[Congressional Record (Bound Edition), Volume 145 (1999), Part 2]
[Senate]
[Pages 3070-3074]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          AMENDMENTS SUBMITTED

                                 ______
                                 

 SOLDIERS', SAILORS', AIRMEN'S, AND MARINES' BILL OF RIGHTS ACT OF 1999

                                 ______
                                 

                         BOND AMENDMENT NO. 20

  (Ordered to lie on the table.)
  Mr. BOND submitted an amendment intended to be proposed by him to the 
bill (S. 4) to improve pay and retirement equity for members of the 
Armed Forces; and for other purposes; as follows:

       On page 46, after line 16, add the following:

                        TITLE V--OTHER BENEFITS

     SECTION 501. MEDICARE PART B SPECIAL ENROLLMENT PERIOD AND 
                   WAIVER OF PART B LATE ENROLLMENT PENALTY AND 
                   MEDIGAP SPECIAL OPEN ENROLLMENT PERIOD FOR 
                   CERTAIN MILITARY RETIREES AND DEPENDENTS.

       (a) Medicare Part B Special Enrollment Period; Waiver of 
     Part B Penalty for Late Enrollment.--
       (1) In general.--In the case of any eligible individual (as 
     defined in subsection (c)), the Secretary of Health and Human 
     Services shall provide for a special enrollment period during 
     which the individual may enroll under part B of title XVIII 
     of the Social Security Act (42 U.S.C. 1395j et seq.). Such 
     period shall be for a period of 6 months and shall begin with 
     the first month that begins at least 45 days after the date 
     of enactment of this Act.
       (2) Coverage period.--In the case of an eligible individual 
     who enrolls during the special enrollment period provided 
     under paragraph (1), the coverage period under part B of 
     title XVIII of the Social Security Act shall begin on the 
     first day of the month following the month in which the 
     individual enrolls.
       (3) Waiver of part b late enrollment penalty.--In the case 
     of an eligible individual who enrolls during the special 
     enrollment period provided under paragraph (1), there shall 
     be no increase pursuant to section 1839(b) of the Social 
     Security Act (42 U.S.C. 1395r(b)) in the monthly premium 
     under part B of title XVIII of such Act.
       (b) Medigap Special Open Enrollment Period.--
     Notwithstanding any other provision of law, an issuer of a 
     medicare supplemental policy (as defined in section 1882(g) 
     of the Social Security Act (42 U.S.C. 1395ss))--
       (1) may not deny or condition the issuance or effectiveness 
     of a medicare supplemental policy; and
       (2) may not discriminate in the pricing of the policy on 
     the basis of the individual's health status, medical 
     condition (including both physical and mental illnesses), 
     claims experience, receipt of health care, medical history, 
     genetic information, evidence of insurability (including 
     conditions arising out of acts of domestic violence), or 
     disability;

     in the case of an eligible individual who seeks to enroll 
     during the 6-month period described in subsection (a)(1).
       (c) Eligible Individual Defined.--In this section, the term 
     ``eligible individual'' means an individual--
       (1) who, as of the date of the enactment of this Act, has 
     attained 65 years of age and was eligible to enroll under 
     part B of title XVIII of the Social Security Act, and
       (2) who at the time the individual first satisfied 
     paragraph (1) or (2) of section 1836 of the Social Security 
     Act (42 U.S.C. 1395o)--
       (A) was a covered beneficiary (as defined in section 
     1072(5) of title 10, United States Code), and
       (B) did not elect to enroll (or to be deemed enrolled) 
     under section 1837 of the Social Security Act (42 U.S.C. 
     1395p) during the individual's initial enrollment period.

     The Secretary of Health and Human Services shall consult with 
     the Secretary of Defense in the identification of eligible 
     individuals.
                                 ______
                                 

              ROCKEFELLER (AND BINGAMAN) AMENDMENT NO. 21

  Mr. ROCKEFELLER (for himself and Mr. Bingaman) proposed an amendment 
to the bill, S. 4, supra; as follows:

       On page 46, between the matter following line 5 and line 6, 
     insert the following:

     SEC. 305. AVAILABILITY OF MONTGOMERY GI BILL BENEFITS FOR 
                   PREPARATORY COURSES FOR COLLEGE AND GRADUATE 
                   SCHOOL ENTRANCE EXAMS.

       For purposes of section 3002(3) of title 38, United States 
     Code, the term ``program of education'' shall include the 
     following:
       (1) A preparatory course for a test that is required or 
     utilized for admission to an institution of higher education.
       (2) A preparatory course for test that is required or 
     utilized for admission to a graduate school.
                                 ______
                                 

                  WARNER (AND ALLARD) AMENDMENT NO. 22

  Mr. WARNER (for himself and Mr. Allard) proposed an amendment to the 
bill, S. 4, supra; as follows:

       On page 21, line 19, insert ``2000,'' after ``January 1,''.
       On page 21, line 23, strike out ``(1)''.
       Beginning on page 22, in the table under the heading 
     ``commissioned officers with over 4 years of active duty 
     service as an enlisted member or warrant officer'', strike 
     out the superscript ``\4\'' each place it appears in the 
     column under the heading ``Pay Grade''.
       Beginning on page 27, line 25, strike out ``the Secretary 
     of Health and Human Services'' and all that follows through 
     ``Administration),'' on page 28, line 4.
                                 ______
                                 

                 HARKIN (AND BINGAMAN) AMENDMENT NO. 23

  Mr. HARKIN (for himself and Mr. Bingaman) proposed an amendment to 
the bill, S. 4, supra; as follows:


[[Page 3071]]

       On page 25, strike lines 10 through 15, and insert the 
     following:

     (b)(1), the Secretary concerned shall pay the member a 
     special subsistence allowance for each month for which the 
     member is eligible to receive food stamp assistance, as 
     determined by the Secretary.
       ``(b) Covered Members.--(1) A member referred to subsection 
     (a) is an enlisted member in pay grade E-5 or below.
       ``(2) For the purposes of this section, a member shall be 
     considered as being eligible to receive food stamp assistance 
     if the household of the member meets the income standards of 
     eligibility established under section 5(c)(2) of the Food 
     Stamp Act of 1977 (7 U.S.C. 2014(c)(2)), not taking into 
     account the special subsistence allowance that may be payable 
     to the member under this section and any allowance that is 
     payable to the member under section 403 or 404a of this 
     title.
       On page 28, between lines 8 and 9, insert the following:

     SEC. 104. IMPLEMENTATION OF THE SPECIAL SUPPLEMENTAL 
                   NUTRITION PROGRAM.

       (a) Clarification of Benefits Responsibility.--Subsection 
     (a) of section 1060a of title 10, United States Code, is 
     amended by striking ``may carry out a program to provide 
     special supplemental food benefits'' and inserting ``shall 
     carry out a program to provide supplemental foods and 
     nutrition education''.
       (b) Relationship to WIC Program.--Subsection (b) of such 
     section is amended to read as follows:
       ``(b) Federal Payments.--For the purpose of providing 
     supplemental foods under the program required under 
     subsection (a), the Secretary of Agriculture shall make 
     available to the Secretary of Defense for each of fiscal 
     years 1999 through 2003, out of funds available for such 
     fiscal year pursuant to the authorization of appropriations 
     under section 17(g)(1) of the Child Nutrition Act of 1966 (42 
     U.S.C. 1786(g)(1)), $10,000,000 plus such additional amount 
     as is necessary to provide supplemental foods under the 
     program for such fiscal year. The Secretary of Defense shall 
     use funds available for the Department of Defense to provide 
     nutrition education and to pay for costs for nutrition 
     services and administration under the program.''.
       (c) Program Administration.--Subsection (c)(1)(A) of such 
     section is amended by adding at the end the following: ``In 
     the determining of eligibility for the program benefits, a 
     person already certified for participation in the special 
     supplemental nutrition program for women, infants, and 
     children under section 17 of the Child Nutrition Act of 1996 
     (42 U.S.C. 1786) shall be considered eligible for the 
     duration of the certification period under that program.''.
       (d) Nutritional Risk Standards.--Subsection (c)(1)(B) of 
     such section is amended by inserting ``and nutritional risk 
     standards'' after ``income eligibility standards''.
       (e) Definitions.--Subsection (f) of such section is amended 
     by adding at the end the following:
       ``(4) The terms `costs for nutrition services and 
     administration', `nutrition education' and `supplemental 
     foods' have the meanings given the terms in paragraphs (4), 
     (7), and (14), respectively, of section 17(b) of the Child 
     Nutrition Act of 1966 (42 U.S.C. 1786(b)).''.
       (f) Report.--Not later than March 1, 2001, the Secretary of 
     Defense, in consultation with the Secretary of Agriculture, 
     shall submit to Congress a report on the implementation of 
     the special supplemental food program required under section 
     1060a of title 10, United States Code. The report shall 
     include a discussion of whether the amount required to be 
     provided by the Secretary of Agriculture for supplemental 
     foods under subsection (b) of that section is adequate for 
     the purpose and, if not, an estimate of the amount necessary 
     to provide supplemental foods under the program.
                                 ______
                                 

                       BINGAMAN AMENDMENT NO. 24

  Mr. BINGAMAN proposed an amendment to the bill, S. 4, supra; as 
follows:

       On page 46, after line 16, add the following:

                         TITLE V--MISCELLANEOUS

     SEC. 501. SENSE OF SENATE REGARDING PROCESSING OF CLAIMS FOR 
                   VETERANS' BENEFITS.

