Congressional Record United States Th of America PROCEEDINGS and DEBATES of the 108 CONGRESS, FIRST SESSION

E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 108 CONGRESS, FIRST SESSION

Vol. 149 WASHINGTON, THURSDAY, JUNE 26, 2003 No. 96—Part II Senate PRESCRIPTION DRUG AND MEDI- and the Senator from Connecticut (Mr. AMENDMENT 975, AS MODIFIED CARE IMPROVEMENT ACT OF LIEBERMAN) are necessarily absent. The PRESIDING OFFICER. There 2003—Continued I further announce that, if present are now 2 minutes evenly divided prior AMENDMENTS NOS. 1014, 1015, 1059, 1106, 1086, 1067, and voting, the Senator from Massa- to the next vote. 1033, 935, 959, 1038, 1095, EN BLOC chusetts (Mr. KERRY) would vote Mr. ROCKEFELLER. Mr. President, Mr. GRASSLEY. Mr. President, I ask ‘‘nay’’. this next amendment has to do with unanimous consent that the pending The PRESIDING OFFICER (Mr. COR- dual eligibility. Never in the history of amendments be temporarily set aside NYN). Are there any other Senators in Medicare have we precluded Medicare and that the following amendments be the Chamber desiring to vote? beneficiaries from being Medicare called up en bloc: No. 1014, by Senator The result was announced—yeas 33, beneficiaries. In the underlying bill, for BOND, study of pharmacy services; No. nays 65, as follows: the very first time, we do. 1015, by Senator DODD, study of blind [Rollcall Vote No. 256 Leg.] The people I refer to are called dual and disabled; No. 1059, by Senator YEAS—33 eligibles. Their average income is $6,500 a year. They tend to be over 85, single HATCH, HHS review; No. 1106, by Sen- Allard Dole Lott ator HATCH, citizens councils; No. 1086, Allen Ensign McConnell women, and very sick. They are on by Senator MURKOWSKI, pharmacy ac- Bennett Enzi Murkowski Medicaid. Medicaid, however, is op- Bunning Frist Nickles cess; No. 1067, by Senator LINCOLN, kid- tional according to the States. We Burns Graham (SC) Santorum know the States to be broke. The fast- ney disease; No. 1033, by Senator MI- Byrd Gregg Sessions KULSKI, municipal health services; No. Campbell Hagel Shelby est growing expense they face is Med- 935, by Senator LINCOLN, geriatric Chambliss Hatch Stevens icaid. So they are cutting the benefits. Cornyn Hutchison Sununu They are cutting Medicaid. They will GME; No. 959, by Senator LINCOLN, Craig Inhofe Talent physical therapy demo; No. 1038, by Crapo Kyl Thomas continue to do that. The States have no choice but to cut Medicaid. Some Senator JEFFORDS, critical access hos- NAYS—65 pital; No. 1095, by Senator JOHNSON, will do it because they wish to, all will Akaka Dodd Lugar therapy management. do it because they have to. Alexander Domenici McCain When that possibility is gone, there I further ask unanimous consent that Baucus Dorgan Mikulski these amendments be agreed to en bloc Bayh Durbin Miller is no place for these poorest of the poor and the motion to reconsider be laid Biden Edwards Murray to go. They are then, under the under- Bingaman Feingold Nelson (FL) lying bill, precluded from being Medi- upon the table en bloc. Bond Feinstein Nelson (NE) care beneficiaries. That is wrong. In The PRESIDING OFFICER. Is there Boxer Fitzgerald Pryor Breaux Graham (FL) objection? Reed my budget-neutral amendment I at- Brownback Grassley Reid tempt to fix it. I hope my colleagues Without objection, it is so ordered. Cantwell Harkin Roberts The amendments were agreed to. Carper Hollings will support the amendment. Rockefeller VOTE ON AMENDMENT NO. 1011 Chafee Inouye The PRESIDING OFFICER. The Sen- Clinton Jeffords Sarbanes ator from Iowa. The PRESIDING OFFICER. Under Schumer Cochran Johnson Mr. GRASSLEY. Two things for my the previous order, the question is on Coleman Kennedy Smith agreeing to the Sessions amendment Collins Kohl Snowe colleagues to consider during the con- No. 1011. Conrad Landrieu Specter sideration of how to vote on this Corzine Lautenberg Stabenow amendment: No. 1 is the money that is Mr. BAUCUS. Mr. President, I ask for Daschle Leahy Voinovich the yeas and nays. Dayton Levin Warner available to pay for his amendment, an The PRESIDING OFFICER. Is there a DeWine Lincoln Wyden offset, is the very same amount of money we, Senator BAUCUS and I, are sufficient second? NOT VOTING—2 There is a sufficient second. using to offset the cost of a lot of dem- Kerry Lieberman The yeas and nays were ordered. onstration projects that colleagues Mr. BAUCUS. Mr. President, I ask The amendment (No. 1011) was re- have asked us to do, a lot of minor unanimous consent that the following jected. amendments they have asked us to do. two votes be 10-minute votes. Mr. GRASSLEY. I move to recon- If that money is not there, there can- The PRESIDING OFFICER. Without sider the vote. not be consideration given. That is not objection, it is so ordered. Mr. GRAHAM of Florida. I move to a threat; it is just a practical aspect of The clerk will call the roll. lay that motion on the table. how the budget law works. Mr. REID. I announce that the Sen- The motion to lay on the table was Secondly, remember, these dual eligi- ator from Massachusetts (Mr. KERRY) agreed to. bles are being taken care of very well

∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor.

S8647

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00001 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8648 CONGRESSIONAL RECORD — SENATE June 26, 2003 in our underlying legislation. The you are thereby prohibited from buying [Rollcall Vote No. 258 Leg.] point being, they will not be taken care any supplemental insurance to cover YEAS—43 of better. It is just it is going to cost prescription drugs. Today, people are Akaka Dorgan Levin the Federal Government more. able to buy Medigap policies that cover Bayh Durbin Mikulski I hope you will take those things into prescription drugs. In the future they Biden Edwards Murray Bingaman Feingold Nelson (FL) consideration and vote down this will not be able to, if this bill becomes Boxer Feinstein Nelson (NE) amendment. law as it is. Byrd Graham (FL) Pryor I ask for the yeas and nays. My amendment would merely give Cantwell Harkin Reed Carper Hollings Reid The PRESIDING OFFICER. Is there a people the option of buying a prescrip- Clinton Inouye Rockefeller sufficient second? There is a sufficient tion drug supplemental policy if they Collins Johnson Sarbanes Conrad Kennedy second. chose to do so. It directs that two poli- Schumer The question is on agreeing to Corzine Kohl cies be developed that would accom- Daschle Landrieu Stabenow amendment No. 975, as modified. The plish that. Dayton Lautenberg Wyden clerk will call the roll. It is supported by the insurance in- Dodd Leahy Mr. REID. I announce that the Sen- dustry. It is supported by the Con- NAYS—55 ator from Massachusetts (Mr. KERRY) sumers Union. Seniors would like to Alexander Dole McConnell and the Senator from Connecticut (Mr. have this opportunity to reduce their Allard Domenici Miller LIEBERMAN) are necessarily absent. risk of substantial out-of-pocket costs. Allen Ensign Murkowski I further announce that, if present We ought to provide this benefit. Baucus Enzi Nickles and voting, the Senator from Massa- Bennett Fitzgerald Roberts Mr. GRASSLEY. Mr. President, first Bond Frist Santorum chusetts (Mr. KERRY) would vote of all, let me make very clear that we Breaux Graham (SC) Sessions ‘‘yea.’’ know that Medigap is very important Brownback Grassley Shelby Bunning Gregg The PRESIDING OFFICER. Are there Smith as part of Medicare. We leave that un- Burns Hagel Snowe any other Senators in the Chamber de- touched as it relates to 1965 model Campbell Hatch Specter siring to vote? Medicare. In fact, many of my Iowa Chafee Hutchison Chambliss Inhofe Stevens The result was announced—yeas 47, constituents want to keep that. But we Sununu nays 51, as follows: Cochran Jeffords as a policy matter have made it a very Coleman Kyl Talent [Rollcall Vote No. 257 Leg.] conscious choice to prevent the sale of Cornyn Lincoln Thomas YEAS—47 wraparound Medigap plans for the new Craig Lott Voinovich Crapo Lugar Warner Akaka Dorgan Lincoln Part D drug benefit. This policy makes DeWine McCain Bayh Durbin Mikulski sense considering drug plans could be NOT VOTING—2 Biden Edwards Murray different everywhere else in the United Bingaman Feingold Nelson (FL) Kerry Lieberman Boxer Feinstein Pryor States. Byrd Graham (FL) Reed It is impossible to standardize The amendment (No. 1066) was re- Cantwell Harkin Reid Medigap policies like we did about 15 jected. Carper Hollings Rockefeller Mr. GRASSLEY. Mr. President, I Clinton Inouye years ago so that seniors don’t get Sarbanes Collins Johnson move to reconsider the vote and I move Schumer ripped off. But the Congressional Budg- Conrad Kennedy to lay that motion on the table. Snowe et Office tells us this new Medigap plan Corzine Kohl Specter that is before us now will increase the The motion to lay on the table was Daschle Landrieu agreed to. Dayton Lautenberg Stabenow cost of our bill. The cost of this amend- DeWine Leahy Voinovich ment is $1.5 billion over 10 years, ac- The PRESIDING OFFICER. The ma- Wyden Dodd Levin cording to the Congressional Budget jority leader is recognized. Mr. FRIST. Mr. President, very brief- NAYS—51 Office. That is because of the increased ly, it is almost 6:25, and we have just Alexander Crapo utilization that comes from having ad- Lugar completed our 12th rollcall vote. We Allard Dole McCain ditional insurance. Allen Domenici still have a fair amount of work to do. McConnell I share the Senator’s concern with Baucus Ensign Miller But in discussion with the managers of gaps in coverage. I wish we didn’t have Bennett Enzi Murkowski the bill and the Democratic leader, it is Bond Fitzgerald Nelson (NE) any. our intent to finish this bill tonight. I Breaux Frist Nickles But we believe participating drug Brownback Graham (SC) Roberts optimistically think we can finish in 2 plans—especially drug plans delivered Bunning Grassley Santorum or 3 hours, or this bill can go until mid- Burns Gregg Sessions by PPOs—will offer benefits in a com- Campbell Hagel Shelby night, or 1, or 2, or 3 in the morning. prehensive fashion, lessening the need Part of the problem we are having Chafee Hatch Smith for expensive supplemental policies. Chambliss Hutchison Stevens now is that people are still coming up Cochran Inhofe Sununu I urge my colleagues to reject this and submitting amendments, and be- Coleman Jeffords Talent amendment. cause we have been working in good Cornyn Kyl Thomas Mr. BAUCUS. Mr. President, I ask for Craig Lott Warner faith over the last 2 weeks in the the yeas and nays. NOT VOTING—2 amendment process, we have not set The PRESIDING OFFICER. Is there a strict filing deadlines. Kerry Lieberman sufficient second? Now that we are in the last several The amendment (No. 975), as modi- There is a sufficient second. hours of consideration, I want to make fied, was rejected. The question is on agreeing to the the case and, in fact, plead with my Mr. GRASSLEY. Mr. President, I amendment. The clerk will call the colleagues that any amendments that move to reconsider the vote. roll. need to be considered—let us hear Mr. CRAIG. I move to lay that mo- The legislative clerk called the roll. about them. Let the managers hear tion on the table. Mr. REID. I announce that the Sen- about them in the next 15 minutes. The motion to lay on the table was ator from Massachusetts (Mr. KERRY) That is the only way we can get a list agreed to. and the Senator from Connecticut (Mr. to deal with them, and we will have AMENDMENT NO. 1066 LIEBERMAN) are necessarily absent. rollcall votes on those that are nec- The PRESIDING OFFICER. There I further announce that, if present essary. are now 2 minutes equally divided on and voting, the Senator from Massa- There will be a certain number of the Bingaman amendment. chusetts (Mr. KERRY) would vote those amendments looked at by the Mr. BINGAMAN. Mr. President, the ‘‘yea.’’ managers. The ones I encourage you to bill before us has, in my view, a signifi- The PRESIDING OFFICER (Mr. bring to them for consideration to be cant flaw in it. We are holding out this CHAMBLISS). Are there any other Sen- accepted need to be budget neutral and prescription drug benefit. But the bill ators in the Chamber desiring to vote? have bipartisan support, and they need we are considering here says if you The result was announced—yeas 43, to be scored by the CBO. People keep want to take advantage of the benefit, nays 55, as follows: bringing amendments forward now. I

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00002 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8649 will ask—and then I want the Demo- taking time out of the schedule, which cause I believe very strongly that cratic leader to comment—that people, is obviously crowded. I do think it is needy senior citizens should have a in the next 15 minutes or so, make sure important to speak up on the issue of drug benefit. Clearly, prescription the managers have the amendments. this piece of legislation. drugs have become the new way to That way we can move ahead. We will This is the most significant piece of treat disease and maintain public finish tonight. spending legislation, and maybe even health in our Nation. We have been The PRESIDING OFFICER. The public policy legislation, outside of an able to move from a system where you Democratic leader is recognized. international issue, that I expect I will had to have invasive activity in the Mr. DASCHLE. Mr. President, I hope vote on in my tenure in the Senate. health care system, where you had to we can do as the majority leader has Ironically, when I ran for this job, after go through surgery, to a system where suggested. We have had a good debate. serving as Governor of New Hampshire, people can, as result of the keen use of I think this has been an excellent de- one of the reasons I sought the job and our scientific community, take a phar- bate. The managers deserve credit for one of the reasons I wanted to pursue a maceutical and actually have a better the way they have managed the legisla- term in the Senate was that I was con- life than if they were to go under the tion. We have had 12 rollcall votes cerned about entitlement spending. In knife, have surgery. today already. It is likely that we will fact, during my first few years, I ag- This is a revolution, and it is a revo- have 16 or 17 by the end of the day, if gressively pursued setting up an enti- lution that is exploding and growing. not more; we had 9 yesterday. More tlement commission to address entitle- Biotech activity, the nanotech activ- than 50 amendments have now been ment spending, which I sponsored with ity, is only going to lead to more and considered. Senator Kempthorne, who came in more and better and better pharma- I think it is time that we bring the with me that year, and Senator Cover- ceuticals coming on the market to help debate to a close. There will be many dell and Senator BENNETT, all of whom people with their health. more opportunities to talk about pre- came in the year I was elected, in a bill It is absolutely unfair, in my opinion, scription drugs and health care with to end unfunded mandates, many of that people who are in a low-income the array of legislative challenges that which were entitlement oriented. situation, especially retired people who we face relating to health. I think we I tried to lead an effort in passing are on a fixed low income, have to have been able to do a good deal, and I legislation to address reform of the So- choose between their food and their hope we can get cooperation now on cial Security system. I consider that to housing and maybe their pharma- both sides of the aisle. I hope the ma- be a huge entitlement that we con- ceuticals. That is not right in our soci- jority leader will hold to the commit- front. My basic reason for seeking enti- ety, and we can certainly afford to ment that we finish tonight. That tlement reform and responsibility was have that addressed. would accommodate people’s travel that I was concerned that it not only is It was my hope as we brought for- schedules tomorrow. what is driving the deficits of our coun- ward a pharmaceutical drug benefit for If we are going to do that—it is now try—which they continue to do—but, senior citizens that we would do it in a 6:30—over the course of the next 4 or 5 more importantly, as the demographics way that would address low-income hours, we have a lot of work to do even shifted in the Nation and we saw the seniors. Equally important, it is impor- with what we know we have to vote on. baby boom generation, which rep- tant that a middle-income senior I hope everybody will cooperate so we resents a huge population, moving to- should not have to spend all their as- can minimize the time required to con- ward retirement, we, as a nation, were sets for health care as a result of phar- sider amendments. I hope those who going to be placing on our children and maceutical costs. After a certain may have remarks to make will per- our children’s children an inordinate amount of spending, there should be haps hold off until after final passage burden in the area of taxes in order to catastrophic coverage that kicks in, re- and make those remarks after final support the older generation—my gen- lieving that person of the full responsi- passage. That would accommodate our eration—which would be retiring. It is bility or a large portion of their re- time as well. because all the major programs, wheth- sponsibility for the pharmaceutical We will work with the majority leader they are Social Security or Medi- cost. That is the type of structure at er to see if we can accomplish the care, are built on the theory that there which we should be looking. schedule he has laid out. I hope we can is a pyramid out there, that there will do so well before the bewitching hour. always be more people working and a Putting in place this brand new drug I yield the floor. lot more people working than those benefit, we also have to look at the un- Mr. FRIST. Mr. President, when we people who are taking their retirement derlying Medicare system which we all finish this bill tonight, my expectation benefits out of the system. That, of know is fundamentally broken as we would be that we would not have votes course, is the way it began. look out into the future. When the tomorrow. That is assuming we are Back in 1950, there were 12.5 people baby boom generation hits, it simply is going to finish. I encourage anyone working for every person who retired not going to work. It is not going to who has an amendment that needs to under Social Security. Today, we are support that generation. That is be- be considered to get it to the managers down to 3.5 people working for every 1 cause it is a 1959 design, an automobile within the next 15 minutes. If we can person retired on Social Security and built in the fifties driving on the high- do that, we can finish tonight and we under Medicare, and that is stressing ways of the year 2000 which, when it will be able to consider each of those the system. gets to 2015, is going to be too old to amendments, as the Democratic leader Unfortunately, when we hit the re- function effectively. It needs to have said. tirement situation for the baby boom put in place forces which are going to I know some people want to talk for generation, the largest generation in cause it to be more efficient, to be an hour but I ask Senators to keep the history of our Nation, the genera- more effective in addressing a person’s their comments to a few minutes and tion born between 1946 and 1955, we go approach to their health care. Those we can vote throughout the night. We down to two people working for every forces have to be basically marketplace will have the opportunity after final one person retired. We go from a pyr- oriented. They cannot be price-control passage tonight, or through tomorrow, amid to basically a rectangle, and the oriented. to make statements—for those who result is that we will end up putting an My hope, my goal, my belief was that wish to continue the debate. inordinate amount of stress on those we would create a drug benefit that The PRESIDING OFFICER. The Sen- people who are working to support would help low-income seniors and, at ator from New Hampshire is recog- those folks who are retired. So we need the same time, give catastrophic cov- nized. to address thoughtfully any entitle- erage, and that would, fundamentally, Mr. GREGG. Mr. President, I rise to ment expansion, to say nothing of the reform the Medicare system so that we address this bill. I had hoped to do it entitlements that are already on the would end up with a more market-ori- earlier in the day but, unfortunately, books. ented system, something that was the managers of the bill were unable to That is what brings me to the Cham- going to contain costs as we moved work the time in. I certainly regret ber today to address this legislation be- into the outyears.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00003 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8650 CONGRESSIONAL RECORD — SENATE June 26, 2003 What did we get? What is before us home, better food, or even just a nice Unfunded means it is just there. We today? Essentially, what we have be- car or a night out at the movies. Their have to pay it, but nobody has an idea fore us today is a drug benefit that will ability to do that is going to be under- of how they are going to do it. There is plant a fiscal disease that will afflict mined if this bill goes forward in its no trust fund for it. There is no money our children and our children’s chil- present form because so much will have out there to do it. So the only way it dren. It is a drug benefit that is going to flow back to benefit people who al- is going to be done is to raise taxes or to put in place a fiscal disease that will ready have the benefit in the private to cut the benefit, which is politically afflict our children for the next 75 sector and are now going to be mi- probably impossible, so to raise taxes years. By afflict them, I mean that our grated over to the public sector. on the young people who are working. children and our children’s children, Mr. President, $4.5 trillion to $6 tril- There is a third way, however, to do under the benefit in this bill, are going lion is a huge amount of money, a huge it, and that is to make Medicare a to have to pay $6 trillion. That is the burden to put on our children. It is more cost-sensitive, more thoughtful, estimate. That may be the high end. It hard to put it in terms that are real- more efficient system for delivery of is somewhere between $4.6 trillion and istic and are visible when we are talk- health care. Regrettably, under this $6 trillion. When you get into those ing those type of dollars, but every bill that does not happen. There is a numbers, it is pretty hard to get very American child born tonight—and representation that that might happen, definitive. there are a lot of kids being born to- something called a PPO, which is sup- That is the burden this drug benefit night in America—starts out with a posedly going to create an opportunity in this bill puts on our children and our $44,000 debt they have to pay for Medi- for the private sector to come in and children’s children to support my gen- care for my retirement, for the retire- compete with the traditional Medicare eration which is going to retire and ment of everybody in this room, for the system. The price control system will take advantage of it. retirement of most of the people who have a chance to compete with a mar- That is a huge problem because what are watching who are over the age of ketplace system. That is the thematic we are essentially saying to the person 45. They start out with a $44,000 debt. statement of the bill. Unfortunately, it who is working in a restaurant or When this bill passes, they will have is illusory. It will not happen under the working in a garage or working on a another $12,000 to $15,000 added to that bill. CBO says maybe 2 percent of the computer line or working as a sales debt. So before they get through the people will migrate, will move over, to person, who is young and trying to first night of their life, as a result of a PPO system. The administration says raise a family, is that they are going to this legislation they are going to owe it is 48 percent. Logic tells us it is not have to pay an inordinate amount of $60,000. It is not fair. It is not right. We going to fly, because the bill has been are not doing it the correct way. tax burden to support people who are structured to defeat the probability a There are ways to do this where the retired with this drug benefit. PPO, a marketplace system, will be al- system is not nationalized, where all That would not be so bad if the drug lowed to work. All the little gimmicks the people who already have a drug benefit was not an income transfer in this bill are aimed at essentially un- benefit are told there is no incentive from that person working in that ga- for them to keep it. dermining that. rage, working in that restaurant, or We do not say in the private sector to Classic was the amendment that we working on that computer line to the people who bought Medigap, to the passed earlier, which had been so ger- somebody who is a great deal wealthier people who have reached contractual rymandered, which was an effort by than they are potentially. That would agreements in retirement, to the peo- Senator KYL. So what are we told? not be so bad if it was a transfer from ple who have retained retirement cov- Well, even though the bill has these that person to people who are low in- erage through the private sector, that fundamental flaws of having a drug come or whose assets are about to be there is no advantage to them keeping benefit that migrates a large number of wiped out because of a drug expendi- their program or, alternatively, the people out of the private sector into ture. people who are giving them that pro- the public sector and essentially causes That is not the way this bill works. gram saying they are not going to give low-income working Americans who The way this bill works is essentially it to them anymore, and move those are young to have to support middle- to nationalize the entire drug delivery folks onto the public dole, onto the income Americans who are retired and service for senior citizens to take all public system. It makes no sense. who had a private sector benefit, and the present programs which presently Then there is the issue of the under- even though the bill has this illusory benefit senior citizens for drug bene- lying question of Medicare. Not only is marketplace representation, basically fits—and there are a lot of them; there the drug benefit in this bill fundamen- no real reform of Medicare, we are told are a lot of seniors in this country tally flawed because it migrates huge we should vote for it because it is going today who already have a drug benefit; numbers of people off the private sec- to be improved in conference. At least something like 76 percent is the esti- tor and into the public sector, but the that is what we are being told on our mate—to take a large percentage of underlying purpose of the Medicare ef- side of the aisle. I do not know what is those people and move them from their fort in this bill is flawed. If we are being said on the other side of the private programs to the public pro- going to put in place this huge new aisle. Maybe they are not getting that grams. benefit for seniors, and especially if it same message. We are being told that If you retired from a major corpora- is going to be as grand and as perva- by the administration. tion or even a smaller corporation in sive, where we are basically saying to The problem is, we are betting on the this country, it is very likely that in all seniors that they get a benefit here, come. I mean, this is $6 trillion of un- your retirement package, depending on no matter what their income is—if that funded liability we are talking about how aggressive your union was or how is going to be put in place, that ought passing on to our kids. It is massive. If successful your company was, you re- to at least be coupled with some sort of this bill were to pass in its present ceived a drug benefit during your re- reform of the underlying Medicare sys- form, or anything near to its present tirement. But when this bill passes, the tem to try to bring under control those form, it would fundamentally extin- incentive is going to be to take that costs which are driving the outyear li- guish the torch which the Republican drug benefit which presently exists in ability, which will be the tax burden Party has allegedly—and I thought the private sector under some sort of for our children and their children. pretty effectively—carried for years contractual agreement which you had The estimated outyear cost of Medi- which was the torch of spending re- when you retired and move it out of care that is unfunded is $13.3 trillion. sponsibility. the private sector and throw it on the When the baby-boom generation starts That is why I came here, as I said taxpayers of America. to hit the system in 2008, that is when when I began my statement. I came to Who are those taxpayers going to be? it really starts to crank up, by the year try to do something about controlling They are going to be our children and 2020, 2025, when there will be large re- the rate of growth of spending in the our children’s children, people who are tirement populations as a result of this Federal Government, especially in the working for a living, trying to buy demographic shift, $13.3 trillion of un- area of entitlements. I was told by one their kids a better education, a better funded liability. of the finest legislators I have ever met

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00004 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8651 in my experience in 20 years in Govern- Medicare with the extension of pre- dle of choices that Federal employees ment—a man named Barber Conable— scription drugs in it offers. have today to choose from. More and one time on the floor of the House For a few moments tonight, I did more employees are signing up for this when I was mumbling about the fact want to speak about that and explain concept. that some bill was coming through it. As we get into conference with the This is what the union Web site that was a little expensive, you have to House, the House has a consumer-driv- states: We believe that people who have understand, JUDD, all Government en health care concept within their leg- more control over how their health moves to the left, and it is just a ques- islation that is critical. It is something care dollars are spent are more satis- tion of how many engines are on that we ought to address. fied consumers and the APWU health train—think of it as a train—as it First, the amendment before the Sen- plan consumer-driven option is de- moves to the left, and our job as fiscal ate is designed to dovetail with and not signed to give that kind of control. conservatives is to limit the number of disturb the overall MedicareAdvantage It is the very thing the Senator from engines that go on that train. competitive dynamic. As a complement New Hampshire was talking about. It is This bill, if it passes in its present to MedicareAdvantage, consumer-driv- what we ought to be striving for to bal- form, is going to be all engine, and it is en health care plans would be subject ance off the differences and to create going to undermine our capacity to as- to the same competitive rules as pre- the competitive forces within the sure our children they have the oppor- ferred provider organizations. MedicareAdvantage program. tunity to have the type of lifestyle Second, I emphasize this amendment Benefits make sense in consumer- which we have, because it is going to is carefully crafted. We thought it driven health care plans. I draw your put a huge and unfair tax burden on would ensure budget neutrality. But attention to my chart. My amendment them. CBO says tonight, no, and I am not is designed to encourage market flexi- I yield the floor. going to be too critical of them; we bility. The information on this chart is The PRESIDING OFFICER. The Sen- pushed them very hard in the last good one example of what consumer-driven ator from Louisiana. number of days to quickly analyze and health care plans can provide. Web site Mr. BREAUX. Mr. President, this bring forth estimates. I think they are education and decision support is one morning one of the very able legisla- simply swamped. We will continue to example. In other words, you can go to tive assistants who has worked on this work with them. We believe what we the Web site, look at it, make choices legislation for almost 7 years, going are offering is budget neutral. and decisions based on the best avail- back to the time on the Medicare Com- Additionally, the Finance Committee able information. 100-percent preven- mission when we first started doing chairman, the majority leader, and the tive care coverage—the very kind of Medicare reform, was on the floor White House have expressed the kind of thing we want in modern medicine working with me on amendments in support for these concepts in amend- today. Preventive benefits keep this legislation. She had to tempo- ments. I appreciate it. As everyone be- healthy people healthy instead of mak- rarily leave because at 5:47 this after- gins to examine this structure, they ing the repairs after the human body noon she had a little baby girl. That is become increasingly enthusiastic that breaks down. a very good excuse to not be on the this could become a component of the There are no more barriers to nec- Senate floor. But my legislative direc- MedicareAdvantage Program. essary care, including annual tor, Sarah Walter, is doing fine. It is a For the benefit of my colleagues, let physicals, mammograms, and preven- baby girl. The name is yet to be deter- me describe for a moment the key fea- tive services. All are within this kind mined, but I wanted to bring that to tures of this amendment. The amend- of health care plan. All are available the attention of my colleagues and all ment establishes a new category of today offered by the postal workers. of her colleagues on the professional competition within Medicare Advan- Patient control of personal care ac- staff. tage designed to encourage participa- counts for routine health care services I yield the floor. tion by consumer-driven health plans. are also included. Unused funds in The PRESIDING OFFICER. The Sen- These plans would be subject to the these accounts then roll over into the ator from Idaho. same requirements of PPOs in next year. AMENDMENT NO. 1087 WITHDRAWN MedicareAdvantage, including pre- High deductibles, that is true insur- Mr. CRAIG. Mr. President, this after- scription drug benefits and risk adjust- ance, to protect against financial ruin noon I will speak to amendment 1087. ment parameters. in an acute health care crisis, in other That amendment was pulled up last Consumer-driven health care is one words, catastrophic coverage. night by the manager of the bill, Sen- of the fastest growing innovations A limit on annual out-of-pocket ator GRASSLEY. I believe that amend- emerging in the employer health insur- spending is an especially important ment is at the desk. ance market. Already 1.5 million feature. Traditional Medicare does not The PRESIDING OFFICER. The Sen- Americans are estimated to be in con- have an out-of-pocket limit and drives ator is correct. The amendment has sumer-driven health care in the sum- many seniors into bankruptcy. In other been called up and is pending. mer of 2002, and that number is now words, it limits financial risk when it Mr. CRAIG. Mr. President, it is my growing very rapidly. kicks in at a certain point. intent within a few moments to with- What is the consumer-driven health It includes care coordination, disease draw this amendment, but I thought I care? It harnesses market forces in management, and provider network should speak to it tonight because I am ways similar to medical savings ac- discounts. Consumer-driven health care disappointed at this time that we could counts. However, there are some dif- gives control of health care back to pa- not get the scoring from CBO we felt ferences between medical savings ac- tients. That is why more and more are would produce a revenue-neutral bill, counts and consumer-driven health enrolling in it. We know today, many or a cost-neutral bill, going into the care plans. For example, enrollees in who work in the health care area with final hours of this debate. consumer-driven health care do not our seniors know they look at the de- This is an amendment that produces have to make contributions to the ac- tails of their spending; they look at the in this legislation, and hopefully to count. In the private sector, the em- billing; they know more about their take up in conference, a consumer- ployer or in my amendment if it were health care and what is being charged driven health care plan under the new to pass, Medicare makes the contribu- than most people realize. Patients and MedicareAdvantage program all of us tion to the personal care account. their physicians, ultimately, with this are talking about at this moment. The There would be no tax consequence for kind of insurance, join in partnerships Senator from New Hampshire gave a the senior under this amendment. In to seek the finest care at the most rea- very impassioned speech from the other words, it would not be viewed as sonable costs. depths of his heart, frustrated that this income. Some in Congress might be fa- Consumer-driven care is especially bill does not balance out and provide miliar with the account because the suited for patients who like to be per- enough of the incentives in the market American Postal Workers Union of the sonally involved in their health care that will offset and create the kind of AFL–CIO consumer-driven health care decisions. More and more Americans competitive forces being designed for plan is now available. It is in that bun- who can use the necessary information

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00005 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8652 CONGRESSIONAL RECORD — SENATE June 26, 2003 want that kind of personal involve- eral poverty level. Effective January 1, a different plan—as is customary, with ment. 2006, a new optional Medicare prescrip- our bicameral legislative approach. Consumer-driven care eliminates tion drug benefit would be established Then the bill can be improved in con- wasteful Medicare spending, it in- under Medicare Part D. ference. creases patient awareness of health This bill has the potential to make a The legislative process has the com- care costs, and encourages prudent pur- dramatic difference for millions of mittee turning out a bill, and then chasing of health care services. Any Americans living with lower incomes many amendments, which generally unspent funds in the personal care ac- and chronic health care needs. Low-in- are not known to Members in advance count would be returned to the Medi- come Medicare beneficiaries, who make of brief debate and then votes. It is in care trust fund upon the death or the up 44 percent of all Medicare bene- the conference, after the bill is ana- disenrollment. That is a key factor. ficiaries, would be provided with pre- lyzed, that another fresh look is taken Federal dollars go into the trust fund scription drug coverage with minimal at the bill to produce the best legisla- and, if there are dollars remaining, out-of-pocket costs. For these seniors, tive product in the public interest. they flow back into the trust fund of copayments would not exceed 20 per- AMENDMENT NO. 983 Medicare upon disenrollment or the cent of the cost of the drugs. I have already offered an amendment death of the individual. For medical services, Medicare bene- relating to end of life directives, num- This amendment would be an impor- ficiaries will have the freedom to re- ber 983, which was adopted by unani- tant addition to the bill. I wish we main in traditional fee-for-service mous consent. could get it into the bill tonight. But it Medicare for drug coverage, or to en- Commenting on it very briefly, we would be unfair to the manager of the roll in Health Maintenance Organiza- find statistically that nearly 30 percent bill at this time because it cannot get tions (HMOs) or Preferred Provider Or- of Medicare expenditures occur during scored. I would not want to drive the ganizations (PPOs), also called Medi- a person’s last year of life. We find, be- cost up of the already-fixed segment of careAdvantage, which offers bene- yond the last year of life, a tremendous the MedicareAdvantage side. Already, ficiaries a wide choice of health care percentage of medical costs occur in it is less competitive than we would providers, while also coordinating the last month, in the last few weeks, like it to be. I don’t want to add to health care effectively, especially for in the last week, or in the last few that disadvantage. those with multiple chronic conditions. days. We believe ultimately that this will MedicareAdvantage health plans would Nobody should decide for anybody be a budget-neutral program. At that be required to offer at least the stand- else what that person should have by time, it will be the right thing to offer ard drug benefit, available through tra- way of end-of-life medical care. What as part of the dynamics that we want ditional fee-for-service Medicare. care ought to be available is a very per- to see in a modern health care delivery The legislation which is pending has sonal decision. system and in an improved Medicare been worked on, now, for many years. I The living wills would give an indi- with a prescription drug program. congratulate the chairman of the com- vidual an opportunity to make that I thank my colleagues for listening. mittee, Senator GRASSLEY, and the judgment, to make a decision as to how We will return with this when it is a ranking member, Senator BAUCUS, for much care he or she wanted near the final product. It may well make it into the outstanding work which they have end of his or her life and that is, to re- the conference between the House and done. This is an extraordinarily com- peat, a matter highly personalized for the Senate. We will be working with plex subject, and it is a very complex the individual. our colleagues in the House because bill. But if that decision was made to they have already provided that kind We already know that there are eliminate some of the very high costs of a provision within the legislation many criticisms directed to this bill at at the very end of life, there would ob- which they are currently debating and various levels. Many would like to see viously be substantial savings to our voting upon. the prescription drug program cover all medical system. As long as that com- With that, I ask unanimous consent of the costs without deductibles and ports with the will of the individual, to withdraw amendment No. 1086. without copays. There has been allo- that is something which ought to be The PRESIDING OFFICER. Without cated in our budget plan $400 billion for considered. objection, it is so ordered. prescription drug coverage. That is, ob- The amendment directs the Sec- The amendment (No. 1086) was with- viously, a very substantial sum of retary of Health and Human Services drawn. money. There are a variety of formulas to include in its annual ‘‘Medicare And The PRESIDING OFFICER. The Sen- which could be worked out to utilize You’’ handbook, to be provided to each ator from Pennsylvania. this funding. The current plan, depend- beneficiary, a section that specifies in- Mr. SPECTER. Since Medicare was ing upon levels of income, provides a formation on advanced directives and established in 1965, people are living deductible, then a copay, then what is details on living wills, durable powers longer and living better. Today Medi- called a donut hole where the recipient of attorney for health care, and directs care covers more than 40 million Amer- pays the entire costs of their drug cov- the Secretary of HHS, in the introduc- icans, including 35 million over the age erage, and when it gets to a certain tory letter to the ‘‘Medicare And You’’ of 65 and nearly 6 million younger high level, it is catastrophic and there handbook, to reference the inclusion of adults with permanent disabilities. is coverage that pays almost all of it. advanced directives. Congress now has the opportunity to As I have reviewed these projections AMENDMENT NO. 1085 modernize this important Federal enti- and these analyses, it is hard to say I have also submitted an amendment ty to create a 21st century Medicare where the line ought to be drawn. It is which is pending at the desk, amend- Program that offers comprehensive a value judgment as to what ment No. 1085, which has not yet been coverage for pharmaceutical drugs and deductibles ought to be, and for whom, acted upon but which I will call up at improves the Medicare delivery sys- and what the copays ought to be and an appropriate time. tem. for whom. I am seriously troubled by This is an amendment which would The proposal before the Senate would the so-called donut hole. But it is cal- update the Medicare physician fee for- make available a voluntary Medicare culated to encourage people to take the mula. It is a sense-of-the-Senate reso- prescription drug plan for all seniors. If medical care they really need, and at lution. The projections from the Medi- enacted, Medicare beneficiaries have lower levels of income to have certain care payment formula called for a 4.4- access to a discount card for prescrip- copays, which it is projected will be af- percent reduction on March 1, which tion drug purchases starting in 2004. fordable. Then, when the costs move would have been very problematic. The Projected savings from cards for con- into the so-called catastrophic range, fact is, the Center for Medicare and sumers would range between 10 to 25 to have the plan pay for nearly all of Medicaid Services, CMS, now projects a percent. A $600 subsidy would be ap- the medical costs. Medicare conversion factor figure of 4.2 plied to the card, offering additional I think passage by the Senate would percent will be projected for the year assistance for low-income beneficiaries be a significant step forward. The 2004. This reduction threatens to desta- defined as 160 percent or below the Fed- House of Representatives, as usual, has bilize an important element of the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00006 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8653 Medicare Program; namely, physician There is a serious concern that if Medicare expenditures occur during a per- participation and willingness to accept there is not a coordinated program, son’s last year of life. Medicare payments. This instability is people will not be informed as to how Your amendment directs the Secretary of a result of the sustainable growth rate, to move from PACE to another pro- HHS to include in its annual ‘‘Medicare and You’’ handbook, which is provided to each a system of annual spending which tar- gram. This affects not only Pennsyl- beneficiary, a section that provides informa- gets physicians’ services under Medi- vania but, as I stated, 17 other States. tion on advanced directives and details on care. The pending bill does not provide for living wills and durable power of attorney This sense-of-the-Senate amendment coordination of benefits between State for health care; and directs the Secretary of would provide that the conferees on pharmaceutical programs and private HHS, in the introductory letter to the Medicare reform and prescription drug insurers. Without a coordination of ‘‘Medicare and You’’ handbook, to reference legislation should include in the con- benefits for State plans to facilitate the inclusion of advanced directives informa- ference agreement a provision to estab- enrollment in private plans, many of tion. lish a minimum percentage update in these State program beneficiaries will SUMMARY ON THE AMENDMENT TO UPDATE THE physician fees for the next 2 years, and be unable to assess the new Medicare should consider adding provisions MEDICARE PHYSICIAN FEE FORMULA drug benefit. Earlier this year, Congress passed legisla- which would mitigate the swings in This amendment provides for coordi- payment, such as establishing tion as part of the Fiscal Year 2003 Omnibus nation of benefits between States and Appropriations bill (H.J. Res. 2) that avoided multiyear adjustments to recoup the private insurance companies and facili- an impending 4.4 percent cut in the Medicare variance and creating tolerance cor- tates the enrollment of State phar- conversion factor. Although this change re- ridors for variations around the up- macy assistance beneficiaries in the sulted in a welcomed 1.6 percent increase in dated target trend. private plans. Without this amend- the Medicare conversion factor for 2003, the AMENDMENT NO. 1118 ment, the majority of seniors enrolled Centers for Medicare and Medicaid Services’ I have also submitted an amendment (CMS) preliminary Medicare conversion fac- in their State pharmacy programs will designated as amendment No. 1118, tor figure predicts a 4.2 percent reduction for not be able to effectively access private which provides for a lifestyle modifica- 2004. plans. tion program demonstration. This is It is clear that this scheduled 4.2 percent I note the presence of other Senators reduction in the physician reimbursement projected on the factor that heart dis- who are seeking recognition. I at- formula threatens to destabilize an impor- ease kills some 500,000 Americans each tant element of the Medicare program, year. The costs of coronary disease cur- tempted to be brief in my general statement about the bill and also in namely physician participation and willing- rently relate to an expenditure of some ness to accept Medicare patients. $58 billion annually. There has been a my descriptions of these four amend- The primary source of this instability is test program of the Medicare lifestyle ments, one of which has already been the sustainable growth rate (SGR), a system modification program operating in adopted. of annual spending targets for physicians’ some 12 States which has been dem- I ask unanimous consent that at the services under Medicare. onstrated to reduce the need for coro- conclusion of my remarks, there be The sustainable growh rate (SGR) system printed in the RECORD a summary of has a number of defects that result in unre- nary procedures by 88 percent. This alistically low spending targets, such as the program could reduce cardiovascular the end-of-life directive amendment, a summary of the updating of the Medi- use of the increase in the gross domestic expenditures by as much as $36 billion product (GDP) as a proxy for increases in the annually. care physician fee formula, a summary volume and intensity of services provided by Lifestyle choices such as diet and ex- of the lifestyle modification program, physicians, no tolerance for variance be- ercise affect heart disease and heart and a summary of the State pharma- tween growth in Medicare beneficiary health disease outcomes by 50 percent or ceutical assistance programs for the el- care costs and our Nation’s GDP, and a re- greater. This program has also been ap- derly and disabled, and also printed in quirement for the immediate recoupment of plied to men with prostate cancer, who the RECORD at this point the amend- the difference. have shown significant improvements ments themselves. Both administrative and legislative action There being no objection, the mate- are needed to return stability to the Medi- in prostate cancer markers using a care physician payment system. similar approach in lifestyle modifica- rial was ordered to be printed in the In its March 2003 report, the Medicare Pay- tions. My amendment expresses the RECORD, as follows: ment Advisory Commission (MedPAC) stated sense of the Senate that the Secretary SUMMARY ON THE END OF LIFE DIRECTIVE that if ‘‘Congress does not change current of Health and Human Services should AMENDMENT law, then payments may not be adequate in carry out the lifestyle modification The purpose of this amendment is to make 2003 and a compensating adjustment in pay- program demonstration at the national it easier for individuals to make their own ments would be necessary in 2004.’’ level and then provide it on a perma- choices regarding their treatment when With 17 percent of its population eligible nearing the end of their life. for Medicare, the Pennsylvania Medical So- nent basis, and include as many Medi- ciety has calculated that Pennsylvania’s care beneficiaries as would like to par- A health care advance directive is a document where a beneficiary gives instructions physicians have already suffered a $128.6 mil- ticipate in the project on a voluntary about their health care if, in the future, that lion loss, or $4,074 per physician, as a result basis. beneficiary cannot speak for him or herself. of the 2002 Medicare payment reduction. If I have submitted one additional The beneficiary can give someone they name not corrected, the flawed formula will cost amendment, which is No. 1128 and (‘‘agent’’ or ‘‘proxy’’) the power to make Pennsylvania physicians another $553 mil- which relates to State pharmaceutical health care decisions on their behalf. They lion or $17,396 per physician for the period assistance programs for the elderly and may also give instructions about the kind of 2003–2005. disabled. Currently, 18 States have health care they do or do not want. Your amendment expresses the sense of the comprehensive pharmacy assistance In a traditional Living Will, a beneficiary Senate that the conferees on Medicare re- would state their wishes about life-sus- form and prescription drug legislation should programs which provide prescription include in the conference agreement a provi- drug coverage for more than 1.1 million taining medical treatments if he or she is terminally ill. In a Health Care Power of At- sion to establish a minimum percentage up- older and disabled Americans. torney, one appoints someone else to make date in physician fees for the next 2 years In my own State, Pennsylvania’s medical treatment decisions for the bene- and should consider adding provisions that Pharmaceutical Assistance Contract ficiary if they cannot make them on their would mitigate the swings in payment, such for the Elderly, known as PACE, estab- own. as establishing multi-year adjustments to re- lished in 1984 provides prescription Unlike most Living Wills, a Health Care coup the variance and creating ‘‘tolerance’’ drug coverage to 230,000 Medicare bene- Advance Directive is not limited to cases of corridors for variations around the update ficiaries, the vast majority of whom terminal illness. If the beneficiary cannot target trend. have incomes below 160 percent of the make or communicate decisions because of a SUMMARY OF THE AMENDMENT ON THE Federal poverty level. This enrollment temporary or permanent illness or injury, a Health Care Advance Directive helps them LIFESTYLE MODIFICATION PROGRAM is comprised largely of 70- and 80-year- keep control over important health care de- Heart disease kills more than 500,000 Amer- old widows who have multiple diseases cisions. icans per year. The number and costs of and limited educational background Observers have long noted that individuals interventions for the treatment of coronary who have been enrolled in the PACE incur the majority of health care costs in the disease are rising and currently cost the program for more than a decade. last few months of life. Nearly 30 percent of health care system $58 billion annually.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00007 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8654 CONGRESSIONAL RECORD — SENATE June 26, 2003 The Medicare Lifestyle Modification Pro- ficiaries into private plans, without this SEC. ll. SENSE OF THE SENATE ON PAYMENT gram (also known as the Dean Ornish Pro- amendment the majority of the seniors en- REDUCTIONS UNDER MEDICARE gram for Reversing Heart Disease) has been rolled in their state pharmacy programs will PHYSICIAN FEE SCHEDULE. operating throughout 12 states and has been not be able to effectively access private (a) FINDINGS.—Congress finds that— demonstrated to reduce the need for coro- plans. (1) the fees Medicare pays physicians were nary procedures by 88 percent per year. reduced by 5.4 percent across-the-board in AMENDMENT NO. 983 The Medicare Lifestyle Modification Pro- 2002; gram is less expensive to deliver than inter- (Purpose: To provide medicare beneficiaries (2) recent action by Congress narrowly ventional cardiac procedures and could re- with information on advance directives) averted another across-the-board reduction duce cardiovascular expenditures by $36 bil- On page 676, after line 22, insert the fol- of 4.4 percent for 2003; lion annually. lowing: (3) based on current projections, the Cen- Lifestyle choices such as diet and exercise SEC. ll. PROVISION OF INFORMATION ON AD- ters for Medicare & Medicaid Services (CMS) effect heart disease and heart disease out- VANCE DIRECTIVES. estimates that, absent legislative or admin- comes by 50 percent or greater. Section 1804(c) of the Social Security Act istrative action, fees will be reduced across- Intensive lifestyle interventions which in- (42 U.S.C. 1395b-2(c)) is amended— the-board once again in 2004 by 4.2 percent; clude teams of nurses, doctors, exercise (1) by redesignating paragraphs (1) through (4) the prospect of continued payment re- physiologists, registered dieticians, and be- (4) as subparagraphs (A) through (D), respec- ductions under the Medicare physician fee havioral health clinicians have been dem- tively; onstrated to reduce heart disease risk fac- (2) in the matter preceding subparagraph schedule for the foreseeable future threatens tors and enhance heart disease outcomes (A), as so redesignated, by striking ‘‘The no- to destabilize an important element of the dramatically. tice’’ and inserting ‘‘(1) The notice’’; and program, namely physician participation The National Institutes of Health esti- (3) by adding at the end the following: and willingness to accept Medicare patients; mates that 17 million Americans have diabe- ‘‘(2)(A) The Secretary shall annually pro- (5) the primary source of this instability is tes and the Centers for Disease Control and vide each medicare beneficiary with informa- the sustainable growth rate (SGR), a system Prevention estimates that the number of tion concerning advance directives. Such in- of annual spending targets for physicians’ Americans who have a diagnosis of diabetes formation shall be provided by the Secretary services under Medicare; increased 61 percent in the last decade and is as part of the Medicare and You handbook (6) the SGR system has a number of defects expected to more than double by 2050. that is provided to each such beneficiary. that result in unrealistically low spending Lifestyle modification programs are supe- Such handbook shall include a separate sec- targets, such as the use of the increase in the rior to medication therapy for treating dia- tion on advanced directives and specific de- gross domestic product (GDP) as a proxy for betes. Individuals with diabetes are now con- tails on living wills and the durable power of increases in the volume and intensity of sidered to have coronary disease at the date attorney for health care. The Secretary shall services provided by physicians, no tolerance of diagnosis of their diabetic state. ensure that the introductory letter that ac- for variance between growth in Medicare The Medicare Lifestyle Modification Pro- companies such handbook contain a state- beneficiary health care costs and our Na- ment concerning the inclusion of such infor- gram has been an effective lifestyle program tion’s GDP, and a requirement for immediate mation. for the reversal and treatment of heart dis- ‘‘(B) In this section: recoupment of the difference; ease. ‘‘(i) The term ‘advance directive’ has the (7) both administrative and legislative ac- Men with prostate cancer have shown sig- meaning given such term in section 1866(f)(3). tion are needed to return stability to the nificant improvement in prostate cancer ‘‘(ii) The term ‘medicare beneficiary’ physician payment system; markers using a similar approach in lifestyle means an individual who is entitled to, or (8) using the discretion given to it by Medi- modification. These lifestyle changes are enrolled for, benefits under part A or en- care law, CMS has included expenditures for therefore likely to affect other chronic dis- rolled under part B, of this title.’’. prescription drugs and biologicals adminis- ease states, in addition to heart disease. tered incident to physicians’ services under AMENDMENT NO. Your amendment expresses the sense of the the annual spending targets without making (Purpose: To permit existing State pharma- Senate that the Secretary of Health and appropriate adjustments to the targets to re- ceutical assistance programs to wrap Human Services should carry out the Life- flect price increases in these drugs and style Modification Program Demonstration around the coverage provided by Medicare Prescription Drug plans and to facilitate biologicals or the growing reliance on such at the national level on a permanent basis therapies in the treatment of Medicare pa- and include as many medicare beneficiaries the enrollment of eligible beneficiaries for prescription drug coverage) tients; as would like to participate in the project on (9) between 1996 and 2002, annual Medicare On page 133, after line 25, insert the fol- a voluntary basis. spending on these drugs grew from lowing: $1,800,000,000 to $6,200,000,000, or from $55 per ‘‘(3) COORDINATION WITH EXISTING STATE SUMMARY OF THE AMENDMENT ON STATE beneficiary to an estimated $187 per bene- PHARMACEUTICAL ASSISTANCE PROGRAMS.— PHARMACEUTICAL ASSISTANCE PROGRAMS ficiary; FOR THE ELDERLY AND DISABLED ‘‘(A) IN GENERAL.—An eligible entity offering a Medicare Prescription Drug plan, or a (10) although physicians are responsible for Currently, 18 states have comprehensive MedicareAdvantage organization offering a prescribing these drugs and biologicals, nei- pharmacy assistance programs that provide MedicareAdvantage plan (other than an MSA ther the price of the drugs and biologicals, prescription drug coverage to more than 1.1 plan or a private fee-for-service plan that nor the standards of care that encourage million older and disabled residents. does not provide qualified prescription drug their use, are within the control of physi- The majority of these beneficiaries receive coverage), shall enter into an agreement cians; and life saving medications to treat high blood with each existing State pharmaceutical as- (11) SGR target adjustments have not been pressure, heart disease, arthritis, diabetes, sistance program to coordinate the coverage made for cost increases due to new coverage and eye disease. provided under the plan with the assistance decisions and new rules and regulations. Pennsylvania’s Pharmaceutical Assistance provided under the existing State pharma- Contract for the Elderly (PACE), established (b) SENSE OF THE SENATE.—It is the sense ceutical assistance program. in 1984, provides prescription drug coverage of the Senate that— ‘‘(B) ELECTION.—Under the process estab- to 230,000 Medicare beneficiaries, the vast (1) the Center for Medicare & Medicaid lished under section 1860D–3(a), an eligible majority of whom have incomes below 160% Services (CMS) should use its discretion to beneficiary who resides in a State with an of the federal poverty level. This enrollment exclude drugs and biologicals administered existing State pharmaceutical assistance is comprised largely of 70 and 80–year-old incident to physician services from the sus- program and who is eligible to enroll in such widows who have multiple disease states, tainable growth rate (SGR) system; program shall elect to enroll in a Medicare and less than a tenth grade education, and (2) CMS should use its discretion to make Prescription Drug plan or MedicareAdvan- have been enrolled in PACE for more than a SGR target adjustments for new coverage de- tage plan through the existing State phar- decade. cisions and new rules and regulations; and maceutical assistance program. Currently, the pending bill the Senate does (3) in order to provide ample time for Con- ‘‘(C) EXISTING STATE PHARMACEUTICAL AS- not provide for ‘coordination of benefits’, be- gress to consider more fundamental changes SISTANCE PROGRAM DEFINED.—In this para- tween state pharmaceutical programs and to the SGR system, the conferees on the Pre- graph, the term ‘existing State pharma- private insurers. Without a coordination of scription Drug and Medicare Improvement ceutical assistance program’ means a pro- benefit mandate and a role for the state Act of 2003 should include in the conference gram that has been established pursuant to a plans to facilitate enrollment in private agreement a provision to establish a min- waiver under section 1115 or otherwise before plans, many of these state program bene- imum percentage update in physician fees January 1, 2004.’’ ficiaries will not be able to access the new for the next 2 years and should consider add- Medicare drug benefit. AMENDMENT NO. 1085 ing provisions that would mitigate the This amendment provides for the coordina- (Purpose: To express the sense of the Senate swings in payment, such as establishing tion of benefits between states and private regarding payment reductions under the multi-year adjustments to recoup the vari- insurance companies, and facilitates the en- Medicare physician fee schedule) ance and creating ‘‘tolerance’’ corridors for rollment of state pharmacy assistance bene- At the end of title VI, insert the following: variations around the update target trend.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00008 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8655 AMENDMENT NO. The PRESIDING OFFICER. Without spans and led to a senior population (Purpose: To express the sense of the Senate objection, it is so ordered. with vigor and vitality. regarding the establishment of a nation- The Senator from West Virginia. But when the health of seniors does wide permanent lifestyle modification pro- Mr. BYRD. Mr. President, I thank decline, this Nation does an embarrass- gram for Medicare beneficiaries) the distinguished Democratic whip for ingly poor job of dealing with their At the end of title VI, insert the following: his thoughtfulness and courtesies. needs. Child care has become a boom- SEC. ll. SENSE OF THE SENATE REGARDING Mr. President, just last month we ing business in this Nation. Millions THE ESTABLISHMENT OF A NATION- WIDE PERMANENT LIFESTYLE MODI- celebrated Older Americans Month, a are spent on bigger, brighter, better FICATION PROGRAM FOR MEDICARE time of reflect on the contribution of child care centers—lively places, filled BENEFICIARIES. older Americans to our society—to with happy activities and stimulation. (a) FINDINGS.—Congress finds that: their families, their communities, and That is as it should be. But when the (1) Heart disease kills more than 500,000 their Nation. For many seniors, these elderly need daily care, too often they Americans per year. ‘‘golden years’’ are the most valuable are relegated to dim, overcrowded cen- (2) The number and costs of interventions for the treatment of coronary disease are ris- time in their lives, a time when they ters, places that serve as little more ing and currently cost the health care sys- may no longer have the day-to-day ag- than warehouses that provide busy tem $58,000,000,000 annually. gravations of work, and can con- work for the hands, and little to fill (3) The Medicare Lifestyle Modification centrate their time and efforts on the heart and soul. Program has been operating throughout 12 something else—grandchildren, lifelong Inestimable numbers of scam artists States and has been demonstrated to reduce passions, learning new skills, acquiring focus on the elderly. The offices of At- the need for coronary procedures by 88 per- knowledge, or participating in creative torney Generals across the nation are cent per year. endeavors. besieged with complaints from seniors (4) The Medicare Lifestyle Modification But that is not the case for many Program is less expensive to deliver than who were prey for some con artists and interventional cardiac procedures and could seniors. In too many instances, seniors ended up losing their life savings. reduce cardiovascular expenditures by who have worked and saved a lifetime Newspapers carry stories about CEOs $36,000,000,000 annually. find that today’s cost of living far ex- of big, once-profitable companies who (5) Lifestyle choices such as diet and exer- ceeds the level they can afford. Despite are awarded big bonuses, while the pen- cise affect heart disease and heart disease planning and frugality, today’s costs sions of loyal retirees are squeezed. outcomes by 50 percent or greater. simply have exceeded the means of When this is how we treat our seniors, (6) Intensive lifestyle interventions which many older Americans, and they find something is wrong with America. include teams of nurses, doctors, exercise that the visions of the secure life they Older citizens should rejoice in their physiologists, registered dietitians, and behavioral health clinicians have been dem- had expected post-retirement are now long lives, in their collected experi- onstrated to reduce heart disease risk fac- more a nightmare than a dream. ences, and in their accomplishments. tors and enhance heart disease outcomes A big part of the problem is the value But in America today, magazines show- dramatically. that our society places on the elderly— case images of young, vibrant models. (7) The National Institutes of Health esti- it is much too low! Movies and television shows feature mates that 17,000,000 Americans have diabe- Age discrimination is all too preva- youthful actors and actresses. No one tes and the Centers for Disease Control and lent in the workplace. Long-held wants to be ‘‘old’’ anymore. It has be- Prevention estimates that the number of stereotypes—that seniors are slow, for- come a tarnished word. Americans who have a diagnosis of diabetes increased 61 percent in the last decade and is getful, less competent than their Older citizens today are generally expected to more than double by 2050. younger counterparts—limit opportu- not appreciated as either experienced (8) Lifestyle modification programs are su- nities for older workers and prevent ‘‘elders’’ or possessors of special wis- perior to medication therapy for treating di- businesses from benefiting from well- dom. Older people are respected only to abetes. honed talents. Those stereotypical im- the extent that they remain capable of (9) Individuals with diabetes are now con- ages are just plain wrong. working, exercising, and taking care of sidered to have coronary disease at the date To be 65 today is not like it was to be themselves. In American culture, in- of diagnosis of their diabetic state. 65 when I was a young man. The idea of creasing age seems to portend decreas- (10) The Medicare Lifestyle Modification pushing senior citizens out of the door Program has been an effective lifestyle pro- ing value as a human being. It should gram for the reversal and treatment of heart to make room for younger workers is, be just the opposite. disease. itself, antiquated. How did the American culture de- (11) Men with prostate cancer have shown I grew up during the Great Depres- velop such blatant disregard and dis- significant improvement in prostate cancer sion when one had to work hard just to respect for the elderly? Well, however markers using a similar approach in lifestyle get a job and then work even harder to we got to such a point, we are defi- modification. keep it. People of my generation, the nitely here. (12) These lifestyle changes are therefore generation Tom Brokaw has referred to Senior citizens need to rise up and likely to affect other chronic disease states, as ‘‘The Greatest Generation’’—I kind make their voices heard or else they in addition to heart disease. (b) SENSE OF THE SENATE.—It is the sense of like that term, ‘‘The Greatest Gen- will be forgotten, especially when it of the Senate that— eration,’’ although I don’t quite agree comes to policy formation that di- (1) the Secretary of Health and Human with it. rectly affects them, such as Medicare Services should carry out the demonstration Seniors in the workforce can be a legislation before us today. The Senate project known as the Lifestyle Modification positive and inspiring force. is in the midst of an important debate Program Demonstration, as described in the The reason I don’t agree with it is on a major restructuring of Medicare— Health Care Financing Administration that I think the greatest generation a debate that will shape the health Memorandum of Understanding entered into was that generation that produced the care choices of millions of our Nation’s on November 13, 2000, on a permanent basis; (2) the project should include as many Constitution of the United States and senior citizen for years to come. Medicare beneficiaries as would like to par- produced this constitutional system of The Medicare program is in desperate ticipate in the project on a voluntary basis; government that we have today. We need of renovation to meet the needs of and will talk more about that on a later today’a older citizens living in a new (3) the project should be conducted on a na- day. era with dramatic advancements in the tional basis. I grew up during the Great Depres- delivery of health care. Medicare was Mr. SPECTER. I thank the Chair. I sion when one had to work hard, as I designed to provide health care bene- yield the floor. say, just to get a job and then work fits to the most vulnerable segments of Mr. REID. Mr. President, I ask unan- harder to keep it. People of my genera- the population, the elderly and the dis- imous consent that the distinguished tion, coming from that experience, de- abled. Senator from West Virginia be recog- veloped a work ethic which can inspire When I voted, way back in 1965, to es- nized to speak on the bill for up to 20 young people today. Seniors in the tablish the Medicare program, pharma- minutes and that following his state- workforce can be a positive, inspiring ceutical treatments, then more of foot- ment, the Senator from Florida, Mr. force. Moreover, better health care and note in health care, were not nearly as GRAHAM, be recognized for 15 minutes. healthier lifestyles have extended life- commonly available as they are now.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00009 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8656 CONGRESSIONAL RECORD — SENATE June 26, 2003 Today, they are a primary form of diminished service, especially for rural legislation? Why wait? What are we so medical care and often substitute for areas such as West Virginia. Pensions afraid of? We had Medicare up and run- more costly treatments like hos- and retirement security have taken a ning less than 12 months after creating pitalization and surgery. similar beating. it from scratch in 1965. So why can’t we Today, 40 million Americans rely on The Medicare program, for which I do it now? Mr. President, it seems that Medicare to help provide for their med- voted in 1965, was originally created be- this Congress is trying to pull the wool ical needs. With more than one-third of cause the private sector did not offer over the eyes of our Nation’s senior all Medicare beneficiaries lacking in- affordable and reliable health insur- citizens—hoping to claim victory and surance coverage for the cost of needed ance to the elderly and the disabled. keep senior citizens in the dark until medications, finding affordable pre- Health care has certainly changed in they become painfully aware of the scription drug coverage is a critical the past 38 years, but what has not fine print—the fine print—of this legis- issue for our Nation’s seniors. Prescrip- changed is the fact that the private lation upon a visit to their local phar- tion drugs are an essential tool for market does not want to insure people macist in 2006. treating and preventing many acute who are old or disabled or likely to Mr. President, this legislation, as it and chronic conditions, but Medicare need care. Mr. President, what is the stands, does not provide the real, guar- fails to cover them on an outpatient rationale for inventing some new anteed, defined benefit that our senior basis. Too many seniors and disabled hocus-pocus type of plan that exposes citizens desperately need and does lit- persons in this country, especially senior citizens to the whims of private tle to address the high cost of prescrip- those living on fixed incomes, are insurance companies which may be tion drugs. I had hoped we could im- forced to choose each month between more interested in profits than in pro- prove this legislation through the paying for food and paying for shelter, viding comprehensive drug benefits? amendment process, but that does not or buying the essential medicines that Mr. President, this legislation, as appear to be the will of this Senate in their doctors have prescribed. currently designed, does not even pro- the mad dash—the mad dash—to reach Our Nation’s senior citizens are los- vide sufficient prescription drug cov- final passage before the recess. We ing their patience. They are losing erage. It would cover less than a quar- should do better for our older citizens. their dignity. And they are fed up with ter of Medicare beneficiaries’ esti- We owe them so much. fast-rising drug costs that they cannot mated drug costs over the next 10 Mr. President, I yield the floor. afford. Older citizens should not have years, and the complicated coverage The PRESIDING OFFICER. The Sen- to travel in bus loads to Canada and formula has a large donut hole pro- ator from Florida. Mexico just to obtain the medications viding zero coverage just when seniors Mr. GRAHAM of Florida. Mr. Presi- their doctors prescribe. What does it might need it most. dent, this is a sad evening for me. I rise say about this country and its values This legislation also includes copay- to oppose the prescription drug bill when we fail to take care of our elderly ments, premiums, and deductibles that that we will be voting on shortly. No citizens whose lifetime of work and may be unaffordable for man low- and issue that we have debated over recent sacrifice and dedication and industry middle-income seniors. The $35-per- years has held so much promise, the helped to endow this country with the month premium, the 50-percent copay, promise that we could fundamentally greatness it now enjoys? the $275 annual deductible, and the reform Medicare from a program which Mr. President, I fear that the legisla- $5,800 stop-loss amount that we have today requires you to be sick enough to tion before us today is a glaring exam- heard so much about are only sug- go to the doctor or the hospital in ple of how this Nation shortchanges gested amounts and certainly not a order to get services to one that would our senior citizens. We are not taking guarantee. A closer look at the fine have its focus on wellness, including care of our elderly citizens as they print of this legislation reveals that the opportunity to participate in a vol- wrestle with the most serious issue in private insurers could choose to charge untary, comprehensive, universal, and their lives. We are offering a partial fix senior citizens double or even triple affordable plan of prescription drugs. to assuage senior anger. This bill fails these amounts. Prescription drugs are, in today’s to go far enough to meet the needs of Let’s fact it, the kind of prescription health care system, a fundamental part our Nation’s senior citizens. I am con- drug benefit that we have repeatedly of maintaining good health. I have cerned that this measure would force promised our Nation’s elderly citizens, spent the better part of the last 5 Medicare beneficiaries to rely on a pri- and that they now rightly expect, years, as have so many of my col- vate, untried, untested, drug-only in- would cost at least $800 billion over the leagues—and in the case of Senator surance market for their prescription next decade. Yet the administration BYRD, many more than 5 years—at- drug coverage, rather than the tradi- and congressional Republicans have tempting to deliver a meaningful drug tional Medicare program that they only allocated $400 billion for the next benefit for our Nation’s seniors. I have know and trust. We split drug benefit 10 years for a Medicare prescription learned some things during this period. off from Medicare? drug benefit. And during this same pe- Unfortunately, what I have learned I am concerned that this administra- riod, drug costs for senior citizens convinces me that the bill before us to- tion and some Members of Congress alone, according to the Congressional night is not worthy of America’s sen- plan to phase out the traditional Medi- Budget Office, are expected to total al- iors. Because what we are about to de- care program as an option for new most $2 trillion. liver is a hollow promise and little beneficiaries in the future. Some peo- One of the primary reasons this legis- else. ple have asserted that this legislation lation contains such glaring defi- Why do I believe this? Why have I is merely a Trojan horse designed to ciencies in the drug benefits being of- come to the conclusion that this pro- get rid of Medicare. I sincerely hope fered to seniors is not difficult to un- posal is not worthy of using all of the that this is not the case, but there is derstand—this administration and Con- years of enthusiasm and commitment something very suspicious about this gress have chosen to make tax cuts a of America’s seniors and many of those particular horse. higher priority than prescription drugs such as myself who represent a sub- I am worried that we may be endors- for senior citizens. Since the Federal stantial number of those seniors? Why ing the slow suicide of one of the most Treasury has already been raided, do we feel that this path is not accept- popular and effective Government pro- there is not enough money to ade- able? grams in history. I have been down this quately cover prescription drugs. Sen- First, there are gaps in the benefit tortured road before during my 50-year ior citizens ought to be outraged—out- which are too large to overcome. I tenure in Congress. My constituents raged. Senior citizens ought to be out- could not go home to Florida or to any and others around the Nation are reel- raged. I am a senior citizen, and I rep- other place in America and tell people ing from public programs that have resent a State with a lot of senior citi- that this legislation is a good deal. been turned over to the so-called free zens, and I am outraged! I am outraged! This is especially the case for those market. Utility rates, cable rates, air- What is the rationale for waiting with large out-of-pocket expenses. How line rates, you name it, the free mar- until 2006—conveniently right after the do we tell a senior who halfway ket has ensured exorbitant prices with next election cycle—to implement this through the first year in which this

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00010 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8657 will be available, 2006, their drug costs good system, why don’t we provide it astrophic care provision, so that sen- will double but they will continue to for all Federal employees so they can iors who, today, are relatively healthy pay the monthly premiums? get, we as Federal employees can get, are insuring themselves against the That would be analogous to car in- the benefit of this greater efficiency risk that they might have a disease or surance which says: You will be cov- and cost savings? The reason is because an accident that would put them into ered in case you have an accident from insuring drugs only is not an actuari- much higher prescription drug costs. January to August but if you have one ally sustainable risk. It has been analo- Last year we determined that the from September to December it is out gized to buying a fire insurance policy level necessary to induce a large of your pocket. Who would buy that just to cover the kitchen. No insurance enough number of healthy seniors to automobile coverage? company is going to sell you a policy participate was $4,000 in an annual drug The worst thing is that millions of for the most vulnerable area of your expenditure, and if their previous em- seniors will never realize they have house to actually experience a fire. ployer made a contribution, that would bought in to such an inadequate policy That is why no private insurance be counted toward that $4,000. This bill until it is too late. plan is available today which will pro- increases the level at which a person Second, this bill does not provide a vide you a prescription-only coverage. would be eligible for catastrophic care universal drug benefit. Under this plan, That is the equivalent of the kitchen in to $5,800, and employer contributions for instance, if you are a Medicare ben- terms of its intensity and potential for would be excluded. This new level is eficiary but you are also poor, you will explosion of cost within health care. significantly less of an inducement for not get the prescription drug benefits Yet we are about to say that some 40 healthy seniors to participate, and the for Medicare. That is right. Seniors at million of the most vulnerable and effect is likely to be disappointing lev- 74 percent or below the poverty level frail Americans are going to be the ex- els of participation. would be excluded from the Medicare periment for this ideology. Mr. President, I ask unanimous con- benefit. They would get their prescrip- I have said it before and I will say it sent that a copy of today’s front page tion drugs through Medicaid. This is a again: There is simply no reason to article ‘‘For Struggling Seniors, Medi- clear effort for the Federal Govern- subject our Nation’s seniors to this care Drug Plan’s Proof Is in the Purse’’ ment to unload a substantial part of its grand experiment, particularly when from the Washington Post be printed in prescription drug expenses on the we already know what works. There is the RECORD following my remarks. States, States which are already strug- no reason to pump extra dollars into The PRESIDING OFFICER. Without gling with serious financial problems. private insurance plans. objection, it is so ordered. It is for that reason that the Na- A few hours ago we adopted an (See exhibit 1.) tional Governors Association has op- amendment which will pump in $6 bil- Mr. GRAHAM of Florida. The re- posed this design saying: lion for additional benefits to HMOs. porter interviewed active, healthy sen- It is not good health policy. It is not good Those $6 billion could have been used iors at centers in Cleveland, OH, and precedent. to reduce the monthly premium, to they were skeptical of the cost of the The argument is made that this is all close part of the gap of coverage. But benefits that would be offered under we can do. We cannot do better because what did we decide to do? We are going this bill. we do not have the resources to do bet- to give it to the HMOs so the Federal Sixth, the fact that this bill doesn’t ter. This is analogous to the child who Government will be assuming more of take effect until 2006 is another brutal just has shot his mother and his father the risk of coverage as opposed to these hoax on seniors, truly an abusive, and now throws himself on the mercy plans whose reason for being is to as- shameful, misleading ploy. of the court claiming to be an orphan. sume the risk and, therefore, have the The fact is, many of those who most We have made the decision to be in the incentive to provide the most efficient need prescription drug coverage today financial status that we are, and the plans. simply will not live long enough to get consequence of that decision, as we de- We are begging these HMOs to par- any benefits under this plan. As much bated a few weeks ago when we adopted ticipate in the Medicare Program for as I have wanted to vote for a drug bill, the Senate’s budget for the year, is the sake of a private sector veneer, for for those reasons, I simply cannot vote that we are going to have to have an the sake of an ideology untested. We for the one before us this evening. unnecessarily and unacceptably low actually tried a version of this before. We have lost our focus. The focus level of financial support for a mean- Guess what. It didn’t work. I speak should be on the Medicare Program in ingful prescription drug benefit. from experience. Medicare HMOs have reform and how to help our 40 million Third, this plan will cost many sen- dumped hundreds of thousands of Flo- seniors and disabled persons. Instead, iors more than they can afford. From ridians from their rolls as they have in the focus is everywhere else—insurance repeated surveys, seniors have stated virtually every other State, and more companies, drug companies, and hiding that they need a plan with no deduct- are being dumped each day. But this the flaws which ought to be exposed. ible so that coverage starts from the Congress, rather than look to the re- This focus is often presented as the first prescription. And they need a pre- ality of past experience, has deter- issue of choice. Choice has different mium of no more than $25 a month. Yet mined to embark on this collision meanings. For the idealog, choice the sponsors of this bill suggest a $275 course at the expense of seniors and at means a choice among delivery sys- deductible and an average premium of the expense of common sense. tems. But for seniors, choice means $35 per month, an average premium Fifth, I fear that we will have dif- doctors, hospitals, and, hopefully, pre- which could actually be higher because ficulty in convincing healthier seniors scription drugs. Yes, this gives seniors the private insurance companies will to sign up for this prescription drug a choice among delivery systems. For determine the level of the premium. benefit. As it is with virtually all in- instance, if you are one of the 89 per- You can look through the over 600 surance plans, it is critical that there cent of seniors in a fee-for-service pages of this bill and not find the num- be a mixture of those who have the Medicare Program, you will get a ber $35. That is a hope number but the greater likelihood of experiencing the choice of between two or more pre- actual number will be determined by risk with those who have the lesser scription drug plans. If that fails, you the private insurance carriers. likelihood in order to create an actu- will then drop back into traditional Fourth, this bill would subject mil- arially sound balance. Medicare. lions of America’s seniors to a giant One-third of our seniors would not The Stabenow amendment, which experiment, a giant experiment in de- break even under this legislation. That was defeated earlier in the debate, livering prescription drugs through an is, one-third of seniors with drug would have given seniors at least real untested delivery system, a system spending of less than $1,135 per year choice between a prescription drug de- which is unheard of in the private mar- would get no benefit should they volun- livery system and fee-for-service Medi- kets. It is stated that this system will tarily sign up for this plan. Therefore, care as the delivery system. be justified because it will be efficient how do we induce them to do so? One of The tragedy is that we know what we and will use the power of competition the ways that we had induced them in ought to be doing. What we ought to be to suppress cost. If this was such a the past was to have a meaningful cat- doing is building on the strengths of

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00011 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8658 CONGRESSIONAL RECORD — SENATE June 26, 2003 our current Medicare system—one of will try to cobble together the money to buy watching with guarded optimism and could the most popular health care programs the prescription coverage that lawmakers revolt if the final package fails to meet ex- in this Nation’s history. We also ought plan to offer Medicare recipients. pectations. That would dash Republicans’ ‘‘I don’t know,’’ she said. ‘‘My finances hopes of taking away an issue that has been to be seeing that we have a plan that is right now are very tight. I guess I’d have to mostly associated with Democrats for dec- affordable and comprehensive. go with it.’’ ades. I think the dye is cast and this bill is In interviews at two senior centers here, Their elderly residents’ fundamental ques- likely to pass the Senate. I will be Urban and other retirees expressed deeply tion is whether they would save money hopeful that in conference it will im- mixed feelings about the voluntary prescrip- under the new plans. The answer isn’t easy. prove but I think there is every likeli- tion drug benefit scheduled for votes in Con- Urban is torn. Most years she spends about gress as early as today. They exhibited a vis- $800 on medicine, so a benefit that does not hood to suspect that it will get worse. ceral distrust of Washington, voicing skep- begin paying off until after $1,000 in out-of- It will be my intention to introduce ticism that elected officials would deliver a pocket spending looks like a money loser for legislation that will correct the flaws package that fits their health needs and her. But this year, a mysterious infection of this legislation which, among other budgetary constraints—in time for them to and several hospitalizations pushed her drug things, will provide for a patients’ bill use it. They were disappointed that in most bills to $1,500, and the federally subsidized of rights, so that as we herd more sen- cases, benefits would not begin until a per- insurance would have saved her money. iors into HMOs, at least they will know son spent nearly $1,000 a year on prescription Urban drives 30 minutes to several phar- the standards by which they will be drugs. And they were annoyed—but not to- macies in the Cleveland suburbs to shop for tally surprised—that the program would not the best deals. She gets agitated thinking asked to operate within that. begin until 2006. about the complex math of the new proposal. We are beginning to hear the first ‘‘They’ve been kicking this ball around for Howard Bram, 77, also complained about rumblings of dissent. Today’s Miami a while,’’ said Carrie Adams, 66. ‘‘If they the complexity of a program that will in- Herald looked at the legislation before wanted to solve this, they would. The people volve choosing a plan, tracking out-of-pock- the two Houses and this is what they with the ball are not relating to the people et expenses and knowing when the coverage had to say: out here.’’ kicks in, lapses and then resumes in severe Ruby Bogus, 83, was a bit more sanguine. cases, all according to a sliding scale of ben- House and Senate bills attempting to offer ‘‘We just have to live longer, girls,’’ she said. efits. prescription drug cost relief to Medicare sen- Both the House and Senate plans would re- ‘‘It’s just gonna blow their minds,’’ he said. iors can be summed up with the movie title, quire seniors to pay about $35 in monthly Bram is trying to figure out whether the Dumb and Dumber. premiums and an annual deductible of $250 to drug plan would put a significant dent in the Both bills promise dubious benefits with- $275 before receiving any subsidy. The Senate cost of the eight medications he takes. out providing the security that seniors want plan would cover half of a person’s annual Carrie Adams and Jean Nagorski are pre- and have, with traditional Medicare health drug expenditures between $276 and $4,500. cisely the sort of customer-patients that coverage. The recipient would pay the next $1,300 in Medicare will need—comparatively young, I ask unanimous consent that a copy prescription costs. If the person’s total drug healthy and with some retirement income. of that editorial be printed in the costs rose above $5,800 in a year, subsidies Yet both women doubt they would buy the would resume. Medicare drug coverage because they believe RECORD after my remarks. The House bill would offer retirees an 80 they get a better bargain with the current The PRESIDING OFFICER. Without percent subsidy on drug bills between $251 supplemental insurance plans. Without cli- objection, it is so ordered. and $2,000 and no coverage for the next $1,500 ents such as Adams and Nagorski, policy- (See exhibit 2.) worth of medications. The ‘‘catastrophic makers worry, the new Medicare package Mr. GRAHAM of Florida. Medicare coverage’’ would begin when costs reached will draw the oldest, sickest and poorest pa- has served our seniors superbly. And $3,501. tients, leading to skyrocketing costs. Asked whether either plan was attractive, Despite the plan’s limits, Adams predicted where it has not, as in the area of pre- Emily Eckert pulled a tiny notebook from scription drugs, it has been because many friends will sign up for any program her purse. It listed her daily medications: that might lower their drug bills. ‘‘They’re Congress has not allowed it to do so. two pills to control sugar, one for high blood gonna jump on this like white on rice,’’ she I hope when this bill comes back pressure, another to regulate potassium. said. from conference, it will be better but I Using her People’s Drug Mart discount Zev Harel, 73, agreed. doubt that will be the case. card—also tucked in her pocketbook—Eckert ‘‘There are always those who hope for a The PRESIDING OFFICER. The Sen- spends about $100 a month on prescriptions, revolution, but what has worked in the plus $22 for diabetes test strips. United States is evolution,’’ said Harel, a ator has consumed 15 minutes. At 79, she has outlived two husbands, but Mr. GRAHAM of Florida. Mr. Presi- professor at Cleveland State University and at a high cost. Caring for her first husband, board member of the Western Reserve Area dent, I will vote no today in the hopes who had cancer, and the second, who had dia- Agency on Aging. Many of his friends will be that soon we will have an opportunity betes, wiped out $7,000 in savings and two life disappointed with the limits of the drug cov- to pass a prescription drug bill that insurance policies valued at $3,000. Eckert erage, he said, but he considers it ‘‘a major will fully meet the needs and expecta- has been in bankruptcy and worries about improvement over the current situation.’’ tions of older Americans. helping her three children, 10 grandchildren If analyzed in the context of other types of and 10 great-grandchildren. insurance, the Medicare drug plan is a rea- EXHIBIT 1 ‘‘If it wasn’t for this center, I’d be starv- sonable approach, Harel said. ‘‘This follows [From The Washington Post, June 26, 2003] ing,’’ she said, referring to the Senior Citi- on the principle of purchasing protection.’’ FOR STRUGGLING SENIORS, MEDICARE DRUG zens Resources facility in the Old Brooklyn But many others said the fundamental PLAN’S PROOF ISINTHEPURSE neighborhood. She wants to buy the drug promise of Medicare—a system they sup- coverage proposed for Medicare but isn’t cer- (By Ceci Connolly) ported through payroll taxes throughout tain she will be able to pay the premiums. their careers—has always been health care CLEVELAND—As the Medicare drug pack- The situations of Marie Urban and Emily for all, and in today’s world, that should in- age moving through Congress takes on an air Eckert may sound dire, but in many respects clude prescriptions. of inevitability, Washington politicians are they are typical for the millions of senior ‘‘The politicians seem to say it’s better already jostling for credit. But in this work- citizens and disabled people who rely on than nothing, and we should be grateful,’’ ing-class city 370 miles from Capitol Hill, Medicare for their health care. Not poor Urban grumbled. prospects for the plan’s eventual success enough to qualify for Medicaid, yet not for- To some retirees here, who chip coupons may lie deep inside the handbags of women tunate enough to have substantial savings or and follow the news, Washington’s Medicare such as Marie A. Urban. a lucrative retirement package, such people is just the latest example of the doings of Stashed in there are her monthly Social have clamored for years for help with the ris- out-of-touch elitists. Security statement, a half-dozen prescrip- ing cost of medication. Nagorski reached into her purse and re- tion discount cards and insurance letters re- Assuming the House and Senate pass their trieved a recent newspaper clipping detailing jecting several recent medical claims. The spending bills and then resolve their dif- the personal riches of the United States’ scraps of paper—creased and scribbled on— ferences, Congress hopes to answer those de- elected leaders. The article identified several document a life near the financial edge. mands by spending nearly $400 billion on millionaires, including Sens. Bill Frist (R- After working 24 years as the secretary at drug coverage over 10 years. The legislation Tenn.), Edward M. Kennedy (D-Mass.) and St. Paul’s Shrine, Urban, 72 collects $843.70 a would mark the largest Medicare expansion Ohio’s senators, Mike DeWine and George V. month in Social Security. After housing and in the program’s 38-year history and could Voinovich, both Republicans. Medicare payments, she has $459 for utilities, provide a political boost to President Bush ‘‘Do you really think they care about the food, car insurance, taxes and medication. and fellow Republicans who campaigned on average person with what they earn?’’ ‘‘Some months I have 87 cents to live on,’’ the promise of alleviating drug costs. Nagorski asked. ‘‘I don’t think any of them she said. With her drug bills this year al- However, as the conversations in Cleveland are ever going to have to live on $1,100 a ready exceeding $1,500, she said she probably illustrated, many older Americans are month.’’

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00012 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8659 [From the Miami Herald, June 26, 2003] He will speak for 10 or 15 minutes, is real problem, the need to help strug- THE WRONG PRESCRIPTION—CONGRESS my understanding. gling middle and low-income seniors. CONSIDERS INADEQUATE BILLS We are at a point where we have very However, we must have no illusions. U.S. House and Senate bills attempting to few amendments left. We have a couple There are dangerous complexities and offer prescription-drug cost relief to Medi- that may take a little debate but I potential unintended consequences as- care seniors can be summed up with a movie think most of them will be disposed of sociated with this bill. title: Dumb and Dumber. Both bills promise with minimal debate. I hope everyone First, we must be realistic about the dubious benefits without providing the secu- understands we are moving this along cost of this new entitlement program. rity that seniors want, and have, with tradi- as quickly as possible. The managers For anyone who believes this bill will tional Medicare health coverage. cost a maximum of $400 billion over the With election-year politicking started al- have worked for 2 weeks on this mat- ready, the bad news is that a bad bill may ter. next 10 years, I have some oceanfront actually be enacted after years of waiting. After the Senator from Arizona fin- property in Gila Bend, AZ, to sell you. The politicians may easily be miscalcu- ishes his statement, we should be in a Medicare and Social Security, to- lating. Most seniors, who faithfully turn out position to have a number of votes gether, represent an enormous un- to vote, want prescription-drug coverage lined up for later this evening. funded liability for our Nation. In a few through Medicare—not the private insurers The PRESIDING OFFICER. The Sen- short years, millions of baby boomers that the GOP-controlled Congress and White ator from Arizona is recognized. will hit retirement age and the system House are pushing. Mr. MCCAIN. Mr. President, the pas- will quickly become insolvent. Further, an increasing number of Ameri- The numbers speak for themselves. cans—32 percent today versus 16 percent in sage of the Medicare prescription drug benefits legislation is a difficult vote Medicare currently has an unfunded li- 1999—says that neither the Republican Party ability of $13.3 trillion. Some have esti- nor the Democratic Party is doing a good job for me. It is unacceptable that in a on the issue of prescription-drug benefits for country as wealthy as ours seniors mated the unfunded liability of the the elderly, according to a recent poll by the across the country are struggling to af- package before us in the $6 to $7 tril- Kaiser Family Foundation and Harvard ford the high cost of prescription lion range. A scholar at the American School of Public Health. The proposed con- drugs. I have supported adding a pre- Enterprise Institute Scholar estimated gressional legislation can only deepen that scription drug benefit to Medicare be- that if passed, the Senate’s prescrip- sense. tion drug benefit legislation will result Each bill would cost about $400 billion over cause I believe no beneficiary should have to choose between life-sustaining in a $12 trillion unfunded liability. So- 10 years and suffer from complexity and cov- cial Security and Medicare, with a pre- erage gaps. Under the Senate bill, for in- prescription medications and other stance, a senior would pay the first $275 in vital necessities. Far too many Amer- scription drug benefit, will together drug costs (the deductible), then half of the ican seniors face those choices every consume an estimated 21 percent of in- costs—up to $4,500. They would then get no day. Many ration their supplies of come taxes by the year 2020. benefit until the bills total $5,800 (an out-of- medication, skip dosages, or cut pills Long after the Members of this Con- pocket expense of $3,700), after which 90 per- in half. gress and administration have left of- cent of the cost would be covered. Have you In Arizona, busloads of seniors depart fice, our children and our grand- got that? children, and a future Congress and ad- It gets worse. Beyond the deductible and from Phoenix and Tucson every week, heading south to Mexico to purchase ministration, will be struck with the co-payments, seniors would pay a monthly burden of cleaning up the mess we have premium—even while getting no benefits lower cost prescription drugs. The when they are in the coverage gap. Although story is similar across the northern created. In the past 2 years, we have passed the premium is ‘‘estimated’’ at $35 a month, border, where seniors make daily trips two large tax cuts. Government spend- it’s actually subject to a drug-cost inflator to Canadian pharmacies. Throughout ing, however, has continued to increase that, at the moment, is four times higher the country, an increasing number of than inflation. It’s also subject to interpre- well above the inflation use. Much of seniors are looking to online phar- tation by private insurers, who presumably that spending is unnecessary, and rep- would contract with the government to ad- macies, selling reduced-priced prescrip- resents a lack of fiscal discipline more minister this plan—an uncertain assump- tions imported from other countries, common in times of federal budget sur- tion. oftentimes with questionable safety. pluses. Yet our current budget deficit The Senate bill also provides for a ‘‘fall- That said, I also recognize, as does and national debt have risen dramati- back’’: if a region doesn’t attract two com- every other Member of Congress, that cally. Security concerns in the post 9/11 peting private insurers, the government may Medicare is on a fast track toward contract with pharmacy-benefit managers, era necessitate substantial increases in bankruptcy. The most recent Trustee’s spending on defense and homeland se- firms that actually manage the prescription- Report adjusted down the year Medi- drug programs of most large health-insur- curity. We cannot sustain this level of ance plans. So why contract with the private care will reach financial insolvency by fiscal profligacy indefinitely. insurers in the first place when these phar- 4 years, to 2026. Clearly, it is incum- This extraordinary large new entitle- macy-benefit managers have the expertise to bent upon us to include comprehensive ment we are debating will impose an drive down drug costs by leveraging Medi- reform of the system in any Medicare equally extraordinary burden on tax- care’s enormous volume-buying power? prescription drug package in order to payers. The money has to come from That the pharmaceutical companies are ensure that Medicare is financially trying to strip this fallback provision does somewhere, and none of the ‘‘some- sound for current beneficiaries as well wheres’’ are desirable. The reality is, indicate who wants the benefits here—and as future generations. we’re not talking about Medicare seniors. this new benefit will be funded by raid- The House GOP measure, indeed, has no Medicine has changed substantially ing other entitlement trust funds, or fallback provision—which could leave large since the creation of the Medicare sys- by increasing our national debt, or by areas of the country without access to the tem in 1965. Advances in medical tech- substantially increasing taxes. Medicare drug benefit. It has the same pre- nology and pharmaceuticals have led Despite the enormous cost of this mium problem and a bigger coverage gap. to more prescription-based treatments. bill, this new entitlement will not pro- But it would provide more generous benefits: The simple fact is, Americans now con- vide the prescription drug coverage A $250 deductible and 80 percent cost cov- sume more prescriptions than ever be- many seniors expect to receive. Nor erage up to $2,000. fore. In 1968, soon after the enactment Neither bill offers the drug-price relief, does it enact significant reform meas- simplicity and security that seniors need. of Medicare, American seniors spent ures needed to ensure the long-term But what do you expect from a Congress and about $65 a year on a handful of pre- solvency of the Medicare system. White House that already have spent $1.7 scription medications. Today, seniors Those seniors who think this bill will trillion on tax cuts since 2001? Seniors, and fill an average of 22 prescriptions a solve their financial problems will soon critical Medicare and Social Security con- year, spending an estimated $999. learn that there are substantial limita- cerns, apparently only matter as talking The bill before us represents one of tions to the benefit. When it does pass, points for an election year. the largest enhancements to Medicare the new prescription benefit will not be The PRESIDING OFFICER. The Sen- since its creation, setting up an en- available immediately. In fact, it will ator from Nevada is recognized. tirely new bureaucracy and estab- take several years just to establish the Mr. REID. Mr. President, I know the lishing a sizable new entitlement pro- new bureaucracy which will administer Senator from Arizona is here to speak. gram. I believe this bill addresses a the prescription benefits.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00013 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8660 CONGRESSIONAL RECORD — SENATE June 26, 2003 Low-income seniors will benefit from ments, which would not have been pos- lic servant should want to be remem- this package, and I am pleased that sible without the leadership of Senator bered for, we will have left the country they will. Many other seniors, however, GREGG and the support of Senator KEN- worse off than we found it. will not receive a generous benefit, and NEDY, will reduce the cost to the gov- I yield the floor. might not even get out of the system ernment of any Medicare prescription Mr. REID. I suggest the absence of a what they will pay in deductible sand drug benefit. quorum. premiums. The Congressional Budget I was happy to cosponsor an impor- The PRESIDING OFFICER (Mr. Office estimates that 37 percent of em- tant amendment with Senators FEIN- ALEXANDER). The clerk will call the ployers currently providing coverage to STEIN, NICKLES, CHAFEE, and GRAHAM, roll. The assistant legislative clerk pro- Medicare eligible seniors, will drop which I believe will add some fiscal discipline to the bill and the Medicare ceeded to call the roll. coverage if this bill passes. Last week, Mr. REID. Mr. President, I ask unan- the Wall Street Journal quoted one an- program. The amendment will add means testing to Medicare Part B—in- imous consent that the order for the alyst who called this bill the ‘‘auto- quorum call be rescinded. creasing co-payments for wealthier maker enrichment act,’’ because com- The PRESIDING OFFICER. Without panies such as the automakers who seniors. objection, it is so ordered. currently provide their retired employ- I am also pleased that several meas- Mr. REID. Mr. President, the Senator ures which I have supported and co- ees with a prescription drug benefit are from Michigan, Mr. LEVIN, has been ex- unlikely to continue doing so if the sponsored as separate bills, have been tremely patient. He has been waiting Federal Government assumes part of adopted as part of this package, includ- for us to get a unanimous consent for the burden for them. ing the Immigrant Children’s Health his amendment. We are very shortly I am concerned that we are about to Improvement Act, the Blind Empower- going to get that, but prior to that repeat—I emphasize repeat—an enor- ment Act, and funds to reimburse hos- being announced, the Senator from mous mistake. I have been around here pitals for the uncompensated cost of Michigan is going to offer amendment long enough to remember another large caring for undocumented immigrants. No. 1111. He is going to speak for 10 Medicare prescription drug entitlement Additionally, there have been several minutes. Senator STABENOW will speak program we enacted in 1988, Medicare good amendments that I think will im- for 5 minutes, and Senator GRASSLEY Catastrophic. The image of seniors out- prove overall health care in our coun- and Senator BAUCUS will speak for up raged by the high cost and ineffective- try. In particular, I believe Senator to 10 minutes in opposition, if they ness of that package should be a cau- GRASSLEY’S amendment which requires need to. The leaders will arrange a vote tionary tale to all of us. agreements between brand and generic at some time that they have agreed Moreover, I am not confident that pharmaceutical companies to be re- upon. the Medicare Advantage portion of this ported to the Federal Trade Commis- I ask unanimous consent that that be new scheme, which establishes regional sion and the Justice Department will the case. PPO options for seniors, will succeed. shine some much needed light on po- The PRESIDING OFFICER. Is there Many in the insurance industry have tential collusive agreements. objection? expressed skepticism and concern that Despite these welcome improve- Without objection, it is so ordered. such plans will not be profitable. In the ments, and recognizing that this legis- The Senator from Michigan. end, the Federal Government, which lation will address the crisis faced by AMENDMENT NO. 1111 acts as a fallback if no private plans lower income seniors, the costs of this Mr. LEVIN. Mr. President, the are available, might end up covering entitlement remain, simply put, be- amendment which I will be offering is the majority of the country. Not ex- yond the means of this country absent designed to ensure that the CBO esti- actly the reform we all had hoped for. real reform of Medicare. Therefore, mate of 37 percent of current retirees The American people should be aware after much thought, I regret that I who now get their prescription drug that this new benefit has substantial cannot vote for this legislation. I have coverage from their former employer cost to seniors, and to current and fu- reached this conclusion, not because I and who will lose that coverage as a re- ture generations of taxpayers, who will believe our seniors and disabled do not sult of this bill will at least have the bear the majority of a crushing finan- need or deserve prescription drug cov- option of a prescription drug coverage under the Medicare fallback. cial burden. There will be unintended erage, but because I do not believe our There are a number of problems country can sustain the cost of this consequences of our actions. We can be which have been identified with this benefit, which will not, despite it’s sure of that. Moreover, we should be bill. Some of them are significant prob- staggering expense, provide the assist- honest about the cost of this measure— lems which cause many of us, who very ance many beneficiaries will expect. $400 billion is merely a down payment much favor having a prescription drug As I noted, Congress and the adminis- for what we are creating. Given the fis- benefit available to our seniors, great tration should have addressed the cal realities we face, realities that will pause before we support this bill. For acute need for assistance of lower in- become more dire with every passing instance, there is a so-called yo-yo ef- come seniors. And before we consider year, Congress and the administration fect in this legislation. Some have should have committed to addressing extending that assistance to other sen- called it the revolving door effect. The the acute need for a drug benefit to al- iors, we should save Medicare first by problem there is that seniors who are leviate the impossible choices con- instituting the reforms we all know are offered two private plans in their serv- fronting lower income seniors. And, necessary, but which we apparently ice area must pick one of those private most importantly, begun to seek con- prefer to defer until we have retired plans. They cannot use the Medicare sensus among responsible Members of from public service. I know that those fallback. There will not be a Medicare both parties for the reforms we all reforms pose a very difficult political fallback with a guaranteed premium know are necessary to save Medicare. challenge to us, and that the biparti- because if two or more private compa- I recently heard a good assessment of sanship we have commended in the nies offer a prescription drug program, this package: it is ‘‘an effort to do too drafting and consideration of the legis- with whatever premium they decide much with too little, and thus doing lation before us today would be put to upon, then the seniors in that service nothing very well at all.’’ a far more severe test should we genu- area must pick one of those two pri- There are several good amendments inely attempt to save the Medicare sys- vate plans. that have been adopted during this de- tem from insolvency. However, should What happens then if the senior says, bate. I am encouraged that a bill Sen- we simply add another huge, new un- okay, I am going to pick that private ator SCHUMER and I worked on for the funded liability to an already fiscally plan A, and then a couple of years later last 4 years, might finally be enacted unsound entitlement, imposing a the private sector decides to pull out of into law as part of this package. Our breathtakingly heavy tax burden on that service area? At that point, the amendment will increase competition our children and their children, with senior will be offered the Medicare fall- in the pharmaceutical industry and en- devastating consequences for their back. sure that all Americans have access to prosperity and the national economy, Then what happens if the private in- lower cost generic drugs. That amend- we will have done the one thing no pub- surance folks decide to come back into

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00014 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8661 that service area? Could the senior have millions of seniors who will lose do for those who are going to lose their keep the Medicare fallback plan? No. an existing prescription drug program prescription drug benefit that they cur- They are kicked out of that plan even as a result of our enacting a plan. That rently have following the enactment of if they want it. They have to go into is the time bomb in the bill before the this legislation. one of the private plans again. Then Senate. We should not leave people I reserve the remainder of my time. that can be repeated over and over worse off than they otherwise would The PRESIDING OFFICER. The Sen- again. Each time private insurance be. ator has 1 minute 15 seconds. companies decide to pull out of an During the markup of this bill, we Mr. LEVIN. I reserve the remainder area, the seniors then can get into a had some experts who testified. One of my time. Medicare fallback, but when private was Tom Scully, Administrator of the I ask unanimous consent to call up amendment No. 1111. companies come into the service area Centers for Medicare and Medicaid The PRESIDING OFFICER. The again, they are removed from the Services at HHS: amendment is pending. Medicare Program and have to go back Among employees who have employer- Mr. LEVIN. I ask unanimous consent to one of the plans. It is confusing, un- sponsored insurance, our estimate is con- that my colleague from Michigan, Sen- sistent with 37 percent having their coverage certain, unfair. It is the yo-yo effect, ator STABENOW, be listed as a cosponsor dropped. what others call the revolving door. It of this amendment. is a real problem with this plan. We A little later on, page 6 of the tran- The PRESIDING OFFICER. Without ought to give much more certainty to script of the markup of the Finance objection, it is so ordered. that. Committee: Mr. LEVIN. I ask unanimous consent Another problem identified is the so- TOM SCULLY: Thirty-seven percent of that the excerpts from the quoted tes- called donut hole problem. We have those retirees who have employer-sponsored timony be printed in the RECORD. heard quite a bit about that problem coverage . . . [will lose their coverage]. There being no objection, the mate- where once a senior is told her drug Then, a little later on in the markup rial was ordered to be printed in the spending reaches $4,500 for a year, she of the Finance Committee, Senator RECORD, as follows: will have to pay 100 percent of the CONRAD was going to ask a question of Senator ROCKEFELLER. Okay. Actual costs of the prescriptions until the Mr. Holtz-Eakin, our CBO Director, dollars in the plan that are spent on, number total drug spending reaches $5,800. about this issue, and the majority lead- one, the drug benefit itself, provider add Now, premiums will continue to be er posed a question. backs and that’s all I can see. I don’t need the third one I’ve written down. paid during that period, but the gap in Senator FRIST: Senator CONRAD, could I— TOM SCULLY. These are figures that were coverage will be there, so from $4,500 to on that last—I’m over here—on this employ- in the table. We issued it to the Committee. $5,800. There is not a 50/50 deal between ers dropping it, can I just ask a follow-up Since this table was put together, there were the plan and the senior; it is 100 per- question just real quick. some modest modifications to the drug ben- cent burden of the senior during that Senator CONRAD: Yeah. Absolutely. efit. In particular, putting the cap at period. That is a real gap in coverage. Senator FRIST: You said—is it 37 percent $4,500.00 instead of $4,725.00. That changes the of employers are going to drop—— estimate on the drug benefit from $408 bil- That is a gaping hole in coverage. I TOM SCULLY: Yes. lion to $402 billion over ten years. don’t know of any other insurance pro- Colleagues, Senator FRIST said some- Senator ROCKEFELLER. Four hundred gram that is so unfairly structured. thing which I hope will reverberate in two? That is another problem which has TOM SCULLY. Four hundred two. Six bil- this Chamber. been identified. There have been efforts lion dollars lower. And, the provider add made to correct that, without success. Senator FRIST: This has huge implica- backs are listed on pages 2 and 3—or, pages Another problem identified is that tions. 1 and 2—— Then the Director of the CBO said Senator ROCKEFELLER. Could you give the private insurance plans that may them to me? come into a service area do not have a the following: TOM SCULLY. There’s a long list of them, cap on the premium; it is an unlimited Mr. HOLTZ-EAKIN: Thirty-seven percent and simply adding them up is not that—they premium. That is a problem which has of employees—of retirees with such em- interact in many ways. ployee insurance. Senator ROCKEFELLER. [Unintelligible]. been identified. The effort to put a cap TOM SCULLY. [Unintelligible]. on the premiums has failed. Then there was a voice, unidentified Senator ROCKEFELLER. Next one is, per- But of all the flaws that have been by the reporter: cent of employers who drop retiree coverage. identified, the weaknesses in this pro- MALE VOICE: As I understand it, this 37 And, the number and percent of beneficiaries gram, the one that troubles me most percent is the effect of our legislation. who will lose retiree coverage under this and that troubled seniors most is the Mr. HOLTZ-EAKIN: Correct. plan so far. TOM SCULLY. We don’t have an estimate Colleagues, Senator FRIST is correct. fact that it has been estimated by the of the number of employers. But, among em- CBO and by the Health and Human This has huge implications. And we ployees who have employer-sponsored insur- Services folks who operate Medicare ought to address it. The least we can ance, our estimate is consistent with 37% that 37 percent of current retirees who do is to direct Health and Human Serv- having their coverage dropped. Of that 37% have a prescription drug program ices to make available to designate a of those who have such coverage, about 11% through their former employer are Medicare backup plan for the 37 per- of beneficiaries overall. going to lose their prescription drug cent of our current seniors who have a MALE VOICE. Could you repeat that? I didn’t get the—you might pull the micro- benefit following the enactment of the prescription drug program through phone up a little closer to you. plan before the Senate; that is, a situa- their previous employer to make avail- TOM SCULLY. Thirty seven percent of tion where we are actually going to see able to them the Medicare backup pro- those employees who have employer-spon- 37 percent of our seniors—that is the gram so they at least know there will sored coverage, it’s 11% of beneficiaries over- estimate—who currently have a benefit be a Medicare backup for them if they all. lose their current prescription drug Senator ROCKEFELLER. And, what per- being worse off as a result of what we cent would drop it? do. program, as is projected by the Con- TOM SCULLY. We don’t know the number There is a debate here as to whether gressional Budget Office and by Health of employers who would drop coverage. We the plan before the Senate is going to and Human Services. It seems to me know the number of employees who are ef- be good for seniors because of the that is the least we can do. fected. donut hole or because of the fact there It still will be harmful because it is MALE VOICE. I thought you gave an estimate—excuse me—this is Senator Rocke- is no cap on premiums or because of very unlikely for most of the people feller’s time, and I just want to make sure this yo-yo effect, this revolving door that the Medicare backup will be as I—— effect. Is it a good plan? Is it not a good as their current prescription drug TOM SCULLY. Let me repeat so it’s—— good plan? Will seniors who don’t have program. It is unlikely. But at least we MALE VOICE. Just repeat what you said. health insurance, a prescription drug can say, for those people, there will be TOM SCULLY. Underlying our estimate are that 37% of employees who have bene- program now, actually want to opt into a Medicare backup plan designated by ficiaries who have employed-sponsored insur- this program? That people can debate. HHS which will have the criteria estab- ance, retirees who have such employer-spon- But, at a minimum, we should do no lished by HHS and the premium estab- sored coverage, 37% will lose their coverage. harm. At a minimum, we should not lished by HHS. That is the least we can And, that is 11% of total beneficiaries.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00015 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8662 CONGRESSIONAL RECORD — SENATE June 26, 2003 MALE VOICE. Could I also add into this, having their healthcare—there’s not that who right now are fortunate enough to Senator Rockefeller? What we also need to much erosion going on. have health care insurance and pre- know is, what percentage of the figure you MALE VOICE. I’ll have the people from scription drug coverage. said might drop—or, case would be dropped Bethlehem Steel and about seven other steel While there are positives in this bill even companies in Pennsylvania that I can just Or, they could drop it entirely. think of off the top of my head give you a so there are those who will receive help In those latter two cases, they can use the call, and let you know that their retiree as a result of being low-income seniors, additional resources to provide other kinds health benefits have been eliminated. I or those with very high prescription of employee compensation. mean, it’s happening all over the place. drug costs who will receive help under What we’ve done is examine the literature Senator Rockefeller, would you like to join this bill, one of the glaring omissions to the extent that we can find it on employer into this? I mean—so, I just—I think you and great concerns that I have relates responses to the shape of compensation need to look at your baseline, please. to what Senator LEVIN was just speak- packages in shaping our estimate of the And, then give us an understanding of number that would drop. maybe looking back over the last few years ing about, the unfairness of saying to a Senator CONRAD. Okay. Let me go to and projecting forward given the trends group of people who have been fortu- something that I have found difficult to fol- what—how the baseline would be affected. nate enough to have insurance and pre- low. And, I’d like, if I could, to have the at- And, I think that would much—be a much scription drug coverage that, as a retention of the Chairman. fairer score as to what the impact of this bill sult of something done by the Con- Senator FRIST. Senator Conrad, could I— would be. gress, they would potentially lose that on that last—I’m over here—on this employ- Senator CONRAD. Mr. Chairman? coverage. That makes absolutely no ers dropping it, can I just ask a follow up The CHAIRMAN. Senator Conrad. question just real quick. Senator CONRAD. Let me just say that I sense. Senator CONRAD. Yeah. Absolutely. agree entirely with Senator Santorum. We What our amendment is saying is if, Senator FRIST. You said—is it 37% of em- know that people are dropping—employers in fact, their employer would have the ployers are going to drop—— are dropping their plans. incentive to change or drop their cov- TOM SCULLY. Yes. And, I understand your answer to this erage, they should be guaranteed that Senator FRIST. This has huge implica- question is the effect of this bill. something else is right there, that tions. I think one of the things we’ve got to do— Medicare as a backup should be there. Mr. HOLTZ-EAKIN. Thirty seven percent Senator Frist said it well—this has got of employees—of retirees with such em- major implications; 37% having their My preference would be that we ployee insurance. healthcare plans dropped. That means it’s change the formulas so there is not the Senator FRIST. Okay. going from being on the company’s nickel to incentive to drop anyone. That was one Mr. HOLTZ-EAKIN. And, that’s 11% of being on our nickel; that dramatically in- of the reasons I strongly supported overall Medicare beneficiaries. creases the cost. Senator ROCKEFELLER’s amendment MALE VOICE. Okay. If we did nothing, So, if we can find ways to hold that num- and other amendments that have been how many would be dropped over the next ber down, that’s in our interest and we on the floor. Because my first choice is ten years? If you look at these curves, the should pursue it. employees—yours are getting out of the Let me go—— we take away any incentive for anyone business, anyway—not out of the business, Mr. HOLTZ-EAKIN. If we could, before to lose their prescription drug cov- but the curve is going down. we—— erage. But unfortunately those amend- What would it be ten years from now? Senator CONRAD. Yes, sir. ments were not successful. We did not Mr. HOLTZ-EAKIN. We don’t have an esti- Mr. HOLTZ-EAKIN. I understand the pol- have the support to do that here. mate of that. We isolated our estimate on icy interest, and * * *. Given that, we are now coming in the impact of the bill above the baseline. The PRESIDING OFFICER. The Sen- That’s a question about the baseline esti- and saying if, in fact, an employer, be- mate, and I don’t have that. ator from Michigan. cause of the incentives, makes a deter- MALE VOICE. Okay. Ms. STABENOW. Mr. President, I am mination to drop coverage, that at a MALE VOICE. It’s 37%, just so we’re clear very proud to be joining with my col- minimum, out of a sense of decency with each other. As I understand it, this 37% league on this very critical amend- and fairness, at a minimum that re- is the effect of our legislation. ment. Can you imagine, you are some- tiree needs to know that Medicare pre- Mr. HOLTZ-EAKIN. Correct. one who has worked hard all of your scription drug coverage, through Medi- MALE VOICE. I think the question Sen- life, you have been fortunate enough to ator Frist has is, in your baseline you have care, is available without wading an assumption that there will be changes, have a good-paying job with benefits, through tons of insurance forms or though, correct? Or, don’t you? you are now retired and you are fortu- picking through plans or going through Mr. HOLTZ-EAKIN. No, we do not. nate to have good health benefits and all the ups and downs that have been MALE VOICE. And, would you suggest you find yourself in a situation that, as described so many times in this Cham- that that’s an inaccurate baseline? a result of an action taken here—and ber. They need to know, after having Mr. HOLTZ-EAKIN. In reality—— certainly there is an effort to move for- MALE VOICE. Its reality is not that. And, coverage, having it available, having it I can have a few of my retirees in Pennsyl- ward and provide people with prescrip- dependable, that another plan is right vania give you a call if you have any question drug coverage—but if those who there for them. That is the least we tions on that subject. already have coverage find, as a result can do. I mean, I think that’s an unfair—I mean, of an action we take, there is an incen- I hope we will join together in a bi- baselines are supposed to be real, but not tive for their employer to drop their partisan way this evening to agree to supposed to be artificial. That’s artificial. coverage, how would you feel about this very important amendment, and Mr. HOLTZ-EAKIN. The baseline issue that? that we—that is most important, that we let us send a message to those fortu- capture is new retirees not having such cov- I know how I would feel about that. nate enough to have health care insur- erage. This amendment is about making sure ance and prescription drug coverage This is a provision that would induce exist- those who have worked hard all of that we remember them, we care about ing retirees who have such coverage to have their lives, who have retired and have them, and we are going to make sure their coverage dropped or modified by the had the confidence and the security to no harm is done to them in the process their employer. know that those health care benefits, of putting together this prescription MALE VOICE. I understand what this pro- retirement benefits they have worked drug plan. vision does. I just want you—I just want an so hard to have in their retirement, understanding of what would happen without I yield the floor. this being calculated into the baseline. would be secure—to make sure if some- Mr. REID. Mr. President, I suggest MALE VOICE. Senator Santorum, we’ve one is covered right now for prescrip- the absence of a quorum. looked at the literature and the surveys of tion drugs that he or she not lose the The PRESIDING OFFICER. The the employee benefits consultants of retiree ability to continue, at least to know clerk will call the roll. offerings. that if their employer changes their The assistant legislative clerk pro- What we understand is mainly happening benefit, they would have immediately ceeded to call the roll. is that, for current workers who are newly the security of the backup Medicare Mr. REID. Mr. President, I ask unan- hired, they are—employers are no longer putting as part of their compensation pack- prescription drug plan. imous consent that the order for the age a guarantee of retiree healthcare. This is very critical in a State such quorum call be rescinded. As far as we can tell, the base of people as Michigan where we have 37 percent The PRESIDING OFFICER. Without who are near retirement or retired are not of our retirees who have insurance, objection, it is so ordered.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00016 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8663 Mr. REID. Mr. President, this is the promise to senior citizens. It a start, comes back from conference in a sig- greatest and most prosperous Nation in and I won’t stop fighting until we fin- nificantly different form we will not be history. Nobody has worked harder to ish the job. in the same position we are tonight. make this country great than our sen- The PRESIDING OFFICER. The mi- This bill will enjoy broad bipartisan ior citizens. And few things weigh more nority leader is recognized. support tonight. But if we fail, if we heavily on their minds than the soar- Mr. DASCHLE. Mr. President, I know endorse a bill with some of the provi- ing cost of prescription drugs. we are waiting for some completion on sions of the House, then I daresay this You would think such a great, pros- negotiations on an amendment. As I legislation may still be in trouble. perous Nation would honor its elders, understand it, no one is seeking rec- My hope is that we can do what I by making sure they get the medicines ognition to continue work on other have just suggested—that over the they need. That is why a comprehen- amendments. So I will speak for a cou- course of the next several years we can sive, meaningful and voluntary drug ple of minutes until somebody is pre- take a very close look at ways to make benefit for our senior citizens has been pared to come to the floor to continue this legislation better and that we can among my highest priorities. our work. I don’t want to delay the address what I would consider to be se- Over the last several weeks, this Sen- business of the Senate but I want to ex- rious shortfalls, especially the benefits ate has worked hard to achieve that. In press myself, as the distinguished shutdown that exists after a person the process, many of us who shared Democratic whip has been doing with pays $4,500. We are talking about a that goal have disagreed about how to regard to the legislation. sickness penalty that, frankly, cannot react it. In the end, we wound up with I, too, intend to support this bill. I be sustained. We have to find a way to a bill that is not how I would have cream thinking of the old joke about a address that serious shortcoming in ated a prescription drug benefit. But it camel being a horse designed by a com- this legislation. I hope it is done sooner is a start. mittee. Oftentimes, I think of that as rather than later. I am voting for this bill, because I be- we work our will on legislation. In I come to the floor with my gratitude lieve some benefit is better than none. many respects, this is the legislative for the work that has been done. This I am voting for it because of people version of a committee horse, a camel. is the fifth year we have made an effort like Shirley Rosamond of Sparks, NV. It is not the kind of bill I would to pass meaningful prescription drug Shirley, who is 78 years old, raised write. It is not the kind of bill I would legislation. We can wait no longer. We eight children in the Sierra Nevada. cosponsor. It is not the kind of bill I simply can’t allow the perfect to be the She currently spends $400 a month on would enthusiastically endorse. enemy of the good. We have to take medicine, and has less than $400 left I look at some of the concerns we what we can do and move to build upon over to live on. This bill would reduce have about this legislation—concerns something that we will do in future her monthly costs to less than $20 in about an unlimited volatility in the years to make it more meaningful, medicine. And it would provide a simi- premium, uncertainty about the ben- make it a better piece of legislation, lar level of assistance for tens of thou- efit package, uncertainty with regard and make it a law that we can be en- sands of Nevada seniors. to the deductible, uncertainty with re- thusiastic about someday. I am voting for this bill in the hope gard to the backup, uncertainty with I vote tonight with that expectation it will be like the camel’s nose under regard to the way the provisions can be and that hope. I am hopeful that there the tent—a foot in the door for our sen- provided in rural areas. There are will be many on both sides of the aisle who will share that perspective and ior citizens. many issues. Mostly I think there is I’m hoping we will pass this bill far greater confusion than there is un- that expectation. I yield the floor. derstanding with regard to the benefits today, and then improve it in the fu- Mr. FRIST. Mr. President, I ask ture. And, yes, there is plenty of room themselves as seniors attempt to deter- unanimous consent that at 9:15 tonight for improvement. mine whether they will be assisted by the Senate proceed to a vote in rela- For example,this bill will do little to this bill. tion to the Levin amendment, No. 1111, The confusion and the uncertainty help seniors whose income is $15,000 a to be followed by a vote in relation to year or more. Even if they spend more will be issues that we have to address the Hagel-Ensign amendment, No. 1026, than $100 a month on prescription at some later date. But having said with no second degrees in order to the drugs. That is why I voted to make the that, I must say that the rural provi- amendments prior to the votes and program more generous. sions—the effort made by our two dis- with 2 minutes of debate equally di- This bill doesn’t take effect soon tinguished managers to address the vided prior to each vote. enough. That is why I voted for and co- rural needs to overcome the inequities I further ask unanimous consent that sponsored the Lautenberg amendment that exist today—alone merit consider- prior to the vote Senator ENSIGN be to move the start date up to 2004, ination and I would suggest support for recognized for up to 15 minutes and stead of 2006. this legislation. The help for low-in- Senator HAGEL, for up to 10 minutes, There are gaps in the coverage this come seniors—tens of thousands of and the two managers be given up to 5 bill provides. That is why I voted for South Dakotans will get help they are minutes each; further, that it be in Senator Boxers’ amendment to close not getting today in part because of order for the Hagel-Ensign amendment the coverage gap, and Senator Gra- this bill. The possibility that seniors to be modified up to the beginning of ham’s amendment to cancel premiums could access generic drugs with far the stacked votes. while coverage is suspended. more regularly and successfully, and The PRESIDING OFFICER. Is there There were other amendments that the possibility that we could reimport objection? were very good but were not agreed to. drugs at a lower price from Canada, all Mr. DASCHLE. Mr. President, reserv- Finally, this plan is just plain con- are reasons why I think this bill merits ing the right to object, I suggest that fusing—which means it won’t give our our support. we make them perhaps 10-minute votes senior citizens the peace of mind they As I look to the balance and look to as well to expedite our votes. deserve. all of those things I wish were better, Mr. FRIST. Mr. President, let us I voted to address all of these issues. my response is that we are going to make it 10-minute votes. I wish we had succeeded, and that this make them better. It may take The PRESIDING OFFICER. Is there bill would provide the kind of coverage months, if not years, but we are going objection? our senior citizens need. We didn’t and to continue to work to make this a bet- Without objection, it is so ordered. it doesn’t. ter bill and a better program. The Senator from Nevada. We have to be honest with our senior There are so many ways that I hope AMENDMENT NO. 1026 citizens, and with the American people. we as Senators—Republican and Demo- Mr. ENSIGN. Mr. President, I rise to This isn’t the best we can do for our crat—can work together to make this a speak on behalf of the amendment on senior citizens, but it is the best we better bill in future years. which Senator HAGEL and I have been can do tonight. There is a warning and a hope as we working actually for the last several I will vote for this bill today, because complete our debate tonight. The years. This amendment received bipar- it provides a start toward fulfilling our warning is that if this legislation tisan support in the last Congress as a

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00017 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8664 CONGRESSIONAL RECORD — SENATE June 26, 2003 stand-alone bill. We actually made plans. And they agreed they will prob- 200 and 400 percent of poverty are about some improvements to it. We think if ably drop their plans. the same. this amendment is adopted, it will dra- Our bill works with the States that When you start getting to the matically improve what the committee have those programs, States such as wealthier seniors, there is no question, has attempted to do to add a prescrip- my State of Nevada, and encourages the committee bill is more generous. tion drug benefit to Medicare. The only those programs to be kept. For very low income seniors, the com- portion of the bill we are modifying in A couple of other advantages that mittee bill is slightly more generous. substantial form is the prescription our bill has: I want to illustrate those But for those who are really sick, our drug part of it. with a couple of examples. These are amendment is much better. Let me talk about what our amend- real-life cases. This is a fictitious Also, there are a couple of other ad- ment exactly does. It would say to a name, of course, to protect this wom- vantages. person who is below 200 percent of pov- an’s identity, but this is a real person. In the future, to control costs, our erty, they would pay the first $1,500 out We call her Doris Jones. She is 75 years amendment says: The person receiving of pocket. After that, the Government old. She has an income of about $17,000 the medication has something at stake. is going to pay for the rest of their a year. She is being treated for diabe- They are paying out of their own pock- drug costs, other than a 10-percent tes, hypertension, and high cholesterol. et for the first dollars, so they are copay the person would pay. She is taking medications that are going to shop. They are going to go However, if a person is up to 160 per- very typical of what this type of a dis- around and see: Do I need generics? cent of poverty, we will give them, in a ease management would require. Her First of all, do I need the drug? Could pharmaceutical benefit account, $500 out-of-pocket expenses right now are I take a generic, which may be less exper year, which they can use to go to a $3,648. pensive? Are there perhaps other alter- local pharmacy to buy their prescrip- Let’s compare how our amendment, natives for treatment that may be tion drugs or they can use that money the Hagel-Ensign approach, would af- cheaper and just as effective? They will and negotiate the price of their pre- fect her out-of-pocket expenses versus have that conversation with their doc- scription drugs through a pharma- the bill on the floor if our amendment tor because they have something at ceutical benefit manager and mass buy is not accepted. stake. them with their drug discount card. If Under our bill, she would have $1,700 I would argue that what the com- they want to use their local phar- out-of-pocket expenses a year. Under mittee is doing—and I applaud what macist, they can do that. And this $500, the committee bill that is before us they are doing, trying in a bipartisan if they did not spend it that year, today, she would have $2,383 a year. So fashion—I believe our amendment would be rolled over to the next year it is a savings of almost $700 under our would strengthen the committee’s bill where it would cover the first part of approach. dramatically because it would target their deductible. So if you are below Another person: James is 68 years the dollars, those precious taxpayers’ 160 percent of poverty, the most you old. He has an income of about $16,000 dollars, to the people who need it the are going to pay out of pocket is less a year. He is being treated for diabetes, most. It will also, though, in the fu- than $100 per month. a pretty severe case of diabetes, and he ture, control costs and, therefore, be There are several benefits to our has all these different medications— more responsible to the next genera- plan. First of all, with the committee very common medications today for a tion. mark, you pay a monthly premium of diabetic. His total out-of-pocket ex- The committee mark, especially for $35. You also have a deductible of $275. penses today are $5,700. very low income people, pays 97.5 per- With our bill, you have no monthly How does he compare under the two cent of their drug costs, maybe a $1 to premiums, you have a one-time annual provisions? $2 copay. Well, there is going to be a fee of $25, and for low-income people, Under the Hagel-Ensign approach, tremendous amount of overutilization we waive that. about $1,900 would be his out-of-pocket in that group. Our plan is completely voluntary. It expenses for the year; under the bill Our amendment gives that group also gives the most help to lower in- that is before us today, a little over help by putting $500 of their first costs come seniors and gives progressively $4,000 in out-of-pocket expenses a year. into an account. They will use that to less help the more money you make. So the difference is almost $2,200 to go shop because if they do not use it, it So between 200 percent and 400 per- this senior who is sick. And we cer- gets rolled over to the next year where cent of poverty, $3,500 is your out-of- tainly would not call him a rich per- it covers more of their deductible. So pocket expenses. Above that amount, son. I would call this person certainly they have something to benefit by if the Government pays 90 percent. And a low- to moderate-income senior. they do not use it. from 400 percent to 600 percent of pov- Now, Betty is another example. So I implore our colleagues to look erty, $5,500 is your out-of-pocket ex- These are real-life examples taking and compare. If you look and compare, penses. Above that amount, 20 percent real medicine, prescribed by real doc- you will see there truly is a difference. is your deductible before catastrophic tors. She is 66 years old. She has an in- Mr. President, I reserve the remain- coverage kicks in. come of $15,500. She is being treated for der of my time. For all of these people, though, who breast cancer and she is taking com- The PRESIDING OFFICER. Who want to sign up for the plan, they get monly prescribed medications for that. yields time? a drug discount card where they will She is on low-dose radiation. She pays Mr. BAUCUS. Mr. President, I sug- save between 25 to 40 percent on their about $8,000 for her prescription drugs gest the absence of a quorum. prescription drug costs. It is a com- a year. The PRESIDING OFFICER. The pletely voluntary program. And in this What would happen to her under the clerk will call the roll. program, we have several benefits that two different scenarios? The legislative clerk proceeded to we think are better than the commit- Under our scenario, she would pay call the roll. tee’s underlying bill. about $2,100 out of pocket. Under the Mr. GRASSLEY. Mr. President, I ask One is, under our bill, States that bill that is before us today, she would unanimous consent that the order for have already enacted programs will be pay $4,300. the quorum call be rescinded. encouraged to keep their programs. What we have done with our amend- The PRESIDING OFFICER. Without Under the committee mark, every ment is we have said: Let’s help the objection, it is so ordered. State that has a program for low-in- seniors who need it the most. And we Mr. GRASSLEY. I commend Senator come seniors is going to drop those. put the dollars to them. Under our HAGEL and Senator ENSIGN because There is no debate about that. As a amendment, people who are sick, with they have been working very carefully matter of fact, the Secretary of HHS low and moderate income, they really over the last few years to help move was before us. The person who oversees get help. For people above that, they this process along. They have had a dif- Medicare was before us. Both of them are treated about the same between ferent approach than I have had. I have said there is nothing in this bill that our amendment and the bill. The out- had what I call a comprehensive, uni- will say to the States: Don’t drop your of-pocket expenses for people between versal, voluntary approach. They have

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00018 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8665 had one that is more targeted toward role for private preferred provider or- amendment. For instance, we will low-income people and toward cata- ganization plans to deliver an improved allow Medicaid, the dual eligibles that strophic. We deal with that in our leg- Medicare benefit package. It doesn’t people have been talking about today, islation, but we are very comprehen- make modern innovations such as dis- to give States help in handling those sive. We are very universal. I don’t at- ease management services or rational dual eligibles through Medicare be- tack their attempt, but it is just not as cost sharing available to beneficiaries cause our prescription drug cost to the good as what is before the Senate. S. 1 who choose them. It simply dumps a taxpayer was less. It is because we already reflects the influence of their catastrophic drug benefit on to the 1965 have more reform on the prescription plan by providing a drug discount card vintage Medicare system. drug part of it than the underlying bill. which will give seniors access to dis- What the people of this country need It just a difference of philosophy of counted drug prices. is improvement in Medicare, strength- how you do it. I would like to point out a few ening of Medicare, voluntary, uni- I come to this based on my experi- things. The Hagel-Ensign plan has two versal, comprehensive. The Ensign plan ence in the private sector and how laudable objectives: to protect seniors wouldn’t improve S. 1, but it would health care can be delivered by individ- against catastrophic costs and to en- make it substantially worse. uals shopping. sure that low-income seniors are fully I urge my colleagues to defeat the I reserve the remainder of my time. protected. amendment. The PRESIDING OFFICER. Who I am happy to report that S. 1 al- I yield the floor. yields time? ready meets these goals. S. 1 provides a The PRESIDING OFFICER. The Sen- Mr. BAUCUS. Mr. President, I sug- generous protection for low-income ator from Nevada. gest the absence of a quorum and ask beneficiaries, very generous. It also Mr. ENSIGN. Mr. President, I want unanimous consent that the time be covers fully 90 percent of beneficiaries’ to clear up something. We don’t touch equally charged. The PRESIDING OFFICER. Without out-of-pocket costs beyond $3,700. Most any of the other Medicare reforms in objection, it is so ordered. The clerk seniors don’t have catastrophic drug your bill. The whole thing with the PPOs, we touch the prescription drug will call the roll. costs and thus would not see any ben- The legislative clerk proceeded to part of the underlying bill. efit from the coverage in the Hagel-En- call the roll. sign plan. S. 1, on the other hand, You mentioned competition. I prac- Mr. HAGEL. Mr. President, I ask would provide a significant basic ben- ticed veterinary medicine, built, unanimous consent that the order for efit to most seniors each year. Passing owned, and operated two different ani- the quorum call be rescinded. a drug bill that most seniors would see mal hospitals. Why do I bring that up? The PRESIDING OFFICER. Without no benefit from is a prescription for It is because in veterinary medicine objection, it is so ordered. disaster. I am afraid of that. people pay out of their own pocket. Mr. HAGEL. Mr. President, in the So S. 1 already meets the main goals Veterinarians are in an incredibly com- last 2 weeks the Senate has engaged in of the Hagel-Ensign plan, but it pro- petitive field because we know that if an historic effort to reform and vides additional value to a much broad- somebody brings a case to you, they strengthen Medicare. When we opened er group of beneficiaries as well, the are going to shop about half the time this debate 2 weeks ago, I said that underlying bill, the one that they based on price. So veterinarians have what we would do here debating this amend, the one they would decimate. to be very competitive and price sen- bill would affect every American and Another thing S. 1 does very well is sitive to that, so they work to become future generations. use competition to maximize value to more efficient, to keep their costs Health care is a defining issue for our the taxpayers. There has been some down, because individuals shop. Nation and future generations. Just a concern that S. 1 doesn’t have as much In our health care system today, in- reminder: When Medicare was enacted competitive reform as many of us dividuals do not shop because we have in 1965, the Federal Government’s lead would have preferred. But the Hagel- low deductible policies, and a lot of actuary at that time projected that the Ensign plan has far less reform and is times the doctors waive those hospital program, Medicare Part A, much more government run. deductibles. Senator FRIST will be able would grow to $9 billion by 1990. In I would like to explain: First, this to tell you about that. The hospitals fact, the program, in 1990, had then amendment would rule out any true waive the deductibles. So the person cost the taxpayers $66 billion. So we competition in the delivery of Medi- receiving the care is not accountable have some sense of how these programs care drug benefits. S. 1 would let pri- for the care, and so they don’t shop. can get out of hand if not defined clear- vate drug plans assume a modest The doctor tells them, go get this serv- ly at the front end. amount of financial risk, giving them ice or this drug, and they don’t think In addition to the internal problems an incentive to drive hard bargains and about it. They have modest, low of the changing realities of health care, keep taxpayers’ costs down. It seems to copays, and they don’t think about it. Medicare is facing a looming external me that is very significant—the dif- The cost control, the competition, is problem. The largest generation in ference between the underlying bill and established by 40 million people on American history, the baby boomers, their bill. We are going to drive drug Medicare, 40 million people receiving are aging. These Americans—over 75 prices down more through competition. drugs. If they are paying out of their million of them—will be added to the The Hagel-Ensign plan, it is pretty own pocket or low-income people have Medicare rolls over the next few years. obvious from my point of view, allows the $500 in a pharmaceutical benefit ac- The baby boom generation has changed for no such exemption, specifically count, they have something at stake, and shaped every market it has ever mandating that the Government—in so they go shop. entered. Medicare will be no exception. this case we are talking about the tax- They ask the questions: Do I need the We have a responsibility to address payers—bears all the financial risk for drug in the first place? Maybe I can get this demographic pressure now or risk delivering the benefit, much as Senator a generic. So they do the shopping. the system collapsing under its own BOB GRAHAM’s did the last year when Also, we have pharmaceutical benefit weight in the future. we debated this very issue. managers in the bill. That is what the Senator ENSIGN and I have come to Under this amendment, the benefit whole drug discount card is about. So the floor to offer an amendment to sub- would be delivered just like other those pharmaceutical benefit managers stitute only title I of the Finance Com- Medicare benefits are today—by con- help lower the costs as well. mittee’s bill, providing a prescription tractors that merely pay the claims We have several reforms in this bill drug benefit for seniors. We believe any that come in without any effort what- that are true reforms, that introduce Medicare drug benefit must be sustain- soever, no effort to contain costs. competition to keep the costs down. able for future generations. The benefit Second, the Hagel amendment That is why our bill actually scored must deal with the realities that peo- doesn’t include any of the improve- lower. ple are living longer and better and ments to the Medicare Program that Because of that, we were able to add have higher health care expectations President Bush has proposed and our a couple other things. When Senator than ever before. We believe we can do bill includes. It does not include the HAGEL arrives, he will modify the better with our amendment.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00019 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8666 CONGRESSIONAL RECORD — SENATE June 26, 2003 Our amendment is a simple amend- ‘‘(ii) a biological product described in prescription drug card plans offered by eligi- ment. Seniors will be able to under- clauses (i) through (iii) of subparagraph (B) ble entities in which eligible beneficiaries stand it clearly. Unlike the underlying of such section or insulin described in sub- may voluntarily enroll and receive benefits under this part. bill, our amendment contains no pre- paragraph (C) of such section, and such term includes a vaccine licensed ‘‘(b) ENDORSEMENT OF PRESCRIPTION DRUG miums, no deductibles, and no gaps in under section 351 of the Public Health Serv- DISCOUNT CARD PLANS.— coverage. Our modified amendment ad- ice Act and any use of a covered drug for a ‘‘(1) IN GENERAL.—The Secretary shall en- dresses three of the major issues we medically accepted indication (as defined in dorse a prescription drug card plan offered have tried to deal with in constructing section 1927(k)(6)). by an eligible entity with a contract under this plan. First, it helps low-income ‘‘(B) EXCLUSIONS.— this part if the eligible entity meets the re- seniors, those who need it the most. ‘‘(i) IN GENERAL.—Such term does not in- quirements of this part with respect to that clude drugs or classes of drugs, or their med- plan. Two, it protects seniors from high out- ‘‘(2) NATIONAL PLANS.—In addition to other of-pocket expenses, and it eases the ical uses, which may be excluded from coverage or otherwise restricted under section types of plans, the Secretary may endorse burden prescription drug costs have 1927(d)(2), other than subparagraph (E) there- national prescription drug plans under para- placed on the States. of (relating to smoking cessation agents), or graph (1). Our modified amendment would re- under section 1927(d)(3). ‘‘(c) VOLUNTARY NATURE OF PROGRAM.— Nothing in this part shall be construed as replace the prescription drug benefit in ‘‘(ii) AVOIDANCE OF DUPLICATE COVERAGE.— quiring an eligible beneficiary to enroll in A drug prescribed for an individual that the Finance Committee plan with, No. the program under this part. would otherwise be a covered drug under this 1, a prescription drug discount card for ‘‘(d) FINANCING.—The costs of providing all seniors on Medicare with $30 billion part shall not be so considered if payment benefits under this part shall be payable in added funds for low-income seniors; for such drug is available under part A or B from the Federal Supplementary Medical In- for an individual entitled to benefits under No. 2, catastrophic coverage for all sen- surance Trust Fund established under sec- part A and enrolled under part B. tion 1841. iors; No. 3, $35 billion in cost-sharing ‘‘(C) APPLICATION OF FORMULARY RESTRIC- ‘‘ENROLLMENT for catastrophic drug costs with the TIONS.—A drug prescribed for an individual States for the lowest income seniors el- that would otherwise be a covered drug ‘‘SEC. 1860B. (a) ENROLLMENT UNDER PART igible for both Medicare and Medicaid. under this part shall not be so considered D.— ‘‘(1) ESTABLISHMENT OF PROCESS.— We give the Secretary of Health and under a plan if the plan excludes the drug ‘‘(A) IN GENERAL.—The Secretary shall es- under a formulary and such exclusion is not Human Services the discretion to di- tablish a process through which an eligible successfully appealed under section vide $65 billion for seniors and for help beneficiary (including an eligible beneficiary 1860D(a)(4)(B). with drug costs at the State level. With enrolled in a Medicare+Choice plan offered ‘‘(D) APPLICATION OF GENERAL EXCLUSION our amendment, the Secretary will by a Medicare+Choice organization) may PROVISIONS.—A prescription drug discount make an election to enroll under this part. provide low-income seniors with money card plan or Medicare+Choice plan may ex- Except as otherwise provided in this sub- on a drug discount card to help defray clude from qualified prescription drug cov- section, such process shall be similar to the their drug expenses. erage any covered drug— process for enrollment under part B under ‘‘(i) for which payment would not be made States would also benefit under our section 1837. if section 1862(a) applied to part D; or amendment, and $35 billion is available ‘‘(B) REQUIREMENT OF ENROLLMENT.—An el- to help States cover the catastrophic ‘‘(ii) which are not prescribed in accord- igible beneficiary must enroll under this drug expenses for the dual eligibles. ance with the plan or this part. part in order to be eligible to receive the These are the very poorest of seniors. Such exclusions are determinations subject benefits under this part. to reconsideration and appeal pursuant to These modifications to the amend- ‘‘(2) ENROLLMENT PERIODS.— section 1860D(a)(4). ‘‘(A) IN GENERAL.—Except as provided in ment make it stronger by targeting aid ‘‘(2) ELIGIBLE BENEFICIARY.—The term ‘eli- to those who need it the most. This bill this paragraph, an eligible beneficiary may gible beneficiary’ means an individual who not enroll in the program under this part has been scored. We fall within the $400 is— during any period after the beneficiary’s ini- billion budget number that is required. ‘‘(A) eligible for benefits under part A or tial enrollment period under part B (as de- This is a commonsense plan that is enrolled under part B; and termined under section 1837). workable and responsible, and it ad- ‘‘(B) not eligible for prescription drug cov- ‘‘(B) SPECIAL ENROLLMENT PERIOD.—In the dresses prescription drug concerns in erage under a State plan under the medicaid case of eligible beneficiaries that have re- the right way. program under title XIX. cently lost eligibility for prescription drug ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible coverage under a State plan under the med- AMENDMENT NO. 1026, AS MODIFIED entity’ means any— icaid program under title XIX, the Secretary Mr. HAGEL. Mr. President, I have a ‘‘(A) pharmaceutical benefit management shall establish a special enrollment period in modification at the desk to amend- company; which such beneficiaries may enroll under ment No. 1026. I ask unanimous consent ‘‘(B) wholesale pharmacy delivery system; this part. that the amendment be modified. ‘‘(C) retail pharmacy delivery system; ‘‘(C) OPEN ENROLLMENT PERIOD IN 2005 FOR The PRESIDING OFFICER. The ‘‘(D) insurer (including any issuer of a CURRENT BENEFICIARIES.—The Secretary shall amendment is so modified. medicare supplemental policy under section establish a period, which shall begin on the The amendment (No. 1026), as modi- 1882); date on which the Secretary first begins to ‘‘(E) Medicare+Choice organization; fied, is as follows: accept elections for enrollment under this ‘‘(F) State (in conjunction with a pharma- part, during which any eligible beneficiary TITLE I—MEDICARE PRESCRIPTION DRUG ceutical benefit management company); may— DISCOUNT ‘‘(G) employer-sponsored plan; ‘‘(i) enroll under this part; or SEC. 101. VOLUNTARY MEDICARE PRESCRIPTION ‘‘(H) other entity that the Secretary deter- ‘‘(ii) enroll or reenroll under this part after DRUG DISCOUNT AND SECURITY mines to be appropriate to provide benefits having previously declined or terminated PROGRAM. under this part; or such enrollment. (a) ESTABLISHMENT OF PROGRAM.—Title ‘‘(I) combination of the entities described ‘‘(3) PERIOD OF COVERAGE.— XVIII of the Social Security Act (42 U.S.C. in subparagraphs (A) through (H). ‘‘(A) IN GENERAL.—Except as provided in 1395 et seq.) is amended— ‘‘(4) POVERTY LINE.—The term ‘poverty subparagraph (B) and subject to subpara- (1) by redesignating part D as part E; and line’ means the income official poverty line graph (C), an eligible beneficiary’s coverage (2) by inserting after part C the following (as defined by the Office of Management and under the program under this part shall be new part: Budget, and revised annually in accordance effective for the period provided under sec- ‘‘PART D—VOLUNTARY MEDICARE PRESCRIP- with section 673(2) of the Omnibus Budget tion 1838, as if that section applied to the TION DRUG DISCOUNT AND SECURITY PRO- Reconciliation Act of 1981) applicable to a program under this part. GRAM family of the size involved. ‘‘(B) ENROLLMENT DURING OPEN AND SPECIAL ‘‘DEFINITIONS ‘‘(5) SECRETARY.—The term ‘Secretary’ ENROLLMENT.—Subject to subparagraph (C), ‘‘SEC. 1860. In this part: means the Secretary of Health and Human an eligible beneficiary who enrolls under the ‘‘(1) COVERED DRUG.— Services, acting through the Administrator program under this part under subparagraph ‘‘(A) IN GENERAL.—Except as provided in of the Centers for Medicare & Medicaid Serv- (B) or (C) of paragraph (2) shall be entitled to this paragraph, the term ‘covered drug’ ices. the benefits under this part beginning on the means— ‘‘ESTABLISHMENT OF PROGRAM first day of the month following the month ‘‘(i) a drug that may be dispensed only ‘‘SEC. 1860A. (a) PROVISION OF BENEFIT.— in which such enrollment occurs. upon a prescription and that is described in The Secretary shall establish a Medicare ‘‘(4) PART D COVERAGE TERMINATED BY TER- subparagraph (A)(i) or (A)(ii) of section Prescription Drug Discount and Security MINATION OF COVERAGE UNDER PARTS A AND B 1927(k)(2); or Program under which the Secretary endorses OR ELIGIBILITY FOR MEDICAL ASSISTANCE.—

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‘‘(A) IN GENERAL.—In addition to the tion in which the beneficiary is enrolled if tity on the basis of discounts, formularies, causes of termination specified in section the organization has been awarded a con- pharmacy networks, and other services pro- 1838, the Secretary shall terminate an indi- tract under this part. vided for under the contract. vidual’s coverage under this part if the indi- ‘‘(4) CONTINUOUS PRESCRIPTION DRUG COV- ‘‘PROVIDING ENROLLMENT AND COVERAGE vidual is— ERAGE.—An individual is considered for pur- INFORMATION TO BENEFICIARIES ‘‘(i) no longer enrolled in part A or B; or poses of this part to be maintaining contin- ‘‘(ii) eligible for prescription drug coverage uous prescription drug coverage on and after ‘‘SEC. 1860C. (a) ACTIVITIES.—The Secretary under a State plan under the medicaid pro- the date the individual first qualifies to elect shall provide for activities under this part to gram under title XIX. prescription drug coverage under this part if broadly disseminate information to eligible ‘‘(B) EFFECTIVE DATE.—The termination de- the individual establishes that as of such beneficiaries (and prospective eligible bene- scribed in subparagraph (A) shall be effective date the individual is covered under any of ficiaries) regarding enrollment under this on the effective date of— the following prescription drug coverage and part and the prescription drug card plans of- ‘‘(i) the termination of coverage under part before the date that is the last day of the 63- fered by eligible entities with a contract A or (if later) under part B; or day period that begins on the date of termi- under this part. ‘‘(ii) the coverage under title XIX. nation of the particular prescription drug ‘‘(b) SPECIAL RULE FOR FIRST ENROLLMENT ‘‘(b) ENROLLMENT WITH ELIGIBLE ENTITY.— coverage involved (regardless of whether the UNDER THE PROGRAM.—To the extent prac- ‘‘(1) PROCESS.—The Secretary shall estab- individual subsequently obtains any of the ticable, the activities described in subsection lish a process through which an eligible ben- following prescription drug coverage): (a) shall ensure that eligible beneficiaries eficiary who is enrolled under this part shall ‘‘(A) COVERAGE UNDER PRESCRIPTION DRUG are provided with such information at least make an annual election to enroll in a pre- CARD PLAN OR MEDICARE+CHOICE PLAN.—Pre- 60 days prior to the first enrollment period scription drug card plan offered by an eligi- scription drug coverage under a prescription described in section 1860B(c). ble entity that has been awarded a contract drug card plan under this part or under a ‘‘ENROLLEE PROTECTIONS under this part and serves the geographic Medicare+Choice plan. ‘‘SEC. 1860D. (a) REQUIREMENTS FOR ALL EL- area in which the beneficiary resides. ‘‘(B) MEDICAID PRESCRIPTION DRUG COV- IGIBLE ENTITIES.—Each eligible entity shall ‘‘(2) ELECTION PERIODS.— ERAGE.—Prescription drug coverage under a meet the following requirements: ‘‘(A) IN GENERAL.—Except as provided in medicaid plan under title XIX, including this paragraph, the election periods under through the Program of All-inclusive Care ‘‘(1) GUARANTEED ISSUANCE AND NON- this subsection shall be the same as the cov- for the Elderly (PACE) under section 1934, DISCRIMINATION.— erage election periods under the through a social health maintenance organi- ‘‘(A) GUARANTEED ISSUANCE.— Medicare+Choice program under section zation (referred to in section 4104(c) of the ‘‘(i) IN GENERAL.—An eligible beneficiary 1851(e), including— Balanced Budget Act of 1997), or through a who is eligible to enroll in a prescription ‘‘(i) annual coordinated election periods; Medicare+Choice project that demonstrates drug card plan offered by an eligible entity and the application of capitation payment rates under section 1860B(b) for prescription drug ‘‘(ii) special election periods. for frail elderly medicare beneficiaries coverage under this part at a time during In applying the last sentence of section through the use of a interdisciplinary team which elections are accepted under this part 1851(e)(4) (relating to discontinuance of a and through the provision of primary care with respect to the coverage shall not be de- Medicare+Choice election during the first services to such beneficiaries by means of nied enrollment based on any health status- year of eligibility) under this subparagraph, such a team at the nursing facility involved. related factor (described in section 2702(a)(1) in the case of an election described in such ‘‘(C) PRESCRIPTION DRUG COVERAGE UNDER of the Public Health Service Act) or any section in which the individual had elected GROUP HEALTH PLAN.—Any prescription drug other factor. or is provided qualified prescription drug coverage under a group health plan, includ- ‘‘(ii) MEDICARE+CHOICE LIMITATIONS PER- coverage at the time of such first enrolling a health benefits plan under the Federal MITTED.—The provisions of paragraphs (2) ment, the individual shall be permitted to Employees Health Benefit Plan under chap- and (3) (other than subparagraph (C)(i), relat- enroll in a prescription drug card plan under ter 89 of title 5, United States Code, and a ing to default enrollment) of section 1851(g) this part at the time of the election of cov- qualified retiree prescription drug plan (as (relating to priority and limitation on termi- erage under the original fee-for-service plan. defined by the Secretary), but only if (sub- nation of election) shall apply to eligible en- ‘‘(B) INITIAL ELECTION PERIODS.— ject to subparagraph (E)(ii)) the coverage tities under this subsection. ‘‘(i) INDIVIDUALS CURRENTLY COVERED.—In provides benefits at least equivalent to the ‘‘(B) NONDISCRIMINATION.—An eligible enti- the case of an individual who is entitled to benefits under a prescription drug card plan ty offering prescription drug coverage under benefits under part A or enrolled under part under this part. this part shall not establish a service area in B as of November 1, 2005, there shall be an ‘‘(D) PRESCRIPTION DRUG COVERAGE UNDER a manner that would discriminate based on initial election period of 6 months beginning CERTAIN MEDIGAP POLICIES.—Coverage under health or economic status of potential en- on that date. a medicare supplemental policy under sec- rollees. ‘‘(ii) INDIVIDUAL COVERED IN FUTURE.—In tion 1882 that provides benefits for prescrip- ‘‘(2) DISCLOSURE OF INFORMATION.— the case of an individual who is first entitled tion drugs (whether or not such coverage ‘‘(A) INFORMATION.— to benefits under part A or enrolled under conforms to the standards for packages of ‘‘(i) GENERAL INFORMATION.—Each eligible part B after such date, there shall be an ini- benefits under section 1882(p)(1)) and if (sub- entity with a contract under this part to pro- tial election period which is the same as the ject to subparagraph (E)(ii)) the coverage vide a prescription drug card plan shall dis- initial enrollment period under section provides benefits at least equivalent to the close, in a clear, accurate, and standardized 1837(d). benefits under a prescription drug card plan form to each eligible beneficiary enrolled in ‘‘(C) ADDITIONAL SPECIAL ELECTION PERI- under this part. a prescription drug discount card program ODS.—The Administrator shall establish spe- ‘‘(E) STATE PHARMACEUTICAL ASSISTANCE offered by such entity under this part at the cial election periods— PROGRAM.—Coverage of prescription drugs time of enrollment and at least annually ‘‘(i) in cases of individuals who have and under a State pharmaceutical assistance pro- thereafter, the information described in sec- involuntarily lose prescription drug coverage gram, but only if (subject to subparagraph tion 1852(c)(1) relating to such prescription described in paragraph (3); (E)(ii)) the coverage provides benefits at drug coverage. ‘‘(ii) in cases described in section 1837(h) least equivalent to the benefits under a pre- ‘‘(ii) SPECIFIC INFORMATION.—In addition to (relating to errors in enrollment), in the scription drug card plan under this part. the information described in clause (i), each same manner as such section applies to part ‘‘(F) VETERANS’ COVERAGE OF PRESCRIPTION eligible entity with a contract under this B; and DRUGS.—Coverage of prescription drugs for part shall disclose the following: ‘‘(iii) in the case of an individual who veterans under chapter 17 of title 38, United ‘‘(I) How enrollees will have access to cov- meets such exceptional conditions (including States Code, but only if (subject to subpara- ered drugs, including access to such drugs conditions provided under section graph (E)(ii)) the coverage provides benefits through pharmacy networks. 1851(e)(4)(D)) as the Secretary may provide. at least equivalent to the benefits under a ‘‘(II) How any formulary used by the eligi- ‘‘(D) ENROLLMENT WITH ONE PLAN ONLY.— prescription drug card plan under this part. ble entity functions. The rules established under subparagraph (B) For purposes of carrying out this paragraph, ‘‘(III) Information on grievance and ap- shall ensure that an eligible beneficiary may the certifications of the type described in peals procedures. only enroll in 1 prescription drug card plan sections 2701(e) of the Public Health Service ‘‘(IV) Information on enrollment fees and offered by an eligible entity per year. Act and in section 9801(e) of the Internal prices charged to the enrollee for covered ‘‘(3) MEDICARE+CHOICE ENROLLEES.—An eli- Revenue Code of 1986 shall also include a drugs. gible beneficiary who is enrolled under this statement for the period of coverage of ‘‘(V) Any other information that the Sec- part and enrolled in a Medicare+Choice plan whether the individual involved had pre- retary determines is necessary to promote offered by a Medicare+Choice organization scription drug coverage described in this informed choices by eligible beneficiaries must enroll in a prescription drug discount paragraph. among eligible entities. card plan offered by an eligible entity in ‘‘(5) COMPETITION.—Each eligible entity ‘‘(B) DISCLOSURE UPON REQUEST OF GENERAL order to receive benefits under this part. The with a contract under this part shall com- COVERAGE, UTILIZATION, AND GRIEVANCE IN- beneficiary may elect to receive such bene- pete for the enrollment of beneficiaries in a FORMATION.—Upon request of an eligible ben- fits through the Medicare+Choice organiza- prescription drug card plan offered by the en- eficiary, the eligible entity shall provide the

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The entity shall make available, ‘‘(ii) USE OF POINT-OF-SERVICE SYSTEM.— ‘‘(ii) quality assurance measures and sys- through an Internet website and, upon re- Each eligible entity offering a prescription tems to reduce medical errors and adverse quest, in writing, information on specific drug discount card plan shall establish an drug interactions, including a medication changes in its formulary. optional point-of-service method of oper- therapy management program described in ‘‘(3) GRIEVANCE MECHANISM, COVERAGE DE- ation under which— subparagraph (B); and TERMINATIONS, AND RECONSIDERATIONS.— ‘‘(I) the plan provides access to any or all ‘‘(iii) a program to control fraud, abuse, ‘‘(A) IN GENERAL.—With respect to the ben- pharmacies that are not participating phar- and waste. efit under this part, each eligible entity of- macies in its network; and Nothing in this section shall be construed as fering a prescription drug discount card plan ‘‘(II) discounts under the plan may not be impairing an eligible entity from applying shall provide meaningful procedures for available. cost management tools (including differen- hearing and resolving grievances between The additional copayments so charged shall tial payments) under all methods of oper- the organization (including any entity or in- not be counted as out-of-pocket expenses for ation. dividual through which the eligible entity purposes of section 1860F(b). ‘‘(B) MEDICATION THERAPY MANAGEMENT provides covered benefits) and enrollees with ‘‘(B) USE OF STANDARDIZED TECHNOLOGY.— PROGRAM.— prescription drug card plans of the eligible ‘‘(i) IN GENERAL.—Each eligible entity of- ‘‘(i) IN GENERAL.—A medication therapy entity under this part in accordance with fering a prescription drug discount card plan management program described in this para- section 1852(f). shall issue (and reissue, as appropriate) such graph is a program of drug therapy manage- ‘‘(B) APPLICATION OF COVERAGE DETERMINA- a card (or other technology) that may be ment and medication administration that is TION AND RECONSIDERATION PROVISIONS.—Each used by an enrolled beneficiary to assure ac- designed to ensure, with respect to bene- eligible entity shall meet the requirements cess to negotiated prices under section ficiaries with chronic diseases (such as dia- of paragraphs (1) through (3) of section 1860F(a) for the purchase of prescription betes, asthma, hypertension, and congestive 1852(g) with respect to covered benefits under drugs for which coverage is not otherwise heart failure) or multiple prescriptions, that the prescription drug card plan it offers provided under the prescription drug dis- covered drugs under the prescription drug under this part in the same manner as such count card plan. discount card plan are appropriately used to requirements apply to a Medicare+Choice or- ‘‘(ii) STANDARDS.—The Secretary shall pro- achieve therapeutic goals and reduce the ganization with respect to benefits it offers vide for the development of national stand- risk of adverse events, including adverse under a Medicare+Choice plan under part C. ards relating to a standardized format for drug interactions. ‘‘(C) REQUEST FOR REVIEW OF TIERED FOR- the card or other technology referred to in ‘‘(ii) ELEMENTS.—Such program may in- MULARY DETERMINATIONS.—In the case of a clause (i). Such standards shall be compat- clude— prescription drug card plan offered by an eli- ible with standards established under part C ‘‘(I) enhanced beneficiary understanding of gible entity that provides for tiered cost- of title XI. such appropriate use through beneficiary sharing for drugs included within a for- ‘‘(C) REQUIREMENTS ON DEVELOPMENT AND education, counseling, and other appropriate mulary and provides lower cost-sharing for APPLICATION OF FORMULARIES.—If an eligible means; preferred drugs included within the for- entity that offers a prescription drug dis- ‘‘(II) increased beneficiary adherence with mulary, an individual who is enrolled in the count card plan uses a formulary, the fol- prescription medication regimens through plan may request coverage of a nonpreferred lowing requirements must be met: medication refill reminders, special pack- drug under the terms applicable for preferred ‘‘(i) PHARMACY AND THERAPEUTIC (P&T) COM- aging, and other appropriate means; and drugs if the prescribing physician determines MITTEE.—The eligible entity must establish a ‘‘(III) detection of patterns of overuse and that the preferred drug for treatment of the pharmacy and therapeutic committee that underuse of prescription drugs. same condition is not as effective for the in- develops and reviews the formulary. Such ‘‘(iii) DEVELOPMENT OF PROGRAM IN CO- dividual or has adverse effects for the indi- committee shall include at least 1 physician OPERATION WITH LICENSED PHARMACISTS.—The vidual. and at least 1 pharmacist both with expertise program shall be developed in cooperation ‘‘(4) APPEALS.— in the care of elderly or disabled persons and with licensed pharmacists and physicians. ‘‘(A) IN GENERAL.—Subject to subparagraph a majority of its members shall consist of in- ‘‘(iv) CONSIDERATIONS IN PHARMACY FEES.— (B), each eligible entity offering a prescrip- dividuals who are a physician or a practicing Each eligible entity offering a prescription tion drug card plan shall meet the require- pharmacist (or both). drug discount card plan shall take into ac- ments of paragraphs (4) and (5) of section ‘‘(ii) FORMULARY DEVELOPMENT.—In devel- count, in establishing fees for pharmacists 1852(g) with respect to drugs not included on oping and reviewing the formulary, the com- and others providing services under the any formulary in the same manner as such mittee shall base clinical decisions on the medication therapy management program, requirements apply to a Medicare+Choice or- strength of scientific evidence and standards the resources and time used in implementing ganization with respect to benefits it offers of practice, including assessing peer-re- the program. under a Medicare+Choice plan under part C. viewed medical literature, such as random- ‘‘(C) TREATMENT OF ACCREDITATION.—Sec- ‘‘(B) FORMULARY DETERMINATIONS.—An in- ized clinical trials, pharmacoeconomic stud- tion 1852(e)(4) (relating to treatment of ac- dividual who is enrolled in a prescription ies, outcomes research data, and such other creditation) shall apply to prescription drug drug card plan offered by an eligible entity information as the committee determines to discount card plans under this part with re- may appeal to obtain coverage under this be appropriate. spect to the following requirements, in the part for a covered drug that is not on a for- ‘‘(iii) INCLUSION OF DRUGS IN ALL THERA- same manner as they apply to mulary of the eligible entity if the pre- PEUTIC CATEGORIES.—The formulary must in- Medicare+Choice plans under part C with re- scribing physician determines that the for- clude drugs within each therapeutic category spect to the requirements described in a mulary drug for treatment of the same con- and class of covered drugs (although not nec- clause of section 1852(e)(4)(B): dition is not as effective for the individual or essarily for all drugs within such categories ‘‘(i) Paragraph (1) (including quality assur- has adverse effects for the individual. and classes). ance), including any medication therapy ‘‘(5) CONFIDENTIALITY AND ACCURACY OF EN- ‘‘(iv) PROVIDER EDUCATION.—The com- management program under paragraph (2). ROLLEE RECORDS.—Each eligible entity offer- mittee shall establish policies and proce- ‘‘(ii) Subsection (c)(1) (relating to access to ing a prescription drug discount card plan dures to educate and inform health care pro- covered benefits). shall meet the requirements of the Health viders concerning the formulary. ‘‘(iii) Subsection (g) (relating to confiden- Insurance Portability and Accountability ‘‘(v) NOTICE BEFORE REMOVING DRUGS FROM tiality and accuracy of enrollee records). Act of 1996. FORMULARY.—Any removal of a drug from a ‘‘(D) PUBLIC DISCLOSURE OF PHARMA- ‘‘(b) ELIGIBLE ENTITIES OFFERING A DIS- formulary shall take effect only after appro- CEUTICAL PRICES FOR EQUIVALENT DRUGS.— COUNT CARD PROGRAM.—If an eligible entity priate notice is made available to bene- Each eligible entity offering a prescription offers a discount card program under this ficiaries and physicians. drug discount card plan shall provide that part, in addition to the requirements under ‘‘(vi) GRIEVANCES AND APPEALS RELATING TO each pharmacy or other dispenser that ar- subsection (a), the entity shall meet the fol- APPLICATION OF FORMULARIES.—For provi- ranges for the dispensing of a covered drug lowing requirements: sions relating to grievances and appeals of shall inform the beneficiary at the time of ‘‘(1) ACCESS TO COVERED BENEFITS.— coverage, see paragraphs (3) and (4) of sec- purchase of the drug of any differential be- ‘‘(A) ASSURING PHARMACY ACCESS.— tion 1860D(a). tween the price of the prescribed drug to the ‘‘(i) IN GENERAL.—The eligible entity offer- ‘‘(2) COST AND UTILIZATION MANAGEMENT; enrollee and the price of the lowest cost drug ing the prescription drug discount card plan QUALITY ASSURANCE; MEDICATION THERAPY covered under the plan that is therapeuti- shall secure the participation in its network MANAGEMENT PROGRAM.— cally equivalent and bioequivalent. of a sufficient number of pharmacies that ‘‘(A) IN GENERAL.—Each eligible entity of- ‘‘ANNUAL ENROLLMENT FEE dispense (other than by mail order) drugs di- fering a prescription drug discount card plan ‘‘SEC. 1860E. (a) AMOUNT.—

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‘‘(1) IN GENERAL.—Except as provided in under part A or B is not available because ‘‘(A) IN GENERAL.—The Secretary, and not subsection (c), enrollment under the program the beneficiary has not met the deductible or the eligible entity, shall be at financial risk under this part is conditioned upon payment has exhausted benefits under part A or B). for the provision of the catastrophic benefit of an annual enrollment fee of $25. ‘‘(2) DISCOUNT CARD.—The Secretary shall under this subsection. ‘‘(2) ANNUAL PERCENTAGE INCREASE.— develop a uniform standard card format to be ‘‘(B) PROVISIONS RELATING TO PAYMENTS TO ‘‘(A) IN GENERAL.—In the case of any cal- issued by each eligible entity offering a pre- ELIGIBLE ENTITIES.—For provisions relating endar year beginning after 2006, the dollar scription drug discount card plan that shall to payments to eligible entities for admin- amount in paragraph (1) shall be increased be used by an enrolled beneficiary to ensure istering the catastrophic benefit under this by an amount equal to— the access of such beneficiary to negotiated subsection, see section 1860H. ‘‘(i) such dollar amount; multiplied by prices under paragraph (1). ‘‘(6) ENSURING CATASTROPHIC BENEFIT IN ‘‘(ii) the inflation adjustment. ‘‘(3) ENSURING DISCOUNTS IN ALL AREAS.— ALL AREAS.—The Secretary shall develop pro- ‘‘(B) INFLATION ADJUSTMENT.—For purposes The Secretary shall develop procedures that cedures for the provision of the catastrophic of subparagraph (A)(ii), the inflation adjust- ensure that each eligible beneficiary that re- benefit under this subsection to each eligible ment for any calendar year is the percentage sides in an area where no prescription drug beneficiary that resides in an area where (if any) by which— discount card plans are available is provided there are no prescription drug discount card ‘‘(i) the average per capita aggregate ex- with access to negotiated prices for prescrip- plans offered that have been awarded a con- penditures for covered drugs in the United tion drugs (including applicable discounts). tract under this part. ‘‘(b) CATASTROPHIC BENEFIT.— States for medicare beneficiaries, as deter- ‘‘REQUIREMENTS FOR ENTITIES TO PROVIDE ‘‘(1) TEN PERCENT COST-SHARING.—Subject mined by the Secretary for the 12-month pe- PRESCRIPTION DRUG COVERAGE riod ending in July of the previous year; ex- to any formulary used by the prescription ‘‘SEC. 1860G. (a) ESTABLISHMENT OF BIDDING ceeds drug discount card program in which the eligible beneficiary is enrolled, the cata- PROCESS.—The Secretary shall establish a ‘‘(ii) such aggregate expenditures for the process under which the Secretary accepts 12-month period ending with July 2005. strophic benefit shall provide benefits with cost-sharing that is equal to 10 percent of bids from eligible entities and awards con- ‘‘(C) ROUNDING.—If any increase deter- the negotiated price (taking into account tracts to the entities to provide the benefits mined under clause (ii) is not a multiple of under this part to eligible beneficiaries in an $1, such increase shall be rounded to the any applicable discounts) of each drug dispensed to such beneficiary after the bene- area. nearest multiple of $1. ‘‘(b) SUBMISSION OF BIDS.—Each eligible en- ‘‘(b) COLLECTION OF ANNUAL ENROLLMENT ficiary has incurred costs (as described in paragraph (3)) for covered drugs in a year tity desiring to enter into a contract under FEE.— equal to the applicable annual out-of-pocket this part shall submit a bid to the Secretary ‘‘(1) IN GENERAL.—Unless the eligible bene- at such time, in such manner, and accom- ficiary makes an election under paragraph limit specified in paragraph (2). ‘‘(2) ANNUAL OUT-OF-POCKET LIMITS.—For panied by such information as the Secretary (2), the annual enrollment fee described in may require. subsection (a) shall be collected and credited purposes of this part, the annual out-of- pocket limits specified in this paragraph are ‘‘(c) ADMINISTRATIVE FEE BID.— to the Federal Supplementary Medical Insur- as follows: ‘‘(1) SUBMISSION.—For the bid described in ance Trust Fund in the same manner as the ‘‘(A) BENEFICIARIES WITH ANNUAL INCOMES subsection (b), each entity shall submit to monthly premium determined under section BELOW 200 PERCENT OF THE POVERTY LINE.—In the Secretary information regarding admin- 1839 is collected and credited to such Trust the case of an eligible beneficiary whose in- istration of the discount card and cata- Fund under section 1840. come (as determined under section 1860I) is strophic benefit under this part. ‘‘(2) DIRECT PAYMENT.—An eligible bene- below 200 percent of the poverty line, the an- ‘‘(2) BID SUBMISSION REQUIREMENTS.— ficiary may elect to pay the annual enroll- nual out-of-pocket limit is equal to $1,500. ‘‘(A) ADMINISTRATIVE FEE BID SUBMISSION.— ment fee directly or in any other manner ap- ‘‘(B) BENEFICIARIES WITH ANNUAL INCOMES In submitting bids, the entities shall include proved by the Secretary. The Secretary shall BETWEEN 200 AND 400 PERCENT OF THE POVERTY separate costs for administering the discount establish procedures for making such an LINE.—In the case of an eligible beneficiary card component, if applicable, and the cata- election. whose income (as so determined) equals or strophic benefit. The entity shall submit the ‘‘(c) WAIVER.—The Secretary shall waive exceeds 200 percent, but does not exceed 400 administrative fee bid in a form and manner the enrollment fee described in subsection percent, of the poverty line, the annual out- specified by the Secretary, and shall include (a) in the case of an eligible beneficiary of-pocket limit is equal to $3,500. a statement of projected enrollment and a whose income is below 200 percent of the pov- ‘‘(C) BENEFICIARIES WITH ANNUAL INCOMES separate statement of the projected adminis- erty line. BETWEEN 400 AND 600 PERCENT OF THE POVERTY trative costs for at least the following func- ‘‘BENEFITS UNDER THE PROGRAM LINE.—In the case of an eligible beneficiary tions: ‘‘SEC. 1860F. (a) ACCESS TO NEGOTIATED whose income (as so determined) equals or ‘‘(i) Enrollment, including income eligi- PRICES.— exceeds 400 percent, but does not exceed 600 bility determination. ‘‘(1) NEGOTIATED PRICES.— percent, of the poverty line, the annual out- ‘‘(ii) Claims processing. ‘‘(A) IN GENERAL.—Subject to subparagraph of-pocket limit is equal to $5,500. ‘‘(iii) Quality assurance, including drug (B), each prescription drug card plan offering ‘‘(D) BENEFICIARIES WITH ANNUAL INCOMES utilization review. a discount card program by an eligible entity THAT EXCEED 600 PERCENT OF THE POVERTY ‘‘(iv) Beneficiary and pharmacy customer with a contract under this part shall provide LINE.—In the case of an eligible beneficiary service. each eligible beneficiary enrolled in such whose income (as so determined) equals or ‘‘(v) Coordination of benefits. plan with access to negotiated prices (includ- exceeds 600 percent of the poverty line, the ‘‘(vi) Fraud and abuse prevention. ing applicable discounts) for such prescrip- annual out-of-pocket limit is an amount ‘‘(B) NEGOTIATED ADMINISTRATIVE FEE BID tion drugs as the eligible entity determines equal to 20 percent of that beneficiary’s in- AMOUNTS.—The Secretary has the authority appropriate. Such discounts may include dis- come for that year (rounded to the nearest to negotiate regarding the bid amounts sub- counts for nonformulary drugs. If such a ben- multiple of $1). mitted. The Secretary may reject a bid if the eficiary becomes eligible for the catastrophic ‘‘(3) APPLICATION.—In applying paragraph Secretary determines it is not supported by benefit under subsection (b), the negotiated (2), incurred costs shall only include those the administrative cost information pro- prices (including applicable discounts) shall expenses for covered drugs that are incurred vided in the bid as specified in subparagraph continue to be available to the beneficiary by the eligible beneficiary using a card ap- (A). for those prescription drugs for which pay- proved by the Secretary under this part that ‘‘(C) PAYMENT TO PLANS BASED ON ADMINIS- ment may not be made under section are paid by that beneficiary and for which TRATIVE FEE BID AMOUNTS.—The Secretary 1860H(b). For purposes of this subparagraph, the beneficiary is not reimbursed (through shall use the bid amounts to calculate a the term ‘prescription drugs’ is not limited insurance or otherwise) by another person. benchmark amount consisting of the enroll- to covered drugs, but does not include any ‘‘(4) ANNUAL PERCENTAGE INCREASE.— ment-weighted average of all bids for each over-the-counter drug that is not a covered ‘‘(A) IN GENERAL.—In the case of any cal- function and each class of entity. The class drug. endar year after 2006, the dollar amounts in of entity is either a regional or national en- ‘‘(B) LIMITATIONS.— subparagraphs (A), (B), and (C) of paragraph tity, or such other classes as the Secretary ‘‘(i) FORMULARY RESTRICTIONS.—Insofar as (2) shall be increased by an amount equal may determine to be appropriate. The func- an eligible entity with a contract under this to— tions are the discount card and catastrophic part uses a formulary, the negotiated prices ‘‘(i) such dollar amount; multiplied by components. If an eligible entity’s combined (including applicable discounts) for nonfor- ‘‘(ii) the inflation adjustment determined bid for both functions is above the combined mulary drugs may differ. under section 1860E(a)(2)(B) for such calendar benchmark within the entity’s class for the ‘‘(ii) AVOIDANCE OF DUPLICATE COVERAGE.— year. functions, the eligible entity shall collect The negotiated prices (including applicable ‘‘(B) ROUNDING.—If any increase deter- additional necessary revenue through 1 or discounts) for prescription drugs shall not be mined under subparagraph (A) is not a mul- both of the following: available for any drug prescribed for an eligi- tiple of $1, such increase shall be rounded to ‘‘(i) Additional fees charged to the bene- ble beneficiary if payment for the drug is the nearest multiple of $1. ficiary, not to exceed $25 annually. available under part A or B (but such nego- ‘‘(5) ELIGIBLE ENTITY NOT AT FINANCIAL RISK ‘‘(ii) Use of rebate amounts from drug man- tiated prices shall be available if payment FOR CATASTROPHIC BENEFIT.— ufacturers to defray administrative costs.

