[Congressional Record (Bound Edition), Volume 146 (2000), Part 12]
[Senate]
[Pages 17634-17642]
[From the U.S. Government Publishing Office, www.gpo.gov]



          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. WYDEN:
  S. 3026. A bill to establish a hospice demonstration and grant 
program for beneficiaries under the Medicare Program under title XVIII 
of the Social Security Act, and for other purposes; to the Committee on 
Finance.


                hospice demonstration and grant program

  Mr. WYDEN. Mr. President, today, I am introducing groundbreaking 
legislation to make a difference in the way in which dying patients and 
their families can access hospice care. Ninety percent of Americans do 
not realize that there is a hospice benefit provided under the Medicare 
program. Over time, the length of stay in a hospice is decreasing so 
that patients do not get the full benefit of services that could make 
them more comfortable at a crucial time in their lives.
  The issues related to how we die are too important to permit the 
Medicare Hospice benefit to remain fixed in time. Now is the time to 
begin to test new ways to design the benefit so that the benefit can 
remain truly patient-centered at one of the most crucial times in 
patients' and their families' lives.
  Just as we push our health care system for medical breakthroughs that 
will allow more of us to live healthier and longer, we need to drive 
our health care system to create accessible, positive care for those 
facing the end of life.
  My legislation, the Hospice Improvement Act of 2000, would require 
the Secretary to establish a demonstration program to increase access 
and use of hospice care for patients at the end-of-life, and to 
increase the knowledge of hospice among the medical, mental health and 
patient communities. My legislation stresses the following:
  Supportive and Comfort Care: To assist families and patients in 
getting the benefit of hospice care, the Demonstration program will 
allow for a new supportive and comfort care benefit. This benefit, 
elected at the option of the patient, will not require the terminally 
ill to elect hospice care instead of other medical treatment, but

[[Page 17635]]

will permit a patient to have supportive and comfort care in place 
while the patient still seeks ``curative treatment.'' This will permit 
patients and families to learn about hospice without forcing them to 
make a choice between hospice and other care. Case management would be 
provided through a hospice provider reimbursed on a fee-for-service 
basis.
  Severity Index Instead of a Six-Month Prognosis: To determine whether 
or not a patient is eligible for the supportive and comfort care 
option, a severity index will be used instead of the current hospice 
requirement of a 6 month prognosis. This will permit patients to have 
access to support services, as needed, instead of relying on an often 
inaccurate time-related prognosis.
  Increase Rural Hospice Access: Permit nurse practitioners and 
physician assistants to admit patients to hospice if this is within 
their authority under state practice law. In communities without a 
qualified social worker, other professionals with skills, knowledge and 
ability may provide medical social services such as counseling on the 
effects of illness on the family.
  Respite Care: Nursing facilities used for respite care would not be 
required to have skilled nurses on the premises 24 hours a day (because 
hospice will be caring for the patient) or respite could be provided in 
the patient's home.
  Payment Issues: Permit reimbursement for consultations, preadmission 
informational visits, even if the patient does not elect hospice/
supportive care and provide minimum payment for Medicare hospice 
services provided under the demonstration program based on the 
provision of services for a period of 14 days, regardless of length of 
stay.
  In addition, the demonstration project could address other payment 
issues such as offsetting changes in services and oversight and the 
increased cost of providing services in rural areas and creating a per 
diem rate of payment for respite care that reflects the range of care 
needs.
  In addition to the Demonstration program, the Secretary would be 
required to establish an education grant program for the purpose of 
providing information about the Medicare hospice benefit, and the 
benefits available under the demonstration program. Education grants 
could be used to provide individual or group education to patients and 
their families and to the medical and mental health community, and to 
test messages to improve public knowledge about the Medicare hospice 
benefit.
  Let me conclude by saying that in the time left for this Congress, we 
have a unique opportunity to truly begin to improve care for the dying. 
There are fewer who are more vulnerable than someone who is dying and 
having to cope with the physical breakdown of their body and the 
emotional turmoil that imminent death brings to a family. This 
legislation provides us an opportunity to begin to remove the barriers 
to care for those who facing death.
  Mr. President, I ask unanimous consent that the full text of the bill 
be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3026

       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 ``Hospice Improvement Program 
     Act of 2000''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Each year more than \1/3\ of the people who die suffer 
     from a chronic illness.
       (2) Approximately \1/3\ of Americans are unsure about whom 
     to contact to get the best care during life's last stages.
       (3) Americans want a team of professionals to care for the 
     patient at the end of life.
       (4) Americans want emotional and spiritual support for the 
     patient and family.
       (5) Ninety percent of Americans do not realize that hospice 
     care is a benefit provided under the medicare program under 
     title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.).
       (6) Health Care Financing Administration data show that 
     beneficiaries were enrolled in hospice for an average of less 
     than 7 weeks in 1998, far less than the full 6-month benefit 
     under the medicare program.
       (7) According to the most recent data available, although 
     the average hospice enrollment is longer, half of the 
     enrollees live only 30 days after admission and almost 20 
     percent die within 1 week of enrollment.
       (8) Use of hospice among medicare beneficiaries has been 
     decreasing, from a high of 59 days in 1995 to less than 48 
     days in 1998.

     SEC. 3. HOSPICE DEMONSTRATION PROGRAM AND HOSPICE EDUCATION 
                   GRANTS.

       (a) Definitions.--In this section:
       (1) Demonstration program.--The term ``demonstration 
     program'' means the Hospice Demonstration Program established 
     by the Secretary under subsection (b)(1).
       (2) Medicare beneficiary.--The term ``medicare 
     beneficiary'' means any individual who is entitled to 
     benefits under part A or enrolled under part B of the 
     medicare program, including any individual enrolled in a 
     Medicare+Choice plan offered by a Medicare+Choice 
     organization under part C of such program.
       (3) Medicare hospice services.--The term ``medicare hospice 
     services'' means the items and services for which payment may 
     be made under section 1814(i) of the Social Security Act (42 
     U.S.C. 1395f(i)).
       (4) Medicare program.--The term ``medicare program'' means 
     the health benefits program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.).
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services, acting through the 
     Administrator of the Health Care Financing Administration.
       (b) Hospice Demonstration Program.--
       (1) Establishment.--The Secretary shall establish a Hospice 
     Demonstration Program in accordance with the provisions of 
     this subsection to increase the utility of the medicare 
     hospice services for medicare beneficiaries.
       (2) Services under demonstration program.--The provisions 
     of section 1814(i) of the Social Security Act (42 U.S.C. 
     1395f(i)) shall apply to the payment for items and services 
     provided under the demonstration program, except that--
       (A) notwithstanding section 1862(a)(1)(C) of such Act (42 
     U.S.C. 1395y(a)(1)(C)), the Secretary shall provide for 
     reimbursement for items and services provided under the 
     supportive and comfort care benefit established under 
     paragraph (3);
       (B) any licensed nurse practitioner or physician assistant 
     may certify a medicare beneficiary as the primary care 
     provider when necessary and within the scope of practice of 
     such practitioner or assistant under State law;
       (C) if a community does not have a qualified social worker, 
     any professional who has the necessary knowledge, skills, and 
     ability (other than social workers) to provide medical social 
     services shall provide such services;
       (D) the Secretary shall waive any requirement that nursing 
     facilities used for respite care have skilled nurses on the 
     premises 24 hours per day;
       (E) the Secretary shall permit respite care to be provided 
     to the medicare beneficiary at home; and
       (F) the Secretary shall waive reimbursement regulations to 
     provide--
       (i) reimbursement for consultations and preadmission 
     informational visits, even if the medicare beneficiary does 
     not choose hospice care (including the supportive and comfort 
     care benefit under paragraph (3)) at that time;
       (ii) a minimum payment for medicare hospice services 
     provided under the demonstration program based on the 
     provision of medicare hospice services to a medicare 
     beneficiary for a period of 14 days, that the Secretary shall 
     pay to any hospice provider participating in the 
     demonstration program and providing such services (regardless 
     of the length of stay of the medicare beneficiary);
       (iii) an increase in the reimbursement rates for hospice 
     services to offset--

