[Congressional Record Volume 148, Number 137 (Thursday, October 17, 2002)]
[Senate]
[Pages S10661-S10664]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    ASSISTANCE FOR SOUTH DAKOTA MEDICARE BENEFICIARIES AND PROVIDERS

  Mr. JOHNSON. Mr. President, one of the key remaining issues of the 
107th Congress that I believe must be addressed yet this year is 
Medicare relief for rural health care providers and beneficiaries. 
Recently, bipartisan legislation was introduced, called the Beneficiary 
Access to Care and Medicare Equity Act of 2002, S. 3018, that will 
provide definitive steps to strengthen South Dakota's rural health care 
delivery system. I am pleased to be a cosponsor of this bill.
  The legislation will provide $43 billion over ten years for provider 
and beneficiary improvements in the Medicare and Medicaid programs. 
Earlier

[[Page S10662]]

this summer, the House passed a Medicare bill, which provides 
approximately $30 billion over ten years. The Senate legislation will 
provide South Dakota with nearly $84.2 million in Medicare improvements 
for rural hospitals, skilled nursing facilities, home health services, 
physicians, and beneficiaries alike. Although the Administration has 
expressed some resistance to working with Congress on Medicare 
legislation this year, I will continue to fight for passage of this 
critically important legislation.
  As I travel throughout South Dakota, many health care providers and 
Medicare beneficiaries have expressed concerns regarding inequities 
with Medicare reimbursements in rural states like South Dakota. It is a 
travesty that nationwide, rural providers receive less Medicare 
reimbursement for providing the same services as their urban 
counterparts. Therefore, I remain committed to improving the equity in 
Medicare reimbursement levels for rural States, and increasing access 
to quality, affordable health care for the citizens of South Dakota.
  As a member of the Senate Rural Health Caucus, I joined several of my 
fellow caucus members in sending a letter to the Senate Finance 
Committee expressing our rural health priorities as compiled from the 
input that I received from South Dakotans, such as yourself. I was 
pleased that many of my rural priorities were included in S. 3018, and 
would ask unanimous consent that the text of this letter be printed in 
the Congressional Record. As well, I ask unanimous consent that the 
summary of S. 3018 also be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


                                                  U.S. Senate,

                               Washington, DC, September 16, 2002.
     Hon. Max Baucus, Chairman,
     Hon. Charles Grassley, Ranking Member,
     Committee on Finance,
     Washington, DC.
       Dear Chairman Baucus and Ranking Member Grassley: As 
     members of the Senate Rural Health Caucus, we write to urge 
     you to take definitive steps this year to strengthen our 
     nation's rural health care delivery system. We are 
     particularly concerned about geographic inequities in 
     Medicare spending, which are caused in part by disparities in 
     current Medicare payment formulas. Related to this, we 
     strongly urge the Committee to address needed rural payment 
     improvements in its Medicare refinement bill.
       Nationwide, rural providers receive less Medicare 
     reimbursement for providing the same services as their urban 
     counterparts. According to the latest Medicare figures, 
     Medicare's annual inpatient payments per beneficiary by state 
     of residence range from slightly more than $3,000 in 
     predominately rural states like Wyoming, Idaho and Iowa to 
     over $7,000 in other states.
       This problem is compounded by the fact that rural Medicare 
     beneficiaries tend to be poorer and have more chronic 
     illnesses than urban beneficiaries. This inherent 
     vulnerability of rural providers combined with historic 
     funding shortfalls and rising costs has placed additional 
     burdens on an already strained rural health care system.
       It is due to these unique circumstances that rural 
     providers and beneficiaries deserve to be the Committee's top 
     priority as it writes legislation to strengthen the Medicare 
     system. We encourage the Committee to give special 
     consideration to those states that are experiencing the 
     lowest aggregate negative Medicare margins. We request the 
     following rural specific provisions be included in the 
     Committee's final Medicare provider legislation:

                           1. Rural Hospitals

       Market Basket Update: Under current law, all hospitals will 
     receive a Medicare payment update in FY2003 of hospital cost 
     inflation minus approximately one-half percent. However, 
     hospitals in rural areas and smaller urban areas have 
     Medicare profit margins far lower than those of hospitals in 
     large urban areas. Therefore, we urge the Committee to 
     provide hospitals located in rural or smaller urban areas 
     with a full inflation update.
       Equalize Medicare Disproportionate Share Hospital Payment 
     (DSH) Formula: Hospitals receive add-on payments to help 
     cover the costs of serving a high proportion of uninsured 
     patients. While urban facilities can receive unlimited add-
     ons corresponding with the amount of patients served, rural 
     add-on payments are capped at 5.25 percent of the total 
     amount of the inpatient payment. We urge the Committee to 
     remove this cap for rural hospitals, bringing their payments 
     in line with the benefits urban facilities receive.
       Close Gap Between Urban and Rural ``Standardized Payment'' 
     Levels: Inpatient hospital payments are calculated by 
     multiplying several different factors, including a 
     standardized payment amount. Under current law, hospitals 
     located in cities with more than 1 million people receive a 
     base payment among 1.6 percent higher than those serving 
     smaller populations. We urge the Committee to address this 
     disparity by bringing the rural base payment up to the urban 
     payment level.
       Low-Volume Hospital Payment: According to recent data, the 
     current hospital inpatient payment rate has placed low-volume 
     hospitals at a disadvantage because it does not adequately 
     account for the fact that smaller facilities have difficulty 
     achieving the economies of scale of their larger 
     counterparts. To address this problem, we request the 
     Committee create a low-volume inpatient payment adjustment 
     for hospitals that have less than 1,000 annual discharges per 
     year and are located more than 15 miles from another 
     hospital.
       Outpatient Payment Improvements: Rural Hospitals are highly 
     dependent on outpatient services for revenue; however, the 
     Medicare Outpatient Prospective Payment System sets payments 
     at 16 percent below costs. We urge the Committee to take the 
     following actions to ensure outpatient stability for rural 
     hospitals.
       1. Increase emergency room and APC payments by 10 percent.
       2. Limit the pro rata reduction in pass-through payments to 
     20 percent.
       3. Limit the budget neutrality adjustment to no more than 2 
     percent.
       4. Extend current provision that holds small, rural 
     hospitals harmless from the current Outpatient PPS for three 
     more years.
       5. Improve and extend transitional corridor payments to 
     rural hospitals.
       Wage Index Issues: Medicare's current inpatient hospital 
     payments fail to accurately reflect today's labor costs in 
     rural areas. The Caucus has long been concerned about this 
     issue and its impact on rural hospitals as they strive to 
     recruit and retain key health care personnel. We strongly 
     urge the Committee to address the area wage index disparities 
     with new money.
       Current law allows rural facilities located near urban area 
     to receive the higher wage index available to the facilities 
     located in the metropolitan area. However, this wage index 
     ``reclassification'' is available only for inpatient and 
     outpatient services. We believe re-classification should 
     extend to other services offered by hospitals, such as home 
     care and skilled nursing services.

            2. Critical Access Hospital Program Improvements

       The Balanced Budget Act of 1997 created the Critical Access 
     Hospital program (CAH) to ensure access to essential health 
     services in underserved rural communities that cannot support 
     a full service hospital. This program has proven to be 
     critically important to rural areas as 667 hospitals across 
     the nation have converted to Critical Access Hospital status. 
     We urge the Committee to include the following modifications 
     to strengthen this critical program.
        Reinstate Periodic Interim Payments (PIP), which 
     provide facilities with a steadier stream of payment in order 
     to improve their cash flow.
        Eliminate the current requirement that CAH-based 
     ambulance services be at least 35 miles from another 
     ambulance service in order to receive cost-based payment.
        Allow for home health services operated by CAHs to 
     be reimbursed on a cost basis, as other CAH services already 
     are.
        Provide cost-based reimbursement for certain 
     clinical diagnostic lab tests furnished by a CAH.
        Provide Medicare coverage to CAHs for certain 
     emergency room on-call providers.
        Allow CAHs to interchange the number of their 
     acute and swing beds as necessary, but still maintain the 
     current 25 bed limit.
        Alleviate payment reductions that will occur as a 
     result of recent cost report changes made by CMS related to 
     the amount of allowable beneficiary coinsurance payments.

                   3. Rural Home Health Improvements

       Home health care is a critical element of the continuum of 
     care, allowing Medicare beneficiaries to remain in their 
     homes rather than being hospitalized. Current law provides 
     for a 10 percent payment boost for patients residing in rural 
     areas, to reflect the higher costs due to distance, as well 
     as the reality that there is often only one provider in rural 
     areas. However, this special payment will expire with the 
     current fiscal year.

