[Congressional Record Volume 150, Number 88 (Wednesday, June 23, 2004)]
[Senate]
[Pages S7313-S7325]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
[[Page S7313]]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. JOHNSON:
S. 2561. A bill to amend title 38, United States Code, to provide for
certain servicemembers to become eligible for educational assistance
under the Montgomery GI Bill; to the Committee on Veterans' Affairs.
Mr. JOHNSON. Mr. President, I rise today to introduce a very
important piece of legislation, the Montgomery GI Bill Enhancement Act.
This bill will allow a one year open enrollment period for thousands of
career military personal who are not allowed to sign up for education
benefits under the Montgomery GI Bill (MGIB).
In 1976 Congress created the Veterans' Educational Assistance Program
(VEAP) as a recruitment and retention tool for the post-Vietnam era.
However, Congress greatly expanded education benefits in 1984 and
allowed individuals with VEAP accounts to transfer their benefits to
the new MGIB in 1996. The opportunity to convert to MGIB was important
because the benefits available were much greater than those under VEAP.
However, those individuals who were on active duty before 1985 and
did not participate in VEAP were not eligible to sign-up for MGIB,
leaving a gap in available coverage for certain career military
personnel. Congress has voted several times in the last decade to allow
VEAP participants opportunities to transfer to MGIB, but there has
never been an opportunity for those who did not have VEAP accounts to
sign up for the new program, excluding them from taking advantage of
MGIB educational benefits.
My bill would correct this inequity and allow individuals falling
into this gap to attain MGIB benefits. Organizations such as the Non-
Commissioned Officers Association, the Association of the United States
Army, and the Military Coalition have come out in strong support for
this legislation.
I believe that we must do more to honor our Nation's commitments to
our military personnel. As the father of a soldier in the Army, I fully
appreciate what a poor ``quality of life'' can do to the morale of
military families. We have a long way to go, but I will continue to
work with my colleagues to make sure our country's military personnel
receive the benefits they deserve.
Today, there are fewer than 74,000 VEAP ``decliners'' on active duty.
These men and women have dedicated their lives to a career of service
to the Nation, and many are deployed in harms way leading our troops in
Iraq and Afghanistan.
For these servicemen and women--many of whom are reaching retirement
eligibility--time is running out. Therefore, before it is too late, I
encourage my Senate colleagues to support the Montgomery GI Bill
Enhancement Act and provide our servicemen and women with the benefits
they deserve.
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. 2561
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 ``Montgomery GI Bill
Enhancement Act of 2004''.
SEC. 2. OPPORTUNITY FOR CERTAIN ACTIVE-DUTY PERSONNEL TO
ENROLL UNDER THE MONTGOMERY GI BILL.
(a) In General.--Chapter 30 of title 38, United States
Code, is amended by inserting after section 3018C the
following new section:
``Sec. 3018D. Opportunity for certain active-duty personnel
to enroll
``(a)(1) Notwithstanding any other provision of this
chapter, during the one-year period beginning on the date of
the enactment of this section, a qualified individual
(described in subsection (b)) may make an irrevocable
election under this section to become entitled to basic
educational assistance under this chapter.
``(2) The Secretary of each military department shall
provide for procedures for a qualified individual to make an
irrevocable election under this section in accordance with
regulations prescribed by the Secretary of Defense for the
purpose of carrying out this section or which the Secretary
of Homeland Security shall provide for such purpose with
respect to the Coast Guard when it is not operating as a
service in the Navy.
``(b) A qualified individual referred to in subsection (a)
is an individual who meets each of the following
requirements:
``(1) The individual first became a member of the Armed
Forces or first entered on active duty as a member of the
Armed Forces before July 1, 1985.
``(2) The individual has served on active duty without a
break in service since the date the individual first became
such a member or first entered on active duty as such a
member and continues to serve on active duty for some or all
of the one-year period referred to in subsection (a).
``(3) The individual, before applying for benefits under
this section, has completed the requirements of a secondary
school diploma (or equivalency certificate) or has
successfully completed (or otherwise received academic credit
for) the equivalent of 12 semester hours in a program of
education leading to a standard college degree.
``(4) The individual, when discharged or released from
active duty, is discharged or released therefrom with an
honorable discharge.
``(c)(1) Subject to the succeeding provisions of this
subsection, with respect to a qualified individual who makes
an election under this section to become entitled to basic
educational assistance under this chapter--
``(A) the basic pay of the qualified individual shall be
reduced (in a manner determined by the Secretary concerned)
until the total amount by which such basic pay is reduced is
$2,700; and
``(B) to the extent that basic pay is not so reduced before
the qualified individual's discharge or release from active
duty as specified in subsection (b)(4), at the election of
the qualified individual--
``(i) the Secretary concerned shall collect from the
qualified individual; or
``(ii) the Secretary concerned shall reduce the retired or
retainer pay of the qualified individual by,
an amount equal to the difference between $2,700 and the
total amount of reductions under subparagraph (A), which
shall be paid into the Treasury of the United States as
miscellaneous receipts.
``(2)(A) The Secretary concerned shall provide for an 18-
month period, beginning on the date the qualified individual
makes an election under this section, for the qualified
individual to pay that Secretary the amount due under
paragraph (1).
``(B) Nothing in subparagraph (A) shall be construed as
modifying the period of eligibility for and entitlement to
basic educational assistance under this chapter applicable
under section 3031 of this title.
``(d) With respect to qualified individuals referred to in
subsection (c)(1)(B), no amount of educational assistance
allowance under this chapter shall be paid to the qualified
individual until the earlier of the date on which--
``(1) the Secretary concerned collects the applicable
amount under clause (i) of such subsection; or
``(2) the retired or retainer pay of the qualified
individual is first reduced under clause (ii) of such
subsection.
``(e) The Secretary, in conjunction with the Secretary of
Defense, shall provide for notice of the opportunity under
this section to elect to become entitled to basic educational
assistance under this chapter.''.
(b) Conforming Amendments.--Section 3017(b)(1) of such
title is amended--
(1) in subparagraphs (A) and (C), by striking ``or
3018C(e)'' and inserting ``3018C(e), or 3018D(c)''; and
(2) in subparagraph (B), by inserting ``or 3018D(c)'' after
``under section 3018C(e)''.
(c) Clerical Amendment.--The table of sections at the
beginning of chapter 30 of such title is amended by inserting
after the item relating to section 3018C the following new
item:
``3018D. Opportunity for certain active-duty personnel to enroll.''.
______
By Mr. BAUCUS:
S. 2562. A bill to amend title XVIII of the Social Security Act
provide incentives for the furnishing of quality care under Medicare
Advantage plans and by end stage renal disease providers and
facilities, and for other purposes; to the Committee on Finance.
Mr. BAUCUS. Mr. President, I rise today to introduce the ``Medicare
Quality Improvement Act of 2004.''
This bill will establish a new payment incentive structure for
quality health care, starting with the Medicare Advantage and End Stage
Renal Disease programs. Under this policy, Medicare would give a
financial boost to plans and renal care providers demonstrating the
highest quality care and a bonus to those that are working hard to
improve.
Why focus on quality? I hear from all corners that the U.S. health
care system is unsustainable in its current form. Costs are rising, and
the care provided is not always appropriate or necessary. Not to
mention that 43 million Americans lack health insurance.
As I travel around Montana, I hear so much from so many constituents
about the rising cost of health care. Countless parents tell me they
are struggling to pay for health care for their families, afraid that
one more illness will force them into bankruptcy. Working people tell
me they fear their employers will raise their premiums or drop
[[Page S7314]]
coverage altogether due to rising health care costs. And employers,
both large industries and small enterprises, tell me they face
competition from companies in countries where healthcare is
significantly less expensive. While these employers are trying to keep
jobs at home, health care costs are pushing them abroad.
And most recently, my personal experience with the health care system
has brought the issue of health costs and quality even closer to home.
A few weeks ago, I chose to have an elective procedure to keep my
heart healthy. I have excellent health care coverage, and I was able to
seek out excellent doctors and nurses at the Mayo Clinic. In short, I
am fortunate that the care I received was high-quality care. The
doctors and nurses who took care of me were on the ball--making sure I
got the right medications with no dangerous interactions, using proper
surgical safety so I wouldn't get an infection, and providing good
follow-up care so I could get back to my family and back to work.
My experience with the health system was a positive one.
Unfortunately, not everyone is as lucky. Ninety-eight thousand people
die every year in this country as a result of medical errors. That's
270 people each day. An appalling statistic. Many of these deaths can
be prevented, and we must work to make sure that they are.
In addition to the cases of medical error we know about, there are
many that go unreported and even undetected. Studies have shown that
patients in the U.S. receive recommended care and treatment when they
visit the doctor or hospital only about half of the time. Failure to
follow proper patterns of care or recommended guidelines can lead to
poor outcomes, and it is also more expensive in the short and long run.
Errors can mean more trips to the hospital or to the doctor, more
drugs, and sometimes even additional surgeries. Each preventable
medication error costs about $4,700 in added hospital costs alone, not
to mention the personal costs of childcare and lost wages, and the
societal costs of lost productivity.
While not as fatal as actual errors, missed health care opportunities
also carry a cost. Each year, missed health care opportunities--
inappropriate care and generally poor quality care costs the U.S.
health system more than $1 billion dollars in avoidable hospital bills
and 41 million lost work days, which costs American businesses about
$11.5 billion. Improving the quality of health care can reduce health
care costs and stimulate our economy. In a time of slow economic growth
and large deficits, health care is a compelling place to start.
Last year's Medicare Modernization Act got the ball rolling. The
Medicare bill ties hospital reimbursement to reporting data on specific
quality indicators. And hospitals are responding. Today, almost 2,000
hospitals are sharing data with the Centers for Medicare and Medicaid
on at least one of the quality measures. Knowing more about the care
that is delivered across the country should help us target incentives
and resources to improve quality. It also provides employers and
patients with new information about where to find the best deal for
their health care dollar. And it also provides hospitals a way to
compare their performance to other hospitals.
The bill I am introducing today builds on this strong start. It would
establish a mechanism to pay for quality in the Medicare Advantage and
End Stage Renal Disease Programs, through bonus payments for the best
quality nationwide and bonuses for improving from one year to the next.
Rewards for improvement are an important piece of my proposal--last
year, the top ten percent of health plans in the country reported
perfect scores on a set of quality indicators. There is no doubt that
they deserve recognition. But we don't want to leave behind smaller or
historically poorer-performing organizations that are making major
strides to improve.
Medicare Advantage plans, which tend to utilize a coordinated model
of care, have a unique opportunity to impact a patient's health
outcomes--plans have access to information about a patient's medical
history, and can follow patients more closely to ensure that they are
receiving appropriate preventive, acute, and follow-up care. Medicare
Advantage plans can translate their own payments into quality
incentives downstream. They can reward providers for performing certain
procedures known to be effective, or for prescribing drugs known to
have equal or greater effectiveness at a reduced cost. And they can
improve a beneficiary's preventive and wellness benefits.
Dialysis clinics that participate in Medicare through the program for
patients with End Stage Renal Disease have a momentous mission, helping
these patients enjoy life for years longer than we might have thought
possible just a few decades ago. Because dialysis is such a complex
operation, quality of care is extremely important.
Plans and providers in the Medicare Advantage and ESRD programs have
already started measuring and reporting on quality, which makes them an
excellent place to start. But I want to be clear these programs should
not be singled out simply because they are ahead of the game. Working
with ESRD providers and Medicare Advantage plans heralds the beginning
of a longer journey, and we need to stay the course.
First, we need to monitor this quality incentive program and ensure
that the methods used to measure health care quality and evaluate
performance are evidence-based and valid.
Second, we should evaluate the impact of a pay-for-performance
program on health plans and providers--particularly small organizations
and those that are just entering the market. Additionally, because last
year's Medicare legislation made payment and policy changes to these
providers--for example, a short-term payment increase for ESRD and a
new payment policy and the addition of regional plans for Medicare
Advantage--we would need to keep a close eye on the consequences of
these changes and the interaction with the pay-for-performance quality
initiative and take action where necessary.
