[Congressional Record Volume 154, Number 64 (Tuesday, April 22, 2008)]
[House]
[Pages H2502-H2508]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             PROTECTING THE MEDICAID SAFETY NET ACT OF 2008

  Mr. DINGELL. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5613) to extend certain moratoria and impose additional 
moratoria on certain Medicaid regulations through April 1, 2009, as 
amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5613

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Protecting the Medicaid 
     Safety Net Act of 2008''.

     SEC. 2. MORATORIA ON CERTAIN MEDICAID REGULATIONS.

       (a) Extension of Certain Moratoria in Public Law 110-28.--
     Section 7002(a)(1) of the U.S. Troop Readiness, Veterans' 
     Care, Katrina Recovery, and Iraq Accountability 
     Appropriations Act, 2007 (Public Law 110-28) is amended--
       (1) by striking ``prior to the date that is 1 year after 
     the date of enactment of this Act'' and inserting ``prior to 
     April 1, 2009'';
       (2) in subparagraph (A), by inserting after ``Federal 
     Regulations)'' the following: ``or in the final regulation, 
     relating to such parts, published on May 29, 2007 (72 Federal 
     Register 29748)''; and
       (3) in subparagraph (C), by inserting before the period at 
     the end the following: ``, including the proposed regulation 
     published on May 23, 2007 (72 Federal Register 28930)''.
       (b) Extension of Certain Moratoria in Public Law 110-173.--
     Section 206 of the Medicare, Medicaid, and SCHIP Extension 
     Act of 2007 (Public Law 110-173) is amended--
       (1) by striking ``June 30, 2008'' and inserting ``April 1, 
     2009'';
       (2) by inserting ``, including the proposed regulation 
     published on August 13, 2007 (72 Federal Register 45201),'' 
     after ``rehabilitation services''; and
       (3) by inserting ``, including the final regulation 
     published on December 28, 2007 (72 Federal Register 73635),'' 
     after ``school-based transportation''.
       (c) Additional Moratoria.--
       (1) In general.--Notwithstanding any other provision of 
     law, the Secretary of Health and Human Services shall not, 
     prior to April 1, 2009, 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 a provision described in 
     subparagraph (A), (B), or (C) of paragraph (2) if such 
     restrictions are more restrictive in any aspect than those 
     applied to the respective provision as of the date specified 
     in paragraph (3) for such provision.
       (2) Provisions described.--
       (A) Portion of interim final regulation relating to 
     medicaid treatment of optional case management services.--
       (i) In general.--Subject to clause (ii), the provision 
     described in this subparagraph is the interim final 
     regulation relating to optional State plan case management 
     services under the Medicaid program published on December 4, 
     2007 (72 Federal Register 68077) in its entirety.
       (ii) Exception.--The provision described in this 
     subparagraph does not include the portion of such regulation 
     as relates directly to implementing section 1915(g)(2)(A)(ii) 
     of the Social Security Act, as amended by section 6052 of the 
     Deficit Reduction Act of 2005 (Public Law 109-171), through 
     the definition of case management services and targeted case 
     management services contained in proposed section 440.169 of 
     title 42, Code of Federal Regulations, but only to the extent 
     that such portion is not more restrictive than the policies 
     set forth in the Dear State Medicaid Director letter on case 
     management issued on January 19, 2001 (SMDL #01-013), and 
     with respect to community transition case management, the 
     Dear State Medicaid Director letter issued on July 25, 2000 
     (Olmstead Update 3).
       (B) Proposed regulation relating to redefinition of 
     medicaid outpatient hospital services.--The provision 
     described in this subparagraph is the proposed regulation 
     relating to clarification of outpatient clinic and hospital 
     facility services definition and upper payment limit under 
     the Medicaid program published on September 28, 2007 (72 
     Federal Register 55158) in its entirety.
       (C) Portion of proposed regulation relating to medicaid 
     allowable provider taxes.--
       (i) In general.--Subject to clause (ii), the provision 
     described in this subparagraph is the final regulation 
     relating to health-care-related taxes under the Medicaid 
     program published on February 22, 2008 (73 Federal Register 
     9685) in its entirety.
       (ii) Exception.--The provision described in this 
     subparagraph does not include the portions of such regulation 
     as relate to the following:

       (I) Reduction in threshold.--The reduction from 6 percent 
     to 5.5 percent in the threshold applied under section 
     433.68(f)(3)(i) of title 42, Code of Federal Regulations, for 
     determining whether or not there is an indirect guarantee to 
     hold a taxpayer harmless, as required to carry out section 
     1903(w)(4)(C)(ii) of the Social Security Act, as added by 
     section 403 of the Medicare

[[Page H2503]]

     Improvement and Extension Act of 2006 (division B of Public 
     Law 109-432).
       (II) Change in definition of managed care.--The change in 
     the definition of managed care as proposed in the revision of 
     section 433.56(a)(8) of title 42, Code of Federal 
     Regulations, as required to carry out section 
     1903(w)(7)(A)(viii) of the Social Security Act, as amended by 
     section 6051 of the Deficit Reduction Act of 2005 (Public Law 
     109-171).

       (3) Date specified.--The date specified in this paragraph 
     for the provision described in--
       (A) subparagraph (A) of paragraph (2) is December 3, 2007;
       (B) subparagraph (B) of such paragraph is September 27, 
     2007; or
       (C) subparagraph (C) of such paragraph is February 21, 
     2008.

     SEC. 3. FUNDS TO REDUCE MEDICAID FRAUD AND ABUSE.

       (a) In General.--For purposes of reducing fraud and abuse 
     in the Medicaid program under title XIX of the Social 
     Security Act, there is appropriated to the Secretary of 
     Health and Human Services, out of any money in the Treasury 
     not otherwise appropriated, $25,000,000, for each fiscal year 
     (beginning with fiscal year 2009). Amounts appropriated under 
     this section shall remain available for expenditure until 
     expended and shall be in addition to any other amounts 
     appropriated or made available to the Secretary for such 
     purposes with respect to the Medicaid program.
       (b) Annual Report.--Not later than September 30 of 2009 and 
     of each subsequent year, the Secretary of Health and Human 
     Services shall submit to the Committee on Energy and Commerce 
     of the House of Representatives and the Committee on Finance 
     of the Senate a report on the activities (and the results of 
     such activities) funded under subsection (a) to reduce waste, 
     fraud, and abuse in the Medicaid program under title XIX of 
     the Social Security Act during the previous 12 month period, 
     including the amount of funds appropriated under such 
     subsection (a) for each such activity and an estimate of the 
     savings to the Medicaid program resulting from each such 
     activity.

