[Congressional Record Volume 147, Number 97 (Thursday, July 12, 2001)]
[Senate]
[Pages S7591-S7595]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. FEINGOLD (for himself, Mr. Murkowski, Ms. Collins, and Mr. 
        Kerry):
  S. 1169. A bill to streamline the regulatory processes applicable to 
home health agencies under the medicare program under title XVIII of 
the social Security Act and the medicaid program under title XIX of 
such Act, and for other purposes; to the Committee on Finance.
  Mr. FEINGOLD. Mr. President, I rise today to introduce the Home 
Health Nurse and Patient Act of 2001. This legislation reduces 
administrative burdens, requires a focused analysis of crucial claims 
processing concerns, and provides the opportunity for constructive 
reforms of current inefficiencies.
  I am especially pleased to be joined by a number of my colleagues, 
including Senator Murkowski and Senator Kerry who have been leaders in 
the regulatory reform movement, and Senator Collins, who has truly been 
a champion for preserving access to home health care.
  Without Senator Collins' leadership on this issue, including the 1999 
hearing that she held on the issue of regulatory burdens facing the 
home health care industry, this legislation would not be where it is 
today.
  Senator Collins' legislation to repeal the 15 percent reduction in 
payments to home health care providers is also of the utmost 
importance, and is the other piece to the puzzle in terms of preserving 
access to home health care. It is my hope that the Senate Finance 
Committee will report out her legislation this year.
  Scope of the problem: As many of my colleagues know, home health care 
provides compassionate, at-home care to seniors and people with 
disabilities in cities and towns throughout America.
  Without it, many patients have no choice but to go to a nursing home, 
or even an emergency room, to get the care they need. For too many home 
health patients in my home state of Wisconsin, that day has arrived.
  Over the past few years, home health agencies around Wisconsin have 
closed their doors due to massive changes in Medicare, and seniors and 
the disabled have been forced to go elsewhere for care.
  In Wisconsin, over 40 Medicare home health providers have shut down 
since the implementation of the Interim Payment System. Still more have 
shrunken their service areas, stopped accepting Medicare patients, or 
refused assignment for high cost patients because the payments are 
simply too low.
  Over the past 3 years, nearly 30 of Wisconsin's 72 counties have lost 
between one and fifteen home health care agencies.
  Quite frankly, in many parts of Wisconsin, beneficiaries in certain 
areas or with certain diagnoses simply don't have access to home health 
care.
  While we have thankfully moved beyond the interim payment system, 
many home health agencies are facing another cloud in the horizon--an 
impending nursing shortage and a regulatory system that causes nurses 
to fill out paperwork instead of caring for patients.
  Burdensome and excessive paperwork often causes nurses to leave the 
home health care profession, and that can mean that patients stay in 
the hospital longer than necessary.
  A 2000 national survey by the Hospital and Healthcare Compensation 
Service reported a 21-percent turnover rate for home health registered 
nurses, a 24-percent turnover rate for home health licensed practicing 
nurses, and a 28-percent turnover for home health aides.
  The actual amount of time that a nurse provides medical care during 
an average ``start of care'' home health visit is approximately 45 
minutes, only 30 percent of the average 2.5 hours of a nurse's time 
during the admission visit. According to Price Waterhouse Cooper, every 
hour of patient care time requires 48 minutes of paperwork time for 
hospital-owned home health agencies.
  I would like to share with my colleagues this advertisement from 
Nursing Spectrum magazine.
  Let me read this line here in bold print: ``No OASIS.''
  As you can see the main selling point in the advertisement is the 
fact that the job will not force nurses to collect OASIS data. This is 
just one simple example of how the administrative burden we have 
imposed on our nurses.
  Our legislation takes a common sense approach to developing Medicare 
home health regulatory policies that are pro-consumer, provider-
friendly, and efficient for the Center for Medicare and Medicaid 
Services, CMS, to administer.
