[Congressional Record Volume 144, Number 56 (Thursday, May 7, 1998)]
[Senate]
[Pages S4528-S4538]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. BAUCUS (for himself, Mr. Graham, Mr. Breaux, Mr. Reid, Mr.
Grassley, Ms. Mikulski, and Mr. Johnson):
S. 2040. A bill to amend title XIX of the Social Security Act to
extend the authority of State medicaid fraud control units to
investigate and prosecute fraud in connection with Federal health care
programs and abuse of residents of board and care facilities; to the
Committee on Finance.
the senior citizen protection act of 1998
Mr. BAUCUS. Mr. President, today I rise to introduce the Senior
Citizen Protection Act of 1998. The legislation aims to protect our
nation's seniors from patient and elder abuse. The bill also protects
our federal health care programs, most notably Medicare, from fraud.
In the past two years, we have made great strides against fraud and
abuse by passing new initiatives. These initiatives include closing
loopholes, improving coordination between Federal, State, and local law
enforcement programs, and enhancing the powers of the Inspector General
of the Department of Health and Human Services to combat fraud and
recover lost money.
These measures are helping, but there is another vision which I think
will help us stay ahead of those who endlessly scheme to defraud our
health care programs. The Senior Citizen Protection Act deputizes
Medicaid investigators and enables them to weed out fraud and abuse in
our federal health program.
Currently, when a Medicaid Fraud Control Unit investigates a state
Medicaid fraud case and finds a similar violation in Medicare, the Unit
cannot investigate the Medicare infraction. Common sense will tell you
that an unscrupulous actor defrauding Medicaid will likely do the same
to federal health programs.
In Montana, for example, the Medicaid Fraud Control Unit routinely
finds co-existing cases of Medicaid and Medicare fraud in patient
records. While the Unit has the documents right in front of them, they
can not pursue the Medicare abuses.
Federal authorities must conduct a new and separate investigation.
Unfortunately, these violations may be too small to justify a federal
investigation. The majority of health care fraud recoveries, 62%, are
more than a million dollars. Even more striking, only 6% of federal
fraud recoveries are in an amount lower than $100,000. Thus, the
Federal Government is doing a good job of weeding out the big actors in
the anti-fraud war, but the smaller actors--which still cost money--
continue to ride scot-free.
That is where our legislation can help. If a fraud Unit is
investigating a fraudulent doctor, for example, and finds some Medicare
claims that look false, currently the investigator has to call the
Inspector General's office and report their suspicions.
In many cases, however, they hear back from Washington that the
claims may be fraudulent, but the fraud is not
[[Page S4529]]
widespread enough to justify the expense of a federal investigation.
Under our legislation, the Units will now be able to wrap the Medicare
case into their own investigation and the Federal Government will be
able to continue spending their resources on larger fraud operations.
The Senior Citizen Protection Act allows state Fraud Control Units to
investigate federal violations which come to their attention during an
existing state Medicaid investigation. By giving the Units this
discreet authority, we can take another step toward reducing fraud and
abuse.
While most fraud cases are the result of overbilling, false billing,
or a provider performing unnecessary services, almost 25% of health
care fraud cases are due to poor quality of care or care not provided.
And that is when these problems cross over from health care fraud to
actual patient abuse and neglect. It alarms all of us when we hear
stories of older individuals being harmed by unscrupulous persons. What
upsets me so much about elderly abuse is how vulnerable these victims
are, especially since they depend so much on their health care
providers for actual daily activities.
Some Senators may have heard about the egregious case in Arizona
where two defendants pled guilty to three counts of aggravated assault
for sexually assaulting, intimidating and abusing patients. Their
crimes included spitting at and kicking patients, and threatening to
give a pill to a patient so he would never wake up. Some patients were
so afraid they would not eat or drink. This is a modern tragedy.
Other stories include incidents of physical abuse, verbal ridicule
and mockery, and neglect, such as depriving patients of food, water and
the opportunity for communication.
Under current law, state Medicaid Fraud Control Units can only
investigate and prosecute cases of elder abuse in state-funded
facilities. However, more and more seniors are moving into assisted
living and residential treatment settings that receive no state funds.
Let me be clear: I support this trend, as it gives seniors more choices
about the type of long-term care they receive. I am concerned, however,
that assisted living facilities have little oversight to prevent
patient neglect and abuse. Local authorities often lack the resources
and skill to investigate health care cases.
In Montana, our state Medicaid Fraud Control Unit routinely receives
calls from local law enforcement agencies, local public health
departments, and even Adult Protective Services requesting assistance
with elder abuse cases. However, the Fraud Unit's hands are tied; they
lack the jurisdictional authority to offer help.
The Senior Citizen Protection Act will enable state Medicaid Fraud
Control Units to investigate cases of patient abuse and neglect in
residential facilities that do not receive state reimbursement.
Medicaid investigators have the experience and expertise to assist
local authorities with this job. Allowing the Medicaid Fraud Control
Units to lend their expertise to cases in non-Medicaid facilities makes
good sense and is right for our seniors.
Mr. REID. Mr. President, I rise in support of S. 2040 the Senior
Citizens Protection Act introduced by Senator Baucus earlier this
morning.
I am pleased to be an original cosponsor on this important
legislation.
There are 47 federally certified Medicaid Fraud Control Units across
the country. Since the program began in 1978, more than 8,000 cases
have been prosecuted. They do an excellent job.
Millions of dollars have been returned as a result of their work.
The ``Senior Citizens Protection Act of 1998'' makes two very simple
changes to Medicaid Fraud Control Unit authority.
First it gives MFCU's the authority to investigate violations in our
federal health programs--primarily Medicare in addition to their
current authority to investigate violations in Medicaid.
Secondly, the bill would enable MFCU's to investigate patient abuse
and neglect in residential health care facilities that do not receive
Medicaid reimbursement.
In short the bill has two goals: to stop health care fraud and to
protect vulnerable seniors.
As the face of long-term care changes, local authorities need the
resources to investigate claims of patient and elder abuse.
Rather than create new bureaucracies, this bill allows us to build
upon the expertise of an existing entity--the state Medicaid Fraud
Control Units.
During two Aging Committee field hearings that I held in Las Vegas
and Reno in January 1998, I heard first hand from the Nevada Attorney
General, Frankie Sue Del Papa, how important this legislation was.
She made it very clear to me that her Medicaid Fraud Control Unit has
the expertise to investigate these cases. They simply need the
authority.
The MFCU's have the know how and experience to protect seniors in
residential health care facilities. They merely lack the authority to
get involved in non-Medicaid cases.
This legislation will give them the needed authority. That is why
this bill is endorsed by the National Association of Attorneys General,
the Department of Justice, the American Association of Retired Persons
and the Department of Health and Human Services Office of the Inspector
General.
Simply put, it is the right thing to do.
It is unfortunate that when MFCU investigators involved in a case of
Medicaid fraud discover evidence that this fraud may also be happening
in the Medicare program, or other federally funded health care
programs, they are restricted from taking action. This bill will change
that.
Under current law, the MFCU can only investigate patient abuse in
medical facilities which receive Medicaid funds.
In 1996 and 1997, the Nevada MFCU received 120 referrals but only
opened 20 investigations due in part to limited jurisdiction.
Although many of these cases are referred to local law enforcement,
they may never be criminally investigated or prosecuted due to lack of
expertise or available resources.
State MFCUs are able to conduct these investigations and this bill
will give them the needed authority.
In Nevada 47 nursing homes and 54 adult group homes receive Medicaid
funding.
When abuse or neglect occurs in such facilities, the state MFCU can
investigate.
However, we also have approximately 265 residential facilities for
groups and 321 registered homes which could fall within the definition
of ``board and care facilities'' set forth in this bill.
With the passage of this bill, seniors and other residents in these
facilities would be protected regardless of whether the facility
receives Medicaid funding or not.
This bill would give the state MFCU the authority to investigate
allegations of abuse and neglect in these facilities.
As we collectively strive to reduce fraud and abuse in our Medicare
and Medicaid programs, we cannot overlook any opportunity to make a
difference.
This bill is a welcome weapon in our arsenal to fight abuse.
I commend Senators Baucus of Montana and Graham of Florida for their
sponsorship of this bill and Senators Mikulski, Grassley, Johnson, and
Breaux for their original cosponsorship of this important legislation.
We need all the ammunition possible in the war against health care
fraud and in assuring the protection of our nation's most vulnerable
seniors in the spectrum of long-term care facilities.
The bill introduced by my colleagues today is a major step in the
right direction.
I am pleased to join them in sponsoring this important legislation.
Ms. MIKULSKI. Mr. President, I am pleased to be an original cosponsor
of the Senior Citizens Protection Act of 1998, introduced by Senator
Baucus. I support this legislation for two reasons--it fights fraud and
protects seniors.
