[Congressional Record Volume 153, Number 144 (Wednesday, September 26, 2007)]
[House]
[Pages H10932-H10935]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    TMA, ABSTINENCE EDUCATION, AND QI PROGRAMS EXTENSION ACT OF 2007

  Mr. GENE GREEN of Texas. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 3668) to provide for the extension of transitional 
medical assistance (TMA), the abstinence education program, and the 
qualifying individuals (QI) program, and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3668

       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 ``TMA, Abstinence Education, 
     and QI Programs Extension Act of 2007''.

     SEC. 2. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA) 
                   AND ABSTINENCE EDUCATION PROGRAM THROUGH 
                   DECEMBER 31, 2007.

       Section 401 of division B of the Tax Relief and Health Care 
     Act of 2006 (Public Law 109-432), as amended by section 1 of 
     Public Law 110-48, is amended--
       (1) by striking ``September 30'' and inserting ``December 
     31'';
       (2) by striking ``for fiscal year 2006'' and inserting 
     ``for fiscal year 2007'';
       (3) by striking ``the fourth quarter of fiscal year 2007'' 
     and inserting ``the first quarter of fiscal year 2008''; and
       (4) by striking ``the fourth quarter of fiscal year 2006'' 
     and inserting ``the first quarter of fiscal year 2007''.

     SEC. 3. EXTENSION OF QUALIFYING INDIVIDUAL (QI) PROGRAM 
                   THROUGH DECEMBER 2007.

       (a) Through December 2007.--Section 1902(a)(10)(E)(iv) of 
     the Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is 
     amended by striking ``September 2007'' and inserting 
     ``December 2007''.
       (b) Extending Total Amount Available for Allocation.--
     Section 1933(g) of such Act (42 U.S.C. 1396u-3(g)) is 
     amended--
       (1) in paragraph (2)--
       (A) by striking ``and'' at the end of subparagraph (F);
       (B) by striking the period at the end of subparagraph (G) 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(H) for the period that begins on October 1, 2007, and 
     ends on December 31, 2007, the total allocation amount is 
     $100,000,000.''; and
       (2) in paragraph (3), in the matter preceding subparagraph 
     (A), by striking ``or (F)'' and inserting ``(F), or (H)''.
       (c) Effective Date.--The amendments made by this section 
     shall be effective as of September 30, 2007.

     SEC. 4. EXTENSION OF SSI WEB-BASED ASSET DEMONSTRATION 
                   PROJECT TO THE MEDICAID PROGRAM.

       (a) In General.--Beginning on October 1, 2007, and ending 
     on September 30, 2012, the Secretary of Health and Human 
     Services shall provide for the application to asset 
     eligibility determinations under the Medicaid program under 
     title XIX of the Social Security Act of the automated, 
     secure, web-based asset verification request and response 
     process being applied for determining eligibility

[[Page H10933]]

     for benefits under the Supplemental Security Income (SSI) 
     program under title XVI of such Act under a demonstration 
     project conducted under the authority of section 
     1631(e)(1)(B)(ii) of such Act (42 U.S.C. 1383(e)(1)(B)(ii)).
       (b) Limitation.--Such application shall only extend to 
     those States in which such demonstration project is operating 
     and only for the period in which such project is otherwise 
     provided.
       (c) Rules of Application.--For purposes of carrying out 
     subsection (a), notwithstanding any other provision of law, 
     information obtained from a financial institution that is 
     used for purposes of eligibility determinations under such 
     demonstration project with respect to the Secretary of Health 
     and Human Services under the SSI program may also be shared 
     and used by States for purposes of eligibility determinations 
     under the Medicaid program. In applying section 
     1631(e)(1)(B)(ii) of the Social Security Act under this 
     subsection, references to the Commissioner of Social Security 
     and benefits under title XVI of such Act shall be treated as 
     including a reference to a State described in subsection (b) 
     and medical assistance under title XIX of such Act provided 
     by such a State.

