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The Protecting Seniors from Fraud Act also includes important proposals for addressing the problem of crimes against the elderly, especially fraud

[Page: S9946]  GPO's PDF

   I hope that we can also take the time to consider the rest of the Seniors Safety Act, and enact even more comprehensive protections for our seniors. The Seniors Safety Act offers a comprehensive approach that would increase law enforcement's ability to battle telemarketing, pension, and health care fraud, as well as to police nursing homes with a record of mistreating their residents. The Justice Department has said that the Seniors Safety Act would ``be of assistance in a number of ways.'' I asked Senator HATCH to hold Judiciary Committee hearings on the bill as long ago as October 1999, and again this past February, but my requests have thus far not been granted. I ask again today for hearings on this important and comprehensive proposal.

   First, the Seniors Safety Act provides additional protections to nursing home residents. Nursing homes provide an important service for our seniors--indeed, more than 40 percent of Americans turning 65 this year will need nursing home care at some point in their lives. Many nursing homes do a wonderful job with a very difficult task--this legislation simply looks to protect seniors and their families by isolating the bad providers in operation. It does this by giving federal law enforcement the authority to investigate and prosecute operators of those nursing homes that engage in a pattern of health and safety violations. This authority is all the more important given the study prepared by the Department of Health and Human Services and reported this summer in the New York Times showing that 54 percent of American nursing homes fail to meet the Department's ``proposed minimum standard'' for patient care. The study also showed that 92 percent of nursing homes have less staff than necessary to provide optimal care.

   Second, the Seniors Safety Act helps protect seniors from telemarketing fraud, which costs billions of dollars every year. My bill would give the Attorney General the authority to block or terminate telephone service where that service is being used to defraud seniors. If someone takes your money at gunpoint, the law says we can take away their gun. If someone uses their phone to take away your money, the law should allow us to protect other victims by taking their phone away. In addition, my proposal would establish a Better Business Bureau-style clearinghouse that would keep track of complaints made about telemarketing companies. With a simple phone call, seniors could fine out whether the company trying to sell to them over the phone or over the Internet has been the subject of complaints or been convinced of fraud. Senator BAYH has recently introduced another bill, S. 3025, the Combating Fraud Against Seniors Act, which includes the part of the Seniors Safety Act that establishes the clearinghouse for telemarketing fraud information.

   Third, the Seniors Safety Act punishes pension fraud. Seniors who have worked hard for years should not have to worry that their hard-earned retirement savings will not be there when they need them. The bill would create new criminal and civil penalties for those who defraud pension plans, and increase the penalties for bribery and graft in connection with employee benefit plans.

   Fourth and finally, the Seniors Safety Act strengthens law enforcement's ability to fight health care fraud. A recent study by the National Institute for Justice reports that many health care fraud schemes ``deliberately target vulnerable populations, such as the elderly or Alzheimer's patients, who are less willing or able to complain or alert law enforcement.'' This legislation gives law enforcement the additional investigatory tools it needs to uncover, investigate, and prosecute health care offenses in both criminal and civil proceedings. It also protects whistle-blowers who alert law enforcement officers to examples of health care fraud.

   In conclusion, I would like to commend Senators BAYH and CLELAND for working to take steps to improve the safety and security of America's seniors. I call upon my colleagues to pass this bipartisan legislation and begin the fight to lower the crime rate against seniors. I also urge them to consider and pass the Seniors Safety Act. Taken together, these two bills would provide a comprehensive approach toward giving law enforcement and older Americans the tools they need to prevent crime.

   By Mr. ROTH (for himself, Mr. MOYNIHAN, Mr. JEFFORDS, Mr. MURKOWSKI, Mr. HATCH, and Mr. KERREY):

   S. 3165. 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; read the first time.

   MEDICARE, MEDICAID AND SCHIP IMPROVEMENTS ACT OF 2000

   Mr. ROTH. Mr. President, I am very pleased today to join Senator MOYNIHAN and my other colleagues on the Senate Finance Committee in introducing the Medicare, Medicaid and SCHIP Improvements Act of 2000. This is important, bipartisan legislation intended to address needed health care funding and other improvements in these programs that are so important to millions of Americans. Every year on the Finance Committee we maintain watchful oversight of these critical programs to make sure that beneficiary access to services is maintained, and that payments and benefits are adjusted to meet beneficiaries' needs. This bill would add about $28 billion in funds to these programs over the next five years. Following are some of the highlights of this legislation.

   (1) Medicare beneficiary assistance provisions would reduce coinsurance liability for hospital outpatient services; improve access to Medigap coverage; permit Medicare+Choice plans to give beneficiaries cash rebates of Part B premiums; protect access to immunosuppressive, cancer, hemophilia and other drugs, and extend Part B premium assistance for lower-income beneficiaries.

