[Congressional Record Volume 141, Number 112 (Wednesday, July 12, 1995)]
[Senate]
[Pages S9802-S9810]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. WELLSTONE:
  S. 1024. A bill to amend title XVIII of the Social Security Act to 
assure fairness and choice to patients under the Medicare Program, and 
for other purposes; to the Committee on Finance.


              the medicare health care quality act of 1995

 Mr. WELLSTONE. Mr. President, I am pleased to introduce the 
Medicare Health Care Quality Act of 1995 today to make certain that 
Medicare beneficiaries are protected and receive access to high-quality 
care when they enroll in health plans offered through the Medicare 
Program.
  I am deeply concerned about the extreme cuts in the Medicare Program 
that would be necessitated by the recently adopted budget resolution. A 
careful examination of the program clearly shows that the increasing 
numbers of elderly, disabled, and end-stage-renal disease patients--
changing demographics--and overall health care inflation account for 
most of the increased growth in spending. According to projections 
based on CBO numbers, the cuts contained in the Republican budget 
resolution will not allow the Medicare Program to even keep pace with 
the private sector on a per person basis. And the Medicare Program 
takes care of many of our society's sickest and frailest members.
  We have heard a lot recently about Republican proposals to 
restructure Medicare by giving seniors a voucher and allowing them to 
purchase health coverage in the private market. This legislation would 
ensure that plans participating in such a program would be required to 
meet minimum standards of performance, and that access to needed care, 
and quality of that care are assured. Many health plans already meet 
the standards I have included in this legislation, but for those that 
do not, this legislation will provide a critical safety net for 
patients.
  If a voucher system is created, it is likely that constraints on the 
amount of the voucher will force many seniors to choose managed care 
plans, as their most affordable alternative. Currently abut 3 million 
Medicare beneficiaries are enrolled in managed care plans through the 
Medicare Program. Most of these patients are satisfied with the care 
they receive. A significant fraction, however, primarily the frailest, 
the sick and disabled, are not satisfied, according to a recent report 
by the office of the inspector general of the Department of Health and 
Human Services. Serious problems identified with the program identified 
in this report included:

       Compliance with Federal enrollment standards for health 
     screening and informing beneficiaries of their appeal rights 
     appeared to be problematic.
       Perceived unmet service needs . . . led 22% of disenrollees 
     and
      7% of enrollees to seek out-of-plan care''
       Some beneficiaries reported having difficulty making 
     appointment for services in terms of the days waited for 
     scheduled appointments. . .
       Some beneficiaries reported they were refused referrals to 
     specialists. . .

  It is clear to me, however, when I look at the managed care plans in 
Minnesota, that managed care plans can provide access and quality in 
health care, while holding down the growth of costs. In a recent 
editorial on July 6, 1995, in the New England Journal of Medicine, the 
editor-in-chief, Dr. Jerome Kassirer stated:

       Managed care itself is not the enemy. On the contrary, many 
     of its effects are salutary. Patients stay in the hospital 
     far fewer days, many surgical procedures that previously 
     required hospitalization are now safely performed in day 
     surgery, there is far more attention to preventive care, many 
     medical practices have been standardized to produce better 
     outcomes, and satisfying patients has become an explicit 
     goal. There is, however, remarkable diversity among managed-
     care plans. Some, mostly older plans that were created when 
     cost containment was an unexpected benefit rather than their 
     central purpose, deliver high-quality care economically. 
     Unfortunately, others cut costs by recruiting the healthiest 
     patients, excluding the sickest, rationing care by making it 
     inconvenient to obtain, and denying care by a variety of 
     mechanisms.

  The Medicare Health Care Quality Act of 1995 defines the standards 
that must be met by any health plan, including managed care plans, if 
they are to participate as a plan for Medicare patients. The major 
standards would include those for:
  Information to be provided to enrollees on plan coverage, benefits, 
patient satisfaction, and quality indicators to assist consumers in 
making informed purchasing decisions.
  Utilization review activities, credentialing of health professionals, 
and handling of grievances by consumers and providers to assure that 
all are treated fairly by the health plan.
  Provision of adequate access to care, including specialty and 
emergency care without penalizing consumers.
  Fair marketing of health plans to Medicare beneficiaries to be 
certain plans cannot selectively market, and enroll only the healthiest 
patients.
  Mr. President, I have repeatedly stated that trying to restructure 
the Medicare Program without addressing the bigger question of overall 
health system reform is foolish, and likely to worsen the situation in 
the private sector. As Medicare cuts are put in place, providers will 
be forced to shift charges to private sector payers, insurance rates 
will rise, more people will be unable to afford coverage, and we will 
all end up paying more for our health care in the end. I believe that 
we must tackle health care reform in this Congress. Until that happens, 
however, and as Medicare beneficiaries continue to join private sector 
health plans, including managed care plans, in increasing numbers, it 
is critical to be certain that adequate patient protections are in 
place. The Medicare Health Care Quality Act of 1995 will go a long way 
toward doing that.
  I ask unanimous consent that a copy of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:
                                S. 1024

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,
     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Health Care Quality 
     Act of 1995''.

     SEC. 2. REFERENCES IN ACT; TABLE OF CONTENTS.

       (a) Amendments to Social Security Act.--Except as otherwise 
     specifically provided, whenever in this Act an amendment is 
     expressed in terms of an amendment to or repeal of a section 
     or other provision, the reference shall be considered to be 
     made to that section or other provision of the Social 
     Security Act.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title.
Sec. 2. References in Act; table of contents.
Sec. 3. Requirements relating to health professionals.
Sec. 4. Grievance procedures.
Sec. 5. Discrimination.
Sec. 6. Requirement for utilization review program.
Sec. 7. Access.
Sec. 8. Requirements for organization service areas.
Sec. 9. Other enrollee protections.

[[Page S 9803]]

Sec. 10. Information on eligible organization.
Sec. 11. Enrollment by mail.
Sec. 12. Waiver of certain medicare coinsurance and deductibles not 
              remuneration.
Sec. 13. Effective date.
     SEC. 3. REQUIREMENTS RELATING TO HEALTH PROFESSIONALS.