  It would also help to ensure that the policies are successful, fair 
and effective because all parties would collaborate on recommendations 
to the Secretary of Health and Human Services, HHS, through joint task 
forces.
  This legislation would significantly alleviate the burdens that the 
Outcomes Assessment and Information Set (OASIS), the claims process for 
patients who are enrolled in both Medicare and Medicaid, and certain 
audit and medical review processes have had on home health providers.
  More importantly, the changes to the OASIS and the claims review 
process also would reduce the stress often experienced by home health 
patients due to the complexity of both regulations.
  It would also create a task force to analyze the appropriateness and 
efficacy of the OASIS patient assessment

[[Page S7592]]

instrument on Medicare, Medicaid and non-government financed patients.
  During the study, the OASIS process would be optional for the non-
Medicare and non-Medicaid patients and inapplicable to those patients 
receiving personal care services only.
  Many beneficiaries are also concerned about arbitrary coverage 
decisions, that leaves beneficiaries in the lurch. That is why this 
legislation requires the Secretary to form a task force to develop an 
efficient process for the handling of Medicare claims related to 
individuals also eligible for Medicaid coverage where the claim may not 
be covered under Medicare.
  Finally, the Home Health Nurse and Patient Act would create a task 
force that would engage in a wholesale evaluation of the process used 
by Medicare to select and review home health services' claims.
  The task force would consider such changes as establishing time 
limits for claim determinations, the use of alternative dispute 
resolution processes, the development of formal claims sampling 
protocols, allowing re-submission of corrected claims, and permitting 
physician assistants and nurse practitioners to establish care plans.
  I hope to continue to work with both providers and beneficiaries to 
take a serious look at what refinements need to occur to ensure the 
home bound elderly and disabled can receive the services they need.
  Without that fine-tuning, I am quite certain that more home health 
agencies in Wisconsin and across our country will close, leaving some 
of our frailest Medicare beneficiaries without the choice to receive 
care at home.
                                 ______
                                 
      By Mr. MURKOWSKI:
  S. 1170. A bill to make the United States' energy policy toward Iraq 
consistent with the national security policies of the United States; to 
the Committee on Finance.
  Mr. MURKOWSKI. Mr. President, I take the opportunity at this time to 
introduce S. 1170. It is my intention to introduce the following bill 
to make the United States energy policy towards Iraq consistent with 
the national security policies of the United States.
  I anticipate that several colleagues will be cosponsoring the bill 
with me. I will enter into that at a later time.
  Mr. MURKOWSKI. Mr. President, for some time I have been coming to the 
floor to speak of a major inconsistency in our foreign and energy 
policies. I am referring, of course, to our growing dependence on 
imported petroleum from Iraq.
  We import somewhere between 500,000 to 750,000 barrels of oil from 
Iraq every day. About six billion dollars worth last year. Since the 
end of the gulf war, we have also flown some 250,000 sorties to prevent 
Saddam Hussein from threatening our allies in the region. We spend 
billions every year to keep him in check.
  We fill up our planes with Iraqi oil, send our pilots to fly over and 
get shot at by Iraqi artillery, and return to fill up on Iraqi oil 
again.
  Saddam heats our homes in winter, gets our kids to school each day, 
gets our food from farm to dinner table, and we pay him well to do 
that.
  What does he do with the money he gets from oil?
  He pays his Republican Guards to keep him safe.
  He supports international terrorist activities; he funds his military 
campaign against American servicemen and women and those of our allies; 
and he builds an arsenal of weapons of mass destruction to threaten 
Israel and our allies in the Persian Gulf.
  Am I missing something? Is this good policy? For a number of years 
the United States has worked closely with the United Nations on the 
``Oil-for-Food'' Program.
  This program allows Iraq to export petroleum in exchange for funds 
which can be used for food, medicine and other humanitarian products.
  Despite more than $15 billion available for those purposes, Iraq has 
spent only a fraction of that amount on its people's needs.
