[Congressional Record Volume 153, Number 77 (Thursday, May 10, 2007)]
[Senate]
[Pages S5930-S5949]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. DURBIN (for himself and Mr. Obama):
S. 1352. A bill to designate the facility of the United States Postal
Service located at 127 East Locust Street in Fairbury, Illinois, as the
``Dr. Francis Townsend Post Office Building''; to the Committee on
Homeland Security and Governmental Affairs.
Mr. DURBIN. Mr. President, today I am pleased to introduce
legislation to designate the U.S. Post Office at 127 East Locust Street
in Fairbury, IL, as the ``Dr. Francis Townsend Post Office Building.''
I am grateful to Senator Barack Obama, Mayor Robert Walter, Jr. and the
Fairbury City Council for their support of this legislation.
This legislation honors Dr. Francis Townsend, the creator of the
Townsend old-age revolving pension plan, and his hometown of Fairbury,
IL, a town which will celebrate its sesquicentennial anniversary this
June.
Dr. Francis E. Townsend, the son of a farmer, was born in January
1867. He became a physician and served in the Army Medical Corps during
World War I. Following his retirement from medicine, Dr. Townsend
developed an old-age pension plan for seniors during the Depression.
The Townsend Plan created a Federal pension of $200 a month paid to
every citizen age 60 and older, on the condition that the pensioner
spend the entire sum within 30 days of receipt, in order to stimulate
the economy.
[[Page S5931]]
Dr. Townsend advocated tirelessly around the country on behalf of his
plan and encouraged 25 million Americans to sign petitions to the White
House and to Congress demanding that the Federal Government institute a
revolving old-age pension fund. It is likely that Townsend's efforts
expedited passage of President Franklin D. Roosevelt's Social Security
Act, a major New Deal initiative. The Social Security Act included
matching payments from the Federal Government, known as Old Age
Assistance, and a national old-age annuity program. Though the
initiative fell short of Dr. Townsend's vision, he continued to press
for increased benefits to the elderly. Dr. Townsend's persistence
helped to sustain the movement for increased elder benefits.
Dr. Francis Townsend, an innovator and social activist, was a pivotal
figure in the antipoverty movement and became the leader of a social
movement. I am pleased to introduce this legislation to permanently and
publicly recognize Dr. Townsend by naming this post office in Fairbury
in his honor. Given Dr. Townsend's dedication to his community and his
commitment towards the improvement of society, the renaming of this
post office would be a most appropriate way for us to express our
appreciation to Dr. Townsend and to celebrate his contributions to our
Nation's pension programs.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 1352
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. DR. FRANCIS TOWNSEND POST OFFICE BUILDING.
(a) Designation.--The facility of the United States Postal
Service located at 127 East Locust Street in Fairbury,
Illinois, shall be known and designated as the ``Dr. Francis
Townsend Post Office Building''.
(b) References.--Any reference in a law, map, regulation,
document, paper, or other record of the United States to the
facility referred to in subsection (a) shall be deemed to be
a reference to the ``Dr. Francis Townsend Post Office
Building''.
______
By Mr. WYDEN (for himself and Mr. Brownback):
S. 1353. A bill to nullify the determinations of the Copyright
Royalty Judges with respect to webcasting, to modify the basis for
making such a determination, and for other purposes; to the Committee
on the Judiciary.
Mr. WYDEN. Mr. President, today, I come back to the floor to
introduce legislation to keep the Internet free of discrimination. For
over a decade, people have tried to get their grubby hands all over the
Internet and I have sprung into action to stop them. I have fought hard
to prevent discrimination in the taxation of Internet commerce. I have
fought hard to prevent discrimination on the content and applications
layer of the Internet. Now, I am back here one more time, to prevent
discriminatory treatment against Internet radio companies and consumers
of their product in how copyright royalties are collected.
Make no bones about it, the recent decision on copyright royalty fees
by the Copyright Royalty Board is discrimination. The fees that
webcasters will have to pay will discriminate in favor of traditional
radio broadcasting and satellite radio broadcasting, which pay a much
lower percentage of their revenues in royalties.
The decision of the Copyright Royalty Board would increase royalties
on webcasters to levels between 300 and 1200 percent of their current
royalty fees. For most webcasters, the royalties will exceed their
gross revenues. There are not many people who are going to stay in
business long when their costs exceed their revenues. This is certainly
the case for webcasters. That is why I am introducing the Internet
Radio Equality Act today.
The Bipartisan Internet Radio Equality Act, that I am introducing
today with my friend from Kansas, Senator Brownback, will prevent this
discrimination. It does so by invalidating the decision of the
Copyright Royalty Board and instead puts Internet radio on par with
Satellite Radio, jukeboxes, and cable radio. Additionally, it has
special protections in place for noncommercial webcasters, like
National Public Radio and college radio, to ensure that they can take
advantage of webcasting as well.
Unfortunately, time is of the essence in saving Internet radio. On
July 15, if Congress does not intervene, collection of these new
royalty fees will begin. It is no coincidence that on the same day, if
Congress does not intervene, that hundreds of thousands of Internet
radio stations will be turned off for good. It is imperative that we
act within the next 2 months to prevent this from happening.
I want to thank my friend from Kansas, Senator Brownback, for joining
me in introducing this important legislation. I look forward to working
with him and Congressman Inslee, my friend from Washington, who has
introduced companion legislation in the House, to get the job done.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 1353
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 ``Internet Radio Equality Act
of 2007''.
SEC. 2. NULLIFICATION OF DECISION OF COPYRIGHT ROYALTY
JUDGES.
The March 2, 2007, Determination of Rates and Terms of the
United States Copyright Royalty Judges regarding rates and
terms for the digital performance of sound recordings and
ephemeral recordings, including that determination as
modified by the April 17, 2007, Order Denying Motions for
Rehearing and any subsequent modification to that
determination by the Copyright Royalty Judges that is
published in the Federal Register and the April 23, 2007,
Final Determination of Rates and Terms of the United States
Copyright Royalty Judges regarding rates and terms for the
digital performance of sound recordings and ephemeral
recordings and any subsequent modification to that
determination by the Copyright Royalty Judges that is
published in the Federal Register, are not effective, and
shall be deemed never to have been effective.
SEC. 3. COMPUTATION OF ROYALTY FEES FOR COMMERCIAL INTERNET
RADIO SERVICES OFFERING DIGITAL PERFORMANCES OF
SOUND RECORDINGS.
(a) Standard for Determining Rates and Terms.--Section
114(f)(2)(B) of title 17, United States Code, is amended by
striking ``Such rates and terms shall distinguish'' and all
that follows through the end of clause (ii) and inserting the
following: ``The Copyright Royalty Judges shall establish
rates and terms in accordance with the objectives set forth
in section 801(b)(1). Such rates and terms may include a
minimum annual royalty of not more than $500 for each
provider of services that are subject to such rates and
terms, which shall be the only minimum royalty fee and shall
be assessed only once annually to that provider.''.
(b) Transition Rule.--Except for services covered by
section 118 of title 17, United States Code, each provider of
digital audio transmissions that otherwise would have been
subject to the rates and terms of the determination of the
Copyright Royalty Judges made ineffective by section 2 of
this Act shall instead pay royalties for each year of the 5-
year period beginning on January 1, 2006, at 1 of the
following rates, as selected by the provider for that year:
(1) 0.33 cents per hour of sound recordings transmitted to
a single listener.
(2) 7.5 percent of the revenues received by the provider
during that year that are directly related to the provider's
digital transmissions of sound recordings.
SEC. 4. COMPUTATION OF ROYALTY FEES FOR NONCOMMERCIAL
STATIONS OFFERING DIGITAL PERFORMANCES OF SOUND
RECORDINGS.
(a) Amendments to Section 118 of Title 17, United States
Code.--Section 118 of title 17, United States Code, is
amended--
(1) in subsection (b), in the matter preceding paragraph
(1), by striking ``and published pictorial'' and inserting
``, sound recordings, and published pictorial'';
(2) in subsection (c)--
(A) in the matter preceding paragraph (1), by striking
``and published pictorial'' and inserting ``, sound
recordings, and published pictorial''; and
(B) in paragraph (1), by inserting ``or nonprofit
institution or organization'' after ``broadcast station'';
and
(3) in subsection (f), by striking ``paragraph (2)'' and
inserting ``paragraph (1) or (2)''.
(b) Transition Rules.--
(1) In general.--Except as provided under paragraph (2),
for each calendar year (or portion thereof) beginning after
December 31, 2004, until an applicable voluntary license
agreement is filed with the Copyright Royalty Judges under
section 118 of title 17, United States Code (as amended by
subsection (a) of this section), or an applicable
determination is issued by the Copyright Royalty Judges under
section 118 of such title (as so amended) --
(A) except as provided under subparagraphs (B) and (C), the
annual royalty that a public
[[Page S5932]]
broadcast entity shall pay to owners of copyrights in sound
recordings for the uses provided under section 118(c) of such
title (as so amended) shall be an amount equal to 1.05 times
the amount paid by that entity (or in the case of a group of
related entities, the fees paid by such group) under section
114(f)(2) of title 17, United States Code, for such uses
during the calendar year ending December 31, 2004;
(B) the annual royalty that a public broadcasting entity
that is a noncommercial webcaster and did not owe royalties
under section 114(f)(2) of title 17, United States Code,
during the calendar year ending December 31, 2004, shall pay
to owners of copyrights in sound recordings for the uses
provided under section 118(c) of such title (as so amended)
shall be the amount that would have been owed under the
agreement entered into under section 114(f)(5) of that title
for such uses applicable to noncommercial webcasters as in
effect during calendar year 2004; and
(C) the annual royalty that public broadcasting entities
constituting National Public Radio, Inc., its member stations
and public radio stations qualified to receive funding from
the Corporation for Public Broadcasting, shall collectively
pay to owners of copyrights in sound recordings for the uses
provided under section 118(c) of such title (as so amended)
shall be an amount equal to 1.05 times the amount paid on the
behalf of these entities under section 114(f)(2) of title 17,
United States Code, for such uses during the calendar year
ending December 31, 2004.
(2) Limitation.--No entity shall be required under
paragraph (1)(A) or (B) to pay more than $5,000 for any
calendar year.
SEC. 5. CREDIT OF ROYALTY FEES.
Any royalties received under the March 2, 2007,
Determination of Rates and Terms of the United States
Copyright Royalty Judges regarding rates and terms for the
digital performance of sound recordings and ephemeral
recordings, including that determination as modified by the
April 17, 2007, Order Denying Motions for Rehearing and any
subsequent modification to that determination by the
Copyright Royalty Judges that is published in the Federal
Register and the April 23, 2007, Final Determination of Rates
and Terms of the United States Copyright Royalty Judges
regarding rates and terms for the digital performance of
sound recordings and ephemeral recordings and any subsequent
modification to that determination by the Copyright Royalty
Judges that is published in the Federal Register shall be
credited against royalties required to be paid under section
3 or 4 of this Act.
______
By Mr. MARTINEZ (for himself, Mr. Bingaman, Mr. Nelson of
Florida, Mrs. Hutchison, Mrs. Feinstein, Mrs. Dole, and Mr.
Domenici):
S. 1355. A bill to amend the Internal Revenue Code of 1986 to treat
spaceports like airports under the exempt facility bond rules; to the
Committee on Finance.
Mr. MARTINEZ. Mr. President, today I rise with my colleagues,
Senators Bingaman, Nelson of Florida, Hutchison, Domenici, Feinstein,
and Dole, to introduce the Spaceport Equality Act of 2007, a bill to
help bring additional investment to the space transportation industry.
Last summer, Kazakhstan launched its first satellite, catapulting
them into the space transportation industry. Also joining the race for
space launch capacity are Singapore, Australia, Canada, and the United
Arab Emirates, with seven new commercial spaceports proposed between
the four countries. With new entrants being added to the space
transportation marketplace, is the U.S. falling behind in the race for
access to space?
The U.S. once dominated the commercial satellilte-manufacturing field
with an average market share of 83 percent; however, that market share
has since declined to below 50 percent. The U.S. satellite industry
faces increasing pressure to consider the use of foreign launch
vehicles and launch sites, due to the lack of sufficient domestic
launch capability. An even smaller share of U.S. manufactured
satellites is actually launched from U.S. spaceports.
This past year, only 2 of the 21 commercial launches worldwide were
launched from locations in the United States, that is less than 10
percent of the market share. This comes at a loss of billions of
dollars to the U.S. economy.
These are just some of the many reasons why my colleagues and I are
introducing the Spaceport Equality Act.
The space economy is made up of manufacturers, service providers, and
technologists in both the government and private sector that deploy and
operate launch vehicles, satellites, and space platforms. Many everyday
goods and services rely on space infrastructure, including: broadcast,
cable, and satellite television; global Internet services; satellite
radio; and cellular and international phone calls.
Satellites are also used global positioning systems, known as GPS,
which enables us to have hands-on directions in our cars and other
vehicles. GPS is also influential in the trucking, aviation, and
maritime industries for day-to-day operations, and for our Nation's
military operations. Thousands of gas stations use inexpensive small
satellite dishes to connect to credit card networks so customers can
pay instantly at the pump. Satellites also generate 90 percent of the
weather forecasting data in the U.S., and are used to track hurricanes,
tsunamis, and other weather phenomenon.
These satellites are launched vertically atop of rockets, propelling
them into orbit in space. Because most U.S. space-launch facilities are
operated by NASA and the Air Force, priority for launches at these
facilities is given to government projects. This means our commercial
satellite needs take a backseat to Government operations. This often
leaves U.S. commercial satellite ventures without reliable launch
availability.
This in turn has forced many companies seeking manufacturing and
launch services toward our international competitors.
Commercial spaceports are subdivisions of State governments that
provide additional launch infrastructure than that which is available
at Federal facilities. They attract and promote the U.S. commercial
space transportation industry. Spaceport authorities function much like
airport and port authorities by providing economic and transportation
incentives to the industry, which in turn benefits the surrounding
communities. Many States are forming space authorities to pursue ways
of developing space transportation infrastructure.
The Florida Space Authority, now known as ``Space Florida,'' was the
first such entity, and was created as a subdivision of the Florida
State Government by Florida's Governor and State legislature in 1989.
Space Florida focuses on expanding and strengthening my state's space
industry through partnering with the commercial space industry to
improve space transportation and to provide innovative, forward-
thinking solutions to the challenges facing this evolving industry.
The last few years have begun a new phase in space exploration.
Spaceports presently operate in Florida, California, Virginia, and
Alaska, and efforts are currently underway in New Mexico and Oklahoma
to establish spaceports for the new emerging space tourism industry.
Still additional commercial spaceports have been considered in the
following states: Alabama, California, Montana, Nevada, Oklahoma, South
Dakota, Texas, Utah, Washington, and Wisconsin.
The commercial space transportation industry includes not only
spaceports themselves, but also companies that develop the needed
infrastructure for testing and servicing launch vehicles. When
including these industry partners with spaceports, at least 23 States
are directly affected by the commercial space transportation industry.
Both spaceports and industry partners face increasing pressure from
Government sponsored or subsidized competitors in various countries
across Europe, and also in China, Japan, India, and Russia. And soon
they will face new competitors in Australia, Canada, Singapore, and the
United Arab Emirates.
Commercial space transportation is a growing part of the U.S.
economy. In 2004, this industry alone generated a total of nearly $98.1
billion in economic activity, more than $25 billion in earnings, and
over 550,000 jobs. The Federal Aviation Administration, FAA, recently
issued a report on 2006 launch activities, in that report, it was noted
that in 2006, U.S. launches generated approximately $140 million in
revenues.
A 2004 Gallup poll shows overwhelming public support for space
exploration. Roughly 80 percent of Americans agree that ``America's
space program helps give America the scientific and technological edge
it needs to compete in the international marketplace.'' and 76 percent
agree that our space program ``benefits the nation's economy'' and
inspires ``students to pursue careers in technical fields.''
The space industry has also led to a number of ``spin-off''
technologies,
[[Page S5933]]
those influenced by space technology research and development.
Home roof insulation and air filtration, anti-lock brakes, athletic
shoes, vehicle protective airbags, cellular phones, and Lasik surgery
all owe their development to space-based research and technology. The
list of space ``spin-off'' technologies is estimated to exceed 40,000.
These related technologies have helped employ tens of millions of
Americans. Encouraging commercial investment in the space industry and
increasing U.S. market share in this industry will certainly lead to
additional innovation and technology that will positively influence
other fields.
As you can see, this once Government-dominated industry is now
becoming a diverse mix of Government and commercial entities, also
leading the way into future avenues of commercial space transportation,
such as space tourism.
The increase in recent commercial launches includes the debut of the
first commercial crewed suborbital launches of SpaceShipOne, the
beginnings of public space travel. ``Space tourism,'' as public space
travel is now referred to, has the potential to become a major growth
industry. Recent market studies have shown that, within 20 years, space
tourism has the potential to become a multibillion-dollar industry.
Even though the average American may not be able to participate in
public space travel, its potential impact on our economy and
international competitiveness is something to be appreciated. Space
tourism industry players expect there to be a market demand of at least
15,000 Americans per year to travel into suborbit and orbital flights.
This would require an estimated 665 launches per year by 2010.
If the U.S. continues as is, we will only be able to capture a 10-
percent market share, at best, of this emerging industry. If needed
infrastructure is added, however, the U.S. could potentially pick up 60
to 70 percent of space flight demand by 2010. Every launch that we do
not provide for in the U.S. means a loss to our economy, and a gain for
our international competitors. The Federal Aviation Administration's
Commercial Space Transportation division expects a $3 billion dollar
loss to our economy if we do not meet the rising demand for space
tourism.
