official acts and decisions of such officers (b) CONFORMING AMENDMENT.—Section 542 projects, and biannually thereafter, the Sec- of the Medicare, Medicaid, and SCHIP Bene- retary shall submit to Congress a report on and employees shall have the same force and fits Improvement and Protection Act of 2000 the evaluation, and shall include in the re- effect as though performed or rendered by (114 Stat. 2763A–550), as enacted into law by port the following: the Administrator. section 1(a)(6) of Public Law 106–554, is re- (A) An analysis of the patient outcomes ‘‘(2) DEPUTY ADMINISTRATOR.— pealed. and costs of furnishing care to the medicare ‘‘(A) IN GENERAL.—There shall be a Deputy (c) EFFECTIVE DATES.—The amendments beneficiaries participating in the projects as Administrator of the Medicare Benefits Ad- made by this section shall take effect as if compared to such outcomes and costs to ministration who shall be appointed by the included in the enactment of the Medicare, other beneficiaries for the same health con- President, by and with the advice and con- Medicaid, and SCHIP Benefits Improvement ditions. sent of the Senate. and Protection Act of 2000 (Appendix F, 114 (B) Evaluation of patient satisfaction ‘‘(B) COMPENSATION.—The Deputy Adminis- Stat. 2763A–463), as enacted into law by sec- under the demonstration projects. trator shall be paid at the rate of basic pay tion 1(a)(6) of Public Law 106–554. (C) Such recommendations regarding the payable for level IV of the Executive Sched- ule under section 5315 of title 5, United SEC. 735. CLINICAL INVESTIGATION OF MEDI- extension, expansion, or termination of the CARE PANCREATIC ISLET CELL projects as the Secretary determines appro- States Code. TRANSPLANTS. priate. ‘‘(C) TERM OF OFFICE.—The Deputy Admin- The Secretary shall authorize payment istrator shall be appointed for a term of 4 TITLE VIII—MEDICARE BENEFITS under title XVIII of the Social Security Act years. In any case in which a successor does ADMINISTRATION for the routine costs for items and services not take office at the end of a Deputy Ad- for medicare beneficiaries received as part of SEC. 801. ESTABLISHMENT OF MEDICARE BENE- ministrator’s term of office, such Deputy Ad- FITS ADMINISTRATION. a clinical investigation of pancreatic islet ministrator may continue in office until the (a) IN GENERAL.—Title XVIII (42 U.S.C. 1395 cell transplants conducted by the National entry upon office of such a successor. A Dep- et seq.), as amended by sections 105 and 721, Institutes of Health. uty Administrator appointed to a term of of- is amended by inserting after 1808 the fol- fice after the commencement of such term SEC. 736. DEMONSTRATION PROJECT FOR CON- lowing new section: SUMER-DIRECTED CHRONIC OUT- may serve under such appointment only for PATIENT SERVICES. ‘‘MEDICARE BENEFITS ADMINISTRATION the remainder of such term. (a) ESTABLISHMENT.— ‘‘SEC. 1809. (a) ESTABLISHMENT.—There is ‘‘(D) DUTIES.—The Deputy Administrator (1) IN GENERAL.—Subject to the succeeding established within the Department of Health shall perform such duties and exercise such provisions of this section, the Secretary and Human Services an agency to be known powers as the Administrator shall from time shall establish demonstration projects (in as the Medicare Benefits Administration. to time assign or delegate. The Deputy Ad- this section referred to as ‘‘demonstration ‘‘(b) ADMINISTRATOR; DEPUTY ADMINIS- ministrator shall be Acting Administrator of projects’’) under which the Secretary shall TRATOR; CHIEF ACTUARY.— the Administration during the absence or evaluate methods that improve the quality ‘‘(1) ADMINISTRATOR.— disability of the Administrator and, unless of care provided to medicare beneficiaries ‘‘(A) IN GENERAL.—The Medicare Benefits the President designates another officer of with chronic conditions and that reduce ex- Administration shall be headed by an admin- the Government as Acting Administrator, in penditures that would otherwise be made istrator to be known as the ‘Medicare Bene- the event of a vacancy in the office of the under the medicare program on behalf of fits Administrator’ (in this section referred Administrator. such individuals for such chronic conditions, to as the ‘Administrator’) who shall be ap- ‘‘(3) CHIEF ACTUARY.— such methods to include permitting those pointed by the President, by and with the ad- ‘‘(A) IN GENERAL.—There is established in beneficiaries to direct their own health care vice and consent of the Senate. The Adminis- the Administration the position of Chief Ac- needs and services. trator shall be in direct line of authority to tuary. The Chief Actuary shall be appointed (2) MEDICARE BENEFICIARIES WITH CHRONIC the Secretary. by, and in direct line of authority to, the Ad- CONDITIONS DEFINED.—In this section, the ‘‘(B) COMPENSATION.—The Administrator ministrator of such Administration. The term ‘‘medicare beneficiaries with chronic shall be paid at the rate of basic pay payable Chief Actuary shall be appointed from conditions’’ means an individual entitled to for level III of the Executive Schedule under among individuals who have demonstrated, benefits under part A of title XVIII of the section 5314 of title 5, United States Code. by their education and experience, superior
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00115 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.062 H26PT1 H6056 CONGRESSIONAL RECORD — HOUSE June 26, 2003 expertise in the actuarial sciences. The Chief pertise in negotiating contracts in the pri- and formulary restrictions) under parts C, D, Actuary may be removed only for cause. vate sector. and E. ‘‘(B) COMPENSATION.—The Chief Actuary ‘‘(B) FLEXIBILITY WITH RESPECT TO COM- ‘‘(ii) Benefits, and limitations on payment shall be compensated at the highest rate of PENSATION.— under parts A and B, including information basic pay for the Senior Executive Service ‘‘(i) IN GENERAL.—The staff of the Medicare on medicare supplemental policies under sec- under section 5382(b) of title 5, United States Benefits Administration shall, subject to tion 1882. Code. clause (ii), be paid without regard to the pro- Such information shall be presented in a ‘‘(C) DUTIES.—The Chief Actuary shall ex- visions of chapter 51 (other than section 5101) manner so that medicare beneficiaries may ercise such duties as are appropriate for the and chapter 53 (other than section 5301) of compare benefits under parts A, B, D, and office of the Chief Actuary and in accordance such title (relating to classification and medicare supplemental policies with benefits with professional standards of actuarial schedule pay rates). under Medicare Advantage plans under part independence. ‘‘(ii) MAXIMUM RATE.—In no case may the C and EFFS plans under part E. ‘‘(4) SECRETARIAL COORDINATION OF PRO- rate of compensation determined under ‘‘(B) DISSEMINATION OF APPEALS RIGHTS IN- GRAM ADMINISTRATION.—The Secretary shall clause (i) exceed the rate of basic pay pay- FORMATION.—The Office of Beneficiary As- ensure appropriate coordination between the able for level IV of the Executive Schedule sistance shall disseminate to medicare bene- Administrator and the Administrator of the under section 5315 of title 5, United States ficiaries in the manner provided under sub- Centers for Medicare & Medicaid Services in Code. paragraph (A) a description of procedural carrying out the programs under this title. ‘‘(C) LIMITATION ON FULL-TIME EQUIVALENT rights (including grievance and appeals pro- ‘‘(c) DUTIES; ADMINISTRATIVE PROVISIONS.— STAFFING FOR CURRENT CMS FUNCTIONS BEING cedures) of beneficiaries under the original ‘‘(1) DUTIES.— TRANSFERRED.—The Administrator may not medicare fee-for-service program under parts ‘‘(A) GENERAL DUTIES.—The Administrator employ under this paragraph a number of A and B, the Medicare Advantage program shall carry out parts C, D, and E, including— full-time equivalent employees, to carry out under part C, the Voluntary Prescription ‘‘(i) negotiating, entering into, and enforc- functions that were previously conducted by Drug Benefit Program under part D, and the ing, contracts with plans for the offering of the Centers for Medicare & Medicaid Serv- Enhanced Fee-for-Service program under Medicare Advantage plans under part C and ices and that are conducted by the Adminis- part E. EFFS plans under part E, including the of- trator by reason of this section, that exceeds ‘‘(e) MEDICARE POLICY ADVISORY BOARD.— fering of qualified prescription drug coverage the number of such full-time equivalent em- ‘‘(1) ESTABLISHMENT.—There is established under such plans; and ployees authorized to be employed by the within the Medicare Benefits Administration ‘‘(ii) negotiating, entering into, and enforc- the Medicare Policy Advisory Board (in this Centers for Medicare & Medicaid Services to ing, contracts with PDP sponsors for the of- section referred to the ‘Board’). The Board conduct such functions as of the date of the fering of prescription drug plans under part shall advise, consult with, and make rec- enactment of this Act. D. ommendations to the Administrator of the ‘‘(3) REDELEGATION OF CERTAIN FUNCTIONS ‘‘(B) OTHER DUTIES.—The Administrator Medicare Benefits Administration with re- OF THE CENTERS FOR MEDICARE & MEDICAID shall carry out any duty provided for under spect to the administration of parts C, D, SERVICES.— part C, part D, or part E, including dem- and E, including the review of payment poli- ‘‘(A) IN GENERAL.—The Secretary, the Ad- onstration projects carried out in part or in cies under such parts. ministrator, and the Administrator of the whole under such parts, the programs of all- ‘‘(2) REPORTS.— Centers for Medicare & Medicaid Services inclusive care for the elderly (PACE pro- ‘‘(A) IN GENERAL.—With respect to matters shall establish an appropriate transition of gram) under section 1894, the social health of the administration of parts C, D, and E maintenance organization (SHMO) dem- responsibility in order to redelegate the ad- the Board shall submit to Congress and to onstration projects (referred to in section ministration of part C from the Secretary the Administrator of the Medicare Benefits 4104(c) of the Balanced Budget Act of 1997), and the Administrator of the Centers for Administration such reports as the Board de- medicare cost contractors under section Medicare & Medicaid Services to the Admin- termines appropriate. Each such report may 1876(h), and through a Medicare Advantage istrator as is appropriate to carry out the contain such recommendations as the Board project that demonstrates the application of purposes of this section. determines appropriate for legislative or ad- capitation payment rates for frail elderly ‘‘(B) TRANSFER OF DATA AND INFORMA- ministrative changes to improve the admin- medicare beneficiaries through the use of a TION.—The Secretary shall ensure that the istration of such parts, including the topics interdisciplinary team and through the pro- Administrator of the Centers for Medicare & described in subparagraph (B). Each such re- vision of primary care services to such bene- Medicaid Services transfers to the Adminis- port shall be published in the Federal Reg- ficiaries by means of such a team at the trator of the Medicare Benefits Administra- ister. nursing facility involved). tion such information and data in the posses- ‘‘(B) TOPICS DESCRIBED.—Reports required ‘‘(C) PRESCRIPTION DRUG CARD.—The Ad- sion of the Administrator of the Centers for under subparagraph (A) may include the fol- ministrator shall carry out section 1807 (re- Medicare & Medicaid Services as the Admin- lowing topics: lating to the medicare prescription drug dis- istrator of the Medicare Benefits Adminis- ‘‘(i) FOSTERING COMPETITION.—Rec- count card endorsement program). tration requires to carry out the duties de- ommendations or proposals to increase com- ‘‘(D) NONINTERFERENCE.—In carrying out scribed in paragraph (1). petition under parts C, D, and E for services its duties with respect to the provision of ‘‘(C) CONSTRUCTION.—Insofar as a responsi- furnished to medicare beneficiaries. qualified prescription drug coverage to bene- bility of the Secretary or the Administrator ‘‘(ii) EDUCATION AND ENROLLMENT.—Rec- ficiaries under this title, the Administrator of the Centers for Medicare & Medicaid Serv- ommendations for the improvement to ef- may not— ices is redelegated to the Administrator forts to provide medicare beneficiaries infor- ‘‘(i) require a particular formulary or insti- under this section, any reference to the Sec- mation and education on the program under tute a price structure for the reimbursement retary or the Administrator of the Centers this title, and specifically parts C, D, and E, of covered outpatient drugs; for Medicare & Medicaid Services in this and the program for enrollment under the ‘‘(ii) interfere in any way with negotia- title or title XI with respect to such respon- title. tions between PDP sponsors and Medicare sibility is deemed to be a reference to the ‘‘(iii) IMPLEMENTATION OF RISK-ADJUST- Advantage organizations and EFFS organi- Administrator. MENT.—Evaluation of the implementation zations and drug manufacturers, wholesalers, ‘‘(d) OFFICE OF BENEFICIARY ASSISTANCE.— under section 1853(a)(3)(C) of the risk adjust- or other suppliers of covered outpatient ‘‘(1) ESTABLISHMENT.—The Secretary shall ment methodology to payment rates under drugs; and establish within the Medicare Benefits Ad- that section to Medicare Advantage organi- ‘‘(iii) otherwise interfere with the competi- ministration an Office of Beneficiary Assist- zations offering Medicare Advantage plans tive nature of providing such coverage ance to coordinate functions relating to out- (and the corresponding payment provisions through such sponsors and organizations. reach and education of medicare bene- under part E) that accounts for variations in ‘‘(E) ANNUAL REPORTS.—Not later March 31 ficiaries under this title, including the func- per capita costs based on health status, geog- of each year, the Administrator shall submit tions described in paragraph (2). The Office raphy, and other demographic factors. to Congress and the President a report on shall be separate operating division within ‘‘(iv) RURAL ACCESS.—Recommendations to the administration of parts C, D, and E dur- the Administration. improve competition and access to plans ing the previous fiscal year. ‘‘(2) DISSEMINATION OF INFORMATION ON BEN- under parts C, D, and E in rural areas. ‘‘(2) STAFF.— EFITS AND APPEALS RIGHTS.— ‘‘(C) MAINTAINING INDEPENDENCE OF ‘‘(A) IN GENERAL.—The Administrator, with ‘‘(A) DISSEMINATION OF BENEFITS INFORMA- BOARD.—The Board shall directly submit to the approval of the Secretary, may employ, TION.—The Office of Beneficiary Assistance Congress reports required under subpara- without regard to chapter 31 of title 5, shall disseminate, directly or through con- graph (A). No officer or agency of the United United States Code, other than sections 3102 tract, to medicare beneficiaries, by mail, by States may require the Board to submit to through 3108, 3110 through 3113, 3136m and posting on the Internet site of the Medicare any officer or agency of the United States 3151, such officers and employees as are nec- Benefits Administration and through a toll- for approval, comments, or review, prior to essary to administer the activities to be car- free telephone number, information with re- the submission to Congress of such reports. ried out through the Medicare Benefits Ad- spect to the following: ‘‘(3) DUTY OF ADMINISTRATOR OF MEDICARE ministration. The Administrator shall em- ‘‘(i) Benefits, and limitations on payment BENEFITS ADMINISTRATION.—With respect to ploy staff with appropriate and necessary ex- (including cost-sharing, stop-loss provisions, any report submitted by the Board under
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paragraph (2)(A), not later than 90 days after ‘‘(i) IN GENERAL.—The Director and staff of (1) to compromise or affect existing legal the report is submitted, the Administrator of the Board shall, subject to clause (ii), be paid remedies for addressing fraud or abuse, the Medicare Benefits Administration shall without regard to the provisions of chapter whether it be criminal prosecution, civil en- submit to Congress and the President an 51 and chapter 53 of such title (relating to forcement, or administrative remedies, in- analysis of recommendations made by the classification and schedule pay rates). cluding under sections 3729 through 3733 of Board in such report. Each such analysis ‘‘(ii) MAXIMUM RATE.—In no case may the title 31, United States Code (known as the shall be published in the Federal Register. rate of compensation determined under False Claims Act); or ‘‘(4) MEMBERSHIP.— clause (i) exceed the rate of basic pay pay- (2) to prevent or impede the Department of ‘‘(A) APPOINTMENT.—Subject to the suc- able for level IV of the Executive Schedule Health and Human Services in any way from ceeding provisions of this paragraph, the under section 5315 of title 5, United States its ongoing efforts to eliminate waste, fraud, Board shall consist of seven members to be Code. and abuse in the medicare program. appointed as follows: ‘‘(D) ASSISTANCE FROM THE ADMINISTRATOR Furthermore, the consolidation of medicare ‘‘(i) Three members shall be appointed by OF THE MEDICARE BENEFITS ADMINISTRATION.— administrative contracting set forth in this the President. The Administrator of the Medicare Benefits Act does not constitute consolidation of the ‘‘(ii) Two members shall be appointed by Administration shall make available to the Federal Hospital Insurance Trust Fund and the Speaker of the House of Representatives, Board such information and other assistance the Federal Supplementary Medical Insur- with the advice of the chairmen and the as it may require to carry out its functions. ance Trust Fund or reflect any position on ranking minority members of the Commit- ‘‘(10) CONTRACT AUTHORITY.—The Board that issue. may contract with and compensate govern- (b) DEFINITION OF SUPPLIER.—Section 1861 tees on Ways and Means and on Energy and ment and private agencies or persons to (42 U.S.C. 1395x) is amended by inserting Commerce of the House of Representatives. carry out its duties under this subsection, after subsection (c) the following new sub- ‘‘(iii) Two members shall be appointed by without regard to section 3709 of the Revised section: the President pro tempore of the Senate with Statutes (41 U.S.C. 5). the advice of the chairman and the ranking ‘‘Supplier ‘‘(f) FUNDING.—There is authorized to be ‘‘(d) The term ‘supplier’ means, unless the minority member of the Senate Committee appropriated, in appropriate part from the on Finance. context otherwise requires, a physician or Federal Hospital Insurance Trust Fund and other practitioner, a facility, or other entity ‘‘(B) QUALIFICATIONS.—The members shall from the Federal Supplementary Medical In- be chosen on the basis of their integrity, im- (other than a provider of services) that fur- surance Trust Fund (including the Medicare nishes items or services under this title.’’. partiality, and good judgment, and shall be Prescription Drug Account), such sums as individuals who are, by reason of their edu- are necessary to carry out this section.’’. SEC. 902. ISSUANCE OF REGULATIONS. (a) REGULAR TIMELINE FOR PUBLICATION OF cation and experience in health care benefits (b) EFFECTIVE DATE.— FINAL RULES.— management, exceptionally qualified to per- (1) IN GENERAL.—The amendment made by form the duties of members of the Board. subsection (a) shall take effect on the date of (1) IN GENERAL.—Section 1871(a) (42 U.S.C. ‘‘(C) PROHIBITION ON INCLUSION OF FEDERAL the enactment of this Act. 1395hh(a)) is amended by adding at the end EMPLOYEES.—No officer or employee of the (2) DUTIES WITH RESPECT TO ELIGIBILITY DE- the following new paragraph: ‘‘(3)(A) The Secretary, in consultation with United States may serve as a member of the TERMINATIONS AND ENROLLMENT.—The Ad- Board. ministrator of the Medicare Benefits Admin- the Director of the Office of Management and Budget, shall establish and publish a ‘‘(5) COMPENSATION.—Members of the Board istration shall carry out enrollment under shall receive, for each day (including travel title XVIII of the Social Security Act, make regular timeline for the publication of final time) they are engaged in the performance of eligibility determinations under such title, regulations based on the previous publica- the functions of the board, compensation at and carry out parts C and E of such title for tion of a proposed regulation or an interim final regulation. rates not to exceed the daily equivalent to years beginning or after January 1, 2006. ‘‘(B) Such timeline may vary among dif- the annual rate in effect for level IV of the (3) TRANSITION.—Before the date the Ad- ferent regulations based on differences in the ministrator of the Medicare Benefits Admin- Executive Schedule under section 5315 of complexity of the regulation, the number istration is appointed and assumes respon- title 5, United States Code. and scope of comments received, and other sibilities under this section and section 1807 ‘‘(6) TERMS OF OFFICE.— relevant factors, but shall not be longer than of the Social Security Act, the Secretary of ‘‘(A) IN GENERAL.—The term of office of 3 years except under exceptional cir- Health and Human Services shall provide for members of the Board shall be 3 years. cumstances. If the Secretary intends to vary the conduct of any responsibilities of such ‘‘(B) TERMS OF INITIAL APPOINTEES.—As such timeline with respect to the publication Administrator that are otherwise provided designated by the President at the time of of a final regulation, the Secretary shall under law. appointment, of the members first ap- cause to have published in the Federal Reg- (c) MISCELLANEOUS ADMINISTRATIVE PROVI- pointed— ister notice of the different timeline by not SIONS.— ‘‘(i) one shall be appointed for a term of 1 later than the timeline previously estab- (1) ADMINISTRATOR AS MEMBER OF THE year; lished with respect to such regulation. Such BOARD OF TRUSTEES OF THE MEDICARE TRUST ‘‘(ii) three shall be appointed for terms of notice shall include a brief explanation of 2 years; and FUNDS.—Section 1817(b) and section 1841(b) (42 U.S.C. 1395i(b), 1395t(b)) are each amended the justification for such variation. ‘‘(iii) three shall be appointed for terms of ‘‘(C) In the case of interim final regula- by striking ‘‘and the Secretary of Health and 3 years. tions, upon the expiration of the regular Human Services, all ex officio,’’ and insert- ‘‘(C) REAPPOINTMENTS.—Any person ap- timeline established under this paragraph for ing ‘‘the Secretary of Health and Human pointed as a member of the Board may not the publication of a final regulation after op- Services, and the Administrator of the Medi- serve for more than 8 years. portunity for public comment, the interim care Benefits Administration, all ex offi- ‘‘(D) VACANCY.—Any member appointed to final regulation shall not continue in effect fill a vacancy occurring before the expira- cio,’’. unless the Secretary publishes (at the end of tion of the term for which the member’s (2) INCREASE IN GRADE TO EXECUTIVE LEVEL the regular timeline and, if applicable, at the predecessor was appointed shall be appointed III FOR THE ADMINISTRATOR OF THE CENTERS end of each succeeding 1-year period) a no- only for the remainder of that term. A mem- FOR MEDICARE & MEDICAID SERVICES; LEVEL tice of continuation of the regulation that ber may serve after the expiration of that FOR MEDICARE BENEFITS ADMINISTRATOR.— includes an explanation of why the regular member’s term until a successor has taken (A) IN GENERAL.—Section 5314 of title 5, timeline (and any subsequent 1-year exten- office. A vacancy in the Board shall be filled United States Code, by adding at the end the sion) was not complied with. If such a notice in the manner in which the original appoint- following: is published, the regular timeline (or such ment was made. ‘‘Administrator of the Centers for Medi- timeline as previously extended under this care & Medicaid Services. ‘‘(7) CHAIR.—The Chair of the Board shall paragraph) for publication of the final regu- be elected by the members. The term of of- ‘‘Administrator of the Medicare Benefits lation shall be treated as having been ex- fice of the Chair shall be 3 years. Administration.’’. tended for 1 additional year. ‘‘(8) MEETINGS.—The Board shall meet at (B) CONFORMING AMENDMENT.—Section 5315 ‘‘(D) The Secretary shall annually submit the call of the Chair, but in no event less of such title is amended by striking ‘‘Admin- to Congress a report that describes the in- than three times during each fiscal year. istrator of the Health Care Financing Ad- stances in which the Secretary failed to pub- ‘‘(9) DIRECTOR AND STAFF.— ministration.’’. lish a final regulation within the applicable ‘‘(A) APPOINTMENT OF DIRECTOR.—The (C) EFFECTIVE DATE.—The amendments regular timeline under this paragraph and Board shall have a Director who shall be ap- made by this paragraph take effect on Janu- that provides an explanation for such fail- pointed by the Chair. ary 1, 2004. ures.’’. ‘‘(B) IN GENERAL.—With the approval of the TITLE IX—REGULATORY REDUCTION AND (2) EFFECTIVE DATE.—The amendment Board, the Director may appoint, without re- CONTRACTING REFORM made by paragraph (1) shall take effect on gard to chapter 31 of title 5, United States Subtitle A—Regulatory Reform the date of the enactment of this Act. The Code, such additional personnel as the Direc- SEC. 901. CONSTRUCTION; DEFINITION OF SUP- Secretary shall provide for an appropriate tor considers appropriate. PLIER. transition to take into account the backlog ‘‘(C) FLEXIBILITY WITH RESPECT TO COM- (a) CONSTRUCTION.—Nothing in this title of previously published interim final regula- PENSATION.— shall be construed— tions.
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(b) LIMITATIONS ON NEW MATTER IN FINAL transmitted electronically) provided by the (1) IN GENERAL.—Title XVIII is amended by REGULATIONS.— Secretary or by a medicare contractor (as inserting after section 1874 the following new (1) IN GENERAL.—Section 1871(a) (42 U.S.C. defined in section 1889(g)) acting within the section: 1395hh(a)), as amended by subsection (a), is scope of the contractor’s contract authority, ‘‘CONTRACTS WITH MEDICARE ADMINISTRATIVE amended by adding at the end the following with respect to the furnishing of items or CONTRACTORS new paragraph: services and submission of a claim for bene- ‘‘SEC. 1874A. (a) AUTHORITY.— ‘‘(4) If the Secretary publishes a final regu- fits for such items or services with respect to ‘‘(1) AUTHORITY TO ENTER INTO CON- lation that includes a provision that is not a such provider or supplier; TRACTS.—The Secretary may enter into con- logical outgrowth of a previously published ‘‘(ii) the Secretary determines that the tracts with any eligible entity to serve as a notice of proposed rulemaking or interim provider of services or supplier has accu- medicare administrative contractor with re- final rule, such provision shall be treated as rately presented the circumstances relating spect to the performance of any or all of the a proposed regulation and shall not take ef- to such items, services, and claim to the con- functions described in paragraph (4) or parts fect until there is the further opportunity tractor in writing; and of those functions (or, to the extent provided for public comment and a publication of the ‘‘(iii) the guidance was in error; in a contract, to secure performance thereof the provider of services or supplier shall not provision again as a final regulation.’’. by other entities). be subject to any sanction (including any (2) EFFECTIVE DATE.—The amendment ‘‘(2) ELIGIBILITY OF ENTITIES.—An entity is made by paragraph (1) shall apply to final penalty or requirement for repayment of any amount) if the provider of services or sup- eligible to enter into a contract with respect regulations published on or after the date of to the performance of a particular function the enactment of this Act. plier reasonably relied on such guidance. ‘‘(B) Subparagraph (A) shall not be con- described in paragraph (4) only if— SEC. 903. COMPLIANCE WITH CHANGES IN REGU- ‘‘(A) the entity has demonstrated capa- LATIONS AND POLICIES. strued as preventing the recoupment or re- payment (without any additional penalty) bility to carry out such function; (a) NO RETROACTIVE APPLICATION OF SUB- relating to an overpayment insofar as the ‘‘(B) the entity complies with such conflict STANTIVE CHANGES.— overpayment was solely the result of a cler- of interest standards as are generally appli- (1) IN GENERAL.—Section 1871 (42 U.S.C. ical or technical operational error.’’. cable to Federal acquisition and procure- 1395hh), as amended by section 902(a), is (2) EFFECTIVE DATE.—The amendment ment; amended by adding at the end the following made by paragraph (1) shall take effect on ‘‘(C) the entity has sufficient assets to fi- new subsection: nancially support the performance of such ‘‘(e)(1)(A) A substantive change in regula- the date of the enactment of this Act but function; and tions, manual instructions, interpretative shall not apply to any sanction for which no- ‘‘(D) the entity meets such other require- rules, statements of policy, or guidelines of tice was provided on or before the date of the enactment of this Act. ments as the Secretary may impose. general applicability under this title shall ‘‘(3) MEDICARE ADMINISTRATIVE CONTRACTOR not be applied (by extrapolation or other- SEC. 904. REPORTS AND STUDIES RELATING TO REGULATORY REFORM. DEFINED.—For purposes of this title and title wise) retroactively to items and services fur- (a) GAO STUDY ON ADVISORY OPINION AU- XI— nished before the effective date of the THORITY.— ‘‘(A) IN GENERAL.—The term ‘medicare ad- change, unless the Secretary determines (1) STUDY.—The Comptroller General of the ministrative contractor’ means an agency, that— United States shall conduct a study to deter- organization, or other person with a contract ‘‘(i) such retroactive application is nec- mine the feasibility and appropriateness of under this section. essary to comply with statutory require- establishing in the Secretary authority to ‘‘(B) APPROPRIATE MEDICARE ADMINISTRA- ments; or provide legally binding advisory opinions on TIVE CONTRACTOR.—With respect to the per- ‘‘(ii) failure to apply the change retro- appropriate interpretation and application of formance of a particular function in relation actively would be contrary to the public in- regulations to carry out the medicare pro- to an individual entitled to benefits under terest.’’. gram under title XVIII of the Social Secu- part A or enrolled under part B, or both, a (2) EFFECTIVE DATE.—The amendment rity Act. Such study shall examine the ap- specific provider of services or supplier (or made by paragraph (1) shall apply to sub- propriate timeframe for issuing such advi- class of such providers of services or sup- stantive changes issued on or after the date sory opinions, as well as the need for addi- pliers), the ‘appropriate’ medicare adminis- of the enactment of this Act. tional staff and funding to provide such opin- trative contractor is the medicare adminis- (b) TIMELINE FOR COMPLIANCE WITH SUB- ions. trative contractor that has a contract under STANTIVE CHANGES AFTER NOTICE.— (2) REPORT.—The Comptroller General this section with respect to the performance (1) IN GENERAL.—Section 1871(e)(1), as shall submit to Congress a report on the added by subsection (a), is amended by add- of that function in relation to that indi- study conducted under paragraph (1) by not vidual, provider of services or supplier or ing at the end the following: later than one year after the date of the en- ‘‘(B)(i) Except as provided in clause (ii), a class of provider of services or supplier. actment of this Act. ‘‘(4) FUNCTIONS DESCRIBED.—The functions substantive change referred to in subpara- (b) REPORT ON LEGAL AND REGULATORY IN- graph (A) shall not become effective before referred to in paragraphs (1) and (2) are pay- CONSISTENCIES.—Section 1871 (42 U.S.C. ment functions, provider services functions, the end of the 30-day period that begins on 1395hh), as amended by section 2(a), is the date that the Secretary has issued or and functions relating to services furnished amended by adding at the end the following to individuals entitled to benefits under part published, as the case may be, the sub- new subsection: A or enrolled under part B, or both, as fol- stantive change. ‘‘(f)(1) Not later than 2 years after the date ‘‘(ii) The Secretary may provide for such a of the enactment of this subsection, and lows: substantive change to take effect on a date every 2 years thereafter, the Secretary shall ‘‘(A) DETERMINATION OF PAYMENT that precedes the end of the 30-day period submit to Congress a report with respect to AMOUNTS.—Determining (subject to the pro- under clause (i) if the Secretary finds that the administration of this title and areas of visions of section 1878 and to such review by waiver of such 30-day period is necessary to inconsistency or conflict among the various the Secretary as may be provided for by the comply with statutory requirements or that provisions under law and regulation. contracts) the amount of the payments re- the application of such 30-day period is con- ‘‘(2) In preparing a report under paragraph quired pursuant to this title to be made to trary to the public interest. If the Secretary (1), the Secretary shall collect— providers of services, suppliers and individ- provides for an earlier effective date pursu- ‘‘(A) information from individuals entitled uals. ant to this clause, the Secretary shall in- to benefits under part A or enrolled under ‘‘(B) MAKING PAYMENTS.—Making pay- clude in the issuance or publication of the part B, or both, providers of services, and ments described in subparagraph (A) (includ- substantive change a finding described in the suppliers and from the Medicare Beneficiary ing receipt, disbursement, and accounting first sentence, and a brief statement of the Ombudsman and the Medicare Provider Om- for funds in making such payments). reasons for such finding. budsman with respect to such areas of incon- ‘‘(C) BENEFICIARY EDUCATION AND ASSIST- ‘‘(C) No action shall be taken against a sistency and conflict; and ANCE.—Providing education and outreach to provider of services or supplier with respect ‘‘(B) information from medicare contrac- individuals entitled to benefits under part A to noncompliance with such a substantive tors that tracks the nature of written and or enrolled under part B, or both, and pro- change for items and services furnished be- telephone inquiries. viding assistance to those individuals with fore the effective date of such a change.’’. ‘‘(3) A report under paragraph (1) shall in- specific issues, concerns or problems. (2) EFFECTIVE DATE.—The amendment clude a description of efforts by the Sec- ‘‘(D) PROVIDER CONSULTATIVE SERVICES.— made by paragraph (1) shall apply to compli- retary to reduce such inconsistency or con- Providing consultative services to institu- ance actions undertaken on or after the date flicts, and recommendations for legislation tions, agencies, and other persons to enable of the enactment of this Act. or administrative action that the Secretary them to establish and maintain fiscal (c) RELIANCE ON GUIDANCE.— determines appropriate to further reduce records necessary for purposes of this title (1) IN GENERAL.—Section 1871(e), as added such inconsistency or conflicts.’’. and otherwise to qualify as providers of serv- by subsection (a), is further amended by add- Subtitle B—Contracting Reform ices or suppliers. ing at the end the following new paragraph: SEC. 911. INCREASED FLEXIBILITY IN MEDICARE ‘‘(E) COMMUNICATION WITH PROVIDERS.— ‘‘(2)(A) If— ADMINISTRATION. Communicating to providers of services and ‘‘(i) a provider of services or supplier fol- (a) CONSOLIDATION AND FLEXIBILITY IN suppliers any information or instructions lows the written guidance (which may be MEDICARE ADMINISTRATION.— furnished to the medicare administrative
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contractor by the Secretary, and facilitating ‘‘(A) DEVELOPMENT OF SPECIFIC PERFORM- States, be liable with respect to any pay- communication between such providers and ANCE REQUIREMENTS.—In developing contract ment by such officer under this section if it suppliers and the Secretary. performance requirements, the Secretary was based upon an authorization (which ‘‘(F) PROVIDER EDUCATION AND TECHNICAL shall develop performance requirements ap- meets the applicable requirements for such ASSISTANCE.—Performing the functions relat- plicable to functions described in subsection internal controls established by the Comp- ing to provider education, training, and tech- (a)(4). troller General) of a certifying officer des- nical assistance. ‘‘(B) CONSULTATION.— In developing such ignated as provided in paragraph (1) of this ‘‘(G) ADDITIONAL FUNCTIONS.—Performing requirements, the Secretary may consult subsection. such other functions as are necessary to with providers of services and suppliers, or- ‘‘(3) LIABILITY OF MEDICARE ADMINISTRATIVE carry out the purposes of this title. ganizations representing individuals entitled CONTRACTOR.— ‘‘(5) RELATIONSHIP TO MIP CONTRACTS.— to benefits under part A or enrolled under ‘‘(A) IN GENERAL.—No medicare adminis- ‘‘(A) NONDUPLICATION OF DUTIES.—In enter- part B, or both, and organizations and agen- trative contractor shall be liable to the ing into contracts under this section, the cies performing functions necessary to carry United States for a payment by a certifying Secretary shall assure that functions of out the purposes of this section with respect or disbursing officer unless, in connection medicare administrative contractors in car- to such performance requirements. with such payment, the medicare adminis- rying out activities under parts A and B do ‘‘(C) INCLUSION IN CONTRACTS.—All con- trative contractor acted with reckless dis- not duplicate activities carried out under the tractor performance requirements shall be regard of its obligations under its medicare Medicare Integrity Program under section set forth in the contract between the Sec- administrative contract or with intent to de- 1893. The previous sentence shall not apply retary and the appropriate medicare admin- fraud the United States. with respect to the activity described in sec- istrative contractor. Such performance re- ‘‘(B) RELATIONSHIP TO FALSE CLAIMS ACT.— tion 1893(b)(5) (relating to prior authoriza- quirements— Nothing in this subsection shall be construed tion of certain items of durable medical ‘‘(i) shall reflect the performance require- to limit liability for conduct that would con- equipment under section 1834(a)(15)). ments developed under subparagraph (A), but stitute a violation of sections 3729 through ‘‘(B) CONSTRUCTION.—An entity shall not be may include additional performance require- 3731 of title 31, United States Code (com- treated as a medicare administrative con- ments; monly known as the ‘False Claims Act’). tractor merely by reason of having entered ‘‘(ii) shall be used for evaluating con- ‘‘(4) INDEMNIFICATION BY SECRETARY.— into a contract with the Secretary under sec- tractor performance under the contract; and ‘‘(A) IN GENERAL.—Subject to subpara- tion 1893. ‘‘(iii) shall be consistent with the written graphs (B) and (D), in the case of a medicare ‘‘(6) APPLICATION OF FEDERAL ACQUISITION statement of work provided under the con- administrative contractor (or a person who REGULATION.—Except to the extent incon- tract. is a director, officer, or employee of such a sistent with a specific requirement of this ‘‘(4) INFORMATION REQUIREMENTS.—The Sec- contractor or who is engaged by the con- title, the Federal Acquisition Regulation ap- retary shall not enter into a contract with a tractor to participate directly in the claims plies to contracts under this title. medicare administrative contractor under administration process) who is made a party this section unless the contractor agrees— to any judicial or administrative proceeding ‘‘(b) CONTRACTING REQUIREMENTS.— ‘‘(A) to furnish to the Secretary such time- arising from or relating directly to the ‘‘(1) USE OF COMPETITIVE PROCEDURES.— ly information and reports as the Secretary claims administration process under this ‘‘(A) IN GENERAL.—Except as provided in may find necessary in performing his func- title, the Secretary may, to the extent the laws with general applicability to Federal tions under this title; and Secretary determines to be appropriate and acquisition and procurement or in subpara- ‘‘(B) to maintain such records and afford as specified in the contract with the con- graph (B), the Secretary shall use competi- such access thereto as the Secretary finds tractor, indemnify the contractor and such tive procedures when entering into contracts necessary to assure the correctness and persons. with medicare administrative contractors verification of the information and reports ‘‘(B) CONDITIONS.—The Secretary may not under this section, taking into account per- under subparagraph (A) and otherwise to provide indemnification under subparagraph formance quality as well as price and other carry out the purposes of this title. (A) insofar as the liability for such costs factors. ‘‘(5) SURETY BOND.—A contract with a arises directly from conduct that is deter- ‘‘(B) RENEWAL OF CONTRACTS.—The Sec- medicare administrative contractor under mined by the judicial proceeding or by the retary may renew a contract with a medi- this section may require the medicare ad- Secretary to be criminal in nature, fraudu- care administrative contractor under this ministrative contractor, and any of its offi- lent, or grossly negligent. If indemnification section from term to term without regard to cers or employees certifying payments or is provided by the Secretary with respect to section 5 of title 41, United States Code, or disbursing funds pursuant to the contract, or a contractor before a determination that any other provision of law requiring com- otherwise participating in carrying out the such costs arose directly from such conduct, petition, if the medicare administrative con- contract, to give surety bond to the United the contractor shall reimburse the Secretary tractor has met or exceeded the performance States in such amount as the Secretary may for costs of indemnification. requirements applicable with respect to the deem appropriate. ‘‘(C) SCOPE OF INDEMNIFICATION.—Indem- contract and contractor, except that the ‘‘(c) TERMS AND CONDITIONS.— nification by the Secretary under subpara- Secretary shall provide for the application of ‘‘(1) IN GENERAL.—A contract with any graph (A) may include payment of judg- competitive procedures under such a con- medicare administrative contractor under ments, settlements (subject to subparagraph tract not less frequently than once every five this section may contain such terms and (D)), awards, and costs (including reasonable years. conditions as the Secretary finds necessary legal expenses). ‘‘(C) TRANSFER OF FUNCTIONS.—The Sec- or appropriate and may provide for advances ‘‘(D) WRITTEN APPROVAL FOR SETTLE- retary may transfer functions among medi- of funds to the medicare administrative con- MENTS.—A contractor or other person de- care administrative contractors consistent tractor for the making of payments by it scribed in subparagraph (A) may not propose with the provisions of this paragraph. The under subsection (a)(4)(B). to negotiate a settlement or compromise of a Secretary shall ensure that performance ‘‘(2) PROHIBITION ON MANDATES FOR CERTAIN proceeding described in such subparagraph quality is considered in such transfers. The DATA COLLECTION.—The Secretary may not without the prior written approval of the Secretary shall provide public notice (wheth- require, as a condition of entering into, or Secretary to negotiate such settlement or er in the Federal Register or otherwise) of renewing, a contract under this section, that compromise. Any indemnification under sub- any such transfer (including a description of the medicare administrative contractor paragraph (A) with respect to amounts paid the functions so transferred, a description of match data obtained other than in its activi- under a settlement or compromise of a pro- the providers of services and suppliers af- ties under this title with data used in the ad- ceeding described in such subparagraph are fected by such transfer, and contact informa- ministration of this title for purposes of conditioned upon prior written approval by tion for the contractors involved). identifying situations in which the provi- the Secretary of the final settlement or com- ‘‘(D) INCENTIVES FOR QUALITY.—The Sec- sions of section 1862(b) may apply. promise. retary shall provide incentives for medicare ‘‘(d) LIMITATION ON LIABILITY OF MEDICARE ‘‘(E) CONSTRUCTION.—Nothing in this para- administrative contractors to provide qual- ADMINISTRATIVE CONTRACTORS AND CERTAIN graph shall be construed— ity service and to promote efficiency. OFFICERS.— ‘‘(i) to change any common law immunity ‘‘(2) COMPLIANCE WITH REQUIREMENTS.—No ‘‘(1) CERTIFYING OFFICER.—No individual that may be available to a medicare admin- contract under this section shall be entered designated pursuant to a contract under this istrative contractor or person described in into with any medicare administrative con- section as a certifying officer shall, in the subparagraph (A); or tractor unless the Secretary finds that such absence of the reckless disregard of the indi- ‘‘(ii) to permit the payment of costs not medicare administrative contractor will per- vidual’s obligations or the intent by that in- otherwise allowable, reasonable, or allocable form its obligations under the contract effi- dividual to defraud the United States, be lia- under the Federal Acquisition Regulations.’’. ciently and effectively and will meet such re- ble with respect to any payments certified (2) CONSIDERATION OF INCORPORATION OF quirements as to financial responsibility, by the individual under this section. CURRENT LAW STANDARDS.—In developing legal authority, quality of services provided, ‘‘(2) DISBURSING OFFICER.—No disbursing contract performance requirements under and other matters as the Secretary finds per- officer shall, in the absence of the reckless section 1874A(b) of the Social Security Act, tinent. disregard of the officer’s obligations or the as inserted by paragraph (1), the Secretary ‘‘(3) PERFORMANCE REQUIREMENTS.— intent by that officer to defraud the United shall consider inclusion of the performance
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00119 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.063 H26PT1 H6060 CONGRESSIONAL RECORD — HOUSE June 26, 2003 standards described in sections 1816(f)(2) of (vi) by striking subparagraph (I); fied under subparagraph (A) that continue to such Act (relating to timely processing of re- (vii) in subparagraph (L), by striking the retain the terms and conditions in effect on considerations and applications for exemp- semicolon and inserting a period; such date (except as otherwise provided tions) and section 1842(b)(2)(B) of such Act (viii) in the first sentence, after subpara- under this Act, other than under this sec- (relating to timely review of determinations graph (L), by striking ‘‘and shall contain’’ tion) until such date as the contract is let and fair hearing requests), as such sections and all that follows through the period; and out for competitive bidding under such were in effect before the date of the enact- (ix) in the seventh sentence, by inserting amendments. ment of this Act. ‘‘medicare administrative contractor,’’ after (C) DEADLINE FOR COMPETITIVE BIDDING.— (b) CONFORMING AMENDMENTS TO SECTION ‘‘carrier,’’; and The Secretary shall provide for the letting 1816 (RELATING TO FISCAL INTERMEDIARIES).— (D) by striking paragraph (5); by competitive bidding of all contracts for Section 1816 (42 U.S.C. 1395h) is amended as (E) in paragraph (6)(D)(iv), by striking functions of medicare administrative con- follows: ‘‘carrier’’ and inserting ‘‘medicare adminis- tractors for annual contract periods that (1) The heading is amended to read as fol- trative contractor’’; and begin on or after October 1, 2010. lows: (F) in paragraph (7), by striking ‘‘the car- (D) WAIVER OF PROVIDER NOMINATION PROVI- ‘‘PROVISIONS RELATING TO THE rier’’ and inserting ‘‘the Secretary’’ each SIONS DURING TRANSITION.—During the period ADMINISTRATION OF PART A’’. place it appears. beginning on the date of the enactment of (2) Subsection (a) is amended to read as (4) Subsection (c) is amended— (A) by striking paragraph (1); this Act and before the date specified under follows: subparagraph (A), the Secretary may enter ‘‘(a) The administration of this part shall (B) in paragraph (2)(A), by striking ‘‘con- into new agreements under section 1816 of be conducted through contracts with medi- tract under this section which provides for the Social Security Act (42 U.S.C. 1395h) care administrative contractors under sec- the disbursement of funds, as described in tion 1874A.’’. subsection (a)(1)(B),’’ and inserting ‘‘con- without regard to any of the provider nomi- (3) Subsection (b) is repealed. tract under section 1874A that provides for nation provisions of such section. (4) Subsection (c) is amended— making payments under this part’’; (2) GENERAL TRANSITION RULES.—The Sec- (A) by striking paragraph (1); and (C) in paragraph (3)(A), by striking ‘‘sub- retary shall take such steps, consistent with (B) in each of paragraphs (2)(A) and (3)(A), section (a)(1)(B)’’ and inserting ‘‘section paragraph (1)(B) and (1)(C), as are necessary by striking ‘‘agreement under this section’’ 1874A(a)(3)(B)’’; to provide for an appropriate transition from and inserting ‘‘contract under section 1874A (D) in paragraph (4), in the matter pre- contracts under section 1816 and section 1842 that provides for making payments under ceding subparagraph (A), by striking ‘‘car- of the Social Security Act (42 U.S.C. 1395h, this part’’. rier’’ and inserting ‘‘medicare administra- 1395u) to contracts under section 1874A, as (5) Subsections (d) through (i) are repealed. tive contractor’’; and added by subsection (a)(1). (6) Subsections (j) and (k) are each amend- (E) by striking paragraphs (5) and (6). (3) AUTHORIZING CONTINUATION OF MIP FUNC- ed— (5) Subsections (d), (e), and (f) are repealed. TIONS UNDER CURRENT CONTRACTS AND AGREE- (A) by striking ‘‘An agreement with an (6) Subsection (g) is amended by striking MENTS AND UNDER ROLLOVER CONTRACTS.—The agency or organization under this section’’ ‘‘carrier or carriers’’ and inserting ‘‘medi- provisions contained in the exception in sec- and inserting ‘‘A contract with a medicare care administrative contractor or contrac- tion 1893(d)(2) of the Social Security Act (42 administrative contractor under section tors’’. U.S.C. 1395ddd(d)(2)) shall continue to apply 1874A with respect to the administration of (7) Subsection (h) is amended— notwithstanding the amendments made by this part’’; and (A) in paragraph (2)— this section, and any reference in such provi- (B) by striking ‘‘such agency or organiza- (i) by striking ‘‘Each carrier having an sions to an agreement or contract shall be agreement with the Secretary under sub- tion’’ and inserting ‘‘such medicare adminis- deemed to include a contract under section section (a)’’ and inserting ‘‘The Secretary’’; trative contractor’’ each place it appears. 1874A of such Act, as inserted by subsection and (7) Subsection (l) is repealed. (a)(1), that continues the activities referred (c) CONFORMING AMENDMENTS TO SECTION (ii) by striking ‘‘Each such carrier’’ and in- to in such provisions. 1842 (RELATING TO CARRIERS).—Section 1842 serting ‘‘The Secretary’’; (42 U.S.C. 1395u) is amended as follows: (B) in paragraph (3)(A)— (e) REFERENCES.—On and after the effective (1) The heading is amended to read as fol- (i) by striking ‘‘a carrier having an agree- date provided under subsection (d)(1), any lows: ment with the Secretary under subsection reference to a fiscal intermediary or carrier ‘‘PROVISIONS RELATING TO THE (a)’’ and inserting ‘‘medicare administrative under title XI or XVIII of the Social Secu- contractor having a contract under section ADMINISTRATION OF PART B’’. rity Act (or any regulation, manual instruc- 1874A that provides for making payments (2) Subsection (a) is amended to read as under this part’’; and tion, interpretative rule, statement of pol- follows: (ii) by striking ‘‘such carrier’’ and insert- icy, or guideline issued to carry out such ti- ‘‘(a) The administration of this part shall tles) shall be deemed a reference to a medi- be conducted through contracts with medi- ing ‘‘such contractor’’; care administrative contractors under sec- (C) in paragraph (3)(B)— care administrative contractor (as provided tion 1874A.’’. (i) by striking ‘‘a carrier’’ and inserting ‘‘a under section 1874A of the Social Security (3) Subsection (b) is amended— medicare administrative contractor’’ each Act). place it appears; and (A) by striking paragraph (1); (f) REPORTS ON IMPLEMENTATION.— (ii) by striking ‘‘the carrier’’ and inserting (B) in paragraph (2)— (1) PLAN FOR IMPLEMENTATION.—By not ‘‘the contractor’’ each place it appears; and (i) by striking subparagraphs (A) and (B); later than October 1, 2004, the Secretary (D) in paragraphs (5)(A) and (5)(B)(iii), by (ii) in subparagraph (C), by striking ‘‘car- shall submit a report to Congress and the riers’’ and inserting ‘‘medicare administra- striking ‘‘carriers’’ and inserting ‘‘medicare administrative contractors’’ each place it Comptroller General of the United States tive contractors’’; and that describes the plan for implementation (iii) by striking subparagraphs (D) and (E); appears. (8) Subsection (l) is amended— of the amendments made by this section. (C) in paragraph (3)— The Comptroller General shall conduct an (i) in the matter before subparagraph (A), (A) in paragraph (1)(A)(iii), by striking evaluation of such plan and shall submit to by striking ‘‘Each such contract shall pro- ‘‘carrier’’ and inserting ‘‘medicare adminis- Congress, not later than 6 months after the vide that the carrier’’ and inserting ‘‘The trative contractor’’; and date the report is received, a report on such Secretary’’; (B) in paragraph (2), by striking ‘‘carrier’’ evaluation and shall include in such report (ii) by striking ‘‘will’’ the first place it ap- and inserting ‘‘medicare administrative con- pears in each of subparagraphs (A), (B), (F), tractor’’. such recommendations as the Comptroller (G), (H), and (L) and inserting ‘‘shall’’; (9) Subsection (p)(3)(A) is amended by General deems appropriate. (iii) in subparagraph (B), in the matter be- striking ‘‘carrier’’ and inserting ‘‘medicare (2) STATUS OF IMPLEMENTATION.—The Sec- fore clause (i), by striking ‘‘to the policy- administrative contractor’’. retary shall submit a report to Congress not holders and subscribers of the carrier’’ and (10) Subsection (q)(1)(A) is amended by later than October 1, 2008, that describes the inserting ‘‘to the policyholders and sub- striking ‘‘carrier’’. status of implementation of such amend- scribers of the medicare administrative con- (d) EFFECTIVE DATE; TRANSITION RULE.— ments and that includes a description of the tractor’’; (1) EFFECTIVE DATE.— following: (iv) by striking subparagraphs (C), (D), and (A) IN GENERAL.—Except as otherwise pro- (A) The number of contracts that have (E); vided in this subsection, the amendments been competitively bid as of such date. (v) in subparagraph (H)— made by this section shall take effect on Oc- (B) The distribution of functions among (I) by striking ‘‘if it makes determinations tober 1, 2005, and the Secretary is authorized contracts and contractors. or payments with respect to physicians’ to take such steps before such date as may (C) A timeline for complete transition to services,’’ in the matter preceding clause (i); be necessary to implement such amendments full competition. and on a timely basis. (D) A detailed description of how the Sec- (II) by striking ‘‘carrier’’ and inserting (B) CONSTRUCTION FOR CURRENT CON- retary has modified oversight and manage- ‘‘medicare administrative contractor’’ in TRACTS.—Such amendments shall not apply ment of medicare contractors to adapt to clause (i); to contracts in effect before the date speci- full competition.
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00120 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.063 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6061 SEC. 912. REQUIREMENTS FOR INFORMATION SE- assessments of the scope and sufficiency of odology under section 1874A(f) of the Social CURITY FOR MEDICARE ADMINIS- such evaluations. Security Act, as added by paragraph (1), and TRATIVE CONTRACTORS. ‘‘(iii) AGENCY REPORTING.—The Secretary shall include in the report such recommenda- (a) IN GENERAL.—Section 1874A, as added shall address the results of such evaluations tions as the Comptroller General determines by section 911(a)(1), is amended by adding at in reports required under section 3544(c) of appropriate with respect to the method- the end the following new subsection: title 44, United States Code.’’. ology. ‘‘(e) REQUIREMENTS FOR INFORMATION SECU- (b) APPLICATION OF REQUIREMENTS TO FIS- (4) REPORT ON USE OF METHODOLOGY IN AS- RITY.— CAL INTERMEDIARIES AND CARRIERS.— SESSING CONTRACTOR PERFORMANCE.—Not ‘‘(1) DEVELOPMENT OF INFORMATION SECU- (1) IN GENERAL.—The provisions of section later than October 1, 2004, the Secretary RITY PROGRAM.—A medicare administrative 1874A(e)(2) of the Social Security Act (other shall submit to Congress a report that de- contractor that performs the functions re- than subparagraph (B)), as added by sub- scribes how the Secretary intends to use ferred to in subparagraphs (A) and (B) of sub- section (a), shall apply to each fiscal inter- such methodology in assessing medicare con- section (a)(4) (relating to determining and mediary under section 1816 of the Social Se- tractor performance in implementing effec- making payments) shall implement a con- curity Act (42 U.S.C. 1395h) and each carrier tive education and outreach programs, in- tractor-wide information security program under section 1842 of such Act (42 U.S.C. cluding whether to use such methodology as to provide information security for the oper- 1395u) in the same manner as they apply to a basis for performance bonuses. The report shall include an analysis of the sources of ation and assets of the contractor with re- medicare administrative contractors under identified errors and potential changes in spect to such functions under this title. An such provisions. systems of contractors and rules of the Sec- information security program under this (2) DEADLINE FOR INITIAL EVALUATION.—In retary that could reduce claims error rates. paragraph shall meet the requirements for the case of such a fiscal intermediary or car- (c) PROVISION OF ACCESS TO AND PROMPT information security programs imposed on rier with an agreement or contract under such respective section in effect as of the RESPONSES FROM MEDICARE ADMINISTRATIVE Federal agencies under paragraphs (1) CONTRACTORS.— through (8) of section 3544(b) of title 44, date of the enactment of this Act, the first evaluation under section 1874A(e)(2)(A) of the (1) IN GENERAL.—Section 1874A, as added by United States Code (other than the require- section 911(a)(1) and as amended by section ments under paragraphs (2)(D)(i), (5)(A), and Social Security Act (as added by subsection (a)), pursuant to paragraph (1), shall be com- 912(a) and subsection (b), is further amended (5)(B) of such section). by adding at the end the following new sub- ‘‘(2) INDEPENDENT AUDITS.— pleted (and a report on the evaluation sub- mitted to the Secretary) by not later than 1 section: ‘‘(A) PERFORMANCE OF ANNUAL EVALUA- ‘‘(g) COMMUNICATIONS WITH BENEFICIARIES, year after such date. TIONS.—Each year a medicare administrative PROVIDERS OF SERVICES AND SUPPLIERS.— contractor that performs the functions re- Subtitle C—Education and Outreach ‘‘(1) COMMUNICATION STRATEGY.—The Sec- ferred to in subparagraphs (A) and (B) of sub- SEC. 921. PROVIDER EDUCATION AND TECH- retary shall develop a strategy for commu- section (a)(4) (relating to determining and NICAL ASSISTANCE. nications with individuals entitled to bene- making payments) shall undergo an evalua- (a) COORDINATION OF EDUCATION FUNDING.— fits under part A or enrolled under part B, or tion of the information security of the con- (1) IN GENERAL.—Title XVIII is amended by both, and with providers of services and sup- tractor with respect to such functions under inserting after section 1888 the following new pliers under this title. this title. The evaluation shall— section: ‘‘(2) RESPONSE TO WRITTEN INQUIRIES.—Each ‘‘(i) be performed by an entity that meets ‘‘PROVIDER EDUCATION AND TECHNICAL medicare administrative contractor shall, such requirements for independence as the ASSISTANCE for those providers of services and suppliers Inspector General of the Department of ‘‘SEC. 1889. (a) COORDINATION OF EDUCATION which submit claims to the contractor for Health and Human Services may establish; FUNDING.—The Secretary shall coordinate claims processing and for those individuals and the educational activities provided through entitled to benefits under part A or enrolled ‘‘(ii) test the effectiveness of information medicare contractors (as defined in sub- under part B, or both, with respect to whom security control techniques of an appropriate section (g), including under section 1893) in claims are submitted for claims processing, subset of the contractor’s information sys- order to maximize the effectiveness of Fed- provide general written responses (which tems (as defined in section 3502(8) of title 44, eral education efforts for providers of serv- may be through electronic transmission) in a United States Code) relating to such func- ices and suppliers.’’. clear, concise, and accurate manner to in- tions under this title and an assessment of (2) EFFECTIVE DATE.—The amendment quiries of providers of services, suppliers and compliance with the requirements of this made by paragraph (1) shall take effect on individuals entitled to benefits under part A subsection and related information security the date of the enactment of this Act. or enrolled under part B, or both, concerning policies, procedures, standards and guide- (3) REPORT.—Not later than October 1, 2004, the programs under this title within 45 busi- lines, including policies and procedures as the Secretary shall submit to Congress a re- ness days of the date of receipt of such in- may be prescribed by the Director of the Of- port that includes a description and evalua- quiries. fice of Management and Budget and applica- tion of the steps taken to coordinate the ‘‘(3) RESPONSE TO TOLL-FREE LINES.—The ble information security standards promul- funding of provider education under section Secretary shall ensure that each medicare gated under section 11331 of title 40, United 1889(a) of the Social Security Act, as added administrative contractor shall provide, for States Code. by paragraph (1). those providers of services and suppliers ‘‘(B) DEADLINE FOR INITIAL EVALUATION.— (b) INCENTIVES TO IMPROVE CONTRACTOR which submit claims to the contractor for ‘‘(i) NEW CONTRACTORS.—In the case of a PERFORMANCE.— claims processing and for those individuals medicare administrative contractor covered (1) IN GENERAL.—Section 1874A, as added by entitled to benefits under part A or enrolled by this subsection that has not previously section 911(a)(1) and as amended by section under part B, or both, with respect to whom performed the functions referred to in sub- 912(a), is amended by adding at the end the claims are submitted for claims processing, a paragraphs (A) and (B) of subsection (a)(4) following new subsection: toll-free telephone number at which such in- (relating to determining and making pay- ‘‘(f) INCENTIVES TO IMPROVE CONTRACTOR dividuals, providers of services and suppliers ments) as a fiscal intermediary or carrier PERFORMANCE IN PROVIDER EDUCATION AND may obtain information regarding billing, under section 1816 or 1842, the first inde- OUTREACH.—The Secretary shall use specific coding, claims, coverage, and other appro- pendent evaluation conducted pursuant sub- claims payment error rates or similar meth- priate information under this title. paragraph (A) shall be completed prior to odology of medicare administrative contrac- ‘‘(4) MONITORING OF CONTRACTOR RE- commencing such functions. tors in the processing or reviewing of medi- SPONSES.— ‘‘(ii) OTHER CONTRACTORS.—In the case of a care claims in order to give such contractors ‘‘(A) IN GENERAL.—Each medicare adminis- medicare administrative contractor covered an incentive to implement effective edu- trative contractor shall, consistent with by this subsection that is not described in cation and outreach programs for providers standards developed by the Secretary under clause (i), the first independent evaluation of services and suppliers.’’. subparagraph (B)— conducted pursuant subparagraph (A) shall (2) APPLICATION TO FISCAL INTERMEDIARIES ‘‘(i) maintain a system for identifying who be completed within 1 year after the date the AND CARRIERS.—The provisions of section provides the information referred to in para- contractor commences functions referred to 1874A(f) of the Social Security Act, as added graphs (2) and (3); and in clause (i) under this section. by paragraph (1), shall apply to each fiscal ‘‘(ii) monitor the accuracy, consistency, ‘‘(C) REPORTS ON EVALUATIONS.— intermediary under section 1816 of the Social and timeliness of the information so pro- ‘‘(i) TO THE DEPARTMENT OF HEALTH AND Security Act (42 U.S.C. 1395h) and each car- vided. HUMAN SERVICES.—The results of independent rier under section 1842 of such Act (42 U.S.C. ‘‘(B) DEVELOPMENT OF STANDARDS.— evaluations under subparagraph (A) shall be 1395u) in the same manner as they apply to ‘‘(i) IN GENERAL.—The Secretary shall es- submitted promptly to the Inspector General medicare administrative contractors under tablish and make public standards to mon- of the Department of Health and Human such provisions. itor the accuracy, consistency, and timeli- Services and to the Secretary. (3) GAO REPORT ON ADEQUACY OF METHOD- ness of the information provided in response ‘‘(ii) TO CONGRESS.—The Inspector General OLOGY.—Not later than October 1, 2004, the to written and telephone inquiries under this of Department of Health and Human Serv- Comptroller General of the United States subsection. Such standards shall be con- ices shall submit to Congress annual reports shall submit to Congress and to the Sec- sistent with the performance requirements on the results of such evaluations, including retary a report on the adequacy of the meth- established under subsection (b)(3).
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‘‘(ii) EVALUATION.—In conducting evalua- ‘‘(2) includes other published materials of Secretary shall enter into contracts with tions of individual medicare administrative the contractor, qualified organizations (such as peer review contractors, the Secretary shall take into that relate to providers of services and sup- organizations or entities described in section account the results of the monitoring con- pliers under the programs under this title 1889(g)(2) of the Social Security Act, as in- ducted under subparagraph (A) taking into (and title XI insofar as it relates to such pro- serted by section 5(f)(1)) with appropriate ex- account as performance requirements the grams).’’. pertise with billing systems of the full range standards established under clause (i). The (2) EFFECTIVE DATE.—The amendment of providers of services and suppliers to pro- Secretary shall, in consultation with organi- made by paragraph (1) shall take effect on vide the technical assistance. In awarding zations representing providers of services, October 1, 2004. such contracts, the Secretary shall consider suppliers, and individuals entitled to bene- (f) ADDITIONAL PROVIDER EDUCATION PROVI- any prior investigations of the entity’s work fits under part A or enrolled under part B, or SIONS.— by the Inspector General of Department of both, establish standards relating to the ac- (1) IN GENERAL.—Section 1889, as added by Health and Human Services or the Comp- curacy, consistency, and timeliness of the in- subsection (a) and as amended by subsections troller General of the United States. formation so provided. (d) and (e), is further amended by adding at (c) DESCRIPTION OF TECHNICAL ASSIST- ‘‘(C) DIRECT MONITORING.—Nothing in this the end the following new subsections: ANCE.—The technical assistance provided paragraph shall be construed as preventing ‘‘(e) ENCOURAGEMENT OF PARTICIPATION IN under the demonstration program shall in- the Secretary from directly monitoring the EDUCATION PROGRAM ACTIVITIES.—A medi- clude a direct and in-person examination of accuracy, consistency, and timeliness of the care contractor may not use a record of at- billing systems and internal controls of information so provided.’’. tendance at (or failure to attend) edu- small providers of services or suppliers to de- (2) EFFECTIVE DATE.—The amendment cational activities or other information termine program compliance and to suggest made by paragraph (1) shall take effect Octo- gathered during an educational program con- more efficient or effective means of achiev- ber 1, 2004. ducted under this section or otherwise by the ing such compliance. (3) APPLICATION TO FISCAL INTERMEDIARIES Secretary to select or track providers of (d) AVOIDANCE OF RECOVERY ACTIONS FOR AND CARRIERS.—The provisions of section services or suppliers for the purpose of con- PROBLEMS IDENTIFIED AS CORRECTED.—The 1874A(g) of the Social Security Act, as added ducting any type of audit or prepayment re- Secretary shall provide that, absent evidence by paragraph (1), shall apply to each fiscal view. of fraud and notwithstanding any other pro- intermediary under section 1816 of the Social ‘‘(f) CONSTRUCTION.—Nothing in this sec- vision of law, any errors found in a compli- Security Act (42 U.S.C. 1395h) and each car- tion or section 1893(g) shall be construed as ance review for a small provider of services rier under section 1842 of such Act (42 U.S.C. providing for disclosure by a medicare con- or supplier that participates in the dem- 1395u) in the same manner as they apply to tractor of information that would com- onstration program shall not be subject to medicare administrative contractors under promise pending law enforcement activities recovery action if the technical assistance such provisions. or reveal findings of law enforcement-related personnel under the program determine (d) IMPROVED PROVIDER EDUCATION AND audits. that— TRAINING.— ‘‘(g) DEFINITIONS.—For purposes of this sec- (1) the problem that is the subject of the (1) IN GENERAL.—Section 1889, as added by tion, the term ‘medicare contractor’ includes compliance review has been corrected to subsection (a), is amended by adding at the the following: their satisfaction within 30 days of the date end the following new subsections: ‘‘(1) A medicare administrative contractor of the visit by such personnel to the small ‘‘(b) ENHANCED EDUCATION AND TRAINING.— with a contract under section 1874A, includ- provider of services or supplier; and ‘‘(1) ADDITIONAL RESOURCES.—There are au- ing a fiscal intermediary with a contract (2) such problem remains corrected for thorized to be appropriated to the Secretary under section 1816 and a carrier with a con- such period as is appropriate. (in appropriate part from the Federal Hos- tract under section 1842. The previous sentence applies only to claims pital Insurance Trust Fund and the Federal ‘‘(2) An eligible entity with a contract filed as part of the demonstration program Supplementary Medical Insurance Trust under section 1893. and lasts only for the duration of such pro- Fund) $25,000,000 for each of fiscal years 2005 Such term does not include, with respect to gram and only as long as the small provider and 2006 and such sums as may be necessary activities of a specific provider of services or of services or supplier is a participant in for succeeding fiscal years. supplier an entity that has no authority such program. ‘‘(2) USE.—The funds made available under under this title or title IX with respect to (e) GAO EVALUATION.—Not later than 2 paragraph (1) shall be used to increase the such activities and such provider of services years after the date of the date the dem- conduct by medicare contractors of edu- or supplier.’’. onstration program is first implemented, the cation and training of providers of services (2) EFFECTIVE DATE.—The amendment Comptroller General, in consultation with and suppliers regarding billing, coding, and made by paragraph (1) shall take effect on the Inspector General of the Department of other appropriate items and may also be the date of the enactment of this Act. Health and Human Services, shall conduct used to improve the accuracy, consistency, SEC. 922. SMALL PROVIDER TECHNICAL ASSIST- an evaluation of the demonstration program. and timeliness of contractor responses. ANCE DEMONSTRATION PROGRAM. The evaluation shall include a determination ‘‘(c) TAILORING EDUCATION AND TRAINING (a) ESTABLISHMENT.— of whether claims error rates are reduced for ACTIVITIES FOR SMALL PROVIDERS OR SUP- (1) IN GENERAL.—The Secretary shall estab- small providers of services or suppliers who PLIERS.— lish a demonstration program (in this sec- participated in the program and the extent ‘‘(1) IN GENERAL.—Insofar as a medicare tion referred to as the ‘‘demonstration pro- of improper payments made as a result of the contractor conducts education and training gram’’) under which technical assistance de- demonstration program. The Comptroller activities, it shall tailor such activities to scribed in paragraph (2) is made available, General shall submit a report to the Sec- meet the special needs of small providers of upon request and on a voluntary basis, to retary and the Congress on such evaluation services or suppliers (as defined in paragraph small providers of services or suppliers in and shall include in such report rec- (2)). order to improve compliance with the appli- ommendations regarding the continuation or ‘‘(2) SMALL PROVIDER OF SERVICES OR SUP- cable requirements of the programs under extension of the demonstration program. PLIER.—In this subsection, the term ‘small medicare program under title XVIII of the (f) FINANCIAL PARTICIPATION BY PRO- provider of services or supplier’ means— Social Security Act (including provisions of VIDERS.—The provision of technical assist- ‘‘(A) a provider of services with fewer than title XI of such Act insofar as they relate to ance to a small provider of services or sup- 25 full-time-equivalent employees; or such title and are not administered by the plier under the demonstration program is ‘‘(B) a supplier with fewer than 10 full- Office of the Inspector General of the Depart- conditioned upon the small provider of serv- time-equivalent employees.’’. ment of Health and Human Services). ices or supplier paying an amount estimated (2) EFFECTIVE DATE.—The amendment (2) FORMS OF TECHNICAL ASSISTANCE.—The (and disclosed in advance of a provider’s or made by paragraph (1) shall take effect on technical assistance described in this para- supplier’s participation in the program) to be October 1, 2004. graph is— equal to 25 percent of the cost of the tech- (e) REQUIREMENT TO MAINTAIN INTERNET (A) evaluation and recommendations re- nical assistance. SITES.— garding billing and related systems; and (g) AUTHORIZATION OF APPROPRIATIONS.— (1) IN GENERAL.—Section 1889, as added by (B) information and assistance regarding There are authorized to be appropriated to subsection (a) and as amended by subsection policies and procedures under the medicare the Secretary (in appropriate part from the (d), is further amended by adding at the end program, including coding and reimburse- Federal Hospital Insurance Trust Fund and the following new subsection: ment. the Federal Supplementary Medical Insur- ‘‘(d) INTERNET SITES; FAQS.—The Sec- (3) SMALL PROVIDERS OF SERVICES OR SUP- ance Trust Fund) to carry out the dem- retary, and each medicare contractor insofar PLIERS.—In this section, the term ‘‘small onstration program— as it provides services (including claims providers of services or suppliers’’ means— (1) for fiscal year 2005, $1,000,000, and processing) for providers of services or sup- (A) a provider of services with fewer than (2) for fiscal year 2006, $6,000,000. pliers, shall maintain an Internet site 25 full-time-equivalent employees; or SEC. 923. MEDICARE PROVIDER OMBUDSMAN; which— (B) a supplier with fewer than 10 full-time- MEDICARE BENEFICIARY OMBUDS- ‘‘(1) provides answers in an easily acces- equivalent employees. MAN. sible format to frequently asked questions, (b) QUALIFICATION OF CONTRACTORS.—In (a) MEDICARE PROVIDER OMBUDSMAN.—Sec- and conducting the demonstration program, the tion 1868 (42 U.S.C. 1395ee) is amended—
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00122 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.063 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6063 (1) by adding at the end of the heading the ‘‘(3) submit annual reports to Congress and employed by the Department of Health and following: ‘‘; MEDICARE PROVIDER OMBUDS- the Secretary that describe the activities of Human Services provide advice and assist- MAN’’; the Office and that include such rec- ance to individuals entitled to benefits under (2) by inserting ‘‘PRACTICING PHYSICIANS ommendations for improvement in the ad- part A of title XVIII of the Social Security ADVISORY COUNCIL.—(1)’’ after ‘‘(a)’’; ministration of this title as the Ombudsman Act, or enrolled under part B of such title, or (3) in paragraph (1), as so redesignated determines appropriate. both, regarding the medicare program at the under paragraph (2), by striking ‘‘in this sec- The Ombudsman shall not serve as an advo- location of existing local offices of the Social tion’’ and inserting ‘‘in this subsection’’; cate for any increases in payments or new Security Administration. (4) by redesignating subsections (b) and (c) coverage of services, but may identify issues (b) LOCATIONS.— as paragraphs (2) and (3), respectively; and and problems in payment or coverage poli- (1) IN GENERAL.—The demonstration pro- (5) by adding at the end the following new cies. gram shall be conducted in at least 6 offices subsection: ‘‘(c) WORKING WITH HEALTH INSURANCE or areas. Subject to paragraph (2), in select- ‘‘(b) MEDICARE PROVIDER OMBUDSMAN.—The COUNSELING PROGRAMS.—To the extent pos- ing such offices and areas, the Secretary Secretary shall appoint within the Depart- sible, the Ombudsman shall work with shall provide preference for offices with a ment of Health and Human Services a Medi- health insurance counseling programs (re- high volume of visits by individuals referred care Provider Ombudsman. The Ombudsman ceiving funding under section 4360 of Omni- to in subsection (a). shall— bus Budget Reconciliation Act of 1990) to fa- (2) ASSISTANCE FOR RURAL BENEFICIARIES.— ‘‘(1) provide assistance, on a confidential cilitate the provision of information to indi- The Secretary shall provide for the selection basis, to providers of services and suppliers viduals entitled to benefits under part A or of at least 2 rural areas to participate in the with respect to complaints, grievances, and enrolled under part B, or both regarding demonstration program. In conducting the requests for information concerning the pro- Medicare+Choice plans and changes to those demonstration program in such rural areas, grams under this title (including provisions plans. Nothing in this subsection shall pre- the Secretary shall provide for medicare spe- of title XI insofar as they relate to this title clude further collaboration between the Om- cialists to travel among local offices in a and are not administered by the Office of the budsman and such programs.’’. rural area on a scheduled basis. Inspector General of the Department of (c) DEADLINE FOR APPOINTMENT.—The Sec- (c) DURATION.—The demonstration pro- Health and Human Services) and in the reso- retary shall appoint the Medicare Provider gram shall be conducted over a 3-year period. lution of unclear or conflicting guidance Ombudsman and the Medicare Beneficiary (d) EVALUATION AND REPORT.— given by the Secretary and medicare con- Ombudsman, under the amendments made by (1) EVALUATION.—The Secretary shall pro- tractors to such providers of services and subsections (a) and (b), respectively, by not vide for an evaluation of the demonstration suppliers regarding such programs and provi- later than 1 year after the date of the enact- program. Such evaluation shall include an sions and requirements under this title and ment of this Act. analysis of— such provisions; and (d) FUNDING.—There are authorized to be (A) utilization of, and satisfaction of those ‘‘(2) submit recommendations to the Sec- appropriated to the Secretary (in appro- individuals referred to in subsection (a) with, retary for improvement in the administra- priate part from the Federal Hospital Insur- the assistance provided under the program; tion of this title and such provisions, includ- ance Trust Fund and the Federal Supple- and ing— mentary Medical Insurance Trust Fund) to (B) the cost-effectiveness of providing ben- ‘‘(A) recommendations to respond to recur- carry out the provisions of subsection (b) of eficiary assistance through out-stationing ring patterns of confusion in this title and section 1868 of the Social Security Act (relat- medicare specialists at local offices of the such provisions (including recommendations ing to the Medicare Provider Ombudsman), Social Security Administration. regarding suspending imposition of sanctions as added by subsection (a)(5) and section 1807 (2) REPORT.—The Secretary shall submit to where there is widespread confusion in pro- of such Act (relating to the Medicare Bene- Congress a report on such evaluation and gram administration), and ficiary Ombudsman), as added by subsection shall include in such report recommenda- ‘‘(B) recommendations to provide for an (b), such sums as are necessary for fiscal tions regarding the feasibility of perma- appropriate and consistent response (includ- year 2004 and each succeeding fiscal year. nently out-stationing medicare specialists at ing not providing for audits) in cases of self- (e) USE OF CENTRAL, TOLL-FREE NUMBER (1– local offices of the Social Security Adminis- identified overpayments by providers of serv- 800–MEDICARE).— tration. ices and suppliers. (1) PHONE TRIAGE SYSTEM; LISTING IN MEDI- SEC. 925. INCLUSION OF ADDITIONAL INFORMA- The Ombudsman shall not serve as an advo- CARE HANDBOOK INSTEAD OF OTHER TOLL-FREE TION IN NOTICES TO BENEFICIARIES cate for any increases in payments or new NUMBERS.—Section 1804(b) (42 U.S.C. 1395b– ABOUT SKILLED NURSING FACILITY coverage of services, but may identify issues 2(b)) is amended by adding at the end the fol- BENEFITS. and problems in payment or coverage poli- lowing: ‘‘The Secretary shall provide, (a) IN GENERAL.—The Secretary shall pro- cies.’’. through the toll-free number 1–800–MEDI- vide that in medicare beneficiary notices (b) MEDICARE BENEFICIARY OMBUDSMAN.— CARE, for a means by which individuals provided (under section 1806(a) of the Social Title XVIII, as previously amended, is seeking information about, or assistance Security Act, 42 U.S.C. 1395b–7(a)) with re- amended by inserting after section 1809 the with, such programs who phone such toll- spect to the provision of post-hospital ex- following new section: free number are transferred (without charge) tended care services under part A of title XVIII of the Social Security Act, there shall ‘‘MEDICARE BENEFICIARY OMBUDSMAN to appropriate entities for the provision of be included information on the number of ‘‘SEC. 1810. (a) IN GENERAL.—The Secretary such information or assistance. Such toll- free number shall be the toll-free number days of coverage of such services remaining shall appoint within the Department of under such part for the medicare beneficiary Health and Human Services a Medicare Ben- listed for general information and assistance in the annual notice under subsection (a) in- and spell of illness involved. eficiary Ombudsman who shall have exper- (b) EFFECTIVE DATE.—Subsection (a) shall stead of the listing of numbers of individual tise and experience in the fields of health apply to notices provided during calendar contractors.’’. care and education of (and assistance to) in- quarters beginning more than 6 months after dividuals entitled to benefits under this (2) MONITORING ACCURACY.— the date of the enactment of this Act. title. (A) STUDY.—The Comptroller General of SEC. 926. INFORMATION ON MEDICARE-CER- ‘‘(b) DUTIES.—The Medicare Beneficiary the United States shall conduct a study to TIFIED SKILLED NURSING FACILI- Ombudsman shall— monitor the accuracy and consistency of in- TIES IN HOSPITAL DISCHARGE ‘‘(1) receive complaints, grievances, and re- formation provided to individuals entitled to PLANS. quests for information submitted by individ- benefits under part A or enrolled under part (a) AVAILABILITY OF DATA.—The Secretary uals entitled to benefits under part A or en- B, or both, through the toll-free number 1– shall publicly provide information that en- rolled under part B, or both, with respect to 800–MEDICARE, including an assessment of ables hospital discharge planners, medicare any aspect of the medicare program; whether the information provided is suffi- beneficiaries, and the public to identify ‘‘(2) provide assistance with respect to cient to answer questions of such individ- skilled nursing facilities that are partici- complaints, grievances, and requests referred uals. In conducting the study, the Comp- pating in the medicare program. to in paragraph (1), including— troller General shall examine the education (b) INCLUSION OF INFORMATION IN CERTAIN ‘‘(A) assistance in collecting relevant in- and training of the individuals providing in- HOSPITAL DISCHARGE PLANS.— formation for such individuals, to seek an formation through such number. (1) IN GENERAL.—Section 1861(ee)(2)(D) (42 appeal of a decision or determination made (B) REPORT.—Not later than 1 year after U.S.C. 1395x(ee)(2)(D)) is amended— by a fiscal intermediary, carrier, the date of the enactment of this Act, the (A) by striking ‘‘hospice services’’ and in- Medicare+Choice organization, or the Sec- Comptroller General shall submit to Con- serting ‘‘hospice care and post-hospital ex- retary; gress a report on the study conducted under tended care services’’; and ‘‘(B) assistance to such individuals with subparagraph (A). (B) by inserting before the period at the any problems arising from disenrollment SEC. 924. BENEFICIARY OUTREACH DEMONSTRA- end the following: ‘‘and, in the case of indi- from a Medicare+Choice plan under part C; TION PROGRAM. viduals who are likely to need post-hospital and (a) IN GENERAL.—The Secretary shall es- extended care services, the availability of ‘‘(C) assistance to such individuals in pre- tablish a demonstration program (in this such services through facilities that partici- senting information under section 1860D– section referred to as the ‘‘demonstration pate in the program under this title and that 2(b)(4)(D)(v); and program’’) under which medicare specialists serve the area in which the patient resides’’.
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(2) EFFECTIVE DATE.—The amendments priate reimbursement from the Trust Funds a final decision and not subject to review by made by paragraph (1) shall apply to dis- described in paragraph (5). the Secretary. charge plans made on or after such date as (c) INCREASED FINANCIAL SUPPORT.—In ad- ‘‘(C) ACCESS TO JUDICIAL REVIEW.— the Secretary shall specify, but not later dition to any amounts otherwise appro- ‘‘(i) IN GENERAL.—If the appropriate review than 6 months after the date the Secretary priated, to ensure timely action on appeals panel— provides for availability of information before administrative law judges and the De- ‘‘(I) determines that there are no material under subsection (a). partmental Appeals Board consistent with issues of fact in dispute and that the only Subtitle D—Appeals and Recovery section 1869 of the Social Security Act (as issue is one of law or regulation that no re- amended by section 521 of BIPA, 114 Stat. view panel has the authority to decide; or SEC. 931. TRANSFER OF RESPONSIBILITY FOR ‘‘(II) fails to make such determination MEDICARE APPEALS. 2763A–534), there are authorized to be appro- within the period provided under subpara- (a) TRANSITION PLAN.— priated (in appropriate part from the Federal graph (B); (1) IN GENERAL.—Not later than October 1, Hospital Insurance Trust Fund and the Fed- 2004, the Commissioner of Social Security eral Supplementary Medical Insurance Trust then the appellant may bring a civil action and the Secretary shall develop and transmit Fund) to the Secretary such sums as are nec- as described in this subparagraph. to Congress and the Comptroller General of essary for fiscal year 2005 and each subse- ‘‘(ii) DEADLINE FOR FILING.—Such action the United States a plan under which the quent fiscal year to— shall be filed, in the case described in— functions of administrative law judges re- (1) increase the number of administrative ‘‘(I) clause (i)(I), within 60 days of date of sponsible for hearing cases under title XVIII law judges (and their staffs) under subsection the determination described in such subpara- of the Social Security Act (and related pro- (b)(4); graph; or visions in title XI of such Act) are trans- (2) improve education and training oppor- ‘‘(II) clause (i)(II), within 60 days of the end ferred from the responsibility of the Com- tunities for administrative law judges (and of the period provided under subparagraph missioner and the Social Security Adminis- their staffs); and (B) for the determination. tration to the Secretary and the Department (3) increase the staff of the Departmental ‘‘(iii) VENUE.—Such action shall be brought of Health and Human Services. Appeals Board. in the district court of the United States for (2) GAO EVALUATION.—The Comptroller (d) CONFORMING AMENDMENT.—Section the judicial district in which the appellant is General of the United States shall evaluate 1869(f)(2)(A)(i) (42 U.S.C. 1395ff(f)(2)(A)(i)), as located (or, in the case of an action brought the plan and, not later than the date that is added by section 522(a) of BIPA (114 Stat. jointly by more than one applicant, the judi- 6 months after the date on which the plan is 2763A–543), is amended by striking ‘‘of the cial district in which the greatest number of received by the Comptroller General, shall Social Security Administration’’. applicants are located) or in the district submit to Congress a report on such evalua- SEC. 932. PROCESS FOR EXPEDITED ACCESS TO court for the District of Columbia. tion. REVIEW. ‘‘(iv) INTEREST ON AMOUNTS IN CON- (b) TRANSFER OF ADJUDICATION AUTHOR- (a) EXPEDITED ACCESS TO JUDICIAL RE- TROVERSY.—Where a provider of services or ITY.— VIEW.—Section 1869(b) (42 U.S.C. 1395ff(b)) as supplier seeks judicial review pursuant to (1) IN GENERAL.—Not earlier than July 1, amended by BIPA, is amended— this paragraph, the amount in controversy 2005, and not later than October 1, 2005, the (1) in paragraph (1)(A), by inserting ‘‘, sub- shall be subject to annual interest beginning Commissioner of Social Security and the ject to paragraph (2),’’ before ‘‘to judicial re- on the first day of the first month beginning Secretary shall implement the transition view of the Secretary’s final decision’’; after the 60-day period as determined pursu- plan under subsection (a) and transfer the (2) in paragraph (1)(F)— ant to clause (ii) and equal to the rate of in- administrative law judge functions described (A) by striking clause (ii); terest on obligations issued for purchase by in such subsection from the Social Security (B) by striking ‘‘PROCEEDING’’ and all that the Federal Hospital Insurance Trust Fund Administration to the Secretary. follows through ‘‘DETERMINATION’’ and in- and by the Federal Supplementary Medical (2) ASSURING INDEPENDENCE OF JUDGES.— serting ‘‘DETERMINATIONS AND RECONSIDER- Insurance Trust Fund for the month in The Secretary shall assure the independence ATIONS’’; and which the civil action authorized under this of administrative law judges performing the (C) by redesignating subclauses (I) and (II) paragraph is commenced, to be awarded by administrative law judge functions trans- as clauses (i) and (ii) and by moving the in- the reviewing court in favor of the prevailing ferred under paragraph (1) from the Centers dentation of such subclauses (and the matter party. No interest awarded pursuant to the for Medicare & Medicaid Services and its that follows) 2 ems to the left; and preceding sentence shall be deemed income contractors. In order to assure such inde- (3) by adding at the end the following new or cost for the purposes of determining reim- pendence, the Secretary shall place such paragraph: bursement due providers of services or sup- judges in an administrative office that is or- ‘‘(2) EXPEDITED ACCESS TO JUDICIAL RE- pliers under this Act. ganizationally and functionally separate VIEW.— ‘‘(D) REVIEW PANELS.—For purposes of this from such Centers. Such judges shall report ‘‘(A) IN GENERAL.—The Secretary shall es- subsection, a ‘review panel’ is a panel con- to, and be under the general supervision of, tablish a process under which a provider of sisting of 3 members (who shall be adminis- the Secretary, but shall not report to, or be services or supplier that furnishes an item or trative law judges, members of the Depart- subject to supervision by, another other offi- service or an individual entitled to benefits mental Appeals Board, or qualified individ- cer of the Department. under part A or enrolled under part B, or uals associated with a qualified independent (3) GEOGRAPHIC DISTRIBUTION.—The Sec- both, who has filed an appeal under para- contractor (as defined in subsection (c)(2)) or retary shall provide for an appropriate geo- graph (1) may obtain access to judicial re- with another independent entity) designated graphic distribution of administrative law view when a review panel (described in sub- by the Secretary for purposes of making de- judges performing the administrative law paragraph (D)), on its own motion or at the terminations under this paragraph.’’. judge functions transferred under paragraph request of the appellant, determines that no (b) APPLICATION TO PROVIDER AGREEMENT (1) throughout the United States to ensure entity in the administrative appeals process DETERMINATIONS.—Section 1866(h)(1) (42 timely access to such judges. has the authority to decide the question of U.S.C. 1395cc(h)(1)) is amended— (4) HIRING AUTHORITY.—Subject to the law or regulation relevant to the matters in (1) by inserting ‘‘(A)’’ after ‘‘(h)(1)’’; and amounts provided in advance in appropria- controversy and that there is no material (2) by adding at the end the following new tions Act, the Secretary shall have authority issue of fact in dispute. The appellant may subparagraph: to hire administrative law judges to hear make such request only once with respect to ‘‘(B) An institution or agency described in such cases, giving priority to those judges a question of law or regulation in a case of subparagraph (A) that has filed for a hearing under subparagraph (A) shall have expedited with prior experience in handling medicare an appeal. access to judicial review under this subpara- appeals and in a manner consistent with ‘‘(B) PROMPT DETERMINATIONS.—If, after or graph in the same manner as providers of paragraph (3), and to hire support staff for coincident with appropriately filing a re- services, suppliers, and individuals entitled such judges. quest for an administrative hearing, the ap- to benefits under part A or enrolled under (5) FINANCING.—Amounts payable under pellant requests a determination by the ap- part B, or both, may obtain expedited access law to the Commissioner for administrative propriate review panel that no review panel to judicial review under the process estab- law judges performing the administrative has the authority to decide the question of lished under section 1869(b)(2). Nothing in law judge functions transferred under para- law or regulations relevant to the matters in this subparagraph shall be construed to af- graph (1) from the Federal Hospital Insur- controversy and that there is no material fect the application of any remedy imposed ance Trust Fund and the Federal Supple- issue of fact in dispute and if such request is under section 1819 during the pendency of an mentary Medical Insurance Trust Fund shall accompanied by the documents and mate- appeal under this subparagraph.’’. become payable to the Secretary for the rials as the appropriate review panel shall (c) EFFECTIVE DATE.—The amendments functions so transferred. require for purposes of making such deter- made by this section shall apply to appeals (6) SHARED RESOURCES.—The Secretary mination, such review panel shall make a de- filed on or after October 1, 2004. shall enter into such arrangements with the termination on the request in writing within (d) EXPEDITED REVIEW OF CERTAIN PRO- Commissioner as may be appropriate with 60 days after the date such review panel re- VIDER AGREEMENT DETERMINATIONS.— respect to transferred functions of adminis- ceives the request and such accompanying (1) TERMINATION AND CERTAIN OTHER IMME- trative law judges to share office space, sup- documents and materials. Such a determina- DIATE REMEDIES.—The Secretary shall de- port staff, and other resources, with appro- tion by such review panel shall be considered velop and implement a process to expedite
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proceedings under sections 1866(h) of the So- 1395ff(a)), as amended by BIPA, is amended (4) SUBMISSION OF RECORD FOR APPEAL.— cial Security Act (42 U.S.C. 1395cc(h)) in by adding at the end the following new para- Section 1869(c)(3)(J)(i) (42 U.S.C. which the remedy of termination of partici- graphs: 1395ff(c)(3)(J)(i)) by striking ‘‘prepare’’ and pation, or a remedy described in clause (i) or ‘‘(4) REQUIREMENTS OF NOTICE OF DETER- inserting ‘‘submit’’ and by striking ‘‘with re- (iii) of section 1819(h)(2)(B) of such Act (42 MINATIONS.—With respect to an initial deter- spect to’’ and all that follows through ‘‘and U.S.C. 1395i–3(h)(2)(B)) which is applied on an mination insofar as it results in a denial of relevant policies’’. immediate basis, has been imposed. Under a claim for benefits— (d) QUALIFIED INDEPENDENT CONTRAC- such process priority shall be provided in ‘‘(A) the written notice on the determina- cases of termination. tion shall include— TORS.— (2) INCREASED FINANCIAL SUPPORT.—In addi- ‘‘(i) the reasons for the determination, in- (1) ELIGIBILITY REQUIREMENTS OF QUALIFIED tion to any amounts otherwise appropriated, cluding whether a local medical review pol- INDEPENDENT CONTRACTORS.—Section to reduce by 50 percent the average time for icy or a local coverage determination was 1869(c)(3) (42 U.S.C. 1395ff(c)(3)), as amended administrative determinations on appeals used; by BIPA, is amended— under section 1866(h) of the Social Security ‘‘(ii) the procedures for obtaining addi- (A) in subparagraph (A), by striking ‘‘suffi- Act (42 U.S.C. 1395cc(h)), there are authorized tional information concerning the deter- cient training and expertise in medical to be appropriated (in appropriate part from mination, including the information de- science and legal matters’’ and inserting the Federal Hospital Insurance Trust Fund scribed in subparagraph (B); and ‘‘sufficient medical, legal, and other exper- and the Federal Supplementary Medical In- ‘‘(iii) notification of the right to seek a re- tise (including knowledge of the program surance Trust Fund) to the Secretary such determination or otherwise appeal the deter- under this title) and sufficient staffing’’; and additional sums for fiscal year 2005 and each mination and instructions on how to initiate (B) by adding at the end the following new subsequent fiscal year as may be necessary. such a redetermination under this section; subparagraph: The purposes for which such amounts are and ‘‘(K) INDEPENDENCE REQUIREMENTS.— available include increasing the number of ‘‘(B) the person provided such notice may ‘‘(i) IN GENERAL.—Subject to clause (ii), a administrative law judges (and their staffs) obtain, upon request, the specific provision qualified independent contractor shall not and the appellate level staff at the Depart- of the policy, manual, or regulation used in conduct any activities in a case unless the mental Appeals Board of the Department of making the determination. entity— Health and Human Services and educating ‘‘(5) REQUIREMENTS OF NOTICE OF REDETER- ‘‘(I) is not a related party (as defined in such judges and staffs on long-term care MINATIONS.—With respect to a redetermina- subsection (g)(5)); issues. tion insofar as it results in a denial of a ‘‘(II) does not have a material familial, fi- (e) PROCESS FOR REINSTATEMENT OF AP- claim for benefits— nancial, or professional relationship with PROVAL OF CERTAIN SNF TRAINING PRO- ‘‘(A) the written notice on the redeter- such a party in relation to such case; and GRAMS.— mination shall include— ‘‘(III) does not otherwise have a conflict of (1) IN GENERAL.—In the case of a termi- ‘‘(i) the specific reasons for the redeter- interest with such a party. nation of approval of a nurse aide training mination; ‘‘(ii) EXCEPTION FOR REASONABLE COMPENSA- program described in paragraph (2) of a ‘‘(ii) as appropriate, a summary of the clin- TION.—Nothing in clause (i) shall be con- skilled nursing facility, the Secretary shall ical or scientific evidence used in making strued to prohibit receipt by a qualified inde- develop and implement a process for the re- the redetermination; pendent contractor of compensation from instatement of approval of such program be- ‘‘(iii) a description of the procedures for the Secretary for the conduct of activities fore the end of the mandatory 2 year dis- obtaining additional information concerning under this section if the compensation is approval period if the facility and program is the redetermination; and provided consistent with clause (iii). certified by the Secretary, in coordination ‘‘(iv) notification of the right to appeal the ‘‘(iii) LIMITATIONS ON ENTITY COMPENSA- with the applicable State survey and certifi- redetermination and instructions on how to TION.—Compensation provided by the Sec- cation agency and after public notice, as initiate such an appeal under this section; retary to a qualified independent contractor being in compliance with applicable require- ‘‘(B) such written notice shall be provided in connection with reviews under this sec- ments and as having remedied any defi- in printed form and written in a manner cal- tion shall not be contingent on any decision ciencies in the facility or program that re- culated to be understood by the individual rendered by the contractor or by any review- sulted in noncompliance. entitled to benefits under part A or enrolled ing professional.’’. under part B, or both; and (2) TERMINATION OF APPROVAL DESCRIBED.— (2) ELIGIBILITY REQUIREMENTS FOR REVIEW- ‘‘(C) the person provided such notice may A termination of approval of a training pro- ERS.—Section 1869 (42 U.S.C. 1395ff), as obtain, upon request, information on the spe- gram described in this paragraph is a manda- amended by BIPA, is amended— cific provision of the policy, manual, or reg- tory 2-year disapproval provided for under (A) by amending subsection (c)(3)(D) to ulation used in making the redetermina- section 1819(f)(2)(B)(iii) of the Social Secu- read as follows: tion.’’. rity Act (42 U.S.C. 1395i–3(f)(2)(B)(iii)) if the ‘‘(D) QUALIFICATIONS FOR REVIEWERS.—The (2) RECONSIDERATIONS.—Section only basis for the mandatory disapproval requirements of subsection (g) shall be met 1869(c)(3)(E) (42 U.S.C. 1395ff(c)(3)(E)), as was the assessment of a civil money penalty (relating to qualifications of reviewing pro- amended by BIPA, is amended— of not less than $5,000. fessionals).’’; and (A) by inserting ‘‘be written in a manner SEC. 933. REVISIONS TO MEDICARE APPEALS calculated to be understood by the individual (B) by adding at the end the following new PROCESS. subsection: (a) REQUIRING FULL AND EARLY PRESEN- entitled to benefits under part A or enrolled TATION OF EVIDENCE.— under part B, or both, and shall include (to ‘‘(g) QUALIFICATIONS OF REVIEWERS.— (1) IN GENERAL.—Section 1869(b) (42 U.S.C. the extent appropriate)’’ after ‘‘in writing, ’’; ‘‘(1) IN GENERAL.—In reviewing determina- 1395ff(b)), as amended by BIPA and as amend- and tions under this section, a qualified inde- ed by section 932(a), is further amended by (B) by inserting ‘‘and a notification of the pendent contractor shall assure that— adding at the end the following new para- right to appeal such determination and in- ‘‘(A) each individual conducting a review graph: structions on how to initiate such appeal shall meet the qualifications of paragraph ‘‘(3) REQUIRING FULL AND EARLY PRESEN- under this section’’ after ‘‘such decision,’’. (2); TATION OF EVIDENCE BY PROVIDERS.—A pro- (3) APPEALS.—Section 1869(d) (42 U.S.C. ‘‘(B) compensation provided by the con- vider of services or supplier may not intro- 1395ff(d)), as amended by BIPA, is amended— tractor to each such reviewer is consistent duce evidence in any appeal under this sec- (A) in the heading, by inserting ‘‘; NOTICE’’ with paragraph (3); and tion that was not presented at the reconsid- after ‘‘SECRETARY’’; and ‘‘(C) in the case of a review by a panel de- eration conducted by the qualified inde- (B) by adding at the end the following new scribed in subsection (c)(3)(B) composed of pendent contractor under subsection (c), un- paragraph: physicians or other health care professionals less there is good cause which precluded the ‘‘(4) NOTICE.—Notice of the decision of an (each in this subsection referred to as a ‘re- introduction of such evidence at or before administrative law judge shall be in writing viewing professional’), a reviewing profes- that reconsideration.’’. in a manner calculated to be understood by sional meets the qualifications described in (2) EFFECTIVE DATE.—The amendment the individual entitled to benefits under part paragraph (4) and, where a claim is regarding made by paragraph (1) shall take effect on A or enrolled under part B, or both, and shall the furnishing of treatment by a physician October 1, 2004. include— (allopathic or osteopathic) or the provision (b) USE OF PATIENTS’ MEDICAL RECORDS.— ‘‘(A) the specific reasons for the determina- of items or services by a physician Section 1869(c)(3)(B)(i) (42 U.S.C. tion (including, to the extent appropriate, a (allopathic or osteopathic), a reviewing pro- 1395ff(c)(3)(B)(i)), as amended by BIPA, is summary of the clinical or scientific evi- fessional shall be a physician (allopathic or amended by inserting ‘‘(including the med- dence used in making the determination); osteopathic). ical records of the individual involved)’’ ‘‘(B) the procedures for obtaining addi- ‘‘(2) INDEPENDENCE.— after ‘‘clinical experience’’. tional information concerning the decision; ‘‘(A) IN GENERAL.—Subject to subparagraph (c) NOTICE REQUIREMENTS FOR MEDICARE and (B), each individual conducting a review in a APPEALS.— ‘‘(C) notification of the right to appeal the case shall— (1) INITIAL DETERMINATIONS AND REDETER- decision and instructions on how to initiate ‘‘(i) not be a related party (as defined in MINATIONS.—Section 1869(a) (42 U.S.C. such an appeal under this section.’’. paragraph (5));
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00125 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.064 H26PT1 H6066 CONGRESSIONAL RECORD — HOUSE June 26, 2003 ‘‘(ii) not have a material familial, finan- ‘‘(F) Any other party determined under issue regulations under section 1874A(h) of cial, or professional relationship with such a any regulations to have a substantial inter- the Social Security Act, as added by sub- party in the case under review; and est in the case involved.’’. section (a), by not later than 1 year after the ‘‘(iii) not otherwise have a conflict of in- (3) REDUCING MINIMUM NUMBER OF QUALIFIED date of the enactment of this Act. terest with such a party. INDEPENDENT CONTRACTORS.—Section (3) APPLICATION OF STANDARD PROTOCOLS ‘‘(B) EXCEPTION.—Nothing in subparagraph 1869(c)(4) (42 U.S.C. 1395ff(c)(4)) is amended by FOR RANDOM PREPAYMENT REVIEW.—Section (A) shall be construed to— striking ‘‘not fewer than 12 qualified inde- 1874A(h)(1)(B) of the Social Security Act, as ‘‘(i) prohibit an individual, solely on the pendent contractors under this subsection’’ added by subsection (a), shall apply to ran- basis of a participation agreement with a fis- and inserting ‘‘with a sufficient number of dom prepayment reviews conducted on or cal intermediary, carrier, or other con- qualified independent contractors (but not after such date (not later than 1 year after tractor, from serving as a reviewing profes- fewer than 4 such contractors) to conduct re- the date of the enactment of this Act) as the sional if— considerations consistent with the time- Secretary shall specify. ‘‘(I) the individual is not involved in the frames applicable under this subsection’’. (c) APPLICATION TO FISCAL INTERMEDIARIES provision of items or services in the case (4) EFFECTIVE DATE.—The amendments AND CARRIERS.—The provisions of section under review; made by paragraphs (1) and (2) shall be effec- 1874A(h) of the Social Security Act, as added ‘‘(II) the fact of such an agreement is dis- tive as if included in the enactment of the by subsection (a), shall apply to each fiscal closed to the Secretary and the individual respective provisions of subtitle C of title V intermediary under section 1816 of the Social entitled to benefits under part A or enrolled of BIPA, (114 Stat. 2763A–534). Security Act (42 U.S.C. 1395h) and each car- under part B, or both, (or authorized rep- (5) TRANSITION.—In applying section 1869(g) rier under section 1842 of such Act (42 U.S.C. resentative) and neither party objects; and of the Social Security Act (as added by para- 1395u) in the same manner as they apply to ‘‘(III) the individual is not an employee of graph (2)), any reference to a medicare ad- medicare administrative contractors under the intermediary, carrier, or contractor and ministrative contractor shall be deemed to such provisions. does not provide services exclusively or pri- include a reference to a fiscal intermediary SEC. 935. RECOVERY OF OVERPAYMENTS. marily to or on behalf of such intermediary, under section 1816 of the Social Security Act (a) IN GENERAL.—Section 1893 (42 U.S.C. carrier, or contractor; (42 U.S.C. 1395h) and a carrier under section 1395ddd) is amended by adding at the end the ‘‘(ii) prohibit an individual who has staff 1842 of such Act (42 U.S.C. 1395u). following new subsection: privileges at the institution where the treat- SEC. 934. PREPAYMENT REVIEW. ‘‘(f) RECOVERY OF OVERPAYMENTS.— ment involved takes place from serving as a (a) IN GENERAL.—Section 1874A, as added ‘‘(1) USE OF REPAYMENT PLANS.— reviewer merely on the basis of having such by section 911(a)(1) and as amended by sec- ‘‘(A) IN GENERAL.—If the repayment, within staff privileges if the existence of such privi- tions 912(b), 921(b)(1), and 921(c)(1), is further 30 days by a provider of services or supplier, leges is disclosed to the Secretary and such amended by adding at the end the following of an overpayment under this title would individual (or authorized representative), new subsection: constitute a hardship (as defined in subpara- and neither party objects; or ‘‘(h) CONDUCT OF PREPAYMENT REVIEW.— graph (B)), subject to subparagraph (C), upon ‘‘(iii) prohibit receipt of compensation by a ‘‘(1) CONDUCT OF RANDOM PREPAYMENT RE- request of the provider of services or supplier reviewing professional from a contractor if VIEW.— the Secretary shall enter into a plan with the compensation is provided consistent with ‘‘(A) IN GENERAL.—A medicare administra- the provider of services or supplier for the paragraph (3). tive contractor may conduct random prepay- repayment (through offset or otherwise) of For purposes of this paragraph, the term ment review only to develop a contractor- such overpayment over a period of at least 6 ‘participation agreement’ means an agree- wide or program-wide claims payment error months but not longer than 3 years (or not ment relating to the provision of health care rates or under such additional circumstances longer than 5 years in the case of extreme services by the individual and does not in- as may be provided under regulations, devel- hardship, as determined by the Secretary). clude the provision of services as a reviewer oped in consultation with providers of serv- Interest shall accrue on the balance through under this subsection. ices and suppliers. the period of repayment. Such plan shall ‘‘(3) LIMITATIONS ON REVIEWER COMPENSA- ‘‘(B) USE OF STANDARD PROTOCOLS WHEN meet terms and conditions determined to be TION.—Compensation provided by a qualified CONDUCTING PREPAYMENT REVIEWS.—When a appropriate by the Secretary. independent contractor to a reviewer in con- medicare administrative contractor con- ‘‘(B) HARDSHIP.— nection with a review under this section ducts a random prepayment review, the con- ‘‘(i) IN GENERAL.—For purposes of subpara- shall not be contingent on the decision ren- tractor may conduct such review only in ac- graph (A), the repayment of an overpayment dered by the reviewer. cordance with a standard protocol for ran- (or overpayments) within 30 days is deemed ‘‘(4) LICENSURE AND EXPERTISE.—Each re- dom prepayment audits developed by the to constitute a hardship if— viewing professional shall be— Secretary. ‘‘(I) in the case of a provider of services ‘‘(A) a physician (allopathic or osteo- ‘‘(C) CONSTRUCTION.—Nothing in this para- that files cost reports, the aggregate amount pathic) who is appropriately credentialed or graph shall be construed as preventing the of the overpayments exceeds 10 percent of licensed in one or more States to deliver denial of payments for claims actually re- the amount paid under this title to the pro- health care services and has medical exper- viewed under a random prepayment review. vider of services for the cost reporting period tise in the field of practice that is appro- ‘‘(D) RANDOM PREPAYMENT REVIEW.—For covered by the most recently submitted cost priate for the items or services at issue; or purposes of this subsection, the term ‘ran- report; or ‘‘(B) a health care professional who is le- dom prepayment review’ means a demand for ‘‘(II) in the case of another provider of gally authorized in one or more States (in the production of records or documentation services or supplier, the aggregate amount of accordance with State law or the State regu- absent cause with respect to a claim. the overpayments exceeds 10 percent of the latory mechanism provided by State law) to ‘‘(2) LIMITATIONS ON NON-RANDOM PREPAY- amount paid under this title to the provider furnish the health care items or services at MENT REVIEW.— of services or supplier for the previous cal- issue and has medical expertise in the field ‘‘(A) LIMITATIONS ON INITIATION OF NON-RAN- endar year. of practice that is appropriate for such items DOM PREPAYMENT REVIEW.—A medicare ad- ‘‘(ii) RULE OF APPLICATION.—The Secretary or services. ministrative contractor may not initiate shall establish rules for the application of ‘‘(5) RELATED PARTY DEFINED.—For pur- non-random prepayment review of a provider this subparagraph in the case of a provider of poses of this section, the term ‘related party’ of services or supplier based on the initial services or supplier that was not paid under means, with respect to a case under this title identification by that provider of services or this title during the previous year or was involving a specific individual entitled to supplier of an improper billing practice un- paid under this title only during a portion of benefits under part A or enrolled under part less there is a likelihood of sustained or high that year. B, or both, any of the following: level of payment error (as defined in sub- ‘‘(iii) TREATMENT OF PREVIOUS OVERPAY- ‘‘(A) The Secretary, the medicare adminis- section (i)(3)(A)). MENTS.—If a provider of services or supplier trative contractor involved, or any fiduciary, ‘‘(B) TERMINATION OF NON-RANDOM PREPAY- has entered into a repayment plan under officer, director, or employee of the Depart- MENT REVIEW.—The Secretary shall issue reg- subparagraph (A) with respect to a specific ment of Health and Human Services, or of ulations relating to the termination, includ- overpayment amount, such payment amount such contractor. ing termination dates, of non-random pre- under the repayment plan shall not be taken ‘‘(B) The individual (or authorized rep- payment review. Such regulations may vary into account under clause (i) with respect to resentative). such a termination date based upon the dif- subsequent overpayment amounts. ‘‘(C) The health care professional that pro- ferences in the circumstances triggering pre- ‘‘(C) EXCEPTIONS.—Subparagraph (A) shall vides the items or services involved in the payment review.’’. not apply if— case. (b) EFFECTIVE DATE.— ‘‘(i) the Secretary has reason to suspect ‘‘(D) The institution at which the items or (1) IN GENERAL.—Except as provided in this that the provider of services or supplier may services (or treatment) involved in the case subsection, the amendment made by sub- file for bankruptcy or otherwise cease to do are provided. section (a) shall take effect 1 year after the business or discontinue participation in the ‘‘(E) The manufacturer of any drug or date of the enactment of this Act. program under this title; or other item that is included in the items or (2) DEADLINE FOR PROMULGATION OF CERTAIN ‘‘(ii) there is an indication of fraud or services involved in the case. REGULATIONS.—The Secretary shall first abuse committed against the program.
