[Congressional Record Volume 148, Number 77 (Wednesday, June 12, 2002)]
[Senate]
[Pages S5455-S5461]
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. Miller):
  S. 2613. A bill to amend section 507 of the Omnibus Parks and Public 
Lands Management Act of 1996 to authorize additional appropriations for 
historically black colleges and universities, to decrease the cost-
sharing requirement relating to the additional appropriations, and for 
other purposes; to the Committee on Energy and Natural Resources.
  Mr. LIEBERMAN. Mr. President, on behalf of myself and Senator Miller, 
I am submitting legislation that is designed to facilitate historic 
preservation activities at historically black colleges and 
universities. Specifically, this legislation would amend section 507 of 
the Omnibus Parks and Public Lands Management Act of 1996 to decrease 
the cost-sharing requirement for those seeking Federal funds for 
historic preservation activities at historically black colleges and 
universities. I am proud to say that the legislation I am submitting 
today is a companion bill to H.R. 1606, submitted by Congressman James 
Clyburn of South Carolina.
  American history has been a constant, if not always consistent, march 
toward an ideal. That ideal is equal opportunity for all.
  In every generation, it's taken the work of pioneers to open the 
gates of the American community to people who had previously been 
excluded. Pioneers have stepped forward when others would not to 
defiantly state, in effect, that we as a Nation will not be defined by 
surface characteristics. We will look deeper and try harder. The 
pioneers have held us to our national promise, and reminded us that 
America and Americanism are not about where you came from, what 
language you speak, what religion you practice, or what you look like, 
but about belief in basic ideals of responsibility, opportunity and 
community.
  Historically Black Colleges and Universities have been such pioneers 
for generations, and they continue today to help America become its 
best self.
  Today, America has 103 historically black colleges and universities 
in twenty-two States and the Virgin Islands, which educate about 
300,000 undergraduate students and thousands of graduate, professional 
and doctoral students. In fact, 8 of the top 10 producers of African-
American engineers are HBCUs. 42 percent of all the PhDs earned each 
year by African-Americans are earned by graduates of HBCUs.

[[Page S5456]]

  Despite playing such a central role in our economy, society, and 
culture, HBCUs have been physically eroding for years. In 1998, the 
National Trust for Historic Preservation reported that most of the 
HBCUs in the United States are showing serious signs of neglect. The 
Trust said that campus landmarks are decaying and college grounds are 
badly in need of attention. And a 1998 General Accounting Office report 
estimated that in HBCUs nationwide, there were more than 700 historic 
buildings in states of disrepair.
  That's why I am proudly sponsoring Representative Clyburn's bill to 
provide more restoration funding for historic sites at Historically 
Black Colleges and Universities throughout the Nation.
  These beautiful, architecturally significant structures are in most 
cases over a hundred years old, and were often built using the help of 
the students themselves. Their architectural beauty is a sign of 
something deeper, the fact that they have served as critical portals of 
opportunity for African-Americans throughout our history. That's why 
they deserve our strong protection and sensitive preservation.
  I saw this firsthand. When I visited Allen University in South 
Carolina in April of this year, I went to Arnett Hall, a building that 
had been transformed from an eyesore into a beautiful and stately 
facility with the help of Federal funds, thanks to Representative 
Clyburn. In the past, students and faculty would walk into the hall and 
get the message that we as a Nation were neglecting these historic 
treasures. Now, they absorb the message that we consider historically 
black colleges and universities central to our history and to our 
future.
  Thanks in no small part to these institutions, the overarching 
history of African-Americans in this country has been not a tragedy, as 
it once was, but a brilliant movement toward dignity, inclusion, 
freedom, and opportunity. That's the right message for African-
Americans and all Americans.
  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. 2613

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

     SECTION 1. DECREASED MATCHING REQUIREMENT; AUTHORIZATION OF 
                   APPROPRIATIONS.

       (a) Decreased Matching Requirement.--Section 507(c) of the 
     Omnibus Parks and Public Lands Management Act of 1996 (16 
     U.S.C. 470a note) is amended--
       (1) by striking ``(1) Except'' and inserting the following:
       ``(1) In general.--Except'';
       (2) by striking ``paragraph (2)'' and inserting 
     ``paragraphs (2) and (3)'';
       (3) by striking ``(2) The Secretary'' and inserting the 
     following:
       ``(2) Waiver.--The Secretary'';
       (4) by striking ``paragraph (1)'' and inserting 
     ``paragraphs (1) and (3)''; and
       (5) by adding at the end the following new paragraph:
       ``(3) Exception.--The Secretary may obligate funds made 
     available under subsection (d)(2) for a grant with respect to 
     a building or structure listed on, or eligible for listing 
     on, the National Register of Historic Places only if the 
     grantee agrees to provide, from funds derived from non-
     Federal sources, an amount that is equal to 30 percent of the 
     total cost of the project for which the grant is provided.''.
       (b) Authorization of Appropriation.--Section 507(d) of the 
     Omnibus Parks and Public Lands Management Act of 1996 (16 
     U.S.C. 470a note) is amended--
       (1) by striking ``Pursuant to'' and inserting the 
     following:
       ``(1) 1996 authorization.--Pursuant to''; and
       (2) by adding at the end the following new paragraph:
       ``(2) Additional authorization.--In addition to amounts 
     made available under paragraph (1), pursuant to section 108 
     of the National Historic Preservation Act, there are 
     authorized to be appropriated such sums as are necessary to 
     carry out the purposes of this section.''.
                                 ______
                                 