  Instead, the Iraqi government spends that money on items of 
questionable, and often highly suspicious purposes. Why, when billions 
are available to care for the Iraqi people, who are malnourished, sick, 
and have inadequate medical care, would Saddam Hussein withhold the 
money available, and choose instead to blame the United States for the 
plight of his people?
  Why is Iraq reducing the amount it spends on nutrition and pre-natal 
care, when millions of dollars are available?
  Why does $200 million of medicine from the UN sit undistributed in 
Iraqi warehouses?
  Why, given the urgent state of humanitarian conditions in Iraq, does 
Saddam Hussein insist that the country's highest priority is the 
development of sophisticated telecommunications and transportation 
infrastructure?
  Why, if there are billions available, and his people are starving, is 
Iraq only buying $8 million of food from American farmers each year?
  I have no quarrel with the Oil-for-Food program. It is a well-
intentioned effort.
  I do, however, have a problem with the means in which Saddam Hussein 
has manipulated our growing dependency on Iraqi oil.
  Three times since the beginning of the Oil-for-Food program, Saddam 
Hussein has threatened or actually halted oil production, disrupting 
energy markets and sending oil prices skyrocketing.
  Why do this? Simply to send a message to the United States: ``I have 
leverage over you.''
  Every time he has done this, he has had his way. We have proven 
ourselves addicted to Iraqi oil. Saddam has been proven right: he does 
have leverage over us.
  We have placed our energy security in the hands of a madman.
  The Administration has attempted valiantly to reconstruct a sensible 
multilateral policy toward Iraq. Those attempts have unfortunately not 
been successful.
  I think that before we can construct a sensible US policy toward 
Iraq, we need to end the blatant inconsistency between our energy 
policy and our foreign policy.
  We need to end our addiction to Iraqi oil. We need to go ``cold 
turkey.''
  To that end I have introduced legislation today which would prohibit 
imports from Iraq, whether or not under the Oil for Food Program, until 
it is no longer inconsistent with our national security to resume those 
imports.
  I hope that this will be an initial step towards a more rational and 
coherent policy toward Iraq.
                                 ______
                                 
      By Mr. LEAHY (for himself, Mr. Hatch, and Mr. Kennedy):
  S. 1174. A bill to provide for safe incarceration of juvenile 
offenders; to the Committee on the Judiciary.
  Mr. LEAHY. Mr. President, I rise today to introduce with Senator 
Hatch legislation that addresses the problems caused by housing 
juveniles who are prosecuted in the criminal justice system in adult 
correctional facilities. In addition, this legislation reauthorizes the 
Juvenile Justice and Delinquency Prevention Act, to maintain the core 
protections afforded to juveniles who are adjudicated delinquent and 
detained in the juvenile court system. This two-pronged approach will 
help ensure that we treat juvenile offenders with appropriate severity, 
but also in a way that assists States in providing safe conditions for 
their confinement and appropriate access to educational, vocational, 
and health programs that address the needs of juveniles. Improving 
conditions for juveniles today will improve the public safety in the 
future, as juveniles who are not exposed to adult inmates have a lower 
likelihood of committing future crimes.
  The Justice Department reported last fall that of the 50 States and 
the District of Columbia, 44 house juveniles in adult jails and 
prisons, and 26 of those do not maintain designated youthful offender 
housing units. As a nation, we are relying increasingly on adult 
facilities to house juveniles; for example, according to the Bureau of 
Justice Statistics' survey of jails, there was a 35 percent increase in 
the number of juveniles held in adult jails between 1994 and 1997. I 
believe that there is a will in the States to improve conditions for 
these juveniles, but resources are often lacking. The Federal 
Government can play a useful role by providing funding to States that 
want to take account of the differences between juveniles and adults.
