[Congressional Record Volume 157, Number 43 (Tuesday, March 29, 2011)]
[Senate]
[Pages S1934-S1937]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Ms. COLLINS (for herself and Ms. Cantwell):
S. 659. A bill to amend title XVIII of the Social Security Act to
protect Medicare beneficiaries' access to home health services under
the Medicare program; to the Committee on Finance.
Ms. COLLINS. Mr. President, I rise today to join with my colleague
from Washington in introducing legislation, the Home Health Care Access
Protection Act of 2011, to prevent future unfair administrative cuts in
Medicare home health payment rates.
Home health has become an increasingly important part of our health
care system. The kinds of highly skilled and often technically complex
services that our Nation's home health agencies provide have helped to
keep families together and enabled millions of our most frail and
vulnerable older and disabled persons to avoid hospitals and nursing
homes and stay just where they want to be--in the comfort and security
of their own homes. Moreover, by helping these individuals to avoid
more costly institutional care, they are saving Medicare billions of
dollars each year.
That is why I find it so ironic--and troubling--that the Medicare
home health benefit continually comes under attack.
The health care reform bill signed into law by the President last
year includes $40 billion in cuts to home care over 10 years. Moreover,
these cuts are a ``double-whammy'' because they come on top of $25
billion in additional cuts to home health imposed by the Centers for
Medicare and Medicaid Services through regulation in the last several
years.
These cuts are particularly disproportionate for a program that costs
Medicare less than $20 billion a year. This simply is not right, and it
certainly is not in the best interest of our nation's seniors who rely
on home care to keep them out of hospitals, nursing homes, and other
institutions.
The payment rate cuts implemented and proposed by CMS are based on
the assertion that home health agencies have intentionally ``gamed the
system'' by claiming that their patients have conditions of higher
clinical severity than they actually have in order to receive higher
Medicare payments. This unfounded allegation of ``case mix creep'' is
based on what CMS contends to be an increase in the average clinical
assessment ``score'' of home health patients over the last few years.
In fact, there are very real clinical and policy explanations for why
the average clinical severity of home care patients' health conditions
may have increased over the years. For example, the incentives built
into the hospital diagnosis-related group--or DRG--reimbursement system
have led to the faster discharge of sicker patients. Advances in
technology and changes in medical practice have also enabled home
health agencies to treat more complicated medical conditions that
previously could only be treated in hospitals, nursing homes, or
inpatient rehabilitation facilities.
Moreover, this unfair payment rate cut is being assessed across the
board, even for home health agencies that showed a decrease in their
clinical assessment scores. If an individual home
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health agency is truly gaming the system, CMS should target that one
agency, not penalize everyone.
The research method, data and findings that CMS has used to justify
the administrative cuts also raise serious concerns about the validity
of the payment rate cuts. For example, while changes in the need for
therapy services significantly affect the case mix ``score,'' the CMS
research methodology disregards those changes in evaluating whether the
patient population has changed. Moreover, the method by which CMS
evaluates changes in case mix coding is not transparent, does not allow
for true public participation, and is not performed in a manner that
ensures accountability to Medicare patients and providers in terms of
its validity and accuracy of outcomes.
The legislation we are introducing today will establish a reliable
and transparent process for determining whether payment rate cuts are
needed to account for improper changes in ``case mix scoring'' that are
not related to changes in the nature of the patients served in home
health care or the nature of the care they received. This process will
still enable the Secretary of Health and Human Services to enact rate
adjustments provided there is reliable evidence that higher case mix
scores are resulting from factors other than changes in patient
conditions. The legislation will also prevent the implementation of
future Medicare payment rate cuts in home health until the Secretary is
able to justify the payment cuts through the improved process set forth
in the bill.
Home health care has consistently proven to be a compassionate and
cost-effective alternative to institutional care. Additional deep cuts
will be completely counterproductive to our efforts to control overall
health care costs. The Home Health Care Access Protection Act of 2011
will help to ensure that our seniors and disabled Americans continue to
have access to the quality home health services they deserve, and I
encourage all of my colleagues to sign on as cosponsors.