       (I) changes in medicare hospice services and oversight 
     under the demonstration program;
       (II) the higher costs of providing medicare hospice 
     services in rural areas due to lack of economies of scale or 
     large geographic areas; and
       (III) the higher costs of providing medicare hospice 
     services in urban underserved areas due to unique costs 
     specifically associated with people living in those areas, 
     including providing security;

       (iv) direct payment of any nurse practitioner or physician 
     assistant practicing within the scope of State law in 
     relation to medicare hospice services provided by such 
     practitioner or assistant; and
       (v) a per diem rate of payment for in-home care under 
     subparagraph (E) that reflects the range of care needs of the 
     medicare beneficiary and that--

       (I) in the case of a medicare beneficiary that needs 
     routine care, is not less than 150 percent, and not more than 
     200 percent, of the routine home care rate for medicare 
     hospice services; and

       (II) in the case of a medicare beneficiary that needs acute 
     care, is equal to the continuous home care day rate for 
     medicare hospice services.
       (3) Supportive and comfort care benefit.--

[[Page 17636]]

       (A) In general.--For purposes of the demonstration program, 
     the Secretary shall establish a supportive and comfort care 
     benefit for any eligible medicare beneficiary (as defined in 
     subparagraph (C)).
       (B) Benefit.--Under the supportive and comfort care benefit 
     established under subparagraph (A), any eligible medicare 
     beneficiary may--
       (i) continue to receive benefits for disease and symptom 
     modifying treatment under the medicare program (and the 
     Secretary may not require or prohibit any specific treatment 
     or decision);
       (ii) receive case management and medicare hospice services 
     through a hospice provider, which the Secretary shall 
     reimburse on a fee-for-service basis; and
       (iii) receive information and experience in order to better 
     understand the utility of medicare hospice services.
       (C) Eligible medicare beneficiary defined.--
       (i) In general.--In this paragraph, the term ``eligible 
     medicare beneficiary'' means any medicare beneficiary with a 
     serious illness that has been documented by a physician to be 
     at a level of severity determined by the Secretary to meet 
     the criteria developed under clause (ii).
       (ii) Development of criteria.--

       (I) In general.--The Secretary, in consultation with 
     hospice providers and experts in end-of-life care, shall 
     develop criteria for determining the level of severity of an 
     established serious illness taking into account the factors 
     described in subclause (II).
       (II) Factors.--The factors described in this clause include 
     the level of function of the medicare beneficiary, any 
     coexisting illnesses of the beneficiary, and the severity of 
     any chronic condition that will lead to the death of the 
     beneficiary.
       (III) Prognosis not a basis for criteria.--The Secretary 
     may not base the criteria developed under this subparagraph 
     on the prognosis of a medicare beneficiary.

       (4) Conduct of program.--Under the demonstration program, 
     the Secretary shall--
       (A) accept proposals submitted by any State hospice 
     association;
       (B)(i) except as provided in clause (ii), conduct the 
     program in at least 3, but not more than 6, geographic areas 
     (which may be statewide) that include both urban and rural 
     hospice providers; and
       (ii) if a geographic area does not have any rural hospice 
     provider available to participate in the demonstration 
     program, such area may substitute an underserved urban area, 
     but the Secretary shall give priority to those proposals that 
     include a rural hospice provider;
       (C)(i) except for the geographic area designated under 
     clause (ii), select such geographic areas so that such areas 
     are geographically diverse and readily accessible to a 
     significant number of medicare beneficiaries; and
       (ii) designate as such an area 1 State in which the largest 
     metropolitan area of such State had the lowest percentage of 
     medicare beneficiary deaths in a hospital compared to the 
     largest metropolitan area of each other State according to 
     the Hospital Referral Region of Residence, 1994-1995, as 
     listed in the Dartmouth Atlas of Health Care 1998;
       (D) provide for the participation of medicare beneficiaries 
     in such program on a voluntary basis;
       (E) permit research designs that use time series, 
     sequential implementation of the intervention, randomization 
     by wait list, and other designs that allow the strongest 
     possible implementation of the demonstration program, while 
     still allowing strong evaluation about the merits of the 
     demonstration program; and
       (F) design the program to facilitate the evaluation 
     conducted under paragraph (6).
       (5) Duration.--The Secretary shall complete the 
     demonstration program within a period of 6\1/2\ years that 
     includes a period of 18 months during which the Secretary 
     shall complete the evaluation under paragraph (6).
       (6) Evaluation.--During the 18-month period following the 
     first 5 years of the demonstration program, the Secretary 
     shall complete an evaluation of the demonstration program in 
     order to determine--
       (A) the short-term and long-term costs and benefits of 
     changing medicare hospice services to include the items, 
     services, and reimbursement options provided under the 
     demonstration program;
       (B) whether increases in payments for the medicare hospice 
     benefit are offset by savings in other parts of the medicare 
     program;
       (C) the projected cost of implementing the demonstration 
     program on a national basis; and
       (D) in consultation with hospice organizations and hospice 
     providers (including organizations and providers that 
     represent rural areas), whether a payment system based on 
     diagnosis-related groups is useful for administering the 
     medicare hospice benefit.
       (7) Reports to congress.--
       (A) Preliminary report.--Not later than 3 years after the 
     date of enactment of this Act, the Secretary shall submit a 
     preliminary report to the Committee on Ways and Means of the 
     House of Representatives and to the Committee on Finance of 
     the Senate on the progress made in the demonstration program.
       (B) Interim report.--Not later than 30 months after the 
     implementation of the demonstration program, the Secretary, 
     in consultation with participants in the program, shall 
     submit an interim report on the demonstration program to the 
     committees described in subparagraph (A).
       (C) Final report.--Not later than the date on which the 
     demonstration program ends, the Secretary shall submit a 
     final report to the committees described in subparagraph (A) 
     on the demonstration program that includes the results of the 
     evaluation conducted under paragraph (6) and recommendations 
     for appropriate legislative changes.
       (8) Waiver of medicare requirements.--The Secretary shall 
     waive compliance with such requirements of the medicare 
     program to the extent and for the period the Secretary finds 
     necessary for the conduct of the demonstration program.
       (9) Special rules for payment of medicare+choice 
     organizations.--The Secretary shall establish procedures 
     under which the Secretary provides for an appropriate 
     adjustment in the monthly payments made under section 1853 of 
     the Social Security Act (42 U.S.C. 1395w-23) to any 
     Medicare+Choice organization offering a Medicare+Choice plan 
     in which a medicare beneficiary that participates in the 
     demonstration program is enrolled to reflect such 
     participation.
       (c) Hospice Education Grants.--
       (1) In general.--The Secretary shall establish a Hospice 
     Education Grant program under which the Secretary awards 
     education grants to entities participating in the 
     demonstration program for the purpose of providing 
     information about--
       (A) the medicare hospice benefit; and
       (B) the benefits available to medicare beneficiaries under 
     the demonstration program.
       (2) Use of funds.--Grants awarded pursuant to paragraph (1) 
     shall be used--
       (A) to provide--
       (i) individual or group education to medicare beneficiaries 
     and their families; and
       (ii) individual or group education of the medical and 
     mental health community caring for medicare beneficiaries; 
     and
       (B) to test strategies to improve the general public 
     knowledge about the medicare hospice benefit and the benefits 
     available to medicare beneficiaries under the demonstration 
     program.
       (d) Funding.--
       (1) Hospice demonstration program.--
       (A) In general.--Except as provided in subparagraph (B), 
     expenditures made for the demonstration program shall be in 
     lieu of the funds that would have been provided to 
     participating hospices under section 1814(i) of the Social 
     Security Act (42 U.S.C. 1395f(i)).
       (B) Supportive and comfort care benefit.--The Secretary 
     shall pay any expenses for the supportive and comfort care 
     benefit established under subsection (a)(3) from the Federal 
     Hospital Insurance Trust Fund established under section 1817 
     of the Social Security Act (42 U.S.C. 1395i) and the Federal 
     Supplementary Medical Insurance Trust Fund established under 
     section 1841 of such Act (42 U.S.C. 1395t), in such 
     proportion as the Secretary determines is appropriate.
       (2) Hospice education grants.--The Secretary is authorized 
     to expend such sums as may be necessary for the purposes of 
     carrying out the Hospice Education Grant program established 
     under subsection (c)(1) from the Research and Demonstration 
     Budget of the Health Care Financing Administration.
                                 ______
                                 