  Although many juvenile offenders serving time in adult prisons have 
committed extraordinarily serious offenses, others are there because of 
relatively minor crimes and will be released at a young age. According 
to the

[[Page S7593]]

1999 report of the Office of Juvenile Justice and Delinquency 
Prevention, 22 percent of juveniles committed to State prisons were 
there because they had committed property crimes, 11 percent because 
they committed drug-related crimes, and only 25 percent because they 
had committed murder, kidnaping, sexual assault or assault. Certainly, 
many of those juveniles can be convinced not to commit further crimes. 
The social and moral cost of not making that attempt is simply 
incalculable.
  There is stunning statistical evidence that something is deeply wrong 
with our current approach to incarcerating juveniles. According to the 
Justice Department, the suicide rate for juveniles held in adult jails 
is five times the rate in the general youth population and eight times 
the rate for adolescents in juvenile detention facilities. Juveniles in 
adult facilities are also more likely to be violently victimized. 
Sexual assault was five times more likely than in juvenile facilities, 
beatings by staff nearly twice as likely, and attacks with weapons 
almost 50 percent more common.
  Moreover, many scholars have questioned whether housing juvenile 
offenders with adult inmates serves our long-term interest in public 
safety. Multiple studies have shown that youth transferred to the adult 
system recidivate at higher rates and with more serious offenses than 
youth who have committed similar offenses but are retained in the 
juvenile justice system. Some would suggest that we should not be 
transferring youth to the adult system at all, and I am sympathetic to 
that view. But that is a decision our States must make, and for now 
most of our States have taken the contrary position. At the very least, 
then, we must ensure that juveniles are treated humanely in the 
criminal justice system to reduce the risks that upon release they will 
commit additional and more serious crimes. One of the ways we can do 
that is by helping States improve confinement conditions.
  The problem this bill is intended to address cannot be described 
simply through statistics or academic studies. The compelling stories 
of young people who have been part of the corrections system should 
command our attention. For example, United Press International and 
numerous newspapers have reported the story of 15-year-old Robert, who 
was held in a Kentucky adult jail for the minor infraction of truancy 
and petty theft. One night during his time there, Robert wrapped one 
end of his shirt around his neck, and one around the cell bars, and 
hanged himself. The county has now agreed not to house juveniles and 
adults together.
  The New York Times magazine last year told the story of Jessica, who 
at 14 was the youngest female in the Florida correctional system and, 
within her first few weeks in prison, tried to commit suicide. Jessica 
was then transferred to a rougher Miami prison where she does not 
receive psychological counseling or attend class to get her GED. 
Jessica has found an extensive surrogate prison family whom she turns 
to for advice. The woman she refers to as ``Mommy'' is serving a life 
sentence for murder. Jessica will be released at age 22 with no 
education beyond the sixth grade, no job skills, and no life experience 
outside of prison after age 13. Now some will point out that Jessica 
committed a serious criminal offense she and two older teenagers robbed 
her grandparents and she deserves harsh punishment. And I agree that we 
must deal severely with such crimes. But the fact remains that when 
Jessica is released from prison she will be 22, with an entire adult 
life ahead of her. I believe it is critical for the public safety for 
her and others like her to have options besides a life of crime.
  The Miami Herald reported the stories of Joseph Tejera and Rebekah 
Homerston. Tejera was sentenced as an adult for a burglary offense, and 
was placed in an adult prison instead of an intensive juvenile program 
where he would have received 24-hour supervision, had access to 
educational and other programs, and been surrounded by other juveniles. 
Instead, at the age of 16 and weighing 135 pounds, he was surrounded by 
adult inmates who constantly tried to beat him up. Despite a sterling 
disciplinary record, he was involved in five fights because of the 
aggressiveness of adult inmates. Homerston was the daughter of a father 
serving life in prison for sex crimes against minors and a mother 
arrested for theft and drunk driving. At the age of 13, she ran away 
from home, and lived on the streets of Fort Lauderdale. At 15, she too 
was prosecuted and sentenced to a two-year term as an adult after 
vandalizing the city's recreation center. Upon her release from that 
prison term, she was arrested at age 16 for shoplifting a shirt, and is 
now serving three and a half years in an adult facility for that 
offense. While in prison, she has witnessed numerous suicide attempts.