Fraud and abuse pose a serious threat to Medicare and Medicaid. We
cannot afford to tolerate any more abuse of the system. The job of
Medicaid Fraud Control Units (MFCUs) is to investigate and prosecute
Medicaid fraud in state programs. MFCUs have prosecuted thousands of
cases and recovered hundreds of thousands of Medicaid dollars. Every
dollar saved by MFCUs is another dollar we can use to provide quality
service to those who need it.
[[Page S4530]]
This legislation expands the authority of Medicaid Fraud Control
Units in two ways. It allows MFCUs to investigate federal fraud
violations discovered during a state Medicaid investigation. Currently,
MFCUs cannot investigate Medicare fraud or other federal fraud
violations. Under the Senior Citizens Protection Act, MFCUs will be
able to investigate federal fraud, and return recovered funds to the
federal government.
I am firmly committed to protecting seniors from elder abuse. This
legislation protects seniors by authorizing to MFCUs to investigate
patient abuse in residential health care facilities that do not receive
Medicaid reimbursement. The number of residential facilities is
growing, but local authorities often lack the resources to investigate
elder abuse. MFCUs are already investigating elder abuse in facilities
that receive Medicaid funding. But under the Senior Citizens Protection
Act, MFCUs will be able to protect all of our senior citizens living in
residential facilities.
I want to let those who depend on Medicaid and Medicare know that we
are fighting to stop fraud and waste. We have done an outstanding job
in protecting Medicaid-covered seniors from fraud and abuse. It is now
time to extend that protection to all of our senior citizens.
______
By Mr. SMITH of Oregon:
S. 2041. A bill to amend the Reclamation Wastewater and Groundwater
Study and Facilities Act to authorize the Secretary of the Interior to
participate in the design, planning, and construction of the Willow
Lake Natural Treatment System Project for the reclamation and reuse of
water, and for other purposes; to the Committee on Energy and Natural
Resources.
the willow lake project act
Mr. SMITH of Oregon. Mr. President, today I am introducing
legislation to authorize the Secretary of the Interior to participate
in the design, planning and construction of the Willow Lake Natural
Treatment System Project for the reclamation and reuse of water by the
city of Salem, Oregon. This project is an innovative approach to an
ongoing sewer overflow problem. It will not only provide environmental
benefits for the city and the Willamette Valley, but could also provide
irrigation water for the local farming community.
This natural treatment system is one component of the city's recently
adopted Wastewater Master Plan. Currently, the city has a combined
sanitary sewer system. Unfortunately, each winter season during the wet
weather, sewer overflows spill into Salem-area creeks and streams, as
well as the Willamette River.
The proposed natural treatment system, working in conjunction with
the city's wastewater treatment plant, will provide Salem with the
ability to meet regulatory requirements by storing and treating all
wastewater from Salem's sewer system and significantly reducing wet
weather sewer system overflows. The finished system will meet Oregon
Department of Environmental Quality (DEQ) standards, and be fully
operational by 2010. Although the specific site has not yet been
selected, I am hopeful that any land needed for the project will be
acquired on a willing buyer-willing seller basis.
The natural treatment system proposed includes both overland flow
treatment and constructed wetlands treatment. The overland flow system
will include grassy swales and poplar trees to provide a high level of
wastewater treatment. The constructed wetlands will include shallow
ponds with wetland-type vegetation, and provide both treatment and
storage. This system will be capable of producing between 10 and 20
million gallons per day of high quality effluent during the summer
months that could potentially be used as a source of irrigation water
for the farming community in the area. A separate feasibility study
will have to be conducted before a determination is made on whether to
use this water for irrigation purposes. Any application of this water
would have to be in accordance with state water quality standards and
the requirements of the food processing industry.
This bill would authorize the Secretary to participate in this
project under the Bureau of Reclamation's existing Title XVI water
reuse program. This program requires a feasibility study for all
projects authorized, and caps the federal cost-share of the
construction costs. Under the Title XVI program, the city would have
title to the project, and be responsible for all operation and
maintenance costs.
This project will provide multiple benefits for the environment. It
will naturally treat wastewater, provide habitat for fish and wildlife,
improve water quality in Salem-area streams and the Willamette River,
and reduce wintertime sewer system overflows. As water supplies tighten
throughout the western United States, we need to look at innovative,
cost-effective programs such as this to reuse water as efficiently as
possible.
I urge my colleagues to support enactment of this legislation, and
will ask for its timely consideration by the Committee on Energy and
Natural Resources. Mr. President, I ask unanimous consent to have the
bill printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 2041
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION. 1. WILLOW LAKE NATURAL TREATMENT SYSTEM PROJECT.
(a) In General.--The Reclamation Wastewater and Groundwater
Study and Facilities Act (43 U.S.C. 390h et seq.) is
amended--
(1) by redesignating sections 1631, 1632, and 1633 as
sections 1632, 1633, and 1634, respectively; and
(2) by inserting after section 1630 the following new
section 1631:
``SEC. 1631. WILLOW LAKE NATURAL TREATMENT SYSTEM PROJECT.
``(a) Authorization.--The Secretary, in cooperation with
the City of Salem, Oregon, is authorized to participate in
the design, planning, and construction of the Willow Lake
Natural Treatment System Project to reclaim and reuse
wastewater within and without the service area of the City of
Salem.
``(b) Cost Share.--The Federal share of the cost of a
project described in subsection (a) shall not exceed 25
percent of the total cost.
``(c) Limitation.--The Secretary shall not provide funds
for the operation and maintenance of a project described in
subsection (a).''.
(b) Conforming Amendments.--That Act is further amended--
(1) in section 1632 (43 U.S.C. 390h-13) (as redesignated by
subsection (a)(1)), by striking ``section 1630'' and
inserting ``section 1631'';
(2) in section 1633(c) (43 U.S.C. 390h-14) (as so
redesignated), by striking ``section 1633'' and inserting
``section 1634''; and
(3) in section 1634 (43 U.S.C. 390h-15) (as so
redesignated), by striking ``section 1632'' and inserting
``section 1633''.
(c) Clerical Amendment.--The table of contents in section 2
of the Reclamation Projects Authorization and Adjustment Act
of 1992 is amended by striking the items relating to sections
1631 through 1633 and inserting the following:
``Sec. 1631. Willow Lake Natural Treatment System Project.
``Sec. 1632. Authorization of appropriations.
``Sec. 1633. Groundwater study.
``Sec. 1634. Authorization of appropriations.''.
______
By Mr. FAIRCLOTH:
S. 2042. A bill to provide for a program to improve commercial motor
vehicle safety in the vicinity of the borders between the United States
and Canada and the United States and Mexico; to the Committee on
Commerce, Science, and Transportation.
the safe highways act of 1998
Mr. FAIRCLOTH.
Mr. President, I rise to introduce the Safe Highways Act.
This bill authorizes $20 million per year over the next five years
for enforcement activities to prevent unsafe foreign trucks from
rolling across our borders under NAFTA. This bill will fund inspections
at our borders to keep these Mexican and Canadian trucks off our roads
unless they meet our tough truck safety standards. Our standards are
higher than in Mexico and Canada, and, certainly, I do not want these
trucks rumbling down our roads and threatening the safety of our
families.
Mexican trucks are already permitted to operate in limited areas in
the United States and, in fact, they have been doing so for two
decades. We can enforce these standards at the border, but it will take
training and an increased effort to handle the additional traffic from
NAFTA, so we need to step up and put this money aside. These foreign
trucks will soon roam more of our roads under NAFTA. We need to be
ready. This is literally a matter of life and death for American
families who share the road with these trucks.
______
By Mrs. BOXER (for herself, Mr. Bumpers, and Mr. Durbin):
[[Page S4531]]
S. 2043. A bill to repeal the limitation on use of appropriations to
issue rules with respect to valuation of crude oil for royalty
purposes; to the Committee on Energy and Natural Resources.
TAX LEGISLATION
Mrs. BOXER. Mr. President, today Senator Durbin and Senator Bumpers
join me in introducing legislation to repeal a special-interest rider
attached to the emergency supplemental appropriations bill last week.
Representatives Caroyln Maloney and George Miller are introducing
companion legislation in the House.
This rider is a taxpayer rip-off. It blocks the Interior Department
from implementing a proposed rule to ensure that oil companies pay a
fair royalty for oil drilled on public lands. These royalties are
shared between the federal government and the state.
California law requires that all royalty payments be credited
directly to the State Schools Fund. So every penny the oil companies
fail to pay is stolen directly form our state's classrooms and our
children's education.