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‘‘(D) IMMEDIATE COLLECTION IF VIOLATION OF ‘‘(ii) provide for a 45-day period during standard methodology for medicare contrac- REPAYMENT PLAN.—If a provider of services which the provider of services or supplier tors to use in selecting a sample of claims or supplier fails to make a payment in ac- may furnish additional information con- for review in the case of an abnormal billing cordance with a repayment plan under this cerning the medical records for the claims pattern.’’. paragraph, the Secretary may immediately that had been reviewed. (b) EFFECTIVE DATES AND DEADLINES.— seek to offset or otherwise recover the total ‘‘(C) CONSENT SETTLEMENT OFFER.—The (1) USE OF REPAYMENT PLANS.—Section balance outstanding (including applicable in- Secretary shall review any additional infor- 1893(f)(1) of the Social Security Act, as added terest) under the repayment plan. mation furnished by the provider of services by subsection (a), shall apply to requests for ‘‘(E) RELATION TO NO FAULT PROVISION.— or supplier under subparagraph (B)(ii). Tak- repayment plans made after the date of the Nothing in this paragraph shall be construed ing into consideration such information, the enactment of this Act. as affecting the application of section 1870(c) Secretary shall determine if there still ap- (2) LIMITATION ON RECOUPMENT.—Section (relating to no adjustment in the cases of pears to be an overpayment. If so, the Sec- 1893(f)(2) of the Social Security Act, as added certain overpayments). retary— by subsection (a), shall apply to actions ‘‘(2) LIMITATION ON RECOUPMENT.— ‘‘(i) shall provide notice of such determina- taken after the date of the enactment of this ‘‘(A) IN GENERAL.—In the case of a provider tion to the provider of services or supplier, Act. of services or supplier that is determined to including an explanation of the reason for (3) USE OF EXTRAPOLATION.—Section have received an overpayment under this such determination; and 1893(f)(3) of the Social Security Act, as added title and that seeks a reconsideration by a ‘‘(ii) in order to resolve the overpayment, by subsection (a), shall apply to statistically qualified independent contractor on such de- may offer the provider of services or sup- valid random samples initiated after the termination under section 1869(b)(1), the Sec- plier— date that is 1 year after the date of the en- retary may not take any action (or authorize ‘‘(I) the opportunity for a statistically actment of this Act. any other person, including any medicare valid random sample; or (4) PROVISION OF SUPPORTING DOCUMENTA- contractor, as defined in subparagraph (C)) ‘‘(II) a consent settlement. TION.—Section 1893(f)(4) of the Social Secu- to recoup the overpayment until the date the The opportunity provided under clause (ii)(I) rity Act, as added by subsection (a), shall decision on the reconsideration has been ren- does not waive any appeal rights with re- take effect on the date of the enactment of dered. If the provisions of section 1869(b)(1) spect to the alleged overpayment involved. this Act. (providing for such a reconsideration by a ‘‘(D) CONSENT SETTLEMENT DEFINED.—For (5) CONSENT SETTLEMENT.—Section qualified independent contractor) are not in purposes of this paragraph, the term ‘con- 1893(f)(5) of the Social Security Act, as added effect, in applying the previous sentence any sent settlement’ means an agreement be- by subsection (a), shall apply to consent set- reference to such a reconsideration shall be tween the Secretary and a provider of serv- tlements entered into after the date of the treated as a reference to a redetermination ices or supplier whereby both parties agree enactment of this Act. by the fiscal intermediary or carrier in- to settle a projected overpayment based on (6) NOTICE OF OVERUTILIZATION.—Not later volved. less than a statistically valid sample of than 1 year after the date of the enactment ‘‘(B) COLLECTION WITH INTEREST.—Insofar claims and the provider of services or sup- of this Act, the Secretary shall first estab- as the determination on such appeal is plier agrees not to appeal the claims in- lish the process for notice of overutilization against the provider of services or supplier, volved. of billing codes under section 1893A(f)(6) of interest on the overpayment shall accrue on ‘‘(6) NOTICE OF OVER-UTILIZATION OF the Social Security Act, as added by sub- and after the date of the original notice of CODES.—The Secretary shall establish, in section (a). overpayment. Insofar as such determination consultation with organizations representing (7) PAYMENT AUDITS.—Section 1893A(f)(7) of against the provider of services or supplier is the classes of providers of services and sup- the Social Security Act, as added by sub- later reversed, the Secretary shall provide pliers, a process under which the Secretary section (a), shall apply to audits initiated for repayment of the amount recouped plus provides for notice to classes of providers of after the date of the enactment of this Act. interest at the same rate as would apply services and suppliers served by the con- (8) STANDARD FOR ABNORMAL BILLING PAT- under the previous sentence for the period in tractor in cases in which the contractor has TERNS.—Not later than 1 year after the date which the amount was recouped. identified that particular billing codes may of the enactment of this Act, the Secretary ‘‘(C) MEDICARE CONTRACTOR DEFINED.—For be overutilized by that class of providers of shall first establish a standard methodology purposes of this subsection, the term ‘medi- services or suppliers under the programs for selection of sample claims for abnormal care contractor’ has the meaning given such under this title (or provisions of title XI in- billing patterns under section 1893(f)(8) of the term in section 1889(g). sofar as they relate to such programs). Social Security Act, as added by subsection ‘‘(3) LIMITATION ON USE OF EXTRAPO- ‘‘(7) PAYMENT AUDITS.— (a). LATION.—A medicare contractor may not use ‘‘(A) WRITTEN NOTICE FOR POST-PAYMENT SEC. 936. PROVIDER ENROLLMENT PROCESS; extrapolation to determine overpayment AUDITS.—Subject to subparagraph (C), if a RIGHT OF APPEAL. amounts to be recovered by recoupment, off- medicare contractor decides to conduct a (a) IN GENERAL.—Section 1866 (42 U.S.C. set, or otherwise unless— post-payment audit of a provider of services 1395cc) is amended— ‘‘(A) there is a sustained or high level of or supplier under this title, the contractor (1) by adding at the end of the heading the payment error (as defined by the Secretary shall provide the provider of services or sup- following: ‘‘; ENROLLMENT PROCESSES’’; and by regulation); or plier with written notice (which may be in (2) by adding at the end the following new ‘‘(B) documented educational intervention electronic form) of the intent to conduct subsection: has failed to correct the payment error (as such an audit. ‘‘(j) ENROLLMENT PROCESS FOR PROVIDERS determined by the Secretary). ‘‘(B) EXPLANATION OF FINDINGS FOR ALL AU- OF SERVICES AND SUPPLIERS.— ‘‘(4) PROVISION OF SUPPORTING DOCUMENTA- DITS.—Subject to subparagraph (C), if a ‘‘(1) ENROLLMENT PROCESS.— TION.—In the case of a provider of services or medicare contractor audits a provider of ‘‘(A) IN GENERAL.—The Secretary shall es- supplier with respect to which amounts were services or supplier under this title, the con- tablish by regulation a process for the en- previously overpaid, a medicare contractor tractor shall— rollment of providers of services and sup- may request the periodic production of ‘‘(i) give the provider of services or sup- pliers under this title. records or supporting documentation for a plier a full review and explanation of the ‘‘(B) DEADLINES.—The Secretary shall es- limited sample of submitted claims to ensure findings of the audit in a manner that is un- tablish by regulation procedures under which that the previous practice is not continuing. derstandable to the provider of services or there are deadlines for actions on applica- ‘‘(5) CONSENT SETTLEMENT REFORMS.— supplier and permits the development of an tions for enrollment (and, if applicable, re- ‘‘(A) IN GENERAL.—The Secretary may use appropriate corrective action plan; newal of enrollment). The Secretary shall a consent settlement (as defined in subpara- ‘‘(ii) inform the provider of services or sup- monitor the performance of medicare admin- graph (D)) to settle a projected overpayment. plier of the appeal rights under this title as istrative contractors in meeting the dead- ‘‘(B) OPPORTUNITY TO SUBMIT ADDITIONAL well as consent settlement options (which lines established under this subparagraph. INFORMATION BEFORE CONSENT SETTLEMENT are at the discretion of the Secretary); ‘‘(C) CONSULTATION BEFORE CHANGING PRO- OFFER.—Before offering a provider of services ‘‘(iii) give the provider of services or sup- VIDER ENROLLMENT FORMS.—The Secretary or supplier a consent settlement, the Sec- plier an opportunity to provide additional in- shall consult with providers of services and retary shall— formation to the contractor; and suppliers before making changes in the pro- ‘‘(i) communicate to the provider of serv- ‘‘(iv) take into account information pro- vider enrollment forms required of such pro- ices or supplier— vided, on a timely basis, by the provider of viders and suppliers to be eligible to submit ‘‘(I) that, based on a review of the medical services or supplier under clause (iii). claims for which payment may be made records requested by the Secretary, a pre- ‘‘(C) EXCEPTION.—Subparagraphs (A) and under this title. liminary evaluation of those records indi- (B) shall not apply if the provision of notice ‘‘(2) HEARING RIGHTS IN CASES OF DENIAL OR cates that there would be an overpayment; or findings would compromise pending law NON-RENEWAL.—A provider of services or sup- ‘‘(II) the nature of the problems identified enforcement activities, whether civil or plier whose application to enroll (or, if appli- in such evaluation; and criminal, or reveal findings of law enforce- cable, to renew enrollment) under this title ‘‘(III) the steps that the provider of serv- ment-related audits. is denied may have a hearing and judicial re- ices or supplier should take to address the ‘‘(8) STANDARD METHODOLOGY FOR PROBE view of such denial under the procedures problems; and SAMPLING.—The Secretary shall establish a that apply under subsection (h)(1)(A) to a
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00127 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.064 H26PT1 H6068 CONGRESSIONAL RECORD — HOUSE June 26, 2003
provider of services that is dissatisfied with ‘‘(h) PRIOR DETERMINATION PROCESS FOR ‘‘(C) INFORMING BENEFICIARY IN CASE OF a determination by the Secretary.’’. CERTAIN ITEMS AND SERVICES.— PHYSICIAN REQUEST.—In the case of a request (b) EFFECTIVE DATES.— ‘‘(1) ESTABLISHMENT OF PROCESS.— in which an eligible requester is not the indi- (1) ENROLLMENT PROCESS.—The Secretary ‘‘(A) IN GENERAL.—With respect to a medi- vidual described in paragraph (1)(B)(ii), the shall provide for the establishment of the en- care administrative contractor that has a process shall provide that the individual to rollment process under section 1866(j)(1) of contract under section 1874A that provides whom the item or service is proposed to be the Social Security Act, as added by sub- for making payments under this title with furnished shall be informed of any deter- section (a)(2), within 6 months after the date respect to eligible items and services de- mination described in clause (ii) (relating to of the enactment of this Act. scribed in subparagraph (C), the Secretary a determination of non-coverage) and the (2) CONSULTATION.—Section 1866(j)(1)(C) of shall establish a prior determination process right (referred to in paragraph (6)(B)) to ob- the Social Security Act, as added by sub- that meets the requirements of this sub- tain the item or service and have a claim section (a)(2), shall apply with respect to section and that shall be applied by such submitted for the item or service. changes in provider enrollment forms made contractor in the case of eligible requesters. ‘‘(5) EFFECT OF DETERMINATIONS.— on or after January 1, 2004. ‘‘(B) ELIGIBLE REQUESTER.—For purposes of ‘‘(A) BINDING NATURE OF POSITIVE DETER- (3) HEARING RIGHTS.—Section 1866(j)(2) of this subsection, each of the following shall MINATION.—If the contractor makes the de- the Social Security Act, as added by sub- be an eligible requester: termination described in paragraph (4)(A)(i), section (a)(2), shall apply to denials occur- ‘‘(i) A physician, but only with respect to such determination shall be binding on the ring on or after such date (not later than 1 eligible items and services for which the contractor in the absence of fraud or evi- year after the date of the enactment of this physician may be paid directly. dence of misrepresentation of facts presented Act) as the Secretary specifies. ‘‘(ii) An individual entitled to benefits to the contractor. SEC. 937. PROCESS FOR CORRECTION OF MINOR under this title, but only with respect to an ‘‘(B) NOTICE AND RIGHT TO REDETERMINA- ERRORS AND OMISSIONS WITHOUT item or service for which the individual re- TION IN CASE OF A DENIAL.— PURSUING APPEALS PROCESS. ceives, from the physician who may be paid ‘‘(i) IN GENERAL.—If the contractor makes (a) CLAIMS.—The Secretary shall develop, directly for the item or service, an advance the determination described in paragraph in consultation with appropriate medicare beneficiary notice under section 1879(a) that (4)(A)(ii)— contractors (as defined in section 1889(g) of payment may not be made (or may no longer ‘‘(I) the eligible requester has the right to the Social Security Act, as inserted by sec- be made) for the item or service under this a redetermination by the contractor on the tion 301(a)(1)) and representatives of pro- title. determination that the item or service is not viders of services and suppliers, a process ‘‘(C) ELIGIBLE ITEMS AND SERVICES.—For so covered; and whereby, in the case of minor errors or omis- purposes of this subsection and subject to ‘‘(II) the contractor shall include in notice sions (as defined by the Secretary) that are paragraph (2), eligible items and services are under paragraph (4)(A) a brief explanation of detected in the submission of claims under items and services which are physicians’ the basis for the determination, including on the programs under title XVIII of such Act, services (as defined in paragraph (4)(A) of what national or local coverage or noncov- a provider of services or supplier is given an section 1848(f) for purposes of calculating the erage determination (if any) the determina- opportunity to correct such an error or omis- sustainable growth rate under such section). tion is based, and the right to such a redeter- sion without the need to initiate an appeal. ‘‘(2) SECRETARIAL FLEXIBILITY.—The Sec- mination. Such process shall include the ability to re- retary shall establish by regulation reason- ‘‘(ii) DEADLINE FOR REDETERMINATIONS.— submit corrected claims. able limits on the categories of eligible The contractor shall complete and provide (b) PERMITTING USE OF CORRECTED AND items and services for which a prior deter- notice of such redetermination within the SUPPLEMENTARY DATA.— mination of coverage may be requested same time period as the time period applica- (1) IN GENERAL.—Section 1886(d)(10)(D)(vi) under this subsection. In establishing such ble to the contractor providing notice of re- (42 U.S.C. 1395ww(d)(10)(D)(vi)) is amended by limits, the Secretary may consider the dollar determinations relating to a claim for bene- adding after subclause (II) at the end the fol- amount involved with respect to the item or fits under subsection (a)(3)(C)(ii). lowing: ‘‘Notwithstanding subclause (I), a hospital service, administrative costs and burdens, ‘‘(6) LIMITATION ON FURTHER REVIEW.— may submit, and the Secretary may accept and other relevant factors. ‘‘(A) IN GENERAL.—Contractor determina- upon verification, data that corrects or sup- ‘‘(3) REQUEST FOR PRIOR DETERMINATION.— tions described in paragraph (4)(A)(ii) or plements the data described in such sub- ‘‘(A) IN GENERAL.—Subject to paragraph (4)(A)(iii) (and redeterminations made under clause without regard to whether the cor- (2), under the process established under this paragraph (5)(B)), relating to pre-service rected or supplementary data relate to a cost subsection an eligible requester may submit claims are not subject to further administra- report that has been settled.’’. to the contractor a request for a determina- tive appeal or judicial review under this sec- (2) EFFECTIVE DATE.—The amendment tion, before the furnishing of an eligible item tion or otherwise. made by paragraph (1) shall apply to fiscal or service involved as to whether the item or ‘‘(B) DECISION NOT TO SEEK PRIOR DETER- years beginning with fiscal year 2004. service is covered under this title consistent MINATION OR NEGATIVE DETERMINATION DOES (3) SUBMITTAL AND RESUBMITTAL OF APPLI- with the applicable requirements of section NOT IMPACT RIGHT TO OBTAIN SERVICES, SEEK CATIONS PERMITTED FOR FISCAL YEAR 2004.— 1862(a)(1)(A) (relating to medical necessity). REIMBURSEMENT, OR APPEAL RIGHTS.—Nothing (A) IN GENERAL.—Notwithstanding any ‘‘(B) ACCOMPANYING DOCUMENTATION.—The in this subsection shall be construed as af- other provision of law, a hospital may sub- Secretary may require that the request be fecting the right of an individual who— mit (or resubmit) an application for a change accompanied by a description of the item or ‘‘(i) decides not to seek a prior determina- described in section 1886(d)(10)(C)(i)(II) of the service, supporting documentation relating tion under this subsection with respect to Social Security Act for fiscal year 2004 if the to the medical necessity for the item or serv- items or services; or hospital demonstrates on a timely basis to ice, and any other appropriate documenta- ‘‘(ii) seeks such a determination and has the satisfaction of the Secretary that the use tion. In the case of a request submitted by received a determination described in para- of corrected or supplementary data under an eligible requester who is described in graph (4)(A)(ii), the amendment made by paragraph (1) would paragraph (1)(B)(ii), the Secretary may re- from receiving (and submitting a claim for) materially affect the approval of such an ap- quire that the request also be accompanied such items services and from obtaining ad- plication. by a copy of the advance beneficiary notice ministrative or judicial review respecting involved. (B) APPLICATION OF BUDGET NEUTRALITY.—If such claim under the other applicable provi- one or more hospital’s applications are ap- ‘‘(4) RESPONSE TO REQUEST.— sions of this section. Failure to seek a prior proved as a result of paragraph (1) and sub- ‘‘(A) IN GENERAL.—Under such process, the determination under this subsection with re- paragraph (A) for fiscal year 2004, the Sec- contractor shall provide the eligible re- spect to items and services shall not be quester with written notice of a determina- retary shall make a proportional adjustment taken into account in such administrative or tion as to whether— in the standardized amounts determined judicial review. ‘‘(i) the item or service is so covered; under section 1886(d)(3) of the Social Secu- ‘‘(C) NO PRIOR DETERMINATION AFTER RE- ‘‘(ii) the item or service is not so covered; rity Act (42 U.S.C. 1395ww(d)(3)) for fiscal CEIPT OF SERVICES.—Once an individual is or year 2004 to assure that approval of such ap- provided items and services, there shall be ‘‘(iii) the contractor lacks sufficient infor- plications does not result in aggregate pay- no prior determination under this subsection mation to make a coverage determination. ments under section 1886(d) of such Act that with respect to such items or services.’’. are greater or less than those that would If the contractor makes the determination (b) EFFECTIVE DATE; TRANSITION.— otherwise be made if paragraph (1) and sub- described in clause (iii), the contractor shall (1) EFFECTIVE DATE.—The Secretary shall paragraph (A) did not apply. include in the notice a description of the ad- establish the prior determination process SEC. 938. PRIOR DETERMINATION PROCESS FOR ditional information required to make the under the amendment made by subsection (a) CERTAIN ITEMS AND SERVICES; AD- coverage determination. in such a manner as to provide for the ac- VANCE BENEFICIARY NOTICES. ‘‘(B) DEADLINE TO RESPOND.—Such notice ceptance of requests for determinations (a) IN GENERAL.—Section 1869 (42 U.S.C. shall be provided within the same time pe- under such process filed not later than 18 1395ff(b)), as amended by sections 521 and 522 riod as the time period applicable to the con- months after the date of the enactment of of BIPA and section 933(d)(2)(B), is further tractor providing notice of initial determina- this Act. amended by adding at the end the following tions on a claim for benefits under sub- (2) TRANSITION.—During the period in new subsection: section (a)(2)(A). which the amendment made by subsection
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00128 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.064 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6069 (a) has become effective but contracts are lines for, or clinical examples of, evaluation (A) different types of physician practices, not provided under section 1874A of the So- and management physician services under including those with fewer than 10 full-time- cial Security Act with medicare administra- the title XVIII of the Social Security Act on equivalent employees (including physicians); tive contractors, any reference in section or after the date of the enactment of this and 1869(g) of such Act (as added by such amend- Act unless the Secretary— (B) the costs of physician compliance, in- ment) to such a contractor is deemed a ref- (1) has developed the guidelines in collabo- cluding education, implementation, audit- erence to a fiscal intermediary or carrier ration with practicing physicians (including ing, and monitoring. with an agreement under section 1816, or both generalists and specialists) and pro- (6) PERIODIC REPORTS.—The Secretary shall contract under section 1842, respectively, of vided for an assessment of the proposed submit to Congress periodic reports on the such Act. guidelines by the physician community; pilot projects under this subsection. (3) LIMITATION ON APPLICATION TO SGR.—For (2) has established a plan that contains (c) OBJECTIVES FOR EVALUATION AND MAN- purposes of applying section 1848(f)(2)(D) of specific goals, including a schedule, for im- AGEMENT GUIDELINES.—The objectives for the Social Security Act (42 U.S.C. 1395w– proving the use of such guidelines; modified evaluation and management docu- 4(f)(2)(D)), the amendment made by sub- (3) has conducted appropriate and rep- mentation guidelines developed by the Sec- section (a) shall not be considered to be a resentative pilot projects under subsection retary shall be to— change in law or regulation. (b) to test modifications to the evaluation (1) identify clinically relevant documenta- (c) PROVISIONS RELATING TO ADVANCE BEN- and management documentation guidelines; tion needed to code accurately and assess EFICIARY NOTICES; REPORT ON PRIOR DETER- (4) finds that the objectives described in coding levels accurately; MINATION PROCESS.— subsection (c) will be met in the implemen- (2) decrease the level of non-clinically per- (1) DATA COLLECTION.—The Secretary shall tation of such guidelines; and tinent and burdensome documentation time establish a process for the collection of in- (5) has established, and is implementing, a and content in the physician’s medical formation on the instances in which an ad- program to educate physicians on the use of record; vance beneficiary notice (as defined in para- such guidelines and that includes appro- (3) increase accuracy by reviewers; and graph (5)) has been provided and on instances priate outreach. (4) educate both physicians and reviewers. in which a beneficiary indicates on such a (d) STUDY OF SIMPLER, ALTERNATIVE SYS- The Secretary shall make changes to the notice that the beneficiary does not intend TEMS OF DOCUMENTATION FOR PHYSICIAN manner in which existing evaluation and to seek to have the item or service that is CLAIMS.— management documentation guidelines are the subject of the notice furnished. (1) STUDY.—The Secretary shall carry out a (2) OUTREACH AND EDUCATION.—The Sec- implemented to reduce paperwork burdens study of the matters described in paragraph retary shall establish a program of outreach on physicians. (2). (b) PILOT PROJECTS TO TEST EVALUATION and education for beneficiaries and providers (2) MATTERS DESCRIBED.—The matters re- of services and other persons on the appro- AND MANAGEMENT DOCUMENTATION GUIDE- ferred to in paragraph (1) are— priate use of advance beneficiary notices and LINES.— (A) the development of a simpler, alter- coverage policies under the medicare pro- (1) IN GENERAL.—The Secretary shall con- native system of requirements for docu- gram. duct under this subsection appropriate and mentation accompanying claims for evalua- (3) GAO REPORT REPORT ON USE OF ADVANCE representative pilot projects to test new tion and management physician services for BENEFICIARY NOTICES.—Not later than 18 evaluation and management documentation which payment is made under title XVIII of months after the date on which section guidelines referred to in subsection (a). the Social Security Act; and 1869(g) of the Social Security Act (as added (2) LENGTH AND CONSULTATION.—Each pilot (B) consideration of systems other than by subsection (a)) takes effect, the Comp- project under this subsection shall— current coding and documentation require- troller General of the United States shall (A) be voluntary; ments for payment for such physician serv- submit to Congress a report on the use of ad- (B) be of sufficient length as determined by ices. the Secretary to allow for preparatory physi- vance beneficiary notices under title XVIII (3) CONSULTATION WITH PRACTICING PHYSI- cian and medicare contractor education, of such Act. Such report shall include infor- CIANS.—In designing and carrying out the mation concerning the providers of services analysis, and use and assessment of potential study under paragraph (1), the Secretary and other persons that have provided such evaluation and management guidelines; and shall consult with practicing physicians, in- notices and the response of beneficiaries to (C) be conducted, in development and cluding physicians who are part of group such notices. throughout the planning and operational practices and including both generalists and (4) GAO REPORT ON USE OF PRIOR DETER- stages of the project, in consultation with specialists. MINATION PROCESS.—Not later than 18 months practicing physicians (including both gener- (4) APPLICATION OF HIPAA UNIFORM CODING after the date on which section 1869(g) of the alists and specialists). REQUIREMENTS.—In developing an alternative Social Security Act (as added by subsection (3) RANGE OF PILOT PROJECTS.—Of the pilot system under paragraph (2), the Secretary (a)) takes effect, the Comptroller General of projects conducted under this subsection— shall consider requirements of administra- the United States shall submit to Congress a (A) at least one shall focus on a peer re- tive simplification under part C of title XI of report on the use of the prior determination view method by physicians (not employed by the Social Security Act. process under such section. Such report shall a medicare contractor) which evaluates med- (5) REPORT TO CONGRESS.—(A) Not later include— ical record information for claims submitted than October 1, 2005, the Secretary shall sub- (A) information concerning the types of by physicians identified as statistical mit to Congress a report on the results of the procedures for which a prior determination outliers relative to definitions published in study conducted under paragraph (1). has been sought, determinations made under the Current Procedures Terminology (CPT) (B) The Medicare Payment Advisory Com- the process, and changes in receipt of serv- code book of the American Medical Associa- mission shall conduct an analysis of the re- ices resulting from the application of such tion; sults of the study included in the report process; and (B) at least one shall focus on an alter- under subparagraph (A) and shall submit a (B) an evaluation of whether the process native method to detailed guidelines based report on such analysis to Congress. was useful for physicians (and other sup- on physician documentation of face to face (e) STUDY ON APPROPRIATE CODING OF CER- pliers) and beneficiaries, whether it was encounter time with a patient; TAIN EXTENDED OFFICE VISITS.—The Sec- timely, and whether the amount of informa- (C) at least one shall be conducted for serv- retary shall conduct a study of the appro- tion required was burdensome to physicians ices furnished in a rural area and at least priateness of coding in cases of extended of- and beneficiaries. one for services furnished outside such an fice visits in which there is no diagnosis (5) ADVANCE BENEFICIARY NOTICE DEFINED.— area; and made. Not later than October 1, 2005, the In this subsection, the term ‘‘advance bene- (D) at least one shall be conducted in a set- Secretary shall submit a report to Congress ficiary notice’’ means a written notice pro- ting where physicians bill under physicians’ on such study and shall include rec- vided under section 1879(a) of the Social Se- services in teaching settings and at least one ommendations on how to code appropriately curity Act (42 U.S.C. 1395pp(a)) to an indi- shall be conducted in a setting other than a for such visits in a manner that takes into vidual entitled to benefits under part A or B teaching setting. account the amount of time the physician of title XVIII of such Act before items or (4) BANNING OF TARGETING OF PILOT PROJECT spent with the patient. services are furnished under such part in PARTICIPANTS.—Data collected under this (f) DEFINITIONS.—In this section— cases where a provider of services or other subsection shall not be used as the basis for (1) the term ‘‘rural area’’ has the meaning person that would furnish the item or service overpayment demands or post-payment au- given that term in section 1886(d)(2)(D) of the believes that payment will not be made for dits. Such limitation applies only to claims Social Security Act, 42 U.S.C. some or all of such items or services under filed as part of the pilot project and lasts 1395ww(d)(2)(D); and such title. only for the duration of the pilot project and (2) the term ‘‘teaching settings’’ are those Subtitle V—Miscellaneous Provisions only as long as the provider is a participant settings described in section 415.150 of title SEC. 941. POLICY DEVELOPMENT REGARDING in the pilot project. 42, Code of Federal Regulations. EVALUATION AND MANAGEMENT (E (5) STUDY OF IMPACT.—Each pilot project SEC. 942. IMPROVEMENT IN OVERSIGHT OF & M) DOCUMENTATION GUIDELINES. shall examine the effect of the new evalua- TECHNOLOGY AND COVERAGE. (a) IN GENERAL.—The Secretary may not tion and management documentation guide- (a) COUNCIL FOR TECHNOLOGY AND INNOVA- implement any new documentation guide- lines on— TION.—Section 1868 (42 U.S.C. 1395ee), as
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00129 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.064 H26PT1 H6070 CONGRESSIONAL RECORD — HOUSE June 26, 2003 amended by section 921(a), is amended by velops and makes available to the public of such tests, or both) furnished without a adding at the end the following new sub- (through an Internet site and other appro- face-to-face encounter between the indi- section: priate mechanisms) a list of final determina- vidual entitled to benefits under part A or ‘‘(c) COUNCIL FOR TECHNOLOGY AND INNOVA- tions of the payment amounts for such tests enrolled under part B, or both, and the hos- TION.— under this subsection, together with the ra- pital involved and in which the hospital sub- ‘‘(1) ESTABLISHMENT.—The Secretary shall tionale for each such determination, the mits a claim only for such test or interpreta- establish a Council for Technology and Inno- data on which the determinations are based, tion. vation within the Centers for Medicare & and responses to comments and suggestions SEC. 944. EMTALA IMPROVEMENTS. Medicaid Services (in this section referred to received from the public. (a) PAYMENT FOR EMTALA-MANDATED as ‘CMS’). ‘‘(C) Under the procedures established pur- SCREENING AND STABILIZATION SERVICES.— ‘‘(2) COMPOSITION.—The Council shall be suant to subparagraph (A), the Secretary (1) IN GENERAL.—Section 1862 (42 U.S.C. composed of senior CMS staff and clinicians shall— 1395y) is amended by inserting after sub- and shall be chaired by the Executive Coordi- ‘‘(i) set forth the criteria for making deter- section (c) the following new subsection: nator for Technology and Innovation (ap- minations under subparagraph (A); and ‘‘(d) For purposes of subsection (a)(1)(A), in pointed or designated under paragraph (4)). ‘‘(ii) make available to the public the data the case of any item or service that is re- ‘‘(3) DUTIES.—The Council shall coordinate (other than proprietary data) considered in quired to be provided pursuant to section the activities of coverage, coding, and pay- making such determinations. 1867 to an individual who is entitled to bene- ment processes under this title with respect ‘‘(D) The Secretary may convene such fur- fits under this title, determinations as to to new technologies and procedures, includ- ther public meetings to receive public com- whether the item or service is reasonable ing new drug therapies, and shall coordinate ments on payment amounts for new tests and necessary shall be made on the basis of the exchange of information on new tech- under this subsection as the Secretary deems the information available to the treating nologies between CMS and other entities appropriate. physician or practitioner (including the pa- that make similar decisions. ‘‘(E) For purposes of this paragraph: tient’s presenting symptoms or complaint) ‘‘(4) EXECUTIVE COORDINATOR FOR TECH- ‘‘(i) The term ‘HCPCS’ refers to the Health at the time the item or service was ordered NOLOGY AND INNOVATION.—The Secretary Care Procedure Coding System. or furnished by the physician or practitioner shall appoint (or designate) a noncareer ap- ‘‘(ii) A code shall be considered to be ‘sub- (and not on the patient’s principal diag- pointee (as defined in section 3132(a)(7) of stantially revised’ if there is a substantive nosis). When making such determinations title 5, United States Code) who shall serve change to the definition of the test or proce- with respect to such an item or service, the as the Executive Coordinator for Technology dure to which the code applies (such as a new Secretary shall not consider the frequency and Innovation. Such executive coordinator analyte or a new methodology for measuring with which the item or service was provided shall report to the Administrator of CMS, an existing analyte-specific test).’’. to the patient before or after the time of the shall chair the Council, shall oversee the (c) GAO STUDY ON IMPROVEMENTS IN EXTER- admission or visit.’’. execution of its duties, and shall serve as a NAL DATA COLLECTION FOR USE IN THE MEDI- (2) EFFECTIVE DATE.—The amendment single point of contact for outside groups CARE INPATIENT PAYMENT SYSTEM.— made by paragraph (1) shall apply to items and entities regarding the coverage, coding, (1) STUDY.—The Comptroller General of the and services furnished on or after January 1, and payment processes under this title.’’. United States shall conduct a study that 2004. (b) METHODS FOR DETERMINING PAYMENT analyzes which external data can be col- (b) NOTIFICATION OF PROVIDERS WHEN BASIS FOR NEW LAB TESTS.—Section 1833(h) lected in a shorter time frame by the Centers EMTALA INVESTIGATION CLOSED.—Section (42 U.S.C. 1395l(h)) is amended by adding at for Medicare & Medicaid Services for use in 1867(d) (42 U.S.C. 42 U.S.C. 1395dd(d)) is the end the following: computing payments for inpatient hospital amended by adding at the end the following ‘‘(8)(A) The Secretary shall establish by services. The study may include an evalua- new paragraph: regulation procedures for determining the tion of the feasibility and appropriateness of ‘‘(4) NOTICE UPON CLOSING AN INVESTIGA- basis for, and amount of, payment under this using of quarterly samples or special surveys TION.—The Secretary shall establish a proce- subsection for any clinical diagnostic labora- or any other methods. The study shall in- dure to notify hospitals and physicians when tory test with respect to which a new or sub- clude an analysis of whether other executive an investigation under this section is stantially revised HCPCS code is assigned on agencies, such as the Bureau of Labor Statis- closed.’’. or after January 1, 2005 (in this paragraph re- tics in the Department of Commerce, are (c) PRIOR REVIEW BY PEER REVIEW ORGANI- ferred to as ‘new tests’). best suited to collect this information. ZATIONS IN EMTALA CASES INVOLVING TERMI- ‘‘(B) Determinations under subparagraph (2) REPORT.—By not later than October 1, NATION OF PARTICIPATION.— (A) shall be made only after the Secretary— 2004, the Comptroller General shall submit a (1) IN GENERAL.—Section 1867(d)(3) (42 ‘‘(i) makes available to the public (through report to Congress on the study under para- U.S.C. 1395dd(d)(3)) is amended— an Internet site and other appropriate mech- graph (1). (A) in the first sentence, by inserting ‘‘or anisms) a list that includes any such test for (d) PROCESS FOR ADOPTION OF ICD CODES AS in terminating a hospital’s participation which establishment of a payment amount DATA STANDARD.—Section 1172(f) (42 U.S.C. under this title’’ after ‘‘in imposing sanc- under this subsection is being considered for 1320d–1(f)) is amended by inserting after the tions under paragraph (1)’’; and a year; first sentence the following: ‘‘Notwith- (B) by adding at the end the following new ‘‘(ii) on the same day such list is made standing the first sentence of this sub- sentences: ‘‘Except in the case in which a available, causes to have published in the section, if the National Committee on Vital delay would jeopardize the health or safety Federal Register notice of a meeting to re- and Health Statistics has not made a rec- of individuals, the Secretary shall also re- ceive comments and recommendations (and ommendation to the Secretary, within 1 year quest such a review before making a compli- data on which recommendations are based) after the date of the enactment of this sen- ance determination as part of the process of from the public on the appropriate basis tence, with respect to the adoption of the terminating a hospital’s participation under under this subsection for establishing pay- International Classification of Diseases, 10th this title for violations related to the appro- ment amounts for the tests on such list; Revision, Procedure Coding System (‘ICD–10– priateness of a medical screening examina- ‘‘(iii) not less than 30 days after publica- PCS’) and the International Classification of tion, stabilizing treatment, or an appro- tion of such notice convenes a meeting, that Diseases, 10th Revision, Clinical Modifica- priate transfer as required by this section, includes representatives of officials of the tion (‘ICD–10–CM’) as a standard under this and shall provide a period of 5 days for such Centers for Medicare & Medicaid Services in- part, then the Secretary may adopt ICD–10– review. The Secretary shall provide a copy of volved in determining payment amounts, to PCS and ICD–10–CM as such a standard.’’. the organization’s report to the hospital or receive such comments and recommenda- SEC. 943. TREATMENT OF HOSPITALS FOR CER- physician consistent with confidentiality re- tions (and data on which the recommenda- TAIN SERVICES UNDER MEDICARE quirements imposed on the organization tions are based); SECONDARY PAYOR (MSP) PROVI- under such part B.’’. ‘‘(iv) taking into account the comments SIONS. (2) EFFECTIVE DATE.—The amendments and recommendations (and accompanying (a) IN GENERAL.—The Secretary shall not made by paragraph (1) shall apply to termi- data) received at such meeting, develops and require a hospital (including a critical access nations of participation initiated on or after makes available to the public (through an hospital) to ask questions (or obtain infor- the date of the enactment of this Act. Internet site and other appropriate mecha- mation) relating to the application of sec- (d) MODIFICATION OF REQUIRMENT FOR MED- nisms) a list of proposed determinations with tion 1862(b) of the Social Security Act (relat- ICAL SCREENING EXAMINATIONS FOR PATIENTS respect to the appropriate basis for estab- ing to medicare secondary payor provisions) NOT REQUESTING EMERGENCY DEPARTMENT lishing a payment amount under this sub- in the case of reference laboratory services SERVICES.— section for each such code, together with an described in subsection (b), if the Secretary (1) IN GENERAL.—Section 1867(a) (42 U.S.C. explanation of the reasons for each such de- does not impose such requirement in the 1395dd(a)) is amended— termination, the data on which the deter- case of such services furnished by an inde- (A) by designating all that follows ‘‘(a) minations are based, and a request for public pendent laboratory. MEDICAL SCREENING REQUIREMENT.—’’ as written comments on the proposed deter- (b) REFERENCE LABORATORY SERVICES DE- paragraph (1) with the heading ‘‘IN GEN- mination; and SCRIBED.—Reference laboratory services de- ERAL.—’’; ‘‘(v) taking into account the comments re- scribed in this subsection are clinical labora- (B) by aligning such paragraph with the ceived during the public comment period, de- tory diagnostic tests (or the interpretation paragraph added by paragraph (3); and
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(C) by adding at the end the following new (e) TERMINATION.—The Advisory Group the same manner as civil money penalties paragraph: shall terminate 30 months after the date of under subsection (a) of section 1128A are im- ‘‘(2) EXCEPTION FOR CERTAIN CASES.—The its first meeting. posed and collected under that section.’’. requirement for an appropriate medical (f) WAIVER OF ADMINISTRATIVE LIMITA- (b) EFFECTIVE DATE.—The amendments screening examination under paragraph (1) TION.—The Secretary shall establish the Ad- made by this subsection (a) shall apply to shall not apply in the case of an individual visory Group notwithstanding any limita- hospitals as of July 1, 2004. who comes to the emergency department and tion that may apply to the number of advi- SEC. 948. BIPA-RELATED TECHNICAL AMEND- neither the individual, nor another person on sory committees that may be established MENTS AND CORRECTIONS. the individual’s behalf, requests examination (within the Department of Health and (a) TECHNICAL AMENDMENTS RELATING TO or treatment for an emergency medical con- Human Services or otherwise). ADVISORY COMMITTEE UNDER BIPA SECTION dition (such as a request solely for preven- SEC. 946. AUTHORIZING USE OF ARRANGEMENTS 522.—(1) Subsection (i) of section 1114 (42 tive services, such as blood pressure screen- TO PROVIDE CORE HOSPICE SERV- U.S.C. 1314)— ing or non-emergency laboratory and diag- ICES IN CERTAIN CIRCUMSTANCES. (A) is transferred to section 1862 and added (a) IN GENERAL.—Section 1861(dd)(5) (42 nostic tests).’’. at the end of such section; and U.S.C. 1395x(dd)(5)) is amended by adding at (2) EFFECTIVE DATE.—The amendments (B) is redesignated as subsection (j). made by paragraph (1) shall apply to termi- the end the following: ‘‘(D) In extraordinary, exigent, or other (2) Section 1862 (42 U.S.C. 1395y) is amend- nations of participation initiated on or after non-routine circumstances, such as unantici- ed— the date of the enactment of this Act. pated periods of high patient loads, staffing (A) in the last sentence of subsection (a), SEC. 945. EMERGENCY MEDICAL TREATMENT shortages due to illness or other events, or by striking ‘‘established under section AND ACTIVE LABOR ACT (EMTALA) temporary travel of a patient outside a hos- 1114(f)’’; and TECHNICAL ADVISORY GROUP. pice program’s service area, a hospice pro- (B) in subsection (j), as so transferred and (a) ESTABLISHMENT.—The Secretary shall gram may enter into arrangements with an- redesignated— establish a Technical Advisory Group (in other hospice program for the provision by (i) by striking ‘‘under subsection (f)’’; and this section referred to as the ‘‘Advisory that other program of services described in (ii) by striking ‘‘section 1862(a)(1)’’ and in- Group’’) to review issues related to the paragraph (2)(A)(ii)(I). The provisions of serting ‘‘subsection (a)(1)’’. Emergency Medical Treatment and Labor paragraph (2)(A)(ii)(II) shall apply with re- (b) TERMINOLOGY CORRECTIONS.—(1) Section Act (EMTALA) and its implementation. In spect to the services provided under such ar- 1869(c)(3)(I)(ii) (42 U.S.C. 1395ff(c)(3)(I)(ii)), as this section, the term ‘‘EMTALA’’ refers to rangements. amended by section 521 of BIPA, is amend- the provisions of section 1867 of the Social ‘‘(E) A hospice program may provide serv- ed— Security Act (42 U.S.C. 1395dd). ices described in paragraph (1)(A) other than (A) in subclause (III), by striking ‘‘policy’’ (b) MEMBERSHIP.—The Advisory Group directly by the program if the services are and inserting ‘‘determination’’; and shall be composed of 19 members, including highly specialized services of a registered (B) in subclause (IV), by striking ‘‘medical the Administrator of the Centers for Medi- professional nurse and are provided non-rou- review policies’’ and inserting ‘‘coverage de- care & Medicaid Services and the Inspector tinely and so infrequently so that the provi- terminations’’. General of the Department of Health and sion of such services directly would be im- (2) Section 1852(a)(2)(C) (42 U.S.C. 1395w– Human Services and of which— practicable and prohibitively expensive.’’. 22(a)(2)(C)) is amended by striking ‘‘policy’’ (1) 4 shall be representatives of hospitals, (b) CONFORMING PAYMENT PROVISION.—Sec- and ‘‘POLICY’’ and inserting ‘‘determination’’ including at least one public hospital, that tion 1814(i) (42 U.S.C. 1395f(i)) is amended by each place it appears and ‘‘DETERMINATION’’, have experience with the application of adding at the end the following new para- respectively. EMTALA and at least 2 of which have not graph: (c) REFERENCE CORRECTIONS.—Section been cited for EMTALA violations; ‘‘(4) In the case of hospice care provided by 1869(f)(4) (42 U.S.C. 1395ff(f)(4)), as added by (2) 7 shall be practicing physicians drawn a hospice program under arrangements under section 522 of BIPA, is amended— from the fields of emergency medicine, cardi- section 1861(dd)(5)(D) made by another hos- (1) in subparagraph (A)(iv), by striking ology or cardiothoracic surgery, orthopedic pice program, the hospice program that ‘‘subclause (I), (II), or (III)’’ and inserting surgery, neurosurgery, pediatrics or a pedi- made the arrangements shall bill and be paid ‘‘clause (i), (ii), or (iii)’’; atric subspecialty, obstetrics-gynecology, for the hospice care.’’. (2) in subparagraph (B), by striking ‘‘clause and psychiatry, with not more than one phy- (c) EFFECTIVE DATE.—The amendments (i)(IV)’’ and ‘‘clause (i)(III)’’ and inserting sician from any particular field; made by this section shall apply to hospice ‘‘subparagraph (A)(iv)’’ and ‘‘subparagraph (3) 2 shall represent patients; care provided on or after the date of the en- (A)(iii)’’, respectively; and (4) 2 shall be staff involved in EMTALA in- actment of this Act. (3) in subparagraph (C), by striking ‘‘clause vestigations from different regional offices SEC. 947. APPLICATION OF OSHA BLOODBORNE (i)’’, ‘‘subclause (IV)’’ and ‘‘subparagraph of the Centers for Medicare & Medicaid Serv- PATHOGENS STANDARD TO CERTAIN (A)’’ and inserting ‘‘subparagraph (A)’’, ices; and HOSPITALS. ‘‘clause (iv)’’ and ‘‘paragraph (1)(A)’’, respec- (a) IN GENERAL.—Section 1866 (42 U.S.C. (5) 1 shall be from a State survey office in- tively each place it appears. 1395cc) is amended— volved in EMTALA investigations and 1 shall (d) OTHER CORRECTIONS.—Effective as if in- (1) in subsection (a)(1)— be from a peer review organization, both of cluded in the enactment of section 521(c) of (A) in subparagraph (R), by striking ‘‘and’’ whom shall be from areas other than the re- BIPA, section 1154(e) (42 U.S.C. 1320c–3(e)) is at the end; gions represented under paragraph (4). amended by striking paragraph (5). (B) in subparagraph (S), by striking the pe- (e) EFFECTIVE DATE.—Except as otherwise In selecting members described in para- riod at the end and inserting ‘‘, and’’; and provided, the amendments made by this sec- graphs (1) through (3), the Secretary shall (C) by inserting after subparagraph (S) the tion shall be effective as if included in the consider qualified individuals nominated by following new subparagraph: enactment of BIPA. organizations representing providers and pa- ‘‘(T) in the case of hospitals that are not tients. otherwise subject to the Occupational Safety SEC. 949. CONFORMING AUTHORITY TO WAIVE A PROGRAM EXCLUSION. (c) GENERAL RESPONSIBILITIES.—The Advi- and Health Act of 1970, to comply with the sory Group— Bloodborne Pathogens standard under sec- The first sentence of section 1128(c)(3)(B) (1) shall review EMTALA regulations; tion 1910.1030 of title 29 of the Code of Fed- (42 U.S.C. 1320a–7(c)(3)(B)) is amended to read (2) may provide advice and recommenda- eral Regulations (or as subsequently redesig- as follows: ‘‘Subject to subparagraph (G), in tions to the Secretary with respect to those nated).’’; and the case of an exclusion under subsection (a), regulations and their application to hos- (2) by adding at the end of subsection (b) the minimum period of exclusion shall be pitals and physicians; the following new paragraph: not less than five years, except that, upon (3) shall solicit comments and rec- ‘‘(4)(A) A hospital that fails to comply with the request of the administrator of a Federal ommendations from hospitals, physicians, the requirement of subsection (a)(1)(T) (re- health care program (as defined in section and the public regarding the implementation lating to the Bloodborne Pathogens stand- 1128B(f)) who determines that the exclusion of such regulations; and ard) is subject to a civil money penalty in an would impose a hardship on individuals enti- (4) may disseminate information on the ap- amount described in subparagraph (B), but is tled to benefits under part A of title XVIII or plication of such regulations to hospitals, not subject to termination of an agreement enrolled under part B of such title, or both, physicians, and the public. under this section. the Secretary may waive the exclusion under (d) ADMINISTRATIVE MATTERS.— ‘‘(B) The amount referred to in subpara- subsection (a)(1), (a)(3), or (a)(4) with respect (1) CHAIRPERSON.—The members of the Ad- graph (A) is an amount that is similar to the to that program in the case of an individual visory Group shall elect a member to serve amount of civil penalties that may be im- or entity that is the sole community physi- as chairperson of the Advisory Group for the posed under section 17 of the Occupational cian or sole source of essential specialized life of the Advisory Group. Safety and Health Act of 1970 for a violation services in a community.’’. (2) MEETINGS.—The Advisory Group shall of the Bloodborne Pathogens standard re- SEC. 950. TREATMENT OF CERTAIN DENTAL first meet at the direction of the Secretary. ferred to in subsection (a)(1)(T) by a hospital CLAIMS. The Advisory Group shall then meet twice that is subject to the provisions of such Act. (a) IN GENERAL.—Section 1862 (42 U.S.C. per year and at such other times as the Advi- ‘‘(C) A civil money penalty under this 1395y) is amended by adding after subsection sory Group may provide. paragraph shall be imposed and collected in (g) the following new subsection:
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‘‘(h)(1) Subject to paragraph (2), a group (2) PHYSICIAN COMPENSATION GENERALLY.— be derived from other information available health plan (as defined in subsection Not later than 12 months after the date of to, or collected by, such agencies; and (a)(1)(A)(v)) providing supplemental or sec- the enactment of this Act, the Comptroller (B) the value of collecting such informa- ondary coverage to individuals also entitled General shall submit to Congress a report on tion by small home health agencies com- to services under this title shall not require all aspects of physician compensation for pared to the administrative burden related a medicare claims determination under this services furnished under title XVIII of the to such collection. title for dental benefits specifically excluded Social Security Act, and how those aspects In conducting the study the Secretary shall under subsection (a)(12) as a condition of interact and the effect on appropriate com- obtain recommendations from quality as- making a claims determination for such ben- pensation for physician services. Such report sessment experts in the use of such informa- efits under the group health plan. shall review alternatives for the physician tion and the necessity of small, as well as ‘‘(2) A group health plan may require a fee schedule under section 1848 of such title large, home health agencies collecting such claims determination under this title in (42 U.S.C. 1395w–4). information. cases involving or appearing to involve inpa- (b) ANNUAL PUBLICATION OF LIST OF NA- (2) REPORT.—The Secretary shall submit to tient dental hospital services or dental serv- TIONAL COVERAGE DETERMINATIONS.—The Congress a report on the study conducted ices expressly covered under this title pursu- Secretary shall provide, in an appropriate under paragraph (1) by not later than 18 ant to actions taken by the Secretary.’’. annual publication available to the public, a months after the date of the enactment of list of national coverage determinations (b) EFFECTIVE DATE.—The amendment this Act. made under title XVIII of the Social Secu- made by subsection (a) shall take effect on (d) CONSTRUCTION.—Nothing in this section the date that is 60 days after the date of the rity Act in the previous year and informa- shall be construed as preventing home health enactment of this Act. tion on how to get more information with re- agencies from collecting non-medicare/med- spect to such determinations. SEC. 951. FURNISHING HOSPITALS WITH INFOR- icaid OASIS information for their own use. (c) GAO REPORT ON FLEXIBILITY IN APPLY- MATION TO COMPUTE DSH FOR- TITLE X—MEDICAID MULA. ING HOME HEALTH CONDITIONS OF PARTICIPA- Beginning not later than 1 year after the TION TO PATIENTS WHO ARE NOT MEDICARE SEC. 1001. MEDICAID DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS. date of the enactment of this Act, the Sec- BENEFICIARIES.—Not later than 6 months after the date of the enactment of this Act, Section 1923(f)(3) (42 U.S.C. 1396r–4(f)(3)) is retary shall arrange to furnish to subsection the Comptroller General of the United States amended— (d) hospitals (as defined in section shall submit to Congress a report on the im- (1) in subparagraph (A), by striking ‘‘sub- 1886(d)(1)(B) of the Social Security Act, 42 plications if there were flexibility in the ap- paragraph (B)’’ and inserting ‘‘subparagraphs U.S.C. 1395ww(d)(1)(B)) the data necessary for plication of the medicare conditions of par- (B) and (C)’’; and such hospitals to compute the number of pa- ticipation for home health agencies with re- (2) by adding at the end the following new tient days used in computing the dispropor- spect to groups or types of patients who are subparagraphs: tionate patient percentage under such sec- not medicare beneficiaries. The report shall ‘‘(C) SPECIAL, TEMPORARY INCREASE IN AL- tion for that hospital for the current cost re- include an analysis of the potential impact LOTMENTS ON A ONE-TIME, NON-CUMULATIVE porting year. Such data shall also be fur- of such flexible application on clinical oper- BASIS.—The DSH allotment for any State— nished to other hospitals which would qual- ations and the recipients of such services and ‘‘(i) for fiscal year 2004 is equal to 120 per- ify for additional payments under part A of an analysis of methods for monitoring the cent of the DSH allotment for the State for title XVIII of the Social Security Act on the quality of care provided to such recipients. fiscal year 2003 under this paragraph, not- basis of such data. (d) OIG REPORT ON NOTICES RELATING TO withstanding subparagraph (B); and SEC. 952. REVISIONS TO REASSIGNMENT PROVI- USE OF HOSPITAL LIFETIME RESERVE DAYS.— ‘‘(ii) for each succeeding fiscal year is SIONS. Not later than 1 year after the date of the equal to the DSH allotment for the State for (a) IN GENERAL.—Section 1842(b)(6)(A) (42 enactment of this Act, the Inspector General fiscal year 2004 or, in the case of fiscal years U.S.C. 1395u(b)(6)(A)) is amended by striking of the Department of Health and Human beginning with the fiscal year specified in ‘‘or (ii) (where the service was provided in a Services shall submit a report to Congress subparagraph (D) for that State, the percent- on— hospital, critical access hospital, clinic, or age change in the consumer price index for (1) the extent to which hospitals provide other facility) to the facility in which the all urban consumers (all items; U.S. city av- notice to medicare beneficiaries in accord- service was provided if there is a contractual erage), for the previous fiscal year. ance with applicable requirements before arrangement between such physician or ‘‘(D) FISCAL YEAR SPECIFIED.—For purposes they use the 60 lifetime reserve days de- other person and such facility under which of subparagraph (C)(ii), the fiscal year speci- scribed in section 1812(a)(1) of the Social Se- such facility submits the bill for such serv- fied in this subparagraph for a State is the curity Act (42 U.S.C. 1395d(a)(1)); and ice,’’ and inserting ‘‘or (ii) where the service first fiscal year for which the Secretary esti- (2) the appropriateness and feasibility of was provided under a contractual arrange- mates that the DSH allotment for that State hospitals providing a notice to such bene- ment between such physician or other person will equal (or no longer exceed) the DSH al- ficiaries before they completely exhaust and an entity (as defined by the Secretary), lotment for that State under the law as in such lifetime reserve days. to the entity if, under the contractual ar- effect before the date of the enactment of rangement, the entity submits the bill for SEC. 954. TEMPORARY SUSPENSION OF OASIS RE- this subparagraph.’’. the service and the contractual arrangement QUIREMENT FOR COLLECTION OF SEC. 1002. CLARIFICATION OF INCLUSION OF IN- meets such other program integrity and DATA ON NON-MEDICARE AND NON- MEDICAID PATIENTS. PATIENT DRUG PRICES CHARGED other safeguards as the Secretary may deter- TO CERTAIN PUBLIC HOSPITALS IN (a) IN GENERAL.—During the period de- mine to be appropriate,’’. THE BEST PRICE EXEMPTIONS FOR scribed in subsection (b), the Secretary may (b) CONFORMING AMENDMENT.—The second THE MEDICAID DRUG REBATE PRO- not require, under section 4602(e) of the Bal- sentence of section 1842(b)(6) (42 U.S.C. GRAM. anced Budget Act of 1997 or otherwise under 1395u(b)(6)) is amended by striking ‘‘except (a) IN GENERAL.—Section 1927(c)(1)(C)(i)(I) OASIS, a home health agency to gather or to an employer or facility’’ and inserting (42 U.S.C. 1396r–8(c)(1)(C)(i)(I)) is amended by submit information that relates to an indi- ‘‘except to an employer, entity, or other per- inserting before the semicolon the following: vidual who is not eligible for benefits under son’’. ‘‘(including inpatient prices charged to hos- either title XVIII or title XIX of the Social (c) EFFECTIVE DATE.—The amendments pitals described in section 340B(a)(4)(L) of Security Act (such information in this sec- made by section shall apply to payments the Public Health Service Act)’’. tion referred to as ‘‘non-medicare/medicaid made on or after the date of the enactment (b) ANTI-DIVERSION PROTECTION.—Section OASIS information’’). 1927(c)(1)(C) (42 U.S.C. 1396r–8(c)(1)(C)) is of this Act. ERIOD OF SUSPENSION.—The period de- (b) P amended by adding at the end the following: SEC. 953. OTHER PROVISIONS. scribed in this subsection— ‘‘(iii) APPLICATION OF AUDITING AND REC- (a) GAO REPORTS ON THE PHYSICIAN COM- (1) begins on the date of the enactment of ORDKEEPING REQUIREMENTS.—With respect to PENSATION.— this Act; and a covered entity described in section (1) SUSTAINABLE GROWTH RATE AND UP- (2) ends on the last day of the 2nd month 340B(a)(4)(L) of the Public Health Service DATES.—Not later than 6 months after the beginning after the date as of which the Sec- Act, any drug purchased for inpatient use date of the enactment of this Act, the Comp- retary has published final regulations re- shall be subject to the auditing and record- troller General of the United States shall garding the collection and use by the Centers keeping requirements described in section submit to Congress a report on the appro- for Medicare & Medicaid Services of non- 340B(a)(5)(C) of the Public Health Service priateness of the updates in the conversion medicare/medicaid OASIS information fol- Act.’’. factor under subsection (d)(3) of section 1848 lowing the submission of the report required of the Social Security Act (42 U.S.C. 1395w– under subsection (c). TITLE XI—ACCESS TO AFFORDABLE 4), including the appropriateness of the sus- (c) REPORT.— PHARMACEUTICALS tainable growth rate formula under sub- (1) STUDY.—The Secretary shall conduct a Subtitle A—Access to Affordable section (f) of such section for 2002 and suc- study on how non-medicare/medicaid OASIS Pharmaceuticals ceeding years. Such report shall examine the information is and can be used by large home SEC. 1101. 30-MONTH STAY-OF-EFFECTIVENESS stability and predictability of such updates health agencies. Such study shall examine— PERIOD. and rate and alternatives for the use of such (A) whether there are unique benefits from (a) ABBREVIATED NEW DRUG APPLICA- rate in the updates. the analysis of such information that cannot TIONS.—Section 505(j) of the Federal Food,
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Drug, and Cosmetic Act (21 U.S.C. 355(j)) is an amendment or supplement to the applica- ‘‘(II) RIGHT OF CONFIDENTIAL ACCESS TO AP- amended— tion), which the Secretary later determines PLICATION.—For purposes of subclause (I), the (1) in paragraph (2)— to be substantially complete, was sub- document described in this subclause is a (A) by striking subparagraph (B) and in- mitted.’’; and document providing a right of confidential serting the following: (II) in the second sentence— access to the application of the applicant ‘‘(B) NOTICE OF OPINION THAT PATENT IS IN- (aa) by striking subclause (I) and inserting under paragraph (2) for the purpose of deter- VALID OR WILL NOT BE INFRINGED.— the following: mining whether an action referred to in sub- ‘‘(i) AGREEMENT TO GIVE NOTICE.—An appli- ‘‘(I) if before the expiration of such period paragraph (B)(iii) should be brought. The cant that makes a certification described in the district court decides that the patent is document providing the right of confidential subparagraph (A)(vii)(IV) shall include in the invalid or not infringed (including any sub- access shall contain such restrictions as to application a statement that the applicant stantive determination that there is no persons entitled to access, and on the use will give notice as required by this subpara- cause of action for patent infringement or and disposition of any information accessed, graph. invalidity), the approval shall be made effec- as would apply had a protective order been ‘‘(ii) TIMING OF NOTICE.—An applicant that tive on— entered for the purpose of protecting trade makes a certification described in subpara- ‘‘(aa) the date on which the court enters secrets and other confidential business infor- graph (A)(vii)(IV) shall give notice as re- judgment reflecting the decision; or mation. Any person provided a right of con- quired under this subparagraph— ‘‘(bb) the date of a settlement order or con- fidential access shall review the application ‘‘(I) if the certification is in the applica- sent decree signed and entered by the court for the sole and limited purpose of evalu- tion, not later than 20 days after the date of stating that the patent that is the subject of ating possible infringement of the patent the postmark on the notice with which the the certification is invalid or not in- that is the subject of the certification under Secretary informs the applicant that the ap- fringed;’’; paragraph (2)(A)(vii)(IV) and for no other plication has been filed; or (bb) by striking subclause (II) and insert- purpose, and may not disclose information of ‘‘(II) if the certification is in an amend- ing the following: no relevance to any issue of patent infringe- ment or supplement to the application, at ‘‘(II) if before the expiration of such period ment to any person other than a person pro- the time at which the applicant submits the the district court decides that the patent has vided a right of confidential access. Further, amendment or supplement, regardless of been infringed— the application may be redacted by the ap- whether the applicant has already given no- ‘‘(aa) if the judgment of the district court plicant to remove any information of no rel- tice with respect to another such certifi- is appealed, the approval shall be made effec- evance to any issue of patent infringement. cation contained in the application or in an tive on— ‘‘(ii) COUNTERCLAIM TO INFRINGEMENT AC- amendment or supplement to the applica- ‘‘(AA) the date on which the court of ap- TION.— tion. peals decides that the patent is invalid or ‘‘(I) IN GENERAL.—If an owner of the patent ‘‘(iii) RECIPIENTS OF NOTICE.—An applicant not infringed (including any substantive de- or the holder of the approved application required under this subparagraph to give no- termination that there is no cause of action under subsection (b) for the drug that is tice shall give notice to— for patent infringement or invalidity); or claimed by the patent or a use of which is ‘‘(I) each owner of the patent that is the ‘‘(BB) the date of a settlement order or claimed by the patent brings a patent in- subject of the certification (or a representa- consent decree signed and entered by the fringement action against the applicant, the tive of the owner designated to receive such court of appeals stating that the patent that applicant may assert a counterclaim seeking a notice); and is the subject of the certification is invalid an order requiring the holder to correct or ‘‘(II) the holder of the approved application or not infringed; or delete the patent information submitted by under subsection (b) for the drug that is ‘‘(bb) if the judgment of the district court the holder under subsection (b) or (c) on the claimed by the patent or a use of which is is not appealed or is affirmed, the approval ground that the patent does not claim ei- claimed by the patent (or a representative of shall be made effective on the date specified ther— the holder designated to receive such a no- by the district court in a court order under ‘‘(aa) the drug for which the application tice). section 271(e)(4)(A) of title 35, United States was approved; or ‘‘(iv) CONTENTS OF NOTICE.—A notice re- Code;’’; ‘‘(bb) an approved method of using the quired under this subparagraph shall— (cc) in subclause (III), by striking ‘‘on the drug. ‘‘(I) state that an application that contains date of such court decision.’’ and inserting ‘‘(II) NO INDEPENDENT CAUSE OF ACTION.— data from bioavailability or bioequivalence ‘‘as provided in subclause (I); or’’; Subclause (I) does not authorize the asser- studies has been submitted under this sub- (dd) by inserting after subclause (III) the tion of a claim described in subclause (I) in section for the drug with respect to which following: any civil action or proceeding other than a the certification is made to obtain approval ‘‘(IV) if before the expiration of such period counterclaim described in subclause (I). to engage in the commercial manufacture, the court grants a preliminary injunction ‘‘(iii) NO DAMAGES.—An applicant shall not use, or sale of the drug before the expiration prohibiting the applicant from engaging in be entitled to damages in a civil action of the patent referred to in the certification; the commercial manufacture or sale of the under subparagraph (i) or a counterclaim and drug until the court decides the issues of under subparagraph (ii).’’. ‘‘(II) include a detailed statement of the patent validity and infringement and if the factual and legal basis of the opinion of the court decides that such patent has been in- (b) APPLICATIONS GENERALLY.—Section 505 applicant that the patent is invalid or will fringed, the approval shall be made effective of the Federal Food, Drug, and Cosmetic Act as provided in subclause (II).’’; and not be infringed.’’; and (21 U.S.C. 355) is amended— (ee) in the matter after and below sub- (B) by adding at the end the following sub- (1) in subsection (b)— clause (IV) (as added by item (dd)), by strik- paragraph: (A) by striking paragraph (3) and inserting ing ‘‘Until the expiration’’ and all that fol- ‘‘(D)(i) An applicant may not amend or the following: supplement an application to seek approval lows; of a drug referring to a different listed drug (B) by redesignating subparagraphs (C) and ‘‘(3) NOTICE OF OPINION THAT PATENT IS IN- from the listed drug identified in the appli- (D) as subparagraphs (E) and (F), respec- VALID OR WILL NOT BE INFRINGED.— cation as submitted to the Secretary. tively; and ‘‘(A) AGREEMENT TO GIVE NOTICE.—An appli- ‘‘(ii) With respect to the drug for which an (C) by inserting after subparagraph (B) the cant that makes a certification described in application is submitted, nothing in this sub- following: paragraph (2)(A)(iv) shall include in the ap- section prohibits an applicant from amend- ‘‘(C) CIVIL ACTION TO OBTAIN PATENT CER- plication a statement that the applicant will ing or supplementing the application to seek TAINTY.— give notice as required by this paragraph. approval of a different strength.’’; and ‘‘(i) DECLARATORY JUDGMENT ABSENT IN- ‘‘(B) TIMING OF NOTICE.—An applicant that (2) in paragraph (5)— FRINGEMENT ACTION.— makes a certification described in paragraph (A) in subparagraph (B)— ‘‘(I) IN GENERAL.—No action may be (2)(A)(iv) shall give notice as required under (i) by striking ‘‘under the following’’ and brought under section 2201 of title 28, United this paragraph— inserting ‘‘by applying the following to each States Code, by an applicant under para- ‘‘(i) if the certification is in the applica- certification made under paragraph graph (2) for a declaratory judgment with re- tion, not later than 20 days after the date of (2)(A)(vii)’’; and spect to a patent which is the subject of the the postmark on the notice with which the (ii) in clause (iii)— certification referred to in subparagraph Secretary informs the applicant that the ap- (I) in the first sentence, by striking ‘‘un- (B)(iii) unless the forty-five day period re- plication has been filed; or less’’ and all that follows and inserting ‘‘un- ferred to in such subparagraph has expired, ‘‘(ii) if the certification is in an amend- less, before the expiration of 45 days after and unless, if the notice provided under para- ment or supplement to the application, at the date on which the notice described in graph (2)(B) relates to noninfringement, the the time at which the applicant submits the paragraph (2)(B) is received, an action is notice was accompanied by a document de- amendment or supplement, regardless of brought for infringement of the patent that scribed in subclause (II). Any such action whether the applicant has already given no- is the subject of the certification and for shall be brought in the judicial district tice with respect to another such certifi- which information was submitted to the Sec- where the defendant has its principal place cation contained in the application or in an retary under subsection (b)(1) or (c)(2) before of business or a regular and established place amendment or supplement to the applica- the date on which the application (excluding of business. tion.
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‘‘(C) RECIPIENTS OF NOTICE.—An applicant ‘‘(I) if the judgment of the district court is vided a right of confidential access. Further, required under this paragraph to give notice appealed, the approval shall be made effec- the application may be redacted by the ap- shall give notice to— tive on— plicant to remove any information of no rel- ‘‘(i) each owner of the patent that is the ‘‘(aa) the date on which the court of ap- evance to any issue of patent infringement. subject of the certification (or a representa- peals decides that the patent is invalid or ‘‘(ii) COUNTERCLAIM TO INFRINGEMENT AC- tive of the owner designated to receive such not infringed (including any substantive de- TION.— a notice); and termination that there is no cause of action ‘‘(I) IN GENERAL.—If an owner of the patent ‘‘(ii) the holder of the approved application for patent infringement or invalidity); or or the holder of the approved application under this subsection for the drug that is ‘‘(bb) the date of a settlement order or con- under subsection (b) for the drug that is claimed by the patent or a use of which is sent decree signed and entered by the court claimed by the patent or a use of which is claimed by the patent (or a representative of of appeals stating that the patent that is the claimed by the patent brings a patent in- the holder designated to receive such a no- subject of the certification is invalid or not fringement action against the applicant, the tice). infringed; or applicant may assert a counterclaim seeking ‘‘(D) CONTENTS OF NOTICE.—A notice re- ‘‘(II) if the judgment of the district court is an order requiring the holder to correct or quired under this paragraph shall— not appealed or is affirmed, the approval delete the patent information submitted by ‘‘(i) state that an application that contains shall be made effective on the date specified the holder under subsection (b) or this sub- data from bioavailability or bioequivalence by the district court in a court order under section on the ground that the patent does studies has been submitted under this sub- section 271(e)(4)(A) of title 35, United States not claim either— section for the drug with respect to which Code;’’; ‘‘(aa) the drug for which the application the certification is made to obtain approval (IV) in clause (iii), by striking ‘‘on the date was approved; or to engage in the commercial manufacture, of such court decision.’’ and inserting ‘‘as ‘‘(bb) an approved method of using the use, or sale of the drug before the expiration provided in clause (i); or’’; drug. of the patent referred to in the certification; (V) by inserting after clause (iii), the fol- ‘‘(II) NO INDEPENDENT CAUSE OF ACTION.— and lowing: Subclause (I) does not authorize the asser- ‘‘(ii) include a detailed statement of the ‘‘(iv) if before the expiration of such period tion of a claim described in subclause (I) in factual and legal basis of the opinion of the the court grants a preliminary injunction any civil action or proceeding other than a applicant that the patent is invalid or will prohibiting the applicant from engaging in counterclaim described in subclause (I). not be infringed.’’; and the commercial manufacture or sale of the ‘‘(iii) NO DAMAGES.—An applicant shall not (B)(i) by redesignating paragraph (4) as drug until the court decides the issues of be entitled to damages in a civil action paragraph (5); and patent validity and infringement and if the under clause (i) or a counterclaim under (ii) by inserting after paragraph (3) the fol- court decides that such patent has been in- clause (ii).’’. fringed, the approval shall be made effective lowing paragraph: (c) APPLICABILITY.— as provided in clause (ii).’’; and (1) IN GENERAL.—Except as provided in ‘‘(4)(A) An applicant may not amend or (VI) in the matter after and below clause paragraphs (2) and (3), the amendments made supplement an application referred to in (iv) (as added by subclause (V)), by striking by subsections (a), (b), and (c) apply to any paragraph (2) to seek approval of a drug that ‘‘Until the expiration’’ and all that follows; proceeding under section 505 of the Federal is a different drug than the drug identified in and Food, Drug, and Cosmetic Act (21 U.S.C. 355) the application as submitted to the Sec- (iii) in the third sentence, by striking that is pending on or after the date of enact- ‘‘paragraph (3)(B)’’ and inserting ‘‘subsection retary. ment of this Act regardless of the date on (b)(3)’’; ‘‘(B) With respect to the drug for which which the proceeding was commenced or is (C) by redesignating subparagraph (D) as commenced. such an application is submitted, nothing in subparagraph (E); and this subsection or subsection (c)(3) prohibits (D) by inserting after subparagraph (C) the (2) NOTICE OF OPINION THAT PATENT IS IN- an applicant from amending or following: VALID OR WILL NOT BE INFRINGED.—The amendments made by subsections (a)(1) and supplementing the application to seek ap- ‘‘(D) CIVIL ACTION TO OBTAIN PATENT CER- (b)(1) apply with respect to any certification proval of a different strength.’’; and TAINTY.— under subsection (b)(2)(A)(iv) or (2) in subsection (c)(3)— ‘‘(i) DECLARATORY JUDGMENT ABSENT IN- (A) in the first sentence, by striking FRINGEMENT ACTION.— (j)(2)(A)(vii)(IV) of section 505 of the Federal ‘‘under the following’’ and inserting ‘‘by ap- ‘‘(I) IN GENERAL.—No action may be Food, Drug, and Cosmetic Act (21 U.S.C. 355) plying the following to each certification brought under section 2201 of title 28, United after the date of enactment of this Act in an made under subsection (b)(2)(A)(iv)’’; States Code, by an applicant referred to in application filed under subsection (b)(2) or (j) (B) in subparagraph (C)— subsection (b)(2) for a declaratory judgment of that section or in an amendment or sup- (i) in the first sentence, by striking ‘‘un- with respect to a patent which is the subject plement to an application filed under sub- less’’ and all that follows and inserting ‘‘un- of the certification referred to in subpara- section (b)(2) or (j) of that section. less, before the expiration of 45 days after graph (C) unless the forty-five day period re- (3) EFFECTIVE DATE OF APPROVAL.—The the date on which the notice described in ferred to in such subparagraph has expired, amendments made by subsections subsection (b)(3) is received, an action is and unless, if the notice the applicant pro- (a)(2)(A)(ii)(I) and (b)(2)(B)(i) apply with re- brought for infringement of the patent that vided under subsection (b)(3) relates to non- spect to any patent information submitted is the subject of the certification and for infringement, the notice was accompanied under subsection (b)(1) or (c)(2) of section 505 which information was submitted to the Sec- by a document described in subclause (II). of the Federal Food, Drug, and Cosmetic Act retary under paragraph (2) or subsection Any such action shall be brought in the judi- (21 U.S.C. 355) made after the date of enact- (b)(1) before the date on which the applica- cial district where the defendant has its ment of this Act. tion (excluding an amendment or supple- principal place of business or a regular and SEC. 1102. FORFEITURE OF 180-DAY EXCLUSIVITY ment to the application) was submitted.’’; established place of business. PERIOD. (ii) in the second sentence— ‘‘(II) RIGHT OF CONFIDENTIAL ACCESS TO AP- (a) IN GENERAL.—Section 505(j)(5) of the (I) by striking ‘‘paragraph (3)(B)’’ and in- PLICATION.—For purposes of subclause (I), the Federal Food, Drug, and Cosmetic Act (21 serting ‘‘subsection (b)(3)’’; document described in this subclause is a U.S.C. 355(j)(5)) (as amended by section 1101) (II) by striking clause (i) and inserting the document providing a right of confidential is amended— following: access to the application of the applicant re- (1) in subparagraph (B), by striking clause ‘‘(i) if before the expiration of such period ferred to in subsection (b)(2) for the purpose (iv) and inserting the following: the district court decides that the patent is of determining whether an action referred to ‘‘(iv) 180-DAY EXCLUSIVITY PERIOD.— invalid or not infringed (including any sub- in subparagraph (C) should be brought. The ‘‘(I) DEFINITIONS.—In this paragraph: stantive determination that there is no document providing the right of confidential ‘‘(aa) 180-DAY EXCLUSIVITY PERIOD.—The cause of action for patent infringement or access shall contain such restrictions as to term ‘180-day exclusivity period’ means the invalidity), the approval shall be made effec- persons entitled to access, and on the use 180-day period ending on the day before the tive on— and disposition of any information accessed, date on which an application submitted by ‘‘(I) the date on which the court enters as would apply had a protective order been an applicant other than a first applicant judgment reflecting the decision; or entered for the purpose of protecting trade could become effective under this clause. ‘‘(II) the date of a settlement order or con- secrets and other confidential business infor- ‘‘(bb) FIRST APPLICANT.—As used in this sent decree signed and entered by the court mation. Any person provided a right of con- subsection, the term ‘first applicant’ means stating that the patent that is the subject of fidential access shall review the application an applicant that, on the first day on which the certification is invalid or not in- for the sole and limited purpose of evalu- a substantially complete application con- fringed;’’; ating possible infringement of the patent taining a certification described in para- (III) by striking clause (ii) and inserting that is the subject of the certification under graph (2)(A)(vii)(IV) is submitted for ap- the following: subsection (b)(2)(A)(iv) and for no other pur- proval of a drug, submits a substantially ‘‘(ii) if before the expiration of such period pose, and may not disclose information of no complete application containing a certifi- the district court decides that the patent has relevance to any issue of patent infringe- cation described in paragraph (2)(A)(vii)(IV) been infringed— ment to any person other than a person pro- for the drug.
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‘‘(cc) SUBSTANTIALLY COMPLETE APPLICA- have been withdrawn as a result of a deter- of this Act) has occurred on or before the TION.—As used in this subsection, the term mination by the Secretary that the applica- date of enactment of this Act, the term ‘‘de- ‘substantially complete application’ means tion does not meet the requirements for ap- cision of a court’’ as used in clause (iv) of an application under this subsection that on proval under paragraph (4). section 505(j)(5)(B) of that Act means a final its face is sufficiently complete to permit a ‘‘(III) AMENDMENT OF CERTIFICATION.—The decision of a court from which no appeal substantive review and contains all the in- first applicant amends or withdraws the cer- (other than a petition to the Supreme Court formation required by paragraph (2)(A). tification for all of the patents with respect for a writ of certiorari) has been or can be ‘‘(dd) TENTATIVE APPROVAL.— to which that applicant submitted a certifi- taken. ‘‘(AA) IN GENERAL.—The term ‘tentative cation qualifying the applicant for the 180- SEC. 1103. BIOAVAILABILITY AND BIOEQUIVA- approval’ means notification to an applicant day exclusivity period. LENCE. by the Secretary that an application under ‘‘(IV) FAILURE TO OBTAIN TENTATIVE AP- (a) IN GENERAL.—Section 505(j)(8) of the this subsection meets the requirements of PROVAL.—The first applicant fails to obtain Federal Food, Drug, and Cosmetic Act (21 paragraph (2)(A), but cannot receive effective tentative approval of the application within U.S.C. 355(j)(8)) is amended— approval because the application does not 30 months after the date on which the appli- (1) by striking subparagraph (A) and in- meet the requirements of this subparagraph, cation is filed, unless the failure is caused by serting the following: there is a period of exclusivity for the listed a change in or a review of the requirements ‘‘(A)(i) The term ‘bioavailability’ means drug under subparagraph (E) or section 505A, for approval of the application imposed after the rate and extent to which the active in- or there is a 7-year period of exclusivity for the date on which the application is filed. gredient or therapeutic ingredient is ab- the listed drug under section 527. ‘‘(V) AGREEMENT WITH ANOTHER APPLICANT, sorbed from a drug and becomes available at ‘‘(BB) LIMITATION.—A drug that is granted THE LISTED DRUG APPLICATION HOLDER, OR A the site of drug action. tentative approval by the Secretary is not an PATENT OWNER.—The first applicant enters ‘‘(ii) For a drug that is not intended to be approved drug and shall not have an effective into an agreement with another applicant absorbed into the bloodstream, the Secretary approval until the Secretary issues an ap- under this subsection for the drug, the hold- may assess bioavailability by scientifically proval after any necessary additional review er of the application for the listed drug, or valid measurements intended to reflect the of the application. an owner of the patent that is the subject of rate and extent to which the active ingre- ‘‘(II) EFFECTIVENESS OF APPLICATION.—Sub- the certification under paragraph dient or therapeutic ingredient becomes ject to subparagraph (D), if the application (2)(A)(vii)(IV), the Federal Trade Commis- available at the site of drug action.’’; and contains a certification described in para- sion or the Attorney General files a com- (2) by adding at the end the following: graph (2)(A)(vii)(IV) and is for a drug for plaint, and there is a final decision of the ‘‘(C) For a drug that is not intended to be which a first applicant has submitted an ap- Federal Trade Commission or the court with absorbed into the bloodstream, the Secretary plication containing such a certification, the regard to the complaint from which no ap- may establish alternative, scientifically application shall be made effective on the peal (other than a petition to the Supreme valid methods to show bioequivalence if the date that is 180 days after the date of the Court for a writ of certiorari) has been or alternative methods are expected to detect a first commercial marketing of the drug (in- can be taken that the agreement has vio- significant difference between the drug and cluding the commercial marketing of the lated the antitrust laws (as defined in sec- the listed drug in safety and therapeutic ef- listed drug) by any first applicant.’’; and tion 1 of the Clayton Act (15 U.S.C. 12), ex- fect.’’. (2) by inserting after subparagraph (C) the cept that the term includes section 5 of the (b) EFFECT OF AMENDMENT.—The amend- following: Federal Trade Commission Act (15 U.S.C. 45) ment made by subsection (a) does not alter ‘‘(D) FORFEITURE OF 180-DAY EXCLUSIVITY to the extent that that section applies to un- the standards for approval of drugs under PERIOD.— fair methods of competition). section 505(j) of the Federal Food, Drug, and ‘‘(i) DEFINITION OF FORFEITURE EVENT.—In ‘‘(VI) EXPIRATION OF ALL PATENTS.—All of Cosmetic Act (21 U.S.C. 355(j)). this subparagraph, the term ‘forfeiture the patents as to which the applicant sub- SEC. 1104. CONFORMING AMENDMENTS. event’, with respect to an application under mitted a certification qualifying it for the Section 505A of the Federal Food, Drug, this subsection, means the occurrence of any 180-day exclusivity period have expired. and Cosmetic Act (21 U.S.C. 355a) is amend- of the following: ‘‘(ii) FORFEITURE.—The 180-day exclusivity ed— ‘‘(I) FAILURE TO MARKET.—The first appli- period described in subparagraph (B)(iv) (1) in subsections (b)(1)(A)(i) and cant fails to market the drug by the later shall be forfeited by a first applicant if a for- (c)(1)(A)(i), by striking ‘‘(j)(5)(D)(ii)’’ each of— feiture event occurs with respect to that place it appears and inserting ‘‘(j)(5)(F)(ii)’’; ‘‘(aa) the earlier of the date that is— first applicant. (2) in subsections (b)(1)(A)(ii) and ‘‘(AA) 75 days after the date on which the ‘‘(iii) SUBSEQUENT APPLICANT.—If all first (c)(1)(A)(ii), by striking ‘‘(j)(5)(D)’’ each approval of the application of the first appli- applicants forfeit the 180-day exclusivity pe- place it appears and inserting ‘‘(j)(5)(F)’’; and cant is made effective under subparagraph riod under clause (ii)— (3) in subsections (e) and (l), by striking (B)(iii); or ‘‘(I) approval of any application containing ‘‘505(j)(5)(D)’’ each place it appears and in- ‘‘(BB) 30 months after the date of submis- a certification described in paragraph serting ‘‘505(j)(5)(F)’’. sion of the application of the first applicant; (2)(A)(vii)(IV) shall be made effective in ac- Subtitle B—Federal Trade Commission or cordance with subparagraph (B)(iii); and Review ‘‘(bb) with respect to the first applicant or ‘‘(II) no applicant shall be eligible for a 180- SEC. 1111. DEFINITIONS. any other applicant (which other applicant day exclusivity period.’’. In this subtitle: has received tentative approval), the date (b) EFFECTIVE DATE.— (1) ANDA.—The term ‘‘ANDA’’ means an that is 75 days after the date as of which, as (1) IN GENERAL.—Except as provided in abbreviated drug application, as defined to each of the patents with respect to which paragraph (2), the amendment made by sub- under section 201(aa) of the Federal Food, the first applicant submitted a certification section (a) shall be effective only with re- Drug, and Cosmetic Act. qualifying the first applicant for the 180-day spect to an application filed under section (2) BRAND NAME DRUG.—The term ‘‘brand exclusivity period under subparagraph 505(j) of the Federal Food, Drug, and Cos- name drug’’ means a drug for which an appli- (B)(iv), at least 1 of the following has oc- metic Act (21 U.S.C. 355(j)) after the date of cation is approved under section 505(c) of the curred: enactment of this Act for a listed drug for Federal Food, Drug, and Cosmetic Act, in- ‘‘(AA) In an infringement action brought which no certification under section cluding an application referred to in section against that applicant with respect to the 505(j)(2)(A)(vii)(IV) of that Act was made be- 505(b)(2) of such Act. patent or in a declaratory judgment action fore the date of enactment of this Act. (3) BRAND NAME DRUG COMPANY.—The term brought by that applicant with respect to (2) COLLUSIVE AGREEMENTS.—If a forfeiture ‘‘brand name drug company’’ means the the patent, a court enters a final decision event described in section 505(j)(5)(D)(i)(V) of party that holds the approved application re- from which no appeal (other than a petition that Act occurs in the case of an applicant, ferred to in paragraph (2) for a brand name to the Supreme Court for a writ of certio- the applicant shall forfeit the 180-day period drug that is a listed drug in an ANDA, or a rari) has been or can be taken that the pat- under section 505(j)(5)(B)(iv) of that Act party that is the owner of a patent for which ent is invalid or not infringed. without regard to when the first certifi- information is submitted for such drug under ‘‘(BB) In an infringement action or a de- cation under section 505(j)(2)(A)(vii)(IV) of subsection (b) or (c) of section 505 of the Fed- claratory judgment action described in that Act for the listed drug was made. eral Food, Drug, and Cosmetic Act. subitem (AA), a court signs a settlement (3) DECISION OF A COURT WHEN THE 180-DAY (4) COMMISSION.—The term ‘‘Commission’’ order or consent decree that enters a final EXCLUSIVITY PERIOD HAS NOT BEEN TRIG- means the Federal Trade Commission. judgment that includes a finding that the GERED.—With respect to an application filed (5) GENERIC DRUG.—The term ‘‘generic patent is invalid or not infringed. before, on, or after the date of enactment of drug’’ means a drug for which an application ‘‘(CC) The patent expires. this Act for a listed drug for which a certifi- under section 505(j) of the Federal Food, ‘‘(DD) The patent is withdrawn by the cation under section 505(j)(2)(A)(vii)(IV) of Drug, and Cosmetic Act is approved. holder of the application approved under sub- that Act was made before the date of enact- (6) GENERIC DRUG APPLICANT.—The term section (b). ment of this Act and for which neither of the ‘‘generic drug applicant’’ means a person ‘‘(II) WITHDRAWAL OF APPLICATION.—The events described in subclause (I) or (II) of who has filed or received approval for an first applicant withdraws the application or section 505(j)(5)(B)(iv) of that Act (as in ef- ANDA under section 505(j) of the Federal the Secretary considers the application to fect on the day before the date of enactment Food, Drug, and Cosmetic Act.
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(7) LISTED DRUG.—The term ‘‘listed drug’’ ties involved shall file written descriptions ‘‘(1) IMPORTER.—The term ‘importer’ means means a brand name drug that is listed of such agreement that are sufficient to dis- a pharmacist or wholesaler. under section 505(j)(7) of the Federal Food, close all the terms and conditions of the ‘‘(2) PHARMACIST.—The term ‘pharmacist’ Drug, and Cosmetic Act. agreement. means a person licensed by a State to prac- SEC. 1112. NOTIFICATION OF AGREEMENTS. SEC. 1113. FILING DEADLINES. tice pharmacy, including the dispensing and (a) AGREEMENT WITH BRAND NAME DRUG Any filing required under section 1112 shall selling of prescription drugs. COMPANY.— be filed with the Commission not later than ‘‘(3) PRESCRIPTION DRUG.—The term ‘pre- (1) REQUIREMENT.—A generic drug appli- 10 business days after the date the agree- scription drug’ means a drug subject to sec- cant that has submitted an ANDA con- ments are executed. tion 503(b), other than— taining a certification under section SEC. 1114. DISCLOSURE EXEMPTION. ‘‘(A) a controlled substance (as defined in 505(j)(2)(A)(vii)(IV) of the Federal Food, Any information or documentary material section 102 of the Controlled Substances Act Drug, and Cosmetic Act and a brand name filed with the Commission pursuant to this (21 U.S.C. 802)); drug company that enter into an agreement subtitle shall be exempt from disclosure ‘‘(B) a biological product (as defined in sec- described in paragraph (2) shall each file the under section 552 of title 5, United States tion 351 of the Public Health Service Act (42 agreement in accordance with subsection (c). Code, and no such information or documen- U.S.C. 262)); ‘‘(C) an infused drug (including a peri- The agreement shall be filed prior to the tary material may be made public, except as toneal dialysis solution); date of the first commercial marketing of may be relevant to any administrative or ju- ‘‘(D) an intravenously injected drug; the generic drug that is the subject of the dicial action or proceeding. Nothing in this ‘‘(E) a drug that is inhaled during surgery; ANDA. section is intended to prevent disclosure to or (2) SUBJECT MATTER OF AGREEMENT.—An either body of Congress or to any duly au- ‘‘(F) a drug which is a parenteral drug, the agreement described in this paragraph be- thorized committee or subcommittee of the importation of which pursuant to subsection tween a generic drug applicant and a brand Congress. (b) is determined by the Secretary to pose a name drug company is an agreement regard- SEC. 1115. ENFORCEMENT. threat to the public health, in which case ing— (a) CIVIL PENALTY.—Any brand name drug section 801(d)(1) shall continue to apply. (A) the manufacture, marketing or sale of company or generic drug applicant which ‘‘(4) QUALIFYING LABORATORY.—The term the brand name drug that is the listed drug fails to comply with any provision of this subtitle shall be liable for a civil penalty of ‘qualifying laboratory’ means a laboratory in the ANDA involved; in the United States that has been approved (B) the manufacture, marketing, or sale of not more than $11,000, for each day during which such entity is in violation of this sub- by the Secretary for the purposes of this sec- the generic drug for which the ANDA was tion. submitted; or title. Such penalty may be recovered in a ‘‘(5) WHOLESALER.— civil action brought by the United States, or (C) the 180-day period referred to in section ‘‘(A) IN GENERAL.—The term ‘wholesaler’ brought by the Commission in accordance 505(j)(5)(B)(iv) of the Federal Food, Drug, and means a person licensed as a wholesaler or with the procedures established in section Cosmetic Act as it applies to such ANDA or distributor of prescription drugs in the 16(a)(1) of the Federal Trade Commission Act to any other ANDA based on the same brand United States under section 503(e)(2)(A). (15 U.S.C. 56(a)). name drug. ‘‘(B) EXCLUSION.—The term ‘wholesaler’ (b) COMPLIANCE AND EQUITABLE RELIEF.—If (b) AGREEMENT WITH ANOTHER GENERIC does not include a person authorized to im- DRUG APPLICANT.— any brand name drug company or generic drug applicant fails to comply with any pro- port drugs under section 801(d)(1). (1) REQUIREMENT.—A generic drug appli- ‘‘(b) REGULATIONS.—The Secretary shall vision of this subtitle, the United States dis- cant that has submitted an ANDA con- promulgate regulations permitting phar- trict court may order compliance, and may taining a certification under section macists and wholesalers to import prescrip- 505(j)(2)(A)(vii)(IV) of the Federal Food, grant such other equitable relief as the court tion drugs from Canada into the United Drug, and Cosmetic Act with respect to a in its discretion determines necessary or ap- States. listed drug and another generic drug appli- propriate, upon application of the Commis- ‘‘(c) LIMITATION.—The regulations under cant that has submitted an ANDA con- sion. subsection (b) shall— taining such a certification for the same list- SEC. 1116. RULEMAKING. ‘‘(1) require that each prescription drug ed drug shall each file the agreement in ac- The Commission, by rule in accordance imported under the regulations complies cordance with subsection (c). The agreement with section 553 of title 5, United States with section 505 (including with respect to shall be filed prior to the date of the first Code, consistent with the purposes of this being safe and effective for the intended use commercial marketing of either of the ge- subtitle— of the prescription drug), with sections 501 neric drugs for which such ANDAs were sub- (1) may define the terms used in this sub- and 502, and with all other applicable re- mitted. title; quirements of this Act; (2) SUBJECT MATTER OF AGREEMENT.—An (2) may exempt classes of persons or agree- ‘‘(2) require that an importer of a prescrip- agreement described in this paragraph be- ments from the requirements of this sub- tion drug under the regulations comply with tween two generic drug applicants is an title; and subsections (d)(1) and (e); agreement regarding the 180-day period re- (3) may prescribe such other rules as may ‘‘(3) require that any prescription drug ferred to in section 505(j)(5)(B)(iv) of the Fed- be necessary and appropriate to carry out from Canada imported by a domestic phar- eral Food, Drug, and Cosmetic Act as it ap- the purposes of this subtitle. macist or wholesaler under this section be plies to the ANDAs with which the agree- SEC. 1117. SAVINGS CLAUSE. contained in packaging which the Secretary ment is concerned. Any action taken by the Commission, or has determined to be reasonably certain to (c) FILING.— any failure of the Commission to take ac- be tamper-resistant and not capable of coun- (1) AGREEMENT.—The parties that are re- tion, under this subtitle shall not at any terfeiting; quired in subsection (a) or (b) to file an time bar any proceeding or any action with ‘‘(4) require that all prescription drugs agreement in accordance with this sub- respect to any agreement between a brand from Canada imported by a domestic phar- section shall file with the Commission the name drug company and a generic drug ap- macist or a wholesaler under this section text of any such agreement, except that such plicant, or any agreement between generic contain a statement designed to inform the parties are not required to file an agreement drug applicants, under any other provision of end-user of such drug that such drug has that solely concerns— law, nor shall any filing under this subtitle been imported from a foreign seller other (A) purchase orders for raw material sup- constitute or create a presumption of any than a manufacturer; plies; violation of any competition laws. ‘‘(5) require that only prescription drugs (B) equipment and facility contracts; SEC. 1118. EFFECTIVE DATE. which have not left the possession of the (C) employment or consulting contracts; or This subtitle shall— first Canadian recipient of such prescription (D) packaging and labeling contracts. (1) take effect 30 days after the date of en- drugs after receipt from the manufacturer of (2) OTHER AGREEMENTS.—The parties that actment of this Act; and such prescription drugs be eligible for impor- are required in subsection (a) or (b) to file an (2) shall apply to agreements described in tation into the United States under this sec- agreement in accordance with this sub- section 1112 that are entered into 30 days tion; section shall file with the Commission the after the date of enactment of this Act. ‘‘(6) require, if determined appropriate by text of any agreements between the parties Subtitle C—Importation of Prescription the Secretary, that all prescription drugs that are not described in such subsections Drugs imported from Canada under this section by and are contingent upon, provide a contin- SEC. 1121. IMPORTATION OF PRESCRIPTION domestic pharmacists and wholesalers enter gent condition for, or are otherwise related DRUGS. the United States through ports of entry des- to an agreement that is required in sub- (a) IN GENERAL.—Chapter VIII of the Fed- ignated by the Secretary for purposes of this section (a) or (b) to be filed in accordance eral Food, Drug, and Cosmetic Act (21 U.S.C. section; with this subsection. 381 et seq.) is amended by striking section ‘‘(7) contain any additional provisions de- (3) DESCRIPTION.—In the event that any 804 and inserting the following: termined by the Secretary to be appropriate agreement required in subsection (a) or (b) to ‘‘SEC. 804. IMPORTATION OF PRESCRIPTION to protect the public health; and be filed in accordance with this subsection DRUGS. ‘‘(8) contain any additional provisions de- has not been reduced to text, each of the par- ‘‘(a) DEFINITIONS.—In this section: termined by the Secretary to be appropriate
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00136 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.066 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6077
to facilitate the importation of prescription ‘‘(ii) confirm that the labeling of the pre- ‘‘(i) IN GENERAL.—The Secretary shall re- drugs that do not jeopardize the public scription drug complies with labeling re- quest that the Institute of Medicine of the health. quirements under this Act; National Academy of Sciences conduct a ‘‘(d) INFORMATION AND RECORDS.— be supplied by the manufacturer of the pre- study of— ‘‘(1) IN GENERAL.—The regulations under scription drug to the pharmacist or whole- ‘‘(I) importations of prescription drugs subsection (b) shall require an importer of a saler; and made under the regulations under subsection prescription drug under subsection (b) to ‘‘(B) that the information supplied under (b); and submit to the Secretary the following infor- subparagraph (A) be kept in strict confidence ‘‘(II) information and documentation sub- mation and documentation: and used only for purposes of testing under mitted under subsection (d). ‘‘(A) The name and quantity of the active this section; and ‘‘(ii) REQUIREMENTS.—In conducting the ingredient of the prescription drug. ‘‘(3) may include such additional provisions study, the Institute of Medicine shall— ‘‘(B) A description of the dosage form of as the Secretary determines to be appro- ‘‘(I) evaluate the compliance of importers the prescription drug. priate to provide for the protection of trade with the regulations under subsection (b); ‘‘(C) The date on which the prescription secrets and commercial or financial informa- ‘‘(II) compare the number of shipments drug is shipped. tion that is privileged or confidential. under the regulations under subsection (b) ‘‘(D) The quantity of the prescription drug ‘‘(f) REGISTRATION OF FOREIGN SELLERS.— during the study period that are determined that is shipped. Any establishment within Canada engaged in to be counterfeit, misbranded, or adulter- ‘‘(E) The point of origin and destination of the distribution of a prescription drug that ated, and compare that number with the the prescription drug. is imported or offered for importation into number of shipments made during the study ‘‘(F) The price paid and the price charged period within the United States that are de- by the importer for the prescription drug. the United States shall register with the Secretary the name and place of business of termined to be counterfeit, misbranded, or ‘‘(G) Documentation from the foreign sell- adulterated; and er specifying— the establishment and the name of the United States agent for the establishment. ‘‘(III) consult with the Secretary to evalu- ‘‘(i) the original source of the prescription ate the effect of importations under the reg- drug; and ‘‘(g) SUSPENSION OF IMPORTATION.—The Secretary shall require that importations of ulations under subsection (b) on trade and ‘‘(ii) the quantity of each lot of the pre- patent rights under Federal law. scription drug originally received by the a specific prescription drug or importations ‘‘(B) REPORT.—Not later than 2 years after seller from that source. by a specific importer under subsection (b) be immediately suspended on discovery of a the effective date of the regulations under ‘‘(H) The lot or control number assigned to subsection (b), the Institute of Medicine the prescription drug by the manufacturer of pattern of importation of that specific pre- shall submit to Congress a report describing the prescription drug. scription drug or by that specific importer of the findings of the study under subparagraph ‘‘(I) The name, address, telephone number, drugs that are counterfeit or in violation of (A). and professional license number (if any) of any requirement under this section, until an ‘‘(2) BY THE COMPTROLLER GENERAL.— the importer. investigation is completed and the Secretary ‘‘(A) STUDY.—The Comptroller General of ‘‘(J)(i) Documentation demonstrating that determines that the public is adequately pro- the United States shall conduct a study to the prescription drug was received by the re- tected from counterfeit and violative pre- determine the effect of this section on the cipient from the manufacturer and subse- scription drugs being imported under sub- price of prescription drugs sold to consumers quently shipped by the first foreign recipient section (b). at retail. to the importer. ‘‘(h) APPROVED LABELING.—The manufac- ‘‘(ii) Documentation of the quantity of turer of a prescription drug shall provide an ‘‘(B) REPORT.—Not later than 18 months each lot of the prescription drug received by importer written authorization for the im- after the effective date of the regulations the first foreign recipient demonstrating porter to use, at no cost, the approved label- under subsection (b), the Comptroller Gen- that the quantity being imported into the ing for the prescription drug. eral of the United States shall submit to United States is not more than the quantity ‘‘(i) CHARITABLE CONTRIBUTIONS.—Notwith- Congress a report describing the findings of that was received by the first foreign recipi- standing any other provision of this section, the study under subparagraph (A). ‘‘(l) CONSTRUCTION.—Nothing in this sec- ent. section 801(d)(1) continues to apply to a pre- tion limits the authority of the Secretary re- ‘‘(iii) In the case of an initial imported scription drug that is donated or otherwise lating to the importation of prescription shipment, documentation demonstrating supplied at no charge by the manufacturer of drugs, other than with respect to section that each batch of the prescription drug in the drug to a charitable or humanitarian or- 801(d)(1) as provided in this section. the shipment was statistically sampled and ganization (including the United Nations and ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.— affiliates) or to a government of a foreign tested for authenticity and degradation. There are authorized to be appropriated such country. ‘‘(K) Certification from the importer or sums as are necessary to carry out this sec- ‘‘(j) WAIVER AUTHORITY FOR IMPORTATION manufacturer of the prescription drug that tion. BY INDIVIDUALS.—The Secretary may, for the prescription drug— ‘‘(n) CONDITIONS.—This section shall be- ‘‘(i) is approved for marketing in the drugs being imported from a licensed Cana- come effective only if the Secretary dem- United States and is not adulterated or mis- dian pharmacy, grant to individuals, by reg- onstrates to the Congress that the imple- branded; and ulation or on a case-by-case basis, a waiver mentation of this section will— ‘‘(ii) meets all labeling requirements under of the prohibition of importation of a pre- ‘‘(1) pose no additional risk to the public’s this Act. scription drug or device or class of prescrip- health and safety; and ‘‘(L) Laboratory records, including com- tion drugs or devices, under such conditions ‘‘(2) result in a significant reduction in the plete data derived from all tests necessary to as the Secretary determines to be appro- cost of prescription drugs to the American ensure that the prescription drug is in com- priate. Such conditions shall include condi- consumer.’’. pliance with established specifications and tions that such drug or device be— (b) CONFORMING AMENDMENTS.—The Fed- standards. ‘‘(1) in the possession of an individual when eral Food, Drug, and Cosmetic Act is amend- ‘‘(M) Documentation demonstrating that the individual enters the United States; ed— the testing required by subparagraphs (J) ‘‘(2) imported by such individual from a li- (1) in section 301(aa) (21 U.S.C. 331(aa)), by and (L) was conducted at a qualifying labora- censed pharmacy for personal use by the in- striking ‘‘covered product in violation of sec- tory. dividual, not for resale, in quantities that do tion 804’’ and inserting ‘‘prescription drug in ‘‘(N) Any other information that the Sec- not exceed a 90-day supply, which individual violation of section 804’’; and retary determines is necessary to ensure the will use the drug or device (or for a family (2) in section 303(a)(6) (21 U.S.C. 333(a)(6), protection of the public health. member of such individual); by striking ‘‘covered product pursuant to ‘‘(2) MAINTENANCE BY THE SECRETARY.—The ‘‘(3) accompanied by a copy of a valid pre- section 804(a)’’ and inserting ‘‘prescription Secretary shall maintain information and scription; drug under section 804(b)’’. ‘‘(4) imported from Canada, from a seller documentation submitted under paragraph The SPEAKER pro tempore. After 3 (1) for such period of time as the Secretary registered with the Secretary; determines to be necessary. ‘‘(5) a prescription drug approved by the hours of debate on the bill, it shall be ‘‘(e) TESTING.—The regulations under sub- Secretary under chapter V that is not adul- in order to consider the amendment section (b) shall require— terated or misbranded; printed in House Report 108–181, if of- ‘‘(1) that testing described in subpara- ‘‘(6) in the form of a final finished dosage fered by the gentleman from New York graphs (J) and (L) of subsection (d)(1) be con- that was manufactured in an establishment (Mr. RANGEL) or his designee, which ducted by the importer or by the manufac- registered under section 510; and shall be considered read, and shall be turer of the prescription drug at a qualified ‘‘(7) imported under such other conditions debatable for 1 hour, equally divided laboratory; as the Secretary determines to be necessary ‘‘(2) if the tests are conducted by the im- to ensure public safety. and controlled by the proponent and an porter— ‘‘(k) STUDIES; REPORTS.— opponent. ‘‘(A) that information needed to— ‘‘(1) BY THE INSTITUTE OF MEDICINE OF THE The gentleman from California (Mr. ‘‘(i) authenticate the prescription drug NATIONAL ACADEMY OF SCIENCES.— THOMAS), the gentleman from New being tested; and ‘‘(A) STUDY.— York (Mr. RANGEL), the gentleman
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00137 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.066 H26PT1 H6078 CONGRESSIONAL RECORD — HOUSE June 26, 2003 from Louisiana (Mr. TAUZIN), and the legislation that we have offered this say, ‘‘We are encouraged by the bill’s gentleman from Michigan (Mr. DIN- House, notwithstanding the fact that inclusion of all Medicare beneficiaries, GELL) each will control 45 minutes of twice previously we have passed Medi- including dual eligibles.’’ We spend $43 debate on the bill. care modernization with prescription billion over the next decade picking up The Chair recognizes the gentleman drugs. these low-income seniors. We believe from California (Mr. THOMAS). And let me say that I do want to sin- they should be classified as seniors Mr. THOMAS. Mr. Speaker, I yield gle out two members of the Committee first in the Federal Medicare program myself such time as I may consume. on Ways and Means, the gentleman and not low-income first, as they cur- As we begin the 3 hours of debate on from Iowa (Mr. NUSSLE), who also hap- rently are today. the primary bill and an additional hour pens to be the chairman of the Com- But they go on to say that they are on the substitute, I do want to indicate mittee on the Budget, and the gen- concerned because eligibility is limited that this day, in my opinion, has been tleman from North Dakota (Mr. POM- by a restrictive assets test. And we too long in coming. EROY), who offered together a bipar- took that letter to heart and we have I want to thank President Bush for tisan amendment which was very sig- examined that provision, notwith- his position during the campaign that nificant in helping us redress the fail- standing the fact that the original bill Medicare needed to be modernized and ure to provide those Americans espe- doubled the assets provision under the we were overdue for putting prescrip- cially in middle America but in prin- SSI, Social Security provisions for low- tion drugs in Medicare. cipally rural areas with a fair and equi- income eligibility. The bill had doubled b 1900 table Medicare program. it. We examined it, we determined that I want to thank, and I do not want to perhaps we should go that extra mile. I believe he has continued to be firm go through every staff member, but I Under the bill before you today we in his resolve that both the House, and do want to thank the chief of our Sub- have tripled it. We have tripled the SSI the Senate now for the first time, pass committee on Health staff John standards in terms of low-income pro- legislation so that we can conference a McManus for the enormous number of tections. These are the kinds of ex- common bill and send it to him for his hours he and the staff have put in. You changes that improved this legislation signature. cannot produce as complex and dif- as we move forward. I also want to thank the Speaker of ficult a piece of legislation as you have the House. The gentleman from Illinois And let me say lastly that I am very in front of you without the dedicated pleased that the Senate, I believe, will (Mr. HASTERT) was involved in these staff. And I mean not just on the com- discussions prior to our becoming the pass legislation and join the House fi- mittees, but the Congressional Budget nally in conference to craft a piece of majority and, of course, prior to his be- Office, and I will mention from Leg coming Speaker. If you examine H.R. 1, legislation that will become law. Mr. Counsel Ed Grossman, who is an insti- Speaker, I understand the rules of the you will find that the Speaker has been tutional glue. He is the one who spends willing to be the lead author. I think it House in terms of the very narrow line the hours to make sure that the lan- we must tread, and I am not allowed to is entirely proper and appropriate that guage makes sense in the legislative the Speaker of the House lead the mention a Senator, but just let me say language that we have before us. He is that a senior Senator, who has been a House through the most fundamental absolutely indispensable to the func- and important change in Medicare leader in health care debate for a num- tioning of this institution, and I want ber of years, frankly needs to be com- since its inception. to personally thank him once again for I especially want to thank my col- mended, because without his coura- the hours of commitment that he has geous step forward I do not believe the league and friend and chairman of the put in to produce this piece of legisla- Committee on Energy and Commerce, Senate would have moved as quickly or tion. as rapidly as they have to a conclusion the gentleman from Louisiana (Mr. There are organizations and associa- on their legislation. TAUZIN). In this institution, where ju- tions who have very strong feelings risdictions are guarded with a pretty about the direction of Medicare and the I have enjoyed my conversations that vicious willingness to have turf wars changes that might be made, and I I have had with him over the years, ob- whenever necessary to hang on to your want to thank all of them for their viously more frequently as I have jurisdiction, the working relationship openness and willingness to present moved into a position to help effect with the shared jurisdiction of the comments upon which we reacted. adding prescription drugs to Medicare. Committee on Energy and Commerce Most recently, I think one of the more Although we have profound differences and the Committee on Ways and Means prominent organizations, formerly in terms of our view oftentimes of the has been a very pleasant experience, known as the American Association of role of the Federal Government and as- and the working relationship between Retired Persons, now AARP, and I am sistance, we have never ever left the the staff, of which I will have more to indebted to my colleague, the gentle- focus of policy, and although we may differ, the differences have always been say a little bit later, could not have woman from California (Mrs. CAPPS), been better. for circulating the letter from AARP, over policy. And, frankly, the product we have be- because I think it is very instructive. Never, ever has he mentioned Jim fore us, although the gentleman from It provides us with an example of how Jones, Kool-aid, mass suicide. Never, Louisiana (Mr. TAUZIN) joined me in these organizations point with pride ever in our discussions has he men- the initial sponsorship of legislation, and view with alarm some of the tioned the Holocaust. Never, ever has we could not have gotten it through changes that are being made. he mentioned blacks or slavery. He has both committees and back together For example, the opening paragraph always carried on the discussion on the again in the Committee on Rules to in the letter addressed to me says, and basis of substance and the differences present to you here today as H.R. 1 I quote, ‘‘AARP is encouraged by the that we have on substance and the fact without complete and open and very advancement in the House of legisla- that in this society, in this civil soci- comradely behavior between the chair- tion to add prescription drug coverage ety, the debate ought to be over man of the Committee on Energy and to Medicare. Relief from the high cost choices of a legislative nature rather Commerce and this committee, and I of drugs is long overdue. Our members than trying to create an atmosphere of thank him for that. and all older Americans and their fami- fear. For that I am grateful for his I especially thank the gentlewoman lies expect and need legislation this friendship and the fact that we will from Connecticut (Mrs. JOHNSON), who year. We appreciate your efforts and meet in conference and, finally, sen- is the chairman of the Subcommittee leadership toward this end.’’ iors, who are the last bastion of paying on Health of the Committee on Ways But they go on to say in the letter, in the price of retail for drugs, that will and Means. The members of that com- terms of a number of additional points, no longer be the case. And for that, all mittee have been very, very helpful in that they think certain areas need to of us will be grateful. Policy will have holding the hearings and continuing to be strengthened and perhaps some triumphed over politics. shape this legislation. This bill, as it changes need to be made. For example, Mr. Speaker, I reserve the balance of rightly should be, is the best piece of under low-income protections, they my time.
