[Congressional Record Volume 161, Number 33 (Thursday, February 26, 2015)]
[Senate]
[Pages S1163-S1170]
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 Mr. Schumer):
  S. 578. A bill to amend title XVIII of the Social Security Act to 
ensure more timely access to home health services for Medicare 
beneficiaries under the Medicare program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today on behalf of myself and 
Senator Schumer to introduce legislation to ensure that our seniors and 
disabled citizens have timely access to home health services under the 
Medicare program.
  Nurse practitioners, physician assistants, certified nurse midwives 
and clinical nurse specialists are all playing increasingly important 
roles in the delivery of health care services, particularly in rural 
and medically underserved areas of our country where physicians may be 
in scarce supply. In recognition of their growing role, Congress, in 
1997, authorized Medicare to begin paying for physician services 
provided by these health professionals as long as those services are 
within their scope of practice under State law.
  Despite their expanded role, these advanced practice registered 
nurses and physician assistants are currently unable to order home 
health services for their Medicare patients. Under current law, only 
physicians are allowed to certify or initiate home health care for 
Medicare patients, even though they may not be as familiar with the 
patient's case as the non-physician provider. In fact, in many cases, 
the certifying physician may not even have a relationship with the 
patient and must rely upon the input of the nurse practitioner, 
physician assistant, clinical nurse specialist or certified nurse 
midwife to order the medically necessary home health care. At best, 
this requirement adds more paperwork and a number of unnecessary steps 
to the process before home health care can be provided. At worst, it 
can lead to needless delays in getting Medicare patients the home 
health care they need simply because a physician is not readily 
available to sign the form.
  The inability of advanced practice registered nurses and physician 
assistants to order home health care is particularly burdensome for 
Medicare beneficiaries in medically underserved areas, where these 
providers may be the only health care professionals available. For 
example, needed home health care was delayed by more than a week for a 
Medicare patient in Nevada because the physician assistant was the only 
health care professional serving the patient's small town, and the 
supervising physician was located 60 miles away.
  A nurse practitioner told me about another case in which her 
collaborating physician had just lost her father and was not available. 
As a consequence, the patient experienced a 2 day delay in getting 
needed care while they waited to get the paperwork signed by another 
physician.
  Another nurse practitioner pointed out that it is ridiculous that she 
can order physical and occupational therapy in a subacute facility but 
cannot order home health care. One of her patients had to wait eleven 
days after being discharged before his physical and occupational 
therapy could continue simply because the home health agency had 
difficulty finding a physician to certify the continuation of the same 
therapy that the nurse practitioner had been able to authorize when the 
patient was in the facility.
  The Home Health Care Planning Improvement Act will help to ensure 
that our Medicare beneficiaries get the home health care that they need 
when they need it by allowing physician assistants, nurse 
practitioners, clinical nurse specialists and certified nurse midwives 
to order home health services. Our legislation is supported by a broad 
coalition of organizations, including the AARP, the National Council on 
Aging, the American Geriatrics Society, the National Association for 
Home Care and Hospice, the American Nurses Association, the American 
Association of Nurse Practitioners, the American Academy of Physician 
Assistants, the American College of Nurse Midwives, and the Visiting 
Nurse Associations of America. I urge my colleagues to join us as 
cosponsors of this important legislation.
  Mr. President, I ask unanimous consent that a letter of support be 
printed in the Record.
  There being no objection, the text of the material was ordered to be 
printed in the Record, as follows:

                                                February 25, 2015.
     Hon. Susan Collins,
     U.S. Senate, Washington, DC.
     Hon. Chuck Schumer,
     U.S. Senate, Washington, DC.
       Dear Senator Collins and Senator Schumer: Thank you for 
     introducing the bipartisan Home Health Care Planning 
     Improvement Act of 2015. We, the undersigned groups, pledge 
     our continued support of your efforts to obtain passage of 
     this important legislation in the 114th Congress. As you 
     know, the bill authorizes nurse practitioners, clinical nurse 
     specialists, certified nurse-midwives and physician 
     assistants as eligible health care professionals who can 
     certify patient eligibility for home health care services 
     under Medicare. This critical

[[Page S1164]]

     change would improve access to important home health care 
     services, and potentially prevent additional hospital, sub-
     acute care facility and nursing home admissions--all of which 
     are costly to the consumer, the taxpayer and Medicare.
       The undersigned organizations are committed to ensuring 
     that consumers have access to health care providers who are 
     qualified, educated, and certified to provide high quality 
     primary care, chronic care management, and other services 
     that keep them living a high quality life, with dignity, in 
     locations of their choice.
       Although current law has long recognized advanced practice 
     registered nurses and physician assistants as authorized 
     Medicare providers, and allows these clinicians to certify 
     eligibility for nursing home care for their patients, it 
     precludes these same practitioners from certifying patient 
     eligibility for home health care services. This is an 
     unnecessary barrier to care and adds at least one more step 
     in the process of accessing home health care services by 
     requiring the provider to find a physician to certify 
     eligibility. In addition, time delays to locate a physician 
     to certify eligibility, particularly in rural and underserved 
     areas, can result in an extended hospital stay or nursing 
     home admission because the beneficiary could not be moved 
     back to or remain at home without home health care services.
       There are decades of data supporting the ability of these 
     providers to deliver high quality care to people of all ages, 
     including Medicare recipients with multiple chronic 
     conditions. Advanced practice registered nurses are often the 
     only care providers available in health professional shortage 
     areas such as urban, rural, and frontier regions. Given the 
     existing and future projected primary care physician 
     shortages, and the coming of increased numbers of Medicare 
     eligible patients, the need will be even greater for all 
     qualified providers to be allowed to certify home health care 
     eligibility.
       The Home Health Care Planning Improvement Act would help to 
     ensure that Medicare beneficiaries in need of home health 
     care services whose providers are nurse practitioners, 
     clinical nurse specialists, certified nurse midwives, and 
     physician assistants would be able to directly access home 
     health care by referral from their providers. This bill would 
     provide beneficiaries continued access to care and increase 
     the likelihood that they would experience better health and a 
     higher quality of life. Additionally, outside experts 
     assessed the impact of the bill earlier last year and 
     projected a Medicare savings of $7.1 million in 2015 and up 
     to a ten-year savings of $252.6 million. This analysis also 
     notes the potential to reduce beneficiary admissions to and 
     lengths of stay in institutional settings under the policy 
     change.
       We appreciate your continued leadership and are committed 
     to working with you to ensure that this bipartisan 
     legislation is passed and placed on the President's desk for 
     signature at the first opportunity. The time is now to ensure 
     that patients have timely access to the quality, cost 
     effective care they need. For any questions, please contact 
     [email protected] or 703-740-2529.
       Thank you for your help.
           Sincerely,
       AARP, AFT Nurses and Health Professionals, AMDA-The Society 
     for Post-Acute and Long-Term Care Medicine, Alzheimer's 
     Foundation of America, American Academy of Nursing, American 
     Academy of Physician Assistants, American Association of 
     Colleges of Nursing, American Association of Heart Failure 
     Nurses, American Association of Nurse Practitioners, American 
     Association of Occupational Health Nurses, American College 
     of Nurse-Midwives, American Geriatrics Society, American 
     Nephrology Nurses' Association, American Nurses Association, 
     American Organization of Nurse Executives.
       American Pediatric Surgical Nurses Association, American 
     Psychiatric Nurses Association, Association of Community 
     Health Nursing Educators, Association of Public Health 
     Nurses, Association of Rehabilitation Nurses, Center for 
     Medicare Advocacy, Gerontological Advance Practice Nurses 
     Association, International Society of Psychiatric-Mental 
     Health Nurses, The Jewish Federations of North America, 
     Justice in Aging, Leading Age, Medicare Rights Center, 
     National Academy of Elder Law Attorneys, National Association 
     for Home Care & Hospice.
       National Association of Clinical Nurse Specialists, 
     National Association of Neonatal Nurses, National Association 
     of Neonatal Nurse Practitioners, National Association of 
     Pediatric Nurse Practitioners, National Association of 
     Professional Geriatric Care Managers, National Black Nurses 
     Association, National Committee to Preserve Social Security 
     and Medicare, National Consumer Voice for Quality Long-Term 
     Care, National Council on Aging, National Organization of 
     Nurse Practitioner Faculties, Organization for Associate 
     Degree Nursing, OWL--The Voice of Women 40+, Public Health 
     Nursing Section, American Public Health Association, VNAA--
     The Visiting Nurse Associations of America, Women's Institute 
     for a Secure Retirement.
                                 ______
                                 