      By Mr. THURMOND (for himself and Mr. Hollings):
  S. 3027. A bill to authorize the Secretary of Agriculture to purchase 
and transfer certain land; to the Committee on Agriculture, Nutrition, 
and Forestry.


   A BILL TO AUTHORIZE THE SECRETARY OF AGRICULTURE TO PURCHASE LAND 
   ADJACENT TO THE COASTAL PLAINS SOIL, AND PLANT RESEARCH CENTER IN 
                        FLORENCE, SOUTH CAROLINA

  Mr. THURMOND. Mr. President, I rise today, along with Senator 
Hollings, to introduce legislation that will enable the Secretary of 
Agriculture to purchase up to ten acres of land for the U.S. Department 
of Agriculture's Coastal Plains Soil, Water, and Plant Research Center 
in Florence, South Carolina. This land is located within 150 feet of 
the Center's administrative offices. Part of it has been leased and 
used for agricultural research for almost 25 years. If these ten acres 
were to be developed commercially the Center's operations would be 
impaired substantially. This land will be used for agricultural 
research.
  The Coastal Plains Soil, Water, and Plant Research Center focuses its 
research on the agricultural needs of farmers in both North and South 
Carolina. However, much of the work done by its staff benefits all U.S. 
agriculture. The Center undertakes basic

[[Page 17637]]

and applied research with an emphasis toward total resource management. 
I would like to highlight just a few of its research programs in soil, 
water, and plant management. The Center's staff investigates the 
effects of soil erosion, non-point-source pollution, and animal waste 
disposal. Further, they work to develop better cropping systems for 
major field crops including cotton, corn, soybeans, and small grains; 
to identify high-value horticultural crops suitable for production on 
the soils of the coastal plains; and to improve cotton germ plasm.
  Mr. President, the Coastal Plains Soil, Water, and Plant Research 
Center does outstanding work that is not only very important to the 
farmers of the Carolinas but to all our Nation's farmers. This land 
purchase is important to the efficient continued operation of the 
Florence Center, and I urge my colleagues to support the legislation.
  I ask unanimous consent that the bill be printed in the Record 
following my statement.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3027

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     ASECTION 1. AUTHORIZATION FOR SECRETARY OF AGRICULTURE TO 
                   PURCHASE AND TRANSFER LAND.

       Subject to the availability of funds appropriated to the 
     Agricultural Research Service, the Secretary of Agriculture 
     may--
       (1) purchase a tract of land in the State of South Carolina 
     that is contiguous to land owned on the date of enactment of 
     this Act by the Department of Agriculture, acting through the 
     Coastal Plains Soil, Water, and Plant Research Center of the 
     Agriculture Research Service; and
       (2) transfer land owned by the Department of Agriculture to 
     the Florence Darlington Technical College, South Carolina, in 
     exchange for land owned by the College.
                                 ______
                                 
      By Mr. THOMPSON:
  S. 3030. A bill to amend title 31, United States Code, to provide for 
executive agencies to conduct annual recovery audits and recovery 
activities, and for other purposes; to the Committee on Governmental 
Affairs.


              A BILL TO PROVIDE FOR ANNUAL RECOVERY AUDITS

  Mr. THOMPSON. Mr. President, I rise today to introduce a bill which 
begins to address the issue of improper payments in Federal programs.
  Each year, the Federal government spends hundreds of billions of 
dollars for a variety of grants, transfer payments, and the procurement 
of goods and services. The Federal government must be accountable for 
how it spends these funds and for safeguarding against improper 
payments. Unfortunately, the problem of improper payments by Federal 
agencies and departments is immense. Today, I released a GAO report 
which I requested which identifies $20.7 billion in improper payments 
in just 20 major programs administered by 12 Federal agencies in Fiscal 
Year 1999 alone. And this represents an increase of more than $1.5 
billion from the previous year's estimate. In its report, GAO writes 
that its ``audits and those of agency inspectors general continue to 
demonstrate that improper payments are much more widespread than agency 
financial statement reports have disclosed thus far.''
  Legislative efforts have focused on improving the Federal 
government's control processes. Recently-enacted laws, such as the 
Chief Financial Officers Act, the Government Management Reform Act, and 
the Government Performance and Results Act, have provided an impetus 
for agencies to systematically measure and reduce the extent of 
improper payments.
  However, the risk of improper payments and the government's ability 
to prevent them continue to be a significant problem. While we continue 
to work to improve the government's widespread financial management 
weaknesses, we also can attempt to recover the tens of billions of 
dollars in improper payments. And that's what the legislation I am 
introducing today will do.
  The legislation is modeled on H.R. 1827, a bill sponsored by House 
Committee on Government Reform Chairman Dan Burton, to require the use 
of a management technique called ``recovery auditing'' which would be 
applied to a Federal agency's records to identify improper payments or 
payment errors made by the agency.
  Recovery auditing is used extensively by private sector businesses, 
including a majority of Fortune 500 companies. These businesses 
typically contract with specialized recovery auditing firms that are 
paid a contingent fee based on the amounts recovered from overpayments 
they identify. Recovery auditing is not ``auditing'' in the usual 
sense. Recovery auditing firms do not examine the records of vendors 
doing business with their client companies or assess the vendors' 
performance. Instead, these firms develop and use computer software 
programs that are capable of analyzing their clients' own contract and 
payment records in order to identify discrepancies in those records 
between what was owed and what was paid. They focus on obvious but 
inadvertent errors, such as duplicate payments or failure to get credit 
for applicable discounts and allowances.
  The bill I am introducing today would require Federal agencies to 
perform recovery audits in order to identify discrepancies between what 
was actually paid by the agency and what should have been paid. This 
bill seeks to address concerns with H.R. 1827 which were raised after 
its passage by the House. For example, this bill would make clear that 
the relationship established by this bill is one between the agency and 
the recovery audit contractor, and all communications and interaction 
on the part of the recovery audit contractor is with the agency. 
Further, this bill includes exemptions for contracts which, under 
current law, already are subject to extensive audit scrutiny and 
oversight. Also, this bill includes Federal agency authority for 
recovery audit pilot programs for contracts, grants or other 
arrangements other than those covered by this bill.
  I appreciate all the work done by Chairman Burton on H.R. 1827. I 
believe my legislation appropriately addresses concerns raised with 
that bill and goes a long way in addressing the wasted taxpayer dollars 
and government inefficiencies resulting from Federal agency payment 
errors which are made each year.
                                 ______
                                 
      Mr. CAMPBELL:
  S. 3031. A bill to make certain technical corrections in laws 
relating to Native Americans, and for other purposes; to the Committee 
on Indian Affairs.