      By Mr. CORZINE:
  S. 2614. A bill to amend title XVIII of the Social Security Act to 
reduce the work hours and increase the supervision of resident 
physicians to ensure the safety of patients and resident physicians 
themselves; to the Committee on Finance.
  Mr. CORZINE. Mr. President, I rise today to introduce legislation, 
the Patient and Physician Safety and Protection Act of 2002, to limit 
medical resident work hours to 80 hours a week and to provide real 
protections for patients and resident physicians who are negatively 
affected by excessive work hours. This is a companion bill to 
legislation introduced in the House of Representatives by 
Representative John Conyers.
  It is very troubling that hospitals across the Nation are requiring 
young doctors to work 36 hour shifts and as many as 120 hours a week in 
order to complete their residency programs. These long hours lead to a 
deterioration of cognitive function similar to the effects of blood 
alcohol levels of 0.1 percent. This is a level of cognitive impairment 
that would make these doctors unsafe to drive, yet these physicians are 
not only allowed but in fact are required to care for patients and 
perform procedures on patients under these conditions.
  While the medical community has been aware of this problem for many 
years, the issue has largely been pushed under the rug. Only recently 
has the medical community taken a more serious look at the problem. In 
the last couple of months, my office has worked with the Association of 
American Medical Colleges and teaching hospitals in New Jersey and New 
York to address this problem and to try to find a workable solution.
  As a result of these efforts and increased public pressure on the 
medical community to address this quality of care and labor issue, the 
Accreditation Council for Graduate Medical Education, ACGME, announced 
today new work hour recommendations. This is an important first step. 
But while some of their recommendations are commendable, they would 
still require residents to work in excess of 80 hours a week and 30-
hour shifts. I look forward to working with the Council to adapt strong 
standards that are not only recommendations, but are enforceable 
requirements that truly protect patients and residents.
  Today, I am introducing legislation that not only recognizes the 
problem of excessive work hours, but also creates strong enforcement 
mechanisms. The bill also provides funding support to teaching 
hospitals to implement new work hour standards. Without enforcement and 
financial support, efforts to reduce work hours are not likely to be 
successful.
  Let me again emphasize that the Patient and Physician Safety and 
Protection Act of 2002 will limit medical resident work hours to 80 
hours a week. Not 40 hours or 60 hours. 80 hours a week. It is hard to 
argue that this standard is excessively strict. In fact, it is 
unconscionable that we now have resident physicians, or any physicians 
for that matter, caring for very sick patients 120 hours a week and 36 
hours straight with fewer than 10 hours between shifts. This is an 
outrageous violation of a patient's right to quality care. And, for 
many patients, it is literally a matter of life and death.
  In addition to limiting work hours to 80 hours week, my bill limits 
the length of any one shift to 24 consecutive hours and limits the 
length of an emergency room shift to 12 hours. The bill also ensures 
that residents have at least one out of seven days off and ``on-call'' 
shifts no more often than every third night.
  Finally, my legislation provides meaningful enforcement mechanisms 
that will protect the identity of resident physicians who file 
complaints about work hour violations. The guidelines that the ACGME 
released today do not contain any whistleblower protections for 
residents that seek to report program violations. Without this 
important protection, residents will be reluctant to report these 
violations, which in turn will weaken enforcement.
  My legislation also makes compliance with these work hour 
requirements a condition of Medicare participation. Each year, Congress 
provides $8 billion to teaching hospitals to train new physicians. 
While Congress must continue to vigorously support adequate funding so 
that teaching hospitals are able to carryout this important public 
service, these hospitals must also make a commitment to ensuring safe 
work conditions for these physicians and providing the highest quality 
of care to the patients they treat.
  In closing I would like to read a quote from an Orthopedic Surgery

[[Page S5457]]

Resident from Northern California, which I think illustrates why we 
need this legislation:

       I was operating post-call after being up for over 36 hours 
     and was holding retractors. I literally fell asleep standing 
     up and nearly face-planted into the wound. My upper arm hit 
     the side of the gurney, and I caught myself before I fell to 
     the floor. I nearly put my face in the open wound, which 
     would have contaminated the entire field and could have 
     resulted in an infection for the patient.

  This is a very serious problem that must be addressed before medical 
errors like this occur. I hope every member of the Senate will consider 
this legislation and the potential it has to reduce medical errors, 
improve patient care, and create a safer working environment for the 
backbone of our Nation's healthcare system.
  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. 2614

       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 ``Patient and Physician Safety 
     and Protection Act of 2002''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) The Federal Government, through the medicare program, 
     pays approximately $8,000,000,000 per year solely to train 
     resident-physicians in the United States, and as a result, 
     has an interest in assuring the safety of patients treated by 
     resident-physicians and the safety of resident-physicians 
     themselves.
       (2) Resident-physicians spend a significant amount of their 
     time performing activities not related to the educational 
     mission of training competent physicians.
       (3) The excessive numbers of hours worked by resident-
     physicians is inherently dangerous for patient care and for 
     the lives of resident-physicians.
       (4) The scientific literature has consistently demonstrated 
     that the sleep deprivation of the magnitude seen in residency 
     training programs leads to cognitive impairment.
       (5) A substantial body of research indicates that excessive 
     hours worked by resident-physicians lead to higher rates of 
     medical error, motor vehicle accidents, depression, and 
     pregnancy complications.
       (6) The medical community has not adequately addressed the 
     issue of excessive resident-physician work hours.
       (7) Different medical specialty training programs have 
     different patient care considerations but the effects of 
     sleep deprivation on resident-physicians does not change 
     between specialties.
       (8) The Federal Government has regulated the work hours of 
     other industries when the safety of employees or the public 
     is at risk.

     SEC. 3. REVISION OF MEDICARE HOSPITAL CONDITIONS OF 
                   PARTICIPATION REGARDING WORKING HOURS OF 
                   RESIDENTS.

