Congressional Record, Volume 153 Issue 195 (Wednesday, December 19, 2007)

[Congressional Record Volume 153, Number 195 (Wednesday, December 19, 2007)]
[House]
[Pages H16842-H16855]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

MEDICARE, MEDICAID, AND SCHIP EXTENSION ACT OF 2007

Mr. PALLONE. Madam Speaker, I move to suspend the rules and pass the
Senate bill (S. 2499) to amend titles XVIII, XIX, and XXI of the Social
Security Act to extend provisions under the Medicare, Medicaid, and
SCHIP programs, and for other purposes.
The Clerk read the title of the Senate bill.
The text of the Senate bill is as follows:

S. 2499

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) In General.--This Act may be cited as the ``Medicare,
Medicaid, and SCHIP Extension Act of 2007''.
(b) Table of Contents.--The table of contents of this Act
is as follows:

Sec. 1. Short title; table of contents.

TITLE I--MEDICARE

Sec. 101. Increase in physician payment update; extension of the
physician quality reporting system.
Sec. 102. Extension of Medicare incentive payment program for physician
scarcity areas.
Sec. 103. Extension of floor on work geographic adjustment under the
Medicare physician fee schedule.
Sec. 104. Extension of treatment of certain physician pathology
services under Medicare.
Sec. 105. Extension of exceptions process for Medicare therapy caps.
Sec. 106. Extension of payment rule for brachytherapy; extension to
therapeutic radiopharmaceuticals.
Sec. 107. Extension of Medicare reasonable costs payments for certain
clinical diagnostic laboratory tests furnished to
hospital patients in certain rural areas.
Sec. 108. Extension of authority of specialized Medicare Advantage
plans for special needs individuals to restrict
enrollment.
Sec. 109. Extension of deadline for application of limitation on
extension or renewal of Medicare reasonable cost contract
plans.
Sec. 110. Adjustment to the Medicare Advantage stabilization fund.
Sec. 111. Medicare secondary payor.
Sec. 112. Payment for part B drugs.
Sec. 113. Payment rate for certain diagnostic laboratory tests.
Sec. 114. Long-term care hospitals.
Sec. 115. Payment for inpatient rehabilitation facility (IRF) services.
Sec. 116. Extension of accommodation of physicians ordered to active
duty in the Armed Services.
Sec. 117. Treatment of certain hospitals.
Sec. 118. Additional Funding for State Health Insurance Assistance
Programs, Area Agencies on Aging, and Aging and
Disability Resource Centers.

TITLE II--MEDICAID AND SCHIP

Sec. 201. Extending SCHIP funding through March 31, 2009.
Sec. 202. Extension of transitional medical assistance (TMA) and
abstinence education program.
Sec. 203. Extension of qualifying individual (QI) program.
Sec. 204. Medicaid DSH extension.
Sec. 205. Improving data collection.
Sec. 206. Moratorium on certain payment restrictions.

TITLE III--MISCELLANEOUS

Sec. 301. Medicare Payment Advisory Commission status.
Sec. 302. Special Diabetes Programs for Type I Diabetes and Indians.

TITLE I--MEDICARE

SEC. 101. INCREASE IN PHYSICIAN PAYMENT UPDATE; EXTENSION OF
THE PHYSICIAN QUALITY REPORTING SYSTEM.

(a) Increase in Physician Payment Update.--
(1) In general.--Section 1848(d) of the Social Security Act
(42 U.S.C. 1395w-4(d)) is amended--
(A) in paragraph (4)(B), by striking ``and paragraphs (5)
and (6)'' and inserting ``and the succeeding paragraphs of
this subsection''; and
(B) by adding at the end the following new paragraph:
``(8) Update for a portion of 2008.--
``(A) In general.--Subject to paragraph (7)(B), in lieu of
the update to the single conversion factor established in
paragraph (1)(C) that would otherwise apply for 2008, for the
period beginning on January 1, 2008, and ending on June 30,
2008, the update to the single conversion factor shall be 0.5
percent.
``(B) No effect on computation of conversion factor for the
remaining portion of 2008 and 2009.--The conversion factor
under this subsection shall be computed under paragraph
(1)(A) for the period beginning on July 1, 2008, and ending
on December 31, 2008, and for 2009 and subsequent years as if
subparagraph (A) had never applied.''.
(2) Revision of the physician assistance and quality
initiative fund.--
(A) Revision.--Section 1848(l)(2) of the Social Security
Act (42 U.S.C. 1395w-4(l)(2)) is amended--
(i) by striking subparagraph (A) and inserting the
following:
``(A) Amount available.--
``(i) In general.--Subject to clause (ii), there shall be
available to the Fund the following amounts:

``(I) For expenditures during 2008, an amount equal to
$150,500,000.
``(II) For expenditures during 2009, an amount equal to
$24,500,000.
``(III) For expenditures during 2013, an amount equal to
$4,960,000,000.

``(ii) Limitations on expenditures.--

``(I) 2008.--The amount available for expenditures during
2008 shall be reduced as provided by subparagraph (A) of
section 225(c)(1) and section 524 of the Departments of
Labor, Health and Human Services, and Education, and Related
Agencies Appropriations Act, 2008 (division G of the
Consolidated Appropriations Act, 2008).
``(II) 2009.--The amount available for expenditures during
2009 shall be reduced as provided by subparagraph (B) of such
section 225(c)(1).
``(III) 2013.--The amount available for expenditures during
2013 shall only be available for an adjustment to the update
of the conversion factor under subsection (d) for that
year.''; and

(ii) in subparagraph (B), by striking ``entire amount
specified in the first sentence of subparagraph (A)'' and all
that follows and inserting the following: ``entire amount
available for expenditures, after application of subparagraph
(A)(ii), during--
``(i) 2008 for payment with respect to physicians' services
furnished during 2008;
``(ii) 2009 for payment with respect to physicians'
services furnished during 2009; and
``(iii) 2013 for payment with respect to physicians'
services furnished during 2013.''.
(B) Effective date.--
(i) In general.--Subject to clause (ii), the amendments
made by subparagraph (A) shall take effect on the date of the
enactment of this Act.
(ii) Special rule for coordination with consolidated
appropriations act, 2008.--If the date of the enactment of
the Consolidated Appropriations Act, 2008, occurs on or after
the date described in clause (i), the amendments made by
subparagraph (A) shall be deemed to be made on the day after
the effective date of sections 225(c)(1) and 524 of the
Departments of Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Act, 2008
(division G of the Consolidated Appropriations Act, 2008).
(C) Transfer of funds to part b trust fund.--Amounts that
would have been available to the Physician Assistance and
Quality Initiative Fund under section 1848(l)(2) of the
Social Security Act (42 U.S.C. 1395w-4(l)(2)) for payment
with respect to physicians' services furnished prior to
January 1, 2013, but for the amendments made by subparagraph
(A), shall be deposited into, and made available for
expenditures from, the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t).
(b) Extension of the Physician Quality Reporting System.--
(1) System.--Section 1848(k)(2)(B) of the Social Security
Act (42 U.S.C. 1395w-4(k)(2)(B)) is amended--
(A) in the heading, by inserting ``and 2009'' after
``2008'';
(B) in clause (i), by inserting ``and 2009'' after
``2008''; and
(C) in each of clauses (ii) and (iii)--
(i) by striking ``, 2007'' and inserting ``of each of 2007
and 2008''; and
(ii) by inserting ``or 2009, as applicable'' after
``2008''.

[[Page H16843]]

(2) Reporting.--Section 101(c) of division B of the Tax
Relief and Health Care Act of 2006 (42 U.S.C. 1395w-4 note)
is amended--
(A) in the heading, by inserting ``and 2008'' after
``2007'';
(B) in paragraph (5), by adding at the end the following:
``(F) Extension.--For 2008 and 2009, paragraph (3) shall
not apply, and the Secretary shall establish alternative
criteria for satisfactorily reporting under paragraph (2) and
alternative reporting periods under paragraph (6)(C) for
reporting groups of measures under paragraph (2)(B) of
section 1848(k) of the Social Security Act (42 U.S.C. 1395w-
4(k)) and for reporting using the method specified in
paragraph (4) of such section.''; and
(C) in paragraph (6), by striking subparagraph (C) and
inserting the following new subparagraph:
``(C) Reporting period.--The term `reporting period'
means--
``(i) for 2007, the period beginning on July 1, 2007, and
ending on December 31, 2007; and
``(ii) for 2008, all of 2008.''.
(c) Implementation.--For purposes of carrying out the
provisions of, and amendments made by subsections (a) and
(b), in addition to any amounts otherwise provided in this
title, there are appropriated to the Centers for Medicare &
Medicaid Services Program Management Account, out of any
money in the Treasury not otherwise appropriated, $25,000,000
for the period of fiscal years 2008 and 2009.

SEC. 102. EXTENSION OF MEDICARE INCENTIVE PAYMENT PROGRAM FOR
PHYSICIAN SCARCITY AREAS.

Section 1833(u) of the Social Security Act (42 U.S.C.
1395l(u)) is amended--
(1) in paragraph (1), by striking ``before January 1,
2008'' and inserting ``before July 1, 2008''; and
(2) in paragraph (4)--
(A) by redesignating subparagraph (D) as subparagraph (E);
and
(B) by inserting after subparagraph (C) the following new
subparagraph:
``(D) Special rule.--With respect to physicians' services
furnished on or after January 1, 2008, and before July 1,
2008, for purposes of this subsection, the Secretary shall
use the primary care scarcity counties and the specialty care
scarcity counties (as identified under the preceding
provisions of this paragraph) that the Secretary was using
under this subsection with respect to physicians' services
furnished on December 31, 2007.''.

SEC. 103. EXTENSION OF FLOOR ON WORK GEOGRAPHIC ADJUSTMENT
UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.

Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C.
1395w-4(e)(1)(E)), as amended by section 102 of division B of
the Tax Relief and Health Care Act of 2006, is amended by
striking ``before January 1, 2008'' and inserting ``before
July 1, 2008''.

SEC. 104. EXTENSION OF TREATMENT OF CERTAIN PHYSICIAN
PATHOLOGY SERVICES UNDER MEDICARE.

Section 542(c) of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000 (as enacted
into law by section 1(a)(6) of Public Law 106-554), as
amended by section 732 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w-4
note) and section 104 of division B of the Tax Relief and
Health Care Act of 2006 (42 U.S.C. 1395w-4 note), is amended
by striking ``and 2007'' and inserting ``2007, and the first
6 months of 2008''.

SEC. 105. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE
THERAPY CAPS.

Section 1833(g)(5) of the Social Security Act (42 U.S.C.
1395l(g)(5)) is amended by striking ``December 31, 2007'' and
inserting ``June 30, 2008''.

SEC. 106. EXTENSION OF PAYMENT RULE FOR BRACHYTHERAPY;
EXTENSION TO THERAPEUTIC RADIOPHARMACEUTICALS.

(a) Extension of Payment Rule for Brachytherapy.--Section
1833(t)(16)(C) of the Social Security Act (42 U.S.C.
1395l(t)(16)(C)), as amended by section 107(a) of division B
of the Tax Relief and Health Care Act of 2006, is amended by
striking ``January 1, 2008'' and inserting ``July 1, 2008''.
(b) Payment for Therapeutic Radiopharmaceuticals.--Section
1833(t)(16)(C) of the Social Security Act (42 U.S.C.
1395l(t)(16)(C)), as amended by subsection (a), is amended--
(1) in the heading, by inserting ``and therapeutic
radiopharmaceuticals'' before ``at charges'';
(2) in the first sentence--
(A) by inserting ``and for therapeutic radiopharmaceuticals
furnished on or after January 1, 2008, and before July 1,
2008,'' after ``July 1, 2008,'';
(B) by inserting ``or therapeutic radiopharmaceutical''
after ``the device''; and
(C) by inserting ``or therapeutic radiopharmaceutical''
after ``each device''; and
(3) in the second sentence, by inserting ``or therapeutic
radiopharmaceuticals'' after ``such devices''.

SEC. 107. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS FOR
CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS
FURNISHED TO HOSPITAL PATIENTS IN CERTAIN RURAL
AREAS.

Section 416(b) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (42 U.S.C. 1395l-
4), as amended by section 105 of division B of the Tax Relief
and Health Care Act of 2006 (42 U.S.C. 1395l note), is
amended by striking ``the 3-year period beginning on July 1,
2004'' and inserting ``the period beginning on July 1, 2004,
and ending on June 30, 2008''.

SEC. 108. EXTENSION OF AUTHORITY OF SPECIALIZED MEDICARE
ADVANTAGE PLANS FOR SPECIAL NEEDS INDIVIDUALS
TO RESTRICT ENROLLMENT.

(a) Extension of Authority To Restrict Enrollment.--Section
1859(f) of the Social Security Act (42 U.S.C. 1395w-28(f)) is
amended by striking ``2009'' and inserting ``2010''.
(b) Moratorium.--
(1) Authority to designate other plans as specialized ma
plans.--During the period beginning on January 1, 2008, and
ending on December 31, 2009, the Secretary of Health and
Human Services shall not exercise the authority provided
under section 231(d) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w-
21 note) to designate other plans as specialized MA plans for
special needs individuals under part C of title XVIII of the
Social Security Act. The preceding sentence shall not apply
to plans designated as specialized MA plans for special needs
individuals under such authority prior to January 1, 2008.
(2) Enrollment in new plans.--During the period beginning
on January 1, 2008, and ending on December 31, 2009, the
Secretary of Health and Human Services shall not permit
enrollment of any individual residing in an area in a
specialized Medicare Advantage plan for special needs
individuals under part C of title XVIII of the Social
Security Act to take effect unless that specialized Medicare
Advantage plan for special needs individuals was available
for enrollment for individuals residing in that area on
January 1, 2008.

