October 17, 2002 CONGRESSIONAL RECORD — SENATE S10661 sanctions are threatened or imposed. delegations. When President James Madison OUR LADY OF PEACE ACT Keeping Congressional advisers in the appointed Senator James A. Bayard and Mr. LEVIN. Mr. President, a sensible Speaker of the House Henry Clay to the com- monitoring and enforcement loop tends gun safety measure has been recently to be episodic. It should be systematic. mission that negotiated the Treaty of Ghent in 1814, both resigned from Congress to un- passed by our colleagues in the House The Guidelines should provide for dertake the task. More recently, as in the of Representatives. The ‘‘Our Lady of consultations with Congressional ad- annual appointment of Senators or Members Peace Act’’ was first introduced by visers on monitoring and enforcement of Congress to be among the U.S. representa- Representative CAROLYN MCCARTHY at least every two months. These con- tives to the United Nations General Assem- after Reverend Lawrence Penzes and sultations should not just highlight bly, Members have participated in delega- Eileen Tosner were killed at Our Lady problems. They should provide a com- tions without resigning, and many observers of Peace church in Lynbrook, NY on plete picture of how the Executive consider it ‘‘now common practice and no March 12, 2002. These deaths may have longer challenged.’’ Branch is deploying its monitoring and been prevented if the assailant’s mis- enforcement resources. They should One issue has been whether service by a demeanor and mental health records identify where these efforts are suc- Member of Congress on a delegation violated were part of an automated and com- ceeding, as well as where they require Article I, Section 6 of the Constitution. This section prohibits Senators or Representa- plete background check system. reenforcement. tives during their terms from being ap- According to the House Judiciary In conclusion, the Trade Act of 2002 pointed to a civil office if it has been created Committee Report on the bill, 25 represents a watershed in relations be- or its emoluments increased during their States have automated less than 60 tween the Executive and Legislative terms, and prohibits a person holding office percent of their felony criminal convic- Branches when it comes to trade policy to be a Member of the Senate or House. tion records. While many States have and negotiations. Before the Trade Act, Some contend that membership on a negoti- the capacity to fully automate their the Executive Branch generally took ating delegation constitutes holding an of- background check systems, 13 States the lead, and the involvement of Con- fice while others contend that because of its do not automate or make domestic vio- temporary nature it is not. gressional advisers tended to be cur- lence restraining orders accessible sory and episodic. In the Trade Act, Another issue concerns the separation of through the National Instant Criminal Congress sent a clear message that the powers. One view is that as a member of a Background Check System, otherwise old way will not do. negotiating delegation a Senator would be subject to the instructions of the President known as NICS. Fifteen States do not From now on, the involvement of and would face a conflict of interest when automate domestic violence mis- Congressional advisers in developing later required to vote on the treaty in the demeanor records or make them acces- trade policy and negotiations must be Senate. Others contend that congressional sible through NICS. Since 1994, the in depth and systematic. Congress can members of delegations may insist on their Brady Law has successfully prevented no longer be an afterthought. The independence of action and that in any event more than 689,000 individuals from ille- Trade Act establishes a partnership of upon resuming their legislative duties have a gally purchasing a firearm. More ineli- equals. It recognizes that Congress’s right and duty to act independently of the gible firearm purchases could have constitutional authority to regulate executive branch on matters concerning the treaty. been prevented, and more shooting foreign trade and the President’s con- deaths may have been avoided had stitutional authority to negotiate with A compromise solution has been to appoint state records been fully automated. foreign nations are interdependent. It Members of Congress as advisers or observ- The Our Lady of Peace Act would re- ers, rather than as members of the delega- requires a working relationship that tion. The administration has on numerous quire Federal agencies to provide any reflects that interdependence. occasions invited one or more Senators and government records with information Our first opportunity to memorialize Members of Congress or congressional staff relevant to determining the eligibility this