      By Mr. DURBIN (for himself, Mr. Nelson, Mr. Blumenthal, Mr. 
        Markey, and Ms. Klobuchar):
  S. 588. A bill to require the Consumer Product Safety Commission to 
establish a consumer product safety standard for liquid detergent 
packets to protect children under the age of five from injury or 
illness, and for other purposes; to the Committee on Commerce, Science, 
and Transportation.
  Mr. DURBIN. 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. 588

       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 ``Detergent Poisoning And 
     Child Safety Act of 2015'' or the ``Detergent PACS Act of 
     2015''.

     SEC. 2. SPECIAL PACKAGING AND OTHER REQUIREMENTS FOR LIQUID 
                   DETERGENT PACKETS.

       (a) Definitions.--In this Act:
       (1) Commission.--The term ``Commission'' means the Consumer 
     Product Safety Commission.
       (2) Consumer product.--The term ``consumer product'' has 
     the meaning given such term in section 3(a) of the Consumer 
     Product Safety Act (15 U.S.C. 2052(a)).
       (3) Detergent packet.--The term ``detergent packet'' means 
     a consumer product that consists of a detergent enclosed in a 
     water soluble outer layer.
       (4) Liquid detergent packet.--The term ``liquid detergent 
     packet'' means a consumer product that consists of a 
     substantially liquid or gel detergent enclosed in a water 
     soluble outer layer.
       (5) Special packaging.--The term ``special packaging'' has 
     the meaning given that term in section 2 of the Poison 
     Prevention Packaging Act of 1970 (15 U.S.C. 1471).
       (b) Safety Standards Required.--
       (1) In general.--Except as provided in subsection (c)(1), 
     not later than 540 days after the date of the enactment of 
     this Act, the Commission shall promulgate a final rule that 
     establishes safety standards for liquid detergent packets to 
     protect children who are younger than 5 years of age from 
     injury or illness caused by exposure to such packets.
       (2) Elements.--The final rule promulgated under paragraph 
     (1) shall--
       (A) require special packaging for liquid detergent packets;
       (B) include standards to address the design and color of 
     liquid detergent packets to--
       (i) make them less attractive to children;
       (ii) reduce the likelihood of exposure to detergent; and
       (iii) otherwise reduce risks related to the ingestion or 
     aspiration of, or ocular contact with, detergent and other 
     potential injury risks of liquid detergent packets;
       (C) include standards to address the composition of liquid 
     detergent packets to make the consequences of exposure less 
     severe; and
       (D) prescribe warning labels that--
       (i) adequately inform consumers of the potential risks of 
     injury and death caused by liquid detergent packets;
       (ii) are conspicuous and visible at the point of sale;
       (iii) clarify hazard patterns, including known consequences 
     of such hazards; and
       (iv) identify actions needed to avoid injury.
       (3) Treatment as consumer product safety standard.--A rule 
     promulgated under paragraph (1) shall be treated as a 
     consumer product safety standard described in section 7(a) of 
     the Consumer Product Safety Act (15 U.S.C. 2056(a)).
       (4) Rulemaking.--
       (A) In general.--A rule under paragraph (1) shall be 
     promulgated in accordance with section 553 of title 5, United 
     States Code.
       (B) Inapplicability of certain requirements.--Section 9 of 
     the Consumer Product Safety Act (15 U.S.C. 2058) shall not 
     apply to a rulemaking under paragraph (1).
       (c) Adoption of Voluntary Standard.--
       (1) In general.--Subsection (b)(1) shall not apply if the 
     Commission determines that--
       (A) a voluntary standard pertaining to liquid detergent 
     packets manufactured or imported for use in the United States 
     protects children as described in subsection (b)(1);
       (B) such voluntary standard is or will be in effect not 
     later than 1 year after the date of the enactment of this 
     Act; and
       (C) such voluntary standard is developed by ASTM 
     International Subcommittee F15.71 on Liquid Laundry Packets, 
     or such other entity as the Commission considers a successor 
     to ASTM International Subcommittee F15.71.
       (2) Publication of determination.--If the Commission makes 
     a determination under paragraph (1), the Commission shall 
     publish such determination in the Federal Register.
       (3) Treatment of voluntary standard.--If the Commission 
     determines that a voluntary standard meets the conditions in 
     paragraph (1), such standard shall be treated as a consumer 
     product safety standard described in section 7(a) of the 
     Consumer Product Safety Act (15 U.S.C. 2056(a)) beginning on 
     the date that is the later of--
       (A) the date that is 180 days after the date of the 
     publication under paragraph (2) of such determination; or
       (B) the effective date specified in the voluntary standard.
       (4) Revision of voluntary standard.--
       (A) Notice of revision.--If a voluntary standard is treated 
     as a consumer product safety standard under paragraph (3) and 
     such standard is revised by ASTM International

[[Page S1165]]