Currently, U.S. launch facilities are few and most are owned and
operated by the Federal Government, putting commercial users in direct
competition with the U.S. military, NASA, and other Government entities
that, as I mentioned earlier, receive priority over commercial
projects.
Recently, the U.S. Air Force provided license to Space Exploration
Technologies, known as SpaceX, to utilize one of the decommissioned
launch complexes at Cape Canaveral Air Force Station for its commercial
launch ventures.
The utilization of existing Federal resources by commercial ventures
will open up opportunity for further commercial launches, but this
alone will not afford America the resources it needs to remain
competitive internationally. If the U.S. is to remain competitive in
the commercial space industry, added and improved infrastructure will
be needed to support this growing industry.
On a more local note, my own State of Florida could stand to gain
much by way of economic development from increased investment in
Spaceport infrastructure.
According to recent studies, increased spaceport infrastructure and
activity in Florida could mean as much as $29.7 million in additional
economic activity by the year 2015, this does not include the economic
activity generated from increased tourism, secondary contracts, and
spin-off technologies.
Other modes of transportation, highways, airports, and seaports,
currently enjoy a tax incentive for meeting their infrastructure needs,
so why not spaceports? Perhaps this policy made sense in the past, when
space did not have the enormous potential for commercial growth that it
now does. Our ability to utilize space is more apparent than ever
before; we need to acknowledge this emerging reality.
This Spaceport Equality Act of 2007 would provide spaceports with the
same tax incentives granted to airports, seaports, rail, and other
transit projects under the exempt facility bond rules. With
international competition on the rise, our Nation's spaceports are a
vital component of the infrastructure needed to expand and enhance the
U.S. role in the international space arena. The Spaceport Equality Act
is an important step to increasing our competitiveness in this field,
because it will stimulate investment in expanding and modernizing our
space launch facilities and lower the costs of financing spaceport
projects.
Since 1968, tax-exempt bonds have played a crucial role in meeting
airport investment needs, with 50 percent or more of major airport
projects being financed through municipal tax-exempt bonds. By
extending this favorable tax treatment to spaceports, this bill will
help meet spaceport needs and increase our Nation's ability to compete
with expanded international interests in space exploration and
technology. Similar legislation has been considered since the 1980s,
and we cannot afford to wait any longer to address the needs of this
important sector.
This proposal does not provide direct Federal spending to our
commercial space transportation industry, but rather, it creates the
conditions necessary to stimulate private capital investment in
industry infrastructure. By issuing tax-free bonds to finance spaceport
infrastructure, space authorities could provide site-specific and
vehicle-specific tailoring to promote the competition and innovation
necessary to maintain the U.S. competitive edge in the space
transportation industry.
This is an efficient means for achieving our space transportation
needs, and I urge my colleagues in the Senate to join us in this most
important effort by cosponsoring this bill.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 1355
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 ``Spaceport Equality Act of
2007''.
SEC. 2. SPACEPORTS TREATED LIKE AIRPORTS UNDER EXEMPT
FACILITY BOND RULES.
(a) In General.--Paragraph (1) of section 142(a) of the
Internal Revenue Code of 1986 (relating to exempt facility
bonds) is amended to read as follows:
``(1) airports and spaceports,''.
(b) Treatment of Ground Leases.--Paragraph (1) of section
142(b) of the Internal Revenue Code of 1986 (relating to
certain facilities must be governmentally owned) is amended
by adding at the end the following new subparagraph:
``(C) Special rule for spaceport ground leases.--For
purposes of subparagraph (A), spaceport property which is
located on land owned by the United States and which is used
by a governmental unit pursuant to a lease (as defined in
section 168(h)(7)) from the United States shall be treated as
owned by such unit if--
``(i) the lease term (within the meaning of section
168(i)(3)) is at least 15 years, and
``(ii) such unit would be treated as owning such property
if such lease term were equal to the useful life of such
property.''.
(c) Definition of Spaceport.--Section 142 of the Internal
Revenue Code of 1986 is amended by adding at the end the
following new subsection:
``(n) Spaceport.--
``(1) In general.--For purposes of subsection (a)(1), the
term `spaceport' means--
``(A) any facility directly related and essential to
servicing spacecraft, enabling spacecraft to launch or
reenter, or transferring passengers or space cargo to or from
spacecraft, but only if such facility is located at, or in
close proximity to, the launch site or reentry site, and
``(B) any other functionally related and subordinate
facility at or adjacent to the launch site or reentry site at
which launch services or reentry services are provided,
including a launch control center, repair shop, maintenance
or overhaul facility, and rocket assembly facility.
``(2) Additional terms.--For purposes of paragraph (1)--
``(A) Space cargo.--The term `space cargo' includes
satellites, scientific experiments, other property
transported into space, and any other type of payload,
whether or not such property returns from space.
``(B) Spacecraft.--The term `spacecraft' means a launch
vehicle or a reentry vehicle.
``(C) Other terms.--The terms `launch', `launch site',
`launch services', `launch vehicle', `payload', `reenter',
`reentry services', `reentry site', and `reentry vehicle'
shall have the respective meanings given to such terms by
section 70102 of title 49, United States Code (as in effect
on the date of enactment of this subsection).''.
[[Page S5934]]
(d) Exception From Federally Guaranteed Bond Prohibition.--
Paragraph (3) of section 149(b) of the Internal Revenue Code
of 1986 (relating to exceptions) is amended by adding at the
end the following new subparagraph:
``(E) Exception for spaceports.--Paragraph (1) shall not
apply to any exempt facility bond issued as part of an issue
described in paragraph (1) of section 142(a) to provide a
spaceport in situations where--
``(i) the guarantee of the United States (or an agency or
instrumentality thereof) is the result of payment of rent,
user fees, or other charges by the United States (or any
agency or instrumentality thereof), and
``(ii) the payment of the rent, user fees, or other charges
is for, and conditioned upon, the use of the spaceport by the
United States (or any agency or instrumentality thereof).''.
(e) Conforming Amendment.--The heading for section 142(c)
of the Internal Revenue Code of 1986 is amended by inserting
``Spaceports,'' after ``Airports,''.
(f) Effective Date.--The amendments made by this section
shall apply to obligations issued after the date of the
enactment of this Act.
______
By Mr. GRASSLEY (for himself and Mr. Johnson):
S. 1358. A bill to amend the Clean Air Act to require all gasoline
sold for use in motor vehicles to contain 10 percent renewable fuel in
the year 2010 and thereafter, and for other purposes; to the Committee
on Environment and Public Works.
Mr. GRASSLEY. Mr. President, I am introducing legislation today along
with Senator Johnson that will take a bold step in reducing our
dependence on fossil fuel and foreign oil. It is the 10 by 10 Act.
The 10 by 10 Act will require that 10 percent of each gallon of motor
fuel sold beginning January 1, 2010, contain at least 10 percent
renewable fuel. The 10 by 10 Act is a signal that Congress remains
interested and adamant in seeking energy independence by promoting the
development of renewable fuels in the United States.
Because the U.S. imports more than 60 percent of the crude oil we
need, we have become dangerously reliant on foreign sources of energy.
It is a threat to our national security for the United States to be
dependent upon countries like Iran and Venezuela for our energy needs.
It's also a threat to our economic security to be dependent on foreign
countries for the energy that drives our economy.
It is up to our farmers and ranchers to help liberate our consumers
and our economy from the stranglehold of OPEC and other foreign
countries on our energy needs. I am here to say to America's
agriculture community that we are serious and we are going to do
something about it.
This legislation will demonstrate to consumers, in a common sense
way, that each and every gallon of gasoline will contain at least 10
percent of domestically produced renewable fuel. It'll show that we're
serious about reducing our dependence on foreign oil, and it will show
in a tangible way that we're working to reduce that dependence.
The 10 by 10 Act is a commitment to our constituents that we're
working to lower that dependence, and reduce our consumption of foreign
oil in every gallon of fuel they pump. With this legislation, Americans
would know with certainty that 10 percent of each gallon of motor fuel
was home-grown by farmers and ranchers right here in America.
Today, ethanol, a renewable fuel produced primarily from corn, is
blended in nearly 50 percent of the gasoline sold in the United States.
There are currently 116 biorefineries producing nearly 6 billion
gallons of ethanol annually. By the end of 2009, it is projected that
we will have the capacity to produce over twelve billion gallons
annually.
It is important for consumers to recognize that for the vast majority
of cars on the road today, no modifications are necessary to operate on
a 10-percent renewable fuel blend. No significant changes are required
to the fuel distribution network to allow for a 10-percent blend. The
only thing standing in the way of reduced dependence on foreign oil is
a signal from Congress that we recognize the virtue of home-grown
alternatives to foreign oil.
With this legislation, we would ensure the use of approximately 14
billion gallons of renewable fuels in our Nation's automobiles. The
ethanol use would be distributed around the country in each gallon of
gasoline. In this way, we will ensure the use of the fuel even if an
extensive E-85 market is not yet in place. This effort could very well
be a stepping stone if it's determined that ethanol could be blended in
higher ratios, such as 15 or 20 percent. By blending in each gallon of
gasoline, we ensure the benefits of homegrown, renewable fuels reach
all consumers without the immediate need for additional fueling
infrastructure or alternative fuel vehicles.
We owe it to the American people to pursue aggressive policies to
free our country from our foreign oil dependence. I hope my colleagues
will join me in this effort to replace 10 percent of each gallon of
gasoline with homegrown, environmentally friendly, renewable fuel.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 1358
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 ``10 by 10 Act''.
SEC. 2. 10 PERCENT RENEWABLE FUEL REQUIRED FOR MOTOR
VEHICLES.
Section 211 of the Clean Air Act (42 U.S.C. 7545) is
amended--
(1) by inserting after subsection (o) the following:
``(p) 10 Percent Renewable Fuel Requirement.--
``(1) In general.--After December 31, 2009, it shall be
unlawful for any person to sell or offer for sale, supply or
offer for supply, dispense, transport, or introduce into
commerce, for use in any motor vehicle (as defined in section
216) any gasoline containing less than 10 percent renewable
fuel by volume.
``(2) Fuel blends.--For the purpose of enforcing this
subsection, a blend of gasoline and renewable fuel shall be
considered to be sold or offered for sale, supplied or
offered for supply, dispensed, transported, or introduced
into commerce in accordance with this subsection if the
renewable fuel content, exclusive of denaturants and
permitted contaminants, comprises not less than 9.2 percent
by volume and not more than 10 percent by volume of the
blend, as determined by the Administrator.
``(3) Manifests and labeling.--By regulation effective
January 1, 2010, the Administrator shall require that each
bill of lading or transportation manifest for all gasoline
containing renewable fuel and all gasoline not containing
renewable fuel indicate the renewable fuel content of the
gasoline.
``(4) Notices on gasoline pumps; exemption for collector
vehicles.--The Administrator shall provide, by regulation,
for--
``(A) appropriate notices to be displayed on gasoline
pumps--
``(i) indicating the renewable fuel content of the gasoline
dispensed by the pump; and
``(ii) notifying the public of the prohibition under this
subsection; and
``(B) an exemption from the requirements of this subsection
in the case of gasoline for use in collector motor vehicles,
as defined by the Administrator.''; and
(2) by redesignating the second subsection (r) (as added by
section 1512 of the Energy Policy Act of 2005 (Public Law
109-58; 119 Stat. 1088)) as subsection (t) and moving the
subsection so as to appear at the end of the section.
______
By Mr. DURBIN:
S. 1362. A bill to establish a Strategic Gasoline and Fuel Reserve;
to the Committee on Energy and Natural Resources.
Mr. President, 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. 1362
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 ``Strategic Gasoline and Fuel
Reserve Act of 2007''.
SEC. 2. STRATEGIC GASOLINE AND FUEL RESERVE.
(a) In General.--Title I of the Energy Policy and
Conservation Act (42 U.S.C. 6201 et seq.) is amended--
(1) by redesignating part E (42 U.S.C. 6251 et seq.) as
part F;
(2) by redesignating section 191 (42 U.S.C. 6251) as
section 199; and
(3) by inserting after part D (42 U.S.C. 6250 et seq.) the
following:
``PART E--STRATEGIC GASOLINE AND FUEL RESERVE
``SEC. 191. DEFINITIONS.
``In this part:
``(1) Gasoline.--The term `gasoline' means regular unleaded
gasoline.
``(2) Reserve.--The term `Reserve' means the Strategic
Gasoline and Fuel Reserve established under section 192(a).
``SEC. 192. ESTABLISHMENT.
``(a) In General.--Notwithstanding any other provision of
this Act, the Secretary
[[Page S5935]]
shall establish, maintain, and operate a Strategic Gasoline
and Fuel Reserve.
``(b) Not Component of Strategic Petroleum Reserve.--The
Reserve is not a component of the Strategic Petroleum Reserve
established under part B.
``(c) Capacity.--The Reserve shall contain not more than--
``(1) 50,000,000 barrels of gasoline; and
``(2) 7,500,000 barrels of jet fuel.
``(3) 21,000,000 barrels of diesel fuel.
``(d) Reserve Sites.--
``(1) Siting.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall determine not less
than 3 Reserve sites, and not more than 5 Reserve sites,
throughout the United States that are regionally strategic.
``(2) Operation.--The Reserve sites described in paragraph
(1) shall be operational not later than 2 years after the
date of enactment of this Act.
``(e) Security.--In establishing the Reserve under this
section, the Secretary shall obtain the concurrence of the
Secretary of Homeland Security with respect to physical
design security and operational security.
``(f) Authority.--In carrying out this part, the Secretary
may--
``(1) purchase, contract for, lease, or otherwise acquire,
in whole or in part, storage and related facilities and
storage services;
``(2) use, lease, maintain, sell, or otherwise dispose of
storage and related facilities acquired under this part;
``(3) acquire by purchase, exchange, lease, or other means
gasoline and fuel for storage in the Reserve;
``(4) store gasoline and fuel in facilities not owned by
the United States; and
``(5) sell, exchange, or otherwise dispose of gasoline and
fuel from the Reserve, including to maintain--
``(A) the quality or quantity of the gasoline or fuel in
the Reserve; or
``(B) the operational capacity of the Reserve.
``(g) Fill Date.--
``(1) In general.--Except as provided in paragraph (2), the
Secretary shall complete the process of filling the Reserve
under this section by March 1, 2008.
``(2) Extensions.--The President may extend the deadline
established under paragraph (1) if--
``(A) the President determines that filling the Reserve
within that deadline would cause an undue economic burden on
the United States; and
``(B) the President receives approval from Congress.
``SEC. 193. RELEASE OF GASOLINE AND FUEL.
``(a) In General.--The Secretary shall release gasoline or
fuel from the Reserve only if--
``(1) the President finds that there is a severe fuel
supply disruption by finding that--
``(A) a regional or national supply shortage of gasoline or
fuel of significant scope and duration has occurred;
``(B) a substantial increase in the price of gasoline or
fuel has resulted from the shortage;
``(C) the price increase is likely to cause a significant
adverse impact on the national economy; and
``(D) releasing gasoline or fuel from the Reserve would
assist directly and significantly in reducing the adverse
impact of the shortage; or
``(2)(A) the Governor of a State submits to the Secretary a
written request for a release from the Reserve that contains
a finding that--
``(i) a regional or statewide supply shortage of gasoline
or fuel of significant scope and duration has occurred;
``(ii) a substantial increase in the price of gasoline or
fuel has resulted from the shortage; and
``(iii) the price increase is likely to cause a significant
adverse impact on the economy of the State; and
``(B) the Secretary concurs with the findings of the
Governor under subparagraph (A) and determines that--
``(i) a release from the Reserve would mitigate gasoline or
fuel price volatility in the State;
``(ii) a release from the Reserve would not have an adverse
effect on the long-term economic viability of retail gasoline
or fuel markets in the State and adjacent States; and
``(iii) a release from the Reserve would not suppress
prices below long-term market trend levels.
``(b) Procedure.--
``(1) Response of secretary.--The Secretary shall respond
to a request submitted under subsection (a)(2) not later than
5 days after receipt of the request by--
``(A) approving the request;
``(B) denying the request; or
``(C) requesting additional supporting information.
``(2) Release.--The Secretary shall establish procedures
governing the release of gasoline or fuel from the Reserve in
accordance with this subsection.
``(3) Requirements.--
``(A) Eligible entity.--In this paragraph, the term
`eligible entity' means an entity that is customarily engaged
in the sale or distribution of gasoline or fuel.
``(B) Sale or disposal from reserve.--The procedures
established under this subsection shall provide that the
Secretary may--
``(i) sell gasoline or fuel from the Reserve to an eligible
entity through a competitive process; or
``(ii) enter into an exchange agreement with an eligible
entity under which the Secretary receives a greater volume of
gasoline or fuel as repayment from the eligible entity than
the volume provided to the eligible entity.
``(c) Continuing Evaluation.--The Secretary shall conduct a
continuing evaluation of the drawdown and sales procedures
established under this section.
``SEC. 194. REPORTS.
``(a) Gasoline and Fuel.--Not later than 45 days after the
date of enactment of this section, the Secretary shall submit
to Congress and the President a plan describing--
``(1) the acquisition of storage and related facilities or
storage services for the Reserve, including the use of
storage facilities not currently in use or not currently used
to capacity;
``(2) the acquisition of gasoline and fuel for storage in
the Reserve;
``(3) the anticipated methods of disposition of gasoline
and fuel from the Reserve;
``(4) the estimated costs of establishment, maintenance,
and operation of the Reserve;
``(5) efforts that the Department will take to minimize any
potential need for future drawdowns from the Reserve; and
``(6) actions to ensure the quality of the gasoline and
fuel in the Reserve are maintained.
``(b) Natural Gas and Diesel.--Not later than 90 days after
the date of enactment of this section, the Secretary shall
submit to Congress a report describing the feasibility of
creating a natural gas and diesel reserve similar to the
Reserve under this part.
