[Congressional Record Volume 159, Number 82 (Tuesday, June 11, 2013)]
[Senate]
[Pages S4214-S4216]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mrs. FEINSTEIN:
S. 1136. A bill to authorize the extension of preferential tariff
treatment for certain textile goods imported from Nicaragua; to the
Committee on Finance.
Mrs. FEINSTEIN. Mr. President, I rise today to introduce legislation
to extend a critical textile and apparel trade program with Nicaragua,
currently set to expire at the end of 2014 through the end of 2024.
This is a unique program which benefits not only Nicaraguan apparel
factories and U.S. apparel companies and retailers, but U.S. fabric and
yarn mills as well.
Let me explain.
In an effort to promote trade between the United States and
Nicaragua, the 2006 Central American Free Trade Agreement, CAFTA,
allows Nicaragua to export to the United States a limited amount of
apparel products duty free regardless of the source of the yarn or
fabric.
Specifically, this Tariff Preference Level, TPL, allows Nicaragua to
export 100 million square meter equivalents, SMEs, of apparel made with
fabric from non-CAFTA countries as long as the apparel is assembled in
Nicaragua.
In order to ensure that U.S. fabric producers could also take
advantage of this program, it contains a special rule for trousers.
It requires Nicaragua to purchase one square meter of U.S. fabric for
every one square meter of non-CAFTA woven trouser fabric.
That is, under this ``one for one'' rule, for each export of woven
trousers made from non-CAFTA fabric, Nicaragua agreed to export to the
U.S. an equal amount of woven trousers made of U.S. fabric, up to a
certain level 50 million square meter equivalents.
This ``one for one'' feature has been especially successful,
resulting in an increase in U.S. fabric exports to Nicaragua and an
increase in apparel production jobs in Central America.
In fact, since 2006, when the program went into effect, U.S. fabric
exports to Nicaragua have nearly doubled from $57.3 million to $110.2
million.
Nicaragua is now the fastest growing market for U.S. fabric exports
to the CAFTA region.
Nicaragua has also greatly benefited from this program.
I would remind my colleagues that Nicaragua, with a GDP per capita of
$3,300, is the poorest country in Central America and the second
poorest country in the Western Hemisphere.
Approximately 42.5 percent of Nicaragua's population lives below the
poverty line.
It is vital that Nicaragua develop and grow new export opportunities
to help lift its people out of poverty. And that is what this program
has done.
Since 2006, total apparel exports from Nicaragua to the U.S. have
doubled. The program now accounts for 25 percent of those exports.
Between 2005 and 2013, jobs in the apparel sector in Nicaragua have
grown
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by 23 percent. That is, 13,236 new jobs have been created since CAFTA
went into effect.
With a program that has proven to be so successful and mutually
beneficial, it is appropriate for Congress to extend it and ensure that
these benefits continue.
Some of my colleagues may wonder why I am introducing legislation now
to extend a textile and apparel trade program that will not expire
until the end of 2014.
The simple answer is that an early renewal is critical for business
planning purposes.
U.S. companies that have taken advantage of this program are making
decisions now about their long-term investments and where they will
source apparel products.
Extending this program several months before its expiration date will
help give U.S. companies the necessary confidence to continue to invest
in Nicaragua and take advantage of its benefits.
If we wait until the last minute to extend the program, the ties that
have been developed between U.S. and Nicaraguan companies and the
benefits accrued will be put at risk.
Simply put, U.S. companies will not make the commitments to Nicaragua
if there is a chance the textile and apparel trade program will lapse.
They will look elsewhere for new business opportunities to avoid what
would in essence be a new trade barrier to U.S. textile exports and
U.S. apparel companies in Nicaragua.
And as U.S. apparel orders from Nicaragua decline, U.S. textile
exports to Nicaragua will also decline. Jobs will be lost.
U.S. companies are looking for assurances that the U.S. is committed
to this program after 2014 and that is why this legislation is needed
now.
