Congressional Record, Volume 149 Issue 96 (Thursday, June 26, 2003)

[Congressional Record Volume 149, Number 96 (Thursday, June 26, 2003)]
[Senate]
[Pages S8679-S8685]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PRESCRIPTION DRUG AND MEDICARE IMPROVEMENT ACT OF 2003--Continued

Amendment No. 1132

Mr. SANTORUM. Mr. President, I call up amendment No. 1132 and ask for
its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Pennsylvania [Mr. Santorum] proposes an
amendment numbered 1132.

Mr. SANTORUM. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To allow eligible beneficiaries in MedicareAdvantage plans to
elect zero premium, stop-loss drug coverage protection)

On page 343, between lines 15 and 16, insert the following:
``(f) Zero Premium Stop-Loss Protection and Access to
Negotiated Prices For Eligible Beneficiaries Enrolled in
MedicareAdvantage Plans.--
``(1) In general.--Notwithstanding any provision of this
part or part D, a MedicareAdvantage plan shall be treated as
meeting the requirements of this section if, in lieu of the
qualified prescription drug coverage otherwise required, the
plan makes available such coverage with the following
modifications:
``(A) No premium.--Notwithstanding subsection (d) or
sections 1860D-13(e)(2) and 1860D-17, the amount of the
MedicareAdvantage monthly beneficiary obligation for
qualified prescription drug coverage shall be zero.
``(B) Beneficiary receives access to negotiated prices and
stop-loss protection for no additional premium.--
Notwithstanding section 1860D-6, qualified prescription drug
coverage shall include coverage of covered drugs that meets
the following requirements:
``(i) The coverage has cost-sharing (for costs up to the
annual out-of-pocket limit under subsection (c)(4) of such
section) that is equal to 100 percent.
``(ii) The coverage provides the limitation on out-of-
pocket expenditures under such subsection (c)(4), except that
in applying such subsection, `$5000.00' shall be substituted
for `$3,700' in subparagraph (B)(i)(I) of such subsection.
``(iii) The coverage provides access to negotiated prices
under subsection (e) of such section during the entire year.
``(C) Application of low-income subsidies.--Notwithstanding
subsection (f) or section 1860D-19, the Administrator shall
not apply the following provisions of subsection (a) of such
section:
``(i) Subparagraphs (A), (B), (C), and (D) of paragraph
(1).
``(ii) Subparagraphs (A), (B), (C), and (D) of paragraph
(2).
``(iii) Clauses (i), (ii), (iii), and (iv) of paragraph
(3)(A).
``(2) Penalty for enrolling in a zero premium stop-loss
protection plans after initial eligibility for such
enrollment.--In the case of an eligible beneficiary that
enrolled in a plan offered pursuant to this subsection at any
time after the initial enrollment period described in section
1860D-2, the Secretary shall establish procedures for
imposing a monthly beneficiary obligation for enrollment
under such plan. The amount of such obligation shall be an
amount that the Administrator determines is actuarially sound
for each full 12-month period (in the same continuous period
of eligibility) in which the eligible beneficiary could have
been enrolled under such a plan but was not so enrolled. The
provisions of subsection (b) of such section shall apply to
the penalty under this paragraph in a manner that is similar
to the manner such provisions apply to the penalty under part
D.
``(3) Procedures.--The Administrator shall establish
procedures to carry out this subsection. Under such
procedures, the Administrator may waive or modify any of the
preceding provisions of this part or part D to the extent
necessary to carry out this subsection.
``(4) No effect on medicare drug plans.--This subsection
shall have no effect on eligible beneficiaries enrolled under
part D in a Medicare Prescription Drug plan or under a
contract under section 1860D-13(e).''

Mr. SANTORUM. Mr. President, one of the key components that many
Members on this side of the aisle would like to see accomplished is to
draw as many people as possible into the competitive model set up in
this bill. We believe it is the more efficient, higher quality delivery
of health care services, the Medicare Advantage plan.
Unfortunately, through negotiations, a lot of the incentives the
President has to encourage people to get into those plans and thereby
make them work have been taken out in the current version on the floor.
That is to the great consternation, I know, of the White House and many
Members on this side of the aisle.
For quite some time I have been trying to think how they can create
incentives--carrots, if you will, as opposed to sticks--to encourage
people to get into these kinds of plans. Originally, I intended to
offer a differential benefit--in other words, a benefit that would have
what I call a standard benefit in the fee-for-service option and an
enhanced benefit in the Medicare Advantage option. I was fairly
convinced, in discussing with the people on my side of the aisle, we
probably would not have a chance to succeed; that there were people who
had made commitments that a differential benefit was not something for
this time.
I went about trying to figure out, could we create incentives to
people to come into Medicare Advantage, which I believe is the future
of Medicare and the best way to run the system without creating a
differential benefit. The amendment before the Senate does that. The
amendment before the Senate creates an option for beneficiaries who
participate in Medicare Advantage. It is a pharmaceutical option.
Instead of just having no pharmaceutical benefit, which you could if
you do not get into the Medicare Advantage Program, we have the
standard benefit which is required if you participate in the PPOs,
HMOs, and POSs that will be created here.
What I will do with this amendment is create another option for
seniors who select Medicare Advantage. That option would be a zero
premium catastrophic benefit. So you could choose between the standard
benefit, the $35 premium, and the 50 percent copay, and the donut hole,
and all the things described over and over again, or if you did not
want to pay a premium but wanted some catastrophic coverage,

[[Page S8680]]

wanted some benefit, no premium, no cost, you could join this.
The CBO scored this as attracting twice as many people into the PPOs
and HMOs as the underlying bill. It would make those plans much more
desirable for beneficiaries. I believe that should be one of the goals
of this legislation, to make the new and improved and stronger plan a
more robust plan.
Unfortunately, according to the Congressional Budget Office, when
people move from the fee-for-service plan into the Medicare Advantage
plan, the Congressional Budget Office assumes those plans will be more
expensive. And because they will be more expensive, this amendment
costs money. It doubles the participation but costs $20, to $25
billion, which is the back of the envelope. And God bless the CBO; that
is the best they could do at this late hour.
I firmly believe this is a reasonable compromise between those who
would not want to have the differential benefit and those who would
because it is unfair to the fee-for-service participants and those who
believe we need to have an incentive for people to get into the
Medicare Advantage Program. This strikes the compromise. This is where
we could go.
There are all sorts of things we have done to eliminate adverse
selection and all the other problems inherent in offering two different
benefits. We believe we actually address the vast majority of those
problems in this amendment. Nevertheless, we have run into the
roadblock that this bill has run into the entire time when it comes to
the competitive model and CBO and their estimation of costs.
For the record, the White House does not see it that way. The White
House sees the competitive model as saving money. Under their scoring,
this would probably actually save money and move people into a higher
quality, more efficient system.