If allowed to stand, this special interest rider will cost American
taxpayers an estimated $5.5 million per month, approximately $25
million by the end of this fiscal year. California's share of this lost
revenue could be used to hire new teachers, help rebuild crumbling
schools, or put dozens of computers in our classrooms.
When oil companies drill on public lands, they pay a royalty to the
federal government, which in turn sends a share of these royalties to
the states. The royalty is calculated as a percentage of the value of
the oil drilled.
Here is where the problem lies. The oil companies currently
understate the value of the oil drilled, and as a result, they underpay
their royalties. Now, and after years of study and Congressional
prodding, the Department of the Interior has finally decided to do
something about it.
The Department of the Interior has billed 12 major oil companies over
$260 million for back royalty payments. It will have to sue to collect
because the current system is so fraught with ambiguity.
To guarantee taxpayers a fair royalty payment in the future, the
Interior Department proposed a simple and common sense solution: pay
royalties based on actual market prices, not estimates the oil
companies themselves make up. The rule was first proposed 2\1/2\ years
ago. It has held 14 public workshops and published 5 separate requests
for industry comments. And now it has been stopped cold in the dead of
night.
This is one of the clearest examples of a special interest taxpayer
rip-off I have ever seen. It saves the wealthiest oil companies in the
world millions of dollars while shortchanging taxpayers and California
schoolchildren. What does this say about our nation's priorities? This
action must not stand, and my colleagues and I will fight it to the
end.
I ask unanimous consent that the text of the legislation be printed
in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 2043
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. REPEAL OF LIMITATION ON ISSUANCE OF RULES
REGARDING VALUATION OF CRUDE OIL FOR ROYALTY
PURPOSES.
Section 3009 of the 1998 Supplemental Appropriations and
Rescissions Act is repealed.
______
By Mr. KENNEDY (for himself, Mrs. Murray, Mr. Levin, Mr. Inouye,
Mr. Dodd, and Mr. Kerry):
S. 2044. A bill to assist urban and rural local education agencies in
raising the academic achievement of all of their students; to the
Committee on Labor and Human Resources.
the educational opportunity zones act of 1998
Mr. KENNEDY. Mr. President, it is an honor to introduce President
Clinton's Education Opportunity Zones bill to strengthen urban and
rural public schools where the need is greatest. Congress needs to do
more to improve teaching and learning for all students across the
nation, and that means paying close attention to school districts and
children with the greatest needs.
Too many schools now struggle with low expectations for students,
high dropout rates, watered-down curricula, unqualified teachers, and
inadequate resources. This legislation will lead to the designation of
approximately 50 high-poverty urban and rural school districts as
``Education Opportunity Zones,'' and help them to implement the
effective reforms needed to turn themselves around.
These school districts will become models of system-wide, standards-
based reform for the nation. They must agree to specific benchmarks for
improved student achievement, lower dropout rates, and other indicators
of success. Schools in these districts will also be eligible for
greater flexibility in the use of federal education funds.
Our goal is to increase achievement, raise standards, upgrade teacher
skills, and strengthen ties between schools, parents, and the community
as a whole. Under this proposal, schools can use effective reform
measures such as ending social promotion, increasing accountability,
improving teacher recruitment and training, and providing students and
parents with school report cards.
We know that this approach can work. Last fall, I visited the Harriet
Tubman Elementary School in New York City, where 95 percent of the
pupils are from low-income families. Before 1996, it was one of the
lowest achieving schools in the city. In September, 1996, the
principal, the superintendent, teachers, and parents worked together to
reorganize the school. They put extra resources into training teachers
to teach reading. They upgraded the curriculum to reflect high
standards. They created a parent resource center to increase family and
community involvement. These and other reforms worked.
Each day, many parents are at the school too, helping maintain
discipline and at the same time expanding their own education.
Each morning, teachers stop their regular classwork and teach reading
to their students for 90 minutes. Since 1996, scores on statewide
reading exams have risen by 20 percent.
In Boston, under the leadership of Superintendent Tom Payzant,
schools are making significant progress by creating new curriculum
standards, setting higher achievement standards, and expanding
technology through public and private sector partnerships. They are
focusing on literacy, after-school programs, and school-to-career
opportunities.
These successes are not unusual. Public schools can improve even when
facing the toughest odds. We need to do all we can to help such schools
get the resources they need, so that they can implement the changes
they know will work and help children learn more effectively.
Under the Education Opportunity Zone approach, urban and rural school
districts can apply for funds to implement a wide range of reforms.
School districts will apply to the Secretary of Education for three-
year grants. The Secretary will ensure a fair distribution of grants
among geographic regions, and among various sizes of urban and rural
schools districts.
In determining the amount of each grant, the Secretary will consider
factors such as the scope of activities in the application, the number
of students from poor families in the school district, the number of
low-performing schools in the district, and the number of low-achieving
children in the district.
This legislation proposes funding of $200 million in fiscal year 1999
and $1.5 billion over the next 5 years to support these grants.
I commend President Clinton for developing this worthwhile
initiative, and I look forward to its enactment. Investing in students,
teachers, and schools is one of the best investments America can make.
For schools across the nation, help can't come a minute too soon.
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. 2044
Be it enacted by the Senate and the House of
Representatives of the United States of America in Congress
assembled,
* * * * *
Findings
Sec. 2. The Congress finds as follows:
[[Page S4532]]
(1) Students in schools that have high concentrations of
poor children begin school academically behind their peers in
other schools and are often unable to close the gap as they
progress through school. In later years, these students are
less likely than other students to attend a college or
university and more likely to experience unemployment.
(2) Many children who attend these high-poverty schools
lack access to the challenging curricula, well-prepared
teachers, and high expectations that make better achievement
possible. More specifically, they are often educated in over-
crowded classrooms and by teachers who are assigned to teach
in subject areas outside their areas of certification.
(3) Data from the National Assessment of Educational
Progress consistently show large gaps between the achievement
of students in high-poverty schools and those in other
schools. High-poverty schools will face special challenges in
preparing their students to reach high standards of
performance on national and State assessments, such as
voluntary national tests and the assessments States are
developing under the Goals 2000 and ESEA, Title I programs.
(4) Recent reports have found that students in urban
districts are more likely to attend high-poverty schools;
more frequently taught by teachers possessing only an
emergency or temporary license; and less likely to score
above the basic level on achievement tests than are nonurban
students.
(5) High-poverty rural schools, because of their isolation,
small size, and low levels of resources, also face particular
challenges. For example, teachers in rural districts are
nearly twice as likely as other teachers to provide
instruction in three or more subjects.
(6) Notwithstanding these general trends, some high-poverty
school districts have shown that they can increase student
achievement, if they adopt challenging standards for all
children, focus on improving curriculum and instruction,
expand educational choice among public schools for parents
and students, adopt other components of systemic educational
reform, and hold schools, staff, and students accountable for
results.
(7) Districts that have already established the policies
needed to attain widespread student achievement gains, and
have attained those gains in some of their schools, can serve
as models for other districts desiring to improve the
academic achievement of their students. The Federal
Government can spur more districts in this direction by
providing targeted resources for urban and rural districts
willing to carry out solid plans for improving the
educational achievement of all their children.
purpose
Sec. 3. The purpose of this Act is to assist urban and
rural local educational agencies that: (1) have high
concentrations of children from low-income families; (2) have
a record of achieving high educational outcomes, in at least
some of their schools; (3) are implementing standards-based
systemic reform strategies; and (4) are keeping their schools
safe and drug-free, to pursue further reforms and raise the
academic achievement of all their students.
Definitions
Sec. 4. As used in this Act, the following terms have the
following meanings:
(1) the term ``central city'' has the meaning given that
term by the Office of Management and Budget.
(2) the term ``high-poverty local educational agency''
means a local educational agency in which the percentage of
children, ages 5 through 17, from families with incomes below
the poverty level is 20 percent or greater or the number of
such children exceeds 10,000.
(3) The term ``local educational agency''--
(A) has the meaning given that term in section 14101(18)(A)
and (B) of the Elementary and Secondary Education Act of
1965; and
(B) includes elementary and secondary schools operated or
supported by the Bureau of Indian Affairs.
(4) the term ``metropolitan statistical area'' has the
meaning given that term by the Office of Management and
Budget.
(5) the term ``rural locality'' means a locality that is
not within a metropolitan statistical area and has a
population of less than 25,000.
(6) The term ``urban locality'' means a locality that is--
(A) a central city of a metropolitan statistical area; or
(B) any other locality within a metropolitan statistical
area, if that area has a population of at least 400,000 or a
population density of at least 6,000 persons per square mile.
eligibility
Sec. 5. (a) Eligible LEAS.--(1) A local educational agency
is eligible to receive a grant under this Act if it is--
(A) a high-poverty local educational agency; and
(B) located in, or serves, either an urban locality or a
rural locality.
