June 18, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 12 15595 the United States to further improve cent of all substance abuse treatment To support its business functions, water-use efficiency in agricultural, facilities are able to accommodate DoD has thousands of separate business residential, and commercial activities. children. The goal of this legislation is systems that it has layered upon one S. RES. 182 to offer support and flexibility to such another for decades. They are archaic, At the request of Mr. KERRY, the promising programs by allowing chil- overly complex, and error-prone. They name of the Senator from Delaware dren who are in foster care be placed are sometimes redundant and often (Mr. KAUFMAN) was added as a cospon- with their parent in the comprehensive lack standardization. It is no wonder sor of S. Res. 182, a resolution recog- residential family treatment center, that since 1995, GAO has classified the nizing the democratic accomplish- and bring their foster care payment Pentagon’s financial management as ments of the people of Albania and ex- with them as their placement is trans- high-risk, which makes it vulnerable to pressing the hope that the parliamen- ferred. By allowing these funds to fol- fraud and waste. Indeed, according to tary elections on June 28, 2009, main- low the child to the residential facil- GAO, DoD’s accounting problems cost tain and improve the transparency and ity, the chances for that family’s suc- the American taxpayer $13 billion in fairness of democracy in Albania. cess are much greater. 2005—that’s $35 million a day. Family based substance abuse treat- This has been a problem for decades. AMENDMENT NO. 1330 ment centers have proven to be an ef- In 1975, the Army disclosed that it had At the request of Mr. NELSON of Flor- fective means of treating substance spent $225 million over its budget be- ida, his name was added as a cosponsor abuse and reuniting families, but most cause of a serious breakdown in its ac- of amendment No. 1330 intended to be facilities are struggling to make ends counting and financial management re- proposed to S. 1023, a bill to establish a meet. Many of the parents in treat- porting system. For fiscal year 1986, non-profit corporation to communicate ment are motivated by the hope of the Navy failed to disclose $58 million United States entry policies and other- overcoming their addiction and reunit- in real property, $1.7 billion in guaran- wise promote leisure, business, and ing with their children. This bill is de- teed loans, and data on operating scholarly travel to the United States. signed to give them that chance, and it leases on ships. According to the Gov- At the request of Mr. SANDERS, the will hopefully inspire them by allowing ernment Accountability Office, be- name of the Senator from Alaska (Mr. their children to be part of the recov- tween 1970 and 1980, the Air Force in- BEGICH) was added as a cosponsor of ery, in a completely safe environment. curred numerous over obligations in amendment No. 1330 intended to be pro- I urge my colleagues to support this amounts up to $210 million of its indus- posed to S. 1023, supra. important legislation to help keep fam- trial funds. This would never be toler- AMENDMENT NO. 1337 ilies together and provide another ated in the private sector. At the request of Ms. SNOWE, the funding source for these promising pro- This is not only about numbers and name of the Senator from Maryland grams for children and parents. audits—this is also about the security (Mr. CARDIN) was added as a cosponsor of our troops and our nation. These of amendment No. 1337 intended to be By Mr. MCCAIN (for himself, Mr. broken systems affect operations and proposed to S. 1023, a bill to establish a COBURN, and Mr. GRASSLEY): endanger our troops. Over the years, non-profit corporation to communicate S. 1287. A bill to provide for the audit the GAO has reported that the Penta- United States entry policies and other- of financial statements of the Depart- gon’s poor financial management has wise promote leisure, business, and ment of Defense for fiscal year 2017 and caused pay problems for National scholarly travel to the United States. fiscal years thereafter, and for other Guard and reservists; impeded delivery f purposes; to the Committee on Armed of food and other essential supplies to Services. U.S. troops; and had the Pentagon STATEMENTS ON INTRODUCED Mr. MCCAIN. Mr. President, today scrambling to identify and locate BILLS AND JOINT RESOLUTIONS Senators COBURN, GRASSLEY, and I are 250,000 defective chem-bio suits, some By Mr. ROCKEFELLER: introducing the Department of Defense of which were being sold over the Inter- S. 1286. A bill to amend part E of title Financial Accountability Act of 2009, net. IV of the Social Security Act to allow which imposes hard legislative dead- Let me read into the record one ac- children in foster care to be placed lines on the Department of Defense to count of how this impacted ongoing op- with their parents in residential family finally fix its broken bookkeeping sys- erations in Iraq. According to a Feb- treatment centers that provide safe en- tem. This legislation is not only nec- ruary 5, 2006 Star Tribune news article: vironments for treating addiction and essary, it is long overdue. ‘‘When Perry Jeffries was serving in promoting healthy parenting; to the The bill establishes a series of dead- Iraq, the computers showed that his Committee on Finance. lines, beginning next year and running 4th Infantry Division troops had access Mr. ROCKEFELLER. Mr. President, I through 2017, for DoD and the Services to drinking water, a place to shower rise today to introduce the Keeping to become audit ready. In particular, it and working wheels on their vehicles. Families Safe Act of 2009 which seeks compels the Services to account for As the first sergeant came to under- to keep families together when a par- military equipment, real property, in- stand when scrounging for water, tow- ent is in a comprehensive residential ventory, operating materials and sup- ing immobilized tanks and driving to family treatment program. Com- plies, environmental liabilities, and other posts or to Kuwait to pick up prehensive residential family treat- fund balances with Treasury. There- needed parts, the Pentagon’s book- ment is a unique program that serves after, DOD must undergo a full, inde- keeping doesn’t always match reality. parents and children together in a safe pendent audit of its financial state- Jefferies saw the real-life results of residential environment as the parent ments. If DoD fails to meet any dead- what has been a visible ‘accounting’ undergoes treatment for substance line set forth in the bill, it must timely problem in Washington—the Penta- abuse. document and explain its failure to gon’s inability to keep accurate track Such programs tend to be small, but Congress. of transactions and assets.’’ their results are impressive. One study The Department of Defense is the Congress has already enacted several found that 60 percent of mothers who most massive and complex of any orga- laws mandating financial management participated in the Pregnant and nization, public or private. It is en- reform and the Office of Management Postpartum Women and Their Infants trusted with more taxpayer dollars and Budget has issued circulars on in- program were completely clean and than any other federal department or ternal controls over financial reporting sober six months after their discharge. agency. For fiscal year 2009 alone, Con- and financial management systems. This same study found that 88 percent gress appropriated over $513 billion for Notably, none contain hard deadlines of these children were still with their DoD’s base budget. It added an addi- for an audit. mothers six months after the mother tional $7.4 billion for DoD in this year’s Meanwhile, DoD has repeatedly was discharged. However, only 5 per- so-called stimulus bill. promised Congress that it would fix the

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In 1999 and 2000, then-DoD be audited, and an opinion shall be rendered dated as ready for audit by not later than Comptroller William Lynn testified be- pursuant to such audit, for the first fiscal September 30, 2016. fore Congress that financial manage- year for which the financial statements are (B) AUDIT.—The financial statements of ment reform was his highest priority. ready for audit, but not later than fiscal the Department of the Air Force for a fiscal year 2017, and for each fiscal year thereafter. year shall be audited, and an opinion shall be In fact, Mr. Lynn’s successor, Dov (3) DEADLINE FOR AUDIT.—The audit of the rendered pursuant to such audit, for the first Zakheim, set a deadline to have the financial statements of the Department of fiscal year for which the financial state- Department of Defense audit ready by Defense shall be completed as follows: ments are ready for audit, but not later than 2007. Under DoD’s latest Financial Im- (A) In the event the financial statements fiscal year 2016, and for each fiscal year provement and Audit Readiness Plan, for a fiscal year before fiscal year 2017 are thereafter. that deadline is now 2017. ready for audit, by not later than two years (C) DEADLINE FOR AUDIT.—The audit of the I want to recognize that the Depart- after the last day of such fiscal year. financial statements of the Department of ment has tried, with varying degrees of (B) In the case of the financial statement the Air Force shall be completed as follows: effort, to improve financial manage- fiscal year 2017, by not later than September (i) In the event the financial statements 30, 2019. for a fiscal year before fiscal year 2016 are ment, but DoD auditors and GAO con- (C) In the case of the financial statement ready for audit, by not later than two years tinue to report significant weaknesses. for any fiscal year after fiscal year 2017, by after the last day of such fiscal year. I appreciate that our military is en- not later than one year after the last day of (ii) In the case of the financial statement gaged in ongoing operations in Iraq and such fiscal year. fiscal year 2016, by not later than September Afghanistan. That is why Senators (b) FINANCIAL STATEMENTS OF THE MILI- 30, 2018. COBURN, GRASSLEY and I have sought TARY DEPARTMENTS AND DLA.—In further- (iii) In the case of the financial statement to be reasonable and realistic with the ance of compliance with the requirements in for any fiscal year after fiscal year 2016, by deadlines. They are the same deadlines subsection (a), the following requirements not later than one year after the last day of shall apply: such fiscal year. in DoD’s current Financial Improve- (1) DEPARTMENT OF THE ARMY.— (4) DEFENSE LOGISTICS AGENCY.— ment and Audit Readiness Plan. (A) VALIDATION AS READY FOR AUDIT.—The (A) VALIDATION AS READY FOR AUDIT.—The It has been 19 years since the CFO financial statements of the Department of financial statements of the Defense Logistics Act was passed requiring DoD and the Army for a fiscal year shall be validated Agency for a fiscal year shall be validated as other departments to have an audit. It as ready for audit by not later than March ready for audit by not later than September will be 2019—nearly 30 years after the 31, 2017. 30, 2017. passage of the CFO Act—before the De- (B) AUDIT.—The financial statements of (B) AUDIT.—The financial statements of partment of Defense is able to get an the Department of the Army for a fiscal year the Defense Logistics Agency for a fiscal audit opinion, if we hold them to their shall be audited, and an opinion shall be ren- year shall be audited, and an opinion shall be dered pursuant to such audit, for the first rendered pursuant to such audit, for the first current timeline. If we do not, this fiscal year for which the financial state- fiscal year for which the financial state- may never happen. ments are ready for audit, but not later than ments are ready for audit, but not later than The ultimate outcome of this legisla- fiscal year 2017, and for each fiscal year fiscal year 2017, and for each fiscal year tion will be the implementation of ef- thereafter. thereafter. fective financial management proc- (C) DEADLINE FOR AUDIT.—The audit of the (C) DEADLINE FOR AUDIT.—The audit of the esses, efficient business systems and financial statements of the Department of financial statements of the Defense Logistics strong internal controls that are essen- Army shall be completed as follows: Agency shall be completed as follows: tial to producing timely, reliable and (i) In the event the financial statements (i) In the event the financial statements useful financial information. Quality for a fiscal year before fiscal year 2017 are for a fiscal year before fiscal year 2017 are ready for audit, by not later than two years ready for audit, by not later than two years information will allow DoD to make in- after the last day of such fiscal year. after the last day of such fiscal year. formed business decisions and ensure (ii) In the case of the financial statement (ii) In the case of the financial statement accountability on an ongoing basis. fiscal year 2017, by not later than September fiscal year 2017, by not later than September Every dollar we save through im- 30, 2019. 30, 2019. proved financial management is an- (iii) In the case of the financial statement (iii) In the case of the financial statement other dollar for our troops—for body for any fiscal year after fiscal year 2017, by for any fiscal year after fiscal year 2017, by armor, for medical supplies, for vet- not later than one year after the last day of not later than one year after the last day of erans care. Improved financial systems such fiscal year. such fiscal year. (2) DEPARTMENT OF THE NAVY.— (c) VALIDATION AS READY FOR AUDIT OF FI- will ensure that troops in the future do (A) VALIDATION AS READY FOR AUDIT.—The NANCIAL STATEMENTS REGARDING PARTICULAR not find themselves in the same straits financial statements of the Department of MATTERS.—In furtherance of compliance as the 4th Infantry Division, searching the Navy for a fiscal year shall be validated with the requirements in subsections (a) and for supplies that a computer says they as ready for audit by not later than March (b), the following requirements shall apply: already have. 31, 2016. (1) MILITARY EQUIPMENT.— Mr. President, I ask unanimous con- (B) AUDIT.—The financial statements of (A) DEPARTMENT OF THE ARMY.—The finan- sent that the text of the bill be printed the Department of the Navy for a fiscal year cial statements of the Department of the in the RECORD. shall be audited, and an opinion shall be ren- Army with respect to military equipment There being no objection, the text of dered pursuant to such audit, for the first shall be validated as ready for audit by not the bill was ordered to be printed in fiscal year for which the financial state- later than December 31, 2013. ments are ready for audit, but not later than (B) DEPARTMENT OF THE NAVY.—The finan- the RECORD, as follows: fiscal year 2016, and for each fiscal year cial statements of the Department of the S. 1287 thereafter. Navy with respect to military equipment Be it enacted by the Senate and House of Rep- (C) DEADLINE FOR AUDIT.—The audit of the shall be validated as ready for audit by not resentatives of the United States of America in financial statements of the Department of later than September 30, 2014. Congress assembled, Navy shall be completed as follows: (C) DEPARTMENT OF THE AIR FORCE.—The fi- SECTION 1. SHORT TITLE. (i) In the event the financial statements nancial statements of the Department of the This Act may be cited as the ‘‘Department for a fiscal year before fiscal year 2016 are Air Force with respect to military equip- of Defense Financial Accountability Act of ready for audit, by not later than two years ment shall be validated as ready for audit by 2009’’. after the last day of such fiscal year. not later than March 31, 2016. SEC. 2. AUDIT OF FINANCIAL STATEMENTS OF (ii) In the case of the financial statement (2) REAL PROPERTY.— THE DEPARTMENT OF DEFENSE. fiscal year 2016, by not later than September (A) DEPARTMENT OF THE ARMY.—The finan- (a) FINANCIAL STATEMENTS OF DEPARTMENT 30, 2018. cial statements of the Department of the OF DEFENSE.— (iii) In the case of the financial statement Army with respect to real property shall be (1) VALIDATION AS READY FOR AUDIT.—The for any fiscal year after fiscal year 2016, by validated as ready for audit by not later financial statements of the Department of not later than one year after the last day of than December 31, 2013. Defense for a fiscal year shall be validated as such fiscal year. (B) DEPARTMENT OF THE NAVY.—The finan- ready for audit by not later than September (3) DEPARTMENT OF THE AIR FORCE.— cial statements of the Department of the 30, 2017. (A) VALIDATION AS READY FOR AUDIT.—The Navy with respect to real property shall be (2) AUDIT.—The financial statements of the financial statements of the Department of validated as ready for audit by not later Department of Defense for a fiscal year shall the Air Force for a fiscal year shall be vali- than March 31, 2014.

