[Congressional Record Volume 149, Number 67 (Wednesday, May 7, 2003)]
[Senate]
[Pages S5860-S5877]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. CAMPBELL:

[[Page S5861]]

  S. 1008. A bill to provide for the establishment of summer health 
career introductory programs for middle and high school students; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. CAMPBELL. Mr. President, today I am introducing legislation aimed 
at addressing the long term shortage of workers in our health care 
system.
  In recent months, America's health care workforce shortage has made 
headline news. While most of the stories have focused on the lack of 
nurses, the shortage of health care professionals also includes 
radiology technicians, respiratory therapists, clinical laboratory 
scientists, imaging technologists, rehabilitation professionals, 
pharmacists and others.
  This shortage is different than the one hospitals have experienced in 
the past because it is only the prelude to a long-term shortage of 
crisis proportions. The demand for health care is increasing as 
Americans are living longer than previous generations, and advances in 
medicine have let more people live with chronic and age-related 
diseases. With the demand for hospital services increasing because of a 
growing and aging population, the workforce shortages present our 
Nation with a potential health care crisis. I believe we must do 
something to change this disturbing trend.
  In my State of Colorado, a task force made up of community colleges, 
universities, corporations, hospitals, social services and interested 
community activists has been convened to actively find solutions for 
the workforce shortages. One of the proposals would be to hold a health 
career summer youth camp under the title, Gee Whiz Jobs, where young 
people would be introduced to a full range of career possibilities in 
the health care field. I believe this idea and their program can become 
a model for other such programs throughout the country.
  The legislation I am introducing today attempts to build on the 
career camp idea. It authorizes the Secretary of Health and Human 
Services to make demonstration grants to accredited universities and/or 
community colleges to establish summer health career introductory 
programs for middle school and high school students.
  Many students are not prepared in the necessary levels of math, 
science and reading to enter health education programs directly out of 
high school. Many others have never been exposed to health careers and 
do not even consider them as a possibility. And, a significant number 
have little knowledge of the range of career possibilities or what the 
working environments may be like. Summer school exposure to health 
careers which allows young people to visit hospitals, doctors' offices, 
emergency rooms, and community health clinics and witness professionals 
at work in providing health care services may be just what they need to 
guide them into a health career.
  I believe that we must broaden the base of health care workers by 
designing strategies that attract and retain a diverse workforce. We 
must collaborate with others--hospitals, health care and professional 
associations, educational institutions, corporations, philanthropic 
organizations, and government to attract new entrants to the health 
professions. And, we must begin these efforts early in the lives of our 
young people.
  It is going to take all of us--educators, government and community 
officials, hospital leaders, health care workers, and the public--
working together to meet the challenge facing our health care system 
today. That is why I urge my colleagues to act quickly on this 
legislation. Let's begin to aggressively address the health care worker 
shortage in a way that will carry us into the future.
  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. 1008

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

     SECTION 1. SUMMER HEALTH CAREER INTRODUCTORY PROGRAMS.

       (a) Findings.--Congress finds that--
       (1) the success of the health care system is dependent on 
     qualified personnel;
       (2) hospitals and health facilities across the United 
     States have been deeply impacted by declines among nurses, 
     pharmacists, radiology and laboratory technicians, and other 
     workers;
       (3) the health care workforce shortage is not a short term 
     problem and such workforce shortages can be expected for many 
     years; and
       (4) most States are looking for ways to address such 
     shortages.
       (b) Grants.--The Secretary of Health and Human Services, 
     acting through the Bureau of Health Professions of the Health 
     Resources and Services Administration, may award not to 
     exceed 5 grants for the establishment of summer health career 
     introductory programs for middle and high school students.
       (c) Eligibility.--To be eligible to receive a grant under 
     subsection (b) an entity shall--
       (1) be an institution of higher education (as defined in 
     section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 
     1001(a)); and
       (2) prepare and submit to the Secretary of Health and Human 
     Services an application at such time, in such manner, and 
     containing such information as the Secretary may require.
       (d) Duration.--The term of a grant under subsection (b) 
     shall not exceed 4 years.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2004 through 2007.
                                 ______
                                 

  By Mr. HARKIN (for himself, Mr. Specter, and Mr. Kennedy):
  S. 1010. A bill to enhance and further research into paralysis and to 
improve rehabilitation and the quality of life for persons living with 
paralysis and other physical disabilities; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. HARKIN. Mr. President, I am pleased to be joined by Senators 
Specter and Kennedy today in re-introducing legislation that will give 
new hope to Americans with paralysis.
  Recent news reports about the medical miracle Christopher Reeve has 
experienced over the two past years is an inspiration for every 
American living with paralysis as a result of a spinal cord injury. 
When it was announced that, for the first time since his accident in 
1995, Chris regained sensation and movement in parts of his body, 
providing inspiration for some of the two million Americans with 
paralysis. Most recently, Chris has started weaning himself from a 
ventilator, breathing on his own for the first time since his accident.
  Today, through the Christopher Reeve Paralysis Act of 2003, we seek 
to achieve two primary goals. First, to further advance the science 
needed to promote spinal regeneration. And second, to build quality of 
life programs throughout the country that will further advance full 
participation, independent living, self-sufficiency and equality of 
opportunity for individuals with paralysis and other physical 
disabilities.
  Chris' recovery and recent scientific evidence show that progress is 
possible. At research centers in the United States, Europe and Japan, 
techniques of rigorous exercise have helped numerous persons with 
paraplegia with limited sensations in their lower bodies walk for short 
distances, unassisted or using walkers.
  While the results of these new methods are quite promising, the 
limits of what physical exercise can do for patients remains grossly 
understudied. While each person and each injury is unique, and some 
people recover spontaneously, an estimated 250,000 Americans are living 
with spinal cord injuries that have not improved. Which therapy or 
combination of therapies will work for each person is unknown. Today 
two million Americans are living with paralysis, including spinal cord 
injury, stroke, cerebral palsy, multiple sclerosis, ALS and spina 
bifida. We need research to see how these new interventions work on the 
entire population of individuals with paralysis.
  What we do know is the ordinary repetitive motions used in most 
rehabilitation centers, like squeezing a ball, are almost certainly not 
enough to appropriately address neurological injuries.
  Patients are usually told that after one year, two at the most, they 
will never make further progress in their abilities to move or feel 
sensation. Yet eight years after his accident, through a rigorous 
exercise plan, Chris is finally seeing results.
  Due to efforts led by the National Institutes of Health and the 
Christopher Reeve Paralysis Foundation, our Nation stands on the brink 
of amazing

[[Page S5862]]

breakthroughs in science for those with paralysis. However, the biotech 
and pharmaceutical industries have not invested in paralysis research 
because they believe the market does not support the private 
investment. There is an urgent need for the Federal Government to 
further step up its commitment in this area. The Christopher Reeve 
Paralysis Act would do just that.
  By establishing Paralysis Research Consortia at the National 
Institute of Neurological Disorders and Stroke, we can substantially 
increase our ability to capitalize on research advances in paralysis. 
These consortia would be formed to explore unique scientific expertise 
and focus across the existing research centers at NINDS in an effort to 
further advance treatments, therapies and developments on one or more 
forms of paralysis that result from central nervous system trauma and 
stroke.

  Additional breakthroughs are underway in rehabilitation research on 
paralysis. Federal funding for rehabilitation research at the National 
Center for Medical Rehabilitation Research at NIH is showing real 
potential to improve functional mobility; prevent secondary 
complications like bladder and urinary tract infections and ulcers; and 
to develop improved assistive technology. These rehabilitation 
interventions have the potential to greatly reduce pain and other 
complications for people with neurological disorders and stroke and, at 
the same time, save millions in health care costs.
  Over the past 20 years, overall days in the hospital and 
rehabilitation center for those with paralysis have been cut in half. 
Those with paralysis face astronomical medical costs, and our best 
estimates tell us that only one-third of those individuals remain 
employed after paralysis. At least one-third of those with paralysis 
have incomes of $15,000 or less.
  To date, there are no State-based programs at CDC that address 
paralysis and other physical disability with the goal of improving 
health outcomes and prevent secondary complications. This bill will, 
for the first time, ensure that individuals with paralysis get the 
information they need; have access to public health programs; and 
support in their communities to navigate services. Ultimately these 
programs will help remove the barriers to community participation and 
help improve quality of life. The bill also establishes hospital-based 
registries on paralysis to collect needed data on the true numbers of 
individuals with these conditions, and it invests in population-based 
research to see how various therapies impact different people.
  We are on the brink of major breakthroughs for individuals with 
neurological disorders and stroke that result in paralysis. This bill 
will ensure that the federal government does its part to help more than 
2 million Americans.
  When Christopher Reeve was injured, he put a face on an issue that 
has been neglected for too long. Since then, his tireless efforts to 
walk again, coupled with his passion and commitment to improve quality 
of life for others with paralysis, make him an inspiration to all 
Americans.
  It is a pleasure and an honor to lead a bipartisan group of Senators, 
along with the support of a number of disability groups, including the 
American Stroke Association, the American Heart Association, the 
Christopher Reeve Paralysis Foundation, the National Family Caregivers 
Association, the National Spinal Cord Injury Association, Paralyzed 
Veterans of America and Easter Paralyzed Veterans, in introducing this 
bill.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Mr. Corzine, Mrs. Clinton, Mr. 
        Kerry, Mr. Lautenberg, Mr. Dayton, and Mr. Johnson):
  S. 1012. A bill to amend title XIX of the Social Security Act to 
provide fiscal relief and program simplification to States, to improve 
coverage and services to medicaid beneficiaries, and for other 
purposes; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, our Nation's States and health safety 
net are simultaneously facing a crisis. According to State budget 
officers, the states are facing a nearly $30 billion budget shortfall 
this year and an $80 billion gap in fiscal year 2004 due to the 
economic recession. At the same time, it is estimated that the number 
of uninsured increased from 41 to 45 million this past year. And, due 
to the State budget shortfalls, the numbers of uninsured may increase 
even further.
  In fact, the lead paragraph in the New York Times in an article 
entitled ``Cutbacks Imperil Health Coverage for States' Poor'' on April 
28, 2003, reads, ``Millions of low-income Americans face the loss of 
health insurance or sharp cuts in benefits, like coverage for 
prescription drugs and dental care, under proposals now moving through 
state legislatures around the country.''
  The article continues, ``State officials and health policy experts 
say the cuts will increase the number of uninsured, threaten recent 
progress in covering children and impose severe strains on hospitals, 
doctors and nursing homes.''
  As a result, I believe the Federal Government should take immediate 
steps to fundamentally reassert and reassert its role in helping the 
States with this fiscal crisis and rising Medicaid costs, lowering the 
number of uninsured, and finally, confronting infant and maternal 
mortality and morbidity statistics that are unworthy of our great 
Nation.
  To address these issues, today and tomorrow, I will be introducing 
three relevant bills. The first addresses the fiscal crisis confronting 
States and the Medicaid program entitled ``Strengthening Our States,'' 
or the ``SOS Act.''
  The second addresses our Nation's long-standing and growing crisis of 
the uninsured that is entitled the ``Health Coverage, Affordability, 
Responsibility, and Equity Act'' or the ``Health CARE Act.''
  The final bill takes on our Nation's high infant and mortality rates 
and is called the ``Start Healthy, Stay Health Act.''
  First things first. In any campaign--whether in sports, business, or 
politics--you have to have both offensive and defensive strategies. In 
trying to reduce the number of uninsured in our country, we must first, 
as an emergency room doctor would, stop the bleeding. Therefore, our 
first priority should be to support and strengthen the Medicaid 
program.
  Unfortunately, the Center on Budget and Policy Priorities estimated 
in March that as many as 1.7 million Americans could lose coverage 
altogether under proposals advanced by governors or adopted by State 
legislative committees this year.
  Therefore, I am introducing today with Senators Corzine, Clinton, 
Kerry, Lautenberg, Dayton, and Johnson legislation entitled the 
``Strengthening Our States Act of 2003.'' This bill is a companion bill 
to that being introduced by Representative Dingell, Brown of Ohio, 
Waxman, and others and is aimed at improving Medicaid and providing 
support to States to enhance their ability to provide coverage to their 
uninsured residents in these difficult times.
  The SOS Act uses a combination of approaches which: first, provide 
additional Federal fiscal relief to States; second, provide additional 
flexibility to States in administering and improving the Medicaid 
program; and third, provide incentives and assistance to stave off cuts 
to existing coverage, and facilitate coverage expansions in the future.
  The legislation will simplify Medicaid and enable States to 
strengthen the program and stands in sharp contrast to the President's 
proposal to convert Medicaid into a block grant that would erode health 
insurance coverage.
  In fact, the Administration's prescription is the wrong medicine for 
the wrong ailment. The Federal Government should be stepping up its 
commitment to seniors, people with disabilities, and low-income 
children rather than stepping away and leaving States holding the bag.
  First and foremost, our legislation acknowledges and reflects on the 
important role that Medicaid plays in our entire health care system. As 
Diane Rowland and Jim Tallon of the Kaiser Commission on Medicaid and 
the Uninsured have noted: ``. . . it is hard to envision our health 
system and society without a program like Medicaid. Medicaid is the 
glue that helps hold our health system together and takes on the 
highest-risk, sickest, and most expensive populations from private 
insurance and Medicare. For low-income Medicare beneficiaries, Medicaid 
picks

[[Page S5863]]

up Medicare premiums and some cost sharing as well as filling the gaps 
in coverage for long-term care services, prescription drugs, and vision 
and dental care.''
  Medicaid addresses the failure of the marketplace to deliver 
affordable health coverage to our Nation's most fragile and vulnerable 
citizens. However, there is no reason why it should also have to play 
the role of picking up the slack of the Medicare program. A central 
tenet of our SOS proposal is for the Federal Government to begin taking 
the steps to assume 100 percent of the costs associated with care and 
services in Medicaid for Medicare beneficiaries, also known as dual 
eligibles.
  This, I would add, is in keeping with long-standing policy of the 
National Governors' Association, or NGA, and is in sharp contrast to 
the Administration's proposal to maintain the current Medicaid 
financing system for mandatory populations and services while block 
granting care of optional populations and services to States. Who are 
these optional populations? They are largely the elderly and people 
with disabilities, many of whom are dually eligible for Medicare and 
Medicaid.

