[Congressional Record (Bound Edition), Volume 149 (2003), Part 17]
[Senate]
[Pages 23608-23610]
[From the U.S. Government Publishing Office, www.gpo.gov]




 EXTENDING TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT PROGRAM

  Mr. McCONNELL. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of H.R. 3146, which is at the 
desk.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (H.R. 3146) to extend the Temporary Assistance for 
     Needy Families block grant program and certain tax and trade 
     programs, and for other purposes.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. GRASSLEY. Mr. President, I thank the majority leader for his work 
on the extension for the Temporary Assistance for Needy Families 
program. Unfortunately, this program has had to be extended several 
times while the Senate finance Committee worked to complete a very 
ambitious agenda.
  Happily, though, the Senate finance Committee was able to report a 
welfare reauthorization bill on September 10, 2003. I plan to file the 
committee bill shortly. It is critical that the Senate act swiftly to 
complete action on this legislation. This program has languished, 
unauthorized, for a year. States need to make plans to adjust to the 
new provisions. Recipients need some assurances that the program will 
continue.
  It was my preference that Senate action on the welfare bill take 
place this fall, but I understand that the time frame for adjournment 
is fluid and this impacts what the Leader is able to bring to the 
floor. Additionally, I would have preferred a shorter extension, in 
order to keep the process moving forward. I do not want to send the 
signal that since we are passing a 6-month extension, this means that 
there will be no action on this legislation until March next year. If 
that should occur, we would find ourselves in the position of having to 
seek yet another extension. This is a situation which can only be 
avoided, in my view, by prompt action on this legislation.
  I understand why the majority leader wants a 6-month extension 
because I recognize that it is nearly impossible to envision a scenario 
in which the Senate passes a bill, the House and Senate have a 
conference, a conference report is drafted and filed and the measure 
goes back to both houses for a final vote, prior to a possible 
adjournment date in late November. But if it becomes at all possible 
for the Senate to act on the legislation in what remains of this 
session, leaving conference committee consideration for early next 
year, we should certainly do that.
  It is my intention, if a window of opportunity does open up before we 
adjourn for the year, to work with the Leadership to bring this 
legislation up for consideration. In the event that such a window of 
opportunity does not open up in what remains of this session, I am 
confident that this bill will be among the first pieces of legislation 
brought up for consideration as soon as we reconvene next year.


                        montana's welfare waiver

  Mr. BAUCUS. Mr. President, as we have worked over the last 2 years to 
reauthorize the 1996 landmark welfare reform law, I have often talked 
with pride about the welfare reform program in my own State of Montana. 
Montana was a welfare reform pioneer, embarking on reform under a 
waiver before 1996. We have continued to operate a program under that 
waiver and it has served us well.
  The number of Montana families receiving monthly welfare checks is 
down sharply since the early 1990s. Under the waiver program, Montana 
achieved a participation rate of 84 percent in fiscal year 2002, 
despite a struggling economy. Montana is a regular recipient of ``high 
performance'' bonus awards, especially for the key criteria of moving 
welfare recipients quickly into jobs. An independent study by Abt 
Associates concluded that under Montana's program ``a Work First model 
has been implemented effectively in varied rural settings, including 
Indian reservations and remote areas'' and that it reflects an 
``efficient and successful'' strategy. In other words, we're on the 
right track.
  However, the waiver expires on December 31. We would like it 
extended. Given our track record, we think it is only common sense to 
continue a successful model. Others, unfortunately, have opposed such 
an extension. It is an issue we expect to be debated during 
consideration of the full 5 year reauthorization bill.
  As we extend the Temporary Assistance for Needy Families, or TANF, 
program for 6 months, I want to confirm with the distinguished chairman 
of the Finance Committee, that he is willing to work with me to ensure 
that the welfare reauthorization bill allows Montana to maintain the 
successful direction of the program it has operated under its waiver. 
Given his efforts to work in a bipartisan manner, I am optimistic we 
will be able to reach an understanding on these policies.

