[Congressional Record Volume 146, Number 106 (Tuesday, September 12, 2000)]
[Senate]
[Pages S8413-S8421]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. WYDEN:
S. 3026. A bill to establish a hospice demonstration and grant
program for beneficiaries under the Medicare Program under title XVIII
of the Social Security Act, and for other purposes; to the Committee on
Finance.
hospice demonstration and grant program
Mr. WYDEN. Mr. President, today, I am introducing groundbreaking
legislation to make a difference in the way in which dying patients and
their families can access hospice care. Ninety percent of Americans do
not realize that there is a hospice benefit provided under the Medicare
program. Over time, the length of stay in a hospice is decreasing so
that patients do not get the full benefit of services that could make
them more comfortable at a crucial time in their lives.
The issues related to how we die are too important to permit the
Medicare Hospice benefit to remain fixed in time. Now is the time to
begin to test new ways to design the benefit so that the benefit can
remain truly patient-centered at one of the most crucial times in
patients' and their families' lives.
Just as we push our health care system for medical breakthroughs that
will allow more of us to live healthier and longer, we need to drive
our health care system to create accessible, positive care for those
facing the end of life.
My legislation, the Hospice Improvement Act of 2000, would require
the Secretary to establish a demonstration program to increase access
and use of hospice care for patients at the end-of-life, and to
increase the knowledge of hospice among the medical, mental health and
patient communities. My legislation stresses the following:
Supportive and Comfort Care: To assist families and patients in
getting the benefit of hospice care, the Demonstration program will
allow for a new supportive and comfort care benefit. This benefit,
elected at the option of the patient, will not require the terminally
ill to elect hospice care instead of other medical treatment, but will
permit a patient to have supportive and comfort care in place while the
patient still seeks ``curative treatment.'' This will permit patients
and families to learn about hospice without forcing them to make a
choice between hospice and other care. Case management would be
provided through a hospice provider reimbursed on a fee-for-service
basis.
Severity Index Instead of a Six-Month Prognosis: To determine whether
or not a patient is eligible for the supportive and comfort care
option, a severity index will be used instead of the current hospice
requirement of a 6 month prognosis. This will permit patients to have
access to support services, as needed, instead of relying on an often
inaccurate time-related prognosis.
Increase Rural Hospice Access: Permit nurse practitioners and
physician assistants to admit patients to hospice if this is within
their authority under state practice law. In communities without a
qualified social worker, other professionals with skills, knowledge and
ability may provide medical social services such as counseling on the
effects of illness on the family.
Respite Care: Nursing facilities used for respite care would not be
required to have skilled nurses on the premises 24 hours a day (because
hospice will be caring for the patient) or respite could be provided in
the patient's home.
Payment Issues: Permit reimbursement for consultations, preadmission
informational visits, even if the patient does not elect hospice/
supportive care and provide minimum payment for Medicare hospice
services provided under the demonstration program based on the
provision of services for a period of 14 days, regardless of length of
stay.
In addition, the demonstration project could address other payment
issues such as offsetting changes in services and oversight and the
increased cost of providing services in rural areas and creating a per
diem rate of payment for respite care that reflects the range of care
needs.
In addition to the Demonstration program, the Secretary would be
required to establish an education grant program for the purpose of
providing information about the Medicare hospice benefit, and the
benefits available under the demonstration program. Education grants
could be used to provide individual or group education to patients and
their families and to the medical and mental health community, and to
test messages to improve public
[[Page S8414]]
knowledge about the Medicare hospice benefit.
Let me conclude by saying that in the time left for this Congress, we
have a unique opportunity to truly begin to improve care for the dying.
There are fewer who are more vulnerable than someone who is dying and
having to cope with the physical breakdown of their body and the
emotional turmoil that imminent death brings to a family. This
legislation provides us an opportunity to begin to remove the barriers
to care for those who facing death.
Mr. President, I ask unanimous consent that the full 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. 3026
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 ``Hospice Improvement Program
Act of 2000''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Each year more than \1/3\ of the people who die suffer
from a chronic illness.
(2) Approximately \1/3\ of Americans are unsure about whom
to contact to get the best care during life's last stages.
(3) Americans want a team of professionals to care for the
patient at the end of life.
(4) Americans want emotional and spiritual support for the
patient and family.
(5) Ninety percent of Americans do not realize that hospice
care is a benefit provided under the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).
(6) Health Care Financing Administration data show that
beneficiaries were enrolled in hospice for an average of less
than 7 weeks in 1998, far less than the full 6-month benefit
under the medicare program.
(7) According to the most recent data available, although
the average hospice enrollment is longer, half of the
enrollees live only 30 days after admission and almost 20
percent die within 1 week of enrollment.
(8) Use of hospice among medicare beneficiaries has been
decreasing, from a high of 59 days in 1995 to less than 48
days in 1998.
SEC. 3. HOSPICE DEMONSTRATION PROGRAM AND HOSPICE EDUCATION
GRANTS.
(a) Definitions.--In this section:
(1) Demonstration program.--The term ``demonstration
program'' means the Hospice Demonstration Program established
by the Secretary under subsection (b)(1).
(2) Medicare beneficiary.--The term ``medicare
beneficiary'' means any individual who is entitled to
benefits under part A or enrolled under part B of the
medicare program, including any individual enrolled in a
Medicare+Choice plan offered by a Medicare+Choice
organization under part C of such program.
(3) Medicare hospice services.--The term ``medicare hospice
services'' means the items and services for which payment may
be made under section 1814(i) of the Social Security Act (42
U.S.C. 1395f(i)).
(4) Medicare program.--The term ``medicare program'' means
the health benefits program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(5) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services, acting through the
Administrator of the Health Care Financing Administration.
(b) Hospice Demonstration Program.--
(1) Establishment.--The Secretary shall establish a Hospice
Demonstration Program in accordance with the provisions of
this subsection to increase the utility of the medicare
hospice services for medicare beneficiaries.
(2) Services under demonstration program.--The provisions
of section 1814(i) of the Social Security Act (42 U.S.C.
