[Congressional Record Volume 148, Number 35 (Friday, March 22, 2002)]
[Senate]
[Pages S2326-S2330]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. BINGAMAN (for himself, Mr. Bond, and Mr. Inouye):
  S. 2067. A bill to amend title XVIII of the Social Security Act to 
enhance the access of Medicare beneficiaries who live in medically 
underserved areas to critical primary and preventive health care 
benefits to improve the Medicare+Choice program, and for other 
purposes; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, the legislation I am introducing today 
with Senators Bond and Inouye entitled the ``Medicare Safety Net Access 
Act of 2002,'' or ``Access 2002,'' would improve services for Medicare 
beneficiaries and protect a critical mission of health centers, to 
provide access to care to underserved rural, frontier, and inner-city 
communities.
  Community health centers, CHC's, provide primary and preventive care 
to more than 700,000 medically underserved Medicare beneficiaries, 
including over 20,000 in New Mexico. Health centers also provide 
critical support services that help seniors more easily access care. In 
many cases, the local health center may be the only source of primary 
and preventive care for Medicare beneficiaries in a community.
  While hundreds of thousands of Medicare beneficiaries turn to health 
centers for care, many centers struggle to provide services to these 
patients. Current Medicare regulations cause health centers significant 
financial losses that have a direct impact on access to care. In 
addition, the Medicare federally qualified health center, FQHC, benefit 
has not been modernized to include many of the new preventive and other 
services added to the Medicare package by Congress in recent years 
again undermining the critical role that health centers play in 
providing access to care.
  To address these and other issues, Senators Bond, Inouye, and I are 
introducing the ``Medicare Safety Net Access Act of 2002'', also known 
as ``Access 2002.'' The legislation would address the following 
problems.
  With respect to payment issues, the bill ensures that Medicare covers 
the cost of providing care to Medicare beneficiaries at CHC's. Congress 
provides more than $1.3 billion in section 330 funding to CHC's to 
provide care to

[[Page S2327]]

the uninsured. When Medicare fails to cover the costs of care for 
Medicare beneficiaries, CHC's must make up for the shortfall through a 
variety of mechanisms including drawing from the section 330 grants, 
which are supposed to be dedicated for care to the uninsured.
  Medicare has historically provided such cost-based reimbursement to 
other safety net providers, such as certain rural hospitals, cancer 
hospitals, and children's hospitals. Moreover, Congress passed 
legislation in 2000 to protect health centers from the same problem in 
Medicaid.
  The legislation assures that CHC's are afforded the same protections 
through the Medicare program so that Federal funding for the uninsured 
is not redirected to pay for shortfalls from Medicare patients. It does 
so by eliminating the per visit payment cap on health centers' Medicare 
payments. In the Medicare statute, Congress clearly intended to cover 
the cost of a health centers' Medicare patients, but the Centers for 
Medicare and Medicaid Services, CMS, applies an arbitrary ``payment 
cap'' that is not in the Federal statute. For many health centers, the 
cap has significantly reduced their Medicare payments, particularly for 
patients that have chronic illnesses, and forced them to reduce care 
they would have otherwise provided for their uninsured patients. Our 
bipartisan legislation prevents the imposition of the Medicare payment 
cap for health centers, and again, mirrors cost-based reimbursement 
that a number of other safety-net providers receive through Medicare.