______
By Mr. KYL (for himself, Mr. McConnell, Mr. Barrasso, Mr. Coburn,
Mr. Crapo, and Mr. Roberts):
S. 660. A bill to protect all patients by prohibiting the use of data
obtained from comparative effectiveness research to deny or delay
coverage of items or services under Federal health care programs and to
ensure that comparative effectiveness research accounts for
advancements in personalized medicine and differences in patient
treatment response; to the Committee on Health, Education, Labor, and
Pensions.
Mr. KYL. Mr. President, I ask unanimous consent that the text of the
bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 660
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 ``Preserving Access to
Targeted, Individualized, and Effective New Treatments and
Services (PATIENTS) Act of 2011'' or the ``PATIENTS Act of
2011''.
SEC. 2. PROHIBITION ON CERTAIN USES OF DATA OBTAINED FROM
COMPARATIVE EFFECTIVENESS RESEARCH; ACCOUNTING
FOR PERSONALIZED MEDICINE AND DIFFERENCES IN
PATIENT TREATMENT RESPONSE.
(a) In General.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services--
(1) shall not use data obtained from the conduct of
comparative effectiveness research, including such research
that is conducted or supported using funds appropriated under
the American Recovery and Reinvestment Act of 2009 (Public
Law 111-5) or authorized or appropriated under the Patient
Protection and Affordable Care Act (Public Law 111-148), to
deny or delay coverage of an item or service under a Federal
health care program (as defined in section 1128B(f) of the
Social Security Act (42 U.S.C. 1320a-7b(f))); and
(2) shall ensure that comparative effectiveness research
conducted or supported by the Federal Government accounts for
factors contributing to differences in the treatment response
and treatment preferences of patients, including patient-
reported outcomes, genomics and personalized medicine, the
unique needs of health disparity populations, and indirect
patient benefits.
(b) Rule of Construction.--Nothing in this section shall be
construed as affecting the authority of the Commissioner of
Food and Drugs under the Federal Food, Drug, and Cosmetic Act
or the Public Health Service Act.
______
By Mr. BROWN of Ohio (for himself and Ms. Snowe):
S. 665. A bill to promote industry growth and competitiveness and to
improve worker training, retention, and advancement, and for other
purposes; to the Committee on Health, Education, Labor, and Pensions.
Ms. SNOWE. Mr. President, I rise today in support of the Selecting
Employment Clusters to Organize Regional Success, SECTORS, Act, which
Senator Sherrod Brown and I are introducing. This legislation would
amend the Workforce Investment Act of 1998 to establish an industry or
sector partnership grant program administered by the Department of
Labor.
The SECTORS Act provides grants to industry clusters--interrelated
group of businesses, service providers, and associated institutions--in
order to establish and expand sector partnerships. By providing
financial assistance to these partnerships, this legislation would
create customized workforce training solutions for specific industries
at a regional level. A sector approach is beneficial because it can
focus on the dual goals of promoting the long-term competitiveness of
industries and advancing employment opportunities for workers, thereby
encouraging economic growth. Existing sector partnerships have long
been recognized as key strategic elements within some of the most
successful economic development initiatives throughout the country.
Unfortunately, current federal policy does not provide sufficient
support for these critical ventures.
As Co-Chair of the bipartisan Senate Task Force on Manufacturing, one
of my key goals is to ensure that manufacturers have access to a
capable workforce. Unfortunately, manufacturers across the country have
raised significant concerns about whether the next generation of
workers is being trained to meet the needs of an increasingly high-tech
workplace.