     SEC. 4. STUDY AND REPORTS TO CONGRESS.

       (a) Secretarial Report Identifying Problems.--Not later 
     than July 1, 2008, the Secretary of Health and Human Services 
     shall submit to the Committee on Energy and Commerce of the 
     House of Representatives and the Committee on Finance of the 
     Senate a report that--
       (1) outlines the specific problems the Medicaid regulations 
     referred to in the amendments made by subsections (a) and (b) 
     of section 2 and in the provisions described in subsection 
     (c)(2) of such section were intended to address;
       (2) detailing how these regulations were designed to 
     address these specific problems; and
       (3) cites the legal authority for such regulations.
       (b) Independent Comprehensive Study and Report.--
       (1) In general.--Not later than July 1, 2008, the Secretary 
     of Health and Human Services shall enter into a contract with 
     an independent organization for the purpose of--
       (A) producing a comprehensive report on the prevalence of 
     the problems outlined in the report submitted under 
     subsection (a);
       (B) identifying strategies in existence to address these 
     problems; and
       (C) assessing the impact of each regulation referred to in 
     such subsection on each State and the District of Columbia.
       (2) Additional matter.--The report under paragraph (1) 
     shall also include--
       (A) an identification of which claims for items and 
     services (including administrative activities) under title 
     XIX of the Social Security Act are not processed through 
     systems described in section 1903(r) of such Act;
       (B) an examination of the reasons why these claims for such 
     items and services are not processed through such systems; 
     and
       (C) recommendations on actions by the Federal government 
     and the States that can make claims for such items and 
     services more accurate and complete consistent with such 
     title.
       (3) Deadline.--The report under paragraph (1) shall be 
     submitted to the Committee on Energy and Commerce of the 
     House of Representatives and the Committee on Finance of the 
     Senate not later than March 1, 2009.
       (4) Cooperation of states.--If the Secretary of Health and 
     Human Services determines that a State or the District of 
     Columbia has not cooperated with the independent organization 
     for purposes of the report under this subsection, the 
     Secretary shall reduce the amount paid to the State or 
     District under section 1903(a) of the Social Security Act (42 
     U.S.C. 1396b(a)) by $25,000 for each day on which the 
     Secretary determines such State or District has not so 
     cooperated. Such reduction shall be made through a process 
     that permits the State or District to challenge the 
     Secretary's determination.
       (c) Funding.--
       (1) In general.--Out of any money in the Treasury of the 
     United States not otherwise appropriated, there are 
     appropriated to the Secretary without further appropriation, 
     $5,000,000 to carry out this section.
       (2) Availability; amounts in addition to other amounts 
     appropriated for such activities.--Amounts appropriated 
     pursuant to paragraph (1) shall--
       (A) remain available until expended; and
       (B) be in addition to any other amounts appropriated or 
     made available to the Secretary of Health and Human Services 
     with respect to the Medicaid program.

     SEC. 5. ASSET VERIFICATION THROUGH ACCESS TO INFORMATION HELD 
                   BY FINANCIAL INSTITUTIONS.

       (a) Addition of Authority.--Title XIX of the Social 
     Security Act is amended by inserting after section 1939 the 
     following new section:


 ``asset verification through access to information held by financial 
                              institutions

       ``Sec. 1940.  (a) Implementation.--
       ``(1) In general.--Subject to the provisions of this 
     section, each State shall implement an asset verification 
     program described in subsection (b), for purposes of 
     determining or redetermining the eligibility of an individual 
     for medical assistance under the State plan under this title.
       ``(2) Plan submittal.--In order to meet the requirement of 
     paragraph (1), each State shall--
       ``(A) submit not later than a deadline specified by the 
     Secretary consistent with paragraph (3), a State plan 
     amendment under this title that describes how the State 
     intends to implement the asset verification program; and
       ``(B) provide for implementation of such program for 
     eligibility determinations and redeterminations made on or 
     after 6 months after the deadline established for submittal 
     of such plan amendment.
       ``(3) Phase-in.--
       ``(A) In general.--
       ``(i) Implementation in current asset verification demo 
     states.--The Secretary shall require those States specified 
     in subparagraph (C) (to which an asset verification program 
     has been applied before the date of the enactment of this 
     section) to implement an asset verification program under 
     this subsection by the end of fiscal year 2009.
       ``(ii) Implementation in other states.--The Secretary shall 
     require other States to submit and implement an asset 
     verification program under this subsection in such manner as 
     is designed to result in the application of such programs, in 
     the aggregate for all such other States, to enrollment of 
     approximately, but not less than, the following percentage of 
     enrollees, in the aggregate for all such other States, by the 
     end of the fiscal year involved:

       ``(I) 12.5 percent by the end of fiscal year 2009.
       ``(II) 25 percent by the end of fiscal year 2010.
       ``(III) 50 percent by the end of fiscal year 2011.
       ``(IV) 75 percent by the end of fiscal year 2012.
       ``(V) 100 percent by the end of fiscal year 2013.