  The bill also extends payment protections to Medicare+Choice. This is 
achieved by establishing a supplemental or ``wrap-around'' payment much 
like the one that currently exists in the Medicaid program for FQHC's 
contracting with managed care organizations. As this has worked so well 
in the Medicaid program, Congress should also enact a ``wrap-around'' 
payment in the Medicare+Choice program to ensure CHC's are having their 
reasonable costs appropriately covered.
  In addition, the legislation eliminates regulatory hurdles that 
impair health centers' ability to provide preventive ambulatory 
services to Medicare patients. While CHC's provide primary care 
services to their patients, Medicare does not cover anything other than 
the most basic services provided at CHC's. Such services that health 
centers may provide that Medicare does not pay on a cost basis, 
include: mammograms, nutrition services, or laboratory or x-ray 
services. Some of these services have been recently been added by 
Congress but the Medicare FQHC benefit has not been updated to reflect 
those changes. This legislation would expand the services that health 
centers could provide to medically underserved Medicare beneficiaries.
  Furthermore, the bill ensures the availability of these services to 
those enrolling in Medicare managed care but requiring Medicare+Choice 
plans to contract with a sufficient number of FQHC's to make FQHC 
services accessible to plan enrollees.
  And finally, the ``Medicare Safety Net Access Act of 2002'' 
establishes a safe harbor in the federal anti-kickback statute for 
arrangements between health centers and other providers that improve 
access to services for low-income patients in underserved communities. 
Health centers and other providers often participate in arrangements 
designed to expand their ability to provide care in the poor 
communities they serve. However, these arrangements can potentially 
expose health centers under the federal anti-kickback laws.
  For nine years, a proposed ``safe harbor'' has been pending before 
the U.S. Department of Health and Human Services' Office of the 
Inspector General, HHS IOG, that would allow health centers to contract 
with other providers to improve health services to low-income patients 
without fear of being in violation of the anti-kickback law. To qualify 
under the proposed safe harbor, the arrangement would have to meet 
strict criteria to protect against fraud and abuse, including the 
demonstration of a community benefit through the savings of grant 
dollars intended for care for the uninsured or an increase in the 
availability of services to a medically underserved community. There 
are additional requirements, such as assurances that the arrangement to 
not limit a patient's freedom of choice, in addition to any others that 
the IOG deems are needed as long as they are consistent with 
congressional intent.
  Community health centers enjoy strong bipartisan support in Congress 
because they are cost-effective providers of services that keep 
patients healthy and out of costly specialty and emergency settings. As 
more people prepare to enter the Medicare program, it is vital that 
beneficiaries in rural, frontier, and inner-city areas have access to 
the full range of Medicare benefits. Health centers are the vehicle to 
make that happen. I urge passage of this legislation.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordererd to be printed in the 
Record, as follows:

                                S. 2067

       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 
     Safety Net Access Act of 2002''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Supplemental reimbursement for Federally qualified health 
              centers participating in medicare managed care.
Sec. 3. Revision of Federally qualified health center payment limits.
Sec. 4. Coverage of additional Federally qualified health center 
              services.
Sec. 5. Providing safe harbor for certain collaborative efforts that 
              benefit medically underserved populations.

     SEC. 2. SUPPLEMENTAL REIMBURSEMENT FOR FEDERALLY QUALIFIED 
                   HEALTH CENTERS PARTICIPATING IN MEDICARE 
                   MANAGED CARE.

       (a) Supplemental Reimbursement.--
       (1) In general.--Section 1833(a)(3) of the Social Security 
     Act (42 U.S.C. 1395l(a)(3)) is amended to read as follows:
       ``(3) in the case of services described in section 
     1832(a)(2)(D)--
       ``(A) except as provided in subparagraph (B), the costs 
     which are reasonable and related to the cost of furnishing 
     such services or which are based on such other tests of 
     reasonableness as the Secretary may prescribe in regulations, 
     including those authorized under section 1861(v)(1)(A), less 
     the amount a provider may charge as described in clause (ii) 
     of section 1866(a)(2)(A), but in no case may the payment for 
     such services (other than for items and services described in 
     section 1861(s)(10)(A)) exceed 80 percent of such costs; or
       ``(B) with respect to the services described in clause (ii) 
     of section 1832(a)(2)(D) that are furnished to an individual 
     enrolled with a Medicare+Choice organization under part C 
     pursuant to a written agreement described in section 1853(j), 
     the amount by which--
       ``(i) the amount of payment that would have otherwise been 
     provided under subparagraph (A) (calculated as if `100 
     percent' were substituted for `80 percent' in such 
     subparagraph) for such services if the individual had not 
     been so enrolled; exceeds
       ``(ii) the amount of the payments received under such 
     written agreement for such services (not including any 
     financial incentives provided for in such agreement such as 
     risk pool payments, bonuses, or withholds),