Third, we should look with a wide lens and move forward with quality
initiatives in all government health care programs. It is our
responsibility to set an example for the industry through quality
improvement programs in Medicare and Medicaid, including traditional
fee-for-service Medicare.
As I mentioned, the National Voluntary Hospital Reporting Initiative
is a groundbreaking program, but we need to do more in traditional
Medicare to encourage high quality care. My bill sketches out a roadmap
that will lead us toward expanding the quality measures currently
collected for fee-for-service providers, and ultimately toward
additional Medicare payment systems that promote quality improvement.
We can also do more to focus on quality care in Medicaid. Today,
there are a number of people at the Centers for Medicare and Medicaid
Services whose responsibility it is to improve the quality of care in
Medicare. On the Medicaid side, there is one person--one person who,
while given the responsibility for quality, has no resources or
authority to develop program innovations.
You might say that quality is already addressed in Medicaid. I
applaud my colleague and Chairman of the Finance Committee, Senator
Grassley, for encouraging CMS to increase its quality improvement
activities for home and community-based services in Medicaid. We should
build on this foundation and broaden the effort. We need to identify
barriers to quality improvement throughout the Medicaid program, and
take steps toward removing those barriers.
The bill I introduce today would target a few of those barriers, and
it would require further studies to identify others. It authorizes
money to hire new staff--experienced health professionals--to improve
the quality and coordination of care delivered to Medicaid
beneficiaries. It explores ways to integrate data on Medicaid
beneficiaries who are also enrolled in Medicare--the dual-eligibles and
coordinate the care they receive from both programs. Many dual-
eligibles are among the sickest and costliest beneficiaries. By better
coordinating their care we can improve health outcomes and save money
in both programs at once.
As you can tell, I have a lot of ideas. But I have only scratched the
surface of this issue and am deeply committed to working with my
colleagues in the
[[Page S7315]]
Senate to move forward. This bill is a good start, but it is just
that--a start. We must do more.
Many of my colleagues in the Senate also care deeply about improving
the health care system, and I commend their efforts to develop
courageous proposals that will spark change. Senator Clinton introduced
a bill last year, the Health Information for Quality Improvement Act.
More recently, Senator Kennedy Introduced the Health Care
Modernization, Cost Reduction, and Quality Improvement Act.
These bills lay out a comprehensive array of policies to improve
health care quality and reduce costs, and my bill focuses on one piece
of that picture--paying for quality. They represent the gold standard
toward which we should all be working. But we share a common goal to
make the most of the American health care dollar, so that we can
provide better care to more people.
As I mentioned, health care in this country is more expensive than it
is elsewhere. But we don't necessarily get more for our money. The
United States spends twice as much on health care than any other
country, but studies have shown that quality is about the same. Better
in some areas, worse in others, but all in all about the same. No
matter how you cut it, that means that the value of our health care--
what we are getting for each dollar is less in the United States than
in other developed countries.
I've always believed that Americans were all about value. We are the
country of start-up companies and the home of Wal-Mart. We know about
good business, and we know about hard work. We should know more--and do
more--about health care.
We are an amazing country, but today our health care system is sick.
Why? It is not the fault of hard-working doctors and nurses who put in
long hours to make their patients healthy. It is our fault. We need to
support the work of health care professionals by providing the right
resources and designing payment systems to promote quality. Today, it
takes an average 17 years for a new discovery in medical care to move
from the lab bench into regular clinical practice. And for providers
working in settings without regular Internet access or without the
luxury of time to peruse medical journals, it may take even longer. As
Members of Congress, we have the opportunity to change the system, to
provide incentives for good care, funding for research into best
medical practices, and to require the development and reporting of
quality measures.
The road to this goal is long and difficult. I call on my colleagues
for their energy and support, and I call on health care professionals
and the health insurance industry to work with us. This is challenging
work, and involves many difficult decisions. But I've never been one to
shirk a challenge, and I hope you will join me. This bill is the
beginning of what must be a strong bipartisan push to improve our
health care system--to increase quality of care, to reduce costs, and
to strengthen the American spirit.
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. 2562
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) In General.--This Act may be cited as the ``Medicare
Quality Improvement Act of 2004''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Medicare Advantage and reasonable cost reimbursement contract
quality performance incentive payment program.
Sec. 4. Quality performance incentive payment program for providers and
facilities that provide services to medicare
beneficiaries with ESRD.
Sec. 5. Medicare innovative quality practice award program.
Sec. 6. Quality improvement demonstration program for pediatric renal
dialysis facilities providing care to medicare
beneficiaries with end stage renal disease.
Sec. 7. Medicare Quality Advisory Board.
Sec. 8. Studies and reports on financial incentives for quality items
and services under the medicare program.
Sec. 9. MedPAC study and report on use of adjuster mechanisms under
medicare quality performance incentive payment programs.
Sec. 10. Demonstration program on measuring the quality of health care
furnished to pediatric patients under the medicaid and
SCHIP programs.
Sec. 11. Provisions relating to medicaid quality improvements.
Sec. 12. Demonstration program for Medical Smart Cards.
SEC. 2. FINDINGS.
The Senate makes the following findings:
(1) The Institute of Medicine has highlighted problems with
our health care system in the areas of quality and patient
safety.
(2) The New England Journal of Medicine has published
research in an article entitled ``The Quality of Health Care
Delivered to Adults in the United States'' showing that
adults in the United States receive recommended health care
only about \1/2\ of the time.
(3) Payment policies under the medicare program do not
include mechanisms designed to improve the quality of care.
(4) The medicare program should reward health care
providers who show, through measurement and reporting of
quality indicators and through the practice of innovations,
that they are working to deliver high quality health care to
their patients.
(5) Reimbursement for services provided under the original
medicare fee-for-service program under parts A and B of title
XVIII of the Social Security Act should be based on a pay-
for-performance system.
(6) A more aggressive research agenda on the development of
appropriate quality measurement and payment methodologies
under the medicare program is necessary.
SEC. 3. MEDICARE ADVANTAGE AND REASONABLE COST REIMBURSEMENT
CONTRACT QUALITY PERFORMANCE INCENTIVE PAYMENT
PROGRAM.
(a) Program.--Part C of title XVIII of the Social Security
Act, as amended by section 241 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law
108-173; 117 Stat. 2214), is amended by adding at the end the
following new section:
``quality performance incentive payment program
``Sec. 1860C-2. (a) Program.--
``(1) In general.--The Secretary shall establish a program
under which financial incentive payments are provided each
year to Medicare Advantage organizations offering Medicare
Advantage plans and organizations that are providing benefits
under a reasonable cost reimbursement contract under section
1876(h) that demonstrate the provision of superior quality
health care to enrollees under the plan or contract.
``(2) Program to begin in 2007.--The Secretary shall
establish the program so that National Performance Quality
Payments (described in subsection (c)) and National Quality
Improvement Payments (described in subsection (d)) are made
with respect to 2007 and each subsequent year.
``(3) Requirement.--In order for an organization to be
eligible for a financial incentive payment under this section
with respect to a Medicare Advantage plan or a reasonable
cost reimbursement contract under section 1876(h), the
organization shall--
``(A) provide for the collection, analysis, and reporting
of data pursuant to sections 1852(e)(3) and 1876(h)(8),
respectively, with respect to the plan or contract; and
``(B) not later than a date specified by the Secretary
during each baseline year (as defined in subsection (d)(4)),
submit such data on the quality measures described in
subsection (e)(2) as the Secretary determines appropriate for
the purpose of establishing a baseline with respect to the
plan or contract.
``(4) Use of most recent data.--Financial incentive
payments under this section shall be based upon the most
recent available quality data.
``(5) Timing of quality incentive payments.--The Secretary
shall ensure that financial incentive payments under this
section with respect to a year are made by March 1 of the
subsequent year.
``(6) Applicability of program to ma plans.--For purposes
of this section, the term `Medicare Advantage plan' shall--
``(A) include both MA regional plans and MA local plans;
and
``(B) not include an MA plan described in subparagraph
(A)(ii) or (B) of section 1851(a)(2).
``(b) Quality Incentive Payments.--
``(1) In general.--Beginning with 2007, the Secretary shall
allocate the total amount available for financial incentive
payments in the year under subsection (f) as follows:
``(A) The per beneficiary payment amount for National
Performance Quality Payments established under paragraph (2)
shall be greater than the per beneficiary payment amount for
National Quality Improvement Payments established under such
paragraph.
``(B) With respect to National Performance Quality
Payments, the per beneficiary payment amount established
under paragraph (2) shall be greatest for the organizations
offering the highest performing plans or contracts.
``(C) With respect to National Quality Improvement
Payments, the per beneficiary
[[Page S7316]]
payment amount established under paragraph (2) shall be
greatest for the organizations offering plans or contracts
with the highest degree of improvement.
``(2) Amount of quality incentive payment.--
``(A) In general.--The amount of a financial incentive
payment under subsection (c) or (d) to a Medicare Advantage
organization with respect to a Medicare Advantage plan or to
an organization with respect to a reasonable cost
reimbursement contract under section 1876(h) shall be
determined by multiplying the number of beneficiaries
enrolled under the plan or contract on the first day of the
year for which the payment is provided by a dollar amount
established by the Secretary (in this section referred to as
the `per beneficiary payment amount') that is the same for
all beneficiaries enrolled under the plan or contract.
``(B) Limitation on total amount of quality incentive
payments.--The total amount of all the financial incentive
payments given with respect to a year shall be equal to the
amount available for such payments in the year under
subsection (f).
``(3) Use of quality incentive payments.--Financial
incentive payments received under this section may only be
used for the following purposes:
``(A) To reduce any beneficiary cost-sharing applicable
under the plan or contract.
``(B) To reduce any beneficiary premiums applicable under
the plan or contract.
``(C) To initiate, continue, or enhance health care quality
programs for enrollees under the plan or contract.
``(D) To improve the benefit package under the plan or
contract.
``(4) Reporting on use of quality incentive payments.--
Beginning in 2008, each MA organization that receives a
financial incentive payment under this section shall report
to the Secretary pursuant to section 1854(a)(7) on how the
organization will use such payment.
``(5) Limitations on quality incentive payments.--
``(A) Plan only eligible for 1 payment in a year.--A
Medicare Advantage organization offering a Medicare Advantage
plan or an organization that is providing benefits under a
reasonable cost reimbursement contract under section 1876(h)
may not receive more than 1 financial incentive payment under
this section in a year with respect to such plan or contract.
If an organization with respect to the plan or contract is
eligible for a National Performance Quality Payment and a
National Quality Improvement Payment, the organization shall
be given the National Performance Quality Payment.
``(B) Plan must be available for entire year.--A Medicare
Advantage organization offering a Medicare Advantage plan or
an organization that is providing benefits under a reasonable
cost reimbursement contract under section 1876(h) is not
eligible for a financial incentive payment under this section
with respect to such plan or contract unless the plan or
contract offers benefits throughout the year in which the
payment is provided.
``(c) National Performance Quality Payments.--The Secretary
shall make National Performance Quality Payments to the
Medicare Advantage organizations and organizations offering
reasonable cost reimbursement contracts under section 1876(h)
with respect to each Medicare Advantage plan or reasonable
cost contract offered by the organization that receives
ratings for the year in the top applicable percent of all
plans and contracts rated by the Secretary pursuant to
subsection (e) for the year. For purposes of the preceding
sentence, the term `applicable percent' means a percent
determined appropriate by the Secretary in consultation with
the Quality Advisory Board, but in no case less than 20
percent.
``(d) National Quality Improvement Payments.--
``(1) In general.--Subject to paragraph (2), the Secretary
shall make National Quality Improvement Payments to Medicare
Advantage organizations and organizations offering reasonable
cost reimbursement contracts under section 1876(h) with
respect to each Medicare Advantage plan or reasonable cost
reimbursement contract offered by the organization that
receives a rating under subsection (e) for the payment year
that exceeds the rating received under such subsection for
the plan or contract for the baseline year.
``(2) National improvement standard.--Beginning with 2009,
the Secretary may implement a national improvement standard
that Medicare Advantage plans and reasonable cost
reimbursement contracts must meet in order to receive a
National Quality Improvement Payment.