     after the Commission makes a determination under paragraph 
     (1), ASTM International shall notify the Commission of such 
     revision not later than 60 days after making such revision.
       (B) Treatment of revisions.--A voluntary standard with 
     respect to which the Commission receives notice under 
     subparagraph (A) shall be treated as a consumer product 
     safety standard described in section 7(a) of the Consumer 
     Product Safety Act (15 U.S.C. 2056(a)), promulgated in lieu 
     of the prior version, effective 180 days after the date the 
     Commission is notified of the revision under subparagraph 
     (A), unless not later than 90 days after receiving that 
     notice the Commission determines that the revised voluntary 
     standard does not meet the requirements of paragraph (1)(A), 
     in which case the Commission shall continue to enforce the 
     prior version.
       (d) Future Rulemaking.--
       (1) In general.--The Commission may, at any time after 
     promulgating a final rule under subsection (b)(1) or making a 
     determination under subsection (c)(1), promulgate such rules 
     in accordance with section 553 of title 5, United States 
     Code, as the Commission considers appropriate to protect, to 
     the maximum degree practicable, children as described in 
     subsection (a)(1).
       (2) Treatment as consumer product safety standard.--A rule 
     promulgated under paragraph (1) shall be treated as a 
     consumer product safety standard described in section 7(a) of 
     the Consumer Product Safety Act (15 U.S.C. 2056(a)).
       (3) Inapplicability of certain requirements.--Section 9 of 
     the Consumer Product Safety Act (15 U.S.C. 2058) shall not 
     apply to a rulemaking under paragraph (1).
       (e) Report to Congress.--
       (1) In general.--Not later than 4 years after the date of 
     the enactment of this Act, the Commission shall submit to the 
     Committee on Commerce, Science, and Transportation of the 
     Senate and the Committee on Energy and Commerce of the House 
     of Representatives a report on risks posed by detergent 
     packets to young children and how the Commission is working 
     to protect such children from such risks.
       (2) Matters covered.--The report required by paragraph (1) 
     shall include the following:
       (A) A quantitative assessment of annual national pediatric 
     exposure to detergent packets, including the number of 
     exposure incidents, the means of exposure (whether by 
     ingestion, aspiration, or ocular contact), the clinical 
     effects of the exposures, and medical outcomes.
       (B) An assessment as to whether the rule promulgated under 
     subsection (b)(1) or the voluntary standard adopted under 
     subsection (c), as the case may be, has been effective in 
     protecting young children from injury or illness caused by 
     exposure to detergent packets.
       (C) Such recommendations for legislative or administrative 
     action as the Commission may have to protect young children 
     as described in subparagraph (B).
       (3) Publication.--The Commission shall make the report 
     required by paragraph (1) available to the public on Internet 
     website of the Commission.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself and Mrs. Boxer):
  S. 596. A bill to amend the Federal Water Pollution Control Act to 
establish a grant program to support the restoration of San Francisco 
Bay; to the Committee on Environment and Public Works.
  Mrs. FEINSTEIN. Mr. President, I rise on behalf of myself and Senator 
Boxer to introduce legislation to further the restoration of the San 
Francisco Bay.
  San Francisco Bay is truly a national treasure. Encompassing 
approximately 550 square miles, it is the largest estuary on the west 
coast, and is vital to the Nation for both ecological and economic 
reasons. It is home to more than 1,000 plant and wildlife species, 
roughly 77 percent of California's remaining perennial estuarine 
wetlands, and an important stopover for birds along the Pacific Flyway. 
Marshes around the bay help prevent flooding, protecting more than 40 
cities in nine counties, one of the Nation's busiest seaports, and two 
international airports. The bay is critical to the region's economy, 
which if it were its own nation, would be the world's 19th largest 
economy.
  Over the last 150 years, the water quality and health of the San 
Francisco Bay Estuary have been diminished by pollution, invasive 
species, loss of wetland habitat and other factors. The degradation has 
not only impacted fish and wildlife, but has also reduced the estuary's 
ability to support important economic activities such as commercial and 
sport fishing, shipping, agriculture, recreation, and tourism.
  Federal funding in recent years has started the Bay's recovery 
process by investing in projects that improve water quality and restore 
critical habitat. These investments, $43 million between 2008 and 2015, 
were critical to leveraging $145 million from other partners. But much 
work remains.
  That is why I am pleased to introduce the San Francisco Bay 
Restoration Act with Senator Boxer, Ranking Member of the Senate 
Environment and Public Works Committee. Companion legislation has also 
been introduced in the U.S. House of Representatives by Congresswoman 
Jackie Speier.
  This bill was first introduced in the 112th Congress. The Senate 
Committee on Environment and Public Works reported favorably on the 
bill in both the 112th and 113th Congresses and recommended its 
passage.
  This bill recognizes the important restoration work that must be done 
to restore and protect the iconic San Francisco Bay. It authorizes $5 
million a year for restoration work between 2015 and 2019, prioritizing 
funding for projects that will protect and restore vital estuarine 
habitat for migratory waterfowl, shorebirds, and wildlife; improve and 
restore water quality and rearing habitat for fish; and in turn 
reinvigorate recreation, tourism, and agricultural activities in and 
around the bay.
  I urge my colleagues to join me in their support for this measure.
  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. 596

       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 ``San Francisco Bay 
     Restoration Act''.

     SEC. 2. SAN FRANCISCO BAY RESTORATION GRANT PROGRAM.

       Title I of the Federal Water Pollution Control Act (33 
     U.S.C. 1251 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 123. SAN FRANCISCO BAY RESTORATION GRANT PROGRAM.

       ``(a) Definitions.--In this section:
       ``(1) Annual priority list.--The term `annual priority 
     list' means the annual priority list compiled under 
     subsection (b).
       ``(2) Comprehensive plan.--The term `comprehensive plan' 
     means--
       ``(A) the comprehensive conservation and management plan 
     approved under section 320 for the San Francisco Bay estuary; 
     and
       ``(B) any amendments to that plan.
       ``(3) Estuary partnership.--The term `Estuary Partnership' 
     means the San Francisco Estuary Partnership, the entity that 
     is designated as the management conference under section 320.
       ``(b) Annual Priority List.--
       ``(1) In general.--After providing public notice, the 
     Administrator shall annually compile a priority list 
     identifying and prioritizing the activities, projects, and 
     studies intended to be funded with the amounts made available 
     under subsection (c).
       ``(2) Inclusions.--The annual priority list compiled under 
     paragraph (1) shall include--
       ``(A) activities, projects, or studies, including 
     restoration projects and habitat improvement for fish, 
     waterfowl, and wildlife, that advance the goals and 
     objectives of the approved comprehensive plan;
       ``(B) information on the activities, projects, programs, or 
     studies specified under subparagraph (A), including a 
     description of--
       ``(i) the identities of the financial assistance 
     recipients; and
       ``(ii) the communities to be served; and
       ``(C) the criteria and methods established by the 
     Administrator for selection of activities, projects, and 
     studies.
       ``(3) Consultation.--In developing the priority list under 
     paragraph (1), the Administrator shall consult with and 
     consider the recommendations of--
       ``(A) the Estuary Partnership;
       ``(B) the State of California and affected local 
     governments in the San Francisco Bay estuary watershed; and
       ``(C) any other relevant stakeholder involved with the 
     protection and restoration of the San Francisco Bay estuary 
     that the Administrator determines to be appropriate.
       ``(c) Grant Program.--
       ``(1) In general.--Pursuant to section 320, the 
     Administrator may provide funding through cooperative 
     agreements, grants, or other means to State and local 
     agencies, special districts, and public or nonprofit 
     agencies, institutions, and organizations, including the 
     Estuary Partnership, for activities, studies, or projects 
     identified on the annual priority list.
       ``(2) Maximum amount of grants; non-federal share.--
       ``(A) Maximum amount of grants.--Amounts provided to any 
     individual or entity under this section for a fiscal year 
     shall not exceed an amount equal to 75 percent of the total 
     cost of any eligible activities that are to be carried out 
     using those amounts.
       ``(B) Non-federal share.--The non-Federal share of the 
     total cost of any eligible activities that are carried out 
     using amounts provided under this section shall be--

[[Page S1166]]

       ``(i) not less than 25 percent; and
       ``(ii) provided from non-Federal sources.
       ``(d) Funding.--
       ``(1) Authorization of appropriations.--There is authorized 
     to be appropriated to the Administrator to carry out this 
     section $5,000,000 for each of fiscal years 2015 through 
     2019.
       ``(2) Administrative expenses.--Of the amount made 
     available to carry out this section for a fiscal year, the 
     Administrator shall use not more than 5 percent to pay 
     administrative expenses incurred in carrying out this 
     section.
       ``(3) Relationship to other funding.--Nothing in this 
     section limits the eligibility of the Estuary Partnership to 
     receive funding under section 320(g).
       ``(4) Prohibition.--No amounts made available under 
     subsection (c) may be used for the administration of a 
     management conference under section 320.''.
                                 ______
                                 