new, interdependent relationship to serve as advisers to negotiations of multi- of a person to buy a gun for inclusion is only weeks away. I am very hopeful lateral treaties. In 1991 and 1992, for example, in NICS. It would also require states to that the Administration will work Members of Congress and congressional staff make available any records that would closely with us in developing the were included as advisers and observers in disqualify a person from acquiring a Guidelines to make the partnership of the U.S. delegations to the United Nations firearm, such as records of convictions Conference on Environment and Develop- equals a reality. ment and its preparatory meetings. In 1992, for misdemeanor crimes of domestic vi- EXHIBIT 1 congressional staff advisers were included in olence and individuals adjudicated as TREATIES AND OTHER INTERNATIONAL AGREE- the delegations to the World Administrative mentally defective. To make this pos- MENTS: THE ROLE OF THE UNITED STATES Radio Conference (WARC) of the Inter- sible, this bill would authorize appro- SENATE national Radio Consultative Committee priations for grant programs to assist On occasion Senators or Representatives (CCIR) of the International Telecommuni- States, courts, and local governments have served as members of or advisers to the cations Union. in establishing or improving auto- U.S. delegation negotiating a treaty. The In the early 1990s, Congress took initia- mated record systems. I hope we can practice has occurred throughout American tives to assure congressional observers. The move in this direction this Congress or history. In September 1898, President Wil- Senate and House each designated an ob- next. liam McKinley appointed three Senators to a server group for strategic arms reductions commission to negotiate a treaty with talks with the Soviet Union that began in f Spain. President Warren G. Harding ap- 1985 and culminated with the Strategic Arms ASSISTANCE FOR SOUTH DAKOTA pointed Senators Henry Cabot Lodge and Reduction Treaty (START) approved by the MEDICARE BENEFICIARIES AND Oscar Underwood as delegates to the Con- Senate on October 1, 1992. In 1991, the Senate PROVIDERS ference on the Limitation of Armaments in established a Senate World Climate Conven- 1921 and 1922 which resulted in four treaties, tion Observer Group. As of late 2000, at least Mr. JOHNSON. Mr. President, one of and President Hoover appointed two Sen- two ongoing groups of Senate observers ex- the key remaining issues of the 107th ators to the London Naval Arms Limitation isted: Congress that I believe must be ad- Conference in 1930. dressed yet this year is Medicare relief The practice has increased since the end of 1. Senate National Security Working the Second World War, in part because Presi- Group.—This is a bipartisan group of Sen- for rural health care providers and dent Wilson’s lack of inclusion of any Sen- ators who ‘‘act as official observers to nego- beneficiaries. Recently, bipartisan leg- ators in the American delegation to the tiations * * * on the reduction or limitation islation was introduced, called the Ben- Paris Peace Conference was considered one of nuclear weapons, conventional weapons or eficiary Access to Care and Medicare of the reasons for the failure of the weapons of mass destruction; the reduction, Equity Act of 2002, S. 3018, that will Versailles Treaty. Four of the eight members limitation, or control of missile defenses; or related export controls.’’ provide definitive steps to strengthen of the official U.S. delegation to the San South Dakota’s rural health care deliv- Francisco Conference establishing the 2. Senate Observer Group on U.N. Climate ery system. I am pleased to be a co- United Nations were Members of Congress: Change Negotiations.—This is a ‘‘bipartisan Senators Tom Connally and Arthur Vanden- group of Senators, appointed by the Majority sponsor of this bill. berg and Representatives Sol Bloom and and Minority Leaders’’ to monitor ‘‘the sta- The legislation will provide $43 bil- Charles A. Eaton. tus of negotiations on global climate change lion over ten years for provider and There has been some controversy over ac- and report[ing] periodically to the Senate beneficiary improvements in the Medi- tive Members of Congress serving on such * * *.’’ care and Medicaid programs. Earlier

