[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5162 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5162

 To amend title XI of the Social Security Act to create an independent 
   and nonpartisan commission to assess the health care needs of the 
uninsured and to monitor the financial stability of the Nation's health 
                            care safety net.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 12, 2000

Mrs. McCarthy of New York (for herself and Mrs. Morella) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
   and in addition to the Committee on Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XI of the Social Security Act to create an independent 
   and nonpartisan commission to assess the health care needs of the 
uninsured and to monitor the financial stability of the Nation's health 
                            care safety net.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care Safety Net Oversight Act 
of 2000''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress makes the following findings:
            (1) America's core health care safety net is made up of 
        providers that deliver a significant level of health care and 
        other related services to uninsured individuals, to 
        beneficiaries under the medicaid program under title XIX of the 
        Social Security Act, and to other vulnerable populations.
            (2) Thousands of providers render uncompensated care to 
        uninsured and underinsured individuals.
            (3) There are currently 44,000,000 uninsured individuals in 
        the Nation, and an equal number of low-income underinsured 
        individuals (including medicaid beneficiaries) who depend on 
        the core health care safety net.
    (b) Purpose.--The purpose of this Act is to create an independent 
and nonpartisan commission to assess the health care needs of the 
uninsured and to monitor the infrastructure, effectiveness, and 
financial stability of the Nation's core health care safety net.

SEC. 3. SAFETY NET ORGANIZATIONS AND PATIENT ADVISORY COMMISSION.

    (a) In General.--Title XI of the Social Security Act (42 U.S.C. 
1320 et seq.) is amended by adding at the end the following new part:

   ``Part D--Safety Net Organizations and Patient Advisory Commission

       ``safety net organizations and patient advisory commission

    ``Sec. 1181. (a) Establishment.--There is established the Safety 
Net Organizations and Patient Advisory Commission (in this section 
referred to as the `Commission').
    ``(b) Study of Health Care Safety Net Programs and Reporting 
Requirements.--
            ``(1) Study.--The Commission shall study the health care 
        safety net programs by--
                    ``(A) monitoring each health care safety net 
                program to document and analyze the effects of changes 
                in these programs on the core health care safety net;
                    ``(B) evaluating the impact of the Emergency 
                Medical Treatment and Labor Act, the Balanced Budget 
                Act of 1997, the Medicare, Medicaid, and SCHIP Balanced 
                Budget Refinement Act of 1999, and other forces on the 
                capacity of the core health care safety net to continue 
                their roles in the core health care safety net system 
                to care for uninsured individuals, medicaid 
                beneficiaries, and other vulnerable populations;
                    ``(C) monitoring existing data sets to assess the 
                status of the core health care safety net and health 
                outcomes for vulnerable populations;
                    ``(D) wherever possible, linking and integrating 
                existing data systems to enhance the ability of the 
                core health care safety net to track changes in the 
                status of the core health care safety net and health 
                outcomes for vulnerable populations;
                    ``(E) supporting the development of new data 
                systems where existing data are insufficient or 
                inadequate;
                    ``(F) developing criteria and indicators of 
                impending core health care safety net failure;
                    ``(G) establishing an early-warning system to 
                identify impending failures of core health care safety 
                net systems and providers;
                    ``(H) providing accurate and timely information to 
                Federal, State, and local policy makers on the 
                indicators that may lead to the failure of the core 
                health care safety net and an estimate of the projected 
                consequences of such failures and the impact of such a 
                failure on the community;
                    ``(I) monitoring and providing oversight for the 
                transition of individuals receiving supplemental 
                security income, medicaid, or SCHIP benefits who enroll 
                with a managed care entity (as defined in section 
                1932(a)(1)(B)), including the review of--
                            ``(i) the degree to which health plans have 
                        the capacity (including case management and 
                        management information system infrastructure) 
                        to provide quality managed care services to 
                        such an individual;
                            ``(ii) the degree to which these plans may 
                        be overburdened by adverse selection; and
                            ``(iii) the degree to which emergency 
                        departments are used by enrollees of these 
                        plans; and
                    ``(J) identifying and disseminating the best 
                practices for more effective application of the lessons 
                that have been learned.
            ``(2) Reports.--
                    ``(A) Annual reports.--Not later than June 1 of 
                each year (beginning with 2002), the Commission shall 
                submit to the appropriate committees of Congress a 
                report on the health care needs of the uninsured and 
                the financial and infrastructure stability of the 
                Nation's core health care safety net based on the 
                review conducted under paragraph (1).
                    ``(B) Agenda and additional reviews.--
                            ``(i) Agenda.--The Chair of the Commission 
                        shall consult periodically with the 
                        Chairpersons and Ranking Minority Members of 
                        the appropriate committees of Congress 
                        regarding the Commission's agenda and progress 
                        toward achieving the agenda.
                            ``(ii) Additional reviews.--The Commission 
                        may conduct additional reviews, and submit 
                        additional reports to the appropriate 
                        committees of Congress, from time to time on 
                        such topics relating to the health care safety 
                        net programs as may be requested the 
                        Commission.
                    ``(C) Availability of reports.--The Commission 
                shall transmit to the Comptroller General and the 
                Secretary a copy of each report submitted under this 
                subsection and shall make such reports available to the 
                public.
            ``(3) Definitions.--In this section:
                    ``(A) Appropriate committees of congress.--The term 
                `appropriate committees of Congress' means the 
                Committees on Ways and Means and Commerce of the House 
                of Representatives and the Committee on Finance of the 
                Senate.
                    ``(B) Core health care safety net.--The term `core 
                health care safety net' means any health care provider 
                that--
                            ``(i) by legal mandate or explicitly 
                        adopted mission, offers access to health care 
                        services to patients, regardless of the ability 
                        of such patient to pay for such services; and
                            ``(ii) has a case mix that is substantially 
                        comprised of patients who are uninsured, 
                        covered under the medicaid program, covered 
                        under any other public health care program, or 
                        are otherwise vulnerable populations.
                Such term includes each disproportionate share 
                hospital, federally qualified health centers, other 
                Federal, State, and locally supported clinic, rural 
                health clinic, local health department, and provider 
                covered under the Emergency Medical Treatment and Labor 
                Act.
                    ``(C) Health care safety net programs.--The term 
                `health care safety net programs' includes the 
                following:
                            ``(i) Medicaid.--The medicaid program under 
                        title XIX.
                            ``(ii) SCHIP.--The State children's health 
                        insurance program under title XXI.
                            ``(iii) Maternal and child health services 
                        block grant program.--The maternal and child 
                        health services block grant program under title 
                        V.
                            ``(iv) FQHC programs.--Each federally 
                        funded program under which a health center (as 
                        defined in section 330(1) of the Public Health 
                        Service Act), a Federally qualified health 
                        center (as defined in section 1861(aa)(4)), or 
                        a Federally-qualified health center (as defined 
                        in section 1905(l)(2)(B)) receives funds.
                            ``(v) RHC programs.--Each federally funded 
                        program under which a rural health clinic (as 
                        defined in section 1861(aa)(4) or 1905(l)(1)) 
                        receives funds.
                            ``(vi) DSH payment plans.--Each federally 
                        funded program under which a disproportionate 
                        share hospital receives funds.
                            ``(vii) Emergency medical treatment and 
                        labor act.--All care provided under section 
                        1867 for the uninsured, underinsured, 
                        beneficiaries under title XIX, and other 
                        vulnerable individuals.
                            ``(viii) Other health care safety net 
                        programs.--Such term also includes any other 
                        health care program that the Commission 
                        determines to be appropriate.
                    ``(D) Vulnerable populations.--The term `vulnerable 
                populations' includes uninsured individuals, low-income 
                individuals, farm workers, homeless individuals, 
                individuals with disabilities, individuals with HIV or 
                AIDS, and such other individuals as the Commission may 
                designate.
    ``(c) Membership.--
            ``(1) Number and appointment.--The Commission shall be 
