[Congressional Record Volume 144, Number 49 (Tuesday, April 28, 1998)]
[Senate]
[Pages S3709-S3723]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. COLLINS (for herself, Mr. Chafee, Mr. Leahy, Mr. Jeffords, 
        Mr. Feingold, Mr. Durbin, Mr. Harkin, Ms. Snowe, Mr. Reed, Mr. 
        Santorum, Mr. Torricelli, Mr. Levin, Mr, Daschle, and Mr. 
        Specter):
  S. 1993. A bill to amend title XVIII of the Social Security Act to 
adjust the formula used to determine costs limits for home health 
agencies under medicare program, and for other purposes; to the 
Committee on Finance.


              THE MEDICARE HOME HEALTH EQUITY ACT OF 1998

  Ms. COLLINS. Mr. President, America's home health agencies provide 
invaluable services that have enabled a growing number of our most 
frail and vulnerable senior citizens to avoid hospitals and nursing 
homes and stay just where they want to be--in their own homes. Today, 
home health is the fastest growing component of Medicare spending, and 
the program grew at an astounding average annual rate of more than 25 
percent from 1990 to 1997. As a consequence, the number of Medicare 
home health beneficiaries has more than doubled, and Medicare home 
health spending has soared from $2.7 billion in 1989 to $17.1 billion 
in 1996.
  This rapid growth in home health spending understandably prompted 
Congress and the Health Care Financing Administration, as part of the 
Balanced Budget Act of 1997, to initiate changes that were intended to 
make the program more cost-effective and efficient and protect it from 
fraud and abuse. However, in trying to get a handle on costs, we in 
Congress and the administration have unintentionally created problems 
that may restrict some elderly citizens' access to vitally needed home 
health care.
  Critics have long pointed out that Medicare's cost-based payment 
method for home health care has inherent incentives for home care 
agencies to provide more services, which has driven up costs. 
Therefore, the Balanced Budget Act called for the implementation of a 
prospective payment system for home care by October 1, 1999. Until 
then, home health agencies will be paid according to what is known as 
an Interim Payment System.
  Under the new IPS, home health agencies will be paid the lesser of: 
their actual costs; a per-visit cost limit; or a new blended agency-
specific per beneficiary annual limit based 75 percent on an agency's 
own costs per beneficiary and 25 percent on the average cost per 
beneficiary for agencies in the same region. These costs are to be 
calculated from cost reports for reporting periods ending in 1994.
  I spent some time going over the formula because it is important to 
understand what the importance of that very

[[Page S3710]]

complicated formula is for many of our home health agencies.
  At a recent hearing of the Senate Special Committee on Aging, on 
which I serve, we heard testimony from a number of witnesses who 
expressed concern that the new Interim Payment System inadvertently 
penalizes cost-efficient home health agencies by basing 75 percent of 
the agencies' per patient payment limits on their FY 1994 average cost 
per patient. This system effectively rewards agencies that provided the 
most visits and spent the most Medicare dollars in 1994, while it 
penalizes low-cost, more efficient providers. Let me repeat that point, 
Mr. President. The agencies, usually the non-profits, that have 
provided services at the lowest cost, are penalized by the new payment 
system.
  Home health agencies in the Northeast are among those that have been 
particularly hard-hit by the formula change. As the Wall Street Journal 
recently observed,

       If New England had been just a little greedier, its home-
     health industry would be a lot better off now . . . 
     Ironically, . . . [the region] is getting clobbered by the 
     system because of its tradition of non-profit community 
     service and efficiency.

  Moreover, there is no logic to the variance in payment levels. As the 
same article goes on to point out, the average patient cap in Tennessee 
is expected to be $2,200 higher than Connecticut's, and the cap for 
Mississippi is expected to be $2,000 more than Maine's, without any 
evidence that patients in the Southern states are sicker or that nurses 
and other home health personnel in this region cost more. Mr. 
President, I ask unanimous consent that the entire text of this article 
be printed in the Record.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Ms. COLLINS. Mr. President, this system also gives a competitive 
advantage to high-cost agencies over their lower cost neighbors, since 
agencies in a particular region may have dramatically different 
reimbursement levels regardless of any differences among their patient 
populations. And finally, this system may force low-cost agencies to 
stop accepting patients with more serious health care needs.
  That is exactly the opposite of what we should want. I simply do not 
think that this is what Congress intended. To rectify this problem, 
today I am pleased to introduce legislation along with Senators Chafee, 
Jeffords, Leahy, Feingold, Snowe, Durbin, Harkin, Reed and Santorum. 
The Medicare Home Health Equity Act will level the playing field and 
make certain that home health agencies that have been prudent in their 
use of Medicare resources are not unfairly penalized. The legislation 
will also ensure that home health agencies in the same region are 
reimbursed similarly for treating similar patients.
  Instead of allowing the experience of high-cost agencies to serve as 
the basis for the new cost limits, the bill we are introducing today 
sets a new per beneficiary cost limit based on a blend of national and 
regional average costs per patient. This new formula will be based 75 
percent on the national average cost per patient and 25 percent on the 
regional average cost per patient. Moreover, by eliminating the agency-
specific data from the formula, the Medicare Home Health Equity Act 
will move us more quickly to the national and regional rates which will 
be the cornerstones of the future prospective payment system, and it 
will do so in a way that is budget neutral. This is a matter of common 
sense and fairness. It is also a matter of ensuring that there is a 
fair system for reimbursing these vitally needed home health agencies 
that are providing services that are so important to so many of our 
senior citizens. I urge all of my colleagues to join as cosponsors of 
the Medicare Home Health Equity Act, and I ask unanimous consent that 
the text of the bill as well as a section by section summary be printed 
in the Record.

  The ACTING PRESIDENT pro tempore. Without objection, the items were 
ordered printed in the Record, as follows:

                                S. 1993

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Home Health Equity 
     Act of 1998''.

     SEC. 2. REVISION OF HOME HEALTH INTERIM PAYMENT FORMULA.

       (a) Restoration of Cost Limits.--Section 
     1861(v)(1)(L)(i)(IV) of the Social Security Act (42 U.S.C. 
     1395x(v)(1)(L)(i)(IV)) (as added by section 4602 of the 
     Balanced Budget Act of 1997) is amended--
       (1) by striking ``105 percent'' and inserting ``112 
     percent''; and
       (2) by striking ``median'' and inserting ``mean''.
       (b) Change in Additions to Cost Limits.--Section 
     1861(v)(1)(L)(v) of the Social Security Act (42 U.S.C. 
     1395x(v)(1)(L)(v)) (as added by section 4602 of the Balanced 
     Budget Act of 1997) is amended to read as follows:
       ``(v)(I) For services furnished by home health agencies for 
     cost reporting periods beginning on or after October 1, 1997, 
     the Secretary shall provide for an interim system of limits. 
     Payment shall not exceed the costs determined under the 
     preceding provisions of this subparagraph or, if lower, the 
     product of--
       ``(aa) an agency-specific per beneficiary annual limitation 
     calculated based 75 percent on the reasonable costs 
     (including nonroutine medical supplies) of the standardized 
     national average cost per patient in calendar year 1994, or 
     best estimate thereof, (as published in the Health Care 
     Financing Review Medicare and Medicaid 1997 Statistical 
     Supplement) and based 25 percent on the reasonable costs 
     (including nonroutine medical supplies) of the standardized 
     regional average cost per patient for the agency's census 
     division in calendar year 1995 (as so published), such 
     national and regional costs updated by the home health market 
     basket index and adjusted pursuant to clause (II); and
       ``(bb) the agency's unduplicated census count of patients 
     (entitled to benefits under this title) for the cost 
     reporting period subject to the limitation.
       ``(II) The labor-related portion of the updated national 
     and regional costs described in subclause (I)(aa) shall be 
     adjusted by the area wage index applicable under section 
     1886(d)(3)(E) for the area in which the agency is located (as 
     determined without regard to any reclassification of the area 
     under section 1886(d)(8)(B) or a decision of the Medicare 
     Geographic Classification Review Board or the Secretary under 
     section 1886(d)(10) for cost reporting periods beginning 
     after October 1, 1995).''.
       (c) Conforming Amendments.--
       (1) Section 1861(v)(1)(L)(vi) of the Social Security Act 
     (42 U.S.C. 1395x(v)(1)(L)(vi)) (as added by section 4602 of 
     the Balanced Budget Act of 1997) is amended to read as 
     follows:
       ``(vi) In any case in which the Secretary determines that 
     beneficiaries use services furnished by more than 1 home 
     health agency for purposes of circumventing the per 
     beneficiary annual limitation in clause (v), the per 
     beneficiary limitations shall be prorated among the 
     agencies.''.
       (2) Section 1861(v)(1)(L)(vii)(I) of the Social Security 
     Act (42 U.S.C. 1395x(v)(1)(L)(vii)(I)) (as added by section 
     4602 of the Balanced Budget Act of 1997) is amended by 
     striking ``clause (v)(I)'' and inserting ``clause 
     (v)(I)(aa)''.
       (d) Effective Date.--The amendments made by this section 
     shall apply as if included in the enactment of the Balanced 
     Budget Act of 1997.

     SEC. 3. CBO ESTIMATE OF HOME HEALTH PAYMENT SAVINGS.

       (a) Estimate.--Not later than 60 days after the date of 
     enactment of this Act, and annually thereafter until the 
     prospective payment system for home health agencies 
     established by section 1895 of the Social Security Act (42 
     U.S.C. 1395fff) is in effect, the Director of the 
     Congressional Budget Office (referred to in this section as 
     the ``Director'') shall estimate the amount of savings to the 
     medicare program under title XVIII of such Act (42 U.S.C. 
     1395 et seq.) resulting from the interim payment system for 
     home health services established by the amendments to section 
     1861 of such Act (42 U.S.C. 1395x) made by section 4602 of 
     the Balanced Budget Act of 1997.
       (b) Certification.--If the Director determines that the 
     amount estimated under subsection (a) exceeds the amount of 
     savings to the medicare program that the Director estimated 
     immediately prior to the enactment of the Balanced Budget Act 
     of 1997 by reason of such interim payment system, then the 
     Director shall certify such excess to the Secretary of Health 
     and Human Services (referred to in this subsection as the 
     ``Secretary'').
       (c) Adjustment.--
       (1) In general.--If the Director certifies an amount to the 
     Secretary pursuant to subsection (b), the Secretary shall 
     prescribe rules under which appropriate adjustments are made 
     to the amount of payments to home health agencies otherwise 
     made under subparagraph (L) of section 1861(v)(1) of the 
     Social Security Act (42 U.S.C. 1395x(v)(1)(L)) (as amended by 
     section 4602 of the Balanced Budget Act of 1997) in the case 
     of outliers--
       (A) where events beyond the home health agency's control or 
     extraordinary circumstances, including the case mix of such 
     agency, create reasonable costs for a payment year which 
     exceed the applicable payment limits; or
       (B) in any case not described in subparagraph (A) where the 
     Secretary deems such an adjustment appropriate.
       (2) Amount.--The total amount of adjustments made under 
     paragraph (2) for a year may not exceed the amount certified 
     to the Secretary pursuant to subsection (b) for such year. To 
     the extent that such adjustments in

[[Page S3711]]

     a year would otherwise exceed the amount certified to the 
     Secretary pursuant to subsection (b) for such year, the 
     Secretary shall reduce the payments to home health agencies 
     in a pro rata manner so that the adjustments do not exceed 
     such amount.
                                  ____


      Medicare Home Health Equity Act--Section-by-Section Summary


                              CURRENT LAW

       The cost-based payment method that has historically been 
     used for Medicare home health services has inherent 
     incentives for home care agencies to provide a higher volume 
     of services. Therefore, the Balanced Budget Act of 1997 (BBA) 
     called for the implementation of a prospective payment system 
     (PPS) for home care by October 1, 1999. In the interim (FYs 
     1998 and 1999), home health agencies will be paid according 
     to an Interim Payment System (IPS) established by the BBA.
       The IPS reimburses home health agencies using the lowest of 
     three cost limits: 1) an agency's actual costs; 2) a per 
     visit cost limit applied to each skilled nursing, physical 
     therapy, or other type of home health visit provided; or 3) 
     an agency-specific aggregate per patient cost limit that is 
     based 75 percent on an agency's average cost per patient in 
     1994 and 25 percent on a regional average cost per patient in 
     1994.
       The Interim Payment System penalizes cost-efficient home 
     health agencies by basing 75 percent of the agencies' per 
     patient payment limits on their FY 1994 average cost per 
     patient. Giving such a heavy weight to the agency-specific 
     costs per beneficiary effectively rewards agencies that 
     provided the most visits and spent the most Medicare dollars 
     in 1994, while it penalizes low-cost, more efficient 
     providers. As a result, high-cost and inefficient agencies 
     will continue to receive a disproportionate share of Medicare 
     home health dollars.


