[Congressional Record Volume 147, Number 27 (Monday, March 5, 2001)]
[Senate]
[Pages S1818-S1827]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. MURKOWSKI (for himself, Mr. Kerry, Mr. Kyl, Mr. Smith of 
        New Hampshire, Mr. Helms, Mr. Reid, Mrs. Lincoln, and Mr. 
        Hagel):
  S. 452. A bill to amend title XVIII of the Social Security Act to 
ensure that the Secretary of Health and Human Services provides 
appropriate guidance to physicians, providers of services, and 
ambulance providers that are attempting to properly submit claims under 
the medicare program to ensure that the Secretary does not target 
inadvertent billing errors; to the Committee on Finance.
  Mr. MURKOWSKI. Mr. President, right now, all across America, Medicare 
beneficiaries are seeking medical care from a flawed health care 
system. Reduced benefit packages, ever escalating costs, and limited 
access in rural areas are just a few of the problems our system faces 
on a daily basis. For these reasons, Congress must continue to move 
towards the modernization of Medicare. But as we address the needs of 
beneficiaries, we must not turn our back upon the very providers that 
seniors rely upon for their care.
  Who are providers? They are the physicians, the hospitals, the 
nursing homes, and others who deliver quality care to our needy 
Medicare population. They are the backbone of our complex health care 
network. When our nation's seniors need care, it is the provider who 
heals, not the health insurer, and certainly not the federal 
government.
  But more, and more often, seniors are being told by providers that 
they don't accept Medicare. This is becoming even more common in rural 
areas, where the number of physicians is limited and access to quality 
care is extremely restricted. Quite simply, beneficiaries are being 
told that their insurance is simply not wanted. Why? Well it's not as 
simple as low reimbursement rates. In fact it's much more complex.
  The infrastructure that manages the Medicare program, the Health Care 
Financing Administration, HCFA, and its network of contractors, have 
built up a system designed to block care and micro-manage independent 
practices. Providers simply cannot afford to keep up with the seemingly 
endless number of complex, redundant, and unnecessary regulations. And 
if providers do participate? Well, a simple administrative error in 
submitting a claim could subject them to heavy-handed audits and the 
financial devastation of their practice. Should we force providers to 
choose between protecting their practice and caring for seniors?
  I believe the answer is no. For this reason, I am introducing the 
``Medicare Education and Regulatory Fairness Act of 2001.'' Co-
sponsored by Senators Kerry, Kyl, Helms, Reid, Lincoln, Hagel, and Bob 
Smith, this legislation will restore fairness to the Medicare system. 
It will allow providers to practice medicine without fearing the 
threats, intimidation, and aggressive tactics of a faceless 
bureaucratic machine.
  Most importantly, this bill will reform the flawed appeals process 
within HCFA. Currently, a provider who allegedly has received an 
overpayment is forced to choose between three options: admit the 
overpayment, submit additional information to mitigate the charge, or 
appeal the decision. However, providers who choose to submit

[[Page S1819]]

additional evidence must subject their entire practice to review and 
waive their appeal rights. That's right--to submit additional evidence 
you must waive your right to an appeal!
  And what is the result of this maddening system that runs contrary to 
our nation's history of fair and just administrative decisions? Often, 
providers are intimidated into accepting the arbitrary decision of an 
auditor employed by a HCFA contractor. Sometimes, they are even forced 
to pull out of the Medicare program. In the end, our senior population 
suffers.
  I was particularly heartened to see that our new President agrees 
with the spirit of this bill. In his recent budget, the administration 
stated that the ``current system is too complex, too centralized, and 
becoming more so each year. Burdensome regulations and other central 
directives force providers to take time away from patients to comply 
with excessive and complex paperwork.'' I completely agree.
  Under my bill, providers will be allowed to retain their appeal 
rights should they choose to first submit additional evidence to 
mitigate the charge. Many providers receive an overpayment as the 
result of a simple administrative mistake. For cases not involving 
fraud, a provider will be able to return that overpayment within twelve 
months without fear of prosecution. This is a common sense approach, 
and will not lead to any additional costs to the Medicare system.
  To bring additional fairness to the system, my bill will prohibit the 
retroactive application of regulations, and allow providers to 
challenge the constitutionality of HCFA regulations. Further, it will 
prohibit the crippling recovery of overpayments during an appeal, and 
bar the unfair method of withholding valid future payments to recover 
past overpayments. These common sense measures maintain the financial 
viability of medical practices during the resolution of payment 
controversies, and restore fundamental fairness to the dispute 
resolution procedures existing within HCFA.
  Like many of our nation's problems, the key to improvement is found 
in education. For this reason, I have included language that stipulates 
that at least 10 percent of the Medicare Integrity Program funds, and 
two percent of carrier funds, must be devoted to provider education 
programs. Providers cannot be expected to comply with the endless 
number of Medicare regulations if they are not shown how to submit 
clean claims. We must ensure that providers are given the information 
needed to eliminate future billing errors, and improve the 
responsiveness of HCFA.
  It is with the goal of protecting our Medicare population, and the 
providers who tend care, that leads me to introduce the ``Medicare 
Education and Regulatory Fairness Act of 2001.'' This bill will ensure 
that providers are treated with the respect that they deserve, and that 
Medicare beneficiaries aren't told that their health insurance isn't 
wanted. We owe it to our nation's seniors. I urge immediate action on 
this worthy bill.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 452

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Education and Regulatory Fairness Act of 2001''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.

                       TITLE I--REGULATORY REFORM

Sec. 101. Prospective application of certain regulations.
Sec. 102. Requirements for judicial and regulatory challenges of 
              regulations.
Sec. 103. Prohibition of recovering past overpayments by certain means.
Sec. 104. Prohibition of recovering past overpayments if appeal 
              pending.
Sec. 105. Prohibition of random prepayment audits.
Sec. 106. Exception on prohibition of waiving medicare copayment.
Sec. 107. Effective date.

                   TITLE II--APPEALS PROCESS REFORMS

Sec. 201. Construction of hearing rights related to decisions to deny 
              or not renew a physician enrollment agreement.
Sec. 202. Reform of post-payment audit process.
Sec. 203. Definitions relating to physicians, providers of services, 
              and providers of ambulance services.
Sec. 204. Right to appeal on behalf of deceased beneficiaries.
Sec. 205. Effective date.

                    TITLE III--EDUCATION COMPONENTS

Sec. 301. Designated funding levels for physician and provider 
              education.
Sec. 302. Information requests.

               TITLE IV--SUSTAINABLE GROWTH RATE REFORMS

Sec. 401. Inclusion of regulatory costs in the calculation of the 
              sustainable growth rate.

          TITLE V--POLICY DEVELOPMENT REGARDING E&M GUIDELINES

Sec. 501. Policy development regarding E&M Documentation Guidelines.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) Congress should focus more resources on and work with 
     physicians and health care providers to combat fraud in the 
     medicare program.
       (2) The overwhelming majority of physicians and other 
     providers in the United States are law-abiding citizens who 
     provide important services and care to patients each day.
       (3) Physicians and other providers of services that 
     participate in the medicare program often have trouble wading 
     through a confusing and sometimes even contradictory maze of 
     medicare regulations. Keeping track of the morass of medicare 
     regulations detracts from the time that physicians have to 
     treat patients.
       (4) Due to the overly complex nature of medicare 
     regulations and the risk of being the subject of an 
     aggressive government investigation, many physicians are 
     leaving the medicare program, limiting the number of medicare 
     patients they see, or refusing to accept new medicare 
     patients at all. If this trend continues, health care for the 
     millions of patients nationwide who depend on medicare will 
     be seriously compromised. Congress has an obligation to 
     prevent this from happening.
       (5) Regulatory fairness for physicians and providers as 
     well as increased access to education about medicare 
     regulations are necessary to preserve the integrity of our 
     health care system and provide for the health of our 
     population.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Billing.--The term ``billing'' includes any requirement 
     related to the content and timing of an order for care or a 
     plan of treatment by a physician, a provider of service, or a 
     provider of ambulance services.
       (2) Carrier.--The term ``carrier'' means a carrier (as 
     defined in section 1842(f) of the Social Security Act (42 
     U.S.C. 1395u(f))) with a contract under title XVIII of such 
     Act to administer benefits under part B of such title.
       (3) Extrapolation.--The term ``extrapolation'' has the 
     meaning given such term in section 1861(ww)(1) of the Social 
     Security Act (as added by section 203(a)).
       (4) Fiscal intermediary.--The term ``fiscal intermediary'' 
     means a fiscal intermediary (as defined in section 1816(a) of 
     the Social Security Act (42 U.S.C. 1395h(a))) with an 
     agreement under section 1816 of such Act to administer 
     benefits under part A or B of such title.
       (5) HCFA.--The term ``HCFA'' means the Health Care 
     Financing Administration.
       (6) 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.).
       (7) Physician.--The term ``physician'' has the meaning 
     given such term in section 1861(r) of the Social Security Act 
     (42 U.S.C. 1395x(r)).
       (8) Prepayment review.--The term ``prepayment review'' has 
     the meaning given such term in section 1861(ww)(2) of the 
     Social Security Act (as added by section 203(a)).
       (9) Provider of services.--The term ``provider of 
     services'' has the meaning given such term in section 1861(u) 
     of the Social Security Act (42 U.S.C. 1395x(u)).
       (10) Provider of ambulance services.--The term ``provider 
     of ambulance services'' means a provider of ambulance 
     services described in section 1861(s)(7) of the Social 
     Security Act (42 U.S.C. 1395x(s)(7)).
       (11) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

                       TITLE I--REGULATORY REFORM

     SEC. 101. PROSPECTIVE APPLICATION OF CERTAIN REGULATIONS.

