Congressional Record, Volume 143 Issue 90 (Tuesday, June 24, 1997)

[Congressional Record Volume 143, Number 90 (Tuesday, June 24, 1997)]
[Senate]
[Pages S6163-S6182]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

MEDICARE SUBVENTION

Mr. KEMPTHORNE. Mr. President, today I join my colleagues in support

[[Page S6164]]

of Medicare subvention. I want to thank Chairman Roth and the Finance
Committee for including this important demonstration project in the
bill now before the Senate. After 4 years, I believe that it is high
time the Congress enact Medicare subvention. This project is part of
the solution toward providing military retirees the quality health care
they deserve. For these reasons, I strongly urge my colleagues to
support Medicare subvention.
Mr. President, the Medicare portion of the reconciliation bill now
before us on the floor includes two demonstration projects for Medicare
subvention. The first will reimburse the Department of Veterans Affairs
with funding from the Medicare Program for health care services
provided to targeted Medicare-eligible veterans. The second
demonstration project, Mr. President, will offer military retirees over
the age of 65 the option to use familiar medical treatment facilities,
with Medicare reimbursing the Department of Defense.
Mr. President, in my opinion, these two solutions will address the
frustrations many of our veterans endure after serving their country so
honorably. Subvention gives America's veterans an option to choose the
best possible medical care available. I urge my colleagues to support
the Medicare subvention demonstration project with the hopes that this
year we will pass this cost-saving, commonsense solution to some of the
health care needs of our Nation's veterans.
Ms. MOSELEY-BRAUN. Mr. President, the legislation pending before the
Senate is designed to provide sufficient savings to implement the
balanced budget blueprint we passed last month. While the balanced
budget plan set the broad framework for balancing the budget by 2002,
it was up to the various committees to implement this plan. This bill
combines recommendations from eight Senate panels, including changes in
Medicare, Medicaid, and spectrum auctions. I commend the committees for
their work thus far because many of the provisions in the Balanced
Budget Act of 1997 are long overdue steps in the right direction. It is
clear that unless we get our deficit under control, we will be leaving
our children--and our children's children--a legacy of debt that will
make it impossible for them to achieve the American Dream.
The best news about this plan is that it will help balance the
Federal budget. More work however, needs to be done to meet our
obligations to future generations of Americans, to invest in people,
and to protect their retirement security. Every generation of Americans
has addressed and resolved challenges unique to their time. That is
what makes our country great. Now is the time to take steps toward
ensuring that our generation will honestly address its needs so that
future generations will have at least the same opportunity. Our
generation should leave no less than we inherited.
This is not a perfect bill before us today. My colleagues and I on
the Finance Committee held several marathon sessions last week in order
to craft a large part of this legislation. I think we reached agreement
on a package of provisions about which everyone has some objections but
also, all the members of the Finance Committee were able to support in
the end. This unanimous support for the bill is a complete change from
the Balanced Budget Act of 1995 and a testament to the leadership of
Senators Roth and Moynihan. I want to congratulate my colleagues for
working together in a bipartisan fashion aimed at not only improving
the Medicare and Medicaid programs but also the Nation as a whole.
I am however, particularly concerned about several provisions
included in the bill. The first is the impact of increasing the
Medicare eligibility age to 67. This provision will have a negative
effect on millions of Americans. Many businesses and employees plan
their retirement and health coverage around eligibility for Medicare.
Increasing the age to qualify will exacerbate the existing problem of
being uninsured among people age 55 to 65. Given our goal during this
Congress of increasing health coverage for vulnerable populations--
through the kids health care and allowing the disabled to buy into
Medicaid--this provision moves in the wrong direction.
Similarly, the proposed fourfold increase in the Medicare deductible
for some beneficiaries is particularly problematic. I voted against
this provision in the Finance Committee because I do not think the
issue was sufficiently considered nor were we given the kind of impact
analysis that is essential before making a decision of such magnitude.
Such a significant increase in the deductible is essentially a tax on
the sickest seniors. Those people who have to use the doctor more are
the only ones who will incur the increased costs. Any
deterred utilization of services will likely be the result of a senior
deciding between needed health services or other expenses that must
come from their fixed income.

Furthermore, we have to be careful before preceding down this road.
Means testing stands to erode support for the Medicare Program. We all
have witnessed the backlash against so called welfare programs over the
past 2 years. We must not allow Medicare to become regarded as transfer
program solely for the poor. Americans pay into Medicare and expect to
have the insurance when they retire. We already make wealthier
Americans pay more in Medicare payroll taxes. It does not seem
appropriate to be so hasty in increasing their cost-sharing obligations
for the program as well.
I also think that the Finance Committee went too far in its zeal to
increase managed care enrollment in rural areas. This by no means
suggest that I do not support enhanced managed care in rural areas--the
majority of my State is rural. However, essentially freezing payment
rates in high cost area, which coincidentally also have the
overwhelming majority of existing managed care enrollment, in order to
increase payment rates in rural areas may have the reverse effect. The
committee bill contains so many incentives for rural areas that we may
erode existing managed care enrollment and extra benefits that many
health plans offer like prescription drugs and eye glasses. I hope that
a more appropriate balance between encouraging managed care in
underserved areas and maintaining existing enrollment can be achieve in
the conference with the House.
On the other hand, there are a number of good aspects of this
legislation. Increased choice for Medicare beneficiaries through the
development of Provider Sponsored Organizations and the removal of teen
parents from the limit on vocational education under the welfare
program are just two example of very meaningful policy changes included
in this bill. Removing teen parents from the vocational education limit
will facilitate states' promotion of education for 240,000 additional
individuals as a means of moving permanently from welfare to work.
The legislation would also cover diabetes self management training,
colorectal cancer screenings, and mammography screens without copayment
obligations. This investment in mammograms without a copayment
obligations will benefit over 2 million women. Mr. President, S. 947
protects the vitally important Early Periodic Screening Diagnostic and
Treatment [EPSDT] benefits for children under Medicaid. Despite
requests from Governors to diminish the benefit package for children,
this bill does not allow it to occur. Similarly, the legislation
protects disproportionate share funding for those hospitals that treat
large volumes of indigent patients and are overly burdened by
uncompensated care.
I am certain that members on both sides of the aisle believe that
this bill can be improved and there are a number of proposed amendments
to do so; a number of which I plan to support. I hope that this body
can get through this process in the same bipartisan fashion displayed
in the Finance Committee. Chairman Roth said it best both in the
Committee and on the Senate floor, that no one got everything but
everyone got something that they wanted in this bill. That I believe,
is the true mark of legislation through consensus.
As I said at the outset, this bill takes several steps in the right
direction--the direction of a balanced budget. However, Congress must
not only look at the 5 and 10 year effect of the policies we enact or
rest on the laurels this package. We need to look to the future and
continue to reform programs in a fashion that maintain a balanced
budget. The worse thing that we could do is

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not act again for another 60 years. Long-range economic forecasts are
notoriously unreliable, but our long-range demographic changes are a
reality that cannot be ignored. The retiring baby-boom generation will
place considerable strain on our public systems. This budget bill only
extends Medicare solvency through 2007--not even to the point at which
the baby-boomers begin to retire. The longer we wait to enact more
substantive program changes, the greater the threat to the viability of
the Medicare Program.
Our actions now will impact future generations--our grandchildren and
great grandchildren. We have to remind ourselves to look beyond the
next 5 to 10 years. I am not suggesting that we not celebrate being on
the brink of a victory--balancing the budget for the first time in 60
years. I am simply stressing that Congress cannot retreat from its
commitment to ensuring that future generations will have at least the
same opportunity as we and our parents. Our generation should not leave
no less than we inherited.
Mr. DOMENICI. Mr. President, I think what both sides are waiting for
now is to prepare all of the amendments that we are going to offer en
bloc in an appropriate unanimous consent request--both Senator
Lautenberg and myself. So the time is going to be much to our advantage
because we will not be here very long after we get started on that.
Mr. President, when we first started negotiating with the President
of the United States, the Republican and Democratic leadership, the
Budget Committee chairman and some others asked how are we going to get
through these contentious issues? Some Republicans on our side said how
will we be sure what we get done will be signed by the President? That
had to do with the reconciliation bill that we are going to finish
tomorrow about noon, it had to do with the tax bill, it had to do with
the 13 appropriations bills.
My stock answer was it seems to me what we have learned over the past
4 years is that the best way to get that done is to have the proposals
done in a bipartisan manner. That is, send to the President proposals
that are both Republican and Democratic in terms of the party
affiliation of those who support it.
From what I gather, at least in the U.S. Senate, the epitomy of that
is Senator Roth and his chairmanship, with his ranking member, Senator
Moynihan. For even today, on almost all of the amendments that the
Finance Committee either offered or were challenged on, almost every
member of the Democratic Party voted for--not all, but almost all--and
you saw the results. Some of the issues that we were never able to do
before in a reconciliation bill following a budget resolution were done
today and they were done with overwhelming votes.
The general understanding in this place that contentious, difficult
matters would never clear the point of order under the waiver because
it requires 60 votes was dispelled today because of the bipartisan
nature of the results desired. I believe that will hold true. I am
hopeful when we go to conference that the same thing will happen, that
the distinguished chairman of the Finance Committee, who has most of
these matters even if he splits it up into subcommittees, that it will
come out of there bipartisan and we will continue to work with the
President.
We want to tell the White House that we know the bill which will be
cleared tomorrow is deficient in at least two places and we will have
to fix those in conference because we cannot fix them here today. We
will tomorrow in an amendment to be offered by Senator McCain, Senator
Lott, and myself, attempt to bring the revenues to be received from
spectrum closer to the mandate in the reconciliation bill. We are
hopeful everyone will support us on that. It will be short by a bit.
Unless other things mesh out when we go to conference, we will be
short the balanced budget by a couple of billion dollars in the last
year. We will work very hard on that in conference to try to fix it.
I look forward to the same thing happening. In fact, some said, how
are we going to be sure we do not get Government closure on the
appropriations bills when the President vetoes the bills and we close
down Government, and my response to most, there is no magic to it. We
will not be able to do it by some kind of statute. We tried that.
Obviously, it didn't work. I said the best way to do it is to have
bipartisan appropriations bills that have been worked on in an effort
to meet the agreement which the President joined us on and where there
was no joinder because it was not required, that the contents be at
least bipartisanly supported.
Now, our chairman is trying to do that in appropriations. If that
continues, I think two things result: We get it done; and second, the
American people praise us for it because I believe that is exactly what
they want us to do.
Frankly, that does not mean we have to give away our philosophy or
our ideas. In many instances it will take a long time to get where we
want to go. I assume the Democrats are saying the same thing on their
side, wondering when they will take over again and be able to move it
in their direction. None of it will occur in 1 year. It will take
longer. We will get only part of what we want.
The tax cuts are not sufficient when you take into consideration the
huge burden imposed on our people, but we also, some of us, recognize
we are also spending a lot of money and as we diminish that spending
and decrease it, maybe we can have even more tax cuts in years to come.
I hope so.
So that is the way I understand what is going on. I feel good about
it and, in particular, the support that was so bipartisan on many
critical issues here today. If that can continue, I am almost positive
we will end up in early October giving the American people one of the
best legislative sessions with one of the most significant
accomplishments in modern legislative history.
Staff is copying the lists so we can do the amendments en bloc, but
one amendment that did not get into that is one by Senator Abraham.

Amendment No. 456

(Purpose: To extend the moratorium regarding HealthSource Saginaw)

Mr. DOMENICI. Mr. President, I send the Abraham amendment to the desk
and ask that it be read so it will qualify for tomorrow's stacking.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Mexico [Mr. Domenici] for Mr. Abraham
for himself and Mr. Levin, proposes an amendment numbered
456.

Mr. DOMENICI. I ask unanimous consent that the reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

SEC. . EXTENSION OF MORATORIUM.

Section 6408(a)(3) of the Omnibus Budget Reconciliation Act
of 1989, as amended by section 13642 of the Omnibus Budget
Reconciliation Act of 1993 is amended by striking ``December
31, 1995'' and inserting ``December 31, 2002.''.

Uninsured Children

Mr. COATS. Mr. President, because we are waiting, already after a
long day, but because we are waiting for some material to come back, if
I could ask the chairman of the Budget Committee a question that I
raised at lunch. I know that the Budget Committee deliberated at great
length on the issue of providing insurance for uninsured children and
that after that deliberation, on a bipartisan basis, it was determined
that a $16 billion chunk of money for the 5-year budget plan be set
aside to address that problem. Many of us applauded the work of the
chairman and others in not only that but in putting the entire budget
together.
Having said that, I am aware that we will be addressing the second
phase of reconciliation and a decision on the part of the Finance
Committee to add an additional $8 billion for that program in a block
grant to the States. I am also aware of the fact there may be an
amendment offered that may add to that an additional $8 billion,
raising the total to double or more of what the Budget Committee
decided.
I am wondering if either the chairman of the Budget Committee or the
chairman of the Finance Committee can explain to me what changed? What
was necessary? Why was it necessary? What new facts came to light that
required the additional $8 billion, at least?
I know we will be debating this issue, and I do not mean to take up
time this

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evening to debate it. We will debate it under the tax bill. But in the
interim, I wonder if we can discuss that a little bit so this Senator
can better understand what it is we are attempting to do.
Mr. DOMENICI. Mr. President, let me try for a couple of minutes, and
if Senator Lautenberg would like to chime in, and obviously the
distinguished chairman of the Finance Committee is here.
I think it is fair to say, for starters, that the issue of uninsured
children--that is, children without any health insurance--has been a
longstanding issue. But in all honesty, it has only become an issue
that has been looked at diligently in an effort to see how you might
change the way we were doing things this year.
As a matter of fact, it is very interesting, if uninsured children as
a class were a big insurable group, it is interesting to note that you
could not buy health insurance for children. In other words, if some
State had decided, ``Let's go ask Aetna or somebody else, do you have
an insurance policy we can buy just to insure kids?'' it is within the
last 6 months, I understand, that for an exclusive child health care
insurance policy--it is a very short-lived instrument that exists. For
starters, nobody knew exactly what it would cost.
There were two other things that came into the discussion, and that
was there are at least two ways, maybe three, of getting insurance. One
was to expand the Medicaid system, which will cover some of these
uninsureds in any event, but to expand it further so that it would
encompass more. That amount was estimated by those who do that kind of
work. But there were not really any real estimates on if you did it the
second way, which was to let the States either provide it or buy
insurance for them--those numbers were not readily available.
So some will say that the $16 billion was too much. In fact, one of
our Senators who has studied it diligently believes you could cover all
the uninsureds for less than $16 billion. Others say when you are
finished with the $16 billion, there will still be some that are not
covered. I do not believe a magic formula was arrived at in the Finance
Committee. I believe there are those who said not enough prevailed.
They found a source of money in a compromise cigarette tax--$8 billion
out of the total of $20 billion in revenues from that was used for that
one function.