In fact, in my home State of Maine, the manufacturing sector has shed
an alarming 26,200 jobs in the past ten years, or 1/3 of the State's
manufacturing employment. And since the beginning of 1990, our state
has lost 43,000 jobs. It is therefore critical that we as a Nation
provide unemployed manufacturing workers the training needed to excel
as our manufacturing sector becomes increasingly technical. This
legislation provides a crucial link between establishing worker
training programs and fostering new employment opportunities for those
who have been affected by the manufacturing industry's decline. By
promoting this innovative partnership, we will take a crucial step
toward rejuvenating our economy.
Throughout the country, sector partnerships are being used to promote
the long-term competitiveness of industries and to advance employment
opportunities. For example, the State of Maine has created the North
Star Alliance Initiative. The Alliance has brought together Maine's
boat builders, the University of Maine's Advanced Engineered Wood
Composites Centers, Maine's marine and composite trade association,
economic development groups, and investment organizations for the
purpose of advancing workforce training.
Our Nation's capacity to innovate is a key reason why our economy,
despite difficult times, remains the envy of the world. Ideas by
innovative Americans across the spectrums of professions and industries
have paid enormous dividends, improving the lives of millions
throughout the world. We must continue to encourage all avenues for
advancing our nation's economic well-being if America is to compete at
the vanguard of innovation. The SECTORS Act will help align America's
workforce with the needs of our Nation's employers to promote a robust
and growing economy.
______
By Mr. BAUCUS (for himself, Mr. Johnson of South Dakota, Mr.
Conrad, and Mr. Tester):
S. 666. A bill to require a report on the establishment of a
Polytrauma Rehabilitation Center or Polytrauma Network Site of the
Department of Veterans Affairs in the northern Rockies or Dakotas, and
for other purposes; to the Committee on Veterans' Affairs.
[[Page S1936]]
Mr. BAUCUS. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 666
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 ``Veterans Traumatic Brain
Injury Care Improvement Act of 2011''.
SEC. 2. REPORT ON ESTABLISHMENT OF A POLYTRAUMA
REHABILITATION CENTER OR POLYTRAUMA NETWORK
SITE OF THE DEPARTMENT OF VETERANS AFFAIRS IN
THE NORTHERN ROCKIES OR DAKOTAS.
(a) Findings.--Congress makes the following findings:
(1) The States of the northern Rockies and the Dakotas are
among those States in the United States with the highest per
capita rates of veterans with injuries from military service
in Iraq and Afghanistan.
(2) Traumatic brain injury (TBI) has become known as one of
the ``signature wounds'' of military service in Iraq and
Afghanistan due to its high occurrence among veterans of such
service.
(3) A recent RAND Corporation study estimates that as many
as 20 percent of the veterans of military service in Iraq and
Afghanistan have a traumatic brain injury as a result of such
service, and many of these veterans require ongoing care for
mild, moderate, or severe traumatic brain injury.
(4) The Department of Veterans Affairs recommends that all
veterans experiencing a polytraumatic injury be referred to a
Polytrauma Rehabilitation Center or a Polytrauma Network
Site.
(5) The Department of Veterans Affairs Polytrauma System of
Care includes 4 Polytrauma Rehabilitation Centers and 22
Polytrauma Network Sites, none of which are located in North
Dakota, South Dakota, Idaho, Montana, eastern Washington, or
Wyoming, an area that encompasses approximately 740,000
square miles.
(6) The vastness of this area imposes significant hardships
on veterans residing in this area who require care within the
Department of Veterans Affairs Polytrauma System of Care and
wish to live close to home while receiving care within such
system of care.
(b) Report.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to Congress a report on the feasibility and
advisability of establishing a Polytrauma Rehabilitation
Center or Polytrauma Network Site for the Department of
Veterans Affairs in the northern Rockies or the Dakotas. One
of the locations evaluated as a potential location for the
Polytrauma Rehabilitation Center or Polytrauma Network Site,
as the case may be, shall be the Fort Harrison Department of
Veterans Affairs hospital in Lewis and Clark County, Montana.
