[Congressional Record Volume 145, Number 78 (Thursday, May 27, 1999)]
[Senate]
[Pages S6450-S6451]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           FEDERAL PRISONER HEALTH CARE COPAYMENT ACT OF 1999

  Mr. HUTCHINSON. Mr. President, I ask unanimous consent that the 
Senate now proceed to the consideration of Calendar No. 97, S. 704.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The legislative clerk read as follows:

       A bill (S. 704) to amend title 18, United States Code, to 
     combat the over-utilization of prison health care services 
     and control rising prisoner health care costs.

  The Senate proceeded to consider the bill which had been reported 
from the Committee on the Judiciary, with an amendment to strike all 
after the enacting clause and inserting in lieu thereof the following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Federal Prisoner Health Care 
     Copayment Act of 1999''.

     SEC. 2. HEALTH CARE FEES FOR PRISONERS IN FEDERAL 
                   INSTITUTIONS.

       (a) In General.--Chapter 303 of title 18, United States 
     Code, is amended by adding at the end the following:

     ``Sec. 4048. Fees for health care services for prisoners

       ``(a) Definitions.--In this section--
       ``(1) the term `account' means the trust fund account (or 
     institutional equivalent) of a prisoner;
       ``(2) the term `Director' means the Director of the Bureau 
     of Prisons;
       ``(3) the term `health care provider' means any person who 
     is--
       ``(A) authorized by the Director to provide health care 
     services; and
       ``(B) operating within the scope of such authorization;
       ``(4) the term `health care visit' means a visit, as 
     determined by the Director, by a prisoner to an institutional 
     or noninstitutional health care provider; and
       ``(5) the term `prisoner' means--
       ``(A) any individual who is incarcerated in an institution 
     under the jurisdiction of the Bureau of Prisons; or
       ``(B) any other individual, as designated by the Director, 
     who has been charged with or convicted of an offense against 
     the United States.
       ``(b) Fees for Health Care Services.--
       ``(1) In general.--The Director, in accordance with this 
     section and with such regulations as the Director shall 
     promulgate to carry out this section, may assess and collect 
     a fee for health care services provided in connection with 
     each health care visit requested by a prisoner.
       ``(2) Exclusion.--The Director may not assess or collect a 
     fee under this section for preventative health care services, 
     as determined by the Director.
       ``(c) Persons Subject to Fee.--Each fee assessed under this 
     section shall be collected by the Director from the account 
     of--
       ``(1) the prisoner receiving health care services in 
     connection with a health care visit described in subsection 
     (b)(1); or
       ``(2) in the case of health care services provided in 
     connection with a health care visit described in subsection 
     (b)(1) that results from an injury inflicted on a prisoner by 
     another prisoner, the prisoner who inflicted the injury, as 
     determined by the Director.
       ``(d) Amount of Fee.--Any fee assessed and collected under 
     this section shall be in an amount of not less than $2.
       ``(e) No Consent Required.--Notwithstanding any other 
     provision of law, the consent of a prisoner shall not be 
     required for the collection of a fee from the account of the 
     prisoner under this section.
       ``(f) No Refusal of Treatment for Financial Reasons.--
     Nothing in this section may be construed to permit any 
     refusal of treatment to a prisoner on the basis that--
       ``(1) the account of the prisoner is insolvent; or
       ``(2) the prisoner is otherwise unable to pay a fee 
     assessed under this section.
       ``(g) Use of Amounts.--
       ``(1) Restitution to specific victims.--Amounts collected 
     by the Director under this section from a prisoner subject to 
     an order of restitution issued pursuant to section 3663 or 
     3663A shall be paid to victims in accordance with the order 
     of restitution.
       ``(2) Allocation of other amounts.--Of amounts collected by 
     the Director under this section from prisoners not subject to 
     an order of restitution issued pursuant to section 3663 or 
     3663A--
       ``(A) 75 percent shall be deposited in the Crime Victims 
     Fund established under section 1402 of the Victims of Crime 
     Act of 1984 (42 U.S.C. 10601); and
       ``(B) 25 percent shall be available to the Attorney General 
     for administrative expenses incurred in carrying out this 
     section.
       ``(h) Reports to Congress.--Not later than 2 years after 
     the date of enactment of the Federal Prisoner Copayment Act 
     of 1999, and annually thereafter, the Director shall submit 
     to Congress a report, which shall include--
       ``(1) a description of the amounts collected under this 
     section during the preceding 24-month period; and
       ``(2) an analysis of the effects of the implementation of 
     this section, if any, on the nature and extent of heath care 
     visits by prisoners.''.
       (b) Clerical Amendment.--The analysis for chapter 303 of 
     title 18, United States Code, is amended by adding at the end 
     the following:

``4048. Fees for health care services for prisoners.''.

     SEC. 3. HEALTH CARE FEES FOR FEDERAL PRISONERS IN NON-FEDERAL 
                   INSTITUTIONS.

       Section 4013 of title 18, United States Code, is amended by 
     adding at the end the following:
       ``(c) Health Care Fees for Federal Prisoners in Non-Federal 
     Institutions.--
       ``(1) In general.--Notwithstanding amounts paid under 
     subsection (a)(3), a State or local government may assess and 
     collect a reasonable fee from the trust fund account (or 
     institutional equivalent) of a Federal prisoner for health 
     care services, if--
       ``(A) the prisoner is confined in a non-Federal institution 
     pursuant to an agreement between the Federal Government and 
     the State or local government;
       ``(B) the fee--
       ``(i) is authorized under State law; and
       ``(ii) does not exceed the amount collected from State or 
     local prisoners for the same services; and
       ``(C) the services--
       ``(i) are provided within or outside of the institution by 
     a person who is licensed or certified under State law to 
     provide health care services and who is operating within the 
     scope of such license;
       ``(ii) are provided at the request of the prisoner; and
       ``(iii) are not preventative health care services.
       ``(2) No refusal of treatment for financial reasons.--
     Nothing in this subsection may be construed to permit any 
     refusal of treatment to a prisoner on the basis that--
       ``(A) the account of the prisoner is insolvent; or
       ``(B) the prisoner is otherwise unable to pay a fee 
     assessed under this subsection.''.