                        4. Rural Health Clinics

       Under current law, rural health clinics receive an all-
     inclusive payment rate that is capped at approximately $63. 
     Various analyses have suggested that this cap does not 
     appropriately cover the cost of services for more than 50 
     percent of rural health clinics that the cap should be raised 
     by 25 percent to address this shortfall. We request that the 
     Committee raise the rural health clinic cap to $79.
       Certain provider services, such as those offered by 
     physicians, nurse practitioners, physician assistants, and 
     qualified psychologists are excluded from the consolidated 
     payments made to skilled nursing facilities (SNFs) under the 
     prospective payment system. However, the same services 
     provided to SNFs by physicians and other providers employed 
     by rural health clinics are not excluded from the 
     consolidated SNF payment. We request the Committee ensure 
     skilled nursing services offered by rural health clinic 
     providers will receive the same payment treatment as services 
     offered by providers employed in other settings.

                           5. Rural Providers

       Rural Physicians: There are several ways to improve the 
     current Medicare Incentive

[[Page S10663]]

     Payment program to increase payments to rural physicians. 
     Such changes include: placing the burden for determining 
     eligibility for the current 10 percent rural physician bonus 
     payment on the Medicare carrier rather than the individual 
     physician; creating a Medicare Incentive Payment Education 
     program at CMS; and establishing an on-going analysis of the 
     program's ability to improve Medicare beneficiaries' access 
     to physician services. We urge the Committee to make these 
     critical changes to the Medicare Inventive Payment program.
       Mental Health Providers: The majority of rural and frontier 
     areas are federally designated mental health professional 
     shortage areas. In many of these underserved communities, a 
     Marriage and Family Therapist or a Licensed Professional 
     Counselor is the only mental health provider available to 
     seniors, but is not able to bill Medicare for their services. 
     We strongly urge the Committee to provide Medicare 
     reimbursement for Licensed Professional Counselors and 
     Marriage and Family Therapists at the rate that Social 
     Workers are paid.

                         6. Other Rural Issues

       Ambulance Services: The Balanced Budget Act of 1997 
     directed the Secretary of Health and Human services to 
     establish a fee schedule payment system for ambulance 
     services. The negotiated rule making committee that was 
     utilized in the regulatory process instructed the Secretary 
     to account for geographic differences and develop a more 
     appropriate coding system. However, the current ambulance 
     payment system does not recognize the unique circumstances of 
     low-volume, rural providers. We strongly urge the Committee 
     to address these issues to ensure access to critical 
     ambulance services in rural and frontier communities.
       Pathology Labs: Currently, independent labs can bill 
     Medicare directly for all services. After January 1, 2003 
     labs will only be able to bill for diagnosis of slides 
     prepared by the lab. The costs of slide preparation must be 
     recovered separately from the hospital. Small, rural 
     hospitals that do not have their own pathology departments 
     and independent labs face increased administrative costs and 
     complexity in this new billing arrangement. We request that 
     the Committee make permanent the grandfather clause enacted 
     in BIPA to allow independent labs to receive direct 
     reimbursement from Medicare.
       National Health Service Corps Taxation: The National Health 
     Service Corps program (NHSC) provides either scholarships or 
     loan-repayments to clinicians who agree to serve for at least 
     three years in a designated health professional shortage 
     area. Last year's tax cut exempted NHSC scholarships from 
     taxation, but loan-repayments are still considered taxable 
     income. As a result, almost half of the current NHSC 
     appropriation is spent in the form of stipends to clinicians 
     to offset the tax liability on loan repayments. We strongly 
     urge the Committee to exempt the NHSC loan repayments from 
     taxation.
       Flex Reauthorization: As you know, the Balanced Budget Act 
     of 1997 created the Rural Hospital Flexibility program (known 
     as the ``flex'' program) to assist small rural hospitals in 
     making the switch to Critical Access Hospital status (CAH). 
     This program has proven to be very successful in rural areas 
     as it has maintained access to critical care in small 
     communities. Program funds are used by states for Critical 
     Access Hospital designation and assistance, rural health 
     planning and network development, and rural emergency medical 
     services. We urge the Committee to reauthorize this important 
     rural health program.
       We greatly appreciate the Committee's past efforts on 
     behalf of our nation's rural health care delivery system. We 
     look forward to continuing to work with you to ensure that 
     all rural providers receive the necessary resources to 
     provide quality health care services to rural seniors.
           Sincerely,
         Craig Thomas (Co-Chair), Sam Brownback, ----, Byron L. 
           Dorgan, Ben Nelson, ----, Fred H. Thompson, Conrad R. 
           Burns, Jesse Helms, Wayne Allard, Michael Crapo, Chris 
           Bond, James Inhofe, Patrick Leahy, Jeff Sessions, 
           Debbie Stabenow, Paul Wellstone, Mike DeWine, Carl 
           Levin, Ben Nighthorse Campbell, Jean Carnahan.
         Tom Harkin (Co-Chair), Tim Johnson, Jeff Bingaman, Maria 
           Cantwell, Mary Landrieu, Larry Craig, Pat Roberts, John 
           Edwards, Blanche Lincoln, Susan Collins, Patty Murray, 
           Mark Dayton, Gordon Smith, Tom Daschle, Tim Hutchinson, 
           Jim Jeffords, ----, Ernest Hollings, Thad Cochran, Kay 
           Bailey Hutchison, Ron Wyden, Orrin Hatch.
                                  ____


