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This Act may be cited as the ``International Academic Opportunity Act of 2000''.
[Page: S8825] GPO's PDF
SEC. 2. STATEMENT OF PURPOSE.
It is the purpose of this Act to establish an undergraduate grant program for students of limited financial means from the United States to enable such students to study abroad. Such foreign study is intended to broaden the outlook and better prepare such students of demonstrated financial need to assume significant roles in the increasingly global economy.
SEC. 3. ESTABLISHMENT OF GRANT PROGRAM FOR FOREIGN STUDY BY AMERICAN COLLEGE STUDENTS OF LIMITED FINANCIAL MEANS.
(a) ESTABLISHMENT.--Subject to the availability of appropriations and under the authorities of the Mutual Educational and Cultural Exchange Act of 1961, the Secretary of State shall establish and carry out a program in each fiscal year to award grants of up to $5,000, to individuals who meet the requirements of subsection (b), toward the cost of up to one academic year of undergraduate study abroad. Grants under this Act shall be known as the ``Benjamin A. Gilman International Scholarships''.
(b) ELIGIBILITY.--An individual referred to in subsection (a) is an individual who--
(1) is a student in good standing at an institution of higher education in the United States (as defined in section 101(a) of the Higher Education Act of 1965);
(2) has been accepted for up to one academic year of study--
(A) at an institution of higher education outside the United States (as defined by section 102(b) of the Higher Education Act of 1965); or
(B) on a program of study abroad approved for credit by the student's home institution;
(3) is receiving any need-based student assistance under title IV of the Higher Education Act of 1965; and
(4) is a citizen or national of the United States.
(c) APPLICATION AND SELECTION.--
(1) Grant application and selection shall be carried out through accredited institutions of higher education in the United States or a combination of such institutions under such procedures as are established by the Secretary of State.
(2) In considering applications for grants under this section--
(A) consideration of financial need shall include the increased costs of study abroad; and
(B) priority consideration shall be given to applicants who are receiving Federal Pell Grants under title IV of the Higher Education Act of 1965.
SEC. 4. REPORT TO CONGRESS.
The Secretary of State shall report annually to the Congress concerning the grant program established under this Act. Each such report shall include the following information for the preceding year:
(1) The number of participants.
(2) The institutions of higher education in the United States that participants attended.
(3) The institutions of higher education outside the United States participants attended during their year of study abroad.
(4) The areas of study of participants.
SEC. 5. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated $1,500,000 for each fiscal year to carry out this Act.
SEC. 6. EFFECTIVE DATE.
This Act shall take effect October 1, 2000.
By Mr. MOYNIHAN (for himself, Mr. DASCHLE, Mr. ROCKEFELLER, Mr. BREAUX, Mr. GRAHAM, Mr. KERREY, Mr. ROBB, Mr. KENNEDY, Mr. AKAKA, Mr. BINGAMAN, Mrs. BOXER, Mr. CLELAND, Mr. DODD, Mr. DORGAN, Mr. EDWARDS, Mr. HOLLINGS, Mr. INOUYE, Mr. JOHNSON, Mr. KERRY, Ms. LANDRIEU, Mr. LEAHY, Mr. LEVIN, Mrs. LINCOLN, Ms. MIKULSKI, Mr. MILLER, Mrs. MURRAY, Mr. REED, Mr. SARBANES, Mr. SCHUMER, Mr. TORRICELLI, and Mr. WELLSTONE):
S. 3077. A bill to amend the Social Security Act to make corrections and refinements in the Medicare, Medicaid, and SCHIP health insurance programs, as revised by the Balanced Budget Act of 1997 and the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, and for other purposes; to the Committee on Finance.
BALANCED BUDGET REFINEMENT ACT OF 2000
Mr. MOYNIHAN. Mr. President, I am pleased to join with Senator DASCHLE and many of my Democratic colleagues in sponsoring the Balanced Budget Refinement Act of 2000 (BBRA-2000). First, a few words on the genesis of this bill.
As part of the effort to balance the Federal Budget, the Balanced Budget Act of 1997 (BBA) provided for reduction in Medicare payments for medical services. At the time of enactment, the Congressional Budget Office (CBO) estimated that these provisions would reduce Medicare outlays by $112 billion over 5 years. We now know that these BBA cuts have been much larger than originally anticipated.
Hospital industry representatives and other providers of health care services have asserted that the magnitude of the reductions are having unintended consequences which are seriously impacting the quantity and quality of health care services available to our citizens.
Last year, the Congress address some of those unintended consequences, by enacting the Balanced Budget Refinement Act (BBRA), which added back $16 billion over 5 years in payments to various Medicare providers, including: Teaching Hospitals; Hospital Outpatient Departments; Medicare HMOs (Health Maintenance Organizations); Skilled Nursing Facilities; Rural Health Providers; and Home Health Agencies.