     less the amount the Federally qualified health center may 
     charge as described in section 1857(e)(3)(C);''.
       (b) Continuation of Medicare+Choice Monthly Payments.--
       (1) In general.--Section 1853 of the Social Security Act 
     (42 U.S.C. 1395w-23) is amended by adding at the end the 
     following new subsection:
       ``(j) Special Payment Rule for Federally Qualified Health 
     Center Services.--If an individual who is enrolled with a 
     Medicare+Choice organization under this part receives a 
     service from a Federally qualified health center that has a 
     written agreement with such organization for providing such a 
     service (including any agreement required under section 
     1857(e)(3))--
       ``(1) the Secretary shall pay the amount determined under 
     section 1833(a)(3)(B) directly to the Federally qualified 
     health center not less frequently than quarterly; and
       ``(2) the Secretary shall not reduce the amount of the 
     monthly payments to the Medicare+Choice organization made 
     under section 1853(a) as a result of the application of 
     paragraph (1).''.
       (2) Conforming amendments.--
       (A) Paragraphs (1) and (2) of section 1851(i) of the Social 
     Security Act (42 U.S.C. 1395w-21(i)(1)) are each amended by 
     inserting ``1853(j),'' after ``1853(h),''.
       (B) Section 1853(c)(5) is amended by striking ``subsections 
     (a)(3)(C)(iii) and (i)'' and inserting ``subsections 
     (a)(3)(C)(iii), (i), and (j)(1)''.
       (c) Additional Medicare+Choice Contract Requirements.--
     Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-
     27(e)) is

[[Page S2328]]

     amended by adding at the end the following new paragraph:
       ``(3) Agreements with federally qualified health centers.--
       ``(A) Ensuring equal access to services of fqhcs.--A 
     contract under this part shall require the Medicare+Choice 
     organization to enter into (and to demonstrate to the 
     Secretary that it has entered into) a sufficient number of 
     written agreements with Federally qualified health centers 
     providing Federally qualified health center services for 
     which payment may be made under this title in the service 
     area of each Medicare+Choice plan offered by such 
     organization so that such services are reasonably available 
     to individuals enrolled in the plan.
       ``(B) Ensuring equal payment levels and amounts.--A 
     contract under this part shall require the Medicare+Choice 
     organization to provide a level and amount of payment to each 
     Federally qualified health center for services provided by 
     such health center that are covered under the written 
     agreement described in subparagraph (A) that is not less than 
     the level and amount of payment that the organization would 
     make for such services if the services had been furnished by 
     a provider of services that was not a Federally qualified 
     health center.
       ``(C) Cost-sharing.--Under the written agreement described 
     in subparagraph (A), a Federally qualified health center must 
     accept the Medicare+Choice contract price plus the Federal 
     payment as payment in full for services covered by the 
     contract, except that such a health center may collect any 
     amount of cost-sharing permitted under the contract under 
     this part, so long as the amounts of any deductible, 
     coinsurance, or copayment comply with the requirements under 
     section 1854(e) and do not result in a total payment to the 
     center in excess of the amount determined under section 
     1833(a)(3)(A) (calculated as if `100 percent' were 
     substituted for `80 percent' in such section).''.
       (d) Safe Harbor From Antikickback Prohibition.--Section 
     1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a-
     7b(b)(3)) is amended--
       (1) in subparagraph (E), by striking ``and'' after the 
     semicolon at the end;
       (2) in subparagraph (F), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(G) any remuneration between a Federally qualified health 
     center (or an entity controlled by such a health center) and 
     a Medicare+Choice organization pursuant to the written 
     agreement described in section 1853(j).''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to services provided on or after January 1, 2003, 
     and contract years beginning on or after such date.

     SEC. 3. REVISION OF FEDERALLY QUALIFIED HEALTH CENTER PAYMENT 
                   LIMITS.

       (a) Per Visit Payment Requirements for FQHCs.--Section 
     1833(a)(3)(A) of the Social Security Act (42 U.S.C. 
     1395l(a)(3)(A)), as amended by section 2(a), is amended by 
     adding ``(which regulations may not limit the per visit 
     payment amount, or a component of such amount, for services 
     described in section 1832(a)(2)(D)(ii))'' after ``the 
     Secretary may prescribe in regulations''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to services provided on or after January 1, 2003.