[[Page 23609]]


  Mr. GRASSLEY. Mr. President, I understand the concerns of the Senator 
from Montana, and look forward to continuing to work with him to 
reauthorize the TANF program in the coming months. I appreciate his 
concern for the need for Montana to pursue welfare policies it believe 
make sense in that State. I agree that we will discuss these and other 
issues as we reauthorize the TANF program and am also optimistic we 
will be able to reach an understanding on these policies.
  Mr. President, current law penalizes rural and small urban facilities 
by paying them 1.6 percent less on every inpatient discharge than their 
counterparts in urban areas of a million or more people. This is one 
reason for MedPAC's finding that Medicare inpatient profit margins are 
substantially worse for rural and small urban facilities than for those 
located in large urban areas.
  The provision raises the inpatient base rate for hospitals in rural 
and small urban areas to the same rate as that in large urban areas 
from October 1, 2003 through March 31, 2004. Every State except Rhode 
Island has rural or small urban hospitals, so 49 States will benefit 
from this provision.
  The fiscal year 2003 omnibus Appropriations bill included a 6-month 
version of this policy. The policy ends on September 30, 2003. A 
permanent version of this policy was included in the Senate- and House-
passed prescription drug bills this summer. MedPAC has endorsed a 
permanent version of this policy in its 2003 recommendations.
  The cost of the provision is $300 million, for the 6-month period 
beginning October 1, 2003 and ending March 31, 2004, according to 
preliminary scores from CBO.
  I ask unanimous consent to print in the Record the preliminary CBO 
estimates.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  PRELIMINARY CBO ESTIMATE OF THE FEDERAL BUDGET EFFECTS OF H.R. 3146--BASED ON DRAFT LEGISLATIVE LANGUAGE, THOMAS.068, DATED SEPTEMBER 29, 2003 (11:22
                                                      AM)--ESTIMATED USING CBO MARCH 2003 BASELINE
                                                        [By fiscal year, in millions of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                     2004    2005    2006    2007    2008    2009    2010    2011    2012    2013   2004-2008  2004-2013
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CHANGES IN DIRECT SPENDING
 
      Title I: Family assistance Provisions
 
Fund Supplemental Grants for 2 quarters:
    Budget Authority.............................      191       0       0       0       0       0       0       0       0       0       191        191
    Outlays......................................       96      38      19      19      19       0       0       0       0       0       191        191
Increase Transfer Authority to 10 percent for 2
 quarters:
    Budget Authority.............................        0       0       0       0       0       0       0       0       0       0         0          0
    Outlays......................................       77     -14     -28     -15     -15      -5       0       0       0       0         5          0
Extend TMA through March 2004:
    Budget Authority.............................       86     135      19       4       0      -1       0       0       0      -1       244        242
    Outlays......................................       83     130      20       5       0       0       0       1       0       0       238        239
Extend Abstinence Education Grants for 2
 quarters:
    Budget Authority.............................       25       0       0       0       0       0       0       0       0       0        25         25
    Outlays......................................        7       9       3       2       1       0       0       0       0       0        22         22
Extend TANF Research Funding for 2 quarters:
    Budget Authority.............................        8       0       0       0       0       0       0       0       0       0         8          8
    Outlays......................................        1       3       4       0       0       0       0       0       0       0         8          8
Extend Child Welfare Research Funding for 2
 quarters:
    Budget Authority.............................        3       0       0       0       0       0       0       0       0       0         3          3
    Outlays......................................    (\1\)       1       2       0       0       0       0       0       0       0         3          3
    Subtotal Title I:
        Budget Authority.........................      313     135      19       4       0      -1       0       0       0      -1       471        469
        Outlays..................................      264     167      20      11       5      -5       0       1       0       0       467        463
 
           Title III: Trade Provisions
 
Extend Custom User Fees through March 2004:
    Budget Authority.............................     -698       0       0       0       0       0       0       0       0       0      -698       -698
    Outlays......................................     -698       0       0       0       0       0       0       0       0       0      -698       -698
 