       (a) Findings.--The Senate makes the following findings:
       (1) Despite advances in technology, telecommunications, and 
     training, the Department of Veterans Affairs currently 
     requires 20 percent more time to process claims for veterans' 
     benefits than the Department required to process such claims 
     in 1997.
       (2) The Department does not currently process claims for 
     veterans' benefits in a timely manner.
       (b) Sense of Senate.--It is the sense of the Senate to urge 
     the Secretary of Veterans Affairs to--
       (1) review the program, policies, and procedures of the 
     Veterans Benefits Administration of the Department of 
     Veterans Affairs in order to identify areas in which the 
     Administration does not currently process claims for 
     veterans' benefits in a manner consistent with the objectives 
     set forth in the National Performance Review (including 
     objectives regarding timeliness of Executive branch 
     activities); and
       (2) initiate any actions necessary to ensure that the 
     Administration processes claims for such benefits in a manner 
     consistent with such objectives.
       (3) report to the Congress by June 1, 1999 on measures 
     taken to improve processing time for veterans' claims.
                                 ______
                                 

                       FEINGOLD AMENDMENT NO. 25

  Ms. LANDRIEU (for Mr. Feingold) proposed an amendment to the bill, S. 
4, supra; as follows:

       On page 28, between lines 8 and 9, insert the following:

     SEC. 104. ENTITLEMENT OF RESERVES NOT ON ACTIVE DUTY TO 
                   RECEIVE SPECIAL DUTY ASSIGNMENT PAY.

       (a) Authority.--Section 307(a) of title 37, United States 
     Code, is amended by inserting after ``is entitled to basic 
     pay'' in the first sentence the following: ``, or is entitled 
     to compensation under section 206 of this title in the case 
     of a member of a reserve component not on active duty,''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the first day of the first month that 
     begins on or after the date of the enactment of this Act.
                                 ______
                                 

               ROCKEFELLER (AND OTHERS) AMENDMENT NO. 26

  Mr. ROCKEFELLER (for himself, Mr. Wellstone, Mr. Kennedy, Mr. Grams, 
Mr. Ashcroft, Mr. Reid, Mr. Kerry, Mr. Specter, Mr. Jeffords, and Mr. 
Daschle) proposed an amendment to the bill, S. 4, supra; as follows:

       On page 46, after line 16, add the following:

     SEC. __. MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR 
                   VETERANS.

       Title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.) is amended by adding at the end the following:


        ``MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR VETERANS

       ``Sec. 1897. (a) Definitions.--In this section:
       ``(1) Administering secretaries.--The term `administering 
     Secretaries' means the Secretary and the Secretary of 
     Veterans Affairs acting jointly.
       ``(2) Demonstration project; project.--The terms 
     `demonstration project' and `project' mean the demonstration 
     project carried out under this section.
       ``(3) Demonstration site.--The term `demonstration site' 
     means a Veterans Affairs medical facility, including a group 
     of Veterans Affairs medical facilities that provide hospital 
     care or medical services as part of a service network or 
     similar organization.
       ``(4) Military retiree.--The term `military retiree' means 
     a member or former member of the Armed Forces who is entitled 
     to retired pay.
       ``(5) Targeted medicare-eligible veteran.--The term 
     `targeted medicare-eligible veteran' means an individual 
     who--
       ``(A) is a veteran (as defined in section 101(2) of title 
     38, United States Code) and is described in section 
     1710(a)(3) of title 38, United States Code;
       ``(B) has attained age 65;
       ``(C) is entitled to benefits under part A of this title; 
     and
       ``(D)(i) is enrolled for benefits under part B of this 
     title; and
       ``(ii) if such individual attained age 65 before the date 
     of enactment of the Veterans' Equal Access to Medicare Act, 
     was so enrolled on such date.
       ``(6) Trust funds.--The term `trust funds' means the 
     Federal Hospital Insurance Trust Fund established in section 
     1817 and the Federal Supplementary Medical Insurance Trust 
     Fund established in section 1841.
       ``(7) Veterans affairs medical facility.--The term 
     `Veterans Affairs medical facility' means a medical facility 
     as defined in section 8101 of title 38, United States Code.
       ``(b) Demonstration Project.--
       ``(1) In general.--
       ``(A) Establishment.--The administering Secretaries are 
     authorized to establish a demonstration project (under an 
     agreement entered into by the administering Secretaries) 
     under which the Secretary shall reimburse the Secretary of 
     Veterans Affairs, from the trust funds, for medicare health 
     care services furnished to certain targeted medicare-eligible 
     veterans at a demonstration site.
       ``(B) Agreement.--The agreement entered into under 
     subparagraph (A) shall include at a minimum--
       ``(i) a description of the benefits to be provided to the 
     participants in the demonstration project established under 
     this section;
       ``(ii) a description of the eligibility rules for 
     participation in the demonstration project, including any 
     terms and conditions established under subparagraph (C) and 
     any cost-sharing required under subparagraph (D);
       ``(iii) a description of how the demonstration project will 
     satisfy the requirements under this title (including 
     beneficiary protections and quality assurance mechanisms);
       ``(iv) a description of the demonstration sites selected 
     under paragraph (2);

[[Page 3072]]

       ``(v) a description of how reimbursement and maintenance of 
     effort requirements under subsection (h) will be implemented 
     in the demonstration project;
       ``(vi) a statement that the Secretary shall have access to 
     all data of the Department of Veterans Affairs that the 
     Secretary determines is necessary to conduct independent 
     estimates and audits of the maintenance of effort 
     requirement, the annual reconciliation, and related matters 
     required under the demonstration project;
       ``(vii) a description of any requirement that the Secretary 
     waives pursuant to subsection (d); and
       ``(viii) a certification, provided after review by the 
     administering Secretaries, that any entity that is receiving 
     payments by reason of the demonstration project has 
     sufficient--

       ``(I) resources and expertise to provide, consistent with 
     payments under subsection (h), the full range of benefits 
     required to be provided to beneficiaries under the project; 
     and
       ``(II) information and billing systems in place to ensure 
     the accurate and timely submission of claims for benefits and 
     to ensure that providers of services, physicians, and other 
     health care professionals are reimbursed by the entity in a 
     timely and accurate manner.