``SEC. 195. STRATEGIC GASOLINE AND FUEL RESERVE FUND.
``(a) Establishment.--There is established in the Treasury
of the United States a revolving fund, to be known as the
`Strategic Gasoline and Fuel Reserve Fund' (referred to in
this section as the `Fund'), consisting of--
``(1) such amounts as are appropriated to the Fund under
subsection (b);
``(2) such amounts as are appropriated to the Fund under
section 196; and
``(3) any interest earned on investment of amounts in the
Fund under subsection (d).
``(b) Transfers to Fund.--There are appropriated to the
Fund amounts equivalent to amounts collected as receipts and
received in the Treasury from the sale, exchange, or other
disposition of gasoline or fuel from the Reserve.
``(c) Expenditures From Fund.--On request by the Secretary
and without the need for further appropriation, the Secretary
of the Treasury shall transfer from the Fund to the Secretary
such amounts as the Secretary determines are necessary to
carry out activities under this part, to remain available
until expended.
``(d) Investment of Amounts.--
``(1) In general.--The Secretary of the Treasury shall
invest such portion of the Fund as is not, in the judgment of
the Secretary of the Treasury, required to meet current
withdrawals.
``(2) Interest-bearing obligations.--Investments may be
made only in interest-bearing obligations of the United
States.
``(3) Acquisition of obligations.--For the purpose of
investments under paragraph (1), obligations may be
acquired--
``(A) on original issue at the issue price; or
``(B) by purchase of outstanding obligations at the market
price.
``(4) Sale of obligations.--Any obligation acquired by the
Fund may be sold by the Secretary of the Treasury at the
market price.
``(5) Credits to fund.--The interest on, and the proceeds
from the sale or redemption of, any obligations held in the
Fund shall be credited to and form a part of the Fund.
``(e) Transfers of Amounts.--
``(1) In general.--The amounts required to be transferred
to the Fund under this section shall be transferred at least
monthly from the general fund of the Treasury to the Fund on
the basis of estimates made by the Secretary of the Treasury.
``(2) Adjustments.--Proper adjustment shall be made in
amounts subsequently transferred to the extent prior
estimates were in excess of or less than the amounts required
to be transferred.
``SEC. 196. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as are
necessary to carry out this part, to remain available until
expended.''.
SEC. 3. CONFORMING AMENDMENTS.
The table of contents for title I of the Energy Policy and
Conservation Act (42 U.S.C. 6201 note) is amended by striking
the matter relating to part D and inserting the following:
``Part D--Northeast Home Heating Oil Reserve
``Sec. 181. Establishment.
``Sec. 182. Authority.
``Sec. 183. Conditions for release; plan.
``Sec. 184. Northeast home heating oil reserve account.
``Sec. 185. Exemptions.
``Sec. 186. Authorization of appropriations.
``Part E--Strategic Gasoline and Fuel Reserve
``Sec. 191. Definitions.
``Sec. 192. Establishment.
``Sec. 193. Release of gasoline and fuel.
``Sec. 194. Reports.
``Sec. 195. Strategic Gasoline and Fuel Reserve Fund.
[[Page S5936]]
``Sec. 196. Authorization of appropriations.
``Part F--Expiration
``Sec. 199. Expiration.''.
______
By Mrs. CLINTON (for herself and Mr. Durbin):
S. 1363. A bill to improve health care for severely injured members
and former members of the Armed Forces, and for other purposes; to the
Committee on Armed Services.
Mrs. CLINTON. Mr. President, today, I am introducing the Bridging the
Gap for Wounded Warriors Act to provide comprehensive solutions to
problems that have arisen from military bureaucracy's failure to meet
the medical needs of this generation's wounded warriors as they
transition from the Armed Services to civilian life.
This is a moment of profound challenge for our country, for our
military, and for our men and women in uniform. And while there are
often strong disagreements here in Washington, I hope we can unite
around our common values and patriotism when it comes to how we treat
our servicemembers and veterans.
If you serve your country your country should serve you. That is the
promise our country must keep to the men and women who enlist, who
fight, and who return home often bearing the visible and invisible
scars of sacrifice. Sadly, too often in the past several years, that
promise has been broken: whether it's a lack of up-armored vehicles on
the ground in Iraq or a lack of appropriate care in outpatient
facilities at Walter Reed.
Last year, I authored and passed into law the Heroes at Home
initiative to assist returning servicemembers experiencing the complex,
diffuse, and life-altering symptoms of traumatic brain injury and other
mental health difficulties.
This past March, I followed up with the introduction of the Heroes at
Home Act of 2007, S. 1065, the Restoring Disability Benefits for
Injured and Wounded Warriors Act of 2007, S. 1064, and the Protecting
Military Family Financial Benefits Act of 2007, S. 1063, to serve our
servicemembers and send a message: you will be treated as heroes before
deployment, during deployment, and upon returning home. You didn't
offer excuses and do not deserve to be offered excuses by your country.
Finally, Senator Evan Bayh and I introduced the Traumatic Brain
Injury Access to Options Act, S. 1113, in order to provide a temporary
and immediate solution to the discrepancy in health care services and
benefits encountered by TBI patients.
However, a broader and permanent solution is needed to assist all
members and former members of the Armed Services who have incurred any
type of combat-related injury. The mistreatment of servicemembers at
Walter Reed and testimony from recent hearings in both the Senate Armed
Services and Veterans Affairs Committees have revealed major gaps
affecting servicemembers, including discrepancies in benefits for
active duty and medically retired servicemembers; difficulties in
obtaining needed care for wounded servicemembers transitioning from the
Armed Services to civilian life; and disparities between the DoD and VA
disability rating systems.
Although the military, more often than not, offers quality health
care services, wounded servicemembers often encounter barriers to
receiving the optimal health benefit. The two major barriers are: (1) a
confusing array of benefits; and (2) discrepancies between benefits for
those on active duty versus those who are medically retired.
Recent events at Walter Reed have highlighted the longstanding need
to overhaul the DoD and VA disability rating systems, which are
unnecessarily complex and result in delays in payment that hinder
efforts of wounded servicemembers to support themselves and their
families. On March 6, 2007, the Chief of Staff of the Army General
Peter Schoomaker and then-Army Surgeon General Lieutenant General Kevin
C. Kiley testified before the Senate Armed Services Committee that
soldiers appearing before the Physical Evaluation Board were ``short-
changed'' and had not received appropriate disability benefits.
According to the Congressional Research Service, since the enactment of
the Traumatic Servicemembers Group Life Insurance program at least 45
percent of claims have been denied. In March 2006 the Comptroller
General issued GAO Report 06-362: Military Disability System: Improved
Oversight Needed to Ensure Consistent and Timely Outcomes for Reserve
and Active Duty Service Members--the Department of Defense did not heed
the recommendations provided in this report and as a result injured and
wounded warriors continue to languish in an inefficient and adversarial
disability system. We must stop short-changing our wounded warriors.
Finally, a blanket overlap of benefits and disability rating reform
are necessary but not sufficient for addressing the needs of those who
are wounded. In order to support an all-volunteer force and meet the
needs of this generation's wounded warriors, it is critical to achieve
efficient DoD and VA collaboration and coordination of assistance to
members of the Armed Forces in their transition from Active Duty to
civilian life. Thus, the duties of the existent VA Office of Seamless
Transition must be terminated and transferred to a new organizational
structure that will achieve the long-sought goals of seamless
transition between the DoD and VA and improved coordination between
these agencies.
That's why I am introducing the Bridging the Gap for Wounded Warriors
Act today, to ensure a continuum of care for severely injured
servicemembers and fix the problems that stymie the transition process.
I am grateful to have developed this proposal with the Wounded Warrior
Project, the National Military Family Association, and the Military
Officers Association of America.
We should provide our wounded warriors with the best care options
available. This legislation would establish a 2 year blanket overlap of
active duty and veterans health services and benefits for severely
injured service
members to facilitate their recovery and help resolve administrative
problems like those found at Walter Reed. All costs of health care, for
both active duty and medically retired servicemembers, will be paid for
by the DoD. The provisions of this section shall take effect for those
injured on or after October 7, 2001, but eligibility shall not include
retroactive compensation for payments already made.
We should also create a joint DoD-VA Office of Transition for the
coordination of assistance to members of the Armed Forces in their
transition from service in the Armed Forces to civilian life. The
Office of Transition would absorb the duties of the existent VA Office
of Seamless Transition as well as the functions and responsibilities of
applicable offices within the Office of the Secretary of Defense, OSD.
Leadership of the Office of Transition would consist of a Director and
Deputy Director, who would both have seats on the Joint Executive
Committee, JEC. The Secretaries of DoD and VA would have oversight of
the Office of Transition, although the office would also be required to
submit mandatory annual reports and biannual briefings to Congress. The
GAO would also submit a biennial report on the Office of Transition's
activities, in order to ensure that the Office's progress is not being
stymied by the DoD or VA.
Further, we should reform the current disability rating system to
ensure that there is continuity of medical care and no disruption in
compensation payments made to wounded service
members. My legislation would change the roles of the agencies, so that
DoD would no longer assign the actual disability rating but would still
determine fitness for duty and document such a decision in writing,
while VA would assign final ratings for all service-connected injuries.
Further, the legislation would repeal the provision in the Omnibus
Reconciliation Act of 1982 that requires the delay in payment of VA
benefits until the first day of the second month after they are
entitled. This provision would eliminate the gap in payments and allow
servicemembers to continue to support themselves and their families.
Finally, we should do what we can to ensure that both DoD and VA
medical facilities have the appropriate trained professionals to deal
with the range of injuries that our wounded servicemembers now incur,
including
[[Page S5937]]
traumatic brain injury, burns, amputations, vision problems, spinal
cord injuries, and broken and fractured bones. In order to move in that
direction, my legislation would require the GAO to submit a preliminary
assessment and final report on the extent to which medical facilities
of the DoD and VA offer interdisciplinary medical treatment for wounded
members of the Armed Forces.
Let us all join together in accepting our responsibility as a nation
to those who serve and resolve to achieve efficient DoD and VA
collaboration and coordination that is critical for supporting an all-
volunteer force and meeting the needs of this generation's wounded
warriors.
I ask unanimous consent letters of support for this legislation be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Military Officers
Association of America,
Alexandria, VA, May 9, 2007.
Hon. Hillary Clinton,
U.S. Senate,
Washington, DC.
Dear Senator Clinton: On behalf of the 362,000 members of
the Military Officers Association of America (MOAA), I am
writing to express MOAA's appreciation for your leadership in
sponsoring the Bridging the Gap for Wounded Warriors Act.
This piece of legislation will ensure a continuum of care for
all the severely injured servicemembers from OIF and OEF.
The bill's three elements address the most significant
problems that currently stymie transition for our
servicemembers between DoD and VA programs. The two-blanket
overlap of health services addresses their health care
concerns. The transition office would institutionalize a
joint team of permanent DoD and VA personnel working together
to develop and implement solutions to long-standing,
unresolved transition issues. Finally, your bill would reform
the disability rating system to ensure fair and consistent
long-term compensation and benefits for wounded
servicemembers.
We are proud of and grateful for the sacrifices our
military members and their families are willing to make for
our country. The extreme sacrifices of the wounded have
earned and deserve our special attention, which your bill
would deliver. We look forward to working closely with you in
seeking timely enactment of this legislation in the 110th
Congress.
Sincerely,
Norb Ryan,
President.
____
National Military
Family Association, Inc.,
Alexandria, VA, May 9, 2007.
Hon. Hillary Rodham Clinton,
U.S. Senate,
Washington DC.
Dear Senator Clinton: The National Military Family
Association (NMFA) is the only national organization whose
sole focus is the military family and whose goal is to
influence the development and implementation of policies that
will improve the lives of the families of the Army, Navy, Air
Force, Marine Corps, Coast Guard, and the Commissioned Corps
of the Public Health Service and the National Oceanic and
Atmospheric Administration. For more than 35 years, its staff
and volunteers, comprised mostly of military members, have
built a reputation for being the leading experts on military
family issues. On behalf of NMFA and the families it serves,
we commend your sponsorship of the Bridging the Gap for
Wounded Warriors Act.
NMFA thanks you for recognizing the problems wounded
service members face as they recover from their injuries. In
addition to the family stress and the often-lengthy recovery
process in multiple medical facilities, wounded service
members must also navigate a complex maze through two
distinct disability benefit processes, that of the Department
of Defense (DoD) and the Department of Veterans' Affairs
(VA). NMFA believes this legislation acknowledges the need
for more coordination between the DoD and VA to create a
truly seamless transition for these service members and ease
the care burden on their families. NMFA endorses this
legislation as a first step in addressing the need for a
standardized approach to the DoD Medical Evaluation Board
(MEB), and Physical Evaluation Board (PEB) plus determination
for VA Disability Compensation. The legislation would also
respond to the need for wounded service members to receive
consistent quality care in both health care systems and for
the establishment of a ``joint office'' to address these
concerns.
Thank you for your support of military service members and
veterans diagnosed with TBI, and the families who care for
them. If you have any questions you may contact Barbara
Cohoon in our Government Relations department.
Sincerely,
Tanna K. Schmidli,
Chairman, Board of Governors.
____
Wounded Warrior Project,
New York, NY, May 9, 2007.
Hon. Hillary Rodham Clinton,
U.S. Senate,
Washington, DC.
Dear Senator Clinton: The Wounded Warrior Project (WWP)
strongly supports your legislation entitled the Bridging the
Gap for our Wounded Warriors Act. As a result of WWP's
direct, daily contact with the severely injured and their
families, we have identified three consistent issues causing
confusion and frustration among those most in need of
assistance. A discrepancy in benefits between the Departments
of Defense and Veterans Affairs, confusion during the actual
transition process, and the inconsistent and redundant
disability ratings system are all problems cited by the
wounded as obstacles they face as they attempt to recover.
The comprehensive provisions included in your bill will
address many of these issues and provide access to the care
and compensation our nation's heroes need as they continue in
their recovery.
The first provision would establish a two-year overlap of
active duty and veterans benefits and services for severely
injured servicemembers. By removing the artificial barrier
between active duty service and veterans status, the bill
would allow those who are injured to enjoy the differing
benefits and health care services offered by each agency
regardless of their duty status.
The second provision would establish a joint DoD-VA Office
of Transition to improve assistance from the two agencies as
members of the Armed Forces move from the Department of
Defense to the Department of Veterans Affairs. While there
are currently many entities within each agency charged with
assisting transitioning servicemembers, the creation of a
joint office with oversight over these programs and policies
will ensure a more coordinated effort on behalf of our
wounded servicemembers.
Finally, the legislation would reform the current
disability ratings system to ensure consistency and fairness
in the ratings while providing immediate compensation for
those leaving the service.
These provisions will go far towards insuring the long term
health and well-being of wounded service members. Again, WWP
thanks you for your leadership on these issues, and we stand
committed to assisting you in seeing this legislation through
to passage and enactment.
Sincerely,
Meredith Beck,
National Policy Director.
______
By Mr. DURBIN:
S. 1364. A bill to amend titles XIX and XXI of the Social Security
Act to extend the State Children's Health Insurance Program (SCHIPS)
and stremline enrollment under SCHIP and Medicaid, and for other
purposes; to the Committee on Finance.
Mr. DURBIN. Mr. President, over 25 years ago, a member of the Select
Panel for the Promotion of Child Health said in a statement to
Congress, ``Children are one-third of our population and all of our
future.'' We must protect the health and welfare of our nation's
children if we are to secure the future of our country. This year we
have a tremendous opportunity to ensure that security. With the
reauthorization of the State Children's Health Insurance Program,
SCHIP, we can improve the health and health care of our Nation's
future, for the over 70 million children in America and, in particular,
the 9 million children who have no health coverage.
Since the creation of SCHIP 10 years ago, more than 6.2 million
children have been covered by this vital program, including over
290,000 children in Illinois. As the first State to provide coverage
for all children, Illinois has been a leader in the movement to change
the course of health care in this country. Since 1993, SCHIP, its
relationship to Medicaid, and the flexibility that this administration
has permitted the programs to have, have made it possible for Illinois
to provide health care to the more than 313,000 children who did not
have access to it before.
Nearly 1 million Illinois families have at least one uninsured family
member, and the face of the uninsured is changing. The uninsured are
not only the mother and daughter living in downtown Chicago. The
uninsured includes the family who runs a small business in the suburbs,
the family farm in central Illinois, and the single father working at a
factory downstate.
The majority of kids without health care coverage come from working
families, families like Mr. and Mrs. Buss and their three young sons.
Lisa Buss and her husband own a small home inspection company. They
paid over $9,000 last year alone on regular medical care, without any
catastrophic events or emergencies. That's a lot of money for a family
living in the suburbs of Chicago. There is also the Hickey family of
Godfrey, Illinois. After an
[[Page S5938]]
unfortunate accident, their son broke a couple of bones in his hand.
Without insurance, they were hesitant to see the specialist at the
suggestion of the emergency room physicians, but for the health of
their son, they did so. For a 5 minute visit, they paid close to
$1,000. Mr. Hickey works in the construction trade and work had been
slow. Susan is a teacher for the Alton School District. They were given
no financial assistance except to be offered a payment plan. Now, the
Hickeys have to find a way to pay for their house payment and their
utilities, rising gas prices, and this medical treatment.
The unnecessary burden and anxiety caused by health care is an
unfortunate reality for too many, and children often bear the brunt of
this hardship. Kids should not have to wait until their fever is 103
degrees to see a doctor. Kids should be able to obtain glasses when
they are straining to see the chalkboard. Kids should be able to obtain
antibiotics when that ``cold'' just won't go away. Our parents should
not have to worry about whether they can afford to take their son to a
bone specialist.