``(3) Application of thresholds.--In determining whether a
rating received under subsection (e) for the payment year
exceeds the rating received under such subsection for the
baseline year, the Secretary shall hold any applicable
thresholds constant. For purposes of the preceding sentence,
the term `threshold' means norms used to assess performance.
``(4) Baseline year defined.--In this subsection, the term
`baseline year' means the year prior to the payment year.
``(e) Rating Methodology.--
``(1) Scoring and ranking systems.--
``(A) In general.--The Secretary shall develop separate
scoring and ranking systems for purposes of determining which
organizations offering Medicare Advantage plans and
reasonable cost reimbursement contracts under section 1876(h)
qualify for--
``(i) National Performance Quality Payments; and
``(ii) National Quality Improvement Payments.
``(B) Requirements.--In developing, implementing, and
updating the scoring and ranking systems, the Secretary
shall--
``(i) consult with the Quality Advisory Board established
under section 1898;
``(ii) take into account the report on health care
performance measures submitted by the Institute of Medicine
of the National Academy of Sciences under section 238 of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003; and
``(iii) take into account the Managed Care Organization
(MCO) standards and guideline methodology of the National
Committee for Quality Assurance for awarding total Health
Plan Employer Data and Information Set (HEDIS) points (based
on HEDIS and Consumer Assessment of Health Plans Survey
(CAHPS) measures).
``(2) Measures.--
``(A) In general.--Subject to subparagraph (B), in
developing the scoring and ranking systems under paragraph
(1), the Secretary shall use all measures determined
appropriate by the Secretary. Such measures may include--
``(i) outcome measures for highly prevalent chronic
conditions;
``(ii) audited HEDIS outcomes and process measures, CAHPS
data, and other data reported to the Department of Health and
Human Services; and
``(iii) the Joint Commission on Accreditation of Healthcare
Organizations core measures.
``(B) Scoring and ranking system for national performance
quality payments only based on measures of clinical
effectiveness.--The scoring and ranking system for National
Performance Quality Payments shall only include measures of
clinical effectiveness.
``(3) Weights of measures.--In developing the scoring and
ranking systems under paragraph (1), the Secretary shall
assign weights to the measures used by the Secretary under
such system pursuant to paragraph (2). In assigning such
weights, the Secretary shall provide greater weight to the
measures that measure clinical effectiveness.
``(4) Risk adjustment.--In developing the scoring and
ranking systems under paragraph (1), the Secretary shall
establish procedures for adjusting the data used under the
system to take into account differences in the health status
of individuals enrolled under Medicare Advantage plans and
reasonable cost contracts.
``(5) Update.--
``(A) In general.--The Secretary shall as determined
appropriate, but in no case more often than once each 12-
month period, update the scoring and ranking systems
developed under paragraph (1), including the measures used by
the Secretary under such system pursuant to paragraph (2),
the weights established pursuant to paragraph (3), and the
risk adjustment procedures established pursuant to paragraph
(4).
``(B) Comparison for national quality improvement
payments.--Each update under subparagraph (A) of the scoring
and ranking system for National Quality Improvement Payments
shall allow for the comparison of data from one year to the
next for purposes of identifying which plans or contracts
will receive such Payments.
``(C) Consultation.--In determining when and how to update
the scoring and ranking systems under subparagraph (A), the
Secretary shall consult with the Quality Advisory Board.
``(f) Funding of Payments.--The amount available for
financial incentive payments under this section with respect
to a year shall be equal to the amount of the reduction in
expenditures under the Federal Hospital Insurance Trust Fund
and the Federal Supplementary Medical Insurance Trust Fund in
the year as a result of the amendments made by section 3(b)
of the Medicare Quality Improvement Act of 2004.''.
(b) Reduction in Payments to Organizations in Order To Fund
Program.--
(1) MA payments.--
(A) In general.--Section 1853(j) of the Social Security Act
(42 U.S.C. 1395w-23(j)), as added by section 222(d) of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (Public Law 108-173; 117 Stat. 2200), is
amended--
(i) in subparagraphs (A) and (B) of paragraph (1), by
inserting ``and, beginning in 2007, reduced by 2 percent in
the case of an MA plan described in subparagraph (A)(i) or
(C) of section 1851(a)(2)'' before the semicolon at the end;
and
(ii) in paragraph (2), by inserting ``and, beginning in
2007, reduced by 2 percent in the case of an MA plan
described in subparagraph (A)(i) or (C) of section
1851(a)(2)'' before the period at the end.
(B) Reductions in payments do not effect the government
savings for bids below the benchmark.--Section
1854(b)(1)(C)(i) of the Social Security Act (42 U.S.C. 1395w-
24(b)(1)(C)(i)), as added by section 222(b) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003
(Public Law 108-173; 117 Stat. 2196), is amended--
(i) by striking ``75 percent'' and inserting ``100
percent''; and
(ii) by inserting the following before the period at the
end: ``, reduced by 25 percent of such average per capita
savings (if any), as applicable to the plan and year
involved, that would be computed if sections 1853(j) and
1860C-1(e)(1) was applied by substituting
[[Page S7317]]
`zero percent' for `2 percent' each place it appears''.
(2) Reasonable cost contract payments.--Section 1876(h) of
the Social Security Act (42 U.S.C. 1395mm(h)) is amended by
adding at the end the following new paragraph:
``(6) Notwithstanding the preceding provisions of this
subsection, the Secretary shall reduce each payment to an
eligible organization under this subsection with respect to
benefits provided on or after January 1, 2007, by an amount
equal to 2 percent of the payment amount. The preceding
sentence shall have no effect on payments to eligible
organizations for the provision of qualified prescription
drug coverage under part D.''.
(3) CCA payments.--The first sentence of section 1860C-
1(e)(1) of the Social Security Act, as added by section 241
of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat.
2214) is amended by inserting ``, reduced by 2 percent in the
case of an MA plan described in subparagraph (A)(i) or (C) of
section 1851(a)(2)'' before the period at the end.
(c) Requirement for Reporting on Use of Financial Incentive
Payments.--
(1) MA plans.--Section 1854(a) of the Social Security Act
(42 U.S.C. 1395w-24(a)), as amended by section 222(a) of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (Public Law 108-173; 117 Stat. 2193), is
amended--
(A) in paragraph (1)(A)(i), by striking ``or (6)(A)'' and
inserting ``(6)(A), or (7)''; and
(B) by adding at the end the following:
``(7) Submission of information of how financial incentive
payments will be used beginning in 2008.--For an MA plan
described in subparagraph (A)(i) or (C) of section 1851(a)(2)
for a plan year beginning on or after January 1, 2008, the
information described in this paragraph is a description of
how the organization offering the plan will use any financial
incentive payment that the organization received under
section 1860C-2 with respect to the plan.''.
(2) Eligible entities with reasonable cost contracts.--
Section 1876(h) of the Social Security Act (42 U.S.C.
1395mm(h)), as amended by subsection (b)(2), is amended by
adding at the end the following new paragraph:
``(7)(A) Not later than July 1 of each year (beginning in
2008), any eligible entity with a reasonable cost
reimbursement contract under this subsection that receives a
financial incentive payment under section 1860C-2 with
respect to each plan year shall submit to the Secretary a
report containing the information described in subparagraph
(B).
``(B) The information described in this subparagraph is a
description of how the organization offering the plan will
use any financial incentive payment that the organization
received under section 1860C-2 with respect to the plan.''.
(d) Submission of Quality Data.--
(1) MA organizations.--Section 1852(e) of the Social
Security Act (42 U.S.C. 1395w-22(e)), as amended by section
722 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat.
2347), is amended--
(A) in paragraph (1), by striking ``an MA private fee-for-
service plan or''; and
(B) by striking paragraph (3) and inserting the following
new paragraph:
``(3) Collection, analysis, and reporting.--
``(i) In general.--As part of the quality improvement
program under paragraph (1), each MA organization shall
provide for the collection, analysis, and reporting of data
that permits the measurement of health outcomes and other
indices of quality.
``(ii) Coordination with commercial enrollee reporting
requirements.--The Secretary shall establish procedures to
ensure the coordination of the reporting requirement under
clause (i) with reporting requirements for the organization
under this part relating to individuals enrolled with the
organization but not under this part. Although such reporting
requirements shall be coordinated pursuant to the preceding
sentence, the use of the data reported may vary.''.
(2) Eligible entities with reasonable cost contracts.--
Section 1876(h) of the Social Security Act (42 U.S.C.
1395mm(h)), as amended by subsection (c)(2), is amended by
adding at the end the following new paragraph:
``(8)(A) With respect to plan years beginning on or after
January 1, 2006, an eligible entity with a reasonable cost
reimbursement contract under this subsection shall provide
for the collection, analysis, and reporting of data that
permits the measurement of health outcomes and other indices
of quality.
``(B) The Secretary shall establish procedures to ensure
the coordination of the reporting requirement under
subparagraph (A) with reporting requirements for the entity
under this title relating to individuals enrolled with the
entity but not receiving benefits under this title.''.
SEC. 4. QUALITY PERFORMANCE INCENTIVE PAYMENT PROGRAM FOR
PROVIDERS AND FACILITIES THAT PROVIDE SERVICES
TO MEDICARE BENEFICIARIES WITH ESRD.
Section 1881(b) of the Social Security Act (42 U.S.C.
1395rr(b)), as amended by section 623(d)(1) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003
(Public Law 108-173; 117 Stat. 2313), is amended--
(1) in paragraph (11)(B), by striking ``paragraphs (12) and
(13)'' and inserting ``paragraphs (12), (13), and (14)'';
(2) in paragraph (12), by striking ``In lieu of'' and
inserting ``Subject to paragraph (14), in lieu of'';
(3) in paragraph (13)(A), in the matter preceding clause
(i), by striking ``The payment amounts'' and inserting
``Subject to paragraph (14), the payment amounts''; and
(4) by adding at the end the following new paragraph:
``(14) Renal dialysis performance incentive payment
program.--
``(A) Establishment of program.--
``(i) In general.--The Secretary shall establish a program
under which financial incentive payments are provided each
year to providers of services and renal dialysis facilities
that receive payments under paragraph (12) or (13) and
demonstrate the provision of superior quality health care to
individuals with end stage renal disease.
``(ii) Program to begin in 2007.--The Secretary shall
establish the program so that National Performance Quality
Payments (described in subparagraph (C)) and National Quality
Improvement Payments (described in subparagraph (D)) are made
with respect to 2007 and each subsequent year.
``(iii) Requirement.--In order for a provider of services
or a renal dialysis facility to be eligible for a financial
incentive payment under this section, the provider or
facility shall, not later than a date specified by the
Secretary during the baseline year (as defined in
subparagraph (D)(iv)), submit such data on the quality
measures as the Secretary determines appropriate for the
purpose of establishing a baseline with respect to the
provider or facility.
``(iv) Use of most recent data.--Financial incentive
payments under this paragraph shall be based upon the most
recent available quality data as provided by the Consolidated
Renal Operations in a Web-enabled Network (CROWN) system.
``(v) Pediatric facilities not included in program.--For
purposes of this paragraph, including subparagraph (F)(i),
the terms `renal dialysis facility' and `facility' do not
include a renal dialysis facility at least 50 percent of
whose patients are individuals under 18 years of age.
``(B) Payments.--
``(i) In general.--Beginning with 2007, the Secretary shall
allocate the total amount available for financial incentive
payments in the year under subparagraph (F)(ii) as follows:
``(I) The amount allocated for National Performance Quality
Payments shall be greater than the amount allocated for
National Quality Improvement Payments.
``(II) With respect to National Performance Quality
Payments, the per capita amount of the payments shall be
greatest for the organizations offering the highest
performing plans or contracts.
``(III) With respect to National Quality Improvement
Payments, the per capita amount of the payments shall be
greatest for the organizations offering plans or contracts
with the highest degree of improvement.
``(ii) Amount of quality incentive payment.--
``(I) In general.--The amount of a financial incentive
payment under subparagraph (C) or (D) to a provider of
services or renal dialysis facility shall be determined by
multiplying the number of beneficiaries who received dialysis
services from the provider or facility during the year for
which the payment is provided by a dollar amount established
by the Secretary that is the same with respect to each
beneficiary receiving dialysis services from the provider or
facility.