    Title IV: Medicare Cost-Sharing Provisions
 
Extend Medicare Cost-Sharing through March 2004:
    Budget Authority.............................       42       0       0       0       0       0       0       0       0       0        42         42
    Outlays......................................       42       0       0       0       0       0       0       0       0       0        42         42
Extend Inpatient Hospital SPA Equalization
 through March 2004:
    Budget Authority.............................      292       0       0       0       0       0       0       0       0       0       292        292
    Outlays......................................      292       0       0       0       0       0       0       0       0       0       292        292
    Subtotal Title IV:
        Budget Authority.........................      334       0       0       0       0       0       0       0       0       0       334        334
        Outlays..................................      334       0       0       0       0       0       0       0       0       0       334        334
        Total Direct Spending:
            Budget Authority.....................      -51     135      19       4       0      -1       0       0       0      -1       107        105
            Outlays..............................     -100     167      20      11       5      -5       0       1       0       0       103         99
 
                                                                   CHANGES IN REVENUE
 
             Title II: Tax Provisions
                                                        33       8       0       0       0       0       0       0       0       0        41         41
Net Effect on Deficit/Surplus....................     -133     159      20      11       5      -5       0       1       0       0        62         58
--------------------------------------------------------------------------------------------------------------------------------------------------------
Notes: TANF=Temporary Assistance for Needy Families. TMA=Transitional Medical Assistance. SPA=Standardized Payment Amount.

  Mr. McCONNELL. Mr. President, I ask unanimous consent that the 
amendment that is at the desk be agreed to; that the bill, as amended, 
be read a third time and passed; that the motion to reconsider be laid 
upon the table; and that any statements relating to the bill be printed 
in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 1793) was agreed to, as follows:

  (Purpose: 6-month extension of provision equalizing urban and rural 
    standardized payment amounts under Medicare Inpatient Hospital 
                      Prospective Payment System)

       At the end of title IV, insert:

     SEC. __. EXTENSION OF PROVISION EQUALIZING URBAN AND RURAL 
                   STANDARDIZED MEDICARE INPATIENT HOSPITAL 
                   PAYMENTS.

       (a) In General.--Paragraphs (1) and (2) of section 402(b) 
     of the Miscellaneous Appropriations Act, 2003 (Public Law 
     108-7; 117 Stat. 548) are each amended by striking 
     ``September 30, 2003'' and inserting ``March 31, 2004''.
       (b) Effective Date.--
       (1) In general.--Subject to paragraph (2), the amendments 
     made by subsection (a) shall take effect as if included in 
     the enactment of the Miscellaneous Appropriations Act, 2003.
       (2) Authority to delay implementation.--
       (A) In general.--If the Secretary of Health and Human 
     Services (in this subsection referred to as the 
     ``Secretary'') determines that it is not administratively 
     feasible to implement the amendments made by subsection (a), 
     notwithstanding such amendments and in order to comply with 
     Congressional intent, the Secretary may delay the 
     implementation of such amendments until such time as the 
     Secretary determines to be appropriate, but in no case later 
     than November 1, 2003.
       (B) Temporary adjustment for remainder of fiscal year 2004 
     to effect full rate

[[Page 23610]]

     change.--If the Secretary delays implementation of the 
     amendments made by subsection (a) under subparagraph (A), the 
     Secretary shall make such adjustment to the amount of 
     payments affected by such delay, for the portion of fiscal 
     year 2004 after the date of the delayed implementation, in 
     such manner as the Secretary estimates will ensure that the 
     total payments for inpatient hospital services so affected 
     with respect to such fiscal year is the same as would have 
     been made if this paragraph had not been enacted.
       (C) No effect on payments for subsequent payment periods.--
     The application of subparagraphs (A) and (B) shall not affect 
     payment rates and shall not be taken into account in 
     calculating payment amounts for services furnished for 
     periods after September 30, 2004.
       (D) Administration of provisions.--
       (i) No rulemaking or notice required.--The Secretary may 
     carry out the authority under this paragraph by program 
     memorandum or otherwise and is not required to prescribe 
     regulations or to provide notice in the Federal Register in 
     order to carry out such authority.
       (ii) Limitation on review.--There shall be no 
     administrative or judicial review under section 1869 or 1878 
     of the Social Security Act (42 U.S.C. 1395ff and 1395oo), or 
     otherwise of any delay or determination made by the Secretary 
     under this paragraph or the application of the payment rates 
     determined under this paragraph.

  The bill (H.R. 3146), as amended, was read the third time and passed.

                          ____________________