                  The Medicare Home Health Equity Act

         Formula change for setting per beneficiary cost limits

       The Medicare Home Health Equity Act will level the playing 
     field and make certain that those home health agencies that 
     have been prudent in their use of Medicare resources are not 
     unfairly penalized. Moreover, it will ensure that home health 
     agencies in the same region are reimbursed similarly for 
     treating similar patients. Instead of allowing the experience 
     of high cost agencies to serve as the basis for the cost 
     limits, the bill sets a new per beneficiary cost limit based 
     on a blend of national and regional average costs per 
     patient. This new formula would be based 75 percent on the 
     national average cost per patient in calendar year 1994 
     ($3,987) and 25 percent on the regional average cost per 
     patient in calendar year 1995.

Restoration of the per-visit cost limit to 112 percent of the national 
                                  mean

       The per visit cost limits essentially place a cap on the 
     amount of costs that can be reimbursed by Medicare for each 
     home health care visit provided. The BBA reduced these cost 
     limits from 112 percent of the mean to 105 percent of the 
     median. This was done to provide additional savings. However, 
     most of the BBA savings (at least 80 percent) came from the 
     per-beneficiary cost limits. According to Price-Waterhouse, 
     changing the formula from an agency-specific to a national/
     regional average cost per patient blend achieves an 
     additional $5.5 billion in savings. The Medicare Home Health 
     Equity Act of 1998 uses these savings to restore the per-
     visit cost limit to 112 percent of the national mean.
       Most analysts agree that the growth in Medicare home health 
     expenditures is due to the high number of visits provided to 
     patients, not by the cost per visit. In fact, the cost per 
     visit has remained relatively stable in recent years, and CBO 
     confirms that controlling use, not price, is the key to 
     Medicare home health cost containment. It is appropriate to 
     use the savings achieved by rewarding rather than penalizing 
     cost-efficient agencies to re-establish the cost limits that 
     enabled many of those agencies to provide more efficient care 
     over the entire episode of care. The average cost per visit 
     tends to be higher for lower-overall cost, non-profit HHAs 
     which tend to provide care in fewer visits. By keeping visits 
     to the number that are medically necessary, costs per visit 
     may increase slightly, but overall costs per patient 
     decrease.

 Modifies Application of Proration of Per Beneficiary Limits Provision

       The BBA contained a provision which requires proration of 
     the per beneficiary annual limit where the patient is served 
     by more than one home health agency. The Medicare Home Health 
     Equity Act modifies this provision to clarify that proration 
     only applies where it can be demonstrated that a home health 
     agency is attempting to circumvent the limits by shifting 
     care between agencies.

                    Establishes an Outlier Provision

       The bill instructs the Secretary of HHS to prescribe rules 
     under which adjustments can be made in payments to home 
     health agencies that are ``outliers'' where events beyond 
     their control or extraordinary circumstances, including their 
     case mix, create ``reasonable costs'' that exceed what 
     otherwise would be their payment limits. This is included so 
     that there is some provision for higher payments for home 
     health agencies that treat the sickest Medicare home care 
     patients and does so in a way that is budget neutral.
                                  ____


                     [From the Wall Street Journal]

   Region's Home-Care Firms Face Being Punished for Their Efficiency

                           (By Carol Gentry)

       If New England had been just a little greedier, its home-
     health industry would be a lot better off now.
       In a rush to cut Medicare spending, Congress has set up a 
     home-health payment system that punishes low-cost agencies 
     and states, while it rewards big spenders and regions where 
     audits have found widespread fraud and abuse. Ironically, New 
     England is getting clobbered by the system because of its 
     tradition of non-profit community service and efficiency.
       And patients are feeling the effects. In the past two 
     weeks, about 30 complaints have come into the Boston office 
     of the federal agency that must implement the change, the 
     Health Care Financing Administration. The agency says the 
     complaints are coming from patients who need frequent, long-
     term nursing visits, but say they are being turned away or 
     cut off.
       ``I fear we're now looking at home health agencies dumping 
     (expensive) patients,'' says Margaret Leoni-Lugo, chief of 
     the HCFA quality-improvement branch for New England. Such 
     discrimination violates state and federal regulations.
       Ms. Leoni-Lugo says she sympathizes with the difficult 
     situation confronting New England agencies, but cannot 
     condone patient dumping. Today she is expected to hold a 
     telephone conference with health-department officials in the 
     six New England states, warning them to watch for evidence 
     that agencies are cutting care too much.
       ``We want to keep the beneficiaries safe,'' says Ms. Leoni-
     Lugo.


                            the new formula

       The new system rolls back payments to 1993-94 levels minus 
     2%, regardless of whether an agency's budget was low or 
     grossly inflated during those years. Under the system, home-
     health agencies' Medicare payments will be affected not only 
     by their own budget history, but also by their location. If a 
     company is in a penny-pinching region, its payments will be 
     lower than if it comes from an area of big spenders. The 
     agencies that come out best under this formula are those that 
     spent money willy-nilly five years ago and were surrounded by 
     companies that did the same thing. The biggest winners will 
     be states in the South.
       Meanwhile, frugal agencies in regions with moderate costs--
     especially New England, the Midwest and the Mountain states--
     are reeling. Vermont, New Hampshire and Maine will be among 
     the hardest-hit states in the nation. Massachusetts, 
     Connecticut and Rhode Island fare only marginally better.
       Advocates for the elderly and the region's home-health 
     agencies say such a system gives a competitive advantage to 
     the worst players in the industry. ``This is not in the best 
     interest of taxpayers,'' says Susan Young, executive director 
     of the Home Care Association of New Hampshire.
       Adds Margaret Gilmour, president and chief executive 
     officer of Home Health & Hospice Care, a home-care agency in 
     Nashua, N.H.: ``This is going to be a tidal wave of disaster 
     for elder care.''
       Layoffs are already under way in New Hampshire, Ms. Young 
     says, where the industry is among the leanest in the nation.
       The congressional delegation from Massachusetts hopes to 
     derail the new system before it can do massive damage. ``This 
     defies common sense.'' says Rep. James P. McGovern, a 
     Democrat from Worcester. ``This is a big, fat mistake.''


                      Taking Care of the Homebound

       In late November, Rep. McGovern and 11 other members of the 
     state's congressional delegation sent a letter of concern to 
     HCFA. The group hopes to meet with top agency officials in 
     Washington soon.
       Home-health agencies send nurses, aides, and physical and 
     speech therapists to the homes of patients who are so 
     physically or mentally disabled that they cannot easily go or 
     be taken to a medical clinic.
       While most private insurers and health-maintenance 
     organizations cover home health care, the main money pipeline 
     is Medicare. All homebound elderly and disabled beneficiaries 
     of the program are eligible for free unlimited visits, as 
     long as the visits are part of a treatment plan that is 
     authorized by a physician and is updated every two months.
       There are several types of home-health agencies, including 
     the community-based nonprofits, such as the Visiting Nurses 
     Associations of America; the newer for-profit companies; and 
     hospital-affiliated agencies. Medicare's costs have been 
     higher for patients who go through one of the hospital or 
     for-profit companies.
       Hospital-affiliated agencies tend to have higher per-visit 
     costs than independent ones because they can legally transfer 
     some of the hospital's overhead to the home-health books and 
     have Medicare pay for it. For-profit agencies tend to 
     generate higher Medicare payments by billing for a greater 
     number of visits per patient.
       Patients recuperating from surgery or a short-term illness 
     may need only a few visits, but home-health agencies are a 
     lifeline for patients with long-term conditions--multiple 
     sclerosis. Alzheimer's disease, heart failure, severe 
     diabetes--who are trying to stay out of nursing homes.

[[Page S3712]]

       The new system sets an annual limit on the amount that 
     Medicare will spend on any given patient. While that cap is 
     different for every agency, it averages out to 75 visits a 
     year in Massachusetts. Patient advocates say this gives 
     agencies an incentive to take only those clients who are 
     going to get better or die in a short time.
       To make matters worse, agencies must reduce expenses 
     without knowing just how deep the cuts will be. The details 
     of the payments formula won't be determined until April 1, 
     but will be retroactive to Oct. 1.


                         seeking formula change

       In the letter to HCFA, the Massachusetts delegation asked 
     administrators to alter the new formula to ``lessen the 
     blow'' to low-cost, efficient home-health agencies. The 
     letter says it is unfair to tag payments to a 1994 average 
     per-patient cost of $4,328 in Massachusetts, when Tennessee 
     was getting $6,508 and Louisiana $6,700.
       Rep. McGovern says he hopes to repeal the payment-system 
     provision when Congress convenes later this month, but he 
     knows that may not be easy. Many of the leaders of Congress 
     are from the South, where payment rates are projected to be 
     double those in much of New England.
       Massachusetts has a lot at stake. In 1995, the last year 
     for which Medicare has complete data, the program spent more 
     than $1 billion in New England to provide home health to 
     246,000 beneficiaries. Of that money, Massachusetts absorbed 
     more than half for 119,000 homebound patients. More than 14% 
     of the state's Medicare beneficiaries were served by home 
     care, while the rate was about 10% nationwide.
       Under the new payment system, members of the Massachusetts 
     delegation say, their state stands to lose $95 million and at 
     least 1.5 million patient visits in the first year.
       Why will the system affect Massachusetts so much? The 
     state's home-health agencies deliver care at a more moderate 
     cost per visit than most other states, federal data show, but 
     also perform more visits per patient, on average. Pat 
     Kelleher. executive director of the Home Health Care 
     Association of Massachusetts, says one reason is that the 
     state has deliberately pushed home care to save state tax 
     money. Federally paid Medicare home-health visits keep 
     patients out of nursing homes, which draw most of their 
     revenue from the state Medicaid program.


                      Rough Time Ahead for Vermont

       If the other New England states affected, Vermont, the only 
     state that legally requires home-health companies to be non-
     profit, especially faces troubled times. After consistently 
     providing home care at the lowest cost per patient in the 
     nation. Vermont's 13 agencies stand to lose more than $2 
     million this year and estimate they will have to reduce 
     service by 10%.
       The Vermont Assembly of Home Health Agencies estimates the 
     average per person payments in the state this year will be 
     $2,600 a year, less than half what they payout is expected to 
     be in, say, Alabama.
       ``The system was supposed to limit the high rollers'' says 
     the association's director, Peter Cobb but instead ``Congress 
     rewarded excess.''
       The rule changes stem from the passage last August of the 
     Balanced Budget Act, which cuts $115 billion from Medicare by 
     2002. The home-care portion of the act slices $16.2 billion 
     from the budget.
       Home care seemed a logical place to look for cuts, since 
     it's the fastest-growing segment of the health industry. 
     Between 1990 and 1995, while the number of Medicare 
     beneficiaries rose 10%, the number of home-health visits grew 
     255% and spending went up 316%.
       Some of that increase accompanied the rise of managed-care 
     companies that try to keep patients out of the hospital to 
     save money and, if they must go, keep the visits as brief as 
     possible. However, much of the inflation in home care was a 
     predictable response to a payment system that offered no 
     incentive to be frugal.


                        probe finds waste, fraud

       Massive fraud, waste and ineptitude in Medicare billings 
     were reported last summer by the Office of the Inspector 
     General of the U.S. Department of Health and Human Services 
     following a two-year investigation called Operation Restore 
     Trust. The study covered five states that account for 40% of 
     Medicare payments: California, New York, Florida, Texas and 
     Illinois.
       The report said one-fourth of home-health agencies in those 
     states received nearly half the Medicare dollars spent on 
     home-health care. According to the report, the ``problem'' 
     agencies tended to be for-profit, closely held corporations 
     with owners that were involved in a tangle of interlocking, 
     self-referring businesses. Texas was cited as the biggest 
     home-health spender of the states studied. (An HCFA audit 
     conducted in Massachusetts and Connecticut last year found a 
     few overpayments, but no cases of fraud.)
       It just so happened that the revelations of Operation 
     Restore Trust occurred at the same time that Congress was 
     looking for ways to cut Medicare spending.
       Congress wanted to change the home-health payment system so 
     that it would reward efficiency, by switching to a flat rate 
     by diagnosis. This ``prospective payment system'' would be 
     similar to the one that Medicare uses to pay hospitals.
       But HCFA said it needed more time to develop the complex 
     formula to set prospective payment in motion. So Congress 
     created an interim system that will run until Oct. 1, 1999. 
     It freezes spending at the rates there were in place in 1993-
     94--before Operation Restore Trust began.


