[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.''.
____________________