  According to the Kaiser Commission on Medicaid and the Uninsured, 83 
percent of all Medicaid spending on the elderly is for either optional 
populations or services, such as prescription drugs and long-term care. 
In fact, according to Cindy Mann of Georgetown University and a former 
Medicaid director under the Clinton Administration, an estimated 35 
percent of all State Medicaid costs are for so-called ``dual 
eligibles.''
  Therefore, rather than stepping up to the plate, the Administration 
is instead stepping away from its commitment to the elderly and 
disabled, which should be our responsibility at the Federal level, by 
moving these groups and their health care services into a block grant. 
Groups representing the elderly and disabled communities have already 
spoken out against this.
  As AARP Executive Director and CEO Bill Novelli says, ``This 
[Administration's block grant] proposal handcuffs states because it 
leaves people more vulnerable in future years as States struggle to 
meet increased needs with decreased dollars.''
  The Consortium for Citizens with Disabilities adds, ``The Bush 
Administration proposal fails people with disabilities and dishonors 
the Nation's commitment to its residents--it is not in the national 
interest. . . . What the Medicaid program calls `optional' services 
are, in reality, mandatory disability services for the children and 
adults who need them. These services often are not only life-saving, 
but also the key to a positive quality of life--something everyone in 
our nation deserves.''
  Again, the Federal Government should be stepping up its commitment to 
seniors and people with disabilities rather than stepping away, as the 
President's proposal does.
  With respect to the fiscal crisis facing states, the Administration 
has long opposed fiscal relief to States as part of its economic 
stimulus package. Instead, the Administration points out that its 
Medicaid block grant proposal provides more funding up front to States, 
in the amount of $3.5 billion over one year and $12.7 billion over the 
first seven years to help States. But the proposal has strong elements 
of a typical bait and switch by yanking every dime of that money away 
starting in 2011. Secretary Thompson noted at the press conference that 
he would not be around at the time of the $12.7 billion in reductions 
eight years from now and the plan clearly counts on the fact that most 
of this crop of governors would not be either.
  However, that is exactly when our Nation's baby boomers hit 
retirement age in rapidly increasing numbers and the long term care 
costs within Medicaid will significantly increase.
  In sharp contrast, the SOS Act includes a temporary increase in the 
Federal matching assistance percentage, or FMAP, to state Medicaid 
programs in the amount of $15 billion and another $15 billion in 
additional aid to States--far more than the temporary $3 billion 
offered by the Administration.
  Also, unlike a block grant, the current Medicaid matching rate is 
responsive to States in times of recessions by providing Federal 
matching funds to States for each additional person who becomes 
eligible for Medicaid. Moreover, our SOS Act recognizes the formula can 
be even more responsive by preserving coverage during difficult times 
and includes a General Accounting Office study of ways to make the 
formula more responsive to fiscal distress during either a national or 
State recession.
  In addition, the Strengthening Our States Act would increase Federal 
payments for certain services critical for special populations or 
federally-imposed services. It would provide enhanced Federal funding 
for urban Indian health services, translation services, outstationed 
workers, and reimbursement to health providers for emergency services 
delivered undocumented individuals who are otherwise eligible for 
Medicaid. Again, the Administration's proposal simply block grants 
funding for these services and steps away from its Federal 
responsibility.
  For example, services delivered to Native Americans by Indian Health 
Service providers and health organizations are reimbursed at 100 
percent federal match currently in recognition of the Federal 
responsibility and role in delivering services to Native Americans 
apart from States. Under a block grant, the Federal match is eliminated 
and the Federal role in providing care to Native Americans is 
abandoned. This is contrary to longstanding Federal policy and its 
relationship with tribes and tribal organizations and to policy by the 
National Governors' Association.
  And finally, with respect to giving States flexibility and assistance 
to expand upon existing coverage options, the Strengthening Our States 
Act is far better and responsive to states than a block grant. Block 
grants do not adjust for population changes, recessions, or efforts to 
expand coverage by States. At its unveiling, Secretary Thompson spoke 
about the added options the block grants offer States to expand 
coverage. However, it does so with no new funding. This offer of 
flexibility is, therefore, illusory.
  In fact, because Federal funding is capped for optional opulations by 
the Administration's block grant, states cannot draw down additional 
Federal support when it chooses to expand coverage. Under current law 
and the SOS Act, they can. Some of the more ground-breaking efforts by 
states such as those by Vermont, Washington, Minnesota, Rhode Island, 
Hawaii, and even Wisconsin, would have likely never come to pass 
without that added Federal support.
  Therefore, the SOS Act continues and expands upon that Federal 
support by giving States additional coverage options, such as to set 
uniform eligibility levels for families rather than covering parents 
and children separately. The SOS Act also would make States eligible 
for enhanced matching funds to cover low-income working parents under 
Medicaid.
  States should also beware of the Administration's promise of 9 
percent growth rates for the next 10 years. Earlier this year, the 
House of Representatives passed a budget that would have reduced 
Medicaid spending by $92 billion over 10 years. While that was rejected 
in conference, such efforts become much easier under the rubric of a 
block grant. Again, recent history contains many such promises and 
examples.
  For example, as the NGA policy on the Social Service Block Grant 
notes, during passage of TANF, ``Congress and the Administration made a 
commitment to Governors to fund SSBG at $2.38 billion each year through 
fiscal year 2002, with the funding increasing to $2.8 billion in fiscal 
2003 and each year thereafter.'' The reality is that funding has been 
reduced to $1.7 billion in fiscal years 2002 and 2003, 65 percent below 
the promised funding levels.
  There is an old saying, which goes, ``Fool me once, shame on you. 
Fool me twice, shame on me.'' When members of Congress and future 
Administrations see 9 percent growth rates in these Medicaid block 
grants and have a particular tax cut, Medicare change, transportation 
program, or whatever they wish to fund, you can already hear them 
saying, ``What if we just reduce the growth rates to 8 percent or 7 
percent or 6 percent or 5 percent. . . .'' Well, we all can see where 
this rapidly heads and we have all been fooled once before.

[[Page S5864]]

  Some governors, including Secretary Thompson, seem to have a short 
memory on these matters. On April 14, 1997, 41 Governors, including 
Secretary Thompson, Bush Administration Cabinet Members Tom Ridge, and 
Christine Todd Whitman, wrote President Clinton, and said: ``We 
adamantly oppose a cap on federal Medicaid spending in any form. 
Unilateral caps in federal Medicaid spending will result in cost shifts 
to states, enabling the federal government to balance its budget at the 
expense of the states.''
  What was true then remains true 6 years later.
  Moreover, on behalf of the NGA, Governors Bob Miller of Nevada and 
Mike Leavitt testified before the Senate Finance Committee and made the 
following statement: ``. . . caps could result in states becoming 
solely responsible for unexpected program costs, such as a loss in a 
lawsuit on reimbursement rates or the development of expensive new 
therapies that drive up treatment costs beyond the federal allowable 
rate.
  They added: ``. . . the cost shift resulting from a unilateral cap 
would present states with a number of bad alternatives. States 
essentially would have to choose between cutting back on payment rates 
to providers, eliminating optional benefits provided to recipients, 
ending coverage for optional beneficiaries, or coming up with 
additional state funds to absorb 100 percent of the cost of services.''
  I do not see why this needs to be an all-or-nothing proposition. Why 
do we have to throw out the entire Medicaid financing structure, which 
benefits States, beneficiaries, and providers, in order to grant States 
additional flexibility to their programs?
  In 1997, we rejected the all-or-nothing proposal and worked with the 
States and gave them a package of added flexibility, including the 
ability to enroll much of their Medicaid population in managed care 
without the need for a waiver.
  Secretary Thompson talks a great deal about the flexibility the block 
grant offers and cites the need to allow States the ability to move 
people out of institutional settings into more appropriate home- and 
community-based settings and is right. Under the block grant, States 
are only granted additional flexibility to do so if they accept a block 
grant. In contrast, the SOS Act provides States an enhanced Federal 
matching rate to provide home- and community-based services.
  However, rather than saying to States that they can only do so 
through the acceptance of a block grant, why can't we provide them this 
option without the imposition of a Federal limit on funding? Both 
states and beneficiary groups are asking for it and we can and should 
act.
  It is on this point that I must add that the Medicaid program was not 
created for Federal officials or governors. We all clearly need to be 
reminded that there are other stakeholders in the Medicaid program, 
including the 43 million people served by the program.
  As Alan Weil of the Urban institute and the former Medicaid director 
of the State of Colorado wrote in a recent article published in Health 
Affairs: ``If money is at the heart of debates over Medicaid, the 
millions of indigent people whose varied and complex medical needs are 
met by the program are its sole. The amount of human suffering the 
program alleviates is immense.''
  As the Administration attempts to proceed on negotiations with the 
governors on a deal on block grants, let's not forget the children, 
mothers, seniors, and people with disabilities served by Medicaid. The 
SOS Act provides a far better alternative.
  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. 1012

       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 
     ``Strengthening Our States Act of 2003'' or the ``SOS Act of 
     2003''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:
Sec. 1. Short title; table of contents.

      TITLE I--STRENGTHENING FEDERAL RESPONSIBILITY FOR MEDICARE 
                             BENEFICIARIES

Sec. 101. Assuming Federal responsibility for all medicare cost-
              sharing.
Sec. 102. Expanded protections for low income medicare beneficiaries.

                TITLE II--PROVIDING STATES FISCAL RELIEF

Sec. 201. Temporary increase of medicaid FMAP.
Sec. 202. Temporary grants for State fiscal relief.
Sec. 203. Increasing medicaid DSH allotments.
Sec. 204. Increased State access to unspent SCHIP funds.
Sec. 205. Federal responsibility for emergency care for illegal 
              immigrants.
Sec. 206. Increased Federal responsibility for translation services.
Sec. 207. Increased Federal matching rates for certain services.

  TITLE III--HELPING STATES WITH COMMITMENT TO ELDERLY AND DISABLED; 
                         FAMILY OPPORTUNITY ACT

           Subtitle A--Elderly and Persons with Disabilities

Sec. 301. Full accounting of savings in determining cost-effectiveness.
Sec. 302. Extension of medicaid coverage under the ticket to work 
              program to cover spouses.
Sec. 303. Encouraging transition to home and community care.
Sec. 304. Enhanced matching rate for disabled individuals awaiting 
              medicare eligibility.
Sec. 305. Providing initial term of 5 years for section 1915 waivers.
Sec. 306. Optional coverage of community-based attendant services and 
              supports under the medicaid program.

                   Subtitle B--Family Opportunity Act

Sec. 311. Short title.
Sec. 312. Opportunity for families of disabled children to purchase 
              medicaid coverage for such children.
Sec. 313. Treatment of inpatient psychiatric hospital services for 
              individuals under age 21 in home or community-based 
              services waivers.
Sec. 314. Demonstration of coverage under the medicaid program of 
              children with potentially severe disabilities.
Sec. 315. Development and support of family-to-family health 
              information centers.
Sec. 316. Restoration of medicaid eligibility for certain SSI 
              beneficiaries.

 TITLE IV--FACILITATING PROGRAM ADMINISTRATION AND PRESERVING COVERAGE

Sec. 401. Allowing uniform coverage of all low income Americans.
Sec. 402. Facilitating coverage of families.
Sec. 403. Assistance with coverage of legal immigrants under the 
              medicaid program and SCHIP.
Sec. 404. Flexibility in eligibility determinations.

      TITLE I--STRENGTHENING FEDERAL RESPONSIBILITY FOR MEDICARE 
                             BENEFICIARIES

     SEC. 101. ASSUMING FEDERAL RESPONSIBILITY FOR ALL MEDICARE 
                   COST-SHARING.

       (a) In General.--Section 1905(b) of the Social Security Act 
     (42 U.S.C. 1396d(b)) is amended--
       (1) by striking ``and'' before ``(4)''; and
       (2) by inserting before the period the following: ``, and 
     (5) the Federal medical assistance percentage shall be 100 
     percent with respect to medical assistance provided with 
     costs described in section 1905(p)(3)''.
       (b) Conforming Amendment.--Section 1902 of such Act (42 
     U.S.C. 1396a) is amended by striking subsection (n).
       (c) Effective Date.--The amendments made by this section 
     shall apply to medical assistance for medicare cost-sharing 
     for months beginning with July 2003.

     SEC. 102. EXPANDED PROTECTIONS FOR LOW INCOME MEDICARE 
                   BENEFICIARIES.

       (a) In General.--Section 1902(a)(10)(E) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended--
       (1) by adding ``and'' at the end of clause (ii);
       (2) in clause (iii), by striking ``110 percent in 1993 and 
     1994, and 120 percent in 1995 and years'' and inserting ``135 
     percent''; and
       (3) by striking clause (iv).
       (b) Conforming Amendment.--Section 1933 of such Act (42 
     U.S.C. 1396v) is repealed.
       (c) Effective Date.--The amendments made by subsection (a), 
     and the repeal made by subsection (b), shall apply to months 
     after September 2003.

                TITLE II--PROVIDING STATES FISCAL RELIEF

     SEC. 201. TEMPORARY INCREASE OF MEDICAID FMAP.

       (a) Permitting Maintenance of Fiscal Year 2002 FMAP for 
     Last 2 Calendar Quarters of Fiscal Year 2003.--
     Notwithstanding any other provision of law, but subject to 
     subsection (e), if the FMAP determined without regard to this 
     section for a State for fiscal year 2003 is less than the 
     FMAP as so determined for fiscal year 2002, the FMAP for the 
     State for fiscal year 2002 shall be substituted for the 
     State's FMAP for the third and fourth calendar quarters of 
     fiscal year 2003, before the application of this section.
       (b) Permitting Maintenance of Fiscal Year 2003 FMAP for 
     Fiscal Year 2004.--

[[Page S5865]]

     Notwithstanding any other provision of law, but subject to 
     subsection (e), if the FMAP determined without regard to this 
     section for a State for fiscal year 2004 is less than the 
     FMAP as so determined for fiscal year 2003, the FMAP for the 
     State for fiscal year 2003 shall be substituted for the 
     State's FMAP for each calendar quarter of fiscal year 2004, 
     before the application of this section.
       (c) General 3.73 Percentage Points Increase for Last 2 
     Calendar Quarters of Fiscal Year 2003 and Fiscal Year 2004.--
     Notwithstanding any other provision of law, but subject to 
     subsections (e) and (f), for each State for the third and 
     fourth calendar quarters of fiscal year 2003 and each 
     calendar quarter of fiscal year 2004, the FMAP (taking into 
     account the application of subsections (a) and (b)) shall be 
     increased by 3.73 percentage points.
       (d) Increase in Cap on Medicaid Payments to Territories.--
     Notwithstanding any other provision of law, but subject to 
     subsection (f), with respect to the third and fourth calendar 
     quarters of fiscal year 2003 and each calendar quarter of 
     fiscal year 2004, the amounts otherwise determined for Puerto 
     Rico, the Virgin Islands, Guam, the Northern Mariana Islands, 
     and American Samoa under subsections (f) and (g) of section 
     1108 of the Social Security Act (42 U.S.C. 1308) shall each 
     be increased by an amount equal to 7.46 percent of such 
     amounts.
       (e) Scope of Application.--The increases in the FMAP for a 
     State under this section shall apply only for purposes of 
     title XIX of the Social Security Act and shall not apply with 
     respect to--
       (1) disproportionate share hospital payments described in 
     section 1923 of such Act (42 U.S.C. 1396r-4); or
       (2) payments under title IV or XXI of such Act (42 U.S.C. 
     601 et seq. and 1397aa et seq.).
       (f) State Eligibility.--
       (1) In general.--Subject to paragraph (2), a State is 
     eligible for an increase in its FMAP under subsection (c) or 
     an increase in a cap amount under subsection (d) only if the 
     eligibility under its State plan under title XIX of the 
     Social Security Act (including any waiver under such title or 
     under section 1115 of such Act (42 U.S.C. 1315)) is no more 
     restrictive than the eligibility under such plan (or waiver) 
     as in effect on September 2, 2003.
       (2) State reinstatement of eligibility permitted.--A State 
     that has restricted eligibility under its State plan under 
     title XIX of the Social Security Act (including any waiver 
     under such title or under section 1115 of such Act (42 U.S.C. 
     1315)) after September 2, 2003, but prior to the date of 
     enactment of this Act is eligible for an increase in its FMAP 
     under subsection (c) or an increase in a cap amount under 
     subsection (d) in the first calendar quarter (and subsequent 
     calendar quarters) in which the State has reinstated 
     eligibility that is no more restrictive than the eligibility 
     under such plan (or waiver) as in effect on September 2, 
     2003.
       (3) Rule of construction.--Nothing in paragraph (1) or (2) 
     shall be construed as affecting a State's flexibility with 
     respect to benefits offered under the State medicaid program 
     under title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.) (including any waiver under such title or under section 
     1115 of such Act (42 U.S.C. 1315)).
       (g) Definitions.--In this section:
       (1) FMAP.--The term ``FMAP'' means the Federal medical 
     assistance percentage, as defined in section 1905(b) of the 
     Social Security Act (42 U.S.C. 1396d(b)).
       (2) State.--The term ``State'' has the meaning given such 
     term for purposes of title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.).
       (h) Repeal.--Effective as of October 1, 2004, this section 
     is repealed.

     SEC. 202. TEMPORARY GRANTS FOR STATE FISCAL RELIEF.

       (a) In General.--Title XX of the Social Security Act (42 
     U.S.C. 1397-1397f) is amended by adding at the end the 
     following:

     ``SEC. 2008. ADDITIONAL TEMPORARY GRANTS FOR STATE FISCAL 
                   RELIEF.