                            varying payments

       Now payments vary illogically. The average patient cap in 
     Tennessee is expected to be $2,200 higher than that in 
     Connecticut, and the cap for Mississippi $2,000 more than 
     Maine, without any evidence that patients in the Southern 
     states are sicker or that nurses cost more there.
       But those who think the Southern states are pleased at 
     getting a patient cap double that of New England are 
     mistaken. Officials at the Texas Association for Home Care 
     say they need bigger payment rates because they have a high 
     rate of poor elderly who have never had proper health care, 
     and the state Medicaid program hasn't taken care of them 
     because it's stingy.
       ``Congress has cut into the bone,'' says Sara Speights, 
     director of government and public relations for the Texas 
     group.
       Inequities exist even within the same region. Ms. Gilmour 
     of the Nashua, N.H., home-care agency says a competitor in 
     northern Massachusetts could end up with a payment cap twice 
     as high as her own as a result of her staff's efforts to keep 
     costs down. Because patients are free to choose either 
     agency, she worries they will gravitate to the one that has a 
     bigger budget.
       Joan Hull, chief executive of the nearby competitor, the 
     Home Health Visiting Nurses Association of Haverhill, Mass., 
     says her agency is a product of a merger between agencies 
     that had different payment rates, so she doesn't know whether 
     the Medicare cap will be $3,400 or $4,600 per patient. 
     Unfortunately for her agency, services it has delivered since 
     the beginning of its fiscal year in October will be on the 
     new payment rate, but the agency won't know what the rate is 
     until April.
       ``It's crazy, isn't it?'' Ms. Hull says with a laugh.


                             yankee thrift

       Home health agencies in the New England states have 
     delivered care for less money than the national average, both 
     in Medicare payments per visit and per patient. (Data shown 
     here are from 1995.)

----------------------------------------------------------------------------------------------------------------
                                                                                       Pct.               Pct.  
                                                                  No. of      Avg.   above or    Avg.   above or
                                                                 patients   payment    below   payment    below 
                                                                    (in       per    national    per    national
                                                                thousands)   visit     avg.    patient    avg.  
----------------------------------------------------------------------------------------------------------------
Connecticut...................................................         57       $60       -30   $4,770       6.6
Massachusetts.................................................        119        50     -19.0    4,730      -5.7
Rhode Island..................................................         19        64       3.0    4,037      -9.7
Maine.........................................................         22        53     -15.0    3,717     -16.9
New Hampshire.................................................         17        50     -19.0    3.057     -31.7
Vermont.......................................................         12        45     -28.0    3,030     -32.3
New England...................................................        246        53     -15.0    4,400      -1.6
U.S...........................................................      3,430        62  ........    4,473  ........
----------------------------------------------------------------------------------------------------------------
Sources: Health Care Financing Administration and The Wall Street Journal                                       

                              big spenders

       While Medicare costs for home health services have gone up 
     nationwide, Sunbelt states led the spending spree. The new 
     payment system rewards states where payments were far above 
     average, as shown below (Data are for 1995.)

------------------------------------------------------------------------
                                           No. of      Avg.       Pct.  
                                           visits    payment     above  
                                            per        per      national
                                          patient    patient      avg.  
------------------------------------------------------------------------
Louisiana..............................        144     $7,867       75.9
Oklahoma...............................        127      7,358       64.5
Texas..................................        117      7,217       61.3
Tennessee..............................        121      6,886       53.9
Utah...................................        106      6,283       40.5
Mississippi............................        128      6,205       38.7
THE SOUTH..............................         95      5,488       22.7
U.S....................................         72      4,473  .........
------------------------------------------------------------------------
Sources: Health Care Financing Administration and The Wall Street       
  Journal                                                               

  Mr. FEINGOLD. Mr. President, I rise today to join my colleagues, 
Senators Collins, Chafee, Jeffords, Leahy, Reid and others in 
introducing the Home Health Medical Equity Act of 1998. I especially 
want to compliment the Senator from Maine, who has taken the lead on 
this issue. It is a matter of enormous concern in her State and also in 
mine. I think it is worth taking a moment just to acknowledge how 
useful the Senate Aging Committee is, to be able to highlight an issue 
like this. I wonder whether this issue would have gotten the attention 
it deserves had it not been for that forum, where we were able to have 
an excellent hearing and hear from Senators all over the country whose 
States are very negatively affected by the rules that were put into 
place. I congratulate the Senator from Maine for taking the initiative 
out of that hearing to introduce legislation.
  This legislation is a crucial step in ensuring that the Medicare Home 
Health Care program's Interim Payment System does not penalize regions 
of the country that have been providing home health services 
efficiently.
  Mr. President, I have been working to promote the availability of 
home care and other long-term care options for my entire public life 
because I believe strongly in the importance of enabling people to stay 
in their own homes. For seniors who are homebound and have skilled 
nursing needs, having access to home health services through

[[Page S3713]]

the Medicare program is the difference between staying in their own 
home and being moved into a nursing facility. Home care offers feelings 
of security, dignity and hope. Where there is a choice, we should do 
our best to allow patients to choose home health care.
  Mr. President, I recognize that there are situations when one's 
ability to conduct the activities of daily living are so limited, and 
the medical needs are so great, that the patient would be better 
served, in some cases, in a skilled nursing facility. I also want to 
recognize that my State of Wisconsin has a very, very good network of 
caring and high-quality nursing homes. Without a doubt, there is a need 
for these services. But, Mr. President, as I travel throughout 
Wisconsin's 72 counties every year, what seniors tell me again and 
again is that, to the extent possible, and as long as it is medically 
appropriate for them to do so, they would like to remain in their own 
homes. I think seniors need and deserve that choice.
  Mr. President, seniors clearly prefer to remain in their own homes 
rather than be moved to a nursing home. Their medical needs can often 
be met through home health services. Despite these facts, the 
implementation of the Medicare Home Health Interim Payment System as 
passed in last year's budget could create serious access problems for 
seniors in States like Wisconsin and Maine when they seek the home 
health benefit. The cuts to the Medicare Home Health program imposed by 
the Interim Payment System are so severe that home health agencies will 
have no choice but to reduce dramatically the amount of services 
provided. Some home care agencies may get out of the home care business 
altogether. But, Mr. President, the real impact of the Interim Payment 
System will not be simply to reduce payments to home care providers and 
force some out of business, what it will really do and what really 
concerns me is it will drastically reduce the options that homebound 
seniors now have today with respect to whether they will remain in 
their home in the community or whether they will be forced into a 
nursing home situation that is not necessarily the best place for them.
  As of right now, Mr. President, the Interim Payment System for 
Medicare home health care is a system that pays agencies the lowest of 
the following three measures: (1) actual costs; (2) a per visit limit 
of 105% of the national median; or (3) a per beneficiary annual limit, 
derived from a blend of 75% an agency's costs and 25% regional costs. 
Now, these measures are pretty technical and I will not go into any 
more of the specifics about them. But suffice it to say that the net 
effect of the Interim Payment System will be to penalize severely 
agencies who have been operating efficiently all these years. Since the 
Interim Payment System will pay the agency the lowest of the 
three measures that I mentioned, agencies in areas where costs have 
been kept lower will be disproportionately and unfairly affected.

  Mr. President, according to the Health Care Financing Administration, 
just in Wisconsin alone, there are currently 181 home health care 
agencies that participate in Medicare. Of these, two-thirds of them are 
operated as nonprofit entities. These nonprofit home health care 
providers are often county health departments and visiting nurse 
organizations; these are not entities out to make a fast buck on the 
backs of homebound seniors. According to administrators of Valley 
Visiting Nurse Association in Neenah, WI, the average, per patient 
Medicare home care cost in Wisconsin is $2,586, compared to $5,000 in 
other parts of the country. Let me repeat that, the statistics, because 
it is really quite striking. The average, per patient Medicare home 
care cost in Wisconsin is only $2,586, compared to often over $5,000 or 
more in other places in the country. These nonprofit providers in 
Wisconsin are already as lean as they can be. I am fairly convinced 
they don't have any ``fat'' to cut from their programs. The Visiting 
Nurse Association Home Health of Wausau showed me some figures 
demonstrating that, over the past 5 years, their services have averaged 
30 percent below limits imposed by the Health Care Financing 
Administration, with 36 percent fewer visits per beneficiary than the 
national average.
  Mr. President, the effect of the deep reductions imposed by the 
Interim Payment System will be, quite simply, a devastating blow to 
these types of agencies, and, in turn, will seriously impact the 
availability of home health care services to many people in Wisconsin. 
This devastating blow is dealt not because Wisconsin has been providing 
too many services too expensively. It is just to the contrary. States 
like Wisconsin and others are being penalized more precisely because 
they have always operated efficiently. Moreover, on a national level, 
with a reduced per-patient limit, home health agencies have a 
disincentive to take more seriously ill patients onto their rolls.
  Mr. President, the legislation my colleagues and I introduce today 
will change the Interim Payment System to bring about greater payment 
equity for Medicare home health providers in different parts of the 
country. The bill, as the Senator from Maine outlined, would create a 
new formula for the per-patient limit that reflects a higher percentage 
of national data rather than relying solely on regional and local data. 
The change in payment calculation would enable high-efficiency, low-
cost home health agencies to continue providing services efficiently 
and cost-effectively. But, Mr. President, the most important impact of 
the Medicare Home Health Equity Act will be to make sure that seniors 
who are homebound and have skilled nursing needs will retain for as 
long as possible the right to decide to stay in their own homes.
  Mr. President, I thank the Chair and yield the floor.
  Ms. COLLINS. Mr. President, I thank the Senator from Wisconsin for 
his cosponsorship of this important legislation and for his leadership 
in this issue.
  Mr. CHAFEE. Mr. President, I am pleased to sponsor the Medicare Home 
Health Equity Act of 1998 with my distinguished colleague from Maine. I 
want to applaud Senator Collins' efforts to correct a provision in the 
Balanced Budget Act (BBA) of 1997 which has had the effect of 
penalizing those home health agencies that have taken the lead in 
becoming more cost-efficient over the last several years.
  The Medicare Home Health Equity Act of 1998 will help avert the 
potentially devastating effect of the Interim Payment System (IPS), 
established by the Balanced Budget Act, on many home health agencies in 
Rhode Island, and throughout the country.
  The IPS for Medicare home health services that was established by the 
BBA bases its reimbursement in large part on agency-specific costs 
during fiscal year 1994. Consequently, home health agencies that had 
already been implementing cost-efficient practices at that time, like 
many agencies in Rhode Island were doing, are now finding their 
reimbursements greatly reduced.
  Home health agencies in my home state have told me that this 
decreased reimbursement, in addition to being unfair, might lead to 
reductions in critical health services that currently enable elderly 
patients to maintain their dignity and quality of life. These agencies 
also have pointed out that this interim payment system may well result 
in a loss of jobs in the home health industry.
  I am greatly troubled by the thought that the IPS now in effect may 
well put into financial jeopardy those Rhode Island home health 
agencies that have been working diligently to heed our appeal to 
deliver cost-efficient services. The impact of this payment system on 
one of Rhode Island's most vulnerable populations, the infirm elderly, 
is unpredictable and potentially devastating.
  The Medicare Home Health Equity Act of 1998 bases Medicare 
reimbursement for home health services primarily on national costs 
during the baseline year rather than agency-specific costs. 
Consequently, the most efficient home health agencies will not be 
placed at financial disadvantage. This is a matter of economic 
necessity--we will never be able to maintain the financial security of 
the Medicare program unless we encourage everyone involved in the 
system to help make it work.
  This bill is budget-neutral and will not increase overall Medicare 
expenditures. The legislation is a big step forward in our goal of a 
cost-efficient and reliable health care system for our older citizens.
  Mr. President, I encourage my colleagues to join me in supporting the

[[Page S3714]]

