[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

[[Page S6165]]

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

[[Page S6166]]

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

[[Page S6167]]

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

   (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. 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.

  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.'')


                    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.

  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.'')


                 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.

                          ____________________