[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.
____________________