       Section 1876(c) (42 U.S.C. 1395mm(c)) is amended by adding 
     at the end the following new paragraph:
       ``(9)(A) The eligible organization shall credential health 
     professionals furnishing health care services through the 
     organization.
       ``(B)(i) The eligible organization shall establish a 
     credentialing process. Such process shall ensure that a 
     health professional is credentialed prior to that 
     professional being listed as a health professional in the 
     eligible organization's marketing materials, in accordance 
     with recorded (written or otherwise) policies and procedures. 
     The credentialing process shall provide for the review of an 
     application for credentialing by the credentialing committee 
     established under clause (iii).
       ``(ii) The medical director of the eligible organization, 
     or another designated health professional, shall have 
     responsibility for the credentialing of health professionals 
     under the organization.
       ``(iii)(I) The eligible organization shall establish a 
     credentialing committee that--
       ``(I) is composed of licensed physicians and other health 
     professionals to review credentialing information and 
     supporting documents;
       ``(II) provides input to the eligible organization on the 
     credentialing process and procedures; and
       ``(III) appropriately represents the medical specialties of 
     applicants for credentialing.
       ``(iv)(I) Credentialing decisions under the eligible 
     organization shall be based on objective standards with input 
     from providers of health services credentialed under the 
     organization. Information concerning all application and 
     credentialing policies and procedures shall be made available 
     for review by the health professional involved upon written 
     request.
       ``(II) The standards referred to in subclause (I) shall 
     include determinations as to--
       ``(aa) whether the health professional has a current 
     unrestricted valid license to practice the particular health 
     profession involved;
       ``(bb) whether the health professional has clinical 
     privileges in good standing at the hospital designated by the 
     practitioner and the primary admitting facility, as 
     applicable;
       ``(cc) whether the health professional has a valid DEA or 
     CDS certificate, as applicable;
       ``(dd) whether the health professional has graduated from 
     medical school (allopathic or osteopathic), completed a 
     residency (accredited by the Accreditation Council on 
     Graduate Medical Education or the American Osteopathic 
     Association), or received Board certification (by medical 
     specialty boards recognized by the American Board of Medical 
     Specialties or the American Osteopathic Association), as 
     applicable;
       ``(ee) the work history of the health professional;
       ``(ff) whether the health professional has current, 
     adequate malpractice insurance in accordance with the policy 
     of the eligible organization;
       ``(gg) the professional liability claims history of the 
     health professional;
       ``(hh) whether the health professional has been convicted 
     of a crime or cited by a licensing board for professional 
     misconduct; and
       ``(ii) whether the health professional has any malpractice 
     payments or disciplinary actions registered with the National 
     Practitioner Data Bank under section 427(b) of the Health 
     Care Quality Improvement Act (42 U.S.C. 11134(b)).
       ``(III) A health professional who undergoes the 
     credentialing process shall have the right to review the 
     basis information, including the sources of that information, 
     that was used to meet the designated credentialing criteria.
       ``(C)(i) A health professional who is subject to 
     credentialing under this paragraph shall, upon written 
     request, receive from the eligible organization any 
     information obtained by the organization during the 
     credentialing process that, as determined by the 
     credentialing committee, does not meet the credentialing 
     standards of the organization, or that varies substantially 
     from the information provided to the eligible organization by 
     the health professional.
       ``(ii) The eligible organization shall have a formal, 
     recorded (written or otherwise) process by which a health 
     professional may submit supplemental information to the 
     credentialing committee if the health professional determines 
     that erroneous or misleading information has been previously 
     submitted. The health professional may request that such 
     information be reconsidered in the evaluation for 
     credentialing purposes.
       ``(iii)(I) A health professional is not entitled to be 
     selected or retained by the eligible organization as a 
     participating or contracting provider whether or not such 
     professional meets the credentialing standards established 
     under this paragraph.
       ``(II) If economic considerations, including the health 
     care professional's patterns of expenditure per patient, are 
     part of a selection decision, objective criteria shall be 
     used in examining such considerations and a written 
     description of such criteria shall be provided to applicants, 
     participating health professionals, and enrollees. Any 
     economic profiling of health professionals must be adjusted 
     to recognize case mix, severity of illness, and the age of 
     patients of a health professional's practice that may account 
     for higher or lower than expected costs, to the extent 
     appropriate data in this regard is available to the eligible 
     organization.
       ``(iv)(I) The eligible organization shall develop and 
     implement procedures for the reporting, to appropriate 
     authorities, of serious quality deficiencies that result in 
     the suspension or termination of a contract with a health 
     professional.
       ``(II) The eligible organization shall develop and 
     implement policies and procedures under which the 
     organization reviews the contract privileges of health 
     professionals who--
       ``(aa) have seriously violated policies and procedures of 
     the eligible organization;
       ``(bb) have lost their privilege to practice with a 
     contracting institutional provider; or
       ``(cc) otherwise pose a threat to the quality of service 
     and care provided to the enrollees of the eligible 
     organization.

     At a minimum, the policies and procedures implemented under 
     this subparagraph shall meet the requirements of the Health 
     Care Quality Improvement Act of 1986.
       ``(III) The policies and procedures implemented under 
     subclause (II) shall include requirements for the timely 
     notification of the affected health professional of the 
     reasons for the reduction, withdrawal, or termination of 
     privileges, and provide the health professional with the 
     right to appeal the determination of reduction, withdrawal, 
     or termination.
       ``(IV) A written copy of the policies and procedures 
     implemented under this paragraph shall be made available to a 
     health professional on request prior to the time at which the 
     health professional contracts to provide services under the 
     organization.
       ``(D) For purposes of this paragraph, the term `health 
     professional' means an individual who is licensed, credited, 
     accredited, or otherwise credentialed to provide health care 
     items and services as authorized under State law.''.

     SEC. 4. GRIEVANCE PROCEDURES.

       Section 1876(c)(5)(A) (42 U.S.C. 1395mm(c)(5)(A)) is 
     amended--
       (1) by adding ``(i)'' after ``(A)''; and
       (2) by adding at the end the following new clause:
       ``(ii) The procedures described under clause (i) shall 
     include--
       ``(I) recorded (written or otherwise) procedures for 
     registering and responding to complaints and grievances in a 
     timely manner;
       ``(II) documentation concerning the substance of 
     complaints, grievances, and actions taken concerning such 
     complaints and grievances, which shall be in writing.
       ``(III) procedures to ensure a resolution of a complaint or 
     grievance;
       ``(IV) the compilation and analysis of complaint and 
     grievance data;
       ``(V) procedures to expedite the complaint process if the 
     complaint involves a dispute about the coverage of an 
     immediately and urgently needed service; and
       ``(VI) procedures to ensure that if an enrollee orally 
     notifies the eligible organization about a complaint, the 
     organization (if requested) must send the enrollee a 
     complaint form that includes the telephone numbers and 
     addresses of member services, a description of the 
     organization's grievance procedure.
       ``(iii) The eligible organization shall adopt an appeals 
     process to enable covered individuals to appeal decisions 
     that are adverse to the individuals. Such a process shall 
     include--
       ``(I) the right to a review by a grievance panel;
       ``(II) the right to a second review with a different panel, 
     independent from the eligible organization, or to a review 
     through an impartial arbitration process which shall be 
     described in writing by the organization; and
       ``(III) an expedited process for review in emergency cases.

     The Secretary shall develop guidelines for the structure and 
     requirements applicable to the independent review panel and 
     impartial arbitration process described in subclause (II).
       ``(iv) With respect to the complaint, grievance, and 
     appeals processes required under this paragraph, the eligible 
     organization shall, upon the request of a covered individual, 
     provide the individual a written decision concerning a 
     complaint, grievance, or appeal in a timely fashion.
       ``(v) The complaint, grievance, and appeals processes 
     established in accordance with this paragraph may not be used 
     in any fashion to discourage or prevent a covered individual 
     from receiving medically necessary care in a timely 
     manner.''.

     SEC. 5. DISCRIMINATION.

       Section 1876(c) (42 U.S.C. 1395mm(c)), as amended by 
     section 3, is amended by adding at the end the following new 
     paragraph:
       ``(10)(A) The eligible organization may not discriminate or 
     engage (directly or through contractual arrangements) in any 
     activity, including the selection of service area, that has 
     the effect of discriminating against an individual on the 
     basis of race, national origin, gender, language, socio-
     economic status, age, disability, health status, or 
     anticipated need for health services.
       ``(B) The eligible organization may not engage in marketing 
     or other practices intended to discourage or limit the 
     enrollment 

[[Page S 9804]]
     of individuals on the basis of health condition, geographic area, 
     industry, or other risk factors.
       ``(C) The eligible organization may not discriminate in the 
     selection of members of the health professional or provider 
     network (and in establishing the terms and conditions for 
     membership in the network) of the organization based on--
       ``(i) the race, national origin, disability, gender, or age 
     of the health professional;
       ``(ii) the socio-economic status, disability, health 
     status, age, or anticipated need for health services of the 
     patients of the health professional or provider; or
       ``(iii) the health professional or provider's lack of 
     affiliation with, or admitting privileges at, a hospital.
       ``(D) The eligible organization may not discriminate in 
     participation, reimbursement, or indemnification against a 
     health professional who is acting within the scope of the 
     license, training, or certification of the professional under 
     applicable State law solely on the basis of the license, 
     training, or certification of the health professional. The 
     eligible organization may not discriminate in participation, 
     reimbursement, or indemnification against a health provider 
     that is providing services within the scope of services that 
     it is authorized to perform under State law.''.

     SEC. 6. REQUIREMENT FOR UTILIZATION REVIEW PROGRAM.