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00138 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.138 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6079 ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE transfer of the ability to determine They want freedom in the marketplace. The SPEAKER pro tempore (Mr. how much prescription drugs will cost, But they want security to know they LAHOOD). Although it is permissible to which prescriptions would be filled, will not go broke. This bill provides refer to a Senator as the sponsor of leg- what is the recipient entitled to, when that. islation, other personal references are does the bill lock into place, and at the The bill provides for a discount card not permitted. year 2010 what do they do with the that I helped author, along with Sen- Mr. RANGEL. Mr. Speaker, I yield voucher if we do not have Medicare, all ator HAGEL, which provides immediate such time as he may consume to the of these things, I think, will be an- access to discount pharmaceutical distinguished gentleman from Rhode swered at some time, but I really hope prices. Real reforms in Medicare allow- Island (Mr. KENNEDY). that they are answered today. ing generics, something I have heard (Mr. KENNEDY of Rhode Island) We have many people that have about on this floor repeatedly from the asked and was given permission to re- worked hard on this bill; certainly the other side of the aisle. We have to get vise and extend his remarks.) gentleman from Michigan (Mr. DIN- generics to the market place sooner, Mr. KENNEDY of Rhode Island. Mr. GELL) has been a champion for health faster, quicker, cheaper. That is in this Speaker, I would just like to state for care for decades; the gentleman from bill. the record that the Senator from Mas- California (Mr. STARK), who will be This bill provides for increased rural sachusetts referred to is my father, and handling the remainder of this bill, the funding for hospitals, which is an in- I rise in opposition to H.R. 1. gentleman from New Jersey (Mr. credibly important thing for people in Mr. Speaker, I rise in opposition to the Re- PALLONE), the gentleman from Ohio my community and rural communities publican prescription drug bill. (Mr. BROWN), and so many others. But like Glades, Okeechobee, Hendry, and Our seniors know that Democrats have as I have said so many times publicly, Highlands County. These are Medicare worked to provide them with universal, afford- at some point in time people will be reforms that will save billions of dol- able, and reliable drug coverage. asking, when they were moving to dis- lars. And they know that THIS bill is just another solve Medicare, where were you and Republican attempt to dismantle Medicare. b 1915 This bill won’t help seniors . . . in fact, what were you doing? I think, as so many votes in the past, Yes, this is an historic night, not one there is no guaranteed backstop to insure that that people will remember this vote. to be celebrating fear and animosity or there will be drug coverage in their area. In- And those of us who oppose this piece negative pessimism about our seniors, deed, seniors may end up without ANY drug of legislation will be giving our col- but rejoicing in the fact that we are coverage . . . or forced into an HMO that they leagues an opportunity on voting for helping them provide for themselves do not want to be in. and their families. And the problems with the bill today will only legislation that provides all of the cov- erage that the letter requested from Yes, there is a phenomenal oppor- increase in 2010, when premium support and tunity tonight to pass a bill that will competitive bidding kicks in. AARP, and while parts of the letter was read, I think it is safe to say that help seniors in my community. And the Republicans divide this issue between help- instructions they gave me when I first ing our Nation’s elderly now or helping our the objections that were raised to the bill or the questions that they had ran for office and have continued to young in the future, but we can help both. give me is do not make it free, do not James, a Boy Scout from Lincoln, Rhode Is- hoped that would be changed, that that make it cheap, do not make it for po- land, wrote to me because he is worried about is handled in the substitute. litical purposes, make it so it works. his two grandmothers who cannot afford their Mr. Speaker, I ask unanimous con- This bill works, and I applaud the lead- medications. sent to allocate the remainder of my ership for giving us a chance to make I hope he doesn’t grow up only to realize time to the gentleman from California history tonight on the floor of the that we passed a bill in Congress that actually (Mr. STARK), with the understanding House. made it worse for his loved ones. that he be permitted to allocate the We should not disappoint James, his family, rest of the remaining time. Mr. STARK. Mr. Speaker, I yield my- or the forty million Medicare beneficiaries in The SPEAKER pro tempore. Is there self such time as I may consume. this Nation. objection to the request of the gen- Mr. Speaker, it is difficult to know Vote ‘‘no’’ on H.R. 1. tleman from New York? where to begin to warn the seniors in Mr. RANGEL. Mr. Speaker, I yield There was no objection. this country about this sham of a bill myself such time as I may consume. Mr. THOMAS. Mr. Speaker, I yield 2 and the beginning of the destruction of Mr. Speaker, I think this is one of minutes to the gentleman from Florida Medicare, as the Republicans have those days that we will never forget as (Mr. FOLEY), a member of the Com- wanted to do for a number of years. legislators. This is one of those days mittee on Ways and Means. There is no question that this is a that I think as legislators we will Mr. FOLEY. Mr. Speaker, I thank the major move toward privatizing Medi- never forget. And even though we have chairman for yielding me this time, care. By the calculations that we have some people who have not studied the and to both chairmen who have from the last feeble attempt to do this, bill that are so anxious to believe that brought this bill to the floor, I con- of course Health and Human Services they are going to get prescription drug gratulate them for this landmark legis- refuses to give us the most recent actu- relief, I think at the end of the day lation. arial computations, but using the last that they might be able to see that this During the rule debate, it was a little ones, the Medicare premium for B in is the first step that has been specifi- depressing to me to hear so many peo- this drug benefit would rise to $142 a cally designed not to reform the Medi- ple refer to the fact that our seniors month if the premium could hold at care system as we know it but to dis- would not be able to figure these pro- $35. solve it. grams out. These people we are talking By 2010, all Medicare will be There are some people who are hon- about survived the Depression, they privatized and immediately there will est enough, at least outside of this fought in World War II and Korea, they be a means test, the first time ever, an hallway, to admit that that is exactly taught us how to read and write, they attempt to turn a government program what they would want to do, to dis- taught us how to ride our bikes and into a welfare program, and the inter- solve the Medicare. Many of the people drive our cars. They are our parents. esting thing is that every senior’s in- on the other side of the aisle, and per- They are smart enough to figure this come data will be turned over to any haps a handful on our side, believe that out. insurance company in the United health care should not be an entitle- I come from a district in Florida, the States that requests it. So seniors, so ment, Social Security should not be an fifth largest population of Medicare re- much for their privacy. Every one of entitlement; that the free marketplace cipients in the Nation, the fifth largest those people that calls on the phone to should be able to work its will; that Medicare recipients in the Nation. sell you some hokey insurance is going government should not be involved in When I go to town hall meetings, they to have complete data on your income providing these type of services. do not ask for anything free. They courtesy of the Republicans. Ultimately, I do believe that when want a break. They want a discount. Mr. Speaker, the sad part even fur- the bill is studied and they see that the They want an opportunity to shop. ther is that the Republicans would like
VerDate Jan 31 2003 06:13 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00139 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.142 H26PT1 H6080 CONGRESSIONAL RECORD — HOUSE June 26, 2003 to turn this over to private companies The Akron Beacon Journal says that the highest threshold. That is your to operate it, and it is very interesting while the Medicare reform bills would right. But only 5 percent will fall above that one of the largest and best known address the lack of drug coverage in the threshold, and we think that is pro- private companies, Medco, a subsidiary Medicare, beneficiaries might be ‘‘no gressive. We think we need to target of Merck was just indicted, or as they better off with the benefit than they this benefit at those who need it the say, essentially indicted, by the U.S. are at present’’ because ‘‘on the key most, and that is what we do. Attorney in Philadelphia for a series of issues of affordability, the structure of Mr. THOMAS. Mr. Speaker, I yield 2 crimes committed on our Federal em- premiums, deductibles and copay- minutes to the gentleman from Illinois ployees’ health insurance benefits. This ments, both versions follow an elabo- (Mr. CRANE), chairman of the Sub- company that the Republicans would rate path to disappointment.’’ The list committee on Trade, a long time mem- turn the management of this drug ben- goes on. ber of the Committee on Ways and efit over to was indicted for canceling, In North Carolina, the Raleigh News Means. deleting and destroying patients mail Observer says the bill’s actual benefit (Mr. CRANE asked and was given order prescriptions to avoid penalties does not begin to outweigh the draw- permission to revise and extend his re- for late filing and mailing; short- backs of its so-called reforms. marks.) changing patients on the number of The Roanoke Times and World News Mr. CRANE. Mr. Speaker, I rise in pills paid for; making false statements says even if the drug bill passes, sen- support of H.R. 1, the Medicare Pre- to the insurance plan they were con- iors still will have to fear the possi- scription Drug and Modernization Act tracted with about compliance with bility they will face crushing drug of 2003. As a member of the Committee mailing timelines; calling and inducing bills. on Ways and Means’ Subcommittee on physicians to authorize switching to In Kansas, the Windfield Courier says Health, I can say with confidence that higher cost medications while rep- the doughnut hole ‘‘hurts many seniors this bill is a fair and balanced approach resenting that this would save money when they need the help the most.’’ towards providing millions of Amer- for the insurance company, which was ‘‘The majority Republicans are at risk ica’s seniors with prescription drug untrue; fabricating records of calls by of passing a Medicare bill that looks, coverage. pharmacists to physicians, and the list walks and talks like a political cam- Congress is long overdo in helping goes on. paign creature.’’ our seniors with the skyrocketing This is the type of company who sup- Washington State, the Seattle Post- costs of their prescription medication. ports the Republicans, and they in turn Intelligencer says what Congress fi- Seniors are struggling and we need to are paying back that favor by offering nally sends to the White House will help them. But we cannot ignore that Medco and Merck and their ilk the op- surely be a disappointment. the current program without an expen- portunity to provide a so-called benefit The Oregonian says it is difficult to sive new drug benefit is not financially to seniors. I say so-called benefit be- see the congressional proposals for stable. The Medicare program is al- cause the next cruel hoax in this bill is Medicare drug coverage as much more ready struggling to provide a finite there is no benefit defined in the bill. than a big letdown. They are thin in number of health services to nearly 41 Nowhere in the bill does it define a pre- coverage and convoluted in delivery. million elderly and disabled. It is im- mium, nowhere in the bill does it de- Mr. Speaker, I think we can sum this perative that this House takes action fine a copay, and nowhere in the bill all up, people will say this is drug cov- before the retirement of the baby boom does it define a benefit. Now, we can all erage for old folks. The truth is this generation, which will add another 36 do some math and the CBO actuaries bill is nothing but political coverage million beneficiaries to the Medicare tell us that the actuarial value of a for the Republicans. roll. Simply adding a new drug benefit suggested benefit might be $1,360. It is Mr. Speaker, I reserve the balance of is not the answer. important to add that our actuarial my time. I support H.R. 1 because it includes a benefit for our health employees’ ben- Mr. THOMAS. Mr. Speaker, I yield number of reforms that will ensure the efit plan is probably closer to $3,000, myself 15 seconds. long-term fiscal integrity of Medicare but there is nothing that states in this Mr. Speaker, Members will find peri- through modernization. This legisla- law that the U.S. Government shall odically during this 3-hour debate that tion gives seniors the same range of create, provide, or require a benefit of we will take a very short segment of private health insurance plans avail- any type. In other words, if the insur- time to make sure that when an out- able to Members of Congress and other ance companies cannot be induced or landish, outrageous, untrue statement Federal employees. If seniors do not bribed into offering a benefit, there has been made, we will correct the want to enroll in a private plan, they will not be any. This is a nothing bill. record immediately. have the option of staying in tradi- It does not provide a benefit. Mr. Speaker, I yield 1 minute to the tional fee-for-service. Now, I guess perhaps Members may gentlewoman from Connecticut (Mrs. The time has come for Congress to not want to just take my word for it, JOHNSON), the chairman of the Sub- work together to move past political so I think it is important to note what committee on Health for the Com- rhetoric and provide prescription drug many others might say about the bill. mittee on Ways and Means. coverage for seniors. More impor- Mr. Speaker, the Arizona Daily Star Mrs. JOHNSON of Connecticut. Mr. tantly, it is time to institute reforms says that ‘‘the Democratic bill is bet- Speaker, this bill does not allow the to ensure that future generations will ter in every respect,’’ and that the IRS to share your income information have the security of knowing that House drug bill is ‘‘awful’’ and ‘‘repul- with insurance companies. The bill Medicare will be there when they re- sive.’’ very clearly protects the confiden- tire. I urge my colleagues on both sides The Chicago Tribune says the Medi- tiality of your information, and there of the aisle to support H.R. 1. care debate ‘‘has more to do with cam- are criminal and civil penalties for vio- Mr. STARK. Mr. Speaker, I yield 3 paign 2004 than providing a prescrip- lating those provisions. Violators can minutes to the gentleman from Cali- tion drug benefit.’’ go to jail. fornia (Mr. MATSUI), a member of the The Long Island Newsday said that It is true that for 5 percent of the Committee on Ways and Means. ‘‘the proposals racing through the seniors, they will have a higher thresh- Mr. MATSUI. Mr. Speaker, I thank House are a mess. Unless they improve old for catastrophic coverage. I person- the gentleman for yielding me this dramatically en route to passage, doing ally do not believe that someone with a time. nothing would be better than enacting $200,000 income living in a gated com- I have to first of all say that I am ex- such flawed laws.’’ munity should have exactly the same tremely disappointed that my col- The Evansville Courier & Press says subsidy as someone struggling along on leagues on the other side of the aisle the ‘‘ridiculously complex Medicare re- $25,000 or $30,000 of income. I think that have put this bill before us. It is a form now being considered by Congress is a strength of this bill. But if some- shame because if they would have may be one of the more irresponsible one does not want the government to thought through the matter better and measures in the long history of cradle- tell you what your catastrophic thresh- instead of bringing up those tax cuts, to-grave legislation.’’ old is, you can opt out and just take particularly the dividend tax cut and
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00140 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.145 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6081 the capital gains tax cut, we could of my colleagues given their ability to flexible, and voluntary prescription have gotten a bill on the floor that all take reality and distort it. Here is my drug plan while at the same time aug- Americans could be proud of, and every quote: menting Pennsylvania’s PACE plan. senior citizen in this country would ‘‘Some of our friends on the other Importantly, for the nearly 2 million not only be proud of, but would have an side of the aisle are saying that if this seniors in Pennsylvania, this bill would adequate benefit. bill becomes law, it will be the end of allow PACE to wrap around the Fed- I think this bill is a sham and I think Medicare as we know it. Our answer to eral benefit which would largely sup- instead of covering senior citizens, that is, We certainly hope so. Why plant and build on PACE’s current ben- what we are doing is giving my Repub- should seniors be the last group that efits. And to ensure that Pennsylva- lican colleagues cover, political cover pays retail prices for drugs?’’ We have nia’s seniors get maximum drug cov- that eventually the senior citizens will not heard that from the other side. erage, this Medicare bill would allow lift and begin to understand what this ‘‘Old-fashioned Medicare isn’t very PACE to pay for beneficiaries’ copays bill is really all about. I guarantee good. Why should the insurance for under Medicare while at the same time Members by the fall of this year, senior seniors be called MediGap? I think that counting those contributions toward citizens in America will understand indicates just how good the insurance out-of-pocket expenditures to more this bill and they will be very, very un- is.’’ We have not heard that from the rapidly trigger catastrophic coverage. happy with a vote in favor of this legis- other side. Our seniors have waited too long to lation. But what I did say was, you will hear receive the benefits that they deserve. When we think about it for a minute, scare tactics. But seniors with ex- This flexible, voluntary, and affordable this bill does not do much at all. If a tremely high drug costs when this be- plan would provide seniors with de- senior citizen has $5,000 worth of pre- comes law will save more than 60 per- pendable benefits. This is a huge ben- scription drug coverage in any given cent of their current costs if they efit for seniors in the roughly 10 States year, the senior citizen will have to spend $10,000 a year on prescription that have a significant State plan al- pay $4,000 immediately, $4,000 of the drugs today. That is real change. That ready in place. first $5,000 of coverage before they can is real progress, making Medicare a Mr. Speaker, this bill also provides even get $1 of Federal government ben- real day-to-day benefit. I would say to real help to America’s rural health pro- efit. They have to have $670 that they my colleagues, if you really think that viders to allow them to deliver the have to pay out in the form of monthly current Medicare should not end, why highest quality care to seniors and premiums, in the form of copayments. in the world did you put up such a fit meet the demanding fiscal challenges to have a substitute so that if we ac- that they currently face. In many rural b 1930 cept your bill, current Medicare as we areas like my own district of western And so this bill is not a good bill for know it will end as well? Half quotes Pennsylvania, inequities in Medicare’s senior citizens. are not going to get it done. Try the wage reimbursements and payments In addition to that, this bill will ulti- full quote, because if you do, you will for hospitals often drive workers, espe- mately in the next 5 years begin the vote ‘‘yes’’ on this bill. cially skilled nurses, to look for jobs in erosion of Medicare as we know it. Mr. Speaker, it is my pleasure to higher-paying metropolitan hospitals Newt Gingrich had said when he be- yield to the gentleman from Pennsyl- and contribute to staffing shortages in came Speaker of the House a few years vania (Mr. GERLACH) to enter into a many local communities. ago that he wanted to see Medicare colloquy. Several provisions in this bill mirror wither on the vine. We had the gen- Mr. GERLACH. Mr. Speaker, I thank legislation I introduced earlier this tleman from California (Mr. THOMAS) the gentleman from California for his year to help alleviate those high costs just the other day say on national tele- dedication to adding a prescription by increasing Medicare’s salary reim- vision, ‘‘Those who say that the bill drug benefit to Medicare. Members of bursements to our hospitals. These two would end Medicare as we know it, our the Pennsylvania delegation have some provisions would pump $13.3 billion answer is, ‘We certainly hope so.’ ’’ Be- concerns as to whether State pharma- into the struggling rural health sys- cause what they really want to do is ceutical assistance programs like tems, and I am pleased to note that privatize Medicare, make it so that in- PACE and PACENET in Pennsylvania hospitals in my district alone would re- surance companies could increase pre- will be able to fully coordinate their ceive approximately $65 million as part miums to whatever they want to do programs with Medicare drug plans to of this fix. I ask for support for the bill. and only insure the healthy senior cit- provide a seamless transition for bene- Mr. STARK. Mr. Speaker, I am izen so that the chronically ill will ul- ficiaries and States that already have pleased to yield 3 minutes to the gen- timately wither on the vine. prescription drug plans. tleman from Michigan (Mr. LEVIN). This system that is being put forward Mr. THOMAS. I will tell the gen- (Mr. LEVIN asked and was given per- today is one that will in fact do major tleman from Pennsylvania that we mission to revise and extend his re- damage to the Medicare system in have a generous amount, and we be- marks.) America. Why did we have Medicare in lieve it will be appropriate; but cer- Mr. LEVIN. Mr. Speaker, the Repub- 1964 in the first place? Because we tainly as we get to conference, our in- lican bill contains a ticking time knew senior citizens could not get cov- tent is to provide a seamless transition bomb, a ticking time bomb of Medicare erage because seniors by their very na- for beneficiaries and States and that privatization set to go off in 2010. ture are the ones that get ill and the will be done. Under this bill, starting in 2010, sen- ones that ultimately go into very, very Mr. GERLACH. I thank the gen- iors, in essence, would receive a vouch- difficult physical situations. And so ul- tleman. er instead of Medicare’s guaranteed timately what we are going to have is Mr. THOMAS. Mr. Speaker, it is my benefits, instead of open access to doc- going back to 1964 with this legislation. pleasure to yield 2 minutes to the gen- tors and hospitals and predictable That is their intent, because they want tleman from Pennsylvania (Mr. costs. to see Medicare wither on the vine. ENGLISH), a member of the Committee Seniors who cannot afford to pay This bill is a bad bill and we need to on Ways and Means. more than they do right now would vote ‘‘no’’ on it so the American public Mr. ENGLISH. Mr. Speaker, I rise in have to leave Medicare and join HMOs. understands exactly what my col- strong support of the bill before the This so-called benefit for prescription leagues on the other side of the aisle House today. This bill is the most his- drugs in the Republican bill serves as a are attempting to do. toric and significant addition to Medi- decoy, but it is not a very good one. Mr. THOMAS. Mr. Speaker, I yield care in the program’s history. This The Republican drug plan is insur- myself such time as I may consume. Medicare bill offers enormous benefits ance without assurance. No assured This is the first mention of the quote for all of Pennsylvania’s seniors while premium, no assured deductible, no as- that I made, and it is not surprising saving the Commonwealth hundreds of sured size of the gap between the basic that the quote is certainly truncated. millions of dollars. The Medicare Pre- coverage and stop-loss, no assured list Perhaps a journalism spot on The New scription Drug and Modernization Act of drugs, no assured list of pharmacies, York Times might be available to some provides all seniors with a thorough, no assured plan from one year to the
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00141 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.148 H26PT1 H6082 CONGRESSIONAL RECORD — HOUSE June 26, 2003 next. It could change from year to will be different in different parts of cause, you know, when Republicans be- year. the country. Mr. Speaker, I tried to came the majority in 1995, there was From the very beginning, Repub- correct that by offering an amendment literally no prevention and wellness in licans have wanted to use prescription in the Committee on Ways and Means, Medicare. We are the ones that are sup- drugs as leverage to end Medicare. The and it was rejected by the Republicans. posed to be destroying Medicare? We President said earlier to seniors, we I tried to give this body an opportunity are the ones that added diabetes. We will give you some prescription drug to vote on it, but the Committee on are the ones that added osteoporosis. help depending on whether you leave Rules would not make that amendment We are the ones that added prostate Medicare and join an HMO. And now in order. and colorectal screening. We are the what this Republican bill is doing is Reason number two. We are set on a ones that added the mammography. In using a very inferior drug insurance course to privatize Medicare. Only pri- fact, in this bill that they continue to plan in 2006, not until then, to make vate insurance can participate in the speak against, we provide for the first everything except HMOs unaffordable prescription drug coverage. Private in- time every new beneficiary should have for seniors in 2010. The chairman did surance only has to offer a 1-year com- a physical. say just a few days ago, ‘‘Old-fashioned mitment. Mr. Speaker, my citizens of b 1945 Medicare isn’t very good,’’ and I quote Maryland remember when we had I want to underscore that. Every new his quote. What Republicans call old- Medicare+Choice; 100,000 Marylanders beneficiary should have a physical. In fashioned Medicare is the system of lost their coverage when all eight addition to that, we believe that cho- guaranteed benefits, set premiums and HMOs left Maryland. It is irresponsible lesterol screening has now been ad- deductibles and access to doctors and to claim that private insurance compa- vanced, and it should be provided as hospitals that have served seniors so nies are eager to return to a market well. well since 1965. Republicans want to that they have abandoned in the past. I find it amazing that they go back end all that, but current and future Reason number three. This bill will to the same old scare statements. Medicare beneficiaries do not. And we jeopardize coverage for seniors who Read the bill. It is an enhanced and Democrats intend to keep fighting for have good private retiree prescription an improved Medicare. What in the those good aspects of old-fashioned drug coverage today. CBO has esti- world were you doing for 30 years? The Medicare. Indeed, it has been very, mated that 30 percent of our seniors fact of the matter is you did not have very, very good. who currently have their own private a competent challenge. Mr. THOMAS. Mr. Speaker, I yield coverage for prescription drugs What we have done is provide real myself such time as I may consume. If through their prior employment will change, and they are afraid those old it has been very, very good, why did lose those benefits as a result of the en- frayed bumper stickers will not work the Democrats fight for a substitute actment of this legislation. anymore. which will change the structure signifi- Reason number four. We are missing Mr. Speaker, I yield 3 minutes to the cantly? an opportunity to bring down drug gentlewoman from Washington (Ms. Mr. Speaker, I yield 1 minute to the prices. The legislation specifically pro- DUNN), a very valued member of the gentlewoman from Connecticut (Mrs. hibits our government from using the Committee on Ways and Means. JOHNSON) to point out once again an purchasing power of 40 million bene- Ms. DUNN. Mr. Speaker, I for one am absolutely outrageous statement that ficiaries to lower drug prices just like very proud that the President in his cannot go unchallenged. the Canadians do. State of the Union address directed the Mrs. JOHNSON of Connecticut. Mr. Reason number five. The benefits are Congress to put together a program Speaker, scare tactics have no place in inadequate. The Republicans project that will cost about $400 billion to pro- this debate. There are no vouchers in that this bill will provide for a $35 a vide prescription drugs for seniors be- this bill. In 2010, a senior that wants to month premium, $250 deductible, then cause I think it is time to keep our be in the Medicare program will be in some help up to $2,000, but then our promise to the people we represent and the Medicare program exactly as they seniors are on their own for the next provide a comprehensive and voluntary are now. They will be in that Medicare $2,900. Our seniors are expected to pay prescription drug benefit for all sen- program and have that choice of the a $35-a-month premium when they are iors. Medicare program in 2010, in 2011, in not entitled to any benefit for a good We have all heard stories of seniors 2012, in 2013. They will never receive a part of the year. I think that is unreal- paying too much for prescription voucher. That word is not in this legis- istic. drugs. This problem is even more acute lation. It is used rhetorically to scare My Republican friends say, well, you among low-income seniors, especially seniors. I want to assure the seniors only have $400 billion. We offered alter- for women who comprise half of Medi- listening that this bill represents the natives within $400 billion that would care beneficiaries with annual incomes most dramatic expansion of benefits provide real benefits. I offered a sub- below 150 percent of the poverty level. under Medicare since the program was stitute that said, look, if you cannot In this bill we help seniors on fixed in- founded, not only prescription drugs afford all drugs, let us at least cover comes and those with high drug costs. but additional preventive benefits and drugs for those illnesses such as high A woman, for example, with an income a whole system to support seniors with blood pressure and coronary artery dis- of less than $14,400 today, which is 150 chronic illness. ease and diabetes and severe depres- percent of poverty, will receive assist- Mr. STARK. Mr. Speaker, I am happy sion. But, no, the Committee on Rules ance from the Federal Government for to yield 3 minutes to the gentleman would not allow this body to decide prescription drugs. While all seniors from Maryland (Mr. CARDIN). The gen- whether that would be a better pack- will benefit, nearly 11 million or 34 per- tleman from Maryland understands age and a guaranteed benefit package. cent of Medicare beneficiaries will that with proponents like THOMAS and Mr. Speaker, I cannot support a bill qualify for additional assistance when JOHNSON, the seniors do not need any that provides no guaranteed benefit, this bill is fully implemented. scaring from us. relies solely on the whim of private in- Improving Medicare is not only about Mr. CARDIN. Mr. Speaker, I oppose surance companies, causes harm to providing a drug benefit, but it is also the passage of this bill. The passage seniors who currently have adequate about giving seniors access to doctors, will make it much more difficult for prescription drug coverage, will not do hospitals, Medicare HMOs, and other Congress to enact a meaningful pre- enough to bring down the cost of pre- services they need. To ensure access to scription drug benefit for our Nation’s scription drugs, and provides inad- doctors, we address the low reimburse- seniors. Let me give you five reasons equate benefits. Therefore, I will vote ments that they are receiving. We also why. ‘‘no’’ on the Republican bill. increase funding for rural hospitals so Reason number one. There is no Mr. THOMAS. Mr. Speaker, I yield that seniors can get the health care guaranteed benefit in this bill. Unlike myself 1 minute. service they need right in their com- seeing a doctor or going to a hospital, You know, it just kind of makes you munity. we cannot tell our seniors that their wonder what the Democrats did for 30 For Medicare HMOs, this bill requires prescription drugs will be covered. It years when they were the majority, be- Medicare to accurately account for
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00142 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.152 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6083 military retirees in the formula and one, we will give them a little bit high- line waiting for a prescription to be that means higher Medicare+Choice re- er benefit. They are going to divide and filled, somebody going up. I have a very imbursements in areas with military conquer the American people. This is a vivid memory of the last one I saw, facilities. Strengthening Medicare also sham. this elderly lady coming up and finding means improving the quality of life for In Canada they get their price re- out what her prescription drugs was every senior. For this reason I am very duced very simply by saying let us going to cost and looking at this bottle happy that we were able to provide pre- make the Canadian price the average and that bottle and then handing that ventative services like cholesterol of the G–7. The United States is way up bottle back. She was low income. This screening, initial physical exams and here and Canada is way down there. bill will take care of her. She will be chronic care management to help those Why could we not pass a little amend- taken care of under this bill, and she seniors with serious diseases. ment in here that said let us give the will not have to give that bottle back Seniors will also have access to inno- average of the G–7? I do not know. In because she needs it. These are pre- vative treatments to deal with rheu- my State everybody goes across the scription medicines, these are what matoid arthritis and other chronic dis- border to Canada or they mail across control her quality of life, and this is a eases. This bill provides seniors imme- the border. They do it in Vermont. good bill. diate access to self-injectable biologics. They do it in New Hampshire. They do The Republican bill looks after the Besides providing the choice of which it in Maine. They do it in New York low-income people first, and it also drug works best for rheumatoid arthri- State. Why? Because everybody knows takes care of those who are the heavy tis, these self-injectable treatments the Canadians have got a better deal drug users because of the illnesses that will allow seniors to receive treat- than we. But you say no, no, we cannot they are suffering from. Obviously we ments right in their homes instead of make one change. When we are sent in can sweeten the pie by increasing the going to the hospital or to a physi- here with our rubber stamp to approve expenditures, but we heard tonight one cian’s office and will take the burden of everything George Bush does, we of the Members from the other side was off those hospitals, clinics and doctors. have to give him the bill exactly as he saying that we are letting it wither on This is a real prescription drug plan, sent it over here. the vine. We are putting $400 billion Mr. Speaker. It is one that provides up The idea that you could come out into Medicare. We are propping it up. to 25 percent in drug discounts for here with a bill and say that we have a We are putting some reforms in there, manufacturers. It covers seniors to perfect piece of legislation, the seniors we are putting some cost containments participate in the drug program, and it are like Abraham Lincoln. Do you re- in there that is going to make it a bet- protects those with very high drug member, the founder of the Republican ter deal. The price of drugs because of costs. It strengthens Medicare’s future Party? He said, You can fool some peo- the Republican bill will come down, without compromising the benefits ple all of the time and all of the people and the people that need it most, the seniors enjoy today. I ask my col- some of the time, but you cannot fool heavy users and the low income, will be leagues to support a real prescription all the people all of the time. taken care of. drug by passing this legislation. I know the President is going to raise This is a very good bill. It is one that Mr. STARK. Mr. Speaker, I yield 3 $200 billion for ads in this campaign to the Congress should definitely, defi- minutes the gentleman from Wash- say this, I got this from that rubber- nitely pass. H.R. 1, its time has come ington (Mr. MCDERMOTT), a member of stamped Congress and it is good for and it is time for this Congress to act. the Committee on Ways and Means, you, and he is going to give the tax I compliment the chairman and all of who understands that seniors are going cuts and the child never left behind, those who did this very complex bill to have to pay 4,000 bucks for the first and he is going to give this stuff, and and put it together. It is a good bill $5,000 of drugs regardless. every one of those is phony. The child and it is one this Congress should pass. Mr. MCDERMOTT. Mr. Speaker, well never left behind? He puts a budget out Mr. STARK. Mr. Speaker, I yield 3 the rubber stamp Congress is ready to- here $17 billion short to fund it, and minutes to the gentleman from Wis- night. The drug companies, after they the people are going to figure it out. consin (Mr. KLECZKA), a member of the contributed and got the President Counting on believing that the Amer- Committee on Ways and Means, who, elected, gave him this bill, and they ican people are stupid is not a good po- unlike the authors of this bill, did not said this is what we want. The Presi- litical way to go. Vote against this bill spend his entire life in the public dent brought it up here. We are rubber because the rubber stamp is wrong. trough but actually worked in private stamping it out of here. Can you be- Mr. THOMAS. Mr. Speaker, I yield 3 enterprise; so he understands what pri- lieve that the Senate, excuse me, in an- minutes to the gentleman from Florida vatization is. other part of this building they are (Mr. SHAW), a valued member of the Mr. KLECZKA. Mr. Speaker, I considering something like 400 amend- Committee on Ways and Means. worked for an insurance company be- ments, but we cannot have one because Mr. SHAW. Mr. Speaker, I thank the fore I was elected to the legislature. when you are using a rubber stamp, chairman for yielding me this time. So with that as an opening, Mr. you cannot have one single amendment This is probably, I think without Speaker, let me say to the body that in in here. Nothing can be improved in question, one of the most important my view this is the beginning of the this bill. Can you believe it? It is like sessions that this Congress has had re- end of the Medicare program. For 38 the Ten Commandments. It is perfect. garding Medicare since its inception. years Medicare has provided seniors It came down from God or somewhere, We have heard a lot of argument about with quality health care, a defined ben- or the White House. old fashioned Medicare and new Medi- efit, and whether one lived in Cali- This bill was put together by drug care and the changes, and the truth be fornia, Alaska, Maine, or Florida, the companies, 10 of them. They had $38 known, both political parties under- premium was the same, they knew billion in profit last year. That is 50 stand that medical treatment has what the benefit was, and they knew percent of the profit of the Fortune 500. changed in the last 40 some years since what the services were, and it has If the Members think they did not have Medicare first came on line. We know worked. an impact on this bill, why do they that. Drugs are more important to So there are those in this House who want to privatize? Why do they want to keep the seniors out of hospitals, to say there has been a change in the way give no guaranteed benefit? Why do keep them mobile, to keep their qual- we deliver medicine today, and that is they want to have all openness in the ity of life moving. So this is a very im- called drug therapy. Let us add that world? And why do they put the one portant thing, and it is important that coverage to the Medicare program and line in there that says that the Sec- we put this in the Medicare law. And it we can use the purchasing power of the retary cannot negotiate on behalf of 40 is very important that we make it Federal Government to get the best million people, soon to be 80 million where the seniors can afford it. deal on drugs for in excess of 40 million people? They want it all broken up into Florida has the seven most heavily people. And there are those on the little different pieces so they can di- used Medicare congressional districts other side of the aisle who say no, we vide and conquer. This little agency in the country. I have seen on more do not want to do that, and the reason will get so much. But a little bit bigger than one occasion, while standing in is because that is going to cut into the
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00143 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.158 H26PT1 H6084 CONGRESSIONAL RECORD — HOUSE June 26, 2003 drug profits of their friends, the drug is where government determines how where from 30 to 70 percent of your pre- companies. But know full well, Mr. much the drug is going to cost. It is scription drug costs. Speaker, we do it for the VA and it going to be the best price. Think about that. When you think of works and it works well. When we looked at ways to change that elderly man or woman who you So instead of doing a benefit con- Medicare, we looked at the ‘‘best have had the opportunity to talk with nected to the Medicare program, what price’’ concept. Guess what? We sat in their home and sit there while they we are doing is we are going to send down with the Congressional Budget are seated in that chair, perhaps they our seniors out to the private insur- Office and we said, what would happen are home-bound, they have that tray of ance market, we are going to tell them if we did not use best price? They sat pill bottles, and they are, frankly, very go shop for a drug-only policy. The pol- down and calculated and they said, you concerned because they cannot do icy that is being offered in this bill has know, if you actually had competition much else, other than buy their drugs one big problem, and that is once one for the drugs, instead of putting in the and hopefully get to the grocery store, spends $2,000 on drugs in any one year government phony floor of ‘‘best they are going to really benefit from coverage stops until their expenditures price,’’ you could save $18 billion. Do this plan. It is affordable. It is avail- total $4,900. Know full well during that my colleagues know why we do not able for all seniors. period they are paying 100 percent of have government negotiating the We also give seniors choices. It is af- their drug cost. Their premiums go on. price? It would cost us tens of billions fordable, a dollar a day, $35 a month; it They are paying premiums and getting of dollars over a real negotiation on provides real savings, 30 to 70 percent no benefit. There is something wrong drugs. Yet, here we are, hearing the that is projected by nonpartisan ana- with that system, and that is why this same old same old: I am going to vote lysts who look at this and say, what bill is very bad in that respect. ‘‘no’’ because we do not have govern- does it really mean, is the question The other problem with the bill is we ment dictating the price. That is what they ask. To qualify for Medicare, you had this program for a couple years has gotten us into the problem in the qualify for this program, and you are now called Medicare+Choice, and we first place. going to have choice. You do not have are going to show those seniors that Mr. Speaker, it is my real pleasure to to pick the one-size-fits-all that some the private market who did not want yield 3 minutes to the gentleman from of my friends on the other side of the them 35 years ago wants them now. Illinois (Mr. WELLER), a member of the aisle want to have and say, seniors, you They are holding their arms open. We Committee on Ways and Means. only get one choice, and we are going want the seniors because we know they (Mr. WELLER asked and was given to tell you what it is. have a lot of drug costs and a lot of permission to revise and extend his re- Mr. Speaker, we are going to give health care costs. So the Committee on marks.) seniors more than one choice so they Ways and Means and this Congress go Mr. WELLER. Mr. Speaker, tonight can find a plan that best fits them. along with this Medicare+Choice. What we hear some partisan political rhet- Think about that. That is what this it is, is a private insurance company oric, particularly from the other side of really means. We are helping seniors selling policies to seniors. Milwaukee, the aisle, who began this process by an- who need help with their prescription where I come from, has four of these nouncing they were going to oppose the drug costs. We are modernizing Medi- companies and they were peddling bill. It does not matter what is in it; care for the 21st century. We have a these policies and offering the sun and they are going to oppose it. plan that is almost 50 years old that the moon and all of a sudden bingo, So I think the important question has not changed. We are going to mod- three of them go belly up, the seniors that we really should ask is: What does ernize it. The most important choice have to scurry to get back into some this mean, this modernization of Medi- that seniors face today is, of course, type of Medicare program, and today care? What does it mean that we are the availability and affordability of we have one left. One left. modernizing Medicare for the 21st cen- prescription drug costs. tury? What does it mean that we are Mr. Speaker, this is a commonsense b 2000 investing $400 billion in modernizing plan. It deserves bipartisan support. I And the reimbursement for that one Medicare with prescription drugs? hope my friends on the other side of Medicare+Choice program is 110 per- When I think of prescription drug the aisle will do the right thing. I rec- cent of the Medicare rate. So clearly, coverage, I think of the seniors who I ognize that they set out today with a we are not saving a heck of a lot of have met over the 9 years I have had decision to oppose the bill, regardless money with that Medicare choice plan. the privilege of serving in this body. of what is in it. Well, let us work to- Well, it is a failed experiment, Mr. They are men and women who I have gether. Let us provide a bipartisan vote Speaker. So what are we doing in this talked with in their homes who sit to provide prescription drug coverage bill? We are changing the name. We are there and they sit in that easy chair that will help every senior in America. going to call it Medicare Advantage, and right next to their chair, they have Mr. STARK. Mr. Speaker, I yield my- and it is supposed to look and smell that tray, a tray full of pill bottles, self such time as I may consume, be- better; but, my friends, it is the same and they talked and shared with me cause I do not intend to let unsubstan- thing that has failed in the past. It will the choices they have had to make, tiated remarks go unchallenged either. fail again. whether or not they go to the drug- We do not oppose this bill because of Mr. Speaker, I urge a ‘‘no’’ vote on store, the grocery store that particular what is in it, because there is nothing this legislation. week because of the expenses they are in it. There are no benefits in it. There Mr. THOMAS. Mr. Speaker, I yield facing because of rising prescription is nothing in the bill except to spend myself such time as I may consume. drug costs. money to get private insurance compa- Mr. Speaker, well, I guess, if all of Well, those are the people that are nies, if they decide to come. the innovations are going to fail, what the primary beneficiaries of this legis- Mr. Speaker, I yield 3 minutes to the will be left is the current Medicare. I lation. Because we have a plan before gentleman from Georgia (Mr. LEWIS), find it interesting that one of the rea- us that helps those who are truly who recognizes that. sons the gentleman from Wisconsin needy, low-income, by ensuring they Mr. LEWIS of Georgia. Mr. Speaker, (Mr. KLECZKA), my friend, is going to pay no premiums; and for others, they here we are once again debating Medi- vote against the bill is because there is pay a pretty affordable premium. This care. Thirty-eight years ago, the Re- no government ultimate negotiation of plan would cost a senior about $35 a publicans did not like Medicare, and the price. month, $1 a day. Think about that. A they do not like it now. In 1965, 88 per- Let me tell my colleagues a story, dollar a day for a senior participating cent of Republicans voted against and I believe before I give my col- in this plan. And if you qualify for Medicare. And here they are, once leagues the punch line, they will know Medicare today and you are going to be again, trying to privatize prescription the story. We have government nego- eligible tomorrow, you qualify and are drugs for seniors, just like they tried tiation of price. And as is typically the able to take advantage of this new pre- to privatize Medicare. case, currently, in law, in the Medicaid scription drug plan. But for a dollar a This is just another scheme by the program, it is called ‘‘best price.’’ That day, it is projected you could save any- Republicans to entice older voters. Not
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00144 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.190 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6085 last week, not last year, but just yes- But at some point in this debate, we we can afford it as a society, and de- terday, the gentleman from California ought to realize that we are in the mid- liver quality health care for our sen- (Mr. THOMAS), the Republican chair- dle of the greatest intergenerational iors. man of the Committee on Ways and transfer of wealth in the history of the b 2015 Means, made it crystal clear when he world. Because while we strive to pro- said, ‘‘To those who say that the bill vide a decent and appropriate health So, Mr. Speaker, I am here after would end Medicare as we know it, our program for seniors, we all know some- much thought and consideration and answer is: We hope so.’’ He went on to one else is going to be paying for it. yes, reluctantly arriving here, but I am say, ‘‘Old-fashioned Medicare is not And so we really ought to focus on here because I do believe this is our very good.’’ Tell my mother. Tell your what we are trying to do to make sure best chance to save Medicare, to make mother that old-fashioned Medicare is that the young people who are going to it a truly viable program that will not not good. Tell your grandmother, tell be carrying this bill understand that bust the budget, and if we do not take your grandfather that old-fashioned while we are providing additional bene- advantage of this opportunity and I Medicare was not good. It was good in fits to seniors, we want to make sure want to speak, Mr. Speaker, through 1965. It was good yesterday. It was good that the program stays within the rea- you to the conservatives out there on then, and it is still good right now. We sonable bounds of the $400 billion that both sides of the aisle about supporting do not need to destroy Medicare. We we are proposing to add to Medicare. this bill, do not blow this opportunity. need to save and strengthen Medicare. Mr. Speaker, to insist on focusing on If you are a conservative, if you are Mr. Speaker, this bill is just another that, it is my real pleasure to yield 4 concerned about the cost of the Medi- Republican scheme to deceive our sen- minutes to the gentleman from Lou- care program, do not miss this oppor- iors, to deceive our elderly. That is not isiana (Mr. MCCRERY), the chairman of tunity to give us the best chance to re- right. That is not fair. I want my Re- the Subcommittee on Select Revenue form it in a way that can save costs publican colleagues to tell the Amer- of the Committee on Ways and Means. over the long term, that can keep us ican people the truth. We must tell our Mr. MCCRERY. Mr. Speaker, I rise in from rationing health care, not only seniors that the Republican bill does support of this legislation which re- for our seniors, but I believe eventually not offer our seniors the basic right to forms Medicare and adds prescription for all of our society. affordable prescription drugs. We must drugs to the program; but I arrived at Mr. Speaker, I urge everyone to sup- and we will tell the American people this position of support haltingly, port this bill tonight and hope and that the Republicans want to privatize grudgingly, reluctantly. I will tell my pray that the reforms contained there- Medicare. colleagues why. in work. We must tell the American people I was reluctant to support this bill Mr. STARK. Mr. Speaker, I yield my- the truth. This is no time to play par- because I believe the current Medicare self such time as I may consume. tisan politics with the lives of our sen- program as it is structured is finan- Mr. Speaker, how short memories iors. cially unsustainable. I believe it is are. It was just an hour ago that we The clock is running. Time is run- only a matter of time before, as the fi- threw away $174 billion on useless med- ning out. My Republican colleagues, nancial experts tell us, Medicare, one ical savings accounts and over the last you still have time to do the right of the two fastest growing programs in year or two we gave $800 billion in in- thing. Do not turn your back on our the Federal Government, consumes an heritance tax relief to an average of seniors, on the elderly. This is a matter ever-larger and larger share of our na- 10,000 people a year so we could punish of life and death. tional income; an ever-larger and larg- a hundred million people a year by de- I beg, I plead with my colleagues to er share of our Federal budget, with stroying their Medicare. They just do vote against the Republican bill, not the potential to crowd out spending on not remember. But the gentleman from just for our parents, our grandparents, other government priorities. And, as Massachusetts, the distinguished mem- our children, but also for generations we all know, there are numerous, very ber of the Committee on Ways and yet unborn. Old-fashioned Medicare important priorities of government. Means (Mr. NEAL) remembers. was like a bridge over troubled waters. Health care is not the only one. I be- Mr. Speaker, I yield 3 minutes to the It was reliable. It was dependable then, gentleman from Massachusetts (Mr. and it is still dependable. lieve, Mr. Speaker, that as that oc- NEAL). Ask the seniors, ask the old people curred and as policymakers in Congress Mr. NEAL of Massachusetts. Mr. who live on fixed incomes in our cities realized that Medicare was crowding Speaker, let me thank the gentleman and rural areas. I say to my Republican out other spending, causing us to re- from California (Mr. STARK) for yield- colleagues, follow the dictates of your duce our commitment to other prior- ing me time. conscience. You have a moral obliga- ities, we would do as most other coun- Only in this Chamber over the last tion, a mission, and a mandate to up- tries that have similar programs have hold the legislation of 1965 when Lyn- done: we would start to ration health few months could we have written $2 don Johnson signed the Medicare bill. care for our seniors. I do not want to do trillion out of our tax system irrespon- I urge my colleagues to vote against that. sibly over the next decade and then say this unreliable bill. So, Mr. Speaker, I was reluctant to that the cost of Medicare is Mr. THOMAS. Mr. Speaker, I yield add to the current program, which is unsustainable. Only in this Chamber myself such time as I may consume. going to go belly up or bust the budget, could we have this debate from a polit- Mr. Speaker, I will tell my friend a new entitlement program, prescrip- ical party who says, let us not take a from Georgia, we do not intend to turn tion drugs, which would exacerbate truncated quotation. Let us not take a our backs on seniors. Indeed, we intend that situation, which would make it scare tactic. But you know what? You to reach out our hand. If someone worse, which would get us to that point cannot truncate history. wants to stay in yesterday’s Medicare, where we would have to start rationing When I came to this House 15 years they can tomorrow. We want to make health care faster. Yes, I was reluctant ago, the Republican leader in the Sen- sure of that, because in 1965 and yester- to do that. ate, Bob Dole, had voted against the es- day, there were no drugs, there was no But as I studied the bill and listened tablishment of Medicare. The Repub- preventive care, there was no disease to those who put together the compo- lican leader in this House, Bob Michel, management, that by passage of this nents of the bill, I realized that the re- wonderful human being, had voted legislation, tomorrow there will be. forms contained in the bill, particu- against the establishment of Medicare. But Mr. Speaker, as we have carried larly those beginning in the year 2010, And they say, do not use these quotes on this debate about improving Medi- which give us a chance to move Medi- because they are not true. They are not care, and I know that to my friends on care into a form much like the FEHBP for real. the other side of the aisle $400 billion program, the premium support model Speaker Gingrich said, in time we does not look like much to them. I un- that the Medicare Commission rec- would let Medicare wither on the vine. derstand they are going to offer a sub- ommended several years ago, then I re- The third ranking Republican in the stitute that proposes spending $1 tril- alized that this is maybe our last best United States in the other body down lion, rather than the $400 billion. chance to save Medicare in a way that the hallway, said recently, I believe the
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00145 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.164 H26PT1 H6086 CONGRESSIONAL RECORD — HOUSE June 26, 2003 standard benefit, the traditional Medi- that Medicare should be allowed ‘‘to Medicare from the time Democrats and care program, has to be phased out. wither on the vine.’’ He has been chat- Lyndon Johnson got it passed through And they say, but trust us on Medicare. tering again this month, that Medicare Congress in 1965, and they have not re- Do not be skeptical of our intentions. is an ‘‘obsolete government monop- lented until this very moment. We have come to love Medicare. oly.’’ Mr. THOMAS. Mr. Speaker, I ask There is not anybody on that side of The gentleman from California (Mr. unanimous consent to place in the the aisle that believes that tonight and THOMAS) joined him yesterday by de- RECORD an exchange of letters between there certainly is not anybody on this claring, ‘‘To those who say that [the myself as chairman of the Committee side of the aisle that believes that to- bill] would end Medicare as we know it, on Ways and Means and the gentleman night as well. And then they argue, our answer is: We certainly hope so.’’ from Virginia (Mr. DAVIS), chairman of well, we have improved Medicare. ‘‘Old fashioned Medicare isn’t very the Committee on Government Reform. Think of what we might have done good,’’ he added. The SPEAKER pro tempore. Is there without those tax cuts over the last 2 The gentleman may not like report- objection to the request of the gen- years. ers, especially if they report, but really tleman from California? A predictable, carefully defined ben- there is nothing new or inconsistent in There was no objection. efit would have been in place for Medi- this statement and many that he has HOUSE OF REPRESENTATIVES, care recipients. It is the closest thing, made for years. He just referred a few COMMITTEE ON WAYS AND MEANS, Medicare, that this Nation has ever moments ago to Medicare as ‘‘yester- Washington, DC, June 25, 2003. had to universal health care. It is an day’s Medicare,’’ denigrating and derid- Hon. TOM DAVIS, extraordinary achievement for those ing it. ‘‘Yesterday’s Medicare,’’ ‘‘old Chairman, Committee on Government Reform, who turn 65 years old, and they refer to fashioned Medicare’’ has served mil- House of Representatives, Washington, DC. it as old-fashioned Medicare and we are lions of Americans pretty well. DEAR CHAIRMAN DAVIS: Thank you for your The one problem we have with it is letter regarding H.R. 2473, the ‘‘Medicare to trust them. But let us talk about Prescription Drug and Modernization Act of Medicare+Choice where I live in Massa- not the result of a defective Medicare. 2003.’’ chusetts, the private sector’s answer to Rather the failure to deal with the out- As you have noted, the Committee on the problems of Medicare. rageous, predatory pricing of prescrip- Ways and Means has ordered favorably re- Well, they are all gone and the ones tion drugs has resulted from the sus- ported, as amended, H.R. 2473. The general that are not gone have jacked pre- tained collusion of House Republicans text of this legislation will be incorporated miums through the roof. They do not and pharmaceutical manufacturers. We into H.R. 1, the ‘‘Medicare Prescription Drug want to take care of the most vulner- can do something meaningful about and Modernization Act of 2003.’’ I appreciate able and whether we have a debate that, but this bill is not it. your agreement to expedite the passage of What of this plan that seniors are fi- this legislation despite affecting programs about government tonight and its role within the jurisdiction of Committee on Gov- or not, that in the end is what govern- nally offered tonight? It is basically a ernment Reform. I acknowledge your deci- ment does. It takes care of those who ‘‘pay a lot and get a little’’ plan. If you sion to forego further action on the bill was are outside the mainstream of this eco- are a senior and you have been hoping based on the understanding that it will not nomic life. Not the top 1 percent of the and praying we would finally be able to prejudice the Committee on Government Re- wage earners in this country, not those overcome this Republican resistance form with respect to the appointment of con- who benefit from the repeal of an es- and deal with prescription drugs, what ferees or its jurisdictional prerogatives on tate tax. It is government that does do you get from this bill according to this or similar legislation. its own clear language? Well, this year Finally, I will include in the Congressional that. Record a copy of our exchange of letters on Medicare is a legacy and an amend- you get nothing. Next year you get this matter during floor consideration of ment to the Social Security program, nothing. The year after that you get H.R. 1. Thank you for your assistance and the greatest achievement domestically nothing. Oh, yes, you are entitled to a cooperation. We look forward to working in this Nation’s history. And that discount card. It is as valuable as one with you in the future. amendment in Medicare is a greatchild of those cards you pull out of a cereal Best regards, and a success of a determined Congress box. With it and a dollar or two you BILL THOMAS, and an enlightened President, Lyndon can get a cup of coffee, but it does not Chairman. Johnson. Tonight let us stand with his- guarantee you a cent of reduction in the cost of your medications. HOUSE OF REPRESENTATIVES, tory, stand with Roosevelt and stand COMMITTEE ON GOVERNMENT REFORM, with Lyndon Johnson on what Medi- Finally, in 2006 you get all their Washington, DC, June 25, 2003. care has done to make us a much more much ballyhooed help. If you have Hon. WILLIAM M. THOMAS, equitable society. What a great $4,900 in drug bills, and that is mighty Chairman, Committee on Ways and Means, achievement it is. easy to get at today’s outrageous House of Representatives, Washington, DC. Reject the notion tonight of where prices, you pay $3,500, and you get DEAR CHAIRMAN THOMAS: I am writing to they are going to take us, and that is $1,400 paid for you, and that is only if confirm our mutual understanding with re- down the road to privatization of Medi- you also pay an unknown premium, al- spect to the consideration of H.R. 2473, the ready estimated at least $35 per month. Medicare Prescription Drug and Moderniza- care. tion Act of 2003, which was referred to the Mr. STARK. Mr. Speaker, may I in- And such incomplete coverage at such Committees on Ways and Means and Energy quire of the time remaining? a cost tells us what this initiative is and Commerce. I am writing specifically re- The SPEAKER pro tempore (Mr. really all about. This is a plan to elimi- garding Sections 302 and 303, which waive HASTINGS of Washington). The gen- nate Medicare and force seniors out provisions of the Federal Acquisition Regu- tleman from California (Mr. THOMAS) into inadequate private insurance lation and exempts a newly established advi- has 7 minutes remaining. The gen- plans. This is not a prescription drug. sory committee from the Federal Advisory tleman from California (Mr. STARK) This is a prescription for disaster. Committee Act (FACA). As you know, the has 12 minutes remaining. I hope that our Republican col- Federal Acquisition Regulation and the Fed- leagues continue holding up this poster eral Advisory Committee Act are within the Mr. STARK. Mr. Speaker, I yield 3 jurisdiction of the Committee on Govern- minutes to the gentleman from Texas about ‘‘strengthening Medicare’’ that ment Reform. (Mr. DOGGETT), a member of the Com- they have been showing here because it I have concerns regarding the appropriate- mittee on Ways and Means. looks like the type of solicitation ness of waiving FACA, as it would pertain to Mr. DOGGETT. Mr. Speaker, since scams that so many seniors receive the Program Advisory and Oversight Com- President Lyndon B. Johnson signed weekly. Their poster shows seniors out mit proposed in section 302. I would welcome Medicare into law over massive Repub- frolicking on the beach because of all the opportunity to work with you and Chair- lican resistance, Republicans have the benefits they will get, when in fact man Tauzin to address the applicability of never ceased in their determination to seniors will be denied the very protec- FACA to this proposed committee. In the interests of moving this important end Medicare. We all remember the tion they so desperately need on their legislation forward, I do not intend to ask partner of the gentleman from Cali- prescription drugs. That is because for sequential referral of this bill. However, fornia (Mr. THOMAS), former House those who are proposing this bill are I do so only with the understanding that this Speaker Newt Gingrich, who insisted the same folks, who tried to undermine procedural route should not be construed to
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00146 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.168 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6087 prejudice the Committee on Government Re- and other GOP leaders Wednesday morning That’s especially true for seniors like 77- form’s jurisdictional interest and preroga- to release figures that purport to show what year-old Pat Roussous of Madison, Conn. She tives on these provisions or any other simi- seniors would save on some popular drugs. suffers from arthritis, diabetes and high lar legislation and will not be considered as For example, Thompson said that seniors are blood pressure. Her out-of-pocket drug costs precedent for consideration of matters of ju- now paying $108.65 for 30 tablets of Lipitor. are as much as $6,500 a year. ‘‘It’s only a risdictional interest to my Committee in the Under the system, he projects that the cost start. And I’m not convinced it’s going to go future. Furthermore, should these provisions would come down to $86.92. Seniors would very far,’’ she said. or similar provisions be considered in a con- have to pay only 20% as co-pay ($17.38). Roussous is one of an estimated 10 million ference with the Senate, I would expect That’s a savings of $91.27, according to his seniors who will fall into a benefit gap, be- Members of the Committee on Government figures. cause, under the Senate plan, the govern- Reform be appointed as outside conferees on But House Minority Leader Nancy Pelosi ment will pay for half of drug costs up to those provisions. and other House Democrats fought back $4,500. But, there’s a huge gap for the next Finally, I would ask that you include a Wednesday, saying Thompson has forbidden $1,300, where the beneficiary must pay for all copy of our exchange of letters on this mat- Health and Human Services actuary Rick of their drug costs. ter in the Congressional Record during Foster from releasing his analysis of how Catastrophic coverage does not kick in House debate of the bill. If you have ques- much Part B premiums would go up under until one’s drug costs exceed $5,800. Then the tions regarding this matter, please do not the House GOP plan. Part B is the existing government will pay 90 percent of drug cost hesitate to call me. I thank you for your program that insures seniors for medical over that amount. consideration. services other than prescriptions. ‘‘I think, the gap—where people are re- Sincerely, They suspect the figures would show that quired to pay for the drug themselves—I TOM DAVIS, the premium would rise substantially. A can’t imagine that working,’’ said Roussous. Chairman. similar bill in 2000 would have resulted in a ‘‘Because those are the people who actually I also include for the RECORD a quote: rise in Part B premiums of 47 percent. Pelosi need to have the help.’’ and Rep. Pete Stark, D–Calif., say that Fos- Still, the AARP will not use its political Some of our friends on the other side of the ter is being threatened with termination if might to block the plan. ‘‘This year, ‘some- aisle are saying that if this bill becomes law, he reveals the figures this time. thing’ in prescription drugs is better than it will be the end of Medicare as we know it. Once the measure passes, congressional Re- ‘nothing,’ ’’ said Rother. Our answer to that is, we certainly hope so. publicans and President George W. Bush will The bulk of the proposed assistance in the Why should seniors be the last group that declare victory on an issue that Democrats prescription drug plan will not be enacted pays retail prices for drugs? Old-fashioned have traditionally championed. ‘‘This could until 2006. Until then, seniors will receive a Medicare is not very good . . . You’re going be transformational in terms of the image of discount card that will provide them with 10 to hear scare tactics . . . but seniors with ex- the Republican Party among seniors,’’ Bill to 15 percent off their drug costs. Low-in- tremely high drug costs, when this becomes McInturff, a Republican pollster, said. come seniors will get an annual $600 credit. law, will save more than 60 percent of cur- Seniors or older voters have historically Mr. THOMAS. Mr. Speaker, I yield rent costs, that’s real change, real progress, favored Democrats when it comes to the making Medicare a real day-to-day benefit.— issue of Medicare and prescription drugs. But myself 15 seconds. Bill Thomas, Chairman, Committee on Ways a recent survey by the Kaiser Family Foun- I see the gentleman from Texas (Mr. and Means. dation found older voters now trust Repub- DOGGETT) had two quotes connected Mr. DOGGETT. Mr. Speaker, I ask licans and Democrats equally. with a description of myself, rather unanimous consent to place in the Older Americans are the nation’s most re- than the continuation of the real RECORD the report from NBC news cor- liable voters. Two-thirds of them go to the quote, and I can understand why he respondent Norah O’Donnell entitled polls. And with a large number of seniors liv- would fabricate the quote in that way. ‘‘Prescription Drug Benefit Imminent’’ ing in big swing states that are expected to Because what I said was, why should decide the presidential election in 2004, the from yesterday’s MSNBC. seniors be the last group that pays re- The SPEAKER pro tempore. Is there issue could be pivotal. As a quick example, George W. Bush lost tail prices for drugs? That really did objection to the request of the gen- the state of Pennsylvania to Al Gore by five not fit the intention of the gentleman’s tleman from California? points in the year 2000. He lost among older thrust, but that is simply the truth. There was no objection. voters by a whopping 17 points. If the presi- Mr. Speaker, I yield 2 minutes to the PRESCRIPTION DRUG BENEFIT IMMINENT dent improves his standing among older vot- gentleman from Iowa (Mr. NUSSLE), the (By Norah O’Donnell) ers, he could close the margin of victory in chairman of the Committee on Budget, such a state. After years of promising a prescription But the potential political windfall could but I proudly say also a member of drug benefit for seniors, Congress is on the be stymied once seniors get a closer look at Committee on Ways and Means. verge of a breakthrough. This week, the the details of the plan. After conducting Mr. NUSSLE. Mr. Speaker, I thank House and Senate are expected to pass bills polls and focus groups, Republican strate- the gentleman for yielding me time that for the first time will allow seniors to gists are warning fellow party members that and for his partnership and hard work sign up for a prescription drug plan in which seniors who’ve done the kitchen-table test the government helps pay their drug bills. on this bill. are not happy. The policy and political consequences are The Democrats are living in 1965. In fact, according to an internal Repub- Boy, we have heard a lot about that to- enormous. lican memo by McInturff, obtained by NBC Congress had agreed to spend $400 billion, News, the pollster warns that, in focus night. We have heard about Bob Dole which in effect means the biggest expansion groups, seniors ere very disappointed: ‘‘The and Lyndon Baines Johnson. Well, that of Medicare since its creation nearly four current drug coverage plan is not as gen- is great but it is not 1965. Medicare is decades ago. Critics charge that the bill’s erous as the private coverage two-thirds of going bankrupt. Tax cuts did not cause passage is the largest expansion of a federal seniors already enjoy. It’s clear most seniors that. Health care costs are out of con- entitlement since Lyndon Johnson’s Great are first evaluating this plan in comparison Society, with huge costs to American tax- trol. The reimbursement system under to their current, private coverage, then de- payers when the Baby Boomers enter the Medicare is broken and it is not paying ciding it’s not as generous and certainly not Medicare program. the bills. Hospitals are closing. Doctors a replacement for that coverage, so some are Passions surrounding the Medicare reform reacting unfavorably.’’ are leaving rural areas or not taking bill are reaching a crescendo heading into McInturff is advising Republican law- Medicare patients at all. Cost shifting votes in both the House and the Senate by makers and the president that they can over- is running rampant onto the private the end of this week, perhaps as early as come deficiencies with the bill, stressing pay side, and as a result, problems are Thursday. rhetorically that the plan provides seniors ‘‘To those who say that (the bill) would end running rampant within our health with additional choices in coverage. Medicare as we know it, our answer is: We care system. certainly hope so,’’ declared Ways and Means GAPS IN COVERAGE Benefits have not improved. We do Chairman Bill Thomas, R-Calif., Wednesday The nation’s largest lobby for seniors, the not have drugs. We do not have preven- morning. ‘‘Old-fashioned Medicare isn’t very American Association of Retired Persons, or tion. We do not have disease manage- good,’’ he added. AARP, has warned Congress that it is deeply ment. We have a sick care system, and House Speaker Dennis Hastert, R-Ill., concerned about huge benefit gaps in the the Democrats have done nothing echoed the sense around Capitol Hill that plan. ‘‘People are disappointed that there about it for the past 30 years since they this is indeed the year that it gets done. ‘‘We isn’t more of a benefit here,’’ said John are at the point now where politics and pol- Rother, policy director for the AARP. ‘‘And did pass Medicare in 1965. icy have to be married up,’’ he said. sometimes they’re mad, and sometimes they Doing nothing tonight is not an op- Health and Human Services Secretary think, ‘Well, at least it’s a first step.’ But ev- tion, and that is why in the budget we Tommy Thompson appeared with Thomas eryone is disappointed.’’ put $400 billion to improve Medicare,
VerDate Jan 31 2003 05:30 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00147 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.053 H26PT1 H6088 CONGRESSIONAL RECORD — HOUSE June 26, 2003 increasing Medicare by $400 billion, seniors across this country that there company plan allows HMOs and phar- hardly withering on anybody’s vine, be- will be a gap in coverage, and it will maceutical companies to determine cause doing nothing is not an option. not be Medicare improved for prescrip- how much to charge and what coverage Tonight, H.R. 1 is the choice. It mod- tion drugs. to offer. ernizes Medicare, saves it from bank- Truly, 35 years ago we did not think Mr. Speaker, I would like to take a ruptcy, controls costs, modernizes ben- about prescriptions as being part of vote, what do my colleagues think the efits, fixes the Iowa and other rural re- Medicare; but it is, in fact, a part of insurance companies will choose, more imbursement problems, keeps these Medicare today, and our seniors do not coverage or less coverage? What will hospitals open and viable so that they want to wait till 2006 and then find out the pharmaceutical companies charge, can pay the bills as a result of amend- that after paying premiums all year more money or less money? The answer ments that have been passed in both that they do not get any coverage in is clear. the Committee on Ways and Means and this gap of coverage. Explain the gap The other day the President said, the Committee on Energy and Com- Mr. and Mrs. Republican on the Repub- ‘‘When the government determines merce. lican side. which drugs are covered and which ill- Quality health care will be available What about the new preventive? nesses are treated, patients face delays in rural areas on into the future as a Every new beneficiary gets an oppor- and inflexible limits on coverage.’’ And result of what we have done tonight. tunity, but what about the old folks? It yet the Republican private insurance Inaction is not an option. is like Mrs. Ruby Bogus from Cleve- company bill wants to turn over these But there is one other choice. The land, Ohio, said. She was annoyed that decisions to an insurance company who Democrats will offer a $1 trillion Medi- the program would not begin until 2006, has financial interest in denying cov- care drug benefit tonight; one that and do my colleagues know what she erage. The more insurance companies CBO says costs $1 trillion. Guess what? told her friends. Well, girls, I guess we deny, the more money they keep. Now, That not only busts the Republican will just have to live a little bit longer is that not special? Mr. THOMAS. Mr. Speaker, I have budget, but it busts the Democratic to get a prescription drug benefit. one speaker to close. budget and it busts both of our budgets Mr. THOMAS. Mr. Speaker, I yield myself 15 seconds. Mr. STARK. Mr. Speaker, I am de- combined. Do not bankrupt Medicare. lighted to yield 1 minute to the gen- Save it by passing H.R. 1. If the gentlewoman would go to page tleman from Georgia (Mr. SCOTT). 1 260, line 19, from the legislation before Mr. STARK. Mr. Speaker, I yield 2 ⁄4 (Mr. SCOTT of Georgia asked and us now, I quote, ‘‘Nothing in this part minutes to the gentlewoman from Ohio was given permission to revise and ex- or the amendments made by this part (Mrs. JONES), a member of the Com- tend his remarks, and include extra- shall be construed as changing the en- mittee on Ways and Means who under- neous material.) stands that the Republican bill does titlement to defined benefits under Mr. SCOTT of Georgia. Mr. Speaker, not extend the life of the Medicare part A and B of title XVIII of the So- let us get right to the chase of it. What Trust Fund at all. In fact, it probably cial Security Act.’’ the Republican plan is designed to do is reduces it some. Mr. STARK. Mr. Speaker, if the end Medicare as we know it today. Mrs. JONES of Ohio. Mr. Speaker, I Chairman could explain the gap, but Make no mistake about it. I have the will begin with a quote. ‘‘Seniors face a obviously he cannot. So I am happy to quote right here and it says, ‘‘To those confusing hodgepodge of co-payments yield 2 minutes to the gentleman from who say that the bill would end Medi- and deductibles in Medicare. The sys- Texas (Mr. SANDLIN), a member of the care as we know it, our answer is: We tem is irrational and difficult to navi- Committee on Ways and Means. certainly hope so.’’ Bill Thomas, chair- gate. Simplifying and modernizing cost Mr. SANDLIN. Mr. Speaker, it is the man of the Committee on Ways and sharing will make coverage easier to old bait and switch. The Republican Means, MSNBC News, on 6/25/2003. understand and will strengthen the leadership has used smoke and mirrors It was stated, to back that up, the Medicare program over the long term. I to trick seniors into thinking they are chairman of the Senate Republican believe we can better design both Medi- getting a Medicare prescription drug conference said this, ‘‘I believe the care and Medigap so that seniors and plan when in reality they are forcing standard benefit, the traditional Medi- people with disabilities get the most of them to seek medication from private care program, has to be phased out.’’ the health care dollars they spent.’’ insurance companies, not Medicare. That is what we are faced with today, That is a quote from a Republican Mr. Speaker, this is not an entitle- and that is what the American people colleague. But let me report from How- ment Medicare plan for seniors. All need to understand, and that is what ard Brown, 77 years old, from Cleve- this is is an entitlement to ask to be the Democratic Party is doing in here land, Ohio. He complained about the able to make an offer, to make a pur- today, to pull these covers off. We are complexity of the program that will in- chase from a reluctant, profit-seeking talking about people who cannot afford volve choosing a plan, tracking out-of- insurance company who may or may it. Medicare was designed to help peo- pocket expenses, and knowing when not accept that offer. Importantly, not ple, to help the least of us, to help the coverage kicks in, lapses and then a single insurance company in the those senior citizens who cannot afford resumes in severe cases, all according United States of America has volun- the medicine. Government is there for to a sliding scale of benefit. teered or agreed to take part in this something. They do not want it Mr. BROWN said, ‘‘I am too old to try program, not one, nada, zip, zilch. This privatized. to figure all this out. Make it simple. plan is nothing more than a mere Mr. Speaker, let me just say this Make it plain so I can understand it.’’ vapor. from one of my constituents, and I The people in the United States, the What has history shown us about want to read this note. He said: ‘‘I am seniors who are on Medicare, they want what happens when private insurance a 74-year-old retired senior on Medi- a defined benefit giving them an enti- companies get involved in Medicare? care and this Medicare drug prescrip- tlement and a guarantee. They want it Medicare+Choice, the great managed tion plan is just a stone’s throw away to be affordable with reasonable pre- care experiment on our Nation’s sen- from privatization of Medicare. That miums and deductibles. They want it iors, should have been named Medicare should not be allowed to happen.’’ Let to be designed to significantly reduce Minus Choice. After all, it has been a us not let it happen. the price of their prescriptions, and total disaster for seniors. Between 1998 SNELLVILLE, GA, they want a meaningful Medicare pre- and 2003 the number of June 14, 2003. scription drug bill that provides abso- Medicare+Choice plans dropped by Representative DAVID SCOTT, lutely no gaps and no separate more than half. In my home State of Jonesboro, GA. Texas, 313,000 Medicare+Choice seniors DEAR REPRESENTATIVE SCOTT: I’m a 74 year privatized ambulance. old retired senior that’s on Medicare at home have been dropped by insurance compa- b 2030 recovering from a massive heart attack and nies just since 1999. bladder infection so I am very concerned But we have not heard any Repub- Question: Who sets the price of the about what course of action Congress is pres- lican get up tonight and define what drugs in the Republican insurance com- ently taking on the Medicare Drug Prescrip- the gap is. They have not explained to pany plan? The Republican insurance tion Plan.
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00148 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.171 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6089 When the news first came out that Con- plan. American seniors by the Repub- Mr. Speaker, when we look at the health gress was finally going to add prescription lican plan, forgotten. care system for our seniors in the United drugs to Medicare in order to provide finan- Mr. STARK. Mr. Speaker, I yield 1 States today, we see good news and bad cial relief for seniors that are paying way to minute to the gentleman from Texas much for their medication verses their news. The bad news is that drug costs are meaner yearly income from Social Security (Mr. BELL). outrageously high. The good news is that and if they have one, their pension fund and Mr. BELL. Mr. Speaker, the gen- Medicare is an effective and efficient program any life savings they may have. At that time tleman from Texas (Mr. DELAY), the that is working well for our seniors, and that I heard that Congress would be working on majority leader, has stated that the senior trust. I have never met a senior that such a plan Medicare beneficiaries would be Democratic strategy on his Medicare disagree with these two facts: that drug costs given a choice if they needed and wanted bill is obstruction, obstruction, ob- are too high and need to be brought down, their prescription drugs covered by Medi- struction; but when the best that the and that Medicare is a good program that care. If they did all they had to do is sign up GOP can do is create a plan that de- needs to be protected. for it and pay whatever the cost of the plan stroys Medicare, we should all rise in covers. For the rest of us who are happy So it is outrageous to me that the Prescrip- staying with Medicare and our present sec- opposition. tion Drugs Bill that the Republicans are shov- ondary insurance coverage that provides bet- I want to point out that the Repub- ing through Congress today without oppor- ter prescription drug coverage at a lower licans blocked every attempt at a tunity for amendment or time for debate, is cost would not have to participate in any Democratic substitute, sound proposals preserving the bad—the high cost of drugs— Medicare prescription drug plan. that would protect Medicare and pro- and is dismantling the good—Medicare. Seniors that don’t have prescription drug vide comprehensive coverage for all We Democrats have been fighting for years coverage should be covered by this plan as a seniors, regardless of the size of their for a Medicare prescription drug program that matter of choice, however; I feel it is unfair bank accounts. The AARP, a trusted for Congress to make it a mandatory re- is (1) affordable; (2) available to all seniors quirement for all seniors to pay for this plan voice on this subject, says the Repub- and Medicare beneficiaries with disabilities; (3) which would override their own secondary lican plan is not good public policy be- offers meaningful benefits; and (4) is available insurance plan for their prescription drug cause it has too many coverage gaps. in the Medicare program—the tried and true plan. It just isn’t fair. Why should we have to Why do the Republicans oppose bet- program that seniors trust. give up our plan and end up paying far more ter plans without gaps for seniors? And now it seems that we have the political than what we are presently paying? I’m sure Well, the gentleman from Iowa says momentum to make a good prescription drug if all seniors were aware of what really is one of the plans is too expensive. It was benefit a reality. The President says he wants going on they would want to make it a mat- not too expensive for them to pass the it. Both parties, both sides of Capitol—every- ter of choice also. Representative Scott please give us Medi- largest tax cut in American history, one has declared their commitment to getting care beneficiaries a choice to join or not to only to create the largest deficit this affordable prescription drugs to our nation. So join the Medicare prescription drug cov- country has ever seen. It is just when it why is it that the only Medicare prescription erage. Even though I’m not in your district comes to providing our seniors with drug ‘‘plan’’ the Republicans have to offer is a I’m asking you to please support us many the most basic ability to protect their terrible bill with full of holes, and gifts to the seniors by making sure this choice provision health the cost is too high. HMOs, and protections for pharmaceuticals will get covered in the final bill that is sent It does seem to me to be a simple companies. Every time we get a chance to to President Bush. If this choice does not be- matter of priorities. So do we intend to come part of this Medicare Drug Prescrip- take a closer look at the Republican drug tion plan it is just a stone’s throw away from obstruct the gentleman from Texas scheme, it becomes more obvious that it is the privatization of Medicare and that (Mr. DELAY) and the Republican’s plan just another piece of the Republican machine should not be allowed to happen. Please re- to destroy Medicare? Absolutely. that is trying to dismantle Medicare and turn member when you vote whatever the out- Mr. STARK. Mr. Speaker, I yield 1 our federal commitment to our nation’s sen- come is on this plan it will affect all Ameri- minute to the gentlewoman from Texas iors, over to HMOs and the private insurance cans nation wide and in some way or other (Ms. JACKSON-LEE). industry. I’m sure it will have some sort of a bearing (Ms. JACKSON-LEE of Texas asked The Republican plan would be run by on the outcome of the 2004 elections. and was given permission to revise and HMOs, not Medicare. HMOs would design the May God Bless you and may God Bless America. extend her remarks.) new prescription drug plans, decide what to Sincerely yours, Ms. JACKSON-LEE of Texas. Mr. charge, and even decide which drugs seniors RICHARD MCGRAW. Speaker, I did not want this historic would get. Plus, HMOs would only have to Mr. STARK. Mr. Speaker, I yield 1 debate to leave without my words in promise to stay in the program for one year. minute to the gentleman from Florida opposition to a plan that does nothing That means that seniors might have to change (Mr. WEXLER). to serve the needs of seniors in Amer- plans, change doctors, change pharmacies, Mr. WEXLER. Mr. Speaker, I am ica. The reason? Because I am proud and even change the drugs they take every privileged to represent the oldest dis- that President Lyndon Baines Johnson twelve months. Medicare expert Marilyn Moon trict in this country, and I thought it in 1965 extended the lives of American told the Senate Finance Committee on Friday was important to hear from some of senior citizens, but today we have a that ‘‘There will be a lot of confused and angry those seniors who fought in World War plan that will be shoved through on consumers in line at their local pharmacies in II and Korea and who rebuilt this coun- this floor that denies the preservation the fall,’’ if the Republican approach is not try after the depression. of Medicare, denies the real Medicare changed. She’s right. Mr. and Mrs. Robert Moore of benefit. Lower prices are denied. Full The Republican plan provides poor benefits, Lantana, Florida: ‘‘Why do we worry coverage is denied. Choice of drugs is and has a giant gap in coverage. Under the about tax cuts for the rich while so denied because when a sick senior cit- House Republican plan, many seniors would many older folks have to choose be- izen gets to a certain amount of their be required to pay high premiums even when tween food and medicine?’’ prescription drug benefit, then they they don’t receive benefits. Reportedly, under Speaking directly to the Republican drop through the doughnut hole; and if the House GOP plan, Medicare beneficiaries plan, Mr. Arthur Taubman of Delray they survive, if they live through the have a high $250 deductible. After they reach Beach, Florida: ‘‘I prefer nothing in- gap between when we start paying for that deductible, they would then be required to stead of a botched up Republican it, then they may be able to hit again pay a portion of their first $2,000 in drug plan.’’ when the amount of the prescriptions costs—that is a fairly normal system. But, after Mrs. Elaine Schwartz from Boynton go up to $5,000. a senior’s costs hit $2000 for a year—that is Beach: ‘‘It is very disappointing to me The doughnut and privatization are when it becomes obvious just how bad this that I live in this wonderful country two items in this particular legislation plan is. Once a senior’s drug costs hit $2000, and senior citizens who have contrib- that I will stand against, and again, the Republican plan cuts them off. Even uted for so many years supporting this Medicare denied, real Medicare benefits though they must continue to pay premiums, country have been forgotten.’’ denied, lower prices denied, full cov- they get no assistance in paying their drug Mrs. Schwartz has got it right, for- erage denied, choice of drugs denied. costs at all until their costs reach $5,100. Let gotten benefits. Drug benefits for sen- This is a historic debate. Vote ‘‘no’’ me say that again. It seems so crazy, it is al- iors, forgotten; lower drug costs for and stand on the side of saving lives of most unbelievable. The sickest of our seniors, seniors, forgotten by the Republican America’s senior citizens. the ones on the most medications—once their
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00149 Fmt 7634 Sfmt 9920 E:\CR\FM\A26JN7.069 H26PT1 H6090 CONGRESSIONAL RECORD — HOUSE June 26, 2003 costs reach the $2000 mark—they fall into the care was developed in the first place, was that publicans because there is nothing, ab- Republican gap. They are left to pay the next private industry would not rise to the challenge solutely nothing in this bill that re- $3000 out of their own pockets, while con- of taking care of our nation’s seniors the way quires anybody to provide a drug ben- tinuing to pay premiums. Almost half of sen- they deserve. efit to the seniors, and perhaps they iors would be affected by this gap in coverage. The Republican plan is a risky scheme only will give the Republicans enough cam- They will be outraged, and our offices will be an HMO could love. The Bush Administration’s paign money or promises and favors of hearing about it. Already we are hearing that Medicare Administrator has called traditional other sorts to get them to change this 4 out of 5 seniors, the people we are trying to Medicare ‘‘dumb’’ and ‘‘a disaster,’’ high- in the future; but right now, sexual fa- help, are against this plan. lighting Republicans’ disdain for a program vors will not do it, nothing will do it. I have attended hundreds of health care that Democrats have been fighting for since We are not giving the seniors anything briefings, and have read everything I can get 1965. While Democrats have worked to mod- but a hoax. my hands on, on the subject of improving ernize Medicare with prescription drugs, pre- The SPEAKER pro tempore. All time Medicare and getting good health insurance to ventive care and other new benefits, Repub- for the gentleman from California (Mr. the American people. And I have never heard licans are insisting on a riskier course even STARK) has expired. anyone say that a hallmark of a smart health the Wall Street Journal calls a business and The gentleman from California (Mr. insurance program is to have a giant gap in social ‘‘experiment.’’ THOMAS) has 41⁄2 minutes remaining. coverage for those who need help the most. The Republican plan destroys Employer Re- Mr. THOMAS. Mr. Speaker, I yield Why would our Republican colleagues put in tiree coverage. The Congressional Budget Of- the remaining time to the gentle- this ditch in the road to health for seniors? Be- fice has concluded that about one third of pri- woman from Connecticut (Mrs. JOHN- cause they wasted all of our nation’s hard vate employers will drop their retiree drug cov- SON), to close for our side, to continue earned money, on massive tax breaks for the erage under a proposal like the one being to talk about the bill that for the first rich, and an unnecessary war. contemplated. In order to lower its cost, the time in the history of Medicare pro- So now they have placed an arbitrary budg- House Republican plan stipulates that any dol- vides low-income help, and she is the et cap on vital programs, pushed by President lar an employer pays for an employee’s drug chairwoman of the Subcommittee on Bush, in order to compensate for the irrespon- costs would not count towards the employee’s Health of the Committee on Ways and sible Republican tax cut they jammed through $3,700 out-of-pocket catastrophic cap. This Means. this Congress and last Congress. The way would therefore disadvantage seniors with em- Mrs. JOHNSON of Connecticut. Mr. they are dealing with the mess that they have ployer retiree coverage because it would be Speaker, I thank the gentleman for made is by throwing bad policy after bad pol- almost impossible for them to ever reach the yielding me the time. icy. To remain within their own arbitrary budg- $3,700 catastrophic cap, over which Medicare Today, is an historic day for Amer- et cap, they are pitching a bill that will provide would pay 100 percent of their drug costs. The ica’s seniors. Congress is about to ful- a confusing, insubstantial benefit to the major- practical effect of this is that employers will fill the promise and the potential of ity of seniors. stop offering retiree coverage. That is a step Medicare, which has been one of our If the Republicans wanted to save money, in the wrong direction. greatest success stories in our history; they could have put in a provision that I and We can do better. The House Democrats’ but when Medicare was created in 1965, many Democrats have pushed for—and that is legislation, that I am a proud cosponsor of, is prescription drugs were few and far be- to allow the Secretary of the HHS to negotiate designed to help seniors and people with dis- tween. Instead, painful and invasive with the pharmaceutical to get fairer prices for abilities, not HMOs and the pharmaceuticals surgeries were standard treatment; but the American people. I believe that the Amer- industry. Under the Democratic proposal, the now, with the health security of our ican pharmaceuticals industry is the best in new Medicare prescription drug program seniors tied directly to medicines, would be affordable for seniors and Americans the world. They make good products that ben- medicines that extend life and restore with disabilities and available to all no matter efit the world. But Americans are now paying hope, we must add prescription drugs where they lived. It offers a meaningful benefit double the cost for drugs than their counter- to Medicare for all our seniors. with a guaranteed low premium; and would be parts in other rich nations such as German, A Medicare program without a drug available as a new ‘‘Medicare Part D’’ within Canada, Great Britain, or Japan. I am glad our benefit is a false promise in the 21st the traditional Medicare program that seniors companies are making money. But as we century. I am proud to stand here on know and trust. this House floor and bring prescription enact a prescription drug benefit under Medi- I am committed to getting seniors the pre- drugs to Medicare for all of our seniors care, access to drugs will rise—and drug com- scription medications that their doctors deem and a benefit that is simple, generous, pany profits will rise as well. It is only fair that they need. I want to work with our Colleagues and fair. the Secretary should have the power to nego- on the other side of the aisle, and the Admin- It is simple because it pays 80 percent tiate a good price for American consumers, to istration to make that happen. But unless I see of the first $2,000 of drug costs; and it make sure we get the best returns possible on a plan without a gap—with a consistent ben- guarantees the peace of mind of our our federal investment. efit—with some smart cost-controls—and seniors, protecting them against cata- Not only did the Republicans not put in a some protections for Medicare, an excellent provision to allow such negotiations, they went program for Americans, I cannot support this strophic drug costs, covering all costs out of their way to forbid the Secretary from Republican drug scheme. above $3,500. trying to get better prices for Americans. Why? This bill is a sham. Our seniors have been It is generous because the average Because they value the profits of their cor- looking forward to getting relief from the high senior spends $1,200 on prescription porate sponsors at Pharma, more than they cost of drugs. They will be waiting with antici- drugs every year. Yet in this bill we do the well-being of our nation’s seniors. pation until after the next elections, when this cover 80 percent of the cost up to $2,000. American consumers are now subsidizing the bill conveniently kicks in. When it does, they It is fair because it helps the low-in- drug-costs of the rest of the world. The Cana- will be furious. Let’s do better. come seniors more than any other dians, British, Germans, Japanese—the rich The SPEAKER pro tempore (Mr. group. It not only helps the very poor, nations of the world—still pay half of what we HASTINGS of Washington). The Chair below 150 percent of poverty, but for pay for drugs. We need to bring leaders in the would remind the gentleman from Cali- the first time, by allowing State sub- Pharmaceutical companies to the table. They fornia (Mr. STARK) that he has 30 sec- sidies to help seniors toward that want to sell their products to more Americans, onds remaining. threshold of catastrophic coverage, we and we want more Americans to have access Mr. STARK. Mr. Speaker, I yield my- help the next income group to have to their products. Surely, the Secretary should self the remaining time and will use it that security that seniors depend on in be able work with the industry to negotiate a to sum up because that is about all the their retirement. compromise that serves all Americans well. time it will take to explain what is in In addition, there is fairness at both Similarly, the Republican plan’s design the Republican bill, which is nothing. ends of this bill. Should someone with wastes billions in kickbacks for HMOs—in- It privatizes Medicare, and it promises a $200,000 income have the same level of stead of using that money to bring down the a benefit as good as we Members of catastrophic protection as a low-in- premiums and out-of-pocket costs that seniors Congress get, and it does not get a come senior? Of course not. and the disabled are forced to pay. third of the way there. But modernizing Medicare cannot be The Republican plan is to privatize Medicare It is a hoax. It is phony. It is a fig just about prescription drugs, as im- starting in 2010. The whole reason that Medi- leaf. It only gives coverage to the Re- portant as prescription drugs are. It
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00150 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.071 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6091 must also be about addressing the most for jurisdiction. I want to commend which so many citizens have depended crippling threat to our seniors’ well- him for that statement and acknowl- on for years for their health care, is ab- being and their retirement. It must ad- edge my personal gratitude for him and sent this vital asset of prescription dress chronic illness. the entire membership of the Com- drug coverage. So we began our efforts b 2045 mittee on Ways and Means and their to make sure we could add that cov- great staff for the spirit in which they erage to the bill. We have been doing Current Medicare is an old-fashioned worked with the Committee on Energy this over several Congresses now, and illness treatment program. This bill and Commerce to accomplish this his- every year we battle over what is the will provide seniors with chronic ill- toric moment for our country. right number to fund this program and nesses a chance to have truly progres- I also want to thank the gentle- how best to fund it. sive care, whose goal it is to prevent woman from Connecticut (Mrs. JOHN- I want to point out that we owe a the progression of chronic illness. Our SON) of the Committee on Ways and great debt of gratitude to the chairman goal must be to be sure that if you Means for the extraordinary work she of the Committee on the Budget, the have diabetes, you do not end up on di- has personally given to this effort and gentleman from Iowa (Mr. NUSSLE), for alysis. the way in which she has worked with including this year $400 billion for us to Disease management is the new fron- members of the Committee on Energy fund this effort. In last year’s budget, tier in medicine. It will slow, interrupt and Commerce, so many long hours, to we dealt with considerably less. In fact, or reverse disease. It requires more so- accomplish this bill. in the Democratic budget that was pre- phisticated technology. It requires It is important also that I highlight, pared for the year 2002, our friends on greater patient involvement in their while not acknowledging all the staff the other side allocated only $330 bil- own care. But it results in higher qual- who contributed so many hours, the lion to their effort to fund prescription ity health care and much improved head of our health care staff of the drugs. This year, our Committee on the quality of life and lower costs for hos- Committee on Energy and Commerce, Budget provided us with $70 billion pital care, emergency room care, and Mr. Pat Morrisey, who has done Hercu- more than even the Democrats did doctors’ visits. lean work once again on behalf of this when they prepared their budget for Mr. Speaker, this bill will bring the effort. And I want to acknowledge and the year 2002. And I want to thank the cutting edge of medical science and thank, again, Mr. Ed Grossman, who is Committee on the Budget and Chair- modern technology to the service of a legend in the Legislative Counsel’s man NUSSLE for that great effort. our seniors and disabled veterans. With office, in terms of his contribution to With that amount of money avail- over half of our seniors suffering from this entire body and the work we do in able, we have been able to construct five or more chronic illnesses and using preparing legislation for the floor. this year, as the gentleman from Cali- 80 percent of Medicare’s resources, we When we began this effort 21⁄2 years fornia (Mr. THOMAS) and his team have must bring chronic disease manage- ago to create once again an oppor- so adequately described, a much better ment to the service of our seniors. And tunity for this House to pass a pre- bill, a bill richer in benefits, more se- no bill to this point has ever done that. scription drug benefit for Medicare cure in the texture of its structure, to So I am proud to say that this bill and, at the same time, to modernize a make sure that seniors would, in fact, brings both prescription drugs and pre- system that is in deep trouble, we an- have more choices. Those like my ventive health care programs to Medi- nounced that the entire effort in health mother, who want to stay in Medicare, care and will provide unprecedented vi- care would be dedicated to a theme of cannot only stay in Medicare but enjoy tality to our Medicare program. patients first; the idea that everything a prescription drug benefit now; and In conclusion, let me remind us all we did should be designed to make sure those who might enter their senior that this bill will revitalize our Medi- that patients in America continue to years knowing about choice, liking care Choice plans and provide that reli- have the best health care delivery sys- choice, preferring choice, having the able high-quality care year after year tem in our country and, importantly in availability of different plans offered in after year that seniors depend on, a this area, that seniors get something the private sector that they could more holistic integrated care than fee- they desperately need; and that is that choose their prescription drug benefit for-service can provide. So I ask my every senior get access to prescription from. colleagues tonight to support whole- drug coverage and that the Medicare That is the kind of world we hope to heartedly and enthusiastically H.R. 1. system itself, which has long been ab- create when we pass this bill tonight, a It is historic. It brings prescription sent of that important product in the bill that historically modernizes the drugs into Medicare and it prepares arsenal of products that keep our sen- Medicare system and, at the same Medicare to provide 21st century medi- iors healthy and long living in our time, brings some more stores to town cine to our seniors in the years to country, that prescription drugs be and makes sure that every store, the come. added to this system, this important government store and the private The SPEAKER pro tempore (Mr. new element of health care in our stores, all have the products that sen- HASTINGS of Washington). All time al- country that has long been missing iors need so desperately, and that is located to the Committee on Ways and from the program. prescription drugs. Means has expired. The gentleman At the same time, we recognize that In this bill this year, we do a number from Louisiana (Mr. TAUZIN) is recog- the worst thing that can happen to any of other things. We address the con- nized for 45 minutes. citizen is to be forced to go to a single cerns of many of our health care pro- Mr. TAUZIN. Mr. Speaker, I yield store, whether it is a government-run viders in terms of their lack of proper myself such time as I may consume. store or a private-run store. We know reimbursement from the government, Mr. Speaker, when the chairman of when there is only one store in town, and we add reimbursements to hos- the Committee on Ways and Means, the generally you get bad products and bad pitals and physicians and caregivers gentleman from California (Mr. THOM- services and often bad attitudes. No across America. We have an excellent, AS), opened this debate tonight in pre- matter what store it is, no matter who and I thank the Committee on Ways senting H.R. 1 to the floor, he acknowl- runs it, when more than one store is and Means again for their work on this, edged the extraordinary cooperation available, when we have choice, wheth- we have an excellent rural package and the spirit by which our two com- er it is choice between a government that will provide $27.2 billion of assist- mittees, the venerable Committee on store or a privately-run store, all of a ance to rural health care givers and Ways and Means and the venerable sudden prices become better, products hospitals to beef up care in America Committee on Energy and Commerce, become better, attitudes become bet- where care is desperately short and, of the House have worked together on ter, and service becomes better. unfortunately, hospitals are closing this bill again this Congress, with the We know that Medicare is described and doctors are leaving their practices. kind of harmony and dedication to ac- by so many members of the Committee Indeed, because this bill adds to the complishing a good purpose for this on Ways and Means as being in deep mix of choices that seniors will have in country that is seldom seen between trouble. We know it is on a path toward the future, there are predictions from committees that often fight and juggle insolvency. And Medicare, a system by CBO that Medicare will get back on its
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00151 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.177 H26PT1 H6092 CONGRESSIONAL RECORD — HOUSE June 26, 2003 feet, will not necessarily have to go in- And if you do not believe it, take the Mr. Speaker, less than 2 weeks ago, the solvent. It will have a chance to be one words of my good friend, the chairman House Republicans divorced themselves from of the options that seniors wish to of the Committee on Ways and Means, the Senate bipartisan legislation and unveiled choose for a long time in the future. who says, ‘‘To those who say this bill their lengthy and complicated proposal to These benefits are going to benefit would end Medicare as we know it. Our make sweeping changes in Medicare. After all Americans. I know there is some answer is, we certainly hope so. Old- taking months to develop more than 300 talk about how the plan has coverage fashioned Medicare isn’t very good.’’ pages of fine print in secret consultation with and then there is a donut hole and Well, it is a safety net that has pre- selected corporate allies, they rammed the bill there is coverage again for cata- served and protected the health and through committees last week and are ram- strophic coverage. The discounts pro- the well-being of Americans for 38 ming it through the House today under a rule vided to seniors in this bill will be years. It has been a fabulous system for developed in the wee hours this morning. No available at all stages of prescription the protection of the health and the hearings, no significant opportunity for public drug coverage, at all stages of prescrip- welfare of the people. comment, no concessions—just the way the tion drug use and purchase throughout This thought echoes the words of House Republican leadership wants things. the bill. Seniors will see lower drug ex- Speaker Gingrich, who wanted Medi- But the Republican leadership is playing penses in this bill. CBO estimates, in care to wither on the vine. with fire. Not content merely to privatize a wa- many cases, by as much as 50 to 70 per- Well, it is a fraud upon the American tered-down drug benefit, this bill, H.R. 1 cent. All seniors will benefit. people. It provides very little for most privatizes the entire program in 7 years. As people who are looking for the benefit And for the seniors who live below Chairman THOMAS said yesterday, ‘‘[t]o those 135 percent of poverty, and there are of receiving prescription pharma- who say that [the bill] would end Medicare as thousands and millions of those seniors ceuticals. What it does is it subsidizes we know it, our answer is: We certainly hope living across America, this bill pro- the insurance companies. It does not so. * * * Old fashioned Medicare isn’t very control prices. It does not stimulate vides a 100 percent subsidy, 100 percent good.’’ And a Republican Senate leader was competition. It affords to the senior coverage for the drugs they are going quoted last month as saying that ‘‘I believe the citizens a situation where they wait 2 to need under this prescription drug standard benefit, the traditional Medicare pro- years. And after they wait 2 years, plan. And that is a pretty good effort gram, has to be phased out,’’ echoing Speak- what do they get? An enormous donut and that is a pretty good reform of our er Gingrich’s 1995 prediction that traditional hole into which they fall after they system. Medicare would ‘‘wither on the vine.’’ The list Indeed, we are also going to do some have spent $2,000, during which period, goes on. Former Majority Leader Dick Armey interesting things. We are concerned for a period of about $2,900, they get no said, also in 1995, that Medicare was ‘‘a pro- about the high prices of drugs. And like additional help from their government, gram I would have no part of in a free world.’’ the Senate, we include reforms in the but during which time they have to Hatch-Waxman laws that will speed the pay more money, more money, to not Most recently, the Bush administration official approval of generic drugs into the mar- draw any benefits. in charge of Medicare, Tom Scully, 2 months ketplace. And we reformed that awful, And it should be noted there is no re- ago called Medicare an ‘‘unbelievable dis- that awful wholesale price system that quirement whatsoever, none in this aster’’ and a ‘‘dumb system.’’ And, of course, the government currently uses with legislation, that requires the insurance I was here in 1965 to witness the over- phony wholesale prices that force sen- companies, who will begin getting sub- whelming majority of Republicans vote for the iors to pay 20 percent of phony prices sidized enormously in just 2 years after motion to recommit the legislation that created whenever they suffer cancer and have the enactment, to do a single thing to Medicare. to endure cancer therapies and urinary provide for prescription pharma- How will seniors react when told they will be tract therapies and respiratory thera- ceuticals for the benefit of their sub- forced to pay more to see their family doctor, pies. In short, we are going to lower scribers. Indeed, most insurance com- or accept whatever doctors and benefits a pri- the cost of drugs to America across the panies have said they do not want to vate plan chooses to give them? How will sen- board, and we are going to increase the participate in the pharmaceutical-only iors react when traditional fee-for-service availability of drug coverage for every care benefit that would be offered by Medicare is no longer a trusted safety net? senior in this country and build new this legislation. So they have set up How will seniors react when given a voucher options for seniors to choose from. this wonderful situation where there and told to fend for themselves in the insur- That is a pretty good package. will be enormous boundless subsidies to ance marketplace—the same marketplace that I want to again congratulate all who try to induce somebody to come in and failed them before Medicare? They should, worked on it and all in the two com- set up HMOs which will serve the peo- and will, be outraged. mittees who contributed so much to it. ple in the area or provide prescription Seniors will also be angry when they learn In the House Committee on Energy and pharmaceuticals to them. that the Republican drug benefit helps insur- Commerce we had 65 amendments, I The Democrats have a simple, easy- ance companies more than them. Democrats think 29 recorded votes, over 221⁄2 hours to-understand piece of legislation, one propose a true benefit provided under Medi- of debate again this year. Are we ready which builds upon the practices which care, with set premiums and benefits. Repub- for this vote tonight? You bet we are. we have used in Medicare with such licans propose payments to insurers to offer Are seniors ready for the debate to great success and so efficiently for so uncertain benefits, with uncertain premiums. end? You bet they are. Are seniors long to see to it that the people get the The only certainty in the Republican plan is a ready for us to really do it this year? benefit on the payments of a modest huge coverage gap, when seniors will con- You know it. Are seniors ready for this sum and a modest deductible and then tinue to pay premiums after substantial out-of- House, the Senate, and the President they get their benefits. No donut hole pocket expenses, and yet receive no benefit. to come together and actually sign a during which they do not gain benefits. And drug costs will continue to rise, because law that gives them these benefits, in- And I would note that, by an inter- the Republicans prevent bargaining by Medi- stead of constantly just debating the esting circumstance, many people care to make prescription drugs more afford- issue? You know that is true. under this wonderful Republican bill able to seniors. This is a historic moment, and this is will pay a lot more than they will get Other nasty surprises will hurt seniors as our time to get it done. out of this legislation. It is a piece of well. Cuts in payments to hospital, when many Mr. Speaker, I reserve the balance of legislation which can best and most are closing down. Inadequate payments to my time. kindly be defined as a fraud upon a doctors, when seniors’ access already is jeop- The SPEAKER pro tempore. The gen- group of people who have high hopes ardized. Increasing seniors’ costs by $8.3 bil- tleman from Michigan (Mr. DINGELL) is that their Congress is going to take lion for their Part B coverage. These are short- recognized for 45 minutes. care of them. sighted acts of extraordinary callousness. Mr. DINGELL. Mr. Speaker, I yield I urge my colleagues to reject this dan- myself 3 minutes. b 2100 gerous Republican plan. Our senior citizens Mr. Speaker, three things: One, this Well, this Congress is going to take deserve better than to be guinea pigs for risky is a bad bill. Two, it is not the Senate care of them; it is going to give them ideological experimentation. bill. And, three, it destroys Medicare as a deceitful piece of legislation which Mr. Speaker, I reserve the balance of we now know it. benefits them very little, if at all. my time.
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00152 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.180 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6093 Mr. TAUZIN. Mr. Speaker, I yield 3 which will provide real help to tens of tive costs five times higher than Medi- minutes to the gentleman from Florida millions of Medicare beneficiaries. care. (Mr. BILIRAKIS), the chairman of the Mr. DINGELL. Mr. Speaker, I yield 3 Mr. Speaker, it is irresponsible to Subcommittee on Health. minutes to the gentleman from Ohio spend tax dollars bribing HMOs. It is Mr. BILIRAKIS. Mr. Speaker, I (Mr. BROWN), the ranking member of irresponsible to provoke employers thank the gentleman for yielding me the Subcommittee on Health. into dropping retiree health coverage. this time. Mr. BROWN of Ohio. Mr. Speaker, for Vote ‘‘no’’ on H.R. 1. Mr. Speaker, I rise in support of H.R. years Republicans have tried to fright- Mr. TAUZIN. Mr. Speaker, I yield 1, and I urge my colleagues to lend en seniors by telling them that Medi- myself 30 seconds. their support to this very important care was going broke. The media in Mr. Speaker, the Mediscam bill that bill. We have before us a historic oppor- this country scolded the Republicans the gentleman just described is pat- tunity to provide our constituents with for their Mediscare tactics. Well to- terned after H.R. 1495, authored by the a meaningful prescription drug benefit night, Republicans have graduated gentleman from California (Mr. that our Nation can afford. While the from using Mediscare tactics to a new STARK), the gentleman from Michigan bill before us certainly is not perfect, it level, and that is scam. (Mr. DINGELL), the gentleman from targets the $400 billion available under Mediscam number one: my Repub- California (Mr. WAXMAN), and the gen- our budget resolution towards areas lican colleagues tout H.R. 1 as the larg- tleman from Ohio (Mr. BROWN) just a where it can do the most good. est expansion of Medicare since the few sessions ago in the 106th Congress. Our bill provides a great deal of as- program’s inception calling their plan It provided a $220 deductible, 20 per- sistance to our lower-income seniors generous. But under H.R. 1, seniors will cent cost share up to $1,700, a doughnut for whom we waive a deductible and co- be required to pay $4,000 out of pocket hole with a $3,000 catastrophic cov- insurance requirements. These seniors, to receive $5,000 in benefits. That is not erage, and no defined premiums. Does those with incomes below 150 percent generous; that is not even insurance. that sound familiar? The bill we wrote of the poverty level, which in 2002 was Mediscam number two: my Repub- today is patterned after a bill written $13,290 for an individual and $17,910 for lican colleagues say we should pass by my friends on the other side of the a married couple, will only be respon- H.R. 1 because seniors deserve better aisle back then, and they complain sible for a small copayment per pre- coverage options like those available today that it is Mediscam. scription. to Members of Congress, yet this bill’s Mr. Speaker, I yield 3 minutes to the In addition, the bill targets the pre- drug coverage is less generous than the gentleman from Florida (Mr. STEARNS), scription drug benefit towards where least generous coverage available to the chairman of the Subcommittee on the need is greatest. Beneficiaries are Members of Congress. That is not Commerce, Trade and Consumer Pro- only responsible for 20 percent of their treating seniors like Members of Con- tection. drug costs between a $250 deductible gress; that is treating seniors for suck- (Mr. STEARNS asked and was given and a $2,000 initial coverage limit. ers. permission to revise and extend his re- When we consider that the 2003 median Mediscam number three: my Repub- marks.) drug costs for Medicare beneficiaries lican colleagues say H.R. 1 gives sen- Mr. STEARNS. Mr. Speaker, we have are estimated to be $1,390, it is clear iors coverage they can trust. It is an heard from the Democrats that this is that our bill provides a very good, up- expansion of the old, failed a plan that will not work and is a front benefit. Medicare+Choice program which has fraud. We had 2 days of hearing, and I Finally, the bill ensures that seniors dropped coverage for 2 million seniors never heard a plan from the gentleman will have the peace of mind of knowing outright. H.R. 1 is not coverage you from Michigan (Mr. DINGELL) or the that their annual drug costs will be can trust; H.R. 1 is coverage that gentleman from Ohio (Mr. BROWN). We capped at no more than $3,500 out of cashes the check, then leaves seniors had 64 amendments. pocket. While that number does rise for hanging. PARLIAMENTARY INQUIRY some wealthier seniors, I would note Mediscam number four: my Repub- Mr. BROWN of Ohio. Mr. Speaker, that 95 percent of seniors will qualify lican colleagues say H.R. 1 will en- parliamentary inquiry. for the $3,500 figure. Our bill makes hance the security of America’s retir- The SPEAKER pro tempore (Mr. other improvements to the Medicare ees, but the nonpartisan Congressional HASTINGS of Washington). Will the gen- program, and includes some Medicare Budget Office says about one-third of tleman yield for a parliamentary in- payment modifications to ensure that employers will drop their retiree bene- quiry? beneficiaries will still have access to fits if H.R. 1 becomes law. In other Mr. STEARNS. Mr. Speaker, I do not high-quality health care. words, H.R. 1 will force seniors out of yield. I would like to close by noting my the drug coverage they now have. It The SPEAKER pro tempore. The gen- great disappointment with my col- will force seniors out of the drug cov- tleman from Florida (Mr. STEARNS) leagues on the other side of the aisle, erage they now have. controls the time. who for 30 years when they controlled Mediscam number five: my Repub- Mr. STEARNS. Mr. Speaker, what we this House did not do a thing for Medi- lican colleagues say H.R. 1 will bring have here is a plan that the Repub- care. I had to sit through a 3-day mark- prices down through the magic of com- licans have been on their knees trying up where my intentions and those of petition. How could that be? The drug to come up with to try and solve this my colleagues were constantly ques- industry wrote this legislation; the in- problem. It is voluntary. It brings tioned. Republicans were often accused surance industry wrote this legislation. choice, everything that the Federal of not being willing to commit ade- They do not want lower prices, they employees health benefit plan has, the quate resources to a Medicare prescrip- want higher prices, and that is why my same program that all these folks tion drug benefit. I find that odd since Republican colleagues took out any have. in 2001, 2 years ago, the Democratic ability for the Secretary of Health and Joshua Hammond wrote a book substitute to the budget resolution in- Human Services to lower drug prices. called ‘‘The 7 Cultural Forces,’’ which cluded only $330 billion for a new drug In fact, the drug companies gave $85 defines who we are as Americans; and benefit. Republicans added $70 billion million to my Republican friends for one of those cultural forces is we are to that number only 2 years later, and their reelection in 2002 and tens of mil- ready, fire, aim. That is, sometimes we still our colleagues accuse us of under- lions of dollars to President Bush. do not get it perfect. We do the best we funding that benefit. Mediscam number six: my Repub- can, and that has been our history for Mr. Speaker, all this tells me is that lican colleagues say forcing seniors 230 years. Is this bill perfect? No. In most Democrats only care about en- into private health insurance will re- fact, the people on this side will argue gaging in a reckless bidding war with duce health care costs because private back and forth, but all of us know this Republicans and not about developing plans are more efficient. My Repub- bill is not perfect. However, we have a reasonable, affordable benefit. H.R. 1 lican friends know that private insur- carefully balanced the needs and re- is a good bill, and its passage today ance plans actually operate less effi- sources from home health to physical will move us one step closer to a law ciently than Medicare with administra- therapy.
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00153 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.181 H26PT1 H6094 CONGRESSIONAL RECORD — HOUSE June 26, 2003 This bill contains the long-overdue Evaluation Projects, known nationally as to add prescription drug coverage to the Medi- addition of a prescription drug benefit. ‘‘Cash and Counseling,’’ in Medicaid in Flor- care program; none of us would choose a Our seniors and disabled beneficiaries ida, Arkansas, and New Jersey. the Energy health plan in FEHBP (Federal Employee have waited many years, particularly and Commerce Committee held a hearing Health Benefits Program) that lacked drug true in Florida; and I am pleased to be June 5 on Consumer-Directed Care, and coverage. And, through economies of scale, part of the solution and part of that every single Member praised that demonstra- both the traditional fee-for-service program markup that we did for 2 days. tion’s progress, but many cautioned not to and the participating private sector plans will Now the folks on this side of the aisle overreach expanding its application. I agree. have the purchasing power to contain costs. say they have a bill. Their bill is for $1 To that end, at markup I agreed to language However, there always runs the risk of this ex- trillion. Ours meets the budget de- from my friend, the ranking Member of the ploding beyond our control. We have a re- mands of $400 billion. If we could spend Committee, the gentleman of Michigan, Mr. sponsibility for the fiscal health of this nation, all we want in the world, that would be DINGELL, tightening some boundaries for the and it is essential that proper cost containment the Democrat’s plan. demonstration project. The Consumer-Directed be addressed in conference, as I understand But at long last Medicare bene- Care demo is working, let’s expand the ele- the Speaker has assured. ficiaries will have available the same ments of Consumer-Directed Care that have Mr. TAUZIN. Mr. Speaker, I yield options that the President of the been successful in a voluntary, incremental myself 15 seconds. United States has, the Senate and the fashion and see how the demonstration in Mr. Speaker, just to correct the House and the staff here in Congress, a Medicare might be evaluated down the road. record, the Democrats did offer a sub- choice to choose the plan that best Section 736 will direct the Secretary to de- stitute plan in our committee which meets their needs. sign a demonstration project allowing for par- was defeated, and I think it is pretty Mr. Speaker, I am very happy that ticipating Medicare beneficiaries to cash out close to the substitute plan we will see part of this plan that we have here has the value of certain services. They then, with later tonight. a demonstration project in consumer Mr. Speaker, I yield 10 seconds to the the assistance of a designated ‘‘counselor’’ of directed care for chronic conditions gentleman from Florida (Mr. STEARNS). their choosing, and government-provided fiscal such as folks with diabetes. It is analo- Mr. STEARNS. Mr. Speaker, if the intermediary, would have some flexibility in gous to the successful consumer-di- Democrats’ plan is for $1 trillion and making decisions directing care for their condi- rected care demonstration and evalua- our is for $400 billion, we cannot say tion. tion projects, known as cash and coun- they offered a plan that met the budget Furthermore, Consumer-Directed Care type seling in Florida, Arkansas and New requirements. I would like to ask the models are now offered in major health plans Jersey. It is consumer-directed, and in Democrats tonight: Do you have a plan in the private sector: in 2003, the American fact this type of plan is part of the that is under $400 billion like the Re- Postal Workers Union (APWU–AFL–CIO) are American Postal Workers Union. It has publicans? the very first Federal employee group with a a consumer-directed option. So what Mr. DINGELL. Mr. Speaker, I yield 2 Consumer-Directed Care plan available to we have with Medicaid, we are going to minutes to the gentleman from Florida them. Do our Medicare beneficiaries deserve have with Medicare. I am glad that is (Mr. DEUTSCH). any less choice? part of the solution we have. Mr. DEUTSCH. Mr. Speaker, the So I would conclude by saying to my At the June 5 hearing, the National Director House bill in front of us, as the ranking colleagues who are wondering what to of Cash and Counseling, Dr. Kevin Mahoney, Democrat of our full committee has do on this side of the aisle, come along outlined that there are generally three charac- ably quoted the chairman of the Com- with us. It is a start. It is not perfect. teristics of a condition that make it a good fit mittee on Ways and Means in his own We can move it to the Senate, have a for the consumer-directed care model. Disabil- words, ‘‘To those who say the bill conference on it, and improve it. In ities fit these three, and I believe diabetes would end Medicare as we know it, the fact, the gentleman from Louisiana does, too: (1) It is chronic, and one of the answer is we certainly hope so.’’ (Mr. TAUZIN) in the markup amended most self-managed diseases; (2) it follows a This bill is a nonstarter. The Repub- the bill with a GAO study of the im- relatively predictable course of treatment; and licans in the Senate oppose it. It will pact of this new cost regime. It is my (3) there is room for choice, in tailoring a treat- not happen. It destroys Medicare. I am hope that this will provide an objec- ment plan to the individual. going to take my 2 minutes and even tive, balanced approach and give us a I remind my colleagues that under the Med- talk about that. proper understanding of how much this icaid demonstration, satisfaction has been in Mr. Speaker, I am going to talk whole thing is going to cost. I com- the high 90 percentage, no adverse health about the disingenuous nature of the mend the chairman every step of the outcomes have occurred (in some measures it proposal that the Republicans are fos- way trying to be balanced, listening to has improved), and fraud has been virtually tering at this point as a final product. the Democrats’ amendments, many of zero. And I say disingenuous because both which were accepted, many we de- From that, I must turn to other provisions of this bill and that proposal does abso- feated. the bill. I do not stand here without some res- lutely nothing about cost containment. Mr. Speaker, thank you for bringing this ervations. For example, the reform of reim- How can they have a prescription drug package of Medicare additions, updates and bursement for oncologists. No one, no Mem- bill that does nothing on cost contain- reforms here to the Floor today. There is ber, no oncologist, and no patient wishes for ment? It is totally disingenuous. much here to applaud. We have carefully bal- the accounting mismatch of Average Whole- For real seniors, and I would encour- anced needs and resources varying from sale Price (AWP), to perpetuate, and we age all of my colleagues to talk to sen- home health to the physical therapy cap. Most should never let dialogue about AWP degrade iors because one of the things that is significantly, this bill contains the long-overdue into accusations about gaming the system. It going on in America today is we do not addition of a prescription drug benefit to Medi- is true that H.R. 1 eliminates the current over- know the number. We just had the FDA care. Our seniors and disabled beneficiaries payment on Medicare-covered drugs, while in our committee again several times. have waited for this for many years now, and concurrently increasing the practice expense We do not know the number of how I am pleased to be part of the solution. At long reimbursement to appropriate levels that re- many seniors are availing themselves last, Medicare’s beneficiaries will have avail- flect their costs. But my understanding is that of purchases through Canada by the able to them the same options that we, and this is still a net decrease for the practice. I Internet, but it is easily 10 million sen- the Senators, and all of our staff and employ- ask that the negotiations continue in good iors. We have 10 million seniors who ees have: a choice of selections from which to faith. In Energy and Commerce, Chairman are purchasing drugs in Canada where choose the plan that best meets their needs. TAUZIN amended the bill with a GAO study of the benefits of purchasing drugs in Leading off with ‘‘choice,’’ I am pleased that the impact of this new cost regime, and it is Canada far exceed any proposal the Re- my provision for a voluntary, small-scale, con- my hope that this will provide an objective, ac- publicans have made. Just because peo- trolled demonstration project in consumer-di- cepted arbiter on true proper costs of admin- ple are old, just because they are sick rected care for Medicare beneficiaries with istering total community-based cancer care. does not mean they are stupid. They chronic conditions, my particular interest is di- Further, I harbor concerns that this bill not are going to continue to purchase abetes, is included in H.R. 1 as Section 736. become a runaway money train. We have them. So this bill for most seniors, for This would be an analog to the successful budgeted $400 billion over 10 years: is that a probably over 95 percent of the seniors Consumer-Directed Care Demonstration and ceiling, or a floor? It is a logical modernization in America, does absolutely nothing.
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00154 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.207 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6095 b 2115 House who cannot vote for this and words in the RECORD. We love Medi- What it does is even worse, though. will not vote for it because it is too care. We put it on the books, and we In a Congress, in a country, in a soci- conservative; it does not spend enough have defended it ever since then. And ety that is facing the largest budget money; it is not big government we want a policy in Medicare that is deficits in the history of the world, we enough; it uses private sector factors, ennobling and recognizes what senior take $400 billion out of working Ameri- influences to curb prices. If you want citizens are. cans, give it to seniors, but effectively to get 218 votes for a bill to provide a The advertisers are very busy, but take that $400 billion and flush it down prescription drug benefit to the elderly beware. Beware of the advertising. the toilet and we get absolutely noth- and the disabled in this country, you Read the bill. If your insurance sales- ing from my Republican colleagues’ have to work very hard with very com- man comes to you, the first thing you proposal. plex issues and strike a political bal- say is, how much is this going to cost Mr. TAUZIN. Mr. Speaker, I first ance down the center through the eye a month? Read the bill. There is no want to take 15 seconds, if I may, to of the needle to get the job done, and premium cost in the bill. It says point out that the bill before us does that is what this bill before the House choice. Yes, there will be choice of in- now contain the drug reimportation of Representatives stands for. That is surance companies but not choices of provisions similar to the Senate provi- what it results from. doctors. sions and adds language directing the Now we have got the jerkers. We are By 2010, every senior citizen that is FDA to conduct rulemaking to make trying to get this carefully balanced, listening in, you will be forced, you sure that there is safe packaging, to incredibly complicated piece of work will be mandated to go into a private make sure when we do get drugs under that our staff on both sides of the aisle insurance program. That is what our any such program, that they are safe have labored over for years to get done, friends have written. and effective. want to try to move it through the Mr. TAUZIN. Mr. Speaker, I am Mr. Speaker, I yield 4 minutes to the House today, get it over to Senate, we pleased to yield 2 minutes to the dis- gentleman from Pennsylvania (Mr. have got some bipartisan support here, tinguished gentleman from the great GREENWOOD), distinguished chairman of we have got some bipartisan support in State of Nebraska (Mr. OSBORNE). the Subcommittee on Oversight and In- the Senate, and we are going to get it Mr. OSBORNE. Mr. Speaker, rural vestigations of the Committee on En- done. And at the end of the day when health care is struggling. The hospitals ergy and Commerce, our grand inquisi- the little old ladies and the little old are closing and many doctors are leav- tor. men in my district and your districts ing. If you are in a small community (Mr. GREENWOOD asked and was who have been writing us letters and and the doctor leaves or the hospital given permission to revise and extend saying, with tears rolling down their closes, the whole community begins to his remarks.) cheeks, I have got a prescription for unravel. H.R. 1 addresses the troubles Mr. GREENWOOD. I thank the gen- cholesterol drugs, I have got a prescrip- that we see currently in rural health tleman for yielding me this time. tion for antidepressants, I have got a care. Number one, it lowers the labor Mr. Speaker, my parents, my mother prescription for my arthritis, I have share of the wage index for rural hos- and father, are 81 years of age, alive got a prescription for this and for that pitals. This allows them to be more and well, and I would like to dedicate and I can’t afford them, what am I competitive with urban areas in terms all the work that I have put into this going to do. We have all been getting of salary scale. bill to them and I know it will benefit those letters for years and years. And Number two, H.R. 1 increases Medi- them immensely. My father used to say when this year is over and when we care reimbursement for rural doctors. when I was a young lad, ‘‘Jim, there stand with the President of the United Sixty percent of the patient load in my are three kinds of people in this world. States and he signs these bills, we will district and many other rural districts There are shirkers, there are workers say to the little old men and the little are Medicare patients. Doctors simply and there are jerkers. The shirkers are old ladies and the disabled people of all cannot afford to treat Medicare patient the people who just don’t do anything. ages in our district, we got the job loads of this size because on many They don’t contribute. They don’t help. done, when nobody else could or no- Medicare patients they lose money. As The workers are the people who roll up body else would. Whether the shirkers a result, they cut back Medicare pa- their sleeves and get the job done. The did not do their job or the jerkers tried tients or sometimes leave the area. jerkers are the ones that all the time to get in the way, the workers will get Thirdly, H.R. 1 provides a full and the workers are working they keep the job done and this will be an his- permanent equalization of Medicare tugging at them, pulling at them, jerk- toric year for the Medicare program of payments to rural hospitals. An appen- ing them around trying to interfere this United States. dectomy is not cheaper in a small hos- with the work.’’ I am proud of everyone on either side pital than in a large urban hospital. In I would submit that the Democratic of the aisle who actually rolled up some cases it is actually more expen- Party, in all due respect, between 1965 their sleeves and contributed to the sive. Also, H.R. 1 provides additional and 1994, when they lost control of the product. home health care payments and pro- House, were shirkers when it came to Mr. DINGELL. Mr. Speaker, I yield 2 vides provision for rural ambulance. the issue of a prescription drug benefit, minutes to the distinguished gentle- Mr. Speaker, the reason I want to for they did nothing. They did not pro- woman from California (Ms. ESHOO). come to the floor tonight is simply to vide a big plan, a little plan, a medium- Ms. ESHOO. I thank the distin- thank the gentleman from Louisiana sized plan, they did not provide a plan guished ranking member of the com- for all that he has done for rural health with a doughnut, without a doughnut. mittee for yielding me this time. care. This is probably, as far as I am They did not provide a plan of any Mr. Speaker, for those that are lis- concerned, the most important part of kind. They did nothing. We have been tening in this evening, besides the vote the bill. I would also like to say I rep- the worker party. We have passed a that some Members of Congress have resent a rural area. Many retirees in prescription drug bill in this House had to take on going to war, I consider my area live on fixed incomes. Most of year after year since we have had con- this the most important vote in the these people are making 15, $20,000 a trol. That is hard to do. That is hard to House of Representatives. Tonight we year. Most of them are spending 30, 40, do because mature legislators have to debate a bill where there is only one 50 percent of their income on prescrip- figure out how to strike a balance. thing that the two parties agree on, tion drugs. And so the number one con- We have people in this House who do and that is that our seniors deserve cern that I see in rural America is the not want to vote for this bill. They do prescription drug coverage. prescription drug bill. This bill offers not want to vote for this bill because For 38 years, there has been a gold considerable help to these people. they think it is too liberal. They think standard for those that are 65 years and Again, I would like to thank the gen- it is a big new entitlement program older and it was named Medicare. How tleman from Louisiana, the gentleman that will bankrupt the country. They dare my colleagues on this side of the from California (Mr. THOMAS) and also are against it because it is too liberal. aisle say that the Democrats have not the gentleman from Iowa (Mr. NUSSLE). There are a whole lot of people in this done a damn thing. I regret those I urge the passage of H.R. 1.
