[Congressional Record Volume 140, Number 139 (Thursday, September 29, 1994)]
[Senate]
[Page S]
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[Congressional Record: September 29, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
  DISTRICT OF COLUMBIA APPROPRIATIONS ACT, 1995, DISTRICT OF COLUMBIA 
   SUPPLEMENTAL APPROPRIATIONS AND RESCISSIONS ACT, 1994--CONFERENCE 
                                 REPORT

  The Senate continued with the consideration of the amendments in 
disagreement to the conference report.


                           Amendment No. 2595

  Mr. COHEN. Mr. President, I believe the regular order has been 
called.
  The PRESIDING OFFICER. The question before the Senate is on the 
amendment in the second degree, amendment No. 2595, offered by the 
Senator from Pennsylvania [Mr. Wofford].


                    Amendment No. 2594, as Modified

  Mr. COHEN. Mr. President, I modify my amendment to accept the pending 
second-degree amendment, as well as to make the following changes that 
I now send to the desk.
  The PRESIDING OFFICER. The Senator has that right.
  The amendment is so modified.
  The amendment (No. 2594), as modified, reads as follows:
       At the appropriate place, insert the following new 
     subtitle:
        Subtitle ____--Enhanced Penalties for Health Care Fraud

           PART 1--ALL-PAYER FRAUD AND ABUSE CONTROL PROGRAM

     SEC. ____01. ALL-PAYER FRAUD AND ABUSE CONTROL PROGRAM.

       (a) Establishment of Program.--
       (1) In general.--Not later than January 1, 1995, the 
     Secretary of Health and Human Services (in this subtitle 
     referred to as the ``Secretary''), acting through the Office 
     of the Inspector General of the Department of Health and 
     Human Services, and the Attorney General shall establish a 
     program--
       (A) to coordinate Federal, State, and local law enforcement 
     programs to control fraud and abuse with respect to the 
     delivery of and payment for health care in the United States,
       (B) to conduct investigations, audits, evaluations, and 
     inspections relating to the delivery of and payment for 
     health care in the United States,
       (C) to facilitate the enforcement of the provisions of 
     sections 1128, 1128A, and 1128B of the Social Security Act 
     and other statutes applicable to health care fraud and abuse, 
     and
       (D) to provide for the modification and establishment of 
     safe harbors and to issue interpretative rulings and special 
     fraud alerts pursuant to section ____03.
       (2) Coordination with health plans.--In carrying out the 
     program established under paragraph (1), the Secretary and 
     the Attorney General shall consult with, and arrange for the 
     sharing of data with representatives of health plans.
       (3) Regulations.--
       (A) In general.--The Secretary and the Attorney General 
     shall by regulation establish standards to carry out the 
     program under paragraph (1).
       (B) Information standards.--
       (i) In general.--Such standards shall include standards 
     relating to the furnishing of information by health plans, 
     providers, and others to enable the Secretary and the 
     Attorney General to carry out the program (including 
     coordination with health plans under paragraph (2)).
       (ii) Confidentiality.--Such standards shall include 
     procedures to assure that such information is provided and 
     utilized in a manner that appropriately protects the 
     confidentiality of the information and the privacy of 
     individuals receiving health care services and items.
       (iii) Qualified immunity for providing information.--The 
     provisions of section 1157(a) of the Social Security Act 
     (relating to limitation on liability) shall apply to a person 
     providing information to the Secretary or the Attorney 
     General in conjunction with their performance of duties under 
     this section, in the same manner as such section applies to 
     information provided to organizations with a contract under 
     subtitle B of title V of this Act, with respect to the 
     performance of such a contract.
       (C) Disclosure of ownership information.--
       (i) In general.--Such standards shall include standards 
     relating to the disclosure of ownership information described 
     in clause (ii) by any entity providing health care services 
     and items.
       (ii) Ownership information described.--The ownership 
     information described in this clause includes--

       (I) a description of such items and services provided by 
     such entity;
       (II) the names and unique physician identification numbers 
     of all physicians with a financial relationship (as defined 
     in section 1877(a)(2) of the Social Security Act) with such 
     entity;
       (III) the names of all other individuals with such an 
     ownership or investment interest in such entity; and
       (IV) any other ownership and related information required 
     to be disclosed by such entity under section 1124 or section 
     1124A of the Social Security Act, except that the Secretary 
     shall establish procedures under which the information 
     required to be submitted under this subclause will be reduced 
     with respect to health care provider entities that the 
     Secretary determines will be unduly burdened if such entities 
     are required to comply fully with this subclause.

       (4) Authorization of appropriations for investigators and 
     other personnel.--In addition to any other amounts authorized 
     to be appropriated to the Secretary and the Attorney General 
     for health care anti-fraud and abuse activities for a fiscal 
     year, there are authorized to be appropriated additional 
     amounts as may be necessary to enable the Secretary and the 
     Attorney General to conduct investigations and audits of 
     allegations of health care fraud and abuse and otherwise 
     carry out the program established under paragraph (1) in a 
     fiscal year.
       (5) Ensuring access to documentation.--The Inspector 
     General of the Department of Health and Human Services is 
     authorized to exercise the authority described in paragraphs 
     (4) and (5) of section 6 of the Inspector General Act of 1978 
     (relating to subpoenas and administration of oaths) with 
     respect to the activities under the all-payer fraud and abuse 
     control program established under this subsection to the same 
     extent as such Inspector General may exercise such 
     authorities to perform the functions assigned by such Act.
       (6) Authority of inspector general.--Nothing in this Act 
     shall be construed to diminish the authority of any Inspector 
     General, including such authority as provided in the 
     Inspector General Act of 1978.
       (7) Health plan defined.--For the purposes of this 
     subsection, the term ``health plan'' shall have the meaning 
     given such term in section 1128(i) of the Social Security 
     Act.
       (b) Health Care Fraud and Abuse Control Account.--
       (1) Establishment.--
       (A) In general.--There is hereby established an account to 
     be known as the ``Health Care Fraud and Abuse Control 
     Account'' (in this section referred to as the ``Anti-Fraud 
     Account''). The Anti-Fraud Account shall consist of--
       (i) such gifts and bequests as may be made as provided in 
     subparagraph (B);
       (ii) such amounts as may be deposited in the Anti-Fraud 
     Account as provided in subsection (a)(4), sections ____41(b) 
     and ____42(b), and title XI of the Social Security Act except 
     for those penalties attributable to laws in existence prior 
     to the enactment of this Act; and
       (iii) such amounts as are transferred to the Anti-Fraud 
     Account under subparagraph (C).
       (B) Authorization to accept gifts.--The Anti-Fraud Account 
     is authorized to accept on behalf of the United States money 
     gifts and bequests made unconditionally to the Anti-Fraud 
     Account, for the benefit of the Anti-Fraud Account or any 
     activity financed through the Anti-Fraud Account.
       (C) Transfer of amounts.--
       (i) In general.--The Secretary of the Treasury shall 
     transfer to the Anti-Fraud Account an amount equal to the sum 
     of the following:

       (I) Criminal fines imposed in cases involving a Federal 
     health care offense (as defined in section 982(a)(6)(B) of 
     title 18, United States Code).

       (ii) Administrative penalties and assessments imposed under 
     titles XI, XVIII, and XIX of the Social Security Act (except 
     as otherwise provided by law) except for those penalties 
     attributable to laws in existence prior to the enactment of 
     this Act.
       (iii) Amounts resulting from the forfeiture of property by 
     reason of a Federal health care offense.
       (iv) Penalties and damages imposed under the False Claims 
     Act (31 U.S.C. 3729 et seq.), in cases involving claims 
     related to the provision of health care items and services 
     (other than funds awarded to a relator or for restitution) 
     except for those penalties attributable to laws in existence 
     prior to the enactment of this Act.
       (2) Use of funds.--
       (A) In general.--Amounts in the Anti-Fraud Account shall be 
     available without appropriation and until expended as 
     determined jointly by the Secretary and the Attorney General 
     of the United States in carrying out the health care fraud 
     and abuse control program established under subsection (a) 
     (including the administration of the program), and may be 
     used to cover costs incurred in operating the program, 
     including costs (including equipment, salaries and benefits, 
     and travel and training) of--
       (i) prosecuting health care matters (through criminal, 
     civil, and administrative proceedings);
       (ii) investigations;
       (iii) financial and performance audits of health care 
     programs and operations;
       (iv) inspections and other evaluations; and
       (v) provider and consumer education regarding compliance 
     with the provisions of this subtitle.
       (B) Funds used to supplement agency appropriations.--It is 
     intended that disbursements made from the Anti-Fraud Account 
     to any Federal agency be used to increase and not supplant 
     the recipient agency's appropriated operating budget.
       (3) Annual report.--The Secretary and the Attorney General 
     shall submit jointly an annual report to Congress on the 
     amount of revenue which is generated and disbursed by the 
     Anti-Fraud Account in each fiscal year.
       (4) Use of funds by inspector general.--
       (A) Reimbursements for investigations.--The Inspector 
     General is authorized to receive and retain for current use 
     reimbursement for the costs of conducting investigations, 
     when such restitution is ordered by a court, voluntarily 
     agreed to by the payer, or otherwise.
       (B) Crediting.--Funds received by the Inspector General as 
     reimbursement for costs of conducting investigations shall be 
     deposited to the credit of the appropriation from which 
     initially paid, or to appropriations for similar purposes 
     currently available at the time of deposit, and shall remain 
     available for obligation for 1 year from the date of their 
     deposit.

     SEC. ____02. APPLICATION OF FEDERAL HEALTH ANTI-FRAUD AND 
                   ABUSE SANCTIONS TO ALL FRAUD AND ABUSE AGAINST 
                   ANY HEALTH PLAN.

       (a) Crimes.--
       (1) Social security act.--Section 1128B of the Social 
     Security Act (42 U.S.C. 1320a-7b) is amended as follows:
       (A) In the heading, by adding at the end the following: 
     ``or health plans''.
       (B) In subsection (a)(1)--
       (i) by striking ``title XVIII or'' and inserting ``title 
     XVIII,'', and
       (ii) by adding at the end the following: ``or a health plan 
     (as defined in section 1128(i)),''.
       (C) In subsection (a)(5), by striking ``title XVIII or a 
     State health care program'' and inserting ``title XVIII, a 
     State health care program, or a health plan''.
       (D) In the second sentence of subsection (a)--
       (i) by inserting after ``title XIX'' the following: ``or a 
     health plan'', and
       (ii) by inserting after ``the State'' the following: ``or 
     the plan''.
       (E) In subsection (b)(1), by striking ``title XVIII or a 
     State health care program'' each place it appears and 
     inserting ``title XVIII, a State health care program, or a 
     health plan''.
       (F) In subsection (b)(2), by striking ``title XVIII or a 
     State health care program'' each place it appears and 
     inserting ``title XVIII, a State health care program, or a 
     health plan''.
       (G) In subsection (b)(3), by striking ``title XVIII or a 
     State health care program'' each place it appears in 
     subparagraphs (A) and (C) and inserting ``title XVIII, a 
     State health care program, or a health plan''.
       (H) In subsection (d)(2)--
       (i) by striking ``title XIX,'' and inserting ``title XIX or 
     under a health plan,'', and
       (ii) by striking ``State plan,'' and inserting ``State plan 
     or the health plan,''.
       (2) Identification of community service opportunities.--
     Section 1128B of such Act (42 U.S.C. 1320a-7b) is further 
     amended by adding at the end the following new subsection:
       ``(f) The Secretary may--
       ``(1) in consultation with State and local health care 
     officials, identify opportunities for the satisfaction of 
     community service obligations that a court may impose upon 
     the conviction of an offense under this section, and
       ``(2) make information concerning such opportunities 
     available to Federal and State law enforcement officers and 
     State and local health care officials.''.
       (b) Health Plan Defined.--Section 1128 of the Social 
     Security Act (42 U.S.C. 1320a-7) is amended by redesignating 
     subsection (i) as subsection (j) and by inserting after 
     subsection (h) the following new subsection:
       ``(i) Health Plan Defined.--For purposes of sections 1128A 
     and 1128B, the term `health plan' means a public or private 
     program for the delivery of or payment for health care items 
     or services.''
       (c) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 1995.

     SEC. ____03. HEALTH CARE FRAUD AND ABUSE GUIDANCE.