       Section 1876(c) (42 U.S.C. 1395mm(c)), as amended by 
     sections 3 and 5, is amended by adding at the end the 
     following new paragraph:
       ``(11)(A) The eligible organization shall have in place a 
     utilization review program that meets the requirements of 
     this paragraph and that is certified by the Secretary.
       ``(B) The Secretary shall establish standards for the 
     establishment, operation, and certification and periodic 
     recertification of eligible organization utilization review 
     programs.
       ``(C)(i) The Secretary may certify an eligible organization 
     as meeting the standards established under subparagraph (B) 
     if the Secretary determines that the eligible organization 
     has met the utilization standards required for accreditation 
     as applied by a nationally recognized, independent, nonprofit 
     accreditation entity.
       ``(ii) The Secretary shall periodically review the 
     standards used by the private accreditation entity to ensure 
     that such standards meet or exceed the standards established 
     by the Secretary under this paragraph.
       ``(D) The standards developed by the Secretary under 
     subparagraph (B) shall require that utilization review 
     programs comply with the following:
       ``(i) The eligible organization shall provide a written 
     description of the utilization review program of the 
     organization, including a description of--
       ``(I) the delegated and nondelegated activities under the 
     program;
       ``(II) the policies and procedures used under the program 
     to evaluate medical necessity; and
       ``(III) the clinical review criteria, information sources, 
     and the process used to review and approve the provision of 
     medical services under the program.
       ``(ii) With respect to the administration of the 
     utilization review program, the eligible organization may not 
     employ utilization reviewers or contract with a utilization 
     management organization if the conditions of employment or 
     the contract terms include financial incentives to reduce or 
     limit the medically necessary or appropriate services 
     provided to covered individuals.
       ``(iii) The eligible organization shall develop procedures 
     for periodically reviewing and modifying the utilization 
     review of the organization. Such procedures shall provide for 
     the participation of providers in the eligible organization 
     in the development and review of utilization review policies 
     and procedures.
       ``(iv)(I) A utilization review program shall develop and 
     apply recorded (written or otherwise) utilization review 
     decision protocols. Such protocols shall be based on sound 
     medical evidence.
       ``(II) The clinical review criteria used under the 
     utilization review decision protocols to assess the 
     appropriateness of medical services shall be clearly 
     documented and available to participating health 
     professionals upon request. Such protocols shall include a 
     mechanism for assessing the consistency of the application of 
     the criteria used under the protocols across reviewers, and a 
     mechanism for periodically updating such criteria.
       ``(v)(I) The procedures applied under a utilization review 
     program with respect to the preauthorization and concurrent 
     review of the necessity and appropriateness of medical items, 
     services or procedures, shall require that qualified medical 
     professionals supervise review decisions. With respect to a 
     decision to deny the provision of medical items, services or 
     procedures, a provider licensed in the same field shall 
     conduct a subsequent review to determine the medical 
     appropriateness of such a denial. Physicians from the same 
     medical branch (allopathic or osteopathic medicine) and 
     specialty (recognized by the American Board of Medical 
     Specialties or the American Osteopathic Association) shall be 
     utilized in the review process as needed.
       ``(II) All utilization review decisions shall be made in a 
     timely manner, as determined appropriate when considering the 
     urgency of the situation.
       ``(III) With respect to utilization review, an adverse 
     determination or noncertification of an admission, continued 
     stay, or service shall be clearly documented, including the 
     specific clinical or other reason for the adverse 
     determination or noncertification, and be available to the 
     covered individual or any individual acting on behalf of the 
     covered individual and the affected provider or facility. The 
     eligible organization may not deny or limit coverage with 
     respect to a service that the enrollee has already received 
     solely on the basis of lack of prior authorization or second 
     opinion, to the extent that the service would have otherwise 
     been covered by the organization had such prior authorization 
     or a second opinion been obtained.
       ``(IV) The eligible organization shall provide a covered 
     individual with timely notice of an adverse determination or 
     noncertification of an admission, continued stay, or service. 
     Such a notification shall include information concerning the 
     utilization review program appeals procedure.
       ``(vi) An eligible organization utilization review program 
     shall ensure that requests by covered individuals or 
     physicians for prior authorization of a nonemergency service 
     shall be answered in a timely manner after such request is 
     received. If utilization review personnel are not available 
     in a timely fashion, any medical services provided shall be 
     considered approved.
       ``(vii) A utilization review program shall implement 
     policies and procedures to evaluate the appropriate use of 
     new medical technologies or new applications of established 
     technologies, including medical procedures, drugs, and 
     devices. The program shall ensure that appropriate 
     professionals participate in the development of technology 
     evaluation criteria.
       ``(viii) Where prior authorization for a service or other 
     covered item is obtained under a program under this 
     paragraph, the service shall be considered to be covered 
     unless there was fraud or incorrect information provided at 
     the time such prior authorization was obtained. If a provider 
     supplied the incorrect information that led to the 
     authorization of medically unnecessary care, the provider 
     shall be prohibited from collecting payment directly from the 
     enrollee, and shall reimburse the organization and subscriber 
     for any payments or copayments the provider may have 
     received.
       ``(E)(i) The eligible organization shall, with respect to 
     any materials distributed to prospective covered individuals, 
     include a summary of the utilization review procedures of the 
     organization.
       ``(ii) The eligible organization shall, with respect to any 
     materials distributed to newly covered individuals, include a 
     clear and comprehensive description of utilization review 
     procedures of the organization and a statement of patient 
     rights and responsibilities with respect to such procedures.
       ``(iii) The eligible organization shall disclose to the 
     Secretary of the eligible organization utilization review 
     program policies, procedures, and reports required by the 
     Secretary for certification.
       ``(iv) The eligible organization shall have a membership 
     card which shall have printed on the card the toll-free 
     telephone number that an enrollee should call for customer 
     service issues.
       ``(v) The eligible organization shall establish mechanisms 
     to evaluate the effects of the utilization review program of 
     the organization through the use of member satisfaction data 
     or through other appropriate means.''.

     SEC. 7. ACCESS.

       (a) In General.--Section 1876(c) (42 U.S.C. 1395mm(c)), as 
     amended by sections 3, 5, and 6, is amended by adding at the 
     end the following new paragraph:
       ``(12)(A) The eligible organization shall demonstrate that 
     the organization has a sufficient number, distribution, and 
     variety of qualified health care providers to ensure that all 
     covered health care services will be available and accessible 
     in a timely manner to all individuals enrolled in the 
     organization.
       ``(B) The eligible organization shall demonstrate that 
     organization enrollees have access, when medically or 
     clinically indicated in the judgment of the treating health 
     professional, to specialized treatment expertise.
       ``(C)(i) Any process established by the eligible 
     organization to coordinate care and control costs may not 
     impose an undue burden on enrollees with chronic health 
     conditions. The organization shall ensure a continuity of 
     care and shall, when medically or clinically indicated in the 
     judgment of the treating health professional, ensure direct 
     access to relevant specialists for continued care.
       ``(ii) In the case of an enrollee who has a severe, 
     complex, or chronic condition, the eligible organization 
     shall determine, based on the judgment of the treating health 
     professional, whether it is medically or clinically necessary 
     or appropriate to use a care coordinator from an 
     interdisciplinary team or a specialist to ensure continuity 
     of care.
       ``(D)(i) The requirements of this paragraph may not be 
     waived and shall be met in all areas where the eligible 
     organization has enrollees, including rural areas.
       ``(ii) If the eligible organization fails to meet the 
     requirements of this paragraph, the organization shall 
     arrange for the provision of out-of-organization services to 
     enrollees in a manner that provides enrollees with access to 
     services in accordance with this paragraph.''.

[[Page S 9805]]

       (b) Access to Emergency Care Services.--Section 
     1876(c)(4)(B) (42 U.S.C. 1395mm(c)(4)(B)) is amended--
       (1) by inserting ``emergency'' before ``services'' the 
     first place it appears;
       (2) by striking ``, if (i)'' and all that follows through 
     ``the organization''; and
       (3) by adding at the end the following new sentence: ``In 
     such subparagraph, `emergency services' are services provided 
     to an individual after the sudden onset of a medical 
     condition that manifests itself by symptoms of sufficient 
     severity (including severe pain) such that the absence of 
     immediate medical attention could reasonably be expected by a 
     prudent layperson (possessing an average knowledge of health 
     and medicine) to result in placing the individual's health in 
     serious jeopardy, the serious impairment of a bodily 
     function, or the serious dysfunction of any bodily organ or 
     part, and includes services provided as a result of a call 
     through the 911 emergency system.''.

     SEC. 8. REQUIREMENTS FOR ORGANIZATION SERVICE AREAS.

       (a) In General.--Section 1876 (42 U.S.C. 1395mm) is amended 
     by adding at the end the following new subsection:
       ``(k)(1) Except as provided in paragraph (2), for purposes 
     of this section, if the eligible organization's service area 
     includes any part of a metropolitan statistical area, the 
     service area shall include the entire metropolitan 
     statistical area (including any area designated by the 
     Secretary as a health professional shortage area under 
     section 332(a)(1)(A) of the Public Health Service Act within 
     such metropolitan statistical area).
       ``(2) The Secretary may permit an organization's service 
     area to exclude any portion of a metropolitan statistical 
     area (other than the central county of such metropolitan 
     statistical area) if--
       ``(A) the organization demonstrates that it lacks the 
     financial or administrative capacity to serve the entire 
     metropolitan statistical area; and
       ``(B) the Secretary finds that the composition of the 
     organization's service area does not reduce the financial 
     risk to the organization of providing services to enrollees 
     because of the health status or other demographic 
     characteristics of individuals residing in the service area 
     (as compared to the health status or demographic 
     characteristics of individuals residing in the portion of the 
     metropolitan statistical area not included in the 
     organization's service area).''.
       (b) Conforming Amendment.--Section 1876(c)(4)(A)(i) (42 
     U.S.C. 1395mm(c)(4)(A)(i)) is amended by striking ``the area 
     served by the organization'' and inserting ``the 
     organization's service area''.
     SEC. 9. OTHER ENROLLEE PROTECTIONS.