      By Mr. TILLIS:
  S. 597. A bill to amend section 706 of the Telecommunications Act of 
1996 to provide that such section does not authorize the Federal 
Communications Commission to preempt the laws of certain States 
relating to the regulation of municipal broadband, and for other 
purposes; to the Committee on Commerce, Science, and Transportation.
  Mr. TILLIS. Mr. President, I rise today to announce that along with 
my colleague in the House of Representatives, Representative Marsha 
Blackburn, have introduced legislation that prohibits the Federal 
Communications Commission from pre-empting States with municipal 
broadband laws already on the books, or any other States that 
subsequently adopt such municipal broadband laws. The bill also 
includes a Sense of Congress stating that the FCC should not impose 
municipal broadband regulations on any state.
  Earlier today, the FCC took an unprecedented and legally questionable 
step to allow Wilson, North Carolina, to ignore North Carolina law when 
expanding its municipal broadband network.
  The North Carolina law the FCC preempted is intended to protect 
taxpayers and consumers from the financial risks we have seen many 
municipalities, including Wilson, face when venturing into broadband 
ventures that are best left to the private market to provide.
  After witnessing how some local governments wasted taxpayer dollars 
and accumulated millions in debt through poor decision making, the 
legislatures of states like North Carolina and Tennessee passed 
commonsense, bipartisan laws that protect hardworking taxpayers and 
maintain the fairness of free-market competition. Representative 
Blackburn and I recognize the need for Congress to step in and take 
action to keep unelected bureaucrats from acting contrary to the 
expressed will of the American people through their State legislatures.
                                 ______
                                 
      By Mr. CARDIN (for himself, Mr. Crapo, and Mr. Nelson):
  S. 598. A bill to improve the understanding of, and promote access to 
treatment for, chronic kidney disease, and for other purposes; to the 
Committee on Finance.
  Mr. CARDIN. Mr. President, I rise in support of the bipartisan 
Chronic Kidney Disease Improvement in Research and Treatment Act of 
2015, which I am introducing with Senators Crapo and Nelson today. This 
legislation seeks to make a real difference in the lives of Americans 
suffering from kidney disease and end-stage renal disease.
  Kidney disease is the 9th leading cause of death in the United 
States, and unfortunately, more than one in ten Americans today suffer 
from some form of kidney disease. More than 615,000 Americans are 
living with kidney failure or end-stage renal disease, which is an 
irreversible condition that can be fatal without a kidney transplant or 
life-sustaining dialysis. 430,000 patients in our country rely on life-
sustaining dialysis care to survive.
  This legislation seeks to promote research, expand patient choice, 
and improve care coordination for these hundreds of thousands of 
patients. Specifically, it would identify the gaps in research and 
improve the coordination of Federal research efforts. The bill would 
require the Government Accountability Office to submit a comprehensive 
report analyzing current federally funded research projects regarding 
chronic kidney disease and identifying knowledge gaps that are not 
being addressed through those research efforts. It would also direct 
the Department of Health and Human Services to evaluate and report on 
the biological, social, and behavioral factors related to kidney 
disease and efforts to slow the progression of disease in minority 
populations disproportionately affected by this disease.
  This legislation would improve access to pre-dialysis kidney 
education programs to better manage patients' kidney disease and even 
prevent kidney failure in some cases. Nephrologists and other health 
professionals would be incentivized to work in underserved rural and 
urban areas, and current payment policies would be modified to 
encourage home dialysis, which is not incentivized under the current 
Medicare payment structure. Patients with acute kidney injury would 
also be allowed to receive treatments through dialysis providers, 
therefore reducing costs associated with care provided in the more 
expensive hospital outpatient setting. Perhaps most importantly, our 
legislation would establish a voluntary coordinated care program that 
would incentivize doctors and dialysis facilities to work together to 
improve the coordination of care and reduce costly hospitalization.
  Lastly, the bill would expand the options for patients by allowing 
individuals diagnosed with kidney failure to enroll in the Medicare 
Advantage program and reauthorizing on a permanent basis the Medicare 
Advantage Special Needs Plan for patients with kidney failure.
  I urge my colleagues to join me, Senator Crapo and Senator Nelson in 
supporting the Chronic Kidney Disease Improvement in Research and 
Treatment Act of 2015, which will improve the care of patients who 
suffer from kidney disease and end-stage renal disease.
  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. 598

       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 ``Chronic Kidney Disease 
     Improvement in Research and Treatment Act of 2015''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

  TITLE I--IMPROVING UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH 
                   EXPANDED RESEARCH AND COORDINATION

Sec. 101. Identifying gaps in chronic kidney disease research.
Sec. 102. Coordinating research on chronic kidney disease.
Sec. 103. Understanding the progression of kidney disease and treatment 
              of kidney failure in minority populations.
Sec. 104. Identifying Medicare payment disincentives for transplant and 
              post-transplant care.

    TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS

Sec. 201. Increasing access to Medicare kidney disease education 
              benefit.
Sec. 202. Improving access to chronic kidney disease treatment in 
              underserved rural and urban areas.
Sec. 203. Promoting access to home dialysis treatments.
Sec. 204. Expanding access for patients with acute kidney injury.

    TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR 
                INDIVIDUALS WITH CHRONIC KIDNEY DISEASE

Sec. 301. Stabilizing Medicare payments for services provided to 
              beneficiaries with stage V chronic kidney disease 
              receiving dialysis services.
Sec. 302. Providing individuals with kidney failure access to managed 
              care and coordinated care programs.

  TITLE I--IMPROVING UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH 
                   EXPANDED RESEARCH AND COORDINATION

     SEC. 101. IDENTIFYING GAPS IN CHRONIC KIDNEY DISEASE 
                   RESEARCH.

       (a) Report.--Not later than one year after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall develop and submit to Congress a comprehensive 
     report assessing the adequacy of Federal expenditures in 
     chronic kidney disease research relative to Federal 
     expenditures for chronic kidney disease care.
       (b) Contents.--The report required by this section shall--
       (1) analyze the current chronic kidney disease research 
     projects being funded by Federal agencies;

[[Page S1167]]

       (2) identify, including by surveying the kidney care 
     community, areas of chronic kidney disease knowledge gaps 
     that are not part of current Federal research efforts;
       (3) report on the level of Federal expenditures on kidney 
     research as compared to the amount of Federal expenditures on 
     treating individuals with chronic kidney disease; and
       (4) identify areas of kidney failure knowledge gaps in 
     research to assess treatment patterns associated with 
     providing care to minority populations that are 
     disproportionately affected by kidney failure.

     SEC. 102. COORDINATING RESEARCH ON CHRONIC KIDNEY DISEASE.

       (a) Interagency Committee.--The Secretary of Health and 
     Human Services shall establish and maintain an interagency 
     committee for the purpose of improving the coordination of 
     chronic kidney disease research.
       (b) Reports.--For the purpose described in subsection (a), 
     the interagency committee established under such subsection 
     shall issue public reports that--
       (1) include a strategic plan, including recommendations 
     for--
       (A) improving communication and coordination among Federal 
     agencies;
       (B) procedures for monitoring Federal chronic kidney 
     disease research activities; and
       (C) ways to maximize the efficiency of the Federal chronic 
     kidney disease research investment and minimize the potential 
     for unnecessary duplication;
       (2) include a portfolio analysis that provides information 
     on chronic kidney disease research projects, organized by the 
     strategic plan objectives; and
       (3) address such other topics as the interagency committee 
     determines appropriate.
       (c) Meetings.--The interagency committee established under 
     subsection (a) shall meet not less frequently than semi-
     annually.