It is supported by the American Apparel and Footwear Association, the
National Retail Federation, the Retail Industry Leaders Association,
and the United States Association of Importers of Textile and Apparel.
It is a win-win trade program promoting jobs and economic growth in
both countries.
Nicaragua will be able to continue to develop a vital export industry
and U.S. apparel companies, retailers, and textile manufacturers will
continue to access a growing, thriving market in Central America.
I urge my colleagues to support this legislation.
______
By Mr. WYDEN (for himself, Mr. Crapo, Ms. Landrieu, Ms. Cantwell,
Mr. Merkley, and Mr. Blumenthal):
S. 1137. A bill to amend title XVIII of the Social Security Act to
modernize payments for ambulatory surgical centers under the Medicare
program, and for other purposes; to the Committee on Finance.
Mr. WYDEN. 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. 1137
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 ``Ambulatory Surgical Center
Quality and Access Act of 2013''.
SEC. 2. ALIGNING UPDATES FOR AMBULATORY SURGICAL CENTER
SERVICES WITH UPDATES FOR OPD SERVICES.
Section 1833(i)(2)(D) of the Social Security Act (42 U.S.C.
13951(i)(2)(D)) is amended--
(1) by redesignating clause (vi) as clause (vii);
(2) in the first sentence of clause (v), by inserting
before the period the following: ``and, in the case of 2014
or a subsequent year, by the adjustment described in
subsection (t)(3)(G) for the respective year''; and
(3) by inserting after clause (v) the following new clause:
``(vi) In implementing the system described in clause (i)
for 2014 and each subsequent year, there shall be an annual
update under such system for the year equal to the OPD fee
schedule increase factor specified under subsection
(t)(3)(C)(iv) for such year, adjusted in accordance with
clauses (iv) and (v).''.
SEC. 3. TRANSPARENCY OF QUALITY REPORTS AND APPLICATION OF
VALUE-BASED PURCHASING TO ASCS.
(a) Quality Measures.--Paragraph (7) of section 1833(i) of
the Social Security Act (42 U.S.C. 1395l(i)) is amended by
adding at the end the following new subparagraphs:
``(C) To the extent that quality measures implemented by
the Secretary under this paragraph for ambulatory surgical
centers and under section 1833(t)(17) for hospital outpatient
departments are applicable to the provision of surgical
services in both ambulatory surgical centers and hospital
outpatient departments, the Secretary shall make reported
data available on the website `Medicare.gov' in a manner that
will permit side-by-side comparisons on such measures for
ambulatory surgical centers and hospital outpatient
departments in the same geographic area.
``(D) For each procedure covered for payment in an
ambulatory surgical center, the Secretary shall publish,
along with the quality reporting comparisons provided for in
subparagraph (C), comparisons of the Medicare payment and
beneficiary copayment amounts for the procedure when
performed in ambulatory surgical centers and hospital
outpatient departments in the same geographic area.
``(E) The Secretary shall ensure that an ambulatory surgery
center and a hospital has the opportunity to review, and
submit any corrections for, the data to be made public with
respect to the ambulatory surgery center under subparagraph
(C)(ii) prior to such data being made public.''.
(b) Ambulatory Surgical Center Value-Based Purchasing
Program.--Section 1833(i) of the Social Security Act (42
U.S.C. 1395l(i)) is amended by adding at the end the
following new paragraph:
``(8) Value-based purchasing program.--
``(A) Establishment.--The Secretary shall establish an
ambulatory surgical center value-based purchasing program (in
this subsection referred to as the `Program') under which,
subject to subparagraph (I), each ambulatory surgical center
that the Secretary determines meets (or exceeds) the
performance standards under subparagraph (D) for the
performance period (as established under subparagraph (E))
for a calendar year is eligible, from the amounts made
available in the total shared savings pool under subparagraph
(I)(iv), for shared savings under subparagraph (I), which
shall be in the form, after application of the adjustments
under clauses (iv), (v), and (vi) of paragraph (2)(D), of an
increase in the amount of payment determined under the
payment system under paragraph (2)(D) for surgical services
furnished by such center during the subsequent year, by the
value-based percentage amount under subparagraph (H)
specified by the Secretary for such center and year.