``(II) Limitation on total amount of quality incentive
payments.--The total amount of all the financial incentive
payments given with respect to a year shall be equal to the
amount available for such payments in the year under
subparagraph (F)(ii).
``(iii) Use of quality incentive payments.--Financial
incentive payments received under this paragraph may be used
for the following purposes:
``(I) To invest in information technology systems that will
improve the quality of care provided to individuals with end
stage renal disease.
``(II) To initiate, continue, or enhance health care
quality programs for individuals with end stage renal
disease.
``(III) Any other purpose determined appropriate by the
Secretary.
``(iv) Limitations on quality incentive payments.--
``(I) Only eligible for 1 payment in a year.--A provider of
services or a renal dialysis facility may not receive more
than 1 financial incentive payment under this paragraph in a
year. If a provider of services or a renal dialysis facility
is eligible for a National Performance Quality Payment and a
National Quality Improvement Payment, the organization shall
be given the National Performance Quality Payment.
``(II) Services must be available for entire year.--A
provider of services or renal dialysis facility is not
eligible for a financial incentive payment under this
paragraph unless the provider or facility is in operation and
providing dialysis services for the entire year for which the
payment is provided.
``(C) National performance quality payments.--The Secretary
shall make National Performance Quality Payments to the
providers of services and renal dialysis facilities that
receive ratings for the year in the top applicable percent of
all providers and facilities rated by the Secretary pursuant
to subparagraph (E) for the year. For purposes of the
preceding sentence, the term `applicable percent' means a
percent determined appropriate by the Secretary in
consultation with
[[Page S7318]]
the Quality Advisory Board, but in no case less than 20
percent.
``(D) National quality improvement payments.--
``(i) In general.--National Quality Improvement Payments
shall be paid to each provider of services and renal dialysis
facility that receives ratings under subparagraph (E) for the
payment year that exceed the ratings received under such
subparagraph for the provider or facility for the baseline
year.
``(ii) National improvement standard.--Beginning with 2009,
the Secretary shall have the authority to implement a
national improvement standard that providers of services and
renal dialysis facilities must meet in order to receive a
National Quality Improvement Payment.
``(iii) Application of thresholds.--In determining whether
a rating received under subparagraph (E) for the payment year
exceeds the rating received under such subsection for the
baseline year, the Secretary shall hold any applicable
thresholds constant.
``(iv) Baseline year defined.--In this subparagraph, the
term `baseline year' means the year prior to the payment
year.
``(E) Rating methodology.--
``(i) Scoring and ranking systems.--
``(I) In general.--The Secretary shall develop separate
scoring and ranking systems for purposes of determining which
providers of services and renal dialysis facilities qualify
for--
``(aa) National Performance Quality Payments; and
``(bb) National Quality Improvement Payments.
``(II) Requirements.--In developing, implementing, and
updating the scoring and ranking systems, the Secretary
shall--
``(aa) consult with the Quality Advisory Board established
under section 1898 and the network administrative
organizations designated under subsection (c)(1)(A)(i)(II);
and
``(bb) take into account the report on health care
performance measures submitted by the Institute of Medicine
of the National Academy of Sciences under section 238 of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003.
``(ii) Measures.--
``(I) In general.--Subject to subclause (II), in developing
the scoring and ranking system under clause (i), the
Secretary shall use all measures determined appropriate by
the Secretary. Such measures may include the following:
``(aa) The measures profiled in the ESRD Clinical
Performance Measures (CPM) project of the Centers for
Medicare & Medicaid Services.
``(bb) The measures for bone disease to be determined by
the K-DOQI project of the National Kidney Foundation.
``(II) Scoring and ranking system for national performance
quality payments only based on measures of clinical
effectiveness.--The scoring and ranking system for National
Performance Quality Payments shall only include measures of
clinical effectiveness.
``(iii) Weights of measures.--In developing the scoring and
ranking systems under clause (i), the Secretary shall assign
weights to the measures used by the Secretary under such
system pursuant to clause (ii). In assigning such weights,
the Secretary shall provide greater weight to the measures
that measure clinical effectiveness.
``(iv) Risk adjustment.--In developing the scoring and
ranking systems under clause (i), the Secretary shall
establish procedures for adjusting the data used under the
system to take into account differences in the health status
of individuals receiving dialysis services from providers of
services and renal dialysis facilities.
``(v) Update.--
``(I) In general.--The Secretary shall as determined
appropriate, but in no case more often than once each 12-
month period, update the scoring and ranking systems
developed under clause (i), including the measures used by
the Secretary under such system pursuant to clause (ii), the
weights established pursuant to clause (iii), and the risk
adjustment procedures established pursuant to clause (iv).
``(II) Comparison for national quality improvement
payments.--Each update under subclause (I) of the National
Quality Improvement Payments shall allow for the comparison
of data from one year to the next for purposes of identifying
which providers of services and renal dialysis facilities
will receive such Payments.
``(III) Consultation.--In determining when and how to
update the scoring and ranking systems under subclause (I),
the Secretary shall consult with the Quality Advisory Board.
``(F) Funding of payments.--
``(i) Reduction in payments.--In order to provide the
funding for the financial incentive payments under this
paragraph, for each year (beginning with 2007), the Secretary
shall reduce each payment under paragraphs (12) and (13) to a
provider of service and a renal dialysis facility by an
amount equal to 2 percent of the payment.
``(ii) Amount available.--The amount available for
financial incentive payments under this section with respect
to a year shall be equal to the amount of the reduction in
expenditures under the Federal Supplementary Medical
Insurance Trust Fund in the year as a result of the
application of clause (i).''.
SEC. 5. MEDICARE INNOVATIVE QUALITY PRACTICE AWARD PROGRAM.
(a) Establishment.--The Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall establish a program under which the Secretary shall
award bonus payments to entities and individuals providing
items and services under the medicare program under title
XVIII of the Social Security Act that demonstrate innovative
practices, structural improvements, or capacity enhancements
that improve the quality of health care provided to medicare
beneficiaries by such entities and individuals.
(b) Period of Program.--Awards under the program shall be
made during 2006, 2007, and 2008.
(c) Selection of Recipients.--
(1) In general.--The Secretary shall ensure that the
entities and individuals that receive an award under this
section have demonstrated improvements in the quality of
health care provided to medicare beneficiaries by such
entities and individuals through comparison with a control
group or baseline evaluation. For purposes of the program,
improvements in the quality of health care provided to
medicare beneficiaries shall be defined as providing
additional services, such as translator services and health
literacy education services, or providing care to an expanded
service area or an expanded population through telemedicine,
increased cultural competence, or other means, in combination
with improved health outcomes or reduced beneficiary costs.
(2) All entities and individuals eligible.--Any entity,
including a plan, or individual that is providing services
under the medicare program is eligible for receiving an award
under this section.
(3) Consultation.--In selecting the recipients of the
awards under this section, the Secretary shall consult with
the Quality Advisory Board established under section 1898 of
the Social Security Act, as added by section 7.
(d) Minimum Number of Awards.--The Secretary shall make at
least 10 awards under this section in each year of the
program.
(e) Application.--An entity or individual desiring an award
under this section shall submit an application to the
Secretary at such time, in such manner, and accompanied by
such information as the Secretary may reasonably require.
(f) Amount of Award.--
(1) In general.--Subject to paragraph (2) and subsection
(h), the Secretary shall determine the amount of awards under
this section.
(2) Requirement.--In determining the amount of awards under
this section, the Secretary shall ensure that--
(A) no single award is excessive; and
(B) consideration is given to the number of beneficiaries
served by the entity or individual receiving the award.
(g) Report.--Not later than 6 months after the date on
which the program established under subsection (a) ends, the
Secretary shall submit to Congress a report on the program
together with such recommendations for legislation or
administrative action as the Secretary determines
appropriate.
(h) Funding.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated $10,000,000
for each of 2006, 2007, and 2008 to carry out this section.
SEC. 6. QUALITY IMPROVEMENT DEMONSTRATION PROGRAM FOR
PEDIATRIC RENAL DIALYSIS FACILITIES PROVIDING
CARE TO MEDICARE BENEFICIARIES WITH END STAGE
RENAL DISEASE.
(a) Demonstration Projects.--
(1) Establishment.--The Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall conduct a 3-year demonstration program under which the
Secretary establishes demonstration projects that encourage
pediatric dialysis facilities to provide superior quality
health care to individuals with end stage renal disease.
(2) Consultation in selecting sites.--In selecting the
demonstration project sites under this section, the Secretary
shall consult with the Quality Advisory Board established
under section 1898 of the Social Security Act, as added by
section 7.
(3) Submission of quality data.--Under the demonstration
projects, demonstration sites shall select appropriate
measures of quality of care provided to individuals eligible
for benefits under title XVIII of the Social Security Act who
are under 18 years of age and shall report data on such
measures to the Secretary.
(4) Assessment of measures.--The Secretary, in consultation
with the Quality Advisory Board, shall assess the validity
and reliability of the measures selected under paragraph (2).
(b) Waiver Authority.--The Secretary may waive such
requirements of titles XI and XVIII as may be necessary to
carry out the purposes of the demonstration program
established under this section.
(c) Funding.--
(1) In general.--Subject to paragraph (2), the Secretary
shall provide for the transfer from the Federal Supplementary
Medical Insurance Trust Fund 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 program under
this section.
(2) Budget neutrality.--In conducting the demonstration
program under this section, the Secretary shall ensure that
the aggregate expenditures made by the Secretary do
[[Page S7319]]
not exceed the amount which the Secretary would have expended
if the demonstration program under this section was not
implemented.
(d) Report.--Not later than 6 months after the date on
which the demonstration program established under this
section ends, the Secretary shall prepare and submit to
Congress a report on the demonstration program together
with--
(1) recommendations on whether pediatric renal dialysis
facilities should be included in the renal dialysis
performance payment program under section 1881(b)(14) of the
Social Security Act (42 U.S.C. 1395rr(b)(14)), as added by
section 4(4); and
(2) such recommendations for legislation or administrative
action as the Secretary determines appropriate.
(e) Pediatric Renal Dialysis Facility Defined.--The term
``pediatric renal dialysis facility'' means a renal dialysis
facility that receives payments under paragraph (12) or (13)
of section 1881(b) of the Social Security Act (42 U.S.C.
1395rr(b)) and is not eligible to participate in the renal
dialysis performance payment program under paragraph (14) of
such section (as added by section 4(4)) because of the
application of subparagraph (A)(iv) of such paragraph.
SEC. 7. MEDICARE QUALITY ADVISORY BOARD.
Title XVIII of the Social Security Act, as amended by
section 1016 of the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 (Public Law 108-173; 117 Stat.
2447), is amended by adding at the end the following new
section:
``quality advisory board
``Sec. 1898. (a) Establishment.--The Secretary shall
establish a Medicare Quality Advisory Board (in this section
referred to as the `Board').
``(b) Membership and Terms.--
``(1) In general.--Subject to paragraphs (3), (4), and (5),
the Board shall be composed of representatives described in
paragraph (2) who shall serve for such term as the Secretary
may specify.
``(2) Representatives.--Representatives described in this
subparagraph include representatives of the following:
``(A) Patients or patient advocate organizations.
``(B) Individuals with expertise in the provision of
quality care, such as medical directors, heads of hospital
quality improvement committees, health insurance plan
representatives, and academic researchers.
``(C) Health care professionals and providers.
``(D) Organizations that focus on the measurement and
reporting of quality indicators.
``(E) State government health care programs.
``(3) Majority nonproviders.--Individuals who are directly
involved in the provision, or management of the delivery, of
items and services covered under this title shall not
constitute a majority of the membership of the Board.
``(4) Experience with urban and rural health care issues.--
The membership of the Board should be representative of
individuals with experience with urban health care issues and
individuals with experience with rural health care issues.
``(5) Experience across a spectrum of activities.--The
membership of the Board should be representative of
individuals with experience across the spectrum of activities
that the Secretary is responsible for with respect to this
title, including the coverage of new services and
technologies, payment rates and methodologies, beneficiary
services, and claims processing.