       Section 1871(a) of the Social Security Act (42 U.S.C. 
     1395hh(a)) is amended by adding at the end the following new 
     paragraphs:
       ``(3) Any regulation described under paragraph (2) shall 
     not take effect earlier than the effective date of the final 
     regulation. Any regulation described under such paragraph 
     that applies to an agency action, including any agency 
     determination, shall only apply as that regulation is in 
     effect at the time that agency action is taken.
       ``(4) The Secretary shall issue a final rule within 12 
     months of the date of publication

[[Page S1820]]

     of an interim final rule. Such final rule shall provide 
     responses to comments submitted in response to the interim 
     final rule. Such final rule shall not establish or change a 
     legal standard not raised in the interim final rule unless a 
     new 60-day comment period is provided.
       ``(5) Carriers, fiscal intermediaries, and States pursuant 
     to an agreement under section 1864 shall not apply new policy 
     guidances or policy changes retroactively to services 
     provided before the date the new policy was issued.''.

     SEC. 102. REQUIREMENTS FOR JUDICIAL AND REGULATORY CHALLENGES 
                   OF REGULATIONS.

       (a) Right To Challenge Constitutionality and Statutory 
     Authority of HCFA Regulations.--Section 1872 of the Social 
     Security Act (42 U.S.C. 1395ii) is amended to read as 
     follows:


            ``application of certain provisions of title ii

       ``Sec. 1872. Subject to subparagraphs (A), (B), (D), and 
     (E) of section 1848(i)(1), the provisions of sections 206 and 
     216(j), and of subsections (a), (d), (e), (h), (i), (j), (k), 
     and (l) of section 205, shall also apply with respect to this 
     title to the same extent as they are applicable with respect 
     to title II, except that--
       ``(1) in applying such provisions with respect to this 
     title, any reference therein to the Commissioner of Social 
     Security or the Social Security Administration shall be 
     considered a reference to the Secretary or the Department of 
     Health and Human Services, respectively; and
       ``(2) section 205(h) shall not apply with respect to any 
     action brought against the Secretary under section 1331, 
     1346, 1361, or 2201 of title 28, United States Code, 
     regardless of whether such action is unrelated to a specific 
     determination of the Secretary, that challenges--
       ``(A) the constitutionality of any provision of this title;
       ``(B) the constitutionality of substantive or interpretive 
     rules of general applicability issued by the Secretary to 
     carry out this title'';
       ``(C) the Secretary's statutory authority to promulgate 
     such substantive or interpretive rules of general 
     applicability; or
       ``(D) a finding of good cause under subparagraph (B) of the 
     third sentence of section 553(b)(3) of title 5, United States 
     Code, if used in the promulgation of such substantive or 
     interpretive rules of general applicability.''.
       (b) Administrative and Judicial Review of Secretary 
     Determinations.--Section 1866(h) of the Act (42 U.S.C. 
     1395cc(h)) is amended--
       (1) in paragraph (1), by striking ``(1)'' and all that 
     follows and inserting the following: ``(1) Except as provided 
     in paragraph (3), an institution or agency dissatisfied with 
     a determination by the Secretary that it is not a provider of 
     services or with a determination described in subsection 
     (b)(2) (regardless of whether such determination has been 
     made by the Secretary or by a State pursuant to an agreement 
     entered into with the Secretary under section 1864 and 
     regardless of whether the Secretary has imposed or may impose 
     a remedy, penalty, or other sanction on the institution or 
     agency in connection with such determination) shall be 
     entitled to a hearing thereon by the Secretary (after 
     reasonable notice) to the same extent as is provided in 
     section 205(b), and to judicial review of the Secretary's 
     final decision after such hearing as is provided in section 
     205(g), except that, in so applying such sections and in 
     applying section 205(l) thereto, any reference therein to the 
     Commissioner of Social Security or the Social Security 
     Administration shall be considered a reference to the 
     Secretary or the Department of Health and Human Services, 
     respectively, and such hearings are subject to the deadlines 
     specified in paragraph (2)f.'';
       (2) by redesignating paragraph (2) as paragraph (3);
       (3) by inserting after paragraph (1) the following new 
     paragraph:
       ``(2)(A)(i) Except as provided in clause (ii), an 
     administrative law judge shall conduct and conclude a hearing 
     on a determination described in subsection (b)(2) and render 
     a decision on such hearing by not later than the end of the 
     90-day period beginning on the date a request for hearing has 
     been timely filed.
       ``(ii) The 90-day period under clause (i) shall not apply 
     in the case of a motion or stipulation by the party 
     requesting the hearing to waive such period.
       ``(B) The Department Appeals Board of the Department of 
     Health and Human Services shall conduct and conclude a review 
     of the decision on a hearing described in subparagraph (A) 
     and make a decision or remand the case to the administrative 
     law judge for reconsideration by not later than the end of 
     the 90-day period beginning on the date a request for review 
     has been timely filed.
       ``(C) In the case of a failure by an administrative law 
     judge to render a decision by the end of the period described 
     in subparagraph (A)(i), the party requesting the hearing may 
     request a review by the Departmental Appeals Board of the 
     Departmental of Health and Human Services, notwithstanding 
     any requirements for a hearing for purposes of the party's 
     right to such a review.
       ``(D) In the case of a request described in subparagraph 
     (D), the Departmental Appeals Board shall review the case de 
     novo. In the case of the failure of the Departmental Appeals 
     Board to render a decision on such hearing by not later than 
     the end of the 60-day period beginning on the date a request 
     for such a Department Appeals Board hearing has been filed, 
     the party requesting the hearing may seek judicial review of 
     the Secretary's decision, notwithstanding any requirements 
     for a hearing for purposes of the party's right to such 
     review.
       ``(E) In the case of a request described in subparagraph 
     (D), the court shall review the case de novo.''; and
       (4) by adding at the end the following new paragraph:
       ``(4) An institution or agency dissatisfied with a finding 
     or determination by the Secretary, or by a State pursuant to 
     an agreement under section 1864, that the institution of 
     agency if out of compliance with any standard or condition of 
     participation under this title (except a determination 
     described in subsection (b)(2)) shall be entitled to a formal 
     review or reconsideration of the finding or determination, in 
     accordance with the regulations prescribed by the Secretary, 
     prior to the imposition of any remedy, penalty, corrective 
     action, or other sanction in connection with the finding or 
     determination.''.

     SEC. 103. PROHIBITION OF RECOVERING PAST OVERPAYMENTS BY 
                   CERTAIN MEANS.

       (a) In General.--Subject to section 104 and except as 
     provided in subsection (b) and notwithstanding sections 
     1815(a), 1842(b), and 1861(v)(1)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1395g(a), 1395u(a), and 
     1395x(v)(1)(A)(ii)), or any other provision of law, for 
     purposes of applying sections 1842(b)(3)(B)(ii), 
     1866(a)(1)(B)(ii), 1870, and 1893 of such Act (42 U.S.C. 
     1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg, and 1395ddd) 
     to pending and future audits, the Secretary shall give a 
     physician, provider of services, or provider of ambulance 
     services the option of entering into an arrangement to offset 
     alleged overpayments against future payments or entering into 
     a repayment plan with its carrier or fiscal intermediary to 
     recoup such an overpayment. Under such an arrangement or 
     plan, a physician, provider of services, or provider of 
     ambulance services shall have up to 3 years to offset or 
     repay the overpayment if the amount of such overpayment 
     exceeds $5,000.
       (b) Exception.--This section shall not apply to cases in 
     which the Secretary finds clear and convincing evidence of 
     fraud or similar fault on the part of the physician, provider 
     of services, or provider of ambulance services or in the case 
     of overpayments for which an offset arrangement is in place 
     as of the date of the enactment of this Act.

     SEC. 104. PROHIBITION OF RECOVERING PAST OVERPAYMENTS IF 
                   APPEAL PENDING.

       Notwithstanding any provision of law, for purposes of 
     applying sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, 
     and 1893 of the Social Security Act (42 U.S.C. 
     1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg, and 
     1395ddd), the Secretary may not take any action (or authorize 
     any other person, including any fiscal intermediary, carrier, 
     and contractor under section 1893 of such Act (42 U.S.C. 
     1395ddd)) to recoup an overpayment or to impose a penalty 
     during the period in which a physician, provider of services, 
     or provider of ambulance services is appealing a 
     determination that such an overpayment has been made or the 
     amount of the overpayment.

     SEC. 105. PROHIBITION OF RANDOM PREPAYMENT AUDITS.

       Carriers may not, prior to paying a claim under the 
     medicare program, demand the production of records or 
     documentation absent cause.

     SEC. 106. EXCEPTION ON PROHIBITION OF WAIVING MEDICARE 
                   COPAYMENT.

       (a) In General.--Section 1128A(i)(6)(A) of the Social 
     Security Act (42 U.S.C. 1320a-7a(i)(6)(A)) is amended by 
     inserting ``, except for written, mailed communication with 
     existing patients,'' before ``waiver is not''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to communications made on or after the date of 
     the enactment of this Act.

     SEC. 107. EFFECTIVE DATE.

       Except as otherwise provided in section 106(b), the 
     amendments made by this title shall take effect 60 days after 
     the date of enactment of this Act.