SEC. 109. EXTENSION OF DEADLINE FOR APPLICATION OF LIMITATION
ON EXTENSION OR RENEWAL OF MEDICARE REASONABLE
COST CONTRACT PLANS.

Section 1876(h)(5)(C)(ii) of the Social Security Act (42
U.S.C. 1395mm(h)(5)(C)(ii)), in the matter preceding
subclause (I), is amended by striking ``January 1, 2008'' and
inserting ``January 1, 2009''.

SEC. 110. ADJUSTMENT TO THE MEDICARE ADVANTAGE STABILIZATION
FUND.

Section 1858(e)(2)(A)(i) of the Social Security Act (42
U.S.C. 1395w-27a(e)(2)(A)(i)), as amended by section 3 of
Public Law 110-48, is amended by striking ``the Fund'' and
all that follows and inserting ``the Fund during 2013,
$1,790,000,000.''

SEC. 111. MEDICARE SECONDARY PAYOR.

(a) In General.--Section 1862(b) of the Social Security Act
(42 U.S.C. 1395y(b)) is amended by adding at the end the
following new paragraphs:
``(7) Required submission of information by group health
plans.--
``(A) Requirement.--On and after the first day of the first
calendar quarter beginning after the date that is 1 year
after the date of the enactment of this paragraph, an entity
serving as an insurer or third party administrator for a
group health plan, as defined in paragraph (1)(A)(v), and, in
the case of a group health plan that is self-insured and
self-administered, a plan administrator or fiduciary, shall--
``(i) secure from the plan sponsor and plan participants
such information as the Secretary shall specify for the
purpose of identifying situations where the group health plan
is or has been a primary plan to the program under this
title; and
``(ii) submit such information to the Secretary in a form
and manner (including frequency) specified by the Secretary.
``(B) Enforcement.--
``(i) In general.--An entity, a plan administrator, or a
fiduciary described in subparagraph (A) that fails to comply
with the requirements under such subparagraph shall be
subject to a civil money penalty of $1,000 for each day of
noncompliance for each individual for which the information
under such subparagraph should have been submitted. The
provisions of subsections (e) and (k) of section 1128A shall
apply to a civil money penalty under the previous sentence in
the same manner as such provisions apply to a penalty or
proceeding under section 1128A(a). A civil money penalty
under this clause shall be in addition to any other penalties
prescribed by law and in addition to any Medicare secondary
payer claim under this title with respect to an individual.
``(ii) Deposit of amounts collected.--Any amounts collected
pursuant to clause (i) shall be deposited in the Federal
Hospital Insurance Trust Fund under section 1817.
``(C) Sharing of information.--Notwithstanding any other
provision of law, under terms and conditions established by
the Secretary, the Secretary--
``(i) shall share information on entitlement under Part A
and enrollment under Part B under this title with entities,
plan administrators, and fiduciaries described in
subparagraph (A);
``(ii) may share the entitlement and enrollment information
described in clause (i) with entities and persons not
described in such clause; and
``(iii) may share information collected under this
paragraph as necessary for purposes of the proper
coordination of benefits.
``(D) Implementation.--Notwithstanding any other provision
of law, the Secretary may implement this paragraph by program
instruction or otherwise.

[[Page H16844]]

``(8) Required submission of information by or on behalf of
liability insurance (including self-insurance), no fault
insurance, and workers' compensation laws and plans.--
``(A) Requirement.--On and after the first day of the first
calendar quarter beginning after the date that is 18 months
after the date of the enactment of this paragraph, an
applicable plan shall--
``(i) determine whether a claimant (including an individual
whose claim is unresolved) is entitled to benefits under the
program under this title on any basis; and
``(ii) if the claimant is determined to be so entitled,
submit the information described in subparagraph (B) with
respect to the claimant to the Secretary in a form and manner
(including frequency) specified by the Secretary.
``(B) Required information.--The information described in
this subparagraph is--
``(i) the identity of the claimant for which the
determination under subparagraph (A) was made; and
``(ii) such other information as the Secretary shall
specify in order to enable the Secretary to make an
appropriate determination concerning coordination of
benefits, including any applicable recovery claim.
``(C) Timing.--Information shall be submitted under
subparagraph (A)(ii) within a time specified by the Secretary
after the claim is resolved through a settlement, judgment,
award, or other payment (regardless of whether or not there
is a determination or admission of liability).
``(D) Claimant.--For purposes of subparagraph (A), the term
`claimant' includes--
``(i) an individual filing a claim directly against the
applicable plan; and
``(ii) an individual filing a claim against an individual
or entity insured or covered by the applicable plan.
``(E) Enforcement.--
``(i) In general.--An applicable plan that fails to comply
with the requirements under subparagraph (A) with respect to
any claimant shall be subject to a civil money penalty of
$1,000 for each day of noncompliance with respect to each
claimant. The provisions of subsections (e) and (k) of
section 1128A shall apply to a civil money penalty under the
previous sentence in the same manner as such provisions apply
to a penalty or proceeding under section 1128A(a). A civil
money penalty under this clause shall be in addition to any
other penalties prescribed by law and in addition to any
Medicare secondary payer claim under this title with respect
to an individual.
``(ii) Deposit of amounts collected.--Any amounts collected
pursuant to clause (i) shall be deposited in the Federal
Hospital Insurance Trust Fund.
``(F) Applicable plan.--In this paragraph, the term
`applicable plan' means the following laws, plans, or other
arrangements, including the fiduciary or administrator for
such law, plan, or arrangement:
``(i) Liability insurance (including self-insurance).
``(ii) No fault insurance.
``(iii) Workers' compensation laws or plans.
``(G) Sharing of information.--The Secretary may share
information collected under this paragraph as necessary for
purposes of the proper coordination of benefits.
``(H) Implementation.--Notwithstanding any other provision
of law, the Secretary may implement this paragraph by program
instruction or otherwise.''.
(b) Rule of Construction.--Nothing in the amendments made
by this section shall be construed to limit the authority of
the Secretary of Health and Human Services to collect
information to carry out Medicare secondary payer provisions
under title XVIII of the Social Security Act, including under
parts C and D of such title.
(c) Implementation.--For purposes of implementing
paragraphs (7) and (8) of section 1862(b) of the Social
Security Act, as added by subsection (a), to ensure
appropriate payments under title XVIII of such Act, the
Secretary of Health and Human Services shall provide for the
transfer, from the Federal Hospital Insurance Trust Fund
established under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical Insurance
Trust Fund established under section 1841 of such Act (42
U.S.C. 1395t), in such proportions as the Secretary
determines appropriate, of $35,000,000 to the Centers for
Medicare & Medicaid Services Program Management Account for
the period of fiscal years 2008, 2009, and 2010.

SEC. 112. PAYMENT FOR PART B DRUGS.

(a) Application of Alternative Volume Weighting in
Computation of ASP.--Section 1847A(b) of the Social Security
Act (42 U.S.C. 1395w-3a(b)) is amended--
(1) in paragraph (1)(A), by inserting ``for a multiple
source drug furnished before April 1, 2008, or 106 percent of
the amount determined under paragraph (6) for a multiple
source drug furnished on or after April 1, 2008'' after
``paragraph (3)'';
(2) in each of subparagraphs (A) and (B) of paragraph (4),
by inserting ``for single source drugs and biologicals
furnished before April 1, 2008, and using the methodology
applied under paragraph (6) for single source drugs and
biologicals furnished on or after April 1, 2008,'' after
``paragraph (3)''; and
(3) by adding at the end the following new paragraph:
``(6) Use of volume-weighted average sales prices in
calculation of average sales price.--
``(A) In general.--For all drug products included within
the same multiple source drug billing and payment code, the
amount specified in this paragraph is the volume-weighted
average of the average sales prices reported under section
1927(b)(3)(A)(iii) determined by--
``(i) computing the sum of the products (for each National
Drug Code assigned to such drug products) of--

``(I) the manufacturer's average sales price (as defined in
subsection (c)), determined by the Secretary without dividing
such price by the total number of billing units for the
National Drug Code for the billing and payment code; and
``(II) the total number of units specified under paragraph
(2) sold; and

``(ii) dividing the sum determined under clause (i) by the
sum of the products (for each National Drug Code assigned to
such drug products) of--

``(I) the total number of units specified under paragraph
(2) sold; and
``(II) the total number of billing units for the National
Drug Code for the billing and payment code.

``(B) Billing unit defined.--For purposes of this
subsection, the term `billing unit' means the identifiable
quantity associated with a billing and payment code, as
established by the Secretary.''.
(b) Treatment of Certain Drugs.--Section 1847A(b) of the
Social Security Act (42 U.S.C. 1395w-3a(b)), as amended by
subsection (a), is amended--
(1) in paragraph (1), by inserting ``paragraph (7) and''
after ``Subject to''; and
(2) by adding at the end the following new paragraph:
``(7) Special rule.--Beginning with April 1, 2008, the
payment amount for--
``(A) each single source drug or biological described in
section 1842(o)(1)(G) that is treated as a multiple source
drug because of the application of subsection (c)(6)(C)(ii)
is the lower of--
``(i) the payment amount that would be determined for such
drug or biological applying such subsection; or
``(ii) the payment amount that would have been determined
for such drug or biological if such subsection were not
applied; and
``(B) a multiple source drug described in section
1842(o)(1)(G) (excluding a drug or biological that is treated
as a multiple source drug because of the application of such
subsection) is the lower of--
``(i) the payment amount that would be determined for such
drug or biological taking into account the application of
such subsection; or
``(ii) the payment amount that would have been determined
for such drug or biological if such subsection were not
applied.''.

SEC. 113. PAYMENT RATE FOR CERTAIN DIAGNOSTIC LABORATORY
TESTS.

Section 1833(h) of the Social Security Act (42 U.S.C.
1395l(h)) is amended by adding at the end the following new
paragraph:
``(9) Notwithstanding any other provision in this part, in
the case of any diagnostic laboratory test for HbA1c that is
labeled by the Food and Drug Administration for home use and
is furnished on or after April 1, 2008, the payment rate for
such test shall be the payment rate established under this
part for a glycated hemoglobin test (identified as of October
1, 2007, by HCPCS code 83036 (and any succeeding codes)).''.

SEC. 114. LONG-TERM CARE HOSPITALS.

(a) Definition of Long-Term Care Hospital.--Section 1861 of
the Social Security Act (42 U.S.C. 1395x) is amended by
adding at the end the following new subsection:

``Long-Term Care Hospital

``(ccc) The term `long-term care hospital' means a hospital
which--
``(1) is primarily engaged in providing inpatient services,
by or under the supervision of a physician, to Medicare
beneficiaries whose medically complex conditions require a
long hospital stay and programs of care provided by a long-
term care hospital;
``(2) has an average inpatient length of stay (as
determined by the Secretary) of greater than 25 days, or
meets the requirements of clause (II) of section
1886(d)(1)(B)(iv);
``(3) satisfies the requirements of subsection (e); and
``(4) meets the following facility criteria:
``(A) the institution has a patient review process,
documented in the patient medical record, that screens
patients prior to admission for appropriateness of admission
to a long-term care hospital, validates within 48 hours of
admission that patients meet admission criteria for long-term
care hospitals, regularly evaluates patients throughout their
stay for continuation of care in a long-term care hospital,
and assesses the available discharge options when patients no
longer meet such continued stay criteria;
``(B) the institution has active physician involvement with
patients during their treatment through an organized medical
staff, physician-directed treatment with physician on-site
availability on a daily basis to review patient progress, and
consulting physicians on call and capable of being at the
patient's side within a moderate period of time, as
determined by the Secretary; and
``(C) the institution has interdisciplinary team treatment
for patients, requiring interdisciplinary teams of health
care professionals, including physicians, to prepare and
carry out an individualized treatment plan for each
patient.''.
(b) Study and Report on Long-Term Care Hospital Facility
and Patient Criteria.--

[[Page H16845]]