     SEC. 103. UNDERSTANDING THE PROGRESSION OF KIDNEY DISEASE AND 
                   TREATMENT OF KIDNEY FAILURE IN MINORITY 
                   POPULATIONS.

       Not later than one year after the date of enactment of this 
     Act, the Secretary of Health and Human Services shall--
       (1) complete a study on--
       (A) the social, behavioral, and biological factors leading 
     to kidney disease;
       (B) efforts to slow the progression of kidney disease in 
     minority populations that are disproportionately affected by 
     such disease; and
       (C) treatment patterns associated with providing care, 
     under the Medicare program under title XVIII of the Social 
     Security Act, the Medicaid program under title XIX of such 
     Act, and through private health insurance, to minority 
     populations that are disproportionately affected by kidney 
     failure; and
       (2) submit to Congress a report on the results of such 
     study.

     SEC. 104. IDENTIFYING MEDICARE PAYMENT DISINCENTIVES FOR 
                   TRANSPLANT AND POST-TRANSPLANT CARE.

       Not later than 2 years after the date of enactment of this 
     Act, the Secretary of Health and Human Services shall submit 
     to Congress a report on any disincentives in the payment 
     systems under the Medicare program under title XVIII of the 
     Social Security Act that create barriers to kidney 
     transplants and post-transplant care for beneficiaries with 
     end-stage renal disease.

    TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS

     SEC. 201. INCREASING ACCESS TO MEDICARE KIDNEY DISEASE 
                   EDUCATION BENEFIT.

       (a) In General.--Section 1861(ggg) of the Social Security 
     Act (42 U.S.C. 1395x(ggg)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A), by inserting `` or stage V'' after 
     ``stage IV'';
       (B) in subparagraph (B), by inserting ``or of a physician 
     assistant, nurse practitioner, or clinical nurse specialist 
     (as defined in section 1861(aa)(5)) assisting in the 
     treatment of the individual's kidney condition'' after 
     ``kidney condition''; and
       (2) in paragraph (2)--
       (A) by striking subparagraph (B); and
       (B) in subparagraph (A)--
       (i) by striking ``(A)'' after ``(2)'';
       (ii) by striking ``and'' at the end of clause (i);
       (iii) by striking the period at the end of clause (ii) and 
     inserting ``; and'';
       (iv) by redesignating clauses (i) and (ii) as subparagraphs 
     (A) and (B), respectively; and
       (v) by adding at the end the following:
       ``(C) a renal dialysis facility subject to the requirements 
     of section 1881(b)(1) with personnel who--
       ``(i) provide the services described in paragraph (1); and
       ``(ii) is a physician (as defined in subsection (r)(1)) or 
     a physician assistant, nurse practitioner, or clinical nurse 
     specialist (as defined in subsection (aa)(5)).''.
       (b) Payment to Renal Dialysis Facilities.--Section 1881(b) 
     of such Act (42 U.S.C. 1395rr(b)) is amended by adding at the 
     end the following new paragraph:
       ``(15) For purposes of paragraph (14), the single payment 
     for renal dialysis services under such paragraph shall not 
     take into account the amount of payment for kidney disease 
     education services (as defined in section 1861(ggg)). 
     Instead, payment for such services shall be made to the renal 
     dialysis facility on an assignment-related basis under 
     section 1848.''.
       (c) Effective Date.--The amendments made by this section 
     apply to kidney disease education services furnished on or 
     after January 1, 2016.

     SEC. 202. IMPROVING ACCESS TO CHRONIC KIDNEY DISEASE 
                   TREATMENT IN UNDERSERVED RURAL AND URBAN AREAS.

       (a) Definition of Primary Care Services.--Section 
     331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 
     254d(a)(3)(D)) is amended by inserting ``and includes renal 
     dialysis services'' before the period at the end.
       (b) National Health Service Corps Scholarship Program.--
     Section 338A(a)(2) of the Public Health Service Act (42 
     U.S.C. 254l(a)(2)) is amended by inserting ``, including 
     nephrologists and non-physician practitioners providing renal 
     dialysis services'' before the period at the end.
       (c) National Health Service Corps Loan Repayment Program.--
     Section 338B(a)(2) of the Public Health Service Act (42 
     U.S.C. 254l-1(a)(2)) is amended by inserting ``, including 
     nephrologists and non-physician practitioners providing renal 
     dialysis services'' before the period at the end.

     SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREATMENTS.

       Section 1834(m)(4)(C)(ii) of the Social Security Act (42 
     U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end 
     the following new subclause:

       ``(IX) A renal dialysis facility (as defined in section 
     1881).''.

     SEC. 204. EXPANDING ACCESS FOR PATIENTS WITH ACUTE KIDNEY 
                   INJURY.

       Section 1881(b) of the Social Security Act (42 U.S.C. 
     1395rr(b)) is amended--
       (1) in paragraph (1), by inserting ``or acute kidney 
     injury'' after ``individuals who have been determined to have 
     end stage renal disease'';
       (2) in paragraph (2)(A), by inserting ``or acute kidney 
     injury'' after ``end stage renal disease'';
       (3) in paragraph (2)(B), by inserting ``or acute kidney 
     injury'' after ``end stage renal disease'';
       (4) in paragraph (3), in the matter preceding subparagraph 
     (A), by inserting ``or acute kidney injury'' after ``end 
     stage renal disease'';
       (5) in paragraph (11)(A), by inserting ``or acute kidney 
     injury'' after ``end stage renal disease'';
       (6) in paragraph (11)(B), by inserting ``or acute kidney 
     injury'' after ``end stage renal disease'';
       (7) in paragraph (14)(B)--
       (A) in clause (ii), by inserting ``or acute kidney injury'' 
     after ``end stage renal disease'';
       (B) in clause (iii), by inserting ``or acute kidney 
     injury'' after ``end stage renal disease''; and
       (C) in clause (iv), by inserting ``or acute kidney injury'' 
     after ``end stage renal disease''; and
       (8) in paragraph (14)(H)(i), by inserting ``or acute kidney 
     injury'' after ``end stage renal disease''.

    TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR 
                INDIVIDUALS WITH CHRONIC KIDNEY DISEASE

     SEC. 301. STABILIZING MEDICARE PAYMENTS FOR SERVICES PROVIDED 
                   TO BENEFICIARIES WITH STAGE V CHRONIC KIDNEY 
                   DISEASE RECEIVING DIALYSIS SERVICES.

       Section 1881(b)(14) of the Social Security Act (42 U.S.C. 
     1395rr(b)(14)) is amended--
       (1) in subparagraph (D), in the matter preceding clause 
     (i), by striking ``Such system'' and inserting ``Subject to 
     subparagraph (J), such system''; and
       (2) by adding at the end the following new subparagraph:
       ``(J)(i) For payment for renal dialysis services furnished 
     on or after January 1, 2016, under the system under this 
     paragraph--
       ``(I) the payment adjustment described in clause (i) of 
     subparagraph (D) shall not take into account comorbidities;
       ``(II) the payment adjustment described in clause (ii) of 
     such subparagraph shall not be included;
       ``(III) the standardization factor described in the final 
     rule published in the Federal Register on November 8, 2012 
     (77 Fed. Reg. 67470), shall be established using the most 
     currently available data (and not historical data) and 
     adjusted on an annual basis, based on such available data, to 
     account for any change in utilization of drugs and any 
     modification in adjustors applied under this paragraph; and
       ``(IV) the Secretary shall take into account reasonable 
     costs consistent with paragraph (2)(B) when calculating such 
     payments.
       ``(ii) Not later than January 1, 2016, the Secretary shall 
     amend the ESRD facility cost report to--
       ``(I) include the per treatment network fee (as described 
     in paragraph (7)) as an allowable cost; and
       ``(II) eliminate the limitation for reporting medical 
     director fees on such reports in order to take into account 
     the wages of a board-certified nephrologist.''.