       (a) Clarification of Restrictions on Charges for Out-of-
     Plan Services.--
       (1) Inpatient hospital and extended care services.--Section 
     1866(a)(1)(O) (42 U.S.C. 1395cc(a)(1)(O)) is amended in the 
     matter preceding clause (i) by inserting after ``this title'' 
     the following: ``(without regard to whether or not the 
     services are furnished on an emergency basis)''.
       (2) Physicians' services and renal dialysis services.--
     Section 1876(j)(2) (42 U.S.C. 1395mm(j)(2)) is amended by 
     striking ``this setion'' and inserting ``this section 
     (without regard to whether or not the services are furnished 
     on an emergency basis)''.
       (b) Arrangements for Dialysis Services.--Section 1876(c) 
     (42 U.S.C. 1395mm(c)), as amended by sections 3, 5, 6, and 7 
     is amended by adding at the end the following new paragraph:
       ``(13) Each eligible organization shall assure that 
     enrollees requiring renal dialysis services who are 
     temporarily outside of the organization's service area 
     (within the United States) have reasonable access to such 
     services by--
       ``(A) making such arrangements with providers of services 
     or renal dialysis facilities outside the service area for the 
     coverage of and payment for such services furnished to 
     enrollees as the Secretary determines necessary to assure 
     reasonable access; or
       ``(B) providing for the reimbursement of any provider of 
     services or renal dialysis facility outside the service area 
     for the furnishing of such services to enrollees.''.

     SEC. 10. INFORMATION ON ELIGIBLE ORGANIZATION.

       Section 1876(c)(3)(C) (42 U.S.C. 1395mm(c)(3)(C)) is 
     amended--
       (1) by redesignating clauses (i) and (ii) as subclauses (I) 
     and (II);
       (2) by inserting ``(i)'' after ``(C)''; and
       (3) by adding at the end the following new clause:
       ``(ii)(I) The eligible organization shall provide 
     prospective covered individuals with written information 
     concerning the terms and conditions of the eligible 
     organization to enable such individuals to make informed 
     decisions with respect to a certain system of health care 
     delivery. Such information shall be standardized so that 
     prospective covered individuals may compare the attributes of 
     all such organizations offered within the coverage area.
       ``(II) Information provided under this section, whether 
     written or oral shall be easily understandable, truthful, 
     linguistically appropriate and objective with respect to the 
     terms used. Descriptions provided in such information shall 
     be consistent with standards developed for medicare 
     supplemental policies under section 1882.
       ``(III) Information required under this clause shall 
     include information specific to medicare beneficiaries 
     concerning--
       ``(aa) coverage provisions, benefits, and any exclusions by 
     category of service or product;
       ``(bb) plan loss ratios with an explanation that such 
     ratios reflect the percentage of the premiums expended for 
     health services;
       ``(cc) prior authorization or other review requirements 
     including preauthorization review, concurrent review, post-
     service review, post-payment review, and procedures that may 
     lead the patient to be denied coverage for, or not be 
     provided, a particular service or product;
       ``(dd) an explanation of how organization design impacts 
     enrollees, including information on the financial 
     responsibility of covered individuals for payment for 
     coinsurance or other out-of-plan services;
       ``(ee) covered individual satisfaction statistics, 
     including disenrollment statistics;
       ``(ff) advance directives and organ donation;
       ``(gg) the characteristics and availability of health care 
     professionals and institutions participating in the 
     organization, including descriptions of the financial 
     arrangements or contractual provisions with hospitals, 
     utilization review organizations, physicians, or any other 
     provider of health care services that would affect the 
     services offered, referral or treatment options, or 
     physician's fiduciary responsibility to patients, including 
     financial incentives regarding the provision of medical or 
     other services;
       ``(hh) quality indicators for the organization and for 
     participating health professionals and providers under the 
     organization, including population-based statistics such as 
     immunization rates and other preventive care and health 
     outcomes measures such as survival after surgery, adjusted 
     for case mix; and
       ``(ii) an explanation of the appeals process and the 
     grievance procedure.''.

     SEC. 11. ENROLLMENT BY MAIL.

       Section 1876(c)(3) (42 U.S.C. 1395mm(c)(3)) is amended by 
     adding at the end the following new subparagraphs:
       ``(H) Each eligible organization that provides items and 
     services pursuant to a contract under this section shall 
     permit an individual entitled to benefits under part A to 
     obtain enrollment forms and information and to enroll under 
     this section by mail, and no agent of an eligible 
     organization may visit the residence of such an individual 
     for purposes of enrolling the individual under this section 
     or providing enrollment information to the individual other 
     than at the individual's request.
       ``(I)(i) Each eligible organization that provides items and 
     services pursuant to a contract under this section shall 
     include the information described in clause (ii) in any 
     solicitation for enrollment in such organization sent by mail 
     to an individual entitled to benefits under part A.
       ``(ii) The information described in this clause is--
       ``(I) the toll-free number of the health insurance advisory 
     service program established under section 4359 of the Omnibus 
     Budget Reconciliation Act of 1990 (42 U.S.C. 1395b-3); and
       ``(II) an appropriate explanation of the services provided 
     by such program.

     SEC. 12. WAIVER OF CERTAIN MEDICARE COINSURANCE AND 
                   DEDUCTIBLES NOT REMUNERATION.

       (a) In General.--The Secretary of Health and Human Services 
     shall modify section 1001.952(k) of title 42, Code of Federal 
     Regulations, to provide that the term ``remuneration'' as 
     used in section 1128B of the Social Security Act (42 U.S.C. 
     1320a-7b) does not include any reduction or waiver of a 
     coinsurance or deductible amount owed to a provider 
     furnishing patient services covered under part B of the 
     medicare program under title XVIII of such Act if such 
     reduction or waiver is provided under a program that--
       (1) facilitates access to health services for patients, who 
     because of economic circumstances might otherwise refrain 
     from seeking needed health care;
       (2) initially and annually screens patients to determine 
     financial need and eligibility for the program; and
       (3) establishes financial need and eligibility on a case-
     by-case basis and grants such a reduction or waiver only if 
     the beneficiary--
       (A) has an annual gross income (including Social Security 
     benefits, tax-exempt income, and income from any other 
     source) of 200 percent or less of the Federal poverty level;
       (B) does not have assets in excess of $30,300, excluding 
     the homestead (as defined in State law) and one automobile;
       (C) is not eligible for medical assistance under a State 
     plan under title XIX of such Act; and
       (D) is not enrolled in a prepaid health plan.
       (b) Additional exclusion.--The modification described in 
     subsection (a) shall be in addition to any exclusions 
     contained in such section on the date of the enactment of 
     this Act.

     SEC. 13. EFFECTIVE DATE.

       The amendments made by this Act shall apply with respect to 
     contract years beginning on or after January 1, 1997.
                                 ______

      By Mr. BUMPERS (for himself, Mr. Nickles, Mr. Pryor, and Mr. 
        Inhofe):
  S. 1025. A bill to provide for the exchange of certain federally 
owned lands and mineral interests therein, and for other purposes; to 
the Committee on Energy and Natural Resources.