Now, frankly, I'm hopeful for myself, I'm very pleased we did not go
the Medicaid route. Neither the House bill nor the Senate bill made it
singularly a mandate that you cover the children under expanded
Medicaid. In both bills--in the Senate bill they are allowed the option
of taking a block grant to be administered by the States, and that is
one of the amendments that was around here tonight--what kind of
coverage would that be?
I am hopeful when we are finished and get this implemented that we
will see to it that we are able to measure what we are doing with that
money and how well we have covered people. It may very well be--
although for Government money, I doubt it, because whenever you put it
out there I assume it will get spent--but I am hopeful if it is more
than necessary, we will not spend it, although I assume that might not
happen. That is the best I have.
Mr. COATS. I thank the chairman. Of course, he put his finger on my
concern, and that is that before we have identified the scope of the
problem and the resources necessary to address the scope of the
problem, we have set aside a chunk of money, a very significant chunk
of money, $24 billion. I just wonder where that figure came from and
what it is based upon, because as the Senator from New Mexico has just
said and we all know, once the money is made available, those who are
beneficiaries of the money, whether it is the States or whether we put
it in Medicaid or wherever we put it, they will find a way to spend it.
I do not think anybody is arguing that we do not want to address the
issue of uninsured children, but I think what we were arguing is we
want to do it in a responsible way, a way that is responsible to the
taxpayers so that we do not just arbitrarily come up with a number
without knowing the scope of the problem and what dollar amount needs
to be applied to that.
So my question really goes to the rationale that was used in arriving
at the $16 billion initially by the Budget Committee. I assume they had
significant debate and research into that in arriving at that figure,
but what has changed from that point forward on the Finance Committee?
What new information did they learn that was not available to the
Budget Committee that caused the Finance Committee to raise that figure
by $8 billion? Was it simply the availability of additional tax money
through an identified tax and a decision to divide it up and throw $8
billion here and $4 billion there and whatever, or was there a specific
rationale or new piece of information that came forward that said,
``No, we were short when we made our Budget Committee estimate. We now
need to put in an additional $8 billion to cover the problem that we
have identified''?
That goes to the nature of my question. That clearly is something
that we need to debate in the tax bill. I do not want to hold up the
proceedings here this evening.
Mr. ROCKEFELLER. Will the Senator yield?
Mr. COATS. I am happy to yield to the Senator from West Virginia.
Mr. ROCKEFELLER. Mr. President, I don't pretend to speak for the
chairman of the Finance Committee, but I think it would be helpful to
the Senator's concern by expressing this.
There are 10 million uninsured children in this country, and that was
deemed to be unacceptable. The first approach was to try and insure 5
million children. That is what the $16 billion was for, to try to get
the first 5 million uninsured children covered. This came from the
Senator's side of the aisle in the Finance Committee. We thought that
maybe we could go beyond that and approach beyond 5 million. But to be
quite honest, I think as we have gone our way through this process, we
have come to understand that we can't judge exactly what the States are
going to do and we can't be entirely sure. So the CBO is now beginning
to give us figures that suggest we won't be able to reach the 5 million
children mark, perhaps even with both the $16 billion and the $8
billion program. But then again, we are not sure. But we know we have
to try because having uninsured children is not acceptable in America.
It is not a question of throwing money at a problem or suddenly a
discovery of a new source of money. There was simply the desire that we
ought to get health insurance to the 10 million children who do not
have it. We worked within the Finance Committee to try to accomplish
that.
Mr. COATS. I thank the Senator. As the Senator from West Virginia
knows, we had debate on that during the proposal offered by Senator
Kennedy earlier, which was defeated. But there was significant
disagreement on the floor. I don't know the answer, as to the number of
uninsured children, cost policies to insure those children, or the best
mechanism to use. Even the charts that the Senator from Utah had
designating the number of uninsured children and the charts that the
sponsor of the bill, Senator Kennedy from Massachusetts, had at the
same time they offered the bill; the two charts were off by several
million, in terms of the number of uninsured children. So even the
sponsors of the bill hadn't coordinated the numbers or checked with
each other relative to how many uninsured children existed. We learned
that three-point-some million of the children were covered under the
existing Medicaid Program and several million of these children were
temporarily uninsured, not full-time uninsured, because their parents
were in and out of employment. And, normally, in employment you get a
family policy that covers dependents.
So I was confused as to what the total number was, how many were
insured, and what mechanisms we ought to put in place and, more
important, how we ought to derive a number. Obviously, we all want to
be responsible with the taxpayers' dollars and, at the same time,
provide the important coverage. I wasn't able to get an answer where
there is some unanimity regarding the number of children, who is
covered, who needs to be covered, how long they need to be covered,
what the cost of the policy is to cover them. And it seemed to me that
we were pursuing a problem by addressing a solution designed in terms
of the amount of

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money available, not necessarily in terms of the specifics of the
problem.
Mr. ROCKEFELLER. If the Senator will further yield, I simply say that
I really don't think this was a money chase where, in trying to find a
solution, they had to go find the problem. The problem was there. One
of the most outstanding problems, which is vexatious, is there are 3
million children out there right now who are eligible for Medicaid, but
their families do not know; they do not know that they are in fact
eligible for Medicaid. So part of the problem was, how do you find,
through various public and State agencies, those 3 million children
across the country who are already eligible?
Mr. COATS. I ask the Senator, if we could not find them before under
existing State-run programs, how are we going to find them now under
State block grant programs?
Mr. ROCKEFELLER. I say to the Senator up front, the Senator is asking
for kind of an exactitude in an area where exactitude is really very
difficult, which is the whole area of the uninsured--how much it would
cost? Where are they? How long will they be on Medicaid or insurance?
When will they go off? Does the State know about it? Will the State,
under a block grant money program, take children already on Medicaid
and substitute that money, thus freeing the other money? I can't worry
about that.
I have faith in the chairman of the Finance Committee. I think this
was a bipartisan decision to do something about a problem that has been
with us throughout our history, which is no longer deemed acceptable.
The Senator is entirely correct when he says there are no simple
answers. I want to assure the Senator--because I sat through,
obviously, all the Finance Committee meetings, both public and
private--there was never an attempt to sort of grab at money for the
purpose of saying let's put that toward health insurance for children.
It was a sense that we have a real problem here and we want to try
to address it as responsibly and carefully as possible. That was
followed by a bipartisan discussion and agreement.

Mr. COATS. I thank the Senator. I don't want to hold up the
proceedings here this evening. I am happy to yield to the chairman.
Mr. ROTH. I will make one comment regarding the figures as to what it
costs to cover children. What we did in committee is agree that there
should be outreach, that we do want to ensure that all children that
are not currently insured have the opportunity of having such
insurance. But there is a lack of precision in the information, and
that essentially creates the problem. I think all you have to do is
listen to the discussion that we are having here this evening and it
shows you that you don't have hard figures on this. But it was agreed
upon, in a bipartisan way, that we wanted to develop a program that
would assure all children health care with the enactment of this
legislation.
Mr. COATS. I wonder if I can ask the chairman one last question?
Mr. ROTH. Yes.
Mr. COATS. If it is an undefined figure, or at least a loosely
defined figure--going back to a question the chairman of the Budget
Committee raised--is there a provision, or will there be a provision in
the law that would give us the ability to monitor or audit the State
response and return of excess funds if States meet their uninsured
children's needs, but have money left over from the block grant; is
there a basis upon which we can return that money and use it for,
obviously, other important needs?
Mr. ROTH. Well, I think there is an accountability in the program.
There was considerable discussion about wanting to make certain that
these funds were spent by the States for the purpose of children's
health insurance. So, yes, we did ensure that that had to be used for
that purpose.
Mr. COATS. I thank the Senator. I will be happy to get those
materials from the staff and continue to work with him on this
question.
I yield the floor.
Mr. DOMENICI. Mr. President, I thank Senator Coats very much for the
colloquy this evening. I think it was very helpful. I am sorry, from my
standpoint, that I can't be more technical on the amendment. I believe
there is a lot of objectivity that is lacking, and I am sure that is
going to evolve with time. Your question seems to be very relevant and
germane to a serious problem.
Mr. President, I believe on our side, and soon to be followed on the
Democratic side, we are prepared to ask unanimous consent that a series
of amendments be in order for tomorrow's stacked event that we have
spoken of.
I have an amendment that has been agreed to on both sides. This
amendment is made on behalf of Senator Harkin and Senator McCain.

Amendment No. 457

(Purpose: To reduce health care fraud, waste, and abuse)

Mr. DOMENICI. Mr. President, I send an amendment to the desk on
behalf of Senators Harkin and McCain and ask for its immediate
consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Mexico [Mr. Domenici], for Mr. Harkin,
for himself and Mr. McCain, proposes an amendment numbered
457.

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 amendment is as follows:

At the end of the bill, add the following:

SEC. . IMPROVING INFORMATION TO MEDICARE BENEFICIARIES.

(a) Clarification of Requirement To Provide Explanation of
Medicare Benefits.--Section 1804 of the Social Security Act
(42 U.S.C. 1395b-2) is amended by adding at the end the
following new subsection:
``(c)(1) The Secretary shall provide a statement which
explains the benefits provided under this title with respect
to each item or service for which payment may be made under
this title which is furnished to an individual, without
regard to whether or not a deductible or coinsurance may be
imposed against the individual with respect to such item or
service.
``(2) Each explanation of benefits provided under paragraph
(1) shall include----
``(A) a statement which indicates that because errors do
occur and because medicare fraud, waste and abuse is a
significant problem, beneficiaries should carefully check the
statement for accuracy and report any errors or questionable
charges by calling the toll-free phone number described in
(C).
(B) a statement of the beneficiary's rights to request an
itemized bill (as provided in section 1128A(n)); and
``(C) a toll-free telephone number for reporting errors,
questionable charges or other acts that would constitute
medicare fraud, waste, or abuse, which may be the same number
as described in subsection (b).''.
(b) Request for Itemized Bill for Medicare Items and
Services.----
(1) In general.--Section 1128A of the Social Security Act
(42 U.S.C. 1320a-7(a) is amended by adding at the end the
following new subsection:
``(m) Written Request for Itemized Bill.----
``(1) In general.--A beneficiary may submit a written
request for an itemized bill for medical or other items or
services provided to such beneficiary by any person
(including an organization, agency, or other entity) that
receives payment under title XVIII for providing such items
or services to such beneficiary.
``(2) 30-day period to receive bill.----
``(A) In general.--Not later than 30 days after the date on
which a request under paragraph (1) has been received, a
person described in such paragraph shall furnish an itemized
bill describing each medical or other item or service
provided to the beneficiary requesting the itemized bill.
``(B) Penalty.--Whoever knowingly fails to furnish an
itemized bill in accordance with subparagraph (A) shall be
subject to a civil fine of not more than $100 for each such
failure.
``(3) Review of itemized bill.----
``(A) In general.--Not later than 90 days after the receipt
of an itemized bill furnished under paragraph (1), a
beneficiary may submit a written request for a review of
the itemized bill to the appropriate fiscal intermediary
or carrier with a contract under section 1816 or 1842.
``(B) Specific allegations.--A request for a review of the
itemized bill shall identify--
``(i) specific medical or other items or services that the
beneficiary believes were not provided as claimed, or
``(ii) any other billing irregularity (including duplicate
billing).
``(4) Findings of fiscal intermediary or carrier.--Each
fiscal intermediary or carrier with a contract under section
1816 or 1842 shall, with respect of each written request
submitted to the fiscal intermediary or carrier under
paragraph (3), determine whether the itemized bill identifies
specific medical or other items or services that were not
provided as claimed or any other billing irregularity
(including duplicate billing) that has resulted in
unnecessary payments under title XVIII.
``(5) Recovery of amounts.--The Secretary shall require
fiscal intermediaries and carriers to take all appropriate
measures to recover amounts unnecessarily paid under title

[[Page S6168]]

XVIII with respect to a bill described in paragraph (4).''.
``(c) Effective Date.--The amendments made by this section
shall apply with respect to medical or other items or
services provided on or after January 1, 1998.

SEC. PROHIBITING UNNECESSARY AND WASTEFUL MEDICARE PAYMENTS
FOR CERTAIN ITEMS.

Section 1861(v) of the Social Security Act is amended by
adding at the end the following new paragraph:
``(8) ITEMS UNRELATED TO PATIENT CARE--.Reasonable costs do
not include costs for the following:
(i) entertainment;
(ii) gifts or donations;
(iii) costs for fines and penalties resulting from
violations Federal, State or local laws; and,
(iv) education expenses for spouses or other dependents of
providers of services, their employees or contractors.

SEC. ----. REDUCING EXCESSIVE BILLINGS AND UTILIZATION FOR
CERTAIN ITEMS.

Section 1834(a)(15) of the Social Security Act (42 U.S.C.
1395m(a)(15)) is amended by striking ``Secretary may'' both
places it appears and inserting ``Secretary shall''.

The PRESIDING OFFICER. Without objection, amendment No. 457 is agreed
to.
The amendment (No. 457) was agreed to.

Amendments Nos. 458 through 474

Mr. DOMENICI. I ask unanimous consent that it be in order for me to
offer a package of amendments on behalf of various Senators so that
they would qualify under the consent agreement.
The amendments offered are as follows:
Two amendments on behalf of Senator Helms; two amendments on behalf
of Senator McCain; two amendments on behalf of Senator Jeffords; one
amendment by Senator Brownback; one amendment by Senator Allard; one by
Senator Chafee; one amendment by Senator Grassley; one by Senator Kyl;
three by Senator Specter; one by Senator Burns; one by Senator
Hutchison; one by Senators McCain and Domenici.
I send the amendments to the desk and ask unanimous consent that the
amendments be considered read and be numbered accordingly.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendments are as follows:

amendment no. 458

(Purpose: To provide that, for purposes of section 1886(d) of the
Social Security Act, the large urban area of Charlotte-Gastonia-Rock
Hill-North Carolina-South Carolina be deemed to include Stanly County,
North Carolina)

At the appropriate place in division 1 of title V, insert
the following:

SEC. --. INCLUSION OF STANLY COUNTY, N.C. IN A LARGE URBAN
AREA UNDER MEDICARE PROGRAM.

(a) In General.--For purposes of section 1886(d) of the
Social Security Act (42 U.S.C. 1395ww(d)), the large urban
area of Charlotte-Gastonia-Rock Hill-North Carolina-South
Carolina may be deemed to include Stanly County, North
Carolina.
(b) Effective Date.--This section shall apply with respect
to discharges occurring on or after Oct. 1, 1997.
____

amendment no. 459

At the appropriate place in division 1 of title V, insert
the following:

SEC. --. INCLUSION OF STANLY COUNTY, N.C. IN A LARGE URBAN
AREA UNDER MEDICARE PROGRAM.

amendment no. 460

(Purpose: To provide for the continuation of certain Statewide medicaid
waivers)

On page 844, between lines 7 and 8, insert the following:

SEC. 5768. CONTINUATION OF STATE-WIDE SECTION 1115 MEDICAID
WAIVERS.

(a) In General.--Section 1115 of the Social Security Act
(42 U.S.C. 1315) is amended by adding at the end the
following:
``(d)(1) The provisions of this subsection shall apply to
the extension of statewide comprehensive research and
demonstration projects (in this subsection referred to as
`waiver project') for which waivers of compliance with the
requirements of title XIX are granted under subsection (a).
With respect to a waiver project that, but for the enactment
of this subsection, would expire, the State at its option
may--
``(A) not later than 1 year before the waiver under
subsection (a) would expire (acting through the chief
executive officer of the State who is operating the project),
submit to the Secretary a written request for an extension of
such waiver project for up to 3 years; or
``(B) permanently continue the waiver project if the
project meets the requirements of paragraph (2).
``(2) The requirements of this paragraph are that the
waiver project--
``(A) has been successfully operated for 5 or more years;
and
``(B) has been shown, through independent evaluations
sponsored by the Health Care Financing Administration, to
successfully contain costs and provide access to health care.
``(3)(A) In the case of waiver projects described in
paragraph (1)(A), if the Secretary fails to respond to the
request within 6 months after the date on which the request
was submitted, the request is deemed to have been granted.
``(B) If the request is granted or deemed to have been
granted, the deadline for submittal of a final report shall
be 1 year after the date on which the waiver project would
have expired but for the enactment of this subsection.
``(C) The Secretary shall release an evaluation of each
such project not later than 1 year after the date of receipt
of the final report.
``(D) Phase-down provisions which were applicable to waiver
projects before an extension was provided under this
subsection shall not apply.
``(4) The extension of a waiver project under this
subsection shall be on the same terms and conditions
(including applicable terms and conditions related to quality
and access of services, budget neutrality as adjusted for
inflation, data and reporting requirements and special
population protections), except for any phase down
provisions, and subject to the same set of waivers that
applied to the project or were granted before the extension
of the project under this subsection. The permanent
continuation of a waiver project shall be on the same terms
and conditions, including financing, and subject to the same
set of waivers. No test of budget neutrality shall be applied
in the case of projects described in paragraph (2) after that
date on which the permanent extension was granted.
``(5) In the case of a waiver project described in
paragraph (2), the Secretary, acting through the Health Care
Financing Administration shall, deem any State's request to
expand Medicaid coverage in whole or in part to individuals
who have an income at or below the Federal poverty level as
budget neutral if independent evaluations sponsored by the
Health Care Financing Administration have shown that the
State's Medicaid managed care program under such original
waiver is more cost effective and efficient than the
traditional fee-for-service Medicaid program that, in the
absence of any managed care waivers under this section, would
have been provided in the State.''.
``(b) Effective Date.--The amendment made by subsection (a)
shall become effective on the date of enactment of this Act.