     SEC. 5. 6-MONTH DELAY IN REQUIREMENT TO USE TAMPER-RESISTANT 
                   PRESCRIPTION PADS UNDER MEDICAID.

       Effective as if included in the enactment of section 
     7002(b) of the U.S. Troop Readiness, Veterans' Care, Katrina 
     Recovery, and Iraq Accountability Appropriations Act, 2007 
     (Public Law 110-28, 121 Sta. 187), paragraph (2) of such 
     section is amended by striking ``September 30, 2007'' and 
     inserting ``March 31, 2008''.

     SEC. 6. ADDITIONAL FUNDING FOR THE MEDICARE PHYSICIAN 
                   ASSISTANCE AND QUALITY INITIATIVE FUND.

       Section 1848(l)(2) of the Social Security Act (42 U.S.C. 
     1395w-4(l)(2)) is amended--
       (1) in subparagraph (A), by adding at the end the 
     following: ``In addition, there shall be available to the 
     Fund for expenditures during 2009 an amount equal to 
     $325,000,000 and for expenditures during or after 2013 an 
     amount equal to $60,000,000.''; and
       (2) in subparagraph (B)--
       (A) in the heading, by striking ``furnished during 2008'';
       (B) by striking ``specified in subparagraph (A)'' and 
     inserting ``specified in the first sentence of subparagraph 
     (A)''; and
       (C) by inserting after ``furnished during 2008'' the 
     following: ``and for the obligation of the entire first 
     amount specified in the second sentence of such subparagraph 
     for payment with respect to physicians' services furnished 
     during 2009 and of the entire second amount so specified for 
     payment with respect to physicians' services furnished on or 
     after January 1, 2013''.

     SEC. 7. LIMITATION ON IMPLEMENTATION FOR FISCAL YEARS 2008 
                   AND 2009 OF A PROSPECTIVE DOCUMENTATION AND 
                   CODING ADJUSTMENT IN RESPONSE TO THE 
                   IMPLEMENTATION OF THE MEDICARE SEVERITY 
                   DIAGNOSIS RELATED GROUP (MS-DRG) SYSTEM UNDER 
                   THE MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR 
                   INPATIENT HOSPITAL SERVICES.

       (a) In General.--In implementing the final rule published 
     on August 22, 2007, on pages 47130 through 48175 of volume 72 
     of the Federal Register, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     shall apply prospective documentation and coding adjustments 
     (made in response to the implementation of a Medicare 
     Severity Diagnosis Related Group (MS-DRG) system under the 
     hospital inpatient prospective payment system under section 
     1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) of--
       (1) for discharges occurring during fiscal year 2008, 0.6 
     percent rather than the 1.2 percent specified in such final 
     rule; and
       (2) for discharges occurring during fiscal year 2009, 0.9 
     percent rather than the 1.8 percent specified in such final 
     rule.
       (b) Subsequent Adjustments.--
       (1) In general.--Notwithstanding any other provision of 
     law, if the Secretary determines that implementation of such 
     Medicare Severity Diagnosis Related Group (MS-DRG) system 
     resulted in changes in coding and classification that did not 
     reflect real changes in case mix under section 1886(d) of the 
     Social Security Act (42 U.S.C. 1395ww(d)) for discharges 
     occurring during fiscal year 2008 or 2009 that are different 
     than the prospective documentation and coding adjustments 
     applied under subsection (a), the Secretary shall--
       (A) make an appropriate adjustment under paragraph 
     (3)(A)(vi) of such section 1886(d); and
       (B) make an additional adjustment to the standardized 
     amounts under such section 1886(d) for discharges occurring 
     only during fiscal years 2010, 2011, and 2012 to offset the 
     estimated amount of the increase or decrease in aggregate 
     payments (including interest as determined by the Secretary) 
     determined, based upon a retrospective evaluation of claims 
     data submitted under such Medicare Severity Diagnosis Related 
     Group (MS-DRG) system, by the Secretary with respect to 
     discharges occurring during fiscal years 2008 and 2009.
       (2) Requirement.--Any adjustment under paragraph (1)(B) 
     shall reflect the difference between the amount the Secretary 
     estimates that implementation of such Medicare Severity 
     Diagnosis Related Group (MS-DRG) system resulted in changes 
     in coding and classification that did not reflect real 
     changes in case mix and the prospective documentation and 
     coding adjustments applied under subsection (a). An 
     adjustment made under paragraph (1)(B) for discharges 
     occurring in a year shall not be included in the 
     determination of standardized amounts for discharges 
     occurring in a subsequent year.
       (3) Rule of construction.--Nothing in this section shall be 
     construed as--
       (A) requiring the Secretary to adjust the average 
     standardized amounts under paragraph (3)(A)(vi) of such 
     section 1886(d) other than as provided under this section; or
       (B) providing authority to apply the adjustment under 
     paragraph (1)(B) other than for discharges occurring during 
     fiscal years 2010, 2011, and 2012.
       (4) Judicial review.--There shall be no administrative or 
     judicial review under section 1878 of the Social Security Act 
     (42 U.S.C. 1395oo) or otherwise of any determination or 
     adjustments made under this subsection.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Gene Green) and the gentleman from Georgia (Mr. Deal) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Texas.