VerDate Mar 15 2010 11:15 Oct 24, 2011 Jkt 079102 PO 00000 Frm 00062 Fmt 0685 Sfmt 0634 E:\BR09\S18JN9.002 S18JN9 wreier-aviles on DSK7SPTVN1PROD with BOUND RECORD June 18, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 12 15597 (C) DEPARTMENT OF THE AIR FORCE.—The fi- (D) DEFENSE LOGISTICS AGENCY.—The finan- S. 1289. A bill to improve title 18 of nancial statements of the Department of the cial statements of the Defense Logistics the United States Code; to the Com- Air Force with respect to real property shall Agency with respect to the fund balance mittee on the Judiciary. be validated as ready for audit by not later with the Treasury shall be validated as ready Mr. WHITEHOUSE. Mr. President, I than September 30, 2014. for audit by not later than September 30, rise to urge my colleagues to support (D) DEFENSE LOGISTICS AGENCY.—The finan- 2011. cial statements of the Defense Logistics (d) PERFORMANCE OF AUDITS AND VALIDA- the Foreign Evidence Request Effi- Agency with respect to real property shall be TIONS.—Any audit or validation as ready for ciency Act, which I have introduced on validated as ready for audit by not later audit of a financial statement required under behalf of myself and the Chairman and than March 31, 2015. subsections (a) through (c) may be performed Ranking Members of the Judiciary (3) INVENTORY.— by an independent auditor qualified for the Committee, Senators LEAHY and SES- (A) DEPARTMENT OF THE ARMY.—The finan- performance of such audit or validation, as SIONS. It has been a pleasure to work cial statements of the Department of the the case may be. with them on this truly bipartisan ef- Army with respect to inventory shall be vali- (e) ACTION IF COMPLIANCE NOT ACHIEVED.— dated as ready for audit by not later than (1) IN GENERAL.—In the event the Depart- fort, and I am grateful for their sup- March 31, 2017. ment of Defense or a component of the De- port. (B) DEPARTMENT OF THE NAVY.—The finan- partment of Defense is unable to achieve Chairman LEAHY, Ranking Member cial statements of the Department of the compliance with a requirement in subsection SESSIONS, and I have all served as pros- Navy with respect to inventory shall be vali- (a), (b), or (c) by the completion date for ecutors. I can say with no exaggeration dated as ready for audit by not later than such requirement otherwise specified in the that few responsibilities are more im- December 31, 2013. applicable provision of such subsection, the portant to the rule of law, to the secu- (C) DEPARTMENT OF THE AIR FORCE.—The fi- Secretary of Defense or the head of the com- rity of our communities, and to the nancial statements of the Department of the ponent, as applicable, shall submit to the ap- Air Force with respect to inventory shall be propriate committees of Congress, not later rights and freedoms that we enjoy as validated as ready for audit by not later than 30 days after the completion date other- Americans. I served as the U.S. Attor- than September 30, 2016. wise so specified, a report setting forth the ney for Rhode Island—Senator SES- (D) DEFENSE LOGISTICS AGENCY.—The finan- following: SIONS served in that capacity in Ala- cial statements of the Defense Logistics (A) A statement of the reasons why com- bama—and I know we both will always Agency with respect to inventory shall be pliance with the requirement was not remember the feeling of standing up in validated as ready for audit by not later achieved by the completion date for the re- than September 30, 2015. court to say: ‘‘Your Honor, may it quirement. please the Court, I represent the (4) OPERATING MATERIAL AND SUPPLIES.— (B) A description of the actions to be taken (A) DEPARTMENT OF THE ARMY.—The finan- to achieve compliance with the requirement. United States of America.’’ It was the cial statements of the Department of the (C) A proposed completion date for honor of a lifetime. Army with respect to operating material and achievement of compliance with the require- As my colleagues know, the United supplies shall be validated as ready for audit ment. States routinely helps foreign law en- by not later than March 31, 2017. (2) CONSTRUCTION.—Nothing in this sub- forcement agencies as they pursue (B) DEPARTMENT OF THE NAVY.—The finan- section shall be construed to waive any dead- criminal conduct involving activity cial statements of the Department of the line for the completion of a requirement outside their borders, including inside Navy with respect to operating material and under subsections (a) through (c). supplies shall be validated as ready for audit the United States, and they do the (f) SEMIANNUAL REPORTS ON FINANCIAL IM- same for us. This is exactly as it should by not later than March 31, 2016. PROVEMENT AUDIT READINESS PLAN.— (C) DEPARTMENT OF THE AIR FORCE.—The fi- (1) IN GENERAL.—Not later than May 15 and be. As the world grows more inter- nancial statements of the Department of the November 15 each year, the Under Secretary connected and crime becomes increas- Air Force with respect to operating mate- of Defense (Comptroller) shall submit to the ingly global, it becomes all the more rials and supplies shall be validated as ready appropriate committees of Congress a report important for law enforcement agen- for audit by not later than September 30, on progress under the financial improvement cies in the United States and around 2016. audit readiness (FIAR) plan during two cal- (5) ENVIRONMENTAL LIABILITIES.— the world to work together to bring endar year quarters ending March 31 and criminals to justice. Otherwise, it (A) DEPARTMENT OF THE ARMY.—The finan- September 30, respectively, of such year. cial statements of the Department of the would be very hard to build cases (2) ELEMENTS.—Each report under para- Army with respect to environmental liabil- graph (1) shall include, for the two calendar against international organized crime ities shall be validated as ready for audit by year quarters covered by such report, the fol- organizations, drug cartels, purveyors not later than December 31, 2013. lowing with respect to the portion of such re- of child pornography on the internet, (B) DEPARTMENT OF THE NAVY.—The finan- port relating to priority segments: and other criminal threats from out- cial statements of the Department of the (A) A detailed description of any defi- Navy with respect to environmental liabil- side our borders. ciencies identified during discovery. ities shall be validated as ready for audit by One way that a law enforcement (B) A description of the actions to be taken not later than March 31, 2010. agency provides assistance to another to remedy any deficiency so identified. (C) DEPARTMENT OF THE AIR FORCE.—The fi- is by gathering evidence from within (C) A deadline for the completion of any nancial statements of the Department of the its borders that a foreign law enforce- Air Force with respect to environmental li- actions set forth under subparagraph (B). (g) DEFINITIONS.—In this section: ment agency needs to prosecute a case. abilities shall be validated as ready for audit (1) APPROPRIATE COMMITTEES OF CON- The United States routinely completes by not later than December 31, 2011. GRESS.—The term ‘‘appropriate committees requests submitted to it by foreign law (D) DEFENSE LOGISTICS AGENCY.—The finan- of Congress’’ means— cial statements of the Defense Logistics enforcement agencies just as it re- Agency with respect to environmental liabil- (A) the Committee on Armed Services and ceives comparable assistance when it ities shall be validated as ready for audit by the Committee on Homeland Security and makes evidence requests in foreign not later than September 30, 2017. Governmental Affairs of the Senate; and countries. For example, let’s assume (B) the Committee on Armed Services and (6) FUND BALANCE WITH THE TREASURY.— the Committee on Oversight and Govern- that Spanish authorities are inves- (A) DEPARTMENT OF THE ARMY.—The finan- ment Reform of the House of Representa- tigating a complicated financial fraud cial statements of the Department of the that is being conducted over the inter- Army with respect to the fund balance with tives. the Treasury shall be validated as ready for (2) VALIDATION.—The term ‘‘validation’’, net, apparently from a base in the audit by not later than September 30, 2010. with respect to the auditability of financial United States. After conducting their (B) DEPARTMENT OF THE NAVY.—The finan- statements, means a determination fol- investigation in Spain, the Spanish au- cial statements of the Department of the lowing an examination engagement that the thorities submit a request to the Navy with respect to the fund balance with financial statements comply with generally United States for financial records, the Treasury shall be validated as ready for accepted accounting principles and applica- ble laws and regulations and reflect reliable internet records, and various other audit by not later than December 31, 2010. kinds of evidence. U.S. Attorneys re- (C) DEPARTMENT OF THE AIR FORCE.—The fi- internal controls. nancial statements of the Department of the view the requests and then seek war- Air Force with respect to the fund balance By Mr. WHITEHOUSE (for him- rants for the evidence as appropriate. with the Treasury shall be validated as ready self, Mr. SESSIONS, and Mr. When the evidence is collected, the for audit by not later than December 31, 2011. LEAHY): United States transmits it to Spanish

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authorities, leading to prosecution in Ranking Member SESSIONS for their section 2703(a) requires that the court Spanish courts. support. issuing a search warrant for stored elec- This process sounds quite simple, but Mr. President, I ask unanimous con- tronic evidence have ‘‘jurisdiction over the unfortunately in practice it is ex- offense’’. As a U.S. court often has no juris- sent that a letter of support be printed diction to try a foreign offender, the wording tremely cumbersome. This is because in the RECORD. of 2703(a) needlessly complicates the use of under the existing rules, any foreign There being no objection, the mate- this sort of court process. evidence request must be split up and rial was ordered to be printed in the The proposed legislation addresses both of sent to each district where the evi- RECORD, as follows: these difficulties by clarifying which courts dence exists. So take the Spanish ex- U.S. DEPARTMENT OF JUSTICE, have jurisdiction and can respond to appro- priate foreign requests for evidence in crimi- ample I just gave, and imagine that the OFFICE OF LEGISLATIVE AFFAIRS, Washington, D.C., March 27, 2009. nal investigations. Under this proposal, a le- financial records sought are in banks gitimate request for assistance can be filed in six different federal judicial dis- Hon. SHELDON WHITEHOUSE, U.S. Senate, in the District of Columbia, in any of the dis- tricts, that the internet records are in Washington, DC. tricts in which any of several records or wit- nesses are located, or in any district in another five federal judicial districts, DEAR SENATOR WHITEHOUSE: Per your re- which there is a related federal criminal and that other documentary evidence quest, the Department of Justice (the De- case. The proposal would clarify the ambi- is spread over another five districts. partment) has examined the draft bill enti- guity in section 2703 by re-articulating the tled ‘‘To improve Title 18 of the United Under existing law, sixteen different bases for courts to act without changing any U.S. Attorneys’ Offices would have to States Code’’. The Department strongly sup- of the procedural safeguards present in U.S. work on the evidence request. This is ports early introduction and consideration of law. incredibly inefficient and burdensome the proposed legislation ‘‘[t]o improve title We note that the proposed legislation 18 of the United States Code’’ which clarifies for U.S. Attorneys across the country. would not in any way change the existing procedures for executing and fulfilling for- standards that the government must meet in The Foreign Evidence Request Effi- eign requests for evidence. We firmly believe ciency Act would end this problem by order to obtain evidence, nor would it alter this legislation will facilitate the ability of any existing safeguards on the proper exer- allowing such foreign evidence requests the United States to assist foreign investiga- cise of such authority. Moreover, it would to be handled centrally, by a single or tions, prosecutions and related proceedings not expand the nature or kind of assistance more limited number of U.S. Attorneys involving organized crime, trafficking in the Department provides to foreign law en- offices as appropriate. Why, as in my child pornography, intellectual property vio- forcement agencies. Indeed, the proposed leg- example, should sixteen U.S. Attor- lations, identity theft, and all other serious islation would not alter U.S. obligations or neys’ Offices have to deal with an evi- crimes. The ability of the United States to authorities under existing bilateral and mul- assist foreign authorities to obtain evidence tilateral law enforcement treaties. Instead, dence request that one office can co- and other assistance in an effective and by streamlining procedures, the amendment ordinate? Simply put, this reform timely manner will improve reciprocal treat- would eliminate needless confusion and would make life easier for our U.S. At- ment when we seek assistance in foreign wasted time in the government’s response to torneys. We owe them no less. countries in all types of U.S. criminal