       ``(a) In General.--For the purpose of providing State 
     fiscal relief allotments to States under this section, there 
     are hereby appropriated, out of any funds in the Treasury not 
     otherwise appropriated, $15,000,000,000. Such funds shall be 
     available for obligation by the State through June 30, 2005, 
     and for expenditure by the State through September 30, 2005. 
     This section constitutes budget authority in advance of 
     appropriations Acts and represents the obligation of the 
     Federal Government to provide for the payment to States of 
     amounts provided under this section.
       ``(b) Allotment.--Funds appropriated under subsection (a) 
     shall be allotted by the Secretary among the States in 
     accordance with the following table:

       

------------------------------------------------------------------------
               ``State                       Allotment (in dollars)
------------------------------------------------------------------------
 Alabama                                $170,940,139
 Alaska                                 $42,076,374
 Amer. Samoa                            $414,007
 Arizona                                $261,264,449
 Arkansas                               $133,398,723
 California                             $1,583,851,051
 Colorado                               $143,030,332
 Connecticut                            $207,204,156
 Delaware                               $38,537,434
 District of Columbia                   $65,034,813
 Florida                                $624,655,953
 Georgia                                $368,582,068
 Guam                                   $669,845
 Hawaii                                 $46,337,939
 Idaho                                  $48,659,904
 Illinois                               $543,631,283
 Indiana                                $271,629,605
 Iowa                                   $130,309,854
 Kansas                                 $94,370,028
 Kentucky                               $212,122,967
 Louisiana                              $239,827,085
 Maine                                  $92,781,591
 Maryland                               $236,000,265
 Massachusetts                          $472,765,757
 Michigan                               $435,451,207
 Minnesota                              $302,429,550
 Mississippi                            $176,956,163
 Missouri                               $302,534,081
 Montana                                $36,437,168
 Nebraska                               $79,550,313
 Nevada                                 $52,331,624
 New Hampshire                          $54,101,351
 New Jersey                             $411,954,920
 New Mexico                             $112,850,197
 New York                               $2,383,327,447
 North Carolina                         $439,742,488
 North Dakota                           $27,253,781
 N. Mariana Islands                     $233,880
 Ohio                                   $616,448,513
 Oklahoma                               $146,240,811
 Oregon                                 $167,002,460
 Pennsylvania                           $745,862,667
 Puerto Rico                            $18,916,230
 Rhode Island                           $80,098,624
 South Carolina                         $184,217,430
 South Dakota                           $30,302,145
 Tennessee                              $350,273,887
 Texas                                  $814,722,031
 Utah                                   $63,422,131
 Vermont                                $40,549,714
 Virgin Islands                         $624,499
 Virginia                               $215,155,129
 Washington                             $298,697,312
 West Virginia                          $95,818,709
 Wisconsin                              $270,901,128
 Wyoming                                $17,496,788
------------------------------------------------------------------------
 Total                                  $15,000,000,000
------------------------------------------------------------------------

       ``(c) Use of Funds.--Funds appropriated under this section 
     may be used by a State for services directed at the goals set 
     forth in section 2001, subject to the requirements of this 
     title.
       ``(d) Payment to States.--Not later than 30 days after 
     amounts are appropriated under subsection (a), in addition to 
     any payment made under section 2002 or 2007, the Secretary 
     shall make a lump sum payment to a State of the total amount 
     of the allotment for the State as specified in subsection 
     (b).
       ``(e) Definition.--For purposes of this section, the term 
     `State' means the 50 States, the District of Columbia, and 
     the territories contained in the list under subsection 
     (b).''.
       (b) Repeal.--Effective as of October 1, 2005, section 2008 
     of the Social Security Act, as added by subsection (a), is 
     repealed.
       (c) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study to determine an appropriate index that 
     could be used to temporarily adjust the Federal medical 
     assistance percentage for purposes of programs authorized 
     under the Social Security Act either with respect to all 
     States during a period of national recession or with respect 
     to a specific State when the State's economy takes a 
     significant turn for the worse.
       (2) Report.--Not later than 1 year after the date of the 
     enactment of this Act, the Comptroller General of the United 
     States shall submit a report to Congress on the study 
     conducted under paragraph (1).

     SEC. 203. INCREASING MEDICAID DSH ALLOTMENTS.

       (a) Continuation of Medicaid DSH Allotment Adjustments 
     Under BIPA 2000.--
       (1) In general.--Section 1923(f) of the Social Security Act 
     (42 U.S.C. 1396r-4(f))--
       (A) in paragraph (2)--
       (i) in the heading, by striking ``through 2002'' and 
     inserting ``through 2000'';
       (ii) by striking ``ending with fiscal year 2002'' and 
     inserting ``ending with fiscal year 2000''; and
       (iii) in the table in such paragraph, by striking the 
     columns labeled ``FY 01'' and ``FY02'';
       (B) in paragraph (3)(A), by striking ``paragraph (2)'' and 
     inserting ``paragraph (4)''; and
       (C) in paragraph (4), as added by section 701(a)(1) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (as enacted into law by section 
     1(a)(6) of Public Law 106-554)--
       (i) by striking ``for fiscal years 2001 and 2002'' in the 
     heading;
       (ii) in subparagraph (A), by striking ``Notwithstanding 
     paragraph (2), the'' and inserting ``The'';
       (iii) in subparagraph (C)--

       (I) by striking ``No application'' and inserting 
     ``Application''; and
       (II) by striking ``without regard to'' and inserting 
     ``taking into account''.

       (2) Increase in medicaid dsh allotment for the district of 
     columbia.--
       (A) In general.--Effective for DSH allotments beginning 
     with fiscal year 2003, the item in the table contained in 
     section 1923(f)(2) of the Social Security Act (42 U.S.C. 
     1396r-4(f)(2)) for the District of Columbia for the DSH 
     allotment for FY 00 (fiscal year 2000) is amended by striking 
     ``32'' and inserting ``49''.
       (B) Construction.--Nothing in subparagraph (A) shall be 
     construed as preventing the application of section 1923(f)(4) 
     of the Social Security Act (as amended by subsection (a)) to 
     the District of Columbia for fiscal year 2003 and subsequent 
     fiscal years.

[[Page S5866]]

       (3) Effective date.--The amendments made by this subsection 
     shall apply to DSH allotments for fiscal years beginning with 
     fiscal year 2003.
       (b) Increase in Floor for Treatment As an Extremely Low DSH 
     State to 3 Percent in Fiscal Year 2003.--
       (1) Increase in dsh floor.--Section 1923(f)(5) of the 
     Social Security Act (42 U.S.C. 1396r-4(f)(5)) is amended--
       (A) by striking ``fiscal year 1999'' and inserting ``fiscal 
     year 2001'';
       (B) by striking ``August 31, 2000'' and inserting ``August 
     31, 2002'';
       (C) by striking ``1 percent'' each place it appears and 
     inserting ``3 percent''; and
       (D) by striking ``fiscal year 2001'' and inserting ``fiscal 
     year 2003''.
       (2) Effective date.--The amendments made by paragraph (1) 
     take effect as if enacted on October 1, 2002, and apply to 
     DSH allotments under title XIX of the Social Security Act for 
     fiscal year 2003 and each fiscal year thereafter.

     SEC. 204. INCREASED STATE ACCESS TO UNSPENT SCHIP FUNDS.

       (a) Retained and Redistributed Allotments for Fiscal Years 
     1998 and 1999.--Paragraphs (2)(A)(i) and (2)(A)(ii) of 
     section 2104(g) of the Social Security Act (42 U.S.C. 
     1397dd(g)) are each amended by striking ``fiscal year 2002'' 
     and inserting ``fiscal year 2004''.
       (b) Extension and Revision of Retained and Redistributed 
     Allotments for Fiscal Year 2000.--
       (1) Permitting and extending retention of portion of fiscal 
     year 2000 allotment.--Paragraph (2) of such section 2104(g) 
     is amended--
       (A) in the heading, by striking ``and 1999'' and inserting 
     ``through 2000''; and
       (B) by adding at the end of subparagraph (A) the following:
       ``(iii) Fiscal year 2000 allotment.--Of the amounts 
     allotted to a State pursuant to this section for fiscal year 
     2000 that were not expended by the State by the end of fiscal 
     year 2002, 50 percent of that amount shall remain available 
     for expenditure by the State through the end of fiscal year 
     2004.''.
       (2) Redistributed allotments.--Paragraph (1) of such 
     section 2104(g) is amended--
       (A) in subparagraph (A), by inserting ``or for fiscal year 
     2000 by the end of fiscal year 2002,'' after ``fiscal year 
     2001,'';
       (B) in subparagraph (A), by striking ``1998 or 1999'' and 
     inserting ``1998, 1999, or 2000'';
       (C) in subparagraph (A)(i)--
       (i) by striking ``or'' at the end of subclause (I),
       (ii) by striking the period at the end of subclause (II) 
     and inserting ``; or''; and
       (iii) by adding at the end the following new subclause:

       ``(III) the fiscal year 2000 allotment, the amount 
     specified in subparagraph (C)(i) (less the total of the 
     amounts under clause (ii) for such fiscal year), multiplied 
     by the ratio of the amount specified in subparagraph (C)(ii) 
     for the State to the amount specified in subparagraph 
     (C)(iii).'';

       (D) in subparagraph (A)(ii), by striking ``or 1999'' and 
     inserting ``, 1999, or 2000'';
       (E) in subparagraph (B), by striking ``with respect to 
     fiscal year 1998 or 1999'';
       (F) in subparagraph (B)(ii)--
       (i) by inserting ``with respect to fiscal year 1998, 1999, 
     or 2000,'' after ``subsection (e),''; and
       (ii) by striking ``2002'' and inserting ``2004''; and
       (G) by adding at the end the following new subparagraph:
       ``(C) Amounts used in computing redistributions for fiscal 
     year 2000.--For purposes of subparagraph (A)(i)(III)--
       ``(i) the amount specified in this clause is the amount 
     specified in paragraph (2)(B)(i)(I) for fiscal year 2000, 
     less the total amount remaining available pursuant to 
     paragraph (2)(A)(iii);
       ``(ii) the amount specified in this clause for a State is 
     the amount by which the State's expenditures under this title 
     in fiscal years 2000, 2001, and 2002 exceed the State's 
     allotment for fiscal year 2000 under subsection (b); and
       ``(iii) the amount specified in this clause is the sum, for 
     all States entitled to a redistribution under subparagraph 
     (A) from the allotments for fiscal year 2000, of the amounts 
     specified in clause (ii).''.
       (3) Conforming amendments.--Such section 2104(g) is further 
     amended--
       (A) in its heading, by striking ``and 1999'' and inserting 
     ``, 1999, and 2000''; and
       (B) in paragraph (3)--
       (i) by striking ``or fiscal year 1999'' and inserting ``, 
     fiscal year 1999, or fiscal year 2000''; and
       (ii) by striking ``or November 30, 2001'' and inserting 
     ``November 30, 2001, or November 30, 2002'', respectively.
       (c) Extension and Revision of Retained and Redistributed 
     Allotments for Fiscal Year 2001.--
       (1) Permitting and extending retention of portion of fiscal 
     year 2001 allotment.--Paragraph (2) of such section 2104(g), 
     as amended in subsection (b)(1)(B), is further amended--
       (A) in the heading, by striking ``2000'' and inserting 
     ``2001''; and
       (B) by adding at the end of subparagraph (A) the following:
       ``(iv) Fiscal year 2001 allotment.--Of the amounts allotted 
     to a State pursuant to this section for fiscal year 2001 that 
     were not expended by the State by the end of fiscal year 
     2003, 50 percent of that amount shall remain available for 
     expenditure by the State through the end of fiscal year 
     2005.''.
       (2) Redistributed allotments.--Paragraph (1) of such 
     section 2104(g), as amended in subsection (b)(2), is further 
     amended--
       (A) in subparagraph (A), by inserting ``or for fiscal year 
     2001 by the end of fiscal year 2003,'' after ``fiscal year 
     2002,'';
       (B) in subparagraph (A), by striking ``1999, or 2000'' and 
     inserting ``1999, 2000, or 2001'';
       (C) in subparagraph (A)(i)--
       (i) by striking ``or'' at the end of subclause (II),
       (ii) by striking the period at the end of subclause (III) 
     and inserting ``; or''; and
       (iii) by adding at the end the following new subclause:

       ``(IV) the fiscal year 2001 allotment, the amount specified 
     in subparagraph (D)(i) (less the total of the amounts under 
     clause (ii) for such fiscal year), multiplied by the ratio of 
     the amount specified in subparagraph (D)(ii) for the State to 
     the amount specified in subparagraph (D)(iii).'';

       (D) in subparagraph (A)(ii), by striking ``or 2000'' and 
     inserting ``2000, or 2001'';
       (E) in subparagraph (B)--
       (i) by striking ``and'' at the end of clause (ii);
       (ii) by redesignating clause (iii) as clause (iv); and
       (iii) by inserting after clause (ii) the following new 
     clause:
       ``(iii) notwithstanding subsection (e), with respect to 
     fiscal year 2001, shall remain available for expenditure by 
     the State through the end of fiscal year 2005; and''; and
       (F) by adding at the end the following new subparagraph:
       ``(D) Amounts used in computing redistributions for fiscal 
     year 2001.--For purposes of subparagraph (A)(i)(IV)--
       ``(i) the amount specified in this clause is the amount 
     specified in paragraph (2)(B)(i)(I) for fiscal year 2001, 
     less the total amount remaining available pursuant to 
     paragraph (2)(A)(iv);
       ``(ii) the amount specified in this clause for a State is 
     the amount by which the State's expenditures under this title 
     in fiscal years 2001, 2002, and 2003 exceed the State's 
     allotment for fiscal year 2001 under subsection (b); and
       ``(iii) the amount specified in this clause is the sum, for 
     all States entitled to a redistribution under subparagraph 
     (A) from the allotments for fiscal year 2001, of the amounts 
     specified in clause (ii).''.
       (3) Conforming amendments.--Such section 2104(g) is further 
     amended--
       (A) in its heading, by striking ``and 2000'' and inserting 
     ``2000, and 2001''; and
       (B) in paragraph (3)--
       (i) by striking ``or fiscal year 2000'' and inserting 
     ``fiscal year 2000, or fiscal year 2001''; and
       (ii) by striking ``or November 30, 2002,'' and inserting 
     ``November 30, 2002, or November 30, 2003,'', respectively.
       (d) Authority for Qualifying States To Use Portion of SCHIP 
     Funds for Medicaid Expenditures.--Section 2105 of the Social 
     Security Act (42 U.S.C. 1397ee) is amended by adding at the 
     end the following:
       ``(g) Authority for Qualifying States To Use Certain Funds 
     for Medicaid Expenditures.--
       ``(1) State option.--
       ``(A) In general.--Notwithstanding any other provision of 
     law, with respect to allotments for fiscal years 1998, 1999, 
     2000, 2001, for fiscal years in which such allotments are 
     available under subsections (e) and (g) of section 2104, a 
     qualifying State (as defined in paragraph (2)) may elect to 
     use not more than 20 percent of such allotments (instead of 
     for expenditures under this title) for payments for such 
     fiscal year under title XIX in accordance with subparagraph 
     (B).
       ``(B) Payments to states.--
       ``(i) In general.--In the case of a qualifying State that 
     has elected the option described in subparagraph (A), subject 
     to the total amount of funds described with respect to the 
     State in subparagraph (A), the Secretary shall pay the State 
     an amount each quarter equal to the additional amount that 
     would have been paid to the State under title XIX for 
     expenditures of the State for the fiscal year described in 
     clause (ii) if the enhanced FMAP (as determined under 
     subsection (b)) had been substituted for the Federal medical 
     assistance percentage (as defined in section 1905(b)) of such 
     expenditures.
       ``(ii) Expenditures described.--For purposes of clause (i), 
     the expenditures described in this clause are expenditures 
     for such fiscal years for providing medical assistance under 
     title XIX to individuals who have not attained age 19 and 
     whose family income exceeds 150 percent of the poverty line.
       ``(iii) No impact on determination of budget neutrality for 
     waivers.--In the case of a qualifying State that uses amounts 
     paid under this subsection for expenditures described in 
     clause (ii) that are incurred under a waiver approved for the 
     State, any budget neutrality determinations with respect to 
     such waiver shall be determined without regard to such 
     amounts paid.
       ``(2) Qualifying state.--In this subsection, the term 
     `qualifying State' means a State that--
       ``(A) as of April 15, 1997, has an income eligibility 
     standard with respect to any 1 or more categories of children 
     (other than infants) who are eligible for medical assistance 
     under section 1902(a)(10)(A) or under a waiver under section 
     1115 implemented on January 1, 1994, that is up to 185 
     percent of the poverty line or above; and

[[Page S5867]]

       ``(B) satisfies the requirements described in paragraph 
     (3).
       ``(3) Requirements.--The requirements described in this 
     paragraph are the following:
       ``(A) SCHIP income eligibility.--The State has a State 
     child health plan that (whether implemented under title XIX 
     or this title)--
       ``(i) as of January 1, 2001, has an income eligibility 
     standard that is at least 200 percent of the poverty line or 
     has an income eligibility standard that exceeds 200 percent 
     of the poverty line under a waiver under section 1115 that is 
     based on a child's lack of health insurance;
       ``(ii) subject to subparagraph (B), does not limit the 
     acceptance of applications for children; and
       ``(iii) provides benefits to all children in the State who 
     apply for and meet eligibility standards on a statewide 
     basis.
       ``(B) No waiting list imposed.--With respect to children 
     whose family income is at or below 200 percent of the poverty 
     line, the State does not impose any numerical limitation, 
     waiting list, or similar limitation on the eligibility of 
     such children for child health assistance under such State 
     plan.
       ``(C) Additional requirements.--The State has implemented 
     at least 3 of the following policies and procedures (relating 
     to coverage of children under title XIX and this title):
       ``(i) Uniform, simplified application form.--With respect 
     to children who are eligible for medical assistance under 
     section 1902(a)(10)(A), the State uses the same uniform, 
     simplified application form (including, if applicable, 
     permitting application other than in person) for purposes of 
     establishing eligibility for benefits under title XIX and 
     this title.
       ``(ii) Elimination of asset test.--The State does not apply 
     any asset test for eligibility under section 1902(l) or this 
     title with respect to children.
       ``(iii) Adoption of 12-month continuous enrollment.--The 
     State provides that eligibility shall not be regularly 
     redetermined more often than once every year under this title 
     or for children described in section 1902(a)(10)(A).
       ``(iv) Same verification and redetermination policies; 
     automatic reassessment of eligibility.--With respect to 
     children who are eligible for medical assistance under 
     section 1902(a)(10)(A), the State provides for initial 
     eligibility determinations and redeterminations of 
     eligibility using the same verification policies (including 
     with respect to face-to-face interviews), forms, and 
     frequency as the State uses for such purposes under this 
     title, and, as part of such redeterminations, provides for 
     the automatic reassessment of the eligibility of such 
     children for assistance under title XIX and this title.
       ``(v) Outstationing enrollment staff.--The State provides 
     for the receipt and initial processing of applications for 
     benefits under this title and for children under title XIX at 
     facilities defined as disproportionate share hospitals under 
     section 1923(a)(1)(A) and Federally-qualified health centers 
     described in section 1905(l)(2)(B) consistent with section 
     1902(a)(55).''.
       (e) Effective Date.--Subsections (a) through (c), and the 
     amendments made by such subsections, shall be effective as if 
     this section had been enacted on September 30, 2002, and 
     amounts under title XXI of the Social Security Act (42 U.S.C. 
     1397aa et seq.) from allotments for fiscal years 1998 through 
     2000 are available for expenditure on and after October 1, 
     2002, under the amendments made by such subsections as if 
     this section had been enacted on September 30, 2002.