                             General Leave

  Mr. GENE GREEN of Texas. Mr. Speaker, I ask unanimous consent that 
all Members have 5 legislative days to revise and extend their remarks 
and include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I am pleased to bring forward H.R. 3668, the TMA 
Abstinence, Education, and QI Programs Extension Act of 2007, a bill to 
protect the health of Americans, both young and old.
  The Transitional Medical Assistance program assists mothers who are 
transitioning off of welfare and into the workforce. Unfortunately, 
these working parents often find themselves in low-income jobs that do 
not offer health insurance. The TMA program extends Medicaid coverage 
to these vulnerable individuals for up to 1 year. The TMA expires on 
September 30, and this bill extends it for one additional quarter.
  Along with the TMA extension is a one-quarter extension of the 
Abstinence Education program. In addition, the bill provides a one-
quarter extension of the Qualifying Individual (QI) program. The QI 
program provides Medicare part B premium assistance to low-income 
seniors, helping ensure Medicare remains affordable for more than 
200,000 seniors.
  The legislation also includes provisions that will provide immediate 
relief to hospitals threatened by regulatory cuts, and a 6-month delay 
of the recently enacted requirement that all Medicaid prescriptions be 
written on tamper-resistant paper in order to be eligible for 
reimbursement. This latter provision postpones what would otherwise 
take effect on October 1, causing significant disruption in access to 
medicines. This will give pharmacies and physicians more time to 
prepare for the new requirement.
  Finally, the bill invests an additional $385 million into the 
Medicare Physician Assistance and Quality Initiative Fund. This funding 
is used to improve care for millions of seniors and people with 
disabilities in Medicare.
  These critical programs are fully funded under PAYGO by an item in 
the President's budget that extends the current Web-based SSI Asset 
Demonstration program to Medicaid in the two States in which it is 
currently operating. This demonstration program would be funded for 5 
years.
  Finally, this legislation extends and improves programs that are of 
critical importance to Americans young and old, and I ask my colleagues 
to join me in supporting this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I rise today in support of the bill 
before us which extends Transitional Medical Assistance and the Title V 
Abstinence Education programs, and the Qualified Individuals programs, 
more commonly referred to as QI-1 program. I am pleased that the 
Congress can work together toward extending the funding for these 
particular programs.
  I support the reauthorization of Title V Abstinence Education 
program, a program that provides resources to

