[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.
____________________