  Housing juveniles with adult inmates creates problems not just for 
the juveniles involved. Such policies also create difficulties for 
corrections administrators, whose prisons and jails often lack the 
physical structure, programs, and trained personnel to manage a mixed 
juvenile-adult population. John Gorsik, the head of the Department of 
Corrections in my State of Vermont, has advised that corrections 
officials from around the nation dislike having juveniles in their 
facilities. These officials often become responsible for delivering 
those services to which juveniles are entitled, including special 
education services. As one report on Youth in the Criminal Justice 
System recently recommended: ``Administrative staff and people in 
policy making positions dealing with youth in the adult system should 
have education, training, and experience regarding the distinctive 
characteristics of children and adolescents.'' This bill would provide 
for such education and training to make the jobs of corrections 
officials around the nation easier. In addition, the presence of 
juveniles among adult inmates can lead to increased disciplinary 
problems and the inculcation of a criminal mentality in young, highly 
impressionable offenders like Jessica. Our prisons and jails are too 
often becoming schools for young lawbreakers.
  I would like to explain how this bill addresses confinement 
conditions for juveniles.
  Title I: The first title of this bill creates a new incentive grant 
program for State and local governments and Indian tribes. These grants 
can be used for the following purposes related to juveniles under the 
jurisdiction of an adult criminal court: (a) alter existing 
correctional facilities, or develop separate facilities, to provide 
segregated facilities for them, (b) provide orientation and ongoing 
training for correctional staff supervising them, (c) provide monitors 
who will report on their treatment, and (d) provide them with access to 
educational programs, vocational training, mental and physical health 
assessment and treatment, and drug treatment. Grants can also be used 
to seek alternatives to housing juveniles with adult inmates, including 
the expansion of juvenile facilities.
  It is important to note that States that choose not to house 
juveniles who are convicted as adults with adult inmates are still 
eligible for grants under this bill. For example, they could use the 
money to train staff, or to provide educational or other programs for 
juveniles, or to improve juvenile facilities.
  Applicants for these grants must provide a detailed plan explaining 
how they will improve conditions for juveniles in their adult 
corrections system. Let me be clear: the purpose of this grant program 
is not to fuel a prison-building boom, or to make it easier for States 
to prosecute juveniles as adults, but to improve conditions for 
juveniles. States will need to take this purpose into account in making 
their grant proposals. Moreover, to be eligible for a grant, States 
must have developed guidelines on the appropriate use of force against 
incarcerated juveniles, and must also have prohibited the use of 
electroshock devices, chemical restraints and punishment, and 4-point 
restraints. The use of such punishment is inconsistent with our 
commitments to treating juveniles humanely, and is at variance with the 
very purpose of this grant program. Every State that can meet the 
requirements of the grant program will receive funding under 
this title, and rural representation is guaranteed.

  Title II: The second title of the bill authorizes States to use their 
Violent Offender Incarceration/Truth in Sentencing (VOI/TIS) grant 
money to improve the treatment of juveniles under

[[Page S7594]]

the jurisdiction of the adult criminal justice system. It also offers 
States an incentive to use a substantial percentage of their VOI/TIS 
money for that purpose. States that use 10 percent of their grant money 
to improve juvenile conditions will receive a bonus of 5 percent above 
the amount to which they are otherwise entitled under that program. The 
money can be used to alter existing facilities to provide separate 
space for juveniles under the jurisdiction of an adult criminal court, 
or to provide training and supervision of corrections officials and 
reporting on juvenile conditions. This title, in conjunction with Title 
I, allows us to make improving conditions for juveniles a national 
priority by working through the States. No State will be forced to use 
their money for this purpose or see their funding reduced if they 
choose not to. But those States that do make a serious effort in this 
regard will be rewarded.