(2) Requirements.--The report required by this subsection
shall include the following:
(A) An assessment of the adequacy of existing Department of
Veterans Affairs facilities in the northern Rockies and the
Dakotas to address matters that are otherwise addressed by
Polytrauma Rehabilitation Centers and Polytrauma Network
Sites.
(B) A comparative assessment of the effectiveness of
rehabilitation programs for individuals with traumatic brain
injuries in urban areas with the effectiveness of such
programs for individuals with traumatic brain injuries in
rural and frontier communities.
(C) An assessment whether the low cost of living in the
northern Rockies and the Dakotas could reduce the financial
stress faced by veterans receiving care for traumatic brain
injury and their families and thereby improve the
effectiveness of such care.
(D) An assessment whether therapies that can prevent or
remediate the development of secondary neurologic conditions
related to traumatic brain injury can be interrupted by
stress caused by living in an urban area.
(3) Consultation.--The Secretary shall consult with
appropriate State and local government agencies in the
northern Rockies and the Dakotas in preparing the report
required by this subsection.
______
By Mr. SESSIONS (for himself, Mr. Blumenthal, Mr. Hatch, Ms.
Klobuchar, Mr. Grassley, Mr. Whitehouse, Mr. Cornyn, Mr. Kyl,
Mr. Graham, Mr. Lee, Ms. Collins, Mr. Thune, Mr. Coburn, Mr.
Burr, and Mr. Chambliss):
S. 671. A bill to authorize the United States Marshals Service to
issue administrative subpoenas in investigations relating to
unregistered sex offenders; to the Committee on the Judiciary.
Mr. SESSIONS. Mr. President, I seek recognition today to introduce
and speak in favor of the Finding Fugitive Sex Offenders Act of 2011,
which would give administrative subpoena authority to the Director of
the U.S. Marshals Service for the investigation of sex offenders who
have failed to register as required by the Sex Offender Registration
and Notification Act. The language of the bill is the product of
bipartisan negotiations during the last Congress, which was included in
a broader child crimes bill last year that passed both the Senate
Judiciary Committee and the Senate, but did not become law.
To understand the need for this bill, it is important to understand
the history of recent child crimes legislation in Congress. When the
Adam Walsh Act, which I cosponsored, was enacted in July 2006 to create
a more uniform and enforceable sex offender registry system, over
150,000 convicted sex offenders were believed to be unregistered and
missing from the various state sex offender registries. A key component
of the Walsh Act, one requested by John Walsh himself, was to give the
U.S. Marshals Service primary enforcement authority to locate and
arrest unregistered sex offenders who had crossed state lines or had
earlier been convicted under federal law. The Walsh Act, however, did
not provide the Marshals Service with administrative subpoena authority
to perform these investigations, which can span jurisdictions and move
quickly. The Finding Fugitive Sex Offenders Act will fix this gap in
the law and grant the Marshals Service this long-needed authority.
It is very surprising that this authority does not already exist in
light of the hundreds of administrative subpoena authorities that are
in place for various federal agencies, including the EPA, the DEA, the
FBI, the CFTC, and even the Appalachian Regional Commission. In March
2006, the Congressional Research Service reported that ``[t]here are
now over 300 instances where federal agencies have been granted
administrative subpoena power in one form or another.'' In reality,
that number is even higher. According to the Department of Justice's
2002 Report to Congress on the Use of Administrative Subpoena
Authorities by Executive Branch Agencies and Entities, the Office of
Legal Policy ``identified approximately 335 existing administrative
subpoena authorities held by various executive branch entities under
current law.'' Most of these authorities are for civil enforcement or
regulatory compliance--matters far less critical and time-sensitive
than locating a fugitive sex offender who has intentionally evaded
registering his location or place of employment to avoid detection by
law enforcement.