     SEC. 302. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE ACCESS TO 
                   MANAGED CARE AND COORDINATED CARE PROGRAMS.

       (a) Expanding Access to Medicare Advantage.--
       (1) Eligibility under medicare advantage.--
       (A) In general.--Section 1851(a)(3) of the Social Security 
     Act (42 U.S.C. 1395w-21(a)(3)) is amended--
       (i) by striking subparagraph (B); and
       (ii) by striking ``eligible individual.--'' and all that 
     follows through ``In this title''

[[Page S1168]]

     and inserting ``eligible individual.--In this title''.
       (B) Conforming amendment.--Section 1852(b)(1) of the Social 
     Security Act (42 U.S.C. 1395w-22(b)(1)) is amended--
       (i) by striking subparagraph (B); and
       (ii) by striking ``Beneficiaries.--'' and all that follows 
     through ``A Medicare+Choice organization'' and inserting 
     ``Beneficiaries.--A Medicare Advantage organization''.
       (C) Effective date.--The amendments made by this paragraph 
     shall apply with respect to plan years beginning on or after 
     January 1, 2016.
       (2) Education.--Section 1851(d)(2)(A)(iii) of the Social 
     Security Act (42 U.S.C. 1395w-21(d)(2)(A)(iii)) is amended by 
     inserting before the period at the end the following ``, 
     including any additional information that individuals 
     determined to have end stage renal disease may need to make 
     informed decisions with respect to such an election''.
       (3) Quality metrics.--Section 1852(e)(3)(A) of the Social 
     Security Act (42 U.S.C. 1395w-22(e)(3)(A)) is amended by 
     adding at the end the following new clause:
       ``(v) Requirements with respect to individuals with esrd.--
     In addition to the data required to be collected, analyzed, 
     and reported under clause (i) and notwithstanding the 
     limitations under subparagraph (B), as part of the quality 
     improvement program under paragraph (1), each MA organization 
     shall provide for the collection, analysis, and reporting of 
     data, determined in consultation with the kidney care 
     community, that permits the measurement of health outcomes 
     and other indices of quality with respect to individuals 
     determined to have end stage renal disease.''.
       (b) Permanent Extension of Medicare Advantage ESRD Special 
     Needs Plans Authority.--Section 1859(f)(1) of the Social 
     Security Act (42 U.S.C. 1395w-28(f)(1)) is amended by 
     inserting ``, in the case of a specialized MA plan for 
     special needs individuals who have not been determined to 
     have end stage renal disease,'' before ``for periods before 
     January 1, 2017''.
       (c) Voluntary ESRD Coordinated Care Gainsharing Program.--
       (1) In general.--Section 1881(b) of the Social Security Act 
     (42 U.S.C. 1395rr(b)) is amended by adding at the end the 
     following new paragraph:
       ``(15)(A) Not later than January 1, 2017, the Secretary 
     shall, in accordance with this paragraph, establish an ESRD 
     Care Coordination gainsharing program for nephrologists, 
     renal dialysis facilities, and providers of services that 
     develop coordinated care organizations to provide a full 
     range of clinical and supportive services (as described in 
     subparagraph (D)) to individuals determined to have end stage 
     renal disease.
       ``(B) Under such program, subject to subparagraph (C), the 
     payment amounts renal dialysis facilities and providers of 
     services described in subparagraph (A) would otherwise 
     receive under paragraph (14) and nephrologists described in 
     subparagraph (A) would otherwise receive under section 1848 
     with respect to dialysis services furnished by such a 
     facility, provider, or nephrologist during a year, shall be 
     increased by a portion of the amount (as determined by the 
     Secretary) of actual reductions in expenditures under this 
     title attributable to the coordinated care organization 
     developed by such facility, provider, or nephrologist 
     involved, taking into account non-dialysis expenditures under 
     parts A and B, during the preceding calendar year. The 
     payment amount under this subparagraph shall be provided to a 
     nephrologist, renal dialysis facility, and provider of 
     services that developed the coordinated care organization not 
     later than March 31 of the year after the year during which 
     such services are provided by such nephrologist, facility, or 
     provider.
       ``(C) The aggregate incentive payment amounts provided 
     under such program for a year may not exceed the amount equal 
     to 2 percent less than the estimated total amount of non-
     dialysis expenditures under parts A and B for 2017 for items 
     and services that are not related to dialysis or transplant 
     services.
       ``(D) For purposes of subparagraph (A), the full range of 
     clinical and supportive services includes at least the 
     following:
       ``(i) Primary care and other preventative services.
       ``(ii) Specialty care for co-morbidities or non-renal acute 
     conditions, including at least podiatry, cardiology, and 
     orthopedics.
       ``(iii) Vascular access.
       ``(iv) Laboratory testing and diagnostic imaging.
       ``(v) Pharmacy care management.
       ``(vi) Patient, family, and caregiver education.
       ``(vii) Psychiatric, behavioral therapy, and counseling 
     services.
       ``(E) In providing payment incentive amounts under such 
     program, the Secretary shall apply a risk adjustment 
     methodology that--
       ``(i) uses risk adjuster factors applied under part C; and
       ``(ii) adjusts such payments to exclude the top 2 percent 
     of outliers.
       ``(F) In establishing such program, the Secretary shall 
     ensure that each of the following is satisfied:
       ``(i) The program allows for all types and sizes of renal 
     dialysis facilities and providers of services described in 
     subparagraph (A), including profit and not-for-profit, urban 
     and rural, as well as all other types and sizes of such 
     facilities and providers, to participate.
       ``(ii) The program rewards high quality, efficient 
     facilities and providers through gain-sharing.
       ``(iii) For purposes of determining the actual reductions 
     in expenditures under this title attributable to a 
     coordinated care organization described in subparagraph (A), 
     the program includes a market-based benchmark system that 
     will not be rebased against which such expenditures shall be 
     compared.
       ``(iv) The program results in reductions of expenditures 
     under parts A and B for services that are not dialysis-
     related services.
       ``(v) The program allows new applicants to participate in 
     the program after the initial implementation period.
       ``(vi) The program establishes clear quality metrics in 
     consultation with the kidney care community.
       ``(vii) The program provides for waivers of Federal laws or 
     requirements, in consultation with interested stakeholders.
       ``(viii) Under such program the Secretary attributes 
     individuals described in subparagraph (A) who receive 
     treatment through a care coordination organization described 
     in such subparagraph to such organization rather than to any 
     other payment model that requires beneficiary attribution.
       ``(ix) Under such program the Secretary provides quarterly 
     Medicare parts A and B claims data to facilities and 
     providers described in subparagraph (A) participating in such 
     program.
       ``(G) Not later than 3 years after the date of the 
     implementation of the ESRD Care Coordination gainsharing 
     program, the Secretary shall submit to Congress a report on 
     the waivers granted under subparagraph (F)(vii) and the 
     effectiveness of such waivers in allowing the coordination of 
     care.''.
       (2) Conforming amendments.--
       (A) Section 1881.--Section 1881(b) of the Social Security 
     Act (42 U.S.C. 1395rr(b)) is amended--
       (i) in each of paragraphs (12)(A) and (13)(A), by striking 
     ``paragraph (14)'' and inserting ``paragraphs (14) and 
     (15)''; and
       (ii) in paragraph (14)(A)(i), by inserting ``and paragraph 
     (15)'' after ``Subject to subparagraph (E)''.
       (B) Section 1848.--Section 1848 of the Social Security Act 
     (42 U.S.C. 1395w-4) is amended by adding at the end the 
     following new subsection:
       ``(q) Voluntary ESRD Coordinated Care Program.--For 
     provisions related to incentive payment amounts to 
     nephrologists under the ESRD Care Coordination gainsharing 
     program, see section 1881(b)(15).''.
       (d) Patient Information Requirement.--The Secretary of 
     Health and Human Services shall require hospitals that 
     furnish items and services to individuals entitled to 
     benefits under part A of title XVIII of the Social Security 
     Act or eligible for benefits under part B of such title and 
     who subsequently receive dialysis services at a renal 
     dialysis facility (as defined in section 1881 of such Act (42 
     U.S.C. 1395rr)) to provide to such facility health 
     information with respect to such individual, including a 
     discharge summary and co-morbidity information, upon request 
     of the facility, not later than 7 days after notification by 
     the hospital of the provision of such services to such 
     individual or of the determination that such individual has 
     end stage renal disease, as applicable.

