[Congressional Record Volume 146, Number 35 (Monday, March 27, 2000)]
[Senate]
[Pages S1747-S1749]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mrs. FEINSTEIN (for herself and Mrs. Boxer):
  S. 2294. A bill to establish the Rosie the Riveter-World War II Home 
Front National Historical Park in the State of California, and for 
other purposes; to the Committee on Energy and Natural Resources.


 rosie the riveter-world war ii home front national historical park act

  Mrs. FEINSTEIN. Mr. President, I am proud to introduce this bill 
today to establish the Rosie the Riveter/World War II Home Front 
National Historic Park. This park will be constructed on the former 
site of Richmond Kaiser Shipyard #2 which produced WWII ships at the 
site of the present-day Marina Park in Richmond California.
  The Home Front industrial buildup in Richmond, California and across 
America to strengthen U.S. military capability and eventually win World 
War II started in early 1941 with the Lend Lease Program. Employment at 
the Richmond Shipyards peaked at 90,000 and forced an unprecedented 
integration of workers into the nation's work force.
  ``Rosie the Riveter'' was a term coined to help recruit female 
civilian workers and came to symbolize a workforce mobilized to fill 
the gap created by working men who left their jobs for active military 
duty. Nationwide, six million women entered the WWII Home Front 
workforce, which also provided unprecedented opportunities for 
minorities.
  I am proud to offer this legislation to commemorate these invaluable 
contributions to the U.S. victory in World War II, and I urge my 
colleagues to support this bill.
                                 ______
                                 
      By Mr. CRAPO:
  S. 2296. A bill to provide grants for special environmental 
assistance for the regulation of communities and habitat (SEARCH) to 
small communities; to the Committee on Environment and Public Works.


                             PROJECT SEARCH

  Mr. CRAPO. Mr. President, I rise today to introduce legislation to 
authorize a national environmental grants program for small communities 
called Project SEARCH.
  The national Project SEARCH (Special Environmental Assistance for the 
Regulation of Communities and Habitat) concept is based on a 
demonstration program that has been operating with great success in 
Idaho in 1999 and 2000. In short, the bill establishes a simplified 
application process for communities of under 2,500 individuals to 
receive assistance in meeting a broad array of federal, state, or local 
environmental regulations. Grants would be available for initial 
feasibility studies, to address unanticipated costs arising during the 
course of a project, or when a community has been turned down or 
underfunded by traditional sources. The grant program would require no 
match from the recipients.
  Some of the major highlights of the program are:
  A simplified application process--no special grants coordinators 
required;
  No unsolicited bureaucratic intrusions into the decision-making 
process;
  Communities must first have attempted to receive funds from 
traditional sources;
  It is open to studies or projects involving any environmental 
regulation;
  Applications are reviewed and approved by citizens panel of 
volunteers;
  The panel chooses number of recipients and size of grants;
  The panel consists of volunteers representing all regions of the 
state; and
  No local match is required to receive the SEARCH funds.
  Over the past several years, it has become increasing apparent that 
small communities are having problems complying with environmental 
rules and regulations due primarily to lack of funding, not a 
willingness to do so. They, like all of us, want clean water and air 
and a healthy natural environment. Sometimes, they simply cannot 
shoulder the financial burden with their limited resources.
  In addition, small communities wishing to pursue unique collaborative 
efforts might be discouraged by grant administrators who prefer 
conformity. Some run into unexpected costs during a project and have 
borrowed and bonded to the maximum. Others are in critical habitat 
locations and any project may have additional costs, which may not be 
recognized by traditional financial sources. Still others just need 
help

[[Page S1748]]

for the initial environmental feasibility study so they can identify 
the most effective path forward.
  With these needs in mind, in 1998, I was able to secure $1.3 million 
through the Environmental Protection Agency (EPA) for a demonstration 
grant program for Idaho's small communities. Idaho's program does not 
replace other funding sources, but serves as a final resort when all 
other means have been exhausted.
  The application process was simplified so that any small town mayor, 
county commissioner, sewer district chairman, or community leader could 
manage it without hiring a professional grant writer. An independent 
citizens committee with statewide representation was established to 
make the selections and get the funds on the ground as quickly as 
possible. No bureaucratic or political intrusions were permitted.
  Although the EPA subsequently insisted that grants be limited to 
water and wastewater projects, forty-four communities in Idaho 
ultimately applied, not including two that failed to meet the 
eligibility requirements. Ultimately, twenty-one communities were 
awarded grants in several categories, and ranged in size from $9,000 to 
$319,000. A Native American community, a migrant community, and several 
innovative collaborative efforts were included in the successful 
applicants. The communities that were not selected are being given 
assistance in exploring other funding sources and other advice.
  The response and feedback from all participants has been overwhelming 
positive. Environmental officials from the state and EPA who witnessed 
the process have stated that the process worked well and was able to 
accomplish much on a volunteer basis. There was even extraordinary 
appreciation from other funding agencies because some communities they 
were not able to reach were provided funds for feasibility studies. The 
only negative comments were from those who wished that the EPA had not 
limited the program to water and wastewater projects.
  The conclusion of all participants was that Project SEARCH is a 
program worthy of being expanded nationally. So many small communities 
in so many states can benefit from a program that assists underserved 
and often overlooked communities. This legislation provides us the 
opportunity to help small communities throughout the United States.
                                 ______
                                 