       Technical Amendments to laws Relating to Native Americans

  Mr. CAMPBELL. Mr. President, today I introduce a bill making certain 
technical amendments to laws relating to Native Americans. As my 
colleagues know, Congress typically considers legislation like this 
every year or so. This bill provides an opportunity to address a series 
of corrections to the law or other non-controversial, minor amendments 
to Indian laws in one broad stroke, rather than having to introduce 
several separate bills.
  This bill includes amendments regarding issues of importance to a 
number of my colleagues that have been brought to my attention over 
recent months. The amendments include, for instance, one-year 
reauthorizations of the Indian Health Care Improvement Act and the 
Indian Alcohol and Substance Abuse Prevention and Treatment Act, as 
well as a clarification of a bill signed into law earlier this year 
relating to the status of certain lands held in trust by the 
Mississippi Band of Choctaw Indians.
  All amendments included in this bill will serve to promote the 
original intent of the affected laws, and do not alter the meaning or 
substance of the laws they amend. I urge my colleagues to join me in 
supporting this bill, the sole purpose of which is to ensure that the 
laws this body has already passed are carried forward in the way we 
originally intended.
  Mr. President, I ask unanimous consent that a copy of the bill be 
printed in the Record. I thank the Chair and yield the floor.
  There being no objection, the bill was order to be printed in the 
Record, as follows:

[[Page 17638]]



                                S. 3031

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. TECHNICAL CORRECTION TO AN ACT AFFECTING THE 
                   STATUS OF MISSISSIPPI CHOCTAW LANDS AND ADDING 
                   SUCH LANDS TO THE CHOCTAW RESERVATION.

       Section 1(a)(2) of Public Law 106-228 (an Act to make 
     technical corrections to the status of certain land held in 
     trust for the Mississippi Band of Choctaw Indians, to take 
     certain land into trust for that Band, and for other 
     purposes) is amended by striking ``September 28, 1999'' and 
     inserting ``February 7, 2000''.

     SEC. 2. TECHNICAL CORRECTIONS CONCERNING THE FIVE CIVILIZED 
                   TRIBES OF OKLAHOMA.

       (a) Indian Self-Determination Act.--Section 1(b)(15)(A) of 
     the model agreement set forth in section 108(c) of the Indian 
     Self-Determination Act (25 U.S.C. 450l(c)) is amended--
       (1) by striking ``and section 16'' and inserting ``, 
     section 16''; and
       (2) by striking ``shall not'' and inserting ``and the Act 
     of July 3, 1952 (25 U.S.C. 82a), shall not''.
       (b) Indian Self-Determination and Education Assistance 
     Act.--Section 403(h)(2) of the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 458cc(h)(2)) is amended--
       (1) by striking ``and section'' and inserting ``section''; 
     and
       (2) by striking ``shall not'' and inserting ``and the Act 
     of July 3, 1952 (25 U.S.C. 82a), shall not''.
       (c) Repeals.--The following provisions of law are repealed:
       (1) Section 2106 of the Revised Statutes (25 U.S.C. 84).
       (2) Sections 438 and 439 of title 18, United States Code.

     SEC. 3. WAIVER OF REPAYMENT OF EXPERT ASSISTANCE LOANS TO THE 
                   RED LAKE BAND OF CHIPPEWA INDIANS AND THE 
                   MINNESOTA CHIPPEWA TRIBES.

       (a) Red Lake Band of Chippewa Indians.--Notwithstanding any 
     other provision of law, the balances of all expert assistance 
     loans made to the Red Lake Band of Chippewa Indians under the 
     authority of Public Law 88-168 (77 Stat. 301), and relating 
     to Red Lake Band v. United States (United States Court of 
     Federal Claims Docket Nos. 189 A, B, C), are canceled and the 
     Secretary of the Interior shall take such action as may be 
     necessary to document such cancellation and to release the 
     Red Lake Band of Chippewa Indians from any liability 
     associated with such loans.
       (b) Minnesota Chippewa Tribe.--Notwithstanding any other 
     provision of law, the balances of all expert assistance loans 
     made to the Minnesota Chippewa Tribe under the authority of 
     Public Law 88-168 (77 Stat. 301), and relating to Minnesota 
     Chippewa Tribe v. United States (United States Court of 
     Federal Claims Docket Nos. 19 and 188), are canceled and the 
     Secretary of the Interior shall take such action as may be 
     necessary to document such cancellation and to release the 
     Minnesota Chippewa Tribe from any liability associated with 
     such loans.

     SEC. 4. TECHNICAL AMENDMENT TO THE INDIAN CHILD PROTECTION 
                   AND FAMILY VIOLENCE PROTECTION ACT.

       Section 408(b) of the Indian Child Protection and Family 
     Violence Prevention Act (25 U.S.C. 3207(b)) is amended--
       (1) by striking ``any offense'' and inserting ``any 
     felonious offense, or any of 2 of more misdemeanor 
     offenses,''; and
       (2) by striking ``or crimes against persons'' and inserting 
     ``crimes against persons; or offenses committed against 
     children''.

     SEC. 5. TECHNICAL AMENDMENT REGARDING THE TREATMENT OF 
                   CERTAIN INCOME FOR PURPOSES OF FEDERAL 
                   ASSISTANCE.

       Notwithstanding any other provision of law, none of the 
     funds paid by the State of Minnesota to the Bois Forte Band 
     of Chippewa Indians and the Grand Portage Band of Chippewa 
     Indians pursuant to the agreement of such Bands' to 
     voluntarily restrict tribal rights to hunt and fish in 
     territory ceded under the Treaty of September 30, 1854 (10 
     Stat. 1109), including all interest accrued on such funds 
     during any period in which such funds are held in a minor's 
     trust, shall be considered as income or resources, or 
     otherwise be used as the basis for denying or reducing the 
     financial assistance or other benefits to which a household 
     or member of such Bands would be entitled to under the Social 
     Security Act (42 U.S.C. 301 et seq.), the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1966 (Public Law 104-193; 110 Stat. 2105) and the amendments 
     made by such Act, or any Federal or Federally assisted 
     program.

     SEC. 6. TECHNICAL AMENDMENT TO EXTEND THE AUTHORIZATION 
                   PERIOD UNDER THE INDIAN HEALTH CARE IMPROVEMENT 
                   ACT.

       The authorization of appropriations for, and the duration 
     of, each program or activity under the Indian Health Care 
     Improvement Act (25 U.S.C. 1601 et seq.) is extended through 
     fiscal year 2001.

     SEC. 7. TECHNICAL AMENDMENT TO EXTEND THE AUTHORIZATION 
                   PERIOD UNDER THE INDIAN ALCOHOL AND SUBSTANCE 
                   ABUSE PREVENTION AND TREATMENT ACT OF 1986.