1395f(i)) shall apply to the payment for items and services
provided under the demonstration program, except that--
(A) notwithstanding section 1862(a)(1)(C) of such Act (42
U.S.C. 1395y(a)(1)(C)), the Secretary shall provide for
reimbursement for items and services provided under the
supportive and comfort care benefit established under
paragraph (3);
(B) any licensed nurse practitioner or physician assistant
may certify a medicare beneficiary as the primary care
provider when necessary and within the scope of practice of
such practitioner or assistant under State law;
(C) if a community does not have a qualified social worker,
any professional who has the necessary knowledge, skills, and
ability (other than social workers) to provide medical social
services shall provide such services;
(D) the Secretary shall waive any requirement that nursing
facilities used for respite care have skilled nurses on the
premises 24 hours per day;
(E) the Secretary shall permit respite care to be provided
to the medicare beneficiary at home; and
(F) the Secretary shall waive reimbursement regulations to
provide--
(i) reimbursement for consultations and preadmission
informational visits, even if the medicare beneficiary does
not choose hospice care (including the supportive and comfort
care benefit under paragraph (3)) at that time;
(ii) a minimum payment for medicare hospice services
provided under the demonstration program based on the
provision of medicare hospice services to a medicare
beneficiary for a period of 14 days, that the Secretary shall
pay to any hospice provider participating in the
demonstration program and providing such services (regardless
of the length of stay of the medicare beneficiary);
(iii) an increase in the reimbursement rates for hospice
services to offset--
(I) changes in medicare hospice services and oversight
under the demonstration program;
(II) the higher costs of providing medicare hospice
services in rural areas due to lack of economies of scale or
large geographic areas; and
(III) the higher costs of providing medicare hospice
services in urban underserved areas due to unique costs
specifically associated with people living in those areas,
including providing security;
(iv) direct payment of any nurse practitioner or physician
assistant practicing within the scope of State law in
relation to medicare hospice services provided by such
practitioner or assistant; and
(v) a per diem rate of payment for in-home care under
subparagraph (E) that reflects the range of care needs of the
medicare beneficiary and that--
(I) in the case of a medicare beneficiary that needs
routine care, is not less than 150 percent, and not more than
200 percent, of the routine home care rate for medicare
hospice services; and
(II) in the case of a medicare beneficiary that needs acute
care, is equal to the continuous home care day rate for
medicare hospice services.
(3) Supportive and comfort care benefit.--
(A) In general.--For purposes of the demonstration program,
the Secretary shall establish a supportive and comfort care
benefit for any eligible medicare beneficiary (as defined in
subparagraph (C)).
(B) Benefit.--Under the supportive and comfort care benefit
established under subparagraph (A), any eligible medicare
beneficiary may--
(i) continue to receive benefits for disease and symptom
modifying treatment under the medicare program (and the
Secretary may not require or prohibit any specific treatment
or decision);
(ii) receive case management and medicare hospice services
through a hospice provider, which the Secretary shall
reimburse on a fee-for-service basis; and
(iii) receive information and experience in order to better
understand the utility of medicare hospice services.
(C) Eligible medicare beneficiary defined.--
(i) In general.--In this paragraph, the term ``eligible
medicare beneficiary'' means any medicare beneficiary with a
serious illness that has been documented by a physician to be
at a level of severity determined by the Secretary to meet
the criteria developed under clause (ii).
(ii) Development of criteria.--
(I) In general.--The Secretary, in consultation with
hospice providers and experts in end-of-life care, shall
develop criteria for determining the level of severity of an
established serious illness taking into account the factors
described in subclause (II).
(II) Factors.--The factors described in this clause include
the level of function of the medicare beneficiary, any
coexisting illnesses of the beneficiary, and the severity of
any chronic condition that will lead to the death of the
beneficiary.
(III) Prognosis not a basis for criteria.--The Secretary
may not base the criteria developed under this subparagraph
on the prognosis of a medicare beneficiary.
(4) Conduct of program.--Under the demonstration program,
the Secretary shall--
(A) accept proposals submitted by any State hospice
association;
(B)(i) except as provided in clause (ii), conduct the
program in at least 3, but not more than 6, geographic areas
(which may be statewide) that include both urban and rural
hospice providers; and
(ii) if a geographic area does not have any rural hospice
provider available to participate in the demonstration
program, such area may substitute an underserved urban area,
but the Secretary shall give priority to those proposals that
include a rural hospice provider;
(C)(i) except for the geographic area designated under
clause (ii), select such geographic areas so that such areas
are geographically diverse and readily accessible to a
significant number of medicare beneficiaries; and
(ii) designate as such an area 1 State in which the largest
metropolitan area of such State had the lowest percentage of
medicare beneficiary deaths in a hospital compared to the
largest metropolitan area of each other State according to
the Hospital Referral Region of Residence, 1994-1995, as
listed in the Dartmouth Atlas of Health Care 1998;
(D) provide for the participation of medicare beneficiaries
in such program on a voluntary basis;
(E) permit research designs that use time series,
sequential implementation of the intervention, randomization
by wait list, and
[[Page S8415]]
other designs that allow the strongest possible
implementation of the demonstration program, while still
allowing strong evaluation about the merits of the
demonstration program; and
(F) design the program to facilitate the evaluation
conducted under paragraph (6).
(5) Duration.--The Secretary shall complete the
demonstration program within a period of 6\1/2\ years that
includes a period of 18 months during which the Secretary
shall complete the evaluation under paragraph (6).
(6) Evaluation.--During the 18-month period following the
first 5 years of the demonstration program, the Secretary
shall complete an evaluation of the demonstration program in
order to determine--
(A) the short-term and long-term costs and benefits of
changing medicare hospice services to include the items,
services, and reimbursement options provided under the
demonstration program;
(B) whether increases in payments for the medicare hospice
benefit are offset by savings in other parts of the medicare
program;
(C) the projected cost of implementing the demonstration
program on a national basis; and
(D) in consultation with hospice organizations and hospice
providers (including organizations and providers that
represent rural areas), whether a payment system based on
diagnosis-related groups is useful for administering the
medicare hospice benefit.
(7) Reports to congress.--
(A) Preliminary report.--Not later than 3 years after the
date of enactment of this Act, the Secretary shall submit a
preliminary report to the Committee on Ways and Means of the
House of Representatives and to the Committee on Finance of
the Senate on the progress made in the demonstration program.
(B) Interim report.--Not later than 30 months after the
implementation of the demonstration program, the Secretary,
in consultation with participants in the program, shall
submit an interim report on the demonstration program to the
committees described in subparagraph (A).
(C) Final report.--Not later than the date on which the
demonstration program ends, the Secretary shall submit a
final report to the committees described in subparagraph (A)
on the demonstration program that includes the results of the
evaluation conducted under paragraph (6) and recommendations
for appropriate legislative changes.
(8) Waiver of medicare requirements.--The Secretary shall
waive compliance with such requirements of the medicare
program to the extent and for the period the Secretary finds
necessary for the conduct of the demonstration program.
(9) Special rules for payment of medicare+choice
organizations.--The Secretary shall establish procedures
under which the Secretary provides for an appropriate
adjustment in the monthly payments made under section 1853 of
the Social Security Act (42 U.S.C. 1395w-23) to any
Medicare+Choice organization offering a Medicare+Choice plan
in which a medicare beneficiary that participates in the
demonstration program is enrolled to reflect such
participation.
(c) Hospice Education Grants.--
(1) In general.--The Secretary shall establish a Hospice
Education Grant program under which the Secretary awards
education grants to entities participating in the
demonstration program for the purpose of providing
information about--
(A) the medicare hospice benefit; and
(B) the benefits available to medicare beneficiaries under
the demonstration program.
(2) Use of funds.--Grants awarded pursuant to paragraph (1)
shall be used--
(A) to provide--
(i) individual or group education to medicare beneficiaries
and their families; and
(ii) individual or group education of the medical and
mental health community caring for medicare beneficiaries;
and
(B) to test strategies to improve the general public
knowledge about the medicare hospice benefit and the benefits
available to medicare beneficiaries under the demonstration
program.