There is no reason why the Marshals Service should not have this type
of authority. In these fast-moving investigations across state lines,
law enforcement simply cannot afford delays, especially on weekends and
holidays when U.S. Attorney's Offices are closed and grand jury
subpoenas are unavailable. Assistant Attorney General Rachel Brand
explained the delays and limitations of traditional grand jury
subpoenas in fast-moving investigations when she testified before the
Senate Judiciary Committee on another administrative subpoena proposal
in June 2004:
Although grand jury subpoenas are a sufficient tool in many
investigations, there are circumstances in which an
administrative subpoena would save precious minutes or hours.
. . . For example, the ability to use an administrative
subpoena will eliminate delays caused by factors such as the
unavailability of an Assistant United States Attorney to
immediately issue a grand jury subpoena, especially in rural
areas; the time it takes to contact an Assistant United
States Attorney in the context of a time-sensitive
investigation; the lack of a grand jury sitting at the moment
the documents are needed (under federal law, the `return
date' for a grand jury subpoena must be on a day the grand
jury is sitting); or the absence of an empaneled grand jury
in the judicial district where the investigation is taking
place, a rare circumstance that would prevent a grand jury
subpoena from being issued at all.
The reality is that sex offenders often fail to register precisely so
they can evade detection and move to a new place where they won't face
scrutiny. During the hearings and floor debates on the Adam Walsh Act,
the Senate heard of the heart-breaking tragedies caused when sex
offenders knowingly evaded registration so they could disappear from
detection. Senators from Washington and Idaho went to the floor to
describe the registry failures and disappearance of Joseph Duncan, who
shortly after his release from custody in 2005, absconded from
Minnesota
[[Page S1937]]
and traveled across the country to Idaho, where he kidnapped Dylan and
Shasta Groene from their home in the middle of the night. In the course
of the kidnapping, he murdered the children's mother, brother, and the
mother's boyfriend by beating them to death with a framing hammer. He
then took the children to remote campgrounds across the state line into
Montana, where he brutally abused them and later killed Dylan. As one
Senator explained during the debate: ``Joseph Duncan was essentially
lost by three States. He moved from State to State to avoid capture. No
one knew where he was nor even how to look for him.''
A similar tragic story involved the convicted sex offender who killed
Florida 9-year-old Jessica Lunsford. John Couey had failed to tell
authorities that he was living in a trailer just feet from Jessica's
home. In 2005, he kidnapped Jessica from her bedroom and took her to
his home where he raped and killed her. Ernie Allen, the President of
the National Center for Missing and Exploited Children, cited Couey in
his congressional testimony in support of the Walsh Act, explaining
that he ``was not where he was supposed to be and [his] presence was
unknown to the police or Jessica's family even though he lived 150
yards down the street from her and had worked construction at her
elementary school.''
As the Lunsford and Groene cases demonstrate, some sex offenders
evade the registry requirements because they want to offend again. In
these cases, time is law enforcement's enemy. According to the
Department of Justice's guide for families with missing children, ``the
actions of parents and of law enforcement in the first 48 hours are
critical to the safe recovery of a missing child.'' The Lunsford case
illustrates how vital it is for law enforcement to quickly locate sex
offenders during a missing child investigation. John Couey reportedly
told law enforcement that he kept young Jessica alive for three days
before he smothered her inside a plastic trash bag. In a case like
Jessica's, this type of authority literally could mean the difference
between life and death.
This legislation has broad support. When I drafted this language last
Congress, I shared it with the Marshals Service and lawyers who work in
the field of protecting children from exploitation. These professionals
were not only supportive, but also very clear about the need for this
subpoena authority.
I strongly support this legislation and am thankful to the broad
bipartisan group, including Senators Blumenthal, Hatch, Klobuchar,
Grassley, Whitehouse, Cornyn, Kyl, Graham, Lee, Collins, Thune, Coburn,
Burr and Chambliss, who have agreed to cosponsor this legislation. I
hope the full Senate will take up and pass this legislation soon.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 671
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 ``Finding Fugitive Sex
Offenders Act of 2011''.
SEC. 2. SUBPOENA AUTHORITY FOR THE UNITED STATES MARSHALS
SERVICE.