Medicare Home Health Equity Act of 1998.
  Mr. JEFFORDS. Mr. President, Vermont's home health agencies are a 
model of efficiency for the nation. For the past seven consecutive 
years, the average Medicare expenditure for home health care in Vermont 
has been the lowest in the nation. This efficiency was achieved by 
exclusive reliance on 13 nonprofit agencies which provide care without 
sacrificing quality, and which adhere strictly to Medicare requirements 
and guidelines. Today, I am cosponsoring The Medicare Home Health 
Equity Act of 1998, with my good friend Senator Collins, in order to 
preserve this high-quality, low-cost home health system from possible 
insolvency.
  At this moment, Vermont is facing an unprecedented crisis in its home 
health care system. This is not a crisis of their own making, and the 
home health agencies had little, if any, advance warning that disaster 
was imminent. The crisis that befalls Vermont's home health care 
agencies, and many others throughout the country, arose from the 
decision made by Congress, as a part of the Balanced Budget Act of 1997 
(BBA), to adopt a Medicare prospective payment system for home health 
care.
  There is compelling rationale and general agreement for moving 
Medicare to a prospective payment system (PPS) in the home health care 
sector. Under a national, prospective payment system, low-cost agencies 
will fare well, as they have already learned how to manage their 
resources wisely. However, the interim system created by the BBA for 
the transition to a PPS is fundamentally flawed and rewards high-cost 
agencies. Under the Interim Payment System, reimbursement limits for 
home health care are heavily weighted toward an agency's historical 
costs. This means that until a prospective payment system can be 
designed and implemented, the lowest cost agencies will face the most 
significant caps on their Medicare payments.
  Where a prospective payment system aims to level the playing field 
for agencies that care for similarly situated patients, the interim 
system preserves and reinforces significant disparities across 
agencies. Although high-cost agencies will face reductions in payments 
under the interim system, these will be the agencies in the best 
position to make those cuts. Low-cost agencies with budgets that are 
already lean have no place to turn. It would be a national tragedy if 
those low-cost agencies cannot survive the transition to a prospective 
system.
  I commend the efforts of my good friend Senator Collins for bringing 
this bill forward. it was a difficult task to craft a remedy that 
allows committed and responsible home health agencies to survive and 
also maintain budget neutrality. The Medicare Home Health Equity Act of 
1998 would alter the interim payment formula by basing payment caps on 
a blend of national and regional averages. In this way, we can move 
toward a more uniform level of reimbursement and allow home health care 
agencies in the same locale to operate under the same constraints. 
Furthermore, this legislation can be implemented quickly. This is 
important, because the regulations defining the interim payment system 
were not published until January of this year--nearly four months after 
the payment system was in force.
  The situation is serious. We must provide relief to home health 
agencies and peace of mind to the clients who are under their care. 
Last August, I voted in support of the Balanced Budget Act of 1997. I 
was proud of the changes we made to preserve Medicare benefits for the 
present and for future generations. Today, I urge my colleagues to 
enact The Medicare Home Health Equity Act of 1998 and correct the 
unintended consequences of the BBA's interim payment system 
reimbursement limits on low-cost home health agencies.
  Mr. HARKIN. Mr. President, I am pleased to join today with my 
distinguished colleague, Senator Susan Collins, in the introduction of 
the ``Medicare Home Health Equity Act of 1998.'' This bill tries to fix 
what we believe to be an unintended injustice in the Balanced Budget 
Act of 1997.
  As many of you know, home health agencies have historically been 
reimbursed on the basis of costs. The Health Care Financing 
Administration paid each agency to cover the cost of providing care. 
This arrangement has been widely criticized because of offers no 
incentive for agencies to control their costs.
  In order to correct this, we in Congress agreed that Medicare should 
move to a prospective payment system to control costs and ensure 
quality and access to care. The Balanced Budget Act establishes this 
system for home health, effective as of October 1, 1999. In the mean 
time, an interim payment system has been put in place. These changes 
were needed in order to rein in the incredible growth--some due to 
inappropriate payments--in the industry in the last seven years. In 
1990, Medicare spent $3.7 billion on home health care. In 1996, $16.7 
billion was spent. In addition, the average number of visits per 
beneficiary soared from 26 in 1990 to 76 in 1996.
  I believe the change to the prospective payment system had to be 
done. However, the interim payment system will reward high-cost, 
inefficient home health provides at the expense of those home health 
agencies that have historically kept their costs low. I don't believe 
this was the intent of Congress, and that is why I am cosponsoring 
Senator Collins' bill to correct this injustice.
  As co-chair of the Senate Rural Health Caucus, I've been working for 
a long time to change the big city, urban bias in Medicare's 
reimbursement payments. It penalizes more conservative cost-effective 
approaches to health care, and that hurts rural areas like Iowa. We 
went a long way towards fixing that bias in Balanced Budget Act by 
equalizing Medicare's reimbursement payments for managed care services.
  But unbeknownst to me and, I believe, most of my colleagues, while we 
provided rural equity in one area, we took it away in another. It is 
just common sense that we should reward those who provide quality care 
in a cost-effective, efficient manner. We did this when we changed the 
Medicare managed care rates. It doesn't seem right that in the same 
Act, we created an interim payment system for home health services that 
rewards the high cost, wasteful agencies and leaves those that have 
successfully kept their costs low struggling to survive.
  The system's reliance on a provider's historical costs in determining 
their reimbursement amounts has produced an uneven playing field. Many 
of the newer agencies, who got started during a period of high growth, 
now have a competitive advantage. They will now be reimbursed at a 
higher rate than their lower cost competitors.
  Senator Collins' bill does the right thing--it rewards those agencies 
who have done the most to save Medicare money. These include many 
visiting nurse associations, non-profit free standing agencies and most 
non-profit hospital based programs.
  The Home Health Equity Act will revise the current system of 
reimbursement based on 75 percent of agency cost blended with 25 
percent of national costs. The legislation would create a 75 percent 
national rate blended with 25 percent regional rate to level payments 
to providers in a given geographic area. In addition, this bill 
continues the cost savings that the interim payment system was intended 
to achieve. Price Waterhouse has analyzed the bill and found it to be 
budget neutral.
  If we don't fix the interim payment system, I am afraid we risk a 
reduction in access to and quality of health care for Iowa seniors. 
Iowa home health care agencies have historically provided efficient, 
quality service and they ought to be rewarded, not punished for this. 
Most importantly, rural patients and their families deserve continued 
access to the best possible care.
  Mr. DASCHLE. Mr. President, today I join my colleagues in introducing 
the Medicare Home Health Equity Act of 1998.
  The Balanced Budget Act (BBA) included numerous changes to Medicare 
that were necessary to extend the solvency of the trust fund and 
increase the program's integrity. It was extremely important 
legislation that I strongly supported, but there was no way to know the 
impact of every provision it included.
  One provision of the BBA in particular, the interim payment system 
for

[[Page S3715]]

home health care, locks in place inequities between regions of the 
country, efficient and inefficient providers, and new and older 
agencies. I am concerned about the impact of that provision on my state 
of South Dakota.
  In South Dakota, the interim payment system has raised significant 
concern. The interim payment system bases each agency's per patient 
cost limit largely on its per beneficiary cost in 1994. My concern is 
that South Dakota's cost per beneficiary and number of visits per 
patient were well below the national average in 1994. Many of the home 
health agencies in the state have expanded the geographic area they 
serve since 1994 and have added services that formerly were not 
available in the more rural parts of the state. Some of these agencies 
are the sole providers in our most rural counties.
  I have heard from Hand County Home Health Agency which primarily 
serves women, age 85 and older, with little family nearby and with 
difficult health conditions. Since 1994, the Hand County Home Health 
Agency has kept its costs down, but has added new services such as 
physical therapy and has expanded the geographic area to serve areas 
that no other provider covers. The agency has told me that they have to 
consider discontinuing the new services they cover or decreasing the 
geographic area they serve. Neither of these options seems acceptable 
to me.
  The interim payment system also creates problems between new and 
older agencies. In the same geographic area, where there is a new 
provider and an old agency, the new provider's limit will be based on 
the national median reimbursement. This results in significant 
discrepancies in reimbursement and ultimately the services that 
agencies can afford to deliver within the same area and market.
  Ultimately the impact of this payment system falls on beneficiaries, 
and this must be foremost in our minds. Senator Collins' bill would go 
a long way to addressing the access, quality, and equity issues that 
have been raised by the interim payment system in South Dakota. I am 
pleased to join her in beginning the dialogue on this issue that I hope 
will lead to construction changes for home health care patients in 
South Dakota and across the nation.
                                 ______
                                 
      By Mr. COATS (for himself, Mr. Abraham, Mr. Brownback, Mr. 
        Coverdell, and Mr. Santorum):
  S. 1994. A bill to assist States in providing individuals a credit 
against State income taxes or a comparable benefit for contributions to 
charitable organizations working to prevent or reduce poverty and to 
protect and encourage donations to charitable organizations; to the 
Committee on Finance.
                                 ______
                                 
      By Mr. ABRAHAM (for himself, Mr. Brownback, Mr. Coats, Mr. 
        Coverdell, Mr. Hutchinson, Mr. Santorum, and Mr. Lieberman):
  S. 1995. A bill to amend the Internal Revenue Code of 1986 to allow 
the designation of renewal communities, and for other purposes; to the 
Committee on Finance.
                                 ______
                                 
      By Mr. SANTORUM (for himself, Mr. Abraham, Mr. Brownback, Mr. 
        Coats, Mr. Coverdell, and Mr. Hutchinson):
  S. 1996. A bill to provide flexibility to certain local educational 
agencies that develop voluntary public and private parental choice 
programs under title VI of the Elementary and Secondary Education Act 
of 1965; to the Committee on Labor and Human Resources.


                      renewal alliance legislation

  Mr. COATS. Mr. President, I am here today to announce, along with 
several Members--in fact, a coalition of 30 Republican Members from 
both the House and the Senate called the Renewal Alliance, which has 
been in business now for a considerable amount of time--more than a 
year--will be jointly introducing new initiatives to help restore hard-
pressed urban neighborhoods of our country to reach out to families and 
communities and neighbors that are dealing with some of the most 
difficult and intractable social problems that affect our society.
  This package, called REAL Life--renewal, empowerment, achievement, 
and learning for life--contains what we believe are essential elements 
to help bring improvements and restore hope to impoverished communities 
and to bring self-sufficiency to low-income individuals and families. 
REAL Life seeks to address the critical deficits facing neighborhoods 
and communities, families, those communities and neighborhoods who lie 
behind the gleaming skyscrapers, the neighborhoods where some of the 
most difficult problems in our society--homelessness, drug abuse, teen 
pregnancy, poverty, and violence--are found in some of the most complex 
and intractable forms in the neighborhoods, however, where groups of 
individuals and private community organizations and leaders are already 
at work defeating the poverty and dysfunction that have defied our 
well-intentioned and lavishly funded Federal efforts.
  Before I begin to make specific comments about the legislation that 
we will be introducing, let me take a moment to read from a letter 
given to me by Light of Life Ministries, a rescue mission operating in 
Pittsburgh, PA. I think this letter communicates in a very compelling 
and clear way both the problems that we face today in our low-income 
areas and particularly in our cities--although these are no respecters 
of income or persons, but it seems that the problems are particularly 
acute in some of our urban areas--but also addresses some of the 
solutions that even today are within our grasp.
  This letter is from a fellow named Benjamin Primis, a young man who, 
after a promising start in life, fell on hard times. He was a graphic 
artist working in the television industry, and he began using drugs and 
became addicted to crack cocaine. Soon he was homeless and desperate.
  Benjamin writes:

       I found myself homeless in Pittsburgh. It seemed as though 
     the world had turned its back on me. . . . When there was 
     nowhere else to run, the Light of Life Ministry in Pittsburgh 
     opened their doors of unconditional love. . . . Instantly I 
     was comforted with three hot meals a day, clean linens, drug 
     and alcohol therapy. . . . They fed me when I was hungry. 
     They clothed me when I had nothing else to wear. [Most 
     importantly,] they cared for me when I didn't care for 
     myself.

  Benjamin Primis's story is one of thousands, maybe tens of thousands, 
of stories of hope and restoration and healing that bring us together 
here on this floor, the Senate floor, this morning. Ben Primis was 
failed by both the dogmas and initiatives of Republicans and Democrats, 
conservatives and liberals. A booming economy did not prevent his fall 
into poverty. And the Government safety net proved to be an illusion. 
Instead, Ben was rescued by one of the thousands of neighborhood-based, 
privately run, often faith-based religious charities that operate in 
poor neighborhoods across our country.
  Let me give another example, Mr. President. For years, officials in 
the District of Columbia and Members of Congress have wrestled with the 
problem of violence in this city that has plagued this city. A lot of 
programs have been tried, and the police department has been 
strengthened and reorganized and redeployed on several occasions to 
almost no effect. It seemed that none of the often very expensive 
initiatives had any fruition.
  Last year, a group of African American men called the Alliance of 
Concerned Men began brokering peace treaties among the gangs that 
inhabit, and frequently dominate, some of the city's public housing 
complexes. Benning Terrace in southeast Washington, known to the D.C. 
police department as perhaps the most dangerous area of the city, has 
not had a single murder since the Alliance's peace treaty went into 
effect early last year. This movement is now spreading across the city.
  These are community healers who are saving lives where all other 
Government efforts have failed. I have met with these individuals. I 
have listened to their stories and some of the most remarkable stories 
of transformation of individual lives and reconciliation that anyone 
could ever encounter.

