[Congressional Record Volume 148, Number 102 (Wednesday, July 24, 2002)]
[Senate]
[Pages S7311-S7314]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SMITH of Oregon (for himself, Mr. Reid, Mr. Wyden, Mr. 
        Ensign, Mrs. Clinton, Mr. Schumer, Mrs. Boxer, and Mrs. 
        Feinstein):
  S. 2782. A bill to amend part C of title XVII of the Social Security 
Act to consolidate and restate the Federal laws relating to the social 
health maintenance organization projects, to make such projects 
permanent, to require the Medicare Payment Advisory Commission to 
conduct a study on ways to expand such projects, and for other 
purposes; to the Committee on Finance.
  Mr. SMITH of Oregon. Mr. President, I rise today to introduce a bill 
that will make Medicare's Social Health Maintenance Organization, SHMO, 
demonstration a permanent part of the Medicare+Choice, M+C, program. I 
am joined by my colleagues from Oregon, New York, Arizona, and 
California. The Social HMO demonstration was authorized 17 years ago to 
test models for improving care for frail seniors, expanding access to 
social and supportive services and better integrating these expanded 
benefits with medical services. Clearly, a seventeen year test is long 
enough--it's time for this successful program to become a permanent 
choice for Medicare beneficiaries.
  Close to 80 percent of national health care expenditures are for 
persons with chronic conditions. Medicare beneficiaries are 
disproportionately affected by chronic illness. About 85 percent of 
people 65 and older have one chronic condition, and two thirds have two 
or more. Fully a third of Medicare beneficiaries have four or more 
chronic conditions. This group accounts for almost 80 percent of all 
Medicare spending. Yet, despite the predominance of chronic illness 
among seniors, Medicare continues to operate as an acute care model. So 
many of the services that are central to the health care needs of 
seniors are not covered by Medicare, including a number of preventive 
services, care coordination and disease management services, and home 
and community-based support services.

[[Page S7312]]

  Social HMOs provide the care coordination and disease management 
services so critically important to frail and at-risk seniors with 
multiple chronic conditions and complex care needs. They are required 
to provide expanded care benefits such as prescription drugs, ancillary 
services such as eyeglasses and hearing aids, and community-based 
services such as personal care, homemaker services, adult day care, 
meals, and transportation. These services meet the chronic health care 
needs of seniors, helping them remain independent, while reducing 
Medicaid expenditures by avoiding or delaying nursing home placement.
  Several recent studies have shown that Social HMO members are about 
40 percent to 50 percent less likely to have long-term nursing home 
placements than comparison group members. Further, in a recent survey 
of Social HMO beneficiaries, over three-quarter of respondents 
indicated that the special services offered by their Social HMO were 
important to allowing them to keep living at home. Enhanced Social HMO 
services, such as early detection of illness, development of 
coordinated care plans to address problems identified during routine 
assessments, screening, and ongoing monitoring of care, has paid off in 
improved health outcomes for beneficiaries.
  I am fortunate to represent one of the four original Social HMOs that 
were approved as part of the initial Medicare demonstration project in 
1985. Senior Advantage II, offered by Kaiser Permanente's Northwest 
Division, currently serves about 4,300 Medicare beneficiaries from 
Salem, OR to Longview, WA, with its primary service area in Portland, 
OR. Since Kaiser opened its Social HMO program, it has served close to 
15,000 beneficiaries with its enhanced benefits and special geriatric 
programs, which have led to fewer overall nursing home care days and a 
more consumer-oriented approach to care for frail or ill seniors.
  The legislation I am introducing with my distinguished colleagues 
today would make permanent the existing Social HMO plans, like Kaiser, 
and would lay the ground work for evaluating whether to expand and 
replicate this model. Our bill requires the Secretary to conduct a 
comparative study of beneficiary and family member satisfaction to see 
how Social HMOs compare to Medicare+Choice and fee-for-service 
Medicare. It also requires MedPAC to evaluate the cost-effectiveness of 
Social HMOs with respect to reduced nursing home admissions, reduced 
incidence of Medicaid spend-down, and other aspects of the model that 
represent potential cost-savings. If MedPAC finds that Social HMOs are 
cost-effective, it must make recommendations to Congress on expanding 
and replicating this model.
  To ensure that beneficiaries continue to receive the value added they 
have come to enjoy under this program, the Social HMOs must continue to 
provide the expanded benefit package currently offered under this 
legislation. Further, this benefit could not be changed by the 
Secretary without notification of Congress. Finally, to ensure that 
Social HMOs, which have significantly higher risk levels than average 
Medicare+Choice plans, can continue to finance a high level of 
benefits, any changes in plans' existing payments would need to go 
through a formal rulemaking process.
  The Social HMO demonstration project has been re-validated by six 
acts of Congress since its creation. It is time to make this program 
permanent and lend a measure of stability to the plans and 
beneficiaries served by this innovative model. This program represents 
a fiscally sound approach to helping manage the chronic health care 
needs of our Nation's seniors, and I urge all of my colleagues to join 
with me and the rest of this bill's cosponsors in support of this 
important legislation.
  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. 2782