VerDate Mar 15 2010 20:40 Jan 09, 2014 Jkt 081600 PO 00000 Frm 00031 Fmt 4624 Sfmt 0634 E:\2002SENATE\S17OC2.PT2 S17OC2 mmaher on DSKCGSP4G1 with SOCIALSECURITY S10662 CONGRESSIONAL RECORD — SENATE October 17, 2002 this summer, the House passed a Medi- It is due to these unique circumstances mittee to address the area wage index dis- care bill, which provides approximately that rural providers and beneficiaries de- parities with new money. $30 billion over ten years. The Senate serve to be the Committee’s top priority as Current law allows rural facilities located near urban area to receive the higher wage legislation will provide South Dakota it writes legislation to strengthen the Medi- care system. We encourage the Committee to index available to the facilities located in with nearly $84.2 million in Medicare give special consideration to those states the metropolitan area. However, this wage improvements for rural hospitals, that are experiencing the lowest aggregate index ‘‘reclassification’’ is available only for skilled nursing facilities, home health negative Medicare margins. We request the inpatient and outpatient services. We believe services, physicians, and beneficiaries following rural specific provisions be in- re-classification should extend to other serv- alike. Although the Administration cluded in the Committee’s final Medicare ices offered by hospitals, such as home care and skilled nursing services. has expressed some resistance to work- provider legislation: 2. CRITICAL ACCESS HOSPITAL PROGRAM ing with Congress on Medicare legisla- 1. RURAL HOSPITALS IMPROVEMENTS tion this year, I will continue to fight Market Basket Update: Under current law, The Balanced Budget Act of 1997 created all hospitals will receive a Medicare pay- for passage of this critically important the Critical Access Hospital program (CAH) ment update in FY2003 of hospital cost infla- legislation. to ensure access to essential health services tion minus approximately one-half percent. As I travel throughout South Da- in underserved rural communities that can- kota, many health care providers and However, hospitals in rural areas and small- not support a full service hospital. This pro- er urban areas have Medicare profit margins Medicare beneficiaries have expressed gram has proven to be critically important far lower than those of hospitals in large to rural areas as 667 hospitals across the na- concerns regarding inequities with urban areas. Therefore, we urge the Com- Medicare reimbursements in rural tion have converted to Critical Access Hos- mittee to provide hospitals located in rural pital status. We urge the Committee to in- states like South Dakota. It is a trav- or smaller urban areas with a full inflation clude the following modifications to esty that nationwide, rural providers update. strengthen this critical program. receive less Medicare reimbursement Equalize Medicare Disproportionate Share ∑ Reinstate Periodic Interim Payments for providing the same services as their Hospital Payment (DSH) Formula: Hospitals (PIP), which provide facilities with a stead- urban counterparts. Therefore, I re- receive add-on payments to help cover the ier stream of payment in order to improve costs of serving a high proportion of unin- main committed to improving the eq- their cash flow. sured patients. While urban facilities can re- ∑ Eliminate the current requirement that uity in Medicare reimbursement levels ceive unlimited add-ons corresponding with CAH-based ambulance services be at least 35 for rural States, and increasing access the amount of patients served, rural add-on miles from another ambulance service in to quality, affordable health care for payments are capped at 5.25 percent of the order to receive cost-based payment. the citizens of South Dakota. total amount of the inpatient payment. We ∑ Allow for home health services operated As a member of the Senate Rural urge the Committee to remove this cap for by CAHs to be reimbursed on a cost basis, as Health Caucus, I joined several of my rural hospitals, bringing their payments in other CAH services already are. ∑ fellow caucus members in sending a line with the benefits urban facilities re- Provide cost-based reimbursement for certain clinical diagnostic lab tests fur- letter to the Senate Finance Com- ceive. Close Gap Between Urban and Rural nished by a CAH. mittee expressing our rural health pri- ‘‘Standardized Payment’’ Levels: Inpatient ∑ Provide Medicare coverage to CAHs for orities as compiled from the input that hospital payments are calculated by multi- certain emergency room on-call providers. ∑ I received from South Dakotans, such plying several different factors, including a Allow CAHs to interchange the number as yourself. I was pleased that many of standardized payment amount. Under cur- of their acute and swing beds as necessary, rent law, hospitals located in cities with but still maintain the current 25 bed limit. my rural priorities were included in S. ∑ Alleviate payment reductions that will more than 1 million people receive a base 3018, and would ask unanimous consent occur as a result of recent cost report payment among 1.6 percent higher than that the text of this letter be printed changes made by CMS related to the amount those serving smaller populations. We urge in the CONGRESSIONAL RECORD. As well, of allowable beneficiary coinsurance pay- the Committee to address this disparity by ments. I ask unanimous consent that the sum- bringing the rural base payment up to the mary of S. 3018 also be printed in the urban payment level. 