       ``(B) Consideration.--In selecting States under 
     subparagraph (A)(ii), the Secretary shall consult with the 
     States involved and take into account the feasibility of 
     implementing asset verification programs in each such State.
       ``(C) States specified.--The States specified in this 
     subparagraph are California, New York, and New Jersey.
       ``(D) Construction.--Nothing in subparagraph (A)(ii) shall 
     be construed as preventing a State from requesting, and the 
     Secretary approving, the implementation of an asset 
     verification program in advance of the deadline otherwise 
     established under such subparagraph.
       ``(4) Exemption of territories.--This section shall only 
     apply to the 50 States and the District of Columbia.
       ``(b) Asset Verification Program.--
       ``(1) In general.--For purposes of this section, an asset 
     verification program means a program described in paragraph 
     (2) under which a State--
       ``(A) requires each applicant for, or recipient of, medical 
     assistance under the State plan under this title on the basis 
     of being aged, blind, or disabled to provide authorization by 
     such applicant or recipient (and any other person whose 
     resources are material to the determination of the 
     eligibility of the applicant or recipient for such 
     assistance) for the State to obtain (subject to the cost 
     reimbursement requirements of section 1115(a) of the Right to 
     Financial Privacy Act but at no cost to the applicant or 
     recipient) from any financial institution (within the meaning 
     of section 1101(1) of such Act) any financial record (within 
     the meaning of section 1101(2) of such Act) held by the 
     institution with respect to the applicant or recipient (and 
     such other person, as applicable), whenever the State 
     determines the record is needed in connection with a 
     determination with respect to such eligibility for (or the 
     amount or extent of) such medical assistance; and
       ``(B) uses the authorization provided under subparagraph 
     (A) to verify the financial resources of such applicant or 
     recipient (and such other person, as applicable), in order to 
     determine or redetermine the eligibility of such applicant or 
     recipient for medical assistance under the State plan.
       ``(2) Program described.--A program described in this 
     paragraph is a program for verifying individual assets in a 
     manner consistent with the approach used by the Commissioner 
     of Social Security under section 1631(e)(1)(B)(ii).
       ``(c) Duration of Authorization.--Notwithstanding section 
     1104(a)(1) of the Right to Financial Privacy Act, an 
     authorization provided to a State under subsection (b)(1) 
     shall remain effective until the earliest of--
       ``(1) the rendering of a final adverse decision on the 
     applicant's application for medical assistance under the 
     State's plan under this title;
       ``(2) the cessation of the recipient's eligibility for such 
     medical assistance; or
       ``(3) the express revocation by the applicant or recipient 
     (or such other person described in subsection (b)(1), as 
     applicable) of the authorization, in a written notification 
     to the State.
       ``(d) Treatment of Right to Financial Privacy Act 
     Requirements.--
       ``(1) An authorization obtained by the State under 
     subsection (b)(1) shall be considered to meet the 
     requirements of the Right to Financial Privacy Act for 
     purposes of section 1103(a) of such Act, and need not be 
     furnished to the financial institution, notwithstanding 
     section 1104(a) of such Act.
       ``(2) The certification requirements of section 1103(b) of 
     the Right to Financial Privacy Act shall not apply to 
     requests by the State pursuant to an authorization provided 
     under subsection (b)(1).
       ``(3) A request by the State pursuant to an authorization 
     provided under subsection (b)(1) is

[[Page H2504]]

     deemed to meet the requirements of section 1104(a)(3) of the 
     Right to Financial Privacy Act and of section 1102 of such 
     Act, relating to a reasonable description of financial 
     records.
       ``(e) Required Disclosure.--The State shall inform any 
     person who provides authorization pursuant to subsection 
     (b)(1)(A) of the duration and scope of the authorization.
       ``(f) Refusal or Revocation of Authorization.--If an 
     applicant for, or recipient of, medical assistance under the 
     State plan under this title (or such other person described 
     in subsection (b)(1), as applicable) refuses to provide, or 
     revokes, any authorization made by the applicant or recipient 
     (or such other person, as applicable) under subsection 
     (b)(1)(A) for the State to obtain from any financial 
     institution any financial record, the State may, on that 
     basis, determine that the applicant or recipient is 
     ineligible for medical assistance.
       ``(g) Use of Contractor.--For purposes of implementing an 
     asset verification program under this section, a State may 
     select and enter into a contract with a public or private 
     entity meeting such criteria and qualifications as the State 
     determines appropriate, consistent with requirements in 
     regulations relating to general contracting provisions and 
     with section 1903(i)(2). In carrying out activities under 
     such contract, such an entity shall be subject to the same 
     requirements and limitations on use and disclosure of 
     information as would apply if the State were to carry out 
     such activities directly.
       ``(h) Technical Assistance.--The Secretary shall provide 
     States with technical assistance to aid in implementation of 
     an asset verification program under this section.
       ``(i) Reports.--A State implementing an asset verification 
     program under this section shall furnish to the Secretary 
     such reports concerning the program, at such times, in such 
     format, and containing such information as the Secretary 
     determines appropriate.
       ``(j) Treatment of Program Expenses.--Notwithstanding any 
     other provision of law, reasonable expenses of States in 
     carrying out the program under this section shall be treated, 
     for purposes of section 1903(a), in the same manner as State 
     expenditures specified in paragraph (7) of such section.''.
       (b) State Plan Requirements.--Section 1902(a) of such Act 
     (42 U.S.C. 1396a(a)) is amended--
       (1) in paragraph (69) by striking ``and'' at the end;
       (2) in paragraph (70) by striking the period at the end and 
     inserting ``; and''; and
       (3) by inserting after paragraph (70), as so amended, the 
     following new paragraph:
       ``(71) provide that the State will implement an asset 
     verification program as required under section 1940.''.
       (c) Withholding of Federal Matching Payments for 
     Noncompliant States.--Section 1903(i) of such Act (42 U.S.C. 
     1396b(i)) is amended--
       (1) in paragraph (22) by striking ``or'' at the end;
       (2) in paragraph (23) by striking the period at the end and 
     inserting ``; or''; and
       (3) by adding after paragraph (23) the following new 
     paragraph:
       ``(24) if a State is required to implement an asset 
     verification program under section 1940 and fails to 
     implement such program in accordance with such section, with 
     respect to amounts expended by such State for medical 
     assistance for individuals subject to asset verification 
     under such section, unless--
       ``(A) the State demonstrates to the Secretary's 
     satisfaction that the State made a good faith effort to 
     comply;
       ``(B) not later than 60 days after the date of a finding 
     that the State is in noncompliance, the State submits to the 
     Secretary (and the Secretary approves) a corrective action 
     plan to remedy such noncompliance; and
       ``(C) not later than 12 months after the date of such 
     submission (and approval), the State fulfills the terms of 
     such corrective action plan.''.
       (d) Repeal.--Section 4 of Public Law 110-90 is repealed.