       The authorization of appropriations for, and the duration 
     of, each program or activity under the Indian Alcohol and 
     Substance Abuse Prevention and Treatment Act of 1986 (25 
     U.S.C. 2401 et seq.) is extended through fiscal year 2001.
                                 ______
                                 
      By Mr. SMITH of New Hampshire (for himself, Mr. Warner, and Mr. 
        L. Chafee):
  S. 3032. A bill to reauthorize the Junior Duck Stamp Conservation and 
Design Program Act of 1994, and for other purposes; to the Committee on 
Environment and Public Works.


             junior duck stamp reauthorization act of 2000

  Mr. SMITH of New Hampshire. Mr. President, I would like to introduce 
the Junior Duck Stamp Reauthorization Act of 2000.
  The Junior Duck Stamp Program is a wonderful program that allows 
children from kindergarten through twelfth grade to participate in an 
integrated art and science curriculum that is designed to teach 
environmental science and habitat conservation. It also raises 
awareness for wetlands and waterfowl conservation. Students and 
teachers work together through a set curriculum that incorporates 
ecological and wildlife management principles, allowing students to 
learn about conserving wildlife habitat while they explore the esthetic 
qualities of wildlife and nature.
  As part of the curriculum, each student is encouraged to focus his or 
her efforts on a particular waterfowl species. The culmination of the 
curriculum is an artistic depiction of that species. Each state selects 
a Best-of-Show winner and that piece of artwork competes to become the 
national winner of the Junior Duck Stamp contest. The winning depiction 
is chosen as the Federal Junior Duck Stamp, and the student receives 
$2,500. Revenues from selling the stamp are used for conservation 
awards and scholarships to the participants.
  By all accounts the Junior Duck Stamp Program has been extremely 
successful. Last year alone more than 44,000 students entered the state 
competitions. The Fish and Wildlife Service and educators estimate that 
for every child who enters the state program, ten others are exposed to 
the curriculum. The program has also been very successful in 
introducing urban children to nature, allows all children to develop an 
important connection to the environment, and motivates students to take 
an active role in conservation of waterfowl species.
  This legislation is a simple reauthorization of the program through 
2005. The U.S. Fish and wildlife Service would be authorized to receive 
$250,000 a year for the administration of the Junior Duck Stamp 
Program. In addition, the Junior Duck Stamp Conservation and Design 
Program Act of 1994 would be amended to allow schools in the District 
of Columbia and the U.S. territories to participate in the program.
  Mr. President, I strongly urge the passage of this legislation. The 
Junior Duck Stamp Program has played an important role in the education 
of children and the conservation of our natural resources, and it 
should continue to do so. I ask that the full text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3032

       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 ``Junior Duck Stamp 
     Reauthorization Act of 2000''.

     SEC. 2. REAUTHORIZATION OF JUNIOR DUCK STAMP CONSERVATION AND 
                   DESIGN PROGRAM ACT OF 1994.

       Section 5 of the Junior Duck Stamp Conservation and Design 
     Program Act of 1994 (16 U.S.C. 719c) is amended by striking 
     ``for each of the fiscal years 1995 through 2000'' and 
     inserting ``for each of fiscal years 2001 through 2005''.

     SEC. 3. EXPANSION OF PROGRAM TO INSULAR AREAS.

       The Junior Duck Stamp Conservation and Design Program Act 
     of 1994 is amended--
       (1) by redesignating sections 2 through 6 (16 U.S.C. 719 
     through 719c; 16 U.S.C. 668dd note) as sections 3 through 7, 
     respectively;
       (2) by inserting after section 1 (16 U.S.C. 719 note) the 
     following:

[[Page 17639]]



     ``SEC. 2. DEFINITION OF STATE.

       ``In this Act, the term `State' means a State, the District 
     of Columbia, the Commonwealth of Puerto Rico, the 
     Commonwealth of the Northern Mariana Islands, American Samoa, 
     Guam, the Virgin Islands, and any other territory or 
     possession of the United States.'';
       (3) in section 3(c) (16 U.S.C. 719(c)) (as redesignated by 
     paragraph (1)), by striking ``50 States'' each place it 
     appears and inserting ``States''; and
       (4) in section 5 (16 U.S.C. 719b) (as redesignated by 
     paragraph (1)), by striking ``section 3(c)(1) (A) and (B)'' 
     and inserting ``subparagraphs (A) and (B) of section 
     4(c)(1)''.
                                 ______
                                 
      By Mr. BOND:
  S. 3033. A bill to delegate the Primary Responsibility for the 
Preservation and Expansion of Affordable Low-Income Housing to States 
and Localities; to the Committee on Banking, Housing, and Urban 
Affairs.


                       housing needs act of 2000

  Mr. BOND. Mr. President. I rise today to introduce an important piece 
of housing legislation that addresses the affordable-housing needs of 
needy Americans. The Housing Needs Act of 2000 is a direct response to 
the affordable housing crisis being experienced by millions of 
Americans today. By working with State and localities, this legislation 
will produce thousands of affordable housing units and ensure that 
existing federally-assisted housing properties are maintained for lower 
income families.
  As Chairman of the Appropriations Subcommittee on VA, HUD, and 
Independent Agencies, I have become increasingly alarmed by the news 
reports and housing studies that have shown that lower income Americans 
are having a difficult time finding decent, safe, and affordable 
housing. The Administration's response to this problem has been to 
provide section 8 tenant-based assistance or vouchers. However, I have 
heard from communities in Missouri to here in the Washington, D.C. area 
that it is becoming increasingly difficult to use vouchers to find 
affordable housing. It has also come to my attention that despite the 
resources given to the Department of Housing and Urban Development 
(HUD), the Federal government has lost thousands of scarce affordable 
housing that were once subsidized by the Federal government. Instead of 
preserving these scarce and valuable housing resources, the Department 
has replaced these units with vouchers. While some families have been 
able to locate replacement housing, many have experienced displacement 
and hardship, resulting in returning the voucher unused or becoming 
homeless.
  Due to these well-publicized problems, I instructed my subcommittee 
staff to conduct a review of the section 8 program and to provide 
recommendations on how to meet better the housing needs of lower income 
Americans. The recommendations of the report are captured in the 
Housing Needs Act of 2000, which I am introducing today.
  Before I discuss the contents of the bill, I summarize the key 
findings of the Subcommittee Staff report entitled ``Empty Promises--
Subcommittee Staff Report on HUD's Failing Grade on the Utilization of 
Section 8 Vouchers.'' The key findings of the report are (1) housing 
units for low-income families are disappearing; (2) worse case housing 
needs are worsening; and (3) section 8 vouchers are proving to be less 
and less effective in meeting the housing needs of low-income families.
  Specifically, the staff reported that over the past 4 years, nearly 
125,000 housing units have been lost to the national inventory of 
affordable housing. These units have been lost due to the decision of 
landlords to leave or opt-out of the section 8 program, HUD's policy to 
voucher out properties that they have acquired title to and those that 
the Department actually owns.
  The staff also found that a record high of 5.4 million households 
have major housing needs. Based on HUD's Worst Case Housing Needs 
study, many of these households are our most vulnerable individuals 
such as the elderly, disabled, and children.
  Lastly, the staff reported that about 1 out of every 5 families that 
received a voucher are unable to find housing and thus, the voucher 
remains unused. The report also found not enough landlords were 
participating in the voucher program, the payment standard of the 
vouchers were too low for the market area, and voucher holders had 
personal problems which affected the utilization of vouchers.
  Mr. President, the staffs' findings were disturbing to me. As a 
result, I am here today to introduce the Housing Needs Act of 2000 to 
address the report's findings.
  Briefly, the legislation creates a new affordable housing block grant 
production program that would allocate funds to state housing agencies. 
States currently administer other federal programs such as the Low-
Income Housing Tax Credit program, HOME block grant program, and the 
Community Development Block Grant program, which have expanded and 
increased the capacity of states to create affordable housing units. 
Thus, state housing finance agencies have the tools to make this 
program work effectively. I am a big believer in local decision-making. 
States and localities know and understand their housing problems and 
needs and are in the best position to make decisions on their housing 
needs.
  The legislation would also create a new section 8 success program 
that would allow public housing agencies (PHA) to raise the payment 
standard for vouchers up to 150 percent of the fair market rent. This 
will greatly improve the ability of voucher holders to use the vouchers 
in economically strong markets. As the Subcommittee Staff report found, 
19 percent or one in five families that receive a voucher cannot use 
it. I believe that this new success program will improve greatly the 
number of voucher holders actually to use the voucher.
  Lastly, the bill includes a number of smaller provisions that would 
enhance the ability of state and local housing entities to produce low-
income housing and ensure that HUD maintains section 8 assistance on 
properties that it has acquired through foreclosure.
  I urge my colleagues to support this critical piece of legislation. 
Families all over the country are experiencing hardships never before 
seen. It is clear that vouchers alone do not adequately address the 
housing needs of our vulnerable populations. I believe strongly that 
the Housing Needs Act of 2000 provides a much-needed, flexible, 
balanced approach to ensure that the affordable-housing problems can be 
solved.
                                 ______
                                 