       (a) Solicitation and Publication of Modifications to 
     Existing Safe Harbors and New Safe Harbors.--
       (1) In general.--
       (A) Solicitation of proposals for safe harbors.--Not later 
     than January 1, 1995, and not less than annually thereafter, 
     the Secretary shall publish a notice in the Federal Register 
     soliciting proposals, which will be accepted during a 60-day 
     period, for--
       (i) modifications to existing safe harbors issued pursuant 
     to section 14(a) of the Medicare and Medicaid Patient and 
     Program Protection Act of 1987 (42 U.S.C. 1320a-7b note);
       (ii) additional safe harbors specifying payment practices 
     that shall not be treated as a criminal offense under section 
     1128B(b) of the Social Security Act the (42 U.S.C. 1320a-
     7b(b)) and shall not serve as the basis for an exclusion 
     under section 1128(b)(7) of such Act (42 U.S.C. 1320a-
     7(b)(7));
       (iii) interpretive rulings to be issued pursuant to 
     subsection (b); and
       (iv) special fraud alerts to be issued pursuant to 
     subsection (c).
       (B) Publication of proposed modifications and proposed 
     additional state harbors.--After considering the proposals 
     described in clauses (i) and (ii) of subparagraph (A), the 
     Secretary, in consultation with the Attorney General, shall 
     publish in the Federal Register proposed modifications to 
     existing safe harbors and proposed additional safe harbors, 
     if appropriate, with a 60-day comment period. After 
     considering any public comments received during this period, 
     the Secretary shall issue final rules modifying the existing 
     safe harbors and establishing new safe harbors, as 
     appropriate.
       (C) Report.--The Inspector General of the Department of 
     Health and Human Services (hereafter in this section referred 
     to as the ``Inspector General'') shall, in an annual report 
     to Congress or as part of the year-end semiannual report 
     required by section 5 of the Inspector General Act of 1978 (5 
     U.S.C. App.), describe the proposals received under clauses 
     (i) and (ii) of subparagraph (A) and explain which proposals 
     were included in the publication described in subparagraph 
     (B), which proposals were not included in that publication, 
     and the reasons for the rejection of the proposals that were 
     not included.
       (2) Criteria for modifying and establishing safe harbors.--
     In modifying and establishing safe harbors under paragraph 
     (1)(B), the Secretary may consider the extent to which 
     providing a safe harbor for the specified payment practice 
     may result in any of the following:
       (A) An increase or decrease in access to health care 
     services.
       (B) An increase or decrease in the quality of health care 
     services.
       (C) An increase or decrease in patient freedom of choice 
     among health care providers.
       (D) An increase or decrease in competition among health 
     care providers.
       (E) An increase or decrease in the ability of health care 
     facilities to provide services in medically underserved areas 
     or to medically underserved populations.
       (F) An increase or decrease in the cost to Government 
     health care programs.
       (G) An increase or decrease in the potential 
     overutilization of health care services.
       (H) The existence or nonexistence of any potential 
     financial benefit to a health care professional or provider 
     which may vary based on their decisions of--
       (i) whether to order a health care item or service; or
       (ii) whether to arrange for a referral of health care items 
     or services to a particular practitioner or provider.
       (I) Any other factors the Secretary deems appropriate in 
     the interest of preventing fraud and abuse in Government 
     health care programs.
       (b)  Interpretive Rulings.--
       (1) In general.--
       (A) Request for interpretive ruling.--Any person may 
     present, at any time, a request to the Inspector General for 
     a statement of the Inspector General's current interpretation 
     of the meaning of a specific aspect of the application of 
     sections 1128A and 1128B of the Social Security Act 
     (hereafter in this section referred to as an ``interpretive 
     ruling'').
       (B) Issuance and effect of interpretive ruling.--
       (i) In general.--If appropriate, the Inspector General 
     shall in consultation with the Attorney General, issue an 
     interpretive ruling in response to a request described in 
     subparagraph (A). Interpretive rulings shall not have the 
     force of law and shall be treated as an interpretive rule 
     within the meaning of section 553(b) of title 5, United 
     States Code. All interpretive rulings issued pursuant to this 
     provision shall be published in the Federal Register or 
     otherwise made available for public inspection.
       (ii) Reasons for denial.--If the Inspector General does not 
     issue an interpretive ruling in response to a request 
     described in subparagraph (A), the Inspector General shall 
     notify the requesting party of such decision and shall 
     identify the reasons for such decision.
       (2) Criteria for interpretive rulings.--
       (A) In general.--In determining whether to issue an 
     interpretive ruling under paragraph (1)(B), the Inspector 
     General may consider--
       (i) whether and to what extent the request identifies an 
     ambiguity within the language of the statute, the existing 
     safe harbors, or previous interpretive rulings; and
       (ii) whether the subject of the requested interpretive 
     ruling can be adequately addressed by interpretation of the 
     language of the statute, the existing safe harbor rules, or 
     previous interpretive rulings, or whether the request would 
     require a substantive ruling not authorized under this 
     subsection.
       (B) No rulings on factual issues.--The Inspector General 
     shall not give an interpretive ruling on any factual issue, 
     including the intent of the parties or the fair market value 
     of particular leased space or equipment.
       (c) Special Fraud Alerts.--
       (1) In general.--
       (A) Request for special fraud alerts.--Any person may 
     present, at any time, a request to the Inspector General for 
     a notice which informs the public of practices which the 
     Inspector General considers to be suspect or of particular 
     concern under section 1128B(b) of the Social Security Act (42 
     U.S.C. 1320a-7b(b)) (hereafter in this subsection referred to 
     as a ``special fraud alert'').
       (B) Issuance and publication of special fraud alerts.--Upon 
     receipt of a request described in subparagraph (A), the 
     Inspector General shall investigate the subject matter of the 
     request to determine whether a special fraud alert should be 
     issued. If appropriate, the Inspector General shall in 
     consultation with the Attorney General, issue a special fraud 
     alert in response to the request. All special fraud alerts 
     issued pursuant to this subparagraph shall be published in 
     the Federal Register.
       (2) Criteria for special fraud alerts.--In determining 
     whether to issue a special fraud alert upon a request 
     described in paragraph (1), the Inspector General may 
     consider--
       (A) whether and to what extent the practices that would be 
     identified in the special fraud alert may result in any of 
     the consequences described in subsection (a)(2); and
       (B) the volume and frequency of the conduct that would be 
     identified in the special fraud alert.

     SEC. ____04. REPORTING OF FRAUDULENT ACTIONS UNDER MEDICARE.

       Not later than 1 year after the date of the enactment of 
     this Act, the Secretary shall establish a program through 
     which individuals entitled to benefits under the medicare 
     program may report to the Secretary on a confidential basis 
     (at the individual's request) instances of suspected 
     fraudulent actions arising under the program by providers of 
     items and services under the program.

       PART 2--REVISIONS TO CURRENT SANCTIONS FOR FRAUD AND ABUSE

     SEC. ____11. MANDATORY EXCLUSION FROM PARTICIPATION IN 
                   MEDICARE AND STATE HEALTH CARE PROGRAMS.

       (a) Individual Convicted of Felony Relating to Fraud.--
       (1) In general.--Section 1128(a) of the Social Security Act 
     (42 U.S.C. 1320a-7(a)) is amended by adding at the end the 
     following new paragraph:
       ``(3) Felony conviction relating to fraud.--Any individual 
     or entity that has been convicted after the date of the 
     enactment of the Health Reform Act, under Federal or State 
     law, in connection with the delivery of a health care item or 
     service or with respect to any act or omission in a program 
     (other than those specifically described in paragraph (1)) 
     operated by or financed in whole or in part by any Federal, 
     State, or local government agency, of a criminal offense 
     consisting of a felony relating to fraud, theft, 
     embezzlement, breach of fiduciary responsibility, or other 
     financial misconduct.''.
       (2) Conforming amendment.--Section 1128(b)(1) of such Act 
     (42 U.S.C. 1320a-7(b)(1)) is amended--
       (A) in the heading, by striking ``Conviction'' and 
     inserting ``Misdemeanor conviction''; and
       (B) by striking ``criminal offense'' and inserting 
     ``criminal offense consisting of a misdemeanor''.
       (b) Individual Convicted of Felony Relating to Controlled 
     Substance.--
       (1) In general.--Section 1128(a) of the Social Security Act 
     (42 U.S.C. 1320a-7(a)), as amended by subsection (a), is 
     amended by adding at the end the following new paragraph:
       ``(4) Felony conviction relating to controlled substance.--
     Any individual or entity that has been convicted after the 
     date of the enactment of the Health Reform Act, under Federal 
     or State law, of a criminal offense consisting of a felony 
     relating to the unlawful manufacture, distribution, 
     prescription, or dispensing of a controlled substance.''.
       (2) Conforming amendment.--Section 1128(b)(3) of such Act 
     (42 U.S.C. 1320a-7(b)(3)) is amended--
       (A) in the heading, by striking ``Conviction'' and 
     inserting ``Misdemeanor conviction''; and
       (B) by striking ``criminal offense'' and inserting 
     ``criminal offense consisting of a misdemeanor''.

     SEC. ____12. ESTABLISHMENT OF MINIMUM PERIOD OF EXCLUSION FOR 
                   CERTAIN INDIVIDUALS AND ENTITIES SUBJECT TO 
                   PERMISSIVE EXCLUSION FROM MEDICARE AND STATE 
                   HEALTH CARE PROGRAMS.

       Section 1128(c)(3) of the Social Security Act (42 U.S.C. 
     1320a-7(c)(3)) is amended by adding at the end the following 
     new subparagraphs:
       ``(D) In the case of an exclusion of an individual or 
     entity under paragraph (1), (2), or (3) of subsection (b), 
     the period of the exclusion shall be 3 years, unless the 
     Secretary determines in accordance with published regulations 
     that a shorter period is appropriate because of mitigating 
     circumstances or that a longer period is appropriate because 
     of aggravating circumstances.
       ``(E) In the case of an exclusion of an individual or 
     entity under subsection (b)(4) or (b)(5), the period of the 
     exclusion shall not be less than the period during which the 
     individual's or entity's license to provide health care is 
     revoked, suspended, or surrendered, or the individual or the 
     entity is excluded or suspended from a Federal or State 
     health care program.
       ``(F) In the case of an exclusion of an individual or 
     entity under subsection (b)(6)(B), the period of the 
     exclusion shall be not less than 1 year.''.

     SEC. ____13. PERMISSIVE EXCLUSION OF INDIVIDUALS WITH 
                   OWNERSHIP OR CONTROL INTEREST IN SANCTIONED 
                   ENTITIES.

       Section 1128(b) of the Social Security Act (42 U.S.C. 
     1320a-7(b)) is amended by adding at the end the following new 
     paragraph:
       ``(15) Individuals controlling a sanctioned entity.--Any 
     individual who has a direct or indirect ownership or control 
     interest of 5 percent or more, or an ownership or control 
     interest (as defined in section 1124(a)(3)) in, or who is an 
     officer, director, agent, or managing employee (as defined in 
     section 1126(b)) of, an entity--
       ``(A) that has been convicted of any offense described in 
     subsection (a) or in paragraph (1), (2), or (3) of this 
     subsection;
       ``(B) against which a civil monetary penalty has been 
     assessed under section 1128A; or
       ``(C) that has been excluded from participation under a 
     program under title XVIII or under a State health care 
     program.''.

     SEC. ____14. ACTIONS SUBJECT TO CRIMINAL PENALTIES.

       (a) Restriction on Application of Exception for Amounts 
     Paid to Employees.--Section 1128B(b)(3)(B) of the Social 
     Security Act (42 U.S.C. 1320a-7b(b)(3)(B)) is amended by 
     striking ``services;'' and inserting the following: 
     ``services, but only if the amount of remuneration under the 
     arrangement is (i) consistent with fair market value; (ii) 
     not determined in a manner that takes into account (directly 
     or indirectly) the volume or value of any referrals of 
     patients directly contacted by the employee to the employer 
     for the furnishing (or arranging for the furnishing) of such 
     items or services; and (iii) provided pursuant to an 
     arrangement that would be commercially reasonable even if no 
     such referrals were made;''.
       (b) New Exception for Capitated Payments.--Section 
     1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a-
     7b(b)(3)) is amended--
       (A) by striking ``and'' at the end of subparagraph (D);
       (B) by striking the period at the end of subparagraph (E) 
     and inserting a semicolon; and
       (C) by adding at the end the following new subparagraphs:
       ``(F) any reduction in cost sharing or increased benefits 
     given to an individual, any amounts paid to a provider for an 
     item or service furnished to an individual, or any discount 
     or reduction in price given by the provider for such an item 
     or service, if the individual is enrolled with and such item 
     or service is covered under any of the following:
       ``(i) A health plan which is furnishing items or services 
     under a risk-sharing contract under section 1876 or section 
     1903(m).
       ``(ii) A health plan receiving payments on a prepaid basis, 
     under a demonstration project under section 402(a) of the 
     Social Security Amendments of 1967 or under section 222(a) of 
     the Social Security Amendments of 1972;
       ``(G) any amounts paid to a provider for an item or service 
     furnished to an individual or any discount or reduction in 
     price given by the provider for such an item or service, if 
     the individual is enrolled with and such item or service is 
     covered under a health plan under which the provider 
     furnishing the item or service is paid by the health plan for 
     furnishing the item or service only on a capitated basis 
     pursuant to a written arrangement between the plan and the 
     provider in which the provider assumes financial risk for 
     furnishing the item or service;
       ``(H) differentials in coinsurance and deductible amounts 
     as part of a benefit plan design as long as the differentials 
     have been disclosed in writing to all third party payors to 
     whom claims are presented and as long as the differentials 
     meet the standards as defined in regulations promulgated by 
     the Secretary; and
       ``(I) remuneration given to individuals to promote the 
     delivery of preventive care in compliance with regulations 
     promulgated by the Secretary.''.

     SEC. ____15. SANCTIONS AGAINST PRACTITIONERS AND PERSONS FOR 
                   FAILURE TO COMPLY WITH STATUTORY OBLIGATIONS.

       (a) Minimum Period of Exclusion for Practitioners and 
     Persons Failing To Meet Statutory Obligations.--
       (1) In general.--The second sentence of section 1156(b)(1) 
     of the Social Security Act (42 U.S.C. 1320c-5(b)(1)) is 
     amended by striking ``may prescribe)'' and inserting ``may 
     prescribe, except that such period may not be less than 1 
     year)''.
       (2) Conforming amendment.--Section 1156(b)(2) of such Act 
     (42 U.S.C. 1320c-5(b)(2)) is amended by striking ``shall 
     remain'' and inserting ``shall (subject to the minimum period 
     specified in the second sentence of paragraph (1)) remain''.
       (b) Repeal of ``Unwilling or Unable'' Condition for 
     Imposition of Sanction.--Section 1156(b)(1) of the Social 
     Security Act (42 U.S.C. 1320c-5(b)(1)) is amended--
       (1) in the second sentence, by striking ``and determines'' 
     and all that follows through ``such obligations,''; and
       (2) by striking the third sentence.

     SEC. ____16. INTERMEDIATE SANCTIONS FOR MEDICARE HEALTH 
                   MAINTENANCE ORGANIZATIONS.

       (a) Application of Intermediate Sanctions for Any Program 
     Violations.--
       (1) In general.--Section 1876(i)(1) of the Social Security 
     Act (42 U.S.C. 1395mm(i)(1)) is amended by striking ``the 
     Secretary may terminate'' and all that follows and inserting 
     the following: ``in accordance with procedures established 
     under paragraph (9), the Secretary may at any time terminate 
     any such contract or may impose the intermediate sanctions 
     described in paragraph (6)(B) or (6)(C) (whichever is 
     applicable) on the eligible organization if the Secretary 
     determines that the organization--
       ``(A) has failed substantially to carry out the contract;
       ``(B) is carrying out the contract in a manner inconsistent 
     with the efficient and effective administration of this 
     section; or
       ``(C) no longer substantially meets the applicable 
     conditions of subsections (b), (c), (e), and (f).''.
       (2) Other intermediate sanctions for miscellaneous program 
     violations.--Section 1876(i)(6) of such Act (42 U.S.C. 
     1395mm(i)(6)) is amended by adding at the end the following 
     new subparagraph:
       ``(C) In the case of an eligible organization for which the 
     Secretary makes a determination under paragraph (1) the basis 
     of which is not described in subparagraph (A), the Secretary 
     may apply the following intermediate sanctions:
       ``(i) Civil money penalties of not more than $25,000 for 
     each determination under paragraph (1) if the deficiency that 
     is the basis of the determination has directly adversely 
     affected (or has the substantial likelihood of adversely 
     affecting) an individual covered under the organization's 
     contract.
       ``(ii) Civil money penalties of not more than $10,000 for 
     each week beginning after the initiation of procedures by the 
     Secretary under paragraph (9) during which the deficiency 
     that is the basis of a determination under paragraph (1) 
     exists.
       ``(iii) Suspension of enrollment of individuals under this 
     section after the date the Secretary notifies the 
     organization of a determination under paragraph (1) and until 
     the Secretary is satisfied that the deficiency that is the 
     basis for the determination has been corrected and is not 
     likely to recur.''.
       (3) Procedures for imposing sanctions.--Section 1876(i) of 
     such Act (42 U.S.C. 1395mm(i)) is amended by adding at the 
     end the following new paragraph:
       ``(9) The Secretary may terminate a contract with an 
     eligible organization under this section or may impose the 
     intermediate sanctions described in paragraph (6) on the 
     organization in accordance with formal investigation and 
     compliance procedures established by the Secretary under 
     which--
       ``(A) the Secretary provides the organization with the 
     opportunity to develop and implement a corrective action plan 
     to correct the deficiencies that were the basis of the 
     Secretary's determination under paragraph (1);
       ``(B) in deciding whether to impose sanctions, the 
     Secretary considers aggravating factors such as whether an 
     entity has a history of deficiencies or has not taken action 
     to correct deficiencies the Secretary has brought to their 
     attention;
       ``(C) there are no unreasonable or unnecessary delays 
     between the finding of a deficiency and the imposition of 
     sanctions; and
       ``(D) the Secretary provides the organization with 
     reasonable notice and opportunity for hearing (including the 
     right to appeal an initial decision) before imposing any 
     sanction or terminating the contract.''.
       (4) Conforming amendments.--Section 1876(i)(6)(B) of such 
     Act (42 U.S.C. 1395mm(i)(6)(B)) is amended by striking the 
     second sentence.
       (b) Agreements With Peer Review Organizations.--
       (1) Requirement for written agreement.--Section 
     1876(i)(7)(A) of the Social Security Act (42 U.S.C. 
     1395mm(i)(7)(A)) is amended by striking ``an agreement'' and 
     inserting ``a written agreement''.
       (2) Development of model agreement.--Not later than July 1, 
     1995, the Secretary shall develop a model of the agreement 
     that an eligible organization with a risk-sharing contract 
     under section 1876 of the Social Security Act must enter into 
     with an entity providing peer review services with respect to 
     services provided by the organization under section 
     1876(i)(7)(A) of such Act.
       (3) Report by gao.--
       (A) Study.--The Comptroller General of the United States 
     shall conduct a study of the costs incurred by eligible 
     organizations with risk-sharing contracts under section 
     1876(b) of such Act of complying with the requirement of 
     entering into a written agreement with an entity providing 
     peer review services with respect to services provided by the 
     organization, together with an analysis of how information 
     generated by such entities is used by the Secretary to assess 
     the quality of services provided by such eligible 
     organizations.
       (B) Report to congress.--Not later than July 1, 1997, the 
     Comptroller General shall submit a report to the Committee on 
     Ways and Means and the Committee on Energy and Commerce of 
     the House of Representatives and the Committee on Finance and 
     the Special Committee on Aging of the Senate on the study 
     conducted under subparagraph (A).
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to contract years beginning on or 
     after January 1, 1995.