     SEC. 6. ADJUSTMENT TO PAQI FUND.

       Section 1848(l)(2) of the Social Security Act (42 U.S.C. 
     1395w-4(l)(2)), as amended by section 101(a)(2) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), is amended--
       (1) in subparagraph (A)(i)--
       (A) in subclause (III), by striking ``$4,960,000,000'' and 
     inserting ``$3,790,000,000''; and
       (B) by adding at the end the following new subclause:

       ``(IV) For expenditures during 2014, an amount equal to 
     $3,690,000,000.'';

       (2) in subparagraph (A)(ii), by adding at the end the 
     following new subclause:

       ``(IV) 2014.--The amount available for expenditures during 
     2014 shall only be available for an adjustment to the update 
     of the conversion factor under subsection (d) for that 
     year.''; and

       (3) in subparagraph (B)--
       (A) in clause (ii), by striking ``and'' at the end;
       (B) in clause (iii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iv) 2014 for payment with respect to physicians' 
     services furnished during 2014.''.

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


                             General Leave

  Mr. DINGELL. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and to 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Mr. Speaker, I yield myself 3 minutes.
  Mr. Speaker, I rise today in support of H.R. 5613, the Protecting the 
Medicaid Safety Net Act of 2008. This is a bipartisan bill, critically 
important to our Nation's safety net. The Committee on Energy and 
Commerce reported it favorably with a strong bipartisan vote of 46-0.
  I want to commend and thank our subcommittee chairman, Mr. Pallone, 
and our distinguished colleague and cosponsor of the legislation, Mr. 
Murphy of Pennsylvania, for their leadership on this matter. And I want 
to express to my good friends and the ranking members on the committee 
and the subcommittee, Mr. Barton and Mr. Deal, for their superb 
cooperation.
  I also want to thank my colleagues on the Committees on Ways and 
Means and Financial Services for the splendid cooperation and help they 
gave us in moving this legislation to the floor expeditiously. The 
support of Chairmen Rangel and Stark were both necessary and very much 
appreciated.
  H.R. 5613 places a 1-year moratorium on seven regulations recently 
issued by the U.S. Department of Health and Human Services. The 
regulations would have restricted payments to critical safety net 
providers such as hospitals and nursing homes, as well as payments for 
graduate medical education training. The regulation would have reduced 
or eliminated payments that allow children with severe mental illness 
to remain in family settings, and payments to schools transporting poor 
children with disabilities. The Governors of all 50 States oppose these 
rules, as do the State Medicaid directors, State legislators, and the 
National Association of Counties.
  More than 2,000 national and local groups such as the American 
Hospital Association, the American Federation of Teachers and the March 
of Dimes support this legislation. They know of the devastating effect 
these rules would have upon local communities, upon the hospitals, and 
upon vulnerable beneficiaries.
  Without this moratorium, schools would be forced to lay off workers 
starting in June. Hospitals and nursing homes would be forced to cut 
off services and to lay off workers as well. In troublesome economic 
times, we cannot afford to lose good-paying jobs or to cut services 
that enable people with disabilities to be gainfully employed.
  H.R. 5613 will postpone the implementation of these seven rules for 1 
year, giving Congress time to evaluate the effect they would have on 
States, providers and beneficiaries.
  I want to again commend my colleagues on both sides of the aisle, 
including my dear friend, Mr. Barton, and Mr. Deal for their leadership 
and hard work on this matter. I urge my colleagues to vote for H.R. 
5613.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. BARTON of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. BARTON of Texas. Mr. Speaker, I rise today to join my good 
friend, Chairman John Dingell of the Energy and Commerce Committee, in 
support of H.R. 5613, the Protecting the Medicaid Safety Net Act of 
2008.
  Given the fact that Secretary Leavitt of Health and Human Services 
indicated that he would recommend to the President of the United States 
that he veto the bill before us in its current form, I do wish we could 
have brought the bill to the floor under a rule with several potential 
amendments and a motion to recommit so that we can have a little bit 
fuller debate rather than putting it on the suspension calendar. Having 
said that, I am very glad that it is coming to the floor as a stand-
alone bill, and that Chairman Dingell and Chairman Pallone of the 
subcommittee have followed regular order in passing this legislation.
  I want to thank Chairman Dingell and Chairman Pallone for holding a

[[Page H2505]]