Mr. McCAIN. Mr. President, I rise to offer an amendment which would
allow States to continue offering innovative cost effective health care
through an 1115 Medicaid waiver on a permanent basis or on a continuous
basis for 3 years. In addition, this measure would ensure that State's
are given credit for the cost savings which they have incurred by
operating an efficient managed care Medicaid program.
Several States have led the way in innovation for expanding coverage
through cost containment. These States have not used accounting
gamesmanship to ask the Federal Government to do the job; they have
used their own resources to revise their programs to expand coverage
while reducing both State and Federal costs.
Among these States is Arizona, Oregon, Rhode Island, Florida, and
Tennessee. Any other State operating under an 1115 waiver may find
herself in the same position.
In Arizona, 72 percent of her voters decided last fall that they
should cover everyone under the poverty line, whether man, woman, or
child. This initiative is the only hope for health care coverage for
50,000 men who live under the poverty line. Arizona can afford to do
this because of the success of the Arizona statewide managed care
program. AHCCCS [access] in containing cost and providing access to
care. This has been proven. The satisfaction of Arizona's health care
providers, members, and taxpayers further underscore the success of the
program.
In spite of substantial savings documented by HCFA hired evaluators,
documented savings since the program began in 1982, more than enough to
offset the cost of expanding coverage, the Federal Government won't
allow Arizona to reinvest the savings it achieved over a traditional
fee-for-service program in expanded coverage. Nor will HCFA allow the
State credit for their

[[Page S6169]]

program's savings over the next 5 years.
Other States have been allowed to use the savings managed care
achieves over a traditional fee-for-service program in expanded
coverage including the States of Tennessee, Hawaii, Rhode Island,
Oregon among others.
The rationale for treating Arizona different from these other States
boils down to timing. When Arizona's program began in 1982, HCFA did
not use a test of budget neutrality for approving section 1115 research
and demonstration waivers. The budget neutrality requirement that is
now applied was put in place several years later. If Arizona had a test
of budget neutrality in 1982 where the baseline was a traditional fee-
for-service program, then the State would be allowed to use its managed
care savings. Because the requirement did not exist, the State is
penalized.
HCFA now indicates that the test of budget neutrality is the current,
cost-saving, successful AHCCCS program, not the traditional fee-for-
service program.
Arizona should not be penalized for a change in Federal guidelines
which occurred after the program began. No one is questioning whether
AHCCCS saved the Federal Government millions. Arizona, as Tennessee,
Hawaii, Rhode Island, and any other State with such a proven track
record, should be allowed to use the managed care savings it achieved
over a traditional fee-for-service program to expand coverage as
Arizona voters overwhelmingly requested.

amendment no. 461

(Purpose: To provide for the treatment of certain Amerasian immigrants
as refugees)

On page 874, between lines 7 and 8, insert the following:

SEC. 5817A. TREATMENT OF CERTAIN AMERASIAN IMMIGRANTS AS
REFUGEES.

(a) Amendments to Exceptions for Refugees/Asylees.--
(1) For purposes of ssi and food stamps.--Section
402(a)(2)(A) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C.
1612(a)(2)(A)) is amended--
(A) by striking ``; or'' at the end of clause (ii);
(B) by striking the period at the end of clause (iii) and
inserting ``; or''; and
(C) by adding at the end the following:
``(iv) an alien who is admitted to the United States as an
Amerasian immigrant pursuant to section 584 of the Foreign
Operations, Export Financing, and Related Programs
Appropriations Act, 1988 (as contained in section 101(e) of
Public Law 100-202 and amended by the 9th proviso under
migration and refugee assistance in title II of the Foreign
Operations, Export Financing, and Related Programs
Appropriations Act, 1989, Public Law 100-461, as amended).''.
(2) For purposes of tanf, ssbg, and medicaid.--Section
402(b)(2)(A) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C.
1612(a)(2)(A)) is amended--
(A) by striking ``; or'' at the end of clause (ii);
(B) by striking the period at the end of clause (iii) and
inserting ``; or''; and
(C) by adding at the end the following:
``(iv) an alien described in subsection (a)(2)(A)(iv) until
5 years after the date of such alien's entry into the United
States.''.
(3) For purposes of exception from 5-year limited
eligibility of qualified aliens.--Section 403(b)(1) of the
Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (8 U.S.C. 1613(b)(1)) is amended by adding at the
end the following:
``(D) An alien described in section 402(a)(2)(A)(iv).''.
(4) For purposes of certain state programs.--Section
412(b)(1) of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1622(b)(1)) is amended
by adding at the end the following new subparagraph:
``(D) An alien described in section 402(a)(2)(A)(iv).''.
(b) Funding.--
(1) Levy of fee.--The Attorney General through the
Immigration and Naturalization Service shall levy a $100
processing fee upon each alien that the Service determines--
(A) is unlawfully residing in the United States;
(B) has been arrested by a Federal law enforcement officer
for the commission of a felony; and
(C) merits deportation after having been determined by a
court of law to have committed a felony while residing
illegally in the United States.
(2) Collection and use.--In addition to any other penalty
provided by law, a court shall impose the fee described in
paragraph (1) upon an alien described in such paragraph upon
the entry of a judgment of deportation by such court. Funds
collected pursuant to this subsection shall be credited by
the Secretary of the Treasury as offsetting increased Federal
outlays resulting from the amendments made by section 5817A
of the Balanced Budget Act of 1997.
(c) Effective Date.--The amendments made by this section
shall be effective with respect to the period beginning on or
after October 1, 1997.

Mr. McCAIN. Mr. President, I rise today to offer an amendment to S.
947, the Budget Reconciliation Act, that will redress what I assume to
be an inadvertent omission in a section of this bill that discriminates
against Amerasian children of U.S. military personnel who served in
Vietnam.
My amendment will add a new provision to section 5817 to include
Amerasian children to the category of legal aliens eligible for
Medicaid. The Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 excluded from eligibility these children of
American soldiers because they are admitted as refugees under section
584 of the Foreign Operations, Export Financing, and Related Programs
Act of 1988, rather than section 207 of the Immigration and Nationality
Act, under which refugees are excepted from the Welfare Region
legislation's ban on Medicaid, SSI, and other forms of assistance. This
amendment corrects that oversight.
Because there is a cost associated with this amendment, I propose to
offset it by mandating that the Attorney General of the United States,
acting through the Immigration and Naturalization Service, impose a
$150 processing fee on each illegal alien deported from the United
States who committed a felony while in this country. According to CBO,
this will generate the revenue necessary to offset the cost of my
amendment over the 5-year period for which the welfare bill excludes
aliens from Medicaid eligibility.
I hope that I can count on my colleagues' support for this worthwhile
amendment.

AMENDMENT NO. 462

(Purpose: To require the Secretary of Health and Human Services to
provide medicare beneficiaries with notice of the medicare cost-sharing
assistance available under the medicaid program for specified low-
income medicare beneficiaries)

On page 685, after line 25, add the following:

SEC. . REQUIREMENT TO PROVIDE INFORMATION REGARDING CERTAIN
COST-SHARING ASSISTANCE.

(a) In General.--Section 1804(a) (42 U.S.C. 1395b-2(a)) is
amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting
``, and''; and
(3) by adding at the end, the following:
``(4) an explanation of the medicare cost sharing
assistance described in section 1905(p)(3)(A)(ii) that is
available for individuals described in section
1902(a)(10)(E)(iii) and information regarding how to request
that the Secretary arrange to have an application for such
assistance made available to an individual.''.
(b) Effective Date.--The information required to be
provided under the amendment made by subsection (a) applies
to notices distributed on and after October 1, 1997.
____

AMENDMENT NO. 463

(Purpose: To provide for the evaluation and quality assurance of the
children's health insurance initiative)

On page 852, between lines 12 and 13, insert the following:
``(d) Evaluation and Quality Assurance.--
``(1) In general.--Not later than 1 year after the date on
which the Secretary approves the program outline of a State,
and annually thereafter, the State shall prepare and submit
to the Secretary such information as the Secretary may
require to enable the Secretary to evaluate the progress of
the State with respect to the program outline. Such
information shall address the manner in which the State in
implementing the program outline has--
``(A) expanded health care coverage to low-income uninsured
children;
``(B) provided quality health care to low-income children;
``(C) improved the health status of low-income children;
``(D) served the health care needs of special populations
of low-income children; and
``(E) utilized available resources in a cost effective
manner.
``(2) Availability of evaluations.--The Secretary shall
make the results of the evaluations conducted under paragraph
(1) available to Congress and the States.
``(3) Reports.--The Secretary shall annually prepare and
submit to the appropriate committees of Congress, and make
available to the States, a report containing the findings of
the Secretary as a result of the evaluations conducted under
paragraph (1) and the recommendations of the Secretary for
achieving or exceeding the objectives of this title.
____

amendment no. 464

(Purpose: To establish procedures to ensure a balanced Federal budget
by fiscal year 2002)

At the end of the ____, add the following:

[[Page S6170]]

TITLE ____--BUDGET CONTROL

SEC. ____01. SHORT TITLE; PURPOSE.

(a) Short Title.--This title may be cited as the
``Bipartisan Budget Enforcement Act of 1997''.
(b) Purpose.--The purpose of this title is--
(1) to ensure a balanced Federal budget by fiscal year
2002;
(2) to ensure that the Bipartisan Budget Agreement is
implemented; and
(3) to create a mechanism to monitor total costs of direct
spending programs, and, in the event that actual or projected
costs exceed targeted levels, to require the President and
Congress to address adjustments in direct spending.

SEC. ____02. ESTABLISHMENT OF DIRECT SPENDING TARGETS.

(a) In General.--The initial direct spending targets for
each of fiscal years 1998 through 2002 shall equal total
outlays for all direct spending except net interest as
determined by the Director of the Office of Management and
Budget (hereinafter referred to in this title as the
``Director``) under subsection (b).
(b) Initial Report by Director.--
(1) In general.--Not later than 30 days after the date of
enactment of this title, the Director shall submit a report
to Congress setting forth projected direct spending targets
for each of fiscal years 1998 through 2002.
(2) Projections and assumptions.--The Director's
projections shall be based on legislation enacted as of 5
days before the report is submitted under paragraph (1). The
Director shall use the same economic and technical
assumptions used in preparing the concurrent resolution on
the budget for fiscal year 1998 (H.Con.Res. 84).

SEC. ____03. ANNUAL REVIEW OF DIRECT SPENDING AND RECEIPTS BY
PRESIDENT.

As part of each budget submitted under section 1105(a) of
title 31, United States Code, the President shall provide an
annual review of direct spending and receipts, which shall
include--
(1) information on total outlays for programs covered by
the direct spending targets, including actual outlays for the
prior fiscal year and projected outlays for the current
fiscal year and the 5 succeeding fiscal years; and
(2) information on the major categories of Federal
receipts, including a comparison between the levels of those
receipts and the levels projected as of the date of enactment
of this title.

SEC. ____04. SPECIAL DIRECT SPENDING MESSAGE BY PRESIDENT.

(a) Trigger.--If the information submitted by the President
under section ____03 indicates--
(1) that actual outlays for direct spending in the prior
fiscal year exceeded the applicable direct spending target;
or
(2) that outlays for direct spending for the current or
budget year are projected to exceed the applicable direct
spending targets,

the President shall include in his budget a special direct
spending message meeting the requirements of subsection (b).
(b) Contents.--
(1) Inclusions.--The special direct spending message shall
include--
(A) an analysis of the variance in direct spending over the
direct spending targets; and
(B) the President's recommendations for addressing the
direct spending overages, if any, in the prior, current, or
budget year.
(2) Additional matters.--The President's recommendations
may consist of any of the following:
(A) Proposed legislative changes to recoup or eliminate the
overage for the prior, current, and budget years in the
current year, the budget year, and the 4 outyears.
(B) Proposed legislative changes to recoup or eliminate
part of the overage for the prior, current, and budget year
in the current year, the budget year, and the 4 outyears,
accompanied by a finding by the President that, because of
economic conditions or for other specified reasons, only some
of the overage should be recouped or eliminated by outlay
reductions or revenue increases, or both.
(C) A proposal to make no legislative changes to recoup or
eliminate any overage, accompanied by a finding by the
President that, because of economic conditions or for other
specified reasons, no legislative changes are warranted.
(c) Proposed Special Direct Spending Resolution.--If the
President recommends reductions consistent with subsection
(b)(2)(A) or (B), the special direct spending message shall
include the text of a special direct spending resolution
implementing the President's recommendations through
reconciliation directives instructing the appropriate
committees of the House of Representatives and Senate to
determine and recommend changes in laws within their
jurisdictions. If the President recommends no reductions
pursuant to (b)(2)(C), the special direct spending message
shall include the text of a special resolution concurring in
the President's recommendation of no legislative action.

SEC. ____05. REQUIRED RESPONSE BY CONGRESS.

(a) In General.--It shall not be in order in the House of
Representatives or the Senate to consider a concurrent
resolution on the budget unless that concurrent resolution
fully addresses the entirety of any overage contained in the
applicable report of the President under section ____04
through reconciliation directives.
(b) Waiver and Suspension.--This section may be waived or
suspended in the Senate only by the affirmative vote of
three-fifths of the Members, duly chosen and sworn. This
section shall be subject to the provisions of section 258 of
the Balanced Budget and Emergency Deficit Control Act of
1985.
(c) Appeals.--Appeals in the Senate from the decisions of
the Chair relating to any provision of this section shall be
limited to 1 hour, to be equally divided between, and
controlled by, the appellant and the manager of the bill or
joint resolution, as the case may be. An affirmative vote of
three-fifths of the Members of the Senate, duly chosen and
sworn, shall be required in the Senate to sustain an appeal
of the ruling of the Chair on a point of order raised under
this section.

SEC. ____06. RELATIONSHIP TO BALANCED BUDGET AND EMERGENCY
DEFICIT CONTROL ACT.

Reductions in outlays or increases in receipts resulting
from legislation reported pursuant to section ____05 shall
not be taken into account for purposes of any budget
enforcement procedures under the Balanced Budget and
Emergency Deficit Control Act of 1985.

SEC. ____07. ESTIMATING MARGIN.

For any fiscal year for which the overage is less than one-
half of 1 percent of the direct spending target for that
year, the procedures set forth in sections ____04 and ____05
shall not apply.

SEC. ____08. EFFECTIVE DATE.

This title shall apply to direct spending targets for
fiscal years 1998 through 2002 and shall expire at the end of
fiscal year 2002.
____

amendment no. 465

(Purpose: To expand medical savings accounts to families with uninsured
children)

On page 865, between lines 2 and 3, insert the following:

SEC. . EXPANSION OF MEDICAL SAVINGS ACCOUNTS TO FAMILIES
WITH UNINSURED CHILDREN

(a) In General.--Section 220 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(k) Families With Uninsured Children.--
``(1) In general.--In the case of an individual who has a
qualified dependent as of the first day of any month--
``(A) Waiver of employer requirement.--Clause (iii) of
subsection (c)(1)(A) shall not apply.
``(B) Waiver of compensation limitation.--Paragraph (4) of
subsection (b) shall not apply.
``(C) Coordination with exclusion for employer
contributions..--In lieu of the limitation of subsection
(b)(5), the amount allowable for a taxable year as a
deduction under subsection (a) to such individual shall be
reduced (but not below zero) by the amount not includible in
such individual's gross income for such taxable year solely
by reason of section 106(b).
``(D) Numerical limitations.--Subsection (i) shall not
apply to such individual if such individual is the account
holder of a medical savings account by reason of this
subsection, and subsection (j) shall be applied without
regard to any such medical savings account.
``(2) Qualified dependent.--For purposes of this
subsection, the term `qualified dependent' means a dependent
(within the meaning of section 152) who--
``(A) has not attained the age of 19 as of the close of the
calendar year in which the taxable year of the taxpayer
begins, and with respect to whom the taxpayer is entitled to
a deduction for the taxable year under section 151(c),
``(B) is covered by a high deductible health plan, and
``(C) prior to such coverage, was a previously uninsured
individual (as defined by subsection (j)(3)).''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to taxable years ending after the date of the
enactment of this Act.

Mr. ALLARD. Mr. President, I would like to take this time to discuss
an amendment that would give families with uninsured children the
opportunity to obtain proper health coverage. Congress is constantly
searching for ways to provide children with adequate health care, and I
have proposed an amendment that would allow children the means to be
covered. My amendment would give the working poor health expense
accounts to use for their families.
It is reported that there are 10 million children who are uninsured
in the United States. Many of these children are uninsured because
their parents have incomes that are high enough to be ineligible for
Medicaid or do not have private or employer-sponsored health insurance.
My amendment would allow families to deposit money in a medical
savings account to use for health care services. I believe it is
critical to provide lower income families with the option to establish
medical savings accounts. MSA's allow consumers to pay for medical
expenses through affordable tax-deductible plans that are most suited
to their needs.
Americans want choice in health care. It is time for the Federal
Government to listen to the American people

[[Page S6171]]

and make medical savings accounts an available option. Medical savings
accounts are a viable free-market approach to ensuring greater access
to affordable health care coverage for the uninsured. Through MSA's,
individuals would be given the choice and opportunity to obtain
affordable health services.
I believe our efforts need to be focused on providing uninsured
children with accessible health care services. My amendment would give
these families the opportunity of setting aside MSA funds, especially
benefiting those who are self-employed, between jobs, or employed where
health coverage is not available.
I am hopeful that in the 105th Congress, we will be able to expand
the availability of medical savings accounts. Medical savings plans
allow individuals the freedom to shop for competitive health care
services, which in turn, can help keep the costs of health care down.
My amendment is one step to achieving the goal of decreasing the
number of uninsured children by providing families with the option to
receive much needed health care coverage. By making more MSA's
available, we can make it easier for parents to finance their
children's health care; after all, the health of our Nation's children
is at stake.

amendment no. 466

(Purpose: To extend the authority of the Nuclear Regulatory Commission
to collect fees through 2002)

At the end of the bill, add the following:

TITLE IX--COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS

SEC. 9001. NUCLEAR REGULATORY COMMISSION ANNUAL CHARGES.