Amendment No. 1132 Withdrawn

As a result of the fact of the score which is $20 to $25 billion, and
we do not have that, I am going to withdraw my amendment and hope this
idea which I believe is in the center here is a compromise between two
competing ideas of how to structure this bill.
It will be considered in conference as a way of trying to bring the
two sides together in something that does not disadvantage the fee-for-
service plan but creates an opportunity for incentives to go to the
Medicare Advantage plan.
Mr. President, with that I ask unanimous consent to withdraw my
amendment.
The PRESIDING OFFICER. The amendment is withdrawn.
The Senator from Oklahoma.
Mr. NICKLES. I compliment my colleague from Pennsylvania. Especially
this late at night, when a lot of us are thinking about our departed
friend and colleague, Senator Thurmond, I appreciate his withdrawing
this amendment.
For the information of our colleagues, I think we are very close to
finishing this bill. We may have one or two rollcall votes. I think we
are just about ready to vote on the Feinstein-Chafee amendment and
possibly one other amendment, and I think we are very close to be able
to vote on final passage, for the information of our colleagues.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. KENNEDY. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 1060

Mr. KENNEDY. Mr. President, I will just take a moment to address the
amendment of the Senator from California, Mrs. Feinstein, and her
colleagues, in terms of means testing the Medicare system. That is what
we would be doing, changing what is effectively an insurance system
into a welfare system. There is, really, no question about that.
The fact is, the Part B of the Medicare system is basically a
progressive system as it is at the present time. Wealthy people are
paying a great deal more into that system than they are taking out.
My concern is, if this passes, it is only a question of time before
the healthiest individuals who can qualify under the Part B premium are
going to leave the Medicare system and it is going to deteriorate into
a general welfare system. The kind of Medicare system seniors relied
on, day in and day out, would be destroyed. Make no mistake about it.
That is why the AARP is strongly opposed to it, as well as the
National Committee to Preserve Social Security.
I hope this amendment is not accepted. I suggest the absence of a
quorum.
The PRESIDENT pro tempore. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. GRASSLEY. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDENT pro tempore. Without objection, it is so ordered.

Amendment No. 990, As Modified

Mr. GRASSLEY. Mr. President, I ask unanimous consent that amendment
No. 990, previously adopted, be modified with language I send to the
desk.
The PRESIDENT pro tempore. Without objection, it is so ordered.
The amendment is as follows:

At the end of subtitle A of title II, add the following:

SEC. __. IMPROVEMENTS IN MEDICAREADVANTAGE BENCHMARK
DETERMINATIONS.

(c) Inclusion of Costs of DOD and VA Military Facility
Services to Medicare-eligible Beneficiaries in Calculation of
MedicareAdvantage Payment Rates.--
(1) For purposes of calculating medicare+choice payment
rates.--Section 1853(c)(3) (42 U.S.C. 1395w-23(c)(3)), as
amended by section 203, is amended--
(A) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (E)''; and
(B) by adding at the end the following new subparagraph:
``(E) Inclusion of costs of dod and va military facility
services to medicare-eligible beneficiaries.--In determining
the area-specific Medicare+Choice capitation rate under
subparagraph (A) for a year (beginning with 2006), the annual
per capita rate of payment for 1997 determined under section
1876(a)(1)(C) shall be adjusted to include in the rate the
Secretary's estimate, on a per capita basis, of the amount of
additional payments that would have been made in the area
involved under this title if individuals entitled to benefits
under this title had not received services from facilities of
the Department of Defense or the Department of Veterans
Affairs.''.
(2) For purposes of calculating local fee-for-service
rates.--Section 1853(d)(5) (42 U.S.C. 1395w-23(d)(5)), as
amended by section 203, is amended--
(A) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (C)''; and
(B) by adding at the end the following new subparagraph:
``(C) Inclusion of costs of dod and va military facility
services to medicare-eligible beneficiaries.--In determining
the local fee-for-service rate under subparagraph (A) for a
year (beginning with 2006), the annual per capita rate of
payment for 1997 determined under section 1876(a)(1)(C) shall
be adjusted to include in the rate the Secretary's estimate,
on a per capita basis, of the amount of additional payments
that would have been made in the area involved under this
title if individuals entitled to benefits under this title
had not received services from facilities of the Department
of Defense or the Department of Veterans Affairs.''.
(d) Effective Date.--The amendments made by this section
shall apply with respect to plan years beginning on and after
January 1, 2006.

Amendment No. 960, As Modified

Mr. GRASSLEY. Mr. President, I ask unanimous consent that Senator
Dayton's amendment, No. 960, be modified with the modification that I
send to the desk.
The PRESIDENT pro tempore. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To require a streamlining of the medicare regulations)

At the end of subtitle A of title V, add the following:

SEC. __. STREAMLINING AND SIMPLIFICATION OF MEDICARE
REGULATIONS.

[[Page S8681]]

(1) reduce the number of words comprising all regulations
by at least two-thirds by October 1, 2004, and
(2) ensure the simple, effective, and efficient operation
of the medicare program.
(c) Application of the Paperwork Reduction Act.--The
Secretary shall apply the provisions of chapter 35 of title
44, United States Code (commonly known as the ``Paperwork
Reduction Act'') to the provisions of this Act to ensure that
any regulations issued to implement this Act are written in
plain language, are streamlined, promote the maximum
efficiency and effectiveness of the medicare and medicaid
programs without harming beneficiaries or providers, and
minimize the burdens the payment systems affected by this Act
impose on both beneficiaries and providers.
If the Secretary determines that the two-thirds reduction
in words by October 1, 2004 required in (b)(1) is not
feasible, he shall inform Congress in writing by July 1, 2004
of the reasons for its infeasibility. He shall then establish
a possible reduction to be achieved by January 1, 2005.

