[Congressional Record Volume 147, Number 147 (Tuesday, October 30, 2001)]
[Senate]
[Pages S11199-S11216]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. LIEBERMAN (for himself and Mr. Ensign):
S. 1585. A bill to establish grant and scholarship programs to enable
hospitals to retain and further educate their nursing staffs; to the
Committee on Health, Education, Labor, and Pensions.
Mr. LIEBERMAN. Madam President, I rise today to introduce the
Hospital Based Nursing Initiative Act, a bill that will create new and
innovative incentives to lessen the impact of the critical shortage of
nurses in our Nation's hospitals. I am very pleased that my respected
colleague, Senator John Ensign, is joining as sponsor of this
legislation/
Before I get into the specific about the bill, I'd like to talk about
the overall condition of nursing in America for a moment. Several
studies have been completed in the past year that show troubling trends
developing in this historic profession. Take for example, the study
that reflects a 41 percent dissatisfaction rate among nurses in
America, higher than the dissatisfaction rate in most other countries
throughout the world. Think about that for a moment, 4 out of 10 nurses
in America are dissatisfied with their profession.
Another study reveals that nearly one third of nurses under the age
of 30 plan to leave the nursing profession within the next year. In
addition, the average age of nurses in America is 45, with many nurses
headed toward early retirement. We cannot afford to lose both the older
and younger nurses at the same time. Further, while the number of
people that are being hospitalized may continue to decrease, those
people who are being admitted are sicker and need more intensive
nursing care. Not a very rosy picture for patients who are sick. We
need to ask will there be someone to provide care for them?
The shortage of nurses has severely affected the health care
industry. And hospitals have been hit the hardest since nearly 60
percent of nurses work in hospitals. Further, we know that when nurses
have more autonomy, greater control and input into the decision making
process, and better communication with physicians and hospital
administration, they are more likely to experience greater job
satisfaction and stay in their jobs longer. These very tenets make up
the American Nurse Credentialing Center's ``Magnet'' accreditation
process of nursing services at hospitals. As a result, Magnet hospitals
lead the way in attracting and retaining nurses.
Many hospitals have begun to take these steps already. But more must
be done. There must be incentives for hospitals to revise their
management principles to improve the quality of the work environment in
the hospital, initiate aggressive retention programs for nurses
currently working in the hospital setting, and create the types of
programs that will increase personal and professional satisfaction for
the nurses in their facilities.
That is why I am introducing the Hospital Based Nursing Initiative
Act of 2001. This bill will create innovative incentives for hospitals
that have taken the first steps in developing aggressive retention
techniques and develop a scholarship program for hospital-based nurses
to return to school on full tuition scholarship to complete a nursing
degree.
The first component of this bill will create a competitive grant
program that would provide funds to hospitals of up to $600,000 based
on staffed bed size for nursing services to use to bolster their
retention efforts and improve the work environment for the nursing
staff in the hospital. These grants would be made available every two
years on a competitive basis. Several major nursing and hospital
organizations, such as the American Hospital Association, American
Nurses Association, American College of Health Care Executives, the
American Organization of Nurse Executives, the American Academy of
Nursing, the Pennsylvania State Nurses Association and the American
Federation of Hospitals have wholeheartedly endorsed this bill. I am
pleased that legislation which incorporates a number of ideas in this
bill is moving toward markup in the Senate Health, Education, Labor and
Pensions Committee. I appreciate the cooperative spirit with which
members of the committee have worked together on these ideas.
The second part of my bill would allow nurses who work in hospitals
to return to school on a full tuition scholarship in order to complete
a Bachelor of Science in Nursing. This ``Bridge'' scholarship program
targets the nearly 55 percent of the nursing workforce who hold an
Associate's Degree in Nursing or Diploma in Nursing. Under the Bridge
program, nurses will have up to three years to complete the Bachelor's
degree. In turn, nurses who accept the scholarship must agree to work
in the sponsoring hospitals for the same number of months that they
receive scholarship funding. This program is a win-win situation: It
provides ongoing advanced education for nurses who seek a higher level
of training and we keep skilled nurses working in our hospitals.
We have the opportunity to make a difference. With the bill that
Senator
[[Page S11200]]
Ensign and I are now introducing, we can take the necessary steps to
thwart the nursing shortage and provide the critical incentives for
hospitals to retain their nurses. We must do all we can to improve job
satisfaction for nurses, provide them with opportunities for advanced
education, and keep nurses on the job. The Hospital Based Nursing
Initiative is the right bill at the right time. I urge my colleagues to
support this legislation and help ease the burden on hospitals and
nurses in our hospitals.
I ask unanimous consent that the text of the bill be printed in the
Record. I further ask unanimous consent that letters supporting this
legislation and its approach from each of the organizations I cited
above likewise be printed in the Record.
There being no objection, the bill and additional material was
ordered to be printed in the Record, as follows:
S. 1585
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 ``Hospital-Based Nursing
Initiative Act of 2001''.
SEC. 2. FINDINGS.
Congress finds that--
(1) a Department of Health and Human Services study found a
correlation between the number of registered nurses on the
staff of a facility and patient health outcomes;
(2) studies have shown that hospitals that promote greater
autonomy for nurses, greater nurse control and input into the
decisionmaking process in the hospital setting, better
communication between nurses and physicians, and input from
nurses at the executive level in the hospital lead to
increased retention of and satisfaction for nurses;
(3) the job dissatisfaction rate among nurses in the United
States, 41 percent, is higher than in most other countries;
(4) \1/3\ of nurses under the age of 30 are planning to
leave the nursing profession within the next year;
(5) hospitals employ nearly 60 percent of the entire
nursing workforce;
(6) while the number of inpatient hospitalizations is
expected to continue to decrease, the acuity of those
patients requiring hospital stays is expected to increase;
(7) the projected supply of registered nurses is
anticipated to grow at a rate of less than 1.5 percent per
year through the next 8 years, while the demand rate (growth)
is projected to be over 21 percent per year;
(8) there must be incentives for hospitals to revise
management principles to improve the quality of the work
environment in hospitals, initiate aggressive retention
programs for the nurses currently employed in hospital
settings, and employ aggressive recruiting tactics to attract
nurses back to hospital settings; and
(9) while numerous hospitals have begun to take the
necessary steps to address these issues, Congress recognizes
the need for intervention and stimulus.
SEC. 3. NURSE GRANT AND SCHOLARSHIP PROGRAMS.
Title VIII of the Public Health Service Act (42 U.S.C. 296
et seq.) is amended by adding at the end the following:
``PART H--NURSE GRANT AND SCHOLARSHIP PROGRAM
``SEC. 851. DEFINITIONS.
``In this part:
``(1) Division.--The term `Division' means the Nursing
Division of the Bureau of Health Professions of the Health
Resources and Services Administration.
``(2) Nurse leadership.--The term `nurse leadership'
includes--
``(A) nurse executives;
``(B) nurse administrators; and
``(C) nurse managers.
``(3) Professional nurse.--The term `professional nurse'
means a registered nurse who holds a valid and unrestricted
license to practice nursing in a State.
``SEC. 852. QUALITY OF WORK ENVIRONMENT AND RETENTION GRANT
PROGRAM.
``(a) Authorization of Grants.--The Secretary may award
grants to hospitals--
``(1) to improve the quality of the work environment in
hospitals;
``(2) to initiate aggressive retention programs for nurses
employed in hospitals; and
``(3) to employ aggressive recruiting tactics to attract
nurses back to hospitals.
``(b) Application.--
``(1) Development of application form.--Not later than
October 1, 2002, the Secretary shall develop an application
form that a hospital shall use in applying for a grant under
this section.
``(2) Submission.--Each hospital desiring a grant under
subsection (a) shall submit an application to the Division at
such time, in such manner, and accompanied by such
information as the Secretary may reasonably require.
``(3) Duties of the division.--The Division shall--
``(A) review each application submitted under paragraph
(2); and
``(B) not later than 30 business days after receipt of an
application submitted under paragraph (2), forward the
application to the Secretary with a recommendation as to
whether the Secretary should award a grant to the applicant.
``(4) Duties of the secretary.--Not later than 30 business
days after receipt of an application from the Division under
paragraph (3), the Secretary shall determine whether to award
a grant to the applicant.
``(c) Grant Approval Criteria.--
``(1) Priority criteria.--The Secretary shall give priority
in awarding grants under this section to hospitals that have
not previously received a grant under this section.
``(2) Requirements.--Before awarding a grant under
subsection (a), the Secretary shall assure that the hospital
meets the following criteria:
``(A) Multiple grants.--The hospital has not received a
grant under this section during the previous 2 year period.
``(B) System of patient outcomes measurement.--
``(i) In general.--The nurse leadership and professional
nurses of the hospital have developed a system of patient
outcomes measurement.
``(ii) Delivery of care.--The system of patient outcomes
measurement under clause (i) evaluates the specific care
needs of the patients served by the hospital and the
educational needs of the nursing staff of the hospital to
ensure that the care the hospital is providing is meeting the
needs of the patients.
``(iii) Funding.--The hospital allocates sufficient funds
to carry out the system of patient outcomes measurement under
clause (i).
``(C) Decisionmaking.--
``(i) Multidisciplinary approach.--The hospital uses a
multidisciplinary decisionmaking process that incorporates
the input of the nursing staff of the hospital when
refinements, resulting from the evaluation under subparagraph
(B)(ii), are developed.
``(ii) Participation in decisionmaking.--The nurse
leadership of the hospital has developed and implemented
policies and practices that--
``(I) ensure participation of the nursing staff of the
hospital in the decisionmaking processes of the hospital; and
``(II) foster the nursing staff's ability to maintain
autonomy in the delivery of care.
``(D) Nurse executive participation.--The nurse executive
in the hospital participates and provides input in all facets
of senior level management as a member of the executive team
of the hospital.
``(E) Nurse retention committee.--The nurse leadership of
the hospital has organized a Nurse Retention Committee that--
``(i) includes nursing staff representatives from the
various nursing specialties practicing in the hospital;
``(ii) meets on a regular basis and forwards
recommendations for initiatives to increase nurse retention
to the nurse leadership; and
``(iii) works with the nurse leadership of the hospital to
address and forward the recommendations under clause (ii) to
the executive team of the hospital.
``(F) Nurse residency training program.--
``(i) In general.--The hospital has developed a Nurse
Residency Training Program (referred to in this section as
the `NRTP') for--
``(I) new graduate nurses entering the workforce on a full-
time basis in a hospital setting; and
``(II) nurses returning to a hospital staff on a full-time
basis after an absence of not less than 3 years without
working in the nursing field.
``(ii) Returning nurses.--The nurse leadership of the
hospital evaluates the skills and competencies of each nurse
described in clause (i)(II) to determine--
(I) whether that nurse needs to participate in the NRTP;
and
(II) for how long that nurse should participate in the NRTP
if it is determined under subclause (I) that the nurse needs
to participate in the NRTP.
``(iii) Training.--The--
``(I) hospital coordinates, to the greatest extent
possible, the NRTP with an accredited school of nursing; or
``(II) NRTP is not less than 3 months and not more than 1
year in duration and accommodates sufficient training
opportunities as determined by the nurse leadership in the
facility.
``(G) Continuing education.--The hospital promotes and, to
the greatest extent possible, provides continuing education
for the nursing staff--
``(i) to obtain nursing-related certification;
``(ii) to maintain continuing education units as required
for nursing-licensure; and
``(iii) to further clinical skills through advanced
training opportunities.
``(H) Recognition and reward program.--The hospital has
developed a recognition and reward program in conjunction
with subparagraph (G) for a nurse who obtains a nursing-
related certification from an accredited or professionally
recognized organization that provides--
``(i) financial recognition and rewards; or
``(ii) non-financial recognition and rewards that are
determined by the Nurse Retention Committee of the hospital
to be appropriate.
``(d) Allocation.--
``(1) In general.--The Secretary shall determine the amount
of a grant awarded to a hospital under this section on a case
by case basis subject to paragraph (2).
``(2) Maximum amounts.--The Secretary shall not award a
grant exceeding--
``(A) $200,000 for a hospital with less than 100 staffed
beds;
[[Page S11201]]
``(B) $400,000 for a hospital with less than 400 staffed
beds; and
``(C) $600,000 for a hospital with 400 or more staffed
beds.
``(e) Receipt of Funds.--Not later than 60 days after
awarding a grant to a hospital under subsection (a), the
Secretary shall distribute the grant funds to the hospital.
``(f) Uses of Funds.--A grant awarded to a hospital under
subsection (a) shall be used for 1 or more of the following:
``(1) Improvements to the work environment of the hospital
for the nursing staff that improves the nursing staff's job
satisfaction or safety, or both.
``(2) To provide continuing education programs for the
nursing staff.
``(3) To continue the Nurse Residency Training Program.
``(4) To carry out initiatives recommended by the Nursing
Retention Committee of the hospital to increase retention of
the nursing staff.
``(g) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $30,000,000 for
each of fiscal years 2003 through 2005 and such sums as are
necessary for each of fiscal years 2006 and 2007.
``SEC. 853. BRIDGE SCHOLARSHIP PROGRAM.
``(a) Program Authorized.--The Secretary shall establish a
Bridge Scholarship Program (referred to in this section as
the `program') to provide scholarships to hospital-based
professional nurses to enable such nurses to complete a
Bachelor of Science in Nursing degree (referred to in this
section as the `degree') in exchange for service from such
nurses in sponsoring hospitals upon completion of such
degree.
``(b) Eligibility.--To be eligible to participate in the
program an individual shall--
``(1) be employed by a hospital;
``(2) be accepted for enrollment, or be enrolled, in an
accredited school of nursing;
``(3) submit the required materials in accordance with
subsection (c)(2); and
``(4) be able to complete the degree not later than 3 years
after enrolling in the accredited school of nursing.
``(c) Application Process.--
``(1) Development of application form.--The Secretary shall
develop an application form that an individual shall use to
apply for a scholarship under the program.
``(2) Submission.--Each individual desiring a scholarship
under the program shall submit to the hospital where the
individual is employed--
``(A) an official letter from each State licensing agency
where the individual is licensed to practice nursing that the
individual--
``(i) has an unrestricted license to practice nursing; and
``(ii) is in good standing;
``(B) an application for participation in the program;
``(C) proof of acceptance for enrollment, or enrollment in,
an accredited school of nursing; and
``(D) a written contract accepting payment of a scholarship
in exchange for providing the required service in the
hospital where the individual is employed.
``(3) Duty of the hospital.--A hospital that receives the
materials described in paragraph (2) shall--
``(A) make a determination as to whether to enter into the
contract under paragraph (2)(D) with the individual; and
``(B) if the hospital elects to enter into the contract
with the individual, not later than May 31 of each calendar
year, forward the materials it receives under paragraph (2)
to the Division.
``(4) Duties of the division.--The Division shall--
``(A) review the materials forwarded under paragraph (3);
and
``(B) not later than 30 days after receipt of the materials
forwarded under paragraph (3), forward the materials to the
Secretary with a recommendation as to whether the Secretary
should award a scholarship to the applicant.
``(5) Duties of the secretary.--Not later than 30 days
after--
``(A) receipt of the materials forwarded under paragraph
(4), the Secretary shall approve or disapprove the
application submitted under paragraph (2); and
``(B) the Secretary approves or disapproves an application
under subparagraph (A), the Secretary shall notify the
applicant in writing of the approval or disapproval.
``(d) Contract.--
``(1) In general.--The Secretary shall develop a written
contract for participation in the program.