As is often the case, States are leading the way with children's
health coverage initiatives. In 2005, my State of Illinois was the
first State to ensure health care coverage for all children. Since
then, many States have taken on the challenge of expanding health care
coverage. The State of the States 2007 report by AcademyHealth
indicates that more than a dozen States have enacted innovative
policies to expand coverage. These range from comprehensive health care
reform in States such as Massachusetts, Vermont, and Maine; to public-
private partnerships in States such as Arkansas, Montana, New Mexico,
Oklahoma, Rhode Island, Tennessee, and Utah; to initiatives to cover
all children in Illinois and Pennsylvania.
Democratic and Republican governors alike are exploring ways to reach
the uninsured, proving that children's health and health care coverage
are American issues, not partisan issues. One important way to insure
more children is through a strong reauthorization of SCHIP.
Today, with the introduction of the Healthy Kids Act, I propose SCHIP
reauthorization legislation that builds on the progress made in these
States. First, the bill provides States with more funding to enroll
children who are eligible but not enrolled in SCHIP. These kids account
for more than half of all uninsured children.
Second, the Healthy Kids Act will eliminate obvious barriers to
coverage and simplify enrollment procedures. For example, seven States
have reported declines in Medicaid enrollments because of new
citizenship requirements. Approximately 65 percent of internists report
serving patients with Limited English Proficiency; for children living
in these families, making language assistance services available is a
critical precursor to quality care. My bill proposes options for States
to reach the neediest children through SCHIP by reducing some of these
barriers. For example, the bill provides for funds for language
assistance services.
Third, the bill also supports the establishment of medical homes, a
network of providers for children that helps prevent them from falling
through the cracks. The bill puts forth an effort to create pediatric
quality and performance measures. The Healthy Kids Act also establishes
a disease prevention and treatment demonstration project for ethnic and
racial minority children, using research that specifically examines
disparities in minority children enrolled in Medicaid/SCHIP. We can
reduce health disparities and improve health outcomes for this
population.
Finally, the bill creates a commission to study children's health
coverage. The Commission on Children's Health Coverage will develop
policy recommendations and track the program's overall performance.
Feedback and analysis of SCHIP's performance is critical to improving
the program in the future.
SCHIP has been an unparalleled success and a model for health
insurance coverage that both Democrats and Republicans can be proud of.
Ensuring health care coverage for children in need is a priority for
both sides of the aisle. The reauthorization of SCHIP is a rare
opportunity for the Federal Government to expand its support for
policies in States like Illinois and others. Let's take a step forward
and work to provide basic health insurance for all children. Healthy
children grow into healthy adults, in turn, these individuals are
happier and spend less money on health care in the long run. The SCHIP
program is critical for our Nation's health and economic future.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 1364
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 ``Healthy
Kids Act of 2007''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--EXTENSION OF SCHIP
Sec. 101. Extension of SCHIP program; increase in allotments to take
into account growth in child population and health care
costs.
Sec. 102. 2-year initial availability of SCHIP allotments.
Sec. 103. Redistribution of unused allotments to address State funding
shortfalls.
TITLE II--STATE OPTIONS FOR INCREASING COVERAGE OF CHILDREN AND
PREGNANT WOMEN UNDER MEDICAID AND SCHIP
Sec. 201. Bonus payments for States that implement administrative
policies to streamline enrollment process.
Sec. 202. State option to provide for ``express lane'' and simplified
determinations of a child's financial eligibility for
medical assistance under Medicaid or child health
assistance under SCHIP.
Sec. 203. Information technology connections to improve health coverage
determinations.
Sec. 204. State option to expand or add coverage of certain pregnant
women under Medicaid and SCHIP.
Sec. 205. Optional coverage of legal immigrants under Medicaid and
SCHIP.
Sec. 206. Authorizing adjustment of SCHIP allotment due to increased
outreach.
Sec. 207. Model of Interstate coordinated enrollment and coverage
process.
Sec. 208. Authority for qualifying States to use portion of SCHIP
allotment for any fiscal year for certain Medicaid
expenditures.
Sec. 209. Application of Medicaid outreach procedures to all pregnant
women and children.
Sec. 210. No impact on section 1115 waivers.
Sec. 211. Elimination of counting Medicaid child presumptive
eligibility costs against title XXI allotment.
Sec. 212. Prohibiting limitations on enrollment.
TITLE III--ELIMINATION OF CERTAIN BARRIERS TO COVERAGE
Sec. 301. State option to require certain individuals to present
satisfactory documentary evidence of proof of citizenship
or nationality for purposes of eligibility for Medicaid.
Sec. 302. Increased Federal matching rate for language services
provided under Medicaid or SCHIP.
TITLE IV--GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT UNDER
MEDICAID AND SCHIP
Sec. 401. Grants to promote innovative outreach and enrollment under
Medicaid and SCHIP.
TITLE V--IMPROVING THE QUALITY OF PEDIATRIC CARE
Sec. 501. Requiring coverage of EPSDT services, including dental
services, State option to provide supplemental coverage
of dental services.
Sec. 502. Pediatric quality and performance measures program.
Sec. 503. Grants to States for demonstration projects transforming
delivery of pediatric care.
Sec. 504. Report by the comptroller general on design and
implementation of a demonstration project evaluating
existing quality and performance measures for children's
inpatient hospital services.
Sec. 505. Medical home demonstration project.
Sec. 506. Disease prevention and treatment demonstration projects for
ethnic and racial minority children.
[[Page S5939]]
TITLE VI--COMMISSION ON CHILDREN'S HEALTH COVERAGE
Sec. 601. Commission on Children's Health Coverage.
TITLE I--EXTENSION OF SCHIP
SEC. 101. EXTENSION OF SCHIP PROGRAM; INCREASE IN ALLOTMENTS
TO TAKE INTO ACCOUNT GROWTH IN CHILD POPULATION
AND HEALTH CARE COSTS.
(a) In General.--Section 2104 of the Social Security Act
(42 U.S.C. 1397dd) is amended--
(1) in subsection (a)--
(A) by striking ``and'' at the end of paragraph (9);
(B) by striking the period at the end of paragraph (10) and
inserting ``; and''; and
(C) by adding at the end the following new paragraph:
``(11) for each fiscal year 2008 and each subsequent fiscal
year, $7,500,000,000 multiplied by the population and cost
inflation factor for that fiscal year, as determined under
subsection (i).''; and
(2) by adding at the end the following new subsection:
``(i) Population and Cost Inflation Factor.--For purposes
of subsection (a)(11), the population and cost inflation
factor for a fiscal year is equal to the product of the
following:
``(1) Child population growth factor.--One plus the
percentage increase in the population of children under 20
years of age in the United States from July 1, 2007, to July
1 during the fiscal year involved, as projected by the
Secretary based on the most recent published estimates of the
Bureau of the Census before the beginning of the fiscal year
involved.
``(2) Per capita health care growth factor.--One plus the
percentage increase in the projected per capita amount of
National Health Expenditures from fiscal year 2007 to the
fiscal year involved, as most recently published by the
Secretary before the beginning of the fiscal year
involved.''.
(b) Additional Allotments to Territories.--Section
2104(c)(4)(B) of such Act (42 U.S.C. 1397dd(c)(4)(B)) is
amended by striking ``and $40,000,000 for fiscal year 2007''
and inserting ``$40,000,000 for fiscal year 2007, and for
each of fiscal years 2008 through 2017, the amount
appropriated under this subparagraph for the preceding fiscal
year increased by the population and cost inflation factor
for that fiscal year, as determined under subsection (i)''.
SEC. 102. 2-YEAR INITIAL AVAILABILITY OF SCHIP ALLOTMENTS.
Section 2104(e) of the Social Security Act (42 U.S.C.
1397dd(e)) is amended to read as follows:
``(e) Availability of Amounts Allotted.--
``(1) In general.--Except as provided in paragraphs (2) and
(3), amounts allotted to a State pursuant to this section--
``(A) for each of fiscal years 1998 through 2007, shall
remain available for expenditure by the State through the end
of the second succeeding fiscal year; and
``(B) for fiscal year 2008 and each fiscal year thereafter,
shall remain available for expenditure by the State through
the end of the succeeding fiscal year.
``(2) Availability of amounts reallotted.--Subject to
paragraph (3), amounts reallotted to a State under subsection
(f) shall be available for expenditure by the State through
the end of the fiscal year in which they are reallotted.
``(3) Permanent availability of unused funds.--Reallotted
funds that are not used by the end of the fiscal year
described in paragraph (2) shall be subject to reallotment
under subsection (f) in subsequent fiscal years subject to
such paragraph and shall remain available for subsequent
reallotment until expended.''.
SEC. 103. REDISTRIBUTION OF UNUSED ALLOTMENTS TO ADDRESS
STATE FUNDING SHORTFALLS.
Section 2104(f) of the Social Security Act (42 U.S.C.
1397dd(f)) is amended--
(1) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--The Secretary'';
(2) by striking ``States that have fully expended the
amount of their allotments under this section'' and inserting
``States that the Secretary determines with respect to the
fiscal year for which unused allotments are available for
redistribution under this subsection, are shortfall States
described in paragraph (2) for such fiscal year''; and
(3) by adding at the end the following new paragraph:
``(2) Shortfall states described.--
``(A) In general.--For purposes of paragraph (1), with
respect to a fiscal year, a shortfall State described in this
subparagraph is a State with a State child health plan
approved under this title for which the Secretary estimates
on the basis of the most recent data available to the
Secretary, that the projected expenditures under such plan
for the State for the fiscal year will exceed the sum of--
``(i) the amount of the State's allotments for any
preceding fiscal years that remain available for expenditure
and that will not be expended by the end of the immediately
preceding fiscal year; and
``(ii) the amount of the State's allotment for the fiscal
year (taking into account any increase made in such allotment
under section 2104(j), as added by section 205(a) of the
Healthy Kids Act of 2007).
``(B) Proration rule.--If the amounts available for
redistribution under paragraph (1) for a fiscal year are less
than the total amounts of the estimated shortfalls determined
for the year under subparagraph (A), the amount to be
reallotted under such paragraph for each shortfall State
shall be reduced proportionally.
``(C) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made under paragraph (1) and
this paragraph with respect to a fiscal year as necessary on
the basis of the amounts reported by States not later than
November 30 of the succeeding fiscal year, as approved by the
Secretary.''.
TITLE II--STATE OPTIONS FOR INCREASING COVERAGE OF CHILDREN AND
PREGNANT WOMEN UNDER MEDICAID AND SCHIP
SEC. 201. BONUS PAYMENTS FOR STATES THAT IMPLEMENT
ADMINISTRATIVE POLICIES TO STREAMLINE
ENROLLMENT PROCESS.
(a) Bonus in FMAP and Enhanced FMAP for Application of
Streamline Enrollment Procedures Under Medicaid and SCHIP.--
Section 2102 of the Social Security Act (42 U.S.C. 1397bb) is
amended by adding at the end the following new subsection:
``(d) Streamline Enrollment Procedures.--
``(1) Increase in federal matching rate.--
``(A) In general.--In the case of a State that meets the
conditions described in subparagraph (B) (relating to
agreeing to implement administrative enrollment policies
under this title and title XIX) for a fiscal year, the
Federal medical assistance percentage (for purposes of title
XIX only) and the enhanced FMAP (for purposes of this title,
but determined without regard to the application of this
subsection to the Federal medical assistance percentage under
title XIX) otherwise computed for such fiscal year as applied
to medical assistance for children and child health
assistance, respectively, shall be increased by such number
of percentage points as the Secretary determines is necessary
to provide an incentive for the State to satisfy the
conditions described in subparagraph (B) (but not to exceed
such number of percentage points that would result in a
Federal medical assistance percentage or enhanced FMAP for
the State that would exceed 83 or 85 percent, respectively).
``(B) Agreeing to remove enrollment and access barriers.--
The conditions described in this subparagraph, for a State
for a fiscal year are that the State agrees to do the
following:
``(i) Presumptive eligibility for children.--The State
agrees--
``(I) to provide presumptive eligibility for children under
this title and title XIX in accordance with section 1920A;
and
``(II) to treat any items or services that are provided to
an uncovered child (as defined in section 2110(c)(8)) who is
determined ineligible for medical assistance under title XIX
as child health assistance for purposes of paying a provider
of such items or services, so long as such items or services
would be considered child health assistance for a targeted
low-income child under this title.
``(ii) 12-month continuous eligibility.--The State agrees
to provide that eligibility of children for assistance under
this title and title XIX shall not be regularly redetermined
more often than once every year.
``(iii) Automatic renewal.--The State agrees to provide for
the automatic renewal of the eligibility of children for
assistance under this title and under title XIX if the
child's family does not report any changes to family income
or other relevant circumstances, subject to verification of
information from databases available to the State for such
purpose.
``(iv) Elimination of asset test.--The State has amended
its plans under this title and title XIX so that no asset or
resource test is applied for eligibility under this title or
title XIX with respect to children.
``(v) Administrative verification of income.--The State
agrees to permit the family of a child applying for child
health assistance under this title or medical assistance
under title XIX to declare and certify, by signature under
penalty of perjury, the family income for purposes of
collecting financial eligibility information.''.
(b) Conforming Medicaid Amendments.--
(1) In general.--Section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b)) is amended by inserting ``and section
2102(d)(1)'' after ``section 1933(d)''.
(2) Increase in medicaid cap for territories.--Section
1108(g) of such Act (42 U.S.C. 1308(g)) is amended--
(A) in paragraph (2), by striking ``paragraph (3)'' and
inserting ``paragraphs (3) and (4)''; and
(B) by adding at the end the following new paragraph:
``(4) Disregard of increased expenditures directly
attributable to increase in fmap for application of
streamlined enrollment procedures.--The limitation of
paragraph (2) shall not apply to payment under title XIX to a
territory insofar as such payment is attributable to an
increase in the Federal medical assistance percentage under
subparagraph (A) of section 2102(d)(1).''.
(c) Effective Date.--The amendments made by this section
shall apply beginning with fiscal year 2007.
[[Page S5940]]
SEC. 202. STATE OPTION TO PROVIDE FOR ``EXPRESS LANE'' AND
SIMPLIFIED DETERMINATIONS OF A CHILD'S
FINANCIAL ELIGIBILITY FOR MEDICAL ASSISTANCE
UNDER MEDICAID OR CHILD HEALTH ASSISTANCE UNDER
SCHIP.
(a) Medicaid.--Section 1902(e) of the Social Security Act
(42 U.S.C. 1396a(e)) is amended by adding at the end the
following:
``(13)(A) At the option of the State, the plan may provide
that eligibility requirements (including such requirements
applicable to redeterminations or renewals of eligibility)
for medical assistance relating to income, assets (or
resources), or citizenship status are met for a child who is
under an age specified by the State (not to exceed 21 years
of age) by using a determination made within a reasonable
period (as determined by the State) before its use for this
purpose, of the child's family or household income, or if
applicable for purposes of determining eligibility under this
title or title XXI, assets or resources, or citizenship
status, respectively, (notwithstanding any other provision of
law, including sections 1902(a)(46)(B), 1903(x), and
1137(d)), by a Federal or State agency, or a public or
private entity making such determination on behalf of such
agency, specified by the plan, including an agency
administering the State program funded under part A of title
IV, the Food Stamp Act of 1977, the Richard B. Russell
National School Lunch Act, or the Child Nutrition Act of
1966, notwithstanding any differences in budget unit,
disregard, deeming, or other methodology, but only if--
``(i) the agency has fiscal liabilities or responsibilities
affected by such determination; and
``(ii) the agency or entity notifies the child's family--
``(I) of the information which shall be disclosed in
accordance with this subparagraph;
``(II) that the information disclosed will be used solely
for purposes of determining eligibility for medical
assistance under this title or for child health assistance
under title XXI; and
``(III) that interagency agreements limit the use of such
information to that purpose; and
``(iii) the requirements of section 1939 are satisfied.
``(B) Nothing in this paragraph shall be construed to
relieve a State of the obligation to determine, on another
basis, eligibility for medical assistance under this title or
for child health assistance under title XXI if a child is
determined ineligible for such assistance on the basis of
information furnished pursuant to this paragraph.
``(C) If a State applies the eligibility process described
in subparagraph (A) to individuals eligible under this title
and to individuals eligible under title XXI, the State may,
at its option, implement its duties under subparagraphs (A)
and (B) of section 2102(b)(3) using either or both of the
following approaches:
``(i) The State may--
``(I) establish a threshold percentage of the Federal
poverty level (that shall exceed the income eligibility level
applicable for a population of individuals under this title
by 30 percentage points (as a fraction of the Federal poverty
level) or such other higher number of percentage points as
the State determines reflects the typical application of
income methodologies by the non-health program and the State
plan under this title); and
``(II) provide that, with respect to any individual within
such population whom a non-health agency determines has
income that does not exceed such threshold percentage for
such population, such individual is eligible for medical
assistance under this title (regardless of whether such
individual would otherwise be determined to be eligible to
receive such assistance).
In exercising the approach under this clause, a State shall
inform families whose children are enrolled in a State child
health plan under title XXI based on having family income
above the threshold described in subclause (I) that they may
qualify for medical assistance under this title and, at their
option, can seek a regular eligibility determination for such
assistance for their child.
``(ii) Regardless of whether a State otherwise provides for
presumptive eligibility under section 1920A, a State may
provide presumptive eligibility under this title, consistent
with subsection (e) of section 1920A, to a child who, based
on a determination by a non-health agency, would qualify for
child health assistance under a State child health plan under
title XXI. During such presumptive eligibility period, the
State may determine the child's eligibility for medical
assistance under this title, pursuant to subparagraph (A) of
section 2102(b)(3), based on telephone contact with family
members, access to data available in electronic or paper
form, and other means of gathering information that are less
burdensome to the family than completing an application form
on behalf of the child. The procedures described in the
previous sentence may be used regardless of whether the State
uses similar procedures under other circumstances for
purposes of determining eligibility for medical assistance
under this title.