     SEC. 205. FEDERAL RESPONSIBILITY FOR EMERGENCY CARE FOR 
                   ILLEGAL IMMIGRANTS.

       (a) In General.--Section 1903(a)(3) of the Social Security 
     Act (42 U.S.C. 1396b(a)(3)) is amended--
       (1) in subparagraph (D), by striking ``plus'' at the end 
     and inserting ``and''; and
       (2) by adding at the end the following:
       ``(E) 100 percent of the sums expended with respect to 
     costs incurred during such quarter as are attributable to the 
     provision of care and services that are furnished to an alien 
     described in subsection (v)(1) that are necessary for the 
     treatment of an emergency medical condition, as defined in 
     subsection (v)(3); and''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on July 1, 2003.

     SEC. 206. INCREASED FEDERAL RESPONSIBILITY FOR TRANSLATION 
                   SERVICES.

       (a) In General.--Section 1903(a)(3) of the Social Security 
     Act (42 U.S.C. 1396b(a)(3)), as amended by section 205(a), is 
     amended by adding at the end the following:
       ``(F) 90 percent of the sums expended with respect to costs 
     incurred during such quarter as are attributable to the 
     provision of language services, including oral 
     interpretation, translations of written materials, and other 
     language services, for individuals with limited English 
     proficiency who apply for, or receive, medical assistance 
     under the State plan; and''.
       (b) SCHIP.--Section 2105(A)(1) of the Social Security Act 
     (42 U.S.C.1397ee(a)(1)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``section 1905(b))'' and inserting ``section 1905(b)) or, in 
     the case of expenditures described in subparagraph (D)(iv), 
     90 percent''; and
       (2) in subparagraph (D)--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) by redesignating clause (iv) as clause (v); and
       (C) by inserting after clause (iii) the following:
       ``(D) for expenditures attributable to the provision of 
     language services, including oral interpretation, 
     translations of written materials, and other language 
     services, for individuals with limited English proficiency 
     who apply for, or receive, child health assistance under the 
     plan; and''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on July 1, 2003.

     SEC. 207. INCREASED FEDERAL MATCHING RATES FOR CERTAIN 
                   SERVICES.

       (a) Outstationed Workers.--Section 1903(a)(3) of the Social 
     Security Act (42 U.S.C. 1396b(a)(3)), as amended by sections 
     205(a) and 206(a), is amended by adding at the end the 
     following:
       ``(G) 90 percent of the sums expended with respect to costs 
     incurred during such quarter as are attributable to providing 
     for the receipt and initial processing of applications of 
     children and pregnant women for medical assistance consistent 
     with the requirements of section 1902(a)(55); plus''.
       (b) 100 Percent Matching Rate for Urban Indian Health 
     Services.--The third sentence of section 1905(b) of the 
     Social Security Act (42 U.S.C. 1396d(b)) is amended--
       (1) by inserting ``or program'' after ``facility'';
       (2) by striking ``or by'' and inserting ``, by''; and
       (3) by inserting ``, or by an urban Indian organization 
     pursuant to a grant or contract with the Indian Health 
     Service under title V of the Indian Health Care Improvement 
     Act'' before the period.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on July 1, 2003.

 TITLE III--STRENGTHENING STATE AND FEDERAL COMMITMENT TO THE ELDERLY 
         AND PERSONS WITH DISABILITIES; FAMILY OPPORTUNITY ACT

           Subtitle A--Elderly and Persons with Disabilities

     SEC. 301. FULL ACCOUNTING OF SAVINGS IN DETERMINING COST-
                   EFFECTIVENESS.

       (a) In General.--Section 1915(c)(2)(D) of the Social 
     Security Act (42 U.S.C. 1396n(c)(2)(D)) is amended by 
     inserting ``(reduced by average per capita reductions in 
     spending under other Federal mandatory spending programs 
     resulting from operation of the waiver)'' after ``with 
     respect to such individuals''.
       (b) Effective Date.--The amendment made by subsection shall 
     take effect on the date of the enactment of this Act.

     SEC. 302. EXTENSION OF MEDICAID COVERAGE UNDER THE TICKET TO 
                   WORK PROGRAM TO COVER SPOUSES.

       (a) In General.--Section 1902(a)(10)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
       (1) in clause (i)(II), by inserting before the comma at the 
     end the following: ``, and at the option of a State, any 
     individual who is the spouse of such an individual'';
       (2) in clause (ii)(XIII), by inserting before the semicolon 
     at the end the following: ``, and at the option of a State, 
     any individual who is the spouse of such an individual'';
       (3) in subclause (XV), by inserting before the semicolon at 
     the end the following: ``, and at the option of a State, any 
     individual who is the spouse of such an individual''; and
       (4) in subclause (XVI), by inserting before the semicolon 
     at the end the following: ``, and at the option of a State, 
     any individual who is the spouse of such an individual''.
       (b) Conforming Amendment.--Section 1905(a)(xii) of such Act 
     (42 U.S.C. 1396d(a)(xii)) is amended by inserting ``and 
     spouses described in clauses (i)(II), (ii)(XIII), (ii)(XV), 
     and (ii)(XVI) of section 1902(a)(10)(A)'' after ``subsection 
     (v))''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2003, whether or not regulations 
     implementing such amendments have been issued.

     SEC. 303. ENCOURAGING TRANSITION TO HOME AND COMMUNITY CARE.

       (a) In General.--Section 1905(b) of the Social Security Act 
     (42 U.S.C. 1396d(b)), as amended by section 101(a), is 
     amended--
       (1) by striking ``and'' before ``(5)''; and
       (2) by inserting before the period the following: ``, and 
     (6) the Federal medical assistance percentage shall be equal 
     to the enhanced FMAP described in section 2105(b) with 
     respect to medical assistance provided under a waiver under 
     section 1915(c)''.
       (b) Conforming Amendment.--Section 1915(c) of such Act (42 
     U.S.C. 1396n(c)) is amended by adding at the end the 
     following new paragraph:
       ``(11) For purposes of determining the amount of 
     expenditures under this section or a State plan for purposes 
     of applying any test of cost-effectiveness or similar test in 
     carrying out this subsection, the provisions of section 
     1905(b)(6) shall not be taken into account.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to medical assistance for items and services 
     furnished on or after July 1, 2003, regardless of whether the 
     waiver under which such assistance is provided was approved 
     before, on, or after the date of the enactment of this Act.

     SEC. 304. ENHANCED MATCHING RATE FOR DISABLED INDIVIDUALS 
                   AWAITING MEDICARE ELIGIBILITY.

       (a) In General.--Section 1905(b) of the Social Security Act 
     (42 U.S.C. 1396d(b)), as

[[Page S5868]]

     amended by sections 101(a) and 303(a), is amended--
       (1) by striking ``and'' before ``(6)''; and
       (2) by inserting before the period the following: ``, and 
     (7) the Federal medical assistance percentage shall be equal 
     to 100 percent with respect to medical assistance provided to 
     individuals who are not entitled to benefits under part A of 
     title XVIII pursuant to section 226(b) but who would be 
     entitled to such benefits pursuant to such section but for 
     the application of a 24-month waiting period under such 
     section''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to medical assistance for items and services 
     furnished on or after October 1, 2003.

     SEC. 305. PROVIDING INITIAL TERM OF 5 YEARS FOR SECTION 1915 
                   WAIVERS.

       (a) In General.--Subsections (d)(3) and (e)(3) of section 
     1915 of the Social Security Act (42 U.S.C. 1396n) are each 
     amended by striking ``3 years'' and inserting ``5 years''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to waivers granted on or after the date of the 
     enactment of this Act.

     SEC. 306. OPTIONAL COVERAGE OF COMMUNITY-BASED ATTENDANT 
                   SERVICES AND SUPPORTS UNDER THE MEDICAID 
                   PROGRAM.

       (a) Optional Coverage.--Section 1902(a)(10)(D) of the 
     Social Security Act (42 U.S.C. 1396a(a)(10)(D)) is amended--
       (1) by inserting ``(i)'' after `(D)'';
       (2) by adding ``and'' after the semicolon; and
       (3) by adding at the end the following new clause:
       ``(ii) at the option of the State and subject to section 
     1935, for the inclusion of community-based attendant services 
     and supports for any individual who--
       ``(I) is eligible for medical assistance under the State 
     plan;
       ``(II) with respect to whom there has been a determination 
     that the individual requires the level of care provided in a 
     nursing facility or an intermediate care facility for the 
     mentally retarded (whether or not coverage of such 
     intermediate care facility is provided under the State plan); 
     and
       ``(III) who chooses to receive such services and supports;
     insofar as such services are appropriate for the individual's 
     condition according to the individual's plan of care;''.
       (b) Community-Based Attendant Services and Supports 
     Option.--
       (1) In general.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) is amended--
       (A) by redesignating section 1935 as section 1936; and
       (B) by inserting after section 1934 the following:


           ``community-based attendant services and supports

       ``Sec. 1935. (a) Coverage.--
       ``(1) In general.--A State may provide through a plan 
     amendment for the inclusion of community-based attendant 
     services and supports (as defined in subsection (g)(1)) for 
     individuals described in section 1902(a)(10)(D)(ii) in 
     accordance with this section.
       ``(2) Enhanced FMAP for Coverage.--Notwithstanding section 
     1905(b), in the case of a State with an approved plan 
     amendment under this section during that period that also 
     satisfies the requirements of subsection (c) the Federal 
     medical assistance percentage shall be equal to the enhanced 
     FMAP described in section 2105(b) with respect to medical 
     assistance in the form of community-based attendant services 
     and supports provided to individuals described in section 
     1902(a)(10)(D)(ii) in accordance with this section.
       ``(b) Development and Implementation of Benefit.--In order 
     for a State plan amendment to be approved under this section, 
     a State shall develop and implement the proposal through a 
     public process which includes individuals with disabilities, 
     elderly individuals, their representatives, and providers, 
     and include in that proposed plan amendment--
       ``(1) a State process to notify and inform individuals 
     (including individuals who live in nursing facilities, 
     individuals who live in intermediate care facilities for the 
     mentally retarded, and individuals who live in the community 
     and who have an unmet need for such services) of the 
     availability of such services and supports under the this 
     title, and of other items and services that may be provided 
     to the individual under this title or title XVIII; and
       ``(2) a quality assurance program that will maximize 
     consumer independence and consumer control and will --
       ``(A) train consumers to appropriately manage their own 
     attendant;
       ``(B) provide a quality review process; and
       ``(C) provide for investigation and resolution of 
     allegations of neglect, abuse, or exploitation in connection 
     with the provision of such services and supports.
       ``(c) No Effect on Ability To Provide Coverage Under a 
     Waiver.--
       ``(1) In general.--Nothing in this section shall be 
     construed as affecting the ability of a State to provide 
     coverage under the State plan for community-based attendant 
     services and supports (or similar coverage) under a waiver 
     approved under section 1915, section 1115, or otherwise.
       ``(2) Eligibility for enhanced match.--In the case of a 
     State that provides coverage for such services and supports 
     under a waiver, the State shall not be eligible under section 
     1935 for the enhanced FMAP for the provision of such coverage 
     under this unless the State submits a plan amendment to the 
     Secretary that meets the requirements of this section.
       ``(d) Definitions.--In this title:
       ``(1) Community-based attendant services and supports.--
       ``(A) In general.--The term `community-based attendant 
     services and supports' may include one or more of the 
     following: attendant services and supports furnished to an 
     individual, as needed, to assist in accomplishing activities 
     of daily living, instrumental activities of daily living, and 
     health-related functions through hands-on assistance, 
     supervision, or cueing--
       ``(i) under a plan of services and supports that is based 
     on an assessment of functional need and that is agreed to by 
     the individual or, as appropriate, the individual's 
     representative;
       ``(ii) in a home or community setting, which may include a 
     school, workplace, or recreation or religious facility, but 
     does not include a nursing facility or an intermediate care 
     facility for the mentally retarded;
       ``(iii) under an agency-provider model or other model (as 
     defined in paragraph (2)(C)); and
       ``(iv) the furnishing of which is selected, managed, and 
     dismissed by the individual, or, as appropriate, with 
     assistance from the individual's representative.
       ``(B) Included services and supports.--Such term may 
     include one or more of the following:
       ``(i) Tasks necessary to assist an individual in 
     accomplishing activities of daily living, instrumental 
     activities of daily living, and health-related functions.
       ``(ii) The acquisition, maintenance, and enhancement of 
     skills necessary for the individual to accomplish activities 
     of daily living, instrumental activities of daily living, and 
     health-related functions.
       ``(iii) Backup systems or mechanisms (such as the use of 
     beepers), as defined by the State according to the client's 
     needs, to ensure continuity of services and supports.
       ``(iv) Voluntary training on how to select, manage, and 
     dismiss attendants.
       ``(C) Excluded services and supports.--Subject to 
     subparagraph (D), such term does not include--
       ``(i) the provision of room and board for the individual;
       ``(ii) special education and related services provided 
     under the Individuals with Disabilities Education Act and 
     vocational rehabilitation services provided under the 
     Rehabilitation Act of 1973;
       ``(iii) assistive technology devices and assistive 
     technology services;
       ``(iv) durable medical equipment; or
       ``(v) home modifications.
       ``(D) Flexibility in transition to community-based home 
     setting.--Such term may include expenditures for transitional 
     costs required for an individual to make the transition from 
     a nursing facility or intermediate care facility for the 
     mentally retarded to a community-based home setting where the 
     individual resides.
       ``(E) Clarification of permitting payment of relatives for 
     providing services and supports.--Nothing in this section 
     shall be construed as preventing community-based attendant 
     services and supports from being furnished to an individual 
     by others who are related to that individual and for such 
     others being paid for so furnishing such services and 
     supports.
       ``(2) Additional definitions.--
       ``(A) Activities of daily living.--The term `activities of 
     daily living' includes eating, toileting, grooming, dressing, 
     bathing, and transferring.
       ``(B) Consumer controlled.--The term `consumer controlled' 
     means a method of providing services and supports that allow 
     the individual, or where appropriate, the individual's 
     representative, maximum control of the community-based 
     attendant services and supports, regardless of who acts as 
     the employer of record.
       ``(C) Delivery models.--
       ``(i) Agency-provider model.--The term `agency-provider 
     model' means, with respect to the provision of community-
     based attendant services and supports for an individual, a 
     method of providing consumer controlled services and supports 
     under which entities contract for the provision of such 
     services and supports.
       ``(ii) Other models.--The term `other models' means 
     methods, other than an agency-provider model, for the 
     provision of consumer controlled services and supports. Such 
     models may include direct cash payments or use of a fiscal 
     agent to assist in obtaining services.
       ``(D) Health-related functions.--The term `health-related 
     functions' means functions that can be delegated or assigned 
     by licensed health-care professionals under State law to be 
     performed by an attendant.
       ``(E) Instrumental activities of daily living.--The term 
     `instrumental activities of daily living' includes meal 
     planning and preparation, managing finances, shopping for 
     food, clothing, and other essential items, performing 
     essential household chores, communicating by phone and other 
     media, and other activities needed to participate in the 
     community, as appropriate.
       ``(F) Individual's representative.--The term `individual's 
     representative' means a parent, a family member, a guardian, 
     an advocate, or an authorized representative of an 
     individual.''.