    The Beneficiary Access to Care and Medicare Equality Act of 2002


          total cost over 10 years: approximately $43 billion

       Note: subtotals below do not sum to $42 billion due to Part 
     B premium and Medicaid interactions and rounding. Part B 
     premium and Medicaid interactions total approximately -$2.5 
     billion over 10 years.
     Title I--Rural Health Care Improvements
       (Approx. $12.8 billion over 10 years)
       Sec. 101. Full standardized amount for rural and small 
     urban hospitals by FY04 and thereafter.
       Sec. 102. Wage index changes: labor-related share for 
     hospitals with a wage index below 1.0 is 68% for FY03 through 
     FY05; labor-related share for hospital with a wage index 
     above 1.0 is held harmless (i.e. remains at current level of 
     71%).
       Sec. 103. Medicare disproportionate share (DSH) payments: 
     increases the maximum DSH adjustment for rural hospitals and 
     urban hospitals with under 100 beds to 10% (phased-in over 
     ten years).
       Sec. 104. 1-year extension of hold harmless from outpatient 
     PPS for small rural hospitals.
       Sec. 105. 5% add-on for clinic and ER visits for small 
     rural hospitals.
       Sec. 106. 2-year extension of reasonable cost payments for 
     diagnostic lab tests in Sole Community Hospitals.
       Sec. 107. Critical Access Hospital improvements: (a) 
     Reinstatement of periodic interim payments; (b) Condition for 
     application of special physician payment adjustment; (c) 
     Coverage of costs for certain emergency room on-call 
     providers; (d) Prohibition on retroactive recoupment; (e) 
     Increased flexibility for states with respect to certain 
     frontier critical access hospitals; (f) Permitting hospitals 
     to allocate swing beds and acute care inpatient beds subject 
     to a total limit of 25 beds; (g) Provisions related to 
     certain rural grants; (h) Coordinated survey demonstration 
     program.
       Sec. 108. Temporary relief for certain non-teaching 
     hospital for FY03 through FY05 (same as House-passed 
     provision).
       Sec. 109. Physician work Geographic Practice Cost Index at 
     1.0 for CY03 through CY05, holding harmless those areas with 
     work GPCIs over 1.0.
       Sec. 110. Make existing Medicare Incentive Payment 10% 
     bonus payments on claims by physicians serving patients in 
     rural Health Professional Shortage Areas automatic, rather 
     than requiring special coding on such claims.
       Sec. 111. GAP study on geographic differences in physician 
     payments.
       Sec. 112. Extension of 10% rural add-on for home health 
     through FY04.
       Sec. 113. 10% add-on for frontier hospice for CY03 through 
     CY07.
       Sec. 114. Exclude services provided by Rural Health Clinic-
     based practitioners from Skilled Nursing Facility 
     consolidated billing.
       Sec. 115. Rural Hospital Capital Loan Authorization.
     Title II--Provisions Relating to Part A
       (Approx. $9.0 billion over 10 years)
       Subtitle A--Inpatient Hospital Services
       Sec. 201. FY03 inflation adjustment of market basket minus 
     -0.25% for PPS hospitals; full market basket for Sole 
     Community Hospitals.
       Sec. 202. Update hospital market basket weights more 
     frequently.
       Sec. 203. IME Adjustment: 6.5% in FY03, 6.5% in FY04, 6.0% 
     in FY05.
       Sec. 204. Puerto Rico: 75%-25% Federal-Puerto Rico blend 
     beginning in FY 03.
       Sec. 205. Geriatric GME programs: certain geriatric 
     residents do not count against caps.
       Sec. 206. DSH increase for Pickle hospitals from 35% to 
     40%.
       Subtitle B--Skilled Nursing Facility Services
       Sec. 211. Increase to nursing component of RUGs: 15% in 
     FY03, 13% in FY04, 11% in FY05; increase in payment for AIDS 
     patients cared for by SNFs; GAO study.
       Sec. 212. Require collection of staffing data; require 
     staffing measure in CMS quality initiative.
       Subtitle C--Hospice
       Sec. 221. Allow payment for hospice consultation services 
     based on fee schedule set by Secretary; remove one-time limit 
     set by House.
       Sec. 222. Authorize use of arrangements with other hospice 
     programs.
     Title III--Provisions Relating to Part B
       (Approx. $10.0 billion over 10 years)
       Subtitle A--Physicians' Services
       Sec. 301. Physician payment increase (same as House-passed 
     version); GAO study; MedPAC report.
       Sec. 302. Extension of treatment of certain physician 
     pathology services through FY05.
       Subtitle B--Other Services
       Sec. 311. Competitive bidding for DME: begin national 
     phase-in CY03 for MSAs with over 500,000 people.
       Sec. 312. 2-year extension of moratorium on therapy caps.
       Sec. 313. Acceleration of reduction of beneficiary 
     copayment for hospital outpatient department services.
       Sec. 314. End-Stage Renal Disease: Increase composite rate 
     to 1.2% in CY03 and CY04; composite rate exceptions for 
     pediatric facilities.
       Sec. 315. Improved payment for certain mammography 
     services.
       Sec. 316. Waiver of Part B late enrollment penalty for 
     certain military retirees and special enrollment period.
       Sec. 317. Coverage of cholesterol and blood lipid 
     screening.
       Sec. 318. 5% payment increase for rural ground ambulance 
     service, 2% increase for urban ground ambulance services.
       Sec. 319. Medical necessity criteria for air ambulance 
     services under ambulance fee schedule.
       Sec. 320. Improved payment for thin prep pap tests.
       Sec. 321. Coverage of immunsuppressive drugs.
       Sec. 322. Geriatric care assessment demonstration program.