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‘‘(d) AWARDING OF CONTRACTS.— with manufacturers to eligible beneficiaries ‘‘DETERMINATION OF INCOME LEVELS ‘‘(1) IN GENERAL.—The Secretary shall, con- enrolled with the entity. ‘‘SEC. 1860I. (a) DETERMINATION OF INCOME sistent with the requirements of this part ‘‘(5) NEGOTIATED AGREEMENTS WITH EM- LEVELS.— and the goal of containing medicare program PLOYER-SPONSORED PLANS.—Notwithstanding ‘‘(1) IN GENERAL.—The Secretary shall es- costs, award at least 2 contracts in each any other provision of this part, the Sec- tablish procedures under which each eligible area, unless only 1 bidding entity meets the retary may negotiate agreements with em- entity awarded a contract under this part de- terms and conditions specified by the Sec- ployer-sponsored plans under which eligible termines the income levels of eligible bene- retary under paragraph (2). beneficiaries are provided with a benefit for ficiaries enrolled in a prescription drug card ‘‘(2) TERMS AND CONDITIONS.—The Sec- prescription drug coverage that is more gen- plan offered by that entity at least annually retary shall not award a contract to an eligi- erous than the benefit that would otherwise for purposes of sections 1860E(c) and 1860F(b). ble entity under this section unless the Sec- have been available under this part if such ‘‘(2) PROCEDURES.—The procedures estab- retary finds that the eligible entity is in an agreement results in cost savings to the lished under paragraph (1) shall require each compliance with such terms and conditions Federal Government. eligible beneficiary to submit such informa- as the Secretary shall specify. ‘‘(e) REQUIREMENTS FOR OTHER ELIGIBLE tion as the eligible entity requires to make ‘‘(3) REQUIREMENTS FOR ELIGIBLE ENTITIES ENTITIES.—An eligible entity that is licensed the determination described in paragraph (1). PROVIDING DISCOUNT CARD PROGRAM.—Except under State law to provide the health insur- ‘‘(b) ENFORCEMENT OF INCOME DETERMINA- as provided in subsection (e), in determining ance benefits under this section shall be re- TIONS.—The Secretary shall— which of the eligible entities that submitted quired to meet the requirements of sub- ‘‘(1) establish procedures that ensure that bids that meet the terms and conditions section (d)(3). If an eligible entity offers a eligible beneficiaries comply with sections specified by the Secretary under paragraph national plan, such entity shall not be re- 1860E(c) and 1860F(b); and (2) to award a contract, the Secretary shall quired to meet the requirements of sub- ‘‘(2) require, if the Secretary determines consider whether the bid submitted by the section (d)(3), but shall meet the require- that payments were made under this part to entity meets at least the following requirements of Employee Retirement Income Secu- which an eligible beneficiary was not enti- ments: rity Act of 1974 that apply with respect to tled, the repayment of any excess payments ‘‘(A) LEVEL OF SAVINGS TO MEDICARE BENE- such plan. with interest and a penalty. FICIARIES.—The program passes on to medicare beneficiaries who enroll in the program ‘‘PAYMENTS TO ELIGIBLE ENTITIES FOR ‘‘(c) QUALITY CONTROL SYSTEM.— discounts on prescription drugs, including ADMINISTERING THE CATASTROPHIC BENEFIT ‘‘(1) ESTABLISHMENT.—The Secretary shall discounts negotiated with manufacturers. establish a quality control system to mon- ‘‘SEC. 1860H. (a) IN GENERAL.—The Sec- itor income determinations made by eligible ‘‘(B) PROHIBITION ON APPLICATION ONLY TO retary may establish procedures for making entities under this section and to produce MAIL ORDER.—The program applies to drugs payments to an eligible entity under a con- appropriate and comprehensive measures of that are available other than solely through tract entered into under this part for— mail order and provides convenient access to error rates. ‘‘(1) the costs of providing covered drugs to ‘‘(2) PERIODIC AUDITS.—The Inspector Gen- retail pharmacies. beneficiaries eligible for the benefit under ‘‘(C) LEVEL OF BENEFICIARY SERVICES.—The eral of the Department of Health and Human this part in accordance with subsection (b) Services shall conduct periodic audits to en- program provides pharmaceutical support minus the amount of any cost-sharing col- services, such as education and services to sure that the system established under para- lected by the eligible entity under section graph (1) is functioning appropriately. prevent adverse drug interactions. 1860F(b); and ‘‘APPROPRIATIONS ‘‘(D) ADEQUACY OF INFORMATION.—The pro- ‘‘(2) costs incurred by the entity in admin- gram makes available to medicare bene- istering the catastrophic benefit in accord- ‘‘SEC. 1860J. There are authorized to be ap- ficiaries through the Internet and otherwise ance with section 1860G. propriated from time to time, out of any information, including information on en- ‘‘(b) PAYMENT FOR COVERED DRUGS.— moneys in the Treasury not otherwise appro- rollment fees, prices charged to bene- priated, to the Federal Supplementary Med- ficiaries, and services offered under the pro- ‘‘(1) IN GENERAL.—Except as provided in subsection (c) and subject to paragraph (2), ical Insurance Trust Fund established under gram, that the Secretary identifies as being section 1841, an amount equal to the amount necessary to provide for informed choice by the Secretary may only pay an eligible entity for covered drugs furnished by the eligible by which the benefits and administrative beneficiaries among endorsed programs. costs of providing the benefits under this ‘‘(E) EXTENT OF DEMONSTRATED EXPERI- entity to an eligible beneficiary enrolled with such entity under this part that is eligi- part exceed the enrollment fees collected ENCE.—The entity operating the program has under section 1860E. demonstrated experience and expertise in op- ble for the catastrophic benefit under section erating such a program or a similar program. 1860F(b). ‘‘MEDICARE COMPETITION AND PRESCRIPTION DRUG ADVISORY BOARD ‘‘(F) EXTENT OF QUALITY ASSURANCE.—The ‘‘(2) LIMITATIONS.— entity has in place adequate procedures for ‘‘(A) FORMULARY RESTRICTIONS.—Insofar as ‘‘SEC. 1860K. (a) ESTABLISHMENT OF assuring quality service under the program. an eligible entity with a contract under this BOARD.—There is established a Medicare Pre- ‘‘(G) OPERATION OF ASSISTANCE PROGRAM.— part uses a formulary, the Secretary may scription Drug Advisory Board (in this sec- The entity meets such requirements relating not make any payment for a covered drug tion referred to as the ‘Board’). to solvency, compliance with financial re- that is not included in such formulary, ex- ‘‘(b) ADVICE ON POLICIES; REPORTS.— porting requirements, audit compliance, and cept to the extent provided under section ‘‘(1) ADVICE ON POLICIES.—The Board shall contractual guarantees as specified by the 1860D(a)(4)(B). advise the Secretary on policies relating to Secretary. ‘‘(B) NEGOTIATED PRICES.—The Secretary the Voluntary Medicare Prescription Drug ‘‘(H) PRIVACY COMPLIANCE.—The entity im- may not pay an amount for a covered drug Discount and Security Program under this plements policies and procedures to safe- furnished to an eligible beneficiary that ex- part. guard the use and disclosure of program ceeds the negotiated price (including appli- ‘‘(2) REPORTS.— beneficiaries’ individually identifiable cable discounts) that the beneficiary would ‘‘(A) IN GENERAL.—With respect to matters health information in a manner consistent have been responsible for under section of the administration of the program under with the Federal regulations (concerning the 1860F(a) or the price negotiated for insurance this part, the Board shall submit to Congress privacy of individually identifiable health coverage under the Medicare+Choice pro- and to the Secretary such reports as the information) promulgated under section gram under part C, a medicare supplemental Board determines appropriate. Each such re- 264(c) of the Health Insurance Portability policy, employer-sponsored coverage, or a port may contain such recommendations as and Accountability Act of 1996. State plan. the Board determines appropriate for legisla- ‘‘(I) ADDITIONAL BENEFICIARY PROTEC- ‘‘(C) COST-SHARING LIMITATIONS.—An eligi- tive or administrative changes to improve TIONS.—The program meets such additional ble entity may not charge an individual en- the administration of the program under this requirements as the Secretary identifies to rolled with such entity who is eligible for the part. Each such report shall be published in protect and promote the interest of medicare catastrophic benefit under this part any co- the Federal Register. beneficiaries, including requirements that payment, tiered copayment, coinsurance, or ‘‘(B) MAINTAINING INDEPENDENCE OF ensure that beneficiaries are not charged other cost-sharing that exceeds 10 percent of BOARD.—The Board shall directly submit to more than the lower of the negotiated retail the cost of the drug that is dispensed to the Congress reports required under subpara- price or the usual and customary price. individual. graph (A). No officer or agency of the United The prices negotiated by a prescription drug ‘‘(3) PAYMENT IN COMPETITIVE AREAS.—In a States may require the Board to submit to discount card program endorsed under this geographic area in which 2 or more eligible any officer or agency of the United States section shall (notwithstanding any other entities offer a plan under this part, the Sec- for approval, comments, or review, prior to provision of law) not be taken into account retary may negotiate an agreement with the the submission to Congress of such reports. for the purposes of establishing the best entity to reimburse the entity for costs in- ‘‘(c) STRUCTURE AND MEMBERSHIP OF THE price under section 1927(c)(1)(C). curred in providing the benefit under this BOARD.— ‘‘(4) BENEFICIARY ACCESS TO SAVINGS AND part on a capitated basis. ‘‘(1) MEMBERSHIP.—The Board shall be com- REBATES.—The Secretary shall require eligi- ‘‘(c) SECONDARY PAYER PROVISIONS.—The posed of 7 members who shall be appointed as ble entities offering a discount card program provisions of section 1862(b) shall apply to follows: to pass on savings and rebates negotiated the benefits provided under this part. ‘‘(A) PRESIDENTIAL APPOINTMENTS.—

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‘‘(i) IN GENERAL.—Three members shall be member’s term until a successor has taken (c) EFFECTIVE DATE.— appointed by the President, by and with the office. A vacancy in the Board shall be filled (1) IN GENERAL.—The amendment made by advice and consent of the Senate. in the manner in which the original appoint- subsection (a) shall take effect on the date of ‘‘(ii) LIMITATION.—Not more than 2 such ment was made. enactment of this Act. members may be from the same political ‘‘(e) CHAIRPERSON.—A member of the Board (2) IMPLEMENTATION.—Notwithstanding any party. shall be designated by the President to serve provision of part D of title XVIII of the So- ‘‘(B) SENATORIAL APPOINTMENTS.—Two as Chairperson for a term of 4 years or, if the cial Security Act (as added by subsection members (each member from a different po- remainder of such member’s term is less (a)), the Secretary of Health and Human litical party) shall be appointed by the Presi- than 4 years, for such remainder. Services shall implement the Voluntary dent pro tempore of the Senate with the ad- ‘‘(f) EXPENSES AND PER DIEM.—Members of Medicare Prescription Drug Discount and Se- vice of the Chairman and the Ranking Mi- the Board shall serve without compensation, curity Program established under such part nority Member of the Committee on Finance except that, while serving on business of the in a manner such that— of the Senate. Board away from their homes or regular (A) benefits under such part for eligible ‘‘(C) CONGRESSIONAL APPOINTMENTS.—Two places of business, members may be allowed beneficiaries (as defined in section 1860 of members (each member from a different po- travel expenses, including per diem in lieu of such Act, as added by such subsection) with litical party) shall be appointed by the subsistence, as authorized by section 5703 of annual incomes below 200 percent of the pov- Speaker of the House of Representatives, title 5, United States Code, for persons in the erty line (as defined in such section) are with the advice of the Chairman and the Government employed intermittently. available to such beneficiaries not later than Ranking Minority Member of the Committee ‘‘(g) MEETINGS.— the date that is 6 months after the date of on Ways and Means of the House of Rep- ‘‘(1) IN GENERAL.—The Board shall meet at enactment of this Act; and resentatives. the call of the Chairperson (in consultation (B) benefits under such part for other eligi- ‘‘(2) QUALIFICATIONS.—The members shall with the other members of the Board) not ble beneficiaries are available to such bene- be chosen on the basis of their integrity, im- less than 4 times each year to consider a spe- ficiaries not later than the date that is 1 partiality, and good judgment, and shall be cific agenda of issues, as determined by the year after the date of enactment of this Act. individuals who are, by reason of their edu- Chairperson in consultation with the other SEC. 102. ADMINISTRATION OF VOLUNTARY cation, experience, and attainments, excep- members of the Board. MEDICARE PRESCRIPTION DRUG tionally qualified to perform the duties of ‘‘(2) QUORUM.—Four members of the Board DISCOUNT AND SECURITY PRO- members of the Board. (not more than 3 of whom may be of the GRAM. ‘‘(3) COMPOSITION.—Of the members ap- same political party) shall constitute a (a) ESTABLISHMENT OF CENTER FOR MEDI- pointed under paragraph (1)— quorum for purposes of conducting business. CARE PRESCRIPTION DRUGS.—There is estab- ‘‘(A) at least 1 shall represent the pharma- ‘‘(h) FEDERAL ADVISORY COMMITTEE ACT.— lished, within the Centers for Medicare & ceutical industry; The Board shall be exempt from the provi- Medicaid Services of the Department of ‘‘(B) at least 1 shall represent physicians; sions of the Federal Advisory Committee Act Health and Human Services, a Center for ‘‘(C) at least 1 shall represent medicare (5 U.S.C. App.). Medicare Prescription Drugs. Such Center beneficiaries; ‘‘(i) PERSONNEL.— shall be separate from the Center for Bene- ‘‘(D) at least 1 shall represent practicing ‘‘(1) STAFF DIRECTOR.—The Board shall, ficiary Choices, the Center for Medicare pharmacists; and without regard to the provisions of title 5, Management, and the Center for Medicaid ‘‘(E) at least 1 shall represent eligible enti- United States Code, relating to the competi- and State Operations. (b) DUTIES.—It shall be the duty of the ties. tive service, appoint a Staff Director who Center for Medicare Prescription Drugs to ‘‘(d) TERMS OF APPOINTMENT.— shall be paid at a rate equivalent to a rate administer the Voluntary Medicare Prescrip- ‘‘(1) IN GENERAL.—Subject to paragraph (2), established for the Senior Executive Service tion Drug Discount and Security Program each member of the Board shall serve for a under section 5382 of title 5, United States established under part D of title XVIII of the term of 6 years. Code. Social Security Act (as added by section 101). ‘‘(2) CONTINUANCE IN OFFICE AND STAGGERED ‘‘(2) STAFF.— (c) DIRECTOR.— TERMS.— ‘‘(A) IN GENERAL.—The Board may employ, (1) APPOINTMENT.—There shall be in the ‘‘(A) CONTINUANCE IN OFFICE.—A member without regard to chapter 31 of title 5, Center for Medicare Prescription Drugs a Di- appointed to a term of office after the com- United States Code, such officers and em- rector of Medicare Prescription Drugs, who mencement of such term may serve under ployees as are necessary to administer the shall be appointed by the President, by and such appointment only for the remainder of activities to be carried out by the Board. with the advice and consent of the Senate. such term. ‘‘(B) FLEXIBILITY WITH RESPECT TO CIVIL (2) RESPONSIBILITIES.—The Director shall ‘‘(B) STAGGERED TERMS.—The terms of SERVICE LAWS.— be responsible for the exercise of all powers service of the members initially appointed ‘‘(i) IN GENERAL.—The staff of the Board and the discharge of all duties of the Center under this section shall begin on January 1, shall be appointed without regard to the pro- for Medicare Prescription Drugs and shall 2006, and expire as follows: visions of title 5, United States Code, gov- have authority and control over all per- ‘‘(i) PRESIDENTIAL APPOINTMENTS.—The erning appointments in the competitive sonnel and activities thereof. terms of service of the members initially ap- service, and, subject to clause (ii), shall be (d) PERSONNEL.—The Director of the Center pointed by the President shall expire as des- paid without regard to the provisions of for Medicare Prescription Drugs may appoint ignated by the President at the time of nom- chapters 51 and 53 of such title (relating to and terminate such personnel as may be nec- ination, 1 each at the end of— classification and schedule pay rates). essary to enable the Center for Medicare Pre- ‘‘(I) 2 years; ‘‘(ii) MAXIMUM RATE.—In no case may the scription Drugs to perform its duties. ‘‘(II) 4 years; and rate of compensation determined under SEC. 103. EXCLUSION OF PART D COSTS FROM ‘‘(III) 6 years. clause (i) exceed the rate of basic pay pay- DETERMINATION OF PART B ‘‘(ii) SENATORIAL APPOINTMENTS.—The able for level IV of the Executive Schedule MONTHLY PREMIUM. terms of service of members initially ap- under section 5315 of title 5, United States Section 1839(g) of the Social Security Act pointed by the President pro tempore of the Code. (42 U.S.C. 1395r(g)) is amended— Senate shall expire as designated by the ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.— (1) by striking ‘‘attributable to the appli- President pro tempore of the Senate at the There are authorized to be appropriated, out cation of section’’ and inserting ‘‘attrib- time of nomination, 1 each at the end of— of the Federal Supplemental Medical Insur- utable to— ‘‘(I) 3 years; and ance Trust Fund established under section ‘‘(1) the application of section’’; ‘‘(II) 6 years. 1841, and the general fund of the Treasury, (2) by striking the period and inserting ‘‘; ‘‘(iii) CONGRESSIONAL APPOINTMENTS.—The such sums as are necessary to carry out the and’’; and terms of service of members initially ap- purposes of this section.’’. (3) by adding at the end the following new pointed by the Speaker of the House of Rep- (b) CONFORMING REFERENCES TO PREVIOUS paragraph: resentatives shall expire as designated by PART D.— ‘‘(2) the Voluntary Medicare Prescription the Speaker of the House of Representatives (1) IN GENERAL.—Any reference in law (in Drug Discount and Security Program under at the time of nomination, 1 each at the end effect before the date of enactment of this part D.’’. of— Act) to part D of title XVIII of the Social Se- SEC. 104. MEDIGAP REVISIONS. ‘‘(I) 4 years; and curity Act is deemed a reference to part E of Section 1882 of the Social Security Act (42 ‘‘(II) 5 years. such title (as in effect after such date). U.S.C. 1395ss) is amended by adding at the ‘‘(C) REAPPOINTMENTS.—Any person ap- (2) SECRETARIAL SUBMISSION OF LEGISLATIVE end the following new subsection: pointed as a member of the Board may not PROPOSAL.—Not later than 6 months after ‘‘(v) MODERNIZATION OF MEDICARE SUPPLE- serve for more than 8 years. the date of enactment of this section, the MENTAL POLICIES.— ‘‘(D) VACANCIES.—Any member appointed Secretary of Health and Human Services ‘‘(1) PROMULGATION OF MODEL REGULA- to fill a vacancy occurring before the expira- shall submit to the appropriate committees TION.— tion of the term for which the member’s of Congress a legislative proposal providing ‘‘(A) NAIC MODEL REGULATION.—If, within 9 predecessor was appointed shall be appointed for such technical and conforming amend- months after the date of enactment of the only for the remainder of that term. A mem- ments in the law as are required by the pro- Prescription Drug and Medicare Improve- ber may serve after the expiration of that visions of this section. ment Act of 2003, the National Association of

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00025 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8672 CONGRESSIONAL RECORD — SENATE June 26, 2003 Insurance Commissioners (in this subsection to be a reference to the appropriate date an eligible beneficiary enrolled in a prescrip- referred to as the ‘NAIC’) changes the 1991 under this subsection. tion drug discount card plan offered by such NAIC Model Regulation (described in sub- ‘‘(B) OTHER REFERENCES.—Any reference to entity. section (p)) to revise the benefit package a provision of subsection (p) or a date appli- ‘‘(B) APPLICABLE AMOUNT DEFINED.—For classified as ‘J’ under the standards estab- cable under such subsection shall also be purposes of subparagraph (A), the term ‘ap- lished by subsection (p)(2) (including the considered to be a reference to the appro- plicable amount’ means the total amount benefit package classified as ‘J’ with a high priate provision or date under this sub- that the Secretary determines will not cause deductible feature, as described in subsection section.’’. expenditures under this part to exceed the (p)(11)) so that— SEC. l. PARTIAL FEDERAL ASSUMPTION OF total amount that would have been expended ‘‘(i) the coverage for prescription drugs MEDICAID RESPONSIBILITY FOR under this title if this part had not been en- available under such benefit package is re- CATASTROPHIC COST-SHARING SUB- acted by more than $30,000,000,000 during the placed with coverage for prescription drugs SIDIES FOR DUALLY ELIGIBLE INDI- period beginning on January 1, 2005, and end- VIDUALS. that complements but does not duplicate the ing on September 30, 2010. (1) IN GENERAL.—Section 1903(a)(1) (42 benefits for prescription drugs that bene- ‘‘(2) REDUCTION FOR LATE ENROLLMENT.— U.S.C. 1396b(a)(1): is amended by inserting ficiaries are otherwise entitled to under this For each month during a calendar quarter in before the semicolon the following: ‘‘, re- title; which an eligible beneficiary is not enrolled duced by the amount computed under sec- ‘‘(ii) a uniform format is used in the policy in a prescription drug discount card plan of- tion 1935(d)(1) for the State and the quarter’’. with respect to such revised benefits; and fered by an eligible entity with a contract (2) AMOUNT DESCRIBED.—Section 1935, as in- ‘‘(iii) such revised standards meet any ad- under this part, the amount of assistance serted by subsection (a)(2), is amended by ditional requirements imposed by the Pre- available under paragraph (1) shall be re- adding at the end the following new sub- duced by $50. scription Drug and Medicare Improvement section: Act of 2003; ‘‘(3) CREDITING OF UNUSED BENEFITS TOWARD ‘‘(d) FEDERAL ASSUMPTION OF MEDICAID subsection (g)(2)(A) shall be applied in each FUTURE YEARS.— PRESCRIPTION DRUG COSTS FOR DUALLY-ELI- State, effective for policies issued to policy ‘‘(A) IN GENERAL.—The dollar amount of GIBLE BENEFICIARIES.— holders on and after January 1, 2006, as if the coverage described in paragraph (1) shall be ‘‘(1) IN GENERAL.—For purposes of section increased by any amount of coverage de- reference to the Model Regulation adopted 1903(a)(1), for a State that is one of the 50 on June 6, 1979, were a reference to the 1991 scribed in such subparagraph that was not States or the District of Columbia for a cal- used during the previous calendar year. NAIC Model Regulation as changed under endar quarter in a year (beginning with 2005) this subparagraph (such changed regulation ‘‘(B) REFUND OF EXCESS AMOUNTS.—The Ad- the amount computed under this subsection ministrator shall refund to the eligible bene- referred to in this section as the ‘2006 NAIC is equal to the product of the following: Model Regulation’). ficiary the amount (if any) by which the dol- ‘‘(A) MEDICARE BENEFITS FOR MEDICAID ELI- lar amount of coverage described in subpara- ‘‘(B) REGULATION BY THE SECRETARY.—If GIBLES.—The total amount of payments the NAIC does not make the changes in the graph (A) exceeds the catastrophic limit de- made in the quarter because of the operation scribed in subsection (b). 1991 NAIC Model Regulation within the 9- of section 1845 that are attributable to indi- ‘‘(4) WAIVER TO ENSURE PROVISION OF BEN- month period specified in subparagraph (A), viduals who are residents of the State and EFIT.—The Administrator may waive such the Secretary shall promulgate, not later are eligible for medical assistance with re- than 9 months after the end of such period, requirements of this part as may be nec- spect to prescription drugs under this title. essary to ensure that each eligible bene- a regulation and subsection (g)(2)(A) shall be ‘‘(B) STATE MATCHING RATE.—A proportion applied in each State, effective for policies ficiary has access to the assistance described computed by subtracting from 100 percent in subparagraph (A). issued to policy holders on and after January the Federal medical assistance percentage ‘‘(5) APPLICATION OF FORMULARY RESTRIC- 1, 2006, as if the reference to the Model Regu- (as defined in section 1905(b)) applicable to lation adopted on June 6, 1979, were a ref- TIONS.—A drug prescribed for an eligible ben- the State and the quarter. eficiary that would otherwise be a covered erence to the 1991 NAIC Model Regulation as ‘‘(C) PHASE-OUT PROPORTION.—The phase- drug under this section shall not be so con- changed by the Secretary under this sub- out proportion (as defined in paragraph (2)) sidered under a prescription drug discount paragraph (such changed regulation referred for the quarter. card plan if the program excludes the drug to in this section as the ‘2006 Federal Regula- ‘‘(2) PHASE-OUT PROPORTION.—For purposes under a formulary and such exclusion is not tion’). of paragraph (1)(C), the ‘phase-out propor- successfully resolved under the grievance or ‘‘(C) CONSULTATION WITH WORKING GROUP.— tion’ for a calendar quarter in— appeals processes provided for under this In promulgating standards under this para- ‘‘(A) 2005 is 90 percent; part. graph, the NAIC or Secretary shall consult ‘‘(B) a subsequent year before 2014, is the ‘‘(6) PAYMENTS TO PLANS.—The Adminis- with a working group similar to the working phase-out proportion for calendar quarters in trator shall reimburse each eligible entity group described in subsection (p)(1)(D). the previous year decreased by 10 percentage for any costs incurred under this sub- ‘‘(D) MODIFICATION OF STANDARDS IF MEDI- points; or section.’’. CARE BENEFITS CHANGE.—If benefits under ‘‘(C) a year after 2013 is 0 percent.’’. (b) EFFECTIVE DATE.—Part D is amended part D of this title are changed and the Sec- (3) MEDICAID PROVIDING WRAP-AROUND BENE- by adding at the end the following new secretary determines, in consultation with the FITS.—Section 1935, as so inserted and NAIC, that changes in the 2006 NAIC Model amended, is further amended by adding at tion: Regulation or 2006 Federal Regulation are the end the following new subsection: ‘‘EFFECTIVE DATE needed to reflect such changes, the preceding ‘‘(e) MEDICAID AS SECONDARY PAYOR.—In ‘‘Sec. 1860L. Nothwithstanding any other provisions of this paragraph shall apply to the case of an individual who is entitled to provision of this part, the Voluntary Medi- the modification of standards previously es- benefits under part B of title XVIII and is el- care Prescription Drug Discount and Secu- tablished in the same manner as they applied igible for medical assistance with respect to rity Program under this part shall apply to the original establishment of such stand- prescribed drugs under this title, medical as- only during the period beginning on January ards. sistance shall continue to be provided under 1, 2005 and ending on December 31, 2010.’’. ‘‘(2) CONSTRUCTION OF BENEFITS IN OTHER this title for prescribed drugs to the extent Mr. HAGEL. Mr. President, I now ask MEDICARE SUPPLEMENTAL POLICIES.—Nothing payment is not made under such part B, in the benefit packages classified as ‘A’ without regard to section 1902(n)(2).’’. for the yeas and nays. through ‘I’ under the standards established (4) LIMITATION AND CAPS.—The Secretary The PRESIDING OFFICER. Is there a by subsection (p)(2) (including the benefit will implement the above section to the ex- sufficient second? package classified as ‘F’ with a high deduct- tent possible within a total federal author- There is a sufficient second. ible feature, as described in subsection ization of $35,000,000,000. The yeas and nays were ordered. (p)(11)) shall be construed as providing cov- SEC. l. ADDITION OF DOLLAR AMOUNT TO PRE- Mr. HAGEL. I thank the Chair and erage for benefits for which payment may be SCRIPTION DRUG DISCOUNT CARDS; yield the floor. made under part D. EFFECTIVE DATE. The PRESIDING OFFICER. Who ‘‘(3) APPLICATION OF PROVISIONS AND CON- (a) ADDITION OF DOLLAR AMOUNTS TO PRE- FORMING REFERENCES.— SCRIPTION DRUG DISCOUNT CARDS.—Section yields time? ‘‘(A) APPLICATION OF PROVISIONS.—The pro- 1860F (as added by section 101) is amended by The Senator from Nevada is recog- visions of paragraphs (4) through (10) of sub- adding at the end the following: nized. section (p) shall apply under this section, ex- ‘‘(c) PROVISION OF DOLLAR AMOUNTS ON Mr. ENSIGN. Mr. President, the pre- cept that— CARDS.— scription drug bill, Medicare reform ‘‘(i) any reference to the model regulation ‘‘(1) AMOUNT OF ANNUAL ASSISTANCE.— bill combination that we have before us applicable under that subsection shall be ‘‘(A) IN GENERAL.—Subject to the suc- today, as we all know, is a freight train deemed to be a reference to the applicable ceeding provisions of this subsection, each 2006 NAIC Model Regulation or 2006 Federal eligible entity with a contract under this coming through this place and there is Regulation; and section shall provide coverage for the appli- no stopping it. ‘‘(ii) any reference to a date under such cable amount of expenses for prescription What is very unfortunate is that we paragraphs of subsection (p) shall be deemed drugs incurred during each calendar year by have a very legitimate amendment on

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00026 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8673 the floor today that is getting 20, 30 I think that is what the goal of this Mr. BAUCUS. Parliamentary inquiry: minutes’ worth of debate. I put up Congress should be, and that is why Will the Chair inform the Senate as to some examples on the chart here of what we have in the provisions here to the time allowable on this amendment? how this amendment we are offering is give them prescription drugs, which The PRESIDING OFFICER. The Sen- superior. I have tried to be objective, would be within the Medicare Program, ator from Nebraska has 4 minutes 30 to say that above 200 percent of pov- that people can voluntarily continue to seconds remaining. No time remains in erty, between 200 and 400 percent of accept the traditional Medicare or, if opposition. poverty they are pretty equal plans. they would like, move into an ex- Mr. BAUCUS. I wonder if I can get For the very low income, our amend- panded Medicare Advantage and get all consent to speak for 1 minute on this ment is slightly less generous, but it of the benefits through a private, com- amendment. keeps the low-income people with petitively delivered system. The PRESIDING OFFICER. Without something at stake so they will shop. What we have is the beginning of a objection, it is so ordered. We have heard nothing about that from program that can be improved upon Mr. BAUCUS. Mr. President, two the other side. There has been no de- and will be. But we have essentially an points: One, this amendment is totally bate, in other words. It is because there insurance-type program, similar to new. We have not seen the language. is an agreement to defeat any sub- what we have as Federal employees, We have been asking for the language stantive amendment. It is unfortunate. which can be improved upon. But it is for days. It has been filed in various This is probably the most important for everybody. We, too, give special at- forms. This is new language. The Sen- vote, as far as an entitlement program, tention to lower income individuals, ate has no idea what is in this amend- that any of us in our careers will ever and maybe they can do it better, but it ment. We saw it for the first time take, and this bill is being rushed is going to have to come from some- maybe 15, 20, 30 minutes ago. It is im- through so that we can get a ‘‘bill’’ to where else, and the somewhere else is possible to know what this amendment conference, where all of the improve- the vast number of other seniors who does. ments are going to be made. would have some of their benefits di- Point No. 2, essentially what we can We have an amendment before us luted and reduced in order to make this tell by a cursory glance at the amend- that I believe should be debated. If you a little better than what is in this bill. ment is the amendment enters a whole disagree, fine, but let’s debate it and The goal is to try to create a uni- new concept in Medicare that has not vote on it up or down. But I don’t think versal program across the board, and been done before, and that is means this kind of a process is healthy for the one that is fair to everyone. I think testing. It means tests those at the Senate. that is what is in the bill as it now catastrophic levels. I reserve the remainder of my time. stands. I do not think we want to begin to go The PRESIDING OFFICER. The Sen- Mr. GREGG. Will the Senator yield down that road tonight. It makes more ator from Louisiana is recognized. for a question? sense to stay with the underlying bill Mr. BREAUX. Mr. President, I yield Mr. BREAUX. Yes, I am happy to which essentially gives a 44-percent myself whatever time we have in oppo- yield. rate to those beneficiaries with lower sition to the amendment. Mr. GREGG. Would the Senator income. The PRESIDING OFFICER. Of whose agree that there wasn’t, in the original The problem is it does not help, as time? program set up as an insurance pro- our bill does, up to catastrophic, and Mr. BREAUX. Off of the chairman, gram, which you would pay into during then catastrophic is means tested. Senator GRASSLEY’s time. your working life under the Part A That is not the right thing to do, cer- The PRESIDING OFFICER. The Sen- part of the insurance program, with tainly at this hour after looking at it ator is recognized. the concept that when you retired, you 30 minutes ago. Mr. BREAUX. Mr. President, I start would have paid for your health insur- The PRESIDING OFFICER. The Sen- off by commending the authors of the ance. That is why everyone is covered ator’s time has expired. amendment for a real serious effort to under it. But is it not also true that The Senator from Nevada. try to improve the bill. But I rise in op- under this drug benefit as proposed, no- Mr. ENSIGN. Mr. President, I ask position because there is not any seg- body will have paid into the Medicare unanimous consent for whatever time I ment of the senior population that you insurance plan for the purposes of this consume from Senator HAGEL’s time to could not isolate and target and say we drug program? This drug program will respond. can make, for this particular group, a be a new entitlement, and therefore it The PRESIDING OFFICER. Without better deal than they have in this bill. is reasonable that since it is going to objection, it is so ordered. That is not the purpose of this legisla- be borne not by the people who worked Mr. HAGEL. Mr. President, I under- tion. for it but by the people who are work- stand I have 4 minutes 20 seconds. The purpose of Medicare is that it is ing—it is going to be borne by them The PRESIDING OFFICER. That is universal. It is not a welfare bill. It is rather than the recipients—then it correct. not just for low-income individuals. It should be set up in a different struc- Mr. HAGEL. I yield to my colleague is for every American citizen who has ture along the lines that are proposed, whatever time he requires from my reached the age of 65, or older, and which is you benefit the low income time. qualifies for the program. That is one and you benefit people who have a cat- The PRESIDING OFFICER. Without of the greatest features of the Medicare astrophic event rather than have a pro- objection, it is so ordered. Program—that everyone is essentially gram that puts the benefit out to ev- Mr. ENSIGN. Mr. President, means treated equal. eryone and forces 37 percent of the pop- testing and universal have been men- So it is easy, if you want to isolate a ulation off private insurance plans and tioned. The Senator from New Hamp- low-income group and say we are going on to a public plan. shire mentioned that this is a brand to give them a better deal. But when Mr. BREAUX. I am not sure whose new benefit, and that is why we are you are looking at the entire popu- time this is on. I will respond to the only talking about the prescription lation of almost 40 million Americans Senator’s question. We have a health drug part—a brand new benefit for with whom we have to deal, that, in- delivery system supervised by the Fed- which young people in America are deed, is the real challenge, and that is eral Government, and the beneficiaries going to be paying for years and years. why the content of this bill is far supe- are going to contribute to it. Those It seems to make sense that we try to rior than to narrowly isolate only low- benefiting from it are going to have an control those costs. income people and say we can do a bet- average premium of $35 a month, a $275 Yes, our bill means tests. So does the ter deal for them. Of course, but you deductible, and 50 percent copayment. underlying bill. To sit up here and say are not going to be able to do that in The PRESIDING OFFICER. The Sen- their bill does not means test is com- keeping with the general theme of ator’s time has expired. pletely disingenuous. They have sev- what Medicare is all about and taking Mr. BREAUX. I yield the floor. eral levels in the low-income areas care of all Medicare seniors with the The PRESIDING OFFICER. The Sen- they means test. They are just means best possible deal. ator from Montana. testing in a different area. If you

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00027 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8674 CONGRESSIONAL RECORD — SENATE June 26, 2003 means test one, why is calling our bill DOMENICI) and the Senator from Okla- I encourage a ‘‘yes’’ vote on this means testing when their bill means homa (Mr. INHOFE) are necessarily ab- amendment. tests as well? How can they say our bill sent. Mr. HAGEL. Mr. President, to sum- means tests and theirs does not? That Mr. REID. I announce that the Sen- marize our amendment is simple: It is disingenuous. ator from Massachusetts (Mr. KERRY) helps those who need it most. It helps It is critical that we have this de- and the Senator from Connecticut (Mr. the States provide a discount drug bate. There was a complaint that they LIEBERMAN) are necessarily absent. card. It is affordable, with no monthly just saw this amendment tonight. Part I further announce that, if present premiums, no deductibles, catastrophic of the reason is that we are trying to and voting, the Senator from Massa- coverage, and accountable market- rush this bill through what is supposed chusetts (Mr. KERRY) would vote based tools. It is a complete, afford- to be the most deliberative body in the ‘‘yea.’’ able, discount drug plan that the next world, and we have this false deadline The PRESIDING OFFICER (Mr. generation of this country can support. that we must get this bill passed before GREGG). Are there any other Senators We can be proud of what we are doing the July break. I submit, this deserves in the Chamber desiring to vote? for our seniors. more debate. The debate cannot happen The result was announced—yeas 42, I yield the floor. when it goes to conference because nays 54, as follows: The PRESIDING OFFICER. The Sen- most of the Senate is cut out then and [Rollcall Vote No. 259 Leg.] ator from Montana. there is no debate when it comes back YEAS—42 Mr. BAUCUS. Mr. President, the here. Akaka Durbin Levin major fatal problem with this amend- With all due respect, I think we have Bayh Edwards Lincoln ment is it dispenses with the under- a superior portion of the prescription Biden Feingold Mikulski lying principle of the underlying bill. drug plan, and I hope our colleagues Bingaman Feinstein Murray Boxer Graham (FL) Nelson (FL) That is universality. We are, in the leg- vote for this plan. Byrd Harkin Nelson (NE) islation before us, providing for uni- I reserve the remainder of our time. Cantwell Hollings Pryor versal benefits. The PRESIDING OFFICER. The Sen- Clinton Inouye Reed This amendment violates that prin- Conrad Johnson Reid ator from Nebraska. ciple by saying no, not across the board Mr. HAGEL. Mr. President, how Corzine Kennedy Rockefeller Daschle Kohl Sarbanes for Americans but, rather, it intro- much time is remaining? Dayton Landrieu Schumer duces a whole new means testing provi- The PRESIDING OFFICER. Two and Dodd Lautenberg Stabenow sion for catastrophic. I just think it fa- a half minutes. Dorgan Leahy Wyden tally violates the spirit of the legisla- Mr. HAGEL. Mr. President, in addi- NAYS—54 tion we are about to pass. tion to what my colleague from Nevada Alexander Craig McCain The PRESIDING OFFICER. All time has said in response to the distin- Allard Crapo McConnell has expired. The question is on agree- guished Senator from Montana, there Allen DeWine Miller ing the amendment No. 1026, as modi- is nothing new about this bill except Baucus Dole Murkowski Bennett Ensign Nickles fied. The clerk will call the roll. two features. Bond Enzi Roberts The assistant legislative clerk called This bill, the Hagel-Ensign bill, last Breaux Fitzgerald Santorum year received more bipartisan votes on Brownback Frist Sessions the roll. the floor of this Senate than any other Bunning Graham (SC) Shelby Mr. MCCONNELL. I announce that Burns Grassley Smith the Senator from New Mexico (Mr. bill. There is nothing new in this bill Campbell Gregg Snowe except two features. One is the $30 bil- Carper Hagel Specter DOMENICI) and the Senator from Okla- lion for low-income seniors’ additional Chafee Hatch Stevens homa (Mr. INHOFE) are necessarily ab- Chambliss Hutchison Sununu coverage, and the other is the $35 bil- sent. Cochran Jeffords Talent Mr. REID. I announce that the Sen- lion in cost sharing for catastrophic Coleman Kyl Thomas drug costs with Medicare and Medicaid Collins Lott Voinovich ator from Massachusetts (Mr. KERRY) to dual eligibles. That is what is new in Cornyn Lugar Warner and the Senator from Connecticut (Mr. the bill. NOT VOTING—4 LIEBERMAN) are necessarily absent. I further announce that, if present To say this is new and we have just Domenici Kerry sprung this on the Senate is a bit dis- Inhofe Lieberman and voting, the Senator from Massa- chusetts (Mr. KERRY) would vote ingenuous. This bill has been around The amendment (No. 1111) was re- ‘‘nay’’. for almost 4 years in its current form. jected. I yield the floor. Mr. LOTT. Mr. President, I move to The PRESIDING OFFICER. Are there The PRESIDING OFFICER. Does the reconsider the vote and I move to lay any other Senators in the Chamber de- Senator yield back his time? that motion on the table. siring to vote? Mr. HAGEL. Mr. President, I yield The motion to lay on the table was The result was announced—yeas 21, back all of my time. agreed to. nays 75, as follows: AMENDMENT NO. 1111 [Rollcall Vote No. 260 Leg.] AMENDMENT NO. 1026, AS MODIFIED The PRESIDING OFFICER. There The PRESIDING OFFICER. Before YEAS—21 are 2 minutes evenly divided on the we can go to the next amendment, we Allard Graham (SC) McConnell Levin amendment No. 1111. Who yields Brownback Gregg Reid will have to have order in the Senate. Burns Hagel Roberts time on the Levin amendment No. 1111? There are 2 minutes equally divided. Mr. BAUCUS. It is my understanding Chambliss Hutchison Santorum Who seeks recognition? The Senator Crapo Lott Sessions the sponsor, Senator LEVIN, is in the from Nevada. Dole Lugar Sununu Chamber. Ensign McCain Talent Mr. ENSIGN. Mr. President, I will Mr. LEVIN. I have already spoken on use 30 seconds and Senator HAGEL will NAYS—75 the amendment. use 30 seconds on this side. Akaka Chafee Enzi The PRESIDING OFFICER (Mr. EN- The Hagel-Ensign amendment cor- Alexander Clinton Feingold SIGN). All time is yielded back. Allen Cochran Feinstein The question is on agreeing to rects several problems in the bill. Let Baucus Coleman Fitzgerald amendment No. 1111. me go over those real briefly. Bayh Collins Frist We have no monthly premiums. We Bennett Conrad Graham (FL) Mr. BAUCUS. I ask for the yeas and Biden Cornyn Grassley nays. do not make middle-class taxpayers Bingaman Corzine Harkin The PRESIDING OFFICER. Is there a pay for prescription drugs for wealthy Bond Craig Hatch sufficient second? seniors. We preserve the State and the Boxer Daschle Hollings private plans that are already out Breaux Dayton Inouye There appears to be a sufficient sec- Bunning DeWine Jeffords ond. The clerk will call the roll. there, which the underlying bill does Byrd Dodd Johnson The legislative clerk called the roll. not do. We give most of our help to Campbell Dorgan Kennedy Mr. MCCONNELL. I announce that low- and moderate-income seniors but Cantwell Durbin Kohl the Senator from New Mexico (Mr. we still control costs in our bill. Carper Edwards Kyl

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00028 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8675 Landrieu Nelson (FL) Smith We can do it. Things have gone very get these two or four amendments fin- Lautenberg Nelson (NE) Snowe Leahy Nickles Specter well. We have had adequate time for ished. I would be happy to talk to the Levin Pryor Stabenow debate and amendment. The distin- Senator. I understand he wants us to be Lincoln Reed Stevens guished Senator from West Virginia efficient and work 5 days a week. I Mikulski Rockefeller Thomas told me from day one: My advice to would like to work 6 days a week. Miller Sarbanes Voinovich Murkowski Schumer Warner you as the majority leader is to make Mr. BYRD. I have a wife at home and Murray Shelby Wyden sure you give time for debate and she needs me there. I ought to be there. amendment. He did forget to tell me NOT VOTING—4 I have stopped early on two occasions that it is sometimes hard dealing back lately just to go be with her and let the Domenici Kerry Inhofe Lieberman and forth as you are waiting for lan- Senate run its course. There is going to guage to come, as you are trying to get come a time when this Senator is going The amendment (No. 1026), as modi- the order for amendments in these last to keep the Senate in session a while. fied, was rejected. hours on a very complex bill, a bill He can still do it. The PRESIDING OFFICER. The ma- that is as big as any bill we have I say this in the very best of spirit to jority leader. passed this year and as complex, and it the leader—and he is doing the best he Mr. FRIST. Mr. President, for the in- has taken a little bit more time. can—there comes a time when some of formation of Senators, we have made I would have liked to have finished at us have duties elsewhere and we would tremendous progress today, and we are 9 o’clock tonight. I think at this junc- like to keep our rollcall records clean. on the final leg. In conversations with ture, if we proceed over the next 45 Soon I will have cast 17,000 rollcall the managers, it appears we will have minutes—let’s do those rollcall votes votes. So I have been here for my share one more series of stacked votes to- in 10 minutes—we will be out of here. of the votes. I am getting a little bit night and that will include final pas- People will be able to leave tomorrow fed up staying around here. This last sage. That series will be it. The bill or stay and come to the floor and talk. rollcall vote was 23 minutes and the will be done. I think that is the general sense of one before that was 28 minutes. There We need somewhere between 45 min- where we should go. is a lot of hooping and hollering. What utes and an hour—hopefully 45 min- Mr. BYRD. Mr. President, will the do the American people think of us? It utes, and hopefully people can yield Senator yield? is time we went home if we don’t work. Mr. FRIST. The Senator is happy to back their time—before we can begin I hope, Mr. Leader, that those of you yield to the Senator from West Vir- those votes. I think that is all we can who are so good at working out these ginia. say at this juncture, working in good things can get people to have voice faith. There are a lot of details. We are Mr. BYRD. Mr. President, we are falling into this way of doing things. votes or maybe cut down the time on waiting for some of the final wording their amendments. to come through in terms of the man- Three-day work weeks. I will tell you, Mr. Leader, one night I am going to get Mr. FRIST. Mr. President, I suggest agers’ package. Once we have that, we that, since we have our colleagues here will be able to proceed with the voting. the floor and Senators will be planning on finishing and going home the next and ready to work, we go back to work I don’t know how many amendments now. I think the Senator made his it will be. It could be two amendments; day. They won’t get to do that. I have seen this happening over and over and point. I am listening and I will heed it could be four amendments; it could that advice and counsel. I suggest we be one amendment or passage. But it is over more recently. Three-day work weeks, and we don’t come in on Friday go back to work so we can get home to- going to be probably two or four night to our families as well. amendments beginning in about 45 and work and vote. If the Senator will continue to yield, I yield the floor. minutes to an hour. The PRESIDING OFFICER. Who Mr. BYRD. Will the leader yield? just briefly? Mr. FRIST. If the Senator will yield seeks recognition? The Senator from Mr. FRIST. Yes. for a couple more minutes because we Oklahoma is recognized. Mr. BYRD. On the preceding rollcall do have people who want to get on to Mr. NICKLES. Mr. President, I be- vote, 28 minutes were required. On this the business. I certainly do yield for a lieve we are in the process of trying to rollcall vote, 22 or 23 minutes were re- few more minutes. wrap up debate on a few amendments. quired. So we have over 50 minutes on Mr. BYRD. Mr. President, I don’t I believe momentarily Senator FEIN- two rollcall votes. Now, time is worth want to overtax the leader at this STEIN and Senator CHAFEE and I will be a little something around here to many point or overtax other Senators. Just discussing our amendment. I will make of us who don’t have much time left. I suffice it to say, we had better get out my comments very brief. I know Sen- wonder if we can’t do better than that. of this habit of just having 3-day work- ator FEINSTEIN wishes to speak on it. I I think the Senate ought to treat weeks, staying here until 10, 11, 12 on hope we can conclude debate. I think itself better than that. Senators owe to Thursday night so that people can go there will only be two more amend- it other Senators to not just lag and out on Friday. I started this thing of ments. I urge colleagues to make their cause rollcall votes to last so long. having a week at home every 4 weeks, comments brief and let’s vote and fin- Twenty-eight minutes on a rollcall but we worked the 5 days. We worked 5 ish action on this bill. I will defer my vote? Why can’t we go over to tomor- days in each of the 3 weeks in between, comments on the amendment because I row? We are going to be here anyhow. and we started voting early on Mon- believe the Senator from California is Why can’t we go over? Here it is 15 days and we voted a full day on Friday. ready to speak. minutes after 10. Do I have the floor, I know things have changed. I am not The PRESIDING OFFICER. The Sen- Mr. President? majority leader. I don’t mean to be a ator from California is recognized. The PRESIDING OFFICER. The ma- problem to the majority leader. But AMENDMENT NO. 1060, AS MODIFIED jority leader has the floor. this is getting to be a problem with Mrs. FEINSTEIN. Mr. President, I Mr. BYRD. Very well. some of us. call up amendment No. 1060, as modi- Mr. FRIST. Mr. President, we can do Mr. FRIST. Mr. President, let me fied. better, and I think we ought to do our just reply and say: Last Friday, you The PRESIDING OFFICER. Without best to try to do maybe 10 minutes on and I were on the floor at 3 in the objection, the amendment, as modified, the last series. It is late at night. We afternoon. Just because we are not vot- is now the pending business. have all been working about 12, 13 ing doesn’t mean we are not working. The amendment (No. 1060), as modi- hours nonstop. It is an important bill. Some of us do have constituents we go fied, is as follows: We set out this morning to finish to- back to and spend time with. Some of At the end of title IV, insert: night. People are here. They are ready us are working on bills and reading. Subtitle D—Part B Premium to finish it. It is late. After talking to Just because we are not voting does SEC. ll. INCOME-RELATED INCREASE IN MEDI- the managers and the leadership on not mean we are not working. CARE PART B PREMIUM. both sides, there is a general consensus Mr. BYRD. I understand that. (a) IN GENERAL.—Section 1839 (42 U.S.C. that we ought to push ahead, get this Mr. FRIST. Again, I suggest that we 1395r) is amended by adding at the end the bill done for the American people. go back so we can work and debate and following:

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‘‘(h) INCREASE IN PREMIUM FOR HIGH-INCOME meaning given such term by section under subparagraph (B) of such paragraph, if BENEFICIARIES.— 7701(a)(38) of the Internal Revenue Code of the Secretary determines under subpara- ‘‘(1) AMOUNT OF INCREASE.— 1986. graph (A) that the amount of the individual’s ‘‘(A) IN GENERAL.—Except as provided in ‘‘(2) DETERMINATION OF MODIFIED ADJUSTED actual modified adjusted gross income for a paragraph (4), if the modified adjusted gross GROSS INCOME.—The Secretary shall make an taxable year is greater than the amount ini- income of an individual for a taxable year initial determination of the amount of an in- tially determined under paragraph (2), the ending with or within a calendar year (as ini- dividual’s modified adjusted gross income for Secretary shall increase the amount other- tially determined by the Secretary in ac- a taxable year ending with or within a cal- wise determined for the year under subpara- cordance with paragraph (2)) exceeds the endar year for purposes of this subsection as graph (A) by an amount of interest equal to follows: threshold amount, the amount of the pre- the sum of the amounts determined under ‘‘(A) NOTICE.—Not later than September 1 mium under subsection (a) for the individual clause (ii) for each of the months described of the year preceding the year, the Secretary for the calendar year shall, in lieu of the in such clause. amount otherwise determined under sub- shall provide notice to each individual whom ‘‘(ii) COMPUTATION.—Interest shall be com- section (a), be equal to the applicable per- the Secretary finds (on the basis of the indi- puted for any month in an amount deter- centage of an amount equal to 200 percent of vidual’s actual modified adjusted gross in- mined by applying the underpayment rate the monthly actuarial rate for enrollees age come for the most recent taxable year for established under section 6621 of the Internal 65 and over as determined under subsection which such information is available or other Revenue Code of 1986 (compounded daily) to (a)(1) for the calendar year. information provided to the Secretary by the any portion of the difference between the ‘‘(B) APPLICABLE PERCENTAGE.—The term Secretary of the Treasury) will be subject to ‘applicable percentage’ means the percentage an increase under this subsection that the amount initially determined under para- determined in accordance with the following individual will be subject to such an in- graph (2) and the amount determined under tables: crease, and shall include in such notice the subparagraph (A) for the period beginning on ‘‘(i) INDIVIDUALS NOT FILING JOINT RE- Secretary’s estimate of the individual’s the first day of the month beginning after TURNS.— modified adjusted gross income for the year. the individual provided information to the In providing such notice, the Secretary shall Secretary under subparagraph (B) of para- ‘‘If the modified ad- The applicable use the most recent poverty line available as graph (2) and ending 30 days before the first justed gross income percentage is: of the date the notice is sent. month for which the individual’s monthly exceeds the thresh- ‘‘(B) CALCULATION BASED ON INFORMATION premium is increased under this paragraph. old amount by: PROVIDED BY BENEFICIARY.—If, during the 60- Not more than $50,000 ...... 50 percent ‘‘(iii) EXCEPTION.—Interest shall not be im- day period beginning on the date notice is More than $50,000 but not posed under this subparagraph if the amount provided to an individual under subpara- more than $100,000 ...... 75 percent of the individual’s modified adjusted gross graph (A), the individual provides the Sec- More than $100,000 ...... 100 percent. income provided by the individual under sub- retary with appropriate information (as de- ‘‘(ii) INDIVIDUALS FILING JOINT RETURNS.— paragraph (B) of paragraph (2) was not less termined by the Secretary) on the individ- than the individual’s modified adjusted gross ‘‘If the modified ad- The applicable ual’s anticipated modified adjusted gross in- justed gross income percentage is: income determined on the basis of informa- come for the year, the amount initially de- tion shown on the return of tax imposed by exceeds the thresh- termined by the Secretary under this para- chapter 1 of the Internal Revenue Code of old amount by: graph with respect to the individual shall be 1986 for the taxable year involved. Not more than $100,000 ...... 50 percent based on the information provided by the in- ‘‘(C) STEPS TO RECOVER AMOUNTS DUE FROM More than $100,000 but not dividual. PREVIOUSLY ENROLLED BENEFICIARIES.—In the more than $200,000 ...... 75 percent ‘‘(C) CALCULATION BASED ON NOTICE AMOUNT More than $200,000 ...... 100 percent. IF NO INFORMATION IS PROVIDED BY THE BENE- case of an individual who is not enrolled ‘‘(C) DEFINITION OF THRESHOLD AMOUNT.— FICIARY OR IF THE SECRETARY DETERMINES under this part for any calendar year for For purposes of this subsection, the term THAT THE PROVIDED INFORMATION IN NOT AP- which the individual’s monthly premium ‘threshold amount’ means— PROPRIATE.—The amount initially deter- under this part for months during the year ‘‘(i) except as provided in clause (ii), mined by the Secretary under this paragraph would be increased pursuant to subparagraph $100,000; and with respect to an individual shall be the (A) if the individual were enrolled under this ‘‘(ii) $200,000 in the case of a taxpayer filing amount included in the notice provided to part for the year, the Secretary may take a joint return. the individual under subparagraph (A) if— such steps as the Secretary considers appro- ‘‘(D) INFLATION ADJUSTMENT FOR THRESH- ‘‘(i) the individual does not provide the priate to recover from the individual the OLD AMOUNT.— Secretary with information under subpara- total amount by which the individual’s ‘‘(i) IN GENERAL.—In the case of any cal- graph (B); or monthly premium under this part for endar year beginning after 2006, the dollar ‘‘(ii) the Secretary determines that the in- months during the year would have been in- amount in clause (i) of subparagraph (C) formation provided by the individual to the creased under subparagraph (A) if the indi- shall be increased by an amount equal to— Secretary under such subparagraph in not vidual were enrolled under this part for the ‘‘(I) such dollar amount, multiplied by appropriate. year. ‘‘(II) the percentage (if any) by which the ‘‘(3) ADJUSTMENTS.— ‘‘(D) DECEASED BENEFICIARY.—In the case average of the Consumer Price Index for all ‘‘(A) IN GENERAL.—If the Secretary deter- of a deceased individual for whom the urban consumers (United States city aver- mines (on the basis of final information pro- amount of the monthly premium under this age) for the 12-month period ending with vided by the Secretary of the Treasury) that part for months in a year would have been June of the preceding calendar year exceeds the amount of an individual’s actual modi- decreased pursuant to subparagraph (A) if such average for the 12-month period ending fied adjusted gross income for a taxable year the individual were not deceased, the Sec- with June 2005. ending with or within a calendar year is less retary shall make a payment to the individ- ‘‘(ii) JOINT RETURNS.—The dollar amount than or greater than the amount initially de- ual’s surviving spouse (or, in the case of an described in clause (ii) of subparagraph (C) termined by the Secretary under paragraph individual who does not have a surviving for any calendar year after 2006 shall be in- (2), the Secretary shall increase or decrease spouse, to the individual’s estate) in an creased to an amount equal to twice the the amount of the individual’s monthly pre- amount equal to the difference between— amount in effect under clause (i) of subpara- mium under this part (as the case may be) ‘‘(i) the total amount by which the individ- graph (C) (after application of this subpara- for months during the following calendar ual’s premium would have been decreased for graph). year by an amount equal to 1⁄12 of the dif- all months during the year pursuant to sub- ‘‘(iii) ROUNDING.—If any dollar amount ference between— after being increased under clause (i) is not ‘‘(i) the total amount of all monthly pre- paragraph (A); and a multiple of $1,000, such dollar amount shall miums paid by the individual under this part ‘‘(ii) the amount (if any) by which the indi- be rounded to the nearest multiple of $1,000. during the previous calendar year; and vidual’s premium was decreased for months ‘‘(E) DEFINITION OF MODIFIED ADJUSTED ‘‘(ii) the total amount of all such pre- during the year pursuant to subparagraph GROSS INCOME.—For purposes of this sub- miums which would have been paid by the (A). section, the term ‘modified adjusted gross in- individual during the previous calendar year ‘‘(4) WAIVER BY SECRETARY.—The Secretary come’ means adjusted gross income (as de- if the amount of the individual’s modified may waive the imposition of all or part of fined in section 62 of the Internal Revenue adjusted gross income initially determined the increase of the premium or all or part of Code of 1986)— under paragraph (2) were equal to the actual any interest due under this subsection for ‘‘(i) determined without regard to sections amount of the individual’s modified adjusted any period if the Secretary determines that 135, 911, 931, and 933 of such Code; and gross income determined under this para- a gross injustice would otherwise result ‘‘(ii) increased by the amount of interest graph. without such waiver. received or accrued by the taxpayer during ‘‘(B) INTEREST.— ‘‘(5) TRANSFER TO PART B TRUST FUND.— the taxable year which is exempt from tax ‘‘(i) INCREASE.—In the case of an individual ‘‘(A) IN GENERAL.—The Secretary shall under such Code. for whom the amount initially determined transfer amounts received pursuant to this ‘‘(F) JOINT RETURN.—For purposes of this by the Secretary under paragraph (2) is based subsection to the Federal Supplementary subsection, the term ‘joint return’ has the on information provided by the individual Medical Insurance Trust Fund.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00030 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8677 ‘‘(B) DISREGARD.—In applying section (1) IN GENERAL.—The amendments made by Much has changed since the creation 1844(a), amounts attributable to subpara- subsections (a) and (b) shall apply to the of Medicare in 1965. People are living graph (A) shall not be counted in deter- monthly premium under section 1839 of the longer, due in large part to improved mining the dollar amount of the premium Social Security Act for months beginning diagnostic tools and treatment. There per enrollee under paragraph (1)(A) or (1)(B) with January 2006. thereof.’’ (2) INFORMATION FOR PRIOR YEARS.—The is no way Congress could have pre- (b) CONFORMING AMENDMENTS.—(1) Section Secretary of Health and Human Services dicted the number of people who would 1839 (42 U.S.C. 1395r) is amended— may request information under section come to rely on Medicare or the rate at (A) in subsection (a)(2), by inserting ‘‘or 6013(l)(19) of the Social Security Act (as which medical expenses would grow. section subsection (h)’’ after ‘‘subsections (b) added by subsection (c)) for taxable years be- When Medicare was established in 1965, and (e)’’; ginning after December 31, 2002. the Part B premium was set at a level (B) in subsection (a)(3) of section 1839(a), Mrs. FEINSTEIN. Mr. President, this to cover about 50 percent of program by inserting ‘‘or subsection (h)’’ after ‘‘sub- amendment is presented on behalf of costs. With medical inflation, the dol- section (e)’’; myself, Senators NICKLES, CHAFEE, (C) in subsection (b), inserting ‘‘(and as in- lar amount of the premium has decreased under subsection (h))’’ after ‘‘sub- LINDSEY GRAHAM, ALEXANDER, and clined to cover only 25 percent of pro- section (a) or (e)’’; and MCCAIN. gram costs. (D) in subsection (f), by striking ‘‘if an in- This amendment provides that Medi- The Omnibus Budget Reconciliation dividual’’ and inserting the following: ‘‘if an care beneficiaries with an annual ad- Act of 1993 established the Medicare individual (other than an individual subject justed gross income of over $200,000, or Part B premium to equal 25 percent of to an increase in the monthly premium above, pay the full cost of the Medicare the program cost from 1996 to 1998. The under this section pursuant to subsection Part B premium. The amendment uses Balanced Budget Act of 1997 perma- (h))’’. a sliding scale to ramp up the bene- nently established the Part B premium (2) Section 1840(c) (42 U.S.C. 1395r(c)) is ficiary’s share of the Part B premium. amended by inserting ‘‘or an individual de- at 25 percent. The bill to balance the termines that the estimate of modified ad- The amendment we are offering budget in 1997 that passed out of the justed gross income used in determining would hold Medicare beneficiaries with Senate Finance Committee included a whether the individual is subject to an in- annual adjusted gross incomes between provision to income relate the Medi- crease in the monthly premium under sec- $100,000 and $150,000 a year responsible care Part B premium. So this is noth- tion 1839 pursuant to subsection (h) of such for 50 percent of the cost of the pre- ing new. section (or in determining the amount of mium. In 2003, this amounts to $116.40 a The provision included in 1997 would such increase) is too low and results in a por- month, or $1,396 annually, rather than have had beneficiaries with incomes tion of the premium not being deducted,’’ be- $58.20 monthly, or $698 annually, which over $50,000 for an individual and $75,000 fore ‘‘he may’’. is what the beneficiary pays today for for a couple paying a greater share of (c) REPORTING REQUIREMENTS FOR SEC- RETARY OF THE TREASURY.— the benefit. the premium. This provision was (1) IN GENERAL.—Subsection (l) of section Medicare beneficiaries with incomes stripped out during conference. 6103 of the Internal Revenue Code of 1986 (re- between $150,000 a year and $200,000 a Well, we were in a different financial lating to confidentiality and disclosure of re- year—that is $300,000 to $400,000 for a situation when Congress made the deci- turns and return information) is amended by couple—would be responsible for 75 per- sion to set the beneficiary’s share of adding at the end the following new para- cent of the total cost of the Part B pre- the Part B premium at 25 percent in graph: mium. In 2003, this amounts to $174 or 1997. At that time, we had only a $22 ‘‘(19) DISCLOSURE OF RETURN INFORMATION $2,095 annually. billion deficit. The next year the budg- TO CARRY OUT INCOME-RELATED REDUCTION IN Medicare beneficiaries with annual MEDICARE PART B PREMIUM.— et was in surplus to the tune of $69 bil- ‘‘(A) IN GENERAL.—The Secretary may, incomes above $200,000—that is $400,000 lion. upon written request from the Secretary of for couples—would be responsible for With a Federal budget deficit of over Health and Human Services, disclose to offi- 100 percent of the total cost of the pre- $400 billion in the year 2003 and an in- cers and employees of the Centers for Medi- mium. In 2003, this amounts to $232.80 a crease in the Federal debt of $5.3 tril- care & Medicaid Services return information month, or $2,793 annually. Now, for a lion, for a total of $12 trillion in debt with respect to a taxpayer who is required to beneficiary with an annual income of expected by 2013, I believe that now is pay a monthly premium under section 1839 of $200,000, this amounts to less than 1.4 the time to rethink the premium struc- the Social Security Act. Such return infor- percent of their annual income. For the mation shall be limited to— ture of Medicare Part B. ‘‘(i) taxpayer identity information with re- vast majority of Medicare bene- As the baby boomers age, there will spect to such taxpayer, ficiaries, some 37 million of the 38 mil- be an increasing reliance on and de- ‘‘(ii) the filing status of such taxpayer, lion beneficiaries, Part B premiums mand for the Medicare Program. ‘‘(iii) the adjusted gross income of such would remain the same as they are The number of people age 65 and taxpayer, today. older will more than double over the ‘‘(iv) the amounts excluded from such tax- According to the Census Bureau, coming decades, rising from 37 million payer’s gross income under sections 135 and about 98 percent of all Medicare bene- today to 70 million in 2030 and 82 mil- 911, ficiaries have annual incomes below lion in 2050. Over the next 75 years, the ‘‘(v) the interest received or accrued during the taxable year which is exempt from the $100,000. So the amendment we are pro- Medicare program will cost 71 percent tax imposed by chapter 1 to the extent such posing will affect about 2 percent of the more than that provided under current information is available, and most affluent and well off Medicare law in order to meet its needs. ‘‘(vi) the amounts excluded from such tax- beneficiaries. It is predicted the Medicare hospital payer’s gross income by sections 931 and 933 Let me be clear. This amendment trust fund will be insolvent by 2030. to the extent such information is available. does not deprive any Medicare bene- The CBO projects Medicare spending ‘‘(B) RESTRICTION ON USE OF DISCLOSED IN- ficiary of any benefit. What this will nearly quadruple by 2075 in order FORMATION.—Return information disclosed amendment says is that if you can af- to meet the growing need for the pro- under subparagraph (A) may be used by offi- ford to pay the price for the Medicare gram, with budget outlays of $277 bil- cers and employees of the Centers for Medi- care & Medicaid Services only for the pur- Part B premium, you should. Those lion in 2003. This means spending for poses of, and to the extent necessary in, es- Medicare beneficiaries who have an- the program could reach $1.1 trillion by tablishing the appropriate monthly premium nual incomes below $100,000 a year will 2075. under section 1839 of the Social Security still be able to receive a 75-percent With the legislation currently before Act.’’ Government subsidy for their pre- the Senate, Congress is proposing some (2) CONFORMING AMENDMENTS.— mium. major changes to the Medicare Pro- (A) Paragraph (3)(A) of section 6103(p) of Now, I strongly believe the time has gram. I am in full support of adding a such Code is amended by striking ‘‘or (18)’’ come to begin to income-relate some of drug benefit, but Congress should also each place it appears and inserting ‘‘(18), or (19)’’. these benefits. The Federal Govern- rethink the financing mechanisms of (B) Paragraph (4) of section 6103(p) of such ment should not be subsidizing the the program, and this bill is short in Code is amended by striking ‘‘or (16)’’ and in- Part B premiums of those beneficiaries that direction. High-income bene- serting ‘‘(16), or (19)’’. who can afford to pay for the cost of ficiaries can afford to pay a larger (d) EFFECTIVE DATE.— the premiums themselves. share of Medicare’s costs, at least of

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00031 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8678 CONGRESSIONAL RECORD — SENATE June 26, 2003 the premium. They can afford to pay pay $2,800 a year. I do not think that is Similarly, SMI general revenues in the for the benefits they receive. too much to ask to help keep this pro- year 2002 were equivalent to about 7.8 per- In light of the fact the Federal Gov- gram solvent. cent of personal and corporate Federal in- ernment has just provided tax cuts in Finally, if we do not do this today, come tax collected in that year. If such tax some other Congress is going to do it. is to remain at the current level relative to the range of $1,841 for people with in- the national economy, then SMI— comes between $77,000 and $154,000 and In 1997, the National Bipartisan Com- up to $30,000 for people with incomes mission on the Future of Medicare was That is Part B— above $374,000, it seems to me people created to resolve the long-term insol- general revenue financing in 2077 would rep- with annual incomes above $200,000 can vency facing the system. That was in resent roughly 32 percent of total income taxes. afford to pay $2,793, which is the annual 1997 and it was known as the Breaux- That is almost one-third of total in- premium for Medicare Part B this year. Frist Commission. They did not report come taxes. That is not affordable. We should focus funding so that 98 their work to Congress. They fell short That is not sustainable. So I think the percent of Medicare beneficiaries who of the votes necessary to report their amendment we have before us by Sen- have an annual adjusted gross income work to Congress. ator FEINSTEIN and Senator CHAFEE of less than $100,000 can continue to ac- However, it is interesting to note and others is a small step in the right cess benefits. I think it is reasonable to that one of the reasons they failed to direction to try to make this system ask those who can afford it to pay a get the votes to report to Congress was more affordable for future generations. greater share of the premium. We are the President at the time, President I compliment my colleagues for this still waiting for an official cost savings Clinton, called for putting aside 15 per- amendment. I urge our colleagues to score from CBO, but I believe this cent of budget surpluses the next 15 support this small step toward reform. amendment could save billions of dol- years to pay down the debt and to I yield the floor. lars. shore up Medicare. Fifteen years of Once again, Mr. President, this budget surpluses—when will we see The PRESIDING OFFICER. The Sen- amendment affects less than 2 percent those again?—to shore up Medicare. ator from Nevada. and only those with incomes of more Because the Breaux-Frist plan did not Mr. REID. I suggest the absence of a than $200,000 a year adjusted gross in- include that, they did not get the votes quorum. come would pay the full premium of necessary. The PRESIDING OFFICER. The about $2,900 a year. We think this is a Mr. President, now is the time to clerk will call the roll. reasonable proposal. It is scaled up. It adopt this amendment. If we do not The legislative clerk proceeded to impacts no one below $100,000 adjusted adopt it, future Congresses will have to call the roll. gross income a year, and at the max- wrestle with this dilemma. Mr. FRIST. Mr. President, I ask I thank the Chair. imum for people of over $200,000 a year unanimous consent that the order for The PRESIDING OFFICER. The Sen- the quorum call be rescinded. in adjusted gross income, the premium ator from Oklahoma. would be just $2,900. The PRESIDING OFFICER. Without Mr. NICKLES. Mr. President, for the objection, it is so ordered. The income limits would be indexed information of our colleagues, I am f to medical inflation and, according to going to make a couple comments on current population survey data from this amendment. There may be an IN REMEMBRANCE OF STROM 2002, only 2 percent, or about 1 million amendment by the Senator from Penn- THURMOND people of the 38 million Medicare bene- sylvania that will require a vote on or Mr. FRIST. Mr. President, a few mo- ficiaries, have incomes of over $100,000 in relation to Senator CORZINE’s ments ago we were made aware that at a year. This would protect the tax sub- amendment. I think we are close to fin- 9:45 tonight a close friend, a confidant, sidy for people who need it by encour- ishing. I hope we can. I just make those a colleague to most of us in this body, aging those who have the dollars sim- comments. Strom Thurmond, passed away. ply to pay either a greater share of the I compliment Senator FEINSTEIN and It was a century ago when Mark premium cost or the full premium cost. also Senator CHAFEE, Senator ALEX- Twain was alive and Teddy Roosevelt I thank the Chair. I yield the floor. ANDER, Senator MCCAIN, and others for The PRESIDING OFFICER (Mr. EN- was President that James Strom Thur- supporting this amendment. Senator mond was born in South Carolina and SIGN). The Senator from Rhode Island. CHAFEE mentioned we passed the in- Mr. CHAFEE. Mr. President, I join at that time began a life unmatched in come-related Part B premium several public service. Just about all of us in with Senator FEINSTEIN, Senator NICK- years ago with 70 votes. I believe the LES, and others in presenting this this body have had the real privilege of majority of people, a strong majority— serving alongside Strom Thurmond. A amendment this evening. I believe this looking at the people who voted for it— income-related Part B premium for long-time friend of Senator Thurmond, are still here. I hope we vote for it Hortense Woodson, once said of him: only the wealthiest of seniors, a little again. over 1 percent of the entire Medicare Medicare has some big problems long Everything he’s done has been done in the full. There’s no halfway doings about Strom. population, is necessary to sustain the term. The bill before us has a lot of long-term solvency of the Medicare new subsidies but does not have a lot of Indeed, Strom Thurmond will forever Program. reform to make it affordable for future be a symbol of what one person can ac- I wish to make just three points on generations. complish when they live life, as we all this issue. First, as Senator FEINSTEIN Part B right now is subsidized by know he did, to the fullest. To his fam- has said, previous Congresses have general revenues 3 to 1 Federal Govern- ily and his friends, we offer our sin- worked on this issue. In 1997, the Sen- ment and individuals. The amendment cerest sympathies. ate voted 70 to 30 to do exactly what we before us on Part B says if individuals It was unexpected that he would die are doing here, and most of those Sen- have income above $100,000, they should this evening while we are in the middle ators are still here today. pay at least 50 percent. If they have in- of completing a very historic bill, and Second, many of these seniors can af- come above $200,000, they should pay it it would be clearly appropriate for us ford this added premium. Most seniors, all. For couples, that would be $400,000. to make recognition of his passing for it is safe to say, who are making over A couple could make $400,000 before a moment now, with plans, either after $100,000 a year have already paid off they pay all their Part B premium. completion of the bill tonight or to- their mortgages. They have paid off Surely we can do that. Why should morrow, for people to make more ex- their loans. They have educated their we ask our kids and/or our grandkids, tended statements. children. They can afford these higher who might have incomes of $20,000 or Again, we extend to his family our premiums which would go from only $30,000, to be subsidizing individuals to deepest sympathies and our continued $1,400 a year to $2,800 a year, at the that degree? prayers. most, depending on the income they I compliment my colleagues for this The PRESIDING OFFICER. The make. So seniors who are making amendment. I will read from the an- Democratic leader. $100,000 at the most will pay only $1,400 nual report of the board of trustees of Mr. DASCHLE. Mr. President, I join a year, and those making $200,000 will the HI trust fund. It says: with the majority leader in expressing

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00032 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8679 our heartfelt condolences to the family The PRESIDING OFFICER. The under this paragraph in a manner that is and to the State of Strom Thurmond. clerk will report. similar to the manner such provisions apply In many respects, he was a legend. The legislative clerk read as follows: to the penalty under part D. ‘‘(3) PROCEDURES.—The Administrator shall Many of us had the good fortune to The Senator from Pennsylvania [Mr. serve with him as a Senator. He was a establish procedures to carry out this sub- SANTORUM] proposes an amendment num- section. Under such procedures, the Adminis- Governor, a Presidential candidate, a bered 1132. trator may waive or modify any of the pre- soldier, a father, a citizen. In many re- Mr. SANTORUM. Mr. President, I ceding provisions of this part or part D to spects, he fought, lived, contributed, ask unanimous consent that the read- the extent necessary to carry out this sub- and legislated in a way that will be ing of the amendment be dispensed section. written about and commented on for with. ‘‘(4) NO EFFECT ON MEDICARE DRUG PLANS.— years and decades to come. The PRESIDING OFFICER. Without This subsection shall have no effect on eligi- Much more will be said, but I think ble beneficiaries enrolled under part D in a objection, it is so ordered. Medicare Prescription Drug plan or under a as we consider his contribution tonight The amendment is as follows: we can say, as we consider the oppor- contract under section 1860D–13(e).’’ tunity that we had to serve with him, (Purpose: To allow eligible beneficiaries in Mr. SANTORUM. Mr. President, one MedicareAdvantage plans to elect zero pre- of the key components that many Republicans and Democrats, that it mium, stop-loss drug coverage protection) was our privilege to do so. Members on this side of the aisle would The PRESIDING OFFICER. The Sen- On page 343, between lines 15 and 16, insert like to see accomplished is to draw as ator from South Carolina. the following: ‘‘(f) ZERO PREMIUM STOP-LOSS PROTECTION many people as possible into the com- Mr. HOLLINGS. Mr. President, my AND ACCESS TO NEGOTIATED PRICES FOR ELI- petitive model set up in this bill. We friend and colleague of 36 years in the GIBLE BENEFICIARIES ENROLLED IN believe it is the more efficient, higher Senate is gone. A giant oak in the for- MEDICAREADVANTAGE PLANS.— quality delivery of health care serv- est of public service has fallen. ‘‘(1) IN GENERAL.—Notwithstanding any ices, the Medicare Advantage plan. I started with Senator Thurmond as provision of this part or part D, a Unfortunately, through negotiations, a young law student in 1946 when he MedicareAdvantage plan shall be treated as a lot of the incentives the President first ran for Governor and have been meeting the requirements of this section if, has to encourage people to get into in lieu of the qualified prescription drug cov- more or less with him over these many, those plans and thereby make them many years. I will have a real recount erage otherwise required, the plan makes available such coverage with the following work have been taken out in the cur- of our work together later. That is the rent version on the floor. That is to the way it was even though we ended up on modifications: ‘‘(A) NO PREMIUM.—Notwithstanding sub- great consternation, I know, of the other sides of the aisle. There was section (d) or sections 1860D–13(e)(2) and White House and many Members on never any doubt about the interests of 1860D–17, the amount of the this side of the aisle. South Carolina. MedicareAdvantage monthly beneficiary ob- We have all this argument going on For quite some time I have been try- ligation for qualified prescription drug cov- ing to think how they can create incen- now with respect, for example, to erage shall be zero. judges. He and I got together very ‘‘(B) BENEFICIARY RECEIVES ACCESS TO NE- tives—carrots, if you will, as opposed early. We agreed when his President GOTIATED PRICES AND STOP-LOSS PROTECTION to sticks—to encourage people to get was in office from his particular party FOR NO ADDITIONAL PREMIUM.—Notwith- into these kinds of plans. Originally, I that he had the appointment, but he al- standing section 1860D–6, qualified prescrip- intended to offer a differential ben- ways asked me about it and, of course, tion drug coverage shall include coverage of efit—in other words, a benefit that I in turn asked him about it. We covered drugs that meets the following re- would have what I call a standard ben- quirements: checked with each other. That is the efit in the fee-for-service option and an ‘‘(i) The coverage has cost-sharing (for enhanced benefit in the Medicare Ad- kind of way we worked together over costs up to the annual out-of-pocket limit the some 36 years. under subsection (c)(4) of such section) that vantage option. I was fairly convinced, I can say just a living legend of is equal to 100 percent. in discussing with the people on my South Carolina now has been termi- ‘‘(ii) The coverage provides the limitation side of the aisle, we probably would not nated. But I want to give Nancy and on out-of-pocket expenditures under such have a chance to succeed; that there the children my heartfelt condolences. subsection (c)(4), except that in applying were people who had made commit- Peatsy and I have known them and such subsection, ‘$5000.00’ shall be sub- ments that a differential benefit was been with them over the many, many stituted for ‘$3,700’ in subparagraph (B)(i)(I) not something for this time. years. I will have more to say at a later of such subsection. I went about trying to figure out, ‘‘(iii) The coverage provides access to nego- time. I thank the leadership for their tiated prices under subsection (e) of such sec- could we create incentives to people to recognition. I hope, perhaps, when we tion during the entire year. come into Medicare Advantage, which I complete our work tonight, we might ‘‘(C) APPLICATION OF LOW-INCOME SUB- believe is the future of Medicare and adjourn out of respect for our col- SIDIES.—Notwithstanding subsection (f) or the best way to run the system without league. section 1860D–19, the Administrator shall not creating a differential benefit. The Mr. FRIST. Why don’t we take just a apply the following provisions of subsection amendment before the Senate does moment of silence in honor of Strom (a) of such section: that. The amendment before the Sen- Thurmond. ‘‘(i) Subparagraphs (A), (B), (C), and (D) of ate creates an option for beneficiaries paragraph (1). (Moment of Silence.) who participate in Medicare Advan- Mr. FRIST. I suggest the absence of a ‘‘(ii) Subparagraphs (A), (B), (C), and (D) of paragraph (2). tage. It is a pharmaceutical option. In- quorum. stead of just having no pharmaceutical The PRESIDING OFFICER. The ‘‘(iii) Clauses (i), (ii), (iii), and (iv) of paragraph (3)(A). benefit, which you could if you do not clerk will call the roll. ‘‘(2) PENALTY FOR ENROLLING IN A ZERO PRE- get into the Medicare Advantage Pro- The assistant legislative clerk pro- MIUM STOP-LOSS PROTECTION PLANS AFTER INI- gram, we have the standard benefit ceeded to call the roll. TIAL ELIGIBILITY FOR SUCH ENROLLMENT.—In Mr. SANTORUM. Mr. President, I which is required if you participate in the case of an eligible beneficiary that en- the PPOs, HMOs, and POSs that will be ask unanimous consent that the order rolled in a plan offered pursuant to this sub- for the quorum call be rescinded. section at any time after the initial enroll- created here. The PRESIDING OFFICER. Without ment period described in section 1860D–2, the What I will do with this amendment objection, it is so ordered. Secretary shall establish procedures for im- is create another option for seniors posing a monthly beneficiary obligation for f who select Medicare Advantage. That enrollment under such plan. The amount of option would be a zero premium cata- PRESCRIPTION DRUG AND MEDI- such obligation shall be an amount that the strophic benefit. So you could choose CARE IMPROVEMENT ACT OF Administrator determines is actuarially between the standard benefit, the $35 2003—Continued sound for each full 12-month period (in the premium, and the 50 percent copay, and same continuous period of eligibility) in AMENDMENT NO. 1132 which the eligible beneficiary could have the donut hole, and all the things de- Mr. SANTORUM. Mr. President, I been enrolled under such a plan but was not scribed over and over again, or if you call up amendment No. 1132 and ask for so enrolled. The provisions of subsection (b) did not want to pay a premium but its immediate consideration. of such section shall apply to the penalty wanted some catastrophic coverage,

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00033 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8680 CONGRESSIONAL RECORD — SENATE June 26, 2003 wanted some benefit, no premium, no For the information of our col- ELIGIBLE BENEFICIARIES IN CALCULATION OF cost, you could join this. leagues, I think we are very close to MEDICAREADVANTAGE PAYMENT RATES.— The CBO scored this as attracting finishing this bill. We may have one or (1) FOR PURPOSES OF CALCULATING twice as many people into the PPOs MEDICARE+CHOICE PAYMENT RATES.—Section two rollcall votes. I think we are just 1853(c)(3) (42 U.S.C. 1395w–23(c)(3)), as amend- and HMOs as the underlying bill. It about ready to vote on the Feinstein- ed by section 203, is amended— would make those plans much more de- Chafee amendment and possibly one (A) in subparagraph (A), by striking ‘‘sub- sirable for beneficiaries. I believe that other amendment, and I think we are paragraph (B)’’ and inserting ‘‘subparagraphs should be one of the goals of this legis- very close to be able to vote on final (B) and (E)’’; and lation, to make the new and improved passage, for the information of our col- (B) by adding at the end the following new and stronger plan a more robust plan. leagues. subparagraph: Unfortunately, according to the Con- I yield the floor. ‘‘(E) INCLUSION OF COSTS OF DOD AND VA gressional Budget Office, when people MILITARY FACILITY SERVICES TO MEDICARE-ELI- I suggest the absence of a quorum. GIBLE BENEFICIARIES.—In determining the move from the fee-for-service plan into The PRESIDING OFFICER. The area-specific Medicare+Choice capitation the Medicare Advantage plan, the Con- clerk will call the roll. rate under subparagraph (A) for a year (be- gressional Budget Office assumes those The assistant legislative clerk pro- ginning with 2006), the annual per capita rate plans will be more expensive. And be- ceeded to call the roll. of payment for 1997 determined under section cause they will be more expensive, this Mr. KENNEDY. Mr. President, I ask 1876(a)(1)(C) shall be adjusted to include in amendment costs money. It doubles unanimous consent that the order for the rate the Secretary’s estimate, on a per the participation but costs $20, to $25 the quorum call be rescinded. capita basis, of the amount of additional The PRESIDING OFFICER. Without payments that would have been made in the billion, which is the back of the enve- area involved under this title if individuals lope. And God bless the CBO; that is objection, it is so ordered. entitled to benefits under this title had not the best they could do at this late AMENDMENT NO. 1060 received services from facilities of the De- hour. Mr. KENNEDY. Mr. President, I will partment of Defense or the Department of I firmly believe this is a reasonable just take a moment to address the Veterans Affairs.’’. compromise between those who would amendment of the Senator from Cali- (2) FOR PURPOSES OF CALCULATING LOCAL FEE-FOR-SERVICE RATES.—Section 1853(d)(5) not want to have the differential ben- fornia, Mrs. FEINSTEIN, and her col- (42 U.S.C. 1395w–23(d)(5)), as amended by sec- efit and those who would because it is leagues, in terms of means testing the unfair to the fee-for-service partici- tion 203, is amended— Medicare system. That is what we (A) in subparagraph (A), by striking ‘‘sub- pants and those who believe we need to would be doing, changing what is effec- paragraph (B)’’ and inserting ‘‘subparagraphs have an incentive for people to get into tively an insurance system into a wel- (B) and (C)’’; and the Medicare Advantage Program. This fare system. There is, really, no ques- (B) by adding at the end the following new strikes the compromise. This is where tion about that. subparagraph: we could go. The fact is, the Part B of the Medi- ‘‘(C) INCLUSION OF COSTS OF DOD AND VA There are all sorts of things we have care system is basically a progressive MILITARY FACILITY SERVICES TO MEDICARE-ELI- GIBLE BENEFICIARIES.—In determining the done to eliminate adverse selection and system as it is at the present time. all the other problems inherent in of- local fee-for-service rate under subparagraph Wealthy people are paying a great deal (A) for a year (beginning with 2006), the an- fering two different benefits. We be- more into that system than they are nual per capita rate of payment for 1997 de- lieve we actually address the vast ma- taking out. termined under section 1876(a)(1)(C) shall be jority of those problems in this amend- My concern is, if this passes, it is adjusted to include in the rate the Sec- ment. Nevertheless, we have run into only a question of time before the retary’s estimate, on a per capita basis, of the roadblock that this bill has run healthiest individuals who can qualify the amount of additional payments that into the entire time when it comes to under the Part B premium are going to would have been made in the area involved the competitive model and CBO and under this title if individuals entitled to ben- leave the Medicare system and it is efits under this title had not received serv- their estimation of costs. going to deteriorate into a general wel- For the record, the White House does ices from facilities of the Department of De- fare system. The kind of Medicare sys- fense or the Department of Veterans Af- not see it that way. The White House tem seniors relied on, day in and day fairs.’’. sees the competitive model as saving out, would be destroyed. Make no mis- (d) EFFECTIVE DATE.—The amendments money. Under their scoring, this would take about it. made by this section shall apply with respect probably actually save money and That is why the AARP is strongly op- to plan years beginning on and after January 1, 2006. move people into a higher quality, posed to it, as well as the National AMENDMENT NO. 960, AS MODIFIED more efficient system. Committee to Preserve Social Secu- Mr. GRASSLEY. Mr. President, I ask AMENDMENT NO. 1132 WITHDRAWN rity. unanimous consent that Senator DAY- As a result of the fact of the score I hope this amendment is not accept- which is $20 to $25 billion, and we do TON’s amendment, No. 960, be modified ed. I suggest the absence of a quorum. with the modification that I send to not have that, I am going to withdraw The PRESIDENT pro tempore. The my amendment and hope this idea the desk. clerk will call the roll. The PRESIDENT pro tempore. With- which I believe is in the center here is The assistant legislative clerk pro- out objection, it is so ordered. a compromise between two competing ceeded to call the roll. The amendment is as follows: ideas of how to structure this bill. Mr. GRASSLEY. Mr. President, I ask (Purpose: To require a streamlining of the It will be considered in conference as unanimous consent that the order for medicare regulations) a way of trying to bring the two sides the quorum call be rescinded. At the end of subtitle A of title V, add the together in something that does not The PRESIDENT pro tempore. With- following: disadvantage the fee-for-service plan out objection, it is so ordered. SEC. ll. STREAMLINING AND SIMPLIFICATION OF MEDICARE REGULATIONS. but creates an opportunity for incen- AMENDMENT NO. 990, AS MODIFIED tives to go to the Medicare Advantage (a) IN GENERAL.—The Secretary of Health Mr. GRASSLEY. Mr. President, I ask and Human Services shall conduct an anal- plan. unanimous consent that amendment Mr. President, with that I ask unani- ysis of the regulations issued under title No. 990, previously adopted, be modi- XVIII of the Social Security Act and related mous consent to withdraw my amend- fied with language I send to the desk. laws in order to determine how such regula- ment. The PRESIDENT pro tempore. With- tions may be streamlined and simplified to The PRESIDING OFFICER. The out objection, it is so ordered. increase the efficiency and effectiveness of amendment is withdrawn. The amendment is as follows: the medicare program without harming The Senator from Oklahoma. beneficiaries or providers and to decrease the Mr. NICKLES. I compliment my col- At the end of subtitle A of title II, add the burdens the medicare payment systems im- league from Pennsylvania. Especially following: pose on both beneficiaries and providers. this late at night, when a lot of us are SEC. ll. IMPROVEMENTS IN MEDICARE- (b) REDUCTION IN REGULATIONS.—The Sec- ADVANTAGE BENCHMARK DETER- retary, after completion of the analysis thinking about our departed friend and MINATIONS. under subsection (a), shall direct the rewrit- colleague, Senator Thurmond, I appre- (c) INCLUSION OF COSTS OF DOD AND VA ing of the regulations described in subsection ciate his withdrawing this amendment. MILITARY FACILITY SERVICES TO MEDICARE- (a) in such a manner as to—

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00034 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8681 (1) reduce the number of words comprising AMENDMENT NO. 989, AS MODIFIED (Amendments Nos. 1017, 968, 948, 1054 all regulations by at least two-thirds by Oc- Mr. GRASSLEY. Mr. President, I ask and 1030 are printed in a previous edi- tober 1, 2004, and unanimous consent that the Collins tion of the RECORD.) (2) ensure the simple, effective, and effi- amendment, amendment No. 989, be cient operation of the medicare program. AMENDMENT NO. 1074 modified with modifications that I (c) APPLICATION OF THE PAPERWORK REDUC- (Purpose: To amend title XVIII of the Social TION ACT.—The Secretary shall apply the send to the desk. Security Act to make improvements in the provisions of chapter 35 of title 44, United The PRESIDENT pro tempore. With- national coverage determination process States Code (commonly known as the ‘‘Pa- out objection, it is so ordered. to respond to changes in technology) perwork Reduction Act’’) to the provisions of The amendment is as follows: this Act to ensure that any regulations At the end of subtitle C of title IV, add the (Purpose: To increase medicare payments for following: issued to implement this Act are written in home health services furnished in a rural plain language, are streamlined, promote the area) SEC. ll. IMPROVEMENTS IN NATIONAL COV- maximum efficiency and effectiveness of the ERAGE DETERMINATION PROCESS medicare and medicaid programs without At the appropriate place in subtitle C of TO RESPOND TO CHANGES IN TECH- harming beneficiaries or providers, and mini- title IV, insert the following: NOLOGY. mize the burdens the payment systems af- SEC. ll. INCREASE IN MEDICARE PAYMENT FOR (a) IN GENERAL.—Section 1862 (42 U.S.C. fected by this Act impose on both bene- CERTAIN HOME HEALTH SERVICES. 1395y) is amended— ficiaries and providers. (a) IN GENERAL.—Section 1895 of the Social (A) in the third sentence of subsection (a) If the Secretary determines that the two- Security Act (42 U.S.C. 1395fff) is amended by by inserting ‘‘consistent with subsection (j)’’ thirds reduction in words by October 1, 2004 adding at the end the following: after ‘‘the Secretary shall ensure’’; and required in (b)(1) is not feasible, he shall in- ‘‘(f) INCREASE IN PAYMENT FOR SERVICES (B) by adding at the end the following new form Congress in writing by July 1, 2004 of FURNISHED IN A RURAL AREA.— subsection: the reasons for its infeasibility. He shall ‘‘(1) IN GENERAL.—In the case of home ‘‘(j) NATIONAL COVERAGE DETERMINATION then establish a possible reduction to be health services furnished in a rural area (as PROCESS.— achieved by January 1, 2005. defined in section 1886(d)(2)(D)) on or after ‘‘(1) TIMEFRAME FOR DECISIONS ON REQUESTS VITIATION OF VOTE ON AMENDMENT NO. 1041 October 1, 2004 and before October 1, 2006, the FOR NATIONAL COVERAGE DETERMINATIONS.—In Mr. GRASSLEY. Mr. President, I ask Secretary shall increase the payment the case of a request for a national coverage amount otherwise made under this section determination that— unanimous consent to vitiate the vote for such services by 10 percent. by which amendment No. 1040 was ‘‘(A) does not require a technology assess- ‘‘(2) WAIVER OF BUDGET NEUTRALITY.—The ment from an outside entity or deliberation adopted. Secretary shall not reduce the standard pro- from the Medicare Coverage Advisory Com- Mr. BAUCUS. Amendment No. 1041. spective payment amount (or amounts) mittee, the decision on the request shall be Mr. GRASSLEY. I am sorry, No. 1041. under this section applicable to home health made not later than 6 months after the date The PRESIDING OFFICER. Without services furnished during any period to offset of the request; or objection, it is so ordered. the increase in payments resulting from the ‘‘(B) requires such an assessment or delib- AMENDMENT NO. 1096 application of paragraph (1).’’. eration and in which a clinical trial is not Mr. GRASSLEY. I ask unanimous (b) PAYMENT ADJUSTMENT.—Section requested, the decision on the request shall 1895(b)(5) of the Social Security Act (42 U.S. be made not later than 9 months after the consent that the pending amendment C. 1395fff(b)(5)) is amended by adding at the be temporarily set aside, amendment date of the request. end the following: ‘‘Notwithstanding this ‘‘(2) PROCESS FOR PUBLIC COMMENT IN NA- No. 1096 be called up, adopted, and the paragraph, the total amount of the addi- TIONAL COVERAGE DETERMINATIONS.—At the motion to reconsider be laid on the tional payments or payment adjustments end of the 6-month period (with respect to a table. made under this paragraph may not exceed, request under paragraph (1)(A)) or 9-month The PRESIDENT pro tempore. With- with respect to fiscal year 2004, 3 percent, period (with respect to a request under para- out objection, it is so ordered. and, with respect to fiscal years 2005 and graph (1)(B)) that begins on the date a re- The amendment (No. 1096) was agreed 2006, 4 percent, of the total payments pro- quest for a national coverage determination to, as follows: jected or estimated to be made based on the is made, the Secretary shall— prospective payment system under this sub- ‘‘(A) make a draft of proposed decision on (Purpose: To require the Secretary of Health section in the year involved.’’. and Human Services to conduct a frontier the request available to the public through (c) EFFECTIVE DATE.—The amendments the Medicare Internet site of the Department extended stay clinic demonstration made by this section shall apply to services project) of Health and Human Services or other ap- furnished on or after October 1, 2003. propriate means; On page 529, between lines 8 and 9, insert AMENDMENTS NOS. 1122, 1074, 1023, 1114, 1115, 1045, ‘‘(B) provide a 30-day period for public com- the following: 1058, 1117, 1044, 1056, 996, 1013, 1121, 989, AS MODI- ment on such draft; SEC. 455. FRONTIER EXTENDED STAY CLINIC FIED, 1126, 996, 1118, 1085, 1017, 968, 948, 960 AS ‘‘(C) make a final decision on the request DEMONSTRATION PROJECT. MODIFIED, 1054, AND 1030 within 60 days of the conclusion of the 30-day (a) AUTHORITY TO CONDUCT DEMONSTRATION period referred to under subparagraph (B); PROJECT.—The Secretary shall waive such Mr. GRASSLEY. Mr. President, I ask ‘‘(D) include in such final decision sum- provisions of the medicare program estab- unanimous consent that the pending maries of the public comments received and lished under title XVIII of the Social Secu- amendments be temporarily set aside responses thereto; rity Act (42 U.S.C. 1395 et seq.) as are nec- and that the following amendments be ‘‘(E) make available to the public the clin- essary to conduct a demonstration project called up en bloc: No. 1122, Brownback; ical evidence and other data used in making under which frontier extended stay clinics No. 1074, Coleman; No. 1023, Collins; No. such a decision when the decision differs described in subsection (b) in isolated rural 1114, Kyl; No. 1115, Kyl; No. 1045, Cham- from the recommendations of the Medicare areas are treated as providers of items and Coverage Advisory Committee; and services under the medicare program. bliss; No. 1058, Craig; No. 1117, Baucus; ‘‘(F) in the case of a decision to grant the (b) CLINICS DESCRIBED.—A frontier ex- No. 1044, Bayh; No. 1056, Shelby; No. tended stay clinic is described in this sub- 996, Reed of Rhode Island; Bond amend- coverage determination, assign a temporary section if the clinic— ment No. 1013; Kyl, No. 1128; Collins, or permanent code and implement the cov- (1) is located in a community where the erage decision at the end of the 60-day period No. 989, as modified; Dole, No. 1126, referred to in subparagraph (C). closest short-term acute care hospital or with Edwards added as a cosponsor; critical access hospital is at least 75 miles ‘‘(3) NATIONAL COVERAGE DETERMINATION Reed of Rhode Island, No. 996; Specter, DEFINED.—For purposes of this subsection, away from the community or is inaccessible No. 1118; Specter, No. 1085. by public road; and the term ‘national coverage determination’ (2) is designed to address the needs of— The PRESIDENT pro tempore. Is has the meaning given such term in section (A) seriously or critically ill or injured pa- there objection? 1869(f)(1)(B).’’. tients who, due to adverse weather condi- Mr. BAUCUS. Mr. President, this side (b) EFFECTIVE DATE.—The amendments tions or other reasons, cannot be transferred agrees. made by this section shall apply to national quickly to acute care referral centers; or The PRESIDENT pro tempore. Is coverage determinations as of January 1, (B) patients who need monitoring and ob- there objection? 2004. servation for a limited period of time. If not, the amendments will be con- AMENDMENT NO. 1023 (c) DEFINITIONS.—In this section, the terms sidered en bloc. ‘‘hospital’’ and ‘‘critical access hospital’’ (Purpose: To provide for the establishment of have the meanings given such terms in sub- The amendments are as follows: a demonstration project to clarify the defi- sections (e) and (mm), respectively, of sec- (Amendments Nos. 1122 and 1117 are nition of homebound) tion 1861 of the Social Security Act (42 printed in today’s RECORD under ‘‘Text At the appropriate place in subtitle B of U.S.C. 1395x). of Amendments.’’) title IV, insert the following:

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SEC. ll. DEMONSTRATION PROJECT TO CLAR- (h) CONSTRUCTION.—Nothing in this section and how much goes to benefit patients and IFY THE DEFINITION OF HOME- shall be construed as waiving any applicable health systems where parallel importing is BOUND. civil monetary penalty, criminal penalty, or significant; and (a) DEMONSTRATION PROJECT.—Not later other remedy available to the Secretary (8) How much cost is imposed on the owner than 180 days after the date of enactment of under title XI or title XVIII of the Social Se- of a property right from counterfeiting and this Act, the Secretary shall conduct a two- curity Act for acts prohibited under such ti- from international violation of intellectual year demonstration project under part B of tles, including penalties for false certifi- property rights for prescription medicines. title XVIII of the Social Security Act under cations for purposes of receipt of items or (B) REPORT.—Not later than 1 year after which medicare beneficiaries with chronic services under the medicare program. the date of enactment of this Act, the Comp- conditions described in subsection (b) are (i) AUTHORIZATION OF APPROPRIATIONS.— troller General of the United States shall deemed to be homebound for purposes of re- Payments for the costs of carrying out the submit to Congress a report on the study ceiving home health services under the medi- demonstration project under this section conducted under subsection (A). care program. shall be made from the Federal Supple- AMENDMENT NO. 1115 (b) MEDICARE BENEFICIARY DESCRIBED.—For mentary Insurance Trust Fund under section (Purpose: To express the sense of the Senate purposes of subsection (a), a medicare bene- 1841 of such Act (42 U.S.C. 1395t). ficiary is eligible to be deemed to be home- concerning Medicare payments to physi- (j) DEFINITIONS.—In this section: cians and other health professionals) bound, without regard to the purpose, fre- (1) MEDICARE BENEFICIARY.—The term quency, or duration of absences from the ‘‘medicare beneficiary’’ means an individual At the appropriate place, insert the fol- home, if the beneficiary— who is enrolled under part B of title XVIII of lowing: (1) has been certified by one physician as the Social Security Act. SEC. . SENSE OF THE SENATE CONCERNING MEDICARE PAYMENT UPDATE FOR an individual who has a permanent and se- (2) HOME HEALTH SERVICES.—The term vere condition that will not improve; PHYSICIANS AND OTHER HEALTH ‘‘home health services’’ has the meaning PROFESSIONALS. (2) requires the individual to receive assist- given such term in section 1861(m) of the So- ance from another individual with at least 3 (a) FINDINGS.—The Senate makes the fol- cial Security Act (42 U.S.C. 1395x(m)). lowing findings: out of the 5 activities of daily living for the (3) ACTIVITIES OF DAILY LIVING DEFINED.— rest of the individual’s life; (1) The formula by which Medicare pay- The term ‘‘activities of daily living’’ means ments are updated each year for services fur- (3) requires 1 or more home health services eating, toileting, transferring, bathing, and to achieve a functional condition that gives nished by physicians and other health profes- dressing. sionals is fundamentally flawed. the individual the ability to leave home; and (4) SECRETARY.—The term ‘‘Secretary’’ (4) requires technological assistance or the (2) The flawed physician payment update means the Secretary of Health and Human formula is causing a continuing physician assistance of another person to leave the Services. home. payment crisis, and, without Congressional AMENDMENT NO. 1114 (c) DEMONSTRATION PROJECT SITES.—The action, Medicare payment rates for physi- demonstration project established under this (Purpose: To require the GAO to study the cians and other practitioners are predicted section shall be conducted in 3 States se- impact of price controls on pharmaceuticals) to fall by 4.2 percent in 2004. lected by the Secretary to represent the At the appropriate place, insert the fol- (3) A physician payment cut in 2004 would Northeast, Midwest, and Western regions of lowing: be the fifth cut since 1991, and would be on the United States. top of a 5.4 percent cut in 2002, with addi- SEC. . GAO STUDY OF PHARMACEUTICAL PRICE tional cuts estimated for 2005, 2006, and 2007; (d) LIMITATION ON NUMBER OF PARTICI- CONTROLS AND PATENT PROTEC- PANTS.—The aggregate number of such bene- TIONS IN THE G–7 COUNTRIES. from 1991–2003, payment rates for physicians ficiaries that may participate in the project (A) STUDY.—The Comptroller General of and health professionals fell 14 percent be- may not exceed 15,000. the United States shall conduct a study of hind practice cost inflation as measured by (e) DATA.—The Secretary shall collect such price controls imposed on pharmaceuticals Medicare’s own conservative estimates. data on the demonstration project with re- in France, Germany, Italy, Japan, the (4) The sustainable growth rate (SGR) ex- spect to the provision of home health serv- United Kingdom and Canada to review the penditure target, which is the basis for the ices to medicare beneficiaries that relates to impact such regulations have on consumers, physician payment update, is linked to the quality of care, patient outcomes, and addi- including American consumers, and on inno- gross domestic product and penalizes physi- tional costs, if any, to the medicare pro- vation in medicine. Such study shall in- cians and other practitioners for volume in- gram. clude— creases that they cannot control and that (f) REPORT TO CONGRESS.—Not later than 1 (1) The pharmaceutical price control struc- the government actively promotes through year after the date of the completion of the ture in each country for a wide range of new coverage decisions, quality improve- demonstration project under this section, pharmaceuticals, compared with average ment activities and other initiatives that, the Secretary shall submit to Congress a re- pharmaceutical prices paid by Americans while beneficial to patients, are not reflected port on the project using the data collected covered by private sector health insurance; in the SGR. under subsection (e) and shall include— (2) The proportion of the costs for innova- (b) SENSE OF THE SENATE.—It is the Sense (1) an examination of whether the provi- tion borne by American consumers, com- of the Senate that Medicare beneficiary ac- sion of home health services to medicare pared with consumers in the other six coun- cess to quality care may be compromised if beneficiaries under the project— tries; Congress does not take action to prevent (A) adversely effects the provision of home (3) A review of how closely the observed cuts next year and the following that result health services under the medicare program; prices in regulated markets correspond to from the SGR formula. or the prices that efficiently distribute com- AMENDMENT NO. 1045 (B) directly causes an unreasonable in- mon costs of production (‘‘Ramsey prices’’); (Purpose: To provide for a demonstration crease of expenditures under the medicare (4) A review of any peer-reviewed literature project for the exclusion of brachytherapy program for the provision of such services that might show the health consequences to devices from the prospective payment sys- that is directly attributable to such clari- patients in the listed countries that result tem for outpatient hospital services) fication; from the absence or delayed introduction of At the end of subtitle B of title IV, add the (2) the specific data evidencing the amount medicines, including the cost of not having following: of any increase in expenditures that is a di- access to medicines, in terms of lower life SEC. ll. DEMONSTRATION PROJECT FOR EX- rectly attributable to the demonstration expectancy and lower quality of health; CLUSION OF BRACHYTHERAPY DE- project (expressed both in absolute dollar (5) The impact on American consumers, in VICES FROM PROSPECTIVE PAY- terms and as a percentage) above expendi- terms of reduced research into new or im- MENT SYSTEM FOR OUTPATIENT tures that would otherwise have been in- proved pharmaceuticals (including the cost HOSPITAL SERVICES. curred for home health services under the of delaying the introduction of a significant (a) DEMONSTRATION PROJECT.—The Sec- medicare program; and advance in certain major diseases), if similar retary shall conduct a demonstration project (3) specific recommendations to exempt price controls were adopted in the United under part B of title XVIII of the Social Se- permanently and severely disabled home- States; curity Act under which brachytherapy de- bound beneficiaries from restrictions on the (6) The existing standards under inter- vices shall be excluded from the prospective length, frequency and purpose of their ab- national conventions, including the World payment system for outpatient hospital sences from the home to qualify for home Trade Organization and the North American services under the medicare program and, health services without incurring additional Free Trade Agreement, regarding regulated notwithstanding section 1833(t) of the Social unreasonable costs to the medicare program. pharmaceutical prices, including any restric- Security Act (42 U.S.C. 1395l(t)), the amount (g) WAIVER AUTHORITY.—The Secretary tions on anti-competitive laws that might of payment for a device of brachytherapy shall waive compliance with the require- apply to price regulations and how economic furnished under the demonstration project ments of title XVIII of the Social Security harm caused to consumers in markets with- shall be equal to the hospital’s charges for Act (42 U.S.C. 1395 et seq.) to such extent and out price regulations may be remedied; each device furnished, adjusted to cost. for such period as the Secretary determines (7) In parallel trade regimes, how much of (b) SPECIFICATION OF GROUPS FOR is necessary to conduct demonstration the price difference between countries in the BRACHYTHERAPY DEVICES.—The Secretary projects. European Union is captured by middlemen shall create additional groups of covered

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00036 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8683 OPD services that classify devices of (ii) were issued to the Trust Fund and were SEC. ll. COMMITTEE ON DRUG COMPOUNDING. brachytherapy furnished under the dem- redeemed by reason of the clerical error; and (a) ESTABLISHMENT.—The Secretary of onstration project separately from the other (B) redeem from the Trust Fund obliga- Health and Human Services shall establish services (or group of services) paid for under tions that would have been redeemed from an Committee on Drug Compounding (re- section 1833(t) of the Social Security Act (42 the Trust Fund if the clerical error had not ferred to in this section as the ‘‘Committee’’) U.S.C. 1395l(t)) in a manner reflecting the occurred. within the Food and Drug Administration on number, isotope, and radioactive intensity of (c) APPROPRIATION.—Not later than 120 drug compounding to ensure that patients such devices furnished, including separate days after the date of enactment of this Act, are receiving necessary, safe and accurate groups for palladium–103 and iodine–125 de- there is appropriated to the Trust Fund, out dosages of compounded drugs. vices. of any money in the Treasury not otherwise (b) MEMBERSHIP.—The membership of the (c) DURATION.—The Secretary shall con- appropriated, an amount determined by the Advisory Committee shall be appointed by duct the demonstration project under this Secretary of the Treasury, in consultation the Secretary of Health and Human Services section for the 3-year period beginning on with the Secretary of Health and Human and shall include representatives of— the date that is 90 days after the date of en- Services, to be equal to the interest income (1) the National Association of Boards of actment of this Act. lost by the Trust Fund through the date on Pharmacy; (d) REPORT.—Not later than January 1, which the appropriation is being made as a (2) pharmacy groups; 2007, the Secretary shall submit to Congress result of the clerical error. (3) physician groups; a report on the demonstration project con- (4) consumer and patient advocate groups; ducted under this section. The report shall AMENDMENT NO. 1044 (5) the United States Pharmacopoeia; and include an evaluation of patient outcomes (Purpose: To adjust the urban health (6) other individuals determined appro- under the demonstration project, as well as provider payment) priate by the Secretary. an analysis of the cost effectiveness of the At the appropriate place, insert the fol- (c) REPORT AND RECOMMENDATIONS.—Not demonstration project. lowing: later than 1 year after the date of enactment (e) WAIVER AUTHORITY.—The Secretary of this Act, the Committee shall submit to shall waive compliance with the require- SEC. ll. URBAN HEALTH PROVIDER ADJUST- MENT. the Secretary a report concerning the rec- ments of title XVIII of the Social Security ommendations of the Committee to improve Act to such extent and for such period as the (a) IN GENERAL.—Beginning with fiscal year 2004, notwithstanding section 1923(f) of and protect patient safety. Secretary determines is necessary to con- (d) TERMINATION.—The Committee shall duct the demonstration project under this the Social Security Act (42 U.S.C. 1396r–4(f)) and subject to subsection (c), with respect to terminate on the date that is 1 year after the section. date of enactment of this Act. (f) FUNDING.— a State, payment adjustments made under AMENDMENT NO. 1121 (1) IN GENERAL.—The Secretary shall pro- title XIX of the Social Security Act (42 vide for the transfer from the Federal Sup- U.S.C. 1396 et seq.) to a hospital described in (Purpose: To express the sense of the Senate plementary Insurance Trust Fund estab- subsection (b) shall be made without regard concerning the structure of Medicare re- lished under section 1841 of the Social Secu- to the DSH allotment limitation for the form and the prescription drug benefit to rity Act (42 U.S.C. 1395t) of such funds as are State determined under section 1923(f) of ensure Medicare’s long-term solvency and necessary for the costs of carrying out the that Act (42 U.S.C. 1396r–4(f)). high quality of care) demonstration project under this section. (b) HOSPITAL DESCRIBED.—A hospital is de- At the appropriate place, insert the fol- (2) BUDGET NEUTRALITY.—In conducting the scribed in this subsection if the hospital— lowing: demonstration project under this section, (1) is owned or operated by a State (as de- SEC. . SENSE OF THE SENATE CONCERNING THE the Secretary shall ensure that the aggre- fined for purposes of title XIX of the Social STRUCTURE OF MEDICARE REFORM gate payments made by the Secretary do not Security Act), or by an instrumentality or a AND THE PRESCRIPTION DRUG BEN- EFIT. exceed the amount which the Secretary municipal governmental unit within a State (a) FINDINGS.—The Senate makes the fol- would have paid if the demonstration project (as so defined) as of January 1, 2003; and (2) is located in Marion County, Indiana. lowing findings: under this section was not implemented. (1) America’s seniors deserve a fiscally- (c) LIMITATION.—The payment adjustment AMENDMENT NO. 1058 described in subsection (a) for fiscal year 2004 strong Medicare system that fulfills its (Purpose: To restore the Federal Hospital In- promise to them and future retirees. and each fiscal year thereafter shall not ex- surance Trust Fund to the financial posi- (2) The impending retirement of the ‘‘baby ceed 175 percent of the costs of furnishing tion it would have been in if a clerical boom’’ generation will dramatically increase hospital services described in section bookkeeping error had not occurred) the costs of providing Medicare benefits. 1923(g)(1)(A) of the Social Security Act (42 Medicare costs will double relative to the At the appropriate place in title VI, insert U.S.C. 1396r–4(g)(1)(A)). the following: size of the economy from 2 percent of GDP AMENDMENT NO. 1056 SEC. ll. RESTORATION OF FEDERAL HOSPITAL today to 4 percent in 2025 and double again to INSURANCE TRUST FUND. (Purpose: To prevent the Secretary of Health 8 percent of GDP in 2075. This growth will ac- (a) DEFINITIONS.—In this section: and Human Services from modifying the celerate substantially when Congress adds a (1) CLERICAL ERROR.—The term ‘‘clerical treatment of certain long-term care hos- necessary prescription drug benefit. error’’ means the failure that occurred on pitals as subsection (d) hospitals) (3) Medicare’s current structure does not have the flexibility to quickly adapt to rapid April 15, 2001, to have transferred the correct At the end of subtitle A of title IV, add the advances in modern health care. Medicare amount from the general fund of the Treas- following: ury to the Trust Fund. lags far behind other insurers in providing SEC. ll. TREATMENT OF GRANDFATHERED prescription drug coverage, disease manage- (2) TRUST FUND.—The term ‘‘Trust Fund’’ LONG-TERM CARE HOSPITALS. means the Federal Hospital Insurance Trust ment programs, and host of other advances. (a) IN GENERAL.—The last sentence of sec- Reforming Medicare to create a more self-ad- Fund established under section 1817 of the tion 1886(d)(1)(B) is amended by inserting ‘‘, Social Security Act (42 U.S.C. 1395i). justing, innovative structure is essential to and the Secretary may not impose any spe- improve Medicare’s efficiency and the qual- (b) CORRECTION OF TRUST FUND HOLDINGS.— cial conditions on the operation, size, num- (1) IN GENERAL.—Not later than 120 days ity of the medical care it provides. ber of beds, or location of any hospital so (4) Private-sector choice for Medicare after the date of enactment of this Act, the classified for continued participation under beneficiaries would provide two key benefits: Secretary of the Treasury shall take the ac- this title or title XIX or for continued classi- it would be tailored to the needs of Amer- tions described in paragraph (2) with respect fication as a hospital described in clause ica’s seniors, not the government, and would to the Trust Fund with the goal being that, (iv)’’ before the period at the end. create a powerful incentive for private-sec- after such actions are taken, the holdings of (b) TREATMENT OF PROPOSED REVISION.— tor Medicare plans to provide the best qual- the Trust Fund will replicate, to the extent The Secretary shall not adopt the proposed ity health care to seniors at the most afford- practicable in the judgment of the Secretary revision to section 412.22(f) of title 42, Code able price. of the Treasury, in consultation with the of Federal Regulations contained in 68 Fed- (5) The method by which the national pre- Secretary of Health and Human Services, the eral Register 27154 (May 19, 2003) or any revi- ferred provider organizations in the Federal holdings that would have been held by the sion reaching the same or substantially the Employees Health Benefits Program have Trust Fund if the clerical error had not oc- same result as such revision. been reimbursed has proven to be a reliable curred. (c) EFFECTIVE DATE.—The amendment and successful mechanism for providing (2) OBLIGATIONS ISSUED AND REDEEMED.— made by, and provisions of, this section shall Members of Congress and federal employees The Secretary of the Treasury shall— apply to cost reporting periods ending on or with excellent health care choices. (A) issue to the Trust Fund obligations after December 31, 2002. (6) Unlike the Medicare payment system, under chapter 31 of title 31, United States AMENDMENT NO. 1013 which has had to be changed by Congress Code, that bear issue dates, interest rates, every few years, the Federal Employees and maturity dates that are the same as (Purpose: To ensure that patients are receiv- Health Benefits Program has existed for 43 those for the obligations that— ing safe and accurate dosages of com- years with minimal changes from Congress. (i) would have been issued to the Trust pounded drugs) (b) SENSE OF THE SENATE.—It is the Sense Fund if the clerical error had not occurred; At the appropriate place, insert the fol- of the Senate that Medicare reform legisla- or lowing: tion should:

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00037 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8684 CONGRESSIONAL RECORD — SENATE June 26, 2003 (1) Ensure that prescription drug coverage SEC. ll. TREATMENT OF CERTAIN ENTITIES ‘‘(8) an evaluation of the effect of the ad- is directed to those who need it most. FOR PURPOSES OF PAYMENTS justment described in paragraph (7) on physi- (2) Provide that government contributions UNDER THE MEDICARE PROGRAM. cian location and retention in higher than used to support Medicare Advantage plans (a) PAYMENTS TO HOSPITALS.— average cost-of-living areas, taking into ac- are based on market principles beginning in (1) IN GENERAL.—Notwithstanding any count difference in recruitment costs and re- 2006 to ensure the long and short term viabil- other provision of law, effective for dis- tention rates for physicians, including spe- ity of such options for America’s seniors. charges occurring on or after October 1, 2003, cialists; and (3) Develop a payment system for the Medi- for purposes of making payments to hos- ‘‘(9) an evaluation of the appropriateness of pitals (as defined in section 1886(d) and care Advantage preferred provider organiza- the 1⁄4 adjustment for the work geographic tions similar to the payment system used for 1833(t) of the Social Security Act (42 U.S.C. practice cost index.’’. 1395(d)) under the medicare program under the national preferred provider organizations AMENDMENT NO. 1118 in the Federal Employees Health Benefits title XVIII of such Act (42 U.S.C. 1395 et (Purpose: To express the sense of the Senate Program. seq.), Iredell County, North Carolina, and (4) Limit the addition of new unfunded ob- Rowan County, North Carolina, are deemed regarding the establishment of a nation- ligations in the Medicare program so that to be located in the Charlotte-Gastonia-Rock wide permanent lifestyle modification pro- the long-term solvency of this important Hill, North Carolina, South Carolina Metro- gram for Medicare beneficiaries) program is not further jeopardized. politan Statistical Area. At the end of title VI, insert the following: (5) Incorporate private sector, market- (2) BUDGET NEUTRAL WITHIN NORTH CARO- SEC. ll. SENSE OF THE SENATE REGARDING based elements, that do not rely on the inef- LINA.—The Secretary shall adjust the area THE ESTABLISHMENT OF A NATION- ficient Medicare price control structure. wage index referred to in paragraph (1) with WIDE PERMANENT LIFESTYLE MODI- (6) Keep the cost of structural changes and respect to payments to hospitals located in FICATION PROGRAM FOR MEDICARE new benefits within the $400 billion provided North Carolina in a manner which assures BENEFICIARIES. for under the current Congressional Budget that the total payments made under section (a) FINDINGS.—Congress finds that: Resolution for implementing Medicare re- 1886(d) of the Social Security Act (42 U.S.C., (1) Heart disease kills more than 500,000 form and providing a prescription drug ben- 1395(ww)(d)) in a fiscal year for the operating Americans per year. efit. cost of inpatient hospital services are not (2) The number and costs of interventions (7) Preserve the current employer-spon- greater or less than the total of such pay- for the treatment of coronary disease are ris- sored retiree health plans and not design a ments that would have been made in the ing and currently cost the health care sys- benefit which has the unintended con- year if this subsection had not been enacted. tem $58,000,000,000 annually. sequences of supplanting private coverage. (b) PAYMENTS TO SKILLED NURSING FACILI- (3) The Medicare Lifestyle Modification (8) Incorporate regulatory reform proposals TIES AND HOME HEALTH AGENCIES.— Program has been operating throughout 12 to eliminate red tape and reduce costs. (1) IN GENERAL.—Notwithstanding any States and has been demonstrated to reduce (9) Restore the right of Medicare bene- other provision of law, effective beginning the need for coronary procedures by 88 per- ficiaries and their doctors to work together October 1, 2003, for purposes of making pay- cent per year. to provide services, allow private fee for ments to skilled nursing facilities (SNFs) (4) The Medicare Lifestyle Modification service plans to set their own premiums, and and home health agencies (as defined in sec- Program is less expensive to deliver than permit seniors to add their own dollars be- tions 1861(j) and 1861(o) of the Social Secu- interventional cardiac procedures and could yond the government contribution. rity Act (42 U.S.C. 1395x(j); 1395x(o)) under reduce cardiovascular expenditures by AMENDMENT NO. 989, AS MODIFIED the medicare program under title XVIII of $36,000,000,000 annually. (5) Lifestyle choices such as diet and exer- (Purpose: To increase medicare payments for such Act, Iredell County, North Carolina, cise affect heart disease and heart disease home health services furnished in a rural and Rowan County, North Carolina, are outcomes by 50 percent or greater. area) deemed to be located in the Charlotte-Gas- tonia-Rock Hill, North Carolina, South Caro- (6) Intensive lifestyle interventions which At the appropriate place in subtitle C of include teams of nurses, doctors, exercise title IV, insert the following: lina Metropolitan Statistical Area. (2) APPLICATION AND BUDGET NEUTRAL physiologists, registered dietitians, and be- SEC. ll. INCREASE IN MEDICARE PAYMENT FOR havioral health clinicians have been dem- CERTAIN HOME HEALTH SERVICES. WITHIN NORTH CAROLINA.—Effective for fiscal year 2004, the skilled nursing facility PPS onstrated to reduce heart disease risk fac- (a) IN GENERAL.—Section 1895 of the Social tors and enhance heart disease outcomes Security Act (42 U.S.C. 1395fff) is amended by and home health PPS rates for Iredell Coun- ty, North Carolina, and Rowan County, dramatically. adding at the end the following: (7) The National Institutes of Health esti- ‘‘(f) INCREASE IN PAYMENT FOR SERVICES North Carolina, will be updated by the mates that 17,000,000 Americans have diabe- FURNISHED IN A RURAL AREA.— prefloor, prereclassified hospital wage index tes and the Centers for Disease Control and ‘‘(1) IN GENERAL.—In the case of home available for the Charlotte-Gastonia-Rock Prevention estimates that the number of health services furnished in a rural area (as Hill, North Carolina, South Carolina Metro- Americans who have a diagnosis of diabetes defined in section 1886(d)(2)(D)) on or after politan Statistical Area. This subsection increased 61 percent in the last decade and is October 1, 2004 and before October 1, 2006, the shall be implemented in a budget neutral expected to more than double by 2050. Secretary shall increase the payment manner, using a methodology that ensures (8) Lifestyle modification programs are su- amount otherwise made under this section that the total amount of expenditures for perior to medication therapy for treating di- for such services by 10 percent. skilled nursing facility services and home abetes. ‘‘(2) WAIVER OF BUDGET NEUTRALITY.—The health services in a year does not exceed the (9) Individuals with diabetes are now con- Secretary shall not reduce the standard pro- total amount of expenditures that would sidered to have coronary disease at the date spective payment amount (or amounts) have been made in the year if this subsection of diagnosis of their diabetic state. under this section applicable to home health had not been enacted. Required adjustments (10) The Medicare Lifestyle Modification services furnished during any period to offset by reason of the preceding sentence shall be Program has been an effective lifestyle pro- the increase in payments resulting from the done with respect to skilled nursing facili- gram for the reversal and treatment of heart application of paragraph (1).’’. ties and home health agencies located in disease. (b) PAYMENT ADJUSTMENT.—Section North Carolina. (11) Men with prostate cancer have shown 1895(b)(5) of the Social Security Act (42 U.S. (c) CONSTRUCTION.—The provisions of this significant improvement in prostate cancer C. 1395fff(b)(5)) is amended by adding at the section shall have no effect on the amount of markers using a similar approach in lifestyle end the following:‘‘Notwithstanding this payments made under title XVIII of the So- modification. paragraph, the total amount of the addi- cial Security Act to entities located in (12) These lifestyle changes are therefore tional payments or payment adjustments States other than North Carolina. likely to affect other chronic disease states, made under this paragraph may not exceed, AMENDMENT NO. 996 in addition to heart disease. with respect to fiscal year 2004, 3 percent, (Purpose: To modify the GAO study of geo- (b) SENSE OF THE SENATE.—It is the sense and, with respect to fiscal years 2005 and graphic differences in payments for physi- of the Senate that— 2006, 4 percent, of the total payments pro- cians’ services relating to the work geo- (1) the Secretary of Health and Human jected or estimated to be made based on the graphic practice cost index) Services should carry out the demonstration prospective payment system under this sub- In section 445(a) of the bill, strike para- project known as the Lifestyle Modification section in the year involved.’’. graph (6) and insert the following: Program Demonstration, as described in the (c) EFFECTIVE DATE.—The amendments made by this section shall apply to services ‘‘(6) an evaluation of the appropriateness of Health Care Financing Administration furnished on or after October 1, 2003. extending such adjustment or making such Memorandum of Understanding entered into adjustment permanent; on November 13, 2000, on a permanent basis; AMENDMENT NO. 1126 ‘‘(7) an evaluation of the adjustment of the (2) the project should include as many (Purpose: To provide for the treatment of work geographic practice cost index required Medicare beneficiaries as would like to par- certain entities for purposes of payments under section 1848(e)(1)(A)(iii) of the Social ticipate in the project on a voluntary basis; under the medicare program) Security Act (42 U.S.C. 1395w-4(e)(1)(A)(iii)) and At the end of subtitle A of title IV, add the to reflect 1⁄4 of the area cost difference in (3) the project should be conducted on a na- following: physician work; tional basis.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00038 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8685 AMENDMENT NO. 1085 multi-year adjustments to recoup the vari- Carolina, Senator HOLLINGS, about the (Purpose: To express the sense of the Senate ance and creating ‘‘tolerance’’ corridors for passing of Senator Thurmond. This is regarding payment reductions under the variations around the update target trend. something I really don’t know how to Medicare physician fee schedule) AMENDMENT NO. 960 put in words. All of us from South At the end of title VI, insert the following: (Purpose: To Require a Streamlining of the Carolina knew Senator Thurmond in so SEC. ll. SENSE OF THE SENATE ON PAYMENT Medicare Regulations) many ways. But his colleagues in this REDUCTIONS UNDER MEDICARE At the end of subtitle A of title V, add the body, the vast majority of you, have PHYSICIAN FEE SCHEDULE. following: (a) FINDINGS.—Congress finds that— served with him for many years. You SEC. ll. STREAMLINING AND SIMPLIFICATION have great admiration and fondness for (1) the fees Medicare pays physicians were OF MEDICARE REGULATIONS. reduced by 5.4 percent across-the-board in Senator Thurmond but I stand before (a) IN GENERAL.—The Secretary of Health 2002; and Human Services shall conduct an anal- you as his successor. I often state back (2) recent action by Congress narrowly ysis of the regulations issued under title home that we change Senators every 50 averted another across-the-board reduction XVIII of the Social Security Act and related years and that so many people have of 4.4 percent for 2003; laws in order to determine how such regula- been waiting to take Senator Thur- (3) based on current projections, the Cen- tions may be streamlined and simplified to ters for Medicare & Medicaid Services (CMS) mond’s place. The jokes just go on and increase the efficiency and effectiveness of estimates that, absent legislative or admin- on about what a rich life he has lived. the medicare program without harming istrative action, fees will be reduced across- Tonight his family is mourning his beneficiaries or providers and to decrease the the-board once again in 2004 by 4.2 percent; passing. Whether a person lives to be burdens the medicare payment systems im- (4) the prospect of continued payment re- 100 or 200, it is difficult to lose your fa- pose on both beneficiaries and providers. ductions under the Medicare physician fee (b) REDUCTION IN REGULATIONS.—The Sec- ther. If you lose someone you love, it is schedule for the foreseeable future threatens retary, after completion of the analysis always difficult. But when you think to destabilize an important element of the under subsection (a), shall direct the rewrit- about Senator Thurmond, you always program, namely physician participation ing of the regulations described in subsection have a smile on your face. and willingness to accept Medicare patients; (a) in such a manner as to— He lived a rich life. He lived at times (5) the primary source of this instability is (1) reduce the number of words comprising a controversial life. But the biggest the sustainable growth rate (SGR), a system all regulations by at least two-thirds by Oc- of annual spending targets for physicians’ testament I can give to Senator Thur- tober 1, 2004, and mond is that he changed. He changed services under Medicare; (2) ensure the simple, effective, and effi- (6) the SGR system has a number of defects cient operation of the medicare program. with the times. that result in unrealistically low spending (c) APPLICATION OF THE PAPERWORK REDUC- Those of you who embraced him dur- targets, such as the use of the increase in the TION ACT.—The Secretary shall apply the ing difficult times your love was much gross domestic product (GDP) as a proxy for provisions of chapter 35 of title 44, United appreciated. Recently people have tried increases in the volume and intensity of States Code (commonly known as the ‘‘Pa- to freeze Senator Thurmond in time services provided by physicians, no tolerance perwork Reduction Act’’) to the provisions of for variance between growth in Medicare which is unfair to him or anyone else. this Act to ensure that any regulations Those who knew him best understood beneficiary health care costs and our Na- issued to implement this Act are written in tion’s GDP, and a requirement for immediate that he changed with the times. And plain language, are streamlined, promote the his legacy in my State across party recoupment of the difference; maximum efficiency and effectiveness of the (7) both administrative and legislative ac- medicare and medicaid programs without lines, across racial lines, and across re- tion are needed to return stability to the harming beneficiaries or providers, and mini- gional lines was that he was the go-to physician payment system; mize the burdens the payment systems af- guy. If you had a problem with your (8) using the discretion given to it by Medi- fected by this Act impose on both bene- family or with your business, the first care law, CMS has included expenditures for ficiaries and providers. If the Secretary de- prescription drugs and biologicals adminis- thought in your mind, if the Govern- termines that the two-thirds reduction in ment was involved, or if somebody was tered incident to physicians’ services under words by October 1, 2004 required in (B)(1) is the annual spending targets without making treating you unfairly, was get on the not feasible, he shall inform Congress in phone and call Senator Thurmond. You appropriate adjustments to the targets to re- writing by July 1, 2004 of the reasons for its flect price increases in these drugs and unfeasibility. He shall then establish a fea- would get a phone call back, and he biologicals or the growing reliance on such sible reduction to be received by January 1, would go to bat for you. Whether you therapies in the treatment of Medicare pa- 2005. owned the company, or you were the tients; Mr. GRASSLEY. I ask unanimous janitor, whether you were black, white, (9) between 1996 and 2002, annual Medicare spending on these drugs grew from consent that these amendments and rich or poor, his office and he as a per- $1,800,000,000 to $6,200,000,000, or from $55 per the following pending amendments be son had a reputation of going to bat for beneficiary to an estimated $187 per bene- adopted en bloc and that the motion to individuals. To me, that is his greatest ficiary; reconsider be laid upon the table: legacy. (10) although physicians are responsible for Amendment No. 1017, Allard; No. 968, I stand before you as his successor— prescribing these drugs and biologicals, nei- Harkin; No. 948, Graham of South Caro- but not only that, as his friend. He em- ther the price of the drugs and biologicals, lina; No. 960, Dayton; No. 1054, Fein- braced my campaign in 1995. He came nor the standards of care that encourage gold; No. 1030, Enzi. to campaign for me when he was 93 their use, are within the control of physi- years of age. And I was worried to cians; and The PRESIDENT pro tempore. Is (11) SGR target adjustments have not been there objection? death about if he could make it made for cost increases due to new coverage Without objection, it is so ordered. through the day. Three days later I was decisions and new rules and regulations. The amendments were agreed to. glad to see him leave because he about (b) SENSE OF THE SENATE.—It is the sense Mr. GRASSLEY. Thank you. I sug- killed me. of the Senate that— gest the absence of a quorum. He had enthusiasm and passion like (1) the Center for Medicare & Medicaid The PRESIDENT pro tempore. The no one I have ever met in my life. He Services (CMS) should use its discretion to clerk will call the roll. did things he didn’t have to do. He was exclude drugs and biologicals administered a sitting judge in South Carolina in his incident to physician services from the sus- The legislative clerk proceeded to tainable growth rate (SGR) system; call the roll. 40s. He left the judgeship to go volun- (2) CMS should use its discretion to make Mr. GRAHAM of South Carolina. Mr. teer for the Army. He landed in a glider SGR target adjustments for new coverage de- President, I ask unanimous consent on D-Day, he was shot up, the pilot was cisions and new rules and regulations; and that the order for the quorum call be killed, and he fought the Germans (3) in order to provide ample time for Con- rescinded. until they quit, and then he went over gress to consider more fundamental changes The PRESIDENT pro tempore. With- to Japan and fought until they quit. to the SGR system, the conferees on the Pre- out objection, it is so ordered. This man, your friend, my friend, scription Drug and Medicare Improvement f South Carolina’s favorite son, is gone Act of 2003 should include in the conference but he will never be forgotten. His big- agreement a provision to establish a min- STROM THURMOND imum percentage update in physician fees gest legacy is in the small things he for the next 2 years and should consider add- Mr. GRAHAM of South Carolina. Mr. did—not the large things he did. There ing provisions that would mitigate the President, I rise to make a brief state- are so many large things he accom- swings in payment, such as establishing ment, like my colleague from South plished. But he lives on in families.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00039 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8686 CONGRESSIONAL RECORD — SENATE June 26, 2003 Great relationships were established, Mr. REID. I announce that the Sen- The amendment (No. 1060), as modi- and good constituent service. He won ator from Massachusetts (Mr. KERRY) fied, was rejected. his last election by getting more Afri- and the Senator from Connecticut (Mr. Mr. BAUCUS. I move to reconsider can-American votes than any Repub- LIEBERMAN) are necessarily absent. the vote. lican in the South. I further announce that, if present Mr. REID. I move to lay that motion All I can say about Senator Thur- and voting, the Senator from Massa- on the table. mond is that we pray for his family, we chusetts (Mr. KERRY) would vote The motion to lay on the table was mourn his loss, but we thank God that ‘‘yea.’’ agreed to. He provided us a great public servant. The PRESIDENT pro tempore. Are The PRESIDENT pro tempore. The Well done, Senator Thurmond. there any other Senators in the Cham- Senator from Iowa. Thank you, Mr. President. ber desiring to vote? Mr. GRASSLEY. Mr. President, I Mr. NICKLES. Mr. President, I sug- The result was announced—yeas 38, have a unanimous consent request to gest the absence of a quorum. nays 59, as follows: correct a previous unanimous consent request. In a previous unanimous con- The PRESIDENT pro tempore. The [Rollcall Vote No. 261 Leg.] sent request, I referred to amendment clerk will call the roll. YEAS—38 The legislative clerk proceeded to No. 990 when I meant to refer to the Akaka Edwards Murray previously adopted Murray amendment call the roll. Baucus Grassley Nelson (FL) Mr. FRIST. Mr. President, I ask Bayh Harkin Nelson (NE) No. 961. unanimous consent that the order for Bingaman Hollings Pryor I ask unanimous consent to make Boxer Inouye the quorum call be rescinded. Reed that change. Breaux Johnson Reid I referred to the Kyl amendment No. The PRESIDENT pro tempore. With- Byrd Kennedy Rockefeller 1128 when I meant to refer to Kyl out objection, it is so ordered. Cantwell Lautenberg Sarbanes Clinton Leahy Schumer amendment No. 1121. f Corzine Levin Snowe I also ask unanimous consent to Daschle Lincoln Specter make that change. EXECUTIVE SESSION Dorgan Mikulski Durbin Miller Stabenow The PRESIDENT pro tempore. Is there objection? Without objection, it EXECUTIVE CALENDAR NAYS—59 is so ordered. Alexander Dayton Landrieu Mr. FRIST. Mr. President, I ask Mr. BAUCUS. Mr. President, I sug- Allard DeWine Lott gest the absence of a quorum. unanimous consent that the Senate im- Allen Dodd Lugar The PRESIDENT pro tempore. The mediately proceed to executive session Bennett Dole McCain Biden Domenici clerk will call the roll. to consider the following nomination McConnell Bond Ensign Murkowski The legislative clerk proceeded to on today’s executive calendar: Brownback Enzi Nickles call the roll. Calendar No. 252, the nomination of Bunning Feingold Roberts Burns Feinstein Mr. GRASSLEY. Mr. President, I ask Santorum Joshua Bolten to be Director of the Of- Campbell Fitzgerald Sessions unanimous consent that the order for fice of Management and Budget. I fur- Carper Frist Shelby the quorum call be rescinded. ther ask unanimous consent that the Chafee Graham (FL) Smith The PRESIDENT pro tempore. With- nomination be confirmed, the motion Chambliss Graham (SC) Cochran Gregg Stevens out objection, it is so ordered. to reconsider be laid upon the table, Sununu Coleman Hagel AMENDMENT NO. 1133 the President be immediately notified Collins Hatch Talent Conrad Hutchison Thomas Mr. GRASSLEY. Mr. President, I of the Senate’s action, and the Senate send an amendment to the desk. then return to legislative session. Cornyn Jeffords Voinovich Craig Kohl Warner The PRESIDENT pro tempore. The The PRESIDENT pro tempore. Is Crapo Kyl Wyden clerk will report. there objection? Without objection, it NOT VOTING—3 The assistant legislative clerk read is so ordered. as follows: The nomination was considered and Inhofe Kerry Lieberman The Senator from Iowa [Mr. GRASSLEY] confirmed. The motion was rejected. proposes an amendment numbered 1133. Mr. BAUCUS. Mr. President, I sug- f Mr. GRASSLEY. Mr. President, I ask gest the absence of a quorum. unanimous consent that reading of the LEGISLATIVE SESSION The PRESIDENT pro tempore. The amendment be dispensed with. clerk will call the roll. The PRESIDENT pro tempore. Under The PRESIDENT pro tempore. With- The legislative clerk proceeded to the previous order, the Senate will re- out objection, it is so ordered. turn to legislative session. call the roll. (The amendment, No. 1133, is printed Mr. GRASSLEY. Mr. President, I ask f in today’s RECORD under ‘‘Amendments unanimous consent that the order for PRESCRIPTION DRUG AND MEDI- Submitted.’’) the quorum call be rescinded. Mr. GRASSLEY. Mr. President, is CARE IMPROVEMENT ACT OF The PRESIDENT pro tempore. With- 2003—Continued there no discussion necessary on the out objection, it is so ordered. amendment? Mr. BAUCUS. Mr. President, will the Mr. GRASSLEY. Mr. President, what The PRESIDENT pro tempore. Who Chair state the regular order? is the business before the Senate? seeks recognition? The PRESIDENT pro tempore. The The PRESIDENT pro tempore. The Senator from Texas. pending amendment numbered 1060, as Amendment No. 1060, as modified. Mrs. HUTCHISON. Mr. President, I modified is the regular order. Mr. GRASSLEY. I urge adoption of would just like to say that we have Mr. BAUCUS. Mr. President, is that the amendment. help for our teaching hospitals in the the Nickles-Feinstein amendment? The PRESIDENT pro tempore. Is managers’ amendment. It is not much. The PRESIDENT pro tempore. It is. there further debate? But I am working with all of the man- Mr. BAUCUS. Mr. President, I move Mr. BAUCUS. Mr. President, will the agers, the ranking member as well as to table the Nickles-Feinstein amend- Chair identify the sponsors of that the chairman, to try to increase fund- ment, and I ask for the yeas and nays. amendment? ing for teaching hospitals. The PRESIDENT pro tempore. Is The PRESIDENT pro tempore. Sen- I want to point out our teaching hos- there a sufficient second? ator BAUCUS for Senator FEINSTEIN, pitals must have the support that is in There is a sufficient second. amendment No. 1060, Part B premium, this bill at a higher percentage if we The question is on agreeing to the subtitle (d). are going to keep the young physicians motion. The clerk will call the roll. Mr. BAUCUS. Mr. President, the Sen- trained and if our country will keep The legislative clerk called the roll. ate is ready to vote. the greatest health care system in the Mr. MCCONNELL. I announce that The PRESIDENT pro tempore. The world. the Senator from Oklahoma (Mr. question is on agreeing to the amend- I thank the managers for helping me INHOFE) is necessarily absent. ment. put that in the managers’ amendment.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00040 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8687 The PRESIDENT pro tempore. The ful for your consideration and approval FEE FOR SERVICE Senator from Pennsylvania. of my language, Chairman GRASSLEY. Mr. FRIST. Mr. President, I believe Mr. SANTORUM. Mr. President, I op- Mr. GRASSLEY. Yes, Senator BUN- in assuring the ability of seniors who pose the managers’ amendment be- NING, I remember your submitted lan- choose to do so to add their own funds cause of an amendment that is in the guage regarding Adult Day Care. on top of the government contribution managers’ amendment, the Corzine Mr. BUNNING. After we voted to pass in order to participate in private fee- amendment which provides three S. 1 out of the Finance Committee, I for-service plans under Medicare. I also States the opportunity to basically opt have since learned that the adult day believe that private fee-for-service out of the Medicare Program for pre- care language accepted and made part plans should be able to provide an scription drugs and have an entitle- of the bill is not the language I sub- unmanaged form of the subsidized pre- ment flow of funding going to the mitted at all, but instead it is language scription drug benefit. States for the States to develop their based on a bill introduced by Senator Accordingly, I am committed to en- own stand-alone drug benefit. As a re- SANTORUM related to the same issue. suring that the bill reported from the sult of that, States like mine and two Mr. GRASSLEY. Yes, this is true, conference committee that will con- others will not have the advantage of and I apologize for the inaccurate in- sider S. 1 and H.R. 1 incorporates the an integrated drug benefit which I formation and misunderstanding pro- functional equivalent of those provi- fought very strongly for on this floor vided to you and your staff from the sions in H.R. 1 that permit private fee- and which I believe will also lead po- Finance Committee on this issue. The for-service plans to provide the sub- tentially to this unlimited entitlement language included in the base bill in- sidized prescription drug benefit as an flow of funds to the States because of stead is based on Senator SANTORUM’s unmanaged benefit whose premium the way this language is drafted, the bill. amount, just like the premium amount potential for lots of mischief in respect Mr. BUNNING. While Senator such plans charge for the core Medicare benefit under current law, is not sub- to double dipping, inter-government SANTORUM’s adult day care proposal transfers, disproportionate share pay- and my adult day care language are ject to governmental review or ap- ments. We could be opening a virtual different, they both share the same proval. Mr. GRASSLEY. I agree. Pandora’s box. Yes. For my States and goal of providing services to those spe- two others. But I think, frankly, it is cial and needy adults who require extra REPEAL OF THERAPY CAPS not good policy and does not do the attention and care. However, I have Mr. ENSIGN. Mr. President, I will kind of improvement of the overall some differences with Senator withdraw my amendment to repeal the arbitrary beneficiary caps on therapy. Medicare program which my State SANTORUM’s proposal, and he has some should participate in as well as the differences with my proposed language. However, I would urge my colleague other States represented here. Mr. SANTORUM. Yes, we do share from Iowa, the Chairman of the Fi- There is no Federal oversight by the the same goal on this adult day care nance Committee, to work in con- Secretary of Health and Human Serv- issue, and we do have some funda- ference to find a way to delay this law. ices for this plan. mental differences with one another’s As you know, the beneficiary caps will There are a host of other problems proposals and language on the matter. have one of three results—beneficiaries with this amendment. It is my under- will either: (1) pay 100 percent out-of- Mr. GRASSLEY. Yes, that is my un- standing that the managers gave a their own pocket once the caps are ex- derstanding, as well. commitment that this amendment be ceeded; (2) self-ration therapy care; or included in the package. And so to Mr. BUNNING. I am hopeful that (3) forgo medically necessary care alto- honor the chairman’s commitment, I once this bill gets to conference, we gether. Mr. President, I recognize that will not object to this amendment nor and our staffs can work out our dif- the Chairman has been a voice to call for a vote to strike the amend- ferences on this adult day care issue eliminate these caps and hope that a ment. But I, unfortunately, will have and find a solution that is amenable to final Medicare bill further delays im- to vote against this bill. all of us. It is also my understanding plementation of them. The PRESIDENT pro tempore. Is the current version of the House of Mrs. LINCOLN. Mr. President, I there further debate? Representative’s prescription drug ben- would like the opportunity to join my Mr. GRASSLEY. I ask unanimous efit bill includes the adult day care colleague from Nevada to speak in sup- consent that the amendment be agreed language which is identical to my lan- port of repealing the caps on out- to. guage. patient physical therapy, occupational The PRESIDENT pro tempore. Is Mr. SANTORUM. I am willing to therapy, and speech-language pathol- there objection? Without objection, it work on this matter further, and do ogy. is so ordered. agree that since the Senate’s and The current therapy cap discrimi- The amendment (No. 1133) was agreed House of Representative’s versions on nates against the most vulnerable of to. the adult day care language will be dif- Medicare beneficiaries. While the ma- AMENDMENTS EN BLOC WITHDRAWN ferent, we will have to find a solution jority of enrollees will not exceed an Mr. GRASSLEY. Mr. President, I ask to our differences on this important annual $1,590 limitation on rehabilita- unanimous consent to withdraw the issue. tion services, approximately 13 percent pending amendments. Mr. GRASSLEY. I will be happy to of seniors and individuals with disabil- The PRESIDENT pro tempore. With- work with both of you and our staffs to ities covered by Medicare will be forced out objection, it is so ordered. rectify this problem. Adult day care is to pay for medically necessary services The amendments (Nos. 953, 958, 934, an important issue, and being that the out of pocket. 964, 965, 980, 979, 973, 986, 990, 977, 993, Senate and House of Representatives This is a particularly burdensome 962, 1004, 1019, 1020, 1021, 999, 954, 1037, will have different language on this situation for beneficiaries living in 1039, 1051, 1012, 1061, 1075, 1076, 1077, 1024, issue, it must be conferenced in a way rural communities. Most likely to be 1073, 1088, 1089, 1090, 1091, 1110, and 1041) to ensure that all with interests in this harmed are beneficiaries who have ex- were withdrawn. matter, including interested provider perienced a stroke or hip fracture or ADULT DAY CARE and senior organizations, are involved who have Parkinson’s disease or other Mr. BUNNING. Mr. President, during and approving of the final adult day conditions that require extensive reha- consideration of this bill in the Fi- care language. I am looking forward to bilitation following injury or illness. nance Committee, I submitted lan- further working with both of you on I urge the Chairman and Ranking guage regarding adult day care which I this matter. Member of the Finance Committee to and my staff were told by Finance Mr. BUNNING. Thank you, Mr. work with me and my colleague, the Committee staff was acceptable and in- Chairman and Senator SANTORUM. I ap- Senator from Nevada, on repealing this cluded in S. 1, the Prescription Drug preciate both your willingness to re- cap or at least suspending it for 1 or 2 and Medicare Improvement Act of 2003, visit this matter and your leadership years. My colleague and I have spon- as part of the base bill to be considered on this important legislation for our sored legislation (S. 569) to perma- on the Senate floor. I was very thank- seniors. nently repeal this cap. Our bill has

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00041 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8688 CONGRESSIONAL RECORD — SENATE June 26, 2003 been cosponsored by 41 members of the creases in the gross domestic product. abled by combining Medicare and Med- Senate. The problem is magnified when gross icaid services through a waiver ap- Again, I appreciate the opportunity domestic product decreases. Essen- proved by the Department of Health to join my colleagues from Nevada tially, the formula penalizes physicians and Human Services that integrates today. It is my sincere hope, Mr. Presi- for factors over which they have no services under Medicare and Medicaid dent, that we will be able to address control. capitated financing arrangements. the issue of the burdensome $1,590 cap It is true that as the population of These programs provide beneficiaries on outpatient therapy services. our country ages, the volume of Medi- with a comprehensive benefit package Mr. GRASSLEY. I thank both the care health care services consumed in- that combines the services tradition- Senator from Nevada and the Senator creases. However, physicians have no ally provided by Medicare, Medicaid, from Arkansas for their comments and control over this and our Medicare sys- and home and community based waiver for withdrawing the amendment. As tem penalizes them because of it. As a programs. you may know, I asked CMS Adminis- result, some physicians no longer take In my home State of Wisconsin, the trator Scully at the Finance Com- new Medicare patients, some decline to Wisconsin Partnership Program is one mittee markup to further delay imple- participate in the Medicare program such success, a community-based pro- mentation of these beneficiary caps. altogether, and young people are con- gram that has improved the quality, Unfortunately, as a result of the Sen- sidering other professions. access, and cost-effectiveness of the ate Budget Resolution constraints, I do I would submit that as the baby- care delivered to its beneficiaries. Per- not have Medicare dollars to repeal the boomer generation ages and increasing haps most important to the bene- beneficiary cap on therapy services. I numbers of Americans become Medi- ficiaries, these programs help the disagree that this arbitrary limit does not care beneficiaries, we need physicians abled and the frail elderly remain in make sense and have sought to address and other health care providers more their own community, and avoid insti- this issue in the past. I will work in than ever. If anything, we should be re- tutionalized care. Wisconsin is lucky to conference to enact a therapy cap mor- warding our physicians, not penalizing have four such programs across our atorium and appreciate your hard work them. State: Elder Care and Community Liv- and passion on this issue. An additional problem with the Sus- ing Alliance of Dane County, Commu- Mr. ENSIGN. I appreciate the Chair- tained Growth Rate calculation is that nity Care for the Elderly of Milwaukee man’s leadership on this issue and I it does not account for many changes County, and Community Health Part- thank my colleague for agreeing, at a in health care that improve quality but nership Eau Claire, Dunn, and Chip- minimum, to work toward another increase physician work also. The fed- pewa Counties. moratorium on implementation of the eral government actively promotes In order to qualify for these programs, a person must be Medicaid-eli- therapy cap. I would also like to thank new coverage decisions, quality im- gible, have physical disabilities or the Senator from Arkansas for her provement activities and other initia- frailties of aging, and require a level of words of support. Mr. President, I yield tives that benefit patients but are not care provided by nursing homes. the floor. taken into account by the Sustained Through programs such as the Wis- I ask unanimous consent that this Growth Rate calculation. consin Partnership Program, these full statement be included in the MedPAC’s recommendation to Con- frail elderly and disabled beneficiaries RECORD as if read. gress is that annual updates in physi- are able to receive quality preventive Mr. HATCH. Mr. President, I strongly cian payments should reflect increases care upfront, which allows more bene- support Senator KYL’s sense of the in the Medicare Economic Index or ficiaries to stay in their communities Senate resolution to S. 1. His resolu- MEI rather than the gross domestic tion asks Congress to rectify problems and reduces the rate of hospitalization. product. Using the Medicare Economic In Wisconsin, about 26 percent of all with the formula that is used to update Index would eliminate the penalty that Medicaid recipients age 65 or older are Medicare physician reimbursement. physicians and other practitioners cur- in nursing homes. This rate drops dra- Due to flaws in this formula, pay- rently experience when the volume of matically for those enrolled in the Wis- ment rates for physicians and other health care services increases due to consin Partnership Program, where practitioners are predicted to fall by factors that they are unable to control. only 5.9 percent of recipients age 65 or 4.2 percent in 2004. This cut in physi- What we have before us is a flawed older are in nursing homes. cian compensation would be the fifth formula that is threatening the health While the Wisconsin Partnership Pro- since 1991 including a 5.4 percent de- of Americans and the future of our gram is a success, we must ensure that crease in 2002. According to Medicare’s country. Congress has addressed this the Federal Government continues to own conservative estimates, between problem before, but it seems that we support these State-based solutions to the years 1991 and 2003, reductions for were only putting a bandage over the our long-term care needs and other spe- physicians and other health profes- wound; we never cured the disease that cialty managed care programs that sionals resulted in Medicare physician caused it. The wound continues to fes- focus on frail, chronically ill seniors. reimbursement that equates to 14 per- ter and it will continue to do so until Last year I introduced the Frail Elder- cent below their actual practice costs. we cure the problem. And the cure, it ly Act of 2002, which promoted spe- The 2004 reduction would decrease Utah seems, is to revise the formula. cialty managed care programs and physician income by $13 million which I for one, am tired of applying ban- helped those already in existence to translates to $3003 per physician in dages to this wound. I believe that it is continue to operate. This amendment 2004. And this is in addition to the $9 time to address this problem directly will work to accomplish both goals by million decrease in reimbursement and definitively. I urge my colleagues providing a population-based designa- that Utah physicians received in 2002. to join with me in supporting this reso- tion that allows plans to be recognized Furthermore, unless we correct this lution and in working to correct this for specialization in services for special formula, it is estimated that more cuts problem. needs beneficiaries. By establishing will occur in 2005, 2006, and 2007. Mr. FEINGOLD. Mr. President, I this specialized designation, we hope to The Medicare Payment Advisory joined my colleague, the distinguished be able to more easily move specialized Commission, MedPAC, has stated that Senator from Oregon, Mr. SMITH, in of- plans from demonstration status to these reimbursement reductions are fering an amendment to promote bet- mainstream provider status, helping to the result of a problem with the Sus- ter care for frail elderly and disabled. promote a more effective way of caring tained Growth Rate that is used as part This amendment will allow the Sec- for the frail elderly and disabled. of the calculation to adjust rates each retary of the Department of Health and Mr. President I also want to point year. The SGR expenditure target is Human Services to designate health out that this amendment does not linked to gross domestic product. plans that disproportionately serve change payments, does not change ad- Therefore, the formula may decrease special needs beneficiaries as special- ministrative rules, and therefore doe Medicare reimbursement for physicians ized Medicare Advantage plans. not have a fiscal effect. and other practitioners when health A number of States have successfully Fundamental long-term care reform care volume increases outstrip in- chosen to serve seniors and the dis- is vital to any health care reform that

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00042 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8689 Congress may consider. As part of and other WPP members additional flexi- tion for specialized Medicare Advantage these reforms, we must support State bility in expanding our unique program to plans that exclusively serve special needs and local efforts to encourage care for other beneficiary groups such as those who beneficiaries. Your amendment would allow the most vulnerable populations. We are eligible for Medicare, but not Medicaid the Secretary also to designate as special- and ‘‘pre-duals’’—those who are at risk of ized Medicare Advantage plans those that must provide our seniors and disabled spending down to Medicaid based on health disproportionately serve special needs bene- with real choices. They are entitled to status and/or income limitations. Targeting ficiaries. the opportunity to continue to live in healthy beneficiaries before they become The expansion of the specialized Medicare the homes and communities that they frail or disabled would reduce long-run Medi- Advantage designation would provide Elder helped build and sustain. I urge my col- care and Medicaid costs by preventing or de- Care and other WWP members additional leagues to support this amendment laying health care decline and the need for flexibility in expanding our unique program that will help provide a measure of sup- costly medical or long-term care services. to other beneficiary groups such as those port for the most frail elderly and dis- Your amendment also would offer CHP a who are eligible for Medicare, but not Med- mechanism to serve non-special needs bene- abled to allow them to stay in their icaid and ‘‘pre-duals’’—those who are at risk ficiaries as a strategy for expanding our of spending down to Medicaid based on own homes. membership under a mainstream model or health status and/or income limitations. Mr. President, I ask unanimous con- reducing our risk through a more representa- Targeting healthy beneficiaries before they sent that two letters of support for this tive cross-section of Medicare beneficiaries become frail or disabled would reduce long- amendment, from the Community in West Central Wisconsin. run Medicare and Medicaid costs by pre- Health Partnership and Elder Care of Your compassion for seniors, disabled and venting or delaying health care decline and Dane County be printed in the RECORD. other special needs beneficiaries has been the need for costly medical or long-term care There being no objection, the mate- evident since you served as the Chair of the services. Your amendment also would offer Senate Aging Committee in the State of Wis- Elder Care a mechanism to serve non-special rial was ordered to be printed in the consin. The amendment you are offering to RECORD, as follows: needs beneficiaries as a strategy for expand- the Senate Medicare bill only provides fur- ing our membership under a mainstream COMMUNITY ther evidence that you continue to be hard HEALTH PARTNERSHIP, INC., model or reducing our risk through a more at work on behalf of Wisconsin’s most vul- representative cross-section of Medicare Eau Claire, WI, June 26, 2003. nerable populations. Thank you for all of Hon. RUSSELL FEINGOLD, beneficiaries in Madison. your work on behalf of Wisconsin’s seniors. Your compassion for seniors, disabled and U.S. Senate, Sincerely, Washington, DC. other special needs beneficiaries has been KAREN A. BULLOCK, evident since you served as the Chair of the DEAR SENATOR FEINGOLD: I am writing to CEO. express my support for the amendment you Senate Aging Committee in the State of Wis- will be offering with Senator Gordon Smith consin. The amendment you are offering to ELDER CARE OF DANE COUNTY, the Senate Medicare bill only provides fur- to create a designation for Medicare Advan- Madison, WI, June 24, 2003. tage plans that target special needs bene- ther evidence that you continue to be hard Hon. RUSSELL FEINGOLD, at work on behalf of Wisconsin’s most vul- ficiaries. Community Health Partnership, U.S. Senate, Inc. (CHP) is one of four Wisconsin Partner- nerable populations. Thank you for all of Washington, DC your work on behalf of Wisconsin’s seniors. ship Program demonstration sites that has DEAR SENATOR FEINGOLD: I am writing to Sincerely, developed innovative models of care specifi- express my support for the amendment you KAREN MUSSER, cally for frail seniors and people with phys- will be offering with Senator Gordon Smith CEO. ical disabilities that would benefit from a to create a designation for Medicare Advan- specialty designation. tage plans that target special needs bene- Mr. HATCH. Mr. President, I rise to The Wisconsin Partnership Program (WPP) ficiaries. Elder Care of Dane County is one of speak on the Gregg-Schumer amend- is an integrated program of acute and long- four Wisconsin Partnership Program dem- term care services designed to improve ac- ment which was adopted last week. onstration sites that has developed innova- cess to needed care, reduce fragmentation of This amendment was based on a piece tive models of care specifically for frail sen- care across providers and settings, and help of legislation, S. 1225, the Greater Ac- iors and people with physical disabilities people remain independent in the commu- cess to Affordable Pharmaceuticals Act that would benefit from a specialty designa- nity, while achieving cost savings. The tar- tion. of 2003, reported by the HELP Com- get populations for WPP include both elderly The Wisconsin Partnership Program mittee on June 11th. and physically disabled individuals who meet (WWP) is an integrated program of acute and I want to take this opportunity to ex- nursing home level of care criteria. CHP long-term care services designed to improve serves both populations in a 3 county, rural plain why I cast the lone vote against access to needed care, reduce fragmentation area. Participants must be Medicaid eligible this amendment. It is my hope that of care across providers and settings, and or dually eligible for Medicare and Medicaid when my colleagues consider my expla- help people remain independent in the com- services. A hallmark of this program is the nation that they may be open to mak- munity, while achieving cost savings. The use of an inter-disciplinary care team com- target populations for WWP include both el- ing additional changes to this very im- prised of a physician, nurse practitioner and portant amendment as the process social worker that help coordinate bene- derly and physically disabled individuals who meet nursing home level of care cri- moves forward. ficiaries’ care across all health care settings. Let me start by commending Sen- The WPP also participates in the Medicare/ teria. Elder Care Partnership serves frail el- Medicaid Integration Program, a demonstra- derly beneficiaries. Participants must be ators GREGG, SCHUMER, MCCAIN, and tion to test strategies for integrating Medi- Medicaid eligible or dually eligible for Medi- KENNEDY for their work in developing care and Medicaid services. The goal of this care and Medicaid services. A hallmark of this provision which I believe is a sig- program is to create a seamless system of this program is the use of an inter-discipli- nificant improvement on legislation care for beneficiaries and to reduce costs re- nary care team comprised of a physician, nurse practitioner and social worker that that was adopted by the Senate last lated to duplication of services and adminis- Congress, S. 812. trative functions across programs. help coordinate beneficiaries’ care across all Like a number of other specialty health care settings. The WWP also partici- The Gregg-Schumer amendment re- Medicare+Choice programs, the WPP cur- pates in the Medicare/Medicaid Integration lates to a complex and often admit- rently operates under demonstration author- Program, a demonstration to test strategies tedly confusing law I coauthored with ity, which expires at the end of next year. for integrating Medicare and Medicaid serv- my friend, Representative HENRY WAX- And, like virtually all Medicare demonstra- ices. The goal of this program is to create a MAN of California in 1984 the Drug Price tion programs, there is no mechanism for seamless system of care for beneficiaries and Competition and Patent Term Restora- to reduce costs related to duplication of transitioning from demonstration status tion Act. into the mainstream of Medicare. I under- services and administrative functions across stand that The Medicare Prescription Drug programs. I chaired a hearing of the Senate Ju- and Reform Act of 2003 begins to address this Like a number of other speciality diciary Committee in May of 2001 that problem by establishing a special designa- Medicare+Choice programs, the WWP cur- helped document some abuses that tion for specialized Medicare Advantage rently operates under demonstration author- were occurring in the law. Since our plans that exclusively serve special needs ity, which expires at the end of next year. last hearing on this issue, much has beneficiaries. Your amendment would allow And, like virtually all Medicare demonstra- happened. the Secretary also to designate as special- tion programs, there is no mechanism for Both the Federal Trade Commission transitioning from demonstration status ized Medicare Advantage plans those that and the Food and Drug Administration disproportionately serve special needs bene- into the mainstream of Medicare. I under- ficiaries. stand that The Medicare Prescription Drug played a constructive role in attempt- The expansion of the specialized Medicare and Reform Act of 2003 begins to address this ing to end several mechanisms by Advantage designation would provide CHP problem by establishing a special designa- which some research-based and generic

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00043 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8690 CONGRESSIONAL RECORD — SENATE June 26, 2003 drug firms were attempting to game stantially altered by the Edwards-Col- again, it is entitled the Greater Access the system put in place by the 1984 and lins substitute, with active involve- to Affordable Pharmaceuticals Act. subsequent court decisions to avoid ment of Senator KENNEDY. Once again, it is cosponsored by Sen- competition in the marketplace. While there is no question my col- ators MCCAIN, SCHUMER, and KENNEDY. The FTC succeeded in achieving sev- leagues were motivated by their goal of Due in large part to the leadership of eral widely-publicized consent decrees making drugs more affordable for sen- Chairman GREGG, there are significant with a variety of offending firms under iors and all Americans, and despite the changes in the bill compared with last the existing antitrust statutes. fact that it garnered 78 votes in the year’s legislation. In addition, the FTC conducted an Senate, there were significant short- While I have significant concerns exhaustive survey and study of how comings in the bill. over certain aspects of S. 1225 as adopt- certain provisions of the 1984 Waxman- Let me briefly review a few of the ed in its amended form on June 19, 2003, Hatch Act affected competition in the most troublesome provisions of the I must acknowledge Chairman GREGG pharmaceutical industry. Edwards-Collins substitute to S. 812. and Majority Leader FRIST for their The FTC study contained two major The proposed legislation would have roles in working with the cosponsors of recommendations. The first addressed created for the first time a private last year’s bill to make substantial im- the use of the statutory 30-month stay right of action in the Federal Food, provements in the legislation. granted by the 1984 law in situations Drug, and Cosmetic Act. The last thing Likewise, I commend Senators SCHU- where patents are challenged by ge- the already overburdened FDA staff MER, MCCAIN and KENNEDY for aban- neric competitors. The FTC rec- needs is a bunch of trial lawyers bring- doning many of the troublesome fea- ommended that the law: ing the agency to a screeching halt by tures of a bill that garnered 78 votes Permit only one automatic 30-month stay second-guessing its judgment calls. last Congress. per drug product per ANDA to resolve patent The bill that passed last year would I can only believe that the factual infringement disputes over patent listed . . . have resulted in the waiver of patent presentation, analysis, and rec- prior to the filing date of the generic appli- rights apparently against even third ommendations contained in the FTC cant’s ANDA. parties—if pioneer drug firms did not report and subsequent public notice This was precisely the position that I file its patents with the FDA and, if and comment process surrounding the suggested in testimony before the challenged by a generic drug applicant, recently-issued FDA final rule on pat- HELP Committee on May 8, 2002 and pursue expensive litigation within ent listings and the application of the argued for last year during the Senate tight time frames. debate on the Edwards-Collins sub- In sharp contrast to the FTC rec- statutory 30-month stay both played a stitute amendment to the McCain- ommendation, S. 812 basically made constructive role in helping to form Schumer legislation. any patents listed with the FDA after a the basis of the Gregg-Schumer legisla- I would note that the 30-month stay month from the date the pioneer drug tion. provision in the McCain-Schumer bill application was approved by the FDA It is appropriate to recognize the ef- last year, S. 812, and in the Edwards- ineligible for the 30-month stay. In forts of the Bush administration for Collins substitute, were both at vari- most cases, this is at least four years tackling the problem of multiple, suc- ance with this central recommendation earlier than what I and the FTC rec- cessive 30-months stays through rule- of the FTC report. ommended—freezing the Orange Book making. Secretary Thompson, Com- The second major FTC recommenda- to patents listed before a generic drug missioner McClellan, and FDA Chief tion responds to those situations in application was filed. Counsel Dan Troy, should be saluted which R&D and generic firms were en- The American Intellectual Property for their roles in so promptly com- tering into agreements not to impede Law Association opposed S. 812. The pleting a rulemaking regarding patent generic competition. The FTC rec- patent-dependent biotech industry listing that generally embraced the ommended that Congress: worked against the bill. The Patent one-and-only-one 30-month stay policy Pass legislation to require brand-name and and Trademark Office found that ‘‘S. recommended in the FTC Report. first generic companies applicants to provide 812 would forfeit unnecessarily the core Chairman Muris and the FTC staff de- copies of certain agreements to the Federal right of patent holders—the right to serve credit for a report that helped Trade Commission. exclude others from practicing the in- shape a more carefully targeted policy Senator LEAHY, working very closely ventions for the entire patent term. response. with the FTC, developed legislation, After years of research and develop- There can be no doubt that this the Drug Competition Act, S. 946, that ment and significant investment, the year’s vehicle, S. 1225, is superior to S. squarely addressed this second rec- patent right is extinguished for the 812. This new Gregg-Schumer bill, S. ommendation. mere failure to satisfy an administra- 1225, embraces exactly the type of one- During the 107th Congress, I worked tive task or respond in a timely man- and-only-one 30-month stay policy that with Senator LEAHY on refining that ner.’’ I suggested to the HELP Committee bill. I supported it in committee, and Here is what the July 18, 2002 State- last May, argued for on the floor last worked with him to pass it through the ment of Administration Policy said July, and was ultimately recommended Senate late last year. I supported his about the Edwards-Collins-McCain- by the FTC. efforts to have it attached to the Medi- Schumer legislation: The Gregg-Schumer legislation, S. care vehicle earlier this week. I expect . . . the Administration opposes S. 812 in its 1225 in the form adopted by the Senate, that the 108th Congress will adopt this current form because it will not provide also addresses some problems that the measure. lower drug prices. S. 812 would unnecessarily FDA rule perhaps did not resolve satis- The FTC study served an important encourage litigation around the initial ap- factorily. As FDA Chief Counsel Dan purpose of cataloging the facts sur- proval of new drugs and would complicate Troy stated at the June 17th Judiciary rounding certain abuses of the 1984 act. the process of filing and protecting patents Committee hearing: In formulating public policy, the facts on new drugs. The resulting higher costs and delays in making new drugs available will We tried as best we could to cut down on should matter and a legislative or reg- all opportunities for gaming. We did not suc- ulatory response should be tailored to reduce access to new breakthrough drugs. Moreover, the new cause of action is not nec- ceed in cutting down all opportunities for fit the problem. essary to address patent process abuses. gaming, because nothing, no legislation is so Unfortunately, the timing of the Clearly, the bill would benefit from consider- good, no rule could be so good as to cut down issuance of FTC study did not allow ation by the Senate’s experts on Hatch-Wax- all opportunities for gaming, because there the report to get the attention it de- man law on the Judiciary Committee, the are unforeseen circumstances and unin- served by the Senate. The FTC report proper committee of jurisdiction for this tended consequences. was published only one day before the bill. I think Mr. Troy is correct about the Senate adopted S. 812, the Greater Ac- While S. 812 passed by a very wide nature of the inherent limitations of cess to Affordable Pharmaceuticals Act margin, it was certainly not without regulatory and legislative fixes for of 2003, last July 31st. its critics. complex problems where there are pow- The GAAP Act, developed by Sen- Comes now S. 1225. This bill emerged erful incentives to game the system to ators MCCAIN and SCHUMER, was sub- from the HELP Committee. Once gain financial advantage. We need to

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00044 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8691 keep this in mind as we analyze further I have requested the Department of parking lot that come days, weeks, and the amendment the Senate adopted Justice for its formal views on this lan- in some cases even months in advance last week. guage. At this point, I think it pre- of a particular date. Why we should re- As I stated at the June 17th hearing, mature to embrace this language. It is ward someone because they camp out it was unfortunate that the PTO was my understanding that the bill that longer in the parking lot is a good unable to present a witness. Admit- the House will take up does not con- question?’’ tedly, the invitation was issued on tain the controversial case or con- I am concerned that the language short notice. I have asked PTO for its troversy language. I stand prepared to that passed the Senate could allow formal comments on the Gregg-Schu- work with the sponsors of the amend- some unintended and, in fact, counter- mer amendment. I would also be inter- ment, DOJ and others on this impor- productive, results. Changes in current ested in the PTOs comments on what- tant issue. law with respect to the court decision ever language the House adopts. We Yet another improvement of S. 1225 and commercial marketing triggering would also be wise to hear from the Of- over the bill adopted by the Senate last mechanisms for the 180-day exclusivity fice of the United States Trade Rep- year relates to the manner in which provision demand careful attention and resentative if USTR finds that the leg- the 180-day rule is addressed. In short, analysis. The amendment does not ap- islation raises any concerns for inter- I am pleased that the policy embraced pear to adopt all the FTC recommenda- national trade and intellectual prop- last year, the rolling exclusivity pol- tions in this area. erty under the TRIPS provisions. icy, was replaced in favor of a ‘‘use it Other questions should be raised. It is my understanding that FDA and or lose it’’ approach. I have long stated What if, for example, the generic appli- FTC staff provided a great deal of what a preference for the consumer friend- cant that successfully challenges the is known as ‘‘technical assistance’’ on lier ‘‘use it or lose it’’ rule over the too validity of the patent is not also a first the Gregg-Schumer amendment, a good open-ended rolling exclusivity. filer? Why should such a non-first fil- deal of it between the markup on June The Waxman-Hatch law provides an ing but successful invalidity challenger 11th and the time the amendment was incentive for generic firms to challenge not be granted the 180 days exclu- offered on June 19th. I am not aware patents. To encourage generic competi- sivity? Stated another way, why should whether PTO or USTR were consulted. tors to pursue patent challenges in a the first filer—or in Chairman Muris’ PTO and USTR should understand vigorous fashion, the 1984 law provided ‘‘shantytown’’ situation, a whole group that this is a fast moving train, so they 180 days of marketing exclusivity in of first-day, exclusivity-sharing, first- should be prepared to give us any com- situations where a generic drug firm filers, gain while the actual successful ments they may have in short order. could show the pioneer’s patents were challenger waits out the 180-days? I am President Bush and the congressional invalidated or not infringed. For many not sure that such an outcome is fair leadership have made it plain that they years it was thought, as intended, that or even rational. Moreover, such a sys- expect the conference report on the this valuable 180-day period of exclu- tem may not result in the most effi- Medicare bill to be completed as soon sive marketing would be granted to the cient or aggressive pursuit of patent as possible. first generic firm to successfully inval- challenges. One special area of concern to me as idate or invent around the pioneer’s One thing is for sure: You can expect Chairman of the Judiciary Committee patents. a lot more first filers to appear at the is that one provision of the amendment FDA regulations issued in 1994 re- door of the FDA building on the first overwhelmingly adopted by the Senate quired that the first generic applicant day that successful drugs become eligi- raises significant issues with respect to had to defend successfully against a ble for patent challenges. As I pointed civil justice policy, including a con- patent claim made by a brand name out at the Judiciary Committee hear- stitutional concern. Specifically, pro- company to receive the 180-day exclu- ing, some have already suggested that posed section 271(e)(5) of title 35, would sivity. In a 1998 D.C. Circuit case, Mova the first to file system might result in make the failure of a patentee to file a v. Shalala, the court construed the an increase in willful infringement patent infringement action within a plain language of the statute to strike cases. In fact, there was a decision last specified time frame sufficient to es- down the successful defense require- month by a Federal court in Chicago tablish ‘‘an actual controversy’’ for the ment. As a result FDA now makes 180- that ruled against a generic firm which purpose of establishing subject matter day exclusivity decisions by applying filed a generic drug challenge before jurisdiction for a declaratory judge- the literal words of the statute. This obtaining the opinion of outside coun- ment action by a generic drug firm results in a system that rewards first sel on either non-infringement or inva- challenging a patent. filers, not necessarily successful chal- lidity. Whether the Congress can, or should, lengers. Another type of potential problem by statute grant subject matter juris- The Gregg-Schumer amendment re- could arise, and frankly I am not cer- diction for a declaratory judgment tains the preference for first filers. I tain how it can be avoided, if a non- based on the failure to bring a suit believe that re-instating the successful first filing generic drug challenger raises some interesting questions, par- defense requirement may prove pref- wins a court decision on grounds of ticularly in light of manner in which erable than intentionally sanctioning a non-infringement. Unless I am wrong the U.S. Courts of Appeals, including first filer regime. in my understanding of the Gregg- the Federal Circuit, have developed Frankly, I am uncertain of the policy Schumer amendment, a generic chal- and applied the ‘‘reasonable apprehen- justification for S. 1225’s retention of lenger that prevailed on a non-infringe- sion’’ test. At our June 17th hearing, granting the 180-day reward to the first ment theory would have to wait for the DOJ did not present the Judiciary filer rather than the first successful de- 180-days granted the first filer, or a Committee with its final opinion on fendant. I believe that there is a lot to group of first-day, first-filers, to expire the matter but Mr. Sheldon Bradshaw, be said for giving the reward to the ac- before the non-infringing firm could Deputy Assistant Attorney General, tual winner in court or the first not to enter the market. Such an outcome Office of Legal Counsel, noted, ‘‘that be sued, not just the first one to enter only hurts consumers by needlessly de- the actual case of controversy require- the Parklawn Building with an applica- laying introduction of the non-infring- ment is constitutionally compelled tion. ing generic product for 180 days. rather than statutorily required. And The amendment places a high pre- Unlike a determination of patent in- as a result, Congress can’t simply cre- mium on being a first filer. At our validity, a finding of non-infringement ate a case or controversy by statute hearing last week, FTC Chairman does not accrue to third parties. It is but the plaintiffs must establish the Muris characterized the rush to be a important to understand that there are constitutional requirement for bring- first filer as ‘‘the shantytown problem two ways for a generic firm patent ing the case.’’ The committee has re- of people in line to file.’’ FDA Chief challenger to be awarded the 180-day ceived a spirited correspondence that Counsel Troy described that ‘‘. . . right exclusivity under the law. First, the takes differing views on the case or now, there are sometimes limousines, generic challenger can show that the controversy provision of the Gregg- sometimes vans, sometimes cars, some- pioneer’s patent is invalid. And second, Schumer amendment. times even tents in the Metro North the generic challenger can demonstrate