legislative hearing as well as a subcommittee markup and a full 
committee markup on the bill that's now before us. I also want to thank 
them for having an open process, where staff on both sides of the aisle 
could work together, amendments could be shared, and some of those 
amendments could be agreed upon and incorporated into the bill that's 
before us today. I would not have been able to support H.R. 5613 as 
originally introduced, but I can support the bill that's before us this 
afternoon. I'm proud that, on occasion, we do put good public policy 
ahead of partisan politics, and the bill before us, again, is an 
example of what I believe to be better public policy.
  I do hope that we take this opportunity to take the issue before us, 
if this bill becomes law, and actually work on it for the year that the 
moratorium is in place. The bill before us would place a year-long 
moratorium on seven Medicaid rules. It does not mean that the suspended 
rules themselves are all bad and don't address a problem that needs to 
be addressed. It does mean that many of the interest groups and many of 
the States had significant problems with those rules, and so it was 
felt prudent to have a moratorium where we could hopefully, in the 
interim, determine how to fine tune and maybe change some of those 
rules.
  We do need to save money in Medicaid. We do need to do something on 
this system of intergovernmental transfers. For those of you who don't 
understand what an intergovernmental transfer is, as used in Medicaid, 
a State will give money to the Federal Government that is then matched 
by the Federal Government and sent back to the State. The State will 
give some of that money to, in this case a hospital system, but then 
keep some of the money that it initially gave. So it's kind of a shell 
game where you put up some money to get it matched, and once you get 
the matched back, the money you put up you use for another purpose, not 
for a health purpose, but maybe for a different purpose, like building 
a highway or something like that. One of the suspended rules would have 
addressed this intergovernmental transfer, and I hope that in the next 
year, on a bipartisan basis, we can address the intergovernmental 
transfer issue itself.
  Mr. DINGELL. Will the gentleman from Texas yield?
  Mr. BARTON of Texas. I would be happy to yield.
  Mr. DINGELL. I want to again commend my friend from Texas for his 
superb performance on this legislation. And I want to assure him that I 
share his concerns on the intergovernmental transfer matter, and that 
we will be going into it. I thank my friend.
  Mr. BARTON of Texas. I thank the distinguished chairman.
  We simply cannot pretend on a day that we're suspending these rules 
that there are not fundamental financial difficulties facing Medicaid. 
So while we agree to suspend the rules for the next year, I hope we can 
also agree, as the chairman just indicated that he did, that we're 
going to continue to work on the problems these rules were designed to 
address so that over time we can reach agreement on how to save money 
under Medicaid.
  I do believe the bill before us is a good bill. It does have a pay-
for. It is, on a net basis, a slight revenue increase to the Federal 
Treasury, so it is paid for. And if we spend the next year working 
together, if we implement some of the things in this bill, the bill 
gives $25 million a year to combat waste, fraud and abuse in Medicaid, 
if we use that money wisely, we will uncover some savings. And if we 
look at some of these suspended rules, we can perhaps work together to 
fine tune them so that a year from now, at the beginning of the next 
administration, we don't have to extend the moratorium.
  In short, Mr. Speaker, while this is not a perfect bill, it's a good 
bill. Don't let the pursuit of perfection prevent the accomplishment of 
what is something that is good and possible.
  I would urge a ``yes'' vote on H.R. 5613, especially on my side of 
the aisle, among the Republicans in the House of Representatives.
  With that, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 3 minutes to the distinguished 
gentleman from California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, I rise in strong support of the Dingell-
Murphy bill, H.R. 5613, which would delay seven Medicaid regulations 
that would shift billions of dollars in costs from the Federal 
Government to States, counties, school districts, hospitals, and other 
medical providers. There is absolutely no justification for such a cost 
shift, especially at a time when many States are struggling to avoid 
budget cuts as their economies slow and revenues decline. The bill 
would delay the implementation of these regulations until April 1, 
2009.
  The Oversight Committee held hearings on this matter. We heard 
testimony from public and teaching hospital administrators, an 
emergency room physician, a child welfare worker and a school nurse. 
They explained how the regulations would shift costs to States and 
localities and what that cost would mean for access to services for 
beneficiaries. We also heard from a representative from the Centers for 
Medicare and Medicaid Services, which issued these regulations.
  And since Medicaid is a Federal-State program, one would think that 
when the Federal Government changes the rules, as these regulations 
would do, it would first try to determine what the impact of these 
changes would be on the different States. Well, we followed up with the 
head of the CMS for Medicaid, and he told us that he had not done a 
State-by-State specific analysis of the impact and he had no plans to 
do such an analysis. So our committee made our own analysis. We did a 
survey of Medicaid directors for 43 States and the District of 
Columbia, and they told us that if CMS were allowed to implement all 
seven Medicaid regulations, their States would lose nearly $50 billion 
in Federal funds over the next 5 years. The result of these cost shifts 
would not be greater efficiency, it would not be a savings of money, it 
would simply come out of the reimbursements, and fewer eligible 
populations. They would disrupt the existing systems for care of 
fragile populations, such as adults with severe mental illness or 
children with special health care needs. They would undercut the 
financial stability of hospitals and emergency rooms that treat 
Americans without health insurance. They would impose large, new 
administrative burdens and costs on State Medicaid programs without any 
offsetting policy benefit.
  In short, the best professional judgment was that the regulations 
would have harmful fiscal and programmatic consequences for their 
States and the people that look to the Medicaid program as the safety 
net for health care.

                              {time}  1500

  The bill before us gives the department and the Congress the time to 
look into these issues in the detail they deserve without making 
fundamental changes in Federal Medicaid policy.
  I urge support for this bipartisan legislation.
  Mr. BARTON of Texas. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 3 minutes to the distinguished 
gentlewoman from California (Ms. Harman).
  Ms. HARMAN. Mr. Speaker, it's an honor to serve under Chairman 
Dingell on the Energy and Commerce Committee and to support this effort 
to keep the Medicaid safety net intact. That our chairman shepherded 
this must-pass bill through our committee with unanimous support is 
testament to his enormous legislative skill and bipartisanship.
  Unless we pass this bill, Mr. Speaker, public hospitals and the 
essential services they provide will be at grave risk. A major public 
hospital in my district, Harbor-UCLA Medical Center, is among them. It 
is the only level 1 trauma center near top terror targets like LAX and 
the ports of Long Beach and L.A. In the event of an attack, Harbor 
would be on the front lines. As a teaching hospital, it helps train the 
next generation of doctors.
  Mr. Speaker, if all seven Medicaid regulations are implemented, Los 
Angeles County will lose $240 million in annual funding, the equivalent 
of closing a public hospital like Harbor. Harbor is already 
overcrowded. It needs more help, not less. It needs to offer more 
services, not to close. H.R. 5613 will stop these catastrophic cuts, 
and it deserves our full support.
  I urge our colleagues to vote ``aye'' and to join in overriding a 
White House veto should one occur.
  Mr. BARTON of Texas. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield myself such time as I may consume.
  The distinguished gentleman from Pennsylvania (Mr. Tim Murphy) worked 
very hard on this important