[[Page S 9806]]



            the arkansas-oklahoma land exchange act of 1995

  Mr. BUMPERS. Mr. President, today I am pleased to introduce a piece 
of legislation that will begin a public process for a project of great 
importance. This legislation would allow for the exchange of lands 
between the Weyerhaeuser Co., the Forest Service, and the Fish and 
Wildlife Service. This land exchange could, in my view, achieve a 
number of worthy goals for the environment in my home State of Arkansas 
and for the State of Oklahoma. It is a bill that I have been working 
on, and will continue to work on, with the advice and assistance of 
Senators Pryor, Nickles, and Inhofe, as well as Congressman Brewster of 
Oklahoma and the entire Arkansas House delegation.
  First, let me provide a bit of background on this exchange proposal. 
In 1985, I learned that the Weyerhaeuser Co. had informed the Forest 
Service that it had thousands of acres of land for sale in Arkansas. 
These lands included undeveloped timberland adjacent to Lake Ouachita. 
After a meeting that I had with representatives of the Weyerhaeuser 
Co., they agreed to withhold the sale to allow me time to work through 
the appropriations process and acquire environmentally significant 
lands through the land and water conservation fund for the Ouachita 
National Forest.
  The acquisition of lands inside the Lake Ouachita Management Area 
presents opportunities for more dispersed recreation, wildlife 
enhancement work, and protection of visual and water quality of the 
lake. These acquisitions began in 1989 and have continued up through 
this year. As a result of these acquisitions, the Government has been 
able to acquire almost 40,000 acres of some of the best forest lands I 
have seen. Since the acquisition program started, the bald eagle has 
become established on Lake Ouachita. In addition, habitat is provided 
for the red-cockaded woodpecker, Southern lady slipper, and Arkansas 
fat mucket mussel. The area is popular for deer, turkey, and small game 
hunting.
  While it would be nice to continue acquiring lands through the land 
and water conservation fund, that is just not a practical strategy. I 
know that some of my constituents do not like the concept of a land 
exchange because it means some lands leave Federal ownership and, under 
this proposal, would go to the Weyerhaeuser Co. However, reality is 
that this Government has a budget deficit, and funds for land 
acquisition have been decreasing for several years. In fact, the money 
that has been dedicated to land acquisition of the Weyerhaeuser 
property has fallen steadily since 1991. The decrease of funds has not 
resulted from my lack of interest in this area. It is due to the fact 
that Federal dollars are scarce for the kind of environmental 
enhancement I would like to see. Therefore, I believe it is incumbent 
upon Congress, the Federal Government, land owners and interest groups 
to be creative about how we can reach mutual goals for conservation. I 
challenged the Weyerhaeuser Co. to work with me in finding such an 
opportunity, and I believe they have taken a good step toward such an 
effort. I know Senator Nickles offered the same challenge. As a result, 
for the past year, the Weyerhaeuser Co., the Forest Service and the 
Fish and Wildlife Service have been working to determine if a mutually 
agreed upon land exchange proposal could be achieved. The bill today 
represents the result of that preliminary effort.
  Pursuant to this legislation, the State of Arkansas would gain 
approximately 25,000 acres for a national wildlife refuge. This unique 
bottomland forest called Pond Creek is located in the floodplain 
between the Cossatot River and the Little River. It is extremely rich 
and diverse in wetland habitat for wading birds, resident and migratory 
waterfowl, small mammals, deer, fish, alligators, and other wildlife. I 
understand that there are four bird rookeries there, used by herons, 
egrets, and other birds. This land would become part of the Cossatot 
National Wildlife Refuge.
  Arkansas would also benefit by acquiring lands that would complement 
Lake Ouachita; the Little Missouri Wild and Scenic River; Flatside 
Wilderness, and parts of the Ouachita National Forest. These 
acquisitions would enhance recreational opportunities for hiking, rock 
climbing and mountain bicycling. It would protect watersheds, and help 
block up ownership that is currently intermingled between the 
Weyerhaeuser Co. and the Forest Service. In the State of Arkansas, 
approximately 30,000 acres would be added to the Ouachita National 
Forest.
  In Oklahoma, the exchange would add more than 100,000 acres to the 
Ouachita National Forest through the addition of lands around Lake 
Broken Bow. This lake is similar to Lake Ouachita--very beautiful, and 
worthy of protection. I will work closely with my colleagues in the 
Senate and House from Oklahoma to ensure that this legislation fits 
with their goals for the area.
  To summarize, through this exchange the Federal Government stands to 
receive almost 160,000 acres of land that is currently owned by the 
Weyerhaeuser Co. I want to emphasize that I have personally viewed this 
property and believe it is worthy for consideration in this land 
exchange bill.
  Of course, Weyerhaeuser will also receive something in this exchange 
through the acquisition of approximately 28,000 acres of the Tiak 
district of the Ouachita National Forest in Oklahoma and approximately 
20,000 acres in Arkansas. This is land currently under timber 
management, and would continue under timber management by the 
Weyerhaeuser Co. I have inquired into the company's forest practices 
and understand that these lands would be managed in conjunction with 
its recently adopted Forestry Resource Goals. These goals strengthen 
and reinforce the company's commitment to continue protecting water 
quality and fish habitat in carrying out forest management, providing 
habitat for wildlife associated with managed forests, using 
scientifically based practices to protect soil stability and ensuring 
long term soil productivity; and considering aesthetics in forest 
practices as they manage forestlands for sustainable production of wood 
and other forest products. I understand that the Weyerhaeuser practices 
go beyond the guidelines of State Best Management Practices [BMP's], 
and that it has a good neighbor policy that calls for carefully 
considering the concerns of adjacent landowners and host communities.
  There are several issues I would like to address. First, is the 
concern that Weyerhaeuser is merely trading away cutover lands. I have 
toured the exchange area and seen first hand the quality of lands that 
the Forest Service has been receiving through the land and water 
conservation fund, as well as the lands that Weyerhaeuser would 
transfer to the
 Government. These are some of the best forests I have seen, and they 
deserve to be in Federal ownership.

  Currently, the Arkansas Nature Conservancy has scientists conducting 
an ecological assessment of all of the Weyerhaeuser lands that would 
come into Federal ownership. I am anxious to see the result of this 
work, and it will be important for Congress to review this proposal as 
the bill moves ahead. I plan to hold hearings on this very topic so 
that we can all understand the environmental impact of the land 
exchange. While we know a great deal about the lands currently in 
Federal ownership that would go to Weyerhaeuser, this assessment will 
help us learn more information about the quality of lands owned by 
Weyerhaeuser that would go to the Ouachita National Forest for 
management. I understand that preliminary data show that this land 
provides habitat for a number of sensitive species and serves important 
watersheds.
  A question has arisen about whether this exchange would be a value-
for-value exchange. I can assure my colleagues that this exchange would 
be a value-for-value exchange. I understand that the Forest Service, 
Fish and Wildlife Service, and Weyerhaeuser Co., have contracted with 
an independent land appraiser to determine the values of the land and 
ensure that land is traded on a value-for-value basis. That is, the 
total value of the land, timber and other economic resources that the 
Federal Government would give up will equal the total value that it 
receives from Weyerhaeuser. Determining resource values will involve 
surveys, land appraisals, timber cruises, mineral and 

[[Page S 9807]]
geologic assessments. As with any other business transaction, 
evaluations would be based on such items as recent comparable sales and 
current market values. These will provide an economically sound basis 
for discussion and negotiation--even for areas where the highest and 
best land uses may be environmental, recreational, or aesthetic rather 
than economic. I plan to be sure that the land values will be 
established precisely before this legislation is enacted.
  Concerns have also been raised about whether or not hunting and 
fishing will be allowed in the Cossatot National Wildlife Refuge. I 
believe that as long as hunting and fishing can be conducted in a 
manner that is compatible with sound wildlife management, then it makes 
sense to allow this and other forms of recreation.
  One issue that I am committed to working on with my colleagues from 
Oklahoma is an issue regarding the school districts in McCurtain 
County. I understand that under the current land exchange proposal, two 
school districts--Haworth and Tom--would lose money they presently 
receive under current allocations from the timber receipt payments. I 
know these timber receipt payments are important to the operation of 
these school districts and look forward to finding an equitable 
solution to this situation.
  Then there is the issue of minerals. Because of the acreage 
imbalance, the exchange would result in approximately 100,000 acres of 
Weyerhaeuser minerals being located under the lands to be conveyed to 
the Federal Government. At my request, Weyerhaeuser Co. has met with 
the Forest Service to come up with a recommendation that could be 
agreed to by all parties. The result of these discussions includes a 
proposal whereby Weyerhaeuser would trade all Forest Service mineral 
rights--approximately 50,000 acres--for an equivalent amount of acreage 
of Weyerhaeuser mineral rights when the surface is exchanged. The 
Weyerhaeuser hardrock minerals, which means all minerals except oil and 
gas, on all of the property Weyerhaeuser conveys to the Government, 
would be conveyed at the time of the surface exchange. However, 
Weyerhaeuser will reserve oil and gas rights on the acres for 45 years. 
Ownership by Weyerhaeuser of all oil and gas rights within any section 
containing a producing oil or gas well would extend beyond 45 years for 
as long as production continued. Weyerhaeuser would also reserve a 
proportionally reduced 6.25 percent of 8/8's overriding royalty 
interest in all oil and/or gas produced from any well located within 
the eight governmental sections immediately surrounding any section in 
which well is producing as of December 31, 2041.
  Finally, let me say Mr. President that this proposal has a great deal 
of support. It is supported in concept by the Forest Service and the 
Fish and Wildlife Service. It has the support of the Arkansas Nature 
Conservancy and the Oklahoma Wildlife Federation to name but a few. I 
was particularly encouraged recently by the statement of the Department 
of Agriculture's Under Secretary for Natural Resources and Environment, 
James Lyons. When I asked him about the exchange in an Interior 
Appropriations Subcommittee hearing, he said ``I think it is a good 
exchange for the taxpayers and for Weyerhaeuser, and certainly for the 
State of Arkansas''. I would encourage anyone who has concerns about 
this proposal to contact Weyerhaeuser and the Forest Service and take 
the time to tour the proposed lands for exchange. It was time well 
spend for me, and I would highly recommend it.
  I would emphasize that I want to hear from my constituents about this 
proposal. I want to hear about what they like and what they don't like 
so that I can be sure that the public process we are beginning today 
will benefit from their views.
  I ask unanimous consent that a copy of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:
                                S. 1025