``(D) At the option of a State, the eligibility process
described in subparagraph (A) may apply to an individual who
is not a child.
``(E)(i) At the option of a State, an individual determined
to be eligible for medical assistance or child health
assistance pursuant to subparagraph (A), (C), or (D) or other
procedures through which eligibility is determined based on
data obtained from sources other than the individual may
receive medical assistance under this title if such
individual (or, in the case of an individual under age 19 (or
if the State elects the option under subparagraph (A), age 20
or 21) who is not authorized to consent to medical care, the
individual's parent, guardian, or other caretaker relative)
has acknowledged notice of such determination and has
consented to such eligibility determination. The State (at
its option) may waive any otherwise applicable requirements
for signatures by or on behalf of an individual who has so
consented.
``(ii) In the case of an individual enrolled pursuant to
clause (i), the State shall inform the individual (or, in the
case of an individual under age 19 (or if the State elects
the option under subparagraph (A), age 20 or 21), the
individual's parent, guardian, or other caretaker relative)
about the significance of such enrollment, including
appropriate methods to access covered services.
``(F) For purposes of this paragraph--
``(i) the term `non-health agency' means an agency or
entity described in subparagraph (A); and
``(ii) the term `non-health benefits' means the benefits or
assistance provided by a non-health agency.''.
(b) SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C.
1397gg(e)(1)) is amended by redesignating subparagraphs (B)
through (E) as subparagraphs (C) through (F) and by inserting
after subparagraph (B) the following new subparagraph:
``(C) Section 1902(e)(13) (relating to the State option to
base a determination of a child's eligibility for assistance
on determinations made by a program providing nutrition or
other public assistance (except that the State option under
subparagraph (D) of such section shall apply under this title
only if an individual is pregnant)).''.
(c) Presumptive Eligibility.--Section 1920A of such Act (42
U.S.C. 1396r-1a) is amended--
(1) in subsection (b)(3)(A)(i), is amended by striking ``or
(IV)'' and inserting ``(IV) is an agency or entity described
in section 1902(e)(13)(A), or (V)''; and
(2) by adding at the end the following:
``(e) In the case of a State with a child health plan under
title XXI that provides for presumptive eligibility under
such plan for children, the State shall make a reasonable
effort to place each presumptively eligible child in the
program under this title or title XXI for which the child
appears most likely to qualify. During the child's period of
presumptive eligibility, the State shall receive Federal
matching funds under section 1903 or section 2105, depending
on the program in which the child has been placed. If at the
conclusion of such period, the child is found to qualify for,
and is enrolled in, the program established under this title
or title XXI when the child was enrolled in the program under
the other such title during such period, the State's receipt
of Federal matching funds shall be adjusted both
retroactively and prospectively so that Federal matching
funds are provided, both during and following such period of
presumptive eligibility, based on the program in which the
child is enrolled.''.
(d) Signature Requirements.--Section 1902(a) of such Act
(42 U.S.C. 1396a(a)) is amended by adding at the end the
following: ``Notwithstanding any other provision of law, a
signature under penalty of perjury shall not be required on
an application form for medical assistance as to any element
of eligibility for which eligibility is based on information
received from a source other than applicant, rather than on
representations from the applicant. Notwithstanding any other
provision of law, any signature requirement for an
application for medical assistance may be satisfied through
an electronic signature, as defined in section 1710(1) of the
Government Paperwork Elimination Act (44 U.S.C. 3504
note).''.
SEC. 203. INFORMATION TECHNOLOGY CONNECTIONS TO IMPROVE
HEALTH COVERAGE DETERMINATIONS.
(a) Enhanced Federal Funding for Improvements Related to
Implementation of Certain Model Outreach and Enrollment
Practices.--
(1) In general.--Section 1903(a)(3)(A) of the Social
Security Act (42 U.S.C. 1396b(a)(3)(A)) is amended--
(A) by striking ``and'' at the end of clause (i); and
(B) by adding at the end the following new clause:
``(iii) 75 percent of so much of the sums expended during
such quarter as are attributable to the design, development,
or installation of such mechanized claims processing and
information retrieval systems and the implementation of
administrative systems and processes (including modification
of eligibility computer systems to permit the exchange of
electronic information with other Federal or State programs)
as the Secretary determines are directly related to the
implementation of a model outreach and enrollment practice
described in subparagraph (B), (C), (D), (E), or (F) of
section 1905(y)(3), and''.
(2) Conforming amendment to ensure availability for
territories.--Section 1108(g) of such Act (42 U.S.C.
1308(g)), as amended by section 201(b)(2)(B), is amended--
(A) in paragraph (2), by striking ``and (4)'' and inserting
``, (4), and (5)''; and
(B) by adding at the end the following new paragraph:
[[Page S5941]]
``(5) Additional increase for certain expenditures.--With
respect to fiscal year 2008 and each fiscal year thereafter,
if Puerto Rico, the Virgin Islands, Guam, the Northern
Mariana Islands, or American Samoa qualify for a payment
under section 1903(a)(3)(A)(iii) for a calendar quarter of
such fiscal year, the additional Federal financial
participation under such section shall not be counted towards
the limitation on expenditures under title XIX for such
commonwealth or territory otherwise determined under
subsection (f) and this subsection for such fiscal year.''.
(b) Authorization of Information Disclosure.--
(1) In general.--Title XIX of such Act (42 U.S.C. 1396 et
seq.) is amended--
(A) by redesignating section 1939 as section 1940; and
(B) by inserting after section 1938 the following:
``AUTHORIZATION TO RECEIVE PERTINENT INFORMATION
``Sec. 1939. (a) In General.--Notwithstanding any other
provision of law, a Federal or State agency or private entity
in possession of the sources of data potentially pertinent to
eligibility determinations under this title or title XXI
(including eligibility files maintained by programs described
in section 1902(e)(13)(A), information described in paragraph
(2) or (3) of section 1137(a), vital records information
about births in any State, and information described in
sections 453(i) and 1902(a)(25)(I)) is authorized to convey
such data or information to a State agency administering a
State plan under this title or title XXI, if--
``(1) such data or information are used only to establish
or verify eligibility or provide coverage under this title or
title XXI; and
``(2) an interagency or other agreement, consistent with
standards developed by the Secretary, prevents the
unauthorized use, disclosure, or modification of such data
and otherwise meets applicable Federal requirements
safeguarding privacy and data security.
``(b) Requirements for Conveyance.--Data or information may
be conveyed pursuant to this section only if the following
requirements are met:
``(1) The individual whose circumstances are described in
the data or information (or such individual's parent,
guardian, caretaker relative, or authorized representative)
has either provided advance consent to disclosure or has not
objected to disclosure after receiving advance notice of
disclosure and a reasonable opportunity to object.
``(2) Such data or information are used solely for the
purposes of--
``(A) identifying individuals who are eligible or
potentially eligible for assistance under this title or title
XXI and enrolling such individuals in the State plans
established under such titles; and
``(B) verifying the eligibility of individuals for
assistance under the State plans established under this title
or title XXI.
``(3) An interagency or other agreement, consistent with
standards developed by the Secretary--
``(A) prevents the unauthorized use, disclosure, or
modification of such data and otherwise meets applicable
Federal requirements safeguarding privacy and data security;
and
``(B) requires the State agencies administering the State
plans established under this title and title XXI to use the
data and information obtained under this section to seek to
enroll individuals in such plans.
``(c) Criminal Penalty.--A person described in the
subsection (a) who publishes, divulges, discloses, or makes
known in any manner, or to any extent not authorized by
Federal law, any information obtained under this section
shall be fined not more than $1,000 or imprisoned not more
than 1 year, or both for each such unauthorized activity.
``(d) Rule of Construction.--The limitations and
requirements that apply to disclosure pursuant to this
section shall not be construed to prohibit the conveyance or
disclosure of data or information otherwise permitted under
Federal law (without regard to this section).''.
(2) Conforming amendment to assure access to national new
hires database.--Section 453(i)(1) of such Act (42 U.S.C.
653(i)(1)) is amended by striking ``and programs funded under
part A'' and inserting ``, programs funded under part A, and
State plans approved under title XIX or XXI''.
(3) Conforming amendment to provide schip programs with
access to national income data.--Section 6103(l)(7)(D)(ii) of
the Internal Revenue Code of 1986 is amended by inserting
``or title XXI'' after ``title XIX''.
(4) Conforming amendment to provide access to data about
enrollment in insurance for purposes of evaluating
applications and for schip.--Section 1902(a)(25)(I)(i) of the
Social Security Act (42 U.S.C. 1396a(a)(25)(I)(i)) is
amended--
(A) by inserting ``(and, at State option, individuals who
are potentially eligible or who apply)'' after ``with respect
to individuals who are eligible''; and
(B) by inserting ``under this title (and, at State option,
child health assistance under title XXI)'' after ``the State
plan''.
SEC. 204. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN
PREGNANT WOMEN UNDER MEDICAID AND SCHIP.
(a) Medicaid.--
(1) Authority to expand coverage.--Section 1902(l)(2)(A)(i)
of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is
amended by inserting ``(or such higher percentage as the
State may elect for purposes of expenditures for medical
assistance for pregnant women described in section
1905(u)(4)(A))'' after ``185 percent''.
(2) Enhanced matching funds available if certain conditions
met.--Section 1905 of such Act (42 U.S.C. 1396d) is amended--
(A) in the fourth sentence of subsection (b), by striking
``or subsection (u)(3)'' and inserting ``, (u)(3), or
(u)(4)''; and
(B) in subsection (u)--
(i) by redesignating paragraph (4) as paragraph (5); and
(ii) by inserting after paragraph (3) the following new
paragraph:
``(4) For purposes of the fourth sentence of subsection (b)
and section 2105(a), the expenditures described in this
paragraph are the following:
``(A) Certain pregnant women.--If the conditions described
in subparagraph (B) are met, expenditures for medical
assistance for pregnant women described in subsection (n) or
in section 1902(l)(1)(A) in a family the income of which
exceeds 185 percent of the poverty line, but does not exceed
the income eligibility level established under title XXI for
a targeted low-income child.
``(B) Conditions.--The conditions described in this
subparagraph are the following:
``(i) The State plans under this title and title XXI do not
provide coverage for pregnant women described in subparagraph
(A) with higher family income without covering such pregnant
women with a lower family income.
``(ii) The State does not apply an effective income level
for pregnant women that is lower than the effective income
level (expressed as a percent of the poverty line and
considering applicable income disregards) specified under the
State plan under subsection (a)(10)(A)(i)(III) or (l)(2)(A)
of section 1902, on the date of enactment of this paragraph
to be eligible for medical assistance as a pregnant woman.
``(C) Definition of poverty line.--In this subsection, the
term `poverty line' has the meaning given such term in
section 2110(c)(5).''.
(3) Payment from title xxi allotment for medicaid expansion
costs.--Section 2105(a)(1) of such Act (42 U.S.C.
1397ee(a)(1)), as amended by section 211, is amended by
striking subparagraph (B) and inserting the following new
subparagraph:
``(B) for the portion of the payments made for expenditures
described in section 1905(u)(4)(A) that represents the
additional amount paid for such expenditures as a result of
the enhanced FMAP being substituted for the Federal medical
assistance percentage of such expenditures;''.
(b) CHIP.--
(1) Coverage.--Title XXI of such Act(42 U.S.C. 1397aa et
seq.) is amended by adding at the end the following new
section:
``SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-INCOME
PREGNANT WOMEN.
``(a) Optional Coverage.--Notwithstanding any other
provision of this title, a State may provide for coverage,
through an amendment to its State child health plan under
section 2102, of pregnancy-related assistance for targeted
low-income pregnant women in accordance with this section,
but only if--
``(1) the State has established an income eligibility level
for pregnant women under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 that is at least 185 percent of the
income official poverty line; and
``(2) the State meets the conditions described in section
1905(u)(4)(B).
``(b) Definitions.--For purposes of this title:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term `child
health assistance' in section 2110(a) as if any reference to
targeted low-income children were a reference to targeted
low-income pregnant women.
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means a woman--
``(A) during pregnancy and through the end of the month in
which the 60-day period (beginning on the last day of her
pregnancy) ends;
``(B) whose family income exceeds the effective income
level (expressed as a percent of the poverty line and
considering applicable income disregards) specified under
subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902,
on January 1, 2008, to be eligible for medical assistance as
a pregnant woman under title XIX but does not exceed the
income eligibility level established under the State child
health plan under this title for a targeted low-income child;
and
``(C) who satisfies the requirements of paragraphs (1)(A),
(1)(C), (2), and (3) of section 2110(b) in the same manner as
a child applying for child health assistance would have to
satisfy such requirements.
``(c) References to Terms and Special Rules.--In the case
of, and with respect to, a State providing for coverage of
pregnancy-related assistance to targeted low-income pregnant
women under subsection (a), the following special rules
apply:
``(1) Any reference in this title (other than in subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income pregnant woman.
``(2) Any such reference to child health assistance with
respect to such women is deemed a reference to pregnancy-
related assistance.
[[Page S5942]]
``(3) Any such reference to a child is deemed a reference
to a woman during pregnancy and the period described in
subsection (b)(2)(A).
``(4) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State Medicaid plan under title XIX is
deemed a reference to pregnant women.
``(5) There shall be no exclusion of benefits for services
described in subsection (b)(1) based on any preexisting
condition and no waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) shall apply.
``(6) In applying section 2103(e)(3)(B) in the case of a
pregnant woman provided coverage under this section, the
limitation on total annual aggregate cost sharing shall be
applied to such pregnant woman.
``(7) The reference in section 2107(e)(1)(F) to section
1920A (relating to presumptive eligibility for children) is
deemed a reference to section 1920 (relating to presumptive
eligibility for pregnant women).
``(d) Automatic Enrollment for Children Born to Women
Receiving Pregnancy-Related Assistance.--If a child is born
to a targeted low-income pregnant woman who was receiving
pregnancy-related assistance under this section on the date
of the child's birth, the child shall be deemed to have
applied for child health assistance under the State child
health plan and to have been found eligible for such
assistance under such plan or to have applied for medical
assistance under title XIX and to have been found eligible
for such assistance under such title, as appropriate, on the
date of such birth and to remain eligible for such assistance
until the child attains 1 year of age. During the period in
which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child
health or medical assistance eligibility identification
number of the mother shall also serve as the identification
number of the child, and all claims shall be submitted and
paid under such number (unless the State issues a separate
identification number for the child before such period
expires).''.
(2) Additional conforming amendments.--
(A) No cost sharing for pregnancy-related benefits.--
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``or pregnancy-related
services'' after ``preventive services''; and
(ii) by inserting before the period at the end the
following: ``or for pregnancy-related services''.
(B) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(i) in clause (i), by striking ``, and'' at the end and
inserting a semicolon;
(ii) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(iii) by adding at the end the following new clause:
``(iii) may not apply a waiting period (including a waiting
period to carry out paragraph (3)(C)) in the case of a
targeted low-income pregnant woman.''.
(c) Other Amendments to Medicaid.--
(1) Eligibility of a newborn.--Section 1902(e)(4) (42
U.S.C. 1396a(e)(4)) is amended in the first sentence by
striking ``so long as the child is a member of the woman's
household and the woman remains (or would remain if pregnant)
eligible for such assistance''.
(2) Application of qualified entities to presumptive
eligibility for pregnant women under medicaid.--Section
1920(b) (42 U.S.C. 1396r-1(b)) is amended by adding after
paragraph (2) the following new flush sentence:
``The term `qualified provider' includes a qualified entity
as defined in section 1920A(b)(3).''.
SEC. 205. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER
MEDICAID AND SCHIP.
(a) Medicaid Program.--Section 1903(v) of the Social
Security Act (42 U.S.C. 1396b(v)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) A State may elect (in a plan amendment under this
title) to provide medical assistance under this title,
notwithstanding sections 401(a), 402(b), 403, and 421 of the
Personal Responsibility and Work Opportunity Reconciliation
Act of 1996, for aliens who are lawfully residing in the
United States (including battered aliens described in section
431(c) of such Act) and who are otherwise eligible for such
assistance, within either or both of the following
eligibility categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the
pregnancy).
``(ii) Children.--Individuals under 21 years of age,
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(B) In the case of a State that has elected to provide
medical assistance to a category of aliens under subparagraph
(A), no debt shall accrue under an affidavit of support
against any sponsor of such an alien on the basis of
provision of assistance to such category and the cost of such
assistance shall not be considered as an unreimbursed
cost.''.
(b) SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C.
1397gg(e)(1)), as amended by section 202(b), is amended by
redesignating subparagraphs (D) and (E) as subparagraph (E)
and (F), respectively, and by inserting after subparagraph
(C) the following new subparagraph:
``(D) Section 1903(v)(4) (relating to optional coverage of
categories of lawfully residing immigrant children), but only
if the State has elected to apply such section to the
category of children under title XIX.''.
(c) Effective Date.--The amendments made by this section
take effect on October 1, 2007, and apply to medical
assistance and child health assistance furnished on or after
such date.
(d) Construction.--Nothing in this section shall be
construed as affecting eligibility of aliens who are not
lawfully residing in the United States to benefits under the
Medicaid program under title XIX of the Social Security Act
or under the State children's health insurance program
(SCHIP) under title XXI of such Act.
SEC. 206. AUTHORIZING ADJUSTMENT OF SCHIP ALLOTMENT DUE TO
INCREASED OUTREACH.