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00045 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8692 CONGRESSIONAL RECORD — SENATE June 26, 2003 that its product will not infringe a pio- to fully support this measure at this KOHL, and SCHUMER, offered our bill as neer’s patent. time. an amendment to the larger Medicare These are two very different theories. Mr. BUNNING. Mr. President, during bill. I hope that in this Congress it is Al Engelberg, a highly successful and consideration of S. 1, an amendment actually enacted into law as part of the highly respected attorney engaged by was introduced by Senators SANTORUM larger effort to improve the health care generic drug firms to attack pioneer and SCHUMER dealing with payments to of millions of Americans. Prescription patents, has made the following obser- the Medicare+Choice program. This drug prices are rapidly increasing, and vation about the difference between in- amendment would have increased pay- they are a source of considerable con- validity and non-infringement chal- ments to the M+C plans over the next cern to many Americans, especially lenges: 2 years, to make sure they are still via- senior citizens and families. Generic In cases involving an assertion of non-in- ble when the MedicareAdvantage pro- drug prices can be as much as 80 per- fringement, an adjudication in favor of one gram takes effect in 2006. cent lower than the comparable brand- challenger is of no immediate benefit to any I realize the amendment was with- name versions. other challenger and does not lead to multi- drawn because of the lack of funding in While the Drug Competition Act is source competition. Each case involving the Senate bill, but it is still an impor- small in terms of length, it is large in non-infringement is decided on the specific tant issue I would like to lend my sup- terms of impact. It will ensure that law facts related to that challenger’s product enforcement agencies can take quick and provides no direct benefit to any other port to. challenger. In contrast, a judgment of patent The Medicare+Choice program al- and decisive action against companies invalidity or enforceability creates an estop- ready provides a good prescription drug that are driven more by greed than by pel against any subsequent attempt to en- benefit to many seniors across the good sense. It gives the Federal Trade force the patent against any party. The county, and gives these seniors another Commission and the Justice Depart- drafters of the 180-day exclusivity provision option to the Medicare fee-for-service ment access to information about se- failed to consider this important distinction. program. cret deals between drug companies that As one of the drafters of the 1984 law, Unfortunately, many keep generic drugs off the market. This I must accept a measure of responsi- Medicare+Choice plans are pulling out is practice that hurts American fami- bility for this problem. It is not clear, of the program because their reim- lies, particularly senior citizens, by de- however, that S. 1225 has addressed this bursement levels are too low. This is nying them access to low-cost generic issue in a satisfactory fashion. The lan- leaving many seniors scrambling for a drugs, and further inflating medical guage adopted in the Gregg-Schumer new Medicare+Choice plan or having to costs. amendment does not appear to solve go back into fee-for-service Medicare Last July, the Federal Trade Com- the problem created by the 1998 Mova which doesn’t offer them the same mission released to comprehensive re- decision that effectively eliminated the types of benefits as their old M+C plan. port on barriers to the entry of generic successful defense requirement. In fact, it seems like every year, drugs into the pharmaceutical market- Frankly, I think we need further more and more Medicare+Choice plans place. The FTC had two recommenda- thought on how best to address the im- leave the market. tions to improve the current situation plications of the distinction between I am concerned if we do not provide and to close the loopholes in the law invalidity and non-infringement claims these plans with enough funding over that allow drug manufacturers to main the context of Hatch-Waxman pat- the next two years while the nipulate the timing of generics’ intro- ent challenges and 180-day exclusivity MedicareAdvantage program is being duction to the market. One of those awards. Specifically, I question the ap- implemented, these M+C plans will recommendations was simply to enact propriateness of continuing to group continue to leave the program and our bill, as the most effective solution together patent invalidity and patent more seniors will be left in the lurch. to the problem of ‘‘sweetheart’’ deals non-infringement challenges, particu- This isn’t fair to our seniors. between brand name and generic drug larly in light of the fact that the latter I had hoped we could provide some manufactures that keep generic drugs may in practice extend longer than the additional funding for the off the market, thus depriving con- purported 180-day award. From what I Medicare+Choice plans over the next 2 sumers of the benefits of quality drugs know now, there are strong arguments years so the plans currently in the pro- at lower prices. Indeed, at a hearing to prefer the reinstatement of the suc- gram will remain and we might actu- just yesterday in the Judiciary Com- cessful defense requirement over the ally attract new plans to other areas mittee, Chairman Timothy Muris of establishment of a new system based that have not been served. the FTC praised the Drug Competition on first filing. In Kentucky, we have a limited num- Act in his testimony and urged its pas- Let me close by once again com- ber of Medicare+Choice plans. In fact, sage. In short, this bill enjoys the un- mending Senators GREGG, SCHUMER, only seniors in certain counties in qualified endorsement of the current MCCAIN, and KENNEDY for all their hard Northern Kentucky and around Louis- FTC, which follows on the support by work in reaching the compromise ville have access to these plans. With the Clinton administration’s FTC dur- amendment that was so overwhelm- higher payments to Medicare+Choice ing the initial stages of our formula- ingly adopted by the Senate. The plans, we might actually get some tion of this bill. We can all have every Gregg-Schumer amendment represents more plans to come into our state and confidence in the commonsense ap- significant improvement over the legis- cover more counties. proach that our bill takes to ensuring lation passed by the Senate last year. I We shouldn’t give up on the that our law enforcement agencies am pleased that the amendment adopts Medicare+Choice plans, or the seniors have the information they need to take the one-and-only-one 30-month stay enrolled in them. I hope this is an issue quick action, if necessary to protect policy that I, and the FTC, advocated we can resolve during the conference consumers from drug companies that last year. with the House, and I commend Sen- abuse the law. I am also pleased that the Senate has ators SANTORUM and SCHUMER for Under current law, the first generic adopted Senator LEAHY’s Drug Com- bringing this issue before the Senate. manufacturer that gets permission to petition Act, which also addressed a Mr. LEAHY. Mr. President, I am sell a generic drug before the patent on major recommendation of the FTC. I pleased that late last night the Senate the brand-name drug expires, enjoys have worked with Senator LEAHY to again supported lowering drug prices protection from competition for 180 perfect and pass this measure. and maintaining a fair generic drug ap- days—a head start on other generic As a co-author of the 1984 Drug Price proval process by adding the Drug companies. That was a good idea, but Competition and Patent Term Restora- Competition Act of the Prescription the unfortunate loophole exploited by a tion Act, I support efforts to bring af- Drug and Medicare Improvement Act of few is that secret deals can be made fordable and innovative drugs to the 2003, S. 1. Last November, the Drug that allow the manufacturer of the ge- American public. While I support the Competition Act passed the Senate by neric drug to claim the 180-day grace spirit and much of the letter of the unanimous consent. On Monday, Sen- period to block other generic drugs Gregg-Schumer amendment, for the ator GRASSLEY and I, along with Sen- from entering the market, while at the reasons I have set forth, I was unable ators CANTWELL, DURBIN, FEINGOLD, same time, getting paid by the brand-

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00046 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8693 name manufacturer not to sell the ge- Shield, and Fallon Community Health cratic colleagues, I would support vol- neric drug. Plan. We must step up to the plate to untary coverage that is available and Our legislation closes this loophole help these plans—nonprofit plans in my affordable for all seniors. Along with for those who want to cheat the public State—in their time of need. my Republican colleagues, I would sup- but keeps the system the same for The Schumer-Santorum-Kerry port choice and competition to con- companies engaged in true competi- amendment takes important steps to strain costs. And to the extent we tion. I think it is important for Con- address this problem. By providing found ourselves constrained by limited gress not to overreact and throw out funding now to stabilize existing pri- resources, I would seek to provide the the good with the bad. Most generic vate health plan options for Medicare greatest assistance to those with the companies want to take advantage of beneficiaries, we can help ensure that greatest needs. this 180-day provision and deliver qual- the proposed Medicare Advantage Pro- The bill before us today achieves ity generic drugs at much lower cost gram will be successful in the future. some of that vision. It is bipartisan. It for consumers. We should not eliminate Our amendment lays the groundwork will provide a benefit available to all the incentive for them. Instead, we for successful long-term efforts to pro- seniors on a voluntary basis. It will should let the FTC and Justice look at vide beneficiaries with high-quality harness market forces to strengthen every deal that could lead to abuse, so health care choices. the integrity of the Medicare Program that only the deals that are consistent As the Senate continues to debate for the future. And it will provide com- with the intent of that law will be al- changes in Medicare, it is important prehensive health security to our most lowed to stand. The Drug Competition for us to remember that, for more than vulnerable, low-income seniors. Act accomplishes precisely that goal, 4.5 million Medicare beneficiaries Still, the bill we have before us today and helps ensure effective and timely across America, Medicare+Choice is an is not everything I would have hoped access to generic pharmaceuticals that essential program that provides high- for. The overriding priority of the cur- can lower the cost of prescription drugs quality, comprehensive, affordable cov- rent majority here in Congress has for seniors, for families, and for all of erage that is not always available, or been to make dramatic reductions in us. affordable under the Medicare fee-for- Federal revenues without cor- The effects of this amendment will service program. These seniors and dis- responding reductions in Federal only benefit the effort to bring quality abled Americans have voluntarily cho- spending. As a result, there is insuffi- health care at lower costs to more of sen to receive their health coverage cient money in the budget under which our citizens. The Drug Competition Act through Medicare HMOs and other pri- we are currently operating to provide enjoyed the unqualified support of the vate sector plans because they recog- the kind of comprehensive coverage Senate last year, and I am pleased that nize the value they offer. that all seniors—not just low-income my colleagues have recognized that it Seniors in Massachusetts have come seniors—truly deserve. This is an un- fits well within the framework of the to rely on the high-quality health care fortunate choice of priorities, I think, Prescription Drug and Medicare Im- they receive through their but it is the choice that this President provement Act of 2003. It is a good Medicare+Choice plans. Prescription and this Congress have made. complement to the larger bill and does drugs coverage, disease management Unfortunately, the consequences of nothing to disrupt the bill’s balance. I services, physician exams, vision bene- the majority’s misguided priorities are sincerely hope that this commonsense fits, and hearing aids are examples of evident in this legislation. When Medi- legislation is a part of any final agree- the additional benefits that are rou- care was created, the idea was to pro- ment with the House on the larger tinely offered by their vide seniors with health coverage that Medicare prescription drug bill. Medicare+Choice plans. was similar to the coverage available (At the request of Mr. DASCHLE, the These additional benefits are valued to most working Americans through following statement was ordered to be by all seniors, but they are particu- their employers. This is what seniors printed in the RECORD.) larly important to low-income seniors expect when we say that we are pro- ∑ Mr. KERRY. Mr. President, I wish to who cannot afford other Medicare sup- viding them with a Medicare prescrip- express my enthusiastic support for the plementary plans that might provide tion drug benefit. However, the major- amendment Senators SCHUMER and them such benefits but at a greater ity has only set aside for this bill about SANTORUM offered to increase funding cost. half of what it would take, according for the Medicare+Choice Program in As the Medicare debate moves for- to the Congressional Budget Office, to 2004 and 2005. This amendment address- ward, it is important for Congress to provide seniors a benefit comparable to es a critically important issue that has remember that Medicare+Choice serves standard employer-provided coverage. far-reaching implications affecting the as a vital safety net for many of our Thus, there is a very noticeable gap in health care benefits of millions of low- Nation’s most vulnerable seniors. For this bill’s coverage, reflective of a sub- income and minority seniors. I am millions of beneficiaries who cannot af- stantial hole in our Nation’s budget. pleased to be a cosponsor of this ford to purchase a Medigap policy, When seniors reach $4,500 in prescrip- amendment to ensure that this ur- Medicare+Choice is their only hope for tion drug costs, the coverage in this gently needed funding increase is in- obtaining comprehensive health cov- bill gives out. It does not kick back in cluded in the Medicare bill. erage. until total spending reaches $5,800. It is I believe we must take bold action to The Schumer-Santorum-Kerry widely acknowledged that this makes address the fact that Congress has not amendment focuses on protecting this no sense. It makes no sense from an in- provided adequate funding for the important option for seniors who have surance perspective. It certainly is not health care of Medicare beneficiaries nowhere else to turn for the quality reflective of the standard either in pri- who select HMOs and other private sec- health coverage they need. I urge my vate employer-provided coverage or in tor health plans. In many parts of Mas- colleagues to support the additional the coverage provided to those of us sachusetts, and in other parts of the funding that is urgently needed to who are fortunate enough to serve as country, funding for Medicare+Choice strengthen the Medicare+Choice Pro- Members of Congress. Nobody likes plans has been limited to annual in- gram for seniors. This should be among this gap in coverage. Nobody, so far as creases of only 2 percent in most years our highest priorities in this year’s I can tell, defends it. However, because since 1998. These increase are inad- Medicare debate.∑ the root of problem is the majority’s equate at a time when health care Mr. CARPER. Mr. President, when I failure to set aside sufficient resources costs are rising by 8 to 10 percent annu- ran for the U.S. Senate, I promised for this program, efforts to deal with ally. This level of inadequate funding Delawareans that I would work in a bi- the problem have only created new and is unfair to the 170,000 Medicare bene- partisan fashion to provide a Medicare potentially more serious difficulties. ficiaries in Massachusetts who have se- prescription drug benefit for our Na- For example, the authors of this leg- lected private health plan options. I am tion’s seniors. I pledged that I would islation have attempted to narrow the a strong supporter of the wonderful seek consensus around what is right coverage gap by not allowing employer health plans we have in Massachu- with competing Republican and Demo- contributions to count towards the cal- setts—Harvard, Tufts, Blue Cross/Blue cratic plans. Along with my Demo- culation of seniors’ out-of-pocket

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00047 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8694 CONGRESSIONAL RECORD — SENATE June 26, 2003 spending in the gap. To see how this very concerned about our future pros- This year, I am pleased to say that works, we need to understand how the pects. Should we let the present oppor- the Grassley-Baucus bill is even better coverage gap works. Once seniors reach tunity pass us by? I am concerned that than our effort from last year, and I $4,500 in total drug costs, they fall into if we do not act to get started with pre- commend Chairman GRASSLEY and the coverage gap. They then have to scription drug coverage this year, even Ranking Member BAUCUS for their spend a certain amount of their own the limited resources that now remain leadership and initiative in bringing it money—in the final bill reported out of may go out the door for other pur- to the Senate floor. the Finance Committee it is $1,300—be- poses—most likely another round of One of the most important reasons fore their coverage resumes, or they top-heavy, upper bracket tax cuts. that the Prescription Drug and Medi- get out of the coverage gap. This is a first step. It is a downpay- care Improvement Act is stronger than The effect of not allowing seniors to ment. Just as I pledged when I ran for the tripartisan plan from last year is count payments made by their retiree the Senate to work in a bipartisan because it includes provisions that health plans toward this out-of-pocket fashion to get results, I pledge today to begin to resolve longstanding inequi- requirement is to ensure that seniors continue to work to build on these re- ties in payments to rural doctors, hos- will remain in the gap longer and fewer sults. I continue to believe that we pitals, and other provisions. This prob- will get out of it. This allows the level should provide our seniors with quality lem can be stated simply. Rural health of spending at which the gap ends to be coverage without caps or gaps. I will care providers are paid less than pro- set at a lower level than would other- work to ensure that filling the gap of viders in more densely populated areas wise be possible for the same budgetary coverage that exists in the present bill for the same exact services. Earlier cost. The problem with this, however, is given greater priority in future this year, I joined with my colleagues, is that it also provides an unintended budgets than it was in this year’s Re- Senators HATCH, GRASSLEY, LINCOLN, incentive for employers to drop or publican budget. I also believe that it and BINGAMAN, in introducing the leg- scale back their retiree drug coverage. is a mistake to shun rather than wel- islation that addressed geographic in- Thankfully, contributions from State come employer efforts to wrap around equities for physician services by prescription drug plans, like our Dela- the new Medicare benefit, and I will changes to the physician reimbursement formulas. ware Pharmacy Assistance Program, work to rectify that mistake as we As many of our colleagues are aware, count toward the out-of-pocket remove toward implementation of this quirement, which should encourage Senator GRASSLEY fought to include program over the next few years. these rural provisions in the recent tax States to ‘‘stay in the game.’’ Employ- Mr. President, it is often said that bill that was signed by the President. ers, though, are effectively barred from politics is the art of the possible. The And although I strongly disagreed with wrapping their coverage around Medi- bounds of the possible are a bit nar- enacting further tax cuts, I was doubly care in the way that would be most rower now than they need, thanks to disappointed to see the rural health beneficial for their retirees, which our Republican friends. But, as the provisions stripped out in the con- would be by filing Medicare’s coverage ranking member of the Budget Com- ference with the House. These unfair gap. mittee has said, this may be the best In the course of our consideration of geographic differences in reimburse- bill that could be written under the this legislation here on the floor of the ment rates have gone on far too long, constraints of the Republican budget. Senate, I have urged my colleagues to and I am especially pleased to see re- For that reason, I commend the au- address these shortcomings in the bill, imbursement issues for rural providers thors of this legislation—Chairman even if that means reconsidering the getting the attention they deserve—in- GRASSLEY and Senator BAUCUS, among majority’s budget plan and the re- cluding the commitment from the others—for their work. I urge my col- source allocation for this program. I President to my friend from Iowa leagues to support this compromise as supported an amendment by Senator pledging his support for rural health an important, if limited, first step to- BOXER to eliminate the gap in cov- relief as part of the effort we have un- erage. And I cosponsored an amend- ward addressing what clearly is a derway. I am, therefore, very pleased pressing priority, not just for our el- ment offered by Senator ROCKEFELLER to see that these provisions are in- to allow employer-provided coverage to derly population, but for our Nation as cluded in the chairman’s mark and are wrap around the Medicare benefit and a whole. now part of this bill. Mr. JEFFORDS. Mr. President, as we thus to eliminate the incentive for em- I am also glad that Chairman GRASS- debate the Prescription Drug and Medi- ployers to drop coverage for their retir- LEY and Ranking Member BAUCUS have care Improvement Plan of 2003, I would ees. worked with me to address another in- The majority has made clear, how- like to take a few minutes today to equity in the system. Critical access ever, that they are unwilling to reorder speak in support of the overall bill, but hospitals provide care in the most re- their priorities or to emplore the possi- I would also like to highlight several mote regions of my State of Vermont bility of finding the necessary re- provisions in the bill that are of par- and all other rural States. These hos- sources elsewhere in the budget to fix ticular importance to me and my State pitals are small, yet serve as critical what they acknowledge are short- of Vermont. resources to their communities. The comings in this legislation. Thus, the Over the last several days, we have managers have agreed to include a pro- rest of us are left to choose between a focused much of our discussion on the vision in their amendment that will prescription drug benefit that provides aspects of this bill related to prescrip- make a technical correction to current some, but not all, of the assistance tion drugs and the Medicare Advantage law, allowing hospitals like the Mt. As- that seniors deserve, or no prescription Program. These are clearly among the cutney Hospital in Windsor, VT, to ex- drug benefit at all. most important provisions of this bill pand access to psychiatric and rehabili- Congress has been debating this issue and these issues warrant the attention tative services to the most vulnerable for more than a decade. In many ways, and debate they are receiving. I espe- citizens in that community. it has been debating the issue since cially appreciate the close relationship I would also like to speak today in Medicare was first created back in 1965. this bill has to last year’s tripartisan support of a provision in this bill that I ran for the Senate in part because I effort—which effectively is the parent establishes Medicare demonstration was frustrated at the inability or un- of the current bill Last year, my programs to improve health care qual- willingness of the parties in Wash- friends—Senators GRASSLEY, SNOWE, ity. I heard my friend from Montana ington to come together to do what HATCH, and BREAUX—and I set out to speak yesterday about quality and geo- they could to solve problems and get design a bill that provided a prescrip- graphic disparities, and I know how things done. I am unwilling to walk tion drug benefit along with other im- committed he is to improving the qual- away from the table this year with provements, what we called ‘‘enhance- ity of services delivered under Medi- nothing for Delaware’s seniors. They ments,’’ to the basic operations of the care. Earlier in this Congress, I was have waited too long and the need is Medicare Program. The tripartisan bill pleased that Senators FRIST, BEAUX, too great. was good legislation—something all of and GREGG joined me in introducing S. In light of the budgetary priorities of its original cosponsors were very proud 1148, the Medicare Quality Improve- the Republican majority, I am also to work on together. ment Act. I want to thank Chairman

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00048 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8695 GRASSLEY and Ranking Member BAU- Mr. DORGAN. Mr. President, over amount of funding I felt was needed to CUS for including this provision in this the last 2 weeks the Senate has debated provide a more generous and reliable bill. the most significant changes to the benefit. Unfortunately, the majority in I became concerned about the issue Medicare Program since it was created the Senate rejected my amendment, so of health care quality after reading the in 1965. Today, we passed this legisla- we are limited to a package of just $400 work of Dr. Jack Wennberg of Dart- tion by a 76 to 21 vote, and I would like billion over 10 years. When you con- mouth, which has shown that higher to take a few minutes to explain why I sider that Medicare beneficiaries are levels of Medicare spending do not lead supported this bill. projected to spend $1.8 trillion on pre- to better health outcomes. Let me re- This bill will, for the first time, pro- scription drugs over the next 10 years, peat this finding. Higher levels of Med- vide the option of modest prescription it is impossible to develop a robust icine spending do not lead to better drug coverage for nearly 39 million benefit within the $400 billion budget health outcomes. Instead, spending Medicare beneficiaries, including about constraint, in my judgment. tends to vary by region—generally re- 103,000 beneficiaries in North Dakota. The benefit provided for in this legis- flecting the availability of physicians It is also intended to give Medicare lation is better than that which Presi- and hospitals—rather than the health beneficiaries more choices of health dent Bush proposed in several key re- or needs of the population. plans. And it takes significant steps to- spects. Most importantly, this bill will I have followed Dr. Wennberg’s work wards equalizing the Medicare pay- not force seniors to leave the tradi- for a very long time. One of his early ments that rural health care providers tional Medicare Program—and the doc- studies looked at rates of surgical pro- receive, compared to their urban coun- tors they depend on—in order to get cedures at Vermont hospitals. He found terparts. the prescription drug coverage they that communities in Vermont that had There is no question that, if Medicare also need. I could not support a bill many more medical procedures were were being created today, it would in- that coerces seniors out of the tradi- not necessarily healthier. I saw how clude prescription drug coverage. Pre- tional Medicare Program that virtually this result led Vermont health care scription medicines are a vital part of all of North Dakota’s Medicare bene- providers to join with the business modern medicine. Last year alone, ficiaries rely on. community in achieving high quality, pharmaceutical companies introduced In addition, this bill provides extra supportable outcomes. I also saw how 26 new prescription medicines into the assistance above the basic drug benefit our State government used this effort marketplace. But these advancements for those older or disabled beneficiaries to improve health care across our in medicine mean little if Americans who have low incomes or very high State. Today, I am happy to say that cannot afford to access them. That is drug expenses. Medicare beneficiaries Vermonters enjoy some of the highest especially true for senior citizens who with incomes below about $14,400 for quality health care in the United have reached their declining income individuals and $19,400 for couples— States, at a cost that is among the low- years. about 40 percent of North Dakota’s For years now, Congress has been de- est in the country. beneficiaries—would qualify for extra As we prepare to vote for the bill be- bating proposals to add a prescription assistance. And those with the highest fore us, I think it is critically impor- drug benefit to Medicare. Unfortu- drug costs—totaling more than about tant for us to consider some of the les- nately, however, in past years we have $5,800—would qualify for the cata- sons learned from Vermont. Some of not been able to reach agreement on strophic drug coverage. About 7 per- my colleagues have expressed concern just how to do this. With each passing cent of North Dakota Medicare bene- about the costs of the bill before us. year, older Americans continue to ficiaries would reach this threshold. Others have expressed concern that the struggle to pay for their medicine. In bill does not go far enough. The quality North Dakota, about 48,000 Medicare Despite these improvements over the demonstration program in this bill will beneficiaries have no prescription drug President’s proposal, there are other give us some of the answers we need to coverage, and many more have limited concerns that I worked to address dur- these funding questions. drug coverage. I hear from North Da- ing the Senate’s debate. In some in- The need for these demonstrations is kota seniors regularly who tell me that stances, we were able to make changes critical. RAND Health published a they have to choose between taking to address these concerns, and in other study today in the New England Jour- the medicines their doctor prescribed cases, those efforts were rejected. In nal of Medicine that describes the for them and other necessities such as those instances where concerns still problems with overuse and underuse of food and heat. exist, I intend to continue working to needed medical care services in the These older North Dakotans say that fix them in conference with the House United States. The RAND study will they want and need Medicare drug cov- of Representatives. make it clear that every American is erage, and they want and need it now. For instance, as I have already men- at risk—not only for failing to receive If Congress doesn’t enact legislation tioned, I am concerned that this cov- needed medical care, but also for re- this year, chances are that several erage is not as generous as it should be, ceiving care that is not needed and more years will go by before there is and in fact, there are some holes in the may even be harmful. This is a problem another serious opportunity to con- coverage. Under this benefit, seniors that belongs to each and every one of sider this issue. In other words, we will have to reach a $275 deductible be- us, and we must find ways to fix it. could pass the legislation before the fore their Medicare drug coverage The legislation before us closes a sig- Senate today or we could do nothing starts. In addition, seniors whose drug nificant gap in the health benefit pack- for yet another year. In my judgment, expenses reach $4,500 will have to pay age available to our Nation’s seniors. doing nothing is not an option. 100 percent of their drug costs between However, providing coverage for health The prescription drug benefit in this $4,501 and $5,800. Then, when their drug care services is not enough. We must bill is not as helpful to seniors as I spending reaches $5,800, the cata- do a better job of ensuring that people would like or as generous as I think strophic drug coverage will kick in and are getting the care they need, and also Medicare beneficiaries deserve—but it Medicare will pay 90 percent of their that they need the care they get. is a start. drug expenses after that. This means In closing, I would like to urge my Frankly, I think our budget prior- that there could be periods—in some colleagues from both sides of the aisle ities have been wrong. If I had my way, cases as much as 3 months—when to support this bill as we move for- Congress would have reduced the size Medicare beneficiaries will have paid a ward. This bill will establish a drug of the tax cuts for the very wealthy premium for drug coverage but will be benefit that is universal, comprehen- and instead set aside more money for getting no benefit. sive, affordable, and sustainable. This improving and modernizing Medicare. That makes no sense to me. No other bill restores necessary and long-needed During the Senate’s debate earlier this insurance plans that I am aware of in- fairness to our physicians and pro- year on the budget, I offered an amend- clude such gaps in coverage. I sup- viders in rural areas. And, the bill will ment to set aside a total of $620 billion ported various amendments on the improve the quality of care offered over the next 10 years for a Medicare Senate floor to close these coverage under Medicare. prescription drug benefit. This is the gaps or at least ensure that seniors

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00049 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8696 CONGRESSIONAL RECORD — SENATE June 26, 2003 don’t have to pay premiums for the pe- back option to remain in that plan for neric drugs are safe, effective, and riods when they aren’t receiving cov- 2 years, not just 1 year. That amend- lower priced alternatives to heavily ad- erage. Regrettably, however, those ef- ment was also rejected. vertised brand-name prescription forts were rejected. Even though this bill doesn’t require drugs. Unfortunately, however, some of I am also concerned that rural Medi- Medicare beneficiaries to leave tradi- the big brand-name drug companies use care beneficiaries may not receive a tional Medicare, I know there are some loopholes in the patent laws to keep benefit that is as stable or as generous concerns that Medicare beneficiaries generic drugs off the market for longer as other beneficiaries receive. This bill will be getting their drug coverage than intended. This amendment, which envisions that seniors will basically through private plans. I, too, would passed the Senate by a 94-to-1 vote, have two options for receiving drug strongly have preferred that all seniors will close these loopholes and thereby coverage. First, this bill creates a new be able to choose from a Medicare-ad- speed consumers’ access to generic Medicare Advantage Program through ministered benefit. medicines. which beneficiaries could choose to get However, let me say this if I felt that I am also pleased that this bill im- their drug coverage, as well as the rest by structuring the drug coverage the proves Medicare’s coverage of preven- of their medical care, through an HMO way it is in this bill, we were under- tive services, especially by including a or a PPO. Frankly, however, I am very mining the entire underlying Medicare provision that I authored to provide for skeptical that HMOs or PPOs will want Program, I would not support it. Medi- a cholesterol screening benefit for to serve rural areas, and even if they care has been a wonderful success, and Medicare beneficiaries. I have felt for a do, I don’t think most North Dakota in our efforts to modernize it, we long time that Medicare needs to do a beneficiaries will want to leave the tra- should exercise extreme caution not to better job of preventing disease, rather ditional Medicare Program. undermine it. However, virtually all of than just paying to treat it. In the case Those seniors who want to remain in the major Medicare prescription drug of cholesterol screening in particular, the traditional Medicare Program will proposals would have used a private en- high cholesterol is one of the major, be able to do so and get their prescrip- tity in some way to provide the drug changeable risk factors for heart at- tion drug coverage through private benefit. Indeed, the traditional Medi- tacks, stroke and other cardiovascular ‘‘drug only’’ insurance plans. Budget care Program currently contracts with diseases. Yet when Americans turn 65 experts estimate that Medicare bene- private insurance companies to pay the and enter the Medicare Program, their ficiaries who sign up for these drug- millions of Medicare claims that come coverage for cholesterol screening only plans will pay an average monthly in each year. Furthermore, the Con- stops unless they already have cardio- premium of about $35. However, this is gressional Budget Office estimates that vascular disease. That makes no sense, only an estimate, and the actual pre- only 1 to 2 percent more beneficiaries and I am glad the Senate has taken mium that seniors pay could vary sub- will choose the new Medicare Advan- steps to provide this coverage. stantially from area to area. That is al- tage option, so it seems clear that the Finally, I am very happy that this ready the case in the current Medicare vast majority of seniors will continue bill includes a range of provisions that HMO program—for instance, a Medi- to rely on the traditional Medicare will make Medicare reimbursement care HMO with drug coverage currently Program for the bulk of their medical more fair and equitable for our rural charges $99 per month in Connecticut care. hospitals, physicians, and other health and only $16 a month in Florida. I am One area where we had some success care providers. It is simply not right worried that it would be rural seniors in improving the bill during the Sen- that Medicare has historically reim- who would pay the highest premiums, ate’s debate is in the area of reducing bursed urban health care providers at a even though they paid the same Medi- drug costs. This bill relies largely on much higher rate than their urban care payroll taxes as other bene- private insurance companies to nego- counterparts. This inequity in Medi- ficiaries. tiate lower drug prices. However, we care reimbursement has very real con- To address this concern, I supported have seen from prior experience that sequences for hospitals and clinics in an amendment by Senator DASCHLE insurance companies have not been rural States like ours. They have to re- that would have limited the variation able to keep drug spending from induce services, have greater difficulty in premiums to only 10 percent above creasing by nearly double digits every recruiting staff, are less able to make the national average, no matter where year 9.7 percent in 2002, 17 percent in capital improvements, struggle to give beneficiaries live. In other words, in- 2001, 18.8 percent in 2000, and 16 percent their patients access to the latest inno- surance companies could charge bene- in 1999. vations in medical care, and in same ficiaries a lower premium but they To help put downward pressure on instances, they even have to close. couldn’t charge them more than 10 per- drug prices, I offered an amendment I have been fighting for a long time cent above the national average. Unfor- that was passed by the Senate by a 62- to correct this inequity. In fact, some tunately, however, Senator DASCHLE’s to-28 vote to allow for the reimporta- of the provisions in this bill are similar amendment was rejected. tion of lower-priced, FDA-approved to legislation that I introduced in the In areas where there are not at least medicines from Canada. As many Senate earlier this year, and I am glad two private drug-only plans offered to North Dakotans know first hand, the they have been included in this bill. Medicare beneficiaries in any given same FDA-approved prescription drug I know there will be some who feel year, Medicare would step in and en- that costs $1 in the United States costs that this bill should have been rejected sure that there is a ‘‘fallback’’ plan only 62 cents in Canada, even though it by the Senate because it relies too available. This is a vital guarantee for is the exact same drug, in the same heavily on private plans and others be- beneficiaries in rural States like North bottle, made by the same manufac- cause it does not place enough empha- Dakota where I believe it is unlikely turer. sis on enrolling seniors in private that there will be two stable drug-only It is not my intention with this plans. Others will feel that the Medi- plans available. But even with this fall- amendment to require Americans to go care benefit is not generous enough, back plan, seniors could still be to Canada in order to get lower drug and some feel its coverage is too lib- bounced back and forth between dif- prices. Rather, by allowing U.S. li- eral. I agree that this legislation isn’t ferent plans, depending on how private censed pharmacists and drug distribu- perfect—far from it, in fact. In the plans move in and out of an area. tors to do the importing for them, coming months and years, I will con- I supported an amendment that Americans can stay at home, and by tinue working to improve it. But it is would have addressed this concern by breaking the monopoly that the drug a start in the right direction, and that allowing all Medicare beneficiaries to companies currently have on drug pric- is why I have supported it. choose the fallback option, no matter ing in this country, we will force a re- The House of Representatives is also how many private plans are available pricing of drugs here in the United expected to pass its version of Medi- where they live. When that amendment States. care legislation this week. The House failed, I cosponsored an amendment I also supported an amendment that and the Senate will now need to have a with Senator CONRAD that would at will help to make more affordable ge- conference committee to work out the least allow seniors who have the fall- neric drugs more readily available. Ge- differences between the two bills. I

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00050 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8697 have some serious concerns about the there is no guarantee for seniors that His alternative would have provided a House-passed bill. I hope these con- they will not have to pay much more Medicare-delivered drug benefit that cerns and the concerns that I have with than that estimate. allows the Secretary of HHS to employ the Senate bill can be resolved in the The bill has the serious potential to negotiating strategies used by the VA final bill, so that we can send a bill to cause a number of retirees to lose ex- and other government entities to bring the President for his signature this isting employer-sponsored prescription down drug prices. Under Senator DUR- year. drug coverage. CBO estimates that as BIN’s plan, seniors would have no de- Mr. SARBANES. Mr. President, I rise many as 37 percent of Medicare bene- ductible, pay only 30 percent of costs today to speak on S. 1, the Prescription ficiaries would lose existing coverage. until reaching the catastrophic limit, Drug and Medicare Improvement Act of This is an unacceptable consequence of and face no coverage gap. In addition, 2003. I applaud my colleagues in work- legislation that is supposed to make employer contributions would count ing toward enactment of legislation to life easier for seniors. This serious defi- toward out-of-pocket limits so there provide prescription drug coverage ciency is the number one concern of would be much less risk of employers under Medicare. However, I am deeply constituents who have called into my dropping retiree coverage. This was the concerned that the bill before us today office about this bill. proposal we should be working from would not ensure an affordable, guar- The bill before us leaves a large gap today, but unfortunately the Durbin anteed benefit that would cover sen- in coverage and forces seniors to con- alternative was defeated by a vote of 56 iors’ outpatient prescription drug ex- tinue premium coverage during that to 39. penses. gap period. Seniors may have to face Those opposed to providing a richer Under this legislation, the Secretary months without any assistance, wait- benefit argue we don’t have the money. of the Department of Health and ing to reach the limit where cata- The selective amnesia of these so- Human Services would temporarily strophic coverage begins. The seniors called fiscal conservatives is baffling. issue prescription drug discount cards who fall into this coverage gap are Not too long ago, this body passed a for seniors until the drug benefit be- among the most ill, with severe chron- tax cut that primarily benefited the gins in 2006. At that time, all Medicare ic conditions and prescription needs. It wealthiest Americans. Where was their beneficiaries would receive a standard is difficult to support legislation that sense of fiscal responsibility then? As prescription drug benefit whether they would cease coverage for prescription my colleagues Senators DURBIN and remained in traditional fee-for-service drugs for seniors at the very time when HARKIN noted yesterday, this is about or in a private plan. For a $275 deduct- it is needed most. priorities. I’m sure others have raised ible and an estimated $35 per month, 50 Finally, because this proposal relies this very good point as well. We can percent of a beneficiary’s drug costs on private plans to deliver the drug risk greater budget deficits to give would be covered up to $4,500. A bene- benefit, seniors could be forced to shift huge tax cuts to Americans who are al- ficiary would receive no coverage for from plan-to-plan, year-to-year as they ready prospering, but we cannot pro- drug costs between $4,501 and $5,800, did when Medicare+Choice HMOs vide the necessary resources for mil- though they are still responsible for pulled out of the Medicare program a lions of Medicare beneficiaries to get paying the monthly premium during few years ago. In my own State of an affordable, reliable drug benefit this coverage gap. Furthermore, any Maryland, insurance companies left that they can understand? I have long been a strong supporter assistance provided by employer-spon- the Medicare program, abandoning of providing older Americans and dis- sored plans or third parties on behalf of more than 100,000 seniors. abled individuals who rely on Medicare the beneficiary does not count toward This legislation makes our Nation’s an affordable, comprehensive, reliable the out-of-pocket costs. After drug ex- seniors the subject of an experiment to and voluntary prescription drug ben- penses reach $5,801, the plan would which none of us should be willing to subject our parents and grandparents. efit. However, I want to ensure we do cover 90% of drug expenses. so in a way that does not worsen the The bill creates a new Medicare Ad- We don’t know what the benefit is situation in which many seniors find vantage program, which would replace under this bill. We don’t know how themselves as they face rapidly rising Medicare+Choice, and create a new much it will cost. We don’t know how drug costs. As we consider proposals to agency, the Center for Medicare private plans will participate and make expand our Nation’s major health enti- Choices, CMC, with authority parallel a profit. We don’t know how many sen- tlement programs, it is appropriate to to the existing Centers for Medicare iors would lose existing coverage. What follow a guiding principle in the prac- we know is we are prepared to spend and Medicaid Services. The CMC would tice of medicine—do no harm. Our sen- approximately $400 billion over 10 years administer the Medicare Advantage iors deserve a drug benefit that is a to create an inadequate drug benefit, a program and the prescription drug real improvement, not a complex ex- new bureaucracy, and subsidies for pri- plans. The drug plans would be admin- periment that may cause more trouble istered through private plans, but when vate insurance companies. than it’s worth. We must not enact a With modest additional resources, we no private plans exist, the government law intended to help that might even- could have closed the coverage gaps in would provide a fallback plan for sen- tually harm millions. The American this bill. Amendments offered by my iors in fee-for-service. However, if a people deserve better. new private plan decides to enter an colleagues to provide stability for sen- Mrs. BOXER. Mr. President, for over area, beneficiaries would again be iors, move up the start date of the drug 35 years, Medicare has been a savior for forced to receive their coverage benefit, eliminate beneficiary pre- our seniors citizens. It has helped pay through that plan. miums during the coverage gap period, their doctor bills, their hospital bills, If this sounds terribly confusing, it and improve a variety of shortcomings and their home health bills. is. One hundred Senators and their have been defeated. We have lost so But it has not paid for their prescrip- staffs found it difficult to work many opportunities to make this bill tion drug bills, and millions of seniors through this bill and understand ex- something all Medicare beneficiaries across the country have been waiting a actly how the benefit would work. Sen- can support. I am hopeful that in the long time for the day when prescrip- iors who don’t sign up as soon as they future we can improve upon this and tion drug coverage is offered through are eligible are subject to a penalty create a system that is easier for sen- Medicare. That day is getting closer. similar to the penalty imposed on iors to understand, more affordable, I am supporting—and the Senate will those who delay enrollment in Part B. and more reliable than what is offered soon pass—a Medicare prescription It is unfair to expect seniors and their today. drug benefit. families to work through this web to I want to highlight one amendment Let me tell you why this is impor- make an informed decision. that would have provided Medicare tant. In California, four million people The complexity of this drug plan is beneficiaries with a substantial, reli- are enrolled in Medicare. Every day, only one of numerous flaws with this able and straight-forward prescription far too many of them are forced into bill. S. 1 does not provide a national drug benefit. I cosponsored and voted the difficult choice of paying for their fixed premium. The bill sets out an es- for this amendment offered by my col- prescriptions or putting food on the timate of a $35 monthly premium, but league from Illinois, Senator DURBIN. table.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00051 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8698 CONGRESSIONAL RECORD — SENATE June 26, 2003 I want to tell you a few of their sto- month. And I supported an amendment should be coerced or forced into a pri- ries. by Senator DASCHLE to limit the dis- vate program or forced to give up cov- I recently heard from a California parities in premiums so that seniors in erage they currently have. woman who told me she struggles to different parts of the country are not It must be affordable. I am not so survive on $950 a month income. She paying different premiums for the sure. I am concerned about the signifi- cannot, she says, afford all of her pre- same benefit. cant deductible—$275 a year and the scription drugs. She is, unfortunately, These amendments would have made hefty premiums—almost $400 a year. It all too typical. the Medicare drug benefit a better drug also has a coverage gap. Once you A constituent from San Marcos, CA benefit for seniors. Unfortunately, spend $4,500 a year—you get no help told me that her annual costs for pre- none of them passed. until you spend $5,800. This will cost scription drugs this year will top But we should not—and I will not— too much. That is why I supported the $10,000. stop trying to make it the best benefit Durbin amendment, which would have Another constituent from Indio, CA it can be. provided a better benefit at less cost to told me that she has made five trips to The good news is that Medicare will seniors. Mexico over the last several years to soon, for the first time ever, cover pre- It must be accessible. It must be purchase her prescriptions. She drives scription drugs. The better news will be available to all seniors, regardless of all day long to Mexico in order to pur- when we fix the problems with this bill where they live. This bill does that. It must be meaningful. It must cover chase affordable heart medication. She and improve the coverage for our sen- the kind of drugs your doctor says you wanted me to remind my colleagues iors. I look forward to the day when need, not what an insurance executive that ‘‘thousands of seniors are forced enough of my colleagues will join me thinks you should get. This bill does to do this.’’ in that effort. that by creating a medical necessity A retired physician from Marina Del Finally, let me say that I hope the override. This means your doctor has Rey told me that a pill he takes for his conference report on this bill—the final version of the bill before it goes to the the final say on which drugs you get, heart disease has gone up 600 percent not an insurance company. I feel pretty from $15 per month to $85. President—does not come back to the Senate in a way that would provide good about that. These seniors—all of our seniors— I tried to improve the bill. I voted for need and deserve to have Medicare help even less help to seniors or in a way that would undermine the entire Medi- amendments to improve the bill. For pay for their prescription drugs. We example: For the Durbin substitute need to end this situation where sen- care program. Ms. MIKULSKI. Mr. President, senior which would have created a stronger, iors are cutting their pills in half or citizens are facing a crisis—a crisis in more comprehensive benefit at a lower forgoing their medications altogether affording health care and a crisis in af- cost to seniors. or skipping meals in order to pay for fording prescription drugs. For an amendment to get rid of the their prescription drugs. That is unac- I have been in communities all over coverage gap. This would guarantee ceptable. Maryland. Listening to seniors who are that seniors would have continuous Today, we are making a prescription desperate. Listening to their families coverage for their prescription drug drug benefit a part of Medicare. And in the diners—who want to help their costs. that is why I am supporting this bill— For an amendment to provide seniors parents, yet face stresses of their own. because, at long last, it puts a Medi- with a guaranteed prescription plan Listening to the employers in the care prescription drug benefit on the that is under Medicare. This would boardrooms—who want to help their books. allow seniors to stay in a prescription retirees, but can no longer afford to. drug plan that is operated by Medicare But, this bill is wanting. It has prob- Here is what they tell me. They say: and not have to move in and out of pri- lems. And I have voted for amendment We need a prescription drug benefit in vate plans and a Medicare fallback after amendment to fix those problems. Medicare. We need a safety net for sen- I offered an amendment to close the plan that is only available when the iors and families. Congress must enact benefit shutdown. Under this bill, even private plans leave the market. a Medicare prescription drug benefit, when seniors have paid and continue to For amendments to protect the bene- and must do it now. pay premiums, Medicare stops covering fits of retirees who already have drug I absolutely agree. It is time Con- coverage. These amendments would prescription drugs, forcing seniors to gress made Medicare prescription drug pay the entire cost. When that failed, I help employers to continue to be able coverage a national priority. to offer quality health care to their re- offered an amendment to ensure that For so many years, Congress has seniors with cancer would never have tirees. talked about prescription drugs and For an amendment to implement the their benefit stopped. Medicare. Talk, talk, talk. You can’t I supported an amendment by Sen- drug benefit next year—instead of talk yourself out of high cholesterol; waiting until 2006 to start these bene- ator STABENOW to ensure that all sen- you need Lipitor. You can’t talk your iors could get prescription drug cov- fits. way out of diabetes; you need insulin. I am sorry all these amendments erage from Medicare itself—the tried The problem with the Senate is— failed on party line votes. and proven system—rather than from a when all gets said and done—more gets This legislation is a beginning. It is private insurance company. said than gets done. Finally—the Con- something we can build on. What it I supported an amendment by Sen- gress is acting. comes down to for me is—will it help ator GRAHAM to stop charging seniors Here are my principles. These prin- the majority of seniors in Maryland? premiums when they are not getting ciples are the yardstick by which I The answer is, yes; it will help over any benefits. measure any proposal. 394,000 people. For people who spend at I supported an amendment by Sen- The benefit must be for seniors, not least $1,110 a year on prescription ator LAUTENBERG to start this benefit for insurance companies. That means drugs—it will help. For someone who is next year not 2 and a half years from the cornerstone must be Medicare. This facing a catastrophic disease like can- now. bill does that. It does not force seniors cer and has very high drug costs—it I supported an amendment by Sen- to give up the Medicare they love to will help. So I will vote for this bill. It ator DODD to encourage employers not get the drugs they need. is not the bill I want. Yet we can’t let to drop their retiree health coverage so It must help the majority of Mary- the perfect be the enemy of the good. seniors who have good coverage can landers. I work for Marylanders. So I We can’t do nothing—as seniors strug- keep it. And the Levin amendment, did the numbers—570,000 Marylanders gle to pay for the drugs they need. which I also supported, would have en- are on Medicare. According to Johns But let me be very clear, this is as sured that if employers did drop such Hopkins, 68 percent of these seniors far as I will go. If this bill comes back coverage, Medicare would be there to would benefit from this legislation. from conference and it is a benefit for provide prescription drugs. That means 394,000 would benefit from insurance companies—say goodbye to I supported an amendment by Sen- this bill. my vote. If it increases costs for senator DORGAN to reduce the premiums It must be voluntary. And the answer iors, say goodbye to my vote. If it cuts that beneficiaries must pay each is, yes, this bill is voluntary. No one benefits, say goodbye to my vote.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00052 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8699 So I will vote for this legislation to- ported that would have brought much efit. I believe such a benefit is long night because I don’t want to say good- needed simplicity and fairness to the overdue for our Nation’s seniors. For bye to this opportunity to provide a bill including the Boxer amendment, years we have promised them we would Medicare prescription drug benefit for which would have closed the coverage give them the crucial help they need seniors. gap for all seniors, and the Daschle with their skyrocketing prescription Mr. HOLLINGS. Mr. President, I rise amendment, which would have limited drug costs. And I believe that it is fi- today in opposition to the Prescription the regional variation among pre- nally time to deliver on that promise. Drug and Medicare Improvement Act of miums to 110 percent of the national It has taken Congress too many years 2003. average. Finally, we chose to provide to act on this pressing need. We have The Senate has spent the last 2 $13 billion in new subsidies to PPOs been debating for years about the best weeks debating how to help our Na- and HMOs instead of using that money way to provide this benefit, and I am tion’s senior citizens afford their pre- to reduce premiums or fill in the cov- afraid that if we do not take the oppor- scription drugs. The Kaiser Family erage gap for cancer or Alzheimer’s pa- tunity in front of us today, it will take Foundation estimates that average an- tients. All in all, the bill provides us even longer to provide seniors the nual out-of-pocket drug spending for Medicare beneficiaries with a benefit help they deserve. Our seniors cannot Medicare beneficiaries grew from $644 3 valued at about $1,000 less than the wait any longer. years ago to $999 this year and will drug coverage available to Federal em- The costs of prescription drugs are reach $1,454 by the time this bill takes ployees. soaring, and the financial toll they This is a plan only Washington could effect in 2006. As a result, 25 percent of take on our seniors means that too dream up. It should come as no sur- seniors without drug coverage declined often seniors must choose between eat- prise that the authors of this con- to fill a prescription and 27 percent of ing and taking the medication that voluted mess and their friends in the seniors without drug coverage skipped will help them live productive, healthy doses to make their prescriptions last White House have decided to wait until after the 2004 election before allowing lives. Our seniors should not have to longer. This is unacceptable. These make that choice. They contributed to citizens deserve affordable, comprehen- Medicare beneficiaries to see what they are in for. the Medicare system over their life- sive, and reliable drug coverage. Unfor- times. That system, which is supposed tunately, the legislation now before us I should also note that this Nation is more than $6.6 trillion in debt. This bill to provide health care to all seniors, fails to provide sufficient coverage. needs to be able to help them obtain From the outset this proposal will is part of budget resolution and eco- the prescription drugs they need to confuse seniors. Enrollees in private nomic plan that will run up an average preserve their health. plans better not get too comfortable deficit of $600 billion a year for the because their plans could be gone in 2 next 10 years. Make no mistake about The second reason I am voting for years if the HMOs find them unprofit- it, we will borrow every red cent to pay this benefit is that it takes a big step able just like they have with for this program. And what do we get in addressing what I see as one of the Medicare+Choice in my state of South in return? Massive subsidies for HMOs, biggest flaws of the current Medicare Carolina. The same goes for enrollees spotty drug coverage for senior citi- system—the geographic inequities in fallback plans. They will be kicked zens, and a lack of attention to the fac- within the Medicare reimbursement out of their plan in as early as a year tors driving the rapid increase of system. We need to end Medicare’s con- if enough private plans enter their health care costs in this country. If we tinued discrimination against Wiscon- area. This volatile system could force are going to borrow from future gen- sin’s seniors. As I have previously dis- seniors to move in between three sepa- erations to pay for this benefit, we cussed on this floor, Wisconsin seniors rate plans, with three separate should get it right. already receive the short end of the formularies, in 3 years. This bill should Now that we have disposed of all stick when it comes to Medicare. Wis- amendments and final passage appears create a sense of stability in the sys- consinites pay the same payroll taxes imminent, I have concluded taxpayers tem and reduce the confusion over cov- to Medicare as all American workers and Medicare beneficiaries would be erage. That is why I supported first the do, but receive fewer benefits in return. better served if we go back to the draw- Stabenow amendment and then the Instead, Wisconsinites’ Medicare dol- ing board. We should come back with a Lincoln-Conrad amendment, which lars are used to subsidize higher reim- proposal with affordable premiums and would have extended the availability of bursements in other parts of the coun- cost sharing requirements with no gaps fallback plans to ensure that seniors try. in coverage that is administered in a will have access to stable drug cov- Wisconsin Medicare beneficiaries re- manner that gives seniors the same erage. ceive on average $4,318 in Medicare sense of security they receive under Senior citizens will need to hire an benefits per year, the eighth lowest in the current Medicare program. I have accountant just to comprehend the the country. By contrast, beneficiaries heard many of my colleagues say this benefits available to them under this in the State with the greatest per cap- is an important first step and it is im- legislation. Once seniors select their ita reimbursement receive $7,209. This portant that we get something on the Medicare drug plan, they will have to distribution of Medicare dollars among books. Nonsense. Thirty months will maneuver a maze of premiums, the 50 States is grossly unfair to Wis- pass before the first beneficiary re- deductibles and copayments for bene- consin. I thank the leadership of the ceives coverage. That was enough time fits that contain huge gaps in coverage. Finance Committee for including pro- to draft and ratify the Constitution. It visions to begin to address this in- On top of their premiums, which will was enough time to complete the Man- vary from region to region and plan to equity in this prescription drug bill. hattan Project. Thirty months should But I know that we still have more to plan, seniors will get no help for the be more than enough time for us to first $275 of their drug costs, pay half of do to reverse the Medicare discrimina- create a real, meaningful prescription tion against States like Wisconsin. costs from $276 to $4,500, pay all the drug benefit for our senior citizens. costs from $4,501 to at least $5,813, and I hope this body will have the wisdom I am pleased that key provisions then pay a tenth of costs above $5,288. to vote no and do this right. have been accepted that greatly im- With a breakeven point of $1,115, many Mr. FEINGOLD. Mr. President, I will prove this bill. The Senate adopted the healthier Medicare beneficiaries will vote for passage of the Medicare pre- Gregg-Schumer-McCain-Kennedy opt not to participate. With a coverage scription drug bill that has been de- amendment, which I was proud to co- gap of $1,302, many of the sickest pa- bated over the past several weeks. sponsor and support, which will bring tients will still have to continue pay- I do so, however, with great reserva- more competition to the prescription ing premiums even though they may tions about many of the provisions in drug market by preventing pharma- have to resort to rationing their care the bill. ceutical companies from blocking ge- until they can spend their way out of I am voting for this measure for two neric drugs from entering the market. the ‘‘doughnut.’’ principal reasons. This amendment is one of the only pro- Once again, the Senate defeated a First, I believe that we owe our sen- visions that will help to bring cost sav- number of amendments that I sup- iors a Medicare prescription drug ben- ings to seniors.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00053 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8700 CONGRESSIONAL RECORD — SENATE June 26, 2003 By adopting Senator DORGAN’s I am also troubled that this bill does little choice with Medicare prescrip- amendment relating to the reimporta- not provide clear, uniform benefits and tion drug plans. tion of prescription drugs from Canada, premiums for all seniors. Many aspects And I am concerned that the uncer- the Senate will help seniors obtain af- of the benefits provided in the bill re- tainty in this bill regarding monthly main uncertain, and will continue to fordable prescription drugs. This legis- premiums, the possible differences in remain uncertain after the plan goes lation helps both consumers who buy benefits packages and the stability of prescription drugs and businesses into effect. Under this bill, the pre- private plans that will deliver these which sell them. I supported this provi- miums are not defined. The premiums benefits may lead to more inequity for sion, both in its earlier legislative form for the Medicare prescription drug plan Wisconsin seniors. and in this amendment, because it is will be dictated by the private insurers the right thing to do. Our seniors and who will offer the plans. The only thing I was disappointed that Senator DUR- other Americans in need of affordable we know for sure is that the Congres- BIN’s amendment, the MediSAVE Act, prescription drugs deserve no less. sional Budget Office estimates that the was not adopted in the Senate. Senator I also supported Senator ENZI’s national average for premiums will be DURBIN’s amendment, which I strongly amendment, which passed overwhelm- $35. However, those premiums may supported, would have fixed most of ingly, that will make sure that com- vary dramatically. Just look at Medi- the errors that exist in this bill. The munity pharmacies, like the ones in care HMO premiums. Medicare HMO MediSAVE Act would have made this my home State of Wisconsin, can still premiums in Connecticut are $99, but benefit one that would truly help all operate within this new prescription in Florida they are only $16. seniors with all of their prescription drug program. Smaller pharmacies will Who will offer the plans is also uncertain. There is no guarantee that plans drug benefit. Senator DURBIN’s probe protected from being shut out by posal offered a meaningful, enhanced larger pharmacies through this amend- will be offered in regions where there may not be enough profit. History prescription drug benefit that would ment, and that means helping seniors have covered all seniors regardless of to access the prescription drugs they again shows us that private companies do not always find rural and smaller whether their prescription drug costs need in their own communities. are high, low, or somewhere in be- I also worked with Senator ALLARD urban areas profitable enough to move tween. on an amendment to provide regu- in. All too often, private companies latory relief for home health care pro- that do move into less desirable Medi- The MediSAVE Act not only put viders that the Senate adopted. Our care markets end up deciding to leave forth cost controls so that taxpayers as amendment enables home health care the region, leaving Medicare bene- well as seniors could save money, but providers to spend more time with pa- ficiaries scrambling to figure out it also would have given seniors cer- tients and less time on paperwork. This where they will turn for coverage. tainty. Seniors would have known ex- Furthermore, my understanding is is particularly important at a time actly what their premiums and benefits that this plan only offers a guaranteed when some home health care providers were and would have the certainty of Medicare-administered plan, or ‘‘fall- are leaving the home health industry knowing that a Medicare-administered back plan,’’ if there are less than two because of burdensome paperwork re- private plans in a region. This means prescription drug benefit would be quirements. that, if only one private plan offers a available to them, no matter what pri- And I am pleased that an amendment prescription drug benefit in the region vate plans were offered to them. Most I offered to bring some clarity to the that includes Almena, WI, a Medicare importantly, the MediSAVE Act pro- Medicare Program for our seniors was beneficiary living in Almena may in- vided the certainty that a senior would adopted. The Medicare Program is al- stead choose the Medicare-adminis- have assistance with their prescription ready full of bureaucratic red tape, tered fallback plan. While on the fall- drug costs year-round and would never often creating barriers for seniors look- back plan, my Almena constituent be caught in the so-called ‘‘donut hole’’ ing for basic information about their would become familiar with the medi- of coverage that this bill provides. health care options. This prescription cations that are included in their for- I am voting for this bill because drug benefit is the biggest expansion of mulary and the cost of their premiums. the Medicare Program since its incep- something, some help for our seniors If a second private plan subsequently with their pressing prescription drug tion in 1965. We are adding an entire decides to move into that region, my new part to the program, and we need costs, is better than nothing. I will understanding is that my constituent support this legislation with the inten- to help guide our seniors through it. will be dropped from the Medicare fall- My amendment is simple. It estab- tion of working with my colleagues back plan, and forced to join one of the lishes a Medicare Beneficiary Advocate over the next 2 years to improve this private plans even if those plans have bill and finally deliver on our promise Office within the Department of Health higher premiums, or do not include and Human Services, with the sole to give seniors a meaningful prescrip- their prescriptions in their tion drug benefit under Medicare. function of providing clear information formularies. to all Medicare beneficiaries. The office Further, my Almena constituent can Mr. JEFFORDS. Mr. President, this will serve as a one-stop information be forced to leave the plan that he or bill is a landmark piece of legislation source on all of Medicare for our sen- she has come to know, if that plan the most significant modernization of iors. leaves the region. This leads to insta- the Medicare Program since its incep- This new office will provide a toll- bility and uncertainty for seniors. tion in 1965. Its passage by the Senate free phone number, a regularly updated Benefits are also uncertain under is a major accomplishment on the path website and regional publications that this proposal. Again, benefit packages toward enacting a prescription drug will give our seniors all of the informa- will be determined by the private in- benefit for our Nation’s seniors. It is tion they need to make informed surers who offer the plans. And we can the result of years of bipartisan, I health care decisions. assume, from experience with the might even say tripartisan, effort and That is the good news. But as I said Medicare+Choice Program, that the earlier, I have many reservations about it puts in place many long-sought benefits will vary widely. I am con- changes. It has many significant fea- this bill. This is not the bill I would cerned about what this may mean for tures for the citizens of my home State have proposed. States like my home State of Wis- of Vermont. It provides a sustainable, This bill does not go far enough to consin, States that have had a difficult universal, and comprehensive prescrip- deliver on our promise to give seniors a time attracting and keeping private meaningful prescription drug benefit. Medicare plans. Some Medicare pre- tion drug benefit. It guarantees access It fails to provide any assistance after scription drug plans may be able to to traditional Medicare for all bene- a senior’s prescription drug costs total offer more brand name drugs at a lower ficiaries. It allows Medicare bene- $3,450, until they spend another $1,850 cost to beneficiaries, while others in ficiaries to participate, if they choose, on prescription drugs, or $5,300 total. less profitable areas may limit the in new systems of care that better re- And it adds insult to injury by making amount of brand name drugs they can flect today’s dynamic health care envi- beneficiaries continue to pay a pre- offer at affordable rates. ronment. The bill recognizes the high mium even during the time they re- I fear that as with Medicare HMOs, cost of providing quality care in rural ceive no benefit. Wisconsin seniors may be faced with settings and closes the reimbursement

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00054 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8701 gap between rural providers and their the Senate do. However, there are hon- for the year, she will have to pay 100 urban counterparts. Finally, it con- est disagreements about how to get it percent of the cost of their prescrip- tains a provision that will allow us to done and whether the bill before us will tions until her total drug spending better understand how to provide qual- strengthen or weaken Medicare. reaches $5,800. This has come to be ity health care—not care driven by My principles are simple. The benefit called the donut hole. This coverage using more and more resources, but in- should be voluntary, guaranteed, uni- gap will leave many seniors to pay the stead one based on ensuring quality pa- versal, and affordable. full cost of prescriptions at a time tient outcomes. Perhaps my greatest concern with when they most need assistance. I Over the past 2 weeks, I have ap- the bill before us is the effect its pas- know of no other insurance program plauded the work of my colleagues who sage is likely to have on retirees who that is so unfairly structured in that have labored over this bill. Today, I currently have prescription drug cov- way. There is a gaping hole in coverage have the pleasure of congratulating erage provided by their former employ- but no gap in the requirement to pay them on their success and thanking ers. Many retirees currently enjoy good premiums. That obligation continues them for their efforts. prescription drug coverage from their even during the period that benefits I have worked for more than 3 years former employer. However, the Con- are halted. gressional Budget Office has indicated with my good friends, Chairman The bill before the Senate also has an that if we adopt the legislation before GRASSLEY and Senators SNOWE, unspecified premium that could fluc- us approximately 37 percent of retirees BREAUX, and HATCH. In many meetings tuate from service area to service area who are currently receiving prescrip- over many months, we delved into the as well as from year to year. Premium tion drug coverage from their former details of what came to be called the amounts are left up to the insurance employers will lose that coverage. Spe- Tripartisan Bill. This has been one of companies. I believe there should be a cifically, on June 12, the Director of the finest experiences of my many cap on those premiums. The effort to the Congressional Budget Office, CBO, years in Congress. I am very proud to adopt one failed. have been a part of that group and that Mr. Douglas Holtz-Eakin, who pre- our efforts led the way to our success viously served for 18 months as chief Adding a prescription drug benefit to today. economist for President Bush’s Council Medicare is one of the most important I especially want to salute the efforts of Economic Advisers, testified at a Fi- things Congress can do this or any of Senator BAUCUS and Senator KEN- nance Committee markup that 37 per- other year. We spend more on prescrip- NEDY without whose hard work and cent of retirees would be dropped from tion drugs than we do on hospital commitment to working through an their former employers coverage. At costs. Members of Congress have been agreement we would not have accom- that same markup, the Administrator promising for years that we would pass plished this remarkable victory, and of HHS’ Center of Medicare and Med- a Medicare prescription drug benefit they deserve our accolades. icaid Services, CMS, Mr. Tom Scully, for seniors. The only way to assure A bill such as this is the result of stated that for current retirees ‘‘who that the benefit will be available reli- great effort on the part of many dif- have employer-sponsored insurance, ably and without complications to our ferent people who are not elected to our estimate is consistent with 37 per- seniors is to make it a guaranteed part this body, but upon whom we all rely. cent having their coverage dropped.’’ of Medicare. The bill before us falls I would like to recognize the staff During the debate so far, amendments short of that. We should at least do no members who have worked so hard on to strengthen incentives for employers harm. When CBO estimated 37 percent this bill and deserve much of the credit to maintain their prescription drug of seniors currently receiving a pre- for its successful passage. coverage for their retirees have failed. scription drug benefit from their On Senator GRASSLEY’s staff: Ted Also very troubling is what I call the former employer are going to lose the Tottman, Linda Fishman, Colin yo-yo effect. To participate in the pro- benefit because of this legislation, that Roskey, Mark Hayes, Jennifer Bell, posed plan, a senior in any service area is real harm. and Leah Kegler, and on Senator BAU- where two or more private plans are of- I hope the major flaws of this bill are CUS’ staff Jeff Forbes, Liz Fowler, Jon fered, no matter what the premium, somehow corrected in conference so I Blum, Pat Bousliman, Kate would only have the option of pur- can vote for a conference report. But I Kirschgraber, and Andrea Cohen de- chasing private insurance. The reason cannot vote for the version before us. serve considerable recognition for their is that only if there are not two private Ms. COLLINS. Mr. President, I was tireless efforts. Catherine Finley, Tom plans offered in the region is the so- pleased to join my colleagues, Senators Geier, and Carolyn Holmes from my called Medicare fallback plan avail- BOXER, COLEMAN, LANDRIEU, KOHL & friend Senator SNOWE’s staff; Patricia able. So let’s assume that there are MURRAY in offering an amendment to DeLoatche and Trecia Knight of Sen- two plans offered in 2006 in a particular authorize a Medicare demonstration ator HATCH’s office; and most espe- service area and a senior opts in. As- project on pancreatic islet cell trans- cially Senator BREAUX’s legislative di- sume further that in 2008, one of the plantation to help advance this tre- rector Sarah Walters deserve enormous two insurance companies pulls out of mendously important research that credit for this bill. Finally, we would the service area and the so-called Medi- holds the promise of a cure for more not be claiming a victory today if it care fallback plan is then available. So than 1 million Americans with Type 1 were not for the contributions of Sen- the senior opts for the Medicare fall- or juvenile diabetes. ator KENNEDY’s staff, especially, David back plan. However, if two private Nexon and Michael Meyers. plans become available a later time, As the founder and cochair of the On my own staff, I particularly want say 2009, the Medicare fallback plan is Senate Diabetes Caucus, I have learned to recognize the contributions of Paul no longer available to the senior and a great deal about this serious disease Harrington during the last Congress, she would then be required to again en- and the difficulties and heartbreak and most especially the work of Sean roll in one of the private plans to re- that it causes for so many Americans Donohue who took up that effort on tain coverage. This yo-yo effect could and their families as they await a cure. the tripartisan bill and who has contin- be repeated forcing seniors to deal Earlier this week, I had the privilege of ued to see it through to today’s suc- again and again with different pro- chairing a hearing featuring young del- cess, with the recent assistance of Dan- grams with different costs and dif- egates from the Juvenile Diabetes Re- iel Crimmins, our Robert Wood John- ferent benefits and lots of paperwork. search Foundation’s Children’s Con- son Health Policy Fellow. Each and all This is totally unacceptable. Seniors gress who had traveled to Washington have worked tirelessly to gather the want stability and continuity in their from every State in the country to tell input, analyze the issues, and build a Medicare Program. They want a pro- Congress what it is like to have diabe- consensus toward achieving this final gram on which they can trust and rely. tes, just how serious it is, and how im- product. In addition, the legislation we are portant it is that we find a cure. Mr. LEVIN. Mr. President, I support considering has a large gap in the pre- Diabetes is a devastating, lifelong making a prescription drug benefit scription drug coverage. Once a sen- condition that affects people of every available to seniors. Most Members of ior’s total drug spending reaches $4,500 age, race, and nationality. It is the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00055 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8702 CONGRESSIONAL RECORD — SENATE June 26, 2003 leading cause of kidney failure, blind- cide whether it should cover pancreatic they see the drug industry continue to ness in adults, and amputations not re- islet cell transplants, the amendment raise their prices and reap record prof- lated to injury. Moreover, a study re- authorizes a 5-year demonstration its—they will—rightly, rightly—revolt. leased by the American Diabetes Asso- project to test the efficacy of pan- I warn my colleagues, this is no bird ciation earlier this year estimates that creatic islet cell transplantation for in- in the hand—it is a vulture. And I can- diabetes cost the Nation $132 billion dividuals with Type 1 diabetes who are not support it. last year and that health spending for eligible for Medicare because they have I cannot support a so-called benefit people with diabetes is almost double end-stage renal disease, ESRD. that asks many seniors, for months at what it would be if they did not have The cost of this demonstration would a time, to pay premiums but receive diabetes. not be high. The Health Strategies absolutely no help with their drug The burden of diabetes is particularly Consultancy LLC, a highly regarded costs. I cannot support a ‘‘benefit’’ that heavy for people with juvenile diabe- independent health policy firm, esti- could cause up to 37 percent of retirees tes. Juvenile diabetes is the second mates that the net Federal cost of the to lose their retiree health plans, leav- most common chronic disease affecting proposal would be about $6.2 million in ing their former employees worse off children. Moreover, it is one that they 2004 and about $84 million over 10 than before we passed this bill. And I never outgrow. years. cannot support a ‘‘benefit’’ which is de- In individuals with juvenile diabetes, The cost of the demonstration nied to low-income seniors eligible for the body’s immune system attacks the project is low because the number of both Medicaid and Medicare. A ‘‘ben- pancreas and destroys the islet cells islet cell transplants that could be per- efit’’ of no benefit for seniors above av- that produce insulin. While the dis- formed is limited. Islet cells are ex- erage drug costs, for seniors with de- covery of insulin was a landmark tracted from a donated pancreas, and cent retiree plans, for seniors who are breakthrough in the treatment of peo- the number of pancreas donors is ex- poor. ple with diabetes, it is not a cure, and tremely small when compared to the I also cannot support a plan that nei- people with juvenile diabetes face the number of Medicare beneficiaries who ther I nor anyone in this body can ex- constant threat of developing life- could benefit from islet cell trans- plain because its details depend on the threatening complications as well as a plants. In 2002, there were 1,875 pan- vagaries of a private market that drastic reduction in their quality of creas donations, but there were over doesn’t exist yet. Under this system, life. 27,000 Medicare beneficiaries who have seniors could be forced into a different Thankfully, there is good news for diabetes as the primary cause of their plan, pay a different premium, and people with diabetes. We have seen end-stage renal disease and who might have different medicines covered every some tremendous breakthroughs in di- potentially benefit from islet cell year. Insurance companies can come in abetes research in recent years, and I transplants. and out, leaving seniors lost and con- am convinced that diabetes is a disease The Health Strategies’ cost estimate fused in a maze of paperwork and that can be cured and will be cured. does not include the financial benefits choices every year. And we know that I am encouraged by the development that would accrue to Medicare for the for those insurance companies that do of the Edmonton Protocol, an experi- reduced medical care costs that would participate, premiums are sure to in- mental treatment developed at the occur for beneficiaries who receive crease because there is no limitation University of Alberta involving the islet cell transplants and, as a result, on premiums in this law. transplantation of insulin-producing suffer fewer diabetes-related complica- I also cannot support a plan that re- pancreatic islet cells, which has been tions such as kidney failure, heart dis- lies so heavily on the private sector to hailed as the most important advance ease, blindness and amputation. Since offer something they have never been in diabetes research since the discovery diabetes currently accounts for one out willing to offer before. Drug-only plans of insulin in 1921. Of the 257 patients of every four Medicare dollars, I be- are virtually nonexistent in today’s who have been treated using variations lieve that this amendment actually marketplace. And the Medicare+Choice of the Edmonton Protocol, all have holds much promise for reducing Medi- experiment, which also uses private in- seen a reversal of their life-disabling care spending in the future. surance companies, has not worked in hypoglycemia, and 80 percent have I understand this demonstration Wisconsin and in many other States. I maintained normal glucose levels with- project has been included in the Medi- cannot support a plan that has to pay out insulin shots for more than 1 year. care prescription drug legislation that insurance companies huge subsidies in Amazingly, many of the transplant re- is being considered by the House. I order to offer a drug benefit. Not only cipients have even reported a reversal hope that the Senate demonstrates is there no guarantee that they will of some of their complications, such as similar wisdom, and I urge all of my participate; but precious Medicare dol- improved vision and less pain from colleagues to support it. lars that could be used to pay directly neuropathy. Mr. KOHL. Mr. President, I rise to for medicines are wasted, funneled to a Earlier this year, I joined with my oppose S. 1, the Prescription Drug and drug industry that, last I checked, was colleague from Washington, Senator Medicare Improvement Act. This bill is not in need of a Federal handout. Even PATTY MURRAY, as well as my col- good for drug companies, insurance worse, this plan does not take advan- league and cochair of the Senate Dia- companies, and people who make TV tage of the potential for controlling betes Caucus, Senator JOHN BREAUX, in ads for politicians—but it is not good drug costs by utilizing the purchasing introducing the Pancreatic Islet Cell for Wisconsin seniors. power of the millions of Medicare bene- Transplantation Act of 2003, which will I know that many of my colleagues ficiaries. help to advance this significant re- will vote for this legislation and that it I do not want to point out that aside search that holds the promise of a cure will pass the Senate. I know that many from the Medicare drug benefit, there for the more than 1 million Americans of my colleagues believe that this is a are several provisions that I strongly with juvenile diabetes. The amendment first step, if an imperfect one. I would in this bill. I am very pleased that the we are introducing today is based on like to agree with them. I would like to bill includes long-needed reforms that one of the provisions of that bill, which vote for a bipartisan compromise that will finally take a strong step toward currently has 43 Senate cosponsors. delivers even a part of the drug benefit fixing the distorted Medicare system Diabetes is the most common cause our seniors rightly demand. But this is we have today—a system that penalizes of kidney failure, accounting for 40 per- not that bill. This is, instead, an empty Wisconsin health care providers by cent of new cases, and a significant promise of straightforward help for paying them less than other States, percentage of individuals with Type 1 seniors struggling with crippling drug and a system that penalizes Wisconsin diabetes will experience kidney failure costs. When they figure out the de- seniors by offering them fewer benefits and become Medicare-eligible before tails—when they see the costs—when than seniors in other States enjoy. Not they are 65. Medicare currently covers they understand the limited benefit only is this unfair for people in the both kidney transplants and simulta- provided—when they work through the Medicare system; it also increases neous pancreas-kidney transplants for complicated formulas determining costs for Wisconsin businesses, employ- these individuals. To help Medicare de- whether they ought to sign up—when ees, and families, who pay higher costs

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00056 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8703 to make up the Medicare shortfall. The expenses, and other factors. Because of that we will be able to work this out so bill before us changes many of Medi- the longer travel times, rural care- that we will be able to ensure that care’s payment systems, especially for givers are unable to make as many vis- Medicare patients in rural areas con- rural areas, and goes a long way toward its in a day as their urban counter- tinue to have access to the home making Medicare fair for seniors and parts. Saundra Scott-Adams, the exec- health services that they need. providers, no matter where they live. utive director of the Visiting Nurses of There being no objection, the mate- I am also pleased that the bill in- Aroostook in Aroostook County, ME, rial was ordered to be printed in the cludes provisions to make generic where I am from, tells me her agency RECORD, as follows: drugs more available to all Americans. covers 6,600 square miles with a popu- U.S. SENATE, It will close loopholes in our current lation of only 72,000. Her costs are un- Washington, DC, June 5, 2003. law that keep generics off the market derstandably much higher than the av- Hon. CHARLES E. GRASSLEY, Chairman, and keep drug prices too high for too erage agency due to the long distances Hon. MAX BAUCUS, Ranking Member, long. The CBO estimates that this pro- her staff must drive to see clients. And, Senate Committee on Finance, Dirksen Senate vision will save Americans $60 billion her staff is not able to see as many pa- Office Building, Washington, DC. DEAR SENATORS GRASSLEY AND BAUCUS: over 10 years. tients. Home health has become an increasingly im- I hope, but don’t expect, that these Agencies in rural areas are also fre- portant part of our health care system. The two important provisions will survive quently smaller than their urban coun- kinds of highly skilled and often technically the upcoming conference with the terparts, which means that their rel- complex services that our nation’s home House of Representatives. And while I ative costs are higher due to smaller health agencies provide have enabled mil- continue to hope that the conference scale operations. Smaller agencies with lions of our most frail and vulnerable older will come back with a better Medicare fewer patients and fewer visits mean persons to avoid hospitals and nursing homes drug benefit, I regret that it is unlikely that fixed costs, particularly those as- and stay just where they want to be—in the to be the case. The House bill is in sociated with meeting regulatory re- comfort and security of their own homes. By the late 1990s, home health was the many ways even worse than the Senate quirements, are spread over a smaller fastest growing component of Medicare bill before us. number of patients and visits, increas- spending. The rapid growth in home health Mr. President, I regret that none of ing overall per-patient and per-visit spending understandably prompted the Con- the amendments that I supported dur- costs. gress and the Administration—as part of the ing this debate prevailed. These Moreover, in many rural areas, home Balanced Budget Act of 1997—to initiate amendments would have greatly im- health agencies are the primary care- changes that were intended to slow this proved this bill and provided a real pre- givers for homebound beneficiaries growth in spending and make the program scription drug benefit to seniors—a with limited access to transportation. more cost-effective and efficient. These benefit we could all have been proud of. measures however, produced cuts in home These rural patients often require more health spending far beyond what Congress Instead, this bill is an empty promise time and care than their urban coun- intended. Home health spending dropped to to seniors and the disabled on Medi- terparts, and are understandably more $10 billion in FY 2002, nearly half the 1997 care. This is not the kind of plan they expensive for agencies to serve. If the amount, and it is clear that the savings have been asking for or have a right to rural add-on payment is not reinstated, goals set for home health in the Balanced expect. We could and should have done agencies may be forced to make deci- Budget Act have not only been met, but far better. But at minimum, we could and sions not to accept rural patients with surpassed. should be able to hold our work here to greater care needs, and access will suf- According to the Congressional Budget Of- the standard set in the Hippocratic fice (CBO), the post-Balanced Budget Act refer further. ductions in home health spending totaled Oath: do no harm. And we have failed. The loss of the rural add-on has al- more than $72 billion between fiscal years I yield the floor. ready caused many agencies to reduce 1998 and 2002. This is over four times the $16 Ms. COLLINS. Mr. President, I want their service areas. Some are elimi- billion that the CBO originally estimated for to thank the chairman of the Finance nating services altogether in remote that time period and is a clear indication Committee for including provisions in areas. There are some counties in Mon- that the Medicare home health cutbacks S. 1 that will provide a measure of re- tana, for example, that have no home have been far deeper than Congress intended. lief to rural health care providers, and health services. And agencies in my As a consequence of these cutbacks, over in particular to home health agencies home State of Maine have had to elimi- 3,400 home health agencies nationwide have serving patients in rural areas. I am either closed or stopped serving Medicare nate delivery of services to some of our beneficiaries. Moreover, the number of Medi- concerned, however, that the under- outlying islands. care patients receiving home health care na- lying bill does not go quite far enough If the 10 percent rural add-on pay- tionwide has dropped by 1.3 million—more and have filed an amendment with Sen- ment is not restored, it will only put than one-third. Which points to the central ator BOND to increase the rural add-on more pressure on rural home health and most critical issue—cuts of this mag- payment for home health agencies to 10 agencies that are already operating on nitude simply cannot be sustained without percent. This was the amount of the very narrow margins and could force ultimately affecting patient care. payment prior to its expiration on more of these agencies to close. Many On October 1, 2002, home health agencies April 1, and I believe it is the amount home health agencies operating in received an additional across-the-board cut in Medicare home health payments, and the that is necessary to ensure that Medi- rural areas are the only home health Centers for Medicare & Medicaid Services care patients in rural areas continue to providers in a vast geographic area. If has dramatically reduced projections for have access to the home health serv- any of these agencies are forced to home health spending under the Medicare ices that they need. close, the Medicare patients in that re- program over the next ten years. We are con- Home health has become an increas- gion will lose complete access to home cerned that any further cuts in payments for ingly important part of our health care care. home health services simply cannot be sus- system. The kinds of highly skilled— There is strong support in the Senate tained without affecting patient care, par- and often technically complex—serv- for restoring the rural add-on. Earlier ticularly for those Medicare beneficiaries with complex care requirements. ices that our Nation’s home health this month, 55 Senators joined me in As you begin consideration of a Medicare agencies provide have enabled millions sending a letter to the chair and rank- modernization package, we urge that you of our most frail and vulnerable older ing member of the senate Finance avoid any further cuts in payments for home persons to avoid hospitals and nursing Committee urging that they extend the health services and preserve the full market homes and stay just where they want 10 per cent rural add-on for home basket update for payments for home health to be—in the comfort and security of health agencies, and I ask unanimous services for 2004. In addition, we urge that their own homes. consent that this letter be printed in you extend the 10 percent add-on payment for home health services in rural areas that Surveys have shown that the delivery the RECORD. of home health services in rural areas The chairman of the Finance Com- expired on April 1, 2003. Surveys have shown that the delivery of home health services in can be as much as 12 to 15 percent more mittee and his staff have been working rural areas can be as much as 12 to 15 percent costly because of the extra travel time with us to try to accommodate my more costly because of the extra travel time required to cover long distances be- amendment, and I am very appre- required to cover long distances between pa- tween patients, higher transportation ciative of their efforts. I am hopeful tients, higher transportation expenses, and

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00057 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8704 CONGRESSIONAL RECORD — SENATE June 26, 2003 other factors. Extension of this add-on pay- bate. At these forums I heard from my These are the seniors facing the most ment will therefore help to ensure that Medi- constituents on many matters regard- sever health problems, and most in care patients in rural areas continue to have ing their health care. But the present need of financial assistance. That is access to the home health services they lack of coverage for prescription drugs what this bill provides—even if it is not need. Thank you for your consideration, and we under the Medicare program was by far to the extent that many of us would look forward to working with you to ensure the issue raised most often. have liked. that elderly and disabled Americans con- At these forums I heard from seniors I am voting for this bill because so tinue to have access to quality home health who literally could not afford to fill many seniors in Connecticut and services. prescriptions called for by their doc- throughout the country stand to ben- Sincerely, tors. I heard from elderly Medicare efit. However, no bill is perfect and S. Susan M. Collins; Christopher S. Bond; beneficiaries forced to choose between 1 clearly still leaves much room for im- Wayne Allard; Gordon Smith; Robert purchasing groceries or filling their provement even as it moves toward F. Bennett; Richard Lugar; Jack Reed; Russell D. Feingold; Patty Murray; prescriptions. I heard from seniors who final Senate passage. I am particularly John W. Warner; James Talent; Carl were forced to skip dosages of their disheartened that, despite numerous Levin. medicines in an attempt to stretch attempts over the past 2 weeks, we Charles Schumer; Chuck Hagel; Barbara their limited supplies of needed medi- have failed to address concerns over Mikulski; Jon Corzine; Tim Johnson; cines. I heard from Medicare bene- the present bill’s lack of adequate pro- Patrick Leahy; Herb Kohl; Mary Lan- ficiaries requiring more than 10 pre- visions to ensure that those companies drieu; Evan Bayh; Dianne Feinstein; scribed medicines a day unable to af- presently providing their retirees with Hillary Rodham Clinton; Maria Cant- ford even half of these prescriptions. prescription drug coverage receive ade- well; Frank Lautenberg; Ron Wyden; John Kerry; Ben Nelson; Debbie Stabe- Clearly, what I heard from hundreds of quate Federal support for their laud- now; Mark Dayton; Ben Nighthorse Connecticut’s more than 500,000 Medi- able efforts. While the creation of a Campbell; Mike DeWine. care beneficiaries is their grave con- prescription drug benefit under the Arlen Specter; George Voinovich; James cern over the present lack of a pre- Medicare program is laudable, it Jeffords; Bill Nelson; Saxby Chambliss; scription drug benefit under the Medi- should not come at the price of dis- Conrad Burns; Christopher Dodd; Jo- care Program. placing the employer-based benefits seph Lieberman; Blanche L. Lincoln; I believe that the legislation about to that so many seniors have come to rely Larry Craig; Paul Sarbanes; Lincoln be approved by this body offers an an- on. Chafee; Mike Crapo; Richard Durbin; swer to those concerns. It is not the Additionally, I remain concerned Barbara Boxer. Tom Harkin; Pat Roberts; Jim Bunning; most complete answer, but it is a that the gap in coverage in the present Ted Kennedy; Sam Brownback; Byron start—based on which we can improve bill, the so-called donut hole, will leave Dorgan; Thad Cochran; and Richard in the future. It is a start because it many Medicare beneficiaries facing Shelby. will make so many seniors better off high prescription drug costs with no Mr. DODD. Mr. President, I rise than they are today. And that should assistance at the very time when it is today to speak in support of S. 1, the be our ultimate goal as legislators—to most needed. Over the past 2 weeks, I Prescription Drug and Medicare Im- make people’s lives better. Often this have both offered and supported provement Act of 2003. However, I do so must be done incrementally, in steps. amendments designed to provide assist- with great trepidation. While I intend This bill is a positive first step. ance to those with prescription drug to vote for the bill that is presently be- What do I mean when I say that it costs within the hole, especially those fore the Senate, I believe that drastic will make people better off? In Con- with lower incomes who can least af- changes are still necessary to make the necticut, one-third of all Medicare ford any gap in coverage, that have benefit created by this legislation one beneficiaries have incomes below 160 failed to win support by the Senate. that meets the needs of our senior citi- percent of poverty. For many of these Failure to close this gap, in my view, zens. seniors, drug costs can be crippling. constitutes a glaring failure, one that I I am also deeply concerned that They are forced to choose between put- hope can be reversed as this bill moves Members on the other side of the ting food on the table, and buying the into conference. aisle—as well as those in the House of medicines that they need to live I also am concerned that S. 1 fails to Representatives, and the administra- healthy lives. With the passage of this adequately protect Medicare bene- tion—will attempt to move this bill in bill, these seniors will no longer have ficiaries form the very understandable a destructive direction during con- to make this choice. The new Medicare confusion and uncertainty that may ference. Let me reiterate what I said in prescription drug benefit will cover surround them just as they begin to an earlier statement on this issue: we most, if not all, of their drug costs. I navigate the intricacies of a brand-new must not approve any Medicare reform congratulate Senator GRASSLEY and program. Specifically, if enacted the measure that would force seniors to Senator BAUCUS, and other members of underlying bill will require Medicare join private plans in order to receive a the Senate Finance Committee for in- beneficiaries choosing a prescription more generous prescription drug ben- cluding in this bill such a generous drug plan to stay with that plan for a efit. Such a measure would signal an benefit for those low-income seniors. minimum of 1 year. With the enact- end to the Medicare Program as we This legislation is not as clear cut for ment of such broad and weeping know it and should be rejected out of those seniors who have incomes above changes to the Medicare program, I am hand. I urge my colleagues to protect 160 percent of poverty. However, I be- fearful that many Medicare bene- the Medicare that our seniors have lieve that the majority will be helped ficiaries will face great uncertainty come to rely on, and I urge the Presi- by passage of this bill. The break even trying to find the best plan to meet dent not to sign any bill that privatizes for this benefit—the point where an in- their particular needs. For this reason, Medicare. If such changes are made, I dividual is better off with the benefit I offered an amendment to S. 1 that will not hesitate to oppose the con- rather than just paying for all prescrip- would have simply granted Medicare ference report. tion drugs our of their own pocket—is beneficiaries navigating this new ben- Given these concerns, it is reasonable about $1,100 in total annual drug costs. efit for the very first time the ability to ask why I am supporting this bill. The average Medicare beneficiary to switch plans as they seek to deter- The answer is quite simple—seniors in spends approximately $2,300 on pre- mine which plan fits their particular my home State of Connecticut and scription medicines today. That num- health care needs in the first 2 years of across the country have been waiting ber will undoubtedly be higher when the bill’s benefit. Unfortunately, this far too long for a prescription drug this new benefit goes into effect in 2006. amendment was not agreed to and I re- benefit under Medicare. And it is time With the benefit created by this bill, main concerned that without its pro- that we in Congress heard them. that average beneficiary will realize tections, senior Medicare beneficiaries Over the past month I had the oppor- nearly $600 in savings. The savings will will be unfairly locked into plans that tunity to convene a series of forums on be even greater for the 11 percent of do not meet their needs. senior health care in Connecticut in an beneficiaries who spend more than Mr. President, I am pleased that S. 1 attempt to frame the scope of this de- $5,000 per year on prescription drugs. represents a significant departure from

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00058 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8705 previous plans supported by the admin- the vitality of our democracy can and reduced or waived monthly pre- istration that would have required shape the oldest of our values to the miums and deductible. Medicare beneficiaries to leave the tra- needs and obligations of today.’’ Nearly Equally important, this plan provides ditional fee-for-service Medicare Pro- four decades later, we are on the cusp seniors with the security of knowing gram in order to receive coverage for of a similar challenge. Let us move that they are covered in the event their prescribed medicines. Such a Medicare toward the future without something happens and they find them- move would be unconscionable as 89 threatening its proven ability to pro- selves facing exorbitant drug costs. At percent of all Medicare beneficiaries vide for the health and well being of $3,700 in out of pocket drug costs, stop- today are in the traditional program. this Nation’s senior citizens. loss coverage kicks in and the senior is To force these beneficiaries to leave Mr. COLEMAN. Mr. President, I am only responsible for 10 percent of costs their present system of coverage, and proud to mark this extraordinary day beyond this amount. most likely the doctor that they have by coming to the floor of the Senate to This bill is also about expanding op- come to know and trust, would not celebrate the imminent passage of a tions for this generation and future only create great disruption, it would prescription drug benefit for Medicare. generations of seniors. The incre- also for the first time since the pro- This is a triumph not for a party or a mental improvements to the Medicare gram’s inception create a tiered benefit President, but for America’s seniors program have largely been the result of system under Medicare that would and their families. This is an incredibly legislative action over the last 40 more greatly reward those who choose hopeful day for all Americans who long years. The legislative process, however, to join a private preferred provider or- for a national government that can get is not a quick process, and it is simply ganization, PPO, or health mainte- things done for people. not possible to keep the program cur- nance organization, HMO. Thirty-eight years ago Congress rent in the first parcel environment we And while I am pleased that the bill voted to create a health care program currently live. before us soundly rejects a tiered ben- that would be the primary source of The Medicare Advantage program in- efit system, I am deeply concerned that health insurance for this Nation’s sen- cluded in this bill offers seniors the the plan presently taking shape in the iors. Most people would agree that this choice of receiving their health care House of Representatives appears to program has served us well for almost benefits in a Preferred Provider Orga- rely on such a flawed plan. As I said four decades. However, the practice of nization, PPO, the same type of health plan enjoyed by many families. earlier, such a measure should be medicine has changed. Drug therapies, Under this health care option—not soundly rejected. medical devices, and human genome re- mandate—seniors will have increased So it is with great caution that we search all hold great hope for breaking access to the latest advances in care come to the final moments of debate on through physical limitations that such as desire management and better this important issue. Medicare’s nearly hinder many seniors’ ability to enjoy preventive screenings. Additionally, 41 million beneficiaries clearly need as- the later years of life. seniors who chose this option will also sistance in affording their needed The question we now ask is what have a lower deductible for inpatient medicines. The result of our efforts level of care are we going to provide and hospital care than those in tradi- over the past 2 weeks, and more impor- our seniors and is the current system tional Medicare. tant, the result of the coming con- equipped to provide the type of care This bill lays the foundation for a ference committee on this legislation our seniors need and deserve. Medicare program that is better able to will greatly determine to what extent The benefits provided under Medi- respond to an evolving health care sys- we assist our Nation’s Medicare bene- care, considered generous at its incep- tem by harnessing the efficiencies of ficiaries to afford their needed medi- tion in 1965, pale in comparison to the health care market, while pre- cines. those enjoyed by Federal employees serving traditional Medicare for those Clearly, a great opportunity is pres- and most workers in the private sector seniors who are satisfied with their ently before us. As the underlying bill today. A recent report submitted by current coverage. moves to conference committee. I look the Joint Economic Committee found This bill is about expanding options forward to working with my colleagues that Medicare has the least generous for seniors so our parents and grand- to ensure that we seize this oppor- benefit package among leading forms parents have access to the type of care tunity by strengthening the underlying of insurance. Medicare covers 56 per- best suited for them. bill. With passage of the bill presently cent of total health care expenses, Is this bill everything everyone before us, we now face a choice. We can while typical employment-based health wants? Of course not. Are there deci- insist on the good start that we have insurance covers 70 percent. sions still to be made as it is imple- made here with passage of S. 1, and Seniors need prescription drug cov- mented and we see how it actually work to strengthen its provisions. Or, erage. Seniors need better access to works in the marketplace? Certainly. conversely, we can accede to the House preventative care and disease manage- But this bill says we are not going to legislation that in my view unfairly ment. Seniors need more choices in let the lack of perfection stop us from jeopardizes the traditional Medicare their health care options than they doing real good for people as soon and Program by tilting the system in favor have today. Without updating, it may as effectively as we practically can. of risky privatization schemes and take years to add this kind of care to I would be remiss if I didn’t express against seniors. the current program—after all, it has my appreciation to Senators GRASSLEY I ask my colleagues to join with me taken over 30 years to add a prescrip- and BAUCUS for their leadership in in- in working to ensure that any Medi- tion drug benefit. cluding many provisions in this bill to care prescription drug legislation The Prescription Drug and Medicare strengthen rural health care. passed by this Congress is at least as Improvement bill is a step toward The availability of health care in strong as the bill we are about to vote meeting the needs of this Nation’s sen- rural areas in Minnesota is absolutely on. A tilt toward the House-drafted iors. critical to the stability and viability of language would signify not a strength- This bill provides a solid drug benefit many communities. ening of Medicare, but rather a weak- that will provide assistance to every The provisions in this bill to improve ening of this vital program’s founda- senior struggling to pay for prescrip- payments to hospitals in rural areas tion and must be avoided at all costs. tion drugs as well as the security of and reduce the geographic disparity in Nearly 38 years ago on July 9, 1965, knowing they are covered for unfore- physician payments are critical to en- this body passed the legislation cre- seen drug expenses. suring that these hospitals that threat ating the Federal Medicare Program Under this plan, the average senior’s not only seniors, but entire commu- sending it to a conference committee annual drug costs will be reduced by 53 nities continued to receive care. with the House. On that day, President percent each year. That amounts to I am pleased that we did not allow Lyndon Baines Johnson remarked, $1,677 each year back in the pocket of perfect to be the enemy of good as we ‘‘This is a great day for older Ameri- our seniors. And seniors with the great- considered this package. cans. And it is a great day for America. est needs will receive additional assist- This is a substantial and dependable For we have proved, once again, that ance through increased cost-sharing, benefit for America’s seniors. Again,

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00059 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8706 CONGRESSIONAL RECORD — SENATE June 26, 2003 it’s not everything everyone wants. bulk of the cost of a heart bypass oper- The PRESIDENT pro tempore. The There are still decisions to be made as ation for all beneficiaries, it should question is on agreeing to the com- it is implemented and we monitor how similarly pay the bulk of the cost of mittee amendment in the nature of a it works in the marketplace. But today the drugs used to lower the cholesterol, substitute, as amended. we are delivering on a promise to pro- and which would prevent the need for The committee amendment in the vide quality care to our seniors. the bypass operation, for all bene- nature of a substitute, as amended, was I am hopeful that with bipartisan ficiaries. This bill does not achieve agreed to. support this landmark legislation will that commonsense goal. Not even The PRESIDENT pro tempore. The pass the Senate and the House of Rep- close. question is on engrossment and third resentatives by the July 4th holiday. But we need to start somewhere. This reading of the bill. When it does, there may not be any is the first step in gradually moving The bill was ordered to be engrossed fireworks and parades but millions of the health plan that covers nearly 40 for a third reading and was read the seniors will be able to declare their million seniors and disabled individ- third time. independence from worrying about get- uals into the 21st century. And it is, Mr. GRASSLEY. Mr. President, I ask ting the prescription drugs they need very frankly, the best that we can ex- unanimous consent that following pas- to live a quality life. pect to pass this Congress and that the sage of S. 1, the bill be held at the Mr. BIDEN. Mr. President, after President will sign. desk; further, when the Senate receives many years of preparation and delib- There are some good provisions in from the House the companion measure eration, and following weeks of debate this bill. All Medicare beneficiaries to S. 1 the Senate proceed to its consid- and discussion on the floor this year will have access to a prescription drug eration, all after the enacting clause be and last, we in the Senate are about to plan. Individuals with low incomes, stricken, and the text of S. 1 as passed vote on a bill providing some prescrip- below 160 percent of Federal poverty be inserted in lieu thereof; the bill then tion drug benefits for Medicare bene- level, will have access to prescription be read a third time and passed with ficiaries that is widely expected to drug coverage at very little cost. Those the motion to reconsider laid upon the pass. with very high prescription drug ex- table; further, that the Senate then in- Seniors have been demanding pre- penses, in the many thousands of dol- sist on its amendments and request a scription drug coverage for many years lars, will have stop-loss protection to conference with the House, and the now. They need it and they deserve it, help protect them against catastrophic Chair be authorized to appoint con- and I believe what we should be passing drug costs. And no one is forced to ferees with a ratio of 5 to 4; finally, here today is a bill that will bring the abandon the traditional Medicare Pro- with that action, I ask unanimous con- American people the type of prescrip- gram for their basic health care, with sent that passage of S. 1 be vitiated tion drug benefit they have been seek- which they are so familiar, in order to and the bill be placed back on the cal- ing—one that is easy to understand and obtain prescription drug coverage. endar. use, one that covers a substantial por- During the Senate deliberation on The PRESIDENT pro tempore. With- tion of all their costs, and one that is this bill, I have voted for amendments out objection, it is so ordered. affordable. that would improve the prescription Mr. BAUCUS. Mr. President, I want But to the many Medicare bene- drug coverage and decrease the cost to to take a few moments to return to the ficiaries who will read the details of beneficiaries. Almost all of these basics of what this bill is all about. this bill and say, ‘‘there isn’t much in amendments were not adopted, mostly Let’s keep our eyes on the ball. here for me and it will cost me more with the rationale that there was not We are working here to make a than I am now paying for drugs,’’ I enough money. I do not feel con- meaningful improvement in health would say: I hear you. This bill is not strained by some arbitrary $400 billion care for seniors. We are working to enough, not nearly enough. cost limit on this bill. I never agreed to bring prescription drug coverage to I have a lot of concerns about this such a limit. In fact, my sense of val- Medicare beneficiaries. bill. There is no uniformity from re- ues tells me that prescription drug ben- Too many seniors do without drug gion to region in the benefit package or efits are a high priority, and I would be coverage. The Congressional Budget Of- beneficiary payments. Seniors in the willing to spend more than $400 billion fice reports that roughly a quarter of East could be paying far higher pre- for a good prescription drug plan, while Medicare beneficiaries have no drug miums than their relatives in the Mid- cutting budget items of lower priority, coverage. Ten million people. They west. such as tax cuts for the very wealthy. have to pay all of their drug costs out The drug plan relies on private insur- In the end, I decided to vote for this of their own pockets. They pay full ance companies to provide a type of in- bill, despite its severe limitations. price. surance policy that they have already Given the many past years of fruitless Lack of coverage means poorer said they are unwilling to sell. I am discussions on this matter, I feel it is health. Seniors who get along without skeptical that these private plans will critical to put something into law now drug coverage get fewer of the healing stay, and that could mean seniors will that can serve as a starting point for benefits that prescription drugs pro- have no stability in their coverage. The development of a true prescription vide. CBO reports that when seniors do bill does allow traditional Medicare to drug plan. But that is not to say that not have drug coverage, they fill about step in and fill the gap but seniors I will accept any lesser of a bill, and a quarter fewer prescriptions, on aver- might have to move back to a private my colleagues should not count on my age, than do those who have coverage. drug plan if new ones come to the re- continued support, if the final version But whether seniors have coverage or gion. of this bill that comes out of negotia- not, they still need a significant There is also a gap in coverage which tions with the House of Representa- amount of prescription drugs. CBO says I think is unfair and will surprise a lot tives undercuts the Medicare Program that in 1999, Medicare beneficiaries who of people. or moves toward reducing protections had coverage filled an average of 32 Finally, the bill falls short in its ef- for beneficiaries. prescriptions a year. Those without forts to induce employers not to aban- We also need to remember, this bill coverage still filled an average of 25 don their retiree prescription drug cov- comes with a warning to all of us: the prescriptions a year. erage, a situation that too many retir- public is a lot smarter than they are These prescriptions cost seniors a ees have already faced in recent years. sometimes given credit for, and if we good deal of money. The average Medi- In summary, I view this bill not as a do not work diligently to improve what care beneficiary spends about $2,500 a situation where we would say that the we have begun, they will rightly take year on prescription drugs. That’s a big glass is half full and half empty; to my out their anger on us. We need to en- number—especially as the median in- thinking, the glass is only about one- sure that this bill is the first step, not come for all elderly households in 2001 quarter full. In 2003, prescription drugs the last step. was less than $19,000. are as important in medical care as Mr. GRASSLEY. Mr. President, par- Those costs are rising fast. CBO surgery; consequently, it seems logical liamentary inquiry. Are we now ready projects that the average Medicare to me that if Medicare pays for the for third reading? beneficiary’s drug costs will rise at a

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00060 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8707 rate of more than 10 percent a year ment program. This is a historic oppor- The PRESIDENT pro tempore. Are over the next decade. That is far faster tunity to make a fundamental change there any other Senators in the Cham- than the cost of living. That means for the better for millions of Ameri- ber desiring to vote? that without this legislation, seniors cans. The result was announced—yeas 76, will need to devote larger and larger In so doing, this bill would finally do nays 21, as follows: shares of their income to paying pre- something that the overwhelming ma- [Rollcall Vote No. 262 Leg.] scription drug bills. jority of industrialized nations have al- YEAS—76 ready done. So we are here to try to make pre- Akaka Daschle Lugar scription drugs more affordable for sen- This is a broad compromise. This is Alexander Dayton McConnell iors. And we are here to extend cov- not a bill of the left or a bill of the Allen DeWine Mikulski erage to the roughly 10 million seniors right. This is a weaving together of ap- Baucus Dodd Miller Bayh Dole Murkowski who have no prescription drug coverage proaches, in the finest American tradi- Bennett Domenici tion. Murray at all. Biden Dorgan Nelson (FL) We are here to try to end seniors’ This is a historic opportunity. Let us Bingaman Durbin Nelson (NE) Bond Enzi painful choice between filling prescrip- finally seize that opportunity, and im- Pryor Boxer Feingold Reid tions and buying food. Seniors should prove health care for our seniors. Let Breaux Feinstein not have to choose among the neces- us finally seize the opportunity, and Brownback Fitzgerald Roberts Schumer sities to maintain their health. We are bring prescription drug coverage to all. Bunning Frist Mr. GRASSLEY. Mr. President, we Burns Grassley Sessions here to do something about that today. Campbell Hagel Shelby Let me review what this bill would are about to take a historical vote. Cantwell Hatch Smith do. Since 1965, Medicare hasn’t covered Carper Hutchison Snowe This bill would make available pre- prescription drugs. Now, 38 years later, Chafee Inouye Specter we’re changing that—on a strong bipar- Chambliss Jeffords Stabenow scription drug insurance to all seniors. Cochran Johnson Stevens This bill would ensure that 44 percent tisan basis. Coleman Kennedy Talent of Medicare beneficiaries—those with Because of this bill, on January 1, Collins Kyl Thomas 2004, seniors across America will have Conrad Landrieu Voinovich the lowest incomes—would have truly Corzine Lautenberg affordable prescription drug coverage immediate help with prescription drug Warner Craig Leahy Wyden with minimal out-of-pocket costs. For costs. Moreover, on January 1, 2006, Crapo Lincoln seniors will have access to affordable, these lower-income seniors, with in- NAYS—21 comes up to 160 percent of the poverty comprehensive drug coverage as a permanent part of Medicare. Allard Graham (SC) McCain level, copayments would never exceed Byrd Gregg Nickles 20 percent of the cost of drugs. No longer will seniors have to make Clinton Harkin Reed Let me take some examples. Let’s hard choices when it comes to paying Cornyn Hollings Rockefeller look at what this bill would do for for prescription drugs. Edwards Kohl Santorum This bill also strengthens and im- Ensign Levin Sarbanes beneficiaries with what will likely be Graham (FL) Lott Sununu proves Medicare, giving seniors more average drug spending of $3,155 in 2006. NOT VOTING—3 For seniors with average drug ex- choices and better benefits than they penses, even with higher incomes, this have today. Inhofe Kerry Lieberman bill would save them $1,677. That is a 40 At the same time, it brings long The bill (S. 1), as amended, was percent savings in out-of-pocket costs. overdue Medicare equity to the people passed. The savings would be greater for of Iowa and to other rural States. (The bill will be printed in a future We are on the verge of a major vic- lower income seniors. For an individual edition of the RECORD.) tory. making $14,000 or a couple making The PRESIDENT pro tempore. With- I urge my colleagues to support S. 1. out objection, the title amendment is $19,000 a year, with average drug spend- Mr. BAUCUS. Mr. President, we are ing, they would save $2,842. That is a 90 agreed to. about to vote. I want to thank all Sen- The title was amended so as to read: percent savings in out-of-pocket costs. ators for their tremendous patience. It For an individual making $12,000 or ‘‘A bill to amend title XVIII of the So- is not an easy task. I particularly couple making $16,000 a year with aver- cial Security Act to provide for a vol- thank the chairman of the committee age drug spending, they would save untary prescription drug benefit under but also all Senators. the medicare program and to strength- $2,842 in out-of-pocket costs. That Second, I thank the staff who have en and improve the medicare program, would be a savings of 96 percent in out- not had any sleep in the last two or and for other purposes.’’. of-pocket costs. three weeks. I don’t know how they are Mr. GRASSLEY. Mr. President, I This bill would thus ensure that still standing. A lot of people have been move to reconsider the vote. those who have been least able to re- working on this bill. My thanks. I The PRESIDENT pro tempore. The ceive the healing benefits of prescrip- know I speak for all the Senators in Chair, in my capacity as a Senator tion drugs would now be able to do so. thanking all the staff that worked so from the State of Alaska, moves to lay Millions of people would have a better hard to help achieve this end. that motion on the table. quality of life. Lives would be saved. The PRESIDENT pro tempore. The The motion to lay on the table was This bill would create a strong Gov- bill having been read the third time, agreed to. ernment fallback. Seniors would have the question is, shall it pass? access to at least two private plans for Mr. HOLLINGS. Mr. President, I ask Mr. INHOFE. Mr. President, because a prescription drug benefit, or the Gov- for the yeas and nays. of urgent business back in my State of ernment would provide a standard fall- The PRESIDENT pro tempore. Is Oklahoma, I will be unable to be in at- back plan. If there is not true competi- there a sufficient second? tendance to vote on S. 1. It makes no tion, then traditional Medicare would There is a sufficient second. The difference, however, because I would provide a fallback. clerk will call the roll. have voted against it. The Department of Health and The legislative clerk called the roll. Last week, I addressed this Chamber Human Services would continue to Mr. MCCONNELL. I announce that regarding S. 1, the Prescription Drug oversee these plans. The plans would the Senator from Oklahoma (Mr. and Medicare Improvement Act. At operate within tightly controlled lim- INHOFE) is necessarily absent. that time, I said I could not support its. This bill includes strong consumer Mr. REID. I announce that the Sen- the legislation in its current form and protections. ator from Massachusetts (Mr. KERRY) expressed my hope that it could be im- And this bill does not tilt the playing and the Senator from Connecticut (Mr. proved on the floor. Unfortunately, field. This bill does not make private LIEBERMAN) are necessarily absent. that has not occurred. I am restating plans a better deal than traditional I further announce that, if present my opposition to this legislation. Medicare. and voting, the Senator from Massa- This is simply another Federal enti- This bill would make a nearly $400 chusetts (Mr. KERRY) would vote tlement program designed to balloon billion expansion of a major entitle- ‘‘nay’’. past expected costs of $400 billion. For

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00061 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8708 CONGRESSIONAL RECORD — SENATE June 26, 2003 example, in the past, Medicare ex- for millions of seniors and individuals improve this legislation and to make penses have soared nearly five times with disabilities. Tonight seniors and sure that it does not inadvertently dis- the projected costs. I remember that individuals with disabilities, through place good private health care coverage well because I remember in 1965 when this bill, will get relief from high pre- that exists today—options that are it was passed. This trend will only es- scription drug costs and outdated, available to millions of Medicare bene- calate if we continue to add unfunded often inadequate medical care. Tonight ficiaries, including employer-sponsored obligations without ensuring the long- we are one step closer to providing real health coverage. term solvency of the entire program. health care security to seniors all Compromise and debate are the cor- We must examine the necessity of across the Nation. nerstone of this great democratic sys- such obligations prior to placing the We stand on the shoulders of many in tem of government. I commend my col- burden on the backs of the future tax- this body and in the House of Rep- leagues for their admirable show of bi- payers. And is a full prescription drug resentatives who have labored mightily partisan spirit. Thanks to the leader- benefit necessary? Currently, 76 per- to improve the Medicare Program. We ship of our colleagues in the Senate cent of seniors already have some form have reached this point of success be- and the commitment of President of prescription drug coverage. A recent cause of the commitment of the leader- Bush, America’s seniors will finally re- Zogby poll found that three-fourths of ship in the House as well as the Senate. ceive the health coverage they need seniors thought the coverage offered Above all, we are indebted to the bold and the security they deserve. under this plan would be no better than leadership of the President of the I want to take a brief moment to what they currently have. In fact, less United States without whom we would thank all of my colleagues for their than one-half would even purchase the not be transforming or improving the hard work and dedication over the last option if given the choice. However, system. several weeks. It has been about 3 with the passage of S. 1, those individ- Indeed, the bill we have just passed is months ago that I set out that we uals may not be given that choice. CBO nothing less than historic. By dramati- would address Medicare for these 2 estimates that one-third of Medicare cally expanding opportunities for pri- weeks—the 2 weeks prior to the July 4 beneficiaries with employer-sponsored vate sector innovation, it offers gen- recess. Many people said we were try- uine reform that will dramatically im- coverage will lose those benefits once ing to do too much in too short a pe- prove the quality of health care for all the bill takes effect. Seniors who cur- riod of time. Others said it is some- seniors. At the same time, the legisla- rently have private coverage that they thing that has been debated for weeks tion preserves traditional Medicare so like will be forced to buy the Govern- and months, and indeed years, and that those who wish can remain in tra- ment-sponsored benefit simply because there is no way we can finish it before ditional Medicare and keep exactly it is the only thing that will be avail- July 4. what they have today. Yet through the hard work of our col- able. This bill combines the best of the leagues—again, on both sides of the There is something wrong with that public and private sectors and posi- aisle—we have fulfilled that vision. picture. The Government should not be tions Medicare to evolve with the med- Again, it is a first step, a step that will replacing coverage that already exists. ical treatments of the future. It is en- be improved in that conference before However, this legislation opens the tirely voluntary. us. Nevertheless, we succeeded in what door for continued Government inter- I am very pleased by the over- we set out to do with the legislation vention. With the inclusion of the fall- whelming majority of this body who that is built upon the work of many back provision, this benefit has the po- tonight voted to move this legislation Members of the Senate, as well as the tential to become fully federalized if towards a more competitive private House of Representatives and, in par- private plans do not surface. Once model but a partnership between the ticular, the members of the Senate Fi- again, we are placing more and more public and private sector. nance Committee. I do want to thank expense at the door of the taxpayers, I am also pleased that the amend- especially Senators HATCH, NICKLES, our children, and our grandchildren. ment maintained the balance that has LOTT, SNOWE, KYL, THOMAS, SANTORUM, I am concerned about the effect this been so important in what I set out a SMITH, BUNNING, and BREAUX for their bill could have on the future of the en- few weeks ago, to be a truly bipartisan hard work and leadership. tire Medicare Program. I have worked effort. The bill devotes increased re- In particular, of course, I thank with my colleagues to support im- sources and expands opportunities Chairman GRASSLEY and Senator BAU- provements to this legislation. I and within the traditional Medicare Pro- CUS, the managers, who for the last 2 many of my colleagues have signed let- gram for chronic care coordination, for weeks have so capably managed the ters to both Senator FRIST and Presi- disease management, for preventive bill on the floor. Their cooperation and dent Bush outlining the principles that care. their leadership has been invaluable. need to be included in the final version As many people have stated, it is not Without it, we would not be here so of this bill. I also cosponsored an a perfect bill, but we will continue to close to the finish line. amendment with Senators ENSIGN, move this legislation forward now to I would like to recognize all of the HAGEL, and LOTT to provide a more conference once, later in the evening or staff who have contributed to this ef- reasonable prescription drug benefit in the hours of the morning, after the fort: that does not create a massive entitle- House passes its legislation, we will First, I would like to thank my chief ment program. I believe the House of have the opportunity to make the pri- of staff, Lee Rawls: my policy director, Representatives is on the right track vate sector provisions more flexible, Eric Ueland; and my health policy di- with this issue. indeed more competitive, and more rector, Dean Rosen. Paul Jacobson, I am hopeful that with the passage of like the Federal Employees Health Bob Stevenson, Nick Smith, Bill S. 1, the conferees will work to see that Benefits Plan. All of us in this body are Hoagland, and Amy Holmes of my the final legislation adheres to the familiar with the impressive record of Leadership office also made important principles stated in the letters to that plan, the Federal employees plan. contributions. I also would like to rec- President Bush and Senator FRIST and Every Member of Congress and over 8 ognize the other members of my health the proposal supported by the House. million other Federal workers and re- team who worked so hard to help make At that time, I will look forward to tirees enjoy the ability to choose the possible the passage of this legislation: supporting this legislation. plan that best suits their medical Elizabeth Scanlon, Craig Burton, The PRESIDENT pro tempore. The needs. Susan Goelzer, Shana Christrup, Alli- majority leader. Indeed, as we go through conference son Winnike, and Jennifer Romans. Mr. FRIST. Mr. President, for years and once the bill is signed by the Presi- The Majority Whip’s staff deserves Congress has debated providing pre- dent of the United States, all seniors special recognition, especially Kyle scription drug coverage to seniors and will have that same opportunity to vol- Simmons, Michael Solon, and Amy how to strengthen and improve the untarily choose the plan that best Swonger, for the long hours they put in Medicare Program. Tonight we have meets their medical needs. and for the guidance they provided to acted. Tonight America is one step I look forward to working with my our Finance Committee Chairman and closer to being a more caring society colleagues on both sides of the aisle to our entire Republican leadership team.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00062 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8709 As I have said, passage of this legisla- still enjoyable, skies richly blue, and That vision took great courage, com- tion was made possible in the United trees and lawns still lush and green, ing as it did on the eve of putting his States Senate because of the genuine and gardens coming into bewildering signature to a document that could spirit of bipartisan cooperation. Both abundance. In fields and along the easily become his death warrant. Every the Republican and Democratic staff of roadsides, wildflowers bloom in profu- signer of that Declaration of Independ- the Senate Finance Committee worked sion, and wild blackberries earn our ence committed treason against Eng- incredibly hard, long hours these past forgiveness for their thorns by offering land, against the King of England, several weeks and months. Their exper- the tender treasures of their glossy against the crown. Every signer could tise, support, and stamina has been in- berries. have been arrested, put in chains and valuable. It is a golden period of enjoyment for sent by boat to England; tried, con- I would like to thank Kolan Davis, students on summer holiday, the res- victed, and hanged. The delegates to Ted Totman, Linda Fishman, Colin pite still feels luxuriously long, full of the Continental Congress had, with Roskey, Leah Kegler, Mark Hayes, Jen- golden days of enjoyment. this act, committed treason against nifer Bell, and Alicia Ziemiecki of The Fourth of July this year falls on the crown and set their nascent nation- Chairman GRASSLEY’s staff. a Friday, easily making a long week- state on the road to war. After the And I would also like to thank Jef- end for summer pleasure. With luck, failed Jacobite uprising against Eng- frey Forbes, Elizabeth Fowler, Bill the Fourth will be clear and cooler, land in 1745 under Bonnie Prince Dauster, John Blum, Pat Bousilman, comfortable for marching bands and Charles, only 31 years before the dele- Kate Kirchgraber, and Andrea Cohen of hometown parades, bathed in glorious gate met in Philadelphia, the Scottish Senator BAUCUS’ staff for their con- sunshine for family picnics and perfect leaders had been beheaded in public tributions. for evening symphonies and fireworks ceremonies. Hazen Marshall, Stacey Hughes, and to compete with the glittering stars One Delegate to the Congress, John Megan Hauck of the Senate Budget above. Witherspoon, put it thus: If the weather is sweltering, however, Committee staff are also commended There is a tide in the affairs of men, a nick then we might be better able to for their efforts. of time. We perceive it now before us. To empathize with the Delegates to the hesitate is to consent to our own slavery. Thank you to you all. Second Continental Congress, who met That noble instrument upon your table, that I look forward to working with in Philadelphia in the spring and sum- insures immortality to its author, should be Chairman GRASSLEY and our colleagues mer of 1776. In hot and muggy summer subscribed this very morning by every pen in in the House of Representatives to weather, clad in heavy styles that were this house. He that will not respond to its ac- produce a conference report that can cents, and strain every nerve to carry into designed for a cooler European sum- effect its provisions, is unworthy of the pass both Houses and be signed by the mer, the Delegates debated and amend- President in a timely manner later this name of free man. For my own part, of prop- ed, reportedly fending off flies from a erty, I have some; of reputation, more. That year. nearby stable that swarmed the Hall reputation is staked, that property is Mr. President, I suggest the absence and bit the Delegates through the silk pledged on the issue of this contest; and al- of a quorum. hose on their lower legs. But they per- though these grey hairs must soon descend The PRESIDING OFFICER. The severed in their momentous task. into the sepulcher, I would infinitely rather clerk will call the roll. On June 7, 1776, Richard Henry Lee of that they descend thither by the hand of the The legislative clerk proceeded to Virginia offered a motion to declare executioner than desert at this crisis the sa- cred cause of my country. call the roll. independence from England. His resolu- Mr. FRIST. Mr. President, I ask tion declared: What beautiful words. The signers knew full well what risks they were unanimous consent that the order for These United Colonies are and of right the quorum call be rescinded. ought to be free and independent States. running. The first anniversary of the adoption The PRESIDING OFFICER. Without His resolution passed on July 2 by a 12– of the Declaration of Independence objection, it is so ordered. 0 vote, with New York temporarily ab- took place in a nation at war, with our f staining. The next day, on July 3, John Adams battle fortunes at low ebb. But Ameri- ORDER TO PRINT S. 1 wrote to his wife, Abigail, rejoicing cans still celebrated in Philadelphia, U.S. ships of war were decked in red, Mr. FRIST. Mr. President, I ask over the decision to secede. To Abigail, white, and blue. At 1 o’clock, each ship unanimous consent that S. 1, as passed, he wrote: fired a salvo of 13 cannons to honor the be printed. The 2nd of July will be a memorable epoch 13 States. Members of Congress dined The PRESIDING OFFICER. Without in the history of America. I am apt to be- in state with other civil and military objection, it is so ordered. lieve that it will be celebrated by succeeding dignitaries and made toasts to liberty (This bill will be printed in a future generations as the Great Anniversary Fes- tival. and to fallen patriots. After dinner, the edition of the RECORD.) He further suggested that it ought to Members and officers of the Army re- f be commemorated as the day of deliv- viewed the troops, followed by a ring- MORNING BUSINESS erance, by solemn acts of devotion to ing of bells and a show of fireworks. God Almighty. In 1788, Philadelphia was serving as Mr. FRIST. Mr. President, I ask the U.S. Capital. On that year, not only unanimous consent that the Senate This is John Adams speaking. This is not some rustic boob like I was when I was the Declaration of Independence proceed to a period for morning busi- celebrated, but also the U.S. Constitu- ness. came to the House more than half a century ago. Listen to him again: tion, which had recently been ratified The PRESIDING OFFICER. Without by 10 States. This July Fourth celebra- objection, it is so ordered. It ought to be commemorated as the day of deliverance by solemn acts of devotion to tion included another new feature—a f God Almighty. parade with horse-drawn floats. One float, that of an enormous eagle, car- INDEPENDENCE DAY It ought to be solemnized with pomp, shows, games, sports, guns, bells, bonfires, il- ried the Justices of the Supreme Court Mr. BYRD. Madam President, the luminations, from one end of this Continent in lieu of today’s beauty pageant Senate is poised to adjourn, but before to the other, from this time forward, forever. queens. we adjourn, I want to call us away How remarkably prescient. Adams In 1826, the Nation achieved a mile- from the onrushing press of Senate was off on the date, as we celebrate the stone when the 50th Independence Day business and impending airline sched- approval of the Declaration of Inde- celebration was being planned. The ules to pay tribute to Independence pendence rather than of the adoption of mayor of Washington wrote to invite Day. Next Friday is the glorious the motion, but he certainly knew how the surviving ex-Presidents and Sign- Fourth of July, that most patriotic and Americans like to celebrate. As well, ers of the Declaration to attend the star-spangled of holidays. With the he accurately predicted the explosive festivities. The five men, John Adams, Fourth of July holiday, summer is at growth of an embryonic nation into a Thomas Jefferson, James Madison, its Halcyon best, with temperatures continent-spanning colossus. James Monroe, and Charles Carroll,

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00063 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8710 CONGRESSIONAL RECORD — SENATE June 26, 2003 were unable to attend. Why? Because of Federal Government and of belonging nate I am to live in this country and to age or infirmity, or other reasons. In- to a union that is the United States. represent the sovereign State of Ne- deed, at 10 minutes before 1 o’clock on Each star on the flag, the flag beside vada and to be a Member of the Senate. July 4, 1826, Thomas Jefferson, prin- the Presiding Officer’s desk, we salute It is a blessing that I have had, for cipal drafter of the Declaration, passed so proudly represents a single state, whatever reasons. Whether I am wor- away. but only when they are aligned to- thy or not, that is for someone else to John Adams, too, breathed his last gether in the constellation of 50 do we determine. But one of the most impor- on the same day. In his 90s and gravely feel the strength and the glory that tant aspects of my life has been my as- ill, he had determined to hold on until were won for us, beginning on July 4, sociation, my friendship, my service the 50th anniversary of independence. 1776. This Independence Day, we would with the Senator from West Virginia, a That morning, he roused long enough all do well to read and cherish the Dec- man who served in the Congress for to confirm to a servant that he knew laration of Independence. Even more, more than 50 years, who, like clock- that ‘‘it is the glorious Fourth of July. we would do well as a Nation to study work, comes to the Senate floor on spe- God bless it. God bless you all,’’ before and cherish our Constitution, by which cial occasions like the Fourth of July fading into unconsciousness. Rousing our freedom, so dearly won and so cost- or Thanksgiving, and makes us all feel later that afternoon, he confided un- ly held, lives on. better for having had the opportunity knowingly as he passed on to that Too often in recent years and months to listen to a speech by the Senator other shore that ‘‘Thomas Jefferson have I seen unwise attempts to erode from West Virginia. still survives.’’ He did not know that the checks and balances of the Con- As I look back over the time I spent Jefferson had died earlier that day. stitution, unknowing or unthinking ef- here on the Senate floor, listening to James Monroe, who fought in the forts to dissolve the institutions and the Senator from West Virginia, I am Revolutionary War and became the practices established to make our Na- drawn to a number of things I will fifth President of the United States, tion the free and representative gov- never forget. I remember the speech- also died on July 4, in 1831. James ernment by our Founding Fathers. At- es—and I sat with every one of them. I Madison, the fourth President, died a tacks on the United States from with- missed a couple of them, but I watched week short of the 60th anniversary of out are met with instant, unhesitating them in my office—the speeches on the Independence Day, on June 28, 1836. defense by all Americans, but we are fall of the Roman Empire that were The last living Signer of the Declara- not so knowledgeable vigilant against based on the line-item veto. The Sen- tion of Independence, Charles Carroll, the insidious weakening from within, ator from West Virginia was indicating performed one of his last public acts on even within this Chamber. We are all of the line-item veto would be the begin- July 2, 1828. He participated in a us, with our voices and our votes, the ning of the end of the Senate. ground breaking ceremony initiating last, best guardians of American free- The Senator delivered those speeches construction of the Baltimore and Ohio dom and independence. We lack only without a note. I didn’t realize at the Railway, the first important railroad the weapons of knowledge and aware- time, but the Senator knew every word in the Nation. He died in 1832, at the ness. he intended to say. They were not ex- age of 95. Also in 1828, President John I close with a poem by Henry Wads- temporaneous in the sense I would give Quincy Adams led an unusual 4th of worth Longfellow, entitled ‘‘O Ship of an extemporaneous speech. He knew July parade, up the Potomac River and State.’’ before he gave the speech, beforehand, the old Washington Canal to the site Thou, too, sail on, O Ship of State! every word he was going to deliver. I was so impressed with that series of where construction was to start on the Sail on, O Union, strong and great! Humanity with all its fears, speeches that I sent them to the head Chesapeake and Ohio Canal. These two With all the hopes of future years, of the political science then at the Uni- acts underscore the vital link between Is hanging breathless on thy fate! versity of Nevada at Las Vegas, An- the Declaration of Independence, the We know what Master laid thy keel! drew Tuttle. Tuttle was so impressed— Constitution which followed it, and the What Workmen wrought thy ribs of steel, I sent him the speeches so he could vibrant economy which has made and Who made each mast, and sail, and rope, watch them—he started a course at What anvils rang, what hammers beat, kept the United States economy vi- UNLV based on the lectures of Senator brant and strong for so many years. In what a forge and what a heat Were shaped the anchors of thy hope! BYRD. Our Nation is a union of disparate I am not going to go on, other than States, each of which has considerable Fear not each sudden sound and shock, ’Tis of the wave and not the rock; to say our country is so much better as power within its boundaries. But across ’Tis but the flapping of the sail, a result of the service granted by the those boundaries, linking the Union And not a rent made by the gale! people of West Virginia to the Senator into a seamless web of bustling com- In spite of rock and tempest’s roar, from West Virginia. People may not al- merce and economic might, is the na- In spite of false lights on the shore, ways agree with the Senator from West tional infrastructure. Just as the Con- Sail on, nor fear to breast the sea! Virginia, but no one can take away the stitution provides for the common de- Our hearts, our hopes, are all with thee. Our hearts, our hopes, our prayers, our tears, fact he is the epitome of the Senate. fense, so it promotes the common good And when the history books are writ- by linking markets and people across Our faith triumphant o’er our fears, Are all with thee—are all with thee! ten—and they will be written—there States. Over the Years, Federal support Mr. President, I yield the floor and will be a place where they will list the for great infrastructure projects, from great Senators of this body, and in the the Chesapeake and Ohio Canal to the suggest the absence of a quorum. The PRESIDING OFFICER. The top two or three will be the Senator National Highway System, have woven clerk will call the roll. from West Virginia. the Nation into a unified economic The assistant legislative clerk pro- Mr. BYRD. Mr. President, I thank my structure. Federal support for rural ceeded to call the roll. dear friend, the distinguished Senator electrification and rural telephone and Mr. REID. Mr. President, I ask unan- from Nevada, who is also the Demo- Internet access have spread oppor- imous consent the order for the cratic whip here in the Senate. tunity and progress from border to bor- quorum call be rescinded. Tennyson in Ulysses says: der and coast to coast, just as John The PRESIDING OFFICER. Without I am a part of all that I have met. Adams foretold in 1776. objection, it is so ordered. Mr. President, I don’t know how long This 4th of July, as we all visit na- f the great God of the universe will spare tional parks, tour Federal monuments, me. But however long it may be, the drive on interstate highways, call THANKING SENATOR BYRD distinguished Senator from Nevada, friends and family around the country, Mr. REID. Mr. President, I wish that Mr. REID, will always be a part of me. and buy picnic goods grown all over the I were able to express myself in a man- f United States—as we celebrate a na- ner that is worthy of my feelings about tional Federal holiday under the pro- the Senator from West Virginia. I can’t HONORING SENATOR STROM tective watch of the U.S. military and do that, but I can do the best I can. THURMOND Federal law enforcement agencies—we There isn’t a day that goes by that I Mr. HATCH. Mr. President, I wish to unconsciously enjoy the benefits of the don’t recognize personally how fortu- take a minute to say a few words in

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00064 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8711 honor of Strom Thurmond, our friend perience of Strom Thurmond holding public service he has provided. His able and former colleague, who passed away our arm tightly as he explains a view- leadership and steady hand will be today. point and asked for our support. I missed. From the moment Strom Thurmond might add that this proved to be a very f set foot in this Chamber in 1954, he has effective approach. been setting records. He was the only Strom was also known to have a kind OREGON’S TANF WAIVER person ever elected to the U.S. Senate word or greeting for everyone who Mr. WYDEN. Mr. President, on June on a write-in vote. He set the record for came his way, and for being extremely 12, 2003, I published a notice in the CON- the longest speech on the Senate floor, good to his staff. Despite his power and GRESSIONAL RECORD of my intent to ob- clocked at an astounding 24 hours and influence, he never forgot the impor- ject to moving to H.R. 2350, a bill to ex- 18 minutes. He was the longest serving tance of small acts of kindness. For extend the Temporary Assistance for Senator in the history of the Senate. ample, whenever he ate in the Senate Needy Families, or ‘‘TANF,’’ our Na- He was also the oldest serving Senator. dining room, he grabed two fistfuls of tion’s welfare program. My good friend Many of my colleagues will recall the candy. When he returned to the floor of from Oregon, Senator SMITH, joined in momentous occasion in September of the Senate, he handed the candy out to this effort because the legislation does 1998 when he cast his 15,000th vote in the Senate pages. Unfortunately, it not contain a provision critical to Or- the Senate. With these and so many was usually melted into a keleidoscope egon’s welfare program: a waiver of other accomplishments over the years, of sugar by then. I have a feeling that certain provisions that gives Oregon he has appropriately been referred to the pages preferred it when Strom took flexibility to operate a successful wel- as ‘‘an institution within an institu- them out for ice cream. fare program. Because of its waiver, tion.’’ Strom Thurmond was truly a leg- which expires on June 30, 2003, Oregon In 1902, the year Strom Thurmond end—someone to whom the people of has reduced its welfare rolls nearly 60 was born, life expectancy was 51 South Carolina owe an enormous debt percent since 1994. It is clear that the years—and today it is 77 years. Strom of gratitude for all his years of service. waiver has allowed Oregon to meet continued to prove that, by any meas- Clearly, the people of South Carolina local needs and craft what has been ure, he was anything but average. recognize the sacrifices he made and heralded as one of the best welfare pro- He saw so much in his life. To pro- are grateful for all he did for them. In grams in the country. vide some context, let me point out fact, you cannot mention the name Since Senator SMITH and I announced that during his lifetime, Oklahoma, Strom Thurmond in South Carolina our public holds, the distinguished New Mexico, Arizona, Alaska and Ha- without the audience bursting into chairman of the Finance Committee, waii gained Statehood, and 11 amend- spontaneous applause. He truly was an Senator GRASSLEY, and the ranking ments were added to the Constitution. American political icon. member, Senator BAUCUS, have worked The technological advancements he Abraham Lincoln once said that closely with us to find a way so that witnessed, from the automobile to the ‘‘The better part of one’s life consists Oregon can continue to operate under airplane to the Internet, literally of friendships.’’ With a friend like its waiver until TANF is fully reau- spanned a century of progress. Conven- Strom Thurmond, this sentiment could thorized. They have helped obtain a iences we have come to take for grant- not be more true. I am a great admirer letter from Department of Health & ed today were not always part of Strom of Strom Thurmond, and I am proud to Human Services Secretary Tommy Thurmond’s world. Perhaps this ex- have called him my friend. Thompson to Oregon Governor Ted plains why, during Judiciary Com- One final note about Strom Thur- Kulongoski, myself and Senator SMITH mittee hearings, he was often heard mond. He was a great patriot. A deco- assuring us that Oregon can continue asking witnesses who were too far rated veteran of World War II who to operate without penalty under its away from the microphone to ‘‘please fought at Normandy on D-day, Strom waiver. I believe this letter provides speak into the machine.’’ Oregon the assurances necessary to The story of his remarkable political Thurmond loved this country. Let me continue to operate as if the waiver career truly could fill several volumes. close by saying that this country loved were still in place, and ask unanimous It began with a win in 1928 for the him, too. Edgefield County Superintendent of f consent to insert the letter in the Schools. Eighteen years later, he was RECORD. A SALUTE TO PAUL GALIS Mr. SMITH. I join Senator WYDEN in Governor of South Carolina. Strom was Mr. BYRD. Mr. President, the great expressing deep pride in Oregon’s even a Presidential candidate in 1948, State of West Virginia has produced TANF program and in thanking the running on the ‘‘Dixiecrat’’ ticket numerous individuals who have dedi- chairman and ranking member of the against Democrat Harry Truman. I must admit, he came a long way in cated their lives to the service of the Finance Committee, on which I serve, his political career, given that he origi- Nation. These sons and daughters of for their cooperation. I share his as- nally came to the Senate as a Demo- West Virginia have contributed to the sessment that this letter will enable crat. I was happy to say that wisdom betterment of their communities, their Oregon to maintain its TANF program came within a few short years when State and their country. One such pub- without penalty until the program is Strom saw the light and joined the Re- lic servant is Paul L. Galis, who for 35 reauthorized. publican Party. years has served admirably in the Fed- I also express my appreciaiton to When I first arrived in the Senate in eral Aviation Administration, and has Senators GRASSLEY and BAUCUS for January of 1977, he was my mentor. As contributed to the development of an their efforts on TANF reauthorization. my senior on the Judiciary Committee, aviation system unsurpassed in the We have been working together for it was Strom Thurmond who helped me world. months to ensure that all TANF pro- find my way and learn how the com- Mr. Galis retires in July as the Dep- posals, including those elements which mittee functioned. He was not only a uty Associate Administrator for Air- have made Oregon’s TANF program so respected colleague, but a personal ports in FAA. In this position as well successful, are carefully considered as friend. as his previous position of Director of we move toward TANF reauthoriza- During his tenure as chairman of the the Office of Airport Planning and Pro- tion. Judiciary Committee, Strom Thur- gram, Mr. Galis has overseen the plan- Oregon’s TANF program, often called mond left an indelible mark on the ning and development of over 3,000 air- the Oregon Option, works because it committee and the laws that came ports in the national plan for airports. recognizes local barriers to work and through it. He became known and re- This has been no small task and Mr. works with individuals to asses their spected for many fine qualities and po- Galis has served with distinction. needs and get them onto a path toward sitions—his devotion to the Constitu- All of us in the State of West Vir- independence. For example, Oregon al- tion, his toughness on crime, his sense ginia salute Mr. Galis for his career lows individuals with severe substance of fairness. and wish him the best in his future en- abuse problems to seek treatment. This He was famous for his incredible grip. deavors. Our country is better for the helps people address the root of their Many of us in this Chamber had the ex- work he has done and the example of problems—not just the symptons. The

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00065 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8712 CONGRESSIONAL RECORD — SENATE June 26, 2003 Oregon Option has put people into real It is a tremendous honor to receive an LOCAL LAW ENFORCEMENT ACT work situations—not just make work— award named after Admiral Burke. Like OF 2003 many of you, I am familiar with the Admi- and this has helped Oregon move peo- Mr. SMITH. Mr. President, I rise ple off the welfare rolls and into real, ral’s distinguished life of dedication, service, and achievement. When I served in China today to speak about the need for hate sustainable jobs. I believe the Senate during World War II, he was an admiral in crimes legislation. On May 1, 2003, Sen- can learn from the lessons of Oregon’s the Navy, and the battles that made him one ator KENNEDY and I introduced the program, and I will continue to work of that war’s greatest combat leaders were Local Law Enforcement Act, a bill that with my colleagues to ensure that all well-known. would add new categories to current state TANF programs have the flexi- I met Admiral Burke during the Eisen- hate crimes law, sending a signal that bility they need to operate success- hower Administration. I was working on violence of any kind is unacceptable in fully. statehood for Alaska and Hawaii in the De- our society. Mr. GRASSLEY. Mr. President, I un- partment of Interior in those days. Admiral I would like to describe a terrible derstand the concerns of the Senators Burke was the Chief of Naval Operations. crime that occurred in New Bedford, Like everything he did, Admiral Burke from Oregon, and look forward to served as CNO with tremendous distinction. MA. On June 22, 2003, Saurabh working with them to reauthorize the He was the youngest and longest serving Bhalerao, a 24-year-old graduate stu- TANF program in the coming months. CNO in history, and during his tenure he dent, was ambushed by four men and I appreciate their concern for the need fought for technologies and strategies that savagely beaten when the assailants for Oregon to retain flexibility in continue to form the foundation of our mistook the student for a Muslim. Mr. TANF. I hope the Senator from Mon- Armed Services. Bhalerao, a Hindu Indian, works part- tana will agree that the Finance Com- To refresh my memory of Admiral Burke’s time as a pizza delivery man. One of mittee, on both sides of the aisle, accomplishments, I went back to E.B. Pot- the suspects placed a phone order at ter’s book about him. should discuss this issue as we move to the local pizzeria where Mr. Bhalerao is Potter reported that in January of 1958, employed. When Mr. Bhalerao arrived reauthorize the TANF program. the year Alaska’s Statehood Bill was en- Mr. BAUCUS. I agree with the chair- with the order, two men shoved him acted, Burke opposed the Gaither Report, into the apartment and pushed him to man and look forward to moving on which recommended streamlining and cen- these issues. My home State of Mon- tralization of defense. At the National Press the floor. After Mr. Bahlerao was lying tana is currently operating under a Club he warned against control of all U.S. on the floor, the attackers kicked and waiver that expires on December 31st forces by ‘‘one man, a military Solomon.’’ beat him. At one point, one suspect hit of this year. I know that Montana, like Notwithstanding that position of the CNO, him with a kitchen chair. The per- Oregon, has been able to craft a suc- in April 1958, and I quote from Potter’s book petrators also burned Mr. Bhalerao’s cessful TANF program because of its on Arleigh Burke: body with lit cigarettes. According to ‘‘. . . Eisenhower sent to Congress a spe- court documents, one of the attackers waiver, and I look foward to working cial message on reorganization of the De- told Mr. Bhalerao to ‘‘Go back to your with my distinguished colleagues to partment of Defense. Its chief recommenda- own country.’’ Mr. Bhalerao eventually see that it is retained. tions were (1) to remove the Service Chiefs escaped from the trunk of an assail- f from the operation chain of command; (2) to ant’s car after he managed to loosen restrict Service Secretaries to administra- the fisherman’s rope binding his hands RECOGNIZING SENATOR TED STE- tion, relieving them of responsibility for VENS, THE RECIPIENT OF THE military operations; (3) to restrict duties of and feet. He is currently in the inten- ARLEIGH BURKE AWARD FROM Joint Chiefs of Staff mainly to advising the sive care unit at a local hospital. I believe that Government’s first THE CENTER FOR STRATEGIC Secretary of Defense; (4) to enlarge the Joint duty is to defend its citizens, to defend AND INTERNATIONAL STUDIES Staff; and (5) to limit control of operating forces to the President and the Secretary of them against the harms that come out Mr. INOUYE. Mr. President, our dis- Defense.’’ of hate. The Local Law Enforcement tinguished colleague, the Honorable Eisenhower sent word through Secretary of Enhancement Act is a symbol that can TED STEVENS, was presented with the Defense McElroy that he wanted all senior become substance. I believe that by Arleigh Burke Award on June 11, 2003, officers and officials to support his plan. passing this legislation and changing by the Center for Strategic and Inter- Arleigh was called before the Senate current law, we can change hearts and national Studies. The award, named Armed Services Committee. As Potter stat- minds as well. after the famed Admiral, who was the ed, Admiral Burke ‘‘put duty to country over duty to the Commander-in-Chief,’’ and op- f longest serving Chief of Naval Oper- posed this concentration of power in the Sec- NOMINATION OF JOSHUA BOLTEN ations, recognizes Senator STEVENS’s retary of Defense. TO BE DIRECTOR OF THE OFFICE leadership in the fields of strategy, re- The Defense Reorganization Act of 1958 did OF MANAGEMENT AND BUDGET sources, and maritime affairs, as well not rubber stamp the Gaither Report. It fol- as his hard work and selfless dedication lowed many of Admiral Burke’s suggestions. Mr. CONRAD. Mr. President, I rise in to promote public service and the To his great credit, Ike appointed Admiral support of Joshua Bolten as Director of ideals of freedom. Burke to a third term as CNO in August 1959. the Office of Management and Budget, When Senator STEVENS accepted the It is my hope that in reviewing the current and to urge Mr. Bolten to do every- Burke Award, he delivered a thoughtful proposals from D.O.D. before Congress, sen- thing within his power to help put the speech that underscored Admiral ior officers and officials of D.O.D. and all Federal budget back on sound footing. members of Congress will follow the great Burke’s conviction that duty to coun- The position of OMB Director is al- traditions Admiral Burke upheld. ways one of the most demanding posts try is more important than duty to the Arliegh Burke lived his life by principles Commander-in-Chief, and that we in our Government, but it is especially which guided him through the perils of so right now. The tax cuts pushed should oppose the concentration of World War II and still pertain today. through by the President over the last power. He once described his philosophy as: 1 I ask unanimous consent that Sen- ‘‘An old-time philosophy—a philosophy of 2 ⁄2 years, combined with the continuing economic slowdown and in- ator STEVENS’s speech be printed in the realism. You must always ask yourself the creased spending to respond to the Sep- RECORD. question, ‘What is important in life? . . . I There being no objection, the mate- don’t think it’s very important to be remem- tember 11 terrorist attacks and pros- bered. . . . The ideas I stood for should be re- ecute the military efforts in Afghani- rial was ordered to be printed in the membered.’’ stan and Iraq, have pushed the budget RECORD, as follows: Admiral Burke also demonstrated his loy- deep into deficit. And despite the fact SPEECH BY SENATOR TED STEVENS AT THE alty to the men under his command. The that we desperately need to get our fis- CSIS ARLEIGH BURKE MEMORIAL DINNER ON spirit of Admiral Burke’s commitment to his cal house in order to be ready for the JUNE 11, 2003, IN WASHINGTON, DC sailors is reflected in the steps the Congress imminent retirement of the baby-boom Good evening. Thanks to my good friend has taken to support our troops and honor and colleague Senator Warner for that warm our promises to our veterans. population, this administration and its introduction. Admiral Burke was a hero and a visionary, allies in Congress have not yet accept- My congratulations to General Keene, the and I can think of no greater honor than to ed that the policies they have advo- Army’s new Acting Chief of Staff. I wish him be your guest at this evening’s event. cated are leading us in the wrong direc- success in the coming months. Thanks again for this award. tion.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00066 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8713 I support the nomination of Joshua part of the war against terrorism. This based on their testimonies given to the Bolten as OMB Director because I be- prompted me to join other members of medical authorities. lieve he is a very capable and honor- the Helsinki Commission in writing to As a result of these practices, Turkey able man, with a distinguished record the White House recently urging an in- has been repeatedly sanctioned by the both in public service—including serv- vestigation of ‘‘serious allegations that European Court of Human Rights. The ice as a Senate staffer—and in the pri- the United States is using torture, both Turkish nongovernmental organiza- vate sector. I sincerely hope he will directly and indirectly, during interro- tion, the Human Rights Foundation, take to heart the duty of the OMB Di- gations of those suspected of ter- appears to be making some headway in rector to be an advocate for fiscal re- rorism.’’ Against this backdrop, I urge defending these doctors. Last year, sponsibility—to be willing to present the administration to issue a forth- Turkey’s Grand National Assembly has the President with the facts where the right statement on torture. In his passed significant legislation with se- budget is heading even if those facts State of the Union Address, President vere penalties for those convicted of are unpleasant, and to recommend poli- Bush described the horrific forms of torture. A major effort still needs to be cies to the President that will put the torture employed by the Hussein re- made to conform the application of the budget back on a sustainable path even gime and concluded, ‘‘If this is not evil, law in the regional courts of Turkey if those policies may be politically dif- then evil has no meaning.’’ Even as ex- with the intent of the parliamentar- ficult. perts document the scope of torture in ians. The Helsinki Commission will In a written response to a question Iraq, there must be no doubt con- continue to monitor developments in by the Governmental Affairs Com- cerning U.S. policy and practice. Turkey and the implementation of this mittee, Mr. Bolten reiterated the posi- As Cochairman of the Helsinki Com- law. tion of the Bush administration about mission, I am particularly concerned In the 1999 OSCE Istanbul Charter, the deficits facing us, stating that: that torture remains a tolerated if not the participating States committed ‘‘Our current deficit—as measured as a promoted practice by come countries, themselves to ‘‘eradicating torture and percentage of gross domestic product even within the membership of the 55- cruel, inhumane or degrading treat- (GDP)—is not large by historical stand- nation Organization for Security and ment or punishment throughout the ards and is manageable within the Cooperation in Europe, OSCE. OSCE area. To this end, we will pro- overall context of our economy.’’ In some places, like Uzbekistan, mote legislation to provide procedural I hope when Mr. Bolten assumes his members of the political opposition or and substantive safeguards and rem- post as head of OMB, he recognizes the religious minorities are especially like- edies to combat these practices. We reality of the budget situation and ly to be the victims of torture. Trag- will assist victims and cooperate with leads the administration to reassess ically, two more people there have relevant international organizations that position. That reality is that the joined the long list of those who have and nongovernmental organizations, as deficit we are currently facing is enor- died in custody amid credible allega- appropriate.’’ mous by any standard. According to tions of abuse and torture, just weeks Clearly a strategy to confront and CBO, the total deficit will exceed $400 after the European Bank for Recon- combat torture must emphasize pre- billion this year, more than $100 billion struction and Development hosted a vention of torture, prosecution of those higher than the all-time record deficit prestigious meeting in Tashkent, and who commit torture, and assistance for of $290 billion recorded in 1992. As a days after the Secretary of State deter- the victims of torture. As we mark the percentage of GDP, the deficit will be mined Uzbekistan is eligible for contin- United Nations Day in Support of the about 4 percent, a level that has been ued U.S. assistance. Moreover, the Victims of Torture, I note the good reached only eight times in the 57 shortsighted practice of making mar- work being done by the Rocky Moun- years since the end of World War II. tyrs out of Islamic extremists may tain Survivors Center, located in Den- More troubling, when Social Security have exactly the opposite effect the ver. The center is part of a nationwide is excluded from the calculation, this government claims to be seeking in its network committed to assisting the year’s deficit is likely to total about efforts to combat terrorism. victims of torture living in the United 5.5 percent—a level reached only twice In Georgia, torture and abuse comes States. in the last 57 years. hand in hand with police corruption. In I hope Mr. Bolten accepts how seri- the most recent State Department f ous the budget situation is and how im- Country Report on human rights in Georgia, the Department stated: HONORING PRIVATE FIRST CLASS portant it is that we do not delay be- MICHAEL DEUEL ginning to deal with the situation. I ‘‘[s]ecurity forces continued to torture, hope that he will advise the President beat, and otherwise abuse detainees. Mr. JOHNSON. Mr. President, I am to work with the Congress in a truly . . . NGOs also blamed several deaths saddened to report the passing of Pri- bipartisan way to reach agreement on in custody on physical abuse, torture, vate First Class Michael Deuel of and enact policies that will put the or inhumane and life-threatening pris- Nemo, SD. Pfc. Deuel was killed on budget back on track. on conditions.’’ Even President June 18, 2003, while serving in Oper- ation Iraqi Freedom. f Shevardnadze has, in the past, acknowledged the prevalence of abuse Michael moved from his home in COMBATING TORTURE AND against detainees and prisoners. I wel- Cheyenne, WY to attend school at ASSISTING VICTIMS OF TORTURE come a new initiative of the OSCE Mis- Boxelder Job Corps in South Dakota in Mr. CAMPBELL. Mr. President, I rise sion in Georgia to combat torture, but May 2000. His friends and teachers de- to address the barbaric practices that I would also note that antitorture ini- scribed him as an unassuming, yet con- constitute torture as we mark the tiatives have come and gone in Georgia fident student. Focused and hard work- United Nations Day in Support of the with little to show for it. Without real ing, Michael was determined to per- Victims of Torture. Astonishingly, an political will, I am afraid this latest form well in school. He received his estimated 500,000 victims of torture initiative may end up like the others. general education diploma and certifi- live in the United States today, includ- In Turkey—a country which has been cation from the culinary arts program ing many in my home State of Colo- given particular attention by the Hel- shortly before enlisting in the Army. rado. The United States has provided sinki Commission—even the doctors Following service in the military, he vital leadership in the campaign to who treat the victims of torture have dreamed of becoming a chef and own- prevent torture around the world. The become targets themselves. Their of- ing his own restaurant. United States must not equivocate on fices have been raided, records seized, After enlisting in the Army, Michael this most basic of human rights. and even some doctors have been ar- entered airborne school to become an While the United States has consist- rested and tortured. Moreover, the pa- Airborne Ranger. He went on to Army ently spoken out forcefully against the tients of these doctors, all of whom Ranger School and became a member use of torture around the world, seri- have already suffered at the hands of of the Army’s 325th infantry regiment ous questions have been raised sug- the authorities, have often been re- of the 82nd Airborne Division, which is gesting U.S. complicity in torture as arrested, retortured and recharged based in Fort Bragg, NC.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00067 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8714 CONGRESSIONAL RECORD — SENATE June 26, 2003 On February 13, 2003, he was deployed improved dramatically by increasing Bazzel Mull and his wife, Elizabeth, in to Iraq. While protecting a propane-dis- home ownership. Existing buildings in Knoxville, TN. They host the Mull tribution center in Baghdad, he was these neighborhoods often need exten- Singing Convention, a popular gospel killed by enemy fire. sive renovation before they can provide radio program. The lives of countless people were decent owner-occupied housing. It is Reverend Mull is a legend with an in- enormously enhanced by Michael’s also difficult for renovations to occur teresting story to tell. He was born in goodwill and service. Although he did because the costs involved exceed the 1914 in Burke County, NC, into a musi- not live to see his dreams realized, he prices at which the housing units could cal family. When he was 11 months old, continued to inspire all those who be sold. Similarly, the costs of new he lost his eyesight after falling into knew him. Our Nation and South Da- construction may exceed its market an open-pit fireplace. As a child, he kota are far better places because of value. Properties sit vacant and neigh- played in a gospel group made up of his his life, and the best way to honor his borhoods remain devastated. The New mother, father, brothers and sisters. life is to emulate his commitment to Homestead Economic Opportunity Act He began preaching in 1939 and hasn’t our country. bridges the gap between development stopped since. In 1942, he moved to I join with all South Dakotans in ex- costs and market prices and will revi- Knoxville to start his first radio pro- pressing my sympathies to the family talize these areas. gram, and the rest is history. He be- of Private First Class Deuel. I know he I would like to see every American came well-known nationwide during will always be missed, but his service given the opportunity to succeed at the the 25 years he sold Chuck Wagon Gang to our Nation will never be forgotten. goal of owning their own home. I am Records on several 50,000-watt radio f proud to be the sponsor of this legisla- stations. tion, and I plan to continue to work to This year, all of his many accom- NEW HOMESTEAD ECONOMIC plishments were recognized when he OPPORTUNITY ACT see it become law. I urge my colleagues to join me in supporting the American was honored by the Gospel Music Asso- Mr. SMITH. Mr. President, I rise Dream by supporting S. 198. ciation for his ‘‘outstanding contribu- today with great concern. As you are f tions to gospel music.’’ aware, President Bush named June Na- During our visit in April, Reverend tional Homeownership Month 2003. I HONORING MAYNARD H. JACKSON, Mull gave me 2,000 letters and a num- am proud that our President has seen JR. ber of petitions with thousands of fit to promote an aggressive homeown- Mr. CHAMBLISS. Mr. President, as names on them from Americans angry ership campaign, and I support this ad- Atlanta’s first black mayor, Maynard over the Ninth Circuit’s decision de- ministration’s efforts to see more Jackson dedicated his career and his claring the Pledge of Allegiance uncon- Americans reach the American Dream life to healing the racial inequalities stitutional. Reverend Mull solicited of homeownership. As a member of the that surrounded him and ensuring that these letters from his listeners across Finance Committee, I have had the op- the city of Atlanta was a thriving, in- the country, and I was delighted to see portunity to learn of important ways clusive community. the passion people across America have that we can make that a reality. In Working to expand Hartsfield Inter- for the Pledge. It made me proud to an- January I introduced the New Home- national Airport, Maynard fought for swer all of those letters. stead Economic Opportunity Act, bet- equal treatment for minority workers It is inspiring to me that every day ter known as the Homeownership Tax and businesses. He sought to bring di- Reverend Mull brings out the best in Credit. This legislation will create a versity to government as well as Atlan- America. He challenges us to think, single-family housing tax credit for de- ta’s business community. Through the and he encourages us to be involved in velopers who build in low income areas, equality he sought for all racial issues. He also reminds us to turn to and allow more Americans to reach groups, he was able to foster economic our religious faith for guidance. I ran their dreams of homeownership. It will expansion and growth for Atlanta and for the U.S. Senate because I wanted to also encourage developers of single greater equality for her citizens. find out how to bring out the best in family units to invest in low income Working to secure the 1996 Olympics, people in Tennessee and across this areas and improve our communities. Maynard ensured that Atlanta shined country, all day, every day. The Department of Housing and for the world and was recognized as a I believe the answer to how we do Urban Development has stated that city that offered opportunity for every- that lies with the people. In August of one of its goals is to allow every cit- one regardless of race or socio-eco- 2002, I spent the night with Jim Coley, izen—regardless of race, creed, color, or nomic class. a Tennessee Government high school place of birth—the opportunity to own Serving as the president of the Na- teacher, and his family. One idea that their own home. To reach this goal, tional Conference of Democratic May- came out of that visit was the impor- there must be affordable homes to pur- ors and the National Black Caucus of tance of putting the teaching of Amer- chase. Local Elected Officials, he became a ican history and civics back into our In his testimony before the Senate role model for young African Ameri- classrooms. From that discussion, we Committee on Banking, Housing, and cans hoping to someday make their came up with the framework for the Urban Arrairs earlier this month, mark on this world and worked tire- American History and Civics Act of James Rayburn, the Vice President of lessly to improve interracial relation- 2003 that just passed the Senate. the National Association of Home ships in the South’s largest city. The bill establishes summer residen- Builders stated that the Homeowner- His contributions and accomplish- tial academies for teachers and stu- ship Tax Credit proposal seeks to close ments to help our State thrive eco- dents to encourage the teaching and the gap in homeownership rates among nomically and to expand opportunities learning of American history and civics Americans. While 82 percent of house- for minorities will be remembered for in a more inspired way than is hap- holds earning 100 percent or more of generations to come. The legacy he pening today. We can’t expect our stu- the national median income now own leaves behind is one of a greater re- dents to learn what it means to be an homes, only 53 percent of households spect for all people, greater oppor- American if we don’t teach them. earning less than the national median tunity for all people and greater hope I would also like to see students in are homeowners. The homeownership for the world. every classroom across this Nation be- rate for families earning 80 percent or Our thoughts and prayers are with ginning each schoolday with the Pledge less of the national median is only 40 his loved ones left behind, and his of Allegiance. That could be followed percent to 45 percent. Homeownership memory will forever be with us. with a student or teacher explaining in for whites is 75 percent, while the own- f his or her own words what it means to ership rate for African Americans is them to be an American. just below 48 percent and 48 percent for IN SUPPORT OF THE PLEDGE OF After the terrorist attacks of Sep- Hispanics. ALLEGIANCE tember 11, 2001, we saw how quickly we We can all agree that the quality of Mr. ALEXANDER. Mr. President, re- Americans could come together as one life in distressed neighborhoods can be cently, I visited with Reverend Jacob people, united in purpose, despite our

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00068 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8715 diverse backgrounds. Although we are worked closely with the Alaska con- portance of the U.S. role in that region. The almost 2 years removed from that gressional delegation for many years in Consulate also promotes Israeli culture and time, there is no reason this sense of efforts to preserve Alaska Native lan- business opportunities. Mutual values are unity and purpose cannot continue as guages. And let us not forget the many the corner stones of the relationship and af- finity between the people of Alaska and part of our lives every day. Americans contributions of the Gottstein family Israel. As we maintain U.S. support for have a reputation for being resourceful, to virtually every aspect of Alaska’s Israel’s existence and well being, we aspire resilient, and having common sense. fabric. to continue building stronger relations. These are good qualities for helping to This is not a new phenomenon. The bring out the best in the entire Nation. beautiful municipal library in Anchor- f I thank Reverend Mull for his com- age is named for Zachary J. Loussac, a mitment to this country, for inviting Russian Jewish immigrant, who served HONORING THE LATE DAVID me to visit with him, and for sharing as Mayor of Anchorage. The Girl Scout BRINKLEY American’s outpouring of support in camp in Fairbanks is named for Jessie favor of the basic values and principles Bloom, who along with her husband Mrs. DOLE. Mr. President, I am hon- on which this Nation was founded. I Robert, are regarded as the founding ored today to talk about a pioneer for also appreciate the opportunity to leaders of the Fairbanks Jewish com- North Carolina in the field of jour- bring Reverend Mull’s good work to the munity. In 1926, Jessie started the first nalism . . . the late David Brinkley. attention of our country. Girl Scout troop in Alaska, while Rob- David died on June 12, at the age of 82, from complications resulting from a f ert was a founder of what was later to become the University of Alaska. Our fall. He was laid to rest in his beloved WELCOME BACK TO ALASKA, MR. striking new courthouse in Fairbanks home, Wilmington, North Carolina . . . CONSUL GENERAL is named for Jay Rabinowitz who beside his father—William Graham Ms. MURKOWSKI. Mr. President, served for many years on the Alaska Brinkley and mother—Mary Mac- next week the people of Alaska will Supreme Court. Donald West Brinkley. welcome Mr. Yossi Amrani, the Consul The survival of the State of Israel is David was born in Wilmington . . . General of the State of Israel for the important to the people of Alaska as it He attended high school at New Han- Pacific Northwest, back to our State. is to the American Jewish community over High School. While there . . . and He will begin his trip in Fairbanks, and the American people. In Wash- after several long hours pouring over meeting with students and members of ington, I stand shoulder to shoulder books in the Wilmington Library . . . the community at the University of with my colleagues in praying for David got an itch for journalism. Alaska, visiting with members of Con- peace in the Middle East while stand- He didn’t wait. He took a part-time gregation Or Hatzafon, which has the ing firm on the principle that ter- job while still in high school, working northernmost synagogue building in rorism is morally and politically unac- for the Wilmington Morning Star and the world, and speaking to the Greater ceptable. Terrorism will not undo its afternoon edition, the Wilmington Fairbanks Chamber of Commerce. He Israel’s future. When the Senate re- News. He said he made about $11 a will also visit Anchorage on this trip turns in July, it will consider com- week. and I look forward to meeting with him prehensive energy legislation and I am But the young boy, who once made then. hopeful that my amendment to guar- extra money by changing light bulbs This is not Mr. Amrani’s first visit to antee that Israel will have a secure and running a soft-drink stand at my State, but it is his first visit to source of petroleum in the event it can- Wrightsville Beach’s Lumina Pavillion, Fairbanks, the ‘‘Golden Heart City.’’ not independently acquire it due to an went on to become an icon for millions Although the Fairbanks Jewish com- embargo will be in the bill when it of viewers who watched him each munity is small in numbers, the funda- passes the Senate. night. He and co-anchor Chet Huntley mental Jewish values of tikkun olam, During this visit to Alaska, as on had the highest rated news program on making the world a better place; previous visits, the Consul General will American television during the 1960’s tzedakah, charity; and chesed, kind- encounter the vast natural beauty of with ‘‘The Huntley-Brinkley Report.’’ ness, are deeply ingrained in the Fair- our state. But he will also discover, as Many of us still remember their famil- banks culture, as they are in the cul- in previous visits, that it is the people iar sign-off of ‘‘Good night, Chet,’’ ture of Alaska as a whole. of Alaska that make this place truly ‘‘Good night, David.’’ Like the Fairbanks Jewish commu- special. Shalom, Mr. Consul General. I David went on to host ‘‘This Week nity, the Alaska Jewish community is hope that you will visit with Alaskans With David Brinkley,’’ until he retired small in numbers, but large in spirit. often. in 1996. In the late 1990s, Professor Bernard Mr. President, I ask unanimous con- Mr. President, at a time when we Reisman from Brandeis University vis- sent that the message of Consul Gen- often get news that is too short, too ited Alaska on several occasions to eral Yossi Amrani be printed in the sensationalized and sometimes too learn more about our Jewish commu- RECORD. slanted, David Brinkley was the con- nity. He concluded that in virtually all There being no objection, the mate- summate newsman. He knew the areas, the Alaska Jewish community rial was ordered to be printed in the issues, and his intelligence, quick wit has a higher level of identity than do RECORD, as follows: and thirst for answers kept us all glued American Jews generally. He found MESSAGE OF CONSUL GENERAL YOSSI AMRANI to the television. this to be true not only in places like TO THE PEOPLE OF ALASKA I had the pleasure of personally Anchorage, Fairbanks and Juneau, The friendship and alliance between the knowing David Brinkley, and in addi- which have functioning congregations, United States and Israel have many varied tion to sharing a distinctive Southern but also in the smaller communities, faces, moral, political, economic and stra- twang, we shared a fondness for our where ‘‘conveners’’ organize regular tegic. The partnership is on the federal and home state. David wrote about Wil- state level alike. Israeli consulates in the mington in his 1995 memoirs and even get togethers, especially on Jewish country, local Jewish communities together holidays. with state level administrations aim at fos- with all this success, all his fame, Members of the Jewish community tering and nurturing the relationship for the David and his wife, Susan, returned to occupy a prominent role in the social, benefit of both countries. In the state of his home in North Carolina often and economic, cultural and political life of Alaska, thousands of miles apart, the Con- supported his hometown. He was an ar- Alaska. A few weeks ago, I welcomed sulate General of Israel to the Pacific North- dent supporter of downtown Wil- the internationally known holocaust west Region works with state leaders and the mington preservation. The University scholar, Dr. Michael Schuldiner of the Jewish community to bring the two nations of North Carolina at Wilmington pre- University of Alaska Fairbanks, to my together in sharing the values, ideals and sented him with an honorary Doctor of concerns of both people. The Consulate pro- office in Washington. Dr. Schuldiner vides seminars and speaking engagements in Letters degree in 1974. He was added to discussed his work with the United different campuses, churches and temples to Wilmington’s Walk of Fame in 2001. States Holocaust Memorial. Another educate public opinion on the complexity of As much as David loved North Caro- UAF scholar, Dr. Michael Krauss, has the situation in the Middle East and the im- lina—North Carolina loved him, too.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00069 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8716 CONGRESSIONAL RECORD — SENATE June 26, 2003 His life has been a model for so many forests, and was favored by the North- that I felt the need to bring the benefit North Carolinians—the local boy doing ern Arapaho over the hot and arid of his expertise and enthusiasm to good . . . remembering his roots. Oklahoma landscape. more Montanans. That is why, in 1993, We will forever be indebted to David The Wind River Indian Reservation is I recommended his appointment by Brinkley for solid Washington report- one of Wyoming’s great historical, cul- President Clinton as State Director of ing and his wry sense of humor. The tural, and natural treasures. A grave the Montana Farmers Home adminis- Senate passed a resolution, which I co- site for Sacajawea, the young Shoshone tration. Through a reorganization at sponsored, honoring the life and ac- woman who helped guide the Lewis and the U.S. Department of Agriculture, complishments of David Brinkley. May Clark expedition through Shoshone Tony led a successful transformation of his legacy live on and inspire those lands in the early 1800s, can be visited the Farmers Home Administration who follow in his footsteps. on the reservation. Both tribes con- Agency to the current Rural Develop- In an interview 11 years ago, David tinue to host several powwows during ment agency. While at the U.S. Depart- said this of his profession, ‘‘People go the spring and summer months that ment of Agriculture, Tony served on and find out what is happening, and draw visitors and members of tribes many national committees within the then tell what they have seen. That’s from across the country. Later this rural Development Agency, helping to all a reporter ever did. I think it’s a week, the Eastern Shoshone will be guide the agency during its formative very honorable thing to do.’’ celebrating the Treaty Days Powwow. years. The success of the Rural Devel- As we look back on the past 140 Indeed, it is, David, indeed, it is. opment Agency and the value of its years, I would like to pay tribute to Mr. President, I send out my heart- programs today are largely due to the the important contribution American felt condolences—and those of all efforts that Tony made during his ten- Indians have made to our history and North Carolinians—to Susan and to ure there. our culture. Throughout my time in David Brinkley’s family. In December 1999, Tony accepted the Congress, I have had the pleasure to position as Regional Director for the f work with tribal leaders from both economic Development Administra- ADDITIONAL STATEMENTS tribes on the Wind River Reservation. I tion. In this position, Tony has contin- would like to thank Vernon Hill, chair- ued to impart his expertise and enthu- man of the Eastern Shoshone Business WIND RIVER INDIAN RESERVA- Council and Burton Hutchinson, Sr., siasm to a 10 State region. In his pro- TION’S 140TH ANNIVERSARY chairman of the Northern Arapaho fessional life, Tony has received accolades and awards too numerous to men- ∑ Mr. THOMAS. Mr. President, I rise Business Council, for their leadership tion here. Instead, let me say that I today to recognize the 140th Anniver- as we work to ensure the prosperity of have not met anyone as dedicated to sary of the Wind River Reservation. the Wind River Reservation for future public service as Tony Preite. Tony On July 2, 1863, the U.S. Government generations.∑ does not leave his work at the office. and the Shoshone people signed the f He lives and breathes ‘‘public service’’ Fort Bridger Treaty, creating the Sho- A GREAT MONTANAN—ANTHONY J. every day, all day. It’s immediately ap- shone Reservation, which included over PREITE parent to anyone who meets him that 44 million acres in what is now Colo- ∑ he always cares about the people he rado, Utah, Idaho, and Wyoming. This Mr. BAUCUS. Mr. President, I rise serves. His works has made an enor- area was reduced to roughly 3 million today in celebration of a great Mon- mous difference for Montana and for all acres by the second Fort Bridger Trea- tanan and American, Anthony J. of us who work and play there. ty of July 3, 1868, and was later re- Preite. Today, Mr. Preite, the director of the While Tony’s retirement is a sad oc- named the Wind River Reservation dur- Denver Regional Office of the U.S. De- casion to all of us who work with him, ing the 1930s. Today, the reservation is partment of Commerce Economic De- it is well deserved. I can take comfort roughly more than 2 million acres, one velopment Administration is retiring. I that he will be returning to Montana of the largest in the country, and is lo- have known Tony Preite for about 30 and that he will find some other way to cated in central Wyoming’s beautiful years. He was raised on Montana’s continue to serve his State. I wish Wind River Basin. It remains the con- ‘‘High Line’’ in Havre, MT. After a Tony and his wife Betty all the best temporary home of the Eastern Sho- short time as a high school teacher and and I thank him for more than 35 years shone and Northern Arapaho tribes. coach, he was lured by the Bear Paw of public service. Good luck, Tony, and Chief Washakie, a distinguished Development Corporation, an EDA des- welcome back to Montana!∑ statesman of the Shoshone people, was ignated economic development district, one of the few Indian leaders to suc- to come to work for them in 1968. A f cessfully negotiate with the U.S. Gov- year later, he became the executive di- ernment in determining the reserva- AL BRAIMAN: DEPAUL rector of that fledgling organization UNIVERSITY CLASS OF 2003 tion’s location. For centuries, Amer- and thus began a career in economic ∑ ican Indians who traveled through this development that is virtually unparal- Mr. DURBIN. Mr. President, I rise area referred to it the Warm Valley of leled today. Under Tony’s leadership, today to honor Al Braiman, graduate the Wind River because of surrounding Bear Paw Development Corporation of DePaul University’s Class of 2003. Al hot springs. Renowned for his courage quickly developed a reputation as one was the oldest graduate of DePaul’s on the battlefield, and talent in diplo- of this Nation’s premiere economic de- Class of 2003 when he graduated on macy, the people of Wyoming selected velopment organizations. Tony spear- June 14. Al completed a degree in lib- Chief Washakie to represent our State, headed literally hundreds of economic eral arts at DePaul’s College of New in the U.S. Capitol Building, as one of and community development projects Learning with a grade point average of our two contributions to Statuary and programs in that part of northern 3.92 out of a possible 4.0. Hall. Montana. These projects resulted in Born in Kiev, Russia, in 1920, Al im- The northern band of Arapahos began hundreds of jobs, scores of infrastruc- migrated to the United States at the to make the Wind River Reservation a ture improvements, and other activi- age of one. His family took up resi- more permanent home during the last ties that have improved the lives of dency in Chicago, where he lived most 1870s, though they were not signatories people in that area. Among his other of his life. After high school, Al turned to either of the Fort Bridger Treaties. accomplishments at Bear Paw, he was down an academic scholarship for col- Under the leadership of men such as a founding member of the Montana lege to support his family. Al joined Black Coal, Sharp Nose, Little Wolf Economic Developer’s Association, the Army and served with distinction and White Horse, the Northern served on the Montana Private Indus- in World War II, spending most of his Arapahos settled in Wyoming, while try Council, and was chairman of the time on Guadalcanal. the southern band of Arapahos was Governor’s Economic Development After leaving the Army, Al owned moved to a reservation in western Council. and operated Lakeview Grocerland Oklahoma. Wind River country encom- Tony’s work at Bear Paw Develop- until the mid 1960s when he became an passes mountains, streams, lakes and ment Corporation was so successful insurance salesman with Equitable Life

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00070 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8717 Insurance Company. He became a cer- After working with the Department counted on by not only their friends, tified life underwriter and chartered fi- of Education and serving as principal but so many others. I am proud to nancial consultant. Al won many for schools throughout Lincoln Parish, mark their anniversary, and even more awards in the industry, including in- Dr. Cobb continued his public service pleased to call them friends.∑ duction into the Equitable Hall of in the area of education by serving as Fame. superintendent for the Lincoln Parish f After retiring in 1985, Al decided to School System. For the past 15 years, earn a college degree, something he Dr. Cobb has immensely helped the 14 TRIBUTE TO GARY R. COOPER promised his mother earlier in his life. schools and 6,865 students in the Lin- ∑ Mr. GREGG. Mr. President, I rise Al’s interest in politics led him to take coln Parish School System. During his today to recognize and commend Gary many political science and history tenure, Dr. Cobb helped to construct R. Cooper upon his retirement after courses at DePaul University. Some of the Lincoln Parish Secondary Alter- serving for 20 years as Executive Direc- his favorites included a class on Amer- native School at no cost to local tax- tor of SEARCH, the National Consor- ican presidents and a course on race re- payers. He saw the students in Lincoln tium for Justice Information and Sta- lations. He also enjoyed learning many Parish receive the highest ACT scores tistics. new things such as use of the Internet, throughout the State in 1996. In 2000, SEARCH is a national organization photography, and art. Al has proven Ruston High School graduated seven dedicated to enhancing the use of infor- that it is never too late to learn and we National Merit Finalists, the most of mation and identification technology could all learn a great deal from his any public, nonmagnet high school in in law enforcement. SEARCH provides perseverance. the State. Dr. Cobb helped to expand I know my fellow Senators will join invaluable no-cost technical assist- the preschool program, implement the me in congratulating Al Braiman, ance, training and support to criminal Even Start Program, construct a Pa- DePaul Class of 2003. His story contains justice agencies all over the country. rental Involvement Center, initiate the all the elements of a great American The organization’s members are Gov- Career Options Program, wire all life and I am honored to share it with ernors appointees from each State and schools with the Internet, and imple- my colleagues in the Senate.∑ their common goal is to ensure that ment 4x4 block scheduling in high the criminal justice community has ac- f schools. HONORING SUPERINTENDENT The gifts that Dr. Cobb has given the cess to services that will allow them to GERALD WAYNE COBB, ED.D Lincoln Parish School System and all use the best technology for communications, information sharing, and ∑ of Louisiana go far beyond those that I Ms. LANDRIEU. Mr. President, every criminal identification. SEARCH has session in Congress we spend a large have named above. Dr. Cobb has spent the past 43 years giving his kindness, been a tremendous asset to our Na- amount of time discussing education in tion’s law enforcement and this is due this country. Debates range from ac- his leadership, his vision, his service. It is to educators like Dr. Cobb that we in no small part to the work of Gary countability to school construction to Cooper. teacher recruitment. While our discus- owe many of the successes of our education policy. My best wishes are with Under Gary’s leadership over the past sions are of the utmost importance, it 20 years, SEARCH has truly become a is the implementation of our decisions Dr. Cobb and his family as he enters retirement.∑ leader in encouraging States to partici- by the individuals within the education pate in national information and iden- system that changes how our children f tification technology programs. For in- learn. Today I rise to honor a man who HONORING LOUIS AND LUJUANNA stance, under Gary’s leadership, had dedicated his life to improving CARNEY SEARCH made a profound contribution education for children in Louisiana, ∑ to the States’ effective participation in Dr. Gerald Wayne Cobb. Mr. CRAPO. Mr. President, I rise the Interstate Identification Index and In 1960, Dr. Cobb received his bach- today to congratulate my good friend, elor’s degree in health and physical Louis Carney and his wife LuJuanna. the National Fingerprint File, and the education from Louisiana Tech Univer- Just last week, the Carneys, who live National Crime Information Center sity. Since that time he has been a cru- near my family’s home in Idaho Falls, 2000 (NCIC 2000) program. cial part of school improvements with- celebrated their 50th wedding anniver- Through SEARCH, Gary has also in the Lincoln Parish School System. sary. I am honored to know them and helped to implement policies on the na- Dr. Cobb has served as principal of Hill- pleased that I was asked to join the tional level. While Gary has headed crest Elementary School, Simsboro celebration. SEARCH, it has made a profound con- High School, and Ruston High School. I can think of no better way to com- tribution to the development and im- He has worked as visiting associate memorate their 50 years together than plementation of the National Criminal professor at Louisiana State Univer- to mention that they are the proud Background Check System. SEARCH sity and Louisiana Tech University. parents of eight children, six who are also played a pivotal role in the devel- Dr. Cobb has also served in the Lou- still with us—Don, Nancy, Bob, Terry, opment and enactment of the Crime isiana Department of Education, work- Kevin, and Kenneth; and two who have Identification Technology Act which ing as the director of secondary edu- rejoined their Heavenly Father—Laurie today creates the legal and funding cation, the executive director of aca- Ann and Jean Marie; the even prouder platform for the Federal /State crimi- demic programs, and the executive as- grandparents of fifteen; and the great nal justice technology partnership. Be- sistant to the superintendent. While grandparents of one. It speaks very cause of Gary, SEARCH was, and is, with the Louisiana Department of Edu- highly of their commitment to each the primary State voice in support of cation, Dr. Cobb was instrumental in other and their family that so many of the successful and ongoing national developing the Compensatory Edu- their family members were on hand to adoption of the Interstate Identifica- cation Program in Louisiana which mark the occasion. Louis has been a tion Index and Privacy Compact and provided remediation for students not very good friend to me over the years, the development of the Compact Coun- meeting the passing scores on the and I appreciate his wisdom and guid- cil. State’s Basic Skills Testing Program. ance on many matters. He has been a At every important moment in the Dr. Cobb also revised Bulletin 741, strong supporter of the Boy Scouts of past 20-year history of criminal justice which is the Louisiana Handbook for America program, and I share his en- information and identification tech- School Administration and served as thusiasm for this program which can nology, Gary Cooper has been a coura- the basis for the State’s accreditation be so important in helping young men geous leader, an untiring champion and program. Dr. Cobb worked to increase to learn new skills and achieve goals. an insightful and influential national in-service training for principals by co- Louis and LuJuanna have been im- voice. authoring the Louisiana Academy for portant members of our community. On the occasion of his retirement, I School Administrators Program and They are always available for those thank Gary R. Cooper for all that he representing Louisiana at the Leader- who are in need. They radiate happi- has accomplished on behalf of criminal ship Training for Principals. ness and contentment, and can be justice in the United States.∑