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

     SECTION 1. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds that:
       (1) the Weyerhaeuser Company has offered to the United 
     States Government an exchange of lands under which 
     Weyerhaeuser would receive approximately 50,000 acres of 
     Federal land in Arkansas and Oklahoma in return for conveying 
     to the United States lands owned by Weyerhaeuser consisting 
     of approximately 165,000 acres of forested wetlands and other 
     forest land of public interest in Arkansas and Oklahoma, 
     consisting of:
       (A) certain Arkansas Ouachita lands located near Lake 
     Ouachita, Little Missouri Wild and Scenic River, Flatside 
     Wilderness and the Ouachita National Forest;
       (B) certain lands in Oklahoma located near McCurtain County 
     Wilderness, the Broken Bow Reservoir, the Glover River, and 
     the Ouachita National Forest; and
       (C) certain Arkansas Cossatot lands located on the Little 
     and Cossatot Rivers and identified as the ``Pond Creek 
     Bottoms'' in the Lower Mississippi River Delta section of the 
     North American Waterfowl Management Plan;
       (2) acquisition of the Arkansas Cossatot lands by the 
     United States will remove the lands in the heart of a 
     critical wetland ecosystem from sustained timber production 
     and other development;
       (3) the acquisition of the Arkansas Ouachita lands and the 
     Oklahoma lands by the United States for administration by the 
     Forest Service will provide an opportunity for enhancement of 
     ecosystem management of the National Forest System lands and 
     resources;
       (4) the Arkansas Ouachita lands and the Oklahoma lands have 
     outstanding wildlife habitat and important recreational 
     values and should continue to be made available for 
     activities such as public hunting, fishing, trapping, nature 
     observation, enjoyment, education, and timber management;
       (5) private use of the lands the United States will convey 
     to Weyerhaeuser will not conflict with established management 
     objectives on adjacent Federal lands;
       (6) the lands the United States will convey to Weyerhaeuser 
     as part of the exchange described in paragraph (1) do not 
     contain comparable fish, wildlife, or wetlands values;
       (7) the United States will convey all mineral interests and 
     oil and gas interests to Weyerhaeuser on or under all surface 
     acres designated to be exchanged pursuant to the exchange 
     described in paragraph (1) in which the Federal Government 
     owns such interests;
       (8) pursuant to such exchange, Weyerhaeuser will convey to 
     the United States all mineral interests and equivalent oil 
     and gas interests on or under all surface acres designated to 
     be exchanged pursuant to the exchange described in paragraph 
     (1) in which Weyerhaeuser owns such interests;
       (9) the United States and Weyerhaeuser have agreed to the 
     values and boundaries of all lands, mineral interests, and 
     oil and gas interests to be conveyed in the exchange and 
     concur that the lands, mineral interests, and oil and gas 
     interests to be conveyed by Weyerhaeuser and the lands, 
     mineral interests, and oil and gas interests to be conveyed 
     by the United States are approximately equal in value; and
       (10) the exchange of lands, mineral interests, and oil and 
     gas interests between Weyerhaeuser and the United States is 
     in the public interest.
       (b) Purpose.--The purpose of this Act is to authorize and 
     direct the Secretary of the Interior and the Secretary of 
     Agriculture to enter into an exchange of lands, mineral 
     interests, and oil and gas interests that will provide 
     environmental, land management, recreational, and economic 
     benefits to the States of Arkansas and Oklahoma and to the 
     United States.

     SEC. 2. DEFINITIONS.

       As used in this Act:
       (a) Land.--The terms ``land'' or ``lands'' mean the surface 
     estate and any other interests therein except for mineral 
     interests and oil and gas interests.
       (b) Mineral Interests.--The term ``mineral interests'' 
     means geothermal steam and heat and all metals, ores, and 
     minerals of any nature whatsoever, except oil and gas 
     interests, in or upon lands subject to this Act including, 
     but not limited to, coal, lignite, peat, rock, sand, gravel, 
     and quartz.
       (c) Oil and Gas Interests.--The term ``oil and gas 
     interests'' means all oil and gas of any nature whatsoever 
     including carbon dioxide, helium, and gas taken from coal 
     seams (collectively ``oil and gas'') together with the right 
     to enter lands for the purpose of exploring the lands for oil 
     and gas and drilling, opening, developing, and working wells 
     on such lands and taking out and removing from such lands all 
     such oil and gas together with the right to occupy and make 
     use of as much of the surface of said lands as may reasonably 
     be necessary for these purposes subject to the Secretary of 
     Agriculture's rules and regulations set forth in section 
     251.15 of title 36, Code of Federal Regulations.
       (d) Secretaries.--The term ``Secretaries'' means the 
     Secretary of the Interior and the Secretary of Agriculture.
       (c) Weyerhaeuser.--The term ``Weyerhaeuser'' means 
     Weyerhaeuser Company, a company incorporated in the State of 
     Washington.

     SEC. 3. EXCHANGE.

       (a) Exchange of Lands and Mineral Interests.--
       (1) In General.--Subject to paragraph (a)(2), within 120 
     days after the date of the enactment of this Act, the 
     Secretary of Agriculture shall convey to Weyerhaeuser, 
     subject to any valid existing rights, approximately 20,000 
     acres of Federal lands and mineral interests in the State of 
     Arkansas and 