[[Page H10934]]

educate our Nation's youth about the benefits of an abstinent 
lifestyle. I'm sure many of my colleagues have heard, as I have, from 
the numerous programs within my State that rely on this Federal 
funding. They believe in the program, and they hope to continue 
providing abstinence educational opportunities to local teens.
  The QI-1 program provides money to States to pay the Medicare part B 
premiums of low-income beneficiaries ineligible for Medicaid. Without 
this relief, the low-income beneficiaries enrolled in this program 
would have to start paying for their part B premiums, which have risen 
over the past few years due to overspending in Medicare.
  I am supportive of extending this program in order that we may 
continue to provide assistance for our low-income seniors and 
beneficiaries as we've done in such a bipartisan manner each year for 
the past several years.
  This bill also corrects a provision that was included in a bill for 
money for our troops in Iraq passed earlier this year. There is a 
provision in that bill that denies payment for any Medicaid 
prescription that isn't written on a Secretary-approved, tamper-
resistant drug pad. Since then, we've heard from doctors, nurses, 
pharmacists and State health officials across the Nation that the 
October 1 implementation deadline required by that bill is much too 
soon. I am pleased we are affording our Nation's health care providers 
the flexibility needed to properly implement this new requirement so as 
not to jeopardize access to care for our Medicaid beneficiaries.
  In addition, this package includes $385 million in new funding for 
the Medicare Physician Assistance and Quality Initiative fund created 
by last year's tax relief bill. That fund provides bonus payments to 
physicians for reporting on quality measures this year, and includes 
over $1 billion set aside for bonus payments in 2008. I am pleased to 
see this fund extended into 2009 and beyond.
  It is a bipartisan recognition that incentivizing physicians to 
provide quality, efficient and effective health care holds the promise 
of a better Medicare physician reimbursement system, one that reflects 
accountability for the type and volume of Medicare services. The 
Physician Assistance and Quality Initiative fund that we put in place 
last year takes an important first step in that direction, and I'm 
happy to see that the House Democrats agree with that position.
  In closing, I would like to reiterate my support for the bill and 
encourage my colleagues to do the same.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield whatever time he may 
consume to our colleague from the Ways and Means Committee, Chairman 
Stark.
  (Mr. STARK asked and was given permission to revise and extend his 
remarks.)
  Mr. STARK. I thank the gentleman for yielding.
  The Ways and Means Committee has an interest in several of the issues 
in this bill, and we support the bill. The protection of low-income 
seniors in Medicare deals with people between $12,252 and $13,782 in 
income. And when their part B premium is $1,122, they need that 
protection, and extends that through December 31.
  The Abstinence Education program is one that is very important to the 
Democrats. We've extended it on the theory that if we really enforce 
this abstinence education, there will be fewer Republicans. So, we 
support that big time.
  The Hospital Perspective Payment System regulation is one of the most 
important to our hospital community, and we have changed the way we 
will collect the funds from the hospitals and not collect it all up 
front. We will collect part of it up front, and then wait until later 
in the 5-year cycle to see how they behave to collect the balance, 
which will create less of a financial burden on the hospitals across 
the country.
  I thank all the people who have worked to make this more acceptable 
for the hospitals.
  The 2008 final regulation that governs inpatient hospital payments 
under Medicare makes important, long-overdue refinements to the system 
by differentiating payments based on the severity of illness.
  In doing so, practice shows that hospital payments are likely to 
increase hospitals will get smarter about how the document and code 
their patient cases. There is nothing inappropriate about this 
behavior, but in order to remain budget neutral, the regulation 
includes a ``behavioral offset''. The offset was designed to 
counterbalance the increased spending expected from using the severity-
adjusted payments.
  I want to be clear that the Committee supports both efforts in the 
regulation--moving to severity-adjusted groupings and the so-called 
``behavioral offset.'' However, the regulation includes a prospective 
adjustment.
  Questions have been raised about the size of the adjustment and 
whether it should be prospective or retrospective. Those are fair 
questions, and it seems that a retrospective adjustment would make a 
lot of sense. However, we are advised it may take CMS up to two years 
to gather the necessary data.
  Given historical payment and coding patterns, we feel it is 
appropriate to have an interim policy--rather than simply voiding this 
part of the regulation. As such, this legislation requires a reduction 
of 0.6 percent in 2008 and 0.9 percent in 2009.
  Even with that ``down payment'' from the hospitals, we are concerned 
that the data in 2010 could indicate a need for a substantial reduction 
to fully recoup the extra spending that occurs in the next two years. I 
want to be clear that we have talked with hospitals about this 
possibility and raised with them the difficulty of addressing that when 
the time comes. This exercise may simply be forestalling the 
inevitable, not erasing an unwanted reduction.
  We are limiting the amount of the offset now, in order to spread out 
the payments over time. When that time comes, I do not want to hear 
complaints about the eventual amount of this adjustment when it comes 
on-line down the road.
  Mr. DEAL of Georgia. Mr. Speaker, I have no other requests for time. 
I reserve the balance of my time at this point.
  Mr. GENE GREEN of Texas. Mr. Speaker, I would like to yield to our 
colleague from Ohio, Charles Wilson, whatever time he may consume.
  Mr. WILSON of Ohio. Mr. Speaker, I rise in support of this bill. It 
contains language that I introduced to help us avoid a case of 
unintended consequences.
  This spring, a provision was slipped into the Iraq War Supplemental 
appropriation that requires Medicaid prescriptions to be written on 
tamper-resistant pads for Medicaid reimbursements starting October 1. 
The tamper-proof pad mandate was designed to fight fraud, and that's a 
good thing, but this October 1 deadline isn't enough time for States to 
inform providers and patients about the new requirements. This could 
mean patients are turned away from pharmacies as of this next week and 
their prescriptions not be filled. And that paper isn't widely 
available. Pharmacies that fill prescriptions not written on that 
special paper may be forced out of business if they're not getting 
reimbursed by Medicaid. All we need is a 6-month delay. The clock is 
ticking on this, and I'm asking for your help.