``(2) Content.--The contract described in paragraph (1)
shall be an agreement between the Secretary, the individual,
and the sponsoring hospital that states that, subject to
paragraph (3)--
``(A) the Secretary agrees to--
``(i) provide the individual with a scholarship in each
school year, not to exceed 3 years, in which the individual
is pursuing the degree; and
``(ii) accept the individual into the program;
``(B) the individual agrees to--
``(i) accept any provision of such a scholarship;
``(ii) maintain enrollment in the accredited school of
nursing until the individual completes the degree;
``(iii) while enrolled in the accredited school of nursing,
maintain an acceptable level of academic standing; and
``(iv) work as a nurse at the sponsoring hospital upon
completion of the degree for a period of 1 month for each
month the individual was provided a scholarship under the
program; and
``(C) the sponsoring hospital agrees to--
``(i) provide the option for the individual to work as a
nurse while the individual is enrolled in the accredited
school of nursing for any employment-shifts on which the
individual and sponsoring hospital jointly agree (such work
will not count towards the requirements of the individual to
work at the sponsoring hospital under subparagraph (B)(iv));
and
``(ii) if the sponsoring hospital terminates the employment
of the individual while the individual is working at the
sponsoring hospital pursuant to subparagraph (B)(iv), submit
to the Secretary a written explanation as to why the
individual was terminated.
``(3) Limitation.--The contract described in paragraph (1)
shall contain a provision that any financial obligation of
the United States arising out of a contract entered into
under this section and any obligation of the individual and
the sponsoring hospital which is conditioned thereon, is
contingent upon funds being appropriated for scholarships
under this section.
``(e) Payment.--
``(1) In general.--A scholarship provided to an individual
under the program shall consist of payment to, or (in
accordance with paragraph (2)) on behalf of, the individual
of the amount of the tuition of the individual in such school
year.
``(2) Contract.--The Secretary may contract with an
accredited school of nursing, in which an individual in the
program is enrolled, for the payment to the accredited school
of nursing of the amount of tuition described in paragraph
(1).
``(f) Breach of Agreement.--
``(1) Individual.--Subject to paragraph (3), if an
individual participates in the program under this section and
agrees to work as a nurse at the sponsoring hospital for a
period of time in consideration for receipt of a scholarship
to pursue a degree, the individual is liable to the Federal
Government for the amount of such scholarship, and for
interest on such amount at the maximum legal prevailing rate,
if the individual--
``(A) fails to work as a nurse in accordance with
subsection (d)(2)(B)(iv);
``(B) fails to maintain an acceptable level of academic
standing in the degree program (as indicated by the
accredited school of nursing in accordance with requirements
established by the Secretary);
``(C) is dismissed from the degree program for disciplinary
reasons; or
``(D) voluntarily terminates the degree program.
``(2) Sponsoring hospital.--If the sponsoring hospital
fails to comply with subsection (d)(2)(C)(ii), the sponsoring
hospital is liable to the Federal Government for the amount
of the scholarship, and for interest on such amount at the
maximum legal prevailing rate, of the individual whose
employment was terminated.
``(3) Waiver or suspension of liability.--The Secretary
shall waive liability--
``(A) under paragraph (1) if compliance by the individual
with the agreement involved is impossible due to a
catastrophic life event of the individual; or
``(B) under paragraph (1)(A) if the sponsoring hospital
terminates the employment of the individual.
``(g) Report.--
``(1) In general.--Not later than 18 months after the first
scholarship is awarded under this section, the Division shall
submit to Congress a report evaluating the success of the
program.
``(2) Information.--In order to prepare the report under
paragraph (1), the Division shall maintain information about
the scholarship recipients under this section, including--
``(A) grade reports from the accredited schools of nursing;
``(B) the degree graduation rate; and
``(C) the default rate on the contracts under the program.
``(h) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $20,000,000 for
each of fiscal years 2003 through 2005 and such sums as are
necessary for each of fiscal years 2006 and 2007.''.
____
American Hospital Association,
Washington, DC, October 8, 2001.
Hon. Joseph Lieberman,
U.S. Senate, Washington, DC.
Dear Senator Lieberman: The American Hospital Association
(AHA) commends your efforts to address the nursing workforce
shortage in your bill, The Hospital-Based Nursing Initiative
Act of 2001, and is pleased to endorse your legislation. We
believe your bill is an important component in the overall
strategy of addressing the national nursing shortage.
The AHA represents nearly 5,000 hospitals, health systems,
networks and other health care provider members.
Hospitals and health care facilities across America are
experiencing a critical shortage of nurses. A recent AHA
survey of the workforce shows that there are currently up to
126,000 Registered Nurses (RNs) needed by hospitals today.
Over the past five years, enrollments in nursing programs
have declined and this trend is expected to continue for the
foreseeable future. The average age of a working RN is now
over 43 years old, and is expected to continue to increase
before peaking at age 45.5 in 2010, when many RNs will
[[Page S11202]]
begin to retire. And, the need for nurses will be further
compounded by the potential health care demands of the
looming 78 million aging ``baby boomers'' who will begin to
retire over the next 10 years.
The current nursing shortage is creating an environment
with the potential to jeopardize hospitals' ability to
provide timely access to non-emergency, as well as emergency,
services. An inadequate number and mix of personnel has
caused some facilities to close beds, put emergency rooms on
``divert'' status, delay elective surgeries, and pare down
hospital services.
Hospitals have enlisted many strategies and creative
approaches to address the nursing shortage, but this is a
complex problem that cannot be solved by hospitals alone. The
role of the federal government is critical in the support and
funding of an adequate nursing workforce.
``The Hospital-Based Nursing Initiative Act of 2001''
provides significant incentives for hospitals to examine and
revise management principles to improve the quality of their
work environment, and to foster effective RN retention
programs. It establishes incentives for hospitals to develop
and implement aggressive recruitment programs to attract
nurses into the hospital setting. The legislation also
creates bridge programs for RNs currently employed in
hospitals to move up the career ladder, a significant
recruitment and retention tool.
Helping alleviate the critical shortage of nurses is a
priority for health care providers. As we debate this and
other measures to address the nursing shortage, we hope
Congress will recognize the important of investing in this
critical area of need. We applaud your effort and pledge to
work with you to address this very important issue.
Sincerely,
Rick Pollack,
Executive Vice President.
____
American Organization
of Nurse Executives,
Washington, DC, September 14, 2001.
Hon. Joseph I. Lieberman,
U.S. Senate, Washington, DC.
Dear Senator Lieberman: On behalf of more than 3800 members
of the American Organization of Nurse Executives (AONE)
representing nurses in executive practice, I would like to
express our strong support for the ``Hospital-Based Nursing
Initiative Act of 2001,'' legislation that you have authored
and plan to introduce to address the critical nurse shortage.
During the past year, AONE has played a pivotal role in
addressing the nursing shortage. In October 2000 we published
the first comprehensive monograph on this critical issue
entitled Perspectives on the Nursing Shortage: A Blueprint
for Action and have continued to provide both education and
advocacy for the nursing profession on a number of different
fronts. Your bill will provide important management
incentives for hospitals to revise their management of
nursing services in order to foster retention and promote
recruitment of nurses back into the inpatient delivery
system.
The majority of AONE's membership are leaders in the day-
to-day management and delivery of direct patient care
services, as a result, we understand firsthand the impacts
and consequences of the growing nursing shortage both in this
country and internationally. Our support of the ``Hospital-
Based Nursing Initiative Act of 2001'' is based on the
positive contributions that this legislation will make to
nurse-directed efforts to foster retention and promote
recruitment of nurses within the inpatient settings of our
federal, community, and private hospitals. This legislation
will also establish important bridge programs for registered
nurses currently employed in hospitals to move from diploma
and Associate Degree levels of education on to a Bachelor of
Science degree within three years.
AONE applauds your efforts to address the nursing shortage
through this innovative grant and scholarship program. We
look forward to working with you to solve this critical
health manpower problem.
Sincerely,
Pamela A. Thompson, MSN, RN,
Executive Director.
Dianne Anderson, MS, RN,
President.
____
American Nurses Association,
Washington, DC, September 19, 2001.
Hon. Joseph Lieberman,
U.S. Senate, Washington, DC.
Dear Senator Lieberman: I am writing you on behalf of the
American Nurses Association (ANA) to express support for the
Hospital-Based Nursing Initiative Act. We applaud your hard
work on this important issue. ANA is the only full-service
association representing the nation's registered nurses (RNs)
through its 54 state and territorial member nurse
associations. With more than 160,000 members, the ANA
represents RNs in all practice settings throughout our
nation.
ANA understands that a major contributing factor to the
current and emerging nursing shortage is dissatisfaction with
the work environment. The Congressional Research Service,
General Accounting Office, academic research, and recent ANA
surveys of American nurses have all revealed startling levels
of frustration with working conditions. This dissatisfaction
is leading experienced nurses to leave the bedside, and
hindering recruitment efforts.
Fortunately, we know what can be done to address this
growing problem. There are proven best practices for nursing
that improve patient outcomes, and enhance nurse recruitment
and retention. The American Nurses Credentialing Center, an
ANA affiliate, recognizes facilities that have met these best
practices by granting the `Magnet' designation. Magnet
facilities have consistently outperformed their peers in
nursing services, even in times of national nursing
shortages. In fact, average nurse retention in Magnet
facilities is twice as long as that of non-Magnet
institutions.
ANA is pleased to endorse your efforts to further the
implementation of these best practices through the Hospital-
Based Nursing Initiative Act. The quality of work environment
and nurse retention grant program, and the continuing
education scholarships contained in your bill will greatly
aide in the adoption of Magnet criteria. ANA looks forward to
working with you and your staff to support this legislation.
Sincerely,
Rose Gonzalez, MPS, RN,
Director, Government Affairs.
____
American College
of Healthcare Executives,
Chicago, IL, September 18, 2001.
Hon. Joseph I. Lieberman,
U.S. Senate, Washington, DC.
Dear Senator Lieberman: Thank you for inviting the American
College of Healthcare Executives to review and provide
comments on the ``Hospital-Based Nursing Initiative Act of
2001.''
Upon reviewing the bill, ACHE wishes to endorse it. This
legislation offers a comprehensive approach to the crisis
facing our nation's healthcare system--a shortage of nurses.
The bill attempts to address this important issue by
supporting hospitals in a number of ways, including:
retaining nurses; improving the work environment for nursing
staff; fostering nursing leadership; providing continuing
education programs for nurses; creating recognition and
reward programs for nurses who obtain nursing-related
certification; and finally, offering educational assistance
for nurses to earn their Bachelor of Science Degree in
Nursing. We believe this bill encompasses the various
elements to make a genuine difference and increase the
nursing population.
Thank you for your work in developing this legislation. If
there is anything ACHE can do to assist further in this
endeavor, please contact Susan M. Oster, CAE, Vice President,
Administration at (312) 424-9340.
Sincerely,
Thomas C. Dolan, Ph.D., FACHE, CAE,
President and Chief Executive Officer.
____
Pennsylvania State
Nurses Association,
Harrisburg, PA, September 17, 2001.
Hon. Joseph Lieberman,
U.S. Congress, Washington, DC.
Dear Senator Lieberman: The Pennsylvania State Nurses
Association (PSNA) would like to commend you for the
excellent legislation you plan to introduce, which is meant
to establish grant and scholarship programs enabling
hospitals to retain and further educate their nursing staffs.
The bill contains excellent ideas and creative solutions to
entice nurses to join or remain a member of a hospital
nursing staff.
The focus on nurses having opportunities to participate in
decision-making regarding nursing care and maintaining
autonomy in the delivery of care are especially important
attractants for nurses. Also, the emphasis on having a system
for measuring outcomes is imperative for quality patient
care.
The organization welcomes the opportunity to work with you
in ensuring the passage of the legislation that will greatly
benefit the profession of nursing and the quality of care
provided to consumers.
Sincerely,
Jessie F. Rohner, DrPH, RN,
Interim Executive Administrator.
______
By Mr. KERRY (for himself, Mr. Breaux, and Mr. Hollings):
S. 1587. A bill to provide improved port and maritime security, and
for other purposes; to the Committee on Commerce, Science, and
Transportation.
Mr. BREAUX. Madam President, along with Mr. Kerry, Chairman of the
Oceans, Atmosphere and Fisheries Subcommittee, and Mr. Hollings,
Chairman of the Commerce Committee, I rise today in support of the Port
Threat and Security Act of 2001. I believe this legislation will help
United States' authorities identify and counteract maritime threats
from terrorist actions. Importantly, these provisions are designed in
part to protect U.S. citizens and property from terrorist attacks
before they reach our shores.
As Chairman of the Surface Transportation and Merchant Marine
Subcommittee, I held several oversight hearings on transportation
security, including one on maritime security three weeks after the
terrible attacks of September 11. The maritime security hearing
solidified an opinion that I, and others on the Commerce Committee, had
long held, the need for increased maritime security was important
before September 11, and is absolutely crucial following the terrorist
[[Page S11203]]
attacks on New York city and Washington, D.C. The Oceans, Atmosphere
and Fisheries Subcommittee, of which I am a member, followed with
another hearing that underscored this message. Luckily, because of the
foresight of Chairman Hollings, we had a head start on improving
maritime security. S. 1214, the Maritime and Port Security Improvement
Act, of which I am a proud cosponsor, was introduced in July and was
reported out of the Committee in August. S. 1214 establishes a regime
that will go a long way towards creating a safe and secure maritime
transportation system. However, since much of it was crafted before
September 11, it is only natural that additional measures are needed to
ensure that our maritime system is as safe as possible.
The bill we are introducing today is based on the testimony that was
presented at the hearings before the Commerce Committee in the first
two weeks of October. Administration and industry witnesses testified
on the need to improve certain areas of S. 1214. This bill intends to
fill the gaps identified by our witnesses. We will work with Committee
members to ensure these provisions are included in S. 1214 before the
Senate sends it to the House.
A constant theme following the September 11 attacks has been the need
for better information. Testimony at our hearings confirmed this theme
in the maritime realm, we need to increase our information collection
capabilities immediately and we need to hold our trading partners to
the same standards to which we hold our maritime industry. This
legislation requires the identification of nations that have inherently
insecure or unsafe vessel registration procedures that can pose threats
to our national security. It requires the Secretary of Transportation
and Secretary of State to prepare an annual report for the Congress
that would list those nations whose vessels the Coast Guard has found
don't play by our rules. For example, investigations by the Department
of Transportation reveal that it is common practice for vessels to
possess false, partial, or fraudulent information concerning cargo
manifests, crew identity, or registration of the vessel. This
legislation will allow us to get a handle on these practices by
identifying the most egregious violators of maritime law. However, the
additional information collection required by this bill is just a
start; the bill also requires the Administration to recommend to this
Committee additional actions that can be taken, either domestically or
through international organizations such as the International Maritime
Organization, that will increase the transparency of
vessel registration procedures.
One of the responses following the highjackings has been to
dramatically expand the air marshal program on air carriers, a step
which I fully support. However, there is no similar program for
maritime vessels in U.S. waters. The Coast Guard recently established a
sea marshal program in the port of San Francisco where armed personnel
accompany maritime pilots aboard vessels that cause security concerns.
This legislation expands that small project into a national sea marshal
program to help prevent terrorists from using maritime vessels as
weapons of mass destruction. This legislation directs the Secretary to
analyze vulnerability of ports and place sea marshals in ports that
handle materials or vessels that make them potential targets of attack.
