S 3035 IS

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.

September 12, 2000

Mr. BAUCUS (for himself, Mr. GRASSLEY, Mr. JEFFORDS, Mr. ROCKEFELLER, and Mr. HATCH) introduced the following bill; which was read twice and referred to the Committee on Finance

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.

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 `Health Care Safety Net Oversight Act of 2000'.

SEC. 2. FINDINGS AND PURPOSE.

(a) FINDINGS- Congress makes the following findings:

(1) America's core health care safety net is made up of providers that deliver a significant level of health care and other related services to uninsured individuals, to beneficiaries under the medicaid program under title XIX of the Social Security Act, and to other vulnerable populations.

(2) Thousands of providers render uncompensated care to uninsured and underinsured individuals.

(3) There are currently 44,000,000 uninsured individuals in the Nation, and an equal number of low-income underinsured individuals (including medicaid beneficiaries) who depend on the core health care safety net.

(b) PURPOSE- The purpose of this Act is to create an independent and nonpartisan commission to assess the health care needs of the uninsured and to monitor the infrastructure, effectiveness, and financial stability of the Nation's core health care safety net.

SEC. 3. SAFETY NET ORGANIZATIONS AND PATIENT ADVISORY COMMISSION.

(a) IN GENERAL- Title XI of the Social Security Act (42 U.S.C. 1320 et seq.) is amended by adding at the end the following new part:

`Part D--Safety Net Organizations and Patient Advisory Commission

`SAFETY NET ORGANIZATIONS AND PATIENT ADVISORY COMMISSION

`SEC. 1181. (a) ESTABLISHMENT- There is established the Safety Net Organizations and Patient Advisory Commission (in this section referred to as the `Commission').

`(b) STUDY OF HEALTH CARE SAFETY NET PROGRAMS AND REPORTING REQUIREMENTS-

`(1) STUDY- The Commission shall study the health care safety net programs by--

`(A) monitoring each health care safety net program to document and analyze the effects of changes in these programs on the core health care safety net;

`(B) evaluating the impact of the Emergency Medical Treatment and Labor Act, the Balanced Budget Act of 1997, the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, and other forces on the capacity of the core health care safety net to continue their roles in the core health care safety net system to care for uninsured individuals, medicaid beneficiaries, and other vulnerable populations;

`(C) monitoring existing data sets to assess the status of the core health care safety net and health outcomes for vulnerable populations;

`(D) wherever possible, linking and integrating existing data systems to enhance the ability of the core health care safety net to track changes in the status of the core health care safety net and health outcomes for vulnerable populations;

`(E) supporting the development of new data systems where existing data are insufficient or inadequate;

`(F) developing criteria and indicators of impending core health care safety net failure;

`(G) establishing an early-warning system to identify impending failures of core health care safety net systems and providers;

`(H) providing accurate and timely information to Federal, State, and local policy makers on the indicators that may lead to the failure of the core health care safety net and an estimate of the projected consequences of such failures and the impact of such a failure on the community;

`(I) monitoring and providing oversight for the transition of individuals receiving supplemental security income, medicaid, or SCHIP benefits who enroll with a managed care entity (as defined in section 1932(a)(1)(B)), including the review of--

`(i) the degree to which health plans have the capacity (including case management and management information system infrastructure) to provide quality managed care services to such an individual;

`(ii) the degree to which these plans may be overburdened by adverse selection; and

`(iii) the degree to which emergency departments are used by enrollees of these plans; and

`(J) identifying and disseminating the best practices for more effective application of the lessons that have been learned.

`(2) REPORTS-

`(A) ANNUAL REPORTS- Not later than June 1 of each year (beginning with 2002), the

Commission shall submit to the appropriate committees of Congress a report on the health care needs of the uninsured and the financial and infrastructure stability of the Nation's core health care safety net based on the review conducted under paragraph (1).