  Title III: The third title of this bill reauthorizes the Juvenile 
Justice and Delinquency Prevention Act. Under the JJDPA, States 
receiving federal funds must maintain core protections for detained 
juveniles. These protections include ``sight'' and ``sound'' separation 
between those in the juvenile detention system and adult offenders. 
Children cannot be put in adjoining cells with adults, or placed in 
circumstances that allow them to be subject to threats and verbal abuse 
from adults in dining halls, recreation areas, and other common spaces. 
In addition to establishing sight and sound separation, the JJDPA 
provides three additional core protections: (1) removal of juveniles 
from adult jails or lockups, with a 24-hour exception for rural areas 
and other exceptions for travel and weather-related conditions; (2) 
deinstitutionalization of status offenders; and (3) efforts toward 
reducing the disproportionate confinement of minority youth in the 
juvenile justice system.
  I am very pleased that Senator Hatch has agreed with me that we need 
a straightforward reauthorization of the JJDPA. He and I both worked 
very hard in the last Congress to reauthorize that law, and our efforts 
were sidetracked by numerous factors.
  Title IV: Finally, the fourth title of this bill contains a number of 
provisions that I would like to highlight today. First, it authorizes 
funding for rural States and economically distressed communities that 
lack the resources to provide secure custody for juvenile offenders. 
Second, this title calls for a study on the effect of sentencing 
juvenile drug offenders as adults. Many have raised concerns about the 
toll taken on some of our communities, especially those in poorer 
areas, by lengthy drug sentences. There is no question that the 
proliferation of illegal drugs over the last 20 years has presented a 
social crisis with particularly serious effects on poor and urban 
communities. But we need to take a systematic look at whether our 
approach to that crisis has been effective and fair, and the study in 
this bill should be part of that effort. Third, this bill instructs the 
General Accounting Office to prepare a report on the prevalence and 
effects of the use of electroshock weapons, 4-point restraints, 
chemical restraints, restraint chairs, and solitary confinement against 
juvenile offenders in both the Federal and State corrections systems. I 
am deeply concerned about the disciplinary methods being used against 
juvenile offenders in the U.S., and I believe it is important for 
Congress to receive an accounting of the problem so we can consider 
whether further legislation in this area is appropriate. Fourth, this 
title reauthorizes the Family Unity Demonstration Project, which 
provides funding for projects allowing eligible prisoners who are 
parents to live in structured, community-based centers with their young 
children. A study by the Bureau of Justice Statistics found that about 
two-thirds of incarcerated women were parents of children under 18 
years old. According to the White House, on any given day, America is 
home to 1.5 million children of prisoners. And according to Prison 
Fellowship Industries, more than half of the juveniles in custody in 
the United States had an immediate family member behind bars. This is a 
serious problem, and reauthorizing the Family Unity Demonstration 
Project will help us address it.
  I would like to thank numerous people who have worked with me and my 
staff on this proposal: Ken Schatz of the Vermont Children and Family 
Council, Marc Schindler and Mark Soler of the Youth Law Center, David 
Doi of the Coalition for Juvenile Justice, Jill Ward from the 
Children's Defense Fund, and John Gorsik and John Perry at the Vermont 
Department of Corrections. Without their help, I would not be able to 
introduce this bill today.
  In conclusion, let me say that Congress must act to ensure that 
minimum standards are created in as many States as possible to 
ameliorate the problems resulting from sentencing juveniles as adults. 
I think this bipartisan bill accomplishes that goal, and I urge the 
Senate to give its full consideration, and its approval, to this 
proposal.
                                 ______
                                 
      By Ms. SNOWE (for herself, Ms. Collins, Mr. Jeffords, and Mr. 
        Leahy):
  S. 1177. A bill to amend title XI of the Social Security Act to 
clarify that the Secretary of Health and Human Services has the 
authority to treat certain State payments made in an approved 
demonstration project as medical assistance under the Medicaid program 
for purposes of a rebate agreement under section 1927 of the Social 
Security Act, and for other purposes; to the Committee on Finance.