       ``(C) Voluntary participation.--Participation of targeted 
     medicare-eligible veterans in the demonstration project shall 
     be voluntary, subject to the capacity of participating 
     demonstration sites and the funding limitations specified in 
     subsection (h), and shall be subject to such terms and 
     conditions as the administering Secretaries may establish. In 
     the case of a demonstration site described in paragraph 
     (2)(C)(i), targeted medicare-eligible veterans who are 
     military retirees shall be given preference for participating 
     in the project conducted at that site.
       ``(D) Cost-sharing.--The Secretary of Veterans Affairs may 
     establish cost-sharing requirements for veterans 
     participating in the demonstration project. If such cost-
     sharing requirements are established, those requirements 
     shall be the same as the requirements that apply to targeted 
     medicare-eligible patients at medical centers that are not 
     Veterans Affairs medical facilities.
       ``(E) Data match.--
       ``(i) Establishment of data matching program.--The 
     administering Secretaries shall establish a data matching 
     program under which there is an exchange of information of 
     the Department of Veterans Affairs and of the Department of 
     Health and Human Services as is necessary to identify 
     veterans (as defined in section 101(2) of title 38, United 
     States Code) who are entitled to benefits under part A or 
     enrolled under part B, or both, in order to carry out this 
     section. The provisions of section 552a of title 5, United 
     States Code, shall apply with respect to such matching 
     program only to the extent the administering Secretaries find 
     it feasible and appropriate in carrying out this section in a 
     timely and efficient manner.
       ``(ii) Performance of data match.--The administering 
     Secretaries, using the data matching program established 
     under clause (i), shall perform a comparison in order to 
     identify veterans who are entitled to benefits under part A 
     or enrolled under part B, or both. To the extent such 
     Secretaries deem appropriate to carry out this section, the 
     comparison and identification may distinguish among such 
     veterans by category of veterans, by entitlement to benefits 
     under this title, or by other characteristics.
       ``(iii) Deadline for first data match.--Not later than 
     October 31, 1999, the administering Secretaries shall first 
     perform a comparison under clause (ii).
       ``(iv) Certification by inspector general.--

       ``(I) In general.--The administering Secretaries may not 
     conduct the program unless the Inspector General of the 
     Department of Health and Human Services certifies to Congress 
     that the administering Secretaries have established the data 
     matching program under clause (i) and have performed a 
     comparison under clause (ii).
       ``(II) Deadline for certification.--Not later than December 
     15, 1999, the Inspector General of the Department of Health 
     and Human Services shall submit a report to Congress 
     containing the certification under subclause (I) or the 
     denial of such certification.

       ``(2) Number of demonstration sites.--
       ``(A) In general.--Subject to subparagraphs (B) and (C), 
     and subsection (g)(1)(D)(ii), the administering Secretaries 
     shall establish a plan for the selection of up to 10 
     demonstration sites located in geographically dispersed 
     locations to participate in the project.
       ``(B) Criteria.--The administering Secretaries shall favor 
     selection of those demonstration sites that consideration of 
     the following factors indicate are suited to serve targeted 
     medicare-eligible veterans:
       ``(i) There is a high potential demand by targeted 
     medicare-eligible veterans for the services to be provided at 
     the demonstration site.
       ``(ii) The demonstration site has sufficient capability in 
     billing and accounting to participate in the project.
       ``(iii) The demonstration site can demonstrate favorable 
     indicators of quality of care, including patient 
     satisfaction.
       ``(iv) The demonstration site delivers a range of services 
     required by targeted medicare-eligible veterans.
       ``(v) The demonstration site meets other relevant factors 
     identified in the plan.
       ``(C) Required demonstration sites.--At least 1 of each of 
     the following demonstration sites shall be selected for 
     inclusion in the demonstration project:
       ``(i) Demonstration site near closed base.--A demonstration 
     site that is in the same catchment area as a military 
     treatment facility referred to in section 1074(a) of title 
     10, United States Code, which was closed pursuant to either--

       ``(I) the Defense Base Closure and Realignment Act of 1990 
     (part A of title XXIX of Public Law 101-510; 10 U.S.C. 2687 
     note); or
       ``(II) title II of the Defense Authorization Amendments and 
     Base Closure and Realignment Act (Public Law 100-526; 10 
     U.S.C. 2687 note).