      By Mr. JEFFORDS (for himself, Mr. Reed, and Mr. Leahy):
  S. 2298. A bill to amend title XVIII of the Social Security Act to 
clarify the definition of homebound with respect to home health 
services under the Medicare Program; to the Committee on Finance.


                    THE HOMEBOUND CLARIFICATION ACT

 Mr. JEFFORDS. Mr. President, I am here today to introduce the 
Homebound Clarification Act of 2000. This important bill has been 
crafted to protect Medicare beneficiaries from a growing problem that 
is impeding access to vital home care services. I want to recognize my 
cosponsors, Senator Reed of Rhode Island and Senator Leahy, for their 
continued effort and dedication to protecting access to home health 
care.
  Federally funded home health care is an often quiet but invaluable 
part of life for America's seniors. Medical treatment can often mean 
being subjected to a strange and unfamiliar environment. For our 
nation's elderly, who may have special needs, this inconvenience can be 
more severe and detrimental to successful recovery. Home health care 
means that people recovering from surgery can go home sooner--it means 
that someone recovering from an accident can get physical therapy in 
their home, it means our seniors can stay at home, and out of nursing 
homes.
  The sooner you can return patients to their homes, the sooner they 
can recover. The familiar environment of the home, family, and friends 
is more nurturing to recovering patients than the often stressful and 
unfamiliar surroundings of a hospital. Home health is also a great 
avenue for education. It empowers families to assist in the care of 
their loved ones. It is smart policy from human and financial 
standpoints.
  But there are some seniors who are being denied access to this smart 
policy. An individual must be considered ``homebound'' to qualify for 
Medicare reimbursement for home health. Though an individual is not 
required to be bed-ridden, the condition of the individual should 
include ``a normal inability to leave the home.'' Under the current 
definition, an individual is ``homebound'' if ``leaving the home 
requires a considerable and taxing effort by the individual, and that 
absences of the individual from home are infrequent and of short 
duration, or are attributable to the need to receive medical 
treatment.'' The definition allows for ``infrequent'' or ``short 
duration,'' recognizing that short excursions may be a part of a 
successful recovery process, but leaves it up to fiscal intermediaries 
to interpret exactly what number is frequent and how short an absence 
must be. Interpretation of this definition has varied widely.
  Sadly, there is a ready supply of disturbing examples of the 
overzealous and arbitrary interpretation of the definition. Many 
seniors have found themselves virtual prisoners in their homes, 
threatened with loss of coverage if they attend adult day care, weekly 
religious services, or even visit family members in the hospital. This 
makes no sense because all of these activities are steps on the road to 
successful and healthy recovery. Often, health professionals want 
patients to get outside for fresh air or exercise, as part of their 
care plan. This helps fight off depression.
  Seniors deserve a more consistent standard to depend upon, rather 
than a completely arbitrary number of absences from the home. In April 
1999, Secretary of Health and Human Services Donna Shalala sent a 
report to Congress on the homebound definition. The report identifies 
the wide variety in interpretation of the definition and the absurdity 
of some coverage determinations that follow. While the Administration 
unfortunately stopped short of taking action themselves, Shalala did 
propose that a clarification of the definition is needed to improve 
uniformity of determination.
  The Homebound Clarification Act states that eligibility of an 
individual depends on the condition of the patient, how ``taxing'' it 
is for the patient to leave home. It strikes the clause that states: 
``that absences of the individual from home are infrequent or of 
relatively short duration, or are attributable to the need to receive 
medical treatment.'' This is consistent with the intent of Congress and 
the Administration. This will not open the door to wider coverage of 
home health, but rather protect coverage for those who need it.
  We ask that seniors put their trust in the Medicare program. We are 
responsible for making sure that the Medicare program lives up to its 
promise and that home health will be available to those who need it. 
Once again, I would like to thank my cosponsors, Senators Reed and 
Leahy for their work. We look forward to working with the rest of 
Congress to turn this legislation into law.
                                 ______
                                 
      By Mr. L. CHAFEE (for himself and Ms. Snowe):
  S. 2299. A bill to amend title XIX of the Social Security Act to 
continue State Medicaid disproportionate share hospital (DSH) 
allotments for fiscal year 2001 at the levels for fiscal year 2000; to 
the Committee on Finance.