     SEC. ____17. EFFECTIVE DATE.

       The amendments made by this part shall take effect January 
     1, 1995.

          PART 3--ADMINISTRATIVE AND MISCELLANEOUS PROVISIONS

     SEC. ____21. ESTABLISHMENT OF THE HEALTH CARE FRAUD AND ABUSE 
                   DATA COLLECTION PROGRAM.

       (a) General Purpose.--Not later than January 1, 1995, the 
     Secretary shall establish a national health care fraud and 
     abuse data collection program for the reporting of final 
     adverse actions (not including settlements in which no 
     findings of liability have been made) against health care 
     providers, suppliers, or practitioners as required by 
     subsection (b), with access as set forth in subsection (c).
       (b) Reporting of Information.--
       (1) In general.--Each government agency and health plan 
     shall report any final adverse action (not including 
     settlements in which no findings of liability have been made) 
     taken against a health care provider, supplier, or 
     practitioner.
       (2) Information to be reported.--The information to be 
     reported under paragraph (1) includes:
       (A) The name of any health care provider, supplier, or 
     practitioner who is the subject of a final adverse action.
       (B) The name (if known) of any health care entity with 
     which a health care provider, supplier, or practitioner is 
     affiliated or associated.
       (C) The nature of the final adverse action.
       (D) A description of the acts or omissions and injuries 
     upon which the final adverse action was based, and such other 
     information as the Secretary determines by regulation is 
     required for appropriate interpretation of information 
     reported under this section.
       (3) Confidentiality.--In determining what information is 
     required, the Secretary shall include procedures to assure 
     that the privacy of individuals receiving health care 
     services is appropriately protected.
       (4) Timing and form of reporting.--The information required 
     to be reported under this subsection shall be reported 
     regularly (but not less often than monthly) and in such form 
     and manner as the Secretary prescribes. Such information 
     shall first be required to be reported on a date specified by 
     the Secretary.
       (5) To whom reported.--The information required to be 
     reported under this subsection shall be reported to the 
     Secretary.
       (c) Disclosure and Correction of Information.--
       (1) Disclosure.--With respect to the information about 
     final adverse actions (not including settlements in which no 
     findings of liability have been made) reported to the 
     Secretary under this section respecting a health care 
     provider, supplier, or practitioner, the Secretary shall, by 
     regulation, provide for--
       (A) disclosure of the information, upon request, to the 
     health care provider, supplier, or licensed practitioner, and
       (B) procedures in the case of disputed accuracy of the 
     information.
       (2) Corrections.--Each Government agency and health plan 
     shall report corrections of information already reported 
     about any final adverse action taken against a health care 
     provider, supplier, or practitioner, in such form and manner 
     that the Secretary prescribes by regulation.
       (d) Access to Reported Information.--
       (1) Availability.--The information in this database shall 
     be available to Federal and State government agencies and 
     health plans pursuant to procedures that the Secretary shall 
     provide by regulation.
       (2) Fees for disclosure.--The Secretary may establish or 
     approve reasonable fees for the disclosure of information in 
     this database. The amount of such a fee may not exceed the 
     costs of processing the requests for disclosure and of 
     providing such information. Such fees shall be available to 
     the Secretary or, in the Secretary's discretion to the agency 
     designated under this section to cover such costs.
       (e) Protection From Liability for Reporting.--No person or 
     entity, including the agency designated by the Secretary in 
     subsection (b)(5) shall be held liable in any civil action 
     with respect to any report made as required by this section, 
     without knowledge of the falsity of the information contained 
     in the report.
       (f) Definitions and Special Rules.--For purposes of this 
     section:
       (1) The term ``final adverse action'' includes:
       (A) Civil judgments against a health care provider in 
     Federal or State court related to the delivery of a health 
     care item or service.
       (B) Federal or State criminal convictions related to the 
     delivery of a health care item or service.
       (C) Actions by Federal or State agencies responsible for 
     the licensing and certification of health care providers, 
     suppliers, and licensed health care practitioners, 
     including--
       (i) formal or official actions, such as revocation or 
     suspension of a license (and the length of any such 
     suspension), reprimand, censure or probation,
       (ii) any other loss of license of the provider, supplier, 
     or practitioner, by operation of law, or
       (iii) any other negative action or finding by such Federal 
     or State agency that is publicly available information.
       (D) Exclusion from participation in Federal or State health 
     care programs.
       (E) Any other adjudicated actions or decisions that the 
     Secretary shall establish by regulation.
       (2) The terms ``licensed health care practitioner'', 
     ``licensed practitioner'', and ``practitioner'' mean, with 
     respect to a State, an individual who is licensed or 
     otherwise authorized by the State to provide health care 
     services (or any individual who, without authority holds 
     himself or herself out to be so licensed or authorized).
       (3) The term ``health care provider'' means a provider of 
     services as defined in section 1861(u) of the Social Security 
     Act, and any entity, including a health maintenance 
     organization, group medical practice, or any other entity 
     listed by the Secretary in regulation, that provides health 
     care services.
       (4) The term ``supplier'' means a supplier of health care 
     items and services described in section 1819(a) and (b), and 
     section 1861 of the Social Security Act.
       (5) The term ``Government agency'' shall include:
       (A) The Department of Justice.
       (B) The Department of Health and Human Services.
       (C) Any other Federal agency that either administers or 
     provides payment for the delivery of health care services, 
     including, but not limited to the Department of Defense and 
     the Veterans' Administration.
       (D) State law enforcement agencies.
       (E) State medicaid fraud and abuse units.
       (F) Federal or State agencies responsible for the licensing 
     and certification of health care providers and licensed 
     health care practitioners.
       (6) The term ``health plan'' has the meaning given to such 
     term by section 1128(i) of the Social Security Act.
       (7) For purposes of paragraph (2), the existence of a 
     conviction shall be determined under paragraph (4) of section 
     1128(j) of the Social Security Act.
       (g) Conforming Amendment.--Section 1921(d) of the Social 
     Security Act is amended by inserting ``and section ____21 of 
     subtitle ____ of the appropriations, 1995'' after ``section 
     422 of the Health Care Quality Improvement Act of 1986''.

                    PART 4--CIVIL MONETARY PENALTIES

     SEC. ____31. CIVIL MONETARY PENALTIES.

       (a) General Civil Monetary Penalties.--Section 1128A of the 
     Social Security Act (42 U.S.C. 1320a-7a) is amended as 
     follows:
       (1) In subsection (a)(1), by inserting ``or of any health 
     plan (as defined in section 1128(i)),'' after ``subsection 
     (i)(1)),''.
       (2) In subsection (b)(1)(A), by inserting ``or under a 
     health plan'' after ``title XIX''.
       (3) In subsection (f)--
       (A) by redesignating paragraph (3) as paragraph (4); and
       (B) by inserting after paragraph (2) the following new 
     paragraphs:
       ``(3) With respect to amounts recovered arising out of a 
     claim under a health plan, the portion of such amounts as is 
     determined to have been paid by the plan shall be repaid to 
     the plan, and the portion of such amounts attributable to the 
     amounts recovered under this section by reason of the 
     amendments made by subtitle ____ of the appropriations, 1995 
     (as estimated by the Secretary) shall be deposited into the 
     Health Care Fraud and Abuse Control Account established under 
     section ____01(b) of such Act.''.
       (4) In subsection (i)--
       (A) in paragraph (2), by inserting ``or under a health 
     plan'' before the period at the end, and
       (B) in paragraph (5), by inserting ``or under a health 
     plan'' after ``or XX''.
       (b) Prohibition Against Offering Inducements to Individuals 
     Enrolled Under Programs or Plans.--
       (1) Offer of remuneration.--Section 1128A(a) of the Social 
     Security Act (42 U.S.C. 1320a-7a(a)) is amended--
       (A) by striking ``or'' at the end of paragraph (1)(D);
       (B) by striking ``, or'' at the end of paragraph (2) and 
     inserting a semicolon;
       (C) by striking the semicolon at the end of paragraph (3) 
     and inserting ``; or''; and
       (D) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) offers to or transfers remuneration to any individual 
     eligible for benefits under title XVIII of this Act, or under 
     a State health care program (as defined in section 1128(h)) 
     that such person knows or should know is likely to influence 
     such individual to order or receive from a particular 
     provider, practitioner, or supplier any item or service for 
     which payment may be made, in whole or in part, under title 
     XVIII, or a State health care program;''.
       (2) Remuneration defined.--Section 1128A(i) of such Act (42 
     U.S.C. 1320a-7a(i)) is amended by adding the following new 
     paragraph:
       ``(6) The term `remuneration' includes the waiver of 
     coinsurance and deductible amounts (or any part thereof), and 
     transfers of items or services for free or for other than 
     fair market value. The term `remuneration' does not include--
       ``(A) the waiver of coinsurance and deductible amounts by a 
     person, if--
       ``(i) the waiver is not offered as part of any 
     advertisement or solicitation;
       ``(ii) the person does not routinely waive coinsurance or 
     deductible amounts; and
       ``(iii) the person--

       ``(I) waives the coinsurance and deductible amounts after 
     determining in good faith that the individual is in financial 
     need;
       ``(II) fails to collect coinsurance or deductible amounts 
     after making reasonable collection efforts; or
       ``(III) provides for any permissible waiver as specified in 
     section 1128B(b)(3) or in regulations issued by the 
     Secretary;

       ``(B) differentials in coinsurance and deductible amounts 
     as part of a benefit plan design as long as the differentials 
     have been disclosed in writing to all third party payors to 
     whom claims are presented and as long as the differentials 
     meet the standards as defined in regulations promulgated by 
     the Secretary; or
       ``(C) incentives given to individuals to promote the 
     delivery of preventive care as determined by the Secretary in 
     regulations.''.
       (c) Excluded Individual Retaining Ownership or Control 
     Interest in Participating Entity.--Section 1128A(a) of the 
     Social Security Act (42 U.S.C. 1320a-7a(a)), as amended by 
     subsection (b), is further amended--
       (1) by striking ``or'' at the end of paragraph (3);
       (2) by striking the semicolon at the end of paragraph (4) 
     and inserting ``; or''; and
       (3) by inserting after paragraph (4) the following new 
     paragraph:
       ``(5) in the case of a person who is not an organization, 
     agency, or other entity, is excluded from participating in a 
     program under title XVIII or a State health care program in 
     accordance with this subsection or under section 1128 and 
     who, at the time of a violation of this subsection, retains a 
     direct or indirect ownership or control interest of 5 percent 
     or more, or an ownership or control interest (as defined in 
     section 1124(a)(3)) in, or who is an officer, director, 
     agent, or managing employee (as defined in section 1126(b)) 
     of, an entity that is participating in a program under title 
     XVIII or a State health care program;''.
       (d) Modifications of Amounts of Penalties and 
     Assessments.--Section 1128A(a) of the Social Security Act (42 
     U.S.C. 1320a-7a(a)), as amended by subsections (b) and (c), 
     is amended in the matter following paragraph (6)--
       (1) by striking ``$2,000'' and inserting ``$10,000'';
       (2) by inserting ``; in cases under paragraph (4), $10,000 
     for each such offer or transfer; in cases under paragraph 
     (5), $10,000 for each day the prohibited relationship occurs; 
     in cases under paragraph (6) or (7), $10,000 per violation'' 
     after ``false or misleading information was given'';
       (3) by striking ``twice the amount'' and inserting ``3 
     times the amount''; and
       (4) by inserting ``(or, in cases under paragraph (4), 3 
     times the amount of the illegal remuneration)'' after ``for 
     each such item or service''.
       (e) Claim for Item or Service Based on Incorrect Coding or 
     Medically Unnecessary Services.--Section 1128A(a)(1) of the 
     Social Security Act (42 U.S.C. 1320a-7a(a)(1)) is amended--
       (1) in subparagraph (A) by striking ``claimed,'' and 
     inserting the following: ``claimed, including any person who 
     repeatedly presents or causes to be presented a claim for an 
     item or service that is based on a code that the person knows 
     or should know will result in a greater payment to the person 
     than the code the person knows or should know is applicable 
     to the item or service actually provided,'';
       (2) in subparagraph (C), by striking ``or'' at the end;
       (3) in subparagraph (D), by striking ``; or'' and inserting 
     ``, or''; and
       (4) by inserting after subparagraph (D) the following new 
     subparagraph:
       ``(E) is for a medical or other item or service that a 
     person repeatedly knows or should know is not medically 
     necessary; or''.
       (f) Permitting Secretary To Impose Civil Monetary 
     Penalty.--Section 1128A(b) of the Social Security Act (42 
     U.S.C. 1320a-7a(a)) is amended by adding the following new 
     paragraph:
       ``(3) Any person (including any organization, agency, or 
     other entity, but excluding a beneficiary as defined in 
     subsection (i)(5)) who the Secretary determines has violated 
     section 1128B(b) of this title shall be subject to a civil 
     monetary penalty of not more than $10,000 for each such 
     violation. In addition, such person shall be subject to an 
     assessment of not more than twice the total amount of the 
     remuneration offered, paid, solicited, or received in 
     violation of section 1128B(b). The total amount of 
     remuneration subject to an assessment shall be calculated 
     without regard to whether some portion thereof also may have 
     been intended to serve a purpose other than one proscribed by 
     section 1128B(b).''.
       (g) Sanctions Against Practitioners and Persons for Failure 
     to Comply with Statutory Obligations.--Section 1156(b)(3) of 
     the Social Security Act (42 U.S.C. 1320c-5(b)(3)) is amended 
     by striking ``the actual or estimated cost'' and inserting 
     the following: ``up to $10,000 for each instance''.
       (h) Procedural Provisions.--Section 1876(i)(6) of such Act 
     (42 U.S.C. 1395mm(i)(6)) is further amended by adding at the 
     end the following new subparagraph:
       ``(D) The provisions of section 1128A (other than 
     subsections (a) and (b)) shall apply to a civil money penalty 
     under subparagraph (A) or (B) in the same manner as they 
     apply to a civil money penalty or proceeding under section 
     1128A(a).''.
       (i) Effective Date.--The amendments made by this section 
     shall take effect January 1, 1995.

