June 24, 1997 CONGRESSIONAL RECORD — SENATE S6163 some of our mutual concerns in this While a $50,000 bond is relatively in- procedure. Only 14 percent of those area. Senator HARKIN and I have long expensive to post for scrupulous con- women who had to make some kind of been champions of anti-fraud measures tractors, at a cost of about $500, the re- cash payment actually had a mammo- and pro-competitive measures, some- quirement has achieved tremendous re- gram. In contrast, among women who times to the consternation of health sults in my State. Since implementa- had some kind of insurance to supple- care suppliers and providers. tion of the requirement, the ‘‘fly-by- ment their Medicare benefits, 43 per- Senator HARKIN was right yesterday night’’ providers have scattered like so cent had mammograms. Lack of sup- when he spoke strongly about Medi- many roaches when the lights are plemental coverage should not be a care’s need to begin negotiating for the turned on. barrier to necessary and ultimately best deal on supplies and equipment, Durable Medical Equipment Suppli- cost-saving medical treatment. Mam- like other Federal agencies have done. ers have dropped by 62 percent, from mography should not be a luxury. It is It makes no sense that Medicare—the 4,146 to 1,565; home health agencies a necessity. largest single purchaser of health care have decreased by 41 percent, from 738 Mr. President, another necessary pre- services in the country—has to follow a to 441; providers of transportation serv- ventive measure is Bone Mass Measure- price list set out in seven pages of stat- ices have disenrolled from the State’s ment, the procedure which detects ute rather than relying on competi- Medicaid program in droves—from 1,759 Osteoporosis. tion. to 742, a drop of 58 percent. Fewer pro- Osteoporosis is a debilitating bone disease which afflicts 28 million Ameri- Our efforts in this area have been bi- viders bilking the State’s Medicaid cans and causes 50,000 deaths each partisan. Just last week in the Senate Program is projected to save over $192 year. Eighty percent of its victims are Finance Committee, I, along with Sen- million over the next 2 years in Flor- ator NICKLES, sponsored an amendment women. ida. Osteoporosis fracture patients cost to give the Health Care Financing Ad- Mr. President, we have expanded the ministration the authority to institute Medicare $13.8 billion a year. This cost surety bond requirement not only to is projected to reach $60 billion by the competitive bidding for part B services. Medicare in this bill—but the Finance My colleagues on the Committee stood year 2020 and $240 billion by the year Committee also adopted my amend- 2040 if medical research has not discov- with me as we unanimously adopted ment to expand this requirement to this proposal. It is my sincere hope ered an effective treatment. We can Medicaid. curb these skyrocketing costs by pro- that my House colleagues will follow This is just one of the many anti- suit. viding Medicare coverage of bone mass fraud provisions included in this budg- measurement. Implementation of competitive bid- et. I want to reiterate my thanks to ding is one way in which Congress can Because we now have access to drugs Chairman ROTH for his willingness to which can slow the rate of bone loss, show that we have finally gotten seri- take a tough stance to ensure that ous about preserving the integrity of early detection is our best weapon in Medicare and the State Medicaid Pro- the fight against Osteoporosis. It is Medicare. grams are run efficiently, without the Another way is to begin a serious only through early detection that we graft we have seen overrun the pro- crackdown on fraud in not only Medi- can thwart the progress of the disease grams in recent years. care, but Medicaid. Congress simply and initiate preventive efforts to stop Finally, Mr. President, we must do as cannot be taken seriously when it asks further loss of bone mass. much as we possibly can to ensure that for sacrifice if we are not willing to In order to ensure that we detect our seniors receive preventive care— bone loss early, we need to ensure that push as hard as we can to prevent peo- ‘‘health care’’ not ‘‘sick care.’’ older women have coverage for bone ple from ripping off the system. Let me give you some brief examples In the long run, we stand to save bil- mass tests. Unfortunately, coverage of of the rampant problems we face in lions of dollars by providing early, reg- bone mass measurement is inconsistent this area: ular, and preventive medical care, as from state to state. Qualifications for In 1993, in my home town of Miami opposed to acute, reactive, emergency testing, and the frequency of testing, Lakes, FL, the Office of the Inspector care. It is both fiscally and physically differ from carrier to carrier and region General reviewed 100 claims for Medi- prudent to prevent sickness before the to region. The current system is con- care reimbursement by a home health fact and not after. fusing and inequitable. Medicare Bone agency. About out-fourth of these We can start by covering colon can- Mass Measurement Coverage should be claims did not meet Medicare guide- cer screenings under Medicare. We can covered uniformly in all states. Diabetes, with its tremendous finan- lines in that they either were unneces- save millions of dollars—and millions cial and human toll, also deserves sary, not reasonable, or not provided at of lives—by detecting and treating this greater protection under Medicare. By all. The home health agency made $8.5 cancer in its early stages. Colon cancer providing for Medicare coverage of million in claims, $1.2 million did not is the second most frequent cancer blood glucose monitoring strips and meet the reimbursement guidelines. killer in America, causing 55,000 deaths outpatient self-management training Two years ago, I spend a day working each year. But while it is estimated services, we can expect to see signifi- in the U.S. Attorney’s Office in South that screening and early detection and cant reductions in complications and Florida. There I learned that it is easi- intervention could eliminate up to 90 percent of these deaths, Medicare does expensive treatments. er to get a provider number under Med- Coverage of test strips and self-man- not currently pay for these preventive icare than it is to get a Visa card. It is agement training services will allow easier to get a blank check signed by measures. Colon cancer screenings cost only people with diabetes to care for their Uncle Sam than it is to get a household own individual needs. In so doing, they $125–$300 apiece, and patients diagnosed credit card. can better prevent complications such through early detection have a 90 per- Mr. President, we cannot repair the as blindness, kidney failure and heart cent chance of survival. But if a pa- Medicare Program without first crack- disease. ing down on fraud and abuse. Those tient isn’t diagnosed until symptoms Mr. President, this budget agreement who play by the rules should not have develop, the chance of survival drops to is smart. It cracks down on fraud and to suffer at the hands of cheats and a mere 8 percent. Care for treatment in abuse. It makes medical goods and swindlers, and this Congress should put such cases can cost up to $100,000. The services cheaper. And it promotes pre- an end to the conditions in which cost of not covering colon cancer ventive health, saving millions of lives cheats and swindlers thrive. screenings—in lives and in dollars—is and billions of dollars. I would like to thank Chairman ROTH unacceptable. These are necessary and long overdue for including many of the Medicare It is also imperative that we elimi- measures, and I thank my colleagues anti-fraud proposals contained in bi- nate co-payments for mammography. who have supported them. partisan legislation I introduced with According to a 1995 study in the New f Senator MACK and Senator BAUCUS last England Journal of Medicine, women in month, including mandating that pro- the Medicare Program who have to pay MEDICARE SUBVENTION viders post a $50,000 surety bond to par- some of the cost of mammography are Mr. KEMPTHORNE. Mr. President, ticipate in the Medicare program. far less likely to actually undergo the today I join my colleagues in support S6164 CONGRESSIONAL RECORD — SENATE June 24, 1997 of Medicare subvention. I want to This is not a perfect bill before us aged care in rural areas—the majority thank Chairman ROTH and the Finance today. My colleagues and I on the Fi- of my State is rural. However, essen- Committee for including this impor- nance Committee held several mara- tially freezing payment rates in high tant demonstration project in the bill thon sessions last week in order to cost area, which coincidentally also now before the Senate. After 4 years, I craft a large part of this legislation. I have the overwhelming majority of ex- believe that it is high time the Con- think we reached agreement on a pack- isting managed care enrollment, in gress enact Medicare subvention. This age of provisions about which everyone order to increase payment rates in project is part of the solution toward has some objections but also, all the rural areas may have the reverse ef- providing military retirees the quality members of the Finance Committee fect. The committee bill contains so health care they deserve. For these were able to support in the end. This many incentives for rural areas that reasons, I strongly urge my colleagues unanimous support for the bill is a we may erode existing managed care to support Medicare subvention. complete change from the Balanced enrollment and extra benefits that Mr. President, the Medicare portion Budget Act of 1995 and a testament to many health plans offer like prescrip- of the reconciliation bill now before us the leadership of Senators ROTH and tion drugs and eye glasses. I hope that on the floor includes two demonstra- MOYNIHAN. I want to congratulate my a more appropriate balance between tion projects for Medicare subvention. colleagues for working together in a bi- encouraging managed care in under- The first will reimburse the Depart- partisan fashion aimed at not only im- served areas and maintaining existing ment of Veterans Affairs with funding proving the Medicare and Medicaid enrollment can be achieve in the con- from the Medicare Program for health programs but also the Nation as a ference with the House. care services provided to targeted Med- whole. On the other hand, there are a num- icare-eligible veterans. The second I am however, particularly concerned ber of good aspects of this legislation. demonstration project, Mr. President, about several provisions included in Increased choice for Medicare bene- will offer military retirees over the age the bill. The first is the impact of in- ficiaries through the development of of 65 the option to use familiar medical creasing the Medicare eligibility age to Provider Sponsored Organizations and treatment facilities, with Medicare re- 67. This provision will have a negative the removal of teen parents from the imbursing the Department of Defense. effect on millions of Americans. Many limit on vocational education under Mr. President, in my opinion, these businesses and employees plan their re- the welfare program are just two exam- two solutions will address the frustra- tirement and health coverage around ple of very meaningful policy changes tions many of our veterans endure eligibility for Medicare. Increasing the included in this bill. Removing teen after serving their country so honor- age to qualify will exacerbate the ex- parents from the vocational education ably. Subvention gives America’s vet- isting problem of being uninsured limit will facilitate states’ promotion erans an option to choose the best pos- among people age 55 to 65. Given our of education for 240,000 additional indi- sible medical care available. I urge my goal during this Congress of increasing viduals as a means of moving perma- colleagues to support the Medicare sub- health coverage for vulnerable popu- nently from welfare to work. vention demonstration project with the lations—through the kids health care The legislation would also cover dia- hopes that this year we will pass this and allowing the disabled to buy into betes self management training, cost-saving, commonsense solution to Medicaid—this provision moves in the colorectal cancer screenings, and mam- some of the health care needs of our wrong direction. mography screens without copayment Nation’s veterans. Similarly, the proposed fourfold in- obligations. This investment in mam- Ms. MOSELEY-BRAUN. Mr. Presi- crease in the Medicare deductible for mograms without a copayment obliga- dent, the legislation pending before the some beneficiaries is particularly prob- tions will benefit over 2 million Senate is designed to provide sufficient lematic. I voted against this provision women. Mr. President, S. 947 protects savings to implement the balanced in the Finance Committee because I do the vitally important Early Periodic budget blueprint we passed last month. not think the issue was sufficiently Screening Diagnostic and Treatment While the balanced budget plan set the considered nor were we given the kind [EPSDT] benefits for children under broad framework for balancing the of impact analysis that is essential be- Medicaid. Despite requests from Gov- budget by 2002, it was up to the various fore making a decision of such mag- ernors to diminish the benefit package committees to implement this plan. nitude. Such a significant increase in for children, this bill does not allow it This bill combines recommendations the deductible is essentially a tax on to occur. Similarly, the legislation pro- from eight Senate panels, including the sickest seniors. Those people who tects disproportionate share funding changes in Medicare, Medicaid, and have to use the doctor more are the for those hospitals that treat large vol- spectrum auctions. I commend the only ones who will incur the increased umes of indigent patients and are over- committees for their work thus far be- costs. Any deterred utilization of serv- ly burdened by uncompensated care. cause many of the provisions in the ices will likely be the result of a senior I am certain that members on both Balanced Budget Act of 1997 are long deciding between needed health serv- sides of the aisle believe that this bill overdue steps in the right direction. It ices or other expenses that must come can be improved and there are a num- is clear that unless we get our deficit from their fixed income. ber of proposed amendments to do so; a under control, we will be leaving our Furthermore, we have to be careful number of which I plan to support. I children—and our children’s children— before preceding down this road. Means hope that this body can get through a legacy of debt that will make it im- testing stands to erode support for the this process in the same bipartisan possible for them to achieve the Amer- Medicare Program. We all have wit- fashion displayed in the Finance Com- ican Dream. nessed the backlash against so called mittee. Chairman ROTH said it best The best news about this plan is that welfare programs over the past 2 years. both in the Committee and on the Sen- it will help balance the Federal budget. We must not allow Medicare to become ate floor, that no one got everything More work however, needs to be done regarded as transfer program solely for but everyone got something that they to meet our obligations to future gen- the poor. Americans pay into Medicare wanted in this bill. That I believe, is erations of Americans, to invest in peo- and expect to have the insurance when the true mark of legislation through ple, and to protect their retirement se- they retire. We already make wealthier consensus. curity. Every generation of Americans Americans pay more in Medicare pay- As I said at the outset, this bill takes has addressed and resolved challenges roll taxes. It does not seem appropriate several steps in the right direction— unique to their time. That is what to be so hasty in increasing their cost- the direction of a balanced budget. makes our country great. Now is the sharing obligations for the program as However, Congress must not only look time to take steps toward ensuring well. at the 5 and 10 year effect of the poli- that our generation will honestly ad- I also think that the Finance Com- cies we enact or rest on the laurels this dress its needs so that future genera- mittee went too far in its zeal to in- package. We need to look to the future tions will have at least the same oppor- crease managed care enrollment in and continue to reform programs in a tunity. Our generation should leave no rural areas. This by no means suggest fashion that maintain a balanced budg- less than we inherited. that I do not support enhanced man- et. The worse thing that we could do is June 24, 1997 CONGRESSIONAL RECORD — SENATE S6165 not act again for another 60 years. ters would never clear the point of particular, the support that was so bi- Long-range economic forecasts are no- order under the waiver because it re- partisan on many critical issues here toriously unreliable, but our long- quires 60 votes was dispelled today be- today. If that can continue, I am al- range demographic changes are a re- cause of the bipartisan nature of the most positive we will end up in early ality that cannot be ignored. The retir- results desired. I believe that will hold October giving the American people ing baby-boom generation will place true. I am hopeful when we go to con- one of the best legislative sessions with considerable strain on our public sys- ference that the same thing will hap- one of the most significant accomplish- tems. This budget bill only extends pen, that the distinguished chairman of ments in modern legislative history. Medicare solvency through 2007—not the Finance Committee, who has most Staff is copying the lists so we can do even to the point at which the baby- of these matters even if he splits it up the amendments en bloc, but one boomers begin to retire. The longer we into subcommittees, that it will come amendment that did not get into that wait to enact more substantive pro- out of there bipartisan and we will con- is one by Senator ABRAHAM. gram changes, the greater the threat tinue to work with the President. AMENDMENT NO. 456 to the viability of the Medicare Pro- We want to tell the White House that (Purpose: To extend the moratorium gram. we know the bill which will be cleared regarding HealthSource Saginaw) Our actions now will impact future tomorrow is deficient in at least two Mr. DOMENICI. Mr. President, I send generations—our grandchildren and places and we will have to fix those in the Abraham amendment to the desk great grandchildren. We have to re- conference because we cannot fix them and ask that it be read so it will qual- mind ourselves to look beyond the next here today. We will tomorrow in an ify for tomorrow’s stacking. 5 to 10 years. I am not suggesting that amendment to be offered by Senator The PRESIDING OFFICER. The we not celebrate being on the brink of MCCAIN, Senator LOTT, and myself, at- clerk will report. a victory—balancing the budget for the tempt to bring the revenues to be re- The legislative clerk read as follows: first time in 60 years. I am simply ceived from spectrum closer to the The Senator from New Mexico [Mr. DOMEN- stressing that Congress cannot retreat mandate in the reconciliation bill. We from its commitment to ensuring that ICI] for Mr. ABRAHAM for himself and Mr. are hopeful everyone will support us on LEVIN, proposes an amendment numbered future generations will have at least that. It will be short by a bit. 456. the same opportunity as we and our Unless other things mesh out when Mr. DOMENICI. I ask unanimous parents. Our generation should not we go to conference, we will be short consent that the reading of the amend- leave no less than we inherited. the balanced budget by a couple of bil- Mr. DOMENICI. Mr. President, I ment be dispensed with. lion dollars in the last year. We will think what both sides are waiting for The PRESIDING OFFICER. Without work very hard on that in conference now is to prepare all of the amend- objection, it is so ordered. to try to fix it. The amendment is as follows: ments that we are going to offer en I look forward to the same thing hap- bloc in an appropriate unanimous con- SEC. . EXTENSION OF MORATORIUM. pening. In fact, some said, how are we Section 6408(a)(3) of the Omnibus Budget sent request—both Senator LAUTEN- going to be sure we do not get Govern- Reconciliation Act of 1989, as amended by BERG and myself. So the time is going ment closure on the appropriations section 13642 of the Omnibus Budget Rec- to be much to our advantage because bills when the President vetoes the onciliation Act of 1993 is amended by strik- we will not be here very long after we bills and we close down Government, ing ‘‘December 31, 1995’’ and inserting ‘‘De- get started on that. and my response to most, there is no cember 31, 2002.’’