  Mr. CRAPO. Mr. President, I rise to speak on the importance of the 
Chronic Kidney Disease Improvement in Research and Treatment Act being 
introduced today. This legislation will not only pave the way for 
enhanced research opportunities and allow physicians greater 
flexibility in how and where they treat patients, but, importantly, 
will provide increased access to care for those with chronic and end-
stage kidney disease, particularly in rural and underserved areas. As 
our Nation continues to face dangerously high levels of debt, it is 
imperative we prioritize initiatives such as this while simultaneously 
ensuring we do not worsen our already fragile fiscal picture. Prior to 
passage, as with any piece of legislation, a responsible offset that is 
budget neutral must be included.
                                 ______
                                 
      By Mr. CARDIN (for himself, Mr. Toomey, and Ms. Collins):
  S. 599. A bill to extend and expand the Medicaid emergency 
psychiatric demonstration project; to the Committee on Finance.
  Mr. CARDIN. Mr. President, today Senators Toomey and Collins and I 
are introducing the Improving Access to Emergency Psychiatric Care Act 
of 2015, which will build on the current 3-year Medicaid Emergency 
Psychiatric Demonstration Project to provide timely and cost-effective 
treatment to people who are experiencing an emergency psychiatric 
crisis.
  We know that emergency psychiatric care delivered in general 
hospitals and freestanding psychiatric hospitals is a life-saving 
service for individuals with severe mental illnesses. In addition, a 
Government Accountability Office report, GAO-09-347, on hospital 
emergency departments concluded the difficulties in transferring, 
admitting, or

[[Page S1169]]

discharging psychiatric patients from the emergency department 
contribute to overcrowding in our Nation's emergency rooms.
  Community-based psychiatric hospitals, like Sheppard Pratt Health 
System in my home State of Maryland, could help relieve these back-ups 
in emergency departments; however, due to a longstanding Medicaid 
statutory provision called the Institution for Mental Disease, IMD, 
exclusion, patients receiving care in these freestanding psychiatric 
hospitals are not covered if the patients are between the ages of 21 
and 64, and the hospitals cannot get Medicaid Federal matching payments 
for these services.
  In response to this problem, bipartisan legislation was first 
introduced in the Senate in 2003 by Senators Olympia Snowe and Kent 
Conrad, who were joined by Senators Susan Collins and Ron Wyden, to 
address this problem by allowing Federal Medicaid matching payments to 
freestanding psychiatric hospitals for emergency psychiatric cases. In 
2010, based on this legislation, Congress authorized a three-year 
demonstration that was intended to expand the number of emergency 
inpatient psychiatric beds available in communities. Currently, 11 
States, including my State of Maryland, and the District of Columbia 
are participating in this demonstration.
  The purpose of the demonstration is to determine whether allowing 
Federal Medicaid matching payments to freestanding psychiatric 
hospitals for emergency psychiatric cases improves access to and 
quality of medically necessary care, improves discharge planning for 
demonstration beneficiaries, and has a positive impact on Medicaid cost 
and utilization. The preliminary data shows that, of the total number 
of Medicaid beneficiaries admitted to these freestanding psychiatric 
hospitals, 84 percent had just one admission during the entire first 
year of the demonstration. The average length of stay was a short 8.2 
days and, in 88 percent of the admissions, the patients were discharged 
home.
  The current demonstration project would end no later than December 
31, 2015; however, the final evaluation of this project by CMS is not 
expected to be completed until 1 year later, in the fall of 2016.
  The purpose of the bipartisan legislation we are introducing today is 
to allow the Secretary of Health and Human Services to continue the 
current demonstration project until the Secretary submits a report to 
Congress with her recommendations, based on the final evaluation, 
regarding whether the current demonstration should be extended for an 
additional 3 years and whether additional States should be allowed to 
participate in the demonstration, or September 30, 2016, whichever 
occurs first.
  Importantly, in order to extend the current demonstration project 
until the report is submitted, the Secretary must determine that 
overall Medicaid spending in the participating state is not expected to 
increase during the extension of the demonstration project for a 
maximum of nine months, and the Chief Actuary of CMS must also certify 
that the extension is not projected to result in an increase in net 
Medicaid program spending. If, in her report, the Secretary recommends 
extending the demonstration project for an additional three years and/
or expanding it to include other States, the same requirements 
regarding Medicaid spending would need to be met, ensuring budget 
neutrality. At the completion of those additional 3 years, the 
demonstration project would come to a close unless Congress passes 
authorizing legislation to continue and/or expand the demonstration 
project.
  We have a real crisis in this country for millions of Americans who 
cannot get timely access to life-saving emergency inpatient psychiatric 
treatment. The Medicaid program is a vital source of support for people 
with mental disorders, funding more than 50 percent of state and local 
spending on mental health services. This outdated IMD policy is 
penalizing the disabled and poor. It is also contributing to 
inefficiencies in our health care system and likely adding to the cost 
of care. The legislation introducing today would help ensure that the 
neediest have access to hospital care when they need it and strengthen 
our Nation's health care system. It is an incremental, targeted 
approach with built-in cost safeguards, so I hope my colleagues will 
join with me to support this legislation.
  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. 599

       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 ``Improving Access to 
     Emergency Psychiatric Care Act''.

     SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMERGENCY 
                   PSYCHIATRIC DEMONSTRATION PROJECT.