[[Page S5869]]

       (c) Investigation by State .--Section 1903(q)(4)(A)(i) of 
     such Act (42 U.S.C. 1396b(q)(4)(A)(i)) is amended by 
     inserting ``and for investigation and resolution of 
     allegations of neglect, abuse, or exploitation in connection 
     with the provision of community-based attendant services and 
     supports under section 1935(b)(2)(C)'' before the semicolon.
       (d) Effective Date.--The amendments made by this section 
     take effect on October 1, 2003, and apply to medical 
     assistance provided for community-based attendant services 
     and supports described in section 1935 of the Social Security 
     Act furnished on or after that date.

                   Subtitle B--Family Opportunity Act

     SEC. 311. SHORT TITLE.

       This subtitle may be cited as the ``Family Opportunity Act 
     of 2003'' or the ``Dylan Lee James Act''.

     SEC. 312. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO 
                   PURCHASE MEDICAID COVERAGE FOR SUCH CHILDREN.

       (a) State Option To Allow Families of Disabled Children To 
     Purchase Medicaid Coverage for Such Children.--
       (1) In general.--Section 1902 (42 U.S.C. 1396a) is 
     amended--
       (A) in subsection (a)(10)(A)(ii)--
       (i) by striking ``or'' at the end of subclause (XVII);
       (ii) by adding ``or'' at the end of subclause (XVIII); and
       (iii) by adding at the end the following new subclause:

       ``(XIX) who are disabled children described in subsection 
     (cc)(1);''; and

       (B) by adding at the end the following new subsection:
       ``(cc)(1) Individuals described in this paragraph are 
     individuals--
       ``(A) who have not attained 18 years of age;
       ``(B) who would be considered disabled under section 
     1614(a)(3)(C) (determined without regard to the reference to 
     age in that section) but for having earnings or deemed income 
     or resources (as determined under title XVI for children) 
     that exceed the requirements for receipt of supplemental 
     security income benefits; and
       ``(C) whose family income does not exceed such income level 
     as the State establishes and does not exceed--
       ``(i) 300 percent of the income official poverty line (as 
     defined by the Office of Management and Budget, and revised 
     annually in accordance with section 673(2) of the Omnibus 
     Budget Reconciliation Act of 1981) applicable to a family of 
     the size involved; or
       ``(ii) such higher percent of such poverty line as a State 
     may establish, except that no Federal financial participation 
     shall be provided under section 1903(a) for any medical 
     assistance provided to an individual who would not be 
     described in this subsection but for this clause.''.
       (2) Interaction with employer-sponsored family coverage.--
     Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph 
     (1), is amended by adding at the end the following new 
     paragraph:
       ``(2)(A) If an employer of a parent of an individual 
     described in paragraph (1) offers family coverage under a 
     group health plan (as defined in section 2791(a) of the 
     Public Health Service Act), the State may--
       ``(i) require such parent to apply for, enroll in, and pay 
     premiums for, such coverage as a condition of such parent's 
     child being or remaining eligible for medical assistance 
     under subsection (a)(10)(A)(ii)(XIX) if the parent is 
     determined eligible for such coverage and the employer 
     contributes at least 50 percent of the total cost of annual 
     premiums for such coverage; and
       ``(ii) if such coverage is obtained--
       ``(I) subject to paragraph (2) of section 1916(h), reduce 
     the premium imposed by the State under that section (if any) 
     in an amount that reasonably reflects the premium 
     contribution made by the parent for private coverage on 
     behalf of a child with a disability; and
       ``(II) treat such coverage as a third party liability under 
     subsection (a)(25).
       ``(B) In the case of a parent to which subparagraph (A) 
     applies, if the family income of such parent does not exceed 
     300 percent of the income official poverty line (referred to 
     in paragraph (1)(C)(i)), a State may provide for payment of 
     any portion of the annual premium for such family coverage 
     that the parent is required to pay. Any payments made by the 
     State under this subparagraph shall be considered, for 
     purposes of section 1903(a), to be payments for medical 
     assistance.''.
       (b) State Option To Impose Income-Related Premiums.--
     Section 1916 (42 U.S.C. 1396o) is amended--
       (1) in subsection (a), by striking ``subsection (g)'' and 
     inserting ``subsections (g) and (h)''; and
       (2) by adding at the end the following new subsection:
       ``(h)(1) With respect to disabled children provided medical 
     assistance under section 1902(a)(10)(A)(ii)(XIX), subject to 
     paragraph (2), a State may (in a uniform manner for such 
     children) require the families of such children to pay 
     monthly premiums set on a sliding scale based on family 
     income.
       ``(2) A premium requirement imposed under paragraph (1) may 
     only apply to the extent that--
       ``(A) the aggregate amount of such premium and any premium 
     that the parent is required to pay for family coverage under 
     section 1902(cc)(2)(A)(i) does not exceed 5 percent of the 
     family's income; and
       ``(B) the requirement is imposed consistent with section 
     1902(cc)(2)(A)(ii)(I).
       ``(3) A State shall not require prepayment of a premium 
     imposed pursuant to paragraph (1) and shall not terminate 
     eligibility of a child under section 1902(a)(10)(A)(ii)(XIX) 
     for medical assistance under this title on the basis of 
     failure to pay any such premium until such failure continues 
     for a period of not less than 60 days from the date on which 
     the premium became past due. The State may waive payment of 
     any such premium in any case where the State determines that 
     requiring such payment would create an undue hardship.''.
       (c) Conforming Amendment.--Section 1903(f)(4) (42 U.S.C. 
     1396b(f)(4)) is amended in the matter preceding subparagraph 
     (A) by inserting ``1902(a)(10)(A)(ii)(XIX),'' after 
     ``1902(a)(10)(A)(ii)(XVIII),''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to medical assistance for items and services 
     furnished on or after January 1, 2004.

     SEC. 313. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL 
                   SERVICES FOR INDIVIDUALS UNDER AGE 21 IN HOME 
                   OR COMMUNITY-BASED SERVICES WAIVERS.

       (a) In General.--Section 1915(c) (42 U.S.C. 1396n(c)) is 
     amended--
       (1) in paragraph (1)--
       (A) in the first sentence, by inserting ``, or inpatient 
     psychiatric hospital services for individuals under age 21,'' 
     after ``intermediate care facility for the mentally 
     retarded''; and
       (B) in the second sentence, by inserting ``, or inpatient 
     psychiatric hospital services for individuals under age 21'' 
     before the period;
       (2) in paragraph (2)(B), by striking ``or services in an 
     intermediate care facility for the mentally retarded'' each 
     place it appears and inserting ``, services in an 
     intermediate care facility for the mentally retarded, or 
     inpatient psychiatric hospital services for individuals under 
     age 21'';
       (3) by striking paragraph (2)(C) and inserting the 
     following:
       ``(C) such individuals who are determined to be likely to 
     require the level of care provided in a hospital, nursing 
     facility, or intermediate care facility for the mentally 
     retarded, or inpatient psychiatric hospital services for 
     individuals under age 21, are informed of the feasible 
     alternatives, if available under the waiver, at the choice of 
     such individuals, to the provision of inpatient hospital 
     services, nursing facility services, services in an 
     intermediate care facility for the mentally retarded, or 
     inpatient psychiatric hospital services for individuals under 
     age 21;''; and
       (4) in paragraph (7)(A)--
       (A) by inserting ``, or inpatient psychiatric hospital 
     services for individuals under age 21,'' after ``intermediate 
     care facility for the mentally retarded''; and
       (B) by inserting ``, or who would require inpatient 
     psychiatric hospital services for individuals under age 21'' 
     before the period.
       (b) Effective Date.--The amendments made by subsection (a) 
     apply with respect to medical assistance provided on or after 
     January 1, 2003.

     SEC. 314. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID 
                   PROGRAM OF CHILDREN WITH POTENTIALLY SEVERE 
                   DISABILITIES.

       (a) State Application.--A State may apply to the Secretary 
     of Health and Human Services (in this section referred to as 
     the ``Secretary'') for approval of a demonstration project 
     (in this section referred to as a ``demonstration project'') 
     under which up to a specified maximum number of children with 
     a potentially severe disability (as defined in subsection 
     (b)) are provided medical assistance under the State medicaid 
     plan under title XIX of the Social Security Act (42 U.S.C. 
     1396 et seq.).
       (b) Child With a Potentially Severe Disability Defined.--
       (1) In general.--In this section, the term ``child with a 
     potentially severe disability'' means, with respect to a 
     demonstration project, an individual who--
       (A) has not attained 21 years of age;
       (B) has a physical or mental condition, disease, disorder 
     (including a congenital birth defect or a metabolic 
     condition), injury, or developmental disability that was 
     incurred before the individual attained such age; and
       (C) is reasonably expected, but for the receipt of medical 
     assistance under the State medicaid plan, to reach the level 
     of disability defined under section 1614(a)(3) of the Social 
     Security Act (42 U.S.C. 1382c(a)(3)), (determined without 
     regard to the reference to age in subparagraph (C) of that 
     section).
       (2) Exception.--Such term does not include an individual 
     who would be considered disabled under section 1614(a)(3)(C) 
     of the Social Security Act (42 U.S.C. 1382c(a)(3)(C)) 
     (determined without regard to the reference to age in that 
     section).
       (c) Approval of Demonstration Projects.--
       (1) In general.--Subject to paragraph (3), the Secretary 
     shall approve applications under subsection (a) that meet the 
     requirements of paragraph (2) and such additional terms and 
     conditions as the Secretary may require. The Secretary may 
     waive the requirement of section 1902(a)(1) of the Social 
     Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State 
     demonstrations.
       (2) Terms and conditions of demonstration projects.--The 
     Secretary may not approve a demonstration project under this 
     section unless the State provides assurances satisfactory to 
     the Secretary that the following conditions are or will be 
     met:

[[Page S5870]]

       (A) Independent evaluation.--The State provides for an 
     independent evaluation of the project to be conducted during 
     fiscal year 2006.
       (B) Consultation for development of criteria.--The State 
     consults with appropriate pediatric health professionals in 
     establishing the criteria for determining whether a child has 
     a potentially severe disability.
       (C) Annual report.--The State submits an annual report to 
     the Secretary (in a uniform form and manner established by 
     the Secretary) on the use of funds provided under the grant 
     that includes the following:
       (i) Enrollment and financial statistics on--

       (I) the total number of children with a potentially severe 
     disability enrolled in the demonstration project, 
     disaggregated by disability;
       (II) the services provided by category or code and the cost 
     of each service so categorized or coded; and
       (III) the number of children enrolled in the demonstration 
     project who also receive services through private insurance.

       (ii) With respect to the report submitted for fiscal year 
     2006, the results of the independent evaluation conducted 
     under subparagraph (A).
       (iii) Such additional information as the Secretary may 
     require.
       (3) Limitations on federal funding.--
       (A) Appropriation.--
       (i) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to carry out 
     this section--

       (I) $16,666,000 for each of fiscal years 2002 and 2003; and
       (II) $16,667,000 for each of fiscal years 2004 through 
     2007.

       (ii) Budget authority.--Clause (i) constitutes budget 
     authority in advance of appropriations Acts and represents 
     the obligation of the Federal Government to provide for the 
     payment of the amounts appropriated under clause (i).
       (B) Limitation on payments.--In no case may--
       (i) the aggregate amount of payments made by the Secretary 
     to States under this section exceed $100,000,000;
       (ii) the aggregate amount of payments made by the Secretary 
     to States for administrative expenses relating to the 
     evaluations and annual reports required under subparagraphs 
     (A) and (C) of paragraph (2) exceed $2,000,000 of such 
     $100,000,000; or
       (iii) payments be provided by the Secretary for a fiscal 
     year after fiscal year 2010.
       (C) Funds allocated to states.--
       (i) In general.--The Secretary shall allocate funds to 
     States based on their applications and the availability of 
     funds. In making such allocations, the Secretary shall ensure 
     an equitable distribution of funds among States with large 
     populations and States with small populations.
       (ii) Availability.--Funds allocated to a State under a 
     grant made under this section for a fiscal year shall remain 
     available until expended.
       (D) Funds not allocated to states.--Funds not allocated to 
     States in the fiscal year for which they are appropriated 
     shall remain available in succeeding fiscal years for 
     allocation by the Secretary using the allocation formula 
     established under this section.
       (E) Payments to states.--The Secretary shall pay to each 
     State with a demonstration project approved under this 
     section, from its allocation under subparagraph (C), an 
     amount for each quarter equal to the Federal medical 
     assistance percentage (as defined in section 1905(b) of the 
     Social Security Act (42 U.S.C. 1395d(b))) of expenditures in 
     the quarter for medical assistance provided to children with 
     a potentially severe disability.
       (d) Recommendation.--Not later than October 1, 2005, the 
     Secretary shall submit a recommendation to the Committee on 
     Commerce of the House of Representatives and the Committee on 
     Finance of the Senate regarding whether the demonstration 
     project established under this section should be continued 
     after fiscal year 2007.
       (e) State Defined.--In this section, the term ``State'' has 
     the meaning given such term for purposes of title XIX of the 
     Social Security Act (42 U.S.C. 1396 et seq.).

     SEC. 315. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH 
                   INFORMATION CENTERS.

       Section 501 (42 U.S.C. 701) is amended by adding at the end 
     the following new subsection:
       ``(c)(1) In addition to amounts appropriated under 
     subsection (a) and retained under section 502(a)(1) for the 
     purpose of carrying out activities described in subsection 
     (a)(2), there is appropriated to the Secretary, out of any 
     money in the Treasury not otherwise appropriated, for the 
     purpose of enabling the Secretary (through grants, contracts, 
     or otherwise) to provide for special projects of regional and 
     national significance for the development and support of 
     family-to-family health information centers described in 
     paragraph (2), $10,000,000 for each of fiscal years 2002 
     through 2007. Funds appropriated under this paragraph shall 
     remain available until expended.
       ``(2) The family-to-family health information centers 
     described in this paragraph are centers that--
       ``(A) assist families of children with disabilities or 
     special health care needs to make informed choices about 
     health care in order to promote good treatment decisions, 
     cost-effectiveness, and improved health outcomes for such 
     children;
       ``(B) provide information regarding the health care needs 
     of, and resources available for, children with disabilities 
     or special health care needs;
       ``(C) identify successful health delivery models for such 
     children;
       ``(D) develop with representatives of health care 
     providers, managed care organizations, health care 
     purchasers, and appropriate State agencies a model for 
     collaboration between families of such children and health 
     professionals;
       ``(E) provide training and guidance regarding caring for 
     such children;
       ``(F) conduct outreach activities to the families of such 
     children, health professionals, schools, and other 
     appropriate entities and individuals; and
       ``(G) are staffed by families of children with disabilities 
     or special health care needs who have expertise in Federal 
     and State public and private health care systems and health 
     professionals.
       ``(3) The provisions of this title that are applicable to 
     the funds made available to the Secretary under section 
     502(a)(1) apply in the same manner to funds made available to 
     the Secretary under paragraph (1).''.

     SEC. 316. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI 
                   BENEFICIARIES.

       (a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C. 
     1396a(a)(10)(A)(i)(II)) is amended--
       (1) by inserting ``(aa)'' after ``(II)'';
       (2) by striking ``or who are'' and inserting ``, (bb) who 
     are''; and
       (3) by inserting before the comma at the end the following: 
     ``, or (cc) who are under 21 years of age and with respect to 
     whom supplemental security income benefits would be paid 
     under title XVI if subparagraphs (A) and (B) of section 
     1611(c)(7) were applied without regard to the phrase `the 
     first day of the month following' ''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to medical assistance for items and services 
     furnished on or after the first day of the first calendar 
     quarter that begins after the date of enactment of this Act.

 TITLE IV--FACILITATING PROGRAM ADMINISTRATION AND PRESERVING COVERAGE

     SEC. 401. ALLOWING UNIFORM COVERAGE OF ALL LOW INCOME 
                   AMERICANS.