3. RURAL HOME HEALTH IMPROVEMENTS RECORD. Low-Volume Hospital Payment: According Home health care is a critical element of There being no objection, the mate- to recent data, the current hospital inpa- the continuum of care, allowing Medicare rial was ordered to be printed in the tient payment rate has placed low-volume beneficiaries to remain in their homes rather than being hospitalized. Current law pro- RECORD, as follows: hospitals at a disadvantage because it does vides for a 10 percent payment boost for pa- U.S. SENATE, not adequately account for the fact that tients residing in rural areas, to reflect the Washington, DC, September 16, 2002. smaller facilities have difficulty achieving higher costs due to distance, as well as the Hon. MAX BAUCUS, Chairman, the economies of scale of their larger coun- reality that there is often only one provider Hon. CHARLES GRASSLEY, Ranking Member, terparts. To address this problem, we request in rural areas. However, this special pay- Committee on Finance, the Committee create a low-volume inpa- ment will expire with the current fiscal year. Washington, DC. tient payment adjustment for hospitals that DEAR CHAIRMAN BAUCUS AND RANKING MEM- have less than 1,000 annual discharges per 4. RURAL HEALTH CLINICS BER GRASSLEY: As members of the Senate year and are located more than 15 miles from Under current law, rural health clinics re- Rural Health Caucus, we write to urge you to another hospital. ceive an all-inclusive payment rate that is take definitive steps this year to strengthen Outpatient Payment Improvements: Rural capped at approximately $63. Various anal- our nation’s rural health care delivery sys- Hospitals are highly dependent on outpatient yses have suggested that this cap does not tem. We are particularly concerned about ge- services for revenue; however, the Medicare appropriately cover the cost of services for ographic inequities in Medicare spending, Outpatient Prospective Payment System more than 50 percent of rural health clinics which are caused in part by disparities in sets payments at 16 percent below costs. We that the cap should be raised by 25 percent to current Medicare payment formulas. Related urge the Committee to take the following address this shortfall. We request that the to this, we strongly urge the Committee to actions to ensure outpatient stability for Committee raise the rural health clinic cap address needed rural payment improvements rural hospitals. to $79. in its Medicare refinement bill. 1. Increase emergency room and APC pay- Certain provider services, such as those of- Nationwide, rural providers receive less ments by 10 percent. fered by physicians, nurse practitioners, phy- Medicare reimbursement for providing the 2. Limit the pro rata reduction in pass- sician assistants, and qualified psychologists same services as their urban counterparts. through payments to 20 percent. are excluded from the consolidated payments According to the latest Medicare figures, 3. Limit the budget neutrality adjustment made to skilled nursing facilities (SNFs) Medicare’s annual inpatient payments per to no more than 2 percent. under the prospective payment system. How- beneficiary by state of residence range from 4. Extend current provision that holds ever, the same services provided to SNFs by slightly more than $3,000 in predominately small, rural hospitals harmless from the cur- physicians and other providers employed by rural states like Wyoming, Idaho and Iowa rent Outpatient PPS for three more years. rural health clinics are not excluded from to over $7,000 in other states. 5. Improve and extend transitional corridor the consolidated SNF payment. We request This problem is compounded by the fact payments to rural hospitals. the Committee ensure skilled nursing serv- that rural Medicare beneficiaries tend to be Wage Index Issues: Medicare’s current in- ices offered by rural health clinic providers poorer and have more chronic illnesses than patient hospital payments fail to accurately will receive the same payment treatment as urban beneficiaries. This inherent vulner- reflect today’s labor costs in rural areas. The services offered by providers employed in ability of rural providers combined with his- Caucus has long been concerned about this other settings. toric funding shortfalls and rising costs has issue and its impact on rural hospitals as 5. RURAL PROVIDERS placed additional burdens on an already they strive to recruit and retain key health Rural Physicians: There are several ways strained rural health care system. care personnel. We strongly urge the Com- to improve the current Medicare Incentive