       (a) In General.--Section 1866 of the Social Security Act 
     (42 U.S.C. 1395cc) is amended--
       (1) in subsection (a)(1)--
       (A) by striking ``and'' at the end of subparagraph (R);
       (B) by striking the period at the end of subparagraph (S) 
     and inserting ``, and''; and
       (C) by inserting after subparagraph (S) the following new 
     subparagraph:
       ``(T) in the case of a hospital that uses the services of 
     physician residents or postgraduate trainees, to meet the 
     requirements of subsection (j).''; and
       (2) by adding at the end the following new subsection:
       ``(j)(1)(A) In order that the working conditions and 
     working hours of physicians and postgraduate trainees promote 
     the provision of quality medical care in hospitals, as a 
     condition of participation under this title each hospital 
     shall establish the following limits on working hours for 
     certain members of the medical staff and postgraduate 
     trainees:
       ``(i) Subject to subparagraph (C), postgraduate trainees 
     may work no more than a total of 80 hours per week and 24 
     hours per shift.
       ``(ii) Subject to subparagraph (C), postgraduate trainees--
       ``(I) shall have at least 10 hours between scheduled 
     shifts;
       ``(II) shall have at least 1 full day out of every 7 days 
     off and 1 full weekend off per month;
       ``(III) who are assigned to patient care responsibilities 
     in an emergency department shall work no more than 12 
     continuous hours in that department; and
       ``(IV) shall not be scheduled to be on call in the hospital 
     more often than every third night.
       ``(B) The Secretary shall promulgate such regulations as 
     may be necessary to ensure quality of care is maintained 
     during the transfer of direct patient care from 1 
     postgraduate trainee to another at the end of each such 24-
     hour period referred to in subparagraph (A) and shall take 
     into account cases of individual patient emergencies.
       ``(C) The work hour limitations under subparagraph (A) and 
     requirements of subparagraph (B) shall not apply to a 
     hospital during a state of emergency declared by the 
     Secretary that applies with respect to that hospital.
       ``(2) The Secretary shall promulgate such regulations as 
     may be necessary to monitor and supervise postgraduate 
     trainees assigned patient care responsibilities as part of an 
     approved medical training program, as well as to assure 
     quality patient care.
       ``(3) Each hospital shall inform postgraduate trainees of--
       ``(A) their rights under this subsection, including methods 
     to enforce such rights (including so-called whistle-blower 
     protections); and
       ``(B) the effects of their acute and chronic sleep 
     deprivation both on themselves and on their patients.
       ``(4) For purposes of this subsection, the term 
     `postgraduate trainee' includes a postgraduate intern, 
     resident, or fellow.''.
       (b) Designation.--
       (1) In general.--The Secretary of Health and Human Services 
     shall designate an individual within the Department of Health 
     and Human Services to handle all complaints of violations 
     that arise from residents who report that their programs are 
     in violation of the requirements of section 1866(j) of the 
     Social Security Act (as added by subsection (a)).
       (2) Grievance rights.--A postgraduate trainee or physician 
     resident may file a complaint with the Secretary of Health 
     and Human Services concerning a violation of such 
     requirements. Such a complaint may be filed anonymously. The 
     Secretary may conduct an investigation and take such 
     corrective action with respect to such a violation.
       (3) Civil money penalty enforcement.--Any hospital that 
     violates such requirement is subject to a civil money penalty 
     not to exceed $100,000 for each resident training program in 
     any 6-month period. The provisions of section 1128A of the 
     Social Security Act (other than subsections (a) and (b)) 
     shall apply to civil money penalties under this paragraph in 
     the same manner as they apply to a penalty or proceeding 
     under section 1128A(a) of such Act.
       (4) Disclosure of violations and annual reports.--The 
     individual designated under paragraph (1) shall--
       (A) provide for annual anonymous surveys of postgraduate 
     trainees to determine compliance with such requirements and 
     for the disclosure of the results of such surveys to the 
     public on a residency-program specific basis;
       (B) based on such surveys, conduct appropriate on-site 
     investigations;
       (C) provide for disclosure to the public of violations of 
     and compliance with, on a hospital and residence-program 
     specific basis, such requirements; and
       (D) make an annual report to Congress on the compliance of 
     hospitals with such requirements, including providing a list 
     of hospitals found to be in violation of such requirements.
       (c) Whistleblower Protections.--
       (1) In general.--A hospital covered by the requirements of 
     section 1866(j)(1) of the Social Security Act (as added by 
     subsection (a)) shall not penalize, discriminate, or 
     retaliate in any manner against an employee with respect to 
     compensation, terms, conditions, or privileges of employment, 
     who in good faith (as defined in paragraph (2)), individually 
     or in conjunction with another person or persons--
       (A) reports a violation or suspected violation of such 
     requirements to a public regulatory agency, a private 
     accreditation body, or management personnel of the hospital;
       (B) initiates, cooperates or otherwise participates in an 
     investigation or proceeding brought by a regulatory agency or 
     private accreditation body concerning matters covered by such 
     requirements;
       (C) informs or discusses with other employees, with a 
     representative of the employees, with patients or patient 
     representatives, or with the public, violations or suspected 
     violations of such requirements; or
       (D) otherwise avails himself or herself of the rights set 
     forth in such section or this subsection.
       (2) Good faith defined.--For purposes of this subsection, 
     an employee is deemed to act ``in good faith'' if the 
     employee reasonably believes--
       (A) that the information reported or disclosed is true; and
       (B) that a violation has occurred or may occur.
       (d) Effective Date.--The amendments made by subsection (a) 
     shall take effect on the first July 1 that begins at least 1 
     year after the date of enactment of this Act.

     SEC. 4. ADDITIONAL FUNDING FOR HOSPITAL COSTS.

       There are hereby appropriated to the Secretary of Health 
     and Human Services such amounts as may be required to provide 
     for additional payments to hospitals for their reasonable 
     additional, incremental costs incurred in order to comply 
     with the requirements imposed by this Act (and the amendments 
     made by this Act).
                                 ______
                                 
      By Mr. MURKOWSKI (for himself and Mr. Wellstone):
  S. 2615. A bill to amend title XVII of the Social Security Act to 
provide for improvements in access to services in rural hospitals and 
critical access hospitals; to the Committee on Finance.