(a) In General.--Section 2104 of the Social Security Act
(42 U.S.C. 1397dd), as amended by section 101, is further
amended by adding at the end the following new subsection:
``(j) Authorizing Allotment Adjustment Due to Increased
Outreach.--
``(1) In general.--Notwithstanding the previous provisions
of this section, if the Secretary determines that--
``(A) a State has an increase in the average number of
children enrolled under its State child health plan in a
fiscal year that exceeds the enrollment of children projected
under paragraph (2) for the State for such fiscal year, and
``(B) the total Federal expenditures under the State child
health plan (or waiver) under this title exceeds the amount
of the allotment made available to the State for the fiscal
year,
the Secretary shall increase the allotment under this section
for the State for the fiscal year by the amount specified in
paragraph (3). There are hereby appropriated, out of any
money in the Treasury not otherwise appropriated, such sums
as may be necessary to provide for such increase in
allotment.
``(2) Projected enrollment of children.--The projected
enrollment of children for a State under this paragraph for a
fiscal year is equal to the average number of children
enrolled under the State child health plan in fiscal year
2007 increased, for each subsequent fiscal year through the
fiscal year involved, by a factor equal to the population
growth of children in the State for such fiscal year, as
projected by the Secretary before the beginning of the fiscal
year involved.
``(3) Amount of allotment increase.--
``(A) In general.--Subject to subparagraph (B), the amount
of the allotment increase under this subsection for a State
for a fiscal year shall be an amount equal to the product
of--
``(i) the number by which the average number of children
enrolled under the State child health plan in the fiscal year
exceeds the enrollment of children projected under paragraph
(2) for such State for such fiscal year; and
``(ii) the per capita expenditures for children under the
State child health plan for the previous year, increased by
the average annual rate of increase (for the three previous
fiscal years) in the amount of such per capita expenditures.
The amount of the allotment increase under this subsection
shall not be subject to administrative or judicial review.
``(B) Limitation.--
``(i) In general.--Subject to clause (ii), in no case shall
the sum of the allotment increases for all States under this
subsection for a fiscal year exceed an amount equal to 20
percent of the total Federal payments to all of the States
otherwise made under this title for the fiscal year. If such
sum exceeds such amount, subject to clause (ii), the
allotment increase for each State under this subsection for
the fiscal year shall be reduced in a pro rata manner in
order that such sum does not exceed such amount.
``(ii) Congressional approval of additional amounts.--If
the Secretary estimates that the allotment increases that
should be provided under this subsection, but for clause (i),
would exceed the limitation established under such clause,
the Secretary shall submit to Congress a request for
supplemental appropriations for the purpose of meeting such
shortfall.
``(4) Clarification.--An adjustment in an allotment shall
not be made under this subsection due to excess State
expenditures resulting from a growth in per capita costs,
increased reimbursement to providers, or other factors not
directly related to outreach to eligible, but previously
unenrolled children.''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect beginning with allotments for fiscal year
2008.
SEC. 207. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND
COVERAGE PROCESS.
In order to assure continuity of coverage of low-income
children under the Medicaid program and the State Children's
Health Insurance Program (SCHIP), the Secretary of Health and
Human Services, in consultation with State Medicaid and SCHIP
directors, shall develop and disseminate a model process for
the coordination of the enrollment and coverage under such
programs of children who, because of migration of families,
emergency evacuations, educational needs, or otherwise,
frequently change their State of residency or otherwise are
temporarily
[[Page S5943]]
present outside of the State of their residency.
SEC. 208. AUTHORITY FOR QUALIFYING STATES TO USE PORTION OF
SCHIP ALLOTMENT FOR ANY FISCAL YEAR FOR CERTAIN
MEDICAID EXPENDITURES.
Section 2105(g)(1)(A) of the Social Security Act (42 U.S.C.
1397ee(g)(1)(A)), as amended by section 201(b) of the
National Institutes of Health Reform Act of 2006 (Public Law
109-482) is amended by striking ``fiscal year 1998, 1999,
2000, 2001, 2004, 2005, 2006, or 2007'' and inserting ``a
fiscal year''.
SEC. 209. APPLICATION OF MEDICAID OUTREACH PROCEDURES TO ALL
PREGNANT WOMEN AND CHILDREN.
(a) In General.--Section 1902(a)(55) of the Social Security
Act (42 U.S.C. 1396a(a)(55)) is amended by striking
``individuals for medical assistance under subsection
(a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or
(a)(10)(A)(ii)(IX)'' and inserting ``child and pregnant women
for medical assistance (including under clauses (i)(IV),
(i)(VI), (i)(VII), and (ii)(IX) of paragraph (10)(A))''.
(b) Effective Date.--
(1) In general.--
(2) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act, which
the Secretary of Health and Human Services determines
requires State legislation in order for the plan to meet the
additional requirements imposed by the amendment made by
subsection (a), the State plan shall not be regarded as
failing to comply with the requirements of such Act solely on
the basis of its failure to meet these additional
requirements before the first day of the first calendar
quarter beginning after the close of the first regular
session of the State legislature that begins after the date
of enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
SEC. 210. NO IMPACT ON SECTION 1115 WAIVERS.
Nothing in this Act shall be construed to affect State
flexibility on eligibility and waivers approved by the
Federal government under section 1115 of the Social Security
Act (42 U.S.C. 1315).
SEC. 211. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.
Section 2105(a)(1) of the Social Security Act (42 U.S.C.
1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``(or, in the case of expenditures described in subparagraph
(B), the Federal medical assistance percentage (as defined in
the first sentence of section 1905(b)))''; and
(2) by amending subparagraph (B) to read as follows:
``(B) [reserved]''.
SEC. 212. PROHIBITING LIMITATIONS ON ENROLLMENT.
(a) In General.--Section 2102(b)(3)(B) of the Social
Security Act (42 U.S.C. 1397bb(b)(3)(B)) is amended--
(1) by striking ``and'' at the end of clause (i);
(2) by striking the period at the end of clause (ii) and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) shall not impose, with respect to enrollment of
targeted low-income children under the State child health
plan, any enrollment cap or other numerical limitation on
enrollment, any waiting list, any procedures designed to
delay the consideration of applications for enrollment, or
similar limitation with respect to enrollment.''.
(b) Effective Date.--The amendments made by subsection (a)
shall apply to State child health plans as of October 1,
2007.
TITLE III--ELIMINATION OF CERTAIN BARRIERS TO COVERAGE
SEC. 301. STATE OPTION TO REQUIRE CERTAIN INDIVIDUALS TO
PRESENT SATISFACTORY DOCUMENTARY EVIDENCE OF
PROOF OF CITIZENSHIP OR NATIONALITY FOR
PURPOSES OF ELIGIBILITY FOR MEDICAID.
(a) In General.--Section 1902(a)(46) of the Social Security
Act (42 U.S.C. 1396a(a)(46)) is amended--
(1) by inserting ``(A)'' after ``(46)'';
(2) by adding ``and'' after the semicolon; and
(3) by adding at the end the following new subparagraph:
``(B) at the option of the State and subject to section
1903(x), require that, with respect to an individual (other
than an individual described in section 1903(x)(1)) who
declares to be a citizen or national of the United States for
purposes of establishing initial eligibility for medical
assistance under this title (or, at State option, for
purposes of renewing or redetermining such eligibility to the
extent that such satisfactory documentary evidence of
citizenship or nationality has not yet been presented), there
is presented satisfactory documentary evidence of citizenship
or nationality of the individual (using criteria determined
by the State, which shall be no more restrictive than the
criteria used by the Social Security Administration to
determine citizenship, and which shall accept as such
evidence a document issued by a federally recognized Indian
tribe evidencing membership or enrollment in, or affiliation
with, such tribe (such as a tribal enrollment card or
certificate of degree of Indian blood, and, with respect to
those federally recognized Indian tribes located within
States having an international border whose membership
includes individuals who are not citizens of the United
States, such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary, after
consulting with such tribes, determines to be satisfactory
documentary evidence of citizenship or nationality for
purposes of satisfying the requirement of this
subparagraph));''.
(b) Limitation on Waiver Authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42
U.S.C. 1315), or any other provision of law, the Secretary
may not waive the requirements of section 1902(a)(46)(B) of
such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
(c) Conforming Amendments.--Section 1903 of such Act (42
U.S.C. 1396b) is amended--
(1) in subsection (i)--
(A) in paragraph (20), by adding ``or'' after the
semicolon;
(B) in paragraph (21), by striking ``; or'' and inserting a
period; and
(C) by striking paragraph (22); and
(2) in subsection (x) (as amended by section 405(c)(1)(A)
of division B of the Tax Relief and Health Care Act of 2006
(Public Law 109-432))--
(A) by striking paragraphs (1) and (3);
(B) by redesignating paragraph (2) as paragraph (1);
(C) in paragraph (1), as so redesignated, by striking
``paragraph (1)'' and inserting ``section 1902(a)(46)(B)'';
and
(D) by adding at the end the following new paragraphs:
``(2) In the case of an individual declaring to be a
citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary
evidence of citizenship or nationality under section
1902(a)(46)(B), the individual shall be provided at least the
reasonable opportunity to present satisfactory documentary
evidence of citizenship or nationality under this subsection
as is provided under clauses (i) and (ii) of section
1137(d)(4)(A) to an individual for the submittal to the State
of evidence indicating a satisfactory immigration status.
``(3)(A) In addition to the criteria established by the
State for purposes of section 1902(a)(46)(B), a State shall
deem presentation of the following documents to be
`satisfactory documentary evidence of citizenship or
nationality' (and shall not favor presentation of 1 type of
document described over another):
``(i) Any document described in subparagraph (B).
``(ii) Any document described in subparagraph (C) when
presented with any document described in subparagraph (D).
``(iii) Any document described in subparagraph (E) if the
requirements of that subparagraph are met.
``(B) The following are documents described in this
subparagraph:
``(i) A United States passport.
``(ii) Form N-550 or N-570 (Certificate of Naturalization).
``(iii) Form N-560 or N-561 (Certificate of United States
Citizenship).
``(iv) A valid State-issued driver's license or other
identity document described in section 274A(b)(1)(D) of the
Immigration and Nationality Act, but only if the State
issuing the license or such document requires proof of United
States citizenship before issuance of such license or
document or obtains a social security number from the
applicant and verifies before certification that such number
is valid and assigned to the applicant who is a citizen.
``(v) Such other document as the Secretary may specify, by
regulation, that provides proof of United States citizenship
or nationality and that provides a reliable means of
documentation of personal identity.
``(C) The following are documents described in this
subparagraph:
``(i) A certificate of birth in the United States.
``(ii) Form FS-545 or Form DS-1350 (Certification of Birth
Abroad).
``(iii) Form I-197 (United States Citizen Identification
Card).
``(iv) Form FS-240 (Report of Birth Abroad of a Citizen of
the United States).
``(v) Such other document (not described in subparagraph
(B)(iv)) as the Secretary may specify that provides proof of
United States citizenship or nationality.
``(D) The following are documents described in this
subparagraph:
``(i) Any identity document described in section
274A(b)(1)(D) of the Immigration and Nationality Act.
``(ii) Any other documentation of personal identity of such
other type as the Secretary finds, by regulation, provides a
reliable means of identification.
``(E) A document described in this subparagraph is an
affidavit of citizenship or identity, or both, which need not
be notarized or witnessed, but only if the individual has
been unable to acquire other satisfactory documentary
evidence within the reasonable opportunity period established
by the State, despite a good faith effort to do so. An
individual shall be deemed unable to acquire such documentary
evidence--
``(i) if there is good reason to believe that such
documentary evidence does not exist;
``(ii) if, after a timely request for such documentary
evidence, it has not been received by the State or the
individual within the reasonable opportunity period
established by the State;
[[Page S5944]]
``(iii) if such documentary evidence cannot be acquired at
a nominal cost to the individual; or
``(iv) in such additional situations as the Secretary may
describe.
``(F)(i) A reference in this paragraph to a form includes a
reference to any successor form.
``(ii) Any legible copy of a form described in this
paragraph shall be accepted as if it were the original of
such form.''.
(d) Clarification of Rules for Children Born in the United
States to Mothers Eligible for Medicaid.--Section 1903(x) of
such Act (42 U.S.C. 1396b(x)), as amended by subsection
(c)(2), is amended--
(1) in paragraph (1)--
(A) in subparagraph (C), by striking ``or'' at the end;
(B) by redesignating subparagraph (D) as subparagraph (E);
and
(C) by inserting after subparagraph (C) the following new
subparagraph:
``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall be
deemed to have provided satisfactory documentary evidence of
citizenship or nationality and shall not be required to
provide further documentary evidence on any date that occurs
during or after the period in which the individual is
eligible for medical assistance on such basis); or''; and
(2) by adding at the end the following new paragraph:
``(4) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to
an alien mother for whom medical assistance for the delivery
of such child is available as treatment of an emergency
medical condition pursuant to subsection (v) shall be deemed
eligible for medical assistance during the first year of such
child's life.''.
(e) Effective Date.--
(1) Retroactive application.--The amendments made by this
section shall take effect as if included in the enactment of
the Deficit Reduction Act of 2005 (Public Law 109-171; 120
Stat. 4).
(2) Restoration of eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on the date of enactment of this Act, was determined
to be ineligible for medical assistance under a State
Medicaid program solely as a result of the application of
subsections (i)(22) and (x) of section 1903 of the Social
Security Act (as in effect during such period), but who would
have been determined eligible for such assistance if such
subsections, as amended by this section, had applied to the
individual, a State may deem the individual to be eligible
for such assistance as of the date that the individual was
determined to be ineligible for such medical assistance on
such basis.
SEC. 302. INCREASED FEDERAL MATCHING RATE FOR LANGUAGE
SERVICES PROVIDED UNDER MEDICAID OR SCHIP.
(a) In General.--Section 1903(a)(3) of the Social Security
Act (42 U.S.C. 1396b(a)(3)) is amended--
(1) in subparagraph (E)(ii), by striking ``plus'' at the
end; and
(2) by adding at the end the following:
``(3) 85 percent of the sums expended with respect to costs
incurred during such quarter as are attributable to the
provision of language services on behalf of individuals with
limited English proficiency who apply for or receive medical
assistance under the State plan (including any provisions of
the plan implemented pursuant to any waiver authority of the
Secretary) or child health assistance under title XXI;
plus''.
(b) Effective Date.--The amendments made by subsection (a)
take effect on October 1, 2007, and apply to language
services provided on or after that date.
TITLE IV--GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT UNDER
MEDICAID AND SCHIP
SEC. 401. GRANTS TO PROMOTE INNOVATIVE OUTREACH AND
ENROLLMENT UNDER MEDICAID AND SCHIP.
Title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.), as amended by section 204(b), is amended by adding at
the end the following:
``SEC. 2112. EXPANDED OUTREACH AND ENROLLMENT ACTIVITIES.
``(a) Grants to Conduct Innovative Outreach and Enrollment
Efforts.--
``(1) In general.--The Secretary shall award grants to
eligible entities to--
``(A) conduct innovative outreach and enrollment efforts
that are designed to increase the enrollment and
participation of eligible children under this title and title
XIX; and
``(B) promote understanding of the importance of health
insurance coverage for prenatal care and children.
``(2) Performance bonuses.--The Secretary may reserve a
portion of the funds appropriated under subsection (g) for a
fiscal year for the purpose of awarding performance bonuses
during the succeeding fiscal year to eligible entities that
meet enrollment goals or other criteria established by the
Secretary.
``(b) Priority for Award of Grants.--
``(1) In general.--In making grants under subsection
(a)(1), the Secretary shall give priority to--
``(A) eligible entities that propose to target geographic
areas with high rates of--
``(i) eligible but unenrolled children, including such
children who reside in rural areas; or
``(ii) racial and ethnic minorities and health disparity
populations, including those proposals that address cultural
and linguistic barriers to enrollment; and
``(B) eligible entities that plan to engage in outreach
efforts with respect to individuals described in subparagraph
(A) and that are--
``(i) Federal health safety net organizations; or
``(ii) faith-based organizations or consortia.
``(2) 10 percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) for a fiscal year shall be
used by the Secretary to award grants to Indian Health
Service providers and urban Indian organizations receiving
funds under title V of the Indian Health Care Improvement Act
(25 U.S.C. 1651 et seq.) for outreach to, and enrollment of,
children who are Indians.
``(c) Application.--An eligible entity that desires to
receive a grant under subsection (a)(1) shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may decide.
Such application shall include--
``(1) quality and outcomes performance measures to evaluate
the effectiveness of activities funded by a grant awarded
under this section to ensure that the activities are meeting
their goals; and
``(2) an assurance that the entity shall--
``(A) conduct an assessment of the effectiveness of such
activities against such performance measures; and
``(B) cooperate with the collection and reporting of
enrollment data and other information determined as a result
of conducting such assessments to the Secretary, in such form
and manner as the Secretary shall require.
``(d) Dissemination of Enrollment Data and Information
Determined From Effectiveness Assessments; Annual Report.--
The Secretary shall--
``(1) disseminate to eligible entities and make publicly
available the enrollment data and information collected and
reported in accordance with subsection (c)(2)(B); and
``(2) submit an annual report to Congress on the outreach
activities funded by grants awarded under this section.
``(e) Supplement, Not Supplant.--Federal funds awarded
under this section shall be used to supplement, not supplant,
non-Federal funds that are otherwise available for activities
funded under this section.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State or local government.
``(B) A Federal health safety net organization.
``(C) A national, local, or community-based public or
nonprofit private organization, including organizations that
use community health workers or community-based doula
programs.
``(D) A faith-based organization or consortia, to the
extent that a grant awarded to such an entity is consistent
with the requirements of section 1955 of the Public Health
Service Act (42 U.S.C. 300x-65) relating to a grant award to
non-governmental entities.