       ``(ii) Demonstration site in a rural area.--A demonstration 
     site that serves a predominantly rural population.
       ``(3) Restriction.--No new buildings may be built or 
     existing buildings expanded with funds from the demonstration 
     project.
       ``(4) Duration.--The administering Secretaries shall 
     conduct the demonstration project during the 3-year period 
     beginning on January 1, 2000.
       ``(c) Crediting of Payments.--A payment received by the 
     Secretary of Veterans Affairs under the demonstration project 
     shall be credited to the applicable Department of Veterans 
     Affairs medical appropriation and (within that appropriation) 
     to funds that have been allotted to the demonstration site 
     that furnished the services for which the payment is made. 
     Any such payment received during a fiscal year for services 
     provided during a prior fiscal year may be obligated by the 
     Secretary of Veterans Affairs during the fiscal year during 
     which the payment is received.
       ``(d) Authority To Waive Certain Medicare Requirements.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     Secretary may, to the extent necessary to carry out the 
     demonstration project, waive any requirement under this 
     title.
       ``(2) Beneficiary protections for managed care plans.--In 
     the case of a managed care plan established by the Secretary 
     of Veterans Affairs pursuant to subsection (g), such plan 
     shall comply with the requirements of part C of this title 
     that relate to beneficiary protections and other matters, 
     including such requirements relating to the following areas:
       ``(A) Enrollment and disenrollment.
       ``(B) Nondiscrimination.
       ``(C) Information provided to beneficiaries.
       ``(D) Cost-sharing limitations.
       ``(E) Appeal and grievance procedures.
       ``(F) Provider participation.
       ``(G) Access to services.
       ``(H) Quality assurance and external review.
       ``(I) Advance directives.
       ``(J) Other areas of beneficiary protections that the 
     Secretary determines are applicable to such project.
       ``(3) Description of waiver.--If the Secretary waives any 
     requirement pursuant to paragraph (1), the Secretary shall 
     include a description of such waiver in the agreement 
     described in subsection (b)(1)(B).
       ``(e) Inspector General.--Nothing in the agreement entered 
     into under subsection (b) shall limit the Inspector General 
     of the Department of Health and Human Services from 
     investigating any matters regarding the expenditure of funds 
     under this title for the demonstration project, including 
     compliance with the provisions of this title and all other 
     relevant laws.
       ``(f) Report.--At least 60 days prior to the commencement 
     of the demonstration project, the administering Secretaries 
     shall submit a copy of the agreement entered into under 
     subsection (b) to the committees of jurisdiction in Congress.
       ``(g) Managed Health Care.--
       ``(1) Managed health care plans.--
       ``(A) In general.--The Secretary of Veterans Affairs may 
     establish and operate managed health care plans at 
     demonstration sites.
       ``(B) Requirements.--Any managed health care plan 
     established in accordance with subparagraph (A) shall be 
     operated by or through a Veterans Affairs medical facility, 
     or a group of Veterans Affairs medical facilities, and may 
     include the provision of health care services by public and 
     private entities under arrangements made between the 
     Department of Veterans Affairs and the other public or 
     private entity concerned. Any such managed health care plan 
     shall be established and operated in conformance with 
     standards prescribed by the administering Secretaries.
       ``(C) Minimum benefits.--The administering Secretaries 
     shall prescribe the minimum health care benefits to be 
     provided under a managed health care plan to veterans 
     enrolled in the plan, which benefits shall include at least 
     all health care services covered under the medicare program 
     under this title.
       ``(D) Inclusion in number of demonstration sites.--

[[Page 3073]]