. Mr. President, when we first started UNINSURED CHILDREN negotiating with the President of the magic to it. We will not be able to do it by some kind of statute. We tried Mr. COATS. Mr. President, because United States, the Republican and we are waiting, already after a long Democratic leadership, the Budget that. Obviously, it didn’t work. I said the best way to do it is to have biparti- day, but because we are waiting for Committee chairman and some others some material to come back, if I could asked how are we going to get through san appropriations bills that have been worked on in an effort to meet the ask the chairman of the Budget Com- these contentious issues? Some Repub- mittee a question that I raised at licans on our side said how will we be agreement which the President joined lunch. I know that the Budget Commit- sure what we get done will be signed by us on and where there was no joinder tee deliberated at great length on the the President? That had to do with the because it was not required, that the issue of providing insurance for unin- reconciliation bill that we are going to contents be at least bipartisanly sup- sured children and that after that de- finish tomorrow about noon, it had to ported. liberation, on a bipartisan basis, it was do with the tax bill, it had to do with Now, our chairman is trying to do determined that a $16 billion chunk of the 13 appropriations bills. that in appropriations. If that contin- My stock answer was it seems to me ues, I think two things result: We get money for the 5-year budget plan be set what we have learned over the past 4 it done; and second, the American peo- aside to address that problem. Many of years is that the best way to get that ple praise us for it because I believe us applauded the work of the chairman done is to have the proposals done in a that is exactly what they want us to and others in not only that but in put- bipartisan manner. That is, send to the do. ting the entire budget together. President proposals that are both Re- Frankly, that does not mean we have Having said that, I am aware that we publican and Democratic in terms of to give away our philosophy or our will be addressing the second phase of the party affiliation of those who sup- ideas. In many instances it will take a reconciliation and a decision on the port it. long time to get where we want to go. part of the Finance Committee to add From what I gather, at least in the I assume the Democrats are saying the an additional $8 billion for that pro- U.S. Senate, the epitomy of that is same thing on their side, wondering gram in a block grant to the States. I Senator ROTH and his chairmanship, when they will take over again and be am also aware of the fact there may be with his ranking member, Senator able to move it in their direction. None an amendment offered that may add to MOYNIHAN. For even today, on almost of it will occur in 1 year. It will take that an additional $8 billion, raising all of the amendments that the Fi- longer. We will get only part of what the total to double or more of what the nance Committee either offered or we want. Budget Committee decided. were challenged on, almost every mem- The tax cuts are not sufficient when I am wondering if either the chair- ber of the Democratic Party voted you take into consideration the huge man of the Budget Committee or the for—not all, but almost all—and you burden imposed on our people, but we chairman of the Finance Committee saw the results. Some of the issues also, some of us, recognize we are also can explain to me what changed? What that we were never able to do before in spending a lot of money and as we di- was necessary? Why was it necessary? a reconciliation bill following a budget minish that spending and decrease it, What new facts came to light that re- resolution were done today and they maybe we can have even more tax cuts quired the additional $8 billion, at were done with overwhelming votes. in years to come. I hope so. least? The general understanding in this So that is the way I understand what I know we will be debating this issue, place that contentious, difficult mat- is going on. I feel good about it and, in and I do not mean to take up time this S6166 CONGRESSIONAL RECORD — SENATE June 24, 1997 evening to debate it. We will debate it I am hopeful when we are finished deemed to be unacceptable. The first under the tax bill. But in the interim, and get this implemented that we will approach was to try and insure 5 mil- I wonder if we can discuss that a little see to it that we are able to measure lion children. That is what the $16 bil- bit so this Senator can better under- what we are doing with that money and lion was for, to try to get the first 5 stand what it is we are attempting to how well we have covered people. It million uninsured children covered. do. may very well be—although for Gov- This came from the Senator’s side of Mr. DOMENICI. Mr. President, let me ernment money, I doubt it, because the aisle in the Finance Committee. try for a couple of minutes, and if Sen- whenever you put it out there I assume We thought that maybe we could go be- ator LAUTENBERG would like to chime it will get spent—but I am hopeful if it yond that and approach beyond 5 mil- in, and obviously the distinguished is more than necessary, we will not lion. But to be quite honest, I think as chairman of the Finance Committee is spend it, although I assume that might we have gone our way through this here. not happen. That is the best I have. process, we have come to understand I think it is fair to say, for starters, Mr. COATS. I thank the chairman. Of that we can’t judge exactly what the that the issue of uninsured children— course, he put his finger on my con- States are going to do and we can’t be that is, children without any health in- cern, and that is that before we have entirely sure. So the CBO is now begin- surance—has been a longstanding identified the scope of the problem and ning to give us figures that suggest we issue. But in all honesty, it has only the resources necessary to address the won’t be able to reach the 5 million become an issue that has been looked scope of the problem, we have set aside children mark, perhaps even with both at diligently in an effort to see how a chunk of money, a very significant the $16 billion and the $8 billion pro- you might change the way we were chunk of money, $24 billion. I just won- gram. But then again, we are not sure. doing things this year. der where that figure came from and But we know we have to try because As a matter of fact, it is very inter- having uninsured children is not ac- esting, if uninsured children as a class what it is based upon, because as the ceptable in America. It is not a ques- were a big insurable group, it is inter- Senator from New Mexico has just said tion of throwing money at a problem or esting to note that you could not buy and we all know, once the money is suddenly a discovery of a new source of health insurance for children. In other made available, those who are bene- money. There was simply the desire words, if some State had decided, ficiaries of the money, whether it is that we ought to get health insurance ‘‘Let’s go ask Aetna or somebody else, the States or whether we put it in Med- to the 10 million children who do not do you have an insurance policy we can icaid or wherever we put it, they will have it. We worked within the Finance buy just to insure kids?’’ it is within find a way to spend it. Committee to try to accomplish that. the last 6 months, I understand, that I do not think anybody is arguing that we do not want to address the Mr. COATS. I thank the Senator. As for an exclusive child health care in- the Senator from West Virginia knows, surance policy—it is a very short-lived issue of uninsured children, but I think we had debate on that during the pro- instrument that exists. For starters, what we were arguing is we want to do posal offered by Senator KENNEDY ear- nobody knew exactly what it would it in a responsible way, a way that is lier, which was defeated. But there was cost. responsible to the taxpayers so that we There were two other things that do not just arbitrarily come up with a significant disagreement on the floor. I came into the discussion, and that was number without knowing the scope of don’t know the answer, as to the num- there are at least two ways, maybe the problem and what dollar amount ber of uninsured children, cost policies three, of getting insurance. One was to needs to be applied to that. to insure those children, or the best expand the Medicaid system, which So my question really goes to the ra- mechanism to use. Even the charts will cover some of these uninsureds in tionale that was used in arriving at the that the Senator from Utah had des- any event, but to expand it further so $16 billion initially by the Budget Com- ignating the number of uninsured chil- that it would encompass more. That mittee. I assume they had significant dren and the charts that the sponsor of amount was estimated by those who do debate and research into that in arriv- the bill, Senator KENNEDY from Massa- that kind of work. But there were not ing at that figure, but what has chusetts, had at the same time they of- really any real estimates on if you did changed from that point forward on the fered the bill; the two charts were off it the second way, which was to let the Finance Committee? What new infor- by several million, in terms of the States either provide it or buy insur- mation did they learn that was not number of uninsured children. So even ance for them—those numbers were not available to the Budget Committee the sponsors of the bill hadn’t coordi- readily available. that caused the Finance Committee to nated the numbers or checked with So some will say that the $16 billion raise that figure by $8 billion? Was it each other relative to how many unin- was too much. In fact, one of our Sen- simply the availability of additional sured children existed. We learned that ators who has studied it diligently be- tax money through an identified tax three-point-some million of the chil- lieves you could cover all the and a decision to divide it up and throw dren were covered under the existing uninsureds for less than $16 billion. $8 billion here and $4 billion there and Medicaid Program and several million Others say when you are finished with whatever, or was there a specific ra- of these children were temporarily un- the $16 billion, there will still be some tionale or new piece of information insured, not full-time uninsured, be- that are not covered. I do not believe a that came forward that said, ‘‘No, we cause their parents were in and out of magic formula was arrived at in the Fi- were short when we made our Budget employment. And, normally, in em- nance Committee. I believe there are Committee estimate. We now need to ployment you get a family policy that those who said not enough prevailed. put in an additional $8 billion to cover covers dependents. They found a source of money in a the problem that we have identified’’? So I was confused as to what the compromise cigarette tax—$8 billion That goes to the nature of my ques- total number was, how many were in- out of the total of $20 billion in reve- tion. That clearly is something that we sured, and what mechanisms we ought nues from that was used for that one need to debate in the tax bill. I do not to put in place and, more important, function. want to hold up the proceedings here how we ought to derive a number. Ob- Now, frankly, I’m hopeful for myself, this evening. viously, we all want to be responsible I’m very pleased we did not go the Med- Mr. ROCKEFELLER. Will the Sen- with the taxpayers’ dollars and, at the icaid route. Neither the House bill nor ator yield? same time, provide the important cov- the Senate bill made it singularly a Mr. COATS. I am happy to yield to erage. I wasn’t able to get an answer mandate that you cover the children the Senator from West Virginia. where there is some unanimity regard- under expanded Medicaid. In both Mr. ROCKEFELLER. Mr. President, I ing the number of children, who is cov- bills—in the Senate bill they are al- don’t pretend to speak for the chair- ered, who needs to be covered, how long lowed the option of taking a block man of the Finance Committee, but I they need to be covered, what the cost grant to be administered by the States, think it would be helpful to the Sen- of the policy is to cover them. And it and that is one of the amendments that ator’s concern by expressing this. seemed to me that we were pursuing a was around here tonight—what kind of There are 10 million uninsured chil- problem by addressing a solution de- coverage would that be? dren in this country, and that was signed in terms of the amount of June 24, 1997 CONGRESSIONAL RECORD — SENATE S6167 money available, not necessarily in that would assure all children health Section 1804 of the Social Security Act (42 terms of the specifics of the problem. care with the enactment of this legisla- U.S.C. 1395b–2) is amended by adding at the Mr. ROCKEFELLER. If the Senator tion. end the following new subsection: will further yield, I simply say that I Mr. COATS. I wonder if I can ask the ‘‘(c)(1) The Secretary shall provide a state- ment which explains the benefits provided really don’t think this was a money chairman one last question? under this title with respect to each item or chase where, in trying to find a solu- Mr. ROTH. Yes. service for which payment may be made tion, they had to go find the problem. Mr. COATS. If it is an undefined fig- under this title which is furnished to an indi- The problem was there. One of the ure, or at least a loosely defined fig- vidual, without regard to whether or not a most outstanding problems, which is ure—going back to a question the deductible or coinsurance may be imposed vexatious, is there are 3 million chil- chairman of the Budget Committee against the individual with respect to such dren out there right now who are eligi- raised—is there a provision, or will item or service. there be a provision in the law that ‘‘(2) Each explanation of benefits provided ble for Medicaid, but their families do under paragraph (1) shall include—— not know; they do not know that they would give us the ability to monitor or ‘‘(A) a statement which indicates that be- are in fact eligible for Medicaid. So audit the State response and return of cause errors do occur and because medicare part of the problem was, how do you excess funds if States meet their unin- fraud, waste and abuse is a significant prob- find, through various public and State sured children’s needs, but have money lem, beneficiaries should carefully check the agencies, those 3 million children left over from the block grant; is there statement for accuracy and report any errors across the country who are already eli- a basis upon which we can return that or questionable charges by calling the toll- money and use it for, obviously, other free phone number described in (C). gible? (B) a statement of the beneficiary’s rights Mr. COATS. I ask the Senator, if we important needs? to request an itemized bill (as provided in could not find them before under exist- Mr. ROTH. Well, I think there is an section 1128A(n)); and ing State-run programs, how are we accountability in the program. There ‘‘(C) a toll-free telephone number for re- going to find them now under State was considerable discussion about porting errors, questionable charges or other block grant programs? wanting to make certain that these acts that would constitute medicare fraud, Mr. ROCKEFELLER. I say to the funds were spent by the States for the waste, or abuse, which may be the same Senator up front, the Senator is asking purpose of children’s health insurance. number as described in subsection (b).’’. (b) REQUEST FOR ITEMIZED BILL FOR MEDI- for kind of an exactitude in an area So, yes, we did ensure that that had to CARE ITEMS AND SERVICES.—— where exactitude is really very dif- be used for that purpose. (1) IN GENERAL.—Section 1128A of the So- ficult, which is the whole area of the Mr. COATS. I thank the Senator. I cial Security Act (42 U.S.C. 1320a–7(a) is uninsured—how much it would cost? will be happy to get those materials amended by adding at the end the following Where are they? How long will they be from the staff and continue to work new subsection: on Medicaid or insurance? When will with him on this question. ‘‘(m) WRITTEN REQUEST FOR ITEMIZED I yield the floor. BILL.—— they go off? Does the State know about ‘‘(1) IN GENERAL.—A beneficiary may sub- it? Will the State, under a block grant Mr. DOMENICI. Mr. President, I mit a written request for an itemized bill for money program, take children already thank Senator COATS very much for medical or other items or services provided on Medicaid and substitute that the colloquy this evening. I think it to such beneficiary by any person (including money, thus freeing the other money? I was very helpful. I am sorry, from my an organization, agency, or other entity) can’t worry about that. standpoint, that I can’t be more tech- that receives payment under title XVIII for I have faith in the chairman of the nical on the amendment. I believe providing such items or services to such ben- Finance Committee. I think this was a there is a lot of objectivity that is eficiary. lacking, and I am sure that is going to ‘‘(2) 30-DAY PERIOD TO RECEIVE BILL.—— bipartisan decision to do something ‘‘(A) IN GENERAL.—Not later than 30 days about a problem that has been with us evolve with time. Your question seems after the date on which a request under para- throughout our history, which is no to be very relevant and germane to a graph (1) has been received, a person de- longer deemed acceptable. The Senator serious problem. scribed in such paragraph shall furnish an is entirely correct when he says there Mr. President, I believe on our side, itemized bill describing each medical or are no simple answers. I want to assure and soon to be followed on the Demo- other item or service provided to the bene- ficiary requesting the itemized bill. the Senator—because I sat through, ob- cratic side, we are prepared to ask unanimous consent that a series of ‘‘(B) PENALTY.—Whoever knowingly fails viously, all the Finance Committee to furnish an itemized bill in accordance meetings, both public and private— amendments be in order for tomorrow’s with subparagraph (A) shall be subject to a there was never an attempt to sort of stacked event that we have spoken of. civil fine of not more than $100 for each such grab at money for the purpose of say- I have an amendment that has been failure. ing let’s put that toward health insur- agreed to on both sides. This amend- ‘‘(3) REVIEW OF ITEMIZED BILL.—— ‘‘(A) IN GENERAL.—Not later than 90 days ance for children. It was a sense that ment is made on behalf of Senator HARKIN and Senator MCCAIN. after the receipt of an itemized bill furnished we have a real problem here and we under paragraph (1), a beneficiary may sub- AMENDMENT NO. 457 want to try to address it as responsibly mit a written request for a review of the and carefully as possible. That was fol- (Purpose: To reduce health care fraud, waste, itemized bill to the appropriate fiscal lowed by a bipartisan discussion and and abuse) intermediary or carrier with a contract agreement. Mr. DOMENICI. Mr. President, I send under section 1816 or 1842. Mr. COATS. I thank the Senator. I an amendment to the desk on behalf of ‘‘(B) SPECIFIC ALLEGATIONS.—A request for Senators HARKIN and MCCAIN and ask a review of the itemized bill shall identify— don’t want to hold up the proceedings ‘‘(i) specific medical or other items or serv- here this evening. I am happy to yield for its immediate consideration. The PRESIDING OFFICER. The ices that the beneficiary believes were not to the chairman. provided as claimed, or Mr. ROTH. I will make one comment clerk will report. ‘‘(ii) any other billing irregularity (includ- regarding the figures as to what it The legislative clerk read as follows: ing duplicate billing). costs to cover children. What we did in The Senator from New Mexico [Mr. DOMEN- ‘‘(4) FINDINGS OF FISCAL INTERMEDIARY OR committee is agree that there should ICI], for Mr. HARKIN, for himself and Mr. CARRIER.—Each fiscal intermediary or car- MCCAIN, proposes an amendment numbered be outreach, that we do want to ensure rier with a contract under section 1816 or 457. 1842 shall, with respect of each written re- that all children that are not currently Mr. DOMENICI. Mr. President, I ask quest submitted to the fiscal intermediary or insured have the opportunity of having unanimous consent that reading of the carrier under paragraph (3), determine such insurance. But there is a lack of amendment be dispensed with. whether the itemized bill identifies specific precision in the information, and that medical or other items or services that were The PRESIDING OFFICER. Without essentially creates the problem. I think not provided as claimed or any other billing objection, it is so ordered. irregularity (including duplicate billing) all you have to do is listen to the dis- The amendment is as follows: cussion that we are having here this that has resulted in unnecessary payments At the end of the bill, add the following: evening and it shows you that you under title XVIII. SEC. . IMPROVING INFORMATION TO MEDICARE ‘‘(5) RECOVERY OF AMOUNTS.—The Secretary don’t have hard figures on this. But it BENEFICIARIES. shall require fiscal intermediaries and car- was agreed upon, in a bipartisan way, (a) CLARIFICATION OF REQUIREMENT TO PRO- riers to take all appropriate measures to re- that we wanted to develop a program VIDE EXPLANATION OF MEDICARE BENEFITS.— cover amounts unnecessarily paid under title S6168 CONGRESSIONAL RECORD — SENATE June 24, 1997