[[Page S10664]]

       Sec. 323. CMS study and recommendations to Congress on 
     revisions to outpatient payment methodology for drugs, 
     devices and biologicals.
     Title IV--Provisions Relating to Parts A and B
       (Approx. $0.0 billion over 10 years)
       Subtitle A--Home Health Services
       Sec. 401. Eliminate 15% reduction in payments for home 
     health services.
       Sec. 402. Reduce inflation updates in FY03 through FY05; 
     full market basket increases thereafter.
       Subtitle B--Other Provisions
       Sec. 411. Information technology demonstration project.
       Sec. 412. Modifications to the Medicare Payment Advisory 
     Commission.
       Sec. 413. Requires CMS to maintain a carrier medical 
     director and carrier advisory committee in every state to 
     ensure access to the local coverage process.
     Title V--Medicare+Choice and Related Provisions
       (Approx. $2.3 billion over 10 years, including M+C 
           interactions)
       Sec. 501. Increase minimum updates to 4% in CY03 and 3% in 
     CY04.
       Sec. 502. Clarify Secretary's authority to disapprove 
     certain cost-sharing
       Sec. 503. Extend cost contracts for 5 years.
       Sec. 504. Extend the Social HMO Demonstration through 2006.
       Sec. 505. Extend specialized plans for special needs 
     beneficiaries for 5 years (Evercare).
       Sec. 506. Extend 1% entry bonus for M+C for 2 years; bonus 
     does not apply for private fee-for-service or demonstration 
     plans.
       Sec. 507. PACE technical fix regarding services furnished 
     by non-contract providers.
       Sec. 508. Reference to implementation of certain M+C 
     provisions in 2003.
     Title VI--Medicare Appeals, Regulator, and Contracting 
         Improvements
       (Approx. $0.0 billion over 10 years)
       Subtitle A--Regulatory Reform
       Sec. 601. Require status report on interim final rules; 
     limit effectiveness of interim final rules to 12 months with 
     one extension permitted under certain circumstances.
       Sec. 602. Requires only prospective compliance with 
     regulation changes.
       Sec. 603. Secretary report on legal and regulatory 
     inconsistencies in Medicare.
       Subtitle B--Appeals Process Reform
       Sec. 611. Requires Secretary to submit detailed plan for 
     transfer of responsibility for medicare appeals from SSA to 
     HHS; GAO evaluation of plan.
       Sec. 612. Allows expedited access to judicial review for 
     Medicare appeals involving legal issues that the DAB does not 
     have the authority to decide.
       Sec. 613. Allows expedited appeals for certain provider 
     agreement determinations, including terminations.
       Sec. 614. Tightens eligibility requirements for QICs and 
     reviewers; ensures notice and improved explanation on 
     determination and redetermination decisions; delays 
     implementation of Section 521 of BIPA for 14 months, but 
     continues implementation of expedited redeterminations; 
     expands CMS discretion on the number of QICs.
       Sec. 615. Creates hearing rights in cases of denial or 
     nonrenewal of enrollment agreements; requires consultation 
     before CMS changes provider enrollment forms.
       Sec. 616. Permits provider to appeal determinations 
     relating to services rendered to an individual who 
     subsequently dies if there is no other party available to 
     appeal.
       Sec. 617. Permits providers to seek appeal of local 
     coverage decisions and to request development of local 
     coverage decisions under certain circumstances.