       ``(i) In general.--Subject to clause (ii), if the Secretary 
     of Veterans Affairs elects to establish a managed health care 
     plan under this section, the establishment of such plan is a 
     selected demonstration site for purposes of applying the 
     numerical limitation under subsection (b)(2).
       ``(ii) Limitation.--The Secretary of Veterans Affairs shall 
     not establish more than 4 managed health care plans under 
     this section.
       ``(2) Demonstration site requirements.--The Secretary of 
     Veterans Affairs may establish a managed health care plan 
     under paragraph (1) using 1 or more demonstration sites and 
     other public or private entities only after the Secretary of 
     Veterans Affairs submits to Congress a report setting forth a 
     plan for the use of such sites and entities. The plan may not 
     be implemented until the Secretary of Veterans Affairs has 
     received from the Inspector General of the Department of 
     Veterans Affairs, and has forwarded to Congress, 
     certification of each of the following:
       ``(A) The cost accounting system of the Veterans Health 
     Administration (currently known as the Decision Support 
     System) is operational and is providing reliable cost 
     information on care delivered on an inpatient and outpatient 
     basis at such sites and entities.
       ``(B) The demonstration sites and entities have developed a 
     credible plan (on the basis of market surveys, data from the 
     Decision Support System, actuarial analysis, or other 
     appropriate methods and taking into account the level of 
     payment under subsection (h) and the costs of providing 
     covered services at the sites and entities) to minimize, to 
     the extent feasible, the risk that appropriated funds 
     allocated to the sites and entities will be required to meet 
     the obligation of the sites and entities to targeted 
     medicare-eligible veterans under the demonstration project.
       ``(C) The demonstration sites and entities collectively 
     have available capacity to provide the contracted benefits 
     package to a sufficient number of targeted medicare-eligible 
     veterans.
       ``(D) The Veterans Affairs medical facility administering 
     the health plan has sufficient systems and safeguards in 
     place to minimize any risk that instituting the managed care 
     model will result in reducing the quality of care delivered 
     to participants in the demonstration project or to other 
     veterans receiving care under paragraph (1) or (2) of section 
     1710(a) of title 38, United States Code.
       ``(3) Reserves.--The Secretary of Veterans Affairs shall 
     maintain such reserves as may be necessary to ensure against 
     the risk that appropriated funds, allocated to demonstration 
     sites and public or private entities participating in the 
     demonstration project through a managed health care plan 
     under this section, will be required to meet the obligations 
     of those sites and entities to targeted medicare-eligible 
     veterans.
       ``(h) Payments Based on Regular Medicare Payment Rates.--
       ``(1) Payments.--
       ``(A) In general.--Subject to the succeeding provisions of 
     this subsection, the Secretary shall reimburse the Secretary 
     of Veterans Affairs for services provided under the 
     demonstration project at the following rates:
       ``(i) Noncapitation.--Except as provided in clause (ii) and 
     subject to subparagraphs (B) and (D), at a rate equal to 95 
     percent of the amounts that otherwise would be payable under 
     this title on a noncapitated basis for such services if the 
     demonstration site was not part of this demonstration 
     project, was participating in the medicare program, and 
     imposed charges for such services.
       ``(ii) Capitation.--Subject to subparagraphs (B) and (D), 
     in the case of services provided to an enrollee under a 
     managed health care plan established under subsection (g), at 
     a rate equal to 95 percent of the amount paid to a 
     Medicare+Choice organization under part C with respect to 
     such an enrollee.
       ``(iii) Other cases.--In cases in which a payment amount 
     may not otherwise be readily computed under clauses (i) or 
     (ii), the Secretaries shall establish rules for computing 
     equivalent or comparable payment amounts.
       ``(B) Exclusion of certain amounts.--In computing the 
     amount of payment under subparagraph (A), the following shall 
     be excluded:
       ``(i) Disproportionate share hospital adjustment.--Any 
     amount attributable to an adjustment under section 
     1886(d)(5)(F) of the Social Security Act (42 U.S.C. 
     1395ww(d)(5)(F)).
       ``(ii) Direct graduate medical education payments.--Any 
     amount attributable to a payment under subsection (h) of such 
     section.
       ``(iii) Percentage of indirect medical education 
     adjustment.--40 percent of any amount attributable to the 
     adjustment under subsection (d)(5)(B) of such section.
       ``(iv) Percentage of capital payments.--67 percent of any 
     amounts attributable to payments for capital-related costs 
     under subsection (g) of such section.
       ``(C) Periodic payments from medicare trust funds.--
     Payments under this subsection shall be made--
       ``(i) on a periodic basis consistent with the periodicity 
     of payments under this title; and
       ``(ii) in appropriate part, as determined by the Secretary, 
     from the trust funds.
       ``(D) Annual limit on medicare payments.--The amount paid 
     to the Department of Veterans Affairs under this subsection 
     for any year for the demonstration project may not exceed 
     $50,000,000.
       ``(2) Reduction in payment for va failure to maintain 
     effort.--
       ``(A) In general.--To avoid shifting onto the medicare 
     program under this title costs previously assumed by the 
     Department of Veterans Affairs for the provision of medicare-
     covered services to targeted medicare-eligible veterans, the 
     payment amount under this subsection for the project for a 
     fiscal year shall be reduced by the amount (if any) by 
     which--
       ``(i) the amount of the VA effort level for targeted 
     veterans (as defined in subparagraph (B)) for the fiscal year 
     ending in such year, is less than
       ``(ii) the amount of the VA effort level for targeted 
     veterans for fiscal year 1998.
       ``(B) VA effort level for targeted veterans defined.--For 
     purposes of subparagraph (A), the term `VA effort level for 
     targeted veterans' means, for a fiscal year, the amount, as 
     estimated by the administering Secretaries, that would have 
     been expended under the medicare program under this title for 
     VA-provided medicare-covered services for targeted veterans 
     (as defined in subparagraph (C)) for that fiscal year if 
     benefits were available under the medicare program for those 
     services. Such amount does not include expenditures 
     attributable to services for which reimbursement is made 
     under the demonstration project.
       ``(C) VA-provided medicare-covered services for targeted 
     veterans.--For purposes of subparagraph (B), the term `VA-
     provided medicare-covered services for targeted veterans' 
     means, for a fiscal year, items and services--
       ``(i) that are provided during the fiscal year by the 
     Department of Veterans Affairs to targeted medicare-eligible 
     veterans;
       ``(ii) that constitute hospital care and medical services 
     under chapter 17 of title 38, United States Code; and
       ``(iii) for which benefits would be available under the 
     medicare program under this title if they were provided other 
     than by a Federal provider of services that does not charge 
     for those services.
       ``(3) Assuring no increase in cost to medicare program.--
       ``(A) Monitoring effect of demonstration program on costs 
     to medicare program.--
       ``(i) In general.--The Secretaries, in consultation with 
     the Comptroller General, shall closely monitor the 
     expenditures made under the medicare program for targeted 
     medicare-eligible veterans during the period of the 
     demonstration project compared to the expenditures that would 
     have been made for such veterans during that period if the 
     demonstration project had not been conducted.
       ``(ii) Annual report by the comptroller general.--Not later 
     than December 31 of each year during which the demonstration 
     project is conducted, the Comptroller General shall submit to 
     the Secretaries and the appropriate committees of Congress a 
     report on the extent, if any, to which the costs of the 
     Secretary under the medicare program under this title 
     increased during the preceding fiscal year as a result of the 
     demonstration project.
       ``(B) Required response in case of increase in costs.--
       ``(i) In general.--If the administering Secretaries find, 
     based on subparagraph (A), that the expenditures under the 
     medicare program under this title increased (or are expected 
     to increase) during a fiscal year because of the 
     demonstration project, the administering Secretaries shall 
     take such steps as may be needed--