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00155 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.192 H26PT1 H6096 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Mr. DINGELL. Mr. Speaker, I yield 2 we can afford. The truth of the matter problem that we have ignored for a dec- minutes to the distinguished gen- is that is all we can afford because of ade, the need to add a prescription drug tleman from New York (Mr. ENGEL). their big tax cuts. But keep in mind, plan. I did not come here to argue with Mr. ENGEL. I thank my friend for you did not get a big tax cut. The anybody. I came here because I believe yielding me this time. wealthy got a big tax cut. Mr. and Mrs. we can do better. I believe we can do Mr. Speaker, I rise in strong opposi- Average American got cuts in service, better than the bill we have proposed. tion to this bill. This bill is a cruel cuts in benefits and cuts in quality. I believe we can do better than the sub- hoax perpetrated on America’s seniors. What we have here this evening is an stitute that is offered. This bill is not about helping seniors. attempt by the Republicans to do pre- America understands why we have It is all about privatizing Medicare. scription drug coverage on the cheap. not solved this because all they need to This is not the Senate bill. This bill is There are three problems with this. do is listen to us. We talk about each a wolf in sheep’s clothing. It purports First, in their plan, there are no guar- other’s bills in a way that we point out to help seniors. All it does is create a anteed drug benefits. The private in- things that we think are bad. We forget goal that many people on the other surers determine what drugs are going that we are talking about a population side of the aisle have wanted for years, to be available to you, not your needs. that has nothing. I wish we could have the privatization of Medicare. This bill So that if your drugs are not covered, started with something smaller, but drains the lifeblood out of the Medicare then you have to pay the full price. something that was targeted to people program and breaks the promise we This is no prescription drug benefit. who are faced with the decision every made to seniors 38 years ago when Second, there are no fixed premiums. day of do I buy drugs or do I buy food? Medicare was created. You hear the Republicans tell you, But we have been convinced by this I wish this Congress could have come well, it’s going to be $35 a month. Wait town that our only action has to be together for an historic moment that a minute. $35 a month is nowhere in something comprehensive, something would finally provide seniors with the their bill. These premiums could rise to that includes everybody, something type of prescription drug coverage they as much as $85 a month. You will drive that includes those who have a mini- need and deserve. Unfortunately, we seniors into bankruptcy with that. mal income and those who have an in- are doing a disservice to our seniors by The third problem with this plan is come of $1 million a year. We have not shortchanging them with a woefully in- the hole in the doughnut, the gap. excluded anybody. We will not exclude them over here and we will not exclude adequate drug benefit. Why is it inad- Under the Republican plan, this plan them over here, because there are asso- equate? Let us face it, there is not they are talking about tonight, after ciations and groups that represent sen- enough money in this bill because my the first $2,000 of prescription drug iors, and they have never met those friends on the other side of the aisle costs, you have to pay the rest up to have bankrupted this government with seniors, but we have. $5,000. That is a gap of $3,000. Again, Mr. Speaker, we owe our constituents huge tax cuts, huge tax cuts to benefit that would drive seniors into bank- the rich, huge tax cuts which make it more than to sit on this floor and tear ruptcy. The neediest, sickest seniors do up each other’s legislation. We have to impossible to help entitlement pro- not get the benefits when they need it, be for something. To get up here and grams like Medicare. When the leaders the consequence of doing prescription debate that we are against this and we over there said they wanted Medicare drug coverage on the cheap. Forty- are against that and it is bad, it is in- to wither on the vine, they were speak- eight percent of Medicare beneficiaries adequate is only a suggestion that we ing the truth and that is what is hap- will fall into this gap. This is not a are not good enough to serve here, that pening today. With the enactment of true prescription drug plan. they ought to look for replacements. I this bill, Medicare is withering on the Second, this bill contains something would challenge all of us. vine. called Medicare reform. That is an- I do not know what the outcome of When I came to Congress 15 years other name for privatizing and destroy- tonight would be. I will vote no on both ago, my goal was to provide meaning- ing Medicare as we know it. Plans will proposals that come up. I do not sug- ful prescription drug benefits. My bill have to compete. Medicare will com- gest on either side of the aisle that and others, 1045, would keep the prom- pete against private plans and our sen- Members do that. That is what I am ise of Medicare, which was created to iors will be forced out of a plan that going to do. I have come to the conclu- prevent seniors from having their life they have come to trust. This plan will sion, but never forget if we want a real savings ravaged by health care costs. not work, will not provide the benefits solution to this, a real solution that af- Today we are considering no such as a safety net for our seniors. I urge fects real people, then we have got to thing. The legislation before us is not a its rejection. put our heads together and work to- promise kept to seniors, it is a promise Mr. TAUZIN. Mr. Speaker, I yield gether and remember who it is that we kept to HMOs and insurance compa- myself 10 seconds to ask a question. If are trying to provide for in this bill. I nies. This is not the Senate bill. The this plan funded at $400 billion is pre- reluctantly say that I will vote against Senate bill was a starting point to im- scription drugs on the cheap, what do this. prove upon. This bill bankrupts Medi- you call the $330 billion that was allot- Mr. DINGELL. Mr. Speaker, I yield 2 care, privatizes it by the year 2010. ted by the Democratic budget for the minutes to the distinguished gen- American seniors will not have Medi- year 2002? tleman from Texas (Mr. GREEN). care as they know it by 2010. Again, (Mr. GREEN of Texas asked and was b 2130 when you have tax cuts for the rich and given permission to revise and extend you do it to help your rich friends and Mr. Speaker, I yield 3 minutes to the his remarks.) you want to strangle social programs gentleman from North Carolina (Mr. Mr. GREEN of Texas. Mr. Speaker, and entitlement programs, you do not BURR), the distinguished vice chairman following the gentleman from North have an adequate bill. of the Committee on Energy and Com- Carolina, my good friend, it is frus- This bill should be rejected. merce. trating because I feel the same thing, Mr. DINGELL. Mr. Speaker, I yield 2 (Mr. BURR asked and was given per- that we were given a plan and even minutes to the distinguished gen- mission to revise and extend his re- though we spent 3 days and a long tleman from Maryland (Mr. WYNN). marks.) night debating it in committee we did Mr. WYNN. Mr. Speaker, I thank the Mr. BURR. Mr. Speaker, I am here not really get to legislate because we gentleman for yielding me this time. I tonight to thank the chairman of the really had a plan given to us and it was rise in strong opposition to the Repub- Committee on Energy and Commerce either take it or leave it. But this is lican plan. This Medicare reform plan and the gentleman from Michigan (Mr. the most important issue that we will is woefully inadequate. Everyone DINGELL), ranking member, our col- consider this year not only for our sen- agrees that a real prescription drug leagues on the House Committee on iors but for everyone. I know a lot of plan would cost between $600 and $800 Ways and Means, the leadership of the my colleagues feel that we should sup- billion. This plan only provides $400 bil- House for having the foresight to move port any legislation because it is a step lion. Why? My Republican colleagues forward with legislation to recognize in the right direction or maybe it is will say, well, this is because that’s all that there is a problem in America, a like the Senate bill.
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00156 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.194 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6097 This is not the Senate bill. The Sen- (Ms. MCCARTHY of Missouri asked cancers and diabetes and AIDS and Alz- ate has a better idea. It is not as good and was given permission to revise and heimer’s. as I would like, but it is better than extend her remarks.) What are we here to do tonight? We what we have on the floor today. Ms. MCCARTHY of Missouri. Mr. are here to make these great products This legislation would require Medi- Speaker, the Republican Medicare bill more affordable and more available to care to move to a competitive program fails to provide seniors with meaning- more people. by 2010. A lot of different terms are ful prescription drug coverage and is an As much as I love my mom, her situ- used to describe the model in this bill, attempt to end Medicare as we know it. ation is not unique. She is like millions whether it is called defined contribu- With their plan seniors will have no as- of other Americans who depends on tion, voucher, premium support, or surance from 1 year to the next on prescription drugs for their quality of something else, but it abolishes Medi- what plan will be available to them, life. Our responsibility today is to pass care as we know it. The bottom line is what drugs will cost them nor what this generous and responsible bill, to it is privatization of Medicare. It will doctors will serve them. Under their make the miracle cures of tomorrow take the responsibility of providing plan many seniors will have to pay a available to people like my mom. Just meaningful, affordable, quality health premium without receiving any assist- as importantly, though, we have to do insurance away from the government, ance with their drug costs. so in a way which values and encour- like 1965, and shift the burden onto the Seniors deserve affordable prescrip- ages the incredible research and inno- shoulders of our seniors. The legisla- tion drugs without gaps in coverage. vation which will create the cures of tion relies entirely on private insur- Our seniors should not be forced to pay tomorrow because I do not only love ance plans to provide drug benefits for more to keep their choice of doctors. my mom, but my wife and I love and seniors. No government fall-back plan, Not only would the plan before us limit treasure our three young children and no safety nets for seniors living in or charge extra for choice, it would it is they who will benefit as well be- areas where drug plans do not offer force seniors to go to a primary care cause the lives of our children and our coverage. It places blind faith in pri- physician before seeing a specialist. children’s children will be better and vate drug plans that they will sign peo- The Republicans have produced a stronger and more fulfilling because of ple up. That is the ultimate in faith- plan that fails to make prescription the new cures that will be found and based policy making. There is a huge drugs more affordable and, disturb- the fact that they will be affordable be- gap in this coverage that will dis- ingly, ends the Medicare system that cause of this plan. That is our charge. proportionately hurt individuals who has been an irreplaceable safety net to That is our responsibility. Let us pass need drug coverage. Those with the millions of people for the past four dec- this plan tonight. highest drug costs, they will fall into ades. Instead they are creating a plan Mr. DINGELL. Mr. Speaker, I yield this doughnut hole. Once one has a lit- that costs seniors a lot and gives them 21⁄2 minutes to the distinguished gen- tle over $3,000 a year up to a little over very little. tleman from Maryland (Mr. HOYER), $5,000, they fall in this hole. Mr. Speaker, I urge my colleagues to the very able and respected minority I talked to a senior this evening who oppose H.R. 1, the so-called Medicare whip. has a little over $300 a month in pre- Prescription Drug and Modernization Mr. HOYER. Mr. Speaker, I thank scription drug cost. They will still pay Act of 2003, and to support the Demo- the gentleman for yielding me this their $35 plus a month, but they will cratic motion to recommit which will time. not get one dime of benefits because preserve Medicare and provide our sen- Mr. Speaker, if truth in advertising they will be in this doughnut hole. iors with the affordable prescription applies to legislation, we would have a The ultimate anti-competitive part drugs they need. duty to warn America’s seniors, be- is that this bill prohibits the Secretary Mr. TAUZIN. Mr. Speaker, I yield 2 ware, the Republicans’ prescription from negotiating lower drug costs. The minutes to the distinguished gen- drug bill could be hazardous to your VA does it, Medicare does it, private tleman from New Jersey (Mr. FER- health. This bill is nothing less than an insurance does it, but we are prohib- GUSON), one of our newer members on historic betrayal of America’s seniors. iting in this bill the Secretary of the Committee on Energy and Com- The GOP pretends that it is merely ex- Health and Human Services to reduce merce. tending Medicare, but in fact the bill is costs for our seniors. That is why it is Mr. FERGUSON. Mr. Speaker, I the most dangerous attempt yet to dis- outrageous. thank the chairman and ranking mem- mantle the most popular health care The substitute, on the other hand, is the ber and members of the committee who program in history. kind of benefit that seniors support. It is afford- have worked so hard on this bill. The Republicans fought the adoption able, comprehensive, and will actually help I rise in strong support of H.R. 1. It of Medicare in 1965. Their majority drive down the costs of prescription drugs. includes an amendment that I offered leader said that Medicare should not Yes, it’s more expensive than the base bill, in the Committee on Energy and Com- exist in a free society. Yesterday the but you cannot provide a prescription drug merce which will assist our most vul- chairman of the Committee on Ways benefit on the cheap. Finally, there’s one issue that I’d like to nerable seniors by allowing State drug and Means, the architect of this bill, raise about a provision that would limit the spending to count towards a senior’s said on television, and the Members ability of physicians to refer patients to spe- catastrophic limit. Especially in States can read it here, ‘‘To those who say cialty hospitals in which they have a financial like New Jersey, this provision is going that [the bill] would end Medicare as interest. to dramatically reduce seniors’ out-of- we know it, our answer is we certainly There is language in the Senate bill which pocket spending while saving our hope so.’’ could hurt some innovative practices that are States $5 billion. This bill would drive seniors out of occurring in specialty hospitals. About a year ago I stood in the well Medicare and into the arms of private Patients need access to a broad range of of this House when we debated the drug insurers. There is no guaranteed facilities, and should be able to choose a hos- bill last year and I told the Members monthly premium. There is no defined pital that has expertise in their specific health about my mom who has been battling benefit for seniors. There is no guaran- needs. cancer and who is only alive today by teed access to drugs seniors must have. I know that some have suggested limiting the grace of God and because she has The only guarantee in this bill is that the percentage profit that physicians can enjoy had access to great medical care and it would leave a huge gap in coverage. under these arrangements, or to limit the per- the prescription drugs which have Seniors would pay a $250 deductible, centage of physician ownership and I hope quite literally saved her life. I am $420 a year in premiums, and all costs that both sides can sit down and reach a solu- proud that my State of New Jersey is between $2,000 and $5,100 in drug ex- tion to this problem. home to thousands of researchers and penses. That is $3,100 left to seniors to Mr. TAUZIN. Mr. Speaker, I reserve scientists and companies which have pay. This bill even prohibits the gov- the balance of my time. spent their entire lives and billions of ernment from negotiating lower drug Mr. DINGELL. Mr. Speaker, I yield 2 dollars on research to find the cures of prices for seniors. minutes to the distinguished gentle- tomorrow. This very day, today, they In contrast, the Democratic sub- woman from Missouri (Ms. MCCARTHY). are working on finding the cures to stitute offered by the gentleman from
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00157 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.196 H26PT1 H6098 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Michigan (Mr. DINGELL) and the gen- Mr. TAUZIN. Mr. Speaker, now that ernization Act tonight and deliver on tleman from New York (Mr. RANGEL) we have heard from the doctor of show- your promise to our beloved seniors. would provide a prescription drug ben- manship, we are going to hear from a Mr. DINGELL. Mr. Speaker, I yield 2 efit that guarantees affordable, uni- real OB-GYN doctor. minutes to the distinguished gen- versal and voluntary Medicare cov- Mr. Speaker, I yield 21⁄2 minutes to tleman from Ohio (Mr. STRICKLAND). erage for prescription drugs. There are the gentleman from Georgia (Mr. Mr. STRICKLAND. Mr. Speaker, I no gaps in coverage. Seniors would pay GINGREY). would just like to point out to my $25 a month, $100 deductible, and then (Mr. GINGREY asked and was given friend, the gentleman who just spoke, 20 percent coinsurance. Their out-of- permission to revise and extend his re- my understanding is that he voted re- pocket expenses would be limited to marks.) cently to give $800 billion to about $2,000 a year. That is 1,100 under the Mr. GINGREY. Mr. Speaker, I thank 200,000 people. Surely to God we can do gap that exists in the Republican bill. the gentleman from Louisiana for a little better than that for our 40 mil- The Republican plan also does not yielding me this time. lion senior citizens. give the Secretary of Health and Mr. Speaker, as a physician Member Make no mistake about it. This bill Human Services the authority to nego- of this body, I rise in strong support of will provide no stable, affordable pre- tiate prices. Our bill does. I would ask H.R. 1, the Medicare Prescription Drug scription drug benefit for our seniors, the Members to vote for this substitute and Modernization Act of 2003. but I will tell my colleagues what it which guarantees prescription drug I do not take lightly voting for a will do. It will ultimately destroy coverage for seniors. Federal program that expends $400 bil- Medicare’s social insurance structure, Mr. TAUZIN. Mr. Speaker, I reserve lion of the taxpayers’ money. Being re- a structure that has provided success- the balance of my time. sponsible with that money is a burden ful services to our seniors since 1965. Mr. DINGELL. Mr. Speaker, I am al- that I take very seriously. As appropri- Let me give a clear example of how ways happy to accommodate the gen- ators of the people’s revenue, we must this bill will fail. The Republicans tleman from Louisiana (Mr. TAUZIN), assure that each dollar is spent wisely. claim that premiums offered by the my dear friend, even when he is push- That is a high hurdle, but I believe the private plans will be about $35 a ing an outrageous piece of legislation Medicare Modernization Act clears month. But there is no provision in under an appallingly constrictive rule. that hurdle. this bill that will guarantee a $35 1 Mr. Speaker, I yield 2 ⁄2 minutes to This act is an investment that brings monthly premium or even a range of the distinguished gentleman from Mas- Medicare into the 21st century. We will premiums near $35. Despite what we sachusetts (Mr. MARKEY), and I ask the save money as we expand the focus of have heard, despite what we have chairman from the Committee on En- Medicare spending to include preven- heard, understand this: there is noth- ergy and Commerce to listen closely. tive care. Seniors who take the right ing in this bill to keep the private Mr. MARKEY. Watch out, Grandma. drugs at the right time are more likely plans from charging any premium they Watch out, Grandpa. The GOP is sell- to stay healthy; and they are less like- choose to charge. ing snake oil off the back of a wagon, Now, in fact, Nevada is the only place ly to need expensive, prolonged hos- and, boy, do they have a prescription this model has been tried; and in Ne- pitalizations, painful and complicated for you. vada, the premiums were $85 a month. surgical procedures and, sometimes, Mr. Speaker, every senior citizen Furthermore, premiums will be dif- yes, extended nursing home stays. For gets a bottle with three bitter pills. ferent from State to State, from coun- Bitter pill number one is a lethal dose that reason, I do not think that this ty to county, even from ZIP code to of privatization poison. The Repub- program will really cost $400 billion ZIP code. licans are diverting Medicare funds over 10 years. It will only cost that Finally, private plans will be able to into private drug plans with no max- much if it does not work. increase their premiums each year imum premiums, no guaranteed cov- My experience as a physician for without any regulation, leaving seniors erage, and a cynical drive to destroy more than 28 years teaches that a pre- subject to the possibility of wildly fluc- the Medicare program. scription drug program for preventive tuating premiums. Bitter pill number two is a dose of care will pay dividends and increase Now, I offered a simple amendment crushing costs. Incredibly the Repub- health and a better quality of life. It is in the Committee on Energy and Com- lican bill injects $400 billion into Medi- true what they say: an ounce of preven- merce last week that would have cor- care but spends it in such a tangled, tion is worth a pound of cure. And it is rected this problem and guaranteed convoluted, copay-riddled, incompre- a lot less expensive. seniors a $35 monthly premium, regard- hensible, doughnut-hole-hollowed maze This Congress has a great oppor- less of which drug plan they chose to of bureaucracy and lacks any effective tunity to expand the coverage for sen- enroll in or where they lived. Every effort to keep prescription drug prices iors, particularly our needy seniors, single Republican voted against that from continuing to soar, that Grandma while, at the same time, strengthening amendment. Last night, I asked the is actually going to spend more under the system so that it will be around to Committee on Rules. On a party line this proposal than if we had just left serve the baby boom generation as it vote, they denied me the right to offer well enough alone. moves into retirement. We will serve this amendment. tomorrow’s seniors as we are serving Republicans continue to say their b 2145 today’s. bill will cost $35 a month. It is not Bitter pill number three is a privacy Some of our friends on the other side true. They ought to stop saying it. piracy pill in the form of income tax of the aisle insisted today that this bill Mr. TAUZIN. Mr. Speaker, what is forms. The Republicans require senior could be the death of Medicare. They absolutely true is that 529,000 citizens citizens to hand over to corporations were even grandstanding around with of Ohio are given free coverage under sensitive personal information from in- black arm bands. That is interesting, this bill because they live under 135 come tax returns and the most inti- Mr. Speaker, because their Democratic percent of poverty. mate details of their medical care as a alternative would cost nearly $1 tril- Mr. Speaker, I yield 3 minutes to the condition of qualifying for any cata- lion, threatening to slam the entire gentleman from Rockwall, Texas (Mr. strophic coverage. This information Medicare system onto the rocks of fi- HALL), a Democrat and my dear friend. will then be turned against seniors in nancial insolvency long before 2030. (Mr. HALL asked and was given per- marketing schemes intended to cherry- The plan that we will vote on tonight mission to revise and extend his re- pick the most desirable recruits into provides a good, strong benefit for our marks.) private plans, further weakening the seniors; but just as important, it pro- Mr. HALL. Mr. Speaker, I rise in sup- foundation of Medicare for the seniors vides a sustainable benefit that will be port of this bill because I am for a bill. who need it most. there for future generations of seniors. I want to see a bill passed. I want a bill This is a black day for Medicare. Mr. I encourage my colleagues on both that can pass this House. I want a bill Speaker, GOP used to stand for Grand sides of the aisle to bring Medicare that can get to the conference com- Old Party. Now it stands for Forget Old into the 21st century. Vote for the mittee. I want a bill that we can con- People. Medicare Prescription Drug and Mod- sider along with the Senate bill and get
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00158 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.210 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6099 the best of both bills for the best peo- Like many people, I am not completely We will all go home after passing a ple of this country. satisfied with this bill, but I am very Medicare bill, and we will face our con- Almost 40 years ago when I was in hopeful that we can pass a bill. stituents. I, for one, do not want to tell the Texas senate, Members of this Con- I am particularly pleased that we are intro- the cancer patients in my district that gress came to Texas, came to the Texas ducing long-overdue Medicare reforms that will Congress has decided to curtail their house and the senate, touting two bring health care into the 21st century; name- treatment and endanger their care. great programs that they were going to ly—regulatory reforms and provider reimburse- We can do better. We must. I urge my introduce and pass. They named them ment issues. We are all aware that providers colleagues to vote against this bill. Medicare and Medicaid. And they said nationwide, including our rural providers, have Mr. TAUZIN. Mr. Speaker, I yield by 1990, Medicare could cost $9 billion a been diminishing in the face of increasing myself 10 seconds. I want to point out year. And as I remember, they said costs and decreasing reimbursement. We sim- our bill provides 430 million new dol- Medicaid could cost almost $1 billion a ply must confront this issue because without lars to oncologists in America, twice year. They told us that we really need- access, the rest of the program is meaning- that provided to any other specialist ed to monitor the program closely or less. for nonpractice expenses, twice as the costs could double. Like many people,I am not completely satis- much as any other specialist. Mr. Speaker, I am pleased to yield 3 Well, my colleagues know what has fied with this bill, but I am also not satisfied to minutes to the distinguished gen- happened to the cost, what has hap- see this program collapse. We are closer than tleman from Texas (Mr. BARTON), the pened to Medicaid and Medicare. There we have ever been to making some meaning- chairman of the Subcommittee on En- is an awful lot to do, and we need to be ful reforms and providing a prescription drug ergy of the Committee on Energy and doing it. benefit to seniors. I am hopeful that we will im- There is no doubt that Medicare has Commerce. prove this bill in the conference committee as (Mr. BARTON of Texas asked and helped millions of seniors escape dire we seek to find a bipartisan solution to our poverty and live fuller lives. There is was given permission to revise and ex- common problem. This is just a first step in an tend his remarks.) also no doubt that medical costs have ongoing process of reform to ensure that our far outstripped inflation due to a num- Mr. BARTON of Texas. Mr. Speaker, seniors get the care that they deserve. Con- ber of factors, including expansion of first, I want to commend my chairman, gress, through its oversight and yearly appro- benefits, increased use, and coverage of the gentleman from Louisiana (Mr. priations process, will continue to monitor the the disabled population. Our seniors TAUZIN), for his work in this noble ef- program—making necessary changes and im- are staring into their pocketbooks to fort, and I want to thank him for al- provements to guarantee healthy years for our find the money they need for their lowing the reform group that I have Medicare population. care. We desperately need to do some- been a part of in his committee the op- Mr. DINGELL. Mr. Speaker, I yield 2 portunity to present an alternative and thing to save a great program for peo- minutes to the distinguished gentle- ple in their golden years. to try to make that a part of the pack- woman from California (Mrs. CAPPS). Mr. Speaker, Medicare needs to be age. I really appreciate that. Mrs. CAPPS. Mr. Speaker, I thank modernized to include a meaningful I would say to my friends on the my distinguished ranking member for Democratic side of the aisle, as they provision for drug coverage. In my life- yielding me this time. have talked about privatizing Medi- time, we have seen how prescription Mr. Speaker, the Medicare bill before care, that the first thing that we need drugs have greatly improved and ex- us is not a good bill. The coverage it to do is preserve Medicare. I would tended the lives of Americans. We have provides is unreliable and insufficient. point out that if we do nothing to the also seen how the cost of those life-pro- After a senior has used $2,000 in medi- existing Medicare program, the projec- viding drugs can trouble families every cations, they get no more help until tions are that within the next 5 to 10 day. Unfortunately, Congress has al- they have spent another $2,900 out of years, there will be no Medicare, be- most been timid in seeking parity be- pocket without help and while con- cause doctors and hospitals will opt tween the prices drug companies have tinuing to pay premiums. And that is out of the system because they are not charged domestic dispensers compared only if a private plan chooses to come able to be reimbursed adequately for to the nondomestic dispensers just into their area. This bill turns Medi- the services they are providing. across our borders. care into a voucher, handing it over to So the first thing that we need to do While American drug companies need is to preserve the current Medicare sys- added alliance for research and devel- the insurance companies and forcing seniors to pay more. It reneges on a tem, and the bill before us does that opment, and I am willing to give them with such things as competitive bid- that, for 10 key drugs for seniors, promise that we have made to Amer- ica’s seniors by ending Medicare as ding for durable medical equipment Americans pay an average of 150 per- and other reforms. cent more for the drugs than Cana- they know it. In addition, the bill before us cuts The second thing I would like to dians. This is unacceptable. I do not point out is that we understand that like price controls. The marketplace cancer care by hundreds of millions of dollars, jeopardizing access to cancer seniors need a prescription drug ben- provides the competition necessary to efit. deliver the best price for the people in care for seniors who face this dreaded need. We have to lower the cost of pre- diagnosis. If this bill passes, many can- b 2200 scription drugs, and my hope is that we cer centers will close. Others will cur- And my reform group was able to get can all work together, including drug tail their services, admit fewer pa- into this bill a transition program that companies, to come up with new, bet- tients, and lay off oncology nurses and if this bill becomes law within 90 days ter, and more creative ways to achieve critical support staff. This bill is sup- of enactment, 17 million seniors in this affordable prescription drugs. posed to make it easier for patients to country will begin to get a prescription As we look at introducing new com- get health care, but it will actually drug benefit immediately. They will petition among providers for services, make it harder for cancer patients to get a prescription drug card, and if we should consider provisions that re- get the care they need. they are low income those drug cards spect the choices available to current It is true that Medicare beneficiaries will have $800 of benefits on them; and Medicare beneficiaries. These seniors are paying too much for their oncology if they are moderate income, they will and the disabled have paid for and have medications. We all agree we must fix have $500; and if they are upper income, come to expect a traditional Medicare this. But Medicare also pays way too they will have $100. Their families and system and the safety net that it pro- little for essential oncology services, employers can add money to those vides them, and they should be able to and so the overpayment for oncology cards, up to $5,000, and within 90 days retain their current plans if they con- drugs has been used to pay for treat- of enactment there will be a prescrip- tinue to be pleased with them. The ments oncologists provide to cancer pa- tion drug benefit. Not 3 years from Senate improved upon this provision, tients. We must fix both parts of this now, not 4 years from now but within and I hope that is included in the final problem, but this bill still cuts hun- 90 days. And that drug benefit will not bill. dreds of millions of dollars from cancer require a deductible, and it will not re- The Senate and the House bills have care. And it still risks the lives of can- quire any paperwork. It will not have good provisions to achieve our goal. cer patients. any doughnuts.
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00159 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.200 H26PT1 H6100 CONGRESSIONAL RECORD — HOUSE June 26, 2003 It will require a modest co-pay, but payers’ money, and we always hear tional Medicare and maybe you do not. then you get your prescription drugs from our friends, let us run govern- Depending on what plan you have, plus any discounts that the prescrip- ment like a business. Well, what busi- maybe you keep your doctor or maybe tion drug benefit card allows you. And ness does not negotiate for more favor- you do not. Depending on what year it I think that is important that we as a able prices? But not this plan. is, maybe you keep a good package of country say to our senior citizens, not Our government is prohibited from benefits or maybe you pay very high that we want to get old people but that negotiating lower prices on behalf of prices for a low, low package of bene- we want to give our parents and our senior citizens. I watch seniors in fits. grandparents a break. We want to give Pittsburg get on buses every month And the Republicans are here tonight them a benefit and we want to do it and drive to Canada to buy their drugs, saying choices, choices, choices. We are sooner rather than later. because they cannot afford them in giving America’s seniors choice. Well, I think the most important thing this country, for half the price of what what kind of choice are they giving about this bill is that there is an ac- they have to pay for in the United America’s seniors? Well, not a choice of knowledgment and a guarantee that States. And now when we finally have doctors and not a choice of hospitals. there will be a benefit, there will be a an opportunity to take the buying What they are saying is we are going to prescription drug benefit. power of all these senior citizens and give you a choice of insurance plans. Now, we can debate and we will de- negotiate more favorable prices from Well, no one in my State of Maine has bate whether it is adequate or it needs the drug companies, this bill specifi- ever come up to me and said, You know to be more generous or whether it cally prohibits us from doing that. what I really want is not a choice of needs to be more universal or whether Mr. Speaker, this is a bad bill. We doctors or hospitals, I want to see dif- it needs to be more targeted to the peo- should vote it down. ferent brochures, different insurance ple that need it the most, but the im- Mr. TAUZIN. Mr. Speaker, I yield 2 brochures. Please have some insurance portant step is we are giving the ben- minutes to the gentleman from Geor- agents call me and talk about their dif- efit, we are adding the benefit and we gia (Mr. BURNS). ferent plans. are doing it now. And our transition Mr. BURNS. Mr. Speaker, I appre- What is happening in Maine, in the program will kick in within 90 days of ciate the chairman for yielding me private sector with this wonderful com- enactment, no later than September of time. petition for the employed market is 2004. So I will vote for this bill and Mr. Speaker, we have a bill before us every year 20 percent increases, 30 per- hope we can perfect it as we go through tonight that will improve and it will cent increases, higher payments, lower the process. preserve Medicare. This bill will con- benefits. That is competition and Mr. DINGELL. Mr. Speaker, I yield 2 tinue to provide seniors with funda- choice and what the Republicans are minutes to the distinguished gen- mental health care they so desperately saying is that is what America’s sen- tleman from Pennsylvania (Mr. need but provide something more. It iors need. It is unbelievable. Every sen- DOYLE). provides something that my constitu- ior I talk to says we want lower prices. Mr. DOYLE. Mr. Speaker, I represent ents want and need in affordable pre- Please give us lower prices. We are Allegheny County, Pennsylvania, the scription drug plan for all Americans buying from Canada. We are taking second oldest county in the country. and seniors. buses to Canada, and this bill prevents And this is indeed a sad day for seniors Mr. Speaker, I am a co-sponsor of the administrator from negotiating in Allegheny County because instead of H.R. 1 for one simple reason: Because lower prices for America’s seniors. providing our seniors with an afford- seniors in my home State of Georgia This bill is never likely to work in able prescription drug plan under Medi- must have an improved Medicare sys- my opinion, but if it did, you ought to care, instead, tonight we will give sen- tem. They must have prescription drug follow the money. Who gains from this iors a Medicare+Choice style drug plan. coverage. They do not want excuses. bill? The insurance companies will make millions, hundreds of millions of Now, we all remember in Pennsyl- They want action. They want it now. dollars. The pharmaceutical industry vania what Medicare+Choice is. That is The time for stale ideas and old sys- will be able to keep charging the high- the HMOs trying to provide Medicare, tems and gimmickry are over. the same companies that left hundreds H.R. 1 is legislation we can support est prices in the world. America’s sen- of thousands of Pennsylvanians high because it preserves a system our sen- iors lose. You follow the money to the and dry, not only in my State but all iors know and love, while it addresses insurance companies and the pharma- across this country, when they pulled the issues of increased coverage and ceutical industry and you can tell who out of their plans. solvency of a program for baby boom wins under this bill. This bill is a nightmare for America’s This plan is nothing more than a generations. Make no mistake, we are seniors. Reject this bill and support the huge subsidy to drug companies and far from finished in our efforts to fix will eventually lead to the privatiza- Democratic substitute. our Nation’s health care challenges, Mr. TAUZIN. Mr. Speaker, how much tion of Medicare. Do not just take our but this is the first step into a new time remains on each side? work for it. The AARP, which rep- world of advanced health care. Through The SPEAKER pro tempore (Mr. resents more senior citizens than any H.R. 1, seniors in Georgia can decide HASTINGS of Washington). The gen- other organization in this country, the coverage plan that best fits their tleman from Louisiana (Mr. TAUZIN) says, The provisions that would estab- needs. Seniors in Georgia will be able has 8 minutes remaining. The gen- lish a premium support structure be- to decide which prescription drug plan tleman from Michigan (Mr. DINGELL) ginning in 2010 could destabilize the through Medicare is the best option. has 141⁄2 minutes remaining. traditional Medicare program and lead For those who have no coverage and Mr. TAUZIN. Mr. Speaker, I reserve to much higher costs for beneficiaries. pay exorbitant prices for their drugs the balance of my time. Rather than expand choice, this provi- out of their own pocket, these benefits Mr. DINGELL. Mr. Speaker, I yield 2 sion could limit choice by leading to a are real. We are providing them with minutes to the distinguished gen- substantially higher cost for bene- real savings and real choices. tleman from Louisiana (Mr. JOHN). ficiaries who want to stay in the tradi- Mr. Speaker, it is time for Congress (Mr. JOHN asked and was given per- tional Medicare program. Those who to step up to the plate and ensure mission to revise and extend his re- choose not to enroll in private plans Medicare’s future for all Americans. marks.) should not be put at a financial dis- Mr. DINGELL. Mr. Speaker, I yield 2 Mr. JOHN. Mr. Speaker, I thank the advantage. minutes to the distinguished gen- gentleman for yielding me time. The other part of this plan that I just tleman from Maine (Mr. ALLEN). Mr. Speaker, I strongly support a find unbelievable right here in title Mr. ALLEN. Mr. Speaker, I thank drug benefit in Medicare. And in some VIII, section 801 is we prohibit the ad- the gentleman for yielding me time. aspects, the Democrats have won be- ministrator of the program from nego- Mr. Speaker, the Republican pre- cause it has not been that long ago, tiating better prices from the drug scription drug bill transforms Medicare just a few short years, that the Repub- companies on behalf of taxpayers. We into Maybe care. Depending on where licans wanted to take a privatized out- are going to spend $400 billion of tax- you live, maybe you get your tradi- side-of-Medicare, a drug benefit. But
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00160 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.202 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6101 now all of the debate is about it being have said to those Republicans and vide catastrophic coverage for them as a part of Medicare. So in that aspect, I others, we will work with you on a bill well, but in addition to that tremen- think that we have won as Democrats. that fits within our budget constraints dous benefit, we have a rural health But I do believe that what they have but let us have a traditional Medicare package in this bill that is going to done with this bill is continue to try to benefit that provides drug coverage. help rural America, rural health pro- privatize Medicare and the benefits What does this bill do? It does not set viders. It is going to provide $27 billion that are in it. any maximum premium. It does not set over 10 years for our rural areas, and An entire generation of baby boomers any maximum deductible. It has a the disproportionate share payment for are upon us, Mr. Speaker, and in just a doughnut that almost 50 percent of our rural hospitals, children’s hospitals few years away we are going to have to seniors will experience after they have around the country, urban hospitals deal with this. Unfortunately, this bill spent $2,000 on drug costs. During that that treat our citizens on Medicaid, our falls short of what our seniors deserve time period they will be forced to pay hospitals over the next 10 years are as it has holes in it that the Repub- a premium for basically nothing. going to get $3.8 billion for those who licans refuse to plug. I would like to bring a chart up here treat the neediest in our society. Perhaps the $174 billion bill that we to also show you just how complicated This is a program that we should all passed just previous to this debate this plan will be that is being foisted be supporting, and certainly we should could have been used for the doughnut on seniors. This represents a relatively not support the Democratic substitute. to be plugged. Efforts to fix this prob- detailed description of what this bill Mr. DINGELL. Mr. Speaker, I yield 2 lem were denied us through the amend- attempts to do. minutes to the distinguished gentle- ment process in this body on this de- Would somebody on the majority woman from California (Ms. SOLIS). bate. I offered amendments to try to please explain to me how this bill (Ms. SOLIS asked and was given per- bring some certainty with 2 years for works and how any senior at home, mission to revise and extend her re- our seniors to try to provide our rural Democrat, Republican or Independent, marks.) ambulance services, our rural home is expected to understand how to use Ms. SOLIS. Mr. Speaker, I thank our health care and our rural doctors a fair this drug benefit? ranking member for yielding me the reimbursement. In particular, I believe Mr. Speaker, I ask unanimous con- time. this bill falls short in addressing the sent for 2 additional hours to explain I rise tonight in opposition to this needs of rural seniors and rural Ameri- the chart. bill. We have heard a lot tonight about cans. In fact, our previous experience The SPEAKER pro tempore. Is there how this bill is going to help our sen- should tell us that it has not worked. It objection to the request of the gen- iors from the other side of the aisle. is not profitable to offer plans to sen- tleman from Florida? Well, I want to talk about the seniors iors in rural areas. In southwest Lou- Mr. TAUZIN. Mr. Speaker, I object. that I represent in my hometown in The SPEAKER pro tempore. Objec- isiana we have no Medicare+Choice the San Gabriel Valley in East Los An- tion is heard. geles, California. plans. Mr. TAUZIN. Mr. Speaker, I yield 2 I urge Members to vote against this, In my congressional district, I rep- minutes to the gentleman from Ken- and I urge the other side to work, as resent nearly 6,000, 6,000 seniors in pov- tucky (Mr. WHITFIELD), a distinguished the Senate did, in a bipartisan fashion erty, making less than $11,000 a year. member of the Committee on Energy to fashion a bill that our seniors can For them the cost of prescription drugs and Commerce. is so overwhelming that they often use. Mr. WHITFIELD. Mr. Speaker, I have to forgo between paying their Mr. TAUZIN. Mr. Speaker, I reserve thank the gentleman for yielding me medicine or having a meal or paying a the balance of my time. time. Mr. DINGELL. Mr. Speaker, I yield 2 Mr. Speaker, tonight is the culmina- phone bill. That is what it means to minutes to the distinguished gen- tion of 4 or 5 years of debate of a pre- seniors in my district. tleman from Florida (Mr. DAVIS). scription drug benefit for our senior This is a choice that no senior citizen Mr. DAVIS of Florida. Mr. Speaker, citizens here in America. I hear a lot of should have to make. Yet the Repub- one of the things that Democrats and the criticism and I have heard it all lican bill does nothing to reduce the Republicans ought to be able to agree day today about private insurance cost of prescription drugs. It does not upon tonight is that we owe our seniors companies being involved in this pro- allow us to use the purchasing power of truthfulness. We should be very clear gram that we are submitting tonight. Medicare beneficiaries to negotiate and honest with them and ourselves as Yet, I would remind those on the other lower drug prices. How ironic, just like to exactly what is happening. Our fail- side of the aisle that private insurance we do for the Veterans Administration. So what do we tell Grandma, living ure to do so is a cardinal sin because it companies are involved in Medicare as alone on a fixed income who cannot af- is ultimately to disrespect our seniors. it exists today and has been for some This bill offered by the House Repub- ford her medicine? Sorry, but Medicare time because it is the private compa- licans is based on a remarkable fixa- has a new drug benefit, but it is not for nies that are responsible for the reim- tion with private insurance companies. you? Sorry, but Medicare is raising bursement of our health care. Private insurance companies through- part B deductibles by eight times as out the country in Washington have b 2215 much as our Social Security cost-of- said once again they do not want the So private companies are already living increase? money that is being offered under this very much involved in our Medicare Only the Democratic alternative that bill to write these private insurance system today. we will debate later on tonight will do plans. I would also say, what benefit are what I think my senior citizens want The distinguished chairman of the seniors going to get from this program? to hear, and it will provide them with committee’s response to that is we will First of all, if they are 135 percent of the guaranteed, affordable, easy-to-use subsidize 99 percent of this cost as nec- the poverty level and below, and I can drug benefit that is part of Medicare. essary to get private insurance compa- tell my colleagues, in my district that Let us be clear tonight. For our sen- nies to sell this benefit. How often in is about 60 percent of them, they are iors, for our grandmothers, our uncles, Washington, D.C. do you hear some- not going to have to pay anything. The our fathers and our mothers, there is body turn down that type of money the government’s going to pay their pre- only one thing to talk about tonight government is offering them? Some- mium for them. The only thing that and it is about medicine. This should thing is wrong with this plan. they will have to pay is a $2 small not be about privatization or insurance I salute the Republicans on the com- copay for a generic drug and a $5 copay companies or anything else. Let us give mittee who acknowledge they were for a name-brand drug. What is wrong our senior citizens the help they need concerned about whether private insur- with a program that provides free to pay for that medicine. ance companies would offer this benefit medicines for seniors who today cannot Let us oppose this proposal being put to seniors. Some of them are going to get them? forward tonight by the Republicans vote against the bill tonight based on I would also say that in addition to and support the Democratic prescrip- that concern. A number of Democrats that tremendous benefit, and we pro- tion drug bill.
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00161 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.204 H26PT1 H6102 CONGRESSIONAL RECORD — HOUSE June 26, 2003 Mr. TAUZIN. Mr. Speaker, how much Mr. Speaker, this debate is about What most people want in America, time remains on each side? taking care of America. This debate is including seniors, is to contain the The SPEAKER pro tempore (Mr. about making a guarantee to senior high costs of prescription drugs. This HASTINGS of Washington). The gen- citizens that they will have access to bill prohibits the Secretary of Health tleman from Louisiana (Mr. TAUZIN) quality medical care which includes and Human Services from negotiating has 6 minutes remaining. The gen- prescription drugs. This debate is lower prices for prescription drugs. tleman from Michigan (Mr. DINGELL) about ensuring the future of Medicare. That in itself is enough to say vote has 81⁄2 minutes remaining. This debate is about delivering better ‘‘no’’ on this bill. What a sham for the Mr. TAUZIN. Mr. Speaker, I reserve outcomes at lower cost. seniors who built this country. the balance of my time. H.R. 1 is a strong solution to these This plan will destroy the retirement Mr. DINGELL. Mr. Speaker, I yield 2 serious problems. Providing prescrip- benefits that companies in my district minutes to the distinguished gen- tion drugs for America’s seniors is the like General Motors, like Daimler tleman from Arkansas (Mr. BERRY). right thing to do. I cannot picture what Chrysler already are giving to their re- Mr. BERRY. Mr. Speaker, I thank medicine would look like today if phar- tirees. This plan is a disincentive for the distinguished gentleman from maceuticals were not an available them to keep giving that. Vote ‘‘no’’ on Michigan for yielding me the time, and treatment option. Physicians and other this plan. It is unfortunate I do not I appreciate his leadership on this and providers would have no option but to have any more time. Vote ‘‘no.’’ all other matters before this House. resort to seriously invasive treatments Mr. Speaker, I rise today to express my dis- Mr. Speaker, one thing we under- appointment and opposition to H.R. 1. We, in stand is the Republicans are in the ma- when confronted with acute medical Congress, over the last few years, have re- jority. They are in charge. You can do conditions. There is no doubt that Americans peatedly pledged to provide seniors with the whatever you want to do. You have got have benefited from the development of prescription drug coverage they so des- the Senate. You have got the White perately need—and deserve. My Republican House. Now, you may talk more trash new and innovative medicines. New colleagues have touted this day as a ‘‘histor- than a $3 radio, but you are in charge. drugs can improve and extend lives. The difference in these two plans is New drugs exist that can dramatically ical day.’’ Unfortunately, for Democrats, who very simple. The Democrats would reduce cholesterol, fight cancer, allevi- support a meaningful, universal, and com- offer you the best plan, the best price, ate debilitating arthritis. prehensive drug plan under Medicare, this day and we will pay 80 percent and let the An entirely new class of medicines, is not a ‘‘historical day’’ in the positive sense patient, the Medicare beneficiary, pay collectively known as selective estro- but a day when we failed on our promise to 20 percent. The Republicans only, on gen receptor modulators, are available come through for our seniors. What this bill the other hand, will allow the pharma- for reducing breast cancer mortality does do is afford the Republicans the ability to ceutical companies, by law, statu- rates, and one day may see an ex- say to seniors, ‘‘We came through on our torily, to continue to rob our senior panded role in preventing this disease. pledge.’’ Unfortunately, their rhetoric does not citizens, charge them the highest price Unfortunately, Medicare has been match up to the emptiness that will be felt in and let them pay 80 percent; and they deeply rooted in the medicine of 1965, our seniors’ pocketbooks. Nor does it match will pay 20 percent of the bill, if you not the medicine of today; and this has up in providing seniors with real choice and a are lucky enough to live long enough. negatively impacted the health of our meaningful, comprehensive prescription drug They come to the floor repeatedly senior citizens. program. this evening and talk about this bill is Tonight, the House of Representa- The GOP Prescription Drug Plan is a flawed not perfect. Boy, you have got that tives will take a bold step to improve plan, period. It would put the power in the right. I will agree with you on that the lives of senior citizens. Not only hands of private insurers—those same insur- one. will seniors have greater access to pre- ers who have abandoned seniors in providing They say it is historic, and they are scription drugs, but built-in reforms essential health care services in the past. Why right. Never before in the history of will hold down the cost of these medi- our Republican colleagues want to give even this Republic has there been such an cations. more power to HMOs and private insurers is outrageous attempt to provide the abil- In a report released today by Sec- a question I cannot answer. However, the con- ity to insurance companies, as if they retary Tommy Thompson, seniors will sequences of such actions will be felt by the needed any help, to rob and deceive and save substantially through upfront most vulnerable in our society. cheat our senior citizens. Never before drug discounts under the House plan. The majority of seniors across our nation have they been presented with an op- The Medicare actuary estimates sen- live on fixed monthly incomes. With so many portunity, the pharmaceutical compa- iors will see an immediate savings of 25 seniors today living longer, this also means nies, to cheat and continue to rob our percent off their current prescription that they need to save as much money as senior citizens. drug costs. they can to ensure their survival over the It is indeed historic by their own ad- On the other side of the aisle, those years. They cannot afford to pay exorbitant mission. The chairman of the Com- who were wearing the arm bands ear- costs for their drugs. Moreover, seniors need mittee on Ways and Means says we lier today, where were those arm bands security. What they do not need is to be want to end Medicare as you know it. I in 1998 and 1999? Where were those arm forced into private managed care plans that suggest you all get you a buckeye. It bands when that administration re- are able to opt-out of coverage for seniors at will bring you good luck and keep fused to even open the book and look their free will. Seniors deserve better—they rheumatism away. That is all you are at the Medicare commission, bipar- deserve a universal, comprehensive, afford- going to get through this Medicare pro- tisan commission? able, and meaningful drug plan under Medi- gram. Mr. DINGELL. Mr. Speaker, I yield 1 care. Mr. TAUZIN. Mr. Speaker, I yield 2 minute to the distinguished gentle- The House Republican prescription drug bill minutes to the distinguished gen- woman from Michigan (Ms. KIL- is even worse than the one considered by tleman from Texas (Mr. BURGESS). PATRICK). Congress last year and goes much further in (Mr. BURGESS asked and was given (Ms. KILPATRICK asked and was privatizing Medicare. Seniors would need to permission to revise and extend his re- given permission to revise and extend use private insurance companies for drug cov- marks.) her remarks.) erage and these private insurance companies Mr. BURGESS. Mr. Speaker, I thank Ms. KILPATRICK. Mr. Speaker, I and managed care plans would design the the chairman for yielding me the time, thank the ranking member for yielding new prescription drug plans. These insurance and certainly I want to acknowledge me the time in this most difficult dis- plans would also need to commit to the pro- the great leadership of our chairman cussion, but what a sham we have gram for only one year. What does this mean? and the gentleman from Texas (Mr. today for our seniors of America who It means that seniors can be dropped from BARTON), as well, who proposed the pre- built this country. Not only do you not their plan year-to-year. They would have to scription drug card. have a prescription drug benefit, but change their plan, their doctor, and the drugs I rise tonight to support H.R. 1, the this one you will not get till 2006, if they take every 12 months. This puts seniors Medicare Prescription Drug and Mod- you get it at all. It will privatize Medi- at the mercy of private insurance companies, ernization Act of 2003. care by the year 2010. rather than giving them an option that provides
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00162 Fmt 7634 Sfmt 9920 E:\CR\FM\K26JN7.211 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6103 them with the security and stability they need. plan does not even go into effect until b 2230 2006. Why are they angry? They are Seniors do not want to be forced into an But tonight, what we are debating is angry because this is a question of val- HMO. In fact, 72 percent of seniors polled say nothing more than a false promise for ues. Just when you need it most, the they do not want to be forced into getting cov- our seniors. Seniors need an account- plan ends. erage through an HMO. We need to listen to ant to figure out this plan. those we are trying to serve. The second reason why they are The GOP plan also receives an ‘‘F’’ on the angry is you are going to force them I put a calculator to it, and here is affordability scale. Under their plan, seniors into HMOs. Look what happened in what the Republican national leader- would be required to pay high premiums even New Jersey on Medicare+Choice. Now ship plan offers our seniors. Seniors if they are not receiving coverage. The Repub- you are going to call it Medicare plus will pay the first $2,520 of the first lican plan would deny assistance to those sen- advantage. Bill Safire would have a $3,500 worth of medicine they need iors with drug costs between $2,000 and picnic on this. every year. Now, let us contrast that a $4,900. Nearly half of Medicare beneficiaries This is a joke and a sham, and you moment to a health care plan provided would fall into this ‘‘coverage gap’’ every year; know it. Look at that record that you for Members of Congress, those who however, they would still be expected to pay have provided, that we provided, all of wrote this plan. Guess what they pay? the monthly premium. Seniors would be asked us in the State of New Jersey, where Seven hundred dollars of the first $3,500 to continue paying for a service they are not they lost 100,000 people. What we are worth of medicine. receiving—a service that does not honor sen- going to do, as the gentleman from They want to provide seniors with iors with meaningful support in the first place. Pennsylvania said just a few moments little help while continuing to take Another glitch in the Republican bill is its in- ago, is subsidize insurance plans. That care of Members of Congress. It is sim- ability to deal with the underlying problem— is what we are going to do. ply wrong. This is not a seniors bill, the rising costs of prescription drugs. Seniors The third reason why they are ticked this is a bill written by the big drug want help in curbing the increasing costs of off is that there is no control over manufacturers for one reason only. To prescription drugs. In fact, seniors prefer cost prices. Boy, are they angry. You blew privatize Medicare. To privatize Medi- control measures by a vote of two to one. it. care so that Medicare cannot command Mr. DINGELL. Mr. Speaker, I yield 1 While seniors want help in purchasing their discounts. minute to the distinguished gentle- medicines, they also want solutions in curbing Mr. DINGELL. Mr. Speaker, I would woman from California (Ms. WATERS). inform the gentleman from Louisiana the rising costs. The Republican bill does not Ms. WATERS. Mr. Speaker, last at this time that I have one speaker re- do this. It neglects to include an important pro- night we debated the Homeland Secu- maining. vision supported by Democrats to provide the rity appropriations bill. The Repub- Secretary of Health and Human Services with licans made excuses about not spending Mr. TAUZIN. Mr. Speaker, who has the authority to negotiate for lower prices like enough money to truly secure our the right to close? the Veterans’ Administration has done. Includ- homeland. Tonight, the Republicans The SPEAKER pro tempore (Mr. ing cost-control provisions is the right and re- are crying broke and claiming we do HASTINGS of Washington). The gen- sponsible thing to do; however, our Repub- not have enough money to fund cred- tleman from Louisiana has the right to lican friends do not see the benefit of this. ible prescription drug coverage for our close. How unfortunate. seniors. Mr. TAUZIN. Mr. Speaker, I reserve The Democratic Substitute, which I proudly This bill provides no coverage when a the balance of my time and the right to support, is the coverage that will fulfill our senior’s prescription drug costs are be- close. pledge to seniors. It provides them with real tween $2,000 and $4,900 per year. This Mr. DINGELL. Mr. Speaker, I yield assistance within Medicare and includes provi- huge coverage gap affects 47 percent of the balance of my time to the distin- sions to curb the high cost of prescription Medicare beneficiaries. guished gentlewoman from California drugs. Seniors do not need to worry about This bill is also a giveaway to phar- (Ms. PELOSI), the minority leader, to paying more in the future if they decide to stay maceutical companies, as it prohibits close. in the traditional Medicare program. They do the Secretary of Health and Human Ms. PELOSI. Mr. Speaker, I thank need to worry about this with the Republican Services from negotiating lower drug the distinguished gentleman from bill, since the ‘‘competitive bidding’’ provision prices. The primary beneficiaries of Michigan for yielding me this time and would force seniors to pay more for their pre- this bill are not the beneficiaries of for his tremendous leadership. He has scription drugs than they do now. Seniors Medicare. They are the wealthy special been fighting this fight for America’s want a plan that is straight up, no-nonsense, interests and the pharmaceutical in- seniors for access to quality health and significant. That is what Democrats have dustry and the insurance industry that care for all Americans and an afford- provided in the substitute measure. give huge campaign contributions to able prescription drug benefit for I want to do right by the seniors in my dis- the Republicans. America’s seniors. We are all in your trict and for seniors all across the nation who Mr. Speaker, the Republicans have debt. are struggling to pay for the prescription drugs given huge tax cuts to the wealthy, Mr. Speaker, today is a sad day for they need to live fulfilling and healthy lives. promised the Iraqis a universal health America’s seniors. Another sad day, H.R. 1 was constructed with the interests of care plan. They are spending millions late at night in the Chamber of the pharmaceutical companies and private insur- attempting to buy the loyalty of war- House of Representatives, where the ance companies at heart. The voice of seniors lords in Afghanistan, and the President budget priorities of our country should was nothing but a faint echo in the rooms just gave Musharraf $3 billion. where this bill was constructed and their best Seniors, call your Republican Mem- be debated to their fullest extent, but interests have been left in the dust. For these bers and ask them why they do not where the limitation on time is placed reasons, I vote against passage of H.R. 1. We take care of the seniors of this coun- so that the American people can never need to safeguard our nation’s seniors, not try. really get the full story. This prescrip- private insurance companies. Mr. DINGELL. Mr. Speaker, I yield 1 tion drug benefit bill discussion is an Mr. DINGELL. Mr. Speaker, I yield 1 minute to the gentleman from Arkan- historic occasion for our country be- minute to the distinguished gentleman sas (Mr. ROSS). cause it does indeed, it does indeed give from New Jersey (Mr. PASCRELL). Mr. ROSS. Mr. Speaker, I thank the us the opportunity to expand Medicare (Mr. PASCRELL asked and was given gentleman from Michigan (Mr. DIN- to provide a guaranteed affordable de- permission to revise and extend his re- GELL), the ranking member, for yield- fined benefit for our seniors. The Sen- marks.) ing me the time. ate has taken up the bill for the past 2 Mr. PASCRELL. Mr. Speaker, I real- As the owner of a small-town family weeks. They have considered 30 amend- ly suggest that the other side go to see pharmacy, I got sick and tired of see- ments to the bill. Thirty amendments. the movie, it is an old movie, ‘‘Thelma ing seniors who could not afford their The House is considering the bill this and Louise.’’ Thelma turns to Louise medicine or could not afford to take it evening with no opportunity for and says, ‘‘Do not settle, Louise.’’ properly. That is why back in 2000 I de- amendment. You have settled. You blew it. In cided to run for the United States I do want to commend the gentleman fact, the seniors already are angry. The House of Representatives. from Michigan (Mr. DINGELL) and the
VerDate Jan 31 2003 05:47 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00163 Fmt 7634 Sfmt 0634 E:\CR\FM\A26JN7.080 H26PT1 H6104 CONGRESSIONAL RECORD — HOUSE June 26, 2003 gentleman from New York (Mr. RAN- deed. In doing so, the Republicans in- that they cannot write a decent pre- GEL), the ranking member on the Com- sult the intelligence, they insult the scription drug benefit for seniors. mittee on Ways and Means, for the pro- intelligence of America’s seniors. Many In fact, I might add seniors and chil- posal that they will be putting forth of you are blessed to still have your dren. Where, oh where did the child tax tonight, which is a real prescription parents with you, and some of us are credit go in all of this, as we adjourn drug benefit for seniors. I commend the even bordering on being seniors our- tomorrow? Tax cuts instead of child gentleman from California (Mr. selves, but any of you who have your tax credits. Tax cuts instead of pre- DOOLEY) for his limited opportunity parents or dear relatives who are older scription drug benefits. At the begin- but great product that he put forth on know that they are into stats. They ning of life; toward the end of life. It is the previous question on the rule ear- know their statistics. They know their a cruel hoax. lier. Another excellent proposal. And I blood count, they know their blood And so, my colleagues, no matter commend the Blue Dogs, the gen- pressure, they know their bank ac- what the Republicans tell you about tleman from California (Mr. THOMPSON) count balance, they know the cost of their bill, the euphemism that it is a and the gentleman from Arkansas (Mr. everything, many of them, because modernization of Medicare is really a BERRY), for their hard work on our mo- many of them are on fixed incomes and laugh. It is an elimination of Medicare. tion to recommit, which we hope will the slightest change has an impact on be allowed on the floor tonight. Because no matter what they tell you, their economic security. the facts are these: The Republicans do Any one of these would be far supe- So I want those seniors who are so rior to the proposal that is being put not provide a guaranteed defined ben- sensitive to changes in cost to take a efit for seniors. The Republican bill forth by the Republicans today. Why it look at this chart, which was in the is so sad is because we are supposed to does not reduce the high cost of pre- New York Times this morning, and it scription drugs. honor our parents. Our senior citizens says, ‘‘Under House GOP Bill Seniors’ Indeed, the hardest to explain to any- built our country. They raised our fam- Out-of-pocket Drug Costs Remain one is that the bill prohibits the Sec- ilies, the backbone of America. They Staggering.’’ Remain staggering. The retary of Health and Human Services fought our wars. Some of them are part average cost that seniors will pay in from negotiating for best prices. I re- of the greatest generation. Some of drug costs in 2006 is reported to be peat: Not only does the bill not bring them lived through the New Deal, $3,155. So let us take the $3,000 line for down the cost of drugs, it prohibits the many of them the Fair Deal, and to- the Republican hoax on seniors. If the Secretary of HHS from negotiating for night they are getting a raw deal. What beneficiary’s annual drug costs are the best prices. Every business in makes it so sad is that we had the op- $3,000, seniors out there, if you are pay- America, indeed the VA, does that. portunity to do it right, and one of ing about $3,000, under the House bill Volume gives you leverage; gives you those opportunities we will hear about your deductible will be $250. Your pre- opportunity. Except in this bill it is next, the Dingell-Rangel/Rangel-Din- mium will be $420. The share of initial gell Democratic proposal, of which we prohibited. coverage is $350. Gap in coverage, here are very proud. is where you fall into the gap, $1,000. And at this point I want to say that Nearly 40 years ago, when Medicare So of that $3,000 worth of drug cost, the proposal put forth by the gen- came into existence, it came at a time you, America’s seniors, will be paying tleman from Michigan (Mr. DINGELL) when many, many seniors had no ac- $2,020 out-of-pocket. Where is the ben- and the gentleman from New York (Mr. cess to health care, and now almost RANGEL), the cost of it would be cut in every senior in America has access to efit? And this is the best case scenario. These prices that you see here are sug- half, cut in half, if the Secretary had quality health care. At the time, there the authority, which our bill calls for, was no prescription drug benefit in- gestions to the HMOs. The prices could be much more, and your out-of-pocket and indeed took that responsibility to cluded in the package. That was unfor- negotiate for best prices. tunate. Today, it is imperative that we cost could be much more. What the bill does also, instead of have a prescription drug benefit in the I do not know how many of you think modernizing Medicare, is to unravel package. The advances to science have the hole is the most delicious part of not only Medicare, and I hope seniors been so miraculous. Seniors today, if the donut, but seniors, when they fall are listening, not only the prescription they have a prescription drug benefit, into this donut hole where they get no drug benefit, but part A and part B would be able to self-administer drugs, coverage, they still pay the premium. which would not only be an adjunct to They are paying a premium for some- along with the prescription drug ben- physician or hospital care but be a sup- thing that is not there. It is not there. efit, forcing seniors to compete and pay plement for it. It would be a substitute And of course, if they pay $4,500 in drug more to stay in Medicare, the Medicare for it. costs, they are paying $3,520 out-of- they know and trust. I repeat: When So think of what it means to the pocket. A cruel hoax on America’s sen- this bill, in 2010, comes to fruition, sen- quality of life for our seniors in order iors. And they call that modernization. iors will have to pay more to stay in for them to have that independence I call it humiliation. I call that insult- Medicare for part A, part B, and pre- and to be able to know that it is guar- ing the intelligence of America’s sen- scription drug benefits. anteed, defined, and dependable. Think iors. And this is really a sad one in their of what it means to the taxpayer in the It was interesting, in this same arti- bill. The employer piece. The employer reduction of cost in medical services to cle today one senior who was quoted on piece. There are many businesses in seniors because they can have access to the subject said, ‘‘Do you think any- America who honor their responsibility prescription drug benefits. That is body in Washington, D.C. has any idea to their retirees. The CBO, the Con- what makes this such a tragedy. It what people on a limited income have gressional Budget Office, estimates makes it such a tragedy. to do to live?’’ Clearly, the Republicans that under the Republican bill one- So tonight, instead of honoring our do not. They are just too busy giving third of all retirees who get their bene- parents and our seniors, we are foisting the biggest tax breaks to the highest- fits from their employers will lose a hoax upon them, at least the Repub- end people in our country. They are their coverage. Millions of seniors will licans are. And a cruel hoax it is in- just too busy giving those tax breaks be worse off.
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00164 Fmt 7634 Sfmt 0634 E:\CR\FM\K26JN7.214 H26PT1 June 26, 2003 CONGRESSIONAL RECORD — HOUSE H6105 So that is why I say this is really a care, whose credentials are impeccable benefits; not making millions of sen- tragedy. It is a missed opportunity. It in this regard, they support Medicare. iors be worse off. could be so good. It could be bipartisan. They have promoted a bill that is wor- America’s seniors deserve a benefit It could be what seniors expect and de- thy of the seniors whom we respect. It serve. Democrats have a better idea. is a guaranteed defined benefit under that is affordable, with reasonable pre- The Rangel-Dingell/Dingell-Rangel pro- Medicare. It does give the authority to miums and deductibles. America’s sen- posal, the two distinguished gentlemen the Secretary to negotiate for best iors deserve a benefit that is available who have spent a lifetime in public pol- prices. It protects seniors’ options in to all seniors and disabled Americans, icy promoting access to quality health terms of their employers giving them including Americans in rural areas.
N O T I C E Incomplete record of House proceedings. Today’s House proceedings will be continued in the next issue of the Record.
VerDate Jan 31 2003 06:32 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00165 Fmt 7634 Sfmt 8633 E:\CR\FM\K26JN7.215 H26PT1 E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 108 CONGRESS, FIRST SESSION
Vol. 149 WASHINGTON, THURSDAY, JUNE 26, 2003 No. 96 Senate The Senate met at 9:15 a.m. and was RECOGNITION OF THE MAJORITY RECOGNITION OF THE MINORITY called to order by the President pro LEADER LEADER tempore (Mr. STEVENS). The PRESIDENT pro tempore. The The PRESIDENT pro tempore. The The PRESIDENT pro tempore. To- majority leader is recognized. Democratic leader is recognized. day’s prayer will be offered by our Mr. DASCHLE. Mr. President, I have guest Chaplain, Rev. Richard A. f indicated to the majority leader that I Lapehn of Milton Presbyterian Church, SCHEDULE intend to work with him today to Rittman, OH. schedule as many of these votes and to Mr. FRIST. Mr. President, this morn- work through the pending amend- PRAYER ing the Senate will immediately re- ments. The guest Chaplain offered the fol- sume consideration of S. 1, the pre- As he noted, there are approximately lowing prayer: scription drug benefit/Medicare bill. 50 pending amendments. It is my hope Let us pray: Under the previous agreement, the that our managers might look care- Triumphant and holy God, ruler of Senate will begin two back-to-back fully at many of them and perhaps ac- Heaven and Earth, You have given to rollcall votes shortly. We were in late cept them on voice votes, but those re- us the privilege of living in these un- last night, and we set those votes to quiring rollcalls I hope can be sched- precedented times. We know that our occur the first thing this morning. uled earlier rather than later through- hope is vain when it is placed in hu- The voting schedule will be as fol- out the day. mankind. Scripture cries aloud, ‘‘As lows: The first vote will be in relation We will work on our side to perhaps the heavens are higher than the earth, to the Harkin amendment No. 991 deal- offer them en bloc, where we could so are My ways higher than your ways, ing with demonstration programs. The have a sequence of rollcall votes and My thoughts than your thoughts’’ second vote will be in relation to the throughout the day, but we certainly declares the Lord (Isaiah 55:9). Blessed Edwards amendment No. 1052 dealing will work with the majority leader to is the Nation whose God is the Lord. with drug advertising. For the remain- see if we can accomplish as much as he May we listen for Your voice and der of the day, we will continue to de- has laid out for the schedule, with an learn, hear and obey You amid the bate and vote on amendments to S. 1. expectation that perhaps by the end of competing pressures for our time. Our We have made very good progress this evening we will have completed world will not thrive with pusillani- over the last 2 weeks on this bill. The our work on the bill. mous leaders, bereft of the courage to Democratic leader and I were just talk- I yield the floor. ing, and we still have 50 amendments speak and act for those things which f are just and right in Your eyes. These pending. It is my hope a number of uncommon days require leaders who these amendments will be disposed of RESERVATION OF LEADER TIME will seek out Your vision, soak up Your by voice vote. I know the managers are The PRESIDENT pro tempore. Under wisdom, and rely upon Your strength working along that line. Inevitably, the previous order, the leadership time for the rigorous task they face. though, we are going to have a very is reserved. heavy voting schedule today and into May debate be lively and leavened f with hope, may conversations uplift this evening. Members should expect PRESCRIPTION DRUG AND MEDI- and encourage, and may the words spo- rollcall votes throughout the day and, CARE IMPROVEMENT ACT OF ken in this Chamber bring persistent if necessary, into the wee hours of the 2003—Resumed honor to Your Name. Bless each Sen- morning on Friday. We will know a lit- ator with Your mercy, Your peace, and tle bit later today the pace of these The PRESIDENT pro tempore. Under Your abiding Spirit. Amen. amendments and how they can best be the previous order, the hour of 9:15 a.m. handled. having arrived, the Senate will proceed f My intention was to finish this bill to the consideration of S. 1, which the before the July 4 recess. I think every- clerk will report. PLEDGE OF ALLEGIANCE body is working in good faith to do just The legislative clerk read as follows: The PRESIDENT pro tempore led the that. With the cooperation of all Mem- A bill (S. 1) to amend title XVIII of the So- Pledge of Allegiance, as follows: bers, and if we are able to continue vot- cial Security Act to make improvements in I pledge allegiance to the Flag of the ing throughout the day and the debate- the Medicare Program, to provide prescrip- United States of America, and to the Repub- and-amendment process, we may be tion drug coverage under the Medicare Pro- lic for which it stands, one nation under God, able to pass this legislation this gram, and for other purposes. indivisible, with liberty and justice for all. evening. Pending:
∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor.
S8605
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VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00001 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.000 S26PT1 S8606 CONGRESSIONAL RECORD — SENATE June 26, 2003 Kerry amendment No. 958, to increase the on Finance should hold hearings regarding for Medicare beneficiaries enrolled for pre- availability of discounted prescription drugs. permitting States to provide health benefits scription drug coverage under Part D. Lincoln modified amendment No. 934, to to legal immigrants under Medicaid and Graham (SC) modified amendment No. 948, ensure coverage for syringes for the adminis- SCHIP as part of the reauthorization of the to provide for the establishment of a Na- tration of insulin, and necessary medical Temporary Assistance for Needy Families tional Bipartisan Commission on Medicare supplies associated with the administration Program. Reform. of insulin. Conrad amendment No. 1019, to provide for Stabenow/Levin amendment No. 1075, to Lincoln amendment No. 935, to clarify the coverage of self-injected biologicals under permanently extend a moratorium on the intent of Congress regarding an exception to Part B of the Medicare Program until Medi- treatment of a certain facility as an institu- the initial residency period for geriatric resi- care prescription drug plans are available. tion for mental diseases. dency or fellowship programs. Conrad amendment No. 1020, to perma- Stabenow/Levin amendment No. 1076, to Lincoln amendment No. 959, to establish a nently and fully equalize the standardized provide for the treatment of payments to demonstration project for direct access to payment rate beginning in fiscal year 2004. certain comprehensive cancer centers. Conrad amendment No. 1021, to address physical therapy services under the Medicare Stabenow/Levin amendment No. 1077, to Medicare payment inequities. Program. provide for the redistribution of unused resi- Clinton amendment No. 999, to provide for Baucus (for Jeffords) amendment No. 964, dent positions. to include coverage for tobacco cessation the development of quality indicators for the priority areas of the Institute of Medicine, Ensign/Lincoln amendment No. 1024, to products. amend title XVIII of the Social Security Act Baucus (for Jeffords) amendment No. 965, for the standardization of quality indicators to repeal the Medicare outpatient rehabilita- to establish a Council for Technology and In- for Federal agencies, and for the establish- tion therapy caps. novation. ment of a demonstration program for the re- Smith/Feingold amendment No. 1073, to Nelson (FL) amendment No. 938, to provide porting of health care quality data at the allow the Secretary to include in the defini- for a study and report on the propagation of community level. tion of ‘‘specialized Medicare+Choice plans concierge care. Clinton amendment No. 953, to provide Nelson (FL) amendment No. 936, to provide training to long-term care ombudsman. for special needs beneficiaries’’ plans that for an extension of the demonstration for Clinton amendment No. 954, to require the disproportionately serve such special needs ESRD managed care. Secretary of Health and Human Services to beneficiaries or frail, elderly Medicare bene- Baucus (for Harkin) amendment No. 968, to develop literacy standards for informational ficiaries. restore reimbursement for total body materials, particularly drug information. Grassley (for Craig) amendment No. 1087, orthotic management for nonambulatory, se- Reid (for Boxer) amendment No. 1036, to to permit the offering of consumer-driven verely disabled nursing home residents. eliminate the coverage gap for individuals health plans under Medicare Advantage. Baucus (for Cantwell) amendment No. 942, with cancer. Baucus (for Mikulski) amendment No. 1088, to prohibit an eligible entity offering a Medi- Reid (for Corzine) amendment No. 1037, to to provide equitable treatment for children’s care prescription drug plan, a Medicare Ad- permit Medicare beneficiaries to use feder- hospitals. vantage organization offering a Medicare Ad- ally qualified health centers to fill their pre- Baucus (for Mikulski) amendment No. 1089, vantage plan, and other health plans from scriptions. to provide equitable treatment for certain Reid (for Jeffords) amendment No. 1038, to contracting with a pharmacy benefit man- children’s hospitals. improve the critical access hospital pro- ager (PBM) unless the PBM satisfies certain Baucus (for Mikulski) amendment No. 1090, gram. requirements. to permit direct payment under the Medicare Reid (for Inouye) amendment No. 1039, to Rockefeller amendment No. 975, to make Program for clinical social worker services amend title XIX of the Social Security Act all Medicare beneficiaries eligible for Medi- provided to residents of skilled nursing fa- to provide 100 percent reimbursement for care prescription drug coverage. cilities. medical assistance provided to a Native Ha- Akaka amendment No. 980, to expand as- Baucus (for Mikulski) amendment No. 1091, waiian through a federally qualified health sistance with coverage for legal immigrants to extend certain municipal health service center or a Native Hawaiian health care sys- under the Medicaid Program and SCHIP to demonstration projects. tem. include citizens of the Freely Associated Grassley/Baucus amendment No. 1092, to Thomas/Lincoln amendment No. 988, to States. evaluate alternative payment and delivery provide for the coverage of marriage and Akaka amendment No. 979, to ensure that systems. family therapist services and mental health current prescription drug benefits to Medi- counselor services under Part B of the Medi- Kyl amendment No. 1093 (to amendment care-eligible enrollees in the Federal Em- care Program. No. 1092) in the nature of a substitute. ployees Health Benefits Program will not be Edwards/Harkin amendment No. 1052, to AMENDMENT NO. 991 diminished. strengthen protections for consumers Bingaman amendment No. 973, to amend The PRESIDENT pro tempore. There against misleading direct-to-consumer drug title XVIII of the Social Security Act to pro- will be 2 minutes equally divided on advertising. vide for the authorization of reimbursement Enzi/Lincoln amendment No. 1051, to en- the amendment. for all Medicare Part B services furnished by sure convenient access to pharmacies and Who seeks recognition? certain Indian hospitals and clinics. prohibit the tying of contracts. The Senator from Iowa. Baucus (for Lautenberg) amendment No. Enzi amendment No. 1030, to encourage the Mr. HARKIN. The amendment before 986, to make prescription drug coverage availability of Medicare Advantage benefits available beginning on July 1, 2004. us is the one where the money follows in medically underserved areas. the purse. It is $350 million a year for Murray amendment No. 990, to make im- Hagel/Ensign amendment No. 1012, to pro- provements in the Medicare Advantage vide Medicare beneficiaries with an addi- 5 years whereby States can use this benchmark determinations. tional choice of Medicare prescription drug money to get out of institutions, out of Harkin modified amendment No. 991, to es- plans under Part D that consists of a drug nursing homes, people with disabilities tablish a demonstration project under the discount card and protection against high and get them into community, home- Medicaid Program to encourage the provi- out-of-pocket drug costs. based living. sion of community-based services to individ- Hagel amendment No. 1026, to provide uals with disabilities. Thirteen years ago, this Congress and Medicare beneficiaries with a discount card the President signed a bill called the Dayton amendment No. 960, to require a that ensures access to privately negotiated streamlining of the Medicare regulations. discounts on drugs and protection against Americans With Disabilities Act. One Dayton amendment No. 977, to require that high out-of-pocket drug costs. of the premises of that was we no benefits be made available under Part D on Baucus (for Feinstein) amendment No. longer wanted to segregate people with January 1, 2004. 1060, to provide for an income-related in- disabilities in our society. We wanted Baucus (for Dorgan) amendment No. 993, to crease in the Part B premium for individuals to integrate people with disabilities in amend title XVIII of the Social Security Act with income in excess of $75,000 and married education, work, travel, jobs, every- to provide for coverage of cardiovascular couples with income in excess of $150,000. thing. However, under the Medicaid screening tests under the Medicare Program. Baucus (for Akaka) amendment No. 1061, Smith/Bingaman amendment No. 962, to to provide for treatment of Hawaii as a low- system, it is still segregation. provide reimbursement for federally quali- DSH State for purposes of determining a Seventy percent of our Medicaid fied health centers participating in Medicare Medicaid DSH allotment for the State for money goes to institutional care, only managed care. fiscal years 2004 and 2005. 30 percent to community-based care. Hutchison amendment No. 1004, to amend Bingaman/Domenici amendment No. 1065, What this amendment says is that for title XVIII of the Social Security Act to to update, beginning in 2009, the asset or re- the first year, the Federal Government freeze the indirect medical education adjust- source test used for purposes of determining will pick up the full share of the State ment percentage under the Medicare Pro- the eligibility of low-income beneficiaries gram at 6.5 percent. for premium and cost-sharing subsidies. so the State can take people out of in- Sessions amendment No. 1011, to express Bingaman amendment No. 1066, to permit stitutions and put them into commu- the sense of the Senate that the Committee the establishment of two new Medigap plans nity-based living.
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00002 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.003 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8607 This was proposed by President Bush ica in support of this amendment be amendment, S. AMDT. 991, in the Medicare in his budget proposal for next year. It printed in the RECORD. Prescription Drug bill. is exactly what the President proposed. I likewise ask unanimous consent Sincerely, The PRESIDENT pro tempore. The that a letter I received from United LYNNE CLEVELAND, Co-Chair. Senator’s time has expired. Cerebral Palsy and The Arc of the LEON TRIEST, Mr. HARKIN. I ask unanimous con- United States in support of this amend- Co-Chair. sent for an additional 30 seconds. ment be printed in the RECORD. The PRESIDENT pro tempore. With- Finally, this amendment would help OREGON PARALYZED VETERANS OF out objection, it is so ordered. States comply with the Americans AMERICA Mr. HARKIN. The offset we use is with Disabilities Act. As my colleagues Salem, OR, June 25, 2003. also an offset supported by the admin- in the Senate are well aware, we are Hon. GORDON SMITH, istration. I have a letter Senators can nearing the 13th anniversary of the U.S. Senate, Russell Senate Office Building, Washington, DC. look at—I put it in the RECORD last Americans with Disabilities Act and of DEAR SENATOR SMITH: on behalf of the Or- night—from the Department of Justice, the Olmstead Supreme Court decision. egon Chapter of the Paralyzed Veterans of supporting the offset we use to pay for That decision ruled that needless in- America and other disabled citizens of the this to ensure that we can get people in stitutionalization of Americans with state of Oregon, we thank you for joining community-based settings and out of disabilities constitutes discrimination Senator Harkin in introducing Amendment institutions. under the Americans with Disabilities 991 (‘‘Money Follows the Person’’), to the I yield the floor. Act. I urge my colleagues on both sides Prescription Drug and Medicare Improve- ment Act of 2003 (S. 1). This amendment Mr. SMITH. Mr. President. I would of the aisle to support this important like to urge my colleagues to support would authorize an initiative contained in amendment and to support the freedom the President’s proposed FY 2004 budget, a the Harkin/Smith Money Follows the of choice for Americans with disabil- critical part of the administration’s New Person Amendment pending before the ities. Freedom Initiative to integrate people with Senate. There being no objection, the mate- disabilities into the community. This amendment would authorize the rial was ordered to be printed in the Amendment 991 includes fiscal offsets of 2004 Money Follows the Person initia- RECORD, as follows: $1.75 billion over five years to fund Medicaid demonstrations to assist states in developing tive in Medicaid, a part of the Presi- THE ARC AND UCP dent’s New Freedom Initiative to inte- and implementing cost-effective choices be- PUBLIC POLICY COLLABORATION, tween institutional and community services. grate people with disabilities into the Washington, DC, June 25, 2003. Financing Medicaid services for individuals communities where they live. Hon. GORDON SMITH, who transition from institutions to the com- This amendment would create a 5- U.S. Senate, Russell Senate Office Building, munity is a major part of this effort. year program to help States move peo- Washington, DC. When enacted, the Federal Government ple with disabilities out of institu- DEAR SENATOR SMITH: On behalf of United would fully reimburse states (100% Federal Cerebral Palsy and The Arc of the United tional settings and into their commu- match) the cost of one year of Medicaid States, we applaud your co-sponsorship of S. home and community-based services for peo- nities. For example, under this legisla- AMDT. 991 to the Prescription Drug and tion, Oregon’s effort to help an indi- ple with disabilities who leave institutions. Medicare Improvement Act that would au- After the initial year, states would be re- vidual move out of an institutional thorize the Money Follows the Person initia- sponsible for matching payments at their care facility and into a community tive in Medicaid proposed by President Bush usual Medicaid matching rate. $350 million home would be 100-percent federally in his FY 2004 budget as part of his New would be available in FY 2004 and in each of funded for 1 year. Freedom Initiative. the following four years to implement these After that first year, the Federal Senate Amendment 991 and the President’s changes. Government would pay its usual rate. proposal would create a five-year program to PVA believes that this amendment is es- provide 100 percent federal funding for one Under the provisions of this amend- sential to enable Oregon and other states to year on behalf of individuals who move from comply with the Americans with Disabilities ment, states like Oregon can take ad- an institutional setting to the community Act and the Supreme Court’s Olmstead deci- vantage of $350 million dollars of Fed- with home and community services and sup- sion. People with disabilities must have a eral assistance for 5 years for a total of ports. Money Follows the Person would as- meaningful choice to receive long term serv- $1.75 billion. sist states in meeting their obligations under ices and supports in their home or commu- This amendment is important to the the Olmstead Supreme Court decision to nity. disabled community for many reasons. serve people with long term support needs in Again, thank you for introducing Amend- First, by supporting States’ efforts to the least restrictive setting. The Arc and ment 991 during the prescription drug and UCP believe that the Money Follows the Per- help Americans who have been need- Medicare debate. son initiative will help states increase access Sincerely, lessly placed in institutional settings to home and community-based supports for SAM LEAM move into community settings, this people with disabilities and help states take President. amendment will help States increase greater steps to permanently re-balance PATRICK E. ROGERS access to home and community-based their long-term supports delivery system. Government Relations support for people with disabilities. Changes in the institutional bias in the Med- Director. Second, by assisting the movement of icaid program are long overdue. The Money (At the request of Mr. DASCHLE, the people who are not best served by an Follows the Person initiative will assist following statement was ordered to be states in making a transition for people who institution into a community care fa- want to leave institutional settings. printed in the RECORD.) cility, this amendment gives them the UCP is a national organization that works ∑ Mr. KERRY. Mr. President, I have freedom to make choices. Too often, with and for people with cerebral palsy and been a long-standing supporter of the Americans with disabilities are unable related disabilities and their families. It is Olmstead decision to end the institu- to take advantage of opportunities oth- committed to promoting and improving sup- tional bias in care for people with dis- ers take for granted—to choose where ports and services for people with disabilities abilities. Unfortunately, States have they want to live, when to visit family so that they can live, work, go to school and been slow to implement this landmark and friends, and to be active members otherwise be fully included in their commu- decision. To better help States in this nities. UCP also supports a broad range of re- of their communities. search and education efforts on cerebral effort, I am proud to say that I am an Third, this amendment helps honor palsy and related disabilities. original cosponsor of Senator HARKIN’s those veterans whose disabilities re- The Arc is the national organization of and MiCASSA legislation, S. 971, the Med- sulted from noble and selfless service for people with mental retardation and re- icaid Community-Based Attendant to this Nation. This morning, I heard lated developmental disabilities and their Services and Supports Act of 2003, a from the head of the Oregon Chapter of families. It is devoted to promoting and im- bill to ensure that ‘‘the money follows the Paralyzed Veterans of America. He proving supports and services for people with the people’’ and that true choice is confirmed that this amendment would mental retardation and their families. The granted for people with disabilities to Arc also fosters research and education re- benefit countless disabled veterans in garding the prevention of mental retardation decide whether they wish to live in Oregon alone. I would ask unanimous in infants and young children. their own communities instead of being consent that the letter that I received We urge all Senators to join you and Sen- institutionalized. The bill also provides from the Paralyzed Veterans of Amer- ator Harkin to support inclusion of your major Federal resources to assist
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00003 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.006 S26PT1 S8608 CONGRESSIONAL RECORD — SENATE June 26, 2003 States with the costs of paying for OASIS, a home health agency to gather or cessive paperwork requirements. They community-based attendant and sup- submit information that relates to an indi- said they were going to leave the home port services. Had I been present for vidual who is not eligible for benefits under health industry and return to the hos- either title XVIII or title XIX of the Social the vote, I would have voted against Security Act (such information in this sec- pital industry. the motion to table the Harkin amend- tion referred to as ‘‘non-medicare/medicaid We cannot afford this. Home health ment and would have voted in favor of OASIS information’’). care is a vital player in health care for its inclusion in the Medicare prescrip- (b) PERIOD OF SUSPENSION.—The period de- seniors and all individuals. If this pa- tion drug bill.∑ scribed in this subsection— perwork crisis continues, home health The PRESIDENT pro tempore. The (1) begins on the date of the enactment of care will continue to lose caregivers Senator from Pennsylvania is recog- this Act; and and bloat its current caregiver short- (2) ends on the last day of the 2nd month nized for 11⁄2 minutes. age. beginning after the date as of which the Sec- Currently CMS requires that home Mr. SANTORUM. Mr. President, I retary has published final regulations re- think what the Senator from Iowa has garding the collection and use by the Centers health caregivers administer OASIS to done is a very worthy thing. The Presi- for Medicare & Medicaid Services of non- Medicare patients, to Medicaid pa- dent has focused on this. Part of the medicare/medicaid OASIS information fol- tients, and to patients who have pri- President’s plan is what the Senator lowing the submission of the report required vate health insurance. The problem from Iowa has before us. The problem under subsection (c). with this regulation, however, is that with this is that this is a Medicaid pro- (c) REPORT.— the data collected for private health (1) STUDY.—The Secretary shall conduct a insurance patients is not even used. posal that is under the jurisdiction of study on how non-medicare/medicaid OASIS the Finance Committee. The Finance information is and can be used by large home This data literally sits in the offices of Committee would like the opportunity, health agencies. Such study shall examine— home health agencies with no current in the context of looking at the Med- (A) whether there are unique benefits from purpose. icaid Program, to work this through the analysis of such information that cannot The fact is CMS requires that home the structure. A, to have this amend- be derived from other information available health agencies encode the OASIS data ment come to the floor, not having to, or collected by, such agencies; and for Medicare and Medicaid patients gone through the normal process, I (B) the value of collecting such informa- only and to transmit it to their States. tion by small home health agencies com- Then the information is transmitted think is inappropriate; B, this is a pared to the administrative burden related Medicare bill, not a Medicaid bill. to such collection. into the Federal OASIS Repository. I say to the Senator from Iowa, I For all private insurance patients, In conducting the study the Secretary shall the home health agencies do not have know Senator GRASSLEY has said to me obtain recommendations from quality as- he is willing to work with his colleague sessment experts in the use of such informa- to encode or transmit the data. So from Iowa on moving this forward. The tion and the necessity of small, as well as these nurses, physical therapists, occu- legislation the Senator from Iowa has large, home health agencies collecting such pational therapists, and nurse practi- put forward has merit and will prob- information. tioners are required to collect this data ably receive bipartisan support, but it (2) REPORT.—The Secretary shall submit to for no reason. does not belong on this bill. Congress a report on the study conducted It is my understanding CMS intends So I ask my colleagues—by the way, under paragraph (1) by not later than 18 to require the transmission of data for months after the date of the enactment of private health patients at some point. it is $1.75 billion. I understand there is this Act. an offset, but this is a Medicare bill (d) CONSTRUCTION.—Nothing in this section But it has been 4 years and they have and we should defeat this amendment. shall be construed as preventing home health not done it yet. I ask unanimous consent that the agencies from collecting non-medicare/med- In the meantime there are still many Senator from Colorado be recognized to icaid OASIS information for their own use. problems with OASIS. Until CMS lay down an amendment. Mr. ALLARD. Mr. President, Medi- issues the improved regulation, care- The PRESIDENT pro tempore. The care home health providers are in a pa- givers should be allowed to stop col- Senator from Colorado. perwork crisis. Current regulations of lecting unused data that ends up in the Mr. ALLARD. Mr. President, I ask the Centers for Medicare and Medicaid filing cabinets of home health agen- that the pending amendment be tempo- Services, CMS, requires that caregivers cies. rarily laid aside. administer voluminous paperwork to The amendment I am offering with The PRESIDENT pro tempore. With- patients when they administer care. Senators FEINGOLD, COLLINS, KOHL, and out objection, it is so ordered. These paperwork requirements are LEAHY would suspend the CMS require- AMENDMENT NO. 1017 too excessive for both patients and ment of collecting OASIS data for pri- Mr. ALLARD. I send amendment No. caregivers. Caregivers must administer vate insurance patients, non-Medicare 1017 to the desk. numerous forms including data collec- and non-Medicaid patients, until an The PRESIDENT pro tempore. The tion, patient privacy information, a outcome by CMS’s two OASIS working clerk will report. plan of care, advance directives, a visit groups is reached. The bill clerk read as follows: schedule, a comprehensive assessment, Specifically, OASIS would be sus- The Senator from Colorado (Mr. ALLARD), and more. pended until the 2 months immediately for himself, Mr. FEINGOLD, Mr. KOHL, and Mr. One of these requirements, called after HHS issues its regulations about LEAHY, proposes an amendment numbered OASIS, or the Outcome and Assess- OASIS. The regulations will be based 1017. ment Information Set, is 94 questions on the information collected from and Mr. ALLARD. Mr. President, I ask long and takes a few hours to fill out. the recommendations of CMS’s two unanimous consent that the reading of Before a nurse or physical therapist ad- working groups that are determining the amendment be dispensed with. ministers care, she and the patient over the course of 3 years ways to im- The PRESIDENT pro tempore. With- must sit down and answer questions prove OASIS data collection and qual- out objection, it is so ordered. and fill out this paperwork. Colorado ity assurance. The amendment is as follows: providers have told me they spend Our amendment is supported by care- (Purpose: To provide for temporary suspen- more time filling out paperwork than givers in home health who administer sion of OASIS requirement for collection they do caring for patients. OASIS, including physical therapists, of data on non-medicare and non-medicaid As a result of this excessive data col- nurses, nurse practitioners, occupa- patients) lection and dissemination, home health tional therapists, and speech thera- At the end of title VI, insert the following: caregivers are leaving the home health pists. Congresswoman NANCY JOHNSON, SEC. ll. TEMPORARY SUSPENSION OF OASIS industry. Two weeks ago a home health chairwoman of the Oversight Sub- REQUIREMENT FOR COLLECTION OF administrator in Colorado Springs committee of the House Committee on DATA ON NON-MEDICARE AND NON- came to share with me the situation in Ways and Means, also strongly sup- MEDICAID PATIENTS. (a) IN GENERAL.—During the period de- her agency. On her plane trip here, ports this amendment. In addition, our scribed in subsection (b), the Secretary may three of her newly-home health phys- language was included in Medicare re- not require, under section 4602(e) of the Bal- ical therapists called to tell her they form bills in the Senate in the last 2 anced Budget Act of 1997 or otherwise under were leaving the agency because of ex- consecutive years. Further, I commend
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00004 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.086 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8609 Senator FEINGOLD for introducing leg- Sarbanes Smith Stabenow There being no objection, the mate- islation last Congress to reform OASIS Schumer Specter Wyden rial was ordered to be printed in the and I commend Senator MURKOWSKI NOT VOTING—2 RECORD, as follows: and Senator KERRY for their work on JUNE 26, 2003 the MARCIA regulatory reform legisla- Kerry Lieberman To: Members of the United States Senate: tion, which included an OASIS suspen- The motion was agreed to. The undersigned organizations are writing sion. Mr. SANTORUM. Madam President, I in opposition to the amendment offered by My colleagues and I believe OASIS move to reconsider the vote. Senator EDWARDS regarding changes to Di- Mr. GRASSLEY. I move to lay that rect to Consumer advertising of pharma- data collection is helpful and should be ceutical products. This amendment would applied. Even providers and patients, motion on the table. impose serious restrictions on information who must comply with the law, believe The motion to lay on the table was which is of considerable value to the mil- this. Yet the requirements to collect agreed to. lions of patients we represent. data should be achievable and AMENDMENT NO. 1052 Our organizations are advocates for mil- inexcessive. Mr. BAUCUS. Madam President, will lions of Americans who suffer from a broad I am pleased to offer this amendment the Chair state the regular order? range of illnesses. Early detection and treat- and urge my colleagues to support this The PRESIDING OFFICER. There ment of these illnesses is an important fac- tor in helping those individuals lead longer effort for caregivers and patients. will be 2 minutes evenly divided before and healthier lives. Communication, public Mr. ALLARD. Mr. President, I ask the vote on the next amendment. education and awareness are key compo- unanimous consent that the two addi- Mr. BAUCUS. I thank the Chair. nents in the outcomes American patients tional cosponsors be added to the The PRESIDING OFFICER. Who can hope to achieve. Limiting access to cred- amendment, Senator KOHL and Senator yields time? ible information is bad healthcare policy and LEAHY. Mr. BAUCUS. The Senator from we urge you to oppose the Edwards amend- The PRESIDENT pro tempore. With- North Carolina. ment and any other efforts to deny Ameri- out objection, it is so ordered. Mr. EDWARDS. Madam President, cans information. yesterday we voted on the Edwards- Respectfully, The Senator from Pennsylvania. The National Alliance for the Mentally Ill. VOTE ON AMENDMENT NO. 991 Harkin amendment which had two pro- The National Mental Health Association. Mr. SANTORUM. Mr. President, I visions. The first provision dealt with The American Association of Diabetes move to table the Harkin amendment the FDA approval process for ‘‘me too’’ Educators. drugs. There were concerns expressed The American Foundation for Urologic and ask for the yeas and nays. Disease. The PRESIDENT pro tempore. Is by the Members of the Senate about that provision. Even though I disagreed The American Lung Foundation. there a sufficient second? The National Health Council. There is a sufficient second. with those concerns, I don’t think it The Interamerican College of Physicians The question is on agreeing to the would have slowed down the FDA ap- and Surgeons. motion. proval process. Because of those con- The Kidney Cancer Association. cerns, we have removed those provi- The Society for Womens Health Research. The clerk will call the roll. The National Headache Foundation. The legislative clerk called the roll. sions from this amendment. The amendment we are about to vote The National Coalition for Women with Mr. REID, I announce that the Sen- Heart Disease. on deals only with advertising. It in no ator from Massachusetts (Mr. KERRY) The National Osteoporosis Foundation. way bans advertising. All this amend- and the Senator from Connecticut (Mr. The American Liver Foundation. ment does is require that the adver- The National Stroke Association. LIEBERMAN) are necessarily absent. tising engaged in by drug companies I further announce that, if present Mr. ENZI. Madam President, these and pharmaceutical companies be and voting, the Senator from Massa- are organizations that are advocates evenhanded. The only thing this chusetts (Mr. KERRY) would each vote for millions of Americans who suffer amendment requires is that the infor- ‘‘nay’’. from a broad range of illnesses. Early mation be accurate and evenhanded. In The PRESIDING OFFICER (Ms. MUR- detection and treatment of these ill- other words, you can’t have kids danc- KOWSKI). Are there any other Senators nesses is more communication. Public ing in a field as the image on television in the Chamber desiring to vote? education and awareness are key com- and in small print at the bottom say- The result was announced—yeas 50, ponents. Advertising is the key compo- ing the drug can cause strokes or have nays 48, as follows: nent of it. other side effects. This amendment would require the [Rollcall Vote No. 247 Leg.] We want to make sure the American Secretary of Health and Human Serv- YEAS—50 people in these advertisements get ac- ices to promulgate new rules that Alexander Craig Lugar curate information and which is not would require advertisements to pro- Allard Crapo McCain misleading. This amendment does ex- Allen DeWine McConnell vide information about a drug’s effec- Baucus Dole Murkowski actly that. We have eliminated the pro- tiveness in comparison to other drugs Bennett Domenici Nickles vision so many were concerned about for ‘‘substantially the same condition.’’ Bond Enzi Roberts yesterday. Breaux Fitzgerald In other words, you have to advertise Santorum I urge my colleagues to support this with your competitors as well. The un- Brownback Frist Sessions Bunning Graham (SC) amendment. Let us make sure the Shelby fortunate effect would be to make the Burns Grassley Snowe American people get true and accurate advertisements even more complex, Campbell Gregg Stevens information in the advertising they are Chafee Hagel not less, for consumers. It would force Chambliss Hatch Sununu seeing on drugs on television. ads to drop other information that Cochran Hutchison Talent The PRESIDING OFFICER. Who would be beneficial to consumers. Coleman Inhofe Thomas yields time? Voinovich I ask that you reject the amendment. Collins Kyl Mr. ENZI. Madam President, I rise in Cornyn Lott Warner The PRESIDING OFFICER. The opposition to this amendment sub- question is on agreeing to the amend- NAYS—48 mitted by my colleague from North ment. Akaka Dorgan Landrieu Carolina, Senator EDWARDS. Yesterday, Mr. SANTORUM. Madam President, I Bayh Durbin Lautenberg the Senate defeated an amendment of- Biden Edwards Leahy ask for the yeas and nays. Bingaman Ensign Levin fered by my colleague that would have The PRESIDING OFFICER. Is there a Boxer Feingold Lincoln restricted direct-to-consumer adver- sufficient second? Byrd Feinstein Mikulski tising of prescription medicines. There is a sufficient second. Cantwell Graham (FL) Miller Carper Harkin Murray This new amendment continues this The clerk will call the roll. Clinton Hollings Nelson (FL) effort by offering similar advertising The bill clerk called the roll. Conrad Inouye Nelson (NE) provisions to those already defeated. Mr. REID. I announce that the Sen- Corzine Jeffords Pryor I have a list of 14 organizations which ator from Massachusetts (Mr. KERRY) Daschle Johnson Reed Dayton Kennedy Reid I ask unanimous consent be printed in and the Senator from Connecticut (Mr. Dodd Kohl Rockefeller the RECORD. LIEBERMAN) are necessarily absent.
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00005 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.003 S26PT1 S8610 CONGRESSIONAL RECORD — SENATE June 26, 2003 I further announce that, if present risk adjusters under section 1860D–11, the there are fewer than 3 bids in a highly com- and voting, the Senator from Massa- Secretary shall designate a limited number petitive region for a year, the Secretary chusetts (Mr. KERRY) would vote (but in no case fewer than 1) of preferred pro- shall substitute the lowest bid for the bench- ‘‘Yea’’. vider regions (other than the region de- mark applicable under subsection (c)(4). ‘‘(5) FUNDING LIMITATION.— The PRESIDING OFFICER. Are there scribed in subsection (a)(2)(C)(ii)) as highly competitive regions. ‘‘(A) IN GENERAL.— any other Senators in the Chamber de- ‘‘(B) SUBSEQUENT YEARS.—For each year ‘‘(i) IN GENERAL.—The total amount ex- siring to vote? (beginning with 2009) the Secretary may des- pended as a result of the application of this The result was announced—yeas 39, ignate a limited number of preferred pro- subsection during the period or year, as ap- nays 59, as follows: vider regions (other than the region de- plicable, may not exceed the applicable [Rollcall Vote No. 248 Leg.] scribed in subsection (a)(2)(C)(ii)) as highly amount (as defined in clause (ii)). YEAS—39 competitive regions in addition to any re- ‘‘(ii) APPLICABLE AMOUNT DEFINED.—In this gion designated as a highly competitive re- paragraph, the term ‘applicable amount’ Akaka Durbin Lincoln gion under subparagraph (A). means— Bayh Edwards Mikulski ‘‘(I) for the period beginning on January 1, Bingaman Feingold Miller ‘‘(C) CONSIDERATIONS.—In determining Boxer Feinstein Murray which preferred provider regions to designate 2009, and ending on September 30, 2013, the Byrd Graham (FL) Nelson (FL) as highly competitive regions under subpara- total amount that would have been expended Cantwell Harkin Pryor graph (A) or (B), the Secretary shall consider under this title during the period if this sub- Clinton Inouye Reed the following: section had not been enacted plus Conrad Johnson Reid ‘‘(i) Whether the application of this sub- $6,000,000,000; and Corzine Kennedy Rockefeller section to the preferred provider region ‘‘(II) for fiscal year 2014 and any subse- Daschle Kohl Sarbanes would enhance the participation of preferred quent fiscal year, the total amount that Dayton Landrieu Schumer would have been expended under this title Dodd Leahy Stabenow provider organization plans in that region. Dorgan Levin Wyden ‘‘(ii) Whether the Secretary anticipates during the year if this subsection had not been enacted. NAYS—59 that there is likely to be at least 3 bids sub- mitted under subsection (d)(1) with respect ‘‘(B) APPLICATION OF LIMITATION.—If the Alexander Crapo Lugar to the preferred provider region if the Sec- Secretary determines that the application of Allard DeWine McCain retary designates such region as a highly this subsection will cause expenditures to ex- Allen Dole McConnell competitive region under subparagraph (A) ceed the applicable amount, the Secretary Baucus Domenici Murkowski or (B). shall— Bennett Ensign Nelson (NE) ‘‘(i) take appropriate steps to stay within Biden Enzi Nickles ‘‘(iii) Whether the Secretary expects that Bond Fitzgerald MedicareAdvantage eligible individuals will the applicable amount, including through Roberts providing limitations on enrollment; or Breaux Frist Santorum elect preferred provider organization plans Brownback Graham (SC) ‘‘(ii) rescind the designation under sub- Sessions in the preferred provider region if the region Bunning Grassley paragraph (A) or (B) of paragraph (1) of 1 or Shelby is designated as a highly competitive region Burns Gregg more preferred provider regions as highly Smith under subparagraph (A) or (B). Campbell Hagel competitive regions. Snowe ‘‘(iv) Whether the designation of the pre- Carper Hatch ‘‘(C) TRANSITION.—If the Secretary rescinds Specter ferred provider region as a highly competi- Chafee Hollings a designation under subparagraph (A) or (B) Chambliss Hutchison Stevens tive region will permit compliance with the of paragraph (1) pursuant to subparagraph Cochran Inhofe Sununu limitation described in paragraph (5). Coleman Jeffords Talent (B)(ii) with respect to a preferred provider Collins Kyl Thomas In considering the matters described in region, the Secretary shall provide for an ap- Cornyn Lautenberg Voinovich clauses (i) through (iv), the Secretary shall propriate transition from the payment sys- Craig Lott Warner give special consideration to preferred pro- tem applicable under this subsection to the vider regions where no bids were submitted NOT VOTING—2 payment system described in the other pro- under subsection (d)(1) for the previous year. visions of this section in that region. Any Kerry Lieberman ‘‘(2) EFFECT OF DESIGNATION.—If a preferred amount expended by reason of the preceding The amendment (No. 1052) was re- provider region is designated as a highly sentence shall be considered to be part of the jected. competitive region under subparagraph (A) total amount expended as a result of the ap- Mr. GRASSLEY. Madam President, I or (B) of paragraph (1)— plication of this subsection for purposes of move to reconsider the vote. ‘‘(A) the provisions of this subsection shall applying the limitation under subparagraph Mr. BAUCUS. I move to lay that mo- apply to such region and shall supersede the (A). provisions of this part relating to bench- tion on the table. ‘‘(D) APPLICATION.—Notwithstanding para- marks for preferred provider regions; and graph (1)(B), on or after January 1 of the The motion to lay on the table was ‘‘(B) such region shall continue to be a year in which the fiscal year described in agreed to. highly competitive region until such des- subparagraph (A)(ii)(II) begins, the Secretary AMENDMENT NO. 1092, AS MODIFIED ignation is rescinded pursuant to paragraph may designate appropriate regions under Mr. GRASSLEY. Madam President, I (5)(B)(ii). such paragraph. send to the desk a modification of the ‘‘(3) SUBMISSION OF BIDS.— ‘‘(6) LIMITATION OF JUDICIAL REVIEW.—There Grassley benchmark amendment filed ‘‘(A) IN GENERAL.—Notwithstanding sub- shall be no administrative or judicial review last night. I ask that I have a right to section (d)(1), for purposes of applying sec- under section 1869, section 1878, or otherwise, tion 1854(a)(2)(A)(i), the plan bid for a highly of designations made under subparagraph (A) modify my amendment. competitive region shall consist of a dollar or (B) of paragraph (1). The PRESIDING OFFICER. Without amount that represents the total amount ‘‘(7) SECRETARY REPORTS.—Not later than objection, the amendment is modified. that the plan is willing to accept (not taking April 1 of each year (beginning in 2010), the It is not the pending amendment at into account the application of the com- Secretary shall submit a report to Congress this time. prehensive risk adjustment methodology and the Comptroller General of the United The modification is as follows: under section 1853(a)(3)) for providing cov- States that includes— At the end of subtitle C of title II, add the erage of only the benefits described in sec- ‘‘(A) a detailed description of— following: tion 1852(a)(1)(A) to an individual enrolled in ‘‘(i) the total amount expended as a result Subtitle D—Evaluation of Alternative the plan that resides in the service area of of the application of this subsection in the Payment and Delivery Systems the plan for a month. previous year compared to the total amount ‘‘(B) CONSTRUCTION.—Nothing in subpara- that would have been expended under this SEC. 231. ESTABLISHMENT OF ALTERNATIVE PAY- MENT SYSTEM FOR PREFERRED graph (A) shall be construed as permitting a title in the year if this subsection had not PROVIDER ORGANIZATIONS IN preferred provider organization plan not to been enacted; HIGHLY COMPETITIVE REGIONS. provide coverage for the benefits described in ‘‘(ii) the projections of the total amount (a) ESTABLISHMENT OF ALTERNATIVE PAY- section 1852(a)(1)(C). that will be expended as a result of the appli- MENT SYSTEM FOR PREFERRED PROVIDER OR- ‘‘(4) PAYMENTS TO PREFERRED PROVIDER OR- cation of this subsection in the year in which GANIZATIONS IN HIGHLY COMPETITIVE RE- GANIZATIONS IN HIGHLY COMPETITIVE AREAS.— the report is submitted compared to the GIONS.—Section 1858 (as added by section With respect to highly competitive regions, total amount that would have been expended 211(b)) is amended by adding at the end the the following rules shall apply: under this title in the year if this subsection following new subsection: ‘‘(A) IN GENERAL.—Notwithstanding sub- had not been enacted; ‘‘(i) ALTERNATIVE PAYMENT METHODOLOGY section (c), of the plans described in sub- ‘‘(iii) amounts remaining within the fund- FOR HIGHLY COMPETITIVE REGIONS.— section (d)(1)(E), the Secretary shall sub- ing limitation specified in paragraph (5); and ‘‘(1) ANNUAL DETERMINATION AND DESIGNA- stitute the second lowest bid for the bench- ‘‘(iv) the steps that the Secretary will take TION.— mark applicable under subsection (c)(4). under clauses (i) and (ii) of paragraph (5)(B) ‘‘(A) IN 2008.—In 2008, prior to the date on ‘‘(B) IF THERE ARE FEWER THAN THREE to ensure that the application of this sub- which the Secretary expects to publish the BIDS.—Notwithstanding subsection (c), if section will not cause expenditures to exceed
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00006 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.006 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8611 the applicable amount described in para- onstrations, including expenditures as a re- (D) any improvements in the delivery of graph (5)(A); and sult of the provision of services provided to health care services under the projects; and ‘‘(B) a certification from the Chief Actuary beneficiaries under the demonstrations that (2) recommendations for such legislation of the Centers for Medicare & Medicaid Serv- are incidental to the services provided under or administrative action as the Comptroller ices that the descriptions under clauses (i), the demonstrations, and all other expendi- General determines to be appropriate. (ii), (iii), and (iv) of subparagraph (A) are tures under title XVIII of the Social Secu- (e) FUNDING.— reasonable, accurate, and based on generally rity Act. The report shall also include a cer- (1) IN GENERAL.—Payments for the costs of accepted actuarial principles and methodolo- tification from the Chief Actuary of the Cen- carrying out the projects under this section gies. ters for Medicare & Medicaid Services that shall be made from the Federal Hospital In- ‘‘(8) BIENNIAL GAO REPORTS.—Not later such estimates are reasonable, accurate, and surance Trust Fund under section 1817 of the than January 1, 2011, and biennially there- based on generally accepted actuarial prin- Social Security Act (42 U.S.C. 1395i) and the after, the Comptroller General of the United ciples and methodologies. Federal Supplementary Insurance Trust States shall submit to the Secretary and (2) PROJECTS.—Beginning in 2009, the Sec- Fund under section 1841 of such Act (42 Congress a report on the designation of high- retary, based on the empirical review con- U.S.C. 1395t), as determined appropriate by ly competitive regions under this subsection ducted under paragraph (1), shall establish the Secretary. and the application of the payment system projects under which medicare beneficiaries (2) LIMITATION.—The total amount ex- under this subsection within such regions. receiving benefits under the medicare fee- pended under the medicare fee-for-service Each report shall include— for-service program under parts A and B of program under parts A and B of title XVIII ‘‘(A) an evaluation of— title XVIII of the Social Security Act are of the Social Security Act (including all ‘‘(i) the quality of care provided to bene- provided with coverage of enhanced benefits amounts expended as a result of the projects ficiaries enrolled in a MedicareAdvantage or services under such program. The purpose under this section) during the period or year, preferred provider plan in a highly competi- of such projects is to evaluate whether the as applicable, may not exceed— tive region; provision of such enhanced benefits or serv- (A) for the period beginning on January 1, ‘‘(ii) the satisfaction of beneficiaries with ices to such beneficiaries— 2009, and ending on September 30, 2013, an benefits under such a plan; (A) improves the quality of care provided amount equal to the total amount that ‘‘(iii) the costs to the medicare program for to such beneficiaries under the medicare pro- would have been expended under the medi- payments made to such plans; and gram; care fee-for-service program under parts A ‘‘(iv) any improvements in the delivery of (B) improves the health care delivery sys- and B of title XVIII of the Social Security health care services under such a plan; tem under the medicare program; and Act during the period if the projects had not ‘‘(B) a comparative analysis of the bench- (C) results in reduced expenditures under been conducted plus $6,000,000,000; and mark system applicable under the other pro- the medicare program. (B) for fiscal year 2014 and any subsequent fiscal year, an amount equal to the total visions of this section and the payment sys- (2) ENHANCED BENEFITS OR SERVICES.—For tem applicable in highly competitive regions purposes of this section, enhanced benefits or amount that would have been expended under this subsection; and services shall include— under the medicare fee-for-service program ‘‘(C) recommendations for such legislation (A) preventive services not otherwise cov- under parts A and B of such title during the or administrative action as the Comptroller ered under title XVIII of the Social Security year if the projects had not been conducted. ONITORING AND REPORTS.— General determines to be appropriate. Act; (3) M (A) ONGOING MONITORING BY THE SECRETARY ‘‘(9) REPORT ON BUDGET NEUTRALITY FOR (B) chronic care coordination services; TO ENSURE FUNDING LIMITATION IS NOT VIO- FISCAL YEARS AFTER 2013.— (C) disease management services; or LATED.—The Secretary shall continually ‘‘(A) IN GENERAL.—If the Secretary intends (D) other benefits or services that the Sec- monitor expenditures made under title XVIII to designate 1 or more regions as highly retary determines will improve preventive of the Social Security Act by reason of the competitive regions with respect to calendar health care for medicare beneficiaries, result projects under this section to ensure that 2014 or any subsequent calendar year, the in improved chronic disease management, the limitations described in subparagraphs Secretary shall submit a report to Congress and management of complex, life-threat- (A) and (B) of paragraph (2) are not violated. indicating such intent no later than April 1 ening, or high-cost conditions and are con- (B) REPORTS.—Not later than April 1 of of the calendar year prior to the calendar sistent with the goals described in subpara- year in which the applicable designation each year (beginning in 2010), the Secretary graphs (A), (B), and (C) of paragraph (1). shall submit a report to Congress and the year begins. (b) PROJECT SITES AND DURATION.— Comptroller General of the United States ‘‘(B) REQUIREMENTS.—A report submitted (1) IN GENERAL.—Subject to subsection that includes— under subparagraph (A) shall— (e)(2), the projects under this section shall be (i) a detailed description of— ‘‘(i) specify the steps (if any) that the Sec- conducted— (I) the total amount expended under the retary will take pursuant to paragraph (5)(B) (A) in a region or regions that are com- medicare fee-for-service program under parts to ensure that the total amount expended as parable (as determined by the Secretary) to A and B of title XVIII of the Social Security a result of the application of this subsection the region or regions that are designated as Act (including all amounts expended as a re- during the year will not exceed the applica- a highly competitive region under subpara- sult of the projects under this section) dur- ble amount for the year (as defined in para- graph (A) or (B) of section 1858(i)(1) of the ing the previous year compared to the total graph (5)(A)(ii)(II)); and Social Security Act, as added by section 231 amount that would have been expended ‘‘(ii) contain a certification from the Chief of this Act; and under the original medicare fee-for-service Actuary of the Centers for Medicare and (B) during the years that a region or re- program in the year if the projects had not Medicaid Services that such steps will meet gions are designated as such a highly com- been conducted; the requirements of paragraph (5)(A) based petitive region. (II) the projections of the total amount ex- on an analysis using generally accepted ac- (2) RULE OF CONSTRUCTION.—For purposes pended under the medicare fee-for-service tuarial principles and methodologies.’’. of paragraph (1), a comparable region does program under parts A and B of title XVIII (b) CONFORMING AMENDMENT.—Section not necessarily mean the identical region. of the Social Security Act (including all 1858(c)(3)(A)(i) (as added by section 211(b)) is (c) WAIVER AUTHORITY.—The Secretary amended to read as follows: shall waive compliance with the require- amounts expended as a result of the projects ‘‘(i) Whether each preferred provider region ments of title XVIII of the Social Security under this section) during the year in which has been designated as a highly competitive Act (42 U.S.C. 1395 et seq.) only to the extent the report is submitted compared to the region under subparagraph (A) or (B) of sub- and for such period as the Secretary deter- total amount that would have been expended section (i)(1) and the benchmark amount for mines is necessary to provide for enhanced under the original medicare fee-for-service any preferred provider region (as calculated benefits or services consistent with the program in the year if the projects had not under paragraph (2)(A)) for the year that has projects under this section. been conducted; not been designated as a highly competitive (d) BIENNIAL GAO REPORTS.—Not later (III) amounts remaining within the funding region.’’. than January 1, 2011, and biennially there- limitation specified in paragraph (2); and SEC. 232. FEE-FOR-SERVICE MODERNIZATION after for as long as the projects under this (IV) how the Secretary will change the PROJECTS. section are being conducted, the Comptroller scope, site, and duration of the projects in (a) ESTABLISHMENT.— General of the United States shall submit to subsequent years in order to ensure that the (1) REVIEW AND REPORT ON RESULTS OF EX- the Secretary and Congress a report that limitations described in subparagraphs (A) ISTING DEMONSTRATIONS.— evaluates the projects. Each report shall in- and (B) of paragraph (2) are not violated; and (A) REVIEW.—The Secretary shall conduct clude— (ii) a certification from the Chief Actuary an empirical review of the results of the (1) an evaluation of— of the Centers for Medicare & Medicaid Serv- demonstrations under sections 442, 443, and (A) the quality of care provided to bene- ices that the descriptions under subclauses 444. ficiaries receiving benefits or services under (I), (II), (III), and (IV) of clause (i) are rea- (B) REPORT.—Not later than January 1, the projects; sonable, accurate, and based on generally ac- 2008, the Secretary shall submit a report to (B) the satisfaction of beneficiaries receiv- cepted actuarial principles and methodolo- Congress on the empirical review conducted ing benefits or services under the projects; gies. under subparagraph (A) which shall include (C) the costs to the medicare program (C) REPORT ON BUDGET NEUTRALITY FOR FIS- estimates of the total costs of the dem- under the projects; and CAL YEARS AFTER 2013.—
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00007 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.004 S26PT1 S8612 CONGRESSIONAL RECORD — SENATE June 26, 2003 (i) IN GENERAL.—If the Secretary intends to Mr. BAUCUS. Madam President, I medicare coverage options and benefits continue the projects under this section for ask unanimous consent that the order under parts A, B, C, and D of title XVIII of fiscal year 2014 or any subsequent fiscal year, for the quorum call be rescinded. the Social Security Act. the Secretary shall submit a report to Con- The PRESIDING OFFICER. Without (5) Working with local benefits administra- gress indicating such intent no later than tors, ombudsmen, local benefits specialists, April 1 of the year prior to the year in which objection, it is so ordered. and advocacy groups to ensure that medicare the fiscal year begins. AMENDMENT NO. 1054 beneficiaries are aware of the medicare cov- (ii) REQUIREMENTS.—A report submitted Mr. BAUCUS. Madam President, I erage options and benefits under parts A, B, under clause (i) shall— ask unanimous consent that all pend- C, and D of title XVIII of the Social Security (I) specify the steps (if any) that the Sec- ing amendments be set aside so that I Act. retary will take pursuant to paragraph (4) to (c) FUNDING.— might call up amendment No. 1054 on ensure that the limitations described in (1) ESTABLISHMENT.—Of the amounts au- paragraph (2)(B) will not be violated for the behalf of Senator FEINGOLD, with re- thorized to be appropriated under the Sec- year; and spect to Medicare beneficiaries. retary’s discretion for administrative ex- (II) contain a certification from the Chief The PRESIDING OFFICER. Without penditures, $2,000,000 may be used to estab- Actuary of the Centers for Medicare and objection, it is so ordered. lish the Office in accordance with this sec- Medicaid Services that such steps will meet The clerk will report. tion. the requirements of paragraph (2) based on The legislative clerk read as follows: (2) OPERATION.—With respect to each fiscal an analysis using generally accepted actu- year occurring after the fiscal year in which arial principles and methodologies. The Senator from Montana [Mr. BAUCUS], the Office is established under this section, (4) APPLICATION OF LIMITATION.—If the Sec- for Mr. FEINGOLD, proposes an amendment the Secretary may use, out of amounts au- retary determines that the projects under numbered 1054. thorized to be appropriated under the Sec- this section will cause the limitations de- Mr. BAUCUS. Madam President, I retary’s discretion for administrative ex- scribed in subparagraphs (A) and (B) of para- ask unanimous consent that further penditures for such fiscal year, such sums as graph (2) to be violated, the Secretary shall reading of the amendment be dispensed may be necessary to operate the Office in take appropriate steps to reduce spending with. that fiscal year. under the projects, including through reduc- Mr. BAUCUS. Madam President, I ing the scope, site, and duration of the The PRESIDING OFFICER. Without projects. objection, it is so ordered. suggest the absence of a quorum. (5) AUTHORITY.—Beginning in 2014, the Sec- The amendment is as follows: The PRESIDING OFFICER. The retary shall make necessary spending adjust- (Purpose: To establish an Office of the clerk will call the roll. ments (including pro rata reductions in pay- Medicare Beneficiary Advocate) The assistant legislative clerk pro- ments to health care providers under the ceeded to call the roll. At the end of subtitle D of title I, add the medicare program) to recoup amounts so Mr. GRASSLEY. Madam President, I following: that the limitations described in subpara- ask unanimous consent that the order SEC. 133. OFFICE OF THE MEDICARE BENE- graphs (A) and (B) of paragraph (2) are not to the quorum call be rescinded. violated. FICIARY ADVOCATE. (a) ESTABLISHMENT.—Not later than 1 year The PRESIDING OFFICER. Without Mr. BAUCUS. Mr. President, on be- after the date of enactment of this Act, the objection, it is so ordered. half of Senator CONRAD, I ask unani- Secretary shall establish within the Depart- Mr. GRASSLEY. Madam President, I mous consent that a letter from the ment of Health and Human Services, an Of- ask that the pending amendments be Congressional Budget Office be printed fice of the Medicare Beneficiary Advocate (in set aside and that the Senator from in the RECORD. this section referred to as the ‘‘Office’’). Washington be recognized for an There being no objection, the mate- (b) DUTIES.—The Office shall carry out the amendment. rial was ordered to be printed in the following activities: The PRESIDING OFFICER. Without RECORD, as follows: (1) Establishing a toll-free telephone num- objection, it is so ordered. ber for medicare beneficiaries to use to ob- U.S. CONGRESS, tain information on the medicare program, The Senator from Washington. CONGRESSIONAL BUDGET OFFICE, and particularly with respect to the benefits AMENDMENT NO. 942 Washington, DC, June 26, 2003. provided under part D of title XVIII of the Ms. CANTWELL. Madam President, I Hon. KENT CONRAD, Social Security Act and the Medicare Pre- ask unanimous consent that amend- Ranking Member, Committee on the Budget, scription Drug plans and MedicareAdvantage U.S. Senate, Washington, DC. ment No. 942 be the pending business. plans offering such benefits. The Office shall DEAR SENATOR: The Congressional Budget The PRESIDING OFFICER. Without Office has reviewed a proposed amendment ensure that the toll-free telephone number objection, it is so ordered. The amend- (GOE03.597) by Senators Grassley and Baucus accommodates beneficiaries with disabilities ment is the pending business. to S. 1, a bill to amend title XVIII of the So- and limited-English proficiency. (2) Establishing an Internet website with AMENDMENT NO. 942, AS MODIFIED cial Security Act to make improvements in Ms. CANTWELL. Madam President, I the Medicare program, to provide prescrip- easily accessible information regarding tion drug coverage under the Medicare pro- Medicare Prescription Drug plans and ask unanimous consent that the gram, and for other purposes. That amend- MedicareAdvantage plans and the benefits amendment be modified with the ment would add subtitle D to title II, estab- offered under such plans. The website shall— changes I send to the desk. lishing an alternative payment system for (A) be updated regularly to reflect changes The PRESIDING OFFICER. The Sen- preferred provider organizations in highly in services and benefits, including with re- ator has a right to modify her amend- competitive regions and fee-for-service mod- spect to the plans offered in a region and the ment. The amendment is so modified. ernization projects. associated monthly premiums, benefits of- The amendment (No. 942), as modi- CBO estimates that the amendment would fered, formularies, and contact information add $12 billion in outlays to the cost of the for such plans, and to ensure that there are fied, is as follows: bill over the 2009–2013 period—$6 billion for no broken links or errors; On page 204, after line 22, insert the fol- payments to preferred provider organizations (B) have printer-friendly, downloadable lowing: and $6 billion for the fee-for-service mod- fact sheets on the medicare coverage options SEC. 133. PHARMACY BENEFIT MANAGERS ernization projects. The amendment would and benefits; TRANSPARENCY REQUIREMENTS. allow the programs to continue after 2013, (C) be easy to navigate, with large print (a) MEDICARE.—Subpart 3 of part D of title but under the rules the amendment specifies and easily recognizable links; and XVIII of the Social Security Act (as added by for the Secretary of Health and Human Serv- (D) provide links to the websites of the eli- section 101) is amended by adding at the end ices, CBO estimates that those programs gible entities participating in part D of title the following new section: would incur no additional net costs after XVIII. ‘‘PHARMACY BENEFIT MANAGERS that time. (3) Providing regional publications to TRANSPARENCY REQUIREMENTS If you wish further details on this esti- medicare beneficiaries that include regional ‘‘SEC. 1860D–27. (a) PROHIBITION.— mate, we will be pleased to provide them. contacts for information, and that inform ‘‘(1) IN GENERAL.—Notwithstanding any Sincerely, the beneficiaries of the prescription drug other provision of law, an eligible entity of- ROBERT A. SUNSHINE benefit options under title XVIII of the So- fering a Medicare Prescription Drug plan (For Douglas Holtz-Eakin, Director.) cial Security Act, including with respect under this part or a MedicareAdvantage or- Mr. GRASSLEY. Madam President, I to— ganization offering a MedicareAdvantage suggest the absence of a quorum. (A) monthly premiums; plan under part C shall not enter into a con- The PRESIDING OFFICER. The (B) formularies; and tract with any pharmacy benefit manager (in clerk will call the roll. (C) the scope of the benefits offered. this section referred to as a ‘PBM’) that is The legislative clerk proceeded to (4) Conducting outreach to medicare bene- owned by a pharmaceutical manufacturing call the roll. ficiaries to inform the beneficiaries of the company.