       (a) In General.--Subsection (d) of section 2707 of Public 
     Law 111-148 (42 U.S.C. 1396a note) is amended to read as 
     follows:
       ``(d) Length of Demonstration Project.--
       ``(1) In general.--Except as provided in paragraphs (2) and 
     (3), the demonstration project established under this section 
     shall be conducted for a period of 3 consecutive years.
       ``(2) Temporary extension of participation eligibility for 
     selected states.--
       ``(A) In general.--Subject to paragraph (3), a State 
     selected as an eligible State to participate in the 
     demonstration project on or prior to March 13, 2012, shall, 
     upon the request of the State, be permitted to continue to 
     participate in the demonstration project through the date 
     described in subparagraph (B) if--
       ``(i) the Secretary determines that the continued 
     participation of the State in the demonstration project is 
     not expected to increase spending under title XIX of the 
     Social Security Act; and
       ``(ii) the Chief Actuary of the Centers for Medicare & 
     Medicaid Services certifies that such extension for that 
     State is projected to reduce (or is projected not to result 
     in any increase in) net program spending under title XIX of 
     the Social Security Act.
       ``(B) Date described.--The date described in this 
     subparagraph is the earlier of--
       ``(i) the date on which Secretary submits the 
     recommendations required under subsection (f)(3); or
       ``(ii) September 30, 2016.
       ``(3) Extension and expansion of demonstration project.--
       ``(A) Additional extension.--Taking into account the 
     recommendations submitted to Congress pursuant to subsection 
     (f)(3), the Secretary may, if the Secretary determines that 
     extension and expansion of the demonstration project 
     satisfies the criteria for the temporary extension under 
     subparagraphs (A) and (B) of paragraph (2)--
       ``(i) extend the demonstration project through December 31, 
     2019; and
       ``(ii) permit any eligible State participating in the 
     demonstration project as of the date such recommendations are 
     submitted to continue to participate in the project.
       ``(B) Option for expansion to additional states.--Taking 
     into account the recommendations submitted to Congress 
     pursuant to subsection (f)(3), the Secretary may expand 
     (including on a nationwide basis) the number of eligible 
     States participating in the demonstration project during the 
     extension period established under subparagraph (A) if, with 
     respect to any new eligible State--
       ``(i) the Secretary determines that the participation of 
     the State in the demonstration project is not expected to 
     increase spending under title XIX of the Social Security Act; 
     and
       ``(ii) the Chief Actuary of the Centers for Medicare & 
     Medicaid Services certifies that the participation of the 
     State in the demonstration project is projected to reduce (or 
     is projected not to result in any increase in) net program 
     spending under title XIX of the Social Security Act.
       ``(4) Authority to ensure budget neutrality.--The Secretary 
     annually shall review each participating State's 
     demonstration project expenditures to ensure compliance with 
     the requirements of paragraphs (2)(A), (2)(B), (3)(B)(i), and 
     (3)(B)(ii) (as applicable). If the Secretary determines with 
     respect to a State's participation in the demonstration 
     project that the State's net program spending under title XIX 
     of the Social Security Act has increased as a result of the 
     State's participation in the project, the Secretary shall 
     treat the demonstration project excess expenditures of the 
     State as an overpayment under title XIX of the Social 
     Security Act.''.
       (b) Funding.--Subsection (e) of section 2707 of such Act 
     (42 U.S.C. 1396a note) is amended--
       (1) in the subsection heading, by striking ``Limitations on 
     Federal'';
       (2) in paragraph (2)--
       (A) in the paragraph heading, by striking ``5-year''; and
       (B) by striking ``through December 31, 2015'' and inserting 
     ``until expended'';
       (3) by striking paragraph (3);
       (4) by redesignating paragraphs (4) and (5) as paragraphs 
     (3) and (4), respectively;
       (5) in paragraph (3) (as so redesignated), by striking 
     ``and the availability of funds'' and inserting ``(other than 
     States deemed to be eligible States through the application 
     of subsection (c)(4))''; and
       (6) in paragraph (4) (as so redesignated)--
       (A) in the first sentence--
       (i) by inserting ``(other than a State deemed to be an 
     eligible State through the

[[Page S1170]]

     application of subsection (c)(4))'' after ``eligible State''; 
     and
       (ii) by striking ``paragraph (4)'' and inserting 
     ``paragraph (3)''; and
       (B) by inserting after the first sentence the following 
     ``In addition to any payments made to an eligible State under 
     the preceding sentence, the Secretary shall, during any 
     period in effect under paragraph (2) or (3) of subsection 
     (d), or during any period in which a law described in 
     subsection (f)(4)(C) is in effect, pay each eligible State 
     (including any State deemed to be an eligible State through 
     the application of subsection (c)(4)), an amount each quarter 
     equal to the Federal medical assistance percentage of 
     expenditures in the quarter during such period for medical 
     assistance described in subsection (a). Payments made to 
     States under this paragraph shall be considered to have been 
     made under, and are subject to, the requirements of section 
     1903 of the Social Security Act (42 U.S.C. 1396b).''.
       (c) Recommendations to Congress.--Subsection (f) of section 
     2707 of such Act (42 U.S.C. 1396a note) is amended by adding 
     at the end the following:
       ``(3) Recommendation to congress regarding extension and 
     expansion of project.--Not later than September 30, 2016, the 
     Secretary shall submit to Congress and make available to the 
     public recommendations based on an evaluation of the 
     demonstration project, including the use of appropriate 
     quality measures, regarding--
       ``(A) whether the demonstration project should be continued 
     after December 31, 2016; and
       ``(B) whether the demonstration project should be expanded 
     (including on a nationwide basis).
       ``(4) Recommendation to congress regarding permanent 
     extension and nationwide expansion.--
       ``(A) In general.--Not later than April 1, 2019, the 
     Secretary shall submit to Congress and make available to the 
     public recommendations based on an evaluation of the 
     demonstration project, including the use of appropriate 
     quality measures, regarding--
       ``(i) whether the demonstration project should be 
     permanently continued after December 31, 2019, in 1 or more 
     States; and
       ``(ii) whether the demonstration project should be expanded 
     (including on a nationwide basis).
       ``(B) Requirements.--Any recommendation submitted under 
     subparagraph (A) to permanently continue the project in a 
     State, or to expand the project to 1 or more other States 
     (including on a nationwide basis) shall include a 
     certification from the Chief Actuary of the Centers for 
     Medicare & Medicaid Services that permanently continuing the 
     project in a particular State, or expanding the project to a 
     particular State (or all States) is projected to reduce (or 
     is projected not to result in any increase in) net program 
     spending under title XIX of the Social Security Act. If the 
     Secretary determines with respect to a State's participation 
     in the demonstration project that net program spending under 
     title XIX of such Act has increased as a result of the 
     project, the Secretary shall treat the demonstration project 
     excess expenditures of the State as an overpayment under 
     title XIX of the Social Security Act.
       ``(C) Congressional approval required.--The Secretary shall 
     not permanently continue the demonstration project in any 
     State after December 31, 2019, or expand the demonstration 
     project to any additional State after December 31, 2019, 
     unless Congress enacts a law approving either or both such 
     actions.
       ``(5) Funding.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to the Centers 
     for Medicare & Medicaid Services Program Management Account 
     to carry out this subsection, $100,000 for fiscal year 2015, 
     to remain available until expended.''.
       (d) Conforming Amendments.--Section 2707 of such Act (42 
     U.S.C. 1396a note) is amended--
       (1) in subsection (c)--
       (A) in paragraph (1), by striking ``An eligible State'' and 
     inserting ``Except as otherwise provided in paragraph (4), an 
     eligible State'';
       (B) in paragraph (3), by striking ``A State shall'' and 
     inserting ``Except as otherwise provided in paragraph (4), a 
     State shall''; and
       (C) by adding at the end the following:
       ``(4) Nationwide availability.--In the event that the 
     Secretary makes a recommendation pursuant to subsection 
     (f)(4) that the demonstration project be expanded on a 
     national basis, any State that has submitted or submits an 
     application pursuant to paragraph (2) shall be deemed to have 
     been selected to be an eligible State to participate in the 
     demonstration project.''; and
       (2) in the heading for subsection (f), by striking ``and 
     Report'' and inserting ``, Report, and Recommendations''.
       (e) Effective Date.--The amendments made by this section 
     shall take effect on the date of the enactment of this Act.

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