  The Light of Life Mission in Pittsburgh, the Alliance of Concerned 
Men in Washington, DC, Gospel Rescue Mission of Washington, these are 
the kinds of organizations that the Renewal Alliance REAL Life 
initiative wants to place at the center of our Nation's welfare and 
social policies.
  REAL Life is not a handout, it is an opportunity agenda for America's 
poor,

[[Page S3716]]

and it is concentrated on those who live on America's meanest streets. 
It does acknowledge a role for Government programs, but it makes that 
role one of a junior partner--not a CEO, not a director, but a junior 
partner, a junior partner with those organizations that, without 
Government help, without Government rules and regulations, are reaching 
out and actually bringing hope and bringing restoration to some of the 
most desperate situations that our country encounters. This whole array 
of community-based organizations, faith-based organizations, social 
institutions, help restore individual lives and rebuilds neighborhoods.
  Finally, REAL Life is a vision that starts with a belief that real 
and lasting social reform begins among the families, the churches, the 
schools, the businesses, that are the heart and the soul of local 
communities.
  We have three central components in REAL Life. We have a community 
renewal component, which I will talk a little bit more in a moment, 
which incorporates a State-based voluntary charity tax credit, charity 
donations protection, liability reform. We have an economic empowerment 
component, which incorporates a number of empowerment initiatives that 
have been discussed and talked about over the years. These will be 
discussed by other members of the Renewal Alliance. We have educational 
opportunity for low-income families. This real-life initiative by the 
Renewal Alliance has narrowed its scope to three essential components 
as a means of demonstrating the effectiveness of these initiatives.
  Before I yield to other members of the Renewal Alliance--and I note 
that Senator Abraham, a key member of our Alliance, is here and ready 
to speak--let me briefly discuss the community renewal portion of the 
package we are introducing today.
  The REAL Life Community Renewal Act begins with the belief that 
social capital, the invisible elements of trust, cooperation, and 
mutual support that undergird communities life, have been severely 
damaged by 30 years of misguided Government programs. The traditional 
networks of community action and caring anchored in churches, schools, 
and volunteer programs have been displaced by Government programs. Too 
much money and too little wisdom have combined to wreak havoc in urban 
neighborhoods. We seek to repair that damage done by the Great Society 
by shifting authority and resources out of Government and into the 
private, religious, and voluntary groups that know the deepest needs of 
local neighborhoods. We achieve this through State-based charity tax 
credit.
  We tap a wide range of existing Federal welfare block grants as a 
funding source for these charity tax credits. The credit is entirely 
voluntary. It builds up on efforts in the States to find innovative 
approaches for the delivery of welfare services. Already, Arizona and 
Pennsylvania and Indiana have either incorporated or are in the process 
of incorporating charity tax credits as a way to provide incentives for 
contributions to these organizations.
  As I said, we also contain provisions which will strengthen charities 
through enhanced liability protections and also to prevent IRS actions 
against these organizations to allow them to better do their mission. 
Others here this morning will speak in greater detail about the 
economic empowerment and educational opportunities sessions of our 
proposal.
  The bottom line is this: After 30 years of experiments with top-down 
Federal poverty strategies and an enormous expenditure of money, the 
returns are in. The Great Society approach, the Government-knows-all 
approach, the Government-can solve-all-your-problems approach, has 
failed. It has been a failure that has been widespread across this 
country. Many of the initiatives were well motivated, but the results 
are in. It is time now for us to look at a new approach, a new approach 
that makes local leadership, community-based institutions, and 
neighborhood center reform efforts the heart of our welfare strategy.
  I trust that my colleagues will join us in this effort to bring real 
life to those in greatest need in our society. I could spend the day 
discussing and talking about initiatives that have taken place in 
communities across this country where individuals, inspired by nothing 
more than a dream or a vision, often severely and desperately 
underfunded, have opened their arms and opened their hearts and opened 
their doors to provide real support and real help for real people in 
need. They have done so in a remarkable way.
  The Center for the Homeless in South Bend, IN, has combined the 
efforts of 300 churches spanning the spectrum of denominations and 
religions. They have utilized the services of the University of Notre 
Dame, the hospital community of St. Joseph County, and help from 
volunteers from all walks of life, and put together a model homeless 
shelter which has a six-part, 2-year strategy of taking homeless 
individuals and turning them into homeowners, restoring their lives, 
and, in the process, restoring neighborhoods and restoring communities. 
It is one of the most remarkably efficient and effective efforts that I 
have witnessed.
  But the story is repeated all across the State of Indiana in 
initiative after initiative. The Matthew 25 clinic in Fort Wayne, IN, a 
combination of doctors, dentists, and nurses, on a volunteer basis, is 
reaching out and established a clinic, providing medical care and help 
to low-income individuals who are not insured and don't have 
opportunities for medical treatment in the normal course of things. 
They have made a remarkable difference in our community. It is not a 
Federal program; it has nothing to do with a Federal program; there are 
no Federal funds. It is voluntary efforts by the community of medical 
personnel in our city. Whether it is a maternity home, a home for 
girls, a spouse abuse shelter, any of a number of programs, they are 
duplicated and replicated in virtually every city in America. Yet, they 
are struggling, struggling because, as I said, after 30 years of 
Federal initiatives, their efforts have been almost overwhelmed by the 
well-intended, well-meaning, extraordinarily expensive, and incredibly 
low-result efforts of the Federal Government. It is this problem that 
we are trying to address.
  This doesn't have to be a partisan issue. This is something 
Republicans and Democrats can come together on. I believe liberals, who 
have been well-motivated and well-intended, have seen the dismal 
results of their efforts and are looking for an alternative. And those 
conservatives who say, ``Let this sort itself out; after all, it is an 
issue of personal responsibility and there is nothing Government should 
be involved in,'' I think are ignoring the fact that some of these 
institutions that are so essential to helping in this process need 
support and need to be rebuilt.
  This is not a new, massive Federal program, this is simply some 
startup initiatives to point the way and, hopefully, to encourage the 
support and development of these non-Government institutions.

  My colleague from Michigan is on the floor, Senator Abraham, who has 
been instrumental in helping to develop the REAL Life initiative. I am 
pleased to yield time to him to explain another component of this 
particular package.
  The PRESIDING OFFICER. The distinguished Senator from Michigan is 
recognized.
  Mr. ABRAHAM. Mr. President, I would like to begin by thanking Senator 
Coats for the leadership he has provided. Even before there was such a 
thing as the Renewal Alliance, Senator Coats was, in a variety of 
contexts, bringing forth the arguments in the case that he has begun to 
present here today. I think the existence of his efforts and the 
various projects he has worked on was really the basis upon which a lot 
of us thought it made sense to begin working on a joint venture, the 
Renewal Alliance agenda that we are presenting today.
  I would like to discuss a piece of legislation that has to do with an 
important part of the Renewal Alliance agenda. This is a bill which 
provides economic empowerment in economically distressed areas. It is 
part of an effort by a number of us who wish to bring about the 
revitalization of economically and socially distressed areas in our 
country, especially in our cities.
  Traditional responses to persistent poverty have not been 
particularly effective. Frankly, even in the best of economic times, we 
find that certain parts of our communities still don't see significant 
change and feel that they are left behind--and indeed they are,

[[Page S3717]]

economically. On the other hand, at the other end of the spectrum there 
has been the Government solution approach that we have seen over the 
last several decades, more than $5 trillion in Government programs. 
Yet, we have seen very little change in the level of poverty in the 
country. The fact is that the debate that has occurred over the past 30 
years between, on the one hand, the argument that all we need is a 
strong economy and, on the other hand, all we need are more Government 
programs, leaves us still short of the mark.
  So what the Renewal Alliance has attempted to do is look beyond those 
traditional responses, believing that across America people have an 
abundance of desire to help the less fortunate to rebuild our cities 
and stop moral decay; also believing that too often the Federal 
Government impedes or fails to promote the community renewal that we 
need.
  We must encourage families, churches, small businesses, and community 
organizations to take on the hard work of social renewal. How? By 
reducing Government barriers that are making it difficult for 
economically distressed areas to improve the quality and conditions of 
life there and, at the same time, providing incentives so that the 
culture and the private sector can assist the Government in achieving 
this objective. Yes, we do need a social safety net for the truly 
deserving, but that will never give people the opportunity to get out 
the economically distressed conditions they find themselves in. We must 
go further.
  So what I would like to talk about specifically now is the economic 
empowerment component of the Renewal Alliance agenda. What we need are 
new approaches to our urban problems and problems of any community in 
the country that suffers from economic disadvantage because, as I say, 
despite the War on Poverty, our cities still face an array of problems.
  Illegitimacy in our inner cities is at a record high level, in some 
areas exceeding 80 percent.
  Harvard's Lee Rainwater estimates that by 2000, 40 percent of all 
American births will occur out of wedlock. And our cities are losing 
population, as well.
  Since the mid-1960s, our largest 25 cities have lost approximately 4 
million residents. Too often, the people left behind are the poor.
  Half the people in our distressed inner cities lived below the 
poverty line in 1993.
  To address this tragic situation, we propose the ``REAL Life Economic 
Empowerment Act.'' This legislation would target America's 100 poorest 
communities and offer pro-growth incentives to create jobs and spur 
entrepreneurship where it is needed most.
  In order to become a renewal community, a community must meet several 
criteria. First, it must need the assistance. That means people in the 
area must be experiencing abnormally high rates of poverty and 
unemployment.
  Second, State and local governments must enter into a written 
contract with neighborhood organizations to reduce taxes and fees, 
increase the efficiency of local services, formulate and implement 
crime reduction strategies, and make it easier for charities to 
operate.
  Third, the community must agree not to enforce a number of 
restrictions on entry into business or occupations, including 
unnecessary licensing and zoning requirements.
  In exchange, the community would receive a number of benefits from 
the Federal level. Our legislation would zero out capital gains taxes 
within these empowerment areas, it would increase business expensing, 
it would give a 20 percent wage credit to businesses hiring qualified 
workers who were still employed after 6 months, and it would provide 
tax incentives for entrepreneurs who clean up environmentally 
contaminated ``brownfield'' sites.

  Unlike the administration's current ``empowerment zones,'' our 
incentives recognize that it is the private sector, not the Federal 
Government, that must be part of any effort to revitalize our 
communities.
  Mr. President, there will be no boards established to dole out 
Government patronage, and our legislation will not include the onerous 
conditions and bureaucratic requirements of current programs. What is 
more, States and localities will be joining the Federal Government in 
reducing the burden of Government so that local small businesses can 
start and grow in distressed areas.
  We know that it is these small businesses, from barber shops to local 
grocery stores, that often serve as the glue holding communities 
together. Not only do these small businesses provide jobs, they also 
provide places where people can meet one another to exchange news and 
keep in touch with local events and other job opportunities. It is 
crucial that we seed our distressed areas with businesses like these so 
that residents can pull their communities together and work toward a 
better life.
  Mr. President, in short, what we hope to do with our legislation is 
to provide the incentives so that small entrepreneurial enterprises can 
develop in areas where there is currently significant economic 
distress. Therefore, the jobs being created will be created where the 
people are who don't have jobs. Right now, the biggest impediment to 
creating jobs is to create conditions in which entrepreneurship can 
exist. That means cleaning up contaminated brownfield sites, it means 
providing access to capital so small businesses can begin and flourish, 
it means making sure that Government regulations and rules aren't so 
burdensome and onerous that even the best-intentioned small business 
person can't even open their enterprise. The only way that is going to 
happen is if we have State, local, and Federal teams working together 
in the fashion that our legislation suggests.
  The suggestion that this can work is, I think, abundantly clear if 
one looks to just existing examples of this going on in the country 
today. In our State of Michigan, under Governor John Engler, we have 
launched several extraordinarily interesting initiatives along these 
lines--one called the Renaissance Zone Concept, which essentially does 
the same thing we are proposing in this legislation; it just doesn't 
have the Federal component. Obviously, the State could not include us 
in the mix. But what the State has done is to say that, within a 
certain number of zones in the State, in economically distressed 
areas--and they range from inner-cities to rural areas, Mr. President--
we will dramatically reduce the burdens of taxes and regulations in 
order to try to stimulate economic development. And we are doing that 
with tremendous results.
  Another approach that is somewhat similar is being done in an effort 
to get people off of the welfare rolls and onto the job rolls. In fact, 
we have a country in Michigan which, because of this kind of State and 
local cooperative effort, the county of over 200,000 people has 
virtually nobody left on the welfare rolls because of the innovative 
approach that is being taken.
  It is time to learn from these ``laboratories,'' these experiences at 
the State level. We believe this legislation moves us in that 
direction. So as we proceed forward with this Renewal Alliance agenda, 
I intend to work very hard on that component of it to find us economic 
empowerment. We want to give the Members of the Senate a chance to 
decide whether or not the business-as-usual approach is the way we want 
to enter the 21st century, or whether we want to augment what we do in 
Federal programs, as well as private sector initiatives, by providing, 
through the legislation we will offer, an opportunity to reduce the 
impediments to starting new business opportunities in our economically 
distressed areas, as well as providing incentives to create more of 
those businesses that obviously provide more people with a chance to 
get on the first rung of the economic ladder.
  Mr. President, let me conclude, because other members of the Alliance 
are here. I thank Senator Coats for his leadership on this. I look 
forward to working with all of our colleagues as we try to move this 
agenda forward this year.
  Mr. COATS. Mr. President, I thank the Senator from Michigan for his 
invaluable contributions to this effort. I now turn to another key 
member of our Renewal Alliance, someone who has offered additional 
invaluable contributions, for further explanation of the package we are 
introducing, Senator Santorum of Pennsylvania.