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00071 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8718 CONGRESSIONAL RECORD — SENATE June 26, 2003 HONORING HUGH BRADY I hope my colleagues will join me in during his tenure as the Director of the ∑ Mr. CRAPO. Mr. President, I rise commending all of the cyclists who Marshall Space Flight Center. today to congratulate Mr. Hugh Brady pedaled for peace, and join me in sup- As the Director of one of NASA’s of Boise Idaho who will be inducted porting sensible gun safety legisla- largest field installations, with more into the Idaho High School Activities tion.∑ than 6,500 civil service and contract Hall of Fame on August 6th, 2003. In f employees and an annual budget in excess of $2 billion, Art successfully man- 1954 Mr. BRADY started working at DELBERT L. LATTA POST OFFICE aged a very broad range of activities Idaho Sporting Goods, and he has been BUILDING dedicated to helping young people in for the U.S. space program. Some of ∑ Idaho participate in athletics ever Mr. VOINOVICH. Mr. President, I these critical NASA initiatives included development of new reusable since. Mr. BRADY, who later became the rise today on behalf of a bill considered owner of the sporting goods store, has by the Senate, H.R. 985, to designate a launch vehicles, space shuttle propul- sponsored Little League baseball post office in Bowling Green, OH, as sion, advanced space transportation systems, second and third generation teams, football teams, basketball the Delbert L. Latta Post Office Build- propulsion technology development teams, soccer teams, softball teams, ing. I strongly support this bill hon- programs, research in microgravity, and bowling teams. He also took the oring a long-time member of the Ohio and science payload operations aboard time to coach many teams over the congressional delegation. Naming this the International Space Station. He years. post office after Del Latta is a fitting also oversaw the establishment of the Mr. BRADY has demonstrated extraor- way to honor him. The building that dinary support for athletics and the houses this post office also served as a National Space Science Technology youth of Idaho. There have been nu- district office for Mr. Latta during his Center, a partnership with universities and Federal agencies to conduct cut- merous instances when a student could 30 years of service in Congress. ting-edge research. Art also oversaw not afford the cost of equipment to par- Delbert Latta is a native and lifelong the planning and establishment of the ticipate in a sport and Mr. BRADY made resident of Ohio. Born in the small Propulsion Research Laboratory, a sure that they got it. Mr. BRADY, you northwestern town of Weston, OH, Mr. world-class laboratory for research make Idaho proud! Latta attended Findlay College and into future space transportation and For the past 4 years, Mr. BRADY has Ohio Northern University Law School. battled lung cancer. My wife, Susan, Mr. Latta began his service to our propulsion technology. Art has led the and I along with many Idahoans will Nation as a member of the Ohio Na- Marshall Center in numerous successful space shuttle launches in which keep him in our thoughts and prayers.∑ tional Guard. During World War II, Mr. Marshall was responsible for all propul- f Latta served with the U.S. Marine Corps Reserves. sion elements. Under Art’s direction, HONORING VICTIMS OF GUN After his military service, Mr. Latta the Marshall Center has completed VIOLENCE practiced law in Bowling Green, but in testing of the truss and pressurized ∑ Mr. LEVIN. Mr. President, earlier 1953, he again answered the call to pub- modules for the International Space this week, more than 35 dedicated cy- lic service by running for the State leg- Station, and provided support for the clists with People Pedaling Peace made islature. Mr. Latta was elected to the construction and operation of the the 200-mile trip from Hampton, VA, to Ohio State Senate. After serving three International Space Station, including Washington, DC, to honor and remem- terms, Mr. Latta was elected by the Marshall’s Payload Operations Center ber victims of gun violence. In partner- people of Ohio’s fifth congressional dis- which controls all the science experi- ship with the Alliance for Justice, the trict to the U.S. House of Representa- ments aboard the space station. Art brought more than 35 years of ex- People Pedaling Peace cyclists rode tives. During his long and distin- perience in the space industry to NASA not only in honor of the victims of gun guished career in Congress, Mr. Latta and used it to the great benefit of the violence, but for stronger, more sen- fought hard against wasteful govern- Marshall Center and the U.S. space sible gun safety laws in America and to ment spending and to balance the Fed- program. I could list many additional raise awareness of violence against eral budget, a passion that I share. achievements and professional accom- children in this country. During his 30 years in Congress, Mr. plishments, and I believe that success Pedaling for Peace was started in Latta earned prominent committee as- is directly attributable to Art’s record 2001 by Sandra and Mike McSweeney signments in the House, including serv- whose daughter, Stephanie, was killed as an extraordinary leader throughout ing as the ranking member of the his career. while walking out of a roller rink in Budget Committee, and as a member of Art has been an important and re- Hampton, VA. Mr. and Mrs. McSweeny, the powerful Rules Committee, and the spected member of the Huntsville com- as well as several other individuals af- Agriculture Committee. munity. I know that I speak for many fected by gun violence and violence Naming this post office the Delbert people in Huntsville and everyone in against children made the journey this L. Latta Post Office Building is a won- the NASA family when I say that we year. Others who made the trip include derful tribute to a man who served all thank Art for his tireless commit- Craig Scott, whose sister Rachel is a Ohio and our Nation with distinction ment to NASA and to Marshall. We sin- Columbine survivor; Amber Hensley, a throughout his life. cerely hope that he and his family will student at Thurston High School in Eu- I thank my colleagues for their con- remain part of the Huntsville commu- gene, OR, who witnessed the shootings; sideration of this matter.∑ nity for many years to come.∑ and Lorraine Reed, mother of two f daughters, one of whom was murdered f and one of whom was seriously as- TRIBUTE TO ARTHUR G. ARTHUR LEVITT, JR. STEPHENSON saulted. Unfortunately, the total num- ∑ Mr. SARBANES. Mr. President, ear- ber of people like them who have lost ∑ Mr. SHELBY. Mr. President, I rise lier this month the Franklin D. Roo- family and friends to gun violence con- today to recognize the outstanding ac- sevelt Distinguished Public Service tinues to grow. complishments and distinguished ca- Award was presented to Arthur Levitt, According to the Centers for Disease reer of Mr. Arthur G. Stephenson upon Jr., the widely respected former chair- Control and Prevention, the total num- his retirement as the Director of the man of the Securities and Exchange ber of gun deaths in the United States NASA Marshall Space Flight Center. It Commission. The award is made annu- has been dropping since 1993, when it has been a privilege for me to get to ally by the Franklin D. and Eleanor peaked at nearly 40,000, to around 28,000 know Art. While retirement announce- Roosevelt Institute, on whose board I annually 1999 through 2001. However, ments are things that we do not like to am privileged to serve. guns still kill more young people in hear when it involves someone who has The speaker at the presentation was America than the most common dis- been as vital to the success of an orga- Conrad Black, now Lord Black, chair- eases of our time. Thousands more nization as Art has been to Marshall’s, man of the Telegraph Group, Limited. children are injured, lose a loved one, I would like to say how much I have Lord Black is active in numerous non- or live in fear of gun violence. enjoyed working with Art and his staff profit boards, foundations and councils.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00072 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8719 In his remarks Lord Black spoke viv- per day. The U.S. financial system had and farm and business ownership of veterans. idly and in detail about Depression-era reached the last extremity before it would In the late ’forties, nearly half the male uni- America, and the ‘‘bold experimen- collapse completely, taking the life’s savings versity students of the United States were of tens of millions of people and what was tation,’’ as he put it, of the New Deal beneficiaries of that act and the barriers to left of the international economic system advancement for working class families were years. with it. largely removed. I ask unanimous consent that the American literature achieved a virtual I yield to few people in my enthusiasm for text of Lord Black’s remarks be print- golden age with writers such as John the capitalist system, but we must all reed in the RECORD. Steinbeck, Erskine Caldwell, Edmund Wil- member that in 1933, capitalism in America There being no objection, the mate- son, and John Dos Passos describing depres- had failed, and the political system was in rial was ordered to be printed in the sion conditions. danger of failing with it. FRANKLIN D. ROOSEVELT’S FIRST INAUGURAL RECORD, as follows: Roosevelt developed a refrain in his later ADDRESS elections that served him well and was unan- ADDRESS OF LORD BLACK AT FRANKLIN DELA- Over 400,000 people came out to hear swerable. It want: ‘‘You are, most of you, old NO ROOSEVELT DISTINGUISHED PUBLIC SERV- Franklin D. Roosevelt’s famous first inau- enough to remember what things were like ICE AWARD DINNER gural address; they covered 40 acres of lawns in 1933. On election night, 1932, unemployment adjacent to the Capitol. For the first time ‘‘You remember the closed banks and the stood at approximately 30%. There was mini- since the Civil War, soldiers in full combat breadlines and the starvation wages; the mal direct government relief for the 14 mil- gear and machine gun emplacements sur- foreclosures of homes and farms, and the lion or so unemployed. Their condition was rounded by sand-bags were visibly guarding bankruptcies of business; the ‘Hoovervilles,’ alleviated by private sector charity, and by the main public buildings of Washington. and the young men and women of the Nation theft and begging. Roosevelt promised bold experimentation. facing a hopeless, jobless, future; the closed The Soviet Union advertised in the United In the Hundred Days of the spring of 1933, the factories and mines and mills; the ruined and States for 6,000 skilled workers to go to Rus- Roosevelt administration reorganized and abandoned farms; the stalled railroads and sia in 1932 for a period of several years; it’s reopened the banks and guaranteed their de- the empty docks; the blank despair of a New York office was swamped with 100,000 posits, a great monetary step as bank depos- whole Nation, and the utter impotence of the applications. The natives of West Africa sent its now joined most definitions of the money Federal Government.’’ New York City $3.77 to help with relief for supply. The voters did remember, as people re- the poor. When the city of Birmingham, Ala- The legislation of the Hundred Days member a horrible nightmare; but it had not bama, advertised for 750 ditch-diggers to incentivized price and wage increases, re- been a dream; it was the United States in work ten-hour days for $2 per day, 12,000 ap- duced the working week, cut government 1933.∑ plications arrived in two days. salaries, increased some marginal taxes, tol- f In the coal-mining regions of Kentucky erated a degree of cartelism to raise prices and West Virginia, over 90% of children were and avoid over-production, encouraged col- MESSAGES FROM THE PRESIDENT suffering from malnutrition. The country lective bargaining, and engaged in massive had suffered a general deflation of more than workfare schemes that employed nearly half Messages from the President of the 20%. Millions of Americans faced the distinct the unemployed in projects of conservation United States were communicated to possibility of death by starvation or expo- and public works. In the first year of these the Senate by Ms. Evans, one of his sure to the elements. Large numbers of peo- programs, 500,000 miles of roads and 40,000 secretaries. schools, 3,500 parks and 1,000 airfields were ple lived from the scraps and leftovers f thrown out in the garbage by restaurants built or upgraded. The Civilian Conservation and hotels. Corps, through the ’thirties, thinned four EXECUTIVE MESSAGES REFERRED The volume of cheque transactions and of million acres of trees, stocked one billion fish, and built 30,000 animal shelters. As in executive session the Presiding stock market transactions in the United Officer laid before the Senate messages States had declined by 60% since 1929. The Ordinary unemployment declined by four amount of new capital financing had de- million through 1933, partly due to the re- from the President of the Unite States clined by over 95% since 1929. The volume of duction in the work week. Farmers voted by submitting sundry nominations which new building contracts had declined by 75%. category to approve production cutbacks, were referred to the appropriate com- permitting farm price increases, and some of By inauguration day in March 1933, the Dow- mittees. the agricultural surplus was taken for dis- Jones Industrial Average was down by 90% tribution to the needy. The Tennessee Valley (The nominations received today are from its high in September, 1929. Authority was launched and great progress printed at the end of the Senate pro- BANK FAILURES began on rural electrification, flood control, ceedings.) There had been 5,000 bank failures in three and drought control. f years, wiping out nine million individual The Hundred Days also refinanced the na- bank accounts. Steel production was under tion’s mortgages, effectively departed the MESSAGES FROM THE HOUSE 20% of capacity, and United States Steel gold standard, exchanged embassies with the At 11:59 a.m., a message from the Corporation, which had had 225,000 full-time Soviet Union, and repealed Prohibition. House of Representatives, delivered by employees in 1929, now had no full-time em- THE SECOND NEW DEAL Ms. Niland, one of its reading clerks, ployees, apart from those in the executive of- The second New Deal, in 1934 and 1935, was announced that the House has passed fices. built around Social Security and included Total non-agricultural production was less the Labour Relations Act, the Securities and the following bill, without amendment. than half of its 1929 level. Manufacturing in- Exchange Commission, a comprehensive S. 858. An act to extend the Abraham Lin- come has shrunk by 65%. Agricultural pro- modernization of the Federal Reserve, and coln Bicentennial Commission, and for other duction, while approximately equal in phys- what was called, but was not really, a purposes. ical volume to that of 1929, had shrunk in Wealth Tax. It outraged William Randolph The message also announced that the farm income from $12 billion to slightly over Hearst and stole the thunder of Huey Long House has passed the following bills, in $5 billion. and other radicals, as it was designed to do. About 45% of the residential homes in After a pause, when unemployment again which it requests the concurrence of America had been or were in danger of being began to rise, Roosevelt brought in the third the Senate: foreclosed by mortgage-holders. Through the New Deal in 1938 with the Fair Labor Stand- H.R. 1511. AN act to award a congressional first six months of 1933, 250,000 homes were ards Act and massive public works and con- gold medal to Prime Minister Tony Blair. foreclosed, well over a thousand per day, the servation employment schemes. These were H.R. 2474. An act to authorize the Congres- families pitched out into the streets. The successful and reduced unemployment in sional Hunger Center to award Bill Emerson money supply, deflation-adjusted, had de- mid-1939 to about 8%, less than two points and Mickey Leland Hunger Fellowships for clined by 25% in four years. above where it stands today, if the public fiscal year 2003 and 2004. Many local and state governments, includ- sector relief workers are considered to be H.J. Res. 49. A joint resolution recognizing ing Chicago and Georgia, could not pay their employed people. the important service to the Nation provided schoolteachers. Georgia closed over a thou- Thereafter, like other countries, the by the Foreign Agricultural Service of the sand schools attended by 170,000 students. United States relied on rearmament and the Department of Agriculture on the occasion Most rural Alabama white schools were selective service to reduce unemployment, of its 50th anniversary. closed through the early months of 1933. which fell by up to 500,000 per month coming up to the 1940 election, and had almost van- The message further announced that On the day before inauguration day, 32 the House had agreed to the following states had closed all their banks indefi- ished before the entry of the United States nitely. Six other states had closed almost all into the war in 1941. concurrent resolution, in which it re- their banks. In the other ten states and in THE GI BILL OF RIGHTS quests the concurrence of the Senate: the District of Columbia, withdrawals were Finally, came the GI Bill of Rights, which H. Con. Res. 49. Concurrent resolution ex- limited to 5% of deposits and in Texas to $10 greatly subsidized the education, and home pressing the sense of the Congress that the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00073 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8720 CONGRESSIONAL RECORD — SENATE June 26, 2003 sharp escalation of anti-Semitic violence EXECUTIVE AND OTHER R389, and R390 Propellers’’ ((RIN2120– within many participating States of the Or- COMMUNICATIONS AA64)(2003–0239)) received on June 19, 2003; to ganization for Security and Cooperation in the Committee on Commerce, Science, and Europe (OSCE) is of profound concern and ef- The following communications were Transportation. forts should be undertaken to prevent future laid before the Senate, together with EC–2970. A communication from the Pro- occurrences. accompanying papers, reports, and doc- gram Analyst, Federal Aviation Administra- At 6:19 p.m., a message from the uments, and were referred as indicated: tion, Department of Transportation transmitting, pursuant to law, the report of a rule House of Representatives, delivered by EC–2961. A communication from the Pro- entitled ‘‘Airworthiness Directives: Hartzell Ms. Niland, one of its reading clerks, gram Analyst, Federal Aviation Administra- Propeller Inc. Model HC B3TN 5 Propellers’’ announced that the House has passed tion, Department of Transportation trans- ((RIN2120–AA64)(2003–0238)) received on June the following bill, in which it requests mitting, pursuant to law, the report of a rule 19, 2003; to the Committee on Commerce, the concurrence of the Senate: entitled ‘‘Amendment to Class E Airspace: Science, and Transportation. Windsor Locks, Bradley International Air- H.R. 2559. An act making appropriations EC–2971. A communication from the Pro- port, CT’’ ((RIN2120–AA66)(2003–0100)) re- gram Analyst, Federal Aviation Administra- for military construction, family housing, ceived on June 19, 2003; to the Committee on and base realignment and closure for the De- tion, Department of Transportation trans- Commerce, Science, and Transportation. partment of Defense for the fiscal year end- mitting, pursuant to law, the report of a rule EC–2962. A communication from the Pro- entitled ‘‘Airworthiness Directives: Hartzell ing September 30, 2004, and for other pur- gram Analyst, Federal Aviation Administra- Propeller Inc. Model HD E6C 3B/E13890’’ poses. tion, Department of Transportation trans- ((RIN2120–AA64)(2003–0237)) received on June At 7:50 p.m., a message from the mitting, pursuant to law, the report of a rule 19, 2003; to the Committee on Commerce, House of Representatives, delivered by entitled ‘‘IFR Altitudes; Miscellaneous Science, and Transportation. Ms. Niland, one of its reading clerks, Amendments (13)’’ ((RIN2120–AA63)(2003– EC–2972. A communication from the Pro- announced that the House has passed 0002)) received on June 19, 2003; to the Com- gram Analyst, Federal Aviation Administra- the following bill, in which it requests mittee on Commerce, Science, and Transpor- tion, Department of Transportation transmitting, pursuant to law, the report of a rule the concurrence of the Senate: tation. EC–2963. A communication from the Pro- entitled ‘‘Airworthiness Directives: Bom- H.R. 531. An act to amend title XXI of the gram Analyst, Federal Aviation Administra- bardier Model C1 600 2C10 Series Airplanes’’ Social Security Act to extend the avail- tion, Department of Transportation trans- ((RIN2120–AA64)(2003–0236)) received on June ability of allotments for fiscal years 1998 mitting, pursuant to law, the report of a rule 19, 2003; to the Committee on Commerce, through 2001 under the State Children’s entitled ‘‘IFR Altitudes: Miscellaneous Science, and Transportation. Health Insurance Program (SCHIP). Amendments (60)’’ ((RIN2120–AA63)(2003– EC–2973. A communication from the Pro- f 0003)) received on June 19, 2003; to the Com- gram Analyst, Federal Aviation Administra- tion, Department of Transportation trans- mittee on Commerce, Science, and Transpor- MEASURES REFERRED mitting, pursuant to law, the report of a rule tation. entitled ‘‘Airworthiness Directives: The following bill and joint resolu- EC–2964. A communication from the Pro- Raytheon Aircraft Company Model 1900D tion were read the first and the second gram Analyst, Federal Aviation Administra- Airplanes’’ ((RIN2120–AA64)(2003–0235)) re- tion, Department of Transportation trans- times by unanimous consent, and received on June 19, 2003; to the Committee on ferred as indicated: mitting, pursuant to law, the report of a rule Commerce, Science, and Transportation. H.R. 1511. An act to award a congressional entitled ‘‘Airworthiness Directives: Airbus EC–2974. A communication from the Pro- gold medal to Prime Minister Tony Blair; to Model A319 131, 132, and 133; A320, 232, and gram Analyst, Federal Aviation Administra- the Committee on Banking, Housing, and 233, and A321 231 Series Airplanes; Equipped tion, Department of Transportation trans- Urban Affairs. with International Aero Engines V2500 A5 mitting, pursuant to law, the report of a rule H.J. Res. 49. Joint resolution recognizing Series Engines’’ ((RIN2120–AA64)(2003–0250)) entitled ‘‘Airworthiness Directives: Bell Hel- the important service to the Nation provided received on June 19, 2003; to the Committee icopter Textron Canada Model 427 Heli- by the Foreign Agricultural Service of the on Commerce, Science, and Transportation. copters’’ ((RIN2120–AA64)(2003–0234)) received Department of Agriculture on the occasion EC–2965. A communication from the Pro- on June 19, 2003; to the Committee on Com- of its 50th anniversary; to the Committee on gram Analyst, Federal Aviation Administra- merce, Science, and Transportation. Agriculture, Nutrition, and Forestry. tion, Department of Transportation trans- EC–2975. A communication from the Pro- The following concurrent resolution mitting, pursuant to law, the report of a rule gram Analyst, Federal Aviation Administra- entitled ‘‘Airworthiness Directives: Dassault tion, Department of Transportation trans- was read, and referred as indicated: Model Mystere-Falcon 50 Series Airplanes’’ mitting, pursuant to law, the report of a rule H. Con. Res. 49. Concurrent resolution ex- ((RIN2120–AA64)(2003–0249)) received on June entitled ‘‘Airworthiness Directives: Fokker pressing the sense of the Congress that the 19 , 2003; to the Committee on Commerce, Model F 28 Mark 1000, 2000, 3000, and 4000 Se- sharp escalation of anti-Semitic violence Science, and Transportation . ries Airplanes’’ ((RIN2120–AA64)(2003–0233)) within many participating States of the Or- EC–2966. A communication from the Pro- received on June 19, 2003; to the Committee ganization for Security and Cooperation in gram Analyst, Federal Aviation Administra- on Commerce, Science, and Transportation. Europe (OSCE) is of profound concern and ef- tion, Department of Transportation trans- EC–2976. A communication from the Pro- forts should be undertaken to prevent future mitting, pursuant to law, the report of a rule gram Analyst, Federal Aviation Administra- occurrences; to the Committee on Foreign entitled ‘‘Airworthiness Directives: tion, Department of Transportation trans- Relations. Raytheon Aircraft Company Model 390 Air- mitting, pursuant to law, the report of a rule entitled ‘‘Airworthiness Directives: f planes’’ ((RIN2120–AA64)(2003–0248)) received on June 19, 2003; to the Committee on Com- Eurocopter France Model SA341G and MEASURES PLACED ON THE merce, Science, and Transportation. SA342IJ Helicopters’’ ((RIN2120–AA64)(2003– CALENDAR EC–2967. A communication from the Pro- 0232)) received on June 19, 2003; to the Com- mittee on Commerce, Science, and Transpor- gram Analyst, Federal Aviation Administra- The following bills were read the first tation. and second times by unanimous con- tion, Department of Transportation trans- EC–2977. A communication from the Pro- sent, and placed on the calendar: mitting, pursuant to law, the report of a rule gram Analyst, Federal Aviation Administra- entitled ‘‘Airworthiness Directives: CFM H.R. 2559. An act making appropriations tion, Department of Transportation trans- International CFM56 Series Turbofan En- for military construction, family housing, mitting, pursuant to law, the report of a rule gines’’ ((RIN2120–AA64)(2003–0247)) received and base realignment and closure for the De- entitled ‘‘Airworthiness Directives: Bell Hel- on June 19 , 2003; to the Committee on Com- partment of Defense for the fiscal year end- icopter Textron Canada Limited Model 427 merce, Science, and Transportation . ing September 30, 2004, and for other pur- Helicopters’’ ((RIN2120–AA64)(2003–0231)) re- EC–2968. A communication from the Pro- poses. ceived on June 19, 2003; to the Committee on gram Analyst, Federal Aviation Administra- H.R. 531. An act to amend title XXI of the Commerce, Science, and Transportation. tion, Department of Transportation trans- Social Security Act to extend the avail- EC–2978. A communication from the Pro- mitting, pursuant to law, the report of a rule ability of allotments for fiscal years 1998 gram Analyst, Federal Aviation Administra- entitled ‘‘Airworthiness Directives: Dornier through 2001 under the State Children’s tion, Department of Transportation trans- Weke CmbH Model DO 27Q–6 Airplanes’’ Health Insurance Program (SCHIP). mitting, pursuant to law, the report of a rule ((RIN2120–AA64)(2003–0246)) received on June entitled ‘‘Airworthiness Directives: Agusta f 19, 2003; to the Committee on Commerce, SpA Model A109E Helicopters’’ ((RIN2120– MEASURES READ THE FIRST TIME Science, and Transportation. AA64)(2003–0230)) received on June 19, 2003; to EC–2969. A communication from the Pro- the Committee on Commerce, Science, and The following bill was read the first gram Analyst, Federal Aviation Administra- Transportation. time: tion, Department of Transportation trans- EC–2979. A communication from the Pro- S. 11. A bill to protect patients’ access to mitting, pursuant to law, the report of a rule gram Analyst, Federal Aviation Administra- quality and affordable health care by reduc- entitled ‘‘Airworthiness Directives: Dowty tion, Department of Transportation trans- ing the effects of excessive liability costs. Aerospace Propellers, Models R354, R375, mitting, pursuant to law, the report of a rule

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00074 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8721 entitled ‘‘Airworthiness Directives: Sikorsky EC–2989. A communication from the Pro- entitled ‘‘Modification of Class E Airspace; Aircraft Corp Model S76A, B, and C Heli- gram Analyst, Federal Aviation Administra- Eureka, KS’’ ((RIN2120–AA66)(2003–0103)) re- copters’’ ((RIN2120–AA64)(2003–0229)) received tion, Department of Transportation trans- ceived on June 19, 2003; to the Committee on on June 19, 2003; to the Committee on Com- mitting, pursuant to law, the report of a rule Commerce, Science, and Transportation. merce, Science, and Transportation. entitled ‘‘Airworthiness Directives: Boeing EC–2999. A communication from the Assist- EC–2980. A communication from the Pro- Model 747–200B and 200F Series Airplanes ant Secretary for Export Administration, gram Analyst, Federal Aviation Administra- Powered by Pratt and Whitney JT9D–70 Se- Bureau of Industry and Security, Depart- tion, Department of Transportation trans- ries Engines’’ ((RIN2120–AA64)(2003–0219)) re- ment of Commerce, transmitting, pursuant mitting, pursuant to law, the report of a rule ceived on June 19, 2003; to the Committee on to law, the report of a rule entitled ‘‘Imple- entitled ‘‘Airworthiness Directives: McDon- Commerce, Science, and Transportation. mentation of the Understandings Reached at nell Douglas Model MD 90 30 Airplanes’’ EC–2990. A communication from the Pro- the June 2002 Australia Group (AG) Meeting ((RIN2120–AA64)(2003–0228)) received on June gram Analyst, Federal Aviation Administra- and the AG Intersessional Decision on Cross 19, 2003; to the Committee on Commerce, tion, Department of Transportation trans- Flow Filtration Equipment—Chemical and Science, and Transportation. mitting, pursuant to law, the report of a rule Biological Weapons Controls in the Export EC–2981. A communication from the Pro- entitled ‘‘Airworthiness Directives: Administration Regulations’’ (RIN0694–AC70) gram Analyst, Federal Aviation Administra- Raytheon Model DH 125, HS 125, and BH 125 received on June 24, 2003; to the Committee tion, Department of Transportation trans- Series Airplanes; Model BAe 125 Series 800A, on Commerce, Science, and Transportation. mitting, pursuant to law, the report of a rule 800A (C–29A), 800A (U–125), 800B, 1000A, and EC–3000. A communication from the Sec- entitled ‘‘Airworthiness Directives: Bom- 1000B Airplanes; and Models Hawker 800, 800 retary, Office of the General Counsel, Fed- bardier Model CL 600 2B19 Series Airplanes’’ (including variant U–125A), and 1000, and 8000 eral Trade Commission, transmitting, pursu- ((RIN2120–AA64)(2003–0227)) received on June XP Airplanes’’ ((RIN2120–AA64)(2003–0218)) re- ant to law, the report of a rule entitled ‘‘Pri- 19, 2003; to the Committee on Commerce, ceived on June 19, 2003; to the Committee on vacy Act System Notice for the National Do Science, and Transportation. Commerce, Science, and Transportation. Not Call Registry System’’ received on June EC–2982. A communication from the Pro- EC–2991. A communication from the Pro- 24 , 2003; to the Committee on Commerce, gram Analyst, Federal Aviation Administra- gram Analyst, Federal Aviation Administra- Science, and Transportation . tion, Department of Transportation trans- tion, Department of Transportation trans- EC–3001. A communication from the Acting mitting, pursuant to law, the report of a rule mitting, pursuant to law, the report of a rule Director, Office of Sustainable Fisheries, Na- entitled ‘‘Airworthiness Directives: McDon- entitled ‘‘Airworthiness Directives: tional Marine Fisheries Service, Department nell Douglas Model 717–200 Airplanes’’ Raytheon Aircraft Company Beech Models of Commerce, transmitting, pursuant to law, ((RIN2120–AA64)(2003–0226)) received on June 1900, 1900C, and 1900D Airplanes’’ ((RIN2120– the report of a rule entitled ‘‘Closure of the 19, 2003; to the Committee on Commerce, AA64)(2003–0217)) received on June 19, 2003; to Third Season Apportionment of Directed Science, and Transportation. Fishing for Yellowfin Sole by Vessels Using EC–2983. A communication from the Pro- the Committee on Commerce, Science, and Trawl Gear in the Bering Sea and Aleutian gram Analyst, Federal Aviation Administra- Transportation. EC–2992. A communication from the Pro- Islands Management Area (BSAI)’’ received tion, Department of Transportation trans- gram Analyst, Federal Aviation Administra- on June 24, 2003; to the Committee on Com- mitting, pursuant to law, the report of a rule tion, Department of Transportation, trans- merce, Science, and Transportation. entitled ‘‘Airworthiness Directives: Schwei- mitting, pursuant to law, the report of a rule EC–3002. A communication from the Acting zer Aircraft Corporation Model 269D Heli- Director, Office of Sustainable Fisheries, Na- copters’’ ((RIN2120–AA64)(2003–0225)) received entitled ‘‘Establishment of Class E Airspace; tional Marine Fisheries Service, Department on June 19, 2003; to the Committee on Com- Ridgely, MD’’ ((RIN2120–AA66)(2003–0109)) re- of Commerce, transmitting, pursuant to law, merce, Science, and Transportation. ceived on June 19, 2003; to the Committee on EC–2984. A communication from the Pro- Commerce, Science, and Transportation. the report of a rule entitled ‘‘Fisheries Off gram Analyst, Federal Aviation Administra- EC–2993. A communication from the Pro- West Coast States and in the Western Pa- tion, Department of Transportation trans- gram Analyst, Federal Aviation Administra- cific; Pacific Coast Groundfishery; Annual mitting, pursuant to law, the report of a rule tion, Department of Transportation, trans- Specifications and Management Measures; entitled ‘‘Airworthiness Directives: McDon- mitting, pursuant to law, the report of a rule Trip Limit Adjustments’’ received on June nell Douglas Model DC 9 10, 20, 30, 40, and 50 entitled ‘‘Modification of Class D Airspace; 24, 2003; to the Committee on Commerce, Series Airplanes; and DC 9 81, 82, 83, 87, and and Modification of Class E Airspace; To- Science, and Transportation. MD 88 Airplanes’’ ((RIN2120–AA64)(2003–0224)) peka Philip Billard Unicipa; Airport, KS’’ EC–3003. A communication from the Coun- received on June 19, 2003; to the Committee ((RIN2120–AA66)(2003–0108)) received on June sel, National Institute of Standards and on Commerce, Science, and Transportation. 19, 2003; to the Committee on Commerce, Technology, Department of Commerce, EC–2985. A communication from the Pro- Science, and Transportation. transmitting , pursuant to law, the report of gram Analyst, Federal Aviation Administra- EC–2994. A communication from the Pro- a rule entitled ‘‘Procedures for Implementa- tion, Department of Transportation trans- gram Analyst, Federal Aviation Administra- tion of the National Construction Safety mitting, pursuant to law, the report of a rule tion, Department of Transportation, trans- Team Act’’ (RIN0693–AB52) received on June entitled ‘‘Airworthiness Directives: Cessna mitting, pursuant to law, the report of a rule 24, 2003; to the Committee on Commerce, Aircraft Company Models 441 and F406 Air- entitled ‘‘Modification of Class E Airspace; Science, and Transportation. planes’’ ((RIN2120–AA64)(2003–0223)) received Clinton, IA’’ ((RIN2120–AA66)(2003–0107)) re- EC–3004. A communication from the Coun- on June 19, 2003; to the Committee on Com- ceived on June 19, 2003; to the Committee on sel, National Institute of Standards and merce, Science, and Transportation. Commerce, Science, and Transportation. Technology, Department of Commerce, EC–2986. A communication from the Pro- EC–2995. A communication from the Pro- transmitting , pursuant to law, the report of gram Analyst, Federal Aviation Administra- gram Analyst, Federal Aviation Administra- a rule entitled ‘‘Procedures for Implementa- tion, Department of Transportation trans- tion, Department of Transportation, trans- tion of the National Construction Safety mitting, pursuant to law, the report of a rule mitting, pursuant to law, the report of a rule Team Act’’ (RIN0693–AB52) received on June entitled ‘‘Airworthiness Directives: Rolls entitled ‘‘Modification of Class E Airspace; 24, 2003; to the Committee on Commerce, Royce Deutschland Ltd and Co KG Models Davenport, IA’’ ((RIN2120–AA66)(2003–0106)) Science, and Transportation. BR700 710 A10 and BR700 710 A2 20 Turbofan received on June 19, 2003; to the Committee EC–3005. A communication from the Dep- Engines’’ ((RIN2120–AA64)(2003–0222)) re- on Commerce, Science, and Transportation. uty Assistant Administrator for Regulatory ceived on June 19, 2003; to the Committee on EC–2996. A communication from the Pro- Programs, National Marine Fisheries Serv- Commerce, Science, and Transportation. gram Analyst, Federal Aviation Administra- ice, Department of Commerce, transmitting, EC–2987. A communication from the Pro- tion, Department of Transportation, trans- pursuant to law, the report of a rule entitled gram Analyst, Federal Aviation Administra- mitting, pursuant to law, the report of a rule ‘‘Fisheries of the Northeastern United tion, Department of Transportation trans- entitled ‘‘Modification of Class E Airspace; States; Atlantic Mackerel, Squid and mitting, pursuant to law, the report of a rule Independence, IA’’ ((RIN2120–AA66)(2003– Butterfish Fisheries; Framework Adjust- entitled ‘‘Airworthiness Directives: Rolls 0105)) received on June 19, 2003; to the Com- ment 3’’ (RIN0648–AQ57) received on June 24, Royce Deutschland Ltd and Co KG Models mittee on Commerce, Science, and Transpor- 2003; to the Committee on Commerce, BR700 710 A1 10 and BR700 710 A2 20 Turbofan tation. Science, and Transportation. Engines’’ ((RIN2120–AA64)(2003–0221)) re- EC–2997. A communication from the Pro- EC–3006. A communication from the Assist- ceived on June 19, 2003; to the Committee on gram Analyst, Federal Aviation Administra- ant Administrator for Fisheries, National Commerce, Science, and Transportation. tion, Department of Transportation, trans- Oceanic and Atmospheric Administration, EC–2988. A communication from the Pro- mitting, pursuant to law, the report of a rule Department of Commerce, transmitting, pur- gram Analyst, Federal Aviation Administra- entitled ‘‘Modification of Class E Airspace; suant to law, the 1999 Annual Report regard- tion, Department of Transportation trans- Muskegon, MI’’ ((RIN2120–AA66)(2003–0104)) ing the administration of the Marine Mam- mitting, pursuant to law, the report of a rule received on June 19, 2003; to the Committee mal Protection Act of 1972; to the Committee entitled ‘‘Airworthiness Directives: Rolls on Commerce, Science, and Transportation. on Commerce, Science, and Transportation. Royce Corporation 501–D Series Turboprop EC–2998. A communication from the Pro- EC–3007. A communication from the Chair- Engines’’ ((RIN2120–AA64)(2003–0220)) re- gram Analyst, Federal Aviation Administra- man, Federal Communications Commission, ceived on June 19, 2003; to the Committee on tion, Department of Transportation, trans- transmitting, pursuant to law, a report rel- Commerce, Science, and Transportation. mitting, pursuant to law, the report of a rule ative to 700 MHz auctions, digital television,

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00075 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8722 CONGRESSIONAL RECORD — SENATE June 26, 2003 and mobile communications services; to the moving art and historic objects from the The PRESIDING OFFICER. Without Committee on Commerce, Science, and Senate wing of the Capitol and Senate office objection, it is so ordered. Transportation. buildings for personal use. Army nomination of Kenneth S. Azarow. S. 148. A bill to provide for the Secretary of f Air Force nominations beginning Rebecca Homeland Security to be included in the line G. Abraham and ending Jeffrey Yuen, which REPORTS OF COMMITTEES of Presidential succession. nominations were received by the Senate and The following reports of committees f appeared in the Congressional Record on were submitted: EXECUTIVE REPORTS OF March 26, 2003. By Mr. WARNER, from the Committee on COMMITTEES Air Force nominations beginning Brian J. Armed Services, with amendments: Acker and ending Angela D. Washington, S. 1025. An original bill to authorize appro- The following executive reports of which nominations were received by the Sen- priations for fiscal year 2004 for intelligence committees were submitted: ate and appeared in the Congressional and intelligence-related activities of the By Mr. WARNER for the Committee on Record on March 26, 2003. United States Government, the Community Armed Services. Air Force nominations beginning Paul M. Management Account, and the Central Intel- Army nomination of Lt. Gen. John P. Barzler and ending Charles W. Williamson ligence Agency Retirement and Disability Abizaid. III, which nominations were received by the System, and for other purposes (Rept. No. Army nominations beginning Brigadier Senate and appeared in the Congressional 108–80). General George A. Alexander and ending Record on March 26, 2003. By Mr. SPECTER, from the Committee on Colonel Matthew J. Whittington, which Air Force nomination of James R. Appropriations, without amendment: nominations were received by the Senate and Burkhart. S. 1356. An original bill making appropria- appeared in the Congressional Record on Air Force nominations beginning Charles tions for the Departments of Labor, Health June 12, 2003. M. Belisle and ending Brett A. Wyrick, which and Human Services, and Education, and re- Air Force nomination of Col. William J. nominations were received by the Senate and lated agencies for the fiscal year ending Sep- Germann. appeared in the Congressional Record on tember 30, 2004, and for other purposes (Rept. Army nomination of Col. William M. Ja- June 5, 2003. No. 108–81). cobs. Air Force nominations beginning Glenn D. By Mrs. HUTCHISON, from the Committee Marine Corps nominations beginning Brig. Addison and ending Daniel J. Zachman, on Appropriations, without amendment: Gen. John W. Bergman and ending Brig. Gen. which nominations were received by the Sen- S. 1357. An original bill making appropria- John J. McCarthy, Jr., which nominations ate and appeared in the Congressional tions for military construction, family hous- were received by the Senate and appeared in Record on June 5, 2003. ing, and base realignment and closure for the the Congressional Record on April 2, 2003. Air Force nomination of Thomas K. Hun- Department of Defense for the fiscal year Air Force nomination of Col. Thomas F. ter, Jr. ending September 30, 2004, and for other pur- Deppe. Air Force nomination of Jeffrey J. King. poses (Rept. No. 108–82). Navy nomination of Adm. William J. Air Force nominations beginning Jean B. By Mr. GREGG, from the Committee on Fallon. Dorval and ending Gary M. Walker, which Health, Education, Labor, and Pensions, Air Force nomination of Maj. Gen. Michael nominations were received by the Senate and without amendment: M. Dunn. appeared in the Congressional Record on S. 888. A bill to reauthorize the Museum Army nomination of Maj. Gen. Keith B. June 12, 2003. and Library Services Act, and for other pur- Alexander. Air Force nomination of Richard J. poses (Rept. No. 108–83). Marine Corps nomination of Lt. Gen. Wal- Delorenzo, Jr. By Mr. GREGG, from the Committee on lace C. Gregson, Jr. Air Force nomination of Gerald M. Schnei- Health, Education, Labor, and Pensions, Navy nomination of Capt. Terry L. der. with an amendment: McCreary. Air Force nomination of Jane B. Taylor. S. 650. A bill to amend the Federal Food, Navy nominations beginning Capt. Martin Air Force nominations beginning Darrell Drug, and Cosmetic Act to authorize the J. Brown and ending Capt. Michael J. Lyden, A. Jesse and ending Norbert S. Walker, Food and Drug Administration to require which nominations were received by the Sen- which nominations were received by the Sen- certain research into drugs used in pediatric ate and appeared in the Congressional ate and appeared in the Congressional patients (Rept. No. 108–84). Record on May 14, 2003. Record on June 12, 2003. By Mr. LUGAR, from the Committee on Navy nominations beginning Captain John Air Force nominations beginning Thomas Foreign Relations, without amendment and M. Bird and ending Captain Peter J. Wil- C. Barnett and ending Jean A. Vargo, which with a preamble: liams, which nominations were received by nominations were received by the Senate and S. Res. 62. A resolution calling upon the the Senate and appeared in the Congres- appeared in the Congressional Record on Organization of American States (OAS) sional Record on May 14, 2003. June 12, 2003. Inter-American Commission on Human Air Force nomination of Gen. Robert H. Air Force nomination of Edward C. Rights, the United Nations High Commis- Foglesong. Callaway. sioner for Human Rights, the European Air Force nomination of Maj. Gen. Daniel Air Force nomination of H. Michael Union, and human rights activists through- P. Leaf. Tennerman. out the world to take certain actions in re- Air Force nomination of Brig. Gen. Joseph Air Force nomination of Steven E. Ritter. gard to the human rights situation in Cuba. E. Kelley. Air Force nomination of Bryan A. Keeling. By Mr. LOTT, from the Committee on Air Force nomination of Brig. Gen. Doug- Air Force nomination of Robert L. Zabel, Rules and Administration, without amend- las Burnett. Jr. ment: Air Force nomination of Col. Craig S. Fer- Air Force nominations beginning Darryl G. S. Res. 138. A resolution to amend rule guson. XXII of the Standing Rules of the Senate re- Elrod, Jr. and ending Kevin R. Navy nomination of Vice Adm. Michael G. Vanvalkenburg, which nominations were relating to the consideration of nominations Mullen. requiring the advice and consent of the Sen- ceived by the Senate and appeared in the Air Force nomination of Lt. Gen. William Congressional Record on June 12, 2003. ate. T. Hobbins. By Mr. LUGAR, from the Committee on Air Force nomination of Drew Y. Johnston, Air Force nomination of Maj. Gen. Randall Jr. Foreign Relations, without amendment and M. Schmidt. with an amended preamble: Air Force nomination of Rachel L. Beck. Air Force nomination of Maj. Gen. Walter Air Force nomination of Larry J. Mastin. S. Res. 149. A resolution expressing the E. L. Buchanan III. sense of the Senate that the international Air Force nominations beginning Robert L. Army nomination of Lt. Gen. Dan K. Daugherty, Jr. and ending Charles V. Rath, response to the current need for food in the McNeill. Horn of Africa remains inadequate. Jr., which nominations were received by the Army nomination of Maj. Gen. William G. Senate and appeared in the Congressional By Mr. HATCH, from the Committee on Boykin. the Judiciary, without amendment and with Record on June 16, 2003. Marine Corps nomination of Maj. Gen. Army nominations beginning Craig M An- a preamble: Robert R. Blackman, Jr. S. Res. 174. A resolution designating Thurs- derson and ending Diane M Zierhoffer, which day, November 20, 2003, as ‘‘Feed America Mr. WARNER. Mr. President, for the nominations were received by the Senate and Thursday’’. Committee on Armed Services I report appeared in the Congressional Record on S. Res. 175. A resolution designating the favorably the following nomination list May 20, 2003. month of October 2003, as ‘‘Family History which was printed in the RECORD on Army nominations beginning Anuli L Month’’. the date indicated, and ask unanimous Anyachebelu and ending Donald G Zugner, By Mr. LOTT, from the Committee on which nominations were received by the Sen- Rules and Administration, without amend- consent, to save the expense of reprint- ate and appeared in the Congressional ment: ing on the Executive Calendar that this Record on May 20, 2003. S. Res. 178. A resolution to prohibit Mem- nomination lie at the Secretary’s desk Army nominations beginning Doreen M bers of the Senate and other persons from re- for the information of Senators. Agin and ending Bonnita D Wilson, which

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00076 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8723 nominations were received by the Senate and Navy nominations beginning Gregory S. appeared in the Congressional Record on appeared in the Congressional Record on Adams and ending Peter A. Withers, which May 14, 2003. January 1. nominations were received by the Senate and Navy nominations beginning Brian K. An- Army nominations beginning Kevin R appeared in the Congressional Record on tonio and ending Thomas L. Vanpetten, Armstrong and ending Nancy A May 1, 2003. which nominations were received by the Sen- Vincentjohnson, which nominations were re- Navy nominations beginning Bradford E. ate and appeared in the Congressional ceived by the Senate and appeared in the Ableson and ending Olric R. Wilkins, which Record on May 14, 2003. Congressional Record on May 20, 2003. nominations were received by the Senate and Navy nominations beginning Eugene M. Army nomination of James A. Decamp. appeared in the Congressional Record on Abler and ending Michael E. Zamesnik, Army nomination of Timothy H. Sughrue. May 8, 2003. which nominations were received by the Sen- Army nominations beginning Leslie J. Navy nominations beginning Christopher ate and appeared in the Congressional Mitkos, Jr. and ending Berris D. Samples, A. Barnes and ending Scott M. Stanley, Record on May 14, 2003. which nominations were received by the Sen- which nominations were received by the Sen- Navy nomination of Judy L. Miller. ate and appeared in the Congressional ate and appeared in the Congressional Navy nominations beginning Thomas W. Record on June 5, 2003. Record on May 8, 2003. Harrington and ending Robert L. Young, Army nominations beginning Patricia J. Navy nominations beginning Thomas M. which nominations were received by the Sen- Mcdaniel and ending Nicholas K. Balestrieri and ending Robert S. Wright, ate and appeared in the Congressional Stravelakis, which nominations were re- which nominations were received by the Sen- Record on May 14, 2003. ceived by the Senate and appeared in the ate and appeared in the Congressional Navy nominations beginning Matthew O. Congressional Record on June 5, 2003. Record on May 8, 2003. Foley III and ending Frank G. Usseglio II, Army nomination of Scott D. Navy nominations beginning Lisa L. Ar- which nominations were received by the Sen- Kothenbeutel. nold and ending Peggy W. Williams, which ate and appeared in the Congressional Army nomination of Glenn T. Bessinger. nominations were received by the Senate and Record on May 14, 2003. Army nominations beginning Jane M. appeared in the Congressional Record on Navy nominations beginning Craig E. Anderholt and ending Jay A. Whitaker, May 8, 2003. Bundy and ending Cliff P. Watkins, which which nominations were received by the Sen- Navy nominations beginning Scott W. Bai- nominations were received by the Senate and ate and appeared in the Congressional ley and ending Kevin R. Wheelock, which appeared in the Congressional Record on Record on June 12, 2003. nominations were received by the Senate and May 14, 2003. Army nominations beginning Rodney A. appeared in the Congressional Record on Navy nominations beginning William M. Armon and ending Mark W. Thackston, May 8, 2003. Arbaugh and ending Richard E. Wolfe, which which nominations were received by the Sen- Navy nominations beginning Matthew R. nominations were received by the Senate and ate and appeared in the Congressional Beebe and ending Steven M. Wirsching, appeared in the Congressional Record on Record on June 12, 2003. which nominations were received by the Sen- May 14, 2003. Army nomination of Anthony Sullivan. ate and appeared in the Congressional Navy nominations beginning Daniel M. Army nomination of Bryan C. Sleigh. Record on May 8, 2003. Bleskey and ending William E. Vaughan, Army nomination of Michael F. Navy nominations beginning Evan A. which nominations were received by the Sen- McDonough. Applequist and ending Richard D. Wright, ate and appeared in the Congressional Navy nomination of Michael U. Rump. which nominations were received by the Sen- Record on May 14, 2003. Navy nominations beginning William A. ate and appeared in the Congressional Navy nominations beginning Bartley G. Davies and ending Gary S. Tollerene, which Record on May 8, 2003. Cilento, Jr. and ending James L. White, nominations were received by the Senate and Navy nominations beginning William B. which nominations were received by the Sen- appeared in the Congressional Record on Adams and ending Daniel J. Zinder, which ate and appeared in the Congressional April 30, 2003. nominations were received by the Senate and Record on May 14, 2003. Navy nominations beginning Douglas W. appeared in the Congressional Record on Navy nominations beginning Nancy J. Fenske and ending Michael J. Kautz, which May 8, 2003. Bates and ending Lloyd G. Wingfield, which nominations were received by the Senate and Navy nominations beginning Rebecca E. nominations were received by the Senate and appeared in the Congressional Record on Brenton and ending Warren C., Graham III, appeared in the Congressional Record on April 30, 2003. which nominations were received by the Sen- May 14, 2003. Navy nominations beginning Brian H. Mil- ate and appeared in the Congressional Navy nominations beginning Annemarie ler and ending Perry T. Tuey, which nomina- Record on May 14, 2003. Adamowicz and ending Mary A. White, which tions were received by the Senate and ap- Navy nominations beginning Kathy A. nominations were received by the Senate and peared in the Congressional Record on April Baran and ending Margaret A. Taylor, which appeared in the Congressional Record on 30, 2003. nominations were received by the Senate and May 14, 2003. Navy nominations beginning Gerald W. appeared in the Congressional Record on Navy nominations beginning Sherry L. Clusen and ending Mark A. Wilson, which May 14, 2003. Breland and ending Julia D. Worcester, nominations were received by the Senate and Navy nominations beginning Michael D. which nominations were received by the Sen- appeared in the Congressional Record on Disano and ending Vincent M. Scott, which ate and appeared in the Congressional April 30, 2003. nominations were received by the Senate and Record on June 12, 2003. Navy nominations beginning Kenneth J. appeared in the Congressional Record on Navy nominations beginning Raul D. Braithwaite and ending Andrew H. Wilson, May 14, 2003. Bantog and ending Donna M. Willoughby, which nominations were received by the Sen- Navy nominations beginning Nancy R. Dil- which nominations were received by the Sen- ate and appeared in the Congressional lard and ending Christopher L. Vance, which ate and appeared in the Congressional Record on April 30, 2003. nominations were received by the Senate and Record on June 16, 2003. Navy nominations beginning Christopher appeared in the Congressional Record on Navy nominations beginning Linsly G. M. M. Ballister and ending Carl M. M. Lee, May 14, 2003. Brown and ending Denise M. Shorey, which which nominations were received by the Sen- Navy nominations beginning Jean E. nominations were received by the Senate and ate and appeared in the Congressional Benfer and ending Cynthia L. Widick, which appeared in the Congressional Record on Record on April 30, 2003. nominations were received by the Senate and June 18, 2003. Navy nominations beginning Jeffrey D. Ad- appeared in the Congressional Record on By Mr. LUGAR for the Committee on For- amson and ending Marcus K. Neeson, which May 14, 2003. eign Relations. nominations were received by the Senate and Navy nominations beginning David L. Bai- *Marsha E. Barnes, of Maryland, a Career appeared in the Congressional Record on ley and ending Russell L. Shaffer, which Member of the Senior Foreign Service, Class April 30, 2003. nominations were received by the Senate and of Counselor, to be Ambassador Extraor- Navy nominations beginning Danford S. K. appeared in the Congressional Record on dinary and Plenipotentiary of the United Afong and ending Theodore A. Wyka, which May 14, 2003. States of America to the Republic of nominations were received by the Senate and Navy nominations beginning Robert W. Ar- Suriname. appeared in the Congressional Record on cher and ending Jim O. Romano, which The following is a list of all members of May 1, 2003. nominations were received by the Senate and my immediate family and their spouses. I Navy nominations beginning Scott F. appeared in the Congressional Record on ahve asked each of these persons to inform Bohnenkamp and ending Christopher L. May 14, 2003. me of the pertinent contributions made by Wall, which nominations were received by Navy nominations beginning Christopher them. To the best of my knowledge, the in- the Senate and appeared in the Congres- L. Abbott and ending William A., Wright III, formation contained in this report is com- sional Record on May 1, 2003. which nominations were received by the Sen- plete and accurate. Navy nominations beginning Charles L. ate and appeared in the Congressional Nominee: Marsha E. Barnes Collins and ending Cynthia R. Sugimoto, Record on May 14, 2003. Post: Paramaribo, Suriname. which nominations were received by the Sen- Navy nominations beginning Charles S. Contributions, amount, date, and donee: ate and appeared in the Congressional Anderson and ending Philip A. Yates, which 1. Self, none. Record on May 1, 2003. nominations were received by the Senate and 2. Spouse, none.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00077 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8724 CONGRESSIONAL RECORD — SENATE June 26, 2003 3. No children. 4. Parents: Both deceased more than 20 States of America to the Organization of 4. Parents deceased. years. American States, with the rank of Ambas- 5. Grandparents deceased. 5. Grandparents: Deceased more than 20 sador. 6. Brother and spouse: Malcolm Samuel years. The following is a list of all members of John Barnes and Shirley Barnes, none. 6. Brothers and spouses: Peter R. Wood, not my immediate family and their spouses. I 7. No sisters. married. have asked each of these persons to inform 7. Sisters and spouses: No sisters. me of the pertinent contributions made by *Robert W. Fitts, of New Hampshire, a Ca- them. To the best of my knowledge, the in- reer Member of the Senior Foreign Service, *Tracey Ann Jacobson, of the District of formation contained in this report is com- Class of Minister-Counselor, to be Ambas- Columbia, a Foreign Service Officer of Class plete and accurate. sador Extraordinary and Plenipotentiary of One, to be Ambassador Extraordinary and Nominee John Francis Maisto. the United States of America to Papua New Plenipotentiary of the United States of Post Permanent Representative of the U.S. Guinea, and to serve concurrently and with- America to Turkmenistan. to the Organization of American States. out additional compensation as Ambassador The following is a list of all members of Contributions, amount, date, and donee: Extraordinary and Plenipotentiary of the my immediate family and their spouses. I 1. Self, John F. Maisto, none. United States of America to the Solomon Is- have asked each of these persons to inform 2. Spouse, Maria Consuelo G. Maisto, none. lands and Ambassador Extraordinary and me of the pertinent contributions made by 3. Children and spouses: John J. Maisto and Plenipotentiary of the United States of them. To the best of my knowledge, the in- Karen Nelson, none; Maria C. Maisto and Ed- America to the Republic of Vanuatu. formation contained in this report is com- ward Lynch, none; M. Cristina Maisto, none. The following is a list of all members of plete and accurate. 4. Parents: John Maisto, deceased; Mary P. my immediate family and their spouses. I Nominee Tracey Ann Jacobson. Maisto, none. have asked each of these persons to inform Post: COM, Ashgabat, Turkmenistan. 5. Grandparents: Elpedio and Luisa Maisto, Contributions, amount, date, and donee: me of the pertinent contributions made by Petronilla and Luigi Tomaino, all deceased. 1. Self, none. 6. Brothers and spouses, Alberto L. and them. To the best of my knowledge, the in- 2. Spouse, Lars Johansson, none. formation contained in this report is com- Mary Jean Maisto, none. 3. Children and spouses: stepdaughter, 7. Sisters and spouses, N/A. plete and accurate. Emmelie Johansson, none. Nominee: Robert W. Fitts. 4. Parents: Winifred B. Thomas and John C. Post: U.S. Ambassador—Papua New Guin- *Roger Francisco Noriega, of Kansas, to be Thomas, none. an Assistant Secretary of State (Western ea. 5. Grandparents, none. Contributions, amount, date, and donee: Hemisphere Affairs). 6. Brothers and spouses, none. The following is a list of all members of 1. Self, N/A. 7. Sisters and spouses: Teri and Terry my immediate family and their spouses. I 2. Spouse, N/A. Dermody, none. 3. Children and spouses: none. have asked each of these persons to inform 4. Parents: N/A. *George A. Krol, of New Jersey, a Career me of the pertinent contributions made by 5. Grandparents: N/A. Member of the Senior Foreign Service, Class them. To the best of my knowledge, the in- 6. Brothers and spouses: Gary Allen Fitts, of Counselor, to be Ambassador Extraor- formation contained in this report is com- $100, 2000, Nat Goldharber (VP); James An- dinary and Plenipotentiary of the United plete and accurate. Nominee: Roger F. Noriega. drew Fitts, $50, 2002, Craig Benson (NH Gov). States of America to the Republic of Post: Assistant Secretary of State for 7. Sisters and Spouses, none. Belarus. Western Hemisphere Affairs. The following is a list of all members of Contributions, amount, date, and donee: *John E. Herbst, of Virginia, a Career my immediate family and their spouses. I 1. Self, $250, 10/10/95, Bob Dole for Presi- Member of the Senior Foreign Service, Class have asked each of these persons to inform dent. of Minister-Counselor, to be Ambassador Ex- me of the pertinent contributions made by 2. Spouse, N/A. traordinary and Plenipotentiary of the them. To the best of my knowledge, the in- 3. Children and spouses: N/A. United States of America to Ukraine. formation contained in this report is com- 4. Parents names: Richard Noriega, and The following is a list of all members of plete and accurate. Lucille Noriega, none. my immediate family and their spouses. I Nominee: George Albert Krol. 5. Grandparents: all deceased, none. have asked each of these persons to inform Post: Minsk, Belarus. 6. Brothers and spouses names: James P. me of the pertinent contributions made by Contributions, amount, date, and donee: Noriega, and Carolos R. Noriega, both de- 1. Self, none. them. To the best of my knowledge, the in- ceased. 2. Spouse, none. formation contained in this report is com- 7. Sisters and spouses names: Rita and Mi- 3. Children and spouses, none. plete and accurate. chael Prahm, none; Rosalie and Douglas Nominee: John E. Herbst. 4. Parents, Anthony and Ann Krol, none. 5. Grandparents, deceased. Jackson, none; Emilie Palmer, divorced, Post: Ukraine. none. Contributions, amount, date, and donee: 6. Brothers: David Krol, none; Anthony 1. Self, none. Krol, none, Alice Milrod (spouse), none. 7. Sisters, none. Mr. LUGAR. Mr. President, for the 2. Spouse, none. Committee on Foreign Relations I re- 3. Children and spouses: Maria Herbst, * Greta N. Morris, of California, a Career Ksenia Herbst, Aleksandra Herbst, Nicholas port favorably the following nomina- Member of the Senior Foreign Service, Class Herbst, John Herbst, none. tion lists which were printed in the 4. Parents: Christopher Herbst, deceased; of Minister-Counselor, to be Ambassador Ex- RECORDS on the dates indicated, and Mary Herbst, deceased. traordinary and Plenipotentiary of the ask unanimous consent, to save the ex- United States of America to the Republic of 5. Grandparents: John Herbst and Sadie pense of reprinting on the Executive Herbst, deceased; Egidio Vaccheli and Irene the Marshall Islands. The following is a list of all members of Calendar that these nominations lie at Vaccheli, deceased. the Secretary’s desk for the informa- 6. Brothers and spouses: none. my immediate family and their spouses. I 7. Sisters and spouses: Christine Herbst, have asked each of these persons to inform tion of Senators. none; Mitchell Stern, none. me of the pertinent contributions made by The PRESIDING OFFICER. Without them. To the best of my knowledge, the in- objection, it is so ordered. formation contained in this report is com- *William B. Wood, of New York, a Career Foreign Service nominations beginning Ali plete and accurate. Member of the Senior Foreign Service, Class Abdi and ending Lawrence C. Mandel, which Nominee: Greta N. Morris. of Minister-Counselor, to be Ambassador Ex- Post: Majuro. nominations were received by the Senate and traordinary and Plenipotentiary of the Contributions, amount, date, and donee: appeared in the Congressional Record on United States of America to the Republic of 1. Self, none. May 22, 2003. Colombia. 2. Spouse, Charles H. Morris, deceased, Foreign Service nominations beginning The following is a list of all members of none. Beth A. Salamanca and ending Peter H. my immediate family and their spouses. I 3.Children and spouses, none. Chase, which nominations were received by have asked each of these persons to inform 4. Parents: Gretchen W. Nance, Kendall W. the Senate and appeared in the Congres- me of the pertinent contributions made by Nance, both deceased, none. sional Record on June 3, 2003. them. To the best of my knowledge, the in- 5. Grandparents: Willis and Augusta By Ms. COLLINS for the Committee on formation contained in this report is com- Wiesmore, James Flemming and Frances Governmental Affairs. plete and accurate. Nance, none. Fern Flanagan Saddler, of the District of Nominee: William B. Wood. 6. Brothers and spouses, N/A. Columbia, to be an Associate Judge of the Post: Ambassador to Colombia. 7. Sisters and spouses, Ernestine D. Nance, Superior Court of the District of Columbia Contributions, amount, date, and donee: none. for the term of fifteen years. 1. Self, none. *Joshua B. Bolten, of the District of Co- 2. Spouse: Never married. *John F. Maisto, of Pennsylvania, to be lumbia, to be Director of the Office of Man- 3. Children and spouses: No children. Permanent Representative of the United agement and Budget.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00078 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8725 Judith Nan Macaluso, of the District of Co- By Mrs. FEINSTEIN: By Ms. MURKOWSKI (for herself and lumbia, to be an Associate Judge of the Su- S. 1342. A bill to amend the Graton Mr. STEVENS): perior Court of the District of Columbia for Rancheria Restoration Act to give the Sec- S. 1354. A bill to resolve certain convey- the term of fifteen years. retary of the Interior discretion regarding ances and provide for alternative land selec- By Mr. CAMPBELL for the Committee on taking land into trust; to the Committee on tions under the Alaska Native Claims Settle- Indian Affairs. Indian Affairs. ment Act related to Cape Fox Corporation *John Richard Grimes, of Massachusetts, By Mr. EDWARDS: and Sealaska Corporation, and for other pur- to be a Member of the Board of Trustees of S. 1343. A bill to amend title 11, United poses; to the Committee on Energy and Nat- the Institute of American Indian and Alaska States Code, to provide for the avoidance of ural Resources. Native Culture and Arts Development for a certain transfers, and the alternative pros- By Mr. SMITH (for himself and Mr. term expiring May 19, 2006. ecution of certain actions, relating to cer- WYDEN): *Lisa Genevieve Nason, of Alaska, to be a tain retirement benefits; to the Committee S. 1355. A bill to authorize the Bureau of Member of the Board of Trustees of the Insti- on the Judiciary. Reclamation to participate in the rehabilita- tute of American Indian and Alaska Native By Mr. CORZINE (for himself, Mr. tion of the Wallowa Lake Dam in Oregon, Culture and Arts Development for a term ex- SCHUMER, Mr. AKAKA, and Mrs. and for other purposes; to the Committee on piring October 18, 2004. BOXER): Energy and Natural Resources. *Georgianna E. Ignace, of Wisconsin, to be S. 1344. A bill to amend the Electronic By Mr. SPECTER: a Member of the Board of Trustees of the In- Fund Transfer Act to require additional dis- S. 1356. An original bill making appropria- stitute of American Indian and Alaska Na- closures relating to exchange rates in trans- tions for the Departments of Labor, Health tive Culture and Arts Development for a fers involving international transactions, and Human Services, and Education, and re- term expiring October 18, 2004. and for other purposes; to the Committee on lated agencies for the fiscal year ending Sep- *Charles W. Grim, of Oklahoma, to be Di- Banking, Housing, and Urban Affairs. tember 30, 2004, and for other purposes; from rector of the Indian Health Service, Depart- By Mrs. MURRAY (for herself, Mrs. the Committee on Appropriations; placed on ment of Health and Human Services, for a BOXER, Ms. CANTWELL, Mrs. CLINTON, the calendar. term of four years. Mr. CORZINE, Mr. EDWARDS, Mrs. By Mrs. HUTCHISON: By Mr. HATCH for the Committee on the FEINSTEIN, Mr. KENNEDY, Mr. LAU- S. 1357. An original bill making appropria- Judiciary. TENBERG, Mr. SCHUMER, and Mr. HOL- tions for military construction, family hous- Thomas M. Hardiman, of Pennsylvania, to LINGS): ing, and base realignment and closure for the be United States District Judge for the West- S. 1345. A bill to extend the authorization Department of Defense for the fiscal year ern District of Pennsylvania. for the ferry boat discretionary program, and ending September 30, 2004, and for other pur- Diane M. Stuart, of Utah, to be Director of for other purposes; to the Committee on En- poses; from the Committee on Appropria- the Violence Against Women Office, Depart- vironment and Public Works. tions; placed on the calendar. ment of Justice. By Ms. CANTWELL (for herself and By Mr. AKAKA (for himself, Mr. *Nomination was reported with rec- Ms. COLLINS): GRASSLEY, Mr. LEVIN, Mr. LEAHY, and ommendation that it be confirmed sub- S. 1346. A bill to amend the Workforce In- Mr. DURBIN): vestment Act of 1998 to provide for strategic S. 1358. A bill to amend chapter 23 of title ject to the nominee’s commitment to sectoral skills gap assessments, strategic 5, United States Code, to clarify the disclo- respond to requests to appear and tes- skills gap action plans, and strategic train- sure of information protected from prohib- tify before any duly constituted coming capacity enhancement seed grants, and ited personnel practices, require a statement mittee of the Senate. for other purposes; to the Committee on in non-disclosure policies, forms, and agree- (Nominations without an asterisk Health, Education, Labor, and Pensions. ments that such policies, forms, and agree- were reported with the recommenda- By Ms. CANTWELL: ments conform with certain disclosure pro- tion that they be confirmed.) S. 1347. A bill to amend the Workforce In- tections, provide certain authority for the vestment Act of 1998 to provide for training Special Counsel, and for other purposes; to f service and delivery innovation projects; to the Committee on Governmental Affairs. INTRODUCTION OF BILLS AND the Committee on Health, Education, Labor, By Mrs. BOXER: S. 1359. A bill to allow credit unions to pro- JOINT RESOLUTIONS and Pensions. By Ms. CANTWELL: vide international money transfer services The following bills and joint resolu- S. 1348. A bill to amend the Higher Edu- and to require disclosures in connection with tions were introduced, read the first cation Act of 1965 to modify the computation international money transfers from all and second times by unanimous con- of eligibility for certain Federal Pell Grants, money transmitting service providers; to the sent, and referred as indicated: and for other purposes; to the Committee on Committee on Banking, Housing, and Urban Health, Education, Labor, and Pensions. Affairs. By Mr. ENSIGN (for himself, Mr. By Mr. SMITH (for himself, Mr. KOHL, By Mr. GRAHAM of Florida: FRIST, Mr. MCCONNELL, Mr. KYL, Mr. Mrs. BOXER, Mr. CORNYN, Mr. FEIN- S. 1360. A bill to amend section 7105 of title BUNNING, Mr. ENZI, Mr. THOMAS, Mr. GOLD, Mrs. HUTCHISON, Ms. MUR- 38, United States Code, to clarify the re- VOINOVICH, Mr. HAGEL, Mr. CORNYN, KOWSKI, and Mr. WYDEN): quirements for notices of disagreement for and Mr. INHOFE): S. 1349. A bill to amend the Internal Rev- appellate review of Department of Veterans S. 11. A bill to protect patients’ access to enue Code of 1986 with respect to the eligi- Affairs activities; to the Committee on Vet- quality and affordable health care by reduc- bility of veterans for mortgage bond financ- erans’ Affairs. ing the effects of excessive liability costs. ing, and for other purposes; to the Com- By Mr. SMITH: By Mr. LEVIN: mittee on Finance. S. 1361. A bill to amend the Internal Rev- S. 1338. A bill to decrease the matching By Mrs. FEINSTEIN: enue Code of 1986 to provide that foreign base funds requirement and authorize additional S. 1350. A bill to require Federal agencies, company shipping income shall include only appropriations for Keweenaw National His- and persons engaged in interstate commerce, income from aircraft and income from cer- torical Park in the State of Michigan; to the in possession of electronic data containing tain vessels transporting petroleum and re- Committee on Energy and Natural Re- personal information, to disclose any unau- lated products; to the Committee on Fi- sources. thorized acquisition of such information; to nance. By Mr. BREAUX (for himself and Mr. the Committee on the Judiciary . By Mrs. BOXER: ROBERTS): By Mr. FRIST: S. 1362. A bill to authorize the Port Pas- S. 1339. A bill to amend title 5, United S. 1351. A bill to amend the Tennessee Val- senger Accelerated Service System (Port States Code, to provide for appropriate over- ley Authority Act of 1933 to modify provi- PASS) as a permanent program for land bor- time pay for National Weather Service em- sions relating to the Board of Directors of der inspection under the Immigration and ployees who perform essential services dur- the Tennessee Valley Authority, and for Nationality Act, and for other purposes; to ing severe weather events; to the Committee other purposes; to the Committee on Envi- the Committee on the Judiciary. on Governmental Affairs. ronment and Public Works. By Mr. REID: By Mr. GRAHAM of Florida (for him- By Mr. WYDEN (for himself and Mrs. S. 1363. A bill to prohibit the study or im- self and Mr. NELSON of Florida): FEINSTEIN): plementation of any plan to privatize, divest, S. 1340. A bill to authorize additional S. 1352. A bill to expedite procedures for or transfer any part of the mission, function, judgeships in the middle and southern dis- hazardous fuels reduction activities and res- or responsibility of the National Park Serv- tricts of Florida, and for other purposes; to toration in wildland fire prone National For- ice; to the Committee on Energy and Natural the Committee on the Judiciary. ests and for other purposes; to the Com- Resources. By Mrs. HUTCHISON (for herself and mittee on Agriculture, Nutrition, and For- By Ms. MURKOWSKI: Mr. CORNYN): estry. S. 1364. A bill to amend the Alaska Na- S. 1341. A bill to name the Department of By Mr. BROWNBACK (for himself and tional Interest Lands Conservation Act to Veterans Affairs in Houston, Texas, as the Mr. DEWINE): authorize the payment of expenses after the ‘‘Michael E. DeBakey Department of Vet- S. 1353. A bill to establish new special im- death of certain Federal employees in the erans Affairs Medical Center’’; to the Com- migrant categories; to the Committee on the State of Alaska; to the Committee on En- mittee on Veterans’ Affairs. Judiciary. ergy and Natural Resources.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00079 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8726 CONGRESSIONAL RECORD — SENATE June 26, 2003 By Mr. McCONNELL (for himself, Mr. ADDITIONAL COSPONSORS HUTCHISON) was added as a cosponsor of KYL, and Mr. LEAHY): S. 56 S. 684, a bill to create an office within S. 1365. A bill to provide increased foreign At the request of Mr. JOHNSON, the the Department of Justice to under- assistance for Cambodia under certain cir- take certain specific steps to ensure cumstances, and for other purposes; to the name of the Senator from Maine (Ms. COLLINS) was added as a cosponsor of S. that all American citizens harmed by Committee on Foreign Relations. terrorism overseas receive equal treat- By Mr. ALLARD (for himself, Mr. FEIN- 56, a bill to restore health care cov- ment by the United States Government GOLD, and Mr. CRAPO): erage to retired members of the uni- S. 1366. A bill to authorize the Secretary of formed services. regardless of the terrorists’ country of the Interior to make grants to State and S. 392 origin or residence, and to ensure that tribal governments to assist State and tribal At the request of Mr. REID, the name all terrorists involved in such attacks efforts to manage and control the spread of of the Senator from New York (Mr. are pursued, prosecuted, and punished chronic wasting disease in deer and elk SCHUMER) was added as a cosponsor of with equal vigor, regardless of the ter- herds, and for other purposes; to the Com- S. 392, a bill to amend title 10, United rorists’ country of origin or residence. mittee on Environment and Public Works. S. 777 By Mr. McCONNELL (for himself, Mr. States Code, to permit retired mem- At the request of Mr. INHOFE, the BAYH, and Mr. FITZGERALD): bers of the Armed Forces who have a name of the Senator from Montana S. 1367. A bill to amend the Richard B. Rus- service-connected disability to receive (Mr. BURNS) was added as a cosponsor sell National School Lunch Act to establish both military retired pay by reason of programs to promote increased consumption their years of military service and dis- of S. 777, a bill to amend the impact aid of milk in schools and to improve the nutri- ability compensation from the Depart- program under the Elementary and tion and health of children; to the Com- ment of Veterans Affairs for their dis- Secondary Education Act of 1965 to im- mittee on Agriculture, Nutrition, and For- ability. prove the delivery of payments under estry. S. 478 the program to local educational agen- At the request of Mr. SARBANES, the cies. f name of the Senator from Alaska (Ms. S. 835 MURKOWSKI) was added as a cosponsor At the request of Ms. LANDRIEU, the SUBMISSION OF CONCURRENT AND of S. 478, a bill to grant a Federal char- name of the Senator from Mississippi SENATE RESOLUTIONS ter Korean War Veterans Association, (Mr. LOTT) was added as a cosponsor of Incorporated, and for other purposes. S. 835, a bill to amend the Higher Edu- The following concurrent resolutions S. 491 cation Act of 1965 to provide student and Senate resolutions were read, and At the request of Mr. REID, the loan borrowers with a choice of lender referred (or acted upon), as indicated: names of the Senator from Rhode Is- for loan consolidation, to provide no- By Mr. LUGAR (for himself, Mr. SAR- land (Mr. CHAFEE) and the Senator tice regarding loan consolidation, and BANES, and Mr. FEINGOLD): from Massachusetts (Mr. KERRY) were for other purposes. S. Res. 187. A resolution expressing the added as cosponsors of S. 491, a bill to S. 847 sense of the Senate regarding the centenary At the request of Mr. SMITH, the of the Rhodes Scholarships in the United expand research regarding inflam- States and the establishment of the Mandela matory bowel disease, and for other name of the Senator from South Da- Rhodes Foundation. purposes. kota (Mr. JOHNSON) was added as a co- By Mr. CHAMBLISS (for himself and S. 596 sponsor of S. 847, a bill to amend title Mr. MILLER): At the request of Mr. ENSIGN, the XIX of the Social Security Act to per- S. Res. 188. A resolution honoring Maynard name of the Senator from Virginia (Mr. mit States the option to provide med- Holbrook Jackson, Jr. former Mayor of the WARNER) was added as a cosponsor of S. icaid coverage for low income individ- City of Atlanta, and extending the condo- 596, a bill to amend the Internal Rev- uals infected with HIV. lences of the Senate on his death. enue Code of 1986 to encourage the in- S. 893 By Mr. FRIST (for himself and Mr. vestment of foreign earnings within At the request of Mr. SANTORUM, the DASCHLE): the United States for productive busi- name of the Senator from Pennsyl- S. Res. 189. A resolution electing Doctor ness investments and job creation. Barry C. Black, of Baltimore, Maryland, as vania (Mr. SPECTER) was added as a co- Chaplain of the United States Senate. S. 611 sponsor of S. 893, a bill to amend title By Mr. AKAKA (for himself, Mr. At the request of Mr. CRAIG, his name VII of the Civil Rights Act of 1964 to es- INHOFE, Mr. WARNER, Mr. LEVIN, Mrs. was added as a cosponsor of S. 611, a tablish provisions with respect to reli- MURRAY, Mr. DODD, Ms. LANDRIEU, bill to amend the Internal Revenue gious accommodation in employment, Mr. PRYOR, Mr. DASCHLE, Mr. BIDEN, Code of 1986 to treat gold, silver, and and for other purposes. Mr. KENNEDY, Mr. FEINGOLD, Mr. platinum, in either coin or bar form, in S. 894 DURBIN, Mr. NELSON of Nebraska, Mr. the same manner as stocks and bonds At the request of Mr. WARNER, the NELSON of Florida, Mr. REED, Mr. for purposes of the maximum capital names of the Senator from Louisiana CHAMBLISS, Ms. CANTWELL, Mr. SAR- gains rate for individuals. ANDRIEU BANES, Mrs. CLINTON, Mr. ROBERTS, (Ms. L ) and the Senator from Mr. LAUTENBERG, Mr. LIEBERMAN, Mr. S. 623 Hawaii (Mr. INOUYE) were added as co- DAYTON, Ms. MURKOWSKI, Mr. INOUYE, At the request of Mr. WARNER, the sponsors of S. 894, a bill to require the Mr. HAGEL, Ms. COLLINS, and Mr. name of the Senator from Michigan Secretary of the Treasury to mint STEVENS): (Ms. STABENOW) was added as a cospon- coins in commemoration of the 230th S. Res. 190. A resolution commending Gen- sor of S. 623, a bill to amend the Inter- Anniversary of the United States Ma- eral Eric Shinseki of the United States Army nal Revenue Code of 1986 to allow Fed- rine Corps, and to support construction for his outstanding service and commitment eral civilian and military retirees to of the Marine Corps Heritage Center. to excellence. pay health insurance premiums on a S. 902 By Mr. CORZINE (for himself, Mr. pretax basis and to allow a deduction At the request of Ms. LANDRIEU, the WARNER, Mr. LAUTENBERG, and Mrs. CLINTON): for TRICARE supplemental premiums. name of the Senator from Georgia (Mr. S. Con. Res. 56. A concurrent resolution ex- S. 640 MILLER) was added as a cosponsor of S. pressing the sense of the Congress that a At the request of Mr. LEAHY, the 902, a bill to declare, under the author- commemorative postage stamp should be name of the Senator from Oregon (Mr. ity of Congress under Article I, section issued honoring Gunnery Sergeant John SMITH) was added as a cosponsor of S. 8, of the Constitution to ‘‘provide and Basilone, a great American hero; to the Com- 640, a bill to amend subchapter III of maintain a Navy’’, a national policy mittee on Governmental Affairs. chapter 83 and chapter 84 of title 5, for the naval force structure required By Ms. LANDRIEU: United States Code, to include Federal in order to ‘‘provide for the common S. Con. Res. 57. A concurrent resolution prosecutors within the definition of a defense’’ of the United States through- honoring Dr. Norman Christopher Francis, law enforcement officer, and for other out the 21st century. president of Xavier University of Louisiana, for his longstanding dedication and service purposes. S. 953 specific to Xavier University and to edu- S. 684 At the request of Ms. LANDRIEU, the cation as a whole; to the Committee on At the request of Mr. SMITH, the name of the Senator from Louisiana Health, Education, Labor, and Pensions. name of the Senator from Texas (Mrs. (Mr. BREAUX) was added as a cosponsor

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00080 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8727 of S. 953, a bill to amend chapter 53 of duce the health risks posed by asbes- ment lands, when those forested Fed- title 5, United States Code, to provide tos-containing products. eral lands are not maintained in the special pay for board certified Federal S. 1129 forest health status known as condi- Employees who are employed in health At the request of Mrs. FEINSTEIN, the tion class 1. science positions, and for other pur- name of the Senator from Massachu- S. 1317 poses. setts (Mr. KERRY) was added as a co- At the request of Mr. SMITH, the S. 977 sponsor of S. 1129, a bill to provide for name of the Senator from Vermont At the request of Mr. FITZGERALD, the protection of unaccompanied alien (Mr. LEAHY) was added as a cosponsor the name of the Senator from Indiana children, and for other purposes. of S. 1317, a bill to amend the American Servicemember’s Protection Act of 2002 (Mr. BAYH) was added as a cosponsor of S. 1137 to provide clarification with respect to S. 977, a bill to amend the Public At the request of Mr. LOTT, the name the eligibility of certain countries for Health Service Act, the Employee Re- of the Senator from Mississippi (Mr. United States military assistance. tirement Income Security Act of 1974, COCHRAN) was added as a cosponsor of and the Internal Revenue Code of 1986 S. 1137, a bill to establish a Mississippi S. 1321 At the request of Mrs. CLINTON, the to require that group and individual Gulf Coast National Heritage Area in name of the Senator from Alabama health insurance coverage and group the State of Mississippi, and for other (Mr. SESSIONS) was added as a cospon- health plans provide coverage from purposes. sor of S. 1321, a bill to authorize re- treatment of a minor child’s congenital S. 1139 or developmental deformity or disorder sources to foster a safe learning envi- At the request of Mr. DEWINE, the ronment that supports academic due to trauma, infection, tumor, or dis- name of the Senator from Washington ease. achievement for all students by im- (Mrs. MURRAY) was added as a cospon- proving the quality of interim alter- S. 982 sor of S. 1139, a bill to direct the Na- native educational settings, providing At the request of Mrs. BOXER, the tional Highway Traffic Safety Admin- more behavioral supports in schools, name of the Senator from Montana istration to establish and carry out and supporting whole school interven- (Mr. BURNS) was added as a cosponsor traffic safety law enforcement and tions. of S. 982, a bill to halt Syrian support compliance campaigns, and for other S. 1323 for terrorism, end its occupation of purposes. At the request of Mr. GRASSLEY, the Lebanon, stop its development of weap- S. 1196 names of the Senator from Missouri ons of mass destruction, cease its ille- At the request of Mrs. HUTCHISON, the (Mr. BOND) and the Senator from Ne- gal importation of Iraqi oil, and hold name of the Senator from Nevada (Mr. braska (Mr. HAGEL) were added as co- Syria accountable for its role in the ENSIGN) was added as a cosponsor of S. sponsors of S. 1323, a bill to extend the Middle East, and for other purposes. 1196, a bill to eliminate the marriage period for which chapter 12 of title 11, S. 982 penalty permanently in 2003. United States Code, is reenacted by 6 At the request of Mr. SANTORUM, the S. 1245 months. name of the Senator from Alabama At the request of Ms. COLLINS, the S. 1324 (Mr. SESSIONS) was added as a cospon- names of the Senator from Nebraska At the request of Mr. GRASSLEY, the sor of S. 982, supra. (Mr. HAGEL) and the Senator from name of the Senator from South Da- S. 985 Montana (Mr. BURNS) were added as co- kota (Mr. DASCHLE) was added as a co- At the request of Mr. DODD, the name sponsors of S. 1245, a bill to provide for sponsor of S. 1324, a bill to amend the of the Senator from West Virginia (Mr. homeland security grant coordination Trade Act of 1974 to establish proce- ROCKEFELLER) was added as a cospon- and simplification, and for other pur- dures for identifying countries that sor of S. 985, a bill to amend the Fed- poses. deny market access for agricultural eral Law Enforcement Pay Reform Act S. 1248 products of the United States, and for of 1990 to adjust the percentage dif- At the request of Mr. GREGG, the other purposes . ferentials payable to Federal law en- name of the Senator from Missouri S. 1325 forcement officers in certain high-cost (Mr. BOND) was added as a cosponsor of At the request of Mr. BURNS, the areas, and for other purposes. S. 1248, a bill to reauthorize the Indi- name of the Senator from Missouri ALENT S. 1001 viduals with Disabilities Education (Mr. T ) was added as a cosponsor of S. 1325, a bill to amend the National At the request of Mr. BIDEN, the Act, and for other purposes. Highway System Designation Act of names of the Senator from Wisconsin S. 1293 1995 to modify the applicability of re- (Mr. FEINGOLD) and the Senator from At the request of Mr. LEAHY, the quirements concerning hours of service Massachusetts (Mr. KENNEDY) were name of the Senator from Florida (Mr. to operators of commercial motor vehi- added as cosponsors of S. 1001, a bill to NELSON) was added as a cosponsor of S. cles transporting agricultural commod- make the protection of women and 1293, a bill to criminalize the sending of ities and farm supplies. children who are affected by a complex predatory and abusive e-mail. S. 1331 humanitarian emergency a priority of S. 1299 At the request of Mr. CONRAD, the the United States Government, and for At the request of Ms. SNOWE, the name of the Senator from South Da- other purposes. name of the Senator from Alaska (Mr. kota (Mr. DASCHLE) was added as a co- S. 1046 STEVENS) was added as a cosponsor of sponsor of S. 1331, a bill to clarify the At the request of Mr. STEVENS, the S. 1299, a bill to amend the Trade Act treatment of tax attributes under sec- name of the Senator from Alaska (Ms. of 1974 to provide trade readjustment tion 108 of the Internal Revenue Code MURKOWSKI) was added as a cosponsor and development enhancement for of 1986 for taxpayers which file consoli- of S. 1046, a bill to amend the Commu- America’s communities, and for other dated returns. nications Act of 1934 to preserve local- purposes. S. 1331 ism, to foster and promote the diver- S. 1315 At the request of Mr. SANTORUM, the sity of television programming, to fos- At the request of Mr. CRAIG, the name of the Senator from Utah (Mr. ter and promote competition, and to name of the Senator from Colorado HATCH) was added as a cosponsor of S. prevent excessive concentration of (Mr. ALLARD) was added as a cosponsor 1331, supra. ownership of the nation’s television of S. 1315, a bill to amend the Federal S. CON. RES. 25 broadcast stations. Land Policy and Management Act of At the request of Mr. VOINOVICH, the S. 1115 1976 to provide owners of non-Federal names of the Senator from New York At the request of Mrs. MURRAY, the lands with a reliable method of receiv- (Mr. SCHUMER) and the Senator from name of the Senator from New Jersey ing compensation for damages result- Georgia (Mr. CHAMBLISS) were added as (Mr. LAUTENBERG) was added as a co- ing from the spread of wildfire from cosponsors of S. Con. Res. 25, a concur- sponsor of S. 1115, a bill to amend the nearby forested National Forest Sys- rent resolution recognizing and hon- Toxic Substances Control Act to re- tem lands or Bureau of Land Manage- oring America’s Jewish community on

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00081 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8728 CONGRESSIONAL RECORD — SENATE June 26, 2003 the occasion of its 350th anniversary, amendment No. 975 proposed to S. 1, added as cosponsors of amendment No. supporting the designation of an supra. 1033 proposed to S. 1, a bill to amend ‘‘American Jewish History Month’’, AMENDMENT NO. 979 title XVIII of the Social Security Act and for other purposes. At the request of Mr. AKAKA, the to provide for a voluntary prescription S. CON. RES. 40 name of the Senator from Virginia (Mr. drug benefit under the Medicare pro- At the request of Mrs. CLINTON, the ALLEN) was added as a cosponsor of gram and to strengthen and improve names of the Senator from Florida (Mr. amendment No. 979 proposed to S. 1, a the Medicare program, and for other NELSON), the Senator from Illinois (Mr. bill to amend title XVIII of the Social purposes. DURBIN) and the Senator from Cali- Security Act to provide for a voluntary AMENDMENT NO. 1040 fornia (Mrs. FEINSTEIN) were added as prescription drug benefit under the At the request of Mr. SCHUMER, the cosponsors of S. Con. Res. 40, a concur- Medicare program and to strengthen name of the Senator from Minnesota rent resolution designating August 7, and improve the Medicare program, (Mr. COLEMAN) was added as a cospon- 2003, as ‘‘National Purple Heart Rec- and for other purposes. sor of amendment No. 1040 proposed to ognition Day’’. AMENDMENT NO. 980 S. 1, a bill to amend title XVIII of the S. RES. 62 Social Security Act to provide for a At the request of Mr. AKAKA, the At the request of Mr. ENSIGN, the name of the Senator from New Mexico voluntary prescription drug benefit name of the Senator from Wyoming under the Medicare program and to (Mr. DOMENICI) was added as a cospon- (Mr. ENZI) was added as a cosponsor of sor of amendment No. 980 proposed to strengthen and improve the Medicare S. Res. 62, a resolution calling upon the program, and for other purposes. Organization of American States (OAS) S. 1, a bill to amend title XVIII of the Social Security Act to provide for a AMENDMENT NO. 1060 Inter-American Commission on Human At the request of Mr. ALEXANDER, his Rights, the United Nations High Com- voluntary prescription drug benefit under the Medicare program and to name was added as a cosponsor of missioner for Human Rights, the Euro- amendment No. 1060 proposed to S. 1, a pean Union, and human rights activists strengthen and improve the Medicare program, and for other purposes. bill to amend title XVIII of the Social throughout the world to take certain Security Act to provide for a voluntary AMENDMENT NO. 989 actions in regard to the human rights prescription drug benefit under the At the request of Ms. COLLINS, the situation in Cuba. Medicare program and to strengthen name of the Senator from Missouri S. RES. 153 and improve the Medicare program, (Mr. BOND) was added as a cosponsor of At the request of Mrs. MURRAY, the and for other purposes. name of the Senator from Oregon (Mr. amendment No. 989 proposed to S. 1, a AMENDMENT NO. 1060 WYDEN) was added as a cosponsor of S. bill to amend title XVIII of the Social At the request of Mr. MCCAIN, his Res. 153, a resolution expressing the Security Act to provide for a voluntary name was added as a cosponsor of sense of the Senate that changes to prescription drug benefit under the amendment No. 1060 proposed to S. 1, athletics policies issued under title IX Medicare program and to strengthen supra. of the Education Amendments of 1972 and improve the Medicare program, would contradict the spirit of athletic and for other purposes. AMENDMENT NO. 1063 At the request of Ms. COLLINS, the equality and the intent to prohibit sex AMENDMENT NO. 1004 names of the Senator from Washington discrimination in education programs At the request of Mr. CHAMBLISS, his (Mrs. MURRAY), the Senator from Min- or activities receiving Federal finan- name was added as a cosponsor of nesota (Mr. COLEMAN), the Senator cial assistance. amendment No. 1004 proposed to S. 1, a from California (Mrs. BOXER), the Sen- S. RES. 169 bill to amend title XVIII of the Social ator from Nebraska (Mr. HAGEL), the At the request of Mrs. CLINTON, the Security Act to provide for a voluntary Senator from Louisiana (Ms. LAN- names of the Senator from New Mexico prescription drug benefit under the DRIEU) and the Senator from Wisconsin (Mr. BINGAMAN) and the Senator from Medicare program and to strengthen OHL New York (Mr. SCHUMER) were added as (Mr. K ) were added as cosponsors of and improve the Medicare program, amendment No. 1063 intended to be pro- cosponsors of S. Res. 169, a resolution and for other purposes. expressing the sense of the Senate that posed to S. 1, a bill to amend title AMENDMENT NO. 1017 the United States Postal Service XVIII of the Social Security Act to At the request of Mr. ALLARD, the should issue a postage stamp com- provide for a voluntary prescription names of the Senator from Wisconsin memorating Anne Frank. drug benefit under the Medicare pro- (Mr. KOHL) and the Senator from S. RES. 170 gram and to strengthen and improve Vermont (Mr. LEAHY) were added as co- At the request of Mr. DODD, the name the Medicare program, and for other sponsors of amendment No. 1017 proof the Senator from New York (Mrs. purposes. posed to S. 1, a bill to amend title CLINTON) was added as a cosponsor of S. AMENDMENT NO. 1065 XVIII of the Social Security Act to Res. 170, a resolution designating the At the request of Mr. GRAHAM of provide for a voluntary prescription years 2004 and 2005 as ‘‘Years of Foreign Florida, his name was added as a co- drug benefit under the Medicare pro- Language Study’’. sponsor of amendment No. 1065 program and to strengthen and improve S. RES. 184 posed to S. 1, a bill to amend title the Medicare program, and for other At the request of Mr. SANTORUM, his XVIII of the Social Security Act to purposes. name was added as a cosponsor of S. provide for a voluntary prescription Res. 184, a resolution calling on the AMENDMENT NO. 1031 drug benefit under the Medicare pro- Government of the People’s Republic of At the request of Mr. CRAPO, the gram and to strengthen and improve China immediately and uncondition- name of the Senator from Montana the Medicare program, and for other ally to release Dr. Yang Jianli, and for (Mr. BURNS) was added as a cosponsor purposes. other purposes. of amendment No. 1031 intended to be AMENDMENT NO. 1073 AMENDMENT NO. 975 proposed to S. 1, a bill to amend title At the request of Mr. SMITH, the At the request of Mr. SCHUMER, his XVIII of the Social Security Act to name of the Senator from Washington name was added as a cosponsor of provide for a voluntary prescription (Mrs. MURRAY) was added as a cospon- amendment No. 975 proposed to S. 1, a drug benefit under the Medicare pro- sor of amendment No. 1073 proposed to bill to amend title XVIII of the Social gram and to strengthen and improve S. 1, a bill to amend title XVIII of the Security Act to provide for a voluntary the Medicare program, and for other Social Security Act to provide for a prescription drug benefit under the purposes. voluntary prescription drug benefit Medicare program and to strengthen AMENDMENT NO. 1033 under the Medicare program and to and improve the Medicare program, At the request of Ms. MIKULSKI, the strengthen and improve the Medicare and for other purposes. names of the Senator from Maryland program, and for other purposes. AMENDMENT NO. 975 (Mr. SARBANES), the Senator from Wis- AMENDMENT NO. 1086 At the request of Mr. CORZINE, his consin (Mr. KOHL) and the Senator At the request of Mrs. MURRAY, her name was added as a cosponsor of from California (Mrs. BOXER) were name was added as a cosponsor of

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00082 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8729 amendment No. 1086 proposed to S. 1, a ment of Justice has identified Central signs and I have told both the Boards bill to amend title XVIII of the Social Florida as a High Intensity Drug Traf- of Supervisors and the Tribe that I Security Act to provide for a voluntary ficking Enforcement Area. would like to see them continue to prescription drug benefit under the The Southern and Middle Districts work together. Medicare program and to strengthen are parallel in some of the challenges This legislation guarantees that the and improve the Medicare program, that they face. Despite the additional local and State officials have a voice in and for other purposes. judgeships that were created in the the process. Without this change to the f Southern District in 2001, the amount Graton Rancheria Restoration Act of weighted filings continues to rise. they do not have that voice. STATEMENTS ON INTRODUCED Since 1994, civil and criminal filings In 2000, Congress passed the Graton BILLS AND JOINT RESOLUTIONS per judgeship have stayed above the Rancheria Restoration Act to restore By Mr. LEVIN: national average, with civil filings ris- Federal recognition to the 355 members S. 1338. A bill to decrease the matching by 67 percent and criminal filings of the Federated Indians of the Graton ing funds requirement and authorize increasing by 58 percent. Many of these Rancheria. additional appropriations for increases in criminal filings are linked The Graton Tribe’s original Keweenaw National Historical Park in to the increase in fraud, drugs, fire- Rancheria was in the northern Sonoma the State of Michigan; to the Com- arms and immigration prosecutions. County town of Graton on land pur- mittee on Energy and Natural Re- The administration of justice will chased by the Bureau of Indian Affairs, sources. continue to be a challenge in Florida’s BIA, in 1920 for the ‘‘village home’’ of Mr. LEVIN. Mr. President, I ask Federal courts unless adequate re- otherwise homeless Miwok and Pomo unanimous consent that the text of the sources are committed. It is projected Indians. The Rancheria was terminated Keweenaw National Historical Park that by 2015 Florida may surpass third- in 1958 when the BIA approved a plan to bill be printed in the RECORD. ranked New York in population. As the distribute the assets to resident Indi- There being no objection, the bill was population increases, so do the number ans and remove the Rancheria from ordered to be printed in the RECORD, as of people seeking justice from the Fed- Federal trust. follows: eral courts in our State. I ask that my The original version of the Graton S. 1338 colleagues join me in supporting this restoration bill, H.R. 946, sponsored by Be it enacted by the Senate and House of Rep- important legislation. Congresswoman LYNN WOOLSEY in the resentatives of the United States of America in 106th Congress, passed the House of Congress assembled, By Mrs. FEINSTEIN: Representatives with a gaming restric- SECTION 1. FUNDING FOR KEWEENAW NATIONAL S. 1342. A bill to amend the Graton tion, to which the Tribe agreed. HISTORICAL PARK. Rancheria Restoration Act to give the In testimony before the House Re- (a) MATCHING FUNDS.—Section 8(b) of Pub- Secretary of the Interior discretion resources Committee in May 2000, and in lic Law 102–543 (16 U.S.C. 410yy–7(b)) is garding taking land into trust; to the other public comments, Graton Chair- amended by striking ‘‘$4’’ and inserting ‘‘$1’’. Committee on Indian Affairs. man Greg Sarris stated that the Tribe (b) AUTHORIZATION OF APPROPRIATIONS.— Section 10(a) of Public Law 102–543 (16 U.S.C. Mrs. FEINSTEIN. Mr. President, I had no intention of conducting gaming. 410yy–9(a)) is amended— rise today to introduce legislation to In fact, before the House Resources (1) by striking ‘‘$25,000,000’’ and inserting amend the Graton Rancheria Restora- Committee, Chairman Sarris stated, ‘‘$50,000,000’’; and tion Act to give the State of California ‘‘Many may think our motives for res- (2) by striking ‘‘$3,000,000’’ and inserting and the local communities of Sonoma, toration have been influenced by the ‘‘$25,000,000’’. Napa, and Marin counties the oppor- opportunity gaming affords some other Mr. GRAHAM of Florida. Mr. Presi- tunity for input and review of the recognized tribes. Because our local po- dent, I rise today to introduce legisla- tribe’s plan for a major casino in the litical constituency, both democratic tion that will authorize additional Bay Area. and republican has opposed any sort of judgeships in the Middle and Southern I am offering this legislation because development for environmental rea- Federal Judicial Districts of Florida. the Boards of Supervisors of the local sons, we agreed with these local polit- Additional judgeships are needed in communities impacted by this planned ical forces to not develop a gaming these two districts in order to deal casino have asked me to amend the complex. So, as proof, we voted as a with a large volume of filings, heavy Graton Rancheria Restoration Act. tribe to include a non-gaming clause in pending caseloads, the considerable The Boards of Supervisors of Sonoma, our bill, stipulating that we will not be number of senior judges, and a rapidly Marin, and Napa counties have each a gaming tribe.’’ growing population. It is vital that we unanimously passed resolutions seek- Furthermore, in an article in the add two additional permanent and one ing a change in Federal law to restore Marin Independent Journal on Sep- temporary judgeship in the Middle Dis- the Secretary of Interior’s discretion in tember 21, 2000, Chairman Sarris said, trict and four additional permanent approving land into trust and allowing ‘‘All we want is to be formally recog- judgeships in the Southern District of the State and local government to have nized as Indians and have the same Florida. a voice in the process. rights that other Indians do for edu- Florida’s Middle District is one of the Prior to today’s introduction I have cation and health care. We are not in- busiest Federal district courts in the met with the Presidents of the Sonoma terested in gambling.’’ I ask unani- Nation. In 2001 it was ranked fifth in and Marin Boards of Supervisors, the mous consent to print a copy of this ar- the Nation for the number of criminal Graton tribe, and Senators CAMPBELL ticle in the RECORD. defendants charged with fraud and drug and INOUYE the Chairman and Ranking There being no objection, the article related offenses among all district Member of the Indian Affairs Com- was ordered to be printed in the courts. It handles cases filed in three of mittee. RECORD, as follows: the four largest cities in the State of This week I had a very spirited and [From the Marin Independent Journal, Sept. Florida, Jacksonville, Orlando and frank conversation with Graton Tribal 21, 2000] Tampa, which comprise 60 percent of Chairman Greg Sarris and representa- GAMBLING DISPUTE THREATENS MIWOK BILL the State’s population. tives from the casino investors. During (By Gannet News Service) In 1999 four judges were added to the the meeting Chairman Sarris com- WASHINGTON.—Legislation to formally re- Middle District of Florida. The num- mitted to work with the local Boards establish the identity and standing of bers of weighted filings and pending of Supervisors and he committed to Marin’s band of Coast Miwok Indians appears caseload both decreased in 2000. How- look at alternative sites for the casino. all but dead in the face of a House-Senate ever, numbers quickly rose again in Chairman Sarris also said the Tribe dispute over how tight guarantees must be 2001. A biennial judgeship survey con- and the casino investors would conduct that the tribe will never allow casino gambling. ducted in 2003 showed that in 2001 there an environmental review based on the ‘‘This is insane, this is frustrating, and I were 553 weighted filings in this dis- criteria laid out in the National Envi- just can’t see why we can’t find a way out of trict versus the national average of 490. ronmental Policy Act, NEPA, before a this,’’ said Greg Sarris, the tribe’s chief who In addition, the United States Depart- site is selected. These are positive is an English professor at UCLA.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00083 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8730 CONGRESSIONAL RECORD — SENATE June 26, 2003 Rep. Lynn Woolsey, the Petaluma Demo- cause members believe she should allow the seek to develop a casino. The Sonoma crat who authored the original bill, said she bill to go forward without the clause. and Marin County Boards of Super- shares the frustration but sees little hope ‘‘We’re disappointed, deeply disappointed visors have each passed unanimous res- with Woolsey because she seems to be the other than the fact that ‘‘down the road olutions objecting to the Graton casino there will be other Congresses.’’ one who’s dropped the ball on this, not Bar- The problem is that the bill to restore the bara Boxer,’’ he said. ‘‘It’s a shame that it’s proposal. In fact, even the Board of Su- all-but-vanquished tribe, approved by the getting this far and that Woolsey is letting pervisors of neighboring Napa has also full House in June, included specific lan- it bog down like this.’’ passed a resolution against the casino guage that waived in perpetuity any right to Coast Miwok tribal elder Joanne Campbell, proposal. I ask unanimous consent to establish gaming on the tribe’s remaining a former Marin resident now living in Daly print these resolutions and letters from one-acre ancestral plot in the Sonoma Coun- City, said she often visited her great aunt at the counties in the RECORD. ty town of Graton. the Miwok’s Graton Rancheria in Sonoma Woolsey sought that waiver in agreement County. There being no objection, the mate- with the tiny tribe. In hearings last spring ‘‘I’m really steamed, I’m just so upset that rials were ordered to be printed in the and summer, she and Sarris said the tribe this bill maybe will not pass,’’ Campbell RECORD, as follows: was happy to agree to the waiver. They were said. ‘‘I think it’s a just bill and it’s about MARIN COUNTY, SAN RAFAEL, CA not interested in gaming, and their acreage time we got some recognition because we AND SONOMA COUNTY, SANTA was too small even if they were interested. have all these other issues to deal with, ROSE, CA, Additionally, the fine print in a state-passed Health issues, education issues, and we need May 29, 2003. referendum in California to divide gaming this recognition to move forward.’’ Senator DIANNE FEINSTEIN, resources among tribes prevents them from The bill would make the tribe eligible for U.S. Senate, operating any kind of casino. a wide range of U.S. and California health, San Francisco, CA. education and housing grants and assistance Adding a federal gaming ban on top of an DEAR SENATOR FEINSTEIN: We write this existing state ban was an easy and harmless from various federal agencies, give the tribe joint letter to request your assistance with layer of extra insurance to reassure the com- the right to establish a reservation and ex- an urgent matter facing Marin and Sonoma munity that the tribe would not be bringing empt the tribe from some local, state, or fed- counties. As you are aware, the Graton high-stakes bingo to Marin. eral taxes and local zoning ordinances on Rancheria Tribe has announced plans to ac- ‘‘All we want is to be formally recognized reservation land. quire lands adjacent to the San Pablo Bay If the bill is not passed by Oct. 5, when the as Indians and have the same rights that National Wildlife Refuge and to construct a Senate recesses, a new restoration bill would other Indians do for education and health major casino in partnership with Stations have to wait until the next Congress. care,’’ said Sarris, one of some 300 descend- Casinos of Las Vegas. The proposal came as Camobell described Woolsey’s refusal to ants of the tribe that the government de- a shock to us since, at the time it sought res- drop the redundant anti-gaming clause from clared extinct in the 1950s. ‘‘We are not in- toration in 2000, the Graton tribe represented the Senate version as ‘‘unrelenting’’ and terested in gambling.’’ to Congress that it would not engage in gam- But when the bill reached the Senate as an ‘‘unreasonable.’’ ing. It now appears that the Secretary of the identical version of the bill sponsored by Mrs. FEINSTEIN. Senator BOXER Interior believes she must take into trust Sen. Barbara Boxer, D-Calif., numerous In- sponsored legislation identical to Con- any land within our counties acquired by the dian advocates and the government’s Bureau gresswoman WOOLSEY’S in the Senate, tribe, and that gaming will be permitted on of Indian Affairs objected. The surrender of these lands without consultation with local sovereignty by the Miwoks, however well-in- but the gaming restriction was strick- governments or discretionary review by the tentioned, would set a precedent that could en when the bill was ultimately passed Secretary. be used against other tribes in other states— as part of the Omnibus Indian Advance- We ask that you sponsor legislation to re- in effect a means to pressure tribes on the ment Act of 2000. quire that tribal trust land acquisitions be sensitive issue of gambling. The day the legislation passed on De- subject to consultation with local govern- ‘‘It’s not that we don’t have sympathy cember 11, 2000, Senator BOXER stated with what the Miwoks want to do, or in this ments and an appropriate administrative re- on the Senate Floor that dropping the view. We ask that restored tribal land ac- case don’t want to do. It’s a question of erod- gaming restriction was necessary being the hard-won sovereignty that is the quired for gaming be subject to the two part legal basis for the gambling that has been an cause of opposition to the no-gaming test that it is not detrimental to the commu- important resource of many tribes,’’ said clause by the Senate Committee on In- nity and is supported by the Governor. Fi- John Sanchez, an expert on Indian sov- dian Affairs and the Clinton Adminis- nally, we ask that the Secretary be given ereignty at Pennsylvania State University tration and because, according to Sen- discretion with respect to accepting land into trust for the benefit of the Graton tribe. and a member of the Apache tribe. ator BOXER, ‘‘Senator INOUYE asserts County Counsel from our two counties have Boxer’s spokesman, David Sandretti, said that the no-gaming clause is unneces- his bill was still hopeful, but the key law- prepared a letter to you providing back- sary because the Graton Rancheria ground and supporting details regarding our maker on the issue is Sen. Daniel Inouye of have no intention of conducting gam- Hawaii, vice chairman of the Indian Affairs proposals. Committee and long a powerful voice on being.’’ We know that you share our concern about half of American Indians and native Hawai- So what has changed one might ask? the proliferation of casinos in California, es- ians. Without his support, the bill wouldn’t Well, even though the Gratons volun- pecially those which are close to metropoli- survive in the Senate, Sandretti said. tarily and repeatedly took a no-gaming tan areas or have impacts on sensitive lands. Inouye made it clear this week that the pledge while their restoration bill was We look forward to working with you to bill is dead unless Woolsey agreed to drop under consideration by Congress, on bring about changes in the law which can ad- the gambling ban in her legislation. April 23, 2003, the Tribe and its partner, vance the economic interests of tribes with- ‘‘If you set that precedent, that creates a Stations Casinos of Las Vegas, an- out harm to the local community. lot of problems,’’ Inouye said. ‘‘I would pre- Very truly yours, nounced plans to purchase approxi- fer to see a measure without the waiver, and ANNETTE ROSE, if I do I’d be likely to support it.’’ mately 2,000 acres of land in Southern President, Marin Inouye added that it’s a meaningless, sym- Sonoma County near Sears Point for County Board of Su- bolic waiver to begin with, because the tribe the development of a casino. pervisors. is already prevented from opening a casino This site is located on environ- PAUL KELLEY, by state law. ‘‘I just don’t think this is some- mentally sensative open space and San Chairman, Sonoma thing that the federal government should be Francisco—North Bay tidelands which County Board of Su- involved in,’’ he said. have been the subject of a decades-long pervisors. Woolsey said she has no intention of agreeing to anything that doesn’t include the conservation effort by environmental- RESOLUTION NO. 03–0512 anti-gaming clause as written. ists and local residents. ‘‘I got it out of the House, and now it’s in This site is roughly 30 miles from Whereas, the agricultural lands and wet- the Senate, and I guess that’s just where it San Francisco—along the gateway to lands fronting the San Francisco Bay along is,’’ Woolsey said. ‘‘I’ve heard some proposals Sonoma that leads thousands of trav- Highway 37 constitute one of the most envi- for compromise, but I haven’t seen anything elers into the beautiful wine country ronmentally sensitive regions in the entire that would offer the level of protection Bay Area in light of their proximity to and each day. drainage directly into the Bay; against gaming that the community and the The Tribe’s casino proposal has out- 6th Congressional District would be prepared Whereas, the agricultural lands along to accept.’’ raged local elected officials and resi- Lakeville Highway afford an invaluable agri- Gene Buvelot of Novato, vice chairman of dents who had sympathized with the cultural and scenic resource, not only to the the Federated Indians of Graton Rancheria, Tribe’s plight and supported their res- people of Sonoma County but to the popu- said his group is disappointed in Woolsey, be- toration on the condition that they not lace of the entire Bay Area;

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00084 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8731 Whereas, such lands provide one of the Bay and casino proposal, requesting assistance ists and local communities for many years; Area’s most cherished community separa- from State and Federal elected representa- and tors, and represent an important scenic gate- tive, proposing legislation, participating in Whereas, such land are presently in immi- way to Sonoma County; administrative proceedings, and initiating nent danger of intense development—includ- Whereas, these bay, agriculture and wet litigation to insure that any proposed gaming an enormous casino, a high-rise hotel, an lands have been the focus of preservation and ing project in Sonoma County complies with amphitheater, a residential development, conservation efforts by environmentalists the county General Plan and meets all fed- and acres of parking—by Station Casinos, a and local communities for many years; eral and state environmental, public health, Las Vegas-based developer, and Whereas, based upon press reports, ap- and public safety requirements that other- Whereas, the impact on traffic of a devel- proximately 2,000 acres of such lands are wise would apply to a non-Indian develop- opment of this magnitude will be felt presently in imminent danger of being with- ment project, and to require that any land throughout the North Bay, with this single drawn from County land use control and proposed to be taken into trust goes through development jeopardizing all traffic capac- placed into trust for the purposes of casino a thorough regulatory and environmental re- ity, which local jurisdictions have husbanded development—including the potential of an view process. for purposes consistent with their respective extensive gaming complex, including a hotel, General Plans; and parking and other support services as well as RESOLUTION NO. 2003–70 Whereas, when California voters approved Proposition 1A (Indian Gaming) in March possible residential development, by Station Whereas, the agricultural lands and wet- 2000 as a means of supporting the laudable Casinos, a Las Vegas-based developer and the lands fronting the San Francisco Bay along goal of Indian economic development and Federated Indians of the Graton Rancheria Highway 37 constitute one of the most envi- self-sufficiency, they had no way of knowing (‘‘Tribe’’); ronmentally sensitive regions in the entire that such approval would allow Nevada de- Whereas, the Tribe was restored in 2000 Bay Area in light of their proximity to and velopers to seize our most prized environ- based, in part, on its promise not to engage drainage directly in to the Bay; and in Indian casino gaming; Whereas, the Federated Indians of Graton mental resources for intense development in Whereas, the federal legislation restoring Rancheria have announced their intention to violation of all local zoning controls and the Tribe contains language that could be acquire 2000 acres of land along Highway 37 health and safety ordinances; and used to circumvent the normally required Whereas, under the provisions of Propo- and develop a casino, hotel, housing and re- environmental review and administrative sition 1A and the tribal state compact, local lated development on this precious natural regulatory process for taking land into trust residents have been granted no effective resource; and input into the development of proposed trib- by the United States government on behalf Whereas, the impact on traffic of a devel- al casinos that threaten their civil and prop- of the Tribe; opment of this magnitude will be felt Whereas, the Tribe’s gaming plans were an- erty rights, yet these residents must never- throughout the North Bay, with this single nounced in the media without any govern- theless bear the resultant environmental, so- development jeopardizing all traffic capacity ment to government consultation with af- cietal, traffic, infrastructure, public safety, with local jurisdictions have husbanded for fected local communities; and other burdens that these gambling casi- purposes consistent with their respective Whereas, the Board and Tribe have initi- nos impose on their communities: Now, General Plans; and ated communication regarding the proposed therefore, be it Whereas, when Congress passed the Graton casino but details regarding the project and Resolved, That the Board of Supervisors of Rancheria Restoration Act, the Federated siting have not yet been made available; the County of Napa strongly oppose the cre- Indians of Graton had pledged not to engage Whereas, the proposed project could over- ation of a gambling casino along highway 37 in gaming on any lands placed in trust by whelm the local infrastructure in the area in or Lakeville Highway; and be it further which the casino project is proposed; the federal government; and Resolved, That the Board of Supervisors of Whereas, the Federated Indians of the Whereas, the environmental impacts of the the County of Napa calls on Governor Davis, Graton Rancheria take the position that prosed project have the potential of being the California State Legislature, the U.S. under the provisions of the Graton are reaching and of such a magnitude that Congress, and the U.S. Department of the In- Rancheria Restoration Act, and the tribal they would negatively affect a significant terior to take any and all steps within their state compact, local residents have no effec- portion of the North Bay, including grossly powers and prerogatives to block the cre- tive input into the development of the pro- aggravating existing traffic problems along ation of new tribal land bases that are in- posed tribal casino, yet these residents nev- State Highways 37 and 101 (as well as County tended for gambling casinos and other devel- ertheless bear the resultant environmental, roads in the project vicinity), pose severe opment inconsistent with local zoning and societal, traffic, infrastructure, public safe- water quality risks, and have profound nega- controls and to require that all commercial ty, and other burdens which these gambling tive visual impacts in the scenic area; development on new and existing tribal lands casinos impose on their communities: Now, Whereas, when California voters approved comply with federal, state, and local laws therefore, be it Proposition 1A (Indian Gaming) in March of and regulations intended to safeguard the Resolved, that the Board of Supervisors of 2000 as a means of supporting the laudable environment and to protect public health the County of Marin calls on its elected goal of Indian economic development and and safety. members of the United States Senate, self-sufficiency, they were not aware that Mrs. FEINSTEIN. Let me just read such approval would allow Nevada developers Dianne Feinstein and Barbara Boxer, and its to seize prized off-reservation environmental elected member of the House of Representa- one part of the Resolution from Marin resources of intense development without re- tive, Lynn Woolsey, to assist the residents of County which will give you an idea of garding to locally approved general plans or Marin and the entire North Bay to preserve the opposition to the Graton tribe’s any meaningful environmental review or their environment by introducing legislation proposed casino: protection; that would amend the Graton Rancheria RESOLVED, that the Board of Super- Whereas, under the provisions of Propo- Restoration Act and/or the Indian Gaming visors of the County of Marin calls on Regulatory Act to stop the unregulated cre- sition 1A and the Tribal-State Compact, its elected members of the United local communities have been granted no ef- ation of tribal lands and to subject any de- States Senate, DIANNE FEINSTEIN and fective input into the development of pro- velopment of tribal lands in the newly ac- BARBARA BOXER, and its elected mem- posed tribal casinos that threaten their quired tribal lands by the Indian Gaming rights and the State appears to have no ef- Regulatory Act. ber of the House of Representatives, fective redress for significant environmental LYNN WOOLSEY, to assist the residents impacts these gambling casinos impose on RESOLUTION NO. 03–94 of Marin and the entire North Bay to local communities: Now, therefore, be it Whereas, the agricultural lands and wet- preserve their environment by intro- Resolved, That the Sonoma County Board lands fronting the San Francisco Bay along ducing legislation that would amend of supervisors, based on the information cur- Highway 37 constitute one of the most envi- the Graton Rancheria Restoration Act rently available, strongly opposes the cre- ronmentally sensitive regions in the entire and/or the Indian Gaming Regulatory ation of a gambling casino on the site pro- Bay Area in light of their proximity to and posed by the Tribe; and be it further drainage directly into the Bay; and Act to stop the unregulated creation of Resolved, That County staff is directed to Whereas, the agricultural lands along tribal lands and to subject development enter into good faith discussions with tribal Lakeville Highway afford an invaluable agri- of tribal lands in the Marin and representatives for the purposes of facili- cultural and scenic resource, not only to the Sonoma Counties at a minimum to the tating government to government commu- people of Sonoma County but also to the regulatory and approval processes ap- nications, exploring casino development and populace of the entire Bay Area; and plicable to newly acquired tribal lands reviewing alternative sites, as well as mini- Whereas, such lands provide one of the Bay by the Indian Gaming Regulatory Act. mizing and mitigating environmental im- Area’s most cherished community separa- While the counties acknowledge that pacts of any casino project; be it further tors, enjoyed and remembered by all who Resolved, That County staff is authorized traverse Highway 37; and the Graton have a right to be recog- to take all reasonably required action, in- Whereas, these agricultural lands, bay and nized, they object to the site selected cluding submitting comments to agencies in- wetlands have been the focus of preservation by the tribe and they especially object volved in considering the trust application and conservation efforts by environmental- to language in the Restoration Act

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00085 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8732 CONGRESSIONAL RECORD — SENATE June 26, 2003 that precludes the local community, yield much needed benefits for tribal Senators SCHUMER, AKAKA, and BOXER, the Governor, or the Secretary of the members in terms of healthcare, edu- I am introducing ‘‘The Money Wire Im- Interior from providing input on the cation and general welfare, as Congress provement and Remittance Enhance- suitability of this location for land and California voters intended. How- ment Act’’ (The ‘‘Money WIRE Act’’), taken into trust for gaming purposes. ever, the question is not whether gam- legislation that will protect consumers There is a problematic section of the ing should be permitted, but rather who send cash remittances through Restoration Act that states, ‘‘Upon ap- how and where. Those questions were international money wire transmitters plication by the Tribe, the Secretary asked and answered in the Indian Gam- by providing them with increased dis- shall accept into trust for the benefit ing Regulatory Act of 1988, IGRA. But closure of the exchange rate and serv- of the Tribe any real property located without the modest change made by ice fees, as well as hidden costs, for in Marin or Sonoma County . . .’’ Ac- this legislation, the Graton tribe will those transactions. The legislation also cording to the Department of the Inte- be allowed to develop an off-reserva- expands access to mainstream money rior, this language removes any discretion casino outside the requirements wiring, check cashing, and other im- tion by the Secretary as well as any established in IGRA, the first time portant services for millions of the tribal obligations for consultation with such an exception has ever been made unbanked in America, particularly im- the surrounding community or envi- for a California tribe. Allowing this to migrants, through our Nation’s credit ronmental review, as required by the happen would set a dangerous prece- unions. normal process under the Indian Gam- dent not only for California, but every Every year, thirty million Americans ing Regulatory Act for newly acquired State where tribal gaming is per- send their friends and relatives $40 bil- land taken into trust for gaming pur- mitted. lion in cash remittances through wire poses. The changes we are seeking today are transfers. The majority of these trans- According to the Department of the extremely modest. We are not revers- fers are remittances sent to their na- Interior, the tribe must only conduct a ing any restoration of the tribe. We are tive countries by immigrants to the hazardous materials review and show not infringing on Native American sov- United States. For these individuals, title to the land for land to be taken ereignty. We are not even blocking the many of whom are in low-to-minimum into trust. This could be completed in casino proposal. We are only seeking to wage jobs, sending this money only in- 9 months—and it is an inadequate re- give the State and the local commu- creases their own personal financial view in my opinion. burdens—but they do so to aid their Since the local communities are nities a voice in the process. They were promised the tribe would not open a ca- families and their loved ones. seeking a remedy which would restore Unfortunately, these immigrants in- the Secretary’s discretion in approving sino. That promise was broken, so the least we can do is ensure a normal re- creasingly find themselves being its land trust application and allow preyed upon by the practices of some local government to provide input in view will take place. money wire transfer providers who not the process, I am introducing this leg- I hope my colleagues will support only charge consumers with an upfront islation today that will change the this legislation and I look forward to charge for the money wire transfer ‘‘shall take land into trust’’ to ‘‘may working with the Chairman and Rank- service, but also hit them on the back take land into trust.’’ This legislation ing Member of the Indian Affairs Com- end with hidden costs. Many of these will also require the two-part test that mittee to pass this legislation quickly. charges are extracted when the dollars is standard under the Indian Gaming I ask unanimous consent that the sent by the consumer are converted to Regulatory Act of 1988 to apply so that text of the bill be printed in the the foreign currency value that is sup- the State and local communities have RECORD. posed to be paid out to the friend of the input in the process. There being no objection, the bill was There is precedent for this change. In ordered to be printed in the RECORD, as family member. 1994, legislation was passed restoring follows: This exploitation is especially perva- the United Auburn Tribe with the same S. 1342 sive in Latin American and Caribbean countries, where much of these types of directive to the Secretary of the Inte- Be it enacted by the Senate and House of Rep- rior, requiring that land ‘‘shall’’ be resentatives of the United States of America in transactions occur. According to the taken into trust for the Tribe. One of Congress assembled, Multilateral Investment Fund and the the restoration act’s sponsors, Con- SECTION 1. AMENDMENT TO GIVE SECRETARY Inter-American Development Bank, Latin American and Caribbean immi- gressman JOHN DOOLITTLE sponsored an DISCRETION CONCERNING LANDS TAKEN INTO TRUST. amendment to change ‘‘shall’’ to grants sent a record $32 billion to their (a) REVIEW.—Section 1404 of the Graton home countries in 2002—a dramatic in- ‘‘may’’ after it had been passed, there- Rancheria Restoration Act (25 U.S.C. 1300n–2) by affording the Secretary of Interior crease compared with $23 billion in is amended by adding at the end the fol- 2001. Many of these dollars were used to discretion in accepting particular par- lowing new subsection: cels of land into trust and local govern- ‘‘(f) REVIEW.—No land taken into trust for pay for basic needs, such as food, medi- ment officials an opportunity to weigh the benefit of the Tribe shall be construed to cine, and schooling, and to alleviate in on the Tribe’s proposed site. satisfy the terms for an exception under sec- the suffering of loved ones during a dif- The result of that change was that tion 20(b)(1)(B) of the Indian Gaming Regu- ficult economic year. the Auburn Tribe and Placer County latory Act (25 U.S.C. 2719(b)(1)(B)) to the pro- To bring this amount into even officials successfully cooperated in not hibition on gaming on lands acquired by the greater perspective, the remittances Secretary in trust for the benefit of an In- that flowed into Latin America and the only identifying a mutually agreeable dian tribe after October 17, 1988, under sec- site, but they signed a Memorandum of Caribbean last year equaled roughly tion 20(a) of such Act (25 U.S.C. 2719(a)).’’. the amount of direct foreign invest- Understanding to mitigate potential (b) LAND INTO TRUST.—Section 1405(a) of impacts from the proposed Thunder the Graton Rancheria Restoration Act (25 ment that flowed into the region, and Valley Casino. And earlier this month, U.S.C. 1300n–3(a)) is amended by striking exceeded the amount of development the tribe opened its casino. ‘‘shall’’ and inserting ‘‘may’’. aid to Latin America from all sources. Today California is home to 109 feder- For this decade alone, Latin America ally recognized tribes. 61 tribes have By Mr. CORZINE (for himself, and the Caribbean could receive more gaming compacts with the State and Mr. SCHUMER, Mr. AKAKA, and than $300 billion. And experts believe there are 54 tribal casinos. With more Mrs. BOXER): that number is likely to grow signifi- than 50 tribes seeking Federal recogni- S. 1344. A bill to amend the Elec- cantly in coming years. tion and approximately 23 recognized tronic Fund Transfer Act to require ad- These large cash flows have proven to tribes seeking gaming compacts from ditional disclosures relating to ex- be a powerful incentive for greed in the the Governor, revenues from Califor- change rates in transfers involving case of some wire transfer companies. nia’s tribal gaming industry are ex- international transactions, and for Customers wiring money to Latin pected to surpass Nevada’s by the end other purposes; to the Committee on America and elsewhere in the world of the decade. Banking, Housing, and Urban Affairs. lose billions of dollars annually to un- The dramatic growth in tribal gam- Mr. CORZINE. Mr. President, today, disclosed ‘‘currency conversion fees,’’ ing in California has the potential to along with my distinguished colleagues and other service costs.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00086 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8733 In fact, many large companies ag- immigrant communities, access to ‘‘(A) The exchange rate used by the finan- gressively target immigrant commu- credit unions for international money cial institution or money transmitting busi- nities, often advertising ‘‘low fee’’ or transfer, money order, and check cash- ness in connection with such transaction. ‘‘no fee’’ rates for international trans- ing services, where the costs for these ‘‘(B) The exchange rate prevailing at a major financial center of the foreign country fers. But these misleading ads do not services are significantly less. whose currency is involved in the trans- always clearly disclose the fees This legislation does more than action, as of the close of business on the charged when the currency is ex- merely provide better information to business day immediately preceding the date changed. consumers—it actually helps them and of the transaction (or the official exchange While large wire service companies their families financially. Consumers rate, if any, of the government or central typically obtain foreign currencies at will see increased competition among bank of such foreign country). bulk rates, they charge a significant wire transfer service providers because ‘‘(C) All commissions and fees charged by currency conversion fee to their U.S. they are better-informed and more the financial institution or money transmit- knowledgeable. That competition will ting business in connection with such trans- customers. For example, customers action. wiring money to Mexico are charged an result in lower fees for the wire trans- ‘‘(D) The exact amount of foreign currency exchange rate that routinely varies fer services that will free up a greater to be received by the recipient in the foreign from the benchmark by as much as 15 portion of these cash remittances to go country, which shall be disclosed to the con- percent. These hidden fees create stag- to the friends and families that they sumer before the transaction is con- gering profits, allowing companies to were originally intended for. summated and printed on the receipt re- reap billions of dollars on top of the In short, this is sound public policy ferred to in paragraph (3). stated fees they charge for the wire that empowers those who do their part ‘‘(2) PROMINENT DISCLOSURE INSIDE AND OUT- SIDE THE PLACE OF BUSINESS WHERE AN INTER- transfer services. to help America’s economy move for- NATIONAL MONEY TRANSFER IS INITIATED.—The Last year alone, immigrants who ward. information required to be disclosed under sent money to Latin America and the I hope that my colleagues will sup- subparagraphs (A), (B), and (C) of paragraph Caribbean paid approximately $4 bil- port this legislation and I ask unani- (1) shall be prominently displayed on the lion in transaction costs to the money mous consent that the text of the bill premises of the financial institution or wire transfer companies that dominate be printed in the RECORD. money transmitting business both at the in- this business. In other words, for every There being no objection, the bill was terior location to which the public is admit- $100 that an immigrant sent home, to ordered to be printed in the RECORD, as ted for purposes of initiating an inter- help their family and loved ones, $12 follows: national money transfer and on the exterior of any such premises. S. 1344 was siphoned off by these businesses in ‘‘(3) PROMINENT DISCLOSURE IN ALL RE- Be it enacted by the Senate and House of Rep- order to ‘‘service’’ that transaction. CEIPTS AND FORMS USED IN THE PLACE OF BUSI- resentatives of the United States of America in That adds up to a $20-$30 average NESS WHERE AN INTERNATIONAL MONEY TRANS- Congress assembled, cost, occasionally it can be consider- FER IS INITIATED.—The information required ably more, for poor, hard-working folks SECTION 1. SHORT TITLE. to be disclosed under paragraph (1) shall be for whom the typical remittance— This Act may be cited as the ‘‘Money Wire prominently displayed on all forms and re- Improvement and Remittance Enhancement ceipts used by the financial institution or around $250 to $300 a month—represents Act of 2003’’ (or the ‘‘Money WIRE Act of a significant percentage of their money transmitting business when initiating 2003’’). an international money transfer in such monthly income. SEC. 2. DISCLOSURE OF EXCHANGE RATES IN premises. Multiplied by millions, these exces- CONNECTION WITH INTERNATIONAL ‘‘(c) ADVERTISEMENTS IN PRINT, BROADCAST, MONEY TRANSFERS. sive charges constitute a significant AND ELECTRONIC MEDIA AND OUTDOOR ADVER- (a) IN GENERAL.—The Electronic Fund major economic force. These millions TISING.—The information required to be dis- Transfer Act (15 U.S.C. 1693 et seq.) is amend- could have otherwise been used to feed closed under subparagraphs (A) and (C) of ed— subsection (b)(1) shall be included— children, house a family, or invest in a (1) by redesignating sections 918, 919, 920, ‘‘(1) in any advertisement, announcements, small business—all of which markedly and 921 as sections 919, 920, 921, and 922, re- or solicitation which is mailed by the finan- improve overall quality of life. spectively; and cial institution or money transmitting busi- The ‘‘Money WIRE Act’’ would re- (2) by inserting after section 917 the fol- ness and pertains to international money quire money wire transmitting busi- lowing new section: transfer; or nesses to disclose to senders, and re- ‘‘SEC. 918. DISCLOSURE OF EXCHANGE RATES IN ‘‘(2) in any print, broadcast, or electronic ceivers, of international money wire CONNECTION WITH INTERNATIONAL MONEY TRANSFERS. medium or outdoor advertising display not transfers the exchange rate used in as- ‘‘(a) DEFINITIONS.— on the premises of the financial institution sociation with the transaction; any ‘‘(1) INTERNATIONAL MONEY TRANSFER.—The or money transmitting business and per- surcharges, commissions or fees term ‘international money transfer’ means taining to international money transfer. charged to the customer for the serv- any money transmitting service involving an ‘‘(d) DISCLOSURES IN LANGUAGES OTHER ice; and the exact amount of the for- international transaction which is provided THAN ENGLISH.—The disclosures required eign currency to be received by the re- by a financial institution or a money trans- under this section shall be in English and in mitting business. the same language as that principally used cipient in the foreign country. by the financial institution or money trans- It also requires that that rate and fee ‘‘(2) MONEY TRANSMITTING SERVICE.—The term ‘money transmitting service’ has the mitting business, or any of its agents, to ad- information be prominently displayed meaning given to such term in section vertise, solicit, or negotiate, either orally or at the wire transmitting service loca- 5330(d)(2) of title 31, United States Code. in writing, at that office if other than tion and on all receipts associated with ‘‘(3) MONEY TRANSMITTING BUSINESS.—The English.’’. the money wire transaction—and it en- term ‘money transmitting business’ means (b) EFFECTIVE DATE.—The amendments sures that those disclosures occur in any business which— made by subsection (a) shall take effect at the same language as that principally ‘‘(A) provides check cashing, currency ex- the end of the 3-month period beginning on the date of the enactment of this Act. used by the business to advertise its change, or money transmitting or remit- money transmitting services, if that tance services, or issues or redeems money SEC. 3. STUDY ON FEE DISCLOSURES FOR MONEY orders, travelers’ checks, and other similar WIRE TRANSMISSIONS. language is other than English. instruments; and (a) STUDY.—The Federal banking agencies The bill also requires Federal bank- ‘‘(B) is not a depository institution (as de- (as defined in section 3 of the Federal De- ing regulators and the Department of fined in section 5313(g) of title 31, United posit Insurance Act) and the Secretary of the Treasury to conduct a study, and sub- States Code). Treasury shall jointly conduct a study on mit a report to Congress, of the fees ‘‘(b) EXCHANGE RATE AND FEES DISCLO- fees charged and fee disclosures for money and fees disclosure at traditional finan- SURES REQUIRED.— wire transmissions. cial institutions compared to those ‘‘(1) IN GENERAL.—Any financial institution (b) COMPARISON OF PRICES.—The study re- that occur at money transmitting busi- or money transmitting business which initi- quired by subsection (a) shall compare the ates an international money transfer on be- disclosures provided by federally insured de- nesses for money wire transactions. half of a consumer (whether or not the con- pository institutions for money wire trans- Finally, the Act includes a provision sumer maintains an account at such institu- missions with disclosures provided by money that expands the ‘‘field of membership’’ tion or business) shall provide the following transmitting businesses (as defined in sec- definition for credit unions to give non- disclosures in the manner required under tion 5330(d)(1) of title 31, United States Code) members, particularly unbanked and this section: for such transmissions.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00087 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8734 CONGRESSIONAL RECORD — SENATE June 26, 2003 (c) REPORT REQUIRED.—The Federal bank- cial significance to my home State of Ferries are also the preferred, and ing agencies and the Secretary of the Treas- Hawaii. Hawaii is home to significant the only feasible, method of com- ury shall jointly submit a report on the numbers of recent immigrants from muting from home to work in places study required under subsection (a) to the many nations, including the Phil- like Washington State, New York/New Congress before the end of the 1-year period beginning on the date of enactment of this ippines, who send remittances to their Jersey, North Carolina, Hawaii and Act. relatives abroad. We must do what we Alaska. SEC. 4. FEDERAL CREDIT UNION ACT AMEND- can to ensure that their hard-earned Finally, in many States—like my MENT. dollars are not eroded by unnecessary home State of Washington—they are Paragraph (12) of section 107 of the Federal fees or a lack of transparency regard- an important part of the tourism in- Credit Union Act (12 U.S.C. 1757(12)) is ing exchange rates. dustry and represent a part of our cul- amended to read as follows: I encourage my colleagues to support tural identity. ‘‘(12) in accordance with regulations pre- this much-needed legislation. The symbol of ferries moving people scribed by the Board— ‘‘(A) to sell, to persons in the field of mem- and vehicles on the waterways of the By Mrs. MURRAY (for herself, Puget Sound is as much a part of our bership, negotiable checks (including trav- Mrs. BOXER, Ms. CANTWELL, elers checks), money orders, and other simi- cultural identity as computers, coffee, Mrs. CLINTON, Mr. CORZINE, Mr. lar money transfer instruments; and commercial aircraft and the Wash- ‘‘(B) to cash checks and money orders for EDWARDS, Mrs. FEINSTEIN, Mr. ington Apple. persons in the field of membership for a KENNEDY, Mr. LAUTENBERG, Mr. Ferry use is growing. fee;’’. SCHUMER, and Mr. HOLLINGS): In Washington State our ferry sys- Mr. AKAKA. Mr. President, I rise as S. 1345. A bill to extend the author- tem—the Nation’s largest—currently a cosponsor of the Money Wire Im- ization for the ferry boat discretionary transports 26 million passengers each program, and for other purposes; to the provement and Remittance Enhance- year and carries 11 million vehicles. ment Act introduced by my colleague, Committee on Environment and Public Other systems that serve New York/ Works. Senator CORZINE. I thank Senator New Jersey, North Carolina, San Fran- Mrs. MURRAY. Mr. President, I rise CORZINE for his leadership on this cisco, and Alaska also have significant today to introduce legislation that will issue. numbers of passengers using the fer- greatly enhance Federal participation Immigrants often send a portion of in financing and improving our Na- ries. their hard-earned wages to their rel- The Nation’s six largest ferry sys- tion’s ferry transportation system. atives abroad. Remittances are often Today I am introducing the Ferry tems carried 73 million people and 13 used to improve the standard of living Transportation Enhancement Act. I am million vehicles last year. of recipients by increasing access to The growth projection for ferry use is proud to have Senators BOXER, CANT- health care, education, and essentials WELL, CORZINE, CLINTON, EDWARDS, very high. For these larger systems, it of daily life. In addition, remittances FEINSTEIN, HOLLINGS, KENNEDY, LAU- is projected that by 2009 there will be a contribute significantly to the eco- TENBERG, and SCHUMER as original co- 14-percent increase in passengers and a nomic development of nations. For ex- sponsors. This bill will provide signifi- 17-percent increase in vehicles being ample, Philippines workers across the cantly more resources to state govern- carried by ferries compared to 2002. globe sent an estimated $6.4 billion ments, public ferry systems, and public In San Francisco, that projection is a back to the Philippines in 2001. entities responsible for developing fa- 46-percent increase. Despite the tremendous importance cilities for ferries. It is clear that many people are using of remittances, people who send them Specifically, the bill would: provide ferries and more will be using them in are often unaware of the fees and ex- $150 million a year for the Federal the future. change rates assessed in these trans- Highway Administration’s Ferry Boat This is all with very little help from actions which reduce the amount of Discretionary Program for fiscal years the Federal Government. money received by their family mem- 2004 through 2009. This is approxi- Our investment in ferries pails in bers. Fees for sending remittances mately four times the $38 million a comparison to the Federal investments often can be ten to twenty percent of year that is currently being provided in highways and other forms of mass the value of the transaction. Also, the under this program; add ‘‘ferry mainte- transit. exchange rate used in the transaction nance facilities’’ to the list of allow- Our bill would provide the needed can be significantly lower than the able use of funds under this program; funding for these growing systems for market rate. add ‘‘ferries’’ to the Clean Fuels Pro- new ferry boat construction, for ferry Consumers and their families cannot gram; establish a Ferry Joint Program facilities and terminals, and for main- afford to remain uninformed about Office to coordinate Federal programs tenance facilities. their financial service options and the affecting ferry boat and ferry facility The bill also would make ferries eli- fees placed on their transactions. This construction, maintenance, and oper- gible under the Clean Fuels Program. legislation would ensure that each cus- ations and to promote ferry service as Like busses, ferries are a form of tomer is fully informed of all of the a component of the Nation’s transpor- mass transit that is environmentally fees and the exchange rates used in tation system; establish an informa- cleaner than mass use of cars and sending money. tion database on ferry systems, routes, trucks. Making them eligible for the I am hopeful that the enactment of vessels, passengers and vehicles car- Clean Fuels Program will encourage this legislation will result in more peo- ried; and establish an institute for fer- boat makers to design cleaner and ple utilizing banks and credit unions ries to conduct R&D, conduct training more efficient vessels in the future. for remittances because these institu- programs, encourage collaborative ef- This will make ferry travel an even tions do not charge the exorbitant fees forts to promote ferry service, and pre- more environmentally friendly means often associated with remittances proc- serve historical information. This will of transportation than it already is essed by certain other entities. In addi- parallel institutes that now exist for today. tion, if unbanked immigrants take ad- highways, transit, and rail. Finally, setting up a Ferry Joint vantage of the remittance services of- Currently, the Federal investment in Program Office, keeping track of ferry fered by banks and credit unions, they ferries is only one-tenth of one percent statistics, and establishing a National will be more likely to open up an ac- of the total Surface Transportation Ferry Institute will increase the profile count. This would allow immigrants to Program. There is virtually no coordi- of ferries as part of our Nation’s infra- take advantage of the opportunities for nation at the Federal level to encour- structure and provide a method to ana- saving and borrowing found at main- age and promote ferries as there are for lyze and research ways to improve stream financial institutions and offer other modes of transportation. their use. them alternatives to fringe banking We need better coordinated ferry In the end, I hope this proposal can products, such as check cashing serv- services because it’s the sole means of be included in the TEA–21 Reauthoriza- ices. surface transportation in many areas tion. The Money Wire Improvement and of the country, including Hawaii, Alas- Ferries are an important part of our Remittance Enhancement Act has spe- ka and my home State of Washington. Nation’s transportation infrastructure.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00088 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8735 This bill recognizes their importance extension. We must continue to pursue results of that study were staggering to by providing the resources and support long-term strategies for a sustained me. There are over 110,000 dislocated they need to grow and serve pas- economic recovery. The fundamental workers in my state, the majority of sengers. strength of our economy lies in the whom want to upgrade their skills but I urge the Senate support this bill, working men and women of this Nation cannot do so because of budgetary limi- and I look forward to working with my whose innovation and hard work pro- tations that prevent institutions from colleagues to see it passed. pelled the massive economic expansion offering enough courses, and the lim- of the past decade. ited numbers of available training By Ms. CANTWELL (for herself The competitive edge that will keep vouchers. and Ms. COLLINS): our workers ahead in this changing To make things worse, this year, the S. 1346. A bill to amend the Work- global economy is their skills. Our State of Washington received approxi- force Investment Act of 1998 to provide economy is global, linked by inter- mately 40 percent less in Workforce In- for strategic sectoral skills gap assess- national markets and communications vestment Act, WIA, formula funding ments, strategic skills gap action networks. The sustained success of compared to last year. This drastic cut plans, and strategic training capacity U.S. companies depends on adapt- in WIA funding means that services enhancement seed grants, and for other ability and innovation, which means will be cut back at a time when the de- purposes; to the Committee on Health, that workers themselves need to remand is at an all time high. It is im- Education, Labor, and Pensions. main flexible and continually update perative that during this time of State By Ms. CANTWELL: job skills. deficits, States receive additional help S. 1347. A bill to amend the Work- Even in this time of high unemploy- from the Federal Government for im- force Investment Act of 1998 to provide ment, businesses throughout the coun- portant services such as education and for training service and delivery inno- try cannot find workers with the skills job training. vation projects; to the Committee on they need. According to a study com- As my colleagues know, the Work- Health, Education, Labor, and Pen- pleted by Heldrich Work Trends Sur- force Investment Act is up for reau- sions. vey, American employers are finding it thorization this year. The WIA system difficult to hire qualified workers. is clearly the centerpiece of the Fed- By Ms. CANTWELL: Nearly half, 46 percent, of American eral job training programs. It provides S. 1348. A bill to amend the Higher businesses say they have had trouble a one-stop delivery system designed to Education Act of 1965 to modify the finding workers with the necessary meet a broad range of worker needs, computation of eligibility for certain skills. At the same time, over three and it emerged from years of bipartisan Federal Pell Grants, and for other pur- million workers are laid off each year, work by Congress to consolidate over poses; to the Committee on Health, but well under 500,000 receive any sort 33 Federal programs into one system Education, Labor, and Pensions. of training to learn the skills de- for delivering employment and train- Ms. CANTWELL. Mr. President, I manded by those businesses that face ing services. come to the floor today to discuss a worker shortages. Job training is an Today, I am introducing three bills topic that I believe is critical to our answer to meeting those skill demands that are designed to build upon the ex- Nation’s economic growth and future and bridging the skills gaps that per- isting workforce structure to expand competitiveness—the training of our sist. However, it will not occur widely opportunities for training and improve workforce. without a strong financial commit- its effectiveness. We are living in tough economic ment from the Federal Government to The first piece of legislation would times. The economy of the State of ensure access to job training programs, change the Pell Grant program to Washington and the Nation at large are and ongoing efforts to maximize the ef- make certain that student financial aid suffering through a recession where fectiveness of those funds that we al- is available to recently laid off work- jobs are scarce and workers are scram- ready invest. ers. Under current law, the standard bling to pay the bills. The most recent Investment in job training must be practice in the determination of Pell employment data available from the our first priority not our last—the de- Grant eligibility for student aid is to Bureau of Labor Statistics have offered cisions we make today to invest in our base grant awards upon the applicant’s little comfort in Washington where the workers will pay off many times over income during the previous year. The unemployment rate is 7.3 percent. in the form of stronger local econo- use of tax forms for this purpose, in Washington, along with the other Pa- mies, healthier communities, and im- many cases, is the most appropriate cific Northwest States of Oregon and proved quality of life. and easiest administrative method of Alaska, continues to have among the But the reality is that we are deliv- obtaining a clear and official state- highest unemployment rates in the na- ering a trickle of funding while faced ment of financial need. But, as a result, tion. with a tidal wave of need. I have trav- many recently laid-off workers are not Just a month ago, the Senate moved eled across my state, from Olympia to eligible for critical financial assistance quickly to extend the temporary exten- Kelso, Vancouver to Bellingham, the at a time when the workers’ families sion of unemployment compensation Tri-cities to Spokane and received a are experiencing a dramatic decrease program, so that approximately four great deal of feedback from Washing- in income. My legislation would explic- million workers across this country tonians who are seeking training, are itly provide the authority for edu- will not lose their Federal extended un- providing it, or are serving as employ- cational institutions, after taking suf- employment benefits. I am proud that ers who need to hire skilled workers. ficient precautions to prevent fraud, to the Senate acted quickly to extend this And I heard similar concerns repeated consider current-year income levels for important program. This means that in each of these areas: first, as our applicants seeking training through over 100,000 unemployed workers in economy continues to evolve, the de- Pell Grant-eligible programs. It does Washington State will receive 26 weeks mand for new skills has grown; second, this in a very narrow way, by only al- of Federal extended benefits. I am dis- the enormous increase in demand for lowing institutions in States with high appointed, however, that we were not skills training by individual workers unemployment rates to consider cur- able to pass coverage for the estimated who are upgrading skills or changing rent year financial circumstances rath- 1.1 million unemployed workers who jobs is a trend that appears to be wide- er than previous year income. have entirely exhausted their State spread throughout the Nation; but The second bill addresses issues of and Federal benefits. Therefore, I am third, far too many of those workers distance-learning and delivery of train- fighting to pass a bill that would ex- seeking access to training cannot get ing to hard to reach areas in a com- tend coverage to the long-term unem- the training they need due to limited prehensive manner. While many dis- ployed, so that help is available to the space at training institutions and the tance-learning technologies have been hardest hit workers in this weak econ- limited tuition assistance. developed in recent years, those tech- omy. Last year, my office released a study nologies have not necessarily reached Nonetheless, our efforts should not of this apparent shortfall in capacity of many of those who are most in need of stop with an unemployment insurance training systems in my State, and the training. Many workers in need of

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00089 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8736 CONGRESSIONAL RECORD — SENATE June 26, 2003 training may not be aware of online Mr. President, I ask unanimous con- ‘‘(2) REGION.—The term ‘region’ means 2 or distance learning opportunities and sent that the text of each bill be print- more local areas that comprise a common may not be able to take advantage of ed in the RECORD. labor market for an industry sector or group them even if they do know about them. There being no objection, the bills of related occupations. ‘‘(3) TRAINING SERVICES.—The term ‘train- I believe, it is not enough to create a were ordered to be printed in the ing services’ means services described in sec- distance learning curriculum and pas- RECORD, as follows: tion 134(d)(4). sively provide it through an edu- S. 1346 ‘‘(c) GRANTS TO STATES.— cational institution website. Rather, Be it enacted by the Senate and House of Rep- ‘‘(1) IN GENERAL.—The Secretary shall comprehensive solutions need to be de- resentatives of the United States of America in make grants to States, to enable the States veloped that integrate curriculum in- Congress assembled, to assist local boards and consortia in car- novations, technological access, and SECTION 1. SHORT TITLE. rying out the activities described in sub- the promotion and linkage of workers This Act may be cited as the ‘‘Sectoral section (e). in need of training with such opportu- Market Assessment for Regional Training ‘‘(2) FORMULA.— Enhancement and Revitalization Act’’. ‘‘(A) IN GENERAL.—The Secretary shall nities, especially to help workers in make the grants in accordance with the for- rural areas. That’s why my bill encour- SEC. 2. FINDINGS. Congress makes the following findings: mula used to make grants to States under ages the local workforce development (1) More than 1⁄3 of the Nation’s current section 132(b)(1)(B) (other than clause (iv)), boards to plan a comprehensive ap- workforce lacks the basic skills necessary to subject to subparagraph (B). proach to improve access to and deliv- succeed in today’s labor market. ‘‘(B) SMALL STATE MINIMUM ALLOTMENT.— ery of employment training services by (2) Globalization of the economy is leading The Secretary shall ensure that no State using technology and online resources to losses of jobs in key domestic industries, shall receive an allotment under this para- 1 to connect workers with the informa- as well as challenges to competitiveness and graph for a fiscal year that is less than ⁄2 of productivity in other domestic industries. 1 percent of the funds made available to tion and tools they need to upgrade carry out this section for that fiscal year. their skills. (3) To remain economically vital and com- ‘‘(d) GRANTS TO LOCAL BOARDS.— The third bill that I am introducing petitive, the Nation must invest in gener- ating jobs and train a workforce skilled ‘‘(1) IN GENERAL.—A State that receives a today is designed to help local work- enough to contribute productively to the grant under subsection (c)— force development boards better under- United States economy. ‘‘(A) shall use the funds made available stand regional labor market dynamics (4) Strategic planning that links workforce through the grant to make grants to local and improve system performance by development and economic development, and boards and consortia to carry out the activi- identifying emerging sectors and indus- the targeting of resources to industries that ties described in subsection (e); and tries with chronic worker shortages. can build strong regional economies and cre- ‘‘(B) may use not more than 15 percent of My legislation encourages local work- ate jobs with living wages for workers, need the funds made available through the grant, at the election of the State, to prepare stra- force development boards to target em- to be priorities for the workforce investment system. tegic sectoral skills gap assessments, as de- ployment and training resources so (5) States and local workforce investment scribed in subsection (e)(2), in the local areas that workers can get training in occu- boards can play lead roles in guiding a more or regions involved, or to provide technical pations where employers need workers. strategic process for achieving economic assistance to local boards, consortia, or part- My legislation provides new re- growth through workforce development. nerships described in subsection (e)(3). sources to the state level so that states SEC. 3. SKILLS GAP CAPACITY ENHANCEMENT ‘‘(2) CONSIDERATION.—In making the can direct funding down to the local GRANTS. grants, the State may take into account the workforce development boards to form Subtitle B of title I of the Workforce In- size of the workforce in each local area or re- partnerships with employers, unions, vestment Act of 1998 (29 U.S.C. 2811 et seq.) is gion. ‘‘(3) CONSORTIA.—States shall encourage service providers and other key players amended— (1) by redesignating section 137 as section local boards to aggregate, to the maximum in order to develop a strategic plan for 138; and extent practicable, into consortia rep- addressing regional industry and work- (2) by inserting after section 136 the fol- resenting regions, for purposes of carrying force needs. lowing: out activities described in subsection (e). I want to make clear that this legis- ‘‘SEC. 137. SKILLS GAP CAPACITY ENHANCEMENT Nothing in this paragraph shall be construed lation is not intended to reinvent the GRANTS. to require local boards to aggregate into wheel for areas that are already devel- ‘‘(a) PURPOSES.—The purposes of this sec- such consortia. oping sectoral approaches within exist- tion are— ‘‘(4) APPLICATIONS.—To be eligible to re- ‘‘(1) to assist States and local boards in ceive a grant under this section, a local ing workforce development systems. In board or consortium shall submit an applica- fact, Washington State is a leader in better focusing funds provided under this subtitle on activities and programs that ad- tion to the State, at such time and in such sector approaches: in 2000, the Wash- dress labor shortages and meet the emerging manner as the State may require, con- ington State Legislature enacted legis- demand for skills in high-quality jobs in area taining— lation to support industry skills panels industries; ‘‘(A) information identifying the members known as the ‘‘Skills Initiative.’’ The ‘‘(2) to enhance the efficiency of the one- of the partnership described in subsection Skills Initiative provides grants to stop delivery systems and providers of train- (e)(3) that will carry out the activities de- local workforce development councils ing services; scribed in subsection (e); and ‘‘(3) to establish and improve partnerships ‘‘(B) an assurance that the board or consor- to engage business and industry in tium will use, or ensure that the partnership strategies to close the skill gaps in my between local boards, industry sectors, economic development agencies, providers of uses, the funds to carry out the activities de- State. My legislation emphasizes this training services (including secondary scribed in subsection (e). work by providing funding to support schools, postsecondary educational institu- ‘‘(e) USE OF FUNDS.— these partnerships. tions, community-based organizations, busi- ‘‘(1) IN GENERAL.—A local board or consor- This is a first step on a long journey ness associations, and providers of joint tium that receives a grant under this sec- as we work to improve Federal job labor-management programs), providers of tion— training systems, and it is critical, now supportive services, and other related public ‘‘(A) shall ensure that the partnership de- more than ever, that Congress increase and private entities; scribed in paragraph (3) uses the funds made funding for the job training programs ‘‘(4) to strengthen integration of workforce available through the grant to— development strategies and economic devel- ‘‘(i) prepare a strategic sectoral skills gap under the Workforce Investment Act. opment strategies in States, local areas, and assessment, as described in paragraph (2), By providing the necessary resources, labor markets; unless the State elects to prepare the assess- we send a strong message to the Amer- ‘‘(5) to retain vital industries in the local ment; ican public that our government must areas and regions involved, avoid dislocation ‘‘(ii) develop a strategic skills gap action invest in our greatest resource—the of workers, and strengthen the competitive- plan, as described in paragraph (4); and American worker. Each of these bills is ness of key industries; and ‘‘(iii) provide strategic training capacity an important component of that broad- ‘‘(6) to encourage the development of ca- enhancement seed grants to providers of er strategy, and I look forward to reer ladders and advancement efforts in local training services specified in subsection industries. (a)(3), one-stop operators, and other appro- working with my colleagues as we ‘‘(b) DEFINITIONS.—In this section: priate intermediaries, as described in para- begin to look at the reauthorization of ‘‘(1) CONSORTIUM.—The term ‘consortium’ graph (5); and WIA and the Higher Education Act this means a consortium of local boards, estab- ‘‘(B) may use funds made available through year and next. lished as described in subsection (d)(3). the grant to ensure that activities carried

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00090 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8737 out under this subtitle are carried out in ac- fied gaps between the current and expected thorized to be appropriated under subsection cordance with the strategic skills gap action demand and supply of labor and skills in the (a), (b), or (c), there are authorized to be ap- plan. industry sector or group of related occupa- propriated to carry out section 137 such sums ‘‘(2) STRATEGIC SECTORAL SKILLS GAP AS- tions in the local area or region involved; as may be necessary for fiscal years 2004 SESSMENT.— ‘‘(C) representatives of economic develop- through 2007.’’. ‘‘(A) IN GENERAL.—Except as provided in ment agencies for the local area or region; SEC. 5. CONFORMING AMENDMENTS. subparagraph (E), the local board or consor- ‘‘(D) representatives of providers of train- (a) TABLE OF CONTENTS.—The table of con- tium (or, at the election of the State, that ing services described in subsection (a)(3) in tents in section 1(b) of the Workforce Invest- State) shall prepare a strategic sectoral the local area or region; ment Act of 1998 is amended by striking the skills gap assessment, which shall— ‘‘(E) representatives nominated by State item relating to section 137 and inserting the ‘‘(i) identify areas of current and expected labor federations or local labor federations; following: demand for labor and skills in a specific in- and ‘‘Sec. 137. Skills gap capacity enhancement dustry sector or group of related occupations ‘‘(F) other entities that can provide needed grants. that is— supportive services tailored to the needs of ‘‘Sec. 138. Authorization of appropriations.’’. ‘‘(I) producing high-quality jobs in the workers in the sector or group. local area or region involved; ‘‘(4) STRATEGIC SKILLS GAP ACTION PLAN.— (b) REFERENCES TO AUTHORIZATION OF AP- ‘‘(II) developing emerging jobs in that area The partnership shall develop a strategic PROPRIATIONS.— or region; or skills gap action plan, based on the assess- (1) YOUTH ACTIVITIES.—Subsections (a) and ‘‘(III) suffering chronic worker shortages; ment, that— (b)(1) of section 127 of the Workforce Invest- ‘‘(ii) identify the current and expected sup- ‘‘(A)(i) identifies specific barriers to ade- ment Act of 1998 (29 U.S.C. 2852) are amended ply of labor and skills in that sector or group quate supply of labor and skills in demand in by striking ‘‘section 137(a)’’ each place it ap- in the local area or region; and a specific industry sector or group of related pears and inserting ‘‘section 138(a)’’. ‘‘(iii) identify gaps between the current occupations that is producing high-quality (2) ADULT EMPLOYMENT AND TRAINING AC- and expected demand and supply of labor and jobs in the local area or region involved; and TIVITIES.—Section 132(a)(1) of the Workforce skills in that sector or group in the local ‘‘(ii) identifies activities (which may in- Investment Act of 1998 (29 U.S.C. 2862(a)(1)) is area or region. clude the provision of needed supportive amended by striking ‘‘section 137(b)’’ and in- ‘‘(B) SPECIFIC CONTENTS.—The assessment services) that will remove or alleviate the serting ‘‘section 138(b)’’. shall contain data regarding— barriers described in clause (i) that could be (3) DISLOCATED WORKER EMPLOYMENT AND ‘‘(i)(I) specific high-quality employment undertaken by one-stop operators and pro- TRAINING ACTIVITIES.—Subsections (a)(2) and opportunities offered by industries in the viders of training services described in sub- (b)(2)(A)(i) of section 132 of the Workforce In- local area or region; and section (a)(3); vestment Act of 1998 (29 U.S.C. 2862) are ‘‘(II) specific skills desired for such oppor- ‘‘(B) specifies how the local board (or con- amended by striking ‘‘section 137(c)’’ each tunities; sortium) and economic development agencies place it appears and inserting ‘‘section ‘‘(ii)(I) occupations and positions in the in the partnership will integrate the board’s 138(c)’’. local area or region that are difficult to fill; or consortium’s workforce development S. 1347 and strategies with local or regional economic ‘‘(II) specific skills desired for such occupa- Be it enacted by the Senate and House of Rep- development strategies in that sector or tions and positions; resentatives of the United States of America in group; and ‘‘(iii)(I) areas of growth and decline among Congress assembled, ‘‘(C) identifies resources and strategies industries and occupations in the local area SECTION 1. TRAINING SERVICE AND DELIVERY that will be used in the local area or region or region; and INNOVATION PROJECTS. to address the skill gaps for both unem- ‘‘(II) specific skills desired for such growth Section 171(b)(1)(D) of the Workforce In- ployed and incumbent workers in that sector areas; and vestment Act of 1998 (29 U.S.C. 2916(b)(1)(D)) or group. ‘‘(iv) specific inventories of skills of unem- is amended to read as follows: ‘‘(5) STRATEGIC TRAINING CAPACITY EN- ployed or underemployed individuals in the ‘‘(D) targeted innovation projects that im- HANCEMENT SEED GRANTS.— local area or region. prove access to and delivery of employment ‘‘(A) IN GENERAL.—The local board or con- ‘‘(C) INFORMATION.—The assessment shall and training services, with emphasis given to contain current (as of the date of prepara- sortium, after consultation with the partner- projects that incorporate advanced tech- tion of the assessment) information includ- ship, shall make grants to providers of train- nologies to facilitate the connection of indi- ing specific information from multiple em- ing services described in subsection (a)(3), viduals to the information and tools they ployers in the sector or group described in one-stop operators, and other appropriate need to upgrade skills, including projects subparagraph (A)(i), labor organizations, and intermediaries to pay for the Federal share that link individuals in need of training to others connected to the businesses and work- of the cost of— opportunities for self-guided learning, and ers in that sector or group, to illuminate ‘‘(i) developing curricula to meet needs with priority given to projects that— local needs of both employers and workers. identified in the assessment described in ‘‘(i) actively promote sources of informa- To the maximum extent possible, the infor- paragraph (2) and to overcome barriers iden- tion about training opportunities and train- mation shall be regularly updated informa- tified in the plan described in paragraph (4); ing content by providing technology directly tion. ‘‘(ii) modifying the programs of training to eligible training recipients; ‘‘(D) SURVEY.—The assessment shall con- services offered by the providers in order to ‘‘(ii) provide for the conduct of online eligi- tain the results of a survey or focus group meet those needs and overcome those bar- bility determinations for Federal and State interviews of employers and labor organiza- riers; training programs, and direct individuals to tions and other relevant individuals and or- ‘‘(iii) operating pilot training efforts that the appropriate programs in the area; and ganizations in the local area or region. demonstrate new curricula, or modifications ‘‘(iii) integrate high-quality employment ‘‘(E) EXCEPTION.— to curricula, described in clause (i); and training services information with the ‘‘(i) STATE.—A State shall not be required ‘‘(iv) expanding capacity of providers of delivery of information regarding other so- to use the funds made available through a training services in sectors or groups de- cial services and health care programs;’’. scribed in paragraph (2)(A)(i); grant received under this section, to prepare S. 1348 an assessment described in this paragraph. ‘‘(v) reorganizing service delivery systems Be it enacted by the Senate and House of Rep- ‘‘(ii) LOCAL BOARD OR CONSORTIUM.—A local to better serve the needs of employers and board or consortium shall not be required to workers in the sectors or groups; or resentatives of the United States of America in use the funds made available through a grant ‘‘(vi) developing business services to ensure Congress assembled, received under this section, to prepare an as- retention and greater competitiveness of the SECTION 1. SHORT TITLE. sessment described in this paragraph, if the sectors or groups. This Act may be cited as the ‘‘Federal Pell local board or consortium demonstrates ‘‘(B) FEDERAL SHARE.— Grant Eligibility Clarification Act of 2003’’. that, within the 2 years prior to receiving ‘‘(i) IN GENERAL.—The Federal share of the SEC. 2. CONSIDERATION OF CURRENT YEAR CIR- the grant, an assessment that meets the re- cost described in subparagraph (A) shall be 75 CUMSTANCES. quirements of this paragraph has been pre- percent. Section 480(a) of the Higher Education Act pared for the local area or region involved. ‘‘(ii) NON-FEDERAL SHARE.—The non-Fed- of 1965 (20 U.S.C. 1087vv(a)) is amended— ‘‘(3) SKILLS PARTNERSHIP.—In carrying out eral share of the cost may be provided in (1) in paragraph (1), by striking ‘‘paragraph this section, local boards and consortia shall cash or in kind, fairly evaluated, including (2)’’ and inserting ‘‘paragraphs (2) and (3)’’; enter into partnerships that include— plant, equipment, or services.’’. and ‘‘(A) representatives of the local boards for SEC. 4. AUTHORIZATION OF APPROPRIATIONS. (2) by adding at the end the following: the local area or region involved; Section 138 of the Workforce Investment ‘‘(3) CONSIDERATION OF CURRENT YEAR CIR- ‘‘(B) representatives of multiple employers Act of 1998 (29 U.S.C. 2872), as redesignated CUMSTANCES FOR CERTAIN PELL GRANT for a specific industry sector or group of re- by section 3(1), is amended by adding at the AWARDS.— lated occupations, and related sectors or oc- end the following: ‘‘(A) IN GENERAL.—If a student is a resident cupations, identified through the assessment ‘‘(d) SKILLS GAP CAPACITY ENHANCEMENT of a State that is in an extended benefit pe- described in paragraph (2) as having identi- GRANTS.—In addition to any amounts au- riod (within the meaning of section 203 of the

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ELECTIVE CARRYFORWARD OF UNUSED to identify theft until May 24, 2002—17 pensation Act of 2002 (Public Law 107–147)), LIMITATION. days later. then for purposes of calculating total income (a) IN GENERAL.—Section 143(l)(3) of the In- On December 14, 2002, TriWest Health ternal Revenue Code of 1986 (relating to vol- under paragraph (1) for a student seeking as- Care Alliance, a company that provides sistance under subpart 1 of part A, the Sec- ume limitation) is amended by adding at the retary shall reduce the student’s total in- end the following: health care coverage for military per- come by an amount by which— ‘‘(D) ELECTIVE CARRYFORWARD OF UNUSED sonnel and their families, was burglar- ‘‘(i) the adjusted gross income plus untaxed LIMITATION.— ized at its Phoenix, AZ offices. Thieves income and benefits for the preceding tax ‘‘(i) IN GENERAL.—If— broke into a management suite and year minus excludable income (as defined in ‘‘(I) a State veterans limit for any calendar stole laptop computers and computer subsection (e)), exceeds year after 2002, exceeds hard drives containing the names, ad- ‘‘(ii) the projected gross income plus ‘‘(II) the aggregate amount of qualified dressed, telephone numbers, birth dates veterans’ mortgage bonds issued by such untaxed income and benefits for the current and Social Security numbers of 562,000 tax year minus the projected excludable in- State, military service members, dependents come (as defined in subsection (e)). such State may irrevocably elect to treat ‘‘(B) ANTI-FRAUD PROCEDURES.—The Sec- such excess as a carryforward for qualified and retirees, as well as medical claims retary shall establish procedures to ensure veterans’ mortgage bonds. records for people on active duty in the that computations made pursuant to sub- ‘‘(ii) USE OF CARRYFORWARD.— Persian Gulf. paragraph (A) are not fraudulent.’’. ‘‘(I) IN GENERAL.—If a State elects a In February 2003, a hacker gained ac- carryforward under clause (i), qualified vet- cess to 10 million Visa, MasterCard, By Mr. SMITH (for himself, Mr. erans’ mortgage bonds issued during the 3 American Express Card and Discovery KOHL, Mrs. BOXER, Mr. CORNYN, calendar years following the calendar year in Card numbers from the databases of a Mr. FEINGOLD, Mrs. HUTCHISON, which the carryforward arose shall not be credit processor, DPI Merchant serv- taken into account under subparagraph (A) Ms. MURKOWSKI, and Mr. to the extent the amount of such bonds does ices of Omaha, NE. Company officials WYDEN): not exceed the amount of the carryforward maintained that the intruder did not S. 1349. A bill to amend the Internal so elected. obtain any personal information for Revenue Code of 1986 with respect to ‘‘(II) ORDER IN WHICH CARRYFORWARD these card numbers such as the ac- the eligibility of veterans for mortgage USED.—Carryforwards elected shall be used count holder’s name, address, tele- bond financing, and for other purposes; in the order of the calendar years in which phone number or Social Security num- to the Committee on Finance. such carryforwards arose.’’. ber. However, at least one bank can- Mr. SMITH. Mr. President, on behalf (b) EFFECTIVE DATE.—The amendment celed and replaced 8,800 cards when it made by this section shall apply to bonds of myself and my colleagues, Mr. KOHL issued and carryforward elections made after found out about the security breach. of Wisconsin, Mrs. BOXER of California, December 31, 2003. And in March of this year, a Univer- Mr. CORNYN of Texas, Mr. FEINGOLD of sity of Texas student was charged with Wisconsin, Mrs. HUTCHISON of Texas, By Mrs. FEINSTEIN: hacking into the university’s computer Ms. MURKOWSKI of Alaska, and Mr. S 1350. A bill to require Federal agen- system and stealing 55,000 Social Secu- WYDEN of Oregon, I ask unanimous cies, and persons engaged in interstate rity numbers. consent that the text of the bill, the commerce, in possession of electronic These are just some examples of the ‘‘Veterans American Dream Home data containing personal information, types of breaches that are occurring Ownership Act’’ be printed in the to disclose any unauthorized acquisi- today. Except for California, which as a RECORD. tion of such information; to the Com- notification law going into effect in There being no objection, the bill was mittee on the Judiciary. July, no State of Federal law requires ordered to be printed in the RECORD, as Mrs. FEINSTEIN. Mr. President, I companies or agencies to tell individ- follows: rise to introduce the Notification of uals of the misappropriation of their S. 1349 Risk to Personal Data Act of 2003. This personal data. legislation will require that individuals I strongly believe Americans should Be it enacted by the Senate and House of Rep- resentatives of the United States of America in are notified when their most sensitive be notified if a hacker gets access to Congress assembled, personal information is stolen from a their most personal data. This is both corporate or government database. SECTION 1. ALL VETERANS ELIGIBLE FOR STATE a matter of principle and a practical HOME LOAN PROGRAMS FUNDED BY Specifically, the bill would require measure to curb identity theft. QUALIFIED VETERANS’ MORTGAGE government or private entities to no- Let me take a moment to describe BONDS. tify individuals if a data breach has the proposed legislation. (a) IN GENERAL.—Section 143(l)(4) of the In- compromised their Social Security The Notification of Risk to Personal ternal Revenue Code of 1986 (defining quali- number, driver’s license number, credit Data Act will set a national standard fied veteran) is amended— card number, debit card number, or fi- for notification of consumers when a (1) by striking ‘‘at some time before Janu- ary 1, 1977’’ in subparagraph (A), and nancial account numbers. data breach occurs. (2) by striking subparagraph (B) and insert- In most cases, if authorities know Specifically, the legislation requires ing the following: that someone is a victim of a crime, a business or government entity to no- ‘‘(B) who applied for the financing before the victim is notified. But that isn’t tify an individual when there is a rea- the date 30 years after the last on which such the case if an individual’s most sen- sonable basis to conclude that a hacker veteran left active service.’’. sitive personal information is stolen or other criminal has obtained (b) EFFECTIVE DATE.—The amendments from an electronic database. unencrypted personal data maintained made by this section shall apply to financing Unfortunately, data breaches are be- by the entity. provided and mortgage credit certificates coming all too common. Consider the Personal data is defined by the bill as issued after June 30, 2003. following incidents which have com- an individual’s Social Security num- SEC. 2. REVISION OF STATE VETERANS LIMIT. promised the records of hundreds of ber, State identification number, driv- (a) IN GENERAL.—Subparagraph (B) of sec- thousands of Americans. er’s license number, financial account tion 143(l)(3) of the Internal Revenue Code of 1986 (relating to volume limitation) is On April 5, 2002, a hacker broke into number, or credit card number. amended to read as follows: the electronic records of Steven P. The legislation’s notification scheme ‘‘(B) STATE VETERANS LIMIT.—A State vet- Teale Data Center, the payroll facility minimizes the burdens on companies or erans limit for any calendar year is the for California State employees. The agencies that must report a data amount equal to— hacker compromises files containing breach. ‘‘(i) $425,000,000 for the State of Texas, the first initials, middle initials, and In general, notice would have to be ‘‘(ii) $537,000,000 for the State of California, last names, Social Security numbers, provided to each person whose data was ‘‘(iii) $200,000,000 for the State of Oregon, and payroll deduction information of compromised in writing or through e- ‘‘(iv) $200,000,000 for the State of Wisconsin, and approximately 265,000 people. Despite mail. But there are important excep- ‘‘(v) $200,000,000 for the State of Alaska.’’. the breathtaking potential harm of the tions. (b) EFFECTIVE DATE.—The amendment crime, the breach was not publicly ac- First, companies that have developed made by this section shall apply to bonds knowledged and State employees were their own reasonable notification poli- issued after December 31, 2003. not made aware of their vulnerability cies are given a safe harbor under the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00092 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8739 bill and are exempted from its notification stolen and you just begin to un- (B) conspicuous posting of the notice on tion requirements. derstand the enormity of the problem the Internet site of the agency or person, if Second, encrypted data is exempted. that the lack of notification can the agency or person maintains an Internet Third, where it is too expensive or cause.’’ site; or impractical, e.g., contact address infor- If individuals are informed of the (C) notification to major media. mation is incomplete, to notify every theft of their Social Security numbers SEC. 3. DATABASE SECURITY. individual who is harmed, the bill al- or other sensitive information, they (a) DISCLOSURE OF SECURITY BREACH.— (1) IN GENERAL.—Any agency, or person en- lows entities to send out an alternative can take immediate preventative ac- gaged in interstate commerce, that owns or form of notice called ‘‘substitute no- tion. licenses electronic data containing personal tice.’’ Substitute notice includes post- They can place a fraud alert on their information shall, following the discovery of ing notice on a website or notifying credit report to prevent crooks from a breach of security of the system containing major media. obtaining credit cards in their name; such data, notify any resident of the United Substitute notice would be triggered they can monitor their credit reports States whose unencrypted personal informa- if any of the following factors exist: 1. to see if unauthorized activity has oc- tion was, or is reasonably believed to have the agency or person demonstrates curred; they can cancel any affected fi- been, acquired by an unauthorized person. (2) NOTIFICATION OF OWNER OR LICENSEE.— that the cost of providing direct notice nancial or consumer or utility ac- Any agency, or person engaged in interstate would exceed $250,000; 2. the affected counts; they can change their phone commerce, in possession of electronic data class of subject persons to be notified numbers if necessary. containing personal information that the exceeds 500,000; or 3. the agency or per- I look forward to working with my agency does not own or license shall notify son does not have sufficient contact in- colleagues to pass this vitally needed the owner or licensee of the information if formation to notify people whose infor- legislation. This bill will give ordinary the personal information was, or is reason- mation is at risk. Americans more control and con- ably believed to have been, acquired by an The bill has a tough, but fair enforce- fidence about the safety of their per- unauthorized person through a breach of se- ment regime. Entities that fail to com- sonal information. Americans will have curity of the system containing such data. (3) TIMELINESS OF NOTIFICATION.—Except as ply with the bill will be subject to fines the security of knowing that should a provided in paragraph (4), all notifications by the Federal Trade Commission of breach occur, they will be notified and required under paragraph (1) or (2) shall be $5,000 per violation or up to $25,000 per be able to take protective action. made as expediently as possible and without day while the violation persists. State I ask unanimous consent that the unreasonable delay following— Attorneys General can also file suit to text of the bill be printed in the (A) the discovery by the agency or person enforce the statute. RECORD. of a breach of security of the system; and Additionally, the bill would allow There being no objection, the bill was (B) any measures necessary to determine California’s new law to remain in ef- ordered to be printed in the RECORD, as the scope of the breach, prevent further dis- follows: closures, and restore the reasonable integ- fect, but preempt conflicting State rity of the data system. S. 1350 laws. It is my understanding that legis- (4) DELAY OF NOTIFICATION AUTHORIZED FOR lators in a number of States are devel- Be it enacted by the Senate and House of Rep- LAW ENFORCEMENT PURPOSES.—If a law en- oping bills modeled after the California resentatives of the United States of America in forcement agency determines that the notifi- law. Reportedly, some of these bills Congress assembled, cation required under this subsection would have requirements that are incon- SECTION 1. SHORT TITLE. impede a criminal investigation, such notifi- sistent with the California legislation. This Act may be cited as the ‘‘Notification cation may be delayed until such law en- It is not fair to put companies in a sit- of Risk to Personal Data Act’’. forcement agency determines that the notifi- SEC. 2. DEFINITIONS. cation will no longer compromise such inves- uation that forces them to comply with In this Act, the following definitions shall tigation. database notification laws of 50 dif- apply: (5) METHODS OF NOTICE.—An agency, or per- ferent States. (1) AGENCY.—The term ‘‘agency’’ has the son engaged in interstate commerce, shall be I strongly believe individuals have a same meaning given such term in section in compliance with this subsection if it pro- right to be notified when their most 551(1) of title 5, United States Code. vides the resident, owner, or licensee, as ap- sensitive information is compromised— (2) BREACH OF SECURITY OF THE SYSTEM.— propriate, with— because it is truly their information. The term ‘‘breach of security of the sys- (A) written notification; Ask the ordinary person on the street tem’’— (B) e-mail notice, if the person or business if he or she would like to know if a (A) means the compromise of the security, has an e-mail address for the subject person; confidentiality, or integrity of computerized or criminal had illegally gained access to data that results in, or there is a reasonable (C) substitute notice, if— their personal information from a data- basis to conclude has resulted in, the unau- (i) the agency or person demonstrates that base—the answer will be a resounding thorized acquisition of and access to per- the cost of providing direct notice would ex- yes. sonal information maintained by the person ceed $250,000; Enabling consumers to be notified in or business; and (ii) the affected class of subject persons to a timely manner of security breaches (B) does not include good faith acquisition be notified exceeds 500,000; or involving their personal data will help of personal information by an employee or (iii) the agency or person does not have combat the growth scourge of identity agent of the person or business for the pur- sufficient contact information for those to poses of the person or business, if the per- be notified. theft. According to the Identity Theft sonal information is not used or subject to (6) ALTERNATIVE NOTIFICATION PROCE- Resources Center, a typical identity further unauthorized disclosure. DURES.—Notwithstanding any other obliga- theft victim takes six to 12 months to (3) PERSON.—The term ‘‘person’’ has the tion under this subsection, an agency, or per- discover that a fraud has been perpet- same meaning given such term in section son engaged in interstate commerce, shall be uated against them. 551(2) of title 5, United States Code. deemed to be in compliance with this sub- As Linda Foley, Executive Director (4) PERSONAL INFORMATION.—The term section if the agency or person— of the Identity Theft Resources center ‘‘personal information’’ means an individ- (A) maintains its own reasonable notifica- puts it: ‘‘Identity theft is a crime of op- ual’s last name in combination with any 1 or tion procedures as part of an information se- portunity and time is essential at more of the following data elements, when curity policy for the treatment of personal either the name or the data elements are not information; and every junction. Every minute that encrypted: (B) notifies subject persons in accordance passes after the breach until detection (A) Social security number. with its information security policy in the and notification increases the damage (B) Driver’s license number or State identi- event of a breach of security of the system. done to the consumer victim, the com- fication number. (7) REASONABLE NOTIFICATION PROCE- mercial entities, and law enforcement’s (C) Account number, credit or debit card DURES.—As used in paragraph (6), with re- ability to track and catch the crimi- number, in combination with any required spect to a breach of security of the system nals. It takes less than a minute to fill security code, access code, or password that involving personal information described in out a credit application and to start an would permit access to an individual’s finan- section 2(4)(C), the term ‘‘reasonable notifi- cial account. cation procedures’’ means procedures that— action that could permanently affect (5) SUBSTITUTE NOTICE.—The term ‘‘sub- (A) use a security program reasonably de- the victim’s life. Multiply that times stitute notice’’ means— signed to block unauthorized transactions hundreds of minutes, hundreds of op- (A) e-mail notice, if the agency or person before they are charged to the customer’s ac- portunities to use or sell the informa- has an e-mail address for the subject persons; count;