inves- those requests. Of course, respect for civil liberties tigations. Thus, facilitating our ability to The proposed legislation references ‘‘pro- demands that we not suddenly change provide assistance to foreign investigators vider of electronic communication service’’. the types of evidence that foreign gov- has a direct impact on the safety and secu- The current reference, however, fails to ad- rity of Americans. dress the presence of wire services, though 18 ernments may receive from the United U.S.C. 3124(a), (b) references ‘‘provider of States or reduce the role of courts as The proposed legislation will complement the existing authority in current statutes wire or electronic service’’. To provide con- gatekeepers for searches. The Foreign and self-executing Mutual Legal Assistance sistency throughout Title 18, United States Evidence Request Efficiency Act would Treaties and multilateral conventions. It Code, and to cover more fully the providers leave those important protections in will greatly facilitate the ability of the U.S. involved, the Department recommends add- place, while simultaneously reducing government to meet its obligations under ing ‘‘wire or’’ before ‘‘electronic communica- the paperwork that the cumbersome these valuable international instruments tion service’’ each place it appears. Thank you for the opportunity to com- existing process imposes on our U.S. and will ensure that we can provide, at our discretion, similar assistance to our non- ment on this proposed legislation. The Office Attorneys. of Management and Budget has advised that Two points merit emphasis. First, by treaty foreign law enforcement partners. In addition, the filing provision of the new sec- there is no objection from the standpoint of making it easier for U.S. Attorneys to tion 3512 will permit the U.S. government to the Administration’s program to the submis- collect evidence, the United States can execute foreign assistance requests with sion of this letter. respond more quickly to foreign re- greater efficiency than at present, thereby Sincerely, quests for evidence. Setting a high contributing to the effective administration M. FAITH BURTON, standard of responsiveness will allow of the federal courts and the Offices of the Acting Assistant Attorney General. the United States to urge that foreign United States Attorneys. The statutes that currently govern the ob- By Ms. KLOBUCHAR (for herself, authorities respond to our requests for Mr. GRASSLEY, and Mrs. FEIN- evidence with comparable speed. The taining of electronic and other evidence based upon a foreign request for evidence STEIN): United States will benefit if foreign have two limitations. First, existing law S. 1292. A bill to amend the Con- governments cannot use our own delay does not make it clear which district court trolled Substances Act to provide for to justify responding slowly to our re- can participate in fulfilling legitimate for- take-back disposal of controlled sub- quests. Second, the Foreign Evidence eign requests for assistance in criminal and stances in certain instances, and for Request Efficiency Act would not terrorism investigations. The sole statute re- other purposes; to the Committee on change the United States’ obligations garding international requests for evidence the Judiciary. to foreign nations. It would only make is 28 U.S.C. § 1782, which was designed essen- Mr. GRASSLEY. Mr. President, I am it easier for the United States to re- tially to accommodate the execution of let- pleased to join my colleagues, Senator ters rogatory in civil cases via the issuance spond to these requests by allowing of subpoenas. Under the statute, the Depart- KLOBUCHAR, and Senator FEINSTEIN, in them to be centralized and by putting ment is largely relegated to civil practice introducing the Secure and Responsible the process for handling them within a rules that require prosecutors to file in every Drug Disposal Act of 2009. The abuse of clear statutory system. district in which evidence or a witness may prescription narcotics such as pain re- I urge my colleagues to act promptly be found. In complex cases, this inefficiency lievers, tranquilizers, stimulants, and on this bipartisan legislation. I would means involving several U.S. Attorneys’ Of- sedatives is currently the fastest grow- like to thank the excellent attorneys fices and District Courts in a single case. ing drug abuse trend in the country. in the Department of Justice who have Even in less complex cases, referring the re- According to the most recent National worked with me on this legislation, quests out to the field wastes scarce attor- ney resources and creates delays. Survey of Drug Use and Health, and would like to request unanimous Second, in 2001, Congress changed the NSDUH, nearly 7 million people have consent to insert their letter of support wording of 18 U.S.C. § 2703 in a way that inad- admitted to using controlled sub- into the CONGRESSIONAL RECORD. I vertently introduced confusion in routine stances without a doctor’s prescrip- again thank Chairman LEAHY and mutual legal assistance cases. For example, tion. People between the ages of 12 and

VerDate Mar 15 2010 11:15 Oct 24, 2011 Jkt 079102 PO 00000 Frm 00064 Fmt 0685 Sfmt 0634 E:\BR09\S18JN9.002 S18JN9 wreier-aviles on DSK7SPTVN1PROD with BOUND RECORD June 18, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 12 15599 25 are the most common group to abuse any specific method of disposal upon the school meal enrollment process, these drugs. However, more and more communities. This will enable commu- our bill includes performance awards people are dying because of this abuse. nities to develop methods of disposal for the five states which make the best The Centers for Disease Control and best suited for their areas while mini- use of direct certification and for the Prevention report that the uninten- mizing the pollution of water supplies five states which show the most im- tional deaths involving prescription or increasing the chances that these provement from one school year to the narcotics increased 117 percent from drugs will be diverted for abuse. Since next. Additionally, our bill requires the years 2001 to 2005. These are statis- most long-term care facilities store states which are unable to meet the 95 tics that can no longer be ignored. large amounts of prescription narcotics percent standard to submit a report to Millions of Americans are prescribed for their tenants but are unable to le- Congress and the U.S. Department of controlled substances every year to gally dispose of them the bill also en- Agriculture that identifies the chal- treat a variety of symptoms due to in- ables these facilities to dispose of old lenges prohibiting effective use of di- jury, depression, insomnia, and other medication on behalf of their past and rect certification and maps out a plan conditions. Many legitimate users of current patients. for improvement. these drugs often do not finish their This legislation will not cost the gov- As former Superintendent of Denver prescriptions. As a result, these drugs ernment any money to implement and Public Schools I cannot stress enough remain in the family medicine cabinet would not place any financial burden the importance of reducing red tape for months or years because people for- on states or industries. It simp ives and administrative costs in schools. We get about them or do not know how to local communities the option to safely cannot expect our children to focus on fractions when their stomachs are properly dispose of them. However, dispose of unused controlled sub- growling nor can we expect teachers, these drugs, when not properly used or stances. I am pleased that the Depart- principals and school administrators to administered, are just as addictive and ment of Justice has endorsed this legis- prepare our children to be tomorrow’s deadly as street drugs like meth- lation. They and many others out there leaders if they are spending their time amphetamine or cocaine. know how serious the abuse of pre- filling out paperwork. That’s why mod- According to the NSDUH, more than scription narcotics has become in this ernizing the National School Lunch half of the people who abuse prescrip- country. Now is the time to act, and I and Breakfast programs is one of my tion narcotics reported that they ob- urge my colleagues to join us in sup- top priorities for the child nutrition re- tained controlled substances from a porting the Safe and Responsible Drug authorization this Fall and that is why friend or relative or from the family Disposal Act of 2009. medicine cabinet. As a result, most I am introducing this bill today. Two additional provisions in the bill community anti-drug coalitions, public By Mr. BENNET (for himself, Mr. would eliminate paperwork and im- health officials, and law enforcement BROWN, and Mr. CASEY): prove the existing system of deter- officials have been encouraging people S. 1293. A bill to amend the Richard mining whether or not kids qualify for within their communities to dispose of B. Russell National School Lunch Act free meals. The first is a clarification to improve automatic enrollment pro- old or unused medications in an effort that sending a letter in the mail to a cedures for the national school lunch to combat this growing trend. child’s household letting them know Despite these ongoing efforts across and school breakfast programs, and for they are eligible for free school meals the country to eliminate a primary other purposes; to the Committee on is not an acceptable means of direct source of prescription narcotics from Agriculture, Nutrition, and Forestry. certification. A child who can be en- within their communities, many people Mr. BENNET. Mr. President, I rise rolled for free school meals automati- are finding the Controlled Substances today to introduce a bill with Senators cally should be enrolled without any BROWN of Ohio and CASEY of Pennsyl- Act, CSA, is making these efforts dif- action on behalf of the child’s house- vania called the Enhancing Child ficult. When the CSA was passed in the hold. We make this clarification be- Health with Automatic Enrollment for early 1970’s many people did not antici- cause a vast number of paper notifica- pate the large amount of prescription School Meals Act. We wrote this legis- tions sent to families are not returned narcotics that would be used today or lation because too many kids across and, therefore, kids miss out on meals the high potential for these drugs to be this country are not getting the free they should receive. diverted and abused. Under the CSA, school meals their families are quali- The second is a request for a study most people who legally possess con- fied to receive. As members of the Ag- from the U.S. Department of Education trolled substances cannot legally riculture Committee’s subcommittee that would help determine how data transfer them to anyone for any pur- on Nutrition, Senators BROWN, CASEY the Department of Education is cur- pose, including for the purpose of dis- and I share an interest in eradicating rently collecting is being used cur- posal. Because the legal method for childhood hunger and increasing the ef- rently and could be used in the future disposal is unclear, communities inter- ficiency of the National School Lunch to ensure all kids who should receive ested in providing citizens with an easy and Breakfast programs. free school meals are provided those process of disposal hesitate to do so or Our bill builds on the foundation laid meals. risk violation of the CSA to offer the during the 2004 child nutrition reau- Initially, Senators BROWN, CASEY and service. We need to change the CSA so thorization which included a manda- I were working on ways to expand ac- that unused controlled substances do tory phase-in of an automatic enroll- cess to free school meals independ- not get diverted in to the stream of il- ment process called ‘direct certifi- ently, but now we are working collabo- licit drug use and to prevent potential cation.’ Our bill stipulates that ratively. Meeting President Obama’s environmental harms, as many people schools, districts, and states must di- goal of ending childhood hunger by 2015 dispose of controlled substances by rectly certify at least 95 percent of will require all hands on deck. Last flushing them down the toilet or dump- children who can be enrolled in the na- week Senator CASEY, along with Sen- ing them in unlined landfills. tional school lunch and breakfast pro- ator SPECTER and myself, introduced Accordingly, Senator KLOBUCHAR, grams using this method. The intent of the Paperless Enrollment for School Senator FEINSTEIN and I are intro- this provision is to modernize the en- Meals Act to make it easier for schools ducing the Secure and Responsible rollment process by reducing reliance and districts to serve free meals to all Drug Disposal Act of 2009 to fix the on paper applications and to improve children. The bill we are introducing CSA so these efforts to eradicate abuse access to school meal programs by en- today is yet another installment in the are not impeded by federal law. This suring kids who should be receiving ongoing dialog with Chairman HARKIN, legislation will amend the CSA to free school meals actually receive members of the Agriculture Committee allow a user to transfer unused con- them. and the USDA in preparation for reau- trolled substances to a DEA sanctioned Because we want to reward achieve- thorizing child nutrition and WIC pro- entity for disposal without mandating ment and encourage improvements to grams in the coming months.