(d) Funding.--
(1) Hospice demonstration program.--
(A) In general.--Except as provided in subparagraph (B),
expenditures made for the demonstration program shall be in
lieu of the funds that would have been provided to
participating hospices under section 1814(i) of the Social
Security Act (42 U.S.C. 1395f(i)).
(B) Supportive and comfort care benefit.--The Secretary
shall pay any expenses for the supportive and comfort care
benefit established under subsection (a)(3) from the Federal
Hospital Insurance Trust Fund established under section 1817
of the Social Security Act (42 U.S.C. 1395i) and the Federal
Supplementary Medical Insurance Trust Fund established under
section 1841 of such Act (42 U.S.C. 1395t), in such
proportion as the Secretary determines is appropriate.
(2) Hospice education grants.--The Secretary is authorized
to expend such sums as may be necessary for the purposes of
carrying out the Hospice Education Grant program established
under subsection (c)(1) from the Research and Demonstration
Budget of the Health Care Financing Administration.
______
By Mr. THURMOND (for himself and Mr. Hollings):
S. 3027. A bill to authorize the Secretary of Agriculture to purchase
and transfer certain land; to the Committee on Agriculture, Nutrition,
and Forestry.
A BILL TO AUTHORIZE THE SECRETARY OF AGRICULTURE TO PURCHASE LAND
ADJACENT TO THE COASTAL PLAINS SOIL, AND PLANT RESEARCH CENTER IN
FLORENCE, SOUTH CAROLINA
Mr. THURMOND. Mr. President, I rise today, along with Senator
Hollings, to introduce legislation that will enable the Secretary of
Agriculture to purchase up to ten acres of land for the U.S. Department
of Agriculture's Coastal Plains Soil, Water, and Plant Research Center
in Florence, South Carolina. This land is located within 150 feet of
the Center's administrative offices. Part of it has been leased and
used for agricultural research for almost 25 years. If these ten acres
were to be developed commercially the Center's operations would be
impaired substantially. This land will be used for agricultural
research.
The Coastal Plains Soil, Water, and Plant Research Center focuses its
research on the agricultural needs of farmers in both North and South
Carolina. However, much of the work done by its staff benefits all U.S.
agriculture. The Center undertakes basic and applied research with an
emphasis toward total resource management. I would like to highlight
just a few of its research programs in soil, water, and plant
management. The Center's staff investigates the effects of soil
erosion, non-point-source pollution, and animal waste disposal.
Further, they work to develop better cropping systems for major field
crops including cotton, corn, soybeans, and small grains; to identify
high-value horticultural crops suitable for production on the soils of
the coastal plains; and to improve cotton germ plasm.
Mr. President, the Coastal Plains Soil, Water, and Plant Research
Center does outstanding work that is not only very important to the
farmers of the Carolinas but to all our Nation's farmers. This land
purchase is important to the efficient continued operation of the
Florence Center, and I urge my colleagues to support the legislation.
I ask unanimous consent that the bill be printed in the Record
following my statement.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 3027
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
ASECTION 1. AUTHORIZATION FOR SECRETARY OF AGRICULTURE TO
PURCHASE AND TRANSFER LAND.
Subject to the availability of funds appropriated to the
Agricultural Research Service, the Secretary of Agriculture
may--
(1) purchase a tract of land in the State of South Carolina
that is contiguous to land owned on the date of enactment of
this Act by the Department of Agriculture, acting through the
Coastal Plains Soil, Water, and Plant Research Center of the
Agriculture Research Service; and
(2) transfer land owned by the Department of Agriculture to
the Florence Darlington Technical College, South Carolina, in
exchange for land owned by the College.
______
By Mr. THOMPSON:
S. 3030. A bill to amend title 31, United States Code, to provide for
executive agencies to conduct annual recovery audits and recovery
activities, and for other purposes; to the Committee on Governmental
Affairs.
A BILL TO PROVIDE FOR ANNUAL RECOVERY AUDITS
Mr. THOMPSON. Mr. President, I rise today to introduce a bill which
begins to address the issue of improper payments in Federal programs.
Each year, the Federal government spends hundreds of billions of
dollars for a variety of grants, transfer payments, and the procurement
of goods and services. The Federal government must be accountable for
how it spends these funds and for safeguarding against improper
payments. Unfortunately, the problem of improper payments by Federal
agencies and departments is immense. Today, I released a GAO report
which I requested which identifies $20.7 billion in improper payments
in just 20 major programs administered by 12 Federal agencies in Fiscal
Year 1999 alone. And this represents an increase of more than $1.5
billion from the previous year's estimate. In its report, GAO writes
that its ``audits and those of agency inspectors general continue to
demonstrate that
[[Page S8416]]
improper payments are much more widespread than agency financial
statement reports have disclosed thus far.''
Legislative efforts have focused on improving the Federal
government's control processes. Recently-enacted laws, such as the
Chief Financial Officers Act, the Government Management Reform Act, and
the Government Performance and Results Act, have provided an impetus
for agencies to systematically measure and reduce the extent of
improper payments.
However, the risk of improper payments and the government's ability
to prevent them continue to be a significant problem. While we continue
to work to improve the government's widespread financial management
weaknesses, we also can attempt to recover the tens of billions of
dollars in improper payments. And that's what the legislation I am
introducing today will do.
The legislation is modeled on H.R. 1827, a bill sponsored by House
Committee on Government Reform Chairman Dan Burton, to require the use
of a management technique called ``recovery auditing'' which would be
applied to a Federal agency's records to identify improper payments or
payment errors made by the agency.
Recovery auditing is used extensively by private sector businesses,
including a majority of Fortune 500 companies. These businesses
typically contract with specialized recovery auditing firms that are
paid a contingent fee based on the amounts recovered from overpayments
they identify. Recovery auditing is not ``auditing'' in the usual
sense. Recovery auditing firms do not examine the records of vendors
doing business with their client companies or assess the vendors'
performance. Instead, these firms develop and use computer software
programs that are capable of analyzing their clients' own contract and
payment records in order to identify discrepancies in those records
between what was owed and what was paid. They focus on obvious but
inadvertent errors, such as duplicate payments or failure to get credit
for applicable discounts and allowances.
The bill I am introducing today would require Federal agencies to
perform recovery audits in order to identify discrepancies between what
was actually paid by the agency and what should have been paid. This
bill seeks to address concerns with H.R. 1827 which were raised after
its passage by the House. For example, this bill would make clear that
the relationship established by this bill is one between the agency and
the recovery audit contractor, and all communications and interaction
on the part of the recovery audit contractor is with the agency.
Further, this bill includes exemptions for contracts which, under
current law, already are subject to extensive audit scrutiny and
oversight. Also, this bill includes Federal agency authority for
recovery audit pilot programs for contracts, grants or other
arrangements other than those covered by this bill.
I appreciate all the work done by Chairman Burton on H.R. 1827. I
believe my legislation appropriately addresses concerns raised with
that bill and goes a long way in addressing the wasted taxpayer dollars
and government inefficiencies resulting from Federal agency payment
errors which are made each year.