(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
conduct a study on the establishment of national long-term
care hospital facility and patient criteria for purposes of
determining medical necessity, appropriateness of admission,
and continued stay at, and discharge from, long-term care
hospitals.
(2) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report on the study conducted under paragraph (1), together
with recommendations for such legislation and administrative
actions, including timelines for implementation of patient
criteria or other actions, as the Secretary determines
appropriate.
(3) Considerations.--In conducting the study and preparing
the report under this subsection, the Secretary shall
consider--
(A) recommendations contained in a report to Congress by
the Medicare Payment Advisory Commission in June 2004 for
long-term care hospital-specific facility and patient
criteria to ensure that patients admitted to long-term care
hospitals are medically complex and appropriate to receive
long-term care hospital services; and
(B) ongoing work by the Secretary to evaluate and determine
the feasibility of such recommendations.
(c) Payment for Long-Term Care Hospital Services.--
(1) No application of 25 percent patient threshold payment
adjustment to freestanding and grandfathered ltchs.--The
Secretary shall not apply, for cost reporting periods
beginning on or after the date of the enactment of this Act
for a 3-year period--
(A) section 412.536 of title 42, Code of Federal
Regulations, or any similar provision, to freestanding long-
term care hospitals; and
(B) such section or section 412.534 of title 42, Code of
Federal Regulations, or any similar provisions, to a long-
term care hospital identified by the amendment made by
section 4417(a) of the Balanced Budget Act of 1997 (Public
Law 105-33).
(2) Payment for hospitals-within-hospitals.--
(A) In general.--Payment to an applicable long-term care
hospital or satellite facility which is located in a rural
area or which is co-located with an urban single or MSA
dominant hospital under paragraphs (d)(1), (e)(1), and (e)(4)
of section 412.534 of title 42, Code of Federal Regulations,
shall not be subject to any payment adjustment under such
section if no more than 75 percent of the hospital's Medicare
discharges (other than discharges described in paragraph
(d)(2) or (e)(3) of such section) are admitted from a co-
located hospital.
(B) Co-located long-term care hospitals and satellite
facilities.--
(i) In general.--Payment to an applicable long-term care
hospital or satellite facility which is co-located with
another hospital shall not be subject to any payment
adjustment under section 412.534 of title 42, Code of Federal
Regulations, if no more than 50 percent of the hospital's
Medicare discharges (other than discharges described in
paragraph (c)(3) of such section) are admitted from a co-
located hospital.
(ii) Applicable long-term care hospital or satellite
facility defined.--In this paragraph, the term ``applicable
long-term care hospital or satellite facility'' means a
hospital or satellite facility that is subject to the
transition rules under section 412.534(g) of title 42, Code
of Federal Regulations.
(C) Effective date.--Subparagraphs (A) and (B) shall apply
to cost reporting periods beginning on or after the date of
the enactment of this Act for a 3-year period.
(3) No application of very short-stay outlier policy.--The
Secretary shall not apply, for the 3-year period beginning on
the date of the enactment of this Act, the amendments
finalized on May 11, 2007 (72 Federal Register 26904, 26992)
made to the short-stay outlier payment provision for long-
term care hospitals contained in section 412.529(c)(3)(i) of
title 42, Code of Federal Regulations, or any similar
provision.
(4) No application of one-time adjustment to standard
amount.--The Secretary shall not, for the 3-year period
beginning on the date of the enactment of this Act, make the
one-time prospective adjustment to long-term care hospital
prospective payment rates provided for in section
412.523(d)(3) of title 42, Code of Federal Regulations, or
any similar provision.
(d) Moratorium on the Establishment of Long-Term Care
Hospitals, Long-Term Care Satellite Facilities and on the
Increase of Long-Term Care Hospital Beds in Existing Long-
Term Care Hospitals or Satellite Facilities.--
(1) In general.--During the 3-year period beginning on the
date of the enactment of this Act, the Secretary shall impose
a moratorium for purposes of the Medicare program under title
XVIII of the Social Security Act--
(A) subject to paragraph (2), on the establishment and
classification of a long-term care hospital or satellite
facility, other than an existing long-term care hospital or
facility; and
(B) subject to paragraph (3), on an increase of long-term
care hospital beds in existing long-term care hospitals or
satellite facilities.
(2) Exception for certain long-term care hospitals.--The
moratorium under paragraph (1)(A) shall not apply to a long-
term care hospital that as of the date of the enactment of
this Act--
(A) began its qualifying period for payment as a long-term
care hospital under section 412.23(e) of title 42, Code of
Federal Regulations, on or before the date of the enactment
of this Act;
(B) has a binding written agreement with an outside,
unrelated party for the actual construction, renovation,
lease, or demolition for a long-term care hospital, and has
expended, before the date of the enactment of this Act, at
least 10 percent of the estimated cost of the project (or, if
less, $2,500,000); or
(C) has obtained an approved certificate of need in a State
where one is required on or before the date of the enactment
of this Act.
(3) Exception for bed increases during moratorium.--
(A) In general.--Subject to subparagraph (B), the
moratorium under paragraph (1)(B) shall not apply to an
increase in beds in an existing hospital or satellite
facility if the hospital or facility--
(i) is located in a State where there is only one other
long-term care hospital; and
(ii) requests an increase in beds following the closure or
the decrease in the number of beds of another long-term care
hospital in the State.
(B) No effect on certain limitation.--The exception under
subparagraph (A) shall not effect the limitation on
increasing beds under sections 412.22(h)(3) and 412.22(f) of
title 42, Code of Federal Regulations.
(4) Existing hospital or satellite facility defined.--For
purposes of this subsection, the term ``existing'' means,
with respect to a hospital or satellite facility, a hospital
or satellite facility that received payment under the
provisions of subpart O of part 412 of title 42, Code of
Federal Regulations, as of the date of the enactment of this
Act.
(5) Judicial review.--There shall be no administrative or
judicial review under section 1869 of the Social Security Act
(42 U.S.C. 1395ff), section 1878 of such Act (42 U.S.C.
1395oo), or otherwise, of the application of this subsection
by the Secretary.
(e) Long-Term Care Hospital Payment Update.--
(1) In general.--Section 1886 of the Social Security Act
(42 U.S.C. 1395ww) is amended by adding at the end the
following new subsection:
``(m) Prospective Payment for Long-Term Care Hospitals.--
``(1) Reference to establishment and implementation of
system.--For provisions related to the establishment and
implementation of a prospective payment system for payments
under this title for inpatient hospital services furnished by
a long-term care hospital described in subsection
(d)(1)(B)(iv), see section 123 of the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 1999 and section
307(b) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000.
``(2) Update for rate year 2008.--In implementing the
system described in paragraph (1) for discharges occurring
during the rate year ending in 2008 for a hospital, the base
rate for such discharges for the hospital shall be the same
as the base rate for discharges for the hospital occurring
during the rate year ending in 2007.''.
(2) Delayed effective date.--Subsection (m)(2) of section
1886 of the Social Security Act, as added by paragraph (1),
shall not apply to discharges occurring on or after July 1,
2007, and before April 1, 2008.
(f) Expanded Review of Medical Necessity.--
(1) In general.--The Secretary of Health and Human Services
shall provide, under contracts with one or more appropriate
fiscal intermediaries or medicare administrative contractors
under section 1874A(a)(4)(G) of the Social Security Act (42
U.S.C. 1395kk-1(a)(4)(G)), for reviews of the medical
necessity of admissions to long-term care hospitals
(described in section 1886(d)(1)(B)(iv) of such Act) and
continued stay at such hospitals, of individuals entitled to,
or enrolled for, benefits under part A of title XVIII of such
Act consistent with this subsection. Such reviews shall be
made for discharges occurring on or after October 1, 2007.
(2) Review methodology.--The medical necessity reviews
under paragraph (1) shall be conducted on an annual basis in
accordance with rules specified by the Secretary. Such
reviews shall--
(A) provide for a statistically valid and representative
sample of admissions of such individuals sufficient to
provide results at a 95 percent confidence interval; and
(B) guarantee that at least 75 percent of overpayments
received by long-term care hospitals for medically
unnecessary admissions and continued stays of individuals in
long-term care hospitals will be identified and recovered and
that related days of care will not be counted toward the
length of stay requirement contained in section
1886(d)(1)(B)(iv) of the Social Security Act (42 U.S.C.
1395ww(d)(1)(B)(iv)).
(3) Continuation of reviews.--Under contracts under this
subsection, the Secretary shall establish an error rate with
respect to such reviews that could require further review of
the medical necessity of admissions and continued stay in the
hospital involved and other actions as determined by the
Secretary.
(4) Termination of required reviews.--
(A) In general.--Subject to subparagraph (B), the previous
provisions of this subsection shall cease to apply for
discharges occurring on or after October 1, 2010.

[[Page H16846]]

(B) Continuation.--As of the date specified in subparagraph
(A), the Secretary shall determine whether to continue to
guarantee, through continued medical review and sampling
under this paragraph, recovery of at least 75 percent of
overpayments received by long-term care hospitals due to
medically unnecessary admissions and continued stays.
(5) Funding.--The costs to fiscal intermediaries or
medicare administrative contractors conducting the medical
necessity reviews under paragraph (1) shall be funded from
the aggregate overpayments recouped by the Secretary of
Health and Human Services from long-term care hospitals due
to medically unnecessary admissions and continued stays. The
Secretary may use an amount not in excess of 40 percent of
the overpayments recouped under this paragraph to compensate
the fiscal intermediaries or Medicare administrative
contractors for the costs of services performed.
(g) Implementation.--For purposes of carrying out the
provisions of, and amendments made by, this title, in
addition to any amounts otherwise provided in this title,
there are appropriated to the Centers for Medicare & Medicaid
Services Program Management Account, out of any money in the
Treasury not otherwise appropriated, $35,000,000 for the
period of fiscal years 2008 and 2009.

SEC. 115. PAYMENT FOR INPATIENT REHABILITATION FACILITY (IRF)
SERVICES.

(a) Payment Update.--
(1) In general.--Section 1886(j)(3)(C) of the Social
Security Act (42 U.S.C. 1395ww(j)(3)(C)) is amended by adding
at the end the following: ``The increase factor to be applied
under this subparagraph for each of fiscal years 2008 and
2009 shall be 0 percent.''.
(2) Delayed effective date.--The amendment made by
paragraph (1) shall not apply to payment units occurring
before April 1, 2008.
(b) Inpatient Rehabilitation Facility Classification
Criteria.--
(1) In general.--Section 5005 of the Deficit Reduction Act
of 2005 (Public Law 109-171; 42 U.S.C. 1395ww note) is
amended--
(A) in subsection (a), by striking ``apply the applicable
percent specified in subsection (b)'' and inserting ``require
a compliance rate that is no greater than the 60 percent
compliance rate that became effective for cost reporting
periods beginning on or after July 1, 2006,''; and
(B) by amending subsection (b) to read as follows:
``(b) Continued Use of Comorbidities.--For cost reporting
periods beginning on or after July 1, 2007, the Secretary
shall include patients with comorbidities as described in
section 412.23(b)(2)(i) of title 42, Code of Federal
Regulations (as in effect as of January 1, 2007), in the
inpatient population that counts toward the percent specified
in subsection (a).''.
(2) Effective date.--The amendment made by paragraph (1)(A)
shall apply for cost reporting periods beginning on or after
July 1, 2007.
(c) Recommendations for Classifying Inpatient
Rehabilitation Hospitals and Units.--
(1) Report to congress.--Not later than 18 months after the
date of the enactment of this Act, the Secretary of Health
and Human Services, in consultation with physicians
(including geriatricians and physiatrists), administrators of
inpatient rehabilitation, acute care hospitals, skilled
nursing facilities, and other settings providing
rehabilitation services, Medicare beneficiaries, trade
organizations representing inpatient rehabilitation hospitals
and units and skilled nursing facilities, and the Medicare
Payment Advisory Commission, shall submit to the Committee on
Ways and Means of the House of Representatives and the
Committee on Finance of the Senate a report that includes the
following:
(A) An analysis of Medicare beneficiaries' access to
medically necessary rehabilitation services, including the
potential effect of the 75 percent rule (as defined in
paragraph (2)) on access to care.
(B) An analysis of alternatives or refinements to the 75
percent rule policy for determining criteria for inpatient
rehabilitation hospital and unit designation under the
Medicare program, including alternative criteria which would
consider a patient's functional status, diagnosis, co-
morbidities, and other relevant factors.
(C) An analysis of the conditions for which individuals are
commonly admitted to inpatient rehabilitation hospitals that
are not included as a condition described in section
412.23(b)(2)(iii) of title 42, Code of Federal Regulations,
to determine the appropriate setting of care, and any
variation in patient outcomes and costs, across settings of
care, for treatment of such conditions.
(2) 75 percent rule defined.--For purposes of this
subsection, the term ``75 percent rule'' means the
requirement of section 412.23(b)(2) of title 42, Code of
Federal Regulations, that 75 percent of the patients of a
rehabilitation hospital or converted rehabilitation unit are
in 1 or more of 13 listed treatment categories.

SEC. 116. EXTENSION OF ACCOMMODATION OF PHYSICIANS ORDERED TO
ACTIVE DUTY IN THE ARMED SERVICES.

Section 1842(b)(6)(D)(iii) of the Social Security Act (42
U.S.C. 1395u(b)(6)(D)(iii)), as amended by Public Law 110-54
(121 Stat. 551) is amended by striking ``January 1, 2008''
and inserting ``July 1, 2008''.

SEC. 117. TREATMENT OF CERTAIN HOSPITALS.