``(c) Duties.--
``(1) Incentive programs.--
``(A) Advice.--The Board shall advise the Secretary
regarding--
``(i) the development, implementation, and updating of the
scoring and ranking systems under sections 1860C-2(e) and
1881(b)(14)(E);
``(ii) the determination of the applicable percent for
national performance quality payments under sections 1860C-
2(c) and 1881(b)(14)(C);
``(iii) the selection of recipients of innovative quality
practice awards under the program under section 5 of the
Medicare Quality Improvement Act of 2004;
``(iv) the selection of demonstration project sites and the
assessment of measures of quality of care under the
demonstration program under section 6 of the Medicare Quality
Improvement Act of 2004; and
``(v) the study and report under section 8(b) of the
Medicare Quality Improvement Act of 2004.
``(B) Annual report on incentive programs.--The Board shall
submit an annual report to the Secretary and Congress on the
programs under sections 1860C-2 and 1881(b)(14).
``(C) Additional duties.--The Board shall perform such
additional functions to assist the Secretary in carrying out
the programs described in clauses (ii) and (iii) of
subparagraph (A) and in subparagraph (B) as the Secretary may
specify.
``(2) Development and assessment of national priorities and
agenda.--The Board shall develop and assess national
priorities and an agenda for improving the quality of items
and services furnished to individuals entitled to benefits
under this title.
``(d) Waiver of Administrative Limitation.--The Secretary
shall establish the Board notwithstanding any limitation that
may apply to the number of advisory committees that may be
established (within the Department of Health and Human
Services or otherwise).''.
SEC. 8. STUDIES AND REPORTS ON FINANCIAL INCENTIVES FOR
QUALITY ITEMS AND SERVICES UNDER THE MEDICARE
PROGRAM.
(a) IOM Study and Report on How Medicare Payments for Items
and Services Affect the Quality of Such Items and Services.--
(1) Study.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall request
the Institute of Medicine of the National Academy of Sciences
to conduct a study on how the payment mechanisms for items
and services under the original medicare fee-for-service
program under parts A and B of title XVIII of the Social
Security Act effect the quality of such items and services.
(2) Report to congress.--Not later than January 1, 2006,
the Secretary shall submit to Congress a report on the
results of the study described in paragraph (1) together with
such recommendations for legislation or administrative action
as the Secretary determines appropriate.
(b) HHS Study and Report on Providing Financial Incentives
for Quality Services Under the Original Medicare Fee-for-
Service Program.--
(1) Study.--The Secretary of Health and Human Services
shall conduct a study on the actions necessary to establish a
payment system under the original medicare fee-for-service
program under parts A and B of title XVIII of the Social
Security Act that aligns the quality of services provided
under such program with the reimbursement provided under such
program for such services.
(2) Report.--
(A) In general.--Not later than January 1, 2008, the
Secretary shall submit a report to Congress on the study
conducted under paragraph (1).
(B) Contents.--The report submitted under subparagraph (A)
shall contain recommendations with respect to--
(i) the incremental steps necessary to develop the payment
system described in paragraph (1);
(ii) the performance measures to be used under such payment
system;
(iii) the incentive approaches to be used under such
payment system;
(iv) the geographic and risk adjusters to be used under
such payment system; and
(v) a strategy for aligning payment with performance across
all parts of the medicare program.
(3) Requirement.--In conducting the study under paragraph
(1) and preparing the report under paragraph (2), the
Secretary shall--
(A) consult with the Quality Advisory Board established
under section 1898 of the Social Security Act, as added by
section 7; and
(B) take into account the report on health care performance
measures submitted by the Institute of Medicine of the
National Academy of Sciences under section 238 of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (Public Law 108-173; 117 Stat. 2213).
SEC. 9. MEDPAC STUDY AND REPORT ON USE OF ADJUSTER MECHANISMS
UNDER MEDICARE QUALITY PERFORMANCE INCENTIVE
PAYMENT PROGRAMS.
(a) Study.--The Medicare Payment Advisory Commission shall
conduct a study--
(1) to determine whether it is appropriate to incorporate a
geographic adjuster into the quality performance incentive
payment programs under sections 1860C-2 and 1881(b)(14) of
the Social Security Act, as added by sections 3 and 4,
respectively, to account for different environments of care,
regional payment variation, regional variation of patient
satisfaction, and regional case mix variation; and
(2) on the most appropriate methods to risk adjust data
used under the scoring and ranking system under such programs
pursuant to sections 1860C-2(e)(4) and 1881(b)(14)(E)(iv) of
the Social Security Act.
(b) Report.--Not later than January 1, 2006, the Commission
shall submit a report to Congress and the Secretary of Health
and Human Services on the study conducted under subsection
(a) together with recommendations for such legislation and
administrative actions as the Commission considers
appropriate. If such study concludes that a geographic
adjuster described in subsection (a)(1) is appropriate, the
Commission shall include in the report recommendations on how
such adjuster could be incorporated into the quality
performance incentive payment programs described in such
subsection.
SEC. 10. DEMONSTRATION PROGRAM ON MEASURING THE QUALITY OF
HEALTH CARE FURNISHED TO PEDIATRIC PATIENTS
UNDER THE MEDICAID AND SCHIP PROGRAMS.
(a) Establishment.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
conduct a 3-year demonstration program to examine the
development and use of quality measures, pay-for-performance
programs, and other strategies in order to encourage
providers to furnish superior quality health care to
individuals under 18 years of age under the medicaid program
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) and under the SCHIP program under title XXI of such Act
(42 U.S.C. 1397aa et seq.).
(2) Authority.--The Secretary shall conduct the
demonstration program under this section pursuant to the
authority provided under this section and not under the
authority provided under section 1115 of the Social Security
Act (42 U.S.C. 1315).
[[Page S7320]]
(b) Sites To Include Multiple Settings and Providers.--In
selecting the demonstration program sites under this section,
the Secretary shall ensure that the sites include health care
delivery in multiple settings and through multiple providers,
such as school-based settings and mental health providers.
(c) Waiver Authority.--The Secretary may waive such
requirements of titles XI, XIX, and XXI of the Social
Security Act (42 U.S.C. 1301 et seq.; 1396 et seq.; 1397aa et
seq.) as may be necessary to carry out the purposes of the
demonstration program under this section.
(d) Funding.--
(1) In general.--Subject to paragraph (2), for purposes of
conducting the demonstration program under this section,
expenditures under the demonstration program shall be treated
as medical assistance under section 1903 of the Social
Security Act (42 U.S.C. 1396) or child health assistance
under section 2105 of such Act (42 U.S.C. 1397).
(2) Budget neutrality.--In conducting the demonstration
program under this section, the Secretary shall ensure that
the aggregate expenditures made by the Secretary do not
exceed the amount which the Secretary would have expended if
the demonstration program under this section had not been
implemented.
(e) Report.--Not later than 6 months after the date on
which the demonstration program under this section ends, the
Secretary shall submit to Congress a report on the
demonstration program together with such recommendations for
legislation or administrative action as the Secretary
determines appropriate.
SEC. 11. PROVISIONS RELATING TO MEDICAID QUALITY
IMPROVEMENTS.
(a) Authorization for Additional Staff at the Center for
Medicaid and State Operations.--
(1) Additional staff.--The Secretary of Health and Human
Services shall have the authority to hire 5 full-time
employees to be employed within the Center for Medicaid and
State Operations within the Centers for Medicare & Medicaid
Services from among individuals who have experience with, or
have been trained as, health professionals and who have
experience in any of the following areas:
(A) Quality improvement.
(B) Chronic care management.
(C) Care coordination.
(2) Requirement foe experience with pediatric
populations.--At least 1 of the individuals employed within
the Center for Medicaid and State Operations pursuant to
paragraph (1) shall have experience with pediatric
populations.
(3) Duties of additional staff.--The employees hired under
paragraph (1) shall be responsible for developing strategies
to access and promote quality improvement, chronic care
management, and care coordination with the medicaid program
and for providing technical assistance to the States.
(4) Authorization of appropriations.--There are authorized
to be appropriated such sums as may be necessary to carry out
this subsection.
(b) CMS Study and Report on Medicare and Medicaid Data
Coordination.--
(1) Study.--The Secretary of Health and Human Services
shall conduct a study to identify--
(A) efforts to coordinate and integrate data from the
medicare program under title XVIII of the Social Security Act
and the medicaid program under title XIX of such Act;
(B) barriers to data coordination;
(C) the potential benefits of data integration as perceived
by medicare and medicaid program officials, policymakers,
health care providers, and beneficiaries; and
(D) steps necessary to coordinate and integrate the
beneficiary data from the medicare and medicaid programs.
(2) Report to congress.--Not later than December 31, 2004,
the Secretary of Health and Human Services shall submit to
Congress a report on the results of the study conducted under
paragraph (1) together with such recommendations for
legislation or administrative action as the Secretary
determines appropriate.
(c) Medpac Study and Report on Beneficiaries Who Are Dually
Eligible for Medicare and Medicaid.--
(1) Study.--The Medicare Payment Advisory Commission shall
conduct a study to determine the characteristics of
individuals who are eligible to receive benefits under both
the medicare and medicaid programs under titles XVIII and XIX
of the Social Security Act, respectively, identify the
costliest groups of individuals who are eligible for benefits
under both programs, identify the services used by such
individuals, and develop recommendations on how the provision
of those services could be better coordinated for improved
health outcomes and reduced costs.
(2) Report.--Not later than June 30, 2005, the Commission
shall submit a report to Congress on the study conducted
under paragraph (1) together with recommendations for such
legislation and administrative actions as the Commission
considers appropriate.
(d) Medpac Study and Report on Care Coordination Programs
for Dual-Eligibles.--
(1) Study.--The Medicare Payment Advisory Commission shall
conduct a study on care coordination programs available to
individuals who are eligible to receive benefits under both
the medicare and medicaid programs under titles XVIII and XIX
of the Social Security Act, respectively, the impact of such
care coordination programs on those individuals, the impact
of such care coordination programs on the costs of the
medicare and medicaid programs to the Federal Government, and
whether any savings from care coordination programs are
counted as a benefit to either program.
(2) Report.--Not later than June 30, 2005, the Commission
shall submit a report to Congress on the study conducted
under paragraph (1) together with recommendations for such
legislation and administrative actions as the Commission
considers appropriate.
SEC. 12. DEMONSTRATION PROGRAM FOR MEDICAL SMART CARDS.
(a) In General.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
establish a 5-year demonstration program under which the
Secretary shall award grants for the establishment of
demonstration projects to provide for the development and use
of Medical Smart Cards and to examine the impact of Medical
Smart Cards on health care costs, quality of care, and
patient safety.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall be a public or private
nonprofit entity.
(c) Application.--An eligible entity desiring a grant under
this section shall submit an application to the Secretary at
such time, in such manner, and accompanied by such
information as the Secretary may reasonably require.
(d) Approval of Applications.--
(1) In general.--The Secretary shall approve applications
for grants under this section in accordance with criteria
established by the Secretary.
(2) Limitation.--The Secretary shall approve at least 1
application for a demonstration project that is conducted at
a hospital or hospital system with a large rural service
area.
(e) Use of Funds.--An eligible entity shall use amounts
received under a grant under this section to carry out the
purposes described in subsection (a).
(f) Report.--Not later than 6 months after the date on
which the demonstration program established under subsection
(a) ends, the Secretary shall submit to Congress a report on
the demonstration program together with such recommendations
for legislation or administrative action as the Secretary
determines appropriate.
(g) Authorization of Appropriations.--There are authorized
to be appropriated such sums as may be necessary to carry out
this section.
______
By Mr. KOHL (for himself and Mr. Hatch):
S. 2563. A bill to require imported explosives to be marked in the
same manner as domestically manufactured explosives; to the Committee
on the Judiciary.
Mr. KOHL. Mr. President, I rise today with Senator Hatch to introduce
the Imported Explosives Security Act. Domestic manufacturers are
required to place identification markings on all explosive materials
they produce for important security reasons. These markings enable law
enforcement officers to determine the source of explosives and help
them solve crimes. Yet, these same identifying markings are not
required of those explosives manufactured overseas and imported into
our country. This impedes law enforcement efforts and poses a security
risk.