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Seniors 
     Health and Independence Preservation Act of 2002''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Making the social health maintenance organization (SHMO) 
              projects permanent.
Sec. 3. Expansion of SHMO projects into noncontiguous service areas 
              within a State.
Sec. 4. Permanence of SHMO planning grant sites.
Sec. 5. Procedures for SHMO benefit and payment mechanism changes.
Sec. 6. Comprehensive MedPAC study on SHMO I and SHMO II cost-
              effectiveness and potential expansion.
Sec. 7. SHMO Beneficiary satisfaction survey.
Sec. 8. Conforming cross-references.
Sec. 9. Legislative purpose and construction.
Sec. 10. Repeals.

     SEC. 2. MAKING THE SOCIAL HEALTH MAINTENANCE ORGANIZATION 
                   (SHMO) PROJECTS PERMANENT.

       Part C of title XVIII of the Social Security Act (42 U.S.C. 
     1395w-21 et seq.) is amended by inserting after section 1857 
     the following new section:


         ``waivers for social health maintenance organizations

       ``Sec. 1858. (a) Establishment of SHMO Projects.--In the 
     case of a project described in subsection (b), the Secretary 
     shall approve, with appropriate terms and conditions as 
     defined by the Secretary, applications or protocols submitted 
     for waivers described in subsection (c), and the evaluation 
     of such protocols, in order to carry out such project. Such 
     approval shall be effected not later than 30 days after the 
     date on which the application or protocol for a waiver is 
     submitted or not later than 30 days after the date of 
     enactment of the Deficit Reduction Act of 1984 (Public Law 
     98-369; 98 Stat. 494) in the case of an application or 
     protocol submitted before the date of enactment of such Act. 
     Not later than 36 months after the date of enactment of the 
     Omnibus Budget Reconciliation Act of 1990 (Public Law 101-
     508; 104 Stat. 1388), the Secretary shall approve 
     applications or protocols described in paragraph (1) for not 
     more than 4 additional projects described in subsection (b).
       ``(b) Projects Described.--A project referred to in 
     subsection (a) is a project--
       ``(1) to demonstrate--
       ``(A) the concept of a social health maintenance 
     organization with the organizations as described in Project 
     No. 18-P-9 7604/1-04 of the University Health Policy 
     Consortium of Brandeis University; or
       ``(B) in the case of a project conducted as a result of the 
     amendments made by section 4207(b)(4)(B)(i) of the Omnibus 
     Budget Reconciliation Act of 1990 (Public Law 101-508; 104 
     Stat. 1388-118), the effectiveness and feasibility of 
     innovative approaches to refining targeting and financing 
     methodologies and benefit design, including the effectiveness 
     of feasibility of--
       ``(i) the benefits of expanded post-acute and community 
     care case management through links between chronic care case 
     management services and acute care providers;
       ``(ii) refining targeting or reimbursement methodologies;
       ``(iii) the establishment and operation of a rural services 
     delivery system;
       ``(iv) integrating acute and chronic care management for 
     patients with end-stage renal disease through expanded 
     community care case management services (and for purposes of 
     a project conducted under this clause, any requirement under 
     a waiver granted under this section that a project disenroll 
     individuals who develop end-stage renal disease shall not 
     apply); or
       ``(v) the effectiveness of second-generation sites in 
     reducing the costs of the commencement and management of 
     health care service delivery;
       ``(2) which provides for the integration of health and 
     social services under the direct financial management of a 
     provider of services;
       ``(3) under which all services under this title will be 
     provided by or under arrangements made by the organization at 
     a fixed annual prepaid capitation rate for medicare of 100 
     percent of the adjusted average per capita cost; and
       ``(4) under which services under title XIX will be provided 
     at a rate approved by the Secretary.
       ``(c) Waivers.--The waivers referred to in subsection (a) 
     are appropriate waivers of--
       ``(1) certain requirements of this title, pursuant to 
     section 402(a) of the Social Security Amendments of 1967 
     (Public Law 90-248; 81 Stat. 930), as amended by section 222 
     of the Social Security Amendments of 1972 (Public Law 92-603; 
     86 Stat. 1390);
       ``(2) certain requirements of title XIX, pursuant to 
     section 1115; and
       ``(3) in the case of a project conducted as a result of the 
     amendments made by section 4207(b)(4)(B)(i) of the Omnibus 
     Budget Reconciliation Act of 1990 (Public Law 101-508; 104 
     Stat. 1388-118), any requirements of title XVIII or XIX that, 
     if imposed, would prohibit such project from being conducted.
       ``(d) Aggregate Limit on Number of Members.--The Secretary 
     may not impose a limit on the number of individuals that may 
     participate in a project conducted under this section, other 
     than an aggregate limit of not less than 324,000 for all 
     sites.
       ``(e) Reports.--