VerDate Mar 15 2010 20:40 Jan 09, 2014 Jkt 081600 PO 00000 Frm 00032 Fmt 4624 Sfmt 0634 E:\2002SENATE\S17OC2.PT2 S17OC2 mmaher on DSKCGSP4G1 with SOCIALSECURITY October 17, 2002 CONGRESSIONAL RECORD — SENATE S10663 Payment program to increase payments to health care delivery system. We look forward Sec. 112. Extension of 10% rural add-on for rural physicians. Such changes include: plac- to continuing to work with you to ensure home health through FY04. ing the burden for determining eligibility for that all rural providers receive the necessary Sec. 113. 10% add-on for frontier hospice for the current 10 percent rural physician bonus resources to provide quality health care CY03 through CY07. payment on the Medicare carrier rather than services to rural seniors. Sec. 114. Exclude services provided by the individual physician; creating a Medi- Sincerely, Rural Health Clinic-based practitioners from care Incentive Payment Education program Craig Thomas (Co-Chair), Sam Brown- Skilled Nursing Facility consolidated bill- at CMS; and establishing an on-going anal- back, ——, Byron L. Dorgan, Ben Nel- ing. ysis of the program’s ability to improve son, ——, Fred H. Thompson, Conrad R. Sec. 115. Rural Hospital Capital Loan Au- Medicare beneficiaries’ access to physician Burns, Jesse Helms, Wayne Allard, Mi- thorization. services. We urge the Committee to make chael Crapo, Chris Bond, James Inhofe, Title II—Provisions Relating to Part A these critical changes to the Medicare Inven- Patrick Leahy, Jeff Sessions, Debbie tive Payment program. Stabenow, Paul Wellstone, Mike (Approx. $9.0 billion over 10 years) Mental Health Providers: The majority of DeWine, Carl Levin, Ben Nighthorse Subtitle A—Inpatient Hospital Services rural and frontier areas are federally des- Campbell, Jean Carnahan. ignated mental health professional shortage Sec. 201. FY03 inflation adjustment of mar- Tom Harkin (Co-Chair), Tim Johnson, ket basket minus ¥0.25% for PPS hospitals; areas. In many of these underserved commu- Jeff Bingaman, Maria Cantwell, Mary nities, a Marriage and Family Therapist or a full market basket for Sole Community Hos- Landrieu, Larry Craig, Pat Roberts, pitals. Licensed Professional Counselor is the only John Edwards, Blanche Lincoln, Susan mental health provider available to seniors, Sec. 202. Update hospital market basket Collins, Patty Murray, Mark Dayton, weights more frequently. but is not able to bill Medicare for their Gordon Smith, Tom Daschle, Tim services. We strongly urge the Committee to Sec. 203. IME Adjustment: 6.5% in FY03, Hutchinson, Jim Jeffords, ——, Ernest 6.5% in FY04, 6.0% in FY05. provide Medicare reimbursement for Li- Hollings, Thad Cochran, Kay Bailey Sec. 204. Puerto Rico: 75%–25% Federal- censed Professional Counselors and Marriage Hutchison, Ron Wyden, Orrin Hatch. and Family Therapists at the rate that So- Puerto Rico blend beginning in FY 03. cial Workers are paid. THE BENEFICIARY ACCESS TO CARE AND Sec. 205. Geriatric GME programs: certain 6. OTHER RURAL ISSUES MEDICARE EQUALITY ACT OF 2002 geriatric residents do not count against caps. Sec. 206. DSH increase for Pickle hospitals Ambulance Services: The Balanced Budget TOTAL COST OVER 10 YEARS: APPROXIMATELY $43 from 35% to 40%. Act of 1997 directed the Secretary of Health BILLION and Human services to establish a fee sched- Subtitle B—Skilled Nursing Facility Services NOTE: subtotals below do not sum to $42 ule payment system for ambulance services. billion due to Part B premium and Medicaid Sec. 211. Increase to nursing component of The negotiated rule making committee that interactions and rounding. Part B premium RUGs: 15% in FY03, 13% in FY04, 11% in was utilized in the regulatory process in- and Medicaid interactions total approxi- FY05; increase in payment for AIDS patients structed the Secretary to account for geo- mately ¥$2.5 billion over 10 years. cared for by SNFs; GAO study. graphic differences and develop a more ap- Sec. 212. Require collection of staffing propriate coding system. However, the cur- Title I—Rural Health Care Improvements data; require staffing measure in CMS qual- rent ambulance payment system does not (Approx. $12.8 billion over 10 years) ity initiative. recognize the unique circumstances of low- Sec. 101. Full standardized amount for volume, rural providers. We strongly urge rural and small urban hospitals by FY04 and Subtitle C—Hospice the Committee to address these issues to en- thereafter. Sec. 221. Allow payment for hospice con- sure access to critical ambulance services in Sec. 102. Wage index changes: labor-related sultation services based on fee schedule set rural and frontier communities. share for hospitals with a wage index below by Secretary; remove one-time limit set by Pathology Labs: Currently, independent 1.0 is 68% for FY03 through FY05; labor-re- House. labs can bill Medicare directly for all serv- lated share for hospital with a wage index Sec. 222. Authorize