However, Members of Congress are continuing to hear from providers who argue that the 1997 reductions are still having serious unanticipated consequences.
To respond to these continuing problems, the President last June proposed additional BBA relief in the amount of $21 billion over the next 5 years. On July 27, Senator DASCHLE and I announced the outlines of a similar, but more substantial, Senate Democratic BBA relief package that would provide about $40 billion over 5 years in relief to health care providers and beneficiaries. Today, along with many of our colleagues, Senator DASCHLE and I are introducing this package as the Balanced Budget Refinement Act of 2000 (BBRA-2000).
Before I submit for the record a summary of this legislation, I want, in particular, to highlight that our legislation would prevent further reductions in payments to our Nation's teaching hospitals. The BBA, unwisely in my view, enacted a multi-year schedule of cuts in payments by Medicare to academic medical centers. These cuts would seriously impair the cutting edge research conducted by teaching hospitals, as well as impair their ability to train doctors and to serve so many of our nation's indigent.
Last year, in the BBRA, we mitigated the scheduled reductions in fiscal years 2000 and 2001. The package we are introducing today, would cancel any further reductions in what we call ``Indirect Medical Education payments,'' thereby restoring nearly $2.7 billion over 5 years ($6.9 billion over 10 years) to our Nation's teaching hospitals.
I have stood before my colleagues on countless occasions to bring attention to the financial plight of medical schools and teaching hospitals. Yet, I regret that the fate of the 144 accredited medical schools and 1416 graduate medical education teaching institutions still remains uncertain. The proposals in our Democratic BBRA-2000 package will provide critically needed financing in the short-run.
In the long-run, however, we need to restructure the financing of graduate medical education along the lines I have proposed in the Graduate Medical Education Trust Fund Act (S. 210). What is needed is explicit and dedicated funding for these institutions, which will ensure that the United States continues to lead the world in this era of medical discovery. The Graduate Medical Education Trust Fund Act would require that the public sector, through the Medicare and Medicaid programs, and the private sector through an assessment on health insurance premiums, provide broad-based financial support for graduate medical education . S. 210 would roughly double current funding levels for Graduate Medical Education and would establish a Medical Education Advisory Commission to make recommendations on the operation of the Medical Education Trust Fund, on alternative payment sources for funding graduate medical education and teaching hospitals, and on policies designed to maintain superior research and educational capacities.
In addition to restoring much needed funding to our Nation's teaching hospitals, BBRA-2000 would add back funding in many vital areas of health care. Key provisions of the bill we are introducing today would: provide full market basket (inflation) adjustments to hospitals for 2001 and 2002; prevent further reductions in Indirect Medical Education (IME) payments to teaching hospitals; target additional relief to rural hospitals; eliminate cuts in payments to hospitals for handling large numbers of low-income patients (referred to as ``disproportionate share
[Page: S8826] GPO's PDF
Mr. President, I ask unanimous consent that the bill language, a summary of the bill, and several letters of support which I send to the desk, be placed in the RECORD at the conclusion of my statement. I would like to thank Kyle Kinner and Kirsten Beronio of the minority health staff of the Finance Committee for their efforts in assembling this legislation.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES TO OTHER ACTS; TABLE OF CONTENTS.
(a) SHORT TITLE.--This Act may be cited as the ``Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000''.
(b) AMENDMENTS TO SOCIAL SECURITY ACT.--Except as otherwise specifically provided, whenever in this Act an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.
(c) REFERENCES TO OTHER ACTS.--In this Act:
(1) THE BALANCED BUDGET ACT OF 1997.--The term ``BBA'' means the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).
(2) THE MEDICARE, MEDICAID, AND SCHIP BALANCED BUDGET REFINEMENT ACT OF 1999.--The term ``BBRA'' means the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-321), as enacted into law by section 1000(a)(6) of Public Law 106-113.
(d) TABLE OF CONTENTS.--The table of contents of this Act is as follows:
Sec..1..Short title; amendments to Social Security Act; references to other Acts; table of contents.
TITLE I--PROVISIONS RELATING TO PART A
Subtitle A--Skilled Nursing Facilities
Sec..101..Eliminating reduction in skilled nursing facility (SNF) market basket update..
Sec..102..Revision of BBRA increase for skilled nursing facilities in fiscal years 2001 and 2002.
Sec..103..MedPAC study on payment updates for skilled nursing facilities; authority of Secretary to make adjustments.
Subtitle B--PPS Hospitals
Sec..111..Revision of reduction of indirect graduate medical education payments.
Sec..112..Eliminating reduction in PPS hospital payment update.
Sec..113..Eliminating reduction in disproportionate share hospital (DSH) payments.
Sec..114..Equalizing the threshold and updating payment formulas for disproportionate share hospitals.
Sec..115..Care for low-income patients.
Sec..116..Modification of payment rate for Puerto Rico hospitals.