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(B) provide for notice to be given by the (1) VENUE.—Any action brought under sub- ‘‘(2) PARTY AFFILIATION.—Not more than 5 owner or licensee of the database, or another section (a) may be brought in the district of the 9 members of the Board may be affili- party acting on behalf of such owner or li- court of the United States that meets appli- ated with a single political party. censee, after the security program indicates cable requirements relating to venue under ‘‘(c) RECOMMENDATIONS.—In appointing that the breach of security of the system has section 1391 of title 28, United States Code. members of the Board, the President shall— resulted in fraud or unauthorized trans- (2) SERVICE OF PROCESS.—In an action ‘‘(1) consider recommendations from such actions, but does not necessarily require no- brought under subsection (a), process may be public officials as— tice in other circumstances; and served in any district in which the defend- ‘‘(A) the Governors of States in the service (C) are subject to examination for compli- ant— area; ance with the requirements of this Act by 1 (A) is an inhabitant; or ‘‘(B) individual citizens; or more Federal functional regulators (as de- (B) may be found. ‘‘(C) business, industrial, labor, electric fined in section 509 of the Gramm-Leach Bli- SEC. 5. EFFECT ON STATE LAW. power distribution, environmental, civic, ley Act (15 U.S.C. 6809)), with respect to the The provisions of this Act shall supersede and service organizations; and operation of the security program and the any inconsistent provisions of law of any ‘‘(D) the congressional delegations of the notification procedures. State or unit of local government relating to States in the service area; and (b) CIVIL REMEDIES.— the notification of any resident of the United ‘‘(2) seek qualified members from among (1) PENALTIES.—Any agency, or person en- States of any breach of security of an elec- persons who reflect the diversity and needs gaged in interstate commerce, that violates tronic database containing such resident’s of the service area of the Corporation. this section shall be subject to a fine of not personal information (as defined in this Act), ‘‘(d) TERMS.— more than $5,000 per violation, to a max- except as provided under sections 1798.82 and ‘‘(1) IN GENERAL.—A member of the Board imum of $25,000 per day while such violations 1798.29 of the California Civil Code. shall serve a term of 5 years, except that in persist. SEC. 6. EFFECTIVE DATE. first making appointments after the date of (2) EQUITABLE RELIEF.—Any person engaged This Act shall take effect on the expiration enactment of this paragraph, the President in interstate commerce that violates, proof the date which is 6 months after the date shall appoint— poses to violate, or has violated this section of enactment of this Act. ‘‘(A) 2 members to a term of 2 years; may be enjoined from further violations by a ‘‘(B) 1 member to a term of 3 years; and court of competent jurisdiction. By Mr. FRIST: ‘‘(C) 2 members to a term of 4 years. (3) OTHER RIGHTS AND REMEDIES.—The ‘‘(2) VACANCIES.—A member appointed to rights and remedies available under this sub- S. 1351. A bill to amend the Ten- nessee Valley Authority Act of 1933 to fill a vacancy in the Board occurring before section are cumulative and shall not affect the expiration of the term for which the any other rights and remedies available modify provisions relating to the Board predecessor of the member was appointed under law. of Directors of the Tennessee Valley shall be appointed for the remainder of that (c) ENFORCEMENT.—The Federal Trade Authority, and for other purposes; to term. Commission is authorized to enforce compli- the Committee on Environment and ‘‘(3) REAPPOINTMENT.— ance with this section, including the assess- ‘‘(A) IN GENERAL.—A member of the Board ment of fines under subsection (b)(1). Public Works. Mr. FRIST. Mr. President, I ask that was appointed for a full term may be re- SEC. 4. ENFORCEMENT BY STATE ATTORNEYS appointed for 1 additional term. GENERAL. unanimous consent that the text of the ‘‘(B) APPOINTMENT TO FILL VACANCY.—For (a) IN GENERAL.— bill be printed in the RECORD. the purpose of subparagraph (A), a member (1) CIVIL ACTIONS.—In any case in which the There being no objection, the bill was appointed to serve the remainder of the term attorney general of a State has reason to be- ordered to be printed in the RECORD, as of a vacating member for a period of more lieve that an interest of the residents of that follows: than 2 years shall be considered to have been State has been or is threatened or adversely appointed for a full term. affected by the engagement of any person in S. 1351 a practice that is prohibited under this Act, Be it enacted by the Senate and House of Rep- ‘‘(e) QUORUM.— the State, as parens patriae, may bring a resentatives of the United States of America in ‘‘(1) IN GENERAL.—Six members of the civil action on behalf of the residents of the Congress assembled, Board shall constitute a quorum for the transaction of business. State in a district court of the United States SECTION 1. CHANGE IN COMPOSITION, OPER- of appropriate jurisdiction to— ATION, AND DUTIES OF THE BOARD ‘‘(2) MINIMUM NUMBER OF MEMBERS.—A va- (A) enjoin that practice; OF DIRECTORS OF THE TENNESSEE cancy in the Board shall not impair the (B) enforce compliance with this Act; VALLEY AUTHORITY. power of the Board to act, so long as there (C) obtain damage, restitution, or other (a) IN GENERAL.—The Tennessee Valley Au- are 6 members in office. compensation on behalf of residents of the thority Act of 1933 (16 U.S.C. 831 et seq.) is ‘‘(f) COMPENSATION.— State; or amended by striking section 2 and inserting ‘‘(1) IN GENERAL.—A member of the Board (D) obtain such other relief as the court the following: shall be entitled to receive— may consider to be appropriate. ‘‘SEC. 2. MEMBERSHIP, OPERATION, AND DUTIES ‘‘(A)(i) a stipend of $30,000 per year; plus OF THE BOARD OF DIRECTORS. ‘‘(ii) compensation, not to exceed $10,000 (2) NOTICE.— for any year, at a rate that does not exceed (A) IN GENERAL.—Before filing an action ‘‘(a) MEMBERSHIP.— under paragraph (1), the attorney general of ‘‘(1) APPOINTMENT.—The Board of Directors the daily equivalent of the annual rate of the State involved shall provide to the At- of the Corporation (referred to in this Act as basic pay prescribed under level V of the Ex- torney General— the ‘Board’) shall be composed of 9 members ecutive Schedule under section 5316 of title 5, (i) written notice of the action; and appointed by the President by and with the United States Code, for each day the member (ii) a copy of the complaint for the action. advice and consent of the Senate, who shall is engaged in the actual performance of duties as a member of the Board at meetings or (B) EXEMPTION.— be legal residents of the service area. hearings; and (i) IN GENERAL.—Subparagraph (A) shall ‘‘(2) CHAIRMAN.—The members of the Board not apply with respect to the filing of an ac- shall select 1 of the members to act as chair- ‘‘(B) travel expenses, including per diem in tion by an attorney general of a State under man of the Board. lieu of subsistence, in the same manner as this subsection, if the State attorney general ‘‘(b) QUALIFICATIONS.— persons employed intermittently in Govern- determines that it is not feasible to provide ‘‘(1) IN GENERAL.—To be eligible to be ap- ment service under section 5703 of title 5, the notice described in such subparagraph pointed as a member of the Board, an indi- United States Code. before the filing of the action. vidual— ‘‘(2) ADJUSTMENTS IN STIPENDS.—The amount of the stipend under paragraph (ii) NOTIFICATION.—In an action described ‘‘(A) shall be a citizen of the United States; in clause (i), the attorney general of a State ‘‘(B) shall have widely recognized experi- (1)(A)(i) shall be adjusted by the same per- shall provide notice and a copy of the com- ence or applicable expertise in the manage- centage, at the same time and manner, and plaint to the Attorney General at the time ment of or decisionmaking for a large cor- subject to the same limitations as are appli- the State attorney general files the action. porate structure; cable to adjustments under section 5318 of (b) CONSTRUCTION.—For purposes of bring- ‘‘(C) shall not be an employee of the Cor- title 5, United States Code. ing any civil action under subsection (a), poration; ‘‘(g) DUTIES.— nothing in this Act shall be construed to pre- ‘‘(D) shall have no substantial direct finan- ‘‘(1) IN GENERAL.—The Board shall— vent an attorney general of a State from ex- cial interest in— ‘‘(A) establish the broad goals, objectives, ercising the powers conferred on such attor- ‘‘(i) any public-utility corporation engaged and policies of the Corporation that are ap- ney general by the laws of that State to— in the business of distributing and selling propriate to carry out this Act; (1) conduct investigations; power to the public; or ‘‘(B) develop long-range plans to guide the (2) administer oaths or affirmations; or ‘‘(ii) any business that may be adversely Corporation in achieving the goals, objec- (3) compel the attendance of witnesses or affected by the success of the Corporation as tives, and policies of the Corporation and the production of documentary and other a producer of electric power; and provide assistance to the chief executive offi- evidence. ‘‘(E) shall profess a belief in the feasibility cer to achieve those goals, objectives, and (c) VENUE; SERVICE OF PROCESS.— and wisdom of this Act. policies, including preparing the Corporation

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00094 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8741 for fundamental changes in the electric utili- submitted to Congress and made available to STEIN, the Community and Forest Pro- ties industry; the public for a period of 30 days. tection Act. I ask unanimous consent ‘‘(C) ensure that those goals, objectives, ‘‘(5) POSITIONS AT OR BELOW LEVEL IV.—The that the text of the bill to be printed in and policies are achieved; chief executive officer shall determine the the RECORD. ‘‘(D) approve an annual budget for the Cor- salary and benefits of employees whose an- poration; nual salary is not greater than the annual There being no objection, the bill was ‘‘(E) establish a compensation plan for em- rate payable for positions at level IV of the ordered to be printed in the RECORD, as ployees of the Corporation in accordance Executive Schedule under section 5315 of follows: with subsection (i); title 5, United States Code. Be it enacted by the Senate and House of Rep- ‘‘(F) approve the salaries, benefits, and in- ‘‘(6) POSITIONS ABOVE LEVEL IV.—On the resentatives of the United States of America in centives for managers and technical per- recommendation of the chief executive offi- Congress assembled, sonnel that report directly to the chief exec- cer, the Board shall approve the salaries of (a) FINDINGS.—Congress finds that: utive officer; employees whose annual salaries would be in (1) In 2002, approximately six and one half ‘‘(G) ensure that all activities of the Cor- excess of the annual rate payable for posi- million acres of forest lands in the U.S. poration are carried out in compliance with tions at level IV of the Executive Schedule burned with varying degrees of severity, 21 applicable law; under section 5315 of title 5, United States people lost their lives, and over 3000 struc- ‘‘(H) create an audit committee, composed Code.’’. tures were destroyed. The Forest Service and solely of Board members independent of the (b) CURRENT BOARD MEMBERS.—A member Bureau of Land Management spent more management of the Corporation, which of the board of directors of the Tennessee than $1 billion fighting these fires. shall— Valley Authority who was appointed before (2) 73 million acres of public lands are clas- ‘‘(i) recommend to the Board an external the effective date of the amendment made by sified as condition class 3 fire risks. This in- auditor; subsection (a)— cludes 23 million acres that are in strategic ‘‘(ii) receive and review reports from the (1) shall continue to serve as a member areas designated by the U.S. Forest Service external auditor; and until the date of expiration of the member’s for emergency treatment to withstand cata- ‘‘(iii) make such recommendations to the current term; and strophic fire. Board as the audit committee considers nec- (2) may not be reappointed. (3) The forest management policy of fire suppression has resulted in an accumulation essary; SEC. 2. CHANGE IN MANNER OF APPOINTMENT of fuel loads, dead and dying trees, and non- ‘‘(I) create such other committees of Board OF STAFF. members as the Board considers to be appro- Section 3 of the Tennessee Valley Author- native species that create fuel ladders which priate; ity Act of 1933 (16 U.S.C. 831b) is amended— allow fires to reach the crowns of large old ‘‘(J) conduct public hearings on issues that (1) by striking the first undesignated para- trees and cause catastrophic fire. (4) The U.S. Forest Service and the Depart- could have a substantial effect on— graph and inserting the following: ment of the Interior should immediately un- ‘‘(i) the electric ratepayers in the service ‘‘(a) APPOINTMENT BY THE CHIEF EXECUTIVE dertake an emergency program to reduce the area; or OFFICER.—The chief executive officer shall risk of catastrophic fire. ‘‘(ii) the economic, environmental, social, appoint, with the advice and consent of the (5) This emergency program should or physical well-being of the people of the Board, and without regard to the provisions prioritize the protection of homes and com- service area; and of the civil service laws applicable to officers munities and the restoration of forest health ‘‘(K) establish the electricity rate sched- and employees of the United States, such on lands at the highest risk of catastrophic ule. managers, assistant managers, officers, em- fire. All fuel reduction treatments should ‘‘(2) MEETINGS.—The Board shall meet at ployees, attorneys, and agents as are nec- protect old growth stands and large trees to least 4 times each year. essary for the transaction of the business of ensure a rich and continued species diversity the Corporation.’’; and ‘‘(h) CHIEF EXECUTIVE OFFICER.— in the nation’s forests. ‘‘(1) APPOINTMENT.—The Board shall ap- (2) by striking ‘‘All contracts’’ and insert- SECTION 1. SHORT TITLE; TABLE OF CONTENTS. point a person to serve as chief executive of- ing the following: (a) SHORT TITLE.—This Act may be cited as ficer of the Corporation. ‘‘(b) WAGE RATES.—All contracts’’. the ‘‘Community and Forest Protection ‘‘(2) QUALIFICATIONS.—To serve as chief ex- SEC. 3. CONFORMING AMENDMENTS. Act’’. ecutive officer of the Corporation, a person— (a) The Tennessee Valley Authority Act of (b) TABLE OF CONTENTS.—The table of con- ‘‘(A) shall be a citizen of the United States; 1933 (16 U.S.C. 831 et seq.) is amended— tents for this Act is as follows: ‘‘(B) shall have management experience in (1) by striking ‘‘board of directors’’ each large, complex organizations; place it appears and inserting ‘‘Board of Di- Sec. 1 Short title; table of contents. ‘‘(C) shall not be a current member of the rectors’’; and Sec. 2 Hazardous fuels reduction projects. Board or have served as a member of the (2) by striking ‘‘board’’ each place it ap- Sec. 3 Expedited process. Sec. 4 Judicial review in the United States Board within 2 years before being appointed pears and inserting ‘‘Board’’. District Courts. chief executive officer; and (b) Section 9 of the Tennessee Valley Au- Sec. 5 Contracting. ‘‘(D) shall have no substantial direct finan- thority Act of 1933 (16 U.S.C. 831h) is amend- Sec. 6 Biomass grants. cial interest in— ed— Sec. 7 Forest stands inventory and moni- ‘‘(i) any public-utility corporation engaged (1) by striking ‘‘The Comptroller General toring program. of the United States shall audit’’ and insert- in the business of distributing and selling Sec. 8 Emergency fuels reduction grants. power to the public; or ing the following: Sec. 9 Market incentives for home protec- ‘‘(c) AUDITS.—The Comptroller General of ‘‘(ii) any business that may be adversely tion. affected by the success of the Corporation as the United States shall audit’’; and Sec. 10 Ongoing projects and existing au- a producer of electric power; and (2) by striking ‘‘The Corporation shall de- thorities. ‘‘(3) TENURE.—The chief executive officer termine’’ and inserting the following: Sec. 11 Preference to communities that have shall serve at the pleasure of the Board. ‘‘(d) ADMINISTRATIVE ACCOUNTS AND BUSI- ordinances on fire prevention. ‘‘(i) COMPENSATION PLAN.— NESS DOCUMENTS.—The Corporation shall de- Sec. 12 Sunset. ‘‘(1) IN GENERAL.—The Board shall approve termine’’. Sec. 13 Authorization of appropriations. a compensation plan that specifies salaries, SEC. 4. EFFECTIVE DATE. Sec. 14 Definitions. benefits, and incentives for the chief execu- The amendments made by this Act take ef- SEC. 2. HAZARDOUS FUELS REDUCTION tive officer and employees of the Corpora- fect, and 7 additional members of the Board PROJECTS. tion. of Directors of the Tennessee Valley Author- (a) IN GENERAL.—The Secretaries of Agri- ‘‘(2) ANNUAL SURVEY.—The compensation ity shall be appointed so as to commence culture and the Interior shall conduct imme- plan shall be based on an annual survey of their terms on, the first date following the diately and to completion hazardous fuels re- the prevailing salaries, benefits, and incen- date of enactment of this Act on which the duction projects consistent with the Com- tives for similar work in private industry, term of a member of the Board of Directors prehensive Strategy for a Collaborative Ap- including engineering and electric utility of the Tennessee Valley Authority expires. proach for Reducing Wildland Fire Risks to companies, publicly owned electric utilities, Communities and the Environment on an ag- and Federal, State, and local governments. By Mr. WYDEN (for himself and gregate area of 20 million acres of federal ‘‘(3) CONSIDERATIONS.—The compensation Mrs. FEINSTEIN): land. plan shall provide that education, experi- S. 1352. A bill to expedite procedures (1) These projects shall be conducted on ence, level of responsibility, geographic dif- for hazardous fuels reduction activities the priority lands identified in subsection ferences, and retention and recruitment and restoration in wildland fire prone (d), using the expedited procedures in section needs will be taken into account in deter- National Forests and for other pur- 3. mining salaries of employees. (2) The Secretaries shall protect old ‘‘(4) SUBMISSION TO CONGRESS.—No salary poses; to the Committee on Agri- growth stands and large trees pursuant to shall be established under a compensation culture, Nutrition, and Forestry. subsection (h). plan until after the compensation plan and Mr. WYDEN. Mr. President: Today, I (b) SELECTION OF PROJECTS.—The Secre- the survey on which it is based have been introduce, for myself and Mrs. FEIN- taries of Agriculture and the Interior shall

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(3) EXTRAORDINARY CIRCUMSTANCES EXCEP- LAWS.—Any project carried out pursuant to (C) SECRETARIAL RESPONSE.—The Secretary TION.—For all hazardous fuels reduction this Act shall be consistent with the applica- must respond to the petition within 30 days projects implemented pursuant to this sub- ble forest plan, resource management plan, by. public notice by the same means de- section, if there are extraordinary cir- or other applicable agency plans or environ- scribed in paragraph (1). The Secretary shall cumstances, the Secretary shall follow agen- mental laws except as specifically amended provide a public viewing of the area in ques- cy procedures related to categorical exclu- by this Act. tion if requested in the petition within 90 sions and extraordinary circumstances. For (d) PRIORITY LANDS.—In implementing days of receipt. of the petition, with the peti- the purposes of this subsection, a project’s projects under this Act, the Secretaries of tioner and any other interested parties. location within a municipal watershed shall Agriculture and the Interior shall give high- (D) DETERMINATION OF PETITION.—The Sec- not be considered an extraordinary cir- est priority to: retary must accept or deny the petition cumstance. (1) Wildland-urban interface: Condition within 120 days of its receipt, based on site- (4) APPEALS.—No hazardous fuels reduction class 3 or condition class 2 federal lands or, specific review of historic ecological condi- projects implemented pursuant to this sub- where appropriate, non-federal lands; tions, forest type, present fuel loads, and de- section shall be subject to appeal require- (2) Municipal watersheds: Condition class 3 termination of whether the area properly ments of the Appeals Reform Act (section 322 federal lands located in such proximity to a qualifies as priority lands under subsection of Public Law 102–381) or the Department of municipal water supply system that a haz- (d). the Interior Office of Hearings and Appeals. ardous fuels reduction project must be car- (5) FINAL AGENCY ACTION.—The Secretary (c) ENVIRONMENTAL ASSESSMENTS OUTSIDE ried out to reduce the risk of harm to such shall provide notice by the same means de- THE WILDLAND-URBAN INTERFACE.— system resulting from wildfire; scribed in paragraph (1) of any final agency (1) IN GENERAL.—For hazardous fuels reduc- (3) Fire Regime I lands: Federal lands that action regarding a hazardous fuels reduction tion projects implemented pursuant to this are condition class 3; and project for which the processes established Act on priority lands identified in section (4) Fire Regimes II and III lands: Condition by this Act are used. 2(d), if a categorical exclusion does not class 3 federal lands identified by the Sec- (f) PRIORITY HAZARDOUS FUELS REDUCTION apply, the Secretary shall determine, con- retary as an area where windthrow or blow- FUNDING.—The Secretaries shall expend no sistent with NEPA, whether an environ- down, or the existence of disease or insect in- less than 70 percent of funds under this Act mental assessment is sufficient and use the festation, pose a significant threat to forest on projects within the wildland-urban inter- procedures set forth in the Council on Envi- health or adjacent private lands. face, provided that the Secretaries may ad- ronmental Quality ‘‘Guidance for Environ- (e) PUBLIC NOTICE AND PUBLIC RESPONSE.— just this funding formula for a particular mental Assessments of Forest Health (1) QUARTERLY NOTICE.—The Secretary State at the request of its governor. In no Projects,’’ of December 9, 2002, or as amend- shall provide quarterly notice of each haz- event shall the Secretaries expend less than ed. ardous fuels reduction project which uses the 50 percent or greater than 75 percent of funds (2) ISSUANCE OF DOCUMENTATION AND SHORT- streamlined processes established by this within the wildland-urban interface for a ENED APPEALS.—Notwithstanding the Ap- Act. The quarterly notice shall be provided particular State. peals Reform Act, section 322 of the Depart- for all projects in the Federal Register and (g) MONITORING.—The Secretaries shall es- ment of the Interior and Related Agencies on an agency website and in a local paper of tablish a multiparty monitoring process Appropriations Act, 1993 (Public Law 102 381; record for local projects. The Secretary may with representation from resource indus- 16 U.S.C. 1612 note), or regulations per- combine this quarterly notice with other tries, environmentalists, independent sci- taining to the Department of the Interior Of- quarterly notices otherwise issued regarding entists, community-based organizations, and fice of Hearings and Appeals procedures, for federal forest management. other interested parties in order for Congress hazardous fuels reduction projects imple- (2) CONTENT.—For each hazardous fuels re- to assess a representative sampling of the mented by environmental assessments pur- duction project for which the processes es- hazardous fuels reduction projects imple- suant to subsection (c)(1): tablished by this Act are to be used the no- mented pursuant to this Act. (A) The Secretary may issue the environ- tice required by paragraph (1) shall include (h) LIMITATIONS.—In implementing haz- mental documentation and the decision doc- at a minimum: ardous fuels reduction projects under this ument for the project simultaneously with- (A) identification of each project as a haz- Act the Secretary: out public comment. Such issuance shall ardous fuels reduction project for which the (1) shall not undertake any hazardous fuels begin the administrative appeals process im- processes established by this Act are to be reduction projects in wilderness study areas mediately. used; or components of the National Wilderness (B) Persons must file any administrative (B) a description of the project, including Preservation System; appeal of projects under this subsection as much information on its geographic loca- (2) shall not construct new roads in inven- within 30 days after the date of issuance of a tion as practicable; toried roadless areas as part of any haz- decision; (C) the approximate date on which scoping ardous fuels reduction project; (C) The Secretary shall resolve any appeal for the project will begin; and (3) shall fully maintain the structure, func- not later than 30 days after the closing date (D) information regarding how interested tion, processes and composition of struc- for filing an appeal; members of the public can take part in the turally complex older forests (old growth) (D) If the review officer determines that an development of the project, including, but according to each ecosystem type; and appeal has merit, in lieu of remanding the not limited to, project related public meet- (4) outside old growth stands: proposed agency action, the review officer, ing notification. (A) shall focus on small diameter trees and in consultation with the parties, may sign a (3) PUBLIC MEETING.—Following publication thin from below to modify fire behavior as new decision; and (E) The Secretary shall of each quarterly notice under paragraph (1), measured by rate of spread, height to live stay implementation of the project for 15 but before the beginning of scoping under crown, and flame length; and days beginning on the date on which the Sec- section 3(a), the Secretary shall conduct a (B) shall maximize the retention of large retary resolves any administrative appeal public meeting at an appropriate location in trees to the extent that they promote fire-re- that complies with the requirements in sub- each administrative unit of the federal lands sistant stands and species diversity as appro- section (d). regarding those hazardous fuels reduction priate for the forest type and site. (d) STANDING TO APPEAL.—If a draft docu- projects contained in the quarterly notice SEC. 3. EXPEDITED PROCESS. ment prepared pursuant to NEPA for a haz- that are proposed to be conducted in that ad- (a) SCOPING.—The Secretary shall conduct ardous fuels reduction project was available ministrative unit. The Secretary shall pro- scoping for each hazardous fuels reduction for public comment, or the project had vide advance notice of the date and time of project implemented pursuant to this Act. scoping, the Secretary may require that a the meeting in the quarterly notice or using (b) CATEGORICAL EXCLUSIONS IN THE person filing an administrative appeal with the same means described in paragraph (1). WILDLAND-URBAN INTERFACE.— respect to the project must have been in- (4) PUBLIC RESPONSE TO NOTICE OF (1) IN GENERAL.—The wildland-urban inter- volved in the public comment process for the PROJECTS.— face hazardous fuels reduction projects au- project by submitting specific and sub- (A) IN GENERAL.—A federally formed re- thorized by this Act are conclusively deter- stantive written comments with regard to source advisory committee may petition, mined to be categorically excluded from fur- the project or must have participated in the with supporting evidence, the Secretary to ther analysis under the National Environ- scoping of the project. better assess ground conditions of land to be mental Policy Act of 1969 (‘‘NEPA’’), 42 (e) SALVAGE MONITORING PILOT PROGRAM.— covered by projects, during scoping or public U.S.C. 4332, and the Secretary need not make (1) SALVAGE PILOT.—The Secretary is au- comment on specific hazardous fuels reduc- any findings as to whether the projects indi- thorized to use the administrative appeals tion projects identified under subsection (b). vidually or cumulatively have a significant authorities under this subsection, pursuant (B) PRIORITY LANDS INCLUDED IN THE effect on the environment. to paragraph (2), for salvage hazardous fuels PROJECTS.—For specific hazardous fuels re- (2) VARIED TREATMENTS.—The Secretary reduction projects in the area popularly duction projects the petitioner may seek to shall vary the treatments and avoid clear known as the Biscuit Fire and reference on

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the map entitled and dated llll on file at (C) PREFERENCE.—The Secretaries shall Tribal lands as a raw material to produce the Forest Service llll office. give preference to those projects which take electric energy, sensible heat, transportation (2) MONITORING.—The Secretary shall replace on lands identified as priorities in sec- fuels, or substitutes for petroleum-based quire that any salvage hazardous fuels reduction 2(d) of this Act and can be planned and products. tion project on the Biscuit Fire be subject to initiated promptly. (2) BIOMASS.—The term ‘‘biomass’’ means ecological and economic monitoring of its ef- (D) SUPPORTIVE SERVICES.—The Secretaries pre-commercial thinnings of trees and woody fects, including on-site evaluation and in- are authorized to provide such services as plants, or non-merchantable material, from spections. The monitoring shall be conducted the Secretaries deem necessary to carry out hazardous fuels reduction projects. by a group with representation from inde- the purposes of this Act. (3) GREEN TON.—The term ‘‘green ton’’ pendent scientists, industry representatives, (E) TECHNICAL ASSISTANCE.—The Secre- means 2,000 pounds of biomass that has not environmentalists, community-based organi- taries shall work with the National Associa- been mechanically or artificially dried. zations, and other interested parties. Group tion of Service and Conservation Corps to (4) ELIGIBLE COMMUNITY.—The term ‘‘eligi- selection shall be through the Western Gov- provide technical assistance, oversight, mon- ble community’’ means any Indian Reserva- ernors Association Collaborative process. itoring, and evaluation to the United States tion, or any county, town, township, munici- The group shall report to the public under Departments of Agriculture and the Interior, pality, or other similar unit of local govern- section 2(e)(1) on the ecological and eco- State Departments of Natural Resources and ment that has a population of not more than nomic effects of individual salvage hazardous Agriculture, and Public Lands Corps. 50,000 individuals and is determined by the fuels projects. (2) NONDISPLACEMENT.—The nondisplace- Secretary to be located in an area near fed- SEC. 4. JUDICIAL REVIEW IN THE UNITED STATES ment requirements of Section 177 of the Na- eral or Tribal lands which is at significant DISTRICT COURTS. tional and Community Service Trust Act of risk of catastrophic wildfire, disease, or in- (a) VENUE.—A hazardous fuels reduction 1990 shall be applicable to all activities car- sect infestation or which suffers from disease project conducted under this Act shall be ried out under this Act by the Public Lands or insect infestation. subject to judicial review only in the United Corps. (5) INDIAN TRIBE.—The term ‘‘Indian tribe’’ States district court for the district in which (3) AUTHORIZATION OF APPROPRIATIONS.— has the meaning given the term in section the federal lands to be treated by the haz- For the purposes of this subsection there are 4(e) of the Indian Self-Determination and ardous fuels reduction project are located, authorized to be appropriated $12,500,000 an- Education Assistance Act (25 U.S.C. 450b(e)). notwithstanding 28 U.S.C. 1391 or any other nually for 5 years after the enactment of this (b) BIOMASS COMMERCIAL UTILIZATION applicable venue statutes. Act. GRANT PROGRAM.— (b) EXPEDITIOUS COMPLETION OF JUDICIAL (d) DEFINITIONS.— For the purposes of this (1) IN GENERAL.—The Secretary may make REVIEW.—Congress intends and encourages section— grants to any individual, community, Indian any court in which is filed a lawsuit or ap- tribe, small business or corporation, or non- peal of a lawsuit concerning an authorized (1) CONTRACTS AND AGREEMENTS.—The term ‘‘contracts and agreements’’ means service profit that owns or operates an eligible oper- hazardous fuels reduction project to expe- ation to offset capital expenses and costs in- dite, to the maximum extent practicable, the contracts, timber sale contracts, construction contracts, supply contracts, emergency curred to purchase biomass for use by such proceedings in such lawsuit or appeal with eligible operation with priority given to op- the goal of rendering a final determination equipment rental agreements, architectural and engineering contracts, challenge cost- erations using biomass from the highest risk on jurisdiction, and if jurisdiction exists, a areas. final determination on the merits, as soon as share agreements, cooperative agreements, (2) LIMITATION.—No grant provided under possible from the date the complaint or ap- and participating agreements. (2) QUALIFYING ENTITY.—The term ‘‘quali- this subsection shall be paid at a rate that peal is filed. exceeds $20 per green ton of biomass deliv- (c) DURATION OF INJUNCTION.—Any tem- fying entity’’ means— ered. porary injunctive relief granted regarding a (A) a natural-resource related small or (3) RECORDS.—Each grant recipient shall project undertaken pursuant to this Act micro-enterprise; keep such records as the Secretary may re- shall be limited to 60 days, with authority to (B) a Youth Conservation Corps or Public quire to fully and correctly disclose the use renew each temporary injunction without Lands Corps crew or related partnership with of the grant funds and all transactions in- limitation. For each injunctive renewal the State, local and other non-federal conserva- volved in the purchase of biomass. Upon no- parties shall present the court with updates tion corps; tice by the Secretary, the grant recipient on the status of the project. (C) an entity that will hire and train local shall provide the Secretary reasonable ac- (d) STANDARD OF REVIEW.—Nothing in this people to complete the contract or agree- section shall change the standards of judicial ment; cess to examine the inventory and records of review for any action concerning a project (D) an entity that will re-train non-local any eligible operation receiving grant funds. (4) AUTHORIZATION OF APPROPRIATIONS.— authorized under this Act. traditional forest workers to complete the contract or agreement; or For the purposes of this subsection, there are SEC. 5. CONTRACTING. authorized to be appropriated $12,500,000 each (a) BEST VALUE CONTRACTING.—The Sec- (E) a local entity that meets the criteria to to the Secretary of the Interior and the Sec- retary shall use best value contracting cri- qualify for the Historically Underutilized retary of Agriculture for each fiscal year for teria in awarding at least fifty percent of Business Zone Program under section 32 of five years after the date of enactment of this contracts and agreements for hazardous fuels the Small Business Act (15 U.S.C. 657a). Act. reduction projects pursuant to this Act. Best (3) PUBLIC LANDS CORPS.—The term ‘‘Public (c) IMPROVED BIOMASS UTILIZATION PRO- value contract criteria will include, but not Lands Corps’’ means any organization estab- GRAM.— be limited to: lished by a state or local government, non- (1) IN GENERAL.—The Secretary may make (1) the ability of the contractor to meet profit organization, or Indian tribe that: grants to persons in eligible communities to the ecological goals of the projects; (A) has demonstrated the ability: offset the costs of developing or researching (2) the use of equipment that will minimize (i) to provide labor intensive productive proposals to improve the use of biomass or or eliminate impacts on soils; and (3) benefit work to individuals; add value to biomass utilization. to local economies in performing the restor- (ii) to recruit and train economically dis- (2) SELECTION.—Grant recipients shall be ative treatments and ensuring that wood by- advantaged or at-risk youth; selected based on the potential for the pro- products are processed locally. (iii) to give participants a combination of posal to— (b) MONITORING.—The Forest Service shall work experience, basic and life skills, edu- (A) develop affordable thermal or electric monitor the business and employment im- cation, training and support services; and energy resources for the benefit of an eligi- pacts of hazardous fuels reduction projects (iv) to provide participants with the oppor- ble community; including the total dollar value of contracts tunity to develop citizenship values through and agreements awarded to qualifying enti- (B) provide opportunities for the creation service to their communities and the United or expansion of small businesses within an ties. States; and (c) PUBLIC LANDS CORPS.— eligible community; (B) has also successfully completed, or is (C) create new job opportunities within an (1) CONTRACTS AND AGREEMENTS.— engaged in, a peer-reviewed, standards based (A) IN GENERAL.—The Secretaries are au- eligible community, and program assessment process. thorized to enter into contracts or coopera- (D) reduce the hazardous fuels from the (4) STATE.—The term ‘‘State’’ means any tive agreements with a Public Lands Corps highest risk areas. State of the United States, the District of (i) to implement and complete projects (3) LIMITATION.—No grant awarded under Columbia, Puerto Rico, Guam, the Virgin Is- prioritized in section 2(b) and (d) of this Act; this subsection shall exceed $500,000. lands of the United States, or the Common- and (4) AUTHORIZATION OF APPROPRIATIONS.— (ii) to perform appropriate rehabilitation, wealth of the Northern Mariana Islands. For the purposes of this subsection, there are enhancement, or beautification projects with SEC. 6. BIOMASS GRANTS. authorized to be appropriated $12,500,000 each the Department of Natural Resources, De- (a) DEFINITIONS.—For the purposes of this to the Secretary of the Interior and the Sec- partment of Forestry or Department of Agri- section: retary of Agriculture for each fiscal year for culture of any State. (1) ELIGIBLE OPERATION.—The term ‘‘eligi- the five years after enactment of this Act. (B) INDIAN LANDS.—Such projects may also ble operation’’ means a facility, that is lo- (d) REPORT.—Not later than 3 years after be carried out on Indian lands with the ap- cated within the boundaries of an eligible the date of enactment of this Act, the Sec- proval of the relevant Indian tribe. community and uses biomass from federal or retary of the Interior and the Secretary of

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00097 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8744 CONGRESSIONAL RECORD — SENATE June 26, 2003 Agriculture shall jointly submit to the Con- priated in one fiscal year and unobligated be- (C) vegetation attributes have been mod- gress a report that describes the interim re- fore the end of that fiscal year shall remain erately altered from their historic range. sults of the programs authorized under this available for use in subsequent fiscal years. (2) CONDITION CLASS 3.—The term ‘‘condi- section. SEC. 9. MARKET INCENTIVES FOR HOME PROTEC- tion class 3’’ refers to lands on which— SEC. 7. FOREST STANDS INVENTORY AND MONI- TION. (A) fire regimes have been significantly al- TORING PROGRAM. It is the Sense of Congress that insurers tered from their. historic range, which re- (a) IN GENERAL.—The Secretary of Agri- should reduce premiums for homeowners in sults in dramatic changes to fire size, fre- culture and the Secretary of the Interior condition class 2 and condition class 3 areas quency, intensity, severity, or landscape pat- shall carry out, in conjunction with the Na- within the wildland-urban interface who: terns; tional Aeronautics and Space Administra- (1) clear brush and other flammable mate- (B) there exists a high risk of losing key tion and other relevant agencies and re- rial in the vicinity of their homes; ecosystem components; and search facilities (including the Forest Serv- (2) use non-flammable building materials (C) vegetation attributes have been signifi- ice Research Stations and academic institu- for roofs and other critical structures; or cantly altered from their historic range. tions), a comprehensive program to inven- (3) otherwise improve the defensibility of (3) FIRE REGIME I.—The term ‘‘fire regime tory and assess forest stands on federal for- their homes against catastrophic fire. I’’ refers to lands on which historically fire est land and, with the consent of the owner, SEC. 10. ONGOING PROJECTS AND EXISTING AU- recurs in 0–35 year intervals and burns with private forest land. The objective of this pro- THORITIES. low severity. Nothing in this Act shall affect projects gram shall be to evaluate current and future (4) FIRE REGIME II.—The term ‘‘fire regime begun prior to enactment of this Act or af- forest health conditions and address ecologi- IP’ refers to lands on which historically fire fect authorities otherwise granted to the cal impacts of insect, disease, invasive spe- recurs in .0–35 year intervals and replaces ex- Secretaries under existing law. cies, fire and weather-related episodic isting vegetation. events. Emphasis shall be placed upon co- SEC. 11. PREFERENCE TO COMMUNITIES THAT (5) FIRE REGIME III.—The term ‘‘fire regime HAVE ORDINANCES ON FIRE PRE- III’’ refers to lands on which historically fire ordinating, reconciling, and field verification VENTION. of existing data (including remotely sensed recurs in 35–100 year intervals and burns with (a) IN GENERAL.—In determining the allo- mixed severity. and modeled data utilized to characterize cation of funding for the Community and vegetation/cover types, density, fire regimes, (b) At-Risk Community.—The term ‘‘at- Private Land Fire Assistance Program (16 risk community’’ means a geographic area fire effects, and condition classes), and im- USC 2106c/PL–171 Sec. l0A(b)), the Secretary proving the accuracy of such data to assist designated by the Secretary as any area— shall prioritize funding to those commu- (1) defined as an interface community in in management activities. nities which have taken proactive steps Volume 66, page 753, of the January 4, 2001 (b) LOCATION.—The facility for this pro- through the enactment of ordinances and gram shall be located at the Ochoco National Federal Register; other means, including those that have de- (2) on which conditions are conducive to Forest Headquarters in Prineville, Oregon. veloped a comprehensive fire protection plan large-scale wildland fire disturbance events; (c) AUTHORIZATION OF APPROPRIATIONS.— encompassing all ownerships, to encourage and For the purposes of this section, there are property owners to reduce fire risk on pri- (3) for which a significant threat to human authorized to be appropriated $5,000,000 each vate property. life exists as a result of wildland fire disturb- fiscal year for the five years after enactment (b) PRIVATE LANDS.—Nothing in this Act ance events. of this Act. shall affect existing authorities to use appro- (c) BEST VALUE CONTRACTING.—The term SEC. 8. EMERGENCY FUELS REDUCTION GRANTS. priations authorized by this Act to carry out ‘‘best value contracting’’ means the con- (a) IN GENERAL.—The Secretary of Agri- the provisions under this Act on non-federal tracting process described in section 15.101 of culture shall establish an Emergency Fuels lands with the consent of the land owner. title 48, Code of Federal Regulations, which Reduction Grant program to provide State SEC. 12. SUNSET. allows the inclusion of non-cost factors in and local agencies with financial assistance The provisions of this Act shall expire five the federal contract process. for hazardous fuels reduction projects ad- years after the date of enactment, except (d) COMPREHENSIVE STRATEGY.—The term dressing threats of catastrophic fire that that projects for which a decision notice has ‘‘Comprehensive Strategy’’ means the Com- have been determined by the United States been issued by that date may continue to be prehensive Strategy for a Collaborative Ap- Forest Service to pose a serious threat to implemented. proach for Reducing Wildland Fire Risks to human life. SEC. 13. AUTHORIZATION OF APPROPRIATIONS. Communities and the Environment, dated (b) ELIGIBILITY.—Fuels reduction projects (a) NATIONAL FOREST SYSTEM LANDS.—For May 2002, including by reference the related eligible for funding under the Emergency the purposes of planning and conducting haz- Implementation Plan, which was developed Fuels Reduction Grant program shall: ardous fuels reduction projects under this pursuant to the conference report to accom- (1) be surrounded by or immediately adja- Act on National Forest System Lands, there pany the Department of Interior and Related cent to national forest boundaries; are authorized to be appropriated to the Sec- Agencies Appropriations Act, 2001 (House Re- (2) have been determined to be of para- retary of Agriculture $1,943,100,000 during the port 106–646). mount urgency by virtue of declarations of five-fiscal year period beginning October 1, (e) FEDERAL LANDS.—The term ‘‘federal emergency by both local officials and the 2003. Subject to section 12, amounts appro- lands’’ means National Forest System lands governor of the State in which they are lo- priated in one fiscal year and unobligated be- and public forested lands administered by cated; and fore the end of that fiscal year shall remain the Secretary of the Interior acting through (3) remove fuel loading determined to pose available for use in subsequent fiscal years. the Bureau of Land Management. a serious threat to human life by the United (b) BLM LANDS.—For the purpose of plan- (f) GEOGRAPHIC FEATURE.—The term ‘‘geo- States Forest Service. ning and conducting hazardous fuels reduc- graphic feature’’ means a ridge top, road, (c) USE OF GRANT FUNDS.—Funds author- tion projects under this Act on Federal lands stream, or other landscape feature which can ized under this section shall be limited to managed by the Secretary of the Interior, serve naturally as a firebreak, staging the following uses: there are authorized to be appropriated to ground for firefighting, or boundary affect- (1) removal of trees, shrubs or other poten- the Secretary of the Interior $1,888,000,000 ing fire behavior. tial fuels adjacent to primary evacuation during the five-fiscal year period beginning (g) HAZARDOUS FUELS REDUCTION routes; October 1, 2003. Subject to section 12, PROJECT.—The term ‘‘hazardous fuels reduc- (2) removal of trees, shrubs or other poten- amounts appropriated in one fiscal year and tion project’’ means a project— tial fuels adjacent to emergency response unobligated before the end of that fiscal year (1) undertaken for the purpose of reducing centers, emergency communication facilities shall remain available for use in subsequent the amount of hazardous fuels resulting from or sites designated as shelter-in-place facili- fiscal years. alteration of a natural fire regime as a result ties; and SEC. 14. DEFINITIONS. of fire suppression or other management ac- (3) evacuation drills and preparation. (a) LAND TYPES AND FIRE REGIME AREAS.— tivities; and (d) REVOLVING FUND.—For work done on In this Act definitions of land types and fire (2) accomplished through the use of pre- private property and county lands, the grant regimes originate from the U.S. Forest Serv- scribed burning or mechanical treatment, or recipients shall deposit into a revolving fund ice Rocky Mountain Research Station, as a combination thereof. any proceeds from sale of the timber or bio- follows— (h) INVENTORIED ROADLESS AREA.—The mass from the projects funded under this (1) CONDITION CLASS 2.—The term ‘‘condi- term ‘‘inventoried roadless area’’ means one section. The revolving fund shall be used to tion class 2’’ refers to lands on which— of the areas identified in the set of inven- assist with subsequent grants under this sec- (A) fire frequencies have been moderately toried roadless area maps contained in the tion. altered and have departed from historic fire Forest Service Roadless Areas Conservation, (e) EMERGENCY FUELS REDUCTION return frequencies (either increased or de- Final Environmental Impact Statement, GRANTS.—For the purposes of funding the creased) by one or more return interval, Volume 2, dated November, 2000. Emergency Fuels Reduction Grant program which results in moderate changes to fire (i) LOCAL PREFERENCE CONTRACTING.—The under this Act, there are authorized to be ap- size, frequency, intensity, severity or land- term ‘‘local preference contracting’’ means propriated to the Secretary of Agriculture scape patterns; the federal contracting process that gives $50,000,000 each fiscal year that this Act is in (B) there exists a moderate risk of losing preference to local businesses described in effect. Subject to section 13, amounts appro- key ecosystem components; and section 333 of the Department of Interior and

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00098 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8745 Related Agencies Appropriations Act, 2003 First, the bill prioritizes our efforts. Senator WYDEN and I have worked (division F of Public Law 108–7, 117 Stat. 277). Many people believe that we should very hard to develop a bill that speeds (j) MUNICIPAL WATER SUPPLY SYSTEM.—The protect communities first. The bill up the review process so important term ‘‘municipal water supply system’’ means reservoirs, canals, ditches, flumes, does so. Seventy percent of the funding work can get done without sacrificing laterals, pipes, pipelines, or other surface fa- is directed to the wildland-urban inter- environmental protections. cilities and systems constructed or installed face near communities. Almost everyone agrees that we need for the impoundment, storage, transpor- Of course, conditions vary by State. to work quickly to protect the areas tation, or distribution of drinking water for The bill allows Governors to adjust the immediately around communities. a community. percentage of work that is to be done There is little controversy or debate (k) SECRETARY.—The term ‘‘Secretary’’ within the wildland—urban interface over these projects. means the Secretary of Agriculture, or the for their State, up to a maximum of 75 Secretary’s designee, with respect to Na- The Forest Service has proposed an tional Forest System lands; and the Sec- percent, or down to a minimum of 50 analytical short-cut for these projects, retary of the Interior, or the Secretary’s des- percent. which requires very little environ- ignees, with respect to public lands adminis- By way of contrast, H.R. 1904, which mental analysis and no formal pubic tered by the Secretary through the Bureau passed the House, includes no focus on comment process or administrative ap- of Land Management. protecting communities. All the money peal. (1) WILDLAND-URBAN INTERFACE.—The term can be spent far from communities There is some uncertainty, however, ‘‘wildland-urban interface’’ means the area under H.R. 1904, even if the Governor of over the Forest Service’s proposed ap- either within an at-risk community or with- a State wishes otherwise. in the area. proach. People can claim that laws Senator WYDEN and I believe that in (1) extending out to a geographic feature, if Congress has previously passed will re- there is such a feature within approximately addition to protecting communities, quire some of these projects to be held three-quarters of a mile of the community there are some forest lands that should up by more environmental analysis or boundary; or be thinned to ensure that catastrophic administrative appeals. (2) if there is no such geographic feature, fires do not devastate the forest and Our bill eliminates this uncertainty. extending out one-half mile from the com- eliminate habitat for the species that munity boundary. When the Forest Service works in the have there. immediate vicinity of a community, Mrs. FEINSTEIN. I rise to introduce In the last century, Americans have the bill would make absolutely clear with Senator WYDEN a bill to reduce rigorously suppressed fires, stamping that there need to be no environmental the risk of catastrophic fire in our them out whenever they start. In cer- analysis or administrative appeals. The country’s magnificent national forests. tain forests like ponderosa pine, these only exception is where there might be No one who watched last week as Ar- fires would naturally have cleared out extraordinary circumstances, such as a izona’s community of Summerhaven on the brush and small trees every 10 or 20 major threat to endangered species. We Mount Lemmon burned can doubt the years or so. importance of this issue. My heart goes In the absence of these fires, brush also prohibit the Forest Service from out to the residents of Summerhaven, has grown into ‘‘doghair thickets’’ conducting clearcuts around commu- and to the others who will be displaced with dangerous levels of fuel loadings. nities, requiring them to focus on by the fires yet to come this summer. When fires burn now in these forests, clearing out the brush. Americans know that there is some- they will be so hot that they won’t just By way of comparison, the House- thing wrong with our national forests. clear out the brush but will kill the passed bill does not provide any assist- For too long we have suppressed fires, large trees and often scorch the soil. ance to thinning projects in the imme- gradually letting brush and small trees These are the forests where we need diate vicinity of communities, even multiply until many of our forests are to focus our efforts. We thus target though everyone agrees on the need for now choked by a dense thicket. thinning projects to forests that are these projects. Today, there are 57 million acres of both Fire Regime I and Condition Class Senator WYDEN and I have also sped Federal lands at the highest risk of 3. Fire Regime I forests are those that up the process for projects outside the catastrophic forest fires. If we do not used to have low-intensity, brush- immediate vicinity of communities. take action now, these forests could go clearing fires; and Condition Class 3 These projects are more controversial, up in smoke. This bill we are intro- forests are the most altered from their so we want to make sure that the pub- ducing today is balancing, and it will natural condition. The combination of lic has some opportunity for input. reduce the risk of catastrophic fire in Fire Regime I and Condition Class 3 are In the past, the Forest Service and our country’s magnificent national for- the highest priority lands for treat- the Department of the Interior have ests. ment. been able to conduct the majority of This legislation would speed up the We also direct projects to municipal brush-clearing mechanical treatment environmental review process—without watersheds and diseased or windblown following a National Environmental sacrificing the most important envi- forests that are in Condition Class 3. If Policy Act process known as environ- ronmental protections. It also would we don’t protect the municipal water- mental assessments. Our bill simplified protect the communities which face sheds, catastrophic fires could strip off these environmental assessments in the highest risk and safeguard old the tree cover that prevents soils from several ways. growth stands and large trees. And it eroding into creeks and lakes. Munici- The bill provides one round of public would include sensible provisions on ju- palities’ water quality could suffer. comment—the administrative appeal dicial review that will help projects go In contrast to our bill, H.R. 1904 fails process—rather than two. forward quickly without compromising to prioritize brush-clearing projects for The bill shortens the time frame for our independent judiciary. These are the areas that need it the most. In- administrative appeals from 90 to 60 provisions that makes sense, and I stead, H.R. 1904 provides expedited days. hope that my colleagues will support processes for lands that are only mod- Finally, the appeal deciding offer can the bill. erately altered by fire suppression— make necessary changes rather than We have crafted our bill around three Condition Class 2 lands in addition to having to send the project back to the fundamental principles: Condition Class 3. original decisionmaker for further We should focus limited Federal re- In many of the forests where H.R. time-consuming review. sources on protecting communities and 1904 would direct brush-clearing work, Together, these changes will likely on the forest lands truly most at risk; there naturally would have been severe speed up the process by a few months We should speed up the environ- fires that burned all the trees in the or more. We do all this without elimi- mental review process, but without stand. After a thinning project, fires in nating public comment or gutting core sacrificing the most important envi- these forests will still behave the same parts of the environmental analysis. ronmental protections; and way, scorching and killing most of the In contrast, the House-passed bill We should protect old growth stands trees. Thus, much of the thinning would eliminate the requirement that and large trees. called for in H.R. 1904 would have little the Forest Service consider alter- Let me show how the bill achieves effect on the fire behavior or forest natives to the proposed project as part these three goals. health. of its environmental analysis. In other

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00099 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8746 CONGRESSIONAL RECORD — SENATE June 26, 2003 words, the Forest Service doesn’t have I believe our bill includes more sensible forests. All of us have an interest as to study other, less damaging ways of provisions on judicial review that will well in protecting the magnificent old undertaking the project—it can just do help projects go forward quickly with- growth stands and species habitat that the project the way it wants. out compromising the independence of Americans cherish, and in upholding Many people think that public debate our judiciary. our environmental laws. over alternatives is the core of the Na- Our bill includes several provisions I look forward to working with my tional Environmental Policy Act. Our to address forest health problems on colleagues on both sides of the aisle to bill does not eliminate this important private and State lands. pass a bill as soon as possible. environmental protection. We authorize $50 million annually in Another important part of our bill is emergency grants to States and local- By Mr. BROWNBACK (for himself its protection of magnificent old ities where lives are at risk. The last and Mr. DEWINE): growth stands. The remaining groves of few years have seen vast insect S. 1353. A bill to establish new special these trees provide a connection to na- epidemics killing millions of trees in immigrant categories; to the Com- ture untrammeled by human activity, Southern California, Arizona, and else- mittee on the Judiciary. a connection that many of us cherish. where. Mr. BROWNBACK. Mr. President, I Our bill would require full protection In places like Lake Arrowhead, Big ask unanimous consent that the text of of these old growth stands. In addition, Bear and Idyllwild in Southern Cali- the bill be printed in the RECORD. outside old growth stands, the bill fo- fornia, communities are surrounded by There being no objection, the bill was cuses on small-diameter trees and pro- dead and dying trees that are perfect ordered to be printed in the RECORD, as tects large trees that promote fire-re- kindling for a catastrophic fire. There follows: sistant stands and species diversity. is a real threat to people’s lives that S. 1353 By way of contrast, H.R. 1904 pro- we must address. vides no protection for these magnifi- Be it enacted by the Senate and House of Rep- There is now no good funding source resentatives of the United States of America in cent resources. for clearing evacuation routes and Congress assembled, Let me now talk about judicial re- clearing around schools and other SECTION 1. SHORT TITLE. view. No one wants court cases to go on emergency shelters that are on State This Act may be cited as the ‘‘Widows and too long. In addition, people should not and private lands. The emergency Orphans Act of 2003’’. be able to tie up projects by gaming grants in the bill would authorize funds SEC. 2. NEW SPECIAL IMMIGRANT CATEGORY. the system and picking and choosing for these essential purposes. (a) CERTAIN CHILDREN AND WOMEN AT RISK the friendliest courts to hear their law- The bill also includes two measures OF HARM.—Section 101(a)(27) of the Immigra- suits. tion and Nationality Act (8 U.S.C. 1101(a)(27)) Our bill addresses these problems. to encourage homeowners to clear brush around their houses and install is amended— The bill encourages courts, to the max- (1) in subparagraph (L), by inserting a imum extent practicable, to resolve non-flammable roofs. A study of South- semicolon at the end; lawsuits over brush-clearing projects ern California fires by Forest Service (2) in subparagraph (M), by striking the pe- quickly. These are important projects researcher Jack Cohen has shown that riod at the end and inserting ‘‘; or’’; and for the safety of our communities and these measures could reduce a blaze’s (3) by adding at the end the following: our forests, and it is appropriate to threat to homes by as much as 85 to 95 ‘‘(N) subject to subsection (j), an immi- percent. grant who is not present in the United give them some priority. States— In addition, we require that potential Our bill would encourage these home- saving practices in two ways: ‘‘(i) who is— litigants file suit in the same judicial ‘‘(I) referred to a consular, immigration, or district where a fuels reduction project The bill would prioritize grants to other designated official by a United States takes place, No one can game the sys- those communities that encourage Government agency, an international orga- tem by looking for a friendly judge brush-clearing and use of non-flam- nization, or recognized nongovernmental en- somewhere else. mable roofs or develop comprehensive tity designated by the Secretary of State for Finally, we limit temporary injunc- fire plans. purposes of such referrals; and tions that are typically issued at the The bill would record the Sense of ‘‘(II) determined by such official to be a outset of a case to 60 days. They can be Congress that insurers should offer minor under 10 years of age (as determined under subsection (j)(5))— renewed if necessary—but the chal- lower premiums to homeowners who take steps to protect their homes. ‘‘(aa) for whom no parent or legal guardian lengers to a projects must submit up- is able to provide adequate care; dates explaining why the injunctions Our bill would also include grants to ‘‘(bb) who faces a credible fear of harm re- should be extended. This provision pre- encourage the use of woody material, lated to his or her age; vents projects from being held up any or biomass, for energy production. Bio- ‘‘(cc) who lacks adequate protection from longer than is strictly necessary. mass-to-energy plants serve multiple such harm; and These changes will expedite the proc- beneficial purposes: one, they are a ‘‘(dd) for whom it has been determined to ess—but they still respect our court clean and renewable source of energy; be in his or her best interests to be admitted to the United States; or system’s essential autonomy. As a and two, they make brush-clearing projects more cost-effective, so we can ‘‘(ii) who is— member of the Judiciary Committee, I ‘‘(I) referred to a consular or immigration spend much of my time trying to make protect more with the finite Federal official by a United States Government sure our court system is as fair as pos- dollars available. agency, an international organization or rec- sible. Finally, our bill would also include ognized nongovernmental entity designated Americans count on a judiciary inde- contracting provisions to benefit rural by the Secretary of State for purposes of pendent of the executive branch to pre- communities. The Forest Service and such referrals; and serve their liberties and to right any the Department of the Interior would ‘‘(II) determined by such official to be a fe- wrongs that their government com- be required to use ‘‘best value con- male who has— tracting’’ for brush-clearing projects ‘‘(aa) a credible fear of harm related to her mits. I think it is very important that sex; and we do not interfere with the independ- under the Act. ‘‘(bb) a lack of adequate protection from ence of our judiciary. This contracting approach requires such harm.’’. The House-passed bill would require the agencies to consider other factors (b) STATUTORY CONSTRUCTION.—Section 101 the courts to give weight to certain besides the price of the bid in awarding of the Immigration and Nationality Act (8 findings by the Forest Service and the contractors. Bidders would be rewarded U.S.C. 1101) is amended by adding at the end Department of the Interior. Even if for such factors as their commitment the following: projects had been found to violate the to hire local workers, and their past ‘‘(j)(1) No natural parent or prior adoptive environmental laws, courts would be record of environmental stewardship. parent of any alien provided special immi- I would like to close by saying that grant status under subsection (a)(27)(N)(i) told to give weight to the agencies’ shall thereafter, by virtue of such parentage, findings and allow many of the projects this is truly a bipartisan issue. All of be accorded any right, privilege, or status to go ahead anyway. us, Democrat and Republican, have an under this Act. This is a dangerous provision for a interest in clearing out dangerous ac- ‘‘(2)(A) No alien who qualifies for a special bill to include, and I cannot support it. cumulations of brush in our national immigrant visa under subsection

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00100 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8747 (a)(27)(N)(ii) may apply for derivative status (3) any other appropriate information that in the mountainous northeast corner of or petition for any spouse who is represented the Secretary of Homeland Security deter- Cape Fox’s core township will be an- by the alien as missing, deceased, or the mines to be appropriate. nulled. source of harm at the time of the alien’s ap- (f) AUTHORIZATION OF APPROPRIATIONS.— (2) Cape Fox will be allowed to select There is authorized to be appropriated such plication and admission. The Secretary of and the Secretary of the Interior will Homeland Security may waive this require- sums as may be necessary to carry out this ment for an alien who demonstrates that the section and the amendments made by this be directed to convey 99 acres of timber alien’s representations regarding the spouse section. land adjacent to Cape Fox’s current were bona fide. holdings on Revilla Island. ‘‘(B) An alien who qualifies for a special By Ms. MURKOWSKI (for herself (3) Cape Fox and the Secretary of Ag- immigrant visa under subsection (a)(27)(N) and Mr. STEVENS): riculture will be authorized to enter may apply for derivative status or petition S. 1354. A bill to resolve certain con- into an equal value exchange of lands for any sibling under the age of 10 years or veyances and provide for alternative in Southeast Alaska that will be of mu- children under the age of 10 years of any land selections under the Alaska Na- tual benefit to the Corporation and the such alien, if accompanying or following to tive Claims Settlement Act related to U.S. Forest Service. Lands conveyed to join the alien. For purposes of this subparagraph, a determination of age shall be made Cape Fox Corporation and Sealaska Cape Fox in this exchange will not be using the age of the alien on the date the pe- Corporation, and for other purposes; to timberlands, but will be associated tition is filed with the Department of Home- the Committee on Energy and Natural with a mining property containing ex- land Security. Resources. isting Federal mining claims, some of ‘‘(3) An alien who qualifies for a special im- Ms. MURKOWSKI. Mr. President, I which are patented. Lands anticipated migrant visa under subsection (a)(27)(N) rise today to reintroduce a bill that to be returned to Forest Service owner- shall be treated in the same manner as a ref- passed the Senate with bipartisan sup- ship will be of wildlife habitat, recre- ugee solely for purposes of section 412. port in the 107th Congress. This legisla- ation and watershed values and will ‘‘(4) The provisions of paragraphs (4), (5), tion addresses an equity issue for one and (7)(A) of section 212(a) shall not be appli- consolidate Forest Service holdings in cable to any alien seeking admission to the of Alaska’s rural village corporations. the George Inlet area of Revilla Island. United States under subsection (a)(27)(N), Cape Fox Corporation is an Alaskan The land exchange provisions of this and the Secretary of Homeland Security may Village Corporation organized pursuant bill will help rectify the long-standing waive any other provision of such section to the Alaska Native Claims Settle- inequities associated with restrictions (other than paragraph 2(C) or subparagraph ment Act, by the Native Village of placed on Cape Fox in ANCSA. It will (A), (B), (C), or (E) of paragraph (3) with re- Saxman, near Ketchikan, AK. As with help allow this Native village corpora- spect to such an alien for humanitarian pur- other ANCSA village corporations in tion to make the transition from its poses, to assure family unity, or when it is Southeast Alaska, Cape Fox was lim- major dependence on timber harvest to otherwise in the public interest. Any such waiver by the Secretary of Homeland Secu- ited to selecting 23,040 acres under Sec- a more diversified portfolio of income- rity shall be in writing and shall be granted tion 16. However, unlike other village producing lands. only on an individual basis following an in- corporations, Cape Fox was further re- The bill also provides for the resolu- vestigation. The Secretary of Homeland Se- stricted from selecting lands within 6 tion of a long-standing land ownership curity shall provide for the annual reporting miles of the boundary of the home rule problem with the Tongass National to Congress of the number of waivers granted city of Ketchikan. All other ANCSA Forest. The predominant private land- under this paragraph in the previous fiscal corporations were restricted from se- owner in the region, Sealaska Corpora- year and a summary of the reasons for grant- lecting within 2 miles of such a home tion, holds the subsurface estate on ing such waivers. rule of city. several thousand acres of National For- ‘‘(5) For purposes of subsection (a)(27)(N)(i)(II), a determination of age shall The 6-mile restriction went beyond est System lands. This split estate be made using the age of the alien on the protecting Ketchikan’s watershed and poses a management problem which date on which the alien was referred to the damaged Cape Fox by preventing the the Forest Service has long sought to consular, immigration, or other designated corporation from selecting valuable resolve. Efforts to address this issue go official. timber lands, industrial sites, and back more than a decade. Provisions in ‘‘(6) The Secretary of Homeland Security other commercial property, not only in the Cape Fox Land Entitlement Act of shall waive any application fee for a special its core township, but in surrounding 2003 will allow the agency to consoli- immigrant visa for an alien described in sec- lands far removed from Ketchikan and date its surface and subsurface estate tion 101(a)(27)(N).’’. its watershed. AS a result of the 6-mile and greatly enhance its management (c) ALLOCATION OF SPECIAL IMMIGRANT VISAS.—Section 203(b)(4) of the Immigration restriction, only the mountainous effectiveness and efficiency in the Nationality Act (8 U.S.C. 1153(b)(4)) is northeast corner of Cape Fox’s core Tongass National Forest. I urge my amended by striking ‘‘(A) or (B) thereof’’ and township, which is nonproductive and colleagues to support this important inserting ‘‘(A), (B), or (N) thereof’’. of no economic value, was available for legislation. I ask unanimous consent (d) EXPEDITED PROCESS.—Not later than 45 selection by the corporation. Cape that the text of the bill be printed in days from the date of referral to a consular, Fox’s land selections were further lim- the RECORD. immigration, or other designated official as ited by the fact that the Annette Is- There being no objection, the bill was described in section 101(a)(27)(N) of the Im- land Indian Reservation is within its ordered to be printed in the RECORD, as migration and Nationality Act, as added by subsection (a), special immigrant status selection area, and those lands were follows: shall be adjudicated and, if granted, the alien unavailable for ANCSA selection. Cape S. 1354 shall be paroled to the United States pursu- Fox is the only ANCSA village corpora- Be it enacted by the Senate and House of Rep- ant to section 212(d)(5) of that Act (8 U.S.C. tion affected by this restriction. resentatives of the United States of America in 1182(d)(5)) and allowed to apply for adjust- Clearly, Cape Fox was placed on un- Congress assembled, ment of status to permanent residence under equal economic footing relative to SEC. 1. SHORT TITLE. section 245 of that Act (8 U.S.C. 1255) within other village corporations in Southeast This Act may be cited as the ‘‘Cape Fox 1 year of the alien’s arrival in the United Alaska. Despite its best efforts during Land Entitlement Adjustment Act of 2003’’. States. the years since ANCSA was signed into SEC. 2. FINDINGS. (e) REPORT TO CONGRESS.—Not later than 1 Congress finds that: year after the date of enactment of this sec- law, Cape Fox has been unable to over- (1) Cape Fox Corporation (Cape Fox) is an tion, the Secretary of Homeland Security come the disadvantage the law built Alaska Native Village Corporation organized shall report to the Committees on the Judi- into its land selection opportunities by pursuant to the Alaska Native Claims Set- ciary of the Senate and the House of Rep- this inequitable treatment. tlement Act (ANCSA) (43 U.S.C. 1601 et seq.) resentatives on the progress of the program, To address this inequity, I have infor the Native Village of Saxman. including— troduced the Cape Fox Land Entitle- (2) As with other ANCSA village corpora- (1) data related to the implementation of ment Adjustment Act of 2003. This bill tions in Southeast Alaska, Cape Fox was this section; will address the Cape Fox problem by limited to selecting 23,040 acres under sec- (2) data regarding the number of place- tion 16 of ANCSA. ments of females and children at risk of providing three interrelated remedies: (3) Except for Cape Fox, all other South- harm as referred to in section 101(a)(27)(N) of (1) The obligation of Cape Fox to se- east Alaska ANCSA village corporations the Immigration and Nationality Act, as lect and seek conveyance of the ap- were restricted from selecting within two added by subsection (a); and proximately 160 acres of unusable land miles of a home rule city.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00101 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8748 CONGRESSIONAL RECORD — SENATE June 26, 2003 (4) To protect the watersheds in the vicin- estate to the lands identified in subsection ment is signed. Subject only to conveyance ity of Ketchikan, Cape Fox was restricted (a), the Secretary of the Interior shall con- from Cape Fox to the United States of all its from selecting lands within six miles from vey to Sealaska the subsurface estate to the rights, title and interests in the Cape Fox the boundary of the home rule City of Ketch- lands. lands included in the exchange consistent ikan under section 22(1) of ANCSA (43 U.S.C. (c) TIMING.—The Secretary of the Interior with this title, the Secretary of the Interior 1621(1)). shall complete the interim conveyances to shall complete the interim conveyance to (5) The six mile restriction damaged Cape Cape Fox and Sealaska under this section Cape Fox of the Federal lands included in the Fox by precluding the corporation from se- within 180 days after the Secretary of the In- exchange within 180 days after the execution lecting valuable timber lands, industrial terior receives notice of the Cape Fox selec- of the exchange agreement by Cape Fox and sites, and other commercial property, not tion under subsection (a). the Secretary of Agriculture. only in its core township but in surrounding SEC. 5. EXCHANGE OF LANDS BETWEEN CAPE SEC. 6. EXCHANGE OF LANDS BETWEEN lands far removed from Ketchikan and its FOX AND THE TONGASS NATIONAL SEALASKA AND THE TONGASS NA- watershed. FOREST. TIONAL FOREST. (6) As a result of the 6 mile restriction, (a) GENERAL.—The Secretary of Agri- (a) GENERAL.—Upon conveyance of the only the remote mountainous northeast cor- culture shall offer, and if accepted by Cape Cape Fox lands included in the exchange ner of Cape Fox’s core township, which is Fox, shall exchange the Federal lands de- under section 5 and conveyance and relin- nonproductive and of no known economic scribed in subsection (b) for lands and inter- quishment by Sealaska in accordance with value, was available for selection by the cor- ests therein identified by Cape Fox under this title of the lands and interests in lands described in subsection (c), the Secretary of poration. Selection of this parcel was, how- subsection (c) and, to the extent necessary, the Interior shall convey to Sealaska the ever, mandated by section 16(b) of ANCSA (43 lands and interests therein identified under Federal lands identified for exchange under U.S.C. 1615(b)). subsection (d). subsection (b). (7) Cape Fox’s land selections were further (b) LANDS TO BE EXCHANGED TO CAPE FOX.—The lands to be offered for exchange (b) LANDS TO BE EXCHANGED TO limited by the fact that the Annette Island SEALASKA.—The lands to be exchanged to Indian Reservation is within its selection by the Secretary of Agriculture are Tongass National Forest lands comprising approxi- Sealaska are to be selected by Sealaska from area, and those lands were unavailable for Tongass National Forest lands comprising ANCSA selection. Cape Fox is the only mately 2,663.9 acres in T. 36 S., R. 62 E., C.R.M. and T. 35 S., R. 62 E., C.R.M., as des- approximately 9,329 acres in T. 36 S., R. 62 E., ANCSA village corporation affected by this C.R.M., T. 35 S., R. 62 E., C.R.M., and T. 34 S., restriction. ignated upon a map entitled ‘‘Proposed Ken- sington Project Land Exchange’’, dated Range 62 E., C.R.M., as designated upon a (8) Adjustment of Cape Fox’s selections map entitled ‘‘Proposed Sealaska Corpora- March 18, 2002, and available for inspection and conveyances of land under ANCSA re- tion Land Exchange Kensington Lands Selec- in the Forest Service Region 10 regional of- quires adjustment of Sealaska Corporation’s tion Area’’, dated April 2002 and available for fice in Juneau, Alaska. (Sealaska) selections and conveyances to inspection in the Forest Service Region 10 (c) LANDS TO BE EXCHANGED TO THE UNITED avoid creation of additional split estate be- Regional Office in Juneau, Alaska. Within 60 tween National Forest System surface lands STATES.—Cape Fox shall be entitled, within 60 days after the date of enactment of this days after receiving notice of the identifica- and Sealaska subsurface lands. tion by Cape Fox of the exchange lands (9) Sealaska is the Alaska native regional Act, to identify in writing to the Secretaries of Agriculture and the Interior the lands and under section 5(c), Sealaska shall be entitled corporation for Southeast Alaska, organized to identify in writing to the Secretaries of interests in lands that Cape Fox proposes to under the Alaska Native Claims Settlement Agriculture and the Interior the lands that exchange for the Federal lands described in Act (43 U.S.C. 1601 et seq.). Sealaska selects to receive in exchange for subsection (b). The lands and interests in (10) There is an additional need to resolve the Sealaska lands described in subsection lands shall be identified from lands pre- existing areas of Sealaska/Tongass split es- (c). Lands selected by Sealaska shall be in no viously conveyed to Cape Fox comprising ap- tate, in which Sealaska holds title or con- more than two contiguous and reasonably proximately 2,900 acres and designated as veyance rights to several thousand acres of compact tracts that adjoin the lands de- parcels A–1 to A–3, B–1 to B–3, and C upon a subsurface lands that encumber management scribed for exchange to Cape Fox in section map entitled ‘‘Cape Fox Corporation ANCSA of Tongass National Forest surface lands. 5(b). The Secretary of Agriculture shall de- Land Exchange Proposal’’, dated March 15, (11) The Tongass National Forest lands termine whether these selected lands are identified in this Act for selection by and 2002, and available for inspection in the For- equal in value to the lands described in sub- conveyance to Cape Fox and Sealaska, sub- est Service Region 10 regional office in Ju- section (c) and may adjust the amount of se- ject to valid existing rights, provide a means neau, Alaska. Lands identified for exchange lected lands in order to reach agreement to resolve some of the Cape Fox and within each parcel shall be contiguous to ad- with Sealaska regarding equal value. The ex- Sealaska ANCSA land entitlement issues jacent National Forest System lands and in change conveyance to Sealaska shall be of without significantly affecting Tongass Na- reasonably compact tracts. The lands identi- the surface and subsurface estate in the tional Forest resources, uses or values. fied for exchange shall include a public trail lands selected and agreed to by the Sec- (12) Adjustment of Cape Fox’s selections easement designated as D on said map, un- retary but subject to valid existing rights and conveyances of land under ANCSA less the Secretary of Agriculture agrees oth- and all other provisions of section 14(g) of through the provisions of this Act, and the erwise. The value of the easement shall be ANCSA. related adjustment of Sealaska’s selections included in determining the total value of (c) LANDS TO BE EXCHANGED TO THE UNITED and conveyances hereunder, are in accord- lands exchanged to the United States. STATES.—The lands and interests therein to (d) VALUATION OF EXCHANGE LANDS.—The ance with the purposes of ANCSA and other- be exchanged by Sealaska are the subsurface Secretary of Agriculture shall determine wise in the public interest. estate underlying the Cape Fox exchange whether the lands identified by Cape Fox lands described in section 5(c), an additional SEC. 3. WAIVER OF CORE TOWNSHIP REQUIRE- under subsection (c) are equal in value to the MENT FOR CERTAIN LANDS. approximately 2,506 acres of the subsurface Notwithstanding the provisions of section lands described in subsection (b). If the lands estate underlying Tongass National Forest 16(b) of ANCSA (43 U.S.C. 1615(b)), Cape Fox identified under subsection (c) are deter- surface estate, described in Interim Convey- shall not be required to select or receive con- mined to have insufficient value to equal the ance No. 1673, and rights to be additional ap- veyance of approximately 160 acres of Fed- value of the lands described in subsection (b), proximately 2,698 acres of subsurface estate eral unconveyed lands within Section 1, T. 75 Cape Fox and the Secretary shall mutually of Tongass National Forest lands remaining S., R. 91 E., C.R.M. identify additional Cape Fox lands for ex- to be conveyed to Sealaska from Group 1, 2 SEC. 4. SELECTION OUTSIDE EXTERIOR SELEC- change sufficient to equalize the value of and 3 lands as set forth in the Sealaska Cor- TION BOUNDARY. lands conveyed to Cape Fox. Such land shall poration/United States Forest Service Split (a) SELECTION AND CONVEYANCE OF SURFACE be contiguous to adjacent National Forest Estate Exchange Agreement of November 26, ESTATE.—In addition to lands made available System lands and in reasonably compact 1991, at Schedule B, as modified on January for selection under ANCSA, within 24 months tracts. 20, 1995. after the date of enactment of this Act, Cape (e) CONDITIONS.—The offer and conveyance (d) TIMING.—The Secretary of Agriculture Fox may select, and, upon receiving written of Federal lands to Cape Fox in the exchange shall attempt, within 90 days after receipt of notice of such selection, the Secretary of the shall, notwithstanding section 14(f) of the selection of lands by Sealaska under sub- Interior shall convey approximately 99 acres ANCSA, be of the surface and subsurface es- section (b), to enter into an agreement with of the surface estate of Tongass National tate, but subject to valid existing rights and Sealaska to consummate the exchange con- Forest lands outside Cape Fox’s current ex- all other provisions of section 14(g) of sistent with this Act. The lands identified in terior selection boundary, specifically that ANCSA. the exchange agreement shall be exchanged parcel described as follows: (f) TIMING.—The Secretary of Agriculture by conveyance at the earliest possible date (1) T. 73 S., R. 90 E., C.R.M. shall attempt, within 90 days after the date after the exchange agreement is signed. Sub- (2) Section 33: SW portion of SE1⁄4: 38 acres. of enactment of this Act, to enter into an ject only to the Cape Fox and Sealaska con- (3) Section 33: NW portion of SE1⁄4: 13 acres. agreement with Cape Fox to consummate veyances and relinquishments described in (4) Section 33: SE1⁄4 of SE1⁄4: 40 acres. the exchange consistent with this Act. The subsection (a), the Secretary of the Interior (5) Section 33: SE1⁄4 of SW1⁄4: 8 acres. lands identified in the exchange agreement shall complete the interim conveyance to (b) CONVEYANCE OF SUBSURFACE ESTATE.— shall be exchanged by conveyance at the ear- Sealaska of the Federal lands selected for ex- Upon conveyance to Cape Fox of the surface liest possible date after the exchange agree- change within 180 days after execution of the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00102 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8749 agreement by Sealaska and the Secretary of retary of Agriculture such sums as may be current law, OSC has no authority to Agriculture. necessary for value estimation and related request the Merit Systems Protection (e) MODIFICATION OF AGREEMENT.—The exe- costs of exchanging lands specified in this Board, MSPB, to reconsider its deci- cuted exchange agreement under this section Act, and for road rehabilitation, habitat and sion or to seek review of a MSPB deci- shall be considered a further modification of timber stand improvement, including the Sealaska Corporation/United States For- thinning and pruning, on lands acquired by sion by the Federal Circuit. The limita- est Service Split Estate Exchange Agree- the United States under this Act. tion undermines both OSC’s ability to ment, as ratified in section 17 of Public Law (b) DEPARTMENT OF THE INTERIOR.—There protect whistleblowers and the integ- 102–415 (October 14, 1992). are authorized to be appropriated to the Sec- rity of the WPA. As such, our bill SEC. 7. MISCELLANEOUS PROVISIONS. retary of the Interior such sums as may be would provide OSC authority to appear necessary for land surveys and conveyances (a) EQUAL VALUE REQUIREMENT.—The ex- in any civil action brought in connec- changes described in this Act shall be of pursuant to this Act. tion with the WPA and obtain review equal value. Cape Fox and Sealaska shall By Mr. AKAKA (for himself, Mr. of any MSPB order where OSC deter- have the opportunity to present to the Sec- mines MSPB erred and the case will retary of Agriculture estimates of value of GRASSLEY Mr. LEVIN, Mr. LEAHY, and Mr. DURBIN): impact the enforcement of the WPA. exchange lands with supporting information. Our bill would codify an ‘‘anti-gag’’ (b) TITLE.—Cape Fox and Sealaska shall S. 1358. A bill to amend chapter 23 of convey and provide evidence of title satisfac- title 5, United States Code, to clarify provision that Congress has passed an- tory to the Secretary of Agriculture for their the disclosure of information protected nually since 1988 as part of the appro- respective lands to be exchanged to the from prohibited personnel practices, priations process. The yearly appro- United States under this Act, subject only to require a statement in non-disclosure priations language bars agencies from exceptions, reservations and encumbrances policies, forms, and agreements that implementing or enforcing any non- in the interim conveyance or patent from such policies, forms, and agreements disclosure policy, form, or agreement the United States or otherwise acceptable to that does not contain specified lan- the Secretary of Agriculture. conform with certain disclosure protections, provide certain authority for the guage preserving open government (c) HAZARDOUS SUBSTANCES.—Cape Fox, statutes. In addition, the bill would Sealaska, and the United States each shall Special Council, and for other pur- not be subject to liability for the presence of poses; to the Committee on Govern- make it a prohibited personnel practice any hazardous substance in land or interests mental Affairs. to enforce a non-disclosure agreement in land solely as a result of any conveyance Mr. AKAKA. Mr. President, I rise that does not comply with open gov- or transfer of the land or interests under this today to discuss the Federal Employee ernment statutes. Act. Protection of Disclosures Act. I offered Enactment of the Federal Employee (d) EFFECT ON ANCSA SELECTIONS.—Any legislation under this title earlier this Protection of Disclosures Act will conveyance of Federal surface or subsurface strengthen the rights and protections lands to Cape Fox or Sealaska under this Act month. I am modifying that measure, S. 1229, by introducing a new bill today afforded to federal whistleblowers and shall be considered, for all purposes, land encourage the disclosure of informa- conveyed pursuant to ANCSA. Nothing in which is cosponsored by Senators this Act shall be construed to change the GRASSLEY, LEVIN, LEAHY, and DURBIN. tion vital to an effective government. total acreage of land entitlement of Cape This bill, as with S. 1229, amends the Following the events of September 11, Fox or Sealaska under ANCSA. Cape Fox and Whistleblower Protection Act, WPA. we realized that whistleblowing is even Sealaska shall remain charged for any lands These amendments are necessary to more important when our national se- they exchange under this Act and any lands safeguard Federal employees from re- curity is at stake. In many instances, conveyed pursuant to section 4, but shall not taliation and protect American tax- the security of our Nation depends be charged for any lands received under sec- payers from government waste, fraud, upon those who step forward to blow tion 5 or section 6. The exchanges described the whistle on significant lapses in our in this Act shall be considered, for all pur- and abuse. Our bill follows S. 995 and S. poses, actions which lead to the issuance of 3070, the latter of which was favorably efforts to protect the United States conveyances to Native Corporations pursu- reported by the Governmental Affairs against potential terrorist attacks. ant to ANCSA. Lands or interests therein Committee in the 107th Congress. The Congress should act quickly to assure transferred to the United States under this bill we introduce today is the result of whistleblowers that disclosing illegal Act shall become and be administered as a bipartisan compromise to protect our activities and mismanagement within part of the Tongass National Forest. federal whistleblowers. their agencies will not be met with re- (e) EFFECT ON STATEHOOD SELECTIONS.— Our bill would codify the repeated taliation. I urge my colleagues to join Lands conveyed to or selected by the State with me in protecting our federal whis- of Alaska under the Alaska Statehood Act and unequivocal statements of congres- (Public Law 85–508; 72 Stat. 339; 48 U.S.C. sional intent that Federal employees tleblowers. note prec. 21) shall not be eligible for selec- are to be protected when making ‘‘any I ask unanimous consent that the tion or conveyance under this Act without disclosure’’ evidencing violations of text of the bill be printed in the the consent of the State of Alaska. law, gross mismanagement, or a gross RECORD. (f) MAPS.—The maps referred to in this Act waste of funds. The bill would also There being no objection, the bill was shall be maintained on file in the Forest clarify the test that must be met to ordered to be printed in the RECORD, as Service Region 10 Regional Office in Juneau, prove that a Federal employee reason- follows: Alaska. The acreages cited in this Act are S. 1358 approximate, and if there is any discrepancy ably believed that his or her disclosure Be it enacted by the Senate and House of Rep- between cited acreage and the land depicted was evidence of wrongdoing. The clear resentatives of the United States of America in on the specified maps, the maps shall con- language of the WPA says that an em- Congress assembled, trol. The maps do not constitute an attempt ployee is protected for disclosing infor- by the United States to convey State or pri- SECTION 1. PROTECTION OF CERTAIN DISCLO- mation he or she reasonably believes SURES OF INFORMATION BY FED- vate land. evidences a violation. However, the ERAL EMPLOYEES. (g) EASEMENTS.—Notwithstanding section Federal Circuit Court of Appeals, (a) SHORT TITLE.—This Act may be cited as 17(b) of ANCSA, Federal lands conveyed to the ‘‘Federal Employee Protection of Disclo- Cape Fox or Sealaska pursuant to this Act which has sole jurisdiction over whistleblower cases, ruled in 1999 that the sures Act’’. shall be subject only to the reservation of (b) CLARIFICATION OF DISCLOSURES COV- reasonableness review must begin with public easements mutually agreed to and set ERED.—Section 2302(b)(8) of title 5, United forth in the exchange agreements executed the presumption that public officers States Code, is amended— under this Act. The easements shall include perform their duties in good faith and (1) in subparagraph (A)— easements necessary for access across the that this presumption stands unless (A) by striking ‘‘which the employee or ap- lands conveyed under this Act for use of na- there is ‘‘irrefragable proof’’ to the plicant reasonably believes evidences’’ and tional forest or other public lands. contrary. As irrefragable means impos- inserting ‘‘, without restriction to time, (h) OLD GROWTH RESERVES.—The Secretary place, form, motive, context, or prior disclo- of Agriculture shall add an equal number of sible to refute, our bill replaces this ex- cessively high burden with the more sure made to any person by an employee or acres to old growth reserves on the Tongass applicant, including a disclosure made in the National Forest as are transferred out of reasonable standard of substantial evi- ordinary course of an employee’s duties, that Federal ownership as a result of this Act. dence. the employee or applicant reasonably be- SEC. 8. AUTHORIZATION OF APPROPRIATIONS. The measure would also provide inde- lieves is evidence of’’; and (a) DEPARTMENT OF AGRICULTURE.—There pendent litigating authority to the Of- (B) in clause (i), by striking ‘‘a violation’’ are authorized to be appropriated to the Sec- fice of Special Counsel, OSC. Under and inserting ‘‘any violation’’;

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(2) in subparagraph (B)— (2) PROHIBITED PERSONNEL PRACTICE.—Sec- the Merit Systems Protection Board, and (A) by striking ‘‘which the employee or ap- tion 2302(b) of title 5, United States Code, is any reviewing court.’’. plicant reasonably believes evidences’’ and amended— (B) TECHNICAL AND CONFORMING AMEND- inserting ‘‘, without restriction to time, (A) in paragraph (11), by striking ‘‘or’’ at MENT.—The table of sections for chapter 77 of place, form, motive, context, or prior disclo- the end; title 5, United States Code, is amended by insure made to any person by an employee or (B) in paragraph (12), by striking the pe- serting after the item relating to section 7702 applicant, including a disclosure made in the riod and inserting a semicolon; and the following: ordinary course of an employee’s duties, to (C) by inserting after paragraph (12) the ‘‘7702a. Actions relating to security clear- the Special Counsel, or to the Inspector Gen- following: ances.’’. eral of an agency or another employee des- ‘‘(13) implement or enforce any nondisclo- (f) EXCLUSION OF AGENCIES BY THE PRESI- ignated by the head of the agency to receive sure policy, form, or agreement, if such pol- DENT.—Section 2302(a)(2)(C) of title 5, United such disclosures, of information that the em- icy, form, or agreement does not contain the States Code, is amended by striking clause ployee or applicant reasonably believes is following statement: (ii) and inserting the following: evidence of’’; and ‘‘ ‘These provisions are consistent with and ‘‘(ii)(I) the Federal Bureau of Investiga- (B) in clause (i), by striking ‘‘a violation’’ do not supersede, conflict with, or otherwise tion, the Central Intelligence Agency, the and inserting ‘‘any violation (other than a alter the employee obligations, rights, or li- Defense Intelligence Agency, the National violation of this section)’’; and abilities created by Executive Order No. Imagery and Mapping Agency, the National (3) by adding at the end the following: 12958; section 7211 of title 5, United States Security Agency; and ‘‘(C) a disclosure that— Code (governing disclosures to Congress); ‘‘(II) as determined by the President, any ‘‘(i) is made by an employee or applicant of section 1034 of title 10, United States Code Executive agency or unit thereof the prin- information required by law or Executive (governing disclosure to Congress by mem- cipal function of which is the conduct of for- order to be kept secret in the interest of na- bers of the military); section 2302(b)(8) of eign intelligence or counterintelligence ac- tional defense or the conduct of foreign af- title 5, United States Code (governing disclo- tivities, if the determination (as that deter- fairs that the employee or applicant reason- sures of illegality, waste, fraud, abuse, or mination relates to a personnel action) is ably believes is direct and specific evidence public health or safety threats); the Intel- made before that personnel action; or’’. of— ligence Identities Protection Act of 1982 (50 (g) ATTORNEY FEES.—Section 1204(m)(1) of ‘‘(I) any violation of any law, rule, or regu- U.S.C. 421 et seq.) (governing disclosures that title 5, United States Code, is amended by lation; could expose confidential Government striking ‘‘agency involved’’ and inserting ‘‘(II) gross mismanagement, a gross waste agents); and the statutes which protect ‘‘agency where the prevailing party is em- of funds, an abuse of authority, or a substan- against disclosures that could compromise ployed or has applied for employment’’. tial and specific danger to public health or national security, including sections 641, 793, (h) DISCIPLINARY ACTION.—Section 1215 of safety; or 794, 798, and 952 of title 18, United States title 5, United States Code, is amended in ‘‘(III) a false statement to Congress on an Code, and section 4(b) of the Subversive Ac- subsection (a), by striking paragraph (3) and issue of material fact; and tivities Control Act of 1950 (50 U.S.C. 783(b)). inserting the following: ‘‘(ii) is made to— The definitions, requirements, obligations, ‘‘(3)(A) A final order of the Board may im- ‘‘(I) a member of a committee of Congress rights, sanctions, and liabilities created by pose— having a primary responsibility for oversight such Executive order and such statutory pro- ‘‘(i) disciplinary action consisting of re- of a department, agency, or element of the visions are incorporated into this agreement moval, reduction in grade, debarment from Federal Government to which the disclosed and are controlling.’; or Federal employment for a period not to ex- information relates and who is authorized to ‘‘(14) conduct, or cause to be conducted, an ceed 5 years, suspension, or reprimand; receive information of the type disclosed; investigation of an employee or applicant for ‘‘(ii) an assessment of a civil penalty not to ‘‘(II) any other Member of Congress who is employment because of any activity pro- exceed $1,000; or authorized to receive information of the type tected under this section.’’. ‘‘(iii) any combination of disciplinary ac- disclosed; or (3) BOARD AND COURT REVIEW OF ACTIONS RE- tions described under clause (i) and an as- ‘‘(III) an employee of Congress who has the LATING TO SECURITY CLEARANCES.— sessment described under clause (ii). appropriate security clearance and is author- (A) IN GENERAL.—Chapter 77 of title 5, ‘‘(B) In any case in which the Board finds ized to receive information of the type dis- United States Code, is amended by inserting that an employee has committed a prohib- closed.’’. after section 7702 the following: ited personnel practice under section 2302(b) (c) COVERED DISCLOSURES.—Section 2302(b) ‘‘§ 7702a. Actions relating to security clear- (8) or (9), the Board shall impose disciplinary of title 5, United States Code, is amended— ances action if the Board finds that the activity (1) in the matter following paragraph (12), protected under section 2302(b) (8) or (9) was ‘‘(a) In any appeal relating to the suspen- by striking ‘‘This subsection’’ and inserting a significant motivating factor, even if other sion, revocation, or other determination re- the following: factors also motivated the decision, for the lating to a security clearance, the Merit Sys- ‘‘This subsection’’; and employee’s decision to take, fail to take, or tems Protection Board or any reviewing (2) by adding at the end the following: threaten to take or fail to take a personnel court— ‘‘In this subsection, the term ‘disclosure’ action, unless that employee demonstrates, ‘‘(1) shall determine whether section 2302 means a formal or informal communication by preponderance of evidence, that the em- was violated; or transmission.’’. ployee would have taken, failed to take, or ‘‘(2) may not order the President to restore (d) REBUTTABLE PRESUMPTION.—Section threatened to take or fail to take the same a security clearance; and 2302(b) of title 5, United States Code, is personnel action, in the absence of such pro- ‘‘(3) subject to paragraph (2), may issue de- amended by adding after the matter fol- tected activity.’’. lowing paragraph (12) (as amended by sub- claratory relief and any other appropriate (i) DISCLOSURES TO CONGRESS.—Section 2302 section (c) of this section) the following: relief. of title 5, United States Code, is amended by ‘‘For purposes of paragraph (8), any pre- ‘‘(b)(1) If, in any final judgment, the Board adding at the end the following: sumption relating to the performance of a or court declares that any suspension, rev- ‘‘(f) Each agency shall establish a process duty by an employee who has authority to ocation, or other determination with regards that provides confidential advice to employ- take, direct others to take, recommend, or to a security clearance was made in viola- ees on making a lawful disclosure to Con- approve any personnel action may be rebut- tion of section 2302, the affected agency shall gress of information that is specifically re- ted by substantial evidence.’’. conduct a review of that suspension, revoca- quired by law or Executive order to be kept (e) NONDISCLOSURE POLICIES, FORMS, AND tion, or other determination, giving great secret in the interest of national defense or AGREEMENTS; SECURITY CLEARANCES; AND RE- weight to the Board or court judgment. the conduct of foreign affairs.’’. TALIATORY INVESTIGATIONS.— ‘‘(2) Not later than 30 days after any Board (j) AUTHORITY OF SPECIAL COUNSEL RELAT- (1) PERSONNEL ACTION.—Section or court judgment declaring that a security ING TO CIVIL ACTIONS.— 2302(a)(2)(A) of title 5, United States Code, is clearance suspension, revocation, or other (1) REPRESENTATION OF SPECIAL COUNSEL.— amended— determination was made in violation of sec- Section 1212 of title 5, United States Code, is (A) in clause (x), by striking ‘‘and’’ after tion 2302, the affected agency shall issue an amended by adding at the end the following: the semicolon; and unclassified report to the congressional com- ‘‘(h) Except as provided in section 518 of (B) by redesignating clause (xi) as clause mittees of jurisdiction (with a classified title 28, relating to litigation before the Su- (xiv) and inserting after clause (x) the fol- annex if necessary), detailing the cir- preme Court, attorneys designated by the lowing: cumstances of the agency’s security clear- Special Counsel may appear for the Special ‘‘(xi) the implementation or enforcement ance suspension, revocation, or other deter- Counsel and represent the Special Counsel in of any nondisclosure policy, form, or agree- mination. A report under this paragraph any civil action brought in connection with ment; shall include any proposed agency action section 2302(b)(8) or subchapter III of chapter ‘‘(xii) a suspension, revocation, or other de- with regards to the security clearance. 73, or as otherwise authorized by law.’’. termination relating to a security clearance; ‘‘(c) An allegation that a security clear- (2) JUDICIAL REVIEW OF MERIT SYSTEMS PRO- ‘‘(xiii) an investigation of an employee or ance was revoked or suspended in retaliation TECTION BOARD DECISIONS.—Section 7703 of applicant for employment because of any ac- for a protected disclosure shall receive expe- title 5, United States Code, is amended by tivity protected under this section; and’’. dited review by the Office of Special Counsel, adding at the end the following:

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The Director of the Of- of the Subversive Activities Act of 1950 (50 Court of Appeals for the Federal Circuit if fice of Personnel Management may obtain U.S.C. 783(b)). The definitions, requirements, the Special Counsel determines, in the dis- review of any final order or decision of the obligations, rights, sanctions, and liabilities cretion of the Special Counsel, that the Board by filing, within 60 days after the date created by such Executive order and such Board erred in deciding a case arising under the Director received notice of the final statutory provisions are incorporated into section 2302(b)(8) or subchapter III of chapter order or decision of the Board, a petition for this agreement and are controlling.’’ 73 and that the Board’s decision will have a judicial review in the United States Court of (B) ENFORCEABILITY.—Any nondisclosure substantial impact on the enforcement of Appeals for the Federal Circuit if the Direc- policy, form, or agreement described under section 2302(b)(8) or subchapter III of chapter tor determines, in his discretion, that the subparagraph (A) that does not contain the 73. If the Special Counsel was not a party or Board erred in interpreting a civil service statement required under subparagraph (A) did not intervene in a matter before the law, rule, or regulation affecting personnel may not be implemented or enforced to the Board, the Special Counsel may not petition management and that the Board’s decision extent such policy, form, or agreement is infor review of a Board decision under this sec- will have a substantial impact on a civil consistent with that statement. tion unless the Special Counsel first peti- service law, rule, regulation, or policy direc- (2) PERSONS OTHER THAN GOVERNMENT EM- tions the Board for reconsideration of its de- tive. If the Director did not intervene in a PLOYEES.—Notwithstanding paragraph (1), a cision, and such petition is denied. In addi- matter before the Board, the Director may nondisclosure policy, form, or agreement tion to the named respondent, the Board and not petition for review of a Board decision that is to be executed by a person connected all other parties to the proceedings before under this section unless the Director first with the conduct of an intelligence or intel- the Board shall have the right to appear in petitions the Board for a reconsideration of ligence-related activity, other than an em- the proceedings before the Court of Appeals. its decision, and such petition is denied. In ployee or officer of the United States Gov- The granting of the petition for judicial re- addition to the named respondent, the Board ernment, may contain provisions appropriate view shall be at the discretion of the Court and all other parties to the proceedings be- to the particular activity for which such doc- of Appeals. fore the Board shall have the right to appear ument is to be used. Such form or agreement ‘‘(2) During the 5-year period beginning on in the proceeding before the Court of Ap- shall, at a minimum, require that the person the effective date of the Federal Employee peals. The granting of the petition for judi- will not disclose any classified information Protection of Disclosures Act, this para- cial review shall be at the discretion of the received in the course of such activity unless graph shall apply to any review obtained by Court of Appeals. specifically authorized to do so by the the Special Counsel. The Special Counsel ‘‘(2) During the 5-year period beginning on United States Government. Such nondisclo- may obtain review of any final order or deci- the effective date of the Federal Employee sure forms shall also make it clear that such sion of the Board by filing a petition for judi- Protection of Disclosures Act, this para- forms do not bar disclosures to Congress or cial review in the United States Court of Ap- graph shall apply to any review obtained by to an authorized official of an executive peals for the Federal Circuit or any court of the Director of the Office of Personnel Man- agency or the Department of Justice that appeals of competent jurisdiction as pro- agement. The Director of the Office of Per- are essential to reporting a substantial vio- vided under subsection (b)(2) if the Special sonnel Management may obtain review of any final order or decision of the Board by lation of law. Counsel determines, in the discretion of the (m) CLARIFICATION OF WHISTLEBLOWER filing, within 60 days after the date the Di- Special Counsel, that the Board erred in de- RIGHTS FOR CRITICAL INFRASTRUCTURE INFOR- rector received notice of the final order or ciding a case arising under section 2302(b)(8) MATION.—Section 214(c) of the Homeland Se- decision of the Board, a petition for judicial or subchapter III of chapter 73 and that the curity Act of 2002 (Public Law 107–296) is review in the United States Court of Appeals Board’s decision will have a substantial im- amended by adding at the end the following: for the Federal Circuit or any court of ap- pact on the enforcement of section 2302(b)(8) ‘‘For purposes of this section a permissible peals of competent jurisdiction as provided or subchapter III of chapter 73. If the Special use of independently obtained information under subsection (b)(2) if the Director deter- Counsel was not a party or did not intervene includes the disclosure of such information mines, in his discretion, that the Board erred in a matter before the Board, the Special under section 2302(b)(8) of title 5, United Counsel may not petition for review of a in interpreting a civil service law, rule, or States Code.’’. Board decision under this section unless the regulation affecting personnel management (n) EFFECTIVE DATE.—This Act shall take Special Counsel first petitions the Board for and that the Board’s decision will have a effect 30 days after the date of enactment of reconsideration of its decision, and such pe- substantial impact on a civil service law, this Act. tition is denied. In addition to the named re- rule, regulation, or policy directive. If the Mr. LEVIN. Mr. President, I am Director did not intervene in a matter before spondent, the Board and all other parties to pleased to join Senators AKAKA, GRASS- the proceedings before the Board shall have the Board, the Director may not petition for review of a Board decision under this section LEY, LEAHY, and DURBIN today in intro- the right to appear in the proceedings before ducing the Federal Employees Protec- the court of appeals. The granting of the pe- unless the Director first petitions the Board tition for judicial review shall be at the dis- for a reconsideration of its decision, and tion of Disclosures Act. Our bill cretion of the court of appeals.’’. such petition is denied. In addition to the strengthens the law protecting employ- (k) JUDICIAL REVIEW.— named respondent, the Board and all other ees who blow the whistle on fraud, (1) IN GENERAL.—Section 7703(b) of title 5, parties to the proceedings before the Board waste, and abuse in federal programs. United States Code, is amended by striking shall have the right to appear in the pro- Whistleblowers play a crucial role in paragraph (1) and inserting the following: ceeding before the court of appeals. The ensuring that Congress and the public ‘‘(b)(1)(A) Except as provided in subpara- granting of the petition for judicial review are aware of serious cases of waste, graph (B) and paragraph (2) of this sub- shall be at the discretion of the Court of Ap- fraud, and mismanagement in govern- section, a petition to review a final order or peals.’’. final decision of the Board shall be filed in (l) NONDISCLOSURE POLICIES, FORMS, AND ment. Whistleblowing is never more the United States Court of Appeals for the AGREEMENTS.— important than when our national se- Federal Circuit. Notwithstanding any other (1) IN GENERAL.— curity is at stake. Since the terrorist provision of law, any petition for review (A) REQUIREMENT.—Each agreement in attacks of September 11, 2001, coura- must be filed within 60 days after the date Standard Forms 312 and 4414 of the Govern- geous individuals have stepped forward the petitioner received notice of the final ment and any other nondisclosure policy, to blow the whistle on significant order or decision of the Board. form, or agreement of the Government shall lapses in our efforts to protect the ‘‘(B) During the 5-year period beginning on contain the following statement: ‘‘These re- the effective date of the Federal Employee strictions are consistent with and do not su- United States against potential future Protection of Disclosures Act, a petition to persede, conflict with, or otherwise alter the attacks. Most notably, FBI Agent review a final order or final decision of the employee obligations, rights, or liabilities Coleen Rowley alerted Congress to seri- Board shall be filed in the United States created by Executive Order No. 12958; section ous institutional problems at the FBI Court of Appeals for the Federal Circuit or 7211 of title 5, United States Code (governing and their impact on the agency’s abil- any court of appeals of competent jurisdic- disclosures to Congress); section 1034 of title ity to effectively investigate and pre- tion as provided under subsection (b)(2). Not- 10, United States Code (governing disclosure vent terrorism. withstanding any other provision of law, any to Congress by members of the military); In another example, two Border Pa- petition for review must be filed within 60 section 2302(b)(8) of title 5, United States trol agents from my State of Michigan, days after the date the petitioner received Code (governing disclosures of illegality, notice of the final order or decision of the waste, fraud, abuse or public health or safety Mark Hall and Bob Lindemann, risked Board.’’. threats); the Intelligence Identities Protec- their careers when they blew the whis- (2) REVIEW OBTAINED BY OFFICE OF PER- tion Act of 1982 (50 U.S.C. 421 et seq.) (gov- tle on Border Patrol and INS policies SONNEL MANAGEMENT.—Section 7703 of title 5, erning disclosures that could expose con- that were compromising security on

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00105 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8752 CONGRESSIONAL RECORD — SENATE June 26, 2003 the Northern Border. Their disclosure cause it was too burdensome and seri- management? It is virtually impossible led to my holding a hearing at the Per- ously reduced the education opportuni- standard of proof to meet. Moreover, manent Subcommittee on Investiga- ties available on base. After making there is nothing in the law or legisla- tions in November 2001, that exposed these criticisms, local agency officials tive history that even suggests such a serious deficiencies in the way Border reassigned White, relieving him of his standard applies to the Whistleblower Patrol and INS were dealing with duties and allegedly isolating him. Protection Act. The intent of the law aliens who were arrested while trying However, after an independent manage- is not for a federal employee to act as to enter the country illegally. Since ment review supported White’s con- an investigator and compile ‘‘irref- the hearing, some of the most trouble- cerns, the Air Force canceled the pro- ragable’’ proof that the Federal Gov- some policies have been changed, im- gram White had criticized. White ap- ernment, in fact, committed fraud, proving the security situation and vali- pealed the reassignment in 1992 and the waste or abuse. Rather, under the clear dating the two agents’ concerns. De- case has been in litigation ever since. language of the statute, the employee spite the fact that their concerns The administrative judge initially needs only to have ‘‘a reasonable be- proved to be dead on, shortly after they dismissed White’s case, finding that his lief’’ that there is fraud, waste or abuse blew the whistle, disciplinary action disclosures were not protected by the occurring in order to make a protected was proposed against the two agents. Whistleblower Protection Act. The disclosure. Fortunately in this case, whistleblower MSPB, however, reversed the adminis- LaChance is only one example of the protections worked. The Office of Spe- trative judge’s decision and remanded Federal Circuit misinterpreting the cial Counsel conducted an investiga- the case back to the administrative law. Our bill corrects LaChance and as tion and the decision to discipline the judge, holding that since White dis- well as several other Federal Circuit agents was reversed. However, that disclosed information he reasonably be- holdings. In addition, the bill strength- ciplinary an action was proposed in the lieved evidenced gross mismanage- ens the Office of Special Counsel and first place is a troubling reminder of ment, this disclosure was protected creates additional protections for fed- how important it is for us to both under the Act. On remand, the admin- eral employees who are retaliated strengthen protections for whistle- istrative judge found that the Air against for blowing the whistle. blowers and empower the Office of Spe- Force had violated the Whistleblower One of the most important issues ad- cial Counsel to discipline managers Protection Act and ordered the Air dressed in the bill is to clarify again who seek to muzzle employees. Force to return White to his prior sta- that the law is intended to protect a Agent Rowley, Mark Hall and Bob tus; the MSPB affirmed the decision of broad range of whistleblower disclo- Lindermann are simply the latest in a the administrative judge. OPM peti- sures. The legislative history sup- long line of Federal employees who tioned the Federal Circuit for a review porting the 1994 Whistleblower Protec- have taken great personal risks in of the board’s decision. The Federal tion Act amendments emphasized: ‘‘[I]t blowing the whistle on government Circuit subsequently reversed the also is not possible to further clarify waste, fraud, and mismanagement. MSPB’s decision, holding that there the clear language in section 2302(b)(8) Congress has long recognized the obli- was not adequate evidence to support a that protection for ‘any’ whistle- gation we have to protect a Federal violation under the Whistleblower Pro- blowing disclosure truly means ‘any’. A employee when he or she discloses evi- tection Act. The Federal Circuit held protected disclosure may be made as dence of wrongdoing in a Federal pro- that the evidence that White was a spe- part of an employee’s job duties, may gram. If an employee reasonably be- cialist on the subject at issue and concern policy or individual mis- lieves that a fraud or mismanagement aware of the alleged improper activi- conduct, and may be oral or written is occurring, and that employee has the ties and that his belief was shared by and to any audience inside or outside courage and the sense of responsibility other employees was not sufficient to the agency, without restriction to to make that fraud or mismanagement meet the ‘‘reasonable belief’’ test in time, place, motive or content.’’ known, it is our duty to protect the the law. The court held that ‘‘the board Despite this clear Congressional in- employee from any reprisal. We want must look for evidence that it was rea- tent that was clearly articulated in Federal employees to identify problems sonable to believe that the disclosures 1994, the Federal Circuit has acted to so we can fix them, and if they fear re- revealed misbehavior’’ by the Air push a number of whistleblower disclo- prisal for doing so, then we are not Force. The court went on to say: ‘‘In sures outside the protections of the only failing to protect the whistle- this case, review of the Air Force’s pol- whistleblower law. For example, in blower, but we are also failing to pro- icy and implementation via the QES Horton versus the Department of the tect the taxpayer. standards might well show them to be Navy, the Federal Circuit ruled that a I sponsored the Whistleblower Pro- entirely appropriate, even if not the whistleblower’s disclosures to co-work- tection Act in 1989 which strengthened best option. Indeed, this review would ers, or to the wrong-doer, or to a court and clarified whistleblower rights, as start out with a presumption that pub- ruled that a whistleblower’s disclosures well as the bill passed by Congress to lic officers perform their duties cor- to official in the agency chain of com- strengthen the law further in 1994. Un- rectly, fairly, in good faith, and in ac- mand or those made in the course of fortunately, however, repeated hold- cordance with the law and governing normal job duties were not protected. ings by the United States Court of Ap- regulations. * * * And this presump- In Huffman versus Office of Personnel peals for the Federal Circuit have cor- tion stands unless there is ‘irrefragable Management, the Federal Circuit re- rupted the intent of Congress, with the proof to the contrary’.’’ affirmed Horton and Willis. And in result that additional clarifying lan- It was appropriate for the Federal Meuwissen versus Department of Inte- guage is sorely needed. The case of Circuit to remand the case to the rior, the Federal Circuit held that a LaChance versus White represents per- MSPB to have it reconsider whether it whistleblower’s disclosures of pre- haps the most notable example of the was reasonable for White to believe viously known information do not Federal Circuit’s misinterpretation of that what the Air Force did in this qualify as ‘‘disclosures’’ under the the whistleblower law. case involved gross mismanagement. WPA. All of these rulings violate clear In LaChance, decided on May 14, 1999, However, the Federal Circuit went on Congressional intent to afford broad the court imposed an unfounded and to impose a clearly erroneous and ex- protection to whistleblower disclo- virtually unattainable standard on cessive standard for him to dem- sures. Federal employee whistleblowers in onstrate his ‘‘reasonable belief’’—re- In order to make it clear that any proving their cases. In that case, John quiring him to provide ‘‘irrefragable’’ lawful disclosure that an employee or E. White was an education specialist proof that the Air Force had engaged job applicant reasonably believes is for the Air Force who spoke out in gross mismanagement. evidence of waste, fraud, abuse, or against a new educational system that Irrefragable means ‘‘undeniable, in- gross mismanagement is covered by purported to mandate quality stand- contestable, incontrovertible, incapa- the WPA, the bill codifies previous ards for schools contracting with the ble of being overthrown.’’ How can a statements of Congressional intent. Air Force bases. White criticized the Federal employee meet a standard of Using the 1994 legislative history, it new system as counterproductive be- ‘‘irrefragable’’ in proving gross mis- amends the whistleblower statute to

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00106 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8753 cover any disclosure of information tion, gross mismanagement, a gross ating an investigation of an employee without restriction to time, place, waste of funds, an abuse of authority, a or applicant for employment because form, motive or context, or prior dis- substantial and specified danger to they engage in a protected activity, in- closure made to any person by an em- public health or safety, or a false state- cluding whistleblowing. ployee or applicant, including a disclo- ment to Congress on an issue of mate- Another issue addressed in the bill sure made in the ordinary course of an rial fact. A whistleblower must also involves certain employees who are ex- employee’s duties that the employee or limit the disclosure to a member of cluded from the WPA. Among these are applicant reasonably believes is cred- Congress or staff of the executive or employees who hold ‘‘confidential pol- ible evidence of any violation of any legislative branch holding the appro- icy-making positions.’’ In 1994, Con- law, rule, or regulation, or other mis- priate security clearance and author- gress amended the WPA to keep agen- conduct specified in the whistleblower ized to receive the information dis- cies from designating employees con- law. I want to emphasize here that, closed. Federal agencies covered by the fidential policymakers after the em- other than the explicitly listed excep- WPA would be required to establish a ployees filed whistleblower complaints. tions identified in the statute, we in- process to provide confidential advice The WPA also allows the President to tend for there to be no exceptions, in- to employees on how to lawfully make exclude from WPA jurisdiction any ferred or otherwise, as to what is a pro- a protected disclosure of classified in- agency whose principal function is the tected disclosure. And the prohibition formation to Congress. conduct of foreign intelligence or coun- on inferred exceptions is intended to Current law permits Federal employ- terintelligence activities. Our legisla- apply to all protected speech cat- ees to file a case at the MSPB when tion maintains this authority but egories in section 2302(b)(8) of the law. they feel that a manager has taken a makes it clear that a decision to ex- The intent here, again, is to make it personnel action against them in retal- clude an agency from WPA protections clear that when the WPA speaks of pro- iation for blowing the whistle. The leg- must also be made prior to a personnel tecting disclosures by Federal employ- islation would add three new personnel action being taken against a whistle- ees ‘‘any’’ means ‘‘any.’’ actions to the list of adverse actions blower from that agency. This provi- The bill also addresses the clearly er- that cannot be taken against whistle- sion is necessary to ensure that agen- roneous standard established by the blowers for engaging in protected ac- cies cannot argue that employees are Federal Circuit’s LaChance decision I tivity. These actions would include en- exempt from whistleblower protections mentioned earlier. Rather than needing forcement of any nondisclosure policy, after an employee files a claim that ‘‘irrefragable proof’’ to overcome the form or agreement against a whistle- they were retaliated against. presumption that a public officer per- blower for making a protected disclo- Another key section of the bill would formed his or her duties correctly, fair- sure; the suspension, revocation, or strengthen the Office of Special Coun- ly, in good faith, and in accordance other determination relating to a whis- sel. OSC is the independent federal with the law and regulations, the bill tleblower’s security clearance; and an agency responsible for investigating makes it clear that the whistleblower investigation of an employee or appli- and prosecuting federal employee com- can rebut this presumption with ‘‘sub- cant for employment if taken due to plaints of whistleblower retaliation. stantial evidence.’’ This burden of their participation in whistleblowing Current law, however, limits OSC’s proof is a far more reasonable and ap- activity. ability to effectively enforce and de- propriate standard for whistleblowing It is important to note that, if it is fend whistleblower laws. For example, cases. demonstrated that a security clearance the law provides the OSC with no au- The Federal Circuit’s repeated mis- was suspended or revoked in retalia- thority to request the Merit Systems interpretations of the whistleblower tion for whistleblowing, the legislation Protection Board to reconsider one of law are unacceptable and demand Con- limits the relief that the MSPB and re- its decisions or to seek appellate re- gressional action. In response to the viewing court can order. The bill speci- view of an MSPB decision. Even when court’s inexplicable and inappropriate fies that the MSPB or reviewing court another party petitions for a review of rulings, our bill would suspend for five may issue declaratory and other appro- a MSPB decision, OSC is typically de- years the Federal Circuit’s exclusive priate relief but may not direct a secu- nied the right to participate in the pro- jurisdiction over whistleblower ap- rity clearance to be restored. Appro- ceedings. peals. It would instead allow a whistle- priate relief may include back pay, an Our bill would provide explicit au- blower to file a petition to review a order to reassign the employee, attor- thority for the Office of Special Coun- final order or final decision of the ney fees, or any other relief the Board sel to appear in any civil action MSPB in the Federal Circuit or in any or court is authorized to provide for brought in connection with the whis- other United States appellate court of other prohibited personnel practices. In tleblower law. In addition, it would au- competent jurisdiction and defined addition, if the Board finds an action thorize OSC to obtain circuit court re- under 5 U.S.C. 7703(b)(2). In most cases, on a security clearance to have been il- view of any MSPB order in a whistle- using another court would mean going legal, it may bar the agency from di- blowing case if the OSC determines the to the federal circuit where the con- rectly or indirectly taking any other Board erred and the case would have a tested personnel action took place. personnel action based on that illegal substantial impact on the enforcement This five year period would allow Con- security clearance action. Our legisla- of the whisltleblower statute. In a let- gress to evaluate whether other appel- tion would also require the agency to ter to me addressing these provisions, late courts would issue whistleblower review and provide a report to Congress special Counsel Elaine Kaplan said, ‘‘I decisions which are consistent with the detailing the circumstances of the believe that these changes are nec- Federal Circuit’s interpretation of agency’s security clearance decision, essary, not only to ensure OSC’s effec- WPA protections and guide Congres- and authorizes expedited MSPB review tiveness, but to address continuing sional efforts to clarify the law if nec- of whistleblower cases where a security concerns about the whittling away of essary. clearance was revoked or suspended. the WPA’s protections by narrow judi- In addition to addressing jurisdic- The latter is important because a per- cial interpretations of the law.’’ I ask tional issues and troublesome Federal son whose clearance has been sus- unanimous consent that the OSC letter Circuit precedents, our bill would also pended or revoked and whose job re- be printed in the RECORD. make important additions to the list of sponsibilities require clearance may be There being no objection, the letter protected disclosures. First, it would unable to work while their case is was ordered to be printed in the subject certain disclosures of classified being considered. RECORD, as follows: information to whistleblower protec- Our bill would also add two prohib- U.S. OFFICE OF SPECIAL COUNSEL, tions. However, in order for a disclo- ited personnel practices of the whistle- Washington, DC, September 11, 2002. sure of classified information to be pro- blower law. First, it would codify the Hon. CARL LEVIN, tected, the employee would have to ‘‘anti-gag’’ provision that has been in U.S. Senate, Russell Senate Office Building, Washington, DC. possess a reasonable belief that the dis- force since 1988, by virture of its inclu- DEAR SENATOR LEVIN: Thank you for giv- closure was direct and specific evidence sion in appropriations bills. Second, it ing me the opportunity to comment on the of a violation of law, rule or regula- would prohibit a manager from initi- proposed Title VI of H.R. 5005, concerning

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00107 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8754 CONGRESSIONAL RECORD — SENATE June 26, 2003 the protection of federal employee whistle- so onerous as to make it virtually impossible This amendment provides a balance resolu- blowers. to secure discipline against retaliators. tion of the tension between protecting na- As the head of the U.S. Office of Special Under current law, OSC bears the unprece- tional security whistleblowers against retal- Counsel (OSC), the independent federal agen- dented burden of demonstrating that pro- iation and maintaining the President’s tradi- cy that is responsible for investigating and tected activity was the but-for cause of an tional prerogative to decide who will have prosecuting federal employees’ complaints of adverse personnel action against a whistle- access to classified information. Especially whistleblower retaliation, I share your rec- blower. The amendment would correct the in light of the current heightened concerns ognition that is crucial to ensure that the imbalance by imposing the well-established about issues of national security, this laws protecting whistleblowers are strong Mt. Healthy test in these cases. change in the law is clearly warranted. and effective. Federal employees are often in In addition, the bill would relieve OSC of Thank you again for providing me with an the best position to observe and identify offi- attorney fee liability in disciplinary action opportunity to comment on these amend- cial misconduct or malfeasance as well as cases in which it ultimately does not prevail. ments, and for your continuing interest in dangers to the public health and safety, and The amendment would shift liability for fees the work of the Office of Special Counsel. the national security. to the manager’s employing agency, where Sincerely, Now, perhaps more than ever before, our an award of fees would be in the interest of ELAINE KAPLAN. national interest demands that federal work- justice. The employing agency would indem- ers feel safe to come forward to bring appro- nify the manager for these costs which would Mr. LEVIN. OSC currently has the priate attention to these conditions so that have been incurred by him in the course of authority to pursue disciplinary action they may be corrected. Further, and again performing his official duties. against managers who retaliate against more than ever, the public now needs assur- Under current law, if OSC ultimately does whistleblowers. However, Federal Cir- ance that the workforce which is carrying not prevail in a case it brings against a man- cuit decisions, like LaChance, have un- out crucial operations is alert, and that its ager whom our investigation shows has en- dermined the agency’s ability to suc- leaders welcome and encourage their con- gaged in retaliation, then we must pay attor- structive participation in making the gov- ney fees, even if our prosecution decision was cessfully pursue such cases. The Spe- ernment a highly efficient and effective an entirely reasonable one. For a small agen- cial Counsel has said that ‘‘change is steward of the public interest. cy like OSC, with a limited budget, the spec- necessary in order to ensure that the To these ends, Title VI contains a number ter of having to pay large attorney fee burden of proof in these cases is not so of provisions that will strengthen the Whis- awards simply because we do not ultimately onerous as to make it virtually impos- tleblower Protection Act (WPA) and close prevail in a case, is a significant obstacle to sible to secure disciplinary action loopholes in the Act’s coverage. The amend- our ability to use this important authority ment would reverse the effects of several ju- against retaliators.’’ In addition to it to hold managers accountable. It is, more- being difficult to win, if the OSC loses dicial decisions that have imposed unduly over, an unprecedented burden; virtually all narrow and restrictive tests for determining fee shifting provisions which could result in a disciplinary case, it has to pay the whether employees qualify for the protection an award of fees against a government agen- legal fees of those against whom OSC of the WPA. These decisions, among other cy, depend upon a showing that the govern- initiates disciplinary action. In its let- things, have held that employees are not ment agency has acted unreasonably or in ter, OSC said that ‘‘the specter of hav- protected against retaliation when they bad faith. ing to pay large attorney fee awards make their disclosures in the line of duty or In addition to these provisions, the bill when they confront subject officials with . . . is a significant obstacle to our would also provide that for a period of five ability to use this important authority their suspicions of wrongdoing. They have years, beginning on February 1, 2003, there also made it more difficult for whistle- would be multi-circuit review of decisions of to hold managers accountable.’’ Our blowers to secure the Act’s protection by the MSPB, just as there is now multi-circuit bill addresses these problems by estab- interposing what the Court of Appeals for review of decisions of the MSPB’s sister lishing a reasonable burden of proof for the Federal Circuit has called an ‘‘irref- agency, the Federal Labor Relations Author- disciplinary actions and requiring the ragable’’ presumption that government offi- ity. This experiment will give Congress the cials perform their duties lawfully and in employing agency, not the OSC, to re- opportunity to judge whether providing good faith. imburse the prevailing party for attor- In addition to reversing these rulings, broader perspectives of all of the nation’s ney fees in a disciplinary proceeding. Title VI would grant the Special Counsel courts of appeals will enhance the develop- Finally, the bill addresses a new independent litigating authority and the ment of the law under the WPA. There are several other provisions of the issue that has arisen in connection right to request judicial review of decisions amendments that would strengthen the Act’s with the recent enactment of the of the Merit Systems Protection Board Homeland Security Act or HSA. To (MSPB) in cases that will have a substantial coverage and remedies. The amendments, for impact upon the enforcement of the WPA. I example, would extend coverage of the WPA evaluate the vulnerability to terrorist firmly believe that these changes are nec- to circumstances in which an agency initi- attack of certain critical infrastruc- essary, not only to ensure OSC’s effective- ated an investigation of an employee or ap- ture such as chemical plants, computer ness, but to address continuing concerns plicant in reprisal for whistleblowing or networks and other key facilities, the about the whittling away of the WPA’s pro- where an agency implemented an illegal non- HSA asks private companies that own disclosure form or policy. The amendments tections by narrow judicial interpretations these facilities to submit unclassified of the law. The changes would ensure that also would authorize an award of compensatory damages in federal employee whistle- information about them to the govern- OSC, the government agency charged with ment. In doing so, the law also created protecting whistleblowers, will have a mean- blower cases. Such awards are authorized for ingful opportunity to participate in the federal employees under the civil rights acts, some ambiguity on the question of shaping of the law. and for environmental and nuclear whistle- whether Federal employee whistle- Further, Title VI would strengthen OSC’s blowers, among others, under other federal blowers would be protected by the WPA capacity to use its disciplinary action au- statutes. Given the important public policies if they should disclose information thority to deter agency supervisors, man- underlying the WPA, it seems appropriate that has been independently obtained that the same sort of make whole relief agers, and other officials from engaging in by the whistleblower about such facili- retaliation, and to punish those who do so. should be available to federal employee whis- The amendment does this in two ways. First, tleblowers. ties but which may also have been dis- it clarifies the burden of proof in discipli- Finally, Title VI contains a provision that closed to the government under the nary action cases that OSC brings by em- would provide relief to employees who allege critical infrastructure information pro- ploying the test first set forth by the Su- that their security clearances were denied or gram. preme Court in Mt. Healthy School District revoked because of protected whistleblowing, While I believe it was Congress’s in- v. Board of Education. Under this test, in without interfering with the longstanding tent to extend whistleblower protec- order to secure discipline of an agency offi- authority of the President to make security clearance determinations. The amendment tions to Federal employees who dis- cial accused of engaging in whistleblower re- close such independently obtained in- taliation, OSC would have to show that pro- would allow employees to file OSC com- tected whistleblowing was a ‘‘significant, plaints alleging they suffered a retaliatory formation, the law’s ambiguities are motivating factor’’ in the decision to take or adverse security clearance determination. troublesome in the context of the tend- threaten to take a personnel action. If OSC OSC would be given the authority to inves- ency of the Federal Circuit to narrowly made such a showing, the MSPB would order tigate such complaints and the MSPB would construe the scope of protections af- appropriate discipline unless the official have the authority to issue declaratory and forded by the WPA. Our bill would thus showed, by preponderant evidence, that he or appropriate relief other than ordering the clarify that whistleblower protections restoration of the clearance. Further, where she would have taken or threatened to take do extend to Federal employees who the same action even had there been no pro- the Board found retaliation, the employing tected activity. agency would be required to conduct its own disclose independently obtained infor- This change is necessary in order to ensure investigation of the revocation and report mation that may also have been dis- that the burden of proof in these cases is not back to Congress. closed to the government as part of the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00108 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8755 critical infrastructure information pro- my personal views only, not those of the gov- would not empower MSPB to restore a secu- gram ernment agency for which I work. rity clearance. If MSPB or a reviewing court We need to encourage Federal em- Thank you for your consideration, were to find that a security clearance deci- ployees to blow the whistle on waste, COLEEN ROWLEY. sion was retaliatory, the agency involved fraud and abuse in Federal Government There being no objection, the anal- would be required to review its security ysis was ordered to be printed in the clearance decision and issue a report to Con- agencies and programs. These people gress explaining it. take great risks and often face enor- RECORD, as follows: Exclusions From WPA.—Current law al- mous obstacles in doing what they be- SECTION-BY-SECTION ANALYSIS OF THE FED- lows the President to exclude certain em- lieve is right. The Congress and the ERAL EMPLOYEE PROTECTION OF DISCLO- ployees and agencies from the WPA if they country owe a particular debt of grati- SURES ACT perform certain intelligence related or pol- tude to those whistleblowers who put The Federal Employee Protection of Dis- icy making functions. In 1994, Congress their careers on the line to protect na- closures Act would strengthen protections amended the WPA to stop agencies from re- for Federal employees who blow the whistle tional security. Since September 11, moving employees from WPA coverage after on waste, fraud and abuse in the Federal the employees filed whistleblower com- 2001, we have seen a number of exam- Government. plaints. Section (f) would also require that ples of how crucial people like Coleen Protected Whistleblower Disclosures—To removal of an agency from the WPA be made Rowley, Mark Hall and Bob correct court decisions improperly limiting prior to a personnel action being taken Lindermann are to keeping our coun- the disclosures protected by the Whistle- against a whistleblower at that agency. try safe. I request unanimous consent blower Protection Act, WPA, section (b) of Attorney Fees.—The Office of Special that a letter from Agent Rowley be the bill would clarify Congressional intent Counsel, OSC, has authority to pursue dis- that the law covers ‘‘any’’ whistleblowing printed in the RECORD. In the letter she ciplinary action against managers who re- disclosure, whether that disclosure is made says that when she blew the whistle, taliate against whistleblowers. Currently, if as part of an employee’s job duties, concerns OSC loses a disciplinary case, it must pay she was lucky enough to garner the policy or individual misconduct, is oral or the legal fees of those against whom it initi- support of many of her colleagues and written, or is made to any audience inside or ated the action. Because the amounts in- members of Congress. However, her let- outside an agency, and without restriction volved could significantly deplete OSC’s lim- ter warns that for every Coleen to time, place, motive or context. This sec- ited resources, section (g) would require the Rowley, ‘‘there are many more who do tion would also protect certain disclosures of employing agency, rather than OSC, to reim- not benefit from the relative safety of classified information to Congress when the burse the manager’s attorney fees. public notoriety.’’ It is to protect those disclosure is to a Member or legislative staff Burden of Proof in Disciplinary Actions.— responsible, courageous many that we holding an appropriate security clearance Currently, when OSC pursues disciplinary and authorized to receive the type of infor- action against managers who retaliate offer this legislation. We need more mation disclosed. against whistleblowers, OSC must dem- like them. Informal Disclosures.—Section (c) would onstrate that an adverse personnel action I ask unanimous consent to print in clarify the definition of ‘‘disclosure’’ to in- would not have occurred ‘‘but for’’ the whis- the RECORD a section-by-section expla- clude a formal or informal communication tleblower’s protected activity. Section (i) nation of the bill. or transmission. would establish a more reasonable burden of There being no objection, the letter Irrefragable Proof.—In LaChance v. White, proof by requiring OSC to demonstrate that was ordered to be printed in the the U.S. Court of Appeals for the Federal the whistleblower’s protected disclosure was RECORD, as follows: Circuit imposed an erroneous standard for a ‘‘significant motivating factor’’ in the de- determining when an employee makes a pro- cision by the manager to take the adverse SEPTEMBER 2, 2002. tected disclosure under the WPA. Under the DEAR SENATORS: I have proudly served in action, even if other factors also motivated clear language of the statute, an employee federal law enforcement for over 21 years. the decision. This standard would be equiva- need only have a reasonable belief that he or Prior to my personal involvement in a spe- lent of the Mt. Healthy standard. she is providing evidence of fraud, waste or cific matter, I did not fully appreciate the Disclosures to Congress.—Section (j) would abuse to make a protected disclosure. But strong disincentives that sometimes keep require agencies to establish a process to the court ruled that an employee had to have government employees from exposing waste, provide confidential advice to employees on ‘‘irrefragable proof’’—meaning undeniable fraud, abuse, or other failures they witness how to lawfully make a protected disclosure and incontestable proof—to overcome the on the job. Nor did I appreciate the strong of classified information to Congress. presumption that a public officer is per- Authority of Special Counsel.—Under cur- incentives that do exist for agencies to avoid institutional embarrassment. forming their duties in accordance with law. rent law, OSC has no authority to request The decision to step forward with informa- Section (d) would replace this unreasonable MSPB to reconsider a decision or seek appel- tion that exposed my agency to scrutiny was standard of proof by providing that a whis- late review of a MSPB decision. This limita- one of the most difficult of my career. I did tleblower can rebut the presumption with tion undermines OSC’s ability to protect not come to it quickly or lightly. I first at- ‘‘substantial evidence.’’ whistleblowers and integrity of the WPA. tempted to warn my superiors through reg- Prohibited Personnel Actions.—Section Section k would authorize OSC to appear in ular channels. Only after those warnings (e)(1) would add three actions to the list of any civil action brought in connection with failed to bring about the necessary response prohibited personnel actions that may not be the WPA and request appellate review of any and congressional inquiry was initiated, did taken against whistleblowers for protected MSPB order where OSC determines MSPB I go outside the agency with my concerns. I disclosures: enforcement of a nondisclosure erred and the case would have a substantial had no intention or desire to be in the public policy, form or agreement; suspension, rev- impact on WPA enforcement. spotlight, so I did not go to the news media. ocation, or other determination relating to Judicial Review.—In 1982, Congress re- I provided the information to Members of an employee’s security clearance; and inves- placed normal Administrative Procedures Congress with oversight responsibility. I felt tigation of an employee or applicant for em- Act appellate review of MSPB decisions with compelled to do so because my responsibility ployment due to protected whistleblowing exclusive jurisdiction in the U.S. Court of is to the American people, not to a govern- activities. Appeals for the Federal Circuit. While the ment agency. Nondisclosure Actions Against Whistle- 1989 WPA and its 1994 amendments strength- Unfortunately, the cloak of secrecy which blowers.—Section (e)(2) would bar agencies ened and clarified whistleblower protections, is necessary for the effective operation of from implementing or enforcing against Federal Circuit holdings have repeatedly government agencies involved in national se- whistleblowers any nondisclosure policy, misinterpreted key provisions of the law. curity and criminal investigations fosters an form or agreement that fails to contain spec- Subject to a five year sunset , section (l) environment where the incentives to avoid ified language preserving the right of federal would suspend the Federal Circuit’s exclu- embarrassment and the disincentives to step employees to disclose certain protected in- sive jurisdiction over whistleblower appeals forward combine. When that happens, the formation. It would also prohibit a manager and allow petitions for review to be filed ei- public loses. We need laws that strike a bet- from initiating an investigation of an em- ther in the Federal Circuit or any other fed- ter balance, that are able to protect effective ployee or applicant for employment because eral circuit court of competent jurisdiction. government operation without sacrificing they engaged in protected activity. Nondisclosure Restrictions on Whistle- accountability to the public. I was lucky Retaliations Involving Security Clear- blowers.—Section (m) would require all fed- enough to garner a good deal of support from ances.—Section (e)(3) would make it a pro- eral nondisclosure policies, forms and agree- my colleagues in the Minneapolis office and hibited personnel practice for a manager to ments to contain specified language pre- Members of Congress. But for every one like suspend, revoke or take other action with re- serving the right of federal employees to dis- me, there are many more who do not benefit spect to an employee’s security clearance in close certain protected information. This from the relative safety of public notoriety. retaliation for whistleblowing. This section section would codify the so-called anti-gag They need credible, functioning rights and would also authorize the Merit Systems Pro- provision that has been included in federal remedies to retain the freedom to warn. tection Board, MSPB, to conduct an expe- appropriations bills since 1988. I also need to state that I write this letter dited review of such matters and issue de- Critical Infrastructure Information.—Sec- in my personal capacity, and that it reflects claratory and other appropriate relief, but tion (n) would clarify that section 214(c) of

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00109 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8756 CONGRESSIONAL RECORD — SENATE June 26, 2003 the Homeland Security Act, HSA, maintains ify the requirements for notices of dis- tion was invalid because it required existing WPA rights for independently ob- agreement for appellate review of De- more of the claimant than Congress retained information that may also qualify as partment of Veterans Affairs activi- quired in statute. Last year, in critical infrastructure information under the Gallegos v. Principi, the United States HSA. ties; to the Committee on Veterans’ Af- fairs. Court of Appeals for the Federal Cir- By Mrs. BOXER: Mr. GRAHAM of Florida. Mr. Presi- cuit reversed the CAVC and upheld the S. 1359. A bill to allow credit unions dent, I rise today to introduce legisla- VA regulation, finding that the agency to provide international money trans- tion that will remove a significant and interpretation was entitled to def- fer services and to require disclosures arbitrary barrier to appellate review of erence because Congressional intent in connection with international veterans’ benefits claims. In 1988, when was not clear in limiting the require- money transfers from all money trans- Congress created judicial review for ments of a NOD to those in section mitting service providers; to the Com- veterans’ claims it intended to provide 7105. mittee on Banking, Housing, and ‘‘an opportunity for those aggrieved by Congress never intended to require Urban Affairs. VA decisions to have such decisions re- that level of formality from veterans, Mrs. BOXER. Mr. President, today, I viewed by a court’’ and found such re- in this uniquely pro-claimant system. am introducing the International Re- view ‘‘necessary in order to provide Therefore, I offer legislation that mittances Services Enhancement and such claimants with fundamental jus- would specify that if a claimant’s filing Protection Act of 2003. tice.’’ meets the criteria defined in section Remittances are the funds that im- A veteran or survivor of a veteran 7105 of title 38 of the United States migrants send to their families abroad seeking VA benefits must file a claim Code, the document will be deemed a to help those relatives meet their basic for such benefits, generally at a VA Re- Notice of Disagreements with all the needs. In the Latino community, 47 gional Office. If the VA denies the rights and procedures that accompany percent of all Latinos born outside the claim for benefits, the claimant must that determination. It will also ensure United States regularly send money to file a ‘‘Notice of Disagreement,’’ or that claimants whose NODs were found their country of origin. But since 43 NOD, as defined in section 7105 of title to be defective since the court decision percent to 58 percent of those who send 38 of the United States Code. This NOD will have the opportunity to have their remittances abroad regularly do not initiates appellate review by the agen- NOD reevaluated under this new provi- have a bank account, much of their cy and begins a series of events where sion. hard earned money is lost in fees paid VA communicates the basis of the de- This is very significant because there to check cashing agencies and wire nial to the claimant and allows various are two key consequences of not having transfer companies. They rely on check levels of review of this denial at the re- a valid, timely NOD. First, if a claim- cashing services to cash their pay- gional office. If the claimant still dis- ant fails to file a timely, valid NOD, checks at hefty fees and then pay an- agrees with the VA decision, the claim- the VA denial becomes final. The other fee to send some portion of that ant may file a ‘‘Substantive Appeal’’ claimant will need to submit ‘‘new and money through a wire service to their that vests jurisdiction of the claim material evidence’’ that VA erred in relatives in Latin America and else- with the Board of Veterans’ Appeals, order to reopen the case. If successful, where at varying exchange rates. the appellate arm of VA. the claimant will only be able to re- This legislation will increase com- Section 7105 defines what is required ceive benefits dating to the beginning petition and transparency in the remit- of a valid NOD. It must be filed within of the newly reopened claim, poten- tances market. It will provide immi- 1 year from the notice of the initial de- tially losing years of retroactive bene- grants with access to more choices for nial, in writing, and filed with the re- fits. This may affect a veteran’s ability sending remittances by allowing credit gional office that issued the decision to receive VA health care, a depend- unions to provide wire transfer and over which there is disagreement. The ent’s ability to use educational bene- check cashing services to nonmembers. NOD may be filed by the claimant or fits, and all the other benefits that It will also provide immigrants with the claimant’s guardian or representa- flow from a finding of service-connec- access to information in more than one tive. tion. language from all money transmitters VA has promulgated regulations to Second, if a claimant has not been deemed to file a NOD, there can be no about the fees and exchange rates that implement section 7105. In Section appeal of the VA decision. A NOD is re- they pay. That information will make 20.201 or title 38 of the Code of Federal quired to initiate an appeal. It is a pre- it easier for consumers to compare the Regulations, the Secretary defined a requisite to review by the Board of value of the services they can receive NOD to not require special wording. Veterans’ Appeals and ultimately judi- from different service providers. The regulation does require that the The larger goal is to provide immi- cial review at the CAVC. This con- NOD ‘‘must be in terms which can be grants with more control over their fi- travenes Congress’s intent to remove reasonably construed as disagreement nances. I believe this bill with encour- arbitrary barriers to judicial review as with the determination and a desire for age financial institutions to develop it did in Public Law 107–103. appellate review.’’ The second compo- better services for immigrants and We face the tragic fact that in 2002, nent of that sentence—‘‘a desire for ap- build stronger relationships with immi- America lost 646,264 veterans. The pellate review’’—is not required under grant communities. many aging veterans who still await According to the Multilateral Invest- the statute. justice cannot afford this debate. I ask ment Fund, immigrants living in the In 1997, Raymond Gallegos, a veteran, my colleagues to support this critical United States sent $23 billion to Latin again filed an application for service measure and restore this fundamental America in 2001. More than $3 billion of connection for post-traumatic stress justice to our veterans. that total was consumed in fees paid to disorder that had been previously de- I ask unanimous consent that the money transfer agencies. If current nied. The VA regional office granted text of this bill be printed in the growth rates in remittance transfers his claim. However, Mr. Gallegos be- RECORD. are maintained, cumulative remit- lieved the effective date assigned to his There being no objection, the bill was tances to Latin America could reach claim was wrong and filed what was ordered to be printed in the RECORD, as $300 billion for the 10-year period end- then thought to be a NOD. He appealed follows: ing in 2010. We need to work to ensure this issue to the Board, which reasoned S. 1360 that competition in the market and that the letter expressing his disagree- Be it enacted by the Senate and House of Rep- modern technology come together to ment was not a valid NOD because it resentatives of the United States of America in lower the portion of those monies lost did not express his desire for appellate Congress assembled, in fees and instead are used for produc- review. Mr. Gallegos appealed the SECTION 1. CLARIFICATION OF NOTICE OF DIS- Board’s determination to the United AGREEMENT FOR APPELLATE RE- tive purposes. VIEW OF DEPARTMENT OF VET- States Court of Appeals for Veterans ERANS AFFAIRS ACTIVITIES. By Mr. GRAHAM of Florida: Claims, or the CAVC. (a) CLARIFICATION.—Section 7105(b) of title S. 1360. A bill to amend section 7105 In 2000, the CAVC determined in 38, United States Code, is amended by adding of title 38, United States Code, to clar- Gallegos v. Gober that the VA regula- at the end the following new paragraph:

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00110 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8757 ‘‘(3) A document that meets the require- plicable income tax principle of ‘‘defer- recent years, two of the largest Amer- ments of the second sentence of paragraph ral’’ and places U.S.-based owners of ican shipping companies have been pur- (1) and the first sentence of paragraph (2) international fleets at a distinct tax chased by foreign companies, thereby shall be recognized as a notice of disagree- disadvantage compared to their for- making their shipping operations more ment for purposes of this section.’’. (b) EFFECTIVE DATE.—(1) Except as specifi- eign-based competitors. competitive than the remaining Amer- cally provided otherwise, paragraph (3) of Controlled foreign corporations en- ican companies. section 7105(b) of title 38, United States Code gaged in ocean transport are one of the The time has come for us to make (as added by subsection (a) of this section), only active businesses that are not eli- changes in the tax law that will allow shall apply to any document— gible for general rule of deferral. My our domestic companies to compete (A) filed under section 7105 of such title on bill would amend the Internal Revenue fairly in the global marketplace. I urge or after the date of the enactment of this Code to allow U.S. companies that own my colleagues to join me to enact this Act; or foreign-flagged ships to treat income needed legislation. I ask unanimous (B) filed under section 7105 of such title be- earned by their controlled foreign cor- fore the date of the enactment of this Act consent that the text of the legislation and not rejected by the Secretary of Vet- porations in the same manner as all be printed in the RECORD. erans Affairs as a notice of disagreement other U.S. companies. In short, it There being no objection, the bill was pursuant to section 20.201 of title 38, Code of would allow American shipping compa- ordered to be printed in the RECORD, as Federal Regulations, as of that date. nies to defer the payment of tax on in- follows: (2) In the case of a document described in come that they derive from shipping S. 1361 paragraph (3) of this subsection, the Sec- activities outside the United States Be it enacted by the Senate and House of Rep- retary shall, upon the request of the claim- until that income is repatriated to the resentatives of the United States of America in ant or the Secretary’s own motion, order the United States. Congress assembled, document treated as a notice of disagree- Most foreign-based carriers pay no SECTION 1. SHORT TITLE. ment under section 7105 of such title as if the document had not been rejected by the Sec- home-country taxes on income they This Act may be cited as the ‘‘RAFT (Re- retary as a notice of disagreement pursuant earn abroad from international ship- store Access to Foreign Trade) Act of 2003’’. to section 20.201 of title 38, Code of Federal ping. As a result of this competitive SEC. 2. ELIMINATION OF MOST VESSEL SHIPPING Regulations. INCOME FROM FOREIGN BASE COM- imbalance, U.S. companies now hold PANY INCOME. (3) A document described in this paragraph precious little share of the world ship- (a) FOREIGN BASE COMPANY SHIPPING IN- is a document that— ping marketplace. Indeed, U.S. owner- COME TO INCLUDE ONLY INCOME FROM AIR- (A) was filed as a notice of disagreement ship of international shipping trades CRAFT AND PETROLEUM VESSELS.—Subsection under section 7105 of such title during the pe- (f) of section 954 of the Internal Revenue riod beginning on March 15, 2002, and ending dropped precipitously in the aftermath Code of 1986 (relating to foreign base com- on the date of the enactment of this Act; and of the 1975 and 1986 tax-law changes. pany income) is amended— (B) was rejected by the Secretary as a no- Before 1975, the U.S.-owned share of the (1) by inserting ‘‘petroleum’’ before ‘‘ves- tice of disagreement pursuant to section world’s open-registry shipping fleet sel’’ each place it appears, and 20.201 of title 38, Code of Federal Regula- stood at 26 percent. By 1986, the U.S. (2) by adding at the end the following new tions. share had dropped to 14 percent. By sentence: ‘‘For purposes of this subsection, (4) A document may not be treated as a no- 1996, the U.S. share had dropped to 5 the term ‘petroleum vessel’ means any vessel tice of disagreement under paragraph (2) un- percent. engaged in the carriage of petroleum or re- less a request for such treatment is filed by Other security concerns also are lated products or byproducts if the con- the claimant, or a motion is made by the trolled group (as defined in section 267(f)(1) Secretary, not later than one year after the raised by the decline in U.S. ownership without regard to section 1563(b)(2)(C)) of date of the enactment of this Act. of the international shipping trade. The U.S. military, in times of emer- which the taxpayer is a member is engaged By Mr. SMITH: gency, relies on the ability to requisi- principally in the trade or business of exploring for, or extracting, refining or marketing S. 1361. A bill to amend the Internal tion U.S.-owned foreign-flagged tank- of, petroleum or related products or byprod- Revenue Code of 1986 to provide that ers, bulk carriers, and other vessels to ucts.’’. foreign base company shipping income carry oil, gasoline, and other materials (b) RETENTION OF SEPARATE FOREIGN TAX shall include only income from aircraft in defense of U.S. interests overseas. CREDIT BASKET FOR ALL SHIPPING INCOME.— and income from certain vessels trans- These vessels comprise the Effective Subparagraph (D) of section 904(d)(2) of the porting petroleum and related prod- United States Control, EUSC, fleet. Internal Revenue Code of 1986 is amended by ucts; to the Committee on Finance. The sharp decline in the EUSC fleet striking ‘‘(as defined in section 954(f))’’ and Mr. SMITH of Oregon. Mr. President, since the 1975 and 1986 tax-law changes, inserting ‘‘, as defined in section 954(f), if references in such section to petroleum vessels today I am introducing legislation and the resulting adverse strategic included references to all vessels’’. which would deal with a real problem consequences, have been confirmed in a (c) EFFECTIVE DATE.—The amendments facing our Nation, the decline of our recent MIT study conducted for the made by this section shall apply to taxable U.S.-owned shipping fleet. A U.S. Navy Department. The study rec- years of foreign corporations beginning after owned shipping fleet is essential as a ommended that in the short term, the December 31, 2002, and to taxable years of matter of national and economic secu- most practical and cost-effective United States shareholders (within the rity. My bill would help make U.S. means of reversing this trend would be meaning of section 951(b) of the Internal based shipping companies more com- Revenue Code of 1986) within which or with to ‘‘revise legislation to reflect tax which such taxable years of such foreign cor- petitive in the global market. deferment of income for some or all porations end. This is important to our country and EUSC vessels.’’ to my state. Oregon plays a key role as U.S. security also depends in no By Mrs. BOXER: a facilitator of international com- small part on our ability to maintain S. 1362. A bill to authorize the Port merce. The Port of Portland is one of adequate domestic oil supplies in times Passenger Accelerated Service System the most active ports in the world. It is of emergency. The United States con- (Port PASS) as a permanent program a key link for trade between the United sumes approximately 19.6 million bar- for land border inspection under the States and the Pacific Rim. In addition rels of oil per day, of which roughly 55 Immigration and Nationality Act, and to its key role enabling global com- percent, mostly crude, is imported into for other purposes; to the Committee merce, Portland is home to U.S. owned the United States. It is estimated that on the Judiciary. shipping companies, shipyards, and nu- 95 percent of all oil imported into the Mrs. BOXER. Mr. President, today, I merous support businesses. United States by sea is now imported am introducing legislation that will As a result of tax-law changes en- on foreign-owned tankers. This means strengthen national security, promote acted in 1975 and 1986, U.S. shipping that one half of every gallon of oil con- commerce, and provide assistance to companies must pay tax on income sumed in the United States is carried our dedicated agents at the border. earned by subsidiaries overseas imme- on foreign-owned vessels. This growing Thousands of San Diego and Tijuana diately rather than when such income dependence on foreign parties—who residents cross the border every day as is later brought back to the United may not be sympathetic to U.S. inter- commuters, shoppers, or visitors. Un- States. This treatment represents a ests—to deliver our oil in times of glob- fortunately, our border infrastructure sharp departure from the generally ap- al crisis is cause for potential alarm. In has not kept pace with the increasing

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00111 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8758 CONGRESSIONAL RECORD — SENATE June 26, 2003 traffic volume, and travelers fre- Our Nation’s economic and overall tional parks. It stops costly privatiza- quently encounter delays and conges- security is heavily linked to smooth tion studies and redirects the funds to tion at the border. and secure border crossings. The SAFE address the maintenance backlog that The tragic events of September 11 Border Act provides a way for trusted President Bush promised to eliminate. further intensified these challenges travelers to cross the border securely I am committed to protecting our along the border. Increased security and quickly. parks, and I am proud to introduce this measures severely over-extended in- bill that will ensure that the Park spection resources and resulted in By Mr. REID: Service can preserve them for genera- longer waiting times for crossing the S. 1363. A bill to prohibit the study or tions to come. border. implementation of any plan to pri- I ask unanimous consent that the The Secure Electronic Network for vatize, divest, or transfer any part of text of the bill be printed in the Travelers’ Rapid Inspection, SENTRI, the mission, function, or responsibility RECORD. program was created to help alleviate of the National Park Service; to the There being no objection, the bill was the congestion at the border. Committee on Energy and Natural Re- ordered to be printed in the RECORD, as SENTRI is a dedicated commuter sources. follows: lane program. It allows pre-screened Mr. REID. Mr. President, as thou- S. 1363 travelers to move quickly through the sands of families look forward to sum- Be it enacted by the Senate and House of Rep- inspection process at the United mer vacations at our beautiful national resentatives of the United States of America in States-Mexican border. After partici- parks, we must address an issue that Congress assembled, pants pass a background check, they could one day ruin their experience: SECTION 1. PARK PROFESSIONALS PROTECTION. can move more quickly through a dedi- (a) SHORT TITLE.—This Act may be cited as privatization of the National Park the ‘‘Park Professionals Protection Act’’. cated lane. Service. (b) FINDINGS.—Congress finds the fol- SENTRI accepts only travelers who The Park Service has worked hard to lowing: pass both an extensive background preserve Nevada’s unique landscapes at (1) The National Park System is recognized check to verify their eligibility and a the Great Basin National Park, Death throughout the world as a model for the con- thorough inspection of their vehicle. Valley, and Lake Mead National Recre- servation and enjoyment of natural, scenic, Delays at crossing the border were ation Area. Instead of applauding the recreational, cultural, and historic resources. often an hour or more prior to SENTRI Park Service for a job well done, the But, with the program, the delays for (2) The National Park System would never Administration wants to study 1,800 have achieved such status, nor could the sys- participants are 5 to 15 minutes. Trav- jobs in the Park Service for privatiza- elers in other lanes also benefit be- tem maintain such status, without the pro- tion. fessionalism, dedication, and passion of the cause the prescreened SENTRI crossers Many of these Park Service jobs have men and women of the National Park Serv- move swiftly through the border, re- direct contact with visitors to our ice. ducing the number of motorists using parks. They not only collect fees and (3) Current plans to privatize thousands of general commuter lanes. maintain parks but also give direc- jobs within the National Park Service ignore Expediting inspections through the unique contributions made by the men tions, fight wildfires when necessary, SENTRI is actually helping to improve and women of the National Park Service and border security, as Customs and Border and provide emergency medical assist- threaten to undermine the entire National Patrol agents can focus more attention ance to injured park visitors. They are Park System. on nonscreened drivers and passengers. not required to do these things; they (4) Scarce park operations and mainte- Unfortunately, SENTRI has become a are driven by a love for the parks and nance resources are being diverted to pay victim of its own success. SENTRI a commitment to public service that private consultants to study the current pri- contractors lack. vatization scheme. According to the Na- needs a greater investment of resources tional Park Service, these studies cost ap- to keep up with the current and future Privatizing the Park Service would jeopardize our national parks. Members proximately $3000 for each position proposed demand. Enrollment increased by more to be privatized. than 100 percent after September 11. of the Park Service have a career-long (5) Despite the millions of taxpayer dollars Currently, prospective applicants must interest in maintaining the parks and diverted to these studies, not a single report wait approximately 8 months to par- perform their jobs because they are has been published documenting any cost ticipate in the program. dedicated to serving the public. They savings to be generated by the privatization For innovative programs, such as often go beyond the call of duty to fix of park operations. SENTRI, to work, we must provide a problem in the middle of the night or (6) The current privatization scheme raises serious questions regarding the ability of them with the tools and resources they change a tire for an unlucky park vis- itor. Can we be sure that a contractor temporary workers, provided by the lowest need to succeed. This is why I am in- bidder, to adequately fulfill the responsibil- troducing the Secure and Fast Entry at would do the same? No. ities of professional National Park Service the Border Act or SAFE Border Act. In addition, the Park Service re- employees in the areas of conservation, in- The SAFE Border Act recognizes the ceives tens of thousands of hours of terpretation, emergency fire and rescue, and contribution of SENTRI to border secu- volunteer work every year. At the homeland security. rity and the agents who administer the Lake Mead National Recreation Area (7) The current privatization scheme ap- program. My bill would extend the alone, volunteers provided 92,000 hours pears to affect minority employees dis- length of a SENTRI pass from 1 to 2 of work, the equivalent of 44 full-time proportionately, threatening to significantly employees. Will a contractor find vol- reduce the number of minority employees years—enabling border agents to proc- within the National Park Service. ess more new applicants and reduce the unteers to provide it with 92,000 hours (8) Pendency of the current privatization current enrollment wait. The SAFE of assistance. Not likely. scheme is having detrimental impacts on the Border Act also recommends the ap- Privatization will waste taxpayer morale of current employees and is discour- pointment of dedicated SENTRI staff money. Privatization studies cost aging high quality candidates from applying to expedite application processing, and about $3,000 per position studied, and for positions within the National Park Serv- encourages the creation of a dedicated privatization does not save money. ice. Nevadans visiting the national parks (c) PROHIBITION.—Notwithstanding any commuter lane for prescreened, low- other provision of law, the Secretary is pro- risk pedestrian crossers. this summer want members of the hibited from studying or implementing any In addition, to ensure security at our Park Service, not profit-minded cor- plan to privatize, divest, or transfer any part borders, my legislation bans a person porations, enriching their experience of what is, as of the date of the enactment of convicted of a felony or under active by directing them to the famous sites this section, the mission, function, or re- criminal investigation from partici- and best kept secrets of our parks. sponsibility of the National Park Service. pating in the program. I oppose privatizing the Park Service (d) REALLOCATION OF FUNDS.—Notwith- Our agents at the border shoulder an because it would hurt Nevadans, endan- standing any other provision of law, the Sec- retary shall withhold any funds currently enormous responsibility every day. I ger our national parks, and waste tax- dedicated to the activities prohibited under believe we owe them the appropriate payer money. subsection (c) and shall reallocate those resources and support they need to This bill will keep our dedicated funds to the operations and maintenance ac- carry out their duties. Park Service members running our na- counts within the National Park Service.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00112 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8759 (e) NO EFFECT ON CERTAIN PLANS.—Nothing van to ship the personal effects from ‘‘(B) pay reasonable expenses for trans- in this section shall affect the authority, as South Naknek to Anchorage. There are porting immediate family members and the of the date of the enactment of this section, no roads which connect the bush vil- baggage and household goods of the deceased of a National Park Service Superintendent lage of South Naknek to Anchorage. employee and immediate family members to to develop and implement concessions man- a community in the State of Alaska which is agement plans and commercial services The personal effects need to be trans- selected by the surviving head of household plans covering, in whole or in part, the area ported by air. of the deceased employee.’’. managed by that Superintendent. However, if the deceased employee is (f) SECRETARY DEFINED.—The term ‘‘Sec- a local hire employee, the Federal By Mr. MCCONNELL (for himself, retary’’ means the Secretary of the Interior Travel Regulation does not authorize Mr. KYL, and Mr. LEAHY): and any person employed by the Secretary of the Federal Government to reimburse S. 1365. A bill to provide increased the Interior in any capacity. the surviving family members for their foreign assistance for Cambodia under By Ms. MURKOWSKI: relocation cost because the deceased certain circumstances, and for other S. 1364. A bill to amend the Alaska employee’s hometown is deemed to be purposes; to the Committee on Foreign National Lands Conservation Act to the local hire location. This works an Relations. authorize the payment of expenses inequity where, as in the present case, Mr. MCCONNELL. Mr. President, after the death of certain Federal em- the deceased employee’s surviving today, along with my colleagues Sen- ployees in the State of Alaska; to the spouse does not have ties to the duty ators KYL and LEAHY, I offer the ‘‘Cam- Committee on Energy and Natural Re- station community, but rather to an- bodia Democracy and Accountability sources. other community in Alaska. In this in- Act of 2003’’. This Act is particularly Ms. MURKOWSKI. Mr. President, on stance, the surviving spouse desires to timely, given that national elections the morning following the annual can- relocate to Anchorage, which is Alas- are scheduled in that country on July dlelight vigil to honor fallen law en- ka’s largest city, and continue to raise 27th. forcement officers, I came to the floor her three children there. Cambodia is on its third round of par- to speak about three brave Alaskans The legislation that I am introducing liamentary elections since the 1991 whose names were inscribed on the Na- today is intended to cure this inequity. Paris Peace Accords, with previous tional Law Enforcement Officers’ Me- It would amend ANILCA, the same leg- elections having been funded by the morial at Judiciary Square this year. islation which contains the local hire United Nations in 1993 and by the Cam- One of these brave Alaskans was a Na- authority, to provide that if a local bodian governments in 1998. Despite tional Park Service ranger who lost his hire employee dies in the line of duty, the billions of dollars spent on elec- life when the aircraft he was piloting the Federal Government will reimburse tions in that country—over $2 billion crashed in a remote part of Alaska. the surviving immediate family for the by the U.N. alone—there has yet to be Today, I am introducing legislation cost of transporting the remains to a a credible poll that accurately reflects which I hope will help the surviving location in Alaska of their choosing the will of the Cambodian people. family members of this ranger in their and will also relocate the immediate My colleagues will remember that recovery from this tragic loss and pro- family members to a community in the the U.N.-sponsored elections resulted vide authority for the Federal Govern- State of Alaska which is selected by in a large voter turnout—but also an ment to help the surviving family the surviving head of household. I unworkable power sharing deal bro- members of other similarly situated think that this is the least we can do kered between the winning royalist Federal employees should a similar for the survivors of local hire employ- FUNCINPEC party and the hard line tragedy occur in the future. ees who go to work everyday in the Cambodian People’s Party, CPP, that This ranger I am speaking about was harsh climate and conditions of bush quickly dissolved into open hostilities, assigned to the Katmai National Park Alaska but sadly sometimes do not re- including a bloody grenade attack and Preserve in the Bristol Bay region turn home. against a peaceful, pro-democracy rally I ask unanimous consent that the of Alaska and lived in the community and a CPP sponsored coup d’etat in text of the bill be printed in the of Naknek. Naknek is not connected to 1997. the rest of North America by road. It is RECORD. The debilitating hangover from this There being no objection, the text of what we in Alaska call a ‘‘bush’’ com- coup—destroyed party offices, dead ac- the bill was ordered to be printed in munity. But it was home to the ranger tivists, and a palpable climate of fear the RECORD, as follows: and became the adopted home of his and repression—undermined prospects S. 1364 widow who did not grow up in the area. for free and fair elections in 1998 even The ranger about whom I am speaking Be it enacted by the Senate and House of Rep- before the first ballots were cast. resentatives of the United States of America in was hired under a special hiring au- Congress assembled, Fatigued and frustrated, the inter- thority in the Alaska National Interest SECTION 1. PAYMENT OF EXPENSES AFTER THE national community found it expedient Lands Conservation Act, ANILCA, DEATH OF CERTAIN FEDERAL EM- to endorse the flawed elections, even as which authorizes the Federal land PLOYEES IN THE STATE OF ALASKA. students and Buddhist monks erected a managers to extend a hiring preference Section 1308 of the Alaska National Inter- ‘‘democracy square’’ in Phnom Penh to to those with special knowledge about est Lands Conservation Act (16 U.S.C. 3198) is protest the polls. A CPP crackdown amended— a Conservation System Unit. He was (1) by redesignating subsection (c) as sub- left many of these peaceful protestors regarded as a ‘‘local hire.’’ section (d); and killed, beaten or harassed. Under the Federal Travel Regulation, (2) by inserting after subsection (b) the fol- It is time that Prime Minister Hun when a federal employee dies outside of lowing: Sen—as the self-proclaimed strongman the Continental United States, the ‘‘(c) PAYMENT OF EXPENSES AFTER DEATH of Cambodia—is held accountable for Federal Government will reimburse the OF AN EMPLOYEE.— the murder of political activists, Bud- members of his or her household for ‘‘(1) DEFINITION OF IMMEDIATE FAMILY MEM- dhist monks, civilians, and students. the cost of relocating to their perma- BER.—In this subsection, the term ‘‘imme- There is no rule of law, if the leaders of diate family member’’ means a person re- nent residence. Alaska is regarded as lated to a deceased employee that was a the government are not subject to it. ‘‘outside of the Continental United member of the household of the deceased em- A second ‘‘coalition’’ government be- States’’ under this regulation. ployee at the time of death. tween royalists and hard liners was Thus, if the National Park Service ‘‘(2) PAYMENTS.—If an employee appointed cobbled together in the aftermath of ranger who died in the line of duty under the program established by subsection the 1998 elections. This time, there was came from the Lower 48 before being (a) dies in the performance of any assigned no pretext of power sharing, and for assigned to the Katmai National Park duties on or after October 1, 2002, the Sec- the past 5 years CPP has been firmly and Preserve then the Federal Govern- retary may— and completely in control of the coun- ment, as I read the regulation, could ‘‘(A) pay reasonable expenses for the preparation and transportation of the remains of try. reimburse the surviving family mem- the deceased employee to a location in the Nevertheless, in the months and bers for the cost of relocating to An- State of Alaska which is selected by the sur- weeks before the upcoming July elec- chorage. This cost can be fairly sub- viving head of household of the deceased em- tions, the political marriage between stantial since one cannot hire a moving ployee; FUNCINPEC and CPP is fraying. In an

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00113 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8760 CONGRESSIONAL RECORD — SENATE June 26, 2003 effort to harass and intimidate his op- crecy must be ensured—as well as to State and tribal governments to as- ponents, in late January Prime Min- transparency in the process of vote sist State and tribal efforts to manage ister Hun Sen whipped up nationalistic counting and tabulation—in order that and control the spread of chronic wast- sentiment against Thailand, let loose the will of the Cambodian people is ac- ing disease in deer and elk herds, and the so-called Pagoda Boys, govern- curately expressed. It is my fear that for other purposes; to the Committee ment-paid thugs, and destroyed $50 CPP pre-election chicanery may al- on Environment and Public Works. million worth of Thai public and pri- ready have violated the integrity of the Mr. ALLARD. Mr. President, I ask vate interests in Phnom Penh. election process. unanimous consent that the text of the Despite frantic pleas for assistance, If I wanted to interfere with the elec- bill be printed in the RECORD. the Thai ambassador and other diplo- tions I would have offered legislation There being no objection, the bill was matic personnel escaped injury by scal- that restricts all assistance to Cam- ordered to be printed in the RECORD, as ing the embassy’s walls and scurrying bodia unless a specific political party follows: to safety. In the aftermath of the riots, or parties was elected. This Act does S. 1366 Hun Sen arrested and intimidated stu- not do this. It does not cut any assist- Be it enacted by the Senate and House of Rep- dents, independent broadcasters, and ance—not a single penny—to Cambodia resentatives of the United States of America in political activists. A senior opposition included in the fiscal year 2004 budget Congress assembled, figure sought—and was granted— ref- request. It simply provides that if the SECTION 1. SHORT TITLE. uge in the U.S. Embassy. major obstacle to democracy and de- This Act may be cited as the ‘‘Chronic In February, former royalist parlia- velopment in the country—namely Wasting Disease Financial Assistance Act of mentarian Om Radsady was gunned Prime Minister Hun Sen—is out of 2003’’. down in a mafia-style murder in power, additional foreign aid will be SEC. 2. DEFINITION AND FINDINGS. Phnom Penh. Well liked and respected forthcoming. (a) CHRONIC WASTING DISEASE DEFINED.—In by his colleagues from all Cambodian It is important to recall that Hun this Act, the term ‘‘chronic wasting disease’’ political parties, Radsady’s assassina- Sen’s coup resulted in severe restric- means the animal disease afflicting deer and tion sent a not so subtle message that tions on assistance to Cambodia—that elk that— no one is immune from the black hand continue to this day. If given an oppor- (1) is a transmissible disease of the nervous of CPP. tunity through free and fair elections, system resulting in distinctive lesions in the It is time Hun Sen is held account- the Cambodian people will make the brain; and able for his complicity in actions that (2) belongs to the group of diseases known right choices that will ensure a dawn as transmissible spongiform grossly violate international and do- for development in that country. encephalopathies, which group includes mestic laws, and the human rights and Why will they make the right choice? scrapie, bovine spongiform encephalopathy, dignity of the people of Cambodia. Over the many decades he has been in and Cruetzfeldt-Jakob disease. The fundamental question facing the power, Hun Sen has ruled Cambodia (b) FINDINGS.—Congress finds the fol- Cambodian people today is whether the through violence, fear and repression. lowing: July 27th elections will be a meaning- Under his watch, the country has be- (1) The States retain undisputed primacy ful exercise in democracy, or another come a haven for sexual predators and and policy-making authority with regard to lost opportunity to chart a new course pedophiles, the criminal underworld, wildlife management, and nothing in this Act interferes with or otherwise affects the for that beleaguered country. and international terrorists. Hun Sen Last week, Prime Minister Hun Sen primacy of the States in managing wildlife has repeatedly abused the most basic of generally, or managing, surveying, and mon- assured Secretary of State Colin Pow- freedoms protected by the Cambodian itoring the incidence of chronic wasting dis- ell that Cambodia would hold free and Constitution, attacked his political op- ease in animal populations. fair elections. Secretary Powell should position, and perpetuated a climate of (2) Chronic wasting disease is a funda- not be duped by these hollow promises. impunity that stifles the advancement mental threat to the health and vibrancy of A preponderance of evidence suggests of freedom and free markets. deer and elk populations, and the increased that CPP is actively trying to steal the And he has never—not once—been occurrence of chronic wasting disease in the United States necessitates government ac- elections before July 27th: political ac- held accountable for his actions. tivists continue to be murdered and in- tion to manage and eradicate this lethal dis- In addition to increasing foreign as- ease. timidated, creating a chilling tone of sistance under certain conditions, the (3) As the States and tribal government fear and repression; the CPP continues Act restricts assistance to a Khmer move to manage existing incidence of chron- to directly influence and manipulate Rouge tribunal unless the President de- ic wasting disease and insulate non-infected the election machinery, with members termines that, among other things, the wild cervid populations from the disease, it of the National Election Commission, tribunal is supported by democratic is appropriate for the Federal Government to NEC, nominated in a closed manner by Cambodian political parties and is not support their efforts with financial assist- the co-Ministers of Interior and the under the control or influence of the ance. NEC already failing to investigate alle- CPP. It also requires the Federal Bu- SEC. 3. STATE CHRONIC WASTING DISEASE MAN- AGEMENT CAPACITY BUILDING gations of election improprieties; and, reau of Investigations to resume its in- GRANTS. opposition political parties continue to vestigation of the March 30, 1997 gre- (a) GRANTS AUTHORIZED.—The Secretary of lack access to media, with several nade attack against opposition leader the Interior shall make grants to State wild- broadcast outlets in Cambodia unwill- Sam Rainsy that killed and injured life management agencies to assist States in ing to sell air time to CPP’s chal- scores of Cambodians. developing and implementing long term lengers. I should remind my colleagues that management strategies to address chronic Let me take a moment to describe American democracy worker Ron wasting disease in wild cervids. what the Cambodian Democracy and Abney was injured in this act of ter- (b) ELIGIBILITY.—A wildlife management Accountability Act does—and does agency of a State whose comprehensive wild- rorism, reportedly carried out by the life conservation plan include chronic wast- not—do. CPP. Ron—and all the victims of this ing disease management activities is eligible The Act provides additional foreign attack—are still waiting for justice. for a grant under this section. assistance to Cambodia—an increase by Secretary Powell wrote in a June 24 (c) FUNDING PRIORITIES.—In determining half (or $21.5 million) over the fiscal op-ed that Zimbabwean dictator Robert the amount of grant funds to be provided to year 2004 budget request of $43 mil- Mugabe’s ‘‘time has come and gone.’’ eligible applicants under this section, the lion—if new leadership has been elected As democracy is similarly under siege Secretary shall prioritize applicants based in free and fair elections, and if Hun in both Zimbabwe and Cambodia, dic- on the following criteria: Sen is no longer Prime Minister. It has tator Hun Sen’s time has also come (1) States in which chronic wasting disease been apparent to me that Hun Sen has has been detected and States located adja- and gone. cent or in proximity to States in which long been part of Cambodia’s prob- chronic wasting disease has been detected. lems—and not part of the solution. By Mr. ALLARD (for himself, Mr. (2) States that have expended State funds The Act does not preclude the Cam- FEINGOLD, and Mr. CRAPO): for chronic wasting disease management, bodian people from voting for the polit- S. 1366. A bill to authorize the Sec- monitoring, surveillance, and research, with ical party of their choice. Ballot se- retary of the Interior to make grants additional priority given to those States