XVIII with respect to a bill described in AMENDMENT NO. 459 tions), except for any phase down provisions, paragraph (4).’’. (Purpose: To provide that, for purposes of and subject to the same set of waivers that ‘‘(c) EFFECTIVE DATE.—The amendments section 1886(d) of the Social Security Act, applied to the project or were granted before made by this section shall apply with respect the large urban area of Charlotte-Gasto- the extension of the project under this sub- to medical or other items or services pro- nia-Rock Hill-North Carolina-South Caro- section. The permanent continuation of a vided on or after January 1, 1998. lina be deemed to include Stanly County, waiver project shall be on the same terms SEC. PROHIBITING UNNECESSARY AND WASTE- North Carolina) and conditions, including financing, and sub- FUL MEDICARE PAYMENTS FOR CER- At the appropriate place in division 1 of ject to the same set of waivers. No test of TAIN ITEMS. title V, insert the following: budget neutrality shall be applied in the case Section 1861(v) of the Social Security Act of projects described in paragraph (2) after SEC. —. INCLUSION OF STANLY COUNTY, N.C. IN is amended by adding at the end the follow- that date on which the permanent extension ing new paragraph: A LARGE URBAN AREA UNDER MEDI- CARE PROGRAM. was granted. ‘‘(8) ITEMS UNRELATED TO PATIENT (a) IN GENERAL.—For purposes of section ‘‘(5) In the case of a waiver project de- CARE—.Reasonable costs do not include 1886(d) of the Social Security Act (42 U.S.C. scribed in paragraph (2), the Secretary, act- costs for the following: 1395ww(d)), the large urban area of Char- ing through the Health Care Financing Ad- (i) entertainment; ministration shall, deem any State’s request (ii) gifts or donations; lotte-Gastonia-Rock Hill-North Carolina- South Carolina may be deemed to include to expand Medicaid coverage in whole or in (iii) costs for fines and penalties resulting part to individuals who have an income at or from violations Federal, State or local laws; Stanly County, North Carolina. (b) EFFECTIVE DATE.—This section shall below the Federal poverty level as budget and, neutral if independent evaluations sponsored (iv) education expenses for spouses or other apply with respect to discharges occurring on or after Oct. 1, 1997. by the Health Care Financing Administra- dependents of providers of services, their em- tion have shown that the State’s Medicaid ployees or contractors. AMENDMENT NO. 460 managed care program under such original SEC. ——. REDUCING EXCESSIVE BILLINGS AND waiver is more cost effective and efficient UTILIZATION FOR CERTAIN ITEMS. (Purpose: To provide for the continuation of certain Statewide medicaid waivers) than the traditional fee-for-service Medicaid Section 1834(a)(15) of the Social Security program that, in the absence of any managed Act (42 U.S.C. 1395m(a)(15)) is amended by On page 844, between lines 7 and 8, insert care waivers under this section, would have striking ‘‘Secretary may’’ both places it ap- the following: been provided in the State.’’. pears and inserting ‘‘Secretary shall’’. SEC. 5768. CONTINUATION OF STATE-WIDE SEC- ‘‘(b) EFFECTIVE DATE.—The amendment The PRESIDING OFFICER. Without TION 1115 MEDICAID WAIVERS. made by subsection (a) shall become effec- objection, amendment No. 457 is agreed (a) IN GENERAL.—Section 1115 of the Social tive on the date of enactment of this Act. to. Security Act (42 U.S.C. 1315) is amended by adding at the end the following: Mr. MCCAIN. Mr. President, I rise to The amendment (No. 457) was agreed ‘‘(d)(1) The provisions of this subsection offer an amendment which would allow to. shall apply to the extension of statewide States to continue offering innovative AMENDMENTS NOS. 458 THROUGH 474 comprehensive research and demonstration cost effective health care through an Mr. DOMENICI. I ask unanimous projects (in this subsection referred to as 1115 Medicaid waiver on a permanent consent that it be in order for me to ‘waiver project’) for which waivers of compli- basis or on a continuous basis for 3 offer a package of amendments on be- ance with the requirements of title XIX are years. In addition, this measure would granted under subsection (a). With respect to ensure that State’s are given credit for half of various Senators so that they a waiver project that, but for the enactment would qualify under the consent agree- of this subsection, would expire, the State at the cost savings which they have in- ment. its option may— curred by operating an efficient man- The amendments offered are as fol- ‘‘(A) not later than 1 year before the waiv- aged care Medicaid program. lows: er under subsection (a) would expire (acting Several States have led the way in Two amendments on behalf of Sen- through the chief executive officer of the innovation for expanding coverage ator HELMS; two amendments on behalf State who is operating the project), submit through cost containment. These of Senator MCCAIN; two amendments to the Secretary a written request for an ex- States have not used accounting tension of such waiver project for up to 3 on behalf of Senator JEFFORDS; one gamesmanship to ask the Federal Gov- years; or amendment by Senator BROWNBACK; ‘‘(B) permanently continue the waiver ernment to do the job; they have used one amendment by Senator ALLARD; project if the project meets the requirements their own resources to revise their pro- one by Senator CHAFEE; one amend- of paragraph (2). grams to expand coverage while reduc- ment by Senator GRASSLEY; one by ‘‘(2) The requirements of this paragraph ing both State and Federal costs. Senator KYL; three by Senator SPEC- are that the waiver project— Among these States is Arizona, Or- TER; one by Senator BURNS; one by ‘‘(A) has been successfully operated for 5 or egon, Rhode Island, Florida, and Ten- more years; and Senator HUTCHISON; one by Senators nessee. Any other State operating ‘‘(B) has been shown, through independent MCCAIN and DOMENICI. evaluations sponsored by the Health Care Fi- under an 1115 waiver may find herself I send the amendments to the desk nancing Administration, to successfully con- in the same position. and ask unanimous consent that the tain costs and provide access to health care. In Arizona, 72 percent of her voters amendments be considered read and be ‘‘(3)(A) In the case of waiver projects de- decided last fall that they should cover numbered accordingly. scribed in paragraph (1)(A), if the Secretary everyone under the poverty line, The PRESIDING OFFICER. Without fails to respond to the request within 6 whether man, woman, or child. This objection, it is so ordered. months after the date on which the request initiative is the only hope for health The amendments are as follows: was submitted, the request is deemed to have care coverage for 50,000 men who live been granted. AMENDMENT NO. 458 ‘‘(B) If the request is granted or deemed to under the poverty line. Arizona can af- (Purpose: To provide that, for purposes of have been granted, the deadline for submit- ford to do this because of the success of section 1886(d) of the Social Security Act, tal of a final report shall be 1 year after the the Arizona statewide managed care the large urban area of Charlotte-Gasto- date on which the waiver project would have program. AHCCCS [access] in contain- nia-Rock Hill-North Carolina-South Caro- expired but for the enactment of this sub- ing cost and providing access to care. lina be deemed to include Stanly County, section. This has been proven. The satisfaction North Carolina) ‘‘(C) The Secretary shall release an evalua- of Arizona’s health care providers, tion of each such project not later than 1 At the appropriate place in division 1 of members, and taxpayers further under- title V, insert the following: year after the date of receipt of the final re- score the success of the program. SEC. —. INCLUSION OF STANLY COUNTY, N.C. IN port. A LARGE URBAN AREA UNDER MEDI- ‘‘(D) Phase-down provisions which were ap- In spite of substantial savings docu- CARE PROGRAM. plicable to waiver projects before an exten- mented by HCFA hired evaluators, doc- (a) IN GENERAL.—For purposes of section sion was provided under this subsection shall umented savings since the program 1886(d) of the Social Security Act (42 U.S.C. not apply. began in 1982, more than enough to off- 1395ww(d)), the large urban area of Char- ‘‘(4) The extension of a waiver project set the cost of expanding coverage, the lotte-Gastonia-Rock Hill-North Carolina- under this subsection shall be on the same Federal Government won’t allow Ari- South Carolina may be deemed to include terms and conditions (including applicable Stanly County, North Carolina. terms and conditions related to quality and zona to reinvest the savings it achieved (b) EFFECTIVE DATE.—This section shall access of services, budget neutrality as ad- over a traditional fee-for-service pro- apply with respect to discharges occurring justed for inflation, data and reporting re- gram in expanded coverage. Nor will on or after Oct. 1, 1997. quirements and special population protec- HCFA allow the State credit for their June 24, 1997 CONGRESSIONAL RECORD — SENATE S6169 program’s savings over the next 5 (3) FOR PURPOSES OF EXCEPTION FROM 5- year period for which the welfare bill years. YEAR LIMITED ELIGIBILITY OF QUALIFIED excludes aliens from Medicaid eligi- Other States have been allowed to ALIENS.—Section 403(b)(1) of the Personal Re- bility. use the savings managed care achieves sponsibility and Work Opportunity Rec- I hope that I can count on my col- over a traditional fee-for-service pro- onciliation Act of 1996 (8 U.S.C. 1613(b)(1)) is amended by adding at the end the following: leagues’ support for this worthwhile gram in expanded coverage including ‘‘(D) An alien described in section amendment. the States of Tennessee, Hawaii, Rhode 402(a)(2)(A)(iv).’’. AMENDMENT NO. 462 Island, Oregon among others. (4) FOR PURPOSES OF CERTAIN STATE PRO- (Purpose: To require the Secretary of Health The rationale for treating Arizona GRAMS.—Section 412(b)(1) of the Personal Re- and Human Services to provide medicare different from these other States boils sponsibility and Work Opportunity Rec- beneficiaries with notice of the medicare down to timing. When Arizona’s pro- onciliation Act of 1996 (8 U.S.C. 1622(b)(1)) is cost-sharing assistance available under the gram began in 1982, HCFA did not use a amended by adding at the end the following medicaid program for specified low-income test of budget neutrality for approving new subparagraph: medicare beneficiaries) section 1115 research and demonstra- ‘‘(D) An alien described in section 402(a)(2)(A)(iv).’’. On page 685, after line 25, add the follow- tion waivers. The budget neutrality re- (b) FUNDING.— ing: quirement that is now applied was put (1) LEVY OF FEE.—The Attorney General SEC. . REQUIREMENT TO PROVIDE INFORMA- in place several years later. If Arizona through the Immigration and Naturalization TION REGARDING CERTAIN COST- had a test of budget neutrality in 1982 Service shall levy a $100 processing fee upon SHARING ASSISTANCE. where the baseline was a traditional each alien that the Service determines— (a) IN GENERAL.—Section 1804(a) (42 U.S.C. 1395b–2(a)) is amended— fee-for-service program, then the State (A) is unlawfully residing in the United States; (1) in paragraph (2), by striking ‘‘and’’ at would be allowed to use its managed (B) has been arrested by a Federal law en- the end; care savings. Because the requirement forcement officer for the commission of a fel- (2) in paragraph (3), by striking the period did not exist, the State is penalized. ony; and and inserting ‘‘, and’’; and HCFA now indicates that the test of (C) merits deportation after having been (3) by adding at the end, the following: budget neutrality is the current, cost- determined by a court of law to have com- ‘‘(4) an explanation of the medicare cost saving, successful AHCCCS program, mitted a felony while residing illegally in sharing assistance described in section not the traditional fee-for-service pro- the United States. 1905(p)(3)(A)(ii) that is available for individ- gram. (2) COLLECTION AND USE.—In addition to uals described in section 1902(a)(10)(E)(iii) Arizona should not be penalized for a any other penalty provided by law, a court and information regarding how to request that the Secretary arrange to have an appli- change in Federal guidelines which oc- shall impose the fee described in paragraph (1) upon an alien described in such paragraph cation for such assistance made available to curred after the program began. No one upon the entry of a judgment of deportation an individual.’’. is questioning whether AHCCCS saved by such court. Funds collected pursuant to (b) EFFECTIVE DATE.—The information re- the Federal Government millions. Ari- this subsection shall be credited by the Sec- quired to be provided under the amendment zona, as Tennessee, Hawaii, Rhode Is- retary of the Treasury as offsetting in- made by subsection (a) applies to notices dis- land, and any other State with such a creased Federal outlays resulting from the tributed on and after October 1, 1997. proven track record, should be allowed amendments made by section 5817A of the to use the managed care savings it Balanced Budget Act of 1997. AMENDMENT NO. 463 achieved over a traditional fee-for- (c) EFFECTIVE DATE.—The amendments (Purpose: To provide for the evaluation and made by this section shall be effective with service program to expand coverage as quality assurance of the children’s health respect to the period beginning on or after insurance initiative) Arizona voters overwhelmingly re- October 1, 1997. quested. On page 852, between lines 12 and 13, insert Mr. MCCAIN. Mr. President, I rise the following: AMENDMENT NO. 461 today to offer an amendment to S. 947, ‘‘(d) EVALUATION AND QUALITY ASSUR- (Purpose: To provide for the treatment of the Budget Reconciliation Act, that ANCE.— certain Amerasian immigrants as refugees) will redress what I assume to be an in- ‘‘(1) IN GENERAL.—Not later than 1 year On page 874, between lines 7 and 8, insert after the date on which the Secretary ap- the following: advertent omission in a section of this bill that discriminates against proves the program outline of a State, and SEC. 5817A. TREATMENT OF CERTAIN AMERASIAN annually thereafter, the State shall prepare IMMIGRANTS AS REFUGEES. Amerasian children of U.S. military and submit to the Secretary such informa- (a) AMENDMENTS TO EXCEPTIONS FOR REFU- personnel who served in Vietnam. tion as the Secretary may require to enable GEES/ASYLEES.— My amendment will add a new provi- the Secretary to evaluate the progress of the (1) FOR PURPOSES OF SSI AND FOOD sion to section 5817 to include State with respect to the program outline. STAMPS.—Section 402(a)(2)(A) of the Personal Amerasian children to the category of Such information shall address the manner Responsibility and Work Opportunity Rec- in which the State in implementing the pro- onciliation Act of 1996 (8 U.S.C. 1612(a)(2)(A)) legal aliens eligible for Medicaid. The Personal Responsibility and Work Op- gram outline has— is amended— ‘‘(A) expanded health care coverage to low- (A) by striking ‘‘; or’’ at the end of clause portunity Reconciliation Act of 1996 income uninsured children; (ii); excluded from eligibility these children ‘‘(B) provided quality health care to low- (B) by striking the period at the end of of American soldiers because they are clause (iii) and inserting ‘‘; or’’; and income children; (C) by adding at the end the following: admitted as refugees under section 584 ‘‘(C) improved the health status of low-in- ‘‘(iv) an alien who is admitted to the Unit- of the Foreign Operations, Export Fi- come children; ed States as an Amerasian immigrant pursu- nancing, and Related Programs Act of ‘‘(D) served the health care needs of special ant to section 584 of the Foreign Operations, 1988, rather than section 207 of the Im- populations of low-income children; and Export Financing, and Related Programs Ap- migration and Nationality Act, under ‘‘(E) utilized available resources in a cost propriations Act, 1988 (as contained in sec- which refugees are excepted from the effective manner. ‘‘(2) AVAILABILITY OF EVALUATIONS.—The tion 101(e) of Public Law 100–202 and amend- Welfare Region legislation’s ban on ed by the 9th proviso under MIGRATION AND Secretary shall make the results of the eval- REFUGEE ASSISTANCE in title II of the Foreign Medicaid, SSI, and other forms of as- uations conducted under paragraph (1) avail- Operations, Export Financing, and Related sistance. This amendment corrects able to Congress and the States. Programs Appropriations Act, 1989, Public that oversight. ‘‘(3) REPORTS.—The Secretary shall annu- Law 100–461, as amended).’’. Because there is a cost associated ally prepare and submit to the appropriate (2) FOR PURPOSES OF TANF, SSBG, AND MED- with this amendment, I propose to off- committees of Congress, and make available ICAID.—Section 402(b)(2)(A) of the Personal set it by mandating that the Attorney to the States, a report containing the find- Responsibility and Work Opportunity Rec- General of the United States, acting ings of the Secretary as a result of the eval- onciliation Act of 1996 (8 U.S.C. 1612(a)(2)(A)) uations conducted under paragraph (1) and is amended— through the Immigration and Natu- the recommendations of the Secretary for (A) by striking ‘‘; or’’ at the end of clause ralization Service, impose a $150 proc- achieving or exceeding the objectives of this (ii); essing fee on each illegal alien de- title. (B) by striking the period at the end of ported from the United States who clause (iii) and inserting ‘‘; or’’; and committed a felony while in this coun- AMENDMENT NO. 464 (C) by adding at the end the following: ‘‘(iv) an alien described in subsection try. According to CBO, this will gen- (Purpose: To establish procedures to ensure a (a)(2)(A)(iv) until 5 years after the date of erate the revenue necessary to offset balanced Federal budget by fiscal year 2002) such alien’s entry into the United States.’’. the cost of my amendment over the 5- At the end of the ll, add the following: S6170 CONGRESSIONAL RECORD — SENATE June 24, 1997 TITLE ll—BUDGET CONTROL (B) Proposed legislative changes to recoup SEC. . EXPANSION OF MEDICAL SAVINGS AC- COUNTS TO FAMILIES WITH UNIN- SEC. ll01. SHORT TITLE; PURPOSE. or eliminate part of the overage for the SURED CHILDREN (a) SHORT TITLE.—This title may be cited prior, current, and budget year in the cur- (a) IN GENERAL.—Section 220 of the Inter- as the ‘‘Bipartisan Budget Enforcement Act rent year, the budget year, and the 4 out- nal Revenue Code of 1986 is amended by add- of 1997’’. years, accompanied by a finding by the ing at the end the following new subsection: (b) PURPOSE.—The purpose of this title is— President that, because of economic condi- ‘‘(k) FAMILIES WITH UNINSURED CHIL- (1) to ensure a balanced Federal budget by tions or for other specified reasons, only DREN.— fiscal year 2002; some of the overage should be recouped or ‘‘(1) IN GENERAL.—In the case of an individ- (2) to ensure that the Bipartisan Budget eliminated by outlay reductions or revenue ual who has a qualified dependent as of the Agreement is implemented; and increases, or both. first day of any month— (3) to create a mechanism to monitor total (C) A proposal to make no legislative ‘‘(A) WAIVER OF EMPLOYER REQUIREMENT.— costs of direct spending programs, and, in changes to recoup or eliminate any overage, Clause (iii) of subsection (c)(1)(A) shall not the event that actual or projected costs ex- accompanied by a finding by the President apply. ceed targeted levels, to require the President that, because of economic conditions or for ‘‘(B) WAIVER OF COMPENSATION LIMITA- and Congress to address adjustments in di- other specified reasons, no legislative TION.—Paragraph (4) of subsection (b) shall rect spending. changes are warranted. not apply. SEC. ll02. ESTABLISHMENT OF DIRECT SPEND- (c) PROPOSED SPECIAL DIRECT SPENDING ‘‘(C) COORDINATION WITH EXCLUSION FOR EM- ING TARGETS. RESOLUTION.—If the President recommends PLOYER CONTRIBUTIONS..—In lieu of the limi- (a) IN GENERAL.—The initial direct spend- reductions consistent with subsection tation of subsection (b)(5), the amount allow- ing targets for each of fiscal years 1998 (b)(2)(A) or (B), the special direct spending able for a taxable year as a deduction under through 2002 shall equal total outlays for all message shall include the text of a special subsection (a) to such individual shall be re- direct spending except net interest as deter- direct spending resolution implementing the duced (but not below zero) by the amount mined by the Director of the Office of Man- President’s recommendations through rec- not includible in such individual’s gross in- agement and Budget (hereinafter referred to onciliation directives instructing the appro- come for such taxable year solely by reason in this title as the ‘‘Director‘‘) under sub- priate committees of the House of Represent- of section 106(b). section (b). atives and Senate to determine and rec- ‘‘(D) NUMERICAL LIMITATIONS.—Subsection (b) INITIAL REPORT BY DIRECTOR.— ommend changes in laws within their juris- (i) shall not apply to such individual if such (1) IN GENERAL.—Not later than 30 days dictions. If the President recommends no re- individual is the account holder of a medical after the date of enactment of this title, the ductions pursuant to (b)(2)(C), the special di- savings account by reason of this subsection, Director shall submit a report to Congress rect spending message shall include the text and subsection (j) shall be applied without setting forth projected direct spending tar- of a special resolution concurring in the regard to any such medical savings account. gets for each of fiscal years 1998 through 2002. President’s recommendation of no legislative ‘‘(2) QUALIFIED DEPENDENT.—For purposes (2) PROJECTIONS AND ASSUMPTIONS.—The action. of this subsection, the term ‘qualified de- Director’s projections shall be based on legis- pendent’ means a dependent (within the SEC. ll05. REQUIRED RESPONSE BY CONGRESS. lation enacted as of 5 days before the report meaning of section 152) who— is submitted under paragraph (1). The Direc- (a) IN GENERAL.—It shall not be in order in ‘‘(A) has not attained the age of 19 as of the tor shall use the same economic and tech- the House of Representatives or the Senate close of the calendar year in which the tax- nical assumptions used in preparing the con- to consider a concurrent resolution on the able year of the taxpayer begins, and with current resolution on the budget for fiscal budget unless that concurrent resolution respect to whom the taxpayer is entitled to year 1998 (H.Con.Res. 84). fully addresses the entirety of any overage a deduction for the taxable year under sec- SEC. ll03. ANNUAL REVIEW OF DIRECT SPEND- contained in the applicable report of the tion 151(c), ING AND RECEIPTS BY PRESIDENT. President under section ll04 through rec- ‘‘(B) is covered by a high deductible health As part of each budget submitted under onciliation directives. plan, and section 1105(a) of title 31, United States (b) WAIVER AND SUSPENSION.—This section ‘‘(C) prior to such coverage, was a pre- Code, the President shall provide an annual may be waived or suspended in the Senate viously uninsured individual (as defined by review of direct spending and receipts, which only by the affirmative vote of three-fifths subsection (j)(3)).’’. shall include— of the Members, duly chosen and sworn. This (b) EFFECTIVE DATE.