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00008 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.004 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8613 ‘‘(2) PROVISION OF INFORMATION.—A PBM health plans, employers and govern- Soaring in tandem with prescription that manages prescription drug coverage ments. The allegations in these law- drugs prices are PBM profits. St. under this part or part C shall provide the suits are always the same: overinflated Louis-based Express Scripts—one of following information, on an annual basis, to drug prices, price collusion between the four largest PBMs—provides cov- the Assistant Attorney General for Antitrust of the Department of Justice and the Inspec- PBMs and manufacturers, failure of erage to 40 million people. The com- tor General of the Health and Human Serv- PBMs to share discounts and rebates, pany reported that its net income grew ices Department: and switching patients to more expen- 63 percent last year to $202.8 million. ‘‘(A) The aggregate amount of any and all sive drugs without the consent of the Another one of the big four, Advance rebates, discounts, administrative fees, pro- patient or the doctor. PCS, which covers 75 million people, motional allowances, and other payments re- The PBMs have denied wrongdoing was ranked by Fortune Magazine as ceived or recovered from each pharma- and have settled in many cases. the ninth fastest growing company in ceutical manufacturer. Last year, Merck agreed to pay $42.5 the nation based on its profits over the ‘‘(B) The amount of payments received or million to settle lawsuits over allega- past 5 years. recovered from each pharmaceutical manu- tions that Medco improperly promoted Unfortunately, it has been near im- facturer for each of the top 50 drugs as meas- higher priced Merck drugs when less possible to find out whether PBMs are ured by volume (as determined by the Sec- retary). expensive options from other pharma- fairly sharing rebates and other sav- ‘‘(C) The percentage differential between ceutical companies were available. ings with patients or simply using it to the price the PBM pays pharmacies for a In 1998, Merck signed a settlement boost the bottom line. drug described in subparagraph (B) and the agreement with the Federal Trade Even the General Accounting Office price the PBM charges a Medicare Prescrip- Commission stating that, ‘‘Medco has has been unable to find out how rebates tion Drug Plan or a MedicareAdvantage or- given favorable treatment to Merck are being divided between PBMs and ganization for such drug. drugs.’’ the Federal Employees Health Benefits ‘‘(b) FAILURE TO DISCLOSE.— This admission is proof that pharma- Plan. A GAO requested by Senator ‘‘(1) CIVIL PENALTY.—Any PBM that fails to ceutical companies and PBMs have en- comply with subsection (a) shall be liable for DORGAN last year failed to discover if a civil penalty as determined appropriate gaged in collusion on drug pricing in the PBMs were passing along the sav- through regulations promulgated by the At- the past, extracting excessive profits ings because none of the PBMs finan- torney General. Such penalty may be recov- from people who rely on these drug cial documents were available for re- ered in a civil action brought by the United services. The Cantwell-Lincoln amend- view. States. ment is needed to help prevent price Several private companies and em- ‘‘(2) COMPLIANCE AND EQUITABLE RELIEF.—If gouging in the future. ployee groups that contract with PBMs any PBM fails to comply with subsection (a), Other governments have struggled to have resorted to lawsuits to get access the United States district court may order keep a close watch on PBM practices. to this information. compliance, and may grant such other equi- In 2000, one of the big four PBMs, Ad- The Cantwell-Lincoln amendment re- table relief as the court in its discretion de- vance PCS, was hired by the state of quires the PBM to disclose to the De- termines necessary or appropriate, upon ap- Arkansas to provide coverage for the plication of the Assistant Attorney General. partment of Justice the financial ar- ‘‘(c) DISCLOSURE EXEMPTION.—Any infor- state’s 135,000 employees. A recent rangements that dictate what percent- mation filed with the Assistant Attorney audit found that the PBM was over age of rebates and other savings are General under subsection (a)(2) shall be ex- charging the state for numerous drugs. being passed back to the client. empt from disclosure under section 552 of During one 4-month period, the PBM This disclosure creates a major in- title 5, and no such information may be overcharged the state $479,000 on ge- centive for PBMs to return as much as made public, except as may be relevant to neric drugs alone. possible of the rebates and spread back any administrative or judicial action or pro- PBM executives say that my amend- to the Medicare program. This incen- ceeding. Nothing in this section is intended ment makes turning a profit impos- to prevent disclosure to either body of Con- tive also will help reduce prescription gress or to any duly authorized committee or sible. It is true that PBMs are not drug prices. subcommittee of the Congress.’’. charities but private companies with a The PBMs have argued that report- Ms. CANTWELL. Madam President, I duty to their shareholders to earn a ing this financial information would rise today to offer the Cantwell-Lin- profit. kill their ability to continue to nego- coln Prescription drug transparency Let’s not forget, however, that these tiate low drug prices. I am a business- amendment to S. 1, the medicare pre- are also private companies charged woman, and I understand the need to scription drug bill. I thank my cospon- with providing a Government-funded keep financial agreements confidential. benefit in the best interests of 40 mil- sor, Senator LINCOLN, for working with That is why my amendment mandates me on this important amendment that lion senior citizens. These private com- the information be handed over to the will help protect consumers against panies also are duty bound to get the Department of Justice, where it re- high prescription drug prices. most for the Government’s $400 billion mains confidential. This amendment does three things. investment. Department of Justice oversight also First, it requires any PBM con- Traveling in my home State of Wash- allows for regular review of these fi- tracting with Medicare to disclose to ington, I hear regularly from senior nancial arrangements to weed out any the Department of Justice how much of citizens about the high cost of prescrip- potential collusion on pricing. This the rebates and discounts negotiated tion drugs. While seniors in my State, added protection also will help lower for Medicare are being passed back. like elsewhere in the country, want a drug costs for seniors. Second, the disclosure of these finan- Medicare prescription drug benefit, The Cantwell-Lincoln amendment cial arrangements to the Department they also desperately want some relief also prohibits PBMs from being owned of Justice provides an incentive for from high prescription drug prices. by pharmaceutical manufacturers. This PBMs to return as much of that sav- They say, ‘‘Stop the price gouging. Do cross-ownership is problematic because ings as possible to Medicare, which will something to make sure that prescrip- it could allow for pharmaceutical com- in turn, help reduce the high cost of tion drugs are reasonably affordable for panies to collude with PBMs to favor prescription drugs. everyone.’’ the manufacturers more expensive Finally, it prohibits a pharma- PBMs have come to dominate the drugs over less expensive alternatives. ceutical company from owning a phar- prescription drug benefit market. Near- A report on PBMs by the National macy benefit manager, an inherent ly 210 million Americans are served by Health Policy Forum points out the conflict of interest. one of the four largest PBMs. concerns raised by close relationships By requiring transparency, the Cant- According to the Centers for Med- between PBMs and drug manufactur- well-Lincoln amendment works to pre- icaid and Medicare Services, national ers. Close ties between the two could vent collusion on pricing and helps en- prescription drug spending increased lead to a lack of drug choice for con- sure seniors are not paying unneces- by 15.7 percent in 2001. Despite prom- sumers, with one manufacturer’s drugs sarily high prices for their medica- ises from pharmacy benefit managers getting preferential treatment by the tions. to lower costs, prescription drugs con- PBM. PBMs have been the target of numer- tinue to be the fastest growing sector Actions taken this week by the U.S. ous lawsuits filed in recent years by of health care spending in this country. attorney in Philadelphia reinforce the
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00009 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.007 S26PT1 S8614 CONGRESSIONAL RECORD — SENATE June 26, 2003 need for greater PBM oversight as out- phia, the two former Medco pharmacists plaints, including the health risks associated lined in the Cantwell-Lincoln amend- make detailed charges that enormous pres- with inappropriate drug switches.’’ ment. sure was placed on employees to falsify or- In addition, Medco, like other PBMs, pro- Madam President, I ask unanimous ders to meet goals and to disregard com- vides ‘‘drug utilization reviews’’ of prescrip- plaints by patients and doctors about drug tions and patients. The process aims to pre- consent that articles from the Wash- switching or pill shortages. vent adverse drug interactions, verifies ap- ington Post and Wall Street Journal be Daily internal publication of prescription- propriate drug strength, catches drug aller- printed in the RECORD. error rates to help pharmacists measure gies or duplicate medications. There being no objection, the mate- their own safety standards were eliminated, Until 1995, such calls to physicians to alert rial was ordered to be printed in the the suit asserts. Instead, daily loudspeaker them to possible problems were made by RECORD, as follows: messages announced prescription-filling pharmacists who could fully explain the situ- costs, as well as the stock price of parent ation and suggest alternatives. Subse- [From the Wall Street Journal, June 24, 2003] company Merck, the suit says. Many Medco quently, the suit says, these calls were being U.S. IS JOINING LAWSUIT THAT SAYS MEDCO employees are compensated in part with made only by ‘‘cheaper, non-pharmacists em- PUT PROFITS BEFORE PATIENTS Merck stock options. ployees.’’ The pharmacist was only brought (By Barbara Martinez) To save money, the suit alleges, Medco re- in at the end of a call, to verify information. The Justice Department is joining a law- duced licensed pharmacists’ role in the fill- But with workers having quotas of 20 to 25 suit that alleges Merck & Co.’s Medco phar- ing and supervising of prescription drugs at calls an hour, the pharmacist was handling macy-benefits subsidiary adopted an ‘‘ag- its mail-order facilities. In addition, the job as many as 100 calls within 60 minutes. As a gressive profits-before-patients policy.’’ of calling a physician to discuss a potential result of pressures to meet the quotas, the Medco’s approach resulted in a potentially drug interaction—once the job of only phar- complaint said, employees regularly fab- dangerous lack of oversight in filling pre- macists—ultimately fell to employees who ricated records documenting that they called scriptions and increased pharmaceutical ‘‘seldom have college degrees, and have no doctors to alert them to potential safety costs for the federal government, the suit prior training in pharmacy services other issues, among other matters, when they real- says. than limited on-the-job training.’’ And as a ly hadn’t. Sometimes, the suit says, the em- The department’s involvement in the suit, result of being pressured to meet quotas on ployees would change prescriptions without brought by two former Medco pharmacists, how many doctors to call, employees regu- the pharmacist’s intervention. doesn’t necessarily mean that it believes all larly lied on physician call records to indi- In other areas of the mail-order facility, the allegations. But it signals that the gov- cate they alerted doctors about problems the complaint says, employees ‘‘permanently ernment investigated the accusations and when they really had not, according to the delete, cancel or otherwise falsify prescrip- found at least some of them worth pursuing lawsuit. tions orders’’ to reduce back-order size. As a The lawsuit was filed under the Federal in court. The government, which also joined result, the complaint says, many patients False Claims Act. In such lawsuits, the a second lawsuit against Medco Monday that didn’t get the medications they needed. plaintiff, often a former employee of a com- made similar allegations, intends to file its pany that does business with the govern- own complaint within 90 days. Justice De- [From the Washington Post, June 24, 2003] ment, alleges that the company has de- partment investigators have been examining U.S. JOINING SUIT AGAINST MEDCO frauded the government. If the government Medco and other pharmacy-benefit man- (By Charles Duhigg) considers the allegations valid, if joins the agers, or PBMs, for several years, but this is complaint, litigates the case and shares any The U.S. attorney in Philadelphia an- the first time they have indicated that any recovery or damages with the person who nounced yesterday that he is joining a com- suit would be filed. PBMs handle prescrip- filed the suit. plaint against Medco Health Solutions Inc. tion-drug-card benefits for millions of em- Medco has a significant amount of legal that alleges the nation’s second-largest phar- ployees. government business, providing mail-order macy-benefit manager improperly canceled The complaint alleges that after Merck— prescriptions to millions of federal employ- prescriptions, switched medications without one of the world’s largest drug companies— ees through the Federal Employee’s Health physician approval and sent patients par- purchased Medco in 1993, the PBM began to Benefit Program. tially filled orders. make systemic changes in its mail-order pre- Many of the allegations in this complaint The U.S. attorney’s office has been inves- scription-filling system—disregarding safety relate to Medco’s mail-order business, where tigating whistle-blower allegations against and instead promoting higher profits per pre- patients mail in a prescription and Medco the company since 1999 and intends to file its scription. fills it and sends it back. PBMs such as own complaint in September, said Associate In a statement, Medco said, ‘‘We are con- Medco have been pushing hard to promote U.S. Attorney James G. Sheehan. fident that when all the facts are presented their mail-order facilities as a cost-effective The government has decided to intervene they will show that our business has one alternative to retail stores. in two lawsuits brought by three whistle- focus, providing the highest quality of pre- According to the suit, Medco ‘‘boasts to its blowers. Those suits allege that Medco scription health care to our clients and clients nationwide that licensed pharmacists changed prescriptions without a physician’s members.’’ It added: We are prepared to check each mail-order prescription before it approval to favor more expensive drugs pro- present a nigorous defense and believe that is sent out, with as many as three or four duced by Merck & Co. and induced physi- we will prevail. We will prove that the alle- quality checks.’’ The suit says such scrutiny cians with false information to switch to gations’’ in the complaint ‘‘are absolutely only happened prior to Merck’s 1993 acquisi- higher cost Merck drugs. Medco also de- untrue or reflect years-old isolated issues tion of Medco. stroyed mail order prescriptions without fill- that were identified and corrected and in no After the acquisition, Medco automated ing them and in other cases mailed patients way and at no time compromise the quality more of its prescription-filling capabilities less than the number of pills ordered but of patient care.’’ and ‘‘significant changes’’ were instituted charged for the full amount, the lawsuits al- The airing of previously sealed allegations that ‘‘marked a shift from prudent pharmacy lege. in the suit comes at a difficult time for both practices’’ to a ‘‘focus on profit maximiza- Medco is a subsidiary of Merck. Merck and PBMs. Merck plans to spin off tion,’’ the complaint said. ‘‘We know from industry studies that al- Medco as a publicly traded company this One of Medco’s largest and most techno- most half of mail order participants will run year, while PBMs have been angling to get a logically advanced mail-order facilities is in out of medicine within two days if they fail piece of a Medicare drug benefit currently Las Vegas, where the two former Medco to receive their new prescriptions,’’ said Pat- being debated in Congress. Medco provides pharmacists who filed the complaint worked. rick L. Meehan, the U.S. attorney for the drug benefits to more than 60 million Ameri- According to the suit, after Medco upgraded eastern district of Pennsylvania. cans, including millions of federal and state its Las Vegas facility in the mid-1990s, Medco officials contend that the allega- employees. Medco’s annual revenue totals ‘‘pharmacists were no longer reading and tions are untrue or ‘‘reflect years-old iso- about $30 billion. verifying mailed prescriptions prior to entry lated issues that were identified and cor- The case could have repercussions on Cap- into a computer.’’ Instead, upon arrival, the rected,’’ said Ann Smith, director of public itol Hill, too, where PBMs are locked in a prescriptions were entered by ‘‘data-entry affairs at Medco. At no time was the quality fierce lobbying battle, especially with the re- clerks with no formal pharmacy training’’ of patient care compromised, Smith said. tail-pharmacy industry, over details of Medi- and who were supervised by nonpharmacist Most Americans know pharmacy benefit care legislation. The measure would create a managers. managers, or PBMs, from the plastic cards drug benefit that PBMs would have a promi- The suit also alleges that under a special they hand over at local pharmacies when fill- nent role in providing. Already Monday, the program, touted by Medco as promoting the ing a prescription. Major employers and National Community Pharmacists Associa- most cost-effective drugs, Medco called doc- health plans hire these companies to nego- tion, which represents about 25,000 owners of tors to get them to change their prescrip- tiate with drug companies to control drug independent drugstores, stepped up its lob- tions because of undisclosed payments to costs for plan enrollees, and to oversee the bying efforts. The group is pushing for strict- Medco from drug manufacturers. The suit complex paperwork associated with filling er disclosure requirements for PBMs. said patient and physician complaints about prescriptions. In the newly unsealed complaint, which switching prescriptions were ‘‘common’’ but The Senate is considering plans to provide was filed in U.S. District Court in Philadel- that ‘‘Medco routinely ignores these com- prescription drug coverage to the elderly
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00010 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.010 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8615 that may enhance the clout of pharmacy- benefits, and the company is supposed to use records to make it look as if the pre- benefit managers, industry analysts say. The its bulk-purchasing power to lower drug scription changes were made by doc- companies are expected to administer gov- costs. tors and not by Medco. ernment drug spending under some plans, ac- But the suits say Medco routinely induce These are serious allegations result- cording to congressional testimony offered physicians to switch patients to Merck ing from an investigation that began in by the National Association of Chain Drug drugs, even if a patient had been doing well Stores, and to receive a larger share of gov- on another medication that cost less. 1999. This is the first such action taken ernment reimbursements for prescription The government also says the company by a U.S. attorney against a PBM and drugs. failed to call doctors to explain prescriptions is a strong signal that all is not right More than 62 million Americans get pre- that were unclear, and fabricated records to with this industry. scriptions processed through Medco, accord- make it appear as if calls from pharmacists U.S. Attorney Patrick Meehan told ing to the company. Medco handles phar- to physicians had been made. the Newark Star Ledger: macy benefits totaling nearly $30 billion per The three whistleblowers—a New Jersey The kind of conduct alleged in the com- year, including $1.2 billion from Blue Cross/ doctor and two Nevada pharmacists who plaints threatens not only the integrity of Blue Shield as part of the Federal Employees once worked for Medco—claim the firm also the system as a whole, but also the well Health Benefits Program. misled clients about its practice of accepting being of the very patients it is designed to George Bradford Hund and Walter W. cash rebates from pharmaceutical companies benefit. These allegations suggest that, Gauger, who both worked as pharmacists in in exchange for promoting their products. somewhere along the line, the focus became Medco’s Las Vegas processing facility, and The suits claim the payments amount to the profit instead of the patient. Joseph Piacentile, a physician, allege in kickbacks. The possibility of profitability their complaints that on busy days Medco Medco spokesman Jeffrey Simek said the would cancel or destroy prescriptions to charges are ‘‘either absolutely untrue, or trumping patient care has promoted a avoid penalties for delays in filling orders. they reflect years-old isolated issues that number of consumer groups to favor Customers would be told that the prescrip- were identified and corrected.’’ the accountability system outlined in tions had never been received, Sheehan said. He denied the firm gives preferential treat- my amendment. Consumers Union, The company is also accused of fabricating ment to Merck, or any other drug company. Public Citizen, Families USA, records and, when the handwriting on pre- ‘‘Our policy is that we will never make a AFSCME, the National Community scriptions was unclear or difficult to read, drug interchange that will not result in a Pharmacy Association and the Wash- benefit for either our clients, or the members simply guessing at what they said, according ington State Pharmacy Association all to Sheehan. The government’s suit against of their health plans,’’ he said. ‘‘If we im- Medco could ask for damages in the millions properly favored any drug by any single com- support my amendment. of dollars and new oversight systems. pany, we could never succeed.’’ Mr. President, I ask unanimous con- Merck acquired Medco in 1993 at a time Several health plans have previously sued sent that letters of support be printed when other drugmakers were purchasing Medco, claiming that it improperly accepted in the RECORD. pharmacy-benefit managers. By the end of $3.56 billion in payments from drug compa- There being no objection, the mate- the 1990s, all pharmaceutical manufacturers nies in the late 1990s to promote their prod- rial was ordered to be printed in the but Merck had sold their units amid con- ucts, but Monday’s filing by the U.S. Attor- RECORD, as follows: ney in Philadelphia is the first such action cerns that the drug companies would use the CONSUMERS UNION, by a federal prosecutor. benefit managers to push their own drugs, Washington, DC, June 25, 2003. Medco, like other pharmacy benefit com- rather than doing what was best for clients. DEAR SENATOR: As the Senate continues to I 1998 Merck signed a settlement agree- panies, acknowledges participating in rebate debate S. 1, the ‘‘Prescription Drug and ment with the Federal Trade Commission programs. Simek said the company took in Medicare Improvement Act of 2003,’’ Con- stating that ‘‘Medco has given favorable $2.5 billion in rebates in 2001. But he said the sumers Union urges you to redouble your ef- treatment to Merck drugs.’’ Last December, payments work like coupons and ultimately forts to improve the legislation so that it Medco agreed to pay $42.5 million to settle a lower medication costs for clients. better meets the needs of seniors and people class-action lawsuit alleging that the com- The suits also accuse Medco, of Franklin with disabilities, many of whom are in dire pany improperly promoted higher priced Lakes, N.J., of shortchanging patients by need of meaningful protection from the dev- Merck drugs rather than seeking the best mailing them fewer than the number of pills astating impact of spiraling prescription price from alternative pharmaceutical com- they paid for. They say the company tried to drug costs. panies. Merck announced it intended to spin avoid penalties for delays in filling mail or- Some of Consumers Union’s most serious off Medco last year, but delayed the initial ders by destroying prescriptions on days concerns about S. 1 are: public offering of shares because of the de- when the order volume was heavy. The amount set aside in the Congressional pressed stock market. Simek said the company investigated the budget resolution for a Medicare prescrip- Yesterday’s announcement marks the first allegations and determined they were iso- tion drug bill, $400 billion over 10 years, is in- significant legal action by a federal agency lated incidents that didn’t affect patient adequate for the task and limits coverage to against a pharmacy-benefit manager. Pre- care. Two employees were fired, he said. 22 percent of the projected prescription drug viously, attorneys general of at least 25 Court filings identified the whistleblowers expenditures over this time period; states have opened inquires into Medco to as Dr. Joseph Piacentile, of New Jersey, and Prescription drug coverage provided by S. 1 determine whether it has violated state laws, George Bradford Hunt and Walter W. Gauger, is skimpy, leaving many beneficiaries who and New York State Attorney General Eliot two pharmacists who previously worked for lack coverage in 2003 actually paying more L. Spitzer said last Friday that his office was Medco in Las Vegas. out of their own pockets for prescription investigating another company, Express Attorneys general in several states have drugs in 2007, when they have coverage. (For Scripts Inc., for allegedly overbilling state said they are also investigating whether the more information, please see our report, health plans. company, and other pharmacy benefit firms, Skimpy Benefits and Unchecked Expendi- Shares of Merck closed yesterday at $62.11, broke the law. tures: Medicare Prescription Drug Bills Fail down 78 cents, or 1.24 percent. Merck has been trying to spin off its Medco to Offer Adequate Protection for Seniors and business. It canceled an initial public offer- People with Disabilities, at [From the Washington Post, June 24, 2003] ing for the company in July after revealing www.consumersunion.org); that it had misstated its revenues by $12 bil- The bill lacks a standard, uniform benefit, MEDCO ACCUSED OF FAVORING MERCK DRUGS lion in recent years by counting prescription does not guarantee the availability of a pre- (BY DAVID B. CARUSO) copyaments made to pharmacies as Medco scription drug benefit through the Medicare Federal prosecutors on Monday said a com- revenue. Merck said in May that the firm program, and leaves all beneficiaries uncer- pany that was supposed to help health plans would be spun off instead to Merck share- tain about what coverage will be available to find low-cost prescription drugs instead pres- holders. them (and uncertain about the premium sured doctors to switch patients to medica- Ms. CANTWELL. Madam President, they will be charged); tions made by its owner, pharmaceutical While the Senate has approved helpful giant Merck & Co. it was reported this week that U.S. At- amendments that would accelerate the intro- U.S. Attorney Patrick Meehan said his of- torney Patrick Meehan plans to join a duction of generics and possibly provide fice has joined a pair of civil ‘‘whistle- pair of lawsuits filed by three former beneficiaries access to lower-priced drugs blower’’ lawsuits against Medco Health Solu- Medco Health employees. The employ- from Canada, the bill’s reliance on hundreds tions, accusing the Merck subsidiary of pro- ees—two pharmacists and a doctor—al- of private insurance companies and HMOs viding misleading information to the govern- lege that Medco provided misleading precludes the possibility of the federal gov- ment in connection with its contract to information to the Government related ernment using its purchasing power to nego- manage drug benefits for federal employees. to a contract to provide drug coverage tiate deep discounts for consumers. It does More than 1,000 companies have hired too little, therefore, to rein in spiraling pre- Medco to coordinate prescription drug cov- for Federal employees. The lawsuits scription drug expenditures; erage for employee health plans, making it accuse Medco of switching patients to The bill creates confusion for Medicare the nation’s largest manager of pharmacy more expensive drugs and fabricating beneficiaries, forcing them to sort out the
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00011 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.026 S26PT1 S8616 CONGRESSIONAL RECORD — SENATE June 26, 2003
options in the drug-only marketplace and op- SOCIETY OF PROFESSIONAL ENGI- JUNE 18, 2003. tions in the HMO/PPO marketplace, and it NEERING EMPLOYEES IN AERO- Hon. MARIA CANTWELL, further complicates the ‘‘comparison shop- SPACE, U.S. Senate, ping’’ task by allowing the prescription drug Seattle, WA, June 5, 2003. Washington, DC. benefits to vary from the basic parameters Hon. MARIA CANTWELL, DEAR SENATOR CANTWELL: Families USA, (e.g., deductible, cost-sharing, doughnut, cat- U.S. Senate, the national consumer health advocacy orga- astrophic coverage). Simply-put, the con- Washington, DC. nization, strongly endorses your amendment fusing options that will face Medicare bene- DEAR SENATOR CANTWELL: As you know, to ensure that the conflicts of interest, ficiaries flunks the ‘‘kitchen table’’ test; union members and retirees in Washington which can occur in the delivery of a Medi- are very concerned about the current activi- care prescription drug benefit, are minimized S. 1 will leave many Medicare beneficiaries ties involving prescription drug benefits for or avoided. worse off since employers will cut back their Medicare seniors. We thought you should Everyone agrees that whether Medicare di- retiree coverage because any coverage is not know that we are part of a national delega- rectly administers the benefit or whether it counted toward retirees’ out-of-pocket costs; tion of unions that met with Secretary is administered through private plans, Phar- and Tommy Thompson to express our opposition macy Benefit Managers (PBM) will be used. While the bill provides for a relatively gen- to any PBM-based alternative to our local They have the expertise and knowledge nec- erous subsidy for low-income consumers, it pharmacies. essary to help administer this program. But requires them to get their prescription drug PBMs own much of the mail order drug in the recent past, there have been examples benefit through Medicare instead of the cur- service in this country. For the past 2 years, of abuse in this sector. particularly trou- rently universal Medicare program, even we have been warning congressional mem- bling has been the steering of patients to a though they qualify for Medicare coverage bers that a PBM-based benefit would poten- particular prescription drug product because by virtue of their age or disability. tially harm many local pharmacies that it was more profitable for the administering serve our communities. Still however, law- company and not because it was better for We are deeply troubled by discussions that makers almost passed a PBM-based benefit the patient! In a very real sense, that is mal- are underway that would undermine the tra- in the 107th Congress. practice. It is inexcusable. It must be ditional fee-for-service Medicare program— Since last year, the reputation of PBMs stopped. At least one major PBM has an- the very program that assures beneficiaries has grown worse. Now they are being sued by nounced a code of ethics to prevent such that they have the freedom to go to the doc- a California based union, AFSCME. Alleg- abuses. But these important consumer pro- tor of their choice—by providing extra sub- edly, four of the largest PBMs have been tections should not depend on company-by- sidization to private PPOs and HMOs. By en- pocketing money that is meant for the con- company internal codes of ethics. Your riching the benefits available in the private sumer. amendment is needed. marketplace, PPOs and HMOs will attract SPEEA urges you and your fellow Senators Your amendment requires the confidential relatively healthy people; the traditional to look into this lawsuit before passing any disclosure of the type of information that fee-for-service Medicare option will erode PBM-based legislation. In this day and age, will enable the Department of Health and over time, because of the design of the sub- transparency must be part of any program Human Services to protect against rebates sidies and desire to cut costs. The sickest set up by the United States government. and kickbacks that would cause a company and most vulnerable will be severely dis- Sincerely, to steer people toward profitable medicine advantaged. CHARLES BOFFERDING, rather than needed medicine. Your amend- There are several amendments that would Executive Director. ment helps ensure that those who will surely help address some of the problems with S. 1. be called on to help administer the new ben- We urge you to support amendments that AMERICAN FEDERATION OF STATE, efit provide good health care to the bene- would: COUNTY AND MUNICIPAL EMPLOY- ficiaries and not just profitable health care EES, AFL–CIO, to their owners. Expand the prescription drug benefits so Washington, DC, June 24, 2003. Sincerely, that they are comparable to prescription Hon. MARIA CANTWELL, RONALD F. POLLACK, drug coverage in employer-based health in- U.S. Senate, Executive Director. surance plans; Washington, DC. Rein in prescription drug expenditures DEAR SENATOR CANTWELL: On behalf of WASHINGTON STATE through the use of the federal government’s AFSCME’s 1.4 million members, I am writing PHARMACY ASSOCIATION, buying power to negotiate deep discounts; to express my strong support for your Renton, WA, June 23, 2003. amendment to S. 1, the Medicare prescrip- Hon. MARIA CANTWELL, Provide for scientific study of the com- tion drug bill, that would make certain that U.S. Senate, parative effectiveness of alternative pre- costs savings generated by Pharmacy Benefit Washington, DC. scription drugs; Managers (PBM) on behalf of the Medicare DEAR SENATOR CANTWELL: The Washington Guarantee that beneficiaries would have program are returned to the program. We be- State Pharmacy Association, representing access to a prescription drug benefit through lieve that this is a critical means of control- pharmacy practitioners from all practice the Medicare program at a set premium; ling costs for this new benefit. arenas in the State of Washington, strongly PBMs create most of their cost savings and endorses your amendment to ensure that the Count the contributions made by employ- their profits by negotiating with drug manu- conflicts of interest, which can occur in the ers toward beneficiaries’ out-of-pocket costs; facturers to receive favorable rates on a delivery of a Medicare prescription drug ben- Maintain a level-playing field so that bene- pharmaceutical company’s drugs in ex- efit through a PBM, are minimized or avoid- fits in PPOs and HMOs are not more gen- change for including the drugs on the PBM’s ed. erous than benefits available in traditional formulary of preferred medicines. This bill Pharmacy Benefit Managers (PBM) are an fee-for-service Medicare; would require that all contracts with PBMs integral part of the health care delivery sys- to provide the Medicare benefit with a pri- tem. Efficient plan administration and time- Instruct the National Association of Insur- vate insurer or the government itself include ly claims processing are mandatory compo- ance Commissioners to adjust medigap ben- language that would ensure that all savings nents of a successful health care benefit efit packages to allow beneficiaries to buy negotiated with a pharmacy be passed back which are important to patients, payers and additional coverage; to the government or the private insurer ad- providers. However, in recent years the PBM Increase the transparency of transactions ministering the benefit on behalf of the gov- industry has expanded their role to include by pharmaceutical benefit managers; ernment. benefit design that has created significant We believe it is crucial that PBMs be re- conflicts of interest and ethical questions of Cut the time before the prescription drug quired to disclose the percentage of rebate appropriate health care delivery versus prof- benefits begin. they have negotiated with the pharma- itable health care delivery. The current debate about a Medicare pre- ceutical companies that are passed onto Your amendment, as proposed, provides scription drug benefit has led seniors and their clients. Your amendment would do pre- the necessary transparency that will provide persons with disabilities to believe that re- cisely that—giving some assurance to con- patients, payers, and regulators the nec- lief is in sight. In its present form, S. 1 will sumers and the government that the savings essary information to appropriately monitor be a big disappointment to beneficiaries achieved by the PBMs are being shared. PBM business practices. Your amendment is when it is implemented in 2006. We urge you I believe that your amendment goes a long a significant step toward insuring that the to amend S. 1 so that it is more effective in way toward ensuring that Medicare bene- health care provided to the citizens of this providing meaningful relief to Medicare ficiaries will receive their fair share of the country is focused on improving the pa- beneficiaries while addressing the pressing cost savings produced by contracts with tient’s health and wellbeing and not the fis- need to curb prescription drug expenditures. PBMs, and AFSCME strongly supports its cal wellbeing of the pharmacy benefit man- Sincerely, adoption. agers. GAIL E. SHEARER, Sincerely, Sincerely, Director, Health Policy Analysis, CHARLES M. LOVELESS, ROD SHAFER, R.Ph., Washington Office. Director of Legislation. CEO.
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00012 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.014 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8617 Ms. CANTWELL. Madam President, The PRESIDING OFFICER. The (1) IN GENERAL.—Subject to paragraph (2), these groups and others have been try- clerk will report. the Secretary shall provide for the transfer ing to call attention to problematic The assistant legislative clerk read from the Federal Supplementary Insurance PBM practices. These groups rightly as follows: Trust Fund established under section 1841 of the Social Security Act (42 U.S.C. 1395t) of point out that strong consumer protec- The Senator from Nevada [Mr. REID], for such funds as are necessary for the costs of tions are needed in any Medicare drug Mr. JOHNSON, for himself and Mr. COCHRAN, carrying out the assessment program under benefit. proposes an amendment numbered 1095. this section. The American Association of State, Mr. REID. I ask unanimous consent (2) BUDGET NEUTRALITY.—In conducting the County and Municipal Employees the reading of the amendment be dis- assessment program under this section, the agrees that these protections provide pensed with. Secretary shall ensure that the aggregate ‘‘a critical means of controlling costs.’’ The PRESIDING OFFICER. Without payments made by the Secretary do not ex- A national coalition of workers rep- ceed the amount which the Secretary would objection, it is so ordered. have paid if the assessment program under resenting more than 20 states also are The amendment is as follows: supportive of efforts to monitor PBMs. this section was not implemented. (Purpose: To provide for a 1-year medication Many in this coalition currently use (f) WAIVER AUTHORITY.—The Secretary therapy management assessment program) may waive such requirements of titles XI PBMs to provide benefits and many of At the end of subtitle A of title I, add the and XVIII of the Social Security Act (42 them are wondering why drug costs following: U.S.C. 1301 et seq.; 1395 et seq.) as may be continue to rise. SEC. ll. MEDICATION THERAPY MANAGEMENT necessary for the purpose of carrying out the There is a balance to be had here, and ASSESSMENT PROGRAM. assessment program under this section. the Cantwell-Lincoln amendment (a) ESTABLISHMENT.— (g) AVAILABILITY OF DATA.—During the pe- makes sure the scale is not tipped too (1) IN GENERAL.—The Secretary shall estab- riod in which the assessment program is con- far one way. It is a good amendment lish an assessment program to contract with ducted, the Secretary annually shall make that will lower prescription drug qualified pharmacists to provide medication available data regarding— prices, provide much needed consumer therapy management services to eligible (1) the geographic areas and sites des- protections and ensure strong govern- beneficiaries who receive care under the ignated under subsection (a)(2); original medicare fee-for-service program (2) the number of eligible beneficiaries par- ment oversight. I urge my colleagues ticipating in the program under subsection to support it. under parts A and B of title XVIII of the So- cial Security Act to eligible beneficiaries. (b) and the level and types medication ther- Mr. GRASSLEY. Is the amendment (2) SITES.—The Secretary shall designate 6 apy management services used by such bene- before us now? geographic areas, each containing not less ficiaries; The PRESIDING OFFICER. The than 3 sites, at which to conduct the assess- (3) the number of qualified pharmacists amendment is before us. ment program under this section. At least 2 with contracts under subsection (c), the loca- Mr. GRASSLEY. We have looked at geographic areas designated under this para- tion of such pharmacists, and the number of the amendment on this side. It has graph shall be located in rural areas. eligible beneficiaries served by such phar- been modified, and I urge we accept it (3) DURATION.—The Secretary shall con- macists; and on a voice vote. duct the assessment program under this sec- (4) the types of payment methodologies Mr. BAUCUS. We have looked at this tion for a 1-year period. being tested under subsection (d)(2). amendment. I agree with Senator (4) IMPLEMENTATION.—The Secretary shall (h) REPORT.— implement the program not later than Janu- (1) IN GENERAL.—Not later than 6 months GRASSLEY. We accept the amendment. The PRESIDING OFFICER. The ary 1, 2005, but may not implement the as- after the completion of the assessment pro- sessment program before October 1, 2004. gram under this section, the Secretary shall question is on agreeing to amendment (b) PARTICIPANTS.—Any eligible beneficiary submit to Congress a final report summa- No. 942, as modified. who resides in an area designated by the Sec- rizing the final outcome of the program and The amendment (No. 942), as modi- retary as an assessment site under sub- evaluating the results of the program, to- fied, was agreed to. section (a)(2) may participate in the assess- gether with recommendations for such legis- Mr. GRASSLEY. I move to recon- ment program under this section if such ben- lation and administrative action as the Sec- sider the vote. eficiary identifies a qualified pharmacist retary determines to be appropriate. Mr. BAUCUS. I move to lay that mo- who agrees to furnish medication therapy (2) ASSESSMENT OF PAYMENT METHODOLO- tion on the table. management services to the eligible bene- GIES.—The final report submitted under The motion to lay on the table was ficiary under the assessment program. paragraph (1) shall include an assessment of agreed to. (c) CONTRACTS WITH QUALIFIED PHAR- the feasibility and appropriateness of the Mr. BAUCUS. I suggest the absence MACISTS.— various payment methodologies tested under of a quorum. (1) IN GENERAL.—The Secretary shall enter subsection (d)(2). The PRESIDING OFFICER. The into a contract with qualified pharmacists to (i) DEFINITIONS.—In this section: provide medication therapy management (1) MEDICATION THERAPY MANAGEMENT clerk will call the roll. services to eligible beneficiaries residing in SERVICES.—The term ‘‘medication therapy The assistant legislative clerk pro- the area served by the qualified pharmacist. management services’’ means services or ceeded to call the roll. (2) NUMBER OF QUALIFIED PHARMACISTS.— programs furnished by a qualified phar- Mr. BYRD. Madam President, I ask The Secretary may contract with more than macist to an eligible beneficiary, individ- unanimous consent that the order for 1 qualified pharmacist at each site. ually or on behalf of a pharmacy provider, the quorum call be rescinded. (d) PAYMENT TO QUALIFIED PHARMACISTS.— which are designed— The PRESIDING OFFICER. Without (1) IN GENERAL.—Under an contract entered (A) to ensure that medications are used ap- objection, it is so ordered. into under subsection (c), the Secretary shall propriately by such individual; Mr. BYRD. Madam President, I ask pay qualified pharmacists a fee for providing (B) to enhance the individual’s under- unanimous consent that I may speak medication therapy management services. standing of the appropriate use of medica- out of order. (2) ASSESSMENT OF PAYMENT METHODOLO- tions; The PRESIDING OFFICER. Without GIES.—The Secretary shall, in consultation (C) to increase the individual’s compliance with national pharmacist and pharmacy as- with prescription medication regimens; objection, it is so ordered. sociations, design the fee paid under para- (D) to reduce the risk of potential adverse Mr. BYRD. I thank the Chair. graph (1) to test various payment methodolo- events associated with medications; and (The remarks of Mr. BYRD are print- gies applicable with respect to medication (E) to reduce the need for other costly ed in today’s RECORD under ‘‘Morning therapy management services, including a medical services through better management Business.’’) payment methodology that applies a relative of medication therapy. AMENDMENT NO. 1095 value scale and fee-schedule with respect to (2) ELIGIBLE BENEFICIARY.—The term ‘‘eli- The PRESIDING OFFICER. The Sen- such services that take into account the dif- gible beneficiary’’ means an individual who ator from Nevada. ferences in— is— Mr. REID. Mr. President, I ask unan- (A) the time required to perform the dif- (A) entitled to (or enrolled for) benefits imous consent the pending amend- ferent types of medication therapy manage- under part A and enrolled for benefits under ment services; part B of the Social Security Act (42 U.S.C. ments be temporarily set aside. (B) the level of risk associated with the use 1395c et seq.; 1395j et seq.); The PRESIDING OFFICER. Without of particular outpatient prescription drugs (B) not enrolled with a Medicare+Choice objection, it is so ordered. or groups of drugs; and plan or a MedicareAdvantage plan under part Mr. REID. On behalf of the Senator (C) the health status of individuals to C; and from South Dakota, Senator JOHNSON, whom such services are provided. (C) receiving, in accordance with State law I send an amendment to the desk. (e) FUNDING.— or regulation, medication for—
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00013 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.018 S26PT1 S8618 CONGRESSIONAL RECORD — SENATE June 26, 2003 (i) the treatment of asthma, diabetes, or especially critical. These patients ac- terms of their blood glucose levels. Ele- chronic cardiovascular disease, including an count for 95 percent of Medicare spend- vated blood glucose is a major concern individual on anticoagulation or lipid reduc- ing, according to ‘‘Care Coordination for patients with diabetes, and preven- ing medications; or for People with Chronic Conditions’’, tive services are effective in keeping (ii) such other chronic diseases as the Sec- retary may specify. an analysis published this year by blood glucose levels down. As we know, (3) QUALIFIED PHARMACIST.—The term Johns Hopkins University. diabetes is one of the principal health ‘‘qualified pharmacist’’ means an individual Currently, 60 million Americans have concerns for our country, and is of par- who is a licensed pharmacist in good stand- multiple chronic conditions, and that ticular concern for our seniors. ing with the State Board of Pharmacy. number is expected to grow to 157 mil- A decrease of even one percentage Mr. MCCONNELL. Mr. President, I lion by the year 2020. point in the blood glucose level of a pa- ask unanimous consent that imme- Sixty-two percent of seniors have tient with diabetes can have a profound diately following Senator KENNEDY’s multiple chronic conditions, but their effect on health. That seemingly small comments I be recognized to offer an care is often fragmented. A senior cit- decrease results in a 21 percent drop in amendment regarding cancer. I further izen may get treatment for her diabe- mortality from the disease, a 12 per- ask unanimous consent that this morn- tes from one doctor, care for her ar- cent decrease in strokes, a 24 percent ing the Senate proceed to a vote in re- thritis from a second doctor and atten- decrease in renal failure, and a remark- lation to the McConnell amendment, to tion for her high blood pressure from a able 43 percent drop in the amputations be followed immediately by a vote in third. that so many patients face as a result relation to the Boxer amendment num- Study after study shows that improv- of this cruel disease. More effective bered 1036, to be followed immediately ing the coordination of care for those management of blood glucose levels is by a vote in relation to the Bingaman with multiple chronic conditions can also effective in keeping patients out amendment numbered 1065, with no improve outcomes and reduce costs. of hospitals or nursing homes and thus second degrees in order to the three For example, in Laconia, NH, the reducing costs. A reduction in blood above amendments prior to the vote, Home and Community Based Care pro- glucose levels of just one percent re- with 2 minutes equally divided prior to gram improved disease management duces health care costs by $800 per pa- the vote, and with 10 minutes equally for seniors with multiple conditions. tient. divided before the first vote. This program saved an average of $8,100 These kinds of extraordinary im- Mr. REID. Mr. President, it is my un- in health care costs for each senior provements in health care quality are derstanding that as soon as Senator served and decreased admission to what this amendment is all about. We KENNEDY finishes his speech Senators nursing homes. are going to provide some $6 billion na- MCCONNELL and BOXER will be recog- In Georgia, the Service Options Using tionwide over a 5-year period to give nized for 10 minutes with the time Resources in a Community Environ- life to these kinds of quality improve- equally divided, and then we go into ment—SOURCE—program improved ment efforts, and we are going to chal- the series of votes. Is that right? disease management for 1,600 bene- lenge the private sector to do it as Mr. MCCONNELL. That is my under- ficiaries in 80 counties. The costs of well. standing. caring for those seniors in the SOURCE We believe that the kinds of quality The PRESIDING OFFICER. Is there program over two years was over $4,000 improvement initiatives included in objection? Without objection, it is so lower than for those who were not in this amendment will be a major factor ordered. the program. for the support for this legislation. The Senator from Massachusetts is My own state of Massachusetts is Health care quality and its impact on recognized. part of the New England States Consor- health care costs is an aspect of the AMENDMENT NO. 1092 tium, a multi-state effort funded by health care debate that has not re- Mr. KENNEDY. Mr. President, we the Robert Wood Johnson Foundation ceived sufficient attention. will have a chance to have greater dis- to study the improvements that can be This amendment will give us an op- cussion and debate on one of the impor- made in health care through better portunity to take dramatic steps for- tant amendments that is before the care coordination. ward in Medicare which will strengthen Senate. But I wanted to bring to the Expert groups in health care have and improve the quality of health care attention of our Members as we go said that care coordination should be for our seniors. The amendment will through the course of the day the one of the highest priorities for our also have a very positive impact in Grassley-Baucus amendment, which health care system. For example, in its terms of cost reductions. has two different parts to it. I would recent report, Priority Areas for Na- This amendment also addresses the like to address the part of the amend- tional Action: Transforming Health whole question of prevention which is ment which I find enormously compel- Care Quality, the Institute of Medicine equally critical to keeping people ling and which deserves the broad sup- identified 20 ‘‘priority areas’’ for im- healthy. Immunizations, managing port of all the Members of this body. proving health care. high blood pressure, cancer screening, This amendment provides equal fund- The Institute of Medicine has care- and patient education can all have an ing for Medicare and the private plan fully examined the issue of care qual- enormous impact on keeping people demonstration plans. That is effec- ity. The Institute’s recent report, ‘‘Pri- healthy and reducing costs. Too often tively what will be in the Grassley- ority Areas for National Action’’ has a Medicare pays huge amounts to care Baucus amendment. The Republicans series of recommendations on improv- for people who are sick but fails to in- say the private sector can do a better ing the quality of health care in Amer- vest adequately in keeping them job providing health care for seniors ica. We have included in our amend- healthy. and we say Medicare can do a better ment 13 of the 20 priority items that Failure to invest adequately in pre- job. This amendment tests both. This have been identified by the Institute of ventive services is a tragic con- amendment improves the coordination Medicine that will make a significant sequence of the repayment system we of care for seniors with multiple chron- difference in quality. The amendment now have under the Medicare system. ic conditions who remain in Medicare. will have an important impact in re- When the original Medicare system was Republicans have said we need to move ducing costs by improving care coordi- established, we did not have the knowl- seniors into private plans if we want to nation and providing needed preventive edge, awareness, and understanding of provide chronic care coordination, dis- services. the importance of prevention nearly to ease management, or enhanced preven- A recent study funded by the Robert extent we have it today. Preventive tive services. Wood Johnson Foundation reaches the care was not reimbursed the way it I am confident this demonstration same conclusion. The study examined should be. program will show Medicare can do an the effect of care coordination on out- Under this amendment, we will have even better job than private plans in comes for patients with diabetes. Care the opportunity to provide the kinds of providing preventive health services coordination and simple preventive real, effective support for prevention and ensuring care coordination. Care services dramatically improved the programs they deserve. Increased sup- for patients with chronic conditions is outcome for patients with diabetes in port for preventive services will mean
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00014 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.023 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8619 lower costs and better quality of care ness and hospitalization. The Institute care coordination, disease management for our seniors under Medicare. of Medicine reports that only 0.7 per- and preventive services not otherwise As I mentioned, too often we pay cent of seniors with just one chronic covered under section 18 of the Social huge amounts to care for people who condition require hospitalization in Security Administration. I ask unani- are sick, but fail to invest in keeping any given year. 6.2 percent of seniors mous consent to include the section of people healthy. This amendment gives with 4 chronic conditions are hospital- the bill containing this provision in the Medicare the tools to invest in keeping ized, and over 25 percent of those with RECORD. people healthy. Too often the care for 10 or more chronic conditions require a The amendment provides chronic people with the highest cost, the most hospital stay. Currently, 60 million care coordination services, disease serious illnesses, such as cancer and Americans have multiple chronic con- management services and other bene- stroke, is not optimal. ditions, and that number is expected to fits that the Secretary will determine This demonstration will help Medi- grow to 157 million over the next two to improve preventive health care for care assure the highest quality care for decades. Medicare beneficiaries. These services the sickest patients. Medicare is a fine Improving the coordination of care will improve chronic disease manage- program. It has kept our senior citi- for those with multiple chronic condi- ment and management of complex life- zens secure for 40 years. Today let us tions can markedly improve outcomes. threatening or high-cost conditions. make Medicare even better with this Yet the average Medicare beneficiary The amendment will make a real dif- amendment. sees more than six different doctors in ference in improving the health of mil- I will include the selective parts of a year. Clearly, we need to do more to lions of seniors. the studies I referred to previously in see that seniors receive the most ap- This is really a historic opportunity. the RECORD. I ask unanimous consent propriate care for all their conditions— I can say, having been here for some that the selective parts be printed in not just the one that any particular period of time, the idea that you would the RECORD at the conclusion of my re- doctor among these six is treating indi- get $6 billion over 5 years to be able to marks. vidually. Study after study cited by support prevention and the coordina- The PRESIDING OFFICER. Without the Institute of Medicine indicates that tion of care for our seniors—I didn’t be- objection, it is so ordered. care is inadequately coordinated for lieve it would ever be realized. We have (See exhibit 1). patients with some of the most serious that chance with this amendment. Mr. KENNEDY. Mr. President, as I diseases. I think one of the most important as- mentioned, the New England Journal Our health care system also fails to pects of this legislation is its emphasis of Medicine—in a major study pub- provide adequate preventive services. on the area of prevention, which is so lished just today—focuses on the issue Survival rates for many forms of can- important, as I have just described. In- of quality. The study demonstrates cer increase dramatically if the disease creased support for preventive health that the problem most likely to occur is detected early—yet far too few pa- care services will improve and in our health care system is not over- tients receive the type of early screen- strengthen the quality of health care utilization of services, but under- ing that can literally mean the dif- and also result in savings for the Medi- utilization. This point bears repeating. ference between life and death. For ex- care system. We have seen how these Patients all over America are not re- ample, early diagnosis of colon cancer services help the intensely ill and sick ceiving the services they need to keep results in a survival rate of 90 percent, and fragile elderly. And we will in- them healthy. 46 percent of patients but that survival rate drops precipi- crease the coordination of services as did not receive the recommended care, tously if the cancer spreads or grows well. All of this makes a great deal of while only 11 percent received care before it is detected. Early detection sense. And we have the evidence— that was not recommended and was po- not only saves lives—it reduces costs ample evidence—to show that action in tentially harmful. That means that too. Proper screening can save up to this area can make a very important four times as many patients did not re- $25,000 for every patient who avoids difference to the elderly. ceive the care they needed as received painful and lengthy treatment through I will let others describe the other care they did not need. The problem in early detection of cancer. Despite this part of the amendment dealing with our health care system is not overutili- compelling evidence of the value of private plans. But we challenge them, zation of services, but underutilization. preventive services, only a third of pa- after the 5 years in which the resources The problem of not receiving needed tients receive the recommended form will be spent—with a GAO study that care is particularly acute for some of of colon cancer screening. will report back how the money has the most serious disorders that affect The story is the same with adult im- been spent—we challenge them to see seniors. The New England Journal arti- munization. Pneumonia and influenza which will make the greatest dif- cle states that less than a quarter of are the seventh leading cause of death ference in terms of quality of care for patients with diabetes received rec- in the United States, and the fifth lead- our senior population and will make a ommended blood tests. Fewer than ing cause of death among seniors. Over difference in terms of the savings in two-thirds of patients with high blood a third of seniors with invasive pneu- the Medicare system. There is no ques- pressure received the recommended monia will die of the disease. Many tion in my mind—no question in my care. These two diseases alone take an cases of these diseases are preventable mind—what that GAO report will dem- extraordinary toll on the lives of our with a simple immunization—yet one- onstrate. We have clear documentation citizens. Nearly 600,000 seniors die each third to one-half of all seniors do not and scientific information that talks year from heart disease, and complica- receive needed immunizations. Cov- about the various studies that have tions of diabetes kill over 50,000 sen- erage rates for high-risk seniors are been done to date, and also the conclu- iors. We could dramatically reduce the particularly poor. Tragically, only sions that have been reached by the serious toll of these diseases—and about a quarter of seniors with chronic thoughtful, nonpartisan groups in this many others—by improving access to disease receive a flu shot. very area. preventive services and enhancing the This very important amendment will We welcome the opportunity to show quality of care. address these challenges which the In- to the American people which system Modern medicine—and a strong Medi- stitute of Medicine, the Robert Wood is really going to work effectively. At care program—have been effective in Johnson Foundation, and the New Eng- the end of that period of time, we will allowing seniors to live with chronic land Journal of Medicine have all com- have the chance to enhance and im- conditions that once were fatal. Mil- mented on as being critical if we are prove on that, to make sure the future lions of seniors are alive today because going to strengthen quality and begin generations’ health care will be of advances in the treatment of heart to get a greater handle on costs. strengthened. disease, high cholesterol, cancer and I will refer to the part of the amend- So I hope this amendment, which will other serious illnesses. As a result of ment that addresses these questions. be before us very soon, will receive this success, however, millions of sen- Page 13 of the amendment describes overwhelming support because I think iors have multiple chronic conditions the enhanced benefits that will now be it will have a real chance to evaluate which put them at higher risk for ill- available to beneficiaries in terms of the different approaches and see what
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00015 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.020 S26PT1 S8620 CONGRESSIONAL RECORD — SENATE June 26, 2003 is going to be most effective in terms lowing priority areas for transforming age 50 (American Cancer Society, 2002). The of quality and cost. health care: estimated long-term cost of treating stage II Care coordination (cross-cutting); colon cancer is approximately $60,000 (Brown BLOOD GLUCOSE—REDUCTIONS PAY OFF Self-management/health literacy (cross- et al., 2002). Longitudinal studies demonstrate that a cutting); Cervical cancer is the ninth most common one percentage point reduction in Hemo- Asthma—appropriate treatment for per- cancer among women in the United States, globin A1C (blood glucose) results in: 14% de- sons with mild/moderate persistent asthma; with an estimated incidence of 13,000 cases crease in total mortality; 21% decrease in di- Cancer screening that is evidence-based— annually. Cervical cancer ranks thirteenth abetes-related deaths; 14% decrease in myo- focus on colorectal and cervical cancer; among all causes of cancer death, with about cardial infarction; 12% decrease in strokes; Children with special health care needs; 4,100 women dying of the disease each year 43% decrease in amputations; 24% decrease Diabetes—focus on appropriate manage- (American Cancer Society, 2002). The inci- in renal failure; and $800 reduction in health ment of early disease; dence of cervical cancer has steadily de- care costs. End of life with advanced organ system clined, dropping 46 percent between 1975 and PROBLEMS WITH QUALITY OF CARE failure—focus on congestive heart failure 1999 from a rate of 14.8 per 100,000 women to The problem with quality that is most and chronic obstructive pulmonary disease; 8.0 per 100,000 women (Ries et al., 2002). De- likely to occur, is underuse: 46.3 percent of Frailty associated with old age—pre- spite these gains, cervical cancer continues participants did not receive recommended venting falls and pressure ulcers, maxi- to be a significant public health issue. It has care. With overuse, 11.3 percent of partici- mizing function, and developing advanced been estimated that 60 percent of cases of pants received care that was not rec- care plans; cervical cancer are due to a lack of or defi- ommended and was potentially harmful. Hypertension—focus on appropriate man- ciencies in screening (Sawaya and Grimes, agement of early disease; 1999). VARIATIONS IN QUALITY Immunization—children and adults; PREVENTION—CANCER SCREENING There is substantial variability in the Ischemic heart disease—prevention, reduc- Improvability quality-of-care patients receive for the 25 tion of recurring events, and optimization of Early diagnosis of colorectal cancer while conditions for which at least 100 persons functional capacity; were eligible for analysis. Persons with se- it is still at a localized state results in a 90 Major depression—screening and treat- percent survival rate at 5 years (Ries et al., nile cataracts received 78.7 percent of the ment; recommended care; persons with alcohol de- 2002). The American Cancer Society’s (ACS) Medication management—preventing guidelines recommend screening for pendence received 10.5 percent of the rec- medication errors and overuse of antibiotics; ommended care. The aggregate scores for in- colorectal cancer beginning at age 50 for Nosocomial infections—prevention and adults at average risk using one of the fol- dividual conditions were generally not sen- surveillance; lowing five screening regimens: fecal occult sitive to the presence or absence of any sin- Pain control in advanced cancer; blood test (FOBT) annually; flexible gle indicator of quality. Pregnancy and childbirth—appropriate sigmoidoscopy every 5 years; annual FOBT DISCUSSION prenatal and intrapartum care; plus flexible sigmoidoscopy every 5 years; Overall, participants received about half of Severe and persistent mental illness—focus double contrast barium enema every 5 years; the recommended processes involved in care. on treatment in the public sector; or colonoscopy every 10 years (American These deficits in care have important impli- Stroke—early intervention and rehabilita- Cancer Society, 2001). The United States Pre- cations for the health of the American pub- tion; ventive Services Task Force strongly rec- lic. For example, only 24 percent of partici- Tobacco dependence treatment in adults; ommends screening for men and women 50 pants in our study who had diabetes received and years of age and or older for colorectal can- three or more glycosylated hemoglobin tests Obesity (emerging area). cer. Screening has been found to be cost-ef- over a two-year period. This routine moni- CARE COORDINATION—RATIONALE FOR fective in saving lives, with estimates rang- toring is essential to the assessment of the SELECTION ing from $10,000 and $25,000 life-year saved. effectiveness of treatment, to ensuring ap- Impact IMMUNIZATION (ADULT)—RATIONALE FOR propriate responses to poor glycemic control, SELECTION Nearly half of the population—125 million and to the identification of complications of Impact the disease at an early stage so that serious Americans—lives with some type of chronic condition. About 60 million live with mul- Pneumonia and influenza are the seventh consequences may be prevented. leading cause of death in the United States In our study, persons with hypertension re- tiple such conditions. And more than 3 mil- lion—2.5 million women and 750,000 men— (The Commonwealth Fund, 2002). Pneumo- ceived 64.7 percent of the recommended care. coccal disease causes 10,000 to 14,000 deaths We have previously demonstrated a link be- live with five such conditions (Partnership for Solutions, 2001). For those afflicted by annually; influenza causes an average of tween blood-pressure control and adherence 110,000 hospitalizations and 20,000 deaths an- to process-related measures of quality of one or more chronic conditions, coordination of care over time and across multiple health nually (United States Department of Health care for hypertension. Persons whose blood and Human Services, 2000). Approximately pressure is persistently above normal are at care providers and settings is crucial. Yet in a survey of over 1,200 physicians conducted 30–43 percent of elderly people who have increased risk for heart disease, stroke, and invasive pneumonia will die from the disease death. Poor blood-pressure control contrib- in 2001, two-thirds of respondents reported that their training was not adequate to co- (United States Preventive Services Task utes to more than 68,000 preventable deaths Force, 1996). The elderly are also at increased annually. ordinate care or education for patients with chronic conditions (Partnership for Solu- risk for complications associated with influ- FINAL LIST OF PRIORITY AREAS tions, 2001). enza, and approximately 90 percent of the The committee’s selection process yielded More than 50 percent of patients with hy- deaths attributed to the disease are among a final set of 20 priority areas for improve- pertension (Joint National Committee on those aged 65 and older (Vishnu-Priya et al., ment in health care quality. Improving the Prevention, 1997), diabetes (Clark et al., 2000). delivery of care in any of these areas would 2000), tobacco addition (Perez-Stable and To decrease the burden of these diseases, enable stakeholders at the national, state, Fuentes-Afflick, 1998), hyperlipidemia including incapacitating malaise, doctor vis- and local levels to begin setting a course for (McBride et al., 1998), congestive heart fail- its, hospitalizations, and premature deaths, quality health care while addressing unac- ure (Ni et al., 1998), chronic atrial fibrillation experts recommend vaccination. Yet one- ceptable disparities in care for all Ameri- (Samsa et al., 2000), asthma (Legorreta et al., third to one-half of older adults (aged 65 and cans. The committee made no attempt to 2000), and depression (Young et al., 2001) are over) do not receive these vaccinations (The rank order the priority areas selected. The currently managed inadequately. Among the Commonwealth Fund, 2002). Coverage rates first 2 listed—care coordination and self- Medicare-eligible population, the average for high-risk adults who suffer from chronic management/health literacy—are cross-cut- beneficiary sees 6.4 different physicians in a disease are especially poor, with only 26 per- ting areas in which improvements would year, 4.6 of those being in the outpatient set- cent receiving an influenza vaccination and benefit a broad array of patients. The 17 that ting (Anderson, 2002a). 13 percent a pneumococcal vaccination (In- follow represent the continuum of care stitute of Medicine, 2000). CANCER SCREENING THAT IS EVIDENCE-BASED— across the life span and are relevant to pre- RATIONALE FOR SELECTION Mr. KENNEDY. Mr. President, I sug- ventive care, inpatient/surgical care, chronic gest the absence of a quorum. Impact conditions, end-of-life care, and behavioral The PRESIDING OFFICER. The health, as well as to care for children and Colorectal cancer is the third most com- clerk will call the roll. adolescents (see boxes ES–1 to ES–6). Fi- mon cancer among men and women in the The legislative clerk proceeded to United States, with an estimated incidence nally, obesity is included as an ‘‘emerging call the roll. area’’ that does not at this point satisfy the of 148,300 cases annually. In 2002, 56,600 Amer- selection criteria as fully as the other 19 pri- icans died from colorectal cancer, making it Mr. MCCONNELL. Mr. President, I ority areas. the nation’s second leading cause of cancer- ask unanimous consent that the order Recommendation 3: The committee rec- related death. Lifetime risk for developing for the quorum call be rescinded. ommends that DHHS, along with other pub- colorectal cancer is approximately 6 percent The PRESIDING OFFICER. Without lic and private entities, focus on the fol- with over 90 percent of cases occurring after objection, it is so ordered.
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00016 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.022 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8621 AMENDMENT NO. 1097 such individual shall have access to qualified all seniors with cancer get help with Mr. MCCONNELL. Mr. President, I prescription drug coverage (as described in prescription drug costs, especially the send an amendment to the desk and section 1860D–6(a)(1) of such Act), including poor and moderate-income seniors. ask for its immediate consideration. payment of— Mr. President, how much time do I The PRESIDING OFFICER. The (A) for 2006, a deductible of $275; (B) the limits on cost-sharing described have remaining? clerk will report the amendment. section 1860D–6(c)(2) of such Act up to, for The PRESIDING OFFICER. Two The legislative clerk read as follows: 2006, an initial coverage limit of $4,500; and minutes. The Senator from Kentucky [Mr. MCCON- (C) for 2006, an annual out-of-pocket limit Mr. MCCONNELL. Mr. President, I NELL] proposes an amendment numbered of $3,700 with 10 percent cost-sharing after reserve the remainder of my time. 1097. that limit is reached. The PRESIDING OFFICER. Who Mr. MCCONNELL. Mr. President, I (5) CONSTRUCTION.—Notwithstanding the yields time? ask unanimous consent that reading of preceding provisions of this section, nothing The Senator from Nevada. the amendment be dispensed with. in this section shall be construed in a man- Mr. REID. Mr. President, the Boxer The PRESIDING OFFICER. Without ner that would provide an individual who is diagnosed with cancer with benefits under amendment is very simple. It says if a objection, it is so ordered. part D of title XVIII of the Social Security person is receiving cancer drugs and The amendment is as follows: Act (as added by section 101) that are dif- they come to a period of time—as this (Purpose: To protect seniors with cancer) ferent from the benefits that the individual bill is written—where they run out of At the end of subtitle A of title I, add the would have been eligible for if such indi- the ability to get help from the Medi- following: vidual was not diagnosed with cancer. care Program, that they, in effect, are SEC. ll. PROTECTING SENIORS WITH CANCER. Mr. MCCONNELL. Mr. President, the covered. Any eligible beneficiary (as defined in sec- amendment I just sent to the desk en- We want a cancer patient to have no tion 1860D(3) of the Social Security Act) who sures protection of seniors diagnosed donut hole, no gap in coverage. That is is diagnosed with cancer shall be protected with cancer from the high prescription what the Boxer amendment is all from high prescription drug costs in the fol- drug costs associated with that illness. about. lowing manner: My amendment states specifically (1) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN Mr. KENNEDY. Mr. President, do we that any senior in Medicare and diag- INCOME BELOW 100 PERCENT OF THE FEDERAL have any time? POVERTY LINE.—If the individual is a quali- nosed with cancer shall have the right Mr. REID. We have at least 4 min- fied medicare beneficiary (as defined in sec- to a drug plan in which the beneficiary utes. tion 1860D–19(a)(4) of such Act), such indi- shall pay no deductible, no monthly Mr. KENNEDY. Will the Senator vidual shall receive the full premium subsidy premium, no more than a 2.5-percent yield me a minute? and reduction of cost-sharing described in copayment for any drug spending up to Mr. REID. Of course. section 1860D–19(a)(1) of such Act, including $4,500 a year, no more than a 5-percent The PRESIDING OFFICER. The Sen- the payment of— copayment for drug spending between (A) no deductible; ator from Massachusetts. $4,500 and $5,800 a year, and no more Mr. REID. Mr. President, I yield 2 (B) no monthly beneficiary premium for at than a 2.5-percent copayment for any least one Medicare Prescription Drug plan minutes to the Senator from Massa- available in the area in which the individual drug spending over $5,800 if their in- chusetts. resides; and come is below the poverty level. Mr. KENNEDY. Mr. President, the (C) reduced cost-sharing described in sub- My amendment states that any sen- Boxer amendment provides the addi- ior in Medicare who is also diagnosed paragraphs (C), (D), and (E) of section 1860D– tional resources for the treatment of with cancer, with an income between 19(a)(1) of such Act. cancer. I think all of us understand the (2) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN 100 percent and 135 percent of the pov- importance of the continuity of care in INCOME BETWEEN 100 AND 135 PERCENT OF THE erty level, shall have the right to a the treatment of disease generally. FEDERAL POVERTY LINE.—If the individual is drug plan in which the beneficiary That is why I am going to continue to a specified low income medicare beneficiary shall pay no deductible, no monthly vigorously fight for additional re- (as defined in paragraph 1860D–19(4)(B) of premium, no more than a 5-percent co- such Act) or a qualifying individual (as de- sources to fill in this gap in the future payment for drug spending up to $4,500, fined in paragraph 1860D–19(4)(C) of such Act) for all diseases. But it is particularly no more than a 10-percent copayment who is diagnosed with cancer, such indi- important to fill this gap for people vidual shall receive the full premium subsidy for drug spending between $4,500 and $5,800, and no more than a 2.5-percent who are afflicted with the disease of and reduction of cost-sharing described in cancer. They are waiting for Congress section 1860D–19(a)(2) of such Act, including copayment for any drug spending over payment of— $5,800. to fill in this gap. (A) no deductible; My amendment provides that any It does seem to me, because of the (B) no monthly premium for any Medicare senior in Medicare diagnosed with can- compelling reasons for the continuity Prescription Drug plan described paragraph cer, with an income between 135 per- of care in terms of diseases generally (1) or (2) of section 1860D–17(a) of such Act; cent and 160 percent of the poverty we ought to be able to find the addi- and tional resources to fill this gap. (C) reduced cost-sharing described in sub- level, shall have the right to a drug plan in which the beneficiary shall pay The Boxer amendment does not re- paragraphs (C), (D), and (E) of section 1860D– place the fundamental structure of this 19(a)(2) of such Act. no more than a $50 deductible, an aver- legislation. It finds the additional re- (3) SUBSIDY-ELIGIBLE INDIVIDUALS WITH IN- age monthly premium not greater than COME BETWEEN 135 PERCENT AND 160 PERCENT $35, no more than a 10-percent copay- sources to be able to make sure there OF THE FEDERAL POVERTY LEVEL.—If the indi- ment for drug spending up to $4,500, no will be continuity of care for what is, vidual is a subsidy-eligible individual (as de- more than a 20-percent copayment for for many families, their Number 1 fined in section 1860D–19(a)(4)(D) of such Act) drug spending between $4,500 and $5,800, health concern. So that is a very com- who is diagnosed with cancer, such indi- and no more than a 10-percent copay- pelling reason. I hope the amendment vidual shall receive sliding scale premium ment for any drug spending over $5,800. will be favorably considered. subsidy and reduction of cost-sharing for I suggest the absence of a quorum. subsidy-eligible individuals, including pay- My amendment also provides that ment of— any senior in Medicare and diagnosed Mr. REID. Mr. President, I ask the (A) for 2006, a deductible of only $50; with cancer, with an income above 160 Senator to withhold the suggestion of a (B) only a percentage of the monthly pre- percent of the poverty level, shall have quorum. mium (as described in section 1860D– the right to a drug plan in which the Mr. KENNEDY. I withhold. 19(a)(3)(A)(i)); and beneficiary shall pay no more than a The PRESIDING OFFICER. Who (C) reduced cost-sharing described in $275 deductible, an average monthly yields time? clauses (iii), (iv), and (v) of section 1860D– premium not greater than $35, no more If no one yields time, time will be 19(a)(3)(A). than a 50-percent copayment for drug charged equally to both sides. (4) ELIGIBLE BENEFICIARIES WITH INCOME Who yields time? ABOVE 160 PERCENT OF THE FEDERAL POVERTY spending up to $4,500, and no more than LEVEL.—If an individual is an eligible bene- a 10-percent copayment for drug spend- The minority leader. ficiary (as defined in section 1860D(3) of such ing over $5,800. Mr. DASCHLE. Mr. President, I ask Act), is not described in paragraphs (1) With this amendment, which con- unanimous consent that all time be through (3), and is diagnosed with cancer, forms to the provisions within the bill, yielded back.
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00017 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.023 S26PT1 S8622 CONGRESSIONAL RECORD — SENATE June 26, 2003 The PRESIDING OFFICER. Without The amendment we just voted for did The PRESIDING OFFICER. All time objection, it is so ordered. nothing, not one thing, for cancer pa- has expired. Is there a sufficient sec- The question is on agreeing to the tients, except reiterate what is already ond? McConnell amendment No. 1097. in the underlying bill. There appears to be a sufficient sec- Mr. MCCONNELL. I ask for the yeas What my amendment does, and why I ond. and nays. hope we will rise to the occasion and The question is on agreeing to the The PRESIDING OFFICER. Is there a support it, is to send a strong message motion. sufficient second? to anyone diagnosed with cancer, and The clerk will call the roll. There is a sufficient second. The to their families, friends, and loved The bill clerk called the roll. clerk will call the roll. ones, that if and when they are diag- Mr. REID. I announce that the Sen- The legislative clerk called the roll. nosed with cancer, they will not face ator from Massachusetts (Mr. KERRY) Mr. REID. I announce that the Sen- the benefit shutdown that is now in and the Senator from Connecticut (Mr. ator from Massachusetts (Mr. KERRY) this bill. LIEBERMAN) are necessarily absent. and the Senator from Connecticut (Mr. I will show my colleagues on this I further announce that, if present LIEBERMAN) are necessarily absent. chart that at $4,500 of drug costs, the and voting, the Senator from Massa- I further announce that, if present benefit shuts down. I want my col- chusetts (Mr. KERRY) would vote and voting, the Senator from Massa- leagues to think about someone they ‘‘nay’’. chusetts (Mr. KERRY), would vote know with cancer, someone who is bat- The PRESIDING OFFICER. Are there ‘‘yea.’’ tling cancer. Do we want to put this any other Senators in the Chamber de- The PRESIDING OFFICER (Mr. burden on them? They must take their siring to vote? BURNS). Are there any other Senators drugs. They cannot cut their pills in The result was announced—yeas 54, in the Chamber desiring to vote? half in order to survive. nays 44, as follows: The result was announced—yeas 97, The Cancer Society tells us that 6 [Rollcall Vote No. 250 Leg.] nays 1, as follows: million to 7 million Medicare bene- YEAS—54 [Rollcall Vote No. 249 Leg.] ficiaries are battling some form of can- Alexander Crapo McCain YEAS—97 Allard DeWine McConnell cer, and 380,000 of them will die of can- Allen Dole Miller Akaka Dodd Lugar cer. Please, let us relieve this burden of Baucus Domenici Murkowski Alexander Dole McCain them having to pay 100 percent of their Bennett Ensign Nickles Allard Domenici McConnell drug costs during this benefit shut- Bond Enzi Roberts Allen Dorgan Mikulski Breaux Fitzgerald Santorum Baucus Durbin Miller down. I beg my colleagues to take a Brownback Frist Sessions Bayh Edwards Murkowski stand. I beg my colleagues to be com- Bunning Graham (SC) Shelby Bennett Enzi Murray passionate. I beg my colleagues to be Burns Grassley Smith Biden Feingold Nelson (FL) Campbell Gregg Snowe Bingaman Feinstein independent for once on an amendment Nelson (NE) Chafee Hagel Specter Bond Fitzgerald Nickles and support the cancer patients who Chambliss Hatch Stevens Boxer Frist are counting on us today to at least re- Cochran Hutchison Sununu Breaux Graham (FL) Pryor Reed lieve them of this terrible financial Coleman Inhofe Talent Brownback Graham (SC) Collins Kyl Thomas Bunning Grassley Reid burden that will hit them just when Roberts Cornyn Lott Voinovich Burns Gregg they are the sickest. Craig Lugar Warner Byrd Hagel Rockefeller Campbell Harkin Santorum I urge an aye vote. NAYS—44 Cantwell Sarbanes The PRESIDING OFFICER. The Sen- Hatch Akaka Durbin Levin Carper Hollings Schumer ator from Iowa. Bayh Edwards Lincoln Chafee Hutchison Sessions Mr. GRASSLEY. Before I use my Biden Feingold Mikulski Chambliss Inhofe Shelby time, I have a unanimous consent re- Bingaman Feinstein Murray Clinton Inouye Smith Boxer Graham (FL) Nelson (FL) Cochran Jeffords Snowe quest. That unanimous consent request Byrd Harkin Nelson (NE) Coleman Johnson Specter is that the time lapse between the next Cantwell Hollings Pryor Collins Kennedy Stabenow two votes be 10 minutes instead of 15 Carper Inouye Reed Conrad Kohl Stevens Clinton Jeffords Cornyn minutes. Reid Kyl Sununu Conrad Johnson Corzine Landrieu The PRESIDING OFFICER. Without Rockefeller Talent Corzine Kennedy Craig Lautenberg Sarbanes Thomas objection, it is so ordered. Daschle Kohl Crapo Leahy Schumer Voinovich Mr. GRASSLEY. Mr. President, first, Dayton Landrieu Daschle Levin Stabenow Warner from a parliamentary point of view, Dodd Lautenberg Dayton Lincoln Dorgan Leahy Wyden DeWine Lott Wyden this amendment, if adopted, would sub- NOT VOTING—2 NAYS—1 ject the entire bill to a budget point of Kerry Lieberman Ensign order. We have enough people in this body who maybe do not want a pre- The motion was agreed to. NOT VOTING—2 scription drug bill that could take AMENDMENT NO. 1065 Kerry Lieberman down the whole bill. The PRESIDING OFFICER. There The amendment (No. 1097) was agreed The other reason is, all the concerns are now 2 minutes equally divided prior to. the Senator has mentioned we have to the vote on the amendment offered AMENDMENT NO. 1036 taken into account within the $400 bil- by the Senator from New Mexico. The PRESIDING OFFICER (Mr. lion capability of our legislation. We The Senate will please be in order. GRAHAM of South Carolina). By pre- have before us this $400 billion to pro- The Senator from New Mexico will sus- vious order, there are 2 minutes evenly vide prescription drug benefits to our pend until the Senate is in order. divided prior to the vote on the Boxer seniors. We have used that $400 billion The Senator from New Mexico. amendment. to help low-income seniors with pre- Mr. BINGAMAN. I ask unanimous The Senator from California is recog- scription drug costs if they have can- consent that the RECORD reflect we are nized. cer, diabetes, or anything else for updating the asset test to a limit of Mrs. BOXER. The Senator from Ken- which they need drugs. $10,000 per individual and $20,000 per tucky and I agreed to an extra 30 sec- We have used the $400 billion to limit couple. onds each, so I ask unanimous consent the catastrophic costs of prescription The PRESIDING OFFICER. Is there for that. drugs to all seniors. We do not create objection? The PRESIDING OFFICER. Without two drug classes for the sick and the Mr. GRASSLEY. Reserving the right objection, it is so ordered. ill, and that is why we should move for- to object, have we seen this? We do not Mrs. BOXER. Mr. President, I want ward with this amendment so it does seem to know about this. to speak to the hearts and the minds of not bring down the whole bill on a po- The PRESIDING OFFICER. The Sen- each and every one of my colleagues tential budget point of order. ate will be in order. and friends, so I will speak straight I move to table the amendment, and Mr. GRASSLEY. Reserving the right from the shoulder. I ask for the yeas and nays. to object, we do not know about the
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00018 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.025 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8623 modification—or do we? We do not The PRESIDING OFFICER. The Sen- Lincoln Nelson (NE) Schumer Lugar Pryor Smith seem to. ate will come to order. McCain Reed Specter Mr. BINGAMAN. Mr. President, this The Senator from Maine. Mikulski Reid Stabenow is what the bill was intended to say. It Ms. SNOWE. Mr. President, I urge Miller Roberts Stevens is exactly what we have shared with my colleagues to vote against the Murray Rockefeller Warner Nelson (FL) Sarbanes Wyden your staff. It is just that there was a amendment offered by Senator BINGA- typo in it. MAN. We are not here to alter the NAYS—29 Mr. GRASSLEY. I withdraw the res- guidelines for the Medicaid Program Allard Fitzgerald Nickles ervation. because it certainly would have an im- Bond Frist Santorum The PRESIDING OFFICER. Without Bunning Grassley Sessions pact on the underlying Medicaid Pro- Burns Gregg Shelby objection, it is so ordered. gram. Cochran Hatch The Senator from New Mexico. Snowe Let me be clear. We did not create a Cornyn Inhofe Sununu Mr. BINGAMAN. I ask unanimous Craig Kyl new asset test for this benefit. We fol- Talent consent that the Senator from Florida, Crapo Lott Thomas Dole McConnell lowed the asset test that exists in cur- Voinovich Mr. GRAHAM, be added as a cosponsor. Enzi Murkowski The PRESIDING OFFICER. Without rent law and that governs existing low- objection, it is so ordered. income assistance programs under NOT VOTING—2 Mr. BINGAMAN. I also ask unani- Medicaid and Medicare. Kerry Lieberman Actually, we learned our lesson from mous consent that we be allowed 2 The amendment (No. 1065) was agreed the last debate last fall on the minutes to advocate for the amend- to. ment and the opposition get 2 minutes tripartisan bill. We realized in con- Mr. BINGAMAN. Mr. President, I as well. structing that approach that we ex- move to reconsider the vote. The PRESIDING OFFICER. Without cluded 40 percent of low-income Medi- I move to lay that motion on the objection, it is so ordered. care beneficiaries. So this time we table. Mr. BINGAMAN. Mr. President, I will built on the existing Medicaid and The motion to lay on the table was take one of those 2 minutes and Sen- Medicare Programs. We created a new agreed to. ator DOMENICI the other. program for those under 160 percent of CHANGE OF VOTE This is a Bingaman-Domenici amend- the poverty level that has no asset ment. The purpose of it is not to elimi- test. By doing so, we capture 8.5 mil- Ms. LANDRIEU. Mr. President, on nate the asset test. That was an earlier lion more Medicare beneficiaries for a rollcall vote No. 251, I voted nay. I in- amendment I offered and then with- total of 17.5 million Medicare bene- tended to vote yea. It does not change drew. Instead, it is to update the asset ficiaries or 43 percent of the overall the outcome of the vote. I ask unani- test, where you would still be required program. mous consent that the RECORD reflect as I have stated. to demonstrate that your income was We target our assistance, the most The PRESIDING OFFICER. Without below poverty or in that range, but in- assistance to those most in need. So it objection, it is so ordered. stead of having to demonstrate that is important for our colleagues to un- (The foregoing tally has been your total combined assets were only derstand, we are using asset tests that changed to reflect the above order.) $4,000, you would be able to show that already exist in current law to maxi- Mr. FRIST. Mr. President, I suggest they were less than $10,000. mize the most assistance to those most the absence of a quorum. This also eliminates the paperwork in need of this benefit. burden that currently is imposed in The PRESIDING OFFICER. The Mr. President, I ask for the yeas and clerk will call the roll. most States on people who are required nays. to itemize their assets and essentially The assistant legislative clerk pro- The PRESIDING OFFICER. Is there a ceeded to call the roll. provide a full financial statement to sufficient second? get the full low-income benefit. Mr. FRIST. Mr. President, I ask There is a sufficient second. unanimous consent that the order for We think this is a needed update on The question is on agreeing to the the asset test. It will allow a lot more the quorum call be rescinded. amendment. The PRESIDING OFFICER (Mr. people to get the full benefit. The clerk will call the roll. I yield the remaining time to Senator BUNNING). Without objection, it is so The assistant legislative clerk called DOMENICI. ordered. Mr. DOMENICI. Mr. President, this is the roll. Mr. FRIST. Mr. President, I ask a very simple amendment. I believe it Mr. REID. I announce that the Sen- unanimous consent that at 2:30 the is absolutely fair and nothing more ator from Massachusetts (Mr. KERRY) Senate proceed to a vote in relation to than simple equity. We have had an and the Senator from Connecticut (Mr. a McConnell or designee amendment asset test under Medicaid, which ap- LIEBERMAN) are necessarily absent. regarding Alzheimer’s, to be followed plies here, since 1988. It is $4,000. That I further announce that, if present immediately by a vote in relation to means there is an income test and an and voting, the Senator from Massa- the Durbin amendment on the same asset test of $4,000. I believe the time chusetts (Mr. KERRY) would vote subject, again, with no second degrees has come to change that $4,000 to some- ‘‘yea.’’ in order to either amendment prior to thing more reasonable—not gigantic, The PRESIDING OFFICER. Are there the votes; provided further that the just $10,000. It says the income test any other Senators in the Chamber de- Senate then proceed to a vote in rela- still applies, but you can own assets up siring to vote? tion to the Dorgan second-degree to $10,000. The result was announced—yeas 69, amendment on premiums to the Grass- It also says you do not have to fill nays 29, as follows: ley-Baucus amendment No. 1092. Fi- out all kinds of forms. You can sign an [Rollcall Vote No. 251 Leg.] nally, I ask unanimous consent that affidavit under penalty of felony, as to YEAS—69 following disposition of the Dorgan what your assets are, and that suffices. Akaka Chambliss Feinstein amendment, the Senate then proceed If there is anything this bill needs it is Alexander Clinton Graham (FL) to a vote in relation to the underlying simplicity. So this adds simplicity to Allen Coleman Graham (SC) Grassley-Baucus amendment, with no Baucus Collins Hagel other amendments in order to amend- this form. But most of all, for the poor Bayh Conrad Harkin people, it permits them to own a car Bennett Corzine Hollings ment No. 1092 other than the men- today. You know, hardly any cars are Biden Daschle Hutchison tioned Kyl and Dorgan amendments. I worth less than $4,000. I think you can Bingaman Dayton Inouye also ask unanimous consent that there Boxer DeWine Jeffords be poverty stricken and still own an Breaux Dodd Johnson be 2 minutes equally divided for debate automobile. Brownback Domenici Kennedy between each of the votes in this series The PRESIDING OFFICER. The time Byrd Dorgan Kohl as well. of the Senator has expired. Campbell Durbin Landrieu Mr. REID. Reserving the right to ob- Cantwell Edwards Lautenberg Mr. DOMENICI. I believe the amend- Carper Ensign Leahy ject, everyone here is working in the ment should be adopted. Chafee Feingold Levin best of faith to try to work through
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00019 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.028 S26PT1 S8624 CONGRESSIONAL RECORD — SENATE June 26, 2003 this situation. We don’t have the ac- Mr. MCCONNELL. Mr. President, I (C) for 2006, an annual out-of-pocket limit tual document of the Durbin amend- ask unanimous consent that further of $3,700 with 10 percent cost-sharing after ment. I have been told what is in that. reading of the amendment be dispensed that limit is reached. I related that to the majority and to with. Mr. MCCONNELL. Mr. President, the two managers of the bill. It is very The PRESIDING OFFICER. Without very briefly, the amendment I just sent similar to the Boxer amendment. If it objection, it is so ordered. to the desk ensures protection of sen- is anything different than that, I will The amendment is as follows: iors diagnosed with Alzheimer’s from make sure that we vitiate this agree- (Purpose: To protect seniors with the high prescription drug costs associ- ment. Alzheimer’s disease) ated with that illness. Mr. MCCONNELL. So if the Durbin At the end of subtitle A of title I, add the My amendment states specifically amendment is other than we antici- following: that any senior on Medicare diagnosed pate, I will obviously reserve the right SEC. ll. PROTECTING SENIORS WITH ALZ- with Alzheimer’s shall have the right to modify mine as well. HEIMER’S DISEASE. to a drug plan in which the beneficiary Mr. REID. Absolutely. Any eligible beneficiary (as defined in sec- shall pay no deductible, no monthly Mr. DORGAN. Mr. President, reserv- tion 1860D(3) of the Social Security Act) who premium, no more than a 2.5-percent ing the right to object, I ask the major- is diagnosed with Alzheimer’s disease shall copayment for drug spending up to be protected from high prescription drug ity leader if in the period between now $4,500, no more than a 5-percent copay- and when the first vote occurs, there costs in the following manner: (1) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN ment for drug spending between $4,500 will be provided 30 minutes for the of- INCOME BELOW 100 PERCENT OF THE FEDERAL and $5,800, and no more than a 2.5-per- fering and discussion of my amend- POVERTY LINE.—If the individual is a quali- cent copayment for any drug spending ment. I had previously talked with the fied medicare beneficiary (as defined in sec- over $5,800 if their income is below the Senator from Nevada. Senator PRYOR tion 1860D–19(a)(4) of such Act), such indi- poverty level. and I wish to be recognized for 30 min- vidual shall receive the full premium subsidy My amendment states that any sen- utes to offer our amendment. I simply and reduction of cost-sharing described in ior on Medicare diagnosed with Alz- ask if that timeframe allows that op- section 1860D–19(a)(1) of such Act, including the payment of— heimer’s with an income between 100 portunity so that we have 30 minutes of and 135 percent of the poverty level debate. (A) no deductible; (B) no monthly beneficiary premium for at shall have the right to a drug plan in Mr. MCCONNELL. Mr. President, I least one Medicare Prescription Drug plan which the beneficiary shall pay no de- would like to make sure I am protected available in the area in which the individual ductible, no monthly premium, and no to lay down my amendment now. resides; and more than a 5-percent copayment for The PRESIDING OFFICER. The Sen- (C) reduced cost-sharing described in sub- drug spending up to $4,500, no more ator from Nevada has the floor. paragraphs (C), (D), and (E) of section 1860D– than a 10-percent copayment for drug Mr. REID. Mr. President, we have ap- 19(a)(1) of such Act. spending between $4,500 and $5,800, and proximately an hour and a half. I (2) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN no more than a 2.5-percent copayment would ask, as Senator DORGAN asked INCOME BETWEEN 100 AND 135 PERCENT OF THE for any drug spending over $5,800. earlier, that he and Senator PRYOR be FEDERAL POVERTY LINE.—If the individual is given 30 minutes of that hour and a a specified low income medicare beneficiary My amendment provides that any (as defined in paragraph 1860D–19(4)(B) of senior in Medicare diagnosed with Alz- half, and Senator DURBIN be given a such Act) or a qualifying individual (as de- half hour. heimer’s with an income between 135 fined in paragraph 1860D–19(4)(C) of such Act) percent and 160 percent of the poverty The PRESIDING OFFICER. The ma- who is diagnosed with Alzheimer’s disease, jority leader has the floor. level shall have the right to a drug such individual shall receive the full pre- plan in which the beneficiary shall pay Mr. FRIST. Mr. President, I yield to mium subsidy and reduction of cost-sharing the Senator from Kentucky. described in section 1860D–19(a)(2) of such no more than a $50 deductible, an aver- Mr. MCCONNELL. Mr. President, we Act, including payment of— age monthly premium not greater than are talking about how to divide up an (A) no deductible; $35, no more than a 10-percent copay- hour and a half. How about a consent (B) no monthly premium for any Medicare ment for drug spending up to $4,500, no that we divide the time equally? Prescription Drug plan described paragraph more than a 20-percent copayment for Mr. REID. That will be fine. I ask (1) or (2) of section 1860D–17(a) of such Act; drug spending between $4,500 and $5,800, unanimous consent that the agreement and and no more than a 10-percent copay- give each side an extra 5 minutes, so (C) reduced cost-sharing described in sub- ment for any drug spending above paragraphs (C), (D), and (E) of section 1860D– the vote would occur at 2:40, rather 19(a)(2) of such Act. $5,800. than 2:30, and the time be divided (3) SUBSIDY-ELIGIBLE INDIVIDUALS WITH IN- My amendment also provides that equally. COME BETWEEN 135 PERCENT AND 160 PERCENT any senior on Medicare diagnosed with The PRESIDING OFFICER. Is there OF THE FEDERAL POVERTY LEVEL.—If the indi- Alzheimer’s with an income above 160 objection? vidual is a subsidy-eligible individual (as de- percent of the poverty level shall have Mr. DORGAN. Reserving the right to fined in section 1860D–19(a)(4)(D) of such Act) the right to a drug plan in which the object, I don’t care what the vote is. who is diagnosed with Alzheimer’s disease, beneficiary shall pay no more than a Senator PRYOR and I wish to speak for such individual shall receive sliding scale $275 deductible, an average monthly 30 minutes. If that is not provided for premium subsidy and reduction of cost-shar- ing for subsidy-eligible individuals, including premium not greater than $35, no more in the unanimous consent, I will ob- than a 50-percent copayment for drug ject. payment of— (A) for 2006, a deductible of only $50; spending up to $4,500, and no more than Mr. REID. That is fine on this side. (B) only a percentage of the monthly pre- a 10-percent copayment for drug spend- Mr. FRIST. Mr. President, we have mium (as described in section 1860D– ing over $5,800. no objection. 19(a)(3)(A)(i)); and With this amendment, which con- The PRESIDING OFFICER. Without (C) reduced cost-sharing described in forms to the provisions within the bill, objection, it is so ordered. clauses (iii), (iv), and (v) of section 1860D– The PRESIDING OFFICER. The Sen- all seniors with Alzheimer’s get help 19(a)(3)(A). with drug costs, especially the poor ator from Kentucky is recognized. (4) ELIGIBLE BENEFICIARIES WITH INCOME and moderate-income seniors. AMENDMENT NO. 1102 ABOVE 160 PERCENT OF THE FEDERAL POVERTY I yield the floor. Mr. MCCONNELL. Mr. President, LEVEL.—If an individual is an eligible bene- The PRESIDING OFFICER. Who pursuant to the consent agreement just ficiary (as defined in section 1860D(3) of such yields time? The Senator from Iowa. entered into, I send an amendment to Act), is not described in paragraphs (1) through (3), and is diagnosed with Alz- AMENDMENT NO. 1093 WITHDRAWN the desk. heimer’s disease, such individual shall have The PRESIDING OFFICER. The Mr. GRASSLEY. Mr. President, I ask access to qualified prescription drug cov- unanimous consent, on behalf of Sen- clerk will report. erage (as described in section 1860D–6(a)(1) of The assistant legislative clerk read such Act), including payment of— ator KYL, to withdraw the Kyl amend- as follows: (A) for 2006, a deductible of $275; ment to the Grassley amendment. The Senator from Kentucky [Mr. MCCON- (B) the limits on cost-sharing described The PRESIDING OFFICER. Is there NELL] proposes an amendment numbered section 1860D–6(c)(2) of such Act up to, for objection? Without objection, it is so 1102. 2006, an initial coverage limit of $4,500; and ordered.