use of arrangements ices. After January 1, 2003 labs will only be above 1.0 is held harmless (i.e. remains at with other hospice programs. able to bill for diagnosis of slides prepared current level of 71%). Title III—Provisions Relating to Part B by the lab. The costs of slide preparation Sec. 103. Medicare disproportionate share must be recovered separately from the hos- (DSH) payments: increases the maximum (Approx. $10.0 billion over 10 years) pital. Small, rural hospitals that do not have DSH adjustment for rural hospitals and Subtitle A—Physicians’ Services their own pathology departments and inde- urban hospitals with under 100 beds to 10% Sec. 301. Physician payment increase (same pendent labs face increased administrative (phased-in over ten years). as House-passed version); GAO study; costs and complexity in this new billing ar- Sec. 104. 1-year extension of hold harmless MedPAC report. rangement. We request that the Committee from outpatient PPS for small rural hos- Sec. 302. Extension of treatment of certain make permanent the grandfather clause en- pitals. physician pathology services through FY05. acted in BIPA to allow independent labs to Sec. 105. 5% add-on for clinic and ER visits receive direct reimbursement from Medicare. for small rural hospitals. Subtitle B—Other Services National Health Service Corps Taxation: Sec. 106. 2-year extension of reasonable Sec. 311. Competitive bidding for DME: The National Health Service Corps program cost payments for diagnostic lab tests in begin national phase-in CY03 for MSAs with (NHSC) provides either scholarships or loan- Sole Community Hospitals. over 500,000 people. repayments to clinicians who agree to serve Sec. 107. Critical Access Hospital improve- Sec. 312. 2-year extension of moratorium for at least three years in a designated ments: (a) Reinstatement of periodic interim on therapy caps. health professional shortage area. Last payments; (b) Condition for application of Sec. 313. Acceleration of reduction of bene- year’s tax cut exempted NHSC scholarships special physician payment adjustment; (c) ficiary copayment for hospital outpatient from taxation, but loan-repayments are still Coverage of costs for certain emergency department services. considered taxable income. As a result, al- room on-call providers; (d) Prohibition on Sec. 314. End-Stage Renal Disease: Increase most half of the current NHSC appropriation retroactive recoupment; (e) Increased flexi- composite rate to 1.2% in CY03 and CY04; is spent in the form of stipends to clinicians bility for states with respect to certain fron- composite rate exceptions for pediatric fa- to offset the tax liability on loan repay- tier critical access hospitals; (f) Permitting cilities. ments. We strongly urge the Committee to hospitals to allocate swing beds and acute Sec. 315. Improved payment for certain exempt the NHSC loan repayments from tax- care inpatient beds subject to a total limit of mammography services. ation. 25 beds; (g) Provisions related to certain Sec. 316. Waiver of Part B late enrollment Flex Reauthorization: As you know, the rural grants; (h) Coordinated survey dem- penalty for certain military retirees and spe- Balanced Budget Act of 1997 created the onstration program. cial enrollment period. Rural Hospital Flexibility program (known Sec. 108. Temporary relief for certain non- as the ‘‘flex’’ program) to assist small rural teaching hospital for FY03 through FY05 Sec. 317. Coverage of cholesterol and blood hospitals in making the switch to Critical (same as House-passed provision). lipid screening. Access Hospital status (CAH). This program Sec. 109. Physician work Geographic Prac- Sec. 318. 5% payment increase for rural has proven to be very successful in rural tice Cost Index at 1.0 for CY03 through CY05, ground ambulance service, 2% increase for areas as it has maintained access to critical holding harmless those areas with work urban ground ambulance services. care in small communities. Program funds GPCIs over 1.0. Sec. 319. Medical necessity criteria for air are used by states for Critical Access Hos- Sec. 110. Make existing Medicare Incentive ambulance services under ambulance fee pital designation and assistance, rural Payment 10% bonus payments on claims by schedule. health planning and network development, physicians serving patients in rural Health Sec. 320. Improved payment for thin prep and rural emergency medical services. We Professional Shortage Areas automatic, pap tests. urge the Committee to reauthorize this im- rather than requiring special coding on such Sec. 321. Coverage of immunsuppressive portant rural health program. claims. drugs. We greatly appreciate the Committee’s Sec. 111. GAP study on geographic dif- Sec. 322. Geriatric care assessment dem- past efforts on behalf of our nation’s rural ferences in physician payments. onstration program.