VerDate Mar 15 2010 11:15 Oct 24, 2011 Jkt 079102 PO 00000 Frm 00065 Fmt 0685 Sfmt 0634 E:\BR09\S18JN9.002 S18JN9 wreier-aviles on DSK7SPTVN1PROD with BOUND RECORD 15600 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 12 June 18, 2009 In Colorado and around the nation Food, Conservation, and Energy Act of 2008 (c) FUNDING.— there is a renewed call for common (42 U.S.C. 1758a), States that directly certify (1) IN GENERAL.—On October 1, 2009, out of sense measures to improve existing less than 95 percent of the total number of any funds in the Treasury not otherwise ap- programs and provide assistance to children in the State who are eligible for di- propriated, the Secretary of the Treasury rect certification under this paragraph; and shall transfer to the Secretary to carry out those who need them most during these ‘‘(II) require the States identified under this section $500,000, to remain available tough economic times. I encourage all subclause (I) to implement a corrective ac- through September 30, 2012. Senators to do right by our children tion plan to fully meet the requirements of (2) RECEIPT AND ACCEPTANCE.—The Sec- and support this legislation and the this paragraph. retary shall be entitled to receive, shall ac- principles of the National School ‘‘(ii) IMPROVING PERFORMANCE.—A State cept, and shall use to carry out this section Lunch and Breakfast Programs Sen- may include in a corrective action plan the funds transferred under paragraph (1), ators BROWN, CASEY and I have out- under clause (i)(II) methods to improve di- without further appropriation. lined. rect certification required under this para- graph or paragraph (15) and discretionary By Mrs. SHAHEEN (for herself, Mr. President, I ask unanimous con- certification under paragraph (5). Ms. COLLINS, and Mrs. LINCOLN): sent that the text of the bill be printed ‘‘(iii) FAILURE TO MEET PERFORMANCE S. 1295. A bill to amend title XVIII of in the RECORD. STANDARD.— the Social Security Act to cover tran- There being no objection, the text of ‘‘(I) IN GENERAL.—A State that is required sitional care services to improve the the bill was ordered to be printed in to implement a corrective action plan under quality and cost effectiveness of care clause (i)(II) shall be required to submit to the RECORD, as follows: under the Medicare program; to the S. 1293 the Secretary, for the approval of the Sec- retary, a direct certification improvement Committee on Finance. Be it enacted by the Senate and House of Rep- plan for the following school year. Mrs. SHAHEEN. Mr. President, I rise resentatives of the United States of America in ‘‘(II) REQUIREMENTS.—A direct certifi- today to introduce the Medicare Tran- Congress assembled, cation improvement plan under subclause (I) sitional Care Act of 2009. Time and SECTION 1. SHORT TITLE. shall include— again, we have heard that our health This Act may be cited as the ‘‘Enhancing ‘‘(aa) specific measures that the State will care system is not working. Costs are Child Health with Automatic School Meal use to identify more children who are eligi- too high, outcomes too poor and access Enrollment Act of 2009’’. ble for direct certification; too limited. I agree with so many of SEC. 2. IMPROVING DIRECT CERTIFICATION. ‘‘(bb) a timeline for the State to imple- my colleagues that we need to work to- (a) PERFORMANCE AWARDS.—Section 9(b)(4) ment those measures; and of the Richard B. Russell National School ‘‘(cc) goals for the State to improve direct gether to ensure that all Americans Lunch Act (42 U.S.C. 1758(b)(4)) is amended— certification results.’’. have access to quality and affordable (1) in the paragraph heading, by striking (c) WITHOUT FURTHER APPLICATION.—Sec- health care. ‘‘FOOD STAMP’’ and inserting ‘‘SUPPLEMENTAL tion 9(b)(4) of the Richard B. Russell Na- Everyone deserves stable health care NUTRITION ASSISTANCE PROGRAM’’; and tional School Lunch Act (42 U.S.C. 1758(b)(4)) coverage that they can count on, re- (2) by adding at the end the following: (as amended by subsection (b)) is amended by gardless of the job they hold or the ‘‘(E) PERFORMANCE AWARDS.— adding at the end the following: curveballs life may throw. All Ameri- ‘‘(i) IN GENERAL.—Effective for each of the ‘‘(G) WITHOUT FURTHER APPLICATION.— cans should be able to count on insur- schools years beginning July 1, 2010, July 1, ‘‘(i) IN GENERAL.—In this paragraph, the ance premiums and deductibles that term ‘without further application’ means 2011, and July 1, 2012, the Secretary shall will not continue to rise and eat away offer performance awards to States to en- that no action is required by the household courage the States to ensure that all chil- of the child. more and more of our paychecks. Fi- dren eligible for direct certification under ‘‘(ii) CLARIFICATION.—A requirement that a nally, all Americans deserve stable this paragraph are certified in accordance household return a letter notifying the care that lets you keep your doctor, with this paragraph. household of eligibility for direct certifi- and your health care plan, that you ‘‘(ii) REQUIREMENTS.—For each school year cation or eligibility for free school meals trust and with whom you have built a described in clause (i), the Secretary shall— does not meet the requirements of clause relationship. ‘‘(I) consider State data from the prior (i).’’. Let me be clear: health care costs are school year, including estimates contained SEC. 3. REPORT ON USING STATEWIDE EDU- too high. Every day in New Hampshire in the report required under section 4301 of CATION DATABASES FOR DIRECT the Food, Conservation, and Energy Act of CERTIFICATION. and across our country, families are 2008 (42 U.S.C. 1758a); and (a) REPORT.—Not later than 2 years after struggling with the crushing cost of ‘‘(II) make performance awards to, as de- the date of enactment of this Act, the Sec- health care that threatens their finan- termined by the Secretary— retary of Education shall prepare and submit cial stability, leaving them exposed to ‘‘(aa) 5 States that demonstrate out- to Congress a report regarding how statewide higher premiums and deductibles, and standing performance; and databases developed by States to track com- putting them at risk for a possible loss ‘‘(bb) 5 States that demonstrate substan- pliance with the requirements of part A of of health insurance coverage and even tial improvement. title I of the Elementary and Secondary Edu- bankruptcy. In 2007 our Nation spent ‘‘(iii) FUNDING.— cation Act of 1965 (20 U.S.C. 6311 et seq.) can $2.2 trillion—or 16.2 percent of the GDP ‘‘(I) IN GENERAL.—On October 1, 2009, and be used for purposes of direct certification on each October 1 thereafter through Octo- under section 9(b) of the Richard B. Russell on health care. This is twice the aver- ber 1, 2011, out of any funds in the Treasury National School Lunch Act (42 U.S.C. age of other developed nations. As a not otherwise appropriated, the Secretary of 1758(b)). Nation, our health outcomes are no the Treasury shall transfer to the Secretary, (b) CONTENTS.—The report described in sub- better. We still lag behind other coun- to remain available until expended— section (a) shall— tries when it comes to efficiency, ac- ‘‘(aa) $2,000,000 to carry out clause (ii)(I); (1) identify the States that have, as of the cess, patient safety and adoption of in- and time of the report, developed statewide data- formation technology. ‘‘(bb) $2,000,000 to carry out clause (ii)(II). bases to track compliance with the require- It is essential that we cut our Na- ‘‘(II) RECEIPT AND ACCEPTANCE.—The Sec- ments of part A of title I of the Elementary retary shall be entitled to receive, shall ac- and Secondary Education Act of 1965 (20 tion’s health care costs and improve cept, and shall use to carry out this clause U.S.C. 6311 et seq.); the quality of care our patients re- the funds transferred under subclause (I), (2) describe best practices regarding how ceive. without further appropriation.’’. such statewide databases can be used for pur- I rise today to offer a solution that (b) CORRECTIVE ACTION PLANS.—Section poses of direct certification under section can help address this crisis. I rise to in- 9(b)(4) of the Richard B. Russell National 9(b) of the Richard B. Russell National troduce the Medicare Transitional Care School Lunch Act (42 U.S.C. 1758(b)(4)) (as School Lunch Act (42 U.S.C. 1758(b)); Act of 2009—legislation that will reduce amended by subsection (a)) is amended by (3) include case studies of States that have costly hospital readmissions, improve adding at the end the following: expanded such statewide databases so that Medicare patients’ care and cut Medi- ‘‘(F) CORRECTIVE ACTION PLANS.— such statewide databases can be used for di- LU ‘‘(i) IN GENERAL.—Each school year, the rect certification purposes; and care costs. I thank Representative B - Secretary shall— (4) identify States with such statewide MENAUER and Representative BOUSTANY ‘‘(I) identify, using estimates contained in databases that would be appropriate for ex- for their leadership on this issue in the the report required under section 4301 of the pansion for direct certification purposes. House and I am pleased to be joined by

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colleagues, Senator COLLINS, and Sen- Under the Medicare Transitional conditions accounted for 75 percent of total ator LINCOLN, in introducing this legis- Care Act, a transitional care clinician Medicare spending. The vast majority of lation. would help ensure that appropriate fol- these costs were due to high rates of hospital This bill is about reducing costs and low-up care is provided to patients dur- admission and readmission. offering better support and coordina- (5) According to Medicare claims data from ing the vulnerable time after discharge 2003–2004, almost one fifth (19.6 percent) of tion of care to Medicare patients. It from a hospital—and help ensure that the 11,855,702 Medicare beneficiaries who had will help keep seniors who are dis- they are not re-hospitalized unneces- been discharged from a hospital were re- charged from the hospital from going sarily. hospitalized within 30 days, and 34.0 percent back. Simply put, it will improve the The benefit would be phased-in and were rehospitalized within 90 days. health care we offer our seniors while provided first for the most at-risk indi- (6) A New England Journal of Medicine saving money. viduals. It will be tailored to their study estimates that the cost to Medicare of According to a report from the New needs. It may be as simple as making unplanned rehospitalizations in 2004 was England Journal of Medicine, almost $17.4 billion. sure each patient understands how and (7) The MetLife Caregiving Cost Study one third of Medicare beneficiaries dis- when to take their medication; or help- charged from the hospital were re-hos- demonstrates that American businesses lose ing to make sure they schedule and are an estimated $34 billion each year due to em- pitalized within 90 days. One half of the able to get to follow-up appointments ployees’ need to care for loved ones. individuals re-hospitalized had not vis- with the doctors, or it may be helping (8) The Transitional Care Model, developed ited a physician since their discharge, patients and caregivers coordinate sup- by the University of Pennsylvania, is a care indicating a lack of follow-up care. The port services, such as medical equip- management strategy that identifies pa- study also estimated that in 2004 Medi- ment, meal delivery, transportation or tients’ health goals, coordinates care throughout acute episodes of illness, devel- care spent $17.4 billion on unplanned assistance with other daily activities. re-hospitalizations. This problem is ops a streamlined plan of care to prevent fu- I am pleased that the legislation has ture hospitalizations, and prepares the bene- costly for our government and trouble- the strong support of the AARP. some for our seniors. But the good ficiary and family caregivers to implement Proper transitional care is important this care plan. news is that this problem is avoidable. not only to reduce hospital readmis- (9) The major goal of the Transitional Care Research shows that the transition sions, but also to improve patient out- Model