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00020 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.031 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8625 Mr. REID. Mr. President, I ask unan- Regrettably, the Grassley amend- Some say: We have incredible prob- imous consent that the Dorgan amend- ment before us, to which I have just of- lems financing this program. Yes, we ment be offered now and the pending fered a second-degree amendment, does have some financial problems, no ques- amendment be set aside. not accomplish those goals. So I offer tion about that. Do you know how we The PRESIDING OFFICER. Is there an amendment that is very simple. It solve those problems? Go back to the objection? Without objection. says let’s try to improve this prescrip- old life expectancy. Go back 100 years The Senator from North Dakota. tion drug benefit plan for senior citi- and, on average, you were expected to AMENDMENT NO. 1103 TO AMENDMENT NO. 1092 zens with the $12 billion that is avail- live to 48 years of age in this country. Mr. DORGAN. Mr. President, I send able. Now people live to 76 to 77 years of age. an amendment to the desk and ask for Let me just mention a word gen- Life expectancy has increased dra- its immediate consideration. erally about Medicare. We have people matically in this country. That is good The PRESIDING OFFICER. The on the floor of the Senate who don’t news. Our financing problems with clerk will report. like Medicare. They don’t say it, I Medicare are born of good news. People The assistant legislative clerk read know. One of their colleagues said it are living longer. Good for them. Good as follows: yesterday in New York City. It is the for us. Good for our country. The Senator from North Dakota [Mr. DOR- only flash of candid comment that I Is it a problem to have good news? I GAN] for himself and Mr. PRYOR, proposes an have seen recently. Congressman do not think so. We will solve these amendment numbered 1103. THOMAS, in the New York Times, dated issues. But even as we have done that, Mr. DORGAN. Mr. President, I ask 6/26, says: even as people are living longer and unanimous consent that further read- better lives, these new miracle medi- Some of our friends on the other side of the ing of the amendment be dispensed aisle are saying that if this bill becomes law cines that have been created since with. [meaning the Medicare prescription drug Medicare was created are very expen- The PRESIDING OFFICER. Without bill] it will be the end of Medicare as we sive but very necessary for people to objection, it is so ordered. know it. Our answer to that is, we certainly continue their lifestyle. And we have The amendment is as follows: hope so. no prescription drug coverage in the (Purpose: To reduce aggregate beneficiary Let me read it again so we under- Medicare Program. obligations by $2,400,000,000 per year begin- stand what he is saying: ‘‘Some of our Clearly, if we wrote Medicare start- ning in 2009) friends [Democrats, he means] . . . are ing from scratch today, we would have In lieu of the matter proposed to be in- saying if this bill becomes law, it will prescription drug coverage. That is serted, insert the following: be the end of Medicare as we know it. clear to everyone. But prescription SEC. ll. AGGREGATE REDUCTION IN MONTHLY drugs were not a key medical expense BENEFICIARY OBLIGATIONS. Our answer to that is, we certainly Section 1860D–17, as added by section 101, is hope so.’’ when Medicare was created, so now we amended by adding at the end the following: When I was a young boy in a town of have to put that coverage in the Medi- ‘‘(d) AGGREGATE REDUCTION IN MONTHLY 400 people, my dad asked me to drive care Program. BENEFICIARY OBLIGATIONS.—The Adminis- an old fellow to the hospital in Dickin- Because some people do not like the trator shall for each year (beginning with son, ND. He was a man with a very se- Medicare Program—to wit my col- 2009) determine a percentage which— league, Congressman THOMAS who said, ‘‘(1) shall apply in lieu of the applicable rious health problem, and he had no relatives, had no vehicle, had no re- ‘‘certainly we hope this will be the end percent otherwise determined under sub- of Medicare as we know it,’’—they section (c) for that year, and sources. So I was a teenager just about want to privatize Medicare. Now, keep ‘‘(2) will result in a decrease of out of high school. I got him in my car $2,400,000,000 for that year in the aggregate and drove him to St. Joseph’s Hospital in mind that the private sector is the sector that would not insure old people monthly beneficiary obligations otherwise in Dickinson, ND, and dropped him off in the first place, which is the reason required of all eligible beneficiaries enrolled there to be treated. He had a serious in a Medicare Prescription Drug Plan or a why Congress had to develop the Medi- health problem but no insurance, no Medicare Advantage plan that provides care Program. qualified prescription drug coverage. money, nothing. That brings us back to this question The fact is, that was at a period of This subsection shall not apply in deter- of what to do with the $12 billion. We mining the applicable percent under sub- time in the late 1950s and early 1960s are struggling to put together a benefit section (c) for purposes of section 1860D–21.’’. when a good many senior citizens had that means something to the people Mr. DORGAN. Mr. President, this is no capability to get health care. They who need it. This is not theory. It is an amendment that deals with the had no insurance coverage. It wasn’t not a debate in the abstract. It is about question of what to do about the $12 the case that insurance companies some 85-year-old widow who, today, is billion of remaining available out of were running after old folks to ask going to the pharmacy in the back of a the $400 billion Congress set aside for a them: Can we please sell you a health grocery store and trying to figure out prescription drug benefit plan in the insurance policy? They want to insure how much her prescription drugs are Medicare Program. According to CBO, 22-year-olds—healthy, vibrant, young going to cost so she can figure out how the underlying bill is $12 billion of that 22-year-olds. much money she has left for groceries. $400 billion, so what do we do with that That is where they make money. That is happening in a real sense today $12 billion? If the bill on the floor of They don’t make money by chasing 75- all across this country. the Senate to add prescription drugs to year-old people and selling them health We have $12 billion. We also have a the Medicare Program costs $388 bil- insurance policies. Back in the early bill that says to senior citizens: You lion, and we have allocated $400 billion, 1960s, one-half of America’s elderly had pay $35 a month on an optional basis if the question is, what do you do with no health insurance—none. None at all. you want this program of ours, and the other $12 billion? So we had a group Then along came Medicare. The Con- after $35 a month, you pay the first $275 of people—I am not quite sure who gress had a real debate about that. I in prescription drugs. Between $275 and they were—negotiate over a period of wasn’t here then, but you know there $4,500, the Federal Government will time, and they have now developed a were naysayers who say no to every- help you by paying 50 percent of your plan for what to do with the $12 billion. thing for the first time. They said no, prescription drug costs. And then be- By far, the simplest, most direct, and no, no; you cannot create Medicare. tween $4,500 and $5,800, there is what is most appropriate use of the $12 billion Well, we did create Medicare, and now famously called the donut hole, which would be to improve the prescription 99 percent of the senior citizens in this means you receive no coverage. drug benefit for Medicare recipients. country don’t have to go to bed at So you are not covered until you After all, that is why we are here. That night worrying about whether they can spend $275, then you are partially cov- is the purpose of this discussion and de- get medical care because they have ered, then you are not covered again, bate. That is the purpose of writing health care coverage under Medicare. and then you get catastrophic cov- this legislation—to provide a prescrip- God bless them for that. They needed erage. This is the most byzantine, com- tion drug benefit to the Medicare Pro- it, they deserved it, and this country plicated system we could possibly put gram that serves the interests of our provided it through the Medicare Pro- together. It clearly is done by com- senior citizens. gram. mittee. We could not have done this so
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00021 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.034 S26PT1 S8626 CONGRESSIONAL RECORD — SENATE June 26, 2003 badly if it were done without a com- insurers at a time when Senators have Congressman THOMAS that this bill mittee. been coming to the Chamber and say- ought to be the end of Medicare as we Having said all of that, the question ing we cannot improve this plan be- know it. Congressman THOMAS said: is, What do we do with the $12 billion? cause we do not have any money. I Our answer to that is, we certainly We are told today, with the Grassley have quotes of all the Senators, and I hope so. amendment, that we will provide $6 bil- shall not name them all. I could read Mr. DURBIN. I ask the Senator, is it lion of the $12 billion to test a new al- lots of quotes from the last 2 weeks of possible Halliburton is going to pay ternative bidding system for paying Senators. Why can’t we improve it? Be- some of these services with the six—I PPOs—and if this is not complicated cause we are limited by money. So now will withdraw that question. I ask the enough, just stay with me—that would we have $12 billion more? That is what Senator, if one believes in privatiza- reimburse these PPOs based on the me- happens when you go into a room, shut tion and competition, why does the pri- dian amount of the three lowest bids. the door, make a little deal, and say vate sector need a $6 billion subsidy to There is nothing here that protects this is how we want to use this money: compete with Medicare? If they are American taxpayers by ensuring we are We are going to take $6 billion and try good, if they are efficient, if they are not paying private health plans sub- an experiment that we failed at pre- customer friendly, why do they need stantially more than traditional Medi- viously. It makes no sense to me. It is this Federal subsidy of $6 billion to care costs. a byzantine failure, in my judgment, to offer an attractive health care package Here is what it means in English. It do it this way. to seniors? means we are going to have an experi- What I am proposing in my amend- Mr. DORGAN. First, they do not need ment with private sector delivery, but ment is use the money to actually im- it, and no subsidy is warranted. The we are going to incentivize insurance prove the program for senior citizens. point of my amendment is to say if you companies. We are going to provide We can drive down the cost of the pre- have $12 billion, and they say let’s take them some of this money so that they scription drug policies and improve the $6 billion and use it for an experiment will actually want to offer this plan, so coverage. that we know does not work, let’s in- we can say at the end of it that some- Mr. DURBIN. I ask the Senator, if he stead use that money to help seniors. how the plan is a good plan. will yield further, is the Senator aware Then the underlying amendment says We already know that does not work. of a recent survey of seniors—over 600 let’s take another $6 billion and test My colleague, Senator HOLLINGS, says across the United States—where they whether focusing on wellness will there is no education in the second were told what this plan, S. 1, is all work, which we know it does work. We kick of a mule. We know this does not about? They said the fact that the $35 do not exactly have to have an experi- work. We know what happens. We premium is not mandated in this law ment on that. Do things that promote know the Medicare Payment Advisory but is simply a suggestion; it may go wellness and the fact is you save Committee, MedPAC, which is a non- higher; the fact private insurance com- money on the acute care side by not partisan committee that advises Con- panies that provide the prescription having people go into the hospital be- gress on Medicare payment policies, drug benefit may decide to change the cause they are taking care of them- says private plans cost 15 percent more benefit or go out of business every 2 selves and have the kind of preventive than traditional Medicare. We know years; the fact there is a $275 deduct- care that is necessary to take care of that. We do not have to spend $6 billion ible and a huge gap in coverage for the themselves. giving money to private insurers to do sickness of the senior citizens—when I have another amendment pending. an experiment. We know what does not they looked at all those items, is the It has been pending for nearly a week. work. We know the cost advantage of Senator aware of the fact that most of I hope it will be approved by the end of Medicare, and yet our colleagues con- the seniors, when asked, said they did this process. It is a very inexpensive tinue to resist and continue to insist not believe that S. 1 really answered amendment that deals with that very that we move Medicare beneficiaries the need in America that seniors are kind of wellness approach. into the private sector. And now with looking for? If senior citizens have heart disease, half of the $12 billion, they say let’s do Mr. DORGAN. I know that is the Medicare covers cholesterol screening. this little experiment. case. I have seen the same survey to It makes sense, does it not? But Medi- Will it enhance the health of senior which the Senator referred. I think care does not cover cholesterol screen- citizens? No. Will it improve health there are some provisions in this bill ing if one does not know they have care? No, not at all. Will it actually that have some merit. I prefer we do heart disease. It does not make sense. improve the underlying bill, improve something rather than do nothing, but Heart disease is our biggest killer in the benefits, reduce the costs? No, not when we do something, let’s do some- this country. We ought to cover choles- at all. This is just like a puppy dog fol- thing right and something that bene- terol screening across the board. That lowing the master home. It is putting fits senior citizens. This is the case is the way one can discover who is at more and more money down this chute when you cite the polls, when you cite risk for heart disease at a point when to pursue this dream of trying to dem- what our previous experience has been. steps can be taken to prevent it. Yet onstrate something we already know It is a case, especially with respect to Medicare does not cover that screening does not work. the use of this $6 billion, of the old joke unless a person already has evidence of Mr. DURBIN. Will the Senator yield? from the movies: What are you going heart disease. Mr. DORGAN. I will be happy to to believe, me or your own eyes? There are many things we should do yield. The fact is, we have already had to improve Medicare’s preventive cov- Mr. DURBIN. Do I understand that these experiments. We understand how erage. My hope is that perhaps we will senior citizens, given the choice be- much additional costs are involved in have that amendment approved before tween traditional Medicare and Medi- the private sector delivery of this ben- the end of this process. care HMOs, have already voted and efit, and we also know what Medicare My colleague from Illinois talked that 88 or 89 percent of them want tra- does and how Medicare works. We about HMOs a moment ago. We are not ditional Medicare; that they do not know the private insurers have about a in the trenches of the HMO debate as it want to put their medical fate in the 14-percent overhead in administrative was first envisioned by the White hands of these HMO private insurers costs and delivering their service. We House, which said to senior citizens, who are unreliable, who may or may know that. We also know Medicare has here is a Faustian bargain: we will give not cover the procedures they need? about a 4-percent cost, a dramatic ad- you a prescription drug benefit but Haven’t the seniors of this country, vantage. only if you enroll in an HMO. Talk with their experience, already voted on For that reason alone, you would about a goofy proposal; that is it. this issue we are considering? want to provide this benefit through I have been talking about HMOs. Mr. DORGAN. Seniors have already the traditional Medicare delivery sys- There were some HMOs that did some made that judgment. They have al- tem. Against all odds, we have people good things, held down some prices. I ready decided that. So we want to take in this Chamber who, I guess, although understand that. But we have all also $6 billion and give it to private health they do not say it, believe along with heard the stories of HMOs not taking
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00022 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.036 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8627 good care of people. I guess we do not ought to be good and extensive cov- have shown national leadership on this need to review the HMO stories about erage, and it ought to provide what we effort to try to make this bill better. I what happens to patients when profits know we should provide for senior citi- think there is a broad consensus that were at stake. For instance, a woman zens. we want to add a prescription drug ben- falls off a cliff in the Shenandoah Second, it ought to be done in an af- efit to Medicare. We want to help sen- Mountains, sustains very serious head fordable way. Unfortunately, another iors all over this country, but at the injuries and body injuries. She is weakness of this plan is that there is same time we have to make sure it is hauled into an emergency room on a no defined benefit, which means the set up the right way. It has to make gurney in a coma. After a long con- premiums can vary. The monthly pre- sense. valescence, she finally gets out of the miums will increase year after year be- Quite frankly, one of the things that hospital only to be told by her HMO cause we have not done enough to put to me does not make sense, and prob- that they will not cover her emergency downward pressure on prescription ably to most people around the country room treatment because she did not drug prices—and as prescription drug does not make sense, is that we might have prior approval to use the emer- prices increase, the monthly premium give a pretty healthy sum of money to gency room. This is a woman who is will increase. The expectation is that the insurance industry. hauled in on a gurney in a coma. the monthly premium starts at $35 and All over the country—and I know it I will not revisit all of those HMO goes to $60 in a 10-year period. My is certainly true in my State—insur- stories because it will take too much amendment proposes about a $6 reduc- ance companies are raising premiums. time, but I will say this: With Medi- tion in the monthly premium for senior It may be health care premiums—ev- care, we know what works. Some of my citizens. That is a more effective way erybody knows those are going up. It colleagues make the case that it costs to use this $12 billion. Either that, or I may be property and casualty; it may too much. Do my colleagues really would propose we extend the coverage be homeowners policies, auto policies, know what costs too much in Medi- through the $1,300 gap that exists in medical malpractice, legal mal- care? It costs too much because people coverage, which I think would also rep- practice. You name it, across the are living too long. What a wonderful resent a meritorious way of using this board, as far as I know, the price of set of victories we have in this coun- amount of money. every single kind of insurance in this try. With great health care, people are My colleague, Senator PRYOR from country is going up. living longer. Arkansas, is in the Chamber and he Nonetheless, there are some in this I probably should not talk about my may wish to address this issue as well. Congress who want to actually give uncle again, but I have an 81-year-old I have offered this amendment on be- them a sizable chunk of money that uncle who runs the 400 meter and 800 half of myself and my colleague Sen- could go to people who really need the meter in the Senior Olympics. He is ator PRYOR, so I yield the floor in the help. probably out running today. He runs 3 hope that Senator PRYOR will wish to I take my hat off to Senator DORGAN miles a day at 81 years old. Forty years make some comments as well. for his leadership. One thing he has fig- ago, one reached 81 years old and they Mr. GRASSLEY. Mr. President, it is ured out is a way to make the monthly unfair for Members of the other side of had to be in a chair someplace, but not premium less for people. Now, saving $6 the aisle to give us statistics that say any longer. People live longer, doing a month to someone at my income 89 percent of the seniors are in for fee- things no one ever expected them to level, and all of our income levels, that for-service Medicare and only 11 per- do. And that includes my uncle. Good is not a lot of money, but for those sen- cent are in Medicare+Choice and that for them. Good for him. But because ior citizens all over this country who is a nationwide average. It is an accu- people live longer, Medicare costs live below the poverty level—the only rate statistic, but it does not speak to more. That is not a sign of failure; it is money they get every month is Social the seniors of America who like a sign of success. Security, maybe a little help from the Medicare+Choice and I have figures Now we are trying to add to Medicare family—$6 is a lot of money. Six dol- from four cities—Miami, New York, that which should have been added lars may make this program affordable San Francisco, and Chicago. some long while ago: The miracle drugs In Miami, 45 percent of the senior for them. It is real money. It is money that do provide miracles but only if citizens have chosen managed care, the that at the end of the year, if you add one can afford them. We are talking Medicare+Choice option, as opposed to it up, is only $72 a year, but that is real about covering the drugs that keep fee-for-service; New York, 22 percent; money to so many Americans all over seniors out of the hospital and they do San Francisco, 29 percent. In Chicago, this country. The purpose of the bill, not just this not have to go into an acute care hos- it was only 6 percent. That may be one pital bed. That is what we are dealing amendment but the whole bill, is to reason why Senator DURBIN keeps with. bringing this up quite regularly. This help Americans afford their prescrip- With this amendment, we are dealing data is from the Congressional Re- tion drugs. I know that Senator DUR- with $12 billion. Instead of bifurcating search Service, and it is as recent as BIN, who is in the Chamber, and Sen- it into two different experiments, one March 2003. ator DORGAN and a number of others in of which failed and one of which we do When people, wherever they are in this Chamber have tried to make pre- not need because we know the answer, the Senate, want to denigrate scription drugs more affordable in this what I propose we do is use that $12 bil- Medicare+Choice by saying only 11 per- legislation. There have been different lion to reduce from $43 to $38 the pre- cent of the people in this country join efforts tried in different ways. One of mium our senior citizens will have to in and that is such a small percentage the things I tried was to strengthen re- pay for this prescription drug benefit, and that these figures are evidence it is importation from Canada to try to starting in 2009. not liked, go to Miami and ask 45 per- make prescription drugs more afford- There are people who live on $350 or cent of the citizens who belong to able, but certainly making the pre- $450 a month, their total income from Medicare+Choice why they like it. miums more affordable makes the pro- their miserable little Social Security I yield the floor. gram more accessible to more Ameri- payment, who are living alone in a The PRESIDING OFFICER. The Sen- cans. That is a win/win/win for every- small town, are struggling to buy food, ator from Arkansas. body. struggling to buy the necessities of Mr. PRYOR. Mr. President, last night So I thank the Senator from North life. There are people who have been was a difficult night for me because I Dakota for yielding me some of his told by their doctor: Oh, by the way, was lying in bed worrying about the in- time. I know he is frantically talking you have heart disease and diabetes, surance companies and how we were to colleagues to try to have them adopt and here are the prescription drugs you not getting them enough money during this amendment when we vote on it need; and they sit at home knowing this Congress. Of course, I am being fa- this afternoon. they do not have a penny to pay for cetious because I think we have a very Let’s run through the numbers very those prescription medicines. Talk to clear choice. quickly one more time so we under- those seniors and understand how im- I commend Senator DORGAN, Senator stand clearly what we are talking portant this coverage is. The coverage DURBIN, and a number of others who about. This amendment expends $2.4
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00023 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.039 S26PT1 S8628 CONGRESSIONAL RECORD — SENATE June 26, 2003 billion per year to make premiums cannot help our schools, we cannot pay into the basic bill and cover heart dis- cheaper. It will reduce the typical pre- for President Bush’s No Child Left Be- ease, cancer, Alzheimer’s, diabetes and mium—this is average—by $6 a month. hind, this unfunded mandate on its complications. I take my hat off to the folks in this everybody’s local schools because, Sen- We are not going to leave you high Chamber who worked out compromise ator, we just do not have enough and dry. At the end of $3,700 of subsidy after compromise after compromise money. But the $6 billion we just found from the Government, we are going to trying to come up with solutions to we are going to give to the HMO insur- take the $12 billion and put them back make this bill something that will be- ance industry. in there to try to keep helping you if come law, something that the majority When they write the history of this you are afflicted with one of these dis- of Members can vote for, not just in debate, this amendment will stand out. eases. this Chamber but the House, something This amendment is a tribute to selfish- I will readily concede to my col- the President can sign. ness, a tribute to shortsightedness. leagues that I can think of a half a I believe strongly people in this coun- Why in the world aren’t we helping the dozen other diseases where people have try deserve to have access to these people who need it the most? Why are horrendous prescription drug bills and wonderful prescription medications we giving the money to the HMOs so need help but I will try to appeal to my that are in many ways miracle drugs. they can experiment with an effort to colleagues. Here is your choice. You It is a shame for this country to have end Medicare? have a parent or a grandparent, suf- these drugs available on the market- I just ran into BILL THOMAS in the fering from cancer, who has to buy ex- place but so expensive that people can- hallway, chairman of the House Ways pensive drugs to stay alive. The Gov- not afford them. That is what we are and Means Committee, most powerful ernment program that we are pro- trying to accomplish. man when it comes to Medicare in the posing stops paying for those drugs I yield the floor. House of Representatives. He said in halfway through the year because they The PRESIDING OFFICER. The Sen- today’s New York Times: have reached a point where they spent ator from Illinois. Some of our friends on the other side of the $3,700 and now they have to wait and Mr. DURBIN. I thank my colleague aisle are saying if this bill becomes law, it spend another $1,500 to $1,800 of their from Arkansas as well as my colleague will be the end of Medicare as we know it. own money before they have coverage. from North Dakota. They have come to Our answer to that is, we certainly hope so. You can help them pay for those cancer the floor and said to the Members of Well, thank you, Congressman THOM- therapies or you can send $6 billion in the Senate, look, we found $12 billion. AS, for your candor. And your candor is Federal subsidies to HMO insurance Imagine $12 billion over a period of the reason why so many Senators have companies. time. We are in the middle of debating now come to the Senate and said the That is the choice. It is a fairly a prescription drug bill. What would only way to end Medicare is to sub- straightforward choice. According to a July 2002 study, heart the Senate do with new found money, sidize HMOs with even more money so disease and hypertension are the most $12 billion worth? they can be more profitable and try to expensive conditions to treat. Millions We took a look at the underlying force Medicare out of business. That is of Medicare beneficiaries are suffering bill, the prescription drug bill. There what it is all about. from them and struggling to pay for are a lot of problems with it. There is My colleagues will have two choices. their medications. That is one of the no guaranteed monthly premium. It They can join me in voting with Sen- conditions we would help pay for with has a deductible. It has a period of time ator DORGAN, Senator PRYOR, and oth- the $12 billion, $6 billion of which is when there is no coverage. You are ers and say if you have $12 billion, for headed for these private insurance paying prescription drug bills and you goodness’ sake, put it into this bill. companies’ subsidy. have no protection, no coverage. There Make this bill a little better for sen- The majority of America’s cancer pa- are a lot of uncertainties in this bill. iors. Reduce the cost for seniors. Give tients are on Medicare. They are your You would think the first thing you them some assurance of what they will parents and grandparents. They are would do with the $12 billion is make pay. Provide more prescription drug struggling with all forms of cancer. this a stronger bill, try to take care of coverage. That is one option. I will sup- Nearly 60 percent of new cancer diag- some of the weaknesses, the defi- port it. noses and 50 percent of all cancer-re- ciencies. If it does not succeed, I will offer a lated deaths occur in people 65 years Wrong. Given $12 billion, an agree- second option. It reaches a point under and older. ment has been reached not to give the the bill we are debating, during the I am not identifying a problem that money to the seniors to help them pay course of a year, when there is a gap in does not exist. It exists. Ask any fam- for prescription drugs but to give $6 coverage where the Federal Govern- ily about cancer, my family included. billion to HMOs and private insurance ment will not help pay one penny on We all have stories to tell. And you companies, a $6 billion Federal subsidy your prescription drugs, and about know how expensive it is now to keep so they can experiment with alter- $3,700 into the year out-of-pocket ex- that loved one alive to try to give them natives to Medicare. penses for prescription drugs, this plan a chance to survive. This bill cuts them I am like my colleague from Arkan- cuts off. The underlying plan says you off and leaves them high and dry. My sas; I could not get a moment’s rest are on your own until you get in the amendment gives them a chance. last night for fear that we just were range of $5,500. Then we will start pay- More than 2 million of all Medicare not going to give enough money to the ing you again. So there is a gap in cov- beneficiaries will have cancer in 2003. insurance companies when this was all erage where that senior citizen, that Let me give an example of a couple over with. I lost all my sleep the night widow living by herself, has to pay all who wrote to my office. They wrote a before worried about the fact that of the prescription drug bills until she couple years ago from a downstate maybe pharmaceutical companies reaches the catastrophic coverage community, a small community. It is would not get all the money that we level. one of the letters that Senators get could possibly throw their way. Then This would not be a problem if you every day, one that we saved. It was along comes this amendment. We can did not have over $3,700 in prescription sent to us in September of 2002. rest easy tonight because we will give drugs a year. But a lot of seniors do. I Dear Senator DURBIN: $6 billion to HMOs. This industry have run into them, met them in Illi- My wife has multiple myeloma, which is a which manufactures the milk of human nois, heard their testimony on Capitol cancer of the bone marrow. This disease, kindness for seniors and families across Hill from across the country. while controllable, is not curable. As a re- the America by denying basic health I will offer an alternative to my col- sult, she has to take a great deal of drugs for care coverage so they can run up prof- leagues in the Senate that says simply physical as well as mental anxiety. its is going to need a Federal subsidy. this: We want to make sure people who Last year our combined prescription drug What a delicious irony that we can- suffer from some of the most expensive bill [and this is the year 2000] was $4,500. This year our regular prescription drug bills will not help poor seniors trying to pay for diseases that afflict senior citizens can be more. prescription drugs because, Senator, we pay for their medication. So we will Now my wife Marion has been put on Tha- just do not have enough money. And we take the $12 billion and we will put it lidomide. A great many multiple myeloma
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00024 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.043 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8629 patients are now on Thalidomide. Said drug So my friends on the floor of the Sen- roing in on trying to save Medicare is very expensive. With a low dose [and this ate are going to have a choice: $6 bil- money by managing the chronic dis- is in the year 2000] it is $455.99 a month. lion in Federal subsidies for HMOs or $6 ease situations of the 5 percent of the Incidentally, we checked. That same billion to help seniors struggling with most sick people under Medicare. low dose now costs $645 a month. So in these terrible, life-threatening, expen- So the underlying Grassley-Baucus 3 years it has gone up over 40 percent. sive conditions, to pay their prescrip- amendment, I remind my colleagues, It costs them $5,500 a year just for that tion drug bills. I think that choice is authorizes the Secretary to establish a drug. This is an elderly couple in their easy. I hope the majority of the Senate number of projects in fee-for-service retirement on a fixed income, fighting agrees. Medicare Programs that would provide cancer, putting every dollar in their I reserve the remainder of my time. these enhanced services and benefits savings into keeping one of them alive. The PRESIDING OFFICER. Who for beneficiaries. These enhanced serv- Think about $644 a month. Think about yields time? The Senator from Iowa. ices or benefits include preventive seniors trying to survive on $1,100 a Mr. GRASSLEY. Mr. President, I services, chronic care coordination, month on Social Security. And think yield myself such time as I might con- and disease management services. about this bill which says to this fam- sume to address the issue of the These are very worthwhile projects and ily from Illinois and others just like amendment by the Senator from North have the potential to help many bene- them: I am sorry, but at some point we Dakota and his attempt to take money ficiaries get better care and consider- are going to stop paying. from the $12 billion that is the bipar- ably reduce the cost in the Medicare Doesn’t it make more sense for us to tisan compromise that is a major com- Program. take the $6 billion and not give it in a promise on this amendment between I don’t know how many Members on subsidy to these private insurance Republicans and Democrats. The $12 the other side of the aisle have worked companies but instead give it to these billion is being divided: $6 billion to with this issue we are trying to put $6 seniors to help them pay these bills? I make the marketplace provider organi- billion toward, chronic disease man- think it does. zations more competitive, to save agement. A lot of people who have the I don’t have to tell you the story of money, and to get people into organiza- same political philosophy as the Sen- Alzheimer’s. Is there a family in Amer- tions that will manage particularly ator from North Dakota are very con- ica that does not have a loved one or a chronic disease; and the other $6 billion cerned about doing that. We are con- friend who is struggling with some to go for Medicare demonstration cerned on this side about doing it as form of Alzheimer’s? God bless us; we projects to do the same, have about the well. That is why it is a bipartisan are living longer, but as we do life gets same result, to have chronic disease piece of legislation. more complicated. Let me give an ex- management. I don’t know how, in good conscience, ample of a gentleman in Maplewood, The reason for this compromise is the Senator from North Dakota can MN. His annual out-of-pocket drug both approaches deal with the issue take money that would reduce a costs for Alzheimer’s are $7,000—annual that 5 percent of the sick people under monthly premium by $2.50, still costing cost. This man is 78 years old. He pays Medicare are responsible for about 50 $32.50, away from chronic disease man- as much out of pocket for prescription percent or 55 percent of the cost of agement and a lot of other things that drugs as he does for all of his other Medicare. It is a small segment of peo- people on his side of the aisle are very household expenses combined. He is a ple. If we were in business and we found concerned about. World War II vet, father of three. He is It would not be possible to do these 5 percent of our employees, or a certain a full-time caregiver for his wife. He projects that we have in the underlying problem we had with our business that hasn’t had a vacation in 5 years. He has amendment. It seems to me that the was just 5 percent of it, but it was 50 given up what he loves to do because he Grassley-Baucus amendment with this just can’t afford them. percent of the cost of our business, we bipartisan compromise of $6 billion en- ‘‘I am managing the cost, but I’m would hone in on that problem with hanced membership in PPOs as well as pretty nervous about it,’’ he says. the particular business. $6 billion for chronic disease manage- The Federal Government is in the Medicare can do something to help. ment in the older fee-for-service Medi- business of providing health care for Yes, it can. That is our choice. Are we care Program is preferable to the sec- going to do something to help these our seniors. If we have 5 percent of our ond-degree amendment offered by the seniors facing the most expensive med- senior population who, for various rea- Senator from North Dakota. ical conditions or are we going to give sons, are the cause of 50 percent of the I urge my colleagues to not support $6 billion to private HMOs in a Federal costs of Medicare, then quite obviously the amendment by the Senator from subsidy? we ought to concentrate on that 5 per- North Dakota. The last one I include is diabetes and cent. We have plans to do that. This is This is the second or third time I its complications. I am sad to report to how we use this $12 billion, and we do have heard that seniors have voted on you, those who are following this de- it in a bipartisan way. whether they like fee for service or bate, diabetes is reaching epidemic pro- Honestly, the Senator from North Medicare+Choice, the argument being portions in America. Over 6 percent of Dakota is very open about it; he has a 89 percent of the people in this country the American population suffers from better idea how to use that money. He are in fee for service. Eleven are in some form of diabetes. In the late would take it to lower the monthly managed care, Medicare+Choice, HMO, stages of diabetes, the complications premium paid by beneficiaries in the whatever you want to call it. That is become horrible: Amputations, blind- new Part D prescription drug program. true for the Nation as a whole. ness, severe problems. I have at least two problems with But remember that in the vast geo- Faced with this in your senior retire- that. First of all, the Congressional graphical part of America HMOs are ment years, depending on a prescrip- Budget Office’s rule of thumb is that it not available. In the State of Iowa, tion drug plan, do you really want to costs around $5 billion to lower the es- only 1 county out of 99 has an HMO for say to these people and these families timated $35-a-month premium by just our seniors to join. We have 4,000 battling diabetes and its complica- $1. You spend $5 billion and reduce the Iowans in Medicare+Choice. No place tions: We are going to cut you off. We monthly premium from $35 down to $34. else in Iowa can my citizens get it. The would love to give you more but frank- So if you take the $12 billion that is Des Moines Register is always edito- ly we have to help the HMO insurance available in the Grassley-Baucus rializing why more of Iowa cannot have companies. Those are the ones who amendment and use that to lower the Medicare+Choice so the seniors of our really need a helping hand. premium for the people he wants to country have that opportunity. You couldn’t take that argument to lower the premium for, instead of pay- But what is unfair about the 89 per- any town in America. You couldn’t ing $35 a month they will be paying cent versus the 11 percent, and Sen- take it to any public meeting. You $32.50 a month. ators making statements that it is so couldn’t take it to any senior citizens. My colleagues have to weigh that overwhelming that seniors do not like You couldn’t take it to any family against the use of this money where we Medicare+Choice, is the fact that if with a loved one struggling with one of want to focus in on fee for service as more had that choice more would take these diseases. well as the new Medicare Program, ze- it.
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00025 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.045 S26PT1 S8630 CONGRESSIONAL RECORD — SENATE June 26, 2003 I use, as a basis for my statement, prescription drugs with it, that is your to understand why we are giving a $6 that in the larger cities of America a choice. billion subsidy to the HMOs in Amer- much higher percentage of seniors have The right to choose and fairness and ica. If they are so good, if they are so decided to join Medicare+Choice. They equality and no pressure is the basis efficient, if the free market is truly do it voluntarily. They can go in one for this bipartisan Grassley-Baucus better than the Government-run Medi- year and get out the next, if they don’t legislation. That is the basis for the care system, why in the world do they like it. They have voted by a much compromise amendment that is before need $6 billion worth of the taxpayers’ higher percentage in favor of us which the Senator from North Da- money? You know that of that $6 bil- Medicare+Choice. They like it because kota wants to detract from and use the lion hundreds of millions of dollars are they get more for their money. First, money someplace else. going to go to them in profits. We are they do not have to pay Medigap insur- I think we need to keep this balanced literally subsidizing the profits of these ance. Second, they might get things approach. We need to keep the fairness, companies. We are creating this artifi- such as eye glasses and a better deal on the equality, and no pressure and the cial environment that suggests these prescription drugs than people who are right to choose. Seniors should have companies can do just as good a job or in traditional Medicare fee for service. options just as other people have. better than Medicare with the $6 bil- Where they have had a chance to have I yield the floor. lion Federal subsidy to make it work. that option, a much higher percentage The PRESIDING OFFICER. The Sen- I can’t understand why my col- of seniors than 11 percent will join. All ator from Illinois. leagues on the conservative side who you have to do is talk to people in my AMENDMENT NO. 1108 are hidebound apostles of the free mar- State who go to Arizona, California, Mr. DURBIN. Mr. President, I call up ket system don’t even wince when it and Florida for maybe the winter and my amendment, which I send to the comes to sending $6 billion to the find out about what people in those desk pursuant to the unanimous con- HMOs and the private insurance indus- States have when they join sent request. try in order to let them play on the Medicare+Choice. They ask, Why can’t The PRESIDING OFFICER. The field for health care for seniors in we have that in more places in the clerk will report. America. I don’t get it. I certainly country? The assistant legislative clerk read don’t understand why you wouldn’t A couple of speakers on the other as follows: take that same money to protect the side of the aisle have talked about The Senator from Illinois [Mr. DURBIN] most vulnerable people in America— wasting money with Medicare+Choice. proposes an amendment numbered 1108. our senior citizens who are struggling I think you ought to ask the seniors Mr. President, I ask unanimous con- with heart disease, cancer, Alz- who join and who like it. That is a sent that reading of the amendment be heimer’s, and diabetes and its com- much higher percentage than 11 per- dispensed with. plications. Why is the money for the cent in a lot of the cities. It is not a The PRESIDING OFFICER. Without boardrooms of the HMOs a good ex- fair comparison to imply that since objection, it is so ordered. penditure of tax dollars and the money only 11 percent of the people in the The amendment is as follows: for the family rooms of senior citizens country have it and because such a (Purpose: To provide additional assistance struggling with these deadly diseases high percentage can’t get it that for certain eligible beneficiaries under part not a good investment with taxpayer D) Medicare+Choice is not desired by sen- dollars? iors of America. At the appropriate place insert the fol- The underlying bill is the biggest Our underlying legislation, the lowing: breakthrough for the American phar- Grassley-Baucus bill, is going to make SEC. ll. ADDITIONAL ASSISTANCE FOR CER- maceutical industry since the estab- that opportunity more available for TAIN ELIGIBLE BENEFICIARIES UNDER PART D. lishment of patents in the Constitu- people down the road as we bring in Section 1860D–26, as added by section 101, is tion. This amendment with $6 billion in new options. What we want to do in the amended by adding at the end the following: flatout tax subsidies to HMOs is the underlying bill is give our seniors the ‘‘(d) ADDITIONAL ASSISTANCE FOR CERTAIN answer to the prayers of the insurance right to choose. Not enough of them ELIGIBLE BENEFICIARIES.— companies in America. have a right to choose. They have a ‘‘(1) PROGRAM.—Subject to paragraph (2), right to choose prescription drugs. the Administrator shall implement a pro- Is that what the Senate is all about? They don’t want to join for prescrip- gram (for the period beginning on January 1, Are we supposed to come here to make 2009, and ending on September 30, 2013) to certain that the wealthiest corpora- tion drugs if they don’t have to. They provide additional assistance to applicable have a right to choose between tradi- tions in America get wealthier? I don’t eligible beneficiaries who have reached the think so. They are doing quite well. tional Medicare. If seniors say they are initial coverage limit described in section satisfied with what they have, I can 1860D–6(c)(3) for the year but have not The rate of return for pharmaceutical say to those seniors that they can keep reached the annual out-of-pocket limit under companies across America is 18 per- what they have. It is their choice. But section 1860D–6(c)(4)(A)) for the year in order cent. The average for the S&P compa- it you want to go over here and join to reduce the cost-sharing requirement dur- nies is 3 percent. These companies are something that has more options, you ing this coverage gap. immensely wealthy and profitable. We ‘‘(2) FUNDING LIMITATION.—The Adminis- help them even more with this bill. We will have that right to choose. You trator shall implement the program de- should have that right to choose. know how well the insurance compa- scribed in paragraph (1) in such a manner nies are doing. We know the bonuses One of the complaints people made that will result in a decrease of $12,000,000,000 about the President’s program was in cost-sharing for covered drugs under part they give their executives and we are that if you were going to get prescrip- D by applicable eligible beneficiaries during going to plow in $6 billion to make it tion drugs you had to go over to a new the period described in such paragraph. The even wealthier. type of Medicare. In traditional Medi- Administrator shall take appropriate steps There is something else wrong. We care, you could not get prescription to ensure that the costs of the program dur- know that a lot of average citizens in drugs—or at least not much of a pro- ing such period do not exceed $12,000,000,000. America—particularly senior citizens— ‘‘(3) APPLICABLE ELIGIBLE BENEFICIARY.— are struggling. Pick up the morning gram; at least not equal to what you For purposes of this subsection, the term could get over here in the new pro- ‘applicable eligible beneficiary’ means an eli- papers. Whether it is the Washington gram. gible beneficiary with cardiovascular dis- Post or the New York Times, they go That is where Senator BAUCUS and I ease, diabetes and its complications, cancer, to speak to seniors in their real-life en- disagree with the President of the or Alzheimer’s disease who is enrolled under vironment and talk to them about how United States. We believe in equal ben- part D.’’. they survive. Some of them are well efits. If you want prescription drugs, if Mr. DURBIN. Mr. President, I will off. Some are lucky. They have saved a you want to join it voluntarily, and if speak briefly because I have to go to lot of money or they have a good and you want to stay in traditional Medi- another meeting and return for the generous retirement but a lot of them care fee for service, you can have pre- vote. do not. A lot of them are literally scription drugs. If you want to go over I have great respect for the Senators struggling month to month, some even here and choose a new form and have from Iowa and Montana, but I struggle week to week, just to get by.
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00026 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.047 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8631 This morning in the Washington Post about subjects. I don’t know of many there are two competing philosophies there was a story about a widow lady Senators who are not thoughtful, ar- on the floor of the Senate on how to who said: At the end of the month, I’m ticulate, and fighting hard for their get prescription drug benefits to sen- lucky if I have a dollar left over. At the constituents. And we have, as it turns iors. Even though the two competing end of the article she said: I wonder out, Senators from two political par- philosophies are very different from how many Senators have ever thought ties: 51 Republicans, 48 Democrats, and each other, Senators on both sides of about trying to live on $1,100 a month. 1 Independent; and at this time we are the aisle—most Senators, maybe even I don’t know how she does it. I don’t attempting to finally get prescription all Senators, but certainly most Sen- know how a lot of people do it in my drug benefits to seniors. ators—still want to work as hard as State. Why wouldn’t we want to help This issue has been debated for 4 they can to try to fit these competing these people? Why is it the pharma- years, at least. It has been a politicized philosophies together in order to pass ceutical companies and the HMOs are issue for 4 years. There has been a lot legislation this year to begin finally more important than the most vulner- of talk for 4 years, a lot of rhetoric on getting prescription drug benefits to able people in society? I don’t get it. both sides of the aisle for 4 years, and seniors. Frankly, I think a lot of our col- during all the talking there has not Also, these two competing philoso- leagues, as I said earlier, ought to take been any action; it has been all words, phies are very different. One is com- these arguments, which sound so good no deeds. petition. The argument is: Let private on the floor of the Senate, back to the Well, here we are, at a time—after 4 companies, themselves, with assistance real world of the State they represent, years of just political posturing, to a from the Government, design how they take them into the town of their large degree—where we are on the give prescription drug benefits to our choice, the public meeting of their brink of getting prescription drug ben- senior citizens, make them available at choice, and explain to people why efits passed for our seniors in our coun- a big discount for senior citizens. The HMOs need a subsidy but seniors do not try. other philosophy is: Medicare should be need a helping hand. It just does not Is it the best bill in the world? No. the agency that should be the way— work. Could it be better? Yes. Do all Senators traditional Medicare, basically—to pro- So I will be offering an amendment wish it could be better? Yes. But is it a vide discounts for senior citizens to get that says we will take this $12 billion good start? Is it a beginning? Is it a drugs. and focus it on the elderly people who platform on which we can begin to Essentially, the competing philoso- suffer from some of the worst and most build? Absolutely. phies are 50–50. You have 51 Repub- demanding diseases. If we go back and look at the history licans, 48 Democrats, and 1 Inde- I reserve the remainder of my time. of health care and assistance by the pendent. What are we going to do? Government in providing health care The PRESIDING OFFICER (Mr. AL- Well, all we can do, if we want to get to the needy and to Americans gen- EXANDER). Who yields time? this done, is to just try our best to put The Senator from Montana. erally, it is a history of building, of these two together in a fair, balanced Mr. BAUCUS. Mr. President, I lis- starting somewhere, building on it, and way—and the private competition making it better and better all the tened quite closely to the Senator from model gets a break, gets a fair chance time. Illinois, as well as to the Senator from to see the degree to which it might Back in the 1930s it was the Wagner- North Dakota. They are each offering a work—so that senior citizens really do separate amendment, but they are both Murray-Dingell legislation that was in- troduced to provide national health in- get the benefits and are not taken ad- similar in an attempt, generally, to ac- vantage of during our efforts to pass complish the same result. surance for Americans. That was the idea: We need national health insur- legislation. I say to my good friend from Illinois, It is a balance. It is trying to find the as well as my good friend from North ance for Americans. Well, it was debated and debated. Not right way to accomplish that balance. Dakota, who is presently not in the a lot more really happened. Then sud- It has been extremely difficult. I do not Chamber, I am very sympathetic. If I denly things changed in the 1960s. The have to tell the Presiding Officer just had my way, we would be spending this idea of Medicare came along: Why not how hard this has been. But we are newly found $12 billion very much in help at least our seniors? If we can’t right on the brink. the way the Senator suggested. In fact, get national health insurance, the very We are limited to $400 billion in pro- there are a lot of good ways. It is not least we can do is help our senior citi- viding the drug benefits for seniors only helping those with Alzheimer’s, zens get a break with respect to their over the next 10 years. Why are we lim- but it is also lowering the premium. health care bills. That is a good place ited to $400 billion? Well, this body There are a lot of ways we could be to at least begin—by helping a good, passed a budget resolution not too long spending dollars to help get more drug solid segment of the population. And ago—both the House and the Senate— benefits to more seniors. There is no we did, back in 1965, by providing Medi- saying we are going to set aside $400 doubt about that. But, unfortunately, care. And look what has happened billion for prescription drug benefits we are 100 Senators. since then. We have kept building on for seniors. We never set aside any- The Senator from Illinois, the Sen- Medicare to make it better. thing like that in the past. So we have ator from North Dakota, and I have a When Medicare was first enacted, 50 an opportunity now to use it. I don’t view of how some of these dollars percent of a Part B premium was paid think Senators want to miss this op- should be spent in a perfect world, but by the senior and the Government paid portunity. I think they want to use the the world is not perfect. This is a de- the other 50 percent of the premium for dollars that are there to get prescrip- mocracy. It is messy. As Winston Part B. That is for doctor services. tion drug benefits for seniors. Churchill once said—I will paraphrase Now it is 25 percent. It has been im- Well, as it turned out, when the Sen- very poorly, but the Senator knows proved over time. We also have added ate Finance Committee wrote this bill, this quote—basically, Winston Church- more benefits, some screening provi- trying its hardest to be balanced—and ill said: A democracy, for all its fits sions. End-stage renal treatment has it is balanced; the best evidence of that and starts and delays and inefficiencies been added. There is a list of new addi- is it passed by a large majority from and herky-jerky jolting, and all that, is tions to help our senior citizens. both parties in the Finance Com- the world’s worst form of government, Here we are now, on the brink of add- mittee—we found it actually cost only except for all the others. ing another major benefit: prescription about $388 billion. There was $12 billion Here we are, in a democratic process, drugs. After all these years, all the remaining. trying to figure out how to get pre- years of talking and talking and poli- So the question before us is how we scription drug benefits to seniors. We ticking and giving statements and can spend that $12 billion. That is the have 100 Senators. I don’t know of very speeches, we are finally on the brink of question. In an attempt to maintain a many timid Senators. We don’t have getting prescription drug benefits balance and to work on two competing many Senators who don’t speak their passed. models and in an attempt to get the views. I don’t know very many Sen- It has not been easy. Why has it not legislation passed so we can provide a ators who don’t have strong views been easy? It has not been easy because prescription drug benefit to seniors, we
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00027 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.050 S26PT1 S8632 CONGRESSIONAL RECORD — SENATE June 26, 2003 have decided to split it, 6 and 6; $6 bil- We will try to help with Alzheimer’s (Purpose: To ensure that beneficiaries ini- lion to the PPOs, have it available po- and all the other measures we des- tially covered by a private insurer under tentially for PPOs, if that is needed for perately need to pay attention to as this act who are subsequently covered by a the bidding process, beginning in the the days and years go by. Medicare fallback plan have the option of retaining a Medicare fallback plan) year 2009. I don’t know how many Sen- I implore my colleagues to think a ators are going to be here in 2009, but little bit. Resist the siren song of doing Insert the following in the appropriate place: The Secretary of Health and Human at least beginning then. The other $6 something that sounds good but which Services shall retain or designate one or billion, beginning in 2009, will then go, very well could put the bill in real more Medicare backup plans so that bene- under Medicare fee for services, for dis- jeopardy. This is fair. It has $6 billion ficiaries initially covered by a private in- ease management, chronic care, to help which may or may not be used for surer under this act who are subsequently particularly seniors who really need PPOs, depending upon what the bids covered by a Medicare fallback plan have the that disease management and chronic are. This bill cuts off after a 5-year pe- option of retaining a Medicare fallback plan care. It is really needed because there riod; no more $6 billion can be spent. or entering private insurance under this act. is very little disease management And $6 billion for disease management AMENDMENT NO. 1111 today under traditional Medicare. That under traditional Medicare which will Mr. BAUCUS. Mr. President, I ask is one of its shortcomings. That is be spent. That is the question. Do you unanimous consent that the pending what we have done. want balance or do you want to try to amendments be set aside so that I may Again it is a balance, a start, a begin- get something else passed right now send to the desk on behalf of Senator ning. I have a lot of sympathy with my that you like in the short term but LEVIN an amendment to ensure that friends on this side of the aisle. If I had could very well jeopardize the whole current retirees who have prescription my druthers and I were the only one bill, which means another year, year 5, drug coverage, who will loose their cov- writing this bill, I would take that $12 Congress is talking about this issue, erage as a result of enactment of this billion and spend it along the lines Congress is not doing anything about legislation, would have the option of they are suggesting. But I am not the it. Rather, we want year 1, we have fi- drug coverage under Medicare fallback. only Senator here. I am one of 100. It is nally got it done. The PRESIDING OFFICER. Without my job and that of the chairman of the We are very close to getting it done. objection, it is so ordered. committee, Senator GRASSLEY, to try It is not perfect, but we will keep The clerk will report. to find a balance—not for the sake of working on it over the years. The legislative clerk read as follows: balance but for the sake of getting leg- The PRESIDING OFFICER. Who The Senator from Montana [Mr. BAUCUS], islation passed so we can finally get yields time? for Mr. LEVIN, proposes an amendment num- bered 1111. prescription drugs to seniors. AMENDMENT NO. 1037, AS MODIFIED If the amendments offered by the Mr. BAUCUS. Mr. President, I ask Mr. BAUCUS. Mr. President, on be- Senators from North Dakota or Illinois unanimous consent that reading of the half of the Senator from New Jersey, were to pass, guess what would happen. amendment be dispensed with. Mr. CORZINE, I ask unanimous consent First of all, those are killer amend- The PRESIDING OFFICER. Without that amendment No. 1037 be modified ments. If those amendments were to objection, it is so ordered. with the text that I send to the desk. pass, that would mean this bill is in The amendment is as follows: The PRESIDING OFFICER. Without jeopardy of passage. That would mean objection, it is so ordered. (Purpose: To ensure that current retirees senior citizens may not get the pre- who have prescription drug coverage who scription drug benefits we are all try- The amendment, as modified, is as will lose their prescription drug coverage ing to get; albeit just a first step, or it follows: as a result of the enactment of this legisla- could also mean, on the other hand— At the end of subtitle A of title I, add the tion have the option of drug coverage and this is perhaps even more likely— following: under the Medicare fallback) if that amendment were to pass, I will SEC. . CONFORMING CHANGES REGARDING Insert the following in the appropriate FEDERALLY QUALIFIED HEALTH bet you dollars to donuts—which is not place: The Secretary of Health and Human CENTERS. Services shall retain or designate one or a good phrase to use because we are EXCLUSION FROM PER VISIT LIMIT.—Section more Medicare backup plans so that the 37% trying to put dollars in the donut 1833(a)(3)) (42 U.S.C. 13951(a)(3)) is amended of current retirees who have prescription hole—the conservative part of this by inserting ‘‘(which regulations shall ex- drug coverage, estimated by the Congres- body, the Republican side of the aisle, clude any cost incurred for the provision of sional Budget Office who will lose their cur- would say: We are going to take that services pursuant to a contract with an eligi- rent employer retiree coverage as a result of $12 billion and spend it our way. And ble entity (defined in section 1860D(a)(4)) op- the enactment of this legislation will have erating a plan under Part D, for which pay- they have the votes. They have the the option to enter either a Medicare backup ment is made by such entity)’’ after ‘‘includ- plan or private insurance under this act. White House. So this amendment puts ing those authorized under section in jeopardy a very delicate, very bal- 1861(v)(1)(A)’’. Mr. BAUCUS. Mr. President, I ask unanimous consent that time under anced kind of deal between competing Mr. BAUCUS. Mr. President, I ask philosophies, fairly and evenly, so that the quorum call be charged equally unanimous consent that the pending against both sides. we can get prescription drug legisla- amendments be temporarily laid aside. tion passed, so that we are just not The PRESIDING OFFICER. Without The PRESIDING OFFICER. Without objection, it is so ordered. talking about it anymore and finally objection, it is so ordered. doing something about it. Mr. BAUCUS. I suggest the absence If it were to pass or looked like it AMENDMENT NO. 1110 of a quorum. would pass, the other side, which has Mr. BAUCUS. Mr. President, on be- The PRESIDING OFFICER. The more votes than this side has, would half of the Senator from Michigan, Mr. clerk will call the roll. say: We will spend it our way. LEVIN, I send an amendment to the The legislative clerk proceeded to Then colleagues on my side of the desk and ask for its immediate consid- call the roll. aisle would be quite distressed. They eration. Mr. BAUCUS. Mr. President, I ask would be forced to ask themselves if The PRESIDING OFFICER. The unanimous consent that the order for they would support on final passage a clerk will report. the quorum call be rescinded. bill way off to the right for competi- The legislative clerk read as follows: The PRESIDING OFFICER. Without tion instead of the bill which currently The Senator from Montana [Mr. BAUCUS], objection, it is so ordered. exists, particularly with the under- for Mr. LEVIN, proposes an amendment num- AMENDMENTS NOS. 1027 AND 1041, EN BLOC lying amendment. I wish we could do bered 1110. Mr. BAUCUS. Mr. President, I ask more but at least it is a first step. If Mr. BAUCUS. Mr. President, I ask unanimous consent that the pending the history of Medicare is any guide, in unanimous consent that reading of the amendments be temporarily laid aside future years we will continue to make amendment be dispensed with. and amendments numbered 1027 and it better. We will work on that donut The PRESIDING OFFICER. Without 1041 be immediately considered. hole. We will fill in the gaps. We will objection, it is so ordered. The PRESIDING OFFICER. Without make sure premiums are not too high. The amendment is as follows: objection, it is so ordered.
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00028 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.053 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8633 The clerk will report. (b) CLINICS DESCRIBED.—A frontier ex- be laid upon the table; and that any The legislative clerk read as follows: tended stay clinic is described in this sub- statements relating to the bill be The Senator from Montana [Mr. BAUCUS] section if the clinic— printed in the RECORD. proposes amendments numbered 1027 and (1) is located in a community where the The PRESIDING OFFICER. Without 1041, en bloc. closest short-term acute care hospital or critical access hospital is at least 75 miles objection, it is so ordered. Mr. BAUCUS. Mr. President, I ask away from the community or is inaccessible The amendment (No. 1113) was agreed unanimous consent that further read- by public road; and to, as follows: ing of the amendments be dispensed (2) is designed to address the needs of— (Purpose: To make a technical correction) with. (A) seriously or critically ill or injured pa- At the end, add the following: The PRESIDING OFFICER. Without tients who, due to adverse weather condi- SEC. 2. TECHNICAL CORRECTION. objection, it is so ordered. tions or other reasons, cannot be transferred (a) TEMPORARY INCREASE OF THE MEDICAID The amendments are as follows: quickly to acute care referral centers; or FMAP.—Section 401(a)(6)(A) of the Jobs and AMENDMENT NO. 1027 (B) patients who need monitoring and ob- Growth Tax Relief Reconciliation Act of 2003 (Purpose: To express the sense of the Senate servation for a limited period of time. (Public Law 108–027) is amended by inserting regarding the implementation of the Pre- (c) DEFINITIONS.—In this section, the terms ‘‘after September 2, 2003,’’ after ‘‘(42 U.S.C. scription Drug and Medicare Improvement ‘‘hospital’’ and ‘‘critical access hospital’’ 1315))’’. Act of 2003) have the meanings given such terms in sub- (b) RETROACTIVE EFFECTIVE DATE.—The sections (e) and (mm), respectively, of sec- At the end of title VI, insert the following: amendment made by subsection (a) shall tion 1861 of the Social Security Act (42 take effect as if included in the enactment of SEC. ll. SENSE OF THE SENATE REGARDING IM- U.S.C. 1395x). PLEMENTATION OF THE PRESCRIP- section 401 of the Jobs and Growth Tax Re- TION DRUG AND MEDICARE IM- AMENDMENTS NOS. 936, 938, 988, 1027 AND 1041 EN lief Reconciliation Act of 2003 (Public Law PROVEMENT ACT OF 2003. BLOC 108–027). (a) IN GENERAL.—It is the sense of the Sen- Mr. BAUCUS. Mr. President, on be- The bill (S. 312), as amended, was ate that the Committee on Finance of the half of the chairman of the committee, Senate should hold not less than 4 hearings read the third time and passed, as fol- to monitor implementation of the Prescrip- Senator GRASSLEY, I ask unanimous lows: tion Drug and Medicare Improvement Act of consent that the pending amendments S. 312 2003 (hereinafter in this section referred to as be set aside and that the following Be it enacted by the Senate and House of Rep- the ‘‘Act’’) during which the Secretary or his amendments be agreed to en bloc, and resentatives of the United States of America in designee should testify before the Com- that the motions to reconsider be laid Congress assembled, mittee. on the table en bloc: Amendments Nos. SECTION 1. EXTENSION OF AVAILABILITY OF (b) INITIAL HEARING.—It is the sense of the 936, 938, 988, 1027, and 1041. SCHIP ALLOTMENTS FOR FISCAL Senate that the first hearing described in YEARS 1998 THROUGH 2001. subsection (a) should be held not later than The PRESIDING OFFICER. Without objection, it is so ordered. (a) EXTENDING AVAILABILITY OF SCHIP AL- 60 days after the date of the enactment the LOTMENTS FOR FISCAL YEARS 1998 THROUGH Act. At the hearing, the Secretary or his des- The amendments were agreed to en 2001.— ignee should submit written testimony and bloc. (1) RETAINED AND REDISTRIBUTED ALLOT- testify before the Committee on Finance of Mr. BAUCUS. Mr. President, I ask MENTS FOR FISCAL YEARS 1998 AND 1999.—Para- the Senate on the following issues: unanimous consent that the time I graphs (2)(A)(i) and (2)(A)(ii) of section (1) The progress toward implementation of used be charged equally to both sides. 2104(g) of the Social Security Act (42 U.S.C. the prescription drug discount card under The PRESIDING OFFICER. Without 1397dd(g)) are each amended by striking ‘‘fis- section 111 of the Act. cal year 2002’’ and inserting ‘‘fiscal year (2) Development of the blueprint that will objection, it is so ordered. Mr. BAUCUS. Mr. President, I sug- 2004’’. direct the implementation of the provisions (2) EXTENSION AND REVISION OF RETAINED of the Act, including the implementation of gest the absence of a quorum. AND REDISTRIBUTED ALLOTMENTS FOR FISCAL title I (Medicare Prescription Drug Benefit), The PRESIDING OFFICER. The YEAR 2000.— title II (MedicareAdvantage), and title III clerk will call the roll. (A) PERMITTING AND EXTENDING RETENTION (Center for Medicare Choices) of the Act. The legislative clerk proceeded to OF PORTION OF FISCAL YEAR 2000 ALLOTMENT.— (3) Any problems that will impede the call the roll. Paragraph (2) of such section 2104(g) is timely implementation of the Act. Mr. GRASSLEY. Mr. President, I ask amended— (4) The overall progress toward implemen- (i) in the heading, by striking ‘‘AND 1999’’ tation of the Act. unanimous consent that the order for the quorum call be rescinded. and inserting ‘‘THROUGH 2000’’; and (c) SUBSEQUENT HEARINGS.—It is the sense (ii) by adding at the end of subparagraph of the Senate that the additional hearings The PRESIDING OFFICER. Without (A) the following: described in subsection (a) should be held in objection, it is so ordered. ‘‘(iii) FISCAL YEAR 2000 ALLOTMENT.—Of the each of May 2004, October 2004, and May 2005. Mr. GRASSLEY. I ask unanimous amounts allotted to a State pursuant to this At each hearing, the Secretary or his des- consent to proceed as in morning busi- section for fiscal year 2000 that were not ex- ignee should submit written testimony and ness. pended by the State by the end of fiscal year testify before the Committee on Finance of 2002, 50 percent of that amount shall remain the Senate on the following issues: The PRESIDING OFFICER. Without objection, it is so ordered. available for expenditure by the State (1) Progress on implementation of title I through the end of fiscal year 2004.’’. (Medicare Prescription Drug Benefit), title II f (B) REDISTRIBUTED ALLOTMENTS.—Para- (MedicareAdvantage), and title III (Center graph (1) of such section 2104(g) is amended— for Medicare Choices) of the Act. AMENDING TITLE XXI OF THE SOCIAL SECURITY ACT (i) in subparagraph (A), by inserting ‘‘or (2) Any problems that will impede timely for fiscal year 2000 by the end of fiscal year implementation of the Act. Mr. GRASSLEY. Mr. President, I ask 2002,’’ after ‘‘fiscal year 2001,’’; AMENDMENT NO. 1041 unanimous consent that the Senate (ii) in subparagraph (A), by striking ‘‘1998 (Purpose: To require the Secretary of Health proceed to the immediate consider- or 1999’’ and inserting ‘‘1998, 1999, or 2000’’; and Human Services to conduct a frontier ation of Calendar No. 166, S. 312. (iii) in subparagraph (A)(i)— extended stay clinic demonstration The PRESIDING OFFICER. The (I) by striking ‘‘or’’ at the end of subclause project) clerk will report the bill by title. (I), On page 529, between lines 8 and 9, insert (II) by striking the period at the end of the following: The legislative clerk read as follows: subclause (II) and inserting ‘‘; or’’; and SEC. 455. FRONTIER EXTENDED STAY CLINIC A bill (S. 312) to amend title XXI of the So- (III) by adding at the end the following new DEMONSTRATION PROJECT. cial Security Act to extend the availability subclause: (a) AUTHORITY TO CONDUCT DEMONSTRATION of allotments for fiscal years 1998 through ‘‘(III) the fiscal year 2000 allotment, the PROJECT.—The Secretary shall waive such 2001 under the State Children’s Health Insur- amount specified in subparagraph (C)(i) (less provisions of the medicare program estab- ance Program. the total of the amounts under clause (ii) for lished under title XVIII of the Social Secu- There being no objection, the Senate such fiscal year), multiplied by the ratio of rity Act (42 U.S.C. 1395 et seq.) as are nec- proceeded to consider the bill. the amount specified in subparagraph (C)(ii) essary to conduct a demonstration project Mr. GRASSLEY. Mr. President, I ask for the State to the amount specified in sub- under which frontier extended stay clinics paragraph (C)(iii).’’; described in subsection (b) in isolated rural unanimous consent that the managers’ (iv) in subparagraph (A)(ii), by striking ‘‘or areas of Alaska are treated as providers of amendment be agreed to; that the bill, 1999’’ and inserting ‘‘, 1999, or 2000’’; items and services under the medicare pro- as amended, be read a third time and (v) in subparagraph (B), by striking ‘‘with gram. passed; that the motion to reconsider respect to fiscal year 1998 or 1999’’;
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00029 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.057 S26PT1 S8634 CONGRESSIONAL RECORD — SENATE June 26, 2003 (vi) in subparagraph (B)(ii)— ‘‘(iii) notwithstanding subsection (e), with income exceeds 150 percent of the poverty (I) by inserting ‘‘with respect to fiscal year respect to fiscal year 2001, shall remain line. 1998, 1999, or 2000,’’ after ‘‘subsection (e),’’; available for expenditure by the State ‘‘(iii) NO IMPACT ON DETERMINATION OF and through the end of fiscal year 2005; and’’; and BUDGET NEUTRALITY FOR WAIVERS.—In the (II) by striking ‘‘2002’’ and inserting ‘‘2004’’; (vi) by adding at the end the following new case of a qualifying State that uses amounts and subparagraph: paid under this subsection for expenditures (vii) by adding at the end the following ‘‘(D) AMOUNTS USED IN COMPUTING REDIS- described in clause (ii) that are incurred new subparagraph: TRIBUTIONS FOR FISCAL YEAR 2001.—For pur- under a waiver approved for the State, any ‘‘(C) AMOUNTS USED IN COMPUTING REDIS- poses of subparagraph (A)(i)(IV)— budget neutrality determinations with re- TRIBUTIONS FOR FISCAL YEAR 2000.—For pur- ‘‘(i) the amount specified in this clause is spect to such waiver shall be determined poses of subparagraph (A)(i)(III)— the amount specified in paragraph (2)(B)(i)(I) without regard to such amounts paid. ‘‘(i) the amount specified in this clause is for fiscal year 2001, less the total amount re- ‘‘(2) QUALIFYING STATE.—In this subsection, the amount specified in paragraph (2)(B)(i)(I) maining available pursuant to paragraph the term ‘qualifying State’ means a State for fiscal year 2000, less the total amount re- (2)(A)(iv); that— maining available pursuant to paragraph ‘‘(ii) the amount specified in this clause for ‘‘(A) as of April 15, 1997, has an income eli- (2)(A)(iii); a State is the amount by which the State’s gibility standard with respect to any 1 or ‘‘(ii) the amount specified in this clause for expenditures under this title in fiscal years more categories of children (other than in- a State is the amount by which the State’s 2001, 2002, and 2003 exceed the State’s allot- fants) who are eligible for medical assistance expenditures under this title in fiscal years ment for fiscal year 2001 under subsection under section 1902(a)(10)(A) or under a waiver 2000, 2001, and 2002 exceed the State’s allot- (b); and under section 1115 implemented on January ment for fiscal year 2000 under subsection ‘‘(iii) the amount specified in this clause is 1, 1994, that is up to 185 percent of the pov- (b); and the sum, for all States entitled to a redis- erty line or above; and ‘‘(iii) the amount specified in this clause is tribution under subparagraph (A) from the ‘‘(B) satisfies the requirements described the sum, for all States entitled to a redis- allotments for fiscal year 2001, of the in paragraph (3). tribution under subparagraph (A) from the amounts specified in clause (ii).’’. ‘‘(3) REQUIREMENTS.—The requirements de- allotments for fiscal year 2000, of the (C) CONFORMING AMENDMENTS.—Such sec- amounts specified in clause (ii).’’. tion 2104(g) is further amended— scribed in this paragraph are the following: ‘‘(A) SCHIP INCOME ELIGIBILITY.—The State (C) CONFORMING AMENDMENTS.—Such sec- (i) in its heading, by striking ‘‘AND 2000’’ has a State child health plan that (whether tion 2104(g) is further amended— and inserting ‘‘2000, AND 2001’’; and implemented under title XIX or this title)— (i) in its heading, by striking ‘‘AND 1999’’ (ii) in paragraph (3)— ‘‘(i) as of January 1, 2001, has an income and inserting ‘‘, 1999, AND 2000’’; and (I) by striking ‘‘or fiscal year 2000’’ and in- (ii) in paragraph (3)— serting ‘‘fiscal year 2000, or fiscal year 2001’’; eligibility standard that is at least 200 per- (I) by striking ‘‘or fiscal year 1999’’ and in- and cent of the poverty line or has an income eli- serting ‘‘, fiscal year 1999, or fiscal year (II) by striking ‘‘or November 30, 2002,’’ and gibility standard that exceeds 200 percent of 2000’’; and inserting ‘‘November 30, 2002, or November the poverty line under a waiver under sec- (II) by striking ‘‘or November 30, 2001’’ and 30, 2003,’’, respectively. tion 1115 that is based on a child’s lack of inserting ‘‘November 30, 2001, or November (4) EFFECTIVE DATE.—This subsection, and health insurance; 30, 2002’’, respectively. the amendments made by this subsection, ‘‘(ii) subject to subparagraph (B), does not (3) EXTENSION AND REVISION OF RETAINED shall be effective as if this subsection had limit the acceptance of applications for chil- AND REDISTRIBUTED ALLOTMENTS FOR FISCAL been enacted on September 30, 2002, and dren; and YEAR 2001.— amounts under title XXI of the Social Secu- ‘‘(iii) provides benefits to all children in (A) PERMITTING AND EXTENDING RETENTION rity Act (42 U.S.C. 1397aa et seq.) from allot- the State who apply for and meet eligibility OF PORTION OF FISCAL YEAR 2001 ALLOTMENT.— ments for fiscal years 1998 through 2000 are standards on a statewide basis. Paragraph (2) of such section 2104(g), as available for expenditure on and after Octo- ‘‘(B) NO WAITING LIST IMPOSED.—With re- amended in paragraph (2)(A)(ii), is further ber 1, 2002, under the amendments made by spect to children whose family income is at amended— this subsection as if this subsection had been or below 200 percent of the poverty line, the (i) in the heading, by striking ‘‘2000’’ and in- enacted on September 30, 2002. State does not impose any numerical limita- serting ‘‘2001’’; and (b) AUTHORITY FOR QUALIFYING STATES TO tion, waiting list, or similar limitation on (ii) by adding at the end of subparagraph USE PORTION OF SCHIP FUNDS FOR MEDICAID the eligibility of such children for child (A) the following: EXPENDITURES.—Section 2105 of the Social health assistance under such State plan. ‘‘(iv) FISCAL YEAR 2001 ALLOTMENT.—Of the Security Act (42 U.S.C. 1397ee) is amended by ‘‘(C) ADDITIONAL REQUIREMENTS.—The amounts allotted to a State pursuant to this adding at the end the following: State has implemented at least 3 of the fol- section for fiscal year 2001 that were not ex- ‘‘(g) AUTHORITY FOR QUALIFYING STATES TO lowing policies and procedures (relating to pended by the State by the end of fiscal year USE CERTAIN FUNDS FOR MEDICAID EXPENDI- coverage of children under title XIX and this 2003, 50 percent of that amount shall remain TURES.— title): available for expenditure by the State ‘‘(1) STATE OPTION.— ‘‘(i) UNIFORM, SIMPLIFIED APPLICATION through the end of fiscal year 2005.’’. ‘‘(A) IN GENERAL.—Notwithstanding any FORM.—With respect to children who are eli- (B) REDISTRIBUTED ALLOTMENTS.—Para- other provision of law, with respect to allot- gible for medical assistance under section graph (1) of such section 2104(g), as amended ments for fiscal years 1998, 1999, 2000, 2001, for 1902(a)(10)(A), the State uses the same uni- in paragraph (2)(B), is further amended— fiscal years in which such allotments are form, simplified application form (including, (i) in subparagraph (A), by inserting ‘‘or available under subsections (e) and (g) of sec- if applicable, permitting application other for fiscal year 2001 by the end of fiscal year tion 2104, a qualifying State (as defined in than in person) for purposes of establishing 2003,’’ after ‘‘fiscal year 2002,’’; paragraph (2)) may elect to use not more eligibility for benefits under title XIX and (ii) in subparagraph (A), by striking ‘‘1999, than 20 percent of such allotments (instead this title. or 2000’’ and inserting ‘‘1999, 2000, or 2001’’; of for expenditures under this title) for pay- ‘‘(ii) ELIMINATION OF ASSET TEST.—The (iii) in subparagraph (A)(i)— ments for such fiscal year under title XIX in State does not apply any asset test for eligi- (I) by striking ‘‘or’’ at the end of subclause accordance with subparagraph (B). bility under section 1902(l) or this title with (II), ‘‘(B) PAYMENTS TO STATES.— respect to children. (II) by striking the period at the end of ‘‘(i) IN GENERAL.—In the case of a quali- ‘‘(iii) ADOPTION OF 12-MONTH CONTINUOUS EN- subclause (III) and inserting ‘‘; or’’; and fying State that has elected the option de- ROLLMENT.—The State provides that eligi- (III) by adding at the end the following new scribed in subparagraph (A), subject to the bility shall not be regularly redetermined subclause: total amount of funds described with respect more often than once every year under this ‘‘(IV) the fiscal year 2001 allotment, the to the State in subparagraph (A), the Sec- title or for children described in section amount specified in subparagraph (D)(i) (less retary shall pay the State an amount each 1902(a)(10)(A). the total of the amounts under clause (ii) for quarter equal to the additional amount that ‘‘(iv) SAME VERIFICATION AND REDETERMINA- such fiscal year), multiplied by the ratio of would have been paid to the State under title TION POLICIES; AUTOMATIC REASSESSMENT OF the amount specified in subparagraph (D)(ii) XIX for expenditures of the State for the fis- ELIGIBILITY.—With respect to children who for the State to the amount specified in sub- cal year described in clause (ii) if the en- are eligible for medical assistance under sec- paragraph (D)(iii).’’; hanced FMAP (as determined under sub- tion 1902(a)(10)(A), the State provides for ini- (iv) in subparagraph (A)(ii), by striking ‘‘or section (b)) had been substituted for the Fed- tial eligibility determinations and redeter- 2000’’ and inserting ‘‘2000, or 2001’’; eral medical assistance percentage (as de- minations of eligibility using the same (v) in subparagraph (B)— fined in section 1905(b)) of such expenditures. verification policies (including with respect (I) by striking ‘‘and’’ at the end of clause ‘‘(ii) EXPENDITURES DESCRIBED.—For pur- to face-to-face interviews), forms, and fre- (ii); poses of clause (i), the expenditures de- quency as the State uses for such purposes (II) by redesignating clause (iii) as clause scribed in this clause are expenditures for under this title, and, as part of such redeter- (iv); and such fiscal years for providing medical as- minations, provides for the automatic reas- (III) by inserting after clause (ii) the fol- sistance under title XIX to individuals who sessment of the eligibility of such children lowing new clause: have not attained age 19 and whose family for assistance under title XIX and this title.
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00030 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.042 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8635 ‘‘(v) OUTSTATIONING ENROLLMENT STAFF.— micromanaged, and it has enough pri- money for other benefits and services The State provides for the receipt and initial vate sector involvement to deliver, for that the Secretary determines will im- processing of applications for benefits under the very first time, through a competi- prove preventive health care for the this title and for children under title XIX at tive private delivery system, prescrip- beneficiaries. facilities defined as disproportionate share hospitals under section 1923(a)(1)(A) and Fed- tion drugs for all seniors regardless of What we have crafted is an effort to erally-qualified health centers described in where they are or in what program take the extra money and allow for a section 1905(l)(2)(B) consistent with section they happen to be. legitimate experiment, a legitimate 1902(a)(55).’’. It also says the private sector will test of whether the preferred provider SEC. 2. TECHNICAL CORRECTION. offer, for the first time on a voluntary system will cost less money—I think it (a) TEMPORARY INCREASE OF THE MEDICAID basis, to seniors who want to move into will; they can provide services that I FMAP.—Section 401(a)(6)(A) of the Jobs and a new system a private delivery system think are better and at a better price, Growth Tax Relief Reconciliation Act of 2003 that will cover drugs, will cover hos- but we do not know that for sure, so (Public Law 108–027) is amended by inserting pitals, and will also cover physician let’s do some testing on it in certain ‘‘after September 2, 2003,’’ after ‘‘(42 U.S.C. charges under the program. This is a regions of the country. If it saves 1315))’’. historic opportunity to combine the (b) RETROACTIVE EFFECTIVE DATE.—The money, hallelujah for everybody. But if amendment made by subsection (a) shall best of what Government can do with it costs money, they will have $6 bil- take effect as if included in the enactment of the best of what the private sector can lion to help pay for those extra section 401 of the Jobs and Growth Tax Re- do. charges. lief Reconciliation Act of 2003 (Public Law There is going to be a very important The Democrats, on the other hand, 108–027). amendment offered by Chairman have the provisions to have $6 billion f GRASSLEY and the ranking member, over the period in order to provide dis- PRESCRIPTION DRUG AND MEDI- Senator BAUCUS. Because we were able ease management and preventive CARE IMPROVEMENT ACT OF to get a score that said there is $12 bil- health care services in the traditional 2003—Continued lion extra money available, the ques- Medicare Program. That is as fair as it tion then became, How do we divide it? can be in a divided Senate. If one side The PRESIDING OFFICER. The Sen- I never thought we would have such a had their way, they would do it all ator from Louisiana. difficult time spending money. We nor- with the preferred providers. If our side Mr. BREAUX. I thank the Chair. Mr. mally get into fights when we do not perhaps had their will, it would provide President, I would like to make a cou- have enough money. Lo and behold, we all the money to be put back in tradi- ple comments before we begin voting. found there was $12 billion in extra tional Medicare, but we all know in a This legislation is historic. It is in- funds. divided Senate that is not possible. credibly important. It is the first re- The question then for the Senate is So the best possible compromise has form in a major way to the Medicare how are we going to allocate that been crafted by the chairman, Senator Program since we wrote it over 35 money? Senator BAUCUS and Senator GRASSLEY; by the ranking member, years ago in 1965. GRASSLEY, working with Senator KEN- Senator BAUCUS; and by Senator KEN- To get this legislation adopted by the NEDY and others, came up with a plan NEDY’s involvement and many others Congress and signed into law by the that is fair. who have worked on this issue. President, there obviously has to be a It says to the Republican Members: This is a good amendment. It is an great deal of work, a great deal of le- Take half of it, and they want to uti- important amendment. We are on the gitimate compromise among the var- lize it for a demonstration program to edge of an historic day in being able to ious parties that have put this package determine whether PPOs or the pro- enact real Medicare reform with pre- together. That is what this bill does. vider networks in the private sector scription drugs for all of our Nation’s There are some Members of Congress will work. We are not certain. We seniors. We cannot let that goal be lost who argue the Federal Government think they will. But let’s do a test. And while we fight over how to divide extra should do nothing with regard to Medi- if it costs more, there will be $6 billion funds. I think this division is as fair as care—that the private sector should do available to pay for it starting in the it possibly can be, and I urge all of our everything and that the Federal Gov- year 2009. That is what many Repub- Members to vote for it. In fact, I think ernment should do nothing. There are licans thought was the right way to use the vote should be approximately like others, on the other hand, who take the half of the money. it came out in the Finance Committee. position that with regard to Medicare On the other hand, Members on my We lost a few what I would say were on the Federal Government should do ev- side said, We need to do more for tradi- the left, we lost a few what I would say erything and the private sector should tional fee-for-service. If they are going were on the right, of the political spec- do nothing. to experiment with the preferred pro- trum. But in the end the vast majority What we have been able to put to- viders in the private sector, we want to supported this legislation in the com- gether, under the leadership of the also know what will happen if we are mittee and will do so on the Senate chairman and ranking member and able to put in more money for preven- floor. many others who have worked so hard, tive health care and for people who I certainly ask them to support the is a compromise that says let’s com- want to stay in the old program. Grassley-Baucus amendment when it is bine the best of what the Government What Senator BAUCUS and Senator voted on as well. can do with the best of what the pri- GRASSLEY did, working with Senator I yield the floor. vate sector can do and put that pack- KENNEDY, was to say to people who are The PRESIDING OFFICER. All time age together. That is why we have got- inclined to the Democratic perspective, has expired. ten to the point we are today. we are going to let you use $6 billion VOTE ON AMENDMENT NO. 1102 We saw a bill come out of the Senate for people who want to stay in the old The PRESIDING OFFICER. The Finance Committee in a bipartisan program. Here is what you can do with question is on agreeing to the McCon- fashion with 16 votes in favor; only five it: You can use the money to provide nell amendment No. 1102. votes against it. I predict when the enhanced benefits for people who stay Mr. HATCH. I ask for the yeas and final vote comes on this bill, we will in traditional Medicare. What we mean nays. see the same type of bipartisan rep- by that is to give them additional care The PRESIDING OFFICER. Is there a resentation with a significant number, for chronic care coordination, for the sufficient second? maybe over three-fourths of the Senate chronically ill, to coordinate better There appears to be a sufficient sec- saying, yes, this has sufficient im- how they are getting their health care. ond. provement and reform in it for me to We have more money for disease The clerk will call the roll. support it. management, which is incredibly im- The legislative clerk called the roll. It has enough Government involve- portant. When we are talking about Mr. REID. I announce that the Sen- ment to make sure it is paid for, saving money and giving people a bet- ator from Massachusetts (Mr. KERRY) enough Government involvement to ter quality of life; disease management and the Senator from Connecticut (Mr. make sure it is run properly but not is important. Also, they can use the LIEBERMAN) are necessarily absent.
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00031 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.042 S26PT1 S8636 CONGRESSIONAL RECORD — SENATE June 26, 2003 I further announce that, if present section 1860D–19(a)(1) of such Act, including represent who suffer from heart dis- and voting, the Senator from Massa- the payment of— ease, cancer, Alzheimer’s, diabetes and chusetts (Mr. KERRY) would vote (A) no deductible; its complications. Take your pick—a $6 ‘‘yea’’. (B) no monthly beneficiary premium for at billion tax subsidy for HMO and private least one Medicare Prescription Drug plan The PRESIDING OFFICER. Are there available in the area in which the individual insurance companies or $12 billion for any other Senators in the Chamber de- resides; and your seniors struggling to pay impos- siring to vote? (C) reduced cost-sharing described in sub- sible prescription drug bills who will be The result was announced—yeas 98, paragraphs (C), (D), and (E) of section 1860D– cut off under this bill. It is an easy nays 0, as follows: 19(a)(1) of such Act. choice for me. If you take it home to [Rollcall Vote No. 252 Leg.] (2) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN your State, you will find it is an easy YEAS—98 INCOME BETWEEN 100 AND 135 PERCENT OF THE choice, too. FEDERAL POVERTY LINE.—If the individual is Akaka Dodd Lott a specified low income medicare beneficiary I hope you will vote for this amend- Alexander Dole Lugar (as defined in paragraph 1860D–19(4)(B) of ment. Allard Domenici McCain Allen Dorgan McConnell such Act) or a qualifying individual (as de- The PRESIDING OFFICER. The Sen- Baucus Durbin Mikulski fined in paragraph 1860D–19(4)(C) of such Act) ator from Utah. Bayh Edwards who is diagnosed with cardiovascular dis- Miller Mr. HATCH. Mr. President, I rise in Bennett Ensign Murkowski ease, cancer, or Alzheimer’s disease, such in- Biden Enzi Murray dividual shall receive the full premium sub- opposition. I want to stress my opposi- Bingaman Feingold Nelson (FL) sidy and reduction of cost-sharing described tion is not because I do not understand Bond Feinstein Nelson (NE) in section 1860D–19(a)(2) of such Act, includ- or am not sympathetic to the difficult Boxer Fitzgerald Nickles Breaux Frist ing payment of— situation beneficiaries who are af- Pryor Brownback Graham (FL) (A) no deductible; Reed flicted with cardiovascular disease, Bunning Graham (SC) (B) no monthly premium for any Medicare Reid cancer, or Alzheimer’s disease experi- Burns Grassley Roberts Prescription Drug plan described paragraph Byrd Gregg ence. Rockefeller (1) or (2) of section 1860D–17(a) of such Act; Campbell Hagel Santorum and But I also recognize there are mil- Cantwell Harkin (C) reduced cost-sharing described in sub- Carper Hatch Sarbanes lions and millions of other seniors who Chafee Hollings Schumer paragraphs (C), (D), and (E) of section 1860D– suffer from diseases just as debilitating Chambliss Hutchison Sessions 19(a)(2) of such Act. and life-threatening as the ones my Shelby Clinton Inhofe (3) SUBSIDY-ELIGIBLE INDIVIDUALS WITH IN- colleague has identified here. Under Cochran Inouye Smith COME BETWEEN 135 PERCENT AND 160 PERCENT Snowe this proposal they would be treated as Coleman Jeffords OF THE FEDERAL POVERTY LEVEL.—If the indi- Collins Johnson Specter second-class citizens because they do Stabenow vidual is a subsidy-eligible individual (as de- Conrad Kennedy fined in section 1860D–19(a)(4)(D) of such Act) not suffer from the right disease. Cornyn Kohl Stevens Corzine Kyl Sununu who is diagnosed with cardiovascular dis- The most basic, and really the most Craig Landrieu Talent ease, cancer, or Alzheimer’s disease, such in- important, tenet of the Medicare pro- Crapo Lautenberg Thomas dividual shall receive sliding scale premium gram is to provide a universal benefit Daschle Leahy Voinovich subsidy and reduction of cost-sharing for Dayton Levin Warner subsidy-eligible individuals, including pay- to all seniors. We have done that under DeWine Lincoln Wyden ment of— S. 1. NOT VOTING—2 (A) for 2006, a deductible of only $50; We crafted a prescription drug ben- Kerry Lieberman (B) only a percentage of the monthly pre- efit that helps every senior and also mium (as described in section 1860D– The amendment (No. 1102) was agreed targets the most help to those who are 19(a)(3)(A)(i)); and less able to afford the appropriate care. to. (C) reduced cost-sharing described in Mr. HATCH. Mr. President, I move to clauses (iii), (iv), and (v) of section 1860D– While I am sympathetic to my col- reconsider the vote. 19(a)(3)(A). leagues’ desire to enhance the benefit, Mr. REID. I move to lay that motion (4) ELIGIBLE BENEFICIARIES WITH INCOME I can’t support a proposal that pits one on the table. ABOVE 160 PERCENT OF THE FEDERAL POVERTY group of seniors against the other The motion to lay on the table was LEVEL.—If an individual is an eligible bene- based solely on this disease. agreed to. ficiary (as defined in section 1860D(3) of such Act), is not described in paragraphs (1) I urge my colleagues to vote against AMENDMENT NO. 1102, AS MODIFIED through (3), and is diagnosed with cardio- this amendment so we can remain Mr. HATCH. Mr. President, I ask vascular disease, cancer, or Alzheimer’s dis- faithful to the most basic tenet of the unanimous consent that amendment ease, such individual shall have access to Medicare program, a universal benefit, 1102, which was just agreed to, be modi- qualified prescription drug coverage (as de- and to ensure that the Senate does not fied with the changes that are the scribed in section 1860D–6(a)(1) of such Act), discriminate against seniors based on desk. including payment of— their disease. The PRESIDING OFFICER (Mr. (A) for 2006, a deductible of $275; (B) the limits on cost-sharing described I move to table the amendment, and CRAPO). Without objection, it is so or- section 1860D–6(c)(2) of such Act up to, for I ask for the yeas and nays. dered. 2006, an initial coverage limit of $4,500; and The PRESIDING OFFICER. Is there a The amendment (No. 1102), as modi- (C) for 2006, an annual out-of-pocket limit sufficient second? fied, is as follows: of $3,700 with 10 percent cost-sharing after (Purpose: To protect seniors with cardio- that limit is reached. There is a sufficient second. vascular disease, cancer, diabetes, or Alz- Mr. HATCH. Mr. President, I ask The question is on agreeing to the heimer’s disease) unanimous consent that the next three motion. The clerk will call the roll. At the end of subtitle A of title I, add the votes be 10 minutes in length each. The assistant legislative clerk called following: The PRESIDING OFFICER. Without the roll. SEC. ll. PROTECTING SENIORS WITH CARDIO- objection, it is so ordered. VASCULAR DISEASE, CANCER, OR Mr. REID. I announce that the Sen- AMENDMENT NO. 1108 ALZHEIMER’S DISEASE. ator from Massachusetts (Mr. KERRY) Any eligible beneficiary (as defined in sec- Under the previous order, there will 2 and the Senator from Connecticut (Mr. tion 1860D(3) of the Social Security Act) who minutes equally divided on the Durbin LIEBERMAN) are necessarily absent. is diagnosed with cardiovascular disease, amendment No. 1108. I further announce that, if present cancer, diabetes or Alzheimer’s disease shall Mr. DURBIN. Mr. President, with all be protected from high prescription drug due respect to my colleagues, the and voting, the Senator from Massa- costs in the following manner: amendment we just agreed to did noth- chusetts (Mr. KERRY) would vote (1) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN ing. It did not add one penny or one ‘‘nay.’’ INCOME BELOW 100 PERCENT OF THE FEDERAL new benefit to any senior suffering The PRESIDING OFFICER. Are there POVERTY LINE.—If the individual is a quali- from Alzheimer’s. This amendment I any other Senators in the Chamber de- fied medicare beneficiary (as defined in sec- siring to vote? tion 1860D–19(a)(4) of such Act), such indi- offer, along with Senator HARKIN, will vidual shall receive the full premium subsidy put $12 billion into providing prescrip- The result was announced—yeas 57, and reduction of cost-sharing described in tion drug coverage for the seniors we nays 41, as follows:
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00032 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.034 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8637 [Rollcall Vote No. 253 Leg.] The PRESIDING OFFICER. The Sen- AMENDMENT NO. 1092 YEAS—57 ator from Iowa. The PRESIDING OFFICER. Under Alexander DeWine McCain Mr. GRASSLEY. Yes, $12 billion is a the previous order, there are now 2 Allard Dole McConnell lot of money; $6 billion of that $12 bil- minutes equally divided on the Grass- Allen Domenici Miller lion he wants to take away from this ley amendment. Baucus Ensign Murkowski provision, this bipartisan provision, The Senator from Montana. Bennett Enzi Nelson (NE) Mr. BAUCUS. Mr. President, I say to Bond Fitzgerald Nickles that would be used for things he stands Breaux Frist Roberts for. He has been talking about chronic my colleagues, this is the key amend- Brownback Graham (SC) Santorum ment that will provide for the passage disease management. He has been talk- Bunning Grassley Sessions of this legislation and, therefore, pre- Burns ing about managing to a better extent Gregg Shelby scription drug benefits for seniors. It is Campbell Hagel Smith people with chronic diseases. We have the key amendment. Chafee Hatch Snowe put $6 billion into demonstration Chambliss Hutchison Specter Why do I say key amendment? Very Cochran Inhofe Stevens projects like that to save the tax- simply because we have $12 billion, and Coleman Jeffords Sununu payers’ money. Why? Because 5 percent we have to find a way, in an even- Collins Kennedy Talent of the seniors cause 50 percent of the Cornyn Kyl Thomas handed, balanced way, to spend that Craig Lott Voinovich costs to Medicare. That is why those $12 billion. We have to marry two com- Crapo Lugar Warner demonstration projects are very impor- peting philosophies: private competi- NAYS—41 tant. That is why I hope you will vote tion and Medicare. against this amendment. Akaka Dorgan Levin We have, therefore, designed the so- Bayh Durbin Lincoln Mr. SANTORUM. Mr. President, I lution that the $12 billion will be even- Biden Edwards Mikulski ask for the yeas and nays. ly divided to keep the balance so that Bingaman Feingold Murray The PRESIDING OFFICER. Is there a we can get this legislation passed and, Boxer Feinstein Nelson (FL) sufficient second? more importantly, so seniors get a pre- Byrd Graham (FL) Pryor Cantwell Harkin Reed There appears to be a sufficient sec- scription drug benefit as quickly as Carper Hollings Reid ond. possible. Clinton Inouye Rockefeller If this amendment is not adopted, we Conrad Johnson The question is on agreeing to the Sarbanes Corzine Kohl amendment. The clerk will call the are going to be in the soup. There are Schumer Daschle Landrieu roll. going to be Senators from one side of Dayton Lautenberg Stabenow the aisle who are going to want to Wyden The legislative clerk called the roll. Dodd Leahy spend all of it their way; there are Mr. REID. I announce that the Sen- NOT VOTING—2 going to be Senators on the other side ator from Massachusetts (Mr. KERRY) Kerry Lieberman of the aisle who want it all spent their and the Senator from Connecticut (Mr. way; and we are going to be nowhere. The motion was agreed to. LIEBERMAN) are necessarily absent. We are going to be back where we have Mr. REID. Mr. President, I move to I further announce that, if present been the last 4 years, talking about reconsider the vote and to lay that mo- and voting, the Senator from Massa- prescription drugs benefits but not tion on the table. chusetts (Mr. KERRY) would vote doing something about it, not pro- The motion to lay on the table was ‘‘yea.’’ viding the benefits to our seniors. agreed to. The PRESIDING OFFICER. Are there This is a key amendment. This is the AMENDMENT NO. 1103 TO AMENDMENT NO. 1092 any other Senators in the Chamber de- amendment which will allow benefits The PRESIDING OFFICER. Under siring to vote? to go to seniors. the previous order, there are 2 minutes The result was announced—yeas 39, The PRESIDING OFFICER (Mr. equally divided on the Dorgan second- nays 59, as follows: SMITH). The Senator’s time has ex- degree amendment. [Rollcall Vote No. 254 Leg.] pired. The Senator from Pennsylvania. Who yields time? YEAS—39 Mr. DORGAN. Mr. President, the im- Mr. SANTORUM. Mr. President, to Akaka Dorgan Levin pick up on what Senator BAUCUS said, portance of this amendment is answer- Bayh Durbin Lincoln ing the question, what to do with $12 Biden Edwards Mikulski let me tell you what this does. There billion. I propose we use that $12 billion Bingaman Feingold Murray will be $6 billion spent on our side of to reduce the premium that senior citi- Boxer Feinstein Nelson (FL) the aisle to do the things about which Byrd Graham (FL) Pryor zens will be required to pay for this we are concerned. What? Allow the Cantwell Harkin Reed competitive model to work, allow the prescription drug benefit, roughly $7 a Clinton Hollings Reid month, from $35 to $28. Conrad Inouye Rockefeller new blueprint for Medicare to be suc- The rebuttal to my amendment has Corzine Johnson Sarbanes cessful, starting in 2009, because that is Daschle Kohl Schumer when the money is available, but what been: This really doesn’t mean very Dayton Lautenberg Stabenow much. Only in this Chamber would $12 Dodd Leahy Wyden JON KYL and so many others on this billion not mean very much. Frankly, side of the aisle have been concerned NAYS—59 about is in this amendment. If my col- this means a great deal to senior citi- Alexander DeWine McCain leagues want to give competition a zens. The underlying amendment rep- Allard Dole McConnell chance, this is the amendment they resents the worst of all worlds. It says, Allen Domenici Miller vote for. let’s give $6 billion to insurance compa- Baucus Ensign Murkowski Bennett Enzi On that side of the aisle, what is $6 nies. And I guarantee, you dye that Nelson (NE) Bond Fitzgerald Nickles billion? For chronic care and disease money purple, you will have purple Breaux Frist Roberts management. Senator KENNEDY has pockets in the insurance industry. Brownback Graham (SC) Santorum Bunning Grassley worked on this tirelessly. Five percent Sessions That is where it is going. Let’s have $6 Burns Gregg of Medicare recipients consume 50 per- Shelby billion go to the insurance industry to Campbell Hagel Smith cent of the Medicare benefits. What we conduct an experiment that we already Carper Hatch Snowe need in the fee-for-service plan is pro- know has failed. Chafee Hutchison Chambliss Inhofe Specter grams for disease management and I don’t understand why that is the Cochran Jeffords Stevens chronic illness management. As the way we want to use billions of dollars. Coleman Kennedy Sununu Senator from Massachusetts said to me Why not use it to help senior citizens Collins Kyl Talent Cornyn Landrieu Thomas just a few minutes ago, nowhere else close the coverage gap or, as I suggest, Craig Lott Voinovich will we be able to find $6 billion to do to reduce monthly premiums which Crapo Lugar Warner this very important, cost-saving, qual- start at $35 a month in this bill and NOT VOTING—2 ity improvement to the basic Medicare then ratchet up and up and up as pre- system. It is what both sides want. scription drug prices increase. Pass my Kerry Lieberman We have come together and we hope amendment and help senior citizens re- The amendment (No. 1103) was re- we will get strong support for this duce these premiums. jected. amendment.
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00033 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.036 S26PT1 S8638 CONGRESSIONAL RECORD — SENATE June 26, 2003 Several Senators addressed the make the wrong choices in cir- [Rollcall Vote No. 255 Leg.] Chair. cumstances such as this. We come back YEAS—71 The PRESIDING OFFICER. The ma- with a plan that says let’s use the $12 Alexander Crapo Lugar jority leader. billion for two purposes, and both of Allard DeWine McCain Mr. DORGAN. Mr. President, par- them are for experiments. In both Allen Dole McConnell liamentary inquiry. Who is recognized Baucus Domenici Miller cases, we know the answer to the ex- Bayh Ensign Murkowski to speak in opposition to the amend- periments. One, $6 billion to the insur- Bennett Enzi Nelson (NE) ment? ance companies so we can incentivize— Biden Feinstein Nickles Bingaman Fitzgerald The PRESIDING OFFICER. The ma- subsidize—the insurance companies to Pryor Bond Frist Reid jority leader was recognized. see if they can provide the prescription Breaux Graham (SC) Roberts Mr. FRIST. Mr. President, very brief- Brownback Grassley drug benefit at equivalent or less cost Santorum ly, this amendment is the culmination Bunning Gregg than Medicare does. We know the an- Schumer of several days of debate where both Burns Hagel swer to that. That experiment has been Campbell Hatch Sessions Democrats and Republicans have come done. Carper Hutchison Shelby Smith together, again bringing different Ask senior citizens all across this Chafee Inhofe issues to the table, but together it is a Chambliss Inouye Snowe country what would you rather have, Specter positive, strong amendment for the Cochran Jeffords better benefits or lower costs or would Coleman Kennedy Stevens American people and for seniors. you like to have $12 billion in dem- Collins Kyl Sununu On the one hand, it invests $6 billion, Conrad Landrieu Talent onstration projects? That is the choice. that is not in the underlying bill, in Cornyn Lautenberg Thomas The choice has been presented to us at preventive medicine, which almost Corzine Lincoln Warner this point in this amendment to say Craig Lott Wyden does not exist in traditional Medicare, let’s bifurcate this into two $6 billion and in chronic disease management. NAYS—26 pots, both of which will be demonstra- All of us know 5 percent of the bene- Akaka Durbin Levin tion projects, the answer to which we Boxer Edwards ficiaries are responsible for 50 percent Mikulski know in both cases. First, the cir- Byrd Feingold Murray of the cost and we know we need to Cantwell Graham (FL) cumstance with subsidizing the insur- Nelson (FL) manage those people better. So we Clinton Harkin Reed ance companies, we know the answer have $6 billion for preventive medicine Daschle Hollings Rockefeller to that. They are going to provide this Dayton Johnson and chronic disease management. Sarbanes benefit at higher costs. We know that. Dodd Kohl Stabenow In addition, there is $6 billion to sup- Dorgan Leahy port the concept of private enterprise, Second, does wellness and chronic care help? Yes, we know that. Why do we NOT VOTING—3 competition, the private entities, Kerry Lieberman Voinovich which we believe is not the only salva- not take the $12 billion and use it to tion but critical if we are going to ad- provide better benefits or lower costs The amendment (No. 1092) was agreed dress the long-term, 75-year unfunded for senior citizens? After all, that is to. Mr. REID. Mr. President, I move to liabilities that are incurred when we why we started this process, to provide a prescription drug benefit that works reconsider the vote. add a new prescription drug benefit. Mr. ENSIGN. I move to lay that mo- For that reason, I urge our col- for senior citizens. We come to the end of this process, tion on the table. leagues on both sides of the aisle to The motion to lay on the table was recognize that we worked together, and we have a group of people who go into a closed room and come out with agreed to. Democrats and Republicans, to come to Mr. REID. I suggest the absence of a this carefully negotiated agreement a deal that says we have decided how the $12 billion should be used. quorum. that will be to the benefit of seniors The PRESIDING OFFICER. The and individuals with disabilities. Ask senior citizens how they would clerk will call the roll. Several Senators addressed the like it used and I guarantee there is The assistant legislative clerk pro- Chair. only one answer from every corner of ceeded to call the roll. The PRESIDING OFFICER. The Sen- this country: Use it to provide us bene- Mr. BAUCUS. Mr. President, I ask ator from North Dakota. fits that were promised, deliver that unanimous consent that the order for Mr. DORGAN. Mr. President, par- which was promised to us. the quorum call be rescinded. liamentary inquiry. My understanding The PRESIDING OFFICER. The Sen- The PRESIDING OFFICER. Without was prior to a vote there was to be ator’s time has expired. objection, it is so ordered. The Senate time divided between opponents and Mr. SANTORUM. I ask for the yeas will be in order. supporters. We have just heard from and nays. The Senator from Montana. three supporters. The PRESIDING OFFICER. Is there a Mr. BAUCUS. Mr. President, on be- The PRESIDING OFFICER. The sufficient second? half of myself and the chairman of the agreement was the time was to be There appears to be a sufficient sec- committee, Senator GRASSLEY, I ask evenly divided. ond. unanimous consent that at 5 p.m. Mr. DORGAN. Evenly divided be- The question is on agreeing to today the Senate proceed to a vote in tween whom? amendment No. 1092, as modified. relation to the Sessions amendment, The PRESIDING OFFICER. The The clerk will call the roll. No. 1011, to be followed by a vote in re- managers. The assistant legislative clerk called lation to the Rockefeller amendment Mr. BAUCUS. Mr. President, I ask the roll. numbered 975, as modified; to be fol- unanimous consent that the Senator CCONNELL. I announce that lowed by a vote in relation to the from North Dakota be given 2 minutes. Mr. M the Senator from Ohio (Mr. VOINOVICH) Bingaman amendment numbered 1066; The PRESIDING OFFICER. Without provided further that there be no objection, it is so ordered. is necessarily absent. Mr. REID. I announce that the Sen- amendment in order to the amend- The Senator from North Dakota. ments prior to the votes, and there be Mr. DORGAN. Mr. President, there ator from Massachusetts (Mr. KERRY) and the Senator from Connecticut (Mr. 2 minutes equally divided for debate. does need to be opposition, it seems to The PRESIDING OFFICER. Is there LIEBERMAN) are necessarily absent. me, for those of us who believe this is objection? not the right way to use $12 billion. I further announce that, if present Without objection, it is so ordered. The $12 billion was made available. and voting, the Senator from Massa- Mr. REID. Mr. President, I ask unan- Twelve billion is what we discovered. chusetts (Mr. KERRY) would vote imous consent that the time between The CBO estimate was below the $400 ‘‘nay’’. now and 5 o’clock be equally divided. billion available for this program. So The PRESIDING OFFICER. Are there The PRESIDING OFFICER. Without the question was: How shall the $12 bil- any other Senators in the Chamber de- objection, it is so ordered. lion be used? siring to vote? Who yields time? We have spent all of our lives in this The result was announced—yeas 71, Mr. REID. Mr. President, I suggest Chamber making choices. Too often we nays 26, as follows: the absence of a quorum, and I ask
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00034 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.069 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8639 unanimous consent that the time be ‘‘(c) FEDERAL ASSUMPTION OF MEDICAID SEC. 455. MEDICARE SECONDARY PAYOR (MSP) equally divided. PRESCRIPTION DRUG COSTS FOR DUALLY ELIGI- PROVISIONS. (a) TECHNICAL AMENDMENT CONCERNING The PRESIDING OFFICER. Without BLE BENEFICIARIES.— ‘‘(1) IN GENERAL.—For purpose of section SECRETARY’S AUTHORITY TO MAKE CONDI- objection, it is so ordered. TIONAL PAYMENT WHEN CERTAIN PRIMARY The clerk will call the roll. 1903(a)(1) for a State for a calendar quarter in a year (beginning with 2006) the amount PLANS DO NOT PAY PROMPTLY.— The assistant legislative clerk pro- computed under this subsection is equal to (1) IN GENERAL.—Section 1862(b)(2) (42 ceeded to call the roll. the product of the following: U.S.C. 1395y(b)(2)) is amended— Mr. BAUCUS. Mr. President, I ask ‘‘(A) STANDARD PRESCRIPTION DRUG COV- (A) in subparagraph (A)(ii), by striking unanimous consent that the order for ERAGE UNDER MEDICARE.—With respect to in- ‘‘promptly (as determined in accordance the quorum call be rescinded. dividuals who are residents of the State, who with regulations)’’; The PRESIDING OFFICER. Without are entitled to, or enrolled for, benefits (B) in subparagraph (B)— (i) by redesignating clauses (i) through (iii) objection, it is so ordered. under part A of title XVIII, or are enrolled under part B of title XVIII and are receiving as clauses (ii) through (iv), respectively; and Mr. BAUCUS. Mr. President, I yield 5 (ii) by inserting before clause (ii), as so re- minutes to the Senator from West Vir- medical assistance under subparagraph (A)(i), (A)(ii), or (C) of section 1902(a)(10) (or designated, the following new clause: ginia. ‘‘(i) AUTHORITY TO MAKE CONDITIONAL PAY- as the result of the application of section MENT.—The Secretary may make payment The PRESIDING OFFICER. The Sen- 1902(f)) that includes covered outpatient under this title with respect to an item or ator from West Virginia. drugs (as defined for purposes of section 1927) service if a primary plan described in sub- Mr. ROCKEFELLER. Mr. President, I under the State plan under this title (includ- paragraph (A)(ii) has not made or cannot thank the distinguished ranking mem- ing such a plan operated under a waiver reasonably be expected to make payment ber of the Finance Committee. under section 1115)— with respect to such item or service prompt- ‘‘(i) the total amounts attributable to such AMENDMENT NO. 975, AS MODIFIED ly (as determined in accordance with regula- individuals in the quarter under section Mr. President, in accordance with the tions). Any such payment by the Secretary 1860D–19 (relating to premium and cost-shar- agreement just entered into, I send a shall be conditioned on reimbursement to ing subsidies for low-income medicare bene- the appropriate Trust Fund in accordance modification of my amendment to the ficiaries); and desk and ask for its immediate consid- with the succeeding provisions of this sub- ‘‘(ii) the actuarial value of standard pre- section.’’. eration. scription drug coverage (as determined under The PRESIDING OFFICER. The (2) EFFECTIVE DATE.—The amendments section 1860D–6(f)) provided to such individ- made by paragraph (1) shall be effective as if amendment is so modified. uals in the quarter. included in the enactment of title III of the The amendment (No. 975), as modi- ‘‘(B) STATE MATCHING RATE.—A proportion Medicare and Medicaid Budget Reconcili- fied, is as follows: computed by subtracting from 100 percent ation Amendments of 1984 (Public Law 98- the Federal medical assistance percentage On page 10, lines 12 and 13, strike ‘‘(other 369). (as defined in section 1905(b)) applicable to than a dual eligible individual, as defined in (b) CLARIFYING AMENDMENTS TO CONDI- the State and the quarter. section 1860D–19(a)(4)(E))’’. TIONAL PAYMENT PROVISIONS.—Section On page 21, strike lines 22 through 25, and ‘‘(C) PHASE-OUT PROPORTION.—Subject to 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further insert ‘‘title XIX through a waiver under 1115 subparagraph (D), the phase-out proportion amended— where covered outpatient drugs are the sole for a quarter in— (1) in subparagraph (A), in the matter fol- medical assistance benefit. ‘‘(i) 2006 is 100 percent; lowing clause (ii), by inserting the following On page 107, line 3, strike ‘‘30 percent’’ and ‘‘(ii) 2007 is 95 percent; sentence at the end: ‘‘An entity that engages insert ‘‘27.5 percent’’. ‘‘(iii) 2008 or 2009, is 90 percent; in a business, trade, or profession shall be On page 116, line 10, insert ‘‘and’’ after the ‘‘(iv) 2010 is 86 percent; or deemed to have a self-insured plan if it car- semi-colon. ‘‘(v) 2011, 2012, or 2013 is 80 percent. ries its own risk (whether by a failure to ob- On page 116, line 12, strike ‘‘; and’’ and in- ‘‘(d) MEDICAID AS SECONDARY PAYOR.—In tain insurance, or otherwise) in whole or in sert a period. the case of an individual who is entitled to a part.’’; On page 116, strike lines 13 through 17. Medicare Prescription Drug plan under part (2) in subparagraph (B)(ii), as redesignated On page 116, line 24, insert ‘‘and’’ after the D or drug coverage under a MedicareAdvan- by subsection (a)(2)(B)— semi-colon. tage plan, and medical assistance including (A) by striking the first sentence and in- On page 117, line 2, strike ‘‘; and’’ and in- covered outpatient drugs under this title, serting the following: ‘‘A primary plan, and sert a period. medical assistance shall continue to be pro- an entity that receives payment from a pri- On page 117, strike lines 3 through 7. vided under this title for covered outpatient mary plan, shall reimburse the appropriate On page 117, line 13, insert ‘‘and’’ after the drugs to the extent payment is not made Trust Fund for any payment made by the semicolon. under the Medicare Prescription Drug plan Secretary under this title with respect to an On page 117, line 17, strike ‘‘; and’’ and in- or a MedicareAdvantage plan.’’ item or service if it is demonstrated that sert a period. Beginning on page 152, strike line 3 and all such primary plan has or had a responsi- On page 117, strike lines 18 through 23. that follows through page 153, line 15, and in- bility to make payment with respect to such On page 118, line 6, insert ‘‘and’’ after the sert the following: item or service. A primary plan’s responsi- semicolon. ‘‘(f) DEFINITION.—For purposes of this sec- bility for such payment may be dem- On page 118, in line 13, insert ‘‘or’’ after the tion, the term ‘subsidy-eligible individual’ onstrated by a judgment, a payment condi- semi-colon. has the meaning given that term in subpara- tioned upon the recipient’s compromise, On page 118, line 14, strike ‘‘; or’’ and insert graph (D) of section 1860D–19(a)(4).’’. waiver, or release (whether or not there is a a period. (C) CONFORMING AMENDMENTS.— determination or admission of liability) of On page 118, strike line 15. (1) Section 1903(a)(1) (42 U.S.C. 1396a(a)(1)) Beginning on page 118, strike line 16 and payment for items or services included in a is amended by inserting before the semicolon all that follows through page 119, line 9. claim against the primary plan or the pri- the following: ‘‘, reduced by the amount On page 119, line 10, strike ‘‘(F)’’ and insert mary plan’s insured, or by other means.’’; computed under section 1935(c)(1) for the ‘‘(E)’’. and State and the quarter’’. On page 119, line 15, strike ‘‘(G)’’ and insert (B) in the final sentence, by striking ‘‘on (2) Section 1108(f) (42 U.S.C. 1308(f)) is ‘‘(F)’’. the date such notice or other information is On page 119, line 19, strike ‘‘(C), (D), or amended by inserting ‘‘and section received’’ and inserting ‘‘on the date notice (E)’’ and insert ‘‘(C), or (D)’’. 1935(e)(1)(B)’’ after ‘‘Subject to subsection of, or information related to, a primary On page 120, line 3, strike ‘‘(H)’’ and insert (g)’’. plan’s responsibility for such payment or ‘‘(G)’’. Beginning on page 157, strike line 21 and other information is received’’; and On page 120, lines 5 and 6, strike ‘‘who is a all that follows through page 158, line 4. (3) in subparagraph (B)(iii), as redesignated dual eligible individual or an individual’’. On page 173, beginning on line 15, strike by subsection (a)(2)(B), by striking the first Beginning on page 121, line 24, strike ‘‘dual ‘‘that is not’’ and all that follows through sentence and inserting the following: ‘‘In eligible’’ and all that follows through ‘‘and’’ ‘‘includes’’ on line 18 on that page, and insert order to recover payment made under this on page 122, line 1. ‘‘that includes but is limited solely to’’. title for an item or service, the United On page 146, line 6, insert before the period On page 190, in line 18, strike ‘‘and’’. States may bring an action against any or ‘‘and to the design, development, acquisition On page 190, between lines 18 and 19, insert all entities that are or were required or re- or installation of improved data systems the following: sponsible (directly, as an insurer or self-in- necessary to track prescription drug spend- ‘‘(B) is not a dual eligible beneficiary as surer, as a third-party administrator, as an ing for purposes of implementing section defined under section 1807(i)(1)(B); and’’. employer that sponsors or contributes to a 1935(c)’’. On page 190, line 19, strike ‘‘(B)’’ and insert group health plan, or large group health Beginning on page 146, strike line 23 and ‘‘(C)’’. plan, or otherwise) to make payment with all that follows through page 149, line 21, and On page 529, between lines 8 and 9, insert respect to the same item or service (or any insert the following: the following: portion thereof) under a primary plan. The
VerDate Jan 31 2003 05:20 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00035 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.072 S26PT1 S8640 CONGRESSIONAL RECORD — SENATE June 26, 2003 United States may, in accordance with para- happening. My amendment would fix erage at all; it will simply shift the graph (3)(A) collect double damages against that in a budget-neutral fashion. cost to the Federal Government and in any such entity. In addition, the United I hope my colleagues will support time to the other Medicare bene- States may recover under this clause from this amendment which I consider one ficiaries. any entity that has received payment from a of the most moral and humane of primary plan or from the proceeds of a pri- In closing, I remind my colleagues mary plan’s payment to any entity.’’. amendments that has come before this that S. 1 helps to deliver care that is (c) CLERICAL AMENDMENTS.—Section 1862(b) body on this issue. consistent with current law and is fa- (42 U.S.C. 1395y(b)) is amended— I thank the Presiding Officer. miliar to vulnerable beneficiaries. (1) in paragraph (1)(A), by moving the in- Mr. GRASSLEY. Mr. President, I rise I urge my colleagues to defeat this dentation of clauses (ii) through (v) 2 ems to in opposition to this amendment. In S. amendment. the left; and 1, beneficiaries who are enrolled in I ask unanimous consent to print the (2) in paragraph (3)(A), by striking ‘‘such’’ both Medicaid and Medicare will con- letter to which I referred in the before ‘‘paragraphs’’. tinue to receive the generous drug cov- RECORD. Mr. ROCKEFELLER. Mr. President, erage that they currently know There being no objection, the mate- this amendment ensures that the Medi- through the Medicaid program. rial was ordered to be printed in the Some of my colleagues have argued care prescription drug benefit we are RECORD, as follows: debating is, in fact, truly universal. It that by having dual eligibles remain in the Medicaid program, Congress is LONG TERM CARE PHARMACY ALLIANCE, is a principle we have all espoused over Washington, DC, June 24, 2003. treating these vulnerable seniors as the years. Hon. CHARLES E. GRASSLEY, The underlying bill, which we are de- second-class citizens and subjecting Chairman, Committee on Finance, U.S. Senate, bating, precludes Medicare bene- them to a lower quality benefit. Dirksen Building, Washington, DC. ficiaries who are eligible for Medicaid This is not the case. In fact, this let- DEAR CHAIRMAN GRASSLEY: On behalf of the from enrolling in the Medicare drug ter from the Long Term Care Phar- Long Term Care Pharmacy Alliance, I appre- benefit. That would be the first time macy Alliance applauds S. 1 for keep- ciate this opportunity to express our support ever that Medicare beneficiaries would ing the duals in Medicaid. for provisions of Medicare legislation you Specifically, the letter states, ‘‘This have advanced to protect the nation’s frail be, in fact, precluded from being Medi- elderly beneficiaries residing in nursing fa- care beneficiaries. approach will preserve the time-tested safeguards designed to prevent medica- cilities. In particular, we are pleased that The group, which is referred to as your legislation would allow dual eligible dual eligibles, consists of those who are tion errors and ensure quality care for beneficiaries to retain their prescription the poorest seniors. They are those the majority of these beneficiaries in drug coverage under Medicaid. who have incomes below 74 percent of the institutional setting.’’ While most Medicare beneficiaries are able The policy decision to cover the drug poverty. If my colleagues are inter- to walk into pharmacies to pick up their pre- cost for dual eligibles in Medicaid was ested, that income level is $6,645. That scriptions or to receive vials of pills through not made in vacuum. These vulnerable the mail, a sizable percentage of bene- is their total gross income. The major- citizens deserve the best benefit avail- ficiaries cannot do so and need special serv- ity of them are single. The majority of able, which is the benefit provided ices that retail and mail order pharmacies do them are women who are in poor through Medicaid. I also remind my not provide. Nursing home residents have health and more likely to be over the specific diseases and multiple co-morbidities colleagues that the intent of this legis- age of 85. that require specialized pharmacy care. Precluding these people is wrong, and lation is to expand prescription drug To meet these needs, long-term phar- my amendment would fix it. I am coverage to our senior citizens who do macies provide specialized packaging, 24- happy to say the amendment is budget not have access to prescription drugs hour delivery, infusion therapy services, geriatric-specific formularies, clinical con- neutral. I will explain that in a minute. or who are faced with paying a large share of their income for their drug sultation and other services that are indis- Prescription drugs are optional as a pensable in the long-term care environment. benefit under Medicaid. We all know coverage. This does not describe the current Without such treatment, we cannot expect that. States can limit the number of coverage experienced by those who are positive therapeutic outcomes for these pa- prescriptions they make available. tients. Failure to take into consideration the dually eligible. Some allow two or three prescriptions special pharmacy needs of the frail and insti- These seniors currently have a drug tutionalized elderly will lead to a marked in- per year. They can cap the benefits. benefit through the Medicaid program. They can charge any copayments they crease in medication errors and other ad- In fact, many advocates and bene- verse events. want. They can end it altogether. ficiaries describe and know this benefit In recognition of these concerns, your pro- So you have States, predictably, al- to be very generous. posed legislation would retain the current ready in a situation with very different Medicaid was created to assist indi- system of Medicaid coverage to provide spe- Medicaid levels. Because of our finan- viduals who do not have the means to cialized pharmacy services to dual-eligible cial situation nationally, and in our pay for their share of health care costs. beneficiaries residing in nursing facilities. States, Medicaid is always going to be That is a responsibility shared between This approach will preserve the time-tested the very first benefit which will be cut. safeguards designed to prevent medication the Federal Government and the errors and ensure quality care for the major- It has already happened, and will hap- States. Medicaid pays for many bene- pen substantially more over the com- ity of these beneficiaries in the institutional fits that Medicare does not. setting. Medicaid today provides generous ing years. We all know that the purpose of S. 1 benefits to dual eligible beneficiaries and has I remind, again, my colleagues these is to provide prescription drugs to sen- experience in addressing the special needs of are the poorest of the poor, the oldest iors that do not currently have access nursing home patients. The proposed new of the old, and the sickest of the sick to drugs or are paying extremely high Medicare Part D benefit does not con- we are talking about. drug costs. template the impact on nursing home resi- I strongly urge my colleagues to pro- However, recognizing the costs asso- dents which must be considered to protect these patients. vide all of the seniors in their States ciated with covering the cost of pro- with the benefit of a real Medicare We are encouraged that Section 104 of the viding prescription drug coverage to Senate bill requires the Secretary to provide drug benefit by supporting this amend- the dual eligible population, S. 1 does recommendations to cover dual eligible ment. provide nearly 18 billion in new Federal beneficiaries by the new Medicare Part D If a State gets to the position where dollars to compensate States for some benefit before statutorily mandating such it is simply unable to continue with of these costs. action. Nevertheless, we strongly rec- prescription drugs under the Medicaid This is because S. 1 provides min- ommend additional language to address the program, and they virtually eliminate imum standards that ensure that every special pharmacy needs of beneficiaries re- it, that poor person, below 74 percent of aspect of the benefit provided through siding in nursing facilities who are not du- poverty—which is just a little bit over ally-eligible for Medicare and Medicaid. Medicaid is the same high quality that Such language would require the Secretary $6,000 a year—has nowhere else to go. is provided through part D of the Medi- of Health and Human Services to review the Always—including presently—that per- care program. current standards of practice for pharmacy son can return to Medicare. This un- I remind my colleagues that adoption services provided to patients in nursing fa- derlying bill would preclude that from of this amendment will not expand cov- cilities and to report to the Congress its
VerDate Jan 31 2003 03:59 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00036 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.045 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8641 findings prior to implementation of the new ing their working years—not just some this section to an individual who is enrolled prescription drug benefit. This report would senior citizens. And it should stay that under Part D. include a detailed description of the Depart- way. So you essentially have a choice: Am ment’s plans to implement the provisions of This amendment rights this wrong. It this Act in a manner consistent with appli- I going to enroll in this new Part D and cable state and federal laws designed to pro- says we will not take away the Medi- get this benefit and therefore forego tect the safety and quality of care of nursing care that the poor have earned by a any Medigap policy or am I going to facility patients. Such provisions were in- lifetime of hard work. stay out? cluded in legislation approved by the House The PRESIDING OFFICER. Who We are telling seniors whose cost Ways and Means and Energy and Commerce yields time? burden, on average, will be $2,100 a Committees, and we would respectfully re- Mr. BINGAMAN addressed the Chair. year, and 10 percent of whom are likely quest that you adopt similar language. The PRESIDING OFFICER. Who We appreciate your leadership in carefully to have out-of-pocket expenses of $4,000 yields time to the Senator from New or more per year, they will not be al- considering the multitude of complex issues Mexico? related to the creation of a new Medicare lowed to seek additional prescription prescription drug benefit. We are grateful for Mr. BINGAMAN. Mr. President, I re- drug relief. the chance to work constructively with you quest that the manager allot me 5 min- The amendment I am offering would to protect patient safety and to ensure the utes. give seniors the option of purchasing continued provision of quality pharmacy Mr. BAUCUS. Mr. President, I yield 5 more prescription coverage as part of a services to the most vulnerable seniors. minutes to the Senator from New Mex- If you have any questions or would like ad- comprehensive Medigap plan. The ico. amendment calls on the National Asso- ditional information, please feel free to con- The PRESIDING OFFICER. The Sen- tact me. Again, thank you for your efforts to ciation of Insurance Commissioners to ator from New Mexico. devise two new Medigap plans that ensure patient safety and promote quality Mr. BINGAMAN. I thank the Senator care for Medicare beneficiaries residing in would each offer prescription drug cov- from Montana. nursing facilities. erage to beneficiaries who elect Part D. Sincerely, AMENDMENT NO. 1066 There are currently 10 standard PAUL BALDWIN, Mr. President, I would like to take Medigap plans. They are designated A Executive Director. this opportunity to explain amendment Mr. KENNEDY. One of the great through J, and they offer insurance to No. 1066, which is scheduled to be one seniors. Of those, plans H, I, and J offer strengths of Medicare is that it is for of the amendments considered in this everyone. Rich and poor alike con- prescription drug coverage in addition next block of amendments. to Part A and Part B wraparounds. Of tribute to the system. Rich and poor Mr. President, I am concerned that alike benefit from it. these, H and J are the most commonly the prescription drug coverage in- elected plans. At bottom, Medicare is a commit- cluded in S. 1 is not sufficient to fully Under S. 1, the way it now stands, ment to every senior citizen and every meet the needs of our seniors and that seniors who elect Part D would no disabled American that we will not those seniors who elect to participate longer qualify for H, I, or J. However, if have two-class medicine in America. in Part D and get this prescription the amendment is adopted, the two When a senior citizen enters a hospital, drug benefit will be restricted from new policies designed by the National Medicare pays the same amount for purchasing supplemental coverage. Association of Insurance Commis- their care whether they are a pauper or The Kaiser Family Foundation esti- sioners would be similar to the current a millionaire. When a senior citizen mates that in 2006—which is the year Medigap policies of H and J, but their goes to a doctor, she has the peace of this legislation really takes effect, this prescription drug coverage would be mind of knowing that Medicare has the benefit occurs—the average Medicare tailored to wrap around the Part D same obligation to pay for her treat- beneficiary will spend $3,160 per year coverage. So seniors who are currently ment no matter what her financial cir- on prescription drugs. Under the cur- H or J subscribers would have the op- cumstances—and the doctor has no fi- rent plan, those individuals will have tion of electing Part D and still main- nancial interest in rationing her care $1,700 that same year in out-of-pocket taining a Medigap plan similar to what according to the contents of her bank expenses in addition to the $420 they they have now. account. pay in Part D premiums. Therefore, the Through the Medicaid Program, we average Medicare beneficiary who The amendment would give the Na- do try to provide extra help for those elects Part D will have approximately tional Association of Insurance Com- who are poor. But the fact that Med- $2,100 per year in out-of-pocket ex- missioners 18 months to develop and icaid provides extra assistance for the penses. This translates, of course, into report back on these two new plans. In poor does not reduce Medicare’s obliga- $175 a month. That is a significant ex- my view, it would be a substantial im- tion to provide equal treatment for all. penditure for a lot of individuals and provement to the current bill. Medicare always has primary payment couples on a fixed income. As I said, my amendment will give responsibilities for the service it cov- It would seem reasonable to allow the National Association of Insurance ers. Medicaid is always supplementary. these individuals who want to protect Commissioners 18 months to develop Medicaid provides critical help to the themselves against unpredictable and and report back on two new plans. The poor and elderly, but it does not pro- increasing prescription drug expenses NAIC is the appropriate body to de- vide the same reliable guarantees of to purchase supplemental insurance velop these plans because they have a equal treatment that Medicare does. coverage that would allow additional system already in place for doing so Under Medicaid, States have limited prescription drugs to be purchased. with appropriate representation from the number of days of hospital care Medigap was designed to fill the gaps all interested and affected parties. The they would provide or the number of in Medicare. A sizable gap exists in the NAIC can best determine how the bene- doctor visits they will support. States prescription drug benefit we are offer- fits proposed in this amendment can be have placed arbitrary limits on the ing in this bill. Yet the current bill designed in order to avoid over-utiliza- number of prescriptions. specifically prohibits seniors from fill- tion and to coordinate with the exist- This legislation sets an undesirable ing that gap with a Medigap policy. ing medigap benefit packages. They precedent for treatment of poor senior Section 103 of S. 1, which is the bill were the body employed to develop the citizens who are eligible for both Medi- we are considering, explicitly prohibits current Medigap plans A through J and care and Medicaid. For every other people who elect Part D prescription they are the body best equipped to de- benefit, these senior citizens enroll in drug coverage from purchasing addi- velop these two new plans. Medicare, and Medicaid supplements tional prescription drug coverage as This amendment is similar to lan- Medicare’s coverage. But for this ben- part of any Medigap plan. guage already included in the House efit, the bill says that the poor are ex- Let me give you the quotation out of version of the bill and thus already has cluded from Medicare. The only bene- the bill. It says: a great deal of support in the House of fits they get are from the Medicaid No Medicare supplemental policy that pro- Representatives. Program. Medicare is for all senior vides coverage of expenses for prescription This amendment also provides a pro- citizens who paid into the program dur- drugs may be sold, issued, or renewed under vision to stabilize the Medigap market
VerDate Jan 31 2003 04:02 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00037 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.047 S26PT1 S8642 CONGRESSIONAL RECORD — SENATE June 26, 2003 during this time of transition. The cur- found in section 605, the legal immi- The PRESIDING OFFICER. The Sen- rent bill states that seniors who are en- grant child health provision. Let me ator from Oklahoma. rolled in H, I, or J at the time when give the background on section 605. Mr. NICKLES. I believe our side has they elect Part D will be displaced What this legislation would do would 2 minutes remaining. I ask unanimous from their current Medigap plans and be to allow States on a State option consent for 4 minutes and yield the given open enrollment into any other basis to elect to provide health care for Senator from Alabama 2 minutes. Medigap plan A–G offered in their pregnant women for the period of their The PRESIDING OFFICER. Without State. Our amendment will still guar- pregnancy, plus 60 days thereafter, and objection, it is so ordered. antee them the option of enrolling in immigrant children. In both categories Mr. SESSIONS. Mr. President, in- substitute coverage without the risk of we are talking about legal immigrants, cluded in the Medicare prescription discrimination based on age, health not people who have arrived outside drug reform bill in section 605 is a Med- status, utilization, etc. However, our the system and undocumented. These icaid reform of welfare benefits for amendment will reduce the chaos of are individuals who have come to the noncitizens, reversing a policy adopted this transition time by keeping the United States under all of the proce- by this Senate in 1996 by a vote of 74 to majority of Medigap subscribers with dures that allow for legal immigration, 24. Section 605 is a very substantial their current carriers. with the most prominent category change in our current policy. It will Let me explain. Beneficiaries dis- being for family reunification. cost, according to CBO estimates, $500 placed from H, I, or J will have the op- The restoration of this has already million over just 3 years. It is not to be tion of choosing any other Medigap been considered by the Senate Finance taken lightly. Frankly, we haven’t had plan—A–G—that their carrier offers or Committee, first in 2001, then in June debate on it. one of the two new plans. If their cur- of 2002, and most recently in the con- I have offered an amendment that would strike the existing language in rent carrier does not choose to offer sideration of this legislation. This pro- section 605, along with a sense of the one of the new plans then they will vision was sustained in the chairman’s Senate that this matter go back to the have the option of switching carriers in mark, as it had been placed by Senator Finance Committee for hearings this order to obtain a medigap policy that GRASSLEY and Senator BAUCUS, by a fall, the time when the Finance Com- includes prescription coverage. Thus, vote of 13 to 8. There has been both mittee plans to be addressing Medicaid the majority of seniors will be staying consideration and approval of this pro- welfare reform. That is what this is. with their current carriers and thus, vision by the Finance Committee. It has been alleged that the provision This is Medicaid welfare reform, not those carriers will be better able to of these services to legal immigrants Medicare senior citizens reform. predict the affect of this shift and bet- will encourage illegal immigration. We This is clearly unconnected to the ter able to ease the transition for their are talking exclusively about pregnant purpose of the bill. It was slipped in as subscribers. women and children who have entered some sort of compromise. We ought not This is a simple amendment that to allow that to happen, to erode a should elicit very little controversy. the United States on a legal basis. Prior to 1996, there was no restriction very important part of the 1996 Welfare People may raise concerns because it on health care benefits for legal immi- Reform Act. The administration, which will be difficult to construct a stand- grants. We are now carving out from is very favorable to matters that would ardized wrap around benefit to com- the current exclusion for health care help immigrants in this country, op- pliment Part D when Part D is not two categories, which are both humane poses this change. They say it should standardized. But this is not a reason and very much in the public interest, be done, if at all, as part of the welfare to deny people access to supplemental that pregnant women have adequate reform of this fall. coverage. Rather, we are giving the access to health care and that children That is why our sense of the Senate NAIC 18 months to put together such a grow up with adequate health care. calls on the Finance Committee to re- plan. It has been alleged that there are a evaluate it as part of their requirement Consumer groups such as the Con- number of benefits which have also this fall on reform welfare. Millions of sumer Union and Medicare Advocacy been made available to legal immi- people come to this country legally. support our amendment because it pro- grants, including emergency medical They come here with sponsors. Those vides much needed additional coverage services, Head Start programs, foster sponsors say they will pay for the med- options for our Nation’s seniors. Like- care, school lunches, and food stamps. ical welfare needs of those people they wise, insurance carriers like it because Those can be debated on their own sponsor. That is by affidavit and it it allows them to continue to provide a merits but they are no substitute for should be honored, not undercut. service that they have been providing providing to legal immigrants, chil- Mr. NICKLES. Mr. President, I wish up until this point and yet it does not dren, and pregnant women a place to to compliment Senator SESSIONS for force them to offer these new plans if get appropriate health care. his leadership. I urge my colleagues to they do not see them as viable. The It has also been stated that this vote in favor of the Sessions amend- cost of the amendment should be neg- should be a responsibility of the spon- ment to strike out this provision that ligible as it is not adding any addi- sor. does not belong in a Medicare bill. tional Government expenditure nor ex- The PRESIDING OFFICER. The Sen- This is a Medicaid provision. This is pediting a beneficiary’s trip to the cat- ator’s time has expired. a welfare provision. We are going to re- astrophic threshold. This amendment Mr. GRAHAM of Florida. May I have authorize welfare later this summer. It simply gives seniors an opportunity to 30 seconds to close? should be considered at that time. This continue to seek the insurance indus- Mr. BAUCUS. Mr. President, I ask is part of the reforms that were made try an opportunity to meet the needs unanimous consent that the Senator in 1996 when we passed the welfare re- of our seniors not met by Medicare have 30 additional seconds. form act, one of the most successful Part D. The PRESIDING OFFICER. Without bills we ever passed. If we are going to Mr. President, I ask my colleagues to objection, it is so ordered. undermine that, do it with a little con- review this amendment before they Mr. GRAHAM of Florida. The Immi- sideration. The administration opposes vote. I think it is an excellent amend- gration and Naturalization Service this because it doesn’t belong here, and ment. under the current law has limited the it is bad policy. This turns immigra- I ask them to join me in supporting kinds of public benefits that are rel- tion policy on its head. it. evant to the so-called public charge Let me read the current law on im- The PRESIDING OFFICER. Who finding. INS officers place no weight on migration policy. For a legal immi- yields time? the receipt of noncash public benefits grant who comes into this country, it AMENDMENT NO. 1011 when determining whether an immi- is required that the sponsor of that im- Mr. GRAHAM of Florida. Mr. Presi- grant will be a public charge on soci- migrant sign an affidavit of support to dent, I rise to speak on an issue that ety. This provision, section 605, is con- the U.S. Department of Justice which will come before the Senate shortly. sistent with current national immigra- states: That is an amendment to strike the tion policy. Therefore, I urge the defeat By signing this form, you, the sponsor, language from this legislation which is of this amendment. agree to support the intending immigrant
VerDate Jan 31 2003 04:02 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00038 Fmt 0624 Sfmt 0634 E:\CR\FM\A26JN6.048 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — SENATE S8643 and any spouse or children immigrating with realized this when they included this this country if they are going to be a him or her, and to reimburse any Govern- provision in the prescription drug public charge. ment agency or private entity that provides mark as part of a compromise agree- But the reality is that legal immi- these sponsored immigrants with Federal, ment that included both Senator KYL’s grants don’t come here for our benefits. State, or local means-tested public benefits. undocumented aliens provision to re- They come because they want to work This provision in the underlying bill imburse hospitals for the cost of treat- so they can make better lives for them- would turn this law on its head and ing undocumented aliens and Senator selves and for their children. They would basically take hundreds of mil- GRAHAM’s legal immigrants provision. work hard and they make a vital con- lions of dollars away from Medicare re- Finally, benefits to legal immigrants tribution to our economy. Many are cipients and give them to immigrants. were cut in 1996 as a cost-saving meas- forced to take low-paying jobs. And So this is changing immigration law ure, not as a matter of welfare reform. many of these jobs do not provide and Medicaid law. It needs to be dealt Section 605 of the underlying bill is health insurance. with in the Medicaid bill and welfare also consistent with other policies ap- Immigrant families need access to reform bill. It doesn’t belong in this proved by President Bush. Last year, health insurance just as much as cit- bill. the President signed legislation restor- izen families. They are also just as de- I urge my colleagues to vote in favor ing food stamp benefits for legal immi- serving of this coverage as citizen fam- of the Sessions amendment. grant children. The immigrant child ilies. Immigrants work hard. They pay Mrs. CLINTON. I rise to urge my col- health provisions would make these taxes. They contribute to their com- leagues to defeat this amendment. same children eligible for Medicaid and munities. Immigrant children are also In proposing this amendment, Sen- SCHIP. In an interview with the Asso- required to register for the Selective ator SESSIONS argues that the restora- ciated Press in May 2002, Tommy Service when they turn 18. According tion of health benefits to legal immi- Thompson, Secretary of the Depart- to the American Immigrant Law Foun- grants has not been fully reviewed or ment of Health and Human Services, dation, 60,000 legal immigrants are on discussed. he also argues that SCHIP stated that he had no ‘‘philosophical active duty in the U.S. Armed Forces. Now, when an immigrant woman be- and Medicaid provisions are welfare re- objection’’ to lifting the ban on pro- comes pregnant, or her child gets sick, form measures and therefore not ger- viding health care benefits to legal im- mane to the prescription drug bill. The she has few places to turn except to migrants. emergency care, which is the most ex- amendment also states that Congress Senator SESSIONS’ amendment also pensive means of providing health care. deliberately limited benefits available has significant dire consequences for Many States have realized that this is to legal immigrants when it removed women and children, and could add not an acceptable way to address the these benefits in 1996. costs to the Medicaid program, which I health care needs of these families. I respectfully disagree with all of am certain that Senator SESSIONS did Some 20 States now provide health care these three assertions. not intend. Current restrictions pre- services to legal immigrants using First of all, the Senate Finance Com- vent thousands of legal immigrant their own funds. So the burden of car- mittee has already extensively re- children and pregnant women from get- viewed this issue. In 2001, the Finance ing for these families has been trans- ting the same access to preventive ferred to States and hospitals. Committee held a series of hearings on health care services that they would health coverage for the uninsured, in- To respond to this situation, Senator have if they were U.S. citizens. As a re- GRAHAM introduced S. 845, the Immi- cluding legal immigrants. During the sult of the restrictions, immigrant TANF reauthorization mark-up in grant Children’s Health Improvement children have fewer opportunities to Act, or ICHIA, which simply allows June 2002, there was a full debate on see a pediatrician and receive treat- States to use Federal Medicaid and the restoration of health benefits to ment before minor illnesses become se- SCHIP funding to provide coverage for legal immigrants, and the Immigrant rious and life-threatening. Families pregnant women and children who are Children’s Health Improvement Act who are unable to get basic preventive legal immigrants. The chairman of the passed as an amendment by a vote of 12 care for their children have little Finance Committee included this pro- to 9. This year, during Finance Com- choice but to turn to emergency vision to give States this option for fis- mittee mark-up of the prescription rooms—the least cost-effective place to cal years 2005, 2006, and 2007. This pro- drug bill, there was once again full de- provide care—when their children be- posal has strong bipartisan support in bate on the restoration of health bene- come sick. Similarly, without prenatal both the Senate and in the House. It fits to legal immigrants. Senator NICK- care, a woman may give birth to a baby was adopted on a bipartisan basis last LES offered an amendment to strike the with low-birth weight, placing the baby year in the Finance Committee, and a immigrant children’s health provision at risk and resulting in hundreds of bipartisan group of Finance Committee from the chairman’s mark and that thousands of dollars in neonatal inten- members voted against stripping this amendment failed by a vote of 8 to 13. sive care costs. provision from this bill this year. Second, I disagree with Senator SES- Frankly, I am saddened that we must The administration has suggested SIONS’ argument that Section 605 of the fight over a bipartisan, thoughtful and that this proposal would somehow cre- bill is not germane to Medicare pre- extensively reviewed provision that ate a new burden on the States. In fact, scription drug legislation. Every time will protect the health of children who the proposal only gives States the op- this sort of provision comes to a vote, legally came to our country and had no tion to provide this coverage, and al- my colleagues on the other side of the control over the length of time they lows them to use Federal resources to aisle question the vehicle. When the were legal immigrants. We must ensure do so, thus giving them significant fis- immigrant child health provisions that it is defeated. cal relief. No new burden would be im- came up in committee last year, as Mr. DASCHLE. Mr. President, with posed on the States. The National Gov- part of the TANF reauthorization all deference to my colleague from Ala- ernors Association and the National mark-up, Senator HATCH remarked bama, I strongly oppose this amend- Conference of State Legislatures both that, ‘‘If we start playing with health ment to strike the provisions that support restoring these benefits. Even care policy, this bill isn’t going to go would allow States to cover legal im- Governor Bush of Florida has indicated through.’’ This year, Senator SESSIONS migrants under Medicaid and SCHIP. he supports this proposal. is saying that TANF reauthorization is As health care measures, these provi- More than 5 million children live in the appropriate vehicle. I ask my col- sions are an appropriate addition to poor or ‘‘near-poor’’ noncitizen fami- leagues on the other side of the aisle this legislation, and I am grateful that lies. That is more than one-quarter of then—which one is the appropriate ve- the chairman of the Senate Finance the total population of poor or ‘‘near- hicle? Committee included them in his bill. poor’’ children. Almost half of all low- In fact, the restoration of health ben- Legal immigrants were banned from income immigrant children are unin- efits to legal immigrants is also a receiving Federal benefits under a sured and they are more than twice as major component of the effort to add a number of programs, including Med- likely to be uninsured as low-income prescription drug benefit under Medi- icaid, for 5 years. The argument was citizen children with native-born par- care. Senators GRASSLEY and BAUCUS made that people shouldn’t come to ents.