Vitiation Of Vote On Amendment No. 1041

Mr. GRASSLEY. Mr. President, I ask unanimous consent to vitiate the
vote by which amendment No. 1040 was adopted.
Mr. BAUCUS. Amendment No. 1041.
Mr. GRASSLEY. I am sorry, No. 1041.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 1096

Mr. GRASSLEY. I ask unanimous consent that the pending amendment be
temporarily set aside, amendment No. 1096 be called up, adopted, and
the motion to reconsider be laid on the table.
The PRESIDENT pro tempore. Without objection, it is so ordered.
The amendment (No. 1096) was agreed to, as follows:

(Purpose: To require the Secretary of Health and Human Services to
conduct a frontier extended stay clinic demonstration project)

On page 529, between lines 8 and 9, insert the following:

SEC. 455. FRONTIER EXTENDED STAY CLINIC DEMONSTRATION
PROJECT.

(a) Authority To Conduct Demonstration Project.--The
Secretary shall waive such provisions of the medicare program
established under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) as are necessary to conduct a
demonstration project under which frontier extended stay
clinics described in subsection (b) in isolated rural areas
are treated as providers of items and services under the
medicare program.
(b) Clinics Described.--A frontier extended stay clinic is
described in this subsection if the clinic--
(1) is located in a community where the closest short-term
acute care hospital or critical access hospital is at least
75 miles away from the community or is inaccessible by public
road; and
(2) is designed to address the needs of--
(A) seriously or critically ill or injured patients who,
due to adverse weather conditions or other reasons, cannot be
transferred quickly to acute care referral centers; or
(B) patients who need monitoring and observation for a
limited period of time.
(c) Definitions.--In this section, the terms ``hospital''
and ``critical access hospital'' have the meanings given such
terms in subsections (e) and (mm), respectively, of section
1861 of the Social Security Act (42 U.S.C. 1395x).

Amendment No. 989, As Modified

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the Collins
amendment, amendment No. 989, be modified with modifications that I
send to the desk.
The PRESIDENT pro tempore. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To increase medicare payments for home health services
furnished in a rural area)

At the appropriate place in subtitle C of title IV, insert
the following:

SEC. __. INCREASE IN MEDICARE PAYMENT FOR CERTAIN HOME HEALTH
SERVICES.

(a) In General.--Section 1895 of the Social Security Act
(42 U.S.C. 1395fff) is amended by adding at the end the
following:
``(f) Increase in Payment for Services Furnished in a Rural
Area.--
``(1) In general.--In the case of home health services
furnished in a rural area (as defined in section
1886(d)(2)(D)) on or after October 1, 2004 and before October
1, 2006, the Secretary shall increase the payment amount
otherwise made under this section for such services by 10
percent.
``(2) Waiver of budget neutrality.--The Secretary shall not
reduce the standard prospective payment amount (or amounts)
under this section applicable to home health services
furnished during any period to offset the increase in
payments resulting from the application of paragraph (1).''.
(b) Payment Adjustment.--Section 1895(b)(5) of the Social
Security Act (42 U.S. C. 1395fff(b)(5)) is amended by adding
at the end the following: ``Notwithstanding this paragraph,
the total amount of the additional payments or payment
adjustments made under this paragraph may not exceed, with
respect to fiscal year 2004, 3 percent, and, with respect to
fiscal years 2005 and 2006, 4 percent, of the total payments
projected or estimated to be made based on the prospective
payment system under this subsection in the year involved.''.
(c) Effective Date.--The amendments made by this section
shall apply to services furnished on or after October 1,
2003.

Amendments Nos. 1122, 1074, 1023, 1114, 1115, 1045, 1058, 1117, 1044,
1056, 996, 1013, 1121, 989, as modified, 1126, 996, 1118, 1085, 1017,
968, 948, 960 as modified, 1054, And 1030

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the pending
amendments be temporarily set aside and that the following amendments
be called up en bloc: No. 1122, Brownback; No. 1074, Coleman; No. 1023,
Collins; No. 1114, Kyl; No. 1115, Kyl; No. 1045, Chambliss; No. 1058,
Craig; No. 1117, Baucus; No. 1044, Bayh; No. 1056, Shelby; No. 996,
Reed of Rhode Island; Bond amendment No. 1013; Kyl, No. 1128; Collins,
No. 989, as modified; Dole, No. 1126, with Edwards added as a
cosponsor; Reed of Rhode Island, No. 996; Specter, No. 1118; Specter,
No. 1085.
The PRESIDENT pro tempore. Is there objection?
Mr. BAUCUS. Mr. President, this side agrees.
The PRESIDENT pro tempore. Is there objection?
If not, the amendments will be considered en bloc.
The amendments are as follows:
(Amendments Nos. 1122 and 1117 are printed in today's Record under
``Text of Amendments.'')
(Amendments Nos. 1017, 968, 948, 1054 and 1030 are printed in a
previous edition of the Record.)

amendment no. 1074

(Purpose: To amend title XVIII of the Social Security Act to make
improvements in the national coverage determination process to respond
to changes in technology)

At the end of subtitle C of title IV, add the following:

SEC. __. IMPROVEMENTS IN NATIONAL COVERAGE DETERMINATION
PROCESS TO RESPOND TO CHANGES IN TECHNOLOGY.

(a) In general.--Section 1862 (42 U.S.C. 1395y) is
amended--
(A) in the third sentence of subsection (a) by inserting
``consistent with subsection (j)'' after ``the Secretary
shall ensure''; and
(B) by adding at the end the following new subsection:
``(j) National Coverage Determination Process.--
``(1) Timeframe for decisions on requests for national
coverage determinations.--In the case of a request for a
national coverage determination that--
``(A) does not require a technology assessment from an
outside entity or deliberation from the Medicare Coverage
Advisory Committee, the decision on the request shall be made
not later than 6 months after the date of the request; or
``(B) requires such an assessment or deliberation and in
which a clinical trial is not requested, the decision on the
request shall be made not later than 9 months after the date
of the request.
``(2) Process for public comment in national coverage
determinations.--At the end of the 6-month period (with
respect to a request under paragraph (1)(A)) or 9-month
period (with respect to a request under paragraph (1)(B))
that begins on the date a request for a national coverage
determination is made, the Secretary shall--
``(A) make a draft of proposed decision on the request
available to the public through the Medicare Internet site of
the Department of Health and Human Services or other
appropriate means;
``(B) provide a 30-day period for public comment on such
draft;
``(C) make a final decision on the request within 60 days
of the conclusion of the 30-day period referred to under
subparagraph (B);
``(D) include in such final decision summaries of the
public comments received and responses thereto;
``(E) make available to the public the clinical evidence
and other data used in making such a decision when the
decision differs from the recommendations of the Medicare
Coverage Advisory Committee; and
``(F) in the case of a decision to grant the coverage
determination, assign a temporary or permanent code and
implement the coverage decision at the end of the 60-day
period referred to in subparagraph (C).
``(3) National coverage determination defined.--For
purposes of this subsection, the term `national coverage
determination' has the meaning given such term in section
1869(f)(1)(B).''.
(b) Effective Date.--The amendments made by this section
shall apply to national coverage determinations as of January
1, 2004.

amendment no. 1023

(Purpose: To provide for the establishment of a demonstration project
to clarify the definition of homebound)

At the appropriate place in subtitle B of title IV, insert
the following:

[[Page S8682]]

SEC. __. DEMONSTRATION PROJECT TO CLARIFY THE DEFINITION OF
HOMEBOUND.