        composed of 17 members appointed by the Comptroller General of 
        the United States (in this section referred to as the 
        `Comptroller General'), in consultation with the committees of 
        jurisdiction in the House of Representatives and the Senate.
            ``(2) Qualifications.--
                    ``(A) In general.--The membership of the Commission 
                shall include individuals with national recognition for 
                their expertise in health finance and economics, health 
                care safety net research and program management, 
                actuarial science, health facility management, health 
                plans and integrated delivery systems, reimbursement of 
                health facilities, allopathic and osteopathic medicine 
                (including emergency medicine), and other providers of 
                health services, and other related fields, who provide 
                a mix of different professionals, broad geographic 
                representation, and a balance between urban and rural 
                representatives.
                    ``(B) Inclusion.--The membership of the Commission 
                shall include health professionals, employers, third-
                party payers, individuals skilled in the conduct and 
                interpretation of biomedical, health services, and 
                health economics research and expertise in outcomes and 
                effectiveness research and technology assessment. Such 
                membership shall also include recipients of care from 
                core health care safety net and individuals who provide 
                and manage the delivery of care by the core health care 
                safety net.
                    ``(C) Majority nonproviders.--Individuals who are 
                directly involved in the provision, or management of 
                the delivery, of items and services covered under the 
                health care safety net programs shall not constitute a 
                majority of the membership of the Commission.
                    ``(D) Ethical disclosure.--The Comptroller General 
                shall establish a system for public disclosure by 
                members of the Commission of financial and other 
                potential conflicts of interest relating to such 
                members.
            ``(3) Terms.--
                    ``(A) In general.--The terms of members of the 
                Commission shall be for 3 years except that the 
                Comptroller General shall designate staggered terms for 
                the members first appointed.
                    ``(B) Vacancies.--
                            ``(i) In general.--A vacancy in the 
                        Commission shall be filled in the same manner 
                        in which the original appointment was made.
                            ``(ii) Appointment.--Any member appointed 
                        to fill a vacancy occurring before the 
                        expiration of the term for which the member's 
                        predecessor was appointed shall be appointed 
                        only for the remainder of that term.
                            ``(iii) Term.--A member may serve after the 
                        expiration of that member's term until a 
                        successor has taken office.
            ``(4) Compensation.--
                    ``(A) In general.--While serving on the business of 
                the Commission (including travel time), a member of the 
                Commission--
                            ``(i) shall be entitled to compensation at 
                        the per diem equivalent of the rate provided 
                        for level IV of the Executive Schedule under 
                        section 5315 of title 5, United States Code; 
                        and
                            ``(ii) while so serving away from home and 
                        the member's regular place of business, a 
                        member may be allowed travel expenses, as 
                        authorized by the Commission.
                    ``(B) Other personnel.--For purposes of pay (other 
                than pay of members of the Commission) and employment 
                benefits, rights, and privileges, all personnel of the 
                Commission shall be treated as if they were employees 
                of the United States Senate.
            ``(5) Chair; vice chair.--The Comptroller General shall 
        designate a member of the Commission, at the time of 
        appointment of the member as Chair and a member as Vice Chair 
        for that term of appointment, except that in the case of 
        vacancy of the Chair or Vice Chair, the Comptroller General may 
        designate another member for the remainder of that member's 
        term.
            ``(6) Meetings.--The Commission shall meet at the call of 
        the Chair or upon the written request of a majority of its 
        members.
    ``(d) Director and Staff; Experts and Consultants.--Subject to such 
review as the Comptroller General deems necessary to ensure the 
efficient administration of the Commission, the Commission may--
            ``(1) employ and fix the compensation of an Executive 
        Director (subject to the approval of the Comptroller General) 
        and such other personnel as may be necessary to carry out its 
        review of health care safety net programs and reporting 
        requirements (without regard to the provisions of title 5, 
        United States Code, governing appointments in the competitive 
        service);
            ``(2) seek such assistance and support as may be required 
        in the performance of its review of health care safety net 
        programs and reporting requirements from appropriate Federal 
        departments and agencies;
            ``(3) enter into contracts or make other arrangements, as 
        may be necessary for the conduct of the work of the Commission 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            ``(4) make advance, progress, and other payments which 
        relate to the work of the Commission;
            ``(5) provide transportation and subsistence for persons 
        serving without compensation; and
            ``(6) prescribe such rules and regulations as it deems 
        necessary with respect to the internal organization and 
        operation of the Commission.
    ``(e) Powers.--
            ``(1) Obtaining official data.--
                    ``(A) In general.--The Commission may secure 
                directly from any department or agency of the United 
                States information necessary to enable it to carry out 
                this section.
                    ``(B) Request of chair.--Upon request of the Chair, 
                the head of that department or agency shall furnish 
                that information to the Commission on an agreed upon 
                schedule.
            ``(2) Data collection.--In order to carry out its 
        functions, the Commission shall--
                    ``(A) use existing information, both published and 
                unpublished, where possible, collected and assessed 
                either by its own staff or under other arrangements 
                made in accordance with this section;
                    ``(B) carry out, or award grants or contracts for, 
                original research and experimentation, where existing 
                information is inadequate; and
                    ``(C) adopt procedures allowing any interested 
                party to submit information for the Commission's use in 
                making reports and recommendations.
            ``(3) Access of gao to information.--The Comptroller 
        General shall have unrestricted access to all deliberations, 
        records, and nonproprietary data of the Commission, immediately 
        upon request.
            ``(4) Periodic audit.--The Commission shall be subject to 
        periodic audit by the Comptroller General.
    ``(f) Application of FACA.--Section 14 of the Federal Advisory 
Committee Act does not apply to the Commission.
    ``(g) Appropriations.--
            ``(1) Request for appropriations.--The Commission shall 
        submit requests for appropriations in the same manner as the 
        Comptroller General submits requests for appropriations, but 
        amounts appropriated for the Commission shall be separate from 
        amounts appropriated for the Comptroller General.
            ``(2) Authorization.--
                    ``(A) In general.--Subject to subparagraph (B), 
                there are appropriated from the Federal Hospital 
                Insurance Trust Fund under section 1817 such sums as 
                may be necessary to carry out the provisions of this 
                section.
                    ``(B) Limitation.--For any fiscal year, the sums 
                appropriated under subparagraph (A) may not exceed 
                $7,000,000.''.
    (b) Effective Date.--The Comptroller General of the United States 
shall appoint the initial members of the Safety Net Organizations and 
Patient Advisory Commission established under subsection (a) not later 
than June 1, 2001.
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