Section 6101 of the Omnibus Budget Reconciliation Act of
1990 (42 U.S.C. 2214) is amended)--
(1) in subsection (a)(3), by striking ``September 30,
1998'' and inserting ``September 30, 2002''; and
(2) in subjection (c)--
(A) by striking paragraph (2) and inserting the following:
``(2) Aggregate amount of charges.--The aggregate amount of
the annual charge collected from all licensees shall equal an
amount that approximates 100 percent of the budget authority
of the Commission for the fiscal year for which the charge is
collected, less, with respect to the fiscal year, the sum
of--
``(A) any amount appropriated to the Commission from the
Nuclear Waste Fund;
``(B) the amount of fees collected under subsection (b);
and
``(C) for fiscal year 1999 and each fiscal year thereafter,
to the extent provided in paragraph (5), the costs of
activities of the Commission with respect to which a
determination is made under paragraph (5).''; and
(B) by adding at the end the following:
``(5) Excluded budget costs.--
``(A) In general.--The rulemaking under paragraph (3) shall
include a determination of the costs of activities of the
Commission for which it would not be fair and equitable to
assess annual charges on a Nuclear Regulatory Commission
licensee or class of licensee.
``(B) Considerations.--In making the determination under
subparagraph (A), the Commission shall consider--
``(i) the extent to which activities of the Commission
provide benefits to persons that are not licensees of the
Commission;
``(ii) the extent to which the Commission is unable to
assess fees or charges on a licensee or class of licensee
that benefits from the activities; and
``(iii) the extent to which the costs to the Nuclear
Regulatory Commission of activities are commensurate with the
benefits provided to the licensees from the activities.
``(C) Maximum excluded costs.--The total amount of costs
excluded by the Commission pursuant to the determination
under subparagraph (A) shall not exceed $30,000,000 for any
fiscal year.''.
____

amendment no. 467

(Purpose: To preserve religious choice in long-term care)

On page 689, between lines 2 and 3, insert the following:
``(iii) Religious choice.--The State, in permitting an
individual to choose a managed care entity under clause (i)
shall permit the individual to have access to appropriate
faith-based facilities. With respect to such access, the
State shall permit an individual to select a facility that is
not a part of the network of the managed care entity if such
network does not provide access to appropriate faith-based
facilities. A faith-based facility that provides care under
this clause shall accept the terms and conditions offered by
the managed care entity to other providers in the network.
____

amendment no. 468

(Purpose: To allow medicare beneficiaries to enter into private
contracts for services)

On page 685, after line 25, add the following:

SEC. . FACILITATING THE USE OF PRIVATE CONTRACTS UNDER THE
MEDICARE PROGRAM.

(a) In General.--Title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) is amended by inserting after section
1804 of such Act (42 U.S.C. 1395b-2) the following:

``CLARIFICATION OF PRIVATE CONTRACTS FOR HEALTH SERVICES

``Sec. 1805. (a) In General.--Nothing in this title shall
prohibit a physician or another health care professional who
does not provide items or services under the program under
this title from entering into a private contract with a
medicare beneficiary for health services for which no claim
for payment is to be submitted under this title.
``(b) Limitation on Actual Charge Not Applicable.--Section
1848(g) shall not apply with respect to a health service
provided to a medicare beneficiary under a contract described
in subsection (a).
``(c) Definition of Medicare Beneficiary.--In this section,
the term `medicare beneficiary' means an individual who is
entitled to benefits under part A or enrolled under part B.
``(d) Report.--Not later than October 1, 2001, the
Administrator of the Health Care Financing Administration
shall submit a report to Congress on the effect on the
program under this title of private contracts entered into
under this section. Such report shall include--
``(1) analyses regarding--
``(A) the fiscal impact of such contracts on total Federal
expenditures under this title and on out-of-pocket
expenditures by medicare beneficiaries for health services
under this title; and
``(B) the quality of the health services provided under
such contracts; and
``(2) recommendations as to whether medicare beneficiaries
should continue to be able to enter private contracts under
this section and if so, what legislative changes, if any
should be made to improve such contracts.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply with respect to contracts entered into on and
after October 1, 1997.
____

AMENDMENT NO. 469

(Purpose: To extend premium protection for low-income medicare
beneficiaries under the medicaid program)

Strike section 5544 and in its place insert the following:

SEC. 5544. EXTENSION OF SLMB PROTECTION.

(a) In General.--Section 1902(a)(10)(E)(iii) (42 U.S.C.
1396a(a)(10)(E)(iii)) is amended by striking ``and 120
percent in 1995 and years thereafter'' and inserting ``, 120
percent in 1995 through 1997, 125 percent in 1998, 130
percent in 1999, 135 percent in 2000, 140 percent in 2001,
145 percent in 2002, and 150 percent in 2003 and years
thereafter''.
(b) 100 Percent FMAP.--Section 1905(b) (42 U.S.C.
1396d(b)) is amended by adding at the end the following:
``Notwithstanding the first sentence of this section, the
Federal medical assistance percentage shall be 100 percent
with respect to amounts expended as medical assistance for
medical assistance described in section 1902(a)(10)(E)(iii)
for individuals described in such section whose income
exceeds 120 percent of the official poverty line referred to
in such section.''.
(c) Effective Date.--The amendments made by this section
apply on and after October 1, 1997.
____

AMENDMENT NO. 470

(Purpose: To strike the limitations on DSH payments to institutions for
mental diseases under the medicaid program)

Beginning on page 778, strike line 1 and all that follows
through page 779, line 23.
____

amendment no. 411

(Purpose: To strike the limitations on Indirect Graduate Medical
Education payments to teaching hospitals)

Begining on page 585, strike line 21 and all that follows
through page 586, line 25.
____

amendment no. 472

(Purpose: To provide that information contained in the National
Directory of New Hires be deleted after 6 months)

On page 999, between lines 15 and 16, insert the following:
(f) National Directory of New Hires.--Section 453(i)(2) (42
U.S.C. 653(i)(2)) is amended by adding at the end the
following: ``Information entered into such data base shall be
deleted 6 months after the date of entry.''.
____

amendment no. 473

(Purpose: To clarify the number of individuals that may be treated as
engaged in work for purposes of the mandatory work requirement for TANF
block grants)

Beginning on page 929, strike line 20 and all that follows
through page 930, line 14 and insert the following:
(k) Clarification of Number of Individuals Counted as
Participating in Work Activities.--Section 407 (42 U.S.C.
607) is amended--
(1) in subsection (c)--
(A) in paragraph (1)(A), by striking ``(8)''; and
(B) in paragraph (2)(D)--
(i) in the heading, by striking ``participation in
vocational education activities''; and
(ii) by striking ``determined to be engaged in work in the
State for a month by reason

[[Page S6172]]

of participation in vocational educational training or''; and
(2) by striking subsection (d)(8).
____

amendment no. 474

(Purpose: To revise subtitle A of title III, relating to spectrum
auctions, by deleting certain provisions subject to a point or order,
and for other purposes)

(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')

Amendments No. 475 through 498

Mr. LAUTENBERG. Mr. President, we have one amendment that is still
being considered.
Otherwise, I ask unanimous consent that it be in order to send 25
amendments to the desk on behalf of my Democratic colleagues, that the
amendments be considered as read and laid aside to be voted on in
sequence.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendments are as follows:

amendment no. 475

(Purpose: to ensure that certain legal immigrants who become disabled
are eligible for disability benefits)

On page 8971, strike line 9-11.
____

senate amendment 476

(Purpose: To enhance taxpayer value in auctions conducted by the
Federal Communications Commission)

SECTION . RESERVE.

In any auction conducted or supervised by the Federal
Communications Commission (hereinafter the Commission) for
any license, permit or right which has value, a reasonable
reserve price shall be set by the Commission for each unit in
the auction. the reserve price shall establish a minimum bid
for the unit to be auctioned. If no bid is received above the
reserve price for a unit, the unit shall be retained. The
Commission shall re-assess the reserve price for that unit
and place the unit in the in the next scheduled or next
appropriate auction.
____

amendment no. 477

(Purpose: To provide food stamp benefits to child immigrants)

At the end of title I, add the following:

SEC. 10____. FOOD STAMP BENEFITS FOR CHILD IMMIGRANTS.

(a) In General.--Section 402(a)(2) of the Personal
Responsibility and Work Opportunity Reconciliation Act of
1996 (8 U.S.C. 1612(a)(2)) is amended by adding at the end
the following:
``(E) Child immigrants.--In the case of the program
specified in paragraph (3)(B), paragraph (1) shall not apply
to a qualified alien who is under 18 years of age.''.
(b) Allocation of Administrative Costs.--Section 408(a) of
the Social Security Act (42 U.S.C. 608(a)) is amended by
adding at the end the following:
``(12) Designation of grants under this part as primary
program in allocating administrative costs.--
``(A) In general.--Notwithstanding any other provision of
law, a State shall designate the program funded under this
part as the primary program for the purpose of allocating
costs incurred in serving families eligible or applying for
benefits under the State program funded under this part and
any other Federal means-tested benefits.
``(B) Allocation of costs.--
``(i) In general.--The Secretary shall require that costs
described in subparagraph (A) be allocated in the same manner
as the costs were allocated by State agencies that designated
part A of title IV as the primary program for the purpose of
allocating administrative costs before August 22, 1996.
``(ii) Flexible allocation.--The Secretary may allocate
costs under clause (i) differently, if a State can show good
cause for or evidence of increased costs, to the extent that
the administrative costs allocated to the primary program are
not reduced by more than 33 percent.
``(13) Failure to allocate administrative costs to grants
provided under this part.--If the Secretary determines that,
with respect to a preceding fiscal year, a State has not
allocated administrative costs in accordance with paragraph
(12), the Secretary shall reduce the grant payable to the
State under section 403(a)(1) for the succeeding fiscal year
by an amount equal to--
``(A) the amount the Secretary determines should have been
allocated to the program funded under this part in such
preceding fiscal year; minus
``(B) the amount that the State allocated to the program
funded under this part in such preceding fiscal year.''.

amendment no. 478

(Purpose: To require balance billing protections for individuals
enrolled in fee-for-service plans under the Medicare Choice program
under part C of title XVIII of the Social Security Act)

On page 214, strike lines 21 through 24 and insert the
following:
``(3) Exception for msa plans and unrestricted fee-for-
service plans.--
``(A) In general.--Except as provided in subparagraph (B),
paragraphs (1) and (2) do not apply to an MSA plan or an
unrestricted fee-for-service plan.
``(B) Application of balance billing for physician
services.--Section 1848(g) shall apply to the provision of
physician services (as defined in section 1848(j)(3)) to an
individual enrolled in an unrestricted fee-for-service plan
under this title in the same manner as such section applies
to such services that are provided to an individual who is
not enrolled in a Medicare Choice plan under this title.

amendment no. 479

(Purpose: To provide for medicaid eligibility of disabled children who
lose SSI benefits)

On page 874, between lines 7 and 8, insert the following:

SEC. 5817A. CONTINUATION OF MEDICAID ELIGIBILITY FOR DISABLED
CHILDREN WHO LOSE SSI BENEFITS.

(a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C.
1396a(a)(10)(A)(i)(II)) is amended by inserting ``(or were
being paid as of the date of enactment of section 211(a) of
the Personal Responsibility and Work Opportunity Act of 1996
(Public Law 104-193; 110 Stat. 2188) and would continue to be
paid but for the enactment of that section)'' after ``title
XVI''.
(b) Offset.--Section 2103(b) of the Social Security Act (as
added by section 5801) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(4) the amendment made by section 5817A(a) of the
Balanced Budget Act of 1997 (relating to continued
eligibility for certain disabled children).''.
(c) Effective Date.--The amendment made by subsection (a)
applies to medical assistance furnished on or after July 1,
1997.
____

amendment no. 480

(Purpose: To clarify the family violence option under the temporary
assistance to needy families program)

On page 960, between lines 3 and 4, insert the following:

SEC. ________. PROTECTING VICTIMS OF FAMILY VIOLENCE.

(a) Findings.--Congress finds that--
(1) the intent of Congress in amending part A of title IV
of the Social Security Act (42 U.S.C. 601 et seq.) in section
103(a) of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (Public Law 104-193; 110 Stat
2112) was to allow States to take into account the effects of
the epidemic of domestic violence in establishing their
welfare programs, by giving States the flexibility to grant
individual, temporary waivers for good cause to victims of
domestic violence who meet the criteria set forth in section
402(a)(7)(B) of the Social Security Act (42 U.S.C.
602(a)(7)(B));
(2) the allowance of waivers under such sections was not
intended to be limited by other, separate, and independent
provisions of part A of title IV of the Social Security Act
(42 U.S.C. 601 et seq.);
(3) under section 402(a)(7)(A)(iii) of such Act (42 U.S.C.
602(a)(7)(A)(iii)), requirements under the temporary
assistance for needy families program under part A of title
IV of such Act may, for good cause, be waived for so long as
necessary; and
(4) good cause waivers granted pursuant to section
402(a)(7)(A)(iii) of such Act (42 U.S.C. 602(a)(7)(A)(iii))
are intended to be temporary and directed only at particular
program requirements when needed on an individual case-by-
case basis, and are intended to facilitate the ability of
victims of domestic violence to move forward and meet program
requirements when safe and feasible without interference by
domestic violence.
(b) Clarification of Waiver Provisions.--
(1) In general.--Section 402(a)(7) (42 U.S.C. 602(a)(7)) is
amended by adding at the end the following:
``(C) No numerical limits.--In implementing this paragraph,
a State shall not be subject to any numerical limitation in
the granting of good cause waivers under subparagraph
(A)(iii).
``(D) Waivered individuals not included for purposes of
certain other provisions of this part.--Any individual to
whom a good cause waiver of compliance with this Act has been
granted in accordance with subparagraph (A)(iii) shall not be
included for purposes of determining a State's compliance
with the participation rate requirements set forth in section
407, for purposes of applying the limitation described in
section 408(a)(7)(C)(ii), or for purposes of determining
whether to impose a penalty under paragraph (3), (5), or (9)
of section 409(a).''.
(2) Effective date.--The amendment made by paragraph (1)
takes effect as if it had been included in the enactment of
section 103(a) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (Public Law 104-193;
110 Stat. 2112).
(c) Federal Parent Locator Service.--
(1) In general.--Section 453 (42 U.S.C. 653), as amended by
section 5938, is further amended--
(A) in subsection (b)(2)--
(i) in the matter preceding subparagraph (A), by inserting
``or that the health, safety, or liberty or a parent or child
would by unreasonably put at risk by the disclosure of such
information,'' before ``provided that'';
(ii) in subparagraph (A), by inserting ``, that the health,
safety, or liberty or a parent or child would by unreasonably
put at risk by the disclosure of such information,'' before
``and that information''; and

[[Page S6173]]

(iii) in subparagraph (B)(i), by striking ``be harmful to
the parent or the child'' and inserting ``place the health,
safety, or liberty of a parent or child unreasonably at
risk''; and
(B) in subsection (c)(2), by inserting ``, or to serve as
the initiating court in an action to seek and order,'' before
``against a noncustodial''.
(2) State plan.--Section 454(26) (42 U.S.C. 654), as
amended by section 5956, is further amended--
(A) in subparagraph (C), by striking ``result in physical
or emotional harm to the party or the child'' and inserting
``place the health, safety, or liberty of a parent or child
unreasonably at risk'';
(B) in subparagraph (D), by striking ``of domestic violence
or child abuse against a party or the child and that the
disclosure of such information could be harmful to the party
or the child'' and inserting ``that the health, safety, or
liberty of a parent or child would be unreasonably put at
risk by the disclosure of such information''; and
(C) in subparagraph (E), by striking ``of domestic
violence'' and all that follows through the semicolon and
inserting ``that the health, safety, or liberty of a parent
or child would be unreasonably put at risk by the disclosure
of such information pursuant to section 453(b)(2), the court
shall determine whether disclosure to any other person or
persons of information received from the Secretary could
place the health, safety, or liberty or a parent or child
unreasonably at risk (if the court determines that disclosure
to any other person could be harmful, the court and its
agents shall not make any such disclosure);''.
(3) Effective date.--The amendments made by this subsection
shall take effect 1 day after the effective date described in
section 5961(a).
____

amendment no. 481

(Purpose: To amend the provision on transfer cases, and for other
purposes)

On page 562, between line 20 and 21, insert the following:
``(XIV) for calendar year 1999 for hospitals in all areas,
the market basket percentage increase minus 1.3 percentage
points,''.
On page 562, line 21, strike ``(XIV) for calendar year
1999'' and insert ``(XV) for calendar year 2000.''.
On page 563, line 1, strike ``(XV)'' and insert ``(XVI)''.
On page 604, line 22, strike ``upon discharge from a
subsection (d) hospital'' and insert ``immediately upon
discharge from, and pursuant to the discharge planning
process (as defined in section 1861(ee)) of, a subsection (d)
hospital''.
Beginning on page 605, strike line 7 and all that follows
through page 606, line 6, and insert the following:
(b) Effective Date.--The amendment made by subsection (a)
shall apply with respect to discharges occurring on or after
October 1, 1997.
____

amendment no. 482

(Purpose: To allow vocational educational training to be counted as a
work activity under the temporary assistance for needy families program
for 24 months)

amendment no. 482

On page 930, between lines 14 and 15, insert the following:
(l) Vocational Educational Training.--Section 407(d)(8) (42
U.S.C. 607(d)(8)) is amended by striking ``12'' and inserting
``24''.
____

amendment no. 483

(Purpose: To provide for the continuation of certain State-wide
medicaid waivers)

On page 844, between lines 7 and 8, insert the following:

SEC. 5768. CONTINUATION OF STATE-WIDE SECTION 1115 MEDICAID
WAIVERS.