(a) Demonstration Project.--Not later than 180 days after
the date of enactment of this Act, the Secretary shall
conduct a two-year demonstration project under part B of
title XVIII of the Social Security Act under which medicare
beneficiaries with chronic conditions described in subsection
(b) are deemed to be homebound for purposes of receiving home
health services under the medicare program.
(b) Medicare Beneficiary Described.--For purposes of
subsection (a), a medicare beneficiary is eligible to be
deemed to be homebound, without regard to the purpose,
frequency, or duration of absences from the home, if the
beneficiary--
(1) has been certified by one physician as an individual
who has a permanent and severe condition that will not
improve;
(2) requires the individual to receive assistance from
another individual with at least 3 out of the 5 activities of
daily living for the rest of the individual's life;
(3) requires 1 or more home health services to achieve a
functional condition that gives the individual the ability to
leave home; and
(4) requires technological assistance or the assistance of
another person to leave the home.
(c) Demonstration Project Sites.--The demonstration project
established under this section shall be conducted in 3 States
selected by the Secretary to represent the Northeast,
Midwest, and Western regions of the United States.
(d) Limitation on Number of Participants.--The aggregate
number of such beneficiaries that may participate in the
project may not exceed 15,000.
(e) Data.--The Secretary shall collect such data on the
demonstration project with respect to the provision of home
health services to medicare beneficiaries that relates to
quality of care, patient outcomes, and additional costs, if
any, to the medicare program.
(f) Report to Congress.--Not later than 1 year after the
date of the completion of the demonstration project under
this section, the Secretary shall submit to Congress a report
on the project using the data collected under subsection (e)
and shall include--
(1) an examination of whether the provision of home health
services to medicare beneficiaries under the project--
(A) adversely effects the provision of home health services
under the medicare program; or
(B) directly causes an unreasonable increase of
expenditures under the medicare program for the provision of
such services that is directly attributable to such
clarification;
(2) the specific data evidencing the amount of any increase
in expenditures that is a directly attributable to the
demonstration project (expressed both in absolute dollar
terms and as a percentage) above expenditures that would
otherwise have been incurred for home health services under
the medicare program; and
(3) specific recommendations to exempt permanently and
severely disabled homebound beneficiaries from restrictions
on the length, frequency and purpose of their absences from
the home to qualify for home health services without
incurring additional unreasonable costs to the medicare
program.
(g) Waiver Authority.--The Secretary shall waive compliance
with the requirements of title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) to such extent and for such
period as the Secretary determines is necessary to conduct
demonstration projects.
(h) Construction.--Nothing in this section shall be
construed as waiving any applicable civil monetary penalty,
criminal penalty, or other remedy available to the Secretary
under title XI or title XVIII of the Social Security Act for
acts prohibited under such titles, including penalties for
false certifications for purposes of receipt of items or
services under the medicare program.
(i) Authorization of Appropriations.--Payments for the
costs of carrying out the demonstration project under this
section shall be made from the Federal Supplementary
Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t).
(j) Definitions.--In this section:
(1) Medicare beneficiary.--The term ``medicare
beneficiary'' means an individual who is enrolled under part
B of title XVIII of the Social Security Act.
(2) Home health services.--The term ``home health
services'' has the meaning given such term in section 1861(m)
of the Social Security Act (42 U.S.C. 1395x(m)).
(3) Activities of daily living defined.--The term
``activities of daily living'' means eating, toileting,
transferring, bathing, and dressing.
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.

Amendment No. 1114

(Purpose: To require the GAO to study the impact of price controls on
pharmaceuticals)

At the appropriate place, insert the following:

SEC. . GAO STUDY OF PHARMACEUTICAL PRICE CONTROLS AND PATENT
PROTECTIONS IN THE G-7 COUNTRIES.

(A) Study.--The Comptroller General of the United States
shall conduct a study of price controls imposed on
pharmaceuticals in France, Germany, Italy, Japan, the United
Kingdom and Canada to review the impact such regulations have
on consumers, including American consumers, and on innovation
in medicine. Such study shall include--
(1) The pharmaceutical price control structure in each
country for a wide range of pharmaceuticals, compared with
average pharmaceutical prices paid by Americans covered by
private sector health insurance;
(2) The proportion of the costs for innovation borne by
American consumers, compared with consumers in the other six
countries;
(3) A review of how closely the observed prices in
regulated markets correspond to the prices that efficiently
distribute common costs of production (``Ramsey prices'');
(4) A review of any peer-reviewed literature that might
show the health consequences to patients in the listed
countries that result from the absence or delayed
introduction of medicines, including the cost of not having
access to medicines, in terms of lower life expectancy and
lower quality of health;
(5) The impact on American consumers, in terms of reduced
research into new or improved pharmaceuticals (including the
cost of delaying the introduction of a significant advance in
certain major diseases), if similar price controls were
adopted in the United States;
(6) The existing standards under international conventions,
including the World Trade Organization and the North American
Free Trade Agreement, regarding regulated pharmaceutical
prices, including any restrictions on anti-competitive laws
that might apply to price regulations and how economic harm
caused to consumers in markets without price regulations may
be remedied;
(7) In parallel trade regimes, how much of the price
difference between countries in the European Union is
captured by middlemen and how much goes to benefit patients
and health systems where parallel importing is significant;
and
(8) How much cost is imposed on the owner of a property
right from counterfeiting and from international violation of
intellectual property rights for prescription medicines.
(B) Report.--Not later than 1 year after the date of
enactment of this Act, the Comptroller General of the United
States shall submit to Congress a report on the study
conducted under subsection (A).

amendment no. 1115

(Purpose: To express the sense of the Senate concerning Medicare
payments to physicians and other health professionals)

At the appropriate place, insert the following:

SEC. . SENSE OF THE SENATE CONCERNING MEDICARE PAYMENT
UPDATE FOR PHYSICIANS AND OTHER HEALTH
PROFESSIONALS.