[[Page S7313]]

       ``(1) Preliminary report.--The Secretary shall submit a 
     preliminary report to Congress on the status of the projects 
     and waivers referred to in subsection (a) 45 days after the 
     date of enactment of the Deficit Reduction Act of 1984 
     (Public Law 98-369; 98 Stat. 494).
       ``(2) Interim report.--The Secretary shall submit an 
     interim report to Congress on the projects referred to in 
     subsection (a) not later than 42 months after the date of 
     enactment of the Deficit Reduction Act of 1984 (Public Law 
     98-369; 98 Stat. 494).
       ``(3) Second interim report.--The Secretary shall submit a 
     second interim report to Congress on the project referred to 
     in paragraph (1) not later than March 31, 1993.
       ``(4) Report on integration and transition.--
       ``(A) In general.--The Secretary shall submit to Congress, 
     by not later than January 1, 1999, a plan for the integration 
     of health plans offered by social health maintenance 
     organizations (including SHMO I and SHMO II sites developed 
     under this section and similar plans) as an option under the 
     Medicare+Choice program under this title.
       ``(B) Provision for transition.--The plan submitted under 
     subparagraph (A) shall include a transition for social health 
     maintenance organizations operating under the project 
     authority under this section.
       ``(C) Payment policy.--The report shall also include 
     recommendations on appropriate payment levels for plans 
     offered by such organizations, including an analysis of the 
     application of risk adjustment factors appropriate to the 
     population served by such organizations.
       ``(5) HHS report.--The Secretary shall submit a report on 
     the projects conducted under this section not later than the 
     date that is 21 months after the date on which the Secretary 
     submits to Congress the report described in paragraph (4).
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated $3,500,000 for the costs of 
     technical assistance and evaluation related to projects 
     conducted as a result of the amendments made by section 
     4207(b)(4)(B) of the Omnibus Budget Reconciliation Act of 
     1990 (Public Law 101-508; 104 Stat. 1388-118).''.

     SEC. 3. EXPANSION OF SHMO PROJECTS INTO NONCONTIGUOUS SERVICE 
                   AREAS WITHIN A STATE.

       Not later than the date that is 90 days after the date of 
     enactment of this Act, the Secretary shall promulgate a 
     regulation that permits each social health maintenance 
     organization participating in a project conducted under 
     section 1858 of the Social Security Act (as added by section 
     2) to expand the service area of such organization to include 
     areas within the State served by the organization that are 
     not contiguous to any other service area of the organization.

     SEC. 4. PERMANENCE OF SHMO PLANNING GRANT SITES.