______
Mr. CAMPBELL:
S. 3031. A bill to make certain technical corrections in laws
relating to Native Americans, and for other purposes; to the Committee
on Indian Affairs.
Technical Amendments to laws Relating to Native Americans
Mr. CAMPBELL. Mr. President, today I introduce a bill making certain
technical amendments to laws relating to Native Americans. As my
colleagues know, Congress typically considers legislation like this
every year or so. This bill provides an opportunity to address a series
of corrections to the law or other non-controversial, minor amendments
to Indian laws in one broad stroke, rather than having to introduce
several separate bills.
This bill includes amendments regarding issues of importance to a
number of my colleagues that have been brought to my attention over
recent months. The amendments include, for instance, one-year
reauthorizations of the Indian Health Care Improvement Act and the
Indian Alcohol and Substance Abuse Prevention and Treatment Act, as
well as a clarification of a bill signed into law earlier this year
relating to the status of certain lands held in trust by the
Mississippi Band of Choctaw Indians.
All amendments included in this bill will serve to promote the
original intent of the affected laws, and do not alter the meaning or
substance of the laws they amend. I urge my colleagues to join me in
supporting this bill, the sole purpose of which is to ensure that the
laws this body has already passed are carried forward in the way we
originally intended.
Mr. President, I ask unanimous consent that a copy of the bill be
printed in the Record. I thank the Chair and yield the floor.
There being no objection, the bill was order to be printed in the
Record, as follows:
S. 3031
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. TECHNICAL CORRECTION TO AN ACT AFFECTING THE
STATUS OF MISSISSIPPI CHOCTAW LANDS AND ADDING
SUCH LANDS TO THE CHOCTAW RESERVATION.
Section 1(a)(2) of Public Law 106-228 (an Act to make
technical corrections to the status of certain land held in
trust for the Mississippi Band of Choctaw Indians, to take
certain land into trust for that Band, and for other
purposes) is amended by striking ``September 28, 1999'' and
inserting ``February 7, 2000''.
SEC. 2. TECHNICAL CORRECTIONS CONCERNING THE FIVE CIVILIZED
TRIBES OF OKLAHOMA.
(a) Indian Self-Determination Act.--Section 1(b)(15)(A) of
the model agreement set forth in section 108(c) of the Indian
Self-Determination Act (25 U.S.C. 450l(c)) is amended--
(1) by striking ``and section 16'' and inserting ``,
section 16''; and
(2) by striking ``shall not'' and inserting ``and the Act
of July 3, 1952 (25 U.S.C. 82a), shall not''.
(b) Indian Self-Determination and Education Assistance
Act.--Section 403(h)(2) of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 458cc(h)(2)) is amended--
(1) by striking ``and section'' and inserting ``section'';
and
(2) by striking ``shall not'' and inserting ``and the Act
of July 3, 1952 (25 U.S.C. 82a), shall not''.
(c) Repeals.--The following provisions of law are repealed:
(1) Section 2106 of the Revised Statutes (25 U.S.C. 84).
(2) Sections 438 and 439 of title 18, United States Code.
SEC. 3. WAIVER OF REPAYMENT OF EXPERT ASSISTANCE LOANS TO THE
RED LAKE BAND OF CHIPPEWA INDIANS AND THE
MINNESOTA CHIPPEWA TRIBES.
(a) Red Lake Band of Chippewa Indians.--Notwithstanding any
other provision of law, the balances of all expert assistance
loans made to the Red Lake Band of Chippewa Indians under the
authority of Public Law 88-168 (77 Stat. 301), and relating
to Red Lake Band v. United States (United States Court of
Federal Claims Docket Nos. 189 A, B, C), are canceled and the
Secretary of the Interior shall take such action as may be
necessary to document such cancellation and to release the
Red Lake Band of Chippewa Indians from any liability
associated with such loans.
(b) Minnesota Chippewa Tribe.--Notwithstanding any other
provision of law, the balances of all expert assistance loans
made to the Minnesota Chippewa Tribe under the authority of
Public Law 88-168 (77 Stat. 301), and relating to Minnesota
Chippewa Tribe v. United States (United States Court of
Federal Claims Docket Nos. 19 and 188), are canceled and the
Secretary of the Interior shall take such action as may be
necessary to document such cancellation and to release the
Minnesota Chippewa Tribe from any liability associated with
such loans.
SEC. 4. TECHNICAL AMENDMENT TO THE INDIAN CHILD PROTECTION
AND FAMILY VIOLENCE PROTECTION ACT.
Section 408(b) of the Indian Child Protection and Family
Violence Prevention Act (25 U.S.C. 3207(b)) is amended--
(1) by striking ``any offense'' and inserting ``any
felonious offense, or any of 2 of more misdemeanor
offenses,''; and
(2) by striking ``or crimes against persons'' and inserting
``crimes against persons; or offenses committed against
children''.
SEC. 5. TECHNICAL AMENDMENT REGARDING THE TREATMENT OF
CERTAIN INCOME FOR PURPOSES OF FEDERAL
ASSISTANCE.
Notwithstanding any other provision of law, none of the
funds paid by the State of Minnesota to the Bois Forte Band
of Chippewa Indians and the Grand Portage Band of Chippewa
Indians pursuant to the agreement of such Bands' to
voluntarily restrict tribal rights to hunt and fish in
territory ceded under the Treaty of September 30, 1854 (10
Stat. 1109), including all interest accrued on such funds
during any period in which such funds are held in a minor's
trust, shall be
[[Page S8417]]
considered as income or resources, or otherwise be used as
the basis for denying or reducing the financial assistance or
other benefits to which a household or member of such Bands
would be entitled to under the Social Security Act (42 U.S.C.
301 et seq.), the Personal Responsibility and Work
Opportunity Reconciliation Act of 1966 (Public Law 104-193;
110 Stat. 2105) and the amendments made by such Act, or any
Federal or Federally assisted program.
SEC. 6. TECHNICAL AMENDMENT TO EXTEND THE AUTHORIZATION
PERIOD UNDER THE INDIAN HEALTH CARE IMPROVEMENT
ACT.
The authorization of appropriations for, and the duration
of, each program or activity under the Indian Health Care
Improvement Act (25 U.S.C. 1601 et seq.) is extended through
fiscal year 2001.
SEC. 7. TECHNICAL AMENDMENT TO EXTEND THE AUTHORIZATION
PERIOD UNDER THE INDIAN ALCOHOL AND SUBSTANCE
ABUSE PREVENTION AND TREATMENT ACT OF 1986.
The authorization of appropriations for, and the duration
of, each program or activity under the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of 1986 (25
U.S.C. 2401 et seq.) is extended through fiscal year 2001.
______
By Mr. SMITH of New Hampshire (for himself, Mr. Warner, and Mr.