(a) Findings.--The Senate makes the following findings:
(1) The formula by which Medicare payments are updated each
year for services furnished by physicians and other health
professionals is fundamentally flawed.
(2) The flawed physician payment update formula is causing
a continuing physician payment crisis, and, without
Congressional action, Medicare payment rates for physicians
and other practitioners are predicted to fall by 4.2 percent
in 2004.
(3) A physician payment cut in 2004 would be the fifth cut
since 1991, and would be on top of a 5.4 percent cut in 2002,
with additional cuts estimated for 2005, 2006, and 2007; from
1991-2003, payment rates for physicians and health
professionals fell 14 percent behind practice cost inflation
as measured by Medicare's own conservative estimates.
(4) The sustainable growth rate (SGR) expenditure target,
which is the basis for the physician payment update, is
linked to the gross domestic product and penalizes physicians
and other practitioners for volume increases that they cannot
control and that the government actively promotes through new
coverage decisions, quality improvement activities and other
initiatives that, while beneficial to patients, are not
reflected in the SGR.
(b) Sense of the Senate.--It is the Sense of the Senate
that Medicare beneficiary access to quality care may be
compromised if Congress does not take action to prevent cuts
next year and the following that result from the SGR formula.

amendment no. 1045

(Purpose: To provide for a demonstration project for the exclusion of
brachytherapy devices from the prospective payment system for
outpatient hospital services)

At the end of subtitle B of title IV, add the following:

SEC. __. DEMONSTRATION PROJECT FOR EXCLUSION OF BRACHYTHERAPY
DEVICES FROM PROSPECTIVE PAYMENT SYSTEM FOR
OUTPATIENT HOSPITAL SERVICES.

(a) Demonstration Project.--The Secretary shall conduct a
demonstration project under part B of title XVIII of the
Social Security Act under which brachytherapy devices shall
be excluded from the prospective payment system for
outpatient hospital services under the medicare program and,
notwithstanding section 1833(t) of the Social Security Act
(42 U.S.C. 1395l(t)), the amount of payment for a device of
brachytherapy furnished under the demonstration project shall
be equal to the hospital's charges for each device furnished,
adjusted to cost.
(b) Specification of Groups for Brachytherapy Devices.--The
Secretary shall create additional groups of covered

[[Page S8683]]

OPD services that classify devices of brachytherapy furnished
under the demonstration project separately from the other
services (or group of services) paid for under section
1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) in a
manner reflecting the number, isotope, and radioactive
intensity of such devices furnished, including separate
groups for palladium-103 and iodine-125 devices.
(c) Duration.--The Secretary shall conduct the
demonstration project under this section for the 3-year
period beginning on the date that is 90 days after the date
of enactment of this Act.
(d) Report.--Not later than January 1, 2007, the Secretary
shall submit to Congress a report on the demonstration
project conducted under this section. The report shall
include an evaluation of patient outcomes under the
demonstration project, as well as an analysis of the cost
effectiveness of the demonstration project.
(e) Waiver Authority.--The Secretary shall waive compliance
with the requirements of title XVIII of the Social Security
Act to such extent and for such period as the Secretary
determines is necessary to conduct the demonstration project
under this section.
(f) Funding.--
(1) In general.--The Secretary shall provide for the
transfer from the Federal Supplementary Insurance Trust Fund
established under section 1841 of the Social Security Act (42
U.S.C. 1395t) of such funds as are necessary for the costs of
carrying out the demonstration project under this section.
(2) Budget neutrality.--In conducting the demonstration
project under this section, the Secretary shall ensure that
the aggregate payments made by the Secretary do not exceed
the amount which the Secretary would have paid if the
demonstration project under this section was not implemented.

amendment no. 1058

(Purpose: To restore the Federal Hospital Insurance Trust Fund to the
financial position it would have been in if a clerical bookkeeping
error had not occurred)

At the appropriate place in title VI, insert the following:

SEC. __. RESTORATION OF FEDERAL HOSPITAL INSURANCE TRUST
FUND.

(a) Definitions.--In this section:
(1) Clerical error.--The term ``clerical error'' means the
failure that occurred on April 15, 2001, to have transferred
the correct amount from the general fund of the Treasury to
the Trust Fund.
(2) Trust fund.--The term ``Trust Fund'' means the Federal
Hospital Insurance Trust Fund established under section 1817
of the Social Security Act (42 U.S.C. 1395i).
(b) Correction of Trust Fund Holdings.--
(1) In general.--Not later than 120 days after the date of
enactment of this Act, the Secretary of the Treasury shall
take the actions described in paragraph (2) with respect to
the Trust Fund with the goal being that, after such actions
are taken, the holdings of the Trust Fund will replicate, to
the extent practicable in the judgment of the Secretary of
the Treasury, in consultation with the Secretary of Health
and Human Services, the holdings that would have been held by
the Trust Fund if the clerical error had not occurred.
(2) Obligations issued and redeemed.--The Secretary of the
Treasury shall--
(A) issue to the Trust Fund obligations under chapter 31 of
title 31, United States Code, that bear issue dates, interest
rates, and maturity dates that are the same as those for the
obligations that--
(i) would have been issued to the Trust Fund if the
clerical error had not occurred; or
(ii) were issued to the Trust Fund and were redeemed by
reason of the clerical error; and
(B) redeem from the Trust Fund obligations that would have
been redeemed from the Trust Fund if the clerical error had
not occurred.
(c) Appropriation.--Not later than 120 days after the date
of enactment of this Act, there is appropriated to the Trust
Fund, out of any money in the Treasury not otherwise
appropriated, an amount determined by the Secretary of the
Treasury, in consultation with the Secretary of Health and
Human Services, to be equal to the interest income lost by
the Trust Fund through the date on which the appropriation is
being made as a result of the clerical error.

amendment no. 1044

(Purpose: To adjust the urban health provider payment)

At the appropriate place, insert the following:

SEC. __. URBAN HEALTH PROVIDER ADJUSTMENT.