Expansion of the sea marshal program is strongly supported by our
Nation's sea pilots. Many people do not know that almost all maritime
vessels that enter U.S. ports are accompanied by a U.S. sea pilot that
has intimate knowledge of port and navigational channels, a living
nautical chart, so to speak. They are an integral part of our maritime
system that help to keep our ports and waterways safe. Pilots are often
the first U.S. citizen to board inbound foreign vessels and may be the
only U.S. citizens on vessels bound for U.S. ports; thus, they can be a
valuable source of information. This legislation requires the Secretary
of Transportation to use them more effectively in the war on terror.
The Secretary is directed to investigate secure and reliable methods in
which sea pilots can aid the Coast Guard and other U.S. authorities in
an expanded maritime domain awareness program. The pilots themselves
came forward to this Committee suggesting this idea, and I think it is
critical that these pilots be provided with methods and equipment that
will allow them to safely provide the authorities with information on
illegal or terrorist activities while there is still time to prevent a
catastrophe. One such example is the Vessel Traffic System, VTS, in the
Port of New Orleans and the excellent partnership between the Coast
Guard and the Crescent River Pilots Association. Under this
partnership, vessels entering port are boarded by pilots carrying
transponders. As the vessel transits the Mississippi River, inbound and
outbound, the operations center manned by Coast Guard and pilots know
the exact position of the vessel, as well as the course, speed and
other important information. While already considered a model VTS
program, once additional transponders are acquired, this program will
continue to serve as a template for other ports.
This legislation also greatly improves the information collected on
the safety and security of foreign ports. With regards to foreign
seaport assessments, the bill aligns the authority of the Secretary of
Transportation with authorities that currently exist for foreign
airports. The Secretary of Transportation is required to conduct 25
foreign port vulnerability assessments each year and to ensure that
U.S. citizens are informed about the results of these assessments in
advance of embarking on their travel plans. Testimony before the
Commerce Committee emphasized that in order to ensure that our shores
are as safe as possible, we must view foreign ports as the outer
boundary of our ``maritime domain.'' Much as the first provision in our
bill provides for the collection of better information on vessels and
countries that do not follow international standards, this provision
provides for the collection of information on foreign ports that
present potential security threats to the United States. By requiring
the Secretary to conduct annual assessments of 25 ports, we not only
gain a valuable source of information, but we also put foreign ports on
notice that they will be held responsible for actions to secure their
ports.
If the assessments reveal that foreign ports do not have or maintain
adequate security measures, the President is authorized to prohibit any
vessel, U.S. flagged or foreign, from entering the United States from
that port. Vessels that transit unsafe and insecure ports should not be
allowed unrestricted access to United States ports. I would like to
remind everyone that similar security protections were enacted for
foreign airports, and I see no reason why the President should not have
the same powers with respect to foreign maritime ports.
We must begin to think of a maritime security program that begins
well before a ship enters U.S. waters and certainly before they enter
U.S. ports. I believe that the measures in this bill along with the
port security program of S. 1214 will provide much better tools to
guard against maritime threats to our Nation and our citizens.
Mr. KERRY. Madam President, As Chairman of the Oceans, Atmosphere and
Fisheries Subcommittee, I rise today to introduce legislation to
identify and reduce maritime threats from criminal or terrorist action,
particularly those originating from foreign ports and vessels. I am
particularly pleased to be joined by the Chairman of the Commerce
Committee Mr. Hollings of South Carolina and the Chairman of the
Surface Transportation and Merchant Marine Subcommittee Mr. Breaux of
Louisiana.
Senator Breaux and I recently held oversight hearings before our
respective Subcommittees on the Coast Guard and its role in improving
maritime security after the terrible attacks of September 11. As
Senators Hollings and Breaux well know, even before September 11 our
maritime and port security was in sorry shape. Senator Hollings had
already recognized the need to rectify these deficiencies and authored
S. 1214, the Maritime and Port Security Improvement Act, which was
reported out of the Committee in August, and which I am proud to
cosponsor. However, the attacks on New York and Washington made it
clear we need to go farther afield to guard against terrorism and other
crimes.
Today's legislation is intended to supplement the security provisions
of
[[Page S11204]]
S. 1214 by improving our ability to detect and prevent maritime
terrorism and crime before it has the chance to sail into U.S. ports.
We intend to work with Committee members to ensure these provisions are
included in the final bill the Senate sends to the House.
At our October 11 oversight hearing, Coast Guard Commandant James Loy
and other witnesses gave some thoughtful testimony that is the backbone
of this legislation. The hearing also brought to light the challenges
presented to the Coast Guard in securing our maritime border from such
threats. In addition to introducing this legislation, we also will
address glaring Coast Guard resource shortfalls through increased
authorizations in our FY 2002 Coast Guard authorization bill, which we
will bring to the floor shortly. The Port Threat and Security Act is
focused on giving the Coast Guard the tools and the information they
need to do the job right.
First, we need to improve our base of information to identify bad
actors throughout the maritime realm. This legislation would help us
identify those nations whose vessels and vessel registration procedures
pose potential threats to our national security. It would require the
Secretaries of Transportation and State to prepare an annual report for
the Congress that would list those nations whose vessels the Coast
Guard has found would pose a risk to our ports, or that have presented
our government with false, partial, or fraudulent information
concerning cargo manifests, crew identity, or registration of the
vessel. In addition the report would identify nations that do not
exercise adequate control over their vessel registration and ownership
procedures, particularly with respect to security issues. We need hard
information like this if we are to force ``flag of convenience''
nations from providing cover to criminals and terrorists. Mr.
President, this is very important as Osama bin Laden has used flags of
convenience to hide his ownership in various international shipping
interests. In 1998 one of bin Laden's cargo freighters unloaded
supplies in Kenya for the suicide bombers who later destroyed the
embassies in Kenya and Tanzania. To that end, the bill requires the
Administration to report on actions they have taken, or would
recommend, to close these loopholes and improve transparency and
registration procedures, either through domestic or international
action--including action at the International Maritime Organization.
My legislation would also establish a national Sea Marshal program to
protect our ports from the potential use of vessels as weapons of
terror. A Sea Marshal program was recently established in San
Francisco, and is supported strongly by the maritime pilots who, like
airline pilots, are on the front lines in bringing vessels into U.S.
ports. Sea Marshals would be used in ports that handle materials that
are hazardous or flammable in quantities that make them potential
targets of attack. The Coast Guard took a number of steps including
using armed Coast Guard personnel to escort a Liquid Natural Gas, LNG,
tanker into Boston last evening. This was the first delivery of LNG to
Boston since September 11 and a number of people were concerned about
the safety of bringing LNG into the port. Prior to September 11 these
vessels were escorted by Coast Guard vessels into the port but no armed
guards were present on the vessel. I strongly believe that having armed
personnel, such as Sea Marshals, on these high interest vessels is very
important and will considerably increase security in our nation's
ports, including Boston. The ability of terrorists to board a vessel
and cause a deliberate release of LNG or gasoline for that matter is
very real. Sea Marshals will make it much more difficult for this to
happen. The Secretary of Transportation would be responsible for
establishing qualifications and standards for Sea Marshals which could
be comprised of Federal, State or local law enforcement officials.
This legislation also aims to make use of unarmed pilots as yet
another way to combat terrorism in our ports. Nearly every vessel that
enters a U.S. port is first boarded by a sea pilot to assist the crew
in navigating the harbor. Many times these pilots are the first set of
U.S. eyes on vessels that may be headed to our ports bearing criminals
or contraband from overseas. They are our eyes and ears, but cannot be
expected to be a line of physical defense, that is the job of the Sea
Marshals. This legislation would require the Secretary of
Transportation to use these ``eyes and ears'' effectively in the war on
terror. The Secretary is directed to investigate discrete ways in which
sea pilots can provide information to warn of a possible terrorist
attack or other crime. It is important that we explore secure
mechanisms to allow these pilots to contribute to our maritime domain
awareness, including notifying law enforcement officials of suspicious
activity on a vessel. I am convinced there are a number of ways that
these pilots could safely provide the authorities with information that
can thwart illegal activities without alerting the vessel's captain or
crew, or potential terrorists.
This legislation would also require the Secretary of Transportation
to conduct 25 foreign port vulnerability assessments each year, and
places on foreign ports the same reporting and assessment requirements
we use for foreign airports. This is essential to ensure that U.S.
citizens are protected from harm in foreign ports, and are informed
about any risks before leaving U.S. soil. It is also absolutely
necessary to use foreign ports as our first defense against threats to
U.S. ports. We cannot expect to protect U.S. borders by erecting a
fence only at our own ports. As one of our witnesses said, ``the
leading edge of our boundary for homeland defense is, in fact, foreign
ports.'' In many instances, such defenses would be fruitless because of
the sheer volume of cargo that passes through our ports daily. We need
advance warning long before these vessels appear at our harbor
entrances. Critical information that can help the Coast Guard identify
these risks can only be collected at foreign ports where cargo and
persons are first placed aboard the vessel. Despite this obvious need,
we have fallen behind on our assessments of foreign ports. I firmly
believe that the only way we can make U.S. ports and harbors safe is by
going to the source and ensuring appropriate measures and facilities
are in place to guarantee the safety of U.S. citizens visiting foreign
ports as well as the safety of cargo bound for the United States.
In order to pay for these inspections this legislation authorizes the
Secretary of Transportation to collect a 50 cent user fee on all cruise
passengers that depart the United States for a foreign port. Quite
frankly, 50 cents is a small price to pay for the peace of mind that
comes with knowing that a port vulnerability assessment has been
completed prior to a cruise ship with as many as 5,000 U.S. citizens as
passengers, docks in a particular country. U.S. citizens should not be
disembarking in ports that have not been scrutinized for security
violations. One witness pointed out that in many circumstances U.S.
cruise ship passengers are passing through ports that could not be
assessed because they were deemed too dangerous for military personnel!
This is ludicrous. I am sure those passengers had no idea of this
potential danger, and we need to make sure that they are both safe and
informed.
Lastly, this legislation would allow the President to prohibit any
vessel, U.S. flagged or foreign, from entering the United States if the
vessel has embarked passengers or cargo from foreign ports that do not
have adequate security measures as determined by the Secretary of
Transportation. Recently inspectors in Italy checking a container bound
for Canada discovered a member of the al-Qaida terrorist organization
hiding in a shipping container equipped with a bed and makeshift
bathroom. The suspect, an Egyptian in a business suit, had with him a
Canadian passport, a laptop computer, two cell phones, airport maps,
security passes for airports in three countries and a certificate
proclaiming him an airplane mechanic. We cannot allow any country to
have such poor security such that terrorists can stow away in a
shipping container. I would like to remind everyone that a similar
provision exists in the airline industry and I see no reason why the
President should not have the power to suspend commerce from a port
with inadequate security, just like he can now do with international
airports.
[[Page S11205]]
I believe that these provisions, when combined with the strong port
security program of S. 1214, will ensure that the United States has the
tools, the information, and the personnel to guard against waterborne
threats to our nation and our citizens.
Mr. President, 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. 1587
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 ``Port Threat and Security
Act''.
SEC. 2. IMPROVED REPORTING ON FOREIGN-FLAG VESSELS ENTERING
UNITED STATES PORTS.
Within 6 months after the date of enactment of this Act and
every year thereafter, the Secretary of Transportation, in
consultation with the Secretary of State, shall provide a
report to the Committees on Commerce, Science, and
Transportation and Foreign Relations of the Senate, and the
Committees on Transportation and Infrastructure and
International Relations of the House of Representatives that
lists the following information:
(1) A list of all nations whose flag vessels have entered
United States ports in the previous year.
(2) Of the nations on that list, a separate list of those
nations--
(A) whose registered flag vessels appear as Priority III or
higher on the Boarding Priority Matrix maintained by the
Coast Guard;
(B) that have presented, or whose flag vessels have
presented, false, intentionally incomplete, or fraudulent
information to the United States concerning passenger or
cargo manifests, crew identity or qualifications, or
registration or classification of their flag vessels;
(C) whose vessel registration or classification procedures
have been found by the Secretary to be insufficient or do not
exercise adequate control over safety and security concerns;
or
(D) whose laws or regulations are not sufficient to allow
tracking of ownership and registration histories of
registered flag vessels.
(3) Actions taken by the United States, whether through
domestic action or international negotiation, including
agreements at the International Maritime Organization under
section 902 of the International Maritime and Port Security
Act (46 U.S.C. App. 1801), to improve transparency and
security of vessel registration procedures in nations on the
list under paragraph (2).
(4) Recommendations for legislative or other actions needed
to improve security of United States ports against potential
threats posed by flag vessels of nations named in paragraph
(2).
SEC. 3. SEA MARSHAL PROGRAM.
(a) Establishment.--Within 6 months after the date of
enactment of this Act, the Secretary of Transportation shall
establish a program to place sea marshals on vessels entering
United States Ports identified in subsection (c).
(b) Consultation.--In establishing this program, the
Secretary shall consult with representatives from the port
security task force and local port security committees.
(c) Sea Marshal Ports.--The Secretary shall identify United
States ports for inclusion in the sea marshal program based
on criteria that include the following:
(1) The presence of port facilities that handle materials
that are hazardous or flammable in quantities that make them
potential targets of attack.
(2) The proximity of these facilities to residential or
other densely populated areas.
(3) The proximity of sea lanes or navigational channels to
hazardous areas that would pose a danger to citizens in the
event of a loss of navigational control by the ship's master.
(4) Any other criterion deemed necessary by the Secretary.
(d) Sea Marshal Qualifications.--The Secretary shall
establish appropriate qualifications or standards for sea
marshals. The Secretary may use, or require use of, Federal,
State, or local personnel as sea marshals.
(e) Authorization of Appropriations.--There are authorized
to be appropriated to the Secretary of Transportation such
sums as may be necessary to carry out the requirements of
this section for each of the fiscal years 2002 through 2006.
(f) Report.--Within 3 years after the date of enactment of
this Act, the Secretary shall report to the Committee on
Commerce, Science, and Transportation of the Senate, and
Committee on Transportation and Infrastructure of the House
of Representatives on the success of the program in
protecting the ports listed under (c), and submit any
recommendations.
SEC. 4. SEA PILOT COMMUNICATION AND WARNING SYSTEM.
Within 6 months after the date of enactment of this Act,
the Secretary of Transportation shall provide a secure report
to the Committee on Commerce, Science, and Transportation of
the Senate, and Committee on Transportation and
Infrastructure of the House of Representatives on the
potential for increasing the capabilities of sea pilots to
provide information on maritime domain awareness. The report
should specifically address necessary improvements to both
reporting procedures and equipment that could allow pilots to
be integrated more effectively in an maritime domain
awareness program.
SEC. 5. SECURITY STANDARDS AT FOREIGN SEAPORTS.
(a) Assessment.--
(1) In general.--The Secretary shall assess the
effectiveness of the security measures maintained at--
(A) each foreign seaport--
(i) served by United States vessels;
(ii) from which foreign vessels serve the United States; or
(iii) that poses a high risk of introducing danger to
international sea travel; and
(B) other foreign seaports the Secretary considers
appropriate.
(2) International cooperation and standards.--The Secretary
of Transportation shall conduct an assessment under paragraph
(1) of this subsection--
(A) in consultation with appropriate port authorities of
the government of a foreign country concerned and United
States vessel operators serving the foreign seaport for which
the Secretary is conducting the assessment;
(B) to establish the extent to which a foreign seaport
effectively maintains and carries out security measures; and
(C) by using a standard that will result in an analysis of
the security measures at the seaport based at least on the
standards and recommended practices of the International
Maritime Organization in effect on the date of the
assessment.
(3) Report.--Each report to Congress required under section
2 shall contain a summary of the assessments conducted under
this subsection.
