[Congressional Record Volume 152, Number 54 (Monday, May 8, 2006)]
[Senate]
[Pages S4157-S4160]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. SMITH (for himself and Mr. Bingaman):
  S. 2759. A bill to provide for additional outreach and education 
related to the Medicare program and to amend title XVIII of the Social 
Security Act to provide a special enrollment period for individuals who 
qualify for an income-related subsidy under the Medicare prescription 
drug program; to the Committee on Finance.
  Mr. SMITH. Mr. President, today I am proud to file the Medicare Part 
D Outreach and Enrollment Enhancement Act of 2006. This timely piece of 
legislation addresses two very targeted administrative issues that have 
come to light since Medicare's new prescription drug benefit became 
effective earlier this year. I am also pleased that Senator Bingaman is 
joining on this bill.
  With more than 30 million beneficiaries now receiving coverage 
through Medicare Part D, the program is well on its way to helping 
deliver much needed access to lower cost prescription drugs. And with 
the close of the initial enrollment period on May 15 looming, the 
Centers for Medicare and Medicaid Services (CMS) and advocacy 
organizations across the country are working diligently to provide last 
minute assistance to those beneficiaries still wishing to enroll.
  However, even after the May 15 deadline passes, beneficiaries will 
still need counsel on the program's benefits, including the 
availability of the low-income subsidy. For instance, dual eligible 
beneficiaries and those who previously received assistance through a 
Medicare Savings Program have the ability to change their prescription 
drug plan monthly. This particularly vulnerable group of beneficiaries 
likely will need extra assistance in choosing a plan that more 
appropriately meets their medical and financial needs.
  There also are those beneficiaries who will age into Medicare 
throughout the year. They will be provided an initial enrollment period 
to choose a prescription drug plan once they turn age 65. And with the 
first regular enrollment cycle beginning in November, many 
beneficiaries will need advice as they evaluate new plan options or 
consider switching plans if their existing coverage has changed. We owe 
it to our seniors to provide them quality information so they can make 
the best possible prescription drug plan choice.
  That is why I am asking for increased Part D outreach and education 
funding in the bill I am filing today. State Health Insurance Programs 
(SHIPs), which provide a range of valuable services, help beneficiaries 
select quality prescription drug plans, identify additional financial 
help with their drug costs, and resolve general enrollment 
difficulties.
  This year, CMS supported the outreach work of SHIPs with a $30 
million allotment. Despite this funding, there still remains a great 
need to raise further awareness about the new Part D benefit among 
beneficiaries and provide them assistance with selecting an

[[Page S4158]]