VerDate Mar 15 2010 20:40 Jan 09, 2014 Jkt 081600 PO 00000 Frm 00033 Fmt 4624 Sfmt 0634 E:\2002SENATE\S17OC2.PT2 S17OC2 mmaher on DSKCGSP4G1 with SOCIALSECURITY S10664 CONGRESSIONAL RECORD — SENATE October 17, 2002 Sec. 323. CMS study and recommendations velopment of local coverage decisions under Sec. 806. Extend Medicare Municipal to Congress on revisions to outpatient pay- certain circumstances. Health Services Demonstration for 1 year. ment methodology for drugs, devices and Subtitle C—Contracting Reform Sec. 807. Provides for delayed implementa- biologicals. tion of certain provisions. Sec. 621. Authorizes Medicare contractor Title IV—Provisions Relating to Parts A and B reform beginning in October 2004. f (Approx. $0.0 billion over 10 years) Subtitle D—Education and Outreach Improve- VETERANS DAY 2002 Subtitle A—Home Health Services ments Mr. FEINGOLD. Mr. President, as the Sec. 401. Eliminate 15% reduction in pay- Sec. 631. New education and technical as- Senate prepares to recess until after ments for home health services. sistance requirements. the November elections, I would like to Sec. 632. Requires CMS and contractors to Sec. 402. Reduce inflation updates in FY03 take a moment to express my thanks through FY05; full market basket increases provide written responses to health care pro- thereafter. viders’ and beneficiaries’ questions with 45 and the thanks of the people of Wis- consin to our Nation’s veterans and Subtitle B—Other Provisions days. Sec. 633. Suspends penalties and interest their families. Sec. 411. Information technology dem- payments for providers that have followed The Senate will not be in session on onstration project. incorrect guidance. Sec. 412. Modifications to the Medicare Veterans Day, November 11th. I urge Sec. 634. Creates new ombudsmen offices Payment Advisory Commission. my colleagues and all Americans to for health care providers and beneficiaries. Sec. 413. Requires CMS to maintain a car- take a moment on that day to reflect Sec. 635. Authorizes beneficiary outreach upon the meaning of that day and to rier medical director and carrier advisory demonstration. committee in every state to ensure access to remember those who have served and the local coverage process. Subtitle E—Review, Recovery, and Enforce- sacrificed to protect our country and ment Reform Title V—Medicare+Choice and Related Provi- the freedoms that we enjoy as Ameri- sions Sec. 641. Requires CMS to establish stand- cans. ards for random prepayment audits. (Approx. $2.3 billion over 10 years, including Sec. 642. Requires CMS to enter into over- Webster’s Dictionary defines a vet- M+C interactions) payment repayment plans. Prevents CMS eran as ‘‘one with a long record of serv- Sec. 501. Increase minimum updates to 4% from recovering overpayments until the sec- ice in a particular activity or capac- in CY03 and 3% in CY04. ond level of appeal is exhausted. ity,’’ or ‘‘one who has been in the Sec. 502. Clarify Secretary’s authority to Sec. 643. Establishes a process for the cor- armed forces.’’ But we can also define a disapprove certain cost-sharing rection of incomplete or missing data with- veteran as a grandfather or a grand- Sec. 503. Extend cost contracts for 5 years. out pursuing the appeals process. Sec. 504. Extend the Social HMO Dem- mother, a father or a mother, a brother Sec. 644. Expands the current waiver of or a sister, a son or a daughter. Vet- onstration through 2006. program exclusions in cases where the pro- Sec. 505. Extend specialized plans for spe- vider is a sole community physician or sole erans live in all of our communities, cial needs beneficiaries for 5 years source of essential health care. and their contributions have touched (Evercare). Title VII—Medicaid-SCHIP all of our lives. Sec. 506. Extend 1% entry bonus for M+C November 11 is a date with special (Approx. $10.8 billion over 10 years) for 2 years; bonus does not apply for private significance in our history. On that day fee-for-service or demonstration plans. Sec. 701. Extend Medicaid disproportionate in 1918—at the eleventh hour of the share hospital (DSH) inflation updates (for Sec. 507. PACE technical fix regarding eleventh day of the eleventh month— services furnished by non-contract providers. 