[[Page S 9808]]
     approximately 30,000 acres of Federal lands and mineral interests in 
     the State of Oklahoma as depicted for exchange on maps 
     entitled ``Arkansas-Oklahoma Land Exchange--Federal Arkansas 
     and Oklahoma Lands,'' dated      1995 and available for 
     public inspection in appropriate offices of the Secretaries.
       (2) Offer and Acceptance of Lands.--The Secretary of 
     Agriculture shall make the conveyance to Weyerhaeuser if 
     Weyerhaeuser offers deeds of title, subject to limitations 
     and the reservation described in subsection (b), acceptable 
     to the Secretary of Agriculture that convey to the United 
     States the following:
       (A) approximately 110,000 acres of lands and mineral 
     interests owned by Weyerhaeuser in the State of Oklahoma, as 
     depicted for transfer to the United States upon a map 
     entitled ``Arkansas-Oklahoma Land Exchange--Weyerhaeuser 
     Oklahoma Lands,'' dated      1995 and available for public 
     inspection in appropriate offices of the Secretaries;
       (B) approximately 30,000 acres of lands and mineral 
     interests owned by Weyerhaeuser in the State of Arkansas, as 
     depicted for transfer to the United States upon a map 
     entitled ``Arkansas-Oklahoma Land Exchange--Weyerhaeuser 
     Arkansas Ouachita Lands,'' dated      1995 and available for 
     public inspection in appropriate offices of the Secretaries; 
     and
       (C) approximately 25,000 acres of lands and mineral 
     interests owned by Weyerhaeuser in the State of Arkansas, as 
     depicted for transfer to the United States upon a map 
     entitled ``Arkansas-Oklahoma Land Exhchange--Weyerhaeuser 
     Arkansas Cassatot Lands,'' dated      1995 and available for 
     public inspection in appropriate offices of the Secretaries.
       (b) Exchange of Oil and Gas Interests.--
       (1) In General.--Subject to paragraph (b)(2), at the same 
     time as the land and mineral interests exchange is carried 
     out pursuant to this Section, the Secretary of Agriculture 
     shall exchange all Federal oil and gas interests, including 
     existing leases and other agreements, in the lands described 
     in paragraph (a)(1) for equivalent oil and gas interests, 
     including existing leases and other agreements, owned by 
     Weyerhaeuser in the lands described in paragraph (a)(2). Any 
     exchange of oil and gas interests pursuant to this Act may be 
     made without regard to the limitations requiring that 
     exchanges be made within the same State under section 206 of 
     the Federal Land Policy and Management Act of 1976 (43 U.S.C. 
     1716).
       (2) Reservation.--In addition to exchanging oil and gas 
     interests pursuant to paragraph (b)(1), to account for the 
     acreage imbalance in the exchange required under this Act, 
     there is hereby reserved to Weyerhaeuser, its successors, and 
     assigns until December 31, 2041, and for so long thereafter 
     that oil or gas is produced therefrom (``term reservation''), 
     all oil and gas in and under the acreage imbalance lands 
     depicted for reservation by Weyerhaeuser upon a map entitled 
     ``Arkansas-Oklahoma Land Exchange--Weyerhaeuser Oil and Gas 
     Interest Reservation Lands,'' dated      1995 and available 
     for public inspection in appropriate offices of the 
     Secretaries. Beginning January 1, 2042, there is hereby 
     reserved to Weyerhaeuser, its successors and assigns, a 
     proportionately reduced 6.25 percent of 8/8's overriding 
     royalty interest in all oil and gas produced from any well in 
     any governmental section adjacent to or cornering a section 
     in which oil and gas is being produced at the expiration of 
     the term reservation (``overriding royalty''). The overriding 
     royalty will continue until either the producing well (a well 
     producing on December 31, 2041) ceases production or until 
     all federally leased wells to which the overriding royalty 
     applies ceases production, whichever is later.
       (c) General Provisions.--
       (1) Valuation.--The lands, mineral interests, and oil and 
     gas interests exchanged pursuant to this Act shall be 
     approximately equal in value, as determined by the 
     Secretaries and agreed to by Weyerhaeuser. To ensure that the 
     natural values of the area are not affected by the exchange, 
     a formal appraisal based upon drilling or other surface 
     disturbing activities shall not be required for any mineral 
     interests or oil and gas interests exchanged.
       (2) Maps controlling.--The acreage cited in this Act is 
     approximate. In the case of a discrepancy between the 
     description of lands, mineral interests, and/or oil and gas 
     interests to be exchanged pursuant to subsection (a) and the 
     lands, mineral interests, and/or oil and gas interests 
     depicted on a map referred to in such subsection, the map 
     shall control. Subject to the notification required by 
     paragraph (3), the maps referenced in this Act are subject to 
     such minor corrections as may be agreed upon by the 
     Secretaries and Weyerhaeuser.
       (3) Final maps.--Not later than 180 days after the 
     conclusion of the exchange required by subsection (a), the 
     Secretaries shall transmit maps accurately depicting the 
     lands and mineral interests
      conveyed and transferred pursuant to this Act and the 
     acreage and boundary descriptions of such lands and 
     mineral interests to the Committees on Energy and Natural 
     Resources of the Senate and the Committee on Resources of 
     the House of Representatives.
       (4) Cancellation.--If, before the exchange has been carried 
     out putsuant to subsections (a) and (b), Weyerhaeuser 
     provides written notification to the Secretaries that 
     Weyerhaeuser no longer intends to complete the exchange, with 
     respect to the lands, mineral interests, and oil and gas 
     interests that would otherwise be subject to the exchange, 
     the status of such lands, mineral interests, and oil and gas 
     interests shall revert to the status of such lands, mineral 
     interests, and oil and gas interests as of the day before the 
     date of enactment of this Act and shall be managed in 
     accordance with applicable management plans.
       (5) Withdrawal.--Subject to valid existing rights, the 
     lands, mineral interests, and oil and gas interests depicted 
     for conveyance to Weyerhaeuser for possible exchange on the 
     maps referenced in subsections (a) and (b) are withdrawn from 
     all forms of entry and appropriation under the public land 
     laws (including the mining laws); and from the operation of 
     mineral leasing and geothermal steam leasing laws effective 
     upon the date of the enactment of this Act. Such withdrawal 
     shall terminate 45 days after completion of the exchange 
     provided for in subsections (a) and (b) or on the date of 
     notification by Weyerhaeuser of a decision not to complete 
     the exchange.

     SEC. 4. DESIGNATION AND USE OF LANDS ACQUIRED BY THE UNITED 
                   STATES.

       (a) National Forest System.--
       (1) Addition to the system.--Upon acceptance of title by 
     the Secretary of Agriculture, the 140,000 acres of land 
     conveyed to the United States pursuant to Section 3(a)(2)(A) 
     and (B) of this Act shall be administered by the Secretary of 
     Agriculture in accordance with the laws and regulations 
     pertaining to the National Forest system.
       (2) Plan amendments.--Within 36 months after the completion 
     of the exchange required by this Act, the Secretary of 
     Agriculture shall amend applicable land and resource 
     management plans and accompanying documents pursuant to 
     section 6 of the Forest and Rangeland Renewable Resources 
     Planning Act of 1974, as amended by the National Forest 
     Management Act of 1976 (16 U.S.C. 1604).
       (b) Other.--
       (1) Addition to the national wildlife refuge system.--Once 
     acquired by the United States, the 25,000 acres of land 
     identified in section 3(a)(2)(A), the Cossatot lands, shall 
     be managed by the Secretary of the Interior as a component of 
     the Cossatot National Wildlife Refuge in accordance with the 
     National Wildlife Refuge System Administration Act of 1966 
     (16 U.S.C. 668dd-668ee).
       (2) Plan preparation.--Within 24 months after the 
     completion of the exchange required by this Act, the 
     Secretary of the Interior shall prepare and implement a 
     single refuge management plan for the Cossatot National 
     Wildlife Refuge, as expanded by this Act. Such plans shall 
     recognize the important public purposes served by the 
     nonconsumptive activities, other recreational activities, and 
     wildlife-related public use, including hunting, fishing, and 
     trapping. The plan shall permit, to the maximum extent 
     practicable, compatible uses to the extent that they are 
     consistent with sound wildlife management and in accordance 
     with the National Wildlife Refuge System Administration Act 
     of 1966 (16 U.S.C. 668dd-668ee) and other applicable laws. 
     Any regulations promulgated by the Secretary of the Interior 
     with respect to hunting, fishing, and trapping on those lands 
     shall, to the extent practicable, be consistent with State 
     fish and wildlife laws and regulations. In preparing the 
     management plan and regulations, the Secretary of the 
     Interior shall consult with the Arkansas Game and Fish 
     Commission.
       (3) Interim use of lands.--
       (A) In general.--Except as provided in paragraph (2), 
     during the period beginning on the date of the completion of 
     the exchange of lands required by this Act and ending on the 
     first date of the implementation of the plan prepared under 
     paragraph (2), the Secretary of the Interior shall administer 
     all lands added to the Cossatot National Wildlife Refuge 
     pursuant to this Act in accordance with the National Wildlife 
     Refuge System Administration Act of 1966 (16 U.S.C. 668dd-
     668ee) and other applicable laws.
       (B) Hunting seasons.--During the period described in 
     subparagraph (A), the duration of any hunting season on the 
     lands described in subsection (1) shall comport with the 
     applicable State law.

     SEC. 5. OUACHITA NATIONAL FOREST BOUNDARY ADJUSTMENT.

       (a) In General.--Upon acceptance of title by the Secretary 
     of Agriculture of the lands conveyed to the United States 
     pursuant to Section 4(a)(2)(B) and (C), the boundaries of the 
     Ouachita National Forest shall be adjusted to encompass those 
     lands conveyed to the United States generally depicted on the 
     maps entitled ``Arkansas-Oklahoma Land Exchange--Weyerhaeuser 
     Oklahoma Lands'' and ``Arkansas-Oklahoma Land Exchange--
     Weyerhaeuser Arkansas Ouachita Lands'' dated      1995. For 
     the purpose of section 7 of the Land and Water Conservation 
     Fund Act of 1965 (16 U.S.C. 4601-9), the boundaries of the 
     Ouachita National Forest, as adjusted by this Act, shall be 
     considered to be the boundaries of the Forest as of January 
     1, 1965.
       (b) Maps and Boundary Descriptions.--Not later than 180 
     days after the date of enactment of this Act, the Secretary 
     of Agriculture shall prepare a boundary description of the 
     lands depicted on the maps referred to in Section 3(a)(2)(B) 
     and (C). Such maps and boundary description shall have the 
     same force and effect as if included in this Act, except that 
     the Secretary of Agriculture may correct clerical and 
     typographical errors.