       (a) Original SHMO II Demonstrations.--The 5 organizations 
     authorized by section 4207(b)(4)(B) of the Omnibus Budget 
     Reconciliation Act of 1990 (Public Law 101-508; 104 Stat. 
     1388-118) to demonstrate the concept of social health 
     maintenance organizations that were approved by the Secretary 
     of Health and Human Services in 1995 shall be permitted to 
     participate in the program under section 1858 of the Social 
     Security Act (as added by section 2).
       (b) SHMO II Dual-eligible Planning Grants.--Each entity 
     that received a planning grant in 1998 under the 1997 Grants 
     Program for Reforming Service Delivery for Dual Eligible 
     Beneficiaries to develop a Second Generation Social HMO 
     Demonstration Program shall be permitted to participate in 
     the program under section 1858 of the Social Security Act (as 
     added by section 2).

     SEC. 5. PROCEDURES FOR SHMO BENEFIT AND PAYMENT MECHANISM 
                   CHANGES.

       (a) Congressional Notification of Benefit Changes.--The 
     Secretary of Health and Human Services shall notify the 
     appropriate committees of Congress prior to making any change 
     to the benefits available under a project under section 1858 
     of the Social Security Act (as added by section 2).
       (a) Rulemaking Requirement for Payment Mechanism Changes.--
     The Secretary may not change the payment mechanism applicable 
     with respect to any social health maintenance organization 
     project under section 1858 of the Social Security Act (as 
     added by section 2), except by regulation.

     SEC. 6. COMPREHENSIVE MEDPAC STUDY ON SHMO I AND SHMO II 
                   COST-EFFECTIVENESS AND POTENTIAL EXPANSION.

       (a) Study.--
       (1) In general.--The Medicare Payment Advisory Commission 
     established under section 1805 of the Social Security Act (42 
     U.S.C. 1395b-6) (in this section referred to as the 
     ``Commission'') shall conduct a study on the cost-
     effectiveness of the projects and the potential expansion of 
     such projects.
       (2) Cost-effectiveness.--
       (A) In general.--In determining the cost-effectiveness of 
     the projects under the study conducted under paragraph (1), 
     the Commission shall take into account--
       (i) the extent to which the per beneficiary costs to the 
     medicare program for enrollees in a social health maintenance 
     organization do not exceed the average per beneficiary costs 
     to the medicare program for a comparable case mix of 
     beneficiaries who are enrolled in the original medicare fee-
     for-service program;
       (ii) the actuarial value of items and services available to 
     beneficiaries enrolled in a social health maintenance 
     organization but not available to beneficiaries enrolled in 
     the original medicare fee-for-service program; and
       (iii) the extent to which social health maintenance 
     organizations reduced expenditures under the medicaid program 
     under title XIX of the Social Security Act by--

       (I) preventing individuals from being eligible for medical 
     assistance under such program as medically needy individuals 
     through the application of spend-down requirements for income 
     and resources; or
       (II) reducing the number of nursing home bed days 
     associated with stays of 60 days or longer for medicaid 
     beneficiaries.