The legislation we have introduced today is simple and
straightforward. The legislation would simply treat imported explosives
just like those manufactured inside the United States, requiring all
imported explosives to carry the same markings currently placed on
domestic explosives. It would require the name of the manufacturer,
along with the time, date and shift of manufacture, to be placed on all
explosives materials, whether they are manufactured here or abroad.
These markings can be a tremendously useful tool for law enforcement
officials, enabling investigators to determine the source of explosive
materials. According to the Bureau of Alcohol, Tobacco, Firearms and
Explosives, the explosives can then be tracked through records kept by
those who manufacture and sell them, often leading them to the criminal
who has stolen or misused them. At a recent Senate hearing, FBI
Director Mueller acknowledged that ``determining the source of the
components to any explosive device will assist you in determining who
was responsible for any act using such a device.''
The Bureau of Alcohol, Tobacco, Firearms and Explosives first sought
to fill this gap in the law when it published a notice of a proposed
rulemaking in November 2000. Now, nearly 4 years later, this rulemaking
still has not been finalized. Each year, more than 25,000 pounds of
stolen, lost, or abandoned explosives are recovered by law enforcement.
When explosives do not carry appropriate markings, they
[[Page S7321]]
cannot be quickly and effectively traced for criminal enforcement
purposes.
Millions of pounds of unmarked explosives have already been
distributed in this country. Each day we delay closing this loophole,
we let more untraceable explosive materials cross our borders and
undermine our national security. Failure to address this very
straightforward issue in a timely manner unnecessarily hinders law
enforcement's ability to solve crimes. Because the Department of
Justice has not issued regulations to close this loophole in a timely
manner, it is now incumbent upon us to act for them.
______
By Mr. CRAPO (for himself, Mr. Fitzgerald, Mr. Lugar, Mr. Smith,
Mr. Wyden, Mr. Craig, and Mr. Roberts):
S. 2565. A bill to amend the Agriculture Adjustment Act to convert
the dairy forward pricing program into a permanent program of the
Department of Agriculture; to the Committee on Agriculture, Nutrition,
and Forestry.
Mr. CRAPO. Mr. President, I rise to introduce the Milk Forward
Contracting Act, a bill to make permanent the dairy forward pricing
pilot program.
Without question, dairy producers are subject to a very fickle dairy
market. Dairy prices can go from all time highs to all time lows over a
course of a year, making long-term planning extremely difficult. This
legislation will ensure the continued availability of an important risk
management tool for dairy producers and enable their long-term business
planning.
Over the pat 4 years, dairy producers and processors have been able
to voluntarily enter into agreements for the sale of a specific volume
of milk for a set price over an established period of time trough the
dairy forward pricing pilot program. Many producers in my home State of
Idaho and nationwide have used this voluntary program to reduce
marketing risk by securing stable prices. Unfortunately, this program
expires in December of 2004, and dairy producers want to be able to
continue to utilize this program.
Forward contracting is a very useful tool for dairy farmers. In fact,
a 2002 U.S. Department of Agriculture USDA report to Congress
demonstrated that the program has been effective in reducing price
volatility. According to USDA data for the September 2000 through
December 2002 period, contracted milk averages $14.06 per hundredweight
with a range of $1.63 between high and low prices, while non-contracted
milk averaged $13.68 per hundredweight with a range of $6.69.
Additionally, the U.S. General Accounting Office GAO reported that
forward contracting is a risk management tool most frequently used by
producers of other farm commodities.
Likewise, dairy producers should also have access to this important
tool. There is no reason that dairy farmers should be forced to ride a
dairy price roller coaster, when the extension of this sensible program
would provide farm families with an option to help plan for their
futures.
______
By Mr. BINGAMAN (for himself, Mr. Corzine, Mr. Lautenberg, Ms.
Stabenow, Mrs. Clinton, Mr. Johnson, Ms. Mikulski, Mr. Durbin,
and Mr. Dayton):
S. 2566. A bill to amend title II of the Social Security Act to phase
out the 24-month waiting period for disabled individuals to become
eligible for medicare benefits, to eliminate the waiting period for
individuals with life-threatening conditions, and for other purposes;
to the Committee on Finance.
Mr. BINGAMAN. Mr. President, I rise today to introduce legislation
entitled ``Ending the Medicare Disability Waiting Period Act of 2004''
with Senators Corzine, Lautenberg, Stabenow, Clinton, Johnson,
Mikulski, Durbin, and Dayton. This legislation would phase-out the
current 2-year waiting period that people with disabilities must endure
after qualifying for Social Security Disability Insurance (SSDI). In
the interim, the bill would also create a process by which the
Secretary can immediately waive the waiting period for people with
life-threatening illnesses.
When Medicare was expanded in 1972 to include people with significant
disabilities, lawmakers created the 24-month waiting period. According
to a July 2003 report from the Commonwealth Fund, it is estimated that
over 1.2 million SSDI beneficiaries are in the Medicare waiting period
at any given time, ``all of whom are unable to work because of their
disability and most of whom have serious health problems, low incomes,
and limited access to health insurance.''
As Karen Davis, president of the Commonwealth Fund, said of the
report, ``Individuals in the waiting period for Medicare suffer from a
broad range of debilitating diseases and are in urgent need of
appropriate medical care to manage their conditions. Eliminating the 2-
year wait would ensure access to care for those already on the way to
Medicare.''
These are people who are the most seriously disabled in our society
and most in need of immediate health services. And yet, it is estimated
that one-third of the 1.2 million currently federal policy puts the
disabled on hold for 2 long years. The consequences are unacceptable
and are, in fact, dire.
In fact, various studies show that death rates among SSDI recipients
are highest during the first two years of enrollment. For example, the
Commonwealth Fund report, entitled Elimination of Medicare's Waiting
Period for Seriously Disabled Adults: Impact on Coverage and Costs, 4
percent of these people die during the waiting period. Of the estimated
400,000 uninsured disabled Americans in the waiting period at any given
time, 16,000 of them will die awaiting Medicare coverage. This is
unacceptable.
Moreover, this does not factor in the serious health problems that
others experience while waiting for Medicare coverage during the 2-year
period. Although there is no direct data on the profile of SSDI
beneficiaries in the 2-year waiting period, the Commonwealth Fund has
undertaken a separate analysis of the Medicare Current Beneficiary
Survey for 1998 to get a good sense of the demographic characteristics,
income, and health conditions of this group.
According to the analysis, ``. . . 45 percent of nonelderly Medicare
beneficiaries with disabilities had incomes below the federal poverty
line, and 77 percent had incomes below 200 percent of poverty. Fifth-
nine percent reported that they were in fair or poor health; of this
group, more than 90 percent reported that they suffered from one or
more chronic illnesses, including arthritis (52%), hypertension (46%),
mental disorder (36%), heart condition (35%), chronic lung disease
(26%), cancer (20%), diabetes (19%), and stroke (12%).''
As the Medicare Rights Center has said, ``By forcing Americans with
disabilities to wait 24 months for Medicare coverage, the current law
effectively sentences these people to inadequate health care, poverty,
or death . . . Since disability can strike anyone, at any point in
life, the 24-month waiting period should be of concern to everyone, not
just the millions of Americans with disabilities today.''
Although elimination of the Medicare waiting period will certainly
increase Medicare costs, it is important to note that there will be
some corresponding decrease in Medicaid costs. Medicaid, which is
financed by both federal and state governments, often provides coverage
for a subset of disabled Americans in the waiting period, as long as
they meet certain income and asset limits. Income limits are typically
at or below the poverty level, including at just 74 percent of the
poverty line in New Mexico, with assets generally limited to just
$2,000 for individuals and $3,000 for couples.
The Commonwealth Fund estimates that, of the 1.26 million people in
the waiting period, 40 percent are enrolled in Medicaid. As a result,
the Commonwealth Fund estimates that federal Medicaid savings would
offset nearly 30 percent of the increased costs in its study.
Furthermore, states, which have been struggling financially with their
Medicaid programs, would reap a windfall that would help them better
manage their Medicaid programs.
Furthermore, from a continuity of care point of view, it makes little
sense that somebody with disabilities must leave their job and their
health providers associated with that plan, move on the Medicaid to
often have a different set of providers, to then switch to Medicare and
yet another set of providers.
And finally, private-sector employers and employees in those risk-
pools
[[Page S7322]]
would also benefit from the passage of the bill. As the report notes,
``. . . to the extent that disabled adults rely on coverage through
their prior employer or their spouse's employer, eliminating the
waiting period would also produce savings to employers who provide this
coverage.''
I urge passage of this legislation and 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. 2566
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 ``Ending the
Medicare Disability Waiting Period Act of 2004''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Phase out of waiting period for medicare disability benefits.
Sec. 3. Elimination of waiting period for individuals with life-
threatening conditions.
Sec. 4. Institute of medicine study and report on delay and prevention
of disability conditions.
SEC. 2. PHASE OUT OF WAITING PERIOD FOR MEDICARE DISABILITY
BENEFITS.
(a) In General.--Section 226(b) of the Social Security Act
(42 U.S.C. 426(b)) is amended--
(1) in paragraph (2)(A), by striking ``, and has for 24
calendar months been entitled to,'' and inserting ``, and for
the waiting period (as defined in subsection (k)) has been
entitled to,'';
(2) in paragraph (2)(B), by striking ``, and has been for
not less than 24 months,'' and inserting ``, and has been for
the waiting period (as defined in subsection (k)),'';
(3) in paragraph (2)(C)(ii), by striking ``, including the
requirement that he has been entitled to the specified
benefits for 24 months,'' and inserting ``, including the
requirement that the individual has been entitled to the
specified benefits for the waiting period (as defined in
subsection (k)),''; and
(4) in the flush matter following paragraph
(2)(C)(ii)(II)--
(A) in the first sentence, by striking ``for each month
beginning with the later of (I) July 1973 or (II) the twenty-
fifth month of his entitlement or status as a qualified
railroad retirement beneficiary described in paragraph (2),
and'' and inserting ``for each month beginning after the
waiting period (as so defined) for which the individual
satisfies paragraph (2) and'';
(B) in the second sentence, by striking ``the `twenty-fifth
month of his entitlement' refers to the first month after the
twenty-fourth month of entitlement to specified benefits
referred to in paragraph (2)(C) and''; and
(C) in the third sentence, by striking ``, but not in
excess of 78 such months''.
(b) Schedule for Phase Out of Waiting Period.--Section 226
of the Social Security Act (42 U.S.C. 426) is amended by
adding at the end the following new subsection:
``(k) For purposes of subsection (b) (and for purposes of
section 1837(g)(1) of this Act and section 7(d)(2)(ii) of the
Railroad Retirement Act of 1974), the term `waiting period'
means--
``(1) for 2005, 18 months;
``(2) for 2006, 16 months;
``(3) for 2007, 14 months;
``(4) for 2008, 12 months;
``(5) for 2009, 10 months;
``(6) for 2010, 8 months;
``(7) for 2011, 6 months;
``(8) for 2012, 4 months;
``(9) for 2013, 2 months; and
``(10) for 2014 and each subsequent year, 0 months.''.
(c) Conforming Amendments.--
(1) Sunset.--Effective January 1, 2014, subsection (f) of
section 226 of the Social Security Act (42 U.S.C. 426) is
repealed.
(2) Medicare description.--Section 1811(2) of such Act (42
U.S.C. 1395c(2)) is amended by striking ``entitled for not
less than 24 months'' and inserting ``entitled for the
waiting period (as defined in section 226(k))''.
(3) Medicare coverage.--Section 1837(g)(1) of such Act (42
U.S.C. 1395p(g)(1)) is amended by striking ``of the later of
(A) April 1973 or (B) the third month before the 25th month
of such entitlement'' and inserting ``of the third month
before the first month following the waiting period (as
defined in section 226(k)) applicable under section 226(b)''.
(4) Railroad retirement system.--Section 7(d)(2)(ii) of the
Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is
amended--
(A) by striking ``, for not less than 24 months'' and
inserting ``, for the waiting period (as defined in section
226(k) of the Social Security Act); and
(B) by striking ``could have been entitled for 24 calendar
months, and'' and inserting ``could have been entitled for
the waiting period (as defined is section 226(k) of the
Social Security Act), and''.