     SEC. 4. COVERAGE OF ADDITIONAL FEDERALLY QUALIFIED HEALTH 
                   CENTER SERVICES.

       (a) Coverage for FQHC Ambulatory Services.--Section 
     1861(aa)(3) of the Social Security Act (42 U.S.C. 
     1395x(aa)(3)) is amended to read as follows:
       ``(3) The term `Federally qualified health center services' 
     means--
       ``(A) services of the type described in subparagraphs (A) 
     through (C) of paragraph (1), and such other services 
     furnished by a Federally qualified health center for which 
     payment may otherwise be made under this title if such 
     services were furnished by a health care provider or health 
     care professional other than a Federally qualified health 
     center; and
       ``(B) preventive primary health services that a center is 
     required to provide under section 330 of the Public Health 
     Service Act,

     when furnished to an individual as a patient of a Federally 
     qualified health center.''.
       (b) Offsite FQHC Services.--
       (1) Patients of hospitals and critical access hospitals.--
     Section 1862(a)(14) of the Social Security Act (42 U.S.C. 
     1395y(a)) is amended by inserting ``Federally qualified 
     health center services,'' after ``qualified psychologist 
     services,''.
       (2) Exclusion of federally qualified health center services 
     from the pps for skilled nursing facilities.--Section 1888(e) 
     of the Social Security Act (42 U.S.C. 1395yy(e)) is amended--
       (A) in paragraph (2)(A)(i)(II), by striking ``clauses (ii) 
     and (iii)'' and inserting ``clauses (ii) through (iv)''; and
       (B) by adding at the end of paragraph (2)(A) the following 
     new clause:
       ``(iv) Exclusion of federally qualified health center 
     services.--Services described in this clause are Federally 
     qualified health center services (as defined in section 
     1861(aa)(3)).''.
       (c) Technical Corrections.--
       (1) Section 1861(aa)(1)(B) of the Social Security Act (42 
     U.S.C. 1395x(aa)(1)(B)) is amended by striking ``subsection 
     (hh)(1)),,'' and inserting ``subsection (hh)(1)),''.
       (2) Clauses (i) and (ii)(II) of section 1861(aa)(4)(A) of 
     the Social Security Act (42 U.S.C. 1395x(aa)(4)(A)) are each 
     amended by striking ``(other than subsection (h))''.
       (d) Effective Dates.--The amendments made--
       (1) by subsections (a) and (b) shall apply to services 
     furnished on or after January 1, 2003; and
       (2) by subsection (c) shall take effect on the date of 
     enactment of this Act.

     SEC. 5. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE 
                   EFFORTS THAT BENEFIT MEDICALLY UNDERSERVED 
                   POPULATIONS.

       (a) In General.--Section 1128B(b)(3) of the Social Security 
     Act (42 U.S.C. 1320a-7(b)(3)), as amended by section 2(d), is 
     amended--
       (1) in subparagraph (F), by striking ``and'' after the 
     semicolon at the end;
       (2) in subparagraph (G), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(H) any remuneration between a public or nonprofit 
     private health center entity described under clauses (i) and 
     (ii) of section 1905(l)(2)(B) and any individual or entity 
     providing goods, items, services, donations or loans, or a 
     combination thereof, to such health center entity pursuant to 
     a contract, lease, grant, loan, or other agreement, if such 
     agreement produces a community benefit that will be used by 
     the health center entity to maintain or increase the 
     availability or accessibility, or enhance the quality, of 
     services provided to a medically underserved population 
     served by the health center entity.''.
       (b) Rulemaking for Exception for Health Center Entity 
     Arrangements.--
       (1) Establishment.--
       (A) In general.--The Secretary of Health and Human Services 
     (in this subsection referred to as the ``Secretary'') shall 
     establish, on an expedited basis, standards relating to the 
     exception for health center entity arrangements to the 
     antikickback penalties described in section 1128B(b)(3)(F) of 
     the Social Security Act, as added by subsection (a).
       (B) Factors to consider.--In establishing standards 
     relating to the exception for health center entity 
     arrangements under subparagraph (A), the Secretary--
       (i) shall extend the exception where the arrangement 
     between the health center entity and the other party--