``(B) Program start date.--The Program shall apply to
payments for procedures occurring on or after January 1,
2015.
``(C) Measures.--
``(i) In general.--For purposes of the Program, the
Secretary shall select measures from the measures specified
under paragraph (7).
``(ii) Availability of measure and data.--The Secretary may
not select a measure under this paragraph for use under the
Program with respect to a performance period for a calendar
year unless such measure has been included, and the reported
data available, on the website `Medicare.gov', for at least 1
year prior to the beginning of such performance period.
``(iii) Measure not applicable unless asc furnishes
services appropriate to measure.--A measure selected under
this paragraph for use under the Program shall not apply to
an ambulatory surgical center if such center does not furnish
services appropriate to such measure.
``(D) Performance standards.--
``(i) Establishment.--The Secretary shall establish
performance standards with respect to measures selected under
subparagraph (C)(i) for a performance period for a calendar
year.
``(ii) Achievement and improvement.--The performance
standards established under clause (i) shall include levels
of achievement and improvement.
``(iii) Timing.--The Secretary shall establish and announce
the performance standards under clause (i) not later than 60
days prior to the beginning of the performance period for the
calendar year involved.
``(E) Performance period.--For purposes of the Program, the
Secretary shall establish the performance period for a
calendar year. Such performance period shall begin and end
prior to the beginning of such calendar year.
``(F) ASC performance score.--The Secretary shall develop a
methodology for assessing the total performance of each
ambulatory surgery center based on performance standards with
respect to the measures selected under subparagraph (C) for a
performance period (as established under subparagraph (E)).
Using such methodology, the Secretary shall provide for an
assessment (in this subsection referred to as the `ASC
performance score') for each ambulatory surgical center for
each performance period. The methodology shall provide that
the ASC performance score is determined using the higher of
its achievement or improvement score for each measure.
``(G) Appeals.--The Secretary shall establish a process by
which ambulatory surgery centers may appeal the calculation
of the ambulatory surgery center's performance with respect
to the performance standards established under subparagraph
(D) and the ambulatory surgery center performance score under
subparagraph (E). The Secretary shall ensure that such
process provides for resolution of appeals in a timely
manner.
``(H) Calculation of value-based incentive payment.--
``(i) Value-based percentage amount.--For purposes of
subparagraph (A), the Secretary shall specify a value-based
percentage
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amount for an ambulatory surgical center for a calendar year.
``(ii) Requirements.--In specifying the value-based
percentage amount for each ambulatory surgical center for a
calendar year under clause (i), the Secretary shall ensure
that such percentage is based on--
``(I) the ASC performance score of the ambulatory surgery
center under subparagraph (F); and
``(II) the amount of the total savings pool made available
under subparagraph (I)(iii)(I) for such year.
``(I) Annual calculation of shared savings funding for
value-based incentive payments.--
``(i) Determining bonus pool.--In each year of the Program,
ambulatory surgery centers shall be eligible to receive
payment for shared savings under the Program only if for such
year the sum of--
``(I) the estimated amount of expenditures under this title
for Medicare fee-for-service beneficiaries (as defined in
section 1899(h)(3)) for surgical services for which payment
is made under the payment system under paragraph (2),
adjusted for beneficiary characteristics, and
``(II) the estimated amount of expenditures under this
title for Medicare fee-for-service beneficiaries (as so
defined) for the same surgical services for which payment is
made under the prospective payment system under subsection
(t), adjusted for beneficiary characteristics,
is at least the percent specified by the Secretary below the
applicable benchmark determined for such year under clause
(ii). For purposes of this subparagraph, such sum shall be
referred to as `estimated expenditures'. The Secretary shall
determine the appropriate percent described in the preceding
sentence to account for normal variation in volume of
services under this title and to account for changes in the
coverage of services in ambulatory surgery centers and
hospital outpatient departments during the performance period
involved.