      By Mr. KERRY:
  S. 3034. A bill to amend title XVIII of the Social Security Act with 
respect to payments made under the prospective payment system for home 
health services furnished under the Medicare Program; to the Committee 
on Finance.


               HOME HEALTH REFINEMENT AMENDMENTS OF 2000

  Mr. KERRY. Mr. President, I am pleased to introduce the Home Health 
Refinement Amendments of 2000. This legislation will protect patient 
access to home health care under Medicare, and ensure that providers 
are able to continue serving seniors who reside in medically 
underserved areas, have medically complex conditions, or require non-
routine medical supplies.
  Medicare was enacted in 1965, under the leadership of President 
Lyndon Johnson, as a promise to the American people that, in exchange 
for their years of hard work and service to our country, their health 
care would be protected in their golden years. Today, over 30 million 
seniors rely on the Medicare home health benefit to receive the care 
they need to maintain their independence and remain in their own homes, 
and to avoid the need for more costly hospital or nursing home care. 
Home health care is critical. It is a benefit to which all eligible 
Medicare beneficiaries should be entitled. But, this benefit is being 
seriously undermined. Since enactment of the Balanced Budget Act, BBA, 
of 1997, federal funding for home health care has plummeted. According 
to the Congressional Budget Office, CBO, Medicare spending on home 
health care dropped 48 percent in the last two fiscal years--from $17.5 
billion in 1998 to $9.7 billion in 1999--far beyond the original amount 
of savings sought by the BBA. Across the country, these cuts have 
forced over 2,500 home health agencies to close and over 900,000 
patients to lose their services.

[[Page 17640]]

  In my own State of Massachusetts--a state that, because of economic 
efficiency, sustained a disproportionate share of the BBA cuts in 
Medicare home health funding--28 home health agencies have closed, 6 
more have turned in their Medicare provider numbers and chosen to opt 
out of the Medicare program, and 12 more have been forced to merge in 
order to consolidate their limited resources. The home health agencies 
that have continued to serve patients despite the deep cuts in Medicare 
funding reported net operating losses of $164 million in 1998. The loss 
of home health care providers in Massachusetts has cost 10,000 patients 
access to home health services. Consequently, many of the most 
vulnerable residents in my state are being forced to enter hospitals 
and nursing homes, or going without any help at all.
  To compound the problem, without Congressional action, Medicare 
payments for home health care will be automatically cut by an 
additional 15 percent next year. It is critical that we defend 
America's seniors against future cuts in home health services, and this 
bill will eliminate the additional 15 percent cut in Medicare home 
health payments mandated by the BBA. However, we must do more than 
attempt to stop future cuts. Indeed, it is equally as important that we 
begin to provide relief to home health providers who are already 
struggling to care for patients.
  During the first year of implementation of the Interim Payment 
System, IPS, agencies were placed on precarious financial footing 
because of insufficient payments, particularly for high-cost and long-
term patients. Accordingly, it is critical that we bolster the efforts 
of home health care providers to transcend their current operating 
deficits, especially as they transition from the Interim Payment System 
to the Prospective Payment System, PPS.
  The Home Health Refinement Amendments of 2000 would ensure that 
providers are able to treat the sickest, most expensive patients who 
rely on home health care. Independent studies indicate that, under IPS, 
thousands of patients have been denied home health care benefits--while 
``outlier'' patients (those who require the most intensive services) 
have been most at risk of losing access to care. To address the costs 
of treating the sickest homebound patients, this legislation provides 
additional funding for outliers under PPS. Specifically, this bill 
would set the funding level for outliers at 10 percent of the total 
payments projected or estimated to be made under PPS each year. This 
would double the current 5 percent allocation without reducing the PPS 
base payment.
  In addition, the Home Health Refinement Amendments of 2000 would 
remove the costs of non-routine medical supplies from the PPS base 
payment and, instead, arrange for Medicare reimbursement for these 
supplies on the basis of a fee schedule. PPS rates include average 
medical supply costs, but some agencies' patient populations have 
greater or lesser supply needs than the average. Thus, current rates 
would underpay agencies that treat patients with high medical supply 
needs and overpay agencies that treat patients with low medical supply 
needs. Agencies that treat our most ill, frail, and vulnerable should 
not be punished with low payment rates.
  Agencies that treat patients in medically underserved communities 
also deserve equitable reimbursement for the services they provide. In 
order to address the unique costs of treating patients in underserved 
areas, the Home Health Refinement Amendments of 2000 would establish a 
10 percent add-on to the episodic base payment for patients in rural 
areas, to reflect the increasing costs of travel, and a ``reasonable 
cost'' add-on for security services utilized by providers in our urban 
areas. These add-ons ensure that patients in all types of communities 
across the country continue to receive the home care they need and 
deserve.
  Finally, this legislation would encourage the incorporation of 
telehealth technology in home care plans by allowing cost reporting of 
the telemedicine services utilized by agencies. Telemedicine has 
demonstrated tremendous potential in bringing modern health care 
services to patients who reside in areas where providers and technology 
are scarce. Cost reporting will provide the data necessary to develop a 
fair and reasonable Medicare reimbursement policy for telehomecare and 
bring the benefits of modern science and technology to our nation's 
underserved.
  Unless we increase the federal commitment to the Medicare home health 
care benefit, we can only expect to continue to imperil the health of 
an entire generation. We must act to deliver on that promise that 
President Johnson made 25 years ago--our nation's seniors deserve no 
less.
                                 ______
                                 
      Mr. BAUCUS (for himself, Mr. Grassley,  Mr. Jeffords, Mr. 
        Rockefeller, and Mr. Hatch):
  S. 3035. A bill to amend title XI of the Social Security Act to 
create an independent and nonpartisan commission to assess the health 
care needs of the uninsured and to monitor the financial stability of 
the Nation's health care safety net; to the Committee on Finance.