[[Page S5458]]

  Mr. MURKOWSKI. Mr. President, today I am introducing legislation that 
is designed to strengthen and improve the health care delivered to 
rural Medicare beneficiaries. The ``Rural Community Hospital Assistance 
Act of 2002'' ensures that our Nation's seniors will be able to receive 
the same quality of inpatient care throughout the country, regardless 
of whether they live in New York City or Petersburg, AK.
  The best insurance in the world is worthless if there is not a 
provider or facility nearby to deliver quality health care. Right now, 
in communities across the country, many Medicare beneficiaries are 
underserved because they have no access to care. This is wrong and 
intolerable. I remain committed to ensuring that all Americans, and 
especially those in currently underserved rural communities, received 
the care they deserve.
  Unfortunately, a number of the problems facing rural health care 
arise from the actions and construct of the federal Medicare system. 
Its historical one-size-fits-all approach to health care delivery and 
reimbursement has led to small community facilities that lack the 
ability to make payroll, expand services, add new technologies, and 
guarantee comparable care to more urban providers.
  In recent years, Congress has moved to even the playing field between 
urban and rural medicine. New classifications, such as Critical Access 
Hospitals, have allowed these truly safety-net facilities to remain in 
operation and serve their community. But more work must be done.
  In 1994, a new payment system for hospital inpatient services was 
created to bring efficiency and cost savings into the Medicare program. 
The new prospective payment system paid hospitals a fixed amount before 
services were provided, and severed the historical link between 
reimbursement and reasonable costs. In 2000, hospital outpatient 
services were added to this payment system.
  But what has this system meant for the small rural hospital that has 
only a handful of beds and cares for a small number of patients? Quite 
simply, lower volumes hurt the ability of rural hospitals to handle a 
prospective payment system. They have limited financial reserves, lack 
available funds to make capital improvements and, especially in the 
case of Alaska, have difficulty dealing with volume fluctuations that 
are often times tied to seasonal travel.
  The ``Rural Community Hospital Assistance Act'' seeks to remedy this 
problem and a few others that are facing rural America. This 
legislation would proved enhanced cost-based reimbursement for critical 
access hospitals. Cost-based reimbursement for inpatient and outpatient 
services would include a ``return on equity'' to assist the small 
facilities in addressing technology and infrastructure needs. It would 
also provide an option for rural hospitals with less than 50 inpatient 
beds to receive enhanced cost-based reimbursement for inpatient, 
outpatient, and select post-acute care services.
  Hospitals are resorting to Critical Access status for financial 
reasons. Rural hospitals are facing a financial crisis. In fact, rural 
facilities have a Medicare inpatient margin that is almost 10 
percentage points lower than urban hospitals. And with these financial 
constraints, they have often been forced to pass on facility upgrades 
and acquiring new technologies. Who suffers? The seniors who can't 
receive the same state-of-the-art care simply because they aren't 
fortunate to live in a urban zip code.
  This legislation is vital to the state of Alaska. Hospitals such as 
Petersburg Medical Center, Sitka Community, Valdez Community, Seward 
Medical Center, and Wrangell Medical Center will be able to modernize 
and expand services to their growing elderly population. Access and 
quality will increase. Seniors will reap the benefits.
  I would like to remind my colleagues that many Alaskan hospitals are 
not on a road system. They are true safety-net facilities. If they are 
not there, a need will go unmet.
  We must work together to strengthen Medicare. I encourage my 
colleagues to reflect upon the burdens placed upon rural hospitals and 
to consider this worthy bill. It is an incremental step towards 
leveling the playing field between rural and urban medicine. I urge my 
colleagues to act swiftly upon this bill.
  I ask unanimous consent that the text of the ``Rural Community 
Hospital Assistance Act of 2002'' be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2615

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

     SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT.

       (a) Short Title.--This Act may be cited as the ``Rural 
     Community Hospital Assistance Act of 2002''.
       (b) Amendments to Social Security Act.--Except as otherwise 
     specifically provided, whenever in this Act an amendment is 
     expressed in terms of an amendment to, or repeal of, a 
     section or other provision, the reference shall be considered 
     a reference to that section or other provision of the Social 
     Security Act.

     SEC. 2. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL (RCH) 
                   PROGRAM.

       (a) In General.--Section 1861 (42 U.S.C. 1395x) is amended 
     by adding at the end of the following new subsection:

     ``Rural Community Hospital; Rural Community Hospital Services

       ``(ww)(1) The term `rural community hospital' means a 
     hospital (as defined in subsection (e)) that--
       ``(A) is located in a rural area (as defined in section 
     1886(d)(2)(D)) or treated as being so located pursuant to 
     section 1886(d)(8)(E);
       ``(B) subject to subparagraph (B), has less than 51 acute 
     care inpatient beds, as reported in its most recent cost 
     report;
       ``(C) makes available 24-hour emergency care services;
       ``(D) subject to subparagraph (C), has a provider agreement 
     in effect with the Secretary and is open to the public as of 
     January 1, 2002; and
       ``(E) applies to the Secretary for such designation.
       ``(2) For purposes of paragraph (1)(B), beds in a 
     psychiatric or rehabilitation unit of the hospital which is a 
     distinct part of the hospital shall not be counted.
       ``(3) Subparagraph (1)(C) shall not be construed to 
     prohibit any of the following from qualifying as a rural 
     community hospital:
       ``(A) A replacement facility (as defined by the Secretary 
     in regulations in effect on January 1, 2002) with the same 
     service area (as defined by the Secretary in regulations in 
     effect on such date).
       ``(B) A facility obtaining a new provider number pursuant 
     to a change of ownership.
       ``(C) A facility which has a binding written agreement with 
     an outside, unrelated party for the construction, 
     reconstruction, lease, rental, or financing of a building as 
     of January 1, 2002.
       ``(4) Nothing in this subsection shall be construed as 
     prohibiting a critical access hospital from qualifying as a 
     rural community hospital if the critical access hospital 
     meets the conditions otherwise applicable to hospitals under 
     subsection (e) and section 1866.''.
       (b) Payment.--
       (1) Inpatient services.--Section 1814 (42 U.S.C. 1395f) is 
     amended by adding at the end the following new subsection:

``Payment for Inpatient Services Furnished in Rural Community Hospitals

       ``(m) The amount of payment under this part for inpatient 
     hospital services furnished in a rural community hospital, 
     other than such services furnished in a psychiatric or 
     rehabilitation unit of the hospital which is a distinct part, 
     is, at the election of the hospital in the application 
     referred to in section 1861(ww)(1)(D)--
       ``(1) the reasonable costs of providing such services, 
     without regard to the amount of the customary or other 
     charge, or
       ``(2) the amount of payment provided for under the 
     prospective payment system for inpatient hospital services 
     under section 1886(d).''.
       (2) Outpatient services.--Section 1834 (42 U.S.C. 1395m) is 
     amended by adding at the end the following new subsection:
       ``(n) Payment for Outpatient Services Furnished in Rural 
     Community Hospitals.--The amount of payment under this part 
     for outpatient services furnished in a rural community 
     hospital is, at the election of the hospital in the 
     application referred to in section 1861(ww)(1)(D)--
       ``(1) the reasonable costs of providing such services, 
     without regard to the amount of the customary or other charge 
     and any limitation under section 1861(v)(1)(U), or
       ``(2) the amount of payment provided for under the 
     prospective payment system for covered OPD services under 
     section 1833(t).''.
       (3) Home health services.--
       (A) Exclusion from home health pps.--
       (i) In general.--Section 1895 (42 U.S.C. 1395fff) is 
     amended by adding at the end the following:
       ``(f) Exclusion.--
       ``(1) In general.--In determining payments under this title 
     for home health services furnished on or after October 1, 
     2002, by a qualified RCH-based home health agency (as defined 
     in paragraph (2))--
       ``(A) the agency may make a one-time election to waive 
     application of the prospective payment system established 
     under this section to such services furnished by the agency 
     shall not apply; and

[[Page S5459]]

       ``(B) in the case of such an election, payment shall be 
     made on the basis of the reasonable costs incurred in 
     furnishing such services as determined under section 1861(v), 
     but without regard to the amount of the customary or other 
     charges with respect to such services or the limitations 
     established under paragraph (1)(L) of such section.
       ``(2) Qualified rch-based home health agency defined.--For 
     purposes of paragraph (1), a `qualified RCH-based home health 
     agency' is a home health agency that is a provider-based 
     entity (as defined in section 404 of the Medicare, Medicaid, 
     and SCHIP Benefits Improvement and Protection Act of 2000 
     (Public Law 106-554; Appendix F, 114 Stat. 2763A-506) of a 
     rural community hospital that is located--
       ``(A) in a county in which no main or branch office of 
     another home health agency is located; or
       ``(B) at least 35 miles from any main or branch office of 
     another home health agency.''.
       (ii) Conforming changes.--

       (I) Payments under part a.--Section 1814(b) (42 U.S.C. 
     1395f(b)) is amended by inserting ``or with respect to 
     services to which section 1895(f) applies'' after 
     ``equipment'' in the matter preceding paragraph (1).
       (II) Payments under part b.--Section 1833(a)(2)(A) (42 
     U.S.C. 1395l(a)(2)(A)) is amended by striking ``the 
     prospective payment system under''.
       (III) Per visit limits.--Section 1861(v)(1)(L)(i) (42 
     U.S.C. 1395x(v)(1)(L)(i)) is amended by inserting ``(other 
     than by a qualified RCH-based home health agency (as defined 
     in section 1895(f)(2))'' after ``with respect to services 
     furnished by home health agencies''.

       (iii) Consolidated billing.--

       (I) Recipient of payment.--Section 1842(b)(6)(F) (42 U.S.C. 
     1395u(b)(6)(F)) is amended by inserting ``and excluding home 
     health services to which section to which section 1895(f) 
     applies'' after ``provided for in such section''.
       (II) Exception to exclusion from coverage.--Section 1862(a) 
     (42 U.S.C. 1395y(a)) is amended by inserting before the 
     period at the end of the second sentence the following: ``and 
     paragraph (21) shall not apply to home health services to 
     which section 1895(f) applies''.

       (4) Return on equity.--Section 1861(v)(1)(P) (42 U.S.C. 
     1395x(v)(1)(P)) is amended--
       (A) by inserting ``(i)'' after ``(P)''; and
       (B) by adding at the end the following:
       ``(ii)(I) Notwithstanding clause (i), subparagraph (S)(i), 
     and section 1886(g)(2), such regulations shall provide, in 
     determining the reasonable costs of the services described in 
     subclause (II) furnished by a rural community hospital on or 
     after October 1, 2002, for payment of a return on equity 
     capital at a rate of return equal to 150 percent of the 
     average specified in clause (i):
       ``(II) The services referred to in subclause (I) are 
     inpatient hospital services, outpatient hospital services, 
     home health services furnished by an RCH-based home health 
     agency (as defined in section 1895(f)(2)), and ambulance 
     services.
       ``(III) Payment under this clause shall be made without 
     regard to whether a provider is a proprietary provider.''.
       (5) Exemption from 30 percent reduction in reimbursement 
     for bad debt.--Section 1861(v)(1)(T) (42 U.S.C. 
     1395x(v)(1)(T)) is amended by inserting ``(other than a rural 
     community hospital)'' after ``In determining such reasonable 
     costs for hospitals''.
       (c) Beneficiary Cost-Sharing for Outpatient Services.--
     Section 1834(n) (as added by subsection (b)(2)) is amended--
       (1) by inserting ``(1)'' after ``(n)''; and
       (2) adding at the end the following:
       ``(2) The amounts of beneficiary cost sharing for 
     outpatient services furnished in a rural community hospital 
     under this part shall be as follows:
       ``(A) For items and services that would have been paid 
     under section 1833(t) if provided by a hospital, the amount 
     of cost sharing determined under paragraph (8) of such 
     section.
       ``(B) For items and services that would have been paid 
     under section 1833(h) if furnished by a provider or supplier, 
     no cost sharing shall apply.
       ``(C) For all other items and services, the amount of cost 
     sharing that would apply to the item or service under the 
     methodology that would be used to determine payment for such 
     item or service if provided by a physician, provider, or 
     supplier, as the case may be.''.
       (d) Conforming Amendments.--
       (1) Part a payment.--Section 1814(b) (42 U.S.C. 1395f(b)) 
     is amended by inserting ``other than inpatient hospital 
     services furnished by a rural community hospital,'' after 
     ``critical access hospital services,''.
       (2) Part b payment.--
       (A) In general.--Section 1833(a) (42 U.S.C. 1395l(a)) is 
     amended--
       (i) in paragraph (2), in the matter before subparagraph 
     (A), by striking ``and (I)'' and inserting ``(I), and (K)'';
       (ii) by striking ``and'' at the end of paragraph (8);
       (iii) by striking the period at the end of paragraph (9) 
     and inserting ``; and''; and
       (iv) by adding at the end the following:
       ``(10) in the case of outpatient services furnished by a 
     rural community hospital, the amounts described in section 
     1834(n).''.
       (B) Ambulance services.--Section 1834(l)(8) (42 U.S.C. 
     1395m(l)(8)), as added by section 205(a) of the Medicare, 
     Medicaid, and SCHIP Benefits Improvement and Protection Act 
     of 2000 (Appendix F, 114 Stat. 2763A-463), as enacted into 
     law by section 1(a)(6) of Public Law 106-554, is amended--
       (i) in the heading, by striking ``critical access 
     hospitals'' and inserting ``certain facilities'';
       (ii) by striking ``or'' at the end of subparagraph (A);
       (iii) by redesignating subparagraph (B) as subparagraph 
     (C);
       (iv) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) by a rural community hospital (as defined in section 
     1861(ww)(1)), or''; and
       (v) in subparagraph (C), as so redesignated, by inserting 
     ``or a rural community hospital'' after ``critical access 
     hospital''.
       (3) Technical amendments.--
       (A) Consultation with state agencies.--Section 1863 (42 
     U.S.C. 1395z) is amended by striking ``and (dd)(2)'' and 
     inserting ``(dd)(2), (mm)(1), and (ww)(1)''.
       (B) Provider agreements.--Section 1866(a)(2)(A) (42 U.S. C. 
     1395cc(a)(2)(A)) is amended by inserting ``section 
     1834(n)(2),'' after ``section 1833(b),''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished on or after 
     October 1, 2002.