  Ms. SNOWE. Mr. President, I rise today to introduce a bill along with 
Senator Collins, Jeffords and Leahy to provide the states of Maine and 
Vermont continued authority to expand access to discounted prescription 
drugs under Medicaid.
  Maine has instituted an innovative demonstration program called the 
``Healthy Maine Prescriptions'' program that is leading the way in 
providing affordable prescription drugs for qualifying Maine residents. 
This was made possible because Maine is one of two States, along with 
Vermont, to have received approval from the Secretary of the Department 
of Health and Human Services for demonstration projects to expand 
access to prescription drugs under Medicaid. Thousands of individuals 
with no other prescription drug insurance benefits are enrolled in 
those programs.
  The sad truth is, many low-income individuals cannot afford to 
purchase the drugs prescribed by their doctors. The result is that 
these individuals either split the doses to make them last longer--in 
violation of doctors' orders; they cut back on other necessities like 
food or clothing; or they simply decide not to fill the prescription at 
all--surely a prescription for medical disaster.
  Not only does the inability to pay for medications have an adverse 
and potentially dangerous effect on individuals, it is also a detriment 
to the health care system in general when you consider the number and 
expense of ailments that could have been prevented with the proper 
prescription drug.
  The reason why we are introducing this legislation is that, 
unfortunately, last month, a three-judge panel of the U.S. Court of 
Appeals for the District of Columbia ruled against the Vermont program, 
finding that Vermont ``lacked the authority to offer the same 
prescription rebates offered under federal Medicaid insurance'' because 
Congress ``imposed rebate requirements to reduce the cost of 
Medicaid.'' More recently, because of that ruling, a complaint has been 
brought by PHARMA against the Secretary of Health and Human Services to 
provide injunctive relief in the case of Maine's program.
  This bill sets forth findings that support the need and legitimacy of 
the Maine and Vermont programs and provides, in statute, specific 
authority for these prescription drug discounts for states whose 
waivers were approved before January 31, 2001.
  Specifically, the bill amends Section 1115 of the Social Security 
Act--the portion of the act granting the Secretary of Health and Human 
Services the authority to approve demonstration projections. It makes 
clear that any expenditures the state may make under the demonstration 
project will be treated as payments made under the state plan under 
Medicaid for covered outpatient drugs for purposes of a rebate 
agreement, regardless of whether these expenditures by the state are 
offset or reimbursed, in whole or in part, by rebates received under 
such an agreement.

[[Page S7595]]

  It also makes clear that these projects are entirely consistent with 
the objectives of the Medicaid program. Finally, it states that the 
regular cost-sharing requirements under Medicaid do not have to apply 
in the instance of these programs.
  One of the objectives of the Medicaid program is ``to enable each 
State, as far as practicable under the conditions in such State, to 
provide medical assistance on behalf of families with dependent 
children and of aged, blind, or disabled individuals, whose income and 
resources are insufficient to meet the costs of necessary medical 
services.'' As part of carrying out this objective, every state has 
elected the option of providing prescription drugs as a benefit under 
the Medicaid program, thereby providing an important means of 
increasing the access of low-income individuals to drugs prescribed by 
their doctors.
  Furthermore, Section 1115 of the Social Security Act provides the 
Secretary of Health and Human Services with broad authority to approve 
demonstration projects that are likely to assist in promoting the 
objectives of the Medicaid program, and waive compliance with any of 
the state plan requirements of the Medicaid program. The fact of the 
matter is, Medicaid demonstration projects help promote the objectives 
of the Medicaid program, including obtaining information about options 
for increasing access to prescription drugs for low-income individuals.
  If indeed the States are truly laboratories of democracy--and I 
believe they are--these demonstration projects deserve the chance to 
work, to be examined, and to assist those that they are designed to 
assist. And there is no question of the need--in Maine, 50,000 people 
signed up within the first three weeks of the program.