—The amendment (1) information on total outlays for pro- section shall be subject to the provisions of made by subsection (a) shall apply to taxable grams covered by the direct spending tar- section 258 of the Balanced Budget and years ending after the date of the enactment gets, including actual outlays for the prior Emergency Deficit Control Act of 1985. of this Act. fiscal year and projected outlays for the cur- (c) APPEALS.—Appeals in the Senate from Mr. ALLARD. Mr. President, I would rent fiscal year and the 5 succeeding fiscal the decisions of the Chair relating to any like to take this time to discuss an years; and provision of this section shall be limited to 1 amendment that would give families hour, to be equally divided between, and con- (2) information on the major categories of with uninsured children the oppor- Federal receipts, including a comparison be- trolled by, the appellant and the manager of tween the levels of those receipts and the the bill or joint resolution, as the case may tunity to obtain proper health cov- levels projected as of the date of enactment be. An affirmative vote of three-fifths of the erage. Congress is constantly searching of this title. Members of the Senate, duly chosen and for ways to provide children with ade- SEC. ll04. SPECIAL DIRECT SPENDING MES- sworn, shall be required in the Senate to sus- quate health care, and I have proposed SAGE BY PRESIDENT. tain an appeal of the ruling of the Chair on an amendment that would allow chil- (a) TRIGGER.—If the information submitted a point of order raised under this section. dren the means to be covered. My ll by the President under section 03 indi- SEC. ll06. RELATIONSHIP TO BALANCED BUDG- amendment would give the working cates— ET AND EMERGENCY DEFICIT CON- (1) that actual outlays for direct spending TROL ACT. poor health expense accounts to use for in the prior fiscal year exceeded the applica- Reductions in outlays or increases in re- their families. ble direct spending target; or ceipts resulting from legislation reported It is reported that there are 10 mil- (2) that outlays for direct spending for the pursuant to section ll05 shall not be taken lion children who are uninsured in the current or budget year are projected to ex- into account for purposes of any budget en- United States. Many of these children ceed the applicable direct spending targets, forcement procedures under the Balanced are uninsured because their parents the President shall include in his budget a Budget and Emergency Deficit Control Act have incomes that are high enough to special direct spending message meeting the of 1985. be ineligible for Medicaid or do not requirements of subsection (b). SEC. ll07. ESTIMATING MARGIN. have private or employer-sponsored (b) CONTENTS.— For any fiscal year for which the overage health insurance. (1) INCLUSIONS.—The special direct spend- is less than one-half of 1 percent of the direct ing message shall include— My amendment would allow families spending target for that year, the procedures to deposit money in a medical savings (A) an analysis of the variance in direct set forth in sections ll04 and ll05 shall spending over the direct spending targets; not apply. account to use for health care services. and SEC. ll08. EFFECTIVE DATE. I believe it is critical to provide lower (B) the President’s recommendations for This title shall apply to direct spending income families with the option to es- addressing the direct spending overages, if targets for fiscal years 1998 through 2002 and tablish medical savings accounts. any, in the prior, current, or budget year. shall expire at the end of fiscal year 2002. MSA’s allow consumers to pay for med- (2) ADDITIONAL MATTERS.—The President’s ical expenses through affordable tax- recommendations may consist of any of the AMENDMENT NO. 465 following: deductible plans that are most suited (A) Proposed legislative changes to recoup (Purpose: To expand medical savings ac- to their needs. or eliminate the overage for the prior, cur- counts to families with uninsured children) Americans want choice in health rent, and budget years in the current year, On page 865, between lines 2 and 3, insert care. It is time for the Federal Govern- the budget year, and the 4 outyears. the following: ment to listen to the American people June 24, 1997 CONGRESSIONAL RECORD — SENATE S6171 and make medical savings accounts an ‘‘(i) the extent to which activities of the to enter private contracts under this section available option. Medical savings ac- Commission provide benefits to persons that and if so, what legislative changes, if any counts are a viable free-market ap- are not licensees of the Commission; should be made to improve such contracts.’’. (b) EFFECTIVE DATE.—The amendment proach to ensuring greater access to af- ‘‘(ii) the extent to which the Commission is unable to assess fees or charges on a licensee made by subsection (a) shall apply with re- fordable health care coverage for the or class of licensee that benefits from the ac- spect to contracts entered into on and after uninsured. Through MSA’s, individuals tivities; and October 1, 1997. would be given the choice and oppor- ‘‘(iii) the extent to which the costs to the tunity to obtain affordable health serv- Nuclear Regulatory Commission of activities AMENDMENT NO. 469 ices. are commensurate with the benefits provided (Purpose: To extend premium protection for I believe our efforts need to be fo- to the licensees from the activities. low-income medicare beneficiaries under cused on providing uninsured children ‘‘(C) MAXIMUM EXCLUDED COSTS.—The total the medicaid program) with accessible health care services. amount of costs excluded by the Commission Strike section 5544 and in its place insert pursuant to the determination under sub- the following: My amendment would give these fami- paragraph (A) shall not exceed $30,000,000 for SEC. 5544. EXTENSION OF SLMB PROTECTION. lies the opportunity of setting aside any fiscal year.’’. MSA funds, especially benefiting those (a) IN GENERAL.—Section 1902(a)(10)(E)(iii) (42 U.S.C. AMENDMENT NO. 467 who are self-employed, between jobs, or 1396a(a)(10)(E)(iii)) is amended by striking employed where health coverage is not (Purpose: To preserve religious choice in ‘‘and 120 percent in 1995 and years there- available. long-term care) after’’ and inserting ‘‘, 120 percent in 1995 I am hopeful that in the 105th Con- On page 689, between lines 2 and 3, insert through 1997, 125 percent in 1998, 130 percent gress, we will be able to expand the the following: in 1999, 135 percent in 2000, 140 percent in availability of medical savings ac- ‘‘(iii) RELIGIOUS CHOICE.—The State, in per- 2001, 145 percent in 2002, and 150 percent in counts. Medical savings plans allow in- mitting an individual to choose a managed 2003 and years thereafter’’. dividuals the freedom to shop for com- care entity under clause (i) shall permit the (b) 100 PERCENT FMAP.—Section 1905(b) (42 U.S.C. 1396d(b)) is amended by adding at petitive health care services, which in individual to have access to appropriate faith-based facilities. With respect to such the end the following: ‘‘Notwithstanding the turn, can help keep the costs of health access, the State shall permit an individual first sentence of this section, the Federal care down. to select a facility that is not a part of the medical assistance percentage shall be 100 My amendment is one step to achiev- network of the managed care entity if such percent with respect to amounts expended as ing the goal of decreasing the number network does not provide access to appro- medical assistance for medical assistance de- of uninsured children by providing fam- priate faith-based facilities. A faith-based fa- scribed in section 1902(a)(10)(E)(iii) for indi- ilies with the option to receive much cility that provides care under this clause viduals described in such section whose in- needed health care coverage. By mak- shall accept the terms and conditions offered come exceeds 120 percent of the official pov- ing more MSA’s available, we can by the managed care entity to other provid- erty line referred to in such section.’’. ers in the network. (c) EFFECTIVE DATE.—The amendments make it easier for parents to finance made by this section apply on and after Oc- their children’s health care; after all, AMENDMENT NO. 468 tober 1, 1997. the health of our Nation’s children is (Purpose: To allow medicare beneficiaries to AMENDMENT NO. 470 at stake. enter into private contracts for services) AMENDMENT NO. 466 (Purpose: To strike the limitations on DSH On page 685, after line 25, add the follow- payments to institutions for mental dis- (Purpose: To extend the authority of the Nu- ing: clear Regulatory Commission to collect eases under the medicaid program) SEC. . FACILITATING THE USE OF PRIVATE CON- fees through 2002) TRACTS UNDER THE MEDICARE Beginning on page 778, strike line 1 and all At the end of the bill, add the following: PROGRAM. that follows through page 779, line 23. TITLE IX—COMMITTEE ON (a) IN GENERAL.—Title XVIII of the Social AMENDMENT NO. 411 ENVIRONMENT AND PUBLIC WORKS Security Act (42 U.S.C. 1395 et seq.) is (Purpose: To strike the limitations on Indi- SEC. 9001. NUCLEAR REGULATORY COMMISSION amended by inserting after section 1804 of ANNUAL CHARGES. such Act (42 U.S.C. 1395b–2) the following: rect Graduate Medical Education pay- ments to teaching hospitals) Section 6101 of the Omnibus Budget Rec- ‘‘CLARIFICATION OF PRIVATE CONTRACTS FOR onciliation Act of 1990 (42 U.S.C. 2214) is HEALTH SERVICES Begining on page 585, strike line 21 and all that follows through page 586, line 25. amended)— ‘‘SEC. 1805. (a) IN GENERAL.—Nothing in (1) in subsection (a)(3), by striking ‘‘Sep- this title shall prohibit a physician or an- AMENDMENT NO. 472 tember 30, 1998’’ and inserting ‘‘September other health care professional who does not 30, 2002’’; and provide items or services under the program (Purpose: To provide that information con- (2) in subjection (c)— under this title from entering into a private tained in the National Directory of New (A) by striking paragraph (2) and inserting contract with a medicare beneficiary for Hires be deleted after 6 months) the following: health services for which no claim for pay- On page 999, between lines 15 and 16, insert ‘‘(2) AGGREGATE AMOUNT OF CHARGES.—The the following: aggregate amount of the annual charge col- ment is to be submitted under this title. ‘‘(b) LIMITATION ON ACTUAL CHARGE NOT (f) NATIONAL DIRECTORY OF NEW HIRES.— lected from all licensees shall equal an APPLICABLE.—Section 1848(g) shall not apply Section 453(i)(2) (42 U.S.C. 653(i)(2)) is amend- amount that approximates 100 percent of the with respect to a health service provided to ed by adding at the end the following: ‘‘Infor- budget authority of the Commission for the a medicare beneficiary under a contract de- mation entered into such data base shall be fiscal year for which the charge is collected, scribed in subsection (a). deleted 6 months after the date of entry.’’. less, with respect to the fiscal year, the sum ‘‘(c) DEFINITION OF MEDICARE BENE- of— AMENDMENT NO. 473 ‘‘(A) any amount appropriated to the Com- FICIARY.—In this section, the term ‘medicare mission from the Nuclear Waste Fund; beneficiary’ means an individual who is enti- (Purpose: To clarify the number of individ- ‘‘(B) the amount of fees collected under tled to benefits under part A or enrolled uals that may be treated as engaged in subsection (b); and under part B. work for purposes of the mandatory work ‘‘(C) for fiscal year 1999 and each fiscal ‘‘(d) REPORT.—Not later than October 1, requirement for TANF block grants) year thereafter, to the extent provided in 2001, the Administrator of the Health Care Beginning on page 929, strike line 20 and paragraph (5), the costs of activities of the Financing Administration shall submit a re- all that follows through page 930, line 14 and Commission with respect to which a deter- port to Congress on the effect on the pro- insert the following: mination is made under paragraph (5).’’; and gram under this title of private contracts en- (k) CLARIFICATION OF NUMBER OF INDIVID- (B) by adding at the end the following: tered into under this section. Such report UALS COUNTED AS PARTICIPATING IN WORK AC- ‘‘(5) EXCLUDED BUDGET COSTS.— shall include— TIVITIES.—Section 407 (42 U.S.C. 607) is ‘‘(A) IN GENERAL.—The rulemaking under ‘‘(1) analyses regarding— amended— paragraph (3) shall include a determination ‘‘(A) the fiscal impact of such contracts on (1) in subsection (c)— of the costs of activities of the Commission total Federal expenditures under this title (A) in paragraph (1)(A), by striking ‘‘(8)’’; for which it would not be fair and equitable and on out-of-pocket expenditures by medi- and to assess annual charges on a Nuclear Regu- care beneficiaries for health services under (B) in paragraph (2)(D)— latory Commission licensee or class of li- this title; and (i) in the heading, by striking ‘‘PARTICIPA- censee. ‘‘(B) the quality of the health services pro- TION IN VOCATIONAL EDUCATION ACTIVITIES’’; ‘‘(B) CONSIDERATIONS.—In making the de- vided under such contracts; and and termination under subparagraph (A), the ‘‘(2) recommendations as to whether medi- (ii) by striking ‘‘determined to be engaged Commission shall consider— care beneficiaries should continue to be able in work in the State for a month by reason S6172 CONGRESSIONAL RECORD — SENATE June 24, 1997

of participation in vocational educational (A) be allocated in the same manner as the AMENDMENT NO. 480 training or’’; and costs were allocated by State agencies that (Purpose: To clarify the family violence op- (2) by striking subsection (d)(8). designated part A of title IV as the primary tion under the temporary assistance to program for the purpose of allocating admin- needy families program) AMENDMENT NO. 474 istrative costs before August 22, 1996. On page 960, between lines 3 and 4, insert ‘‘(ii) FLEXIBLE ALLOCATION.—The Secretary (Purpose: To revise subtitle A of title III, re- the following: may allocate costs under clause (i) dif- lating to spectrum auctions, by deleting llll ferently, if a State can show good cause for SEC. . PROTECTING VICTIMS OF FAMILY certain provisions subject to a point or VIOLENCE. or evidence of increased costs, to the extent order, and for other purposes) (a) FINDINGS.—Congress finds that— that the administrative costs allocated to (The text of the amendment is print- (1) the intent of Congress in amending part the primary program are not reduced by A of title IV of the Social Security Act (42 ed in today’s RECORD under ‘‘Amend- more than 33 percent. U.S.C. 601 et seq.) in section 103(a) of the Per- ments Submitted.’’) ‘‘(13) FAILURE TO ALLOCATE ADMINISTRATIVE sonal Responsibility and Work Opportunity AMENDMENTS NO. 475 THROUGH 498 COSTS TO GRANTS PROVIDED UNDER THIS Reconciliation Act of 1996 (Public Law 104– PART.—If the Secretary determines that, Mr. LAUTENBERG. Mr. President, 193; 110 Stat 2112) was to allow States to take with respect to a preceding fiscal year, a we have one amendment that is still into account the effects of the epidemic of State has not allocated administrative costs being considered. domestic violence in establishing their wel- in accordance with paragraph (12), the Sec- Otherwise, I ask unanimous consent fare programs, by giving States the flexibil- retary shall reduce the grant payable to the ity to grant individual, temporary waivers that it be in order to send 25 amend- State under section 403(a)(1) for the succeed- for good cause to victims of domestic vio- ments to the desk on behalf of my ing fiscal year by an amount equal to— lence who meet the criteria set forth in sec- Democratic colleagues, that the ‘‘(A) the amount the Secretary determines tion 402(a)(7)(B) of the Social Security Act amendments be considered as read and should have been allocated to the program (42 U.S.C. 602(a)(7)(B)); funded under this part in such preceding fis- laid aside to be voted on in sequence. (2) the allowance of waivers under such cal year; minus The PRESIDING OFFICER. Without sections was not intended to be limited by ‘‘(B) the amount that the State allocated objection, it is so ordered. other, separate, and independent provisions to the program funded under this part in The amendments are as follows: of part A of title IV of the Social Security such preceding fiscal year.’’. AMENDMENT NO. 475 Act (42 U.S.C. 601 et seq.); AMENDMENT NO. 478 (Purpose: to ensure that certain legal immi- (3) under section 402(a)(7)(A)(iii) of such grants who become disabled are eligible for (Purpose: To require balance billing protec- Act (42 U.S.C. 602(a)(7)(A)(iii)), requirements disability benefits) tions for individuals enrolled in fee-for- under the temporary assistance for needy families program under part A of title IV of On page 8971, strike line 9–11. service plans under the Medicare Choice program under part C of title XVIII of the such Act may, for good cause, be waived for Social Security Act) so long as necessary; and SENATE AMENDMENT 476 (4) good cause waivers granted pursuant to (Purpose: To enhance taxpayer value in auc- On page 214, strike lines 21 through 24 and section 402(a)(7)(A)(iii) of such Act (42 U.S.C. tions conducted by the Federal Commu- insert the following: 602(a)(7)(A)(iii)) are intended to be temporary nications Commission) ‘‘(3) EXCEPTION FOR MSA PLANS AND UNRE- and directed only at particular program re- STRICTED FEE FOR SERVICE PLANS SECTION . RESERVE. - - .— quirements when needed on an individual In any auction conducted or supervised by ‘‘(A) IN GENERAL.—Except as provided in case-by-case basis, and are intended to facili- the Federal Communications Commission subparagraph (B), paragraphs (1) and (2) do tate the ability of victims of domestic vio- (hereinafter the Commission) for any license, not apply to an MSA plan or an unrestricted lence to move forward and meet program re- permit or right which has value, a reason- fee-for-service plan. quirements when safe and feasible without able reserve price shall be set by the Com- ‘‘(B) APPLICATION OF BALANCE BILLING FOR interference by domestic violence. mission for each unit in the auction. the re- PHYSICIAN SERVICES.—Section 1848(g) shall (b) CLARIFICATION OF WAIVER PROVISIONS.— serve price shall establish a minimum bid for apply to the provision of physician services (1) IN GENERAL.—Section 402(a)(7) (42 U.S.C. the unit to be auctioned. If no bid is received (as defined in section 1848(j)(3)) to an individ- 602(a)(7)) is amended by adding at the end the above the reserve price for a unit, the unit ual enrolled in an unrestricted fee-for-serv- following: shall be retained. The Commission shall re- ice plan under this title in the same manner ‘‘(C) NO NUMERICAL LIMITS.—In implement- assess the reserve price for that unit and as such section applies to such services that ing this paragraph, a State shall not be sub- place the unit in the in the next scheduled or are provided to an individual who is not en- ject to any numerical limitation in the next appropriate auction. rolled in a Medicare Choice plan under this granting of good cause waivers under sub- title. paragraph (A)(iii). ‘‘(D) WAIVERED INDIVIDUALS NOT INCLUDED AMENDMENT NO. 477 AMENDMENT NO. 479 FOR PURPOSES OF CERTAIN OTHER PROVISIONS (Purpose: To provide food stamp benefits to (Purpose: To provide for medicaid eligibility OF THIS PART.—Any individual to whom a child immigrants) of disabled children who lose SSI benefits) good cause waiver of compliance with this At the end of title I, add the following: On page 874, between lines 7 and 8, insert Act has been granted in accordance with sub- SEC. 10ll. FOOD STAMP BENEFITS FOR CHILD the following: paragraph (A)(iii) shall not be included for IMMIGRANTS. SEC. 5817A. CONTINUATION OF MEDICAID ELIGI- purposes of determining a State’s compli- (a) IN GENERAL.—Section 402(a)(2) of the BILITY FOR DISABLED CHILDREN ance with the participation rate require- Personal Responsibility and Work Oppor- WHO LOSE SSI BENEFITS. ments set forth in section 407, for purposes of tunity Reconciliation Act of 1996 (8 U.S.C. (a) IN GENERAL.—Section applying the limitation described in section 1612(a)(2)) is amended by adding at the end 1902(a)(10)(A)(i)(II) (42 U.S.C. 408(a)(7)(C)(ii), or for purposes of determining the following: 1396a(a)(10)(A)(i)(II)) is amended by inserting whether to impose a penalty under para- ‘‘(E) CHILD IMMIGRANTS.—In the case of the ‘‘(or were being paid as of the date of enact- graph (3), (5), or (9) of section 409(a).’’. program specified in paragraph (3)(B), para- ment of section 211(a) of the Personal Re- (2) EFFECTIVE DATE.—The amendment graph (1) shall not apply to a qualified alien sponsibility and Work Opportunity Act of made by paragraph (1) takes effect as if it who is under 18 years of age.’’. 1996 (Public Law 104–193; 110 Stat. 2188) and had been included in the enactment of sec- (b) ALLOCATION OF ADMINISTRATIVE would continue to be paid but for the enact- tion 103(a) of the Personal Responsibility and COSTS.—Section 408(a) of the Social Security ment of that section)’’ after ‘‘title XVI’’. Work Opportunity Reconciliation Act of 1996 Act (42 U.S.C. 608(a)) is amended by adding at (Public Law 104–193; 110 Stat. 2112). (b) OFFSET.—Section 2103(b) of the Social the end the following: (c) FEDERAL PARENT LOCATOR SERVICE.— Security Act (as added by section 5801) is ‘‘(12) DESIGNATION OF GRANTS UNDER THIS (1) IN GENERAL.—Section 453 (42 U.S.C. 653), amended— PART AS PRIMARY PROGRAM IN ALLOCATING AD- as amended by section 5938, is further (1) in paragraph (2), by striking ‘‘and’’ at MINISTRATIVE COSTS.— amended— the end; ‘‘(A) IN GENERAL.—Notwithstanding any (A) in subsection (b)(2)— other provision of law, a State shall des- (2) in paragraph (3), by striking the period (i) in the matter preceding subparagraph ignate the program funded under this part as and inserting ‘‘; and’’; and (A), by inserting ‘‘or that the health, safety, the primary program for the purpose of allo- (3) by adding at the end the following: or liberty or a parent or child would by un- cating costs incurred in serving families eli- ‘‘(4) the amendment made by section reasonably put at risk by the disclosure of gible or applying for benefits under the State 5817A(a) of the Balanced Budget Act of 1997 such information,’’ before ‘‘provided that’’; program funded under this part and any (relating to continued eligibility for certain (ii) in subparagraph (A), by inserting ‘‘, other Federal means-tested benefits. disabled children).’’. that the health, safety, or liberty or a parent ‘‘(B) ALLOCATION OF COSTS.— (c) EFFECTIVE DATE.—The amendment or child would by unreasonably put at risk ‘‘(i) IN GENERAL.—The Secretary shall re- made by subsection (a) applies to medical as- by the disclosure of such information,’’ be- quire that costs described in subparagraph sistance furnished on or after July 1, 1997. fore ‘‘and that information’’; and June 24, 1997 CONGRESSIONAL RECORD — SENATE S6173