       (B) Comparable case mix.--In evaluating a comparable case 
     mix of beneficiaries for purposes of clause (i)(I), the 
     Commission shall take into account the following factors:
       (i) Age.
       (ii) Gender.
       (iii) Diagnoses.
       (iv) Functional status.
       (v) Any other available demographic or illness factor 
     deemed appropriate by the Commission.
       (C) Data.--In determining the cost-effectiveness of social 
     health maintenance organizations under this subsection, the 
     Commission shall evaluate data from social health maintenance 
     organizations for the period beginning on January 1, 1997, 
     and ending on the first December 31 occurring after the date 
     of enactment of this Act.
       (b) Report.--
       (1) In general.--Not later than the date that is 24 months 
     after the date of enactment of this Act, the Commission shall 
     submit to the Secretary of Health and Human Services and to 
     the appropriate committees of Congress a report on the study 
     conducted under subsection (a)(1).
       (2) Contents.--The report submitted under paragraph (1) 
     shall contain--
       (A) a statement regarding whether the Commission finds 
     social health maintenance organizations to be cost-effective;
       (B) recommendations regarding whether the projects should 
     be expanded to include additional sites and whether 
     additional social health maintenance organizations should be 
     permitted to participate in the projects;
       (C) recommendations on whether to modify or eliminate the 
     aggregate limit on number of members under section 1858(d) of 
     the Social Security Act (as added by section 2); and
       (D) if the Commission recommends expansion or replication 
     of the projects, recommendations on the appropriate 
     implementation of such expansion.
       (c) Definitions.--In this section:
       (1) Project.--The term ``project'' means a project 
     conducted under section 1858 of the Social Security Act (as 
     added by section 2) other than a project described in 
     subsection (b)(1)(B)(iv) of such section.
       (2) Medicare program.--The term ``medicare program'' means 
     the health benefits program under title XVIII of the Social 
     Security Act.
       (3) Original medicare fee-for-service program.--The term 
     ``original medicare fee-for-service program'' means the 
     program under parts A and B of the medicare program.
       (4) Social health maintenance organization.--The term 
     ``social health maintenance organization'' means an 
     organization participating in a SHMO I project described in 
     subparagraph (A) of section 1858(b)(1) of the Social Security 
     Act (as added by section 2) or a SHMO II project described in 
     subparagraph (B) of such section (other than a project 
     described in clause (iv) of such subparagraph).

     SEC. 7. SHMO BENEFICIARY SATISFACTION SURVEY.

       (a) Survey.--
       (1) In general.--The Secretary of Health and Human Services 
     shall conduct a comparative qualitative survey of the 
     satisfaction of medicare beneficiaries enrolled in--
       (A) the original medicare fee-for-service program under 
     parts A and B of title XVIII of the Social Security Act;
       (B) a Medicare+Choice plan under part C of title XVIII of 
     such Act; and
       (C) a social health maintenance organization under section 
     1858 of such Act (as added by section 2).
       (2) Considerations.--In determining beneficiary 
     satisfaction, the Secretary of Health and Human Services 
     shall take into account--
       (A) the differences in the program or plan benefit 
     structure;
       (B) the extent to which the program or plan benefit 
     structure enables beneficiaries to avoid or delay 
     institutionalization;
       (C) the amount of out-of-pocket costs saved by 
     beneficiaries under the program or plan for traditional and 
     expanded care services;
       (D) the access to services by beneficiaries under the 
     program or plan; and
       (E) the satisfaction level of family members and caregivers 
     of beneficiaries enrolled in the program or plan.
       (b) Publication of Results and Submission to Congress.--Not 
     later than the date that is 24 months after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall post the results of the survey conducted under 
     subsection (a)(1) on an Internet website and shall submit 
     such results to the appropriate committees of Congress.

     SEC. 8. CONFORMING CROSS-REFERENCES.

       (a) Social Security Act.--
       (1) The last sentence of section 1853(a)(1)(B) of the 
     Social Security Act (42 U.S.C. 1395w-

[[Page S7314]]

     23(a)(1)(B)), as added by section 605(a) of the Medicare, 
     Medicaid, and SCHIP Benefits Improvement and Protection Act 
     of 2000 (114 Stat. 2763A-556), is amended by striking 
     ``(established by section 2355 of the Deficit Reduction Act 
     of 1984, as amended by section 13567(b) of the Omnibus Budget 
     Reconciliation Act of 1993)'' and inserting ``(established by 
     section 1858)''.
       (2) Section 1882(g)(1) of the Social Security Act (42 
     U.S.C. 1395ss(g)(1)) is amended by striking ``section 2355 of 
     the Deficit Reduction Act of 1984'' and inserting ``section 
     1858''.
       (b) Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000.--Section 542(b)(2)(B)(iv) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (114 Stat. 2763A-551), as enacted into 
     law by section 1(a)(6) of Public Law 106-554, is amended by 
     striking ``section 4018(b) of the Omnibus Budget 
     Reconciliation Act of 1987 (Public Law 100-203)'' and 
     inserting ``section 1858 of the Social Security Act''.

     SEC. 9. LEGISLATIVE PURPOSE AND CONSTRUCTION.