``(E) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) an Indian tribe, tribal organization, or an urban
Indian organization receiving funds under title V of the
Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.),
or an Indian Health Service provider;
``(B) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
``(C) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
``(D) a covered entity described in section 340B(a)(4) of
the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
``(E) any other entity or a consortium that serves children
under a federally-funded program, including the special
supplemental nutrition program for women, infants, and
children (WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the head start and
early head start programs under the Head Start Act (42 U.S.C.
9801 et seq.), the school lunch program established under the
Richard B. Russell National School Lunch Act, and an
elementary or secondary school.
``(3) Indians; indian tribe; tribal organization; urban
indian organization.--The terms `Indian', `Indian tribe',
`tribal organization', and `urban Indian organization' have
the meanings given such terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
``(g) Appropriation.--There is appropriated, out of any
money in the Treasury not otherwise appropriated, $50,000,000
for each of fiscal years 2008 through 2012 for the purpose of
awarding grants under this section. Amounts appropriated and
paid under the authority of this section shall be in addition
to amounts appropriated under section 2104 and paid to States
in accordance with section 2105, including with respect to
expenditures for outreach activities in accordance with
subsection (a)(1)(D)(iii) of such section.''.
[[Page S5945]]
TITLE V--IMPROVING THE QUALITY OF PEDIATRIC CARE
SEC. 501. REQUIRING COVERAGE OF EPSDT SERVICES, INCLUDING
DENTAL SERVICES; STATE OPTION TO PROVIDE
SUPPLEMENTAL COVERAGE OF DENTAL SERVICES.
(a) Additional Required Services.--
(1) Required coverage of epsdt services, including dental
services.--Section 2103(c) of the Social Security Act (42
U.S.C. 1397cc(c)) is amended--
(A) by redesignating paragraph (5) as paragraph (6); and
(B) by inserting after paragraph (4), the following:
``(5) Other required services.--The child health assistance
provided to a targeted low-income child shall include
coverage of early and periodic screening, diagnostic, and
treatment services described in subsections (a)(4)(B) and (r)
of section 1905 and provided in accordance with section
1903(a)(43) (including dental services that are necessary to
prevent disease and promote oral health, restore oral
structures to health and function, and treat emergency
conditions).''.
(2) State child health plan requirement.--Section
2102(a)(7)(B) of such Act (42 U.S.C. 1397bb(c)(2)) is amended
by inserting ``and services described in section 2103(c)(5)''
after ``emergency services''.
(3) Conforming amendment.--Section 2103(a) of such Act (42
U.S.C. 1397cc(a)) is amended, in the matter preceding
paragraph (1), by striking ``subsection (c)(5)'' and
inserting ``paragraphs (5) and (6) of subsection (c)''.
(b) State Option to Provide Supplemental Coverage of Dental
Services Under SCHIP to Children With Other Health
Coverage.--
(1) In general.--Section 2110(b) of the Social Security Act
(42 U.S.C. 1397jj(b)) is amended--
(A) in paragraph (1)(C), by inserting ``, subject to
paragraph (5),'' after ``under title XIX or''; and
(B) by adding at the end the following:
``(5) State option to provide supplemental coverage of
dental services to children with other health coverage.--
``(A) In general.--A State may waive the requirement of
paragraph (1)(C) that a targeted low-income child may not be
covered under a group health plan or under health insurance
coverage in order to provide dental services that are not
covered, or are only partially covered, under such plan or
coverage. Nothing in subsection (c)(5) of section 2103 shall
be construed as prohibiting a State from limiting the
supplemental coverage of dental services provided in
accordance with this paragraph and nothing in paragraph (2)
or (3) of subsection (e) of such section shall be construed
as prohibiting a State from imposing premiums, deductibles,
cost-sharing, or similar charges for such coverage without
regard to the requirements of either such paragraph.
``(B) Eligibility.--In waiving such requirement, a State
may limit the application of the waiver to children whose
family income does not exceed a level specified by the State,
which may not exceed the maximum income level otherwise
established for other children under the State child health
plan.
``(C) Continued application of duty to prevent substitution
of existing coverage.--Nothing in this paragraph shall be
construed as modifying the application of section
2102(b)(3)(C) to a State.''.
(2) Application of enhanced match under medicaid.--Section
1905 of such Act (42 U.S.C. 1396d) is amended--
(A) in subsection (b), in the fourth sentence, by striking
``subsection (u)(3)'' and inserting ``(u)(3), or (u)(4)'';
and
(B) in subsection (u), by redesignating paragraph (4) as
paragraph (5) and by inserting after paragraph (3) the
following:
``(4) For purposes of subsection (b), the expenditures
described in this paragraph are expenditures for supplemental
coverage of dental services for children described in section
2110(b)(5).''.
(3) Application of secondary payor provisions.--Section
2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B) through (D) as
subparagraphs (C) through (E), respectively; and
(B) by inserting after subparagraph (A) the following new
subparagraph:
``(B) Section 1902(a)(25) (relating to coordination of
benefits and secondary payor provisions) with respect to
children provided supplemental coverage of dental services
under a waiver described in section 2110(b)(5).''.
SEC. 502. PEDIATRIC QUALITY AND PERFORMANCE MEASURES PROGRAM.
Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) is amended--
(1) by redesignating section 1939 as section 1941; and
(2) by inserting after section 1938 the following:
``PEDIATRIC QUALITY AND PERFORMANCE MEASURES PROGRAM
``Sec. 1939. (a) Establishment.--The Secretary, acting
through the Administrator of the Centers for Medicare &
Medicaid Services and in consultation with the Director of
the Agency for Healthcare Research and Quality, shall
establish a program to encourage and support the development
of new and emerging quality and performance measures for
providers of pediatric care through the activities described
in subsection (c). In establishing the program, gaps in
existing evidence-based measures and priority areas for
advancement shall be identified.
``(b) Purpose.--The purpose of the program is to ensure
that--
``(1) evidence-based pediatric quality and performance
measures are developed; and
``(2) such measures are available for States, other
purchasers of pediatric health care services, health care
providers, and consumers to use.
``(c) Program Activities.--
``(1) Identifying quality and performance measures for
providers of pediatric services and opportunities for new
measures.--Not later than 3 months after the date of
enactment of this section, the Secretary shall identify
quality and performance measures for providers of pediatric
services and opportunities for the development of new
measures, taking into consideration existing evidence-based
measures. In conducting this review, the Secretary shall--
``(A) ensure the inclusion of at least 1 measure related to
children's dental and oral health; and
``(B) convene and consult with representatives of--
``(i) States;
``(ii) pediatric hospitals, pediatricians, and other
pediatric health professionals;
``(iii) national organizations representing--
``(I) consumers of children's health care; and
``(II) purchasers of children's health care;
``(iv) experts in pediatric quality and performance
measurement; and
``(v) a voluntary consensus standards setting organization
and other organizations involved in the advancement of
consensus on evidence-based measures of health care.
``(2) Developing, validating, and testing new measures.--
The Secretary shall award grants or contracts to eligible
entities (as defined in subsection (d)(1)) for the
development, validation, and testing of new and emerging
quality and performance measures, including at least 1
measure related to children's dental and oral health, for
providers of pediatric services. Such measures shall--
``(A) provide consumers and purchasers (including States
and beneficiaries under the program under this title and
title XXI) with information about provider performance and
quality; and
``(B) assist health care providers in improving the quality
of the items and services they provide and their performance
with respect to the provision of such items and services.
``(3) Achieving consensus on evidence-based measures.--The
Secretary shall award grants or contracts to eligible
consensus entities (as defined in subsection (d)(2)) for the
development of consensus on evidence-based measures for
pediatric care, including at least 1 measure related to
children's dental and oral health, that have broad
acceptability in the health care industry.
``(d) Eligible Entities.--
``(1) Development, validation, and testing.--For purposes
of paragraph (2) of subsection (c), the term `eligible
entity' means--
``(A) organizations with demonstrated expertise and
capacity in the development and evaluation of pediatric
quality and performance measures;
``(B) an organization or association of health care
providers with demonstrated experience in working with
accrediting organizations in developing pediatric quality and
performance measures; and
``(C) a collaboration of national pediatric organizations
working to improve pediatric quality and performance
measures.
``(2) Achievement of consensus.--For purposes of paragraph
(3) of such subsection, the term `eligible consensus entity'
means an organization, including a voluntary consensus
standards setting organization involved in the advancement of
consensus on evidence-based measures of health care.
``(e) Ongoing Authority to Update and Adjust Pediatric
Measures.--The Secretary may update and adjust measures
developed and advanced under the program under this section
in accordance with--
``(1) any changes that a voluntary consensus standards
setting organization determines should be made with respect
to such measures; or
``(2) new evidence indicating the need for changes with
respect to such measures.
``(f) Addition of Pediatric Consumer Assessment Measures to
CAHPS Hospital Survey Conducted by AHRQ.--The Director of the
Agency for Healthcare Research and Quality shall ensure that
consumer assessment measures for hospital services for
children are added to the Consumer Assessment of Healthcare
Providers and Systems (CAHPS) Hospital survey conducted by
such Agency.
``(g) Appropriation.--There are authorized to be
appropriated and there are appropriated, for the purpose of
carrying out this section, $10,000,000, for each of fiscal
years 2008 through 2012, to remain available until
expended.''.
SEC. 503. GRANTS TO STATES FOR DEMONSTRATION PROJECTS
TRANSFORMING DELIVERY OF PEDIATRIC CARE.
Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.), as amended by section 502, is amended by inserting
after section 1939 the following:
``GRANTS TO STATES FOR DEMONSTRATION PROJECTS TRANSFORMING DELIVERY OF
PEDIATRIC CARE
``Sec. 1940. (a) Establishment.--The Secretary, acting
through the Administrator of the Centers for Medicare &
Medicaid Services, shall establish demonstration projects,
[[Page S5946]]
including demonstration projects in each of the 4 categories
described in subsection (d), to award grants to States to
improve the delivery of health care services provided to
children under this title and title XXI.
``(b) Duration.--The demonstration projects shall be
conducted for a period of 4 years.
``(c) Eligibility.--A State shall not be eligible to
receive a grant under this section unless the State has
demonstrated experience or commitment to the concept of
transformation in the delivery of pediatric care.
``(d) Categories of Projects.--The following categories of
projects are described in this subsection:
``(1) Health information technology systems.--Projects for
developing health information technology systems, including
technology acquisition, electronic health record development,
data standards development, and software development, for
pediatric hospital and physician services and other
community-based services; implementing model systems; and
evaluating their impact on the quality, safety, and costs of
care.
``(2) Disease management.--Projects for providing provider-
based care disease management for children with chronic
conditions (including physical, developmental, behavioral,
and psychological conditions), demonstrating the
effectiveness of provider-based management models in
promoting better care, reducing adverse health outcomes, and
preventing avoidable hospitalizations.
``(3) Evidence-based quality improvements.--Projects for
implementing evidence-based approaches to improving
efficiency, safety, and effectiveness in the delivery of
hospital care for children across hospital services,
evaluating the translation of successful models of such
evidence-based approaches to other institutions, and the
impact of such changes on the quality, safety, and costs of
care.
``(4) Quality and performance measures for providers of
children's health care services.--Projects to pilot test
evidence-based pediatric quality and performance measures for
inpatient hospital services, physician services, or services
of other health professionals, determining the reliability,
feasibility, and validity of such measures, and evaluating
their potential impact on improving the quality and delivery
of children's health care. To the extent feasible, such
measures shall have been approved by consensus standards
setting organizations.
``(e) Uniform Metrics.--The Secretary shall establish
uniform metrics (adjusted, as appropriate, for patient
acuity), collect data, and conduct evaluations with respect
to each demonstration project category described in
subsection (d). In establishing such metrics, collecting such
data, and conducting such evaluations, the Secretary shall
consult with--
``(1) experts in each such demonstration project category;
``(2) participating States;
``(3) national pediatric provider organizations;
``(4) health care consumers; and
``(5) such other entities or individuals with relevant
expertise as the Secretary determines appropriate.
``(f) Evaluation and Report.--The Secretary shall evaluate
the demonstration projects conducted under this section and
submit a report to Congress not later than 3 months before
the completion of each demonstration project that includes
the findings of the evaluation and recommendations with
respect to--
``(1) expansion of the demonstration project to additional
States and sites; and
``(2) the broader implementation of approaches identified
as being successful in advancing quality and performance in
the delivery of medical assistance provided to children under
this title and title XXI.
``(g) Waiver.--The Secretary may waive the requirements of
this title and title XXI to the extent necessary to carry out
the demonstration projects under this section.
``(h) Amounts Paid to a State.--Amounts paid to a State
under this section--
``(1) shall be in addition to Federal payments made to the
State under section 1903(a);
``(2) shall not be used for the State share of any
expenditures claimed for payment under such section; and
``(3) shall be used only for expenditures of the State for
participating in the demonstration projects, or for
expenditures of providers in participating in the
demonstration projects, including--
``(A) administrative costs of States and participating
providers (such as costs associated with the design and
evaluation of, and data collection under, the demonstration
projects); and
``(B) such other expenditures that are not otherwise
eligible for reimbursement under this title or title XXI as
the Secretary may determine appropriate.
``(i) Appropriation.--There are authorized to be
appropriated and there are appropriated, for the purpose of
carrying out this section, to remain available until expended
$10,000,000 for each of fiscal years 2008 through 2012.''.
SEC. 504. REPORT BY THE COMPTROLLER GENERAL ON DESIGN AND
IMPLEMENTATION OF A DEMONSTRATION PROJECT
EVALUATING EXISTING QUALITY AND PERFORMANCE
MEASURES FOR CHILDREN'S INPATIENT HOSPITAL
SERVICES.
(a) In General.--Not later than 12 months after the date of
enactment of this Act, the Comptroller General of the United
States (in this section referred to as the ``Comptroller
General'') shall submit a report to Congress containing
recommendations for the design and implementation of a
demonstration project to evaluate the suitability of existing
quality and performance measures for children's inpatient
hospital services for public reporting, differentiating
quality, identifying best practices, and providing a basis
for payment rewards.
(b) Development of Recommendations.--In developing the
recommendations submitted under subsection (a), the
Comptroller General shall accomplish the following:
(1) Consider which agency within the Department of Health
and Human Services should have primary responsibility and
oversight for such a demonstration project.
(2) Determine a sufficient number of participating
hospitals and volume of children's cases, given existing
measures that might be chosen for evaluation under such a
demonstration project.
(3) Determine the number of States and variety of
geographic locations that may be required to conduct such a
demonstration project.
(4) Describe alternatives for administering and directing
funding for such a demonstration project, taking into
consideration the potential involvement of multiple States,
State plans under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.), and State child health plans under
title XXI of such Act (42 U.S.C. 1397aa et seq.). Such
description shall be included in the recommendations
submitted under subsection (a).
(5) Determine requirements for consistency in measures,
metrics, and risk adjustment for such a demonstration
project, across hospitals and across State lines.
(6) Consider the infrastructure requirements involved in
public reporting of quality and performance measures for
children's inpatient hospital services at the national and
State levels, including the requirements involved with
respect to maintaining such measures and data.
(7) Estimate the cost of undertaking such a demonstration
project.
(c) Suggestion of Existing Measures for Evaluation Under
the Demonstration Project.--
(1) In general.--The report submitted under subsection (a)
shall include suggestions for existing measures to be
evaluated under the demonstration project recommended in such
report, including, to the extent feasible, measures with
respect to--
(A) high volume pediatric inpatient conditions;
(B) high cost pediatric inpatient services;
(C) pediatric conditions with predicted high morbidities;
and
(D) pediatric cases at high risk of patient safety
failures.
(2) Suggested measures.--The measures suggested under
paragraph (1) shall be measures representing process,
structure, patient outcomes, or patient and family
experience--
(A) that are evidence-based;
(B) that are feasible to collect and report;
(C) that include a mechanism for risk adjustment when
necessary; and
(D) for which there is a consensus within the pediatric
hospital community or a consensus determined by a voluntary
consensus standards setting organization involved in the
advancement of evidence-based measures of health care.
(3) Consultation.--In determining the existing measures
suggested under paragraph (1), the Comptroller General shall
consult with representatives of the following:
(A) National associations of pediatric hospitals and
pediatric health professionals.
(B) Experts in pediatric quality and performance
measurement.
(C) Voluntary consensus standards setting organizations and
other organizations involved in the advancement of consensus
on evidence-based measures.
(D) The Department of Health and Human Services, States,
and other purchasers of health care items and services.
SEC. 505. MEDICAL HOME DEMONSTRATION PROJECT.
(a) Establishment.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
establish a medical home demonstration project (in this
section referred to as the ``project'') under titles XIX and
XXI of the Social Security Act (42 U.S.C. 1396 et seq.;
1397aa et seq.) to redesign the health care delivery system
by providing targeted, accessible, continuous, coordinated,
and family-centered care to eligible individuals.
(2) Eligible individuals defined.--In this section, the
term ``eligible individual'' means an individual who--
(A) is receiving child health assistance under a State
child health plan implemented under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.), title XIX of such
Act (42 U.S.C. 1396 et seq.), or both such titles; and
(B) is a member of a high need population (as determined by
the Secretary).
(3) Project goals.--The project shall be designed in order
to determine whether, and if so, the extent to which, medical
homes accomplish the following:
(A) Increase--
(i) cost efficiencies of health care delivery;
(ii) access to appropriate health care services;
(iii) patient satisfaction;
(iv) school attendance; and
[[Page S5947]]
(v) the quality of health care services provided, as
determined based on measures of quality the Secretary
determines are broadly accepted in the health care community.
(B) Decrease--
(i) inappropriate emergency room utilization; and
(ii) duplication of health care services provided.