                   TITLE II--APPEALS PROCESS REFORMS

     SEC. 201. CONSTRUCTION OF HEARING RIGHTS RELATED TO DECISIONS 
                   TO DENY OR NOT RENEW A PHYSICIAN ENROLLMENT 
                   AGREEMENT.

       Section 1842 of the Social Security Act (42 U.S.C. 1395u) 
     is amended by adding at the end the following new subsection:
       ``(u) A carrier decision to deny an initial physician 
     enrollment application and a carrier decision not to renew a 
     physician enrollment agreement shall be treated as an initial 
     determination subject to the same course of appeals as other 
     initial determinations under section 1869.''.

     SEC. 202. REFORM OF POST-PAYMENT AUDIT PROCESS.

       (a) Carriers.--Section 1842 of the Social Security Act (42 
     U.S.C. 1395u), as amended by section 201, is further amended 
     by adding at the end the following new subsection:
       ``(v) In carrying out its contract under subsection (b)(3), 
     with respect to physicians' services or ambulance services, 
     the carrier shall provide for the recoupment of overpayments 
     in the following manner:
       ``(1)(A) During the 1-year period (or 18-month period in 
     the case of a physician who is in a practice with fewer than 
     10 full-time

[[Page S1821]]

     equivalent employees, including physicians) beginning on the 
     date on which a physician or provider of ambulance services 
     receives an overpayment, the physician or provider of 
     ambulance services may return the overpayment without penalty 
     or interest to the carrier making such overpayment if--
       ``(i) the carrier has not requested any relevant record or 
     file; or
       ``(ii) the case has not been referred before the date of 
     repayment to the Department of Justice or the Office of 
     Inspector General.
       ``(B) If a physician or provider of ambulance services 
     returns an overpayment under subparagraph (A), neither the 
     carrier, contractor under section 1893, nor any law 
     enforcement agency may begin an investigation or target such 
     physician or provider of ambulance services based on any 
     claim associated with the amount the physician or provider of 
     ambulance services has repaid.
       ``(2) If a carrier has decided to conduct a post-payment 
     audit of the physician or provider of ambulance services, the 
     carrier shall send written notice to the physician or 
     provider of ambulance services. If the physician or provider 
     of ambulance services practices in a rural area (as defined 
     in section 1886(d)(2)(D)), such notice must be sent by 
     registered mail.
       ``(3) The carrier or a contractor under section 1893 may 
     not recoup or offset payment amounts based on extrapolation 
     (as defined in section 1861(ww)(1)) for the first time that 
     the physician or provider of ambulance services is alleged as 
     a result of a post-payment audit to have received an 
     overpayment.
       ``(4) As part of any written consent settlement 
     communication, the carrier or a contractor under section 1893 
     shall clearly state that the physician or provider of 
     ambulance services may submit additional information 
     (including evidence other than medical records) to dispute 
     the overpayment amount without waiving any administrative 
     remedy or right to appeal the amount of the overpayment.
       ``(5)(A) Each consent settlement communication from the 
     carrier or a contractor under section 1893 shall clearly 
     state that prepayment review (as defined in section 
     1861(ww)(2)) may be imposed where the physician or provider 
     of ambulance services submits an actual or projected 
     repayment to the carrier or a contractor under section 1893. 
     Subject to subparagraph (D), any prepayment review shall 
     cease when the physician or provider of ambulance services 
     has submitted claims, found by carrier to be covered services 
     and coded properly for the same services that were the basis 
     for instituting the prepayment review, in a 180-day period or 
     after processing claims of at least 75 percent of the volume 
     of the claims (whichever occurs first) received by the 
     carrier in the full month preceding the start of the 
     prepayment review. The 180-day period begins with the date of 
     the carrier's written notification that the physician or 
     provider of ambulance services is being placed on prepayment 
     review.
       ``(B) Prepayment review may not be applied under this part 
     as a result of the voluntary submission of a claim or record 
     under section 1897(b)(2) or as a result of information 
     provided pursuant to a request under section 302(b) of the 
     Medicare Education and Regulatory Fairness Act of 2001.
       ``(C) Carrier prepayment and coverage policies and claims 
     processing screens used to identify claims for medical review 
     must be incorporated as part of the education programs on 
     medicare policy and proper coding made available to 
     physicians and providers of ambulance services.
       ``(D) The time and percentage claim limitations in 
     paragraph (5)(A) shall not apply to cases that have been 
     referred to the Department of Justice or the Office of the 
     Inspector General.''.
       (b) Fiscal Intermediaries.--Section 1816 of the Social 
     Security Act (42 U.S.C. 1395h) is amended by adding at the 
     end the following new subsection:
       ``(m) In carrying out its agreement under this section, 
     with respect to payment for items and services furnished 
     under this part, the fiscal intermediary shall provide for 
     the recoupment of overpayments in the following manner:
       ``(1)(A) During the 1-year period beginning on the date on 
     which a provider of services receives an overpayment, the 
     provider of services may return the overpayment without 
     penalty or interest to the fiscal intermediary making such 
     overpayment if--
       ``(i) the fiscal intermediary has not requested any 
     relevant record or file; or
       ``(ii) the case has not been referred before the date of 
     repayment to the Department of Justice or the Office of 
     Inspector General.
       ``(B) If a provider of services returns an overpayment 
     under subparagraph (A), neither the fiscal intermediary, 
     contractor under section 1893, nor any law enforcement agency 
     may begin an investigation or target such provider of 
     services based on any claim associated with the amount the 
     provider of services has repaid.
       ``(2) If a fiscal intermediary has decided to conduct a 
     post-payment audit of the provider of services, the fiscal 
     intermediary shall send written notice to the provider of 
     services. If the provider of services practices in a rural 
     area (as defined in section 1886(d)(2)(D)), such notice must 
     be sent by registered mail.
       ``(3) The fiscal intermediary or a contractor under section 
     1893 may not recoup or offset payment amounts based on 
     extrapolation (as defined in section 1861(ww)(1)) for the 
     first time that the provider of services is alleged as a 
     result of a post-payment audit to have received an 
     overpayment.
       ``(4) As part of any written consent settlement 
     communication, the fiscal intermediary or a contractor under 
     section 1893 shall clearly state that the provider of 
     services may submit additional information (including 
     evidence other than medical records) to dispute the 
     overpayment amount without waiving any administrative remedy 
     or right to appeal the amount of the overpayment.
       ``(5)(A) Each consent settlement communication from the 
     fiscal intermediary or a contractor under section 1893 shall 
     clearly state that prepayment review (as defined in section 
     1861(ww)(2)) may be imposed where the provider of services 
     submits an actual or projected repayment to the fiscal 
     intermediary or a contractor under section 1893. Subject to 
     subparagraph (D), any prepayment review shall cease when the 
     provider of services has submitted claims, found by the 
     fiscal intermediary to be covered services and coded properly 
     for the same services that were the basis for instituting the 
     prepayment review, in a 180-day period or after processing 
     claims of at least 75 percent of the volume of the claims 
     (whichever occurs first) received by the fiscal intermediary 
     in the full month preceding the start of the prepayment 
     review. The 180-day period begins with the date of the fiscal 
     intermediary's written notification that the provider of 
     services is being placed on prepayment review.
       ``(B) Prepayment review may not be applied under this part 
     as a result of the voluntary submission of a claim, cost 
     report, or record under section 1897(b)(2) or as a result of 
     information provided pursuant to a request under section 
     302(b) of the Medicare Education and Regulatory Fairness Act 
     of 2001.
       ``(C) Fiscal intermediary prepayment and coverage policies 
     and claims processing screens used to identify claims for 
     medical review must be incorporated as part of the education 
     programs on medicare policy and proper coding made available 
     to providers of services.
       ``(D) The time and percentage claim limitations in 
     paragraph (5)(A) shall not apply to cases that have been 
     referred to the Department of Justice or the Office of the 
     Inspector General.''.

     SEC. 203. DEFINITIONS RELATING TO PHYSICIANS, PROVIDERS OF 
                   SERVICES, AND PROVIDERS OF AMBULANCE SERVICES.

       (a) In General.--Section 1861 of the Social Security Act 
     (42 U.S.C. 1395 et seq.), as amended by section 102(b) and 
     105(b) of the Medicare, Medicaid, and SCHIP Benefits 
     Improvement and Protection Act of 2000 (as enacted into law 
     by section 1(a)(6) of Public Law 106-554), is amended by 
     adding at the end the following new subsection:

   ``Definitions Relating to Physicians, Providers of Services, and 
                    Providers of Ambulance Services

       ``(ww) For purposes of provisions of this title relating to 
     physicians, providers of services, and providers of ambulance 
     services:
       ``(1) Extrapolation.--The term `extrapolation' means the 
     application of an overpayment dollar amount to a larger 
     grouping of claims than those in the audited sample to 
     calculate a projected overpayment figure.
       ``(2) Prepayment review.--The term `prepayment review' 
     means a carrier's and fiscal intermediary's practice of 
     withholding claim reimbursements from physicians, providers 
     of services, and providers of ambulance services pending 
     review of a claim even if the claims have been properly 
     submitted and reflect medical services provided.''.

     SEC. 204. RIGHT TO APPEAL ON BEHALF OF DECEASED 
                   BENEFICIARIES.

       Notwithstanding section 1870 of the Social Security Act (42 
     U.S.C. 1395gg) or any other provision of law, the Secretary 
     shall permit any physician, provider of services, and 
     provider of ambulance services to appeal any determination of 
     the Secretary under the medicare program on behalf of a 
     deceased beneficiary where no substitute party is available.