                              {time}  1500

  Mr. DEAL of Georgia. Mr. Speaker, I assume that the majority does not 
have any additional speakers. Therefore, I will close.
  I would simply urge my colleagues to support the bill before us. It 
does some short-term extensions of some very vital programs. I think 
that is appropriate.
  Mr. DINGELL. Mr. Speaker, I would like to speak briefly about the 
provision of this legislation which provides for a 3-month 
reauthorization of the Title V abstinence-only education block grant 
program.
  On August 1 of this year, the House of Representatives passed 
legislation which made significant and responsible changes to the 
abstinence-only education programs. The House-passed legislation would 
have provided states with the flexibility to offer programs best suited 
to the needs and desires of their citizens and it would have ensured 
that Federal funds were being spent on effective programs that provide 
medically accurate information.
  Sadly, those changes are not incorporated into the bill before us 
today because opponents of the House-passed abstinence language decided 
to hold hostage the important reauthorizations of TMA and Q1, in an 
effort to ensure that no improvements were made to the discredited 
abstinence-only programs.
  Because it is absolutely necessary that
we reauthorize TMA and Q1, the abstinence-
only education changes were sacrificed for now. Let me be clear: I am 
dismayed that the House-passed abstinence-only language was omitted 
from this legislation and I will continue

[[Page H10935]]