(b) Interval.--The Secretary of Transportation shall
conduct assessments under subsection (a) of this section of
at least 25 foreign seaports annually until all seaports
identified in subsection (a)(1) are completed. The first 25
of these assessments shall be conducted within 18 months
after the date of enactment of this Act.
(c) Consultation.--In carrying out subsection (a) of this
section, the Secretary of Transportation shall consult with
the Secretary of State--
(1) on the terrorist threat that exists in each country;
and
(2) to establish which foreign seaports are not under the
de facto control of the government of the foreign country in
which they are located and pose a high risk of introducing
danger to international sea travel.
(d) Qualified Assessment Entities.--In carrying out
subsection (a) of this section, the Secretary of
Transportation may utilize entities determined by the
Secretary of Transportation and the Secretary of State to be
qualified to conduct such assessments.
(e) Notifying Foreign Authorities.--If the Secretary of
Transportation, after conducting an assessment under
subsection (a) of this section, determines that a seaport
does not maintain and carry out effective security measures,
the Secretary, after advising the Secretary of State, shall
notify the appropriate authorities of the government of the
foreign country of the decision and recommend the steps
necessary to bring the security measures in use at the
seaport up to the standard used by the Secretary in making
the assessment.
(f) Actions When Seaports Not Maintaining and Carrying Out
Effective Security Measures.--
(1) In general.--If the Secretary of Transportation makes a
determination under subsection (e) that a seaport does not
maintain and carry out effective security measures, the
Secretary--
(A) shall publish the identity of the seaport in the
Federal Register;
(B) shall require the identity of the seaport to be posted
and displayed prominently at all United States seaports at
which scheduled passenger carriage is provided regularly;
(C) shall notify the news media of the identity of the
seaport;
(D) shall require each United States and foreign vessel
providing transportation between the United States and the
seaport to provide written notice of the decision, on or with
the ticket, to each passenger buying a ticket for
transportation between the United States and the seaport; and
(E) may, after consulting with the appropriate port
authorities of the foreign country concerned and United
States and foreign vessel operators serving the seaport and
with the approval of the Secretary of State, withhold,
revoke, or prescribe conditions on the operating authority of
a United States or foreign vessel that uses that seaport to
provide foreign sea transportation.
(2) Presidential action.--If the Secretary makes such a
determination under subsection (e) about a seaport, the
President may prohibit a United States or foreign vessel from
providing transportation between the United States and any
other foreign seaport that is served by vessels navigating to
or from the seaport with respect to which a decision is made
under this section.
(3) When action to be taken.--
(A) In general.--The provisions of paragraphs (1) and (2)
shall apply with respect to a foreign seaport--
(i) 90 days after the government of a foreign country is
notified of the Secretary's determination under subsection
(e) of this section unless the Secretary of Transportation
finds that the government has
[[Page S11206]]
brought the security measures at the seaport up to the
standard the Secretary used in making an assessment under
subsection (a) of this section before the end of that 90-day
period; or
(ii) on the date on which the Secretary makes that
determination if the Secretary of Transportation determines,
after consulting with the Secretary of State, that a
condition exists that threatens the safety or security of
passengers, vessels, or crew traveling to or from the
seaport.
(B) Travel advisory notification.--The Secretary of
Transportation immediately shall notify the Secretary of
State of a determination under subparagraph (A)(ii) of this
paragraph so that the Secretary of State may issue a travel
advisory required under section 908 of the International
Maritime and Port Security Act (46 U.S.C. App. 1804).
(4) Congressional notification.--The Secretary of
Transportation promptly shall submit to Congress a report
(and classified annex if necessary) on action taken under
paragraph (1) or (2) of this subsection, including
information on attempts made to obtain the cooperation of the
government of a foreign country in meeting the standard the
Secretary used in assessing the seaport under subsection (a)
of this section.
(5) Cancellation of publication requirements.--If the
Secretary of Transportation, in consultation with the
Secretary of State, determines that effective security
measures are maintained and carried out at the seaport
against which the Secretary took action under paragraph (1),
then the Secretary shall--
(A) terminate action under paragraph (1) against that
seaport; and
(B) notify the Congress of the Secretary's determination.
(g) Suspensions.--The Secretary of Transportation, with the
approval of the Secretary of State and without notice or a
hearing, shall suspend the right of any United States vessel
to provide foreign sea transportation, and the right of a
person to operate vessels in foreign sea commerce, to or from
a foreign seaport if the Secretary of Transportation
determines that--
(1) a condition exists that threatens the safety or
security of passengers, vessels, or crew traveling to or from
that seaport; and
(2) the public interest requires an immediate suspension of
transportation between the United States and that seaport.
(h) Authorization of Appropriations.--There are authorized
to be appropriated to the Secretary of Transportation
$2,000,000 for fiscal year 2002 and each fiscal year
thereafter to carry out this section.
SEC. 6. FOREIGN PORT ASSESSMENT FEES.
(a) In General.--The Secretary of Transportation shall
collect a user fee from cruise vessel lines upon the arrival
of a cruise vessel at a United States port from a foreign
port. Amounts collected under this section shall be treated
as offsetting collections to offset annual appropriations for
the costs of providing foreign port vulnerability assessments
under section 5.
(b) Amount of Fee.--Cruise vessel lines shall remit $0.50
for each passenger embarkment on a cruise that includes at
least one United States port and one foreign port.
(c) Use of Fees.--A fee collected under this section shall
be used solely for the costs associated with providing
foreign port vulnerability assessments and may be used only
to the extent provided in advance in an appropriation law.
(d) Effective Date.--The requirements of this section apply
with respect to travel beginning more than 179 days after the
date of enactment of this Act.
______
By Mr. CRAIG (for himself, Mr. Dorgan, Mr. Grassley, Mr. Baucus,
Mr. Crapo, Mr. Bayh, Mr. Bennett, Mr. Carper, Ms. Collins, Mr.
Ensign, Mr. Hollings, Mr. Hutchinson, Mr. Inhofe, Mr. Kyl, Mrs.
Lincoln, Mr. Murkowski, Mrs. Murray, and Mr. Smith of Oregon):
S. 1588. A bill to provide a 1-year extension of the date for
compliance by certain covered entities with the administrative
simplification standards for electronic transactions and code sets
issued in accordance with the Health Insurance Portability and
Accountability Act of 1996; to the Committee on Finance.
Mr. CRAIG. Mr. President, I am happy to join Senator Dorgan in
reintroducing legislation regarding the administrative simplification
provision of the Health Insurance Portability and Accountability Act.
We originally introduced legislation five months ago and have worked
since then with members from both the Finance and HELP committees to
negotiate a compromise. The bill we are introducing today is the
product of those discussions. It provides for one additional much-
needed year for providers, State health programs, health plans and
others to implement the transactions and code set provision of
administrative simplification. Importantly, this new version also
includes language to clearly differentiate between this provision and
the privacy provision of HIPAA. It was our intention all along that the
medical privacy regulations not be affected by our legislation, and we
believe this bill accomplishes that goal. My colleague and I have the
benefit of being joined on this bill by many of the cosponsors of the
original bill, and we are happy to have their support.
Mr. DORGAN. Mr. President, Like Senator Craig, I appreciate the
cooperation of our colleagues in helping us to work through this issue.
We have arrived at a solution that is agreeable to the majority of
parties involved, while at the same time reaching our goal of providing
relief to small providers and plans and public health programs that are
struggling to prepare their systems for this cost. Senator Craig and I
would have preferred that this bill go further in providing more time
and coordination for affected entities. On the other hand, we
acknowledge that others would prefer no action in this area. Since we
are just one year from the scheduled compliance date, however, we
recognize that all those affected need some certainty as they move
forward with complying with the transactions and code sets regulation.
Given that this bill does provide needed relief for our states and
given the time constraints we are facing, we believe this compromise is
appropriate and do not feel an additional extension can be acquired.
______
By Mr. ROCKEFELLER (for himself, Mr. Wellstone, and Mr. Baucus):
S. 1589. A bill to amend title XVIII of the Social Security Act to
expand medicare benefits to prevent, delay, and minimize the
progression of chronic conditions, establish payment incentives for
furnishing quality services to people with serious and disabling
chronic conditions, and develop national policies on effective chronic
condition care, and for other purposes; to the Committee on Finance.
Mr. ROCKEFELLER. Madam President, I join several colleagues today to
introduce the Medicare Chronic Care Improvement Act of 2001. Although
we in Congress are focused on helping the Nation recover from the
horrific attacks of September 11, we must also stand tall against the
terrorists who wish to sabotage our domestic policy agenda and continue
to work on the issues that affect the everyday health and well being of
American citizens. With this conviction, I believe it is time to
address the leading health care problem of the 21st century, chronic
conditions.
Chronic conditions account for an astounding 90 percent of morbidity,
80 percent of deaths, and over 75 percent of direct medical
expenditures in the United States. Nearly 125 million Americans have
chronic conditions, and this number is expected to increase to 157
million, approximately half the population, by 2020.
Chronic conditions encompass an array of health conditions that are
persistent, recurring, and cannot be cured. They include severely
impairing conditions like Alzheimer's disease, congestive heart
failure, chronic obstructive pulmonary disease, diabetes, depression,
hypertension, and arthritis. Certainly in West Virginia, many of our
workers, especially coal miners and steelworkers, suffer from chronic
conditions.
Treating serious and disabling chronic conditions is the highest cost
and fastest growing segment of health care. Direct medical costs for
chronic conditions reached $510 billion in 2000 and are projected to
reach $1.07 trillion by 2020.
An estimated 80 percent of Medicare beneficiaries suffer from at
least one chronic condition and those beneficiaries account for an
astounding 95 percent of Medicare spending. But Medicare does not
provide many of the health care services that people with chronic
conditions need. For example, current Medicare data show that, on
average, people with chronic conditions see eight different physicians.
Medicare does not compensate these physicians for communicating with
one another, nor are they paid for care coordination, monitoring
medications, early detection, or for educating or counseling patients
and caregivers. As a result, few of these services, which are critical
to people with chronic conditions, are provided.
To meet the needs of these individuals, our health care system must
embrace a person-centered, system-oriented approach to care. Payers and
providers who serve the same person
[[Page S11207]]
must be empowered to work together to help people with chronic
conditions prevent, delay, or minimize disease and disability
progression and maximize their health and well being.
Over 10 years ago, I served as Chairman of the Pepper Commission. Our
final report recognized that people with chronic conditions have
special needs requiring multidisciplinary health care or social
services to compliment or augment their health care. The Commission
further recognized that medical care cannot be fully accessible or
effective for this segment of the population unless it is accompanied
by education, outreach, and systems to coordinate a broad range of
services. The Commission identified these needed changes over ten years
ago. And, as I stand before you today, not a single one of these
recommendations has been made.
I am here to propose a long overdue and much needed solution, The
Medicare Chronic Care Improvement Act of 2001. This bill establishes a
comprehensive plan to update and streamline the Medicare healthcare
delivery system to better meet the needs of people with chronic health
conditions.
First, the Medicare Chronic Care Improvement Act of 2001 helps
prevent, delay, and minimize the progression of chronic conditions by
authorizing the Secretary of Health and Human Services to expand
coverage of preventive health benefits. The bill permits providers to
waive deductibles and co-payments for preventive and wellness services
and streamlines the process of approving preventive benefits.
Second, this bill provides a person-centered, system-oriented
approach to care for this extremely vulnerable segment of our
population by expanding Medicare coverage to include assessment, care-
coordination, self-management services, and patient and family
caregiver education and counseling.
Third, this legislation improves Medicare fee-for-service and managed
care financing for plans that serve beneficiaries with multiple,
complex chronic conditions. The Secretary is directed to develop a plan
to refine payment incentives to ensure appropriate payment for serving
these high-cost individuals.
And finally, the Medicare Chronic Care Improvement Act of 2001
requires the Secretary of HHS to report to Congress on chronic
condition trends and costs as a foundation for establishing national
chronic care policies.
For more detail, I am also entering a section-by-section bill summary
into the Congressional Record following this statement.
This legislation has been endorsed by a variety of health
organizations representing consumers and providers including:
Chronic Care Coalition, comprising the American Association of Homes
and Services for the Aging, American Geriatrics Society, Catholic
Health Association of the United States, Elderplan Social HMO, National
Chronic Care Consortium, National Council on the Aging, and National
Family Caregivers Association;
National Depressive and Manic-Depressive Association;
Association for Ambulatory Behavioral Healthcare; American Lung
Association; American Academy of Neurology; American Neurological
Association; and United Seniors Health Cooperative.
The Medicare Chronic Care Improvement Act of 2001 provides a
comprehensive solution to improving the quality of life and health for
millions of Americans who are struggling with serious and disabling
chronic conditions. It improves benefits for people with chronic
conditions, it empowers providers to better care for these people, and
it provides us with the research we need to better address chronic
conditions in the future.
And last, but not least, this legislation has the potential to save
the Medicare program money, by better managing and treating chronic
conditions before costly complications result. That is good for seniors
and good for Medicare, a win-win situation. It is time to step up to
the plate and fulfill our obligation to our Nation's most vulnerable
citizens. This bill should stimulate the debate, and when Congress
returns to business not related to the September 11th attacks, I intend
to advance this legislation in the Finance Committee.
I ask unanimous consent that the text of the bill and the summary be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
S. 1589
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
Chronic Care Improvement 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. Definitions.
TITLE I--EXPANSION OF BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE
PROGRESSION OF CHRONIC CONDITIONS.
Subtitle A--Improving Access to Preventive Services
Sec. 101. Definitions.
Sec. 102. Elimination of deductibles and coinsurance for existing
preventive health benefits.
Sec. 103. Institute of Medicine medicare prevention benefit study and
report.
Sec. 104. Authority to administratively provide for coverage of
additional preventive benefits.
Sec. 105. Fast-track consideration of prevention benefit legislation.
Subtitle B--Expansion of Access to Health Promotion Services
Sec. 111. Disease self-management demonstration projects.
Sec. 112. Medicare health education and risk appraisal program.
Subtitle C--Medicare Coverage for Care Coordination and Assessment
Services
Sec. 121. Care coordination and assessment services.
TITLE II--PAYMENT INCENTIVES FOR QUALITY CARE FOR INDIVIDUALS WITH
SERIOUS AND DISABLING CHRONIC CONDITIONS
Sec. 201. Adjustments to fee-for-service payment systems.
Sec. 202. Medicare+Choice.
TITLE III--DEVELOPMENT OF NATIONAL POLICIES ON EFFECTIVE CHRONIC
CONDITION CARE
Sec. 301. Study and report on effective chronic condition care.
Sec. 302. Institute of Medicine medicare chronic condition care
improvement study and report.
SEC. 2. DEFINITIONS.
In this Act:
(1) Secretary.--Unless otherwise specifically provided, the
term ``Secretary'' means the Secretary of Health and Human
Services.
(2) Serious and disabling chronic condition.--The term
``serious and disabling chronic condition'' means, with
respect to an individual, that the individual has at least
one physical or mental condition and a licensed health care
practitioner has certified within the preceding 12-month
period that--
(A) the individual has a level of disability such that the
individual is unable to perform (without substantial
assistance from another individual) for a period of at least
90 days due to a loss of functional capacity--
(i) at least 2 activities of daily living; or
(ii) such number of instrumental activities of daily living
that is equivalent (as determined by the Secretary) to the
level of disability described in clause (i);
(B) the individual has a level of disability equivalent (as
determined by the Secretary) to the level of disability
described in subparagraph (A); or
(C) the individual requires substantial supervision to
protect the individual from threats to health and safety due
to severe cognitive impairment.