[[Page S3718]]

  The PRESIDING OFFICER. The distinguished Senator from Pennsylvania is 
recognized.
  Mr. SANTORUM. I thank the distinguished Presiding Officer for his 
recognition.
  Mr. President, let me thank Senator Coats for his tremendous 
leadership on what is, really, a new paradigm. Those listening to the 
debate on the Senate floor and the discussion of the Renewal Alliance 
agenda--renewal, empowerment, achievement learning for life--may be 
hearing some things for the first time, as to a different approach.
  One of the things that I know Senator Coats talked about and, in a 
sense, schooled many of us in here on this side of the aisle and on the 
other side of the aisle, I might add, is the importance of 
understanding the problems of this country, the real intractable 
problems, the ones that we sort of don't believe that there are any 
quick fixes to and are not going to be fixed in Washington. In fact, 
many of us would argue that many were exacerbated by attempts by 
Washington to fix those problems.
  As a result of Senator Coats' urgings, the more I have gotten out 
into the neighborhoods in the last few years--poor neighborhoods, in 
particular, in Pennsylvania--to see what works and what doesn't: What 
are people doing at the local level that is making a difference in 
people's lives, that is taking absolute hopelessness and despair and 
turning it into productivity and optimism?
  What I see is that, almost without exception, they are not Government 
programs and, almost without exception, they don't take Government 
dollars because, in so doing, it would corrupt what works for them 
because the Government would have some way of dictating to them how 
this program must work or what hoops they must jump through. And they 
have designed a program that meets the needs of the people in that 
community, designed by people in that community who have, in many, if 
not most, cases experienced the same kind of hopelessness and despair 
before they arrived where they are today--in a state of now helping 
those come out of the problems they have.
  So what I have learned from my discussions with those very people is 
that we need to look here in Washington as to how we can help them, 
help them do the mission--and it is a mission, it is not a job. I don't 
know of anybody I have met in these communities who is making any 
money, who is getting a good night's sleep at night, who is profiting 
in any real financial way from, or any tangible way from, their work, 
but profiting enormously in the intangibles that are, frankly, the most 
satisfying.
  It is a true labor of love for people in these communities, whether 
they are in the economic development area, or in the community 
development area, or in dealing with homelessness, or abused women, or 
doing a charter school, or running a small parochial school. Whatever 
the case may be, these are people who are convicted, who care deeply--
not about education, not about homelessness, not about drug abuse; they 
care about that person sitting across the table from them. It is not a 
macroissue. It is a one-to-one, person-to-person challenge to save 
someone's life. They do it because they care. They do it because they 
love that person. That is the magic that no Government program can 
provide.
  What Dan Coats, Spencer Abraham, and Sam Brownback--those of us who 
are members of the alliance having looked into the eyes of those who 
care, not those who appropriate money here in Washington who say we 
care, but those who are there across the table shedding the tears, 
holding the hands, embracing those in real pain, those people who 
care--how can we help them? How can we help the world ministries, the 
real healing agents of our society to solve those intractable problems 
that, believe it or not, they solve, and do so so well? How did we help 
them do it better? How can we help them turn more lives around and 
replicate the great accomplishments they have made to so many 
neighborhoods? There isn't a neighborhood in America where there is not 
at least one person or one organization--whether it is a school or 
whether it is a rehab center or whether it is a homeless shelter or a 
soup kitchen--that isn't touching and changing people.
  We have come forward with this agenda that is not, as the speaker 
said before, a Washington-based solution to the problem. But it is, in 
fact, a way that Washington can, one, get out of the way; two, maybe 
help with some of the things in a legal sense to get out of the way; 
three, give financial resources to those organizations that need those 
resources to either help the community or help the economy; and, next, 
give resources to the hands of parents and children so they can have 
the opportunity to hope through an education that gives them the tools 
to be able to be successful in our society.
  But I am going to focus my couple of minutes more to talk in the area 
of education. I cannot tell you the number of employers I talked to 
just within the southeastern Pennsylvania area the other day, 
Philadelphia. Employer after employer, factory or industry, they told 
me how they desperately need skilled people. They desperately need 
people who are even semiskilled who can be trained. There are such 
shortages in the workplace today. Then I asked--the unemployment rate 
in the city of Philadelphia, the center city, or in Chester, or in 
Levittown, or places like that is very high, and there is available 
work? They say, ``Yes, there is. We have job fares. We ask people to 
apply, and they don't.'' I said, ``Why don't they?'' They said, ``Well, 
by and large, they don't have the education. They can't, in many cases, 
fill out applications, or they just simply don't have the education 
necessary to even meet what is a minimal skilled job.''
  The jobs are there. But we just do not have people who are educated 
enough to take advantage of those opportunities. That is, in fact, a 
shame, and, as a result of a variety of factors, a breakdown in the 
family, the breakdown in the community, and, yes, the breakdown of the 
educational structure.
  There are lots of things we can do to solve the first two problems 
that have been talked about. I am going to talk about the third, which 
is the breakdown of the education structure. I am not going to profess 
to you I have the answer--the silver bullet to make public education 
work in America's poor neighborhoods. I do not have a silver bullet. I 
can sit up here and suggest a variety of things that may or may not 
work to solve that intractable problem in educating poor students in 
poor schools. I do not have that answer off the top of my head. What I 
do have is a solution that will give children and families the 
opportunity to send their child to school where they can get a good 
education tomorrow. We have to step back and say, ``Well, is that good 
enough?'' Some may say, ``Senator, you are not solving the big problem 
tomorrow in public education in the poor neighborhoods of our 
country.'' I will answer, You are right. I am not. I am not going to 
solve that problem tomorrow. But what I am going to start to do today 
is to give that young person who may have a dream, or that mother or 
father who sees the spark in that young child's eye and believes that 
spark can lead them to somewhere in life if given the educational 
tools. I am going to give them the chance to get that child a chance. 
That is all we can do right now--to give them a scholarship, to send 
them to a school where they will have the opportunity to see that spark 
catch fire, to feed them what they need to take on the world.

  Our program, called Educational Opportunities for Low-Income 
Families, is to provide scholarships through existing block grants that 
go to the States right now. We would allow that block grant to be used 
for scholarships to go to low-income children and 185 percent of 
poverty and below in the poorest neighborhoods in our country so that 
it will give low-income kids in poor neighborhoods the opportunity to 
have a scholarship that pays up to 60 percent of the cost of their 
tuition and would give them the opportunity to go to school and learn. 
I think it is a great opportunity for us to help one child at a time. I 
believe that in the long run helping one child at a time and giving 
that choice will, in fact, cause dramatic reforms in the whole 
educational system in those communities.
  I have been given the high sign here. I will follow my chairman's 
lead. Again, I thank Senator Coats for his tremendous leadership on 
this.

[[Page S3719]]

  Mr. COATS. Mr. President, it is very difficult to ask the Senator 
from Pennsylvania to wrap up his remarks because he, obviously, has 
such a deep-felt and heartfelt passion for these issues. I appreciate 
his work with us. We are under some time constraint.
  I now turn the floor over to the Senator from Kansas, Senator 
Brownback, who has also been a very key instrumental member of the 
development of this package.
  The PRESIDING OFFICER. The distinguished Senator from Kansas is 
recognized.
  Mr. BROWNBACK. Thank you very much. Mr. President, I am delighted to 
be able to work with the distinguished Senator from Kansas, who is 
presiding today, and also the distinguished Senator from Indiana, who 
has put forth this new alliance. It is a cadre of members who are 
putting forth these points that we think have not been sufficiently 
debated nor brought forward in the overall debate in America about what 
we should do about the crying issues of poverty that has so hit and 
harmed our Nation in so many places, both urban and rural.
  More than 30 years after the United States first declared the War on 
Poverty, most signs point to failure. The United States has spent 
hundreds of billions of dollars--by some accounts we have spent nearly 
$4 trillion--to fight poverty only to find poverty in America has grown 
more widespread, more entrenched, and more pathological. The solution 
is not to expand more Government but rather to go a different way, and 
to say, ``Look, we have tried that route. We have spent nearly $4 
trillion trying that route. We have tried every program you possibly 
can with that route. Maybe there is another way that we should be 
going.''
  This is what the Renewal Alliance, this program, is about--about 
rewarding self-help and not Government help. It is about encouraging 
charity rather than encouraging Government. It is about encouraging 
volunteerism rather than putting more people on the taxpayer rolls to 
solve problems that we have failed to be able to solve. Family 
breakdown, crime, poor education performance, and a lack of opportunity 
in the inner cities, and many other areas, including many rural areas, 
are now national problems. But many of the solutions are to be found on 
a local level and not in Washington, through personal contacts that 
people can make between individuals and the dedicated involvement of 
families, churches, schools, and neighborhood associations. These small 
groups, not big Government, but rather small groups, often referred to 
as the ``little platoons'' in a civil society, can often accomplish 
what no Government program could dream of or ever been able to do. They 
have the soft hearts and the willing hands to be able to reach out and 
touch people directly in a community where they are in there with the 
families working with them.

  Last December, I had the chance to visit several of these small, 
private charities in my home State of Kansas. To me, they are living 
proof of the amazing effectiveness of small, local charities that lead 
with heart, that lead with love.
  Mr. President, in this very body, in this very room, as you enter 
into the main doorway coming in here, there is a sign above the door 
mantle which reads ``In God We Trust.'' As I visited these small 
charities in Kansas, I was reminded at that time and was thinking about 
how many people say that versus how many people do that. These are 
charities, which ``In God We Trust'' they live every day.
  I visited Good Samaritan Clinic in Wichita, which serves around 300 
patients a month from Wichita's poorest neighborhood. This tiny clinic 
operates on less than a shoestring budget. With the exception of a fax 
machine and one piece of furniture, everything in the clinic is 
donated. The clinic's staff, a dedicated and accomplished group of 
doctors, are mostly volunteers. They are reaching out and touching 
people, and helping and healing people with their skills and with their 
hearts.
  I visited the Topeka Rescue Mission and the Union Rescue Mission of 
Wichita, both of which serve thousands of people each year.
  These missions are not merely assigning people to bunks, but they 
challenge them personally and spiritually, and they are challenged to 
change their hearts and their souls along with helping them out in 
their lives.
  I visited the Crisis Pregnancy Outreach Program in Topeka and a 
maternity home in Wichita and saw firsthand the love and personal 
attention devoted to each woman who passes through those doors.
  Contrast that with the large Government solution that we have tried 
for the past 30 years that gets millions of people flowing through the 
door but constantly keeps them flowing back out the door and never 
really changes things in a person's life, continues to hand them 
something but doesn't put arms around them and hug them, doesn't put 
arms around them and give them heart and soul and say, ``Here is my 
phone number; call anytime.''
  It is not that we don't have a lot of good and dedicated servants; we 
do, but they are limited in what they can do. This is a mission for 
them. They must not see the number of people who are walking through; 
they must see a soul at a time. They must see another and another, to 
reach out and touch and help them. We need to encourage these groups 
and not discourage them.
  As the past 35 years of our history has shown, the Federal Government 
is limited in its capacity to solve the problems of poverty and 
pathology, But it can eliminate perverse incentives that reward 
irresponsibility and fuel the flight of capital from the inner cities, 
and it can encourage entrepreneurialism, charitable giving and 
investment in the inner cities and its inhabitants, investment in the 
inhabitants of those areas and rural areas as well. It can do these 
things and it should. And through the renewal alliance REAL Life 
legislation, it will.
  That is why I am delighted to be associated with the Senator from 
Indiana in this package that we have put forward. It is a different 
way. It is a way that people every day are proving can and is working, 
and we need to encourage it and lift it up and move it forward. I am 
delighted to be a part of this legislation.
  Mr. COATS. Mr. President, I thank the Senator from Kansas for his 
invaluable support and effort in helping craft this legislation.
  Mr. President, I know the time allocated to us is just about up.
  I send to the desk three pieces of legislation, one that I am 
introducing, another that Senator Abraham is introducing, and a third 
that Senator Santorum is introducing, all of which encompass the three 
major components of the renewal alliance package. I would ask for its 
immediate referral.
  Mr. President, I also ask unanimous consent if it is possible--a 
qualified unanimous consent request--to have these numbered 
sequentially since these three pieces of legislation are part of a 
package. If it is possible, we would like to have them numbered 
consecutively.
  The PRESIDING OFFICER. Is there an objection? The Chair hears none, 
and the bills will be so numbered. They will be received and 
appropriately referred.
  Mr. COATS. Mr. President, I believe that wraps up our time. I think 
the Senator from Iowa is in the Chamber prepared to speak within a 
moment or two. Let me ask unanimous consent for 2 additional minutes to 
wrap up.
  The PRESIDING OFFICER. The Senator has 2 additional remaining on his 
time.
  Mr. COATS. That is propitious then. The Senator will take all 2 of 
those minutes. I thank the Chair.
  Mr. President, in summary, let me state that what we are attempting 
to accomplish here is a third alternative. We believe that the well-
intentioned, well-motivated programs of the past, at great cost to the 
taxpayers, have failed to successfully address some of the most 
difficult social problems facing our Nation, and particularly problems 
facing low-income urban communities where in many situations nothing 
but crime and drugs are the prevalent activities of those 
organizations. By the same token, the argument that no Federal policy 
is the best policy to address these problems is something that we as a 
group cannot accept.
  We think this third alternative, providing REAL Life meaningful 
solutions to the areas of community renewal, economic empowerment and 
educational opportunities for low-income families offers real hope. It 
does so not through Government organizations,

[[Page S3720]]

Government structures or even significant Government funding. It does 
so by encouraging those community volunteer, nonprofit, often faith-
based organizations that already exist and should exist in greater 
numbers to take a much greater role in addressing these problems. We 
want to make the Federal Government not the dominant partner but a 
junior partner, an entity that can assist through the provision of Tax 
Code changes, primarily tax credits and other incentives, to encourage 
individuals and other organizations to contribute to these nonprofit 
groups to allow them to do a better job. They have demonstrated success 
at an efficiency rate and at a cost-effectiveness that far exceeds 
those current programs in place.
  Are we calling for a dismantling of the safety net? No, we are not. 
We are calling for a better use of dollars, a better commitment, 
stronger commitment to organizations which have demonstrated real 
success in providing hope to individuals, transformation and renewal of 
communities.
  Mr. President, I believe the time is probably expired, and with that 
I yield the floor and encourage my colleagues to take a look at the 
REAL Life Renewal Alliance initiative which we are happy to provide and 
discuss with our colleagues.
                                 ______
                                 
      By Ms. MIKULSKI (for herself and Mr. Faircloth):
  S. 1997. A bill to protect the right of a member of a health 
maintenance organization to receive continuing care at a facility 
selected by that member; to the Committee on Labor and Human Resources.