       (a) In General.--Section 1902(a)(10)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
       (1) by striking ``or'' at the end of subclause (XVII);
       (2) by adding ``or'' at the end of subclause (XVIII); and
       (3) by adding at the end the following the following new 
     subclause:

       ``(XIX) any individual age 21 through 64 whose family 
     income does not exceed 200 percent of the income official 
     poverty line (as defined by the Office of Management and 
     Budget, and revised annually in accordance with section 
     673(2) of the Omnibus Budget Reconciliation Act of 1981) 
     applicable to a family of the size involved;''.

       (b) Conforming Amendments.--
       (1) Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is 
     amended, in the matter before paragraph (1)--
       (A) by striking ``or'' at the end of clause (xii);
       (B) by adding ``or'' at the end of clause (xiii); and
       (C) by inserting after clause (xiii) the following new 
     clause:
       ``(xii) individuals described in section 
     1902(a)(10)(A)(ii)(XIX),''.
       (2) Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)) 
     is amended by inserting ``1902(a)(10)(A)(ii)(XIX),'' after 
     ``1902(a)(10)(A)(ii)(XVIII),''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on October 1, 2003.

     SEC. 402. FACILITATING COVERAGE OF FAMILIES.

       (a) In General.--Section 1905(b) of the Social Security Act 
     (42 U.S.C. 1396d(b)), as amended by sections 101(a), 303(a), 
     and 304(a), is amended--
       (1) by striking ``and'' before ``(7)''; and
       (2) by inserting before the period the following: ``, and 
     (8) the Federal medical assistance percentage shall be equal 
     to the enhanced FMAP described in section 2105(b) with 
     respect to medical assistance provided for individuals who 
     are covered under section 1925 or section 1931 by virtue of 
     being a parent or other caretaker relative (as defined for 
     purposes of such section) of a child and whose income does 
     not exceed the percentage of the income official poverty line 
     applicable under section 1902(l)(2)(C) to children who are 
     eligible for medical assistance under section 
     1902(l)(1)(D)''.
       (b) Construction.--Nothing in section 1905(b)(8) of the 
     Social Security Act, as added by subsection (a)(2), shall be 
     construed as preventing a State from providing medicaid 
     benefits for individuals whose income exceeds 100 percent of 
     the Federal poverty line at the regular FMAP.
       (c) Effective Date.--The amendments made by this section 
     shall apply to medical assistance for items and services 
     furnished on or after July 1, 2003.

     SEC. 403. ASSISTANCE WITH COVERAGE OF LEGAL IMMIGRANTS UNDER 
                   THE MEDICAID PROGRAM AND SCHIP.

       (a) Medicaid Program.--Section 1903(v) of the Social 
     Security Act (42 U.S.C. 1396b(v)) is amended--

[[Page S5871]]

       (1) in paragraph (1), by striking ``paragraph (2)'' and 
     inserting ``paragraphs (2) and (4)''; and
       (2) by adding at the end the following new paragraph:
       ``(4)(A) A State may elect (in a plan amendment under this 
     title) to provide medical assistance under this title, 
     notwithstanding sections 401(a), 402(b), 403, and 421 of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996, for aliens who are lawfully residing in the 
     United States (including battered aliens described in section 
     431(c) of such Act) and who are otherwise eligible for such 
     assistance, within either or both of the following 
     eligibility categories:
       ``(i) Pregnant women.--Women during pregnancy (and during 
     the 60-day period beginning on the last day of the 
     pregnancy).
       ``(ii) Children.--Children (as defined under such plan), 
     including optional targeted low-income children described in 
     section 1905(u)(2)(B).
       ``(B) In the case of a State that has elected to provide 
     medical assistance to a category of aliens under subparagraph 
     (A), no debt shall accrue under an affidavit of support 
     against any sponsor of such an alien on the basis of 
     provision of assistance to such category and the cost of such 
     assistance shall not be considered as an unreimbursed 
     cost.''.
       (b) SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 
     1397gg(e)(1)) is amended by redesignating subparagraphs (C) 
     and (D) as subparagraph (D) and (E), respectively, and by 
     inserting after subparagraph (B) the following new 
     subparagraph:
       ``(C) Section 1903(v)(4) (relating to optional coverage of 
     categories of permanent resident alien children), but only if 
     the State has elected to apply such section to the category 
     of children under title XIX.''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2003, and apply to medical 
     assistance and child health assistance furnished on or after 
     such date.

     SEC. 404. FLEXIBILITY IN ELIGIBILITY DETERMINATIONS.

       (a) In General.--Section 1902(e) of the Social Security Act 
     (42 U.S.C. 1396a(e)) is amended by adding at the end the 
     following:
       ``(13)(A) Subject to the requirements of this paragraph, at 
     the option of the State, the plan may provide that financial 
     eligibility requirements for medical assistance are met for 
     an individual under 19 years of age (or such higher age as 
     determined by the State) by using a determination (made 
     within a reasonable period, as found by the State, before its 
     use for this purpose) of the individual's family or household 
     income and resources, notwithstanding any differences in 
     budget unit, disregards, deeming, or other methodology, by a 
     Federal or State agency (or a public or private entity making 
     such determination on behalf of such agency) specified by the 
     plan, provided that such agency has fiscal liabilities or 
     responsibilities affected or potentially affected by such 
     determinations, provided that all information furnished by 
     such agency pursuant to this subparagraph is used solely for 
     purposes of determining eligibility for medical assistance 
     under the State plan approved under this title or for child 
     health assistance under a State plan approved under title 
     XXI.
       ``(B) Any State electing the option under subparagraph (A) 
     shall--
       ``(i) ensure that if an individual is determined under such 
     subparagraph to be not eligible for medical assistance under 
     the State plan approved under this title or for child health 
     assistance under a State plan under title XXI, the State must 
     subsequently determine if such individual is eligible for 
     such assistance using the methodology that would otherwise be 
     applicable in determining eligibility for such an individual; 
     and
       ``(ii) ensure that any information furnished by an agency 
     specified in such subparagraph shall be furnished with 
     reasonable promptness to the agency determining eligibility 
     for medical assistance under the State plan approved under 
     this title or for child health assistance under a State plan 
     approved under Title XXI.
       ``(C) Nothing in subparagraph (A) shall be construed to 
     restrict the ability of an individual under 19 years of age 
     (or such higher age as specified by the State) to apply for 
     medical assistance under a State plan approved under this 
     title or for child health assistance under a State plan 
     approved under title XXI under the methodology that would 
     otherwise be applicable in determining eligibility for such 
     an individual.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     takes effect on October 1, 2003.

  Mr. JOHNSON. Mr. President, I rise today with my colleagues, Senators 
Bingaman, Corzine, Lautenberg, Clinton, Kerry and Dayton, to introduce 
the ``Strengthening Our States Act of 2003.'' I thank my colleagues for 
joining me in introducing this legislation that marks a first step in 
helping States being to deal with the fiscal crisis many are now 
facing.
  These challenging economic times have forced many States to make 
tough decisions. Among areas affected, some States have had to start 
cutting benefits in their Medicaid programs in order to make ends meet. 
The result is less access to care and poorer health for our most 
vulnerable populations including: low-income, minorities and the 
elderly. Many States are also struggling to meet the needs of a growing 
uninsured population which continues to worsen as more people lose 
their jobs.
  So far, my home State of South Dakota has been one of the lucky ones. 
We have not had to cut Medicaid program benefits to date and our fiscal 
health overall looks fairly good. I do not however have unrealistic 
expectations that South Dakota is protected from the current economic 
downturn and recognize that it is only a matter of time before my State 
experiences the burden of our neighbors.
  The Strengthening Our States Act or SOS Act provides several 
strategies to address these issues by increasing coverage to the 
uninsured, providing flexibility in existing State Medicaid program and 
providing States with assistance to avoid cuts to existing Medicaid 
coverage. Our proposal will improve the Medicaid program without 
shifting costs to States as does the Bush Medicaid proposal which block 
grants the program. I find it particularly troubling that in times when 
State governments across the country are being forced to reduce or 
eliminate Medicaid services in order to save money, the Administration 
would propose to limit the Federal Government's long-term 
responsibility for the only kind of health program many Americans can 
afford.
  This bill will provide temporary fiscal relief to States through a 
$30 billion increase in the Federal share of Medicaid payments or FMAP. 
Unlike the block grant program the Administration has proposed, our 
bill is responsive to the immediate State needs for financial support 
and will keep these important programs going. Other important bill 
provisions include assistance with the costs of care of the elderly and 
people with disabilities through 100 percent Federal financing of 
Medicare premiums and cost-sharing for low-income groups. The bill 
provides States with new flexibility in administering Medicaid and will 
increase access to care for many uninsured groups. It will also close 
several loopholes in existing law that prevent the disabled from 
accessing health care services while waiting to qualify for Medicare 
coverage. Finally, it will provide increased access to home and 
community based services for people with disabilities through mandatory 
waivers for this type of care.
  States are at their wits end trying to juggle new health care 
priorities. Between smallpox vaccination requirements, Severe Acute 
Respiratory Syndrome surveillance and increased numbers of uninsured 
individuals, States are in great need of every bit of help we can 
provide. Senator Daschle and other colleagues in the Senate just rolled 
out a tax cut proposal that recognizes the current fiscal situation 
experienced in our States and this will provide important relief during 
these challenging times.
  The Strengthening Our States Act is a first step in supporting our 
states and I hope additional steps will follow. By providing immediate 
Medicaid relief, we can ease some of the burden currently faced by many 
State governments and will hopefully prevent crises from erupting in 
others that are working hard to just keep afloat. I urge the Senate to 
support this important legislation.
                                 ______
                                 
      By Mr. CORZINE (for himself and Mr. Lautenberg):
  S. 1013. A bill to amend the Outer Continental Shelf Lands Act to 
permanently prohibit the conduct of offshore drilling on the Outer 
Continental Shelf in the Mid-Atlantic and North Atlantic planning 
areas; to the Committee on Energy and Natural Resources.
  Mr. CORZINE. Mr. President, today, along with Senator Lautenberg, I 
am introducing legislation, the Clean Ocean and Safe Tourism, COAST, 
Anti-Drilling Act, to ban oil and gas drilling off the Mid-Atlantic and 
Northern Atlantic coast.
  The people of New Jersey, and other residents of States along the 
Atlantic Coast, do not want oil or gas rigs anywhere near their 
treasured beaches and fishing grounds. Such drilling poses serious 
threats not to our environment, but to our economy, which depends 
heavily on tourism along our shore.
  Until the Bush Administration came into office, there was no reason 
to suspect that drilling was even a remote

[[Page S5872]]

possibility. Since 1982, a statutory moratorium on leasing activities 
in most Outer Continental Shelf, OCS, areas has been included annually 
in Interior Appropriations acts. In addition, President George H.W. 
Bush declared a leasing moratorium on many OCS areas on June 26, 1990 
under section 12 of the OCS Lands Act. On June 12, 1998, President 
Clinton used the same authority to issue a memorandum to the Secretary 
of the Interior that extended the moratorium through 2012 and included 
additional OCS areas.
  Given the long-standing consensus against drilling in these areas, I 
was deeply disturbed to discover that on May 31, 2001, the Minerals 
Management Service released a request for proposals, RFP, to conduct a 
study of the environmental impacts of drilling in the Mid- and North-
Atlantic. The RFP noted that ``there are areas with some reservoir 
potential, for example off the coast of New Jersey.'' In addition, the 
RFP explained that the study would be conducted ``in anticipation of 
managing the exploitation of potential and proven reserves.'' I believe 
that the RFP was not only inappropriate, but probably illegal, and I 
was pleased when at my urging, the Administration rescinded.
  But the Administration is at it again in the energy bill now before 
the Senate. The bill contains provisions that direct the Department of 
Interior to inventory all potential oil and natural gas resources in 
the entire Outer Continental Shelf, including areas off of the New 
Jersey coast. The bill would allow the use of seismic surveys, dart 
core sampling, and other exploration technologies, which could 
negatively impact coastal and marine areas.
  These provisions run directly counter to language that Congress has 
included annually in appropriations bills to prevent leasing, pre-
leasing, and related activities in most areas of the Outer Continental 
Shelf, including areas off the New Jersey coast.
  In my view, it is time for Congress to act to resolve this question 
once and for all. That is why I am introducing the COAST Anti-Drilling 
Act. This bill would permanently ban drilling for oil, gas and other 
minerals in the Mid- and North-Atlantic.
  I look forward to working with my colleagues to enact this important 
legislation. Doing so would ensure the people of New Jersey and 
neighboring States that they need not fear the specter of oil rigs off 
their beaches. I ask unanimous consent that the text of the legislation 
be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1013

       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 ``Clean Ocean and Safe Tourism 
     Anti-Drilling Act'' or the ``COAST Anti-Drilling Act''.

     SEC. 2. PROHIBITION OF OIL AND GAS LEASING IN CERTAIN AREAS 
                   OF THE OUTER CONTINENTAL SHELF.

       Section 8 of the Outer Continental Shelf Lands Act (43 
     U.S.C. 1337) is amended by adding at the end the following:
       ``(p) Prohibition of Oil and Gas Leasing in Certain Areas 
     of the Outer Continental Shelf.--Notwithstanding any other 
     provision of this section or any other law, the Secretary of 
     the Interior shall not issue a lease for the exploration, 
     development, or production of oil, natural gas, or any other 
     mineral in--
       ``(1) the Mid-Atlantic planning area; or
       ``(2) the North Atlantic planning area.''.
                                 ______
                                 
      By Mr. CORZINE (for himself and Mrs. Clinton):
  S. 1014. A bill to amend title 38, United States Code, to require the 
Secretary of Veterans Affairs in the management of health care services 
for veterans to place certain low-income veterans in a higher health-
care priority category; to the Committee on Veterans' Affairs.
  Mr. CORZINE. Mr. President, I rise today along with Senator Hillary 
Rodham Clinton to change the way the Veterans' Administration defines 
low-income veterans by taking into account variations in the cost of 
living in different parts of the country. The Corzine-Clinton 
legislation would make the Veterans Equitable Resource Allocation just 
that: Equitable.
  More specifically, this bill would replace the national income 
threshold for consideration in Priority Group 5--currently $24,000 for 
all parts of the country--with regional thresholds defined by the 
Department of Housing and Urban Development. This simple but far-
reaching proposal would help low-income veterans across the country 
afford quality health care and ensure that Veterans Integrated Service 
Networks or VISNs receive adequate funding to care for their distinct 
veteran populations.
  Our Nation's veterans have made great sacrifics in defense of 
American freedom and values, and we owe them a tremendous debt of 
gratitude. The United States Congress must ensure that all American 
veterans--veterans who have sweated in the trenches to defend liberty--
have access to quality health care.
  In 1997, Congress implemented the Veterans Equitable Resource 
Allocation system, or VERA, to distribute medical care funding provided 
by the VA. The funding formula was established to better take into 
account the costs associated with various veteran populations. 
Unfortunately, the VERA formula that was created fails to take into 
account regional differences in the cost of living, a significant 
metric in determining veteran healthcare costs. This oversight in the 
VERA formula dangerously shortchanges veterans living in regions with 
high costs of living and elevated healthcare expenses.
  To allocate money to the Veterans Integrated Service Networks, VISNs, 
VERA divides veterans into eight priority groups. Veterans who have no 
service-connected disability and whose incomes fall below $24,000 are 
considered low income and placed in Priority Group 5, while veterans 
whose incomes exceed this national threshold and qualify for no other 
special priorities are placed in either Priority Group 7c or Priority 
Group 8. VERA only reimburses the treating Medical Care facility for 
the care that they provided to veterans in priority groups 1-5 and does 
not provide any Federal reimbursement for the care provided to priority 
group 7 and 8 veterans.
  Using a national threshold for determining eligibility as a low-
income veteran puts veterans living in high cost areas at a decided 
disadvantage. In New Jersey, HUD's fiscal year 2002 standards for 
classification as ``low-income'' exceed $24,000 per year in every 
single county. And some areas exceed the VA baseline by more than 50 
percent. Similarly, HUD's ``low-income'' classification for New York 
City is set at $35,150, and for Nassau and Suffolk Counties, at 
$40,150.
  As a result, regions that have a high cost of living, like VISN 3, 
which encompasses substantial portions of New Jersey and New York, tend 
to have a reduced population of Priority Group 5 veterans and an 
inflated population of Priority Group 7c and 8 veterans.
  The fundamental inequity of the VERA formula is apparent when you 
consider the VERA allocations do not take into account the number of 
veterans classified in Priority Groups 7c and 8. Because of the costs 
associated with these Priority Groups 7c and 8 veterans are not 
considered as part of the VERA allocation, and because high cost of 
living areas have large populations of Priority Group 7c and 8 
veterans, high cost regions must provide care to thousands of veterans 
without adequate funding.
  This additional financial burden on VISNs with large populations of 
non-reimbursable veterans in Priority Group 7c and 8 has had a 
tremendous impact on VISN 3. Since FY 1996, VISN 3 has experienced a 
decline in revenue of 10 percent. As a result of the tremendous 
shortfall in the VISN 3 budget, the VA cannot move forward with plans 
to open clinics in various locations, including prospective clinics in 
Monmouth and Passaic Counties. Consequently, veterans in VISN 3 are 
forced to wait for unreasonably long periods to receive medical care 
and travel long distances to existing clinics, and those veterans who 
are able to access care are being treated in facilities operating under 
tremendous financial difficulty.
  Furthermore, miscategorizing which vets quality as Priority Group 5 
unjustifiably reduces access to medical care for thousands of veterans. 
Under existing rules, veterans placed in Priority and Groups 7c and 8 
must provide a copayment to receive medical care at a VA medical 
facility; Veterans placed in Priority Group 5 receive medical care free 
of charge. Under the existing

[[Page S5873]]

framework, low-income vets in high cost areas are often inappropriately 
placed in Priority Groups 7c and 8, and are forced to provide a 
copayment.
  Recent studies by both the RAND Institute and the General Accounting 
Office identify this flaw in the VERA formula and recommend a 
geographic means test like the one provided in our legislation to 
improve the allocation of resources under VERA. Such a test would 
ensure that the VERA formula allocation better reflects the true costs 
of VA healthcare in the various VISNs in the United States.
  Our legislation would make a simple adjustment to the VERA formula to 
account for variations in the cost of living in different regions. The 
bill would help veterans in high cost areas afford VA health care and 
guarantee that VISNs across the country receive adequate compensation 
for the care they provide.
  I hope my colleagues will join Senator Clinton and me in supporting 
this important bill, and I ask unanimous consent that the text of the 
legislation be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1014

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

     SECTION 1. DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE 
                   PRIORITY FOR CERTAIN LOW-INCOME VETERANS BASED 
                   UPON REGIONAL INCOME THRESHOLDS.