(a) In General.--Beginning with fiscal year 2004,
notwithstanding section 1923(f) of the Social Security Act
(42 U.S.C. 1396r-4(f)) and subject to subsection (c), with
respect to a State, payment adjustments made under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.) to a
hospital described in subsection (b) shall be made without
regard to the DSH allotment limitation for the State
determined under section 1923(f) of that Act (42 U.S.C.
1396r-4(f)).
(b) Hospital Described.--A hospital is described in this
subsection if the hospital--
(1) is owned or operated by a State (as defined for
purposes of title XIX of the Social Security Act), or by an
instrumentality or a municipal governmental unit within a
State (as so defined) as of January 1, 2003; and
(2) is located in Marion County, Indiana.
(c) Limitation.--The payment adjustment described in
subsection (a) for fiscal year 2004 and each fiscal year
thereafter shall not exceed 175 percent of the costs of
furnishing hospital services described in section
1923(g)(1)(A) of the Social Security Act (42 U.S.C. 1396r-
4(g)(1)(A)).

amendment no. 1056

(Purpose: To prevent the Secretary of Health and Human Services from
modifying the treatment of certain long-term care hospitals as
subsection (d) hospitals)

At the end of subtitle A of title IV, add the following:

SEC. __. TREATMENT OF GRANDFATHERED LONG-TERM CARE HOSPITALS.

(a) In General.--The last sentence of section 1886(d)(1)(B)
is amended by inserting ``, and the Secretary may not impose
any special conditions on the operation, size, number of
beds, or location of any hospital so classified for continued
participation under this title or title XIX or for continued
classification as a hospital described in clause (iv)''
before the period at the end.
(b) Treatment of Proposed Revision.--The Secretary shall
not adopt the proposed revision to section 412.22(f) of title
42, Code of Federal Regulations contained in 68 Federal
Register 27154 (May 19, 2003) or any revision reaching the
same or substantially the same result as such revision.
(c) Effective Date.--The amendment made by, and provisions
of, this section shall apply to cost reporting periods ending
on or after December 31, 2002.

amendment no. 1013

(Purpose: To ensure that patients are receiving safe and accurate
dosages of compounded drugs)

At the appropriate place, insert the following:

SEC. __. COMMITTEE ON DRUG COMPOUNDING.

(a) Establishment.--The Secretary of Health and Human
Services shall establish an Committee on Drug Compounding
(referred to in this section as the ``Committee'') within the
Food and Drug Administration on drug compounding to ensure
that patients are receiving necessary, safe and accurate
dosages of compounded drugs.
(b) Membership.--The membership of the Advisory Committee
shall be appointed by the Secretary of Health and Human
Services and shall include representatives of--
(1) the National Association of Boards of Pharmacy;
(2) pharmacy groups;
(3) physician groups;
(4) consumer and patient advocate groups;
(5) the United States Pharmacopoeia; and
(6) other individuals determined appropriate by the
Secretary.
(c) Report and Recommendations.--Not later than 1 year
after the date of enactment of this Act, the Committee shall
submit to the Secretary a report concerning the
recommendations of the Committee to improve and protect
patient safety.
(d) Termination.--The Committee shall terminate on the date
that is 1 year after the date of enactment of this Act.

amendment no. 1121

(Purpose: To express the sense of the Senate concerning the structure
of Medicare reform and the prescription drug benefit to ensure
Medicare's long-term solvency and high quality of care)

At the appropriate place, insert the following:

SEC. . SENSE OF THE SENATE CONCERNING THE STRUCTURE OF
MEDICARE REFORM AND THE PRESCRIPTION DRUG
BENEFIT.

(a) Findings.--The Senate makes the following findings:
(1) America's seniors deserve a fiscally-strong Medicare
system that fulfills its promise to them and future retirees.
(2) The impending retirement of the ``baby boom''
generation will dramatically increase the costs of providing
Medicare benefits. Medicare costs will double relative to the
size of the economy from 2 percent of GDP today to 4 percent
in 2025 and double again to 8 percent of GDP in 2075. This
growth will accelerate substantially when Congress adds a
necessary prescription drug benefit.
(3) Medicare's current structure does not have the
flexibility to quickly adapt to rapid advances in modern
health care. Medicare lags far behind other insurers in
providing prescription drug coverage, disease management
programs, and host of other advances. Reforming Medicare to
create a more self-adjusting, innovative structure is
essential to improve Medicare's efficiency and the quality of
the medical care it provides.
(4) Private-sector choice for Medicare beneficiaries would
provide two key benefits: it would be tailored to the needs
of America's seniors, not the government, and would create a
powerful incentive for private-sector Medicare plans to
provide the best quality health care to seniors at the most
affordable price.
(5) The method by which the national preferred provider
organizations in the Federal Employees Health Benefits
Program have been reimbursed has proven to be a reliable and
successful mechanism for providing Members of Congress and
federal employees with excellent health care choices.
(6) Unlike the Medicare payment system, which has had to be
changed by Congress every few years, the Federal Employees
Health Benefits Program has existed for 43 years with minimal
changes from Congress.
(b) Sense of the Senate.--It is the Sense of the Senate
that Medicare reform legislation should:

[[Page S8684]]

(1) Ensure that prescription drug coverage is directed to
those who need it most.
(2) Provide that government contributions used to support
Medicare Advantage plans are based on market principles
beginning in 2006 to ensure the long and short term viability
of such options for America's seniors.
(3) Develop a payment system for the Medicare Advantage
preferred provider organizations similar to the payment
system used for the national preferred provider organizations
in the Federal Employees Health Benefits Program.
(4) Limit the addition of new unfunded obligations in the
Medicare program so that the long-term solvency of this
important program is not further jeopardized.
(5) Incorporate private sector, market-based elements, that
do not rely on the inefficient Medicare price control
structure.
(6) Keep the cost of structural changes and new benefits
within the $400 billion provided for under the current
Congressional Budget Resolution for implementing Medicare
reform and providing a prescription drug benefit.
(7) Preserve the current employer-sponsored retiree health
plans and not design a benefit which has the unintended
consequences of supplanting private coverage.
(8) Incorporate regulatory reform proposals to eliminate
red tape and reduce costs.
(9) Restore the right of Medicare beneficiaries and their
doctors to work together to provide services, allow private
fee for service plans to set their own premiums, and permit
seniors to add their own dollars beyond the government
contribution.

amendment no. 989, as modified

(Purpose: To increase medicare payments for home health services
furnished in a rural area)

At the appropriate place in subtitle C of title IV, insert
the following:

SEC. __. INCREASE IN MEDICARE PAYMENT FOR CERTAIN HOME HEALTH
SERVICES.