       (I) results in savings of Federal grant funds or increased 
     revenues to the health center entity;
       (II) does not limit or restrict a patient's freedom of 
     choice; and
       (III) does not interfere with a health care professional's 
     independent medical judgment regarding medically appropriate 
     treatment; and

       (ii) may include other standards and criteria that are 
     consistent with the intent of Congress in enacting the 
     exception established under this subsection.
       (2) Interim final effect.--No later than 60 days after the 
     date of enactment of this Act, the Secretary shall publish a 
     rule in the Federal Register consistent with the factors 
     under paragraph (1)(B). Such rule shall be effective and 
     final immediately on an interim basis, subject to change and 
     revision after public notice and opportunity (for a period of 
     not more than 60 days) for public comment, provided that any 
     change or revision shall be consistent with this subsection.
                                 ______
                                 
      By Mr. NELSON of Florida (for himself, Mr. Graham, Mr. Cleland, 
        and Mr. Miller):
  S. 2069. A bill to direct the Secretary of Veterans Affairs to 
establish a national cemetery for veterans in the Jacksonville, 
Florida, metropolitan area; to the Committee on Veterans' Affairs.
  Mr. NELSON of Florida. Mr. President, this Nation honors in many ways 
the service of those who have worn the uniform of our Armed Forces and 
placed themselves in harm's way to defend our freedom and way of life. 
This Nation raises great monuments to commemorate the many battles and 
the countless heroes of those battles fought throughout our history. 
This Nation sets aside special days to remember the sacrifice of 
generations of Americans who have stepped forward in America's defense.
  This Nation hallows ground where we lay to rest those who have served 
us in our hour of greatest need. Our National Cemetery System is not 
only hallowed ground, national cemeteries are monuments to military 
service, the places where we go on those special days to pay tribute to 
the sacrifice of so many in our history.
  Today I offer legislation to establish a national cemetery near 
Jacksonville, FL, to meet the needs of thousands of veterans who have 
chosen to live out their lives in northeast Florida and southeast 
Georgia. Florida's veteran population is the second largest in the 
Nation. Right now in northern Florida and southern Georgia, there are 
nearly half-a-million veterans. Florida has the Nation's oldest veteran 
population and one of the largest remaining populations of World War II 
veterans. We are all aware that this greatest of generations is passing 
away at higher and higher rates.

[[Page S2329]]

  Unfortunately for these hundreds of thousands of veterans in Florida 
and Georgia, the nearest national cemetery is located in Bushnell, FL, 
which is 3-hour drive from Jacksonville. The national cemetery in St. 
Augustine is full and closed. The nearest national cemetery in Georgia 
is in Marietta just north of Atlanta.
  Our veterans have made great sacrifices to protect our country in her 
days of peril, and certainly deserve to rest in honored respect in a 
national cemetery. To honor the veterans of northeast Florida and 
southeast Georgia, we must act now, in order to have this facility 
established by 2006 when our World War II veterans' deaths are expected 
to reach their peak.
  Senators Graham and Cleland and I are honored and proud to sponsor 
this important bill, and we look forward to the support of our 
colleagues as we provide for our veterans who have given so much for 
our country.
  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2069

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

     SECTION 1. ESTABLISHMENT.