              health care safety net oversight act of 2000

  Mr. BAUCUS. Mr. President, it is often said that, ``Good health and 
good sense are two of life's greatest blessings.'' Senators Grassley, 
Jeffords, and I hope to further the cause of good health and good sense 
today, through introduction of the Health Care Safety Net Oversight Act 
of 2000.
  Mr. President, currently no entity oversees America's health care 
safety net. This means that all safety net providers--including rural 
health clinics, community heath centers and emergency rooms--are 
laboring on their own. They are like master musicians performing 
without a conductor. Each is trying their hardest and performing their 
part--but no one is coordinating their efforts. No one is able to tell 
an actor when his services will be needed, or when he can take a break.
  This act changes that, by creating the Safety Net Organizations and 
Patient Advisory Commission, an independent and nonpartisan commission 
to monitor the stability of the health care safety net.
  What does this mean?
  The Safety Net is made up of providers that deliver health services 
to the uninsured and vulnerable populations across America. These 
providers are often a last resort for patients who are unable to afford 
the health care they need and have nowhere else to turn. In my state, 
we have about 30 community health centers and rural health clinics, 
serving an estimated 80,000 persons per year. That translates into 
about one in ten Montanans. Were it not for these clinics and health 
centers, many of these folks--the uninsured and underinsured--would 
have no place to turn.
  According to the U.S. Census Bureau, nearly one in five Montanans 
were uninsured in 1998. This number has risen by 36 percent over the 
last ten years, and there are now only five states with a higher 
percentage of uninsured residents. When these uninsured seek medical 
treatment they are often not able to pay. Last year, Montana hospitals 
reported over $67 million in charity care and bad debt. And the problem 
is not going away. At current growth rates for the uninsured, as many 
as one in four Montanans will be uninsured by the year 2007.
  But Mr. President, these people are not uninsured of their own 
volition. Eighty three percent of uninsured Montanans are in working 
families. And self-employed workers--including owners of small 
businesses--and their dependents account for one-fifth of the uninsured 
in our state. In fact, Montana ranks last in the nation with only 40 
percent of firms offering a health insurance benefit.
  So what do we do about this problem? How do we ensure that all 
Americans, irrespective of color, creed gender or geography, have 
access to quality health care?
  Six or seven years ago, Congress and the administration worked on the 
problem of the uninsured. A tremendous amount of time and effort went 
into the Health Security Act, on both sides of the issue. As we know, 
passage of

[[Page 17641]]

that bill failed. Since then, Congress has taken a more incremental 
approach to health care. Congress passed legislation in 1996 to ensure 
portability of health insurance. A year later, the CHIP program was 
signed into law, bipartisan legislation to cover children of working 
families. And last year, Congress passed the Work Incentives 
Improvement Act to allow disabled folks to continue working and not 
lose health care benefits.
  But while these legislative actions are extremely important, they 
affect relatively few Americans. The fact remains, for most uninsured 
and underinsured Americans, the safety net is still the only place to 
turn.
  Yet the safety net has been seriously damaged in recent years. 
According to a recent report by the Institute of Medicine, the health 
care safety net is ``intact but endangered.''
  For instance, the 1997 Balanced Budget Act cut payments to 
Disproportionate Share Hospitals and Community health centers. It also 
cut reimbursement to rural health clinics, so critical to providing 
coverage to rural uninsured individuals. At the same time, Congress 
mandates that emergency departments care for anyone and everyone that 
darkens their door. Though not a reimbursement issue per se, the EMTALA 
dictates that all ER's care for all individuals, regardless of ability 
to pay.
  Despite all these developments, there is no entity responsible for 
making changes to the safety net. And though SNOPAC will not solve the 
problem of America's uninsured, it will work to ensure that no holes 
develop in the Safety Net. An independent, non-partisan commission, 
modeled on the Medicare Payment Advisory Commission (MedPAC), SNOPAC 
will include professionals from across the policy and practical 
spectrum of health care. And like MedPAC, SNOPAC will report to the 
relevant committees of Congress on the status of its mission: tracking 
the well-being of the health care safety net.
  Though it's not a panacea, SNOPAC is a positive step toward a 
coordinated approach in caring for the uninsured. Absent large-scale 
improvements in the number of insured Americans, we should at least 
work to monitor and care for what we already have--an intact, but 
endangered, health care safety net.
  I urge all my colleagues to join me in this effort towards good 
health and good sense.
                                 ______
                                 
      By Mr. TORRICELLI:
  S. 3036. A bill to assure that recreation and other economic benefits 
are accorded the same weight as hurricane and storm damage reduction 
benefits as well as environmental restoration benefits; to the 
Committee on Environment and Public Works.


                     national beach enhancement act

  Mr. TORRICELLI. Mr. President, I rise today to introduce legislation 
which will ensure the preservation of our nation's coastal areas. 
Protection of our beaches is paramount; they are not only where we go 
to enjoy the sand and surf, but they also generate a significant 
portion of our nation's revenue.
  Tourism and recreational activity are extremely important to New 
Jersey, especially to our small businesses and shore communities. New 
Jersey's $17 billion a year tourism industry is supported by the 160 
million people who visit our 127 miles of beaches each year. This 
spending by tourists totaled $26.1 billion in New Jersey in 1998, a 2 
percent increase from $25.6 billion in 1997.
  My state is a microcosm of coastal tourism throughout the United 
States. Travel and tourism is our Nation's largest industry, employer, 
and foreign-revenue earner, and U.S. beaches are its leading tourist 
destination. In 1997, total tourism expenditures in U.S. coastal areas 
was over $185 billion, generating over 2.7 million jobs with a payroll 
of nearly $50 million.
  Americans are not the only ones eager to enjoy our beaches and 
coastal regions. They are also the top destination for foreign 
tourists. Each year, the U.S. takes in $4 billion in taxes from foreign 
tourists, while state and local governments receive another $3.5 
million.
  In Florida alone, foreign tourists spent over $11 billion in 1992, $2 
billion of that amount in the Miami Beach area. This Florida spending 
generated over $750 million in Federal tax revenues. A recent article 
by Dr. James R. Houston, published in the American Shore and Beach 
Preservation Journal, shows that annual tax revenues from foreign 
tourists in Miami Beach are 17 times more than the Federal government 
spent on the entire Federal Shore Protection program from 1950 to 1993. 
If the Federal share of beach nourishment averages about $10 million a 
year, the Federal government collects about 75 times more in taxes from 
foreign tourists in Florida than it spends restoring that State's 
beaches.
  Delaware, one of the smallest states in the Union, is visited by over 
5 million people each year. This, in a state where just over 21,000 
people actually live in beach communities and another 373,000 live 
within a several hours drive. Beach tourism generates over $173 million 
in expenditures each year for ``The First State.''
  Equally significant, however, beach erosion results in an estimated 
loss of over 471,000 visitor days a year, a figure which is estimated 
to increase to over 516,000 after five years. A 1998 study by Jack 
Faucett Associates (Bethesda, MD) in cooperation with independent 
consultants for the Delaware Department of Natural Resources and 
Environmental Control shows that during this five-year period, beach 
erosion will cost an estimated $30.2 million in consumer expenditures, 
the loss of 625 beach area jobs, and the reduction of wages and 
salaries by $11.5 million. Business profits will drop by $1.6 million 
and State and local tax revenues will decrease by $2.3 million. 
Finally, beach erosion will reduce beach area property values by nearly 
$43 million. The situation in Delaware is indicative of beach erosion 
problems throughout the coastlines of our nation. Unless we increase 
our efforts to protect and re-nourish our coastline, we jeopardize a 
significant portion of our country's revenue.
  The Federal government spends $100 million a year for the Federal 
Shore Protection program. While the U.S. Army Corps of Engineers does a 
benefit-cost analysis in connection with every shore protection 
project, that analysis suffers from its own myopia. It places its 
greatest emphasis on the value of the private property that is 
immediately adjacent to the coastline. It is not reasonable to assume 
that a healthy beach with natural dunes and vegetation will benefit 
only that first row of homes and businesses. Homeowners spend money in 
the region; hotels attract tourists, who also spend money; local 
residents who live inland come to the beach to recreate. They too, 
spend money. Countless businesses, from t-shirt vendors to restaurants, 
all depend on these expenditures.
  Prior to the 1986 Water Resources Development Act, the Army Corps of 
Engineers viewed recreation as an equally important component of its 
cost-benefits analysis. However, the 1986 bill omitted recreation as 
benefit to be considered, and our coastal communities have suffered. 
Indeed, the economy of our nation has suffered. My legislation would 
make it clear that recreational benefits will be given the same 
budgetary priority as storm damage reduction and environmental 
restoration. Companion legislation has been introduced in the House of 
Representatives, by Congressmen Lampson and LoBiondo, and enjoys 
bipartisan support.
  Beach replenishment efforts ensure that our beaches are protected, 
property is not damaged, dunes are not washed away, and the resource 
that coastal towns rely on for their lifeblood, is preserved. It is 
imperative that federal policy base beach nourishment assistance on the 
entirety of the economic benefits it provides. To limit benefits to 
hurricane or storm damage reduction ignores the equally important 
economic impact of tourism.
                                 ______
                                 