L. Chafee):
S. 3032. A bill to reauthorize the Junior Duck Stamp Conservation and
Design Program Act of 1994, and for other purposes; to the Committee on
Environment and Public Works.
junior duck stamp reauthorization act of 2000
Mr. SMITH of New Hampshire. Mr. President, I would like to introduce
the Junior Duck Stamp Reauthorization Act of 2000.
The Junior Duck Stamp Program is a wonderful program that allows
children from kindergarten through twelfth grade to participate in an
integrated art and science curriculum that is designed to teach
environmental science and habitat conservation. It also raises
awareness for wetlands and waterfowl conservation. Students and
teachers work together through a set curriculum that incorporates
ecological and wildlife management principles, allowing students to
learn about conserving wildlife habitat while they explore the esthetic
qualities of wildlife and nature.
As part of the curriculum, each student is encouraged to focus his or
her efforts on a particular waterfowl species. The culmination of the
curriculum is an artistic depiction of that species. Each state selects
a Best-of-Show winner and that piece of artwork competes to become the
national winner of the Junior Duck Stamp contest. The winning depiction
is chosen as the Federal Junior Duck Stamp, and the student receives
$2,500. Revenues from selling the stamp are used for conservation
awards and scholarships to the participants.
By all accounts the Junior Duck Stamp Program has been extremely
successful. Last year alone more than 44,000 students entered the state
competitions. The Fish and Wildlife Service and educators estimate that
for every child who enters the state program, ten others are exposed to
the curriculum. The program has also been very successful in
introducing urban children to nature, allows all children to develop an
important connection to the environment, and motivates students to take
an active role in conservation of waterfowl species.
This legislation is a simple reauthorization of the program through
2005. The U.S. Fish and wildlife Service would be authorized to receive
$250,000 a year for the administration of the Junior Duck Stamp
Program. In addition, the Junior Duck Stamp Conservation and Design
Program Act of 1994 would be amended to allow schools in the District
of Columbia and the U.S. territories to participate in the program.
Mr. President, I strongly urge the passage of this legislation. The
Junior Duck Stamp Program has played an important role in the education
of children and the conservation of our natural resources, and it
should continue to do so. I ask that the full 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. 3032
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 ``Junior Duck Stamp
Reauthorization Act of 2000''.
SEC. 2. REAUTHORIZATION OF JUNIOR DUCK STAMP CONSERVATION AND
DESIGN PROGRAM ACT OF 1994.
Section 5 of the Junior Duck Stamp Conservation and Design
Program Act of 1994 (16 U.S.C. 719c) is amended by striking
``for each of the fiscal years 1995 through 2000'' and
inserting ``for each of fiscal years 2001 through 2005''.
SEC. 3. EXPANSION OF PROGRAM TO INSULAR AREAS.
The Junior Duck Stamp Conservation and Design Program Act
of 1994 is amended--
(1) by redesignating sections 2 through 6 (16 U.S.C. 719
through 719c; 16 U.S.C. 668dd note) as sections 3 through 7,
respectively;
(2) by inserting after section 1 (16 U.S.C. 719 note) the
following:
``SEC. 2. DEFINITION OF STATE.
``In this Act, the term `State' means a State, the District
of Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands, American Samoa,
Guam, the Virgin Islands, and any other territory or
possession of the United States.'';
(3) in section 3(c) (16 U.S.C. 719(c)) (as redesignated by
paragraph (1)), by striking ``50 States'' each place it
appears and inserting ``States''; and
(4) in section 5 (16 U.S.C. 719b) (as redesignated by
paragraph (1)), by striking ``section 3(c)(1) (A) and (B)''
and inserting ``subparagraphs (A) and (B) of section
4(c)(1)''.
______
By Mr. BOND:
S. 3033. A bill to delegate the Primary Responsibility for the
Preservation and Expansion of Affordable Low-Income Housing to States
and Localities; to the Committee on Banking, Housing, and Urban
Affairs.
housing needs act of 2000
Mr. BOND. Mr. President. I rise today to introduce an important piece
of housing legislation that addresses the affordable-housing needs of
needy Americans. The Housing Needs Act of 2000 is a direct response to
the affordable housing crisis being experienced by millions of
Americans today. By working with State and localities, this legislation
will produce thousands of affordable housing units and ensure that
existing federally-assisted housing properties are maintained for lower
income families.
As Chairman of the Appropriations Subcommittee on VA, HUD, and
Independent Agencies, I have become increasingly alarmed by the news
reports and housing studies that have shown that lower income Americans
are having a difficult time finding decent, safe, and affordable
housing. The Administration's response to this problem has been to
provide section 8 tenant-based assistance or vouchers. However, I have
heard from communities in Missouri to here in the Washington, D.C. area
that it is becoming increasingly difficult to use vouchers to find
affordable housing. It has also come to my attention that despite the
resources given to the Department of Housing and Urban Development
(HUD), the Federal government has lost thousands of scarce affordable
housing that were once subsidized by the Federal government. Instead of
preserving these scarce and valuable housing resources, the Department
has replaced these units with vouchers. While some families have been
able to locate replacement housing, many have experienced displacement
and hardship, resulting in returning the voucher unused or becoming
homeless.
Due to these well-publicized problems, I instructed my subcommittee
staff to conduct a review of the section 8 program and to provide
recommendations on how to meet better the housing needs of lower income
Americans. The recommendations of the report are captured in the
Housing Needs Act of 2000, which I am introducing today.
Before I discuss the contents of the bill, I summarize the key
findings of the Subcommittee Staff report entitled ``Empty Promises--
Subcommittee Staff Report on HUD's Failing Grade on the Utilization of
Section 8 Vouchers.'' The key findings of the report are (1) housing
units for low-income families are disappearing; (2) worse case housing
needs are worsening; and (3) section 8 vouchers are proving to be less
and less effective in meeting the housing needs of low-income families.
Specifically, the staff reported that over the past 4 years, nearly
125,000 housing units have been lost to the national inventory of
affordable housing. These units have been lost due to the decision of
landlords to leave or opt-out of the section 8 program, HUD's policy to
voucher out properties that they have acquired title to and those that
the Department actually owns.
[[Page S8418]]
The staff also found that a record high of 5.4 million households
have major housing needs. Based on HUD's Worst Case Housing Needs
study, many of these households are our most vulnerable individuals
such as the elderly, disabled, and children.
Lastly, the staff reported that about 1 out of every 5 families that
received a voucher are unable to find housing and thus, the voucher
remains unused. The report also found not enough landlords were
participating in the voucher program, the payment standard of the
vouchers were too low for the market area, and voucher holders had
personal problems which affected the utilization of vouchers.
Mr. President, the staffs' findings were disturbing to me. As a
result, I am here today to introduce the Housing Needs Act of 2000 to
address the report's findings.
Briefly, the legislation creates a new affordable housing block grant
production program that would allocate funds to state housing agencies.
States currently administer other federal programs such as the Low-
Income Housing Tax Credit program, HOME block grant program, and the
Community Development Block Grant program, which have expanded and
increased the capacity of states to create affordable housing units.
Thus, state housing finance agencies have the tools to make this
program work effectively. I am a big believer in local decision-making.