(3) Activities of daily living.--The term ``activities of
daily living'' means each of the following:
(A) Eating.
(B) Toileting.
(C) Transferring.
(D) Bathing.
(E) Dressing.
(F) Continence.
(4) Instrumental activities of daily living.--The term
``instrumental activities of daily living'' means each of the
following:
(A) Medication management.
(B) Meal preparation.
(C) Shopping.
(D) Housekeeping.
(E) Laundry.
(F) Money management.
(G) Telephone use.
(H) Transportation use.
TITLE I--EXPANSION OF BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE
PROGRESSION OF CHRONIC CONDITIONS.
Subtitle A--Improving Access to Preventive Services
SEC. 101. DEFINITIONS.
In this title:
(1) Cost-effective benefit.--The term ``cost-effective
benefit'' means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) demonstrated value as measured by unit costs relative
to health outcomes achieved.
[[Page S11208]]
(2) Cost-saving benefit.--The term ``cost-saving benefit''
means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) caused a net reduction in health care costs for
medicare beneficiaries.
(3) Medically effective.--The term ``medically effective''
means, with respect to a benefit or technique, that the
benefit or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under normal
programmatic conditions.
(4) Medically efficacious.--The term ``medically
efficacious'' means, with respect to a benefit or technique,
that the benefit or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under controlled
conditions.
SEC. 102. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR
EXISTING PREVENTIVE HEALTH BENEFITS.
(a) In General.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l) is amended by inserting after subsection
(o) the following new subsection:
``(p) Deductibles and Coinsurance Waived for Preventive
Health Items and Services.--The Secretary shall not require
the payment of any deductible or coinsurance under subsection
(a) or (b), respectively, of any individual enrolled for
coverage under this part for any of the following preventive
health items and services:
``(1) Blood-testing strips, lancets, and blood glucose
monitors for individuals with diabetes described in section
1861(n).
``(2) Diabetes outpatient self-management training services
(as defined in section 1861(qq)(1)).
``(3) Pneumococcal, influenza, and hepatitis B vaccines and
administration described in section 1861(s)(10).
``(4) Screening mammography (as defined in section
1861(jj)).
``(5) Screening pap smear and screening pelvic exam (as
defined in paragraphs (1) and (2) of section 1861(nn),
respectively).
``(6) Bone mass measurement (as defined in section
1861(rr)(1)).
``(7) Prostate cancer screening test (as defined in section
1861(oo)(1)).
``(8) Colorectal cancer screening test (as defined in
section 1861(pp)(1)).
``(9) Screening for glaucoma (as defined in section
1861(uu)).
``(10) Medical nutrition therapy services (as defined in
section 1861(vv)(1)).''.
(b) Waiver of Coinsurance.--
(1) In general.--Section 1833(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended to read as
follows: ``(B) with respect to preventive health items and
services described in subsection (p), the amounts paid shall
be 100 percent of the fee schedule or other basis of payment
under this title for the particular item or service,''.
(2) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of the
Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by
inserting after ``1861(s)(10)(A)'' the following: ``,
preventive health items and services described in section
1833(p),''.
(c) Waiver of Application of Deductible.--Section
1833(b)(1) of the Social Security Act (42 U.S.C. 1395l(b)(1))
is amended to read as follows: ``(1) such deductible shall
not apply with respect to preventive health items and
services described in subsection (p),''.
(d) Adding ``Lancet'' to Definition of DME.--Section
1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is
amended by striking ``blood-testing strips and blood glucose
monitors'' and inserting ``blood-testing strips, lancets, and
blood glucose monitors''.
(e) Conforming Amendments.--
(1) Elimination of coinsurance for clinical diagnostic
laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of
section 1833(a) of the Social Security Act (42 U.S.C.
1395l(a)), as amended by section 201(b)(1) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act
of 2000 (114 Stat. 2763A-481), as enacted into law by section
1(a)(6) of Public Law 106-554, are each amended by inserting
``or which are described in subsection (p)'' after
``assignment-related basis''.
(2) Elimination of coinsurance for certain dme.--Section
1834(a)(1)(A) of the Social Security Act (42 U.S.C.
1395m(a)(1)(A)) is amended by inserting ``(or 100 percent, in
the case of such an item described in section 1833(p))''
after ``80 percent''.
(3) Elimination of deductibles and coinsurance for
colorectal cancer screening tests.--Section 1834(d) of the
Social Security Act (42 U.S.C. 1395m(d)) is amended--
(A) in paragraph (2)(C)--
(i) by striking ``(C) Facility payment limit.--'' and all
that follows through ``Notwithstanding subsections'' and
inserting the following:
``(C) Facility payment limit.--Notwithstanding
subsections'';
(ii) by striking ``(I) in accordance'' and inserting the
following:
``(i) in accordance'';
(iii) by striking ``(II) are performed'' and all that
follows through ``payment under'' and inserting the
following:
``(ii) are performed in an ambulatory surgical center or
hospital outpatient department,
payment under''; and
(iv) by striking clause (ii); and
(B) in paragraph (3)(C)--
(i) by striking ``(C) Facility payment limit.--'' and all
that follows through ``Notwithstanding subsections'' and
inserting the following:
``(C) Facility payment limit.--Notwithstanding
subsections''; and
(ii) by striking clause (ii).
(f) Effective Date.--The amendments made by this section
shall apply to services furnished on or after the day that is
1 year after the date of enactment of this Act.
SEC. 103. INSTITUTE OF MEDICINE MEDICARE PREVENTION BENEFIT
STUDY AND REPORT.
(a) Study.--
(1) In general.--The Secretary shall contract with the
Institute of Medicine of the National Academy of Sciences
to--
(A) conduct a comprehensive study of current literature and
best practices in the field of health promotion and disease
prevention among medicare beneficiaries, including the issues
described in paragraph (2); and
(B) submit the report described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall include an assessment of--
(A) whether each health promotion and disease prevention
benefit covered under the medicare program is--
(i) medically effective (as defined in section 101(3)); or
(ii) a cost-effective benefit (as defined in section
101(1)) or a cost-saving benefit (as defined in section
101(2));
(B) utilization by medicare beneficiaries of such benefits
(including any barriers to or incentives to increase
utilization);
(C) quality of life issues associated with such benefits;
and
(D) whether health promotion and disease prevention
benefits that are not covered under the medicare program that
would affect all medicare beneficiaries are--
(i) likely to be medically effective (as defined in section
101(3)); or
(ii) likely to be a cost-effective benefit (as defined in
section 101(1)) or a cost-saving benefit (as defined in
section 101(2));
(b) Reports.--
(1) Three-year report.--On the date that is 3 years after
the date of enactment of this Act, and each successive 3-year
anniversary thereafter, the Institute of Medicine of the
National Academy of Sciences shall submit to the President a
report that contains--
(A) a detailed statement of the findings and conclusions of
the study conducted under subsection (a); and
(B) the recommendations for legislation described in
paragraph (3).
(2) Interim report based on new guidelines.--If the United
States Preventive Services Task Force or the Task Force on
Community Preventive Services establishes new guidelines
regarding preventive health benefits for medicare
beneficiaries more than 1 year prior to the date that a
report described in paragraph (1) is due to be submitted to
the President, then not later than 6 months after the date
such new guidelines are established, the Institute of
Medicine of the National Academy of Sciences shall submit to
the President a report that contains a detailed description
of such new guidelines. Such report may also contain
recommendations for legislation described in paragraph (3).
(3) Recommendations for legislation.--The Institute of
Medicine of the National Academy of Sciences, in consultation
with the United States Preventive Services Task Force and the
Task Force on Community Preventive Services, shall develop
recommendations in legislative form that--
(A) prioritize the preventive health benefits under the
medicare program; and
(B) modify such benefits, including adding new benefits
under such program, based on the study conducted under
subsection (a).
(c) Transmission to Congress.--
(1) In general.--Subject to paragraph (2), on the day that
is 6 months after the date on which the report described in
paragraph (1) of subsection (b) (or paragraph (2) of such
subsection if the report contains recommendations in
legislative form described in subsection (b)(3)) is submitted
to the President, the President shall transmit the report and
recommendations to Congress.
(2) Regulatory action by the secretary of health and human
services.--If the Secretary of Health and Human Services has
exercised the authority under section 104(a) to adopt by
regulation one or more of the recommendations under
subsection (b)(3), the President shall only submit to
Congress those recommendations under subsection (b)(3) that
have not been adopted by the Secretary.
(3) Delivery.--Copies of the report and recommendations in
legislative form required to be transmitted to Congress under
paragraph (1) shall be delivered--
(A) to both Houses of Congress on the same day;
(B) to the Clerk of the House of Representatives if the
House is not in session; and
(C) to the Secretary of the Senate if the Senate is not in
session.
SEC. 104. AUTHORITY TO ADMINISTRATIVELY PROVIDE FOR COVERAGE
OF ADDITIONAL PREVENTIVE BENEFITS.
(a) In General.--The Secretary of Health and Human Services
may by regulation adopt any or all of the legislative
recommendations developed by the Institute of Medicine of the
National Academy of Sciences, in consultation with the United
[[Page S11209]]
States Preventive Services Task Force and the Task Force on
Community Preventive Services in a report under section
103(b)(3) (relating to prioritizing and modifying preventive
health benefits under the medicare program and the addition
of new preventive benefits), consistent with subsection (b).
(b) Elimination of Cost-Sharing.--With respect to items and
services furnished under the medicare program that the
Secretary has incorporated by regulation under subsection
(a), the provisions of section 1833(p) of the Social Security
Act (relating to elimination of cost-sharing for preventive
benefits), as added by section 102(a), shall apply to those
items and services in the same manner as such section applies
to the items and services described in paragraphs (1) through
(10) of such section.
(c) Deadline.--The Secretary must publish a notice of
rulemaking with respect to the adoption by regulation under
subsection (a) of any such recommendation within 6 months of
the date on which a report described in section 103(b) is
submitted to the President.
SEC. 105. FAST-TRACK CONSIDERATION OF PREVENTION BENEFIT
LEGISLATION.
(a) Rules of House of Representatives and Senate.--This
section is enacted by Congress--
(1) as an exercise of the rulemaking power of the House of
Representatives and the Senate, respectively, and is deemed a
part of the rules of each House of Congress, but--
(A) is applicable only with respect to the procedure to be
followed in that House of Congress in the case of an
implementing bill (as defined in subsection (d)); and
(B) supersedes other rules only to the extent that such
rules are inconsistent with this section; and
(2) with full recognition of the constitutional right of
either House of Congress to change the rules (so far as
relating to the procedure of that House of Congress) at any
time, in the same manner and to the same extent as in the
case of any other rule of that House of Congress.
(b) Introduction and Referral.--
(1) Introduction.--
(A) In general.--Subject to paragraph (2), on the day on
which the President transmits the report pursuant to section
103(c) to the House of Representatives and the Senate, the
recommendations in legislative form transmitted by the
President with respect to such report shall be introduced as
a bill (by request) in the following manner:
(i) House of representatives.--In the House of
Representatives, by the Majority Leader, for himself and the
Minority Leader, or by Members of the House of
Representatives designated by the Majority Leader and
Minority Leader.
(ii) Senate.--In the Senate, by the Majority Leader, for
himself and the Minority Leader, or by Members of the Senate
designated by the Majority Leader and Minority Leader.
(B) Special rule.--If either House of Congress is not in
session on the day on which such recommendations in
legislative form are transmitted, the recommendations in
legislative form shall be introduced as a bill in that House
of Congress, as provided in subparagraph (A), on the first
day thereafter on which that House of Congress is in session.
(2) Referral.--Such bills shall be referred by the
presiding officers of the respective Houses to the
appropriate committee, or, in the case of a bill containing
provisions within the jurisdiction of 2 or more committees,
jointly to such committees for consideration of those
provisions within their respective jurisdictions.
(c) Consideration.--After the recommendations in
legislative form have been introduced as a bill and referred
under subsection (b), such implementing bill shall be
considered in the same manner as an implementing bill is
considered under subsections (d), (e), (f), and (g) of
section 151 of the Trade Act of 1974 (19 U.S.C. 2191).
(d) Implementing Bill Defined.--In this section, the term
``implementing bill'' means only the recommendations in
legislative form of the Institute of Medicine of the National
Academy of Sciences described in section 103(b)(3),
transmitted by the President to the House of Representatives
and the Senate under subsection 103(c), and introduced and
referred as provided in subsection (b) as a bill of either
House of Congress.
(e) Counting of Days.--For purposes of this section, any
period of days referred to in section 151 of the Trade Act of
1974 shall be computed by excluding--
(1) the days on which either House of Congress is not in
session because of an adjournment of more than 3 days to a
day certain or an adjournment of Congress sine die; and
(2) any Saturday and Sunday, not excluded under paragraph
(1), when either House is not in session.
Subtitle B--Expansion of Access to Health Promotion Services
SEC. 111. DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS.
(a) Demonstration Projects.--
(1) In general.--The Secretary shall conduct demonstration
projects for the purpose of promoting disease self-management
for conditions identified, and appropriately prioritized, by
the Secretary for target individuals (as defined in paragraph
(2)).
(2) Target individual defined.--In this section, the term
``target individual'' means an individual who--
(A) is at risk for, or has, 1 or more of the conditions
identified by the Secretary as being appropriate for disease
self-management; and
(B) is entitled to benefits under part A of title XVIII of
the Social Security Act (42 U.S.C. 1395c et seq.), or
enrolled under part B of such title ( 42 U.S.C. 1395j et
seq.) or is enrolled under the Medicare+Choice program under
part C of such title (42 U.S.C. 1395w-21 et seq.).
(b) Number; Project Areas; Duration.--
(1) Number.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall implement a series
of demonstration projects to carry out the purpose described
in subsection (a)(1).
(2) Project areas.--The Secretary shall implement the
demonstration projects described in paragraph (1) in urban,
suburban, and rural areas.
(3) Duration.--The demonstration projects under this
section shall be conducted during the 3-year period beginning
on the date on which the initial demonstration project is
implemented.
(c) Report to Congress.--
(1) In general.--Not later than 18 months after the
conclusion of the demonstration projects under this section,
the Secretary shall submit a report to Congress on such
projects.
(2) Contents of report.--The report required under
paragraph (1) shall include the following:
(A) A description of the demonstration projects.
(B) An evaluation of--
(i) whether each benefit provided under the demonstration
projects is--
(I) medically effective;
(II) medically efficacious;
(III) cost-effective; or
(IV) cost-saving;
(ii) the level of the disease self-management attained by
target individuals under the demonstration projects; and
(iii) the satisfaction of target individuals under the
demonstration projects.
(C) Recommendations of the Secretary regarding whether to
conduct the demonstration projects on a permanent basis.
(D) Such recommendations for legislation and administrative
action as the Secretary determines to be appropriate.
(E) Any other information regarding the demonstration
projects that the Secretary determines to be appropriate.
(d) Funding.--The Secretary shall provide for the transfer
from the Federal Hospital Insurance Trust Fund under section
1817 of the Social Security Act (42 U.S.C. 1395i) an amount
not to exceed $30,000,000 for the costs of carrying out this
section.
SEC. 112. MEDICARE HEALTH EDUCATION AND RISK APPRAISAL
PROGRAM.