appropriate prescription drug plan. The Outreach and Enrollment 
Enhancement Act would allocate SHIPs an additional $13.5 million, 
bringing their total funding to $43.5 million, or, one dollar per 
Medicare beneficiary. To assure that the work of SHIPs is sufficiently 
supported in future years, the bill also creates a new funding 
authorization that is set to increase as the number of Medicare 
beneficiaries grows.
  The legislation I am filing today also provides funding to the Area 
Agencies on Aging (AAA) and Native American aging programs that have 
absorbed an increased workload since the passage of the Medicare 
Modernization Act. In Oregon, the Multnomah County AAA has incurred 
$30,000 in expenses related to Medicare outreach since the beginning of 
this year, but they have received very little new funding in return. 
The bill recognizes the important role AAAs and Native American aging 
programs play in helping elderly Americans enroll in Medicare by 
providing new funding in the amount of $6.3 million this fiscal year.
  Apart from increased funding for outreach and education, the bill 
addresses a very targeted problem with the current enrollment process 
that has recently become apparent. Beneficiaries who believe their 
income and asset levels may qualify them for extra help with their 
prescription drug costs may apply for a low-income subsidy (LIS) at any 
point during the year. If they submit an application to the Social 
Security Administration (SSA) during an initial enrollment period but 
do not receive notification of their eligibility before the enrollment 
deadline, they have one of two options available to them. They could 
enroll into a prescription drug plan before the deadline not knowing 
whether they will have to pay all or part of the costs of the monthly 
premium. This could place a beneficiary in the awkward position if they 
choose a plan that they ultimately are unable to afford.
  Under a recent CMS administrative action, beneficiaries who have 
applied for the LIS subsidy could choose to delay their enrollment in 
the program until they receive notification of their eligibility for a 
subsidy. However, they still would be required to pay a late enrollment 
penalty. While enrolling late may allow a beneficiary to make a more 
informed decision regarding their prescription drug plan, it would not 
be fair to assess them a fee simply because there was administrative 
delay in processing their LIS application. Both of these scenarios 
place beneficiaries in an untenable position. For the enrollment 
process to be successful, beneficiaries need to have as much 
information available to them as possible so they may choose the 
prescription drug plan that best meets their preferences.
  The Outreach and Enrollment Enhancement Act provides a solution to 
this dilemma. The legislation creates a special 30-day enrollment 
period that begins on the day a beneficiary receives a decision 
regarding their LIS eligibility. Most importantly, the late enrollment 
penalty that would be imposed upon them under current law would be 
waived during the special enrollment period, in addition to the time it 
takes SSA to process their application. This small, yet significant, 
change to the existing enrollment process will allow LIS beneficiaries 
sufficient time to effectively consider and evaluate prescription drug 
plan options with all necessary information. We cannot afford to 
undermine seniors' trust in Medicare's prescription drug program by 
penalizing a certain group of beneficiaries for a problem that is 
created by the federal government.
  I understand that many of my colleagues prefer to address 
administrative issues with Medicare Part D at a later date, so that the 
initial implementation process can run its full course without undue 
interference from Congress. While I would agree with that argument in 
principle, there are a number of existing problems that only serve to 
tarnish Medicare's image if we allow them to linger much longer. I 
believe providing additional resources for outreach and educational 
services and correcting the LIS enrollment issue are two such problems 
that Congress should address immediately--before the May 15 deadline 
passes.
  The SSA has estimated that 80,000 beneficiaries might not have been 
notified of their LIS eligibility by the close of the first regular 
enrollment period. It would be entirely unfair to assess even one of 
these beneficiaries a late enrollment penalty, when by their 
understanding, they were playing by the rules CMS and SSA set forth 
regarding the low-income subsidy.
  I ask the Majority Leader and my colleagues to support my call for 
the Outreach and Enrollment Enhancement Act to be treated as an 
emergency measure and provide it quick passage in the Senate. By taking 
up this very targeted measure, Congress can demonstrate to America's 
seniors that we are committed to the continued success of the Medicare 
prescription drug program.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself, Mr. Kyl, and Mr. Sununu):
  S. 2760. A bill to suspend the duty on imports of ethanol, and for 
other purposes; to the Committee on Finance.
  Mrs. FEINSTEIN. Mr. President, I rise today with Senators Kyl and 
Sununu to introduce a bill to strike the ethanol import tariff.
  With record high gas prices and demand for ethanol growing faster 
than expected, I believe we need to act now to ease the ethanol supply 
crunch.
  As many of my colleagues know, I have been strongly opposed to the 
ethanol mandate that was included in the energy bill enacted last 
August.
  Today, more than ever, I believe that the time has come to end 
unwarranted subsidies to ethanol producers.
  They include: $4.5 billion in agricultural subsidies in 2004 alone 
that benefit corn farmers (Environmental Working Group); a 51 cent per 
gallon tax credit for ethanol producers; and a 7.5 billion gallon 
ethanol mandate that was included in the energy bill.
  The current 51 cent per gallon subsidy is costing American taxpayers 
$2 billion per year, and will cost even more after 2012--almost $4 
billion per year--when the use of ethanol is mandated to nearly double.
  Now that the ethanol mandate is law, it is time for the subsidies to 
cease.
  I believe we need to start by striking the 54 cent per gallon ethanol 
import tariff.
  Ethanol imports are extremely limited, even though production costs 
for ethanol in foreign countries are significantly lower than in the 
United States.
  For example, according to the Congressional Research Service, 
Brazilian productions costs are 40 to 50 percent lower than in the 
United States. Yet the tariff raises the cost of ethanol enough to pose 
a significant barrier to imports.
  It is egregious to put such a high tariff on ethanol importation. It 
makes it impossible for U.S. consumers to purchase the lowest-cost 
ethanol.
  And with the refineries choosing to phase-out MTBE this year, the 
demand for ethanol is even greater than was expected.
  It is not clear if the domestic supply will be able to meet that 
growing demand.
  Any ethanol supply disruption will hurt drivers on the east and west 
coasts the most.
  Right now, ethanol is produced in the Midwest and must be trucked or 
railed to the coasts. According to news reports, ethanol delivery from 
the Midwest is currently being hindered by strong demand for limited 
rail time and a shortage of trucks and drivers.
  If we strike the tariff, refineries can have more economic and 
efficient access to ethanol.
  So, it's time to eliminate this 54 cent tariff and give consumers a 
break at the pump.
  And we are not alone in this effort. Just last week, the President 
asked that Congress consider eliminating the tariff.
  If they are going to be forced to use ethanol, our refineries should 
have the ability to buy it from the cheapest seller. They should not be 
constrained by artificial protectionist tariffs.
  I hope my colleagues will join with me to strike this tariff.
                                 ______
                                 