               The Medicaid DSH Preservation Act of 2000

  Mr. L. CHAFEE. Mr. President, I am pleased to be joined today by 
Senator Snowe in introducing the Medicaid DSH Preservation Act of 2000. 
This legislation will freeze Medicaid disproportionate share hospital 
(DSH) reductions at Fiscal Year 2000 levels, thereby mitigating the 
forthcoming reductions in Fiscal Years 2001 and 2002. This bill will 
also provide a growth rate adjustment to help compensate for the 
increases in the cost of providing care to the most needy and indigent 
patients.
  In addition to the Medicare payment reductions in the Balanced Budget 
Act of 1997 (BBA), federal payments to the Medicaid DSH program were 
also reduced by $10.4 billion over 5 years, with these reductions being 
absorbed by States and our Nation's vulnerable safety net hospitals. 
Medicaid DSH payments help reimburse hospitals' costs of treating 
Medicaid patients, particularly those with complex medical needs. These 
payments also make it possible for communities to care for the 
uninsured--a population that is projected to increase considerably 
during the next few years.

[[Page S1749]]

  The impact of these financial pressures was not fully anticipated at 
the time the BBA was enacted. Other Financial pressures such as 
declining Medicaid enrollment have had a significant impact on these 
safety net hospitals, thereby adding to the rapidly rising number of 
Americans without health insurance. At a time when our Nation's 
uninsured rate continues to climb above 44 million, it makes little 
sense to be reducing much-needed Medicaid DSH payments to our nation's 
safety net hospitals.
  Hospitals in Rhode Island will absorb $400 million in reductions as a 
result of changes made to the Medicare and Medicaid programs in the 
BBA. Ten out of fourteen hospitals in my State had operating losses in 
1999. After the BBA was enacted, it was predicted that cuts in federal 
Medicare and Medicaid payments would cost hospitals in Rhode Island 
$220 million over 5 years; however, this estimate has proven to be 
about $180 million off the mark. Every other State is experiencing 
similar problems. Since the BBA was signed into law, the American 
Hospital Association commissioned a study by the Lewin Group, which 
estimated that there would be $71 billion less paid to hospitals 
nationwide over 5 years. The original estimate of the impact of the BBA 
was $18 billion. While the Balanced Budget Refinement Act of 1999 
provided some relief to our Nation's financially strapped hospitals, 
that relief was targeted to the Medicare program. Clearly, more needs 
to be done to keep our vulnerable safety net hospitals from continuing 
on this downward spiral.
  This legislation we are introducing today represents a commonsense 
compromise that will help prevent the further erosion of our Nation's 
safety net hospitals and the long-term viability of our country's 
health care system.
  I urge my colleagues to join me in supporting this important 
legislation and I ask unanimous consent that the legislation be printed 
in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2299

       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 ``Medicaid DSH Preservation 
     Act of 2000''.

     SEC. 2. CONTINUATION OF MEDICAID DSH ALLOTMENTS AT FISCAL 
                   YEAR 2000 LEVELS FOR FISCAL YEAR 2001.

       Section 1923(f) of the Social Security Act (42 U.S.C. 
     1396r-4(f)), as amended by section 601 of the Medicare, 
     Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, 
     as enacted into law by section 1000(a)(6) of Public Law 106-
     113 (113 Stat. 1501A-394), is amended--
       (1) in paragraph (2)--
       (A) in the heading, by striking ``2002'' and inserting 
     ``2001'';
       (B) in the matter preceding the table, by striking ``2002'' 
     and inserting ``2001''; and
       (C) in the table in such paragraph, by striking the column 
     labeled ``FY 02'' relating to fiscal year 2002; and
       (2) in paragraph (3)--
       (A) in the heading, by striking ``2003'' and inserting 
     ``2002''; and
       (B) in subparagraph (A), by striking ``2003'' and inserting 
     ``2002''.

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