(iii) in subparagraph (B)(i), by striking ‘‘be SEC. 5768. CONTINUATION OF STATE-WIDE SEC- (b) EFFECTIVE DATE.—The amendment harmful to the parent or the child’’ and in- TION 1115 MEDICAID WAIVERS. made by subsection (a) shall become effec- serting ‘‘place the health, safety, or liberty (a) IN GENERAL.—Section 1115 of the Social tive on the date of enactment of this Act. Security Act (42 U.S.C. 1315) is amended by of a parent or child unreasonably at risk’’; AMENDMENT NO. 484 and adding at the end the following: (B) in subsection (c)(2), by inserting ‘‘, or ‘‘(d)(1) The provisions of this subsection (Purpose: To make community action agen- to serve as the initiating court in an action shall apply to the extension of statewide cies, community development corporations to seek and order,’’ before ‘‘against a non- comprehensive research and demonstration and other non-profit organizations eligible custodial’’. projects (in this subsection referred to as for welfare-to-work grants) (2) STATE PLAN.—Section 454(26) (42 U.S.C. ‘waiver project’) for which waivers of compli- On page 885, line 15, insert after ‘‘State’’ 654), as amended by section 5956, is further ance with the requirements of title XIX are the following: ‘‘or a community action agen- amended— granted under subsection (a). With respect to cy, community development corporation or (A) in subparagraph (C), by striking ‘‘re- a waiver project that, but for the enactment other non-profit organizations with dem- sult in physical or emotional harm to the of this subsection, would expire, the State at onstrated effectiveness in moving welfare re- party or the child’’ and inserting ‘‘place the its option may— cipients into the workforce’’. health, safety, or liberty of a parent or child ‘‘(A) not later than 1 year before the waiv- unreasonably at risk’’; er under subsection (a) would expire (acting AMENDMENT NO. 485 (B) in subparagraph (D), by striking ‘‘of do- through the chief executive officer of the mestic violence or child abuse against a (Purpose: To provide that the hospital length State who is operating the project), submit party or the child and that the disclosure of of stay with respect to an individual shall to the Secretary a written request for an ex- such information could be harmful to the be determined by the attending physician) tension of such waiver project for up to 3 party or the child’’ and inserting ‘‘that the At the end of the proposed section 1852(d) years; or health, safety, or liberty of a parent or child of the Social Security Act (as added by sec- ‘‘(B) permanently continue the waiver would be unreasonably put at risk by the dis- tion 5001), add the following: project if the project meets the requirements closure of such information’’; and ‘‘(4) DETERMINATION OF HOSPITAL LENGTH OF of paragraph (2). (C) in subparagraph (E), by striking ‘‘of do- STAY.— mestic violence’’ and all that follows ‘‘(2) The requirements of this paragraph are that the waiver project— ‘‘(A) IN GENERAL.—A Medicare Choice orga- through the semicolon and inserting ‘‘that nization shall cover the length of an inpa- the health, safety, or liberty of a parent or ‘‘(A) has been successfully operated for 5 or more years; and tient hospital stay under this part as deter- child would be unreasonably put at risk by mined by the attending physician, in con- the disclosure of such information pursuant ‘‘(B) has been shown, through independent evaluations sponsored by the Health Care Fi- sultation with the patient, to be medically to section 453(b)(2), the court shall determine appropriate. whether disclosure to any other person or nancing Administration, to successfully con- tain costs and provide access to health care. ‘‘(B) CONSTRUCTION.—Nothing in this para- persons of information received from the graph shall be construed— Secretary could place the health, safety, or ‘‘(3)(A) In the case of waiver projects de- ‘‘(i) as requiring the provision of inpatient liberty or a parent or child unreasonably at scribed in paragraph (1)(A), if the Secretary coverage if the attending physician, in con- risk (if the court determines that disclosure fails to respond to the request within 6 sultation with the patient, determine that a to any other person could be harmful, the months after the date on which the request shorter period of hospital stay is medically court and its agents shall not make any such was submitted, the request is deemed to have appropriate, or disclosure);’’. been granted. ‘‘(ii) as affecting the application of (3) EFFECTIVE DATE.—The amendments ‘‘(B) If the request is granted or deemed to made by this subsection shall take effect 1 have been granted, the deadline for submit- deductibles and coinsurance. day after the effective date described in sec- tal of a final report shall be 1 year after the At the appropriate place in chapter 2 of tion 5961(a). date on which the waiver project would have subtitle H of division 1 of title V, insert the expired but for the enactment of this sub- following new section: AMENDMENT NO. 481 section. SEC. ll. HOSPITAL LENGTH OF STAY. (Purpose: To amend the provision on transfer ‘‘(C) The Secretary shall release an evalua- (a) IN GENERAL.—Section 1866(a)(1) (42 cases, and for other purposes) tion of each such project not later than 1 U.S.C. 1395cc(a)(1)) is amended— On page 562, between line 20 and 21, insert year after the date of receipt of the final re- (1) by striking ‘‘and’’ at the end of subpara- the following: port. graph (Q); ‘‘(XIV) for calendar year 1999 for hospitals ‘‘(D) Phase-down provisions which were ap- (2) by striking the period at the end of sub- in all areas, the market basket percentage plicable to waiver projects before an exten- paragraph (R) and inserting ‘‘; and’’; increase minus 1.3 percentage points,’’. sion was provided under this subsection shall (3) by inserting after subparagraph (R) the On page 562, line 21, strike ‘‘(XIV) for cal- not apply. following: endar year 1999’’ and insert ‘‘(XV) for cal- ‘‘(4) The extension of a waiver project ‘‘(S) in the case of hospitals, not to dis- endar year 2000.’’. under this subsection shall be on the same charge an inpatient before the date the at- On page 563, line 1, strike ‘‘(XV)’’ and in- terms and conditions (including applicable tending physician and patient determine it sert ‘‘(XVI)’’. terms and conditions related to quality and to be medically appropriate.’’. On page 604, line 22, strike ‘‘upon discharge access of services, budget neutrality as ad- (b) EFFECTIVE DATE.—The amendments from a subsection (d) hospital’’ and insert justed for inflation, data and reporting re- made by subsection (a) shall apply to dis- ‘‘immediately upon discharge from, and pur- quirements and special population protec- charges occurring on or after 6 months after suant to the discharge planning process (as tions), except for any phase down provisions, the date of enactment of this Act. defined in section 1861(ee)) of, a subsection and subject to the same set of waivers that At the appropriate place in chapter 5 of (d) hospital’’. applied to the project or were granted before subtitle I of division 2 of title V, insert the Beginning on page 605, strike line 7 and all the extension of the project under this sub- following new section: that follows through page 606, line 6, and in- section. The permanent continuation of a SEC. ll. DETERMINATION OF HOSPITAL STAY. sert the following: waiver project shall be on the same terms (a) IN GENERAL.—Title XIX (42 U.S.C. 1396 (b) EFFECTIVE DATE.—The amendment and conditions, including financing, and sub- made by subsection (a) shall apply with re- et seq.) is amended— ject to the same set of waivers. No test of (1) by redesignating section 1933 as section spect to discharges occurring on or after Oc- budget neutrality shall be applied in the case tober 1, 1997. 1934; and of projects described in paragraph (2) after (2) by inserting after section 1932 the fol- that date on which the permanent extension AMENDMENT NO. 482 lowing new section: was granted. (Purpose: To allow vocational educational ‘‘(5) In the case of a waiver project de- ‘‘DETERMINATION OF HOSPITAL STAY training to be counted as a work activity scribed in paragraph (2), the Secretary, act- ‘‘SEC. 1933. (a) IN GENERAL.—A State plan under the temporary assistance for needy ing through the Health Care Financing Ad- for medical assistance under this title shall families program for 24 months) ministration, shall deem any State’s request cover the length of an inpatient hospital AMENDMENT NO. 482 to expand medicaid coverage in whole or in stay under this part as determined by the at- On page 930, between lines 14 and 15, insert part to individuals who have an income at or tending physician, in consultation with the the following: below the Federal poverty level as budget patient, to be medically appropriate. (l) VOCATIONAL EDUCATIONAL TRAINING.— neutral if independent evaluations sponsored ‘‘(b) CONSTRUCTION.—Nothing in this sec- Section 407(d)(8) (42 U.S.C. 607(d)(8)) is by the Health Care Financing Administra- tion shall be construed— amended by striking ‘‘12’’ and inserting ‘‘24’’. tion have shown that the State’s medicaid ‘‘(1) as requiring the provision of inpatient managed care program under such original coverage if the attending physician, in con- AMENDMENT NO. 483 waiver is more cost effective and efficient sultation with the patient, determine that a (Purpose: To provide for the continuation of than the traditional fee-for-service medicaid shorter period of hospital stay is medically certain State-wide medicaid waivers) program that, in the absence of any managed appropriate, or On page 844, between lines 7 and 8, insert care waivers under this section, would have ‘‘(2) as affecting the application of the following: been provided in the State.’’. deductibles and coinsurance.’’. S6174 CONGRESSIONAL RECORD — SENATE June 24, 1997 (b) EFFECTIVE DATE.—The amendments AMENDMENT NO. 488 about living and quality conditions in made by subsection (a) shall apply to dis- (Purpose: To provide for actuarially some nursing homes? charges occurring on or after 6 months after sufficient reimbursement rates for providers) Well, the Boren amendment helped to the date of enactment of this Act. Beginning on page 764, strike line 7 and all change that. We must protect the in- that follows through page 765, line 17, and in- AMENDMENT NO. 486 tegrity of the law. The amendment sert the following: (Purpose: To provide additional funding for Senator WELLSTONE and I are offering (a) PLAN AMENDMENTS.—Section 1902(a)(13) State emergency health services furnished will do that. is amended— Our amendment protects senior citi- to undocumented aliens) (1) by striking all that precedes subpara- At the appropriate place in chapter 1 of graph (D) and inserting the following: zens living in nursing homes. And it subtitle K of division 2 of title V, insert the ‘‘(13)(A) provide— ensures that nursing homes get an ap- following new section: ‘‘(i) for the State-based determination of propriate level of reimbursement. It SEC. ll. ADDITIONAL FUNDING FOR STATE rates of payment under the plan for hospital does this by requiring States to reim- EMERGENCY HEALTH SERVICES services (and which, in the case of hospitals, burse nursing homes for the costs of FURNISHED TO UNDOCUMENTED take into account the situation of hospitals ALIENS. daily care. which serve a disproportionate number of (a) TOTAL AMOUNT AVAILABLE FOR ALLOT- It ensures that States will have ade- low income patients with special needs), MENT.—There are available for allotments quate reimbursement to provide qual- nursing facility services, and services pro- under this section for each of the 5 fiscal vided in intermediate care facilities for the ity services. It maintains Federal Gov- years (beginning with fiscal year 1998) mentally retarded, under which the State ernment oversight. It maintains qual- $20,000,000 for payments to certain States provides assurances to the Secretary that ity standards and it will protect sen- under this section. proposed rates will be actuarially sufficient (b) STATE ALLOTMENT AMOUNT.— iors. (1) IN GENERAL.—The Secretary of Health to ensure access to and quality of services; We have been through the fight to and Human Services shall compute an allot- ‘‘(ii) that the State will submit such pro- keep Federal nursing home standards. ment for each fiscal year beginning with fis- posed rates for review by an independent ac- And Congress voted last year on a bi- cal year 1998 and ending with fiscal year 2002 tuary selected by the Secretary; and ‘‘(iii) that any new rates or modifications partisan basis to keep Federal stand- for each of the 12 States with the highest ards and to maintain Federal enforce- number of undocumented aliens. The amount to existing rates will be developed through a public rulemaking procedure under which ment. of such allotment for each such State for a In my State of Maryland, already the fiscal year shall bear the same ratio to the such new or modified rates are published in total amount available for allotments under 1 or more daily newspapers of general cir- reimbursement rate is very low. Mary- subsection (a) for the fiscal year as the ratio culation in the State or in any publication land gets $78 per day when it costs an of the number of undocumented aliens in the used by the State to publish State statutes average of $112 to provide nursing home State in the fiscal year bears to the total of or rules, and providers, beneficiaries and care. Maryland nursing homes use this such numbers for all States for such fiscal their representatives, and other concerned reimbursement to provide room and State residents are given a reasonable oppor- year. The amount of allotment to a State board, around the clock medical care, provided under this paragraph for a fiscal tunity for review and comment on such rates or modifications;’’; and three meals a day, and bathing, and year that is not paid out under subsection (c) feeding. You can’t even get a good shall be available for payment during the (2) by redesignating subparagraphs (D), (E), subsequent fiscal year. and (F) as subparagraphs (B), (C), and (D) re- hotel room for that rate. We cannot (2) DETERMINATION.—For purposes of para- spectively. have the rates fall any lower without graph (1), the number of undocumented jeopardizing patients. aliens in a State under this section shall be AMENDMENT NO. 489 Mr. President, we must protect the determined based on estimates of the resi- (Purpose: To strike the repeal of the Boren Boren amendment. That is why I dent illegal alien population residing in each amendment) strongly support the Wellstone/Mikul- State prepared by the Statistics Division of Beginning on page 764, strike line 5 and all ski amendment. I urge my colleagues the Immigration and Naturalization Service that follows through line 23 on page 766. to vote for this amendment. as of October 1992 (or as of such later date if Ms. MIKULSKI. Mr. President, I rise such date is at least 1 year before the begin- AMENDMENT NO. 490 ning of the fiscal year involved). today to support the Wellstone/Mikul- (Purpose: To improve the provisions relating (c) USE OF FUNDS.—From the allotments ski amendment which maintains the to the Higher Education Act of 1965) made under subsection (b), the Secretary Boren amendment on nursing home re- Strike title VII and insert the following: shall pay to each State amounts the State imbursement. demonstrates were paid by the State (or by TITLE VII—COMMITTEE ON LABOR AND The Boren amendment ensures an HUMAN RESOURCES a political subdivision of the State) for emer- adequate daily reimbursement rate for gency health services furnished to undocu- nursing homes under Medicaid. It helps SEC. 7001. MANAGEMENT AND RECOVERY OF RE- mented aliens. SERVES. (d) STATE DEFINED.—For purposes of this nursing homes have the funds they (a) AMENDMENT.—Section 422 of the Higher section, the term ‘‘State’’ includes the Dis- need to meet Federal quality and safe- Education Act of 1965 (20 U.S.C. 1072) is trict of Columbia. ty standards. The Wellstone/Mikulski amended by adding after subsection (g) the (e) STATE ENTITLEMENT.—This section con- amendment will keep this guarantee in following new subsection: stitutes budget authority in advance of ap- place. ‘‘(h) RECALL OF RESERVES; LIMITATIONS ON propriations Acts and represents the obliga- Right now, the Boren policy is under USE OF RESERVE FUNDS AND ASSETS.— tion of the Federal Government to provide attack. It is under attack by States. ‘‘(1) IN GENERAL.—Notwithstanding any for the payment to States of amounts pro- other provision of law, the Secretary shall, vided under subsection (c). And it is under attack by Congress. If except as otherwise provided in this sub- we repeal this law, States will be able section, recall $1,200,000,000 from the reserve AMENDMENT NO. 487 to set their own rates of reimburse- funds held by guaranty agencies under this (Purpose: To provide for the application of ment to nursing homes. part on September 1, 2002. disproportionate share hospital-specific We all know the tough budget cli- ‘‘(2) DEPOSIT.—Funds recalled by the Sec- payment adjustments with respect to Cali- mate we are operating in. Without the retary under this subsection shall be depos- fornia) Boren policy, we take away the Federal ited in the Treasury. At the appropriate place in section 5721, in- guarantee of adequate reimbursement ‘‘(3) EQUITABLE SHARE.—The Secretary shall require each guaranty agency to return sert the following: rates. This threatens the health and (ll) APPLICATION OF DSH PAYMENT AD- reserve funds under paragraph (1) based on safety of senior citizens. States worry JUSTMENT.—Notwithstanding subsection (d), such agency’s equitable share of excess re- effective July 1, 1997, section 1923(g)(2)(A) of about reimbursements. I’m worried serve funds held by guaranty agencies as of the Social Security Act (42 U.S.C. 1396r– about seniors. September 30, 1996. For purposes of this para- 4(g)(2)(A)) shall be applied to the State of Without Boren, the State reimburse- graph, a guaranty agency’s equitable share California as though— ment rates may be too low to ensure of excess reserve funds shall be determined (1) ‘‘or that begins on or after July 1, 1997, that nursing homes can continue to as follows: and before July 1, 1999,’’ were inserted in provide quality care. Do we really want ‘‘(A) The Secretary shall compute each such section after ‘‘January 1, 1995,’’; and agency’s reserve ratio by dividing (i) the (2) ‘‘(or 175 percent in the case of a State to return to the bad old days when sen- amount held in such agency’s reserve (in- fiscal year that begins on or after July 1, ior citizens living in nursing homes cluding funds held by, or under the control 1997, and before July 1, 1999)’’ were inserted faced inadequate care? Can we afford to of, any other entity) as of September 30, 1996, in such section after ‘‘200 percent’’. forget the horror stories from the 1980’s by (ii) the original principal amount of all June 24, 1997 CONGRESSIONAL RECORD — SENATE S6175 loans for which such agency has an outstand- ‘‘(7) DEFINITION.—For purposes of this sub- SEC. 7007. EXTENSION OF STUDENT AID PRO- ing insurance obligation. section the term ‘reserve funds’ when used GRAMS. ‘‘(B) If the reserve ratio of any agency as with respect to a guaranty agency— Title IV of the Higher Education Act of computed under subparagraph (A) exceeds ‘‘(A) includes any reserve funds held by, or 1965 (20 U.S.C. 1070 et seq.) is amended— 1.12 percent, the agency’s equitable share under the control of, any other entity; and (1) in section 424(a), by striking ‘‘1998.’’ and shall include so much of the amounts held in ‘‘(B) does not include buildings, equipment, ‘‘2002.’’ and inserting ‘‘2002.’’ and ‘‘2006.’’, re- such agency’s reserve fund as exceed a re- or other nonliquid assets.’’. spectively; serve ratio of 1.12 percent. (b) CONFORMING AMENDMENT.—Section (2) in section 428(a)(5), by striking ‘‘1998,’’ ‘‘(C) If any additional amount is required 428(c)(9)(A) of the Higher Education Act of and ‘‘2002.’’ and inserting ‘‘2002,’’ and ‘‘2006.’’, to be recalled under paragraph (1) (after de- 1965 (20 U.S.C. 1078(c)(9)(A)) is amended— respectively; and ducting the total of the equitable shares cal- (1) in the first sentence, by striking ‘‘for (3) in section 428C(e), by striking ‘‘1998.’’ culated under subparagraph (B)), the agen- the fiscal year of the agency that begins in and inserting ‘‘2002.’’. cies’ equitable shares shall include addi- 1993’’; and SEC. 7008. EFFECTIVE DATE. tional amounts— (2) by striking the third sentence. This subtitle and the amendments made by ‘‘(i) determined by imposing on each such SEC. 7002. REPEAL OF DIRECT LOAN ORIGINA- this subtitle take effect on October 1, 1997. agency an equal percentage reduction in the TION FEES TO INSTITUTIONS OF amount of each agency’s reserve fund re- HIGHER EDUCATION. AMENDMENT NO. 491 maining after deduction of the amount re- Section 452 of the Higher Education Act of (Purpose: To prohibit cost-sharing for chil- called under subparagraph (B); and 1965 (20 U.S.C. 1087b) is amended— dren in families with incomes that are less ‘‘(ii) the total of which equals the addi- (1) by striking subsection (b); and than 150 percent of the poverty line) tional amount that is required to be recalled (2) by redesignating subsections (c) and (d) Section 1916(g)(1) of the Social Security under paragraph (1) (after deducting the as subsections (b) and (c), respectively. Act, as amended by section 5754, is amended total of the equitable shares calculated SEC. 7003. LENDER AND HOLDER RISK SHARING. by inserting before the period the following: under subparagraph (B)). Section 428(b)(1)(G) of the Higher Edu- ‘‘, except that no cost-sharing may be im- ‘‘(4) RESTRICTED ACCOUNTS.