(a) In General.--Section 1115 of the Social Security Act
(42 U.S.C. 1315) is amended by adding at the end the
following:
``(d)(1) The provisions of this subsection shall apply to
the extension of statewide comprehensive research and
demonstration projects (in this subsection referred to as
`waiver project') for which waivers of compliance with the
requirements of title XIX are granted under subsection (a).
With respect to a waiver project that, but for the enactment
of this subsection, would expire, the State at its option
may--
``(A) not later than 1 year before the waiver under
subsection (a) would expire (acting through the chief
executive officer of the State who is operating the project),
submit to the Secretary a written request for an extension of
such waiver project for up to 3 years; or
``(B) permanently continue the waiver project if the
project meets the requirements of paragraph (2).
``(2) The requirements of this paragraph are that the
waiver project--
``(A) has been successfully operated for 5 or more years;
and
``(B) has been shown, through independent evaluations
sponsored by the Health Care Financing Administration, to
successfully contain costs and provide access to health care.
``(3)(A) In the case of waiver projects described in
paragraph (1)(A), if the Secretary fails to respond to the
request within 6 months after the date on which the request
was submitted, the request is deemed to have been granted.
``(B) If the request is granted or deemed to have been
granted, the deadline for submittal of a final report shall
be 1 year after the date on which the waiver project would
have expired but for the enactment of this subsection.
``(C) The Secretary shall release an evaluation of each
such project not later than 1 year after the date of receipt
of the final report.
``(D) Phase-down provisions which were applicable to waiver
projects before an extension was provided under this
subsection shall not apply.
``(4) The extension of a waiver project under this
subsection shall be on the same terms and conditions
(including applicable terms and conditions related to quality
and access of services, budget neutrality as adjusted for
inflation, data and reporting requirements and special
population protections), except for any phase down
provisions, and subject to the same set of waivers that
applied to the project or were granted before the extension
of the project under this subsection. The permanent
continuation of a waiver project shall be on the same terms
and conditions, including financing, and subject to the same
set of waivers. No test of budget neutrality shall be applied
in the case of projects described in paragraph (2) after that
date on which the permanent extension was granted.
``(5) In the case of a waiver project described in
paragraph (2), the Secretary, acting through the Health Care
Financing Administration, shall deem any State's request to
expand medicaid coverage in whole or in part to individuals
who have an income at or below the Federal poverty level as
budget neutral if independent evaluations sponsored by the
Health Care Financing Administration have shown that the
State's medicaid managed care program under such original
waiver is more cost effective and efficient than the
traditional fee-for-service medicaid program that, in the
absence of any managed care waivers under this section, would
have been provided in the State.''.
(b) Effective Date.--The amendment made by subsection (a)
shall become effective on the date of enactment of this Act.

AMENDMENT NO. 484

(Purpose: To make community action agencies, community development
corporations and other non-profit organizations eligible for welfare-
to-work grants)

On page 885, line 15, insert after ``State'' the following:
``or a community action agency, community development
corporation or other non-profit organizations with
demonstrated effectiveness in moving welfare recipients into
the workforce''.
____

AMENDMENT NO. 485

(Purpose: To provide that the hospital length of stay with respect to
an individual shall be determined by the attending physician)

At the end of the proposed section 1852(d) of the Social
Security Act (as added by section 5001), add the following:
``(4) Determination of hospital length of stay.--
``(A) In general.--A Medicare Choice organization shall
cover the length of an inpatient hospital stay under this
part as determined by the attending physician, in
consultation with the patient, to be medically appropriate.
``(B) Construction.--Nothing in this paragraph shall be
construed--
``(i) as requiring the provision of inpatient coverage if
the attending physician, in consultation with the patient,
determine that a shorter period of hospital stay is medically
appropriate, or
``(ii) as affecting the application of deductibles and
coinsurance.
At the appropriate place in chapter 2 of subtitle H of
division 1 of title V, insert the following new section:

SEC. ____. HOSPITAL LENGTH OF STAY.

(a) In General.--Section 1866(a)(1) (42 U.S.C.
1395cc(a)(1)) is amended--
(1) by striking ``and'' at the end of subparagraph (Q);
(2) by striking the period at the end of subparagraph (R)
and inserting ``; and'';
(3) by inserting after subparagraph (R) the following:
``(S) in the case of hospitals, not to discharge an
inpatient before the date the attending physician and patient
determine it to be medically appropriate.''.
(b) Effective date.--The amendments made by subsection (a)
shall apply to discharges occurring on or after 6 months
after the date of enactment of this Act.
At the appropriate place in chapter 5 of subtitle I of
division 2 of title V, insert the following new section:

SEC. ____. DETERMINATION OF HOSPITAL STAY.

(a) In General.--Title XIX (42 U.S.C. 1396 et seq.) is
amended--
(1) by redesignating section 1933 as section 1934; and
(2) by inserting after section 1932 the following new
section:

``determination of hospital stay

``Sec. 1933. (a) In General.--A State plan for medical
assistance under this title shall cover the length of an
inpatient hospital stay under this part as determined by the
attending physician, in consultation with the patient, to be
medically appropriate.
``(b) Construction.--Nothing in this section shall be
construed--
``(1) as requiring the provision of inpatient coverage if
the attending physician, in consultation with the patient,
determine that a shorter period of hospital stay is medically
appropriate, or
``(2) as affecting the application of deductibles and
coinsurance.''.

[[Page S6174]]

(b) Effective date.--The amendments made by subsection (a)
shall apply to discharges occurring on or after 6 months
after the date of enactment of this Act.
____

amendment no. 486

(Purpose: To provide additional funding for State emergency health
services furnished to undocumented aliens)

At the appropriate place in chapter 1 of subtitle K of
division 2 of title V, insert the following new section:

SEC. ____. ADDITIONAL FUNDING FOR STATE EMERGENCY HEALTH
SERVICES FURNISHED TO UNDOCUMENTED ALIENS.

(a) Total Amount Available for Allotment.--There are
available for allotments under this section for each of the 5
fiscal years (beginning with fiscal year 1998) $20,000,000
for payments to certain States under this section.
(b) State Allotment Amount.--
(1) In general.--The Secretary of Health and Human Services
shall compute an allotment for each fiscal year beginning
with fiscal year 1998 and ending with fiscal year 2002 for
each of the 12 States with the highest number of undocumented
aliens. The amount of such allotment for each such State for
a fiscal year shall bear the same ratio to the total amount
available for allotments under subsection (a) for the fiscal
year as the ratio of the number of undocumented aliens in the
State in the fiscal year bears to the total of such numbers
for all States for such fiscal year. The amount of allotment
to a State provided under this paragraph for a fiscal year
that is not paid out under subsection (c) shall be available
for payment during the subsequent fiscal year.
(2) Determination.--For purposes of paragraph (1), the
number of undocumented aliens in a State under this section
shall be determined based on estimates of the resident
illegal alien population residing in each State prepared by
the Statistics Division of the Immigration and Naturalization
Service as of October 1992 (or as of such later date if such
date is at least 1 year before the beginning of the fiscal
year involved).
(c) Use of Funds.--From the allotments made under
subsection (b), the Secretary shall pay to each State amounts
the State demonstrates were paid by the State (or by a
political subdivision of the State) for emergency health
services furnished to undocumented aliens.
(d) State Defined.--For purposes of this section, the term
``State'' includes the District of Columbia.
(e) State Entitlement.--This section constitutes budget
authority in advance of appropriations Acts and represents
the obligation of the Federal Government to provide for the
payment to States of amounts provided under subsection (c).
____

amendment no. 487

(Purpose: To provide for the application of disproportionate share
hospital-specific payment adjustments with respect to California)

At the appropriate place in section 5721, insert the
following:
(____) Application of DSH Payment Adjustment.--
Notwithstanding subsection (d), effective July 1, 1997,
section 1923(g)(2)(A) of the Social Security Act (42 U.S.C.
1396r-4(g)(2)(A)) shall be applied to the State of California
as though--
(1) ``or that begins on or after July 1, 1997, and before
July 1, 1999,'' were inserted in such section after ``January
1, 1995,''; and
(2) ``(or 175 percent in the case of a State fiscal year
that begins on or after July 1, 1997, and before July 1,
1999)'' were inserted in such section after ``200 percent''.
____

amendment no. 488

(Purpose: To provide for actuarially sufficient reimbursement rates for
providers)

Beginning on page 764, strike line 7 and all that follows
through page 765, line 17, and insert the following:
(a) Plan Amendments.--Section 1902(a)(13) is amended--
(1) by striking all that precedes subparagraph (D) and
inserting the following:
``(13)(A) provide--
``(i) for the State-based determination of rates of payment
under the plan for hospital services (and which, in the case
of hospitals, take into account the situation of hospitals
which serve a disproportionate number of low income patients
with special needs), nursing facility services, and services
provided in intermediate care facilities for the mentally
retarded, under which the State provides assurances to the
Secretary that proposed rates will be actuarially sufficient
to ensure access to and quality of services;
``(ii) that the State will submit such proposed rates for
review by an independent actuary selected by the Secretary;
and
``(iii) that any new rates or modifications to existing
rates will be developed through a public rulemaking procedure
under which such new or modified rates are published in 1 or
more daily newspapers of general circulation in the State or
in any publication used by the State to publish State
statutes or rules, and providers, beneficiaries and their
representatives, and other concerned State residents are
given a reasonable opportunity for review and comment on such
rates or modifications;''; and
(2) by redesignating subparagraphs (D), (E), and (F) as
subparagraphs (B), (C), and (D) respectively.
____

amendment no. 489

(Purpose: To strike the repeal of the Boren amendment)

Beginning on page 764, strike line 5 and all that follows
through line 23 on page 766.

Ms. MIKULSKI. Mr. President, I rise today to support the Wellstone/
Mikulski amendment which maintains the Boren amendment on nursing home
reimbursement.
The Boren amendment ensures an adequate daily reimbursement rate for
nursing homes under Medicaid. It helps nursing homes have the funds
they need to meet Federal quality and safety standards. The Wellstone/
Mikulski amendment will keep this guarantee in place.
Right now, the Boren policy is under attack. It is under attack by
States. And it is under attack by Congress. If we repeal this law,
States will be able to set their own rates of reimbursement to nursing
homes.
We all know the tough budget climate we are operating in. Without the
Boren policy, we take away the Federal guarantee of adequate
reimbursement rates. This threatens the health and safety of senior
citizens. States worry about reimbursements. I'm worried about seniors.
Without Boren, the State reimbursement rates may be too low to ensure
that nursing homes can continue to provide quality care. Do we really
want to return to the bad old days when senior citizens living in
nursing homes faced inadequate care? Can we afford to forget the horror
stories from the 1980's about living and quality conditions in some
nursing homes?
Well, the Boren amendment helped to change that. We must protect the
integrity of the law. The amendment Senator Wellstone and I are
offering will do that.
Our amendment protects senior citizens living in nursing homes. And
it ensures that nursing homes get an appropriate level of
reimbursement. It does this by requiring States to reimburse nursing
homes for the costs of daily care.
It ensures that States will have adequate reimbursement to provide
quality services. It maintains Federal Government oversight. It
maintains quality standards and it will protect seniors.
We have been through the fight to keep Federal nursing home
standards. And Congress voted last year on a bipartisan basis to keep
Federal standards and to maintain Federal enforcement.
In my State of Maryland, already the reimbursement rate is very low.
Maryland gets $78 per day when it costs an average of $112 to provide
nursing home care. Maryland nursing homes use this reimbursement to
provide room and board, around the clock medical care, three meals a
day, and bathing, and feeding. You can't even get a good hotel room for
that rate. We cannot have the rates fall any lower without jeopardizing
patients.
Mr. President, we must protect the Boren amendment. That is why I
strongly support the Wellstone/Mikulski amendment. I urge my colleagues
to vote for this amendment.

AMENDMENT NO. 490

(Purpose: To improve the provisions relating to the Higher Education
Act of 1965)

Strike title VII and insert the following:
TITLE VII--COMMITTEE ON LABOR AND HUMAN RESOURCES

SEC. 7001. MANAGEMENT AND RECOVERY OF RESERVES.

(a) Amendment.--Section 422 of the Higher Education Act of
1965 (20 U.S.C. 1072) is amended by adding after subsection
(g) the following new subsection:
``(h) Recall of Reserves; Limitations on Use of Reserve
Funds and Assets.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary shall, except as otherwise provided in
this subsection, recall $1,200,000,000 from the reserve funds
held by guaranty agencies under this part on September 1,
2002.
``(2) Deposit.--Funds recalled by the Secretary under this
subsection shall be deposited in the Treasury.
``(3) Equitable share.--The Secretary shall require each
guaranty agency to return reserve funds under paragraph (1)
based on such agency's equitable share of excess reserve
funds held by guaranty agencies as of September 30, 1996. For
purposes of this paragraph, a guaranty agency's equitable
share of excess reserve funds shall be determined as follows:
``(A) The Secretary shall compute each agency's reserve
ratio by dividing (i) the amount held in such agency's
reserve (including funds held by, or under the control of,
any other entity) as of September 30, 1996, by (ii) the
original principal amount of all

[[Page S6175]]

loans for which such agency has an outstanding insurance
obligation.
``(B) If the reserve ratio of any agency as computed under
subparagraph (A) exceeds 1.12 percent, the agency's equitable
share shall include so much of the amounts held in such
agency's reserve fund as exceed a reserve ratio of 1.12
percent.
``(C) If any additional amount is required to be recalled
under paragraph (1) (after deducting the total of the
equitable shares calculated under subparagraph (B)), the
agencies' equitable shares shall include additional amounts--
``(i) determined by imposing on each such agency an equal
percentage reduction in the amount of each agency's reserve
fund remaining after deduction of the amount recalled under
subparagraph (B); and
``(ii) the total of which equals the additional amount that
is required to be recalled under paragraph (1) (after
deducting the total of the equitable shares calculated under
subparagraph (B)).
``(4) Restricted accounts.--Within 90 days after the
beginning of each of fiscal years 1998 through 2002, each
guaranty agency shall transfer a portion of each agency's
equitable share determined under paragraph (3) to a
restricted account established by the guaranty agency that is
of a type selected by the guaranty agency with the approval
of the Secretary. Funds transferred to such restricted
accounts shall be invested in obligations issued or
guaranteed by the United States or in other similarly low-
risk securities. A guaranty agency shall not use the funds in
such a restricted account for any purpose without the express
written permission of the Secretary, except that a guaranty
agency may use the earnings from such restricted account for
activities to reduce student loan defaults under this part.
The portion required to be transferred shall be determined as
follows:
``(A) In fiscal year 1998--
``(i) all agencies combined shall transfer to a restricted
account an amount equal to one-fifth of the total amount
recalled under paragraph (1);
``(ii) each agency with a reserve ratio (as computed under
paragraph (3)(A)) that exceeds 2 percent shall transfer to a
restricted account so much of the amounts held in such
agency's reserve fund as exceed a reserve ratio of 2 percent;
and
``(iii) each agency shall transfer any additional amount
required under clause (i) (after deducting the amount
transferred under clause (ii)) by transferring an amount that
represents an equal percentage of each agency's equitable
share to a restricted account.
``(B) In fiscal years 1999 through 2002, each agency shall
transfer an amount equal to one-fourth of the total amount
remaining of the agency's equitable share (after deduction of
the amount transferred under subparagraph (A)).
``(5) Shortage.--If, on September 1, 2002, the total amount
in the restricted accounts described in paragraph (4) is less
than the amount the Secretary is required to recall under
paragraph (1), the Secretary shall require the return of the
amount of the shortage from other reserve funds held by
guaranty agencies under procedures established by the
Secretary.
``(6) Prohibition.--The Secretary shall not have any
authority to direct a guaranty agency to return reserve funds
under subsection (g)(1)(A) during the period from the date of
enactment of this subsection through September 30, 2002, and
any reserve funds otherwise returned under subsection (g)(1)
during such period shall be treated as amounts recalled under
this subsection and shall not be available under subsection
(g)(4).
``(7) Definition.--For purposes of this subsection the term
`reserve funds' when used with respect to a guaranty agency--
``(A) includes any reserve funds held by, or under the
control of, any other entity; and
``(B) does not include buildings, equipment, or other
nonliquid assets.''.
(b) Conforming Amendment.--Section 428(c)(9)(A) of the
Higher Education Act of 1965 (20 U.S.C. 1078(c)(9)(A)) is
amended--
(1) in the first sentence, by striking ``for the fiscal
year of the agency that begins in 1993''; and
(2) by striking the third sentence.