(a) Extending Certain Medicare Hospital Wage Index
Reclassifications Through Fiscal Year 2008.--
(1) In general.--Section 106(a) of division B of the Tax
Relief and Health Care Act of 2006 (42 U.S.C. 1395 note) is
amended by striking ``September 30, 2007'' and inserting
``September 30, 2008''.
(2) Special exception reclassifications.--The Secretary of
Health and Human Services shall extend for discharges
occurring through September 30, 2008, the special exception
reclassifications made under the authority of section
1886(d)(5)(I)(i) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(I)(i)) and contained in the final rule
promulgated by the Secretary in the Federal Register on
August 11, 2004 (69 Fed. Reg. 49105, 49107).
(3) Use of particular wage index.--For purposes of
implementation of this subsection, the Secretary shall use
the hospital wage index that was promulgated by the Secretary
in the Federal Register on October 10, 2007 (72 Fed. Reg.
57634), and any subsequent corrections.
(b) Disregarding Section 508 Hospital Reclassifications for
Purposes of Group Reclassifications.--Section 508 of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (Public Law 108-173, 42 U.S.C. 1395ww note) is
amended by adding at the end the following new subsection:
``(g) Disregarding Hospital Reclassifications for Purposes
of Group Reclassifications.--For purposes of the
reclassification of a group of hospitals in a geographic area
under section 1886(d) of the Social Security Act for purposes
of discharges occurring during fiscal year 2008, a hospital
reclassified under this section (including any such
reclassification which is extended under section 106(a) of
the Medicare Improvements and Extension Act of 2006) shall
not be taken into account and shall not prevent the other
hospitals in such area from continuing such a group for such
purpose.''.
(c) Correction of Application of Wage Index During Tax
Relief and Health Care Act Extension.--In the case of a
subsection (d) hospital (as defined for purposes of section
1886 of the Social Security Act (42 U.S.C. 1395ww)) with
respect to which--
(1) a reclassification of its wage index for purposes of
such section was extended for the period beginning on April
1, 2007, and ending on September 30, 2007, pursuant to
subsection (a) of section 106 of division B of the Tax Relief
and Health Care Act of 2006 (42 U.S.C. 1395 note); and
(2) the wage index applicable for such hospital during such
period was lower than the wage index applicable for such
hospital during the period beginning on October 1, 2006, and
ending on March 31, 2007,
the Secretary shall apply the higher wage index that was
applicable for such hospital during the period beginning on
October 1, 2006, and ending on March 31, 2007, for the entire
fiscal year 2007. If the Secretary determines that the
application of the preceding sentence to a hospital will
result in a hospital being owed additional reimbursement, the
Secretary shall make such payments within 90 days after the
settlement of the applicable cost report.

SEC. 118. ADDITIONAL FUNDING FOR STATE HEALTH INSURANCE
ASSISTANCE PROGRAMS, AREA AGENCIES ON AGING,
AND AGING AND DISABILITY RESOURCE CENTERS.

(a) State Health Insurance Assistance Programs.--
(1) In general.--The Secretary of Health and Human Services
shall use amounts made available under paragraph (2) to make
grants to States for State health insurance assistance
programs receiving assistance under section 4360 of the
Omnibus Budget Reconciliation Act of 1990.
(2) Funding.--For purposes of making grants under this
subsection, the Secretary shall provide for the transfer,
from the Federal Hospital Insurance Trust Fund under section
1817 of the Social Security Act (42 U.S.C. 1395i) and the
Federal Supplementary Medical Insurance Trust Fund under
section 1841 of such Act (42 U.S.C. 1395t), in the same
proportion as the Secretary determines under section 1853(f)
of such Act (42 U.S.C. 1395w-23(f)), of $15,000,000 to the
Centers for Medicare & Medicaid Services Program Management
Account for fiscal year 2008.
(b) Area Agencies on Aging and Aging and Disability
Resource Centers.--
(1) In general.--The Secretary of Health and Human Services
shall use amounts made available under paragraph (2) to make
grants--
(A) to States for area agencies on aging (as defined in
section 102 of the Older Americans Act of 1965 (42 U.S.C.
3002)); and
(B) to Aging and Disability Resource Centers under the
Aging and Disability Resource Center grant program.
(2) Funding.--For purposes of making grants under this
subsection, the Secretary shall provide for the transfer,
from the Federal Hospital Insurance Trust Fund under section
1817 of the Social Security Act (42 U.S.C. 1395i) and the
Federal Supplementary Medical Insurance Trust Fund under
section 1841 of such Act (42 U.S.C. 1395t), in the same
proportion as the Secretary determines under section 1853(f)
of such Act (42 U.S.C. 1395w-23(f)), of $5,000,000 to the
Centers for Medicare & Medicaid Services Program Management
Account for the period of fiscal years 2008 through 2009.

[[Page H16847]]

TITLE II--MEDICAID AND SCHIP

SEC. 201. EXTENDING SCHIP FUNDING THROUGH MARCH 31, 2009.

(a) Through the Second Quarter of Fiscal Year 2009.--
(1) In general.--Section 2104 of the Social Security Act
(42 U.S.C. 1397dd) is amended--
(A) in subsection (a)--
(i) by striking ``and'' at the end of paragraph (9);
(ii) by striking the period at the end of paragraph (10)
and inserting ``; and''; and
(iii) by adding at the end the following new paragraph:
``(11) for each of fiscal years 2008 and 2009,
$5,000,000,000.''; and
(B) in subsection (c)(4)(B), by striking ``for fiscal year
2007'' and inserting ``for each of fiscal years 2007 through
2009''.
(2) Availability of extended funding.--Funds made available
from any allotment made from funds appropriated under
subsection (a)(11) or (c)(4)(B) of section 2104 of the Social
Security Act (42 U.S.C. 1397dd) for fiscal year 2008 or 2009
shall not be available for child health assistance for items
and services furnished after March 31, 2009, or, if earlier,
the date of the enactment of an Act that provides funding for
fiscal years 2008 and 2009, and for one or more subsequent
fiscal years for the State Children's Health Insurance
Program under title XXI of the Social Security Act.
(3) End of funding under continuing resolution.--Section
136(a)(2) of Public Law 110-92 is amended by striking ``after
the termination date'' and all that follows and inserting
``after the date of the enactment of the Medicare, Medicaid,
and SCHIP Extension Act of 2007.''.
(4) Clarification of application of funding under
continuing resolution.--Section 107 of Public Law 110-92
shall apply with respect to expenditures made pursuant to
section 136(a)(1) of such Public Law.
(b) Extension of Treatment of Qualifying States; Rules on
Redistribution of Unspent Fiscal Year 2005 Allotments Made
Permanent.--
(1) In general.--Section 2105(g)(1)(A) of the Social
Security Act (42 U.S.C. 1397ee(g)(1)(A)), as amended by
subsection (d) of section 136 of Public Law 110-92, is
amended by striking ``or 2008'' and inserting ``2008, or
2009''.
(2) Applicability.--The amendment made by paragraph (1)
shall be in effect through March 31, 2009.
(3) Certain rules made permanent.--Subsection (e) of
section 136 of Public Law 110-92 is repealed.
(c) Additional Allotments To Eliminate Remaining Funding
Shortfalls Through March 31, 2009.--
(1) In general.--Section 2104 of the Social Security Act
(42 U.S.C. 1397dd) is amended by adding at the end the
following new subsections:
``(j) Additional Allotments To Eliminate Funding Shortfalls
for Fiscal Year 2008.--
``(1) Appropriation; allotment authority.--For the purpose
of providing additional allotments described in subparagraphs
(A) and (B) of paragraph (3), there is appropriated, out of
any money in the Treasury not otherwise appropriated, such
sums as may be necessary, not to exceed $1,600,000,000 for
fiscal year 2008.
``(2) Shortfall states described.--For purposes of
paragraph (3), a shortfall State described in this paragraph
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 as of November
30, 2007, that the Federal share amount of the projected
expenditures under such plan for such State for fiscal year
2008 will exceed the sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2006 and 2007 that will not be expended by the
end of fiscal year 2007;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2008 in accordance with
subsection (i); and
``(C) the amount of the State's allotment for fiscal year
2008.
``(3) Allotments.--In addition to the allotments provided
under subsections (b) and (c), subject to paragraph (4), of
the amount available for the additional allotments under
paragraph (1) for fiscal year 2008, the Secretary shall
allot--
``(A) to each shortfall State described in paragraph (2)
not described in subparagraph (B), such amount as the
Secretary determines will eliminate the estimated shortfall
described in such paragraph for the State; and
``(B) to each commonwealth or territory described in
subsection (c)(3), an amount equal to the percentage
specified in subsection (c)(2) for the commonwealth or
territory multiplied by 1.05 percent of the sum of the
amounts determined for each shortfall State under
subparagraph (A).
``(4) Proration rule.--If the amounts available for
additional allotments under paragraph (1) are less than the
total of the amounts determined under subparagraphs (A) and
(B) of paragraph (3), the amounts computed under such
subparagraphs shall be reduced proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made to carry out this
subsection as necessary on the basis of the amounts reported
by States not later than November 30, 2008, on CMS Form 64 or
CMS Form 21, as the case may be, and as approved by the
Secretary.
``(6) One-year availability; no redistribution of
unexpended additional allotments.--Notwithstanding
subsections (e) and (f), amounts allotted to a State pursuant
to this subsection for fiscal year 2008, subject to paragraph
(5), shall only remain available for expenditure by the State
through September 30, 2008. Any amounts of such allotments
that remain unexpended as of such date shall not be subject
to redistribution under subsection (f).
``(k) Redistribution of Unused Fiscal Year 2006 Allotments
to States With Estimated Funding Shortfalls During the First
2 Quarters of Fiscal Year 2009.--
``(1) In general.--Notwithstanding subsection (f) and
subject to paragraphs (3) and (4), with respect to months
beginning during the first 2 quarters of fiscal year 2009,
the Secretary shall provide for a redistribution under such
subsection from the allotments for fiscal year 2006 under
subsection (b) that are not expended by the end of fiscal
year 2008, to a fiscal year 2009 shortfall State described in
paragraph (2), such amount as the Secretary determines will
eliminate the estimated shortfall described in such paragraph
for such State for the month.
``(2) Fiscal year 2009 shortfall state described.--A fiscal
year 2009 shortfall State described in this paragraph is a
State with a State child health plan approved under this
title for which the Secretary estimates, on a monthly basis
using the most recent data available to the Secretary as of
such month, that the Federal share amount of the projected
expenditures under such plan for such State for the first 2
quarters of fiscal year 2009 will exceed the sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2007 and 2008 that was not expended by the end
of fiscal year 2008; and
``(B) the amount of the State's allotment for fiscal year
2009.
``(3) Funds redistributed in the order in which states
realize funding shortfalls.--The Secretary shall redistribute
the amounts available for redistribution under paragraph (1)
to fiscal year 2009 shortfall States described in paragraph
(2) in the order in which such States realize monthly funding
shortfalls under this title for fiscal year 2009. The
Secretary shall only make redistributions under this
subsection to the extent that there are unexpended fiscal
year 2006 allotments under subsection (b) available for such
redistributions.
``(4) Proration rule.--If the amounts available for
redistribution under paragraph (1) are less than the total
amounts of the estimated shortfalls determined for the month
under that paragraph, the amount computed under such
paragraph for each fiscal year 2009 shortfall State for the
month shall be reduced proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made to carry out this
subsection as necessary on the basis of the amounts reported
by States not later than May 31, 2009, on CMS Form 64 or CMS
Form 21, as the case may be, and as approved by the
Secretary.
``(6) Availability; no further redistribution.--
Notwithstanding subsections (e) and (f), amounts
redistributed to a State pursuant to this subsection for the
first 2 quarters of fiscal year 2009 shall only remain
available for expenditure by the State through March 31,
2009, and any amounts of such redistributions that remain
unexpended as of such date, shall not be subject to
redistribution under subsection (f).
``(l) Additional Allotments To Eliminate Funding Shortfalls
for the First 2 Quarters of Fiscal Year 2009.--
``(1) Appropriation; allotment authority.--For the purpose
of providing additional allotments described in subparagraphs
(A) and (B) of paragraph (3), there is appropriated, out of
any money in the Treasury not otherwise appropriated, such
sums as may be necessary, not to exceed $275,000,000 for the
first 2 quarters of fiscal year 2009.
``(2) Shortfall states described.--For purposes of
paragraph (3), a shortfall State described in this paragraph
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 Federal
share amount of the projected expenditures under such plan
for such State for the first 2 quarters of fiscal year 2009
will exceed the sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2007 and 2008 that will not be expended by the
end of fiscal year 2008;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2009 in accordance with
subsection (k); and
``(C) the amount of the State's allotment for fiscal year
2009.
``(3) Allotments.--In addition to the allotments provided
under subsections (b) and (c), subject to paragraph (4), of
the amount available for the additional allotments under
paragraph (1) for the first 2 quarters of fiscal year 2009,
the Secretary shall allot--
``(A) to each shortfall State described in paragraph (2)
not described in subparagraph (B) such amount as the
Secretary determines will eliminate the estimated shortfall
described in such paragraph for the State; and
``(B) to each commonwealth or territory described in
subsection (c)(3), an amount equal to the percentage
specified in subsection (c)(2) for the commonwealth or
territory multiplied by 1.05 percent of the sum of

[[Page H16848]]

the amounts determined for each shortfall State under
subparagraph (A).
``(4) Proration rule.--If the amounts available for
additional allotments under paragraph (1) are less than the
total of the amounts determined under subparagraphs (A) and
(B) of paragraph (3), the amounts computed under such
subparagraphs shall be reduced proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made to carry out this
subsection as necessary on the basis of the amounts reported
by States not later than May 31, 2009, on CMS Form 64 or CMS
Form 21, as the case may be, and as approved by the
Secretary.
``(6) Availability; no redistribution of unexpended
additional allotments.--Notwithstanding subsections (e) and
(f), amounts allotted to a State pursuant to this subsection
for fiscal year 2009, subject to paragraph (5), shall only
remain available for expenditure by the State through March
31, 2009. Any amounts of such allotments that remain
unexpended as of such date shall not be subject to
redistribution under subsection (f).''.