       (a) Change in Priority Category.--Section 1705(a) of title 
     38, United States Code, is amended--
       (1) in paragraph (5)--
       (A) by inserting ``(A) who are'' after ``Veterans'';
       (B) by inserting ``and'' after ``through (4)''; and
       (C) by inserting before the period at the end the 
     following: ``, or (B) who are described in section 1710(a)(3) 
     of this title and are eligible for treatment as a low-income 
     family under section 3(b) of the United States Housing Act of 
     1937 (42 U.S.C. 1437a(b)) for the area in which such veterans 
     reside, regardless of whether such veterans are treated as 
     single person families under paragraph (3)(A) of such section 
     3(b) or as families under paragraph (3)(B) of such section 
     3(b)'';
       (2) by striking paragraph (7); and
       (3) by redesignating paragraph (8) as paragraph (7) and in 
     that paragraph by striking ``paragraph (7)'' and inserting 
     ``paragraph (5)(B)''.
       (b) Conforming Amendment.--Section 1710(f)(4) of such title 
     is amended by striking ``section 1705(a)(7)'' and inserting 
     ``section 1705(a)(5)(B)''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on October 2, 2002.
                                 ______
                                 
      By Mr. DOMENICI:
  S. 1016. A bill to amend title 10, United States Code, to provide 
entitlement to health care for reserve officers of the Armed Forces 
pending orders to initial active duty following commissioning; to the 
Committee on Armed Services.
  Mr. DOMENICI. Mr. President, I rise today to offer legislation 
entitled the ``Jesse Spiri Military Medical Coverage Act of 2003.'' The 
purpose of this legislation is to close a gap in medical coverage that 
leaves a certain group of military officers without health care 
benefits. Named in honor of a young New Mexican who fell victim to this 
gap, this bill would extend coverage to commissioned officers who are 
awaiting active duty status.
  Jesse Spiri grew up in the heart of southwestern New Mexico where his 
family instilled in him both a sense of patriotism and an appreciation 
for higher education. Following his graduation from high school, he 
enrolled at Western New Mexico University where he served in the United 
States Marine Corps Reserves. His dedication to each of these endeavors 
culminated on May 11, 2001 when he received both his bachelors degree 
and his commission as a 2nd Lieutenant. Clearly, Jesse had laid a solid 
foundation for success in his life and, naturally, his family was 
extremely proud. Unfortunately, the pride and all the hopes that 
accompany such a crowning moment were short-lived, because one day 
after his graduation Jesse was diagnosed with brain cancer.
  Under any circumstances, such a prognosis is demoralizing, but 
Jesse's situation was even more grave because receiving his commission 
had the effect of triggering his military status to that of ``inactive 
reservist.'' Jesse was not scheduled to gain ``active duty'' status 
until he began basic officer training in November, and since TRICARE 
does not fully cover reservists, his family was left with the burden of 
enormous medical bills--a burden they simply could not meet.
  Despite the heroic efforts of the Spiri family, inquiries by my staff 
and others in the New Mexico congressional delegation, as well as 
efforts by Marine Corps lawyers to find a legal solution to the 
problem, Jesse Spiri, an officer of the United States Marine Corps, 
went without health care coverage and, hence, without proper treatment. 
He lost his battle with cancer in July of 2001.
  It is inconceivable to me, as I am sure it is for all Americans, that 
because of a legislative quirk, an officer of the United States armed 
forces could be left completely exposed to a dread disease without even 
the hope of receiving available treatments. But Jesse's battle is proof 
that if we do not, through legislative enactment, extend full medical 
coverage to commissioned reservists, another promising life may be lost 
in similar fashion.
  I know that Jim Spiri, Jesse's dad, has vowed to dedicate his life to 
ensuring that no family has to face what his experienced. This goal, 
however, should not take a lifetime to achieve. By passing the ``Jesse 
Spiri Military Medical Coverage Act of 2003,'' we can help give Jim and 
the entire Spiri family peace in knowing that others will have hope 
where Jesse did not.
  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. 1016

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

     SECTION 1. ELIGIBILITY OF RESERVE OFFICERS FOR HEALTH CARE 
                   PENDING ORDERS TO ACTIVE DUTY FOLLOWING 
                   COMMISSIONING.

       Section 1074(a) of title 10, United States Code, is 
     amended--
       (1) by inserting ``(1)'' after ``(a)'';
       (2) by striking ``who is on active duty'' and inserting 
     ``described in paragraph (2)''; and
       (3) by adding at the end the following new paragraph:
       ``(2) Members of the uniformed services referred to in 
     paragraph (1) are as follows:
       ``(A) A member of a uniformed service on active duty.
       ``(B) A member of a reserve component of a uniformed 
     service who has been commissioned as an officer if--
       ``(i) the member has requested orders to active duty for 
     the member's initial period of active duty following the 
     commissioning of the member as an officer;
       ``(ii) the request for orders has been approved;
       ``(iii) the orders are to be issued but have not been 
     issued; and
       ``(iv) the member does not have health care insurance and 
     is not covered by any other health benefits plan.''.
                                 ______
                                 
      By Mr. DeWINE (for himself, Mr. Graham of South Carolina, Mr. 
        Hatch, Mr. Brownback, Mr. Santorum, Mr. Bunning, Mr. Chambliss, 
        Mr. Coleman, Mr. Ensign, Mr. Enzi, Mr. Fitzgerald, Mr. 
        Grassley, Mr. Inhofe, Mr. Kyl, Mr. McCain, Mr. Nickles, Mr. 
        Shelby, Mr. Talent, and Mr. Voinovich):
  S. 1019. A bill to amend titles 10 and 18, United States Code, to 
protect unborn victims of violence; read the first time.
  Mr. DeWINE. Mr. President, the recent nationwide publicity 
surrounding the murder of 27-year-old Laci Peterson and her unborn son, 
Conner, has renewed public concern about violence against the unborn--
and rightfully so.
  Not long ago, the bodies of Laci--who was eight months pregnant at 
the time she disappeared--and Conner were discovered on a rocky 
shoreline of the San Francisco Bay. Baby Conner was found near his 
mother with his umbilical cord still attached.
  Under California State law, intentionally killing a fetus is murder, 
and California prosecutors are seeking to bring separate murder charges 
in the deaths of Laci Peterson and her unborn son. But, I want make it 
very clear to my colleagues here in the Senate that the murder charge 
that California prosecutors will bring for the death of Laci's son 
would not be permitted if that crime were being prosecuted under 
current Federal law. And that--that is why we need to pass and get 
signed into law the Unborn Victims of Violence Act. Let me explain.

[[Page S5874]]

  In about half the States today, 26, if you commit a crime of violence 
against a pregnant woman and her unborn baby dies, you can be punished 
for the violence against both the mother and the unborn child. But, 
tragically, if you commit a Federal crime of violence against a 
pregnant woman and her baby dies, the death of the unborn child could 
essentially go unpunished. Examples of such Federal crimes of violence 
would include kidnapping across State lines, drug-related drive-by 
shootings, or assaults on Federal property.
  This gap in the law leads to glaring injustices. It is time that we 
close this gap once and for all and let justice wrap its arms around 
our society's most vulnerable members.
  That is why, it is imperative that we pass the Unborn Victims of 
Violence Act--once and for all. Today, along with several of my 
distinguished colleagues--Senators Graham of South Carolina, Hatch, 
Brownback, Santorum, Kyl, Voinovich, McCain, Ensign, Enzi, Inhofe, 
Nickles, Bunning, Coleman, Chambliss, Grassley, Fitzgerald, Shelby, and 
Talent--we are re-introducing our legislation. This is the fourth time 
that I have introduced this bill--in fact, it was the first piece of 
legislation that I introduced at the start of the 108th Congress. This 
bill is strongly supported by President Bush, and a companion measure 
passed the House of Representatives in two previous Congresses. I 
intend to take procedural steps that would make this bill eligible to 
be taken up directly by the Senate, without further Committee action.
  I thank my colleagues for their support of this effort, and would 
like to recognize especially Senator Graham of South Carolina, who 
championed this issue on the House side before joining us in the 
Senate. He has worked tirelessly to see to it that the most vulnerable 
are protected. I also would like to thank our lead House sponsors--
Congresswoman Melissa Hart from Pennsylvania and my friend and 
colleague from Ohio, Congressman Steve Chabot. They, too, are working 
tirelessly to get this bill passed by the other Chamber and signed into 
law.
  Our bill would establish new criminal penalties for anyone injuring 
or killing a fetus while committing certain Federal offenses. 
Specifically, this bill would make any murder or injury of an unborn 
child during the commission of certain existing Federal crimes a 
separate crime under Federal law and the Uniform Code of Military 
Justice. Twenty-six, 26, States already have criminalized the killing 
or injuring of unborn victims during a crime.
  We live in a violent world. And sadly, sometimes--perhaps more often 
than we realize--even unborn babies are the targets, intended or 
otherwise, of violent acts. We have to protect these innocent victims. 
I'd like to share some disturbing examples with my colleagues of 
situations where the deaths of unborn children would have gone 
unpunished but for the existence of State criminal laws. If these same 
crimes would have occurred in the 24 States today that don't have such 
State laws, justice would not have been served, because there is simply 
no Federal law in place to try these crimes.
  First, let me talk about the example of Airman Gregory Robbins. In 
1996, Airman Robbins and his family were stationed in my home State of 
Ohio at Wright-Patterson Air Force Base in Dayton. At that time, Mrs. 
Robbins was more than eight months pregnant with a daughter they named 
Jasmine. On September 12, 1996, in a fit of rage, Airman Robbins 
wrapped his fist in a T-shirt and savagely beat his wife by striking 
her repeatedly about the head and abdomen. Fortunately, Mrs. Robbins 
survived the violent assault. Tragically, however, her uterus ruptured 
during the attack, expelling the baby into her abdominal cavity, 
causing Jasmine's death.
  Air Force prosecutors sought to prosecute Airman Robbins for 
Jasmine's death, but neither the Uniform Code of Military Justice nor 
the Federal code makes criminal such an act that results in the death 
or injury of an unborn child. The only available Federal offense was 
for the assault on the mother. This was a case in which the only 
available Federal penalty did not fit the crime. So prosecutors 
bootstrapped the Ohio unborn victims law to convict Airman Robbins of 
Jasmine's death. Fortunately, upon appeal, the court upheld the lower 
court's ruling.
  If it hadn't been for the Ohio law that was already in place, there 
would have been no opportunity to prosecute and punish Airman Robbins 
for the assault against Baby Jasmine. That's why we need a Federal 
remedy to avoid having to bootstrap State laws to provide recourse when 
a violent act occurs during the commission of a Federal crime. A 
Federal remedy will ensure that crimes within Federal jurisdiction 
against unborn victims are punished.
  Let me give you another example. In August 1999, Shiwona Pace of 
Little Rock, AK, was days away from giving birth. She was thrilled 
about her pregnancy. Her boyfriend, Eric Bullock, however, did not 
share her joy and enthusiasm. In fact, Eric wanted the baby to die. So, 
he hired three thugs to beat his girlfriend so badly that she lost the 
unborn baby. According to Shiwona, who testified at a Senate Judiciary 
hearing we held in Washington on February 23, 2000:

       I begged and pleaded for the life of my unborn child, but 
     they showed me no mercy. In fact, one of them told me, ``Your 
     baby is dying tonight.'' I was choked, hit in the face with a 
     gun, slapped, punched, and kicked repeatedly in the stomach. 
     One of them even put a gun in my mouth and threatened to 
     shoot.

  In this particular case, just a few short weeks before this vicious 
attack, Arkansas passed its ``Fetal Protection Act.'' Under the State 
law, Erik Bullock was convicted on February 9, 2001, of capital murder 
against Shiwona's unborn child and sentenced to life in prison without 
parole. He was also convicted of first-degree battery for harm against 
Shiwona.
  In yet another example--this one in Columbus--16-year-old Sean Steele 
was found guilty of two counts of murder for the death of his 
girlfriend Barbara ``Bobbie'' Watkins, age 15, and her 22-week-old, 
unborn child. He was convicted under Ohio's unborn victims law, which 
represented the first murder conviction in Franklin County, OH, in 
which a victim was a fetus.
  Ultimately, the fact is that it is just plain wrong that our Federal 
Government does absolutely nothing to criminalize violent acts against 
unborn children. We cannot allow criminals to get away with murder. We 
must close this loophole.
  As a civilized society, we must take a stand against violent crimes 
against children--especially those waiting to be born. We must close 
this loophole.
  We purposely drafted this legislation very narrowly. Because of that, 
our bill would not permit the prosecution for any abortion to which a 
woman consented. It would not permit the prosecution of a woman for any 
action, legal or illegal, in regard to her unborn child. Our 
legislation would not permit the prosecution for harm caused to the 
mother or unborn child in the course of medical treatment. And finally, 
our bill would not allow for the imposition of the death penalty under 
this Act.
  This is about making sure justice is done when a pregnant woman is 
attacked. And ultimately, I think that everyone in this Chamber would 
agree that people who violently attack unborn babies should be 
punished. When acts of violence against unborn victims fall within 
federal jurisdiction, we must have a penalty. We have an obligation to 
our unborn children who cannot speak for themselves. I think Shiwona 
Pace said it best she testified at our hearing: ``The loss of any 
potential life should never be in vain.''
  I strongly urge my colleagues to join 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. 1019

       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 ``Unborn Victims of Violence 
     Act of 2003''.

     SEC. 2. PROTECTION OF UNBORN CHILDREN.

       (a) In General.--Title 18, United States Code, is amended 
     by inserting after chapter 90 the following:

              ``CHAPTER 90A--PROTECTION OF UNBORN CHILDREN

``Sec.
``1841. Causing death of or bodily injury to unborn child.