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00114 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8761 that have shown the greatest financial com- other involved agencies on issues of chronic ments do not have the financial re- mitment to managing, monitoring, sur- wasting disease management. sources to adequately confront the veying, and researching chronic wasting dis- (d) AUTHORIZATION OF APPROPRIATIONS.— problem. Their resources are spread too There are authorized to be appropriated ease. thin as they attempt to prevent the (3) States with comprehensive and inte- $3,000,000 to carry out this section. grated policies and programs focused on SEC. 6. ADMINISTRATION. disease from spreading. Federal help in chronic wasting disease management be- The Secretary of the Interior shall carry the form of management funding is ur- tween involved State wildlife and agricul- out this Act acting through the Director, gently needed. Federal funding will tural agencies and tribal governments, with United States Fish and Wildlife Service. help States and tribes to protect and additional priority given to States that have Funds appropriated to carry out this Act safeguard our valued wild deer and elk integrated the programs and policies of all shall be administered through the Federal from this disease. involved agencies related to chronic wasting Assistance Program in the United States Fish and Wildlife Service. Not more than I look forward to working with the disease management. Senate to secure passage of this meas- (4) States that are seeking to develop a three percent of such funds may be expended rapid response capacity to address outbreaks for administrative expenses of the United ure. This is a good bill, and it deserves of chronic wasting disease, whether occur- States Fish and Wildlife Service to carry out the Senate’s support. ring in States in which chronic wasting dis- this Act. ease is already found or States with first in- Mr. FEINGOLD. Mr. President, I am By Mr. MCCONNELL (for himself, fections, for the purpose of containing the pleased to join with my colleague from Mr. BAYH, and Mr. FITZGERALD): disease in any new area of infection. Colorado, Mr. ALLARD, as a cosponsor S. 1367. A bill to amend the Richard (d) AUTHORIZATION OF APPROPRIATIONS.— of the Chronic Wasting Disease Finan- B. Russell National School Act to es- There are authorized to be appropriated cial Assistance Act of 2003. This legis- tablish programs to promote increased $7,500,000 to carry out this section. lation is similar to legislation, S. 1036, consumption of milk in schools and to SEC. 4. GRANTS FOR STATES WITH CHRONIC the Chronic Wasting Disease Support improve the nutrition and health of WASTING DISEASE OUTBREAKS. Act of 2003, that we introduced earlier children; to the Committee on Agri- (a) GRANTS AUTHORIZED.—The Secretary of this year. the Interior shall make grants to State wild- culture, Nutrition, and Forestry. The House Resources Committee held Mr. McCONNELL. Mr. President, I life management agencies to assist States in a hearing on June 19, 2003 on the issue responding to chronic wasting disease out- rise today to introduce a very impor- breaks in wild cervids. of chronic wasting disease, or CWD. At tant piece of legislation that could pro- (b) ELIGIBILITY.—A wildlife management that hearing, state agency representa- vide great benefits for the health of our agency of a State whose comprehensive wild- tives argued strongly that Congress young people while simultaneously life conservation plan include chronic wast- should create a new grant program to strengthening the future viability of ing disease management activities is eligible provide assistance to states for the dairy producers throughout the United for a grant under this section. management of CWD. They also ex- States. (c) FUNDING PRIORITIES.—In determining pressed an interest in having those the amount of grant funds to be provided to My bill, the Child Nutrition Improve- funds distributed using an existing dis- ment Act of 2003, would provide incen- eligible applicants under this section, the tribution mechanism. This legislation Secretary shall prioritize applicants based tives for schools to encourage the con- on the following criteria: responds directly to these comments. sumption of milk as part of the school (1) State expenditures on chronic wasting In total, the bill directs the U.S. Fish lunch program and supply needed flexi- disease management, monitoring, surveil- and Wildlife Service to provide $20.5 bility for schools to offer a wide vari- lance, and research in response to manage- million in Federal grants to State and ety of milk products and flavors. ment of an on-going outbreak. tribal governments for CWD manage- There is no doubt that the eating (2) The number of chronic wasting disease ment in wild deer and elk, $10.5 million habits we develop when we are young cases detected in the State. more in resources than were included (3) The wild cervid population of the State. affect our habits and nutritional in the bill Senator ALLARD and I intro- choices for the rest of our lives. The (d) AUTHORIZATION OF APPROPRIATIONS.— duced earlier this year. There are authorized to be appropriated school lunch program has provided a The bill creates three new Federal $10,000,000 to carry out this section. key tool in promoting healthy eating CWD grant programs. The first pro- SEC. 5. TRIBAL CHRONIC WASTING DISEASE MAN- habits among young people, which have gram is a new nationwide CWD capac- AGEMENT GRANTS. both health and educational benefits. ity grant, authorized at a total of $7.5 (a) GRANTS AUTHORIZED.—The Secretary of Milk has been a critical component million. This program would provide the Interior shall make grants to tribal wild- of the school lunch program because it life management agencies to assist Indian grants to States so that they can fund is the principal source of calcium and a tribes in developing and implementing long CWD management programs. Pref- leading source of several other impor- term management strategies to address erence would be given to States with tant nutrients in our diet. That was chronic wasting disease in wild cervids. comprehensive and integrated chronic true when the federal program began in (b) ELIGIBILITY.—A wildlife management wasting disease management programs agency of an Indian tribe whose comprehen- 1946 and it is still true today. sive wildlife conservation plan include involving all relevant state agencies. The second grant program would pro- With 9 out of 10 teenage girls and 7 chronic wasting disease management activi- out of 10 teenage boys currently not ties is eligible for a grant under this section. vide additional $10 million in grant assistance to states like Colorado and getting enough calcium, milk’s impor- (c) FUNDING PRIORITIES.—In determining tant is perhaps greater today than ever the amount of grant funds to be provided to Wisconsin that already have detected eligible applicants under this section, the chronic wasting disease in their wild before. Serving milk with the school Secretary shall prioritize applicants based deer and elk. These States need addi- lunch is a critical step in addressing on the following criteria: tional help. Wisconsin has undertaken the calcium crisis. Federal child health (1) Tribal governments managing lands on significant measures to combat CWD at experts who are on the frontlines fight- which cervids with chronic wasting disease significant expense, and this program ing the calcium crisis recognize milk’s have been detected, or managing lands lo- central role in addressing the problem. cated adjacent or in proximity to lands on acknowledges that outbreaks are expensive to manage and require Federal Study after study, emphasize the need which cervids with chronic wasting disease for growing children and teens to con- have been detected. financial assistance. (2) Tribal governments that have expended Finally, the bill would create a third sume more milk for healthy bones, and tribal funds for chronic wasting disease man- $3 million grant program to provide the American Academy of Pediatrics agement, monitoring, surveillance, and re- CWD management grants directly to has urged its members to recommend search, with additional priority given to tribal governments. To be eligible for their patients get enough milk, cheese, tribal governments that have shown the these programs, States and tribes are yogurt and other calcium rich foods to greatest financial commitment to managing, given the ability under the bill to use help build bone mass. monitoring, and surveying chronic wasting an existing mechanism, the U.S. Fish As a result of these recommenda- disease. tions, we have seen a push for more (3) Tribal governments with cooperative and Wildlife Service Federal Assistance arrangements with Federal and State wild- Act procedures to expedite the receipt milk in more places in school, like life and agricultural agencies and State gov- of grant funds. vending machines and school stores. ernments, with additional priority given to This bill is needed because State There’s a real concern about nutritious tribal governments that are working with wildlife departments and tribal govern- choices for school children, and many

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00115 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8762 CONGRESSIONAL RECORD — SENATE June 26, 2003 local school districts and state legisla- is the goal of the legislation I am in- ‘‘(ii) improve the accessibility, presen- tures are pushing to add more health- troducing today. tation, positioning, or promotion of fluid ful beverage choices like milk. I ask my colleagues for your support milk throughout the school or institution or A large school vending test in 2001 of this important piece of legislation. at school or institution activities; demonstrated that kids will eagerly ‘‘(iii) improve the ability of a school or in- I ask unanimous consent that the stitution to tailor the plan to the customs buy milk from vending machines in text of the bill be printed in the and demographic characteristics of— schools when it is offered. The test was RECORD. ‘‘(I) the population of the school or institu- heralded by school nutritionists and There being no objection, the bill was tion; and helped stimulate nationwide interest in ordered to be printed in the RECORD, as ‘‘(II) the area in which the school or insti- getting milk vending machines into follows: tution is located; and more schools. S. 1367 ‘‘(iv) provide— ‘‘(I) packaging, flavor variety, merchan- A pilot test conducted in 146 schools Be it enacted by the Senate and House of Rep- with 100,000 students showed dramatic dising, refrigeration, and handling require- resentatives of the United States of America in ments that promote the consumption of fluid increases in milk consumption—15 per- Congress assembled, cent in elementary schools and 22 per- milk; and SECTION 1. SHORT TITLE. ‘‘(II) increased standard serving sizes for cent in secondary schools—when sim- This Act may be cited as the ‘‘Child Nutri- fluid milk consumed in middle and high ple improvements were made in the tion Improvement Act of 2003’’. schools. way milk was packaged and presented SEC. 2. CONSUMPTION OF MILK IN SCHOOLS. ‘‘(C) ADMINISTRATION.—In establishing cri- to students. The milk was served cold- (a) FLUID MILK.— teria for plans under this subsection, the er and kids loved the addition of a (1) IN GENERAL.—Section 9(a) of the Rich- Secretary shall— third flavor, it was usually strawberry. ard B. Russell National School Lunch Act (42 ‘‘(i) take into account relevant research; No only did kids drink more milk, U.S.C. 1758(a)) is amended by striking para- and more kids ate in the cafeteria. That graph (2) and inserting the following: ‘‘(ii) consult with school food service pro- ‘‘(2) FLUID MILK.— meant they not only got milk, they fessionals, nutrition professionals, food proc- ‘‘(A) IN GENERAL.—Lunches served by essors, agricultural producers, and other also got improved nutrition through schools participating in the school lunch groups, as appropriate. greater intake of vegetables, fruits and program under this Act— ‘‘(3) REIMBURSEMENT RATES AND INCEN- other nutritionally important foods. ‘‘(i) shall offer students fluid milk; and TIVES.— Milk has an unsurpassed nutrient ‘‘(ii) shall offer students a variety of fla- ‘‘(A) IN GENERAL.—For purposes of admin- package for young children and teens. vored and unflavored milk, as determined by istering the program established under para- Milk has nine essential vitamins and the school. graph (1), the Secretary shall annually pro- minerals, including calcium, vitamins ‘‘(B) FLUID MILK PRODUCTS.—A school or in- vide reimbursement rates and incentives for A, D and B12, protein, potassium, ribo- stitution that participates in the school free and reduced price meals otherwise pay- lunch program under this Act— able under this Act and the Child Nutrition flavin, niacin and phosphorus. These ‘‘(i) may offer a la carte fluid milk prod- nutrients are critical to good health Act of 1966 of not less than 2 cents and not ucts to be sold in addition to and, at the op- more than 10 cents per meal, to reflect the and the prevention of chronic disease. tion of the school, adjacent to fluid milk of- additional costs incurred by schools and in- In addition, it is the primary way that fered as part of a reimbursable meal; and stitutions in increasing the consumption of growing children get the calcium they ‘‘(ii) shall not directly or indirectly re- fluid milk under the program. need. In fact, according to the U.S. De- strict the sale or marketing of fluid milk ‘‘(B) CRITERIA.—The Secretary may vary partment of Agriculture about 75 per- products by the school (or by a person ap- the increase in reimbursement rates and in- cent of the calcium in our food supply proved by the school) at any time or any centives for free and reduced price meals place— based on the degree to which the school or comes from milk and foods made with ‘‘(I) on the school premises; or milk. By about age 20, the average institution adopts the criteria established by ‘‘(II) at any school-sponsored event.’’. the Secretary under paragraph (2).’’. young person has acquired about 98 (2) APPLICATION.—The amendment made by percent of his or her skeletal mass. paragraph (1) applies to an agreement or con- SEC. 4. IMPROVED NUTRITION AND PHYSICAL AC- Building strong bones during childhood tract entered into on or after the date of en- TIVITY LEVEL OF CHILDREN. and adolescence is one of the best de- actment of this Act. Section 12 of the Richard B. Russell Na- fenses against developing osteoporosis (b) INCREASED CONSUMPTION OF MILK IN tional School Lunch Act (42 U.S.C. 1760) (as later in life. SCHOOLS.—Section 12 of the Richard B. Rus- amended by section 2(b)) is amended by add- sell National School Lunch Act (42 U.S.C. In addition to the bone-building ben- ing at the end the following: 1760) is amended by adding at the end the fol- efits of milk, research indicates that a lowing: ‘‘(r) IMPROVED NUTRITION AND PHYSICAL AC- diet rich in low-fat milk may help re- ‘‘(q) INCREASED CONSUMPTION OF MILK IN TIVITY LEVEL OF CHILDREN.— duce the risk of high blood pressure SCHOOLS.— ‘‘(1) DEFINITION OF HEALTHY SCHOOL ENVI- and heart disease and help prevent ‘‘(1) IN GENERAL.—To encourage healthier RONMENT PROGRAM.—In this subsection, the breast cancer, colon cancer and even nutritional environments in schools and in- term ‘healthy school environment program’ help in the fight against obesity. stitutions receiving funds under this Act and means a program that— Milk’s role in a nutritious diet has the Child Nutrition Act of 1966 (42 U.S.C. 1771 ‘‘(A) is designed to improve the environ- long been noted by the nutrition and et seq.) (other than section 17 of that Act (42 ment of a school with respect to the nutri- U.S.C. 1786)), the Secretary shall establish a tion and physical activity level of children science community, including the program under which any such school or in- enrolled in the school; and American Academy of Pediatrics, the stitution may (in accordance with paragraph ‘‘(B) includes steps to improve and make American Dietetic Association, the Na- (3)) receive an increase in the reimbursement available healthy food choices (including tional Institute of Child Health and rate for free and reduced price meals other- fruits, vegetables, and dairy products). Human Development, the National wise payable under this Act and the Child ‘‘(2) PROGRAM.—The Secretary shall carry Osteoporosis Foundation, the U.S. De- Nutrition Act of 1966, if the school or institu- out a program to provide grants to schools partment of Agriculture, and many tion implements a plan for improving the nu- that implement healthy school environment other reputable health organizations. tritional value of meals consumed in the programs. As I have already mentioned, govern- school or institution by increasing the con- ‘‘(3) ADMINISTRATION.—In carrying out the sumption of fluid milk in the school, as ap- program, the Secretary may enter into coop- ment statistics indicate that we have a proved by the Secretary in accordance with erative agreements with— calcium crisis among our children and criteria established by the Secretary. ‘‘(A) nonprofit organizations; youth. Nearly 90 percent of teenage ‘‘(2) PLANS.— ‘‘(B) educational and scientific institu- girls and almost 70 percent of teenage ‘‘(A) IN GENERAL.—For purposes of the pro- tions; boys fail to get enough calcium in their gram established under paragraph (1), the ‘‘(C) Federal, State, and local agencies; and diets. During the teen years nearly half Secretary shall establish criteria for the ap- ‘‘(D) other entities that contribute funds of all bone is formed and about 15 per- proval of plans of schools and institutions or in-kind services for the program. cent of your adult height is added. As a for increasing consumption of fluid milk. ‘‘(4) ACCEPTANCE OF FUNDS.—Notwith- ‘‘(B) CRITERIA.—An approved plan may— standing any other provision of law, the Sec- national health priority, for proper ‘‘(i) establish targeted goals for increasing retary may accept funds from an entity re- growth and development, we need to be fluid milk consumption throughout the ferred to in paragraph (3) solely for use in doing all we can to encourage our chil- school or institution or at school or institu- carrying out the program under this sub- dren and youth to drink milk, and that tion activities; section.’’.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00116 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8763 SUBMITTED RESOLUTIONS SENATE RESOLUTION 188—HON- (3) extends its condolences to the Jackson ORING MAYNARD HOLBROOK family and the City of Atlanta on the death JACKSON, JR. FORMER MAYOR of a remarkable man. OF THE CITY OF ATLANTA, AND SENATE RESOLUTION 187—EX- EXTENDING THE CONDOLENCES SENATE RESOLUTION 189—ELECT- PRESSING THE SENSE OF THE OF THE SENATE ON HIS DEATH ING DOCTOR BARRY C. BLACK, OF BALTIMORE, MARYLAND, AS SENATE REGARDING THE CEN- Mr. CHAMBLISS (for himself and Mr CHAPLAIN OF THE UNITED TENARY OF THE RHODES SCHOL- MILLER) submitted the following reso- STATES SENATE ARSHIPS IN THE UNITED STATES lution; which was: AND THE ESTABLISHMENT OF Mr. FRIST (for himself and Mr. S. RES. 188 ASCHLE) submitted the following reso- THE MANDELA RHODES FOUNDA- D Whereas the Honorable Maynard Holbrook lution; which was: TION Jackson, Jr. was born on March 23, 1938, in S. RES. 189 Dallas, Texas, and at the age of 14 entered Mr. LUGAR (for himself, Mr. SAR- Resolved, That Doctor Barry C. Black, of Morehouse College as a Ford Foundation Baltimore, Maryland, be, and he is hereby, BANES, and Mr. FEINGOLD) submitted Early Admission Scholar; elected Chaplain of the Senate, effective the following resolution; which was: Whereas the Honorable Maynard Holbrook Monday, July 7, 2003. Jackson, Jr. graduated cum laude from North S. RES. 187 Carolina Central University School of Law; Whereas the Rhodes Scholarships, the old- Whereas the Honorable Maynard Holbrook SENATE RESOLUTION 190—COM- est international fellowships, were initiated Jackson, Jr. became the first African–Amer- MENDING GENERAL ERIC after the death of Cecil Rhodes in 1902, and ican Vice Mayor of the City of Atlanta; SHINSEKI OF THE UNITED now bring outstanding students from the Whereas the Honorable Maynard Holbrook STATES ARMY FOR HIS OUT- United States, Australia, Bangladesh, Ber- Jackson, Jr. proved to be a gifted and bril- STANDING SERVICE AND COM- muda, Canada, the Commonwealth Carib- liant political leader, and he later became MITMENT TO EXCELLENCE the first African–American Mayor of the bean, Germany, Hong Kong, India, Jamaica, Mr. AKAKA (for himself, Mr. INHOFE, Kenya, Malaysia, New Zealand, Pakistan, City of Atlanta; Whereas, during his years in office, the Mr. WARNER, Mr. LEVIN, Mrs. MURRAY, Singapore, South Africa, Uganda, Zambia, Mr. DODD, Ms. LANDRIEU, Mr. PRYOR, and Zimbabwe to the University of Oxford; Honorable Maynard Holbrook Jackson, Jr. was the catalyst for the design of a $400 mil- Mr. DASCHLE, Mr. BIDEN, Mr. KENNEDY, Whereas the first American Rhodes Schol- lion terminal at Atlanta’s Hartsfield Inter- Mr. FEINGOLD, Mr. DURBIN, Mr. NELSON ars were elected in 1904, and since that time national Airport; of Nebraska, Mr. NELSON of Florida, distinguished American Rhodes alumni have Whereas the Honorable Maynard Holbrook Mr. REED, Mr. CHAMBLISS, Ms. CANT- included over 20 members of Congress, a Jackson, Jr. helped to secure Atlanta’s selec- President of the United States, 3 Supreme WELL, Mr. SARBANES, Mrs. CLINTON, Mr. tion as the site of the 1996 Summer Olym- ROBERTS, Mr. LAUTENBERG, Mr. LIEBER- Court justices, cabinet members, military pics; MAN, Mr. DAYTON, Ms. MURKOWSKI, Mr. leaders, 80 heads of colleges or universities, Whereas the Honorable Maynard Holbrook INOUYE, Mr. HAGEL, Ms. COLLINS, and and prominent artists, scientists, and busi- Jackson, Jr. served as president of the Na- ness people; tional Conference of Democratic Mayors and Mr. STEVENS) submitted the following Whereas the Mandela Rhodes Foundation, the National Black Caucus of Local Elected resolution; which was: a partnership between the Rhodes Trust and Officials; S. RES. 190 the Nelson Mandela Foundation, was estab- Whereas the Honorable Maynard Holbrook Whereas General Eric Shinseki, the Army’s lished in February, 2002; Jackson, Jr. became Chair of the National 34th Chief of Staff, retired in June 2003, from Whereas after a lifetime of struggle Voting Rights Institute of the Democratic active military duty after 37 distinguished against apartheid and the momentous chal- National Committee; years of service; lenge of governing the new South Africa as Whereas the Honorable Maynard Holbrook Whereas General Shinseki, a native of Ha- its first democratically elected President, Jackson, Jr. established the American Vot- waii, graduated from the United States Mili- Nobel Peace Prize Laureate Nelson ers League, a nonpartisan organization com- tary Academy, West Point, in 1965 and served Rolihlahla Mandela continues to be devoted mitted to increasing voter turnout; in a variety of assignments, including 2 com- to building a society characterized by justice Whereas upon being elected Mayor of At- bat tours in Vietnam, and was wounded lanta, the Honorable Maynard Holbrook and opportunity in the Republic of South Af- twice in combat while serving his country; Jackson, Jr. began encouraging and fos- rica; Whereas General Shinseki has been award- tering interracial understanding in Atlanta; ed the Defense Distinguished Service Medal, Whereas President Mandela’s efforts have Whereas the Honorable Maynard Holbrook Distinguished Service Medal, Legion of manifested themselves in the work of the Jackson, Jr. was a strong supporter of af- Merit (with oak leaf clusters), Bronze Star Nelson Mandela Children’s Fund, established firmative action, civil rights, and the expan- Medal with ‘‘V’’ Device (with 2 oak leaf clus- in the wake of President Mandela’s pledge to sion of social and economic gains for minori- ters), Purple Heart (with oak leaf cluster), 1 devote ⁄3 of his Presidential salary to ties; Meritorious Service Medal (with 2 oak leaf projects aimed at improving the quality of Whereas the Honorable Maynard Holbrook clusters), Air Medal, Army Commendation life of South Africa’s disadvantaged children; Jackson, Jr. was a great champion for diver- Medal (with oak leaf cluster), Army Achieve- and sity, inclusion, and fairness–not just in gov- ment Medal, Parachutist Badge, Ranger Tab, Whereas in Cape Town in February, 2002, ernment and business, but also in all areas of Office of the Secretary of Defense Identifica- President Mandela noted that the partner- life; tion Badge, Joint Chiefs of Staff Identifica- ship between the Rhodes Trust and the new Whereas the Honorable Maynard Holbrook tion Badge, and the Army Staff Identifica- Mandela Foundation signals ‘‘the closing of Jackson, Jr. was a wonderful human being tion Badge; the circle and the coming together of 2 who never wavered from the principles that Whereas General Shinseki has spent the strands in our history’’: Now, therefore, be it guided his life and career; last 4 years of his career in the highest posi- Resolved, That the Senate— Whereas the efforts of the Honorable May- tion attainable in the Army and has proven nard Holbrook Jackson, Jr. on behalf on the (1) celebrates the centenary of the Rhodes himself a tremendous leader who has dem- City of Atlanta and all Americans earned Scholarships in the United States; onstrated unselfish devotion to this Nation him the esteem and high regard of his col- and the soldiers he leads; (2) welcomes the establishment of the leagues; and Whereas General Shinseki focused the Mandela Rhodes Foundation, which em- Whereas the untimely death of the Honor- Army on improved readiness in preparation bodies the spirit of reconciliation and shared able Maynard Holbrook Jackson, Jr. has de- for war and transformed the Army into the commitment that is one of South Africa’s prived his community, the City of Atlanta, lean, agile, lethal fighting force that greatest assets; the state of Georgia, and the entire Nation of achieved victories during Operations Endur- (3) shares the Foundation’s commitment to an outstanding leader: Now, therefore, be it: ing Freedom and Iraqi Freedom; support initiatives aimed at increasing edu- Now, therefore, be it Whereas General Shinseki provided the vi- cational opportunities, fostering leadership, Resolved: That the Senate— sion to set the Army on a path of trans- and promoting human resource development (1) honors the life and accomplishments of formation that will provide the Nation with throughout Africa; and the Honorable Maynard Holbrook Jackson an Army that is more lethal, agile, (4) affirms the support of the United States Jr.; deployable, and flexible; capable of fighting for these worthy goals throughout the sub- (2) recognizes the legendary compassion and winning this Nation’s wars in all future Saharan region, and asserts that the pursuit exhibited by the Honorable Maynard Hol- threat environments. of these goals is in the shared interest of the brook Jackson, Jr. as a civil rights leader; Whereas General Shinseki exemplifies the American and African people. and trademark characteristics exhibited by all

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00117 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8764 CONGRESSIONAL RECORD — SENATE June 26, 2003 great leaders and is a remarkable man of in- each one of us—recording whether in ple Heart, and a life-sized bronze statue tegrity, courage, and honor; our brief span of service we fulfilled stands in Raritan, New Jersey, where ‘‘Ma- Whereas General Shinseki is an American our responsibilities, we will be meas- nila John’’ is clad in battle dress and cradles hero who has been selfless in his service to ured by the answers to four questions— a machine gun in his arms; his country through war, peace, and personal Whereas, in 1949, the United States Gov- trial, and epitomizes the spirit of aloha; and were we truly men of courage . . . were ernment commissioned a destroyer the Whereas John F. Kennedy, the 35th Presi- we truly men of judgment . . . were we U.S.S. Basilone, and in November 1951, Gov- dent of the United States once said, ‘‘When truly men of integrity . . . were we ernor Alfred E. Driscoll posthumously at some future date the high court of history truly men of dedication?’’ When his- awarded Sergeant Basilone the State of New sits in judgment of each one of us—recording tory looks back at the Army’s 34th Jersey’s highest decoration; whether in our brief span of service we ful- Chief of Staff, it will be clear that this Whereas, following World War II, Sergeant filled our responsibilities, we will be meas- was truly a man of courage, judgment, Basilone’s remains were reinterred in the Ar- ured by the answers to 4 questions—were we integrity, and dedication. lington National Cemetery; truly men of courage . . . were we truly men General Shinseki is to be commended Whereas Sergeant Basilone was the first of judgment . . . were we truly men of integ- for his patriotism, unwavering commit- recipient of the Congressional Medal of rity . . . were we truly men of dedication?’’ Honor awarded in World War II; and whereas when history looks back at the ment to this Nation, and his meri- Whereas Sergeant Basilone was also award- Army’s 34th Chief of Staff, it will be clear torious service to this country. ed the Navy Cross and the Purple Heart, giv- that this was truly a man of courage, judg- ing him the distinction of being the only en- ment, integrity, and dedication: Now, there- SENATE CONCURRENT RESOLU- listed Marine in World War II to receive all fore, be it TION 56—EXPRESSING THE 3 medals; and Resolved, SENSE OF THE CONGRESS THAT Whereas commemorative postage stamps SECTION 1. COMMENDATION. A COMMEMORATIVE POSTAGE have been commissioned to honor other The Senate— STAMP SHOULD BE ISSUED HON- great heroes in American history: Now, therefore, be it (1) thanks General Eric Shinseki of the ORING GUNNERY SERGEANT United States Army on behalf of a grateful Resolved by the Senate (the House of Rep- Nation; and JOHN BASILONE, A GREAT resentatives concurring), That it is the sense (2) commends General Eric Shinseki for his AMERICAN HERO of Congress that— extraordinary dedication to service to this Mr. CORZINE (for himself, Mr. WAR- (1) a commemorative postage stamp should be issued by the United States Postal Serv- great country and for his lifetime of commit- NER, Mr. LAUTENBERG, and Mrs. CLIN- ment to excellence. ice honoring Gunnery Sergeant John TON) submitted the following concur- Basilone; and SEC. 2. TRANSMITTAL OF RESOLUTION. rent resolution; which was referred to (2) the Citizens’ Stamp Advisory Com- The Senate directs the Secretary of the the Committee on Governmental Af- mittee should recommend to the Postmaster Senate to transmit an enrolled copy of this fairs: General that such a stamp be issued. resolution to General Eric Shinseki. S. CON. RES. 56 Mr. CORZINE. Mr. President, I rise Mr. AKAKA. Mr. President, I rise Whereas Gunnery Sergeant John Basilone today to submit a concurrent resolu- today to honor a great American hero, was born in 1916 in Buffalo, New York, son of tion calling on the United States Post- General Eric Shinseki, the Army’s 34th Salvatore and Dora Basilone, one of 10 chil- al Service to issue a commemorative Chief of Staff. General Shinseki, a na- dren; postage stamp honoring an extraor- tive of Hawaii, attained the Army’s Whereas John Basilone was raised and edu- dinary American hero: Gunnery Ser- cated in Raritan, New Jersey; highest position as the Army’s Chief of geant John Basilone. Basilone is the Staff in June 1999 and retired in June Whereas, at the age of 18, John Basilone enlisted in the United States Army, prin- only person in American history to be 2003. awarded both the Congressional Medal Ric Shinseki graduated from the cipally seeing garrison service in the Phil- ippines; of Honor and the Navy Cross. Only one United States Military Academy, West Whereas, after his honorable discharge in USPS stamp has ever commemorated Point, in 1965. He served two combat 1937, Sergeant Basilone, known by his com- an individual Marine, a stamp fea- tours in Vietnam and was wounded rades as ‘‘Manila John’’, returned to Raritan; turing John Phillip Sousa; it bears not- twice in combat. Throughout his 37 Whereas, seeing the storm clouds of war ing that although Sousa was a Marine, years of service to this country, he has hovering over the Nation, and believing that he was not selected for his service on given his personal best, serving with his place was with this country’s fighting forces, Sergeant Basilone enlisted in the the battlefield. It is time to remember great pride and dignity. His legacy to the tremendous sacrifice of at least one this Nation will live on for years to United States Marine Corps in July 1940; Whereas, on October 24 and 25, 1942, on individual Marine, John Basilone, an come. Guadalcanal, Solomon Islands, Sergeant American Patriot. Over the span of his career, I’ve Basilone was a member of ‘‘C’’ Company, 1st John Basilone was raised in Raritan, watched his progress as a soldier and Battalion, 7th Regiment, 1st Marine Divi- NJ, one of ten children in a large was privileged to participate in his pro- sion, and was in charge of 2 sections of heavy Italian-American family. Soon after he motion ceremony to Colonel. At that machine guns defending a narrow pass that turned 18, Basilone heeded the patri- time, I thought he had a stellar career led to Henderson Airfield; otic call and enlisted in the U.S. Army. as a ‘‘soldier’s soldier.’’ I was very Whereas, although Sergeant Basilone and Basilone was immediately sent to the proud to witness his four years of serv- his machine gunners were vastly out- numbered and without available reinforce- Philippines where he earned a nick- ice as the Army’s Chief of Staff. He was ments, Sergeant Basilone and his fellow Ma- name that would stick with him for the the perfect soldier to lead our Army rines fought valiantly to check the savage rest of his career: ‘‘Manila John.’’ into the 21st century. and determined assault by the Japanese Im- Following his tour of duty in 1937, This remarkable man and distin- perial Army; Basilone returned to Raritan. But he guished decorated soldier set a new Whereas, for this action, Sergeant Basilone wouldn’t stay there long. In July 1940— standard for the Army. With extraor- was awarded the Congressional Medal of with much of Europe at war and the dinary vision, he transformed the Honor and sent home a hero; United States on the brink—‘‘Manila Army into an agile, lean, flexible, and Whereas, in December 1944, Sergeant John’’ left New Jersey, enlisting in the lethal fighting force. This man of Basilone’s restlessness to rejoin his fellow Marines, who were fighting the bloody is- military once again, this time joining honor, integrity, and courage set a land-to-island battles en route to the Phil- the United States Marine Corps. higher standard for all to follow, all ippines and Japan, prompted him to volun- On October 24, 1942, Basilone earned while embodying the spirit of aloha. teer again for combat; his Congressional Medal of Honor. He With his deep sense of pride and dedica- Whereas, on Iwo Jima, on February 19, was sent to a position on the Tenaru tion to service, he made our Army 1945, Sergeant Basilone again distinguished River at Guadalcanal and placed in stronger, one able to achieve swift vic- himself by single-handedly destroying an command of two sections of heavy ma- tories during Operations Enduring enemy blockhouse while braving heavy-cal- chine guns. Sergeant Basilone and his Freedom and Iraqi Freedom. iber fire; men were charged with defending Hen- Whereas, minutes later, an artillery shell As I quoted in the Senate Resolution, killed Sergeant Basilone and 4 of his platoon derson Airfield, an important Amer- President John F. Kennedy once said, members; ican foothold on the island. Although ‘‘When at some future date the high Whereas Sergeant Basilone was post- the Marine contingent was vastly out- court of history sits in judgment of humously awarded the Navy Cross and Pur- numbered and without needed support,

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00118 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8765 Basilone and his men successfully re- Health, Education, Labor, and Pen- purposes; which was ordered to lie on the pelled a Japanese assault. Other sur- sions: table. SA 1095. Mr. REID (for Mr. JOHNSON (for vivors reported that their success can S. CON. RES. 57 himself and Mr . COCHRAN)) proposed an be attributed to one man: ‘‘Manila Whereas Dr. Norman C. Francis, an educa- amendment to the bill S. 1, supra. John.’’ He crossed enemy lines to re- tor and institution builder, earned a Bach- SA 1096. Ms. MURKOWSKI (for herself and plenish a dangerously low stockpile of elor of Science degree from Xavier Univer- Mr. STEVENS) submitted an amendment in- ammunition, repaired artillery pieces, sity of Louisiana, received a Juris Doctorate tended to be proposed by her to the bill S. 1, and steadied his troops in the midst of degree from Loyola University of the South supra. torrential rain. He went several days Law School, and served in the Third Ar- SA 1097. Mr. McCONNELL proposed an mored Division of the United States Army; amendment to the bill S. 1, supra. and nights without food or sleep, and Whereas Dr. Norman C. Francis has served SA 1098. Mr. DAYTON submitted an the U.S. military was able to carry the as president of Xavier University of Lou- amendment intended to be proposed by him day. His exploits became Marine lore, isiana for 34 years, which ranks him among to the bill S. 1, supra; which was ordered to and served as a patriotic inspiration to the most tenured of college presidents now lie on the table. others facing daunting challenges in serving in the United States; SA 1099. Mr. DAYTON submitted an the midst of war. Whereas Dr. Norman C. Francis embodies a amendment intended to be proposed by him to the bill S. 1, supra; which was ordered to For his courage under fire and pro- spirit of greatness and leadership in his roles as an outstanding president and advocate for lie on the table. found patriotism, Basilone was the SA 1100. Mr. DAYTON submitted an academic excellence at Xavier University; amendment intended to be proposed by him first enlisted Marine to be awarded the Whereas Dr. Norman C. Francis has cre- to the bill S. 1, supra; which was ordered to Congressional Medal of Honor. When he ated an environment at Xavier University lie on the table. returned to the United States, he was that gives students the opportunity to gain heralded as a hero and quickly sent on SA 1101. Mr. DAYTON submitted an valuable knowledge and skills that are nec- amendment intended to be proposed by him tour around the country to help fi- essary for success in today’s challenging to the bill S. 1, supra; which was ordered to nance the war through the sale of war world; and lie on the table. bonds. The Marine Corps offered to Whereas Dr. Norman C. Francis has dili- SA 1102. Mr. McCONNELL proposed an commission Basilone as an officer and gently served the African-American and amendment to the bill S. 1, supra. other minority communities: Now, therefore, station him far away from the SA 1103. Mr. DORGAN (for himself and Mr. be it PRYOR) proposed an amendment to amend- frontlines. Resolved by the Senate (the House of Rep- ment SA 1092 proposed by Mr. GRASSLEY But Basilone was not interested in resentatives concurring), (for himself and Mr. BAUCUS) to the bill S. riding out the war in Washington, DC. SECTION 1. COMMENDATION. 1, supra. He was quoted as saying, ‘‘I ain’t no of- That Congress— SA 1104. Mr. KOHL (for himself and Mr. ficer, and I ain’t no museum piece. I be- (1) is grateful to Dr. Norman Christopher REID) submitted an amendment intended to long back with my outfit.’’ In Decem- Francis; be proposed by him to the bill S. 1, supra; (2) honors Dr. Francis for his steadfast which was ordered to lie on the table. ber 1944, he got his wish and returned SA 1105. Mr. HATCH submitted an amend- to the frontlines. commitment and dedication to education; (3) commends Dr. Francis for recognizing ment intended to be proposed by him to the General Douglas MacArthur called the need for diversity in education; and bill S. 1, supra; which was ordered to lie on him ‘‘a one-man army,’’ and on Feb- (4) hopes that Dr. Norman C. Francis, an the table. ruary 19, 1945 at Iwo Jima, Basilone educator and institution builder, continues SA 1106. Mr. HATCH (for himself and Mr. once again lived up to that reputation. to be a leader of the best and brightest stu- WYDEN) submitted an amendment intended dents and educators. to be proposed by him to the bill S. 1, supra. Basilone destroyed an enemy strong- SA 1107. Mr. COCHRAN submitted an hold, a blockhouse on that small Japa- SEC. 2. TRANSMITTAL OF RESOLUTION. amendment intended to be proposed by him nese island and commanded his young The Senate directs the Secretary of the to the bill S. 1, supra; which was ordered to troops to move the heavy guns off the Senate to transmit an enrolled copy of this lie on the table. beach. Unfortunately, less than two resolution to Dr. Norman Christopher SA 1108. Mr. DURBIN proposed an amend- Francis. hours into the assault on that fateful ment to the bill S. 1, supra. Ms. LANDRIEU. Mr. President, I rise SA 1109. Mr. BURNS (for himself and Ms. day in February, Basilone and four of to make a few remarks concerning an MURKOWSKI) submitted an amendment in- his fellow Marines were killed when an individual who has longstanding dedi- tended to be proposed by him to the bill S. 1, enemy mortar shell exploded nearby. cation and service specific to Xavier supra; which was ordered to lie on the table. When Gunnery Sergeant John SA 1110. Mr. BAUCUS (for Mr. LEVIN) pro- University and to education as a whole. Basilone died he was only 27, but he posed an amendment to the bill S. 1, supra. Dr. Francis is being honored by the had already earned the Congressional SA 1111. Mr. BAUCUS (for Mr. LEVIN (for Urban League of Greater New Orleans Medal of Honor, the Navy Cross, the himself, Ms. STABENOW, and Mrs. CLINTON)) on June 28, 2003, for his leadership at proposed an amendment to the bill S. 1, Purple Heart, and the appreciation of Xavier University as an outstanding supra. his Nation. Basilone is a true American President and advocate for academic SA 1112. Mr. KERRY submitted an amend- patriot whose legacy should be pre- ment intended to be proposed by him to the excellence. served. bill S. 1, supra; which was ordered to lie on Mr. President, I wish to recognize Dr. the table. Now more than ever, the United Norman C. Francis who has exhibited a States needs to honor and praise the SA 1113. Mr. GRASSLEY proposed an spirit of greatness and for his leader- amendment to the bill S. 312, to amend title courageous efforts put forth by the ship at Xavier University of Louisiana XXI of the Social Security Act to extend the men and women of our military. I as an outstanding President and advo- availability of allotments for fiscal years strongly urge my colleagues to support cate for academic excellence. 1998 through 2001 under the State Children’s this resolution as an important mes- It is certainly important to reflect Health Insurance Program. sage to our soldiers that we appreciate SA 1114. Mr. KYL submitted an amend- upon his accomplishments as Dr. ment intended to be proposed by him to the and admire all of their efforts in the Francis is still motivated to new lev- war on terrorism. bill S. 1, to amend title XVIII of the Social els, to enhance educational opportuni- Security Act to provide for a voluntary pre- ties throughout our colleges and uni- scription drug benefit under the Medicare SENATE CONCURRENT RESOLU- versities and throughout the commu- program and to strengthen and improve the TION 57—HONORING DR. NORMAN nity at large. Medicare program, and for other purposes. SA 1115. Mr. KYL (for himself, Mr. HATCH, CHRISTOPHER FRANCIS, PRESI- f DENT OF XAVIER UNIVERSITY and Ms. MURKOWSKI) submitted an amendment intended to be proposed by him to the OF LOUISIANA, FOR HIS LONG- AMENDMENTS SUBMITTED & PROPOSED bill S. 1, supra. STANDING DEDICATION AND SA 1116. Mr. DAYTON (for himself, Mr. SERVICE SPECIFIC TO XAVIER SA 1094. Mr. SESSIONS submitted an COLEMAN, and Mr . SMITH) submitted an UNIVERSITY AND TO EDUCATION amendment intended to be proposed by him amendment intended to be proposed by him AS A WHOLE to the bill S. 1, to amend title XVIII of the to the bill S. 1, supra; which was ordered to Social Security Act to provide for a vol- lie on the table. Ms. LANDRIEU submitted the fol- untary prescription drug benefit under the SA 1117. Mr. BAUCUS submitted an amend- lowing concurrent resolution; which Medicare program and to strengthen and im- ment intended to be proposed by him to the was referred to the Committee on prove the Medicare program, and for other bill S. 1, supra.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00119 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8766 CONGRESSIONAL RECORD — SENATE June 26, 2003 SA 1118. Mr. SPECTER submitted an to the bill S. 1, to amend title XVIII of Secretary shall ensure that the aggregate amendment intended to be proposed by him the Social Security Act to provide for payments made by the Secretary do not ex- to the bill S. 1, supra. a voluntary prescription drug benefit ceed the amount which the Secretary would SA 1119. Mrs. LINCOLN submitted an under the Medicare program and to have paid if the assessment program under amendment intended to be proposed by her strengthen and improve the Medicare this section was not implemented. to the bill S. 1, supra; which was ordered to (f) WAIVER AUTHORITY.—The Secretary lie on the table. program, and for other purposes; as fol- may waive such requirements of titles XI SA 1120. Mr. DAYTON (for himself, Mr. lows: and XVIII of the Social Security Act (42 COLEMAN, and Mr . SMITH) submitted an At the end of subtitle A of title I, add the U.S.C. 1301 et seq.; 1395 et seq.) as may be amendment intended to be proposed by him following: necessary for the purpose of carrying out the to the bill S. 1, supra; which was ordered to SEC. ll. MEDICATION THERAPY MANAGEMENT assessment program under this section. lie on the table. ASSESSMENT PROGRAM. (g) AVAILABILITY OF DATA.—During the pe- SA 1121. Mr. KYL (for himself, Mr. NICK- (a) ESTABLISHMENT.— riod in which the assessment program is con- LES, Mr. GREGG, Mr. THOMAS, and Mr. LOTT) (1) IN GENERAL.—The Secretary shall estab- ducted, the Secretary annually shall make proposed an amendment to the bill S. 1, lish an assessment program to contract with available data regarding— supra. qualified pharmacists to provide medication (1) the geographic areas and sites des- SA 1122. Mr. BROWNBACK (for himself and therapy management services to eligible ignated under subsection (a)(2); Mr. NELSON, of Nebraska) submitted an beneficiaries who receive care under the (2) the number of eligible beneficiaries par- amendment intended to be proposed by him original medicare fee-for-service program ticipating in the program under subsection to the bill S. 1, supra. under parts A and B of title XVIII of the So- (b) and the level and types medication ther- SA 1123. Mr. DEWINE submitted an amend- cial Security Act to eligible beneficiaries. apy management services used by such bene- ment intended to be proposed by him to the (2) SITES.—The Secretary shall designate 6 ficiaries; bill S. 1, supra; which was ordered to lie on geographic areas, each containing not less (3) the number of qualified pharmacists the table. than 3 sites, at which to conduct the assess- with contracts under subsection (c), the loca- SA 1124. Mr. ROBERTS submitted an ment program under this section. At least 2 tion of such pharmacists, and the number of amendment intended to be proposed by him geographic areas designated under this para- eligible beneficiaries served by such phar- to the bill S. 1, supra; which was ordered to graph shall be located in rural areas. macists; and lie on the table. (3) DURATION.—The Secretary shall con- (4) the types of payment methodologies SA 1125. Mr. HATCH submitted an amend- duct the assessment program under this sec- being tested under subsection (d)(2). tion for a 1-year period. ment intended to be proposed by him to the (h) REPORT.— (4) IMPLEMENTATION.—The Secretary shall bill S. 1, supra; which was ordered to lie on (1) IN GENERAL.—Not later than 6 months the table. implement the program not later than Janu- after the completion of the assessment pro- SA 1126. Mrs. DOLE (for herself and Mr. ary 1, 2005, but may not implement the as- gram under this section, the Secretary shall EDWARDS) submitted an amendment intended sessment program before October 1, 2004. submit to Congress a final report summa- (b) PARTICIPANTS.—Any eligible beneficiary to be proposed by her to the bill S. 1, supra. rizing the final outcome of the program and who resides in an area designated by the Sec- SA 1127. Mr. CHAMBLISS submitted an evaluating the results of the program, to- retary as an assessment site under sub- amendment intended to be proposed by him gether with recommendations for such legis- to the bill S. 1, supra; which was ordered to section (a)(2) may participate in the assessment program under this section if such ben- lation and administrative action as the Sec- lie on the table. retary determines to be appropriate. SA 1128. Mr. SPECTER submitted an eficiary identifies a qualified pharmacist who agrees to furnish medication therapy (2) ASSESSMENT OF PAYMENT METHODOLO- amendment intended to be proposed by him GIES.—The final report submitted under to the bill S. 1, supra; which was ordered to management services to the eligible beneficiary under the assessment program. paragraph (1) shall include an assessment of lie on the table. (c) CONTRACTS WITH QUALIFIED PHAR- the feasibility and appropriateness of the SA 1129. Mr. DASCHLE (for Mr. KERRY) MACISTS.— various payment methodologies tested under submitted an amendment intended to be pro- (1) IN GENERAL.—The Secretary shall enter subsection (d)(2). posed by Mr. Daschle to the bill S. 1 , supra; into a contract with qualified pharmacists to (i) DEFINITIONS.—In this section: which was ordered to lie on the table. provide medication therapy management (1) MEDICATION THERAPY MANAGEMENT SA 1130. Mr. ROBERTS submitted an services to eligible beneficiaries residing in SERVICES.—The term ‘‘medication therapy amendment intended to be proposed by him the area served by the qualified pharmacist. management services’’ means services or to the bill S. 1, supra; which was ordered to (2) NUMBER OF QUALIFIED PHARMACISTS.— programs furnished by a qualified phar- lie on the table. The Secretary may contract with more than macist to an eligible beneficiary, individ- SA 1131. Mr. KYL submitted an amend- 1 qualified pharmacist at each site. ually or on behalf of a pharmacy provider, ment intended to be proposed by him to the (d) PAYMENT TO QUALIFIED PHARMACISTS.— which are designed— bill S. 1, supra; which was ordered to lie on (1) IN GENERAL.—Under an contract entered (A) to ensure that medications are used ap- the table. into under subsection (c), the Secretary shall propriately by such individual; SA 1132. Mr. SANTORUM proposed an pay qualified pharmacists a fee for providing (B) to enhance the individual’s under- amendment to the bill S. 1 , supra. medication therapy management services. standing of the appropriate use of medica- SA 1133. Mr. GRASSLEY (for himself and (2) ASSESSMENT OF PAYMENT METHODOLO- tions; Mr. BAUCUS) proposed an amendment to the GIES.—The Secretary shall, in consultation (C) to increase the individual’s compliance bill S. 1, supra. with national pharmacist and pharmacy as- with prescription medication regimens; f sociations, design the fee paid under para- (D) to reduce the risk of potential adverse graph (1) to test various payment methodolo- events associated with medications; and TEXT OF AMENDMENTS gies applicable with respect to medication (E) to reduce the need for other costly SA 1094. Mr. SESSIONS submitted an therapy management services, including a medical services through better management of medication therapy. amendment intended to be proposed by payment methodology that applies a relative value scale and fee-schedule with respect to (2) ELIGIBLE BENEFICIARY.—The term ‘‘eli- him to the bill S. 1, to amend title such services that take into account the dif- gible beneficiary’’ means an individual who XVII of the Social Security Act to pro- ferences in— is— vide for a voluntary prescription drug (A) the time required to perform the dif- (A) entitled to (or enrolled for) benefits benefit under the Medicare program ferent types of medication therapy manage- under part A and enrolled for benefits under and to strengthen and improve the ment services; part B of the Social Security Act (42 U.S.C. Medicare program, and for other pur- (B) the level of risk associated with the use 1395c et seq.; 1395j et seq.); poses; which was ordered to lie on the of particular outpatient prescription drugs (B) not enrolled with a Medicare+Choice plan or a MedicareAdvantage plan under part table; as follows: or groups of drugs; and (C) the health status of individuals to C; and On page 637, line 1, strike ‘‘no debt’’ and all whom such services are provided. (C) receiving, in accordance with State law that follows through line 5, and insert the (e) FUNDING.— or regulation, medication for— following: ‘‘the sponsor of such an alien shall (1) IN GENERAL.—Subject to paragraph (2), (i) the treatment of asthma, diabetes, or be responsible for paying 100 percent of the the Secretary shall provide for the transfer chronic cardiovascular disease, including an costs attributable to the provision of such from the Federal Supplementary Insurance individual on anticoagulation or lipid reduc- assistance, unless the sponsor demonstrates Trust Fund established under section 1841 of ing medications; or that the sponsor has an extreme and unusual the Social Security Act (42 U.S.C. 1395t) of (ii) such other chronic diseases as the Sec- financial hardship that prevents the sponsor such funds as are necessary for the costs of retary may specify. from paying such costs.’’ carrying out the assessment program under (3) QUALIFIED PHARMACIST.—The term this section. ‘‘qualified pharmacist’’ means an individual SA 1095. Mr. REID (for himself and (2) BUDGET NEUTRALITY.—In conducting the who is a licensed pharmacist in good stand- Mr. COCHRAN) proposed an amendment assessment program under this section, the ing with the State Board of Pharmacy.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00120 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8767 SA 1096. Ms. MURKOWSKI (for her- fined in paragraph 1860D–19(4)(C) of such Act) established under this section, with respect self and Mr. STEVENS) submitted an who is diagnosed with cancer, such indi- to both the payment rate for service and the amendment intended to be proposed by vidual shall receive the full premium subsidy payment rate for mileage, shall provide that her to the bill S. 1, to amend the title and reduction of cost-sharing described in such rates otherwise established, shall be in- section 1860D–19(a)(2) of such Act, including creased by the higher of either 20 percent of XVIII of the Social Security Act to payment of— the rate determined after the application of provide for a voluntary prescription (A) no deductible; subparagraph (C), in addition to the increase drug benefit under the Medicare pro- (B) no monthly premium for any Medicare provided under subparagraph (A). gram and to strengthen and improve Prescription Drug plan described paragraph ‘‘(C) DETERMINATION OF RURAL AREAS BASED the Medicare program, and for other (1) or (2) of section 1860D–17(a) of such Act; ON POPULATION DENSITY WITHIN POSTAL ZIP purposes; as follows: and CODES.—With respect to ground ambulance services described in subparagraph (B), dur- On page 529, between lines 8 and 9, insert (C) reduced cost-sharing described in sub- ing the period described in that subpara- the following: paragraphs (C), (D), and (E) of section 1860D– 19(a)(2) of such Act. graph, paragraph (9) shall be applied by sub- SEC. 455. FRONTIER EXTENDED STAY CLINIC stituting ‘(as determined under an area clas- DEMONSTRATION PROJECT. (3) SUBSIDY-ELIGIBLE INDIVIDUALS WITH IN- COME BETWEEN 135 PERCENT AND 160 PERCENT sification system established by the Sec- (a) AUTHORITY TO CONDUCT DEMONSTRATION OF THE FEDERAL POVERTY LEVEL.—If the indi- retary that is based on population density PROJECT.—The Secretary shall waive such within postal zip code areas)’ for ‘(as defined provisions of the medicare program estab- vidual is a subsidy-eligible individual (as defined in section 1860D–19(a)(4)(D) of such Act) in section 1886(d)(2)(D)) or in a rural census lished under title XVIII of the Social Secu- tract of a metropolitan statistical area (as rity Act (42 U.S.C. 1395 et seq.) as are nec- who is diagnosed with cancer, such individual shall receive sliding scale premium determined under the most recent modifica- essary to conduct a demonstration project tion of the Goldsmith Modification, origi- under which frontier extended stay clinics subsidy and reduction of cost-sharing for subsidy-eligible individuals, including pay- nally published in the Federal Register on described in subsection (b) in isolated rural February 27, 1992 (57 Fed. Reg. 6725))’. Not areas are treated as providers of items and ment of— (A) for 2006, a deductible of only $50; later than December 31, 2003, the Secretary, services under the medicare program. taking into account the recommendations (b) CLINICS DESCRIBED.—A frontier ex- (B) only a percentage of the monthly premium (as described in section 1860D– contained in the report submitted under sec- tended stay clinic is described in this sub- tion 221(b)(3) of the Medicare, Medicaid, and section if the clinic— 19(a)(3)(A)(i)); and (C) reduced cost-sharing described in SCHIP Benefits Improvement and Protection (1) is located in a community where the Act of 2000, shall implement the increase in closest short-term acute care hospital or clauses (iii), (iv), and (v) of section 1860D– 19(a)(3)(A). payment required under subparagraph (B) critical access hospital is at least 75 miles and shall establish the classification system (4) ELIGIBLE BENEFICIARIES WITH INCOME away from the community or is inaccessible required by the application of this subpara- ABOVE 160 PERCENT OF THE FEDERAL POVERTY by public road; and graph. The Secretary shall provide such in- (2) is designed to address the needs of— LEVEL.—If an individual is an eligible beneficiary (as defined in section 1860D(3) of such creased payment for services furnished on or (A) seriously or critically ill or injured pa- after the earlier of 30 days after the estab- tients who, due to adverse weather condi- Act), is not described in paragraphs (1) through (3), and is diagnosed with cancer, lishment of such classification system or De- tions or other reasons, cannot be transferred cember 31, 2003. quickly to acute care referral centers; or such individual shall have access to qualified prescription drug coverage (as described in ‘‘(D) APPLICATION OF INCREASED PAYMENTS (B) patients who need monitoring and ob- AFTER 2007.—The increased payments under servation for a limited period of time. section 1860D–6(a)(1) of such Act), including payment of— subparagraphs (A) and (B) shall not be taken (c) DEFINITIONS.—In this section, the terms into account in calculating payments for ‘‘hospital’’ and ‘‘critical access hospital’’ (A) for 2006, a deductible of $275; (B) the limits on cost-sharing described services furnished on or after the period have the meanings given such terms in sub- specified in such subparagraph. sections (e) and (mm), respectively, of sec- section 1860D–6(c)(2) of such Act up to, for 2006, an initial coverage limit of $4,500; and ‘‘(11) CONVERSION FACTOR ADJUSTMENTS.— tion 1861 of the Social Security Act (42 The Secretary shall not adjust downward the U.S.C. 1395x). (C) for 2006, an annual out-of-pocket limit of $3,700 with 10 percent cost-sharing after conversion factor in any year because of an evaluation of the prior year conversion fac- Mr. MCCONNELL proposed that limit is reached. SA 1097. tor.’’. an amendment to the bill S. 1, to SEC. 426A. MEDICARE SECONDARY PAYOR (MSP) amend title XVIII of the Social Secu- SA 1098. Mr. DAYTON submitted an amendment intended to be proposed by PROVISIONS. rity Act to provide for a voluntary pre- (a) TECHNICAL AMENDMENT CONCERNING scription drug benefit under the Medi- him to the bill S. 1, to amend title SECRETARY’S AUTHORITY TO MAKE CONDI- care program and to strengthen and XVIII of the Social Security Act to TIONAL PAYMENT WHEN CERTAIN PRIMARY improve the Medical program, and for provide for a voluntary prescription PLANS DO NOT PAY PROMPTLY.— (1) IN GENERAL.—Section 1862(b)(2) (42 other purposes; as follows: drug benefit under the Medicare program and to strengthen and improve U.S.C. 1395y(b)(2)) is amended— At the end of subtitle A of title I, add the (A) in subparagraph (A)(ii), by striking following: the Medicare program, and for other purposes; which was ordered to lie on ‘‘promptly (as determined in accordance SEC. ll. PROTECTING SENIORS WITH CANCER. with regulations)’’; Any eligible beneficiary (as defined in sec- the table; as follows: (B) in subparagraph (B)— tion 1860D(3) of the Social Security Act) who Strike section 426 and insert the following: (i) by redesignating clauses (i) through (iii) is diagnosed with cancer shall be protected SEC. 426. INCREASE FOR GROUND AMBULANCE as clauses (ii) through (iv), respectively; and from high prescription drug costs in the fol- SERVICES. (ii) by inserting before clause (ii), as so re- lowing manner: Section 1834(l) (42 U.S.C. 1395m(l)), as designated, the following new clause: (1) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN amended by section 405(b)(2), is amended by ‘‘(i) AUTHORITY TO MAKE CONDITIONAL PAY- INCOME BELOW 100 PERCENT OF THE FEDERAL adding at the end the following new para- MENT.—The Secretary may make payment POVERTY LINE.—If the individual is a quali- graphs: under this title with respect to an item or fied medicare beneficiary (as defined in sec- ‘‘(10) TEMPORARY INCREASE FOR GROUND AM- service if a primary plan described in sub- tion 1860D–19(a)(4) of such Act), such indi- BULANCE SERVICES.— paragraph (A)(ii) has not made or cannot vidual shall receive the full premium subsidy ‘‘(A) IN GENERAL.—Notwithstanding any reasonably be expected to make payment and reduction of cost-sharing described in other provision of this subsection, in the with respect to such item or service prompt- section 1860D–19(a)(1) of such Act, including case of ground ambulance services furnished ly (as determined in accordance with regula- the payment of— on or after January 1, 2004, and before Janu- tions). Any such payment by the Secretary (A) no deductible; ary 1, 2007, the fee schedule established under shall be conditioned on reimbursement to (B) no monthly beneficiary premium for at this section, with respect to both the pay- the appropriate Trust Fund in accordance least one Medicare Prescription Drug plan ment rate for service and the payment rate with the succeeding provisions of this sub- available in the area in which the individual for mileage, shall provide that such rates section.’’. resides; and otherwise established, shall be increased by (2) EFFECTIVE DATE.—The amendments (C) reduced cost-sharing described in sub- 21.5 percent. made by paragraph (1) shall be effective as if paragraphs (C), (D), and (E) of section 1860D– ‘‘(B) ADDITIONAL INCREASE FOR SERVICES included in the enactment of title III of the 19(a)(1) of such Act. FURNISHED IN A RURAL AREA.—Notwith- Medicare and Medicaid Budget Reconcili- (2) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN standing any other provision of this sub- ation Amendments of 1984 (Public Law 98- INCOME BETWEEN 100 AND 135 PERCENT OF THE section, in the case of ground ambulance 369). FEDERAL POVERTY LINE.—If the individual is services furnished on or after January 1, 2004, (b) CLARIFYING AMENDMENTS TO CONDI- a specified low income medicare beneficiary and before January 1, 2007, for which the TIONAL PAYMENT PROVISIONS.—Section (as defined in paragraph 1860D–19(4)(B) of transportation originates in a rural area de- 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further such Act) or a qualifying individual (as described in subparagraph (C), the fee schedule amended—

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00121 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8768 CONGRESSIONAL RECORD — SENATE June 26, 2003 (1) in subparagraph (A), in the matter fol- services furnished on or after January 1, 2004 SA 1101. Mr. DAYTON submitted an lowing clause (ii), by inserting the following and before January 1, 2007, the fee schedule amendment intended to be proposed by sentence at the end: ‘‘An entity that engages established under this section, with respect him to the bill S. 1, to amend title in a business, trade, or profession shall be to both the payment rate for service and the XVIII of the Social Security Act to deemed to have a self-insured plan if it car- payment rate for mileage, shall provide that provide for a voluntary prescription ries its own risk (whether by a failure to ob- such rates otherwise established shall be in- tain insurance, or otherwise) in whole or in creased by 21.5 percent. drug benefit under the Medicare pro- part.’’; ‘‘(B) ADDITIONAL INCREASE FOR SERVICES gram and to strengthen and improve (2) in subparagraph (B)(ii), as redesignated FURNISHED IN A RURAL AREA.—Notwith- the Medicare program and for other by subsection (a)(2)(B)— standing any other provision of this sub- purposes; which was ordered to lie on (A) by striking the first sentence and in- section, in the case of ground ambulance the table; as follows: serting the following: ‘‘A primary plan, and services furnished on or after January 1, 2004 On page 134, strike line 9 and insert the fol- an entity that receives payment from a pri- and before January 1, 2007, for which the lowing: mary plan, shall reimburse the appropriate transportation originates in a rural area de- under paragraph (1). Trust Fund for any payment made by the scribed in paragraph (10)(C), the fee schedule ‘‘(d) IMPLEMENTATION OF PART D.— Secretary under this title with respect to an established under this section, with respect ‘‘(1) IN GENERAL.—Notwithstanding section item or service if it is demonstrated that to both the payment rate for service and the 1860D–1(a)(4) or any other provision of this such primary plan has or had a responsi- payment rate for mileage, shall provide that part or part C, the Secretary shall imple- bility to make payment with respect to such such rates otherwise established shall be in- ment, and make benefits available under, item or service. A primary plan’s responsi- creased by the higher of either 20 percent or this part on January 1, 2005, unless the Sec- bility for such payment may be dem- the following section: retary certifies in writing to Congress, by onstrated by a judgment, a payment condi- ‘‘(C) BASING RURAL AREAS ON POPULATION not later than March 1, 2004, that such imple- tioned upon the recipient’s compromise, DENSITY BY POSTAL ZIP CODES.’’ mentation is not possible. If such implemen- waiver, or release (whether or not there is a (a) IN GENERAL.—Section 1834(l) of the So- tation is possible by January 1, 2005, the Sec- determination or admission of liability) of cial Security Act (42 U.S.C. 1395m(l)) is retary shall carry out this part until the Ad- payment for items or services included in a amended in paragraph (9), as so redesignated ministrator is appointed and able to carry claim against the primary plan or the pri- by section 2(a)(1), by striking ‘‘(as defined in out this part. The Secretary shall implement mary plan’s insured, or by other means.’’; section 1886(d)(2)(D)’’ and all that follows sections 1807 and 1807A until the date of im- and through ‘‘(57 Fed. Reg. 6725)’’ and inserting plementation as certified by the Secretary. (B) in the final sentence, by striking ‘‘on ‘‘(as determined under an area classification ‘‘(2) CERTIFICATION REQUIREMENTS.—A cer- the date such notice or other information is system established by the Secretary that is tification by the Secretary under paragraph received’’ and inserting ‘‘on the date notice based on population density within postal zip (1) that implementation of this part is not of, or information related to, a primary code areas)’’. possible by January 1, 2005, shall declare the plan’s responsibility for such payment or (b) EFFECTIVE DATE.—The Secretary of reasons for the impossibility and a new date other information is received’’; and Health and Human Services, taking into ac- certain (which in no event shall be later than (3) in subparagraph (B)(iii), as redesignated count the recommendations contained in the January 1, 2006) for implementation of this by subsection (a)(2)(B), by striking the first report submitted under section 221(b)(3) the part. sentence and inserting the following: ‘‘In Medicare, Medicaid, and SCHIP Benefits Im- order to recover payment made under this provements and Protection Act of 2000, shall SA 1102. Mr. MCCONNELL proposed title for an item or service, the United implement such increase in addition to the an amendment to the bill S. 1, to States may bring an action against any or increase under subparagraph (A). The Sec- amend title XVIII of the Social Secu- all entities that are or were required or re- retary shall establish the classification sys- rity Act to provide for a voluntary pre- sponsible (directly, as an insurer or self-in- tem described in the amendment made by scription drug benefit under the Medi- surer, as a third-party administrator, as an subsection (a) by not later than December 31, care program and to strengthen and employer that sponsors or contributes to a 2003. Such amendment shall apply to services improve the Medicare program, and for group health plan, or large group health furnished on or after such date, not later other purposes; as follows: plan, or otherwise) to make payment with than 30 days after the establishment of such system, as the Secretary shall provide by At the end of subtitle A of title I, add the respect to the same item or service (or any following: portion thereof) under a primary plan. The regulation. ‘‘(D) APPLICATION OF INCREASED PAYMENTS SEC. ll. PROTECTING SENIORS WITH ALZ- United States may, in accordance with para- HEIMER’S DISEASE. AFTER 2007.—The increased payments under graph (3)(A) collect double damages against Any eligible beneficiary (as defined in sec- subparagraphs (A) and (B) shall not be taken any such entity. In addition, the United tion 1860D(3) of the Social Security Act) who into account in calculating payments for States may recover under this clause from is diagnosed with Alzheimer’s disease shall services furnished on or after the period any entity that has received payment from a be protected from high prescription drug specified in such subparagraph.’’ primary plan or from the proceeds of a pri- costs in the following manner: ‘‘(11) CONVERSION FACTOR ADJUSTMENTS.— mary plan’s payment to any entity.’’. (1) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN The Secretary shall not adjust downward the (c) CLERICAL AMENDMENTS.—Section 1862(b) INCOME BELOW 100 PERCENT OF THE FEDERAL conversion factor in any year because of an (42 U.S.C. 1395y(b)) is amended— POVERTY LINE.—If the individual is a quali- evaluation of the prior year conversion fac- (1) in paragraph (1)(A), by moving the in- fied medicare beneficiary (as defined in sector.’’ dentation of clauses (ii) through (v) 2 ems to tion 1860D–19(a)(4) of such Act), such indi- the left; and SA 1100. Mr. DAYTON submitted an vidual shall receive the full premium subsidy (2) in paragraph (3)(A), by striking ‘‘such’’ and reduction of cost-sharing described in before ‘‘paragraphs’’. amendment intended to be proposed by section 1860D–19(a)(1) of such Act, including him to the bill S. 1, to amend title the payment of— SA 1099. Mr. DAYTON submitted an XVIII of the Social Security Act to (A) no deductible; amendment intended to be proposed by provide for a voluntary prescription (B) no monthly beneficiary premium for at him to the bill S. 1, to amend title drug benefit under the Medicare pro- least one Medicare Prescription Drug plan XVIII of the Social Security Act to gram and to strengthen and improve available in the area in which the individual provide for a voluntary prescription the Medicare program and for other resides; and drug benefit under the Medicare pro- purposes; which was ordered to lie on (C) reduced cost-sharing described in sub- gram and to strengthen and improve paragraphs (C), (D), and (E) of section 1860D– the table; as follows: 19(a)(1) of such Act. the Medicare program, and for other At the end of subtitle A of title I, add the (2) SUBSIDY ELIGIBLE INDIVIDUALS WITH AN purposes; which was ordered to lie on following: INCOME BETWEEN 100 AND 135 PERCENT OF THE the table; as follows: SEC. ll. INCREASE IN DRUG BENEFIT. FEDERAL POVERTY LINE.—If the individual is Strike section 426 and insert the following: Notwithstanding any other provision of a specified low income medicare beneficiary SEC. 426. INCREASE FOR GROUND AMBULANCE law, the Secretary shall use $12,000,000,000 to (as defined in paragraph 1860D–19(4)(B) of SERVICES. improve the prescription drug benefit added such Act) or a qualifying individual (as de- Section 1834(l) of the Social Security Act under part D of title XVIII of the Social Se- fined in paragraph 1860D–19(4)(C) of such Act) (42 U.S.C. § 1395m(l)), as amended by section curity Act (as added by section 101) by elimi- who is diagnosed with Alzheimer’s disease, 405(b)(2), is amended by adding at the end the nating coverage gaps, reducing the premium such individual shall receive the full pre- following new paragraphs. or cost-sharing, or expanding subsidies for mium subsidy and reduction of cost-sharing ‘‘(10) TEMPORARY INCREASE FOR AMBULANCE low-income beneficiaries in lieu of con- described in section 1860D–19(a)(2) of such SERVICES.— ducting any demonstration projects or mak- Act, including payment of— ‘‘(A) GROUND AMBULANCE SERVICES.—Not- ing any increased payments to providers au- (A) no deductible; withstanding any other provision of this sub- thorized under this Act or the amendments (B) no monthly premium for any Medicare section, in the case of ground ambulance made by this Act. Prescription Drug plan described paragraph

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00122 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8769 (1) or (2) of section 1860D–17(a) of such Act; At the end of title VI, add the following: viders of skilled nursing facility services and and SEC. 6ll. ESTABLISHMENT OF PROGRAM TO entities representing beneficiaries of such (C) reduced cost-sharing described in sub- PREVENT ABUSE OF NURSING FA- services, for an appropriate level of super- paragraphs (C), (D), and (E) of section 1860D– CILITY RESIDENTS. vision with respect to any provisional em- 19(a)(2) of such Act. (a) IN GENERAL.— ployees employed by the facility in accord- (3) SUBSIDY-ELIGIBLE INDIVIDUALS WITH IN- (1) SCREENING OF SKILLED NURSING FACILITY ance with clause (ii). Such regulation should COME BETWEEN 135 PERCENT AND 160 PERCENT AND NURSING FACILITY PROVISIONAL EMPLOY- encourage the provision of direct supervision OF THE FEDERAL POVERTY LEVEL.—If the indi- EES.— of such employees whenever practicable with vidual is a subsidy-eligible individual (as de- (A) MEDICARE PROGRAM.—Section 1819(b) respect to such a facility and if such super- fined in section 1860D–19(a)(4)(D) of such Act) (42 U.S.C. 1395i–3(b)) is amended by adding at vision would not impose an unreasonable who is diagnosed with Alzheimer’s disease, the end the following: cost or other burden on the facility. such individual shall receive sliding scale ‘‘(8) SCREENING OF SKILLED NURSING FACIL- ‘‘(C) REPORTING REQUIREMENTS.—A skilled premium subsidy and reduction of cost-shar- ITY WORKERS.— nursing facility shall report to the State any ing for subsidy-eligible individuals, including ‘‘(A) BACKGROUND CHECKS OF PROVISIONAL instance in which the facility determines payment of— EMPLOYEES.—Subject to subparagraph (B)(ii), that a skilled nursing facility worker has (A) for 2006, a deductible of only $50; after a skilled nursing facility selects an in- committed an act of resident neglect or (B) only a percentage of the monthly pre- dividual for a position as a skilled nursing abuse or misappropriation of resident prop- mium (as described in section 1860D– facility worker, the facility, prior to employ- erty in the course of employment by the fa- 19(a)(3)(A)(i)); and ing such worker in a status other than a pro- cility. (C) reduced cost-sharing described in visional status to the extent permitted under ‘‘(D) USE OF INFORMATION.— clauses (iii), (iv), and (v) of section 1860D– subparagraph (B)(ii), shall— ‘‘(i) IN GENERAL.—A skilled nursing facility 19(a)(3)(A). ‘‘(i) give such worker written notice that that obtains information about a skilled (4) ELIGIBLE BENEFICIARIES WITH INCOME the facility is required to perform back- nursing facility worker pursuant to clauses ABOVE 160 PERCENT OF THE FEDERAL POVERTY ground checks with respect to provisional (iii) and (iv) of subparagraph (A) may use LEVEL.—If an individual is an eligible bene- employees; such information only for the purpose of de- ficiary (as defined in section 1860D(3) of such ‘‘(ii) require, as a condition of employ- termining the suitability of the worker for Act), is not described in paragraphs (1) ment, that such worker— employment. through (3), and is diagnosed with Alz- ‘‘(I) provide a written statement disclosing ‘‘(ii) IMMUNITY FROM LIABILITY.—A skilled heimer’s disease, such individual shall have any conviction for a relevant crime or find- nursing facility that, in denying employ- access to qualified prescription drug cov- ing of patient or resident abuse; ment for an individual selected for hiring as erage (as described in section 1860D–6(a)(1) of ‘‘(II) provide a statement signed by the a skilled nursing facility worker (including such Act), including payment of— worker authorizing the facility to request during the period described in subparagraph (A) for 2006, a deductible of $275; the search and exchange of criminal records; (B)(ii)), reasonably relies upon information (B) the limits on cost-sharing described ‘‘(III) provide in person to the facility a about such individual provided by the State section 1860D–6(c)(2) of such Act up to, for copy of the worker’s fingerprints or thumb pursuant to subsection (e)(6) or section 1128E 2006, an initial coverage limit of $4,500; and print, depending upon available technology; shall not be liable in any action brought by (C) for 2006, an annual out-of-pocket limit and such individual based on the employment de- of $3,700 with 10 percent cost-sharing after ‘‘(IV) provide any other identification in- termination resulting from the information. that limit is reached. formation the Secretary may specify in reg- ‘‘(iii) CRIMINAL PENALTY.—Whoever know- ulation; ingly violates the provisions of clause (i) SA 1103. Mr. DORGAN (for himself ‘‘(iii) initiate a check of the data collec- shall be fined in accordance with title 18, and Mr. PRYOR) proposed an amend- tion system established under section 1128E United States Code, imprisoned for not more ment SA 1092 proposed by Mr. GRASS- in accordance with regulations promulgated than 2 years, or both. by the Secretary to determine whether such LEY (for himself and Mr. BAUCUS) to the ‘‘(E) CIVIL PENALTY.— system contains any disqualifying informa- ‘‘(i) IN GENERAL.—A skilled nursing facility bill S. 1, to amend title XVIII of the tion with respect to such worker; and Social Security Act to provide for a that violates the provisions of this para- ‘‘(iv) if that system does not contain any graph shall be subject to a civil penalty in an voluntary prescription drug benefit such disqualifying information— amount not to exceed— under the Medicare program and to ‘‘(I) request through the appropriate State ‘‘(I) for the first such violation, $2,000; and strengthen and improve the Medicare agency that the State initiate a State and ‘‘(II) for the second and each subsequent program and for other purposes; as fol- national criminal background check on such violation within any 5-year period, $5,000. lows: worker in accordance with the provisions of ‘‘(ii) KNOWING RETENTION OF WORKER.—In In lieu of the matter proposed to be in- subsection (e)(6); and addition to any civil penalty under clause serted, insert the following: ‘‘(II) submit to such State agency the in- (i), a skilled nursing facility that— SEC. ll. AGGREGATE REDUCTION IN MONTHLY formation described in subclauses (II) ‘‘(I) knowingly continues to employ a BENEFICIARY OBLIGATIONS. through (IV) of clause (ii) not more than 7 skilled nursing facility worker in violation Section 1860D–17, as added by section 101, is days (excluding Saturdays, Sundays, and of subparagraph (A) or (B); or amended by adding at the end the following: legal public holidays under section 6103(a) of ‘‘(II) knowingly fails to report a skilled ‘‘(d) AGGREGATE REDUCTION IN MONTHLY title 5, United States Code) after completion nursing facility worker under subparagraph BENEFICIARY OBLIGATIONS.—The Adminis- of the check against the system initiated (C), trator shall for each year (beginning with under clause (iii). shall be subject to a civil penalty in an 2009) determine a percentage which— ‘‘(B) PROHIBITION ON HIRING OF ABUSIVE amount not to exceed $5,000 for the first such ‘‘(1) shall apply in lieu of the applicable WORKERS.— violation, and $10,000 for the second and each percent otherwise determined under sub- ‘‘(i) IN GENERAL.—A skilled nursing facility subsequent violation within any 5-year pe- section (c) for that year, and may not knowingly employ any skilled nurs- riod. ‘‘(2) will result in a decrease of ing facility worker who has any conviction ‘‘(F) DEFINITIONS.—In this paragraph: $2,400,000,000 for that year in the aggregate for a relevant crime or with respect to whom ‘‘(i) CONVICTION FOR A RELEVANT CRIME.— monthly beneficiary obligations otherwise a finding of patient or resident abuse has The term ‘conviction for a relevant crime’ required of all eligible beneficiaries enrolled been made. means any Federal or State criminal convic- in a Medicare Prescription Drug Plan or a ‘‘(ii) PROVISIONAL EMPLOYMENT.—After tion for— Medicare Advantage plan that provides complying with the requirements of clauses ‘‘(I) any offense described in paragraphs (1) qualified prescription drug coverage.5 (i), (ii), and (iii) of subparagraph (A), a through (4) of section 1128(a); and This subsection shall not apply in deter- skilled nursing facility may provide for a ‘‘(II) such other types of offenses as the mining the applicable percent under sub- provisional period of employment for a Secretary may specify in regulations, taking section (c) for purposes of section 1860D–21.’’. skilled nursing facility worker pending com- into account the severity and relevance of pletion of the check against the data collec- such offenses, and after consultation with SA 1104. Mr. KOHL (for himself and tion system described under subparagraph representatives of long-term care providers, Mr. REID) submitted an amendment in- (A)(iii) and the background check described representatives of long-term care employees, tended to be proposed by him to the under subparagraph (A)(iv). Subject to clause consumer advocates, and appropriate Fed- bill S. 1, to amend title XVIII of the (iii), such facility shall maintain direct su- eral and State officials. Social Security Act to provide for a pervision of the covered individual during ‘‘(ii) DISQUALIFYING INFORMATION.—The voluntary prescription drug benefit the worker’s provisional period of employ- term ‘disqualifying information’ means in- ment. formation about a conviction for a relevant under the Medicare program and to ‘‘(iii) EXCEPTION FOR SMALL RURAL SKILLED crime or a finding of patient or resident strengthen and improve the Medicare NURSING FACILITIES.—In the case of a small abuse. program, and for other purposes; which rural skilled nursing facility (as defined by ‘‘(iii) FINDING OF PATIENT OR RESIDENT was ordered to lie on the table; as fol- the Secretary), the Secretary shall provide, ABUSE.—The term ‘finding of patient or resi- lows: by regulation after consultation with pro- dent abuse’ means any substantiated finding

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00123 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8770 CONGRESSIONAL RECORD — SENATE June 26, 2003 by a State agency under subsection (g)(1)(C) against the data collection system described representatives of long-term care employees, or a Federal agency that a skilled nursing fa- under subparagraph (A)(iii) and the back- consumer advocates, and appropriate Fed- cility worker has committed— ground check described under subparagraph eral and State officials. ‘‘(I) an act of patient or resident abuse or (A)(iv). Subject to clause (iii), such facility ‘‘(ii) DISQUALIFYING INFORMATION.—The neglect or a misappropriation of patient or shall maintain direct supervision of the term ‘disqualifying information’ means in- resident property; or worker during the worker’s provisional pe- formation about a conviction for a relevant ‘‘(II) such other types of acts as the Sec- riod of employment. crime or a finding of patient or resident retary may specify in regulations. ‘‘(iii) EXCEPTION FOR SMALL RURAL NURSING abuse. ‘‘(iv) SKILLED NURSING FACILITY WORKER.— FACILITIES.— ‘‘(iii) FINDING OF PATIENT OR RESIDENT The term ‘skilled nursing facility worker’ ‘‘(I) IN GENERAL.—In the case of a small ABUSE.—The term ‘finding of patient or resi- means any individual (other than a volun- rural nursing facility (as defined by the Sec- dent abuse’ means any substantiated finding teer) that has access to a patient of a skilled retary), the Secretary shall provide, by regu- by a State agency under subsection (g)(1)(C) nursing facility under an employment or lation after consultation with providers of or a Federal agency that a nursing facility other contract, or both, with such facility. nursing facility services and entities rep- worker has committed— Such term includes individuals who are li- resenting beneficiaries of such services, for ‘‘(I) an act of patient or resident abuse or censed or certified by the State to provide an appropriate level of supervision with re- neglect or a misappropriation of patient or such services, and nonlicensed individuals spect to any provisional employees employed resident property; or providing such services, as defined by the by the facility in accordance with clause (ii). ‘‘(II) such other types of acts as the Sec- Secretary, including nurse assistants, nurse Such regulation should encourage the provi- retary may specify in regulations. aides, home health aides, and personal care sion of direct supervision of such employees ‘‘(iv) NURSING FACILITY WORKER.—The term workers and attendants.’’. whenever practicable with respect to such a ‘nursing facility worker’ means any indi- (B) MEDICAID PROGRAM.—Section 1919(b) (42 facility and if such supervision would not vidual (other than a volunteer) that has ac- U.S.C. 1396r(b)) is amended by adding at the impose an unreasonable cost or other burden cess to a patient of a nursing facility under end the following new paragraph: on the facility. an employment or other contract, or both, ‘‘(8) SCREENING OF NURSING FACILITY WORK- ‘‘(C) REPORTING REQUIREMENTS.—A nursing with such facility. Such term includes indi- ERS.— facility shall report to the State any in- viduals who are licensed or certified by the ‘‘(A) BACKGROUND CHECKS ON PROVISIONAL stance in which the facility determines that State to provide such services, and non- EMPLOYEES.—Subject to subparagraph (B)(ii), a nursing facility worker has committed an licensed individuals providing such services, after a nursing facility selects an individual act of resident neglect or abuse or misappro- for a position as a nursing facility worker, as defined by the Secretary, including nurse priation of resident property in the course of assistants, nurse aides, home health aides, the facility, prior to employing such worker employment by the facility. in a status other than a provisional status to and personal care workers and attendants.’’. ‘‘(D) USE OF INFORMATION.— the extent permitted under subparagraph (2) FEDERAL RESPONSIBILITIES.— ‘‘(i) IN GENERAL.—A nursing facility that (A) DEVELOPMENT OF STANDARD FEDERAL (B)(ii), shall— obtains information about a nursing facility ‘‘(i) give the worker written notice that AND STATE BACKGROUND CHECK FORM.—The worker pursuant to clauses (iii) and (iv) of Secretary of Health and Human Services, in the facility is required to perform back- subparagraph (A) may use such information ground checks with respect to provisional consultation with the Attorney General and only for the purpose of determining the suit- employees; representatives of appropriate State agen- ability of the worker for employment. ‘‘(ii) require, as a condition of employ- cies, shall develop a model form that a provi- ‘‘(ii) IMMUNITY FROM LIABILITY.—A nursing ment, that such worker— sional employee at a nursing facility may facility that, in denying employment for an ‘‘(I) provide a written statement disclosing complete and Federal and State agencies individual selected for hiring as a nursing fa- any conviction for a relevant crime or find- may use to conduct the criminal background cility worker (including during the period ing of patient or resident abuse; checks required under sections 1819(b)(8) and described in subparagraph (B)(ii)), reason- ‘‘(II) provide a statement signed by the 1919(b)(8) of the Social Security Act (42 ably relies upon information about such indi- worker authorizing the facility to request U.S.C. 1395i–3(b), 1396r(b)) (as added by this vidual provided by the State pursuant to the search and exchange of criminal records; section). ‘‘(III) provide in person to the facility a subsection (e)(6) or section 1128E shall not be (B) PERIODIC EVALUATION.—The Secretary copy of the worker’s fingerprints or thumb liable in any action brought by such indi- of Health and Human Services, in consulta- print, depending upon available technology; vidual based on the employment determination with the Attorney General, periodically and tion resulting from the information. shall evaluate the background check system ‘‘(IV) provide any other identification in- ‘‘(iii) CRIMINAL PENALTY.—Whoever know- imposed under sections 1819(b)(8) and formation the Secretary may specify in reg- ingly violates the provisions of clause (i) 1919(b)(8) of the Social Security Act (42 ulation; shall be fined in accordance with title 18, U.S.C. 1395i–3(b), 1396r(b)) (as added by this ‘‘(iii) initiate a check of the data collec- United States Code, imprisoned for not more section) and shall implement changes, as tion system established under section 1128E than 2 years, or both. necessary, based on available technology, to in accordance with regulations promulgated ‘‘(E) CIVIL PENALTY.— make the background check system more ef- by the Secretary to determine whether such ‘‘(i) IN GENERAL.—A nursing facility that ficient and able to provide a more immediate system contains any disqualifying informa- violates the provisions of this paragraph response to long-term care providers using tion with respect to such worker; and shall be subject to a civil penalty in an the system. ‘‘(iv) if that system does not contain any amount not to exceed— (3) NO PREEMPTION OF STRICTER STATE such disqualifying information— ‘‘(I) for the first such violation, $2,000; and LAWS.—Nothing in section 1819(b)(8) or ‘‘(I) request through the appropriate State ‘‘(II) for the second and each subsequent 1919(b)(8) of the Social Security Act (42 agency that the State initiate a State and violation within any 5-year period, $5,000. U.S.C. 1395i–3(b)(8), 1396r(b)(8)) (as so added) national criminal background check on such ‘‘(ii) KNOWING RETENTION OF WORKER.—In shall be construed to supersede any provision worker in accordance with the provisions of addition to any civil penalty under clause of State law that— subsection (e)(8); and (i), a nursing facility that— (A) specifies a relevant crime for purposes ‘‘(II) submit to such State agency the in- ‘‘(I) knowingly continues to employ a nurs- of prohibiting the employment of an indi- formation described in subclauses (II) ing facility worker in violation of subpara- vidual at a long-term care facility (as de- through (IV) of clause (ii) not more than 7 graph (A) or (B); or fined in section 1128E(g)(6) of the Social Se- days (excluding Saturdays, Sundays, and ‘‘(II) knowingly fails to report a nursing fa- curity Act (as added by subsection (e)) that legal public holidays under section 6103(a) of cility worker under subparagraph (C), is not included in the list of such crimes title 5, United States Code) after completion shall be subject to a civil penalty in an specified in such sections or in regulations of the check against the system initiated amount not to exceed $5,000 for the first such promulgated by the Secretary of Health and under clause (iii). violation, and $10,000 for the second and each Human Services to carry out such sections; ‘‘(B) PROHIBITION ON HIRING OF ABUSIVE subsequent violation within any 5-year pe- or WORKERS.— riod. (B) requires a long-term care facility (as so ‘‘(i) IN GENERAL.—A nursing facility may ‘‘(F) DEFINITIONS.—In this paragraph: defined) to conduct a background check not knowingly employ any nursing facility ‘‘(i) CONVICTION FOR A RELEVANT CRIME.— prior to employing an individual in an em- worker who has any conviction for a rel- The term ‘conviction for a relevant crime’ ployment position that is not included in the evant crime or with respect to whom a find- means any Federal or State criminal convic- positions for which a background check is re- ing of patient or resident abuse has been tion for— quired under such sections. made. ‘‘(I) any offense described in paragraphs (1) (4) TECHNICAL AMENDMENTS.—Effective as if ‘‘(ii) PROVISIONAL EMPLOYMENT.—After through (4) of section 1128(a); and included in the enactment of section 941 of complying with the requirements of clauses ‘‘(II) such other types of offenses as the BIPA (114 Stat. 2763A–585), sections 1819(b) (i), (ii), and (iii) of subparagraph (A), a nurs- Secretary may specify in regulations, taking and 1919(b) (42 U.S.C. 1395i–3(b), 1396r(b)), as ing facility may provide for a provisional pe- into account the severity and relevance of amended by such section 941 are each amend- riod of employment for a nursing facility such offenses, and after consultation with ed by redesignating the paragraph (8) added worker pending completion of the check representatives of long-term care providers, by such section as paragraph (9).

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00124 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8771

(b) FEDERAL AND STATE REQUIREMENTS struction, and dissemination of information, available to the Attorney General, or, in the CONCERNING BACKGROUND CHECKS.— audits and recordkeeping, and the imposition Attorney General’s discretion, to the Federal (1) MEDICARE.—Section 1819(e) (42 U.S.C. of fees. Bureau of Investigation, until expended. 1395i–3(e)) is amended by adding at the end ‘‘(ii) APPEAL PROCEDURES.—The Attorney ‘‘(II) STATE.—A State may charge a nurs- the following: General, in consultation with the Secretary, ing facility a fee for initiating the criminal ‘‘(6) FEDERAL AND STATE REQUIREMENTS shall promulgate such regulations as are background check under this paragraph and CONCERNING CRIMINAL BACKGROUND CHECKS ON necessary to establish procedures by which a subsection (b)(8), including fees charged by SKILLED NURSING FACILITY EMPLOYEES.— provisional employee or an employee may the Attorney General, and for performing ‘‘(A) IN GENERAL.—Upon receipt of a re- appeal or dispute the accuracy of the infor- the review and report required by subpara- quest by a skilled nursing facility pursuant mation obtained in a background check con- graph (C). The amount of such fee shall not to subsection (b)(8) that is accompanied by ducted under this paragraph. Appeals shall exceed the actual cost of such activities. the information described in subclauses (II) be limited to instances in which a provi- ‘‘(ii) PROHIBITION ON CHARGING.—An entity through (IV) of subsection (b)(8)(A)(ii), a sional employee or an employee is incor- may not impose on a provisional employee or State, after checking appropriate State rectly identified as the subject of the back- an employee any charges relating to the per- records and finding no disqualifying informa- ground check, or when information about formance of a background check under this tion (as defined in subsection (b)(8)(F)(ii)), the provisional employee or employee has paragraph. shall immediately submit such request and not been updated to reflect changes in the ‘‘(E) REGULATIONS.— information to the Attorney General and provisional employee’s or employee’s crimi- ‘‘(i) IN GENERAL.—In addition to the Sec- shall request the Attorney General to con- nal record. retary’s authority to promulgate regulations duct a search and exchange of records with ‘‘(F) REPORT.—Not later than 2 years after under this title, the Attorney General, in respect to the individual as described in sub- the date of enactment of this paragraph, the consultation with the Secretary, may pro- paragraph (B). Attorney General shall submit a report to mulgate such regulations as are necessary to ‘‘(B) SEARCH AND EXCHANGE OF RECORDS BY Congress on— carry out the Attorney General’s responsibil- ATTORNEY GENERAL.—Upon receipt of a sub- ‘‘(i) the number of requests for searches ities under this paragraph and subsection mission pursuant to subparagraph (A), the and exchanges of records made under this (b)(8), including regulations regarding the se- Attorney General shall direct a search of the section; curity, confidentiality, accuracy, use, de- records of the Federal Bureau of Investiga- ‘‘(ii) the disposition of such requests; and struction, and dissemination of information, tion for any criminal history records cor- ‘‘(iii) the cost of responding to such re- audits and recordkeeping, and the imposition responding to the fingerprints and other quests.’’. of fees. positive identification information sub- EDICAID (2) M .—Section 1919(e) (42 U.S.C. ‘‘(ii) APPEAL PROCEDURES.—The Attorney mitted. The Attorney General shall provide 1396r(e)) is amended by adding at the end the General, in consultation with the Secretary, any corresponding information resulting following: shall promulgate such regulations as are from the search to the State. ‘‘(8) FEDERAL AND STATE REQUIREMENTS necessary to establish procedures by which a ‘‘(C) STATE REPORTING OF INFORMATION TO CONCERNING CRIMINAL BACKGROUND CHECKS ON provisional employee or an employee may SKILLED NURSING FACILITY.—Upon receipt of NURSING FACILITY EMPLOYEES .— appeal or dispute the accuracy of the infor- the information provided by the Attorney ‘‘(A) IN GENERAL.—Upon receipt of a re- mation obtained in a background check con- General pursuant to subparagraph (B), the quest by a nursing facility pursuant to sub- ducted under this paragraph. Appeals shall State shall— section (b)(8) that is accompanied by the in- be limited to instances in which a provi- ‘‘(i) review the information to determine formation described in subclauses (II) sional employee or an employee is incor- whether the individual has any conviction through (IV) of subsection (b)(8)(A)(ii), a rectly identified as the subject of the back- for a relevant crime (as defined in subsection State, after checking appropriate State ground check, or when information about (b)(8)(F)(i)); records and finding no disqualifying informa- the provisional employee or employee has ‘‘(ii) immediately report to the skilled tion (as defined in subsection (b)(8)(F)(ii)), not been updated to reflect changes in the nursing facility in writing the results of such shall immediately submit such request and provisional employee’s or employee’s crimi- review; and information to the Attorney General and ‘‘(iii) in the case of an individual with a shall request the Attorney General to con- nal record. conviction for a relevant crime, report the duct a search and exchange of records with ‘‘(F) REPORT.—Not later than 2 years after existence of such conviction of such indi- respect to the individual as described in sub- the date of enactment of this paragraph, the vidual to the database established under sec- paragraph (B). Attorney General shall submit a report to Congress on— tion 1128E. ‘‘(B) SEARCH AND EXCHANGE OF RECORDS BY ‘‘(i) the number of requests for searches ‘‘(D) FEES FOR PERFORMANCE OF CRIMINAL ATTORNEY GENERAL.—Upon receipt of a sub- BACKGROUND CHECKS.— mission pursuant to subparagraph (A), the and exchanges of records made under this ‘‘(i) AUTHORITY TO CHARGE FEES.— Attorney General shall direct a search of the section; ‘‘(I) ATTORNEY GENERAL.—The Attorney records of the Federal Bureau of Investiga- ‘‘(ii) the disposition of such requests; and General may charge a fee to any State re- tion for any criminal history records cor- ‘‘(iii) the cost of responding to such requesting a search and exchange of records responding to the fingerprints and other quests.’’. pursuant to this paragraph and subsection positive identification information sub- (c) APPLICATION TO OTHER ENTITIES PRO- (b)(8) for conducting the search and pro- mitted. The Attorney General shall provide VIDING HOME HEALTH OR LONG-TERM CARE viding the records. The amount of such fee any corresponding information resulting SERVICES.— shall not exceed the lesser of the actual cost from the search to the State. (1) MEDICARE.—Part D of title XVIII (42 of such activities or $50. Such fees shall be ‘‘(C) STATE REPORTING OF INFORMATION TO U.S.C. 1395x et seq.) is amended by adding at available to the Attorney General, or, in the NURSING FACILITY.—Upon receipt of the infor- the end the following: Attorney General’s discretion, to the Federal mation provided by the Attorney General ‘‘APPLICATION OF SKILLED NURSING FACILITY Bureau of Investigation until expended. pursuant to subparagraph (B), the State PREVENTIVE ABUSE PROVISIONS TO ANY PRO- ‘‘(II) STATE.—A State may charge a skilled shall— VIDER OF SERVICES OR OTHER ENTITY PRO- nursing facility a fee for initiating the ‘‘(i) review the information to determine VIDING HOME HEALTH OR LONG-TERM CARE criminal background check under this para- whether the individual has any conviction SERVICES graph and subsection (b)(8), including fees for a relevant crime (as defined in subsection ‘‘SEC. 1897. (a) IN GENERAL.—The require- charged by the Attorney General, and for (b)(8)(F)(i)); ments of subsections (b)(8) and (e)(6) of sec- performing the review and report required by ‘‘(ii) immediately report to the nursing fa- tion 1819 shall apply to any provider of serv- subparagraph (C). The amount of such fee cility in writing the results of such review; ices or any other entity that is eligible to be shall not exceed the actual cost of such ac- and paid under this title for providing home tivities. ‘‘(iii) in the case of an individual with a health services, hospice care (including rou- ‘‘(ii) PROHIBITION ON CHARGING.—An entity conviction for a relevant crime, report the tine home care and other services included in may not impose on a provisional employee or existence of such conviction of such indi- hospice care under this title), or long-term an employee any charges relating to the per- vidual to the database established under sec- care services to an individual entitled to formance of a background check under this tion 1128E. benefits under part A or enrolled under part paragraph. ‘‘(D) FEES FOR PERFORMANCE OF CRIMINAL B, including an individual provided with a ‘‘(E) REGULATIONS.— BACKGROUND CHECKS.— Medicare+Choice plan offered by a ‘‘(i) IN GENERAL.—In addition to the Sec- ‘‘(i) AUTHORITY TO CHARGE FEES.— Medicare+Choice organization under part C retary’s authority to promulgate regulations ‘‘(I) ATTORNEY GENERAL.—The Attorney (in this section referred to as a ‘medicare under this title, the Attorney General, in General may charge a fee to any State re- beneficiary’). consultation with the Secretary, may pro- questing a search and exchange of records ‘‘(b) SUPERVISION OF PROVISIONAL EMPLOY- mulgate such regulations as are necessary to pursuant to this paragraph and subsection EES.— carry out the Attorney General’s responsibil- (b)(8) for conducting the search and pro- ‘‘(1) IN GENERAL.—With respect to an entity ities under this paragraph and subsection viding the records. The amount of such fee that provides home health services, such en- (b)(9), including regulations regarding the se- shall not exceed the lesser of the actual cost tity shall be considered to have satisfied the curity confidentiality, accuracy, use, de- of such activities or $50. Such fees shall be requirements of section 1819(b)(8)(B)(ii) or

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(III) in subparagraph (C), by striking ‘‘a aide’’ and inserting ‘‘individual’’. ‘‘(2) REQUIREMENTS.—The regulations re- nurse aide’’ and inserting ‘‘an individual’’; (d) REIMBURSEMENT OF COSTS FOR BACK- quired under paragraph (1) shall provide the and GROUND CHECKS.—The Secretary of Health following: (ii) in subsection (g)(1)— and Human Services shall reimburse nursing ‘‘(A) Supervision of a provisional employee (I) by striking the first sentence of sub- facilities, skilled nursing facilities, and shall consist of ongoing, good faith, paragraph (C) and inserting the following: other entities for costs incurred by the fa- verifiable efforts by the supervisor of the ‘‘The State shall provide, through the agen- cilities and entities in order to comply with provisional employee to conduct monitoring cy responsible for surveys and certification the requirements imposed under sections and oversight activities to ensure the safety of skilled nursing facilities under this sub- 1819(b)(8) and 1919(b)(8) of such Act (42 U.S.C. of a medicare beneficiary. section, for a process for the receipt and 1395i–3(b)(8), 1396r(b)(8)), as added by this sec- ‘‘(B) For purposes of subparagraph (A), timely review and investigation of allegation. monitoring and oversight activities may in- (e) INCLUSION OF ABUSIVE ACTS WITHIN A clude (but are not limited to) the following: tions of neglect and abuse and misappropria- LONG-TERM CARE FACILITY OR PROVIDER IN ‘‘(i) Follow-up telephone calls to the medi- tion of resident property by a nurse aide or THE NATIONAL HEALTH CARE FRAUD AND care beneficiary. a skilled nursing facility employee of a resi- ABUSE DATA COLLECTION PROGRAM.— ‘‘(ii) Unannounced visits to the medicare dent in a skilled nursing facility, by another (1) IN GENERAL.—Section 1128E(g)(1)(A) (42 beneficiary’s home while the provisional em- individual used by the facility in providing U.S.C. 1320a–7e(g)(1)(A)) is amended— ployee is serving the medicare beneficiary. services to such a resident, or by an indi- (A) by redesignating clause (v) as clause ‘‘(iii) To the extent practicable, limiting vidual described in subsection (e)(2)(A)(iii).’’; (vi); and the provisional employee’s duties to serving and (B) by inserting after clause (iv), the fol- only those medicare beneficiaries in a home (II) in the fourth sentence of subparagraph lowing: or setting where another family member or (C), by inserting ‘‘or described in subsection resident of the home or setting of the medi- (e)(2)(A)(iii)’’ after ‘‘used by the facility’’; ‘‘(v) A finding of abuse or neglect of a pa- care beneficiary is present. and tient or a resident of a long-term care facil- ‘‘(C) In promulgating such regulations, the (III) in subparagraph (D)— ity, or misappropriation of such a patient’s Secretary shall take into account the staff- (aa) in the subparagraph heading, by strik- or resident’s property.’’. ing and geographic issues faced by small ing ‘‘NURSE AIDE’’; and (2) COVERAGE OF LONG-TERM CARE FACILITY rural entities (as defined by the Secretary) (bb) in clause (i), in the matter preceding OR PROVIDER EMPLOYEES.—Section 1128E(g)(2) that provide home health services, hospice subclause (I), by striking ‘‘a nurse aide’’ and (42 U.S.C. 1320a–7e(g)(2)) is amended by in- care (including routine home care and other inserting ‘‘an individual’’; and serting ‘‘, and includes any individual of a services included in hospice care under this (cc) in clause (i)(I), by striking ‘‘nurse long-term care facility or provider (other title), or other long-term care services. Such aide’’ and inserting ‘‘individual’’. than any volunteer) that has access to a patient or resident of such a facility under an regulations should encourage the provision (B) MEDICAID.—Section 1919 (42 U.S.C. of monitoring and oversight activities when- 1396r) is amended— employment or other contract, or both, with ever practicable with respect to such an enti- (i) in subsection (e)(2)— the facility or provider (including individ- ty, and if such activities would not impose (I) in the paragraph heading, by striking uals who are licensed or certified by the State to provide services at the facility or an unreasonable cost or other burden on the ‘‘NURSE AIDE REGISTRY’’ and inserting ‘‘EM- through the provider, and nonlicensed indi- entity.’’. PLOYEE REGISTRY’’; viduals, as defined by the Secretary, pro- (2) MEDICAID.—Section 1902(a) (42 U.S.C. (II) in subparagraph (A)— viding services at the facility or through the 1396a), as amended by section 104(a), is (aa) by striking ‘‘By not later than Janu- provider, including nurse assistants, nurse amended— ary 1, 1989, the’’ and inserting ‘‘The’’; aides, home health aides, individuals who (A) in paragraph (65), by striking ‘‘and’’ at (bb) by striking ‘‘a registry of all individ- provide home care, and personal care work- the end; uals’’ and inserting ‘‘a registry of (i) all indi- ers and attendants)’’ before the period. (B) in paragraph (66), by striking the pe- viduals’’; and (3) REPORTING BY LONG-TERM CARE FACILI- riod and inserting ‘‘; and’’; and (cc) by inserting before the period the fol- TIES OR PROVIDERS.— (C) by inserting after paragraph (66) the lowing: ‘‘, (ii) all other nursing facility em- (A) IN GENERAL.—Section 1128E(b)(1) (42 following: ployees with respect to whom the State has ‘‘(67) provide that any entity that is eligi- U.S.C. 1320a–7e(b)(1)) is amended by striking made a finding described in subparagraph ble to be paid under the State plan for pro- ‘‘and health plan’’ and inserting ‘‘, health (B), and (iii) any employee of an entity that viding home health services, hospice care plan, and long-term care facility or pro- is eligible to be paid under the State plan for (including routine home care and other serv- vider’’. providing home health services, hospice care ices included in hospice care under title (B) CORRECTION OF INFORMATION.—Section (including routine home care and other serv- XVIII), or long-term care services for which 1128E(c)(2) (42 U.S.C. 1320a–7e(c)(2)) is amend- medical assistance is available under the ices included in hospice care under title ed by striking ‘‘and health plan’’ and insert- State plan to individuals requiring long- XVIII), or long-term care services and with ing ‘‘, health plan, and long-term care facil- term care complies with the requirements of respect to whom the entity has reported to ity or provider’’. subsections (b)(8) and (e)(8) of section 1919 the State a finding of patient neglect or (4) ACCESS TO REPORTED INFORMATION.— and section 1897(b) (in the same manner as abuse or a misappropriation of patient prop- Section 1128E(d)(1) (42 U.S.C. 1320a–7e(d)(1)) such section applies to a medicare bene- erty’’; and is amended by striking ‘‘and health plans’’ ficiary).’’. (III) in subparagraph (C), by striking ‘‘a and inserting ‘‘, health plans, and long-term (3) EXPANSION OF STATE NURSE AIDE REG- nurse aide’’ and inserting ‘‘an individual’’; care facilities or providers’’. ISTRY.— and (5) MANDATORY CHECK OF DATABASE BY (A) MEDICARE.—Section 1819 (42 U.S.C. (ii) in subsection (g)(1)— LONG-TERM CARE FACILITIES OR PROVIDERS.— 1395i–3) is amended— (I) by striking the first sentence of sub- Section 1128E(d) (42 U.S.C. 1320a–7e(d)) is (i) in subsection (e)(2)— paragraph (C) and inserting the following: amended by adding at the end the following: (I) in the paragraph heading, by striking ‘‘The State shall provide, through the agen- ‘‘(3) MANDATORY CHECK OF DATABASE BY ‘‘NURSE AIDE REGISTRY’’ and inserting ‘‘EM- cy responsible for surveys and certification LONG-TERM CARE FACILITIES OR PROVIDERS.—A PLOYEE REGISTRY’’; of nursing facilities under this subsection, long-term care facility or provider shall (II) in subparagraph (A)— for a process for the receipt and timely re- check the database maintained under this (aa) by striking ‘‘By not later than Janu- view and investigation of allegations of ne- section prior to hiring under an employment ary 1, 1989, the’’ and inserting ‘‘The’’; glect and abuse and misappropriation of resi- or other contract, or both, (other than in a (bb) by striking ‘‘a registry of all individ- dent property by a nurse aide or a nursing fa- provisional status) any individual as an em- uals’’ and inserting ‘‘a registry of (i) all indi- cility employee of a resident in a nursing fa- ployee of such a facility or provider who will viduals’’; and cility, by another individual used by the fa- have access to a patient or resident of the fa- (cc) by inserting before the period the fol- cility in providing services to such a resi- cility or provider (including individuals who lowing: ‘‘, (ii) all other skilled nursing facil- dent, or by an individual described in sub- are licensed or certified by the State to pro- ity employees with respect to whom the section (e)(2)(A)(iii).’’; and vide services at the facility or through the State has made a finding described in sub- (II) in the fourth sentence of subparagraph provider, and nonlicensed individuals, as de- paragraph (B), and (iii) any employee of any (C), by inserting ‘‘or described in subsection fined by the Secretary, that will provide provider of services or any other entity that (e)(2)(A)(iii)’’ after ‘‘used by the facility’’; services at the facility or through the pro- is eligible to be paid under this title for pro- and vider, including nurse assistants, nurse viding home health services, hospice care (III) in subparagraph (D)— aides, home health aides, individuals who (including routine home care and other serv- (aa) in the subparagraph heading, by strik- provide home care, and personal care work- ices included in hospice care under this ing ‘‘NURSE AIDE’’; and ers and attendants).’’.

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(6) DEFINITION OF LONG-TERM CARE FACILITY by this section shall take effect on the date (2) to provide for a vote by Congress on the OR PROVIDER.—Section 1128E(g) (42 U.S.C. that is the earlier of— recommendations that result from the de- 1320a–7e(g)) is amended by adding at the end (A) 18 months after the effective date of bate. the following: final regulations promulgated to carry out (c) ESTABLISHMENT.—The Secretary, acting ‘‘(6) LONG-TERM CARE FACILITY OR PRO- this section and such amendments; or through the Agency for Healthcare Research VIDER.—The term ‘long-term care facility or (B) January 1, 2007. and Quality, shall establish an entity to be provider’ means a skilled nursing facility (as known as the Citizens’ Health Care Working defined in section 1819(a)), a nursing facility SA 1105. Mr. HATCH submitted an Group (referred to in this Act as the ‘‘Work- (as defined in section 1919(a)), a home health amendment intended to be proposed by ing Group’’). agency, a provider of hospice care (as defined him to the bill S. 1, to amend title (d) APPOINTMENT.—Not later than 45 days in section 1861(dd)(1)), a long-term care hos- XVIII of the Social Security Act to after the date of enactment of this Act, the pital (as described in section provide for a voluntary prescription Speaker and Minority Leader of the House of 1886(d)(1)(B)(iv)), an intermediate care facil- drug benefit under the Medicare pro- Representatives and the Majority Leader and ity for the mentally retarded (as defined in gram and to strengthen and improve Minority Leader of the Senate (in this sec- section 1905(d)), or any other facility or enti- tion referred to as the ‘‘leadership’’) shall ty that provides, or is a provider of, long- the Medicare program, and for other purposes; which was ordered to lie on each appoint individuals to serve as mem- term care services, home health services, or bers of the Working Group in accordance hospice care (including routine home care the table; as follows: with subsections (e), (f), and (g). and other services included in hospice care On page 486, line 3, insert ‘‘and’’ after the (e) MEMBERSHIP CRITERIA.— under title XVIII), and receives payment for semicolon at the end. (1) APPOINTED MEMBERS.— such services under the medicare program On page 486, line 4, insert ‘‘(I)’’ after ‘‘(ii)’’. (A) SEPARATE APPOINTMENTS.—The Speaker under title XVIII or the medicaid program On page 486, line 8, strike ‘‘and’’ and insert of the House of Representatives jointly with under title XIX.’’. ‘‘or’’. the Minority Leader of the House of Rep- (7) AUTHORIZATION OF APPROPRIATIONS.— On page 486, line 9, strike ‘‘(iii)’’ and insert resentatives, and the Majority Leader of the There is authorized to be appropriated to ‘‘(II)’’. carry out the amendments made by this sub- Senate jointly with the Minority Leader of section, $10,200,000 for fiscal year 2004. SA 1106. Mr. HATCH (for himself and the Senate, shall each appoint 1 member of (f) PREVENTION AND TRAINING DEMONSTRA- Mr. WYDEN) submitted an amendment the Working Group described in subpara- TION PROJECT.— intended to be proposed by him to the graphs (A), (G), (J), (K), and (M) of paragraph (1) ESTABLISHMENT.—The Secretary of bill S. 1, to amend title XVIII of the (2). Health and Human Services shall establish a (B) JOINT APPOINTMENTS.—Members of the Social Security Act to provide for a Working Group described in subparagraphs demonstration program to provide grants to voluntary prescription drug benefit develop information on best practices in pa- (B), (C), (D), (E), (F), (I), and (N) of paragraph tient abuse prevention training (including under the Medicare program and to (2) shall be appointed jointly by the leader- behavior training and interventions) for strengthen and improve the Medicare ship. managers and staff of hospital and health program, and for other purposes; as fol- (C) COMBINED APPOINTMENTS.—Members of care facilities. lows: the Working Group described in subpara- (2) ELIGIBILITY.—To be eligible to receive a At the end of title VI, insert the following: graphs (H) and (L) shall be appointed in the grant under paragraph (1), an entity shall be SEC. ll. HEALTH CARE THAT WORKS FOR ALL following manner: a public or private nonprofit entity and pre- AMERICANS-CITIZENS HEALTH CARE (i) One member of the Working Group in pare and submit to the Secretary of Health WORKING GROUP. each of such subparagraphs shall be ap- and Human Services an application at such (a) FINDINGS.—Congress finds the fol- pointed jointly by the leadership. time, in such manner, and containing such lowing: (ii) The remaining appointments of the information as the Secretary may require. (1) In order to improve the health care sys- members in each of such subparagraphs shall (3) USE OF FUNDS.—Amounts received under tem, the American public must engage in an be divided equally such that the Speaker of a grant under this subsection shall be used informed national public debate to make the House of Representatives jointly with to— choices about the services they want cov- the Minority Leader of the House of Rep- (A) examine ways to improve collaboration ered, what health care coverage they want, resentatives, and the Majority Leader of the between State health care survey and pro- and how they are willing to pay for coverage. Senate jointly with the Minority Leader of vider certification agencies, long-term care (2) More than a trillion dollars annually is the Senate each appoint an equal number of ombudsman programs, the long-term care in- spent on the health care system, yet— members. dustry, and local community members; (A) 41,000,000 Americans are uninsured; (2) CATEGORIES OF APPOINTED MEMBERS.— (B) examine patient care issues relating to (B) insured individuals do not always have Members of the Working Group shall be ap- regulatory oversight, community involve- access to essential, effective services to im- pointed as follows: ment, and facility staffing and management prove and maintain their health; and (A) 2 members shall be patients or family with a focus on staff training, staff stress (C) employers, who cover over 170,000,000 members of patients who, at least 1 year management, and staff supervision; Americans, find providing coverage increas- prior to the date of enactment of this Act, (C) examine the use of patient abuse pre- ingly difficult because of rising costs and have had no health insurance. vention training programs by long-term care double digit premium increases. (B) 1 member shall be a representative of entities, including the training program de- (3) Despite increases in medical care spend- children. veloped by the National Association of At- ing that are greater than the rate of infla- (C) 1 member shall be a representative of torneys General, and the extent to which tion, population growth, and Gross Domestic the mentally ill. such programs are used; and Product growth, there has not been a com- (D) 1 member shall be a representative of (D) identify and disseminate best practices mensurate improvement in our health status the disabled. for preventing and reducing patient abuse. as a nation. (E) 1 member shall be over the age of 65 (4) AUTHORIZATION OF APPROPRIATIONS.— (4) Health care costs for even just 1 mem- and a beneficiary under the medicare pro- There is authorized to be appropriated such ber of a family can be catastrophic, resulting gram established under title XVIII of the So- sums as may be necessary to carry out this in medical bills potentially harming the eco- cial Security Act (42 U.S.C. 1395 et seq.). subsection. nomic stability of the entire family. (F) 1 member shall be a recipient of bene- (g) EFFECTIVE DATE.— (5) Common life occurrences can jeopardize fits under the medicaid program under title (1) IN GENERAL.—With respect to a skilled the ability of a family to retain private cov- XIX of the Social Security Act (42 U.S.C. 1396 nursing facility (as defined in section 1819(a) erage or jeopardize access to public coverage. et seq.). of the Social Security Act (42 U.S.C. 1395i– (6) Innovations in health care access, cov- (G) 2 members shall be State health offi- 3(a)) or a nursing facility (as defined in sec- erage, and quality of care, including the use cials. tion 1919(a) of the Social Security Act (42 of technology, have often come from States, (H) 3 members shall be employers, includ- U.S.C. 1396r(a)), this section and the amend- local communities, and private sector orga- ing— ments made by this section shall take effect nizations, but more creative policies could (i) 1 large employer (an employer who em- on the date that is the earlier of— tap this potential. ployed 50 or more employees on business (A) 6 months after the effective date of (7) Despite our Nation’s wealth, the health days during the preceding calendar year and final regulations promulgated to carry out care system does not provide coverage to all who employed at least 50 employees on the this section and such amendments; or Americans who want it. first of the year); (B) January 1, 2006. (b) PURPOSES.—The purposes of this Act (ii) 1 small employer (an employer who em- (2) LONG-TERM CARE FACILITIES AND PRO- are— ployed an average of at least 2 employees but VIDERS.—With respect to a long-term care fa- (1) to provide for a nationwide public de- less than 50 employees on business days in cility or provider (as defined in section bate about improving the health care system the preceding calendar year and who em- 1128E(g)(6) of the Social Security Act (42 to provide every American with the ability ploys at least 2 employees on the first of the U.S.C. 1320a–7e(g)(6)) (as added by subsection to obtain quality, affordable health care cov- year); and (e)), this section and the amendments made erage; and (iii) 1 multi-state employer.

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(I) 1 member shall be a representative of (B) the cost of health care and the effec- (B) NUMBER OF MEETINGS.—The Working labor. tiveness of care provided at all stages of dis- Group shall hold a sufficient number of com- (J) 2 members shall be health insurance ease; munity meetings in order to receive infor- issuers. (C) innovative State strategies used to ex- mation that reflects— (K) 2 members shall be health care pro- pand health care coverage and lower health (i) the geographic differences throughout viders. care costs; the United States; (L) 5 members shall be appointed as fol- (D) local community solutions to accessing (ii) diverse populations; and lows: health care coverage; (iii) a balance among urban and rural popu- (i) 1 economist. (E) efforts to enroll individuals currently lations. (ii) 1 academician. eligible for public or private health care cov- (C) MEETING REQUIREMENTS.— (iii) 1 health policy researcher. erage; (i) FACILITATOR.—A State health officer (iv) 1 individual with expertise in (F) the role of evidence-based medical may be the facilitator at the community pharmacoeconomics. practices that can be documented as restor- meetings. (v) 1 health technology expert. ing, maintaining, or improving a patient’s (ii) ATTENDANCE.—At least 1 member of the (M) 2 members shall be representatives of health, and the use of technology in sup- Working Group shall attend and serve as community leaders who have developed porting providers in improving quality of chair of each community meeting. Other State or local community solutions to the care and lowering costs; and members may participate through inter- problems addressed by the Working Group. (G) strategies to assist purchasers of active technology. (N) 1 member shall be a representative of a health care, including consumers, to become (iii) TOPICS.—The community meetings medical school. more aware of the impact of costs, and to shall, at a minimum, address the following (3) SECRETARY.—The Secretary, or the des- lower the costs of health care. issues: ignee of the Secretary, shall be a member of (2) ADDITIONAL HEARINGS.—The Working (I) The optimum way to balance costs and the Working Group. Group may hold additional hearings on sub- benefits so that affordable health coverage is (f) PROHIBITED APPOINTMENTS.—Members of jects other than those listed in paragraph (1) available to as many people as possible. the Working Group shall not include mem- so long as such hearings are determined to (II) The identification of services that pro- bers of Congress or other elected government be necessary by the Working Group in car- vide cost-effective, essential health care officials (Federal, State, or local) other than rying out the purposes of this Act. Such ad- services to maintain and improve health and those individuals specified in subsection (e). ditional hearings do not have to be com- which should be included in health care cov- To the extent possible, individuals appointed pleted within the time period specified in erage. to the Working Group shall have used the paragraph (1) but shall not delay the other (III) The cost of providing increased bene- health care system within the previous 2 activities of the Working Group under this fits. section. years and shall not be paid employees or rep- (IV) The mechanisms to finance health (3) THE HEALTH REPORT TO THE AMERICAN resentatives of associations or advocacy or- care coverage, including defining the appro- PEOPLE.—Not later than 90 days after the ganizations involved in the health care sys- priate financial role for individuals, busi- hearings described in paragraphs (1) and (2) tem. nesses, and government. are completed, the Working Group shall pre- (g) APPOINTMENT CRITERIA.— (iv) INTERACTIVE TECHNOLOGY.—The Work- pare and make available to health care con- (1) HOUSE OF REPRESENTATIVES.—The ing Group may encourage public participa- sumers through the Internet and other ap- tion in community meetings through inter- Speaker and Minority Leader of the House of propriate public channels, a report to be en- active technology and other means as deter- Representatives shall make the appoint- titled, ‘‘The Health Report to the American mined appropriate by the Working Group. ments described in subsection (d) in con- People’’. Such report shall be understandable (D) INTERIM REQUIREMENTS.—Not later than sultation with the chairperson and ranking to the general public and include— 180 days after the date of completion of the member of the following committees of the (A) a summary of— community meetings, the Working Group House of Representatives: (i) health care and related services that shall prepare and make available to the pub- (A) The Committee on Ways and Means. may be used by individuals throughout their lic through the Internet and other appro- (B) The Committee on Energy and Com- life span; merce. (ii) the cost of health care services and priate public channels, an interim set of rec- (C) The Committee on Education and the their medical effectiveness in providing bet- ommendations on health care coverage and Workforce. ter quality of care for different age groups; ways to improve and strengthen the health (2) SENATE.—The Majority Leader and Mi- (iii) the source of coverage and payment, care system based on the information and nority Leader of the Senate shall make the including reimbursement, for health care preferences expressed at the community appointments described in subsection (d) in services; meetings. There shall be a 90-day public com- consultation with the chairperson and rank- (iv) the reasons people are uninsured or ment period on such recommendations. ing member of the following committees of underinsured and the cost to taxpayers, pur- (l) RECOMMENDATIONS.—Not later than 120 the Senate: chasers of health services, and communities days after the expiration of the public com- (A) The Committee on Finance. when Americans are uninsured or under- ment period described in subsection (B) The Committee on Health, Education, insured; (k)(4)(D), the Working Group shall submit to Labor, and Pensions. (v) the impact on health care outcomes and Congress and the President a final set of rec- (h) PERIOD OF APPOINTMENT.—Members of costs when individuals are treated in all ommendations. the Working Group shall be appointed for a stages of disease; (m) ADMINISTRATION.— term of 2 years. Such term is renewable and (vi) health care cost containment strate- (1) EXECUTIVE DIRECTOR.—There shall be an any vacancies shall not affect the power and gies; and Executive Director of the Working Group duties of the Working Group but shall be (vii) information on health care needs that who shall be appointed by the chairperson of filled in the same manner as the original ap- need to be addressed; the Working Group in consultation with the pointment. (B) examples of community strategies to members of the Working Group. (i) APPOINTMENT OF THE CHAIRPERSON.—Not provide health care coverage or access; (2) COMPENSATION.—While serving on the later than 15 days after the date on which all (C) information on geographic-specific business of the Working Group (including members of the Working Group have been issues relating to health care; travel time), a member of the Working appointed under subsection (d), the leader- (D) information concerning the cost of care Group shall be entitled to compensation at ship shall make a joint designation of the in different settings, including institutional- the per diem equivalent of the rate provided chairperson of the Working Group. If the based care and home and community-based for level IV of the Executive Schedule under leadership fails to make such designation care; section 5315 of title 5, United States Code, within such time period, the Working Group (E) a summary of ways to finance health and while so serving away from home and Members shall, not later than 10 days after care coverage; and the member’s regular place of business, a the end of such time period, designate a (F) the role of technology in providing fu- member may be allowed travel expenses, as chairperson by majority vote. ture health care including ways to support authorized by the chairperson of the Work- (j) SUBCOMMITTEES.—The Working Group the information needs of patients and pro- ing Group. For purposes of pay and employ- may establish subcommittees if doing so in- viders. ment benefits, rights, and privileges, all per- creases the efficiency of the Working Group (4) COMMUNITY MEETINGS.— sonnel of the Working Group shall be treated in completing its tasks. (A) IN GENERAL.—Not later than 1 year as if they were employees of the Senate. (k) DUTIES.— after the date of enactment of this Act, the (3) INFORMATION FROM FEDERAL AGENCIES.— (1) HEARINGS.—Not later than 90 days after Working Group shall initiate health care The Working Group may secure directly the date of appointment of the chairperson community meetings throughout the United from any Federal department or agency such under subsection (i), the Working Group States (in this section referred to as ‘‘com- information as the Working Group considers shall hold hearings to examine— munity meetings’’). Such community meet- necessary to carry out this Act. Upon re- (A) the capacity of the public and private ings may be geographically or regionally quest of the Working Group, the head of such health care systems to expand coverage op- based and shall be completed within 180 days department or agency shall furnish such in- tions; after the initiation of the first meeting. formation.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00128 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8775

(4) POSTAL SERVICES.—The Working Group monitoring system in cooperation with the ficiaries initially covered by a private in- may use the United States mails in the same CMS Mississippi Quality Improvement Orga- surer under this act who are subsequently manner and under the same conditions as nization, Information Healthcare, and the covered by a Medicare fallback plan have the other departments and agencies of the Fed- University of Mississippi. option of retaining a Medicare fallback plan eral Government. or entering private insurance under this act. (n) DETAIL.—Not more than 10 Federal SA 1108. Mr. DURBIN proposed an Government employees employed by the De- amendment to the bill S. 1, to amend SA 1111. Mr. BAUCUS (for Mr. LEVIN partment of Labor and 10 Federal Govern- title XVIII of the Social Security Act (for himself, Ms. STABENOW, and Mrs. ment employees employed by the Depart- to provide for a voluntary prescription CLINTON)) proposed an amendment to ment of Health and Human Services may be drug benefit under the Medicare pro- the bill S. 1, to amend title XVIII of detailed to the Working Group under this the Social Security Act to provide for section without further reimbursement. Any gram and to strengthen and improve the Medicare program, and for other a voluntary prescription drug benefit detail of an employee shall be without inter- under the Medicare program and to purposes; as follows: ruption or loss of civil service status or strengthen and improve the Medicare privilege. At the appropriate place, insert the fol- program, and for other purposes; as fol- (o) TEMPORARY AND INTERMITTENT SERV- lowing: lows: ICES.—The chairperson of the Working Group SEC. ll. ADDITIONAL ASSISTANCE FOR CER- may procure temporary and intermittent TAIN ELIGIBLE BENEFICIARIES Insert the following in the appropriate services under section 3109(b) of title 5, UNDER PART D. place: The Secretary of Health and Human United States Code, at rates for individuals Section 1860D–26, as added by section 101, is Services shall retain or designate one or which do not exceed the daily equivalent of amended by adding at the end the following: more Medicare backup plans so that the 37% the annual rate of basic pay prescribed for ‘‘(d) ADDITIONAL ASSISTANCE FOR CERTAIN of current retirees who have prescription level V of the Executive Schedule under sec- ELIGIBLE BENEFICIARIES.— drug coverage, estimated by the Congres- tion 5316 of such title. ‘‘(1) PROGRAM.—Subject to paragraph (2), sional Budget Office who will lose their cur- (p) ANNUAL REPORT.—Not later than 1 year the Administrator shall implement a pro- rent employer retiree coverage as a result of after the date of enactment of this Act, and gram (for the period beginning on January 1, the enactment of this legislation will have annually thereafter during the existence of 2009, and ending on September 30, 2013) to the option to enter either a Medicare backup the Working Group, the Working Group shall provide additional assistance to applicable plan or private insurance under this act. report to Congress and make public a de- eligible beneficiaries who have reached the SA 1112. Mr. KERRY submitted an tailed description of the expenditures of the initial coverage limit described in section Working Group used to carry out its duties 1860D–6(c)(3) for the year but have not amendment intended to by proposed by under this section. reached the annual out-of-pocket limit under him to the bill S. 1, to amend title (q) SUNSET OF WORKING GROUP.—The Work- section 1860D–6(c)(4)(A)) for the year in order XVIII of the Social Security Act to ing Group shall terminate when the report to reduce the cost-sharing requirement dur- provide for a voluntary prescription described in subsection (l) is submitted to ing this coverage gap. drug benefit under the Medicare pro- Congress. ‘‘(2) FUNDING LIMITATION.—The Adminis- gram and to strengthen and improve (r) ADMINISTRATION REVIEW AND COM- trator shall implement the program de- the Medicare program, and for other MENTS.—Not later than 45 days after receiv- scribed in paragraph (1) in such a manner purposes; which was ordered to lie on ing the final recommendations of the Work- that will result in a decrease of $12,000,000,000 the table; as follows: ing Group under subsection (l), the President in cost-sharing for covered drugs under part After section 404, insert the following: shall submit a report to Congress which shall D by applicable eligible beneficiaries during contain— the period described in such paragraph. The SEC. 404A. INCREASE FOR HOSPITALS WITH DIS- PROPORTIONATE INDIGENT CARE (1) additional views and comments on such Administrator shall take appropriate steps REVENUES. recommendations; and to ensure that the costs of the program dur- (a) DISPROPORTIONATE SHARE ADJUSTMENT (2) recommendations for such legislation ing such period do not exceed $12,000,000,000. PERCENTAGE.—Section 1886(d)(5)(F)(iii) (42 and administrative actions as the President ‘‘(3) APPLICABLE ELIGIBLE BENEFICIARY.— U.S.C. 1395ww(d)(5)(F)(iii)) is amended by considers appropriate. For purposes of this subsection, the term striking ‘‘35 percent’’ and inserting ‘‘35 per- (s) REQUIRED CONGRESSIONAL ACTION.—Not ‘applicable eligible beneficiary’ means an eli- cent (or, for discharges occurring on or after later than 45 days after receiving the report gible beneficiary with cardiovascular dis- October 1, 2003, 40 percent)’’. submitted by the President under subsection ease, diabetes and its complications, cancer, (b) CAPITAL COSTS.—Section 1886(g)(1)(B) (r), each committee of jurisdiction of Con- or Alzheimer’s disease who is enrolled under (42 U.S.C. 1395ww(g)(1)(B)) is amended— gress shall hold at least 1 hearing on such re- part D.’’. (1) in clause (iii), by striking ‘‘and’’ at the port and on the final recommendations of end; the Working Group submitted under sub- SA 1109. Mr. BURNS (for himself and (2) in clause (iv), by striking the period at section (l). Ms. MURKOWSKI) submitted an amend- the end and inserting ‘‘, and’’; and (t) AUTHORIZATION OF APPROPRIATIONS.— ment intended to be proposed by him (3) by adding at the end the following new (1) IN GENERAL.—There are authorized to to the bill S. 1, to amend title XVIII of clause: be appropriated to carry out this Act, other the Social Security Act to provide for ‘‘(v) in the case of cost reporting periods than subsection (k)(3), $3,000,000 for each of beginning on or after October 1, 2003, shall fiscal years 2004, 2005, and 2006. a voluntary prescription drug benefit provide for a disproportionate share adjust- (2) HEALTH REPORT TO THE AMERICAN PEO- under the Medicare program and to ment in the same manner as section PLE.—There are authorized to be appro- strengthen and improve the Medicare 1886(d)(5)(F)(iii).’’. priated for the preparation and dissemina- program, and for other purposes; which tion of the Health Report to the American was ordered to lie on table; as follows: SA 1113. Mr. GRASSLEY proposed an People described in subsection (k)(3), such On page 68, between lines 5 and 6, insert amendment to the bill S. 312, to amend sums as may be necessary for the fiscal year the following: title XXI of the Social Security Act to in which the report is required to be sub- ‘‘(E) Not be less than 1,000,000 eligible bene- extend the availability of allotments mitted. ficiaries shall reside in each service area. for fiscal years 1998 through 2001 under On page 354, between lines 19 and 20, insert the State Children’s Health Insurance Mr. COCHRAN submitted an SA 1107. the following: Programs; as follows: amendment intended to be proposed by ‘‘(F) Not be less than 1,000,000 MedicareAd- At the end, add the following: him to the bill S. 1, to amend title vantage eligible individuals shall reside in SEC. 2. TECHNICAL CORRECTION. each region. XVIII of the Social Security Act to (a) TEMPORARY INCREASE OF THE MEDICAID provide for a voluntary prescription FMAP.—Section 401(a)(6)(A) of the Jobs and drug benefit under the Medicare pro- SA 1110. Mr. BAUCUS (for Mr. LEVIN) Growth Tax Relief Reconciliation Act of 2003 gram and to strengthen and improve proposed an amendment to the bill S. 1, (Public Law 108–027) is amended by inserting the Medicare program, and for other to amend title XVIII of the Social Se- ‘‘after September 2, 2003,’’ after ‘‘(42 U.S.C. purposes; which was ordered to lie on curity Act to provide for a voluntary 1315))’’. (b) RETROACTIVE EFFECTIVE DATE.—The the table; as follows: prescription drug benefit under the Medicare program and to strengthen amendment made by subsection (a) shall At the end of title VI, add the following: and improve the Medicare program, take effect as if included in the enactment of SEC. ll. AUTHORIZATION OF APPROPRIATIONS section 401 of the Jobs and Growth Tax Re- TO CONTINUE THE EXISTING CMS and for other purposes; as follows: lief Reconciliation Act of 2003 (Public Law MEDICATION MONITORING SYSTEM. Insert the following in the appropriate 108–027). There are authorized to be appropriated place: The Secretary of Health and Human such sums as are necessary to continue the Services shall retain or designate one or SA 1114. Mr. KYL submitted an Prescription Continuity of Care medication more Medicare backup plans so that bene- amendment intended to be proposed by

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00129 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8776 CONGRESSIONAL RECORD — SENATE June 26, 2003 him to the bill S. 1, to amend title SEC. . SENSE OF THE SENATE CONCERNING subparagraph (C), in addition to the increase XVIII of the Social Security Act to MEDICARE PAYMENT UPDATE FOR provided under subparagraph (A). PHYSICIANS AND OTHER HEALTH ‘‘(C) DETERMINATION OF RURAL AREAS BASED provide for a voluntary prescription PROFESSIONALS. ON POPULATION DENSITY WITHIN POSTAL ZIP drug benefit under the Medicare pro- (a) FINDINGS.—The Senate makes the fol- CODES.—With respect to ground ambulance gram and to strengthen and improve lowing findings: services described in subparagraph (B), dur- the Medicare program, and for other (1) The formula by which Medicare paying the period described in that subpara- purposes; as follows: ments are updated each year for services fur- graph, paragraph (9) shall be applied by sub- nished by physicians and other health profes- At the appropriate place, insert the fol- stituting ‘(as determined under an area clas- sionals is fundamentally flawed. sification system established by the Sec- lowing: (2) The flawed physician payment update SEC. . GAO STUDY OF PHARMACEUTICAL PRICE retary that is based on population density formula is causing a continuing physician within postal zip code areas)’ for ‘(as defined CONTROLS AND PATENT PROTEC- payment crisis, and, without Congressional TIONS IN THE G–7 COUNTRIES. in section 1886(d)(2)(D)) or in a rural census action, Medicare payment rates for physi- tract of a metropolitan statistical area (as (a) STUDY.—The Comptroller General of cians and other practitioners are predicted the United States shall conduct a study of determined under the most recent modifica- to fall by 4.2% in 2004. tion of the Goldsmith Modification, origi- price controls imposed on pharmaceuticals (3) A physician payment cut in 2004 would in France, Germany, Italy, Japan, the nally published in the Federal Register on be the fifth cut since 1991, and would be on February 27, 1992 (57 Fed. Reg. 6725))’. Not United Kingdom and Canada to review the top of a 5.4% cut in 2002, with additional cuts impact such regulations have on consumers, later than December 31, 2003, the Secretary, estimated for 2005, 2006, and 2007; from 1991– taking into account the recommendations including American consumers, and on inno- 2003, payment rates for physicians and vation in medicine. Such study shall in- contained in the report submitted under sec- health professionals fell 14% behind practice tion 221(b)(3) of the Medicare, Medicaid, and clude— cost inflation as measured by Medicare’s own (1) The pharmaceutical price control struc- SCHIP Benefits Improvement and Protection conservative estimates. Act of 2000, shall implement the increase in ture in each country for a wide range of (4) The sustainable growth rate (SGR) ex- pharmaceuticals, compared with average payment required under subparagraph (B) penditure target, which is the basis for the and shall establish the classification system pharmaceutical prices paid by Americans physician payment update, is linked to the covered by private sector health insurance; required by the application of this subpara- gross domestic product and penalizes physi- graph. The Secretary shall provide such in- (2) The proportion of the cost for innova- cians and other practitioners for volume in- tion borne by American consumers compared creased payment for services furnished on or creases that they cannot control and that after the earlier of 30 days after the estab- with consumers in the other six countries; the government actively promotes through (3) A review of how closely the observed lishment of such classification system or De- new coverage decisions, quality improve- cember 31, 2003. prices in regulated markets correspond to ment activities and other initiatives that, ‘‘(D) APPLICATION OF INCREASED PAYMENTS the prices that efficiently distribute com- while beneficial to patients, are not reflected mon costs of production (‘‘Ramsey prices’’); AFTER 2007.—The increased payments under in the SGR. subparagraphs (A) and (B) shall not be taken (4) A review of any peer-reviewed literature (b) SENSE OF THE SENATE.—It is the Sense into account in calculating payments for that might show the health consequences to of the Senate that Medicare beneficiary ac- services furnished on or after the period patients in the listed countries that result cess to quality care may be compromised if specified in such subparagraph. from the absence or delayed introduction of Congress does not take action to prevent ‘‘(11) CONVERSION FACTOR ADJUSTMENTS.— medicines, including the cost of not having cuts next year and the following that result The Secretary shall not adjust downward the access to medicines, in terms of lower life from the SGR formula. conversion factor in any year because of an expectancy and lower quality of health; evaluation of the prior year conversion fac- (5) The impact on American consumers, in SA 1116. Mr. DAYTON (for himself, tor.’’. terms of reduced research into new or im- Mr. COLEMAN, and Mr. SMITH) sub- proved pharmaceuticals (including the cost mitted an amendment intended to be SEC. 426A. MEDICARE SECONDARY PAYOR (MSP) of delaying the introduction of a significant proposed by him to the bill S. 1, to PROVISIONS. advance in certain major diseases), if similar amend title XVIII of the Social Secu- (a) TECHNICAL AMENDMENT CONCERNING price controls were adopted in the United SECRETARY’S AUTHORITY TO MAKE CONDI- States; rity Act to provide for a voluntary prescription drug benefit under the Medi- TIONAL PAYMENT WHEN CERTAIN PRIMARY (6) The existing standards under inter- PLANS DO NOT PAY PROMPTLY.— national conventions, including the World care program and to strengthen and (1) IN GENERAL.—Section 1862(b)(2) (42 Trade Organization and the North American improve the Medicare program, and for U.S.C. 1395y(b)(2)) is amended— Free Trade Agreement, regarding regulated other purposes; which was ordered to (A) in subparagraph (A)(ii), by striking pharmaceutical prices, including any restric- lie on the table; as follows: ‘‘promptly (as determined in accordance tions on anti-competitive laws that might Strike section 426 and insert the following: with regulations)’’; apply to price regulations and how economic (B) in subparagraph (B)— harm caused to consumers in markets with- SEC. 426. INCREASE FOR GROUND AMBULANCE SERVICES. (i) by redesignating clauses (i) through (iii) out price regulations may be remedied; as clauses (ii) through (iv), respectively; and (7) In parallel trade regimes, how much of Section 1834(l) (42 U.S.C. 1395m(l)), as amended by section 405(b)(2), is amended by (ii) by inserting before clause (ii), as so re- the price difference between countries in the designated, the following new clause: European Union is captured by middlemen adding at the end the following new paragraphs: ‘‘(i) AUTHORITY TO MAKE CONDITIONAL PAY- and how much goes to benefit patients and MENT.—The Secretary may make payment ‘‘(10) TEMPORARY INCREASE FOR GROUND AM- health systems where parallel importing is under this title with respect to an item or BULANCE SERVICES.— significant; and service if a primary plan described in sub- ‘‘(A) IN GENERAL.—Notwithstanding any (8) How much cost is imposed on the owner paragraph (A)(ii) has not made or cannot of a property right from counterfeiting and other provision of this subsection, in the case of ground ambulance services furnished reasonably be expected to make payment from international violation of intellectual with respect to such item or service prompt- property rights for prescription medicines. on or after January 1, 2004, and before Janu- ary 1, 2007, the fee schedule established under ly (as determined in accordance with regula- (b) REPORT.—Not later than 1 year after this section, with respect to both the pay- tions). Any such payment by the Secretary the date of enactment of this Act, the Comp- ment rate for service and the payment rate shall be conditioned on reimbursement to troller General of the Untied States shall for mileage, shall provide that such rates the appropriate Trust Fund in accordance submit to Congress a report on the study otherwise established, shall be increased by with the succeeding provisions of this sub- conducted under subsection (A). 21.5 percent. section.’’. (2) EFFECTIVE DATE.—The amendments ‘‘(B) ADDITIONAL INCREASE FOR SERVICES Mr. KYL (for himself, Mr. made by paragraph (1) shall be effective as if SA 1115. FURNISHED IN A RURAL AREA.—Notwith- HATCH, and Ms. MURKOWSKI) submitted standing any other provision of this sub- included in the enactment of title III of the an amendment intended to be proposed section, in the case of ground ambulance Medicare and Medicaid Budget Reconcili- by him to the bill S. 1, to amend title services furnished on or after January 1, 2004, ation Amendments of 1984 (Public Law 98- XVIII of the Social Security Act to and before January 1, 2007, for which the 369). provide for a voluntary prescription transportation originates in a rural area de- (b) CLARIFYING AMENDMENTS TO CONDI- drug benefit under the Medicare pro- scribed in subparagraph (C), the fee schedule TIONAL PAYMENT PROVISIONS.—Section gram and to strengthen and improve established under this section, with respect 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further to both the payment rate for service and the amended— the Medicare program, and for other payment rate for mileage, shall provide that (1) in subparagraph (A), in the matter fol- purposes; as follows: such rates otherwise established, shall be in- lowing clause (ii), by inserting the following At the appropriate place, insert the fol- creased by the higher of either 20 percent of sentence at the end: ‘‘An entity that engages lowing: the rate determined after the application of in a business, trade, or profession shall be

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00130 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8777 deemed to have a self-insured plan if it car- safety net programs (as described in para- submit additional reports to the appropriate ries its own risk (whether by a failure to ob- graph (3)(C)) by— committees of Congress on topics relating to tain insurance, or otherwise) in whole or in ‘‘(A) monitoring each health care safety the health care safety net programs under part.’’; net program to document and analyze the ef- the following circumstances: (2) in subparagraph (B)(ii), as redesignated fects of changes in these programs on the ‘‘(I) If requested by the Chairpersons or by subsection (a)(2)(B)— core health care safety net; Ranking Minority Members of such commit- (A) by striking the first sentence and in- ‘‘(B) evaluating the impact of the Emer- tees. serting the following: ‘‘A primary plan, and gency Medical Treatment and Labor Act, the ‘‘(II) If the Commission deems such addi- an entity that receives payment from a pri- Health Insurance Portability and Account- tional reviews and reports appropriate. mary plan, shall reimburse the appropriate ability Act of 1996, the Balanced Budget Act ‘‘(C) AVAILABILITY OF REPORTS.—The Com- Trust Fund for any payment made by the of 1997, the Medicare, Medicaid, and SCHIP mission shall transmit to the Comptroller Secretary under this title with respect to an Balanced Budget Refinement Act of 1999, the General and the Secretary a copy of each re- item or service if it is demonstrated that Medicare, Medicaid, and SCHIP Benefits Pro- port submitted under this subsection and such primary plan has or had a responsi- tection and Improvement Act of 2000, Pre- shall make such reports available to the pub- bility to make payment with respect to such scription Drug and Medicare Improvement lic. item or service. A primary plan’s responsi- Act of 2003, and other forces on the capacity ‘‘(3) DEFINITIONS.—In this section: bility for such payment may be dem- of the core health care safety net to continue ‘‘(A) APPROPRIATE COMMITTEES OF CON- onstrated by a judgment, a payment condi- their roles in the core health care safety net GRESS.—The term ‘appropriate committees tioned upon the recipient’s compromise, system to care for uninsured individuals, of Congress’ means the Committees on Ways waiver, or release (whether or not there is a medicaid beneficiaries, and other vulnerable and Means and Energy and Commerce of the determination or admission of liability) of populations; House of Representatives and the Commit- payment for items or services included in a ‘‘(C) monitoring existing data sets to as- tees on Finance and Health, Education, claim against the primary plan or the pri- sess the status of the core health care safety Labor, and Pensions of the Senate. mary plan’s insured, or by other means.’’; net and health outcomes for vulnerable pop- and ulations; ‘‘(B) CORE HEALTH CARE SAFETY NET.—The (B) in the final sentence, by striking ‘‘on ‘‘(D) wherever possible, linking and inte- term ‘core health care safety net’ means any the date such notice or other information is grating existing data systems to enhance the health care provider that— received’’ and inserting ‘‘on the date notice ability of the core health care safety net to ‘‘(i) by legal mandate or explicitly adopted of, or information related to, a primary track changes in the status of the core mission, offers access to health care services plan’s responsibility for such payment or health care safety net and health outcomes to patients, regardless of the ability of the other information is received’’; and for vulnerable populations; patient to pay for such services; and (3) in subparagraph (B)(iii), as redesignated ‘‘(E) supporting the development of new ‘‘(ii) has a case mix that is substantially by subsection (a)(2)(B), by striking the first data systems where existing data are insuffi- comprised of patients who are uninsured, sentence and inserting the following: ‘‘In cient or inadequate; covered under the medicaid program, cov- order to recover payment made under this ‘‘(F) developing criteria and indicators of ered under any other public health care pro- title for an item or service, the United impending core health care safety net fail- gram, or are otherwise vulnerable popu- States may bring an action against any or ure; lations. all entities that are or were required or re- ‘‘(G) establishing an early-warning system Such term includes disproportionate share sponsible (directly, as an insurer or self-in- to identify impending failures of core health hospitals, Federally qualified health centers, surer, as a third-party administrator, as an care safety net systems and providers; other Federal, State, and locally supported employer that sponsors or contributes to a ‘‘(H) providing accurate and timely infor- clinics, rural health clinics, local health de- group health plan, or large group health mation to Federal, State, and local policy- partments, and providers covered under the plan, or otherwise) to make payment with makers on the indicators that may lead to Emergency Medical Treatment and Labor respect to the same item or service (or any the failure of the core health care safety net Act. portion thereof) under a primary plan. The and an estimate of the projected con- ‘‘(C) HEALTH CARE SAFETY NET PROGRAMS.— United States may, in accordance with para- sequences of such failures and the impact of The term ‘health care safety net programs’ graph (3)(A) collect double damages against such a failure on the community; includes the following: any such entity. In addition, the United ‘‘(I) monitoring and providing oversight for ‘‘(i) MEDICAID.—The medicaid program States may recover under this clause from the transition of individuals receiving sup- under title XIX. plemental security income benefits, medical any entity that has received payment from a ‘‘(ii) SCHIP.—The State children’s health assistance under title XIX, or child health primary plan or from the proceeds of a pri- insurance program under title XXI. mary plan’s payment to any entity.’’. assistance under title XXI who enroll with a ‘‘(iii) MATERNAL AND CHILD HEALTH SERV- (c) CLERICAL AMENDMENTS.—Section 1862(b) managed care entity (as defined in section ICES BLOCK GRANT PROGRAM.—The maternal (42 U.S.C. 1395y(b)) is amended— 1932(a)(1)(B)), including the review of— and child health services block grant pro- (1) in paragraph (1)(A), by moving the in- ‘‘(i) the degree to which health plans have gram under title V. dentation of clauses (ii) through (v) 2 ems to the capacity (including case management ‘‘(iv) FQHC PROGRAMS.—Each federally the left; and and management information system infra- funded program under which a health center (2) in paragraph (3)(A), by striking ‘‘such’’ structure) to provide quality managed care (as defined in section 330(1) of the Public before ‘‘paragraphs’’. services to such an individual; ‘‘(ii) the degree to which these plans may Health Service Act), a Federally qualified SA 1117. Mr. BAUCUS submitted an be overburdened by adverse selection; and health center (as defined in section amendment intended to be proposed by ‘‘(iii) the degree to which emergency de- 1861(aa)(4)), or a Federally-qualified health him to the bill S. 1, to amend title partments are used by enrollees of these center (as defined in section 1905(l)(2)(B)) receives funds. XVIII of the Social Security Act to plans; and ‘‘(J) identifying and disseminating the best ‘‘(v) RHC PROGRAMS.—Each federally fund- provide for a voluntary prescription ed program under which a rural health clinic drug benefit under the Medicare pro- practices for more effective application of the lessons that have been learned. (as defined in section 1861(aa)(4) or 1905(l)(1)) gram and to strengthen and improve receives funds. ‘‘(2) REPORTS.— ‘‘(vi) DSH PAYMENT PROGRAMS.—Each fed- the Medicare program, and for other ‘‘(A) ANNUAL REPORTS.—Not later than purposes; as follows: June 1 of each year (beginning with 2005), the erally funded program under which a dis- At the end of title VI, add the following: Commission shall, based on the review con- proportionate share hospital receives funds. SEC. ll. SAFETY NET ORGANIZATIONS AND PA- ducted under paragraph (1), submit to the ap- ‘‘(vii) EMERGENCY MEDICAL TREATMENT AND TIENT ADVISORY COMMISSION. propriate committees of Congress a report ACTIVE LABOR ACT.—All care provided under (a) IN GENERAL.—Title XI (42 U.S.C. 1320 et on— section 1867 for the uninsured, underinsured, seq.) is amended by adding at the end the fol- ‘‘(i) the health care needs of the uninsured; beneficiaries under title XIX, and other vul- lowing new part: and nerable individuals. ‘‘PART D—SAFETY NET ORGANIZATIONS AND ‘‘(ii) the financial and infrastructure sta- ‘‘(viii) OTHER HEALTH CARE SAFETY NET PATIENT ADVISORY COMMISSION bility of the Nation’s core health care safety PROGRAMS.—Such term also includes any other health care program that the Commis- ‘‘SAFETY NET ORGANIZATIONS AND PATIENT net. sion determines to be appropriate. ADVISORY COMMISSION ‘‘(B) AGENDA AND ADDITIONAL REVIEWS.— ‘‘(D) VULNERABLE POPULATIONS.—The term ‘‘SEC. 1181. (a) ESTABLISHMENT.—There is ‘‘(i) AGENDA.—The Chair of the Commis- sion shall consult periodically with the ‘vulnerable populations’ includes uninsured hereby established the Safety Net Organiza- and underinsured individuals, low-income in- tions and Patient Advisory Commission (in Chairpersons and Ranking Minority Mem- dividuals, farm workers, homeless individ- this section referred to as the ‘Commission’). bers of the appropriate committees of Con- uals, individuals with disabilities, individ- ‘‘(b) REVIEW OF HEALTH CARE SAFETY NET gress regarding the Commission’s agenda and uals with HIV or AIDS, and such other indi- PROGRAMS AND REPORTING REQUIREMENTS.— progress toward achieving the agenda. viduals as the Commission may designate. ‘‘(1) REVIEW.—The Commission shall con- ‘‘(ii) ADDITIONAL REVIEWS.—The Commis- duct an ongoing review of the health care sion shall conduct additional reviews and ‘‘(c) MEMBERSHIP.—

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‘‘(1) NUMBER AND APPOINTMENT.—The Com- the member as Chair and a member as Vice troller General submits requests for appro- mission shall be composed of 13 members ap- Chair for that term of appointment, except priations, but amounts appropriated for the pointed by the Comptroller General of the that in the case of vacancy of the Chair or Commission shall be separate from amounts United States (in this section referred to as Vice Chair, the Comptroller General may appropriated for the Comptroller General. the ‘Comptroller General’), in consultation designate another member for the remainder ‘‘(2) AUTHORIZATION.—There are authorized with the appropriate committees of Con- of that member’s term. to be appropriated such sums as may be nec- gress. ‘‘(6) MEETINGS.—The Commission shall essary to carry out the provisions of this sec- ‘‘(2) QUALIFICATIONS.— meet at the call of the Chair or upon the tion.’’. ‘‘(A) IN GENERAL.—The membership of the written request of a majority of its members. (b) EFFECTIVE DATE.—The Comptroller Commission shall include individuals with ‘‘(d) DIRECTOR AND STAFF; EXPERTS AND General of the United States shall appoint national recognition for their expertise in CONSULTANTS.—Subject to such review as the the initial members of the Safety Net Orga- health finance and economics, health care Comptroller General determines necessary nizations and Patient Advisory Commission safety net research and program manage- to ensure the efficient administration of the established under subsection (a) not later ment, actuarial science, health facility man- Commission, the Commission may— than June 1, 2004. agement, health plans and integrated deliv- ‘‘(1) employ and fix the compensation of an ery systems, reimbursement of health facili- Executive Director (subject to the approval SA 1118. Mr. SPECTER submitted an ties, allopathic and osteopathic medicine (in- of the Comptroller General) and such other amendment intended to be proposed by cluding emergency medicine), and other pro- personnel as may be necessary to carry out him to the bill S. 1, to amend title viders of health services, and other related the duties of the Commission under this sec- XVIII of the Social Security Act to fields, who provide a mix of different profes- tion (without regard to the provisions of provide for a voluntary prescription title 5, United States Code, governing ap- sionals, broad geographic representation, drug benefit under the Medicare pro- and a balance between urban and rural rep- pointments in the competitive service); resentatives. ‘‘(2) seek such assistance and support as gram and to strengthen and improve ‘‘(B) INCLUSION.—The membership of the may be required in the performance of the the Medicare program, and for other Commission shall include health profes- duties of the Commission under this section purposes; as follows: sionals, employers, third-party payers, indi- from appropriate Federal departments and At the end of title VI, insert the following: viduals skilled in the conduct and interpre- agencies; SEC. . SENSE OF THE SENATE REGARDING THE tation of biomedical, health services, and ‘‘(3) enter into contracts or make other ar- ESTABLISHMENT OF A NATIONWIDE health economics research and expertise in rangements, as may be necessary for the PERMANENT LIFESTYLE MODIFICA- outcomes and effectiveness research and conduct of the work of the Commission TION PROGRAM FOR MEDICARE technology assessment. Such membership (without regard to section 3709 of the Re- BENEFICIARIES. shall also include recipients of care from vised Statutes (41 U.S.C. 5)); (a) FINDINGS.—Congress finds that: core health care safety net and individuals ‘‘(4) make advance, progress, and other (1) Heart disease kills more than 500,000 who provide and manage the delivery of care payments which relate to the work of the Americans per year. by the core health care safety net. Commission; (2) The number and costs of interventions ‘‘(C) MAJORITY NONPROVIDERS.—Individuals ‘‘(5) provide transportation and subsistence for the treatment of coronary disease are ris- who are directly involved in the provision, or for persons serving without compensation; ing and currently cost the health care sys- management of the delivery, of items and and tem $58,000,000,000 annually. services covered under the health care safety ‘‘(6) prescribe such rules and regulations as (3) The Medicare Lifestyle Modification net programs shall not constitute a majority it deems necessary with respect to the inter- Program has been operating throughout 12 of the membership of the Commission. nal organization and operation of the Com- States and has been demonstrated to reduce ‘‘(D) ETHICAL DISCLOSURE.—The Comp- mission. the need for coronary procedures by 88 per- troller General shall establish a system for ‘‘(e) POWERS.— cent per year. public disclosure by members of the Commis- ‘‘(1) OBTAINING OFFICIAL DATA.— (4) The Medicare Lifestyle Modification sion of financial and other potential con- ‘‘(A) IN GENERAL.—The Commission may Program is less expensive to deliver than flicts of interest relating to such members. secure directly from any department or interventional cardiac procedures and could ‘‘(3) TERMS.— agency of the United States information nec- reduce cardiovascular expenditures by ‘‘(A) IN GENERAL.—The terms of members essary for the Commission to carry the du- $36,000,000,000 annually. of the Commission shall be for 3 years except ties under this section. (5) Lifestyle choices such as diet and exer- that of the members first appointed, the ‘‘(B) REQUEST OF CHAIR.—Upon request of cise affect heart disease and heart disease Comptroller General shall designate— the Chair, the head of that department or outcomes by 50 percent or greater. ‘‘(i) four to serve a term of 1 year; agency shall furnish that information to the (6) Intensive lifestyle interventions which ‘‘(ii) four to serve a term of 2 years; and Commission on an agreed upon schedule. include teams of nurses, doctors, exercise ‘‘(iii) five to serve a term of 3 years. ‘‘(2) DATA COLLECTION.—In order to carry physiologists, registered dietitians, and be- ‘‘(B) VACANCIES.— out the duties of the Commission under this havioral health clinicians have been dem- ‘‘(i) IN GENERAL.—A vacancy in the Com- section, the Commission shall— onstrated to reduce heart disease risk fac- mission shall be filled in the same manner in ‘‘(A) use existing information, both pub- tors and enhance heart disease outcomes which the original appointment was made. lished and unpublished, where possible, col- dramatically. ‘‘(ii) APPOINTMENT.—Any member ap- lected and assessed either by the staff of the (7) The National Institutes of Health esti- pointed to fill a vacancy occurring before the Commission or under other arrangements mates that 17,000,000 Americans have diabe- expiration of the term for which the mem- made in accordance with this section; tes and the Centers for Disease Control and ber’s predecessor was appointed shall be ap- ‘‘(B) carry out, or award grants or con- Prevention estimates that the number of pointed only for the remainder of that term. tracts for, original research and experimen- Americans who have a diagnosis of diabetes ‘‘(iii) TERMS.—A member may serve after tation, where existing information is inad- increased 61 percent in the last decade and is the expiration of that member’s term until a equate; and expected to more than double by 2050. successor has taken office. ‘‘(C) adopt procedures allowing any inter- (8) Lifestyle modification programs are su- ‘‘(4) COMPENSATION.— ested party to submit information for the perior to medication therapy for treating di- ‘‘(A) MEMBERS.—While serving on the busi- Commission’s use in making reports and rec- abetes. ness of the Commission (including travel ommendations. (9) Individuals with diabetes are now con- time), a member of the Commission— ‘‘(3) ACCESS OF GAO TO INFORMATION.—The sidered to have coronary disease at the date ‘‘(i) shall be entitled to compensation at Comptroller General shall have unrestricted of diagnosis of their diabetic state. the per diem equivalent of the rate provided access to all deliberations, records, and non- (10) The Medicare Lifestyle Modification for level IV of the Executive Schedule under proprietary data that pertains to the work of Program has been an effective lifestyle pro- section 5315 of title 5, United States Code; the Commission, immediately upon request. gram for the reversal and treatment of heart and The expense of providing such information disease. ‘‘(ii) while so serving away from home and shall be borne by the General Accounting Of- (11) Men with prostate cancer have shown the member’s regular place of business, may fice. significant improvement in prostate cancer be allowed travel expenses, as authorized by ‘‘(4) PERIODIC AUDIT.—The Commission markers using a similar approach in lifestyle the Commission. shall be subject to periodic audit by the modification. ‘‘(B) TREATMENT.—For purposes of pay Comptroller General. (12) These lifestyle changes are therefore (other than pay of members of the Commis- ‘‘(f) APPLICATION OF FACA.—Section 14 of likely to affect other chronic disease states, sion) and employment benefits, rights, and the Federal Advisory Committee Act (5 in addition to heart disease. privileges, all personnel of the Commission U.S.C. App.) does not apply to the Commis- (b) SENSE OF THE SENATE.—It is the sense shall be treated as if they were employees of sion. of the Senate that— the United States Senate. ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— (1) the Secretary of Health and Human ‘‘(5) CHAIR; VICE CHAIR.—The Comptroller ‘‘(1) REQUEST FOR APPROPRIATIONS.—The Services should carry out the demonstration General shall designate a member of the Commission shall submit requests for appro- project known as the Lifestyle Modification Commission, at the time of appointment of priations in the same manner as the Comp- Program Demonstration, as described in the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00132 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8779 Health Care Financing Administration this title as the Secretary shall determine to ‘‘(B) the average number of unique physi- Memorandum of Understanding entered into be appropriate including, but not limited to, cian visits relative to geographic norms for on November 13, 2000, on a permanent basis; activities to facilitate continuity of care and all eligible beneficiaries. (2) the project should include as many patient adherence to plans of care. ‘‘(5) For purposes of this subsection, the Medicare beneficiaries as would like to par- ‘‘(2) For purposes of this subsection, the term ‘functional limitations’ means each of ticipate in the project on a voluntary basis; term ‘eligible individual’ means an indi- the following: and vidual who a care coordinator annually cer- ‘‘(A) Eating. (3) the project should be conducted on a na- tifies has multiple chronic conditions and ‘‘(B) Toileting. tional basis. meets eligibility criteria determined by the ‘‘(C) Transferring. Secretary. ‘‘(D) Bathing. SA 1119. Mrs. LINCOLN submitted an ‘‘(3)(A) For purposes of this subsection, the ‘‘(E) Dressing. amendment intended to be proposed by term ‘care coordinator’ means an individual ‘‘(F) Continence. her to the bill S. 1, to amend title or entity that— ‘‘(6) Rural health clinics and Federally XVIII of the Social Security Act to ‘‘(i) is— qualified health centers shall be eligible provide for a voluntary prescription ‘‘(I) a physician who provides care to at sites at which care coordination and assess- drug benefit under the Medicare pro- least 50 eligible individuals; or ment services may be provided. ‘‘(II) an independent nurse practitioner ‘‘(7) For purposes of this subsection, the gram and to strengthen and improve term ‘chronic condition’ means an illness, the Medicare program, and for other who provides care to at least 50 eligible individuals; functional limitation, or cognitive impair- purposes; which was ordered to lie on ment that is expected to last at least 1 year the table; as follows: ‘‘(ii) has entered into a care coordination agreement with the Secretary; and and limits what a person can do, and re- Strike section 443 and insert the following: ‘‘(iii) has appropriate office staffing, oper- quires ongoing care. SEC. 443. MEDICARE COVERAGE OF CARE CO- ating under the direction of the eligible pro- ‘‘(8) For purposes of this subsection, the ORDINATION AND ASSESSMENT vider, which is sufficient in size and exper- Secretary shall establish eligibility criteria SERVICES. tise to address the complex clinical care co- for the care management benefit that would (a) PART B COVERAGE OF CARE COORDINA- ordination needs of participating bene- target approximately 5 percent of elderly TION AND ASSESSMENT SERVICES.—Section medicare fee-for-service enrollees. The eligi- 1861(s)(2) of the Social Security Act (42 ficiaries in the practice; ‘‘(iv) has an ability and process to identify bility criteria should identify enrollees who U.S.C. 1395x(s)(2)) is amended— need care management because they have (1) in subparagraph (U), by striking ‘‘and’’ eligible beneficiaries; ‘‘(v) has an ability to coordinate care for multiple chronic conditions that result in at the end; high use of Medicare services, high use of (2) in subparagraph (V)(iii), by adding participating beneficiaries; ‘‘(vi) has an ability to maintain and update prescription medications, and high Medicare ‘‘and’’ after the semicolon at the end; and costs. Inability to manage one’s own care (3) by adding at the end the following new patient records to ensure that care provided by other treating providers (including the in- due to cognitive impairment should be con- subparagraph: sidered as an additional indicator of need for ‘‘(W) care coordination and assessment structions of other treating providers and any related lab results, prescription orders, care management. services (as defined in subsection (ww)).’’. (c) PAYMENT AND ELIMINATION OF COINSUR- and ancillary treatment services) is included (b) CARE COORDINATION AND ASSESSMENT ANCE.— in the record; SERVICES DEFINED.—Section 1861 of the So- (1) IN GENERAL.—Section 1833(a)(1) of the ‘‘(vii) has an ability to periodically review cial Security Act (42 U.S.C. 1395x) is amended Social Security Act (42 U.S.C. 1395l(a)(1)) is the medical record of participating bene- by adding at the end the following new sub- amended— ficiaries to identify problems related to tran- section: (A) by striking ‘‘and’’ before ‘‘(U)’’; and sitions, poly-pharmacy, and care continuity ‘‘Care Coordination and Assessment Services (B) by inserting before the semicolon at and to respond to resolve identified prob- ‘‘(ww)(1) The term ‘care coordination and the end the following: ‘‘, and (V) with respect lems; assessment services’ means services that are to assessment services described in section ‘‘(viii) is capable of referring to and coordi- furnished to an eligible individual (as defined 1861(s)(2)(W), the amounts paid shall be 100 nating with community-based supportive in paragraph (2)) by a care coordinator (as percent of the lesser of the actual charge for services; defined in paragraph (3)) under a plan of care the service or the amount determined under ‘‘(ix) has an ability to communicate with prescribed by such care coordinator for the the payment basis determined under section participating beneficiaries or family care- purpose of care coordination and assessment, 1848 by the Secretary for such service and an givers as needed and appropriate, using tele- which may include any of the following serv- administrative fee shall be developed for phonic and/or electronic communications; ices: care coordination services’’. and ‘‘(A) an initial assessment of an individ- (2) PAYMENT UNDER PHYSICIAN FEE SCHED- ‘‘(x) agrees to coordinate care for partici- ual’s medical condition, functional and cog- ULE.—Section 1848(j)(3) of the Social Secu- pating beneficiaries, consult with other nitive capacity and environmental and psy- rity Act (42 U.S.C. 1395w–4(j)(3)) is amended treating providers (including but not limited chological needs and an annual assessment by inserting ‘‘(2)(W),’’ after ‘‘(2)(S),’’. thereafter. to other treating physicians, other medical (3) ELIMINATION OF COINSURANCE IN OUT- ‘‘(B) Management of transitions of care professionals involved in patient care, resi- PATIENT HOSPITAL SETTINGS.—The third sen- dential and inpatient facilities, and phar- across practice settings and between pro- tence of section 1866(a)(2)(A) of the Social macies), and community service providers; viders. Security Act (42 U.S.C. 1395cc(a)(2)(A)) is ‘‘(xi) agrees to recognize patient treatment ‘‘(C) Coordination of, and referral for, med- amended by inserting after ‘‘1861(s)(10)(A)’’ preferences; and ical and other health-related services, in- the following: ‘‘, with respect to care coordi- ‘‘(xii) is certified by the Secretary as meet- cluding— nation and assessment services (as defined in ing standards defined by the Secretary and ‘‘(i) multidisciplinary care conferences; section 1861(ww)(1)),’’. being capable of coordinating clinical care ‘‘(ii) coordination with other providers, in- (d) APPLICATION OF LIMITS ON BILLING.— cluding telephone consultations with physi- for eligible beneficiaries. Section 1842(b)(18)(C) of the Social Security cians; and ‘‘(B) For purposes of subparagraph (A)(ii), Act (42 U.S.C. 1395u(b)(18)(C)) is amended by ‘‘(iii) monitoring and management of medi- each care coordination agreement shall— adding at the end the following new clause: cations, with special emphasis on clients ‘‘(i) be entered into for a period of 1 year ‘‘(vii) A care coordinator (as defined in sec- using multiple prescriptions (including co- and may be renewed if the Secretary is satis- tion 1861(ww)(3)) that is not a physician.’’. ordination with the entity managing bene- fied that the care coordinator continues to (e) EXCEPTION TO LIMITS ON PHYSICIAN RE- fits for the individual). meet the conditions of participation speci- FERRALS.—Section 1877(b) of the Social Secu- ‘‘(D) Patient and family care-giver edu- fied in subparagraph (A); rity Act (42 U.S.C. 1395nn(b)) is amended— cation and counseling (through office visits ‘‘(ii) contain such other terms and condi- (1) by redesignating paragraph (4) as para- or telephone consultation), including self- tions as the Secretary may require. graph (5); and management services and risk appraisal to ‘‘(4) For purposes of this subsection, the (2) by inserting after paragraph (3) the fol- identify behavioral risk factors through self Secretary shall send quarterly reports to lowing new paragraph: assessment. each eligible provider that inform, in aggre- ‘‘(4) PRIVATE SECTOR PURCHASING AND QUAL- ‘‘(E) Providing information about end of gate, on the provider’s participating bene- ITY IMPROVEMENT TOOLS FOR ORIGINAL MEDI- life care, including referral to hospice serv- ficiary caseload, using measures determined CARE.—In the case of a designated health ices, when appropriate, including patient and by the Secretary that are derived from exist- service, if the designated health service is— family caregiver education and counseling ing Medicare date sources. In preparing the ‘‘(A) a care coordination and assessment about hospice, and managing and facilitating reports under this paragraph, the Secretary service (as defined in section 1861(ww)(1)); transition to hospice when elected. shall consider— and ‘‘(F) Referral to and coordination with ‘‘(A) the average number of emergency ‘‘(B) provided by a care coordinator (as de- community resources. room and nursing home visits relative to ge- fined in paragraph (3) of such section).’’. ‘‘(G) Such other services for which pay- ographic norms for all eligible beneficiaries; (f) RULEMAKING.—The Secretary of Health ment would not otherwise be made under and and Human Services shall define such terms