       (a) In General.--The Secretary of Veterans Affairs shall 
     establish, in accordance with chapter 24 of title 38, United 
     States Code, a national cemetery in the Jacksonville, 
     Florida, metropolitan area to serve the needs of veterans and 
     their families.
       (b) Consultation in Selection of Site.--Before selecting 
     the site for the national cemetery established under 
     subsection (a), the Secretary shall consult with--
       (1) appropriate officials of the State of Florida and local 
     officials of the Jacksonville metropolitan area, and
       (2) appropriate officials of the United States, including 
     the Administrator of General Services, with respect to land 
     belonging to the United States in that area that would be 
     suitable to establish the national cemetery under subsection 
     (a).
       (c) Report.--Not later than 90 days after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     a report on the establishment of the national cemetery under 
     subsection (a). The report shall set forth a schedule for 
     such establishment and an estimate of the costs associated 
     with such establishment.
                                 ______
                                 
      By Mr. BINGAMAN (for himself and Mr. Kerry):
  S. 2070. A bill to amend part A of title IV to exclude child care 
from the determination of the 5-year limit on assistance under the 
temporary assistance to needy families program, and for other purposes; 
to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce the Children 
First Act. Since 1996, federal funding for child care assistance under 
the Child Care and Development Block Grant, CCDBG, has significally 
increased, making it possible for states to provide more low-income 
families with child care assistance and expand initiatives to improve 
the quality of child care. This has been an extremely important 
endeavor. Access to quality childcare helps families to work and 
children to succeed. Yet, we must do more. Only one out of seven 
children eligible for assistance through the CCDBG program receives a 
subsidy, approximately 12.9 million eligible children without 
assistance. In March 2000, a family earning as little as $25,000 could 
not qualify for child care assistance in most States. The need for 
child care assistance is likely to significantly increase in the near 
future. Many States are currently faced with serious budget shortfalls 
that threaten the progress they have made in the provision of child 
care in recent years. The administration's recently proposed welfare 
plan would increase work-related requirements for welfare recipients, 
which if passed will create an even greater demand for child care. Even 
if this aspect of the administration's welfare proposal is rejected as 
unworkable, which I believe is the case, we must make providing high-
quality child care to low-income families a priority in this Congress. 
The Children First Act will do just that.
  Increased availability of child care enables low-income parent on 
welfare, and parents trying to stay off welfare, to work and support 
their families. According to a recent administration report, employment 
among single mothers with young children grew in recent years fro 58 
percent to 73 percent. The administration noted: ``These employment 
increased by single mothers and former welfare mothers are 
unprecedented.'' Most people agree that employment gains among single 
mothers can only be sustained if families have access to dependable 
child care. Studies show that when child care is available, and when 
families get help paying for care, they are more likely to work.
  When I talk to people in my home State of New Mexico about welfare 
reform, they identify access to childcare as the most important work 
support we can provide. In New Mexico, 57 percent of children under 6 
live in households in which all parents work. Approximately 67 percent 
of these households have income less than 200 percent of the Federal 
poverty threshold. Yet less than 25 percent of children under the age 
of 6 eligible under federal law for childcare assistance are receiving 
assistance in New Mexico. Families with both parent working aen earning 
he minimum wage must pay 49 percent of their income on childcare for 
one child. Without subsidized care, many of these families can not 
afford to work.
  When I talk to people in New Mexico about improving our education 
system, the need for improved school readiness is often theotp concern. 
Improved quality of child care is an important component in that effort 
as well. Quality child care provides low-income children with the early 
learning experiences that they need to do well in school. We know that 
children in high-quality early care score higher on reading and math 
tests, are more likely to complete high school and go onto college, and 
are less likely to repeat a grade or get charged in juvenile court. In 
contrast, children in poor quality child care have been found to be 
more likely to be referred to special education, delayed in language 
and reading skills and to display more aggression toward other children 
and adults.
  In the recently enacted No Child Left Behind Act, Congress and the 
President signaled a new commitment to improving educational outcomes 
in our schools. The legislation required states, school districts, and 
communities to close achievement gaps between disadvantaged students 
and their peers. In his State of the Union Address earlier this year, 
President Bush acknowledged the important of early learning and made it 
a priority for his administration. Increased federal support for child 
care is critical to supporting high-quality early learning programs. We 
should work on a bipartisan basis--as we did with respect to the No 
Child Left Behind Act--towards this goal.
  We must increase access to child car, but we must also do more to 
ensure the improved quality of child care. Many families in New Mexico, 
even those receiving assistance, cannot provide their children with a 
high quality child car setting. In part, this is caused by the low 
reimbursement rates provided due to limited funding. For example, in 
New Mexico the reimbursement rate is $396, while the market rate 
averaged $470. As a result the higher quality provider often do not 
accept state-subsidized children into their programs.
  A lack of qualified care provider also make the provision of high 
quality care difficult. Childcare workers in New Mexico make, on 
average, $6.24 per hour, less than half the average weekly wage. Less 
than 20 percent of these workers receive employee benefits such as 
health insurance and paid sick leave.
  The Children First Act will address these issues by increasing 
funding for the Child Care Development Block Grant by $11.2 billion 
over five years. With these funds, states will be able to serve 
approximately 1 million more children nationally. The bill also 
contains an increase in the quality set-aside in CCDBG, which will 
provide funds specifically for efforts to improve quality. States can 
use these funds to provide training to care providers and create and 
enforce standards of care. The bill also makes common sense changes to 
the TANF program that support work by enabling states to increase the 
availability and improve the quality of child care.
  I urge my colleagues to support this important piece of legislation. 
It will help low-income families work and help prepare our children to 
succeed.
                                 ______
                                 