(2) Two or more local educational agencies described in
paragraph (1) may apply for, and receive a grant under this
Act as a consortium.
(b) Determination of Eligibility.--The Secretary shall
determine which local educational agencies meet the
eligibility requirements of subsection (a) on the basis of
the most recent data that are satisfactory to the Secretary.
applications
Sec. 6. (a) Applications Required.--In order to receive a
grant under this Act, an eligible local educational agency
shall submit an application to the Secretary at such time, in
such form, and containing such information as the Secretary
may require.
(b) Contents.--Each application shall include evidence that
the local educational agency meets each of the following
conditions:
(1) It has begun to raise student achievement, as measured
by State assessments under title III of the Goals 2000:
Educate America Act, title I of the Elementary and Secondary
Education Act of 1965, or comparably rigorous State or local
assessments; or it has shown significant progress on other
measures of educational performance, including school
attendance, high school competition, and school safety.
Student achievement evidence shall include data disaggregated
to show the achievement of students separately by race and by
gender, as well as for students with disabilities, students
with limited English proficiency, and students who are
economically disadvantaged (compared to students who are not
economically disadvantaged), throughout the district or, at a
minimum, in schools that have implemented a comprehensive
school improvement strategy.
(2) It expects all students to achieve to challenging State
or local content standards, it has adopted or is developing
or adopting assessments aligned with those standards, and it
has implemented or is implementing comprehensive reform
policies designed to assist all children to achieve to the
standards.
(3) It has entered into a partnership that includes the
active involvement of representatives of local organizations
and agencies and other members of the community, including
parents, and is designed to guide the implementation of the
local educational agency's comprehensive reform strategy.
(4) It has put (or is putting) into place effective
educational reform policies, including policies that--
(A) hold schools accountable for helping all students,
including students with limited English proficiency and
students with disabilities, reach high academic standards.
The application shall describe how the agency will reward
schools that succeed and intervene in schools that fail to
make progress;
(B) require all students, including students with
disabilities and students with limited English proficiency,
to meet academic standards before being promoted to the next
grade level at key transition points in their careers or
graduating from high school. The application shall describe
the local educational agency's strategy for providing
students with a rich curriculum tied to high standards, and
with well-prepared teachers and class sizes conducive to high
student achievement;
(C) identify, during the early stages of their academic
careers, students who have difficulty in achieving to high
standards, and provide them with more effective educational
interventions or additional learning opportunities such as
after school programs, so that the students are able to meet
the standards at key transition points in their academic
careers;
(D) hold teachers, principals, and superintendents
accountable for quality, including a description of the local
educational agency's strategies for ensuring quality through,
among other things--
(i) development of clearly articulated standards for
teachers and school administrators, and development, in
cooperation with teachers organizations, of procedures for
identifying, working with, and, if necessary, quickly but
fairly removing teachers and administrators who fail to
perform at adequate levels, consistent with State law and
locally negotiated agreements;
(ii) implementation of a comprehensive professional
development plan for teachers and instructional leaders, such
as a plan developed under title II of the Elementary and
Secondary Education Act of 1965; and
(iii) encouraging excellent teaching, such as by providing
incentives for teachers to obtain certification by the
National Board for Professional Teaching Standards; and
(E) provide students and parents with expanded choice
within public education.
(5) It is working effectively to keep its schools safe,
disciplined, and drug-free.
(c) Description of Proposed Program.--The application shall
also include a description of how the local educational
agency will use the grant made available under this Act,
including descriptions of--
(1) how the district will use all available resources
(Federal, State, local, and private) to carry out its reform
strategy;
(2) the specific measures that the applicant proposes to
use to provide evidence of future progress in improving
student achievement, including the subject areas and grade
levels in which it will measure that progress, and an
assurance that the applicant will collect such student data
in a manner that demonstrates the achievement of students
separately by race and by gender, as well as for students
with disabilities, students with limited English proficiency,
and students who are economically disadvantaged (compared to
students who are not economically disadvantaged); and
(3) how the applicant will continue the activities carried
out under the grant after the grant has expired.
[[Page S4533]]
selection of applications
Sec. 7. (a) Criteria.--The Secretary shall, using a peer-
review process, select applicants to receive funding based
on--
(1) evidence that--
(A) the applicant has made progress in improving student
achievement or the other measures of educational performance
described in section 6(b)(1), in at least some of its schools
that enroll concentrations of children from low-income
families;
(B) the applicant has put (or is putting) into place
effective reform policies as described in section 6(b)(4);
and
(C) the applicant is working effectively to keep its
schools safe, disciplined, and drug-free; and
(2) the quality of the applicant's plan for carrying out
activities under the grant, as set forth in the application.
(b) Equitable Distribution.--In approving applications, the
Secretary shall seek to ensure that there is an equitable
distribution of grants among geographic regions of the
country, to varying sizes of urban local educational
agencies, and to rural local educational agencies, including
rural local educational agencies serving concentrations of
Indian children.
presidential designation; technical assistance
Sec. 8. (a) Designation as Education Opportunity Zone.--The
President shall designate each local educational agency
selected by the Secretary to receive a grant under this Act
as an ``Education Opportunity Zone''.
(b) Technical Assistance.--The President may instruct
Federal agencies to provide grant recipients with such
technical and other assistance as those agencies can make
available to enable the grantees to carry out their
activities under the program.
amount and duration of grants; continuation awards
Sec. 9. (a) Grant Amounts.--In determining the amount of a
grant, the Secretary shall consider such factors as--
(1) the scope of the activities proposed in the
application;
(2) the number of students in the local educational agency
who are from low-income families;
(3) the number of low-performing schools in the local
educational agency; and
(4) the number of children in the local educational agency
who are not reaching State or local standards.
(b) Duration of Grants.--(1) Each grant shall be for three
years, but may be continued for up to two additional years if
the Secretary determines that the grantee is achieving
agreed-upon measures of progress by the third year of the
grant.
(2) The Secretary may increase the amount of a grant in the
second year, in order to permit full implementation of grant
activities, except that--
(A) the amount of a second-year award shall be no more than
140 percent of the award for the first year;
(B) the amount of a third-year award shall be no more than
80 percent of the second-year award;
(C) the amount of a fourth-year award shall be no more than
70 percent of the second-year award; and
(D) the amount of a fifth-year award shall be no more than
50 percent of the second-year award.
(c) Expected Achievement Levels and Continuation Awards.--
(1) Before receiving its award, each grantee shall develop
and adopt, with the approval of the Secretary, specific,
ambitious levels of achievement that exceed typical
achievement levels for comparable local educational agencies
and that the local educational agency commits to attaining
during the period of the grant.
(2) The agreed-upon levels shall--
(A) reflect progress in the areas of--
(i) student academic achievement;
(ii) dropout rates;
(iii) attendance; and
(iv) such other areas as may be proposed by the local
educational agency or the Secretary; and
(B) provide for the disaggregation of data separately by
race and by gender, as well as for students with
disabilities, students with limited English proficiency, and
students who are economically disadvantaged students
(compared to students who are not economically
disadvantaged).
USES OF FUNDS
Sec. 10. (a) In General.--Each grantee shall use its award
only for activities that support the comprehensive reform
efforts described in its application or that are otherwise
consistent with the purpose of this Act.
(b) Authorized Activities.--Activities that may be carried
out with funds under this Act include--
(1) implementing school-performance-information systems to
measure the performance of schools in educating their
students to high standards, maintaining a safe school
environment, and achieving the anticipated school-attendance
and graduation rates;
(2) implementing district accountability systems that
reward schools that raise student achievement and provide
assistance to, and ultimately result in intervention in,
schools that fail to do so, including such intervention
strategies as technical assistance on school management and
leadership, intensive professional development for school
staff, institution of new instructional programs that are
based on reliable research, and the reconstitution of the
school;
(3) providing students with expanded choice and increased
curriculum options within public education, through such
means as open-enrollment policies, schools within schools,
magnet schools, charter schools, distance-learning programs,
and opportunities for secondary school students to take
postsecondary courses;
(4) implementing financial incentives for schools to make
progress against the goals and benchmarks the district has
established for the program;
(5) providing additional learning opportunities, such as
after-school, weekend, and summer programs, to students who
are failing, or are at risk of failing, to achieve to high
standards;
(6) providing ongoing professional development
opportunities to teachers, principals, and other school staff
that are tailored to the needs of individual schools, and
aligned with the State or local academic standards and with
the objectives of the program carried out under the grant;
(7) implementing programs, designed in cooperation with
teacher organizations, to provide recognition and rewards to
teachers who demonstrate outstanding capability at educating
students to high standards, including monetary rewards for
teachers who earn certification from the National Board for
Professional Teaching Standards;
(8) implementing procedures, developed in cooperation with
teacher organizations, for identifying ineffective teachers
and administrators, providing them with assistance to improve
their skills and, if there is inadequate improvement, quickly
but fairly removing them from the classroom or school,
consistent with State law and locally negotiated agreements;
(9) establishing programs to improve the recruitment and
retention of well-prepared teachers, including the use of
incentives to encourage will-prepared individuals to teach in
areas of the district with high needs;
(10) designing and implementing procedures for selecting
and retaining principals who have the ability to provide the
school leadership needed to raise student achievement;
(11) strengthening the management of the local educational
agency so that all components of management are focused on
improving student achievement;
(12) carrying out activities to build stronger partnerships
between schools and parents, businesses, and communities; and
(13) assessing activities carried out under the grant,
including the extent to which the grant is achieving its
objectives.