(d) Effective Date.--Except as provided in subsection
(c)(1), the amendments made by this section shall apply to
insurance benefits under title XVIII of the Social Security
Act with respect to items and services furnished in months
beginning at least 90 days after the date of the enactment of
this Act.
SEC. 3. ELIMINATION OF WAITING PERIOD FOR INDIVIDUALS WITH
LIFE-THREATENING CONDITIONS.
(a) In General.--Section 226(h) of the Social Security Act
(42 U.S.C. 426(h)) is amended--
(1) by redesignating paragraphs (1), (2), and (3) as
subparagraphs (A), (B), and (C), respectively;
(2) in the matter preceding subparagraph (A) (as
redesignated by paragraph (1)), by inserting ``(1)'' after
``(h)'';
(3) in paragraph (1) (as designated by paragraph (2))--
(A) in the matter preceding subparagraph (A) (as
redesignated by paragraph (1)), by inserting ``or any other
life-threatening condition identified by the Secretary''
after ``amyotrophic lateral sclerosis (ALS)''; and
(4) in subparagraph (B) (as redesignated by paragraph (1)),
by striking ``(rather than twenty-fifth month)''; and
(5) by adding at the end the following new paragraph:
``(2) For purposes of identifying life-threatening
conditions under paragraph (1), the Secretary shall compile a
list of conditions that are fatal without medical treatment.
In compiling such list, the Secretary shall consult with the
Director of the National Institutes of Health (including the
Office of Rare Diseases), the Director of the Centers for
Disease Control and Prevention, the Director of the National
Science Foundation, and the Institute of Medicine of the
National Academy of Sciences.''.
(c) Effective Date.--The amendments made by this section
shall apply to insurance benefits under title XVIII of the
Social Security Act with respect to items and services
furnished in months beginning at least 90 days after the date
of the enactment of this Act.
SEC. 4. INSTITUTE OF MEDICINE STUDY AND REPORT ON DELAY AND
PREVENTION OF DISABILITY CONDITIONS.
(a) Study.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall request
that the Institute of Medicine of the National Academy of
Sciences conduct a study on the range of disability
conditions that can be delayed or prevented if individuals
receive access to health care services and coverage before
the condition reaches disability levels.
(b) Report.--Not later than the date that is 2 years after
the date of enactment of this Act, the Secretary shall submit
to Congress a report containing the results of the Institute
of Medicine study authorized under this section.
(c) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $750,000 for the
period of fiscal years 2005 and 2006.
______
By Mrs. FEINSTEIN:
S. 2567. A bill to adjust the boundary of Redwood National Park in
the State of California; to the Committee on Energy and Natural
Resources.
Mrs. FEINSTEIN. Mr. President, I am pleased to introduce companion
legislation to H.R. 3638, a bill introduced by Congressman Mike
Thompson in November 2003. This bill will adjust the boundary of
Redwood National Park in the State of California to include the
addition of the Mill Creek property.
In 2002, the California Department of Parks and Recreation acquired
from the Save-the-Redwoods League 25,500 acres of forest land known as
the Mill Creek property in Del Norte County, which is contiguous with
the Redwood National and State parks boundary. This bill would include
within the park boundary the Mill Creek acquisition and about 900 acres
of land acquired and added to the State redwood parks since the 1978
expansion of the Redwood National Park boundary. There would be no
Federal costs for land acquisition or development resulting from this
legislation.
These lands will be managed by the same cooperative management
agreement between the National Park Service and the California
Department of Parks and Recreation. This partnership is viewed as a
model of interagency cooperative management efforts and will provide
for more efficient and cost-effective management of an ecologically
significant resource.
This bill enjoys strong support from local and Federal officials,
including Del Norte County and the Department of the Interior. Given
this support and lack of controversy, I believe introducing companion
legislation to be of great importance to ensure that our Redwood
National Park is further protected.
I have long held a deep interest in protecting California's
magnificent Redwoods. The Headwaters Agreement that was negotiated in
part in my offices in 1996 protected approximately 7,500 acres of old
growth redwoods, which was the largest grove of redwoods held in
private ownership at the time.
[[Page S7323]]
I applaud Congressman Mike Thompson's commitment to this issue and
hope that this bill receives strong bipartisan support.
I urge my colleagues to support this legislation.
______
By Mr. BIDEN:
S. 2568. A bill to require the Secretary of the Treasury to mint
coins in commemoration of the tercentenary of the birth of Benjamin
Franklin, and for other purposes; to the Committee on Banking, Housing,
and Urban Affairs.
Mr. BIDEN. Mr. President, I rise today to introduce the Benjamin
Franklin Commemorative Coin Act. This bill will authorize the U.S. Mint
to produce a limited edition silver coin, in two designs, to honor the
achievements of Benjamin Franklin, America's distinguished scientist,
statesman, inventor and diplomat.
In 2006, the United States will host a worldwide celebration marking
the 300th anniversary of Franklin's birth on January 17, 1706.
Activities, lectures and exhibits are being developed through the
efforts of the Benjamin Franklin Tercentenary Commission, as ordered by
the Benjamin Franklin Tercentenary Commission Act, Public Law 107-202.
The Commission, on which I serve with other elected officials and
private sector partners, is responsible for providing a proper tribute
to one of our most remarkable founding fathers. Surcharges on the sale
of the coin would help the commission pay for activities it plans for
celebrating Benjamin Franklin's birthday.
During the American Revolution, Franklin designed the first American
coin--the ``Continental'' penny--and, until 1979, he was the only non-
President of the United States whose image graced circulating coin and
paper currency. it is only fitting that we honor Franklin's legacy
through issuance of a commemorative coin.
This bill is the Senate companion to H.R. 3024, which was introduced
by my colleague from Delaware, Congressman Mike Castle, and it
presently enjoys 326 cosponsors. As celebrations for our great leader
are planned, I hope that my colleagues will join me in supporting a
commemorative coin for this important American. I ask unanimous consent
that the text of this bill be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 2568
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 ``Benjamin Franklin
Commemorative Coin Act''.
SEC. 2. FINDINGS.
Congress finds that_
(1) Benjamin Franklin made historic contributions to the
development of our Nation in a number of fields, including
government, business, science, communications, and the arts;
(2) Benjamin Franklin was the only Founding Father to sign
all of our Nation's organizational documents;
(3) Benjamin Franklin spent his career as a successful
printer, which included printing the official currency for
the colonies of Pennsylvania, Delaware, New Jersey and
Maryland;
(4) Franklin's ``Essay on Paper Currency'' of 1741 proposed
methods to fix the rate of exchange between the colonies and
Great Britain;
(5) Benjamin Franklin, during the American Revolution,
designed the first American coin, the ``Continental'' penny;
(6) Franklin made ``A Penny Saved is A Penny Earned'' a
household phrase to describe the American virtues of hard
work and economical living;
(7) Franklin played a major role in the design of the Great
Seal of the United States, which appears on the $1 bill, and
other major American symbols;
(8) Before 1979, Benjamin Franklin was the only non-
president of the United States whose image graced circulating
coin and paper currency;
(9) the official United States half dollar from 1948-1963
showed Franklin's portrait, as designed by John Sinnock;
(10) Franklin's ``Way to Wealth'' has come to symbolize
America's commitment to free enterprise;
(11) the Franklin Institute Science Museum in Philadelphia
(in this Act referred to as the ``Franklin Institute'') is a
museum with an interactive approach to science and technology
dedicated to the work of Benjamin Franklin;
(12) the Franklin Institute houses the first steam printing
machine for coinage used by the United States Mint, which was
placed in service in 1836, the 130th anniversary year of
Franklin's birth;
(13) in 1976, Franklin Hall in the Franklin Institute was
named the Official National Monument to the great patriot,
scientist, and inventor;
(14) the Franklin Institute and 4 other major Benjamin
Franklin-related Philadelphia cultural institutions joined
hands in 2000 to organize international programs to
commemorate the forthcoming 300th anniversary of Franklin's
birth in 2006; and
(15) in 2002, Congress passed the Benjamin Franklin
Tercentenary Commission Act (Public Law 107-202), creating a
panel of distinguished Americans to work with the private
sector in recommending appropriate Tercentenary programs,
with the Franklin Institute serving as its administrative
secretariat.
SEC. 3. COIN SPECIFICATIONS.
(a) Denominations.--The Secretary of the Treasury (in this
Act referred to as the ``Secretary'') shall mint and issue
the following coins:
(1) $1 silver coins with younger franklin image on
obverse.--Not more than 250,000 $1 coins bearing the designs
specified in section 4(a)(2), each of which shall--
(A) weigh 26.73 grams;
(B) have a diameter of 1.500 inches; and
(C) contain 90 percent silver and 10 percent copper.
(2) $1 silver coins with older franklin image on obverse.--
Not more than 250,000 $1 coins bearing the designs specified
in section 4(a)(3), each of which shall--
(A) weigh 26.73 grams;
(B) have a diameter of 1.500 inches; and
(C) contain 90 percent silver and 10 percent copper.
(b) Legal Tender.--The coins minted under this Act shall be
legal tender, as provided in section 5103 of title 31, United
States Code.
(c) Numismatic Items.--For purposes of section 5136 of
title 31, United States Code, all coins minted under this Act
shall be considered to be numismatic items.
(d) Use of the United States Mint at Philadelphia,
Pennsylvania.--It is the sense of the Congress that the coins
minted under this Act should be struck at the United States
Mint at Philadelphia, Pennsylvania, to the greatest extent
possible.
SEC. 4. DESIGN OF COINS.
(a) Design Requirements.--
(1) In general.--The design of the coins minted under this
Act shall be emblematic of the life and legacy of Benjamin
Franklin.
(2) $1 coins with younger franklin image.--
(A) Obverse.--The obverse of the coins minted under section
3(a)(1) shall bear the image of Benjamin Franklin as a young
man.
(B) Reverse.--The reverse of the coins minted under section
3(a)(1) shall bear an image related to Benjamin Franklin's
role as a patriot and a statesman.
(3) $1 coins with older franklin image.--
(A) Obverse.--The obverse of the coins minted under section
3(a)(2) shall bear the image of Benjamin Franklin as an older
man.
(B) Reverse.--The reverse of the coins minted under section
3(a)(2) shall bear an image related to Benjamin Franklin's
role in developing the early coins and currency of the new
country.
(4) Designation and inscriptions.--On each coin minted
under this Act, there shall be--
(A) a designation of the value of the coin;
(B) an inscription of the year ``2006''; and
(C) inscriptions of the words ``Liberty'', ``In God We
Trust'', ``United States of America'', and ``E Pluribus
Unum''.
(b) Selection.--The design for the coins minted under this
Act shall be--
(1) selected by the Secretary after consultation with the
Commission of Fine Arts; and
(2) reviewed by the Citizens Coin Advisory Committee
established under section 5135 of title 31, United States
Code.
SEC. 5. ISSUANCE OF COINS.
(a) Quality of Coins.--Coins minted under this Act shall be
issued in uncirculated and proof qualities.
(b) Commencement of Issuance.--The Secretary may issue
coins minted under this Act beginning January 1, 2006, except
that the Secretary may initiate sales of such coins, without
issuance, before such date.
(c) Termination of Minting Authority.--No coins shall be
minted under this Act after December 31, 2006.
SEC. 6. SALE OF COINS.
(a) Sale Price.--Notwithstanding any other provision of
law, the coins issued under this Act shall be sold by the
Secretary at a price equal to the face value, plus the cost
of designing and issuing such coins (including labor,
materials, dies, use of machinery, overhead expenses, and
marketing).
(b) Bulk Sales.--The Secretary shall make bulk sales of the
coins issued under this Act at a reasonable discount.
(c) Prepaid Orders at a Discount.--
(1) In general.--The Secretary shall accept prepaid orders
for the coins minted under this Act before the issuance of
such coins.
(2) Discount.--Sale prices with respect to prepaid orders
under paragraph (1) shall be at a reasonable discount.