      By Mr. SMITH of New Hampshire:

[[Page S2330]]

  S. 2071. A bill to amend title 23, United States Code, to prohibit 
the collection of tolls form vehicles or military equipment under the 
actual physical control of a uniformed member of the Armed Forces, and 
for other purposes; to the Committee on Environment and Public Works
  Mr. SMITH of New Hampshire. Mr. President, I rise today to offer a 
bill that will exempt our Nation's military vehicles and equipment from 
being subject to paying tolls on America's roads, bridges and ferries. 
As the Ranking Member of Environment & Public Works Committee, which 
has jurisdiction over our highway system, and as a senior member of the 
Armed Services Committee, I believe that this an appropriate action 
long overdue. In this time of war and heightened threat to America's 
shores, the thought of all units in an Army troop convoy digging into 
their pockets to drop quarters into the nets at tollbooths on the 
Jersey turnpike is absurd. When we created the interstate highway 
system in the 1950's under the strong leadership of President 
Eisenhower, a primary motivation of the former General of the Army was 
to facilitate the movement of men and material in times of crisis. Yet 
in the intervening years, as toll roads have been established, no one 
at the Federal level has thought to exempt the armed forces form being 
slowed down to pay these levies. While the Federal Government has not 
acted, many States, most notably my State of New Hampshire, has seen 
fit to exempt those who are protecting us from paying these tolls. 
America's armed forces deserve all the help we can give them. The 
shortsighted among us might say that all we need to do is to provide 
some expedited form of payment, so that the tolls can be collected 
faster. I say that our troops deserve better. There is just no reason 
to subject our military to paying tolls in order to use America's roads 
when their only reason for being on those roads is to protect America. 
Therefore, my bill provides for a complete exemption from tolls, and 
not just half-way measures to simplify the payment. But my bill goes 
even further. In the same vein, I believe that it is essential, should 
a crisis arise, or God forbid, should America again be attacked, to 
speed our troops through the toll facilities. Accordingly, I have 
written the bill a provision to require a toll facility, in times of an 
emergency declared by the President, to reserve a dedicated support for 
America's military by voting for this important bill.
  Mr. President, I ask unanimous consent that the bill be printed in 
the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2071

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

     SECTION 1. PROHIBITION ON COLLECTION OF TOLLS FROM VEHICLES 
                   AND EQUIPMENT USED BY THE ARMED FORCES.

       Section 129 of title 23, United States Code, is amended by 
     adding at the end the following:
       ``(d) Prohibition on Collection of Tolls From Vehicles and 
     Equipment Used by the Armed Forces.--
       ``(1) In general.--No tolls shall be collected from any 
     vehicle or military equipment owned by the Department of 
     Defense for the use of any toll facility described in 
     paragraph (3) when the vehicle or military equipment is under 
     the actual physical control of a uniformed member of the 
     Armed Forces.
       ``(2) Periods of national emergency.--During a period of 
     national emergency declared by the President, upon request of 
     the Secretary of Defense, a toll facility described in 
     paragraph (3)(A) shall reserve a lane of the toll facility 
     for the exclusive use of a vehicle or military equipment 
     described in paragraph (1).
       ``(3) Toll facilities.--A toll facility described in this 
     paragraph is--
       ``(A) a toll highway, bridge, or tunnel located on a public 
     road; or
       ``(B) a toll ferry boat that operates on a route classified 
     as a public road.''.
                                 ______
                                 