  Under the ``Healthy Maine Prescriptions Program,'' Maine provides 
prescription drug discounts of up to 25 percent for all adults with 
incomes of up to 300 percent of the Federal Poverty Level. A second 
benefit offering discounts of 80 percent of the cost of prescription 
drugs is available for disabled citizens, and low-income adults over 
the age of 62 who have an income of up to 185 percent of the Federal 
Poverty Level.
  During this time when virtually everyone agrees that something must 
be done to increase access to affordable prescription drugs, we ought 
to be encouraging innovative programs like those in Maine and Vermont. 
Terminating Medicaid demonstration projects prior to their planned 
expiration dates may result in significant waste of public funds and 
may be detrimental to those who have come to rely on such projects.
  We ought to be doing all we can to provide relief to low-income 
Americans, and at the same time give ourselves the opportunity to 
evaluate what works and what doesn't. Maine and Vermont are to be 
commended for their efforts, not punished--they are entirely in keeping 
with the spirit and intent of Medicaid and I hope my colleagues will 
recognize the value of these demonstration projects.
  Ms. COLLINS. Mr. President, I am pleased to join with my colleague 
from Maine, Senator Snowe, and my colleagues from Vermont, Senators 
Jeffords and Leahy, in introducing legislation to ensure that States 
like Maine and Vermont, which have taken the initiative in developing 
innovative programs to make prescription drugs more affordable for 
their citizens, can proceed with these efforts.
  The last 20 years have witnessed dramatic pharmaceutical 
breakthroughs that have helped reduce deaths and disability from heart 
disease, cancer, diabetes, and many other diseases. As a consequence, 
millions of people around the world are leading longer, healthier, and 
more productive lives. These new medical miracles, however, often come 
with hefty price tags, and many people--particularly lower Americans 
without prescription drug coverage--are simply priced our of the 
market.
  As so often happens, the States have been the laboratories for reform 
in this area and have come up with some creative ways to address this 
problem. In January of this year, the Department of Health and Human 
Services granted Maine a waiver under the Medicaid program through 
which States can offer drug discounts of up to 25 percent for 
individuals with incomes up to three times the Federal poverty level. 
Our new Healthy Maine Prescriptions Program includes both this new 
discount prescription drug benefit and a separate benefit, financed 
entirely with State funds, that offers discounts of up to 80 percent 
for low-income elderly and the disabled. Maine began providing benefits 
under the Healthy Maine Prescription Program on June 1st of this year, 
and by June 26th the Department of Human Services had enrolled 50,460 
individuals into the program. Ultimately, it is estimated that 225,000 
Mainers qualify for the program.
  Unfortunately, however, this important new program has run into a 
stumbling block. Last month, in a case brought by the Pharmaceutical 
Research and Manufacturers of America (PhRMA), a three-judge appeals 
panel ruled that a similar program developed by Vermont ``lacked the 
authority to offer the same prescription rebates offered under federal 
Medicaid insurance'' because Congress ``imposed rebate requirements to 
reduce the cost of Medicaid.'' The pharmaceutical trade group has 
subsequently sued the Department of Health and Human Services to block 
the Maine waiver, and the State of Maine has become a party to that 
case.
  The Maine program is different enough from Vermont's to provide a 
different result in court. However, we believe that innovative programs 
like these, which meet such a clear human need, should be able to 
proceed without having to fight endless legal battles. That is why we 
are introducing legislation today to give the Department of Health and 
Human Services clear authority to grant States these kinds of waivers, 
which will allow them to pursue innovative uses of Medicaid, such as 
the Health Maine Prescription program. Secretary of Health and Human 
Services Tommy Thompson made creative use of these kinds of Medicaid 
waivers when he was Governor of Wisconsin. We believe that he should be 
able to continue to do so in his new role as Secretary without the 
chilling effect brought by lawsuits like PhRMA's.
  The legislation we are introducing today will allow States like Maine 
to proceed with the innovative programs they have developed to meet the 
prescription drug needs of their citizens, and I urge all of my 
colleagues to join us in cosponsoring the legislation.

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