[Congressional Record Volume 159, Number 158 (Thursday, November 7, 2013)]
[Senate]
[Pages S7929-S7930]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. McCONNELL:
  S. 1662. A bill to provide for the introduction of pay-for-
performance compensation mechanisms into contracts of the Department of 
Veterans Affairs with community-based outpatient clinics for the 
provision of health care services, and for other purposes; to the 
Committee on Veterans' Affairs.
  Mr. McCONNELL. 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. 1662

       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 Health Care 
     Improvement Act of 2013''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Veterans of the Armed Forces have made tremendous 
     sacrifices in the defense of freedom and liberty.
       (2) Congress recognizes these great sacrifices and 
     reaffirms America's strong commitment to its veterans.
       (3) As part of the on-going congressional effort to 
     recognize the sacrifices made by America's veterans, Congress 
     has dramatically increased funding for the Department of 
     Veterans Affairs for veterans health care in the years since 
     September 11, 2001.
       (4) Part of the funding for the Department of Veterans 
     Affairs for veterans health care is allocated toward 
     community-based outpatient clinics (CBOCs).
       (5) A number of CBOCs are administered by private 
     contractors.
       (6) CBOCs administered by private contractors operate on a 
     capitated basis.
       (7) Some current contracts for CBOCs may create an 
     incentive for contractors to enroll as many veterans as 
     possible, without ensuring timely access to high quality 
     health care for such veterans.
       (8) The top priorities for CBOCs should be to provide 
     quality health care and patient satisfaction for America's 
     veterans.
       (9) The Department of Veterans Affairs currently tracks the 
     quality of patient care through its Computerized Patient 
     Record System. However, fees paid to contractors are not 
     currently adjusted automatically to reflect the quality of 
     care provided to patients.
       (10) A pay-for-performance payment model offers a promising 
     approach to health care delivery by aligning the payment of 
     fees to contractors with the achievement of better health 
     outcomes for patients.
       (11) The Department of Veterans Affairs should begin to 
     emphasize pay-for-performance in its contracts with CBOCs.

     SEC. 3. PAY-FOR-PERFORMANCE UNDER DEPARTMENT OF VETERANS 
                   AFFAIRS CONTRACTS WITH COMMUNITY-BASED 
                   OUTPATIENT HEALTH CARE CLINICS.

       (a) Plan Required.--Not later than one year after the date 
     of the enactment of this Act, the Secretary of Veterans 
     Affairs shall submit to Congress a plan to introduce pay-for-
     performance measures into contracts which compensate 
     contractors of the Department of Veterans Affairs for the 
     provision of health care services through community-based 
     outpatient clinics (CBOCs).
       (b) Elements.--The plan required by subsection (a) shall 
     include the following:
       (1) Measures to ensure that contracts of the Department for 
     the provision of health care services through CBOCs begin to 
     utilize pay-for-performance compensation mechanisms for 
     compensating contractors for the provision of such services 
     through such clinics, including mechanisms as follows:
       (A) To provide incentives for clinics that provide high-
     quality health care.
       (B) To provide incentives to better assure patient 
     satisfaction.
       (C) To impose penalties (including termination of contract) 
     for clinics that provide substandard care.
       (2) Mechanisms to collect and evaluate data on the outcomes 
     of the services generally provided by CBOCs in order to 
     provide for an assessment of the quality of health care 
     provided by such clinics.
       (3) Mechanisms to eliminate abuses in the provision of 
     health care services by CBOCs under contracts that continue 
     to utilize capitated-basis compensation mechanisms for 
     compensating contractors.
       (4) Mechanisms to ensure that veterans are not denied care 
     or face undue delays in receiving care.
       (c) Implementation.--The Secretary shall commence the 
     implementation of the plan on the date that is 60 days after 
     the date of the submittal of the plan. In implementing the 
     plan, the Secretary may initially carry out one or more pilot 
     programs to assess the feasibility and advisability of 
     mechanisms under the plan.
       (d) Reports.--Not later than 180 days after the date of the 
     enactment of this Act and every 180 days thereafter, the 
     Secretary shall submit to Congress a report setting forth the 
     recommendations of the Secretary as to the feasibility and 
     advisability of utilizing pay-for-performance compensation 
     mechanisms in the provision of health care services by the 
     Department by means in addition to CBOCs.
                                 ______
                                 
      By Mr. NELSON (for himself, Mr. Grassley, Mr. Rockefeller, and 
        Mr. Enzi):
  S. 1672. A bill to amend title XIX of the Social Security Act to 
empower individuals with disabilities to establish their own 
supplemental needs trusts; to the Committee on Finance.
  Mr. NELSON. Mr. President, I am pleased to introduce the Special 
Needs Trust Fairness Act with my friends, Senators Grassley, 
Rockefeller, and Enzi. Our common-sense bill will correct a fundamental 
flaw that prevents individuals with disabilities from creating their 
own trusts. This is a basic right that should have never been 
overlooked.
  November is Long-Term Care Awareness Month, when hopefully many 
families will discuss and decide how to best plan for their retirement 
and their future health care needs. Unfortunately,

[[Page S7930]]

current law assumes people with disabilities lack the requisite 
capacity to create such trusts for their long-term care needs, so these 
individuals must turn to others to create such a trust. This creates an 
unnecessary and sometimes costly burden on the individual and 
additional caseloads in our overworked courts.
  I also am pleased to have the support of the American Association of 
People with Disabilities and Easter Seals as well as the National 
Academy of Elder Law Attorneys, the Academy of Florida Elder Law 
Attorneys, the Academy of Special Needs Planners, and the Florida Joint 
Public Policy Task Force for the Elderly and Disabled.
  I urge my colleagues to support me in this legislation so that we can 
finally correct this flaw.
  Mr. President, I ask unanimous consent that letters of support be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                           American Association of