                   PART 5--AMENDMENTS TO CRIMINAL LAW

     SEC. ____41. HEALTH CARE FRAUD.

       (a) In General.--
       (1)  Fines and imprisonment for health care fraud 
     violations.--Chapter 63 of title 18, United States Code, is 
     amended by adding at the end the following new section:

     ``Sec. 1347. Health care fraud

       ``(a) Whoever knowingly executes, or attempts to execute, a 
     scheme or artifice--
       ``(1) to defraud any health plan or other person, in 
     connection with the delivery of or payment for health care 
     benefits, items, or services; or
       ``(2) to obtain, by means of false or fraudulent pretenses, 
     representations, or promises, any of the money or property 
     owned by, or under the custody or control of, any health 
     plan, or person in connection with the delivery of or payment 
     for health care benefits, items, or services;

     shall be fined under this title or imprisoned not more than 
     10 years, or both. If the violation results in serious bodily 
     injury (as defined in section 1365(g)(3) of this title), such 
     person shall be imprisoned for any term of years.
       ``(b) For purposes of this section, the term `health plan' 
     has the same meaning given such term in section 1128(i) of 
     the Social Security Act.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 63 of title 18, United States Code, is 
     amended by adding at the end the following:

``1347. Health care fraud.''.

       (b) Criminal Fines Deposited in the Health Care Fraud and 
     Abuse Control Account.--The Secretary of the Treasury shall 
     deposit into the Health Care Fraud and Abuse Control Account 
     established under section ____01(b) an amount equal to the 
     criminal fines imposed under section 1347 of title 18, United 
     States Code (relating to health care fraud).

     SEC. ____42. FORFEITURES FOR FEDERAL HEALTH CARE OFFENSES.

       (a) In General.--Section 982(a) of title 18, United States 
     Code, is amended by adding after paragraph (5) the following 
     new paragraph:
       ``(6)(A) The court, in imposing sentence on a person 
     convicted of a Federal health care offense, shall order the 
     person to forfeit property, real or personal, that--
       ``(i) is used in the commission of the offense if the 
     offense results in a financial loss or gain of $50,000 or 
     more; or
       ``(ii) constitutes or is derived from proceeds traceable to 
     the commission of the offense.
       ``(B) For purposes of this paragraph, the term `Federal 
     health care offense' means a violation of, or a criminal 
     conspiracy to violate--
       ``(i) section 1347 of this title;
       ``(ii) section 1128B of the Social Security Act;
       ``(iii) sections 287, 371, 664, 666, 1001, 1027, 1341, 
     1343, or 1954 of this title if the violation or conspiracy 
     relates to health care fraud; and
       ``(iv) section 501 or 511 of the Employee Retirement Income 
     Security Act of 1974, if the violation or conspiracy relates 
     to health care fraud.''.
       (b) Property Forfeited Deposited in Health Care Fraud and 
     Abuse Control Account.--The Secretary of the Treasury shall 
     deposit into the Health Care Fraud and Abuse Control Account 
     established under section ____01(b) an amount equal to 
     amounts resulting from forfeiture of property by reason of a 
     Federal health care offense pursuant to section 982(a)(6) of 
     title 18, United States Code.

     SEC. ____43. INJUNCTIVE RELIEF RELATING TO FEDERAL HEALTH 
                   CARE OFFENSES.

       Section 1345(a)(1) of title 18, United States Code, is 
     amended--
       (1) by striking ``or'' at the end of subparagraph (A);
       (2) by inserting ``or'' at the end of subparagraph (B); and
       (3) by adding at the end the following:
       ``(C) committing or about to commit a Federal health care 
     offense (as defined in section 982(a)(6)(B) of this 
     title);''.

       PART 6--PAYMENTS FOR STATE HEALTH CARE FRAUD CONTROL UNITS

     SEC. ____51. ESTABLISHMENT OF STATE FRAUD UNITS.

       (a) Establishment of Health Care Fraud and Abuse Control 
     Unit.--The Governor of each State shall, consistent with 
     State law, establish and maintain in accordance with 
     subsection (b) a State agency to act as a Health Care Fraud 
     and Abuse Control Unit for purposes of this part.
       (b) Definition.--In this section, a ``State Fraud Unit'' 
     means a Health Care Fraud and Abuse Control Unit designated 
     under subsection (a) that the Secretary certifies meets the 
     requirements of this part.

     SEC. ____52. REQUIREMENTS FOR STATE FRAUD UNITS.

       (a) In General.--The State Fraud Unit must--
       (1) be a single identifiable entity of the State 
     government;
       (2) be separate and distinct from any State agency with 
     principal responsibility for the administration of any 
     Federally-funded or mandated health care program;
       (3) meet the other requirements of this section.
       (b) Specific Requirements Described.--The State Fraud Unit 
     shall--
       (1) be a Unit of the office of the State Attorney General 
     or of another department of State government which possesses 
     statewide authority to prosecute individuals for criminal 
     violations;
       (2) if it is in a State the constitution of which does not 
     provide for the criminal prosecution of individuals by a 
     statewide authority and has formal procedures, (A) assure its 
     referral of suspected criminal violations to the appropriate 
     authority or authorities in the State for prosecution, and 
     (B) assure its assistance of, and coordination with, such 
     authority or authorities in such prosecutions; or
       (3) have a formal working relationship with the office of 
     the State Attorney General or the appropriate authority or 
     authorities for prosecution and have formal procedures 
     (including procedures for its referral of suspected criminal 
     violations to such office) which provide effective 
     coordination of activities between the Fraud Unit and such 
     office with respect to the detection, investigation, and 
     prosecution of suspected criminal violations relating to any 
     Federally-funded or mandated health care programs.
       (c) Staffing Requirements.--The State Fraud Unit shall--
       (1) employ attorneys, auditors, investigators and other 
     necessary personnel; and
       (2) be organized in such a manner and provide sufficient 
     resources as is necessary to promote the effective and 
     efficient conduct of State Fraud Unit activities.
       (d) Cooperative Agreements; Memoranda of Understanding.--
     The State Fraud Unit shall have cooperative agreements with--
       (1) Federally-funded or mandated health care programs;
       (2) similar Fraud Units in other States, as exemplified 
     through membership and participation in the National 
     Association of Medicaid Fraud Control Units or its successor; 
     and
       (3) the Secretary.
       (e) Reports.--The State Fraud Unit shall submit to the 
     Secretary an application and an annual report containing such 
     information as the Secretary determines to be necessary to 
     determine whether the State Fraud Unit meets the requirements 
     of this section.
       (f) Funding Source; Participation in All-Payer Program.--In 
     addition to those sums expended by a State under section 
     ____54(a) for purposes of determining the amount of the 
     Secretary's payments, a State Fraud Unit may receive funding 
     for its activities from other sources, the identity of which 
     shall be reported to the Secretary in its application or 
     annual report. The State Fraud Unit shall participate in the 
     all-payer fraud and abuse control program established under 
     section ____01.

     SEC. ____53. SCOPE AND PURPOSE.

       The State Fraud Unit shall carry out the following 
     activities:
       (1) The State Fraud Unit shall conduct a statewide program 
     for the investigation and prosecution (or referring for 
     prosecution) of violations of all applicable state laws 
     regarding any and all aspects of fraud in connection with any 
     aspect of the administration and provision of health care 
     services and activities of providers of such services under 
     any Federally-funded or mandated health care programs;
       (2) The State Fraud Unit shall have procedures for 
     reviewing complaints of the abuse or neglect of patients of 
     facilities (including patients in residential facilities and 
     home health care programs) that receive payments under any 
     Federally-funded or mandated health care programs, and, where 
     appropriate, to investigate and prosecute such complaints 
     under the criminal laws of the State or for referring the 
     complaints to other State agencies for action.
       (3) The State Fraud Unit shall provide for the collection, 
     or referral for collection to the appropriate agency, of 
     overpayments that are made under any Federally-funded or 
     mandated health care program and that are discovered by the 
     State Fraud Unit in carrying out its activities.

     SEC. ____54. PAYMENTS TO STATES.

       (a) Matching Payments to States.--Subject to subsection 
     (c), for each year for which a State has a State Fraud Unit 
     approved under section ____52(b) in operation the Secretary 
     shall provide for a payment to the State for each quarter in 
     a fiscal year in an amount equal to the applicable percentage 
     of the sums expended during the quarter by the State Fraud 
     Unit.
       (b) Applicable Percentage Defined.--
       (1) In general.--In subsection (a), the ``applicable 
     percentage'' with respect to a State for a fiscal year is--
       (A) 90 percent, for quarters occurring during the first 3 
     years for which the State Fraud Unit is in operation; or
       (B) 75 percent, for any other quarters.
       (2) Treatment of states with medicaid fraud control 
     units.--In the case of a State with a State medicaid fraud 
     control in operation prior to or as of the date of the 
     enactment of this Act, in determining the number of years for 
     which the State Fraud Unit under this part has been in 
     operation, there shall be included the number of years for 
     which such State medicaid fraud control unit was in 
     operation.
       (c) Limit on Payment.--Notwithstanding subsection (a), the 
     total amount of payments made to a State under this section 
     for a fiscal year may not exceed the amounts as authorized 
     pursuant to section 1903(b)(3) of the Social Security Act.

     SEC.   . DISQUALIFICATION OF MEMBERS OF CONGRESS FROM 
                   PARTICIPATING IN THE FEDERAL EMPLOYEE HEALTH 
                   BENEFITS PROGRAM.

       (a) Findings.--The Congress finds that--
       (1) the Congress has failed to enact legislation that 
     extends health insurance to all Americans and reduces 
     inflation in health care costs;
       (2) Members of Congress may obtain health insurance through 
     the Federal Employees Health Benefits Program, which provides 
     Members of Congress with guaranteed and affordable private 
     health insurance, choice of health plans and choice of 
     doctor, and no exclusions for preexisting medical conditions; 
     and
       (3) Members of Congress currently receive on average a 72 
     percent contribution of their health insurance premiums from 
     their employer, the taxpayers.
       (b) Purpose.--The purpose of this section is to provide 
     that Members of Congress shall not obtain taxpayer-financed 
     health insurance under the favorable conditions established 
     through the Federal Employees Health Benefits Program unless 
     Congress enacts health reform legislation that gives the 
     American people the type of affordable, guaranteed health 
     insurance that Members of Congress have provided for 
     themselves.
       (c) Limitation on Federal Employee Health Benefits Plan 
     Coverage for Members of Congress.--Effective on January 1, 
     1995.--
       (1) the Office of Personnel Management shall--
       (A) terminate the enrollment of any Member of Congress in a 
     health benefits plan under chapter 89 of title 5, United 
     States Code; and
       (B) prohibit the original enrollment, re-enrollment, or 
     change of enrollment of any Member of Congress in such a 
     plan; and
       (2) the Secretary of the Senate and the Clerk of the House 
     of Representatives shall cease making applicable employee 
     withholdings and Government contributions under section 8906 
     of title 5, United States Code, for any Member of Congress.
       (d) Continued Coverage.--A Member of Congress who is 
     enrolled in a health benefits plan under chapter 89 of title 
     5, United States Code, on December 31, 1994, may receive 
     continued coverage under section 8905a of such title.


                amendment no. 2599 to amendment no. 2594

  Mr. DOMENICI. Mr. President, on behalf of Senator Dole, I send to the 
desk an amendment to the amendment that is pending.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from New Mexico [Mr. Domenici], for Mr. Dole, 
     for himself, and Mr. Domenici, proposes an amendment numbered 
     2599 to amendment No. 2594, as modified.

  Mr. DOMENICI. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is located in today's Record under 
``Amendments Submitted.'')
  Mr. COHEN. Mr. President, let me just take a moment to explain the 
effect of the change that has been sent to the desk. The effect of the 
change is to the working account language in my amendment to fend off a 
point of order on budget grounds. So any challenge that may lie to the 
amendment by virtue of its violating the budget has been corrected by 
this modification.
  So the debate that took place yesterday, which I think was fully 
debated, is the issue of health care fraud, in which there is no 
disagreement on the part of anyone here that I am aware of, no 
disagreement from the President of the United States, none from the 
majority leader or minority leader in terms of the contents of the 
amendment. I believe it enjoys overwhelming bipartisan support.
  At the proper time, I am going to urge my colleagues to vote in favor 
of it.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER (Mrs. Boxer). The Senator from New Mexico.


                amendment no. 2597 to amendment no. 2596

  Mr. DOMENICI. Madam President, I understand that it would be 
acceptable to Senator Cohen from Maine if we ask consent that his 
amendment be temporarily set aside so we may proceed with the Boren-
Domenici amendments regarding congressional reform.
  The PRESIDING OFFICER. Is there objection?
  Mr. DOMENICI. I seek that request at this point, Madam President.
  The PRESIDING OFFICER. Hearing no objection, it is so ordered.
  Mr. BOREN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. BOREN. Madam President, I am proud to join with the Senator from 
New Mexico in offering this amendment that is now pending. As my 
colleagues know, over 2 years ago, both Houses of the Congress acted to 
pass legislation that established the Joint Committee on the reform of 
this institution. It was a very unusual joint committee that had an 
equal number of Members of the House and Senate, an equal number of 
Members from each party. There were six Democratic Senators, six 
Republican Senators, and a like number from the House of 
Representatives, plus the Democratic and Republican leadership of the 
two Houses.
  That committee was asked to do its work expeditiously with the 
minimum of staff and the minimum amount of expenditures. It worked 
hard. The committee's work was completed on time within 1 year and, 
unlike most temporary committees around here, the committee then 
automatically went out of existence and all expenditures by the 
committee were stopped. We are exceedingly proud of that record.