—Within 90 days cation Act of 1965 (20 U.S.C. 1078(b)(1)(G)) is posed with respect to medical assistance pro- after the beginning of each of fiscal years amended by striking ‘‘not less than 98 per- vided to an individual who has not attained 1998 through 2002, each guaranty agency cent’’ and inserting ‘‘95 percent’’. age 18 if such individuals family income does shall transfer a portion of each agency’s eq- SEC. 7004. FEES AND INSURANCE PREMIUMS. not exceed 150 percent of the poverty line ap- uitable share determined under paragraph (3) (a) IN GENERAL.—Section 428(b)(1)(H) of the plicable to a family of the size involved, and to a restricted account established by the Higher Education Act of 1965 (20 U.S.C. if, as of the date of enactment of the Bal- guaranty agency that is of a type selected by 1078(b)(1)(H)) is amended— anced Budget Act of 1997, cost-sharing could the guaranty agency with the approval of (1) by inserting ‘‘(i)’’ before ‘‘provides’’; not be imposed with respect to medical as- the Secretary. Funds transferred to such re- (2) by striking ‘‘the loan,’’ and inserting stricted accounts shall be invested in obliga- sistance provided to such individual.’’. tions issued or guaranteed by the United ‘‘any loan made under section 428 before July AMENDMENT NO. 492 States or in other similarly low-risk securi- 1, 1998,’’; ties. A guaranty agency shall not use the (3) by inserting ‘‘and’’ after the semicolon; (Purpose: To ensure the provision of appro- funds in such a restricted account for any and priate benefits for uninsured children with purpose without the express written permis- (4) by adding at the end the following: special needs) sion of the Secretary, except that a guaranty ‘‘(ii) provides that no insurance premiums At the appropriate place in section 2102(5) agency may use the earnings from such re- shall be charged to the borrower of any loan of the Social Security Act as added by sec- stricted account for activities to reduce stu- made under section 428 on or after July 1, tion 5801, insert the following: ‘‘The benefits dent loan defaults under this part. The por- 1998;’’. shall include additional benefits to meet the tion required to be transferred shall be deter- (b) SPECIAL ALLOWANCES.—Section 438(c) of needs of children with special needs, includ- mined as follows: the Higher Education Act of 1965 (20 U.S.C. ing— ‘‘(A) In fiscal year 1998— 1087–1(c)) is amended— ‘‘(A) rehabilitation and habilitation serv- ‘‘(i) all agencies combined shall transfer to (1) in paragraph (2), by striking ‘‘paragraph ices, including occupational therapy, phys- a restricted account an amount equal to one- (6)’’ and inserting ‘‘paragraphs (6) and (8)’’; ical therapy, speech and language therapy, fifth of the total amount recalled under and and respiratory therapy services; paragraph (1); (2) by adding at the end the following: ‘‘(B) mental health services; ‘‘(ii) each agency with a reserve ratio (as ‘‘(8) ORIGINATION FEE ON SUBSIDIZED LOANS ‘‘(C) personal care services; computed under paragraph (3)(A)) that ex- ON OR AFTER JULY 1, 1998.—In the case of any ‘‘(D) customized durable medical equip- ceeds 2 percent shall transfer to a restricted loan made or insured under section 428 on or ment, orthotics, and prosthetics, as medi- account so much of the amounts held in such after July 1, 1998, paragraph (2) shall be ap- cally necessary; and agency’s reserve fund as exceed a reserve plied by substituting ‘2.0 percent’ for ‘3.0 per- ‘‘(E) case management services. ratio of 2 percent; and cent’.’’. ‘‘With respect to FEHBP-equivalent chil- ‘‘(iii) each agency shall transfer any addi- (c) DIRECT LOANS.—Section 455(c) of the dren’s health insurance coverage, services tional amount required under clause (i) Higher Education Act of 1965 (20 U.S.C. otherwise covered under the coverage in- (after deducting the amount transferred 1087e(c)) is amended— volved that are medically necessary to main- under clause (ii)) by transferring an amount (1) by striking ‘‘The Secretary’’ and insert- tain, improve, or prevent the deterioration that represents an equal percentage of each ing the following: of the physical, developmental, or mental agency’s equitable share to a restricted ac- ‘‘(1) IN GENERAL.—For loans made under health of the child may not be limited with count. this part before July 1, 1998, the Secretary’’; respect to scope and duration, except to the ‘‘(B) In fiscal years 1999 through 2002, each (2) by striking ‘‘of a loan made under this degree that such services are not medically agency shall transfer an amount equal to part’’; and necessary. Nothing in the preceding sentence one-fourth of the total amount remaining of (3) by adding at the end the following: shall be construed to prevent FEHBP-equiva- the agency’s equitable share (after deduction ‘‘(2) ORIGINATION FEE.—For loans made lent children’s health insurance coverage of the amount transferred under subpara- under this part on or after July 1, 1998, the from utilizing appropriate utilization review graph (A)). Secretary shall charge the borrower an origi- techniques to determine medical necessity ‘‘(5) SHORTAGE.—If, on September 1, 2002, nation fee of 2.0 percent of the principal or to prevent the delivery of such services the total amount in the restricted accounts amount of the loan, in the case of Federal through a managed care plan.’’. described in paragraph (4) is less than the Direct Stafford/Ford Loans.’’. amount the Secretary is required to recall SEC. 7005. SECRETARY’S EQUITABLE SHARE. AMENDMENT NO. 493 under paragraph (1), the Secretary shall re- Section 428(c)(6)(A)(ii) of the Higher Edu- (Purpose: To exempt severely disabled aliens quire the return of the amount of the short- cation Act of 1965 (20 U.S.C. 1078(c)(6)(A)(ii) is from the ban on receipt of supplemental se- age from other reserve funds held by guar- amended by striking ‘‘27 percent’’ and insert- curity income) anty agencies under procedures established ing ‘‘18.5 percent’’. On page 874, between lines 7 and 8, insert by the Secretary. SEC. 7006. FUNDS FOR ADMINISTRATIVE EX- the following: ‘‘(6) PROHIBITION.—The Secretary shall not PENSES. SEC. 5817A. SSI ELIGIBILITY FOR SEVERELY DIS- have any authority to direct a guaranty The first sentence of section 458(a) of the ABLED ALIENS. agency to return reserve funds under sub- Higher Education Act of 1965 (20 U.S.C. Section 402(a)(2) of the Personal Respon- section (g)(1)(A) during the period from the 1087h(a)) is amended by striking sibility and Work Opportunity Reconcili- date of enactment of this subsection through ‘‘$260,000,000’’ and all that follows through ation Act of 1996 (8 U.S.C. 1612(a)(2)), as September 30, 2002, and any reserve funds the end of the sentence and inserting amended by section 5815, is amended by add- otherwise returned under subsection (g)(1) ‘‘$532,000,000 in fiscal year 1998, $610,000,000 in ing at the end the following: during such period shall be treated as fiscal year 1999, $705,000,000 in fiscal year ‘‘(I) SSI EXCEPTION FOR SEVERELY DISABLED amounts recalled under this subsection and 2000, $750,000,000 in fiscal year 2001, and ALIENS.—With respect to eligibility for bene- shall not be available under subsection (g)(4). $750,000,000 in fiscal year 2002.’’. fits for the program defined in paragraph S6176 CONGRESSIONAL RECORD — SENATE June 24, 1997 (3)(A) (relating to the supplemental security istry upon a determination by the State Mr. LAUTENBERG. Again, the first income program), paragraph (1), and the Sep- that— amendment on that list, Mr. President, tember 30, 1997 application deadline under ‘‘(aa) the employment and personal history is the Lautenberg amendment. subparagraph (G), shall not apply to any of the nurse aide does not reflect a pattern of Mr. CONRAD addressed the Chair. alien who is lawfully present in the United abusive behavior or neglect; and States and who has been denied approval of ‘‘(bb) the neglect involved in the original The PRESIDING OFFICER. The Sen- an application for naturalization by the At- finding was a singular occurrence. ator recognizes the Senator from North torney General solely on the ground that the ‘‘(II) In no case shall a determination on a Dakota. alien is so severely disabled that the alien is petition submitted under clause (I) be made Mr. LAUTENBERG. May we finish otherwise unable to satisfy the requirements prior to the expiration of the 1-year period this up? for naturalization.’’. beginning on the date on which the name of Mr. DOMENICI. I need to finish this the petitioner was added to the registry work, if you don’t mind. AMENDMENT NO 494 under this subparagraph.’’. (c) RETROACTIVE REVIEW.—The procedures Senator, I understand you did submit (Purpose: To provide for Medicaid eligibility an amendment with reference to the il- of disabled children who lose SSI benefits) developed by a State under the amendments made by subsection (a) and (b) shall permit legal aliens. On page 874, between lines 7 and 8, insert an individual to petition for a review of any Mr. LAUTENBERG. Legal. the following: finding made by a State under section Mr. DOMENICI. Legal aliens. SEC. 5817A CONTINUATION OF MEDICAID ELIGI- 1819(g)(1)(C) or 1919(g)(1)(C) of the Social Se- AMENDMENT NO. 499 BILITY FOR DISABLED CHILDREN curity Act (42 U.S.C. 1395i–3(g)(1)(C) or WHO LOSE SSI BENEFITS. (Purpose: To provide SSI eligibility for 1396r(g)(1)(C)) after January 1, 1995. N ENERAL disabled legal aliens) (a) I G .—Section (d) STUDY AND REPORT.— 1902(a)(10)(A)(i)(II)(42 U.S.C. (1) STUDY.—The Secretary of Health and Mr. DOMENICI. Mr. President, I send 1396a(a)(10)(A)(i)(II)) is amended by inserting Human Services shall conduct a study of— an amendment to the desk. ‘‘(or were being paid as of the date of enact- (A) the use of nurse aide registries by ment of section 211(a) of the Personal Re- The PRESIDING OFFICER. The States, including the number of nurse aides clerk will report. sponsibility and Work Opportunity Act of placed on the registries on a yearly basis and 1996 (Public Law 104-193; 110 Stat. 2188) and the circumstances that warranted their The legislative clerk read as follows: would continue to be paid but for the enact- placement on the registries; The Senator from New Mexico [Mr. DOMEN- ment of that section)’’ after ‘‘title XVI’’. (B) the extent to which institutional envi- ICI] proposes an amendment numbered 499. (b) OFFSET.—Section 2103(b) of the Social ronmental factors (such as a lack of ade- Mr. DOMENICI. Mr. President, I ask Security Act (as added by section 5801) is quate training or short staffing) contribute amended— unanimous consent that reading of the to cases of abuse and neglect at nursing fa- amendment be dispensed with. (1) in paragraph (2), by striking ‘‘and’’ at cilities; and the end; (C) whether alternatives (such as a proba- The PRESIDING OFFICER. Without (2) in paragraph (3), by striking the period tional period accompanied by additional objection, it is so ordered. and inserting ‘‘; and’’; and training or mentoring or sanctions on facili- The amendment is as follows: (3) by adding at the end the following: ties that create an environment that encour- Strike sections 5811 through 5814 and insert ‘‘(4) the amendment made by section ages abuse or neglect) to the sanctions that the following: 5817A(a) of the Balanced Budget Act of 1997 are currently applied under the Social Secu- (relating to continued eligibility for certain SEC. 5812. EXTENSION OF ELIGIBILITY PERIOD rity Act for abuse and neglect at nursing fa- FOR REFUGEES AND CERTAIN disabled children).’’. cilities might be more effective in minimiz- OTHER QUALIFIED ALIENS FROM 5 (c) EFFECTIVE DATE.—The amendment ing future cases of abuse and neglect. TO 7 YEARS FOR SSI AND MEDICAID. made by subsection (a) applies to medical as- (2) REPORT.—Not later than 2 years after (a) SSI.—Section 402(a)(2)(A) of the Per- sistance furnished on or after July 1, 1997. the date of enactment of this Act, the Sec- sonal Responsibility and Work Opportunity retary of Health and Human Services shall Reconciliation Act of 1996 (8 U.S.C. AMENDMENT NO. 495 prepare and submit to the appropriate com- 1612(a)(2)(A)) is amended to read as follows: (Purpose: To establish a process to permit a mittees of Congress, a report concerning the ‘‘(A) TIME-LIMITED EXCEPTION FOR REFU- nurse aide to petition to have his or her results of the study conducted under para- GEES AND ASYLEES.— name removed from the nurse aide registry graph (1) and the recommendation of the ‘‘(i) SSI.—With respect to the specified under certain circumstances) Secretary for legislation based on such Federal program described in paragraph On page 844, between lines 7 and 8, insert study. (3)(A) paragraph 1 shall not apply to an alien the following: until 7 years after the date— SEC. . REMOVAL OF NAME FROM NURSE AIDE AMENDMENT NO. 496 ‘‘(I) an alien is admitted to the United REGISTRY. (Purpose: To strike the limitation on the States as a refugee under section 207 of the (a) MEDICARE.—Section 1819(g)(1)(C) of the coverage of abortions) Immigration and Nationality Act; Social Security Act (42 U.S.C. 1395i- On page 860, strike all matter after line 10 ‘‘(II) an alien is granted asylum under sec- 3(g)(1)(C)) is amended— and before line 15, and the following: tion 208 of such Act; or (1) in the first sentence by striking ‘‘The ‘‘(d) USE LIMITED TO STATE PROGRAM EX- ‘‘(III) an alien’s deportation is withheld State’’ and inserting ‘‘(i) The State’’; and PENDITURES.—Funds provided to an eligible under section 243(h) of such Act. (2) by adding at the end the following: State under this title shall only be used to ‘‘(ii) FOOD STAMPS.—With respect to the ‘‘(ii)(I) In the case of a finding of neglect, carry out the purpose of this title. specified Federal program described in para- the State shall establish a procedure to per- graph (3)(B), paragraph 1 shall not apply to mit a nurse aide to petition the State to AMENDMENT NO. 497 an alien until 5 years after the date— have his or her name removed from the reg- (Purpose: To clarify that risk solvency ‘‘(I) an alien is admitted to the United istry upon a determination by the State standards established for managed care en- States as a refugee under section 207 of the that— tities under the Medicaid program shall Immigration and Nationality Act: ‘‘(aa) the employment and personal history not preempt any State standards that are ‘‘(II) an alien is granted asylum under sec- of the nurse aide does not reflect a pattern of more stringent) tion 208 of such Act; or abusive behavior or neglect; and ‘‘(III) an alien’s deportation is withheld ‘‘(bb) the neglect involved in the original On page 743, line 6, strike the period and under section 243(h) of such Act.’’. insert ‘‘(but that shall not preempt any finding was a singular occurrence. (b) MEDICAID.—Section 402(b)(2)(A) of the ‘‘(II) In no case shall a determination on a State standards that are more stringent than Personal Responsibility and Work Oppor- petition submitted under clause (I) be made the standards established under this sub- tunity Reconciliation Act of 1996 (8 U.S.C. prior to the expiration of the 1-year period paragraph.’’. 1612(b)(2)(A)) is amended to read as follows: beginning on the date on which the name of ‘‘(A) TIME-LIMITED EXCEPTION FOR REFU- AMENDMENT NO. 498 the petitioner was added to the registry GEES AND ASYLEES.— under this subparagraph.’’. (Purpose: To allow funds provided under the ‘‘(i) MEDICAID.—With respect to the des- (b) MEDICAID.—Section 1919(g)(1)(C) of the welfare-to work grant program to be used ignated Federal program described in para- Social Security Act (42 U.S.C. 1396r(g)(1)(C)) for the microloan demonstration program graph (3)(C), paragraph 1 shall not apply to is amended— under the Small Business Act) an alien until 7 years after the date— (1) in the first sentence by striking ‘‘The On page 888, between lines 22 and 23, insert ‘‘(I) an alien is admitted to the United State’’ and inserting ‘‘(i) The State’’; and the following: States as a refugee under section 207 of the (2) by adding at the end the following: ‘‘(VI) Technical assistance and related Immigration and nationality Act: ‘‘(ii)(I) In the case of a finding of neglect, services that lead to self-employment ‘‘(II) an alien is granted asylum under sec- the State shall establish a procedure to per- through the microloan demonstration pro- tion 208 of such Act; or mit a nurse aide to petition the State to gram under section 7(m) of the Small Busi- ‘‘(III) an alien’s deportation is withheld have his or her name removed from the reg- ness Act (15 U.S.C. 636(m)) under section 243(h) of such Act. June 24, 1997 CONGRESSIONAL RECORD — SENATE S6177 ‘‘(ii) OTHER DESIGNATED FEDERAL PRO- Mr. DOMENICI. You have plenty of 313(b)(1)(D) of the Budget Act, the so- GRAMS.—With respect to the designated Fed- time, Senator. called Byrd rule. eral programs under paragraph (3) (other Several Senators addressed the Mr. President, I urge my colleagues than subparagraph (C)), paragraph 1 shall Chair. to join me in opposing what amounts not apply to an alien until 5 years after the date— Mr. CONRAD. Mr. President, I yield- to a $2 billion blank check for one ‘‘(I) an alien is admitted to the United ed to the distinguished Republican State, the State of Texas. States as a refugee under section 207 of the manager. I would like to reclaim my The bill before us would require the Immigration and Nationality Act; time at this point. Secretary of Health and Human Serv- ‘‘(II) an alien is granted asylum under sec- Mr. DOMENICI. I didn’t know you ices to approve the privatization of all tion 208 of such Act; or had an amendment. Federal and State health and human ‘‘(III) an alien’s deportation is withheld Mr. CONRAD. I have a point of order services benefit programs in the State under section 243(h) of such Act.’’. that I would like to raise. of Texas without any hearings and (c) STATUS OF CUBAN AND HAITIAN EN- Mr. DOMENICI. I wonder if we could without any opportunity to review the TRANTS.—For purposes of sections 402(a)(2)(A) and 402(b)(2)(A) of the Personal finish this part of getting them in. proposal or ensure that the goals of Responsibility and Work Opportunity Rec- Mr. CONRAD. Yes. I would be happy these programs are furthered by the onciliation Act of 1996 (8 U.S.C. 1612(a)(2)(A), to yield for that purpose. proposal. (b)(2)(A), an alien who is a Cuban and Hai- AMENDMENT NO. 500 Mr. President, this is truly unprece- tian entrant, as defined in section 501(e) of (Purpose: To require that any benefits pack- dented. If we look at the potential im- the Refugee Education Assistance Act of age offered under the block grant option pact from this one State waiver, we see 1984, shall be considered a refugee. for the children’s health initiative includes that it affects 2.35 million Medicaid SEC. 5813. SSI ELIGIBILITY FOR PERMANENT hearing and visions services) beneficiaries, 2.1 million food stamp re- RESIDENT ALIENS WHO ARE MEM- BERS OF AN INDIAN TRIBE. Mr. DOMENICI. I send an amendment cipients, 10 percent of all the food Section 402(a)(2) of the Personal Respon- to the desk in behalf of Mr. CHAFEE and stamp recipients in the United States, sibility and Work Opportunity Reconcili- Mr. ROCKEFELLER. nearly 1 million WIC recipients, and ation Act of 1966 (8 U.S.C. 1612(a)(2)) (as The PRESIDING OFFICER. The 20,000 children who are up for adoption amended by section 5311) is amended by add- clerk will report. or qualify for foster care assistance. ing at the end the following: The legislative clerk read as follows: The Texas waiver amounts to a $2 ‘‘(F) PERMANENT RESIDENT ALIENS WHO ARE billion blank check without the benefit MEMBERS OF AN INDIAN TRIBE.—With respect The Senator from New Mexico [Mr. DOMEN- to eligibility for benefits for the program de- ICI] for Mr. CHAFEE for himself and Mr. of one hearing and without the benefit fined in paragraph (3)(A) (relating to the sup- ROCKEFELLER, proposes an amendment num- of any Senator knowing what is in the plemental security income program), para- bered 500. proposal, because this is a proposal graph (1) shall not apply to an alien who— The amendment is as follows: that has not been revealed to the U.S. ‘‘(i) is lawfully admitted for permanent On page 847, beginning on line 1, strike Senate. There has been no waiver sub- residence under the Immigration and Nation- ‘‘and that otherwise satisfies State insur- mitted. ality Act; and ance standards and requirements.’’ and in- We hear a lot of talk that it is a ‘‘(ii) is a member of an Indian tribe (as de- sert ‘‘that includes hearing and vision serv- waiver. There has been no waiver sub- fined in section 4(e) of the Indian Self-Deter- ices for children, and that otherwise satisfies mitted. This is a procurement docu- mination and Education Assistance Act).’’. State insurance standards and require- ment which, by law, is confidential and SEC. 5814. SSI ELIGIBILITY FOR DISABLED LEGAL ments.’’. ALIENS IN THE UNITED STATES ON cannot be reviewed by the U.S. Senate. AMENDMENT NO. 501 AUGUST 22, 1996. There have been no public hearings on (a) Section 402(a)(2) of the Personal Re- (Purpose: To require that any benefits pack- this proposal—not one. Not a single sponsibility and Work Opportunity Rec- age offered under the block grant option Member here has had privy to what onciliation Act of 1996 (8 U.S.C. 1612(a)(2) (as for the children’s health initiative includes hearing and visions services) this procurement document involves. amended by section 5813) is amended by add- There are serious unanswered ques- ing at the end the following: Mr. DOMENICI. Mr. President, I send tions about whether taxpayers are pro- ‘‘(G) SSI ELIGIBILITY FOR DISABLED an amendment to the desk in behalf of ALIENS.