      By Mr. CONRAD (for himself, Mr. Frist, Mr. DeWine, Mr. Bryan, and 
        Mr. Thompson):

[[Page 17642]]

  S. 2038. A bill to amend title XVIII of the Social Security Act to 
update the renal dialysis composite rate; to the Committee on Finance.


        the medicare renal dialysis payment fairness act of 2000

  Mr. CONRAD. Mr. President, today I am pleased to be joined by Senator 
Frist and Representatives Camp and Thurman in introducing the Medicare 
Renal Dialysis Payment Fairness Act of 2000. This legislation takes 
important steps to help sustain and improve the quality of care for 
Medicare beneficiaries suffering from kidney failure.
  Nationwide, more than 280,000 Americans live with end-stage renal 
disease (ESRD). In my State of North Dakota, the number of patients 
living with ESRD is relatively small, just over 600. However, for these 
patients and others across the country, access to dialysis treatments 
means the difference between life and death.
  In 1972, the Congress took important steps to ensure that elderly and 
disabled individuals with kidney failure receive appropriate dialysis 
care. At that time, Medicare coverage was extended to include dialysis 
treatments for beneficiaries with ESRD.
  Over the last three decades, dialysis facilities have provided 
services to increasing numbers of kidney failure patients under 
increasingly strict quality standards; however, during this same time 
frame reimbursement for kidney services has not kept pace with the 
increasing demands of providing dialysis care.
  Last year, Senator Frist and I introduced legislation to ensure 
dialysis facilities could continue providing quality dialysis services 
to Medicare beneficiaries. I am happy to say that, based on these 
efforts, dialysis providers received increased Medicare reimbursement 
in fiscal years 2000 and 2001 as part of the Medicare, Medicaid, and S-
CHIP Refinement Act of 1999.
  While these efforts were a step in the right direction, a recent 
Medicare Payment Advisory Commission (MedPAC) report suggests that we 
must take further action to sustain patients' access to dialysis 
services. In particular, MedPAC recommends a 1.2 percent payment 
adjustment for Medicare-covered dialysis services in the next fiscal 
year. In addition, MedPAC recommends that the Health Care Financing 
Administration provide an annual review of the dialysis payment rate--a 
review that most other Medicare-covered services receive each year.
  I believe these recommendations represent critical adjustments that 
must be addressed this year. For this reason, I have worked with 
Senator Frist, Representative Camp and Representative Thurman to 
develop the Medicare Renal Dialysis Payment Fairness Act of 2000. This 
legislation would provide the payment rate improvements recommended by 
MedPAC and would establish an annual payment review process for 
dialysis services. This proposal would help ensure all dialysis 
providers receive reimbursement that is in line with increasing patient 
load and quality requirements. This is particularly important for our 
Nation's smaller, rural dialysis providers that on average receive 
Medicare payments to do not adequately reflect costs.
  As the Congress considers further improvements to the Medicare 
Program, I urge my colleagues to support this important effort to 
ensure patients with kidney failure continue to have access to quality 
dialysis services. I thank my colleagues for working together on this 
bipartisan and bicameral proposal.
  Mr. FRIST. Mr. President, I am pleased to join Senators Conrad, 
Thompson, Bryan, and DeWine this afternoon to introduce the Medicare 
Renal Dialysis Payment Fairness Act of 2000. This bipartisan 
legislation takes important steps to assure both the quality and 
availability of outpatient dialysis services for Medicare patients with 
end-stage renal disease (ESRD).
  Almost 30 years ago, Congress recognized the pain and suffering 
patients with end-stage renal disease face, and thus moved to provide 
coverage for dialysis treatment to this population under the Medicare 
Program. Today, approximately 300,000 patients nationwide live with 
this disease and receive services through Medicare. Presently, there 
are 3,423 dialysis facilities throughout the Nation that serve the 
Medicare population, 93 of which are in my home State of Tennessee.
  However, I fear that a lack of proper reimbursement may adversely 
impact the quality and availability of dialysis care for Medicare 
beneficiaries. As the Medicare Payment Advisory Commission (MedPAC) 
noted, the payment rate for the critical dialysis services received by 
Medicare beneficiaries was established in 1983, and had never been 
updated.
  Last year, Senator Conrad and I sought to remedy this situation by 
introducing S. 1449, the Medicare Renal Dialysis Fair Payment Act of 
1999, which provided an update to the Medicare reimbursement rate for 
dialysis services for Fiscal Year 2000. Thus, I was pleased to see the 
Balanced Budget Refinement Act of 1999 (BBRA) include a provision 
increasing the payment rate by 1.2 percent for Fiscal Year 2000 and 1.2 
percent for Fiscal Year 2001.
  However, the BBRA represented only the first step toward securing 
access to dialysis services for Medicare patients and ensuring they 
receive the highest quality of care. The legislation we are introducing 
today takes the necessary additional steps, as recommended by MedPAC 
this year, to assure proper reimbursement levels for dialysis services.
  Specifically, the ``Medicare Renal Dialysis Payment Fairness Act of 
2000'' provides a 1.2 percent increase in the payment rate for FY 2001, 
in addition to the 1.2 percent update included in the BBRA, providing a 
2.4 percent total increase. This follows MedPAC's analysis of dialysis 
center costs that concluded that prices paid by dialysis centers would 
rise by 2.4 percent between Fiscal Year 2000 and 2001.
  Second, the legislation ensure proper reimbursement in future years 
by requiring the Health Care Financing Administration (HCFA) to develop 
a market basket index for dialysis centers that measures input prices 
and other relevant factors and to annually review and update the 
payment rate based upon this index.
  Overall, the Medicare Renal Dialysis Payment Fairness Act of 2000 
will ensure that dialysis facilities receive the proper Medicare 
reimbursement to continue to provide high quality dialysis services to 
the ESRD population.
  I am grateful to the National Kidney Foundation, the American 
Nephrology Nurses Association, the Renal Physicians Association, the 
National Renal Administrators Association, and the Renal Leadership 
Council for their support of the Medicare Renal Dialysis Payment 
Fairness Act of 2000, and I urge my colleagues to support this critical 
measure.

                          ____________________