     SEC. 205. EFFECTIVE DATE.

       The amendments made by this title shall take effect at the 
     end of the 180-day period beginning on the date of the 
     enactment of this Act.

                    TITLE III--EDUCATION COMPONENTS

     SEC. 301. DESIGNATED FUNDING LEVELS FOR PHYSICIAN AND 
                   PROVIDER EDUCATION.

       (a) Education Programs for Physicians, Providers of 
     Services, and Providers of Ambulance Services.--Title XVIII 
     of the Social Security Act (42 U.S.C. 1395 et seq.) is 
     amended by adding at the end the following new section:


    ``education programs for physicians, providers of services, and 
                    providers of ambulance services

       ``Sec. 1897. (a) Education Program Defined.--In this 
     section, the term `education programs' means programs 
     undertaken in conjunction with health care associations that 
     focus on current billing, coding, cost reporting, and 
     documentation laws, regulations, program memoranda, 
     instructions to regional offices, and fiscal intermediary and 
     carrier manual instructions that place special emphasis on 
     billing, coding, cost reporting, and documentation errors 
     that the Secretary has found occur frequently and remedies 
     for these improper billing, coding, cost reporting, and 
     documentation practices.

[[Page S1822]]

       ``(b) Conduct of Education Programs.--
       ``(1) In general.--Carriers, fiscal intermediaries, and 
     contractors under section 1893 shall conduct education 
     programs for any physician (or a designee), provider of 
     services, or provider of ambulance services that submits a 
     claim or cost report under paragraph (2)(A). Such carriers, 
     intermediaries, and contractors under section 1893 shall 
     conduct outreach to specifically contact physicians and their 
     designees, providers of services, and providers of ambulance 
     services with fewer than 10 full-time-equivalent employees 
     (including physicians) to implement education programs 
     tailored to their education needs and in proximity to their 
     practices.
       ``(2) Provider education.--
       ``(A) Submission of claims, cost reports, and records.--Any 
     physician, provider of services, or provider of ambulance 
     services may voluntarily submit any present or prior claim, 
     cost report, or medical record to the carrier or fiscal 
     intermediary to determine whether the billing, coding, and 
     documentation associated with the claim or cost report is 
     appropriate.
       ``(B) Prohibition of extrapolation.--No claim submitted 
     under subparagraph (A) is subject to any type of 
     extrapolation (as defined in section 1861(ww)(1)).
       ``(C) Safe harbor.--No submission of a claim, cost report, 
     or record under this section shall result in the carrier, 
     fiscal intermediary, a contractor under section 1893, or any 
     law enforcement agency beginning an investigation or 
     targeting an investigation based on any claim, cost report, 
     or record submitted under such subparagraph.
       ``(3) Treatment of claims.--If the carrier or fiscal 
     intermediary finds a claim or cost report under paragraph (2) 
     to be improper, the physician, provider of services, or 
     provider of ambulance services shall have the following 
     options:
       ``(A) Correction of problems.--To correct the 
     documentation, coding, or billing problem to appropriately 
     substantiate the claim or cost report and either--
       ``(i) remit the actual overpayment; or
       ``(ii) receive the appropriate additional payment from the 
     carrier or fiscal intermediary.
       ``(B) Repayment.--To repay the actual overpayment amount if 
     the service is excluded from medicare coverage under this 
     title or if adequate documentation does not exist.
       ``(4) Prohibition of physician and provider of services 
     tracking.--Carriers, fiscal intermediaries, and contractors 
     under section 1893 may not use the record of attendance or 
     information gathered during an education program conducted 
     under this section or the inquiry regarding claims or cost 
     reports under paragraph (2)(A) to select, identify, or track 
     such physician, provider of services, or provider of 
     ambulance services for the purpose of conducting any type of 
     audit or prepayment review.''.
       (b) Funding of Education Programs.--
       (1) Medicare integrity program.--Section 1893(b)(4) of such 
     Act (42 U.S.C. 1395ddd(b)(4)) is amended by adding at the end 
     the following new sentence: ``No less than 10 percent of the 
     program funds shall be devoted to the education programs for 
     physicians, providers of services, and providers of ambulance 
     services under section 1897.''.
       (2) Carriers.--Section 1842(b)(3)(H) of such Act (42 U.S.C. 
     1395u(b)(3)(H)) is amended by adding at the end the following 
     new clause:
       ``(iii) No less than 2 percent of carrier funds shall be 
     devoted to the education programs for physicians under 
     section 1897.''.
       (3) Fiscal intermediaries.--Section 1816(b)(1) of such Act 
     (42 U.S.C. 1395h(b)(1)) is amended--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) in subparagraph (B), by striking ``; and'' and 
     inserting a comma; and
       (C) by adding at the end the following new subparagraph:
       ``(C) that such agency or organization is using no less 
     than 1 percent of its funding for education programs for 
     providers of services and providers of ambulance services 
     under section 1897.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to fiscal years beginning after the date of the 
     enactment of this Act.

     SEC. 302. INFORMATION REQUESTS.

       (a) Clear, Concise, and Accurate Answers.--Fiscal 
     intermediaries and carriers shall do their utmost to provide 
     physicians, providers of services, and providers of ambulance 
     services with a clear, concise, and accurate answer regarding 
     billing and cost reporting questions under the medicare 
     program, and will give their true first and last names to 
     such physicians, providers of services, and providers of 
     ambulance services.
       (b) Written Requests.--
       (1) In general.--The Secretary shall establish a process 
     under which a physician, provider of services, or provider of 
     ambulance services may request, free of charge and in writing 
     from a fiscal intermediary or carrier, assistance in 
     addressing questions regarding coverage, billing, 
     documentation, coding, and cost reporting procedures under 
     the medicare program and then the fiscal intermediary or 
     carrier shall respond in writing within 30 business days with 
     the correct substantive or procedural answer.
       (2) Use of written statement.--
       (A) In general.--Subject to subparagraph (C), a written 
     statement under paragraph (1) may be used by the physician, 
     provider of services, or provider of ambulance services who 
     submitted the information request and submitted claims in 
     conformance with the answer of the carrier or fiscal 
     intermediary as proof against a future audit or overpayment 
     allegation under the medicare program.
       (B) Extrapolation prohibition.--Subject to subparagraph 
     (C), no claim submitted under this section shall be subject 
     to extrapolation, if the claim adheres to the conditions set 
     forth in the information response.
       (C) Limitation on application.--Subparagraphs (A) and (B) 
     shall not apply to cases of fraudulent billing.
       (3) Safe harbor.--If a physician, provider of services, or 
     provider of ambulance services requests information under 
     this subsection, neither the fiscal intermediary, the 
     carrier, a contractor under section 1893 of the Social 
     Security Act (42 U.S.C. 1395ddd), nor any law enforcement 
     agency may begin an investigation or target such physician or 
     provider based on the request.
       (c) Broad Policy Guidance by the Secretary.--The Secretary 
     shall develop a mechanism to address written questions 
     regarding medicare policy and regulations, which are 
     submitted by health care associations. The Secretary shall 
     issue such answers within 90 calendar days from the date of 
     the receipt of the question and shall make the responses 
     available to the public in an indexed, easily accessible 
     format.
       (d) Notice of Changes in Policy.--Carriers and fiscal 
     intermediaries shall provide written, mailed notice within 30 
     calendar days to physicians, providers of services, and 
     providers of ambulance services of all policy or operational 
     changes to the medicare program. Physicians, providers of 
     services, and providers of ambulance services shall have not 
     less than 30 days to comply with such policy changes.
       (e) Effective Date.--This section shall take effect 180 
     days after the date of the enactment of this Act.

               TITLE IV--SUSTAINABLE GROWTH RATE REFORMS

     SEC. 401. INCLUSION OF REGULATORY COSTS IN THE CALCULATION OF 
                   THE SUSTAINABLE GROWTH RATE.

       (a) In General.--Section 1848(f)(2) of the Social Security 
     Act (42 U.S.C. 1395w-4(f)(2)) is amended--
       (1) by redesignating subparagraphs (A) through (D) as 
     clauses (i) through (iv), respectively;
       (2) by striking ``Specification of growth rate.--The 
     sustainable growth rate'' and inserting ``Specification of 
     growth rate.--
       ``(A) In general.--The sustainable growth rate''; and
       (3) by adding at the end the following new subparagraphs:
       ``(B) Inclusion of sgr regulatory costs.--The estimate 
     established under clause (iv) or any successor thereto shall 
     include--
       ``(i) the impact on costs for physicians' services 
     resulting from regulations implemented by the Secretary 
     during the year for which the sustainable growth rate is 
     estimated, including those regulations that may be 
     implemented during such year; and
       ``(ii) the costs described in subparagraph (C).
       ``(C) Inclusion of other regulatory costs.--The costs 
     described in this subparagraph are per procedure costs 
     incurred by physicians' practices in complying with 
     regulations promulgated by the Secretary, regardless of 
     whether such regulation affects the fee schedule established 
     under subsection (b)(1).
       ``(D) Inclusion of costs in regulatory impact analyses.--
     With respect to any regulation promulgated that may impose a 
     regulatory cost described in subparagraph (B)(i) or (C) on a 
     physician, the Secretary shall include in the regulatory 
     impact analysis accompanying such regulation an estimate of 
     any such cost.
       ``(E) Inclusion of estimated cost on rural physicians.--In 
     promulgating regulations, the Secretary shall specifically 
     estimate the costs to rural physicians and physicians 
     practices in rural areas and the estimated number of hours 
     needed to comply with the regulation.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply with respect to any estimate made (or regulation 
     promulgated) by the Secretary of Health and Human Services on 
     or after 1 year after the date of enactment of this Act.