  The committee brought to us, to the membership of both Houses, a set 
of strong, constructive reform recommendations which would strengthen 
this institution. Those recommendations were then taken to the Rules 
Committee on this side of the Capitol. This Rules Committee made some 
modifications and reported them to us for our consideration.
  Because of procedural problems on the Senate floor, we have been 
unable to bring those recommendations, those important recommendations 
of the bipartisan committee on the reform of Congress to this body for 
consideration. Out of frustration, the Senator from New Mexico, who was 
the vice chair on the Senate side of this committee, and I decided we 
should not allow this Congress to adjourn without giving the Members of 
the Senate an opportunity to vote on these reform recommendations. That 
is why we have taken the only option available to us and have presented 
those recommendations in the form of an amendment on the pending 
legislation.
  It is perhaps ironic, and indeed symbolic, that in order to have the 
reform package--a product of long, bipartisan deliberation, much work, 
and much study--brought to the Congress of the United States for 
consideration, that it had to be added as an amendment to an amendment 
of disagreement to a conference report pending on a totally different 
subject. The fact that we have had to use this parliamentary device to 
bring before the Congress a recommendation on reforms that would make 
this body more efficient, more accountable to the American people, more 
able to make sound policy decisions, is indicative of the problem we 
now face.
  I do not need to tell my colleagues, I do not need to tell the 
current occupant of the chair, that this institution is in grave 
trouble. Public confidence in this institution has sunk to an all-time 
low. According to some polling data, only 14 percent of the American 
people now have confidence in the Congress of the United States or 
approve of the way we are conducting our business --a historic, all-
time low approval rating and confidence rating for the Congress of the 
United States.
  According to a study done by the Kettering Foundation, 79 percent of 
the American people no longer feel that Congress represents or cares 
about people like them. They look at our process and they cannot 
understand what is going on. They see that action on important policy 
decisions simply does not occur and yet the situation is so confusing 
they do not know which Members of Congress to hold accountable. It is 
as if we are speaking a foreign language here when the parliamentary 
tangles in which we find ourselves are viewed by the public, and more 
and more they have come to view the Members of the House and Senate as 
Members of a privileged class of people, not living under the laws 
which we pass as other Americans have to live under those laws, not 
focusing our attention on the important matters that need to be decided 
for the Nation's future.
  Some have said that Congress has always been unpopular to some 
degree. Certainly that is true. People have viewed the political 
process, they have thought of their own problems, and they have always 
expressed some frustration with the inability of Congress to come to 
grips with serious problems. But I suggest that the current level of 
disapproval of this body, the current lack of trust of this 
institution, has sunk to levels that are not normal by any standard of 
judgment.
  Yes, it is true at any given time over the last two centuries of our 
existence as an independent Republic, 40 or 50 percent of the people 
have disapproved of this institution. There have been moments in the 
past when the approval rating of Congress has sunk as low as in the 
range of 30 to 40 percent approval. But we have never been in a period, 
as we have been in the last 4 to 5 years, in which approval ratings 
have hovered in the 20's and now dropped all the way down to 14 
percent. It is not normal.
  What is happening in this country is the development of an 
unparalleled level of cynicism on the part of people about their own 
Government. This institution, which belongs to the people, this 
institution where the people are to have a voice in important policy 
decisions, has come to be judged by the people as a place where they 
have no voice and where they are largely unrepresented. I cannot tell 
you adequately the depth of the concern that I have for the future of 
our political system in this country if we do not rebuild that 
relationship of trust between the American people and our institutions.
  I will leave this Chamber for the last time in a few days as I will 
be leaving my membership in the U.S. Senate to go on to other 
opportunities for public service as president of the University of 
Oklahoma. I look back on my last 16 years as a U.S. Senator with great 
pride and in many ways with great satisfaction. As I walk up the steps 
to the Senate Chamber these days, I find myself pausing on some of the 
steps, looking up at the Capitol dome, and reflecting upon my 
experience here. I think about the greatness of this institution and 
all that it has contributed to this country in the course of its 
history.
  As I sit here at my desk, I sometimes pull open the drawer and I look 
at the names of those Senators who have served here before me and who 
have occupied this desk--as we all have a tradition of carving our own 
names inside the drawers of the desks on the Senate floor where we sit. 
I have been privileged to occupy the desk previously occupied by late 
President Harry Truman. On this floor are the desks that have been used 
by Clay and Calhoun and Webster, by Presidents of the United States, by 
people who have made a great contribution to this country.
  As you sit here you reflect upon the fact we are now the trustees of 
this institution. It has been said that the greatest thing that can 
happen to any human being in his or her life is to be able to be part 
of something larger than oneself; to serve a cause that is far more 
important than the personal success of any one of us as individuals; to 
devote your life to some great cause that matters.
  All of us who have been privileged to come here by the votes of the 
men and women in our own States have, indeed, been given an opportunity 
to be part of something far greater than ourselves. Members of the 
Senate come and go, the membership of this body changes, but it 
remains--regardless of the identities of those who occupy these desks 
temporarily--an essential part, in fact, at the heart of our political 
process. It is the building block on which the legitimacy of our 
political system rests. We all remember the cry at the time of 
independence, ``no taxation without representation,'' that we Americans 
wanted to establish a system of government in which we had the ultimate 
voice.
  So, Madam President, when we reach a situation in this country in 
which the people themselves no longer feel that they are represented or 
heard by the Congress of the United States, we have cast in doubt the 
very legitimacy of our entire political process.
  There is no greater danger to our democracy than the frustration of 
the American people and the feeling that they seem to be developing of 
utter helplessness to affect things in their own country. When the 
American people say to us, as they are saying in poll after poll after 
poll: We no longer are going to be involved in politics at the Federal 
level, either by voting or by campaigning for candidates in whom we 
believe, or participating in our political parties because we do not 
think we can make a difference--we have a problem that must not be 
ignored. We have a political system and a social system in peril.
  And so, it is not only with a great sense of pride that I have had 
the privilege of serving here, not only with a feeling of gratitude to 
the people of my State who allowed me to come and be part of a cause 
and part of an institution far more important than my own individual 
well-being, it is also with an overwhelming sense of foreboding about 
the future of our political system and the future course of American 
politics that I will leave this institution in a few days.
  Madam President, we are going to change what is happening in American 
politics. If we are going to change those figures in which it is 
indicated that four-fifths of the American people no longer believe 
that this institution belongs to them or they have any ability to 
impact it or even hold its Members accountable, we must act. There is 
no one else to do it. Those millions of Americans across this country 
who have lost their trust in this institution cannot come to this floor 
and vote. They cannot adopt the reforms that are necessary to make this 
institution, once again, accountable to them. They cannot come here and 
vote to change the way we finance campaigns.
  Under a system in which people have to raise more and more and more 
money to have any chance to get elected--millions of dollars, $4 to $5 
million on the average to win a U.S. Senate race, and the people look 
at that and they say, ``If I don't have the money to give a thousand 
dollars for a dinner ticket to help some candidate, or $5,000, or if I 
don't have the power to hold a fundraiser and raise $1,200, why are any 
of those people going to listen to me?''
  The American people do not have the opportunity to come here and vote 
for reforms in that system, but we do. We are Members of this 
institution. They have empowered us with their votes to act as their 
trustees. We have a chance to vote on it, Madam President. They do not 
have the power to come here as they look at what has happened to the 
U.S. Senate and the U.S. Congress, in terms of the inefficient way in 
which we conduct our business. They do not have the power to come here 
and change it.
  They look at the fact that since the last major reform of this 
institution when we ended up with 38 committees, an equal number in 
each House, the same committee definitions in the House and the Senate 
so that if we had a difference of opinion between the two Houses we 
could get together and work it out. Thirty-eight committees, 19 in each 
House so the Members of the Senate and the Members of the House could 
belong to committees, focus their attention on important problems and 
get action.
  They look at the fact that we have disintegrated and fragmented into 
a bureaucracy of our own that now strangles us. Three hundred 
committees and subcommittees, 300 committees and subcommittees in the 
Congress of the United States, all going off in different directions. 
No wonder we cannot balance the budget. No wonder we cannot get 
spending under control. No wonder we cannot make decisions on health 
care. No wonder we cannot get trade legislation like GATT. No wonder we 
cannot act on Superfund. Why? Because if you have any essential problem 
in this body, it ends up not going to one committee in each House, it 
ends up going to 10 or 15 committees in each House.
  I have been on conference committees to work out differences between 
the House and the Senate on a particular bill in which as many as 13 
different committees have been represented from the two Houses, and you 
have had over 200 Members of Congress trying to sit down in a room and 
work out a difference of opinion between the House and the Senate. It 
is more like the Versailles Treaty negotiations in the Hall of Mirrors 
at Versailles than it is like an orderly process to conduct business 
here.
  Mr. DOMENICI. Will the Senator yield?
  Mr. BOREN. I will be happy to yield.
  Mr. DOMENICI. Might I ask, would you have a thought as to how many 
staffers were in attendance when you talked about 13 committees? Was 
there a big enough room?
  Mr. BOREN. When I talked about 13 committees and I talked about 200 
Members of the House and Senate, let me say that we had to move that to 
an auditorium, and in the chairs around the room were probably 400 or 
500 staff members as well. That is something else that has happened.
  Since 1946, we have gone from approximately 2,000 staff members 
working for the Members of the House and Senate to 13,000 to 14,000 
working with us directly. If we add in the other support research 
groups, 38,000 staff. I ask my colleagues to ponder this point--the 
American people have already pondered it: The level of statesmanship in 
this institution, the quality of the decisions rendered on important 
policy decisions, has it improved dramatically because we have gone 
from 38 committees to 300 committees and subcommittees, because we have 
gone from 2,000 staff to 38,000 staff? We all know the answer.
  The members of the American public, the American citizens, cannot 
come here and vote to change it. They cannot come here and vote to 
streamline it. They cannot come here and vote to make our process more 
accountable. But, Madam President, we can. We have the vote. We have 
been given the vote. We have been given the responsibility of making a 
decision on those important matters. Not only do we create an 
impossible bureaucracy with a myriad of committees, with a staff grown 
so large now that we can no longer even speak with each other, but we 
talk to each other through staff members.
  Mr. DOMENICI. Will the Senator yield again?
  Mr. BOREN. I will be happy to yield.
  Mr. DOMENICI. I would like to make another observation. Perhaps you 
can comment on it, considering what you discussed. It is my 
understanding the bills clearing both Houses and going to the President 
are five times longer today than they were 20 years ago.
  Mr. BOREN. The Senator is absolutely correct. They have become much 
longer. We micromanage in detail. We create work for ourselves because 
we have 100 or 200 unnecessary subcommittees.
  For example, let us say you give a Member a subcommittee of their 
own. They also get two or three additional staff members to staff that 
subcommittee, which should not even exist in the first place. And then 
they quickly say, ``We must show that there is a reason for our 
existence,'' and so the staff begins to develop some legislation. And 
then you begin to hold hearings on the legislation that was not needed 
in the first place. And then pretty quickly, you are getting letters 
from your constituents who are alarmed that this unnecessary 
subcommittee is holding unnecessary hearings on an unnecessary bill 
that should not have been introduced in the first place, and you have 
to hire more staff to answer the letters and the inquiry, and more 
staff members to dispatch to those unnecessary hearings on the 
unnecessary bill by the subcommittee that should not exist. By the time 
you are through, we have so clogged our agenda that there is no time 
left for us to do anything that is important to the future of this 
Nation.
  Our bipartisan committee held 36 hearings for hundreds of hours, with 
240 witnesses coming from both parties, thoughtful Members of Congress, 
thoughtful former Members of Congress, citizens from the grassroots 
coming here to testify and to talk to us. And one of the themes that 
came back again and again is, we do not make the long-range decisions 
on the important issues affecting America's future: How do we get 
spending under control? How do we change our tax policy to make us more 
competitive so we can compete in the marketplace in the world and have 
jobs for our children and grandchildren? How do we educate the next 
generation? What do we do about the school dropout rate? What do we do 
about the rising level of crime in our society because our social 
fabric is collapsing? These kind of long-range decisions. How do we 
change our foreign policy to develop a new and coherent architecture 
for making decisions in the post cold-war world?
  Why do we not make these important decisions? Because, Madam 
President, for one thing, we do not have the time to even think about 
them because we are running from one unnecessary hearing of one 
unnecessary subcommittee to another, one committee meeting to another, 
we do not even have time to think. We have what Senator Byrd has called 
a fractured attention span. The average Member of the Senate serves on 
12 different committees and subcommittees. You need roller blades to 
get from one place to the next. We are called the greatest deliberative 
body in the world.
  Madam President, you are lucky if you can come from one committee 
meeting and stay there 10 or 15 minutes because you are already being 
called to go to the next one, or something else has happened on the 
Senate floor.
  I was once asked to represent my party--there were four of us asked 
to sit down with four Senators from the other side of the aisle--to 
talk about the civil rights legislation, a very important bill. I 
remember the Senator from Missouri [Mr. Danforth] was leading the group 
on the other side of the aisle at that time. Eight Senators. We had 
passed a bill twice; the President had vetoed a bill twice; and we were 
going to sit down together, with representation from the White House, 
and work out a bipartisan solution that would bring progress to the 
country, that would have the support of the President and actually do 
something.
  Madam President, it took us 3 weeks--3 weeks--to find a 1-hour time 
slot in which those eight Senators could sit down in the same room 
together and think about this problem and try to work it out. And do 
you know what happened? When the 1 hour finally arrived when all eight 
of us were supposed to be able to be there, never were there more than 
three of us in that room at the same time. A couple of people were 
there on time. They stayed about 5 or 10 minutes. They said, ``I 
apologize, I have to rush off'' to this hearing or rush off to that 
meeting. A different group of people, three or four different people, 
came in the middle of the meeting. They left before it was over. And 
two other, different Senators showed up at the end.
  One hour of time that it took 3 weeks to find and we could not even 
keep eight people in the room to deliberate about something that 
important.
  No wonder we have a budgetary situation like we have. No wonder we do 
not have any architecture for educational policy. No wonder our foreign 
policy is floundering all over the lot without any clear sense of 
direction. None of us has any clear sense of direction. We do not have 
time to think. It is outrageous that Members of the Senate would spread 
themselves to belong to 12 different committees and subcommittees. That 
is average. There is at least one Member of the Senate who belongs to 
23 committees and subcommittees and several Members of the Senate who 
belong to more than 20 committees and subcommittees. We give waiver 
after waiver after waiver to Members of the Senate to serve on as many 
committees as they want.
  Why would they do that? Print them all on that letterhead. Senator X 
belongs to this subcommittee and that subcommittee and this committee 
and that committee. And we have to have all those committees, also, so 
that everybody can be chairman or ranking member of something. 
Everybody has a little empire. At the end of the day we have spread 
ourselves so thin, we have become so fragmented we have spent our time 
dealing, as I said, with the unneeded hearing on the unneeded bill put 
forward by the unneeded subcommittee which, of course, is staffed by 
the unneeded staff and we do not have any time left to think about the 
important problems facing this Nation.
  The American people cannot come here and vote to change that, but we 
can. We can. We have an opportunity to vote. We are going to vote at 
the end of this debate on this package of reform, which will cut in 
half virtually the number of unnecessary subcommittees, getting rid of 
them, cut in half the number of subcommittees, reduce the number of 
committees on which Members of the Senate can serve, set up a 
scheduling system that will work so that certain committees meet at 
certain times; they will not be overlapping. We will not be running 
from one place to the next.
  Mr. SIMON. Will my colleague yield for a question?
  Mr. BOREN. I would be happy to yield to my colleague.
  Mr. SIMON. First of all, I wish to commend both Senator Boren and 
Senator Domenici for leadership in facing some of our problems here.
  The Senator mentioned all the committees. Committees are meeting 
right now. People come into the gallery and wonder how come the Senate 
is meeting. Right now, we have five Members of the Senate in the 
Chamber.
  I served in the State legislature in Illinois, and in many ways we 
were not a strong body. We passed way more legislation than we should 
have. Committees were not strong. But when you were in the chamber, in 
the State legislature, whether it was the State Senate or State House 
of Representatives, the other members were there, and they could hear 
and listen to debate and thoughtfully take part in things.
  I can remember one debate when Senator Robert Byrd was particularly 
forceful, and if all the Members of the Senate had heard what he had to 
say, his point of view would have carried. But there were just a 
handful of us here to listen to him.
  One of the things--and I recognize the immediate proposal does not 
deal with this--but one of the things that we have to do, I think, at 
some point is to change our procedure so that when the Senate is in 
session, we are really in session and Senators are here.
  I thank my colleague for yielding.
  Mr. BOREN. I thank my colleague for his comments. He is absolutely 
correct. He is on target. We hope that these recommendations--which are 
included in this amendment, by the way--which set up a sequencing of 
committee meeting schedules would also make it possible for Members to 
be on the Senate floor when we are really conducting business. We have 
an opportunity to reform the system, to begin to get the staff back 
down to reasonable levels. I am here not denigrating the work of staff. 
Members of the staff are dedicated. They do good work. They would do 
better work if there were fewer of them.
  Now, we cannot go all the way back to 2,000. We have a more complex 
situation than we had in 1946. But we never should have moved from 
2,000 to 38,000. That is quite clear. We should have never moved from 
38 committees and very, very few subcommittees to now 300 committees 
and subcommittees. We cannot allow Members of the House and Senate to 
continue to have waiver after waiver to serve on more and more 
committees because they cannot really be a part of the deliberative 
process.
  If we would simplify this process, get rid of our own bureaucracy, 
the American people would also be able to fix responsibility. They 
would know which Senator it was or which group of Senators killed a 
bill or passed a bill. They could hold them accountable in the next 
election. Now they cannot even figure out what we are doing. It is a 
mystery. It is a maze.
  We cannot even understand it. How many of us can even understand the 
Budget Act. We have been through a process here in the last few days on 
the campaign finance reform bill. We have been voting and having 
filibusters and cloture motions on a motion to disagree with the House, 
30 hours of debate, a motion on asking for a conference, 30 hours of 
debate, a motion on appointing conferees before we can even sit down 
and talk to Members of the house on that issue.
  We could pick 100 other issues. People cannot understand what we do 
let alone why we do it. We have a budgetary process, and I am going to 
defer to my colleague and friend from New Mexico to go into more detail 
on this subject because he has had the privilege of being one of the 
leaders of the Budget Committee of this institution, and he has 
provided extraordinary service there, under difficult circumstances 
because of the process, the process that we have. We pass a resolution 
to ourselves, telling ourselves what kind of budget we should write. 
Then we pass another resolution telling us whether we should do it. 
Then we pass another one enforcing it. And then we give instructions to 
all the committees to follow suit. And by the time we complete all the 
process, instructing ourselves and passing resolutions about what we 
ought to do, we do not have time to do it and very often we do not have 
it in place at the end of the year.
  One of the things we do is reinvent the wheel every year. We go back 
and every single year you have to pass a reauthorization for every 
spending program. And then you have to pass an appropriation for every 
spending program. And of course, before that, you have to have passed a 
budget resolution telling us that we ought to pass a certain 
authorizing bill and a certain appropriating bill for that same 
function. We do it every single year, in spite of the fact that studies 
indicate that well over 90 percent of the budget does not change from 
one year to the next. But we spend all of our time and all of our 
effort and energy reenacting those things that remain the same every 
year.
  Why in the world does the Senator from New Mexico propose to the 
joint committee, why not have a 2-year budget, 2-year authorizations, 
and 2-year appropriations? For that 6 or 8 percent that might need 
changing from one year to the next, we can devote our attention just to 
that. We can have supplemental appropriations bills that take care of 
emergency needs, things that have to be changed. But in the meantime we 
can use that other 92 percent of our time providing oversight over the 
programs that we passed last year.
  Every bit as important, and I would think of more importance, to the 
average American is not only that we appropriate and spend their money 
but that we spend some time looking at how it is being spent. We pass a 
program. We pass billions of dollars to fund it. And then we spend 
almost no time looking to see if that money is being spent wisely or as 
it was intended to be spent. What progress could come if we would pass 
a 2-year budget, 2-year authorization bills, 2-year appropriations 
bills. The American people could engage in long-range planning, at 
least 2 years instead of 1 year, and we could spend additional time 
providing oversight for the American taxpayers to determine how their 
money has been spent.
  Now, Madam President, we are not going to restore the confidence of 
the American people overnight. I would not pretend to say that this 
package of reforms solves all the problems. For example, I would like 
to see included in it--and we were not able to at that time complete 
our work on this proposal--I would like to see us pass provisions that 
would make sure we live under the provisions of law under which we 
insist the American people live. We pass labor rules, wage and hour 
laws, safety laws, and we say we will send inspectors down to every 
little, small business to make sure you comply with all these laws, and 
then we say, by the way, we exempt Congress.
  No wonder we are not sensitive to the burdens we are placing on small 
businesses and other Americans with some of the laws we pass, because 
we do not have to struggle with living under them ourselves. That needs 
to be corrected.
  We have an ethics process, for example, in which we are the judge and 
jury of our own Members if they are charged with misconduct. I think 
the American people would have much more confidence in us if we had 
some people from outside the membership of this organization looking at 
ethics cases. It is very difficult. How do you judge a colleague? Do 
you judge a colleague with whom you serve on the same committee? Or 
maybe a colleague who has a life-and-death power over some bill you are 
trying to pass? Yet you are asked to judge them in terms of their 
ethical behavior? So are other things that need to be done.
  But this proposal now before us, the work of a joint bipartisan 
committee with hundreds of hours of hearings, 240 witnesses, 36 days of 
hearings, much tribulation, much working together, with Democrats and 
Republicans joining hands to do very significant things.
  It does cut in half the number of subcommittees. It does cut in half 
individual Senate committee assignments so that people can focus this 
time. It abolishes the four joint committees that are unnecessary. It 
does mean that Members have to be at the committee meetings if they are 
going to cast a deciding vote on whether a bill is going to pass or 
not. They simply cannot send in the proxy and let somebody else vote 
for them.
  It reforms the budget process. It establishes a 2-year process. It 
does require quarterly deficit reports so we know where we are in terms 
of trying to get the budget deficits under control.
  It does bring about a 12-percent reduction in staff so that we can 
begin to get on the right track and stop the creation of unnecessary 
work for both the Members and the staff. It does require that we have 
some kind of control over additional people that are sent to work for 
us by other agencies of Government.
  It does simplify our floor procedures so that we cannot have so many 
filibusters on so many things. So it begins to fix accountability, and 
it begins to help this institution function in a more workable way.
  Madam President, the American people are going to know whether or not 
we voted to take this significant first step. I think it would be 
unthinkable for this session of Congress to adjourn without the Members 
even voting on recommendations that they themselves said they wanted to 
receive. They appointed us, 12 Members of the Senate and 12 Members of 
the House. They asked us to work hard. We did work hard. They said we 
do not want a proposal that is a pro-Democratic proposal or a pro-
Republican proposal. We want to have something that will be in the 
national interest, something on which Republicans and Democrats can 
join hands. We have done that.
  We had a unanimous-consent vote in our committee in terms of bringing 
this package of recommendations to the full Senate. The chairman of the 
Rules Committee, Senator Ford, who is on the floor now, was a member of 
our reform committee, and he also chaired the Rules Committee 
deliberations on that proposal. His committee spent many hours working 
on this proposal as well. It would be a shame and a disgrace if this 
Congress should adjourn without taking positive action on these 
recommendations.
  There is a major disconnect between what we are doing and what the 
people want us to do. They want us to function efficiently. They want 
us to have careful oversight over taxpayer dollars. They want us to 
engage in long-range thinking and not short-term politics. They want us 
to quit spending so much of our time raising money from special 
interest groups to finance our campaigns and concentrate on the 
problems of the country. Above all they want us to quit playing petty 
partisan games like children in the schoolyard calling each other 
names, and figuring out how the Democrats can beat the Republicans or 
the Republicans can beat the Democrats or how we can use this 
institution not as a forum for making these decisions that are needed 
by our country, but as a forum for scoring political points, figuring 
out how we can get that vote to embarrass with an amendment that will 
put the other party on spot so it will be on the 6 o'clock network 
news.
  As the American people have become more and more fed up with partisan 
politics, this institution has become more and more polarized along 
party lines. Here we come with a recommendation that does not come from 
that side of the aisle or this side of the aisle. It comes from both 
sides of the aisle. It comes as a proposal that is in the benefit of 
this country. It comes as a proposal from a committee that decided we 
will stop being Republicans or Democrats and we will be Americans for a 
change.
  For us not to act positively after that kind of bipartisan effort 
would be a message to the American people that we do not care if 86 
percent of you do not like the way we are doing business, and we do not 
care if 80 percent of you think we do not represent you, that we do not 
care about people like you; we are not concerned that the trust 
essential for the functioning of our Government has been broken between 
our institutions of Government and the American people.
  We are willing to take that chance. We are willing to put at risk 
these precious political institutions for which men and women have died 
in one generation after another, in which those who formed this country 
in the beginning set up these institutions and had the intellectual 
insight to form them, and then the generations that have loved them one 
after another, even risking their lives.
  We are willing to jeopardize the future vitality of these 
institutions because we are more interested in protecting our party's 
advantage or the little personal empires so we can have three more 
staff members for that unnecessary committee; so we can put another 
line on our stationery. Far be it from us to give up any of our little 
power bases in the name of accountability and efficiency of an 
institution that does not even belong to us. It belongs to the American 
people--not to a single one of us.
  Madam President, they cannot vote. But we can. We are the trustees of 
this institution. How long are we going to wait to act? Are we going to 
wait until only 1 percent of the American people have confidence and 
trust in this institution? We are down to 14 percent. How long are we 
going to wait to act? It has been 46 years since the last significant 
reform of this institution. How long are we going to wait to act?
  In the last election the American people spoke in every way they 
could, even voting for an independent, third-party candidate for 
President in record numbers. Why? Because they were trying to express 
their frustration. And in State after State, including mine which 
passed it by a 2-to-1 majority less than 10 days ago. The American 
people said we cannot do anything about it, we will turn to term limits 
as a radical solution if all else fails.
  They have told us in every way that they can. How long are we going 
to wait? Are we going to wait until there is a march on Washington? Are 
we going to wait until the American people become so angry and so 
frustrated that they lash out in ways that might be destructive in the 
long run of the political process?
  How long are we going to wait? My appeal to my colleagues is wait no 
longer.
  Mr. DOMENICI. Will the Senator yield for a question?
  Mr. BOREN. I am happy to yield.
  Mr. DOMENICI. Will the Senator from Oklahoma add to his list? He 
mentioned the shameful things. Would he agree with this Senator that it 
would be shameful if this measure was defeated on a procedural vote by 
using an arcane provision of the Budget Act that says you cannot pass a 
bill on the floor of the Senate that affects the budget process unless 
it is reported by the Budget Committee? There are no dollars involved 
in this bill, are there, other than we are going to save money?
  Mr. BOREN. Absolutely not.
  Mr. DOMENICI. Why should the Senate defeat this bill on a point of 
order that it violates the Budget Act? The Budget Act most people think 
has to do with the budget, with dollars. They asked us to do this. They 
appointed us to do it. And sitting over here in a dark little corner is 
another part of this process that people do not understand; namely, 
this whole bill might fall, or we may need 60 votes, because the 
Senator is going to say it should have gone to the Budget Committee so 
they could have looked at two or three provisions that have to do with 
the budget. Is that not correct?
  Mr. BOREN. I thank my colleague for his question. He is absolutely 
right.
  Madam President, if on a matter of this importance, an opportunity to 
reform this institution, this is sidetracked on a procedural basis and 
Members of this institution go home and tell the voters, ``Well, we 
would have voted for it but, of course, it would have violated this 
arcane procedure that we have,'' all I can say is if it is defeated on 
a procedural vote, giving Members an opportunity who do not really want 
reform to say ``I had to vote that way because of the procedure,'' all 
I can say is I think 14 percent is a true high approval rating for this 
institution to have if that is what happens.
  Let me close with this: I said it had been a privilege for me to 
serve here. It has been. Some of the finest men and women I know serve 
in the U.S. Senate. I have great admiration for a large number of my 
colleagues as individuals.
  I am sure that never again in my life will I be associated with 
people who will have as high a commitment to serving their country as 
many of the people with whom I serve in this institution. And the 
saddest thing of all, to me, is to see Members come here, particularly 
the new Members who come here, with such a strong desire to make a 
difference, to render a service, to leave this institution stronger 
than they found it, to put something of themselves back, give something 
back to the country, so that when we hand over our political 
institutions to the next generation, to our children and our 
grandchildren, they will be even stronger than we found them. Think 
about it. Every succeeding generation of Americans has passed on to the 
next generation a country filled with more opportunity for them than 
the preceding generation had enjoyed.
  Madam President, what a sad day and what a tragedy it would be if 
those who have come here desiring to serve, desiring to give of 
themselves, would pass up the opportunity to change the process, which 
so beats down the will of individual Members of this institution to 
make a contribution, and many come to feel it is almost impossible to 
get things done. It is not only the American people who think it is 
impossible to get things done here. It is many of the best Members of 
the House and Senate who have come to that conclusion themselves. And, 
regretfully, in many respects, I have come to that conclusion. That is 
why I am seeking another opportunity to serve the public where I think, 
at the end of the day, I will at least have the satisfaction of knowing 
that I have made a difference, particularly in the lives of young 
people who will be coming along in the next generation and providing 
leadership for this country.
  So, Madam President, I appeal to my colleagues. So many have said, 
``I want to get things done, but the process prevents me from getting 
things done.'' Well, this is our chance. This is our chance to reform 
that process that takes away from our energies, that in the longrun 
defeats our resolve and our determination. Let us change it. Let us not 
wait. We have waited far too long. Let us not take the risk that comes 
from undermining the trust and confidence of the American people in 
this institution. We would be irresponsible indeed to allow that risk 
to continue.
  It is time to act. Let us do it today. There is an opportunity. Let 
us put aside our own personal ambitions, our own personal empires, 
carved out with this institution, and let us take action. Let us take 
action that will make this institution vital, active, long range in its 
thinking, and accountable to the American people.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico is recognized.
  Mr. DOMENICI. Madam President, while I cannot applaud the Senator, I 
really commend him on what he just said. I only regret that, as he said 
so eloquently, the way we are getting this reform measure up is not 
going to permit the American people to find out what we are 
recommending and what happens here. Obviously this matter deserves a 
lot of attention and it probably should have had a full week of debate 
at some point in time, and all those who wanted to pick it to death 
could come down, one by one, and try it. But put this measure that we 
were asked to pass before this body and before the American people for 
a long enough period of time for them to understand.
  I thank the Senator very much for his remarks. He will be missed 
around here.
  The PRESIDING OFFICER. If the Senator will suspend, it is incumbent 
upon the Chair to advise the galleries that the rules of the Senate do 
not permit the expression of approval or disapproval.
  Mr. DOMENICI. Madam President, let us think back a little bit to 
June, July, and August of 1992, because it was in August 1992 that this 
body, the U.S. Senate, passed a resolution. I do not think there was a 
single dissenting Member to that resolution. That resolution asked a 
joint bipartisan committee to recommend reforming the U.S. Senate.
  Why did that come about in August 1992? Because, I say to my friend 
from Oklahoma, the seeds were sewn then that yield the 14 percent 
approval rating of Congress. Either scandals or alleged scandals in the 
other body and in chambers around the U.S. Capitol were rampant. The 
people were absolutely up in arms. They may not be up in arms today, 
but they are very close to giving up on us. When only 14 percent say 
they think we are responsible, that we might change things for the 
better, that August day when this resolution asking that Congress be 
reformed was a good day for the American people. And then everybody 
should know that this is one of the few times that a joint committee 
took a charge as seriously as this joint committee did.
  The first hearing had all five leaders from the U.S. House and 
Senate; the first time in history. They all appeared, and they were 
saying: Reform, reform, reform. There were 36 hearings in 6 months; 243 
witnesses; 37 Senators. Every Senator and 4,000 staff people were 
surveyed. There were 500 proposals, or more, considered. We continually 
consulted with our two leaders--the leader on that side and the leader 
on this side. We completed our work in 1 year, under budget, and 
returned 40 percent of the money that we got to do the work. Then 
although there were some who said they are voting for it in committee, 
with reservations, the truth of the matter is that these were 
unanimously recommended. That is, the 33 recommendations received 
everyone's vote on that committee that was assigned to do this job.
  (Mr. KERREY assumed the chair.)
  Mr. DOMENICI. Obviously, something is wrong with the way we do 
business. I am not one who thinks changing things will fix everything. 
But we are hearing a lot about reform these days, reforming the 
lobbyist activities, reforming gifts to the U.S. Congress and to 
members of our staffs. We have heard a lot about gifts in the White 
House and maintaining independence. We have heard many, many hours of 
talk on the floor about campaign reform. One of the leaders is my 
friend, Senator Boren, who just spoke. I say that none of those reforms 
are as important as reforming the processes, the committees, the 
subcommittees, and the way we do business here on the floor of the 
Senate. Those reforms pale in proportion to making this institution and 
the one across the Capitol, as I see it, more accountable, more 
responsible, and more understandable.
  When I took this job, after 1 week of hearings, I put in my head what 
I was trying to do. I believe to have a democracy and have confidence 
in legislators in the Nation's Capitol, legislators have to be 
accountable for what they do, I believe that they have to be 
responsible, and I believe they have to do work that is understandable. 
If you are doing mumbo jumbo and begging off on votes because they are 
technical, or hiding behind multiple committees that are hearing the 
same issue, and it was not us it was them, then it is not 
understandable and nobody can hold you accountable. Maybe that is the 
way some people like it to be. But I perceive that is what we were 
asked to fix, to make this place more understandable and make Members 
and committees more responsible and accountable.
  I believe we did that, and I am going to repeat now and two or three 
times before we have the first vote because I believe the first vote is 
going to be on a technicality. I believe the first vote is going to be 
to wipe this bill out because of a budget point of order. What that is 
going to do, I say to the occupant of the chair, it is going to put us 
behind the eight ball right from the beginning because we are going to 
need 60 votes to prevail over that point of order.
  I do not believe anybody assumed when this committee was assigned to 
reform the U.S. Congress--or excuse me--make recommendations, I do not 
believe anybody assumed that its recommendations were going to require 
60 votes, at least not recommendations that have to do with 2-year 
budgets, 2-year authorizations. I do not believe anybody thought that 
the package of reforms were going to come to the floor and be subjected 
to a point of order on the basis that we did not send it to another 
committee. Is that not amazing?
  We were charged with streamlining the process, make it so it is 
understandable, make it so you can be responsive and responsible and 
right off the first time the bill hits the floor we are going to use a 
process. We are going to say, no, we did not mean what we said. We want 
it to go to another committee.
  Just so everybody will know, we recognized that we had this problem. 
I want to print in the Record a letter that we jointly sent. The 
chairman and I as vice chairman sent a letter to the leadership on 
August 10, and that letter clearly said that we do not think the 
intention was that this should go to other committees. We asked our 
leadership to help arrange to get this to the Budget Committee and get 
it cleared and get it out either without recommendation or with 
recommendation of pass or do not pass.
  I ask unanimous consent that the letter be printed in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                                  U.S. Senate,