       Subtitle C--Contracting Reform
       Sec. 621. Authorizes Medicare contractor reform beginning 
     in October 2004.
       Subtitle D--Education and Outreach Improvements
       Sec. 631. New education and technical assistance 
     requirements.
       Sec. 632. Requires CMS and contractors to provide written 
     responses to health care providers' and beneficiaries' 
     questions with 45 days.
       Sec. 633. Suspends penalties and interest payments for 
     providers that have followed incorrect guidance.
       Sec. 634. Creates new ombudsmen offices for health care 
     providers and beneficiaries.
       Sec. 635. Authorizes beneficiary outreach demonstration.
       Subtitle E--Review, Recovery, and Enforcement Reform
       Sec. 641. Requires CMS to establish standards for random 
     prepayment audits.
       Sec. 642. Requires CMS to enter into overpayment repayment 
     plans. Prevents CMS from recovering overpayments until the 
     second level of appeal is exhausted.
       Sec. 643. Establishes a process for the correction of 
     incomplete or missing data without pursuing the appeals 
     process.
       Sec. 644. Expands the current waiver of program exclusions 
     in cases where the provider is a sole community physician or 
     sole source of essential health care.
     Title VII--Medicaid-SCHIP
       (Approx. $10.8 billion over 10 years)
       Sec. 701. Extend Medicaid disproportionate share hospital 
     (DSH) inflation updates (for 2001 and 2002) to 2003, 2004 and 
     2005 allotments; update District of Columbia DSH allotment.
       Sec. 702. Raise cap from 1% to 3% for states classified as 
     low Medicaid DSH in FY03 through FY05.
       Sec. 703. Five year extension of QI-1 Program.
       Sec. 704. Enable public safety net hospitals to access 
     discount drug pricing for inpatient drugs.
       Sec. 705. CHIP Redistribution: give states an additional 
     year to spend expiring funds that would otherwise return to 
     the Treasury; continue BIPA arrangement for SCHIP 
     redistribution; establish caseload stabilization pool 
     beginning in FY04; allow certain states to use a portion of 
     unspent SCHIP funds to cover specified Medicaid 
     beneficiaries; GAO study to evaluate program implementation 
     and funding.
       Sec. 706. Improvements to Section 1115 waiver process for 
     Medicaid and State Children's Health Insurance Program 
     (SCHIP) waiver.
       Sec. 707. Increase the federal medical assistance 
     percentage in Medicaid (FMAP) by 1.3% for 12 months for all 
     states; ``hold harmless'' states scheduled to have a lower 
     FMAP in FY03; $1 billion increase in Social Services Block 
     Grant for FY03.
     Title VIII--Other Provisions
       (Approx. $0.9 billion over 10 years)
       Sec. 801. Extend funding for Special Diabetes Programs for 
     FY04, FY05, and FY06 at $150 million per program per year.
       Sec. 802. Disregard of certain payments under the Emergency 
     Supplemental Act, 2000 in the administration of Federal 
     programs and federally assisted programs.
       Sec. 803. Create Safety Net Organizations and Patient 
     Advisory Commission.
       Sec. 804. Guidance on prohibitions against discrimination 
     by national origin.
       Sec. 805. Extend grants to hospitals for EMTALA treatment 
     of undocumented aliens.
       Sec. 806. Extend Medicare Municipal Health Services 
     Demonstration for 1 year.
       Sec. 807. Provides for delayed implementation of certain 
     provisions.

                          ____________________