SEC. 202. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA)
AND ABSTINENCE EDUCATION PROGRAM.

Section 401 of division B of the Tax Relief and Health Care
Act of 2006 (Public Law 109-432, 120 Stat. 2994), as amended
by section 1 of Public Law 110-48 (121 Stat. 244) and section
2 of the TMA, Abstinence, Education, and QI Programs
Extension Act of 2007 (Public Law 110-90, 121 Stat. 984), is
amended--
(1) by striking ``December 31, 2007'' and inserting ``June
30, 2008''; and
(2) by striking ``first quarter'' and inserting ``third
quarter'' each place it appears.

SEC. 203. EXTENSION OF QUALIFYING INDIVIDUAL (QI) PROGRAM.

(a) Extension.--Section 1902(a)(10)(E)(iv) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by
striking ``December 2007'' and inserting ``June 2008''.
(b) Extending Total Amount Available for Allocation.--
Section 1933(g)(2) of the Social Security Act (42 U.S.C.
1396u-3(g)(2)) is amended--
(1) in subparagraph (G), by striking ``and'' at the end;
(2) in subparagraph (H), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(I) for the period that begins on January 1, 2008, and
ends on June 30, 2008, the total allocation amount is
$200,000,000.''.

SEC. 204. MEDICAID DSH EXTENSION.

Section 1923(f)(6) of the Social Security Act (42 U.S.C.
1396r-4(f)(6)) is amended--
(1) in the heading, by inserting ``and portions of fiscal
year 2008'' after ``fiscal year 2007''; and
(2) in subparagraph (A)--
(A) in clause (i), by adding at the end (after and below
subclause (II)) the following:
``Only with respect to fiscal year 2008 for the period ending
on June 30, 2008, the DSH allotment for Tennessee for such
portion of the fiscal year, notwithstanding such table or
terms, shall be \3/4\ of the amount specified in the previous
sentence for fiscal year 2007.'';
(B) in clause (ii)--
(i) by inserting ``or for a period in fiscal year 2008
described in clause (i)'' after ``fiscal year 2007''; and
(ii) by inserting ``or period'' after ``such fiscal year'';
and
(C) in clause (iv)--
(i) in the heading, by inserting ``and fiscal year 2008''
after ``fiscal year 2007'';
(ii) in subclause (I)--

(I) by inserting ``or for a period in fiscal year 2008
described in clause (i)'' after ``fiscal year 2007''; and
(II) by inserting ``or period'' after ``for such fiscal
year''; and

(iii) in subclause (II)--

(I) by inserting ``or for a period in fiscal year 2008
described in clause (i)'' after ``fiscal year 2007''; and
(II) by inserting ``or period'' after ``such fiscal year''
each place it appears; and

(3) in subparagraph (B)(i), by adding at the end the
following: ``Only with respect to fiscal year 2008 for the
period ending on June 30, 2008, the DSH allotment for Hawaii
for such portion of the fiscal year, notwithstanding the
table set forth in paragraph (2), shall be $7,500,000.''.

SEC. 205. IMPROVING DATA COLLECTION.

Section 2109(b)(2) of the Social Security Act (42 U.S.C.
1397ii(b)(2)) is amended by inserting before the period at
the end the following ``(except that only with respect to
fiscal year 2008, there are appropriated $20,000,000 for the
purpose of carrying out this subsection, to remain available
until expended)''.

SEC. 206. MORATORIUM ON CERTAIN PAYMENT RESTRICTIONS.

Notwithstanding any other provision of law, the Secretary
of Health and Human Services shall not, prior to June 30,
2008, take any action (through promulgation of regulation,
issuance of regulatory guidance, use of Federal payment audit
procedures, or other administrative action, policy, or
practice, including a Medical Assistance Manual transmittal
or letter to State Medicaid directors) to impose any
restrictions relating to coverage or payment under title XIX
of the Social Security Act for rehabilitation services or
school-based administration and school-based transportation
if such restrictions are more restrictive in any aspect than
those applied to such areas as of July 1, 2007.

TITLE III--MISCELLANEOUS

SEC. 301. MEDICARE PAYMENT ADVISORY COMMISSION STATUS.

Section 1805(a) of the Social Security Act (42 U.S.C.
1395b-6(a)) is amended by inserting ``as an agency of
Congress'' after ``established''.

SEC. 302. SPECIAL DIABETES PROGRAMS FOR TYPE I DIABETES AND
INDIANS.

(a) Special Diabetes Programs for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C.
254c-2(b)(2)(C)) is amended by striking ``2008'' and
inserting ``2009''.
(b) Special Diabetes Programs for Indians.--Section
330C(c)(2)(C) of the Public Health Service Act (42 U.S.C.
254c-3(c)(2)(C)) is amended by striking ``2008'' and
inserting ``2009''.

The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Barton) each
will control 20 minutes.
The Chair recognizes the gentleman from New Jersey.

General Leave

Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members
may 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 New Jersey?
There was no objection.
Mr. PALLONE. Madam Speaker, I yield 10 minutes to the gentleman from
California (Mr. Stark) and ask unanimous consent that he be allowed to
control that time.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New Jersey?
There was no objection.
Mr. PALLONE. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, when this Congress was first gaveled into session by
Speaker Pelosi, she declared it the Children's Congress. With that in
mind, we set out to enact an ambitious agenda that included legislation
to provide health care to 10 million low-income American children. But
we were forced to go it alone. Instead of working with us, the
President and his Republican foot soldiers in Congress chose to fight
us tooth and nail.
We were not deterred by the President or the opposition that we faced
from congressional Republicans. Earlier this summer, the House passed
the CHAMP Act, which would have strengthened the Children's Health
Insurance Program, CHIP, and helped secure health care coverage for 10
million American children, 4 million of which are presently uninsured
and come from hardworking families.
The CHAMP Act also included dramatic improvements for beneficiaries
and providers under Medicare, which, if enacted, would have put the
program on a more stable financial footing and ensured that seniors
have access to the medical care they need and deserve. The CHAMP Act
would have also protected Medicaid from harmful regulations which are
now about to go into effect and will cut billions of dollars in
critical services for low-income and disabled citizens of all ages.
Now, some may see the defeat of the CHAMP Act this year as a great
victory for the President and his Republican allies in Congress. But
they may have succeeded in being nothing more than obstructionists. No
one has gained anything from these actions by the President or my
Republican colleagues, least of all the people who rely on these
programs for their health care.
This year, we had a chance to strengthen our Nation's health care
safety net and improve the lives of our most vulnerable citizens, the
elderly, the young, the poor and the disabled. Instead, both the
administration and congressional Republicans are content on leaving
here this year with doing the bare minimum on CHIP and Medicare when we
could have accomplished so much more to improve the health of millions
of Americans.
So now, Madam Speaker, we are left with a package that addresses the
most immediate concerns, but leaves any real health care improvements
for another day, and I think that is very unfortunate. But with the
current President and the current Senate, sadly, this is the best we
can do. But I will say, Madam Speaker, the Democrats

[[Page H16849]]

are determined in the next year to revive the CHAMP Act and the
provisions that we care so much about, because we know that that is the
best for the American people.
Madam Speaker, I reserve the balance of my time.
Mr. BARTON of Texas. Madam Speaker, I yield myself 2\1/2\ minutes.
Madam Speaker, it is difficult to speak on this subject because we
have debated it so many times in the last 1\1/2\ months. Suffice it to
say that all is well that ends well, and today we have a bill before us
that is going to temporarily fix the physician reimbursement issue. It
is going to extend the SCHIP program through March of 2009. It is going
to extend the special diabetes program for another year and a number of
other things.
These are all good things and people on both sides of the aisle
support them. It shouldn't have taken all year to do these things, but
it has.
I want to speak very briefly about the SCHIP program. The language in
the bill before us is essentially the Barton-Deal language, which
Congressman Deal of Georgia, the ranking member of the Health
Subcommittee, and myself introduced 7 or 8 months ago to extend the
existing SCHIP program for 18 months, to make sure that all children
currently receiving coverage continue to receive coverage, to have a
slight increase in funding so that some new enrollments could occur. It
is a commonsense approach to an issue while we debate with our friends
on the majority side the extent to which we want to expand or change
the program.
We have had two Presidential vetoes. We have had enough speeches on
the House floor and the other body to probably populate a national
forest in terms of the amount of paper that has been used to cover
those speeches. And yet we are here today doing what we could have done
11 months ago.
I am very pleased that the SCHIP program is going to be extended. I
am very pleased that no State is going to lose funding. I am very
pleased that we are going to continue to cover the children that have
been covered. And I look forward in the next year to the same offer
that Congressman Deal and Mr. McCrery and Mr. Camp and I have made to
our friends on the majority, let's have some hearings.
We now have 15 months. We could hold regular hearings. We could
introduce draft bills. We could circulate those bills. We could have a
bipartisan dialogue. We could have an actual open, transparent
committee markup in both the Ways and Means Committee and the Energy
and Commerce Committee. It is still possible in this Congress to have
the meetings of the mind on SCHIP in terms of changes to the program,
and I hope, Madam Speaker, that that occurs in the next 12 months.

{time} 1045

Mr. STARK. Madam Speaker, I yield myself such time as I may consume.
I wish I could say I was pleased to be here today to support this
important legislation, but you can't say that about this bill the
Republicans have brought us.
Last July we sent to the Senate the CHAMP Act, a strong bill that
preserved and improved both the Medicare and SCHIP program. The CHAMP
Act extended health coverage to 10 million children nationwide. This
bill doesn't even come close.
This bill was designed by the Republicans to support their rich
friends, the pharmaceutical industry, the for-profit insurance
industry, and to destroy Medicare as millions of American seniors have
known it, to harm children, and to cast blame at illegal immigrants and
working single parents. It shows the Republicans in their truest form:
Help the rich at the expense of the poor; to deny government services
to anyone, and only help the profit industries who pay them so
generously through their campaign contributions, which will be useless,
because the public will realize that we don't need them anymore.
The CHAMP Act provided Medicare benefits for all, and it increased
protections for low-income beneficiaries. It extended the physicians'
reimbursement above par for 2 years and it protected rural providers
for those same periods of time. The CHAMP Act overwrote provisions
enacted by the former Republican majority designed to end Medicare as
an entitlement program. The CHAMP Act was paid for by reducing
overpayments to the substandard private plans in Medicare, plans
designed to privatize the program by Republicans.
For this effort, House Members, five Republican Members and the
Democrats, and our staffs are to be congratulated. They worked hard and
took tough and reasoned positions. The Senate failed to act on our
legislation and the irresponsible Republicans in the House of
Representatives failed to help the children in this country as is their
wont.
What we have before us gives the lowest common denominator a bad
name. The Senate has sent us a bill that extends otherwise expiring
Medicare provisions by a mere 6 months, meaning that we will be back
here next summer, next spring trying to fix a system which the
Republicans consistently try and privatize and destroy. That is
Medicare and SCHIP. For the next 6 months, the bill delays the 10
percent physicians cut, prevents some therapy caps from going into
effect, and protects rural providers by extending a host of particular
provisions that would otherwise expire.
There are some provisions that run longer. SCHIP will go for 15
months, moving it forward in time when we have a new President, whom we
hope will be willing to work with Congress to protect children's health
and expand access to care. It also makes longer term reforms to
Medicare payment policies for long-term care hospitals and rehab
hospitals, two changes that are long overdue.
What is wrong with the bill is what it fails to do. It flat out fails
to address real improvements needed for Medicare beneficiaries, many of
which we had addressed in the CHAMP Act. It lacks increased protections
for low-income beneficiaries; it lacks Medicare mental health parity;
it lacks overdue improvements in preventive benefits and nonpayment
related reforms to the HMO program. It lacks limits on physician
hospital ownership and self-referral. And the list goes on.
Adding insult to injury, this legislation also lets HMOs in the
insurance industry off virtually scot free, even though MedPAC, CBO,
GAO, the Office of the Inspector General and even the administration's
own actuaries confirm that we overpay these second-rate, for-profit
plans relative to the rest of Medicare.
I would hope that those of you learned, as I learned, that if you
don't like the food, don't eat it, but don't complain about it.
We still have a strong bill pending in the Senate, the CHAMP Act. The
Senate must act early in 2008 so that we can reach a better outcome for
Medicare. We just can't keep subsidizing the for-profit providers and
failing to serve our own children and seniors. So we must proceed as
best we can.
I reserve the balance of my time.
Mr. BARTON of Texas. Madam Speaker, may I inquire how much time I
have remaining.
The SPEAKER pro tempore. The gentleman from Texas has 17\1/2\
minutes.
Mr. BARTON of Texas. Madam Speaker, I ask unanimous consent to yield
10 minutes of that time to the gentleman from Louisiana (Mr. McCrery),
the ranking member of the Ways and Means Committee, for him to control.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. McCRERY. Madam Speaker, I agree with some of the comments that
have been made by the majority today, not all of them, of course, but
some of them.
I think it is a shame that we were not able to reach a bipartisan
agreement on a longer term extension of the SCHIP program. As Ranking
Member Barton has pointed out on more than one occasion, though, this
process was pretty much doomed from the start because the majority
failed to include the minority at all in the early stages of putting
together legislation for this important program.
And I understand, it is difficult being in the majority for the first
time in 12 years and not really knowing how to get things done. It's
tough to govern. It's tough to have the responsibility to actually pass
legislation and make law. We did it for 12 years, and we had some
troubles ourselves in the first year or