2001 and 2002) to 2003, 2004 and 2005 allot- Sec. 508. Reference to implementation of ments; update District of Columbia DSH al- World War I ended. In 1926, a joint reso- certain M+C provisions in 2003. lotment. lution of Congress called on the Presi- Title VI—Medicare Appeals, Regulator, and Sec. 702. Raise cap from 1% to 3% for states dent to issue a proclamation to encour- Contracting Improvements classified as low Medicaid DSH in FY03 age all Americans to mark this day by through FY05. (Approx. $0.0 billion over 10 years) displaying the United States flag and Sec. 703. Five year extension of QI–1 Pro- by observing the day with appropriate Subtitle A—Regulatory Reform gram. Sec. 704. Enable public safety net hospitals ceremonies. Sec. 601. Require status report on interim In 1938, ‘‘Armistice Day’’ was des- final rules; limit effectiveness of interim to access discount drug pricing for inpatient final rules to 12 months with one extension drugs. ignated as a legal holiday ‘‘to be dedi- permitted under certain circumstances. Sec. 705. CHIP Redistribution: give states cated to the cause of world peace’’ by Sec. 602. Requires only prospective compli- an additional year to spend expiring funds an Act of Congress. This annual rec- ance with regulation changes. that would otherwise return to the Treasury; ognition of the contributions and sac- Sec. 603. Secretary report on legal and reg- continue BIPA arrangement for SCHIP redis- rifices of our Nation’s veterans of ulatory inconsistencies in Medicare. tribution; establish caseload stabilization World War I was renamed ‘‘Veterans Subtitle B—Appeals Process Reform pool beginning in FY04; allow certain states Day’’ in 1954 so that we might also rec- to use a portion of unspent SCHIP funds to Sec. 611. Requires Secretary to submit de- cover specified Medicaid beneficiaries; GAO ognize the service and sacrifice of tailed plan for transfer of responsibility for study to evaluate program implementation those who had fought in World War II medicare appeals from SSA to HHS; GAO and funding. and the veterans of all of America’s evaluation of plan. Sec. 706. Improvements to Section 1115 other wars. Sec. 612. Allows expedited access to judi- waiver process for Medicaid and State Chil- Mr. President, our Nation’s veterans cial review for Medicare appeals involving dren’s Health Insurance Program (SCHIP) and their families have given selflessly legal issues that the DAB does not have the waiver. authority to decide. to the cause of protecting our freedom. Sec. 707. Increase the federal medical as- Too many have given the ultimate sac- Sec. 613. Allows expedited appeals for cer- sistance percentage in Medicaid (FMAP) by tain provider agreement determinations, in- 1.3% for 12 months for all states; ‘‘hold harm- rifice for their country, from the bat- cluding terminations. less’’ states scheduled to have a lower FMAP tlefields of the Revolutionary War that Sec. 614. Tightens eligibility requirements in FY03; $1 billion increase in Social Services gave birth to the United States to the for QICs and reviewers; ensures notice and Block Grant for FY03. Civil War that sought to secure for all improved explanation on determination and Americans the freedoms envisioned by redetermination decisions; delays implemen- Title VIII—Other Provisions tation of Section 521 of BIPA for 14 months, (Approx. $0.9 billion over 10 years) the Founding Fathers. In the last cen- but continues implementation of expedited Sec. 801. Extend funding for Special Diabe- tury, Americans fought and died in two redeterminations; expands CMS discretion tes Programs for FY04, FY05, and FY06 at world wars and in conflicts in Korea, on the number of QICs. $150 million per program per year. Vietnam, and the Persian Gulf. They Sec. 615. Creates hearing rights in cases of Sec. 802. Disregard of certain payments also participated in peacekeeping mis- denial or nonrenewal of enrollment agree- under the Emergency Supplemental Act, 2000 sions around the globe, some of which ments; requires consultation before CMS in the administration of Federal programs are still going on. Today, our men and changes provider enrollment forms. and federally assisted programs. women in uniform are waging a fight Sec. 616. Permits provider to appeal deter- Sec. 803. Create Safety Net Organizations minations relating to services rendered to an and Patient Advisory Commission. against terrorism. And in the future, individual who subsequently dies if there is Sec. 804. Guidance on prohibitions against our military personnel could be asked no other party available to appeal. discrimination by national origin. to undertake a campaign in Iraq. Sec. 617. Permits providers to seek appeal Sec. 805. Extend grants to hospitals for As we prepare to commemorate Vet- of local coverage decisions and to request de- EMTALA treatment of undocumented aliens. erans Day 2002, we should reflect on the

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