                           Amendment No. 538

                (Purpose: To clarify certain provisions)

  Mr. HUTCHINSON. Mr. President, Senator Leahy has an amendment at the 
desk, and I ask for its consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Arkansas (Mr. Hutchinson), for Mr. Leahy, 
     proposes an amendment numbered 538.

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

       On page 8, strike lines 1 through 3 and insert the 
     following:
       ``(4) the term `health care visit'--
       ``(A) means a visit, as determined by the Director, 
     initiated by a prisoner to an institutional or 
     noninstitutional health care provider; and

[[Page S6451]]

       ``(B) does not include a visit initiated by a prisoner--
       ``(i) pursuant to a staff referral; or
       ``(ii) to obtain staff-approved follow-up treatment for a 
     chronic condition;
       On page 8, line 20, after ``services'' insert ``, emergency 
     services, prenatal care, diagnosis or treatment of contagious 
     diseases, mental health care, or substance abuse treatment''.
       On page 10, line 16, strike ``2 years'' and insert ``1 
     year''.
       On page 10, line 21, strike ``24-month'' and insert ``12-
     month''.
       On page 12, strike lines 6 through 9 and insert the 
     following:
       ``(ii) constitute a health care visit within the meaning of 
     section 4048(a)(4) of this title; and
       ``(iii) are not preventative health care services, 
     emergency services, prenatal care, diagnosis or treatment of 
     contagious diseases, mental health care, or substance abuse 
     treatment.''

  Mr. LEAHY. I want to thank Senator Johnson for his leadership on this 
matter and for bringing this matter to my attention. Vermont does not 
have a copayment requirement for prisoners' health care so the problems 
that his Marshal had brought to his attention last year, were not 
matters that had arisen in Vermont.
  I also want to thank those at the Department of Justice who have made 
suggestions to improve the proposals on this subject over the last 
couple of years. I am glad the I have been able to contribute 
constructively to that process of improvement over the past weeks and 
again today.
  A most important part of this bill is its protection against 
prisoners being refused treatment based on an inability to pay. I am 
glad to see my suggestion that the protection of section 2(f) in this 
regard be included in section 3 of the bill, as well, be incorporated 
in the substitute amendment accepted by the Judiciary Committee and 
reported to the Senate. I thank the Department of Justice for having 
included this suggestion in its recent April 27 letter.
  Today we make additional improvements to the bill to ensure that it 
can serve the purposes for which it is intended. In particular, I have 
suggested language to make clear that since the goal of the bill is to 
deter prisoners from seeking unnecessary health care, copayment 
requirements should not apply to prisoner health care visits initiated 
and approved by custodial staff, including staff referrals and staff-
approved follow-up treatment for a chronic condition. In addition, the 
amendments I have suggested adds to those health care visits excluded 
from the copayment requirement visits for emergency services, perinatal 
care, diagnosis or treatment of contagious diseases, mental health care 
and substance abuse treatment. Like preventative care, all these types 
of health care for prisoners should be encouraged and not discouraged 
by a copayment requirement. It would be harmful to custodial staff and 
detrimental the long term interests of the public to create artificial 
barriers to these health care services.
  Finally, I have suggested that we review this new program and its 
impact next year rather than delaying evaluation for the 2-year period 
initially provided by the bill. The bill constitutes a shift in federal 
corrections and custodial policy and it is appropriate that the impact 
of these changes be evaluated promptly and adjusted as need be.
  I continue to be concerned that we are imposing an administrative 
burden on the Bureau of Prisons greatly in excess of any benefit the 
bill may achieve. I wonder about alternatives to cut down on 
unnecessary health care visits besides the imposition of fees, many of 
which may go uncollected. The contemplated $5 a visit fee for prisoners 
compensated at a rate as low as 11 cents an hour seems excessive, but 
that is how the BOP wishes to proceed.
  I also fear that the effort will lead to extensive litigation to sort 
out what it means and how it is implemented. As we impose duties and 
limitations on correctional authorities, that is one of the 
consequences of such duties.
  I will be interested to see whether funds end up being received by 
victims of crime either with respect to restitution orders or by the 
Victims of Crime Fund through the elaborate mechanisms created by this 
legislation. I hope that victims will benefit from its enactment as 
opposed to experiencing another false promise. In this regard, I wonder 
why there is no benefit to victims from the fees collected from federal 
prisoners held in nonfederal institutions. If our policy is to benefit 
victims, the ownership of the facility ought not deter that policy. 
Surely the copayment fee is not designed as payment for the health care 
treatment itself or even payment for the administrative overhead of the 
system.
  Despite my concerns, this bill does have the support of the BOP and 
U.S. Marshals Service. Just as I facilitated the bill being reported 
from this Committee, today I am acting to allow the Senate to pass an 
improved version of the bill.
  Mr. HUTCHINSON. Mr. President, I ask unanimous consent that the 
amendment be agreed to, the committee substitute be agreed to, the bill 
read a third time and passed, the motion to reconsider be laid upon the 
table, and that any statements relating to the bill appear in the 
Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill was read the third time.
  The bill (S. 704), as amended, was passed.
  (The bill will be printed in a future edition of the Record.)

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