SEC. 7002. REPEAL OF DIRECT LOAN ORIGINATION FEES TO
INSTITUTIONS OF HIGHER EDUCATION.

Section 452 of the Higher Education Act of 1965 (20 U.S.C.
1087b) is amended--
(1) by striking subsection (b); and
(2) by redesignating subsections (c) and (d) as subsections
(b) and (c), respectively.

SEC. 7003. LENDER AND HOLDER RISK SHARING.

Section 428(b)(1)(G) of the Higher Education Act of 1965
(20 U.S.C. 1078(b)(1)(G)) is amended by striking ``not less
than 98 percent'' and inserting ``95 percent''.

SEC. 7004. FEES AND INSURANCE PREMIUMS.

(a) In General.--Section 428(b)(1)(H) of the Higher
Education Act of 1965 (20 U.S.C. 1078(b)(1)(H)) is amended--
(1) by inserting ``(i)'' before ``provides'';
(2) by striking ``the loan,'' and inserting ``any loan made
under section 428 before July 1, 1998,'';
(3) by inserting ``and'' after the semicolon; and
(4) by adding at the end the following:
``(ii) provides that no insurance premiums shall be charged
to the borrower of any loan made under section 428 on or
after July 1, 1998;''.
(b) Special Allowances.--Section 438(c) of the Higher
Education Act of 1965 (20 U.S.C. 1087-1(c)) is amended--
(1) in paragraph (2), by striking ``paragraph (6)'' and
inserting ``paragraphs (6) and (8)''; and
(2) by adding at the end the following:
``(8) Origination fee on subsidized loans on or after july
1, 1998.--In the case of any loan made or insured under
section 428 on or after July 1, 1998, paragraph (2) shall be
applied by substituting `2.0 percent' for `3.0 percent'.''.
(c) Direct Loans.--Section 455(c) of the Higher Education
Act of 1965 (20 U.S.C. 1087e(c)) is amended--
(1) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--For loans made under this part before
July 1, 1998, the Secretary'';
(2) by striking ``of a loan made under this part''; and
(3) by adding at the end the following:
``(2) Origination fee.--For loans made under this part on
or after July 1, 1998, the Secretary shall charge the
borrower an origination fee of 2.0 percent of the principal
amount of the loan, in the case of Federal Direct Stafford/
Ford Loans.''.

SEC. 7005. SECRETARY'S EQUITABLE SHARE.

Section 428(c)(6)(A)(ii) of the Higher Education Act of
1965 (20 U.S.C. 1078(c)(6)(A)(ii) is amended by striking ``27
percent'' and inserting ``18.5 percent''.

SEC. 7006. FUNDS FOR ADMINISTRATIVE EXPENSES.

The first sentence of section 458(a) of the Higher
Education Act of 1965 (20 U.S.C. 1087h(a)) is amended by
striking ``$260,000,000'' and all that follows through the
end of the sentence and inserting ``$532,000,000 in fiscal
year 1998, $610,000,000 in fiscal year 1999, $705,000,000 in
fiscal year 2000, $750,000,000 in fiscal year 2001, and
$750,000,000 in fiscal year 2002.''.

SEC. 7007. EXTENSION OF STUDENT AID PROGRAMS.

Title IV of the Higher Education Act of 1965 (20 U.S.C.
1070 et seq.) is amended--
(1) in section 424(a), by striking ``1998.'' and ``2002.''
and inserting ``2002.'' and ``2006.'', respectively;
(2) in section 428(a)(5), by striking ``1998,'' and
``2002.'' and inserting ``2002,'' and ``2006.'',
respectively; and
(3) in section 428C(e), by striking ``1998.'' and inserting
``2002.''.

SEC. 7008. EFFECTIVE DATE.

This subtitle and the amendments made by this subtitle take
effect on October 1, 1997.
____

amendment no. 491

(Purpose: To prohibit cost-sharing for children in families with
incomes that are less than 150 percent of the poverty line)

Section 1916(g)(1) of the Social Security Act, as amended
by section 5754, is amended by inserting before the period
the following: ``, except that no cost-sharing may be imposed
with respect to medical assistance provided to an individual
who has not attained age 18 if such individuals family income
does not exceed 150 percent of the poverty line applicable to
a family of the size involved, and if, as of the date of
enactment of the Balanced Budget Act of 1997, cost-sharing
could not be imposed with respect to medical assistance
provided to such individual.''.
____

amendment no. 492

(Purpose: To ensure the provision of appropriate benefits for uninsured
children with special needs)

At the appropriate place in section 2102(5) of the Social
Security Act as added by section 5801, insert the following:
``The benefits shall include additional benefits to meet the
needs of children with special needs, including--
``(A) rehabilitation and habilitation services, including
occupational therapy, physical therapy, speech and language
therapy, and respiratory therapy services;
``(B) mental health services;
``(C) personal care services;
``(D) customized durable medical equipment, orthotics, and
prosthetics, as medically necessary; and
``(E) case management services.
``With respect to FEHBP-equivalent children's health
insurance coverage, services otherwise covered under the
coverage involved that are medically necessary to maintain,
improve, or prevent the deterioration of the physical,
developmental, or mental health of the child may not be
limited with respect to scope and duration, except to the
degree that such services are not medically necessary.
Nothing in the preceding sentence shall be construed to
prevent FEHBP-equivalent children's health insurance coverage
from utilizing appropriate utilization review techniques to
determine medical necessity or to prevent the delivery of
such services through a managed care plan.''.
____

AMENDMENT NO. 493

(Purpose: To exempt severely disabled aliens from the ban on receipt of
supplemental security income)

On page 874, between lines 7 and 8, insert the following:

SEC. 5817A. SSI ELIGIBILITY FOR SEVERELY DISABLED ALIENS.

Section 402(a)(2) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(a)(2)),
as amended by section 5815, is amended by adding at the end
the following:
``(I) Ssi exception for severely disabled aliens.--With
respect to eligibility for benefits for the program defined
in paragraph

[[Page S6176]]

(3)(A) (relating to the supplemental security income
program), paragraph (1), and the September 30, 1997
application deadline under subparagraph (G), shall not apply
to any alien who is lawfully present in the United States and
who has been denied approval of an application for
naturalization by the Attorney General solely on the ground
that the alien is so severely disabled that the alien is
otherwise unable to satisfy the requirements for
naturalization.''.
____

AMENDMENT NO 494

(Purpose: To provide for Medicaid eligibility of disabled children who
lose SSI benefits)

On page 874, between lines 7 and 8, insert the following:

SEC. 5817A CONTINUATION OF MEDICAID ELIGIBILITY FOR DISABLED
CHILDREN WHO LOSE SSI BENEFITS.

(a) In General.--Section 1902(a)(10)(A)(i)(II)(42 U.S.C.
1396a(a)(10)(A)(i)(II)) is amended by inserting ``(or were
being paid as of the date of enactment of section 211(a) of
the Personal Responsibility and Work Opportunity Act of 1996
(Public Law 104-193; 110 Stat. 2188) and would continue to be
paid but for the enactment of that section)'' after ``title
XVI''.
(b) Offset.--Section 2103(b) of the Social Security Act (as
added by section 5801) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(4) the amendment made by section 5817A(a) of the
Balanced Budget Act of 1997 (relating to continued
eligibility for certain disabled children).''.
(c) Effective Date.--The amendment made by subsection (a)
applies to medical assistance furnished on or after July 1,
1997.
____

AMENDMENT NO. 495

(Purpose: To establish a process to permit a nurse aide to petition to
have his or her name removed from the nurse aide registry under certain
circumstances)

On page 844, between lines 7 and 8, insert the following:

SEC. . REMOVAL OF NAME FROM NURSE AIDE REGISTRY.

(a) Medicare.--Section 1819(g)(1)(C) of the Social Security
Act (42 U.S.C. 1395i-3(g)(1)(C)) is amended--
(1) in the first sentence by striking ``The State'' and
inserting ``(i) The State''; and
(2) by adding at the end the following:
``(ii)(I) In the case of a finding of neglect, the State
shall establish a procedure to permit a nurse aide to
petition the State to have his or her name removed from the
registry upon a determination by the State that--
``(aa) the employment and personal history of the nurse
aide does not reflect a pattern of abusive behavior or
neglect; and
``(bb) the neglect involved in the original finding was a
singular occurrence.
``(II) In no case shall a determination on a petition
submitted under clause (I) be made prior to the expiration of
the 1-year period beginning on the date on which the name of
the petitioner was added to the registry under this
subparagraph.''.
(b) Medicaid.--Section 1919(g)(1)(C) of the Social Security
Act (42 U.S.C. 1396r(g)(1)(C)) is amended--
(1) in the first sentence by striking ``The State'' and
inserting ``(i) The State''; and
(2) by adding at the end the following:
``(ii)(I) In the case of a finding of neglect, the State
shall establish a procedure to permit a nurse aide to
petition the State to have his or her name removed from the
registry upon a determination by the State that--
``(aa) the employment and personal history of the nurse
aide does not reflect a pattern of abusive behavior or
neglect; and
``(bb) the neglect involved in the original finding was a
singular occurrence.
``(II) In no case shall a determination on a petition
submitted under clause (I) be made prior to the expiration of
the 1-year period beginning on the date on which the name of
the petitioner was added to the registry under this
subparagraph.''.
(c) Retroactive Review.--The procedures developed by a
State under the amendments made by subsection (a) and (b)
shall permit an individual to petition for a review of any
finding made by a State under section 1819(g)(1)(C) or
1919(g)(1)(C) of the Social Security Act (42 U.S.C. 1395i-
3(g)(1)(C) or 1396r(g)(1)(C)) after January 1, 1995.
(d) Study and Report.--
(1) Study.--The Secretary of Health and Human Services
shall conduct a study of--
(A) the use of nurse aide registries by States, including
the number of nurse aides placed on the registries on a
yearly basis and the circumstances that warranted their
placement on the registries;
(B) the extent to which institutional environmental factors
(such as a lack of adequate training or short staffing)
contribute to cases of abuse and neglect at nursing
facilities; and
(C) whether alternatives (such as a probational period
accompanied by additional training or mentoring or sanctions
on facilities that create an environment that encourages
abuse or neglect) to the sanctions that are currently applied
under the Social Security Act for abuse and neglect at
nursing facilities might be more effective in minimizing
future cases of abuse and neglect.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Secretary of Health and Human
Services shall prepare and submit to the appropriate
committees of Congress, a report concerning the results of
the study conducted under paragraph (1) and the
recommendation of the Secretary for legislation based on such
study.
____

amendment no. 496

(Purpose: To strike the limitation on the coverage of abortions)

On page 860, strike all matter after line 10 and before
line 15, and the following:
``(d) Use Limited to State Program Expenditures.--Funds
provided to an eligible State under this title shall only be
used to carry out the purpose of this title.
____

amendment no. 497

(Purpose: To clarify that risk solvency standards established for
managed care entities under the Medicaid program shall not preempt any
State standards that are more stringent)

On page 743, line 6, strike the period and insert ``(but
that shall not preempt any State standards that are more
stringent than the standards established under this
subparagraph.''.
____

amendment no. 498

(Purpose: To allow funds provided under the welfare-to work grant
program to be used for the microloan demonstration program under the
Small Business Act)

On page 888, between lines 22 and 23, insert the following:
``(VI) Technical assistance and related services that lead
to self-employment through the microloan demonstration
program under section 7(m) of the Small Business Act (15
U.S.C. 636(m))

Mr. LAUTENBERG. Again, the first amendment on that list, Mr.
President, is the Lautenberg amendment.
Mr. CONRAD addressed the Chair.
The PRESIDING OFFICER. The Senator recognizes the Senator from North
Dakota.
Mr. LAUTENBERG. May we finish this up?
Mr. DOMENICI. I need to finish this work, if you don't mind.
Senator, I understand you did submit an amendment with reference to
the illegal aliens.
Mr. LAUTENBERG. Legal.
Mr. DOMENICI. Legal aliens.

Amendment No. 499

(Purpose: To provide SSI eligibility for disabled legal aliens)

Mr. DOMENICI. Mr. President, I send an amendment to the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Mexico [Mr. Domenici] proposes an
amendment numbered 499.

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 amendment is as follows:

Strike sections 5811 through 5814 and insert the following:

SEC. 5812. EXTENSION OF ELIGIBILITY PERIOD FOR REFUGEES AND
CERTAIN OTHER QUALIFIED ALIENS FROM 5 TO 7
YEARS FOR SSI AND MEDICAID.

(a) SSI.--Section 402(a)(2)(A) of the Personal
Responsibility and Work Opportunity Reconciliation Act of
1996 (8 U.S.C. 1612(a)(2)(A)) is amended to read as follows:
``(A) Time-limited exception for refugees and asylees.--
``(i) SSI.--With respect to the specified Federal program
described in paragraph (3)(A) paragraph 1 shall not apply to
an alien until 7 years after the date--
``(I) an alien is admitted to the United States as a
refugee under section 207 of the Immigration and Nationality
Act;
``(II) an alien is granted asylum under section 208 of such
Act; or
``(III) an alien's deportation is withheld under section
243(h) of such Act.
``(ii) Food stamps.--With respect to the specified Federal
program described in paragraph (3)(B), paragraph 1 shall not
apply to an alien until 5 years after the date--
``(I) an alien is admitted to the United States as a
refugee under section 207 of the Immigration and Nationality
Act:
``(II) an alien is granted asylum under section 208 of such
Act; or
``(III) an alien's deportation is withheld under section
243(h) of such Act.''.
(b) Medicaid.--Section 402(b)(2)(A) of the Personal
Responsibility and Work Opportunity Reconciliation Act of
1996 (8 U.S.C. 1612(b)(2)(A)) is amended to read as follows:
``(A) Time-limited exception for refugees and asylees.--
``(i) Medicaid.--With respect to the designated Federal
program described in paragraph (3)(C), paragraph 1 shall not
apply to an alien until 7 years after the date--
``(I) an alien is admitted to the United States as a
refugee under section 207 of the Immigration and nationality
Act:
``(II) an alien is granted asylum under section 208 of such
Act; or
``(III) an alien's deportation is withheld under section
243(h) of such Act.

[[Page S6177]]

``(ii) Other designated federal programs.--With respect to
the designated Federal programs under paragraph (3) (other
than subparagraph (C)), paragraph 1 shall not apply to an
alien until 5 years after the date--
``(I) an alien is admitted to the United States as a
refugee under section 207 of the Immigration and Nationality
Act;
``(II) an alien is granted asylum under section 208 of such
Act; or
``(III) an alien's deportation is withheld under section
243(h) of such Act.''.
(c) Status of Cuban and Haitian Entrants.--For purposes of
sections 402(a)(2)(A) and 402(b)(2)(A) of the Personal
Responsibility and Work Opportunity Reconciliation Act of
1996 (8 U.S.C. 1612(a)(2)(A), (b)(2)(A), an alien who is a
Cuban and Haitian entrant, as defined in section 501(e) of
the Refugee Education Assistance Act of 1984, shall be
considered a refugee.

SEC. 5813. SSI ELIGIBILITY FOR PERMANENT RESIDENT ALIENS WHO
ARE MEMBERS OF AN INDIAN TRIBE.

Section 402(a)(2) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1966 (8 U.S.C. 1612(a)(2))
(as amended by section 5311) is amended by adding at the end
the following:
``(F) Permanent resident aliens who are members of an
indian tribe.--With respect to eligibility for benefits for
the program defined in paragraph (3)(A) (relating to the
supplemental security income program), paragraph (1) shall
not apply to an alien who--
``(i) is lawfully admitted for permanent residence under
the Immigration and Nationality Act; and
``(ii) is a member of an Indian tribe (as defined in
section 4(e) of the Indian Self-Determination and Education
Assistance Act).''.

SEC. 5814. SSI ELIGIBILITY FOR DISABLED LEGAL ALIENS IN THE
UNITED STATES ON AUGUST 22, 1996.