[[Page H2506]]

legislation and is a cosponsor of it. Regrettably, he is detained, 
unfortunately, on an aircraft and is not able to be with us today to 
speak in favor of this bill on which he worked so hard. And I want the 
Record to show that the House owes the distinguished gentleman from 
Pennsylvania (Mr. Tim Murphy) a real debt of thanks for his hard work 
here and for his remarkable leadership.
  Mr. Speaker, I now yield 2 minutes to my dear friend the gentleman 
from New York (Mr. Towns).
  Mr. TOWNS. Mr. Speaker, I rise to commend Chairman Dingell and, of 
course, Congressman Murphy and Congressman Barton for placing this 1-
year moratorium on the CMS Medicaid rules that would devastate 
patients, persons with disabilities, hospitals, States, and our entire 
safety net. Instead, these are the very entities and people that we 
should be helping, not hurting. CMS went well beyond the authority 
Congress allowed in enacting these rules.
  Therefore, as a cosponsor, I urge my colleagues to vote in favor of 
this measure and support our Nation's Governors who have called for 
this moratorium and rightfully so. So I urge my colleagues to support 
this legislation.
  Mr. BARTON of Texas. Mr. Speaker, I simply want to reiterate that as 
the ranking member on the Energy and Commerce Committee, I strongly 
support this piece of legislation. It did receive the votes of every 
Republican on the committee. It passed 46-0. I had wished it would not 
have been a suspension calendar bill, but I am happy it is a stand-
alone bill, and I would encourage my colleagues to vote for this bill.
  Mr. Speaker, I yield back the balance of my time.
  Mr. DINGELL. Mr. Speaker, I want to thank again my colleague from 
Texas. He is always a gentleman.
  I want to note that last night the Commerce Committee dedicated a 
picture hung in the committee in honor of our good friend Mr. Barton. 
It is a fine-looking picture of a distinguished former chairman of the 
committee, and I would urge my colleagues, if they want to look at a 
distinguished Member of this body hanging on the wall in the committee 
and to look at a very fine piece of art, they should come over and see 
the excellent picture of our good friend Mr. Barton hanging there in 
the committee.
  Mr. BACA. Mr. Speaker, I rise in support of H.R. 5613, the Protecting 
the Medicaid Safety Net Act of 2008. After unsuccessful attempts at S-
CHIP over the last several months, over 33,000 children in my district 
are still uninsured.
  Now the most vulnerable of beneficiaries of Medicaid, children and 
the disabled, are faced with a major crisis. This bill has bipartisan 
support, this is not about politics. It's about helping hardworking 
families and the poorest among us.
  This bill includes a moratorium of 7 CMS regulations, preventing the 
stripping of over $20 billion in Federal Medicaid funding over the next 
5 years to States for vital programs and services. These programs and 
services will only shrink and shrivel if they are put against the wall 
to eat up these costs.
  Even school districts, like Rialto Unified School District from my 
district, will face difficult challenges in providing direct health 
services to the 30,000 students it currently serves.
  Cutting these valuable services at a time when many States, including 
California are facing record budget deficits is not an option. The 
poorest amongst us on Medicaid are most affected. We cannot turn our 
backs during these troubling times of increasing foreclosures and 
rising gas prices.
  Cancer does not distinguish between incomes, why should health care 
coverage?
  I support H.R. 5613, and urge my colleagues to do the honorable thing 
and vote for this bill.
  Mr. STARK. Mr. Speaker, I rise to express my strong support for H.R. 
5613, the ``Protecting the Medicaid Safety Net Act of 2008.'' This bill 
stops George Bush's draconian attempt to gut the Medicaid program, 
which provides medical care to millions of low-income children and 
families.
  If we fail to enact this bill, more than $20 billion in vital Federal 
funding for States will disappear. This is $20 billion that helps 
schools provide transportation for physically disabled children, allows 
local governments to contribute to the State Medicaid share, and trains 
physicians.
  This President has presided over the greatest transition from boom to 
bust since the 1920s. As families face foreclosure and rising food and 
gas costs, States see declining sales tax receipts and greater numbers 
in need of assistance. Our President would add insult to injury for 
working families by dismantling their safety net.
  The seven regulations proposed by the Bush administration would 
undermine longstanding practices upon which States have built their 
Medicaid programs. The regulations are opposed by a bipartisan 
coalition of lawmakers; all the Nation's Governors from both sides of 
the aisle; and a host of public health, physician, and patient 
advocates. The bill passed unanimously out of the Energy and Commerce 
Committee. In this day and age, that is a remarkable phenomenon. I am 
proud to join colleagues from both sides of the aisle to vote in favor 
of this moratorium and to protect the health care safety net for 
America's working families.
  Ms. MOORE of Wisconsin. Mr. Speaker, today I join a bipartisan House 
to stand up to the Bush administration to prevent it from irresponsibly 
slashing the Medicaid budget. States that work with the Federal 
government to run and fund Medicaid programs are already facing 
budgetary restraints, flat funding, and shortfalls. The 
administration's proposed cuts to Medicaid would exacerbate their 
budgetary crunch, and would directly affect the quality of care given 
to low-income kids, seniors, families and people living with 
disabilities.
  The bill before us today, H.R. 5613, would place a 1-year moratorium 
on seven Medicaid regulations proposed by the administration. This 1-
year moratorium would give Congress more time to evaluate the potential 
effects of his proposed cuts on State Medicaid programs and the 
individuals that they serve. Several groups have warned that the 
unexpected slashes in Federal Medicaid dollars could force States to 
shift their Medicaid costs to patients, who would be hard pressed to 
make up the differences in health care costs. At present, some 30 
million low-income children depend on the Medicaid program.
  The Government Accountability Office testified that it had not 
recommended the specific changes proposed by the administration, nor 
had officials there had time to adequately study the potential effects 
of these changes for 6 of the 7 regulations. Before the President 
starts tinkering with domestic programs upon which millions of our most 
vulnerable citizens rely, he owes it to them to do his homework. If he 
won't, then Congress owes it to the American people to investigate his 
proposed changes so we can fully understand their effect on poor and 
working families.
  Nearly 2,000 groups from across the country, including school 
districts, hospitals, case management providers, and organizations 
serving people with disabilities and mental illnesses have joined us in 
support of the Protecting the Medicaid Safety Net Act. I am proud to be 
a cosponsor of this bill and urge my colleagues to cast their votes in 
favor of it.
  Mr. UPTON. Mr. Speaker, I rise today in support of H.R. 5613 the 
Protecting the Medicaid Safety Net Act, and urge my colleagues to join 
me in voting for it.
  Last week, my colleagues and I on the Energy and Commerce Committee 
unanimously approved H.R. 5613, the Protecting the Medicaid Safety Net 
Act. This bill places moratoria on seven regulations issued by the 
Center for Medicare and Medicaid Services, CMS. If allowed to go into 
effect as currently written, these regulations would seriously erode 
federal funding to the states for a range of Medicaid services, 
including rehabilitation and medical services for schoolchildren with 
disabilities, and would totally eliminate federal Medicaid matching 
funds for Graduate Medical Education at a time when my state is already 
in the grip of a growing physician shortage.
  I am particularly concerned about the detrimental effect that these 
regulations would have on students and schools in my district and 
districts across the country. Under the Individuals with Disabilities 
Education Act, schools are required to provide medical and 
rehabilitation services that are necessary for children to enter and 
continue to attend school. If federal matching funds are reduced or 
eliminated, our schools will still be required pay for these services, 
meaning other vital services and programs would have to be 
significantly cut back or eliminated.
  Another major concern of mine is the extent to which these 
regulations would reduce or eliminate federal matching payments for 
many of our community hospitals, seriously undermining access to care 
for poor and disabled women, children, and persons with disabilities. 
Our hospitals are already struggling under low Medicaid reimbursement 
rates and higher rates of uncompensated care as my State's economy has 
worsened. Like schools, hospitals are under a federal mandate--this one 
to examine and stabilize every patient who walks through their 
emergency room doors. These regulations could significantly increase 
hospitals' burden of uncompensated care.
  I am also concerned about provisions in several of the regulations 
that could well undo the progress we have made over many years in 
enabling persons with mental and physical