                                  Washington, DC, August 10, 1994.
     George J. Mitchell, Majority Leader,
     Robert Dole, Republican Leader,
     U.S. Senate, Washington, DC.
       Dear George and Bob: We are writing regarding the Senate's 
     consideration of S. 1824, the Legislative Reorganization Act 
     (Cal. Order #503). We fear the Senate's tight schedule and 
     procedural roadblocks could make it impossible to produce 
     reasoned reforms in Congress's operations this year.
       Because S. 1824 contains matters in the Budget Committee's 
     jurisdiction, it is subject to a point of order under section 
     306 of the Budget Act. If this point of order was raised 
     against the bill, it requires 60 votes in the Senate to waive 
     it.
       We ask that the bill be referred to the Budget Committee 
     for a limited time period, that the bill be discharged from 
     the Budget Committee at the expiration of the referral, and 
     that the Budget Committee's actions on the bill be limited to 
     making recommendations. We hope that this action could take 
     place quickly so that the bill could be taken up on the floor 
     within a week after the recess.
       We realize that this is an unusual request. However, this 
     bill is unique in many respects. Last year, the Joint 
     Committee on the Organization of Congress conducted the most 
     exhaustive study of Congress ever. This effort led to a 
     unanimous recommendation for legislation to reform the 
     Congress, which we introduced as S. 1824.
       Two years ago, the Senate passed legislation that called 
     for Congressional reform and created the Joint Committee. 
     After all this effort, it would be ironic indeed if the 
     Senate did not bother to even consider Congressional reform 
     legislation or if it died on a procedural motion.
       We appreciate your consideration of this request.
           Sincerely,
     David L. Boren.
     Pete V. Domenici.