       (a) Principal Substantive Changes To Make SHMO Projects 
     Permanent.--
       (1) In general.--Except as provided in paragraphs (2) and 
     (3), section 2--
       (A) restates, without substantive change, laws enacted 
     before January 24, 2002, that were replaced by that section;
       (B) may not be construed as making a substantive change in 
     the laws replaced; and
       (C) is superseded by any law that is enacted after January 
     24, 2002, that is inconsistent with such section or that 
     supersedes that section to the extent of the inconsistency.
       (2) Permanency.--Section 2 extends the social health 
     maintenance organization projects for an indefinite time 
     period (beyond the date that is 30 months after the date that 
     the Secretary submits to Congress the report described in 
     section 1858(e)(4) of the Social Security Act, as added by 
     section 2).
       (3) Modification of certain reporting requirements.--
       (A) The report required to be submitted by the Secretary of 
     Health and Human Services under section 1858(e)(5) of the 
     Social Security Act (as added by section 2) is the same 
     report as is required under the first sentence of section 
     4018 of the Omnibus Budget Reconciliation Act of 1987 (Public 
     Law 100-203; 101 Stat. 1330-65), except that such report is 
     no longer characterized as a final report.
       (B) The Medicare Payment Advisory Commission established 
     under section 1805 of the Social Security Act (42 U.S.C. 
     1395b-6) shall not be required to submit the report described 
     in the second sentence of section 4018 of the Omnibus Budget 
     Reconciliation Act of 1987 (Public Law 100-203; 101 Stat. 
     1330-65).
       (b) References.--A reference to a law replaced by section 
     2, including a reference in a regulation, order, or other 
     law, is deemed to refer to the corresponding provision 
     enacted by this Act.
       (c) Continuing Effect.--An order, rule, or regulation in 
     effect under a law replaced by section 2 shall continue in 
     effect under the corresponding provision enacted by this Act 
     until repealed, amended, or superseded.
       (d) Actions Under Prior Law.--An action taken under a law 
     replaced by section 2 is deemed to have been taken under the 
     corresponding provision enacted by this Act.
       (e) Inferences.--No inference of legislative construction 
     may be drawn by reason of a heading of a provision.
       (f ) Severability.--If a provision enacted by this Act is--
       (1) held invalid, each valid provision that is severable 
     from the invalid provision shall remain in effect; and
       (2) held invalid with respect to any application, the 
     provision shall remain valid with respect to each valid 
     application that is severable from the invalid application.

     SEC. 10. REPEALS.

       (a) Inferences of Repeal.--The repeal of a law by this Act 
     may not be construed as a legislative inference that the 
     provision was or was not in effect before its repeal.
       (b) Laws Repealed.--Except for rights and duties that 
     matured, penalties that were incurred, and proceedings that 
     were begun before the date of enactment of this Act, the 
     following provisions (and amendments made by such provisions) 
     are repealed:
       (1) Section 2355 of the Deficit Reduction Act of 1984 
     (Public Law 98-369; 98 Stat. 1103).
       (2) Section 4018(b) of the Omnibus Budget Reconciliation 
     Act of 1987 (Public Law 100-203; 101 Stat. 1330-65).
       (3) Section 4207(b)(4) of the Omnibus Budget Reconciliation 
     Act of 1990 (Public Law 101-508; 104 Stat. 1388-118).
       (4) Section 13567 of the Omnibus Budget Reconciliation Act 
     of 1993 (Public Law 103-66; 107 Stat. 607).
       (5) Paragraphs (6) through (8) of section 160(d) of the 
     Social Security Act Amendments of 1994 (Public Law 103-432; 
     108 Stat. 4443).
       (6) Section 4014 of the Balanced Budget Act of 1997 (Public 
     Law 105-33; 111 Stat. 336).
       (7) Section 531 of the Medicare, Medicaid, and SCHIP 
     Balanced Budget Refinement Act of 1999 (Appendix F of Public 
     Law 106-113; 113 Stat. 1501A-388).
       (8) Section 631 of the Medicare, Medicaid, and SCHIP 
     Benefits Improvement and Protection Act of 2000 (Appendix F 
     of Public Law 106-554; 114 Stat. 2763A-566).
                                 ______