(C) Provide appropriate--
(i) preventive care; and
(ii) referrals to multidisciplinary services.
(b) Project Design.--
(1) Duration.--The project shall be conducted for a 5 year
period.
(2) Sites.--
(A) In general.--The project shall be conducted in 8 States
on a State-wide basis.
(B) Application.--A State seeking to participate in the
project shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may require.
(3) Conduct of project.--
(A) Agreements with academic institutions.--A participating
State may enter into an agreement with an academic
institution in order to have the institution conduct the
project, provide technical assistance and monitoring, and to
participate in the evaluation of the project under subsection
(e)(1).
(B) Choice of participating physician practices.--
(i) In general.--A participating State shall establish
procedures for physician practices to participate in the
project by providing coordinated care to eligible
individuals. Such participation shall be on a voluntary
basis.
(ii) Standards for participating physician practices.--The
procedures established under clause (i) shall encourage
physician practices participating in the project to
demonstrate that they have--
(I) identified care coordinators, family resource guides,
family advisors, and a family advisory committee;
(II) developed care plans for eligible individuals; and
(III) taken such other actions as the State determines
appropriate in order to provide coordinated care to eligible
individuals.
(c) Project Requirements.--Each participating State shall
establish procedures in order to ensure that the following
requirements are met:
(1) Each eligible individual in the State who is enrolled
in the project is provided a medical home with access to
appropriate medical care.
(2) Each medical home in the State that is participating in
the project--
(A) provides for physician-directed care coordination;
(B) uses health information technology (including patient
registry systems, clinical decision support tools, remote
monitoring, and electronic medical record systems);
(C) communicates with physician practices participating in
the project, eligible individuals receiving health care
through the medical home, and other health care providers (as
appropriate) with respect to health matters, including
through electronic mail and telephone consultations;
(D) makes arrangements with teams of other health
professionals, including care coordinators, and facilitates
linkages to community resources to extend access to the full
spectrum of health care services that eligible individuals
require;
(E) establishes networks with community practices,
hospitals, and community health care providers to facilitate
the exchange of ideas and resources in order to improve
project outcomes; and
(F) acts as a facilitator in order to ensure that eligible
individuals enrolled in the medical home under the project
receive high-quality care at the appropriate time and place
in a cost-effective manner.
(3) The State provides payment (in accordance with
subsection (d)) and appropriate support for physician-
directed care coordination services provided to eligible
individuals under the project.
(d) Payment.--
(1) In general.--The Secretary shall establish a structure
for payments to participating States for the cost of services
provided under the project. Such structure shall provide
payments based on the performance of medical homes located in
the State in achieving quality and efficiency goals (as
defined by the Secretary).
(2) Payments for health information technology.--
(A) In general.--The Secretary shall establish a
prospective, bundled, and risk adjusted structural practice
payment to cover health information technology expenses
incurred by medical homes under the project.
(B) In general.--Such payments shall take into account any
expenses the medical home incurs in order to acquire and
utilize health information technology, such as clinical
decision support tools, patient registries, and electronic
medical records.
(3) Payments for physician work outside of office visits.--
The Secretary shall establish a prospective, bundled, and
risk adjusted structural care coordination payment that
represents the value of physician work provided to eligible
individuals under the project that is done outside of any
office visits.
(e) Evaluation and Report.--
(1) Evaluation.--The Secretary, in consultation with
appropriate pediatric medical associations, shall evaluate
the project in order to determine the effectiveness of
medical homes in terms of quality improvement, patient and
provider satisfaction, and the improvement of health
outcomes.
(2) Report.--Not later than 12 months after completion of
the project, the Secretary shall submit to Congress a report
on the project containing the results of the evaluation
conducted under paragraph (1), together with recommendations
for such legislation and administrative action as the
Secretary determines to be appropriate.
(f) Funding.--
(1) In general.--There are authorized to be appropriated,
such sums as may be necessary to carry out this section.
(2) Prohibition.--Amounts paid to a State under the project
shall not be used for purposes of claiming a Federal matching
payment under section 1903(a) or 2105(a) of the Social
Security Act (42 U.S.C. 1396b(a); 1397ee(a)).
(g) Waiver.--The Secretary shall waive compliance with such
requirements of titles XIX and XXI of the Social Security Act
(42 U.S.C. 1396 et seq.; 1397aa et seq.) to the extent and
for the period the Secretary finds necessary to conduct the
project.
SEC. 506. DISEASE PREVENTION AND TREATMENT DEMONSTRATION
PROJECTS FOR ETHNIC AND RACIAL MINORITY
CHILDREN.
(a) Definitions.--In this section:
(1) Child.--The term ``child'' has the meaning given such
term in section 2110(c)(1) of the Social Security Act (42
U.S.C. 1397jj(c)(1)).
(2) Medicaid.--The term ``Medicaid'' means the program
established under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(3) Projects.--The term ``projects'' means the
demonstration projects established under subsection (b)(1).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(5) SCHIP.--The term ``SCHIP'' means the State Children's
Health Insurance Program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(6) Target individual.--
(A) In general.--The term ``target individual'' means a
child--
(i) who is a member of a racial and ethnic minority group;
and
(ii) who is enrolled in a State Medicaid program or a State
child health plan under SCHIP.
(B) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given such term
in section 1707(g)(1) of the Public Health Service Act (42
U.S.C. 300u-6(1)).
(b) Demonstration Projects.--
(1) Establishment.--The Secretary shall establish
demonstration projects for the purpose of developing models
and evaluating methods that--
(A) improve the quality of medical assistance and child
health assistance provided to target individuals under
Medicaid and SCHIP in order to reduce disparities in the
provision of health care services;
(B) improve clinical outcomes, satisfaction, quality of
life, and the appropriate use of services covered and
referral patterns under Medicaid and SCHIP among target
individuals;
(C) eliminate disparities in the rate of preventive
measures, such as well child visits and immunizations, among
target individuals; and
(D) promote collaboration with community-based
organizations to ensure cultural competency of health care
professionals and linguistic access for persons with limited
English proficiency.
(2) Design.--
(A) Initial design.--Not later than 1 year after the date
of enactment of this Act, the Secretary shall--
(i) evaluate best practices in the private sector,
community programs, and academic research with respect to
methods for reducing health care disparities among target
individuals; and
(ii) design the projects based on such evaluation.
(B) Number and project areas.--
(i) In general.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall implement not less
than 9 projects, including the following:
(I) Two projects for each of the 4 following racial and
ethnic minority groups:
(aa) American Indians, including Alaskan Natives, Eskimos,
and Aleuts.
(bb) Asian Americans and Pacific Islanders.
(cc) Blacks.
(dd) Hispanics (as defined in section 1707(g)(2) of the
Public Health Service Act (42 U.S.C. 300u-6(g)(2)).
(II) One project within Puerto Rico.
(ii) Subpopulations.--The 2 projects implemented for the
groups described in clause (i)(I) shall each target different
ethnic subpopulations within such groups.
(iii) Rural and inner-city areas.--Not less than 1 of the
projects implemented under clause (i)(I) shall be conducted
in a rural area and not less than 1 of such projects shall be
conducted in an inner-city area.
(c) Reports to Congress.--
(1) In general.--Not later than 2 years after the date on
which the Secretary initially implements the projects, and
biannually thereafter for the duration of the projects, the
Secretary shall submit to Congress a report on the projects.
(2) Contents of report.--Each report submitted under
paragraph (1) shall include the following:
[[Page S5948]]
(A) A description of the projects.
(B) An evaluation of--
(i) the cost and benefits of the projects, including
whether the projects have reduced expenditures under Medicaid
and SCHIP;
(ii) the quality of the health care services provided to
target individuals under the projects, including whether the
projects have reduced racial and ethnic health disparities in
the quality of health care services provided to such
individuals;
(iii) beneficiary and health care provider satisfaction
under the projects; and
(iv) whether, based on the factors evaluated under clauses
(i) through (iii), the projects should be continued or
conducted on an expanded basis.
(C) Any other information with respect to the projects the
Secretary determines appropriate.
(3) Expansion of projects; implementation of results.--If
the initial report submitted under paragraph (1) includes an
evaluation under paragraph (2)(B)(iv) that the projects
initially established under subsection (b)(1) should be
continued or conducted on an expanded basis, the Secretary--
(A) shall continue to conduct such projects; and
(B) may conduct such additional projects as the Secretary
determines appropriate.
(d) Funding for Projects.--
(1) In general.--There are authorized to be appropriated,
such sums as may be necessary to carry out projects under
this section.
(2) Prohibition.--Amounts paid to a State or territory
under the projects shall not be used for purposes of claiming
a Federal matching payment under section 1903(a) or 2105(a)
of the Social Security Act (42 U.S.C. 1396b(a); 1397ee(a)).
(e) Waiver.--The Secretary shall waive compliance with such
requirements of titles XIX and XXI of the Social Security Act
(42 U.S.C. 1396 et seq.; 1397aa et seq.) to the extent and
for the period the Secretary finds necessary to conduct the
projects.
TITLE VI--COMMISSION ON CHILDREN'S HEALTH COVERAGE
SEC. 601. COMMISSION ON CHILDREN'S HEALTH COVERAGE.
(a) Establishment of Commission.--
(1) Establishment.--There is established a commission to be
known as the ``Commission on Children's Health Coverage''
(referred to in this section as the ``Commission'').
(2) Membership.--
(A) In general.--The Committee shall be composed of 10
members with academic training and practical experience in--
(i) the areas of--
(I) child health and development;
(II) maternal health and development;
(III) pediatric care;
(IV) health care financing;
(V) community-based participatory research;
(VI) public health;
(VII) data collection, analysis, and reporting; and
(VIII) health and health care disparities; and
(ii) such other areas as the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
determines appropriate.
(B) Selection.--The Secretary shall appoint members of the
Committee. No candidate for appointment on the Committee
shall be asked to provide non-relevant information, such as
voting record, political party affiliation, or position on
particular policies.
(3) Term; vacancies.--
(A) Term.--A member shall be appointed for the life of the
Commission.
(B) Vacancies.--A vacancy on the Commission--
(i) shall not affect the powers of the Commission; and
(ii) shall be filled in the same manner as the original
appointment was made.
(4) Meetings.--The Commission shall meet at the call of the
Chairperson.
(5) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(6) Chairperson and vice chairperson.--The Commission shall
select a Chairperson from among the members of the
Commission.
(b) Duties.--
(1) Study.--The Commission shall conduct a study of all
matters relating to children's health coverage.
(2) Recommendations.--The Commission shall develop
recommendations on policy improvements at the State and
national levels, and in the private sector, with respect to
children's health coverage.
(3) Report.--
(A) Annual reports.--During the 2 year period beginning on
the date of enactment of this Act, the Commission shall
submit to the President and Congress annual reports
evaluating the status of children's health coverage, together
with recommendations for such legislation and administrative
administrative actions as the Commission determines would
result in improvements in such health coverage at the State
and national levels, and in the private sector.
(B) Final report.--Not later than 3 years after such date
of enactment, the Commission shall submit to the President
and Congress a report that contains the recommendations of
the Commission for such legislation and administrative
actions as the Commission determines would result in
comprehensive health coverage of all children in the United
States.
(c) Powers.--.
(1) Hearings.--The Commission may hold such hearings, meet
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable
to carry out this Act.
(2) Information from federal agencies.--
(A) In general.--The Commission may secure directly from a
Federal agency such information as the Commission considers
necessary to carry out this Act.
(B) Provision of information.--On request of the
Chairperson of the Commission, the head of the agency shall
provide the information to the Commission.
(3) Postal services.--The Commission may use the United
States mails in the same manner and under the same conditions
as other agencies of the Federal Government.
(4) Gifts.--The Commission may accept, use, and dispose of
gifts or donations of services or property.
(d) Commission Personnel Matters.--
(1) Compensation of members.--
(A) Non-federal employees.--A member of the Commission who
is not an officer or employee of the Federal Government shall
be compensated at a rate equal to the daily equivalent of the
annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during
which the member is engaged in the performance of the duties
of the Commission.
(B) Federal employees.--A member of the Commission who is
an officer or employee of the Federal Government shall serve
without compensation in addition to the compensation received
for the services of the member as an officer or employee of
the Federal Government.
(2) Travel expenses.--A member of the Commission shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for an employee of an agency
under subchapter I of chapter 57 of title 5, United States
Code, while away from the home or regular place of business
of the member in the performance of the duties of the
Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission may,
without regard to the civil service laws (including
regulations), appoint and terminate an executive director and
such other additional personnel as are necessary to enable
the Commission to perform the duties of the Commission.
(B) Confirmation of executive director.--The employment of
an executive director shall be subject to confirmation by the
Commission.
(C) Compensation.--
(i) In general.--Except as provided in subparagraph (B),
the Chairperson of the Commission may fix the compensation of
the executive director and other personnel without regard to
the provisions of chapter 51 and subchapter III of chapter 53
of title 5, United States Code, relating to classification of
positions and General Schedule pay rates.
(ii) Maximum rate of pay.--The rate of pay for the
executive director and other personnel shall not exceed the
rate payable for level V of the Executive Schedule under
section 5316 of title 5, United States Code.
(4) Detail of federal government employees.--
(A) In general.--An employee of the Federal Government may
be detailed to the Commission without reimbursement.
(B) Civil service status.--The detail of the employee shall
be without interruption or loss of civil service status or
privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and
intermittent services in accordance with section 3109(b) of
title 5, United States Code, at rates for individuals that do
not exceed the daily equivalent of the annual rate of basic
pay prescribed for level V of the Executive Schedule under
section 5316 of that title.
(e) Authorization of Appropriations.--There are authorized
to be appropriated such sums as are necessary to carry out
this section.
(f) Termination of Commission.--The Commission shall
terminate 90 days after the date on which the Commission
submits the final report of the Commission under subsection
(b)(3)(B).
______
By Mr. HARKIN:
S. 1367. A bill to amend the Public Health Services Act to provide
methamphetamine prevention and treatment services; to the Committee on
Health, Education, Labor, and Pensions.
Mr. HARKIN. Mr. President, I am honored today to introduce the
Methamphetamine Abuse Treatment and Prevention Act. Meth is one of the
most deadly, addictive, rapidly spreading drugs in history. It is
ravaging rural and urban communities alike. And it is leaving a path of
destruction, human, financial, and environmental, that is staggering.
We've seen violent crime increase significantly for the first time in
more than a decade. This increase was most evident in the meth-plagued
Midwest. We must realize meth abuse is not only a State problem, but a
national problem that is threatening communities across the country.
[[Page S5949]]
Law enforcement efforts to curb the distribution of dangerous meth
making chemicals and locking up fertilizers have been successful. In
Iowa, we've reduced the number of meth labs by nearly 80 percent. But
our effort to fight meth is not over. Unfortunately, many States have
seen dramatic increases in the amount of crystal meth or ``ice''
smuggled into the State. Ice is a much purer and more dangerous form of
the illegal stimulant. Addicts who no longer have access to meth
manufactured through home labs are using this more dangerous form. This
drug puts a heavy toll on our communities, our justice and health care
system, and tears apart families.
We need to remember that the meth epidemic is a double scourge. It is
a public safety crisis. And it is also a public health crisis. Even if
we shut down every home-based lab, we would still have a meth problem
in this country. It will not go away until we do a better job of
preventing people from using meth in the first place and giving addicts
the treatment they need to kick the habit for good.
Bear in mind that meth is more addictive than crack cocaine or
heroin. More than 50 percent of meth users started when they were under
age 18. Law enforcement officers across Iowa tell me that prevention
and treatment are the keys to stopping this epidemic.
Yet this is exactly where we are falling short. There are 22 million
Americans in need of treatment for substance addiction. Less than 3
million are able to get help. The bill I am introducing today would
aggressively step up efforts to prevent meth addiction and provide more
treatment options.
Given the highly addictive nature of methamphetamine, prevention is
crucial. Over 50 percent of meth users started when they were under age
18. We must target our efforts to ensure that people do not ever start
using meth. My bill provides grants to schools and communities for meth
prevention programs. It creates a telephone helpline and an online
parent resource center. When parents or family members want information
on keeping their children safe from drugs, or they fear a young person
is experimenting or in trouble with drugs, this telephone helpline and
Internet resource will give live, real-time support and information, as
well as referrals to community resources.
At the same time, the bill takes a comprehensive approach to
treatment. We know that with proper treatment, meth addicts can recover
and live productive lives. Every dollar spent on treatment saves
taxpayers seven dollars, largely by reducing crime, incarceration, and
health care costs. The bill that I am introducing today is designed to
realize these savings by promoting a comprehensive approach to meth
treatment.
This legislation promotes range of treatment options. First, it
includes family-based treatment. Parental substance use is the culprit
in at least 70 percent of all child welfare spending, yet only 10
percent of child welfare agencies are able to successfully find
substance abuse programs for mothers and children. Comprehensive
treatment specifically for parents can assist them in recovering and
providing safe and nurturing environments for their children. This
legislation provides critical resources for adolescent and family-based
treatment services to ensure that young people and parents are able to
access the treatment they need.
Second, this legislation includes grants to offer treatment services
for nonviolent adults and juveniles as an alternative to jail and
detention. Nearly 80 percent of those in jail have been identified as
having a substance abuse problem and one-third of inmates reported
being under the influence at the time of their offense. We must provide
treatment in order to prevent recidivism and cycling through the
justice system.
My bill also improves services to help recovering addicts make the
transition from treatment to the community, including housing
assistance and help finding work, education, and mental health
services. These things are critical to long-term abstinence and
recovery.
I ask for your help now in joining me to fighting the meth epidemic
that is plaguing our country. This drug tears apart families and is a
heavy burden on our communities, our justice and health care system. We
must dedicate the time and resources to getting this problem under
control and we must do it now.
____________________