is to interrupt cycles of avoidable hos- from the hospital to the patient’s next comes and satisfaction. Experts esti- pitalizations and promote longer-term posi- place of care—be it home, or a nursing mate that this legislation could save as tive health outcomes. facility or rehabilitation center—can (10) The Transitional Care Model has much as $5,000 per Medicare bene- be complicated and risky. This is espe- shown through multiple randomized clinical ficiary. cially true for older individuals with trials to produce significant health outcome I look forward to working with my multiple chronic illnesses. These pa- improvements, reductions in health care colleagues in the Senate to pass com- tients talk about the difficulty remem- costs among at-risk and chronically ill older prehensive health care reform to fix adults, and increased patient satisfaction. bering instructions, confusion over cor- our broken system. I urge them to join (11) Preliminary results from a clinical rect use of medications, and general me in supporting a transitional care trial of the Guided Care Model (based on a uncertainty about their own condi- Medical Home which includes transitional tions. benefit that will support patients dur- ing the very vulnerable time after dis- care) demonstrated reductions in hospital For example, take Michael, a 71-year- days, skilled nursing facility days, and home old patient who lives with his 73-year- charge from the hospital. The evidence health episodes, as well as preliminary find- old wife, and has diabetes. Michael had is clear. We can implement a transi- ings of net savings. a knee replacement that required two tional care option that will save money (12) A clinical trial of the Care Transitions surgical revisions. He uses a walker by reducing hospital re-admisssions Intervention demonstrated lower re-hos- and has been hospitalized four times. while improving the quality of care we pitalization rates and lower hospital costs per patient. He says ‘‘they would discharge me and deliver to patients in New Hampshire the same day I’d be back in the ER. and all across this country. SEC. 3. MEDICARE COVERAGE OF TRANSITIONAL The wound would burst apart.’’ Under Mr. President, I ask unanimous con- CARE. this legislation, a transitional care cli- sent that the text of the bill be printed Title XVIII of the Social Security Act is nician could be there to help make sure in the RECORD. amended by adding at the end the following that Michael and his wife do not need There being no objection, the text of new section: the bill was ordered to be printed in to go back to the hospital. ‘‘COVERAGE OF TRANSITIONAL CARE SERVICES Let me also tell you about Bill. Over the RECORD, as follows: FOR QUALIFIED INDIVIDUALS time, Bill has endured a heart attack S. 1295 ‘‘SEC. 1899. (a) COVERAGE UNDER PART B.— that required open heart surgery, Be it enacted by the Senate and House of Rep- ‘‘(1) IN GENERAL.—In the case of a qualified resentatives of the United States of America in angioplasty with stent placement, individual (as defined in subsection (b)), the Congress assembled, stroke, kidney disease, HIV and depres- Secretary shall provide under part B for ben- sion. He has been hospitalized three SECTION 1. SHORT TITLE. efits for transitional care services (as defined times, underwent rehabilitation ther- This Act may be cited as the ‘‘Medicare in subsection (c)) furnished by a transitional apy in an inpatient facility once and Transitional Care Act of 2009’’. care clinician (as defined in subsection (d)) lives alone. He says ‘‘there was no help SEC. 2. FINDINGS. acting as an employee of (or pursuant to a at home [after surgery]. My mother Congress finds the following: contract with) a qualified transitional care came and took care of household stuff. (1) More than 20 percent of older Ameri- entity (as defined in paragraph (3)(A)) in ac- I was flat on my back for two weeks. cans suffer from five or more chronic condi- cordance with this section during the transi- tions and these older adults typically require tional care period (as defined in paragraph The hospital called to make sure I was health care services from numerous pro- (3)(B)) for the qualified individual. okay—‘Hey how are you doing?’—but viders across several care settings each year. ‘‘(2) INITIAL IMPLEMENTATION.—The Sec- what could they do?’’ Bill also notes (2) Insufficient communication among retary shall first implement this section for the difficulty he had with discharge in- older adults, family caregivers, and health services furnished on or after January 1, 2010. structions: ‘‘By the time I’m home,’’ he care providers contributes to poor continuity ‘‘(3) GENERAL DEFINITIONS.—In this section: says, ‘‘I don’t remember what the doc- of care, inadequate management of complex ‘‘(A) QUALIFIED TRANSITIONAL CARE ENTI- tor said. Sometimes they write it health care needs, and preventable hospital TY.—The term ‘qualified transitional care down, but I have comprehension prob- admissions. entity’ means— lems.’’ (3) Research suggests that family care- ‘‘(i) a hospital or a critical care hospital; givers often lack the knowledge, skills, and ‘‘(ii) a home health agency; Stories like Bill’s and Michael’s dem- resources to effectively address the complex ‘‘(iii) a primary care practice; onstrate that patients need support needs of older adults coping with multiple ‘‘(iv) a Federally qualified health center; and assistance to manage their health coexisting conditions. or needs along with their caregivers. This (4) In 2005, health care services for Medi- ‘‘(v) another entity approved by the Sec- legislation provides that opportunity. care beneficiaries with five or more chronic retary for purposes of this section.

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‘‘(B) TRANSITIONAL CARE PERIOD.—The term ‘‘(B) teaching and promoting self-manage- ‘‘(3) ENCOURAGEMENT OF HIT.—The Sec- ‘transitional care period’ means, with re- ment skills for the individual and any pri- retary may provide for an additional pay- spect to a qualified individual, the period— mary caregiver; ment to encourage transitional care clini- ‘‘(i) beginning on the date the individual is ‘‘(C) teaching and counseling the indi- cians and qualified transitional care entities admitted to a subsection (d) hospital (as de- vidual and the individual’s primary care- to use health information technology in the fined for purposes of section 1886) for inpa- giver (as appropriate) to assure adherence to provision of transitional care services. tient hospital services, or is admitted to a medications and other therapies and avoid ‘‘(e) PAYMENT.— critical care hospital for inpatient critical adverse events; ‘‘(1) IN GENERAL.—The Secretary shall de- access hospital services, for which payment ‘‘(D) promoting individual access to pri- termine the method of payment for transi- may be made under this title; and mary care and community-based services; tional care services under this section, in- ‘‘(ii) ending on the last day of the 90-day ‘‘(E) coordinating services provided by cluding appropriate risk adjustment that re- period beginning on the date of the individ- other health team members and community flects the differences in resources needed to ual’s discharge from such hospital or critical caregivers; and provide transitional care services to individ- care hospital. ‘‘(F) facilitating transitions to palliative uals with differing characteristics and cir- or hospice care, where appropriate. cumstances and, when applicable, the per- ‘‘(b) QUALIFIED INDIVIDUALS.— ‘‘(6) Accompanying the individual to fol- formance measures under subsection (f). The ‘‘(1) LIMITING FIRST PHASE OF IMPLEMENTA- low-up physician visits, as appropriate. payment amount shall be sufficient to en- TION TO HIGH-RISK INDIVIDUALS.—Except as ‘‘(7) Providing information and resources provided in this subsection, qualified individ- sure the provision of necessary transitional about conditions and care. care services throughout the transitional uals are limited to individuals who— ‘‘(8) Educating and assisting the individual ‘‘(A) have been admitted to a subsection (d) care period. The payment shall be structured and the individual’s primary caregiver to ar- in a manner to explicitly recognize transi- hospital (as defined for purposes of section range and coordinate clinician visits and 1886) for inpatient hospital services or to a tional care as an episode of services that health care services. crosses multiple care settings, providers of critical care hospital for inpatient critical ‘‘(9) Informing providers of services and access hospital services; and services, and suppliers. The payment with re- suppliers of those items and services that spect to transitional care services furnished ‘‘(B) are identified by the Secretary as have been ordered for and received by the in- being at highest risk for readmission or for a by a transitional care clinician shall be dividual from other providers. made, notwithstanding any other provision poor transition from such a hospital to a ‘‘(10) Working with providers of services post-hospital site of care. of this title, to the qualified transitional and suppliers to assure appropriate referrals care entity which employs, or has a contract The identification under subparagraph (B) to specialists, tests, and other services. with, the clinician for the furnishing of such shall be based on achieving a minimum hier- ‘‘(11) Educating and assisting the indi- services. archical condition category score (specified vidual and the individual’s primary care- ‘‘(2) NO COST-SHARING.—Notwithstanding by the Secretary) in order to target eligi- giver with arranging and coordinating com- section 1833, there shall be no deductible or bility for benefits under this section to indi- munity resources and support services (such cost-sharing applicable to payment under viduals with multiple chronic conditions and as medical equipment, meals, homemaker this section for transitional care services. other risk factors, such as cognitive impair- services, assistance with daily activities, ‘‘(f) PERFORMANCE MEASURES.— ment, depression, or a history of multiple shopping, and transportation). ‘‘(1) ACCOUNTABILITY.— hospitalizations. ‘‘(12) Providing to the qualified individual, ‘‘(A) IN GENERAL.—The Secretary shall es- primary caregiver, and appropriate clini- ‘‘(2) SECOND PHASE OF IMPLEMENTATION.— tablish a method whereby qualified transi- cians and qualified transitional care entity After submitting to Congress the evaluation tional care entities responsible for fur- providing ongoing care at the conclusion of under subsection (i)(2) and considering any nishing transitional care services would be the transitional care period a written sum- cost-savings and quality improvements from held accountable for process and outcome mary that includes the goals established in the prior implementation of this section, the performance measures specified by the Sec- the plan of care described in paragraph (2), Secretary may expand eligibility of qualified retary from those that have been endorsed progress in achieving such goals, and re- individuals to include moderate-risk and by the National Quality Forum. lower-risk individuals, as determined in ac- maining treatment needs. ‘‘(B) DEVELOPMENT AND ENDORSEMENT OF cordance with eligibility criteria specified by ‘‘(13) Other services that the Secretary de- termines are appropriate. PERFORMANCE MEASURE SET.—For purposes of the Secretary. In expanding eligibility, the carrying out subparagraph (A), the Secretary Secretary may modify or scale transitional The Secretary shall determine and update shall enter into an arrangement— the services to be included in transitional care services to meet the specific needs of ‘‘(i) with the National Quality Forum for care services as appropriate, based on the moderate- and lower-risk individuals. the evaluation, endorsement, and rec- evidence of their effectiveness in reducing ‘‘(3) AVOIDING DUPLICATION OF SERVICES.— ommendation of an appropriate set of per- hospital readmissions and improving health The Secretary shall ensure that qualified in- formance measures for transitional care dividuals receiving transitional care services outcomes. ‘‘(d) TRANSITIONAL CARE CLINICIANS.