(a) In General.--Section 1895 of the Social Security Act
(42 U.S.C. 1395fff) is amended by adding at the end the
following:
``(f) Increase in Payment for Services Furnished in a Rural
Area.--
``(1) In general.--In the case of home health services
furnished in a rural area (as defined in section
1886(d)(2)(D)) on or after October 1, 2004 and before October
1, 2006, the Secretary shall increase the payment amount
otherwise made under this section for such services by 10
percent.
``(2) Waiver of budget neutrality.--The Secretary shall not
reduce the standard prospective payment amount (or amounts)
under this section applicable to home health services
furnished during any period to offset the increase in
payments resulting from the application of paragraph (1).''.
(b) Payment Adjustment.--Section 1895(b)(5) of the Social
Security Act (42 U.S. C. 1395fff(b)(5)) is amended by adding
at the end the following:``Notwithstanding this paragraph,
the total amount of the additional payments or payment
adjustments made under this paragraph may not exceed, with
respect to fiscal year 2004, 3 percent, and, with respect to
fiscal years 2005 and 2006, 4 percent, of the total payments
projected or estimated to be made based on the prospective
payment system under this subsection in the year involved.''.
(c) Effective Date.--The amendments made by this section
shall apply to services furnished on or after October 1,
2003.

amendment no. 1126

(Purpose: To provide for the treatment of certain entities for purposes
of payments under the medicare program)

At the end of subtitle A of title IV, add the following:

SEC. __. TREATMENT OF CERTAIN ENTITIES FOR PURPOSES OF
PAYMENTS UNDER THE MEDICARE PROGRAM.

(a) Payments to Hospitals.--
(1) In general.--Notwithstanding any other provision of
law, effective for discharges occurring on or after October
1, 2003, for purposes of making payments to hospitals (as
defined in section 1886(d) and 1833(t) of the Social Security
Act (42 U.S.C. 1395(d)) under the medicare program under
title XVIII of such Act (42 U.S.C. 1395 et seq.), Iredell
County, North Carolina, and Rowan County, North Carolina, are
deemed to be located in the Charlotte-Gastonia-Rock Hill,
North Carolina, South Carolina Metropolitan Statistical Area.
(2) Budget Neutral Within North Carolina.--The Secretary
shall adjust the area wage index referred to in paragraph (1)
with respect to payments to hospitals located in North
Carolina in a manner which assures that the total payments
made under section 1886(d) of the Social Security Act (42
U.S.C., 1395(ww)(d)) in a fiscal year for the operating cost
of inpatient hospital services are not greater or less than
the total of such payments that would have been made in the
year if this subsection had not been enacted.
(b) Payments to Skilled Nursing Facilities and Home Health
Agencies.--
(1) In general.--Notwithstanding any other provision of
law, effective beginning October 1, 2003, for purposes of
making payments to skilled nursing facilities (SNFs) and home
health agencies (as defined in sections 1861(j) and 1861(o)
of the Social Security Act (42 U.S.C. 1395x(j); 1395x(o))
under the medicare program under title XVIII of such Act,
Iredell County, North Carolina, and Rowan County, North
Carolina, are deemed to be located in the Charlotte-Gastonia-
Rock Hill, North Carolina, South Carolina Metropolitan
Statistical Area.
(2) Application and Budget Neutral Within North Carolina.--
Effective for fiscal year 2004, the skilled nursing facility
PPS and home health PPS rates for Iredell County, North
Carolina, and Rowan County, North Carolina, will be updated
by the prefloor, prereclassified hospital wage index
available for the Charlotte-Gastonia-Rock Hill, North
Carolina, South Carolina Metropolitan Statistical Area. This
subsection shall be implemented in a budget neutral manner,
using a methodology that ensures that the total amount of
expenditures for skilled nursing facility services and home
health services in a year does not exceed the total amount of
expenditures that would have been made in the year if this
subsection had not been enacted. Required adjustments by
reason of the preceding sentence shall be done with respect
to skilled nursing facilities and home health agencies
located in North Carolina.
(c) Construction.--The provisions of this section shall
have no effect on the amount of payments made under title
XVIII of the Social Security Act to entities located in
States other than North Carolina.

amendment no. 996

(Purpose: To modify the GAO study of geographic differences in payments
for physicians' services relating to the work geographic practice cost
index)

In section 445(a) of the bill, strike paragraph (6) and
insert the following:
``(6) an evaluation of the appropriateness of extending
such adjustment or making such adjustment permanent;
``(7) an evaluation of the adjustment of the work
geographic practice cost index required under section
1848(e)(1)(A)(iii) of the Social Security Act (42 U.S.C.
1395w-4(e)(1)(A)(iii)) to reflect \1/4\ of the area cost
difference in physician work;
``(8) an evaluation of the effect of the adjustment
described in paragraph (7) on physician location and
retention in higher than average cost-of-living areas, taking
into account difference in recruitment costs and retention
rates for physicians, including specialists; and
``(9) an evaluation of the appropriateness of the \1/4\
adjustment for the work geographic practice cost index.''.

amendment no. 1118

(Purpose: To express the sense of the Senate regarding the
establishment of a nationwide permanent lifestyle modification program
for Medicare beneficiaries)

At the end of title VI, insert the following:

SEC. __. SENSE OF THE SENATE REGARDING THE ESTABLISHMENT OF A
NATIONWIDE PERMANENT LIFESTYLE MODIFICATION
PROGRAM FOR MEDICARE BENEFICIARIES.

(a) Findings.--Congress finds that:
(1) Heart disease kills more than 500,000 Americans per
year.
(2) The number and costs of interventions for the treatment
of coronary disease are rising and currently cost the health
care system $58,000,000,000 annually.
(3) The Medicare Lifestyle Modification Program has been
operating throughout 12 States and has been demonstrated to
reduce the need for coronary procedures by 88 percent per
year.
(4) The Medicare Lifestyle Modification Program is less
expensive to deliver than interventional cardiac procedures
and could reduce cardiovascular expenditures by
$36,000,000,000 annually.
(5) Lifestyle choices such as diet and exercise affect
heart disease and heart disease outcomes by 50 percent or
greater.
(6) Intensive lifestyle interventions which include teams
of nurses, doctors, exercise physiologists, registered
dietitians, and behavioral health clinicians have been
demonstrated to reduce heart disease risk factors and enhance
heart disease outcomes dramatically.
(7) The National Institutes of Health estimates that
17,000,000 Americans have diabetes and the Centers for
Disease Control and Prevention estimates that the number of
Americans who have a diagnosis of diabetes increased 61
percent in the last decade and is expected to more than
double by 2050.
(8) Lifestyle modification programs are superior to
medication therapy for treating diabetes.
(9) Individuals with diabetes are now considered to have
coronary disease at the date of diagnosis of their diabetic
state.
(10) The Medicare Lifestyle Modification Program has been
an effective lifestyle program for the reversal and treatment
of heart disease.
(11) Men with prostate cancer have shown significant
improvement in prostate cancer markers using a similar
approach in lifestyle modification.
(12) These lifestyle changes are therefore likely to affect
other chronic disease states, in addition to heart disease.
(b) Sense of the Senate.--It is the sense of the Senate
that--
(1) the Secretary of Health and Human Services should carry
out the demonstration project known as the Lifestyle
Modification Program Demonstration, as described in the
Health Care Financing Administration Memorandum of
Understanding entered into on November 13, 2000, on a
permanent basis;
(2) the project should include as many Medicare
beneficiaries as would like to participate in the project on
a voluntary basis; and
(3) the project should be conducted on a national basis.