         THE ``SENIORS' ACCESS TO CONTINUING CARE ACT OF 1998''

  Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Seniors' 
Access to Continuing Care Act of 1998'', a bill to protect seniors' 
access to treatment in the setting of their choice and to ensure that 
seniors who reside in continuing care communities, and nursing and 
other facilities have the right to return to that facility after a 
hospitalization.
  As our population ages, more and more elderly will become residents 
of various long term care facilities. These include independent living, 
assisted living and nursing facilities, as well as continuing care 
retirement communities, which provide the entire continuum of care. In 
Maryland alone, there are over 12,000 residents in 32 continuing care 
retirement communities and 24,000 residents in over 200 licenced 
nursing facilities.
  I have visited many of these facilities and have heard from both 
residents and operators. They have told me about a serious and 
unexpected problem encountered with returning to their facility after a 
hospitalization. Many individuals have little choice when entering a 
nursing facility. They do so because it is medically necessary, because 
they need a high level of care that they can no longer receive in their 
homes or in a more independent setting, such as assisted living. But 
residents are still able to form relationships with other residents and 
staff and consider the facility their ``home''.
  More and more individuals and couples are choosing to enter 
continuing care communities because of the community environment they 
provide. CCRC's provide independent living, assisted living and nursing 
care, usually on the same campus--the Continuum of Care. Residents find 
safety, security and peace of mind. They often prepay for the continuum 
of care. Couples can stay together, and if one spouse needs additional 
care, it can be provided right there, where the other spouse can remain 
close by.
  But hospitalization presents other challenges. Hospitalization is 
traumatic for anyone, but particularly for our vulnerable seniors. We 
know that having comfortable surroundings and familiar faces can aid 
dramatically in the recovery process. So, we should do everything we 
can to make sure that recovery process is not hindered.
  Today, more and more seniors are joining managed care plans. This 
trend is likely to accelerate given the expansion of managed care 
choices under the 1997 Balanced Budget Act. As more and more decisions 
are made based on financial considerations, choice often gets lost. 
Currently, a resident of a continuing care retirement community or a 
nursing facility who goes to the hospital has no guarantee that he or 
she will be allowed by the MCO to return to the CCRC or nursing 
facility for post acute follow up care.
  The MCO can dictate that the resident go to a different facility that 
is in the MCO network for that follow up care, even if the home 
facility is qualified and able to provide the needed care.
  Let me give you a few examples:
  In the fall of 1996, a resident of Applewood Estates in Freehold, New 
Jersey was admitted to the hospital. Upon discharge, her HMO would not 
permit her to return to Applewood and sent her to another facility in 
Jackson. The following year, the same thing happened, but after strong 
protest, the HMO finally relented and permitted her to return to 
Applewood. She should not have had to protest, and many seniors are 
unable to assert themselves.
  A Florida couple in their mid-80's were separated by a distance of 20 
miles after the wife was discharged from a hospital to an HMO-
participating nursing home located on the opposite side of the county. 
This was a hardship for the husband who had difficulty driving and for 
the wife who longed to return to her home, a CCRC. The CCRC had room in 
its skilled nursing facility on campus. Despite pleas from all those 
involved, the HMO would not allow the wife to recuperate in a familiar 
setting, close to her husband and friends. She later died at the HMO 
nursing facility, without the benefit of frequent visits by her husband 
and friends.
  An elderly couple in Riverside, California encountered the same 
problem when the husband was discharged from the hospital and retained 
against her will at the HMO skilled nursing facility instead of the 
couple's community. At 25 miles apart, it was impossible for his wife 
and friends to visit at a time when he needed the tenderness and 
compassion of loved ones.
  Another Florida woman, a resident of a CCRC fractured her hip. Her 
HMO wanted her to move into a nursing home for treatment. She refused 
to abandon her home and received the treatment at the CCRC. Her HMO 
refused to pay for the treatment, so she had to pay out of her pocket.
  Collington Episcopal Life Care Community, in my home state of 
Maryland, reports ongoing problems with its frail elderly having to 
obtain psychiatric services, including medication monitoring, off 
campus, even though the services are available at Collington--how 
disruptive to good patient care!
  On a brighter note, an Ohio woman's husband was in a nursing 
facility. When she was hospitalized, and then discharged, she was able 
to be admitted to the same nursing facility because of the Ohio law 
that protected that right.
  Seniors coming out of the hospital should not be passed around like a 
baton. Their care should be decided based on what is clinically 
appropriate, not what is financially mandated. Why is that important? 
What are the consequences?
  Residents consider their retirement community or long term care 
facility as their home. And being away from home for any reason can be 
very difficult. The trauma of being in unfamiliar surroundings can 
increase recovery time. The staff of the resident's ``home'' facility 
often knows best about the person's chronic care and service needs. 
Being away from ``home'' separates the resident from his or her 
emotional support system.
  Refusal to allow a resident to return to his or her home takes away 
the person's choice. All of this leads to greater recovery time and 
unnecessary trauma for the patient.
  And should a woman's husband have to hitch a ride or catch a cab in 
order to see his recovering spouse if the facility where they live can 
provide the care? No. Retirement communities and other long term care 
facilities are not just health care facilities. They provide an entire 
living environment for their residents, in other words, a home. We need 
to protect the choice of our seniors to return to their ``home'' after 
a hospitalization. And that is what my bill does.
  It protects residents of CCRC's and nursing facilities by: enabling 
them to return to their facility after a hospitalization; and requiring 
the resident's insurer or managed care organization (MCO) to cover the 
cost of the care, even if the insurer does not have a contract with the 
resident's facility.

[[Page S3721]]

  In order for the resident to return to the facility and have the 
services covered by the insurer or MCO: 1. The service to be provided 
must be a service that the insurer covers; 2. The resident must have 
resided at the facility before hospitalization, have a right to return, 
and choose to return; 3. The facility must have the capacity to provide 
the necessary service and meet applicable licensing and certification 
requirements of the state; 4. The facility must be willing to accept 
substantially similar payment as a facility under contract with the 
insurer or MCO.
  My bill also requires an insurer or MCO to pay for a service to one 
of its beneficiaries, without a prior hospital stay, if the service is 
necessary to prevent a hospitalization of the beneficiary and the 
service is provided as an additional benefit. Lastly, the bill requires 
an insurer or MCO to provide coverage to a beneficiary for services 
provided at a facility in which the beneficiary's spouse already 
resides, even if the facility is not under contract with the MCO, 
provided the other requirements are met.
  In conclusion, Mr. President, I am committed to providing a safety 
net for our seniors--this bill is part of that safety net. Seniors 
deserve quality, affordable health care and they deserve choice. This 
bill offers those residing in retirement communities and long term care 
facilities assurance to have their choices respected, to have where 
they reside recognized as their ``home'', and to be permitted to return 
to that ``home'' after a hospitalization. It ensures that spouses can 
be together as long as possible. And it ensures access to care in order 
to prevent a hospitalization. I urge my colleagues to join me in 
passing this important measure to protect the rights of seniors and 
their access to continuing care.
                                 ______
                                 
      By Mr. HATCH (for himself, Mr. Bennett, and Mr. Bingaman):
  S. 1998. A bill to authorize an interpretive center and related 
visitor facilities within the Four Corners Monument Tribal Park, and 
for other purposes; to the Committee on Indian Affairs.


                THE FOUR CORNERS INTERPRETIVE CENTER ACT

  Mr. HATCH. Mr. President, I rise today to introduce legislation that 
would authorize an interpretive center and visitor facilities at the 
Four Corners National Monument. As my colleagues know, Four Corners is 
the only place in our country where four state boundaries meet. Over a 
quarter of a million people visit this monument every year.
  The Four Corners area is also unique for reasons other than the 
political boundaries of four states. Once inhabited by the earliest 
Americans, the Anaxazi, this area is rich in historical, 
archaeological,and cultural significance as well as natural beauty.
  Currently, however, there is nothing at Four Corners that would help 
visitors to fully appreciate and learn about the area. And, at a 
national monument that has 250,000 visitors a year, one would expect 
certain basic facilities to exist--restrooms, for example. But, there 
is no electricity, running water, telephone, or permanent structure at 
Four Corners.
  The bill I am introducing today is simple: We propose a Federal 
matching grant to build an interpretive center and visitor facilities 
within the boundaries of Four Corners Monument Tribal Park.
  We are not suggesting a museum the size of the Guggenheim. But, 
exhibits on the history, geography, culture, and ecology of the region 
would significantly enhance the area and Americans' appreciation of 
this unique part of their country and their heritage. And, I daresay 
that some very basic guest amenities would enhance their enjoyment of 
it.
  There is, as you can imagine, a great deal of excitement and 
enthusiasm for this project from many fronts. Currently, the Monument 
is operated as one of the units of the Navajo Nation Parks and 
Recreation Department. And, since there has been so much debate about 
``monuments'' recently, I should clarify that the Four Corners 
``Monument'' is merely a slightly elevated concrete slab at the 
juncture of our four states.
  The Navajo Nation owns the land in the Arizona, New Mexico, and Utah 
quarters and the Ute Mountain Ute Tribe owns the quarter in Colorado. 
Although the Navajo Nation and the Ute Mountain Ute Tribe are fully 
supportive of the project and have entered into an agreement with one 
another in order to facilitate planning and development at the Four 
Corners Monument, neither Tribe has the necessary resources to improve 
the facilities and create an interpretive center at the Monument.
  The bill, however, does not contemplate federal government give-away. 
The bill requires matching funds from nonfederal sources and for the 
two tribes to work collaboratively toward the development of a 
financial management plan. It is intended that the Interpretive Center 
become fully self-sufficient within five years.
  The bill requires that proposals meeting the stated criteria be 
submitted to the Secretary of the Interior. These criteria include, 
among other things, compliance with the existing agreements between the 
Navajo and Ute Mountain Ute Tribes, a sound financing plan, and the 
commitment of nonfederal matching funds. The federal contribution would 
not exceed $2.25 million over a 5 year period.

  Over the past several years, the Navajo Nation has met with many of 
the local residents of the area and has found overwhelming support to 
improve the quality of the services provided at the Four Corners 
Monument. The local area suffers an unemployment rate of over 50 
percent and any development which would create employment opportunities 
and would encourage visitors to stay longer in the area would be 
welcomed.
  Another important participant in the development of this proposal is 
the Four Corners Heritage Council. This Council, which was established 
in 1992 by the governors of the four states, is a coalition of private, 
tribal, federal, state, and local government interests committed to 
finding ways to make the economy of the Four Corners region sustainable 
into the future. The mission of the Heritage Council is to guide the 
region toward a balance of the sometimes competing interests of 
economic development, resource preservation, and maintenance of 
traditional life ways.
  Back in 1949, nearly 50 years ago, the governors of the states of 
Arizona, Colorado, New Mexico, and Utah assembled at the Four Corners 
in a historic meeting. Each governor sat in their respective state and 
had what is probably the most unusual picnic lunch in history. They 
pledged to meet often at the Four Corners Monument to reaffirm their 
commitment to working together. Clearly, the governors understood that 
they shared stewardship of a unique piece of western real estate.
  Mr. President, the heritage of this area belongs to all Americans. 
The small investment requested in this legislation will help bring it 
to life.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1998

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Four Corners Interpretive 
     Center Act''.

     SEC. 2. FINDINGS AND PURPOSES.