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:
``medicare health education and risk appraisal program
``Sec. 1897. (a) Establishment.--Not later than 18 months
after the date of the conclusion of the demonstration
projects conducted under subsection (b)(1), the Secretary
shall establish a comprehensive and systematic model for
delivering health promotion and disease prevention services
that--
``(1) through self-assessment identifies--
``(A) behavioral risk factors, such as tobacco use,
physical inactivity, alcohol use, depression, lack of proper
nutrition, and risk of falling, among target individuals;
``(B) needed medicare clinical preventive and screening
health benefits among target individuals; and
``(C) functional and self-management information the
Secretary determines to be appropriate;
``(2) provides ongoing followup to reduce risk factors and
promote the appropriate use of preventive and screening
health benefits;
``(3) improves clinical outcomes, satisfaction, quality of
life, and appropriate use by target individuals of items and
services covered under the medicare program; and
``(4) provides target individuals with information
regarding the adoption of healthy behaviors.
``(b) Demonstration Projects.--
``(1) Establishment.--Not later than 1 year after the date
of enactment of this section, the Secretary, in consultation
with the Director of the Centers for Disease Control and
Prevention, and the Director of the Agency for Healthcare
Research and Quality, shall conduct demonstration projects
for the purpose of developing a comprehensive and systematic
model for delivering health promotion and disease prevention
services described in subsection (a).
``(2) Self-assessment and provision of information.--The
Secretary shall conduct the demonstration projects
established under paragraph (1) in the following manner:
``(A) Self-assessment.--
``(i) In general.--The Secretary shall test different--
``(I) methods of making self-assessments available to each
target individual;
``(II) methods of encouraging each target individual to
participate in the self-assessment; and
``(III) methods for processing responses to the self-
assessment.
``(ii) Contents.--A self-assessment made available under
clause (i) shall include--
``(I) questions regarding behavioral risk factors;
``(II) questions regarding needed preventive screening
health services;
``(III) questions regarding the target individual's
preferences for receiving follow-up information; and
[[Page S11210]]
``(IV) other information that the Secretary determines
appropriate.
``(B) Provision of information.--After each target
individual completes the self-assessment, the Secretary shall
ensure that the target individual is provided with such
information as the Secretary determines appropriate, which
may include--
``(i) information regarding the results of the self-
assessment;
``(ii) recommendations regarding any appropriate behavior
modification based on the self-assessment;
``(iii) information regarding how to access behavior
modification assistance that promotes healthy behavior,
including information on nurse hotlines, counseling services,
provider services, and case-management services;
``(iv) information, feedback, support, and recommendations
regarding any need for clinical preventive and screening
health services or treatment; and
``(v) referrals to available community resources in order
to assist the target individual in reducing health risks.
``(3) Project areas and duration.--
``(A) Project areas.--The Secretary shall implement the
demonstration projects in geographic areas that include
urban, suburban, and rural areas.
``(B) Duration.--The Secretary shall conduct the
demonstration projects during the 3-year period beginning on
the date on which the first demonstration project is
implemented.
``(c) Report to Congress.--
``(1) In general.--Not later than 1 year after the date on
which the demonstration projects conclude, the Secretary
shall submit to Congress a report on such projects.
``(2) Contents of report.--The report submitted under
paragraph (1) shall--
``(A) describe the demonstration projects conducted under
this section;
``(B) identify the demonstration project that is the most
effective; and
``(C) contain such other information regarding the
demonstration projects as the Secretary determines
appropriate.
``(3) Measurement of effectiveness.--For purposes of
paragraph (2)(B), in identifying the demonstration project
that is the most effective, the Secretary shall consider--
``(A) how successful the project was at--
``(i) reaching target individuals and engaging them in an
assessment of the risk factors of such individuals;
``(ii) educating target individuals on healthy behaviors
and getting such individuals to modify their behaviors in
order to diminish the risk of chronic disease; and
``(iii) ensuring that target individuals were provided with
necessary information;
``(B) the cost-effectiveness of the demonstration project;
and
``(C) the degree of beneficiary satisfaction under the
demonstration projects.
``(d) Waiver Authority.--The Secretary may waive such
requirements under this title as the Secretary determines
necessary to carry out the demonstration projects under this
section.
``(e) Funding.--There are authorized to be appropriated
$25,000,000 to the Secretary for carrying out the
demonstration projects under this section.
``(f) Definition of Target Individual.--The term `target
individual' means each individual who is--
``(1) entitled to benefits under part A or enrolled under
part B, including an individual enrolled under the
Medicare+Choice program under part C; or
``(2) between the ages of 50 and 64 and who is not
described in paragraph (1).''.
Subtitle C--Medicare Coverage for Care Coordination and Assessment
Services
SEC. 121. CARE COORDINATION AND ASSESSMENT SERVICES.
(a) Services Authorized.--Title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.), as amended by section
112, is further amended by adding at the end the following
new section:
``care coordination and assessment services
``Sec. 1898. (a) Purpose.--The purpose of this section is
to provide assistance to a beneficiary with a serious and
disabling chronic condition (as defined in subsection (f)(1))
to obtain the appropriate level and mix of follow-up care.
``(b) Election of Care Coordination and Assessment
Services.--
``(1) In general.--On or after January 1, 2003, a
beneficiary with a serious and disabling chronic condition
may elect to receive care coordination services in accordance
with the provisions of this section under which, in
appropriate circumstances, the eligible beneficiary has
health care services covered under this title managed and
coordinated by a care coordinator who is qualified under
subsection (e) to furnish care coordination services under
this section.
``(2) Revocation of election.--An eligible beneficiary who
has made an election under paragraph (1) may revoke that
election at any time.
``(c) Outreach.--The Secretary shall provide for the wide
dissemination of information to beneficiaries and providers
of services, physicians, practitioners, and suppliers with
respect to the availability of and requirements for care
coordination services under this section.
``(d) Care Coordination and Assessment Services
Described.--Care coordination services under this section
shall include the following:
``(1) Basic care coordination and assessment services.--
``(A) In general.--Except as otherwise provided in this
section, eligible beneficiaries who have made an election
under this section shall receive the following services:
``(i)(I) An initial assessment of an individual's medical
condition, functional and cognitive capacity, and
environmental and psychosocial needs.
``(II) Annual assessments after the initial assessment
performed under subclause (I), unless the physician or care
coordinator of the individual determines that additional
assessments are required due to sentinel health events or
changes in the health status of the individual that may
require changes in plans of care developed for the
individual.
``(ii) The development of an initial plan of care, and
subsequent appropriate revisions to that plan of care.
``(iii) The management of, and referral for, medical and
other health services, including multidisciplinary care
conferences and coordination with other providers.
``(iv) The monitoring and management of medications.
``(v) Patient education and counseling services.
``(vi) Family caregiver education and counseling services.
``(vii) Self-management services, including health
education and risk appraisal to identify behavioral risk
factors through self-assessment.
``(viii) Providing access for consultations by telephone
with physicians and other appropriate health care
professionals, including 24-hour availability of such
professionals for emergency consultations.
``(ix) Coordination with the principal nonprofessional
caregiver in the home.
``(x) Managing and facilitating transitions among health
care professionals and across settings of care, including the
following:
``(I) Pursuing the treatment option elected by the
individual.
``(II) Including any advance directive executed by the
individual in the medical file of the individual.
``(xi) Activities that facilitate continuity of care and
patient adherence to plans of care.
``(xii) Information about, and referral to, hospice
services, including patient and family caregiver education
and counseling about hospice, and facilitating transition to
hospice when elected.
``(xiii) Such other medical and health care services for
which payment would not otherwise be made under this title as
the Secretary determines to be appropriate for effective care
coordination, including the additional items and services as
described in subparagraph (B).
``(B) Additional benefits.--The Secretary may specify
additional benefits for which payment would not otherwise be
made under this title that may be available to eligible
beneficiaries who have made an election under this section
(subject to an assessment by the care coordinator of an
individual beneficiary's circumstances and need for such
benefits) in order to encourage the receipt of, or to improve
the effectiveness of, care coordination services.
``(2) Care coordination and assessment requirement.--
Notwithstanding any other provision of this title, with
respect to items and services for which payment is made under
this title furnished to a beneficiary for the diagnosis and
treatment of the beneficiary's serious and disabling chronic
condition, if the beneficiary has made an election to receive
care coordination and assessment services under this section,
the Secretary may require that payment may only be made under
this title for such items and services relating to such
condition if the items and services have been furnished by or
coordinated through the care coordinator. Under such
provision, the Secretary shall prescribe exceptions for
emergency medical services (as described in section
1852(d)(3), but without regard to enrollment with a
Medicare+Choice organization), and other exceptions
determined by the Secretary for the delivery of timely and
needed care.
``(e) Care Coordinators.--
``(1) Conditions of participation.--In order to be
qualified to furnish care coordination and assessment
services under this section, an individual or entity shall--
``(A) be a health care professional or entity (which may
include physicians, physician group practices, or other
health care professionals or entities the Secretary may find
appropriate) meeting such conditions as the Secretary may
specify;
``(B) enter into a care coordination agreement under
paragraph (2); and
``(C) meet such criteria as the Secretary may establish
(which may include experience in the provision of care
coordination or primary care physician's services).
``(2) Agreement term; payment.--
``(A) Duration and renewal.--A care coordination agreement
under this subsection shall--
``(i) be entered into for a period of 1 year and may be
renewed if the Secretary is satisfied that the care
coordinator continues to meet the conditions of participation
specified in paragraph (1);
``(ii) assure the compliance of the care coordinator with
such data collection and reporting requirements as the
Secretary determines necessary to assess the effect of care
coordination on health outcomes; and
[[Page S11211]]
``(iii) contain such other terms and conditions as the
Secretary may require.
``(B) Payment for services.--The Secretary shall establish
payment terms and conditions and payment rates for basic care
coordination and assessment services described in subsection
(d)(1). The Secretary may establish new billing codes to
carry out the provisions of this subparagraph.
``(f) Definitions.--In this section:
``(1) Serious and disabling chronic condition.--The term
`serious and disabling chronic condition' means, with respect
to an individual, that the individual has at least one
physical or mental condition and a licensed health care
practitioner has certified within the preceding 12-month
period that--
``(A) the individual has a level of disability such that
the individual is unable to perform (without substantial
assistance from another individual) for a period of at least
90 days due to a loss of functional capacity--
``(i) at least 2 activities of daily living; or
``(ii) such number of instrumental activities of daily
living that is equivalent (as determined by the Secretary) to
the level of disability described in clause (i);
``(B) the individual has a level of disability equivalent
(as determined by the Secretary) to the level of disability
described in subparagraph (A); or
``(C) the individual requires substantial supervision to
protect the individual from threats to health and safety due
to severe cognitive impairment.
``(2) Activities of daily living.--The term `activities of
daily living' means each of the following:
``(A) Eating.
``(B) Toileting.
``(C) Transferring.
``(D) Bathing.
``(E) Dressing.
``(F) Continence.
``(3) Instrumental activities of daily living.--The term
`instrumental activities of daily living' means each of the
following:
``(A) Medication management.
``(B) Meal preparation.
``(C) Shopping.
``(D) Housekeeping.
``(E) Laundry.
``(F) Money management.
``(G) Telephone use.
``(H) Transportation use.
``(4) Beneficiary.--The term `beneficiary' means an
individual entitled to benefits under part A, or enrolled
under part B, including an individual enrolled under the
Medicare+Choice program under part C.''.
(b) Coverage of Care Coordination and Assessment Services
as a Part B Medical Service.--
(1) In general.--Section 1861(s) of the Social Security Act
(42 U.S.C. 1395x(s)) is amended--
(A) in the second sentence, by redesignating paragraphs
(16) and (17) as clauses (i) and (ii); and
(B) in the first sentence--
(i) by striking ``and'' at the end of paragraph (14);
(ii) by striking the period at the end of paragraph (15)
and inserting ``; and''; and
(iii) by adding after paragraph (15) the following new
paragraph:
``(16) care coordination and assessment services furnished
by a care coordinator in accordance with section 1866C.''.
(2) Conforming amendments.--Sections 1864(a) 1902(a)(9)(C),
and 1915(a)(1)(B)(ii)(I) of such Act (42 U.S.C. 1395aa(a),
1396a(a)(9)(C), and 1396n(a)(1)(B)(ii)(I)) are each amended
by striking ``paragraphs (16) and (17)'' each place it
appears and inserting ``clauses (i) and (ii) of the second
sentence''.
(3) Part b coinsurance and deductible not applicable to
care coordination and assessment services.--
(A) Coinsurance.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)), as amended by sections 105 and
223 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--
(i) by striking ``and'' at the end of subparagraph (T); and
(ii) by inserting before the final semicolon ``, and (V)
with respect to care coordination and assessment services
described in section 1861(s)(16) that are furnished by, or
coordinated through, a care coordinator, the amounts paid
shall be 100 percent of the payment amount established under
section 1866C''.
(B) Deductible.--Section 1833(b) of such Act (42 U.S.C.
1395l(b)) is amended--
(i) by striking ``and'' at the end of paragraph (5); and
(ii) by inserting before the final period ``, and (7) such
deductible shall not apply with respect to care coordination
and assessment services (as described in section
1861(s)(16))''.
(C) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of
such Act (42 U.S.C. 1395cc(a)(2)(A)), as amended by section
102(b)(2), is further amended by inserting after ``section
1833(p),'' the following: ``with respect to care coordination
and assessment services (as described in section
1861(s)(16)),''.
TITLE II--PAYMENT INCENTIVES FOR QUALITY CARE FOR INDIVIDUALS WITH
SERIOUS AND DISABLING CHRONIC CONDITIONS
SEC. 201. ADJUSTMENTS TO FEE-FOR-SERVICE PAYMENT SYSTEMS.
(a) In General.--The Secretary of Health and Human Services
shall provide for appropriate adjustments to each of the
payment systems described in subsection (b) to take into
account the additional costs incurred in providing items and
services under the medicare program to medicare beneficiaries
who suffer from serious and disabling chronic conditions,
including the consideration of the patient classification
system (or other methodology) under subsection (d). The
Secretary shall implement such adjustments for items and
services furnished on or after October 1, 2005.
(b) Payment Systems Described.--The payment systems
referred to in subsection (a) are the following:
(1) The prospective payment system for covered skilled
nursing facility services under section 1888(e) of such Act
(42 U.S.C. 1395yy(e)).
(2) The prospective payment system for home health services
under section 1895 of such Act (42 U.S.C. 1395fff).
(3) The prospective payment system for outpatient hospital
services under section 1833(t) of such Act (42 U.S.C.
1395l(t)).
(4) The physician fee schedule under section 1848 of such
Act (42 U.S.C. 1395w-4).
(5) The composite rate of payment for dialysis services
under section 1881(b)(7) of such Act (42 U.S.C.
1395rr(b)(7)).
(6) The payment rate for outpatient therapy services and
comprehensive outpatient rehabilitation services under
section 1834(k) of such Act (42 U.S.C. 1395m(k)).
(7) The payment rate for partial hospitalization services
established by the Secretary in regulations under title XVIII
of such Act.
(8) The payment rate for hospice services under section
1814(i) of such Act (42 U.S.C. 1395f(i)).
(c) Interim Report.--Not later than 18 months after the
date of enactment of this Act, the Secretary shall submit to
Congress a report on the proposed adjustments required under
subsection (a) to the payment systems described in subsection
(b), the methodology employed by the Secretary in providing
for such proposed adjustments, and an assessment of the
impact of such adjustments on access to effective care for
medicare beneficiaries.
(d) Patient Classification System.--The Secretary shall
develop a patient classification system or other methodology
to predict costs within and across postacute care settings
attributable to furnishing items and services to medicare
beneficiaries who suffer from serious and disabling chronic
conditions. The Secretary shall develop such system by not
later than October 1, 2004, and shall consult with
representatives of providers of services and individuals with
expertise in health care financing and risk adjustment
methodology in developing such system.