      Mr. AKAKA:
  S. 2762. A bill to amend title 38, United States Code, to ensure 
appropriate payment for the cost of long-term care provided to veterans 
in State homes, and for other purposes; to the Committee on Veterans' 
Affairs.
  Mr. AKAKA. Mr. President, I introduce legislation today to protect 
the state home program and expand the

[[Page S4159]]

ability of states and the Department of Veterans Affairs (VA) to care 
for veterans. I truly believe that the state home program is an 
incredibly valuable asset as we grapple with how best to care for our 
aging veterans. The program has proven time and time again that it is 
cost effective.
  VA involvement in the state home program dates back to 1888 when 
Congress first authorized Federal grants-in-aid for veterans in State 
homes. Today, there are 119 State-operated Veterans' Homes in 47 States 
and the Commonwealth of Puerto Rico. State homes provide nursing home 
care in 114 of these homes and domiciliary care in 52 of these 
locations.
  As many of my colleagues know, the State home program is supported in 
two ways by VA--construction grants and per diem payments. Subject to 
available funding, VA provides construction matching-grant funding for 
up to 65 percent of the cost of constructing or rehabilitating homes, 
with at least 35 percent covered by State funding commitments.
  The per diem portion of the program provides current reimbursement to 
State homes--currently $63.40 for a day of nursing home care. This 
amount equates to less than 30 percent of the total cost to provide 
this care. Yet, VA is currently authorized to provide up to 50 percent 
of States' costs.
  In January of this year, Chairman Craig and I held field hearings in 
my State of Hawaii. The hearing on the island of Kauai focused 
exclusively on long-term care in rural settings. We heard from two 
witnesses who spoke about the benefits of the State home program and 
ways to improve upon it, so as to specifically care for rural veterans.
  Tom Driskill, the President and CEO of Hawaii Health Systems 
Corporation, testified about the soon-to-be-built State home in Hilo. 
He said, ``The synergy of a combined Federal and State funding of the 
home has been the catalyst for making this dream a reality.'' The Hilo 
home will be Hawaii's first State home and will house 95 beds and will 
serve veterans throughout the State.
  The Committee also heard testimony about an innovative approach to 
fill significant gaps in long-term care services to veterans due to the 
nature and geography of certain States. Bob Shaw, the National 
Legislative Chairman for the National Association of State Veterans' 
Homes, testified that large State homes are not appropriate for the 
more remote locations in Hawaii. Instead, he argued, we should look to 
how Alaska has managed the challenge.
  Rather than building large new homes, the State of Alaska is using 
its own Pioneer Homes, which provide nursing care to older Alaskans, in 
order to care for veterans. Similarly, Hawaii could use existing beds 
in the community and deem such beds as part of the State home program. 
Doing so would trigger per diem payments from VA to help defray the 
cost of nursing home care.
  Accordingly, my legislation would authorize VA to provide 
construction grants and per diem payments for small long-term care 
units, approximately 10 to 30 beds, in pre-existing health care 
facilities. Such units would address gaps in long-term care services 
for veterans living in remote and rural regions including Alaska, 
Wyoming, Idaho, Montana, Kansas and other large, rural States.
  I am quite proud of the changes we made to VA long-term care as part 
of the Millennium Act, which provides nursing home care to veterans who 
are 70 percent or more service-connected. I think we can expand the 
locations where such mandatory nursing home care is available. 
Currently, there is no mechanism in current law to permit VA to pay 
State homes for care provided to service-connected veterans. My 
legislation would authorize VA to place severely disabled service-
connected veterans directly in State homes and would require VA to 
reimburse State homes for the cost of such care.
  The legislation would also authorize severely disabled, service-
connected veterans in State homes to receive VA's comprehensive 
medication benefit. Currently, such veterans are eligible to receive 