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00133 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8780 CONGRESSIONAL RECORD — SENATE June 26, 2003 and establish such procedures as the Sec- this title for an item or service, the United SEC. . SENSE OF THE SENATE CONCERNING THE retary determines necessary to implement States may bring an action against any or STRUCTURE OF MEDICARE REFORM the provisions of this section. all entities that are or were required or re- AND THE PRESCRIPTION DRUG BEN- (g) EFFECTIVE DATE.—The amendments sponsible (directly, as an insurer or self-in- EFIT. (a) FINDINGS.—The Senate makes the fol- made by this section shall apply to care co- surer, as a third-party administrator, as an lowing findings: ordination and assessment services furnished employer that sponsors or contributes to a (1) America’s seniors deserve a fiscally- on or after January 1, 2006, and before Janu- group health plan, or large group health strong Medicare system that fulfills its ary 1, 2011. plan, or otherwise) to make payment with At the end of subtitle B of title IV, add the promise to them and future retirees. respect to the same item or service (or any (2) The impending retirement of the ‘‘baby following: portion thereof) under a primary plan. The SEC. ll. MEDICARE SECONDARY PAYOR (MSP) boom’’ generation will dramatically increase United States may, in accordance with para- the costs of providing Medicare benefits. PROVISIONS. graph (3)(A) collect double damages against (a) TECHNICAL AMENDMENT CONCERNING Medicare costs will double relative to the any such entity. In addition, the United SECRETARY’S AUTHORITY TO MAKE CONDI- size of the economy from 2% of GDP today to States may recover under this clause from TIONAL PAYMENT WHEN CERTAIN PRIMARY 4% in 2025 and double again to 8% of GDP in any entity that has received payment from a PLANS DO NOT PAY PROMPTLY.— 2075. This growth will accelerate substan- primary plan or from the proceeds of a pri- (1) IN GENERAL.—Section 1862(b)(2) (42 tially when Congress adds a necessary pre- U.S.C. 1395y(b)(2)) is amended— mary plan’s payment to any entity.’’. scription drug benefit. (A) in subparagraph (A)(ii), by striking (c) CLERICAL AMENDMENTS.—Section 1862(b) (3) Medicare’s current structure does not ‘‘promptly (as determined in accordance (42 U.S.C. 1395y(b)) is amended— have the flexibility to quickly adapt to rapid with regulations)’’; (1) in paragraph (1)(A), by moving the in- advances in modern health care. Medicare (B) in subparagraph (B)— dentation of clauses (ii) through (v) 2 ems to lags far behind other insurers in providing (i) by redesignating clauses (i) through (iii) the left; and prescription drug coverage, disease manage- as clauses (ii) through (iv), respectively; and (2) in paragraph (3)(A), by striking ‘‘such’’ ment programs, and a host of other ad- (ii) by inserting before clause (ii), as so re- before ‘‘paragraphs’’. vances. Reforming Medicare to create a more designated, the following new clause: self-adjusting, innovative structure is essential to improve Medicare’s efficiency and the ‘‘(i) AUTHORITY TO MAKE CONDITIONAL PAY- SA 1120. Mr. DAYTON (for himself, MENT.—The Secretary may make payment quality of the medical care it provides. Mr. COLEMAN, and Mr. SMITH) sub- under this title with respect to an item or (4) Private-sector choice for Medicare service if a primary plan described in submitted an amendment intended to be beneficiaries would provide two key benefits: paragraph (A)(ii) has not made or cannot proposed by him to the bill S. 1, to it would be tailored to the needs of Amer- reasonably be expected to make payment amend title XVIII of the Social Secu- ica’s seniors, not the government, and would with respect to such item or service prompt- rity Act to provide for a voluntary pre- create a powerful incentive for private-sec- ly (as determined in accordance with regula- scription drug benefit under the Medi- tor Medicare plans to provide the best qual- tions). Any such payment by the Secretary care program and to strengthen and ity health care to seniors at the most afford- shall be conditioned on reimbursement to able price. improve the Medicare program, and for (5) The method by which the national pre- the appropriate Trust Fund in accordance other purposes; which was ordered to with the succeeding provisions of this sub- ferred provider organizations in the Federal section.’’. lie on the table; as follows: Employees Health Benefits Program have (2) EFFECTIVE DATE.—The amendments Strike section 426 and insert the following: been reimbursed has proven to be a reliable made by paragraph (1) shall be effective as if and successful mechanism for providing SEC. 426. TEMPORARY INCREASE FOR GROUND Members of Congress and federal employees included in the enactment of title III of the AMBULANCE SERVICES. Medicare and Medicaid Budget Reconcili- with excellent health care choices. ation Amendments of 1984 (Public Law 98- Section 1834(l) (42 U.S.C. 1395m(l)), as (6) Unlike the Medicare payment system, 369). amended by section 405(b)(2), is amended by which has had to be changed by Congress (b) CLARIFYING AMENDMENTS TO CONDI- adding at the end the following new para- every few years, the Federal Employees TIONAL PAYMENT PROVISIONS.—Section graph: Health Benefits Program has existed for 43 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further ‘‘(10) TEMPORARY INCREASE FOR GROUND AM- years with minimal changes from Congress. amended— BULANCE SERVICES.— (b) SENSE OF THE SENATE.—It is the Sense (1) in subparagraph (A), in the matter fol- ‘‘(A) IN GENERAL.—Notwithstanding any of the Senate that Medicare reform legisla- lowing clause (ii), by inserting the following other provision of this subsection, in the tion should: sentence at the end: ‘‘An entity that engages case of ground ambulance services furnished (1) Ensure that prescription drug coverage in a business, trade, or profession shall be on or after January 1, 2004, and before Janu- is directed to those who need it most. (2) Provide that government contributions deemed to have a self-insured plan if it car- ary 1, 2007 for which the transportation origi- used to support Medicare Advantage plans ries its own risk (whether by a failure to ob- nates in— are based on market principles beginning in tain insurance, or otherwise) in whole or in ‘‘(i) a rural area described in paragraph (9) 2006 to ensure the long and short term viabil- part.’’; or in a rural census tract described in such ity of such options for America’s seniors. (2) in subparagraph (B)(ii), as redesignated paragraph, the fee schedule established (3) Develop a payment system for the Medi- by subsection (a)(2)(B)— under this section shall provide that the rate care Advantage preferred provider organiza- (A) by striking the first sentence and infor the service otherwise established, after tions similar to the payment system used for serting the following: ‘‘A primary plan, and application of any increase under such para- the national preferred provider organizations an entity that receives payment from a pri- graph, shall be increased by 5 percent; and in the Federal Employees Health Benefits mary plan, shall reimburse the appropriate ‘‘(ii) an area not described in clause (i), the fee schedule established under this section Program. Trust Fund for any payment made by the (4) Limit the addition of new unfunded ob- shall provide that the rate for the service Secretary under this title with respect to an ligations in the Medicare program so that otherwise established shall be increased by 2 item or service if it is demonstrated that the long-term solvency of this important percent such primary plan has or had a responsi- program is not further jeopardized. PPLICATION OF INCREASED PAYMENTS bility to make payment with respect to such ‘‘(B) A (5) Incorporate private sector, market- AFTER 2007.—The increased payments under item or service. A primary plan’s responsi- based elements, that do not rely on the inef- subparagraph (A) shall not be taken into ac- bility for such payment may be dem- ficient Medicare price control structure. onstrated by a judgment, a payment condi- count in calculating payments for services (6) Keep the cost of structural changes and tioned upon the recipient’s compromise, furnished on or after the period specified in new benefits within the $400 billion provided waiver, or release (whether or not there is a such subparagraph.’’. for under the current Congressional Budget determination or admission of liability) of Resolution for implementing Medicare repayment for items or services included in a SA 1121. Mr. KYL (for himself, Mr. form and providing a prescription drug ben- claim against the primary plan or the pri- NICKLES, Mr. GREGG, Mr. THOMAS, and efit. mary plan’s insured, or by other means.’’; (7) Preserve the current employer-spon- Mr. LOTT) proposed an amendment to and sored retiree health plans and not design a (B) in the final sentence, by striking ‘‘on the bill S. 1, to amend title XVIII of benefit which has the unintended con- the date such notice or other information is the Social Security Act to provide for sequences of supplanting private coverage. received’’ and inserting ‘‘on the date notice a voluntary prescription drug benefit (8) Incorporate regulatory reform proposals of, or information related to, a primary under the Medicare program and to to eliminate red tape and reduce costs. plan’s responsibility for such payment or strengthen and improve the Medicare (9 Restore the right of Medicare bene- other information is received’’; and program, and for other purposes; as fol- ficiaries and their doctors to work together (3) in subparagraph (B)(iii), , as redesig- lows: to provide services, allow private fee for nated by subsection (a)(2)(B), by striking the service plans to set their own premiums, and first sentence and inserting the following: At the appropriate place, insert the fol- permit seniors to add their own dollars be- ‘‘In order to recover payment made under lowing: yond the government contribution.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00134 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8781 SA 1122. Mr. BROWNBACK (for him- for home health services furnished by a appropriate, of such funds as are necessary self, and Mr. NELSON of Nebraska) sub- qualified RCH-based home health agency (as for the costs of carrying out the demonstra- mitted an amendment intended to be defined in paragraph (2))— tion program under this section. (A) the agency may make a one-time elec- (2) BUDGET NEUTRALITY.—In conducting the proposed by him to the bill S. 1, to tion to waive application of the prospective demonstration program under this section, amend title XVIII of the Social Secu- payment system established under section the Secretary shall ensure that the aggre- rity Act to provide for a voluntary pre- 1895 of the Social Security Act (42 U.S.C. gate payments made by the Secretary do not scription drug benefit under the Medi- 1395fff) to such services furnished by the exceed the amount which the Secretary care program and to strengthen and agency; and would have paid if the demonstration pro- improve the Medicare program, and for (B) in the case of such an election, pay- gram under this section was not imple- other purposes; as follows: ment shall be made on the basis of the rea- mented. sonable costs incurred in furnishing such (d) WAIVER AUTHORITY.—The Secretary At the end of subtitle A of title IV, add the services as determined under section 1861(v) may waive such requirements of titles XI following: of the Social Security Act (42 U.S.C. and XVIII of the Social Security Act (42 SEC. ll. RURAL COMMUNITY HOSPITAL DEM- 1395x(v)), but without regard to the amount U.S.C. 1301 et seq.; 1395 et seq.) as may be ONSTRATION PROGRAM. of the customary or other charges with re- necessary for the purpose of carrying out the (a) ESTABLISHMENT OF RURAL COMMUNITY spect to such services or the limitations es- demonstration program under this section. HOSPITAL (RCH) DEMONSTRATION PROGRAM.— tablished under paragraph (1)(L) of such sec- (e) REPORT.—Not later than 6 months after (1) IN GENERAL.—The Secretary shall estab- tion. the completion of the demonstration pro- lish a demonstration program to test the fea- (4) CONSOLIDATED BILLING.—The Secretary gram under this section, the Secretary shall sibility and advisability of the establishment shall permit consolidated billing under sec- submit to Congress a report on such proof rural community hospitals that furnish tion 1842(b)(6)(E) of the Social Security Act gram, together with recommendations for rural community hospital services to medi- (42 U.S.C. 1395u(b)(6)(E)). such legislation and administrative action as care beneficiaries. (5) EXEMPTION FROM 30 PERCENT REDUCTION the Secretary determines to be appropriate. ESIGNATION OF RCHS (f) DEFINITIONS.—In this section: (2) D .— IN REIMBURSEMENT FOR BAD DEBT.—In deter- (A) APPLICATION.—Each hospital that is lo- mining the reasonable costs for rural com- (1) RURAL COMMUNITY HOSPITAL.— cated in a demonstration area described in munity hospitals, section 1861(v)(1)(T) of the (A) IN GENERAL.—The term ‘‘rural commu- subparagraph (C) that desires to participate Social Security Act (42 U.S.C. 1395x(v)(1)(T)) nity hospital’’ means a hospital (as defined in the demonstration program under this shall not apply. in section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e))) that— section shall submit an application to the (6) BENEFICIARY COST-SHARING FOR OUT- (i) is located in a rural area (as defined in Secretary at such time, in such manner, and PATIENT SERVICES.—The amounts of bene- containing such information as the Sec- ficiary cost-sharing for outpatient services section 1886(d)(2)(D) of such Act (42 U.S.C. retary may require. furnished in a rural community hospital 1395ww(d)(2)(D))) or treated as being so lo- (B) DESIGNATION.—The Secretary shall des- under the demonstration program shall be as cated pursuant to section 1886(d)(8)(E) of ignate any hospital that is located in a dem- follows: such Act (42 U.S.C. 1395ww(d)(8)(E)); onstration area described in subparagraph (A) For items and services that would have (ii) subject to subparagraph (B), has less (C), submits an application in accordance been paid under section 1833(t) of the Social than 51 acute care inpatient beds, as re- with subparagraph (A), and meets the other Security Act (42 U.S.C. 1395l(t)) if provided ported in its most recent cost report; requirements of this section as a rural com- by a hospital, the amount of cost-sharing de- (iii) makes available 24-hour emergency munity hospital for purposes of the dem- termined under paragraph (8) of such section. care services; onstration program. (B) For items and services that would have (iv) subject to subparagraph (C), has a pro- (C) DEMONSTRATION AREAS.—There shall be been paid under section 1833(h) of such Act vider agreement in effect with the Secretary four demonstration areas within this pro- (42 U.S.C. 1395l(h)) if furnished by a provider and is open to the public as of January 1, gram. Two of these demonstration areas de- or supplier, no cost-sharing shall apply. 2003; and scribed in this subparagraph shall include (C) For all other items and services, the (v) applies to the Secretary for such des- Kansas and Nebraska. amount of cost-sharing that would apply to ignation. (3) DURATION.—The Secretary shall con- the item or service under the methodology (B) TREATMENT OF PSYCHIATRIC AND REHA- duct the demonstration program under this that would be used to determine payment for BILITATION UNITS.—For purposes of paragraph section for a 5-year period. such item or service if provided by a physi- (1)(B), beds in a psychiatric or rehabilitation (4) IMPLEMENTATION.—The Secretary shall cian, provider, or supplier, as the case may unit of the hospital which is a distinct part implement the demonstration program not be. of the hospital shall not be counted. later than January 1, 2005, but may not im- (7) RETURN ON EQUITY.— (C) TYPES OF HOSPITALS THAT MAY PARTICI- plement the program before October 1, 2004. (A) IN GENERAL.—Notwithstanding sub- PATE.—Subparagraph (1)(D) shall not be con- (b) PAYMENT.— paragraph (P)(i) and (S)(i) of section strued to prohibit any of the following from (1) INPATIENT HOSPITAL SERVICES.—The 1861(v)(1) of the Social Security Act (42 qualifying as a rural community hospital: amount of payment under the demonstration U.S.C. 1395x(v)(1)) and section 1886(g)(2) of (i) A replacement facility (as defined by program for inpatient hospital services fur- such Act (42 U.S.C. 1395ww(g)(2)), in deter- the Secretary in regulations in effect on Jan- nished in a rural community hospital, other mining the reasonable costs of the services uary 1, 2003) with the same service area (as than such services furnished in a psychiatric described in subclause (II) furnished by a defined by the Secretary in regulations in ef- or rehabilitation unit of the hospital which rural community hospital for payment of a fect on such date). is a distinct part, is, at the election of the return on equity capital at a rate of return (ii) A facility obtaining a new provider hospital in the application referred to in sub- equal to 150 percent of the average specified number pursuant to a change of ownership. section (a)(2)(A)— in section 1861(v)(1)(P)(i) of such Act (42 (iii) A facility which has a binding written (A) the reasonable costs of providing such U.S.C. 1395x(v)(1)(P)(i)). agreement with an outside, unrelated party services, without regard to the amount of (B) SERVICES DESCRIBED.—The services re- for the construction, reconstruction, lease, the customary or other charge; or ferred to in subclause (I) are rural commu- rental, or financing of a building as of Janu- (B) the amount of payment provided for nity hospital services. ary 1, 2003. under the prospective payment system for (C) DISREGARD OF PROPRIETARY PROVIDER (D) INCLUSION OF CAHS.—Nothing in this inpatient hospital services under section STATUS.—Payment under the demonstration subsection shall be construed as prohibiting 1886(d) of the Social Security Act (42 U.S.C. program shall be made without regard to a critical access hospital from qualifying as 1395ww(d)). whether a provider is a proprietary provider. a rural community hospital if the critical (2) OUTPATIENT SERVICES.—The amount of (8) REMOVING BARRIERS TO ESTABLISHMENT access hospital meets the conditions other- payment under the demonstration program OF DISTINCT PART UNITS BY RCH FACILITIES.— wise applicable to hospitals under section for outpatient services furnished in a rural Notwithstanding section 1886(d)(1)(B) of the 1861(e) of the Social Security Act (42 U.S.C. community hospital is, at the election of the Social Security Act (42 U.S.C. 1395x(e)) and section 1866 of such Act (42 hospital in the application referred to in sub- 1395ww(d)(1)(B)), the Secretary shall permit U.S.C. 1395cc). section (a)(2)(A)— rural community hospitals to establish dis- (2) QUALIFIED RCH-BASED HOME HEALTH (A) the reasonable costs of providing such tinct part units for purposes of applying such AGENCY DEFINED.—The term ‘‘qualified RCH- services, without regard to the amount of section. based home health agency’’ is a home health the customary or other charge and any limi- (c) FUNDING.— agency that is a provider-based entity (as de- tation under section 1861(v)(1)(U) of the So- (1) IN GENERAL.—The Secretary shall pro- fined in section 404 of the Medicare, Med- cial Security Act (42 U.S.C. 1395x(v)(1)(U)); or vide for the transfer from the Federal Hos- icaid, and SCHIP Benefits Improvement and (B) the amount of payment provided for pital Insurance Trust Fund under section Protection Act of 2000 (Public Law 106–554; under the prospective payment system for 1817 of the Social Security Act (42 U.S.C. Appendix F, 114 Stat. 2763A–506)) of a rural covered OPD services under section 1833(t) of 1395i) and the Federal Supplementary Insur- community hospital that is located— the Social Security Act (42 U.S.C. 1395l(t)). ance Trust Fund established under section (A) in a county in which no main or branch (3) HOME HEALTH SERVICES.—In determining 1841 of such Act (42 U.S.C. 1395t), in such pro- office of another home health agency is lo- payments under the demonstration program portion as the Secretary determines to be cated; or

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00135 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8782 CONGRESSIONAL RECORD — SENATE June 26, 2003 (B) at least 35 miles from any main or pital participating in the demonstration pro- gate payments made by the Secretary do not branch office of another home health agency. gram— exceed the amount which the Secretary SEC. ll. CRITICAL ACCESS HOSPITAL IMPROVE- (i) the limits imposed under the preceding would have paid if the demonstration pro- MENT DEMONSTRATION PROGRAM. paragraphs of this subsection shall not gram under this section was not imple- (a) ESTABLISHMENT OF CRITICAL ACCESS apply; and mented. HOSPITAL DEMONSTRATION PROGRAM.— (ii) payment shall be made on the basis of (c) WAIVER AUTHORITY.—The Secretary (1) IN GENERAL.—The Secretary shall estab- the reasonable costs incurred in furnishing may waive such requirements of titles XI lish a demonstration program to test various such services as determined under section and XVIII of the Social Security Act (42 methods to improve the critical access hos- 1861(v) of such Act (42 U.S.C. 1395x(v)), but U.S.C. 1301 et seq.; 1395 et seq.) as may be pital program under section 1820 of the So- without regard to the amount of the cus- necessary for the purpose of carrying out the cial Security Act (42 U.S.C. 1395i–4). tomary or other charges with respect to such demonstration program under this section. (2) CRITICAL ACCESS HOSPITAL IMPROVE- services. (d) REPORT.—Not later than 6 months after MENT.—In conducting the demonstration pro- (F) RETURN ON EQUITY.— the completion of the demonstration program under this section, the Secretary shall (i) IN GENERAL.—Notwithstanding subpara- gram under this section, the Secretary shall apply rules with respect to critical access graph (P)(i) and (S)(i) of section 1861(v)(1) of submit to Congress a report on such pro- hospitals participating in the program as fol- the Social Security Act (42 U.S.C. 1395x(v)(1)) gram, together with recommendations for lows: and section 1886(g)(2) of such Act (42 U.S.C. such legislation and administrative action as (A) EXCLUSION OF CERTAIN BEDS FROM BED 1395ww(g)(2)), in determining the reasonable the Secretary determines to be appropriate. COUNT.—In determining the number of beds costs of the services described in subclause of a facility for purposes of applying the bed (II) furnished by a critical access hospital SA 1123. Mr. DEWINE submitted an limitations referred to in subsections participating in the demonstration program amendment intended to be proposed by (c)(2)(B)(iii) and (f) of section 1820 of the So- for payment of a return on equity capital at him to the bill S. 1, to amend title cial Security Act (42 U.S.C. 1395i–4), the Sec- a rate of return equal to 150 percent of the retary shall not take into account any bed of average specified in section 1861(v)(1)(P)(i) of XVIII of the Social Security Act to a distinct part psychiatric or rehabilitation such Act (42 U.S.C. 1395x(v)(1)(P)(i)). provide for a voluntary prescription unit (described in the matter following (ii) SERVICES DESCRIBED.—The services re- drug benefit under the Medicare pro- clause (v) of section 1886(d)(1)(B) of such Act ferred to in subclause (I) are inpatient crit- gram and to strengthen and improve (42 U.S.C. 1395ww(d)(1)(B))) of the facility, ex- ical access hospital services, outpatient crit- the Medicare program, and for other cept that the total number of beds that are ical access hospital services, extended care purposes; which was ordered to lie on not taken into account pursuant to this sub- services, posthospital extended care services, the table; as follows: paragraph with respect to a facility shall not home health services, ambulance services, exceed 10. and inpatient hospital services. At the end of subtitle B of title IV, add the (B) EXCLUSION FROM HOME HEALTH PPS.— (iii) DISREGARD OF PROPRIETARY PROVIDER following: Notwithstanding section 1895 of the Social STATUS.—Payment under the demonstration SEC. ll. SENSE OF THE SENATE REGARDING Security Act (42 U.S.C. 1395fff), in deter- program shall be made without regard to THE PRESERVATION OF BENE- mining payments under the demonstration whether a provider is a proprietary provider. FICIARY CHOICES UNDER MEDICAREADVANTAGE; ESTABLISH- program for home health services furnished (G) REMOVING BARRIERS TO ESTABLISHMENT MENT OF STANDARDS. by a home health agency that is owned and OF DISTINCT PART UNITS BY CAH FACILITIES.— (a) SENSE OF THE SENATE.—It is the sense operated by a critical access hospital partici- Notwithstanding section 1886(d)(1)(B) of the of the Senate that medicare beneficiaries pating in the demonstration program— Social Security Act (42 U.S.C. should have a choice among multiple types (i) the agency may make an election to 1395ww(d)(1)(B)), the Secretary shall permit waive application of the prospective pay- critical access hospitals participating in the of health plans under the ment system established under such section demonstration program to establish distinct MedicareAdvantage program, including re- to such services furnished by the agency; and part units for purposes of applying such sec- gional preferred provider organizations and (ii) in the case of such an election, pay- tion. local health maintenance organization plans in markets where such plans naturally ment shall be made on the basis of the rea- (3) PARTICIPATION OF CAHS.— occur. sonable costs incurred in furnishing such (A) APPLICATION.—Each critical access hos- services as determined under section 1861(v), pital that is located in a demonstration area (b) ESTABLISHMENT OF STANDARDS.—The but without regard to the amount of the cus- described in subparagraph (C) that desires to Secretary shall establish standards with re- tomary or other charges with respect to such participate in the demonstration program spect to the participation of private health services or the limitations established under under this section shall submit an applica- plans in the MedicareAdvantage program paragraph (1)(L) of such section. tion to the Secretary at such time, in such under part C of title XVIII of the Social Se- (C) EXEMPTION OF CAH FACILITIES FROM manner, and containing such information as curity Act (42 U.S.C. 1395w–21 et seq.) that— PPS.—Notwithstanding section 1888(e) of the the Secretary may require. (1) encourage fair competition among such Social Security Act (42 U.S.C. 1395yy(e)), in (B) PARTICIPATION.—The Secretary shall plans; determining payments under this part for permit any critical access hospital that is lo- (2) ensure that beneficiaries who desire to covered skilled nursing facility services fur- cated in a demonstration area described in elect health benefits coverage under such a nished by a skilled nursing facility that is a subparagraph (C), submits an application in plan are provided with benefits that are ac- distinct part unit of a critical access hos- accordance with subparagraph (A), and tuarially equivalent to the benefits provided pital participating in the demonstration pro- meets the other requirements of this section under other beneficiary options for health gram or is owned and operated by a critical to participate in the demonstration program. benefits coverage available under the medi- access hospital participating in the dem- (C) DEMONSTRATION AREAS.—There shall be care program; and onstration program— four demonstration areas within this pro- (3) equally apply incentives to promote (i) the prospective payment system estab- gram. Two of these demonstration areas de- health plan participation to all plans desir- lished under such section shall not apply; scribed in this subparagraph shall include ing to participate in the MedicareAdvantage and Kansas and Nebraska. program. (ii) payment shall be made on the basis of (4) DURATION.—The Secretary shall con- the reasonable costs incurred in furnishing duct the demonstration program under this SA 1125. Mr. HATCH submitted an such services as determined under section section for a 5-year period. amendment intended to be proposed by 1861(v) of such Act (42 U.S.C. 1395x(v)), but (5) IMPLEMENTATION.—The Secretary shall him the bill S. 1, to amend title XVIII without regard to the amount of the cus- implement the demonstration program not of the Social Security Act to provide tomary or other charges with respect to such later than January 1, 2005, but may not im- for a voluntary prescription drug ben- services. plement the program before October 1, 2004. efit under the Medicare program and to (D) CONSOLIDATED BILLING.—The Secretary (b) FUNDING.— strengthen and improve the Medicare shall permit consolidated billing under sec- (1) IN GENERAL.—The Secretary shall pro- tion 1842(b)(6)(E) of the Social Security Act vide for the transfer from the Federal Hos- program, and for other purposes; which (42 U.S.C. 1395u(b)(6)(E)). pital Insurance Trust Fund under section was ordered to lie on the table; as fol- (E) EXEMPTION OF CERTAIN DISTINCT PART 1817 of the Social Security Act (42 U.S.C. lows: PSYCHIATRIC OR REHABILITATION UNITS FROM 1395i) and the Federal Supplementary Insur- Strike title V and insert the following: COST LIMITS.—Notwithstanding section ance Trust Fund established under section TITLE V—MEDICARE EDUCATION, REGU- 1886(b) of the Social Security Act (42 U.S.C. 1841 of such Act (42 U.S.C. 1395t), in such pro- LATORY REFORM, AND CONTRACTING 1395ww(b)), in determining payments under portion as the Secretary determines to be IMPROVEMENTS the demonstration program for inpatient appropriate, of such funds as are necessary hospital services furnished by a distinct part for the costs of carrying out the demonstra- Subtitle A—Regulatory Reform psychiatric or rehabilitation unit (described tion program under this section. SEC. 500. SHORT TITLE. in the matter following section (2) BUDGET NEUTRALITY.—In conducting the This title may be cited as the ‘‘Medicare 1886(d)(1)(B)(v) of such Act (42 U.S.C. demonstration program under this section, Education, Regulatory Reform, and Con- 1395ww(d)(1)(B)(v))) of a critical access hos- the Secretary shall ensure that the aggre- tracting Improvement Act of 2003’’.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00136 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8783 SEC. 501. COMPLIANCE WITH CHANGES IN REGU- or administrative action that the Secretary the administrative law judge functions that LATIONS AND POLICIES. determines appropriate to further reduce are transferred under the plan. (a) NO RETROACTIVE APPLICATION OF SUB- such inconsistency or conflicts.’’. (K) PERFORMANCE STANDARDS.—The estab- STANTIVE CHANGES.— SEC. 503. STATUS OF PENDING INTERIM FINAL lishment of performance standards for judges (1) IN GENERAL.—Section 1871 (42 U.S.C. REGULATIONS. performing the administrative law judge 1395hh) is amended by adding at the end the Section 1871 (42 U.S.C. 1395hh) as amended functions that are transferred under the plan following new subsection: by sections 501 and 502, is amended by adding with respect to timelines for decisions in ‘‘(d)(1)(A) A substantive change in regula- at the end the following new subsection: cases under title XVIII. tions, manual instructions, interpretative ‘‘(f) The Secretary shall publish in the Fed- (L) SHARED RESOURCES.—The feasibility of rules, statements of policy, or guidelines of eral Register at lease once every 6 months a the Secretary entering into such arrange- general applicability under this title shall list that provides the status of each interim ments with the Commissioner of Social Se- not be applied (by extrapolation or other- final regulation for which no final regulation curity as may be appropriate with respect to wise) retroactively to items and services fur- has been published. Such list shall include transferred functions under the plan to share nished before the effective date of the the date by which the Secretary plans to office space, support staff, and other re- change, unless the Secretary determines publish the final regulation that is based on sources, with appropriate reimbursement. that— the interim final regulation.’’. (M) TRAINING.—The training that should be ‘‘(i) such retroactive application is nec- provided to judges performing the adminis- Subtitle B—Appeals Process Reform essary to comply with statutory require- trative law judge functions that are trans- ments; or SEC. 511. SUBMISSION OF PLAN FOR TRANSFER ferred under the plan with respect to laws ‘‘(ii) failure to apply the change retro- OF RESPONSIBILITY FOR MEDICARE and regulations under title XVIII. APPEALS. actively would be contrary to the public in- (3) ADDITIONAL INFORMATION.—The plan (a) SUBMISSION OF TRANSITION PLAN.— terest.’’. may also include recommendations for fur- (1) IN GENERAL.—Not later than April 1, (2) EFFECTIVE DATE.—The amendment ther congressional action, including modi- 2004, the Commissioner of Social Security made by paragraph (1) shall apply to sub- fications to the requirements and deadlines and the Secretary shall develop and transmit stantive changes issued on or after the date established under section 1869 of the Social to Congress and the Comptroller General of of the enactment of this Act. Security Act (as amended by sections 521 and the United States a plan under which the (b) TIMELINE FOR COMPLIANCE WITH SUB- 522 of BIPA (114 Stat. 2763A–534) and this functions of administrative law judges re- STANTIVE CHANGES AFTER NOTICE.— Act). sponsible for hearing cases under title XVIII (1) IN GENERAL.—Section 1871(d)(1), as (b) GAO EVALUATION.—The Comptroller added by subsection (a), is amended by add- of the Social Security Act (and related pro- General of the United States shall— ing at the end the following: visions in title XI of such Act) are trans- (1) evaluate the plan submitted under sub- ‘‘(B) A compliance action may be made ferred from the responsibility of the Com- section (a); and against a provider of services, physician, missioner and the Social Security Adminis- (2) not later than 6 months after such sub- practitioner, or other supplier with respect tration to the Secretary and the Department mission, submit to Congress a report on such to noncompliance with such a substantive of Health and Human Services. evaluation. change only for items and services furnished (2) CONTENTS.—The plan shall include in- SEC. 512. EXPEDITED ACCESS TO JUDICIAL RE- on or after the effective date of the change. formation on the following: VIEW. ‘‘(C)(i) Except as provided in clause (ii), a (A) WORKLOAD.—The number of such ad- (a) IN GENERAL.—Section 1869(b) (42 U.S.C. substantive change may not take effect until ministrative law judges and support staff re- 1395ff(b)) is amended— not earlier than the date that is the end of quired now and in the future to hear and de- (1) in paragraph (1)(A), by inserting ‘‘, sub- the 30-day period that begins on the date cide such cases in a timely manner, taking ject to paragraph (2),’’ before ‘‘to judicial re- that the Secretary has issued or published, into account the current and anticipated view of the Secretary’s final decision’’; and as the case may be, the substantive change. claims volume, appeals, number of bene- (2) by adding at the end the following new ‘‘(ii) The Secretary may provide for a sub- ficiaries, and statutory changes. paragraph: stantive change to take effect on a date that (B) COST PROJECTIONS AND FINANCING.— ‘‘(2) EXPEDITED ACCESS TO JUDICIAL RE- precedes the end of the 30-day period under Funding levels required for fiscal year 2005 VIEW.— clause (i) if the Secretary finds that waiver and subsequent fiscal years to carry out the ‘‘(A) IN GENERAL.—The Secretary shall es- of such 30-day period is necessary to comply functions transferred under the plan and how tablish a process under which a provider of with statutory requirements or that the ap- such transfer should be financed. services or supplier that furnishes an item or plication of such 30-day period is contrary to (C) TRANSITION TIMETABLE.—A timetable service or a beneficiary who has filed an ap- the public interest. If the Secretary provides for the transition. peal under paragraph (1) (other than an ap- for an earlier effective date pursuant to this (D) REGULATIONS.—The establishment of peal filed under paragraph (1)(F)(i)) may ob- clause, the Secretary shall include in the specific regulations to govern the appeals tain access to judicial review when a review issuance or publication of the substantive process. entity (described in subparagraph (D)), on its change a finding described in the first sen- (E) CASE TRACKING.—The development of a own motion or at the request of the appel- tence, and a brief statement of the reasons unified case tracking system that will facili- lant, determines that the Departmental Ap- for such finding.’’. tate the maintenance and transfer of case peals Board does not have the authority to (2) EFFECTIVE DATE.—The amendment specific data across both the fee-for-service decide the question of law or regulation rel- made by paragraph (1) shall apply to compli- and managed care components of the medi- evant to the matters in controversy and that ance actions undertaken on or after the date care program. there is no material issue of fact in dispute. of the enactment of this Act. (F) FEASIBILITY OF PRECEDENTIAL AUTHOR- The appellant may make such request only SEC. 502. REPORT ON LEGAL AND REGULATORY ITY.—The feasibility of developing a process once with respect to a question of law or reg- INCONSISTENCIES. to give decisions of the Departmental Ap- ulation for a specific matter in dispute in a Section 1871 (42 U.S.C. 1395hh), as amended peals Board in the Department of Health and case of an appeal. by section 501(a)(1), is amended by adding at Human Services addressing broad legal ‘‘(B) PROMPT DETERMINATIONS.—If, after or the end the following new subsection: issues binding, precedential authority. coincident with appropriately filing a re- ‘‘(e)(1) Not later than 2 years after the date (G) ACCESS TO ADMINISTRATIVE LAW quest for an administrative hearing, the ap- of the enactment of this subsection, and JUDGES.—The feasibility of— pellant requests a determination by the ap- every 2 years thereafter, the Secretary shall (i) filing appeals with administrative law propriate review entity that the Depart- submit to Congress a report with respect to judges electronically; and mental Appeals Board does not have the au- the administration of this title and areas of (ii) conducting hearings using tele- or thority to decide the question of law or regu- inconsistency or conflict among the various video-conference technologies. lations relevant to the matters in con- provisions under law and regulation. (H) INDEPENDENCE OF JUDGES.—The steps troversy and that there is no material issue ‘‘(2) In preparing a report under paragraph that should be taken to ensure that judges of fact in dispute and if such request is ac- (1), the Secretary shall collect— who perform the administrative law judge companied by the documents and materials ‘‘(A) information from beneficiaries, pro- functions after the transfer under the plan as the appropriate review entity shall re- viders of services, physicians, practitioners, maintain their independence from the Cen- quire for purposes of making such deter- and other suppliers with respect to such ters for Medicare & Medicaid Services and mination, such review entity shall make a areas of inconsistency and conflict; and its contractors. determination on the request in writing ‘‘(B) information from medicare contrac- (I) GEOGRAPHIC DISTRIBUTION.—The steps within 60 days after the date such review en- tors that tracks the nature of communica- that should be taken to provide for an appro- tity receives the request and such accom- tions and correspondence, including the com- priate geographic distribution of judges per- panying documents and materials. Such a munications and correspondence required forming the administrative law judge func- determination by such review entity shall be under section 1874A. tions that are transferred under the plan considered a final decision and not subject to ‘‘(3) A report under paragraph (1) shall in- throughout the United States to ensure review by the Secretary. clude a description of efforts by the Sec- timely access to such judges. ‘‘(C) ACCESS TO JUDICIAL REVIEW.— retary to reduce such inconsistency or con- (J) HIRING.—The steps that should be taken ‘‘(i) IN GENERAL.—If the appropriate review flicts, and recommendations for legislation to hire judges (and support staff) to perform entity—

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00137 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8784 CONGRESSIONAL RECORD — SENATE June 26, 2003 ‘‘(I) determines that there are no material tives a report recommending specific ways to ings or review under this section are 90 days issues of fact in dispute and that the only modernize the cost reporting system under after the date on which the record is com- issue is one of law or regulation that the De- the medicare program under title XVIII of plete. partmental Appeals Board does not have au- the Social Security Act (42 U.S.C. 1395 et ‘‘(D) COMPLETE RECORD DESCRIBED.—For thority to decide; or seq.). Such report shall be consistent with purposes of this paragraph, a record is com- ‘‘(II) fails to make such determination the recommendations of the Secretary’s Ad- plete when the administrative law judge, in within the period provided under subpara- visory Committee on Regulatory Reform, in- the case of a hearing, or the Departmental graph (B); cluding the use of Generally Accepted Ac- Appeals Board, in the case of a review, has then the appellant may bring a civil action counting Principles. received— as described in this subparagraph. (b) CONSULTATION.—In developing the re- ‘‘(i) written or testimonial evidence, or ‘‘(ii) DEADLINE FOR FILING.—Such action port submitted under subsection (a), the Sec- both, submitted by the person filing the re- shall be filed, in the case described in— retary shall consult with representatives of quest, ‘‘(I) clause (i)(I), within 60 days of the date the hospital industry, the Medicare Payment ‘‘(ii) written or oral argument, or both, of the determination described in such Advisory Commission, the General Account- ‘‘(iii) the decision of, and the record for, clause; or ing Office, and such other individuals and en- the prior level of appeal, and ‘‘(II) clause (i)(II), within 60 days of the end tities as the Secretary determines to be ap- ‘‘(iv) such other evidence as such judge or of the period provided under subparagraph propriate. Board, as the case may be, determines is re- (B) for the determination. SEC. 514. EXPEDITED REVIEW OF CERTAIN PRO- quired to make a determination on the re- ‘‘(iii) VENUE.—Such action shall be brought VIDER AGREEMENT DETERMINA- quest.’’. in the district court of the United States for TIONS. (b) REVISIONS TO APPEALS TIMEFRAMES.— (a) TERMINATION AND CERTAIN OTHER IMME- the judicial district in which the appellant is Section 1869 (42 U.S.C. 1395ff) is amended— DIATE REMEDIES.— located (or, in the case of an action brought (1) in subsection (a)(3)(C)(ii), by striking (1) IN GENERAL.—The Secretary shall de- jointly by more than one applicant, the judi- ‘‘30-day period’’ each place it appears and in- velop and implement a process to expedite cial district in which the greatest number of serting ‘‘60-day period’’; proceedings under sections 1866(h) of the So- applicants are located) or in the district (2) in subsection (c)(3)(C)(i), by striking cial Security Act (42 U.S.C. 1395cc(h)) in court for the District of Columbia. ‘‘30-day period’’ and inserting ‘‘60-day pe- which— riod’’; ‘‘(iv) INTEREST ON ANY AMOUNTS IN CON- (A) the remedy of termination of participa- (3) in subsection (d)(1)(A), by striking ‘‘90- TROVERSY.—Where a provider of services or tion has been imposed; supplier is granted judicial review pursuant day period’’ and inserting ‘‘120-day period’’; (B) a sanction described in clause (i) or (iii) to this paragraph, the amount in con- and of section 1819(h)(2)(B) of such Act (42 U.S.C. troversy (if any) shall be subject to annual (4) in subsection (d)(2)(A), by striking ‘‘90- 1395i–3(h)(2)(B)) has been imposed, but only if interest beginning on the first day of the day period’’ and inserting ‘‘120-day period’’. such sanction has been imposed on an imme- (c) USE OF PATIENTS’ MEDICAL RECORDS.— first month beginning after the 60-day period diate basis; or Section 1869(c)(3)(B)(i) (42 U.S.C. as determined pursuant to clause (ii) and (C) the Secretary has required a skilled 1395ff(c)(3)(B)(i)) is amended by inserting equal to the rate of interest on obligations nursing facility to suspend operations of a ‘‘(including the medical records of the indi- issued for purchase by the Federal Supple- nurse aide training program. vidual involved)’’ after ‘‘clinical experience’’. mentary Medical Insurance Trust Fund for (2) PRIORITY FOR CASES OF TERMINATION.— (d) NOTICE REQUIREMENTS FOR MEDICARE the month in which the civil action author- Under the process described in paragraph (1), APPEALS.— ized under this paragraph is commenced, to priority shall be provided in cases of termi- (1) INITIAL DETERMINATIONS AND REDETER- be awarded by the reviewing court in favor of nation described in subparagraph (A) of such MINATIONS.—Section 1869(a) (42 U.S.C. the prevailing party. No interest awarded paragraph. 1395ff(a)) is amended by adding at the end the pursuant to the preceding sentence shall be (b) INCREASED FINANCIAL SUPPORT.—In ad- following new paragraph: deemed income or cost for the purposes of dition to any amounts otherwise appro- ‘‘(4) REQUIREMENTS OF NOTICE OF DETER- determining reimbursement due providers of priated, to reduce by 50 percent the average MINATIONS AND REDETERMINATIONS.—A writ- services, physicians, practitioners, and other time for administrative determinations on ten notice of a determination on an initial suppliers under this Act. appeals under section 1866(h) of the Social determination or on a redetermination, inso- ‘‘(D) REVIEW ENTITY DEFINED.—For pur- Security Act (42 U.S.C. 1395cc(h)), there are far as such determination or redetermina- poses of this subsection, the term ‘review en- authorized to be appropriated (in appropriate tion results in a denial of a claim for bene- tity’ means an entity of up to 3 qualified re- part from the Federal Hospital Insurance fits, shall be provided in printed form and viewers drawn from existing appeals levels Trust Fund and the Federal Supplementary written in a manner to be understood by the other than the redetermination level.’’. Medical Insurance Trust Fund) to the Sec- beneficiary and shall include— (b) APPLICATION TO PROVIDER AGREEMENT retary such sums for fiscal year 2004 and ‘‘(A) the reasons for the determination, in- DETERMINATIONS.—Section 1866(h)(1) (42 each subsequent fiscal year as may be nec- cluding, as appropriate— U.S.C. 1395cc(h)(1)) is amended— essary to increase the number of administra- ‘‘(i) upon request in the case of an initial (1) by inserting ‘‘(A)’’ after ‘‘(h)(1)’’; and tive law judges (and their staffs) at the De- determination, the provision of the policy, (2) by adding at the end the following new partmental Appeals Board of the Department manual, or regulation that resulted in the subparagraph: of Health and Human Services and to edu- denial; and ‘‘(B) An institution or agency described in cate such judges and staff on long-term care ‘‘(ii) upon request, in the case of a redeter- subparagraph (A) that has filed for a hearing issues. mination, a summary of the clinical or sci- under subparagraph (A) shall have expedited SEC. 515. REVISIONS TO MEDICARE APPEALS entific evidence used in making the deter- access to judicial review under this subpara- PROCESS. mination (as appropriate); graph in the same manner as providers of (a) TIMEFRAMES FOR THE COMPLETION OF ‘‘(B) the procedures for obtaining addi- services, suppliers, and beneficiaries may ob- THE RECORD.—Section 1869(b) (42 U.S.C. tional information concerning the deter- tain expedited access to judicial review 1395ff(b)), as amended by section 512(a)(2), is mination or redetermination; and under the process established under section amended by adding at the end the following ‘‘(C) notification of the right to seek a re- 1869(b)(2). Nothing in this subparagraph shall new paragraph: determination or otherwise appeal the deter- be construed to affect the application of any ‘‘(3) TIMELY COMPLETION OF THE RECORD.— mination and instructions on how to initiate remedy imposed under section 1819 during ‘‘(A) DEADLINE.—Subject to subparagraph such a redetermination or appeal under this the pendency of an appeal under this sub- (B), the deadline to complete the record in a section.’’. paragraph.’’. hearing before an administrative law judge (2) RECONSIDERATIONS.—Section (c) CONFORMING AMENDMENT.—Section or a review by the Departmental Appeals 1869(c)(3)(E) (42 U.S.C. 1395ff(c)(3)(E)) is 1869(b)(1)(F)(ii) (42 U.S.C. 1395ff(b)(1)(F)(ii)) is Board is 90 days after the date the request amended to read as follows: amended to read as follows: for the review or hearing is filed. ‘‘(E) EXPLANATION OF DECISION.—Any deci- ‘‘(ii) REFERENCE TO EXPEDITED ACCESS TO ‘‘(B) EXTENSIONS FOR GOOD CAUSE.—The sion with respect to a reconsideration of a JUDICIAL REVIEW.—For the provision relating person filing a request under subparagraph qualified independent contractor shall be in to expedited access to judicial review, see (A) may request an extension of such dead- writing in a manner to be understood by the paragraph (2).’’. line for good cause. The administrative law beneficiary and shall include— (d) EFFECTIVE DATE.—The amendments judge, in the case of a hearing, and the De- ‘‘(i) to the extent appropriate, an expla- made by this section shall apply to appeals partmental Appeals Board, in the case of a nation of the decision as well as a discussion filed on or after October 1, 2004. review, may extend such deadline based upon of the pertinent facts and applicable regula- SEC. 513. COST REPORT REFORM. a finding of good cause to a date specified by tions applied in making such decision; (a) REPORT.—Not later than the date that the judge or Board, as the case may be. ‘‘(ii) a notification of the right to appeal is 1 year after the date of enactment of this ‘‘(C) DELAY IN DECISION DEADLINES UNTIL such determination and instructions on how Act, the Secretary shall submit to the Com- COMPLETION OF RECORD.—Notwithstanding to initiate such appeal under this section; mittee on Finance of the Senate and the any other provision of this section, the dead- and Committees on Ways and Means and Energy lines otherwise established under subsection ‘‘(iii) in the case of a determination of and Commerce of the House of Representa- (d) for the making of determinations in hear- whether an item or service is reasonable and

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necessary for the diagnosis or treatment of (2) ELIGIBILITY REQUIREMENTS OF REVIEW- ‘‘(A) is appropriately credentialed or li- illness or injury (under section 1862(a)(1)(A)) ERS.—Section 1869 (42 U.S.C. 1395ff) is amend- censed in 1 or more States to deliver health an explanation of the decision.’’. ed— care services; and (3) APPEALS.—Section 1869(d) (42 U.S.C. (A) in subsection (c)(3)(B)(i), by striking ‘‘a ‘‘(B) has medical expertise in the field of 1395ff(d)) is amended— panel of physicians or other appropriate practice that is appropriate for the items or (A) in the heading, by inserting ‘‘; NOTICE’’ health care professionals’’ and inserting ‘‘a services at issue. after ‘‘SECRETARY’’; and physician or another appropriate health care ‘‘(5) RELATED PARTY DEFINED.—For pur- (B) by adding at the end the following new professional’’; poses of this section, the term ‘related party’ paragraph: (B) by striking subsection (c)(3)(D) and in- means, with respect to a case under this title ‘‘(4) NOTICE.—Notice of the decision of an serting the following: involving an individual beneficiary, any of administrative law judge shall be in writing ‘‘(D) QUALIFICATIONS FOR REVIEWERS.—The the following: in a manner to be understood by the bene- requirements of subsection (g) shall be met ‘‘(A) The Secretary, the medicare adminis- ficiary and shall include— (relating to qualifications of reviewing pro- trative contractor involved, or any fiduciary, ‘‘(A) the specific reasons for the deter- fessionals).’’; and officer, director, or employee of the Depart- mination; and (C) by adding at the end the following new ment of Health and Human Services, or of ‘‘(B) notification of the right to appeal the subsection: such contractor. decision and instructions on how to initiate ‘‘(B) The individual (or authorized rep- such an appeal under this section.’’. ‘‘(g) QUALIFICATIONS OF REVIEWERS.— resentative). (4) PREPARATION OF RECORD FOR APPEAL.— ‘‘(1) IN GENERAL.—In reviewing determina- ‘‘(C) The health care professional that pro- Section 1869(c)(3)(J) (42 U.S.C. 1395ff(c)(3)(J)) tions under this section, a qualified inde- vides the items or services involved in the is amended by striking ‘‘such information as pendent contractor shall ensure that— case. is required for an appeal’’ and inserting ‘‘the ‘‘(A) each individual conducting a review ‘‘(D) The institution at which the items or record for the appeal’’. shall meet the qualifications of paragraph services (or treatment) involved in the case (e) QUALIFIED INDEPENDENT CONTRAC- (2); are provided. TORS.— ‘‘(B) compensation provided by the con- ‘‘(E) The manufacturer of any drug or (1) ELIGIBILITY REQUIREMENTS OF QUALIFIED tractor to each such reviewer is consistent other item that is included in the items or INDEPENDENT CONTRACTORS.—Section 1869(c) with paragraph (3); and services involved in the case. (42 U.S.C. 1395ff(c)) is amended— ‘‘(C) in the case of a review described in ‘‘(F) Any other party determined under (A) in paragraph (2)— subsection (c)(3)(B) and conducted by a phy- any regulations to have a substantial inter- (i) by inserting ‘‘(except in the case of a sician or another health care professional est in the case involved.’’. utilization and quality control peer review (each in this subsection referred to as a ‘re- (3) NUMBER OF QUALIFIED INDEPENDENT CON- organization, as defined in section 1152)’’ viewing professional’), that the reviewing TRACTORS.—Section 1869(c)(4) (42 U.S.C. after ‘‘means an entity or organization professional meets the qualifications de- 1395ff(c)(4)) is amended by striking ‘‘12’’ and that’’; and scribed in paragraph (4). inserting ‘‘4’’. (ii) by striking the period at the end and ‘‘(2) INDEPENDENCE.— (e) IMPLEMENTATION OF CERTAIN BIPA RE- inserting the following: ‘‘and meets the fol- ‘‘(A) IN GENERAL.—Subject to subparagraph FORMS.— lowing requirements: (B), each individual conducting a review in a (1) DELAY IN CERTAIN BIPA REFORMS.—Sec- ‘‘(A) GENERAL REQUIREMENTS.— case shall— tion 521(d) of BIPA (114 Stat. 2763A–543) is ‘‘(i) The entity or organization has (di- ‘‘(i) not be a related party (as defined in rectly or through contracts or other arrange- amended to read as follows: paragraph (5)); ments) sufficient medical, legal, and other ‘‘(ii) not have a material familial, finan- ‘‘(d) EFFECTIVE DATE.— expertise (including knowledge of the pro- cial, or professional relationship with such a ‘‘(1) IN GENERAL.—Except as specified in gram under this title) and sufficient staffing party in the case under review; and paragraph (2), the amendments made by this to carry out duties of a qualified independent ‘‘(iii) not otherwise have a conflict of in- section shall apply with respect to initial de- contractor under this section on a timely terminations made on or after January 1, basis. terest with such a party (as determined under regulations). 2005. ‘‘(ii) The entity or organization has pro- ‘‘(2) EXPEDITED PROCEEDINGS AND RECONSID- vided assurances that it will conduct activi- ‘‘(B) EXCEPTION.—Nothing in subparagraph (A) shall be construed to— ERATION REQUIREMENTS.—The amendments ties consistent with the applicable require- made by subsection (a) shall apply with re- ments of this section, including that it will ‘‘(i) prohibit an individual, solely on the basis of affiliation with a fiscal inter- spect to initial determinations made on or not conduct any activities in a case unless after October 1, 2003 under the following pro- the independence requirements of subpara- mediary, carrier, or other contractor, from serving as a reviewing professional if— visions: graph (B) are met with respect to the case. ‘‘(A) Subsection (b)(1)(F)(i) of section 1869 ‘‘(iii) The entity or organization meets ‘‘(I) a nonaffiliated individual is not reasonably available; of the Social Security Act. such other requirements as the Secretary ‘‘(B) Subsection (c)(3)(C)(iii) of such sec- provides by regulation. ‘‘(II) the affiliated individual is not involved in the provision of items or services tion. ‘‘(B) INDEPENDENCE REQUIREMENTS.— ‘‘(C) Subsection (c)(3)(C)(iv) of such section in the case under review; ‘‘(i) IN GENERAL.—Subject to clause (ii), an to the extent that it applies to expedited re- ‘‘(III) the fact of such an affiliation is dis- entity or organization meets the independ- considerations under subsection (c)(3)(C)(iii) closed to the Secretary and the beneficiary ence requirements of this subparagraph with of such section. respect to any case if the entity— (or authorized representative) and neither ‘‘(3) TRANSITIONAL USE OF PEER REVIEW OR- ‘‘(I) is not a related party (as defined in party objects; and GANIZATIONS TO CONDUCT EXPEDITED RECON- subsection (g)(5)); ‘‘(IV) the affiliated individual is not an em- SIDERATIONS UNTIL QICS ARE OPERATIONAL.— ployee of the intermediary, carrier, or con- ‘‘(II) does not have a material familial, fi- Expedited reconsiderations of initial deter- tractor and does not provide services exclu- nancial, or professional relationship with minations under section 1869(c)(3)(C)(iii) of sively or primarily to or on behalf of such such a party in relation to such case; and the Social Security Act shall be made by intermediary, carrier, or contractor; ‘‘(III) does not otherwise have a conflict of peer review organizations until qualified interest with such a party (as determined ‘‘(ii) prohibit an individual who has staff independent contractors are available for under regulations). privileges at the institution where the treat- such expedited reconsiderations.’’. ‘‘(ii) EXCEPTION FOR COMPENSATION.—Noth- ment involved takes place from serving as a (2) CONFORMING AMENDMENT.—Section ing in clause (i) shall be construed to pro- reviewer merely on the basis of such affili- 521(c) of BIPA (114 Stat. 2763A–543) and sec- hibit receipt by a qualified independent con- ation if the affiliation is disclosed to the tion 1869(c)(3)(C)(iii)(III) of the Social Secu- tractor of compensation from the Secretary Secretary and the beneficiary (or authorized rity Act (42 U.S.C. 1395ff(c)(3)(C)(iii)(III)), as for the conduct of activities under this sec- representative), and neither party objects; or added by section 521 of BIPA, are repealed. tion if the compensation is provided con- ‘‘(iii) prohibit receipt of compensation by a sistent with clause (iii). reviewing professional from a contractor if (f) EFFECTIVE DATE.—The amendments ‘‘(iii) LIMITATIONS ON ENTITY COMPENSA- the compensation is provided consistent with made by this section shall be effective as if TION.—Compensation provided by the Sec- paragraph (3). included in the enactment of the respective retary to a qualified independent contractor ‘‘(3) LIMITATIONS ON REVIEWER COMPENSA- provisions of subtitle C of title V of BIPA, in connection with reviews under this sec- TION.—Compensation provided by a qualified 114 Stat. 2763A–534. tion shall not be contingent on any decision independent contractor to a reviewer in con- (g) TRANSITION.—In applying section 1869(g) rendered by the contractor or by any review- nection with a review under this section of the Social Security Act (as added by sub- ing professional.’’; and shall not be contingent on the decision ren- section (d)(2)), any reference to a medicare (B) in paragraph (3)(A), by striking ‘‘, and dered by the reviewer. administrative contractor shall be deemed to shall have sufficient training and expertise ‘‘(4) LICENSURE AND EXPERTISE.—Each re- include a reference to a fiscal intermediary in medical science and legal matters to viewing professional shall be a physician under section 1816 of the Social Security Act make reconsiderations under this sub- (allopathic or osteopathic) or health care (42 U.S.C. 1395h) and a carrier under section section’’. professional who— 1842 of such Act (42 U.S.C. 1395u).

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SEC. 516. HEARING RIGHTS RELATED TO DECI- (c) REQUEST FOR LOCAL COVERAGE DETER- and no further proceedings in relation to SIONS BY THE SECRETARY TO DENY MINATIONS BY PROVIDERS.—Section 1869 (42 such request shall be conducted.’’. OR NOT RENEW A MEDICARE EN- U.S.C. 1395ff), as amended by section (d) STUDY AND REPORT ON THE USE OF CON- ROLLMENT AGREEMENT; CON- 515(d)(2)(B), is amended by adding at the end SULTATION BEFORE CHANGING TRACTORS TO MONITOR MEDICARE APPEALS.— PROVIDER ENROLLMENT FORMS. the following new subsection: (1) STUDY.—The Secretary of Health and ‘‘(h) REQUEST FOR LOCAL COVERAGE DETER- (a) HEARING RIGHTS.— Human Services (in this section referred to MINATIONS BY PROVIDERS.— (1) IN GENERAL.—Section 1866 (42 U.S.C. as the ‘‘Secretary’’) shall conduct a study on ‘‘(1) ESTABLISHMENT OF PROCESS.—The Sec- 1395cc) is amended by adding at the end the the feasibility and advisability of requiring retary shall establish a process under which following new subsection: fiscal intermediaries and carriers to monitor a provider of services, physician, practi- ‘‘(j) HEARING RIGHTS IN CASES OF DENIAL OR and track— tioner, or supplier who certifies that they NONRENEWAL.—The Secretary shall establish (A) the subject matter and status of claims by regulation procedures under which— meet the requirements established in para- denied by the fiscal intermediary or carrier graph (3) may request a local coverage deter- ‘‘(1) there are deadlines for actions on ap- (as applicable) that are appealed under sec- mination in accordance with the succeeding plications for enrollment (and, if applicable, tion 1869 of the Social Security Act (42 provisions of this subsection. renewal of enrollment); and U.S.C. 1395ff), as added by section 522 of ‘‘(2) PROVIDER LOCAL COVERAGE DETERMINA- ‘‘(2) a provider of services or supplier BIPA (114 Stat. 2763A–543) and amended by TION REQUEST DEFINED.—In this subsection, whose application to enroll (or, if applicable, this Act; and the term ‘provider local coverage determina- to renew enrollment) under this title is de- (B) any final determination made with re- tion request’ means a request, filed with the nied may have a hearing and judicial review spect to such claims. Secretary, at such time and in such form and of such denial under the procedures that (2) REPORT.—Not later than the date that manner as the Secretary may specify, that is 1 year after the date of the enactment of apply under subsection (h)(1)(A) to a provider the Secretary, pursuant to paragraph (4)(A), this Act, the Secretary shall submit to Con- of services that is dissatisfied with a deter- require a fiscal intermediary, carrier, or progress a report on the study conducted under mination by the Secretary.’’. gram safeguard contractor to make or revise paragraph (1) together with such rec- (2) EFFECTIVE DATE.—The Secretary shall a local coverage determination under this ommendations for legislation and adminis- provide for the establishment of the proce- section with respect to an item or service. dures under the amendment made by para- trative action as the Commission determines ‘‘(3) REQUEST REQUIREMENTS.—Under the appropriate. graph (1) within 18 months after the date of process established under paragraph (1), by the enactment of this Act. not later than 30 days after the date on (e) AUTHORIZATION OF APPROPRIATIONS.— ONSULTATION BEFORE CHANGING PRO- (b) C which a provider local coverage determina- There are authorized to be appropriated such VIDER ENROLLMENT FORMS.—Section 1871 (42 tion request is filed under paragraph (1), the sums as are necessary to carry out the U.S.C. 1395hh), as amended by sections 501, Secretary shall determine whether such re- amendments made by subsections (a), (b), 502, and 503, is amended by adding at the end quest establishes that— and (c). the following new subsection: ‘‘(A) there have been at least 5 reversals of (f) EFFECTIVE DATES.— ‘‘(g) The Secretary shall consult with pro- redeterminations made by a fiscal inter- (1) PROVIDER ACCESS TO REVIEW OF LOCAL viders of services, physicians, practitioners, mediary or carrier after a hearing before an COVERAGE DETERMINATIONS.—The amend- and suppliers before making changes in the administrative law judge on claims sub- ments made by subsections (a) and (b) shall provider enrollment forms required of such mitted by the provider in at least 2 different apply to— providers, physicians, practitioners, and sup- cases before an administrative law judge; (A) any review of any local coverage deter- pliers to be eligible to submit claims for ‘‘(B) each reversal described in subpara- mination filed on or after January 1, 2004; which payment may be made under this graph (A) involves substantially similar ma- (B) any request to make such a determina- title.’’. terial facts; tion made on or after such date; or SEC. 517. APPEALS BY PROVIDERS WHEN THERE ‘‘(C) each reversal described in subpara- (C) any local coverage determination made IS NO OTHER PARTY AVAILABLE. graph (A) involves the same medical neces- on or after such date. (a) IN GENERAL.—Section 1870 (42 U.S.C. sity issue; and (2) PROVIDER LOCAL COVERAGE DETERMINA- 1395gg) is amended by adding at the end the ‘‘(D) at least 50 percent of the total number TION REQUESTS.—The amendment made by following new subsection: subsection (c) shall apply with respect to ‘‘(h) Notwithstanding subsection (f) or any of claims submitted by such provider within provider local coverage determination re- other provision of law, the Secretary shall the past year involving the substantially quests (as defined in section 1869(h)(2) of the permit a provider of services, physician, similar material facts described in subpara- Social Security Act, as added by subsection practitioner, or other supplier to appeal any graph (B) and the same medical necessity (c)) filed on or after the date of the enact- determination of the Secretary under this issue described in subparagraph (C) have ment of this Act. title relating to services rendered under this been denied and have been reversed by an ad- title to an individual who subsequently dies ministrative law judge. Subtitle C—Contracting Reform ‘‘(4) APPROVAL OR REJECTION OF REQUEST.— if there is no other party available to appeal SEC. 521. INCREASED FLEXIBILITY IN MEDICARE such determination and the provider of serv- ‘‘(A) APPROVAL OF REQUEST.—If the Sec- ADMINISTRATION. retary determines that subparagraphs (A) ices, physician, practitioner, or other sup- (a) CONSOLIDATION AND FLEXIBILITY IN through (D) of paragraph (3) have been satis- plier would be prejudiced by the determina- MEDICARE ADMINISTRATION.— fied, the Secretary shall require the fiscal tion.’’. (1) IN GENERAL.—Title XVIII is amended by intermediary, carrier, or program safeguard (b) EFFECTIVE DATE.—The amendment inserting after section 1874 the following new contractor identified in the provider local made by subsection (a) shall take effect on section: the date of the enactment of this Act and coverage determination request, to make or ‘‘CONTRACTS WITH MEDICARE ADMINISTRATIVE shall apply to items and services furnished revise a local coverage determination with CONTRACTORS on or after such date. respect to the item or service that is the sub- SEC. 518. PROVIDER ACCESS TO REVIEW OF ject of the request not later than the date ‘‘SEC. 1874A. (a) AUTHORITY.— LOCAL COVERAGE DETERMINA- that is 210 days after the date on which the ‘‘(1) AUTHORITY TO ENTER INTO CON- TIONS. Secretary makes the determination. Such TRACTS.—The Secretary may enter into con- (a) PROVIDER ACCESS TO REVIEW OF LOCAL fiscal intermediary, carrier, or program safe- tracts with any eligible entity to serve as a COVERAGE DETERMINATIONS.—Section guard contractor shall retain the discretion medicare administrative contractor with re- 1869(f)(5) (42 U.S.C. 1395ff(f)(5)) is amended to to determine whether or not, and/or the cir- spect to the performance of any or all of the read as follows: cumstances under which, to cover the item functions described in paragraph (4) or parts ‘‘(5) AGGRIEVED PARTY DEFINED.—In this or service for which a local coverage deter- of those functions (or, to the extent provided section, with respect to a national or local mination is requested. Nothing in this sub- in a contract, to secure performance thereof coverage determination, the term ‘aggrieved section shall be construed to require a fiscal by other entities). party’ means— intermediary, carrier or program safeguard ‘‘(2) ELIGIBILITY OF ENTITIES.—An entity is ‘‘(A) an individual entitled to benefits contractor to develop a local coverage deter- eligible to enter into a contract with respect under part A, or enrolled under part B, or mination that is inconsistent with any na- to the performance of a particular function both, who is in need of the items or services tional coverage determination, or any cov- described in paragraph (4) only if— that are the subject of the coverage deter- erage provision in this title or in regulation, ‘‘(A) the entity has demonstrated capa- mination; or manual, or interpretive guidance of the Sec- bility to carry out such function; ‘‘(B) a provider of services, physician, prac- retary. ‘‘(B) the entity complies with such conflict titioner, or supplier that is adversely af- ‘‘(B) REJECTION OF REQUEST.—If the Sec- of interest standards as are generally appli- fected by such a determination.’’. retary determines that subparagraphs (A) cable to Federal acquisition and procure- (b) CLARIFICATION OF LOCAL COVERAGE DE- through (D) of paragraph (3) have not been ment; TERMINATION DEFINITION.—Section satisfied, the Secretary shall reject the pro- ‘‘(C) the entity has sufficient assets to fi- 1869(f)(2)(B) (42 U.S.C. 1395ff(f)(2)(B)) is vider local coverage determination request nancially support the performance of such amended by inserting ‘‘, including, where ap- and shall notify the provider of services, function; and propriate, a clear explanation of the reasons physician, practitioner, or supplier that filed ‘‘(D) the entity meets such other require- for the denial’’ before the period at the end. the request of the reason for such rejection ments as the Secretary may impose.

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‘‘(3) MEDICARE ADMINISTRATIVE CONTRACTOR (relating to prior authorization of certain ‘‘(B) CONSIDERATIONS.—The Secretary shall DEFINED.—For purposes of this title and title items of durable medical equipment under include, as one of the standards, provider and XI— section 1834(a)(15)). beneficiary satisfaction levels. ‘‘(A) IN GENERAL.—The term ‘medicare ad- ‘‘(B) CONSTRUCTION.—An entity shall not be ‘‘(C) INCLUSION IN CONTRACTS.—All con- ministrative contractor’ means an agency, treated as a medicare administrative contractor performance requirements shall be organization, or other person with a contract tractor merely by reason of having entered set forth in the contract between the Sec- under this section. into a contract with the Secretary under secretary and the appropriate medicare admin- ‘‘(B) APPROPRIATE MEDICARE ADMINISTRA- tion 1893. istrative contractor. Such performance re- TIVE CONTRACTOR.—With respect to the per- ‘‘(6) APPLICATION OF FEDERAL ACQUISITION quirements— formance of a particular function in relation REGULATION.—Except to the extent incon- ‘‘(i) shall reflect the performance require- to an individual entitled to benefits under sistent with a specific requirement of this ments published under subparagraph (A), but part A or enrolled under part B, or both, a title, the Federal Acquisition Regulation ap- may include additional performance require- specific provider of services, physician, prac- plies to contracts under this title. ments; titioner, facility, or supplier (or class of such ‘‘(b) CONTRACTING REQUIREMENTS.— ‘‘(ii) shall be used for evaluating con- providers of services, physicians, practi- ‘‘(1) USE OF COMPETITIVE PROCEDURES.— tractor performance under the contract; and tioners, facilities, or suppliers), the ‘appro- ‘‘(A) IN GENERAL.—Except as provided in ‘‘(iii) shall be consistent with the written priate’ medicare administrative contractor laws with general applicability to Federal statement of work provided under the con- is the medicare administrative contractor acquisition and procurement, the Federal tract. that has a contract under this section with Acquisition Regulation, or in subparagraph ‘‘(4) INFORMATION REQUIREMENTS.—The Sec- respect to the performance of that function (B), the Secretary shall use competitive pro- retary shall not enter into a contract with a in relation to that individual, provider of cedures when entering into contracts with medicare administrative contractor under services, physician, practitioner, facility, or medicare administrative contractors under this section unless the contractor agrees— supplier or class of provider of services, phy- this section. ‘‘(A) to furnish to the Secretary such time- sician, practitioner, facility, or supplier. ‘‘(B) RENEWAL OF CONTRACTS.—The Sec- ly information and reports as the Secretary ‘‘(4) FUNCTIONS DESCRIBED.—The functions retary may renew a contract with a medi- may find necessary in performing his func- referred to in paragraphs (1) and (2) are pay- care administrative contractor under this tions under this title; and ment functions, provider services functions, section from term to term without regard to ‘‘(B) to maintain such records and afford and beneficiary services functions as follows: section 5 of title 41, United States Code, or such access thereto as the Secretary finds ‘‘(A) DETERMINATION OF PAYMENT any other provision of law requiring com- necessary to assure the correctness and AMOUNTS.—Determining (subject to the pro- petition, if the medicare administrative con- verification of the information and reports visions of section 1878 and to such review by tractor has met or exceeded the performance under subparagraph (A) and otherwise to the Secretary as may be provided for by the requirements applicable with respect to the carry out the purposes of this title. contracts) the amount of the payments re- contract and contractor, except that the ‘‘(5) SURETY BOND.—A contract with a quired pursuant to this title to be made to Secretary shall provide for the application of medicare administrative contractor under providers of services, physicians, practi- competitive procedures, unless laws with this section may require the medicare ad- tioners, facilities, suppliers, and individuals. general applicability to Federal acquisition ministrative contractor, and any of its offi- ‘‘(B) MAKING PAYMENTS.—Making pay- and procurement or the Federal Acquisition cers or employees certifying payments or ments described in subparagraph (A) (includ- Regulation authorize the use of other proce- disbursing funds pursuant to the contract, or ing receipt, disbursement, and accounting dures, under such a contract not less fre- otherwise participating in carrying out the for funds in making such payments). quently than once every 8 years. contract, to give surety bond to the United ‘‘(C) BENEFICIARY EDUCATION AND ASSIST- ‘‘(C) TRANSFER OF FUNCTIONS.—The Sec- States in such amount as the Secretary may ANCE.—Serving as a center for, and commu- retary may transfer functions among medi- deem appropriate. nicating to individuals entitled to benefits care administrative contractors without re- ‘‘(c) TERMS AND CONDITIONS.— under part A or enrolled under part B, or gard to any provision of law requiring com- ‘‘(1) IN GENERAL.—Subject to subsection both, with respect to education and outreach petition. The Secretary shall ensure that (a)(6), a contract with any medicare adminis- for those individuals, and assistance with performance quality is considered in such trative contractor under this section may specific issues, concerns, or problems of transfers. The Secretary shall provide notice contain such terms and conditions as the those individuals. (whether in the Federal Register or other- Secretary finds necessary or appropriate and ‘‘(D) PROVIDER CONSULTATIVE SERVICES.— wise) of any such transfer (including a de- may provide for advances of funds to the Providing consultative services to institu- scription of the functions so transferred and medicare administrative contractor for the tions, agencies, and other persons to enable contact information for the contractors in- making of payments by it under subsection them to establish and maintain fiscal volved) to providers of services, physicians, (a)(4)(B). records necessary for purposes of this title practitioners, facilities, and suppliers af- ‘‘(2) PROHIBITION ON MANDATES FOR CERTAIN and otherwise to qualify as providers of serv- fected by the transfer. DATA COLLECTION.—The Secretary may not ices, physicians, practitioners, facilities, or ‘‘(D) INCENTIVES FOR QUALITY.—The Sec- require, as a condition of entering into, or suppliers. retary may provide incentives for medicare renewing, a contract under this section, that ‘‘(E) COMMUNICATION WITH PROVIDERS.— administrative contractors to provide qual- the medicare administrative contractor Serving as a center for, and communicating ity service and to promote efficiency. match data obtained other than in its activi- to providers of services, physicians, practi- ‘‘(2) COMPLIANCE WITH REQUIREMENTS.—No ties under this title with data used in the ad- tioners, facilities, and suppliers, any infor- contract under this section shall be entered ministration of this title for purposes of mation or instructions furnished to the into with any medicare administrative con- identifying situations in which the provi- medicare administrative contractor by the tractor unless the Secretary finds that such sions of section 1862(b) may apply. Secretary, and serving as a channel of com- medicare administrative contractor will per- ‘‘(d) LIMITATION ON LIABILITY OF MEDICARE munication from such providers, physicians, form its obligations under the contract effi- ADMINISTRATIVE CONTRACTORS AND CERTAIN practitioners, facilities, and suppliers to the ciently and effectively and will meet such re- OFFICERS.— Secretary. quirements as to financial responsibility, ‘‘(1) CERTIFYING OFFICER.—No individual ‘‘(F) PROVIDER EDUCATION AND TECHNICAL legal authority, and other matters as the designated pursuant to a contract under this ASSISTANCE.—Performing the functions de- Secretary finds pertinent. section as a certifying officer shall, in the scribed in subsections (e) and (f), relating to ‘‘(3) PERFORMANCE REQUIREMENTS.— absence of the reckless disregard of the indi- education, training, and technical assistance ‘‘(A) DEVELOPMENT OF SPECIFIC PERFORM- vidual’s obligations or the intent by that in- to providers of services, physicians, practi- ANCE REQUIREMENTS.—The Secretary shall dividual to defraud the United States, be lia- tioners, facilities, and suppliers. develop contract performance requirements ble with respect to any payments certified ‘‘(G) ADDITIONAL FUNCTIONS.—Performing to carry out the specific requirements appli- by the individual under this section. such other functions, including (subject to cable under this title to a function described ‘‘(2) DISBURSING OFFICER.—No disbursing paragraph (5)) functions under the Medicare in subsection (a)(4) and shall develop stand- officer shall, in the absence of the reckless Integrity Program under section 1893, as are ards for measuring the extent to which a disregard of the officer’s obligations or the necessary to carry out the purposes of this contractor has met such requirements. In de- intent by that officer to defraud the United title. veloping such performance requirements and States, be liable with respect to any pay- ‘‘(5) RELATIONSHIP TO MIP CONTRACTS.— standards for measurement, the Secretary ment by such officer under this section if it ‘‘(A) NONDUPLICATION OF ACTIVITIES.—In en- shall consult with providers of services, or- was based upon an authorization (which tering into contracts under this section, the ganizations representative of beneficiaries meets the applicable requirements for such Secretary shall assure that activities of under this title, and organizations and agen- internal controls established by the Comp- medicare administrative contractors do not cies performing functions necessary to carry troller General) of a certifying officer des- duplicate activities carried out under con- out the purposes of this section with respect ignated as provided in paragraph (1) of this tracts entered into under the Medicare In- to such performance requirements. The Sec- subsection. tegrity Program under section 1893. The pre- retary shall make such performance require- ‘‘(3) LIABILITY OF MEDICARE ADMINISTRATIVE vious sentence shall not apply with respect ments and measurement standards available CONTRACTOR.—No medicare administrative to the activity described in section 1893(b)(5) to the public. contractor shall be liable to the United

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00141 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8788 CONGRESSIONAL RECORD — SENATE June 26, 2003 States for a payment by a certifying or dis- care administrative contractors under sec- section (a)(1)(B),’’ and inserting ‘‘contract bursing officer unless, in connection with tion 1874A.’’. under section 1874A that provides for making such a payment, the medicare administra- (3) Subsection (b) is repealed. payments under this part’’; tive contractor acted with reckless disregard (4) Subsection (c) is amended— (C) in paragraph (3)(A), by striking ‘‘sub- of its obligations under its medicare admin- (A) by striking paragraph (1); and section (a)(1)(B)’’ and inserting ‘‘section istrative contract or with intent to defraud (B) in each of paragraphs (2)(A) and (3)(A), 1874A(a)(3)(B)’’; the United States. by striking ‘‘agreement under this section’’ (D) in paragraph (4), by striking ‘‘carrier’’ ‘‘(4) RELATIONSHIP TO FALSE CLAIMS ACT.— and inserting ‘‘contract under section 1874A and inserting ‘‘medicare administrative con- Nothing in this subsection shall be construed that provides for making payments under tractor’’; to limit liability for conduct that would con- this part’’. (E) in paragraph (5), by striking ‘‘contract stitute a violation of sections 3729 through (5) Subsections (d) through (i) are repealed. under this section which provides for the dis- 3731 of title 31, United States Code (com- (6) Subsections (j) and (k) are each amend- bursement of funds, as described in sub- monly known as the ‘‘False Claims Act’’). ed— section (a)(1)(B), shall require the carrier’’ ‘‘(5) INDEMNIFICATION BY SECRETARY.— (A) by striking ‘‘An agreement with an and ‘‘carrier responses’’ and inserting ‘‘con- ‘‘(A) IN GENERAL.—Notwithstanding any agency or organization under this section’’ tract under section 1874A that provides for other provision of law and subject to the suc- and inserting ‘‘A contract with a medicare making payments under this part shall re- ceeding provisions of this paragraph, in the administrative contractor under section quire the medicare administrative con- case of a medicare administrative contractor 1874A with respect to the administration of tractor’’ and ‘‘contractor responses’’, respec- (or a person who is a director, officer, or em- this part’’; and tively; and ployee of such a contractor or who is en- (B) by striking ‘‘such agency or organiza- (F) by striking paragraph (6). gaged by the contractor to participate dition’’ and inserting ‘‘such medicare adminis- (5) Subsections (d), (e), and (f) are repealed. rectly in the claims administration process) trative contractor’’ each place it appears. (6) Subsection (g) is amended by striking who is made a party to any judicial or ad- (7) Subsection (l) is repealed. ‘‘carrier or carriers’’ and inserting ‘‘medi- ministrative proceeding arising from, or re- (c) CONFORMING AMENDMENTS TO SECTION care administrative contractor or contrac- lating directly to, the claims administration 1842 (RELATING TO CARRIERS).—Section 1842 tors’’. process under this title, the Secretary may, (42 U.S.C. 1395u) is amended as follows: (7) Subsection (h) is amended— to the extent specified in the contract with (1) The heading is amended to read as fol- (A) in paragraph (2)— the contractor, indemnify the contractor lows: (i) by striking ‘‘Each carrier having an (and such persons). ‘‘PROVISIONS RELATING TO THE agreement with the Secretary under sub- ‘‘(B) CONDITIONS.—The Secretary may not ADMINISTRATION OF PART B’’. section (a)’’ and inserting ‘‘The Secretary’’; provide indemnification under subparagraph (2) Subsection (a) is amended to read as and (A) insofar as the liability for such costs follows: (ii) by striking ‘‘Each such carrier’’ and in- arises directly from conduct that is deter- ‘‘(a) The administration of this part shall serting ‘‘The Secretary’’; mined by the Secretary to be criminal in na- be conducted through contracts with medi- (B) in paragraph (3)(A)— ture, fraudulent, or grossly negligent. care administrative contractors under sec- (i) by striking ‘‘a carrier having an agree- ‘‘(C) SCOPE OF INDEMNIFICATION.—Indem- tion 1874A.’’. ment with the Secretary under subsection nification by the Secretary under subpara- (3) Subsection (b) is amended— (a)’’ and inserting ‘‘medicare administrative graph (A) may include payment of judg- (A) by striking paragraph (1); contractor having a contract under section ments, settlements (subject to subparagraph (B) in paragraph (2)— 1874A that provides for making payments (D)), awards, and costs (including reasonable (i) by striking subparagraphs (A) and (B); under this part’’; and legal expenses). (ii) in subparagraph (C), by striking ‘‘car- (ii) by striking ‘‘such carrier’’ and insert- ‘‘(D) WRITTEN APPROVAL FOR SETTLE- riers’’ and inserting ‘‘medicare administra- ing ‘‘such contractor’’; MENTS.—A contractor or other person de- tive contractors’’; and (C) in paragraph (3)(B)— scribed in subparagraph (A) may not propose (iii) by striking subparagraphs (D) and (E); (i) by striking ‘‘a carrier’’ and inserting ‘‘a to negotiate a settlement or compromise of a (C) in paragraph (3)— medicare administrative contractor’’ each proceeding described in such subparagraph (i) in the matter before subparagraph (A), place it appears; and without the prior written approval of the by striking ‘‘Each such contract shall pro- Secretary to negotiate a settlement. Any in- (ii) by striking ‘‘the carrier’’ and inserting vide that the carrier’’ and inserting ‘‘The ‘‘the contractor’’ each place it appears; and demnification under subparagraph (A) with Secretary’’; respect to amounts paid under a settlement (D) in paragraphs (5)(A) and (5)(B)(iii), by (ii) by striking ‘‘will’’ the first place it ap- striking ‘‘carriers’’ and inserting ‘‘medicare are conditioned upon the Secretary’s prior pears in each of subparagraphs (A), (B), (F), written approval of the final settlement. administrative contractors’’ each place it (G), (H), and (L) and inserting ‘‘shall’’; appears. ‘‘(E) CONSTRUCTION.—Nothing in this para- (iii) in subparagraph (B), in the matter be- graph shall be construed— (8) Subsection (l) is amended— fore clause (i), by striking ‘‘to the policy- (A) in paragraph (1)(A)(iii), by striking ‘‘(i) to change any common law immunity holders and subscribers of the carrier’’ and that may be available to a medicare admin- ‘‘carrier’’ and inserting ‘‘medicare adminis- inserting ‘‘to the policyholders and sub- trative contractor’’; and istrative contractor or person described in scribers of the medicare administrative con- (B) in paragraph (2), by striking ‘‘carrier’’ subparagraph (A); or tractor’’; and inserting ‘‘medicare administrative con- ‘‘(ii) to permit the payment of costs not (iv) by striking subparagraphs (C), (D), and tractor’’. otherwise allowable, reasonable, or allocable (E); (9) Subsection (p)(3)(A) is amended by under the Federal Acquisition Regulations.’’. (v) in subparagraph (H)— striking ‘‘carrier’’ and inserting ‘‘medicare (2) CONSIDERATION OF INCORPORATION OF (I) by striking ‘‘if it makes determinations administrative contractor’’. CURRENT LAW STANDARDS.—In developing or payments with respect to physicians’ (10) Subsection (q)(1)(A) is amended by contract performance requirements under services,’’; and striking ‘‘carrier’’. section 1874A(b) of the Social Security Act (II) by striking ‘‘carrier’’ and inserting (as added by paragraph (1)) the Secretary ‘‘medicare administrative contractor’’; (d) EFFECTIVE DATE; TRANSITION RULE.— shall consider inclusion of the performance (vi) by striking subparagraph (I); (1) EFFECTIVE DATE.— standards described in sections 1816(f)(2) of (vii) in subparagraph (L), by striking the (A) IN GENERAL.—Except as otherwise pro- such Act (relating to timely processing of re- semicolon and inserting a period; vided in this subsection, the amendments considerations and applications for exemp- (viii) in the first sentence, after subpara- made by this section shall take effect on Oc- tions) and section 1842(b)(2)(B) of such Act graph (L), by striking ‘‘and shall contain’’ tober 1, 2005, and the Secretary is authorized (relating to timely review of determinations and all that follows through the period; and to take such steps before such date as may and fair hearing requests), as such sections (ix) in the seventh sentence, by inserting be necessary to implement such amendments were in effect before the date of the enact- ‘‘medicare administrative contractor,’’ after on a timely basis. ment of this Act. ‘‘carrier,’’; (B) CONSTRUCTION FOR CURRENT CON- (b) CONFORMING AMENDMENTS TO SECTION (D) by striking paragraph (5); TRACTS.—Such amendments shall not apply 1816 (RELATING TO FISCAL INTERMEDIARIES).— (E) in paragraph (6)(D)(iv), by striking to contracts in effect before the date speci- Section 1816 (42 U.S.C. 1395h) is amended as ‘‘carrier’’ and inserting ‘‘medicare adminis- fied under subparagraph (A) that continue to follows: trative contractor’’; and retain the terms and conditions in effect on (1) The heading is amended to read as fol- (F) in paragraph (7), by striking ‘‘the car- such date (except as otherwise provided lows: rier’’ and inserting ‘‘the Secretary’’ each under this title, other than under this sec- ‘‘PROVISIONS RELATING TO THE place it appears. tion) until such date as the contract is let ADMINISTRATION OF PART A’’. (4) Subsection (c) is amended— out for competitive bidding under such (2) Subsection (a) is amended to read as (A) by striking paragraph (1); amendments. follows: (B) in paragraph (2), by striking ‘‘contract (C) DEADLINE FOR COMPETITIVE BIDDING.— ‘‘(a) The administration of this part shall under this section which provides for the dis- The Secretary shall provide for the letting be conducted through contracts with medi- bursement of funds, as described in sub- by competitive bidding of all contracts for

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functions of medicare administrative con- Subtitle D—Education and Outreach (A) IN GENERAL.—Section 1889, as added by tractors for annual contract periods that Improvements subsection (a), is amended by adding at the begin on or after October 1, 2011. SEC. 531. PROVIDER EDUCATION AND TECH- end the following new subsection: (2) GENERAL TRANSITION RULES.— NICAL ASSISTANCE. ‘‘(b) TAILORING EDUCATION AND TRAINING (A) AUTHORITY TO CONTINUE TO ENTER INTO (a) COORDINATION OF EDUCATION FUNDING.— ACTIVITIES FOR SMALL PROVIDERS OR SUP- NEW AGREEMENTS AND CONTRACTS AND WAIVER (1) IN GENERAL.—Title XVIII is amended by PLIERS.— OF PROVIDER NOMINATION PROVISIONS DURING inserting after section 1888 the following new ‘‘(1) IN GENERAL.—Insofar as a medicare TRANSITION.—Prior to the date specified in section: contractor conducts education and training paragraph (1)(A), the Secretary may, con- ‘‘PROVIDER EDUCATION AND TECHNICAL activities, it shall take into consideration sistent with subparagraph (B), continue to ASSISTANCE the special needs of small providers of serv- enter into agreements under section 1816 and ices or suppliers (as defined in paragraph (2)). ‘‘SEC. 1889. (a) COORDINATION OF EDUCATION contracts under section 1842 of the Social Se- Such education and training activities for FUNDING.—The Secretary shall coordinate curity Act (42 U.S.C. 1395h, 1395u). The Sec- small providers of services and suppliers may the educational activities provided through retary may enter into new agreements under include the provision of technical assistance medicare contractors (as defined in subsection 1816 during the time period without (such as review of billing systems and inter- section (e), including under section 1893) in regard to any of the provider nomination nal controls to determine program compli- order to maximize the effectiveness of Fed- provisions of such section. ance and to suggest more efficient and effec- eral education efforts for providers of serv- (B) APPROPRIATE TRANSITION.—The Sec- tive means of achieving such compliance). ices, physicians, practitioners, and sup- retary shall take such steps as are necessary ‘‘(2) SMALL PROVIDER OF SERVICES OR SUP- pliers.’’. to provide for an appropriate transition from PLIER.—In this subsection, the term ‘small (2) EFFECTIVE DATE.—The amendment agreements under section 1816 and contracts provider of services or supplier’ means— made by paragraph (1) shall take effect on under section 1842 of the Social Security Act ‘‘(A) an institutional provider of services the date of the enactment of this Act. (42 U.S.C. 1395h, 1395u) to contracts under with fewer than 25 full-time-equivalent em- (b) INCENTIVES TO IMPROVE CONTRACTOR section 1874A, as added by subsection (a)(1). ployees; or PERFORMANCE.—Section 1874A, as added by (3) AUTHORIZING CONTINUATION OF MIP AC- section 521(a)(1), is amended by adding at the ‘‘(B) a physician, practitioner, or supplier TIVITIES UNDER CURRENT CONTRACTS AND end the following new subsection: with fewer than 10 full-time-equivalent em- AGREEMENTS AND UNDER TRANSITION CON- ‘‘(e) INCENTIVES TO IMPROVE CONTRACTOR ployees.’’. TRACTS.—The provisions contained in the ex- PERFORMANCE IN PROVIDER EDUCATION AND (B) EFFECTIVE DATE.—The amendment ception in section 1893(d)(2) of the Social Se- OUTREACH.— made by subparagraph (A) shall take effect curity Act (42 U.S.C. 1395ddd(d)(2)) shall con- ‘‘(1) METHODOLOGY TO MEASURE CONTRACTOR on January 1, 2004. tinue to apply notwithstanding the amend- ERROR RATES.—In order to give medicare con- (d) ADDITIONAL PROVIDER EDUCATION PROVI- ments made by this section, and any ref- tractors (as defined in paragraph (3)) an in- SIONS.— erence in such provisions to an agreement or centive to implement effective education and (1) IN GENERAL.—Section 1889, as added by contract shall be deemed to include agree- outreach programs for providers of services, subsection (a) and as amended by subsection ments and contracts entered into pursuant physicians, practitioners, and suppliers, the (c)(2), is amended by adding at the end the to paragraph (2)(A). Secretary shall develop and implement by following new subsections: ‘‘(c) ENCOURAGEMENT OF PARTICIPATION IN (e) REFERENCES.—On and after the effective October 1, 2004, a methodology to measure EDUCATION PROGRAM ACTIVITIES.—A medi- date provided under subsection (d)(1), any the specific claims payment error rates of such contractors in the processing or review- care contractor may not use a record of at- reference to a fiscal intermediary or carrier tendance at (or failure to attend) edu- under title XI or XVIII of the Social Secu- ing of medicare claims. ‘‘(2) IG REVIEW OF METHODOLOGY.—The In- cational activities or other information rity Act (or any regulation, manual instruc- gathered during an educational program con- tion, interpretative rule, statement of pol- spector General of the Department of Health and Human Services shall review, and make ducted under this section or otherwise by the icy, or guideline issued to carry out such ti- recommendations to the Secretary, regard- Secretary to select or track providers of tles) shall be deemed a reference to an appro- ing the adequacy of such methodology. services, physicians, practitioners, or sup- priate medicare administrative contractor ‘‘(3) MEDICARE CONTRACTOR DEFINED.—For pliers for the purpose of conducting any type (as provided under section 1874A of the So- purposes of this subsection, the term ‘medi- of audit or prepayment review. cial Security Act). care contractor’ includes a medicare admin- ‘‘(d) CONSTRUCTION.—Nothing in this section or section 1893(g) shall be construed as (f) SECRETARIAL SUBMISSION OF LEGISLA- istrative contractor, a fiscal intermediary providing for disclosure by a medicare con- TIVE PROPOSAL.—Not later than 6 months with a contract under section 1816, and a car- tractor— after the date of the enactment of this Act, rier with a contract under section 1842.’’. (c) IMPROVED PROVIDER EDUCATION AND ‘‘(1) of the screens used for identifying the Secretary shall submit to the appro- claims that will be subject to medical re- priate committees of Congress a legislative TRAINING.— (1) INCREASED FUNDING FOR ENHANCED EDU- view; or proposal providing for such technical and CATION AND TRAINING THROUGH MEDICARE IN- ‘‘(2) of information that would compromise conforming amendments in the law as are re- TEGRITY PROGRAM.—Section 1817(k)(4) (42 pending law enforcement activities or reveal quired by the provisions of this section. U.S.C. 1395i(k)(4)) is amended— findings of law enforcement-related audits. (g) REPORTS ON IMPLEMENTATION.— (A) in subparagraph (A), by striking ‘‘sub- ‘‘(e) DEFINITIONS.—For purposes of this sec- (1) PROPOSAL FOR IMPLEMENTATION.—At paragraph (B)’’ and inserting ‘‘subparagraphs tion and section 1817(k)(4)(C), the term least 1 year before the date specified in sub- (B) and (C)’’; ‘medicare contractor’ includes the following: section (d)(1)(A), the Secretary shall submit (B) in subparagraph (B), by striking ‘‘The ‘‘(1) A medicare administrative contractor a report to Congress and the Comptroller amount appropriated’’ and inserting ‘‘Sub- with a contract under section 1874A, a fiscal General of the United States that describes a ject to subparagraph (C), the amount appro- intermediary with a contract under section plan for an appropriate transition. The priated’’; and 1816, and a carrier with a contract under sec- Comptroller General shall conduct an eval- (C) by adding at the end the following new tion 1842. uation of such plan and shall submit to Con- subparagraph: ‘‘(2) An eligible entity with a contract gress, not later than 6 months after the date ‘‘(C) ENHANCED PROVIDER EDUCATION AND under section 1893. the report is received, a report on such eval- TRAINING.— Such term does not include, with respect to uation and shall include in such report such ‘‘(i) IN GENERAL.—In addition to the activities of a specific provider of services, recommendations as the Comptroller Gen- amount appropriated under subparagraph physician, practitioner, or supplier an entity eral deems appropriate. (B), the amount appropriated under subpara- that has no authority under this title or title (2) STATUS OF IMPLEMENTATION.—The Sec- graph (A) for a fiscal year (beginning with XI with respect to such activities and such retary shall submit a report to Congress not fiscal year 2004) is increased by $35,000,000. provider of services, physician, practitioner, later than October 1, 2008, that describes the ‘‘(ii) USE.—The funds made available under or supplier.’’. status of implementation of such amend- this subparagraph shall be used only to in- (2) EFFECTIVE DATE.—The amendment ments and that includes a description of the crease the conduct by medicare contractors made by paragraph (1) shall take effect on following: of education and training of providers of the date of the enactment of this Act. (A) The number of contracts that have services, physicians, practitioners, and sup- SEC. 532. ACCESS TO AND PROMPT RESPONSES been competitively bid as of such date. pliers regarding billing, coding, and other FROM MEDICARE CONTRACTORS. (B) The distribution of functions among appropriate items and may also be used to (a) IN GENERAL.—Section 1874A, as added contracts and contractors. improve the accuracy, consistency, and by section 521(a)(1) and as amended by sec- (C) A timeline for complete transition to timeliness of contractor responses to written tion 531(b)(1), is amended by adding at the full competition. and phone inquiries from providers of serv- end the following new subsection: (D) A detailed description of how the Sec- ices, physicians, practitioners, and sup- ‘‘(f) COMMUNICATING WITH BENEFICIARIES retary has modified oversight and manage- pliers.’’. AND PROVIDERS.— ment of medicare contractors to adapt to (2) TAILORING EDUCATION AND TRAINING FOR ‘‘(1) COMMUNICATION PROCESS.—The Sec- full competition. SMALL PROVIDERS OR SUPPLIERS.— retary shall develop a process for medicare

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00143 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8790 CONGRESSIONAL RECORD — SENATE June 26, 2003 contractors to communicate with bene- in the scope of the contractor’s contract au- ing not providing for audits) in cases of self- ficiaries and with providers of services, phy- thority, identified overpayments by providers of serv- sicians, practitioners, and suppliers under in response to a written inquiry with respect ices and suppliers; and this title. to the furnishing of items or services or the ‘‘(C) recommendations to improve commu- ‘‘(2) RESPONSE TO WRITTEN INQUIRIES.—Each submission of a claim for benefits for such nication between providers, contractors, and medicare contractor (as defined in paragraph items or services; the Centers for Medicare & Medicaid Serv- (5)) shall provide general written responses ‘‘(B) the Secretary determines that— ices. (which may be through electronic trans- ‘‘(i) the provider of services, physician, ‘‘(c) STAFF.—The Secretary shall provide mission) in a clear, concise, and accurate practitioner, or supplier has accurately pre- appropriate staff to assist in performing the manner to inquiries by beneficiaries, pro- sented the circumstances relating to such duties described in subsection (b).’’. viders of services, physicians, practitioners, items, services, and claim to the Secretary (b) MEDICARE BENEFICIARY OMBUDSMAN.— and suppliers concerning the programs under or the contractor in the written guidance; Title XVIII is amended by inserting after this title within a contractual timeframe es- and section 1806 the following new section: tablished by the Secretary. ‘‘(ii) there is no indication of fraud or ‘‘MEDICARE BENEFICIARY OMBUDSMAN abuse committed by the provider of services, ‘‘(3) RESPONSE TO TOLL-FREE LINES.—The ‘‘SEC. 1807. (a) IN GENERAL.—By not later physician, practitioner, or supplier against Secretary shall ensure that medicare con- than 1 year after the date of the enactment the program under this title; and tractors provide a toll-free telephone number of the Medicare Education, Regulatory Re- at which beneficiaries, providers, physicians, ‘‘(C) the guidance was in error; the provider of services, physician, practi- form, and Contracting Improvement Act of practitioners, and suppliers may obtain in- 2003, the Secretary shall appoint within the formation regarding billing, coding, claims, tioner, or supplier shall not be subject to any penalty or interest under this title (or the Department of Health and Human Services a coverage, and other appropriate information Medicare Beneficiary Ombudsman (including under this title. provisions of title XI insofar as they relate to this title) relating to the provision of such support staff) who shall have expertise and ‘‘(4) MONITORING OF CONTRACTOR RE- items or service or such claim if the provider experience in the fields of health care and SPONSES.— of services, physician, practitioner, or sup- advocacy. ‘‘(A) IN GENERAL.—Each medicare con- plier reasonably relied on such guidance. In ‘‘(b) DUTIES.—The Medicare Beneficiary tractor shall, consistent with standards de- applying this paragraph with respect to guid- Ombudsman shall— veloped by the Secretary under subparagraph ance in the form of general responses to fre- ‘‘(1) receive complaints, grievances, and re- (B)— quently asked questions, the Secretary requests for information submitted by a medi- ‘‘(i) maintain a system for identifying who tains authority to determine the extent to care beneficiary, with respect to any aspect provides the information referred to in para- which such general responses apply to the of the medicare program; graphs (2) and (3); and particular circumstances of individual ‘‘(2) provide assistance with respect to ‘‘(ii) monitor the accuracy, consistency, claims.’’. complaints, grievances, and requests referred and timeliness of the information so pro- (b) EFFECTIVE DATE.—The amendment to in paragraph (1), including— vided. made by subsection (a) shall apply to pen- ‘‘(A) assistance in collecting relevant in- ‘‘(B) DEVELOPMENT OF STANDARDS.— alties imposed on or after the date of the en- formation for such beneficiaries, to seek an ‘‘(i) IN GENERAL.—The Secretary shall es- actment of this Act. appeal of a decision or determination made tablish (and publish in the Federal Register) SEC. 534. MEDICARE PROVIDER OMBUDSMAN; by a fiscal intermediary, carrier, standards regarding the accuracy, consist- MEDICARE BENEFICIARY OMBUDS- Medicare+Choice organization, or the Sec- ency, and timeliness of the information pro- MAN. retary; and vided in response to inquiries under this sub- (a) MEDICARE PROVIDER OMBUDSMAN.—Sec- ‘‘(B) assistance to such beneficiaries with section. Such standards shall be consistent tion 1868 (42 U.S.C. 1395ee) is amended— any problems arising from disenrollment with the performance requirements estab- (1) by adding at the end of the heading the from a Medicare+Choice plan under part C; lished under subsection (b)(3). following: ‘‘; MEDICARE PROVIDER OMBUDS- and ‘‘(ii) EVALUATION.—In conducting evalua- MAN’’; ‘‘(3) submit annual reports to Congress and tions of individual medicare contractors, the (2) by inserting ‘‘PRACTICING PHYSICIANS the Secretary that describe the activities of Secretary shall take into account the results ADVISORY COUNCIL.—(1)’’ after ‘‘(a)’’; the Office and that include such rec- (3) in paragraph (1), as so redesignated of the monitoring conducted under subpara- ommendations for improvement in the ad- under paragraph (2), by striking ‘‘in this sec- graph (A) taking into account as perform- ministration of this title as the Ombudsman tion’’ and inserting ‘‘in this subsection’’; ance requirements the standards established determines appropriate.’’. (4) by redesignating subsections (b) and (c) under clause (i). The Secretary shall, in con- (c) FUNDING.—There are authorized to be as paragraphs (2) and (3), respectively; and sultation with organizations representing appropriated to the Secretary (in appro- (5) by adding at the end the following new providers of services, suppliers, and individ- priate part from the Federal Hospital Insur- subsection: uals entitled to benefits under part A or en- ance Trust Fund and the Federal Supple- ‘‘(b) MEDICARE PROVIDER OMBUDSMAN.—By rolled under part B, or both, establish stand- mentary Medical Insurance Trust Fund) to ards relating to the accuracy, consistency, not later than 1 year after the date of the enactment of the Medicare Education, Regu- carry out the provisions of subsection (b) of and timeliness of the information so pro- section 1868 of the Social Security Act (relat- vided. latory Reform, and Contracting Improve- ment Act of 2003, the Secretary shall appoint ing to the Medicare Provider Ombudsman), ‘‘(C) DIRECT MONITORING.—Nothing in this a Medicare Provider Ombudsman who shall as added by subsection (a)(5) and section 1807 paragraph shall be construed as preventing have experience in health care. The Ombuds- of such Act (relating to the Medicare Bene- the Secretary from directly monitoring the man shall— ficiary Ombudsman), as added by subsection accuracy, consistency, and timeliness of the ‘‘(1) provide assistance, on a confidential (b), such sums as are necessary for fiscal information so provided. basis, to providers of services and suppliers year 2004 and each succeeding fiscal year. ‘‘(5) MEDICARE CONTRACTOR DEFINED.—For with respect to complaints, grievances, and (d) USE OF CENTRAL, TOLL-FREE NUMBER (1– purposes of this subsection, the term ‘medi- requests for information concerning the pro- 800–MEDICARE).—Section 1804(b) (42 U.S.C. care contractor’ has the meaning given such grams under this title (including provisions 1395b–2(b)) is amended by adding at the end term in subsection (e)(3).’’. of title XI insofar as they relate to this title the following: ‘‘By not later than 1 year after (b) EFFECTIVE DATE.—The amendment and are not administered by the Office of the the date of the enactment of the Medicare made by subsection (a) shall take effect Oc- Inspector General of the Department of Education, Regulatory Reform, and Con- tober 1, 2004. Health and Human Services) and in the reso- tracting Improvement Act of 2003, the Sec- (c) AUTHORIZATION OF APPROPRIATIONS.— lution of unclear or conflicting guidance retary shall provide, through the toll-free There are authorized to be appropriated such given by the Secretary and medicare con- number 1–800–MEDICARE, for a means by sums as may be necessary to carry out sec- tractors to such providers of services and which individuals seeking information tion 1874A(f) of the Social Security Act, as suppliers regarding such programs and provi- about, or assistance with, such programs added by subsection (a). sions and requirements under this title and who phone such toll-free number are trans- SEC. 533. RELIANCE ON GUIDANCE. such provisions; and ferred (without charge) to appropriate enti- (a) IN GENERAL.—Section 1871(d), as added ‘‘(2) submit recommendations to the Sec- ties for the provision of such information or by section 501, is amended by adding at the retary for improvement in the administra- assistance. Such toll-free number shall be end the following new paragraph: tion of this title and such provisions, includ- the toll-free number listed for general infor- ‘‘(2) If— ing— mation and assistance in the annual notice ‘‘(A) a provider of services, physician, prac- ‘‘(A) recommendations to respond to recur- under subsection (a) instead of the listing of titioner, or other supplier follows written ring patterns of confusion in this title and numbers of individual contractors.’’. guidance provided— such provisions (including recommendations SEC. 535. BENEFICIARY OUTREACH DEMONSTRA- ‘‘(i) by the Secretary; or regarding suspending imposition of sanctions TION PROGRAM. ‘‘(ii) by a medicare contractor (as defined where there is widespread confusion in pro- (a) IN GENERAL.—The Secretary shall es- in section 1889(e) and whether in the form of gram administration); tablish a demonstration program (in this a written response to a written inquiry under ‘‘(B) recommendations to provide for an section referred to as the ‘‘demonstration section 1874A(f)(1) or otherwise) acting with- appropriate and consistent response (includ- program’’) under which medicare specialists

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employed by the Department of Health and ‘‘(5) RANDOM PREPAYMENT REVIEW DE- ‘‘(ii) there is an indication of fraud or Human Services provide advice and assist- FINED.—For purposes of this subsection, the abuse committed against the program. ance to medicare beneficiaries at the loca- term ‘random prepayment review’ means a ‘‘(D) IMMEDIATE COLLECTION IF VIOLATION OF tion of existing local offices of the Social Se- demand for the production of records or doc- REPAYMENT PLAN.—If a provider of services, curity Administration. umentation absent cause with respect to a physician, practitioner, or supplier fails to (b) LOCATIONS.— claim.’’. make a payment in accordance with a repay- (1) IN GENERAL.—The demonstration pro- (b) EFFECTIVE DATE.— ment plan under this paragraph, the Sec- gram shall be conducted in at least 6 offices (1) IN GENERAL.—Except as provided in this retary may immediately seek to offset or or areas. Subject to paragraph (2), in select- subsection, the amendment made by sub- otherwise recover the total balance out- ing such offices and areas, the Secretary section (a) shall take effect on the date of standing (including applicable interest) shall provide preference for offices with a the enactment of this Act. under the repayment plan. high volume of visits by medicare bene- (2) DEADLINE FOR PROMULGATION OF CERTAIN ‘‘(E) RELATION TO NO FAULT PROVISION.— ficiaries. REGULATIONS.—The Secretary shall first Nothing in this paragraph shall be construed (2) ASSISTANCE FOR RURAL BENEFICIARIES.— issue regulations under section 1874A(g) of as affecting the application of section 1870(c) The Secretary shall provide for the selection the Social Security Act, as added by sub- (relating to no adjustment in the cases of of at least 3 rural areas to participate in the section (a), by not later than 1 year after the certain overpayments). demonstration program. In conducting the date of the enactment of this Act. ‘‘(2) LIMITATION ON RECOUPMENT.— demonstration program in such rural areas, (3) APPLICATION OF STANDARD PROTOCOLS ‘‘(A) NO RECOUPMENT UNTIL RECONSIDER- the Secretary shall provide for medicare spe- FOR RANDOM PREPAYMENT REVIEW.—Section ATION EXERCISED.—In the case of a provider cialists to travel among local offices in a 1874A(g)(1) of the Social Security Act, as of services, physician, practitioner, or sup- rural area on a scheduled basis. added by subsection (a), shall apply to ran- plier that is determined to have received an (c) DURATION.—The demonstration pro- dom prepayment reviews conducted on or overpayment under this title and that seeks gram shall be conducted over a 3-year period. after such date (not later than 1 year after a reconsideration of such determination by a (d) EVALUATION AND REPORT.— the date of the enactment of this Act) as the qualified independent contractor under sec- (1) EVALUATION.—The Secretary shall pro- tion 1869(c), the Secretary may not take any vide for an evaluation of the demonstration Secretary shall specify. The Secretary shall develop and publish the standard protocol action (or authorize any other person, in- program. Such evaluation shall include an cluding any medicare contractor, as defined analysis of— under such section by not later than 1 year after the date of the enactment of this Act. in subparagraph (C)) to recoup the overpay- (A) utilization of, and beneficiary satisfac- ment until the date the decision on the re- tion with, the assistance provided under the SEC. 542. RECOVERY OF OVERPAYMENTS. consideration has been rendered. If the provi- program; and (a) IN GENERAL.—Section 1874A, as added sions of section 1869(b)(1) (providing for such (B) the cost-effectiveness of providing ben- by section 521(a)(1) and as amended by sec- a reconsideration by a qualified independent eficiary assistance through out-stationing tions 531(b)(1), 532(a), and 541(a), is amended contractor) are not in effect, in applying the medicare specialists at local social security by adding at the end the following new sub- previous sentence any reference to such a re- offices. section: consideration shall be treated as a reference (2) REPORT.—The Secretary shall submit to ‘‘(h) RECOVERY OF OVERPAYMENTS.— to a redetermination by the fiscal inter- Congress a report on such evaluation and ‘‘(1) USE OF REPAYMENT PLANS.— mediary or carrier involved. shall include in such report recommenda- ‘‘(A) IN GENERAL.—If the repayment, within ‘‘(B) PAYMENT OF INTEREST.— tions regarding the feasibility of perma- the period otherwise permitted by a provider ‘‘(i) RETURN OF RECOUPED AMOUNT WITH IN- nently out-stationing medicare specialists at of services, physician, practitioner, or other TEREST IN CASE OF REVERSAL.—Insofar as local social security offices. supplier, of an overpayment under this title such determination on appeal against the Subtitle E—Review, Recovery, and meets the standards developed under sub- provider of services, physician, practitioner, Enforcement Reform paragraph (B), subject to subparagraph (C), or supplier is later reversed, the Secretary SEC. 541. PREPAYMENT REVIEW. and the provider, physician, practitioner, or shall provide for repayment of the amount (a) IN GENERAL.—Section 1874A, as added supplier requests the Secretary to enter into recouped plus interest for the period in by section 521(a)(1) and as amended by sec- a repayment plan with respect to such over- which the amount was recouped. tions 531(b)(1) and 532(a), is amended by add- payment, the Secretary shall enter into a ‘‘(ii) INTEREST IN CASE OF AFFIRMATION.— ing at the end the following new subsection: plan with the provider, physician, practi- Insofar as the determination on such appeal ‘‘(g) CONDUCT OF PREPAYMENT REVIEW.— tioner, or supplier for the offset or repay- is against the provider of services, physician, ‘‘(1) STANDARDIZATION OF RANDOM PREPAY- ment (at the election of the provider, physi- practitioner, or supplier, interest on the MENT REVIEW.—A medicare administrative cian, practitioner, or supplier) of such over- overpayment shall accrue on and after the contractor shall conduct random prepay- payment over a period of at least 1 year, but date of the original notice of overpayment. ment review only in accordance with a not longer than 3 years. Interest shall accrue ‘‘(iii) RATE OF INTEREST.—The rate of inter- standard protocol for random prepayment on the balance through the period of repay- est under this subparagraph shall be the rate audits developed by the Secretary. ment. The repayment plan shall meet terms otherwise applicable under this title in the ‘‘(2) LIMITATIONS ON INITIATION OF NON- and conditions determined to be appropriate case of overpayments. RANDOM PREPAYMENT REVIEW.—A medicare by the Secretary. ‘‘(C) MEDICARE CONTRACTOR DEFINED.—For administrative contractor may not initiate ‘‘(B) DEVELOPMENT OF STANDARDS.—The purposes of this subsection, the term ‘medi- nonrandom prepayment review of a provider Secretary shall develop standards for the re- care contractor’ has the meaning given such of services, physician, practitioner, or sup- covery of overpayments. Such standards term in section 1889(e). plier based on the initial identification by shall— ‘‘(3) PAYMENT AUDITS.— that provider of services, physician, practi- ‘‘(i) include a requirement that the Sec- ‘‘(A) WRITTEN NOTICE FOR POST-PAYMENT tioner, or supplier of an improper billing retary take into account (and weigh in favor AUDITS.—Subject to subparagraph (C), if a practice unless there is a likelihood of sus- of the use of a repayment plan) the reliance medicare contractor decides to conduct a tained or high level of payment error (as de- (as described in section 1871(d)(2)) by a pro- post-payment audit of a provider of services, fined by the Secretary). vider of services, physician, practitioner, and physician, practitioner, or supplier under ‘‘(3) TERMINATION OF NONRANDOM PREPAY- supplier on guidance when determining this title, the contractor shall provide the MENT REVIEW.—The Secretary shall establish whether a repayment plan should be offered; provider of services, physician, practitioner, protocols or standards relating to the termi- and or supplier with written notice (which may nation, including termination dates, of non- ‘‘(ii) provide for consideration of the finan- be in electronic form) of the intent to con- random prepayment review. Such regula- cial hardship imposed on a provider of serv- duct such an audit. tions may vary such a termination date ices, physician, practitioner, or supplier in ‘‘(B) EXPLANATION OF FINDINGS FOR ALL AU- based upon the differences in the cir- considering such a repayment plan. DITS.—Subject to subparagraph (C), if a cumstances triggering prepayment review. In developing standards with regard to finan- medicare contractor audits a provider of ‘‘(4) CONSTRUCTION.—Nothing in this sub- cial hardship with respect to a provider of services, physician, practitioner, or supplier section shall be construed as preventing the services, physician, practitioner, or supplier, under this title, the contractor shall— denial of payments for claims actually re- the Secretary shall take into account the ‘‘(i) give the provider of services, physi- viewed under a random prepayment review. amount of the proposed recovery as a propor- cian, practitioner, or supplier a full review In the case of a provider of services, physi- tion of payments made to that provider, phy- and explanation of the findings of the audit cian, practitioner, or supplier with respect to sician, practitioner, or supplier. in a manner that is understandable to the which amounts were previously overpaid, ‘‘(C) EXCEPTIONS.—Subparagraph (A) shall provider of services, physician, practitioner, nothing in this subsection shall be construed not apply if— or supplier and permits the development of as limiting the ability of a medicare admin- ‘‘(i) the Secretary has reason to suspect an appropriate corrective action plan; istrative contractor to request the periodic that the provider of services, physician, ‘‘(ii) inform the provider of services, physi- production of records or supporting docu- practitioner, or supplier may file for bank- cian, practitioner, or supplier of the appeal mentation for a limited sample of submitted ruptcy or otherwise cease to do business or rights under this title as well as consent set- claims to ensure that the previous practice discontinue participation in the program tlement options (which are at the discretion is not continuing. under this title; or of the Secretary); and

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‘‘(iii) give the provider of services, physi- (1) Not later than 1 year after the date of (b) EFFECTIVE DATE.—Section 1893(f) of the cian, practitioner, or supplier an opportunity the enactment of this Act, the Secretary Social Security Act, as added by subsection to provide additional information to the con- shall first— (a), shall apply to statistically valid random tractor. (A) develop standards for the recovery of samples initiated after the date that is 1 ‘‘(C) EXCEPTION.—Subparagraphs (A) and overpayments under section 1874A(h)(1)(B) of year after the date of the enactment of this (B) shall not apply if the provision of notice the Social Security Act, as added by sub- Act. or findings would compromise pending law section (a); Subtitle F—Other Improvements enforcement activities, whether civil or (B) establish the process for notice of over- SEC. 551. INCLUSION OF ADDITIONAL INFORMA- criminal, or reveal findings of law enforce- utilization of billing codes under section TION IN NOTICES TO BENEFICIARIES ment-related audits. 1874A(h)(4) of the Social Security Act, as ABOUT SKILLED NURSING FACILITY ‘‘(4) NOTICE OF OVER-UTILIZATION OF added by subsection (a); and AND HOSPITAL BENEFITS. CODES.—The Secretary shall establish, in (C) establish a standard methodology for (a) IN GENERAL.—The Secretary shall pro- consultation with organizations representing selection of sample claims for abnormal bill- vide that in medicare beneficiary notices the classes of providers of services, physi- ing patterns under section 1874A(h)(5) of the provided (under section 1806(a) of the Social cians, practitioners, and suppliers, a process Social Security Act, as added by subsection Security Act, 42 U.S.C. 1395b–7(a)) with re- under which the Secretary provides for no- (a). spect to the provision of post-hospital ex- tice to classes of providers of services, physi- (2) Section 1874A(h)(2) of the Social Secu- tended care services and inpatient hospital cians, practitioners, and suppliers served by rity Act, as added by subsection (a), shall services under part A of title XVIII of the a medicare contractor in cases in which the apply to actions taken after the date that is Social Security Act, there shall be included contractor has identified that particular 1 year after the date of the enactment of this information on the number of days of cov- billing codes may be over utilized by that Act. erage of such services remaining under such class of providers of services, physicians, (3) Section 1874A(h)(3) of the Social Secu- part for the medicare beneficiary and spell of practitioners, or suppliers under the pro- rity Act, as added by subsection (a), shall illness involved. grams under this title (or provisions of title apply to audits initiated after the date of the (b) EFFECTIVE DATE.—Subsection (a) shall XI insofar as they relate to such programs). enactment of this Act. apply to notices provided during calendar ‘‘(5) STANDARD METHODOLOGY FOR PROBE (4) Section 1874A(h)(6) of the Social Secu- quarters beginning more than 6 months after SAMPLING.—The Secretary shall establish a rity Act, as added by subsection (a), shall the date of the enactment of this Act. standard methodology for medicare adminis- apply to consent settlements entered into SEC. 552. INFORMATION ON MEDICARE-CER- trative contractors to use in selecting a sam- after the date of the enactment of this Act. TIFIED SKILLED NURSING FACILI- ple of claims for review in the case of an ab- SEC. 543. PROCESS FOR CORRECTION OF MINOR TIES IN HOSPITAL DISCHARGE normal billing pattern. ERRORS AND OMISSIONS ON CLAIMS PLANS. (a) AVAILABILITY OF DATA.—The Secretary ‘‘(6) CONSENT SETTLEMENT REFORMS.— WITHOUT PURSUING APPEALS shall publicly provide information that en- ‘‘(A) IN GENERAL.—The Secretary may use PROCESS. a consent settlement (as defined in subpara- (a) IN GENERAL.—The Secretary shall de- ables hospital discharge planners, medicare graph (D)) to settle a projected overpayment. velop, in consultation with appropriate beneficiaries, and the public to identify skilled nursing facilities that are partici- ‘‘(B) OPPORTUNITY TO SUBMIT ADDITIONAL medicare contractors (as defined in section pating in the medicare program. INFORMATION BEFORE CONSENT SETTLEMENT 1889(e) of the Social Security Act, as added by section 531(d)(1)) and representatives of (b) INCLUSION OF INFORMATION IN CERTAIN OFFER.—Before offering a provider of serv- HOSPITAL DISCHARGE PLANS.— ices, physician, practitioner, or supplier a providers of services, physicians, practi- (1) IN GENERAL.—Section 1861(ee)(2)(D) (42 consent settlement, the Secretary shall— tioners, facilities, and suppliers, a process U.S.C. 1395x(ee)(2)(D)) is amended— ‘‘(i) communicate to the provider of serv- whereby, in the case of minor errors or omis- (A) by striking ‘‘hospice services’’ and in- ices, physician, practitioner, or supplier in a sions (as defined by the Secretary) that are serting ‘‘hospice care and post-hospital ex- nonthreatening manner that, based on a re- detected in the submission of claims under the programs under title XVIII of such Act, tended care services’’; and view of the medical records requested by the a provider of services, physician, practi- (B) by inserting before the period at the Secretary, a preliminary evaluation of those tioner, facility, or supplier is given an oppor- end the following: ‘‘and, in the case of indi- records indicates that there would be an tunity to correct such an error or omission viduals who are likely to need post-hospital overpayment; and without the need to initiate an appeal. Such extended care services, the availability of ‘‘(ii) provide for a 45-day period during process shall include the ability to resubmit such services through facilities that partici- which the provider of services, physician, corrected claims. pate in the program under this title and that practitioner, or supplier may furnish addi- (b) DEADLINE.—Not later than 1 year after serve the area in which the patient resides’’. tional information concerning the medical the date of the enactment of this Act, the (2) EFFECTIVE DATE.—The amendments records for the claims that had been re- Secretary shall first develop the process made by paragraph (1) shall apply to dis- viewed. under subsection (a). charge plans made on or after such date as ‘‘(C) CONSENT SETTLEMENT OFFER.—The SEC. 544. AUTHORITY TO WAIVE A PROGRAM EX- the Secretary shall specify, but not later Secretary shall review any additional infor- CLUSION. than 6 months after the date the Secretary mation furnished by the provider of services, The first sentence of section 1128(c)(3)(B) provides for availability of information physician, practitioner, or supplier under (42 U.S.C. 1320a–7(c)(3)(B)) is amended to read under subsection (a). subparagraph (B)(ii). Taking into consider- as follows: ‘‘Subject to subparagraph (G), in ation such information, the Secretary shall SEC. 553. EVALUATION AND MANAGEMENT DOCU- the case of an exclusion under subsection (a), MENTATION GUIDELINES CONSIDER- determine if there still appears to be an the minimum period of exclusion shall be ATION. overpayment. If so, the Secretary— not less than 5 years, except that, upon the The Secretary shall ensure, before making ‘‘(i) shall provide notice of such determina- request of an administrator of a Federal changes in documentation guidelines for, or tion to the provider of services, physician, health care program (as defined in section clinical examples of, or codes to report eval- practitioner, or supplier, including an expla- 1128B(f)) who determines that the exclusion uation and management physician services nation of the reason for such determination; would impose a hardship on beneficiaries of under title XVIII of Social Security Act, and that program, the Secretary may waive the that the process used in developing such ‘‘(ii) in order to resolve the overpayment, exclusion under subsection (a)(1), (a)(3), or guidelines, examples, or codes was widely may offer the provider of services, physician, (a)(4) with respect to that program in the consultative among physicians, reflects a practitioner, or supplier— case of an individual or entity that is the broad consensus among specialties, and ‘‘(I) the opportunity for a statistically sole community physician or sole source of would allow verification of reported and fur- valid random sample; or essential specialized services in a commu- nished services. ‘‘(II) a consent settlement. nity. SEC. 554. IMPROVEMENT IN OVERSIGHT OF The opportunity provided under clause (ii)(I) SEC. 545. RECOVERY OF OVERPAYMENTS. TECHNOLOGY AND COVERAGE. does not waive any appeal rights with re- (a) IN GENERAL.—Section 1893 (42 U.S.C. (a) COUNCIL FOR TECHNOLOGY AND INNOVA- spect to the alleged overpayment involved. 1395ddd) is amended by adding at the end the TION.—Section 1868 (42 U.S.C. 1395ee), as ‘‘(D) CONSENT SETTLEMENT DEFINED.—For following new subsection: amended by section 301(a), is amended by purposes of this paragraph, the term ‘con- ‘‘(f) LIMITATION ON USE OF EXTRAPO- adding at the end the following new sub- sent settlement’ means an agreement be- LATION.—A medicare contractor may not use section: tween the Secretary and a provider of serv- extrapolation to determine overpayment ‘‘(c) COUNCIL FOR TECHNOLOGY AND INNOVA- ices, physician, practitioner, or supplier amounts to be recovered by recoupment, off- TION.— whereby both parties agree to settle a pro- set, or otherwise unless— ‘‘(1) ESTABLISHMENT.—The Secretary shall jected overpayment based on less than a sta- ‘‘(1) there is a sustained or high level of establish a Council for Technology and Inno- tistically valid sample of claims and the pro- payment error (as defined by the Secretary vation within the Centers for Medicare & vider of services, physician, practitioner, or by regulation); or Medicaid Services (in this section referred to supplier agrees not to appeal the claims in- ‘‘(2) documented educational intervention as ‘CMS’). volved.’’. has failed to correct the payment error (as ‘‘(2) COMPOSITION.—The Council shall be (b) EFFECTIVE DATES AND DEADLINES.— determined by the Secretary).’’. composed of senior CMS staff and clinicians

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00146 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8793 and shall be chaired by the Executive Coordi- ‘‘(i) set forth the criteria for making deter- with which the item or service was provided nator for Technology and Innovation (ap- minations under subparagraph (A); and to the patient before or after the time of the pointed or designated under paragraph (4)). ‘‘(ii) make available to the public the data admission or visit.’’. ‘‘(3) DUTIES.—The Council shall coordinate (other than proprietary data) considered in (2) EFFECTIVE DATE.—The amendment the activities of coverage, coding, and pay- making such determinations. made by paragraph (1) shall apply to items ment processes under this title with respect ‘‘(D) The Secretary may convene such fur- and services furnished on or after January 1, to new technologies and procedures, includ- ther public meetings to receive public com- 2004. ing new drug therapies, and shall coordinate ments on payment amounts for new tests (b) NOTIFICATION OF PROVIDERS WHEN the exchange of information on new tech- under this subsection as the Secretary deems EMTALA INVESTIGATION CLOSED.—Section nologies between CMS and other entities appropriate. 1867(d) (42 U.S.C. 42 U.S.C. 1395dd(d)) is that make similar decisions. ‘‘(E) For purposes of this paragraph: amended by adding at the end the following ‘‘(4) EXECUTIVE COORDINATOR FOR TECH- ‘‘(i) The term ‘HCPCS’ refers to the Health new paragraph: NOLOGY AND INNOVATION.—The Secretary Care Procedure Coding System. ‘‘(4) NOTICE UPON CLOSING AN INVESTIGA- shall appoint (or designate) a noncareer ap- ‘‘(ii) A code shall be considered to be ‘sub- TION.—The Secretary shall establish a proce- pointee (as defined in section 3132(a)(7) of stantially revised’ if there is a substantive dure to notify hospitals and physicians when title 5, United States Code) who shall serve change to the definition of the test or proce- an investigation under this section is as the Executive Coordinator for Technology dure to which the code applies (such as a new closed.’’. and Innovation. Such executive coordinator analyte or a new methodology for measuring (c) PRIOR REVIEW BY PEER REVIEW ORGANI- shall report to the Administrator of CMS, an existing analyte-specific test).’’. ZATIONS IN EMTALA CASES INVOLVING TERMI- (c) GAO STUDY ON IMPROVEMENTS IN EXTER- shall chair the Council, shall oversee the NATION OF PARTICIPATION.— NAL DATA COLLECTION FOR USE IN THE MEDI- execution of its duties, and shall serve as a (1) IN GENERAL.—Section 1867(d)(3) (42 single point of contact for outside groups CARE INPATIENT PAYMENT SYSTEM.— U.S.C. 1395dd(d)(3)) is amended— and entities regarding the coverage, coding, (1) STUDY.—The Comptroller General of the (A) in the first sentence, by inserting ‘‘or and payment processes under this title.’’. United States shall conduct a study that in terminating a hospital’s participation (b) METHODS FOR DETERMINING PAYMENT analyzes which external data can be col- under this title’’ after ‘‘in imposing sanc- BASIS FOR NEW LAB TESTS.—Section 1833(h) lected in a shorter time frame by the Centers tions under paragraph (1)’’; and (42 U.S.C. 1395l(h)) is amended by adding at for Medicare & Medicaid Services for use in (B) by adding at the end the following new the end the following: computing payments for inpatient hospital sentences: ‘‘Except in the case in which a ‘‘(8)(A) The Secretary shall establish by services. The study may include an evalua- delay would jeopardize the health or safety regulation procedures for determining the tion of the feasibility and appropriateness of of individuals, the Secretary shall also re- basis for, and amount of, payment under this using of quarterly samples or special surveys quest such a review before making a compli- subsection for any clinical diagnostic labora- or any other methods. The study shall in- ance determination as part of the process of tory test with respect to which a new or sub- clude an analysis of whether other executive terminating a hospital’s participation under stantially revised HCPCS code is assigned on agencies, such as the Bureau of Labor Statis- this title for violations related to the appro- or after January 1, 2005 (in this paragraph re- tics in the Department of Commerce, are ferred to as ‘new tests’). priateness of a medical screening examina- best suited to collect this information. tion, stabilizing treatment, or an appro- ‘‘(B) Determinations under subparagraph (2) REPORT.—By not later than October 1, (A) shall be made only after the Secretary— priate transfer as required by this section, 2004, the Comptroller General shall submit a and shall provide a period of 5 days for such ‘‘(i) makes available to the public (through report to Congress on the study under para- an Internet site and other appropriate mech- review. The Secretary shall provide a copy of graph (1). the organization’s report to the hospital or anisms) a list that includes any such test for SEC. 555. TREATMENT OF HOSPITALS FOR CER- which establishment of a payment amount physician consistent with confidentiality re- TAIN SERVICES UNDER MEDICARE quirements imposed on the organization under this subsection is being considered for SECONDARY PAYOR (MSP) PROVI- a year; SIONS. under such part B.’’. ‘‘(ii) on the same day such list is made (a) IN GENERAL.—The Secretary shall not (2) EFFECTIVE DATE.—The amendments available, causes to have published in the require a hospital (including a critical access made by paragraph (1) shall apply to termi- Federal Register notice of a meeting to re- hospital) to ask questions (or obtain infor- nations of participation initiated on or after ceive comments and recommendations (and mation) relating to the application of sec- the date of the enactment of this Act. data on which recommendations are based) tion 1862(b) of the Social Security Act (relat- SEC. 557. EMERGENCY MEDICAL TREATMENT from the public on the appropriate basis ing to medicare secondary payor provisions) AND ACTIVE LABOR ACT (EMTALA) under this subsection for establishing pay- in the case of reference laboratory services TECHNICAL ADVISORY GROUP. ment amounts for the tests on such list; described in subsection (b), if the Secretary (a) ESTABLISHMENT.—The Secretary shall ‘‘(iii) not less than 30 days after publica- does not impose such requirement in the establish a Technical Advisory Group (in tion of such notice convenes a meeting, that case of such services furnished by an inde- this section referred to as the ‘‘Advisory includes representatives of officials of the pendent laboratory. Group’’) to review issues related to the Centers for Medicare & Medicaid Services in- (b) REFERENCE LABORATORY SERVICES DE- Emergency Medical Treatment and Labor volved in determining payment amounts, to SCRIBED.—Reference laboratory services de- Act (EMTALA) and its implementation. In receive such comments and recommenda- scribed in this subsection are clinical labora- this section, the term ‘‘EMTALA’’ refers to tions (and data on which the recommenda- tory diagnostic tests (or the interpretation the provisions of section 1867 of the Social tions are based); of such tests, or both) furnished without a Security Act (42 U.S.C. 1395dd). ‘‘(iv) taking into account the comments face-to-face encounter between the indi- (b) MEMBERSHIP.—The Advisory Group and recommendations (and accompanying vidual entitled to benefits under part A or shall be composed of 19 members, including data) received at such meeting, develops and enrolled under part B, or both, and the hos- the Administrator of the Centers for Medi- makes available to the public (through an pital involved and in which the hospital sub- care & Medicaid Services and the Inspector Internet site and other appropriate mecha- mits a claim only for such test or interpreta- General of the Department of Health and nisms) a list of proposed determinations with tion. Human Services and of which— respect to the appropriate basis for estab- SEC. 556. EMTALA IMPROVEMENTS. (1) 4 shall be representatives of hospitals, lishing a payment amount under this sub- (a) PAYMENT FOR EMTALA-MANDATED including at least one public hospital, that section for each such code, together with an SCREENING AND STABILIZATION SERVICES.— have experience with the application of explanation of the reasons for each such de- (1) IN GENERAL.—Section 1862 (42 U.S.C. EMTALA and at least 2 of which have not termination, the data on which the deter- 1395y) is amended by inserting after sub- been cited for EMTALA violations; minations are based, and a request for public section (c) the following new subsection: (2) 7 shall be practicing physicians drawn written comments on the proposed deter- ‘‘(d) For purposes of subsection (a)(1)(A), in from the fields of emergency medicine, cardi- mination; and the case of any item or service that is re- ology or cardiothoracic surgery, orthopedic ‘‘(v) taking into account the comments required to be provided pursuant to section surgery, neurosurgery, pediatrics or a pedi- ceived during the public comment period, de- 1867 to an individual who is entitled to bene- atric subspecialty, obstetrics-gynecology, velops and makes available to the public fits under this title, determinations as to and psychiatry, with not more than one phy- (through an Internet site and other appro- whether the item or service is reasonable sician from any particular field; priate mechanisms) a list of final determina- and necessary shall be made on the basis of (3) 2 shall represent patients; tions of the payment amounts for such tests the information available to the treating (4) 2 shall be staff involved in EMTALA in- under this subsection, together with the ra- physician or practitioner (including the pa- vestigations from different regional offices tionale for each such determination, the tient’s presenting symptoms or complaint) of the Centers for Medicare & Medicaid Serv- data on which the determinations are based, at the time the item or service was ordered ices; and and responses to comments and suggestions or furnished by the physician or practitioner (5) 1 shall be from a State survey office in- received from the public. (and not on the patient’s principal diag- volved in EMTALA investigations and 1 shall ‘‘(C) Under the procedures established pur- nosis). When making such determinations be from a peer review organization, both of suant to subparagraph (A), the Secretary with respect to such an item or service, the whom shall be from areas other than the re- shall— Secretary shall not consider the frequency gions represented under paragraph (4).

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00147 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8794 CONGRESSIONAL RECORD — SENATE June 26, 2003 In selecting members described in para- (2) by striking the period at the end of (A) is transferred to section 1862 and added graphs (1) through (3), the Secretary shall paragraph (4) and inserting ‘‘; and’’; and at the end of such section; and consider qualified individuals nominated by (3) by inserting after paragraph (4) the fol- (B) is redesignated as subsection (j). organizations representing providers and pa- lowing new paragraph: (2) Section 1862 (42 U.S.C. 1395y) is amend- tients. ‘‘(5) for individuals who are terminally ill ed— (c) GENERAL RESPONSIBILITIES.—The Advi- and who have not made an election under (A) in the last sentence of subsection (a), sory Group— subsection (d)(1), services that are furnished by striking ‘‘established under section (1) shall review EMTALA regulations; by a physician who is either the medical di- 1114(f)’’; and (2) may provide advice and recommenda- rector or an employee of a hospice program (B) in subsection (j), as so transferred and tions to the Secretary with respect to those and that consist of— redesignated— regulations and their application to hos- ‘‘(A) an evaluation of the individual’s need (i) by striking ‘‘under subsection (f)’’; and pitals and physicians; for pain and symptom management, includ- (ii) by striking ‘‘section 1862(a)(1)’’ and in- (3) shall solicit comments and rec- ing the need for hospice care; serting ‘‘subsection (a)(1)’’. ommendations from hospitals, physicians, ‘‘(B) counseling the individual with respect (b) TERMINOLOGY CORRECTIONS.—(1) Section and the public regarding the implementation to end-of-life issues, the benefits of hospice 1869(c)(3)(I)(ii) (42 U.S.C. 1395ff(c)(3)(I)(ii)), as of such regulations; and care, and care options; and amended by section 521 of BIPA, is amend- (4) may disseminate information on the ap- ‘‘(C) if appropriate, advising the individual ed— plication of such regulations to hospitals, regarding advanced care planning.’’. (A) in subclause (III), by striking ‘‘policy’’ physicians, and the public. (b) PAYMENT.—Section 1814(i) (42 U.S.C. and inserting ‘‘determination’’; and (d) ADMINISTRATIVE MATTERS.— 1395f(i)) is amended by adding at the end the (B) in subclause (IV), by striking ‘‘medical (1) CHAIRPERSON.—The members of the Ad- following new paragraph: review policies’’ and inserting ‘‘coverage de- visory Group shall elect a member to serve ‘‘(4) The amount paid to a hospice program terminations’’. as chairperson of the Advisory Group for the with respect to the services under section (2) Section 1852(a)(2)(C) (42 U.S.C. 1395w– life of the Advisory Group. 1812(a)(5) for which payment may be made 22(a)(2)(C)) is amended by striking ‘‘policy’’ (2) MEETINGS.—The Advisory Group shall under part A shall be the amount determined and ‘‘POLICY’’ and inserting ‘‘determination’’ first meet at the direction of the Secretary. under a fee schedule established by the Sec- each place it appears and ‘‘DETERMINATION’’, The Advisory Group shall then meet twice retary.’’. respectively. per year and at such other times as the Advi- (c) CONFORMING AMENDMENT.—Section (c) REFERENCE CORRECTIONS.—Section sory Group may provide. 1861(dd)(2)(A)(i) (42 U.S.C. 1395x(dd)(2)(A)(i)) 1869(f)(4) (42 U.S.C. 1395ff(f)(4)), as added by (e) TERMINATION.—The Advisory Group is amended by inserting before the comma at section 522 of BIPA, is amended— shall terminate 30 months after the date of the end the following: ‘‘and services de- (1) in subparagraph (A)(iv), by striking its first meeting. scribed in section 1812(a)(5)’’. ‘‘subclause (I), (II), or (III)’’ and inserting (f) WAIVER OF ADMINISTRATIVE LIMITA- (d) EFFECTIVE DATE.—The amendments ‘‘clause (i), (ii), or (iii)’’; TION.—The Secretary shall establish the Ad- made by this section shall apply to services (2) in subparagraph (B), by striking ‘‘clause visory Group notwithstanding any limita- provided by a hospice program on or after (i)(IV)’’ and ‘‘clause (i)(III)’’ and inserting tion that may apply to the number of advi- January 1, 2004. ‘‘subparagraph (A)(iv)’’ and ‘‘subparagraph sory committees that may be established SEC. 560. APPLICATION OF OSHA BLOODBORNE (A)(iii)’’, respectively; and (within the Department of Health and PATHOGENS STANDARD TO CERTAIN (3) in subparagraph (C), by striking ‘‘clause Human Services or otherwise). HOSPITALS. (i)’’, ‘‘subclause (IV)’’ and ‘‘subparagraph (a) IN GENERAL.—Section 1866 (42 U.S.C. SEC. 558. AUTHORIZING USE OF ARRANGEMENTS (A)’’ and inserting ‘‘subparagraph (A)’’, 1395cc) is amended— TO PROVIDE CORE HOSPICE SERV- ‘‘clause (iv)’’ and ‘‘paragraph (1)(A)’’, respec- ICES IN CERTAIN CIRCUMSTANCES. (1) in subsection (a)(1)— tively each place it appears. (a) IN GENERAL.—Section 1861(dd)(5) (42 (A) in subparagraph (R), by striking ‘‘and’’ (d) OTHER CORRECTIONS.—Effective as if in- at the end; U.S.C. 1395x(dd)(5)) is amended by adding at cluded in the enactment of section 521(c) of (B) in subparagraph (S), by striking the pe- the end the following: BIPA, section 1154(e) (42 U.S.C. 1320c–3(e)) is ‘‘(D) In extraordinary, exigent, or other riod at the end and inserting ‘‘, and’’; and amended by striking paragraph (5). nonroutine circumstances, such as unantici- (C) by inserting after subparagraph (S) the (e) EFFECTIVE DATE.—Except as otherwise pated periods of high patient loads, staffing following new subparagraph: provided, the amendments made by this sec- shortages due to illness or other events, or ‘‘(T) in the case of hospitals that are not tion shall be effective as if included in the temporary travel of a patient outside a hos- otherwise subject to the Occupational Safety enactment of BIPA. pice program’s service area, a hospice pro- and Health Act of 1970 or a State occupa- gram may enter into arrangements with an- tional safety and health plan that is ap- SEC. 562. TREATMENT OF CERTAIN DENTAL CLAIMS. other hospice program for the provision by proved under section 18(b) of such Act, to that other program of services described in comply with the Bloodborne Pathogens (a) IN GENERAL.—Section 1862 (42 U.S.C. paragraph (2)(A)(ii)(I). The provisions of standard under section 1910.1030 of title 29 of 1395y) is amended by adding after subsection paragraph (2)(A)(ii)(II) shall apply with re- the Code of Federal Regulations (or as subse- (g) the following new subsection: spect to the services provided under such ar- quently redesignated).’’; and ‘‘(h)(1) Subject to paragraph (2), a group rangements. (2) by adding at the end of subsection (b) health plan (as defined in subsection ‘‘(E) A hospice program may provide serv- the following new paragraph: (a)(1)(A)(v)) providing supplemental or sec- ices described in paragraph (1)(A) other than ‘‘(4)(A) A hospital that fails to comply with ondary coverage to individuals also entitled directly by the program if the services are the requirement of subsection (a)(1)(T) (re- to services under this title shall not require highly specialized services provided by or lating to the Bloodborne Pathogens stand- a medicare claims determination under this under the supervision of a registered profes- ard) is subject to a civil money penalty in an title for dental benefits specifically excluded sional nurse and are provided nonroutinely amount described in subparagraph (B), but is under subsection (a)(12) as a condition of and so infrequently so that the provision of not subject to termination of an agreement making a claims determination for such ben- such services directly would be impracti- under this section. efits under the group health plan. cable and prohibitively expensive.’’. ‘‘(B) The amount referred to in subpara- ‘‘(2) A group health plan may require a (b) CONFORMING PAYMENT PROVISION.—Sec- graph (A) is an amount that is similar to the claims determination under this title in tion 1814(i) (42 U.S.C. 1395f(i)) is amended by amount of civil penalties that may be im- cases involving or appearing to involve inpa- adding at the end the following new para- posed under section 17 of the Occupational tient dental hospital services or dental serv- graph: Safety and Health Act of 1970 for a violation ices expressly covered under this title pursu- ‘‘(4) In the case of hospice care provided by of the Bloodborne Pathogens standard re- ant to actions taken by the Secretary.’’. a hospice program under arrangements under ferred to in subsection (a)(1)(T) by a hospital (b) EFFECTIVE DATE.—The amendment section 1861(dd)(5)(D) made by another hos- that is subject to the provisions of such Act. made by subsection (a) shall take effect on pice program, the hospice program that ‘‘(C) A civil money penalty under this the date that is 60 days after the date of the made the arrangements shall bill and be paid paragraph shall be imposed and collected in enactment of this Act. for the hospice care.’’. the same manner as civil money penalties SEC. 563. REVISIONS TO REASSIGNMENT PROVI- (c) EFFECTIVE DATE.—The amendments under subsection (a) of section 1128A are im- SIONS. made by this section shall apply to hospice posed and collected under that section.’’. (a) IN GENERAL.—Section 1842(b)(6)(A)(ii) care provided on or after the date of the en- (b) EFFECTIVE DATE.—The amendments (42 U.S.C. 1395u(b)(6)(A)(ii)) is amended to actment of this Act. made by this subsection (a) shall apply to read as follows: ‘‘(ii) where the service was SEC. 559. COVERAGE OF HOSPICE CONSULTA- hospitals as of July 1, 2004. provided under a contractual arrangement TION SERVICES. SEC. 561. BIPA-RELATED TECHNICAL AMEND- between such physician or other person and (a) COVERAGE OF HOSPICE CONSULTATION MENTS AND CORRECTIONS. a qualified entity (as defined by the Sec- SERVICES.—Section 1812(a) (42 U.S.C. (a) TECHNICAL AMENDMENTS RELATING TO retary) or other person, to the entity or 1395d(a)) is amended— ADVISORY COMMITTEE UNDER BIPA SECTION other person if under such arrangement such (1) by striking ‘‘and’’ at the end of para- 522.—(1) Subsection (i) of section 1114 (42 entity or individual submits the bill for such graph (3); U.S.C. 1314)— service and such arrangement (I) includes

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00148 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8795 joint and several liability for overpayment ments that would have been made in the recommendations for appropriate payments by such physician or other person and such year if this subsection had not been enacted. for such devices. entity or other person, and (II) meets such (b) PAYMENTS TO SKILLED NURSING FACILI- other program integrity and other safe- TIES AND HOME HEALTH AGENCIES.— SA 1128. Mr. SPECTER submitted an guards as the Secretary may determine to be (1) IN GENERAL.—Notwithstanding any amendment intended to be proposed by appropriate,’’. other provision of law, effective beginning him to the bill S. 1, to amend title (b) CONFORMING AMENDMENTS.— October 1, 2003, for purposes of making pay- XVIII of the Social Security Act to (1) The second sentence of section 1842(b)(6) ments to skilled nursing facilities (SNFs) (42 U.S.C. 1395u(b)(6)) is amended by striking and home health agencies (as defined in sec- provide for a voluntary prescription ‘‘except to an employer or facility as de- tions 1861(j) and 1861(o) of the Social Secu- drug benefit under the Medicare pro- scribed in clause (A)’’ and inserting ‘‘except rity Act (42 U.S.C. 1395x(j); 1395x(o)) under gram and to strengthen and improve to an employer, entity, or other person as the medicare program under title XVIII of the Medicare program, and for other described in subparagraph (A)’’. such Act, Iredell County, North Carolina, purposes; which was ordered to lie on (2) Section 1842(b)(6) (42 U.S.C. 1395u(b)(6)) and Rowan County, North Carolina, are the table; as follows: is amended by adding at the end the fol- deemed to be located in the Charlotte-Gas- On page 133, after line 25, insert the following new sentence: ‘‘Nothing in subpara- tonia-Rock Hill, North Carolina, South Caro- lowing: graph (A)(ii) shall be construed to prohibit lina Metropolitan Statistical Area. ‘‘(3) COORDINATION WITH EXISTING STATE requirements for joint and several liability (2) APPLICATION AND BUDGET NEUTRAL WITH- PHARMACEUTICAL ASSISTANCE PROGRAMS.— for contractual arrangements where such re- IN NORTH CAROLINA.—Effective for fiscal year ‘‘(A) IN GENERAL.—An eligible entity offer- quirements are not explicitly stated in a 2004, the skilled nursing facility PPS and ing a Medicare Prescription Drug plan, or a statute.’’. home health PPS rates for Iredell County, MedicareAdvantage organization offering a (c) EFFECTIVE DATE.—The amendments North Carolina, and Rowan County, North MedicareAdvantage plan (other than an MSA made by this section shall apply to payments Carolina, will be updated by the prefloor, plan or a private fee-for-service plan that made on or after 1 year after the date of the prereclassified hospital wage index available does not provide qualified prescription drug enactment of this Act. for the Charlotte-Gastonia-Rock Hill, North coverage), shall enter into an agreement SEC. 564. GAO STUDY AND REPORT REGARDING Carolina, South Carolina Metropolitan Sta- with each existing State pharmaceutical as- ILLINOIS COUNCIL DECISION. tistical Area. This subsection shall be imple- sistance program to coordinate the coverage (a) STUDY.—The Comptroller General of mented in a budget neutral manner, using a provided under the plan with the assistance the United States shall conduct a study on methodology that ensures that the total provided under the existing State pharma- the access of health care providers and bene- amount of expenditures for skilled nursing ceutical assistance program. ficiaries under the medicare program under facility services and home health services in ‘‘(B) ELECTION.—Under the process estab- title XVIII of the Social Security Act to ju- a year does not exceed the total amount of lished under section 1860D–3(a), an eligible dicial review of the actions of the Secretary expenditures that would have been made in beneficiary who resides in a State with an of Health and Human Services and the ef- the year if this subsection had not been en- existing State pharmaceutical assistance fects of the decision of the Supreme Court of acted. Required adjustments by reason of the program and who is eligible to enroll in such the United States in Shalala v. Illinois Coun- preceding sentence shall be done with re- program shall elect to enroll in a Medicare cil on Long Term Care, Inc., 529 U.S. 1 (1999) spect to skilled nursing facilities and home Prescription Drug plan or on such access. health agencies located in North Carolina. MedicareAdvantage plan through the exist- (c) CONSTRUCTION.—The provisions of this (a) REPORT.—Not later than the date that ing State pharmaceutical assistance pro- section shall have no effect on the amount of is 1 year after the date of enactment of this gram. Act, the Comptroller General of the United payments made under title XVIII of the So- ‘‘(C) EXISTING STATE PHARMACEUTICAL AS- States shall submit to Congress a report on cial Security Act to entities located in SISTANCE PROGRAM DEFINED.—In this para- States other than North Carolina. the study conducted under subsection (a) to- graph, the term ‘existing State pharma- gether with recommendations for such legis- SA 1127. Mr. CHAMBLISS submitted ceutical assistance program’ means a pro- lation or administrative action as the Comp- gram that has been established pursuant to a troller General determines to be appropriate. an amendment intended to be proposed waiver under section 1115 or otherwise before by him to the bill S. 1, to amend title January 1, 2004. SA 1126. Mrs. DOLE (for herself, and XVIII of the Social Security Act to Mr. EDWARDS) submitteed an amend- provide for a voluntary prescription SA 1129. Mr. DASCHLE (for Mr. ment intended to be proposed by her to drug benefit under the Medicare pro- KERRY) submitted an amendment in- the bill S. 1, to amend title XVIII of gram and to strengthen and improve tended to be proposed by Mr. DASCHLE the Social Security Act to provide for the Medicare program, and for other to the bill S. 1, to amend title XVIII of a voluntary prescription drug benefit purposes; which was ordered to lie on the Social Security Act to provide for under the Medicare program and to the table; as follows: a voluntary prescription drug benefit strengthen and improve the Medicare At the end of subtitle B of title IV, add the under the Medicare program and to program, and for other purposes; as fol- following: strengthen and improve the Medicare lows: SEC. ll. BRACHYTHERAPY DEVICES. program, and for other purposes; which At the end of subtitle A of title IV, add the (a) SPECIFICATION OF GROUPS FOR was ordered to lie on the table; as fol- following: BRACHYTHERAPY DEVICES.—Section 1833(t)(2) lows: (42 U.S.C. 1395l(t)(2)) is amended— SEC. ll. TREATMENT OF CERTAIN ENTITIES At the end of title VI, insert the following: FOR PURPOSES OF PAYMENTS (1) in subparagraph (F), by striking ‘‘and’’ UNDER THE MEDICARE PROGRAM. at the end; SEC. ll. SENSE OF THE SENATE REGARDING (a) PAYMENTS TO HOSPITALS.— (2) in subparagraph (G), by striking the pe- PARITY OF MENTAL HEALTH SERV- ICES UNDER MEDICARE. (1) IN GENERAL.—Notwithstanding any riod at the end and inserting ‘‘; and’’; and (a) FINDINGS.—The Senate finds the fol- other provision of law, effective for dis- (3) by adding at the end the following new lowing: charges occurring on or after October 1, 2003, subparagraph: (1) Beneficiaries of the Medicare program for purposes of making payments to hos- ‘‘(H) with respect to devices of under title XVIII of the Social Security Act pitals (as defined in section 1886(d) and brachytherapy furnished on or after January pay 50 percent coinsurance for outpatient 1833(t) of the Social Security Act (42 U.S.C. 1, 2004, and before January 1, 2007, the Sec- psychiatric services. 1395(d)) under the medicare program under retary shall create additional groups of cov- (2) In comparison, such beneficiaries pay 20 title XVIII of such Act (42 U.S.C. 1395 et ered OPD services that classify such devices percent coinsurance for all other medical seq.), Iredell County, North Carolina, and separately from the other services (or group services. Rowan County, North Carolina, are deemed of services) paid for under this subsection in (3) There is no scientific or medical jus- to be located in the Charlotte-Gastonia-Rock a manner reflecting the number of such de- tification for this discriminatory inequity. Hill, North Carolina, South Carolina Metro- vices furnished separately for palladium-103 (b) SENSE OF THE SENATE.—It is the sense politan Statistical Area. and iodine-125.’’. of the Senate that Congress should work to (2) BUDGET NEUTRAL WITHIN NORTH CARO- (b) GAO REPORT.—The Comptroller Gen- achieve parity under the Medicare program LINA.—The Secretary shall adjust the area eral of the United States shall conduct a wage index referred to in paragraph (1) with study to determine appropriate payment under title XVIII of the Social Security Act respect to payments to hospitals located in amounts under section 1833(t)(13)(B) of the between mental health services and other North Carolina in a manner which assures Social Security Act, as added by subsection medical services as soon as practicable. that the total payments made under section (a), for devices of brachytherapy. Not later 1886(d) of the Social Security Act (42 U.S.C., than January 1, 2005, the Comptroller Gen- SA 1130. Mr. ROBERTS submitted an 1395(ww)(d)) in a fiscal year for the operating eral shall submit to Congress and the Sec- amendment intended to be proposed by cost of inpatient hospital services are not retary a report on the study conducted under him to the bill to S. 1, to amend title greater or less than the total of such pay- this subsection, and shall include specific XVIII of the Social Security Act to

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00149 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8796 CONGRESSIONAL RECORD — SENATE June 26, 2003 provide for a voluntary prescription employment-based retiree health coverage ‘‘(A) NO PREMIUM.—Notwithstanding sub- drug benefit under the Medicare pro- using information available for the period— section (d) or sections 1860D–13(e)(2) and gram and to strengthen and improve (1) beginning on the date of enactment of 1860D–17, the amount of the MedicareAdvan- the Medicare program, and for other this Act and ending on January 1, 2005; and tage monthly beneficiary obligation for (2) beginning on January 1, 2006 and ending qualified prescription drug coverage shall be purposes; which was ordered to lie on on January 1, 2007. zero. the table, as follows: (c) REPORT.—Not later than July 1, 2007, ‘‘(B) BENEFICIARY RECEIVES ACCESS TO NE- At the appropriate place in title II, insert the Comptroller General shall submit to the GOTIATED PRICES AND STOP-LOSS PROTECTION the following: Secretary and the appropriate committees of FOR NO ADDITIONAL PREMIUM.—Notwith- Congress a report based on the study con- SEC. ll. STUDY ON TRENDS IN EMPLOYMENT- standing section 1860D–6, qualified prescrip- BASED RETIREE HEALTH COV- ducted under subsection (a). tion drug coverage shall include coverage of ERAGE. covered drugs that meets the following re- SA 1131. Mr. KYL submitted an (a) STUDY.—The Comptroller General of quirements: the United States, in consultation with em- amendment intended to be proposed by ‘‘(i) The coverage has cost-sharing (for ployers, health benefit experts, academia, him to the bill S. 1, to amend title costs up to the annual out-of-pocket limit human resource professionals, State and XVIII of the Social Security Act to under subsection (c)(4) of such section) that local government officials, and employer provide for a voluntary prescription is equal to 100 percent. consulting firms, shall conduct a study to drug benefit under the Medicare pro- ‘‘(ii) The coverage provides the limitation determine the effect of the amendments gram and to strengthen and improve on out-of-pocket expenditures under such made by this Act on the provision of employ- subsection (c)(4), except that in applying the Medicare program, and for other such subsection, ‘$ll’ shall be substituted ment-based retiree health coverage (as such purposes; which was ordered to lie on term is defined in section 1860D-20(e)(4)(B) of for ‘$3,700’ in subparagraph (B)(i)(I) of such the Social Security Act). Such study shall the table; as follows: subsection. examine the following: At the end of subtitle B of title IV, add the ‘‘(iii) The coverage provides access to nego- (1) Trends in employment-based retiree following: tiated prices under subsection (e) of such sec- health coverage, as such trends relate to re- SEC. ll. USE OF DATA COLLECTED BY ORGANI- tion during the entire year. tirees who are eligible for coverage under the ZATIONS AND ENTITIES IN DETER- ‘‘(C) APPLICATION OF LOW-INCOME SUB- medicare program under title XVIII of the MINING PRACTICE EXPENSE REL- SIDIES.—Notwithstanding subsection (f) or ATIVE VALUES. Social Security Act (42 U.S.C. 1395 et seq.). section 1860D–19, the Administrator shall not (a) IN GENERAL.—The Secretary shall re- apply the following provisions of subsection (2) The extent to which health care cov- vise the regulation promulgated under sec- erage, including coverage under (a) of such section: tion 212 of the Medicare, Medicaid, and ‘‘(i) Subparagraphs (A), (B), (C), and (D) of Medicare+Choice, MedicareAdvantage, and SCHIP Balanced Budget Refinement Act of fee-for-service prescription drug plans under paragraph (1). 1999 (113 Stat. 1501A–350) so that, in deter- ‘‘(ii) Subparagraphs (A), (B), (C), and (D) of the medicare program, are available to retir- mining the practice expense component ees who are eligible for coverage under the paragraph (2). under section 1848(c)(2)(C)(ii) of the Social ‘‘(iii) Clauses (i), (ii), (iii), and (iv) of para- medicare program. Security Act (42 U.S.C. 1395w–4(c)(2)(C)(ii)) (3) The extent to which geographic loca- graph (3)(A). for purposes of determining relative values ‘‘(2) PENALTY FOR ENROLLING IN A ZERO PRE- tion plays a role in the structure and avail- for payment for physicians’ services under ability of retiree health benefit coverage. MIUM STOP-LOSS PROTECTION PLANS AFTER INI- the fee schedule under section 1848 of such TIAL ELIGIBILITY FOR SUCH ENROLLMENT.—In (4) Whether incentives built into this Act Act (42 U.S.C. 1395w–4), the Secretary recog- (and the amendments made by this Act) are the case of an eligible beneficiary that en- nizes all costs of clinical staff employed by rolled in a plan offered pursuant to this sub- sufficient to induce employers to maintain cardio-thoracic surgeons (net of any reim- employment-based retiree health coverage, section at any time after the initial enroll- bursements for staff for whom there is direct ment period described in section 1860D–2, the and whether other voluntary incentives exist reimbursement under part B of such Act (42 to encourage employers to maintain such Secretary shall establish procedures for im- U.S.C. 1395j et seq.)), regardless of the site at posing a monthly beneficiary obligation for coverage. which such costs are incurred and notwith- (5) Whether obstacles exist to employers enrollment under such plan. The amount of standing any other provision of law or regu- such obligation shall be an amount that the providing employment-based retiree health lation. For purposes of revising such regula- coverage, including administrative burden, Administrator determines is actuarially tion, the Secretary shall use validated data sound for each full 12-month period (in the the cost of prescription drugs, and the in- collected by organizations and entities creasing overall health care costs. same continuous period of eligibility) in (other than the Department of Health and which the eligible beneficiary could have (6) Whether— Human Services) on all costs incurred by (A) employment-based retiree health cov- been enrolled under such a plan but was not physicians, including data from the Socio- so enrolled. The provisions of subsection (b) erage has changed because of the implemen- economic Monitoring System of the Amer- tation of the MedicareAdvantage and medi- of such section shall apply to the penalty ican Medical Association and from supple- under this paragraph in a manner that is care fee-for-service programs under the mental surveys accepted by the Department amendments made by this Act; similar to the manner such provisions apply of Health and Human Services as consistent to the penalty under part D. (B) such coverage continues to maintain with sound data practices prior to the date the employment-based retiree health benefit ‘‘(3) PROCEDURES.—The Administrator shall of enactment of this Act. establish procedures to carry out this sub- packages that were available prior to the im- (b) EFFECTIVE DATE.—The regulation re- section. Under such procedures, the Adminis- plementation of such programs; vised under subsection (a) shall apply with trator may waive or modify any of the pre- (C) employers conduct health fairs or pro- respect to payments for physicians’ services ceding provisions of this part or part D to vide other educational opportunities for furnished on and after January 1, 2004. their retirees to encourage retirees to obtain the extent necessary to carry out this sub- coverage under MedicareAdvantage or other SA 1132. Mr. SANTORUM proposed section. prescription drug plans that are available; an amendment to the bill S. 1, to ‘‘(4) NO EFFECT ON MEDICARE DRUG PLANS.— and This subsection shall have no effect on eligi- amend title XVIII of the Social Secu- ble beneficiaries enrolled under part D in a (D) employers offer retirees financial in- rity Act to provide for a voluntary pre- centive to obtain coverage under Medicare Prescription Drug plan or under a MedicareAdvantage or other prescription scription drug benefit under the Medi- contract under section 1860D–13(e).’’ drug plans, including premium subsidies. care program and to strengthen and (7) Whether the availability of improve the Medicare program and for SA 1133. Mr. GRASSLEY (for himself MedicareAdvantage and medicare fee-for- other purposes; as follows: and Mr. BAUCUS) proposed an amend- service prescription drug coverage acts as an On page 343, between lines 15 and 16, insert ment to the bill S. 1, to amend title incentive to employers that did not pre- the following: XVIII of the Social Security Act to viously offer employment-based retiree ‘‘(f) ZERO PREMIUM STOP-LOSS PROTECTION provide for a voluntary prescription health coverage to offer such coverage to re- AND ACCESS TO NEGOTIATED PRICES FOR ELI- drug benefit under the Medicare pro- tirees. GIBLE BENEFICIARIES ENROLLED IN gram and to strengthen and improve (8) Whether other tools are used by em- MEDICAREADVANTAGE PLANS.— the Medicare program, and for other ployers to help future employees afford ‘‘(1) IN GENERAL.—Notwithstanding any purposes; as follows: health benefits and prescription drug cov- provision of this part or part D, a On page 8, line 12, insert ‘‘(including sy- erage once such employees reach retirement MedicareAdvantage plan shall be treated as ringes, and necessary medical supplies asso- age. meeting the requirements of this section if, ciated with the administration of insulin, as (b) INFORMATION.—In conducting the study in lieu of the qualified prescription drug cov- defined by the Administrator)’’ before the under subsection (a), the Comptroller Gen- erage otherwise required, the plan makes semicolon. eral shall determine the effect of the amend- available such coverage with the following On page 46, line 9, after the end period in- ments made by this Act on the provision of modifications: sert: ‘‘Such requirement shall not apply to

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00150 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8797 enrollees of a Medicare Prescription Drug Prescription Drug plan for the year. The al- ‘‘(A) is enrolled in this part and in a Medi- plan who are enrolled in the plan pursuant to lowable costs for a plan for a year shall be care Prescription Drug plan; a contractual agreement between the plan equal to the amount described in paragraph ‘‘(B) is enrolled in this part and in a and an employer or other group health plan (1)(A)(i) for the plan for the year. MedicareAdvantage plan (except for an MSA that provides employment-based retiree On page 116, strike lines 11 and 12, and in- plan or a private fee-for-service plan that health coverage (as defined in section 1860D– sert the following: does not provide qualified prescription drug 20(d)(4)(B)) if the premium amount is the ‘‘(ii) is eligible for medicare cost-sharing coverage); same for all such enrollees under such agree- described in section 1905(p)(3) under the ‘‘(C) is eligible for, but not enrolled in, the ment.’’ State plan under title XIX (or under a waiver program under this part, and is covered On page 51, line 19, insert ‘‘(but only with of such plan), on the basis of being described under a qualified retiree prescription drug respect to the percentage of such costs that in section 1905(p)(1), as determined under plan; or the individual is responsible for under that such plan (or under a waiver of plan); and ‘‘(D) is eligible for, but not enrolled in, the section)’’ after ‘‘1860D–19’’. On page 117, strike lines 1 and 2, and insert program under this part, and is covered On page 56, strike lines 3 through 19, and the following: under a qualified State pharmaceutical as- insert the following: ‘‘(ii) is eligible for medicare cost-sharing sistance program. ‘‘(B) MEDICAID RELATED PROVISIONS.—Inso- described in section 1905(p)(3)(A)(ii) under ‘‘(3) QUALIFYING ENTITY.—The term ‘quali- far as a State elects to provide medical as- the State plan under title XIX (or under a fying entity’ means any of the following that sistance under title XIX for a drug based on waiver of such plan), on the basis of being de- has entered into an agreement with the Ad- the prices negotiated under a Medicare Pre- scribed in section 1902(a)(10)(E)(iii), as deter- ministrator to provide the Administrator scription Drug plan under this part— mined under such plan (or under a waiver of with such information as may be required to ‘‘(i) the medical assistance for such a drug plan); and carry out this section: shall be disregarded for purposes of a rebate On page 117, strike lines 14 through 17, and ‘‘(A) An eligible entity offering a Medicare agreement entered into under section 1927 insert the following: Prescription Drug plan under this part. which would otherwise apply to the provi- ‘‘(ii) is eligible for medicare cost-sharing ‘‘(B) A MedicareAdvantage organization of- sion of medical assistance for the drug under described in section 1905(p)(3)(A)(ii) under fering a MedicareAdvantage plan under part title XIX; and the State plan under title XIX (or under a C (except for an MSA plan or a private fee- ‘‘(ii) the prices negotiated under a Medi- waiver of such plan), on the basis of being de- for-service plan that does not provide quali- care Prescription Drug plan with respect to scribed in section 1902(a)(10)(E)(iv) (without fied prescription drug coverage). covered drugs, under a MedicareAdvantage regard to any termination of the application ‘‘(C) The sponsor of a qualified retiree pre- plan with respect to such drugs, or under a of such section under title XIX), as deter- scription drug plan. qualified retiree prescription drug plan (as mined under such plan (or under a waiver of ‘‘(D) A State offering a qualified State defined in section 1860D–20(e)(4)) with respect such plan); and pharmaceutical assistance program. to such drugs, on behalf of eligible bene- On page 120, line 11, strike ‘‘such individ- On page 127, beginning with line 18, strike ficiaries, shall (notwithstanding any other uals’’ and insert ‘‘in the case of such an indi- all through page 128, line 2, and insert: provision of law) not be taken into account vidual who is not a resident of the 50 States ‘‘(i) ATTESTATION OF ACTUARIAL VALUE OF for the purposes of establishing the best or the District of Columbia, such indi- COVERAGE.—The sponsor of the plan shall, price under section 1927(c)(1)(C). vidual’’. On page 74, strike lines 14 through 16, and Beginning on page 123, strike line 10 annually or at such other time as the Ad- insert the following: through page 124, line 6, and insert the fol- ministrator may require, provide the Admin- the plan; lowing: istrator an attestation, in accordance with ‘‘(D) the average aggregate projected cost ‘‘(B) AMOUNTS RESULTING IN ACTUAL the procedures established under section of covered drugs under the plan relative to COSTS.—With respect to the total amount 1860D–6(f), that the actuarial value of pre- other Medicare Prescription Drug plans and under subparagraph (A) for the year— scription drug coverage under the plan is at MedicareAdvantage plans; or ‘‘(i) the aggregate amount of payments least equal to the actuarial value of standard ‘‘(E) other factors determined appropriate made by the entity to pharmacies and other prescription drug coverage. by the Administrator. entities with respect to such coverage for ‘‘(ii) AUDITS.—The sponsor of the plan, or Beginning on page 88, strike lines 9 such enrollees; and an administrator of the plan designated by through page 89, line 10, and insert the fol- ‘‘(ii) the aggregate amount of discounts, di- the sponsor, shall maintain (and afford the lowing: rect or indirect subsidies, rebates, or other Administrator access to) such records as the ‘‘(ii) AMOUNTS RESULTING IN ACTUAL price concessions or direct or indirect remu- Administrator may require for purposes of COSTS.—With respect to the total amount nerations made to the entity with respect to audits and other oversight activities nec- under clause (i) for the year— such coverage for such enrollees. essary to ensure the adequacy of prescription ‘‘(I) the aggregate amount of payments ‘‘(2) CERTAIN EXPENSES NOT INCLUDED.—The drug coverage and the accuracy of payments made by the entity to pharmacies and other amount under paragraph (1)(A) may not in- made under this part to and by the plan. entities with respect to such coverage for clude— On page 128, between lines 12 and 13, insert such enrollees; and ‘‘(A) administrative expenses incurred in the following: ‘‘(II) the aggregate amount of discounts, providing the coverage described in para- ‘‘(6) QUALIFIED STATE PHARMACEUTICAL AS- direct or indirect subsidies, rebates, or other graph (1)(A); SISTANCE PROGRAM.— price concessions or direct or indirect remu- ‘‘(B) amounts expended on providing addi- ‘‘(A) IN GENERAL.—The term ‘qualified nerations made to the entity with respect to tional prescription drug coverage pursuant State pharmaceutical assistance program’ such coverage for such enrollees. to section 1860D–6(a)(2); or means a State pharmaceutical assistance ‘‘(B) CERTAIN EXPENSES NOT INCLUDED.—The ‘‘(C) discounts, direct or indirect subsidies, program if, with respect to a qualifying cov- amount under subparagraph (A)(i) may not rebates, or other price concessions or direct ered individual who is covered under the pro- include— or indirect remunerations made to the entity gram, the following requirements are met: ‘‘(i) administrative expenses incurred in with respect to coverage described in para- ‘‘(i) ASSURANCE.—The State offering the providing the coverage described in subparagraph (1)(A). program shall, annually or at such other graph (A)(i); On page 124, on line 15, insert ‘‘(or 65 per- times as the Administrator may require, pro- ‘‘(ii) amounts expended on providing addi- cent with respect to a qualifying covered in- vide the Administrator an attestation that, tional prescription drug coverage pursuant dividual described in subsection (e)(2)(D))’’ in accordance with the procedures estab- to section 1860D–6(a)(2); after ‘‘80 percent’’. lished under section 1860D–6(f), that— ‘‘(iii) amounts expended for which the enti- Beginning on page 124, strike line 18 ‘‘(I) the actuarial value of prescription ty is subsequently provided with reinsurance through page 125, line 13, and insert the fol- drug coverage under the program is at least payments under section 1860D–20; or lowing: equal to the actuarial value of standard pre- ‘‘(iv) discounts, direct or indirect subsidies, ‘‘(2) ESTABLISHMENT OF ALLOWABLE COSTS.— scription drug coverage; and rebates, or other price concessions or direct In the case of a qualifying entity that has in- ‘‘(II) the actuarial value of subsidies to in- or indirect remunerations made to the entity curred costs described in subsection (b)(1)(A) dividuals provided under the program are at with respect to coverage described in sub- with respect to a qualifying covered indi- least equal to the actuarial value of the subparagraph (A)(i). vidual for a coverage year, the Adminis- sidies that would apply under section 1860D– On page 78, beginning on line 20, strike ‘‘An trator shall establish the allowable costs for 19 if the individual was enrolled under this entity’’ and all that follows through line 24. the individual and year. Such allowable costs part rather than under the program. On page 84, line 6, strike ‘‘(including a con- shall be equal to the amount described in ‘‘(ii) DISCLOSURE OF INFORMATION.—The tract under)’’. such subsection for the individual and year. State complies with the requirements de- Beginning on page 92, strike line 20 Beginning on page 126, strike line 7 scribed in clauses (i) and (ii) of section through page 93, line 25, and insert the fol- through page 127, line 9, and insert the fol- 1860D–16(b)(7)(A). lowing: lowing: ‘‘(B) STATE PHARMACEUTICAL ASSISTANCE ‘‘(3) ESTABLISHMENT OF ALLOWABLE COSTS.— ‘‘(2) QUALIFYING COVERED INDIVIDUAL.—The PROGRAM.—For purposes of subparagraph (A), For each year, the Administrator shall es- term ‘qualifying covered individual’ means the term ‘State pharmaceutical assistance tablish the allowable costs for each Medicare an individual who— program’ means a program—

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‘‘(i) that is in operation as of the date of ‘‘(2) AMOUNT OF PAYMENT.— ‘‘(B) whose income is at least the income enactment of the Prescription Drug and ‘‘(A) IN GENERAL.—The amount of the pay- required for an individual to be an eligible Medicare Improvement Act of 2003; ment under paragraph (1) shall be the individual under section 1611 for purposes of ‘‘(ii) that is sponsored and financed by a amount the Administrator estimates would the supplemental security income program State; and have been made to an entity or organization (as determined under section 1612), but does ‘‘(iii) that provides coverage for outpatient under section 1860D–19 with respect to the not exceed 100 percent of the poverty line (as drugs for individuals in the State who meet applicable low-income individual if such in- defined in section 2110(c)(5)) applicable to a income- and resource-related qualifications dividual was enrolled in this part and under family of the size involved., specified under such program. a Medicare Prescription Drug plan or a On page 149, line 1, insert ‘‘and notwith- On page 128, between lines 15 and 16, insert MedicareAdvantage plan. standing section 1905(b),’’ after ‘‘(2)’’. the following: ‘‘(B) MAXIMUM PAYMENTS.—In no case may On page 149, beginning on line 6, strike ‘‘(g) DISTRIBUTION OF REINSURANCE PAY- the amount of the payment determined ‘‘Secretary’’ and all that follows through MENT AMOUNTS.— under subparagraph (A) with respect to an ‘‘paying’’ on line 8, and insert ‘‘Federal med- ‘‘(1) IN GENERAL.—Any sponsor meeting the applicable low-income individual exceed, as ical assistance percentage shall be’’. requirements of subsection (e)(3) with re- estimated by the Administrator, the average On page 149, line 8, strike ‘‘of the’’ and in- spect to a quarter in a calendar year, but amounts made in a year under section 1860D– sert ‘‘for’’. which is not an employer, shall distribute 19 on behalf of an eligible beneficiary en- On page 151, line 9, strike ‘‘$22,500,000’’ and the reinsurance payments received for such rolled under this part with income that is insert ‘‘$37,500,000’’. quarter under subsection (c) to the employ- the same as the income of the applicable On page 151, line 11, strike ‘‘$30,000,000’’ and ers contributing to the qualified retiree pre- low-income individual. insert ‘‘$50,000,000’’. On page 152, strike lines 8 through 11, and scription drug plan maintained by such spon- ‘‘(3) APPLICABLE LOW-INCOME INDIVIDUAL.— sor during that quarter, in the manner de- For purposes of this subsection, the term insert the following: scribed in paragraphs (2) and (3). ‘applicable low-income individual’ means an (2) CONFORMING AMENDMENTS.— ‘‘(2) ALLOCATION.—The reinsurance pay- individual who is both— (A) Section 1905(b) (42 U.S.C. 1396d(b)) is ments to be distributed pursuant to para- ‘‘(A) a qualifying covered individual (de- amended by inserting ‘‘and subsections (c)(1) graph (1) shall be allocated proportionally scribed in subparagraph (D) of section 1860D– and (d)(1) of section 1935’’ after ‘‘1933(d)’’. among all employers who contribute to the (e)(2)); and (B) Section 1108(f) (42 U.S.C. 1308(f)) is plan during the quarter with respect to ‘‘(B) a qualified medicare beneficiary, a amended by inserting ‘‘and section which the payments are received. The share specified low income medicare beneficiary, 1935(e)(1)(B)’’ after ‘‘Subject to subsection allocated to each employer contributing to or a subsidy-eligible individual, as such (g)’’. On page 157, line 17, strike ‘‘and’’. the plan during a quarter shall be deter- terms are defined in section 1860D–19(a)(4). On page 157, line 20, strike the period and mined by multiplying the total reinsurance ‘‘(c) PAYMENT METHODS.— insert ‘‘; and’’. payments received by the sponsor for the ‘‘(1) IN GENERAL.—Payments under this sec- On page 157, between lines 20 and 21, insert quarter by a fraction, the numerator of tion shall be based on such a method as the the following: which is the total contributions made by an Administrator determines. The Adminis- (C) by adding at the end the following: employer for that quarter, and the denomi- trator may establish a payment method by ‘‘(3) AGREEMENTS TO ESTABLISH INFORMA- nator of which is the total contributions re- which interim payments of amounts under TION AND ENROLLMENT SITES AT SOCIAL SECU- quired to be made to the plan by all employ- this section are made during a year based on RITY FIELD OFFICES.— ers for that quarter. Any share allocated to the Administrator’s best estimate of ‘‘(A) IN GENERAL.—The Commissioner shall an employer required to contribute for a amounts that will be payable after obtaining enter into an agreement with each State op- quarter who does not make the contributions all of the information. erating a State plan under title XIX (includ- required for that quarter on or before the ‘‘(2) SOURCE OF PAYMENTS.—Payments ing under a waiver of such plan) to establish date due shall be retained by the sponsor for under this section shall be made from the information and enrollment sites within all the benefit of the plan as a whole. Prescription Drug Account. the Social Security field offices located in ‘‘(3) TIMING.—Reinsurance payments re- ‘‘(d) CONSTRUCTION.—Nothing in this sec- the State for purposes of— quired to be distributed to employers pursu- tion or section 1860D–20 shall effect the pro- ‘‘(i) the State determining the eligibility ant to this subsection shall be distributed as visions of section 1860D–26(b). of individuals residing in the State for med- soon as practicable after received by the On page 134, between lines 9 and 10, insert: ical assistance for payment of the cost of sponsor, but in no event later than the end of ‘‘(d) WAIVER AUTHORITY.—The Secretary medicare cost-sharing under the medicaid the quarter immediately following the quar- shall have authority similar to the waiver program pursuant to sections 1902(a)(10)(E) ter in which such reinsurance payments are authority under section 1857(i) to facilitate and 1933, the transitional prescription drug received by the sponsor. the offering of Medicare Prescription Drug assistance card program under section 1807A, ‘‘(4) REGULATIONS.—The Secretary shall plans by employer or other group health or premium and cost-sharing subsidies under promulgate regulations providing that any plans as part of employment-based retiree section 1860D–19; and sponsor subject to the requirements of this health coverage (as defined in section 1860D– ‘‘(ii) enrolling individuals who are deter- subsection who fails to meet such require- 20(d)(4)(B)), including the authority to estab- mined eligible for such medical assistance, ments shall not be eligible for a payment lish separate premium amounts for enrollees program, or subsidies in the State plan (or under this section. in a Medicare Prescription Drug plan by rea- On page 130, between lines 7 and 8, insert son of such coverage.’’ waiver), the transitional prescription drug the following: On page 142, beginning on line 16, strike assistance card program under section 1807A, ‘‘in a manner’’ and all that follows through or the appropriate category for premium and ‘‘DIRECT SUBSIDIES FOR QUALIFIED STATE OF- line 19 and insert a semicolon. cost-sharing subsidies under section 1860D– FERING A STATE PHARMACEUTICAL ASSIST- On page 143, beginning on line 15, strike 19. ANCE PROGRAM FOR PROGRAM ENROLLEES EL- ‘‘in a manner’’ and all that follows through ‘‘(B) AGREEMENT TERMS.—The Secretary IGIBLE FOR, BUT NOT ENROLLED IN, THIS PART line 18 and insert a semicolon. and the Commissioner jointly shall develop ‘‘SEC. 1860D–22. (a) DIRECT SUBSIDY.— On page 144, between lines 10 and 11, insert terms for the State agreements required ‘‘(1) IN GENERAL.—The Administrator shall the following: under subparagraph (A) that shall specify provide for the payment to a State offering ‘‘(4) SCREEN AND ENROLL INDIVIDUALS ELIGI- the responsibilities of the State and the a qualified State pharmaceutical assistance BLE FOR MEDICARE COST-SHARING.—As part of Commissioner in the establishment and op- program (as defined in section 1860D–20(e)(6)) making an eligibility determination required eration of such sites. for each qualifying covered individual (de- under paragraph (1) or (2), screen an indi- ‘‘(C) AUTHORIZATION OF APPROPRIATIONS.— scribed in subparagraph (D) of section 1860D– vidual who applies for such a determination There are authorized to be appropriated to (e)(2)) enrolled in the program for each for eligibility for medical assistance for any the Commissioner, such sums as may be nec- month for which such individual is so en- medicare cost-sharing described in section essary to carry out this paragraph.’’. rolled. 1905(p)(3) and, if the individual is eligible for On page 159, line 19, insert the following ‘‘(2) AMOUNT OF PAYMENT.— any such medicare cost-sharing, enroll the before the closing quotation: ‘‘As part of ‘‘(A) IN GENERAL.—The amount of the pay- individual under the State plan (or under a such review, the Commission shall hold 3 ment under paragraph (1) shall be an amount waiver of such plan). field hearings in 2007.’’. equal to the amount of payment for the area On page 147, line 1, insert ‘‘and notwith- On page 174, line 14, insert ‘‘(including sy- and year made under section 1860D–21(a)(2). standing section 1905(b),’’ after ‘‘(4)’’. ringes, and necessary medical supplies asso- ‘‘(b) ADDITIONAL SUBSIDY.— On page 147, beginning on line 6, strike ciated with the administration of insulin, as ‘‘(1) IN GENERAL.—The Administrator shall ‘‘Secretary’’ and all that follows through defined by the Secretary)’’ before the provide for the payment to a State offering ‘‘paying’’ on line 8, and insert ‘‘Federal med- comma. a qualified State pharmaceutical program ical assistance percentage shall be’’. Beginning on page 195, strike line 16 (as defined in section 1860D–20(e)(6)) for each On page 147, line 8, strike ‘‘of the’’ and in- through page 196, line 7, and insert the fol- applicable low-income individual enrolled in sert ‘‘for’’. lowing: the program for each month for which such On page 147, strike lines 13 through 16, and ‘‘(A) PATIENT MAY REQUEST A WRITTEN PRE- individual is so enrolled. insert the following: SCRIPTION.—The standards provide that—

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00152 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8799 ‘‘(i) a prescription shall be written and not On page 349, between lines 4 and 5, insert ardized amount for hospitals located in any transmitted electronically if the patient the following: area of Puerto Rico that is equal to the aver- makes such a request; and (3) UPDATE IN MINIMUM PERCENTAGE IN- age standardized amount computed under ‘‘(ii) no additional charges may be imposed CREASE.—Section 1853(c)(1)(C) (42 U.S.C. subclause (I) for fiscal year 2003 for hospitals on the patient for making such a request. 1395w–23(c)(1)(C)) is amended by striking in an urban area, increased by the applicable On page 199, strike lines 10 through 14, and clause (iv) and inserting the following new percentage increase under subsection insert the following: clauses: (b)(3)(B) for fiscal year 2004. ‘‘(A) IN GENERAL.—Individuals or entities ‘‘(iv) For 2002, 2003, and 2004, 102 percent of ‘‘(III) For discharges in a fiscal year after that transmit or receive prescriptions elec- the annual Medicare+Choice capitation rate fiscal year 2004, the Secretary shall compute tronically shall comply with the standards under this paragraph for the area for the pre- an average standardized amount for hos- adopted or modified under this part. vious year. pitals located in any are of Puerto Rico that On page 200, between lines 16 and 17, insert ‘‘(v) For 2005, 103 percent of the annual is equal to the average standardized amount the following: Medicare+Choice capitation rate under this computed under subclause (II) or this sub- ‘‘(e) NO REQUIREMENT TO TRANSMIT OR RE- paragraph for the area for 2003. clause for the previous fiscal year, increased CEIVE PRESCRIPTIONS ELECTRONICALLY.— ‘‘(vi) For 2006 and each succeeding year, 102 by the applicable percentage increase under Nothing in this part shall be construed to re- percent of the annual Medicare+Choice capi- subsection (b)(3)(B), adjusted to reflect the quire an individual or entity to transmit or tation rate under this paragraph for the area most recent case mix data.’’; receive prescriptions electronically. for the previous year, except that such rate (B) in clause (ii), by inserting ‘‘(or for fis- On page 254, line 25, insert ‘‘(other than shall be determined by substituting ‘102’ for cal year 2004 and thereafter, the standardized deemed contracts or agreements under sub- ‘103’ in clause (v).’’. amount)’’ after ‘‘each of the average stand- section (j)(6))’’ before ‘‘with a sufficient On page 379, strike lines 9 through 13, and ardized amounts’’; and number’’. insert: (C) in clause (iii)(I), by striking ‘‘for hos- On page 255, line 7, before the period, insert ‘‘(A) IN GENERAL.—The term ‘specialized pitals located in an urban or rural area, re- the following: ‘‘, except that, if a plan en- Medicare+Choice plans for special needs spectively’’. tirely meets such requirement with respect beneficiaries’ means a Medicare+Choice plan to a category of health care professional or that— (c) CONFORMING AMENDMENTS.— provider on the basis of subparagraph (B), it ‘‘(i) exclusively serves special needs bene- (1) COMPUTING DRG-SPECIFIC RATES.—Sec- may provide for a higher beneficiary copay- ficiaries (as defined in subparagraph (B)), or tion 1886(d)(3)(D) (42 U.S.C. 1395ww(d)(3)(D)) ment in the case of health care professionals ‘‘(ii) to the extent provided in regulations is amended— and providers of that category who do not prescribed by the Secretary, disproportion- (A) in the heading, by striking ‘‘IN DIF- have contracts or agreements (other than ately serves such special needs beneficiaries, FERENT AREAS’’; deemed contracts or agreements under sub- frail elderly medicare beneficiaries, or both. (B) in the matter preceding clause (i), by section (j)(6)) to provide covered services Beginning on page 411, strike line 5 striking ‘‘, each of’’; under the terms of the plan’’. through page 414, line 9, and insert the fol- (C) in clause (i)— On page 297, strike lines 5 through 9, and lowing: (i) in the matter preceding subclause (I), by insert the following: SEC. 401. EQUALIZING URBAN AND RURAL inserting ‘‘for fiscal years before fiscal year ‘‘(iv) For 2002, 2003, and 2004, 102 percent of STANDARDIZED PAYMENT AMOUNTS 2004,’’ before ‘‘for hospitals’’; and UNDER THE MEDICARE INPATIENT the annual Medicare+Choice capitation rate (ii) in subclause (II), by striking ‘‘and’’ HOSPITAL PROSPECTIVE PAYMENT after the semicolon at the end; under this paragraph for the area for the pre- SYSTEM. (D) in clause (ii)— vious year. (a) IN GENERAL.—Section 1886(d)(3)(A)(iv) ‘‘(v) For 2005, 103 percent of the annual (42 U.S.C. 1395ww(d)(3)(A)(iv)) is amended— (i) in the matter preceding subclause (I), by Medicare+Choice capitation rate under this (1) by striking ‘‘(iv) For discharges’’ and inserting ‘‘for fiscal years before fiscal year paragraph for the area for 2003. inserting ‘‘(iv)(I) Subject to subclause (II), 2004,’’ before ‘‘for hospitals’’; and ‘‘(vi) For 2006 and each succeeding year, 102 for discharges’’; and (ii) in subclause (II), by striking the period percent of the annual Medicare+Choice capi- (2) by adding at the end the following new at the end and inserting ‘‘; and’’; and tation rate under this paragraph for the area subclause: (E) by adding at the end the following new for the previous year, except that such rate ‘‘(II) For discharges occurring in a fiscal clause: shall be determined by substituting ‘102’ for year (beginning with fiscal year 2004), the ‘‘(iii) for a fiscal year beginning after fiscal ‘103’ in clause (v). Secretary shall compute a standardized year 2003, for hospitals located in all areas, On page 323, strike lines 1 through 3, and amount for hospitals located in any area to the product of— insert the following: within the United States and within each re- ‘‘(I) the applicable standardized amount ‘‘(B) EXCEPTION.—The Secretary shall not gion equal to the standardized amount com- (computed under subparagraph (A)), reduced review, approve, or disapprove the amounts puted for the previous fiscal year under this under subparagraph (B), and adjusted or re- submitted under paragraph (3), or, with re- subparagraph for hospitals located in a large duced under subparagraph (C) for the fiscal spect to a private fee-for-service plan (as de- urban area (or, beginning with fiscal year year; and scribed in section 1851(a)(2)(C)) under sub- 2005, for applicable for all hospitals in the ‘‘(II) the weighting factor (determined paragraph (A)(i), (A)(ii)(III), or (B) of para- previous fiscal year) increased by the appli- under paragraph (4)(B)) for that diagnosis-re- graph (2). cable percentage increase under subsection lated group.’’. On page 326, line 11, after the end period in- (b)(3)(B)(i) for the fiscal year involved.’’. (2) TECHNICAL CONFORMING SUNSET.—Sec- sert: ‘‘Subject to the provisions of section (b) APPLICATION TO SUBSECTION (D) PUERTO tion 1886(d)(3) (42 U.S.C. 1395ww(d)(3)) is 1858(h), such requirement shall not apply to RICO HOSPITALS.—Section 1886(d)(9) (42 U.S.C. amended— enrollees of a MedicareAdvantage plan who 1395ww(d)(9)) is amended— (A) in the matter preceding subparagraph are enrolled in the plan pursuant to a con- (1) in subparagraph (A)— (A), by inserting ‘‘, for fiscal years before fis- tractual agreement between the plan and an (A) in clause (i), by striking ‘‘and’’ after cal year 1997,’’ before ‘‘a regional adjusted employer or other group health plan that the comma at the end; DRG prospective payment rate’’; and provides employment-based retiree health (B) in clause (ii)— (B) in subparagraph (D), in the matter pre- coverage (as defined in section 1860D– (i) in the matter preceding subclause (I), by ceding clause (i), by inserting ‘‘, for fiscal 20(d)(4)(B)) if the premium amount is the inserting ‘‘and before October 1, 2003’’ after years before fiscal year 1997,’’ before ‘‘a re- same for all such enrollees under such agree- ‘‘October 1, 1997’’; and gional DRG prospective payment rate for ment.’’. (ii) in the matter following clause (III), by each region,’’. striking the period at the end and inserting On page 328, line 3, strike ‘‘or (C)’’. On page 430, strike lines 19 through 21, and ‘‘, and’’; and On page 328, line 20, strike ‘‘or (C)’’. insert the following: On page 343, strike lines 22 through 24, and (iii) by adding at the end the following new insert: clause: (b) PERMITTING NURSE PRACTITIONERS, PHY- Section 1858(h) (as added by section 211) is ‘‘(iii) for discharges in a fiscal year begin- SICIAN ASSISTANTS, AND CLINICAL NURSE SPE- amended— ning on or after October 1, 2003, 50 percent of CIALIST TO REVIEW HOSPICE PLANS OF CARE.— (1) by inserting ‘‘(including subsection (i) the national standardized rate (determined Section 1814(a)(7)(B) is amended by inserting of such section)’’ after ‘‘section 1857’’; and under paragraph (3)(D)(iii)) for hospitals lo- ‘‘(or by a physician assistant, nurse practi- (2) by adding at the end the following new cated in any area.’’; tioner or clinical nurse specialist who is not sentence: ‘‘In applying the authority under (2) in subparagraph (C)— an employee of the hospice program, and section 1857(i) pursuant to this subsection, (A) in clause (i)— whom the individual identifies as the health the Administrator may permit (i) by striking ‘‘(i) The Secretary’’ and in- care provider having the most significant MedicareAdvantage plans to establish sepa- serting ‘‘(i)(I) For discharges in a fiscal year role in the determination and delivery of rate premium amounts for enrollees in an after fiscal year 1988 and before fiscal year medical care to the individual at the time employer or other group health plan that 2004, the Secretary; and the individual makes an election to receive provides employment-based retiree health (ii) by adding at the end the following: hospice care)’’ after ‘‘and is periodically re- coverage (as defined in section 1860D– ‘‘(II) For discharges in fiscal year 2004, the viewed by the individual’s attending physi- 20(d)(4)(B)).’’ Secretary shall compute an average stand- cian’’.