  Mr. DOMENICI. Mr. President, I lay no blame on anyone. But 
essentially that request was denied because nothing was done.
  So here we are charged with trying to make things work better and we 
are going to get thrown off this floor by a procedure that says we 
really did not mean it. We did not mean your joint committee ought to 
do this. We meant when you are finished you ought to take it to the 
Budget Committee, take to the Governmental Affairs Committee, and you 
ought to take it to the Rules Committee. By the time we finished, we 
would be into the next century.
  So we are here today in a very extraordinary way. You are going to 
get to vote. You are going to get to vote. If anybody thinks when they 
vote on that point of order--I will move to waive that point of order 
or my good friend from Oklahoma will--that it is not a vote on this 
bill, that it is a process vote, they are doing precisely the kind of 
thing in this body that we were asked to try to fix to make things 
understandable, forthright and accountable.
  I would say to anybody that is going to vote against this, if that 
point of order is denied, then this would be subject to amendments. So 
it would be here and if Senators want to amend it, they could. We at 
least would have one vote indicating that ``committee, you did a good 
job.'' Let us lay the work of the committee before the Senate.
  Having said that, I want to remind everybody in one sense, when they 
vote to waive the Budget Act--or let me put it another way: When they 
waive to kill this bill on a point of order, they have just decided 
that they do not want to cut the subcommittees of the Senate in half. 
They are going to be voting that they do not want to cut individual 
Senators' assignments by 25 percent. They are going to vote that they 
do not want to abolish any committees. They are going to vote that 
Senators cannot decide the way the committees are going to be reduced. 
Under our recommendations, Senators are going to have that choice and 
some committees that do not have enough Senators choosing it are going 
to be rolled into other committees with appropriate jurisdiction. They 
are going to be voting against a proposition that says proxies cannot 
affect the outcome of a vote.
  How many times do the American people ask how did that happen? How 
did this vote get out of there? They happen to catch it on C-SPAN and 
there were not very many people in attendance. Maybe five Senators. 
They heard three vote ``no'' and two vote ``aye.'' And all of a sudden 
the bill is reported out 14 votes for it. They are saying why? It is 
because you are going to vote against the proposition that is going to 
say proxies cannot be used to affect the outcome of a vote.
  Committees are meeting right now. I urge every Senator listening to 
pull out his little calendar for the day and see how many meetings are 
scheduled at the same time and we are not even in a real legislative 
session. If this was a month ago and, you took out your calendar you 
would probably have three meetings at the same time at 10 o'clock this 
morning. If you are on the Finance Committee, you have one. Obviously, 
if you were one of those Finance Committee members who is also on 
Governmental Affairs, you might have an investigative subcommittee 
there that you are supposed to be at, and then if you are on the Energy 
Committee, like I am, you would have that there.
  Frankly, we believe the time has come to use computers and modern 
technology to force the scheduling of meetings so we do not have a 
maximum of overlap. Instead of just kind of arbitrarily saying too bad 
if you cannot come, the chairman has just decided that 1 week from 
today at 9:30 there is a hearing. That is what you are going to be 
voting against.
  Mr. President, the Congress of the United States under our 
Constitution goes in session for 2 years, and 2 years happens to be one 
Congress. What do we do that befuddles the American people, frustrates 
Senators? One of our opponents who will raise the point of order, a 
very distinguished Senator, has said one of the things wrong with this 
Congress is fractured attention.
  My friend from Oklahoma quoted Senator Byrd. He encapsulated what was 
one of the things wrong, ``fractured attention.'' My notion of 
fractured attention is that we do things over and over and over again 
when it is not necessary.
  Just think with me. The first year of the 103d Congress--remember it 
goes on for 2 years--the Defense authorization bill, they do one for 1 
year because the appropriators are going to do one for 1 year. So if 
they do their work, they come to the floor and we vote on the same 
issues. My good friend from Arkansas will raise at least three 
amendments on the Defense authorization bill. Some time later on my 
good friend from Hawaii, Senator Inouye, will bring a 1-year 
appropriations bill. We will again vote on the same issues.
  The public is confused. They ought to be. And as it has developed now 
prior to all that, they will vote on a budget resolution, and even 
though the budget resolution says there are no line items in this, you 
just set a big dollar number for defense and all the other 
discretionary spending, you will have a vote probably on the same three 
issues because someone wants to make the point that you can get by with 
less defense if you take out these three things.
  So in 1 year in this body you will vote three times on the same 
issue, and then it goes on to conference. You confer over there and you 
bring it back, and you will debate and vote again on the same issues in 
one combined package.
  Just think of the wasted time, effort, and redundancy to do that all 
over again the next year. It is the same Congress. Hardly enough time 
has gone by for you to have even left the Appropriations Committee.
  It seems to me you could almost sit in there and wait around for the 
next batch of appropriations--it comes so often. The year ends October 
1. You come in this January. By February and March you are working on 
appropriations. You work on it all year. You vote on 13 appropriations 
bills. You have voted on a number of authorizing bills, some for 1 
year, some for 2 years. You would have voted on a budget resolution for 
1 year and you come back the next year and do it all over again.
  Frankly, there probably is going to be some evidence presented here 
or some contention that that is good for the country. They will argue 
that that is how we get oversight, that each year if you do it every 
year you get a chance to look at the appropriations process annually 
and that gives you good Government and you get to develop good 
programs.
  I believe that is not the case. As a matter of fact, I believe we are 
not getting any oversight because we do not have any time to do 
oversight. Anybody who can tell this Senator that with an annual 
budget, an annual appropriation and annual authorizations that there is 
time left over to go over and see what is happening to Medicaid, what 
is happening to any of the programs you got around--is fraud occurring? 
Go over and look at the housing programs. They are in such a mess that 
Congress does not even know which way to turn. We do not have the 
slightest idea how many billions of dollars it is going to cost for one 
of the programs that we have been funding on a short term that should 
be on long term. It could be $11 billion a year that we are short.
  That is hardly enough time to have a hearing. Why? Every year you 
have to do an appropriations bill, you have to do a budget resolution, 
and you have to do a number of authorizations, at least authorizations 
for defense.
  Now, many, many months ago--in fact, the months have now gone into 
years--a very distinguished Senator, who also happened to be from 
Oklahoma, Senator Bellmon, as he left, he kind of delivered one of his 
``Here's what I've learned and here's what the Senate has meant to me'' 
speech. A very basic, simple suggestion was made. Essentially, the 
Senator from Oklahoma, Senator Bellmon, said: ``Wouldn't it be 
marvelous if, for 1 year out of the 2, committees that have 
jurisdiction over programs had no excuse not to have hearings about 
them and oversight and to think about them because there would be no 
appropriations bills or a budget to consider that year?''
  Essentially, he was suggesting that out of a 2-year Congress, you 
take 1 year and do all the appropriating, do the budgeting, do the tax 
writing, and then the second year do oversight, have hearings, in-depth 
hearings, to find out what is going on in the country, what is going 
wrong with legislation, what do we really need that we are not doing. 
He said, ``Wouldn't that change things?''
  That is exactly what this committee said we ought to do. And they 
said we ought to get quarterly budget reports and, yes, there could be 
supplemental appropriations and we are going to have some come down 
here and say, ``That will not work.''
  Well, the Congressional Budget Office says that only 4 percent of the 
discretionary spending--and, to put it in everybody's language, 
discretionary spending is what you appropriate, what you must 
appropriate, because, by definition here, it lasts for 1 year and you 
have got to appropriate it again--4 percent of the discretionary 
spending must be annual because of unpredictable funding patterns.
  That means 96 percent of discretionary spending does not need to be 
funded on an annual basis because it is predictable. Now why do we then 
insist on letting the 4 percent drive the 96? We could at least figure 
out a way that the 96 percent that is predictable go on a 2-year basis. 
That will have to take a little thinking, a little carving out.
  Of the 725 discretionary accounts, says CBO, 63 percent changed by 
less than 10 percent from the previous year. Now, frankly, if we set 
about to do the 2 years, we would even be able to figure that out where 
there would not be any problem between the 2 years, because we would 
learn how to do it and it would not take very long. And then we would 
do the budget resolution for 2 years. We would not have a 
reconciliation bill. That is that big hodgepodge we put together to try 
to make some savings that are required by the budget resolution. We 
could not do those more than once every 2 years.
  Now, I ask the occupant of the chair and every Senator that is 
listening, would not this make a dramatic, positive change in the U.S. 
Senate?
  The committees that you are on, I say to Senators, that do not have 
time to have in-depth hearings, 2 or 3 weeks at a time of an oversight 
nature as to whether our veterans' hospitals are working right or not, 
whether the Indian programs for the Indian people are working or not, 
whether the bureaucracy is carrying out our will or have they gotten to 
a point where they are doing it their way.
  In fact, I believe that our programs are in such a state of shambles 
because of management misdirection, and improper writing of laws, that 
there are scandals just waiting around to occur.
  And guess how we do most of our oversight? I checked for just 3 or 4 
weeks to see what some committees were doing. Most of the oversight 
that goes on goes on because somebody in the press found a program that 
is not working or they found a scandal out there that we were being 
ripped off and they write about it. It does not take a committee 2 
weeks to get on with that. We ought to find those.
  That is why the American people are angry at us. We are not spending 
enough time trying to find that out. And you speak of reinventing 
Government. You are not going to reinvent Government by just reducing 
the number of Federal employees and consolidating a few programs. You 
are reinventing Government when you find out what is not working in 
Government and do something about it across the board.
  And I defy anybody to come here to the floor--dedicated appropriator, 
dedicated authorizer, dedicated tax writer, and entitlement writer--and 
tell this Senate that there is plenty of time under this system to get 
this done.
  And I would also say, for those who think there is plenty of time and 
we go to the 2-year system, 1 year for one part of it and another year 
for the other part of it, for those of you who think we have plenty of 
time, it might be that we could even get out of here earlier. Maybe we 
could cut all this time in Washington in half.
  I know Senator Baker and others have been suggesting we spend way too 
much time here. One way to do that is not to have to do everything so 
redundantly, over and over again every 12 months.
  Now, when you vote within the next couple of hours to kill this bill 
on a point of order, you are voting against all these things that I am 
talking about. And you will have decided that you are going to take the 
easy way out, use a budget point of order that has literally, 
literally, said that the Budget Committee should have had this sent to 
them. This bill that we have ready here, this bill that we have on the 
reorganization of the Congress, did not go to them. Thus, they did not 
have time to look at it, although it went to the Rules Committee, 
although a bipartisan committee voted unanimously to report it out 
after 1 year of hearings, you just kind of cavalierly vote that it is 
subject to this procedural deficiency. If you do that, you are voting 
against these things that I am talking about and more because we have 
not listed all of them yet. There is plenty more reform.
  Senator Boren has alluded to reducing the number of subcommittees, 
cutting them in half. Well, I do not have any more confidence that if 
we do not do something like this that we will ever get them cut back. 
There is a waiver rule. The waiver gets changed all the time and the 
subcommittees grow.
  Frankly, I have a lot of subcommittees. Somebody could come down here 
and say, ``You serve on slightly above average.'' Of course, I do. I 
have been here for 22 years. I take my work seriously. But I cannot 
even go to all the subcommittees. Nobody works harder than this 
Senator. I cannot make it, because I have two or three at the same 
time. That is ridiculous.
  The American people are wondering who is doing all this work up here; 
who is writing all these bills.
  I just mentioned to my good friend, since 1970, on average, bills 
that come out of here are five times longer in terms of number of words 
used--five times. Why do you think we need so many staff? Because we do 
not have enough time to put our own attention on it and do it 
ourselves. We do it very superficially. And very bright, smart staff--
God bless them--they help us all. They do the work. That is why the 
numbers have gone up, too.
  We decided if you go with this 2-year cycle, you can reduce the 
staff, too. And so we are recommending that in here, that Congress get 
littler and its support agencies be more responsive. At the General 
Accounting Office, over 5,000 people work there.
  Our bill says that in the second year of every Congress when we are 
supposed to be doing oversight, the primary role of the GAO--primary 
role--would be to help the committees and subcommittees to see what is 
going on, right or wrong, with their Government that the taxpayers are 
paying for. Those are important things.
  Mr. BOREN. Mr. President, will the Senator yield?
  Mr. DOMENICI. I will be pleased to yield.
  Mr. BOREN. First, I commend the Senator on the comments he has just 
been making. I think those who have heard those comments understand why 
I feel a great debt of gratitude to him for the leadership he provided 
in this joint committee, bipartisan committee, on the reform of 
Congress.
  Let me say, the spirit which he indicated and demonstrated throughout 
our proceedings is exactly the kind of spirit we need if we are going 
to get this country back on track--that is, thinking about what is in 
the national interest before we think about what is in a personal 
interest or in a narrow, partisan interest. I salute him for the spirit 
with which he served as the cochair and vice chair on the Senate side 
of that committee.
  Would the Senator agree with me that it would be best if we could be 
having this debate in the format in which we are not having to tack on 
this comprehensive set of recommendations to another pending matter; in 
fact, an amendment in disagreement to a conference report on 
appropriations for the District of Columbia? As I have said, it is 
ironic and, indeed, symbolic that we are having to take this action, 
because it again demonstrates that it is very difficult in this 
institution to do our business in a straightforward fashion so we can 
focus our attention in an orderly sequence on matters that should come 
before us.
  Would he agree with me that it would not have been our preference to 
have acted in this way and that, indeed, if we could have been assured 
by the leadership on both sides of the aisle--indeed, if we could still 
be assured by the leadership--that the recommendations of our committee 
as they came through the process, through the Rules Committee, both in 
terms of a bill and also of a resolution, that, if we could have 
assurance that we could have those matters considered on the floor, 
scheduled to a time certain, given a chance to have orderly and 
comprehensive debate on these proposals to amend these proposals and 
have them considered as they should be considered, that, indeed, is 
still our preference? It is only because as of this moment--and I 
suppose there is still time, we could receive such assurance and I hope 
we would--but as of this moment we are having to follow this procedural 
mechanism simply because we have not been allowed to receive those 
assurances which could be given by the joint leadership here, and that 
would be what would be preferable to us and I am sure to others on a 
matter of this importance.
  Mr. DOMENICI. I could not agree more, and I thank the Senator for his 
comments about my work. I want to share just one more fact with the 
Senator.
  We have one Appropriations Committee. It really is supposed to spend 
our money except for those programs we create which are entitlements. 
Let me, for the record, state what an entitlement is because it is very 
confusing. An entitlement is a benefit, either in kind or in dollars, 
that a citizen can go to court and sue for and get the money. So all 
these other definitions of entitlements pale before that one. That 
means Social Security recipients, if we stop paying them, they can go 
to a Federal court and have the Federal Government ordered to pay them. 
That means Medicaid, Medicare--the same kind of thing.
  All those programs that are funded by the Appropriations Committees, 
the education program and every other program, is supposed to be 
authorized by a committee. We do not just pull it out and pay for it in 
appropriations.
  This system is so broken down that $57 billion of appropriated money 
annually is not even authorized. We run around and say we have these 
two wonderful systems working together: One is the horse and one is the 
cart. But, frankly, the horse is broken down. The horse is the 
authorizing committee, and they say we are broken down because there 
are too many processes around here. They blame the budget process. Then 
they blame the appropriations process. Why do we not just say we want 
them all to be stronger? But they cannot all be stronger and have to do 
their work every year over and over again on the same or similar 
subject matter.
  I want to go through just a couple more of what is in this bill. I 
repeat, the process we are going for is this: The Boren-Domenici 
amendment, which is the entire recommendation of the special joint 
bipartisan committee, is pending. If we defeat the point of order and 
adopt the amendment, it is subject to amendment. So those who want to 
amend it could amend it then.
  This Senator, as a Republican--I went to those committee meetings in 
a total and pure spirit of not being partisan. But I must tell the 
Senate that I did not agree to be for pieces of this, one piece at a 
time. I am for some floor procedure amendments. They are in this 
package.
  Motion to proceed? We do not take as much time on it. If this package 
is adopted, Senate resolutions have to have 10 sponsors. We did that, 
too. But I am in favor of these changes, if we adopt the full package, 
because I can see them all weaved together and they will make a 
tapestry that will make this place work better. But I am not going to 
be for pieces of it, and I urge my friends on this side of the aisle, 
if we dismember this into little pieces, I am going to urge they 
reconsider the whole thing and wait around until we can get back and 
have another package.
  Let me conclude. We believe in an orderly process, cutting the number 
of subcommittees in half and making it almost impossible to add them by 
waiver because you have to bring it to the floor of the Senate and 
vote. We abolish four joint committees. Obviously, we may have lost a 
number of votes right there, because perhaps those who are on those 
joint committees will come down here and vote procedurally on killing 
this bill on a procedure called a point of order. But we think we did 
what you asked us to do.
  On the 2-year budget cycle, some are going to come down and say, 
``Why do we not do the budget 2 years, but let us do appropriations 
every year?'' Frankly, I believe there is more reason to do a budget 
resolution every year than there is appropriations every year, and I 
say that having been here a while and having done both. I believe that. 
But I think 2 years on both would be far better for this institution 
and for the American people in terms of our being able to get our job 
done right.
  I want to close by saying this U.S. Senate is a fantastic place to 
serve. I have been very privileged. I hope I can serve here a lot 
longer. But I do believe that the most important thing we could do is 
to make the U.S. Senate work better. I believe we are too 
fractionalized, we cannot develop any attention span, and we relegate 
and delegate our job and our work too much to others because we are 
asked, under a process and procedure, to comply with rules and other 
things that make it almost impossible to get our job done.
  So, sometime today there will be a vote. Obviously, I have told my 
colleagues what I think it is going to be. I urge everyone to give this 
reform a chance and deny the point of order and then let us take a look 
at it once it is before us in its true form.
  I yield the floor.
  Mr. PELL. Mr. President, I rise in opposition to the Domenici-Boren 
amendment because it does not reflect the revisions in congressional 
reorganization which were recommended by the Committee on Rules and 
Administration.
  I am opposed to the proposed elimination of the Joint Committee on 
the Library, because I believe the Joint Committee fulfills a useful 
role and its proposed elimination would be a meaningless reform.
  I should note for the record that I have served on the Joint 
Committee on the Library for many years and am its vice chairman during 
the 103d Congress. I might add that I regard this service as somewhat 
of a family tradition inasmuch as my father served on the joint 
committee as a member of the House of Representatives in the 1920's.
  I can understand why the Joint Committee on the Library, which dates 
back to 1802 and is probably the oldest extant congressional committee, 
might be dismissed as an obsolete anachronism. But I would contest such 
a view and suggest it is more accurate to view the Joint Committee as a 
very useful vestige, which has survived precisely because of its 
utility.
  In the early days of the Republic such joint committee were 
established for administrative purposes, and the Joint Committee on the 
Library filled just such a role for nearly a century. In effect, it 
managed the day-to-day operations of the Library, which in those early 
days must have been a very modest task.
  But with the explosive growth of the Library's collections following 
the passage of the 1870 copyright law requiring the deposit of 
copyright items, the management task outgrew the joint committee's 
capacity and in 1897 Congress assigned to the Librarian of Congress 
direct responsibility for day-to-day management.
  There remained a need to oversee and give policy direction to the 
Librarian, and that is what the role of the Joint Committee has been 
since that time. It is a role of consultative supervision somewhat akin 
to that of a corporate board of directors. Since the Joint Committee 
has no legislative authority, it exerts its influence by verbal advice 
and written consent, which reflects its members sense of congressional 
will.
  The consultative process is largely informal and unstructured. The 
Librarian frequently simply advises the Joint Committee of various 
matters, sometimes seeking the assent of the chairman and vice 
chairman, representing as they do by tradition, the two Houses.
  On matters of substance on which the formal approval of the Joint 
Committee is necessary and appropriate, the membership is generally 
polled by document and assent is registered by signature. The Joint 
Committee meets only infrequently, and then generally for informational 
hearings when there would be a clear benefit from a multilateral 
exchange of viewpoints.