          TITLE V--POLICY DEVELOPMENT REGARDING E&M GUIDELINES

     SEC. 501. POLICY DEVELOPMENT REGARDING E&M DOCUMENTATION 
                   GUIDELINES.

       (a) In General.--HCFA may not implement any new evaluation 
     and management documentation guidelines (in this section 
     referred to as ``E&M guidelines'') under the medicare 
     program, unless HCFA--
       (1) has provided for an assessment of the proposed 
     guidelines by organizations representing physicians;
       (2) has established a plan that contains specific goals, 
     including a schedule, for improving use of such guidelines;
       (3) has completed a minimum of 4 pilot projects consistent 
     with subsection (b) in at least 4 different HCFA regions 
     administered by 4 different carriers (to be specified by the 
     Secretary) to test such guidelines; and
       (4) finds that the objectives described in subsection (c) 
     will be met in the implementation of such guidelines.
       (b) Pilot Projects.--
       (1) Length and consultation.--Each pilot project under this 
     subsection shall--

[[Page S1823]]

       (A) be of sufficient length to allow for preparatory 
     physician and carrier education, analysis, and use and 
     assessment of potential E&M guidelines; and
       (B) be conducted, throughout the planning and operational 
     stages of the project, in consultation with organizations 
     representing physicians.
       (2) Peer review pilot projects.--Of the pilot projects 
     conducted under this subsection--
       (A) at least one shall focus on a peer review method by 
     physicians (not employed by a carrier) which evaluates 
     medical record information for claims submitted by physicians 
     identified as statistical outliers relative to definitions 
     published in the CPT book;
       (B) at least one shall be conducted for services furnished 
     in a rural area (as defined in section 1886(d)(2)(D) of the 
     Social Security Act, 42 U.S.C. 1395ww(d)(2)(D)); and
       (C) at least one shall be conducted in a setting where 
     physicians bill under physicians services in teaching 
     settings (described in section 415.150 of title 42, Code of 
     Federal Regulations).
       (3) Banning of targeting of pilot project participants.--
     Data collected under this subsection shall not be used as the 
     basis for overpayment demands or post-payment audits.
       (4) Study of impact.--Each pilot project shall examine the 
     effect of the E&M guidelines on--
       (A) different types of physician practices, including those 
     with few than 10 full-time employees (including physicians); 
     and
       (B) the costs of physician compliance, including education, 
     implementation, auditing, and monitoring.
       (c) Objectives for E&M Guidelines.--The objectives for E&M 
     guidelines specified in this subsection are as follows 
     (relative to the E&M guidelines and review policies in effect 
     as of the date of the enactment of this Act):
       (1) Enhancing clinically relevant documentation needed to 
     code accurately and assess coding levels accurately.
       (2) Decreasing the level of non-clinically pertinent and 
     burdensome documentation time and content in the record.
       (3) Increased accuracy by carrier reviewers.
       (4) Education of both physicians and reviewers.
       (5) Promote appropriate use of E&M codes by physicians and 
     their staffs.
       (6) The extent to which the tested E&M documentation 
     guidelines substantially adhere to the CPT coding definitions 
     and rules.
       (d) Report on How Met Pilot Project Objectives.--HCFA shall 
     submit a report to the Committees on Energy and Commerce and 
     Ways and Means of the House of Representatives, the Committee 
     on Finance of the Senate, and the Practicing Physicians 
     Advisory Council, six months after the conclusion of the 
     pilot projects. Such report shall include the extent to which 
     the pilot projects met the objectives specified in 
     subsections (b)(4) and (c).
                                 ______
                                 
      By Mrs. FEINSTEIN:
  S. 453. A bill for the relief of Denes and Gyorgyi Fulop; to the 
Committee on the Judiciary.
  Mrs. FEINSTEIN. Mr. President, I am pleased to offer today, 
legislation to provide lawful permanent residence status to Denes and 
Gyorgyi Fulop, Hungarian nationals who have lived in California for 
more than 18 years. The Fulops are the parents of six United States 
citizen children. Today, they face deportation.
  The Fulop's story is a compelling one; one I believe merits Congress' 
consideration for humanitarian relief. In May of last year, the Fulops 
suffered the loss of their eldest child, Robert ``Bobby'' Fulop, an 
accomplished 15-year-old teenager who died suddenly of a heart 
aneurism. Bobby was considered the shining star in his family. He was 
very bright and very helpful to his parents.
  That same year the Fulop's six-year-old daughter, Elizabeth, was 
diagnosed with moderate pulmonary stenosis, a potentially life-
threatening heart condition. Not long ago, she underwent heart surgery. 
I am pleased to report that she is doing much better.
  Compounding this unfortunate series of events is the fact that, 
today, the Fulops face deportation. They face deportation, in part, 
because in 1995 they went back to Hungary and stayed for more than 90 
days. Under the pre-1996 immigration laws, their stay in Hungary would 
not have been a factor in their deportation and they would have 
qualified for adjustment to lawful permanent resident status.
  Indeed, in 1996, Mr. and Mrs. Fulop applied to the Immigration and 
Naturalization Service, INS, for permanent resident status. The INS did 
not interview them until 1998. By the time the INS had processed their 
application, the new 1996 immigration laws had taken effect, which 
barred from relief long-term resident aliens who traveled outside the 
U.S. for more than 90 days.
  One cannot help but conclude that had the INS acted on their 
application for relief from deportation in a more timely manner, the 
Fulops would have qualified for suspension of deportation under the 
pre-1996 laws, given that they are long-term residents of the U.S. with 
U.S. citizen children.
  This is a tragic situation. The rules of the game were changed in the 
middle of the Fulop's application for permanent residence, and because 
the INS failed to process their application in a timely fashion they 
are now facing deportation. The Fulop's children, who are United States 
citizens, were not included in the deportation order. But because they 
are minors they would likely have to follow their parents to Hungary. 
Growing up in the American school system, the Fulop children are not 
able to read or write the Hungarian language, and I believe that 
forcing them to leave the only country they have known would pose an 
extreme hardship for them.
  It is my hope that Congress sees fit to provide an opportunity for 
this family to remain together in the United States.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 453

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. PERMANENT RESIDENT STATUS FOR DENES AND GYORGYI 
                   FULOP.

       (a) In General.--Notwithstanding subsections (a) and (b) of 
     section 201 of the Immigration and Nationality Act, Denes and 
     Gyorgyi Fulop shall be eligible for issuance of immigrant 
     visas or for adjustment of status to that of aliens lawfully 
     admitted for permanent residence upon filing an application 
     for issuance of immigrant visas under section 204 of such Act 
     or for adjustment of status to lawful permanent resident.
       (b) Adjustment of Status.--If Denes Fulop or Gyorgyi Fulop 
     enters the United States before the filing deadline specified 
     in subsection (c), the alien shall be considered to have 
     entered and remained lawfully and shall, if otherwise 
     eligible, be eligible for adjustment of status under section 
     245 of the Immigration and Nationality Act as of the date of 
     enactment of this Act.
       (c) Deadline for Application and Payment of Fees.--
     Subsections (a) and (b) shall apply only if the application 
     for issuance of immigrant visas or the application for 
     adjustment of status are filed with appropriate fees within 2 
     years after the date of enactment of this Act.
       (d) Reduction of Immigrant Visa Numbers.--Upon the granting 
     of immigrant visas or permanent residence to Denes and 
     Gyorgyi Fulop, the Secretary of State shall instruct the 
     proper officer to reduce by the appropriate number, during 
     the current or next following fiscal year, the total number 
     of immigrant visas that are made available to natives of the 
     country of the aliens' birth under section 203(a) of the 
     Immigration and Nationality Act or, if applicable, the total 
     number of immigrant visas that are made available to natives 
     of the country of the aliens' birth under section 202(e) of 
     such Act.
                                 ______
                                 
      By Mr. BINGAMAN:
  S. 454. A bill to provide permanent funding for the Bureau of Land 
Management Payment in Lieu of Taxes Program and for other purposes; to 
the Committee on Energy and Natural Resources.
  Mr. BINGAMAN. Mr. President, the bill I am introducing today, the 
PILT and Refuge Revenue Sharing Permanent Funding Act, deals with an 
issue that I believe must be addressed in this Congress. The bill is a 
measure to make permanent funding for two important programs managed by 
the Department of the Interior: the Payment in Lieu of Taxes Program, 
or PILT, in the Bureau of Land Management and the Refuge Revenue 
Sharing Program in the Fish and Wildlife Service. Those programs 
provide support to local governments in areas in which these two 
agencies hold land. Under the authorizations for these programs, the 
funds are to be provided as an offset to the local property tax base 
lost by virtue of the Federal ownership of these lands.
  Federal ownership of lands in the American West, in states like New 
Mexico, does not come without its share of burdens for local 
governments. If there is a fire or other emergency, they must help 
respond. If there is increased traffic to and from the site, they must 
maintain the public roads that provide the necessary access to the 
public. In enacting the original authorizing legislation, Congress 
decided that, as a matter of policy, it was appropriate for the Federal 
government

[[Page S1824]]

to bear a fair share in paying for these costs, in lieu of the taxes 
that would be levied on any private landowner in these localities.
  But in setting up these programs, Congress decided to make them 
subject to annual appropriations, either partially, in the case of 
Refuge Revenue Sharing, or completely, in the case of PILT. In 
retrospect, this was a mistake. The annual appropriations process has 
never come even close to providing the funds agreed upon by the 
underlying authorizing law. Moreover, the amount made available has 
changed significantly from one year to the next, frustrating the 
ability of localities to plan effectively for the use of these funds. 
Many of the burdens they face as a result of Federal land ownership 
require expenditures and commitments that are long-term. If you want to 
have a reasonable system of county roads, you need to have a consistent 
multi-year plan. If you want adequate fire protection, you can't be 
hiring a dozen new firefighters in one year and firing them the next, 
as appropriation levels gyrate up and down.
  The Federal government needs to be a better neighbor and a more 
reliable partner to local governments in the rural West. Since the 
system of meeting our obligations to these localities through the 
annual appropriations process has not worked, I am proposing that we 
start treating our payments in lieu of taxes in the same way that we 
account for incoming tax revenues to the Federal government--on the 
mandatory side of the Federal ledger. By making the funding for these 
crucial programs full and permanent, we will be keeping the commitments 
to rural communities throughout the West made in the original PILT and 
Refuge Revenue Sharing authorizing legislation. It's a matter of simple 
justice to rural communities. I hope that enacting legislation along 
the lines of what I am proposing today will receive high priority in 
the next Congress.
  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 454

       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 ``PILT and Refuge Revenue 
     Sharing Permanent Funding Act''.