VerDate Jan 31 2003 04:02 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00039 Fmt 0624 Sfmt 0634 E:\CR\FM\G26JN6.076 S26PT1 S8644 CONGRESSIONAL RECORD — SENATE June 26, 2003 Many of these children will eventu- on the right bill, but it is something ‘‘(I) the management of comorbidities; ally become American citizens. By de- that should be done. It is the right ‘‘(II) the prevention of uremic complica- nying all but emergency health care, thing to do. I urge Senators to not vote tions; and we increase the risk that these chil- in favor of the Sessions amendment. ‘‘(III) each option for renal replacement therapy (including peritoneal dialysis, hemo- dren will suffer long-term health con- I yield the remainder of my time. dialysis (including vascular access options), sequences, which could reduce their The PRESIDING OFFICER. The Sen- and transplantation); and ability to learn and develop, and be- ator from Iowa is recognized. ‘‘(ii) to ensure that the individual has the come productive, contributing citizens. Mr. GRASSLEY. Mr. President, I ask opportunity to actively participate in the It is also worth noting that the Med- unanimous consent that we delay the choice of therapy. icaid/SCHIP ban also affects citizen vote so I can do some amendments that ‘‘(2) The term ‘qualified person’ means— children living in immigrant families. have been agreed to—a bipartisan list ‘‘(A) a physician (as described in sub- As many as 85 percent of immigrant of amendments—to get them out of the section (r)(1)); families have at least one child who is way at this time. ‘‘(B) an individual who— a citizen. Although many of these chil- The PRESIDING OFFICER. Without ‘‘(i) is— dren are eligible for Medicaid and objection, it is so ordered. ‘‘(I) a registered nurse; ‘‘(II) a registered dietitian or nutrition SCHIP, receipt among eligible citizen AMENDMENT NO. 1033, AS MODIFIED professional (as defined in subsection children of noncitizen parents is sig- Mr. GRASSLEY. Mr. President, I (vv)(2)); nificantly below that for other poor send a modification of Senator MIKUL- ‘‘(III) a clinical social worker (as defined in children. Parents may be confused SKI’s amendment to the desk on munic- subsection (hh)(1)); about their children’s eligibility, or ipal health services and ask unanimous ‘‘(IV) a physician assistant, nurse practi- concerned that somehow claiming consent that it be modified. tioner, or clinical nurse specialist (as those these benefits will affect the status of The PRESIDING OFFICER. Is there terms are defined in subsection (aa)(5)); or other family members. objection? ‘‘(V) a transplant coordinator; and Making sure that pregnant immi- Without objection, it is so ordered. ‘‘(ii) meets such requirements related to grant women, and their children, have The amendment (No. 1033), as modi- experience and other qualifications that the Secretary finds necessary and appropriate access to health care, including preven- fied, is as follows: for furnishing the services described in para- tive care, is an investment in the fu- At the end of title VI, add the following: graph (1); or ture workforce of this Nation. I believe SEC. lll. EXTENSION OF MUNICIPAL HEALTH ‘‘(C) a renal dialysis facility subject to the providing health care for all of our citi- SERVICE DEMONSTRATION requirements of section 1881(b)(1) with per- zens, including pregnant women and PROJECTS. sonnel who— The last sentence of section 9215(a) of the children who are immigrants, is vital ‘‘(i) provide the services described in para- Consolidated Omnibus Budget Reconciliation graph (1); and for our future economic strength. It is Act of 1985 (42 U.S.C. 1395b–1 note), as pre- also the right thing to do. For that rea- ‘‘(ii) meet the requirements of subpara- viously amended, is amended by striking graph (A) or (B). son, I urge my colleagues to oppose ‘‘December 31, 2004’’, and inserting ‘‘Decem- this amendment. ber 31, 2006’’. ‘‘(3) The Secretary shall develop the re- quirements under paragraph (2)(B)(ii) after The PRESIDING OFFICER (Mr. AMENDMENT NO. 1067, AS MODIFIED consulting with physicians, health edu- CORNYN). The Senator from Montana is Mr. GRASSLEY. Mr. President, I cators, professional organizations, accred- recognized. send a modification to Senator LIN- Mr. BAUCUS. Mr. President, I know iting organizations, kidney patient organiza- COLN’s amendment No. 1067 on kidney tions, dialysis facilities, transplant centers, we have an agreement that the vote disease to the desk and ask unanimous network organizations described in section will start at about 5 o’clock. I ask consent that it be modified. 1881(c)(2), and other knowledgeable persons. unanimous consent to speak for 2 min- The PRESIDING OFFICER. Is there ‘‘(4) In promulgating regulations to carry utes. objection? The PRESIDING OFFICER. Without out this subsection, the Secretary shall en- Without objection, the amendment is sure that such regulations ensure that each objection, it is so ordered. so modified. beneficiary who is entitled to kidney disease AMENDMENT NO. 975, AS MODIFIED The amendment (No. 1067), as modi- education services under this title receives Mr. BAUCUS. Mr. President, I will fied, is as follows: such services in a timely manner that en- divide my 2 minutes between two On page 510, after line 18, add the fol- sures that the beneficiary receives the max- issues. First is the dual-eligible issue, lowing: imum benefit of those services. concerning the amendment offered by SEC. ll. MEDICARE COVERAGE OF KIDNEY DIS- ‘‘(5) The Secretary shall monitor the im- the Senator from West Virginia, Mr. EASE EDUCATION SERVICES. plementation of this subsection to ensure ROCKEFELLER. I have a lot of sympathy (a) COVERAGE OF KIDNEY DISEASE EDU- that beneficiaries who are eligible for kidney for what he is trying to do. In fact, my CATION SERVICES.— disease education services receive such serv- preference would be that low-income (1) IN GENERAL.—Section 1861 of the Social ices in the manner described in paragraph Security Act (42 U.S.C.1395x) is amended— (4).’’. senior citizens get benefits under Medi- (A) in subsection (s)(2)— (2) PAYMENT UNDER PHYSICIAN FEE SCHED- care, not Medicaid. (i) in subparagraph (U), by striking ‘‘and’’ ULE.—Section 1848(j)(3) of such Act (42 U.S.C. Regrettably, we tried to strike a bal- at the end; ance at this time so that the money 1395w–4(j)(3)) is amended by inserting ‘‘, (ii) in subparagraph (V)(iii), by adding (2)(W)’’, after ‘‘(2)(S)’’. ‘‘and’’ at the end; and spent on the bill, the $400 billion, was (3) PAYMENT TO RENAL DIALYSIS FACILI- (iii) by adding at the end the following new spent more on seniors, other bene- TIES.—Section 1881(b) of such Act (42 U.S.C. ficiaries, so they get better benefits, subparagraph: 1395rr(b)), as amended by section 433(b)(5), is rather than spending the money in ‘‘(W) kidney disease education services (as further amended by adding at the end the States to, in effect, bail out the States defined in subsection (ww));’’; and following new paragraph: (B) by adding at the end the following new for their responsibilities under Med- ‘‘(13) For purposes of paragraph (7), the sin- subsection: gle composite weighted formulas determined icaid. When we go to conference, I plan ‘‘Kidney Disease Education Services to do what I can, along with the chair- under such paragraph shall not take into ac- ‘‘(ww)(1) The term ‘kidney disease edu- count the amount of payment for kidney dis- man, to work this issue out. I think the cation services’ means educational services ease education services (as defined in section Senator from West Virginia made a that are— 1861(ww)). Instead, payment for such services very good point. ‘‘(A) furnished to an individual with kid- shall be made to the renal dialysis facility AMENDMENT NO. 1011 ney disease who, according to accepted clin- on an assignment-related basis under section On the other issue, the Sessions ical guidelines identified by the Secretary, 1848.’’. amendment, this provision is a health will require dialysis or a kidney transplant; (4) ANNUAL REPORT TO CONGRESS.—Not later care provision, not a welfare provision. ‘‘(B) furnished, upon the referral of the than April 1, 2004, and annually thereafter, physician managing the individual’s kidney the Secretary of Health and Human Services It is whether legal immigrants should condition, by a qualified person (as defined shall submit to Congress a report on the get Medicaid benefits. That is all it in paragraph (2)); and number of medicare beneficiaries who are en- comes down to. ‘‘(C) designed— titled to kidney disease education services My view is that it is the right policy. ‘‘(i) to provide comprehensive information (as defined in section 1861(ww) of the Social It is not neat and tidy, or perhaps not regarding— Security Act, as added by paragraph (1))
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under title XVIII of such Act and who re- to be appropriate to fulfill the legislative in- (b) EFFECTIVE DATE.—The amendments ceive such services, together with such rec- tent that resulted in the enactment of that made by this section shall apply to services ommendations for legislative and adminis- subsection. furnished on or after January 1, 2004. trative action as the Secretary determines
N O T I C E Incomplete record of Senate proceedings. Today’s Senate proceedings will be continued in the next issue of the Record.
VerDate Jan 31 2003 04:02 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00041 Fmt 0624 Sfmt 8633 E:\CR\FM\A26JN6.052 S26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1357 EXTENSIONS OF REMARKS
TAX INCENTIVES FOR TELE- sixty-fold to 3 percent. Since that program was voted for President Bush’s $1.35 trillion tax COMMUNICATIONS BUSINESSES repealed, the number of minority-owned cut, which contained a provision to phase out broadcast properties has declined. and ultimately repeal the estate tax. HON. CHARLES B. RANGEL The bill that I am introducing today contains When I voted for the president’s tax bill last OF NEW YORK provisions specifically designed to address the year, I did so with his assurance that we IN THE HOUSE OF REPRESENTATIVES abuses in the prior program. It is limited to would have the money to pay for it without small business purchasers, it contains restric- dipping into the Social Security surplus. Unfor- Wednesday, June 25, 2003 tions on the number of purchases that can be tunately, due to the recession and the war on Mr. RANGEL. Mr. Speaker, today I am intro- made by any one business, it contains recap- terrorism, the budget surpluses projected last ducing legislation to provide tax incentives to ture provisions to prevent the use of the small year did not materialize and we are now bor- encourage greater diversity of ownership in business as a front for another party, and it rowing money from Social Security Trust telecommunications businesses. My bill is a contains provisions designed to prevent avoid- Funds to pay for even our most basic needs response to the increasing ownership of tele- ance of the ownership requirements through including the war on terrorism. vision and radio properties by large media options or other sophisticated transactions. While I agree that we should fix provisions companies. I am hopeful that we can avoid the emotion- of last year’s tax cut to increase certainty in I strongly believe that promoting a diversity ally charged rhetoric that occurred in 1995 the tax code that will help people plan for their of views on the airwaves is an important pub- when this issue was last considered. All small financial future, we should also make sure that lic policy goal. The only way to accomplish businesses, regardless of their ownership, we are not borrowing money—particularly from that goal is to broaden the ownership of would be eligible for the benefits of my bill. It the Social Security Trust Funds—to pay for broadcast stations. The television and radio is true that the bill provides a slightly larger in- these cuts while we are simultaneously trying spectrum is a limited resource. The trend in centive when the small business purchaser is to enhance our national security needs. We recent years has been a greater concentration owned and controlled by individuals who are should also ensure that we aren’t raising other of ownership of that resource by the large from segments in our society historically taxes to pay for provisions that are, quite media companies. We need to reverse that underrepresented in ownership of broadcast frankly, political in nature and have nothing to trend. businesses. I believe this incentive is appro- do with ensuring that the estate tax burden is Mr. Speaker, small businesses that wish to priate so that the views of those groups are reduced on our small businesses and farms. enter telecommunications businesses face sig- heard on our Nation’s airwaves. The bill sim- For example, Mr. Speaker, the underlying nificant barriers. To enter a broadcast busi- ply attempts to ensure that small businesses, bill contains a hidden tax on all decedents. By ness, a small business must purchase an ex- including minority owned small businesses, fully repealing the estate tax, this bill would isting property. Owners of those properties have a seat at the table when a broadcast have the effect of repealing a provision in the find it much easier to sell to large businesses property is being sold. code, referred to as the ‘‘step up in basis,’’ than to small businesses. Therefore, small Mr. Speaker, I am hopeful that we will be that protects heirs from paying capital gains businesses quite often do not have a seat at able to deal with this issue on a bipartisan on estates. the table when there are negotiations over the basis. We should all support the goal of ex- Anyone who has ever sold a ‘‘capital’’ asset, sale of broadcast properties. panding diversity in ownership of broadcast such as real estate, stocks, bonds, mutual My bill would attempt to reduce those bar- properties. I am pleased that in the past Sen- funds, knows that cost basis is what the gain riers by providing limited deferral of capital ator MCCAIN introduced a similar proposal in or loss on the sales price is measured against. gain taxation when a telecommunications the Senate. I am hopeful that we can find bi- Generally speaking, cost basis is the purchase property is sold to a small business. It would partisan support in the House. Following is a price of property subject to certain adjust- provide the sellers of those properties a posi- brief description of the provisions of the bill. ments upward or downward. For example, if tive incentive to consider a small business f property was purchased in 1950 at a cost of purchaser. $10,000 and sold in 2001 at $100,000, an in- Large segments of our society historically DEATH TAX REPEAL dividual would have a taxable capital gain of have been underrepresented in the ownership PERMANENCY ACT OF 2003 $90,000. The step-up basis interacts with es- of radio and television properties. I believe tates such that when this property passes by SPEECH OF that it is vital that those groups have access reason of death, the heir inherits the asset to the television and radio spectrum so that HON. DENNIS MOORE with a new cost basis equivalent to the market their views may be represented on our air- OF KANSAS value of the asset on the date of the bene- waves. Therefore, my bill would provide a IN THE HOUSE OF REPRESENTATIVES factor’s death. Taking the example above, if larger deferral of capital gain taxation when the property were transferred in 2001 at a the sale is to a small business owned and Wednesday, June 18, 2003 value of $100,000 and the heir sold the prop- controlled by individuals from these historically Mr. MOORE. Mr. Speaker, I rise in opposi- erty in 2006 for $120,000, the heir would only underrepresented groups. tion to H.R. 8, Permanent Death Tax Repeal have a taxable capital gain of $20,000 instead Mr. Speaker, I understand that some may Act and in support of the Democratic sub- of $110,000. attack my bill as being the re-enactment of a stitute. Should this bill become law, an owner of flawed prior program. The provisions in my bill I have long been a supporter of providing farmland, stocks, mutual funds, or even a per- are quite similar to the tax certificate program estate tax relief to American families, small sonal residence would have lost the oppor- that was repealed by the Congress in 1995. I business owners, and farmers who have tunity to pass the asset to the next generation do not quarrel with those who assert that there worked their entire lives to transfer a portion of without passing along the owner’s cost basis, were abuses in that program. However, it is their estates upon their death. I have also thus reducing the future capital gains bill that unfortunate that the Congress chose repeal been an advocate, however, for ensuring that will have to be paid when the heirs sell the and not reform because that program had we transfer to our children and grandchildren asset. In short, this amounts to a tax increase been effective in accomplishing its goal of ex- a healthy economy and a government that on all estates due simply to the increased cost panding ownership of radio and television maintains its commitment to Social Security basis of the estate. businesses. In 1978, before the implementa- and Medicare. I believe there is a more responsible way to tion of that program, only .05 percent of all In the last Congress, I voted to repeal the provide estate tax relief to our small business broadcast stations in this country were owned estate tax and later voted to override Presi- owners and farmers. The substitute will pro- by minority groups. By 1994, the year before dent Clinton’s veto of that legislation. Again, in vide substantial and immediate relief by in- the program was repealed, the program had the 107th Congress, I voted to repeal the es- creasing a family’s exclusion from $1 million to succeeded in increasing minority ownership tate tax as a stand-alone measure and later $6 million. It would also preserve the step-up
∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor.
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00001 Fmt 0626 Sfmt 9920 E:\CR\FM\A25JN8.040 E26PT1 E1358 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 basis provisions in current law so heirs to an NASA Glenn Research Center and Dr. Mi- he could infuse a project with his warmth and estate do not receive a large capital gains bill chael Schwartz, President of Cleveland State energy. Mickey was leading a mission to a ref- as they would if Congress repealed the estate University, will co-chair this year’s Fiesta of ugee camp in Ethiopia when his plane tax entirely. All of these changes would take Hope Scholarship Luncheon. crashed, killing him and 15 others. Mickey place immediately. The Treasury Department Mr. Speaker, I ask my colleagues to join me died on August 7, 1989, near Gambela, Ethi- estimates that increasing the estate credit to in paying special tribute to Esperanza on oc- opia. $6 million would exempt approximately 99 per- casion of the 20th anniversary celebration. f cent of all estates without the dramatic loss in Our communities are served well by having revenues. such honorable and philanthropic organiza- DEATH TAX REPEAL Mr. Speaker, the substitute is also paid for. tions, like Esperanza, who genuinely care PERMANENCY ACT OF 2003 In this environment when our budget is in cri- about the well-being of Northeastern Ohio’s SPEECH OF sis, it is critically important that we do not con- Hispanic community. tinue to drown ourselves in red ink. The major- f HON. JANICE D. SCHAKOWSKY ity’s bill would cost over $60 billion a year, at REMEMBERING THE CONTRIBU- OF ILLINOIS a time when we are running a $400 billion an- TION AND LIFE OF GEORGE IN THE HOUSE OF REPRESENTATIVES nual deficit. We simply cannot afford to borrow THOMAS ‘‘MICKEY’’ LELAND Wednesday, June 18, 2003 even more money to provide additional tax cuts. Ms. SCHAKOWSKY. Mr. Speaker, I rise in Again, I have supported previous efforts to HON. CHARLES B. RANGEL strong opposition to H.R. 8 and in support of provide estate tax relief because, in the past, OF NEW YORK the Pomeroy substitute. The House Repub- we have been able to afford it. I am con- IN THE HOUSE OF REPRESENTATIVES lican leadership and President Bush are once cerned, however, that the total costs of these Wednesday, June 25, 2003 again putting the interests of the Bush class bills will continue to drive our nation into debt, Mr. RANGEL. Mr. Speaker, today, as we ahead of the needs of working families and and reduce our ability to deal with the long- consider a resolution recognizing the work of our future well being. They are once again term challenges facing Social Security and our late colleague in the alleviation of hunger, demonstrating that they have the wrong prior- Medicare. Until we deal with the long term fi- I would like to honor George Thomas ‘‘Mick- ities. nancial problems facing Social Security, we ey’’ Leland for his contributions to this country Providing tax relief for low wage hard work- need to be very careful about any tax or and the world. He may have been the greatest ing families remains a low priority for House spending bills that would place a greater bur- advocate for the hungry that the House of Republicans and the Bush Administration. In- den on the budget in the next decade, effec- Representatives has ever known. Mickey was stead, they want to once again provide even tively transferring these costs and burdens to born on November 27, 1944, in Lubbock, more tax breaks for people who need it the our children and grandchildren. Texas. From 1972, when he was first elected least by eliminating that inheritance tax. Re- publicans are denying immediate assistance to f into public office, until his death in 1989, Mick- ey Leland fought on behalf of the hungry, poor 12 million children who come from families A SPECIAL TRIBUTE TO and less fortunate around the world. Neither that earn between $10,500 to $26 a year, and ESPERANZA ON THE OCCASION partisanship nor race nor political boundaries where one million of the children have parents OF THE 20TH ANNIVERSARY prevented Mickey from reaching those who that currently serve or have served in the mili- CELEBRATION needed him. Republicans and Democrats alike tary. Nearly 674,000 children or one in four respected Mickey for his determination and children back in my home state of Illinois HON. PAUL E. GILLMOR moral rectitude. I urge my friends and col- would have qualified for this aid. This is an OF OHIO leagues in this chamber to honor Mickey’s outrage. Talk about having your priorities IN THE HOUSE OF REPRESENTATIVES memory by rededicating ourselves to eradi- backwards! Proponents of this legislation make baseless Wednesday, June 25, 2003 cating world hunger and the poverty which is its cause. claims that it will help small businesses, farm- Mr. GILLMOR. Mr. Speaker, it is with great In 1984, Leland co-authored legislation cre- ers and working families. The claim that the pride that I rise today to pay special tribute to ating the House Select Committee on Hunger. estate tax puts small family farms out of busi- an outstanding organization in Ohio. It was the Committee’s responsibility to focus ness. The National Farmers Union disputes Esperanza, Ohio’s only non-profit association solely on the widespread problems of hunger this assertion, ‘‘There is no evidence that the dedicated to the promotion and advancement and malnutrition. Mickey chaired the Com- estate tax has forced the liquidation of any of education for Hispanics, has been serving mittee from its inception until his death. The farms, and existing estate tax already exempt the Hispanic community in Northeastern Ohio Committee’s efficacy stemmed from his un- 98 percent of all farms and ranches.’’ The fact since 1983. wavering moral leadership. He legislated on is that the estate tax currently affects only the Over the duration of the last twenty years, infant mortality, fresh food for at-risk women richest 2 percent of estates, and the number Esperanza has become a vital asset to the and children, and comprehensive services for dramatically shrinks as the exemption rises to Hispanic population in Ohio, aiding thousands the homeless. Mickey Leland refused to nar- $3.5 million in 2009. H.R. 8 eliminates the tax of Hispanic youth with educational program- row the scope of his energy and dedication to on the wealthiest 2 percent of all Americans— ming, tutoring, mentoring, college and career his own country. Following reports of famine in people like Bill Gates and Ken Lay. In my guidance, and scholarship opportunities for sub-Saharan Africa, Speaker ‘‘Tip’’ O’Neil ap- home state of Illinois less than 2500 families students pursuing higher educational opportu- pointed Leland to lead a bipartisan Congres- would benefit from the repeal of the estate tax. nities. sional delegation created to assess the mag- The rest of the public would not benefit from Esperanza conducts programs for Cleveland nitude of Africa’s needs. The findings of that it at all. In fact, it will hurt their future and fur- youth in elementary, middle and high school. delegation resulted in $800 million in humani- ther damage our struggling Bush economy, Furthermore, Esperanza offers a complimen- tarian relief. where 2.7 million private sector jobs have tary, instructional computer program to neigh- In his pursuit to help the needy, Mickey trav- been lost. borhood residents. The fully equipped Com- eled around the world. He met with Fidel Cas- H.R. 8 will hurt our economic future be- munity Technology Center provides individual- tro to reunite Cuban families and traveled to cause it would add at least an additional tril- ized training sessions in keyboarding, data Moscow as part of joint U.S.-Soviet food initia- lion dollars to the federal deficit over the next entry, Microsoft Office, Windows, and the tive to Mozambique following the Cold War. twenty years. The vast majority of Americans Internet to Hispanics of all ages. He met privately with Pope John Paul II in will have to make sacrifices to pay for this tax Esperanza’s competitive scholarship pro- 1987 and 1989 to garner support for his ef- cut for millionaires. If this bill is enacted into gram offers an annual process that is avail- forts in Africa. Mickey did everything he could. law there will be less money available for So- able to all Hispanic students residing in North- Those of us who were privileged to serve with cial Security, Medicare, and prescription drugs eastern Ohio. In 2002, with the aid of various him in this Congress were always inspired and for seniors, not to mention homeland security corporations, educational institutions and indi- challenged by Mickey to do more to alleviate and education. Mr. Speaker, how can it be vidual donors, Esperanza was able to reward the suffering of the people whom Jesus called that we do not have money to fund the Leave forty-seven Hispanic students with scholar- ‘‘the least of these.’’ No Child Behind Act but we do have money ships at the annual Fiesta of Hope Scholar- Mickey died just as he lived, trying to help. to give more tax cuts for the super rich? How ship Luncheon. He never passed leadership to others when can this be?
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00002 Fmt 0626 Sfmt 9920 E:\CR\FM\A25JN8.043 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1359 Let me be clear. I am a strong supporter of Defense as a messenger with the 72nd Pre- ing costs. His commendable efforts led to a small businesses and family farms and I am cinct in Brooklyn, New York. significant increase in the number of sub- not against reforming the estate tax. I believe In 1956, Paul enlisted in the Coast Guard. sidized apartments, from 200 to 1,200. that families with modest assets should be ex- Upon promotion, he was assigned to the Mar- In addition to subsidized housing, Ted insti- empt from the estate tax. That is why I sup- shall Island loran station, and was responsible gated numerous other services for the city of port the Pomeroy substitute which exempts for the operation, maintenance and commu- Portsmouth. He developed a transportation estates worth less than $3 million for an indi- nication of loran equipment. After his return to system that supplies 120,000 rides a year for vidual and $6 million for families from the es- the United States, he was an instructor of elderly persons needing to travel to medical tate taxes. The substitute would exempt 99.65 electronics in Connecticut. In 1960, he was appointments, various shopping complexes, or percent of all estates. honorably discharged with a good conduct centers for meals. Ted also oversaw the de- The Bush Administration and their Repub- medal. velopment and completion of a new Senior lican colleagues have a one track mind. They He first came to Washington in the early Citizen’s Center in October 2000, which offers are once again attempting to lower taxes for 1960s representing Raytheon and General various programs such as basic health care, the richest 1%. Just last month the Bush Ad- Electric on the TARTAR radar missile pro- transportation, daily lunches and social activi- ministration and leaders in Congress passed gram. Paul then received a political appoint- ties. tax cuts for millionaires and tax dodging cor- ment from Undersecretary Vance to the Naval Without Ted’s commitment to improving the porations. President Bush made it a top pri- Ordnance Command, working on patrol gun- quality of life for its residents, Portsmouth ority and Vice President CHENEY personally boat missile systems, Antelope and Ready; would not be the city it is today. His efforts to negotiated the final bill language with the Re- the Hydrofoil program; R&D and introduction make New Hampshire a better place have publican Congressional leadership. The tax bill of the frigate program; guided projectile pro- made a lasting impact on the people that passed last month will provide a $604,000 tax gram between NAVSEA and the Army at the know him and know of him. Even Ted’s suc- break for Vice President CHENEY and Picatinny Arsenal in New Jersey; the readi- cessor has admitted that no one can truly fill $332,000 to Treasury Secretary John Snow. In ness of all Navy ships improving their readi- the retiring director’s shoes. Portsmouth and total, it could provide up to $3.2 million in total ness through the CASREP program. He also the state of New Hampshire are fortunate to tax savings for President Bush, Vice President traveled to Holland to purchase the forerunner have dedicated individuals like Ted working to CHENEY, and the Cabinet. I wonder how much of the MK–92 fire control system. make this city and this state a great place to As an intelligence liaison officer at NAVSEA, the families of President Bush, Vice President live. CHENEY, and the Cabinet would benefit from Paul handled special projects including nu- repeal of the estate tax? clear powered submarines. He provided sur- f H.R. 8 undermines our basic sense of fair- vivability assessments for SEA–05, SEA–08, ness. The legislation undermines progressive and the PEOs. As facilities manager he engi- IN MEMORY OF THE HONORABLE aspects of our tax code. It replaces it with a neered and built sensitive, compartmented in- BOB STUMP regressive tax code that puts more of a bur- formation facilities both in Crystal City and the den on middle and low wage families. A re- Washington Navy Yard, and established gressive tax code restricts opportunities for interconnectivity with the intelligence commu- HON. SILVESTRE REYES those who are not born into wealthy families. nity. OF TEXAS William Gates Sr., a supporter of the estate Paul has received numerous awards and ci- IN THE HOUSE OF REPRESENTATIVES tax recently said, ‘‘What makes America great tations for his efforts in providing the Com- is the broad ownership of property and enter- mand with accurate and timely intelligence in- Wednesday, June 25, 2003 prise. We all succeed to the extent that chil- formation regarding the survivability and vul- dren are born without vast disparities in ac- nerability of our ships that were hit by foreign Mr. REYES. Mr. Speaker, it is with a heavy cess to education, health care, and oppor- weapons, such as the USS Stark, USS Sam- heart that I reflect today on the passing of my tunity. We are weakened when our policy uel B. Roberts, USS Bridgetown, USS Prince- dear friend Congressman Bob Stump. Bob makers are more concerned with preserving ton, and USS Cole. was a great man and I am deeply saddened existing wealth and power than creating ave- Our Nation is privileged to have had such a by his passing. He was a great American, a nues for new asset creation and opportunity.’’ dedicated civil servant for these many years. respected legislator, and a good friend. I couldn’t agree with him more. I ask that my colleagues join me in honoring He served with great distinction in Congress Finally, the estate tax gives wealthy individ- him today for his lifetime commitment of out- for twenty-six years, two years as Chairman of uals an incentive to contribute to charity. Char- standing service to this Nation. the House Armed Services Committee and six itable organizations are very concerned about f years as Chairman of the Veterans Affairs efforts to repeal the estate tax. According to Committee. the Joint Economic Committee Democrats, HONORING TED CONNORS I had the honor and privilege to serve on eliminating the estate tax could reduce con- both of these committees with Bob as my tributions by 6 to 12 percent. This would re- HON. JEB BRADLEY Chairman. Although we did not always see duce revenues for soup kitchens, AIDS pre- OF NEW HAMPSHIRE eye to eye, I always had a great deal of re- vention programs, and other vital community IN THE HOUSE OF REPRESENTATIVES spect for Bob’s patriotism and leadership. Bob organizations that rely on charitable contribu- Wednesday, June 25, 2003 was a true supporter of men and women in tions to stay afloat. uniform. Under his leadership, we made huge Support America’s families. Oppose the un- Mr. BRADLEY of New Hampshire. Mr. strides to improve the quality of life for our derlying bill and support the Pomeroy sub- Speaker, I rise today to honor Ted Connors troops and veterans, increasing pay, housing, stitute. upon his retirement from the position of Exec- and healthcare allowances, increasing assist- utive Director of the Portsmouth Housing Au- f ance to disabled veterans and their survivors, thority after 35 years of service. and strengthening the Montgomery GI Bill to TRIBUTE UPON RETIREMENT OF The son of the city’s first night-shift police help millions of veterans fulfill their educational PAUL POGORZELSKI officer, Ted Connors grew up in Portsmouth, and career goals. New Hampshire, known as ‘‘the City of the HON. JAMES P. MORAN Open Door’’. Ted witnessed Portsmouth Bob was a modest and decent man who, in change over the years from a rough-and-tum- dedicating the majority of his life to public OF VIRGINIA service, was a dedicated patriot and a true IN THE HOUSE OF REPRESENTATIVES ble military town into the tourist and business center it is today. This native brought a valu- American Hero. Bob’s enthusiasm and spirit Wednesday, June 25, 2003 able hometown boy’s point of view to his posi- touched the lives of all who had the pleasure Mr. MORAN of Virginia. Mr. Speaker, I rise tion. of meeting him. Although his presence is to pay tribute to Paul Pogorzelski of Falls Ted displayed an inspirational devotion to greatly missed in the halls of the House, I Church who is being honored by We United improving the quality of life for residents in his know that Bob is and will be well remembered. States Navy tomorrow for his 42 years of Fed- hometown. His top priority was to expand My thoughts and prayers are with the Stump eral service. But his abiding love of country work-force housing in the region in support of family and with everyone else who loved and and honor of service actually began at the the growing number of local employees being admired him. young age of 12 when Paul joined the Civil driven out of the city due to increasing hous- Thank you, Mr. Speaker.
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00003 Fmt 0626 Sfmt 0634 E:\CR\FM\A25JN8.047 E26PT1 E1360 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 CBC SPECIAL ORDER ON Along with Reverend Jackson, and many fifty-year old executive directive to end seg- AFFIRMATIVE ACTION others, I was at the Supreme Court the day regation in the military. when this case was heard. I was very proud Again, these retired military officers, like to speak to the thousands and thousands of their business counterparts, stressed that af- HON. BARBARA LEE young people led by the Michigan students firmative action is essential to the success of OF CALIFORNIA and BAM who had come to Washington from their mission. IN THE HOUSE OF REPRESENTATIVES all over the country to protest the effort to Diversity is a critical component of our de- eliminate affirmative action. mocracy as well. That is why I joined my Wednesday, June 25, 2003 Believe me, I see a new sense of energy and congressional colleagues, led by Michigan Ms. LEE. Mr. Speaker, I want to thank our involvement by our young people, and as Congressman John Conyers, ranking member adults we must support their organization of the Judiciary Committee and long a war- CBC Chairman, ELIJAH CUMMINGS, for holding efforts. Thank God, they are preparing them- rior in the fight for civil rights, in submit- this special order. I wish to contribute this selves to take over the world. This victory ting our own amicus brief to the Court. evening by inserting into the RECORD the fol- speaks volumes to their efforts. We asked the Court to recognize the edu- lowing speech which I delivered on Monday I was sitting in the audience when Solic- cational and political benefits of diversity; June 23, 2003 at the Rainbow Push Coalition itor General Ted Olson, the Administration’s to uphold the use of race as one factor and the Citizen Education Fund’s Women’s attorney, passionately argued against af- among others that can be considered in gov- Luncheon in Chicago. firmative action, declaring that the Univer- ernment decision-making; and to reaffirm that the role of race in this decision making Thank you very much for that kind intro- sity of Michigan—and by implication all is not limited to remedying specific in- duction and thank you for inviting me here other universities and institutions—should stances of identified discrimination. today. I want to acknowledge and thank use race-neutral means for its admissions. I thought how sad it was to witness our The fact is we don’t have a level playing Reverend Jesse Jackson for staying the own government arguing against the inter- field in this country. course, for continuing to speak truth to ests of so many of its own people. People of color and women earn less power and for your friendship and support I would suggest race-neutral admissions money, own fewer assets, and enjoy less ac- throughout the years. I want to thank you would be fine—just as soon as this becomes a cess to the nation’s elite institutions. Afri- for the act of courage Award presented to me race-neutral country. And not a day sooner. can American unemployment is twice as last year in Los Angeles. Believe me, the in- In upholding the University of Michigan high as that of whites. spiration and encouragement that I have re- law school’s affirmative action program, Affirmative action is still necessary, not ceived from you during very difficult and race will continue to be a critical component just in the interests of minorities but in the challenging times has given me strength. in achieving parity and equal opportunity interests of the country as a whole. Reverend Barrons, your guidance spirit for all. We must be the active watchdogs This decision upholds justice, access, and and commitment has touched my life. To over this decision and how it is implemented. fair play. Let me tell you what has happened Mrs. Jacqueline Jackson, thank you for your I was there when Justice Scalia told the in my home state of California. leadership and for being an exemplary role University of Michigan that it had a choice: In California, we have seen the devastating model for women. You are our first lady and it could either be an elite, first-rate school effects of the assault on affirmative action. we are so proud. or it could lower its standards and pursue ra- When I was in the state legislature, I fought To the entire Rainbow PUSH family, your cial diversity. tooth and nail against efforts to end affirma- commitment to work for justice and peace How sinister—and wrong—can you get? tive action. has shown the world ‘‘a better way.’’ You Justice Scalia was, in fact, offering a false Reverend Jackson and the Rainbow Coali- continue to fight to make the American dichotomy: in reality, you cannot be a top- tion not only stood with us, they actively op- dream a reality, not just for the select few flight university without diversity. posed Prop 209 by marching, engaging in but for ‘‘all God’s children.’’ While that fact eludes the Bush Adminis- peaceful protests, and organizing. I also want to acknowledge the many tration, it does not escape corporate Amer- All the ‘‘street heat’’ that could be brought elected officials, members of the clergy, and ica, the military, or many members of Con- to bear, Reverend Jackson helped bring it. community leaders, and phenomenal women gress, all of whom voiced their support for During those years, I was chair of the Cali- here today and to acknowledge everyone who the University of Michigan and the principle fornia Legislature Black Caucus, and we de- is part of the struggle to compel our nation of affirmative action. feated each and every anti-affirmative ac- to live up to its own promises of liberty and Sixty-five major businesses, all Fortune tion legislative measure that then Governor justice for all. And in the memory of our 500 companies, submitted a brief as a friend Pete Wilson wanted to sign into law. fallen hero Mayor Maynard Jackson, let us to the court on this case. But a member of the University of Cali- rededicate ourselves to our work for polit- These global businesses have annual reve- fornia Board of Regents, and African Amer- ical, social and economic justice. nues of over a trillion dollars. ican, yes, a brother, well, I should say, a Today, the Supreme Court issued a deci- As employers, they are deeply interested in black man, Ward Connely, led the ballot ini- sion on a monumental affirmative action this case because they recognize, and I quote tiative to end Affirmative Action. case. This morning the Supreme Court re- here from their brief, ‘‘the existence of racial These efforts resulted in a state constitu- jected the Bush Administration’s efforts to and ethnic diversity in institutions of higher tional amendment and action by the Board eliminate affirmative action as we know it. education is vital to [our] efforts to hire and of Regents to end affirmative action on all I say monumental because this judgment maintain a diverse workforce, and to employ campuses. will echo far beyond the boundaries of the individuals who have been educated and So, while we won in the legislature, misin- University of Michigan and far beyond the trained in a diverse environment.’’ formation and prejudice helped carry the day realm of higher education. Affirmative action, these corporate giants at the polls when California voters passed We are still studying the Court’s ruling to explained, does not only benefit minorities Proposition 209 in 1996. understand its ramifications; however, the or the economically disadvantaged: affirma- That initiative eliminated affirmative ac- Supreme Court did uphold affirmative action tive action benefits everyone by offering tion programs for women and people of color and that is a clear defeat for the Bush Ad- cross-cultural experience and understanding. run by state or local governments in the ministration. This decision is a testament to Without that interaction, they argued, we areas of public employment, contracting, the broad mobilization to defend civil rights, all suffer, and without such a workforce, and education. it validates the ‘‘power of the people’’ and these companies will be hard-pressed to com- California and some other states have tried the legality of affirmative action and re- pete in the global business environment. to create alternatives to affirmative action, quires us to be vigilant as we move forward. Those same views were echoed by many of but these alternatives depend on and rein- Many of you, including myself, are proud the highest ranking retired military officers force residential segregation and fall short products of affirmative action. We are duty- in this country, including former Chiefs of in other ways. They just don’t work. Now, bound to protect it. Staff, former Secretaries of Defense, General very few minority and women owned busi- This is one of the most important civil Norman Schwarzkopf, and other decorated nesses have state contracts, and very few are rights cases in the last quarter century. Af- veterans representing all four service employed in key positions. firmative action is still necessary, not just branches. Alumni legacies—such as those President in the interests of people of color, but in the They wrote the court, ‘‘Based on decades of Bush undoubtedly benefited from when he interests of women and country as a whole. experience, [we] have concluded that a high- was admitted to Yale with an exceedingly What was at stake here is the University of ly qualified, racially diverse officer corps’’ is mediocre academic record, to say the least— Michigan’s attempts to create a classroom ‘‘essential to the military’s ability to fulfill combined with emphasis on test scores that that reflects the diversity of this country as its principal mission to provide national se- favor both white applicants and the economi- well as its persistent economic inequalities. curity.’’ cally advantaged are creating campuses that What is also on trial here is the principle ‘‘Limited race-conscious recruiting and ad- are increasingly segregated. of affirmative action, and in this case the missions policies’’ at universities such as In California, we are undergoing the re-seg- Bush Administration weighed in on the side Michigan, they continued, is critical to both regation of our colleges and universities. At of reversing progress rather than pursuing meeting the security needs of this country many of the top schools in the state, minor- justice. and to following through on Harry Truman’s ity enrollment has been cut in half since
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00004 Fmt 0626 Sfmt 0634 E:\CR\FM\A25JN8.051 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1361 Prop 209 passed. Thank God for our histori- tions, just like it’s trying to wipe out affirm- ommendations made by the Taxpayer Advo- cally Black Colleges. Our African American ative action and the Clean Air Act. cate at the Internal Revenue Service (IRS) to students are now going south benefiting This is an administration that wages war improve services of the agency and protect from their excellent education. But what we abroad while also waging war at home, on consumer rights. Most of these provisions are have learned is that 70 percent of these stu- the nation’s poor, on people of color, on dents do not return to California. What a women, on the environment, on seniors, and broadly, if not unanimously, supported. brain drain we have in California. on working families. However, what started as a good bipartisan Shame on California. What can we do in the face of these as- bill has been tarnished by the addition of an One observer described the process of saults? Fight back! Believe me, we must be anti-consumer provision that is troublesome eliminating affirmative action, at Boalt vigilant to stop any legislation—illegal leg- enough that I cannot vote for it. Language was Hall, the University of California’s premiere islation that the Republican House and Sen- added to this bill to strip essential consumer law school, as ‘‘watching justice die.’’ ate will put forward. protections for those purchasing health insur- In looking at the Administration’s position We must take back the House, take back on affirmative action, we have to place that the Senate, and take back the White House ance using tax credits granted under the particular choice within the larger context in 2004. Trade Assistance Act (TAA). These existing, of the Bush Administration’s class war on To do that, we must educate, organize, mo- carefully negotiated consumer protections are America’s working families and their poli- bilize, and vote! in place to ensure adequate coverage for cies of rewarding the rich. We must register our folks to vote, we those using the tax credit. They are enjoyed This Administration and its allies in Con- must vote and we must demand that our by every member of this Congress, and they gress are rolling back advances in racial votes be counted. No more stealing elections. are critical to providing meaningful health cov- equality, economic opportunity, and gender Democracy is at a crossroads. We must make erage. equity. democracy real. First Trent Lott lamented the defeat of Rainbow PUSH represents the very diver- Proponents of removing these consumer Strom Thurmond’s white supremacist Dixie- sity that is under attack. And diversity is a protections call it ‘‘consumer choice.’’ But as a crat Party in 1948. tremendous strength. Use it! former insurance regulator, I can tell you that The Administration may have rushed to If people tell you their vote doesn’t mat- families facing unemployment and possible disown itself from those remarks, but its ter, remind them about Florida. loss of health insurance due to U.S. trade pol- policies are taking us back to those days Each and every vote the Supreme Court icy need health insurance that is both afford- nonetheless. chooses to count matters. We must demand able and provides adequate coverage. They The Administration is creating massive that they all be counted! should not be forced to ‘‘choose’’ one over the tax cuts for the rich, but twelve million chil- This is a critical moment in history and other. dren of America’s working families were left you have to make it our moment. off their master plan for the child tax credit. I am reminded of the Book of Esther and Under current law, insurance companies They did this deliberately. It was not a mis- the conversation between Mordecai and Es- who agree to offer coverage to displaced take. ther when she faced her moment of truth. workers under this program are substantially So were single mothers who apparently Mordecai turned to Esther as she paused in limited in their ability to turn down applicants, don’t deserve tax credits in the world of the face of what looked to be an insurmount- charge excessive premiums or otherwise seek George Bush. They also left out over 200,000 able obstacle, and he said to her, ‘‘Who to cover only the healthiest individuals. With- military families. What a disgrace. knows whether you have not come to the out these requirements, the promise of help We have an Administration that preaches kingdom for such a time as this?’’ leave no child behind, but then wants to gut for most of these people and their families Let me pose a similar question to you here, would be meaningless. Understand, however, Head Start and leaves tens of thousands of today. Who knows whether or not you have children on waiting lists instead of in pre- come for such a time as this? these are not special protections. These are school. They want to block grant head start, Queen Esther and her forces were vic- standard protections and they are being remove it from the Department of Health torious. This too is a battle we can win. We, stripped in this bill. and Human Services, put it in the Depart- too, will be victorious. And, again, women Making coverage cheaper by restricting it to ment of Education and require four year olds will help lead the way. the healthy undermines its purpose—health to take a literacy test. Their proposal would Thank you for all that you do. Let us take end head start as we know it. security for those who need it most. It’s like from this moment the determination to fol- making automobile air bags out of tissue We have an Administration that would like low in the footsteps of our heroes—Dr. King, to privatize both Social Security and Medi- Justice Marshall, Mrs. Parks and Mrs. Till, paper—a tactic sure to make cars cheaper for care, leaving our parents and grandparents Ida B. Wells, Sojourner Truth, Maynard all and hurt only those few who are in acci- with neither financial security nor real pre- Jackson, and Reverend Jesse Jackson—and, dents—those whose goal it is to protect in the scription drug coverage. like Esther, seize our moment. first place. We have an Administration that is trying I say again, Rainbow Push, you have come to block grant Section 8 housing programs, Only healthy people can afford to ‘‘waive’’ for a time such as this. the protections. If the waiver is available, the dismantling Section 8 as we know it. Thank you and God bless you. And we have an Administration that is insurance industry would likely gladly enter stripping away our civil liberties, one by f into arrangements to cover only the young and one. We must stop Patriot Act II from get- healthy displaced workers and walk away from TAXPAYER PROTECTION AND IRS ting through Congress. those who need help most. This would make ACCOUNTABILITY ACT OF 2003 It’s an Administration that is wiping out a mockery out of the agreement the members decades of progress on Clean Air and Clean of this House voted for in passing the TAA. Water, even though asthma, childhood can- SPEECH OF cer rates, and scores of other health prob- Or worse yet, perhaps those most in need lems associated with pollution are on the HON. EARL POMEROY of coverage would indeed be issued policies, rise, especially among people of color. It’s an OF NORTH DAKOTA using this credit, but only coverage that ex- administration that puts our tax dollars into IN THE HOUSE OF REPRESENTATIVES empts any pre-existing conditions. In other a $400 billion dollar defense budget to build words, this credit could be used to under- more missiles, yet cuts after school pro- Thursday, June 19, 2003 insure individuals or families, leaving them vul- grams and won’t fully fund education. Mr. POMEROY. Mr. Speaker, I rise today to nerable without the protection they need most. This is an administration that is launching Is it really helpful to displaced workers to pro- a similar assault on women’s rights. say that I cannot support this bill. I do support Look at its attack on Title IX, for exam- nearly everything in the underlying bill. It is vide a tax credit to purchase coverage that ple, a program that is featured in this con- mostly the product of a bipartisan effort to ad- doesn’t cover what they need most? Of course ference. Title IX has opened up opportunities dress taxpayer rights issues and those provi- it isn’t, and that’s why we included standard for girls and women on the sports field that sions should be enacted. Unfortunately, the consumer protections in the first place. have also opened up opportunities in life. addition of ‘‘poison pill’’ language into this bill Mr. Speaker, aside from this anti-consumer Our beloved, recently deceased Congress- prevents me from supporting this legislation provision related to health care tax credits, I woman Patsy Mink of Hawaii, sponsored today. strongly support the underlying bill. The major- Title IX. In honor of her memory and legacy, we must not let this Administration turn This bill has many good components, in- ity of this bill is good for taxpayers and would back the clock. cluding provisions I worked on personally with serve to improve the operations of the IRS Title IX is about banning sex discrimina- Mr. HOUGHTON. There are several excellent and the services they provide to our constitu- tion, pure and simple. And the Bush Admin- provisions from members of both sides of the ents. However, as long as this poison pill pro- istration is trying to wipe out those protec- aisle, in addition to a number of important rec- vision remains in this bill, I will oppose it.
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00005 Fmt 0626 Sfmt 0634 E:\CR\FM\A25JN8.054 E26PT1 E1362 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 A TRIBUTE TO RAO ANUMOLU fourteen with this status in the entire State of and dedication. He serves as a role model to Ohio. the rest of us, and I wish him success in his HON. CAROLYN McCARTHY Not only has Father Dolan significantly future endeavors. OF NEW YORK raised the bar on academic standards and ex- f IN THE HOUSE OF REPRESENTATIVES cellence at Padua, he also focused on the im- provement of the school’s athletic facilities. TRIBUTE TO MARIE DAVIS OF Wednesday, June 25, 2003 These significant exterior developments cre- NORTH ADAMS, MI Mrs. MCCARTHY of New York. Mr. Speak- ated new baseball and softball fields, new er, I rise before you today to express my deep track fields and facilities, parking and roadway HON. NICK SMITH appreciation and recognition of Mr. Rao S. improvements, and a new football stadium. OF MICHIGAN Anumolu of Hauppauge, NY for his tireless ef- Father Dolan ensured that appropriate land- IN THE HOUSE OF REPRESENTATIVES forts in support of our nations defense. As scaping graced the boundaries of every new Thursday, June 26, 2003 President and CEO of ASR International Cor- development. Mr. SMITH of Michigan. Mr. Speaker, I rise poration, Mr. Anumolu has assisted the De- Moreover, Father Dolan’s goal for Padua in- today to honor Marie Davis of North Adams, partment of Defense in its fight to protect our cluded financial stability for the school, and aid Michigan. homeland since the attack on our country on for eligible students. During his tenure, Father A lifelong resident of North Adams, Marie September 11th and particularly during the Dolan secured a major funding effort to build has enriched the lives of others through her Iraqi war. Since its conception in 1986, ASR a strong endowment, entitled ‘‘The Campaign outstanding participation in civic and volunteer International has developed cost effective For Tomorrow.’’ This significant endeavor ex- activities, and her many accounts of life in technology and systems to protect our nations ists to increase the amount of financial aid to North Adams. airports, waterways, railroads and highways. students in need. This endowment is also de- Marie was born on August 14, 1909 and is Most recently, ASR International has devel- signed to maintain the school’s technological a lifelong resident of North Adams. She at- oped the ‘‘SAFETY/SECURITY ASSURANCE level, and also provides teachers with cutting- tended school there and graduated from North SYSTEM’’ in order to further support our ef- edge educational training. Adams High School, and has been a member forts at Homeland Security in a comprehen- Mr. Speaker and Colleagues, please join me of the North Adams United Methodist Church. sive and cost effective manner. in honor and recognition of Father Walter L. Marie has also represented North Adams as a In addition to Mr. Anumolu’s arduous work Dolan as he retires as President of Padua member of the Women’s Congress at the with ASR International, he has made quite a Franciscan High School, and as he retires Hillsdale County fair for many years. name for himself outside their doors. Earning from active ministry. Father Dolan’s contribu- Mrs. Davis is best known for her historical a MS in Industrial Engineering and a MBA in tions throughout his ministry are significant accounts of life in North Adams and has kept Management, Mr. Anumolu furthered his edu- and immeasurable, and his work and service diaries of all major events that have occurred cation in the field of Defense by enrolling in will be greatly missed. His leadership, exper- there. She has written and published five numerous courses at Defense Systems Man- tise, guidance and concern for others have books about local history, including: ‘‘This is agement College as well as Harvard Univer- served to uplift the entire Padua community, North Adams,’’ ‘‘100 Years of Sports in North sity and other esteemed institutions. With this and the entire Cleveland community, and his Adams’’, ‘‘The History of North Adams stellar academic background, Mr. Anumolu en- gift of faith and compassion will forever light Schools,’’ and ‘‘1886–2002: The History of the tered the work force, holding such prestigious our community. North Adams Fire Department.’’ positions as Senior Engineer, Program Man- f Marie Davis will celebrate her 94th birthday ager and Director of Prime Defense contrac- IN HONOR OF ROY BOHNER on August 14, 2003, and is still considered tors before founding ASR International in North Adams’ official historian, continuing to 1986. chronicle the lives and events of that commu- This is not the first time Mr. Anumolu has HON. MARTIN FROST nity. been recognized for his efforts. In 1993, Mr. OF TEXAS North Adams is a small midwestern town Anumolu received the Business Excellence IN THE HOUSE OF REPRESENTATIVES with tree-lined streets, friendly neighbors, and Award from the U.S. Small Business Adminis- Thursday, June 26, 2003 thanks to Mrs. Davis, a preserved heritage. I tration for his work in the field of Defense. am pleased to recognize the efforts of Marie Mr. FROST. Mr. Speaker, I rise today in Now, it is my turn to say ‘‘Thanks.’’ Davis in preserving the memories, stories and honor of Mr. Roy Orthmor Bohner, who re- Mr. Speaker, I ask my colleagues to join values of the past for present and future gen- cently celebrated his 51st anniversary working with me in expressing our gratitude to Mr. erations. Anumolu for his exemplary work and dedica- with Lockheed Martin Missiles and Fire Con- f tion to the safety and protection of all Ameri- trol in Dallas, TX. cans. His many accomplishments have helped Roy Bohner has been a dedicated em- GENERAL ERIC K. SHINSEKI make the United States a safe place for all. ployee of MFC since he began working there many years ago as an Engineering Trainee f HON. CURT WELDON and a junior hydraulics design engineer. Some OF PENNSYLVANIA HONORING FATHER WALTER L. of his notable accomplishments include a de- IN THE HOUSE OF REPRESENTATIVES DOLAN sign of an autopilot for a radio controlled drone aircraft, a successful R&D program to Thursday, June 26, 2003 HON. DENNIS J. KUCINICH do flight control analysis, and design studies Mr. WELDON of Pennsylvania. Mr. Speaker, OF OHIO for a ‘‘fly-by-wire’’ control system named I rise today to celebrate the outstanding serv- IN THE HOUSE OF REPRESENTATIVES Electro-RAM. In addition to his service in Dal- ice of one of America’s true heroes, General las, Roy spent some time at the General Dy- Eric K. Shinseki. Thursday, June 26, 2003 namics plant, now Lockheed Martin Aero- General Shinseki retires from the Army after Mr. KUCINICH. Mr. Speaker, I rise today in nautics in Fort Worth, as part of the Industry a career that spanned the globe and 38 years honor and recognition of Father Walter L. Assist program. of service in peace and war. Let me be very Dolan, O.F.M., upon the occasion of his retire- Prior to joining MFC, Roy served our coun- clear, what General Shinseki has accom- ment from active ministry. try in World War II as a member in the 11th plished as chief is tied directly to the welfare Father Dolan has served as President of Army Division, and he continues to contribute of soldiers and their ability to remain the Padua Franciscan High School in Parma for to this Nation through his loyalty and dedica- world’s greatest warfighters and we owe him a the past nine years. Under his leadership, the tion to his projects at Lockheed Martin. A man debt of gratitude. high school has flourished in many ways. En- of ardor and great humor, Roy’s objective is to General Shinseki was just a young cadet at rollment has steadily increased at Padua, and be the oldest living employee at Missiles and West Point, when General of the Army Doug- today the high school is the largest Catholic Fire Control in Dallas. las MacArthur, gave his distinguished Farewell co-educational secondary school in northern Roy is an exemplary model of the American Speech on the banks of the Hudson to the Ohio. Additionally, it was because of Father worker who is dedicated to continue serving Corps of Cadets. General MacArthur’s words Dolan that Padua Franciscan High School is this great Nation. embodied the creed of military service: now officially designated as a College Pre- Mr. Speaker, Roy Bohner deserves special ‘‘Duty,’’ ‘‘honor,’’ ‘‘country’’—Those three paratory High School—making it only one of recognition for his tremendous achievement hallowed words reverently dictate what you
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00006 Fmt 0626 Sfmt 9920 E:\CR\FM\A25JN8.059 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1363 want to be, what you can be. They are your Army, owe a debt of gratitude to General In El Salvador, Beatrice Alamanni de Carillo, rallying points to build courage when cour- Shinseki and his wife Patty for their selfless a veteran judge and professor, serves as age seems to fail, to regain faith when there service. They have given meaning to the time- Prosecutor for the Defense of Human Rights. seems to be little cause for faith, to create hope when hope becomes forlorn.—General less values that continue to reverberate across She was appointed by the National Assembly, Douglas MacArthur’s Farewell Speech, May the plain at West Point—‘‘Duty, Honor, Coun- with a majority from the conservative Arena 12, 1962 try.’’ Party. Her comments: These ideals—of duty, honor and country so f ‘‘In the private sector an anti-union culture eloquently expressed by General MacArthur persists in great measure and for many years, THE CASE FOR LABOR STAND- employers have generated a climate that does that day have been personified in General ARDS IN TRADE AGREEMENTS Shinseki’s distinguished career. General not contribute to the promotion of worker orga- Shinseki graduated from the United States nization in their workplace. . . . The Ministry Military Academy in 1965 and later received a HON. BARNEY FRANK of Labor and Social Welfare has not dem- Master of Arts Degree in English Literature OF MASSACHUSETTS onstrated a real will to guarantee in practice from Duke University. IN THE HOUSE OF REPRESENTATIVES the rights of workers, either individually or col- As a young officer, General Shinseki served Thursday, June 26, 2003 lectively. There is a very loud clamor that the two combat tours in Vietnam. He was twice authorities of that Ministry do not make their Mr. FRANK of Massachusetts. Mr. Speaker, wounded, and earned two Purple Hearts as best efforts to adequately check working con- I ask that excerpts of a recent speech by Mr. well as four Bronze Star Medals. He then went ditions in businesses, and, in addition, they on to serve for more than ten years through- LEVIN of Michigan be printed. tolerate and promote an anti-union culture in out Europe in positions of increasing authority In recent years the major industrial the country.’’ growth in El Salvador, Nicaragua and Guate- and responsibility. In 1996, General Shinseki In each country, the rights to associate and mala has been in the maquilas, assembling organize and to bargain collectively are not re- was promoted to lieutenant general and re- apparel in free trade zones. turned to the Pentagon as Deputy Chief of 100,000 to 150,000 people work in the gar- alities. The laws themselves are inadequate. Staff for Operations and Planning. ment maquilas of each nation. Even where there are laws on the books, they General Shinseki’s duties culminated with 75–85 percent of the workers on average are are not well enforced and are often used his promotion and assignment as Chief of women, with an average age of 18–25. against workers trying to organize. Staff of the Army in 1999. Already, as Vice A majority are the sole source of income As far as I could determine, there is not a Chief of Staff, he had developed an innovative for themselves and their children. single effective collective bargaining agree- plan to prepare the Army to face the unique By law, the work week is supposed to be 44 ment in any of the garment maquilas of the hours, with overtime on a voluntary basis. challenges of the 21st century. Soon after be- The typical worker receives about 65 to 75 three countries, though there are almost coming Chief of Staff of the Army, General cents per hour. If paid by piece the average 400,000 workers. Shinseki embarked on a bold plan to trans- could be around $1 per hour. In Guatemala, a leader of the union con- form the Army to a lighter, more lethal, more Almost every nation in the world has nected with the Christian Democrats put it this flexible and transportable force that would be agreed through the International Labor Or- way: the problem is that employers have ‘‘im- fully capable of meeting the full range of ganization (ILO) to respect five core labor punity;’’ ‘‘they make up their own laws.’’ threats that face today’s Army. He was a vi- standards: prohibitions on child labor and You may jump to the conclusion that I came forced labor, non-discrimination, and the sionary who began transformation long before back discouraged. That is not accurate. rights to associate and to bargain collec- If the issue of core labor standards is ad- the term became popular. tively. In the garment maquilas, the most Perhaps most poignantly, General Shinseki salient are the rights to associate and orga- dressed in CAFTA by including a fully enforce- should be remembered as the gladiator Presi- nize and to bargain collectively. able obligation to adopt these standards, it will dent Roosevelt spoke of so long ago: In Central America today, the basic labor- have an important impact on socio-economic It is not the critic who counts, not the man management dynamic is like the United dynamics in these countries by helping de- who points out how the strong man stum- States at the turn of the last century. velop a middle class. bles, or where the doer of deeds could have In Nicaragua and El Salvador, an employer In the last decade the apparel/textile done them better. The credit belongs to the can fire any employee whom it believes is maquilas have been the major source of eco- man who is actually in the arena; whose face sympathetic to an organizing effort simply nomic growth and new employment in each of is marred by dust and sweat and blood: who by paying severance. strives valiantly; who errs, and comes short In one plant I visited in Nicaragua workers the three nations I visited, and in Honduras. again and again, because there is no effort had quite recently been working 70- to-80 The realities within the maquilas today are without error and shortcoming; but who does hours (apparently for the same $100 a built on a total imbalance in relationships be- actually strive to do the deeds; who knows month); in some cases they were working 24 tween employer and employee. The vast ma- the great enthusiasms, the great devotions; hour shifts. Protests finally forced new man- jority of workers, young women, are particu- who spends himself in a worthy cause; who agement, but the new management acknowl- larly vulnerable, with overriding fear that for at best knows in the end the triumph of high edged that they were still working people them losing a job means an end to their in- achievement, and who at the worst, if he longer than permitted in the law. come. fails, at least fails while daring greatly, so In Guatemala, we talked with a worker that his place shall never be with those cold who had personally witnessed other employ- It is essential in order to provide opportuni- and timid souls who know neither victory ees who had been trying to organize being ties to the CAFTA countries to expand trade nor defeat.—Address at the Sorbonne, Paris, beaten with bats at work. and strengthen commercial ties with the re- France, April 23, 1910. In Nicaragua and Guatemala, we heard nu- gion. It is equally essential that the rules of Throughout his thirty-eight years of service merous reports of employers using the crimi- trade and investment be shaped in a way that General Shinseki’s first and primary focus has nal process in order to break up unions in maximizes the benefits to those countries and always been the men and women of the maquilas and other sectors. the U.S. In El Salvador, we visited a free trade zone For workers to be able to break the cycle of United States Army. Among his many accom- in which a plant was shut down to avoid its plishments, General Shinseki revolutionized workers being able to organize. We heard poverty, they need to have the ability to join recruitment, training and education. Just one highly credible evidence that the leaders of together, to participate, to improve their eco- example of General Shinseki’s innovative ap- the organizing effort were subsequently nomic status. This is an antecedent to helping proach is eCybermission, a program that en- blacklisted as they sought other employ- those workers use the potential of courages young men and women to pursue ment. globalization to create, join, or expand the education and careers in engineering and In Guatemala, it is not legally possible for middle class. a union to attempt to organize within an en- science, which he sees as fundamental to the Hernando de Soto recently authored The tire industry, like the garment industry, Mystery Of Capital: Why Capitalism Succeeds future of the Army and the nation. without having in advance 50 percent plus General Shinseki attributes much of his suc- one of the workers signed up and registering In The West And Fails Everywhere Else, cess to the support of his wife Patty, who has with the government. which posits that economies develop where also contributed greatly to aid the wives and Nicaraguan and Guatemalan employees property rights are formalized, are clearly and families of our service men and women. To- cannot strike without government approval. efficiently defined, are enforceable, and may gether, they have raised two wonderful chil- The State Department Human Rights Re- be exercised by all; in this way all property dren, Lori and Ken. port, and numerous other reports from groups can become capital. Labor market standards This nation, the Congress, the Department like Human Rights Watch, confirm that the help workers maximize a key property right— of Defense, and the men and women of the facts and incidents are the constant reality. property in one’s own labor.
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00007 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.004 E26PT1 E1364 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 A key reason to seek a minimum floor of re- goods and service providers, protection for in- Where there are differences, it is a serious spect for the five core, internationally-recog- vestors, and improved intellectual property mistake to use an agreement for one country nized labor standards is to ensure that the protection from the CAFTA countries. These as a model for another, turning a building CAFTA countries will not compete in a race to countries are seeking more investment and block into a stumbling block. the bottom in their efforts to promote trade more U.S. market access, primarily in the tex- This is what seems to be evolving as to use and attract investment. Some argue that the tiles and apparel and agriculture sectors. Oth- of the Chile and Singapore agreements for ne- race to the bottom is a myth, that income lev- erwise, CAFTA will provide no significant ben- gotiations in CAFTA. Last week USTR tabled els will rise when trade and investment flows efits to Central America beyond those pro- in the CAFTA negotiations a proposal on core increase, and all domestic standards will rise vided by the Caribbean Basin Initiative (CBI). labor standards using the Chile and Singapore as income levels increase. These arguments I joined with several others in helping to provisions as a model. Use of a standard of ignore the fact that, as with all other economic shape the enhanced market access in textiles enforcing one’s own laws is viable where a factors, investment dollars are scarce and and apparel when we expanded the CBI a few nation’s laws embody the five ILO core labor there is fierce competition to attract those dol- years ago. The result has been a move to- standards and there is a record of enforce- lars. When the competition is over labor-inten- ward a more integrated Caribbean-area textile ment of those laws. The laws of Chile and sive industries, one of the key points of com- and apparel market. I believe that further inte- Singapore do embody the five core labor petition is the labor market pool. gration is necessary. If not, once quotas are standards and these are enforced in practice. A New York Times article from about two removed in 2005 much more of this market The opposite is true in the Central American years ago quoted the President of El Salvador will be lost to goods from other areas. nations I visited; the standard of ‘‘enforce your regarding intra-regional competition, who stat- One of the keys to increased market access own laws’’ would be a backward step in the ed, ‘‘The difficulty in this region is that there is will be squarely facing up to the core labor CAFTA and benefit those with the worst laws. labor that is more competitively priced than El standards issue. When we considered the ex- This sparked the letter last week to Ambas- Salvador.’’ pansion of CBI, the core labor standards issue sador Zoellick from the Democratic leadership Another article from about one year ago in was directly addressed by heightening the of the House and Mr. Rangel, Mr. Matsui and the Washington Post described the interesting labor standards criterion in the CBI program. myself. We said ‘‘We write as supporters of changes in patterns in banana trade, with Ec- Under that criterion, the United States may uador attracting an increasing share. The ex- negotiations for a U.S.-Central American free unilaterally judge whether a nation is imple- trade agreement. . . That said, we are not planation, according to one major fruit com- menting the core labor standards. With the ne- pany executive, is that ‘‘the costs in Ecuador supportive of the proposed U.S. draft text for gotiation of CAFTA, and the consequent elimi- the FTA’s labor chapter. . . The current are so much lower. There are no unions, no nation of the CBI labor standards criteria, in- labor standards, and the pay is as low as two version of this text does not adequately ad- cluding a fully enforceable obligation to en- dress the economic and individual impact of dollars a day.’’ force the five core labor standards, is even If the promise of expanded trade—increased the egregious conditions for workers in the re- more important. incomes and lower levels of income inequal- gion, and should not be the starting point for The further integration in apparel and textile, consideration of these issues.’’ ity—is to be realized, it is important that the as well as agriculture, means some further CAFTA countries not compete with each other Inclusion of a core labor standards provision displacement in the United States. Compara- based upon abuse of core labor standards. in the CAFTA, and in future trade agreements, tive advantage is sound economics, but the The best way to do that is to establish over a will help answer arguments of those who com- distortion of the labor market by suppression reasonable period of time a floor—adopting plain that globalization is harmful to the poor of workers to create this advantage is un- the five core labor standards as rules of com- and anti- the ‘‘little guy.’’ sound as an economic and policy matter, is petition in this critical economic area in the I came home from my trip with a positive unnecessary, and will only deepen opposition FTA itself—just as we establish floors through view of the opportunities that can be achieved, from competing workers and businesses in the rules of competition in other areas like intellec- but only if we address the significant chal- United States. tual property, investor rights, and tariff levels. lenges. A key challenge is to place core labor Facing the issues surrounding core labor The Central American nations do not need standards in a broader perspective, and to un- standards is not a vehicle for ‘‘protectionism.’’ to suppress their workers in order to compete. derstand that it is vital to the future of each Indeed, it is an opportunity for expanded There is an opportunity to build an economic Central American nation, the Central American trade. structure based on implementation of core region, the integration of the hemispheric mar- Only a coalition that is far broader and sol- labor standards so that garments from those ket and the future of U.S. trade policy. nations could bear a label reading ‘‘made idly bipartisan, much more so than the narrow votes in the U.S. House achieved by last under internationally recognized labor stand- f ards,’’ which many competing goods will not minute concessions, can be the basis for possess. working out decisions on the tough issues of INTRODUCTION OF THE ‘‘WINNING The alternative is an increasing effort by apparel and textiles and agriculture in CAFTA, THE PEACE ACT OF 2003’’ consumer groups in the U.S. to boycott com- and beyond. panies that make garments under conditions More broadly, CAFTA can and should be a HON. SAM FARR that violate these standards. building block towards effective negotiation of Efforts by American retailer-purchasers to an FTAA. OF CALIFORNIA promulgate and implement private business The CAFTA negotiations present the oppor- IN THE HOUSE OF REPRESENTATIVES codes will not make up for a lack of a basic tunity for the United States to negotiate fully Thursday, June 26, 2003 governmental and societal structure. In the enforceable core labor standards, combined New York Times article quoted above, an offi- with a phased-in compliance period, a signifi- Mr. FARR. Mr. Speaker, I rise today to intro- cial from a major American retailer said ‘‘We cant and ongoing commitment of U.S. tech- duce a new piece of legislation—the ‘‘Winning can’t be the whole solution. The solution has nical assistance to the countries to help them the Peace Act of 2003’’. I am pleased to be to be labor laws that are adequate, respected, achieve compliance before and in the initial joined by colleagues from both sides of the and enforced.’’ years of the agreement, and positive market aisle—Representative WOLF of Virginia, Rep- By addressing core internationally recog- access incentives for countries that improve resentative HOEFFEL of Pennsylvania, Rep- nized labor standards in the CAFTA negotia- their laws and enforcement record (for in- resentative LEACH of Iowa, and Representative tions, it is more likely that the domestic coali- stance, by accelerating implementation of mar- WEXLER of Florida—as original cosponsors of tion necessary to tackle the tough market ac- ket access phase-ins or by providing improved the bill. cess issues with the United States can be as- access than required by the terms of the The ‘‘Winning the Peace Act of 2003’’ cre- sembled. FTA). The goal of those of us who seek to es- ates a much-needed institutional framework to Total two-way trade between the United tablish rules in this area is to expand trade, deal with post-conflict situations, such as States and the CAFTA countries is about $20 not shut it off. those the U.S. currently faces in Afghanistan billion. Combined, the CAFTA countries con- There are many similarities between Central and Iraq. The principle components of the bill stitute the 18th largest export market for the American nations and those in the rest of are as follows: U.S. and about half of all foreign direct invest- Latin America. Where there are, what is nego- Creation of Director of Reconstruction Posi- ment in these countries comes from the U.S. tiated in CAFTA will matter. That will be true, tions to provide a point person in the U.S. Beyond the current relationship, the United for example in investment, intellectual prop- government to coordinate operations in post- States is seeking better market access for erty, customs obligations, and labor standards. conflict scenarios.
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00008 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.008 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1365 Creation of a FEMA-like office within USAID tross, the Red-footed Booby, and the Wedge- Whereas, Jackson City Schools’ ‘‘JEEP III’’ to manage a database and serve as a clear- tailed Shearwater, as well as for the endan- received First Place honors for the State of inghouse for post-conflict reconstruction ex- gered nene (Hawaiian Goose). Native plants Ohio; and perts, and to provide support for post-conflict have also been reintroduced to the area. The Whereas, Jackson City Schools will be rec- operations. Refuge and its historic lighthouse have be- ognized in Washington, DC at the National Creation of a NATO unit to respond to post- come one of Hawai‘i’s world-class tourist des- Youth Awards Program for Energy Achieve- conflict scenarios, and authorization of the tinations, visited by some 400,000 visitors ment sponsored by the National Energy Edu- President to make a U.S. contribution of per- each year. cation Development (NEED) Project; sonnel to the unit. The proposed expansion area consists of Therefore, I join with the residents of the en- Establishment of a U.S. post-conflict training three indispensable land parcels that are cur- tire 18th Congressional District of Ohio in con- center, building on existing training programs rently available for purchase and could be gratulating Jackson City Schools for their out- in the country. ‘ added to the eastern boundary of the Refuge. standing pursuit of excellence. Creation of a Civilian Police Reserve to train The Kilauea River runs through the land, f and deploy American police officers interested which also includes an extensive lo‘i (irrigated in serving overseas in post-conflict environ- terrace for traditional cultivation of taro, the IN HONOR OF SAINT BONIFACE ments. staple crop of Native Hawaiians) which could PARISH Creation of a ‘‘Security Development be restored to support endangered Hawaiian Fund’’—$300 million in a drawdown account to water birds, including the Koloa duck, Hawai- HON. DENNIS J. KUCINICH provide resources to cover immediate and un- ian coot, Hawaiian stilt, and Hawaiian OF OHIO foreseen costs in declared post-conflict situa- moorhen. There is also a high quality estua- IN THE HOUSE OF REPRESENTATIVES tions, and potential U.S. contributions to multi- rine ecosystem at the lower reaches of the Thursday, June 26, 2003 lateral operations. river, which includes habitat for endangered The ‘‘Winning the Peace Act of 2003’’ is de- birds as well as native stream life, such as the Mr. KUCINICH. Mr. Speaker, I rise today in signed to fill a vacuum in U.S. foreign policy. hihiwai (an endemic snail) and o‘opu (native honor of the parish community of Saint Boni- It creates institutional mechanisms where only goby). The proposed addition also provides an face Parish, as they celebrate 100 years of adhoc arrangements exist. It establishes a excellent habitat for the nene, Hawai‘i’s state faith and hope in Cleveland’s Westside neigh- permanent source of funding instead of relying bird, which was only recently saved from ex- borhood. Throughout the past century, Saint on the Congressional appropriations calendar, tinction. The beach is also sometimes used by Boniface Parish has served as a spiritual ref- or emergency supplemental bills. Equally im- endangered Hawaiian monk seals, and endan- uge—radiating hope, encouragement, edu- portant, the bill lays the groundwork, through gered sea turtles nest in the area. cation and faith. training and education, for a new cadre of These three parcels are available for sale Father Casimir Reichlin began the ministry post-conflict experts, both civilians and mili- and each of the owners has expressed a de- of Saint Boniface in February of 1903. His vi- tary, in the governmental and non-govern- sire to see the land protected from develop- sionary focus aimed at educating children mental sectors. ment. But given rampant urbanization on within the framework of the neighborhood par- The United States has faced post-conflict Kaua‘i (and elsewhere in Hawai‘i) and the high ish has remained as significant and impactful situations in the past—in the 1940s in Ger- demand for waterfront property, we could very today as it was 100 years ago. As Saint Boni- many and Japan, and more recently in Soma- well lose this remarkable opportunity to add face Parish was born, so was Saint Boniface lia, Haiti, Bosnia and Kosovo, to name a few. high quality wildlife habitat to our national ref- School. In 1904, Reverend A. M. Seeholzer We, along with our allies—countries and multi- uge system. was named Pastor of Saint Boniface Parish. lateral institutions—have observed and The Kilauea community strongly supports Under the guidance of Father Reichlin, Pastor learned much in recent history. While it is true protecting the land from development. In fact, Seeholzer oversaw the construction of a four- that no two situations are identical, it can be the Kilauea Point National Wildlife Refuge is a room frame building that would serve parish- said there are always common challenges. model for management of other federal ref- ioners and students for the next 12 years. The ‘‘Winning the Peace Act of 2003’’ ad- uges nationwide. The operations of the Ref- In March of 1923, parishioners and spiritual dresses those challenges and will strengthen uge are supported by community volunteers, leaders of Saint Boniface Parish celebrated the capacity of the United States to pursue its who give daily tours of the Refuge and help in the grand opening of the new Saint Boniface foreign policy objectives in the future. the preservation of native plant species. The School. The sturdy, two-story brick structure f principal volunteer group, Kilauea Point Nat- contained 16 classrooms, accommodating ural History Association, even has a small more than 700 students, in grades kinder- INTRODUCTION OF THE KILAUEA store in the Visitor Center, the proceeds of garten through high school. Today, Saint Boni- POINT NATIONAL WILDLIFE REF- which go to the Refuge and for environmental face School provides preschool, kindergarten UGE EXPANSION ACT OF 2003 education throughout Hawaii. and first grade instruction. I urge my colleagues to join me in sup- Mr. Speaker and colleagues, please join me HON. ED CASE porting this bill, and invite you to come to the in honor and recognition of every member of OF HAWAII Island of Kaua‘i to visit the Refuge. I know that Saint Boniface Parish, as they celebrate 100 IN THE HOUSE OF REPRESENTATIVES if you did so, you would be convinced as I am years of fostering faith, hope, enlightenment and love within our Cleveland community. Thursday, June 26, 2003 of the importance of protecting these lands. f Saint Boniface Parish continues its dedication Mr. CASE. Mr. Speaker, I rise today to intro- to providing educational and spiritual growth, duce a bill to authorize expansion of the A PROCLAMATION CONGRATU- elevating the lives of countless children, adults Kilauea Point National Wildlife Refuge on the LATING JACKSON CITY SCHOOL and families within our community. Island of Kaua‘i. This bill is a vital component DISTRICT AND THEIR ENERGY f of one of my principal goals in Congress: to PROJECT JEEP III FOR 2003 ensure that federal and/or state or private pro- A RESOLUTION HONORING JOSIE tection is extended to as many of Hawai‘i’s COLE, LEGRAND SMITH SCHOL- HON. ROBERT W. NEY ARSHIP WINNER OF PARMA, MI threatened and irreplaceable areas as pos- OF OHIO sible, both to ensure the survival and recovery IN THE HOUSE OF REPRESENTATIVES of Hawai‘i’s unique endangered and threat- SPEECH OF ened species and to preserve the remaining Thursday, June 26, 2003 HON. NICK SMITH unspoiled natural treasures of our beautiful is- Mr. NEY. Mr. Speaker, OF MICHIGAN lands for future generations. Whereas, JEEP III (Jackson’s Energy Edu- IN THE HOUSE OF REPRESENTATIVES The Kilauea National Wildlife Refuge, lo- cation Project) showcases their dedication to cated at the northermnost tip of Kaua‘i, was Energy awareness and education throughout Tuesday, May 13, 2003 established in 1985. The initial acreage of 31 the school district and community; and Mr. SMITH of Michigan. Mr. Speaker, let it acres was increased to 203 acres through ad- Whereas, these young people have dem- be known that it is with great respect for the ditional acquisitions in 1993 and 1994. The onstrated exceptional talent, ingenuity, and outstanding record of excellence she has com- refuge provides invaluable habitat for many creativeness in finding ways to expand our un- piled in academics, leadership and community native seabirds, including the Laysan Alba- derstanding of energy issues; and service, that I am proud to salute Josie Cole,
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00009 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.011 E26PT1 E1366 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 winner of the 2003 LeGrand Smith Scholar- TRIBUTE TO ADRIAN SPOTTEN Mr. Hooper’s first wife died in 1996, and he ship. This award is made to young adults who HOOPER, A LEGACY OF MARI- married Susan M. Borresen Hooper in 1999. have demonstrated that they are truly com- TIME ACHIEVEMENTS In addition to his wife, Mr. Hooper is survived mitted to playing important roles in our Na- by daughters Suzanne, Elizabeth, and Dana; a tion’s future. HON. CURT WELDON son, Adrian Jr.; stepchildren Karen and Devon As a winner of the LeGrand Smith Scholar- OF PENNSYLVANIA Walsh; and four grandchildren. ship, Josie is being honored for demonstrating IN THE HOUSE OF REPRESENTATIVES Mr. Hooper’s legacy will endure not only in that same generosity of spirit, intelligence, re- the principles he stood for and the improve- sponsible citizenship, and capacity for human Thursday, June 26, 2003 ments he brought to Pennsylvania, but also service that distinguished the late LeGrand Mr. WELDON of Pennsylvania. Mr. Speaker, his wonderful family, his wife and children. Mr. Smith of Somerset, Michigan. I rise today to honor the memory of Adrian Hooper’s legacy is sure to include his keen Josie is an exceptional student at Springport Spotten Hooper, one of Pennsylvania’s most understanding that the most important ele- High School, and possesses an outstanding distinguished business, maritime and commu- ments of our maritime infrastructure are peo- record of achievement in high school. Josie nity leaders. Mr. Hooper was Chairman of ple—shipyard workers, commercial seafarers, has received numerous awards for her excel- Penn’s Landing Corporation, in Philadelphia, merchant fleet operators, and many others lence in academics and athletics, as well as PA, during the area’s initial development and who make America the maritime nation that it her volunteer activities with the Eaton Rapids head of the Independence Seaport Museum is today. Women’s Club and Vacation Bible School. when it was moved to the waterfront. In fact, Mr. Speaker, our region has lost an excep- Josie is also proficient in sign language and there would be no Independence Seaport Mu- tional leader, and I have lost a good friend. I has signed the National Anthem at athletic seum without Adrian’s leadership. wish the family of Adrian Hooper my heartfelt events at Springport High School. Mr. Hooper, born and raised in West Phila- condolences and may they find comfort in Therefore, I am proud to join with her many delphia, had been fascinated by the sea since knowing that the many people he impacted admirers in extending my highest praise and his youth. He ran away from home at the age deeply value his dedication and generosity congratulations to Josie Cole for her selection of 15 and tried to join the Merchant Marine, and the example of his life and work. Adrian as winner of a LeGrand Smith Scholarship. but was forced to return after his father inter- Hooper exemplified the spirit of service that This honor is a testament to the parents, vened and arranged for him to sail on a Nor- has made this country great. It is proper to re- teachers, and others whose personal interest, wegian vessel in the North Atlantic for a few member and honor a man of such worth and strong support and active participation contrib- months. Mr. Hooper got sailing out of his sys- character with great respect for what he ac- uted to her success. To this remarkable young tem for a while, and graduated from Lower complished and stood for. woman, I extend my most heartfelt good wish- Merion High School in 1941. But to the sea he f es for all her future endeavors. soon returned. As soon as World War II broke f out, Adrian joined the Navy. He wanted to be THE REALITY PRINCIPLE SAINT ANTHONY OF PADUA PAR- at sea and fight in the war so badly that he ISH CELEBRATES 75TH ANNIVER- memorized the eye chart, because he was HON. BARNEY FRANK SARY blind in one eye. He went on to serve our OF MASSACHUSETTS country as a torpedoman on a destroyer in the IN THE HOUSE OF REPRESENTATIVES SPEECH OF Atlantic and the Pacific until 1945. Thursday, June 26, 2003 After the war, Mr. Hooper earned a bach- HON. PAUL E. KANJORSKI elor’s in business from the University of Penn- Mr. FRANK of Massachusets. Mr. Speaker, OF PENNSYLVANIA sylvania’s Wharton School in 1950. That year, President Bush’s serious personal involvement IN THE HOUSE OF REPRESENTATIVES he married Elizabeth Wharton Shober, and in the effort to bring about Middle East peace Thursday, May 15, 2003 they moved to Devon, PA. He also began his deserves both praise and, more important, Mr. KANJORSKI. Mr. Speaker, today I call professional career as a dispatcher for Inter- strong support from all Americans. As a strong the attention of the House of Representatives state Oil Transport Company in Philadelphia. supporter of the State of Israel and its right to to the 75th anniversary of Saint Anthony of Mr. Hooper’s career was interrupted in 1951 exist as a democratic, Jewish state in a se- Padua Parish of Exeter, Pennsylvania. The when he joined the Army during the Korean cure environment, I firmly believe that what parish will celebrate this milestone with a War. He served stateside until 1953. President Bush is doing is very much in fur- Mass and dinner on May 18, 2003, with the After the war, Mr. Hooper returned to the therance of the achievement of that goal, and dinner chaired by Attorney Charles J. Bufalino. Interstate Oil Transport Company and served I am pleased that he is taking the risks that At the start of the 20th century, thousands as chief executive officer until the company are inherent when any president seeks genu- of Italian immigrants came to America in was sold in 1981 to Southern Natural Re- inely to push for peace in the Middle East. As search of a better life for themselves and their sources. Thomas Friedman noted in a recent column in families. Many of them came to work in the Mr. Hooper’s public service began in the the New York Times, President Bush’s in- coal mines of Northeastern Pennsylvania, with early 1970s, when former Mayor Frank L. volvement is essential if we are to reach quite a few settling in the Exeter area. In addi- Rizzo appointed him chairman of Penn’s peace. tion to their common heritage and language, Landing Corporation. At the time, the 22.5- As Mr. Friedman also notes, and those of they shared a common faith, so they founded acre area along the Delaware River from Mar- us who seek peace must be prepared to ac- a parish where they could come together as a ket to Lombard Streets, commemorating knowledge this, ‘‘it may be that the Palestin- community. where Philadelphia began more than 300 ians are capable only of self-destructive re- The first church serving Saint Anthony of years ago, was fallow. Under Mr. Hooper’s di- venge, rather than constructive restraint and Padua Parish was built in 1928 and 1929, to rection and able leadership, Penn’s Landing reconciliation.’’ That is, no one can be sure be followed by a new church in 1963. Father became an entertainment center. that peace is attainable on grounds that will Alphonse Manley, a diocesan priest, staffed Mr. Hooper dedicated his life to maritime allow Israel to live securely and without the the parish until the arrival of Father Emilio issues. He served as chairman of the Amer- constant threat of terrorist attacks on its citi- Boccalatte, O.S.J., an Oblate of Saint Joseph, ican Institute of Merchant Shipping in the mid- zens. But as Mr. Friedman adds, ‘‘surely Israel in 1930. The Oblates of Saint Joseph have 1970s. While president of the Independence has more to gain in the long term by giving staffed the parish ever since. The present pas- Seaport Museum, then called the Philadelphia Mr. Abbas every chance to prove otherwise, tor is the Rev. Daniel Schwebs. Maritime Museum, Mr. Hooper led a $15 mil- and to empower him to do so . . .’’ I am told it is quite common to find parish- lion fund drive that enabled the museum to There are two very tough decisions now fac- ioners, young and old alike, in the church of- move from Chestnut Street to Penn’s Landing ing the government of Israel, and I believe that fering prayers throughout the day, and this is in 1995. those of us who have been and are consistent an example of the faith that abides at Saint Mr. Hooper had many other exciting ven- defenders of Israel’s right to exist, in the face Anthony’s. tures outside of Philadelphia. of the overwhelming hostility of so many Mr. Speaker, I am pleased to call to the at- In 1966, Mr. Hooper and the late Charles P. neighboring countries, should be explicit in tention of the House the 75th anniversary of ‘‘Pete’’ Conrad, Apollo 12 commander, found- urging the Israeli government to take the nec- Saint Anthony of Padua Parish, and I extend ed Universal Space Net, a satellite tracking essary action to test the Palestinians willing- my congratulations to all who are associated firm in California. The firm has done work for ness to embrace genuinely a two-state solu- with the parish. NASA, the Air Force, and aerospace firms. tion. One of those decisions is to be willing to
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00010 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.016 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1367 withdraw settlements from much of the West do—and it’s not easy when your civilians are and high medical standards. All of these Bank and all of Gaza. The other, even harder being murdered—is not to play into Hamas’s things contribute to the achievement of given the understandable emotion that the hands. The smart thing is to say to Mr. Planned Parenthood’s goal of ‘‘every child, a Abbas: ‘‘How can we help you crack down on murder of innocent civilians triggers, is to Hamas? We don’t want Israel to own Hamas’s wanted child, every family a healthy family.’’ show the restraint that the Bush Administration demise. Palestinians have to root out this It is frightening that in a country based on has asked Israel to show with regard to retal- cancer within their own society. If Israelis opportunity and equality, there are so many iation against the leaders of Hamas and other try to do it, it will only metastasize.’’ people who are without healthcare. Planned terrorist groups. I do not deny Israel’s right to Israel’s supporters argue that if America Parenthood has become a crucial part of the act in its own defense, but I do urge the gov- can go after Osama bin Laden, Israel can go local healthcare network that provides a broad ernment to consider seriously the wisdom of after Hamas. Of course Israel is entitled to range of affordable services. Over the years, Mr. Friedman’s argument for restraint as a pursue its mortal enemies, just as America the growing health needs of the Watsonville does, but it cannot do it with reckless aban- very important step towards testing the pros- don, notes Mr. Ezrahi, for one reason: Amer- community have been answered by Planned pects for peace. ica will never have to live with Mr. bin Parenthood and their ever-expanding services I have been struck, in conversations with Laden’s children. They are far away and al- and facilities. By utilizing community-based Israeli government officials, by the confidence ways will be. Israel will have to live with the satellites at farm labor camps and community they have expressed in the good intentions of Palestinians, after the war. They are right agencies in addition to the Penny Lane loca- the new Palestinian Prime Minister, Mahmoud next door and always will be. tion, Planned Parenthood fills a special role Abbas. But it is also clear that he faces great The fact is, Ariel Sharon’s two years of serving low-income residents regardless of difficulties, including, sadly, the hostility of using the Israeli Army alone to fight ter- their insurance status. rorism have not made Israelis more secure. Yasir Arafat, whose unwillingness seriously to He needs a Palestinian partner, and he has to In an atmosphere where the constitutionally make peace has been a major factor contrib- operate and negotiate in a way that will nur- established right to reproductive choice is uting to the turmoil in the region. Refraining ture one. And the people who get that the being threatened, and access to comprehen- from actions which will unnecessarily undercut best are Israelis. In a Yediot Ahronot poll re- sive sex education is being limited, the pres- Prime Minister Abbas, is clearly in the interest leased Friday, two-thirds of Israelis were ence and services of Planned Parenthood are of Israel, certainly until it becomes clearer as critical of Mr. Sharon’s tactic of targeted as- critical now more than ever. The presence of to whether or not he will be able to achieve sassinations of Hamas officials and said they Planned Parenthood in Watsonville has en- the peace that Israel believes he seeks. wanted Mr. Abbas to be given a chance to es- sured that residents have the full spectrum of tablish his authority. Thomas Friedman’s article in the New York It may be that Mr. Abbas can’t step up to choices and opportunities regarding their Times for Saturday, June 21, spells out this this. It may be that the Palestinians are ca- health. In addition, through school based edu- complex set of considerations very well, and I pable only of self-destructive revenge, rather cation programs, Planned Parenthood has ask that this important article be reprinted than constructive restraint and reconcili- worked to reduce unintended teen preg- here. ation. But surely Israel has more to gain in nancies by giving young people the informa- THE REALITY PRINCIPLE the long term by giving Mr. Abbas every tion and skills they need to make healthy (By Thomas L. Friedman) change to prove otherwise, and to empower choices. him to do so, rather than killing one more The exceptional services that Planned Par- Have you noticed how often Israel kills a Hamas ‘‘senior official,’’ who will only be re- Hamas activist and the victim is described placed by three others. enthood offers would be impossible without by Israelis as ‘‘a senior Hamas official’’ or a Because if the two sides cannot emerge the dedication of the staff, the generosity of ‘‘key operative’’? This has led me to wonder: from this dead end, then you can forget their many supporters, and the support of How many senior Hamas officials could there about a two-state solution, which is what community leaders. I applaud the hard work of be? We’re not talking about I.B.M. here. both Hamas’s followers and the extremist all those who have devoted their time and en- We’re talking about a ragtag terrorist group. Jewish settlers want. They each want a one- By now Israel should have killed off the en- ergy to the cause of affordable, high quality state solution, in which their side will con- healthcare at the Watsonville Planned Parent- tire Hamas leadership twice. Unless what is trol all of Israel, the West Bank and Gaza. happening is something else, something I The one-state solution would mean the end hood. call Palestinian math: Israel kills one of the Zionist enterprise, because Israel can f Hamas operative and three others volunteer rule such an entity, in which there would INTRODUCING THE ‘‘SMALL BUSI- to take his place, in which case what Israel soon be more Arabs than Jews, only by is doing is actually self-destructive. apartheid or ethnic cleansing. It would also NESS FEDERAL SAFEGUARD Self-destructive is, in fact, a useful term to mean the end of Palestinian nationalism, be- ACT’’ describe Israelis and Palestinians today. cause the Israelis will crush the Palestinians ‘‘Both sides,’’ notes the Israeli political theo- rather than be evicted. That is the outcome HON. ED CASE rist Yaron Ezrahi, ‘‘have crossed the line we are heading toward, though, unless the OF HAWAII where self-defense has turned into self-de- only reality principle left, the United States struction. When self-defense becomes self-de- of America, really intervenes—with its influ- IN THE HOUSE OF REPRESENTATIVES struction, only an external force can bring ence, its wisdom and, if necessary, its troops. people back to their senses. And that force is Thursday, June 26, 2003 President Bush. I think he is the only reality f Mr. CASE. Mr. Speaker, small businesses principle left that either side might listen HONORING CLINICA MARIPOSA are the lifeblood of our economy and generate to, and I hope he understands that.’’ nearly half of our nation’s GDP, yet the federal You know that both sides are in self-de- government is shutting small businesses out struction mode when you can look at their HON. SAM FARR military actions and say that even if they OF CALIFORNIA of the federal contracting process by bundling small contracts together into large succeeded they would be worse off. The ques- IN THE HOUSE OF REPRESENTATIVES tion is not whether Israel has a right to kill megacontracts. senior Hamas officials. They are bad guys. Thursday, June 26, 2003 In my State of Hawai’i for example, the fed- The question is whether it’s smart for Mr. FARR. Mr. Speaker, I rise today to eral government has created large Israelis to do it now. honor Clinica Mariposa, Planed Parenthood of megacontracts for military housing projects. The fact is, the only time Israelis have en- Watsonville, CA. During a time when This allows huge corporations to swoop in and joyed extended periods of peace in the last win the contracts, even though Hawai’i’s small decade has been when Palestinian security healthcare services are continually becoming services disciplined their own people, in the more expensive, and information on reproduc- businesses could do the work. Bundling has heyday of Oslo. Unfortunately, Yasir Arafat tive health is becoming more restricted, put these projects, and many other govern- proved unwilling to do that consistently. Planned Parenthood provides invaluable serv- ment contracts, out of the reach of small busi- The whole idea of the Bush peace process is ices and resources to the Watsonville commu- nesses and forces them to become sub- to move Mr. Arafat aside and replace him nity. For nearly thirty years, Clinica Mariposa contractors. I have heard from countless small with a Palestinian prime minister, Mahmoud has offered education, outreach, and medical business owners who said subcontracting for Abbas, who is ready to rebuild the Pales- services to an ever-growing population that a large prime contractor is detrimental to their tinian security services, and, in the context financial health and unfairly forces them to of an interim peace settlement, corral depends on these affordable services. Hamas. Since the establishment of Planned Parent- abide by the large corporations’ work rules. Hamas knows this. So its tactic is to goad hood services in Watsonville in 1974, there Today I introduce a companion bill to S. Israel into attacks that will unravel the has been a demonstrated commitment to af- 633. This bill will strengthen the definition of a whole process. The smart thing for Israel to fordability, cultural sensitivity, confidentiality, bundled contract and prevent federal agencies
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00011 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.020 E26PT1 E1368 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 from circumventing statutory safeguards in- was past president of the Cleveland Heights depth of intelligence, and capacity for human tended to prevent contract bundling. Chapter of B’nai B’rith, and served on the service that distinguished the late LeGrand This is a fair and temperate solution, and I board of B’nai Jeshurun Synagogue. Smith of Somerset, Michigan. They are young ask for my colleagues’ support. Mr. Speaker and Colleagues, please join me men and women of character, ambition, and f in honor and remembrance of Samuel initiative, who have already learned well the Laderman—beloved family man, respected at- value of hard work, discipline and commit- A PROCLAMATION HONORING MR. torney, CPA, and friend and mentor to count- ment. AND MRS. THOMPSON ON THEIR less. I offer my deepest condolences to his These exceptional students have consist- 70TH WEDDING ANNIVERSARY beloved wife Cecile; beloved children, Flora ently displayed their dedication, intelligence and Gerald; to his three adoring grandchildren, and concern throughout their high school ex- HON. ROBERT W. NEY extended family, and to his many colleagues perience. They stand out among their peers OF OHIO and friends. Mr. Laderman’s life has left a lu- due to their many achievements and the dis- IN THE HOUSE OF REPRESENTATIVES minous mark upon our community, and his ciplined manner in which they meet chal- Thursday, June 26, 2003 spirited work and personal and professional lengers. While they have already accom- legacy will be remembered always. plished a great deal, these young people pos- Mr. NEY. Mr. Speaker, Whereas, Victor and f sess unlimited potential, for they have learned Ruth Thompson were united in marriage June the keys to success in any endeavor. 26, 1933, and are celebrating their 70th anni- IN HONOR OF DUANE SCHAEZLER As a Member of Congress of the United versary this year; and States of America, I am proud to join their Whereas, Victor and Ruth have dem- HON. MARTIN FROST many admirers in extending our highest praise onstrated love and a firm commitment to each OF TEXAS and congratulations to the finalist of the 2003 other; and IN THE HOUSE OF REPRESENTATIVES LeGrand Smith Congressional Scholarship Whereas, Victor and Ruth have proven, by program. their example, to be a model for all married Thursday, June 26, 2003 couples; and Mr. FROST. Mr. Speaker, I rise today to f Whereas, Victor and Ruth must be com- recognize the outstanding service of Arthur mended for their incredible devotion to each Duane Schaezler, a gentleman who has re- HONORING RALPH AND ELEANOR other; cently celebrated his 51st anniversary with LOCHER ON THE OCCASION OF Therefore, I join with the residents of the en- Lockheed Martin Missiles and Fire Control in THEIR 64TH WEDDING ANNIVER- tire 18th Congressional District of Ohio in con- my district. SARY gratulating Victor and Ruth Thompson as they Duane Schaezler served this country as an celebrate their 70th Wedding Anniversary. Air Force navigator for three years before he HON. DENNIS J. KUCINICH f obtained his BS in Aeronautical Engineering OF OHIO from the University of Texas in 1949. Duane IN THE HOUSE OF REPRESENTATIVES IN HONOR AND REMEMBRANCE OF joined what was then-Chance Vought Aircraft Thursday, June 26, 2003 SAMUEL LADERMAN in 1951 and has since applied his vast experi- ence and expert technical knowledge in the Mr. KUCINICH. Mr. Speaker, I rise today in HON. DENNIS J. KUCINICH areas of guidance, navigation, flight dynamics honor and recognition of Mayor Ralph and El- OF OHIO and control systems. eanor Locher, as they celebrate the sixty- IN THE HOUSE OF REPRESENTATIVES Duane is an excellent example of a depend- fourth year of their marriage. Their committed partnership to each other also reflects their Thursday, June 26, 2003 able and deliberate American whose positive work ethic and loyalty are so important in to- deep commitment and service to our entire Mr. KUCINICH. Mr. Speaker, I rise today in day’s society. Cleveland community. honor and remembrance of Samuel Today, I ask my colleagues to join me in Mayor and Mrs. Locher met in their rural Laderman—beloved family man, respected at- congratulating Duane Schaezler on his incred- hometown of Bluffton, Ohio. As a young boy, torney and CPA, and friend and mentor to ible accomplishment of fifty-one years with Mayor Locher and his family emigrated from countless. Lockheed Martin and wish him continued suc- Romania and settled in Bluffton. Mrs. Locher Mr. Laderman began his career in the late cess in the future. was born and raised in Bluffton. Their dedica- 1940s first as an accountant. A few years f tion for each other and their passion for poli- later, he earned a law degree from Cleveland tics originated during their teen years in high Marshall Law School, which singled him out TRIBUTE HONORING 2003 LEGRAND school, as they were avid members of the as one of the few attorneys who also held a SMITH SCHOLARSHIP FINALISTS high school debate team—and they’ve been CPA license. Mr. Laderman built his career in THOMAS CLEVENGER OF JACK- inseparable ever since. law and accounting based on expertise, integ- SON, MICHIGAN, AND JEREMY Mayor and Mrs. Locher attended Dayton rity, and a strong work ethic. He forged life- WAGNER-KAISER OF BATTLE University together. After they graduated, they long professional relationships based on trust, CREEK, MICHIGAN moved to Cleveland and were married in June fairness, good will and his ever-present viva- of 1939. Mr. Locher went on to attend law cious personality and quick wit. HON. NICK SMITH school at Western Reserve University, while Aside from his great professional success, OF MICHIGAN Mrs. Locher worked as a teacher. Soon after, Mr. Laderman possessed a kind heart, great IN THE HOUSE OF REPRESENTATIVES daughter Virginia was born. Mrs. Locher be- sense of humor, and his main priority, focus came the steel frame of the Locher family, and greatest love was his family. He was hap- Thursday, June 26, 2003 evolving into the role of mother, supportive pily married to his college sweetheart, Cecile Mr. SMITH of Michigan. Mr. Speaker, It is wife and civic activist. Throughout Mayor ‘‘Cece’’ Perry for 58 years. Together they lov- with a sincere pleasure to recognize the final- Locker’s impressive career as attorney, mayor ingly raised two daughters, Flora and June, ists of the 2003 LeGrand Smith Congressional and judge, Mrs. Locher was a constant and and a son, Gerald. Their closeness as a family Scholarship Program. This special honor is an committed advocate, organizer and friend. and deep faith carried them through the tragic appropriate tribute to the academic accom- Their unbreakable alliance has served to en- loss of their daughter June, who lost her battle plishment, demonstration of leadership and re- courage, uplift, and bring out the best in one with leukemia as a teenager. In her honor and sponsibility, and commitment to social involve- another. memory, Mr. and Mrs. Laderman worked to ment, demonstration of leadership and respon- Mr. Speaker and colleagues, please join me help others through their creation of the June sibility, and commitment to social involvement in honor and recognition of Mayor Ralph Beverly Laderman Memorial Fund with Univer- displayed by these remarkable young adults. Locher and Eleanor Locher as they celebrate sity Hospitals of Cleveland. Mr. Laderman vol- We all have reason to celebrate their success, sixty four years of marriage. The longevity of unteered his time and talents within our com- for it is in their promising and capable hands their union underscores a deep and abiding munity on a regular basis. He was a member that our future rests. love and commitment for each other—and re- of the Cuyahoga County Bar Association, and The finalists of the LeGrand Smith Congres- flects their deep respect, admiration and solid was first president of the Hillel Alumni Asso- sional Scholarship Program are being honored friendship that continues to grow stronger ciation of Cleveland. In addition, Mr. Laderman for showing that same generosity of spirit, throughout their journey. Family has always
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00012 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.024 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1369 been central to their life together—daughter er Abdel Aziz Rantisi and Secretary of State County, a founding member of the Emergency Virginia Wells; grandson Andrew and his wife Powell speak out against Israel’s attempt to Housing Consortium and the Help House the Heather; and great-granddaughter Caroline. arrest other Hamas operatives. Homeless Coalition. Jim has also worked very We stand in celebration of the wedding anni- Although the Israelis are willing to take risks closely with the United Farm Workers of versary of Ralph and Eleanor Locher—the for peace, they have every right as a sov- America since 1965. spirit of love within their union is cause for ereign state to defend their vital interests. The Jim and Ann worked together to help orga- celebration and is an inspiration to us all. United States, as a nation engaged in the nize and actively promote many community ‘‘Love is the river of life in the world’’— global war on terrorist groups, should stand activities that serve to promote an appreciation Henry Ward Beecher. firmly with Israel on this issue. The same cof- of local ethnic cultures, e.g. The Martin Luther f fers that fund Al Qaeda funnel money and King Celebration, Cinco de Mayo Celebration, weapons to Hamas and Islamic Jihad, and the and the Tet Festival. They also take a leader- HONORING GUY REDMOND same state sponsors of terrorism that arm ship role in promoting social justice in the Hezbollah and smuggle mortars, explosives, community through a church-based organiza- HON. MARTIN FROST and weapons into Gaza. tion called ‘‘Just Faith.’’ OF TEXAS I stand with the President’s in support of a Ann has dedicated her career to teaching, IN THE HOUSE OF REPRESENTATIVES two state solution that will bring security and and for the past 11 years she has taught Spe- cial Education at Lee Mathson Middle School Thursday, June 26, 2003 stability to the region. The reality is, however, that the future of the Road Map depends on where she reaches out to students and fami- Mr. FROST. Mr. Speaker, it is my privilege the direction of the Palestinian leadership. Al- lies by making regular home visits. Ann also today to recognize an outstanding engineer developed a school dispute resolution program though newly appointed Palestinian Prime from my district. Mr. William Guy Redmond, at Lee Mathson to help students develop the Minister Mahmood Abbas faces challenges, he Jr., recently celebrated the remarkable accom- skills to resolve their problems constructively has the ability to move in the direction of plishment of over 50 years of service to Lock- and peacefully. peace by shutting off the constant stream of heed Martin Missiles and Fire Control in Dal- We wish to thank Jim and Ann McEntee for anti-Israel hatred and incitement on Pales- las, Texas. their tireless service to the County and wish Guy Redmond came to what was then- tinian television and newspapers. them the best in their future endeavors. Fur- Chance Vought Aircraft Company as a young Likewise, it the responsibility of the Arab thermore, they have our personal thanks for man after serving in the U.S. Navy and receiv- states, the European Union, Russia, and the our years of friendship. Though we will miss ing degrees from SMU and MIT. Over the United Nations to support Prime Minister their compassion, expertise and commitment, years, Guy has amassed over 20 patents. He Abbas by joining the United States in isolating their dedication has left its mark on Santa is highly respected by all for his integrity and Arafat and shutting down the financing of ter- Clara County. rorist networks that seek to undermine Pales- technical expertise and unwavering dedication f tinian reform. to his organization. CONDEMNING TERRORISM IN- In 1983, Guy was recognized through a The Road Map for peace requires all parties FLICTED ON ISRAEL SINCE nomination for the coveted IEEE Pioneer involved to maintain a commitment to these AQABA SUMMIT AND EXPRESS- award for his contributions to the company principles and to understand that the cessation ING SOLIDARITY WITH THE and the community. of terrorism is the first step toward that vision. ISRAELI PEOPLE Mr. Speaker, I would like to recognize Guy f Redmond again today for his enormous ac- JAMES AND ANN MCENTEE HON- SPEECH OF complishments at Lockheed Martin and offer ORED FOR YEARS OF SERVICE HON. ERIC CANTOR my heartiest congratulations on his 51st anni- TO THE PEOPLE OF SANTA OF VIRGINIA versary. I’m sure the members of this body will CLARA COUNTY agree with me that 50 years of constancy and IN THE HOUSE OF REPRESENTATIVES dedication is a feat not accomplished by Wednesday, June 25, 2003 many, and I wish him great success in his fu- HON. ZOE LOFGREN OF CALIFORNIA Mr. CANTOR. Mr. Speaker, I rise today to ture endeavors. support H. Res. 294, and I thank Mr. DELAY f HON. MICHAEL M. HONDA for scheduling this important resolution this OF CALIFORNIA week. CONDEMNING TERRORISM IN- On June 4, 2003, President Bush, Prime FLICTED ON ISRAEL SINCE HON. ANNA G. ESHOO Minister Sharon, and Prime Minister Abbas AQABA SUMMIT AND EXPRESS- OF CALIFORNIA came together to pledge their commitment to ING SOLIDARITY WITH THE IN THE HOUSE OF REPRESENTATIVES the ‘‘Road Map’’ to Peace. At this summit, Mr. ISRAELI PEOPLE Thursday, June 26, 2003 Abbas promised to reign in the terror groups that have plagued Israel with 3 years of relent- SPEECH OF Ms. LOFGREN. Mr. Speaker, today Mr. less terror. Since this summit, 29 Israelis have HON. HENRY A. WAXMAN HONDA, Ms. ESHOO, and I rise to recognize the been murdered and over 120 have been achievements of Jim and Ann McEntee for OF CALIFORNIA wounded in terrorist attacks by Palestinian or- their contributions to Santa Clara County. Jim IN THE HOUSE OF REPRESENTATIVES ganizations such as Hamas, Islamic Jihad, McEntee is retiring as the Director of the Of- Wednesday, June 25, 2003 and Yasser Arafat’s own Fatah. In all, the fice of Human Relations after 27 years of Israeli defense forces have counted 319 sepa- Mr. WAXMAN. Mr. Speaker, I rise in strong dedicated service to the people of Santa Clara rate attacks on soldiers and civilians. support of this resolution and join my col- County and Ann is retiring after 40 years in Mr. Speaker, the United States sustained a leagues in condemning the ongoing Pales- teaching. horrifying terrorist attack on September 11, tinian terrorist attacks that threaten to derail Jim and Ann have been happily married for 2001, and responded rightfully by pursuing the renewed effort to bring Israelis and Pal- 30 years during which time they have served and attacking those responsible for the cow- estinians back to the peace process. the community as a team. He and his wife ardly murder of innocent civilians on American Since the Aqaba summit, 22 Israeli civilians Ann, a teacher, have raised a large multi-cul- soil. Israel has lived with a perpetual Sep- have been murdered in terrorist attacks even tural family. tember 11 since its inception and must be al- as the Israeli Government has taken meas- Jim’s first career was as a Roman Catholic lowed to pursue those who wish to murder in- ures to release Palestinian prisoners, dis- priest, during which he served as an Associate nocent Israeli civilians. The terrorist actions of mantle settlement outposts, allow Palestinian Pastor in the Roman Catholic Archdiocese of the last few weeks demonstrate that these or- workers back into Israel and transfer revenue San Francisco for 16 years before working for ganizations are not interested in peace, but funds to the Palestinian treasury. Santa Clara County. rather the complete eradication of the State of This is not a cycle of violence. This is a Jim has a long history of building bridges Israel. We must condemn those who use ter- cycle of terrorism where Hamas and Islamic between communities, bringing programs and ror against civilians as a means to destroy Jihad bargain for a ‘‘ceasefire’’ so they can services to the people in Santa Clara County. freedom and peace. buy time to regroup and rearm. He is a founding member of the Confederation Israel, like the United States, was founded I was shocked, therefore, to hear President de la Raza Unida, founding chairperson of the on the common values of democracy, free- Bush condemn Israel’s attack on Hamas lead- Second Harvest Food Bank of Santa Clara dom, and peace. Today, I reiterate that we
VerDate Jan 31 2003 06:27 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00013 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.029 E26PT1 E1370 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 must stand by Israel, our strongest ally in the call Vote No. 314, H.J. Res. 49—‘‘Yea;’’ Roll- CONDEMNING TERRORISM IN- Middle East, in its fight against the terrorist or- call Vote No. 315, H. Con. Res. 49—‘‘Yea;’’ FLICTED ON ISRAEL SINCE ganizations that seek to destroy the peace. Rollcall Vote No. 316, H. Res. 199—‘‘Yea;’’ AQABA SUMMIT AND EXPRESS- We must maintain our commitment to Israel’s Rollcall Vote No. 317, H. Res. 294—‘‘Yea.’’ ING SOLIDARITY WITH THE security and the safety of its citizens. f ISRAELI PEOPLE Peace must come with security, not in spite of it. Israel has always made a sincere com- THE U.S. SUPREME COURT DECI- SPEECH OF mitment to peace in the region. Many times its SION ON AFFIRMATIVE ACTION IN HIGHER EDUCATION HON. RON KIND commitment to peace has come at the ex- OF WISCONSIN pense of innocent life. Before the process can IN THE HOUSE OF REPRESENTATIVES move forward, we must compel the Palestinian HON. HILDA L. SOLIS Wednesday, June 25, 2003 authority to take immediate and effective steps OF CALIFORNIA to dismantle the terrorist infrastructure on the IN THE HOUSE OF REPRESENTATIVES Mr. KIND. Mr. Speaker, I rise today to ex- press my concern over the recent terrorism West Bank and Gaza Strip. Only then can we Thursday, June 26, 2003 come to a peaceful solution of this conflict in conducted by Palestinian extremists against which Israel, the Jewish State, can live side by Ms. SOLIS. Mr. Speaker, I rise to applaud the citizens of the state of Israel. This comes side with a democratic Palestinian State in the Supreme Court’s decision to uphold affirm- just weeks after a groundbreaking summit peace and security. ative action. The Court’s ruling this week was where both Palestinians and Israelis came to- a tremendous victory for all those who believe gether and agreed to the Road Map to Peace. f that diversity is one of our nation’s greatest It is most unfortunate that one small sect of TRIBUTE TO MAYOR PAUL strengths. extremists shake the relationship between the BAUMUNK The historical significance of this important two. ruling cannot be underestimated. For millions My colleagues and I mourn the loss of 22 HON. PHILIP M. CRANE of minority students—Latino, African-Amer- innocent Israeli citizens who have fallen victim to this terror since the summit. In addition, we OF ILLINOIS ican, Native American—it means the oppor- tunity at a better education, higher wages, and morn the loss of the dozens of civilian Pal- IN THE HOUSE OF REPRESENTATIVES a promising future. estinians who have also died as a result of Thursday, June 26, 2003 The Court’s ruling is especially important to terrorism. These lives, I believe, should also Mr. CRANE. Mr. Speaker, I rise today to Latinos, our nation’s fastest growing and now be mentioned. recognize the mayor of Lindenhurst, Illinois, largest minority group. Fewer than 10 percent Mr. Speaker, I will vote in favor of this Paul Baumunk, whose outstanding leadership of college-age Latinos pursues higher edu- measure today, but I think we missed a great and commitment to community service has cation. Only 16 percent of Latinos between the opportunity to send a clear message that this significantly benefited the people of ages of 25–29 have bachelor’s degrees. Congress is fully committed, along with the Lindenhurst. Clearly, many challenges remain to increase President, in support of the Roadmap for A longtime resident of Lindenhurst, Mayor Latino enrollment at colleges and universities Peace. The Roadmap recognizes the impor- Paul Baumunk served as a teacher in Lake across the country. Affirmative action is key to tance of including both Israelis and Palestin- County for 31 years, both with the Lake Forest breaking down the barriers to higher education ians in establishing much desired peace in the High School and the College of Lake County for Latinos. region. While the Roadmap may have its Vocational Center. He also served as a mem- Affirmative action is not only beneficial to flaws, I believe it is the only way to get both ber of the Lindenhurst Plan Commission and minority students, but also to non-minority stu- parties back on the track to peace. the Lindenhurst Lakes Commission. In addi- dents. Greater diversity on our college cam- The people of the United States stand firm tion, Paul somehow found the time to partici- puses ultimately produces students who are in our commitment to the security and health pate in the Chamber of Commerce, the better equipped to thrive in an economy and of a democratic Israel. We must continue to Lindenhurst Men’s Club, the Lyons Club and society that is increasingly multicultural. As do all we can to promote negotiations to ad- in VFW Post #4894. Justice O’Connor noted in the Court’s deci- vance the peace process in the Middle East. Although he has always been a devoted sion, the future of our nation relies on leaders Together we can root out the terrorism that public servant, Paul has always held his family who are comfortable with ‘‘diverse people, cul- plagues the region and move forward with one as a top priority. He and Joy, his wife of 32 tures, ideas and viewpoints.’’ O’Connor was goal in mind, peace. years, originally settled in the community of most likely influenced in her opinion by an un- f Lindenhurst in 1977 to raise their son Philip likely coalition of business, military, civil rights, TRIBUTE TO FRAN AND MARIE and daughter Amy. Paul’s retirement will allow and education groups that urged the Court to BONNER him to spend more time with his family, some- uphold affirmative action because its produces thing he will greatly cherish. leaders who are prepared for today’s increas- ingly global economy. HON. PAUL E. KANJORSKI Mr. Speaker, I ask that you and my other OF PENNSLYVANIA The country’s highest court has ruled that distinguished colleagues join me in congratu- IN THE HOUSE OF REPRESENTATIVES lating Mayor Paul Baumunk on his retirement race may be a factor in college admissions after 12 years of diligent service to the Village because the nation has a compelling need for Thursday, June 26, 2003 of Lindenhurst, Illinois. Paul has been a valu- racial and ethnic diversity on our college cam- Mr. KANJORSKI. Mr. Speaker, I rise today able member of the community for which he puses. The ruling calls into question race-neu- to recognize two very exceptional people I am cares so deeply, and his service will be greatly tral affirmative action plans used in several proud to call my constituents as they reach a missed. I wish him the best of luck in future states, including my own state of California milestone that has become more and more endeavors, and I know he will enjoy his retire- where there has been a 39 percent increase rare in today’s world. Fran and Marie Bonner ment for many years to come. in the rejection of Latino freshman applicants recently celebrated their 40th wedding anni- f to California public universities since the versary. Even more uncommon is their stead- state’s race-neutral plan was implemented. fast dedication to public service, giving back to PERSONAL EXPLANATION Given the Supreme Court’s decision, I hope their community and fellow citizens. I am hon- California will review and revise its affirmative ored to highlight the achievements of two peo- HON. ERNIE FLETCHER action policies so that public universities in my ple who have contributed so much to North- OF KENTUCKY state truly reflect the state’s very diverse pop- eastern Pennsylvania. IN THE HOUSE OF REPRESENTATIVES ulation. The Court has spoken about the im- Francis Peter Bonner and Marie Ann Clatch portance of diversity. Now should California. were engaged on Christmas day in 1961. Thursday, June 26, 2003 Throughout the United States, there are mil- They met in 1959 at The Madison Restaurant Mr. FLETCHER. Mr. Speaker, on Wednes- lions of Latinos and Latinas who want to suc- in Hazleton when Fran was registering Marie day, June 25, 2003, had I been present for ceed. They want equal educational and eco- to vote. His first words to her were ‘‘Are you Rollcall Vote No.’s 312, 313, 314, 315, 316, nomic opportunities. The Court’s ruling pro- registered to vote?’’ When she said no he and 317, I would have voted the following vides great hope for these young people. promptly registered her as a Democrat, and way: Rollcall Vote No. 312, S. 858—‘‘Yea;’’ Again, I applaud the Court for this landmark she has been both his girl and a Democrat Rollcall Vote No. 313, H.R. 2474—‘‘Yea;’’ Roll- decision. ever since.