[[Page H2507]]

disabilities to live independently and participate as fully as they are 
able in the workforce and the life of their communities rather than 
being confined to institutional settings.
  Because of all these factors, I again encourage my colleagues to join 
me in voting for this bill.
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise in strong support of 
H.R. 5613, the Protecting Medicaid Safety Net Act. The rules issued by 
CMS in August were said to be cost saving measures and a way to reduce 
waste, fraud, and abuse.
  If these 7 regulations go into effect Texas would lose $3.4 billion 
in Federal Medicaid funding over the next 5 years and nationwide cuts 
to Medicaid funding could total around $50 billion. These regulations 
attack the core mission of Medicaid by eliminating much needed services 
for children, the elderly, and the poor.
  These cuts will also have a devastating impact on state's Medicaid 
funds; consequently hurting the most vulnerable populations who are 
helped by the Medicaid safety net. This population accesses services 
and support care from Medicaid because they cannot access services 
elsewhere due to costs or restrictions on benefits.
  If these regulations go into effect, I don't know where the states 
will find the funds to continue operating programs such as school 
administrative and transportation services, coverage for rehabilitative 
services, and outpatient hospital services. Especially since the lack 
of Medicaid funding will create budget crises in most states as they 
scramble to pay for services or eliminate them altogether.
  This bill gives Congress enough time to understand the consequences 
of these regulations and come up with a solution we all can agree on 
rather than cutting these necessary services.
  I am disappointed that the Administration has threatened to veto this 
bill. This piece of legislation is the result of a lot of hard work on 
both sides of the aisle.
  I am particularly upset that the Administration seems to have 
forgotten once again about its Texas roots. Texas, along with 
California and New York stand to lose the largest amount of funding 
from these Medicaid cuts and this is money our states cannot afford to 
lose.
  This bill has the support of 2,000 organizations and the National 
Governors Association. I urge my colleagues to support this bill and 
stop these cuts.
  Mr. GRIJALVA. Mr. Speaker, over the past year, the Centers for 
Medicare and Medicaid Services, CMS, have introduced a series of 
Medicaid regulations that have caused grave concern to our States and 
beneficiaries. States are struggling as the economy sinks into 
recession, and these proposed regulations, if not suspended, will add 
billions in Medicaid costs to our States at a time when their tax 
revenues are falling and Medicaid caseloads are growing.
  The seven regulations issued by CMS erode the foundation of the 
Medicaid system by preventing beneficiaries from accessing the care 
they need. These proposed regulations would endanger access to care by 
severely limiting payments to public hospitals, eliminate coverage for 
outpatient services that keep beneficiaries from unnecessary emergency 
room use, and by restricting support for transportation services for 
children with disabilities.
  I would like to take this opportunity to thank Chairman Dingell for 
his superb leadership on this issue and for introducing and garnering 
bipartisan support for this unfortunate but very necessary moratorium. 
This important legislation will help protect beneficiaries from harmful 
cuts and alleviate the immediate concerns that the Medicaid regulations 
cause for long term care patients, residents and providers alike. The 
bill also establishes an independent review of these regulations prior 
to the expiration of the moratorium next year. In addition, it provides 
$25 million to HHS each year, beginning in FY 2009, to fight fraud and 
abuse in the Medicaid program.
  This moratorium is a temporary fix, allowing Congress an opportunity 
to review these regulations as thoroughly as possible before they are 
implemented and the burden is borne by our constituents.
  While CMS argues that these changes will create efficiencies in the 
program, there is no evidence to support this claim. What is known is 
that these changes will cause extreme harm to our most vulnerable 
citizens--low-income children, the disabled, and the elderly. By 
utterly disregarding the immense public outcry surrounding the 
enactment of these rules, this administration is placing desperately 
needed services in jeopardy without thoroughly weighing the effects 
these regulations will have on States.
  Now more than ever, in the face of major State budget deficits, we 
cannot allow the Federal Government to make major regulatory changes to 
Medicaid that will result in billions of additional costs to states.
  I am a proud, original cosponsor of Chairman Dingell's H.R. 5613, the 
Protecting the Medicaid Safety Net Act of 2008 and urge all my 
colleagues in this 110th Congress to stand with me and stop this 
Administration from implementing these foolish and potentially 
devastating regulations.
  Mr. VAN HOLLEN. Madam Speaker, I rise in strong support of the 
Protecting the Medicaid Safety Net Act of 2008.
  Since its inception, Medicaid has been a joint State and Federal 
partnership to provide health care to the country's neediest and most 
vulnerable populations. Unfortunately, the Centers for Medicare and 
Medicaid Services, CMS, recently issued a series of Medicaid 
regulations that will significantly shift costs to States and restrict 
services to needy individuals. These regulations will force States to 
stop providing beneficiaries access to certain Medicaid services.
  Among the damaging Medicaid regulations issued by CMS, I am 
especially concerned about the restrictive rules on targeted case 
management services that help people with disabilities remain in their 
community. Nearly 200,000 people in Maryland receive some type of 
Medicaid case management services, and these new rules will put more 
than $60 million in Federal funds for Maryland at risk. CMS also 
proposes to eliminate or severely restrict Federal Medicaid funding for 
rehabilitation services, graduate medical education, hospital 
outpatient services, safety net institutions, and school-based 
transportation and outreach programs. While CMS claims that the 
elimination of $20 billion in Federal Medicaid funding will create 
efficiencies in the program, it did not consult with Congress on these 
far reaching regulations.
  With so many States, including Maryland, facing huge budget 
shortfalls and trying to figure out how to provide Medicaid services to 
their populations, now is not the time for the Federal Government to 
cut back on its share of funding. The legislation before us today would 
delay implementation of the regulations put forth by CMS so that 
Congress can examine their full impact.
  Mr. Speaker, we have a responsibility and an obligation to our 
vulnerable citizens--low-income children, the disabled, and the 
elderly--to effectively provide access to adequate and quality health 
care services. I urge my colleagues to support this bipartisan bill.
  Mrs. CHRISTENSEN. Mr. Speaker, I rise today in full support of H.R. 
5613--the Medicaid Safety Net Act of 2008.
  The millions of people who depend on this critical safety net and I 
thank and applaud Chairman Dingell for once again protecting our 
Nation's critically important Medicaid program.
  It is a shame that every year Democrats have to fight back at least 
one attempt to cut funding and provisions in this program that is so 
vital to the Nation's poor--the majority of which are people of color.
  The administration and the Secretary's policies are going in the 
absolute wrong direction. Rather Medicaid and Children's Health 
Insurance funding needs to be increased to meet the needs of the 
increasing numbers of un- and under-insured which includes 9 million 
children. This administration's failed economic policies have left more 
people vulnerable.
  Racial and ethnic minorities suffer worse morbidity and mortality 
because of lack of access. Caps on Medicaid in the territories don't 
even allow us to cover residents at 100 percent of poverty and per 
capita spending is a shamefully small fraction of that of our fellow 
Americans in the States.
  This Nation's healthcare system as we all know has become a sick-care 
system and not only is it not doing a good job at that, it is in crisis 
and on the verge of catastrophe.
  The proposed actions restricting payments for graduate medical 
education and blanket regulations against payment for certain services, 
threaten to not only make the healthcare situation in this country 
worse for the poor, but for everyone, and to threaten the 
competitiveness and security of our Nation.
  I look forward to the new Democratic administration, who will work 
with Chairman Dingell and others to transform health care in this 
country and reduce the skyrocketing costs through emphasis on 
prevention and equal access to quality, comprehensive culturally 
competent care for everyone who lives here. The foundation of this 
effort must be stronger Medicaid and SCHIP.
  By stopping the assault on these two programs; by stopping payments 
to hard working providers and for the training of the healthcare 
workforce needed, we set the stage for that transformation to begin.
  Thank you Mr. Chairman, for your continued leadership.
  I urge passage of H.R. 5613 to protect this important safety net.
  Mr. PAYNE. Mr. Speaker, I rise to express my strong support for the 
passage of H.R. 5613, the Protecting the Medicaid Safety Net Act. I 
commend my colleagues Representative Dingell and Representative Murphy 
for introducing this bill, which would extend until March 31, 2009 the 
moratorium on several Medicaid regulations that would strip an 
estimated $20 billion over 5 years from the Medicaid program.