to fight for those important, responsible, and necessary changes in the 
coming months.
  Mr. WELLER of Illinois. Mr. Speaker, H.R. 3668 contains temporary 
extensions of several important programs that affect low-income 
families with children. I urge its passage.
  The subcommittee on which I am the ranking Republican, the Ways and 
Means Subcommittee on Income Security and Family Support, oversees the 
Nation's welfare, child care, and related programs designed to promote 
and support work by low-income families. It is important to extend the 
critical supports Congress enacted in recent years to advance those 
goals, such the Transitional Medical Assistance program continued under 
this bill. I am all for that. Every Member should support that.
  This legislation also extends the Abstinence Education program, which 
supports efforts to prevent teenage pregnancy and premarital sexual 
activity, with a goal of reducing the childbearing outside marriage. 
Childbearing outside marriage is directly associated with higher 
poverty rates and ultimately greater welfare receipt and dependence. 
All Members should support measures designed to reduce the chances 
children are raised in poverty.
  The legislation has other important features, like an extension of 
the Qualified Individuals program that provides Medicare premium 
assistance to certain low-income beneficiaries. However, I would like 
to draw the House's attention to one provision that, as currently 
drafted, may not achieve the intended effect and thus may not result in 
the savings suggested by the CBO scoring of this legislation.
  This provision appears in section 4 of the legislation, titled 
``Extension of SSI Web-Based Asset Demonstration Project to the 
Medicaid Program.'' The Social Security Administration, SSA, currently 
is operating a project testing ways to improve asset verification under 
the Supplemental Security Income, SSI, program. The current project 
seeks to make sure that SSI applicants are accurately reporting all the 
assets, like personal savings accounts, to which they can and should 
turn for support before expecting monthly SSI checks from taxpayers. 
Since SSI is a means-tested benefit program, it only makes sense to 
focus benefits on those who don't have a large amount of personal 
savings, for example, on which to depend.
  In recent years, the SSA project has tested comparing individuals' 
self-reports of their savings account assets with actual bank records. 
This effort has already produced significant savings in the few States 
where it has been applied, including uncovering some individuals with 
tens of thousands or even hundreds of thousands of dollars in 
undisclosed assets. So it makes sense to expand this effort to include 
other means-tested programs, as the legislation proposes, including the 
expensive Medicaid program.
  However, it is my understanding that the legislative language in H.R. 
3668 includes a number of drafting flaws that will effectively prevent 
the proposed expansion of this asset verification project from being 
achieved. Problems include a lack of reference in the legislative 
language to the need to obtain written consent from individuals for the 
purpose of obtaining information for the Medicaid program. This may 
prevent banks from sharing such information with Medicaid officials as 
would be required to actually expand the current project as proposed. 
Such ``consent'' language exists under the current SSI program as 
required by the Right to Financial Privacy Act, but not in H.R. 3668.
  Even if this provision were to work as intended, it is noteworthy 
that nowhere does this legislation provide for reimbursement of Social 
Security Administration administrative costs that would inevitably 
result. SSA is already seeking additional administrative funds to 
address growing disability claims backlogs as well as handle its 
current duties, which include serving millions of America's seniors, 
including the rising numbers applying for retirement and disability 
benefits as the Baby Boom generation heads into retirement in the 
coming years.
  It is my understanding that the authors of this legislation consulted 
with SSA on such technical issues during the drafting process, and 
opted against implementing any of the SSA suggestions.
  Because of that, while the current CBO score suggests this 
legislation is paid for, I am afraid that the real world experience of 
these provisions will not reflect that optimistic forecast. If that 
turns out to be correct, the legislation before the House today will 
not satisfy the pay-as-you-go requirements of this body, which require 
that increases in spending by fully paid for by such as by offsetting 
spending cuts. And some individuals will obtain Medicaid benefits for 
which they should not have qualified.
  While it may be too late to correct the drafting errors in this 
particular bill, I urge my colleagues especially on the House Energy 
and Commerce and the Senate Finance Committees, which have jurisdiction 
over Medicaid law, to revisit this legislative language and make the 
appropriate changes at the next available opportunity. I do not 
disagree with their intent, but suggest the legislative text reflected 
in this bill will not result in the outcome they intend. Related 
language appears in legislation preauthorizing the State Children's 
Health Insurance Program, which as it continues to be acted on in the 
coming days would serve as a worthy vehicle for making the appropriate 
changes to ensure the will of the House is carried out, and misspending 
under the Medicaid program is minimized as the House intends with this 
legislation.
  Mr. DEAL of Georgia. I yield back the balance of my time and urge the 
approval of the bill.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield back the balance of my 
time and encourage our fellow Members to pass H.R. 3668 and the 
extension.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Texas (Mr. Gene Green) that the House suspend the rules 
and pass the bill, H.R. 3668.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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