flexibility
Sec. 11. (a) Eligibility for Schoolwide Programs Under
ESEA, Title I.--Each school operated by a local educational
agency receiving funding under this authority that is
selected by the agency to receive funds under section 1113(c)
of the Elementary and Secondary Education Act of 1965 shall
be considered as meeting the criteria for eligibility to
implement a schoolwide program as described in section 1114
of that Act.
(b) Carrying Out Schoolwide Programs.--All schools in the
local educational agency that qualify for eligibility for a
schoolwide program based solely on the agency's receiving
funding under this Act and that wish to carry out a
schoolwide program shall--
(1) develop a plan that satisfies the requirements of
section 1114(b)(2) of the Elementary and Secondary Education
Act of 1965; and
(2) develop a program that includes the components of a
schoolwide program described in section 1114(b)(1) of that
Act.
participation of private school students and teachers
Sec. 12. (a) Requirements.--(1)(A) If a local educational
agency uses funds under this Act to provide for training of
teachers or administrators, it shall provide for the
participation of teachers or administrators from private
nonprofit elementary or secondary schools, in proportion to
the number of children enrolled in those schools who reside
in attendance areas served by the local educational agency's
program under this Act.
(B) A local educational agency may choose to comply with
subparagraph (A) by providing services to teachers or
administrators from private schools at the same time and
location it provides those services to teachers and
administrators from public schools.
(C) The local educational agency shall carry out
subparagraph (A) after timely and meaningful consultation
with appropriate private school officials.
(2) If the local educational agency uses funds under this
Act to develop curricular materials, it shall make
information about those materials available to private
schools.
(b) Waiver.--If, by reason of any provision of law, a local
educational agency is prohibited from providing the training
for private school teachers or administrators required by
subsection (a)(1)(A), or if the Secretary determines that the
agency is unable to do so, the Secretary shall waive the
requirement of that subsection and shall use a portion of the
agency's grant to arrange for the provision of the training.
evaluation
Sec. 13. The Secretary shall carry out an evaluation of the
program supported under this Act, which shall address such
issues as the extent to which--
(1) student achievement in local educational agencies
receiving support increases;
[[Page S4534]]
(2) local educational agencies receiving support expand the
choices for students and parents within public education; and
(3) local educational agencies receiving support develop
and implement systems to hold schools, teachers, and
principals accountable for student achievement.
national activities
Sec. 14. The Secretary may reserve up to five percent of
the amount appropriated under section 15 for any fiscal year
for--
(1) peer review activities;
(2) evaluation of the program under section 13 and
measurement of its effectiveness in accordance with the
Government Performance and Results Act of 1993;
(3) dissemination of research findings, evaluation data,
and the experiences of districts implementing comprehensive
school reform; and
(4) technical assistance to grantees.
authorization of appropriations
Sec. 15. For the purpose of carrying out this Act, there
are authorized to be appropriated $200 million for fiscal
year 1999, and such sums as may be necessary for each of the
four succeeding fiscal years.
______
By Mr. FAIRCLOTH:
S. 2045. A bill to amend title 10, United States Code, to permit
certain beneficiaries of the military health care system to enroll in
Federal employees health benefits plans, and for other purposes; to the
Committee on Armed Services.
THE IMPROVED MILITARY MEDICAL PLAN ACT
Mr. FAIRCLOTH. Mr. President, today I am introducing the Improved
Military Medical Plan Act, IMMPACT for short, to ensure that military
retirees and their families will continue to be given proper medical
care. This past May 1, the Defense Department implemented its new
health care program, known as TRICARE, in two more regions of the
country, including in North Carolina. As the number of TRICARE
enrollees increases and as the Military Health Services System is
downsized, military retirees will have an even harder time finding
space available at military facilities.
Effectively, those military retirees over 65 are left with no
military medical benefit, since they are unlikely to get into military
facilities.
Mr. President, this is a far cry from the promise that our government
made to these retirees when they put in a full career in uniform
risking their lives for our freedom. They were promised medical care
for life, and everyone believed that it would be at base medical
facilities. It just is not right to renege on that promise after all
that these men and women have done for our country.
We can and must do better. IMMPACT will allow Medicare-eligible
military retirees, their dependents, and their survivors to participate
in the Federal Employees Health Benefits program. It will also provide
a very strong incentive for the Department of Defense to ensure that
TRICARE is offering active duty personnel and younger retirees and
their families a medical benefit equivalent to the federal civilian
program.
IMMPACT sets up a three-year demonstration. Ideally, the
demonstration would be conducted on a nationwide basis, but I realize
that such a broadly geographical demonstration could be difficult to
manage. So the bill directs the Administration to have as expansive a
demonstration as practicable, as long as at least six sites around the
country are selected.
The IMMPACT demonstration is simple. Medicare-eligible retirees of
the uniformed services as well as their dependents and survivors at the
selected demonstration sites will be able to apply for enrollment in
the health care plans of the Federal Employees Health Benefits program.
Every year, the Administration will report to Congress on the value of
this health care option, how many eligible beneficiaries want to
enroll, how much the demonstration is costing, how it compares to other
health care options available to the beneficiaries, to name just a few
of the metrics.
The IMMPACT demonstration is only open to Medicare-eligible retirees.
But, as I mentioned earlier, IMMPACT provides strong incentives for the
Department of Defense to make TRICARE as comprehensive as FEHBP. The
fine men and women now serving in the Armed Services and those who went
before them deserve to be treated at least as well as civilian federal
employee and retirees.
This is very important to me. We have all heard of, or even
experienced, health care plans where ``cost'' is a more important
factor than ``service.'' Two health care plans could appear equivalent
on the surface--their premiums could be about the same, they could have
many locations for treatment, etc. But, if one plan is more
bureaucratic than another, or it delays payments to doctors, or it is
too tight on the definition of what is a ``reasonable and customary
charge,'' eventually, the best doctors are going to drop out. In the
Federal Employees Health Benefits program, civilian employees and
retirees can opt out of a bad plan because they have a choice of many
plans. But, in TRICARE, there is no real choice. There are no
competitive pressures to keep TRICARE equivalent to the better civilian
plans.
IMMPACT will fix that. Within six months after the passage of
IMMPACT, the Administration must submit a report to Congress that sets
forth a plan to enhance TRICARE, if necessary, so that it is at least
as comprehensive as the plans used by civilian federal employees and
retirees.
IMMPACT is independent of other demonstration programs. Some may
argue that IMMPACT is not needed because we are running a Medicare
Subvention demonstration. But, there is no reason why IMMPACT should
wait for that program to be completed and evaluated. In fact, I want
IMMPACT to be offered to the same retirees that could chose the
Medicare Subvention plan. In this manner, we will have some clear
market signals about the value of each of these options within the same
customer community.
At the end of the IMMPACT demonstration program, the Administration
will advise the Congress of the need to extend the eligibility of
participation in the Federal Employees Health Benefits program, first
nationwide to all Medicare-eligible retirees, and then to all retirees
or active duty personnel, if TRICARE proves to be inferior to the
civilian health care benefit.
Mr. President, some may complain that this program will increase the
Defense Department's cost of delivering medical benefits. Perhaps it
will. But, I think our military men and women and their families
deserve a better health care program than they are being offered now.
Clearly, if we can find the money to fund our extravagances in the arts
and entertainment, we can find funding for medical care for those who
have been willing to risk their own lives in defense of our liberty and
freedom.
Mr. President, I urge my colleagues to support IMMPACT.