       ``(I) to recoup for the medicare program the amount of such 
     increase in expenditures; and
       ``(II) to prevent any such increase in the future.

       ``(ii) Steps.--Such steps--

       ``(I) under clause (i)(I), shall include payment of the 
     amount of such increased expenditures by the Secretary of 
     Veterans Affairs from the current medical care appropriation 
     of the Department of Veterans Affairs to the trust funds; and
       ``(II) under clause (i)(II), shall include suspending or 
     terminating the demonstration project (in whole or in part) 
     or lowering the amount of payment under paragraph (1)(A).

       ``(i) Evaluation and Reports.--
       ``(1) Independent evaluation.--
       ``(A) In general.--The administering Secretaries shall 
     arrange for an independent entity with expertise in the 
     evaluation of health care services to conduct an evaluation 
     of the demonstration project.
       ``(B) Contents.--The evaluation conducted under 
     subparagraph (A) shall include an assessment, based on the 
     agreement entered into under subsection (b), of the 
     following:
       ``(i) The cost to the Department of Veterans Affairs of 
     providing care to veterans under the project.
       ``(ii) Compliance of participating demonstration sites with 
     applicable measures of

[[Page 3074]]

     quality of care, compared to such compliance for other 
     medicare-participating medical centers that are not Veterans 
     Affairs medical facilities.
       ``(iii) A comparison of the costs of participation of the 
     demonstration sites in the program with the reimbursements 
     provided for services of such sites.
       ``(iv) Any savings or costs to the medicare program under 
     this title from the project.
       ``(v) Any change in access to care or quality of care for 
     targeted medicare-eligible veterans participating in the 
     project.
       ``(vi) Any effect of the project on the access to care and 
     quality of care for targeted medicare-eligible veterans not 
     participating in the project and other veterans not 
     participating in the project.
       ``(vii) The provision of services under managed health care 
     plans under subsection (g), including the circumstances (if 
     any) under which the Secretary of Veterans Affairs uses 
     reserves described in paragraph (3) of such subsection and 
     the Secretary of Veterans Affairs' response to such 
     circumstances (including the termination of managed health 
     care plans requiring the use of such reserves).
       ``(viii) Any effect that the demonstration project has on 
     the enrollment in Medicare+Choice plans offered by 
     Medicare+Choice organizations under part C of this title in 
     the established site areas.
       ``(ix) Any additional elements that the independent entity 
     determines is appropriate to assess regarding the 
     demonstration project.
       ``(C) Annual reports.--The independent entity conducting 
     the evaluation under subparagraph (A) shall submit reports on 
     such evaluation to the administering Secretaries and to the 
     committees of jurisdiction in the Congress as follows:
       ``(i) Initial report.--The entity shall submit the initial 
     report not later than 12 months after the date on which the 
     demonstration project begins operation.
       ``(ii) Second annual report.--The entity shall submit the 
     second annual report not later than 30 months after the date 
     on which the demonstration project begins operation.
       ``(iii) Final report.--The entity shall submit the final 
     report not later than 3\1/2\ years after the date on which 
     the demonstration project begins operation.
       ``(2) Report on extension and expansion of demonstration 
     project.--Not later than 3\1/2\ years after the date on which 
     the demonstration project begins operation, the administering 
     Secretaries shall submit to Congress a report containing--
       ``(A) their recommendation as to--
       ``(i) whether to extend the demonstration project or make 
     the project permanent;
       ``(ii) whether to expand the project to cover additional 
     demonstration sites and to increase the maximum amount of 
     reimbursement (or the maximum amount of reimbursement 
     permitted for managed health care plans under this section) 
     under the project in any year; and
       ``(iii) whether the terms and conditions of the project 
     should be continued (or modified) if the project is extended 
     or expanded; and
       ``(B) a detailed description of any costs associated with 
     their recommendation made pursuant to clauses (i) and (ii) of 
     subparagraph (A).''.
                                 ______
                                 

                       WELLSTONE AMENDMENT NO. 27

  Mr. WELLSTONE proposed an amendment to the bill, S. 4, supra; as 
follows:

       On page 46, after line 16, add the following:

                         TITLE V--MISCELLANEOUS

     SEC. 501. EXPANSION OF LIST OF DISEASES PRESUMED TO BE 
                   SERVICE-CONNECTED FOR RADIATION-EXPOSED 
                   VETERANS.