     SEC. 3. REMOVING BARRIERS TO ESTABLISHMENT OF DISTINCT PART 
                   UNITS BY RCH AND CAH FACILITIES.

       (a) In General.--Section 1886(d)(1)(B) (42 U.S.C. 
     1395ww(d)(1)(B)) is amended by striking ``a distinct part of 
     the hospital (as defined by the Secretary)'' in the matter 
     following cause (v) and inserting ``a distinct part (as 
     defined by the Secretary) of the hospital or of a critical 
     access hospital or a rural community hospital''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to determinations with respect to distinct part 
     unit status that are made on or after October 1, 2002.

     SEC. 4. IMPROVEMENTS TO MEDICARE CRITICAL ACCESS HOSPITAL 
                   (CAH) PROGRAM.

       (a) Exclusion of Certain Beds From Bed Count.--Section 
     1820(c)(2) (42 U.S.C. 1395i-4(c)(2)) is amended by adding at 
     the end the following:
       ``(E) Exclusion of certain beds from bed count.--In 
     determining the number of beds of a facility for purposes of 
     applying the bed limitations referred to in subparagraph 
     (B)(iii) and subsection (f), the Secretary shall not take 
     into account any bed of a distinct part psychiatric or 
     rehabilitation unit (described in the matter following clause 
     (v) of section 1886(d)(1)(B)) of the facility, except that 
     the total number of beds that are not taken into account 
     pursuant to this subparagraph with respect to a facility 
     shall not exceed 10.''.
       (b) Payments to Home Health Agencies Owned and Operated by 
     a CAH.--Section 1895(f) (42 U.S.C. 1395fff(f)), as added by 
     section 2(b)(3), is further amended by inserting ``or by a 
     home health agency that is owned and operated by a critical 
     access hospital (as defined in section 1861(mm)(1))'' after 
     ``as defined in paragraph (2))''.
       (c) Payments to CAH-Owned SNFs.--
       (1) In general.--Section 1888(e) (42 U.S.C. 1395yy(e)) is 
     amended--
       (A) in paragraph (1), by striking ``and (12)'' and 
     inserting ``(12), and (13)''; and
       (B) by adding at the end thereof the following:
       ``(13) Exemption of cah facilities from pps.--In 
     determining payments under this part for covered skilled 
     nursing facility services furnished on or after October 1, 
     2002, by a skilled nursing facility that is a distinct part 
     unit of a critical access hospital (as defined in section 
     1861(mm)(1)) or is owned and operated by a critical access 
     hospital--
       ``(A) the prospective payment system established under this 
     subsection shall not apply; and
       ``(B) payment shall be made on the basis of the reasonable 
     costs incurred in furnishing such services as determined 
     under section 1861(v), but without regard to the amount of 
     the customary or other charges with respect to such 
     services or the limitations established under subsection 
     (a).''.
       (2) Conforming changes.--
       (A) In general.--Section 1814(b) (42 U.S.C. 1395f(b)), as 
     amended by subsection (b)(2)(A), is further amended in the 
     matter preceding paragraph (1)--
       (i) by inserting ``other than a skilled nursing facility 
     providing covered skilled nursing facility services (as 
     defined in section 1888(e)(2)) or posthospital extended care 
     services to which section 1888(e)(13) applies,'' after 
     ``inpatient critical access hospital services''; and
       (ii) by striking ``1813 1886,'' and inserting ``1813, 1886, 
     1888,''.
       (B) Consolidated billing.--
       (i) Recipient of payment.--Section 1842(b)(6)(E) (42 U.S.C. 
     1395u(b)(6)(E)) is amended by inserting ``services to which 
     paragraph (7)(C) or (13) of section 1888(e) applies and'' 
     after ``other than''.
       (ii) Exception to exclusion from coverage.--Section 
     1862(a)(18) (42 U.S.C. 1395y(a)(18)) is amended by inserting 
     ``(other than services to which paragraph (7)(C) or (13) of 
     section 1888(e) applies)'' after ``section 
     1888(e)(2)(A)(i)''.
       (d) Payments to Distinct Part Psychiatric or Rehabilitation 
     Units of CAHs.--Section 1886(b) (42 U.S.C. 1395ww(b)) is 
     amended--

[[Page S5460]]