                                     People With Disabilities,

                                 Washington, DC, October 31, 2013.
     Hon. Bill Nelson,
     U.S. Senate, Senate Hart Office Building, Washington, DC.
     Hon. Charles Grassley,
     U.S. Senate, Senate Hart Office Building, Washington, DC.
       Dear Senator Nelson and Senator Grassley: I am pleased to 
     support the Special Needs Trust Fairness Act of 2013 (H.R. 
     2123 in the House) on behalf of the American Association of 
     People with Disabilities (AAPD). I commend your bipartisan 
     effort to empower people with disabilities by introducing 
     this legislation. The Special Needs Trust Fairness Act will 
     allow people with disabilities to set up a special needs 
     trust for themselves.
       AAPD is the nation's largest disability rights 
     organization. We promote equal opportunity, economic power, 
     independent living and political participation for people 
     with disabilities. Our members, including people with 
     disabilities and our family, friends, and supporters, 
     represent a powerful force for change.
       A special needs trust allows assets to be held in a trust 
     and protects against the risk of complete impoverishment. As 
     you know, due to a glitch in the current law, a capable, 
     competent person with a disability is prohibited from 
     creating her or his own special needs trust. We are in the 
     position of having to ask a parent, grandparent, guardian, or 
     the court to do so for us. This legislation not only 
     eradicates this discrimination against people with 
     disabilities, but also promotes self-sufficiency and 
     independence.
       Thank you for your leadership on this important issue. AAPD 
     looks forward to working with you on passage of the Special 
     Needs Trust Fairness Act of 2013. Please feel free to contact 
     Colin Schwartz if you have any questions.
           Sincerely,
                                                   Henry Claypool,
     Executive Vice President.
                                  ____

                                                     Easter Seals,


                                     Office of Public Affairs,

                                 Washington, DC, October 31, 2013.
     Hon. Bill Nelson,
     Chairman, Special Committee on Aging, U.S. Senate, Dirksen 
         Senate Office Building, Washington, DC.
       Dear Chairman Nelson:  Easter Seals is pleased to support 
     your efforts to introduce the Special Needs Trust Fairness 
     Act of 2013 in the United States Senate. This legislation 
     would empower individuals with disabilities to help plan and 
     save for their future daily living expenses by allowing them 
     to set up a special needs trust for themselves, which is 
     prevented under current law.
       Easter Seals is a national nonprofit organization that 
     provides individualized services and supports to help people 
     with disabilities or special needs and their families reach 
     their potential. Through our network of 72 community-based 
     affiliates, including the four that serve the state of 
     Florida, Easter Seals assisted more than 1.4 million 
     individuals and their families last year through community-
     based services, including medical rehabilitation, employment, 
     child care, adult and senior services, caregiving, and 
     camping and recreation.
       Easter Seals understands how important access to quality 
     services and long-term supports are for individuals with 
     disabilities. One tool to help ensure individuals with 
     disabilities have access to these essential services and 
     support beyond what is available through the government is 
     through a special needs trust. Currently, a special needs 
     trust can be created for a person with a disability by family 
     members, a guardian or the court. Unfortunately, current law 
     prevents people with disabilities from creating their own 
     special needs trust for their asset, which can later be used 
     to supplement living expenses and care when government 
     benefits alone are insufficient. This legislation would 
     remove this barrier, giving individuals with disabilities 
     direct access to a current tool that can help them live 
     independently and improve their health and well-being.
       Thank you for your leadership on this important issue. 
     Easter Seals looks forward to working with you following your 
     introduction of the Special Needs Trust Fairness Act of 2013 
     to help ensure the legislation receives consideration and 
     approval during the 113th Congress.
           Sincerely,

                                                Katy Beh Neas,

                                            Senior Vice President,
     Government Relations.
                                  ____

                                         National Academy of Elder


                                          Law Attorneys, Inc.,

                                     Vienna, VA, November 7, 2013.
     Hon. Bill Nelson,
     Senate Hart Office Building,
     Washington, DC.
       Dear Senator Nelson: We congratulate you for your 
     leadership in protecting individuals with disabilities from 
     unjust and discriminatory laws and we applaud your 
     introduction of the Special Needs Trust Fairness Act of 2013. 
     As you know, currently under the law, individuals with 
     disabilities who have the requisite mental capacity are 
     prevented from creating their own special needs trusts, which 
     Congress has already authorized. They must have a parent, 
     grandparent, guardian, or the court create their special 
     needs trust even though they have the mental capacity to do 
     it themselves.
       As elder law attorneys, NAELA members' clients experience 
     this injustice on a regular basis. Not all individuals have a 
     parent, grandparent or guardian who can create their special 
     needs trusts for them, and many of these individuals are 
     forced to petition a court and pay additional fees to have a 
     special needs trust. The Special Needs Trust Fairness Act of 
     2013 will remove the current barriers that prevent an 
     individual with disabilities from creating his or her own 
     special needs trust.
       NAELA is a professional association consisting of more than 
     4,300 attorneys who advocate for the rights of seniors and 
     people with disabilities. Elder law attorneys are specialized 
     and trained in a variety of areas in the law that address an 
     individual's long-term care needs.
       NAELA has made your legislation a top priority and stands 
     ready to assist you in securing passage of the Fairness Act 
     and eliminating this unjustified discrimination in the law.
           Sincerely,
     Peter G. Wacht, CAE,
       Executive Director.
     Howard S. Krooks, CELA, CAP,
       President.

                          ____________________