States and localities know and understand their housing problems and
needs and are in the best position to make decisions on their housing
needs.
The legislation would also create a new section 8 success program
that would allow public housing agencies (PHA) to raise the payment
standard for vouchers up to 150 percent of the fair market rent. This
will greatly improve the ability of voucher holders to use the vouchers
in economically strong markets. As the Subcommittee Staff report found,
19 percent or one in five families that receive a voucher cannot use
it. I believe that this new success program will improve greatly the
number of voucher holders actually to use the voucher.
Lastly, the bill includes a number of smaller provisions that would
enhance the ability of state and local housing entities to produce low-
income housing and ensure that HUD maintains section 8 assistance on
properties that it has acquired through foreclosure.
I urge my colleagues to support this critical piece of legislation.
Families all over the country are experiencing hardships never before
seen. It is clear that vouchers alone do not adequately address the
housing needs of our vulnerable populations. I believe strongly that
the Housing Needs Act of 2000 provides a much-needed, flexible,
balanced approach to ensure that the affordable-housing problems can be
solved.
______
By Mr. KERRY:
S. 3034. A bill to amend title XVIII of the Social Security Act with
respect to payments made under the prospective payment system for home
health services furnished under the Medicare Program; to the Committee
on Finance.
HOME HEALTH REFINEMENT AMENDMENTS OF 2000
Mr. KERRY. Mr. President, I am pleased to introduce the Home Health
Refinement Amendments of 2000. This legislation will protect patient
access to home health care under Medicare, and ensure that providers
are able to continue serving seniors who reside in medically
underserved areas, have medically complex conditions, or require non-
routine medical supplies.
Medicare was enacted in 1965, under the leadership of President
Lyndon Johnson, as a promise to the American people that, in exchange
for their years of hard work and service to our country, their health
care would be protected in their golden years. Today, over 30 million
seniors rely on the Medicare home health benefit to receive the care
they need to maintain their independence and remain in their own homes,
and to avoid the need for more costly hospital or nursing home care.
Home health care is critical. It is a benefit to which all eligible
Medicare beneficiaries should be entitled. But, this benefit is being
seriously undermined. Since enactment of the Balanced Budget Act, BBA,
of 1997, federal funding for home health care has plummeted. According
to the Congressional Budget Office, CBO, Medicare spending on home
health care dropped 48 percent in the last two fiscal years--from $17.5
billion in 1998 to $9.7 billion in 1999--far beyond the original amount
of savings sought by the BBA. Across the country, these cuts have
forced over 2,500 home health agencies to close and over 900,000
patients to lose their services.
In my own State of Massachusetts--a state that, because of economic
efficiency, sustained a disproportionate share of the BBA cuts in
Medicare home health funding--28 home health agencies have closed, 6
more have turned in their Medicare provider numbers and chosen to opt
out of the Medicare program, and 12 more have been forced to merge in
order to consolidate their limited resources. The home health agencies
that have continued to serve patients despite the deep cuts in Medicare
funding reported net operating losses of $164 million in 1998. The loss
of home health care providers in Massachusetts has cost 10,000 patients
access to home health services. Consequently, many of the most
vulnerable residents in my state are being forced to enter hospitals
and nursing homes, or going without any help at all.
To compound the problem, without Congressional action, Medicare
payments for home health care will be automatically cut by an
additional 15 percent next year. It is critical that we defend
America's seniors against future cuts in home health services, and this
bill will eliminate the additional 15 percent cut in Medicare home
health payments mandated by the BBA. However, we must do more than
attempt to stop future cuts. Indeed, it is equally as important that we
begin to provide relief to home health providers who are already
struggling to care for patients.
During the first year of implementation of the Interim Payment
System, IPS, agencies were placed on precarious financial footing
because of insufficient payments, particularly for high-cost and long-
term patients. Accordingly, it is critical that we bolster the efforts
of home health care providers to transcend their current operating
deficits, especially as they transition from the Interim Payment System
to the Prospective Payment System, PPS.
The Home Health Refinement Amendments of 2000 would ensure that
providers are able to treat the sickest, most expensive patients who
rely on home health care. Independent studies indicate that, under IPS,
thousands of patients have been denied home health care benefits--while
``outlier'' patients (those who require the most intensive services)
have been most at risk of losing access to care. To address the costs
of treating the sickest homebound patients, this legislation provides
additional funding for outliers under PPS. Specifically, this bill
would set the funding level for outliers at 10 percent of the total
payments projected or estimated to be made under PPS each year. This
would double the current 5 percent allocation without reducing the PPS
base payment.
In addition, the Home Health Refinement Amendments of 2000 would
remove the costs of non-routine medical supplies from the PPS base
payment and, instead, arrange for Medicare reimbursement for these
supplies on the basis of a fee schedule. PPS rates include average
medical supply costs, but some agencies' patient populations have
greater or lesser supply needs than the average. Thus, current rates
would underpay agencies that treat patients with high medical supply
needs and overpay agencies that treat patients with low medical supply
needs. Agencies that treat our most ill, frail, and vulnerable should
not be punished with low payment rates.
Agencies that treat patients in medically underserved communities
also deserve equitable reimbursement for the services they provide. In
order to address the unique costs of treating patients in underserved
areas, the Home Health Refinement Amendments of 2000 would establish a
10 percent add-on to the episodic base payment for patients in rural
areas, to reflect the increasing costs of travel, and a ``reasonable
cost'' add-on for security services utilized by providers in our urban
areas. These add-ons ensure that patients in all types of communities
across the country continue to receive the home care they need and
deserve.
Finally, this legislation would encourage the incorporation of
telehealth
[[Page S8419]]
technology in home care plans by allowing cost reporting of the
telemedicine services utilized by agencies. Telemedicine has
demonstrated tremendous potential in bringing modern health care
services to patients who reside in areas where providers and technology
are scarce. Cost reporting will provide the data necessary to develop a
fair and reasonable Medicare reimbursement policy for telehomecare and
bring the benefits of modern science and technology to our nation's
underserved.
Unless we increase the federal commitment to the Medicare home health
care benefit, we can only expect to continue to imperil the health of
an entire generation. We must act to deliver on that promise that
President Johnson made 25 years ago--our nation's seniors deserve no
less.
______
Mr. BAUCUS (for himself, Mr. Grassley, and Mr. Jeffords):
S. 3035. A bill to amend title XI of the Social Security Act to
create an independent and nonpartisan commission to assess the health
care needs of the uninsured and to monitor the financial stability of
the Nation's health care safety net; to the Committee on Finance.
health care safety net oversight act of 2000
Mr. BAUCUS. Mr. President, it is often said that, ``Good health and
good sense are two of life's greatest blessings.'' Senators Grassley,
Jeffords, and I hope to further the cause of good health and good sense
today, through introduction of the Health Care Safety Net Oversight Act
of 2000.
Mr. President, currently no entity oversees America's health care
safety net. This means that all safety net providers--including rural
health clinics, community heath centers and emergency rooms--are
laboring on their own. They are like master musicians performing
without a conductor. Each is trying their hardest and performing their
part--but no one is coordinating their efforts. No one is able to tell
an actor when his services will be needed, or when he can take a break.