(d) Sales of Single Coins and Sets of Coins.--Coins of each
design specified under section 4 may be sold separately or as
a set containing a coin of each such design.
SEC. 7. SURCHARGES.
(a) Surcharge Required.--All sales of coins minted under
this Act shall include a surcharge of $10 per coin.
(b) Distribution.--Subject to section 5134(f) of title 31,
United States Code, all surcharges which are received by the
Secretary
[[Page S7324]]
from the sale of coins issued under this Act shall be
promptly paid by the Secretary to the Franklin Institute, for
purposes of the celebration of the Benjamin Franklin
Tercentenary.
(c) Audits.--The Franklin Institute shall be subject to the
audit requirements of section 5134(f)(2) of title 31, United
States Code, for purposes of this Act.
______
By Ms. SNOWE:
S. 2569. A bill to amend section 227 of the Communications Act of
1934 to clarify the prohibition on junk fax transmissions; to the
Committee on Commerce, Science, and Transportation.
Mr. SNOWE. Mr. President, I rise today to introduce the Junk Fax
Prevention Act of 2004, a bill to strengthen our laws on protecting
consumers and businesses from receiving unwanted commercial
advertisements by facsimile, while at the same time preserving a key
method of doing business for thousands of companies, large and small,
across the United States. The sending of unsolicited commercial
communications by facsimile--``junk faxes''--has been illegal since
1991, and the Federal Communications Commission is charged with
enforcing that prohibition. Those who engage in ``blast faxes'' can and
should be prosecuted to the full extent of the law, as their behavior
imposes unreasonable expenses upon residential and business facsimile
subscribers.
However, the FCC has long recognized an exception to this general ban
on unsolicited faxes when the parties sending and receiving the fax
have an established business relationship. Businesses of all shapes and
sizes regularly conduct their transactions via facsimile, such as real
estate agents, wholesalers and distributors, travel agents, and those
in the convention industry. In our modern economy, companies that are
often hundreds or thousands of miles away from each other do business
together, often with the same or greater frequency as with those just
up the street. And the reality of business is that sometimes you need
to communicate in writing, and it needs to get there right away.
The established business relationship exemption recognized this
reality, and ensured that government was not placing an undue hardship
on business owners. Yet inexplicably, on June 26, 2003 the FCC issued a
new rule that eliminated the established business relationship. Under
this new rule--which is set to take effect on January 1, 2005--the
sender of a fax would have to acquire, in writing, the permission of
the recipient to receive an unsolicited fax before the fax could be
sent, even if the recipient made a verbal request that the information
be faxed.
As Chair of the Senate Small Business Committee, I can state that the
business community has in unison called upon Congress to take action to
rectify this situation. Industry groups estimate that it will cost
businesses an average of $5,000 in the first year alone to comply with
the new law, and as much as $3,000 each year thereafter in record-
keeping costs. These numbers do not take into account the potential
lost business that could easily result if a primary method of business-
to-business communication is cut off. Quite simply, small businesses in
particular will suffer significantly if these rules are allowed to take
effect.
My bill will restore the established business relationship exemption,
allowing standard business transactions to continue without inhibition.
The term ``Established business relationship'' means the same thing in
the Junk Fax Prevention Act as in the regulations governing the Federal
Do-Not-Call Registry: it means that the fax subscriber either made an
inquiry of the sender within the prior three months or a purchase from
the sender within the prior 18 months.
The Junk Fax Prevention Act also strengthens the protections
available to fax recipients by adding an opt-out provision that the
current law does not have. Even if an established business relationship
exists, a fax subscriber can still request to not receive unsolicited
faxes. The senders of these faxes must, by law, honor these requests,
and they must include a notification of this right on every fax they
send.
As a strong supporter of consumer rights, I also want to assure my
colleagues that this bill does not in any way place consumers at risk.
Very few consumers own fax machines, and those who do are protected by
the general ban on solicitation and the opt-out provision if they do
have an existing business relationship. To ensure that the privacy of
consumers and businesses is protected, my bill also provides for
studies by both the General Accounting Office and the FCC to evaluate
the effectiveness of enforcement.
Small businesses have weathered the storm of the economic downturn
over the past several years. As our economy now climbs out of recession
and people return back to work, American businesses--our nation's
employers do not need these unnecessary economic restraints to further
hinder their recovery. I call upon all of my colleagues to join me in
bringing relief to American businesses and pass the Junk Fax Prevention
Act.
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. 2569
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 ``Junk Fax Prevention Act of
2004''.
SEC. 2. PROHIBITION ON FAX TRANSMISSIONS CONTAINING
UNSOLICITED ADVERTISEMENTS.
(a) Prohibition.--Subparagraph (C) of section 227(b)(1) of
the Communications Act of 1934 (47 U.S.C. 227(b)(1)(C)) is
amended to read as follows:
``(C) to use any telephone facsimile machine, computer, or
other device to send, to a telephone facsimile machine, an
unsolicited advertisement--
``(i) to a person who has made a request to such sender
that complies with the requirements under paragraph (2)(D),
not to send future unsolicited advertisements to a telephone
facsimile machine; or
``(ii) to a person not described in clause (i), unless--
``(I) the sender has an established business relationship
(which term, for purposes of this subclause, shall have the
meaning given the term in section 64.1200 of the Commission's
regulations, as in effect on January 1, 2003, except that
such term shall apply to a business subscriber in the same
manner in which it applies to a residential subscriber) with
such person; and
``(II) the unsolicited advertisement contains a conspicuous
notice on the first page of the unsolicited advertisement
that--
``(aa) states that the recipient may make a request to the
sender of the unsolicited advertisement not to send any
future unsolicited advertisements to such telephone facsimile
machine and that failure to comply, within the shortest
reasonable time, as determined by the Commission, with such a
request meeting the requirements under paragraph (2)(D) is
unlawful;
``(bb) sets forth the requirements for a request under
paragraph (2)(D); and
``(cc) includes a domestic contact telephone and facsimile
number for the recipient to transmit such a request to the
sender, neither of which may be a number for a pay-per-call
service (as such term is defined in section 228(i)); any
number supplied shall permit an individual or business to
make a do-not-fax request during regular business hours;
or''.
(b) Request to Opt-Out of Future Unsolicited
Advertisements.--Paragraph (2) of section 227(b) of the
Communications Act of 1934 (47 U.S.C. 227(b)(2)) is amended--
(1) in subparagraph (B), by striking ``and'' at the end;
(2) in subparagraph (C), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new subparagraphs:
``(D) shall provide, by rule, that a request not to send
future unsolicited advertisements to a telephone facsimile
machine complies with the requirements under this
subparagraph only if--
``(i) the request identifies the telephone number of the
telephone facsimile machine to which the request relates;
``(ii) the request is made to the telephone or facsimile
number of the sender of such an unsolicited advertisement
provided pursuant to paragraph (1)(C)(ii)(II)(cc) or by any
other method of communication as determined by the
Commission; and
``(iii) the person making the request has not, subsequent
to such request, provided express invitation or permission to
the sender, in writing or otherwise, to send such
advertisements to such person at such telephone facsimile
machine; and
``(E) may, in the discretion of the Commission and subject
to such conditions as the Commission may prescribe, allow
professional trade associations that are tax-exempt nonprofit
organizations to send unsolicited advertisements to their
members in furtherance of the association's tax-exempt
purpose that do not contain the notice required by paragraph
(1)(C)(ii)(II), except that the Commission may take action
under this subparagraph only by regulation issued after
notice and opportunity for public comment
[[Page S7325]]
in accordance with section 553 of title 5, United States
Code, and only if the Commission determines that such notice
is not necessary to protect the right of the members of such
trade associations to make a request to their trade
associations not to send any future unsolicited
advertisements.''.
(c) Unsolicited Advertisement.--Paragraph (4) of section
227(a) of the Communications Act of 1934 (47 U.S.C.
227(a)(4)) is amended by inserting ``, in writing or
otherwise'' before the period at the end.
(d) Regulations.--Not later than 270 days after the date of
the enactment of this Act, the Federal Communications
Commission shall issue regulations to implement the
amendments made by this section.
SEC. 3. FCC ANNUAL REPORT REGARDING JUNK FAX ENFORCEMENT.
Section 227 of the Communications Act of 1934 (47 U. S.C.
227) is amended by adding at the end the following new
subsection:
``(g) Junk Fax Enforcement Report.--The Commission shall
submit a report to the Congress for each year regarding the
enforcement of the provisions of this section relating to
sending of unsolicited advertisements to telephone facsimile
machines, which shall include the following information:
``(1) The number of complaints received by the Commission
during such year alleging that a consumer received an
unsolicited advertisement via telephone facsimile machine in
violation of the Commission's rules.
``(2) The number of such complaints received during the
year on which the Commission has taken action.
``(3) The number of such complaints that remain pending at
the end of the year.
``(4) The number of citations issued by the Commission
pursuant to section 503 during the year to enforce any law,
regulation, or policy relating to sending of unsolicited
advertisements to telephone facsimile machines.
``(5) The number of notices of apparent liability issued by
the Commission pursuant to section 503 during the year to
enforce any law, regulation, or policy relating to sending of
unsolicited advertisements to telephone facsimile machines.
``(6) For each such notice--
``(A) the amount of the proposed forfeiture penalty
involved;
``(B) the person to whom the notice was issued;
``(C) the length of time between the date on which the
complaint was filed and the date on which the notice was
issued; and
``(D) the status of the proceeding.
``(7) The number of final orders imposing forfeiture
penalties issued pursuant to section 503 during the year to
enforce any law, regulation, or policy relating to sending of
unsolicited advertisements to telephone facsimile machines.
``(8) For each such forfeiture order--
``(A) the amount of the penalty imposed by the order;
``(B) the person to whom the order was issued;
``(C) whether the forfeiture penalty has been paid; and
``(D) the amount paid.
``(9) For each case in which a person has failed to pay a
forfeiture penalty imposed by such a final order, whether the
Commission referred such matter to the Attorney General for
recovery of the penalty.
``(10) For each case in which the Commission referred such
an order to the Attorney General--
``(A) the number of days from the date the Commission
issued such order to the date of such referral;
``(B) whether the Attorney General has commenced an action
to recover the penalty, and if so, the number of days from
the date the Commission referred such order to the Attorney
General to the date of such commencement; and
``(C) whether the recovery action resulted in collection of
any amount, and if so, the amount collected.''.
SEC. 4. GAO STUDY OF JUNK FAX ENFORCEMENT.
(a) In General.--The Comptroller General of the United
States shall conduct a study regarding complaints received by
the Federal Communications Commission concerning unsolicited
advertisements sent to telephone facsimile machines, which
shall determine--
(1) the number and nature of such complaints;
(2) the number of such complaints that result in final
agency actions by the Commission;
(3) the length of time taken by the Commission in
responding to such complaints;
(4) the mechanisms established by the Commission to
receive, investigate, and respond to such complaints;
(5) the level of enforcement success achieved by the
Commission and the Attorney General regarding such
complaints;
(6) whether complainants to the Commission are adequately
informed by the Commission of the responses to their
complaints; and
(7) whether additional enforcement measures are necessary
to protect consumers, including recommendations regarding
such additional enforcement measures.
(b) Additional Enforcement Remedies.--In conducting the
analysis and making the recommendations required under
paragraph (7) of subsection (a), the Comptroller General
shall specifically examine--
(1) the adequacy of existing statutory enforcement actions
available to the Commission;
(2) the adequacy of existing statutory enforcement actions
and remedies available to consumers;
(3) the impact of existing statutory enforcement remedies
on senders of facsimiles;
(4) whether increasing the amount of financial penalties is
warranted to achieve greater deterrent effect; and
(5) whether establishing penalties and enforcement actions
for repeat violators or abusive violations similar to those
established by section 4 of the CAN-SPAM Act of 2003 (15
U.S.C. 7703) would have a greater deterrent effect.
(c) Report.--Not later than 270 days after the date of the
enactment of this Act, the Comptroller General shall submit a
report on the results of the study under this section to
Committee on Energy and Commerce of the House of
Representatives and the Committee on Commerce, Science, and
Transportation of the Senate.
____________________