Sec..117..MedPAC study on hospital area wage indexes.
Subtitle C--PPS Exempt Hospitals
Sec..121..Treatment of certain cancer hospitals.
Sec..122..Payment adjustment for inpatient services in rehabilitation hospitals.
Subtitle D--Hospice Care
Sec..131..Revision in payments for hospice care.
Subtitle E--Other Provisions
Sec..141..Hospitals required to comply with bloodborne pathogens standard.
Sec..142..Informatics and data systems grant program.
Sec..143..Relief from medicare part A late enrollment penalty for group buy-in for State and local retirees.
Subtitle F--Transitional Provisions
Sec..151..Reclassification of certain counties and areas for purposes of reimbursement under the medicare program.
Sec..152..Calculation and application of wage index floor for a certain area.
TITLE II--PROVISIONS RELATING TO PART B
Subtitle A--Hospital Outpatient Services
Sec..201..Reduction of effective HOPD coinsurance rate to 20 percent by 2014.
Sec..202..Application of transitional corridor to certain hospitals that did not submit a 1996 cost report.
Sec..203..Permanent guarantee of pre-BBA payment levels for outpatient services furnished by children's hospitals.
Subtitle B--Provisions Relating to Physicians
Sec..211..Loan deferment for residents.
Sec..212..GAO studies and reports on medicare payments.
Sec..213..MedPAC study on the resource-based practice expense system.
Subtitle C--Ambulance Services
Sec..221..Election to forego phase-in of fee schedule for ambulance services.
Sec..222..Prudent layperson standard for emergency ambulance services.
Sec..223..Elimination of reduction in inflation adjustments for ambulance services.
Sec..224..Study and report on the costs of rural ambulance services.
Sec..225..Interim payments for rural ground ambulance services until regulation implemented.
Sec..226..GAO study and report on the costs of emergency and medical transportation services.
Subtitle D--Preventive Services
Sec..231..Elimination of deductibles and coinsurance for preventive benefits.
Sec..232..Counseling for cessation of tobacco use.
Sec..233..Coverage of glaucoma detection tests.
Sec..234..Medical nutrition therapy services for beneficiaries with diabetes, a cardiovascular disease, or a renal disease.
Sec..235..Studies on preventive interventions in primary care for older Americans.
Sec..236..Institute of Medicine 5-year medicare prevention benefit study and report.
Sec..237..Fast-track consideration of prevention benefit legislation.
Subtitle E--Other Services
Sec..241..Revision of moratorium in caps for therapy services.
Sec..242..Revision of coverage of immunosuppressive drugs.
Sec..243..State accreditation of diabetes self-management training programs.
Sec..244..Elimination of reduction in payment amounts for durable medical equipment and oxygen and oxygen equipment.
Sec..245..Standards regarding payment for certain orthotics and prosthetics.
Sec..246..National limitation amount equal to 100 percent of national median for new pap smear technologies and other new clinical laboratory test technologies.
Sec..247..Increased medicare payments for certified nurse-midwife services.
Sec..248..Payment for administration of drugs.
Sec..249..MedPAC study on in-home infusion therapy nursing services.
TITLE III--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
Sec..301..Elimination of 15 percent reduction in payment rates under the prospective payment system for home health services.
Sec..302..Exclusion of certain nonroutine medical supplies under the PPS for home health services.
Sec..303..Permitting home health patients with Alzheimer's disease or a related dementia to attend adult day-care.
Sec..304..Standards for home health branch offices.
Sec..305..Treatment of home health services provided in certain counties.
Subtitle B--Direct Graduate Medical Education
Sec..311..Not counting certain geriatric residents against graduate medical education limitations.
Sec..312..Program of payments to children's hospitals that operate graduate medical education programs.
Sec..313..Authority to include costs of training of clinical psychologists in payments to hospitals.
Sec..314..Treatment of certain newly established residency programs in computing medicare payments for the costs of medical education .
Subtitle C--Miscellaneous Provisions
Sec..321..Waiver of 24-month waiting period for medicare coverage of individuals disabled with amyotrophic lateral sclerosis (ALS).
TITLE IV--RURAL PROVIDER PROVISIONS
Subtitle A--Critical Access Hospitals
Sec..401..Payments to critical access hospitals for clinical diagnostic laboratory tests.
Sec..402..Revision of payment for professional services provided by a critical access hospital.
Sec..403..Permitting critical access hospitals to operate PPS exempt distinct part psychiatric and rehabilitation units.
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Subtitle B--Medicare Dependent, Small Rural Hospital Program
Sec..411..Making the medicare dependent, small rural hospital program permanent.
Sec..412..Option to base eligibility for medicare dependent, small rural hospital program on discharges during any of the 3 most recent audited cost reporting periods.
Subtitle C--Sole Community Hospitals
Sec..421..Extension of option to use rebased target amounts to all sole community hospitals.
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