This act changes that, by creating the Safety Net Organizations and
Patient Advisory Commission, an independent and nonpartisan commission
to monitor the stability of the health care safety net.
What does this mean?
The Safety Net is made up of providers that deliver health services
to the uninsured and vulnerable populations across America. These
providers are often a last resort for patients who are unable to afford
the health care they need and have nowhere else to turn. In my state,
we have about 30 community health centers and rural health clinics,
serving an estimated 80,000 persons per year. That translates into
about one in ten Montanans. Were it not for these clinics and health
centers, many of these folks--the uninsured and underinsured--would
have no place to turn.
According to the U.S. Census Bureau, nearly one in five Montanans
were uninsured in 1998. This number has risen by 36 percent over the
last ten years, and there are now only five states with a higher
percentage of uninsured residents. When these uninsured seek medical
treatment they are often not able to pay. Last year, Montana hospitals
reported over $67 million in charity care and bad debt. And the problem
is not going away. At current growth rates for the uninsured, as many
as one in four Montanans will be uninsured by the year 2007.
But Mr. President, these people are not uninsured of their own
volition. Eighty three percent of uninsured Montanans are in working
families. And self-employed workers--including owners of small
businesses--and their dependents account for one-fifth of the uninsured
in our state. In fact, Montana ranks last in the nation with only 40
percent of firms offering a health insurance benefit.
So what do we do about this problem? How do we ensure that all
Americans, irrespective of color, creed gender or geography, have
access to quality health care?
Six or seven years ago, Congress and the administration worked on the
problem of the uninsured. A tremendous amount of time and effort went
into the Health Security Act, on both sides of the issue. As we know,
passage of that bill failed. Since then, Congress has taken a more
incremental approach to health care. Congress passed legislation in
1996 to ensure portability of health insurance. A year later, the CHIP
program was signed into law, bipartisan legislation to cover children
of working families. And last year, Congress passed the Work Incentives
Improvement Act to allow disabled folks to continue working and not
lose health care benefits.
But while these legislative actions are extremely important, they
affect relatively few Americans. The fact remains, for most uninsured
and underinsured Americans, the safety net is still the only place to
turn.
Yet the safety net has been seriously damaged in recent years.
According to a recent report by the Institute of Medicine, the health
care safety net is ``intact but endangered.''
For instance, the 1997 Balanced Budget Act cut payments to
Disproportionate Share Hospitals and Community health centers. It also
cut reimbursement to rural health clinics, so critical to providing
coverage to rural uninsured individuals. At the same time, Congress
mandates that emergency departments care for anyone and everyone that
darkens their door. Though not a reimbursement issue per se, the EMTALA
dictates that all ER's care for all individuals, regardless of ability
to pay.
Despite all these developments, there is no entity responsible for
making changes to the safety net. And though SNOPAC will not solve the
problem of America's uninsured, it will work to ensure that no holes
develop in the Safety Net. An independent, non-partisan commission,
modeled on the Medicare Payment Advisory Commission (MedPAC), SNOPAC
will include professionals from across the policy and practical
spectrum of health care. And like MedPAC, SNOPAC will report to the
relevant committees of Congress on the status of its mission: tracking
the well-being of the health care safety net.
Though it's not a panacea, SNOPAC is a positive step toward a
coordinated approach in caring for the uninsured. Absent large-scale
improvements in the number of insured Americans, we should at least
work to monitor and care for what we already have--an intact, but
endangered, health care safety net.
I urge all my colleagues to join me in this effort towards good
health and good sense.
______
By Mr. TORRICELLI:
S. 3036. A bill to assure that recreation and other economic benefits
are accorded the same weight as hurricane and storm damage reduction
benefits as well as environmental restoration benefits; to the
Committee on Environment and Public Works.
national beach enhancement act
Mr. TORRICELLI. Mr. President, I rise today to introduce legislation
which will ensure the preservation of our nation's coastal areas.
Protection of our beaches is paramount; they are not only where we go
to enjoy the sand and surf, but they also generate a significant
portion of our nation's revenue.
Tourism and recreational activity are extremely important to New
Jersey, especially to our small businesses and shore communities. New
Jersey's $17 billion a year tourism industry is supported by the 160
million people who visit our 127 miles of beaches each year. This
spending by tourists totaled $26.1 billion in New Jersey in 1998, a 2
percent increase from $25.6 billion in 1997.
My state is a microcosm of coastal tourism throughout the United
States. Travel and tourism is our Nation's largest industry, employer,
and foreign-revenue earner, and U.S. beaches are its leading tourist
destination. In 1997, total tourism expenditures in U.S. coastal areas
was over $185 billion, generating over 2.7 million jobs with a payroll
of nearly $50 million.
Americans are not the only ones eager to enjoy our beaches and
coastal regions. They are also the top destination for foreign
tourists. Each year, the U.S. takes in $4 billion in taxes from foreign
tourists, while state and local governments receive another $3.5
million.
In Florida alone, foreign tourists spent over $11 billion in 1992, $2
billion of that amount in the Miami Beach area. This Florida spending
generated over $750 million in Federal tax revenues. A recent article
by Dr. James R.
[[Page S8420]]
Houston, published in the American Shore and Beach Preservation
Journal, shows that annual tax revenues from foreign tourists in Miami
Beach are 17 times more than the Federal government spent on the entire
Federal Shore Protection program from 1950 to 1993. If the Federal
share of beach nourishment averages about $10 million a year, the
Federal government collects about 75 times more in taxes from foreign
tourists in Florida than it spends restoring that State's beaches.
Delaware, one of the smallest states in the Union, is visited by over
5 million people each year. This, in a state where just over 21,000
people actually live in beach communities and another 373,000 live
within a several hours drive. Beach tourism generates over $173 million
in expenditures each year for ``The First State.''
Equally significant, however, beach erosion results in an estimated
loss of over 471,000 visitor days a year, a figure which is estimated
to increase to over 516,000 after five years. A 1998 study by Jack
Faucett Associates (Bethesda, MD) in cooperation with independent
consultants for the Delaware Department of Natural Resources and
Environmental Control shows that during this five-year period, beach
erosion will cost an estimated $30.2 million in consumer expenditures,
the loss of 625 beach area jobs, and the reduction of wages and
salaries by $11.5 million. Business profits will drop by $1.6 million
and State and local tax revenues will decrease by $2.3 million.
Finally, beach erosion will reduce beach area property values by nearly
$43 million. The situation in Delaware is indicative of beach erosion
problems throughout the coastlines of our nation. Unless we increase
our efforts to protect and re-nourish our coastline, we jeopardize a
significant portion of our country's revenue.
The Federal government spends $100 million a year for the Federal
Shore Protection program. While the U.S. Army Corps of Engineers does a
benefit-cost analysis in connection with every shore protection
project, that analysis suffers from its own myopia. It places its
greatest emphasis on the value of the private property that is
immediately adjacent to the coastline. It is not reasonable to assume
that a healthy beach with natural dunes and vegetation will benefit
only that first row of homes and businesses. Homeowners spend money in
the region; hotels attract tourists, who also spend money; local
residents who live inland come to the beach to recreate. They too,
spend money. Countless businesses, from t-shirt vendors to restaurants,
all depend on these expenditures.