     SEC. 2. PERMANENT FUNDING FOR PILT AND REFUGE REVENUE 
                   SHARING.

       (a) Payments in Lieu of Taxes.--Section 6906 of title 31, 
     United States Code, is amended to read as follows:
       ``There is authorized to be appropriated such sums as may 
     be necessary to the Secretary of the Interior to carry out 
     this chapter. Beginning in fiscal year 2002 and each year 
     thereafter, amounts authorized under this chapter shall be 
     made available to the Secretary of the Interior, out of any 
     other funds in the Treasury not otherwise appropriated and 
     without further appropriation, for obligation or expenditure 
     in accordance with this chapter.''.
       (b) Refuge Revenue Sharing.--Section 401(d) of the Act of 
     June 15, 1935, as amended (16 U.S.C. 715s(d)) (relating to 
     refuge revenue sharing), is amended by adding at the end 
     thereof:
       ``Beginning in fiscal year 2002 and each year thereafter, 
     such amount shall be made available to the Secretary, out of 
     any other funds in the Treasury not otherwise appropriated 
     and without further appropriation, for obligation or 
     expenditure in accordance with this section.''.
                                 ______
                                 
      By Ms. COLLINS (for herself, Mr. Cleland, Mr. Breaux, Mr. Allard, 
        Mr. Chafee, Mr. Lieberman, Ms. Landrieu, Mr. Hatch, and Mr. 
        Hutchinson):
  S. 455. A bill to amend the Internal Revenue Code of 1986 to increase 
and modify the exclusion relating to qualified small business stock and 
for other purposes; to the Committee on Finance.

  Ms. COLLINS. Mr. President, the concerns and needs of small 
businesses have always been a priority for me. When I talk to small 
business owners throughout the State of Maine, I hear over and over 
again that they have two major problems: One is the high cost of health 
insurance. I will be introducing legislation shortly to try to help 
small businesses cope with that issue. The second issue is the need for 
more capital to finance their enterprises.
  Today, I rise to introduce the Encouraging Investment in Small 
Business Act, a bill intended to stimulate private investment in the 
entrepreneurs who drive our economy. I am pleased to be joined today by 
my good friends and staunch supporters of small business, Senators 
Cleland, Breaux, Landrieu, Allard, Chafee, Lieberman, Hutchinson, and 
Hatch.
  The bill we introduce today will encourage long-term investment in 
small and emerging businesses by providing incentives to individuals 
who risk investment in such firms. According to the Small Business 
Administration, small firms account for three-quarters of our Nation's 
employment growth and almost all of our net new jobs. At the same time, 
small businesses face unique financing challenges. Simply put, 
entrepreneurs need access to more capital to start and to expand their 
businesses. As the SBA noted last year, ``Adequate financing for 
rapidly growing firms will be America's greatest economic policy 
challenge of the new century.''
  Just a few months ago, it would have been difficult for us to imagine 
that a capital gap could exist in an economy that had experienced such 
an unprecedented run of prosperity. Venture capital investments in 
emerging firms reached a record $103 billion last year, up 74 percent 
from the year before. Yet, there are signs that the rush of funds is 
subsiding. Venture capital investment activity decreased by 31 percent 
in the fourth quarter of last year, and much of the funds that have 
been raised remains uninvested.
  More important, venture capital funds tend to gravitate towards 
certain types of businesses and geographic regions, and tend to be 
invested in increasingly larger amounts, leaving many small business 
entrepreneurs frozen out of the capital markets. Internet-related 
companies attracted 76 percent of the venture capital invested in the 
first three quarters of 2000. And more than two-thirds of all the 
venture capital invested in the United States in 1999 went to just five 
States. Moreover, the average amount of venture capital invested in 
small businesses increased from $6.6 million in 1998 to $13.3 million 
in 1999, prompting the SBA to conclude that the needs of many small 
businesses for equity financing remain unmet.
  The data paint a troubling picture. It is, unfortunately, a familiar 
one. Take the example of Vladimir Koulchin, a Russian by birth but a 
Mainer in heart and spirit. Vladimir holds a doctorate in biochemistry 
and has 25 years of research experience in the field. Six years ago, 
Mr. Koulchin moved to Portland, ME, to work for a biotechnology firm 
where he became vice president for research and development. This past 
fall, with no funding other than his own, he founded Chemogen with the 
goal of developing products to diagnose, treat, and prevent 
tuberculosis and other dangerous infectious diseases in humans and 
animals. Mr. Koulchin told me how difficult it has been to find the 
seed and early stage capital he needs to get his promising business off 
the ground. He spoke of the relative lack of seed capital in small 
markets and the welcome assistance that strong Federal tax incentives 
could provide.
  Vladimir's experiences are all-too-common. A recent report by the 
National Commission on Entrepreneurship presented findings of 18 focus 
groups with more than 250 entrepreneurs across the country. According 
to the report, the focus groups were ``nearly unanimous in identifying 
difficulties in obtaining seed capital investments.''
  And although the capital gap is pervasive, it disproportionately 
harms women- and minority-owned businesses. The Milken Institute, an 
independent economic think tank, concluded in a research report issued 
last year that, ``While minority businesses are growing faster than 
majority firms in number and revenue, they remain severely constrained 
by a lack of access to capital.'' Moreover, women receive only 12 
percent of all credit provided to small businesses in the U.S. despite 
owning nearly 40 percent of the businesses.
  If we want to remain the world's most entrepreneurial country, where 
small businesses generate the ideas and create the jobs that fuel our 
economy, we must continue to create an environment that nurtures and 
supports entrepreneurs.
  The legislation we are introducing helps to create a supportive 
environment, not by establishing an expensive,

[[Page S1825]]

new Federal program, or adding a complicated new section to our Tax 
Code, but rather by simplifying and improving a provision that is 
already there. The provision, known as section 1202, was added to the 
Internal Revenue Code in 1993 with strong bipartisan support.
  Section 1202 allows investors to exclude from taxable income 50 
percent of the gain from the sale of qualified small business stock 
when the stock is held for at least 5 years. Now, that concept is a 
sound one, but unfortunately, section 1202 prescribes a complicated set 
of requirements, and its attractiveness has been diminished due to the 
fact that when capital gains rates were lowered in 1997, the section 
1202 rate remained the same. In addition, the increasing application of 
the alternative minimum tax has reduced its value. Indeed, early data 
on the use of section 1202 suggests that the alternative minimum tax 
has sharply limited its effectiveness.
  Our bill restores section 1202 to its original role as a potent 
engine of small business capital formation. Our legislation simplifies 
section 1202, enhances its incentives, and eliminates the threat that 
gains on small business stock will be subject to the alternative 
minimum tax. In short, our bill makes a number of commonsense changes 
designed to encourage investment in small business.
  The Encouraging Investment in Small Business Act is supported by the 
National Federation of Independent Business, the National Women's 
Business Council, the National Commission On Entrepreneurship, the 
Biotechnology Industry Organization, and the Biotechnology Association 
Of Maine.
  Our legislation would implement changes recommended by a recent 
Securities and Exchange Commission forum on small business capital 
formation. In sum, our legislation would accommodate the capital-
raising needs of small business, the foundation of our economy.
  Mr. President, I ask unanimous consent that a section-by-section 
summary of the Encouraging Investment in Small Business Act be printed 
in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