`(B) AGENDA AND ADDITIONAL REVIEWS-

`(i) AGENDA- The Chair of the Commission shall consult periodically with the Chairpersons and Ranking Minority Members of the appropriate committees of Congress regarding the Commission's agenda and progress toward achieving the agenda.

`(ii) ADDITIONAL REVIEWS- The Commission may conduct additional reviews, and submit additional reports to the appropriate committees of Congress, from time to time on such topics relating to the health care safety net programs as may be requested the Commission.

`(C) AVAILABILITY OF REPORTS- The Commission shall transmit to the Comptroller General and the Secretary a copy of each report submitted under this subsection and shall make such reports available to the public.

`(3) DEFINITIONS- In this section:

`(A) APPROPRIATE COMMITTEES OF CONGRESS- The term `appropriate committees of Congress' means the Committees on Ways and Means and Commerce of the House of Representatives and the Committee on Finance of the Senate.

`(B) CORE HEALTH CARE SAFETY NET- The term `core health care safety net' means any health care provider that--

`(i) by legal mandate or explicitly adopted mission, offers access to health care services to patients, regardless of the ability of such patient to pay for such services; and

`(ii) has a case mix that is substantially comprised of patients who are uninsured, covered under the medicaid program, covered under any other public health care program, or are otherwise vulnerable populations.

Such term includes each disproportionate share hospital, federally qualified health centers, other Federal, State, and locally supported clinic, rural health clinic, local health department, and provider covered under the Emergency Medical Treatment and Labor Act.

`(C) HEALTH CARE SAFETY NET PROGRAMS- The term `health care safety net programs' includes the following:

`(i) MEDICAID- The medicaid program under title XIX.

`(ii) SCHIP- The State children's health insurance program under title XXI.

`(iii) MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM- The maternal and child health services block grant program under title V.

`(iv) FQHC PROGRAMS- Each federally funded program under which a health center (as defined in section 330(1) of the Public Health Service Act), a Federally qualified health center (as defined in section 1861(aa)(4)), or a Federally-qualified health center (as defined in section 1905(l)(2)(B)) receives funds.

`(v) RHC PROGRAMS- Each federally funded program under which a rural health clinic (as defined in section 1861(aa)(4) or 1905(l)(1)) receives funds.

`(vi) DSH PAYMENT PLANS- Each federally funded program under which a disproportionate share hospital receives funds.

`(vii) EMERGENCY MEDICAL TREATMENT AND LABOR ACT- All care provided under section 1867 for the uninsured, underinsured, beneficiaries under title XIX, and other vulnerable individuals.

`(viii) OTHER HEALTH CARE SAFETY NET PROGRAMS- Such term also includes any other health care program that the Commission determines to be appropriate.

`(D) VULNERABLE POPULATIONS- The term `vulnerable populations' includes uninsured individuals, low-income individuals, farm workers, homeless individuals, individuals with disabilities, individuals with HIV or AIDS, and such other individuals as the Commission may designate.

`(c) MEMBERSHIP-

`(1) NUMBER AND APPOINTMENT- The Commission shall be composed of 17 members appointed by the Comptroller General of the United States (in this section referred to as the `Comptroller General'), in consultation with the committees of jurisdiction in the House of Representatives and the Senate.

`(2) QUALIFICATIONS-

`(A) IN GENERAL- The membership of the Commission shall include individuals with national recognition for their expertise in health finance and economics, health care safety net research and program management, actuarial science, health facility management, health plans and integrated delivery systems, reimbursement of health facilities, allopathic and osteopathic medicine (including emergency medicine), and other providers of health services, and other related fields, who provide a mix of different professionals, broad geographic representation, and a balance between urban and rural representatives.

`(B) INCLUSION- The membership of the Commission shall include health professionals, employers, third-party payers, individuals skilled in the conduct and interpretation of biomedical, health services, and health economics

research and expertise in outcomes and effectiveness research and technology assessment. Such membership shall also include recipients of care from core health care safety net and individuals who provide and manage the delivery of care by the core health care safety net.