Prior to the 1986 Water Resources Development Act, the Army Corps of
Engineers viewed recreation as an equally important component of its
cost-benefits analysis. However, the 1986 bill omitted recreation as
benefit to be considered, and our coastal communities have suffered.
Indeed, the economy of our nation has suffered. My legislation would
make it clear that recreational benefits will be given the same
budgetary priority as storm damage reduction and environmental
restoration. Companion legislation has been introduced in the House of
Representatives, by Congressmen Lampson and LoBiondo, and enjoys
bipartisan support.
Beach replenishment efforts ensure that our beaches are protected,
property is not damaged, dunes are not washed away, and the resource
that coastal towns rely on for their lifeblood, is preserved. It is
imperative that federal policy base beach nourishment assistance on the
entirety of the economic benefits it provides. To limit benefits to
hurricane or storm damage reduction ignores the equally important
economic impact of tourism.
______
By Mr. CONRAD (for himself, Mr. Frist, Mr. DeWine, Mr. Bryan, and
Mr. Thompson):
S. 2038. A bill to amend title XVIII of the Social Security Act to
update the renal dialysis composite rate; to the Committee on Finance.
the medicare renal dialysis payment fairness act of 2000
Mr. CONRAD. Mr. President, today I am pleased to be joined by Senator
Frist and Representatives Camp and Thurman in introducing the Medicare
Renal Dialysis Payment Fairness Act of 2000. This legislation takes
important steps to help sustain and improve the quality of care for
Medicare beneficiaries suffering from kidney failure.
Nationwide, more than 280,000 Americans live with end-stage renal
disease (ESRD). In my State of North Dakota, the number of patients
living with ESRD is relatively small, just over 600. However, for these
patients and others across the country, access to dialysis treatments
means the difference between life and death.
In 1972, the Congress took important steps to ensure that elderly and
disabled individuals with kidney failure receive appropriate dialysis
care. At that time, Medicare coverage was extended to include dialysis
treatments for beneficiaries with ESRD.
Over the last three decades, dialysis facilities have provided
services to increasing numbers of kidney failure patients under
increasingly strict quality standards; however, during this same time
frame reimbursement for kidney services has not kept pace with the
increasing demands of providing dialysis care.
Last year, Senator Frist and I introduced legislation to ensure
dialysis facilities could continue providing quality dialysis services
to Medicare beneficiaries. I am happy to say that, based on these
efforts, dialysis providers received increased Medicare reimbursement
in fiscal years 2000 and 2001 as part of the Medicare, Medicaid, and S-
CHIP Refinement Act of 1999.
While these efforts were a step in the right direction, a recent
Medicare Payment Advisory Commission (MedPAC) report suggests that we
must take further action to sustain patients' access to dialysis
services. In particular, MedPAC recommends a 1.2 percent payment
adjustment for Medicare-covered dialysis services in the next fiscal
year. In addition, MedPAC recommends that the Health Care Financing
Administration provide an annual review of the dialysis payment rate--a
review that most other Medicare-covered services receive each year.
I believe these recommendations represent critical adjustments that
must be addressed this year. For this reason, I have worked with
Senator Frist, Representative Camp and Representative Thurman to
develop the Medicare Renal Dialysis Payment Fairness Act of 2000. This
legislation would provide the payment rate improvements recommended by
MedPAC and would establish an annual payment review process for
dialysis services. This proposal would help ensure all dialysis
providers receive reimbursement that is in line with increasing patient
load and quality requirements. This is particularly important for our
Nation's smaller, rural dialysis providers that on average receive
Medicare payments to do not adequately reflect costs.
As the Congress considers further improvements to the Medicare
Program, I urge my colleagues to support this important effort to
ensure patients with kidney failure continue to have access to quality
dialysis services. I thank my colleagues for working together on this
bipartisan and bicameral proposal.
Mr. FRIST. Mr. President, I am pleased to join Senators Conrad,
Thompson, Bryan, and DeWine this afternoon to introduce the Medicare
Renal Dialysis Payment Fairness Act of 2000. This bipartisan
legislation takes important steps to assure both the quality and
availability of outpatient dialysis services for Medicare patients with
end-stage renal disease (ESRD).
Almost 30 years ago, Congress recognized the pain and suffering
patients with end-stage renal disease face, and thus moved to provide
coverage for dialysis treatment to this population under the Medicare
Program. Today, approximately 300,000 patients nationwide live with
this disease and receive services through Medicare. Presently, there
are 3,423 dialysis facilities throughout the Nation that serve the
Medicare population, 93 of which are in my home State of Tennessee.
However, I fear that a lack of proper reimbursement may adversely
impact the quality and availability of dialysis care for Medicare
beneficiaries. As the Medicare Payment Advisory Commission (MedPAC)
noted, the payment rate for the critical dialysis services received by
Medicare beneficiaries was established in 1983, and had never been
updated.
Last year, Senator Conrad and I sought to remedy this situation by
introducing S. 1449, the Medicare Renal
[[Page S8421]]
Dialysis Fair Payment Act of 1999, which provided an update to the
Medicare reimbursement rate for dialysis services for Fiscal Year 2000.
Thus, I was pleased to see the Balanced Budget Refinement Act of 1999
(BBRA) include a provision increasing the payment rate by 1.2 percent
for Fiscal Year 2000 and 1.2 percent for Fiscal Year 2001.
However, the BBRA represented only the first step toward securing
access to dialysis services for Medicare patients and ensuring they
receive the highest quality of care. The legislation we are introducing
today takes the necessary additional steps, as recommended by MedPAC
this year, to assure proper reimbursement levels for dialysis services.
Specifically, the ``Medicare Renal Dialysis Payment Fairness Act of
2000'' provides a 1.2 percent increase in the payment rate for FY 2001,
in addition to the 1.2 percent update included in the BBRA, providing a
2.4 percent total increase. This follows MedPAC's analysis of dialysis
center costs that concluded that prices paid by dialysis centers would
rise by 2.4 percent between Fiscal Year 2000 and 2001.
Second, the legislation ensure proper reimbursement in future years
by requiring the Health Care Financing Administration (HCFA) to develop
a market basket index for dialysis centers that measures input prices
and other relevant factors and to annually review and update the
payment rate based upon this index.
Overall, the Medicare Renal Dialysis Payment Fairness Act of 2000
will ensure that dialysis facilities receive the proper Medicare
reimbursement to continue to provide high quality dialysis services to
the ESRD population.
I am grateful to the National Kidney Foundation, the American
Nephrology Nurses Association, the Renal Physicians Association, the
National Renal Administrators Association, and the Renal Leadership
Council for their support of the Medicare Renal Dialysis Payment
Fairness Act of 2000, and I urge my colleagues to support this critical
measure.
____________________