 Mr. NICKLES. Mr. President, today I am introducing the 
Arkansas-Oklahoma Land Exchange Act of 1995. This 

[[Page S 9809]]
legislation represents several years of work on the part of the U.S. 
Forest Service, the Weyerhaeuser Co., the Oklahoma and Arkansas 
congressional delegations, State officials, and local communities. I 
firmly believe that this land exchange will benefit not only timber 
resource management, but also wildlife habitat, tourism, recreation, 
and the economic vitality of the region.
  During the course of negotiations, I strongly held that any exchange 
of lands would have to serve the best interests of Oklahoma citizens 
and the taxpayer. With this in mind, we crafted a proposal that would 
represent no cost to the Federal Government and that would allow for an 
equitable exchange of land and resources between the U.S. Forest 
Service and the Weyerhaeuser Co.
  Specifically, the public, through the U.S. Forest Service, will 
receive 105,000 acres in southeast Oklahoma adjacent to Broken Bow Lake 
and near the McCurtain County Wilderness Area, the lower Mountain Fork 
River, and the Glover River. These acres will become part of the 
Ouachita National Forest. The U.S. Forest Service will also receive 
approximately 28,000 acres located near Lake Ouachita in Arkansas and 
an additional 25,000 acres in Sevier County, AR, to become part of the 
Cossatot National Wildlife Refuge.
  In exchange, the Weyerhaeuser Co. will receive 28,000 acres of land 
located in the Tiak District of the Ouachita National Forest in 
McCurtain County, OK. The Tiak District was hand planted in pine timber 
and has been managed commercially in large blocks by the U.S. Forest 
Service for many years. In Arkansas, Weyerhaeuser will receive 
approximately 20,000 acres of scattered tracts located in Garland, 
Yell, and Perry Counties.
  I am committed to ensuring this proposal will not have an adverse 
impact on school district funding in southeastern Oklahoma. I am 
presently working with State and local officials, as well as the U.S. 
Forest Service and Weyerhaeuser, to guarantee an equitable and fair 
distribution of Forest Service timber receipt payments to local school 
districts. We are progressing positively and will attempt to reach an 
agreement before the exchange of lands is authorized to proceed.
  I have confidence in Weyerhaeuser's sound forest management practices 
and its commitment to replanting trees and protecting wildlife. I also 
have confidence in the U.S. Forest Service's ability to manage the land 
surrounding Broken Bow Lake as it
 becomes part of the Ouachita National Forest. I appreciate their 
commitment to managing our natural resources for the benefit of all 
citizens, including the development of tourism and recreation in the 
area.

  The Arkansas-Oklahoma Land Exchange Act of 1995 has the support of 
the Oklahoma Wildlife Federation, the Broken Bow Lake and Mountain Fork 
River Association, the Idabel Chamber of Commerce, the Broken Bow 
Chamber of Commerce, and the McCurtain County Chapter of Wild Turkey 
Federation.
                                 ______

      By Mr. BROWN (for himself, Mr. Bradley, Mr. Bryan, Mr. Chafee, 
        and Mr. Lautenberg):
  S. 1027. A bill to eliminate the quota and price support programs for 
peanuts, and for other purposes; to the Committee on Agriculture, 
Nutrition, and Forestry.


                          peanuts legislation

 Mr. BROWN. Mr. President, later this year Congress will be 
considering a new farm bill. This bill will guide our farm program into 
the next century. As we look to the future, we must clean up outdated 
programs of the past. Senator Bradley and I are introducing a bill to 
eliminate the Federal peanut program.
  The peanut program was established as part of the Agricultural 
Adjustment Act in 1938 when America was emerging from the Great 
Depression. Insuring a stable supply and price for agricultural 
commodities, including peanuts, was of great importance during the 
unstable economic times that followed the Great Depression. Today, 
however, the peanut program drives up the price for consumers and 
restricts the number of farmers that can take part in the program.
  The peanut program was originally intended to stabilize prices for 
farmers. Now, it has become a cartel. A small number of farmers own 
licenses, issued by the USDA, that allow them to participate in the 
program. These licensed farmers are restricted by a set production 
quotas reminiscent of communist-era central planning. How does someone 
obtain an allotment under the quota to grow peanuts? The right to 
participate in the program can be inherited, purchased, or rented. In 
fact in 1991, 68 percent of the peanuts produced under the peanut 
program were produced by farmers
 who rented the right to grow peanuts under the Federal program from 
licensed quota-owners. Those who rented collectively paid $208 million 
for the privilege of using someone else's quota.

  Farmers who do not own and are not able to rent a quota allotment are 
shut out of the peanut cartel. They cannot sell their peanuts on the 
U.S. free market. Unlicensed peanut farmers have only two options. They 
can sell their peanuts on the international markets where they receive 
only about half what quota-owners are assured through the Federal 
program. They also could sell their peanuts to the Federal Government 
for one-fifth the price the quota-owners receive, which is below the 
cost to produce the peanuts.
  While the peanut cartel benefits a small number of quota-owners, it 
gouges the American consumer. This program makes peanuts and peanut 
butter more expensive to Americans. In a 1993 report, the General 
Accounting Office estimated that the current program cost the U.S. 
peanut consumer between $314-$513 million per year in higher prices.
  The peanut program differs significantly from other commodity 
programs. Commodity programs should provide a measure of stability to 
the agriculture industry and insure an abundant supply of food at a 
reasonable price. The peanut program does not accomplish this goal. The 
current peanut program prevents farmers who do not own or cannot rent a 
quota from selling on the U.S. market. The current program artificially 
raises the price of peanuts and peanut products to U.S. consumers.
  Consumers do not benefit from the program. Most of the peanut growers 
do not benefit from the program. The peanut program only benefits a 
small number of people who own a quota license.
  This program is simply a bad program that needs to be eliminated. The 
agriculture industry has under gone a significant change since its 
inception. America and the American farmer have outgrown the peanut 
program.
 Mr. BRADLEY. Mr. President, today, Senator Brown and I are 
introducing legislation to end the Federal peanut program, a system of 
production quotas, price support loans and import restrictions which 
benefit a privileged few at great cost to American taxpayers and 
consumers.
  You do not have to be a peanut farmer to take advantage of the peanut 
program. In fact, you do not have to be farmer at all. You just have to 
be lucky enough to inherit--or rich enough to buy--a quota. Quota 
holders live all over the United States and in foreign countries as far 
away as Hong Kong and Great Britain.
  The Federal peanut program has been in place since the 1930's. It 
places strict quotas on peanut production, which drive up the cost to 
consumers by as much as $500 million a year, according to the American 
Peanut Product Manufacturers.
  Farmers who wish to grow peanuts for human consumption in the United 
States must own or lease a quota. And while quotas are assigned to 
particular farms, they can be rented or sold to someone else within the 
same county. 

[[Page S 9810]]

The GAO reports that 68 percent of all quota owners merely rent out 
their quotas to others. Even worse, fewer than 22 percent of all quota 
holders control 80 percent of the total U.S. peanut quota.
  This program does nothing to help American farmers. It simply lines 
the pockets of what amounts to a Park Avenue peanut cartel.
  Additionally, the Government provides Federal price support loans of 
$678 per ton for peanuts grown within the quota limits, despite the 
fact that the world price for peanuts is only $350 per ton. If a farmer 
cannot sell his crop, he can forfeit it to the Government in return for 
the Federal price support. These price supports will cost American 
taxpayers $119 million in 1995.
  This program turns market capitalism on its head. It forces consumers 
to pay twice as much for peanuts than they otherwise would pay. 
Ironically, high peanut prices are shrinking the market for peanut 
products. At this rate, we're going to make peanut butter and jelly a 
delicacy.
  For the dynasty of peanut quota holders, this program is the greatest 
thing since sliced bread. But for everyone else, it is a shell game you 
cannot win. The peanut program does not need overhauling, it needs to 
end now.


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