(a) Section 402(a)(2) of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (8 U.S.C.
1612(a)(2) (as amended by section 5813) is amended by adding
at the end the following:
``(G) SSI eligibility for disabled aliens.--With respect to
eligibility for benefits for the program defined in paragraph
(3)(A) (relating to the supplemental security income
program), paragraph (1) shall not apply--
``(i) to an alien who--
``(I) is lawfully residing in any State on August 22, 1996;
and
``(II) is disabled, as defined in section 1614(a)(3) of the
Social Security Act (42 U.S.C. 1382c(a)(3)); or
``(ii) to an alien who--
``(I) is lawfully residing in any State and after such
date;
``(II) is disabled (as so defined and
``(III) as of June 1, 1997, is receiving benefits under
such program.''.
``(b) Funds shall be made available for not to exceed 2
years for elderly SSI recipients made ineligible for benefits
after August 22, 1996.
Mr. DOMENICI. I wonder if the Senator from Delaware would mind taking
over for me. We are only going to be another 10 minutes, and he can
close it. I would appreciate that.
Senator Lautenberg, I will see you in the morning.
Mr. LAUTENBERG. I look forward to that.
Mr. DOMENICI. Have we run out of time under the bill?
The PRESIDING OFFICER. My understanding is that the time runs out at
9:15.
Mr. DOMENICI. You have plenty of time, Senator.
Several Senators addressed the Chair.
Mr. CONRAD. Mr. President, I yielded to the distinguished Republican
manager. I would like to reclaim my time at this point.
Mr. DOMENICI. I didn't know you had an amendment.
Mr. CONRAD. I have a point of order that I would like to raise.
Mr. DOMENICI. I wonder if we could finish this part of getting them
in.
Mr. CONRAD. Yes. I would be happy to yield for that purpose.

Amendment No. 500

(Purpose: To require that any benefits package offered under the block
grant option for the children's health initiative includes hearing and
visions services)

Mr. DOMENICI. I send an amendment to the desk in behalf of Mr. Chafee
and Mr. Rockefeller.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Mexico [Mr. Domenici] for Mr. Chafee
for himself and Mr. Rockefeller, proposes an amendment
numbered 500.
The amendment is as follows:

On page 847, beginning on line 1, strike ``and that
otherwise satisfies State insurance standards and
requirements.'' and insert ``that includes hearing and vision
services for children, and that otherwise satisfies State
insurance standards and requirements.''.

Amendment No. 501

(Purpose: To require that any benefits package offered under the block
grant option for the children's health initiative includes hearing and
visions services)

Mr. DOMENICI. Mr. President, I send an amendment to the desk in
behalf of Senator Chafee and Senator Rockefeller.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Mexico [Mr. Domenici], for Mr. Chafee,
for himself and Mr. Rockefeller proposes an amendment
numbered 501.
The amendment is as follows:

On page 861, after line 26, add the following:
``(4) Hearing and vision services.--Notwithstanding the
definition of FEHBP-equivalent children's health insurance
coverage in section 2102(5), any package of health insurance
benefits offered by a State that opts to use funds provided
under this title under this section shall include hearing and
vision services for children.''.

Mr. CONRAD addressed the Chair.
The PRESIDING OFFICER. The Senator from North Dakota.
I would assume that the Senator would be willing to yield for
additional amendments that may be filed.
Mr. CONRAD. That is the case.
The PRESIDING OFFICER. The Senator may proceed.

Point of Order

Mr. CONRAD. I rise to make a point of order that section 5822 of this
bill is extraneous and violates section 313(b)(1)(D) of the Budget Act,
the so-called Byrd rule.
Mr. President, I urge my colleagues to join me in opposing what
amounts to a $2 billion blank check for one State, the State of Texas.
The bill before us would require the Secretary of Health and Human
Services to approve the privatization of all Federal and State health
and human services benefit programs in the State of Texas without any
hearings and without any opportunity to review the proposal or ensure
that the goals of these programs are furthered by the proposal.
Mr. President, this is truly unprecedented. If we look at the
potential impact from this one State waiver, we see that it affects
2.35 million Medicaid beneficiaries, 2.1 million food stamp recipients,
10 percent of all the food stamp recipients in the United States,
nearly 1 million WIC recipients, and 20,000 children who are up for
adoption or qualify for foster care assistance.
The Texas waiver amounts to a $2 billion blank check without the
benefit of one hearing and without the benefit of any Senator knowing
what is in the proposal, because this is a proposal that has not been
revealed to the U.S. Senate. There has been no waiver submitted.
We hear a lot of talk that it is a waiver. There has been no waiver
submitted. This is a procurement document which, by law, is
confidential and cannot be reviewed by the U.S. Senate. There have been
no public hearings on this proposal--not one. Not a single Member here
has had privy to what this procurement document involves. There are
serious unanswered questions about whether taxpayers are protected from
liability, mismanagement or fraud.
Mr. President, let me go to the next chart. The contracting of human
services has a very checkered record. I have produced reviews of just
four situations which have occurred around the country, because I think
before we leap off this precipice, we ought to know what is in this
agreement. What is in this proposal? None of us have been privy to what
is here.
Let me just review with my colleagues what we have seen in other
agreements like this around the country. In California, an agreement
with Lockheed Martin for a child support enforcement contract, harshly
criticized in the California Assembly, slated to cost $99 million, now
projected to cost $260 million, cost overrun of 163 percent. The State
of California stopped payment in February of 1997; limited contractor
liability of only $44 million. Taxpayers have to pick up the rest--a
disaster in California.
Do we want this to be repeated in Texas? Some will say, well, it
won't happen in Texas. On what basis do they say that? Not a single
Senator knows what is in that procurement document --not a single one--
because it is confidential.

[[Page S6178]]

Virginia: Electronic Data Systems, a Medicaid contract. By the way,
this is the same company that seeks to privatize all--let me emphasis--
every single Federal and State program in the State of Texas. The same
company is involved in this Virginia matter.
This is a Medicaid contract in Virginia. The contract has been
canceled; 20 months behind schedule; error rate of more than 50
percent--error rate of more than 50 percent--alleged sweetheart deal;
EDS selected over competitor whose bid was 50 percent less; alleged
conflict of interest; company won contract after making revolving-door
hire of a senior Virginia Medicaid official.
Texas: Anderson Consulting, a child support system contract; 559
percent over the budget; over 4 years behind schedule; design errors
result in inability to handle changes in Federal regulations; taxpayers
to foot more than 78 percent of the project cost--another disaster.
Mr. President, before we do this, we ought to know what is in this
procurement document. We shouldn't be handing a blank check to Texas,
or any other State. I wouldn't advocate this for my State--a blank
check that could blow up on the taxpayers like these examples have
blown up.
Let me just conclude with the Florida Unisys contract, a Medicaid
contract. Unisys employees arrested for grand theft; one pleaded guilty
to fraud, forgery and money-laundering; two others charged with
racketeering; more arrests expected; use of temporary employees, one of
whom stole almost a quarter of a million dollars.
And we are getting ready to approve this kind of deal for the State
of Texas without any hearing, without any review, without a single
Senator knowing what is in the proposed agreement?
Mr. President, we ought to think very carefully before we go down
this path.
In Florida, authorities investigating alleged Medicaid theft of $20
million.
Boy, if the warning lights aren't out on this one, I don't know what
it will take.
Mr. President, we ought to review this circumstance, have a chance to
review it, have hearings, and make a determination if it makes any
sense for us to proceed on this basis. I think there are serious and
legitimate questions surrounding this proposed procurement document.
The Texas waiver has serious unanswered questions. How do we prevent
the massive cost overruns and high error rates that plague similar
projects in other States?
How do we protect against revolving-door hiring, kickbacks, or other
fraud?
Will the taxpayers be liable if a contractor fails to enroll eligible
individuals?
You know, this is a fundamental responsibility of Government to make
certain that those who are eligible get the benefits to which they are
entitled.
Who pays for it if they enroll people who are not eligible?
What happens to vulnerable Americans who need these programs for
basic survival if the contractor has financial incentives to minimize
enrollment, even of those who have every legal right to be qualified?
Mr. President, I would like to quote an editorial from the Salt Lake
Tribune of April 27th. This is what the Salt Lake Tribune said on April
27 of this year:

Certain elements of a welfare program lend themselves well
to contracting, vouchers, or other forms of privatization . .
.

I think we all agree with that:

But when it comes to deciding who will receive public
assistance or who should lose custody of a child, the private
sector has its limits. If a private group's primary mission
is to make profits . . . services may be reduced . . .
Government employees, on the other hand, are subject to more
public scrutiny and are expected to promote the public good
within constitutional protections for individuals.

Mr. President, let's not fix what isn't broken.
Virtually every State is currently operating, developing, or planning
the development of an integrated, automated eligibility and enrollment
system for TANF, food stamps, and Medicaid. Thirty-eight States with
Federally certified systems; three States installing; five States
developing; two States planning; three States with State-developed
systems.
Let's not throw the baby out with the bathwater.
I urge my colleagues to support this well-taken point of order.
I thank the Chair. I yield the floor.
Mr. ROTH. Mr. President, I move to waive the point of order.
The PRESIDING OFFICER. The Senator from Delaware.

Motion to Waive the Budget Act

Mr. ROTH. I move to waive the point of order.
Mr. CONRAD. Mr. President, parliamentary inquiry.
The PRESIDING OFFICER. State the inquiry.
Mr. CONRAD. Parliamentary inquiry. The motion to waive the point of
order has been raised. Will this be stacked in votes tomorrow? Would
that be the intention of the Chair?
Mr. ROTH. That would be the intent of the chairman.
Mr. CONRAD. That would be the intent of the chairman.
Mr. President, would that be the intent?
The PRESIDING OFFICER. That would be the procedure.
Mr. CONRAD. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
Mr. CONRAD. I thank the Chair.
Mr. LAUTENBERG addressed the Chair.
The PRESIDING OFFICER. The Chair recognizes the Senator from New
Jersey.
Mr. LAUTENBERG. Mr. President, I can't let this moment pass without
commending----
Mr. ROTH. Could the Senator yield so I can send this amendment to the
desk for consideration?
Mr. LAUTENBERG. Yes, of course. I would be happy to yield to the
chairman of the Finance Committee. But I expect to regain the floor.

Amendment No. 502

Mr. ROTH. Mr. President, I submit an amendment on behalf of Senator
D'Amato on Medicare, on the duplication provision for consideration
tomorrow.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Delaware [Mr. Roth] for Mr. D'Amato,
proposes an amendment numbered 502.

The amendment is as follows:

Section 1. In 42 U.S.C. Sec. 1395ss(d)(3)(A)(v), insert
``(a)'' before ``For'', and after the first sentence insert:
``(b) For purposes of this subparagraph, a health insurance
policy (which may be a contract with a health maintenance
organization) is not considered to ``duplicate'' health
benefits under this title or title XIX or under another
health insurance policy if it--
(I) provides comprehensive health care benefits that
replace the benefits provided by another health insurance
policy,
(II) is being provided to an individual entitled to
benefits under Part A or enrolled under Part B on the basis
of section 226(b), and
(III) coordinates against items and services available or
paid for under this title or title XIX, provided that
payments under this title or title XIX shall not be treated
as payments under such policy in determining annual or
lifetime benefit limits.
Section 2. In 42 U.S.C. Sec. 1395ss(d)(3)(A)(v), insert
``(c)'' before ``For purposes of this clause''.

The PRESIDING OFFICER. The Senator from New Jersey.

Point of Order

Mr. LAUTENBERG. Mr. President, I want to commend our friend and
colleague from North Dakota for being aware of what is potentially
taking place here.
Mr. President, this is a small example of the kind of document that
you might have that has all kinds of bad goodies in here. One of the
things that you have to do around here is to make certain that
everybody is on the alert to the fact that some things get into these
bills without being discussed, without being formally introduced. It
has a way of sneaking in there. There is an osmosis process in which
they fall down from the sky and get in there. This is one that is
really kind of sky-high.
I express very serious concerns about the provision in this bill,
that it will allow, as the Senator from North Dakota said, in this case
Texas, but any State--to have private companies determine the
eligibility for low-income benefits like Medicaid, WIC and food stamps.

Mr. President, this is a budget reconciliation bill, not a Government

[[Page S6179]]

management reform bill. In my view, the privatization provision does
not belong in fast-track legislation--fast track, that means to get it
through here as quickly as you can--that is designed primarily to
implement the budget resolution. This provision has no real impact on
the deficit except to potentially make it worse in the years ahead, and
it would represent a significant policy change with broad-ranging
implications.
I also note that this provision is outside of the bipartisan budget
agreement. It was never discussed at any one of the negotiating
sessions because I personally sat there at every one of them, and it
never appeared in any early drafts of the budget agreement.
This provision raises some very important policy questions. For
example, will these private companies have an incentive, as the Senator
from North Dakota pointed out in his chart, to exclude people that they
would rather not carry from low-income programs. Will they receive
bonuses for doing so? Will they feel inclined to do so in order to win
other State government contracts?
Now, Mr. President, I kind of grew up, if I can say, in the computer
business, and we have seen some of the finest companies in the world
make mistakes. We have seen it here with the FAA contract, a fairly
complicated piece of business, and it was pointed out that it was
Unisys and EDS and names that are very well known in the computer
field. Mistakes are made and sometimes these things run way over the
original cost estimate, as demonstrated in the example we saw, so we
cannot afford to put all of our citizens subject to what might go awry
here and spend $2 billion to take care of an arrangement, whatever that
arrangement is. Ask every citizen here whether they would feel like
kicking into this thing, and I am sure that given a proper
questionnaire they would say, ``Heck, no.'' This is not for us and no
State ought to be so privileged as to get that kind of an advantage.
Mr. President, the Department of Health and Human Services reports
that there may be 3 million children eligible for Medicaid who are not
enrolled in the program. It is a serious problem and I feel could even
get worse under a privatization program. If private companies are put
in charge of enrolling more children for Medicaid, would they really
conduct aggressive outreach programs to enroll children, to encourage
people to bring them in even if it meant that the State's Medicaid
costs would go up? I would not bet on it.
I want to be clear. I am not necessarily opposed to privatization of
some Government services. However, it must be considered very
carefully, especially when the lives of vulnerable Americans are at
stake. This proposal really breaks new ground. For the first time,
private interests would be handed complete power to make benefit
decisions that are of critical importance to people with low incomes.
It is like turning our military over to private hands and letting
them design what conflicts we are going to get involved with. The fact
is that much of the allure of privatization is to save money, and there
is a place for that. For example, Congress has to decide to have
private companies operate some of its cafeterias and do some of its
cleaning, and perhaps that translates into more savings and better
service for congressional employees. But Congress has wisely limited
the roll of private companies in many functions of Government. Private
companies are not allowed to operate our military installations, nor do
we have private companies administer our Social Security system. We
draw the line at some point.
I am concerned that privatizing decisions about benefits for low-
income individuals may go over this line. At least, at the very least,
it needs careful and thorough study. Yet, I understand that the Finance
Committee has not reviewed the details of the Texas waiver, has never
seen the full proposal, and since the Senator from North Dakota is also
a member of the Finance Committee and talks about the secret nature of
this agreement, that further confirms what the rest of us who are not
on the Finance Committee might not know and that is that it has never
had appropriate scrutiny, never had appropriate review.
Mr. CONRAD. Will the Senator yield on that?
Mr. LAUTENBERG. I would be delighted.
Mr. CONRAD. Is the Senator aware that the proposal before us forces
the Secretary of Health and Human Services to approve without comment
or review any proposal submitted by the State of Texas which includes
provisions to contract out for eligibility determinations? Was the
Senator so aware?
Mr. LAUTENBERG. Not aware. I cannot even believe it would be
suggested, because that is such a dereliction of duty that I think
everybody would be embarrassed if something like this took place. What
do you mean? That a Secretary has no right to review the conditions
under which we are spending the taxpayers' money?
Mr. CONRAD. If we think about this, these are programs with respect
to food stamps and WIC that are 100 percent federally funded. The
Medicaid Program is over 50 percent federally funded.
Mr. LAUTENBERG. The rest of it is State funded.
Mr. CONRAD. The rest of it is State funded. We would be in a position
to endorse any proposal the State of Texas sent up here without any
review, without any comment by the Secretary of Health and Human
Services. That is the situation we are in with the proposal in the
underlying legislation. I just ask the Senator, has he ever heard of
such a proposal before the Senate?
Mr. LAUTENBERG. Never, not even in the years that I spent in the
private sector, and I ran a pretty good-sized company with 16,000
employees when I left. It did better after I left. It now has 30,000
employees.
Never have I seen it. Never, when one works with Government, have I
seen this kind of an arrangement that has a peculiar odor, and it is
not Chanel No. 5. The fact is that to give away Government funds in a
program as sensitive as this to take care of the poor--listen, all of
us have seen the abuses of private sector companies that have taken
over health care and things of that nature.
It just blows one's mind when you see that the president of a company
that is in the health care business made $22 million in a single year
and meanwhile is squeezing down because that is where the profits are
going to come from, from cutting conditions. They are cutting programs
that are supposed to take care of people's health.
Well, do you want to have someone up there whose bonus, whose stock
options, whose salary depends on making sure that they service as few
people as possible, reduce expenses as much as possible when, in fact,
the WIC Program is designed to take care of people who are really
impoverished, people who need the nutrition that comes through the
program to sustain them? So do you want to have some executive sitting
at some remote place--and I liked that executive life when I was there,
but it was never at the Government's expense--at Government expense. We
see constant reference to cases being tried, investigations being
conducted where programs were turned over to the private sector. I talk
about things like jails--we have tried that in New Jersey--which were
dismal failures because they could not protect the guards sufficiently
in these jails because they did not hire the right kind of people. They
did not provide them with the right kind of tools. The facilities were
not built enough to make sure the inmates incarcerated were properly
cared for.
So we see this time and time again, and here we walk in and say,
``OK, here is a bunch of poor people. You take care of them. Do the
best you can at the best price you can.'' What an outrage.
Mr. CONRAD. Will the Senator yield for a final question?
Mr. LAUTENBERG. Sure.
Mr. CONRAD. Is the Senator aware that under the proposal in the
underlying legislation, we could have a private company decide the
custody of a child? That this is so far-reaching without any limits we
could be in a circumstance in which a private concern has the authority
to determine the custody of a child? How does that strike the Senator
from New Jersey?
Mr. LAUTENBERG. I will tell the Senator how it strikes me. I say
thank God that the Senator from North Dakota has brought this to the
attention of the Senate and to the public.