              Encouraging Investment in Small Business Act

                       Section-by-Section Summary


                            I. Introduction

       The Encouraging Investment in Small Business Act is 
     intended to stimulate private investment in the entrepreneurs 
     who drive our economy. The Act will encourage long-term 
     investment in small and emerging businesses by providing 
     incentives to investors who risk investment in such firms. 
     According to the Small Business Administration, small firms 
     account for three-quarters of our nation's employment growth 
     and almost all of our net new jobs. Small businesses employ 
     52 percent of all private workers, provide 51 percent of our 
     private sector output, and are responsible for a 
     disproportionate share of innovations. Moreover, small 
     businesses are avenues of opportunity for women and 
     minorities, young and elderly workers, and those formerly on 
     public assistance. Yet entrepreneurs need access to more 
     capital to start and expand their businesses.
       In 1993, Section 1202 was added to the Internal Revenue 
     Code in order to encourage investment in small businesses. In 
     brief, Section 1202 permits non-corporate taxpayers to 
     exclude from gross income 50% of the gain from the sale or 
     exchange of qualified small business (``QSB'') stock held for 
     more than five years. The concept is a sound one. However, in 
     practice, Section 1202 has proven to be cumbersome to use and 
     less advantageous than originally intended. As an article in 
     the December 1998 edition of the Tax Adviser noted, ``Sec. 
     1202 places numerous and complex requirements on both the QSB 
     and the shareholder,'' and that the provision ``is no longer 
     the deal it seemed to be.''
       The Encouraging Investment in Small Business Act would 
     amend Section 1202 to eliminate unnecessary complexity and to 
     make it a more robust engine of capital formation for small 
     businesses. As it now stands, the engine needs work. Given 
     (1) reductions in capital gains rates subsequent to Section 
     1202's enactment and (2) the fact that more taxpayers are now 
     subject to the Alternative Minimum tax, Section 1202 is no 
     longer a viable option in many circumstances it was 
     originally intended to address. Moreover, Section 1202's 
     impact will continue to be diluted by a scheduled decrease in 
     long-term capital gains rates applicable to stock purchased 
     after 2000 and the probability that still more taxpayers will 
     be subject to the AMT. To understand the changes the Act 
     would make, it is first necessary to understand how 1202 
     currently works.
       As noted, Section 1202 imposes numerous restrictions on a 
     business that seeks to qualify under its provisions. To be a 
     QSB, a business must be a domestic C corporation with 
     aggregate gross assets of no greater than $50 million at any 
     time prior to or immediately after issuing stock. Certain 
     types of businesses are excluded from QSB status, including 
     banking, insurance, investing, consulting, law, accounting, 
     financial services, and farming concerns as well as hotels 
     and restaurants. Any trade or business that relies on the 
     reputation or skill of one or more of its employees as its 
     principal asset also cannot be a QSB.
       QSB's must also satisfy an ``active business'' requirement. 
     This means that, during substantially all of the time the 
     taxpayer holds the stock, at least 80 percent of the QSB's 
     gross assets must be used by the corporation in the active 
     conduct of the qualified trade or business. Assets used in 
     certain start-up activities or for research, or which are 
     held as ``reasonably required'' working capital are deemed to 
     be used in the active conduct of a qualified trade or 
     business. Two years after a QSB has come into existence, no 
     more than 50 percent of its assets can qualify as ``active'' 
     by virtue of the Section 1202(e)(6) working capital rule.
       As noted, under Section 1202, an individual can exclude 
     from gross income 50% of any gain from the sale or exchange 
     of qualified small business stock originally issued after 
     August 10, 1993 and held for more than five years. Under 
     Section 1045 of the Code, the taxpayer may roll the gain over 
     tax-free provided that the taxpayer (1) has held the QSB 
     stock for more than six months and (2) invests the gain in 
     other QSB stock within 60 days of the sale. Generally, the 
     holding period of the stock purchased will include the 
     holding period of the stock sold.
       The maximum amount of a taxpayer's gain eligible for the 
     Section 1202 exclusion is limited to the greater of $10 
     million and 10 times the aggregate adjusted bases of the 
     stock sold. Gains of Section 1202 stock are taxed at the rate 
     of 28%.


                    II. Section-by-Section Analysis

       Section 1. Short title.
       The ``Encouraging Investment in Small Business Act.''
       Section 2. Increased Exclusion and Other Modifications 
     Applicable to Qualified Small Business Stock.
       (a) Increased Exclusion.
       This provision increases the amount of QSB stock gain that 
     an individual can exclude from gross income from 50 percent 
     to 75 percent.
       (b) Reduction in Holding Period.
       This provision reduces from 5 years to 3 years the period 
     of time in which an individual must hold QSB stock in order 
     to qualify for the 75-percent exclusion. Section 1045's 
     rollover provisions will still apply.
       (c) Repeal of Minimum Tax Preference.
       This provision strikes Section 57(a)(7), which makes 42 
     percent of the amount excluded pursuant to Section 1202 a 
     preference item under the alternative minimum tax. This 
     change is necessary because the AMT provisions in existing 
     law effectively eviscerate the benefit of Section 1202 in 
     certain situations.
       Example. Jane buys Section 1202 stock for $2,000. After 
     five years, she sells the stock for $12,000. Under current 
     law, she excludes half of her gain and is taxed at 28% on the 
     other half [.28 $5,000 = $1,400]. Hence, her tax on the gain 
     is $1,400. However, if Jane is subject to the AMT, she must 
     pay additional taxes of $588, or 28% of 42% of the excluded 
     half of the gain. Jane's total tax bill of $1,988 amounts to 
     an effective rate of 19.9%, or nearly the same as the current 
     maximum tax rate on long-term capital gains of 20%. Under the 
     Encouraging Investment in Small Business Act, Jane would be 
     able to exclude 75% of her gain, would be subject to the 20% 
     rate that applies to most capital gains, and would not have 
     to recognize any of the gain as a preference item for AMT 
     purposes. Hence, her tax bill would be 20% of $2,500, or 
     $500. Absent the change, Jame would have little incentive to 
     invest in a qualified small business over any other business, 
     particularly if she is subject to the AMT. Under the 
     Encouraging Investment in Small Business Act, Section 1202's 
     original potent incentives to investors in small businesses 
     are restored.
       (d)(1) Working Capital Limitations.
       This provision eases Section 1202(e)'s working capital 
     restrictions on qualified small businesses. The provision 
     increases from 2 years to 5 years the time in which assets 
     that are held for investment by a business can be expected to 
     be used to finance research or an increase in working capital 
     needs. In other words, a corporation will be able to hold 
     assets longer, before eventually using them for research or 
     to satisfy increased working capital needs, and still meet 
     the active business requirements of section 1202.
       (d)(2) Exception from Redemption Rules Where Business 
     Purpose.
       Currently, the Section 1202 exclusion does not apply to 
     stock issued by a corporation if the corporation purchases 
     more than 5 percent of its own stock during the 2-year period 
     beginning on the date one year before the issuance of its 
     stock. Under the Encouraging Investment in Small Business 
     Act, this provision would be waived if the issuing 
     corporation could establish that the purchase was made for a 
     business purpose, and not to avoid the provision described 
     above.
       (e) Excluded Qualified Trade or Business.
       This provision tightens the language of Section 1202(e)(3), 
     which excludes certain

[[Page S1826]]

     businesses from QSB status. It does so in two ways. First, it 
     provides that a coproration can be a QSB even if its 
     principal asset, for a temporary period, is the reputation or 
     skill of one or more of its employees. Hence, in the case of 
     a small start-up computer software company, for example, if 
     its employees engage in consulting work, say, in order to 
     generate some cash flow while the software is under 
     development, the company will not be disqualified from QSB 
     status.
       Second, the provision makes it clear that biotechnology and 
     aquaculture companies are not disqualified from QSB status.
       (f) Increase in Cap on Eligible Gain for Joint Returns.
       The Encouraging Investment in Small Business Act fixes a 
     marriage tax penalty provision in Section 1202 by doubling 
     (to $20,000,000) the maximum amount of eligible gain for 
     taxpayers filing joint returns.
       (g) Decrease in Capital Gains Rate
       Section 1202 gains are currently taxed at a rate of 28 
     percent, which, prior to May 7, 1997, had been the maximum 
     marginal rate for net capital gains. The Taxpayer Relief Act 
     of 1997 reduced the maximum capital gain rate for individuals 
     from 28 percent to 20 percent, but left section 1202 gain 
     subject to the 28 percent rate. The Encouraging Investment in 
     Small Business Act would make section 1202 gains subject to 
     the generally-applicable 20 percent rate.
       (h) Increase in Rollover Period for QSB Stock
       Currently, a taxpayer can roll over, tax free, gain from 
     the sale or exchange of QSB stock where the taxpayer uses the 
     proceeds to purchase other QSB stock within 60 days of the 
     sale of the original stock. The Encouraging Investment in 
     Small Business Act would increase the roll over period to 180 
     days, thus increasing the liquidity of QSB stock. A 180-day 
     roll over period is also employed in section 1031 of the 
     Internal Revenue Code for like-kind exchanges.
                                 ______
                                 