       Section 1112(c)(2) of title 38, United States Code, is 
     amended by adding at the end the following:
       ``(P) Lung cancer.
       ``(Q) Bone cancer.
       ``(R) Skin cancer.
       ``(S) Colon cancer.
       ``(T) Posterior subcapsular cataracts.
       ``(U) Non-malignant thyroid nodular disease.
       ``(V) Ovarian cancer.
       ``(W) Parathyroid adenoma.
       ``(X) Tumors of the brain and central nervous system.
       ``(Y) Rectal cancer.''.
                                 ______
                                 

                COVERDELL (AND McCAIN) AMENDMENT NO. 28

  Mr. WARNER (for Mr. Coverdell for himself, Mr. McCain, and Mr. Levin) 
proposed an amendment to the bill, S. 4, supra; as follows:

       On page 28, between lines 8 and 9, insert the following:

     SEC. 104. SENSE OF THE SENATE REGARDING USE OF EXTENSION OF 
                   TIME TO FILE TAX RETURNS FOR MEMBERS OF 
                   UNIFORMED SERVICES ON DUTY ABROAD.

       (a) Findings.--The Senate finds that--
       (1) the Internal Revenue Service provides a 2-month 
     extension of the deadline for filing tax returns for members 
     of the uniformed services who are in an area outside the 
     United States or the Commonwealth of Puerto Rico for a tour 
     of duty which includes the date for filing tax returns;
       (2) any taxpayer using this 2-month extension who owes 
     additional tax must pay the tax on or before the regular 
     filing deadline;
       (3) those who use the 2-month extension and wait to pay the 
     additional tax at the time of filing are charged interest 
     from the regular filing deadline, and may also be required to 
     pay a penalty; and
       (4) it is fundamentally unfair to members of the uniformed 
     services who make use of this extension to require them to 
     pay penalties and interest on the additional tax owed.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that--
       (1) the 2-month extension of the deadline for filing tax 
     returns for certain members of the uniformed services 
     provided in Internal Revenue Service regulations should be 
     codified; and
       (2) eligible members of the uniformed services should be 
     able to make use of the extension without accumulating 
     interest or penalties.
                                 ______
                                 

                        GRAHAM AMENDMENT NO. 29

  Mr. GRAHAM proposed an amendment to the bill, S. 4, supra; as 
follows:

       At the end add the following:

                           TITLE V--REVENUES

     SEC. 501. EXTENSION OF HAZARDOUS SUBSTANCE SUPERFUND TAXES.

       (a) Extension of Taxes.--
       (1) Environmental tax.--Section 59A(e) of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(e) Application of Tax.--The tax imposed by this section 
     shall apply to taxable years beginning after December 31, 
     1986, and before January 1, 1996, and to taxable years 
     beginning after June 30, 1999.''
       (2) Excise taxes.--Section 4611(e) of such Code is amended 
     to read as follows:
       ``(e) Application of Hazardous Substance Superfund 
     Financing Rate.--The Hazardous Substance Superfund financing 
     rate under this section shall apply after December 31, 1986, 
     and before January 1, 1996, and after June 30, 1999.''
       (b) Effective Dates.--
       (1) Income tax.--The amendment made by subsection (a)(1) 
     shall apply to taxable years beginning after June 30, 1999.
       (2) Excise tax.--The amendment made by subsection (a)(2) 
     shall take effect on July 1, 1999.

     SEC. 502. MODIFICATION TO FOREIGN TAX CREDIT CARRYBACK AND 
                   CARRYOVER PERIODS.

       (a) In General.--Section 904(c) of the Internal Revenue 
     Code of 1986 (relating to limitation on credit) is amended--
       (1) by striking ``in the second preceding taxable year,'', 
     and
       (2) by striking ``or fifth'' and inserting ``fifth, sixth, 
     or seventh''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to credits arising in taxable years beginning 
     after December 31, 1998.

     SEC. 503. EXTENSION OF OIL SPILL LIABILITY TAXES.

       (a) In General.--Section 4611(f)(1) (relating to 
     application of oil spill liability trust fund financing rate) 
     is amended by striking ``after December 31, 1989, and before 
     January 1, 1995'' and inserting ``after the date of the 
     enactment of the Soldiers', Sailors', Airmen's, and Marines' 
     Bill of Rights Act of 1999 and before October 1, 2008''.
       (b) Increase in Unobligated Balance Which Ends Tax.--
     Section 4611(f)(2) (relating to no tax if unobligated balance 
     in fund exceeds $1,000,000,000) is amended by striking 
     ``$1,000,000,000'' each place it appears in the text and 
     heading thereof and inserting ``$5,000,000,000''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on the date of the enactment of this Act.

                          ____________________