  I would submit to you that this arrangement, while not perfect, 
serves very effectively to coordinate congressional supervision of an 
institution which has a wholly unique relationship to the national 
legislature. The Library is the creature of the Congress and the 
Congress is in turn highly dependent on the Library for substantive 
support. There must be a continuing mechanism in place for transmitting 
the will of Congress to the Library, and the Joint Committee, in my 
view, is the most effective mechanism for this purpose.
  I would further submit that there are clear advantages to both 
parties in having the mechanism of a joint committee. It gives the 
Library a single source to which if can turn for an expression of 
policy which represents the will of both bodies. And in this 
connection, I would note that the joint committee structure forces 
interhouse consultation at the staff level, and then assent by members, 
before any action of the Joint Committee can result.
  The advantage, from the congressional point of view, is that the 
joint committee structure requires us to find a common ground of 
agreement on any given issue, and once having done so, we are 
protected, to a good degree, from having our client, the Library, play 
off one House against the other in seeking to manipulate congressional 
will.
  I would hasten to add, parenthetically, that in my view the Joint 
Committee hardly poses a threat to the benefits of bicameralism which 
were argued so effectively by James Madison, because the function in 
this case is limited to consultation and administrative approval, 
relating to an institution which is intimately tied to the Congress as 
a whole and not to the House or Representatives or the Senate as 
separate entities.
  Finally, I would note that the work of the Joint Committee is 
performed by staff members who have many other duties but who would 
probably have to perform the same functions with respect to the Library 
if the Joint Committee were to be abolished. So I submit that the 
proposed abolition would yield no significant economy and would only 
have the effect of removing a useful framework for coordinated 
oversight.
  Turning to another aspect of the proposed reorganization, I would 
like to record my reservations about the proposal to limit the number 
of subcommittees that would apply to most committees. Speaking from my 
perspective as a chairman of the Committee on Foreign Relations, I find 
this proposal arbitrary and unduly restrictive.
  Because the scope of the Foreign Relations Committee is indeed 
worldwide, we traditionally have organized our subcommittee structure 
along geographic lines and to a lesser extent along substantive lines 
as circumstances dictate. We currently have seven subcommittees in all, 
of which five are regional subcommittees, as follows: Subcommittee of 
African Affairs; Subcommittee on East Asian and Pacific Affairs; 
Subcommittee on European Affairs; Subcommittee on Near Eastern and 
South Asian Affairs; and Subcommittee on Western Hemisphere and Peace 
Corps Affairs.
  In addition, we have a Subcommittee on International Economic Policy, 
Trade, Oceans, and Environment and a Subcommittee on Terrorism, 
Narcotics, and International Operations.
  It seems to me that any requirement to merge or consolidate the work 
of these subcommittees could have the effect of reducing the focus and 
intensity of the committee's attention to the matters it must consider. 
And I might also note that most members of the committee already have 
limited themselves to only two subcommittees, so in that sense the 
objectives of the proposed reorganization are already attained, or soon 
can be with minimal adjustments.
  I have the same reservations from my perspective as a member of the 
Committee on Labor and Human Resources, and as chairman of one of its 
subcommittees, namely the Subcommittee on Education, Arts, and 
Humanities.
  The Committee on Labor and Human Resources has extremely broad 
jurisdiction over a wide range of social concerns and presently has six 
subcommittees to address those issues. In addition to the subcommittee 
already mentioned, the other subcommittees are: Subcommittee on Aging; 
Subcommittee on Children, Family, Drugs, and Alcoholism; Subcommittee 
on Disability Policy; Subcommittee on Employment and Productivity; and 
Subcommittee on Labor.
  Given the broad scope of the committee's responsibilities, it seems 
to me that the consolidation of its structure into three subcommittees 
would make for unwieldy workloads at the subcommittee level and result 
in inefficiency and less effective operation of the committee.
  Here too, to the extent the purpose of the proposed limitation is to 
lighten the workload of Senators, that objective can readily be 
obtained by enforcing the limitation on the number of subcommittees 
each member of the committee can serve on, namely two.
  For all these reasons, I oppose the amendment as offered at this 
time. I do so with reservations because I supported the underlying 
reorganization plan in the form in which it was reported by the 
Committee on Rules and Administration. I regret that the committee's 
recommendations have not been considered and hope that they may be 
revived in the 104th Congress. But the amendment as proposed goes too 
far and comes to us at the wrong time and in the wrong form. It should 
be rejected.

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