       (1) in paragraph (1), by inserting ``, other than a 
     distinct part psychiatric or rehabilitation unit to which 
     paragraph (8) applies,'' after ``subsection (d)(1)(B)''; and
       (2) by adding at the end the following:
       ``(8) Exemption of certain distinct part psychiatric or 
     rehabilitation units from cost limits.--In determining 
     payments under this part for inpatient hospital services 
     furnished on or after October 1, 2002, by a distinct part 
     psychiatric or rehabilitation unit (described in the matter 
     following clause (v) of subsection (d)(1)(B)) of a critical 
     access hospital (as defined in section 1861(mm)(1))--
       ``(A) the limits imposed under the preceding paragraphs of 
     this subsection shall not apply; and
       ``(B) payment shall be made on the basis of the reasonable 
     costs incurred in furnishing such services as determined 
     under section 1861(v), but without regard to the amount of 
     the customary or other charges with respect to such 
     services.''.
       (e) Elimination of Isolation Test for Cost-Based CAH 
     Ambulance Services.--Paragraph (8) of section 1834(l) (42 
     U.S.C. 1395m(l)), as added by section 205(a) of BIPA, is 
     amended by striking the comma at the end of the last 
     subparagraph and all that follows and inserting a period.
       (f) Return on Equity.--Section 1861(v)(1)(P) (42 U.S.C. 
     1395x(v)(1)(P)), as amended by section 2(b)(4), is further 
     amended by adding at the end the following:
       ``(iii)(I) Notwithstanding clause (i), subparagraph (S)(i), 
     and section 1886(g)(2), such regulations shall provide, in 
     determining the reasonable costs of the services described in 
     subclause (II) furnished by a rural community hospital on or 
     after October 1, 2002, for payment of a return on equity 
     capital at a rate of return equal to 150 percent of the 
     average specified in clause (i):
       ``(II) The services referred to in subclause (I) are 
     inpatient critical access hospital services (as defined in 
     section 1861(mm)(2)), outpatient critical access hospital 
     services (as defined in section 1861(mm)(3)), extended care 
     services provided pursuant to an agreement under section 
     1883, posthospital extended care services to which section 
     1888(e)(13) applies, home health services to which section 
     1895(f) applies, ambulance services to which section 1834(l) 
     applies, and inpatient hospital services to which section 
     1886(b)(8) applies.
       ``(III) Payment under this clause shall be made without 
     regard to whether a provider is a proprietary provider.''.
       (g) Technical Corrections.--
       (1) Section 403(b) of bbra 1999.--Section 1820(b)(2) (42 
     U.S.C. 1395i-4(b)(2)) is amended by striking ``nonprofit or 
     public hospitals'' and inserting ``hospitals''.
       (2) Section 203(b) of bipa 2000.--Section 1883(a)(3) (42 
     U.S.C. 1395tt(a)(3)) is amended--
       (A) by inserting ``section 1861(v)(1)(G) or'' after 
     ``Notwithstanding''; and
       (B) by striking ``covered skilled nursing facility''.
       (h) Effective Dates.--
       (1) Elimination of requirements.--The amendment made by 
     subsections (a) and (b) shall apply to services furnished on 
     or after October 1, 2002.
       (2) Technical corrections.--
       (A) BBRA.--The amendment made by subsection (f)(1) shall be 
     effective as if included in the enactment of section 403(b) 
     of the Medicare, Medicaid, and SCHIP Balanced Budget 
     Refinement Act of 1999 (Appendix F, 113 Stat. 1501A-321), as 
     enacted into law by section 1000(a)(6) of Public Law 106-113.
       (B) BIPA.--The amendment made by subsection (f)(2) shall be 
     effective as if included in the enactment of section 203(b) 
     of the Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (Appendix F, 114 Stat. 2763A-463), as 
     enacted into law by section 1(a)(6) of Public Law 106-554.

  Mr. WELLSTONE. Mr. President, I rise today along with my colleague, 
the Senator from Alaska, to introduce the Rural Community Hospital 
Assistance Act. Senator Murkowski and I don't agree on a lot of issues. 
But one thing we both care very deeply about is the health of this 
Nation's rural hospitals. Rural hospitals provide essential care for 
more than 54 million people. They provide essential inpatient, 
outpatient and post-acute care, including skilled nursing, home health 
and rehabilitation services. Minnesota has more rural hospitals than 
any other state in the United States with the exception of Texas. The 
hospitals of rural America are the heart of our health care system. In 
rural America, how far away you are from your community hospital can be 
a matter of life and death.
  But the health of our rural hospitals in 2002 is not good. Many are 
struggling to survive. Rural hospitals have Medicare inpatient margins 
that are 10 percent less than urban hospitals. Rural hospital total 
Medicare margins have declined significantly, falling to an average of 
negative 3.2 percent since 1999, and even lower margins, negative 5.4 
percent, for rural hospitals with 50 or fewer beds. Rural hospital 
costs are increasing at a greater rate than urban hospitals. They can't 
survive on the Medicare prospective payment system that we've set up 
for them. That payment system provides a fixed hospital payment 
established in advance of the provisions of services, rather than 
providing reimbursement retroactively on the basis of costs. The 
Medicare Payment Advisory Commission (MedPAC) told the Congress last 
June that the Prospective Payment System is not working for small rural 
hospitals. We set up that system to contain costs and save money. But 
we can't have the kind of healthcare system that the people who live in 
the small towns and on the farms of America deserve, if we try to 
finance it on the cheap. This is about values. This is about 
priorities. This is about giving people who work hard all their lives 
the healthcare they deserve.
  I voted against the Balanced Budget Act of 1997 because I was worried 
that it would lead to significant harm for our healthcare system. I was 
worried that it would hurt healthcare in our rural areas, in our 
cities, and that it would damage our healthcare safety net. 
Unfortunately, I was right and we have seen exactly the kind of 
problems I warned about. But one good thing we included was the 
Medicare Rural Hospital Flexibility Act which set up ``Critical Access 
Hospitals.'' The Critical Access Hospital (CAH) program provides cost 
based Medicare reimbursement for qualifying rural hospitals with 15 of 
fewer inpatient beds. Small rural hospitals face unique circumstances 
that require special consideration when developing Medicare payment 
policies. Because of their small size, a median of 58 beds compared to 
186 beds for urban hospitals, rural hospitals have a much more 
difficult time surviving within a prospective payment system. Rural 
hospitals have fewer financial reserves and greater volume fluctuations 
than urban hospitals. They rely on Medicare as a source of revenue more 
than other hospitals. They have to deal with isolation, high levels of 
poverty, and shortages of critical health care professionals, making it 
much more difficult for small rural hospitals to absorb the impact of 
policy and market changes.
  The Critical Access Hospital Program has done a good job. There are 
43 Critical Access Hospitals in Minnesota. But this program needs to be 
updated and it needs to be extended and enhanced if we are going to 
restore our rural hospitals to financial health. The Rural Community 
Hospital Assistance Act will provide enhanced cost based reimbursement 
for Critical Access Hospitals, and extend such reimbursement to post 
acute care services. It will permit and extend enhanced reimbursement 
fore geriatric psychiatric care. It will provide enhanced cost based 
reimbursement for ambulance services. It would also provide an option 
for rural hospitals with less than 50 acute care beds to receive cost 
based reimbursement for inpatient, outpatient, and ambulance services. 
This is very important because so many rural hospitals with less than 
50 beds are struggling just to survive. It is essential that the doors 
of our rural hospitals remain open. I ask my colleagues to join Senator 
Murkowski and me in supporting this important legislation for rural 
America.
                                 ______
                                 