______
By Mr. ASHCROFT:
S. 2046. A bill to ensure that Federal, State and local governments
consider all nongovernmental organizations on an equal basis when
choosing such organizations to provide assistance under certain
government programs, without impairing the religious character of any
of the organizations, and without diminishing the religious freedom of
beneficiaries of assistance funded under such programs, and for other
purposes; to the Committee on Governmental Affairs
the charitable choice expansion act of 1998
Mr. ASHCROFT. Mr. President, for years, America's charities and
churches have been transforming shattered lives by addressing the
deeper needs of people--by instilling hope and values which help change
behavior and attitudes. By contrast, government social programs have
failed miserably in moving recipients from dependency and despair to
responsibility and independence.
Successful faith-based organizations now have a new opportunity to
transform the character of our welfare system under the ``Charitable
Choice'' provision contained in the 1996 welfare reform law. Charitable
Choice allows--but does not require--states to contract with
charitable, religious or private organizations, or to create voucher
systems, to deliver welfare services within the states. The provision
requires states to consider these organizations on an equal basis with
other private groups once a state decides to use nongovernmental
organizations.
The Charitable Choice legislation provides specific protections for
religious organizations when they provide services. For example, the
government cannot discriminate against an organization on the basis of
its religious
[[Page S4535]]
character. A participating faith-based organization retains its
independence from government, including control over the definition,
development, practice, and expression of its religious beliefs.
Additionally, the government cannot require a religious organization
to alter its form of internal governance or remove religious art,
icons, or symbols to be eligible to participate. Finally, religious
organizations may consider religious beliefs and practices in their
employment decisions.
The Charitable Choice legislation also provides specific protections
to beneficiaries of assistance. A religious organization can't
discriminate against a beneficiary on account of religion. And if a
beneficiary objects to receiving services from a religious
organization, he or she has a right to an alternate provider.
Finally, there is a limitation on use of government funds. Federal
contract dollars cannot be used for sectarian worship, instruction, or
proselytization.
I would like to give a couple of examples of how the Charitable
Choice provision of the welfare law is currently working.
Last fall, Payne Memorial Outreach Center, the non-profit community
development arm of the 100-year-old Payne Memorial African Methodist
Episcopal Church, in Baltimore, received a $1.5 million state contract
to launch an innovative job training and placement program. In a matter
of only five months, over 100 welfare recipients successfully obtained
employment through their participation in Payne's program. A brochure
from this dynamic faith-based institution describes why Payne is
successful: ``The Intensive Job Service Program reaches out in love to
Baltimore's most disenfranchised, helping them to identify and
strengthen their God-given talents--releasing and developing their
human possibilities.''
Another example of Charitable Choice at work is in Shreveport,
Louisiana, where the ``Faith and Families'' program, under a contract
with the state, is running a successful job placement program. Faith
and Families offers job-readiness classes in northwestern Louisiana,
helps set up job interviews, and opens doors into the workplace.
The program also links welfare families with faith communities.
Churches are asked to adopt a family and provide assistance--possibly
child care, transportation, work experience, tutoring, and
encouragement--that will help them make the transition from welfare to
work.
I spoke with the director of Faith and Families in Shreveport just
last week, and he told me that his organization has helped 400 people
get off welfare and find jobs.
These examples demonstrate that under the Charitable Choice provision
of the welfare law, caring, faith-based organizations are providing
effective services that help individuals move from dependency to
independence, from despair to dignity.
With this in mind, today I am introducing ``The Charitable Choice
Expansion Act of 1998,'' which expands the Charitable Choice concept to
all federal laws which authorize the government to use non-governmental
entities to provide services to beneficiaries with federal dollars.
The substance of the Charitable Choice Expansion Act is virtually
identical to that of the original Charitable Choice provision of the
welfare reform law. The only real difference between the two provisions
is that the new bill covers many more federal programs than the
original provision.
While the original Charitable Choice provision applies mainly to the
new welfare reform block grant program, the Charitable Choice Expansion
Act applies to all federal government programs in which the government
is authorized to use nongovernmental organizations to provide federally
funded services to beneficiaries. Some of the programs that will be
covered include: housing, substance abuse prevention and treatment,
juvenile services, seniors services, the Community Development Block
Grant, the Community Services Block Grant, the Social Services Block
Grant, abstinence education, and child welfare services.
The legislation does not cover elementary and secondary education
programs--except it does cover GED programs--or higher education
programs. Further, the bill does not affect the Head Start program or
the Child Care Development Block Grant program, both of which already
contain certain provisions regarding the use of religious organizations
in delivering services under those programs.
We have taken measures to strengthen the bill by providing more
protections to both beneficiaries and religious organizations. For
example, the government must ensure that beneficiaries receive notice
of their right under the bill to object to receiving services from a
religious organization. Additionally, religious organizations must
segregate their own private funds from government funding.
This proposal is necessary because while some areas of the law may
not contain discriminatory language towards religious organizations,
many government officials may assume wrongly that the Establishment
Clause bars religious organizations from participating as private
providers.
The Charitable Choice Expansion Act embodies existing case precedents
to clarify to government officials and religious organizations alike
that it is constitutionally allowable, and even constitutionally
required, to consider religious organizations on an equal basis with
other private providers. It is my hope that these protections in the
law will encourage successful charitable and faith-based organizations
to expand their services while assuring them that they will not have to
extinguish their religious character when receiving government funds.
I am pleased to say that there is broad-based support for the
Charitable Choice Expansion Act. Some of the organizations supporting
the concept of this legislation include Agudath Israel, American Center
for Law and Justice, Call to Renewal, Center for Public Justice,
Christian Coalition, Christian Legal Society, the Coalition on Urban
Renewal and Education, National Association of Evangelicals, the
National Center for Neighborhood Enterprise, the Salvation Army, Teen
Challenge International USA, and World Vision.
America's faith-based charities and nongovernmental organizations,
from the Salvation Army to Catholic Charities, have moved people
successfully from dependency and despair to the dignity of self-
reliance. Government alone will never cure our societal ills. We need
to find ways to help unleash the cultural remedy administered so
effectively by charitable and religious organizations. Allowing a
``charitable choice'' will help transform the lives of those in need
and unleash an effective response to today's challenges in our culture.
______
By Mr. KERREY (for himself, Mr. Bond, Mr. Durbin, Mr. Kennedy,
Mr. DeWine, and Mr. Moynihan):
S. 2049. A bill to provide for payments to children's hospitals that
operate graduate medical education programs; to the Committee on
Finance.
the children's hospitals education and research act of 1998
Mr. KERREY. Mr. President, I am pleased to submit this proposal to
provide critical support to teaching programs at free-standing
children's hospitals. I am also honored to be joined by Senators Bond,
Durbin, Kennedy, DeWine and Moynihan on this bill.
Children's hospitals play an important role in our nation's health
care system. They combine high-quality clinical care, a vibrant
teaching mission and leading pediatric biomedical research within their
walls. They provide specialized regional services, including complex
care to chronically ill children, and serve as safety-net providers to
low-income children.
Teaching is an everyday component of these hospitals' operations.
Pediatric hospitals train one-quarter of the nation's pediatricians,
and the majority of America's pediatric specialists. Pediatric
residents develop the skills they need to care for our nation's
children at these institutions.
In addition, pediatric hospitals combine the joint missions of
teaching and research. Scientific discovery depends on the strong
academic focus of teaching hospitals. The teaching environment attracts
academics devoted to research. It attracts the volume and spectrum of
complex cases needed for clinical research. And the teaching
[[Page S4536]]
mission creates the intellectual environment necessary to test the
conventional wisdom of day-to-day health care and foster the
questioning that leads to breakthroughs in research. Because these
hospitals combine research and teaching in a clinical setting, these
breakthroughs can be rapidly translated into patient care.
Children's hospitals have contributed to advances in virtually every
aspect of pediatric medicine. Thanks to research efforts at these
hospitals, children can survive once-fatal diseases such as polio, grow
and thrive with disabilities such as cerebral palsy, and overcome
juvenile diabetes to become self-supporting adults.
Through patient care, teaching and research, these hospitals
contribute to our communities in many ways. However, their training
programs--and their ability to fulfill their critical role in America's
health care system--are being gradually undermined by dwindling
financial support. Maintaining a vibrant teaching and research program
is more expensive than simply providing patient care. The nation's
teaching hospitals have historically relied on higher payments--
payments above the cost of clinical care itself--in order to finance
their teaching programs. Today, competitive market pressures provide
little incentive for private payers to contribute towards teaching
costs. At the same time, the increased use of managed care plans within
the Medicaid program has decreased the availability of teaching dollars
through Medicaid. Therefore, Medicare's support for graduate medical
education is more important than ever.
Independent children's hospitals, however, serve an extremely small
number of Medicare patients. Therefore, they do not receive Medicare
graduate medical education payments to support their teaching
activities. In 1997, Medicare provided an average of $65,000 per
resident to all teaching hospitals, compared to an average of $230 per
resident in total Medicare GME payments at independent children's
hospitals.