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00014 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.033 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1371 Marie, daughter of Fred Clatch and Jenny Freedom. Iraqi forces detained him for 21 and we are hopeful that it will be on the Corra was married to Francis, son of Miles days as a POW after his helicopter was House floor soon. I believe in being tough on Bonner and Mary Hannigan, on June 23, 1963 grounded near Karbala, Iraq. Williams valiantly crime. But this has nothing to do with being by Father Thomas Hannigan, at Our Lady of fought and survived imprisonment after being tough on crime. It has everything to do with Grace Church in Hazleton. They have been captured. human dignity and ending deliberate indiffer- Pennsylvania residents all of their married Chief Warrant Officer Williams moved to ence toward sexual assaults in prisons, main- lives. First in Secane, then in Berwyn, then in Hampton Roads in 1981 with his family and taining order in prisons, and reducing social Harrisburg and now in Hazleton. They have a grew up in Chesapeake, Virginia. From early and economic costs to a society left to deal daughter, Mary Patricia, who currently resides childhood, David was always enthralled with with physically and psychologically damaged in Washington, DC with her husband Roy planes and the magic of air flight. After grad- former inmates. Eichler. uating from Great Bridge High School in Today I want to share additional stories Marie and Fran have led remarkable lives in Chesapeake, Williams enrolled in community from those whose lives have been forever the arena of public service. Marie has been a college and joined the Army as a full time re- changed by the sexual assaults happening homemaker all her life and very active in her servist. After spending two years as a crew every day in the prisons in our country. daughter’s school and after school programs. chief on a med-evac Huey helicopter, Williams Imagine knowing that someone you love is She has done a considerable amount of vol- searched for a bigger challenge. He was as- being repeatedly raped, abused, and degraded unteer work for both the Harrisburg School signed to the Army’s 106th Special Operations and that there is little to nothing that you system and St. Margaret Mary’s Church. She Aviation Regiment and also went through Sur- can do about it. For the last two and a half years, my fam- remains a terrific role model for the many chil- vival, Evasion, Resistance and Escape school ily and I have been paralyzed by this knowl- dren she has encountered throughout her vol- while traveling the world doing preparatory edge and our inability to stop the rape and unteering career. combat missions. abuse. Fran has been extremely active in local and Next week, we will welcome back David Wil- My name is Vivian Edwards and I am here state government, serving in a senior position liams to his hometown of Chesapeake, Vir- to tell you about my nephew, Roderick John- in Governor Milton Schapp’s Administration ginia with a host of events and celebrations for son. In my family, he goes by Keith. and later on the Unemployment Compensation his heroic return. We are pleased to salute Keith is a Navy veteran and was impris- Board during the Governor Robert Casey’s oned in Marshall, Texas in January of 2000 him for protecting our flag and our freedom. for a non-violent crime. He wrote a $300 Administration. He has been extremely active The Independence Day holiday is a perfect check even though he knew that he did not in the Hazleton Community serving as the time to show our deep appreciation to this have the funds to cover this amount, vio- Chairman of St. Joseph’s Hospital Board, and brave citizen and soldier who spent his child- lating the terms of his parole for a burglary as a Trustee for the Anthracite Health and hood in the Fourth District of Virginia. that he committed over 10 years ago. Welfare Fund for 15 years. It is no surprise he Williams showed tremendous bravery and From the beginning, my nephew knew that was bestowed the honor of ‘‘Hazletonian of commitment to his country while held by his being a gay man put him at risk, so he in- the Year.’’ Iraqi captors. Today we recognize him for his formed prison officials that he was gay in hopes that he would be offered protection. Fran also served on the White House ad- unwavering patriotism and dedication to both My nephew was offered no protection. While hoc Anthracite committee in 1980 and was a his job and the American people. at Allred, he was placed in the general popu- Member of the Marketing Panel for the Gov- Mr. Speaker, please join me in honoring lation. ernor’s Coal Conference that same year. In Chief Warrant Officer David Williams for his He might as well have been put in a lions’ 1977 he was a member of the United States bravery and dedication abroad, his service to den. He was immediately given the name Department of Energy Anthracite Task Force Chesapeake, the Commonwealth of Virginia, ‘‘CoCo’’ by the other inmates which made it and throughout the 1970s he served on both and the American people. clear to all inmates that he was available for the Governor’s Energy Council and the Penn- sexual exploitation. The prison officials also f began to call Keith by this nickname and sylvania Industrial Development Authority. He PERSONAL EXPLANATION would refer to him as ‘‘she’’ or ‘‘her.’’ has been active in the Philadelphia Fellowship Keith was raped by a member of the gang Commission and the Hazleton City Planning called ‘Gangster Disciples’ in early October and Zoning board. He was also the Deputy HON. JIM SAXTON 2000. My nephew informed prison officials State Chairman of the Democratic State Com- OF NEW JERSEY about what had happened and that he feared for his life. He asked for medical attention. mittee and the Assistant Director of the Urban IN THE HOUSE OF REPRESENTATIVES Studies Program at the University of Villanova. He was denied help and denied medical as- Thursday, June 26, 2003 The Pennsylvania House of Representatives sistance. They told him that medical care Mr. SAXTON. Mr. Speaker, yesterday, June was only available for an emergency. My recognized Fran for directing the recovery ef- nephew was raped! How can someone say forts of the Kocher mine disaster in 1976. He 25, 2003, I was unable to cast my vote for roll- that is not an emergency? has testified on the advancement of anthracite call numbers 312, 313, 314, 315, 316, and Soon after the rape, things just got worse coal before both the U.S. Congress and Penn- 317 due to the fact that I was attending a fu- for my nephew. Hernandez began ‘sharing’ sylvania Legislature. neral for my dear friend from Arizona, Rep- Keith with other inmates, and Keith lit- Mr. Speaker, I am proud to showcase the resentative Bob Stump. erally became a sex slave. achievements of these two special residents of Had I been presented, I would have voted Keith wrote to several of his family mem- ‘‘aye’’ for all 6 votes. bers from prison. He was afraid to tell most Pennsylvania’s 11th Congressional District of us that he was being severely sexually and ask my colleagues to join me both in cele- f abused. But the letters started to change, brating their 40 years of marriage and in wish- LEGISLATION ADDRESSES SHOCK- and he eventually told us what was hap- ing them many more happy years together. pening. I can still remember reading the ING PROBLEM OF PRISON RAPE f words: ‘‘they make me do things I don’t want to do’’ and just crying. He told us that he RECOGNIZING CHIEF WARRANT HON. FRANK R. WOLF feared for his life. We called the prison to find out what was OFFICER DAVID WILLIAMS, U.S. OF VIRGINIA going on. Staff at the prison said they would ARMY APACHE HELICOPTER IN THE HOUSE OF REPRESENTATIVES PILOT AND PRISONER OF WAR, check into Keith’s complaints. They said ON HIS VALIANT BRAVERY Thursday, June 26, 2003 Keith’s complaints didn’t warrant an inves- tigation but they would move him to an- OVERSEAS Mr. WOLF. Mr. Speaker, I recently shared other prison wing. He wasn’t safe there ei- with our colleagues several personal accounts ther. Other family members and I continued HON. J. RANDY FORBES related by survivors of the brutal and inhu- to write and call on Keith’s behalf, but noth- OF VIRGINIA mane act of sexual assault in our nation’s pris- ing ever changed—he was never safe. During a period of 18 months, Keith ap- IN THE HOUSE OF REPRESENTATIVES ons. H.R. 1707, the Prison Rape Reduction Act peared before the classification committee of Thursday, June 26, 2003 of 2003, focuses attention on the growing Allred seven times. Each time he asked to be put in protective custody, but his requests Mr. FORBES. Mr. Speaker, I rise today in problem of prison rape. I was pleased to co- were denied each time. recognition of Chief Warrant Officer David Wil- author this legislation with my Virginia col- Each time they denied Keith the protec- liams, U.S. Army Apache helicopter pilot who league, Rep. Bobby Scott. The bill is pending tion that he so badly needed, he was sent was a Prisoner of War during Operation Iraqi mark-up in the House Judiciary Committee back to the general population and raped and
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00015 Fmt 0626 Sfmt 0634 E:\CR\FM\A26JN8.038 E26PT1 E1372 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 forced to perform sexual acts against his Then, it happened again on a subsequent their throat over his radio, signaling that will. He was traded between various gangs in night. I was doped up on the psych meds that someone was coming. I later learned there prison—the Bloods, the Crips, the Tangos, had been prescribed to aid with my with- are no security cameras in the officer’s sta- the Mandingo Warriors—and sold out for $5 drawal symptoms. Again, he took me to the tion. and $10 for sex acts. shower, and raped me. I was defenseless, and After returning to my room, I took off my By December of 2001, Keith feared for his mentally and physically weakened by the sweatpants and put them in plastic and hid life so much that he purposely incurred a se- drugs. The nurses were asleep in their sta- them in my locker. rious disciplinary violation. He was given tion 20 feet up the hall, and the relieving Soon after, I confided in an Officer of the the maximum punishment and received 15 guard was on break. Bureau of Prisons, who was my welding boss, days in solitary confinement. Ironically, this Afterwards, he gave me back my paper that Officer Miller had raped me. I asked her was the first and only protection that he jumpsuit. I was putting it on when another not to tell anyone because I didn’t want any- ever received while at Allred. Sadly, though, guard entered the room and became ex- thing to interfere with my release date, as I this punishment also included extending his tremely suspicious. You’d think this eye-wit- was afraid of what Miller would do to me if sentence for more than two more years past ness would have been enough to prosecute I reported it. I also told one of my room- the date that he would have been eligible for him. But it wasn’t. An ‘‘inconclusive’’ rape mates, and I swore her to secrecy, too. release. test conducted after my shower meant there I stayed silent for months. Having nowhere After Keith’s seventh life endangerment was no follow-up. to hide, I went to sleep every night not claim, he began writing the ACLU and other Since then, my hands have been tied. I knowing if he was going to come for me outside organizations for assistance. The have not been able to prosecute the rapist. I again. Following the rape, Officer Miller har- ACLU National Prison Project came to his have had no avenue for seeking justice. assed, intimidated and threatened me in rescue. They filed a federal lawsuit on behalf Since my release, I have tried to move on many direct and indirect ways. of my nephew against several Texas prison with my life. I am married, I have three chil- I lived in fear, until I was released from officials that ignored his pleas for protection dren, and I am in school studying to be a So- prison in September 2000. That day, I against gangs who forced him into sexual cial Worker with a specialty in addictions brought my sweatpants to the Carswell camp slavery. rehabilitation. But the pain of this experi- administrator and told her about the rape. I Keith had asked us to pray for him, and we ence comes back to me often. I am still did. Our prayers were finally answered. He gave statements and answered questions. struggling to put it behind me. The semen stained sweatpants were taken as was moved to a safety protection unit soon To my rapist, I say God will be your judge. after the ACLU National Prison Project filed evidence to the FBI Crime Lab. I was then I practice daily forgiveness when the mind given a lie detector test, which I passed. the lawsuit. numbing thoughts won’t go away. I pray and Keith has tested negative for HIV, but still Just recently, about three years after my I pray to help me get through this. I keep lives in constant fear that he might have release, a federal jury found Officer Miller praying because it’s my life. contracted other diseases from countless guilty of rape finding that my civil rights forced sex incidents. Prison rape is a serious were indeed violated. Meanwhile, Michael I will never forget that night in March of crime that not only affects the victim, but Miller is still under criminal investigation. I 2000. also the family. As I said before, my entire owe a lot to my attorneys who believed in That was the night I was raped by a federal family has been horrified and devastated for me and my family who supported me. prison guard. the past two and a half years because of what Miller has continued to work as a correc- My name is Marilyn Shirley and I am here has happened to Keith. Today we are praying tions officer with the Federal Bureau of Pris- today as living proof that prisoner rape does for Keith, but we are also fighting for him ons. Even after I reported the rape, he was happen. and for every other prisoner that has been a only transferred to a men’s prison. I cannot I was convicted of a drug charge and placed victim of rape while in prison as well. believe that this rapist is getting paid with in the Federal Medical Center at Carswell in people’s tax dollars; it’s not right. I have tried to write this story many Fort Worth, Texas from January 12, 1998 Back in 1998, preparing to enter prison was times, only to find myself in tears at the until September 10, 2000. one of the hardest things that I ever had to While in prison, I took all of the required thought of recounting the events. But now, do. But, now that I am out, I am left with Bureau of Prisons courses—from substance years later, I am finding the courage, little paralyzing panic attacks, awful nightmares, abuse prevention classes to classes that by little, to speak out. I pray that this cour- and a terrible state of depression all of the taught me job skills. I never once had an in- age will be with me today. time. cident report written against me. In fact, I My name is Hope. In July 1997 I was incar- Rape should not have been part of my pun- was rewarded with time credited for good be- cerated following an arrest for a drug related ishment. Though I am still struggling with havior. Upon my release, I walked away with offense. I had been sent to a rehab facility in the emotional damage I have suffered from a $250 check from the Bureau of Prisons and Virginia, but because of my extreme with- this rape, it is important for me to speak a permanently devastated emotional and drawal symptoms from heroin and cocaine, out. With God’s help, I get strength from mental state as a result of my rape. they pulled me out of this facility and sent knowing that if I refuse to remain silent, On that night in March 2000, I was woken me, instead, to jail. maybe others won’t have to suffer this way. up at approximately 3:30 a.m. by prison I was sent to the DC jail on no particular Thank you for listening, and, please, let’s guard Michael Miller, a Senior Officer of the charges, but simply because I needed medical work together to end this injustice. attention and was pending indictment. From Bureau of Prisons. He told me, in the pres- the DC jail, I was transferred to a medical ence of my roommates, that I was wanted at f the officer’s station. unit at CCA (a privately contracted jail adja- TRIBUTE TO DR. ISRAEL ‘‘IKE’’ cent to DC jail). This was where anyone with I was scared to death that they’d called me medical concerns, pregnancy, injury, ex- because something had happened to my hus- TRIBBLE, JR. treme illness, or other debilitating cir- band who had heart problems and diabetes, cumstances was sent. or to my twins. HON. JIM DAVIS The unit consisted of male and female in- I could not have been more wrong. I should OF FLORIDA mates. When I got there, I was surprised to have feared for my own safety. After enter- realize that male guards were on staff guard- ing the officer’s station, Miller made a phone IN THE HOUSE OF REPRESENTATIVES ing the mixed population. Male guards were call stating that if a Lieutenant heads for Thursday, June 26, 2003 allowed to watch us changing, showering, the Camp to give him the ‘‘signal.’’ and using the toilet. After hanging up the phone, Miller started Mr. DAVIS of Florida. Mr. Speaker, I rise in Also to my surprise, male and female in- forcing himself on me, kissing me and grop- honor of Dr. Israel ‘‘Ike’’ Tribble, Jr., a remark- mates were allowed recreational time to- ing my breasts. I was pushed into a store- able man who dedicated his whole life to gether on this unit. I met a woman pregnant room where supplies were kept for the in- equipping African-American young people in with her third child all of which were con- mates. He continued to assault me; the more our community, our state and our country with ceived in jail. that I begged and pleaded for him to stop, I was denied a shower for more than 2 the more violent he became. He tried to force the educational tools they need to succeed in weeks. When I finally was permitted to have me to perform oral sex on him. He then their personal and professional lives. one, the guard came to get me at 3 a.m. He threw me against the wall and violently Ike had an amazing ability to see the good took me to a private, hospital-type room. He raped me. in everyone, and he knew that education was proposed I smoke a cigarette with him I can still remember him whispering in my the key to fully unlocking everyone’s God- (smoking was not permitted in this facility). ear during the rape: ‘‘Do you think you’re given potential. After earning a masters in I smoked with him, and this he thought al- the only one? Don’t even think of telling, be- school administration and a doctorate in ad- lowed him access to rape me. He attacked me cause it’s your word against mine, and you ministration and policy analysis, Ike began a while I was showering. will lose.’’ Miller also said to me ‘‘who do I was terrified, and I didn’t know what to you think they will believe, an inmate or a career focused on promoting higher education do. I was in terrible physical condition be- fine upstanding officer like me?’’ opportunities for all people. cause of my withdrawal, and I didn’t know The ordeal was finally over after Miller re- Ike first blessed Floridians with his talents in who would believe me. ceived the abrupt signal of someone clearing 1982 when he moved to Tallahassee to serve
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00016 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.042 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1373 as associate vice chancellor for academic pro- promise and pursue the American dream. I am to Susan Booth as she is named a Paul Harris grams for the Florida Board of Regents. From pleased to extend my best wishes to all of Fellow. Yours is a legacy that is sure to con- there he was recruited to start the Florida those involved in the work of the Hispanic Re- tinue to inspire generations to come. Education Fund, a program designed to help source Center upon this happy occasion. f African-Americans earn doctorates and law f degrees. During his 17 years leading the Fund PERSONAL EXPLANATION to new heights, Ike helped thousands of young HONORING SUSAN BOOTH FOR HER people on their path to higher education. OUTSTANDING COMMITMENT TO HON. ROBERT MENENDEZ When Ike was not working long hours at the PUBLIC SERVICE OF NEW JERSEY Fund, he was devoting his energies to a host IN THE HOUSE OF REPRESENTATIVES of other civic boards and committees. He HON. ROSA L. DeLAURO Thursday, June 26, 2003 OF CONNECTICUT served on the Advisory Committee on the Mr. MENENDEZ. Mr. Speaker, I rise to offer Education of Blacks in Florida and as Chair- IN THE HOUSE OF REPRESENTATIVES a personal explanation. On June 23, 2003, I man of the Board of Commissioners of the Thursday, June 26, 2003 was absent from the Chamber as I attended Tampa Housing Authority. As the first African- my son’s high school graduation. During that American chairman of the Greater Tampa Mr. DELAURO. Mr. Speaker, it is with great pleasure that I rise today to join the many time, I was not present to vote on rollcall votes Chamber of Commerce, Ike was responsible 297, 298, 299, and 300. Had I been present, for making the board more representative of gathered to pay tribute to an outstanding member of our community, Susan Booth, as I would have voted ‘‘yea’’ on rollcall votes our diverse business community and focusing 297–300. business and community leaders on the vir- she is honored by the Devon Rotary and tues of educating our young people. named a Paul Harris Fellow. The Paul Harris f In 1999, Ike was diagnosed with acute leu- Fellow recognition was created in memory of HONORING THE CAREER OF kemia. Ike faced his illness with the same Paul Harris, the founder of Rotary as a way to CHARLOTTE LESSER courage and positive attitude that he applied show appreciation for contributions to the to all other facets of his life. Through chemo- Foundation’s charitable and educational pro- HON. JANE HARMAN therapy and multiple transplants, Ike fought to gram. Every Paul Harris Fellow receives a pin, medallion and a certificate when he or she be- OF CALIFORNIA the end, and he never stopped giving back to IN THE HOUSE OF REPRESENTATIVES his community. comes a Fellow, identifying the recipient as an I consider it the highest honor, privilege and advocate of the Foundation’s goals of world Thursday, June 26, 2003 joy to have called Ike Tribble my dear friend peace and international understanding. The Ms. HARMAN. Speaker, in the course of my and a mentor. Ike’s passion and commitment commitment and dedication that Susan has career as a public official I have been privi- to improving the lives of those around him was demonstrated is indeed a reflection of all that leged to work with some truly remarkable peo- unsurpassed. Like so many touched by Ike, I the Rotary stands for. It is wonderful to see ple—often unsung heroes who contribute will forever be inspired by Ike’s compelling ex- her work so proudly recognized by her com- every day, unselfishly and unswervingly, to the ample, his wisdom and his zest for life. munity. health and well-being of our communities. One On behalf of the Tampa Bay community, Founder of the Archway Foundation, Susan such person is my friend and constituent which so greatly benefitted from Ike’s life has spent nearly fifteen years collecting dona- Charlotte Lesser, and I rise today on the occa- work, I would like to extend my deepest sym- tions to feed and clothe homeless children in sion of her retirement as Director of Health pathies to the Tribble family. Romania. Inspired by a television program Education at the Beach Cities Health District about Romanian orphans abandoned when f (BCHD) to commend her for her many communism collapsed, Susan, a railroad con- achievements and contributions. THE HISPANIC RESOURCE CENTER ductor on a commuter train between Con- For 10 years, Charlotte Lesser has success- IN THE CITY OF KENNER, LOU- necticut and New York’s Grand Central Sta- fully spearheaded BCHD efforts to provide crit- ISIANA tion, switched to night shifts so that she could ical assistance to South Bay citizens in need. earn a master’s degree in Social Work. Upon Under her leadership, BCHD has developed HON. DAVID VITTER completing her degree, Susan went to Bucha- organizations and services that promote health OF LOUISIANA rest on a week’s vacation in search of these education activities and fitness awareness for IN THE HOUSE OF REPRESENTATIVES Romanian orphans who were living in sewers the residents of Manhattan Beach, Redondo and abandoned buildings. With only a short Beach and Hermosa Beach. Thursday, June 26, 2003 list of contacts, Susan was fortunate to find an And as is the case with so many local lead- Mr. VITTER. Mr. Speaker, today the City of individual who knew where to look. ‘‘In that ers, Ms. Lesser volunteered her time to Kenner crowns its celebration of June as His- sewer, I found my life’s work,’’ she has said. strengthen South Bay communities through panic Heritage Month with the grand opening Indeed, she has dedicated countless hours to her involvement with the South Bay Family of its Hispanic Resource Center, the first of its her mission. Healthcare Center, the South Bay Youth kind in Louisiana. I am honored to recognize Operating out of her own home and a post Project, the Wellness Community, and the this landmark event in my district. office box, Susan collects clothing and dona- South Bay Coalition for Alcohol and Drug-Free The Hispanic Resource Center will provide tions and has been awarded hundreds of Youth. valuable services ranging from citizenship thousands in charitable grants. Through her In addition to her work as a champion of courses and homebuyers’ training to computer hard work and the generosity of her contribu- local health care services, Charlotte Lesser tutorials and classes in English as a Second tors, Archway has been able to purchase two chaired the Redondo Beach Chamber of Com- Language. In addition to offering specific pro- small homes in Romania as well as employ merce and founded and directed the Manhat- grams that address real needs, the Center will several Romanians. One of the homes is used tan Beach Neighborhood Watch. serve as a facilitator to put Hispanic residents as a soup kitchen from which volunteers take In recognition of her unwavering commit- in touch with local agencies and organizations food out to hundreds of homeless children ment to the community, in 1999, Charlotte that can help with legal advice, health care, every week and provides groceries to squatter Lesser was named Los Angeles County and other concerns. families who take refuge in abandoned build- Woman of the Year. But Charlotte is also my I would like to congratulate Mayor Louis ings. trusted friend and has been a wonderful re- Congemi and the members of the Kenner City It is not often that you find an individual with source to my staff and me. Council for their role in creating this important such dedication and commitment. Susan’s Mr. President, I join the community in thank- institution. Mayor Congemi is to be com- good work has touched the lives of thousands ing Charlotte Lesser for her years of service mended for his leadership in guiding the de- of needy children. More importantly, she has and accomplishment, for they are evidence of velopment of the Resource Center from initial inspired countless numbers of people to do- her dedication and boundless energy. Al- idea to grand opening. nate their time and energy to provide one of though she is retiring from BCHD, her The Hispanic Resource Center proclaims life’s most precious gifts—hope. achievements will not end there. I look forward and symbolizes the vitality of the Hispanic I am proud to stand today to join the Devon to her upcoming appointment to the Los Ange- community in Kenner. I am confident that the Rotary and the many family and friends who les County Commission for Women. I know Center will make a meaningful difference in have gathered this evening in extending my she will continue to be an active leader and the lives of many who hope in America’s sincere thanks and heart-felt congratulations community advocate.
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00017 Fmt 0626 Sfmt 0634 E:\CR\FM\A26JN8.046 E26PT1 E1374 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 INTRODUCING THE REBUILD According to the U.S. Department of Trans- For example, a survey of the state Depart- AMERICA ACT OF 2003 portation, each $1 billion in new infrastructure ments of Transportation by the American As- investment creates 47,500 jobs and $6.2 bil- sociation of State Highway and Transportation HON. JAMES L. OBERSTAR lion in economic activity. The bill will create Officials found that, as of April 2003, the OF MINNESOTA more than two million jobs—virtually elimi- states have 2,710 projects, totaling $17.1 bil- IN THE HOUSE OF REPRESENTATIVES nating the job losses that have occurred since lion, that are ready to go to construction within Thursday, June 26, 2003 the Bush Administration came into office—and 90 days if additional funding is made avail- restore more than $310 billion to our econ- able. Mr. OBERSTAR. Mr. Speaker, today Cong. omy. Moreover, in the wake of the September Accordingly, the bill provides $5 billion in JERRY COSTELLO, LINCOLN DAVIS, other Mem- 11, 2001 terrorist attacks, the bill gives priority additional authority for Federal-aid highway bers of the Committee on Transportation and to infrastructure investments that focus on en- capital investments and gives states the au- Infrastructure, and I have introduced the ‘‘Re- hanced security for our Nation’s transportation thority to obligate $5 billion of existing budget build America Act of 2003’’. and environmental infrastructure systems. authority (contract authority) in state highway In the 107th Congress, the Democrats on By ensuring that the funds are invested in accounts. This proposal would create more Transportation and Infrastructure Committee ready-to-go projects, the bill will provide a than 237,500 jobs and $31 billion of economic introduced similar legislation to invest in the much-needed jumpstart to our economy. The activity. safety and security of the Nation’s infrastruc- bill provides funds for each of the critical areas Similarly, a survey of transit authorities by ture. At that time, we were alarmed by the of our Nation’s transportation and environ- the American Public Transportation Associa- negative effects that the policies of the Bush mental infrastructure, including: $8 billion for tion found that public transportation authorities Administration were having on our Nation’s highways and transit; $3 billion for airports; have $12 billion in projects that are ready to economy. Now, almost two years later, our $21.5 billion for rail including high-speed rail, go to construction within 90 days if additional concerns have been proven correct. funding is made available. Accordingly, the bill Figures released earlier this month show freight rail, and Amtrak; $13 billion for environ- provides $3 billion in transit and operating that the national unemployment rate has in- mental infrastructure including wastewater, creased from 4.2 percent in January 2001 to drinking water, wet weather, and Corps of En- grants and would create more than 142,500 6.1 percent, the highest level since July 1994. gineers projects; $2.5 billion for port security; jobs and $18.6 billion of economic activity. In aviation, an Airport Council International Further since January 2001, the number of and $2 billion for economic development and survey of airport authorities estimates that $5 people unemployed has increased from 5.95 public buildings. billion is needed to install explosive detection million to 9 million—an increase of more than In addition, this infrastructure investment will systems at U.S. airports. In addition, the Fed- 3 million, or more than 50 percent. increase business productivity by reducing the Moreover, workers who have lost their jobs costs of producing goods in virtually all indus- eral Aviation Administration has deferred mil- are having more trouble finding new jobs. The trial sectors of the economy. Increased pro- lions of dollars for airport capacity and safety average length of unemployment is now al- ductivity results in increased demand for labor, projects because of the diversion of airport im- most 20 weeks, the longest it has been in capital, and raw materials and generally leads provement program (AIP) funds to security nearly two decades. In the past two years, the to lower product prices and increased sales. projects. To address these issues, the bill pro- number of workers who have been unem- Also, the bill takes into account the fiscal cri- vides $3 billion for airport development ployed for longer than six months has in- ses that the states are currently facing and al- projects, including $2 billion for AIP grants to creased by 1.3 million to nearly 1.9 million— lows recipients of the funds an extended pe- enhance airport safety, efficiency, and capac- an increase of more than 216 percent. One- riod of time to meet their state and local match ity, and $1 billion for airport security grants to half of the unemployed are out of work for requirements. reconfigure airports to accommodate explosive more than 10 weeks and one in five have Simply put, this bill will strengthen the fabric detection systems. This proposal would create been out of work for more than six months. of our Nation’s infrastructure while creating more than 142,500 jobs and $18.6 billion of The response of the Bush Administration jobs for the millions of people who have lost economic activity. has been tax breaks for the wealthy. And once their jobs under the Bush Administration. This In the area of high-speed rail, there are cur- those are enacted into law, pass more tax investment will specifically help unemployed rently several corridors that are completing en- breaks for the wealthy. The Administration construction workers. The number of unem- vironmental analyses of high-speed rail could have developed a bipartisan plan to use ployed private construction workers is projects and are ready to go to construction. the surplus it inherited to invest in our Nation’s 715,000—an 80 percent increase over the The bill provides funding for these projects infrastructure, shore up the Social Security comparable period in the last year of the Clin- through the issuance of $14 billion in tax credit Trust Fund, and pay down the national debt, ton Administration. The unemployment rate for bonds for construction of infrastructure and the however, it has squandered each of those op- construction workers is now 8.4 percent, more acquisition of rolling stock for two high-speed portunities. Instead, the Administration con- than 68 percent higher than the rate in May rail corridors. This proposal would create more tinues to pursue policies that favor only a 2000. A recent national survey found that than 665,000 jobs and $86 billion of economic small portion of the population (the ultra- transportation construction contractors hire activity. wealthy) and push our economy further and employees within three weeks of obtaining a For passenger rail, Amtrak has identified ap- further into debt and recession. As the econ- project contract. These employees begin re- proximately $8 billion of capital needs for the omy continues to founder, the need for legisla- ceiving paychecks within two weeks of hiring. reconstruction and rehabilitation of the North- tion that will create jobs has become even By giving priority to those projects that can east Corridor and other station upgrades and more apparent. award bids within 90 days of enactment, the for the acquisition and rehabilitation of rolling Unlike the Republican ‘‘trickle down’’ ap- bill ensures that this money is readily dis- stock. With regard to the infrastructure needs proach to the economy, the Rebuild America persed to needed projects that will get people of short line and regional railroads, a recent Act of 2003 stimulates the economy by cre- working again. study concluded that it will take approximately ating jobs—especially jobs in nonresidential This investment will also help address the $7 billion of capital investment to rehabilitate construction—and rebuilding our Nation’s in- disproportionate effect that the increase in un- the track, bridges, and other elements of their frastructure. This bill provides $50 billion to employment has had on people of color. The infrastructure to enable them to carry the enhance the safety, security, and efficiency of rate of unemployment for African Americans is 286,000–pound railcar that is becoming the in- our Nation’s infrastructure, including improve- 10.8 percent—twice the rate for whites. The dustry standard. ments to rail, highway, transit, aviation, mari- unemployment rate for Hispanic Americans is In order to address these needs, the bill time, water resources, environmental, and 8.2 percent—more than 50 percent higher provides $7.5 billion for capital investment for public building infrastructure. By leveraging than the rate for whites. Under the existing passenger and freight rail, including: $2.5 bil- Federal infrastructure investments, the 10-year highway, transit, and aviation laws, as a gen- lion for capital investment for Amtrak; $500 cost to the Federal Treasury would be less eral rule, states, cities, and transportation au- million for direct grants to short-line and re- than $34 billion. thorities are required to provide at least 10 gional railroads to improve their infrastructure; Moreover, the bill fully offsets this $34 billion percent of the amounts made available to Dis- and $250 million for grants to provide the cost to the Treasury by cracking down on abu- advantaged Business Enterprises, including credit risk premium for at least $5 billion in sive corporate tax shelters (e.g., Enron), pre- minority- and women-owned businesses. loans and loan guarantees for freight railroad venting American corporations from avoiding There are thousands of projects that are infrastructure projects under the Railroad Re- paying U.S. taxes by moving to a foreign ready to begin construction in all sectors of habilitation and Improvement Financing (RRIF) country, and extending customs user fees. our transportation and infrastructure systems. program. This proposal would create more
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00018 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.051 E26PT1 June 26, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E1375 than 356,000 jobs and $46.5 billion of eco- more than 150 percent of the national aver- people of Taiwan cannot afford to lose their nomic activity. age. These economically distressed commu- safety, security, and freedom. Our Nation’s environmental and infrastruc- nities and regions rely on federal investments I rise today to call attention to an important ture also has a backlog of important projects to complete basic transportation and public in- resolution that I introduced today concerning in need of funding. The Congressional Budget frastructure projects. The Economic Develop- the safety and security of Taiwan, and the Office estimates that there is an annual invest- ment Administration and existing regional right of Taiwan’s 23 million people to deter- ment need of between $11.6 billion and $20.1 commissions have no shortage of requests for mine their own future. In the past 2 decades, billion to ensure a safe, clean supply of drink- assistance, but are woefully underfunded, and Taiwan has undergone a remarkable trans- ing water, and an additional need of an annual face drastic budget cuts under the Administra- formation from a one party, martial law dicta- investment of between $13 billion and $20.9 tion’s FY2004 budget proposal. torship to a full-fledged democracy that re- billion in wastewater treatment. Further, a sur- This bill addresses this severe underfunding spects human rights and human freedoms. vey conducted by the Association of Metropoli- by providing $1.5 billion in grants to economi- Time and again, Taiwan has proven herself tan Sewerage Agencies found that, in just 58 cally distressed communities for economic de- one of America’s staunchest allies, recently communities, wastewater treatment facilities velopment infrastructure projects. Grants are pledging her support for continued humani- have more than $4 billion of wastewater treat- administered through the Economic Develop- ment projects that are ready to go to construc- ment Administration ($1 billion), the Appa- tarian aid to both Afghanistan and Iraq. At the tion if funding is made available. lachian Regional Commission ($150 million), same time, however, Taiwan’s democracy This bill provides a total of $11.5 billion for the Delta Regional Authority ($150 million), faces a serious military threat from the Peo- wastewater and drinking water infrastructure and the Northern Great Plains Regional Com- ple’s Republic of China. The PRC continues to investment, including: $10 billion to construct, mission ($150 million). This proposal would regard Taiwan as a renegade province, de- rehabilitate, and restore the Nation’s waste- create more than 71,000 jobs and $9.3 billion spite the fact that it has never exercised con- water and drinking water infrastructure through of economic activity. trol over the island. The PRC continues to the existing State Revolving Fund (SRF) pro- Further, the General Services Administration openly entertain the use of force against Tai- grams ($8.5 billion for the Clean Water SRF (GSA)-controlled inventory of 1,860 existing wan, thereby jeopardizing the stability of the and $1.5 billion for the Safe Drinking Water Federal buildings is aging and requires exten- entire Asian Pacific region. SRF), and $1.5 billion for wet weather over- sive repair and renovation to ensure that Fed- A Washington Post report of June 11, 2003, flow grants for planning, design, and construc- eral employees are housed in safe, modern reveals the PRC’s plans to build up its military tion of treatment works to address combined facilities. GSA estimates that it needs $5 bil- for the purpose of ‘‘unification with Taiwan.’’ sewer and sanitary sewer overflows. This pro- lion over the next five years to fund the nec- Already, the PRC has set up 400 short-range posal would create more than 546,000 jobs essary repair, alterations, and rehabilitation of ballistic missiles in the province of Fukien, di- and $71 billion of economic activity. Federal buildings and it currently has approxi- rectly targeted at Taiwan, in addition to pur- In the area of marine transportation, the mately 5,500 work items pending for repair chasing advanced weaponry systems, such as Coast Guard estimates that it will cost approxi- and alteration. The bill provides $500 million fighting aircrafts, submarines, and destroyers. mately $6 billion over the next 10 years for for repair and alteration of Federal buildings The Washington Post reports that the PRC is ports and vessel owners to comply with secu- and would create more than 23,000 jobs and accelerating its military acquisitions and notes rity standards that the Coast Guard will pre- $3.1 billion of economic activity. that this buildup is ‘‘intended to create a force scribe under the Maritime Transportation Se- This package of infrastructure, transpor- capable of bullying Taiwan and thwarting U.S. curity Act. To date, only $370 million has been tation, and environmental investment and se- intervention in any conflict between China and appropriated to fund port security grants. In curity enhancement makes sound economic Taiwan.’’ In other words, the PRC is preparing 2002, ports and marine facility operators sub- sense. It provides funds where they are need- to use force and coercion to take over a terri- mitted 712 proposals, totaling more than $600 ed most and will get America working again. tory it has no legal right to, and to impose its million, which were denied funding because of Our Nation needs an economic stimulus pro- totalitarian ideology on a people who have the lack of available resources. The requests gram that creates jobs in hard hit sectors of fought long and hard for their freedom, and for port security funding were seven times our economy, rehabilitates our basic infra- who have no wish to live under Communist greater than the available funding. structure to allow us to remain competitive in rule. This bill begins to address this funding world markets, addresses the infrastructure The resolution I introduced today is a step shortfall by providing $2.5 billion for port secu- security needs of our transportation and envi- towards protecting a fellow democracy from rity grants to ports and marine facility opera- ronmental systems, and helps to revive our the threat of Chinese aggression. The resolu- tors for their costs to implement facility and stagnant economy. Let us start by passing this tion calls on the Bush administration to seek port security plans pursuant to the Maritime bill. from the leaders of the PRC a public and im- Transportation Security Act of 2002. This pro- f mediate renunciation of any threat or use of posal would create more than 118,000 jobs force against Taiwan. This includes the dis- and $15.5 billion of economic activity. CONCERNING THE SAFETY, SECU- mantling of the Fukien missiles and other mili- The Nation’s water resources are also in RITY, AND FREEDOM OF THE tary apparatus designed to intimidate Taiwan. need of investment to both protect and im- PEOPLE OF TAIWAN The administration must let the PRC govern- prove the quality water related infrastructure ment know that America will no longer tolerate services, such as hydropower facilities, ports, HON. ROBERT E. ANDREWS the constant harassment targeted towards the dams, and water supply facilities. The Corps OF NEW JERSEY people of Taiwan. If the PRC government re- of Engineers has identified a need to assess IN THE HOUSE OF REPRESENTATIVES fuses to dismantle the missiles, the adminis- and improve security at 372 critical infrastruc- tration should then authorize the release of the ture projects, and those efforts have not yet Thursday, June 26, 2003 Aegis system to Taiwan, enabling Taiwan to been completed. The Corps also has an un- Mr. ANDREWS. Mr. Speaker, 54 years ago, defend itself against any Chinese attack. funded operation and maintenance backlog of on June 27, 1949, President Harry Truman more than $1 billion. deployed the U.S. Navy’s 7th Fleet to the Tai- Mr. Speaker, these PRC missiles in Fukien To address these needs, the bill provides wan Strait to protect Taiwan against the possi- province are not conducive to a peaceful reso- $1.5 billion to fund investment in currently au- bility of an invasion by the People’s Republic lution of current Taiwanese-Chinese relations. thorized water resources infrastructure of China, PRC. Since then, we have com- We can not expect the people of Taiwan to projects. This proposal would create more mitted ourselves to defending Taiwan, as en- live their daily lives under such threatening than 71,000 jobs and $9.3 billion of economic shrined in the Taiwan Relations Act of 1979. and uncertain conditions. In the name of de- activity. President Bush himself declared in 2001 that mocracy, we must ensure that the future of There is also considerable unmet need in America would do whatever it takes to defend Taiwan is determined peacefully, and with the the area of economic development. Certain Taiwan. In light of the threat posed by the expressed consent of the Taiwanese people. communities and regions of the country suffer PRC’s military buildup in Fukien, we must un- Also, I urge both my colleagues and the ad- from chronic economic distress. These com- equivocally stand by our promises to support ministration to support Taiwanese efforts to munities and regions often have unemploy- Taiwan. America cannot afford to lose a de- hold a referendum vote on the issue of admit- ment, poverty, and outmigration rates that are mocracy in such a volatile region—and the tance into the World Health Organization,
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00019 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.053 E26PT1 E1376 CONGRESSIONAL RECORD — Extensions of Remarks June 26, 2003 WHO. The people of Taiwan deserve to have around the world, we can not in good faith Taiwan. I ask that my colleagues join me in their voices heard in this ongoing debate, the deter the people of Taiwan from holding their supporting democracy for the Taiwanese peo- outcome of which will have a monumental ef- referendum. There can be no double standard ple, and ensuring their safety and security. Let fect on their health and well-being. As the when it comes to exercising democracy. us ensure that it will never be necessary to Mr. Speaker, no group but the citizenry of foremost promoter of freedom and democracy send the 7th Fleet to the Taiwan Strait again. Taiwan has the right to determine the future of
VerDate Jan 31 2003 06:11 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00020 Fmt 0626 Sfmt 9920 E:\CR\FM\A26JN8.057 E26PT1 Thursday, June 26, 2003 Daily Digest
HIGHLIGHTS Senate passed S. 1—Prescription Drug and Medicare Improvement Act. House Committee ordered reported the Defense and Legislative appro- priations for fiscal year 2004. House Committees ordered reported 11 sundry measures. House passed H.R. 1, Medicare Prescription Drug, Modernization, Health Savings and Affordability Act. House passed H.R. 2559, Military Construction Appropriations Act. House passed H.R. 2417, Intelligence Authorization Act. Senate take certain actions in regard to the human rights Chamber Action situation in Cuba. Routine Proceedings, pages S8605–S8645 S. Res. 138, to amend rule XXII of the Standing Measures Introduced: Thirty-one bills and six reso- Rules of the Senate relating to the consideration of lutions were introduced as follows: S. 11, S. nominations requiring the advice and consent of the 1338–1367, S. Res. 187–190, and S. Con. Res. Senate. 56–57. (See next issue.) S. Res. 149, expressing the sense of the Senate that the international response to the current need Measures Reported: for food in the Horn of Africa remains inadequate, S. 1025, to authorize appropriations for fiscal year and with an amended preamble. 2004 for intelligence and intelligence-related activi- S. Res. 174, designating Thursday, November 20, ties of the United States Government, the Commu- 2003, as ‘‘Feed America Thursday’’. nity Management Account, and the Central Intel- S. Res. 175, designating the month of October ligence Agency Retirement and Disability System, 2003, as ‘‘Family History Month’’. with amendments. (S. Rept. No. 108–80) S. Res. 178, to prohibit Members of the Senate S. 1356, making appropriations for the Depart- and other persons from removing art and historic ob- ments of Labor, Health and Human Services, and jects from the Senate wing of the Capitol and Senate Education, and related agencies for the fiscal year office buildings for personal use. ending September 30, 2004. (S. Rept. No. 108–81) S. 148, to provide for the Secretary of Homeland S. 1357, making appropriations for military con- Security to be included in the line of Presidential struction, family housing, and base realignment and succession. (See next issue.) closure for the Department of Defense for the fiscal Measures Passed: year ending September 30, 2004. (S. Rept. No. 108–82) State Children’s Health Insurance Program S. 888, to reauthorize the Museum and Library Amend Act: Senate passed S. 312, to amend title XXI of the Social Security Act to extend the avail- Services Act. (S. Rept. No. 108–83) ability of allotments for fiscal years 1998 through S. Res. 62, calling upon the Organization of 2001 under the State Children’s Health Insurance American States (OAS) Inter-American Commission Program, after agreeing to the following amendment on Human Rights, the United Nations High Com- proposed thereto: Pages S8633–35 missioner for Human Rights, the European Union, Grassley Amendment No. 1113, to make a tech- and human rights activists throughout the world to nical correction. Pages S8633–35 D744
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00001 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 June 26, 2003 CONGRESSIONAL RECORD — DAILY DIGEST D745 Prescription Drug and Medicare Improvement By 71 yeas to 26 nays (Vote No. 255), Grassley/ Act: By yeas to nays (Vote No. 262), Senate passed Baucus Modified Amendment No. 1092, to evaluate S. 1, to amend title XVIII of the Social Security Act alternative payment and delivery systems. to make improvements in the Medicare program, to Pages S8606, S8610–12, S8618–21, S8637–38 provide prescription drug coverage under the Medi- Grassley (for Bond) Amendment No. 1014, to in- care program, after agreeing to the committee clude pharmacy services in the study relating to out- amendment in the nature of a substitute, and after patient pharmacy therapy reimbursements. taking action on the following amendments proposed (See next issue.) thereto: Pages S8605–33, S8635–44 (continued next issue) Baucus (for Dodd) Amendment No. 1015, to pro- Adopted: vide for a study on making prescription pharma- Baucus (for Cantwell) Modified Amendment No. ceutical information accessible for blind and visually- 942, to prohibit an eligible entity offering a Medi- impaired individuals. (See next issue.) care Prescription Drug plan, a MedicareAdvantage Grassley (for Hatch) Amendment No. 1059, to di- Organization offering a MedicareAdvantage plan, rect the Secretary of Health and Human Services to and other health plans from contracting with a phar- conduct a review and report on current standards of macy benefit manager (PBM) unless the PBM satis- practice for pharmacy services provided to patients in fies certain requirements. Pages S8606, S8612–17 nursing facilities. (See next issue.) By 97 yeas to 1 nay (Vote No. 249), McConnell Grassley (for Hatch/Wyden) Amendment No. Amendment No. 1097, to protect seniors who are 1106, to establish a Citizens Health Care Working diagnosed with cancer from high prescription drug Group to facilitate public debate about how to im- costs. Pages S8621–22 prove the health care system for Americans and to By 69 yeas to 29 nays (Vote No. 251), Bingaman/ provide for hearings by Congress on the rec- Domenici Modified Amendment No. 1065, to up- ommendations that are derived from this debate. date, beginning in 2009, the asset or resource test (See next issue.) used for purposes of determining the eligibility of Grassley (for Murkowski) Amendment No. 1086, low-income beneficiaries for premium and cost-shar- to ensure that pharmacies operated by the Indian ing subsidies. Pages S8606, S8622–23 Health Service and Indian health programs are in- Nelson (FL) Amendment No. 936, to provide for cluded in the network of pharmacies established by an extension of the demonstration for ESRD man- entities and organizations under part D. aged care. Page S8606 (See next issue.) Nelson (FL) Amendment No. 938, to provide for Baucus (for Mikulski) Modified Amendment No. a study and report on the propagation of concierge 1033, to extend certain municipal health service Page S8606 care. demonstration projects. Page S8644 Thomas/Lincoln Modified Amendment No. 988, Baucus (for Lincoln) Modified Amendment No. to provide for the coverage of marriage and family 1067, to provide coverage for kidney disease edu- therapist services and mental health counselor serv- cation services under the Medicare program. ices under part B of the Medicare program. Pages S8644 (continued next issue) Page S8606 Lincoln Amendment No. 959, to establish a dem- Baucus (for Snowe) Amendment No. 1027, to ex- onstration project for direct access to physical ther- press the sense of the Senate regarding the imple- apy services under the Medicare program. Page S8606 mentation of the Prescription Drug and Medicare Lincoln Amendment No. 935, to clarify the intent Improvement Act of 2003. Page S8633 of Congress regarding an exception to the initial Baucus (for Murkowski/Stevens) Amendment No. residency period for geriatric residency or fellowship 1041, to require the Secretary of Health and Human programs. Page S8606 Services to conduct a frontier extended stay clinic Reid (for Jeffords) Amendment No. 1038, to im- demonstration project. Page S8633 prove the critical access hospital program. Page S8606 Subsequently, the adoption of Amendment No. Reid (for Johnson/Cochran) Amendment No. 1041 (listed above) was vitiated. Page S8633 By a unanimous vote of 98 yeas (Vote No. 252), 1095, to provide for a 1-year medication therapy McConnell Amendment No. 1102, to protect seniors management assessment program. Pages S8617–18 who are diagnosed with Alzheimer’s disease from Grassley (for Murkowski/Stevens) Amendment No. 1096, to require the Secretary of Health and Human high prescription drug costs. Pages S8624, S8635–36 Subsequently, the amendment was modified. Services to conduct a frontier extended stay clinic demonstration project. (See next issue.) Page S8635
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00002 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 D746 CONGRESSIONAL RECORD — DAILY DIGEST June 26, 2003 Grassley (for Brownback/Nelson (NE)) Amend- Grassley (for Collins) Modified No. 989, to in- ment No. 1122, to provide for improvements in ac- crease Medicare payments for home health services cess to services in rural hospitals and critical access furnished in a rural area. (See next issue.) hospitals. (See next issue.) Grassley (for Dole/Edwards) Amendment No. Grassley (for Coleman) Amendment No. 1074, to 1126, to provide for the treatment of certain entities amend title XVIII of the Social Security Act to for purposes of payments under the Medicare pro- make improvements in the national coverage deter- gram. (See next issue.) mination process to respond to changes in tech- Grassley (for Reed) Amendment No. 996, to mod- nology. (See next issue.) ify the GAO study of geographic differences in pay- Grassley (for Collins) Amendment No. 1023, to ments for physicians’ services relating to the work provide for the establishment of a demonstration geographic practice cost index. (See next issue.) project to clarify the definition of homebound. Grassley (for Specter) Amendment No. 1118, to (See next issue.) express the sense of the Senate regarding the estab- Grassley (for Kyl) Amendment No. 1114, to re- lishment of a nationwide permanent lifestyle modi- quire the GAO to study the impact of price controls fication program for Medicare beneficiaries. (See next issue.) on pharmaceuticals. (See next issue.) Grassley (for Kyl) Amendment No. 1115, to ex- Grassley (for Specter) Amendment No. 1085, to press the sense of the Senate concerning Medicare express the sense of the Senate regarding payment payments to physicians and other health profes- reductions under the Medicare physician fee sched- ule. (See next issue.) sionals. (See next issue.) Grassley (for Chambliss) Amendment No. 1045, Allard/Feingold Amendment No. 1017, to provide for temporary suspension of OASIS requirement for to provide for a demonstration project for the exclu- collection of data on non-Medicare and non-Medicaid sion of brachytherapy devices from the prospective patients. Pages S8608–09 payment system for outpatient hospital services. Baucus (for Harkin) Amendment No. 968, to re- (See next issue.) store reimbursement for total body orthotic manage- Grassley (for Craig) Amendment No. 1058, to re- ment for nonambulatory, severely disabled nursing store the Federal Hospital Insurance Trust Fund to home residents. Page S8606 the financial position it would have been in if a cler- Graham (SC) Modified Amendment No. 948, to ical bookkeeping error had not occurred. provide for the establishment of a National Bipar- (See next issue.) tisan Commission on Medicare Reform. Page S8606 Grassley (for Baucus) Amendment No. 1117, to Dayton Modified Amendment No. 960, to require establish the Safety Net Organizations and Patient a streamlining of the Medicare regulations. Advisory Commission. (See next issue.) Page S8606 Grassley (for Bayh) Amendment No. 1044, to ad- Baucus (for Feingold) Amendment No. 1054, to just the urban health provider payment. establish an Office of the Medicare Beneficiary Advo- (See next issue.) cate. Page S8612 Grassley (for Shelby) Amendment No. 1056, to Enzi Amendment No. 1030, to encourage the prevent the Secretary of Health and Human Services availability of MedicareAdvantage benefits in medi- from modifying the treatment of certain long-term cally underserved areas. Page S8606 care hospitals as subsection (d) hospitals. Grassley Amendment No. 1133, to provide for a (See next issue.) managers’ amendment. (See next issue.) Grassley (for Murray) Modified Amendment No. Rejected: 961, to make improvements in the Medicare- Harkin Modified Amendment No. 991, to estab- Advantage benchmark determinations. lish a demonstration project under the Medicaid pro- (See next issue.) gram to encourage the provision of community-based Grassley (for Bond/Roberts) Amendment No. services to individuals with disabilities. (By 50 yeas 1013, to ensure that patients are receiving safe and to 48 nays (Vote No. 247), Senate tabled the amend- accurate dosages of compounded drugs. ment.) Pages S8606–09 (See next issue.) By 39 yeas to 59 nays (Vote No. 248), Edwards/ Grassley (for Kyl) Amendment No. 1121, to ex- Harkin Amendment No. 1052, to strengthen protec- press the sense of the Senate concerning the structure tions for consumers against misleading direct-to-con- of Medicare reform and the prescription drug benefit sumer drug advertising. Pages S8606, S8609–10 to ensure Medicare’s long-term solvency and high Reid (for Boxer) Amendment No. 1036, to elimi- quality of care. (See next issue.) nate the coverage gap for individuals with cancer.
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00003 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 June 26, 2003 CONGRESSIONAL RECORD — DAILY DIGEST D747 (By 55 yeas to 44 nays (Vote No. 250), Senate ta- Santorum Amendment No. 1132, to allow eligible bled the amendment.) Pages S8606, S8622 beneficiaries in MedicareAdvantage plans to elect Durbin Amendment No. 1108, to provide addi- zero premium, stop-loss drug coverage protection. tional assistance for certain eligible beneficiaries (See next issue.) under part D. (By 57 yeas to 41 nays (Vote No. Kerry Amendment No. 958, to increase the avail- 253), Senate tabled the amendment.) ability of discounted prescription drugs. Page S8606 Pages S8630–32, S8636–37 Lincoln Modified Amendment No. 934, to ensure By 39 yeas to 59 nays (Vote No. 254), Dorgan/ coverage for syringes for the administration of insu- Pryor Amendment No. 1103 (to Amendment No. lin, and necessary medical supplies associated with 1092), to reduce aggregate beneficiary obligations by the administration of insulin. Page S8606 $2,400,000,000 per year beginning in 2009. Baucus (for Jeffords) Amendment No. 964, to in- Pages S8625–30, S8637 clude coverage for tobacco cessation products. By 33 yeas to 65 nays (Vote No. 256), Sessions Page S8606 Amendment No. 1011, to express the sense of the Baucus (for Jeffords) Amendment No. 965, to es- Senate that the Committee on Finance should hold tablish a Council for Technology and Innovation. hearings regarding permitting States to provide Page S8606 health benefits to legal immigrants under Medicaid Akaka Amendment No. 980, to expand assistance and SCHIP as part of the reauthorization of the tem- with coverage for legal immigrants under the Med- porary assistance for needy families program. icaid program and SCHIP to include citizens of the Pages S8606, S8642, S8644 Freely Associated States. Page S8606 By 47 yeas to 51 nays (Vote No. 257), Rockefeller Akaka Amendment No. 979, to ensure that cur- Modified Amendment No. 975, to make all Medi- rent prescription drug benefits to Medicare-eligible care beneficiaries eligible for Medicare prescription enrollees in the Federal Employees Health Benefits Program will not be diminished. Page S8606 drug coverage. Pages S8606, S8639–41, S8644 By 43 yeas to 55 nays (Vote No. 258), Bingaman Bingaman Amendment No. 973, to amend title Amendment No. 1066, to permit the establishment XVIII of the Social Security Act to provide for the authorization of reimbursement for all Medicare part of 2 new Medigap plans for Medicare beneficiaries B services furnished by certain Indian hospitals and enrolled for prescription drug coverage under part D. clinics. Page S8606 Pages S8606, S8641–42 Baucus (for Lautenberg) Amendment No. 986, to By 42 yeas to 54 nays (Vote No. 259), Baucus make prescription drug coverage available beginning (for Levin) Amendment No. 1111, to ensure that on July 1, 2004. Page S8606 current retirees who have prescription drug coverage Murray Amendment No. 990, to make improve- who will lose their prescription drug coverage as a ments in the MedicareAdvantage benchmark deter- result of the enactment of this legislation have the minations. Page S8606 option of drug coverage under the Medicare fallback. Dayton Amendment No. 977, to require that ben- Page S8632 efits be made available under part D on January 1, By 21 yeas to 75 nays (Vote No. 260), Hagel/En- 2004. (See next issue.) sign Modified Amendment No. 1026, to provide Baucus (for Dorgan) Amendment No. 993, to Medicare beneficiaries with a drug discount card that amend title XVIII of the Social Security Act to pro- ensures access to affordable prescription drugs. vide for coverage of cardiovascular screening tests Page S8606 under the Medicare program. Page S8606 Baucus (for Feinstein) Modified Amendment No. Smith/Bingaman Amendment No. 962, to provide 1060, to provide for an income-related increase in reimbursement for Federally qualified health centers the part B premium for individuals with income in participating in Medicare managed care. Page S8606 excess of $75,000 and married couples with income Hutchison Amendment No. 1004, to amend title in excess of $150,000. (By 38 yeas to 59 nays (Vote XVIII of the Social Security Act to freeze the indi- No. 261), Senate earlier failed to table the amend- rect medical education adjustment percentage under ment.) Page S8606 the Medicare program at 6.5 percent. Page S8606 Withdrawn: Conrad Amendment No. 1019, to provide for cov- Kyl Amendment No. 1093 (to Amendment No. erage of self-injected biologicals under part B of the 1092), in the nature of a substitute. Medicare program until Medicare Prescription Drug Pages S8606, S8624 plans are available. Page S8606 Grassley (for Craig) Amendment No. 1087, to Conrad Amendment No. 1020, to permanently permit the offering of consumer-driven health plans and fully equalize the standardized payment rate be- under MedicareAdvantage. Page S8606 ginning in fiscal year 2004. Page S8606
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00004 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 D748 CONGRESSIONAL RECORD — DAILY DIGEST June 26, 2003 Conrad Amendment No. 1021, to address Medi- cial needs beneficiaries or frail, elderly Medicare care payment inequities. Page S8606 beneficiaries. Page S8606 Clinton Amendment No. 999, to provide for the Baucus (for Mikulski) Amendment No. 1088, to development of quality indicators for the priority provide equitable treatment for children’s hospitals. areas of the Institute of Medicine, for the standard- Page S8606 ization of quality indicators for Federal agencies, and Baucus (for Mikulski) Amendment No. 1089, to for the establishment of a demonstration program for provide equitable treatment for certain children’s the reporting of health care quality data at the com- hospitals. Page S8606 munity level. Page S8606 Baucus (for Mikulski) Amendment No. 1090, to Clinton Amendment No. 953, to provide training permit direct payment under the Medicare program to long-term care ombudsman. Page S8606 for clinical social worker services provided to resi- Clinton Amendment No. 954, to require the Sec- dents of skilled nursing facilities. Page S8606 retary of Health and Human Services to develop lit- Baucus (for Mikulski) Amendment No. 1091, to eracy standards for informational materials, particu- extend certain municipal health service demonstra- larly drug information. Page S8606 tion projects. Page S8606 Reid (for Corzine) Modified Amendment No. Baucus (for Levin) Amendment No. 1110, to en- 1037, to provide conforming changes regarding fed- sure that beneficiaries initially covered by a private erally qualified health centers. Pages S8606, S8632 insurer under this act who are subsequently covered Reid (for Inouye) Amendment No. 1039, to by a Medicare fallback plan have the option of re- amend title XIX of the Social Security Act to pro- taining a Medicare fallback plan. Page S8632 vide 100 percent reimbursement for medical assist- Baucus (for Murkowski/Stevens) Amendment No. ance provided to a Native Hawaiian through a Fed- 1041, to require the Secretary of Health and Human erally-qualified health center or a Native Hawaiian Services to conduct a frontier extended stay clinic demonstration project. (See next issue.) health care system. Page S8606 A unanimous-consent agreement was reached pro- Enzi/Lincoln Amendment No. 1051, to ensure viding that following passage of S. 1 (listed above), convenient access to pharmacies and prohibit the the bill be held at the desk, and when the Senate tying of contracts. Page S8606 receives H.R. 1, House companion measure, all after Hagel/Ensign Amendment No. 1012, to provide the enacting clause be stricken and the text of S. 1 Medicare beneficiaries with an additional choice of be inserted in lieu thereof; Senate insisted on its Medicare Prescription Drug plans under part D that amendment, request a conference with the House consists of a drug discount card and protection thereon, and the Chair be authorized to appoint con- against high out-of-pocket drug costs. Page S8606 ference on the part of the Senate; providing further, Baucus (for Akaka) Amendment No. 1061, to passage of S. 1 be vitiated and the bill be returned provide for treatment of Hawaii as a low-DSH State to the Senate Calendar. (See next issue.) for purposes of determining a Medicaid DSH allot- ment for the State for fiscal years 2004 and 2005. Check Truncation Act: Senate passed H.R. 1474, Page S8606 to facilitate check truncation by authorizing sub- Stabenow/Levin Amendment No. 1075, to perma- stitute checks, to foster innovation in the check col- nently extend a moratorium on the treatment of a lection system without mandating receipt of checks certain facility as an institution for mental diseases. in electronic form, and to improve the overall effi- Page S8606 ciency of the Nation’s payments system, after strik- Stabenow/Levin Amendment No. 1076, to provide ing all after the enacting clause and inserting the for the treatment of payments to certain comprehen- text of S. 1334, Senate companion measure. (See next issue.) sive cancer centers. Page S8606 Subsequently, S. 1334 was returned to the Senate Stabenow/Levin Amendment No. 1077, to provide Calendar. (See next issue.) for the redistribution of unused resident positions. Page S8606 Commending August Hiebert: Senate agreed to Ensign/Lincoln Amendment No. 1024, to amend S. Res. 186, commending August Hiebert for his title XVIII of the Social Security Act to repeal the service to the Alaska Communications Industry. Medicare outpatient rehabilitation therapy caps. (See next issue.) Page S8606 Rhodes Scholarships: Senate agreed to S. Res. Smith/Feingold Amendment No. 1073, to allow 187, expressing the sense of the Senate regarding the the Secretary to include in the definition of ‘special- centenary of the Rhodes Scholarships in the United ized Medicare+Choice plans for special needs bene- States and the establishment of the Mandela Rhodes ficiaries’ plans that disproportionately serve such spe- Foundation. (See next issue.)
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00005 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 June 26, 2003 CONGRESSIONAL RECORD — DAILY DIGEST D749 Honoring Maynard Holbrook Jackson, Jr.: Senate Adjournment: Senate met at 9:15 a.m., and ad- agreed to S. Res. 188, honoring Maynard Holbook journed at 1:15 a.m. on Friday, June 27, 2003, until Jackson, Jr., former Mayor of the City of Atlanta, 10:15 a.m., on the same day. (For Senate’s program, and extending the condolences of the Senate on his see the remarks of the Majority Leader in the next death. (See next issue.) issue of the Record.) Commending General Eric Shinseki: Senate agreed to S. Res. 190, commending General Eric Committee Meetings Shinseki of the United States Army for his out- standing service and commitment to excellence. (Committees not listed did not meet) (See next issue.) Adjournment Resolution—Agreement: A unani- HEALTHY FORESTS RESTORATION ACT mous-consent agreement was reached providing that Committee on Agriculture, Nutrition, and Forestry: Com- when the Senate receives an adjournment resolution mittee concluded hearings to examine H.R. 1904, to from the House, it be agreed to, providing that the improve the capacity of the Secretary of Agriculture text is identical to the resolution being held at the and the Secretary of the Interior to plan and conduct desk. (See next issue.) hazardous fuels reduction projects on National Forest System lands and Bureau of Land Management lands Nominations Confirmed: Senate confirmed the fol- aimed at protecting communities, watersheds, and lowing nominations: certain other at-risk lands from catastrophic wildfire, Joshua B. Bolten, of the District of Columbia, to to enhance efforts to protect watersheds and address be Director of the Office of Management and Budg- threats to forest and rangeland health, including cat- et. (See next issue.) astrophic wildfire, across the landscape, after receiv- Nominations Received: Senate received the fol- ing testimony from Senator McCain; Mark Rey, lowing nominations: Under Secretary of Agriculture for Natural Resources Rick A. Dearborn, of Oklahoma, to be an Assist- and the Environment; Lynn Scarlett, Assistant Sec- ant Secretary of Energy (Congressional and Intergov- retary of the Interior for Policy, Management, and ernmental Affairs). Budget; Michael Carroll, Minnesota State Forester, Scott J. Bloch, of Kansas, to be Special Counsel, St. Paul, on behalf of the National Association of Office of Special Counsel, for the term of five years. State Foresters; Frederick M. Stephen, University of Arkansas, Fayetteville, on behalf of the Society of Penrose C. Albright, of Virginia, to be an Assist- American Foresters; Tom Nelson, Sierra Pacific In- ant Secretary of Homeland Security. (New Position) dustries, Redding, California, on behalf of the Amer- Rene Acosta, of Virginia, to be an Assistant At- ican Forest and Paper Association; Jacquellin L. torney General McAvoy, City Council, Post Falls, Idaho, on behalf Routine lists in the Army. (See next issue.) of the Idaho Women in Timber; Michael Petersen, Messages From the House: (See next issue.) The Lands Council, Spokane, Washington; Norman L. Christensen, Jr., Duke University Nicholas School Measures Referred: (See next issue.) of the Environment and Earth Sciences, Durham, Measures Placed on Calendar: (See next issue.) North Carolina; Hal Salwasser, Oregon State Univer- Measures Read First Time: (See next issue.) sity Department of Forest Resources, Corvallis; Don- ald J. Kochan, George Mason University School of Executive Communications: (See next issue.) Law, Arlington, Virginia; and Patrick Parenteau, Executive Reports of Committees: (See next issue.) Vermont Law School, South Royalton. Additional Cosponsors: (See next issue.) APPROPRIATIONS—LABOR/HHS/ Statements on Introduced Bills/Resolutions: EDUCATION AND MILITARY (See next issue.) CONSTRUCTION Additional Statements: (See next issue.) Committee on Appropriations: Committee ordered favor- Amendments Submitted: (See next issue.) ably reported the following business bills: An original bill (S. 1356) making appropriations Authority for Committees To Meet: for the Departments of Labor, Health and Human (See next issue.) Services, and Education and related agencies for the Record Votes: Sixteen record votes were taken fiscal year ending September 30, 2004; and today. (Total—262) An original bill (S. 1357) making appropriations Pages S8609–10 S8622–23, S8636–38 (continued next issue) for military construction, family housing, and base
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00006 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 D750 CONGRESSIONAL RECORD — DAILY DIGEST June 26, 2003 realignment and closure for the Department of De- BUSINESS MEETING fense for the fiscal year ending September 30, 2004. Committee on Foreign Relations: Committee ordered fa- vorably reported the following business items: FAIR CREDIT REPORTING ACT S. Res. 90, expressing the sense of the Senate that Committee on Banking, Housing, and Urban Affairs: the Senate strongly supports the nonproliferation Committee concluded hearings to examine affiliate programs of the United States, with an amendment; sharing practices in relation to the Fair Credit Re- S. Res. 62, calling upon the Organization of porting Act, focusing on privacy protections, security American States (OAS) Inter-American Commission risks and threats to the credit reporting system, re- on Human Rights, the United Nations High Com- tail credit card programs, and merchandise returns, missioner for Human Rights, the European Union, after receiving testimony from Vermont Assistant and human rights activists throughout the world to Attorney General Julie Brill, Montpelier; Joel R. take certain actions in regard to the human rights Reidenberg, Fordham University School of Law, and situation in Cuba; Martin Wong, Citigroup, Inc., both of New York, S. Res. 149, expressing the sense of the Senate New York; Ronald A. Prill, Target Financial Serv- that the international response to the current need ices, Minneapolis, Minnesota, on behalf of the Na- for food in the Horn of Africa remains inadequate, tional Retail Federation; Edmund Mierzwinski, U.S. with an amendment; and Public Interest Research Group, Washington, D.C.; The nominations of Robert W. Fitts, of New Terry Baloun, Wells Fargo Bank, Sioux Falls, South Hampshire, to be Ambassador to Papua New Guin- Dakota; and Angela Maynard, Keycorp, Cleveland, ea, and to serve concurrently and without additional Ohio. compensation as Ambassador to the Solomon Islands and Ambassador to the Republic of Vanuatu, Marsha BUSINESS MEETING E. Barnes, of Maryland, to be Ambassador to the Re- Committee on Commerce, Science, and Transportation: public of Suriname, John E. Herbst, of Virginia, to Committee ordered favorably reported the following be Ambassador to Ukraine, Tracey Ann Jacobson, of business items: the District of Columbia, to be Ambassador to S. 1264, to reauthorize the Federal Communica- Turkmenistan, George A. Krol, of New Jersey, to be tions Commission, with amendments; Ambassador to the Republic of Belarus, John F. H.R. 1320, to amend the National Telecommuni- Maisto, of Pennsylvania, to be Permanent Represent- cations and Information Administration Organization ative of the United States of America to the Organi- Act to facilitate the reallocation of spectrum from zation of American States, with the rank of Ambas- governmental to commercial users, with an amend- sador, Greta N. Morris, of California, to be Ambas- ment; sador to the Republic of the Marshall Islands, Roger An original bill to authorize funds for highway Francisco Noriega, of Kansas, to be an Assistant Sec- safety programs, motor carrier safety programs, haz- retary of State (Western Hemisphere Affairs), Wil- ardous materials transportation safety programs, and liam B. Wood, of New York, to be Ambassador to boating safety programs; the Republic of Colombia, and certain Foreign Serv- S. 1262, to authorize appropriations for fiscal ice Officer promotion lists. years 2004, 2005, and 2006 for certain maritime INTERNATIONAL PARENTAL ABDUCTION programs of the Department of Transportation, with amendments; and Committee on Foreign Relations: Committee concluded S. 1218, to provide for Presidential support and hearings to examine the Department of State’s Office coordination of interagency ocean science programs of Children’s Issues, focusing on responding to inter- and development and coordination of a comprehen- national parental abduction, after receiving testi- sive and integrated United States research and moni- mony from Senator Lincoln; and Maura Harty, As- toring program, with an amendment in the nature sistant Secretary of State, Bureau of Consular Affairs. of a substitute. NOMINATIONS: NOMINATIONS: Committee on Governmental Affairs: Committee ordered Committee on Finance: Committee concluded hearings favorably reported the nominations of Judith Nan to examine the nominations of Josette Sheeran Shin- Macaluso, to be an Associate Judge of the Superior er, of Virginia, to be a Deputy United States Trade Court of the District of Columbia; Fern Flanagan Representative, with the rank of Ambassador, and Saddler, to be an Associate Judge of the Superior James J. Jochum, of Virginia, to be an Assistant Sec- Court of the District of Columbia; and Joshua B. retary of Commerce, after each nominee testified and Bolten, of the District of Columbia, to be Director answered questions in their own behalf. of the Office of Management and Budget.
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BUSINESS MEETING The nominations of Diane M. Stuart, of Utah, to Committee on Indian Affairs: Committee ordered favor- be Director of the Violence Against Women Office, ably reported the following business items: Department of Justice; and Thomas M. Hardiman, S. 281, to amend the Transportation Equity Act to be United States District Judge for the Western for the 21st Century to make certain amendments District of Pennsylvania. with respect to Indian tribes, to provide for training Also, committee resumed markup of S. 1125, to and technical assistance to Native Americans who are create a fair and efficient system to resolve claims of interested in commercial vehicle driving careers, victims for bodily injury caused by asbestos expo- with an amendment in the nature of a substitute; sure, but did not complete action thereon, and re- and cessed subject to call. The nominations of Lisa Genevieve Nason, of Alaska, Georgianna E. Ignace, of Wisconsin, John GROWING WAHHABI INFLUENCE Richard Grimes, of Massachusetts, each to be a Committee on the Judiciary: Subcommittee on Ter- Member of the Board of Trustees of the Institute of rorism, Technology, and Homeland Security con- American Indian and Alaska Native Culture and cluded hearings to examine the ideological structure Arts Development, and Charles W. Grim, of Okla- homa, to be Director of the Indian Health Service, of Wahhabism, an extreme and violent form of Department of Health and Human Services. Islam, and its potential for politcal and social influ- ence in the United States, after receiving testimony BUSINESS MEETING from David Aufhauser, General Counsel, Department Committee on the Judiciary: Committee ordered favor- of the Treasury; Larry A. Mefford, Assistant Direc- ably reported the following business items: tor, Counterterrorism Division, Federal Bureau of In- S. Res. 174, designating Thursday, November 20, vestigation, Department of Justice; and Alex Alexiev, 2003, as ‘‘Feed America Thursday’’; Center for Security Policy, and Stephen Schwartz, S. Res. 175, designating the month of October Foundation for Defense of Democracies, both of 2003, as ‘‘Family History Month’’; and Washington, D.C. h House of Representatives Guest Chaplain: The prayer was offered by the Chamber Action guest Chaplain, Rabbi Milton Balkany, Dean, Bais Measures Introduced: Measures introduced will ap- Yaakov of Brooklyn, New York. Page H5941 pear in the next issue of the Record. Journal: Agreed to the Speaker’s approval of the Additional Cosponsors: (See next issue.) Journal of June 25 by yea-and-nay vote of 357 yeas Reports Filed: Reports were filed today as follows: to 68 nays, Roll No. 327. Page H5941 H.R. 438, to increase the amount of student loans Intelligence Authorization Act for FY 2004: The that may be forgiven for teachers in mathematics, House passed H.R. 2417, to authorize appropriations science, and special education, amended (H. Rept. for fiscal year 2004 for intelligence and intelligence- 108–182); related activities of the United States Government, H.R. 2211, to reauthorize title II of the Higher the Community Management Account, and the Cen- Education Act of 1965, amended (H. Rept. tral Intelligence Agency Retirement and Disability 108–183); System by yea-and-nay vote of 410 yeas to 9 nays, H.R. 2210, to reauthorize the Head Start Act to Roll No. 333. The House completed general debate improve the school readiness of disadvantaged chil- and began considering amendments to the bill on dren, amended (H. Rept. 108–184); and June 25. Pages H5943–46 H.R. 74, to direct the Secretary of Agriculture to Agreed To: convey certain land in the lake Tahoe Basin Manage- Hastings of Florida amendment No. 4 printed in ment Unit, Nevada, to the Secretary of the Interior, H. Rept. 108–176, debated on June 25, that directs in trust for the Washoe Indian Tribe of Nevada and the Director of Central Intelligence to establish a California (H. Rept. 108–185). (See next issue.) pilot project to improve recruitment of ethnic and cultural minorities and women with diverse skills
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00008 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 D752 CONGRESSIONAL RECORD — DAILY DIGEST June 26, 2003 and language abilities (agreed to by recorded vote of Earlier, the House agreed to H. Res. 298, the rule 418 ayes with none voting ‘‘no’’, Roll No. 318; that provided for consideration of the bill by voice Pages H5943–44 vote. Agreed to order the previous question by yea- Rejected: and-nay vote of 220 yeas to 200 nays, Roll No. 324. Kucinich amendment No. 5 printed in H. Rept. Pages H5978–79 108–176, debated on June 25, that sought to direct Suspension—Support for Freedom in Hong the Inspector General of the Central Intelligence Kong: The House agreed to suspend the rules and Agency to conduct an audit of all communications agree to H. Res. 277, expressing support for freedom between the CIA and the Office of the Vice Presi- in Hong Kong (agreed to by 2/3 yea-and-nay vote dent that relate to weapons of mass destruction ob- of 426 yeas to 1 nay, Roll No. 326). The motion tained or developed by Iraq (rejected by recorded was debated on June 25. Pages H5990–91 vote of 76 ayes to 347 noes, Roll No. 319); and Pages H5944–45 Order of Business—DoD Appropriations: Agreed Lee amendment No. 6 printed in H. Rept. that it be in order on Tuesday, July 8, for the 108–176, debated on June 25, that sought to re- Speaker, as though pursuant to clause 2(b) of rule quire a GAO study on intelligence sharing by the 18, to declare the House resolved into the Com- Department of Defense and intelligence community mittee of the Whole House on the state of the with United Nations inspectors searching for weap- Union for consideration of a bill reported pursuant ons of mass destruction (rejected by recorded vote of to section 6 of H. Res. 299, making appropriations 185 ayes to 239, Roll No. 320. Pages H5945–46 for the Department of Defense for the fiscal year H. Res. 295, the rule that provided for consider- ending September 30, 2004, which shall proceed ac- ation of the bill was agreed to on June 25. cording to the following order: the first reading shall Page H5946 be dispensed with; all points of order against consid- eration of the bill are waived; general debate shall be Recess: The House recessed at 11:48 a.m. and re- confined to the bill and shall not exceed one hour convened at 12:53 p.m. Pages H5951–52 equally divided and controlled by the chairman and Motions to Suspend the Rules on Wednesdays ranking minority member of the Committee on Ap- During the Remainder of the One Hundred propriations; after general debate the bill shall be Eighth Congress: The House agreed to H. Res. considered for amendment under the five-minute 297, providing for motions to suspend the rules by rule; points of order against provisions in the bill for recorded vote of 226 ayes to 203 noes, Roll No. failure to comply with clause 2 of rule XXI are 323. Pages H5946–51, H5973–74 waived; during consideration of the bill for amend- Late Report: The Committee on Appropriations re- ment, the Chairman of the Committee of the Whole ceived permission to have until midnight to file a may accord priority in recognition on the basis of privileged report making appropriations for the Leg- whether the member offering an amendment has islative Branch for the fiscal year ending September caused it to be printed in the portion of the Con- 30, 2004. Page H5979 gressional Record designated for that purpose in clause 8 of rule XVIII. Amendments so printed shall Military Construction Appropriations Act: The be considered as read. At the conclusion of consider- House passed H.R. 2559, making appropriations for ation of the bill for amendment the Committee shall military construction, family housing, and base re- rise and report the bill to the House with such alignment and closure for the Department of Defense amendments as may have been adopted. The pre- for the fiscal year ending September 30, 2004 by vious question shall be considered as ordered on the yea-and-nay vote of 428 yeas with none voting bill and amendments thereto to final passage with- ‘‘nay’’, Roll No. 325. Pages H5974–90 out intervening motion except one motion to recom- Rejected the Obey motion to recommit the bill to mit with or without instructions. Page H5992 the Committee on Appropriations. Earlier, a point of order was sustained against another Obey motion State Children’s Health Insurance Program that sought to recommit the bill to the Committee (SCHIP) Allotments: The House passed H.R. 531, on Appropriations with instructions to report it back to amend title XXI of the Social Security Act to ex- forthwith with an amendment that increases funding tend the availability of allotments for fiscal years for various programs including fitness facilities, fam- 1998 through 2001 under the State Children’s ily housing, and barracks. Page H5986 Health Insurance Program (SCHIP) by unanimous Point of order was sustained against the Obey consent. Pages H6006–07 amendment that sought to reinstate funding for var- Medicare Prescription Drug, Modernization, ious programs including fitness facilities, family Health Savings and Affordability Act: The House housing, and barracks. Pages H5989–90 passed H.R. 1, to amend title XVIII of the Social
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00009 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 June 26, 2003 CONGRESSIONAL RECORD — DAILY DIGEST D753 Security Act to provide for a voluntary program for Section 3 of H. Res. 299, the rule providing for prescription drug coverage under the Medicare Pro- consideration of the bill, provides that in the en- gram, to modernize the Medicare Program and to grossment of H.R. 1, the clerk shall add the text of amend the Internal Revenue Code of 1986 to allow H.R. 2596, as passed by the House as a new matter a deduction to individuals for amounts contributed at the end of H.R. 1, and then lay H.R. 2596 on to health savings security accounts and health sav- the table. (See next issue.) ings accounts, to provide for the disposition of un- Independence Day District Work Period: The used health benefits in cafeteria plans and flexible House agreed to H. Con. Res. 231, providing for a spending arrangements by 216 ayes to 215 noes conditional adjournment of the House of Representa- with 1 voting ‘‘present,’’ Roll No. 332. tives and a conditional recess or adjournment of the Pages H6007–6105 (continued next issue) Senate. (See next issue.) Pursuant to Section 3 of the rule in the engross- ment of H.R. 1, the Clerk shall add the text of H.R. Senate Concurrence in Adjournment Resolution: 2596, as passed by the House as a new matter at the Agreed that when the House adjourns today, it ad- end of H.R. 1, conform the title of H.R. 1 to reflect journ to meet at 2 p.m. on Tuesday, July 1, 2003, the addition of the text of H.R. 2596 to the en- unless it sooner has received a message from the Sen- grossment, and then lay H.R. 2596 on the table. ate transmitting its concurrence in H. Con. Res. (See next issue.) 231, in which case the House shall stand adjourned Rejected the Thompson of California motion to pursuant to that concurrent resolution. recommit the bill jointly to the Committee on Ways (See next issue.) and Means and the Committee on Energy and Com- Calendar Wednesday: Agreed to dispense with the merce with instructions to report the same back to Calendar Wednesday business of Wednesday, July 9. the House promptly with amendments in the nature (See next issue.) of a substitute that establish the Prescription Drug and Medicare Improvement Act. By recorded vote of Speaker Pro Tempore: Read a letter from the Speaker wherein he appointed Representative Tom 208 ayes to 223 noes, Roll No. (See next issue.) Davis of Virginia to act as Speaker pro tempore to Rejected the Rangel amendment in the nature of a substitute numbered 1 printed in H. Rept. sign enrolled bills and joint resolutions through 108–181 that sought to provide prescription drug Monday, July 7. (See next issue.) coverage for all Medicare beneficiaries, enhance Senate Messages: Messages received from the Senate Medicare+Choice plans, includes payments for oncol- today appear on pages H5941, and H5992. ogy providers and related cancer drug therapy pro- Referrals: S. 163 was referred to the Committees on grams; improve rural health delivery; and implement Education and the Workforce and Resources, S. 498 various provisions dealing with Medicare Parts A was referred to the Committee on Financial Services, and B, Medicaid, regulatory reduction and the re- S. 867 was referred to the Committee on Govern- importation of prescription drugs by recorded vote of ment Reform, and S. 1207 and S. 312 were held at 176 ayes to 255 noes with 1 voting ‘‘present’’, Roll the desk. (See next issue.) No. 330. (See next issue.) H. Res. 299, the rule that providing for consider- Call of the House: On the Call of the House, 421 ation of both H.R. 1, Medicare Prescription Drug members reported their presence, Roll No. 329. and Modernization Act, and H.R. 2596, Health Sav- (See next issue.) ings and Affordability Act was agreed to by recorded Quorum Calls—Votes: One quorum call, Roll No. vote of 221 ayes to 203 noes, Roll No. 322. Earlier 329, eight yea-and-nay votes and seven recorded agreed to order the previous question by yea-and-nay votes developed during the proceedings of the House vote of 226 yeas to 203 nays, Roll No. 321. today and appear on pages H5944, H5944–45, Pages H5972–73 H5945–46, H5972–73, H5973, H5973–74, Health Savings and Affordability Act: The House H5978–79, H5990, H5990–91, H5991–92, H6006 passed H.R. 2596, to amend the Internal Revenue (continued next issue). There were no quorum calls. Code of 1986 to allow a deduction to individuals for Adjournment: The House met at 10 a.m. and at amounts contributed to health savings security ac- 2:47 a.m. on Friday, June 27, pursuant to the provi- counts and health savings accounts, to provide for sions of H. Con. Res. 231, the House stands ad- the disposition of unused health benefits in cafeteria journed until 2 p.m. on Tuesday, July 1, 2003, un- plans and flexible spending arrangements by yea- less it sooner has received a message from the Senate and-nay vote of 237 yeas to 191 nays, Roll No. 328. transmitting its adoption of H. Con. Res. 231, in Pages H5952–73, H5992–H6006 which case the House shall stand adjourned pursuant
VerDate Jan 31 2003 07:28 Jun 27, 2003 Jkt 019060 PO 00000 Frm 00010 Fmt 0627 Sfmt 0627 E:\CR\FM\D26JN3.REC D26JN3 D754 CONGRESSIONAL RECORD — DAILY DIGEST June 26, 2003 to that concurrent resolution until 2 p.m. on Mon- heard from the following officials of the Department day, July 7. of Defense: Peter Rodman, Assistant Secretary, Inter- national Security Affairs; and Adm. Thomas B. Committee Meetings Fargo, USN, Commander, U.S. Pacific Command; and Christopher LaFleur, Special Envoy, Northeast MANDATORY COUNTRY OF ORIGIN Asia Security Consultations, Bureau of East Asian LABELING LAW REVIEW and Pacific Affairs, Department of State. Committee on Agriculture: Held a hearing to review the AMERICAN SERVICEMEMBERS’ mandatory country of origin labeling law. Testimony PROTECTION ACT AMENDMENTS was heard from the following officials of the USDA: Charles Lambert, Deputy Under Secretary, Mar- Committee on International Relations: Subcommittee on keting and Regulatory Programs; Nancy Bryson, Europe approved for full Committee action H.R. General Counsel; and Keith Collins, Chief Econo- 2550, to amend the American Servicemembers’ Pro- mist; and public witnesses. tection Act of 2002 to provide clarification with re- spect to the eligibility of certain countries for DEFENSE AND LEGISLATIVE United States miliary assistance. APPROPRIATIONS HOMETOWN HEROES SURVIVORS Committee on Appropriations: Ordered reported the fol- BENEFITS lowing appropriations for fiscal year 2004: Defense and Legislative. Committee on the Judiciary: Subcommittee on Crime, Terrorism, and Homeland Security held a hearing on FOREIGN RELATIONS AUTHORIZATION H.R. 919, Hometown Heroes Survivors Benefits. ACT Testimony was heard from Michael E. Williams, Jr., Committee on Armed Services: Ordered reported, as Fire Rescue Training Specialist, Office of the State amended, H.R. 1950, Foreign Relations Authoriza- Fire Marshall, Department of Insurance, State of tion Act, Fiscal Years 2004 and 2005. North Carolina; and public witnesses. FINANCIAL MAINSTREAM—BROADEN OVERSIGHT—CONSULAR IDENTIFICATION ACCESS CARDS Committee on Financial Services: Subcommittee on Fi- Committee on the Judiciary: Subcommittee on Immi- nancial Institutions and Consumer Credit held a gration, Border Security, and Claims held an over- hearing entitled ‘‘Serving the Underserved: Initia- sight hearing on ‘‘The Federal Government’s Re- tives to Broaden Access to the Financial Main- sponse to the Issuance and Acceptance in the U.S. stream.’’ Testimony was heard from Wayne Aber- of Consular Identification Cards.’’ Testimony was nathy, Assistant Secretary, Financial Institutions, De- heard from Roberta S. Jacobson, Acting Deputy As- partment of the Treasury; Dennis Dollar, Chairman, sistant Secretary, Bureau of Western Hemisphere Af- National Credit Union Administration; and public fairs, Department of State; Steven McCraw, Assistant witnesses. Director, Office of Intelligence, FBI, Department of Justice; C. Stewart Verdery, Assistant Secretary, Pol- COMPETITIVE SOURCING FOR 21ST icy and Planning, Border and Transportation Secu- CENTURY rity Directorate, Department of Homeland Security; Committee on Government Reform: Held a hearing titled and a public witness. ‘‘New Century, New Process: A Preview of Competitive Sourcing for the 21st Century.’’ Testimony was heard MISCELLANEOUS MEASURES from David M. Walker, Comptroller, GAO; Angela Committee on Resources: Subcommittee on Fisheries Styles, Director, Office of Federal Procurement Policy, Conservation, Wildlife and Oceans held a hearing on OMB; Philip Grone, Principal Assistant Deputy Under Secretary, Installations and Environment, Department of the following bills: H.R. 1204, to amend the Na- Defense; Scott J. Cameron, Deputy Assistant Secretary, tional Wildlife Refuge System Administration Act of Performance and Management, Department of the Inte- 1966 to establish requirements for the award of con- rior; and public witnesses. cessions in the National Wildlife Refuge System, to provide for maintenance and repair of properties lo- ASIA AND THE PACIFIC—U.S. SECURITY cated in the System by concessionaires authorized to POLICY use such properties; and H.R. 2408, National Wild- Committee on International Relations: Subcommittee on life Refuge Volunteer Act of 2003. Testimony was East Asia and the Pacific held a hearing on U.S. Se- heard from Marshall P. Jones, Jr. Deputy Director, curity Policy in Asia and the Pacific: Restructuring U.S. Fish and Wildlife Service, Department of the America’s Forward Deployment. Testimony was Interior; and public witnesses.
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NASA FLEXIBILITY ACT Act; H.R. 2357, as amended, to amend title 38, Committee on Science: Subcommittee on Space and Aer- United States Code, to establish standards of access onautics approved for full Committee action, as to care for veterans seeking health care from the De- amended, H.R. 1085, NASA Flexibility Act of partment of Veterans Affairs; H.R. 2433, as amend- 2003. ed, Health Care for Veterans of Project 112/Project SHAD Act of 2003; H.R. 2595, to restore the oper- COMPUTER RESERVATION SYSTEMS ation of the Native American Veteran Housing Loan REGULATIONS AND SMALL BUSINESS— Program during fiscal year 2003 to the scope of that TRAVEL INDUSTRY program as in effect on September 30, 2002; and H. Committee on Small Business: Subcommittee on Regu- Con. Res. 159, declaring Emporia, Kansas, to be the latory Reform and Oversight held a hearing entitled: founding city of the Veterans Day holiday and rec- ‘‘CRS Regulations and Small Business in the Travel ognizing the contributions of Alvin J. King and Industry’’ Testimony was heard from Tom Sullivan, Representative Ed Rees to the enactment into law of Chief Counsel, Office of Advocacy, SBA; and public the observance of Veterans Day. witnesses. PROJECT BIOSHIELD ACT NATIONAL RAIL INFRASTRUCTURE FINANCING PROPOSALS Select Committee on Homeland Security: Ordered re- ported, as amended, H.R. 2122, Project BioShield Committee on Transportation and Infrastructure: Sub- Act of 2003. committee on Railroads held an oversight hearing on National Rail Infrastructure Financing Proposals. f Testimony was heard from the following officials of NEW PUBLIC LAWS the Department of Transportation: Allan Rutter, Ad- (For last listing of Public Laws, see DAILY DIGEST, p. D713 ) ministrator, Federal Railroad Administration; and Roger Nober, Chairman, Surface Transportation S. 342, to amend the Child Abuse Prevention and Board; Joseph Boardman, Commissioner, Depart- Treatment Act to make improvements to and reau- ment of Transportation, State of New York; and thorize programs under that Act. Signed on June 25, public witnesses. 2003. (Public Law 108–36) VETERAN’S LEGISLATION f Committee on Veterans’ Affairs: Ordered reported the COMMITTEE MEETINGS FOR FRIDAY, following measures: H.R. 1516, as amended, Na- JUNE 27, 2003 tional Cemetery Expansion Act of 2003; H.R. 2297, Senate as amended, Veterans Benefits Act of 2003; H.R. No meetings/hearings scheduled. 116, as amended, Veterans’ New Fitzsimons Health Care Facilities Act of 2003; H.R. 1720, as amended, House Veterans Health Care Facilities Capital Improvement No committee meetings are scheduled.
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Next Meeting of the SENATE Next Meeting of the HOUSE OF REPRESENTATIVES 10:15 a.m., Friday, June 27 2 p.m., Monday, July 7
Senate Chamber House Chamber Program for Friday: Senate will be in a period of morn- Program for Monday: To be announced. ing business.
Extensions of Remarks, as inserted in this issue
HOUSE Frost, Martin, Tex., E1362, E1368, E1369 Oberstar, James L., Minn., E1374 Gillmor, Paul E., Ohio, E1358 Pomeroy, Earl, N.D., E1361 Andrews, Robert E., N.J., E1375 Harman, Jane, Calif., E1373 Rangel, Charles B., N.Y., E1357, E1358 Bradley, Jeb, N.H., E1359 Honda, Michael M., Calif., E1369 Reyes, Silvestre, Tex., E1359 Cantor, Eric, Va., E1369 Kanjorski, Paul E., Pa., E1366, E1370 Saxton, Jim, N.J., E1371 Case, Ed, Hawaii, E1365, E1367 Kind, Ron, Wisc., E1370 Crane, Philip M., Ill., E1370 Kucinich, Dennis J., Ohio, E1362, E1365, E1368, E1368 Schakowsky, Janice D., Ill., E1358 Davis, Jim, Fla., E1372 Lee, Barbara, Calif., E1360 Smith, Nick, Mich., E1362, E1365, E1368 DeLauro, Rosa L., Conn., E1373 Lofgren, Zoe, Calif., E1369 Solis, Hilda L., Calif., E1370 Eshoo, Anna G., Calif., E1369 McCarthy, Carolyn, N.Y., E1362 Vitter, David, La., E1373 Farr, Sam, Calif., E1364, E1367 Menendez, Robert, N.J., E1373 Waxman, Henry A., Calif., E1369 Fletcher, Ernie, Ky., E1370 Moore, Dennis, Kansas, E1357 Weldon, Curt, Pa., E1362, E1366 Forbes, J. Randy, Va., E1371 Moran, James P., Va., E1359 Wolf, Frank R., Va., E1371 Frank, Barney, Mass., E1363, E1366 Ney, Robert W., Ohio, E1365, E1368
(Senate and House proceedings for today will be continued in the next issue of the Record.)
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