[Congressional Record Volume 144, Number 64 (Tuesday, May 19, 1998)]
[Senate]
[Pages S5140-S5141]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        NATIONAL TOBACCO POLICY AND YOUTH SMOKING REDUCTION ACT

                                 ______
                                 

                      ASHCROFT AMENDMENT NO. 2427

  Mr. ASCHCROFT proposed an amendment to amendment No. 2422 proposed by 
Mr. Kennedy to the bill, S. 1415, supra; as follows:

       In lieu of the language proposed to be inserted, insert the 
     following:
       (1) Amounts equivalent to penalties paid under section 202, 
     including interest thereon.
       (c) Repayable Advances.--
       (1) Authorization.--There are authorized to be appropriated 
     to the trust fund, as repayable advances, such sums as may 
     from time to time be necessary to make the expenditures 
     authorized by this Act.
       (2) Repayment with interest.--Repayable advances made to 
     the trust fund shall be repaid, and interest on such advances 
     shall be paid, to the general fund of the Treasury when the 
     Secretary of the Treasury determines that moneys are 
     available in the trust fund for such purposes.
       (3) Rate of interest.--Interest on advances made under this 
     subsection shall be at a rate determined by the Secretary of 
     the Treasury (as of the close of the calendar month preceding 
     the month in which the advance is made) to be equal to the 
     current average market yield on outstanding marketable 
     obligations of the United States with remaining period to 
     maturity comparable to the anticipated period during which 
     the advance will be outstanding.
       (d) Expenditures From Trust Fund.--Amounts in the trust 
     fund shall be available in each calendar year, as provided by 
     appropriations Acts, except that distributions to the States 
     from amounts credited to the State Litigation Settlement 
     Account shall not require further authorization or 
     appropriation and shall be as provided in the Master 
     Settlement Agreement and this Act, and not less than 15 
     percent of the amounts shall be expended, without further 
     appropriation, notwithstanding any other provision of this 
     Act, from the trust fund for each fiscal year, in the 
     aggregate, for activities under this Act related to--
       (1) the prevention of smoking;
       (2) education;
       (3) State, local, and private control of tobacco product 
     use; and
       (4) smoking cessation.
       (e) Budgetary Treatment of Trust Fund Operations.--The 
     receipts and disbursements of the National Tobacco Settlement 
     Trust Fund shall not be included in the totals of the budget 
     of the United States Government as submitted by the President 
     or of the congressional budget and shall be exempt from any 
     general budget limitation imposed by statute on expenditures 
     and net lending (budget outlays) of the United States 
     Government.
       (f) Administrative Provisions.--Section 9602 of the 
     Internal Revenue Code of 1986 shall apply to the trust fund 
     to the same extent as if it were established by subchapter A 
     of chapter 95 of such Code.

     SEC. 402. STATE LITIGATION SETTLEMENT ACCOUNT.

       (a) In General.--There is established within the trust fund 
     a separate account, to be known as the State Litigation 
     Settlement Account.
       (b) Transfers to Account.--From amounts received by the 
     trust fund under section 403, the State Litigation Settlement 
     Account shall be credited with all settlement payments 
     designated for allocation, without further appropriation, 
     among the several States.
       (c) Reimbursement for State Expenditures.--
       (1) Payment.--Amounts credited to the account are 
     available, without further appropriation, in each fiscal year 
     to provide funds to each State to reimburse such State for 
     amounts expended by the State for the treatment of 
     individuals with tobacco-related illnesses or conditions.
       (2) Amount.--The amount for which a State is eligible for 
     under subparagraph (A) for a fiscal year shall be based on 
     the Master Settlement Agreement and its ancillary documents 
     in accordance with such agreements thereunder as may be 
     entered into after the date of enactment of this Act by the 
     governors of the several States.
       (3) Use of funds.--A State may use amounts received under 
     this subsection as the State determines appropriate.
       (4) Funds not available as medicaid reimbursement.--Funds 
     in the account shall not be available to the Secretary as 
     reimbursement of Medicaid expenditures or considered as 
     Medicaid overpayments for purposes of recoupment.
       (d) Payments To Be Transferred Promptly To States.--The 
     Secretary of the Treasury shall transfer amounts available 
     under subsection (c) to each State as amounts are credited to 
     the State Litigation Settlement Account without undue delay.
       (  ) Provisions Relating to Amounts in Trust Fund.--
       (1) Certain provisions null and void.--Notwithstanding any 
     other provision of law, the following provisions of this Act 
     shall be null and void and not given effect:
       (B) Sections 402 through 406.
                                 ______
                                 

                    KERREY AMENDMENTS NOS. 2428-2429

  (Ordered to lie on the table.)
  Mr. KERREY submitted two amendments intended to be proposed by him to 
the bill, S. 1415, supra; as follows:

                           Amendment No. 2428

       At the end of subtitle C of title XI add the following:

     SEC. ____. LIMITATION ON FUNDING OF PROGRAMS AND ACTIVITIES.

       Notwithstanding any other provision of law, only amounts 
     deposited into the National Tobacco Trust Fund may used to 
     fund the programs and activities authorized under this Act.
                                  ____


                           Amendment No. 2429

       Section 1991D of the Public Health Service Act, as added by 
     section 221, is amended by inserting after subsection (g) the 
     following:
       ``(i) Community-Based Activities of Tobacco Scholars.--
       ``(1) In general.--Of the sums made available to the 
     National Institutes of Health under this section, the 
     Director shall make available a portion of such sums to 
     support the community-based activities of the tobacco 
     scholars assigned to States in accordance with paragraph (2).
       ``(2) Tobacco scholars.--The Director of the National 
     Institutes of Health shall--
       ``(A) designate individuals to serve as tobacco scholars 
     from among individuals who receive funding through the 
     National Institutes of Health for tobacco-related research; 
     and
       ``(B) assign a tobacco scholar to each State.
       ``(3) Community-based activities.--For purposes of 
     paragraph (1), the term `community-based activities' 
     includes--
       ``(A) public forums for sharing research by tobacco 
     scholars and other tobacco-related research with the medical 
     community within States; and
       ``(B) dissemination of information to the public on 
     tobacco-related research and the health-related implications 
     of the conclusions of such research through means such as 
     public forums, public service announcements, advertisements, 
     and television broadcasts.
                                 ______
                                 

                KERREY (AND KENNEDY) AMENDMENT NO. 2430

                                 ______
                                 
  Mr. KERREY (for himself and Mr. Kennedy) submitted an amendment 
intended to be proposed by them to the bill, S. 1415, supra; as 
follows:
       At the end of title XI, add the following:

     SEC. ____. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       (a) Payments.--
       (1) In general.--The Secretary shall make payments 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 payments to children's hospitals 
     established in this subsection for cost reporting periods 
     ending in a fiscal year are 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

[[Page S5141]]

       (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 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 the payment to be made under this section to the 
     hospital for such period and shall pay 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.

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