VA's full medication benefit if they are residing in community nursing 
homes but not if they reside in State homes. We need to ensure 
equitable coverage of medication needs.
  Finally, this legislation mandates consultation and reporting 
requirements for VA prior to implementation of proposed changes to the 
current per diem system. Such requirements should include, at a 
minimum, consultations with Congress, State governments, and State 
homes. In addition, VA should be required to report to Congress how any 
such proposed changes would affect the long-term viability of the State 
home program before any such changes take effect. As part of the FY 06 
budget, the Administration proposed dramatic restrictions to current 
per diem payments so as to only include a small portion of the veterans 
currently in State homes. Such a proposal, if enacted, would have 
devastated care in the homes.
  Mr. President, we can give States and VA more tools to deal with 
burgeoning long-term care needs of veterans. I urge my colleagues in 
the Senate to join me in supporting this legislation.
  I ask unanimous consent that the text of the bill be printed in the 
Record following this statement.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2762

       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 ``Veterans Long-Term Care 
     Security Act of 2006''.

     SEC. 2. REQUIREMENT FOR REPORT TO CONGRESS BEFORE 
                   IMPLEMENTATION OF REDUCTION IN PER DIEM RATES 
                   FOR CARE PROVIDED TO VETERANS IN STATE HOMES.

       (a) Requirement for Report.--Subsection (c) of section 1741 
     of title 38, United States Code, is amended--
       (1) by inserting ``(1)'' after ``(c)''; and
       (2) by adding at the end the following new paragraph:
       ``(2)(A) If the Secretary proposes to implement a reduction 
     in payments made under this section with respect to a fiscal 
     year the Secretary shall, not later than January 1 of the 
     preceding fiscal year, submit to the Committee on Veterans' 
     Affairs of the Senate and the Committee on Veterans' Affairs 
     of the House of Representatives a report containing a 
     detailed justification of such proposed reduction.
       ``(B) For purposes of this paragraph, a reduction in 
     payments is--
       ``(i) a lack of increase in the rates paid under subsection 
     (a) pursuant to a determination of the Secretary under 
     paragraph (1); or
       ``(ii) a modification of the eligibility for veterans to 
     receive care in State homes that would, if enacted into law, 
     result in fewer veterans eligible to receive such care in 
     State homes.
       ``(C) In preparing a report under subparagraph (A), the 
     Secretary shall consult with the heads and appropriate 
     officials of the State and local agencies responsible for the 
     supervision of State homes in each State in which State homes 
     are operated, and representatives of such other organizations 
     with expertise in State home matters as the Secretary 
     determines appropriate.
       ``(D) A report under subparagraph (A) shall include the 
     following information:
       ``(i) A specific description of the degree to which the 
     proposed reduction in payments would effect the financial 
     well-being of each State home.
       ``(ii) A detailed description of the consultation with 
     heads, officials, and representatives required under 
     subparagraph (C), and the results of that consultation.
       ``(iii) A description of the intent of the Secretary to 
     recover grant amounts under section 8136(a) of this title 
     where a State determines, as a result of the proposed 
     reduction in payments, to close a State home within the 
     period prescribed under that section.
       ``(iv) A description of the effect of the proposed 
     reduction in payments on the long-term care needs of veterans 
     who receive care in State homes, including a description of 
     the options for long-term care in reasonably proximate 
     facilities available to such veterans and an assessment of 
     the cost of the provision of care for such veterans in such 
     facilities.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the date of enactment of this Act, and 
     apply with respect to per diem payments made under section 
     1741 of title 38, United States Code, on or after such date.

