[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 732 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                 S. 732

 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 SENATE OF THE UNITED STATES

                             March 27, 2003

Mr. Baucus (for himself, Mr. Hatch, Mr. Rockefeller, and Mr. Jeffords) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 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 2003''.

SEC. 2. 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 hereby established the 
Safety Net Organizations and Patient Advisory Commission (in this 
section referred to as the `Commission').
    ``(b) Review of Health Care Safety Net Programs and Reporting 
Requirements.--
            ``(1) Review.--The Commission shall conduct an ongoing 
        review of the health care safety net programs (as described in 
        paragraph (3)(C)) 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 Health Insurance 
                Portability and Accountability Act of 1996, the 
                Balanced Budget Act of 1997, the Medicare, Medicaid, 
                and SCHIP Balanced Budget Refinement Act of 1999, the 
                Medicare, Medicaid, and SCHIP Benefits Protection and 
                Improvement Act of 2000, 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 policymakers 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 benefits, medical assistance under 
                title XIX, or child health assistance under title XXI 
                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 January 1 of 
                each year (beginning with 2005), the Commission shall, 
                based on the review conducted under paragraph (1), 
                submit to the appropriate committees of Congress a 
                report on--
                            ``(i) the health care needs of the 
                        uninsured; and
                            ``(ii) the financial and infrastructure 
                        stability of the Nation's core health care 
                        safety net.
                    ``(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 
                        shall conduct additional reviews and submit 
                        additional reports to the appropriate 
                        committees of Congress on topics relating to 
                        the health care safety net programs under the 
                        following circumstances:
                                    ``(I) If requested by the 
                                Chairpersons or Ranking Minority 
                                Members of such committees.
                                    ``(II) If the Commission deems such 
                                additional reviews and reports 
                                appropriate.
                    ``(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 Energy and Commerce of 
                the House of Representatives and the Committees on 
                Finance and Health, Education, Labor, and Pensions 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 the 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 disproportionate share hospitals, 
                Federally qualified health centers, other Federal, 
                State, and locally supported clinics, rural health 
                clinics, local health departments, and providers 
                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 programs.--Each 
                        federally funded program under which a 
disproportionate share hospital receives funds.
                            ``(vii) Emergency medical treatment and 
                        active 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 and underinsured 
                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 13 members appointed by the Comptroller General of 
        the United States (in this section referred to as the 
        `Comptroller General'), in consultation with the appropriate 
        committees of Congress.
            ``(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 of the 
                members first appointed, the Comptroller General shall 
                designate--
                            ``(i) four to serve a term of 1 year;
                            ``(ii) four to serve a term of 2 years; and
                            ``(iii) five to serve a term of 3 years.
                    ``(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) Terms.--A member may serve after 
                        the expiration of that member's term until a 
                        successor has taken office.
            ``(4) Compensation.--
                    ``(A) Members.--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, may be 
                        allowed travel expenses, as authorized by the 
                        Commission.
                    ``(B) Treatment.--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 determines 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 the 
        duties of the Commission under this section (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 the duties of the Commission under this 
        section 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 for the Commission to 
                carry the duties under 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 the duties of 
        the Commission under this section, the Commission shall--
                    ``(A) use existing information, both published and 
                unpublished, where possible, collected and assessed 
                either by the staff of the Commission 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 that pertains to the work of 
        the Commission, immediately upon request. The expense of 
        providing such information shall be borne by the General 
        Accounting Office.
            ``(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 (5 U.S.C. App.) does not apply to the Commission.
    ``(g) Authorization of 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.--There are authorized to be 
        appropriated such sums as may be necessary to carry out the 
        provisions of this section.''.
    (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 January 1, 2004.
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