This proposal will address, for the short-term, this unintended
consequence of current public policy. It will provide time-limited
support to help children's hospitals train tomorrow's pediatricians,
investigate new treatments and pursue pediatric biomedical research. It
will establish a four-year fund, which will provide children's
hospitals with a Federal teaching payment equal to the national average
per resident payment through Medicare. Total spending over four years
will be less than a billion dollars.
All American families have great dreams for their children. These
hopes include healthy, active, happy childhoods, so they seek the best
possible health care for their children. And when these dreams are
threatened by a critical illness, they seek the expertise of highly-
trained pediatricians and pediatric specialists, and rely on the
research discoveries fostered by children's hospitals. All families
deserve a chance at the American dream. Through this legislation, we
will help children's hospitals--hospitals such as Children's Hospital
in Omaha, Boys' Town, St. Louis Children's Hospital, Children's
Memorial Hospital in Chicago, Children's Hospital in Boston and
others--train the doctors and do the research necessary to fulfill this
dream. Through this legislation, Congress will be doing its part to
help American families work towards a successful future.
Mr. President, this legislation will address a short-term problem--
actually a problem that is a short-term solution to a problem that we
have with graduate medical education for pediatricians. Pediatric
hospitals perform a very important part of the teaching and the
training of our pediatricians. But because they see very few Medicare
patients, which is obvious, they don't receive Medicare graduate
education payments to support their teaching activities. What that
means is there is a huge difference in Federal support across teaching
hospitals--about $65,000 per resident in Medicare GME payments to all
teaching hospitals, compared to an average of $230 per resident in
total Medicare GME payments to independent children's hospitals.
It is a very big problem as we increasingly pay attention to the need
for good pediatric health care for our children. We have to make sure
that we solve this problem. This is a short-term solution.
I mentioned the short-term solution. The Presidential Commission on
Medicare will be making its recommendation next year. One of its
responsibilities is to deal with the question of graduate medical
education--coming up with a solution of how we can fund it in an
environment where more and more health care is going into managed care.
That will be an especially difficult problem for us to solve.
But inside of that overall problem is an even more compelling
problem, as I think Members will see when they look at the differential
in reimbursement for teaching costs in pediatric hospitals versus all
residents nationwide.
Thank you, Mr. President. I ask that the complete text of this
legislation be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 2049
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 ``Children's Hospitals
Education and Research Act of 1998''.
SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT
OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.
(a) Payments.--
(1) In general.--The Secretary shall make payment under
this section to each children's hospital for each hospital
cost reporting period beginning after fiscal year 1998 and
before fiscal year 2003 for the direct and indirect expenses
associated with operating approved medical residency training
programs.
(2) Capped Amount.--The payment to children's hospitals
established in this subsection for cost reporting periods
ending in a fiscal year is limited to the extent of funds
appropriated under subsection (d) for that fiscal year.
(3) Pro rata reductions.--If the Secretary determines that
the amount of funds appropriated under subsection (d) for
cost reporting periods ending in a fiscal year is
insufficient to provide the total amount of payments
otherwise due for such periods, the Secretary shall reduce
the amount payable under this section for such period on a
pro rata basis to reflect such shortfall.
(b) Amount of Payment.--
(1) In general.--The amount payable under this section to a
children's hospital for direct and indirect expenses relating
to approved medical residency training programs for a cost
reporting period is equal to the sum of--
(A) the product of--
(i) the per resident rate for direct medical education, as
determined under paragraph (2), for the cost reporting
period; and
(ii) the weighted average number of full-time equivalent
residents in the hospital's approved medical residency
training programs (as determined under section 1886(h)(4) of
the Social Security Act) for the cost reporting period; and
(B) the product of--
(i) the per resident rate for indirect medical education,
as determined under paragraph (3), for the cost reporting
period; and
(ii) the number of full-time equivalent residents in the
hospital's approved medical residency training programs for
the cost reporting period.
(2) Per resident rate for direct medical education.--
(A) In general.--The per resident rate for direct medical
education for a hospital for a cost reporting period ending
in or after fiscal year 1999 is the updated rate determined
under subparagraph (B), as adjusted for the hospital under
subparagraph (C).
(B) Computation of updated rate.--The Secretary shall--
(i) compute a base national DME average per resident rate
equal to the average of the per resident rates computed under
section 1886(h)(2) of the Social Security Act for cost
reporting periods ending during fiscal year 1998; and
(ii) update such rate by the applicable percentage increase
determined under section 1886(b)(3)(B)(i) of such Act for the
fiscal year involved.
(C) Adjustment for variations in labor-related costs.--The
Secretary shall adjust for each hospital the portion of such
updated rate that is related to labor and labor-related costs
to account for variations in wage costs in the geographic
area in which the hospital is located using the factor
determined under section 1886(d)(3)(E) of the Social Security
Act.
(3) Per resident rate for indirect medical education.--
(A) In general.--The per resident rate for indirect medical
education for a hospital for a cost reporting period ending
in or after fiscal year 1999 is the updated amount determined
under subparagraph (B).
(B) Computation of updated amount.--The Secretary shall--
(i) determine, for each hospital with a graduate medical
education program which is paid under section 1886(d) of the
Social Security Act, the amount paid to that hospital
pursuant to section 1886(d)(5)(B) of such Act
[[Page S4537]]
for the equivalent of a full twelve-month cost reporting
period ending during the preceding fiscal year and divide
such amount by the number of full-time equivalent residents
participating in its approved residency programs and used to
calculate the amount of payment under such section in that
cost reporting period;
(ii) take the sum of the amounts determined under clause
(i) for all the hospitals described in such clause and divide
that sum by the number of hospitals so described; and
(iii) update the amount computed under clause (ii) for a
hospital by the applicable percentage increase determined
under section 1886(b)(3)(B)(i) of such Act for the fiscal
year involved.
(c) Making of Payments.--
(1) Interim payments.--The Secretary shall estimate, before
the beginning of each cost reporting period for a hospital
for which a payment may be made under this section, the
amount of payment to be made under this section to the
hospital for such period and shall make payment of such
amount, in 26 equal interim installments during such period.
(2) Final payment.--At the end of each such period, the
hospital shall submit to the Secretary such information as
the Secretary determines to be necessary to determine the
final payment amount due under this section for the hospital
for the period. Based on such determination, the Secretary
shall recoup any overpayments made, or pay any balance due.
The final amount so determined shall be considered a final
intermediary determination for purposes of applying section
1878 of the Social Security Act and shall be subject to
review under that section in the same manner as the amount of
payment under section 1886(d) is subject to review under such
section.
(d) Limitation on Expenditures.--
(1) In general.--Subject to paragraph (2), there are hereby
appropriated, out of any money in the Treasury not otherwise
appropriated, for payments under this section for cost
reporting periods beginning in--
(A) fiscal year 1999 $100,000,000;
(B) fiscal year 2000, $285,000,000;
(C) fiscal year 2001, $285,000,000; and
(D) fiscal year 2002, $285,000,000.
(2) Carryover of excess.--If the amount of payments under
this section for cost reporting periods ending in fiscal year
1999, 2000, or 2001 is less than the amount provided under
this subsection for such payments for such periods, then the
amount available under this subsection for cost reporting
periods ending in the following fiscal year shall be
increased by the amount of such difference.
(e) Relation to Medicare and Medicaid Payments.--
Notwithstanding any other provision of law, payments under
this section to a hospital for a cost reporting period--
(1) are in lieu of any amounts otherwise payable to the
hospital under section 1886(h) or 1886(d)(5)(B) of the Social
Security Act to the hospital for such cost reporting period,
but
(2) shall not affect the amounts otherwise payable to such
hospitals under a State medicaid plan under title XIX of such
Act.
(f) Definitions.--In this section:
(1) Approved medical residency training program.--The term
``approved medical residency training program'' has the
meaning given such term in section 1886(h)(5)(A) of the
Social Security Act (42 U.S.C. 1395ww(h)(5)(A)).
(2) Children's hospital.--The term ``children's hospital''
means a hospital described in section 1886(d)(1)(B)(iii) of
the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)(iii)).
(3) Direct graduate medical education costs.--The term
``direct graduate medical education costs'' has the meaning
given such term in section 1886(h)(5)(C) of the Social
Security Act (42 U.S.C. 1395ww(h)(5)(C)).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
Mr. BOND. Mr. President, I am pleased to rise today as an original
cosponsor with Senator Bob Kerrey of the ``Children's Hospitals
Education and Research Act of 1998.'' This bill seeks to address an
unintended inequity in federal support for graduate medical education.
If not addressed, this inequity will jeopardize the future of the
pediatric health care work force as well as the pediatric biomedical
research enterprise for our nation's children.