— services and for the identification of gaps in are not receiving duplicative services under available measures; and this title. ‘‘(1) IN GENERAL.—In this section, the term ‘transitional care clinician’ means, with re- ‘‘(ii) with the Agency for Healthcare Re- ‘‘(c) TRANSITIONAL CARE SERVICES DE- spect to a qualified individual, a nurse or search and Quality to support measure devel- FINED.—In this section, the term ‘transi- other health professional who— opment, to fill gaps in available measures, tional care services’ means services that sup- ‘‘(A) has received specialized training in and to provide for the ongoing maintenance port a qualified individual during the transi- the clinical care of people with multiple of the set of performance measures for tran- tional care period and includes the following: chronic conditions (including medication sitional care services. ‘‘(1) A comprehensive assessment prior to management) and communication and co- ‘‘(2) PAY FOR PERFORMANCE.—As soon as discharge including an assessment of the in- ordination with multiple providers of serv- practicable after reliable process and out- dividual’s physical and mental condition, ices, suppliers, patients, and their primary come performance measures have been en- cognitive and functional capacities, medica- caregivers; dorsed and specified under subparagraph (A), tion regimen and adherence, social and envi- ‘‘(B) is supported by an interdisciplinary the Secretary shall provide that the pay- ronmental needs, and primary caregiver team in a manner that assures continuity of ment amounts under subsection (e) for tran- needs and resources. care throughout a transitional care period sitional care services shall be linked to per- ‘‘(2) Development of a comprehensive, evi- and across care settings (including the resi- formance on such measures. denced-based plan of transitional care for the dences of qualified individuals); ‘‘(3) PUBLIC REPORTING.—The Secretary individual developed with the individual and ‘‘(C) is employed by (or has a contract shall establish a mechanism to publicly re- the individual’s primary caregiver and other with) with a qualified transitional care enti- port on a qualifying entity’s transitional health team members, identifying potential ty for the furnishing of transitional care care performance on such measures, includ- health risks, treatment goals, current thera- services; and ing providing benchmarks to identify high pies, and future services for both the indi- ‘‘(D) meets such participation criteria as performers and those practices that con- vidual and any primary caregiver. the Secretary may specify consistent with tribute to lower hospital readmission rates. ‘‘(3) A visit at the care setting within 24 this subsection. ‘‘(4) DISSEMINATION OF INFORMATION ON hours after discharge from the hospital or ‘‘(2) PARTICIPATION CRITERIA.—In estab- BEST PRACTICES.—The Secretary shall dis- critical access hospital. lishing participation criteria under para- seminate information on best practices used ‘‘(4) Home visits to implement the plan of graph (1)(C), the Secretary shall assure that by transitional care clinicians and quali- care. transitional care clinicians meet relevant fying transitional care entities in furnishing ‘‘(5) Implementation of the plan of care, in- experience and training requirements and transitional care services for purposes of ap- cluding— have the ability to meet the individual needs plication in other settings, such as in condi- ‘‘(A) addressing symptoms; of qualified individuals. tions of participation under this title, under

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the Quality Improvement Organization (QIO) PAT ROBERTS from Kansas, in intro- living their assets. Specifically, we are Program under part B of title XI, and public- ducing legislation that can help Ameri- proposing a tax incentive to encourage private quality alliances, such as the Hos- cans enjoy a more secure retirement. Americans to annuitize a portion of pital Quality Alliance. In these economically challenging their assets available for retirement. If ‘‘(g) NOTIFICATION OF ELIGIBILITY AND CO- ORDINATION WITH HOSPITAL DISCHARGE PLAN- times, financial security—especially they annuitize—in other words, elect NING.—In establishing standards for dis- during retirement—can be a frus- to receive their money from an annuity charge planning under section 1861(ee)(1), the trating and elusive goal. In retirement, in a series of payments for the rest of Secretary shall require each subsection (d) the chief anxiety for most people is their lives, no matter how long that hospital and each critical care hospital— protecting the savings they have accu- may be—they would be able to exclude ‘‘(1) to identify, as soon as practicable mulated while working and deciding from income 50 percent of the annuity after admission, those patients who are how best to manage those assets. benefit that represents the accumula- qualified individuals under this section; and tion in the annuity above and beyond ‘‘(2) to provide to such patients and their In 21st century America, there is an- primary caregivers a list of qualified transi- other crucial challenge for retirees. the original investment. The exclusion tional care entities available to arrange for The good news is that Americans are would be capped at $20,000, indexed, to the provision of transitional care services, a living longer, but it also means that ensure that tax sheltering activity is list of transitional services provided under people have to plan for a longer period not encouraged and that the incentive this section, and a notice that the transi- of retirement. A successful long-term will be effective for people who would tional care service benefit is provided to retirement income plan is difficult benefit most from securing a lifetime qualified individuals with no deductible or even in a bullish market. How much income stream. cost-sharing. more difficult is this task in today’s This proposal we offer today would Nothing in this section shall be construed as market—particularly for the millions apply only to life-contingent, non- preventing such a hospital from entering qualified annuities. A life-contingent into an agreement with a qualified transi- of Americans with limited investment tional care entity or a transitional care cli- experience? annuity that is subsequently modified nician for the furnishing of transitional care We believe in encouraging people to to a fixed-term payout would be sub- services to the hospital’s patients. save for retirement. Through the tax ject to a recapture tax. ‘‘(h) PREVENTION OF INAPPROPRIATE STEER- code, we encourage asset-building Baby boomers represent an unprece- ING.—The Secretary shall promulgate such through home ownership. We provide dented challenge to our retirement se- regulations as the Secretary deems nec- significant tax incentives for em- curity policies. They should have a essary to address any protections needed, be- ployer-based pension plans and for re- wide range of options available for re- yond those otherwise provided under law and sponsible retirement planning. Our pro- regulations, to prevent inappropriate steer- tirement savings programs by individ- ing of qualified individuals to providers of uals, such as IRAs and 401(k) plans. posal focuses on non-qualified annu- services, suppliers, qualified transitional One of the biggest threats to retire- ities because it is important to have care entities, or transitional care clinicians, ment income security for baby boomers this option considered as part of the under this section or inappropriate limita- is their own longevity. It will not be larger retirement income security de- tions on access to needed transitional care easy to manage their accumulated as- bate that Congress should have before services under this section. sets so that they will last a lifetime. baby boomers begin retiring in large ‘‘(i) EVALUATION OF BENEFIT.— Unprecedented numbers of Americans numbers. Options for making qualified ‘‘(1) IN GENERAL.—The Secretary shall plans more secure should be part of evaluate the performance of the transitional are now living into their 90s and even care benefit under this section by measuring past 100. Consequently, people are that debate as well. the following (for those receiving transi- going to spend more time in retirement I hope that Congress will tackle this tional care services and those not receiving than previous generations. matter promptly because over the last such services): Now our society is witnessing the be- few years too many people have seen ‘‘(A) Admission rates to health care facili- ginning of the retirement wave we their retirement savings severely erod- ties. knew was already building. Before it ed. This legislation will provide an im- ‘‘(B) Hospital readmission rates. portant incentive to help them pre- ‘‘(C) Cost of transitional care and all other recedes, 77 million baby boomers will have entered their retirement years. serve what they have. health care services. Mr. President, I ask unanimous con- ‘‘(D) Quality of transitional care experi- Many of them will not have the guar- ences. anteed monthly retirement checks that sent that the text of the bill be printed ‘‘(E) Measures of quality and efficiency. many of their parents enjoyed as a re- in the RECORD. There being no objection, the text of ‘‘(F) Beneficiary, primary caregiver, and sult of employer-based pension plans. the bill was ordered to be printed in provider experience. Traditional defined benefit pension the RECORD, as follows: ‘‘(G) Health outcomes. plans have given way to defined con- ‘‘(H) Reductions in expenditures under this S. 1297 title over time. tribution plans, which have shifted the retirement income security risk from Be it enacted by the Senate and House of Rep- ‘‘(2) REPORT.—The Secretary shall submit resentatives of the United States of America in a report to Congress no later than April 1, the employer to the individual. Congress assembled, 2013, on the performance measures achieved Of course, there are still many Amer- SECTION 1. SHORT TITLE. by the transitional care benefit in the first 2 icans who have no access at all to em- This Act may be cited as the ‘‘Retirement years of implementation. After submitting ployer-provided pension plans. Some Security for Life Act of 2009’’. such report, the Secretary may expand the have never been in the traditional SEC. 2. EXCLUSION FOR LIFETIME ANNUITY PAY- benefit to moderate-risk and lower-risk indi- workforce; others work in seasonal jobs MENTS. viduals in accordance with subsection (a) LIFETIME ANNUITY PAYMENTS UNDER (b)(2).’’. or part time. In my state of North Da- kota, as well as in rural and farming ANNUITY CONTRACTS.—Section 72(b) of the In- ternal Revenue Code of 1986 is amended by By Mr. CONRAD (for himself and communities across America, there is adding at the end the following new para- Mr. ROBERTS): an acute need for retirement vehicles graph: S. 1297. A bill to amend the Internal that will provide a secure lifetime pay- ‘‘(5) EXCLUSION FOR LIFETIME ANNUITY PAY- Revenue Code of 1986 to encourage out. Others who could face difficulty in MENTS.— guaranteed lifetime income payments securing retirement income are wid- ‘‘(A) IN GENERAL.—In the case of lifetime from annuities and similar payments of owed individuals—both men and annuity payments received under one or life insurance proceeds at dates later women—who suddenly find themselves more annuity contracts in any taxable year, than death by excluding from income a having to make a life insurance benefit gross income shall not include 50 percent of the portion of lifetime annuity payments portion of such payments; to the Com- or proceeds from the sale of a business otherwise includible (without regard to this mittee on Finance. or family home last a lifetime. paragraph) in gross income under this sec- Mr. CONRAD. Mr. President, I am The proposal we are introducing tion. For purposes of the preceding sentence, pleased to be joined by my friend and today will provide a valuable tool for the amount excludible from gross income in Finance Committee colleague, Senator helping people avoid the risk of out- any taxable year shall not exceed $20,000.