[[Page S8685]]

amendment No. 1085

(Purpose: To express the sense of the Senate regarding payment
reductions under the Medicare physician fee schedule)

At the end of title VI, insert the following:

SEC. __. SENSE OF THE SENATE ON PAYMENT REDUCTIONS UNDER
MEDICARE PHYSICIAN FEE SCHEDULE.

(a) Findings.--Congress finds that--
(1) the fees Medicare pays physicians were reduced by 5.4
percent across-the-board in 2002;
(2) recent action by Congress narrowly averted another
across-the-board reduction of 4.4 percent for 2003;
(3) based on current projections, the Centers for Medicare
& Medicaid Services (CMS) estimates that, absent legislative
or administrative action, fees will be reduced across-the-
board once again in 2004 by 4.2 percent;
(4) the prospect of continued payment reductions under the
Medicare physician fee schedule for the foreseeable future
threatens to destabilize an important element of the program,
namely physician participation and willingness to accept
Medicare patients;
(5) the primary source of this instability is the
sustainable growth rate (SGR), a system of annual spending
targets for physicians' services under Medicare;
(6) the SGR system has a number of defects that result in
unrealistically low spending targets, such as the use of the
increase in the gross domestic product (GDP) as a proxy for
increases in the volume and intensity of services provided by
physicians, no tolerance for variance between growth in
Medicare beneficiary health care costs and our Nation's GDP,
and a requirement for immediate recoupment of the difference;
(7) both administrative and legislative action are needed
to return stability to the physician payment system;
(8) using the discretion given to it by Medicare law, CMS
has included expenditures for prescription drugs and
biologicals administered incident to physicians' services
under the annual spending targets without making appropriate
adjustments to the targets to reflect price increases in
these drugs and biologicals or the growing reliance on such
therapies in the treatment of Medicare patients;
(9) between 1996 and 2002, annual Medicare spending on
these drugs grew from $1,800,000,000 to $6,200,000,000, or
from $55 per beneficiary to an estimated $187 per
beneficiary;
(10) although physicians are responsible for prescribing
these drugs and biologicals, neither the price of the drugs
and biologicals, nor the standards of care that encourage
their use, are within the control of physicians; and
(11) SGR target adjustments have not been made for cost
increases due to new coverage decisions and new rules and
regulations.
(b) Sense of the Senate.--It is the sense of the Senate
that--
(1) the Center for Medicare & Medicaid Services (CMS)
should use its discretion to exclude drugs and biologicals
administered incident to physician services from the
sustainable growth rate (SGR) system;
(2) CMS should use its discretion to make SGR target
adjustments for new coverage decisions and new rules and
regulations; and
(3) in order to provide ample time for Congress to consider
more fundamental changes to the SGR system, the conferees on
the Prescription Drug and Medicare Improvement Act of 2003
should include in the conference agreement a provision to
establish a minimum percentage update in physician fees for
the next 2 years and should consider adding provisions that
would mitigate the swings in payment, such as establishing
multi-year adjustments to recoup the variance and creating
``tolerance'' corridors for variations around the update
target trend.

amendment no. 960

(Purpose: To Require a Streamlining of the Medicare Regulations)

At the end of subtitle A of title V, add the following:

SEC. __. STREAMLINING AND SIMPLIFICATION OF MEDICARE
REGULATIONS.

(a) In General.--The Secretary of Health and Human Services
shall conduct an analysis of the regulations issued under
title XVIII of the Social Security Act and related laws in
order to determine how such regulations may be streamlined
and simplified to increase the efficiency and effectiveness
of the medicare program without harming beneficiaries or
providers and to decrease the burdens the medicare payment
systems impose on both beneficiaries and providers.
(b) Reduction in Regulations.--The Secretary, after
completion of the analysis under subsection (a), shall direct
the rewriting of the regulations described in subsection (a)
in such a manner as to--
(1) reduce the number of words comprising all regulations
by at least two-thirds by October 1, 2004, and
(2) ensure the simple, effective, and efficient operation
of the medicare program.
(c) Application of the Paperwork Reduction Act.--The
Secretary shall apply the provisions of chapter 35 of title
44, United States Code (commonly known as the ``Paperwork
Reduction Act'') to the provisions of this Act to ensure that
any regulations issued to implement this Act are written in
plain language, are streamlined, promote the maximum
efficiency and effectiveness of the medicare and medicaid
programs without harming beneficiaries or providers, and
minimize the burdens the payment systems affected by this Act
impose on both beneficiaries and providers. If the Secretary
determines that the two-thirds reduction in words by October
1, 2004 required in (B)(1) is not feasible, he shall inform
Congress in writing by July 1, 2004 of the reasons for its
unfeasibility. He shall then establish a feasible reduction
to be received by January 1, 2005.
Mr. GRASSLEY. I ask unanimous consent that these amendments and the
following pending amendments be adopted en bloc and that the motion to
reconsider be laid upon the table: Amendment No. 1017, Allard; No. 968,
Harkin; No. 948, Graham of South Carolina; No. 960, Dayton; No. 1054,
Feingold; No. 1030, Enzi.
The PRESIDENT pro tempore. Is there objection?
Without objection, it is so ordered.
The amendments were agreed to.
Mr. GRASSLEY. Thank you. I suggest the absence of a quorum.
The PRESIDENT pro tempore. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. GRAHAM of South Carolina. Mr. President, I ask unanimous consent
that the order for the quorum call be rescinded.
The PRESIDENT pro tempore. Without objection, it is so ordered.

____________________