—With respect to eligibility for bene- tected from liability, mismanagement Senator CHAFEE and Senator ROCKE- fits for the program defined in paragraph or fraud. (3)(A) (relating to the supplemental security FELLER. Mr. President, let me go to the next income program), paragraph (1) shall not The PRESIDING OFFICER. The chart. The contracting of human serv- apply— clerk will report. ices has a very checkered record. I have ‘‘(i) to an alien who— The legislative clerk read as follows: produced reviews of just four situations ‘‘(I) is lawfully residing in any State on The Senator from New Mexico [Mr. DOMEN- which have occurred around the coun- August 22, 1996; and ICI], for Mr. CHAFEE, for himself and Mr. ‘‘(II) is disabled, as defined in section try, because I think before we leap off ROCKEFELLER proposes an amendment num- this precipice, we ought to know what 1614(a)(3) of the Social Security Act (42 bered 501. U.S.C. 1382c(a)(3)); or The amendment is as follows: is in this agreement. What is in this ‘‘(ii) to an alien who— proposal? None of us have been privy to ‘‘(I) is lawfully residing in any State and On page 861, after line 26, add the follow- what is here. ing: after such date; Let me just review with my col- ‘‘(II) is disabled (as so defined and ‘‘(4) HEARING AND VISION SERVICES.— Notwithstanding the definition of FEHBP- leagues what we have seen in other ‘‘(III) as of June 1, 1997, is receiving bene- agreements like this around the coun- fits under such program.’’. equivalent children’s health insurance cov- ‘‘(b) Funds shall be made available for not erage in section 2102(5), any package of try. In California, an agreement with to exceed 2 years for elderly SSI recipients health insurance benefits offered by a State Lockheed Martin for a child support made ineligible for benefits after August 22, that opts to use funds provided under this enforcement contract, harshly criti- 1996. title under this section shall include hearing cized in the California Assembly, slat- Mr. DOMENICI. I wonder if the Sen- and vision services for children.’’. ed to cost $99 million, now projected to ator from Delaware would mind taking Mr. CONRAD addressed the Chair. cost $260 million, cost overrun of 163 over for me. We are only going to be The PRESIDING OFFICER. The Sen- percent. The State of California another 10 minutes, and he can close it. ator from North Dakota. stopped payment in February of 1997; I would appreciate that. I would assume that the Senator limited contractor liability of only $44 Senator LAUTENBERG, I will see you would be willing to yield for additional million. Taxpayers have to pick up the in the morning. amendments that may be filed. rest—a disaster in California. Mr. LAUTENBERG. I look forward to Mr. CONRAD. That is the case. Do we want this to be repeated in that. The PRESIDING OFFICER. The Sen- Texas? Some will say, well, it won’t Mr. DOMENICI. Have we run out of ator may proceed. happen in Texas. On what basis do they time under the bill? POINT OF ORDER say that? Not a single Senator knows The PRESIDING OFFICER. My un- Mr. CONRAD. I rise to make a point what is in that procurement document derstanding is that the time runs out of order that section 5822 of this bill is —not a single one—because it is con- at 9:15. extraneous and violates section fidential. S6178 CONGRESSIONAL RECORD — SENATE June 24, 1997 Virginia: Electronic Data Systems, a Who pays for it if they enroll people Mr. LAUTENBERG. Mr. President, I Medicaid contract. By the way, this is who are not eligible? can’t let this moment pass without the same company that seeks to pri- What happens to vulnerable Ameri- commending—— vatize all—let me emphasis—every sin- cans who need these programs for basic Mr. ROTH. Could the Senator yield gle Federal and State program in the survival if the contractor has financial so I can send this amendment to the State of Texas. The same company is incentives to minimize enrollment, desk for consideration? involved in this Virginia matter. even of those who have every legal Mr. LAUTENBERG. Yes, of course. I This is a Medicaid contract in Vir- right to be qualified? would be happy to yield to the chair- ginia. The contract has been canceled; Mr. President, I would like to quote man of the Finance Committee. But I 20 months behind schedule; error rate an editorial from the Salt Lake Trib- expect to regain the floor. of more than 50 percent—error rate of une of April 27th. This is what the Salt AMENDMENT NO. 502 more than 50 percent—alleged sweet- Lake Tribune said on April 27 of this Mr. ROTH. Mr. President, I submit heart deal; EDS selected over competi- year: an amendment on behalf of Senator tor whose bid was 50 percent less; al- Certain elements of a welfare program lend D’AMATO on Medicare, on the duplica- leged conflict of interest; company won themselves well to contracting, vouchers, or tion provision for consideration tomor- contract after making revolving-door other forms of privatization . . . row. hire of a senior Virginia Medicaid offi- I think we all agree with that: The PRESIDING OFFICER. The cial. But when it comes to deciding who will re- clerk will report. Texas: Anderson Consulting, a child ceive public assistance or who should lose The legislative clerk read as follows: custody of a child, the private sector has its support system contract; 559 percent The Senator from Delaware [Mr. ROTH] for limits. If a private group’s primary mission over the budget; over 4 years behind Mr. D’AMATO, proposes an amendment num- is to make profits . . . services may be re- bered 502. schedule; design errors result in inabil- duced . . . Government employees, on the ity to handle changes in Federal regu- other hand, are subject to more public scru- The amendment is as follows: lations; taxpayers to foot more than 78 tiny and are expected to promote the public Section 1. In 42 U.S.C. § 1395ss(d)(3)(A)(v), percent of the project cost—another good within constitutional protections for insert ‘‘(a)’’ before ‘‘For’’, and after the first disaster. individuals. sentence insert: Mr. President, before we do this, we Mr. President, let’s not fix what isn’t ‘‘(b) For purposes of this subparagraph, a ought to know what is in this procure- broken. health insurance policy (which may be a con- ment document. We shouldn’t be hand- Virtually every State is currently op- tract with a health maintenance organiza- ing a blank check to Texas, or any erating, developing, or planning the de- tion) is not considered to ‘‘duplicate’’ health benefits under this title or title XIX or under other State. I wouldn’t advocate this velopment of an integrated, automated another health insurance policy if it— for my State—a blank check that could eligibility and enrollment system for (I) provides comprehensive health care blow up on the taxpayers like these ex- TANF, food stamps, and Medicaid. benefits that replace the benefits provided amples have blown up. Thirty-eight States with Federally cer- by another health insurance policy, Let me just conclude with the Flor- tified systems; three States installing; (II) is being provided to an individual enti- ida Unisys contract, a Medicaid con- five States developing; two States tled to benefits under Part A or enrolled tract. Unisys employees arrested for planning; three States with State-de- under Part B on the basis of section 226(b), and grand theft; one pleaded guilty to veloped systems. (III) coordinates against items and services fraud, forgery and money-laundering; Let’s not throw the baby out with available or paid for under this title or title two others charged with racketeering; the bathwater. XIX, provided that payments under this title more arrests expected; use of tem- I urge my colleagues to support this or title XIX shall not be treated as payments porary employees, one of whom stole well-taken point of order. under such policy in determining annual or almost a quarter of a million dollars. I thank the Chair. I yield the floor. lifetime benefit limits. And we are getting ready to approve Mr. ROTH. Mr. President, I move to Section 2. In 42 U.S.C. § 1395ss(d)(3)(A)(v), this kind of deal for the State of Texas waive the point of order. insert ‘‘(c)’’ before ‘‘For purposes of this clause’’. without any hearing, without any re- The PRESIDING OFFICER. The Sen- view, without a single Senator know- ator from Delaware. The PRESIDING OFFICER. The Sen- ing what is in the proposed agreement? MOTION TO WAIVE THE BUDGET ACT ator from New Jersey. Mr. President, we ought to think Mr. ROTH. I move to waive the point POINT OF ORDER very carefully before we go down this of order. Mr. LAUTENBERG. Mr. President, I path. Mr. CONRAD. Mr. President, par- want to commend our friend and col- In Florida, authorities investigating liamentary inquiry. league from North Dakota for being alleged Medicaid theft of $20 million. The PRESIDING OFFICER. State the aware of what is potentially taking Boy, if the warning lights aren’t out inquiry. place here. on this one, I don’t know what it will Mr. CONRAD. Parliamentary in- Mr. President, this is a small exam- take. quiry. The motion to waive the point of ple of the kind of document that you Mr. President, we ought to review order has been raised. Will this be might have that has all kinds of bad this circumstance, have a chance to re- stacked in votes tomorrow? Would that goodies in here. One of the things that view it, have hearings, and make a de- be the intention of the Chair? you have to do around here is to make termination if it makes any sense for Mr. ROTH. That would be the intent certain that everybody is on the alert us to proceed on this basis. I think of the chairman. to the fact that some things get into Mr. CONRAD. That would be the in- there are serious and legitimate ques- these bills without being discussed, tent of the chairman. without being formally introduced. It tions surrounding this proposed pro- Mr. President, would that be the in- has a way of sneaking in there. There curement document. tent? The Texas waiver has serious unan- The PRESIDING OFFICER. That is an osmosis process in which they fall swered questions. How do we prevent would be the procedure. down from the sky and get in there. the massive cost overruns and high Mr. CONRAD. I ask for the yeas and This is one that is really kind of sky- error rates that plague similar projects nays. high. in other States? The PRESIDING OFFICER. Is there a I express very serious concerns about How do we protect against revolving- sufficient second? the provision in this bill, that it will door hiring, kickbacks, or other fraud? There is a sufficient second. allow, as the Senator from North Da- Will the taxpayers be liable if a con- The yeas and nays were ordered. kota said, in this case Texas, but any tractor fails to enroll eligible individ- Mr. CONRAD. I thank the Chair. State—to have private companies de- uals? Mr. LAUTENBERG addressed the termine the eligibility for low-income You know, this is a fundamental re- Chair. benefits like Medicaid, WIC and food sponsibility of Government to make The PRESIDING OFFICER. The stamps. certain that those who are eligible get Chair recognizes the Senator from New Mr. President, this is a budget rec- the benefits to which they are entitled. Jersey. onciliation bill, not a Government June 24, 1997 CONGRESSIONAL RECORD — SENATE S6179 management reform bill. In my view, sions that are of critical importance to Mr. LAUTENBERG. Never, not even the privatization provision does not be- people with low incomes. in the years that I spent in the private long in fast-track legislation—fast It is like turning our military over to sector, and I ran a pretty good-sized track, that means to get it through private hands and letting them design company with 16,000 employees when I here as quickly as you can—that is de- what conflicts we are going to get in- left. It did better after I left. It now signed primarily to implement the volved with. The fact is that much of has 30,000 employees. budget resolution. This provision has the allure of privatization is to save Never have I seen it. Never, when one no real impact on the deficit except to money, and there is a place for that. works with Government, have I seen potentially make it worse in the years For example, Congress has to decide to this kind of an arrangement that has a ahead, and it would represent a signifi- have private companies operate some peculiar odor, and it is not Chanel No. cant policy change with broad-ranging of its cafeterias and do some of its 5. The fact is that to give away Govern- implications. cleaning, and perhaps that translates ment funds in a program as sensitive as I also note that this provision is out- into more savings and better service this to take care of the poor—listen, all side of the bipartisan budget agree- for congressional employees. But Con- of us have seen the abuses of private ment. It was never discussed at any gress has wisely limited the roll of pri- sector companies that have taken over one of the negotiating sessions because vate companies in many functions of health care and things of that nature. I personally sat there at every one of Government. Private companies are It just blows one’s mind when you see them, and it never appeared in any not allowed to operate our military in- that the president of a company that is early drafts of the budget agreement. stallations, nor do we have private in the health care business made $22 This provision raises some very im- companies administer our Social Secu- million in a single year and meanwhile portant policy questions. For example, rity system. We draw the line at some is squeezing down because that is will these private companies have an point. where the profits are going to come incentive, as the Senator from North I am concerned that privatizing deci- from, from cutting conditions. They Dakota pointed out in his chart, to ex- sions about benefits for low-income in- are cutting programs that are supposed clude people that they would rather dividuals may go over this line. At to take care of people’s health. not carry from low-income programs. least, at the very least, it needs careful Well, do you want to have someone Will they receive bonuses for doing so? and thorough study. Yet, I understand up there whose bonus, whose stock op- Will they feel inclined to do so in order that the Finance Committee has not tions, whose salary depends on making to win other State government con- reviewed the details of the Texas waiv- sure that they service as few people as tracts? er, has never seen the full proposal, and possible, reduce expenses as much as Now, Mr. President, I kind of grew since the Senator from North Dakota possible when, in fact, the WIC Pro- up, if I can say, in the computer busi- is also a member of the Finance Com- gram is designed to take care of people ness, and we have seen some of the fin- mittee and talks about the secret na- who are really impoverished, people est companies in the world make mis- ture of this agreement, that further who need the nutrition that comes takes. We have seen it here with the confirms what the rest of us who are through the program to sustain them? FAA contract, a fairly complicated not on the Finance Committee might So do you want to have some executive piece of business, and it was pointed not know and that is that it has never sitting at some remote place—and I out that it was Unisys and EDS and had appropriate scrutiny, never had ap- liked that executive life when I was names that are very well known in the propriate review. there, but it was never at the Govern- Mr. CONRAD. Will the Senator yield computer field. Mistakes are made and ment’s expense—at Government ex- sometimes these things run way over on that? Mr. LAUTENBERG. I would be de- pense. We see constant reference to the original cost estimate, as dem- lighted. cases being tried, investigations being onstrated in the example we saw, so we Mr. CONRAD. Is the Senator aware conducted where programs were turned cannot afford to put all of our citizens that the proposal before us forces the over to the private sector. I talk about subject to what might go awry here Secretary of Health and Human Serv- things like jails—we have tried that in and spend $2 billion to take care of an ices to approve without comment or re- New Jersey—which were dismal fail- arrangement, whatever that arrange- view any proposal submitted by the ures because they could not protect the ment is. Ask every citizen here wheth- State of Texas which includes provi- guards sufficiently in these jails be- er they would feel like kicking into sions to contract out for eligibility de- cause they did not hire the right kind this thing, and I am sure that given a terminations? Was the Senator so of people. They did not provide them proper questionnaire they would say, aware? with the right kind of tools. The facili- ‘‘Heck, no.’’ This is not for us and no Mr. LAUTENBERG. Not aware. I can- ties were not built enough to make State ought to be so privileged as to not even believe it would be suggested, sure the inmates incarcerated were get that kind of an advantage. because that is such a dereliction of properly cared for. Mr. President, the Department of duty that I think everybody would be So we see this time and time again, Health and Human Services reports embarrassed if something like this and here we walk in and say, ‘‘OK, here that there may be 3 million children el- took place. What do you mean? That a is a bunch of poor people. You take igible for Medicaid who are not en- Secretary has no right to review the care of them. Do the best you can at rolled in the program. It is a serious conditions under which we are spend- the best price you can.’’ What an out- problem and I feel could even get worse ing the taxpayers’ money? rage. under a privatization program. If pri- Mr. CONRAD. If we think about this, Mr. CONRAD. Will the Senator yield vate companies are put in charge of en- these are programs with respect to food for a final question? rolling more children for Medicaid, stamps and WIC that are 100 percent Mr. LAUTENBERG. Sure. would they really conduct aggressive federally funded. The Medicaid Pro- Mr. CONRAD. Is the Senator aware outreach programs to enroll children, gram is over 50 percent federally fund- that under the proposal in the underly- to encourage people to bring them in ed. ing legislation, we could have a private even if it meant that the State’s Med- Mr. LAUTENBERG. The rest of it is company decide the custody of a child? icaid costs would go up? I would not State funded. That this is so far-reaching without bet on it. Mr. CONRAD. The rest of it is State any limits we could be in a cir- I want to be clear. I am not nec- funded. We would be in a position to cumstance in which a private concern essarily opposed to privatization of endorse any proposal the State of has the authority to determine the cus- some Government services. However, it Texas sent up here without any review, tody of a child? How does that strike must be considered very carefully, es- without any comment by the Secretary the Senator from New Jersey? pecially when the lives of vulnerable of Health and Human Services. That is Mr. LAUTENBERG. I will tell the Americans are at stake. This proposal the situation we are in with the pro- Senator how it strikes me. I say thank really breaks new ground. For the first posal in the underlying legislation. I God that the Senator from North Da- time, private interests would be handed just ask the Senator, has he ever heard kota has brought this to the attention complete power to make benefit deci- of such a proposal before the Senate? of the Senate and to the public. S6180 CONGRESSIONAL RECORD — SENATE June 24, 1997