      By Mr. CORZINE (for himself, Mr. Bingaman, and Mr. Breaux):
  S. 2072. A bill to amend title XIX of the Social Security Act to 
provide States with the option of covering intensive community mental 
health treatment under the Medicaid Program, to the Committee on 
Finance.
  Mr. CORZINE. Mr. President, I am very pleased to introduce today a 
critical piece of mental health legislation with my colleagues Senators 
Bingaman and Breaux. This legislation, the Medicaid Intensive Community 
Mental Health Act, will assist and encourage States to provide 
comprehensive intensive mental health services through the Medicaid 
Program.
  Since deinstitutionalization, too many people with severe mental 
illnesses have fallen through the cracks of our mental health system in 
part because too many States and localities have not established 
intensive community-based programs to assist those with severe mental 
illness.
  In 1999, the Supreme Court rules in its Olmstead decision that 
individuals with disabilities, including mental illness, who are 
capable of living in a community setting, must be placed in less 
restrictive settings. Two years after this decision, my State of New 
Jersey and States nationwide are struggling to improve and expand 
community-based mental health services in order to ensure that the 
appropriate services are in place for the mentally ill so that they can 
lead productive lives outside of the institution. And, let me be clear 
that this applies to children just as it applies to adults. I know my 
colleague from New Mexico, Senator Bingaman, has expressed deep concern 
about the hundreds of youth with mental illness in his State who are 
being held at detention centers because there are very limited 
community-based mental health treatment options.
  These children do not deserve to be treated as criminals, they need 
and deserve access to treatment, counseling, and other rehabilitative 
and supportive services. We need to give States the flexibility and the 
resources they need to make these options available. Currently, Federal 
financing for community-based mental health care is so complex and 
burdensome that States are unable to offer a comprehensive, coordinated 
set of community-based intensive mental health services with a single 
point of access. Rather, those in dire need of these services are 
forced to rely on a patchwork of uncoordinated programs with missing 
service components.
  Currently, States must apply for six optional Medicaid waivers in 
order to provide these services. This legislation would help fill the 
cracks in our mental health care system by allowing States, through a 
single policy decision, to finance the entire array of community-based 
services that individuals with severe mental illness need. The Medicaid 
Intensive Community Mental Health Act would allow States to choose the 
``intensive community mental health treatment'' option under Medicaid, 
which would allow States to provide services such as psychiatric 
rehabilitation, crisis residential treatment, medication education and 
management, integrated treatment services for individuals with co-
occurring mental illness and substance abuse disorders, and family 
psycho-education services, among others, in a coordinated manner.
  In my home State of New Jersey, there are about 3,000 people residing 
in psychiatric hospitals. About half of these people, or 1,500 people, 
are eligible to be released, but, due to a lack of intensive community-
based treatment, they continue to remain needlessly institutionalized. 
If passed, this legislation would help States to create an integrated 
system of intensive community-based mental health care for those with 
severe mental illness. Not only would this option improve community-
based services for the mentally ill, but it would also give states a 
mechanism to assist people who otherwise require costly 
hospitalization.
  Far too often in our Nation, individuals with severe mental illness 
are either unable to access appropriate mental health care or have 
repeated but ultimately unsuccessful hospitalizations. And 
unfortunately, untreated mental illness has led many sufferers to 
become homeless. It has also led many to commit crimes. Ultimately, 
this legislation will help States respond to the problems associated 
with deinstitutionalization, homelessness, and the criminalization of 
mental illness, and in doing so, it will help people with severe mental 
illness to live better lives in their communities and with their 
families.
  I want to thank my colleagues, Mr. Bingaman and Mr. Breaux, for 
joining me today to introduce this important legislation.




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