[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.''.
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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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