       (a) Findings.--Congress finds that--
       (1) the Four Corners Monument is nationally significant as 
     the only geographic location in the United States where 4 
     State boundaries meet;
       (2) the States with boundaries that meet at the Four 
     Corners area are Arizona, Colorado, New Mexico, and Utah;
       (3) between 1868 and 1875 the boundary lines that created 
     the Four Corners were drawn, and in 1899 a monument was 
     erected at the site;
       (4) a United States postal stamp will be issued in 1999 to 
     commemorate the centennial of the original boundary marker;
       (5) the Four Corners area is distinct in character and 
     possesses important historical, cultural, and prehistoric 
     values and resources within the surrounding cultural 
     landscape;
       (6) although there are no permanent facilities or utilities 
     at the Four Corners Monument Tribal Park, each year the park 
     attracts approximately 250,000 visitors;
       (7) the area of the Four Corners Monument Tribal Park falls 
     entirely within the Navajo Nation or Ute Mountain Ute Tribe 
     reservations;
       (8) the Navajo Nation and the Ute Mountain Ute Tribe have 
     entered into a Memorandum of Understanding governing the 
     planning and future development of the Four Corners Monument 
     Tribal Park;

[[Page S3722]]

       (9) in 1992 through agreements executed by the governors of 
     Arizona, Colorado, New Mexico, and Utah, the Four Corners 
     Heritage Council was established as a coalition of State, 
     Federal, tribal, and private interests;
       (10) the State of Arizona has obligated $45,000 for 
     planning efforts and $250,000 for construction of an 
     interpretive center at the Four Corners Monument Tribal Park;
       (11) numerous studies and extensive consultation with 
     American Indians have demonstrated that development at the 
     Four Corners Monument Tribal Park would greatly benefit the 
     people of the Navajo Nation and the Ute Mountain Ute Tribe;
       (12) the Arizona Department of Transportation has completed 
     preliminary cost estimates that are based on field experience 
     with rest-area development for the construction of a Four 
     Corners Monument Interpretive Center and surrounding 
     infrastructure, including restrooms, roadways, parking, 
     water, electrical, telephone, and sewage facilities;
       (13) an interpretive center would provide important 
     education and enrichment opportunities for all Americans.
       (14) Federal financial assistance and technical expertise 
     are needed for the construction of an interpretive center.
       (b) Purposes.--The purposes of this Act are--
       (1) to recognize the importance of the Four Corners 
     Monument and surrounding landscape as a distinct area in the 
     heritage of the United States that is worthy of 
     interpretation and preservation;
       (2) To assist the Navajo Nation and the Ute Mountain Ute 
     Tribe in establishing the Four Corners Interpretive Center 
     and related facilities to meet the needs of the general 
     public;
       (3) To highlight and showcase the collaborative resource 
     stewardship of private individuals, Indian tribes, 
     universities, Federal agencies, and the governments of States 
     and political subdivisions thereof (including counties);
       (4) to promote knowledge of the life, art, culture, 
     politics, and history of the culturally diverse groups of the 
     Four Corners region.

     SEC. 3. DEFINITIONS.

       As used in this Act--
       (1) Center.--The term ``Center'' means the Four Corners 
     Interpretive Center established under section 4, including 
     restrooms, parking areas, vendor facilities, sidewalks, 
     utilities, exhibits, and other visitor facilities.
       (2) Four corners heritage council.--The term ``Four Corners 
     Heritage Council'' means the nonprofit coalition of Federal, 
     State, and tribal entities established in 1992 by agreements 
     of the Governors of the States of Arizona, Colorado, New 
     Mexico, and Utah.
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior.
       (4) Recipient.--The term ``Recipient'' means the State of 
     Arizona, Colorado, New Mexico, or Utah, or any consortium of 
     two or more of these states.
       (5) Four corners monument.--The term ``Four Corners 
     Monument'' means the physical monument where the boundaries 
     of the states of Arizona, Colorado, New Mexico and Utah meet.
       (6) Four corners monument tribal park.--The term ``Four 
     Corners Monument Tribal Park'' means lands within the legally 
     defined boundary of the Four Corners Monument Tribal Park.

     SEC. 4. FOUR CORNERS MONUMENT INTERPRETIVE CENTER.

       (a) Establishment.--Subject to the availability of 
     appropriations, the Secretary is authorized to establish 
     within the boundaries of the Four Corners Monument Tribal 
     Park a center for the interpretation and commemoration of the 
     Four Corners Monument, to be known as the ``Four Corners 
     Interpretive Center.''
       (b) Land for the Center shall be designated and made 
     available by the Navajo Nation or the Ute Mountain Ute Tribe 
     within the boundary of the Four Corners Monument Tribal Park 
     in consultation with the Four Corners Heritage Council and in 
     accordance with--
       (1) the memorandum of understanding between the Navajo 
     Nation and the Ute Mountain Ute Tribe that was entered into 
     on October 22, 1996; and
       (2) applicable supplemental agreements with the Bureau of 
     Land Management, the National Park Service, the United States 
     Forest Service.
       (c) Concurrence.--Notwithstanding any other provision of 
     this Act, no such center shall be established without the 
     consent of the Navajo Nation and the Ute Mountain Ute Tribe.
       (d) Components of Center.--The Center shall include--
       (1) a location for permanent and temporary exhibits 
     depicting the archaeological, cultural, and natural heritage 
     of the Four Corners region;
       (2) a venue for public education programs;
       (3) a location to highlight the importance of efforts to 
     preserve southwestern archaeological sites and museum 
     collections;
       (4) a location to provide information to the general public 
     about cultural and natural resources, parks, museums, and 
     travel in the Four Corners region; and
       (5) visitor amenities including restrooms, public 
     telephones, and other basic facilities.

     SEC. 5. CONSTRUCTION GRANT.

       (a) Grant.--The Secretary is authorized to award a Federal 
     grant to the Recipient described in section 3(4) for up to 50 
     percent of the cost to construct the Center. To be eligible 
     for the grant, the Recipient shall provide assurances that--
       (1) The non-Federal share of the costs of construction is 
     paid from non-Federal sources. The non-Federal sources may 
     include contributions made by States, private sources, the 
     Navajo Nation and the Ute Mountain Ute Tribe for planning, 
     design, construction, furnishing, startup, and operational 
     expenses.
       (2) The aggregate amount of non-Federal funds contributed 
     by the States used to carry out the activities specified in 
     subparagraph (A) will not be less than $2,000,000, of which 
     each of the states that is party to the grant will contribute 
     equally in cash or in kind.
       (3) States may use private funds to meet the requirements 
     of paragraph (2).
       (4) The State of Arizona may apply $45,000 authorized by 
     the State of Arizona during fiscal year 1998 for planning and 
     $250,000 that is held in reserve by that State for 
     construction towards the Arizona share.
       (b) Grant Requirements.--In order to receive a grant under 
     this Act, the Recipient shall--
       (1) submit to the Secretary a proposal that meets all 
     applicable--
       (A) laws, including building codes and regulations;
       (B) requirements under the Memorandum of Understanding 
     described in paragraph (2) of this subsection; and
       (C) provides such information and assurances as the 
     Secretary may require.
       (2) The Recipient shall enter into a Memorandum of 
     Understanding (MOU) with the Secretary providing--
       (A) a timetable for completion of construction and opening 
     of the Center;
       (B) assurances that design, architectural and construction 
     contracts will be competitively awarded;
       (C) specifications meeting all applicable Federal, State, 
     and local building codes and laws;
       (D) arrangements for operations and maintenance upon 
     completion of construction;
       (E) a description of center collections and educational 
     programming;
       (F) a plan for design of exhibits including, but not 
     limited to, collections to be exhibited, security, 
     preservation, protection, environmental controls, and 
     presentations in accordance with professional museum 
     standards;
       (G) an agreement with the Navajo Nation and the Ute 
     Mountain Ute Tribe relative to site selection and public 
     access to the facilities;
       (H) a financing plan developed jointly by the Navajo Nation 
     and the Ute Mountain Ute Tribe outlining the long-term 
     management of the Center, including but not limited to--
       (i) the acceptance and use of funds derived from public and 
     private sources to minimize the use of appropriated or 
     borrowed funds;
       (ii) the payment of the operating costs of the Center 
     through the assessment of fees or other income generated by 
     the Center;
       (iii) a strategy for achieving financial self-sufficiency 
     with respect to the Center by not later than 5 years after 
     the date of enactment of this Act; and
       (iv) defining appropriate vendor standards and business 
     activities at the Four Corners Monument Tribal Park.

     SEC. 6. SELECTION OF GRANT RECIPIENT.

       The Secretary is authorized to award a grant in accordance 
     with the provisions of this Act. The Four Corners Heritage 
     Council may make recommendations to the Secretary on grant 
     proposals regarding the design of facilities at the Four 
     Corners Monument Tribal Park.

     SEC. 7. AUTHORIZATION OF APPROPRIATIONS.

       In General.--(a) Authorizations.--There are authorized to 
     be appropriated to carry out this Act--
       (1) $2,000,000 for fiscal year 1999;
       (2) $50,000 for each of fiscal years 2000-2004 for 
     maintenance and operation of the Center, program development, 
     or staffing in a manner consistent with the requirements of 
     section 5(b).
       (b) Carryover.--Any funds made available under this section 
     that are unexpended at the end of the fiscal year for which 
     those funds are appropriated may be used by the Secretary 
     through fiscal year 2001 for the purposes for which those 
     funds were made available.
       (c) Reservation of Funds.--The Secretary may reserve funds 
     appropriated pursuant to this Act until a proposal meeting 
     the requirements of this Act is submitted, but no later than 
     September 30, 2000.

     SEC. 8. DONATIONS.

       Notwithstanding any other provision of law, for purposes of 
     the planning, construction, and operation of the Center, the 
     Secretary may accept, retain, and expend donations of funds, 
     and use property or services donated from private persons and 
     entities or from public entities.

     SEC. 9. STATUTORY CONSTRUCTION.

       Nothing in this Act is intended to abrogate, modify, or 
     impair any right or claim of the Navajo Nation or the Ute 
     Mountain Ute Tribe, that is based on any law (including any 
     treaty, Executive order, agreement, or Act of Congress).

  Mr. BINGAMAN. Mr. President, I am pleased to rise today to co-sponsor 
this important legislation introduced by my friend from Utah, Senator 
Hatch. The bill authorizes the construction of an interpretive visitor 
center at the Four Corners Monument. As I am sure

[[Page S3723]]

all senators know, the Four Corners is the only place in America where 
the boundaries of four states meet in one spot. The monument is located 
on the Navajo and Ute Mountain Ute Reservations and operated as a 
Tribal Park. Nearly a quarter of a million people visit this unique 
site every year. However, currently there are no facilities for 
tourists at the park and nothing that explains the very special 
features of the Four Corners region. The bill authorizes the Department 
of the Interior to contribute $2 million toward the construction of a 
much needed interpretive center for visitors.
  Mr. President, the Four Corners Monument is more than a geographic 
curiosity. It also serves as a focal point for some of the most 
beautiful landscape and significant cultural attractions in our 
country. An interpretive center will help visitors appreciate the many 
special features of the region. For example, within a short distance of 
the monument are the cliff dwellings of Mesa Verde, Colorado; the Red 
Rock and Natural Bridges areas of Utah; and in Arizona, Monument Valley 
and Canyon de Chelly. The beautiful San Juan River, one of the top 
trout streams in the Southwest, flows through Colorado, New Mexico, and 
Utah.
  In my state of New Mexico, both the legendary mountain known as 
Shiprock and the Chaco Canyon Culture National Historical Park are a 
short distance from the Four Corners.
  Mr. President, Shiprock is one of the best known and most beautiful 
landmarks in New Mexico. The giant volcanic monolith rises nearly 2,000 
feet straight up from the surrounding plain. Ancient legend tells us 
the mountain was created when a giant bird settled to earth and turned 
to stone. In the Navajo language, the mountain is named Tse' bi t'ai or 
the Winged Rock. Early Anglo settlers saw the mountain's soaring spires 
and thought they resembled the sails of a huge ship, so they named it 
Shiprock.
  The Four Corners is also the site of Chaco Canyon. Chaco was an 
important Anasazi cultural center from about 900 through 1130 A.D. Pre-
Columbian civilization in the Southwest reached its greatest 
development there. The massive stone ruins, containing hundreds of 
rooms, attest to Chaco's cultural importance. As many as 7,000 people 
may have lived at Chaco at one time. Some of the structures are thought 
to house ancient astronomical observatories to mark the passage of the 
seasons. The discovery of jewelry from Mexico and California and a vast 
network of roads is evidence of the advanced trading carried on at 
Chaco. Perhaps, the most spectacular accomplishment at Chaco was in 
architecture. Pueblo Bonito, the largest structure, contains more than 
800 rooms and 32 kivas. Some parts are more than five stories high. The 
masonry work is truly exquisite. Stones were so finely worked and 
fitted together that no mortar was needed. Remarkably all this was 
accomplished without metal tools or the wheel.
  Mr. President, 1999 marks the centennial year of the first monument 
at the Four Corners. An interpretive center is urgently needed today to 
showcase the history, culture, and scenery of this very special place. 
New facilities at the monument will attract visitors and help stimulate 
economic development throughout the region. I am pleased to co-sponsor 
this bill with Senator Hatch, and I thank him for his efforts.

                          ____________________