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(c) EFFECTIVE DATE.—The amendments this title or title XIX or for continued classi- On page 486, line 9, strike ‘‘(iii)’’ and insert made by this section shall apply to hospice fication as a hospital described in clause ‘‘(II)’’. care furnished on or after October 1, 2004. (iv)’’ before the period at the end. On page 488, after line 25, add the fol- On page 438, between lines 10 and 11, insert (b) TREATMENT OF PROPOSED REVISION.— lowing: the following: The Secretary shall not adopt the proposed (c) LIMITATION OF EXPENDITURES IN YEARS SEC. 414. REVISION OF THE INDIRECT MEDICAL revision to section 412.22(f) of title 42, Code PRIOR TO 2014.— EDUCATION (IME) ADJUSTMENT of Federal Regulations contained in 68 Fed- (1) IN GENERAL.—The Secretary shall en- PERCENTAGE. eral Register 27154 (May 19, 2003) or any revi- sure that the total amount of expenditures (a) IN GENERAL.—Section 1886(d)(5)(B)(ii) sion reaching the same or substantially the under title XVIII of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended— same result as such revision. (including amounts expended by reason of (1) in subclause (VI), by striking ‘‘and’’ (c) EFFECTIVE DATE.—The amendment this section) in a year prior to 2014 does not after the semicolon at the end; made by, and provisions of, this section shall exceed the sum of— (2) in subclause (VII)— apply to cost reporting periods ending on or (A) the total amount of expenditures under (A) by striking ‘‘on or after October 1, after December 31, 2002. such title XVIII that would have made if this 2002’’ and inserting ‘‘during fiscal year 2003’’; On page 440, line 2, insert closing quotation section had not been enacted; and and marks and a period after the period at the (B) the applicable amount. (B) by striking the period at the end and end. (2) APPLICABLE AMOUNT.—For purposes of inserting a semicolon; and Beginning on page 441, strike line 19 and paragraph (1), the term ‘‘applicable amount’’ (3) by adding at the end the following new all that follows through page 442, line 2. means— Beginning on page 445, strike line 5 and all subclauses: (A) for 2005, $32,000,000; that follows through page 446, line 6, and in- ‘‘(VIII) during each of fiscal years 2004 and (B) for 2006, $34,000,000; sert the following: 2005, ‘c’ is equal to 1.36; and (C) for 2007, $36,000,000; ‘‘(IX) on or after October 1, 2005, ‘c’ is equal SEC. 426. TEMPORARY INCREASE FOR GROUND (D) for 2008, $38,000,000; AMBULANCE SERVICES. to 1.355.’’. (E) for 2009, $40,000,000; Section 1834(l) (42 U.S.C. 1395m(l)), as (b) CONFORMING AMENDMENT RELATING TO (F) for 2010, $42,000,000; amended by section 405(b)(2), is amended by DETERMINATION OF STANDARDIZED AMOUNT.— (G) for 2011, $44,000,000; adding at the end the following new para- Section 1886(d)(2)(C)(i) (42 U.S.C. (H) for 2012, $48,000,000; and graphs: 1395ww(d)(2)(C)(i)) is amended— (I) for 2013, $50,000,000. ‘‘(10) TEMPORARY INCREASE FOR GROUND AM- (1) by striking ‘‘1999 or’’ and inserting (3) STEPS TO ENSURE FUNDING LIMITATION BULANCE SERVICES.— ‘‘1999,’’; and NOT VIOLATED.—If the Secretary determines ‘‘(A) IN GENERAL.—Notwithstanding any (2) by inserting ‘‘, or the Prescription Drug that the application of this section will re- other provision of this subsection, in the and Medicare Improvement Act of 2003’’ after sult in the funding limitation described in case of ground ambulance services furnished ‘‘2000’’. paragraph (1) being violated for any year, the on or after January 1, 2005, and before Janu- (c) EFFECTIVE DATE.—The amendments Secretary shall take appropriate steps to ary 1, 2008, for which the transportation made by this section shall apply to dis- stay within such funding limitation, includ- originates in— charges occurring on or after October 1, 2003. ing through limiting the number of clinical ‘‘(i) a rural area described in paragraph (9) SEC. 415. CALCULATION OF WAGE INDICES FOR trials deemed under subsection (a) and only or in a rural census tract described in such HOSPITALS. covering a portion of the routine costs de- paragraph, the fee schedule established (a) IN GENERAL.—Notwithstanding any scribed in such subsection. under this section shall provide that the rate other provision of law, in the calculation of On page 516, after line 22, add the fol- for the service otherwise established, after a wage index in a State for purposes of mak- lowing: ing payments for discharge waive such other application of any increase under such paragraph, shall be increased by 5 percent; and SEC. 446. AUTHORIZATION OF REIMBURSEMENT criteria for re-classification as deemed ap- FOR ALL MEDICARE PART B SERV- propriate by the Secretary. ‘‘(ii) an area not described in clause (i), the fee schedule established under this section ICES FURNISHED BY CERTAIN IN- DIAN HOSPITALS AND CLINICS. SEC. 416. CONFORMING CHANGES REGARDING shall provide that the rate for the service FEDERALLY QUALIFIED HEALTH (a) IN GENERAL.—Section 1880(e) (42 U.S.C. otherwise established shall be increased by 2 CENTERS. 1395qq(e)) is amended— percent. Section 1833(a)(3) (42 U.S.C. 1395l(a)(3)) is (1) in paragraph (1)(A), by striking ‘‘for ‘‘(B) APPLICATION OF INCREASED PAYMENTS amended by inserting ‘‘(which regulations services described in paragraph (2)’’ and in- AFTER 2007.—The increased payments under shall exclude any cost incurred for the provi- subparagraph (A) shall not be taken into ac- serting ‘‘for all items and services for which sion of services pursuant to a contract with count in calculating payments for services payment may be made under such part’’; an eligible entity (as defined in section furnished on or after the period specified in (2) by striking paragraph (2); and 1860D(4)) operating a Medicare Prescription such subparagraph. (3) by redesignating paragraph (3) as para- Drug plan or with an entity with a contract graph (2). ‘‘(11) CONVERSION FACTOR ADJUSTMENTS.— under section 1860D–13(e), for which payment The Secretary shall not adjust downward the (b) EFFECTIVE DATE.—The amendments is made by the entity)’’ after ‘‘the Secretary conversion factor in any year because of an made by this section shall apply to items may prescribe in regulations’’. evaluation of the prior year conversion fac- and services furnished on or after October 1, SEC. 417. INCREASE FOR HOSPITALS WITH DIS- tor.’’. 2004. PROPORTIONATE INDIGENT CARE Beginning on page 470, strike line 21 and SEC. 447. COVERAGE OF CARDIOVASCULAR REVENUES. all that follows through page 471, line 13, and SCREENING TESTS. (a) DISPROPORTIONATE SHARE ADJUSTMENT insert the following: (a) COVERAGE.—Section 1861(s)(2) of the So- PERCENTAGE.—Section 1886(d)(5)(F)(iii) (42 ‘‘(B) Subject to subparagraph (E), in the cial Security Act (42 U.S.C. 1395x(s)(2)) is U.S.C. 1395ww(d)(5)(F)(iii)) is amended by case of dialysis services furnished in 2005, the amended— striking ‘‘35 percent’’ and inserting ‘‘35 per- composite rate for such services shall be an (1) in subparagraph (U), by striking ‘‘and’’ cent (or, for discharges occurring on or after amount equal to the composite rate estab- at the end; October 1, 2003, 40 percent)’’. lished under subparagraph (A), increased by (2) in subparagraph (V)(iii), by inserting (b) CAPITAL COSTS.—Section 1886(g)(1)(B) 0.05 percent and further increased by 1.6 per- ‘‘and’’ at the end; and (42 U.S.C. 1395ww(g)(1)(B)) is amended— cent. (3) by adding at the end the following new (1) in clause (iii), by striking ‘‘and’’ at the ‘‘(C) Subject to subparagraph (E), in the subparagraph: end; case of dialysis services furnished in 2006, the ‘‘(W) cardiovascular screening tests (as de- (2) in clause (iv), by striking the period at composite rate for such services shall be an fined in subsection (ww)(1));’’. the end and inserting ‘‘, and’’; and amount equal to the composite rate estab- (b) SERVICES DESCRIBED.—Section 1861 of (3) by adding at the end the following new lished under subparagraph (B), increased by the Social Security Act (42 U.S.C. 1395x) is clause: 0.05 percent and further increased by 1.6 per- amended by adding at the end the following ‘‘(v) in the case of cost reporting periods cent. new subsection: beginning on or after October 1, 2003, shall ‘‘(D) Subject to subparagraph (E), in the ‘‘Cardiovascular Screening Tests provide for a disproportionate share adjust- case of dialysis services furnished in 2007 and ment in the same manner as section all subsequent years, the composite rate for ‘‘(ww)(1) The term ‘cardiovascular screen- 1886(d)(5)(F)(iii).’’. such services shall be an amount equal to ing tests’ means the following diagnostic SEC. 418. TREATMENT OF GRANDFATHERED the composite rate established under this tests for the early detection of cardio- LONG-TERM CARE HOSPITALS. paragraph for the previous year, increased by vascular disease: (a) IN GENERAL.—The last sentence of sec- 0.05 percent. ‘‘(A) Tests for the determination of choles- tion 1886(d)(1)(B) is amended by inserting ‘‘, On page 486, line 3, insert ‘‘and’’ after the terol levels. and the Secretary may not impose any spe- semicolon at the end. ‘‘(B) Tests for the determination of lipid cial conditions on the operation, size, num- On page 486, line 4, insert ‘‘(I)’’ after ‘‘(ii)’’. levels of the blood. ber of beds, or location of any hospital so On page 486, line 8, strike ‘‘and’’ and insert ‘‘(C) Such other tests for cardiovascular classified for continued participation under ‘‘or’’. disease as the Secretary may approve.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00154 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8801 ‘‘(2)(A) Subject to subparagraph (B), the the Treasury, Postal Service and General nurse first assistant’’ means an individual Secretary shall establish standards, in con- Government Appropriations Act, 1995. Fees who— sultation with appropriate organizations, re- collected under this section shall be avail- (A) is a registered nurse and is licensed to garding the frequency and type of cardio- able for use by the Internal Revenue Service practice nursing in the State in which the vascular screening tests. only to the extent that such authority is surgical first assisting services are per- ‘‘(B) With respect to the frequency of car- provided in advance in an appropriations formed; diovascular screening tests approved by the Act. (B) has completed a minimum of 2,000 Secretary under subparagraph (A), in no case SEC. 450A. INCREASING TYPES OF ORIGINATING hours of first assisting a physician with sur- may the frequency of such tests be more TELEHEALTH SITES AND FACILI- gery and related preoperative, often than once every 2 years.’’. TATING THE PROVISION OF TELE- intraoperative, and postoperative care; and (c) FREQUENCY.—Section 1862(a)(1) of the HEALTH SERVICES ACROSS STATE (C) is certified as a registered nurse first Social Security Act (42 U.S.C. 1395y(a)(1)) is LINES. assistant by an organization recognized by amended— (a) INCREASING TYPES OF ORIGINATING the Secretary. SITES.—Section 1834(m)(4)(C)(ii) (42 U.S.C. (1) by striking ‘‘and’’ at the end of subpara- (c) PAYMENT RATES.—Payment under the graph (H); 1395m(m)(4)(C)(ii)) is amended by adding at demonstration project for surgical first as- (2) by striking the semicolon at the end of the end the following new subclauses: sisting services furnished by a certified reg- subparagraph (I) and inserting ‘‘, and’’; and ‘‘(VI) A skilled nursing facility (as defined istered nurse first assistant shall be made at (3) by adding at the end the following new in section 1819(a)). the rate of 80 percent of the lesser of the ac- subparagraph: ‘‘(VII) An assisted-living facility (as de- tual charge for the services or 85 percent of ‘‘(J) in the case of a cardiovascular screen- fined by the Secretary). the amount determined under the fee sched- ing test (as defined in section 1861(ww)(1)), ‘‘(VIII) A board-and-care home (as defined ule established under section 1848(b) of the which is performed more frequently than is by the Secretary). Social Security Act (42 U.S.C. 1395w–4(b)) for covered under section 1861(ww)(2).’’. ‘‘(IX) A county of community health clinic the same services if furnished by a physician. (as defined by the Secretary). (d) EFFECTIVE DATE.—The amendments (d) DEMONSTRATION PROJECT SITES.—The made by this section shall apply to tests fur- ‘‘(X) A community mental health center project established under this section shall nished on or after January 1, 2005. (as described in section 1861(ff)(2)(B)). be conducted in 5 States selected by the Sec- SEC. 448. MEDICARE COVERAGE OF SELF-IN- ‘‘(XI) A long-term care facility (as defined retary. by the Secretary). JECTED BIOLOGICALS. (e) DURATION.—The Secretary shall con- (a) COVERAGE.— ‘‘(XII) A facility operated by the Indian duct the demonstration project for the 3- (1) IN GENERAL.—Section 1861(s)(2) (42 Health Service or by an Indian tribe, tribal year period beginning on the date that is 90 U.S.C. 1395x(s)(2)) is amended— organization, or an urban Indian organiza- days after the date of the enactment of this (A) in subparagraph (U), by striking ‘‘and’’ tion (as such terms are defined in section 4 of Act. the Indian Health Care Improvement Act (25 at the end; (f) REPORT.—Not later than January 1, U.S.C. 1603)) directly, or under contract or (B) in subparagraph (V), by inserting 2007, the Secretary shall submit to Congress other arrangement.’’. ‘‘and’’ at the end; and a report on the project. The report shall in- (b) FACILITATING THE PROVISION OF TELE- (C) by adding at the end the following new clude an evaluation of patient outcomes HEALTH SERVICES ACROSS STATE LINES.— subparagraph: under the project, as well as an analysis of (1) IN GENERAL.—For purposes of expediting ‘‘(W)(i) a self-injected biological (which is the cost effectiveness of the project. the provision of telehealth services for which approved by the Food and Drug Administra- (g) FUNDING.— payment is made under the medicare pro- tion) that is prescribed as a complete re- (1) IN GENERAL.—The Secretary shall program under section 1834(m) of the Social Se- placement for a drug or biological (including vide for the transfer from the Federal Sup- curity Act (42 U.S.C. 1395m(m)), across State the same biological for which payment is plementary Insurance Trust Fund estab- lines, the Secretary shall, in consultation made under this title when it is furnished in- lished under section 1841 of the Social Secu- with representatives of States, physicians, cident to a physicians’ service) that would rity Act (42 U.S.C. 1395t) of such funds as are health care practitioners, and patient advo- otherwise be described in subparagraph (A) necessary for the costs of carrying out the cates, encourage and facilitate the adoption or (B) and that is furnished during 2004 or project under this section. of State provisions allowing for multistate 2005; and (2) BUDGET NEUTRALITY.—In conducting the practitioner licensure across State lines. ‘‘(ii) a self-injected drug that is used to project under this section, the Secretary (2) DEFINITIONS.—In this subsection: treat multiple sclerosis;’’. shall ensure that the aggregate payments (A) TELEHEALTH SERVICE.—The term ‘‘tele- (2) CONFORMING AMENDMENT.—Subpara- made by the Secretary do not exceed the health service’’ has the meaning given that graphs (A) and (B) of section 1861(s)(2) of the amount which the Secretary would have paid term in subparagraph (F)(i) of section Social Security Act (42 U.S.C. 1395x(s)(2)) are if the project under this section was not im- 1834(m)(4) of the Social Security Act (42 each amended by inserting ‘‘, except for any plemented. U.S.C. 1395m(m)(4)). drug or biological described in subparagraph (i) WAIVER AUTHORITY.—The Secretary (B) PHYSICIAN, PRACTITIONER.—The terms (W),’’ after ‘‘which’’. shall waive compliance with the require- ‘‘physician’’ and ‘‘practitioner’’ have the (b) EFFECTIVE DATE.—The amendments ments of title XVIII of the Social Security meaning given those terms in subparagraphs made by subsection (a) shall apply to drugs Act to such extent and for such period as the (D) and (E), respectively, of such section. and biologicals furnished on or after January Secretary determines is necessary to con- (C) MEDICARE PROGRAM.—The term ‘‘medi- 1, 2004 and before January 1, 2006. duct demonstration projects. SEC. 449. EXTENSION OF MEDICARE SECONDARY care program’’ means the program of health SEC. 450C. EQUITABLE TREATMENT FOR CHIL- PAYER RULES FOR INDIVIDUALS insurance administered by the Secretary DREN’S HOSPITALS. WITH END-STAGE RENAL DISEASE. under title XVIII of the Social Security Act Section 1862(b)(1)(C) (42 U.S.C. (42 U.S.C. 1395 et seq.). (a) IN GENERAL.—Section 1833(t)(7)(D)(ii) (42 U.S.C. 1395l(t)(7)(D)(ii)) is amended to 1395y(b)(1)(C)) is amended— SEC. 450B. DEMONSTRATION PROJECT FOR COV- (1) in the last sentence, by inserting ‘‘, and ERAGE OF SURGICAL FIRST ASSIST- read as follows: before January 1, 2004’’ after ‘‘prior to such ING SERVICES OF CERTIFIED REG- ‘‘(ii) PERMANENT TREATMENT FOR CANCER date)’’; and ISTERED NURSE FIRST ASSISTANTS. HOSPITALS AND CHILDREN’S HOSPITALS.— (2) by adding at the end the following new (a) DEMONSTRATION PROJECT.—The Sec- ‘‘(I) IN GENERAL.—Subject to subclause (II), sentence: ‘‘Effective for items and services retary shall conduct a demonstration project in the case of a hospital described in clause furnished on or after January 1, 2004 (with under part B of title XVIII of the Social Se- (iii) or (v) of section 1886(d)(1)(B), for covered respect to periods beginning on or after June curity Act under which payment is made for OPD services for which the PPS amount is 1, 2002), clauses (i) and (ii) shall be applied by surgical first assisting services furnished by less than the pre-BBA amount, the amount substituting ‘36-month’ for ‘12-month’ each a certified registered nurse first assistant to of payment under this subsection shall be in- place it appears in the first sentence. medicare beneficiaries. creased by the amount of such difference. (b) DEFINITIONS.—In this section: ‘‘(II) SPECIAL RULE FOR CERTAIN CHILDREN’S SEC. 450. REQUIRING THE INTERNAL REVENUE SERVICE TO DEPOSIT INSTALLMENT (1) SURGICAL FIRST ASSISTING SERVICES.— HOSPITALS.—In the case of a hospital de- AGREEMENT AND OTHER FEES IN The term ‘‘surgical first assisting services’’ scribed in section 1886(d)(1)(B)(iii) that is lo- THE TREASURY AS MISCELLANEOUS means services consisting of first assisting a cated in a State with a reimbursement sys- RECEIPTS. physician with surgery and related pre- tem under section 1814(b)(3), but that is not Notwithstanding any other provision of operative, intraoperative, and postoperative reimbursed under such system, for covered law, the Secretary of the Treasury is re- care (as determined by the Secretary) fur- OPD services furnished on or after October 1, quired to deposit in the Treasury as mis- nished by a certified registered nurse first 2003, and for which the PPS amount is less cellaneous receipts any fee receipts, includ- assistant (as defined in paragraph (2)) which than the greater of the pre-BBA amount or ing fees from installment agreements and re- the certified registered nurse first assistant the reasonable operating and capital costs structured installment agreements, collected is legally authorized to perform by the State without reductions of the hospital in pro- under the authority provided by Section 3 of in which the services are performed. viding such services, the amount of payment the Administrative Provisions of the Inter- (2) CERTIFIED REGISTERED NURSE FIRST AS- under this subsection shall be increased by nal Revenue Service of Public Law 103-329, SISTANT.—The term ‘‘certified registered the amount of such difference.’’.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00155 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8802 CONGRESSIONAL RECORD — SENATE June 26, 2003 SEC. 450D. TREATMENT OF PHYSICIANS’ SERV- under subsection (a) shall not exceed the lished in peer-reviewed scientific journals ICES FURNISHED IN ALASKA. cost per recipient per year of the medical nu- using recognized research methods and sta- Section 1848(b) (42 U.S.C. 1395w–4(b)) is tritional therapy benefit currently available tistical analysis that provides— amended— to medicare beneficiaries. (i) assessment of current body weight and (1) in paragraph (1), in the matter pre- (c) SCOPE OF SERVICES.— recording of weight status at each meeting ceding subparagraph (A), by striking ‘‘para- (1) DURATION.—The project shall be con- session; graph (2)’’ and inserting ‘‘paragraphs (2) and ducted for a period of 2 fiscal years. (ii) provision of a healthy eating plan; (4)’’; and (2) SITES.—The Secretary shall designate (iii) provision of an activity plan; (2) by adding at the end the following new the sites at which to conduct the demonstra- (iv) provision of a behavior modification paragraph: tion program under this section. In selecting plan; and ‘‘(4) TREATMENT OF PHYSICIANS’ SERVICES sites under this paragraph, the Secretary (v) a weekly group support meeting. FURNISHED IN ALASKA .— shall give preference to sites located in— (3) GROUP WEIGHT LOSS MANAGEMENT PRO- ‘‘(A) IN GENERAL.—With respect to physi- (A) rural areas; or FESSIONAL.—The term ‘‘group weight loss cians’ services furnished in Alaska on or (B) areas that have a high concentration of management professional’’ means an indi- after January 1, 2004, and before January 1, Native Americans with type 2 diabetes. vidual who has completed training to provide 2006, the fee schedule for such services shall (3) FUNDING.— a program or method that has completed be determined as follows: (A) IN GENERAL.—Subject to subparagraph clinical trials and has demonstrated its effi- ‘‘(i) Subject to clause (ii), the payment (B), the Secretary shall provide for the cacy through publications in peer-reviewed amount for a service furnished in a year transfer from the Federal Supplementary In- scientific journals who— shall be an amount equal to— surance Trust Fund established under sec- (A)(i) holds a baccalaureate or higher de- ‘‘(I) in the case of services furnished in cal- tion 1841 of such Act (42 U.S.C. 1395t) of such gree granted by a regionally accredited col- endar year 2004, 90 percent of the VA Alaska funds as are necessary for the costs of car- lege or university in the United States (or an fee schedule amount for the service for fiscal rying out the demonstration program under equivalent foreign degree) in nutrition social year 2001; and this section. work, psychology with experience in behav- ‘‘(II) in the case of services furnished in (B) LIMITATION.—The total amount of the ioral modification methods to reduce obe- calendar year 2005, the amount determined payments that may be made under this sec- sity; or under subclause (I) for 2004, increased by the tion shall not exceed $2,500,000 for each fiscal annual update determined under subsection (ii) has completed a curriculum of training year in which the project is conducted under for a specific behavioral based weight man- (d) for the year involved. paragraph (1). ‘‘(ii) In the case of a service for which agement program as described in section (d) COVERAGE AS MEDICARE PART B SERV- (4)(A)(2) and recommended in the NIH Clin- there was no VA Alaska fee schedule amount ICES.— for fiscal year 2001, the payment amount ical Guidelines on Identification, Evalua- (1) IN GENERAL.—Subject to the succeeding tion, and Treatment of Overweight and Obe- shall be an amount equal to the sum of— provisions of this subsection, medical nutri- ‘‘(I) the amount of payment for the service sity in Adults, chapter 4, section H, parts 1, tion therapy services furnished under the 2, 3, 4, and pursuant to guidelines by the Sec- that would otherwise apply under this sec- project shall be considered to be services tion; plus retary; and covered under part B of title XVIII of the So- (B)(i) is licensed or certified as a group ‘‘(II) an amount equal to the applicable cial Security Act (42 U.S.C. 1395j et seq.). percent (as described in subparagraph (C)) of weight loss management professional by the (2) PAYMENT.—Payment for such services State in which the services are performed; or the amount described in subclause (I). shall be made at a rate of 80 percent of the ‘‘(B) VA ALASKA FEE SCHEDULE AMOUNT.— (ii) is certified by an organization that lesser of the actual charge for the services or meets such criteria as the Secretary estab- For purposes of this paragraph, the term ‘VA 85 percent of the fee schedule amount pro- Alaska fee schedule amount’ means the lishes with— vided under section 1848 of the Social Secu- amount that was paid by the Department of (I) national organizations representing rity Act (42 U.S.C. 139w–4) for the same serv- Veterans Affairs in Alaska in fiscal year 2001 consumers such as the American Obesity As- ices if such services were furnished by a phy- for non-Department of Veterans Affairs phy- sociation and the elderly; and sician. sicians’ services associated with either out- (II) such other organizations as the Sec- (3) APPLICATION OF LIMITS OF BILLING.—The patient or inpatient care provided to individ- retary determines appropriate. provisions of section 1842(b)(18) of the Social uals eligible for hospital care or medical On page 529, between lines 8 and 9, insert Security Act (42 U.S.C. 1395u(b)(18)) shall services under chapter 17 of title 38, United the following: apply to a group weight loss management States Code, at a non-Department facility SEC. 455. FRONTIER EXTENDED STAY CLINIC professional furnishing services under the (as that term is defined in section 1701(4) of DEMONSTRATION PROJECT. project in the same manner as they to a such title 38. (a) AUTHORITY TO CONDUCT DEMONSTRATION practitioner described in subparagraph (C) of ‘‘(C) APPLICABLE PERCENT.—For purposes of PROJECT.—The Secretary shall waive such this paragraph, the term ‘applicable percent’ such section furnishing services under title provisions of the medicare program estab- means the weighted average percentage XVIII of such Act. lished under title XVIII of the Social Secu- (e) REPORTS.—The Secretary shall submit (based on claims under this section) by rity Act (42 U.S.C. 1395 et seq.) as are nec- to the Committee on Ways and Means and which the fiscal year 2001 VA Alaska fee the Committee on Commerce of the House of essary to conduct a demonstration project schedule amount for physicians’ services ex- Representatives and the Committee on Fi- under which frontier extended stay clinics ceeded the amount of payment for such serv- nance of the Senate interim reports on the described in subsection (b) in isolated rural ices under this section that applied in Alas- project and a final report on the project not areas are treated as providers of items and ka in 2001.’’. later than the date that is 6 months after the services under the medicare program. SEC. 450E. DEMONSTRATION PROJECT TO EXAM- date on which the project concludes. The (b) CLINICS DESCRIBED.—A frontier ex- INE WHAT WEIGHT LOSS WEIGHT tended stay clinic is described in this sub- MANAGEMENT SERVICES CAN COST final report shall include an evaluation of the impact of the use of group weight loss section if the clinic— EFFECTIVELY REACH THE SAME RE- (1) is located in a community where the SULT AS THE NIH DIABETES PRI- management services as part of medical nu- MARY PREVENTION TRIAL STUDY: A trition therapy on medicare beneficiaries closest short-term acute care hospital or 50 PERCENT REDUCTION IN THE and on the medicare program, including any critical access hospital is at least 75 miles RISK FOR TYPE 2 DIABETES FOR IN- impact on reducing costs under the program away from the community or is inaccessible DIVIDUALS WHO HAVE IMPAIRED and improving the health of beneficiaries. by public road; and GLUCOSE TOLERANCE AND ARE (f) DEFINITIONS.—For purposes of this sec- (2) is designed to address the needs of— OBESE. tion: (A) seriously or critically ill or injured pa- (a) IN GENERAL.—Inasmuch as the NIH Dia- (1) The term ‘‘obesity’’ means that an indi- tients who, due to adverse weather condi- betes Primary Prevention Trial study proved vidual has a Body Mass Index (BMI) of 30 and tions or other reasons, cannot be transferred that the risk of type 2 diabetes could be cut quickly to acute care referral centers; or in half when the Institute of Medicine defini- above. (B) patients who need monitoring and ob- tion of successful weight loss (5 percent (2) GROUP WEIGHT LOSS MANAGEMENT SERV- servation for a limited period of time. weight loss maintained for a year) is ICES.—The term ‘‘group weight loss manage- (c) DEFINITIONS.—In this section, the terms achieved by individuals at risk for type 2 dia- ment services’’ means comprehensive serv- ‘‘hospital’’ and ‘‘critical access hospital’’ betes due to obesity and impaired glucose ices furnished to individuals who have been tolerance, the Secretary shall conduct a diagnosed and referred by a physician as hav- have the meanings given such terms in sub- demonstration project to examine the cost ing impaired glucose tolerance and who are sections (e) and (mm), respectively, of sec- effectiveness and health benefits of providing obese that consist of— tion 1861 of the Social Security Act (42 group weight loss management services to (A) assessment and treatment based on the U.S.C. 1395x). achieve the same result for beneficiaries needs of individuals as determined by a SEC. 456. MEDICARE SECONDARY PAYOR (MSP) under the medicare program under title group weight loss management professional; PROVISIONS. XVIII of the Social Security Act who are or (a) TECHNICAL AMENDMENT CONCERNING obese and have impaired glucose tolerance. (B) a specific program or method that has SECRETARY’S AUTHORITY TO MAKE CONDI- (b) LIMITATION.—The cost of the group demonstrated its efficacy to produce and TIONAL PAYMENT WHEN CERTAIN PRIMARY weight loss management services provided maintain weight loss through results pub- PLANS DO NOT PAY PROMPTLY.—

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(1) IN GENERAL.—Section 1862(b)(2) (42 primary plan or from the proceeds of a pri- (1) The formula by which medicare pay- U.S.C. 1395y(b)(2)) is amended— mary plan’s payment to any entity.’’. ments are updated each year for services fur- (A) in subparagraph (A)(ii), by striking (c) CLERICAL AMENDMENTS.—Section 1862(b) nished by physicians and other health profes- ‘‘promptly (as determined in accordance (42 U.S.C. 1395y(b)) is amended— sionals is fundamentally flawed. with regulations)’’; (1) in paragraph (1)(A), by moving the in- (2) The flawed physician payment update (B) in subparagraph (B)— dentation of clauses (ii) through (v) 2 ems to formula is causing a continuing physician (i) by redesignating clauses (i) through (iii) the left; and payment crisis, and, without congressional as clauses (ii) through (iv), respectively; and (2) in paragraph (3)(A), by striking ‘‘such’’ action, medicare payment rates for physi- (ii) by inserting before clause (ii), as so re- before ‘‘paragraphs’’. cians and other practitioners are predicted designated, the following new clause: SEC. 457. MEDICARE PANCREATIC ISLET CELL to fall by 4.2 percent in 2004. ‘‘(i) AUTHORITY TO MAKE CONDITIONAL PAY- TRANSPLANT DEMONSTRATION (3) A physician payment cut in 2004 would PROJECT. MENT.—The Secretary may make payment the fifth cut since 1991, and would be on top under this title with respect to an item or (a) ESTABLISHMENT.—In order to test the of a 5.4 percent cut in 2002, with additional appropriateness of pancreatic islet cell service if a primary plan described in sub- cuts estimated for 2005, 2006, and 2007. From transplantation, not later than 120 days after paragraph (A)(ii) has not made or cannot 1991 through 2003, payment rates for physi- the date of the enactment of this Act, the reasonably be expected to make payment cians and health professionals fell 14 percent Secretary shall establish a demonstration with respect to such item or service prompt- behind practice cost inflation as measured project which the Secretary, provides for ly (as determined in accordance with regula- payment under the medicare program under by medicare’s own conservative estimates. tions). Any such payment by the Secretary title XVIII of the Social Security Act for (4) The sustainable growth rate (SGR) ex- shall be conditioned on reimbursement to pancreatic islet cell transplantation and re- penditure target, which is the basis for the the appropriate Trust Fund in accordance lated items and services in the case of medi- physician payment update, is linked to the with the succeeding provisions of this sub- care beneficiaries who have type I (juvenile) gross domestic product and penalizes physi- section.’’. diabetes and have end stage renal disease. cians and other practitioners for volume in- (2) EFFECTIVE DATE.—The amendments (b) DURATION OF PROJECT.—The authority creases that they cannot control and that made by paragraph (1) shall be effective as if of the Secretary to conduct the demonstra- the government actively promotes through included in the enactment of title III of the tion project under this section shall termi- new coverage decisions, quality improve- Medicare and Medicaid Budget Reconcili- nate on the date that is 5 years after the ment activities, and other initiatives that, ation Amendments of 1984 (Public Law 98- date of the establishment of the project. while beneficial to patients, are not reflected 369). (c) EVALUATION AND REPORT.—The Sec- in the SGR. (b) CLARIFYING AMENDMENTS TO CONDI- retary shall conduct an evaluation of the (b) SENSE OF THE SENATE.—It is the sense TIONAL PAYMENT PROVISIONS.—Section outcomes of the demonstration project. Not of the Senate that medicare beneficiary ac- 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further later than 120 days after the date of the ter- cess to quality care may be compromised if amended— mination of the demonstration project under Congress does not take action to prevent (1) in subparagraph (A), in the matter fol- subsection (b), the Secretary shall submit to cuts in 2004 and the following years that re- lowing clause (ii), by inserting the following Congress a report on the project, including sult from the SGR formula. sentence at the end: ‘‘An entity that engages recommendations for such legislative and On page 542, strike lines 18 through 23, and administrative action as the Secretary in a business, trade, or profession shall be insert the following: deems appropriate. deemed to have a self-insured plan if it car- ‘‘(D) REVIEW ENTITY DEFINED.—For pur- (d) PAYMENT METHODOLOGY.—The Sec- poses of this subsection, the term ‘review en- ries its own risk (whether by a failure to ob- retary shall establish an appropriate pay- tain insurance, or otherwise) in whole or in tity’ means an entity of up to 3 qualified re- ment methodology for the provision of items viewers drawn from existing appeals levels part.’’; and services under the demonstration (2) in subparagraph (B)(ii), as redesignated other than the redetermination level.’’. project, which may include a payment meth- On page 569, between lines 3 and 4, insert by subsection (a)(2)(B)— odology that bundles, to the maximum ex- the following: (A) by striking the first sentence and intent feasible, payment for all such items and serting the following: ‘‘A primary plan, and SEC. 518. REVISIONS TO APPEALS TIMEFRAMES. services. Section 1869 (42 U.S.C. 1395ff) is amended— an entity that receives payment from a pri- SEC. 458. INCREASE IN MEDICARE PAYMENT FOR mary plan, shall reimburse the appropriate (1) in subsection (a)(3)(C)(ii), by striking CERTAIN HOME HEALTH SERVICES. ‘‘30-day period’’ each place it appears and in- Trust Fund for any payment made by the (a) IN GENERAL.—Section 1895 of the Social serting ‘‘60-day period’’; Secretary under this title with respect to an Security Act (42 U.S.C. 1395fff) is amended by (2) in subsection (c)(3)(C)(i), by striking item or service if it is demonstrated that adding at the end the following: ‘‘30-day period’’ and inserting ‘‘60-day pe- such primary plan has or had a responsi- ‘‘(f) INCREASE IN PAYMENT FOR SERVICES bility to make payment with respect to such FURNISHED IN A RURAL AREA.— riod’’; item or service. A primary plan’s responsi- ‘‘(1) IN GENERAL.—In the case of home (3) in subsection (d)(1)(A), by striking ‘‘90- bility for such payment may be dem- health services furnished in a rural area (as day period’’ and inserting ‘‘120-day period’’; onstrated by a judgment, a payment condi- defined in section 1886(d)(2)(D)) on or after and tioned upon the recipient’s compromise, October 1, 2004, and before October 1, 2006, (4) in subsection (d)(2)(A), by striking ‘‘90- waiver, or release (whether or not there is a the Secretary shall increase the payment day period’’ and inserting ‘‘120-day period’’. determination or admission of liability) of amount otherwise made under this section SEC. 519. ELIMINATION OF REQUIREMENT TO payment for items or services included in a for such services by 10 percent. USE SOCIAL SECURITY ADMINISTRA- TION ADMINISTRATIVE LAW ‘‘(2) WAIVER OF BUDGET NEUTRALITY.—The claim against the primary plan or the pri- JUDGES. Secretary shall not reduce the standard pro- mary plan’s insured, or by other means.’’; The first sentence of section 1869(f)(2)(A)(i) spective payment amount (or amounts) and (42 U.S.C. 1395ff(f)(2)(A)(i)) is amended by under this section applicable to home health (B) in the final sentence, by striking ‘‘on striking ‘‘of the Social Security Administra- services furnished during any period to offset the date such notice or other information is tion’’. received’’ and inserting ‘‘on the date notice the increase in payments resulting from the application of paragraph (1).’’. SEC. 520. ELIMINATION OF REQUIREMENT FOR of, or information related to, a primary DE NOVO REVIEW BY THE DEPART- AYMENT DJUSTMENT plan’s responsibility for such payment or (b) P A .—Section MENTAL APPEALS BOARD. other information is received’’; and 1895(b)(5) of the Social Security Act (42 U.S. Section 1869(d)(2) (42 U.S.C. 1395ff(d)(2)) is C. 1395fff(b)(5)) is amended by adding at the (3) in subparagraph (B)(iii), , as redesig- amended to read as follows: end the following:‘‘Notwithstanding this nated by subsection (a)(2)(B), by striking the ‘‘(2) DEPARTMENTAL APPEALS BOARD RE- paragraph, the total amount of the addi- first sentence and inserting the following: VIEW.—The Departmental Appeals Board of tional payments or payment adjustments ‘‘In order to recover payment made under the Department of Health and Human Serv- made under this paragraph may not exceed, this title for an item or service, the United ices shall conduct and conclude a review of States may bring an action against any or with respect to fiscal year 2004, 3 percent, and, with respect to fiscal years 2005 and the decision on a hearing described in para- all entities that are or were required or re- graph (1) and make a decision or remand the sponsible (directly, as an insurer or self-in- 2006, 4 percent, of the total payments projected or estimated to be made based on the case to the administrative law judge for re- surer, as a third-party administrator, as an prospective payment system under this sub- consideration by not later than the end of employer that sponsors or contributes to a section in the year involved.’’. the 90-day period beginning on the date a re- group health plan, or large group health (c) EFFECTIVE DATE.—The amendments quest for review has been timely filed.’’. plan, or otherwise) to make payment with made by this section shall apply to services On page 595, strike lines 1 through 6. respect to the same item or service (or any furnished on or after October 1, 2003. On page 603, after line 25, insert the fol- portion thereof) under a primary plan. The SEC. 459. SENSE OF THE SENATE CONCERNING lowing: United States may, in accordance with para- MEDICARE PAYMENT UPDATE FOR (c) AUTHORIZATION OF APPROPRIATIONS.— graph (3)(A) collect double damages against PHYSICIANS AND OTHER HEALTH There are authorized to be appropriated such any such entity. In addition, the United PROFESSIONALS. sums as are necessary to carry out section States may recover under this clause from (a) FINDINGS.—The Senate makes the fol- 1874A(f) of the Social Security Act, as added any entity that has received payment from a lowing findings: by subsection (a).

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00157 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8804 CONGRESSIONAL RECORD — SENATE June 26, 2003 On page 625, between lines 19 and 20, insert ment processes under this title with respect spect to those States to which paragraph (5) the following: to new technologies and procedures, includ- applies (but without regard to the require- Subtitle F—Other Improvements ing new drug therapies, and shall coordinate ment under such paragraph that total ex- the exchange of information on new tech- penditures under the State plan for dis- SEC. 551. INCLUSION OF ADDITIONAL INFORMA- nologies between CMS and other entities proportionate share hospital adjustments for TION IN NOTICES TO BENEFICIARIES ABOUT SKILLED NURSING FACILITY that make similar decisions. any fiscal year exceeds 0).’’. AND HOSPITAL BENEFITS. ‘‘(4) EXECUTIVE COORDINATOR FOR TECH- On page 676, after line 22, add the fol- (a) IN GENERAL.—The Secretary shall pro- NOLOGY AND INNOVATION.—The Secretary lowing: vide that in medicare beneficiary notices shall appoint (or designate) a noncareer ap- SEC. 615. EMPLOYER FLEXIBILITY. provided (under section 1806(a) of the Social pointee (as defined in section 3132(a)(7) of (a) MEDICARE.—Nothing in part D of title Security Act, 42 U.S.C. 1395b–7(a)) with re- title 5, United States Code) who shall serve XVIII of the Social Security Act, as added by spect to the provision of post-hospital ex- as the Executive Coordinator for Technology section 101, shall be construed as— tended care services and inpatient hospital and Innovation. Such executive coordinator (1) preventing employment-based retiree services under part A of title XVIII of the shall report to the Administrator of CMS, health coverage (as defined in section 1860D– Social Security Act, there shall be included shall chair the Council, shall oversee the 20(e)(4)(B) of such Act, as so added) from pro- information on the number of days of cov- execution of its duties, and shall serve as a viding coverage that is supplemental to the erage of such services remaining under such single point of contact for outside groups benefits provided under a Medicare Prescrip- part for the medicare beneficiary and spell of and entities regarding the coverage, coding, tion Drug plan under such part or a illness involved. and payment processes under this title.’’. MedicareAdvantage plan under part C of (b) EFFECTIVE DATE.—Subsection (a) shall SEC. 555. TREATMENT OF CERTAIN DENTAL such title, as amended by this Act; or apply to notices provided during calendar CLAIMS. (2) requiring employment-based retiree quarters beginning more than 6 months after (a) IN GENERAL.—Section 1862 (42 U.S.C. health coverage (as so defined) that provides the date of enactment of this Act. 1395y) is amended by adding after subsection medical benefits to retired participants who (g) the following new subsection: are not eligible for medical benefits under SEC. 552. INFORMATION ON MEDICARE-CER- ‘‘(h)(1) Subject to paragraph (2), a group TIFIED SKILLED NURSING FACILI- title XVIII of the Social Security Act or health plan (as defined in subsection TIES IN HOSPITAL DISCHARGE under a plan maintained by a State or an PLANS. (a)(1)(A)(v)) providing supplemental or secondary coverage to individuals also entitled agency thereof to provide medical benefits, (a) AVAILABILITY OF DATA.—The Secretary or the same medical benefits, to retired par- shall publicly provide information that en- to services under this title shall not require a medicare claims determination under this ticipants who are so eligible. ables hospital discharge planners, medicare (b) ADEA.— beneficiaries, and the public to identify title for dental benefits specifically excluded under subsection (a)(12) as a condition of (1) IN GENERAL.—Section 4(l) of the Age skilled nursing facilities that are partici- Discrimination in Employment Act of 1967 pating in the medicare program. making a claims determination for such benefits under the group health plan. (29 U.S.C. 623(l)) is amended by adding at the (b) INCLUSION OF INFORMATION IN CERTAIN ‘‘(2) A group health plan may require a end the following: HOSPITAL DISCHARGE PLANS.— claims determination under this title in ‘‘(4) An employee benefit plan (as defined (1) IN GENERAL.—Section 1861(ee)(2)(D) (42 cases involving or appearing to involve inpa- in section 3(3) of the Employee Retirement U.S.C. 1395x(ee)(2)(D)) is amended— tient dental hospital services or dental serv- Income Security Act of 1974 (29 U.S.C. (A) by striking ‘‘hospice services’’ and in- ices expressly covered under this title pursu- 1002(3))) shall not be treated as violating sub- serting ‘‘hospice care and post-hospital ex- ant to actions taken by the Secretary.’’. section (a), (b), (c), or (e) solely because the tended care services’’; and (b) EFFECTIVE DATE.—The amendment plan provides medical benefits to retired par- (B) by inserting before the period at the made by subsection (a) shall take effect on ticipants who are not eligible for medical end the following: ‘‘and, in the case of indi- the date that is 60 days after the date of en- benefits under title XVIII of the Social Secu- viduals who are likely to need post-hospital actment of this Act. rity Act (42 U.S.C. 1395 et seq.) or under a extended care services, the availability of On page 629, between lines 17 and 18, insert plan maintained by a State or an agency such services through facilities that partici- the following: thereof, but does not provide medical bene- pate in the program under this title and that (d) URBAN HEALTH PROVIDER ADJUST- fits, or the same medical benefits, to retired serve the area in which the patient resides’’. MENT.— participants who are so eligible.’’ (2) EFFECTIVE DATE.—The amendments (1) IN GENERAL.—Beginning with fiscal year (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to dis- 2004, notwithstanding section 1923(f) of the made by this subsection shall apply as of the charge plans made on or after such date as Social Security Act (42 U.S.C. 1396r–4(f)) and date of the enactment of this Act. the Secretary shall specify, but not later subject to paragraph (3), with respect to a SEC. 616. 100 PERCENT FMAP FOR MEDICAL AS- than 6 months after the date the Secretary State, payment adjustments made under SISTANCE PROVIDED TO A NATIVE provides for availability of information title XIX of the Social Security Act (42 HAWAIIAN THROUGH A FEDERALLY- under subsection (a). U.S.C. 1396 et seq.) to a hospital described in QUALIFIED HEALTH CENTER OR A SEC. 553. EVALUATION AND MANAGEMENT DOCU- paragraph (2) shall be made without regard NATIVE HAWAIIAN HEALTH CARE MENTATION GUIDELINES CONSIDER- to the DSH allotment limitation for the SYSTEM UNDER THE MEDICAID PRO- GRAM. ATION. State determined under section 1923(f) of (a) MEDICAID.—Section 1905(b) of the Social The Secretary shall ensure, before making that Act (42 U.S.C. 1396r–4(f)). Security Act (42 U.S.C. 1396d(b)) is amended, changes in documentation guidelines for, or (2) HOSPITAL DESCRIBED.—A hospital is de- in the third sentence, by inserting ‘‘, and clinical examples of, or codes to report eval- scribed in this paragraph if the hospital— with respect to medical assistance provided uation and management physician services (A) is owned or operated by a State (as de- to a Native Hawaiian (as defined in section under title XVIII of Social Security Act, fined for purposes of title XIX of the Social 12 of the Native Hawaiian Health Care Im- that the process used in developing such Security Act), or by an instrumentality or a provement Act) through a Federally-quali- guidelines, examples, or codes was widely municipal governmental unit within a State fied health center or a Native Hawaiian consultative among physicians, reflects a (as so defined) as of January 1, 2003; and health care system (as so defined) whether broad consensus among specialties, and (B) is located in Marion County, Indiana. directly, by referral, or under contract or would allow verification of reported and fur- (3) LIMITATION.—The payment adjustment other arrangement between a Federally- nished services. described in paragraph (1) for fiscal year 2004 qualified health center or a Native Hawaiian SEC. 554. COUNCIL FOR TECHNOLOGY AND INNO- and each fiscal year thereafter shall not ex- health care system and another health care VATION. ceed 175 percent of the costs of furnishing provider’’ before the period. Section 1868 (42 U.S.C. 1395ee), as amended hospital services described in section by section 534(a), is amended by adding at 1923(g)(1)(A) of the Social Security Act (42 (b) EFFECTIVE DATE.—The amendment the end the following new subsection: U.S.C. 1396r–4(g)(1)(A)). made by this section applies to medical as- ‘‘(c) COUNCIL FOR TECHNOLOGY AND INNOVA- On page 633, after line 21, add the fol- sistance provided on or after the date of en- TION.— lowing: actment of this Act. ‘‘(1) ESTABLISHMENT.—The Secretary shall (3) APPLICATION TO HAWAII.—Section 1923(f) SEC. 617. EXTENSION OF MORATORIUM. establish a Council for Technology and Inno- (42 U.S.C. 1396r–4(f)), as amended by para- (a) IN GENERAL.—Section 6408(a)(3) of the vation within the Centers for Medicare & graph (1), is amended— Omnibus Budget Reconciliation Act of 1989, Medicaid Services (in this section referred to (A) by redesignating paragraph (7) as para- as amended by section 13642 of the Omnibus as ‘CMS’). graph (8); and Budget Reconciliation Act of 1993 and sec- ‘‘(2) COMPOSITION.—The Council shall be (B) by inserting after paragraph (6), the tion 4758 of the Balanced Budget Act of 1997, composed of senior CMS staff and clinicians following: is amended— and shall be chaired by the Executive Coordi- ‘‘(7) TREATMENT OF HAWAII AS A LOW-DSH (1) by striking ‘‘until December 31, 2002’’, nator for Technology and Innovation (ap- STATE.—The Secretary shall compute a DSH and pointed or designated under paragraph (4)). allotment for the State of Hawaii for each of (2) by striking ‘‘Kent Community Hospital ‘‘(3) DUTIES.—The Council shall coordinate fiscal years 2004 and 2005 in the same manner Complex in Michigan or.’’ the activities of coverage, coding, and pay- as DSH allotments are determined with re- (b) EFFECTIVE DATES.—

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(1) PERMANENT EXTENSION.—The amend- safety net programs (as described in para- submit additional reports to the appropriate ment made by subsection (a)(1) shall take ef- graph (3)(C)) by— committees of Congress on topics relating to fect as if included in the amendment made ‘‘(A) monitoring each health care safety the health care safety net programs under by section 4758 of the Balanced Budget Act of net program to document and analyze the ef- the following circumstances: 1997. fects of changes in these programs on the ‘‘(I) If requested by the Chairpersons or (2) MODIFICATION.—The amendment made core health care safety net; Ranking Minority Members of such commit- by subsection (a)(2) shall take effect on the ‘‘(B) evaluating the impact of the Emer- tees. date of enactment of this Act. gency Medical Treatment and Labor Act, the ‘‘(II) If the Commission deems such addi- SEC. 618. GAO STUDY OF PHARMACEUTICAL Health Insurance Portability and Account- tional reviews and reports appropriate. PRICE CONTROLS AND PATENT PRO- ability Act of 1996, the Balanced Budget Act ‘‘(C) AVAILABILITY OF REPORTS.—The Com- TECTIONS IN THE G-7 COUNTRIES. of 1997, the Medicare, Medicaid, and SCHIP mission shall transmit to the Comptroller (a) STUDY.—The Comptroller General of Balanced Budget Refinement Act of 1999, the General and the Secretary a copy of each re- the United States shall conduct a study of Medicare, Medicaid, and SCHIP Benefits Pro- port submitted under this subsection and price controls imposed on pharmaceuticals tection and Improvement Act of 2000, Pre- shall make such reports available to the pub- in France, Germany, Italy, Japan, the scription Drug and Medicare Improvement lic. United Kingdom and Canada to review the Act of 2003, and other forces on the capacity ‘‘(3) DEFINITIONS.—In this section: impact such regulations have on consumers, of the core health care safety net to continue ‘‘(A) APPROPRIATE COMMITTEES OF CON- including American consumers, and on inno- their roles in the core health care safety net GRESS.—The term ‘appropriate committees vation in medicine. The study shall include system to care for uninsured individuals, of Congress’ means the Committees on Ways the following: medicaid beneficiaries, and other vulnerable and Means and Energy and Commerce of the (1) The pharmaceutical price control struc- populations; House of Representatives and the Commit- ture in each country for a wide range of ‘‘(C) monitoring existing data sets to as- tees on Finance and Health, Education, pharmaceuticals, compared with average sess the status of the core health care safety Labor, and Pensions of the Senate. pharmaceutical prices paid by Americans net and health outcomes for vulnerable pop- covered by private sector health insurance. ulations; ‘‘(B) CORE HEALTH CARE SAFETY NET.—The (2) The proportion of the cost for innova- ‘‘(D) wherever possible, linking and inte- term ‘core health care safety net’ means any tion borne by American consumers, com- grating existing data systems to enhance the health care provider that— pared with consumers in the other 6 coun- ability of the core health care safety net to ‘‘(i) by legal mandate or explicitly adopted tries. track changes in the status of the core mission, offers access to health care services (3) A review of how closely the observed health care safety net and health outcomes to patients, regardless of the ability of the prices in regulated markets correspond to for vulnerable populations; patient to pay for such services; and the prices that efficiently distribute com- ‘‘(E) supporting the development of new ‘‘(ii) has a case mix that is substantially mon costs of production (‘‘Ramsey prices’’). data systems where existing data are insuffi- comprised of patients who are uninsured, (4) A review of any peer-reviewed literature cient or inadequate; covered under the medicaid program, cov- that might show the health consequences to ‘‘(F) developing criteria and indicators of ered under any other public health care pro- patients in the listed countries that result impending core health care safety net fail- gram, or are otherwise vulnerable popu- from the absence or delayed introduction of ure; lations. medicines, including the cost of not having ‘‘(G) establishing an early-warning system Such term includes disproportionate share access to medicines, in terms of lower life to identify impending failures of core health hospitals, Federally qualified health centers, expectancy and lower quality of health. care safety net systems and providers; other Federal, State, and locally supported (5) The impact on American consumers, in ‘‘(H) providing accurate and timely infor- clinics, rural health clinics, local health de- terms of reduced research into new or im- mation to Federal, State, and local policy- partments, and providers covered under the proved pharmaceuticals (including the cost makers on the indicators that may lead to Emergency Medical Treatment and Labor of delaying the introduction of a significant the failure of the core health care safety net Act. advance in certain major diseases), if similar and an estimate of the projected con- ‘‘(C) HEALTH CARE SAFETY NET PROGRAMS.— price controls were adopted in the United sequences of such failures and the impact of The term ‘health care safety net programs’ States. such a failure on the community; includes the following: (6) The existing standards under inter- ‘‘(I) monitoring and providing oversight for ‘‘(i) MEDICAID.—The medicaid program national conventions, including the World the transition of individuals receiving sup- under title XIX. Trade Organization and the North American plemental security income benefits, medical ‘‘(ii) SCHIP.—The State children’s health Free Trade Agreement, regarding regulated assistance under title XIX, or child health insurance program under title XXI. pharmaceutical prices, including any restric- assistance under title XXI who enroll with a ‘‘(iii) MATERNAL AND CHILD HEALTH SERV- tions on anti-competitive laws that might managed care entity (as defined in section ICES BLOCK GRANT PROGRAM.—The maternal apply to price regulations and how economic 1932(a)(1)(B)), including the review of— and child health services block grant pro- harm caused to consumers in markets with- ‘‘(i) the degree to which health plans have gram under title V. out price regulations may be remedied. the capacity (including case management ‘‘(iv) FQHC PROGRAMS.—Each federally (7) In parallel trade regimes, how much of and management information system infra- funded program under which a health center the price difference between countries in the structure) to provide quality managed care (as defined in section 330(1) of the Public European Union is captured by middlemen services to such an individual; Health Service Act), a Federally qualified and how much goes to benefit patients and ‘‘(ii) the degree to which these plans may health center (as defined in section health systems where parallel importing is be overburdened by adverse selection; and 1861(aa)(4)), or a Federally-qualified health significant. ‘‘(iii) the degree to which emergency de- center (as defined in section 1905(l)(2)(B)) re- (8) How much cost is imposed on the owner partments are used by enrollees of these ceives funds. of a property right from counterfeiting and plans; and ‘‘(v) RHC PROGRAMS.—Each federally fund- from international violations of intellectual ‘‘(J) identifying and disseminating the best ed program under which a rural health clinic property rights for prescription medicines. practices for more effective application of (as defined in section 1861(aa)(4) or 1905(l)(1)) (b) REPORT.—Not later than 1 year after the lessons that have been learned. receives funds. the date of enactment of this Act, the Comp- ‘‘(2) REPORTS.— ‘‘(vi) DSH PAYMENT PROGRAMS.—Each fed- troller General of the United States shall ‘‘(A) ANNUAL REPORTS.—Not later than submit to Congress a report on the study June 1 of each year (beginning with 2005), the erally funded program under which a dis- conducted under subsection (a). Commission shall, based on the review con- proportionate share hospital receives funds. SEC. 619. SAFETY NET ORGANIZATIONS AND PA- ducted under paragraph (1), submit to the ap- ‘‘(vii) EMERGENCY MEDICAL TREATMENT AND TIENT ADVISORY COMMISSION. propriate committees of Congress a report ACTIVE LABOR ACT.—All care provided under (a) IN GENERAL.—Title XI (42 U.S.C. 1320 et on— section 1867 for the uninsured, underinsured, seq.) is amended by adding at the end the fol- ‘‘(i) the health care needs of the uninsured; beneficiaries under title XIX, and other vul- lowing new part: and nerable individuals. ‘‘PART D—SAFETY NET ORGANIZATIONS AND ‘‘(ii) the financial and infrastructure sta- ‘‘(viii) OTHER HEALTH CARE SAFETY NET PATIENT ADVISORY COMMISSION bility of the Nation’s core health care safety PROGRAMS.—Such term also includes any other health care program that the Commis- ‘‘SAFETY NET ORGANIZATIONS AND PATIENT net. sion determines to be appropriate. ADVISORY COMMISSION ‘‘(B) AGENDA AND ADDITIONAL REVIEWS.— ‘‘(D) VULNERABLE POPULATIONS.—The term ‘‘SEC. 1181. (a) ESTABLISHMENT.—There is ‘‘(i) AGENDA.—The Chair of the Commis- sion shall consult periodically with the ‘vulnerable populations’ includes uninsured hereby established the Safety Net Organiza- and underinsured individuals, low-income in- tions and Patient Advisory Commission (in Chairpersons and Ranking Minority Mem- dividuals, farm workers, homeless individ- this section referred to as the ‘Commission’). bers of the appropriate committees of Con- uals, individuals with disabilities, individ- ‘‘(b) REVIEW OF HEALTH CARE SAFETY NET gress regarding the Commission’s agenda and uals with HIV or AIDS, and such other indi- PROGRAMS AND REPORTING REQUIREMENTS.— progress toward achieving the agenda. viduals as the Commission may designate. ‘‘(1) REVIEW.—The Commission shall con- ‘‘(ii) ADDITIONAL REVIEWS.—The Commis- duct an ongoing review of the health care sion shall conduct additional reviews and ‘‘(c) MEMBERSHIP.—

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‘‘(1) NUMBER AND APPOINTMENT.—The Com- the member as Chair and a member as Vice troller General submits requests for appro- mission shall be composed of 13 members ap- Chair for that term of appointment, except priations, but amounts appropriated for the pointed by the Comptroller General of the that in the case of vacancy of the Chair or Commission shall be separate from amounts United States (in this section referred to as Vice Chair, the Comptroller General may appropriated for the Comptroller General. the ‘Comptroller General’), in consultation designate another member for the remainder ‘‘(2) AUTHORIZATION.—There are authorized with the appropriate committees of Con- of that member’s term. to be appropriated such sums as may be nec- gress. ‘‘(6) MEETINGS.—The Commission shall essary to carry out the provisions of this sec- ‘‘(2) QUALIFICATIONS.— meet at the call of the Chair or upon the tion.’’. ‘‘(A) IN GENERAL.—The membership of the written request of a majority of its members. (b) EFFECTIVE DATE.—The Comptroller Commission shall include individuals with ‘‘(d) DIRECTOR AND STAFF; EXPERTS AND General of the United States shall appoint national recognition for their expertise in CONSULTANTS.—Subject to such review as the the initial members of the Safety Net Orga- health finance and economics, health care Comptroller General determines necessary nizations and Patient Advisory Commission safety net research and program manage- to ensure the efficient administration of the established under subsection (a) not later ment, actuarial science, health facility man- Commission, the Commission may— than June 1, 2004. agement, health plans and integrated deliv- ‘‘(1) employ and fix the compensation of an ery systems, reimbursement of health facili- Executive Director (subject to the approval SEC. 620. ESTABLISHMENT OF PROGRAM TO PRE- of the Comptroller General) and such other VENT ABUSE OF NURSING FACILITY ties, allopathic and osteopathic medicine (in- RESIDENTS. cluding emergency medicine), and other pro- personnel as may be necessary to carry out (a) IN GENERAL.— viders of health services, and other related the duties of the Commission under this sec- (1) SCREENING OF SKILLED NURSING FACILITY fields, who provide a mix of different profes- tion (without regard to the provisions of AND NURSING FACILITY PROVISIONAL EMPLOY- sionals, broad geographic representation, title 5, United States Code, governing ap- EES.— and a balance between urban and rural rep- pointments in the competitive service); (A) MEDICARE PROGRAM.—Section 1819(b) resentatives. ‘‘(2) seek such assistance and support as (42 U.S.C. 1395i–3(b)) is amended by adding at ‘‘(B) INCLUSION.—The membership of the may be required in the performance of the the end the following: Commission shall include health profes- duties of the Commission under this section ‘‘(8) SCREENING OF SKILLED NURSING FACIL- sionals, employers, third-party payers, indi- from appropriate Federal departments and viduals skilled in the conduct and interpre- agencies; ITY WORKERS.— tation of biomedical, health services, and ‘‘(3) enter into contracts or make other ar- ‘‘(A) BACKGROUND CHECKS OF PROVISIONAL health economics research and expertise in rangements, as may be necessary for the EMPLOYEES.—Subject to subparagraph (B)(ii), outcomes and effectiveness research and conduct of the work of the Commission after a skilled nursing facility selects an in- technology assessment. Such membership (without regard to section 3709 of the Re- dividual for a position as a skilled nursing shall also include recipients of care from vised Statutes (41 U.S.C. 5)); facility worker, the facility, prior to employ- core health care safety net and individuals ‘‘(4) make advance, progress, and other ing such worker in a status other than a pro- who provide and manage the delivery of care payments which relate to the work of the visional status to the extent permitted under by the core health care safety net. Commission; subparagraph (B)(ii), shall— ‘‘(C) MAJORITY NONPROVIDERS.—Individuals ‘‘(5) provide transportation and subsistence ‘‘(i) give such worker written notice that who are directly involved in the provision, or for persons serving without compensation; the facility is required to perform back- management of the delivery, of items and and ground checks with respect to provisional services covered under the health care safety ‘‘(6) prescribe such rules and regulations as employees; net programs shall not constitute a majority it deems necessary with respect to the inter- ‘‘(ii) require, as a condition of employ- of the membership of the Commission. nal organization and operation of the Com- ment, that such worker— ‘‘(D) ETHICAL DISCLOSURE.—The Comp- mission. ‘‘(I) provide a written statement disclosing troller General shall establish a system for ‘‘(e) POWERS.— any conviction for a relevant crime or find- public disclosure by members of the Commis- ‘‘(1) OBTAINING OFFICIAL DATA.— ing of patient or resident abuse; sion of financial and other potential con- ‘‘(A) IN GENERAL.—The Commission may ‘‘(II) provide a statement signed by the flicts of interest relating to such members. secure directly from any department or worker authorizing the facility to request ‘‘(3) TERMS.— agency of the United States information nec- the search and exchange of criminal records; ‘‘(A) IN GENERAL.—The terms of members essary for the Commission to carry the du- ‘‘(III) provide in person to the facility a of the Commission shall be for 3 years except ties under this section. copy of the worker’s fingerprints or thumb that of the members first appointed, the ‘‘(B) REQUEST OF CHAIR.—Upon request of print, depending upon available technology; Comptroller General shall designate— the Chair, the head of that department or and ‘‘(i) four to serve a term of 1 year; agency shall furnish that information to the ‘‘(IV) provide any other identification in- ‘‘(ii) four to serve a term of 2 years; and Commission on an agreed upon schedule. formation the Secretary may specify in reg- ‘‘(iii) five to serve a term of 3 years. ‘‘(2) DATA COLLECTION.—In order to carry ulation; ‘‘(B) VACANCIES.— out the duties of the Commission under this ‘‘(iii) initiate a check of the data collec- ‘‘(i) IN GENERAL.—A vacancy in the Com- section, the Commission shall— tion system established under section 1128E mission shall be filled in the same manner in ‘‘(A) use existing information, both pub- in accordance with regulations promulgated which the original appointment was made. lished and unpublished, where possible, col- by the Secretary to determine whether such ‘‘(ii) APPOINTMENT.—Any member ap- lected and assessed either by the staff of the system contains any disqualifying informa- pointed to fill a vacancy occurring before the Commission or under other arrangements tion with respect to such worker; and expiration of the term for which the mem- made in accordance with this section; ‘‘(iv) if that system does not contain any ber’s predecessor was appointed shall be ap- ‘‘(B) carry out, or award grants or con- such disqualifying information— pointed only for the remainder of that term. tracts for, original research and experimen- ‘‘(I) request through the appropriate State ‘‘(iii) TERMS.—A member may serve after tation, where existing information is inad- agency that the State initiate a State and the expiration of that member’s term until a equate; and national criminal background check on such successor has taken office. ‘‘(C) adopt procedures allowing any inter- worker in accordance with the provisions of ‘‘(4) COMPENSATION.— ested party to submit information for the subsection (e)(6); and ‘‘(A) MEMBERS.—While serving on the busi- Commission’s use in making reports and rec- ‘‘(II) submit to such State agency the in- ness of the Commission (including travel ommendations. formation described in subclauses (II) time), a member of the Commission— ‘‘(3) ACCESS OF GAO TO INFORMATION.—The through (IV) of clause (ii) not more than 7 ‘‘(i) shall be entitled to compensation at Comptroller General shall have unrestricted days (excluding Saturdays, Sundays, and the per diem equivalent of the rate provided access to all deliberations, records, and non- legal public holidays under section 6103(a) of for level IV of the Executive Schedule under proprietary data that pertains to the work of title 5, United States Code) after completion section 5315 of title 5, United States Code; the Commission, immediately upon request. of the check against the system initiated and The expense of providing such information under clause (iii). ‘‘(ii) while so serving away from home and shall be borne by the General Accounting Of- ‘‘(B) PROHIBITION ON HIRING OF ABUSIVE the member’s regular place of business, may fice. WORKERS.— be allowed travel expenses, as authorized by ‘‘(4) PERIODIC AUDIT.—The Commission ‘‘(i) IN GENERAL.—A skilled nursing facility the Commission. shall be subject to periodic audit by the may not knowingly employ any skilled nurs- ‘‘(B) TREATMENT.—For purposes of pay Comptroller General. ing facility worker who has any conviction (other than pay of members of the Commis- ‘‘(f) APPLICATION OF FACA.—Section 14 of for a relevant crime or with respect to whom sion) and employment benefits, rights, and the Federal Advisory Committee Act (5 a finding of patient or resident abuse has privileges, all personnel of the Commission U.S.C. App.) does not apply to the Commis- been made. shall be treated as if they were employees of sion. ‘‘(ii) PROVISIONAL EMPLOYMENT.—After the United States Senate. ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— complying with the requirements of clauses ‘‘(5) CHAIR; VICE CHAIR.—The Comptroller ‘‘(1) REQUEST FOR APPROPRIATIONS.—The (i), (ii), and (iii) of subparagraph (A), a General shall designate a member of the Commission shall submit requests for appro- skilled nursing facility may provide for a Commission, at the time of appointment of priations in the same manner as the Comp- provisional period of employment for a

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skilled nursing facility worker pending com- into account the severity and relevance of ‘‘(B) PROHIBITION ON HIRING OF ABUSIVE pletion of the check against the data collec- such offenses, and after consultation with WORKERS.— tion system described under subparagraph representatives of long-term care providers, ‘‘(i) IN GENERAL.—A nursing facility may (A)(iii) and the background check described representatives of long-term care employees, not knowingly employ any nursing facility under subparagraph (A)(iv). Subject to clause consumer advocates, and appropriate Fed- worker who has any conviction for a rel- (iii), such facility shall maintain direct su- eral and State officials. evant crime or with respect to whom a find- pervision of the covered individual during ‘‘(ii) DISQUALIFYING INFORMATION.—The ing of patient or resident abuse has been the worker’s provisional period of employ- term ‘disqualifying information’ means in- made. ment. formation about a conviction for a relevant ‘‘(ii) PROVISIONAL EMPLOYMENT.—After ‘‘(iii) EXCEPTION FOR SMALL RURAL SKILLED crime or a finding of patient or resident complying with the requirements of clauses NURSING FACILITIES.—In the case of a small abuse. (i), (ii), and (iii) of subparagraph (A), a nurs- rural skilled nursing facility (as defined by ‘‘(iii) FINDING OF PATIENT OR RESIDENT ing facility may provide for a provisional pe- the Secretary), the Secretary shall provide, ABUSE.—The term ‘finding of patient or resi- riod of employment for a nursing facility by regulation after consultation with pro- dent abuse’ means any substantiated finding worker pending completion of the check viders of skilled nursing facility services and by a State agency under subsection (g)(1)(C) against the data collection system described entities representing beneficiaries of such or a Federal agency that a skilled nursing fa- under subparagraph (A)(iii) and the back- services, for an appropriate level of super- cility worker has committed— ground check described under subparagraph vision with respect to any provisional em- ‘‘(I) an act of patient or resident abuse or (A)(iv). Subject to clause (iii), such facility ployees employed by the facility in accord- neglect or a misappropriation of patient or shall maintain direct supervision of the ance with clause (ii). Such regulation should resident property; or worker during the worker’s provisional pe- encourage the provision of direct supervision ‘‘(II) such other types of acts as the Sec- riod of employment. of such employees whenever practicable with retary may specify in regulations. ‘‘(iii) EXCEPTION FOR SMALL RURAL NURSING respect to such a facility and if such super- ‘‘(iv) SKILLED NURSING FACILITY WORKER.— FACILITIES.— vision would not impose an unreasonable The term ‘skilled nursing facility worker’ ‘‘(I) IN GENERAL.—In the case of a small cost or other burden on the facility. means any individual (other than a volun- rural nursing facility (as defined by the Sec- ‘‘(C) REPORTING REQUIREMENTS.—A skilled teer) that has access to a patient of a skilled retary), the Secretary shall provide, by regu- nursing facility shall report to the State any nursing facility under an employment or lation after consultation with providers of instance in which the facility determines other contract, or both, with such facility. nursing facility services and entities rep- that a skilled nursing facility worker has Such term includes individuals who are li- resenting beneficiaries of such services, for committed an act of resident neglect or censed or certified by the State to provide an appropriate level of supervision with re- abuse or misappropriation of resident prop- such services, and nonlicensed individuals spect to any provisional employees employed erty in the course of employment by the fa- providing such services, as defined by the by the facility in accordance with clause (ii). cility. Secretary, including nurse assistants, nurse Such regulation should encourage the provi- ‘‘(D) USE OF INFORMATION.— aides, home health aides, and personal care sion of direct supervision of such employees ‘‘(i) IN GENERAL.—A skilled nursing facility workers and attendants.’’. whenever practicable with respect to such a that obtains information about a skilled (B) MEDICAID PROGRAM.—Section 1919(b) (42 facility and if such supervision would not nursing facility worker pursuant to clauses U.S.C. 1396r(b)) is amended by adding at the impose an unreasonable cost or other burden (iii) and (iv) of subparagraph (A) may use end the following new paragraph: on the facility. such information only for the purpose of de- ‘‘(8) SCREENING OF NURSING FACILITY WORK- ‘‘(C) REPORTING REQUIREMENTS.—A nursing termining the suitability of the worker for ERS.— facility shall report to the State any in- employment. ‘‘(A) BACKGROUND CHECKS ON PROVISIONAL stance in which the facility determines that ‘‘(ii) IMMUNITY FROM LIABILITY.—A skilled EMPLOYEES.—Subject to subparagraph (B)(ii), a nursing facility worker has committed an nursing facility that, in denying employ- after a nursing facility selects an individual act of resident neglect or abuse or misappro- ment for an individual selected for hiring as for a position as a nursing facility worker, priation of resident property in the course of a skilled nursing facility worker (including the facility, prior to employing such worker during the period described in subparagraph in a status other than a provisional status to employment by the facility. (B)(ii)), reasonably relies upon information the extent permitted under subparagraph ‘‘(D) USE OF INFORMATION.— about such individual provided by the State (B)(ii), shall— ‘‘(i) IN GENERAL.—A nursing facility that pursuant to subsection (e)(6) or section 1128E ‘‘(i) give the worker written notice that obtains information about a nursing facility shall not be liable in any action brought by the facility is required to perform back- worker pursuant to clauses (iii) and (iv) of such individual based on the employment de- ground checks with respect to provisional subparagraph (A) may use such information termination resulting from the information. employees; only for the purpose of determining the suit- ‘‘(iii) CRIMINAL PENALTY.—Whoever know- ‘‘(ii) require, as a condition of employ- ability of the worker for employment. ingly violates the provisions of clause (i) ment, that such worker— ‘‘(ii) IMMUNITY FROM LIABILITY.—A nursing shall be fined in accordance with title 18, ‘‘(I) provide a written statement disclosing facility that, in denying employment for an United States Code, imprisoned for not more any conviction for a relevant crime or find- individual selected for hiring as a nursing fa- than 2 years, or both. ing of patient or resident abuse; cility worker (including during the period ‘‘(E) CIVIL PENALTY.— ‘‘(II) provide a statement signed by the described in subparagraph (B)(ii)), reason- ‘‘(i) IN GENERAL.—A skilled nursing facility worker authorizing the facility to request ably relies upon information about such indi- that violates the provisions of this para- the search and exchange of criminal records; vidual provided by the State pursuant to graph shall be subject to a civil penalty in an ‘‘(III) provide in person to the facility a subsection (e)(6) or section 1128E shall not be amount not to exceed— copy of the worker’s fingerprints or thumb liable in any action brought by such indi- ‘‘(I) for the first such violation, $2,000; and print, depending upon available technology; vidual based on the employment determina- ‘‘(II) for the second and each subsequent and tion resulting from the information. violation within any 5-year period, $5,000. ‘‘(IV) provide any other identification in- ‘‘(iii) CRIMINAL PENALTY.—Whoever know- ‘‘(ii) KNOWING RETENTION OF WORKER.—In formation the Secretary may specify in reg- ingly violates the provisions of clause (i) addition to any civil penalty under clause ulation; shall be fined in accordance with title 18, (i), a skilled nursing facility that— ‘‘(iii) initiate a check of the data collec- United States Code, imprisoned for not more ‘‘(I) knowingly continues to employ a tion system established under section 1128E than 2 years, or both. skilled nursing facility worker in violation in accordance with regulations promulgated ‘‘(E) CIVIL PENALTY.— of subparagraph (A) or (B); or by the Secretary to determine whether such ‘‘(i) IN GENERAL.—A nursing facility that ‘‘(II) knowingly fails to report a skilled system contains any disqualifying informa- violates the provisions of this paragraph nursing facility worker under subparagraph tion with respect to such worker; and shall be subject to a civil penalty in an (C), ‘‘(iv) if that system does not contain any amount not to exceed— shall be subject to a civil penalty in an such disqualifying information— ‘‘(I) for the first such violation, $2,000; and amount not to exceed $5,000 for the first such ‘‘(I) request through the appropriate State ‘‘(II) for the second and each subsequent violation, and $10,000 for the second and each agency that the State initiate a State and violation within any 5-year period, $5,000. subsequent violation within any 5-year pe- national criminal background check on such ‘‘(ii) KNOWING RETENTION OF WORKER.—In riod. worker in accordance with the provisions of addition to any civil penalty under clause ‘‘(F) DEFINITIONS.—In this paragraph: subsection (e)(8); and (i), a nursing facility that— ‘‘(i) CONVICTION FOR A RELEVANT CRIME.— ‘‘(II) submit to such State agency the in- ‘‘(I) knowingly continues to employ a nurs- The term ‘conviction for a relevant crime’ formation described in subclauses (II) ing facility worker in violation of subpara- means any Federal or State criminal convic- through (IV) of clause (ii) not more than 7 graph (A) or (B); or tion for— days (excluding Saturdays, Sundays, and ‘‘(II) knowingly fails to report a nursing fa- ‘‘(I) any offense described in paragraphs (1) legal public holidays under section 6103(a) of cility worker under subparagraph (C), through (4) of section 1128(a); and title 5, United States Code) after completion shall be subject to a civil penalty in an ‘‘(II) such other types of offenses as the of the check against the system initiated amount not to exceed $5,000 for the first such Secretary may specify in regulations, taking under clause (iii). violation, and $10,000 for the second and each

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00161 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8808 CONGRESSIONAL RECORD — SENATE June 26, 2003 subsequent violation within any 5-year pe- (B) requires a long-term care facility (as so an employee any charges relating to the per- riod. defined) to conduct a background check formance of a background check under this ‘‘(F) DEFINITIONS.—In this paragraph: prior to employing an individual in an em- paragraph. ‘‘(i) CONVICTION FOR A RELEVANT CRIME.— ployment position that is not included in the ‘‘(E) REGULATIONS.— The term ‘conviction for a relevant crime’ positions for which a background check is re- ‘‘(i) IN GENERAL.—In addition to the Sec- means any Federal or State criminal convic- quired under such sections. retary’s authority to promulgate regulations tion for— (4) TECHNICAL AMENDMENTS.—Effective as if under this title, the Attorney General, in ‘‘(I) any offense described in paragraphs (1) included in the enactment of section 941 of consultation with the Secretary, may pro- through (4) of section 1128(a); and BIPA (114 Stat. 2763A–585), sections 1819(b) mulgate such regulations as are necessary to ‘‘(II) such other types of offenses as the and 1919(b) (42 U.S.C. 1395i–3(b), 1396r(b)), as carry out the Attorney General’s responsibil- Secretary may specify in regulations, taking amended by such section 941 are each amend- ities under this paragraph and subsection into account the severity and relevance of ed by redesignating the paragraph (8) added (b)(9), including regulations regarding the se- such offenses, and after consultation with by such section as paragraph (9). curity confidentiality, accuracy, use, de- representatives of long-term care providers, (b) FEDERAL AND STATE REQUIREMENTS struction, and dissemination of information, CONCERNING BACKGROUND CHECKS.— representatives of long-term care employees, audits and recordkeeping, and the imposition (1) MEDICARE.—Section 1819(e) (42 U.S.C. consumer advocates, and appropriate Fed- of fees. eral and State officials. 1395i–3(e)) is amended by adding at the end ‘‘(ii) APPEAL PROCEDURES.—The Attorney the following: ‘‘(ii) DISQUALIFYING INFORMATION.—The General, in consultation with the Secretary, term ‘disqualifying information’ means in- ‘‘(6) FEDERAL AND STATE REQUIREMENTS shall promulgate such regulations as are formation about a conviction for a relevant CONCERNING CRIMINAL BACKGROUND CHECKS ON necessary to establish procedures by which a crime or a finding of patient or resident SKILLED NURSING FACILITY EMPLOYEES.— provisional employee or an employee may abuse. ‘‘(A) IN GENERAL.—Upon receipt of a re- appeal or dispute the accuracy of the infor- ‘‘(iii) FINDING OF PATIENT OR RESIDENT quest by a skilled nursing facility pursuant mation obtained in a background check con- ABUSE.—The term ‘finding of patient or resi- to subsection (b)(8) that is accompanied by ducted under this paragraph. Appeals shall dent abuse’ means any substantiated finding the information described in subclauses (II) be limited to instances in which a provi- by a State agency under subsection (g)(1)(C) through (IV) of subsection (b)(8)(A)(ii), a or a Federal agency that a nursing facility State, after checking appropriate State sional employee or an employee is incor- worker has committed— records and finding no disqualifying informa- rectly identified as the subject of the back- ‘‘(I) an act of patient or resident abuse or tion (as defined in subsection (b)(8)(F)(ii)), ground check, or when information about neglect or a misappropriation of patient or shall immediately submit such request and the provisional employee or employee has resident property; or information to the Attorney General and not been updated to reflect changes in the ‘‘(II) such other types of acts as the Sec- shall request the Attorney General to con- provisional employee’s or employee’s crimi- retary may specify in regulations. duct a search and exchange of records with nal record. ‘‘(iv) NURSING FACILITY WORKER.—The term respect to the individual as described in sub- ‘‘(F) REPORT.—Not later than 2 years after ‘nursing facility worker’ means any indi- paragraph (B). the date of enactment of this paragraph, the vidual (other than a volunteer) that has ac- ‘‘(B) SEARCH AND EXCHANGE OF RECORDS BY Attorney General shall submit a report to cess to a patient of a nursing facility under ATTORNEY GENERAL.—Upon receipt of a sub- Congress on— an employment or other contract, or both, mission pursuant to subparagraph (A), the ‘‘(i) the number of requests for searches with such facility. Such term includes indi- Attorney General shall direct a search of the and exchanges of records made under this viduals who are licensed or certified by the records of the Federal Bureau of Investiga- section; State to provide such services, and non- tion for any criminal history records cor- ‘‘(ii) the disposition of such requests; and licensed individuals providing such services, responding to the fingerprints and other ‘‘(iii) the cost of responding to such re- as defined by the Secretary, including nurse positive identification information sub- quests.’’. assistants, nurse aides, home health aides, mitted. The Attorney General shall provide (2) MEDICAID.—Section 1919(e) (42 U.S.C. and personal care workers and attendants.’’. any corresponding information resulting 1396r(e)) is amended by adding at the end the (2) FEDERAL RESPONSIBILITIES.— from the search to the State. following: (A) DEVELOPMENT OF STANDARD FEDERAL ‘‘(C) STATE REPORTING OF INFORMATION TO ‘‘(8) FEDERAL AND STATE REQUIREMENTS AND STATE BACKGROUND CHECK FORM.—The SKILLED NURSING FACILITY.—Upon receipt of CONCERNING CRIMINAL BACKGROUND CHECKS ON Secretary of Health and Human Services, in the information provided by the Attorney NURSING FACILITY EMPLOYEES.— consultation with the Attorney General and General pursuant to subparagraph (B), the ‘‘(A) IN GENERAL.—Upon receipt of a re- representatives of appropriate State agen- State shall— quest by a nursing facility pursuant to sub- cies, shall develop a model form that a provi- ‘‘(i) review the information to determine section (b)(8) that is accompanied by the in- sional employee at a nursing facility may whether the individual has any conviction formation described in subclauses (II) complete and Federal and State agencies for a relevant crime (as defined in subsection through (IV) of subsection (b)(8)(A)(ii), a may use to conduct the criminal background (b)(8)(F)(i)); State, after checking appropriate State checks required under sections 1819(b)(8) and ‘‘(ii) immediately report to the skilled records and finding no disqualifying informa- 1919(b)(8) of the Social Security Act (42 nursing facility in writing the results of such tion (as defined in subsection (b)(8)(F)(ii)), U.S.C. 1395i–3(b), 1396r(b)) (as added by this review; and shall immediately submit such request and section). ‘‘(iii) in the case of an individual with a information to the Attorney General and (B) PERIODIC EVALUATION.—The Secretary conviction for a relevant crime, report the shall request the Attorney General to con- of Health and Human Services, in consulta- existence of such conviction of such indi- duct a search and exchange of records with tion with the Attorney General, periodically vidual to the database established under sec- respect to the individual as described in sub- shall evaluate the background check system tion 1128E. paragraph (B). imposed under sections 1819(b)(8) and ‘‘(D) FEES FOR PERFORMANCE OF CRIMINAL ‘‘(B) SEARCH AND EXCHANGE OF RECORDS BY 1919(b)(8) of the Social Security Act (42 BACKGROUND CHECKS.— ATTORNEY GENERAL.—Upon receipt of a sub- U.S.C. 1395i–3(b), 1396r(b)) (as added by this ‘‘(i) AUTHORITY TO CHARGE FEES.— mission pursuant to subparagraph (A), the section) and shall implement changes, as ‘‘(I) ATTORNEY GENERAL.—The Attorney Attorney General shall direct a search of the necessary, based on available technology, to General may charge a fee to any State re- records of the Federal Bureau of Investiga- make the background check system more ef- questing a search and exchange of records tion for any criminal history records cor- ficient and able to provide a more immediate pursuant to this paragraph and subsection responding to the fingerprints and other response to long-term care providers using (b)(8) for conducting the search and pro- positive identification information sub- the system. viding the records. The amount of such fee mitted. The Attorney General shall provide (3) NO PREEMPTION OF STRICTER STATE shall not exceed the lesser of the actual cost any corresponding information resulting LAWS.—Nothing in section 1819(b)(8) or of such activities or $50. Such fees shall be from the search to the State. 1919(b)(8) of the Social Security Act (42 available to the Attorney General, or, in the ‘‘(C) STATE REPORTING OF INFORMATION TO U.S.C. 1395i–3(b)(8), 1396r(b)(8)) (as so added) Attorney General’s discretion, to the Federal NURSING FACILITY.—Upon receipt of the infor- shall be construed to supersede any provision Bureau of Investigation until expended. mation provided by the Attorney General of State law that— ‘‘(II) STATE.—A State may charge a skilled pursuant to subparagraph (B), the State (A) specifies a relevant crime for purposes nursing facility a fee for initiating the shall— of prohibiting the employment of an indi- criminal background check under this para- ‘‘(i) review the information to determine vidual at a long-term care facility (as de- graph and subsection (b)(8), including fees whether the individual has any conviction fined in section 1128E(g)(6) of the Social Se- charged by the Attorney General, and for for a relevant crime (as defined in subsection curity Act (as added by subsection (e)) that performing the review and report required by (b)(8)(F)(i)); is not included in the list of such crimes subparagraph (C). The amount of such fee ‘‘(ii) immediately report to the nursing fa- specified in such sections or in regulations shall not exceed the actual cost of such ac- cility in writing the results of such review; promulgated by the Secretary of Health and tivities. and Human Services to carry out such sections; ‘‘(ii) PROHIBITION ON CHARGING.—An entity ‘‘(iii) in the case of an individual with a or may not impose on a provisional employee or conviction for a relevant crime, report the

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00162 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8809 existence of such conviction of such indi- hospice care under this title), or long-term (aa) by striking ‘‘By not later than Janu- vidual to the database established under sec- care services to an individual entitled to ary 1, 1989, the’’ and inserting ‘‘The’’; tion 1128E. benefits under part A or enrolled under part (bb) by striking ‘‘a registry of all individ- ‘‘(D) FEES FOR PERFORMANCE OF CRIMINAL B, including an individual provided with a uals’’ and inserting ‘‘a registry of (i) all indi- BACKGROUND CHECKS.— Medicare+Choice plan offered by a viduals’’; and ‘‘(i) AUTHORITY TO CHARGE FEES.— Medicare+Choice organization under part C (cc) by inserting before the period the fol- ‘‘(I) ATTORNEY GENERAL.—The Attorney (in this section referred to as a ‘medicare lowing: ‘‘, (ii) all other skilled nursing facil- General may charge a fee to any State re- beneficiary’). ity employees with respect to whom the questing a search and exchange of records ‘‘(b) SUPERVISION OF PROVISIONAL EMPLOY- State has made a finding described in sub- pursuant to this paragraph and subsection EES.— paragraph (B), and (iii) any employee of any (b)(8) for conducting the search and pro- ‘‘(1) IN GENERAL.—With respect to an entity provider of services or any other entity that viding the records. The amount of such fee that provides home health services, such en- is eligible to be paid under this title for pro- shall not exceed the lesser of the actual cost tity shall be considered to have satisfied the viding home health services, hospice care of such activities or $50. Such fees shall be requirements of section 1819(b)(8)(B)(ii) or (including routine home care and other serv- available to the Attorney General, or, in the 1919(b)(8)(B)(ii) if the entity meets such re- ices included in hospice care under this Attorney General’s discretion, to the Federal quirements for supervision of provisional title), or long-term care services and with re- Bureau of Investigation, until expended. employees of the entity as the Secretary spect to whom the entity has reported to the ‘‘(II) STATE.—A State may charge a nurs- shall, by regulation, specify in accordance State a finding of patient neglect or abuse or ing facility a fee for initiating the criminal with paragraph (2). background check under this paragraph and a misappropriation of patient property’’; and ‘‘(2) REQUIREMENTS.—The regulations re- (III) in subparagraph (C), by striking ‘‘a subsection (b)(8), including fees charged by quired under paragraph (1) shall provide the the Attorney General, and for performing nurse aide’’ and inserting ‘‘an individual’’; following: and the review and report required by subpara- ‘‘(A) Supervision of a provisional employee (ii) in subsection (g)(1)— graph (C). The amount of such fee shall not shall consist of ongoing, good faith, (I) by striking the first sentence of sub- exceed the actual cost of such activities. verifiable efforts by the supervisor of the paragraph (C) and inserting the following: ‘‘(ii) PROHIBITION ON CHARGING.—An entity provisional employee to conduct monitoring ‘‘The State shall provide, through the agen- may not impose on a provisional employee or and oversight activities to ensure the safety cy responsible for surveys and certification an employee any charges relating to the per- of a medicare beneficiary. formance of a background check under this ‘‘(B) For purposes of subparagraph (A), of skilled nursing facilities under this subparagraph. monitoring and oversight activities may in- section, for a process for the receipt and ‘‘(E) REGULATIONS.— clude (but are not limited to) the following: timely review and investigation of allega- ‘‘(i) IN GENERAL.—In addition to the Sec- ‘‘(i) Follow-up telephone calls to the medi- tions of neglect and abuse and misappropria- retary’s authority to promulgate regulations care beneficiary. tion of resident property by a nurse aide or under this title, the Attorney General, in ‘‘(ii) Unannounced visits to the medicare a skilled nursing facility employee of a resi- consultation with the Secretary, may pro- beneficiary’s home while the provisional em- dent in a skilled nursing facility, by another mulgate such regulations as are necessary to ployee is serving the medicare beneficiary. individual used by the facility in providing carry out the Attorney General’s responsibil- ‘‘(iii) To the extent practicable, limiting services to such a resident, or by an indi- ities under this paragraph and subsection the provisional employee’s duties to serving vidual described in subsection (e)(2)(A)(iii).’’; (b)(8), including regulations regarding the se- only those medicare beneficiaries in a home and curity, confidentiality, accuracy, use, de- or setting where another family member or (II) in the fourth sentence of subparagraph struction, and dissemination of information, resident of the home or setting of the medi- (C), by inserting ‘‘or described in subsection audits and recordkeeping, and the imposition care beneficiary is present. (e)(2)(A)(iii)’’ after ‘‘used by the facility’’; of fees. ‘‘(C) In promulgating such regulations, the and ‘‘(ii) APPEAL PROCEDURES.—The Attorney Secretary shall take into account the staff- (III) in subparagraph (D)— General, in consultation with the Secretary, ing and geographic issues faced by small (aa) in the subparagraph heading, by strik- shall promulgate such regulations as are rural entities (as defined by the Secretary) ing ‘‘NURSE AIDE’’; and necessary to establish procedures by which a that provide home health services, hospice (bb) in clause (i), in the matter preceding provisional employee or an employee may care (including routine home care and other subclause (I), by striking ‘‘a nurse aide’’ and appeal or dispute the accuracy of the infor- services included in hospice care under this inserting ‘‘an individual’’; and mation obtained in a background check con- title), or other long-term care services. Such (cc) in clause (i)(I), by striking ‘‘nurse ducted under this paragraph. Appeals shall regulations should encourage the provision aide’’ and inserting ‘‘individual’’. be limited to instances in which a provi- of monitoring and oversight activities when- (B) MEDICAID.—Section 1919 (42 U.S.C. sional employee or an employee is incor- ever practicable with respect to such an enti- 1396r) is amended— rectly identified as the subject of the back- ty, and if such activities would not impose (i) in subsection (e)(2)— ground check, or when information about an unreasonable cost or other burden on the (I) in the paragraph heading, by striking the provisional employee or employee has entity.’’. ‘‘NURSE AIDE REGISTRY’’ and inserting ‘‘EM- not been updated to reflect changes in the (2) MEDICAID.—Section 1902(a) (42 U.S.C. PLOYEE REGISTRY’’; provisional employee’s or employee’s crimi- 1396a), as amended by section 104(a), is (II) in subparagraph (A)— nal record. amended— (aa) by striking ‘‘By not later than Janu- ‘‘(F) REPORT.—Not later than 2 years after (A) in paragraph (65), by striking ‘‘and’’ at the date of enactment of this paragraph, the ary 1, 1989, the’’ and inserting ‘‘The’’; the end; (bb) by striking ‘‘a registry of all individ- Attorney General shall submit a report to (B) in paragraph (66), by striking the pe- Congress on— uals’’ and inserting ‘‘a registry of (i) all indi- riod and inserting ‘‘; and’’; and viduals’’; and ‘‘(i) the number of requests for searches (C) by inserting after paragraph (66) the (cc) by inserting before the period the fol- and exchanges of records made under this following: lowing: ‘‘, (ii) all other nursing facility em- section; ‘‘(67) provide that any entity that is eligi- ployees with respect to whom the State has ‘‘(ii) the disposition of such requests; and ble to be paid under the State plan for pro- made a finding described in subparagraph ‘‘(iii) the cost of responding to such re- viding home health services, hospice care (B), and (iii) any employee of an entity that quests.’’. (including routine home care and other serv- (c) APPLICATION TO OTHER ENTITIES PRO- ices included in hospice care under title is eligible to be paid under the State plan for VIDING HOME HEALTH OR LONG-TERM CARE XVIII), or long-term care services for which providing home health services, hospice care SERVICES.— medical assistance is available under the (including routine home care and other serv- (1) MEDICARE.—Part D of title XVIII (42 State plan to individuals requiring long- ices included in hospice care under title U.S.C. 1395x et seq.) is amended by adding at term care complies with the requirements of XVIII), or long-term care services and with the end the following: subsections (b)(8) and (e)(8) of section 1919 respect to whom the entity has reported to ‘‘APPLICATION OF SKILLED NURSING FACILITY and section 1897(b) (in the same manner as the State a finding of patient neglect or PREVENTIVE ABUSE PROVISIONS TO ANY PRO- such section applies to a medicare bene- abuse or a misappropriation of patient prop- VIDER OF SERVICES OR OTHER ENTITY PRO- ficiary).’’. erty’’; and VIDING HOME HEALTH OR LONG-TERM CARE (3) EXPANSION OF STATE NURSE AIDE REG- (III) in subparagraph (C), by striking ‘‘a SERVICES ISTRY.— nurse aide’’ and inserting ‘‘an individual’’; ‘‘SEC. 1897. (a) IN GENERAL.—The require- (A) MEDICARE.—Section 1819 (42 U.S.C. and ments of subsections (b)(8) and (e)(6) of sec- 1395i–3) is amended— (ii) in subsection (g)(1)— tion 1819 shall apply to any provider of serv- (i) in subsection (e)(2)— (I) by striking the first sentence of sub- ices or any other entity that is eligible to be (I) in the paragraph heading, by striking paragraph (C) and inserting the following: paid under this title for providing home ‘‘NURSE AIDE REGISTRY’’ and inserting ‘‘EM- ‘‘The State shall provide, through the agen- health services, hospice care (including rou- PLOYEE REGISTRY’’; cy responsible for surveys and certification tine home care and other services included in (II) in subparagraph (A)— of nursing facilities under this subsection,

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00163 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8810 CONGRESSIONAL RECORD — SENATE June 26, 2003 for a process for the receipt and timely re- section prior to hiring under an employment 3(a)) or a nursing facility (as defined in sec- view and investigation of allegations of ne- or other contract, or both, (other than in a tion 1919(a) of the Social Security Act (42 glect and abuse and misappropriation of resi- provisional status) any individual as an em- U.S.C. 1396r(a)), this section and the amend- dent property by a nurse aide or a nursing fa- ployee of such a facility or provider who will ments made by this section shall take effect cility employee of a resident in a nursing fa- have access to a patient or resident of the fa- on the date that is the earlier of— cility, by another individual used by the facility or provider (including individuals who (A) 6 months after the effective date of cility in providing services to such a resi- are licensed or certified by the State to pro- final regulations promulgated to carry out dent, or by an individual described in sub- vide services at the facility or through the this section and such amendments; or section (e)(2)(A)(iii).’’; and provider, and nonlicensed individuals, as de- (B) January 1, 2006. (II) in the fourth sentence of subparagraph fined by the Secretary, that will provide (2) LONG-TERM CARE FACILITIES AND PRO- (C), by inserting ‘‘or described in subsection services at the facility or through the pro- VIDERS.—With respect to a long-term care fa- (e)(2)(A)(iii)’’ after ‘‘used by the facility’’; vider, including nurse assistants, nurse cility or provider (as defined in section and aides, home health aides, individuals who 1128E(g)(6) of the Social Security Act (42 (III) in subparagraph (D)— provide home care, and personal care work- U.S.C. 1320a–7e(g)(6)) (as added by subsection (aa) in the subparagraph heading, by strik- ers and attendants).’’. (e)), this section and the amendments made ing ‘‘NURSE AIDE’’; and (6) DEFINITION OF LONG-TERM CARE FACILITY by this section shall take effect on the date (bb) in clause (i), in the matter preceding OR PROVIDER.—Section 1128E(g) (42 U.S.C. that is the earlier of— subclause (I), by striking ‘‘a nurse aide’’ and 1320a–7e(g)) is amended by adding at the end (A) 18 months after the effective date of inserting ‘‘an individual’’; and the following: final regulations promulgated to carry out (cc) in clause (i)(I), by striking ‘‘nurse ‘‘(6) LONG-TERM CARE FACILITY OR PRO- this section and such amendments; or aide’’ and inserting ‘‘individual’’. VIDER.—The term ‘long-term care facility or (B) January 1, 2007. (d) REIMBURSEMENT OF COSTS FOR BACK- provider’ means a skilled nursing facility (as SEC. 621. OFFICE OF RURAL HEALTH POLICY IM- GROUND CHECKS.—The Secretary of Health defined in section 1819(a)), a nursing facility PROVEMENTS. and Human Services shall reimburse nursing (as defined in section 1919(a)), a home health Section 711(b) (42 U.S.C. 912(b)) is amend- facilities, skilled nursing facilities, and agency, a provider of hospice care (as defined other entities for costs incurred by the fa- ed— in section 1861(dd)(1)), a long-term care hos- (1) in paragraph (3), by striking ‘‘and’’ cilities and entities in order to comply with pital (as described in section after the comma at the end; the requirements imposed under sections 1886(d)(1)(B)(iv)), an intermediate care facil- (2) in paragraph (4), by inserting ‘‘and’’ 1819(b)(8) and 1919(b)(8) of such Act (42 U.S.C. ity for the mentally retarded (as defined in after the comma at the end; and 1395i–3(b)(8), 1396r(b)(8)), as added by this sec- section 1905(d)), or any other facility or enti- (3) by inserting after paragraph (4) the fol- tion. ty that provides, or is a provider of, long- lowing new paragraph: (e) INCLUSION OF ABUSIVE ACTS WITHIN A term care services, home health services, or ‘‘(5) administer grants, cooperative agree- LONG-TERM CARE FACILITY OR PROVIDER IN hospice care (including routine home care ments, and contracts to provide technical as- THE NATIONAL HEALTH CARE FRAUD AND and other services included in hospice care sistance and other activities as necessary to ABUSE DATA COLLECTION PROGRAM.— under title XVIII), and receives payment for (1) IN GENERAL.—Section 1128E(g)(1)(A) (42 such services under the medicare program support activities related to improving U.S.C. 1320a–7e(g)(1)(A)) is amended— under title XVIII or the medicaid program health care in rural areas.’’. (A) by redesignating clause (v) as clause under title XIX.’’. f (vi); and (7) AUTHORIZATION OF APPROPRIATIONS.— (B) by inserting after clause (iv), the fol- There is authorized to be appropriated to AUTHORITY FOR COMMITTEES TO lowing: carry out the amendments made by this sub- MEET ‘‘(v) A finding of abuse or neglect of a pa- section, $10,200,000 for fiscal year 2004. COMMITTEE ON AGRICULTURE, NUTRITION, AND tient or a resident of a long-term care facil- REVENTION AND RAINING EMONSTRA (f) P T D - FORESTRY ity, or misappropriation of such a patient’s TION PROJECT.— or resident’s property.’’. (1) ESTABLISHMENT.—The Secretary of Mr. MCCONNELL. Mr. President, I ask (2) COVERAGE OF LONG-TERM CARE FACILITY Health and Human Services shall establish a unanimous consent that the Com- OR PROVIDER EMPLOYEES.—Section 1128E(g)(2) demonstration program to provide grants to mittee on Agriculture, Nutrition, and (42 U.S.C. 1320a–7e(g)(2)) is amended by in- develop information on best practices in pa- Forestry be authorized to conduct a serting ‘‘, and includes any individual of a tient abuse prevention training (including hearing during the session of the Sen- long-term care facility or provider (other behavior training and interventions) for ate on Thursday, June 26, 2003. The than any volunteer) that has access to a pa- managers and staff of hospital and health purpose of this hearing will be to re- tient or resident of such a facility under an care facilities. view H.R. 1904, the Healthy Forests employment or other contract, or both, with (2) ELIGIBILITY.—To be eligible to receive a the facility or provider (including individ- grant under paragraph (1), an entity shall be Restoration Act of 2003. uals who are licensed or certified by the a public or private nonprofit entity and pre- The PRESIDING OFFICER. Without State to provide services at the facility or pare and submit to the Secretary of Health objection, it is so ordered. through the provider, and nonlicensed indi- and Human Services an application at such COMMITTEE ON BANKING, HOUSING, AND URBAN viduals, as defined by the Secretary, pro- time, in such manner, and containing such AFFAIRS viding services at the facility or through the information as the Secretary may require. Mr. MCCONNELL. Mr. President, I ask provider, including nurse assistants, nurse (3) USE OF FUNDS.—Amounts received under unanimous consent that the Com- aides, home health aides, individuals who a grant under this subsection shall be used provide home care, and personal care work- to— mittee on Banking, Housing, and ers and attendants)’’ before the period. (A) examine ways to improve collaboration Urban Affairs be authorized to meet (3) REPORTING BY LONG-TERM CARE FACILI- between State health care survey and pro- during the session of the Senate on TIES OR PROVIDERS.— vider certification agencies, long-term care June 26, 2003, at 10:00 a.m. to conduct a (A) IN GENERAL.—Section 1128E(b)(1) (42 ombudsman programs, the long-term care in- hearing on ‘‘Affiliate Sharing Practices U.S.C. 1320a–7e(b)(1)) is amended by striking dustry, and local community members; and Their Relationship with the Fair ‘‘and health plan’’ and inserting ‘‘, health (B) examine patient care issues relating to Credit Reporting Act.’’ plan, and long-term care facility or pro- regulatory oversight, community involve- The PRESIDING OFFICER. Without vider’’. ment, and facility staffing and management (B) CORRECTION OF INFORMATION.—Section with a focus on staff training, staff stress objection, it is so ordered. 1128E(c)(2) (42 U.S.C. 1320a–7e(c)(2)) is amend- management, and staff supervision; COMMITTEE ON COMMERCE, SCIENCE, AND ed by striking ‘‘and health plan’’ and insert- (C) examine the use of patient abuse pre- TRANSPORTATION ing ‘‘, health plan, and long-term care facil- vention training programs by long-term care Mr. MCCONNELL. Mr. President, I ask ity or provider’’. entities, including the training program de- unanimous consent that the Com- (4) ACCESS TO REPORTED INFORMATION.— veloped by the National Association of At- mittee on Commerce, Science, and Section 1128E(d)(1) (42 U.S.C. 1320a–7e(d)(1)) torneys General, and the extent to which Transportation be authorized to meet is amended by striking ‘‘and health plans’’ such programs are used; and and inserting ‘‘, health plans, and long-term (D) identify and disseminate best practices on June 26, 2003, at 9:30 a.m. on pending care facilities or providers’’. for preventing and reducing patient abuse. committee business. (5) MANDATORY CHECK OF DATABASE BY (4) AUTHORIZATION OF APPROPRIATIONS.— The PRESIDING OFFICER. Without LONG-TERM CARE FACILITIES OR PROVIDERS.— There is authorized to be appropriated such objection, it is so ordered. Section 1128E(d) (42 U.S.C. 1320a–7e(d)) is sums as may be necessary to carry out this COMMITTEE ON FINANCE amended by adding at the end the following: subsection. C ONNELL ‘‘(3) MANDATORY CHECK OF DATABASE BY (g) EFFECTIVE DATE.— Mr. M C . Mr. President, I ask LONG-TERM CARE FACILITIES OR PROVIDERS.—A (1) IN GENERAL.—With respect to a skilled unanimous consent that the Com- long-term care facility or provider shall nursing facility (as defined in section 1819(a) mittee on Finance be authorized to check the database maintained under this of the Social Security Act (42 U.S.C. 1395i– meet during the session on Thursday,

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00164 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8811 June 26, 2003, at 10:00 a.m., to hear tes- II. Nominations: William H. Pryor, IMPROVING THE EFFICIENCY OF timony on the Nominations of Josette Jr., to be United States Circuit Judge THE NATION’S PAYMENTS SYSTEM Sheeran Shiner, to Deputy United for the Eleventh Circuit; Diane M. Stu- Mr. FRIST. Mr. President, I ask States Trade Representative, Execu- art to be Director, Violence Against unanimous consent that the Senate tive Office of the President and James Women Office, United States Depart- proceed to the immediate consider- J. Jochum, to be Assistant Secretary, ment of Justice; and Thomas M. ation of Calendar No. 168, S. 1334. Department of Commerce. Hardiman to be United States District The PRESIDING OFFICER. The The PRESIDING OFFICER. Without Judge for the Western District of Penn- clerk will state the bill by title. objection, it is so ordered. sylvania. The legislative clerk read as follows: COMMITTEE ON FOREIGN RELATIONS III. Bills: S.J. Res. 1, a joint resolution proposing an amendment to the A bill (S. 1334) to facilitate check trunca- Mr. MCCONNELL. Mr. President, I tion by authorizing substitute checks, to fos- ask unanimous consent that the Com- constitution of the United States to ter innovation in the check collection sys- mittee on Foreign Relations be author- protect the rights of crime victims tem without mandating receipt of checks in ized to meet during the session of the [Kyl, Chambliss, Cornyn, Craig, electronic form, and to improve the overall Senate on Thursday, June 26, 2003, at DeWine, Feinstein, Graham, Grassley]; efficiency of the Nation’s payments system, 9:15 a.m. to hold a Business Meeting. S. 1280, a bill to amend the Protect Act and for other purposes. The PRESIDING OFFICER. Without to clarify the liability of the National There being no objection, the Senate objection, it is so ordered. Center for Missing and Exploited Chil- proceeded to consider the bill. dren [Hatch, Biden]; S. 174, a resolution Mr. FRIST. Mr. President, I ask COMMITTEE ON FOREIGN RELATIONS designating Thursday, November 20, unanimous consent that the bill be Mr. MCCONNELL. Mr. President, I 2003, as ‘‘Feed America Thursday’’ read the third time, the Banking Com- ask unanimous consent that the Com- [Hatch]; and S. 175, a resolution desig- mittee be discharged from further con- mittee on Foreign Relations be author- nating the month of October 2003, as sideration of H.R. 1474, and the Senate ized to meet during the session of the ‘‘Family History Month’’ [Hatch]. proceed to its immediate consider- Senate on Thursday, June 26, 2003, at 2 The PRESIDING OFFICER. Without ation; that all after the enacting clause p.m. to hold a hearing on The Depart- objection, it is so ordered. be stricken and the text of S. 1334 be ment of State’s Office of Children’s SUBCOMMITTEE ON TERRORISM, TECHNOLOGY, inserted in lieu thereof; that the bill, Issues—Responding to International AND HOMELAND SECURITY as amended, be read the third time and Parental Abduction. Mr. MCCONNELL. Mr. President, I passed; that the motion to reconsider The PRESIDING OFFICER. Without ask unanimous consent that the Com- be laid upon the table, and that any objection, it is so ordered. mittee on the Judiciary Subcommittee statements regarding the measure be COMMITTEE ON GOVERNMENTAL AFFAIRS on Terrorism, Technology, and Home- printed in the RECORD. I further ask Mr. MCCONNELL. Mr. President, I land Security be authorized to meet to unanimous consent that S. 1334 be re- ask unanimous consent that the Com- conduct a hearing on ‘‘Terrorism: turned to the calendar. mittee on Governmental Affairs be au- Growing Wahhabi Influence in the The PRESIDING OFFICER. Without United States’’ on Thursday, June 26, thorized to meet on Thursday, June 26, objection, it is so ordered. 2003 at 2 p.m., in Dirksen 226. 2003, at a time and location to be deter- The bill (H.R. 1474), as amended, was Panel I: David Aufhauser, General mined to consider the nominations of passed, as follows: Joshua B. Bolten to be Director of the Counsel, U.S. Treasury Department, Resolved, That the bill from the House of Office of Management and Budget; Washington, DC; and Larry A. Mefford, Assistant Director, Counterterrorism Representatives (H.R. 1474) entitled ‘‘An Act Fern Flanagan Saddler to be an Asso- to facilitate check truncation by authorizing ciate Judge of the Superior Court of Division, Federal Bureau of Investiga- substitute checks, to foster innovation in the District of Columbia; and Judith tion, Washington, DC. the check collection system without man- Nan Macaluso to be an Associate Judge Panel 2: Dr. Alex Alexiev, Distin- dating receipt of checks in electronic form, of the Superior Court of the District of guished Fellow, Center for Security and to improve the overall efficiency of the Columbia. Policy, Washington, DC; and Stephen Nation’s payments system, and for other Schwartz, Senior Fellow, Foundation purposes.’’, do pass with the following Agenda for Defense of Democracies, Wash- amendment: Nominations: Joshua B. Bolten to be ington, DC. Strike out all after the enacting clause and Director of the Office of Management The PRESIDING OFFICER. Without insert: and Budget; Fern Flanagan Saddler to objection, it is so ordered. SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) SHORT TITLE.—This Act may be cited as be an Associate Judge of the Superior f the ‘‘Check Truncation Act of 2003’’. Court for the District of Columbia; and UNANIMOUS CONSENT REQUEST— (b) TABLE OF CONTENTS.—The table of con- Judith Nan Macaluso to be an Asso- EXECUTIVE CALENDAR tents for this Act is as follows: ciate Judge of the Superior Court for Mr. FRIST. Mr. President, I ask Sec. 1. Short title; table of contents. the District of Columbia. Sec. 2. Findings and purposes. The PRESIDING OFFICER. Without unanimous consent that the Senate im- Sec. 3. Definitions. objection, it is so ordered. mediately proceed to executive session Sec. 4. General provisions governing substitute to consider the following nominations COMMITTEE ON INDIAN AFFAIRS checks. on today’s Executive Calendar: Cal- Sec. 5. Substitute check warranties. Mr. MCCONNELL. Mr. President, I endar Nos. 48 and 49, the nominations Sec. 6. Indemnity. ask unanimous consent that the Com- of Daniel Pearson and Charlotte A. Sec. 7. Expedited recredit for consumers. mittee on Indian Affairs be authorized Lane, to be members of the U.S. Inter- Sec. 8. Expedited recredit procedures for banks. to meet on Thursday, June 26, 2003, at national Trade Commission, which Sec. 9. Delays in an emergency. 11 a.m., in room 485 of the Russell Sen- Sec. 10. Measure of damages. have been pending on the Executive Sec. 11. Statute of limitations and notice of ate Office Building to conduct a busi- Calendar since March 5. I further ask ness meeting on pending committee claim. unanimous consent that the nomina- Sec. 12. Consumer awareness. matters. tions be confirmed, the motions to re- Sec. 13. Effect on other law. The PRESIDING OFFICER. Without consider be laid upon the table, the Sec. 14. Regulations. objection, it is so ordered. President be immediately notified of Sec. 15. Study and report on funds availability. COMMITTEE ON THE JUDICIARY the Senate’s action, and the Senate Sec. 16. Evaluation and report by the Comp- troller General. Mr. MCCONNELL. I ask unanimous then return to legislative session. consent that the Committee on the Ju- Sec. 17. Variation by agreement. The PRESIDING OFFICER. Is there Sec. 18. Effective date. diciary be authorized to meet to con- objection. SEC. 2. FINDINGS AND PURPOSES. duct a markup on Thursday, June 26, Mr. FRIST. Mr. President, on behalf (a) FINDINGS.—Congress finds that— 2003, at 9:30 a.m., in SDG 50. of my colleagues on the other side of (1) the Expedited Funds Availability Act (12 I. Continuation of S. 1125, Fairness in the aisle, I object to my own request. U.S.C. 4001 et seq.)— Asbestos Injury Resolution Act of 2003 The PRESIDING OFFICER. Objec- (A) directs the Board to consider establishing (‘‘The FAIR Act’’) mark-up. tion is heard. regulations requiring Federal reserve banks and

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depository institutions to provide for check (6) CHECK.—The term ‘‘check’’— has the same meaning as in section 602(24) of truncation, in order to improve the check proc- (A) means a draft, payable on demand and the Expedited Funds Availability Act (12 U.S.C. essing system; drawn on or payable through or at an office of 4001(24)). (B) authorizes the Board to regulate all as- a bank, whether or not negotiable, that is han- (21) OTHER TERMS.—Unless the context re- pects of the payment system, including the re- dled for forward collection or return, including quires otherwise, terms used in this Act that are ceipt, payment, collection, and clearing of a substitute check and a travelers check; and not defined in this section shall have the same checks, and related functions of the payment (B) does not include a noncash item or an meanings as in the Uniform Commercial Code. system pertaining to checks; and item payable in a medium other than United SEC. 4. GENERAL PROVISIONS GOVERNING SUB- (C) directs that the exercise of such authority States dollars. STITUTE CHECKS. by the Board shall supersede any State law, in- (7) CONSUMER.—The term ‘‘consumer’’ means (a) NO AGREEMENT REQUIRED.—A person may cluding the Uniform Commercial Code, as in ef- an individual who— deposit, present, or send for collection or return fect in any State; and (A) with respect to a check handled for for- a substitute check without an agreement with (2) check truncation is no less desirable in ward collection, draws the check on a consumer the recipient, to the extent that the bank has 2003 for both financial service customers and the account; or made the warranties described in section 5 with financial services industry, to reduce costs, im- (B) with respect to a check handled for re- respect to the substitute check. prove efficiency in check collections, and expe- turn, deposits the check into, or cashes the (b) LEGAL EQUIVALENCE.—A substitute check dite funds availability for account holders than check against, a consumer account. shall be the legal equivalent of an original check (8) CONSUMER ACCOUNT.—The term ‘‘consumer it was in 1987, when Congress first directed the for all purposes, including any provision of any account’’ has the same meaning as in section Board to consider establishing such a process. Federal or State law, and for all persons, if the 602(10) of the Expedited Funds Availability Act (b) PURPOSES.—The purposes of this Act are— substitute check— (12 U.S.C. 4001(10)). (1) to facilitate check truncation by author- (1) accurately represents all of the informa- (9) CUSTOMER.—The term ‘‘customer’’ means a izing substitute checks; tion on the front and back of the original check person having an account with a bank. (2) to foster innovation in the check collection as of the time at which the original check was (10) FORWARD COLLECTION.—The term ‘‘for- system without mandating receipt of checks in truncated; and ward collection’’ means the transfer by a bank (2) bears the legend: ‘‘This is a legal copy of electronic form; and of a check to a collecting bank for settlement or your check. You can use it the same way you (3) to improve the overall efficiency of the Na- the paying bank for payment. would use the original check.’’. tion’s payments system. (11) INDEMNIFYING BANK.—The term ‘‘indem- (c) ENDORSEMENTS.—A reconverting bank SEC. 3. DEFINITIONS. nifying bank’’ means a bank that is providing shall ensure that the substitute check for which In this Act, the following definitions shall an indemnity under section 6 with respect to a the bank is the reconverting bank bears all en- apply: substitute check. dorsements applied by parties that previously (1) ACCOUNT.—The term ‘‘account’’ means a (12) MICR LINE.—The term ‘‘MICR line’’ or handled the check (whether in electronic form deposit account at a bank. ‘‘magnetic ink character recognition line’’ or in the form of the original paper check or a (2) BANK.—The term ‘‘bank’’— means the numbers, which may include the substitute check) for forward collection or re- (A) means any person located in a State en- bank routing number, account number, check turn. gaged in the business of banking, including any number, check amount, and other information, (d) IDENTIFICATION OF RECONVERTING BANK.— depository institution; and that are printed near the bottom of a check in A reconverting bank shall identify itself as a re- (B) includes— magnetic ink in accordance with generally ap- converting bank on any substitute check for (i) any Federal reserve bank; plicable industry standards. which the bank is a reconverting bank, so as to (ii) any Federal home loan bank; and (13) NONCASH ITEM.—The term ‘‘noncash preserve any previous reconverting bank identi- (iii) to the extent that it acts as a payor— item’’ has the same meaning as in section 602(14) fications, in conformance with generally appli- (I) the Treasury of the United States; of the Expedited Funds Availability Act (12 cable industry standards. (II) the United States Postal Service; U.S.C. 4001(14)). (e) APPLICABLE LAW.—A substitute check that (III) a State government; and (14) PERSON.—The term ‘‘person’’ means a is the legal equivalent of the original check (IV) a unit of general local government. natural person, corporation, unincorporated under subsection (b) shall be subject to any pro- (3) BANKING TERMS.— company, partnership, government unit or in- vision, including any provision relating to the (A) COLLECTING BANK.—The term ‘‘collecting strumentality, trust, or any other entity or orga- protection of consumers, of part 229 of title 12, bank’’ means any bank handling a check for nization. Code of Federal Regulations (or any successor collection except the paying bank. (15) RECONVERTING BANK.—The term ‘‘recon- thereto), the Uniform Commercial Code, and (B) DEPOSITARY BANK.—The term ‘‘depositary verting bank’’ means— any other applicable Federal or State law that bank’’ means— (A) the bank that creates a substitute check; would apply if the substitute check were the (i) the first bank to which a check is trans- or original check, to the extent that such provision ferred, even if such bank is also the paying (B) if a substitute check is created by a person of law is not inconsistent with this Act. other than a bank, the first bank that transfers bank or the payee; or SEC. 5. SUBSTITUTE CHECK WARRANTIES. or presents such substitute check. (ii) a bank to which a check is transferred for A bank that transfers, presents, or returns a (16) SUBSTITUTE CHECK.—The term ‘‘substitute deposit in an account at such bank, even if the substitute check and receives consideration for check’’ means a paper reproduction of the origi- check is physically received and endorsed first the check warrants to the transferee, any subse- nal check that— by another bank. (A) contains an image of the front and back quent collecting or returning bank, the deposi- (C) DEPOSITORY INSTITUTION.—The term ‘‘de- of the original check; tary bank, the drawee, the drawer, the payee, pository institution’’ has the same meaning as (B) bears a MICR line containing all the in- the depositor, and any endorser (regardless of in section 19(b)(1)(A) of the Federal Reserve Act formation appearing on the MICR line of the whether the warrantee receives the substitute (12 U.S.C. 461(b)(1)(A)). original check, except as provided under gen- check or another paper or electronic form of the (D) PAYING BANK.—The term ‘‘paying bank’’ erally applicable industry standards for sub- substitute or original check) that— means— stitute checks to facilitate the processing of sub- (1) the substitute check meets all the require- (i) the bank by which a check is payable, un- stitute checks; ments for legal equivalence under section 4(b); less the check is payable at or through another (C) conforms, in paper stock, dimension, and and bank and is sent to the other bank for payment otherwise, with generally applicable industry (2) no depositary bank, drawee, drawer, or en- or collection; or standards for substitute checks; and dorser will receive presentment or return of the (ii) the bank at or through which a check is (D) is suitable for automated processing in the substitute check, the original check, or a copy payable and to which the check is sent for pay- same manner as the original check. or other paper or electronic version of the sub- ment or collection. (17) STATE.—The term ‘‘State’’ has the same stitute check or original check such that it will (E) RETURNING BANK.— meaning as in section 3(a) of the Federal De- be asked to make a payment based on a check (i) IN GENERAL.—The term ‘‘returning bank’’ posit Insurance Act (12 U.S.C. 1813(a)). it has already paid. means a bank (other than the paying or deposi- (18) TRUNCATE.—The term ‘‘truncate’’ means SEC. 6. INDEMNITY. tary bank) handling a returned check or notice to remove an original paper check from the (a) INDEMNITY.—A reconverting bank and in lieu of return. check collection or return process and send to a each bank that subsequently transfers, presents, (ii) TREATMENT AS COLLECTING BANK.—No pro- recipient, in lieu of such original paper check, a or returns a substitute check in any electronic vision of this Act shall be construed as affecting substitute check or, by agreement, information or paper form, and receives consideration for the treatment of a returning bank as a col- relating to the original check (including data such transfer, presentment, or return shall in- lecting bank for purposes of section 4–202(b) of taken from the MICR line of the original check demnify the transferee, any subsequent col- the Uniform Commercial Code. or an electronic image of the original check), lecting or returning bank, the depositary bank, (4) BOARD.—The term ‘‘Board’’ means the whether with or without subsequent delivery of the drawee, the drawer, the payee, the deposi- Board of Governors of the Federal Reserve Sys- the original paper check. tor, and any endorser, up to the amounts de- tem. (19) UNIFORM COMMERCIAL CODE.—The term scribed in subsections (b) and (c), as applicable, (5) BUSINESS DAY.—The term ‘‘business day’’ ‘‘Uniform Commercial Code’’ means the Uniform to the extent of any loss incurred by any recipi- has the same meaning as in section 602(3) of the Commercial Code in effect in a State. ent of a substitute check if that loss occurred Expedited Funds Availability Act (12 U.S.C. (20) UNIT OF GENERAL LOCAL GOVERNMENT.— due to the receipt of a substitute check instead 4001(3)). The term ‘‘unit of general local government’’ of the original check.

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(b) INDEMNITY AMOUNT.— (D) the production of the original check or a the consumer submitted the claim, the bank (1) AMOUNT IN EVENT OF BREACH OF WAR- better copy of the original check is necessary to shall recredit the subject consumer account RANTY.—The amount of the indemnity under determine the validity of any claim described in for— subsection (a) shall be the amount of any loss subparagraph (B). (i) the lesser of the amount of the substitute (including costs and reasonable attorney fees (2) 40-DAY PERIOD.—Any claim under para- check that was charged against the consumer and other expenses of representation) proxi- graph (1) with respect to a consumer account account, or $2,500, together with interest if the mately caused by a breach of a warranty estab- may be submitted by a consumer before the end account is an interest-bearing account, not later lished under section 5. of the 40-day period beginning on the later of— than the end of such 10th business day; and (2) AMOUNT IN ABSENCE OF BREACH OF WAR- (A) the date on which the financial institu- (ii) the remaining amount of the substitute RANTY.—In the absence of a breach of a war- tion mails or delivers, by a means agreed to by check that was charged against the consumer ranty established under section 5, the amount of the consumer, the periodic statement of account account, if any, together with interest if the ac- the indemnity under subsection (a) shall be the for such account which contains information count is an interest-bearing account, not later sum of— concerning the transaction giving rise to the than the 45th calendar day following the busi- (A) the amount of any loss, up to the amount claim; or ness day on which the consumer submits the of the substitute check; and (B) the date on which the substitute check is claim. (B) interest and expenses (including costs and made available to the consumer. (d) AVAILABILITY OF RECREDIT.— reasonable attorney fees and other expenses of (3) EXTENSION UNDER EXTENUATING CIR- (1) NEXT BUSINESS DAY AVAILABILITY.—Except representation). CUMSTANCES.—If the ability of the consumer to as provided in paragraph (2), a bank that pro- (c) COMPARATIVE NEGLIGENCE.— submit the claim within the 40-day period under vides a recredit to a consumer account under (1) IN GENERAL.—If a loss under subsection (a) paragraph (2) is delayed due to extenuating cir- subsection (c) shall make the recredited funds results in whole or in part from the negligence cumstances, including extended travel or the ill- available for withdrawal by the consumer by the or failure to act in good faith on the part of an ness of the consumer, the 40-day period shall be start of the next business day after the business indemnified party, then the indemnification of extended by a reasonable amount of time. day on which the bank recredits the consumer that party under this section shall be reduced in (b) PROCEDURES FOR CLAIMS.— account under subsection (c). proportion to the amount of negligence or bad (1) IN GENERAL.—To make a claim for an expe- (2) SAFEGUARD EXCEPTIONS.—A bank may faith attributable to that party. dited recredit under subsection (a) with respect delay availability to a consumer of a recredit (2) RULE OF CONSTRUCTION.—Nothing in this to a substitute check, the consumer shall pro- provided under subsection (c)(2)(B)(i) until the subsection reduces the rights of a consumer or vide to the bank that holds the account of such start of either the business day following the any other person under the Uniform Commercial consumer— business day on which the bank determines that Code or other applicable provision of Federal or (A) a description of the claim, including an the claim of the consumer is valid, or the 45th State law. explanation of— calendar day following the business day on (d) EFFECT OF PRODUCING ORIGINAL CHECK OR (i) why the substitute check was not properly which the consumer submits a claim for such re- SUBSTITUTE CHECK.— charged to the subject consumer account; or credit in accordance with subsection (b), which- (1) IN GENERAL.—If the indemnifying bank (ii) the warranty claim with respect to such ever is earlier, in any of the following cir- produces the original check or a copy of the check; cumstances: original check (including an image or a sub- (B) a statement that the consumer suffered a (A) NEW ACCOUNTS.—The claim is made dur- stitute check) that accurately represents all of loss and an estimate of the amount of the loss; ing the 30-day period beginning on the business the information on the front and back of the (C) the reason why production of the original day on which the consumer account was estab- original check (as of the time at which the origi- check or a better copy of the original check is lished. nal check was truncated), or is otherwise suffi- necessary to determine the validity of the charge (B) REPEATED OVERDRAFTS.—Without regard cient to determine whether or not a claim is to the subject consumer account or the warranty to the charge that is the subject of the claim for valid, the indemnifying bank shall— claim; and which the recredit was made— (A) be liable under this section only for losses (D) sufficient information to identify the sub- (i) on 6 or more business days during the 6- covered by the indemnity that are incurred up stitute check and to investigate the claim. month period ending on the date on which the to the time that the original check or copy is (2) CLAIM IN WRITING.— consumer submits the claim, the balance in the (A) IN GENERAL.—The bank holding the con- provided to the indemnified party; and consumer account was negative or would have sumer account that is the subject of a claim by (B) have a right to the return of any funds it become negative if checks or other charges to the consumer under subsection (a) may, in the has paid under the indemnity in excess of those the account had been paid; or discretion of the bank, require the consumer to (ii) on 2 or more business days during such 6- losses. submit the information required under para- month period, the balance in the consumer ac- (2) COORDINATION OF INDEMNITY WITH IMPLIED graph (1) in writing. count was negative or would have become nega- WARRANTY.—The production of the original (B) MEANS OF SUBMISSION.—A bank that re- tive in the amount of $5,000 or more if checks or check, substitute check, or copy under para- quires a submission of information under sub- other charges to the account had been paid. graph (1) by an indemnifying bank shall not ab- paragraph (A) may permit the consumer to make (C) PREVENTION OF FRAUD LOSSES.—The bank solve the bank from any liability on a warranty the submission electronically, if the consumer has reasonable cause to believe that the claim is established under this Act or any other provi- has agreed to communicate with the bank in fraudulent, based on facts (other than the fact sion of law. that manner. that the check in question or the consumer is of (e) SUBROGATION OF RIGHTS.— (c) RECREDIT TO CONSUMER.— a particular class) that would cause a well- (1) IN GENERAL.—Each indemnifying bank (1) CONDITIONS FOR RECREDIT.—The bank grounded belief in the mind of a reasonable per- shall be subrogated to the rights of any indem- shall recredit a consumer account in accordance son that the claim is fraudulent. nified party to the extent of the indemnity. with paragraph (2) for the amount of a sub- (3) OVERDRAFT FEES.—No bank that, in ac- (2) RECOVERY UNDER WARRANTY.—A bank that stitute check that was charged against the con- cordance with paragraph (2), delays the avail- indemnifies a party under this section may at- sumer account, if— ability of a recredit under subsection (c) to any tempt to recover from another party based on a (A) a consumer submits a claim to the bank consumer account may impose any overdraft warranty or other claim. with respect to that substitute check that meets fees with respect to drafts drawn by the con- (3) DUTY OF INDEMNIFIED PARTY.—Each in- the requirement of subsection (b); and sumer on such recredited amount before the end demnified party shall have a duty to comply (B) the bank has not— of the 5-day period beginning on the date on with all reasonable requests for assistance from (i) provided to the consumer— which notice of the delay in the availability of an indemnifying bank in connection with any (I) the original check; or such amount is sent by the bank to the con- claim that the indemnifying bank brings against (II) a copy of the original check (including an sumer. a warrantor or other party related to a check image or a substitute check) that accurately rep- (e) REVERSAL OF RECREDIT.—A bank may re- that forms the basis for the indemnification. resents all of the information on the front and verse a recredit to a consumer account if the SEC. 7. EXPEDITED RECREDIT FOR CONSUMERS. back of the original check, as of the time at bank— (a) RECREDIT CLAIMS.— which the original check was truncated; and (1) determines that a substitute check for (1) IN GENERAL.—A consumer may make a (ii) demonstrated to the consumer that the which the bank recredited a consumer account claim for expedited recredit from the bank that substitute check was properly charged to the under subsection (c) was in fact properly holds the account of the consumer with respect consumer account. charged to the consumer account; and to a substitute check, if the consumer asserts in (2) TIMING OF RECREDIT.— (2) notifies the consumer in accordance with good faith that— (A) IN GENERAL.—The bank shall recredit the subsection (f)(3). (A) the bank charged the consumer account subject consumer account for the amount de- (f) NOTICE TO CONSUMER.— for a substitute check that was provided to the scribed in paragraph (1) not later than the end (1) NOTICE IF CONSUMER CLAIM NOT VALID.—If consumer; of the business day following the business day a bank determines that a substitute check sub- (B) either— on which the bank determines the claim of the ject to the claim of a consumer under this sec- (i) the check was not properly charged to the consumer is valid. tion was in fact properly charged to the con- consumer account; or (B) RECREDIT PENDING INVESTIGATION.—If the sumer account, the bank shall send to the con- (ii) the consumer has a warranty claim with bank has not determined that the claim of the sumer, not later than the business day following respect to such substitute check; consumer is valid before the end of the 10th the business day on which the bank makes the (C) the consumer suffered a resulting loss; and business day after the business day on which determination—

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00167 Fmt 0624 Sfmt 6333 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8814 CONGRESSIONAL RECORD — SENATE June 26, 2003 (A) the original check or a copy of the origi- with an estimate of the amount of the loss or re- SEC. 9. DELAYS IN AN EMERGENCY. nal check (including an image or a substitute credit; Delay by a bank beyond the time limits pre- check) that— (C) the reason why production of the original scribed or permitted by this Act is excused if the (i) accurately represents all of the information check or a better copy of the original check is delay is caused by interruption of communica- on the front and back of the original check (as necessary to determine the validity of the charge tion or computer facilities, suspension of pay- of the time at which the original check was to the consumer account or the warranty claim; ments by another bank, war, emergency condi- truncated); or and tions, failure of equipment, or other cir- (ii) is otherwise sufficient to determine wheth- (D) information sufficient for the indem- cumstances beyond the control of a bank, and if er or not the claim of the consumer is valid; and nifying bank to identify the substitute check the bank uses such diligence as the cir- (B) an explanation of the basis for the deter- and to investigate the claim. cumstances require. mination by the bank that the substitute check (2) REQUIREMENTS RELATING TO COPIES OF SEC. 10. MEASURE OF DAMAGES. was properly charged, including a statement SUBSTITUTE CHECKS.—If the information sub- (a) LIABILITY.— that the consumer may request copies of any in- mitted by a claimant bank pursuant to para- (1) IN GENERAL.—Except as provided in section formation or documents on which the bank re- graph (1) in connection with a claim for an ex- 6, any person who, in connection with a sub- lied in making the determination. pedited recredit includes a copy of any substitute check, breaches any warranty under this (2) NOTICE OF RECREDIT.—If a bank recredits stitute check for which any such claim is made, Act or fails to comply with any requirement im- a consumer account under subsection (c), the the claimant bank shall take reasonable steps to posed by or regulation prescribed pursuant to bank shall send to the consumer, not later than ensure that any such copy cannot be— this Act with respect to any other person shall the business day following the business day on (A) mistaken for the legal equivalent of the be liable to such person in an amount equal to which the bank makes the recredit, a notice of— check under section 4(b); or the sum of— (A) the amount of the recredit; and (B) sent or handled by any bank, including (A) the lesser of— (B) the date on which the recredited funds the indemnifying bank, as a forward collection (i) the amount of the loss suffered by the other will be available for withdrawal. or returned check. person as a result of the breach or failure; or (3) NOTICE OF REVERSAL OF RECREDIT.—In ad- (3) CLAIM IN WRITING.— (ii) the amount of the substitute check; and dition to the notice required under paragraph (A) IN GENERAL.—An indemnifying bank may, (B) interest and expenses (including costs and (1), if a bank reverses a recredited amount in the discretion of the bank, require the claim- reasonable attorney fees and other expenses of under subsection (e), the bank shall send to the ant bank to submit the information required by representation) related to the substitute check. consumer, not later than the business day fol- paragraph (1) in writing, including a copy of (2) OFFSET OF RECREDITS.—The amount of lowing the business day on which the bank re- the written or electronically submitted claim, if damages that any person receives under para- verses the recredit, a notice of— any, that the consumer provided in accordance graph (1), if any, shall be reduced by the (A) the amount of the reversal; and with section 7(b). amount that the claimant receives and retains (B) the date on which the recredit was re- as a recredit under section 7 or 8, if any. (B) MEANS OF SUBMISSION.—An indemnifying versed. (b) COMPARATIVE NEGLIGENCE.— bank that requires a submission of information (4) MODE OF DELIVERY.—A notice described in (1) IN GENERAL.—If a person incurs damages under subparagraph (A) may permit the claim- this subsection shall be delivered by United that resulted in whole or in part from the neg- ant bank to make the submission electronically, States mail or by any other means through ligence or failure of that person to act in good if the claimant bank has agreed to communicate which the consumer has agreed to receive ac- faith, then the amount of any liability due to with the indemnifying bank in that manner. count information. that person under subsection (a) shall be re- (c) RECREDIT BY INDEMNIFYING BANK.— (g) OTHER CLAIMS NOT AFFECTED.—Providing duced in proportion to the amount of negligence (1) PROMPT ACTION REQUIRED.—Not later than a recredit in accordance with this section shall or bad faith attributable to that person. 10 business days after the business day on not absolve the bank from liability for a claim (2) RULE OF CONSTRUCTION.—Nothing in this which an indemnifying bank receives a claim made under any other provision of law, such as subsection reduces the rights of a consumer or under subsection (a) from a claimant bank with a claim for wrongful dishonor under the Uni- any other person under the Uniform Commercial respect to a substitute check, the indemnifying form Commercial Code, or from liability for ad- Code or other applicable provision of Federal or bank shall— ditional damages under section 6 or 10. State law. (A) provide, to the claimant bank, the original (h) SCOPE OF APPLICATION.—This section SEC. 11. STATUTE OF LIMITATIONS AND NOTICE shall only apply to customers who are con- check (with respect to such substitute check) or OF CLAIM. sumers. a copy of the original check (including an image (a) ACTIONS UNDER THIS ACT.— or a substitute check) that— SEC. 8. EXPEDITED RECREDIT PROCEDURES FOR (1) IN GENERAL.—An action to enforce a claim BANKS. (i) accurately represents all of the information under this Act may be brought in any United on the front and back of the original check (as (a) RECREDIT CLAIMS.— States district court, or in any other court of of the time at which the original check was (1) IN GENERAL.—A bank may make a claim competent jurisdiction, before the end of the 1- against an indemnifying bank for expedited re- truncated); or year period beginning on the date on which the credit for which that bank is indemnified, if— (ii) is otherwise sufficient to determine that cause of action accrues. (A) the claimant bank (or a bank that the the claim of the bank is not valid; (2) ACCRUAL.—For purposes of paragraph (1), claimant bank has indemnified) has received a (B) recredit the claimant bank for the amount a cause of action accrues as of the date on claim for expedited recredit from a consumer of the claim up to the amount of the substitute which the injured party first learns, or by which under section 7 with respect to a substitute check, plus interest if applicable; or such person reasonably should have learned, of check, or would have been subject to such a (C) provide information to the claimant bank the facts and circumstances giving rise to the claim had the subject consumer account been as to why the indemnifying bank is not obli- cause of action. charged; gated to comply with subparagraph (A) or (B). (b) NOTICE OF CLAIMS REQUIRED.—Unless a (B) the claimant bank has suffered a resulting (2) RECREDIT DOES NOT ABROGATE OTHER LI- person gives notice of a claim to the indem- loss or is obligated to recredit the consumer ac- ABILITIES.—Providing a recredit under this sub- nifying or warranting bank, not later than 30 count under section 7 with respect to such subsection to a claimant bank with respect to a sub- days after the person has reason to know of the stitute check; and stitute check shall not absolve the indemnifying claim and the identity of the indemnifying or (C) production of the original check or a bet- bank from liability for claims brought under any warranting bank, the indemnifying or war- ter copy of the original check is necessary to de- other law or from additional damages under sec- ranting bank is discharged from liability in an termine the validity of the charge to the con- tion 6 or 10 with respect to such check. action to enforce a claim under this Act, to the sumer account or any warranty claim connected (3) REFUND TO INDEMNIFYING BANK.—If a extent of any loss caused by the delay in giving with such substitute check. claimant bank reverses, in accordance with sec- notice of the claim. (2) 120-DAY PERIOD.—Any claim under para- tion 7(e), a recredit previously made to a con- (c) NOTICE OF CLAIM BY CONSUMER.—A timely graph (1) may be submitted by the claimant sumer account under section 7(c), or otherwise claim by a consumer under section 7 for expe- bank to an indemnifying bank before the end of receives a credit or recredit with regard to such dited recredit constitutes timely notice of a claim the 120-day period beginning on the date of the substitute check, the claimant bank shall by the consumer for purposes of subsection (b). transaction that gave rise to the claim. promptly refund to any indemnifying bank any SEC. 12. CONSUMER AWARENESS. (b) PROCEDURES FOR CLAIMS.— amount previously advanced by the indem- (a) IN GENERAL.—During the 3-year period be- (1) IN GENERAL.—To make a claim under sub- nifying bank in connection with such substitute ginning on the effective date of this Act, each section (a) for an expedited recredit relating to check. bank shall provide to each consumer that is a a substitute check, the claimant bank shall send (d) PRODUCTION OF ORIGINAL CHECK OR A customer of the bank, in accordance with sub- to the indemnifying bank— SUFFICIENT COPY GOVERNED BY SECTION 6(d).— section (b), a brief notice about substitute (A) a description of— If the indemnifying bank provides the claimant checks that describes— (i) the claim, including an explanation of why bank with the original check or a copy of the (1) how a substitute check is the legal equiva- the substitute check cannot be properly charged original check (including an image or a sub- lent of an original check for all purposes, in- to the consumer account; or stitute check) under subsection (c)(1)(A) of this cluding any provision of any Federal or State (ii) the warranty claim; section, section 6(d) shall govern any right of law, and for all persons, if the substitute (B) a statement that the claimant bank has the indemnifying bank to any repayment of any check— suffered a loss or is obligated to recredit the sub- funds that the indemnifying bank has recredited (A) accurately represents all of the informa- ject consumer account under section 7, together to the claimant bank pursuant to subsection (c). tion on the front and back of the original check

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00168 Fmt 0624 Sfmt 6333 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8815 as of the time at which the original check was this section, together with any recommendations of the City of Atlanta, and extending condo- truncated; and for legislative action. lences of the Senate on his death. (B) bears the legend: ‘‘This is a legal copy of SEC. 16. EVALUATION AND REPORT BY THE A resolution (S. Res. 190) commending Gen- your check. You can use it in the same way you COMPTROLLER GENERAL. eral Eric Shinseki of the United States Army would use the original check.’’; and (a) STUDY.—Not later than 5 years after the for his outstanding service and commitment (2) the consumer recredit rights established date of enactment of this Act, the Comptroller to excellence. under section 7 when a consumer believes in General of the United States shall evaluate the There being no objection, the Senate good faith that a substitute check was not prop- implementation and administration of this Act, proceeded to consider the resolutions, erly charged to the account of the consumer. including— (b) DISTRIBUTION.— en bloc. (1) an estimate of the gains in economic effi- Mr. FRIST. Mr. President, I ask (1) IN GENERAL.—The notice required by sub- ciency made possible from check truncation; section (a) shall be provided— (2) an evaluation of the benefits accruing to unanimous consent that the resolu- (A) to each consumer that is a customer of the consumers and financial institutions from re- tions be agreed to, en bloc; that the bank as of the effective date of this Act, and duced transportation costs, longer hours for ac- preambles be agreed to, en bloc; that that receives original checks or substitute checks cepting deposits for credit within 1 business day, the motions to reconsider be laid upon along with periodic account statements, not the impact of fraud losses, and an estimate of the table; and that any statements re- later than together with the first regularly consumers’ share of the total benefits derived lating to these resolutions be printed scheduled communication with the customer from this Act; and after the effective date of this Act; in the RECORD. (3) an assessment of consumer acceptance of The PRESIDING OFFICER. Without (B) at the time at which a customer relation- the check truncation process resulting from this ship is initiated, if such relationship is initiated Act, as well as any new costs incurred by con- objection, it is so ordered. on or after the effective date of this Act and sumers who had their original checks returned The resolution (S. Res. 186) was such customer will receive original checks or with their regular monthly statements prior to agreed to. substitute checks along with periodic account the date of enactment of this Act. The preamble was agreed to. statements; and (b) REPORT TO CONGRESS.—Not later than 5 The resolution, with its preamble, (C) to each customer of the bank that requests years after the date of enactment of this Act, reads as follows: a copy of a check and receives a substitute the Comptroller General shall submit a report to S. RES. 186 check, at the time of the request. Congress concerning the findings and conclu- Whereas Augie Hiebert came to Alaska in (2) MODE OF DELIVERY.—A bank may provide sions of the Comptroller General in connection 1939 and built the first successful commercial the notices required by this subsection by United with the evaluation conducted pursuant to sub- radio station; States mail, or by any other means through section (a), together with such recommendations Whereas on Dec. 7, 1941, Augie Hiebert which the consumer has agreed to receive ac- for legislative and administrative action as the picked up the first report of the raid on count information. Comptroller General may determine to be appro- Pearl Harbor from his radio station in Fair- (c) MODEL LANGUAGE.— priate. (1) IN GENERAL.—Not later than 9 months banks, Alaska giving military leaders the SEC. 17. VARIATION BY AGREEMENT. after the date of enactment of this Act, the first word of the attack that began World Board shall publish model forms and clauses (a) SECTION 8.—Any provision of section 8 War II; that a depository institution may use to describe may be varied by agreement of the banks in- Whereas in 1953, Augie Hiebert founded each of the elements required by subsection (a). volved. Alaska’s first television station; (b) NO OTHER PROVISIONS MAY BE VARIED.— (2) SAFE HARBOR.—A bank shall be treated as Whereas Augie Hiebert established Alas- being in compliance with the requirements of Except as provided in subsection (a), no provi- ka’s first FM radio station and was named subsection (a) if the substitute check notice of sion of this Act may be varied by agreement of president of the Alaska Broadcasting sys- the bank uses a model form or clause published any person or persons. tem, overseeing the affiliation of nine sta- by the Board, and such model form or clause ac- SEC. 18. EFFECTIVE DATE. tions that serve all major Alaska commu- curately describes the policies and practices of Except as otherwise specifically provided in nities; the bank. A bank may delete any information in this Act, this Act shall become effective 12 Whereas Augie Hiebert helped establish the model form or clause that is not required by months after the date of enactment of this Act. Alaska’s first satellite earth station acti- vated in 1970; this Act, or rearrange the format of such form. f (3) USE OF MODEL LANGUAGE NOT REQUIRED.— Whereas Augie Hiebert led in the develop- This section shall not be construed as requiring COMMENDING AUGUST HIEBERT ment of the Territory and State of Alaska, any bank to use a model form or clause that the working for over a half century to pioneer Board prepares under this subsection. modern radio and television on behalf of the broadcast industry; SEC. 13. EFFECT ON OTHER LAW. EXPRESSING SENSE OF THE SEN- Whereas Augie Hiebert has been a pillar of This Act shall supersede any provision of Fed- ATE REGARDING THE CEN- the Alaska community as president of the eral or State law, including the Uniform Com- TENARY OF THE RHODES SCHOL- Anchorage Chamber of Commerce and the mercial Code, that is inconsistent with this Act, ARSHIPS IN THE UNITED STATES Association of the U.S. Army in Alaska, and but only to the extent of the inconsistency. as director of the Alaska Educational Broad- SEC. 14. REGULATIONS. casting Committee, the CBS Television Net- The Board may prescribe such regulations as work Affiliates Association, the Civil Air Pa- it deems necessary to implement, prevent cir- HONORING MAYNARD HOLBROOK JACKSON, JR. trol, and the Pioneers of Alaska: Now, there- cumvention or evasion of, or facilitate compli- fore, be it ance with the provisions of this Act. Resolved, That it is the sense of the Senate SEC. 15. STUDY AND REPORT ON FUNDS AVAIL- that Augie Hiebert is commended for his ABILITY. COMMENDING GENERAL ERIC service to the communications industry in (a) STUDY.—In order to evaluate the imple- SHINSEKI Alaska and the world and for bringing the mentation and the impact of this Act, the Board Mr. FRIST. Mr. President, I ask best that broadcasting has to offer to the shall conduct a study of— people of Alaska. (1) the percentage of total checks cleared in unanimous consent that the Senate which the paper check is not returned to the proceed to the immediate consider- The resolution (S. Res. 187) was paying bank; ation of the following Senate resolu- agreed to. (2) the extent to which financial institutions tions, en bloc: S. Res. 186, S. Res. 187, The preamble was agreed to. make funds available to consumers for local and S. Res. 188, and S. Res. 190. The resolution, with its preamble, nonlocal checks prior to the expiration of max- The PRESIDING OFFICER. The reads as follows: imum hold periods; clerk will report the resolutions by (3) the length of time within which depositary S. RES. 187 banks learn of the nonpayment of local and title. Whereas the Rhodes Scholarships, the old- nonlocal checks; The legislative clerk read as follows: est international fellowships, were initiated (4) the increase or decrease in check-related A resolution (S. Res. 186) commending Au- after the death of Cecil Rhodes in 1902, and losses over the study period; and gust Hiebert for his Service to the Alaska now bring outstanding students from the (5) the appropriateness of the time periods and Communications Industry. United States, Australia, Bangladesh, Ber- amount limits applicable under sections 603 and A resolution (S. Res. 187) expressing the muda, Canada, the Commonwealth Carib- 604 of the Expedited Funds Availability Act, as sense of the Senate regarding the centenary bean, Germany, Hong Kong, India, Jamaica, in effect on the date of enactment of this Act. of the Rhodes Scholarships in the United Kenya, Malaysia, New Zealand, Pakistan, (b) REPORT TO CONGRESS.—Not later than 30 States and the establishment of the Mandela Singapore, South Africa, Uganda, Zambia, months after the effective date of this Act, the Rhodes Foundation. and Zimbabwe to the University of Oxford; Board shall submit a report to Congress con- A resolution (S. Res. 188) honoring May- Whereas the first American Rhodes Schol- cerning the results of the study conducted under nard Holbrooke Jackson, Jr., former Mayor ars were elected in 1904, and since that time

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00169 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8816 CONGRESSIONAL RECORD — SENATE June 26, 2003 distinguished American Rhodes alumni have the National Black Caucus of Local Elected Whereas General Shinseki focused the included over 20 members of Congress, a Officials; Army on improved readiness in preparation President of the United States, 3 Supreme Whereas the Honorable Maynard Holbrook for war and transformed the Army into the Court justices, cabinet members, military Jackson, Jr. became Chair of the National lean, agile, lethal fighting force that leaders, 80 heads of colleges or universities, Voting Rights Institute of the Democratic achieved victories during Operations Endur- and prominent artists, scientists, and busi- National Committee; ing Freedom and Iraqi Freedom; ness people; Whereas the Honorable Maynard Holbrook Whereas General Shinseki provided the vi- Whereas the Mandela Rhodes Foundation, Jackson, Jr. established the American Vot- sion to set the Army on a path of trans- a partnership between the Rhodes Trust and ers League, a nonpartisan organization com- formation that will provide the Nation with the Nelson Mandela Foundation, was estab- mitted to increasing voter turnout; an Army that is more lethal, agile, lished in February, 2002; Whereas upon being elected Mayor of At- deployable, and flexible; capable of fighting Whereas after a lifetime of struggle lanta, the Honorable Maynard Holbrook and winning this Nation’s wars in all future against apartheid and the momentous chal- Jackson, Jr. began encouraging and fos- threat environments. lenge of governing the new South Africa as tering interracial understanding in Atlanta; Whereas General Shinseki exemplifies the its first democratically elected President, Whereas the Honorable Maynard Holbrook trademark characteristics exhibited by all Nobel Peace Prize Laureate Nelson Jackson, Jr. was a strong supporter of af- great leaders and is a remarkable man of in- Rolihlahla Mandela continues to be devoted firmative action, civil rights, and the expan- tegrity, courage, and honor; to building a society characterized by justice sion of social and economic gains for minori- Whereas General Shinseki is an American and opportunity in the Republic of South Af- ties; hero who has been selfless in his service to rica; Whereas the Honorable Maynard Holbrook his country through war, peace, and personal Whereas President Mandela’s efforts have Jackson, Jr. was a great champion for diver- trial, and epitomizes the spirit of aloha; and manifested themselves in the work of the sity, inclusion, and fairness–not just in gov- Whereas John F. Kennedy, the 35th Presi- Nelson Mandela Children’s Fund, established ernment and business, but also in all areas of dent of the United States once said, ‘‘When in the wake of President Mandela’s pledge to life; at some future date the high court of history devote 1⁄3 of his Presidential salary to Whereas the Honorable Maynard Holbrook sits in judgment of each one of us—recording projects aimed at improving the quality of Jackson, Jr. was a wonderful human being whether in our brief span of service we ful- life of South Africa’s disadvantaged children; who never wavered from the principles that filled our responsibilities, we will be meas- and guided his life and career; ured by the answers to 4 questions—were we Whereas in Cape Town in February, 2002, Whereas the efforts of the Honorable May- truly men of courage . . . were we truly men President Mandela noted that the partner- nard Holbrook Jackson, Jr. on behalf on the of judgment . . . were we truly men of integ- ship between the Rhodes Trust and the new City of Atlanta and all Americans earned rity . . . were we truly men of dedication?’’ Mandela Foundation signals ‘‘the closing of him the esteem and high regard of his col- and whereas when history looks back at the the circle and the coming together of 2 leagues; and Army’s 34th Chief of Staff, it will be clear strands in our history’’: Now, therefore, be it Whereas the untimely death of the Honor- that this was truly a man of courage, judg- Resolved, That the Senate— able Maynard Holbrook Jackson, Jr. has de- ment, integrity, and dedication: Now, there- (1) celebrates the centenary of the Rhodes prived his community, the City of Atlanta, fore, be it Scholarships in the United States; the state of Georgia, and the entire Nation of Resolved, (2) welcomes the establishment of the an outstanding leader: Now, therefore, be it SECTION 1. COMMENDATION. Mandela Rhodes Foundation, which em- Resolved: That the Senate— The Senate— bodies the spirit of reconciliation and shared (1) honors the life and accomplishments of (1) thanks General Eric Shinseki of the commitment that is one of South Africa’s the Honorable Maynard Holbrook Jackson United States Army on behalf of a grateful greatest assets; Jr.; Nation; and (3) shares the Foundation’s commitment to (2) recognizes the legendary compassion (2) commends General Eric Shinseki for his support initiatives aimed at increasing edu- exhibited by the Honorable Maynard Hol- extraordinary dedication to service to this cational opportunities, fostering leadership, brook Jackson, Jr. as a civil rights leader; great country and for his lifetime of commit- and promoting human resource development and ment to excellence. throughout Africa; and (3) extends its condolences to the Jackson SEC. 2. TRANSMITTAL OF RESOLUTION. (4) affirms the support of the United States family and the City of Atlanta on the death The Senate directs the Secretary of the for these worthy goals throughout the sub- of a remarkable man. Senate to transmit an enrolled copy of this Saharan region, and asserts that the pursuit resolution to General Eric Shinseki. of these goals is in the shared interest of the The resolution (S. Res. 190) was f American and African people. agreed to. MEASURE READ THE FIRST The resolution (S. Res. 188) was The preamble was agreed to. TIME—S. 11 agreed to. The resolution, with its preamble, The preamble was agreed to. reads as follows: Mr. FRIST. Mr. President, I understand that S. 11 is at the desk, and I The resolution, with its preamble, S. RES. 190 ask for its first reading. reads as follows: Whereas General Eric Shinseki, the Army’s S. RES. 188 The PRESIDING OFFICER. The 34th Chief of Staff, retired in June 2003, from clerk will read the bill by title for the Whereas the Honorable Maynard Holbrook active military duty after 37 distinguished Jackson, Jr. was born on March 23, 1938, in years of service; first time. Dallas, Texas, and at the age of 14 entered Whereas General Shinseki, a native of Ha- The legislative clerk read as follows: Morehouse College as a Ford Foundation waii, graduated from the United States Mili- A bill (S. 11) to protect patients’ access to Early Admission Scholar; tary Academy, West Point, in 1965 and served quality and affordable health care by reduc- Whereas the Honorable Maynard Holbrook in a variety of assignments, including 2 coming the effects of excessive liability costs. Jackson, Jr. graduated cum laude from North bat tours in Vietnam, and was wounded Mr. FRIST. I now ask for its second Carolina Central University School of Law; twice in combat while serving his country; reading and object to further pro- Whereas the Honorable Maynard Holbrook Whereas General Shinseki has been award- ceedings on this matter. Jackson, Jr. became the first African–Amer- ed the Defense Distinguished Service Medal, The PRESIDING OFFICER. Objec- ican Vice Mayor of the City of Atlanta; Distinguished Service Medal, Legion of tion is heard. The bill will remain at Whereas the Honorable Maynard Holbrook Merit (with oak leaf clusters), Bronze Star Jackson, Jr. proved to be a gifted and bril- Medal with ‘‘V’’ Device (with 2 oak leaf clus- the desk. liant political leader, and he later became ters), Purple Heart (with oak leaf cluster), f the first African–American Mayor of the Meritorious Service Medal (with 2 oak leaf UNANIMOUS CONSENT AGREE- City of Atlanta; clusters), Air Medal, Army Commendation Whereas, during his years in office, the Medal (with oak leaf cluster), Army Achieve- MENT—ADJOURNMENT RESOLU- Honorable Maynard Holbrook Jackson, Jr. ment Medal, Parachutist Badge, Ranger Tab, TION was the catalyst for the design of a $400 mil- Office of the Secretary of Defense Identifica- Mr. FRIST. Mr. President, I ask lion terminal at Atlanta’s Hartsfield Inter- tion Badge, Joint Chiefs of Staff Identifica- unanimous consent that when the Sen- national Airport; tion Badge, and the Army Staff Identifica- ate receives the adjournment resolu- Whereas the Honorable Maynard Holbrook tion Badge; tion, it be agreed to and the motion to Jackson, Jr. helped to secure Atlanta’s selec- Whereas General Shinseki has spent the tion as the site of the 1996 Summer Olym- last 4 years of his career in the highest posi- reconsider be laid upon the table, pro- pics; tion attainable in the Army and has proven vided the text is identical to the reso- Whereas the Honorable Maynard Holbrook himself a tremendous leader who has dem- lution that is at the desk. Jackson, Jr. served as president of the Na- onstrated unselfish devotion to this Nation The PRESIDING OFFICER. Without tional Conference of Democratic Mayors and and the soldiers he leads; objection, it is so ordered.

VerDate Mar 15 2010 22:00 Jan 14, 2014 Jkt 081600 PO 00000 Frm 00170 Fmt 0624 Sfmt 0634 E:\2003SENATE\S26JN3.PT2 S26JN3 mmaher on DSKCGSP4G1 with SOCIALSECURITY June 26, 2003 CONGRESSIONAL RECORD — SENATE S8817 ORDERS FOR FRIDAY, JUNE 27, 2003 minated in tonight’s passage—or this IN THE ARMY Mr. FRIST. Mr. President, I ask morning’s passage—of the historic pre- THE FOLLOWING NAMED OFFICER TO THE GRADE INDI- scription drug benefits bill. CATED IN THE RESERVE OF THE ARMY UNDER TITLE 10, unanimous consent that when the Sen- U.S.C., SECTION 12203: ate completes its business today, it f To be colonel stand in adjournment until 10:15 a.m., ADJOURNMENT UNTIL 10:15 A.M. REGINA M. CURTIS, 0000 Friday, June 27. I further ask that fol- TOMORROW THE FOLLOWING NAMED OFFICER TO THE GRADE INDI- lowing the prayer and the pledge, the CATED IN THE RESERVE OF THE ARMY UNDER TITLE 10, morning hour be deemed expired, the Mr. FRIST. If there is no further U.S.C., SECTION 12203: Journal of proceedings be approved to business to come before the Senate, I To be colonel ask unanimous consent that the Sen- date, the time for the two leaders be NANCY M. PRICKETT, 0000 ate stand in adjournment as a mark of reserved for their use later in the day THE FOLLOWING NAMED OFFICERS TO THE GRADE IN- and the Senate then begin a period for further respect for the late Senator DICATED IN THE RESERVE OF THE ARMY UNDER TITLE 10, U.S.C., SECTION 12203: morning business with Members per- Strom Thurmond. To be colonel mitted to speak for up to 10 minutes There being no objection, the Senate, at 1:15 a.m., adjourned until Friday, STEPHEN J. DEMSKI, 0000 each. JOSEPH F. MARANTO, 0000 The PRESIDING OFFICER. Without June 27, 2003, at 10:15 a.m. THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT objection, it is so ordered. f TO THE GRADE INDICATED IN THE UNITED STATES ARMY IN THE JUDGE ADVOCATE GENERAL’S CORPS AND FOR f NOMINATIONS REGULAR APPOINTMENT UNDER TITLE 10, U.S.C., SEC- PROGRAM Executive nominations received by TIONS 624, 531, AND 3064: To be major Mr. FRIST. Tomorrow, the Senate the Senate June 26, 2003: DEPARTMENT OF ENERGY ANDREW S. KANTNER, 0000 will be in a period for morning busi- DANIEL A. TANABE, 0000 ness. Members will be able to pay trib- RICK A. DEARBORN, OF OKLAHOMA, TO BE AN ASSIST- ANT SECRETARY OF ENERGY (CONGRESSIONAL AND ute to our departed friend and col- INTERGOVERNMENTAL AFFAIRS), VICE DAN R. f league Strom Thurmond. We will give BROUILLETTE, RESIGNED. Members an opportunity to submit OFFICE OF SPECIAL COUNSEL CONFIRMATION statements for the RECORD so they can SCOTT J. BLOCH, OF KANSAS, TO BE SPECIAL COUNSEL, be compiled for a printed tribute to OFFICE OF SPECIAL COUNSEL, FOR THE TERM OF FIVE Executive nomination confirmed by Senator Thurmond. There will be no YEARS, VICE ELAINE D. KAPLAN, RESIGNED. the Senate June 26, 2003: rollcall votes tomorrow. DEPARTMENT OF HOMELAND SECURITY EXECUTIVE OFFICE OF THE PRESIDENT Again, I thank my colleagues for PENROSE C. ALBRIGHT, OF VIRGINIA, TO BE AN ASSIST- JOSHUA B. BOLTEN, OF THE DISTRICT OF COLUMBIA, their hard work over the past several ANT SECRETARY OF HOMELAND SECURITY. (NEW POSI- TO BE DIRECTOR OF THE OFFICE OF MANAGEMENT AND TION) BUDGET. weeks. We will have more to say about DEPARTMENT OF JUSTICE THE ABOVE NOMINATION WAS APPROVED SUBJECT TO recent accomplishments of the Senate THE NOMINEE’S COMMITMENT TO RESPOND TO RE- RENE ACOSTA, OF VIRGINIA, TO BE AN ASSISTANT AT- QUESTS TO APPEAR AND TESTIFY BEFORE ANY DULY tomorrow and the events which cul- TORNEY GENERAL, VICE RALPH F. BOYD, JR. CONSTITUTED COMMITTEE OF THE SENATE.

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