     SEC. 3. NURSING HOME CARE AND PRESCRIPTION MEDICATIONS IN 
                   STATE HOMES FOR VETERANS WITH SERVICE-CONNECTED 
                   DISABILITIES.

       (a) Nursing Home Care.--Subchapter V of chapter 17 of title 
     38, United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 1744. Nursing home care and medications for veterans 
       with service-connected disabilities

       ``(a)(1) The Secretary shall pay each State home for 
     nursing home care at the applicable rate payable under 
     section 1720 of this title

[[Page S4160]]

     for nursing home care furnished in a non-Department nursing 
     home (as that term is defined in subsection (e)(2) of such 
     section), where such care is provided to any veteran as 
     follows:
       ``(A) Any veteran in need of such care for a service-
     connected disability.
       ``(B) Any veteran who--
       ``(i) has a service-connected disability rated at 70 
     percent or more; and
       ``(ii) is in need of such care.
       ``(2) Payment by the Secretary under paragraph (1) to a 
     State home for nursing home care provided to a veteran 
     described in that paragraph constitutes payment in full to 
     the State home for such care furnished to that veteran.''.
       (b) Provision of Prescription Medicines.--Such section is 
     further amended by adding at the end the following new 
     subsection:
       ``(b) The Secretary shall furnish such drugs and medicines 
     as may be ordered on prescription of a duly licensed 
     physician as specific therapy in the treatment of illness or 
     injury to any veteran as follows:
       ``(1) Any veteran in need of such drugs and medicines for a 
     service-connected disability.
       ``(2) Any veteran who--
       ``(A) has a service-connected disability rated at 50 
     percent or more;
       ``(B) is provided nursing home care that is payable under 
     subsection (a); and
       ``(C) is in need of such drugs and medicines.''.
       (c) Conforming Amendments.--
       (1) Criteria for payment.--Section 1741(a)(1) of such title 
     is amended by striking ``The'' and inserting ``Except as 
     provided in section 1744 of this title, the''.
       (2) Eligibility for nursing home care.--Section 1710(a)(4) 
     of such title is amended--
       (A) by striking ``and'' before ``the requirement in section 
     1710B of this title''; and
       (B) by inserting ``, and the requirement in section 1744 of 
     this title to provide nursing home care and prescription 
     medicines to veterans with service-connected disabilities in 
     State homes'' after ``a program of extended care services''.
       (d) Clerical Amendment.--The table of sections at the 
     beginning of chapter 17 of such title is amended by inserting 
     after the item relating to section 1743 the following new 
     item:

``1744.  Nursing home care and medications for veterans with service-
              connected disabilities.''.
       (e) Effective Date.--The amendment made by this section 
     shall take effect on October 1, 2006.

     SEC. 4. AUTHORITY TO TREAT CERTAIN HEALTH FACILITIES AS STATE 
                   HOMES.