[[Page S5875]]

     ``Sec. 1841. Causing death of or bodily injury to unborn 
       child

       ``(a)(1) Any person who engages in conduct that violates 
     any of the provisions of law listed in subsection (b) and 
     thereby causes the death of, or bodily injury (as defined in 
     section 1365) to, a child, who is in utero at the time the 
     conduct takes place, is guilty of a separate offense under 
     this section.
       ``(2)(A) Except as otherwise provided in this paragraph, 
     the punishment for that separate offense is the same as the 
     punishment provided for that conduct under Federal law had 
     that injury or death occurred to the unborn child's mother.
       ``(B) An offense under this section does not require proof 
     that--
       ``(i) the person engaging in the conduct had knowledge or 
     should have had knowledge that the victim of the underlying 
     offense was pregnant; or
       ``(ii) the defendant intended to cause the death of, or 
     bodily injury to, the unborn child.
       ``(C) If the person engaging in the conduct thereby 
     intentionally kills or attempts to kill the unborn child, 
     that person shall be punished as provided under section 1111, 
     1112, or 1113, as applicable, for intentionally killing or 
     attempting to kill a human being, instead of the penalties 
     that would otherwise apply under subparagraph (A).
       ``(D) Notwithstanding any other provision of law, the death 
     penalty shall not be imposed for an offense under this 
     section.
       ``(b) The provisions referred to in subsection (a) are the 
     following:
       ``(1) Sections 36, 37, 43, 111, 112, 113, 114, 115, 229, 
     242, 245, 247, 248, 351, 831, 844(d), 844(f), 844(h)(1), 
     844(i), 924(j), 930, 1111, 1112, 1113, 1114, 1116, 1118, 
     1119, 1120, 1121, 1153(a), 1201(a), 1203, 1365(a), 1501, 
     1503, 1505, 1512, 1513, 1751, 1864, 1951, 1952(a)(1)(B), 
     1952(a)(2)(B), 1952(a)(3)(B), 1958, 1959, 1992, 2113, 2114, 
     2116, 2118, 2119, 2191, 2231, 2241(a), 2245, 2261, 2261A, 
     2280, 2281, 2332, 2332a, 2332b, 2340A, and 2441 of this 
     title.
       ``(2) Section 408(e) of the Controlled Substances Act of 
     1970 (21 U.S.C. 848(e)).
       ``(3) Section 202 of the Atomic Energy Act of 1954 (42 
     U.S.C. 2283).
       ``(c) Subsection (a) does not permit prosecution--
       ``(1) for conduct relating to an abortion for which the 
     consent of the pregnant woman has been obtained or for which 
     such consent is implied by law in a medical emergency;
       ``(2) for conduct relating to any medical treatment of the 
     pregnant woman or her unborn child; or
       ``(3) of any woman with respect to her unborn child.
       ``(d) In this section--
       ``(1) the terms `child in utero' and `child, who is in 
     utero' mean a member of the species homo sapiens, at any 
     stage of development, who is carried in the womb; and
       ``(2) the term `unborn child' means a child in utero.''.
       (b) Clerical Amendment.--The table of chapters for part I 
     of title 18, United States Code, is amended by inserting 
     after the item relating to chapter 90 the following:

``90A. Causing death of or bodily injury to unborn child....1841''.....

     SEC. 3. MILITARY JUSTICE SYSTEM.

       (a) Protection of Unborn Children.--Subchapter X of chapter 
     47 of title 10, United States Code (the Uniform Code of 
     Military Justice), is amended by inserting after section 919 
     (article 119) the following:

     ``Sec. 919a. Art. 119a. Causing death of or bodily injury to 
       unborn child

       ``(a)(1) Any person subject to this chapter who engages in 
     conduct that violates any of the provisions of law listed in 
     subsection (b) and thereby causes the death of, or bodily 
     injury (as defined in section 1365 of title 18) to, a child, 
     who is in utero at the time the conduct takes place, is 
     guilty of a separate offense under this section.
       ``(2)(A) Except as otherwise provided in this paragraph, 
     the punishment for that separate offense is the same as the 
     punishment for that conduct under this chapter had that 
     injury or death occurred to the unborn child's mother.
       ``(B) An offense under this section does not require proof 
     that--
       ``(i) the person engaging in the conduct had knowledge or 
     should have had knowledge that the victim of the underlying 
     offense was pregnant; or
       ``(ii) the defendant intended to cause the death of, or 
     bodily injury to, the unborn child.
       ``(C) If the person engaging in the conduct thereby 
     intentionally kills or attempts to kill the unborn child, 
     that person shall be punished as provided under section 918, 
     919, or 880 of this title (article 118, 119, or 80), as 
     applicable, for intentionally killing or attempting to kill a 
     human being, instead of the penalties that would otherwise 
     apply under subparagraph (A).
       ``(D) Notwithstanding any other provision of law, the death 
     penalty shall not be imposed for an offense under this 
     section.
       ``(b) The provisions referred to in subsection (a) are 
     sections 918, 919(a), 919(b)(2), 920(a), 922, 924, 926, and 
     928 of this title (articles 111, 118, 119(a), 119(b)(2), 
     120(a), 122, 124, 126, and 128).
       ``(c) Subsection (a) does not permit prosecution--
       ``(1) for conduct relating to an abortion for which the 
     consent of the pregnant woman has been obtained or for which 
     such consent is implied by law in a medical emergency;
       ``(2) for conduct relating to any medical treatment of the 
     pregnant woman or her unborn child; or
       ``(3) of any woman with respect to her unborn child.
       ``(d) In this section--
       ``(1) the terms `child in utero' and `child, who is in 
     utero' mean a member of the species homo sapiens, at any 
     stage of development, who is carried in the womb; and
       ``(2) the term `unborn child' means a child in utero.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of subchapter X of chapter 47 of title 10, United 
     States Code (the Uniform Code of Military Justice), is 
     amended by inserting after the item relating to section 919 
     the following:

``919a. 119a. Causing death of or bodily injury to unborn child.''.

  Mr. HATCH. Mr. President, I rise today to offer my support for the 
introduction of S. 119, the Unborn Victims of Violence Act of 2003. I 
applaud Senators DeWine and Lindsey Graham for their longstanding and 
essential leadership on this issue in the Senate and the House. The 
importance of this issue is made tragically clear by the recent murder 
of Laci Peterson and her unborn son, Conner.
  In my home State of Utah, if a criminal assaults or kills a woman who 
is pregnant and thereby causes death or injury to the unborn child, the 
criminal faces the possibility of being prosecuted for having taken or 
injured that unborn life. Twenty-five additional States have similar 
laws on the books. Eleven of those States recognize the unborn child as 
a victim throughout the entire period of prenatal development. This is 
only proper and, it seems to me, only just.
  But under existing Federal criminal statutes, if a criminal assaults 
or kills a woman who is pregnant and thereby causes death or injury to 
that unborn child, the criminal faces no consequences in our Federal 
criminal justice system for taking or injuring that innocent, unborn 
life. This is wrong and it is not justified.
  This bill fixes the gap in Federal law by making it a separate 
Federal offense to kill or injure an unborn child during the commission 
of certain already-defined Federal crimes committed against the unborn 
child's mother. This bill does not usurp jurisdiction over States that 
do not currently have laws that protect unborn victims of violence. It 
only applies to Federal crimes.
  I cannot imagine why anyone would oppose this bill. The only reason 
for opposition that I can suppose is that some in the pro-choice 
movement believe that our bill draws attention to the effort to 
dehumanize, desensitize, and depersonalize the unborn child. Given the 
political and legal arguments of abortion supporters, it may be 
difficult for them to concede an unborn child is human and therefore a 
victim of a crime.
  Nevertheless, it is not our intention in this bill to turn the debate 
into a battle on abortion. In no way does this bill interfere with the 
ability of a woman to have an abortion under current law. The bill 
specifically does not apply to a woman who engages in any action, legal 
or illegal, in regard to her unborn child. Therefore, it would not 
apply to any abortion to which a woman consents. In my view, we should 
all be able to support this modest effort to protect mothers and their 
unborn children.
  Some will try to claim that this bill weakens domestic violence laws 
by diverting attention to the unborn. That is simply not true. I am a 
strong supporter of domestic violence laws in this Nation. I believe 
domestic violence is an evil plague that needs to be stopped.
  For nearly 15 years, I have worked hard on the issue of domestic 
violence and violence against women. And when I stand here today before 
the entire United States Senate and offer my support for a bill, I 
certainly make sure that bill does not diminish in any way our capacity 
and will to curb domestic violence and protect women. This bill, in 
fact, strengthens domestic violence laws by making it a separate 
criminal offense under our Federal legal system to cause death or 
injury to an unborn child as a result of violence.
  For several months now, the Nation has watched in the media the 
unfortunate and tragic story of Laci Peterson. She was an expectant 
mother from California who mysteriously vanished shortly before 
Christmas. In mid-April, her decomposing body and the body of her 
unborn child washed ashore at a San Francisco-area beach.

[[Page S5876]]

  The Nation has witnessed a community in mourning over the 
disappearance and death of Laci Peterson and her unborn son, Conner. 
Laci Peterson was the truly tragic victim of violence that not only 
took her life but also the innocent life of her unborn son. This is a 
truly devastating story, especially for those who knew and loved Laci 
Peterson and eagerly awaited the birth of her son Conner. I want to do 
what I can to see that justice is served if there is ever a case 
similar to this that comes before our Federal judicial system, and that 
is why I support this measure.
  A Fox News/Opinion Dynamics Poll conducted on April 22 and 23 
indicated that of the 900 registered voters polled, 49 percent 
considered themselves pro-choice while only 41 percent said they are 
pro-life. But what is even more interesting is this same poll showed 84 
percent believed Scott Peterson should be charged with two counts of 
homicide for murdering his wife and unborn son. California law permits 
criminals to be charged with murder for killing an unborn child when it 
has developed past the embryonic stage.
  Now remember, the majority of those polled in this survey said they 
were pro-choice. But the tragic murder of an innocent, unborn child is 
shocking and twisted enough that, regardless of any stance on abortion, 
the vast majority of Americans strongly believe an unborn life taken in 
murder should result in murder charges brought against the perpetrator. 
It is only fair and just to ask for our Federal judicial system to 
incorporate such a strong desire of the American people.
  Some will try to confuse the issue here. Let me be clear, the debate 
on this bill is not about abortion--far from it. It does not affect 
current law regarding abortion. This bill does not in any way interfere 
with or weaken domestic violence laws or laws intended to prevent 
violence against women. This is a simple remedy to a terrible crime. I 
hope that Congress will seriously consider this bill and promptly pass 
it.
                                 ______
                                 
      By Mr. HATCH (for himself, Mr. Leahy, Mr. Cornyn, Mr. Kennedy, 
        Mr. Alexander, Mr. Chambliss, Mr. Durbin, and Ms. Collins):
  S. 1023. A bill to increase the annual salaries of justices and 
judges of the United States; to the Committee on the Judiciary.
  Mr. HATCH. Mr. President, I rise to address the serious matter of the 
erosion of pay for the Federal judiciary. There is consensus among all 
who have seriously looked at this issue that the independence and 
quality of the judiciary is at risk because of the inadequacy of the 
current salaries of Federal judges.
  The American Bar Association and Federal Bar Association issued a 
report on this issue in February 2001. That report documented the 
factors impacting erosion of judicial pay and the detrimental effects 
on the judiciary. Because of the withholding of cost-of-living 
adjustments, the impact of inflation, and the insufficient attempts to 
stabilize judicial pay, Federal judges are increasingly choosing to 
resign or retire. Furthermore, the report noted, the prospect of a 
declining salary in real terms also discourages potential candidates 
from seeking appointments to the bench.
  In his 2002 Year-End Report, Supreme Court Chief Justice William 
Rehnquist identified the need to increase judicial pay as the most 
pressing issue facing the judiciary. He highlighted his concern that 
salaries of Federal judges have not kept pace with those of lawyers in 
private firms and in business. He observed, ``Inadequate compensation 
seriously compromises the judicial independence fostered by life 
tenure. That low salaries might force judges to return to the private 
sector rather than stay on the bench risks affecting judicial 
performance--instead of serving for life, those judges would serve the 
terms their finances would allow, and they would worry about what 
awaits them when they return to the private sector.''
  In the Report of the National Commission on the Public Service, 
issued January 2003, the Chairman of the Commission, Paul Volker, made 
this observation: ``Judicial salaries are the most egregious example of 
the failure of Federal compensation policies. Federal judicial salaries 
have lost 24 percent of their purchasing power since 1969, which is 
arguably inconsistent with the Constitutional provision that judicial 
salaries may not be reduced by Congress. . . . The lag in judicial 
salaries has gone on too long, and the potential for diminished quality 
in American jurisprudence is now too large.'' Accordingly, the 
Commission made the recommendation that Congress should grant an 
immediate and significant increase in judicial, executive and 
legislative salaries to ensure a reasonable relationship to other 
professional opportunities.
  Responding to this report and recommendation, the Judicial 
Conference, at its recent meeting, unanimously adopted a Resolution 
which contains in part the following:

       ``Whereas, the President at the request of the Chief 
     Justice has agreed to support legislation that would increase 
     judicial salaries by 16.5 percent, which will yield an 
     average of $24,948, across all levels of judicial offices;
       Now therefore, the Committee on the Judicial Branch 
     recommends that the Judicial Conference endorse and 
     vigorously seek legislation that would increase judicial 
     salaries by 16.5 percent, which will yield an average of 
     $24,948, across all levels of judicial offices.''

  Today, Senator Leahy and I, joined by Senator Cornyn, Senator 
Kennedy, Senator Alexander, Senator Collins, Senator Durbin, and 
Senator Chambliss are introducing a bill that will restore the lost 
cost-of-living adjustments which were denied to the judiciary and will 
help reduce the gap between Federal judicial salaries and private 
sector salaries which still remains.
  This legislation enacts a 16.5 percent increase in the salaries of 
the justices of the Supreme Court and other Federal judges appointed 
under Article III of the Constitution, an average salary increase of 
about $25,000. It does so without altering the respective provisions of 
title 28, United States Code, which defines their salary rates. The pay 
adjustment would be effective with the first pay period beginning on or 
after January 1, 2004, and would be applied before any annual salary 
adjustment authorized under the Employment Cost Index approval 
mechanism provided by 28 U.S.C. Sec.  461.
  The judicial officers enumerated in this bill to receive the 16.5 
percent pay increase are the Chief Justice of the United States, 
associate justices of the Supreme Court, United States circuit judges, 
United States district judges, and judges of the United States Court of 
International Trade. In addition, this legislation would have the 
effect of increasing salaries of the judges of the U.S. Court of 
Federal Claims, bankruptcy judges and full-time United States 
magistrate judges whose salaries are related to the rate of pay of 
United States district judges.
  This legislation will do much to improve retention on the bench and 
will aid in the recruitment of outstanding judicial candidates. I urge 
my colleagues to join Senator Leahy, Senator Cornyn, Senator Kennedy, 
Senator Alexander, Senator Collins, Senator Durbin, Senator Chambliss 
and me in this bipartisan measure.
  I ask unanimous consent that the Judicial Conference Resolution, as 
well as the text of the legislation be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                  Judicial Branch Committee Resolution

       Whereas, in January 2003, the National Commission on the 
     Public Service declared that ``Congress should grant an 
     immediate and significant increase in judicial, executive, 
     and legislative salaries to ensure a reasonable relationship 
     to other professional opportunities;'' and
       Whereas, the National Commission also declared that 
     ``[j]udicial salaries are the most egregious example of the 
     failure of federal compensation policies''; and
       Whereas, the National Commission found that ``that the lag 
     in judicial salaries has gone on too long, and the potential 
     for the diminished quality in American jurisprudence is now 
     too large''; and
       Whereas, the National Commission recommended that Congress' 
     and the President's ``first priority should . . . be an 
     immediate and substantial increase in judicial salaries''; 
     and
       Whereas, the President at the request of the Chief Justice 
     has agreed to support legislation that would increase 
     judicial salaries by 16.5 percent, which will yield an 
     average of $24,948 across all levels of judicial offices;
       Now therefore, the Committee on the Judicial Branch 
     recommends that the Judicial Conference endorse and 
     vigorously seek legislation that would increase judicial 
     salaries

[[Page S5877]]

     by 16.5 percent, which will yield an average of $24,948, 
     across all levels of judicial offices.

                                S. 1023

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

     SECTION 1. JUDICIAL SALARY INCREASE.

       The annual salaries of the Chief Justice of the United 
     States, associate justices of the Supreme Court of the United 
     States, United States circuit judges, United States district 
     judges, judges of the United States Court of International 
     Trade, and judges of the United States Court of Federal 
     Claims are increased in the amount of 16.5 percent of their 
     respective existing annual salary rates, rounded to the 
     nearest $100 (or, if midway between multiples of $100, to the 
     next higher multiple of $100).

     SEC. 2. COORDINATION RULE.

       If a pay adjustment under section 1 is to be made for an 
     office or position as of the same date that any other pay 
     adjustment would take effect for such office or position, the 
     adjustment under this Act shall be made first.

     SEC. 3. EFFECTIVE DATE.

       This Act shall take effect on the first day of the first 
     applicable pay period beginning on or after January 1, 2004.

                          ____________________