[[Page H16850]]

so that we were in the majority. So I understand. But I hope the
majority will learn from this experience.
We have two choices, the majority has two choices, really, insofar as
dealing with the SCHIP program. And that is, number one, next year they
could do as Ranking Member Barton suggested and have hearings on the
SCHIP program and work with the minority hand in hand to try to come up
with a reasonable extension reauthorization of this important program.
Number two, they could try the same thing next year that they did
this year and get the same result, and then just wait until after the
elections and hope that they would have a Democratic President, a
Democratic majority, and can do what they want, maybe.
I would submit that the better course is the former, and that is to
work with the minority next year. We certainly made that offer this
calendar year. I would extend it, at least from my committee's
standpoint, that invitation again for next year. And I am hopeful that
we can do that.
This bill before us today covers a lot of other things besides the
SCHIP program. As Chairman Stark said, we do have in here kind of a
stalling of the cliff that physicians find themselves looking over as
far as Medicare reimbursement. We only do that for 6 months. We do
several other things for 6 months, including therapy caps which I think
are very important. So we are under the gun, this Congress is under the
gun, and I would submit that means both the majority and the minority
early next year to get some things done in the Medicare field.
Again, I certainly want to extend my hand to the majority and offer
to work together to get these very important things that are only
extended or only dealt with for 6 months in this bill, a more certain
future with legislation next year.
Madam Speaker, I reserve the balance of my time.
Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from
Colorado (Ms. DeGette).
Ms. DeGETTE. Madam Speaker, December is a month of holidays, holidays
about families; Hanukkah, the Festival of Lights; Kwanzaa about family
traditions. At this time of year I always think about my children when
they were little, their beautiful faces staring into the creche at the
baby Jesus. But during this special time, the very best present we
could give 4 million children in this country is the gift of health
care.
Every parent knows that quality health care is the foundation for a
happy and successful life. Sadly, at this special time, Congress is
denying this gift to 4 million children who are eligible right now
under the SCHIP program but are not enrolled. Although the House and
Senate passed great legislation that would have expanded the coverage
to these children, the President has vetoed it twice. And so,
reluctantly, I stand here today in full support of current law.
The current SCHIP program is a great one that has worked for 10
years, one that we should all stand up for and be proud of. It will
guarantee that the 6 million kids currently enrolled will not lose
their health insurance until March 2009.
As the new year draws close though, Madam Speaker, we must recommit
ourselves to ensuring that every child in this country who is eligible
for SCHIP is enrolled. And that is why I ask the Speaker and my
wonderful committee leadership to recommit ourselves to reauthorizing
this program earlier than March 2009 so all these kids may be covered.
In addition, Madam Speaker, this bill contains protections for
seniors. But, again, it is only a start. There is much more to be done,
and I am committed to working with my colleagues to develop a
comprehensive bill that will do more than extend protections to doctors
and seniors for only 6 months.
Finally, Madam Speaker, I want to commend my colleagues for including
extension of the special diabetes program in this bill. This will
ensure cures for millions of Americans.
Mr. BARTON of Texas. Madam Speaker, I yield 2\1/2\ minutes to the
distinguished ranking member of the Health Subcommittee, Mr. Deal of
Georgia, who has worked tirelessly on these issues this year.
Mr. DEAL of Georgia. I thank the gentleman from Texas for yielding.
Madam Speaker, I am pleased to rise today in support of S. 2499. This
vital legislation will help preserve Medicare beneficiaries' access to
their physicians' services, in addition to providing States certainty
as to their ability to cover their SCHIP children for the next 13
months and to continue to enroll eligible children in their programs.
While this bill does not contain the needed reform of the sustainable
growth rate formula in Medicare, it averts a payment cut for physicians
which, I fear, would have dramatically impacted physician participation
in Medicare. Moving forward, I hope that we would work in a bipartisan
way to reform this SGR system rather than continuing these short fix
programs that we have seen for the last several years. The physicians
who serve this Nation's elderly population should not be subject to
this annual uncertainty, constantly wondering whether or not they will
be able to afford to see their Medicare patients.
On the second subject, for months I have supported a long-term
extension of the SCHIP program to ensure that children currently
enrolled would continue to have health care services, and to allow
States the certainty of funding so that they can continue to enroll
eligible children.
In the coming months there should be ample opportunity for SCHIP
legislation to move through a regular legislative process without the
pressures created by last-minute expiration of the program. I look
forward to working with my colleagues on both sides of the aisle on
this bill, which would help put and continue to put low-income children
first, and continues the purpose of the original program: To serve the
neediest children with health care. As a supporter of the program, it
is unfortunate to me that we have not been able to reauthorize it for a
longer period of time, but this extension should give us the
opportunity to do so in a thoughtful and appropriate process. I would
hope to work on these issues in a bipartisan fashion next year, and I
urge my colleagues to support this bill.
Mr. STARK. Madam Speaker, I am delighted to yield 2 minutes to the
distinguished gentleman from Illinois (Mr. Emanuel).
Mr. EMANUEL. A lot of people have mentioned that in fact this
extension will cover the children that presently are in the program.
That is half true and half not true. Kids who are on the program will
be covered. But if you live in 14 States in the United States, because
of the President's executive order, if you live in California,
Connecticut, Washington, D.C., Hawaii, Maryland, Massachusetts,
Minnesota, Missouri, New Hampshire, New Jersey, Pennsylvania, Rhode
Island, Vermont, or Washington, kids in those States will actually come
off the rolls in August because of the President's executive order. And
in those States, the Governors will have to begin to develop plans to
notify those kids and their parents because of the President's
executive order.
So not all kids who are on the program will actually stay on the
program. And that is just a consequence, after passing two bills to
give 10 million children health care, two bills with 45 Republicans and
220 plus Democrats here in the House, and 18 Republicans in the Senate
and every Democrat in the Senate, we were unable, which is unique
around here, but we were unable to get the President to sign this
legislation. And so what we couldn't resolve, the American people will
resolve in November.
President Kennedy once said, to govern is to choose. We have made our
choice, the President and some on your side made your choice, and in
November the American people will make their choice. And that is how
differences get resolved here. I think we should understand that.
And so, as the President has said, a lot of children will have
universal health care in this country because we have an emergency room
in hospitals. A lot of kids will end up in emergency rooms that didn't
need to go to emergency rooms.
We did right in a bipartisan fashion to get a bill. In my own view,
this will be the first thing that the new Democratic President will get
done. We don't need March 9. It will get done within

[[Page H16851]]

the first month. It will be a major accomplishment for a Democratic
Congress, a Democratic Senate, and a Democratic President.

{time} 1100

Starting this August in those 14 States, kids and their parents that
did have health care will be notified they will no longer get health
care. Now, there is a consequence to that, because August 2008 is 2
months before the election. And I don't think that is a problem. As a
matter of fact, we can't protect the American people from the
consequences of the President's decision, and a number of Republicans
stand by him. We did right. There was a bipartisan bill to resolve a
major problem to give 10 million children health care. We didn't
accomplish it. We will be back and we will get it done because the
American people deserve and the kids deserve the same health care that
their Members of Congress and their kids get. This is what that would
have done.
Mr. McCRERY. Madam Speaker, before I recognize the gentleman from
Pennsylvania (Mr. English), I would just point out under the
President's executive order, those States do have the option of
covering the low-income children in their States first. If they do
that, then they can certainly expand it to higher income children.
At this time I yield 1 minute to the gentleman from Pennsylvania (Mr.
English).
Mr. ENGLISH of Pennsylvania. Thank goodness they are not going to
have to wait a generation for a Democratic President.
This bill, Madam Speaker, is a good resolution to a political impasse
and a good solution to the hindering cuts that impede our Nation's
physicians and would impact on the health care of our young people and
our seniors.
It makes a substantial adjustment for physicians who participate in
the Medicare program, albeit only temporary. Although I would have
liked to have seen a more permanent and comprehensive solution to a
range of Medicare issues, we just couldn't wait and allow 10 percent
cuts in payments to physicians to occur. I hope to work with my
colleagues on both sides of the aisle on a more permanent solution in
the upcoming year to this particularly thorny issue.
The legislation before us also endorses important issues that I have
fought hard to be involved with and to make progress on, including
extending the exceptions process for therapy caps and a revision of the
policy structure for long-term care hospitals. Those are legacy issues
that we are going to have to take up sooner rather than later.
I am glad we have a final resolution temporarily on SCHIP. Thank you.
I urge a vote for the bill.
Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from
California (Ms. Solis).
Ms. SOLIS. Madam Speaker, I thank the gentleman for yielding me this
time. Today I stand boldly in support of this Medicare, Medicaid and
SCHIP Extension Act.
Madam Speaker, 800,000 children, as you know, in the State of
California are covered by this program. It is essential that we
continue to provide that coverage. But many, many low-income and
minority children will not be covered because previously this President
vetoed our bill twice where we would have taken this farther. Instead
of the 6 million that are currently in the program, it would have gone
to 10 million children. But we can't talk about that now.
But one thing is sure, our constituents, our seniors, are telling us
we also need to provide a fix for our doctors because many of our
seniors that are on low-income assistance now need to see their
doctors, and we know how vitally important that is.
Each and every one of us has an obligation to provide support for the
very vulnerable in our communities. And I think there is a saying
somewhere, maybe in the Bible, that says we will be judged by how we
deal with those that are most vulnerable. And those are our frail,
elderly and our children.
I know we can do better. I also pray that we have better outcomes
after 2008, because I do believe that our public, our constituents, are
demanding that we step up to the plate on health care. That is the
number one priority that we are reading about throughout this country,
that we cannot stand behind and not speak up here on the House, on the
floor and demand that we have better coverage for all of our
populations. I speak not only as a Latina and as a woman representing a
low-income community, but I think I speak for many millions of people
who would like to hear their Congresspeople speaking out loud and
shouting out loud about the need for better health care coverage. They
are demanding it. Yes, as my former colleague said on the floor, we
will probably see those results change once November 2008 arrives.
Merry Christmas to the Congress.
Mr. BARTON of Texas. Madam Speaker, I yield myself 15 seconds just to
point out that the subregulatory deadline that Mr. Emanuel referred to
requires States to show a good-faith effort to cover 95 percent of
those children below 200 percent of poverty before they cover children
above 250 percent of poverty.
I yield 2 minutes to the gentlewoman from Tennessee (Mrs. Blackburn),
a member of the committee.
Mrs. BLACKBURN. Madam Speaker, I want to compliment Mr. Barton and
Mr. Deal for the extraordinary amount of work they have done on this
issue this entire year. I know that they are pleased that the
congressional leadership has joined them in working to be certain that
we take the politics out of this issue and we keep the focus on how we
address the health care needs of our Nation's most vulnerable, our
children and our elderly.
A couple of things that we are going to see in this bill, as you have
already heard, the Medicare physician payment schedule, the cut that
was to take place is not going to. They are going to see a half percent
increase through June 2008. My hope is that we will be able to have the
majority work with us to resolve this issue.
I think it is just unconscionable that every single year this SGR
gets revisited and we try to work it through. We know that this is
something that we are going to be providing. It is a service. Health
care is going to be provided for our Medicare enrollees. And, Madam
Speaker, this needs to be dealt with and the problem needs to be
solved.
I am also pleased that SCHIP is going to be extended through March
2009 and that we are keeping the focus there on standing in the gap
between those children that are not eligible for Medicare and those
that have the ability to afford private health insurance. This gets
back to the original intent of that program to be certain that the
children of the working poor are covered.
I am also pleased that this contains the 6-month extension of
critical funding for the Tennessee Medicaid DSH payments to our
hospitals.
Madam Speaker, there should be some lessons learned from the 1115
waiver process that my State of Tennessee has been through and through
the experiment of Hillary Clinton health care and the failures of that.
As we move forward, I hope we look at those lessons learned.
I appreciate this legislation does provide those DSH payments to
these hospitals. I look forward to working with the majority.
Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from
New York (Mrs. Lowey).
Mrs. LOWEY. Madam Speaker, I rise in strong support of the Medicare,
Medicaid and SCHIP Extension Act of 2007.
This bill includes a provision based on legislation I introduced with
Representatives Tanner, LoBiondo and Hulshof that would not only freeze
compliance thresholds under the 75 percent rule at 60 percent, it would
require CMS to consult rehabilitation facilities in developing
recommendations on more appropriate criteria than the 75 percent rule
for determining IRF admission policy.
The legislation will stop CMS in its tracks from continuing to
implement an out-of-date 75 percent rule that is 100 percent wrong for
Americans, and ensure that millions of individuals will continue to
have access to the critical care and medical services provided by
rehabilitation facilities.
There are a number of individuals I would like to thank for their
tireless work on this legislation: Chairman Rangel and the entire Ways
and Means staff, particularly Jon Sheiner, Cybele Bjorklund, and Janice
Mays; my partners on this legislation, Representatives Tanner,
LoBiondo, Hulshof, and