My friend has done a real service in Senator ROCKEFELLER and ask for its SEC. 5361. ESTABLISHMENT OF POST-HOSPITAL doing this. The notion that an individ- consideration. HOME HEALTH BENEFIT UNDER PART A AND TRANSFER OF OTHER ual working for a private living, per- The PRESIDING OFFICER. The HOME HEALTH SERVICES TO PART haps their salary dependent upon their clerk will report. B. ability to curtail services, is hardly the The legislative clerk read as follows: (a) IN GENERAL.—Section 1812(a)(3) (42 way you want to treat a sick patient in U.S.C. 1395d(a)(3)) is amended— The Senator from New Jersey [Mr. LAU- the hospital. That is hardly the way (1) by inserting ‘‘post-hospital’’ before TENBERG], for Mr. ROCKEFELLER, proposes an ‘‘home health services’’, and you want to treat a family problem. amendment numbered 503. That is hardly the way you want to (2) by inserting ‘‘for up to 100 visits’’ before Mr. LAUTENBERG. Mr. President, I the semicolon. protect a mother who has been bat- ask unanimous consent that reading of (b) POST-HOSPITAL HOME HEALTH SERV- tered. That is hardly the way we want the amendment be dispensed with. ICES.—Section 1861 (42 U.S.C. 1395x), as to do things in a society with the con- The PRESIDING OFFICER. Without amended by sections 5102(a) and 5103(a), is science this country has. amended by adding at the end the following: I am delighted, again, that the Sen- objection, it is so ordered. (qq) POST-HOSPITAL HOME HEALTH SERV- ator introduced it. I am concerned that The amendment is as follows: ICES.—The term ‘post-hospital home health privatization like this is not going to At the appropriate place in division 2 of services’ means home health services fur- do the job. Before we go ahead with ap- title V, insert the following: nished to an individual under a plan of treat- proval of a waiver, we ought to at least SEC. . EXTENSION OF SLMB PROTECTION. ment established when the individual was an hold a hearing and review the details. (a) IN GENERAL.—Section 1902(a)(10)(E)(iii) inpatient of a hospital or rural primary care (42 U.S.C. 1396a(a)(10)(E)(iii)) is amended by hospital for not less than 3 consecutive days Mr. President, Congress has established before discharge, or during a covered post- these safety net programs for people in striking ‘‘and 120 percent in 1995 and years thereafter’’ and inserting ‘‘, 120 percent in hospital extended care say, if home health our society who are truly in need, im- 1995 through 1997, 125 percent in 1998, 130 per- services are initiated for the individual with- poverished. They are designed to ease cent in 1999, 135 percent in 2000, 140 percent in 30 days after discharge from the hospital, suffering, to provide nutritional assist- in 2001, 145 percent in 2002, and 150 percent in rural primary care hospital or extended care ance to help children, help struggling 2003 and years thereafter’’. facility.’’. people get into the work force to get (b) 100 PERCENT FMAP.—Section 1905(b) (42 (c) CONFORMING AMENDMENTS.—Section themselves off welfare, to do whatever U.S.C. 1396d(b)) is amended by adding at the 1812(b) (42 U.S.C. 1395d(b)) is amended— (1) by striking ‘‘or’’ at the end of paragraph they can to sustain themselves. These end the following: ‘‘Notwithstanding the first sentence of this section, the Federal (2); programs can literally mean the dif- (2) by striking the period at the end of ference between homelessness and medical assistance percentage shall be 100 percent with respect to amounts expended as paragraph (3) and inserting ‘‘; or’’, and independence, and we ought not to rush medical assistance for medical assistance de- (3) by adding after paragraph (3) the follow- to hand them over to a private interest scribed in section 1902(a)(10)(E)(iii) for indi- ing: at this time, perhaps never, but we viduals described in such section whose in- ‘‘(4) post-hospital home health services fur- sure ought not to do it in the hasty come exceeds 120 percent of the official pov- nished to the individual beginning after such manner that this is being undertaken. erty line referred to in such section.’’. services have been furnished to the individ- ual for a total of 100 visits.’’. We can always revisit this issue, Mr. (c) EFFECTIVE DATE.—The amendments (d) PHASE-IN OF ADDITIONAL PART B COSTS made by this section apply on and after Oc- President, without constraints of a rec- IN DETERMINATION OF PART B MONTHLY PRE- tober 1, 1997. onciliation bill. MIUM.—Section 1839(a) (42 U.S.C. 1395r(a)) is I fully support the action being pro- Mr. LAUTENBERG. Mr. President, I amended— posed by the Senator from North Da- assume that the amendment goes into (1) in paragraph (3) in the sentence inserted kota and commend him for it, I must the line of amendments as turned in by section 5541 of this title, by inserting tell you. and will be considered at that point in ‘‘(except as provided in paragraph (5)(B))’’ Mr. CONRAD. I thank the Senator the order. before the period, and from New Jersey. If I could just take a (2) by adding after paragraph (4) the follow- The PRESIDING OFFICER. It goes in ing: moment to further point out—I want in the stacked order, yes. to rivet this point—there have been no ‘‘(5)(A) The Secretary shall, at the time of Mr. LAUTENBERG. Mr. President, I determining the monthly actuarial rate hearings, not a hearing in the Finance note the absence of a quorum. under paragraph (1) for 1998 through 2003, Committee, not a hearing in the Agri- The PRESIDING OFFICER. The shall determine a transitional monthly actu- culture Committee. Members have not clerk will call the roll. arial rate for enrollees age 65 and over in the been granted the opportunity to ques- same manner as such rate is determined The bill clerk proceeded to call the tion witnesses, experts, company, or under paragraph (1), except that there shall roll. advocates on the merits of privatizing be excluded from such determination an esti- eligibility determinations, protections Mr. LAUTENBERG. Mr. President, I mate of any benefits and administrative against cost overruns or protections ask unanimous consent that the order costs attributable to home health services for the quorum call be rescinded. for which payment would have been made for recipients. under part A during the year but for para- I really believe this is a totally un- The PRESIDING OFFICER. Without objection, it is so ordered. graph (4) of section 1812(b). precedented proposal that is buried in ‘‘(B) The monthly premium for each indi- this very large document that sets a AMENDMENT NO. 504 vidual enrolled under this part for each precedent that I believe is truly alarm- (Purpose: To immediately transfer to part B month for a year (beginning with 1998 and ing. I hope my colleagues will support certain home health benefits) ending with 2003) shall be equal to 50 percent the point of order when we vote on it Mr. LAUTENBERG. Mr. President, of the monthly actuarial rate determined tomorrow. This is, I think, a cir- there is an amendment here from Sen- under subparagraph (A) increased by the fol- lowing proportion of the difference between cumstance in which a very broad pro- ator KENNEDY that failed to get in- posal is being attempted, being made such premium and the monthly premium cluded in the list. I send it to the desk. otherwise determined under paragraph (3) to ram it through Congress as part of The PRESIDING OFFICER. The (without regard to this paragraph): privileged legislation. That is wrong. clerk will report. ‘‘(i) For a month in 1998, 1⁄7. That is simply wrong. The issue de- The legislative clerk read as follows: ‘‘(ii) For a month in 1999, 2⁄7. serves public hearings and full debate. ‘‘(iii) For a month in 2000, 3⁄7. The Senator from New Jersey [Mr. LAU- I thank the Chair, yield the floor, ‘‘(iv) For a month in 2001, 4⁄7. TENBERG] for Mr. KENNEDY, proposes an ‘‘(v) For a month in 2000, 5⁄7. and I thank very much the Senator amendment numbered 504. from New Jersey. ‘‘(vi) For a month in 2003, 6⁄7. Mr. LAUTENBERG. Mr. President, I (e) EFFECTIVE DATE.— AMENDMENT NO. 503 ask unanimous consent that reading of (1) IN GENERAL.—The amendments made by (Purpose: To extend premium protection for the amendment be dispensed with. this section apply to services furnished on or low-income medicare beneficiaries under after October 1, 1997. the medicaid program) The PRESIDING OFFICER. Without objection, it is so ordered. (2) SPECIAL RULE.—If an individual is enti- The PRESIDING OFFICER. The Sen- tled to benefits under part A of title XVIII of ator from New Jersey. The amendment is as follows: the Social Security Act (42 U.S.C. 1395 et Mr. LAUTENBERG. Mr. President, I Strike section 5361 and insert the follow- seq.), but is not enrolled in the insurance send an amendment to the desk for ing: program established by part B of that title, June 24, 1997 CONGRESSIONAL RECORD — SENATE S6181 the individual also shall be entitled under (c) EFFECTIVE DATE.—The amendments AMENDMENT NO. 508 TO AMENDMENT NO. 501 part A of that title to home health services made by this section apply on and after Oc- (Purpose: To provide a substitute for the that are not post-hospital home health serv- tober 1, 1997. children’s health insurance initiative ices (as those terms are defined under that Mr. LAUTENBERG. I thank the under subtitle J of title V) title) furnished before the 19th month that Chair, yield the floor and suggest the (The text of the amendment is print- begins after the date of enactment of this ed in today’s RECORD under ‘‘Amend- Act. absence of a quorum. The PRESIDING OFFICER. The ments Submitted.’’) The PRESIDING OFFICER. The Sen- clerk will call the roll. AMENDMENT NO. 509 TO AMENDMENT NO. 501 ator from Delaware. The bill clerk proceeded to call the (Purpose: To provide a substitute for the AMENDMENT NO. 505 TO AMENDMENT NO. 448 roll. children’s health insurance initiative (Purpose: To improve the children’s health Mr. ROTH. Mr. President, I ask unan- under subtitle J of title V) initiative) imous consent that the order for the (The text of the amendment is print- Mr. ROTH. Mr. President, on behalf quorum call be rescinded. ed in today’s RECORD under ‘‘Amend- of Mr. LOTT I send an amendment to The PRESIDING OFFICER. Without ments Submitted.’’) the desk in the second degree to objection, it is so ordered. AMENDMENT NO. 510 amendment No. 448, proposed by Mr. UNANIMOUS-CONSENT AGREEMENT (Purpose: To require that any benefits pack- CHAFEE. age offered under the block grant option The PRESIDING OFFICER. The Mr. ROTH. Mr. President, I ask unan- imous consent that it now be in order for the children’s health initiative includes clerk will report. hearing and vision services) for me to offer a managers’ amendment The legislative clerk read as follows: Mr. LAUTENBERG. Mr. President, I this evening, and further, prior to final The Senator from Delaware [Mr. ROTH], for send an amendment to the desk on be- passage of the bill on Wednesday, it be Mr. LOTT, proposes an amendment numbered half of Mr. ROCKEFELLER and ask for its in order for me, Senator ROTH, to mod- 505 to amendment No. 448. immediate consideration. Mr. ROTH. Mr. President, I ask unan- ify my amendment after the concur- The PRESIDING OFFICER. The imous consent that reading of the rence of the chairman and ranking clerk will report. amendment be dispensed with. member of the Budget Committee. The legislative clerk read as follows: The PRESIDING OFFICER. Is there The PRESIDING OFFICER. Without The Senator from New Jersey [Mr. LAU- objection, it is so ordered. objection? TENBERG], for Mr. ROCKEFELLER, proposes an (The text of the amendment is print- Mr. CHAFEE. Mr. President, I didn’t amendment numbered 510. ed in today’s RECORD under ‘‘Amend- quite understand what the request Mr. LAUTENBERG. Mr. President, I ments Submitted.’’) was—that Senator LOTT be permitted ask unanimous consent that reading of Mr. ROTH. Mr. President, I suggest to what? the amendment be dispensed with. the absence of a quorum. Mr. ROTH. It has nothing to do with The PRESIDING OFFICER. Without The PRESIDING OFFICER. The Senator LOTT. What it provides is that objection, it is so ordered. clerk will call the roll. I may offer a managers’ amendment The amendment is as follows: The legislative clerk proceeded to this evening, and that tomorrow I may At the appropriate place add the following: call the roll. amend it, with the concurrence of the Notwithstanding any other provision of Mr. LAUTENBERG. Mr. President, I chairman and ranking member of the this Act the following shall be the hearing ask unanimous consent that the order Budget Committee. and vision services provided under the chil- for the quorum call be rescinded. The PRESIDING OFFICER. Is there dren’s health insurance section: objection? ‘‘(4) HEARING AND VISION SERVICES.—Not- The PRESIDING OFFICER. Without withstanding the definition of FEHBP-equiv- objection, it is so ordered. Without objection, it is so ordered. alent children’s health insurance coverage in AMENDMENT NO. 503, AS MODIFIED AMENDMENT NO. 506 section 2102(5), any package of health insur- Mr. LAUTENBERG. Mr. President, I (Purpose: To provide for managers’ ance benefits offered by a State that opts to ask unanimous consent that I be per- amendments) use funds provided under this title under this mitted to send to the desk a modifica- Mr. ROTH. Mr. President, I send a section shall include hearing and vision serv- ices for children.’’. tion to an amendment I earlier sent to managers’ amendment to the desk and the desk on behalf of Senator ROCKE- ask for its immediate consideration. Mr. LAUTENBERG. Mr. President, I FELLER. The PRESIDING OFFICER. The ask that amendment No. 510 be in order The PRESIDING OFFICER. Without clerk will report. for its appearance tomorrow. objection, it is so ordered. The legislative clerk read as follows: The PRESIDING OFFICER. Without Mr. LAUTENBERG. I send the The Senator from Delaware [Mr. ROTH] objection, it is so ordered. amendment to the desk. proposes an amendment numbered 506. AMENDMENT NO. 511 The PRESIDING OFFICER. The Mr. ROTH. Mr. President, I ask unan- (Purpose: To provide a substitute for the amendment is so modified. imous consent that reading of the children’s health insurance initiative under subtitle J of title V) The amendment, as modified, is as amendment be dispensed with. Mr. ROTH. Mr. President, I send an follows: The PRESIDING OFFICER. Without amendment to the desk and ask for its At the appropriate place add the following: objection, it is so ordered. immediate consideration. Notwithstanding any other provisions of (The text of the amendment is print- The PRESIDING OFFICER. The this Act, section 5544 low-income Medicare ed in today’s RECORD under ‘‘Amend- clerk will report. Beneficiary Block Grant Program shall read ments Submitted.’’) as follows: The legislative clerk read as follows: AMENDMENT NOS. 507, 508 AND 509 (a) IN GENERAL.—Section 1902(a)(10)(E)(iii) The Senator from Delaware [Mr. ROTH] (42 U.S.C. 1396a(a)(10)(E)(iii) is amended by Mr. ROTH. Mr. President, I send proposes an amendment numbered 511. striking ‘‘and 120 percent in 1995 and years three second-degree amendments to Mr. ROTH. Mr. President, I ask unan- thereafter’’ and inserting ‘‘, 120 percent in the desk on behalf of Senator LOTT, 1995 through 1997, 125 percent in 1998, 130 per- imous consent that reading of the and I ask unanimous consent that they amendment be dispensed with. cent in 1999, 135 percent in 2000, 140 percent be considered as read and be numbered in 2001, 145 percent in 2002, and 150 percent in The PRESIDING OFFICER. Without 2003 and years thereafter’’. accordingly. objection, it is so ordered. (b) 100 PERCENT FMAP.—Section 1905(b) (42 The PRESIDING OFFICER. Without (The text of the amendment is print- U.S.C. 1396d(b)) is amended by adding at the objection, it is so ordered. ed in today’s RECORD under ‘‘Amend- end the following: ‘‘Notwithstanding the The amendments are as follows: ments Submitted.’’) first sentence of this section, the Federal AMENDMENT NO. 507 TO AMENDMENT NO. 501 AMENDMENT NO. 512 TO AMENDMENT NO. 511 medical assistance percentage shall be 100 (Purpose: To provide a substitute for the percent with respect to amounts expended as (PURPOSE: TO CLARIFY THE STANDARD BENEFITS children’s health insurance initiative medical assistance for medical assistance de- PACKAGE AND THE COST-SHARING REQUIRE- under subtitle J of title V) scribed in section 1902(a)(10)(E)(iii) for indi- MENTS FOR THE CHILDREN’S HEALTH INITIA- viduals described in such section whose in- (The text of the amendment is print- TIVES) come exceeds 120 percent of the official pov- ed in today’s RECORD under ‘‘Amend- Mr. CHAFEE. Mr. President, I send a erty line referred to in such section.’’. ments Submitted.’’) second-degree amendment to the desk S6182 CONGRESSIONAL RECORD — SENATE June 24, 1997 and ask for its immediate consider- The PRESIDING OFFICER. Without ‘‘GROCERS CARE’’ AWARD HONOREES ation. objection, it is so ordered. Representatives from companies, or- The PRESIDING OFFICER. The The amendment is as follows: ganizations and associations around clerk will report. At the appropriate place in chapter 3 of the United States will be honored. The The legislative clerk read as follows: subtitle F of division 1 of title V, insert the honorees include: The Senator from Rhode Island [Mr. following: Alabama: Peter V. Gregerson, CHAFEE] for himself and Mr. ROCKEFELLER, SEC. . MEDICARE SPECIAL REIMBURSEMENT Gregerson’s Foods, Inc., Gadsden; John proposes an amendment numbered 512 to RULE FOR PRIMARY CARE COM- M. Wilson, Super Foods Supermarkets, Amendment No. 511. BINED RESIDENCY PROGRAMS. Luverne; Dennis T. Stewart, Piggly Mr. CHAFEE. Mr. President, I ask (a) IN GENERAL.—Section 1886(h)(5)(G) of Wiggly Alabama, Bessemer; the Social Security Act (42 U.S.C. California: Judy Lynn, Tawa Super- unanimous consent that reading of the 1395ww(h)(5)(G)) is amended— amendment be dispensed with. (1) in clause (i), by striking ‘‘and (iii)’’ and markets, Buena Park Colorado: Harold The PRESIDING OFFICER. Without inserting ‘‘, (iii), and (iv)’’; and J. Kelloff, Kelloff’s Food Market, objection, it is so ordered. (2) by adding at the end the following: Alamosa; The amendment is as follows: ‘‘(iv) SPECIAL RULE FOR PRIMARY CARE COM- Florida: Leland F. Williams, Felton’s On page 4 strike line 17 through line 3 on BINED RESIDENCY PROGRAMS.—(I) In the case Meat & Produce, Plant City; Roy page 5 and insert the following: of a resident enrolled in a combined medical Deffler, Associated Grocers of Florida, ‘(5) FEHBP-EQUIVALENT CHILDREN’S HEALTH residency training program in which all of Miami; INSURANCE COVERAGE.—The term ‘FEHBP- the individual programs (that are combined) Iowa: George Tracy, Sales Force of equivalent children’s health insurance cov- are for training a primary care resident (as Des Moines, Des Moines; Kenneth C. defined in subparagraph (H)), the period of erage’ means, with respect to a State, any Stroud, Food’s, Inc., Des Moines; Scott plan or arrangement that provides, or pays board eligibility shall be the minimum num- the cost of, health benefits that the Sec- ber of years of formal training required to Havens, Plaza Holiday Foods, Norwalk; retary has certified are equivalent to or bet- satisfy the requirements for initial board eli- William D. Long, Waremart, Inc., ter than the services covered for a child, in- gibility in the longest of the individual pro- Boise; Virgil Wahlman, Buy Right cluding hearing and vision services, under grams plus one additional year. Food Center, Inc., Milford; the standard Blue Cross/Blue Shield pre- ‘‘(II) A resident enrolled in a combined Indiana: Larry D Contos, Pay Less ferred provider option service benefit plan medical residency training program that in- Super Markets, Inc., Anderson; offered under chapter 89 of title 5, United cludes an obstetrics and gynecology program Kansas: Doug Highland, Sixth Street States Code. qualifies for the period of broad eligibility Foods, Hays; Bill Lancaster and Doug- Mr. ROTH. Mr. President, I suggest under subclause (I) if the other programs such resident combines with such obstetrics las Carolan Associated Wholesale Gro- the absence of a quorum. and gynecology program are for training a cers, Kansas City; The PRESIDING OFFICER. The primary care resident.’’. Kentucky: James Hughes, Techau’s, clerk will call the roll. (b) EFFECTIVE DATE.—The amendments Inc., Cynthiana; Frank Hinton, D & T The legislative clerk proceeded to made by subsection (a) apply to combined Foods, Murray; William R. Gore, G & J call the roll. medical residency training programs in ef- Market, Inc., Paducah; Peggy Lawson, Mr. ROTH. Mr. President, I ask unan- fect on or after July 1, 1996. Laurel Grocery Company, Inc., London; imous consent that the order for the f Louisiana: Vincent A. Cannata, quorum call be rescinded. MORNING BUSINESS Cannata’s Super Market, Inc., Morgan The PRESIDING OFFICER. Without City; Joseph H. Campbell, Associated objection, it is so ordered. Mr. ROTH. Mr. President, I ask unan- Grocers, Inc. Baton Rouge; AMENDMENT NO. 513 TO AMENDMENT NO. 510 imous consent there now be a period Michigan: Kimberly Brubaker and (Purpose: To provide a substitute for the for the transaction of morning business Mark S. Feldpausch, Felpausch Food children’s health insurance initiative with Senators permitted to speak for Centers, Hastings; Ruthann Shull, J & under subtitle J of title V) up to 5 minutes each. C Family Foods, Carleton; Robert D. Mr. ROTH. Mr. President, I send a The PRESIDING OFFICER. Without DeYoung, Fulton Heights Foods, Grand second-degree amendment to the desk objection, it is so ordered. Rapids; Richard Glidden, Harding’s on behalf of Senator LOTT and I ask f Market, Kalamazoo; Mary Dechow and that it be considered. RECOGNIZING THE NATIONAL James B. Meyer, Spartan Stores, Inc., The PRESIDING OFFICER. The GROCERS ASSOCIATION Grand Rapids; clerk will report. Minnesota: Christopher Coborn and The legislative clerk read as follows: Mr. NICKLES. Mr. President, I wish Daniel G. Coborn, Coborn’s, Inc., St. The Senator from Delaware [Mr. ROTH], for to bring to the attention of the Senate Cloud; Gordon B. Anderson, Gordy’s, Mr. LOTT, proposes an amendment numbered the community contribution of the Inc., Worthington; Tim Mattheison, 513 to amendment No. 510. American independent retail grocers (The text of the amendment is printed in Do-Mats Foods, Benson; William E. and their wholesalers. In past years, Farmer, Fairway Foods, Inc.; Alfred N. today’s RECORD under ‘‘Amendments Sub- through the celebration of National mitted.’’) Flaten, Nash Finch Company, Min- Grocers Week, the House and Senate AMENDMENT NO. 427 neapolis; Jeffrey Noddle, SUPERVALU have recognized the important role INC., Minneapolis; (Purpose: To amend title XVIII of the Social these businesses play in our economy. Security Act to continue full-time-equiva- Missouri: Douglas Gerard, Country lent resident reimbursement for an addi- The week of June 22–28, 1997, com- Mart, Inc., Branson; tional one year under medicare for direct memorates the eleventh year that Na- Nebraska: Patrick Raybould, B & R graduate medical education for residents tional Grocers Week has been observed Stores, Inc., Lincoln; Fran Juro, No enrolled in combined approved primary by the industry to encourage and rec- Frills Supermarkets, Omaha; John F. care medical residency training programs) ognize grocers’ leadership in private Hanson, Sixth Street Food Stores, Mr. ROTH. Mr. President, I ask unan- sector initiatives. Across the nation, North Platte; Douglas D. Cunningham, imous consent that it be in order to community grocers, through environ- John Cunningham, D & D Foodliner, send an amendment to the desk by mental initiatives, political involve- Inc. #9, Wausa; James R. Clarke, Jim’s Senator DEWINE of Ohio. ment, and charitable support, dem- Foodmart, Aurora; The PRESIDING OFFICER. Without onstrate and build on the cornerstone New Hampshire: Richard Delay, objection, it is so ordered. of this great country—the entre- Delay’s, Inc., Greenfield; The clerk will report. preneurial spirit. New Jersey: Mike Reilly, ShopRite of The assistant legislative clerk read In this annual celebration, National Hunterton County, Flemington; David as follows. Grocers Association (N.G.A) and the Zallie, Zallie Enterprises, Clementon; The Senator from Delaware, [Mr. ROTH], nation honor outstanding independent Mark K. Laurenti, Shop Rite of for Mr. DEWINE, proposes an amendment retail and wholesale grocers, state as- Bensalem, Inc., Bensalem; Paul R. numbered 427. sociations and food industry manufac- Buckley, Jr., Murphy’s Market, Inc., Mr. ROTH. Mr. President, I ask unan- turers for their community leadership Medford; Dean Janeway, Catherine imous consent that reading of the with N.G.A.’s ‘‘Grocers Care’’ initia- Frank-White, and Jean Pillet, amendment be dispensed with. tives. Wakefern;