Section 566(e)(1) of title 28, United States Code, is
amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(C) issue administrative subpoenas in accordance with
section 3486 of title 18 solely for the purpose of
investigating unregistered sex offenders (as that term is
defined in section 3486 of title 18).''.
SEC. 3. CONFORMING AMENDMENT TO ADMINISTRATIVE SUBPOENA
STATUTE.
(a) In General.--Section 3486(a)(1) of title 18, United
States Code, is amended--
(1) in subparagraph (A)--
(A) in clause (i)(II), by striking ``or'' at the end;
(B) by redesignating clause (ii) as clause (iii); and
(C) by inserting after clause (i) the following:
``(ii) an unregistered sex offender conducted by the United
States Marshals Service, the Director of the United States
Marshals Service; or''; and
(2) by striking subparagraph (D) and inserting the
following:
``(D) As used in this paragraph--
``(i) the term `Federal offense involving the sexual
exploitation or abuse of children' means an offense under
section 1201, 1591, 2241(c), 2242, 2243, 2251, 2251A, 2252,
2252A, 2260, 2421, 2422, or 2423, in which the victim is an
individual who has not attained the age of 18 years; and
``(ii) the term `sex offender' means an individual required
to register under the Sex Offender Registration and
Notification Act (42 U.S.C. 16901 et seq.).''.
(b) Technical and Conforming Amendments.--Section 3486(a)
of title 18, United States Code, is amended--
(1) in paragraph (6)(A), by striking ``United State'' and
inserting ``United States'';
(2) in paragraph (9), by striking ``or (1)(A)(ii)'' and
inserting ``or (1)(A)(iii)''; and
(3) in paragraph (10), by striking ``paragraph (1)(A)(ii)''
and inserting ``paragraph (1)(A)(iii)''.
______
By Mr. REID (for Mr. Rockefeller (for himself, Mr. Crapo, Mr.
Moran, Mr. Wyden, Mr. Roberts, Mrs. Gillibrand, Mr. Wicker, Mr.
Boozman, Mr. Thune, and Ms. Snowe)):
S. 672. A bill to amend the Internal Revenue Code of 1986 to extend
and modify the railroad track maintenance credit; to the Committee on
Finance.
Mr. ROCKEFELLER. Mr. President, today I am introducing legislation to
extend the Section 45G short line freight railroad tax credit.
Section 45G creates an incentive for short lines to invest in track
rehabilitation by providing a tax credit of 50 cents for every dollar
spent on track improvements. If this credit is allowed to expire at the
end of the year, private-sector investments in infrastructure in our
communities will fall by hundreds of millions of dollars.
``Short line'' railroads are small freight rail companies responsible
for bringing goods to communities that are not directly served by large
railroads. Supporting small railroads allows the communities
surrounding them to attract and maintain businesses and create jobs.
The evidence of the success of this credit can be found in communities
across America.
This credit has a real impact for the people of my state. West
Virginia is the second biggest producer of railroad ties in the
country. Since the credit first was enacted, approximately 750,000
railroad ties have been purchased above what would have otherwise been
purchased with no incentive. Those railroad ties translate directly
into jobs. This credit does not create just West Virginia jobs, it
benefits manufacturers of ties, spikes, and rail all across America.
Over 12,000 rail customers across America depend on short lines. This
credit creates a strong incentive for short lines to invest private
sector dollars on private-sector freight railroad track rehabilitation
and improvements. Shippers rely on the high quality service these
railroads provide to get their goods to market. Unfortunately, this
credit is scheduled to expire at the end of 2011.
This bill would extend the 45G credit through 2017 and provide the
important long-term planning certainty necessary to maximize private-
sector transportation infrastructure investment. 54 Members of this
body sponsored legislation that extended this credit last Congress and
I hope there will be similar support again this year.
I thank the Chair and ask my colleagues to join me in supporting this
important legislation that will benefit small businesses throughout the
country.
____________________