[[Page H16852]]

their staffs, Vicki Walling, Dana Richter, and Erik Rasmussen; and my
legislative director, Jean Doyle.
And last but certainly not least, the key advocates from hospitals in
my district in New York: Dr. Walsh from Burke Rehabilitation Center,
Maggie Ramirez from Helen Hayes Hospital, and Keith Safian from Phelps
Memorial Hospital.
Your tireless work along with the support of Chairman Rangel and
others in Congress helped us get to where we are today. I urge my
colleagues to support this very important legislation.
Mr. McCRERY. Madam Speaker, how much time remains on each side?
The SPEAKER pro tempore. The gentleman from Louisiana (Mr. McCrery)
has 6 minutes. The gentleman from New Jersey (Mr. Pallone) has 2
minutes remaining. The gentleman from California has 2\1/2\ minutes
remaining. The gentleman from Texas has 3\1/4\ minutes remaining.
The Chair will recognize in reverse order the closing arguments,
beginning with the gentleman from Louisiana (Mr. McCrery), the
gentleman from California (Mr. Stark), the gentleman from Texas (Mr.
Barton), and the gentleman from New Jersey (Mr. Pallone).
Mr. McCRERY. Madam Speaker, at this time I recognize the
distinguished ranking member of the Health Subcommittee of the Ways and
Means Committee, the gentleman from Michigan (Mr. Camp), for 2 minutes.
Mr. CAMP of Michigan. Madam Speaker, I appreciate the distinguished
gentleman yielding me this time.
I am glad we have the opportunity to vote on this legislation today
which is critical to protecting doctors from receiving the 10 percent
Medicare cut and providing certainty to the SCHIP program, the State
Children's Health Insurance.
But let's not kid ourselves. This is the bare minimum and we are
capable of much more. It is disappointing that the majority would not
work in a bipartisan fashion to craft at least a 1-year reprieve from
the Medicare cuts for physicians, as Republicans were able to do in
previous years. This 6-month extension is simply putting the problem
off and not solving it. The majority knew this 10 percent cut was
coming. So what did they do? They passed a CHAMP bill that was fraught
with problems that cut home health, skilled nursing facilities,
devastated Medicare Advantage and the individual care, and would have
left 22 States without one senior receiving Medicare Advantage. That
was nearly 6 months ago. And what has happened since then? Nothing.
It is unfortunate that we could not come to a bipartisan compromise
on SCHIP, which was and is within reach. A simple extension, while
better than what the majority offered, and their offer was transforming
a program to assist low-income children to an entitlement for families
earning $80,000 a year, is much worse than what was possible.
As I said before on this floor, I stand ready to work in a bipartisan
fashion to address the looming cuts faced by physicians in Medicare. I
hope we can see this legislation for the Band-Aid that it is and return
next year with a commitment from leaders in both parties to enact real
long-term Medicare payment reform.
Mr. BARTON of Texas. Madam Speaker, I yield 1\1/4\ minutes to the
gentleman from Alabama (Mr. Aderholt) who is one of the negotiators of
an attempt at a compromise.
Mr. ADERHOLT. Madam Speaker, I would like to thank every Member who
has worked on this piece of legislation, and there has been a lot,
especially Mr. Barton and Mr. Deal who have gone beyond the call of
duty in their work. I have been in meetings with them for many hours,
so I appreciate their work.
I think we are all disappointed that it has taken so long to come up
with a solution, but in the end we have arrived at a correct decision.
When SCHIP was first brought to the floor in 1997, I was a new Member
of Congress. It was a bipartisan bill that was enacted by a Republican
House and Senate. And it was signed into law by a Democrat President.
This year's process has been anything but bipartisan. I think it
would be fair to say that the political rancor in the debate that has
occurred over the last several months has surpassed anything that most
of us have seen while we have been in Congress. But it is time to move
forward and it is time that we remember what is important in this whole
process, and that is the children that need health care in America,
that are simply the poor in this country.
In my home State of Alabama, SCHIP has been a tremendous success and
has helped a new generation of children live happier and healthier
lives.

{time} 1115

I'm pleased that this Congress has decided to extend this vital
program into 2009 and provide a level of certainty to State health
directors that did not exist under our previous resolutions. This is a
good solution, and I encourage my colleagues to support it.
Mr. McCRERY. Madam Speaker, I yield 1\1/2\ minutes to the gentleman
from Texas, the ranking member of the Social Security Subcommittee of
the Ways and Means Committee, Mr. Johnson.
(Mr. SAM JOHNSON of Texas asked and was given permission to revise
and extend his remarks.)
Mr. SAM JOHNSON of Texas. Madam Speaker, today we're considering a
bill that does some important things. One, it stops the 2008 physician
cuts. Two, it extends the Children's Health Insurance Program past the
politics of the Presidential election; and three, it helps physicians
who are called up for active duty to serve their country. But in
reality, this isn't the best bill Congress could have put together, and
y'all need to know that.
For the first time, physicians don't know what Medicare will pay them
next year. In 6 short months, doctors will once again be facing more
than a 10 percent cut in their reimbursements. That uncertainty is no
help when you're trying to run a business.
When it comes to physicians who are called up to serve their country
and their community, this bill does deliver temporary relief.
Earlier this year Congress moved in a bipartisan fashion to
temporarily fix an oversight in Medicare. Previously, the law created a
red tape nightmare for any Medicare physician who needed to leave his
practice for more than 60 days at a time. The bill before us today
continues this fix for just 6 months by allowing our Reservists to have
one substitute doctor for their entire deployment.
I look forward to working with my colleagues next year on a permanent
fix for this problem. We need to support our troops and the docs that
are called up.
Mr. PALLONE. Madam Speaker, I just want to inquire if the other side
is prepared to close or has any additional speakers.
Mr. BARTON of Texas. Madam Speaker, I am the only speaker remaining
for my portion of the time, so I am prepared to close.
Mr. McCRERY. Madam Speaker, I have two remaining speakers.
The SPEAKER pro tempore. The gentleman from Louisiana has 3 minutes
remaining.
Mr. McCRERY. Madam Speaker, I would yield 1\1/2\ minutes to the
gentleman from Georgia (Mr. Gingrey).
Mr. GINGREY. Madam Speaker, I appreciate the gentleman yielding. And
I stand today in full support of this 18-month extension of the
Children's Health Insurance Program, and also the 6-month mitigation of
the payment cut to our physicians under Medicare.
But, Madam Speaker, let me say in regard to that 6-month mitigation,
we have done this the whole time that I've been in this Congress, the
past 5 years, with a Band-Aid. We're literally doing it this time with
a spot Band-Aid, and first thing you know we're going to do a 3-month
mitigation and a month-to-month mitigation. It's time to end this
flawed sustainable growth rate, just like it's time to end the
alternative minimum tax that was not indexed for inflation. They're
both flawed, and we need to strike both of them dead permanently.
In regard to the Children's Health Insurance Program, Madam Speaker,
the distinguished chairman of the Democratic Conference spoke a little
earlier, talking about certain children are going to lose their
coverage during this 18-month extension. Well, certain children should
lose their coverage if their

[[Page H16853]]

families make up to 300 percent of the Federal poverty level, which is
about $65,000 a year, and it crowds out those children from needy
families who are not being covered.
So this extension, I want to commend my colleague from Georgia,
Nathan Deal, and Ranking Member Barton. This is their bill, and this is
exactly what we need to do. We need to make sure we have 90 percent
coverage saturation and those children up to 250 percent of the poverty
level before we consider anything else. I support this extension.
Mr. McCRERY. Madam Speaker, I have two remaining speakers. I promise
this will be the last time I will have two remaining speakers.
At this time I would yield 30 seconds to the gentleman from Missouri,
the distinguished minority whip, Mr. Blunt. And I believe my colleague,
Mr. Barton, is going to also give him 30 seconds.
Mr. BARTON of Texas. Madam Speaker, I would like to yield 30 of my
seconds to the gentleman from Missouri (Mr. Blunt).
The SPEAKER pro tempore. The gentleman from Missouri is recognized
for 1 minute.
Mr. BLUNT. Madam Speaker, I thank the gentlemen for yielding.
I'm just here to say that I think this 18-month extension gives us
the time we need to make SCHIP an even better program. It extends the
current program. It increases funding for the current program. It helps
the States that have a shortfall. It ensures that kids who don't have
Medicaid, who are in that second 100 percentile, the families who are
closest to the Medicaid number, get their coverage first, by not
reversing the policies the administration has lately put in place on
waivers. It does important things to ensure that the qualifying
standards for SCHIP don't change. On those areas that extend Medicare
payments to doctors, I would remind my friends here that we're paying
for those, most of that, through the stabilization fund on the last big
fight here we had. This was the fund we thought we might need to make
part D addition to Medicare as a competitive and innovative addition to
Medicare work. We didn't need that money because it's working on its
own. The last fight we had this big on a health care issue, we kept
hearing how terrible it would be for seniors. Eighty-seven percent of
the seniors don't think it's terrible at all.
I think we're going to see that this debate also leads to better
results for SCHIP, not worse results for SCHIP. I'm glad to see this
extension.
The SPEAKER pro tempore. The gentleman from Louisiana has 1 minute
remaining.
Mr. McCRERY. Madam Speaker, I assume all managers of time have one
remaining speaker?
Mr. STARK. I have one.
Madam Speaker, I would yield, at this point, 1\1/2\ minutes to the
distinguished gentleman from Texas (Mr. Doggett).
Mr. DOGGETT. Madam Speaker, this pathetic excuse for a Medicare bill
is made necessary by a Republican refusal to tackle waste, fraud and
abuse. To fulfill an ideological dream, taxpayers are compelled to
continue wasting billions of dollars to fund abusive private Medicare
Advantage plans run by Bush administration buddies, rather than less
expensive, more effective traditional Medicare.
And while doctors are rightly protected from a scheduled payment cut,
how about the millions of poor seniors who are cut off from access to
extra help for prescription drug coverage? As with so many battles in
this Congress, where it is a contest between the poor and a well-
financed special interest, guess who gets knocked out?
This shell of a bill actually means that millions of our youngest
Americans will still be barred from access to the Children's Health
Insurance Program, and, of course, it will enable my State, Texas, to
maintain its dubious distinction of being number one, the number one
State in the country with children who have no health insurance, due
largely to the indifference of then Governor George Bush, now the
``vetoer in chief'' when it comes to children's health insurance.
This House had approved the CHAMP Act. Today, about all that remains
of it, thanks to continued Republican obstructionism and one veto after
another, is what could be called the CHUMP Act because it reeks of
fiscal irresponsibility and social inequity. Something may be better
than nothing, but this is barely something. In 18 months we'll correct
it.
Mr. McCRERY. Madam Speaker, I would yield 1 minute to the gentleman
from Georgia (Mr. Price) and note that I still believe bipartisanship
is the way to solving these problems, especially in the next year.
Mr. PRICE of Georgia. I thank my friend for yielding and for his
leadership.
There's a recurrent theme that we've heard this month and that is
from this majority party that continues to lament the work product of
this 110th Congress. You'd think they weren't in the majority.
But it's time to set the record straight about a couple of items. One
is SCHIP. The reason that SCHIP hasn't moved forward in the way that
they envisioned is because the American people didn't believe that over
half of the American children ought to be on a government-run system.
Were there alternatives? Absolutely. The alternative that we put on
the table was to reauthorize the program, provide premium assistance
for families up to $63,000 and give States greater flexibility. That's
a positive solution.
In the area of SGR or the physician reimbursement in Medicare, it's
important to appreciate that this 6-month extension is wrong. Medicare
is woefully flawed. The 6-month extension is an insult to both patients
and physicians.
What we call for is for bipartisanship, for working together to solve
the Medicare physician payment program that works well for patients and
works for physicians and makes certain that patients and their families
control health care, not government.
Mr. STARK. Madam Speaker, I yield myself the balance of the time and
agree with the gentleman from Georgia that the fix for the physicians
is an abomination, but it was written by the Republicans in the Senate,
and with concurrence with Republicans in the House. So I congratulate
you for at least recognizing a lousy piece of legislation when it's
drafted by Republicans.
The distinguished gentleman from Texas (Mr. Barton) suggested that
all's well that ends well, and that pretty much sums up the Republican
philosophy. They've kept 4 million kids from getting health care.
They've endangered the health care of many of the 6 million kids on
SCHIP now, and they've protected the for-profit insurance industry and
other special interests who fund their campaigns to the detriment of
the children and the seniors in this country.
You might call that all well, but the Democrats don't.
Madam Speaker, I yield back the balance of my time.
Mr. BARTON of Texas. Madam Speaker, I yield myself the remainder of
my time.
The SPEAKER pro tempore. The gentleman is recognized for 1\1/2\
minutes.
Mr. BARTON of Texas. I want to compliment Congresswoman Lowey of New
York for working to include the 60 percent fix for the rehabilitation
hospitals. I wasn't aware that that was in the bill. I'm very pleased
that that is.
I would like to, I guess, compliment my friend from California,
Chairman Stark, for at least agreeing that this bill is worthy of
coming to the floor.
I would like to point out that the whole purpose of SCHIP is to cover
low- and moderate-income kids. That was the original intent. There are
many of us on this side of the aisle that still think that should be
the intent. If you want to go to some of the larger numbers of coverage
of children that are currently not covered, you have to go above 250
and, in some cases, above 300 percent of poverty.
You also are covering right now six to 700,000 adults. There are
those like myself that don't think adults need to be covered by SCHIP
because those same adults can be covered by Medicaid, which is the
coverage for low-income Americans, regardless of how old they are.
I would like to point out the obvious. When you're in the minority,
the only way you can get anything passed is to work with the majority.
That's self-evident. When you're in the majority

[[Page H16854]]

you can pass things in the House just by yourself, but if you want them
to become law, you normally have to work with the minority. And I hope
this debate on SCHIP has shown people on both sides of the aisle that
we should be trying to legislate and work together instead of scoring
political points for one particular side.
With that, Madam Speaker, I yield back the balance of my time.
Mr. PALLONE. Madam Speaker, I yield myself such time as I may
consume.
The SPEAKER pro tempore. The gentleman from New Jersey is recognized
for 2 minutes.
Mr. PALLONE. Madam Speaker, this bill is the result of Republican
intransigence. This is a Band-Aid. And I would remind my Republican
colleagues who seem to think that this is good legislation, that every
day that goes by, more kids are going to get off SCHIP.
They put out that directive of August 17 that says that if a kid's
parents lose their job, they would have to wait 1 year before they
could get SCHIP coverage.
So the bottom line is more kids are going to go off SCHIP. We're just
barely paying for the kids that are on it now.
They're not willing to do anything. They said that they were willing
to negotiate. Well, we had negotiations, our majority leader said, for
over 100 hours, and they still could not come up with an agreement.