SEC. 202. MEDICARE+CHOICE.
(a) Revisions to Risk Adjustment Methodology.--
(1) In general.--The Secretary shall revise the risk
adjustment methodology under section 1853(a)(3) of the Social
Security Act (42 U.S.C. 1395w-23(a)(3)) applicable to
payments to Medicare+Choice organizations offering
specialized programs for frail elderly and at-risk
beneficiaries to take into account variations in costs
incurred by such organizations.
(2) Methods considered.--In revising the risk adjustment
methodology under paragraph (1), the Secretary shall
consider--
(A) hybrid risk adjustment payment systems, such as partial
capitation;
(B) new diagnostic and service markers that more accurately
predict high risk;
(C) improving the structural components of the applicable
method of payment, such as reducing payment lag, using
multiple site diagnostic data, and using several years of
data;
(D) providing for adjustments to payment amounts for
beneficiaries with comorbidities;
(E) testing concurrent risk adjustment methodologies; and
(F) testing payment methods using data from specialized
programs for frail elderly and at-risk beneficiaries.
(3) Implementation.--The Secretary shall implement such
revisions to the risk adjustment methodology for items and
services furnished on or after January 1, 2005.
(4) Interim report.--Not later than January 1, 2004, the
Secretary shall submit to Congress a report on revision of
the risk adjustment methodology required under paragraph (1),
including a description of the methods considered and
employed by the Secretary in providing for such revision and
an assessment of the impacts of such methods on access to
effective care for medicare beneficiaries.
(b) Interim Continuation of Blended Rate for Specialized
Programs for Frail Elderly and At-Risk Medicare Beneficiaries
Residing in Institutions.--
(1) In general.--In the case of a Medicare+Choice
organization that complies with the requirements under
paragraph (2) and that offers a Medicare+Choice plan that
provides for a specialized program for frail elderly and at-
risk beneficiaries that exclusively serves beneficiaries in
institutions or beneficiaries that are entitled to medical
assistance under a State plan under title XIX,
notwithstanding section 1853(a)(3)(C)(ii) of the Social
Security Act (42 U.S.C. 1395w-23(a)(3)(C)(ii)), such
organization shall be paid according to the method described
in section 1853(a)(3)(C)(ii)(I) until such time as
[[Page S11212]]
the Secretary has implemented the revised risk adjustment
methodology required in subsection (a).
(2) Requirements.--A Medicare+Choice organization may not
qualify for the payment methodology under paragraph (1)
unless the organization collects such data (and in such
format) as the Secretary requires to monitor quality of
services provided, outcomes, and costs, including functional
and diagnostic data and information collected through the
Health Outcomes Survey.
(c) Interim Continuation of Payment Methodologies for
Demonstration Programs.--
(1) In general.--Notwithstanding any other provision of
law, payment methodologies for medicare demonstration
programs for specialized programs for frail elderly and at-
risk beneficiaries that comply with the requirements under
paragraph (2) shall continue under the terms and conditions
of the demonstration authority, including the risk adjustment
factors and formula used for paying such demonstration
programs, until such time as the Secretary has implemented
the revised risk adjustment methodology required in
subsection (a).
(2) Requirements.--A medicare demonstration program may not
qualify for the payment methodology under paragraph (1)
unless the program collects such data (and in such format) as
the Secretary requires to monitor quality of services
provided, outcomes, and costs, including functional and
diagnostic data and information collected through the Health
Outcomes Survey.
(d) Interim Demonstration Program for Additional Payments
for Specialized Programs.--
(1) In general.--The Secretary shall establish a
demonstration program under which additional payments (in
such manner and amount as the Secretary determines
appropriate) may be made to a Medicare+Choice organization
that complies with the requirements under paragraph (2) and
that offers a Medicare+Choice plan that--
(A) provides, directly or through contract, for a
specialized program of care for enrollees with serious and
disabling chronic conditions; and
(B) exclusively serves enrollees with serious and disabling
chronic conditions or serves a disproportionate share of such
enrollees.
(2) Requirements.--A Medicare+Choice organization may not
qualify for additional payments under paragraph (1) unless
the organization and the specialized program of care meet the
following requirements:
(A) Under the specialized program of care, a clinical
delivery system is established that meets the needs of such
enrollees, including--
(i) methods to prevent, delay, or minimize the progression
of disabilities;
(ii) disease management protocols, such as high risk
screening to identify risk of hospitalization, nursing home
placement, functional decline, death, and other factors that
increase the costs of care provided;
(iii) appropriate specially trained health care staff, such
as nurse practitioners, geriatric care managers, or mental
health professionals; and
(iv) methods for promoting integration of care, financing,
and administrative functions across health care settings.
(B) The organization collects such data (and in such
format) as the Secretary requires to monitor quality of
services provided, outcomes, and costs, including functional
and diagnostic data and information collected through the
Health Outcomes Survey.
(C) The organization employs quality standards and tracks
quality indicators specified by the Secretary that are
relevant to the special needs of enrollees with serious and
disabling chronic conditions.
(D) The organization does not receive payments, or
adjustment to payments, with respect to any enrollee by
reason of subsection (b) or (c).
(3) Waiver authority.--The Secretary may waive such
requirements of title XVIII of the Social Security Act as may
be necessary to carry out this demonstration program.
(4) Termination.--The demonstration program under this
subsection shall terminate 1 year after such time as the
Secretary has implemented the revised risk adjustment
methodology required in subsection (a).
(5) Funding.--There are authorized to be appropriated to
the Secretary $25,000,000 for carrying out the demonstration
program under this subsection.
(e) Definition.--In this section, the term ``specialized
programs for frail elderly and at-risk beneficiaries''
means--
(1) demonstrations approved by the Secretary for purposes
of testing the integration of acute and expanded care
services under prepaid financing which include prescription
drugs and other noncovered ancillary services, care
coordination, and home and community-based services, such as
the social health maintenance organization demonstration
project authorized under section 2355 of the Deficit
Reduction Act of 1984 and expanded under section
4207(b)(4)(B)(i) of the Omnibus Reconciliation Act of 1990;
(2) demonstrations approved by the Secretary for purposes
of improving quality of care and preventing hospitalizations
for nursing home residents, such as the EverCare
demonstration project;
(3) demonstrations approved by the Secretary for purposes
of testing methods for integrating medicare and medicaid
benefits for the dually eligible, such as the Minnesota
Senior Health Options program, the Wisconsin Partnership
program, the Massachusetts Senior Care Organization program,
and the Rochester Community Care Network program;
(4) demonstrations approved by the Secretary under
subsection (d); and
(5) such other demonstrations or programs approved by the
Secretary for similar purposes, as determined by the
Secretary.
TITLE III--DEVELOPMENT OF NATIONAL POLICIES ON EFFECTIVE CHRONIC
CONDITION CARE
SEC. 301. STUDY AND REPORT ON EFFECTIVE CHRONIC CONDITION
CARE.
(a) Study.--For purposes of improving chronic condition
care furnished to medicare beneficiaries under the medicare
program, the Secretary of Health and Human Services shall
conduct a comprehensive study of chronic condition trends of
medicare beneficiaries and associated service utilization,
quality indicators, and cumulative costs.
(b) Specific Matters Studied.--The study conducted under
subsection (a) shall include an assessment of the following:
(1) Chronic condition prevalence rates.
(2) Demographic, medical, and functional information about
medicare beneficiaries with chronic conditions.
(3) Utilization, cost, and quality data across settings,
including--
(A) expenditures under a State plan under title XIX of the
Social Security Act for individuals dually eligible for
benefits under the medicare and medicaid programs,
(B) data on out-of-pocket expenses paid by medicare
beneficiaries,
(C) data on payments made by non-Federal health insurance
programs,
(D) amounts and percentages of overall payments made to
medicare providers of services and suppliers for medicare
beneficiaries with chronic conditions, and
(E) current and future cost-shifting for treatment of such
beneficiaries between the medicare and medicaid programs.
(c) Information.--
(1) In general.--The Secretary may collect such data from
providers of services, suppliers, fiscal intermediaries, and
carriers. Such providers, suppliers, fiscal intermediaries,
and carriers shall furnish to the Secretary the data the
Secretary requires to conduct the study under subsection (a).
(2) Requirement to consider data previously collected.--To
the maximum extent practicable, in conducting the study, the
Secretary shall analyze existing data and utilize existing
data collection methodologies.
(3) Consultation.--The Secretary shall consult with
representatives of providers of services, suppliers, fiscal
intermediaries, and carriers with respect to data collection
requirements to conduct the study with respect to the
specific matters described in subsection (b).
(d) Report.--
(1) In general.--Not later than 3 years after the date of
enactment of this Act, and triennially thereafter, the
Secretary shall submit to Congress a report on the study
conducted under subsection (a) and the specific matters
studied under subsection (b).
(2) Recommendations.--Each report shall also include
specific recommendations with respect to appropriate care for
medicare beneficiaries with chronic conditions, including the
establishment, and refinement, of goals for reducing chronic
condition prevalence rates and related medical expenses.
(e) Definition.--In this section, the term ``chronic
condition'' means one or more physical or mental conditions
which are likely to last for an unspecified period of time,
or for the duration of an individual's life, for which there
is no known cure, and which may affect an individual's
ability to carry out basic activities of daily living,
instrumental activities of daily living, or both.
(f) Reduction of Paperwork; Assistance With Development of
Computer-Assisted Paperwork Reduction Technology.--
(1) Reduction of paperwork.--Not later than one year after
the date of enactment of this Act, the Secretary shall, in
consultation with providers of services and suppliers under
the medicare program, patient advocacy groups, and State and
local health care administration experts, implement a program
to eliminate or simplify those paperwork requirements that
are not required by law, and do not contribute to the quality
of care furnished to medicare beneficiaries or the integrity
of the medicare program.
(2) Development of best practices software.--
(A) In general.--The Secretary, through the Office of
Research and Development of the Center for Medicare and
Medicaid Services, shall develop and disseminate to providers
of services and suppliers participating in the medicare
program best practices electronic software and medical
technology information systems designed to reduce the
duplicative recording of information, to reduce the need for
handwritten entries, and to reduce the risk of medical and
pharmaceutical errors in data entry.
(B) Technical assistance.--The Secretary shall provide for
technical assistance in the use of the electronic software
developed under subparagraph (A).
(C) Authorization of appropriations.--For each of fiscal
years 2002, 2003, and 2004, there are authorized to be
appropriated to the Secretary $10,000,000 to carry out this
paragraph.
SEC. 302. INSTITUTE OF MEDICINE MEDICARE CHRONIC CONDITION
CARE IMPROVEMENT STUDY AND REPORT.
(a) Study.--
[[Page S11213]]
(1) In general.--The Secretary shall contract with the
Institute of Medicine of the National Academy of Sciences
to--
(A) conduct a comprehensive study of the medicare program
to identify--
(i) factors that facilitate access to effective care
(including, where appropriate, hospice care) for medicare
beneficiaries with chronic conditions; and
(ii) factors that impede access to such care for such
beneficiaries,
including the issues studied under paragraph (2); and
(B) submit the report described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall--
(A) identify inconsistent clinical, financial, or
administrative requirements across provider and supplier
settings or professional services with respect to medicare
beneficiaries;
(B) identify requirements under the program imposed by law
or regulation that--
(i) promote costshifting across providers and suppliers;
(ii) impede access to effective chronic condition care by
requiring the demonstration of continuing clinical
improvement of the condition as a prerequisite to coverage of
certain benefits;
(iii) impose unnecessary burdens on such beneficiaries and
their family caregivers;
(iv) impede coverage for services that prevent, delay, or
minimize the progression of chronic conditions;
(v) impede the establishment of administrative information
systems to track health status, utilization, cost, and
quality data across providers and suppliers and provider
settings;
(vi) impede the establishment of clinical information
systems that support continuity of care across settings and
over time;
(vii) impede the alignment of financial incentives among
the medicare program, the medicaid program, and group health
plans and providers and suppliers that furnish services to
the same beneficiary; or
(viii) impede payment methods that encourage the enrollment
of high-risk populations, support innovation, or encourage
providers and suppliers to maintain or improve health status
for such medicare beneficiaries.
(b) Report.--On the date that is 18 months after the date
of enactment of this Act, the Institute of Medicine of the
National Academy of Sciences shall submit to Congress and the
Secretary of Health and Human Services a report that
contains--
(1) a detailed statement of the findings and conclusions of
the study conducted under subsection (a); and
(2) recommendations to improve access to effective care for
medicare beneficiaries with chronic conditions.
____
Summary of the Medicare Chronic Care Improvement Act of 2001
title I--expansion of benefits to prevent, delay, and minimize the
progression of chronic conditions
Improve access to preventive services
Eliminate deductibles and co-insurance for Medicare covered
preventive services.
Streamline process of approving preventive benefits by
directing the Secretary of Health and Human Services to
contract with the Institute of Medicine (IOM) to investigate
and recommend new preventive benefits every 3 years. Grant
the Secretary the authority to implement these
recommendations, and fast-track the recommendations through
Congress if the Secretary chooses not to act upon this
authority.
Expand access to health promotion services
Establish demonstration projects to promote disease self-
management.
Implement a Medicare health education and risk appraisal
program no later than 18 months after a series of
demonstration projects conclude.
Expand coverage for care coordination and assessment services
Create a new benefit that covers assessment, care
coordination, counseling, and education assistance for
individuals with serious and disabling chronic conditions.
Services could be provided by health care professionals,
including physicians, social workers, and nurses.
Examples of items and services to be covered include:
initial and periodic health screening and assessments;
management and referral for medical and other health
services; medication management; and patient and family
caregiver education and counseling.
title ii--establish payment incentives for furnishing quality services
to individuals with serious and disabling chronic conditions
Improve medicare financing methods
Direct the Secretary to refine Medicare prospective payment
systems for skilled nursing facility (SNF), home health,
therapy, partial hospitalization, end stage renal dialysis
(ESRD), and outpatient hospital services and refine resource-
based relative value scale (RBRVS) payment methods for
physicians to ensure appropriate payment for serving
individuals with serious and disabling chronic conditions.
Direct the Secretary to refine Medicare+Choice risk
adjustment methodology to provide adequate payment for plans
with specialized programs for frail elderly and at-risk
beneficiaries.
Until the refined risk adjustment methodology is
implemented, direct the Secretary to continue current payment
methodologies for existing specialized programs for frail
elderly and at-risk beneficiaries.
Create a demonstration program to provide additional
payments to Medicare+Choice plans that provide a specialized
program of care for beneficiaries with serious and disabling
chronic conditions. These plans must exclusively serve such
beneficiaries or serve a disproportionate share of such
beneficiaries. The demonstration program would expire one
year after the refund risk adjustment methodology is
implemented.
Title III--Study and Report on Effective Chronic Condition Care
Evaluate Medicare policies regarding chronic condition care
Direct the Secretary to study chronic condition trends and
associated service utilization, cumulative costs, and quality
indicators in Medicare.
Direct the Secretary to report the study results to
Congress every 3 years. The report must include
recommendations on improving care for Medicare beneficiaries
with chronic conditions, reducing chronic conditions, and
reducing related medical expenses.
Identify improvements in Medicare to ensure effective chronic condition
care
Direct the Secretary to contract with the IOM to
investigate and identify barriers and facilitators to
effective care for Medicare beneficiaries with chronic
conditions, including inconsistent clinical, financial, or
administrative requirements across care settings. The IOM's
report must include recommendations to improve access to
effective care.