[[Page S6180]]

My friend has done a real service in doing this. The notion that an
individual working for a private living, perhaps their salary dependent
upon their ability to curtail services, is hardly the way you want to
treat a sick patient in the hospital. That is hardly the way you want
to treat a family problem. That is hardly the way you want to protect a
mother who has been battered. That is hardly the way we want to do
things in a society with the conscience this country has.
I am delighted, again, that the Senator introduced it. I am concerned
that privatization like this is not going to do the job. Before we go
ahead with approval of a waiver, we ought to at least hold a hearing
and review the details. Mr. President, Congress has established these
safety net programs for people in our society who are truly in need,
impoverished. They are designed to ease suffering, to provide
nutritional assistance to help children, help struggling people get
into the work force to get themselves off welfare, to do whatever they
can to sustain themselves. These programs can literally mean the
difference between homelessness and independence, and we ought not to
rush to hand them over to a private interest at this time, perhaps
never, but we sure ought not to do it in the hasty manner that this is
being undertaken. We can always revisit this issue, Mr. President,
without constraints of a reconciliation bill.
I fully support the action being proposed by the Senator from North
Dakota and commend him for it, I must tell you.
Mr. CONRAD. I thank the Senator from New Jersey. If I could just take
a moment to further point out--I want to rivet this point--there have
been no hearings, not a hearing in the Finance Committee, not a hearing
in the Agriculture Committee. Members have not been granted the
opportunity to question witnesses, experts, company, or advocates on
the merits of privatizing eligibility determinations, protections
against cost overruns or protections for recipients.

I really believe this is a totally unprecedented proposal that is
buried in this very large document that sets a precedent that I believe
is truly alarming. I hope my colleagues will support the point of order
when we vote on it tomorrow. This is, I think, a circumstance in which
a very broad proposal is being attempted, being made to ram it through
Congress as part of privileged legislation. That is wrong. That is
simply wrong. The issue deserves public hearings and full debate.
I thank the Chair, yield the floor, and I thank very much the Senator
from New Jersey.

Amendment No. 503

(Purpose: To extend premium protection for low-income medicare
beneficiaries under the medicaid program)

The PRESIDING OFFICER. The Senator from New Jersey.
Mr. LAUTENBERG. Mr. President, I send an amendment to the desk for
Senator Rockefeller and ask for its consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Jersey [Mr. Lautenberg], for Mr.
Rockefeller, proposes an amendment numbered 503.

Mr. LAUTENBERG. Mr. President, I ask unanimous consent that reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
At the appropriate place in division 2 of title V, insert
the following:

SEC. . EXTENSION OF SLMB PROTECTION.

(a) In General.--Section 1902(a)(10)(E)(iii) (42 U.S.C.
1396a(a)(10)(E)(iii)) is amended by striking ``and 120
percent in 1995 and years thereafter'' and inserting ``, 120
percent in 1995 through 1997, 125 percent in 1998, 130
percent in 1999, 135 percent in 2000, 140 percent in 2001,
145 percent in 2002, and 150 percent in 2003 and years
thereafter''.
(b) 100 Percent FMAP.--Section 1905(b) (42 U.S.C. 1396d(b))
is amended by adding at the end the following:
``Notwithstanding the first sentence of this section, the
Federal medical assistance percentage shall be 100 percent
with respect to amounts expended as medical assistance for
medical assistance described in section 1902(a)(10)(E)(iii)
for individuals described in such section whose income
exceeds 120 percent of the official poverty line referred to
in such section.''.
(c) Effective Date.--The amendments made by this section
apply on and after October 1, 1997.

Mr. LAUTENBERG. Mr. President, I assume that the amendment goes into
the line of amendments as turned in and will be considered at that
point in the order.
The PRESIDING OFFICER. It goes in in the stacked order, yes.
Mr. LAUTENBERG. Mr. President, I note the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. LAUTENBERG. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 504

(Purpose: To immediately transfer to part B certain home health
benefits)

Mr. LAUTENBERG. Mr. President, there is an amendment here from
Senator Kennedy that failed to get included in the list. I send it to
the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Jersey [Mr. Lautenberg] for Mr.
Kennedy, proposes an amendment numbered 504.

Mr. LAUTENBERG. Mr. President, I ask unanimous consent that reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

Strike section 5361 and insert the following:

SEC. 5361. ESTABLISHMENT OF POST-HOSPITAL HOME HEALTH BENEFIT
UNDER PART A AND TRANSFER OF OTHER HOME HEALTH
SERVICES TO PART B.

(a) In General.--Section 1812(a)(3) (42 U.S.C. 1395d(a)(3))
is amended--
(1) by inserting ``post-hospital'' before ``home health
services'', and
(2) by inserting ``for up to 100 visits'' before the
semicolon.
(b) Post-hospital Home Health Services.--Section 1861 (42
U.S.C. 1395x), as amended by sections 5102(a) and 5103(a), is
amended by adding at the end the following:
(qq) Post-hospital Home Health Services.--The term `post-
hospital home health services' means home health services
furnished to an individual under a plan of treatment
established when the individual was an inpatient of a
hospital or rural primary care hospital for not less than 3
consecutive days before discharge, or during a covered post-
hospital extended care say, if home health services are
initiated for the individual within 30 days after discharge
from the hospital, rural primary care hospital or extended
care facility.''.
(c) Conforming Amendments.--Section 1812(b) (42 U.S.C.
1395d(b)) is amended--
(1) by striking ``or'' at the end of paragraph (2);
(2) by striking the period at the end of paragraph (3) and
inserting ``; or'', and
(3) by adding after paragraph (3) the following:
``(4) post-hospital home health services furnished to the
individual beginning after such services have been furnished
to the individual for a total of 100 visits.''.
(d) Phase-In of Additional Part B Costs In Determination of
Part B Monthly Premium.--Section 1839(a) (42 U.S.C. 1395r(a))
is amended--
(1) in paragraph (3) in the sentence inserted by section
5541 of this title, by inserting ``(except as provided in
paragraph (5)(B))'' before the period, and
(2) by adding after paragraph (4) the following:
``(5)(A) The Secretary shall, at the time of determining
the monthly actuarial rate under paragraph (1) for 1998
through 2003, shall determine a transitional monthly
actuarial rate for enrollees age 65 and over in the same
manner as such rate is determined under paragraph (1), except
that there shall be excluded from such determination an
estimate of any benefits and administrative costs
attributable to home health services for which payment would
have been made under part A during the year but for paragraph
(4) of section 1812(b).
``(B) The monthly premium for each individual enrolled
under this part for each month for a year (beginning with
1998 and ending with 2003) shall be equal to 50 percent of
the monthly actuarial rate determined under subparagraph (A)
increased by the following proportion of the difference
between such premium and the monthly premium otherwise
determined under paragraph (3) (without regard to this
paragraph):
``(i) For a month in 1998, \1/7\.
``(ii) For a month in 1999, \2/7\.
``(iii) For a month in 2000, \3/7\.
``(iv) For a month in 2001, \4/7\.
``(v) For a month in 2000, \5/7\.
``(vi) For a month in 2003, \6/7\.
(e) Effective Date.--
(1) In general.--The amendments made by this section apply
to services furnished on or after October 1, 1997.
(2) Special rule.--If an individual is entitled to benefits
under part A of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.), but is not enrolled in the insurance
program established by part B of that title,

[[Page S6181]]

the individual also shall be entitled under part A of that
title to home health services that are not post-hospital home
health services (as those terms are defined under that title)
furnished before the 19th month that begins after the date of
enactment of this Act.

The PRESIDING OFFICER. The Senator from Delaware.

Amendment No. 505 to Amendment No. 448

(Purpose: To improve the children's health initiative)

Mr. ROTH. Mr. President, on behalf of Mr. Lott I send an amendment to
the desk in the second degree to amendment No. 448, proposed by Mr.
Chafee.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Delaware [Mr. Roth], for Mr. Lott,
proposes an amendment numbered 505 to amendment No. 448.

Mr. ROTH. 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 printed in today's Record under
``Amendments Submitted.'')
Mr. ROTH. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. LAUTENBERG. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 503, As Modified

Mr. LAUTENBERG. Mr. President, I ask unanimous consent that I be
permitted to send to the desk a modification to an amendment I earlier
sent to the desk on behalf of Senator Rockefeller.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. LAUTENBERG. I send the amendment to the desk.
The PRESIDING OFFICER. The amendment is so modified.
The amendment, as modified, is as follows:

At the appropriate place add the following:
Notwithstanding any other provisions of this Act, section
5544 low-income Medicare Beneficiary Block Grant Program
shall read as follows:
(a) In General.--Section 1902(a)(10)(E)(iii) (42 U.S.C.
1396a(a)(10)(E)(iii) is amended by striking ``and 120 percent
in 1995 and years thereafter'' and inserting ``, 120 percent
in 1995 through 1997, 125 percent in 1998, 130 percent in
1999, 135 percent in 2000, 140 percent in 2001, 145 percent
in 2002, and 150 percent in 2003 and years thereafter''.
(b) 100 Percent FMAP.--Section 1905(b) (42 U.S.C. 1396d(b))
is amended by adding at the end the following:
``Notwithstanding the first sentence of this section, the
Federal medical assistance percentage shall be 100 percent
with respect to amounts expended as medical assistance for
medical assistance described in section 1902(a)(10)(E)(iii)
for individuals described in such section whose income
exceeds 120 percent of the official poverty line referred to
in such section.''.
(c) Effective Date.--The amendments made by this section
apply on and after October 1, 1997.

Mr. LAUTENBERG. I thank the Chair, yield the floor and suggest the
absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. ROTH. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Unanimous-Consent Agreement

Mr. ROTH. Mr. President, I ask unanimous consent that it now be in
order for me to offer a managers' amendment this evening, and further,
prior to final passage of the bill on Wednesday, it be in order for me,
Senator Roth, to modify my amendment after the concurrence of the
chairman and ranking member of the Budget Committee.
The PRESIDING OFFICER. Is there objection?
Mr. CHAFEE. Mr. President, I didn't quite understand what the request
was--that Senator Lott be permitted to what?
Mr. ROTH. It has nothing to do with Senator Lott. What it provides is
that I may offer a managers' amendment this evening, and that tomorrow
I may amend it, with the concurrence of the chairman and ranking member
of the Budget Committee.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.

Amendment No. 506

(Purpose: To provide for managers' amendments)

Mr. ROTH. Mr. President, I send a managers' amendment to the desk and
ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Delaware [Mr. Roth] proposes an amendment
numbered 506.

Amendment Nos. 507, 508 and 509

Mr. ROTH. Mr. President, I send three second-degree amendments to the
desk on behalf of Senator Lott, and I ask unanimous consent that they
be considered as read and be numbered accordingly.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendments are as follows:

amendment no. 507 to amendment no. 501

(Purpose: To provide a substitute for the children's health insurance
initiative under subtitle J of title V)

(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')

amendment no. 508 to amendment no. 501

(Purpose: To provide a substitute for the children's health insurance
initiative under subtitle J of title V)

(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')

amendment no. 509 to amendment no. 501

(Purpose: To provide a substitute for the children's health insurance
initiative under subtitle J of title V)

(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')

Amendment No. 510

(Purpose: To require that any benefits package offered under the block
grant option for the children's health initiative includes hearing and
vision services)

Mr. LAUTENBERG. Mr. President, I send an amendment to the desk on
behalf of Mr. Rockefeller and ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New Jersey [Mr. Lautenberg], for Mr.
Rockefeller, proposes an amendment numbered 510.

Mr. LAUTENBERG. Mr. President, I ask unanimous consent that reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

At the appropriate place add the following:
Notwithstanding any other provision of this Act the
following shall be the hearing and vision services provided
under the children's health insurance section:
``(4) Hearing and vision services.--Notwithstanding the
definition of FEHBP-equivalent children's health insurance
coverage in section 2102(5), any package of health insurance
benefits offered by a State that opts to use funds provided
under this title under this section shall include hearing and
vision services for children.''.

Mr. LAUTENBERG. Mr. President, I ask that amendment No. 510 be in
order for its appearance tomorrow.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 511

(Purpose: To provide a substitute for the children's health insurance
initiative under subtitle J of title V)

Mr. ROTH. Mr. President, I send an amendment to the desk and ask for
its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Delaware [Mr. Roth] proposes an amendment
numbered 511.

Amendment No. 512 to Amendment No. 511

(Purpose: To clarify the standard benefits package and the cost-sharing
requirements for the children's health initiatives)

Mr. CHAFEE. Mr. President, I send a second-degree amendment to the
desk

[[Page S6182]]

and ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Rhode Island [Mr. Chafee] for himself and
Mr. Rockefeller, proposes an amendment numbered 512 to
Amendment No. 511.

Mr. CHAFEE. Mr. President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

On page 4 strike line 17 through line 3 on page 5 and
insert the following:
`(5) FEHBP-equivalent children's health insurance
coverage.--The term `FEHBP-equivalent children's health
insurance coverage' means, with respect to a State, any plan
or arrangement that provides, or pays the cost of, health
benefits that the Secretary has certified are equivalent to
or better than the services covered for a child, including
hearing and vision services, under the standard Blue Cross/
Blue Shield preferred provider option service benefit plan
offered under chapter 89 of title 5, United States Code.

Mr. ROTH. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. ROTH. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 513 to Amendment No. 510

(Purpose: To provide a substitute for the children's health insurance
initiative under subtitle J of title V)

Mr. ROTH. Mr. President, I send a second-degree amendment to the desk
on behalf of Senator Lott and I ask that it be considered.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Delaware [Mr. Roth], for Mr. Lott,
proposes an amendment numbered 513 to amendment No. 510.
(The text of the amendment is printed in today's Record
under ``Amendments Submitted.'')

Amendment No. 427

(Purpose: To amend title XVIII of the Social Security Act to continue
full-time-equivalent resident reimbursement for an additional one year
under medicare for direct graduate medical education for residents
enrolled in combined approved primary care medical residency training
programs)

Mr. ROTH. Mr. President, I ask unanimous consent that it be in order
to send an amendment to the desk by Senator DeWine of Ohio.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The assistant legislative clerk read as follows.

The Senator from Delaware, [Mr. Roth], for Mr. DeWine,
proposes an amendment numbered 427.

Mr. ROTH. Mr. President, I ask unanimous consent that reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

At the appropriate place in chapter 3 of subtitle F of
division 1 of title V, insert the following:

SEC. . MEDICARE SPECIAL REIMBURSEMENT RULE FOR PRIMARY CARE
COMBINED RESIDENCY PROGRAMS.

(a) In General.--Section 1886(h)(5)(G) of the Social
Security Act (42 U.S.C. 1395ww(h)(5)(G)) is amended--
(1) in clause (i), by striking ``and (iii)'' and inserting
``, (iii), and (iv)''; and
(2) by adding at the end the following:
``(iv) Special rule for primary care combined residency
programs.--(I) In the case of a resident enrolled in a
combined medical residency training program in which all of
the individual programs (that are combined) are for training
a primary care resident (as defined in subparagraph (H)), the
period of board eligibility shall be the minimum number of
years of formal training required to satisfy the requirements
for initial board eligibility in the longest of the
individual programs plus one additional year.
``(II) A resident enrolled in a combined medical residency
training program that includes an obstetrics and gynecology
program qualifies for the period of broad eligibility under
subclause (I) if the other programs such resident combines
with such obstetrics and gynecology program are for training
a primary care resident.''.
(b) Effective Date.--The amendments made by subsection (a)
apply to combined medical residency training programs in
effect on or after July 1, 1996.

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