{time} 1130

The President refuses to fund anything. He won't pay through a
tobacco increase, the only tax increase. The only thing he says he will
do is cut programs to pay for expanded SCHIP that would even make it
harder, like cutting Medicare.
So the fact of the matter is we are stuck with this lousy bill that
was negotiated between the White House and the Republicans in the
Senate. We don't like it. It's simply a temporary measure, and we as
Democrats are committed to the fact that in the beginning of next year
we're going to take up SCHIP again. We're going to take up the issue of
Medicare to try to prevent the privatization that takes place under the
current program. We're determined to correct these programs.
But it won't happen if the Republicans continue their intransigence,
both at the White House and here in the House of Representatives. There
is no reason to believe, based on what they've done in the last 6
months, that this Republican minority wants to work with us to achieve
a better result.
So we are stuck with this bill today. It is a Band-Aid approach. We
have to pass it so we can continue with the existing programs. But
every day that goes by, Medicare suffers because fewer and fewer
doctors are likely to take Medicare and fewer and fewer kids are going
to get coverage because they're going to have to go to the emergency
room because they can't see a doctor on a regular basis. That's not the
way to operate. And I have to say that it's totally due to the fault,
in my opinion, of the President and the Republicans here in the House
of Representatives. I hope this changes in the next year.
Mr. LEVIN. Madam Speaker, it has become clear, not only to my
colleagues in Congress, but also to the American people, that the
intransigence of President Bush and his supporters in the House and
Senate have made it difficult to advance long-needed bills to improve
Medicare and expand the Children's Health Insurance Program.
The bill we are considering today in no way reflects negotiations
with the Senate on the CHAMP Act that the House approved with a bi-
partisan majority on August 1st, and the Senate's Medicare and SCHIP
priorities. Rather, it is a skinny health extenders package that
generally extends some provisions in current law for only 6 months.
Shoring up Medicare from years of neglect under the Republican
Congress and expanding the Children's Health Insurance Program to cover
10 million low-income children are top priorities for me and the New
Democratic Majority in Congress. That is why the House approved the
CHAMP Act of 2007 to eliminate the scheduled Medicare physician payment
cuts for the next 2 years and expand the Children's Health Insurance
Program to cover 10 million low-income children nationwide. The only
reason that the legislation we approved in August to improve the
Medicare and SCHIP programs has not been signed into law is because
President Bush and his allies in Congress oppose it.
There are several provisions of importance back home that I wish to
recognize. We were able to keep in the health extenders bill a
moratorium on cuts to school-based Medicaid services that the
Administration has proposed. We have included a 6-month extension of a
wage-reclassification program in the Medicare program, and have
provided funding to extend the Special Diabetes Program for research,
treatment and prevention of diabetes through September 30, 2009.
Unfortunately, imperative improvements to the Medicare program have
been dropped from the bill. Improvements approved in the House in
August include mental health parity for seniors, making prevention more
accessible by eliminating co-pays and deductibles for preventative
services like mammograms and colonoscopy screenings, and expanding
programs that help low-income seniors pay for their health care and
prescription drugs.

The Children's Health Insurance expansion that has been dropped from
the bill would have extended children's health insurance to enroll 6
million kids that are currently eligible for the program and not yet
enrolled. That's in addition to the 6 million low-income children
already receiving health care under the SCHIP program nationwide,
including 55,000 kids in my home state of Michigan whose parents make
between $20,535 and $41,300 a year.
I urge my colleagues to support the short-term extensions in the
legislation before us today, and to join me in addressing long-needed
reforms to Medicare and SCHIP in the new year.
Ms. WOOLSEY. Madam Speaker, I support S. 2499, the Medicare, Medicaid
and SCHIP Extension Act of 2007. It's important that Congress pass this
legislation today to ensure that our Nation's poorest children retain
their health insurance and doctors who take care of our seniors on
Medicare do not receive a 10 percent cut in reimbursements.
It's deeply disappointing that this bill doesn't address the issue of
the Medicare physician geographic payment discrepancy that is faced by
many areas in California and across the country. One of these areas is
Sonoma County, in my District. This inconsistency has led to doctor's
reimbursements being based upon their geographic location and not the
true cost of providing services. Because of this discrepancy, doctors
in Sonoma County receive a lower payment for the same services than
doctors in next door Marin County and this discrepancy is causing
doctors to leave Sonoma County. Congress needs to act to fix this
discrepancy and ensure that physicians with Medicare patients can
continue to afford to see their patients regardless of where their
practice is located.
Because of the Republican led efforts, the bill only delays a real
solution to the Medicare physician payment cuts that all doctors are
facing. We can and must do better for our seniors. When the Medicare
extension expires in June, we owe it to our seniors and physicians to
replace it with a permanent fix to the physician payment cuts and
payment discrepancies.
With this bill, the State Children's Health Insurance Program (SCHIP)
will be extended and states will receive enough funding to keep all the
children currently enrolled on SCHIP from being removed from the
program. But, this bill doesn't help the millions more children whose
families cannot afford health insurance and who should be covered under
SCHIP. Earlier this year, Congress passed an SCHIP bill that would have
given 4 million more children healthcare, for a total of 10 million
children receiving healthcare on SCHIP. However, the Administration
showed that its priorities are completely out of line with the rest of
this country when it vetoed that legislation. We need to do better for
our nation's children and provide all of them with the healthy start
and security that SCHIP can provide.
I urge my colleagues to support this bill and look forward to working
with them to provide a permanent solution to the Medicare physician
payment issues and in ensuring that every child in America is insured.
Mr. LANGEVIN. Madam Speaker, I rise today to express my support for
S. 2499, the Medicare, Medicaid and SCHIP Extension Act. This bill
includes a number of provisions that are essential to the continued
delivery of vital healthcare programs to our Nation's most vulnerable
citizens.
This measure offers much-needed relief to physicians that serve our
Medicare population by providing a 6-month suspension of the 10-percent
cut in Medicare payments scheduled to occur on January 1, providing
instead a modest increase of 0.5 percent. It also extends important
incentive payment programs that provide a 5-percent bonus to physicians
serving areas with a shortage of doctors, while ensuring that Medicare
beneficiaries have continued access to therapy services through June
30, 2008.
Also included in this bill is a vital extension for the State
Children's Health Insurance Program (SCHIP) through March 31, 2009.
Currently, 24,900 Rhode Islanders are enrolled in

[[Page H16855]]

the SCHIP portion of Rhode Island's model RITE Care program. As a proud
Representative of Rhode Island and a longtime supporter of SCHIP, I
cannot stress enough how important this program is to the health and
well-being of our children, expectant mothers and parents alike.
Although this was not the outcome that I and many of my colleagues
originally envisioned for SCHIP, this extension is crucial for States
like Rhode Island that are facing tremendous budgetary shortfalls.
Madam Speaker, access to quality, affordable healthcare is integral
to the prosperity of every American. While I am pleased that this
Congress was able to reach a compromise to provide temporary relief for
our country's most important safety net programs, I believe that we
have the potential to do so much more. Health care providers that have
pledged to continue serving the aging, disabled, and low-income
citizens deserve more than stopgap measures and temporary relief. This
Congress has an obligation to take meaningful action to reform and
stabilize the Medicare provider payment system, as well as to ensure
the continued strength and success of our Medicaid and SCHIP programs.
To that end, I will continue to work in a bipartisan manner with my
colleagues in an effort to guarantee that these issues are properly
addressed in this and future Congresses.
Mr. ETHERIDGE. Madam Speaker, I rise in support of this legislation
and the critical services provided by Medicare, Medicaid, and the State
Children's Health Insurance Program (SCHIP). This legislation ensures
continued access to our nation's health care system for our most
vulnerable citizens--children, seniors, the poor, and the disabled. It
also extends incentives that allow health care providers to maintain
practices in rural areas. These federal efforts are critical to
maintaining healthy and productive communities across the country, and
particularly in North Carolina's 2nd District.
North Carolina's citizens are at risk when reimbursements to
physicians fall below the cost of providing care, and doctors must shut
their doors or turn away patients because they cannot afford to attend
to them. North Carolina's citizens are at risk when children go without
care, and untreated illnesses or foregone preventative care reduces the
health and productivity of those who will build our future. North
Carolina's citizens are at risk when Congress fails to act to preserve
benefits that they depend on.
The health of Americans and the future health of America depend upon
the availability of and access to health care. I applaud our leaders in
the House and Senate for working in a bicameral, bipartisan manner to
craft this legislation so that our doctors, hospitals, and other health
care providers can continue their service to keep our citizens healthy.
This legislation improves physician quality and access by averting
the planned 10 percent cut in physician payments and extending the
Medicare physician quality reporting system. It continues Medicare
policy that provides a measure of fairness to the payment system for
rural providers so that they can continue providing valuable services
to individuals in rural parts of the 2nd District and across the
country. I am hopeful that when Congress returns in 2008, we make
extending these provisions on a long-term basis a priority so that
providers can plan to remain in our communities for the long-term.
As the only former State schools chief serving in Congress, my life's
work has been to provide for a better future for the next generation,
and health care is critically important to that effort. This
legislation averts the threat that States will run out of funds for the
State Children's Health Insurance Program, or SCHIP. North Carolina's
Health Choice, which serves over 250,000 needy children, will now be
able to plan enrollment for the next year, whereas without this
legislation it would have run out of money next March. While I am
disappointed that this legislation does not enable the coverage of
additional children, we owe it to the children currently served by
SCHIP to ensure that they are continuously covered and can get the
health care they need when they need it. I look forward to working with
my colleagues in the future to fulfill the vision of health access for
all children.
Madam Speaker, a lack of access to health care has impact beyond the
individual who suffers a sickness without treatment. Untreated
illnesses have long-term consequences, and ensuring access to health
care contributes to a healthy and productive society and heads off
expensive treatments down the road. This legislation is necessary to
keep providers in our communities, and I urge my colleagues to join me
in supporting it.
Mr. SPACE. Madam Speaker, I rise today in support of the legislation
before us that will help both seniors and children alike receive the
health care that they deserve, and continue our national investment in
combating chronic disease.
I am particularly pleased to see that the legislation includes an
extension of the Special Diabetes Program, which affords critical
research funding to research into type one diabetes. Every year,
thousands of parents receive the tragic news that their child will have
to bear the burden of juvenile diabetes. With this news comes the
realities of a life permanently changed by a disease for which we
currently have no cure.
As I have shared with the House before, I am one of these parents.
Nearly a decade ago, my wife and I learned that my son Nick would have
to face the challenge of type one diabetes. We have been blessed and
fortunate that Nick has lived an active and normal life. His successes
are in large part thanks to the insulin pump he wears and other
innovations that help type one diabetes patients manage their disease.
While Nick and so many other children have been able to manage their
disease, they still worry about their future. It is the obligation of
Congress to work towards finding a cure. The Special Diabetes Program
provides the guarantee of continued, groundbreaking research into this
disease. The yields of this research hold unquestioned promise for a
better future.
I am disappointed that the extension of the program prescribed in
this legislation is only one year. An overwhelming bipartisan group of
my colleague in both the House and Senate expressed support for a
longer extension of the program. Unfortunately, those who carry the
weight of type one diabetes were casualties of partisan warfare over
other, unrelated issues.
I look forward to working with my colleagues next year to ensure a
longer renewal of this legislation. Congress has an obligation to lead
the charge against this disease. I know that we can meet this challenge
if we work together.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from New Jersey (Mr. Pallone) that the House suspend the
rules and pass the Senate bill, S. 2499.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. BARTON of Texas. Madam Speaker, on that I demand the yeas and
nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the
Chair's prior announcement, further proceedings on this motion will be
postponed.

____________________