``(ii) Establish and update benchmark.--For purposes of
clause (i), the Secretary shall calculate a benchmark for
each year described in such clause equal to the product of--
``(I) estimated expenditures described in clause (i) for
such year, and
``(II) the average annual growth in estimated expenditures
for the most recent three years.
Such benchmark shall be reset at the start of each calendar
year, and adjusted for changes in enrollment under the
Medicare fee-for-service program.
``(iii) Payments based on shared savings.--If the
requirement under clause (i) is met for a year--
``(I) 50 percent of the total savings pool estimated under
clause (iv) for such year shall be made available for shared
savings to be paid to ambulatory surgical centers under this
paragraph;
``(II) a percent (as determined appropriate by the
Secretary, in accordance with subparagraph (H)) of such
amount made available for such year shall be paid as shared
savings to each ambulatory surgery center that is determined
under the Program to have met or exceeded performance scores
for such year; and
``(III) all funds made available under subclause (I) for
such year shall be used and paid as sharing savings for such
year in accordance with subclause (II).
``(iv) Estimate of the total savings pool.--For purposes of
clause (iii), the Secretary shall estimate for each year of
the Program the total savings pool as the product of--
``(I) the conversion factor for such year determined by the
Secretary under the payment system under paragraph (2)(D)
divided by the conversion factor calculated under subsection
(t)(3)(C) for such year for covered OPD services, multiplied
by 100, and
``(II)(aa) the product of the estimated Medicare
expenditures for surgical services described in clause (i)(I)
furnished during such year to Medicare fee-for-service
beneficiaries (as defined in section 1899(h)(3)) for which
payment is made under subsection (t) and the average annual
growth in the estimated Medicare expenditures for such
services furnished to Medicare fee-for-service beneficiaries
(as so defined) for which payment is made under subsection
(t) in the most recent available 3 years, less
``(bb) the estimated Medicare expenditures for surgical
services described in clause (i)(I) furnished to Medicare
fee-for-service beneficiaries for which payment was made
under subsection (t) in the most recent year.
``(J) No effect in subsequent calendar years.--The value-
based percentage amount under subparagraph (H) and the
percent determined under subparagraph (I)(iii)(I) shall apply
only with respect to the calendar year involved, and the
Secretary shall not take into account such amount or
percentage in making payments to an ambulatory surgery center
under this section in a subsequent calendar year.''.
SEC. 4. ADVISORY PANEL ON HOSPITAL OUTPATIENT PAYMENT
REPRESENTATION.
(a) ASC Representative.--The second sentence of section
1833(t)(9)(A) of the Social Security Act (42 U.S.C.
1395l(t)(9)(A)) is amended by inserting ``and suppliers
subject to the prospective payment system (including at least
one ambulatory surgical center representative)'' after ``an
appropriate selection of representatives of providers''.
(b) Effective Date.--The amendment made by subsection (a)
shall take effect on the date of the enactment of this Act.
SEC. 5. REASONS FOR EXCLUDING ADDITIONAL PROCEDURES FROM ASC
APPROVED LIST.
(a) In General.--Section 1833(i)(1) of the Social Security
Act (42 U.S.C. 1395l(i)(1)) is amended by adding at the end
the following: ``In updating such lists for application in
years beginning after the date of the enactment of this
sentence, for each procedure that was requested to be
included in such lists during the public comment period but
which the Secretary does not propose (in the final rule
updating such lists) to so include in such lists, Secretary
shall cite in such final rule the specific criteria in
paragraph (b) or (c) of section 416.166 of title 42, Code of
Federal Regulations, based on which the procedure was
excluded. If paragraph (b) of such section is cited for
exclusion of a procedure, the Secretary shall identify the
peer reviewed research or the evidence upon which such
determination is based. The Secretary may not use or cite
section 416.166(c)(7) of such title as criteria or a basis
for exclusion of a procedure from such lists.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to lists of ambulatory surgery procedures for
application in years beginning after the date of the
enactment of this Act.
____________________