Definitions
``Chronic condition'' means one or more physical or mental
conditions which are likely to last for an unspecified period
of time, or for the duration of an individual's life, for
which there is no known cure, and which may affect an
individual's ability to carry out basic activities of daily
living (ADLs), instrumental activities of daily living
(IADLs), or both.
``Serious and disabling chronic condition(s)'' means the
individual has one or more physical or mental conditions and
has been certified by a licensed health care practitioner
within the preceding 12 months as having a level of
disability such that the individual, for at least 90 days, is
unable to perform at least 2 ADLs or a number of IADLs or
other measure indicating an equivalent level of disability or
requiring substantial supervision due to severe cognitive
impairment.
______
By Mr. NELSON of Florida:
S. 1592. A bill to amend title XI of the Social Security Act to
prohibit Federal funds from being used to provide payments under a
Federal health care program to any health care provider who charges a
membership or any other extraneous or incidental fee to a patient as a
prerequisite for the provision of an item or services to the patient;
to the Committee on Finance.
Mr. NELSON of Florida. Mr. President, I am pleased to introduce the
Medicare Equal Access to Care Act. I am jointed by my colleagues
Senators Durbin and Edwards. This legislation is designed to address a
disturbing development which may make it harder for some seniors to
have access to Medicare.
I have recently become aware of a practice, an early example if which
took place in Florida, in which doctors assess their existing patients
a $1,500 membership fee in order to receive continued care. In some
States, these fees have been as high as $20,000. By charging these
extraneous and unwarranted dues, the doctors can shrink their practice,
yet maintain their profits. Another version of this arrangement is to
require that patients seek and pay for non-Medicare covered services
from their doctors as a condition for joining or remaining in the
practice. Tragically, the patients who can't afford these large sums
for the privilege of medical care or who choose not to purchase non-
Medicare covered services are simply told to find another doctor. In
areas where there is already a shortage of doctors, this practice could
severely hamper Medicare beneficiaries' access to health care.
Then, in addition to membership fees the doctors bill Medicare for
the cost of the covered services they provide.
Were Medicare a private insurance company, this practice would not be
allowed. Private health insurance companies do not permit their
providers to charge an ``access fee'' as a condition to being accepted
as a patient. The Federal Government, the American taxpayers, should
not hold its providers to a looser standard, thereby supporting a
distasteful division of Medicare beneficiaries into haves and have-
nots. This situation is unacceptable.
[[Page S11214]]
The Medicare Equal Access to Care Act bill will put a damper on such
agreements. This legislation is simple: it will prevent any federal
health program, like Medicare, from reimbursing doctors who charge
their patients membership fees, as defined by the Secretary of Health
and Human Services, or who require that their patients purchase non-
Medicare.
I want to emphasize that this legislation does not interfere with the
right of the doctor and patient to enter into private arrangements. A
doctor may forego Medicare reimbursement and charge patients a
membership fee of any amount, and patients have the choice of whether
to accept that condition. Likewise, a doctor is free to charge a
patient for any service that is not reimbursed under Medicare.
Though they present a carefully crafted loophole, these arrangements
violate the intent and spirit of the Balanced Billing Act.
Clearly, our health care system is not working for patients.
Additionally it's not working for doctors, if they must resort to these
types of practices. Also, hundreds of thousands of our nation's seniors
have been informed that their managed care company will be withdrawing
from the Membership program. We need to adequately reimburse doctors,
to provide the incentive to continue to participate in the
Medicare+Choice program. Just as we don't want Medicare beneficiaries
to be told their HMO is unavailable, we don't want them to be told
their doctor is unavailable, unless they pay a fee. These are among
these reasons that Congress needs to complete and pass a Patient's Bill
of Rights and send it to the President. But in the meantime, we must
protect our seniors and ensure that their access to Medicare is not
subject to hurdles and conditions.
I look forward to working with my colleagues to pass the Medicare
Equal Access to Care Act.
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. 1592
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 ``Equal Access to Care Act''.
SEC. 2. LIMITATION ON PAYMENTS TO PROVIDERS UNDER A FEDERAL
HEALTH CARE PROGRAM.
(a) In General.--Title XI of the Social Security Act (42
U.S.C. 1301 et seq.) is amended by inserting after section
1128F the following new section:
``SEC. 1128G. LIMITATION ON PAYMENTS TO PROVIDERS UNDER A
FEDERAL HEALTH CARE PROGRAM.
``(a) In General.--No Federal funds shall be used to
provide payments under a Federal health care program to any
physician (as defined in section 1861(r)), practitioner (as
described in section 1842(b)(18)(C)), or other individual who
charges a membership fee or any other extraneous or
incidental fee to a patient, or requires a patient to
purchase an item or service, as a prerequisite for the
provision of an item or service to the patient.
``(b) Federal Health Care Program Defined.--In this
section, the term `Federal health care program' has the
meaning given that term under section 1128B(f) except that,
for purposes of this section, such term includes the health
insurance program under chapter 89 of title 5, United States
Code.''.
(b) Effective Date.--The amendment made by subsection (a)
applies to payments made on or after the date of enactment of
this Act.
______
By Mr. JEFFORDS (for himself, Mr. Smith of New Hampshire, and Mr.
Crapo):
S. 1593. A bill to authorize the Administrator of the Environmental
Protection Agency to establish a grant program to support research
projects on critical infrastructure protection for water supply
systems, and for other purposes; to the Committee on Environment and
Public Works.
Mr. JEFFORDS. Mr. President, Members of the Senate, I rise before you
today to introduce the Water Infrastructure Security and Research
Development Act. This legislation authorizes the U.S. Environmental
Protection Agency to provide funding to support research projects on
critical infrastructure protection for water supply systems.
Our Nation's water supply system is truly unique. It uses a
decentralized, community-based approach to provide superior water
services to all citizens of the United States. Here, we turn on the tap
in our homes and receive clean, fresh water without giving it much
thought. This not the way water systems operate throughout the world.
A 1997 United Nations report on the state of water resources
worldwide states that at least one-fifth of all people do not have
access to safe drinking water, and more than one-half lack adequate
sanitation. Quoting from the report:
The World Health Organization estimates that a total of
more than five million people die each year just from
diseases caused by unsafe drinking water, and a lack of
sanitation and water for hygiene. Provision of safe drinking
water and sanitation could reduce the amount of illness and
death by as much as three-quarters, depending on the disease.
In this country, we often take our water system for granted. When
considered in the international context, the true value of our water
system becomes more apparent. We truly have something to protect.
During my tenure as Chairman of the Environment and Public Works
Committee, we have been evaluating the state of our Nation's water
infrastructure, both drinking water and wastewater. It is clear that we
have work to do to modernize our existing systems and ensure that we
continue to provide clean, safe water to our citizens into the future.
Our discussions in the Committee tend to focus on infrastructure
replacement needs, the funds that will be required, and the extent of
the federal role. I am committed to this process, and I look forward to
continuing to work with my colleagues on legislation that we plan to
introduce early next year.
However, today, I rise to speak to you about another aspect of our
Nation's water infrastructure--security. Since the events of September
11, I have worked with the members of the Environment and Public Works
Committee and the Environmental Protection Agency to ensure that we are
taking the steps necessary to protect our nation's water infrastructure
system during these times. There are many short term actions that have
already been taken.
Based on the recommendations of Presidential Decision Directive 63,
issued by President Clinton in 1998, the Environmental Protection
Agency and its industry partner, the Association of Metropolitan Water
Agencies, have established a communications system, a water
infrastructure Information Sharing and Analysis Center, designed to
provide real-time threat assessment data to water utilities throughout
the nation.
Through this partnership, the Environmental Protection Agency and the
Association of Metropolitan Water Agencies are working to develop
generic assessment tools that individual water utilities can use to
assess their facilities for potential physical and cyber threats. I
believe that the rapid completion of both these tools and the
individual assessments is imperative. In early October, I sent a letter
to the President with Senators Smith, Graham, and Crapo and
Representatives Tauzin, Dingell, Gillmor, and Pallone requesting that
he use a portion of the $20 billion of discretionary funds provided to
the Administration by Congress this year to provide assistance for
these assessments to water utilities.
The legislation I am introducing today with Senator Smith will take
us one step further by authorizing support of both ongoing efforts
under Presidential Decision Directive 63 and new research to assess
potential threats to our water supply system and develop solutions.
This legislation authorizes twelve million dollars per year from 2002
to 2007 for the Environmental Protection Agency to use for grants to or
cooperative agreements with research institutions. Projects conducted
under these agreements will be used to conduct research addressing
physical and cyber threats at water supply systems, improvements in
information sharing and analysis efforts, and technical assistance and
training. These projects will address both drinking water and
wastewater systems that make up our nation's water supply
infrastructure.
[[Page S11215]]
Eligible research institutions will include public and private
entities, including national laboratories that perform research that
will improve the security of water supply systems. Our legislation
includes a provision to ensure that those entities conducting this
research have the ability to effectively safeguard sensitive
information.
Individual projects will fall into a series of categories designed to
develop the information we need to protect our water supply system
nationwide.
First, projects will assess the security issues for water supply
systems by conducting assessments and developing and refining
vulnerability assessment tools.
Second, projects will protect water supply systems from potential
threats by developing technologies, processes, guidelines, standards,
and procedures for the purpose of protecting water supply systems.
Projects will also develop real-time monitoring systems to protect
against chemical, biological, or radiological attack.
Third, projects will develop technologies and processes for
addressing the mitigation, response and recovery of biological,
chemical and radiological contamination of water supply systems.
Fourth, projects will implement requirements of Presidential Decision
Directive 63 by refining and operating the Information Sharing and
Analysis Center to capture and share threats, events and best
practices.
Finally, projects will test and evaluate new technologies and
processes by developing regional ``pilot facilities'' to demonstrate
upgraded security systems, assess new technologies, and to determine
operational and cost impacts due to enhanced security.
Individual awards may not exceed one million dollars. Test and
evaluation projects will be cost-shared on a 50-50 basis.
I look forward to working with my colleagues on this legislation and
other efforts to enhance the security of our Nation's water
infrastructure in the weeks, months, and years to come. We truly have
something to protect; clean, safe, fresh water is worth our investment.
______
By Mrs. CLINTON (for herself, Mr. Smith of Oregon, Mr. Kennedy,
and Mrs. Murray):
S. 1594. A bill to amend the Public Health Service Act to provide
programs to improve nurse retention, the nursing workplace, and the
quality of care; to the Committee on Health, Education, Labor, and
Pensions.
Mrs. CLINTON. Mr. President, I am proud to introduce today the Nurse
Retention and Quality Care Act of 2001 and to speak about the
importance of nurses and the work they do. On September 11, nurses were
among those who were on the front lines of the battle against
terrorism. With courage, skill and determination, they were on the job,
treating the injured, helping to save lives.
To this day, nurses are defending America. In clinics, hospitals and
offices around the country, they are working to detect and treat actual
or suspected cases of anthrax. Should our Nation face other biological
threats or terrorist attacks, nurses will be there for us.
Today's news that a woman who works in the Manhattan Eye, Ear and
Throat Hospital is in critical condition with possible inhalation
anthrax is a reminder of the hazards faced by health care workers. And
it is a reminder of how important it is that our public health system
be fully staffed with trained health care professionals.
Sadly, America is facing a nursing shortage at a time when the need
for more nurses is so clear. Our nurses are facing an emergency of
their own and they need our help. The nursing shortage imposes
increasing hardship on hospitals and nurses alike, and threatens the
ability of our health care system to provide basic patient care, much
less respond to health crises and terrorism.
Not only is the number of individuals entering the nursing profession
falling, but hospitals are also facing difficulty retaining the nurses
already on staff. Fifty percent of nurses say they have recently
considered leaving their jobs for reasons other than retirement, and
approximately half a million licensed nurses are not currently
practicing nursing. Many of the nurses who have considered leaving the
profession cite their low level of overall job satisfaction.
While we must do more to improve the number of nurses in training, we
must also take steps to enhance the workplace to retain current nurses,
and that is what the bill that Senator Gordon Smith and I will be
introducing today would address.
One way to retain nurses is to follow the example of those hospitals
that have become nursing ``magnets.'' They are successful because they
involve nurses in decision-making, encourage collaboration among health
professionals, give nurses the opportunity to pursue continuing
education and advancement, and they organize care to improve patient
outcome.
Our bill is designed to encourage more hospitals to follow these
leads. And I am pleased that hospitals and nurses support this bill. It
has been endorsed by the American Nurses Association and the American
Hospitals Association.
It is also a good bill for patients and their quality of care as
well. Research has shown that magnet hospitals have lower mortality
rates, shorter lengths of stay, higher patient satisfaction and cost-
efficiency.
As our Nation faces increasing threats of terrorist and biological
attack, our health system must be stronger than ever before. One of the
best ways we can do this is by taking steps to reverse the nursing
shortage, and ensure that nurses on the front lines are well-prepared
to respond to emergencies.
Our bill does both. First, it creates demonstration programs to
encourage states to adopt magnet hospital practices, which will help
attract and retain the nursing staff our hospitals need so they can
cope with surges in patient volume.
And, second, our bill encourages nurses to pursue continued
education. That is so important today, when we need more health care
professionals who can detect the early signs of a bioterrorist attack.
This legislation will promote the kind of training that the New York
State Nurses Association, Bellevue Hospital and New York College
provide for nurses in my state.
Mr. SMITH of Oregon. Mr. President, I rise today to join my colleague
from New York, Senator Clinton, in introducing the Nurse Retention and
Quality of Care Act of 2001. As most of my colleagues already know, our
Nation is facing an unprecedented nursing shortage. A Northwest Health
Foundation study released this year found that Oregon alone will have
3,200 nursing vacancies in 2010. It is critical that we act immediately
to address this shortage, and we must start by retaining the highly
skilled nurses that already constitute the foundation of our health
care system.
Our Nation's nursing shortage is not merely the result of poor nurse
recruitment, this shortage exists in large part because nurses are
leaving the profession altogether. Half a million licensed nurses are
not currently practicing. These nurses represent some of our Nation's
most compassionate and experienced health care professionals, but they
feel compelled to look elsewhere for work, and we must do something to
change this disturbing trend.
The Nurse Retention and Quality of Care Act will give hospitals
incentives to develop and implement model practices for retaining
nurses, such as the methods used by ``magnet hospitals''. Magnet
hospitals have been in existence for a number of years, and share
certain characteristics designed to make these hospitals attractive
workplaces for nurses. These hospitals promote nurse participation in
decision-making, collaboration and communication among health care
professionals, opportunities for nurses to pursue education and career
advancement, and a balanced and accommodating work environment for
nurses.
Nurses in magnet hospitals stay twice as long on average as those in
non-magnet hospitals, and consistently report greater job satisfaction.
Patients also express higher satisfaction in magnet hospitals. There is
one such hospital in my home state of Oregon, Providence St. Vincent
Medical Center in Portland, OR, and I am not alone in hoping this
legislation will lead to additional magnet facilities. Our legislation
will authorize $40 million in demonstration grants for health care
facilities to implement the model practices
[[Page S11216]]
utilized by magnet hospitals, and I believe that this will be an
important step toward fixing our Nation's impending nursing shortage.
Nurses are the human face of medicine, but the demands on them are
increasingly difficult to bear. The Nurse Retention and Quality of Care
Act paves the way for hospitals to implement practices that will
improve the morale of nurses and encourage them to stay in the nursing
profession. Now, more than ever, with the current health and safety
concerns facing our Nation, we must let nurses know that they are
important to us and that we value their expertise and compassion. By
passing this bill, we can do just that, and take important steps to
ensure an adequate supply of highly qualified nurses for years to come.
____________________