[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.
____________________