      By Mr. THURMOND:
  S. 2616. A bill to amend the Public Health Service Act to establish 
an Office of Men's Health; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. THURMOND. Mr. President, this week in the United States we are 
commemorating Men's Health Week. The National Men's Health Week Act was 
passed by Congress and signed into law in 1994. Since then Men's Health 
Week has been celebrated each year as the week leading up to and 
including Father's Day. I was proud to be a cosponsor of that Act. 
Today, I rise to introduce the Men's Health Act of 2002, to establish 
an Office of Men's Health within the Department of Health and Human 
Services to promote men's health in America.
  In this Nation, there is an ongoing, increasing, and predominantly 
silent crisis in the health and well-being of men. Due to a lack of 
awareness, poor health education, and culturally-induced behavior 
patterns, the state of men's health and well-being is deteriorating 
steadily. Heart disease, stroke, and various cancers, including 
prostate and testicular cancer, continue to be

[[Page S5461]]

major areas of concern. We must address these issues with diligent 
educational efforts, prevention and treatment as we seek to enhance the 
quality and duration of men's lives. Improved distribution of 
information concerning the health challenges men face and the 
utilization of the appropriate preventive measures are imperative to 
addressing this need.
  As a lifelong advocate of regular medical exams, daily exercise, and 
a balanced diet, I feel strongly that an Office of Men's Health should 
be established to help improve the overall health of America's male 
population. The bill I am introducing is similar to a bill introduced 
in the House of Representatives. I invite my colleagues to join me in 
supporting this important measure. 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. 2616

       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 ``Men's Health Act of 2002''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) A silent health crisis is affecting the health and 
     well-being of America's men.
       (2) While this health crisis is of particular concern to 
     men, it is also a concern for women regarding their fathers, 
     husbands, sons, and brothers.
       (3) Men's health is a concern for employers who pay the 
     costs of medical care, and lose productive employees.
       (4) Men's health is a concern to Federal and State 
     governments which absorb the enormous costs of premature 
     death and disability, including the costs of caring for 
     dependents left behind.
       (5) The life expectancy gap between men and women has 
     increased from one year in 1920 to almost six years in 1998.
       (6) Prostate cancer is the most frequently diagnosed cancer 
     in the United States among men, accounting for 36 percent of 
     all cancer cases.
       (7) An estimated 180,000 men will be newly diagnosed with 
     prostate cancer this year alone, and 37,000 will die.
       (8) The American Heart Association reports that heart 
     attack is the single biggest killer of American males. Men 
     are more likely to die of stroke and are almost twice as 
     likely to die of heart disease than are women. High blood 
     pressure increases the risk for stroke and heart attack and 
     men under age 55 are much more likely to suffer from high 
     blood pressure than are women.
       (9) An estimated 7,600 men will be diagnosed this year with 
     testicular cancer, and 400 of these men will die of this 
     disease in 2002. A common reason for delay in treatment of 
     this disease is a delay in seeking medical attention after 
     discovering a testicular mass.
       (10) Studies show that men are at least 25 percent less 
     likely than women to visit a doctor, and are significantly 
     less likely to have regular physician check-ups and obtain 
     preventive screening tests for serious diseases.
       (11) Appropriate use of tests such as prostate specific 
     antigen (PSA) exams and blood pressure, blood sugar, and 
     cholesterol screens, in conjunction with clinical exams and 
     self-testing, can result in the early detection of many 
     problems and in increased survival rates.
       (12) Educating men, their families, and health care 
     providers about the importance of early detection of male 
     health problems can result in reducing rates of mortality for 
     male-specific diseases, as well as improve the health of 
     America's men and its overall economic well-being.
       (13) Recent scientific studies have shown that regular 
     medical exams, preventive screenings, regular exercise, and 
     healthy eating habits can help save lives.
       (14) Establishing an Office of Men's Health is needed to 
     investigate these findings and take such further actions as 
     may be needed to promote men's health.

     SEC. 3. ESTABLISHMENT OF OFFICE OF MEN'S HEALTH.

       (a) In General.--Title XVII of the Public Health Service 
     Act (42 U.S.C. 300u et seq.) is amended by adding at the end 
     the following:


                        ``office of men's health

       ``Sec. 1711. The Secretary shall establish within the 
     Department of Health and Human Services an office to be known 
     as the Office of Men's Health, which shall be headed by a 
     director appointed by the Secretary. The Secretary, acting 
     through the Director of the Office, shall coordinate and 
     promote the status of men's health in the United States.''.
       (b) Report.--Not later than two years after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services, acting through the Director of the Office of Men's 
     Health (established under section 1711 of the Public Health 
     Service Act as added by subsection (a)), shall submit to 
     Congress a report describing the activities of such Office, 
     including findings that the Director has made regarding men's 
     health.

                          ____________________