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‘‘(B) COST-OF-LIVING ADJUSTMENT.—In the ‘‘(iii) EXCEPTIONS.—For purposes of clause ‘‘(C) after the date of receipt of the first case of taxable years beginning after Decem- (ii), annuity payments shall not fail to be lifetime annuity payment under the contract ber 31, 2010, the $20,000 amount in subpara- treated as part of a series of substantially the dollar amount of any subsequent annuity graph (A) shall be increased by an amount equal periodic payments— payment is reduced and a lump sum is not equal to— ‘‘(I) because the amount of the periodic paid in connection with the reduction, unless ‘‘(i) such dollar amount, multiplied by payments may vary in accordance with in- such reduction is— ‘‘(ii) the cost-of-living adjustment deter- vestment experience, reallocations among ‘‘(i) due to an event described in subsection mined under section 1(f)(3) for the calendar investment options, actuarial gains or (c)(5)(A)(iii), or year in which the taxable year begins, deter- losses, cost of living indices, a constant per- ‘‘(ii) due to the addition of, or increase in, mined by substituting ‘calendar year 2009’ centage applied not less frequently than an- a minimum period of payments within the for ‘calendar year 1992’ in subparagraph (B) nually, or similar fluctuating criteria, meaning of subsection (c)(5)(C) or a min- thereof. ‘‘(II) due to the existence of, or modifica- imum amount that must be paid in any tion of the duration of, a provision in the If any amount as increased under the pre- event (within the meaning of subsection contract permitting a lump sum withdrawal ceding sentence is not a multiple of $500, (c)(5)(D)), such amount shall be rounded to the next after the annuity starting date, then gross income for the first taxable year lower multiple of $500. ‘‘(III) because the period between each such in which such modification or reduction oc- ‘‘(C) APPLICATION OF PARAGRAPH.—Subpara- payment is lengthened or shortened, but curs shall be increased by the recapture graph (A) shall not apply to— only if at all times such period is no longer ‘‘(i) any amount received under an eligible than one calendar year, or amount. deferred compensation plan (as defined in ‘‘(IV) because, in the case of an annuity ‘‘(2) RECAPTURE AMOUNT.— section 457(b)) or under a qualified retire- payable over the life of an annuitant and a ‘‘(A) IN GENERAL.—For purposes of this sub- ment plan (as defined in section 4974(c)), joint annuitant, the amounts paid to the sur- section, the recapture amount shall be the ‘‘(ii) any amount paid under an annuity viving annuitant after the death of the first amount, determined under rules prescribed contract that is received by the beneficiary annuitant are less than the amounts payable by the Secretary, equal to the sum of— under the contract— during the joint lives of the two annuitants. ‘‘(i) the excess of— ‘‘(I) after the death of the annuitant in the ‘‘(B) ANNUITY CONTRACT.—For purposes of ‘‘(I) the amount that was excluded from case of payments described in subsection subparagraph (A) and subsections (b)(5) and the taxpayer’s gross income under sub- (c)(5)(A)(ii)(III), unless the beneficiary is the (x), the term ‘annuity contract’ means a section (b)(5) for all taxable years prior to surviving spouse of the annuitant, or commercial annuity (as defined by section the modification or reduction described in ‘‘(II) after the death of the annuitant and 3405(e)(6)), other than an endowment or life paragraph (1), over joint annuitant in the case of payments de- insurance contract. ‘‘(II) the amount that would have been ex- scribed in subsection (c)(5)(A)(ii)(IV), unless ‘‘(C) MINIMUM PERIOD OF PAYMENTS.—For cludible under such subsection for such tax- the beneficiary is the surviving spouse of the purposes of subparagraph (A), the term ‘min- able years had such modifications or reduc- last to die of the annuitant and the joint an- imum period of payments’ means a guaran- tions been in effect at all times, plus nuitant, or teed term of payments that does not exceed ‘‘(ii) interest for the deferral period at the ‘‘(iii) any annuity contract that is a quali- the greater of 10 years or— underpayment rate established by section fied funding asset (as defined in section ‘‘(i) the life expectancy of the annuitant as 6621. of the annuity starting date, in the case of 130(d)), but without regard to whether there ‘‘(B) DEFERRAL PERIOD.—For purposes of lifetime annuity payments described in sub- is a qualified assignment. this subsection, the term ‘deferral period’ paragraph (A)(ii)(III), or ‘‘(D) INVESTMENT IN THE CONTRACT.—For means the period beginning with the taxable ‘‘(ii) the life expectancy of the annuitant purposes of this section, the investment in year in which (without regard to subsection and joint annuitant as of the annuity start- the contract shall be determined without re- (b)(5)) the payment would have been includ- gard to this paragraph.’’. ing date, in the case of lifetime annuity pay- ments described in subparagraph (A)(ii)(IV). ible in gross income and ending with the tax- (b) DEFINITIONS.—Subsection (c) of section able year in which the modification de- For purposes of this subparagraph, life ex- 72 of the Internal Revenue Code of 1986 is scribed in paragraph (1) occurs. pectancy shall be computed with reference amended by adding at the end the following ‘‘(3) EXCEPTIONS TO RECAPTURE TAX.—Para- to the tables prescribed by the Secretary graph (1) shall not apply in the case of any new paragraph: under paragraph (3). For purposes of sub- modification or reduction that occurs be- ‘‘(5) LIFETIME ANNUITY PAYMENT.— section (x)(1)(C)(ii), the permissible min- cause an annuitant— ‘‘(A) IN GENERAL.—For purposes of sub- imum period of payments shall be deter- ‘‘(A) dies or becomes disabled (within the section (b)(5), the term ‘lifetime annuity mined as of the annuity starting date and re- meaning of subsection (m)(7)), payment’ means any amount received as an duced by one for each subsequent year. ‘‘(B) becomes a chronically ill individual annuity under any portion of an annuity ‘‘(D) MINIMUM AMOUNT THAT MUST BE PAID (within the meaning of section 7702B(c)(2)), contract, but only if— IN ANY EVENT.—For purposes of subparagraph ‘‘(i) the only person (or persons in the case (A), the term ‘minimum amount that must or of payments described in subclause (II) or be paid in any event’ means an amount pay- ‘‘(C) encounters hardship.’’. (IV) of clause (ii)) legally entitled (by oper- able to the designated beneficiary under an (d) LIFETIME DISTRIBUTIONS OF LIFE INSUR- ation of the contract, a trust, or other le- annuity contract that is in the nature of a ANCE DEATH BENEFITS.— gally enforceable means) to receive such refund and does not exceed the greater of the (1) IN GENERAL.—Section 101(d) of the Inter- amount during the life of the annuitant or amount applied to produce the lifetime an- nal Revenue Code of 1986 (relating to pay- joint annuitant is such annuitant or joint nuity payments under the contract or the ment of life insurance proceeds at a date annuitant, and amount, if any, available for withdrawal later than death) is amended by adding at ‘‘(ii) such amount is part of a series of sub- under the contract on the date of death.’’. the end the following new paragraph: stantially equal periodic payments made not (c) RECAPTURE TAX FOR LIFETIME ANNUITY ‘‘(4) EXCLUSION FOR LIFETIME ANNUITY PAY- less frequently than annually over— PAYMENTS.—Section 72 of the Internal Rev- MENTS.— ‘‘(I) the life of the annuitant, enue Code of 1986 is amended by redesig- ‘‘(A) IN GENERAL.—In the case of amounts ‘‘(II) the lives of the annuitant and a joint nating subsection (x) as subsection (y) and to which this subsection applies, gross in- annuitant, but only if the annuitant is the by inserting after subsection (w) the fol- come shall not include the lesser of— spouse of the joint annuitant as of the annu- lowing new subsection: ity starting date or the difference in age be- ‘‘(x) RECAPTURE TAX FOR MODIFICATIONS TO ‘‘(i) 50 percent of the portion of lifetime an- tween the annuitant and joint annuitant is OR REDUCTIONS IN LIFETIME ANNUITY PAY- nuity payments otherwise includible in gross 15 years or less, MENTS.— income under this section (determined with- ‘‘(III) the life of the annuitant with a min- ‘‘(1) IN GENERAL.—If any amount received out regard to this paragraph), or imum period of payments or with a min- under an annuity contract is excluded from ‘‘(ii) the amount determined under section imum amount that must be paid in any income by reason of subsection (b)(5), and— 72(b)(5). event, or ‘‘(A) the series of payments under such ‘‘(B) RULES OF SECTION 72(b)(5) TO APPLY.— ‘‘(IV) the lives of the annuitant and a joint contract is subsequently modified so that For purposes of this paragraph, rules similar annuitant with a minimum period of pay- any future payments are not lifetime annu- to the rules of section 72(b)(5) and section ments or with a minimum amount that must ity payments, 72(x) shall apply, substituting the term ‘ben- be paid in any event, but only if the annu- ‘‘(B) after the date of receipt of the first eficiary of the life insurance contract’ for itant is the spouse of the joint annuitant as lifetime annuity payment under the contract the term ‘annuitant’ wherever it appears, of the annuity starting date or the difference an annuitant receives a lump sum and there- and substituting the term ‘life insurance in age between the annuitant and joint annu- after is to receive annuity payments in a re- contract’ for the term ‘annuity contract’ itant is 15 years or less. duced amount under the contract, or wherever it appears.’’.

VerDate Mar 15 2010 11:15 Oct 24, 2011 Jkt 079102 PO 00000 Frm 00070 Fmt 0685 Sfmt 0634 E:\BR09\S18JN9.002 S18JN9 wreier-aviles on DSK7SPTVN1PROD with BOUND RECORD June 18, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 12 15605 (2) CONFORMING AMENDMENT.—Section As such, I am introducing the Vet- SEC. 3. PAY-FOR-PERFORMANCE UNDER DEPART- 101(d)(1) of such Code is amended by insert- erans Health Care Improvement Act of MENT OF VETERANS AFFAIRS CON- ing ‘‘or paragraph (4)’’ after ‘‘to the extent TRACTS WITH COMMUNITY-BASED 2009, which attempts to fix the way VA- OUTPATIENT HEALTH CARE CLIN- not excluded by the preceding sentence’’. contracted health care providers are (e) EFFECTIVE DATE.— ICS. compensated at clinics. This bill would (1) IN GENERAL.—The amendments made by (a) PLAN REQUIRED.—Not later than one this section shall apply to amounts received require the VA to begin to introduce a year after the date of the enactment of this in calendar years beginning after the date of pay-for-performance compensation Act, the Secretary of Veterans Affairs shall the enactment of this Act. plan for contractors, thereby gradually submit to Congress a plan to introduce pay- (2) SPECIAL RULE FOR EXISTING CON- incentivizing a higher quality of care for-performance measures into contracts TRACTS.—In the case of a contract in force on for veterans seen at privately-adminis- which compensate contractors of the Depart- the date of the enactment of this Act that tered community-based outpatient does not satisfy the requirements of section ment of Veterans Affairs for the provision of 72(c)(5)(A) of the Internal Revenue Code of clinics. health care services through community- 1986 (as added by this section), or require- This bill gives the VA the flexibility based outpatient clinics (CBOCs). ments similar to such section in the case of to begin to implement such a system (b) ELEMENTS.—The plan required by sub- a life insurance contract, any modification through a pilot program and leaves the section (a) shall include the following: to such contract (including a change in own- VA the discretion as to how to adopt (1) Measures to ensure that contracts of ership) or to the payments thereunder that and best implement the pay-for-per- the Department for the provision of health is made to satisfy the requirements of such formance standards. In this respect, section (or similar requirements) shall not care services through CBOCs begin to utilize the bill defers to the VA on how to exe- pay-for-performance compensation mecha- result in the recognition of any gain or loss, cute these changes. It is my hope that any amount being included in gross income, nisms for compensating contractors for the or any addition to tax that otherwise might my colleagues will support this meas- provision of such services through such clin- result from such modification, but only if ure. ics, including mechanisms as follows: the modification is completed prior to the Mr. President, I ask unanimous con- (A) To provide incentives for clinics that date that is 2 years after the date of the en- sent that the text of the bill be printed provide high-quality health care. actment of this Act. in the RECORD. (B) To provide incentives to better assure There being no objection, the text of patient satisfaction. By Mr. MCCONNELL: the bill was ordered to be printed in (C) To impose penalties (including termi- S. 1302. A bill to provide for the in- the RECORD, as follows: nation of contract) for clinics that provide troduction of pay-for-performance S. 1302 substandard care. compensation mechanisms into con- (2) Mechanisms to collect and evaluate Be it enacted by the Senate and House of Rep- tracts of the Department of Veterans data on the outcomes of the services gen- resentatives of the United States of America in erally provided by CBOCs in order to provide Affairs with community-based out- Congress assembled, for an assessment of the quality of health patient clinics for the provisions of SECTION 1. SHORT TITLE. care provided by such clinics. health care services, and for other pur- This Act may be cited as the ‘‘Veterans (3) Mechanisms to eliminate abuses in the poses; to the Committee on Veterans’ Health Care Improvement Act of 2009’’. provision of health care services by CBOCs Affairs. SEC. 2. FINDINGS. under contracts that continue to utilize Mr. MCCONNELL. Mr. President, I Congress makes the following findings: capitated-basis compensation mechanisms rise today to introduce the Veterans (1) Veterans of the Armed Forces have Health Care Improvement Act of 2009. made tremendous sacrifices in the defense of for compensating contractors. As we all know, the Department of freedom and liberty. (4) Mechanisms to ensure that veterans are Veterans Affairs strives to provide the (2) Congress recognizes these great sac- not denied care or face undue delays in re- best possible health care for our na- rifices and reaffirms America’s strong com- ceiving care. tion’s heroes. However, it has come to mitment to its veterans. (c) IMPLEMENTATION.—The Secretary shall my attention that the quality of care (3) As part of the on-going congressional commence the implementation of the plan effort to recognize the sacrifices made by required by subsection (a) unless Congress provided to our nation’s veterans has America’s veterans, Congress has dramati- enacts an Act, not later than 60 days after been inconsistent among community- cally increased funding for the Department the date of the submittal of the plan, prohib- based outpatient clinics. Some of these of Veterans Affairs for veterans health care clinics, including two in my home state in the years since September 11, 2001. iting or modifying implementation of the of Kentucky, are operated by private (4) Part of the funding for the Department plan. In implementing the plan, the Sec- health care providers under VA con- of Veterans Affairs for veterans health care retary may initially carry out one or more tracts. These VA-contracted health is allocated toward community-based out- pilot programs to assess the feasability and care providers are compensated for patient clinics (CBOCs). advisability of mechanisms under the plan. (5) Many CBOCs are administered by pri- their work at community-based out- (d) REPORTS.—Not later than 180 days after vate contractors. the date of the enactment of this Act and patient clinics on a capitated basis, (6) CBOCs administered by private contrac- which means they are essentially paid tors operate on a capitated basis. every 180 days thereafter, the Secretary shall based on how many new veterans they (7) Some current contracts for CBOCs may submit to Congress a report setting forth the see during a pay period. These firms create an incentive for contractors to sign recommendations of the Secretary as to the are therefore rewarded for the number up as many veterans as possible, without en- feasability and advisability of utilizing pay- of veterans they sign up, not for the suring timely access to high quality health for-performance compensation mechanisms quality of treatment provided to our care for such veterans. in the provision of health care services by veterans. I am concerned this provides (8) The top priorities for CBOCs should be the Department by means in addition to contractors with the wrong incentives. to provide quality health care and patient CBOCs. satisfaction for America’s veterans. Contracted health care providers (9) The Department of Veterans Affairs should have the incentive to provide currently tracks the quality of patient care the best possible care for veterans, not through its Computerized Patient Record simply get as many veterans as pos- System. However, fees paid to contractors sible through the door once. are not currently adjusted automatically to As a result of the capitated system, reflect the quality of care provided to pa- it has been reported that too many of tients. our nation’s heroes have faced difficul- (10) A pay-for-performance payment model ties at these clinics in scheduling ap- offers a promising approach to health care delivery by aligning the payment of fees to pointments, have suffered from neglect contractors with the achievement of better or have received substandard health health outcomes for patients. care. This occurred under the last ad- (11) The Department of Veterans Affairs ministration and I am concerned it should begin to emphasize pay-for-perform- may be continuing in the current one. ance in its contracts with CBOCs.