       (a) Authority.--Subchapter III of chapter 81 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 8138. Treatment of certain health facilities as State 
       homes

       ``(a) The Secretary may treat a health facility as a State 
     home for purposes of subchapter V of chapter 17 of this title 
     if the following requirements are met:
       ``(1) The facility meets the standards for the provision of 
     nursing home care that is applicable to State homes, as 
     prescribed by the Secretary under section 8134(b) of this 
     title, and such other standards relating to the facility as 
     the Secretary may require.
       ``(2) The facility is licensed or certified by the 
     appropriate State and local agencies charged with the 
     responsibility of licensing or otherwise regulating or 
     inspecting State home facilities.
       ``(3) The State demonstrates in an application to the 
     Secretary that, but for the treatment of a facility as a 
     State home under this subsection, a substantial number of 
     veterans residing in the geographic area in which the 
     facility is located who require nursing home care will not 
     have access to such care.
       ``(4) The Secretary determines that the treatment of the 
     facility as a State home best meets the needs of veterans for 
     nursing home care in the geographic area in which the 
     facility is located.
       ``(5) The Secretary approves the application submitted by 
     the State with respect to the facility.
       ``(b) The Secretary may not treat a health facility as a 
     State home under subsection (a) if the Secretary determines 
     that such treatment would increase the number of beds 
     allocated to the State in excess of the limit on the number 
     of beds provided for by regulations prescribed under section 
     8134(a) of this title.
       ``(c) The number of beds occupied by veterans in a health 
     facility for which payment may be made under subchapter V of 
     chapter 17 of this title by reason of subsection (a) shall 
     not exceed the number of veterans in beds in State homes that 
     otherwise would be permitted in the State under regulations 
     prescribed under section 8134(a) of this title.
       ``(d) The number of beds in a health facility in a State 
     that has been treated as a State home under subsection (a) 
     shall be taken into account in determining the unmet need for 
     beds for State homes for the State under section 8134(d)(1) 
     of this title.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 81 of such title is amended by inserting 
     after the item relating to section 8137 the following new 
     item:

``8138.  Treatment of certain health facilities as State homes.''.
                                 ______
                                 
      By Mr. REID (for himself and Mr. Ensign):
  S. 2764. A bill to amend Public Law 108-67 to correct a provision 
relating to the conveyance of the Lake Tahoe Basin Management Unit; to 
the Committee on Energy and Natural Resources.
  Mr. REID. Mr. President, I ask unanimous consent that the text of the 
bill be printed in the Record.
   There being no oblection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2764

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

     SECTION 1. CORRECTION OF CONVEYANCE.

       Section 2 of Public Law 108-67 (117 Stat. 880) is amended--
       (1) by striking ``Subject to'' and inserting the following:
       ``(a) In General.--Subject to'';
       (2) in subsection (a) (as designated by paragraph (1)), by 
     striking ``the parcel'' and all that follows and inserting 
     the following: ``and to a portion comprising approximately 23 
     acres of land of Lots 3 and 4, as depicted on the United 
     States and Encumbrance Map, revised January 10, 1991, for the 
     Toiyabe National Forest, Ranger District Carson-1, and more 
     particularly described as S\1/2\NW\1/4\SE\1/4\ and N\1/
     2\SW\1/4\SE\1/4\ of sec. 27, T. 15 N., R. 18 E., Mt. Diablo 
     Base and Meridian.''; and
       (3) by adding at the end the following:
       ``(b) Public Access and Use.--Nothing in this Act prohibits 
     any approved general public access (through existing 
     easements or by boat) to or use of land remaining within the 
     Lake Tahoe Basin Management Unit after the conveyance to the 
     Secretary of the Interior, in trust for the Tribe, under 
     subsection (a), including access to and use of the beach and 
     shoreline areas adjacent to the portion of land conveyed 
     under that subsection.''.

                          ____________________