      By Ms. SNOWE:
  S. 456. A bill to amend title 38, United States Code, to enhance the 
assurance of efficiency, quality, and patient satisfaction in the 
furnishing of health care to veterans by the Department of Veterans 
Affairs, and for other purposes; to the Committee on Veterans' Affairs.
  Ms. SNOWE. Mr. President, I rise today to introduce the Veterans 
Health Care Quality Assurance Act of 2001.
  This legislation contains a number of proposals designed to ensure 
that access to high quality medical services for our veterans is not 
compromised as the Department of Veterans Affairs, the VA, strives to 
increase efficiency in its nationwide network of veterans hospitals.
  The VA administers the largest health care network in the U.S., 
including 172 hospitals, 73 home care programs, over 800 community-
based outpatient clinics, and numerous other specialized care 
facilities.
  Moreover, there are approximately 25 million veterans in the U.S., 
including approximately 19.3 million wartime veterans, and the number 
of veterans seeking medical care in VA hospitals is increasing.
  The FY2000 VA medical caseload was projected to total approximately 
3.8 million, an increase of 185,000 over FY1999. This level is expected 
to increase to 3.9 million during FY2001. Furthermore, in FY2001, 
outpatient visits to VA facilities are expected to increase by 2.6 
million to 40.4 million.
  The average age of veterans is increasing as well, and this is 
expected to result in additional demands for health care services, 
including more frequent and long-term health needs.
  The VA is attempting to meet this unprecedented demand for health 
care services without substantial increases in funding, largely through 
efforts to increase efficiency. Not surprisingly, these seemingly 
competing objectives are generating serious concerns about the 
possibility that quality of care and/or patient satisfaction are being 
sacrificed.
  Many VA regional networks and medical center directors report that 
timely access to high quality health care is being jeopardized, and 
that is why I am introducing the Veterans Health Care Quality Assurance 
Act, legislation which seeks to ensure that no veterans' hospital is 
targeted unfairly for cuts, and that efforts to ``streamline'' and 
increase efficiency are not followed by the unintended consequence of 
undermining quality of care or patient satisfaction.
  I believe that all veterans hospitals should be held to the same 
equitable VA-wide standards, and that quality and satisfaction must be 
guaranteed. Toward that end, the Veterans Health Care Quality Assurance 
Act calls for audits of every VA hospital every three years. This will 
ensure that each facility is subject to an outside, independent review 
of its operations on a regular basis, and each audit will include 
findings on how to improve services to our veterans.
  The legislation will also establish an Office of Quality Assurance 
within the VA to ensure that steps taken to increase efficiency in VA 
medical programs do not undermine quality or patient satisfaction. This 
office will collect and disseminate information on efforts that have 
proven to successfully increase efficiency and resource utilization 
without undermining quality or patient satisfaction. The director of 
this new Office of Quality Assurance should be an advocate for veterans 
and would be placed in the appropriate position in the VA command 
structure to ensure that he or she is consulted by the VA Secretary and 
Under Secretary for Veterans Health on matters that impact quality or 
satisfaction.
  The bill would require an initial report to Congress within six 
months of enactment, which would include a survey of each VA regional 
network and a report on each network's efforts to increase efficiency, 
as well as an assessment of the extent to which each network and VA 
hospital is or is not implementing the same uniform, VA-wide policies 
to increase efficiency.
  Under the bill's reporting requirement, the VA would also be required 
to publish, annually, an overview of VA-wide efficiency goals and 
quality/satisfaction standards that each veterans facility should be 
held to. Further, the VA would be required to report to Congress on 
each hospital's standing in relation to efficiency, quality, and 
satisfaction criteria, and how each facility compares to the VA-wide 
average.
  In an effort to encourage innovation in efforts to increase 
efficiency within the agency, the bill would encourage the 
dissemination and sharing of information throughout the VA in order to 
facilitate implementation of uniform, equitable efficiency standards.
  Finally the bill includes provisions calling for sharing of 
information on efforts to maximize resources and increase efficiency 
without compromising quality of care and patient satisfaction; exchange 
and mentoring initiatives among and between networks in order to 
facilitate sharing of such information; incentives for networks to 
increase efficiency and meet uniform quality/patient satisfaction 
targets; and formal oversight by the VA to ensure that all networks are 
meeting uniform efficiency criteria and that efforts to increase 
efficiency are equitable between networks and medical facilities.
  Keeping our promise to our veterans is also an on-going duty. The 
debt of gratitude we owe to our veterans can never be fully repaid. 
What we can and must do for our veterans is repay the financial debt we 
owe to them. Central to that solemn duty is ensuring that the benefits 
we promised our veterans when they enlisted are there for them when 
they need them.
  I consider it a great honor to represent veterans. So many of them 
continue to make contributions in our communities upon their transition 
from military to civilian life, through youth activities and 
scholarships programs, homeless assistance initiatives, efforts to 
reach out to fellow veterans in need, and national leadership on issues 
of importance to veterans and all Americans. The least we can do is 
make good on our promises, such as the promise of access to high 
quality health care.
  I have nothing but the utmost respect for those who have served their 
country, and this legislation is but a small tribute to the men and 
women and their families who have served this country with courage, 
honor and distinction. They answered the call to duty when their 
country needed them, and this is a component of my on-going effort to 
ensure that we, as elected officials, answer their call when they need 
us.
  I urge my colleagues to join me in supporting this legislation.
                                 ______
                                 
      By Ms. SNOWE:
  S. 457. A bill to amend title 38, United States Code, to establish a 
presumption of service-connection for certain veterans with Hepatitis 
C, and for other purposes; to the Committee on Veterans' Affairs.
  Ms. SNOWE. Mr. President, I rise today to reintroduce legislation I 
first

[[Page S1827]]

introduced in the 105th Congress to address a serious health concern 
for veterans specifically the health threat posed by the Hepatitis C 
virus.
  The legislation I am introducing today would make Hepatitis C a 
service-connected condition so that veterans suffering from this virus 
can be treated by the VA. The bill will establish a presumption of 
service connection for veterans with Hepatitis C, meaning that the 
Department of Veterans Affairs will assume that this condition was 
incurred or aggravated in military service, provided that certain 
conditions are met.
  Under this legislation, veterans who received a transfusion of blood 
during a period of service before December 31, 1992; veterans who were 
exposed to blood during a period of service; veterans who underwent 
hemodyalisis during a period of service; veterans diagnosed with 
unexplained liver disease during a period of service; veterans with an 
unexplained liver dysfunction value or test; or veterans working in a 
health care occupation during service, will be eligible for treatment 
for this condition at VA facilities.
  I have reviewed medical research that suggests many veterans were 
exposed to Hepatitis C in service and are now suffering from liver and 
other diseases caused by exposure to the virus. I am troubled that many 
``Hepatitis C veterans'' are not being treated by the VA because they 
can't prove the virus was service connected, despite the fact that 
hepatitis C was little known and could not be tested for until 
recently.
  We are learning that those who served in Vietnam and other conflicts, 
tend to have higher than average rates of Hepatitis C. In fact, VA data 
shows that about 20 percent of its inpatient population is infected 
with the Hepatitis C virus, and some studies have found that 10 percent 
of otherwise healthy Vietnam, Veterans are Hepatitis C positive.
  Hepatitis C was not isolated until 1989, and the test for the virus 
has only been available since 1990. Hepatitis C is a hidden infection 
with few symptoms. However, most of those infected with the virus will 
develop serious liver disease 10 to 30 years after contracting it. For 
many of those infected, Hepatitis C can lead to liver failure, 
transplants, liver cancer, and death.
  And yet, most people who have Hepatitis C don't even know it--and 
often do not get treatment until it's too late. Only five percent of 
the estimated four million Americans with hepatitis C know they have 
it; yet with new treatments, some estimates indicate that 50 percent 
may have the virus eradicated.
  Vietnam Veterans in particular are just now starting to learn that 
they have liver disease likely caused by Hepatitis C. Early detection 
and treatment may help head off serious liver disease for many of them. 
However, many veterans with Hepatitis C will not be treated by the VA 
because they must meet a standard that is virtually impossible to meet 
in order to establish a service connection for their condition--this in 
spite of the fact that we now know that many Vietnam-era and other 
veterans got this disease serving their country.
  Many of my colleagues may be interested to know how veterans were 
likely exposed to this virus. Many veterans received blood transfusions 
while in Vietnam. This is one of the most common ways Hepatitis C is 
transmitted. Medical transmission of the virus through needles and 
other medical equipment is also possible in combat. Medical care 
providers in the services were likely at increased risk as well, and 
may have, in turn, posed a risk to the service members they treated.
  Researchers have discovered that Hepatitis C was widespread in 
Southeast Asia during the Vietnam war, and that some blood sent from 
the U.S. was also infected with the virus. Researchers and veterans 
organizations, including the Vietnam Veterans of America, with whom I 
worked closely to prepare this legislation, believe that many veterans 
were infected after being injured in combat and getting a transfusion 
or from working as a medic around combat injuries.
  I believe we will actually save money in the long run by testing and 
treating this infection early on. The alternative is much more costly 
treatment of end-stage liver disease and the associated complications, 
or other disorders.
  Some will argue that further epidemiologic data is needed to resolve 
or prove the issue of service connection. I agree that we have our work 
cut out for us, and further study should be done. However, there is 
already a substantial body of research on the relationship between 
Hepatitis C and military service. While further research is being 
conducted, we should not ask those who have already sacrificed so much 
for this country to wait--perhaps for years--for the treatment they 
deserve.
  Former Surgeon General C. Everett Koop, well respected both within 
and outside of the medical profession, has said, ``In some studies of 
veterans entering the Department of Veterans Affairs health facilities, 
half of the veterans have tested positive for HCV. Some of these 
veterans may have left the military with HCV infection, while others 
may have developed it after their military service. In any event, we 
need to detect the treat HCV infection if we are to head off very high 
rates of liver disease and liver transplant in VA facilities over the 
next decade. I believe this effort should include HCV testing as part 
of the discharge physical in the military, and entrance screening for 
veterans entering the VA health system.''
  Veterans have already fought their share of battles--these men and 
women who sacrificed in war so that others could live in peace 
shouldn't have to fight again for the benefits and respect they have 
earned.
  We still have a long way to go before we know how best to confront 
this deadly virus. A comprehensive policy to confront such a monumental 
challenge can not be established overnight. It will require the long-
term commitment of Congress and the Administration to a serious effort 
to address their health concern.
  I hope this legislation will be a constructive step in this effort, 
and I look forward to working with the Veterans Affairs Committee, the 
VA-HUD appropriators, Vietnam Veterans of America and other veterans 
groups to meet this emerging challenge.

                          ____________________