Specifically, this bill will provide capped, time-limited, interim
commensurate federal funding for the nearly 60 independent children's
teaching hospitals, including the children's hospitals in Kansas City
and St. Louis, which are so important to the training of the nation's
physicians who serve children. They are equally important to the
conduct of research to benefit children's health and health care.
Let me illustrate the magnitude of the inequity in federal investment
in graduate medical attention (GME). In 1977, the federal Medicare
program reimbursed teaching hospitals, on average, more than $76,000
for each resident trained. In contrast, Medicare reimbursed independent
children's teaching hospitals--children's hospitals that do not share a
Medicare provider number with a larger medical institution--less than
$400 per resident, because children's hospitals care for children, not
the elderly, and therefore do not serve Medicare patients, except for a
small number of children with end stage renal disease.
Until recently, this inequity was not a problem as long as all payers
of health care were willing to reimburse teaching hospitals enough for
their patient care to cover the extra costs of GME. As the health care
market has become increasingly competitive, it has become harder and
harder for all teaching hospitals to generate patient care revenues to
help cover their GME costs. But only independent children's teaching
hospitals face these competitive pressures without the significant
federal GME support, which the rest of the teaching hospital community
relies upon.
This is more than a problem for the financial well-being of the
education programs of a small number of children's hospitals--less than
one percent of the nation's hospitals. It is a problem for our entire
pediatric workforce and pediatric research enterprise, because these
institutions play such a disproportionately large role in academic
medicine for children. On average, their education programs are equal
in size to the GME programs of all teaching hospitals, but they train
twice as many residents per bed as do other teaching hospitals.
As a consequence, independent children's teaching hospitals train
about 5 percent of all physicians, 25 percent of all pediatricians, and
the majority of many pediatric subspecialists who care for children
with the most complex conditions, such as children with cancer, cystic
fibrosis, cerebral palsy, and more.
Recommendations to address the inequity in federal GME support for
children's teaching hospitals are supported by the National Association
of Children's Hospitals as well as the American Academy of Pediatrics
and the Association of Medical School Pediatric Department Chairs. Last
month, the American Academy of Pediatrics wrote to President Clinton,
to express support for the establishment of interim federal support for
the GME program of freestanding, independent children's hospitals. The
AAP said, ``(w)e regard the education programs of independent
children's hospitals as important to our pediatric workforce and
therefore to the future health of all children, because they educate an
important proportion of the nation's pediatricians.''
Last year, many members of the Senate, including myself, recommended
that any comprehensive reform of graduate medical education financing
should include commensurate federal GME support for children's teaching
hospitals. Instead of enacting GME reform, Congress directed the
Bipartisan Commission on the Future of Medicare and the Medicare
Payment Assessment Commission to prepare recommendations for the future
of GME financing, including for children's teaching hospitals.
Since it will be at least another year before Congress receives those
recommendations and potentially several years before Congress is able
to act on them, the ``Children's Hospitals Education and Research Act''
will provide interim funding for just four years. It will be
commensurate to federal GME support for all teaching hospitals.
Specifically, the bill provides, in a capped fund, $100 million in FY
1999 and $285 million in each of the three succeeding fiscal years, for
eligible institutions. It will be financed by general revenues, not
Medicare HI Trust Funds.
I know what a critical role children's hospitals play in the ability
of families and communities to care for all children, including
children with the most complex conditions and children on families with
the most limited economic means. Through their education and research
programs, they are also devoted to serving future generations of
children, too. Certainly, the children of Missouri as well as Kansas
and Southern Illinois, depend vitally on the services and research of
independent children's teaching hospitals such as Children's Mercy in
Kansas City, St. Louis Children's Hospital, and Cardinal Glennon
Children's Hospital, and the care givers they educate.
Children's hospitals are places of daily miracles. Healing that we
would
[[Page S4538]]
never have thought possible a few years ago for children who are burn
victims, or trauma victims, or even cancer victims now occurs daily at
these hospitals. And while I am sure divine intervention plays a role
in this healing, it is also due to the very hard work of skilled
doctors, nurses, and dedicated staff that is second to none. We must
therefore ensure that these facilities have the resources to continue
their noble mission of saving children from the clutches of death and
disease.
I know trustees, and medical and executive leaders of these
institutions. All are committed to controlling the cost of children's
health to the best of their ability. But their future ability to
sustain their education and research programs will also depend on
commensurate federal GME support for them. I urge my colleagues to join
me in supporting the enactment of the ``Children's Hospital Education
and Research Act.''
Mr. KENNEDY. Mr. President, I am honored to join my colleagues
Senator Kerrey, Senator Bond, Senator Durbin, and Senator DeWine in
sponsoring this legislation to assure adequate funding for resident
training in independent children's teaching hospitals.
These hospitals, such as Children's Hospital in Boston, have 60
pediatric training programs. They represent less than 1 percent of the
training programs across the country, yet these hospitals train 5
percent of all physicians, 25 percent of all pediatricians, and the
majority of many pediatric subspecialist.
Too often today, these hospitals are hard-pressed for financial
support. Medicare is the principal source of federal funds that
contributes to the costs of graduate medical education for most
hospitals, but independent children's hospitals have few Medicare
patients, since Medicare coverage for children applies only to end-
stage kidney disease. Medicaid support is declining, as the program
moves more and more toward managed care.
No hospital in the current competitive marketplace can afford to
shift these costs to other payers. As a result, many children's
hospitals find it very difficult to make ends meet.
In 1997, all teaching hospitals relieved a $76,000 in Medicare
graduate medical education support for each medical resident they
trained, but the average independent children's teaching hospital
received only $400.
Last year, Children's Hospital in Boston lost over $30 million on its
patient operations. Two-thirds of this loss was directly attributable
to the direct costs of graduate medical education. Will limited
resources and increasing pressure to reduce patient costs, such losses
cannot continue.
The academic mission of these hospitals is vital. Since its founding
as a 20-bed hospital in 1869, Children's Hospital in Boston has become
the largest pediatric medical center and research facility in the
United States, and an international leader in children's health. It is
also the primary teaching hospital for pediatrics for Harvard Medical
School. For eight years in a row, it has been named the best pediatric
hospital in the country in a nationwide physicians' survey conducted by
U.S. News and World Report.
Clinicians and investigators work together at the hospital in an
environment that fosters new discoveries in research and new treatments
for patients. Scientific breakthroughs are rapidly translated into
better patient care and enhanced medical education. We must assure that
market pressures to not interfere with these advances.
Independent children's hospitals deserve the same strong support that
other hospitals receive for graduate medical education. The current
lack of federal support is jeopardizing the indispensable work of these
institutions and jeopardizing the next generation of leaders in
pediatrics.
Congress needed to do all it can to correct this inequity. This
legislation we are introducing will provide stop-gap support stabilize
the situation while we develop a fair long-run solution to meet the
overall needs of all aspects of graduate medical education. I look
forward to early action by the Senate on this important measure.
Mr. MOYNIHAN. Mr. President, I am pleased to join Senators Bob
Kerrey, Bond, Kennedy, Durbin and DeWine in introducing the
``Children's Hospital Education and Research Act of 1998.'' This
legislation recognizes the value of supporting medical training. it
establishes an interim source of funding for financing residency
training expenses for free-standing children's hospitals until a
permanent source of funding for all medical education is developed.
Medical education is one of America's most precious public resources.
It is a public good--a good from which everyone benefits, but for which
no one is willing to pay. As a public good, explicit and dedicated
funding for residency training programs must be secured so that the
United States will continue to lead the world in the quality of its
health care system. This legislation provides for such dedicated
funding for residency training programs in children's hospitals.
I have introduced legislation--S. 21--which creates a medical
education trust fund to support all accredited medical schools and
teaching hospitals. Additionally, I requested that specific language be
inserted in the Balanced Budget Act of 1997 charging the National
Bipartisan Commission on the Future of Medicare to:
. . . make recommendations regarding the financing of
graduate medical education (GME), including consideration of
alternative broad-based sources of funding for such education
and funding for institutions not currently eligible for such
GME support that conduct approved graduate medical residency
programs, such as children's hospitals.
Children's hospitals have a vitally important mission providing
patient care, medical training and research in the face of an
increasingly competitive health system. I am pleased to support Senator
Kerrey's bill and look forward to working with him and other members of
the National Bipartisan Commission on the Future of Medicare as we seek
stable and sufficient funding for medical education.
______
By Mrs. FEINSTEIN:
S. 2050. A bill to amend title 10, United States Code, to prohibit
members of the Armed Forces from entering into correctional facilities
to present decorations to persons who commit certain crimes before
being presented such decorations; to the Committee on Armed Services.
____________________