`(C) MAJORITY NONPROVIDERS- Individuals who are directly involved in the provision, or management of the delivery, of items and services covered under the health care safety net programs shall not constitute a majority of the membership of the Commission.

`(D) ETHICAL DISCLOSURE- The Comptroller General shall establish a system for public disclosure by members of the Commission of financial and other potential conflicts of interest relating to such members.

`(3) TERMS-

`(A) IN GENERAL- The terms of members of the Commission shall be for 3 years except that the Comptroller General shall designate staggered terms for the members first appointed.

`(B) VACANCIES-

`(i) IN GENERAL- A vacancy in the Commission shall be filled in the same manner in which the original appointment was made.

`(ii) APPOINTMENT- Any member appointed to fill a vacancy occurring before the expiration of the term for which the member's predecessor was appointed shall be appointed only for the remainder of that term.

`(iii) TERM- A member may serve after the expiration of that member's term until a successor has taken office.

`(4) COMPENSATION-

`(A) IN GENERAL- While serving on the business of the Commission (including travel time), a member of the Commission--

`(i) shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code; and

`(ii) while so serving away from home and the member's regular place of business, a member may be allowed travel expenses, as authorized by the Commission.

`(B) OTHER PERSONNEL- For purposes of pay (other than pay of members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the United States Senate.

`(5) CHAIR; VICE CHAIR- The Comptroller General shall designate a member of the Commission, at the time of appointment of the member as Chair and a member as Vice Chair for that term of appointment, except that in the case of vacancy of the Chair or Vice Chair, the Comptroller General may designate another member for the remainder of that member's term.

`(6) MEETINGS- The Commission shall meet at the call of the Chair or upon the written request of a majority of its members.

`(d) DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS- Subject to such review as the Comptroller General deems necessary to ensure the efficient administration of the Commission, the Commission may--

`(1) employ and fix the compensation of an Executive Director (subject to the approval of the Comptroller General) and such other personnel as may be necessary to carry out its review of health care safety net programs and reporting requirements (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service);

`(2) seek such assistance and support as may be required in the performance of its review of health care safety net programs and reporting requirements from appropriate Federal departments and agencies;

`(3) enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Commission (without regard to section 3709 of the Revised Statutes (41 U.S.C. 5));

`(4) make advance, progress, and other payments which relate to the work of the Commission;

`(5) provide transportation and subsistence for persons serving without compensation; and

`(6) prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the Commission.

`(e) POWERS-

`(1) OBTAINING OFFICIAL DATA-

`(A) IN GENERAL- The Commission may secure directly from any department or agency of the United States information necessary to enable it to carry out this section.

`(B) REQUEST OF CHAIR- Upon request of the Chair, the head of that department or agency shall furnish that information to the Commission on an agreed upon schedule.

`(2) DATA COLLECTION- In order to carry out its functions, the Commission shall--

`(A) use existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section;

`(B) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate; and

`(C) adopt procedures allowing any interested party to submit information for the Commission's use in making reports and recommendations.

`(3) ACCESS OF GAO TO INFORMATION- The Comptroller General shall have unrestricted access to all deliberations, records, and nonproprietary data of the Commission, immediately upon request.

`(4) PERIODIC AUDIT- The Commission shall be subject to periodic audit by the Comptroller General.

`(f) APPLICATION OF FACA- Section 14 of the Federal Advisory Committee Act does not apply to the Commission.

`(g) AUTHORIZATION OF APPROPRIATIONS-

`(1) REQUEST FOR APPROPRIATIONS- The Commission shall submit requests for appropriations in the same manner as the Comptroller General submits requests for appropriations, but amounts appropriated for the Commission shall be separate from amounts appropriated for the Comptroller General.

`(2) AUTHORIZATION- There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section.'.

(b) EFFECTIVE DATE- The Comptroller General of the United States shall appoint the initial members of the Safety Net Organizations and Patient Advisory Commission established under subsection (a) not later than June 1, 2001.

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