VerDate Mar 15 2010 11:15 Oct 24, 2011 Jkt 079102 PO 00000 Frm 00071 Fmt 0685 Sfmt 0634 E:\BR09\S18JN9.002 S18JN9 wreier-aviles on DSK7SPTVN1PROD with BOUND RECORD 15606 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 12 June 18, 2009 SUBMITTED RESOLUTIONS against Mr. Khodorkovsky and Mr. Lebedev fifth anniversary of Mikhail Khodorkovsky’s ‘‘politically motivated’’, noted that Mr. arrest, stating ‘‘the conduct of the cases Khodorkovsky and Mr. Lebedev had not been against Khodorkovsky and his associates has SENATE RESOLUTION 189—EX- accorded fair, transparent, and impartial eroded Russia’s reputation and public con- PRESSING THE SENSE OF THE treatment, and deplored their transfer to re- fidence in Russian legal and judicial institu- SENATE THAT THE TRIAL BY mote prison camps; tions’’; Whereas Amnesty International, Freedom Whereas on December 22, 2008, the Euro- THE RUSSIAN GOVERNMENT OF House, and other prominent international pean Court of Human Rights ordered the re- BUSINESSMEN MIKHAIL human rights organizations have cited the lease of the terminally ill former Yukos oil KHODORKOVSKY AND PLATON conviction and imprisonment of Mikhail executive Vasily Aleksanyan, who had been LEBEDEV CONSTITUTES A PO- Khodorkovsky as evidence of the arbitrary held in detention since April 6, 2006, despite LITICALLY-MOTIVATED CASE OF and political use of the legal system and the repeated orders by the European Court that SELECTIVE ARREST AND PROS- lack of a truly independent judiciary in the Mr. Aleksanyan be treated in a humane fash- ECUTION THAT SERVES AS A Russian Federation; ion for cancer and AIDS; Whereas in February 2009, Andrei TEST OF THE RULE OF LAW AND Whereas governments, courts, journalists, and human rights organizations around the Illarianov, former chief economic advisor to INDEPENDENCE OF THE JUDI- world have expressed concern about the pros- President Vladimir Putin, stated that ‘‘[o]ne CIAL SYSTEM OF RUSSIA ecution, trial, imprisonment, and treatment of the best known political prisoners is Mi- Mr. WICKER (for himself and Mr. of the individuals in the Yukos case, and khail Khodorkovsky who has been sentenced to 9 years in the Siberian camp CARDIN) submitted the following reso- have called on President Medvedev to honor his pledge to end ‘‘legal nihilism’’ in Russia; Krasnokamensk on the basis of purely fab- lution; which was referred to the Com- ricated case against him and his oil company mittee on Foreign Relations: Whereas on February 5, 2007, on the eve of their eligibility for parole, Russian prosecu- Yukos’’; S. RES. 189 tors brought new charges against Mr. Whereas on February 24, 2009, human Whereas on April 1, 2009, President Barack Khodorkovsky and Mr. Lebedev, accusing rights lawyer Karinna Moskalenko, said that Obama and President Dmitry Medvedev them of embezzling $20,000,000,000 in Yukos ‘‘[a]ll verdicts are possible in this country. issued a joint statement affirming that ‘‘[i]n oil revenues; But for people like Khodorkovsky, every- our relations with each other, we also seek Whereas in May 2007 the Prosecutor Gen- thing is already planned out and decided as to be guided by the rule of law, respect for eral in Moscow attempted to disbar Karinna long as the political will does not change’’; fundamental freedoms and human rights, Moskalenko, one of Russia’s most distin- Whereas on February 25, 2009, Olga and tolerance for different views’’; guished and renown human rights lawyers Kudeshkina, former Moscow court judge who Whereas the United States and Russia, in a and defense counsel to Mikhail was dismissed from her duties in 2004, stated spirit of cooperation, will continue the dia- Khodorkovsky, in apparent reprisal for ac- that Moscow City Court ‘‘has turned into an logue on the issues affirmed in such joint tions she had taken on behalf of her client; institution of settling political, commercial statement at an upcoming summit to be held Whereas in August 2007 the highest court and other scores’’ and that ‘‘nobody can be in June 2009; of Switzerland denied Russian authorities sure that the case will be resolved in accord- ance with the law’’; Whereas it has been the long-held position access to Yukos documents on the basis that Whereas on April 2, 2009, Senator Ben of the United States to support the develop- the case against Yukos and its principal ex- Cardin, chair of the Helsinki Commission, ment of democracy, rule of law, judicial ecutives and core shareholders, specifically issued a statement in the Senate in which he independence, freedom, and respect for Mikhail Khodorkovsky and Platon Lebedev, noted that ‘‘the Council of Europe, Freedom human rights in the Russian Federation; had a ‘‘political and discriminatory char- House and Amnesty International, among Whereas Russian President Medvedev has acter. . .undermined by the infringement of others, have concluded that Mr. called Russia a country of ‘‘legal nihilism’’ human rights and the right to defense’’; Khodorkovsky was charged and imprisoned and issued a new foreign policy doctrine cit- Whereas courts in Great Britain, the Neth- in a process that did not follow the rule of ing ‘‘the supremacy of law in international erlands, Cyprus, Liechtenstein, Lithuania, law and was politically influenced. . .’’ and relations’’ as one of the top priorities of Rus- and Switzerland have described the Yukos that ‘‘the current charges. . .amount to legal sia; proceeding as politically motivated and have hooliganism and highlight the petty mean- Whereas 2 prominent cases involve the rejected motions from Russian prosecutors ness of the senior government officials be- Yukos Oil Company and its president, Mi- seeking the extradition of Yukos officials or hind this travesty of justice. . .should be khail Khodorkovsky and his partner, Platon materials for use in trials in Russia; dropped and the new trial should be aban- Lebedev, who were convicted and sentenced Whereas on October 25, 2007, the European doned’’; in May 2005 to serve 9 years in a remote Court of Human Rights ruled that Platon Whereas on April 10, 2009, the New York penal camp; Lebedev’s rights to liberty and security were Times published an editorial noting that the Whereas Russian authorities confiscated violated during his arrest and subsequent new charges and trial against Mikhail Yukos assets and assigned ownership to a pretrial detention; Khodorkovsky ‘‘are for show, intended only state company that is chaired by an official Whereas the 2008 Department of State to keep [him] and his colleague in prison for- in the Kremlin; harassed, exiled, persecuted, Human Rights Report stated: ‘‘The arrest ever’’; and imprisoned many Yukos officers and and conviction of Khodorkovsky raised con- Whereas on April 11, 2009, the Washington legal representatives; and issued a series of cerns about the right to due process and the Post wrote: ‘‘If Mr. Medvedev allows [the court rulings against Mr. Khodorkovsky and rule of law, including the independence of Khodorkovsky trial] to go forward to its Mr. Lebedev that violate international legal courts and the lack of a predictable tax re- scripted conclusion—a lengthy extension of norms; gime.’’; Mr. Khodorkovsky’s sentence to a Siberian Whereas at a press conference in May 2005, Whereas on March 13, 2008, the European prison camp—the point will be proved that President George Bush stated, ‘‘it appeared Parliament issued a resolution calling on the Russia still has no rule of law but only a to . . . people in my Administration, that Russian President to ‘‘review the treatment ruler’’; . . . [Mikhail Khodorkovsky] had been of imprisoned public figures (among them Whereas on April 21, 2009, Freedom House, judged guilty prior to having a fair trial. In Mikhail Khodorkovsky and Platon Lebedev), Amnesty International, Human Rights First, other words, he was put in prison, and then whose imprisonment has been assessed by Human Rights Watch, the International was tried’’; most observers as having been politically League for Human Rights, the Lantos Foun- Whereas on October 25, 2005, Congressmen motivated’’; dation for Human Rights and Justice, and Roger Wicker and Tom Lantos introduced H. Whereas in July 2008, President Dmitry the Jacob Blaustein Institute for the Ad- Res. 525, which noted the actions that the Medvedev said it was essential that Russia vancement of Human Rights joined in a let- Russian government had taken with respect ‘‘take all necessary means to strengthen the ter to President Medvedev in which they to Yukos, Mr. Khodorkovsky, and Mr. independence of judges’’ since ‘‘it goes with- note ‘‘the serious human rights concerns Lebedev, and called upon Russian authorities out saying that pressure is applied, influence raised by the case so far’’ and call on the to prove that the cases were not politically is exerted, and direct bribery is often used’’; Russian Government to ‘‘ensure that inter- motivated, that the Russian judicial system Whereas on August 22, 2008, Mikhail national observers are allowed unhindered is truly independent and not simply an in- Khodorkovsky was denied parole on the access to the courtroom’’ to monitor the strument of the Kremlin, and that the state grounds that he refused to take part in voca- trial, to ‘‘ensure that the rule of law is was not engaged in a campaign to selectively tional training in sewing and that he alleg- upheld’’ and that it ‘‘meets the standards of reclaim or re-nationalize private enterprises; edly failed to keep his hands behind his back the Russian Constitution and international Whereas on November 18, 2005, Senators during a jail walk; law’’; Joe Biden, Barack Obama, and John McCain Whereas on October 25, 2008, the State De- Whereas the selective disregard for the introduced S. Res. 322, which called the cases partment issued a statement marking the rule of law by Russian officials undermines

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