[[Page H2508]]

  Mr. Speaker, for more than 40 years, Medicaid has served as the 
Nation's health care safety net, providing access to health services 
for millions who cannot afford private insurance in a dynamic and 
changing economy.
  Today, more than 57 million children, poor, disabled and elderly 
individuals rely on Medicaid for care. The program now serves more 
people than Medicare, and with the ranks of the uninsured growing, and 
the threat of an economic recession, the Medicaid program is more 
important than ever.
  Mr. Speaker, hospitals are the backbone of America's health care 
safety net, providing care to all patients who come through their 
doors, regardless of their ability to pay. But, hospitals are 
experiencing severe payment shortfalls when treating Medicaid patients.
  Despite these financial pressures, the Administration continues to 
call for further cuts in federal funds for the Medicaid program that 
will affect hospitals and the patients they serve.
  Despite concerns raised by Congress, CMS continues to take steps to 
implement these regulations. These rules range from limiting payments 
for teaching hospitals, public hospitals and hospital outpatient 
services to reducing school-based services for children and case 
management for the disabled.
  Last year, Congress imposed a year-long moratorium (P.L. 110-28) on 
two regulations the proposed and final cost-limit rule and the proposed 
graduate medical education (GME) rule. The moratorium on implementation 
of these rules expires May 25, 2008.
  CMS's regulatory budget-cutting policies will have a devastating 
effect on my home State of New Jersey's Medicaid program, along with 
the hospitals and physicians serving our Nation's most vulnerable 
population--poor children and mothers, the disabled and elderly 
individuals. Much of Congress has expressed opposition to these rules.
  This bill would delay implementation of regulations affecting: CPEs; 
IGTs; GME; coverage of rehab services for people with disabilities; 
outreach and enrollment in schools, in addition to specialized medical 
transportation to school for children covered by Medicaid; coverage of 
hospital outpatient services; case management services that allow 
people with disabilities to remain in the community; and state provider 
tax laws.
  Mr. Speaker, there is no question that CMS's regulatory budget-
cutting policies will have a devastating effect on my home State of New 
Jersey's Medicaid program, along with the hospitals and physicians 
serving our Nation's most vulnerable population--poor children and 
mothers, the disabled and elderly individuals.
  Mr. Speaker, we need to pass H.R. 5613 today. I urge my colleagues to 
vote for this bill legislation.
  Mr. DINGELL. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Michigan (Mr. Dingell) that the House suspend the rules 
and pass the bill, H.R. 5613, as amended.
  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. BROUN of Georgia. Mr. 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.

                          ____________________