   (2) Preventive health benefits would expand existing or add new coverage for pap smears, colorectal cancer screening, and nutrition therapy, and request further work on effective preventive benefits for later consideration in Medicare.

   (3) Rural health care improvements address service capacity and access to services through increased payments for critical access, sole-community and Medicare-dependent hospitals. The package also includes provisions for rural health clinics, ambulance services, and telemedicine. Rural hospitals, skilled nursing facilities and home health agencies also benefit from general financing improvements detailed in other sections.

   (4) Medicare+Choice provisions stabilize and improve funding for beneficiaries electing to enroll in privately-offered Medicare+Choice plans, with special attention to rural communities; restore funding for beneficiary education cam paigns; and provide additional assistance for frail, disabled and rural beneficiaries.

   (5) Hospital funding improvements increase annual payment updates; improve disproportionate share hospital (DSH) payments under Medicare and Medicaid for providing uncompensated care to uninsured patients; reform Medicare's DSH program to reduce disparities in the treatment of rural and urban hospitals; add funding for rehabilition hospitals; and protect payments for teaching hospitals.

   (6) Skilled nursing facility (SNF) provisions improve funding, maintain access to therapy services, and reduce regulatory burdens by delaying implementation of consolidated billing.

   (7) Home health and hospice provisions protect funding for home health services by delaying a scheduled 15% cut in payments; increasing funding for high-cost outlier cases, and making special temporary payments to rural agencies. Hospice provisions improve funding, require research on issues related to eligibility for the benefit and

[Page: S9947]  GPO's PDF

   (8) Dialysis and durable medical equi pment (DME) provisions improve payments for DME for all Medicare beneficiaries, and for services received by individuals with end-stage renal disease, as well as enhancing their opportunities to participate in the Medicare+Choice program.

   (9) Additional provisions address physician, laboratory, ambulatory surgery center and other medical serv ices. The package also creates a Joint Committee on Health Care Financing to provide professional support to the Congress in addressing the burgeoning cost and legislative complexity of the Medicare, Medicaid and State Children's Health Insurance programs and monitoring the viability of safety net providers.

   (10) Medicaid and SCHIP provisions improve the financing of and access to services provided by federally qualified health centers and rural health clinics; establish policies for the retention and redistribution of unspent SCHIP funds; increase authorization for the Maternal and Child Health Block Grant; and add funding for special diabetes programs for children and Native Americans.

   I would like to accomplish even more this year, especially in the Medicare program. For instance, I remain committed to securing comprehensive drug benefits for the aged and disabled beneficiaries in Medicare. I will continue to work towards that goal. However, I am pleased that we were able to achieve bipartisan support for these improvements and I will continue my efforts to build the bipartisan consensus needed to proceed on larger Medicare reforms in the near future.

   Mr. MOYNIHAN. Mr. President, I am pleased to join with Senator ROTH, distinguished chairman of the Finance Committee, in sponsoring the Medicare, Medicaid, and SCHIP Improvement Act of 2000.

   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 serv ices. 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--some argue twice as large, although it's difficult to determine this with any precision.

   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 addressed 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 September 20, Senator Daschle and I, along with 32 of our Democratic colleagues, introduced a similar, but more substantial, BBA relief package that would provide about $40 billion over 5 years in relief to health care providers and beneficiaries. Today, along with Senator ROTH, I am pleased to be cosponsoring a bipartisan BBA relief bill to provider about $28 billion in relief over 5 years.

   I want, in particular, to highlight that this legislation would--for fiscal years 2001 and 2002--prevent further reductions in the special Medicare payments to our Nation's teaching hospitals. A little background is in order.

   Medicare provides support to our Nation's teaching hospitals by adjusting its payments upward to reflect Medicare's share of costs associated with care provided by medical resi dents. This is accomplished under two mechanisms: direct graduate medi cal educ ation (dir ect GME) payments; and indirect medical educ ation (IME ) adjustments. Direct GME costs include items such as salaries of residents, interns, and faculty and overhead costs for classroom training. The separate IME adjustment was established in 1983 and pertains to residency training costs that are not directly attributable to medical educ ation expe nses, but are nevertheless associated with teaching activities and the teaching hospital's research mission--for example, extra demands placed on hospital staff, additional tests ordered by residents, and increased use of diagnostic testing and advanced technology. Prior to the BBA, the IME adjustment increased Medicare's hospital payments by approximately 7.7 percent for each 10 percent increase in a hospital's ratio of interns and residents to hospital beds.

   The BBA included a reduction in the IME adjustment from the previous 7.7 percent to 7.0 percent in FY 1998; to 6.5 percent in FY 1999; to 6.0 percent in FY 2000; and to 5.5 percent in FY 2001 and subsequent years. In my judgment, these cuts would have seriously impaired the cutting edge research conducted by teaching hospitals, as well as impaired their ability to train doctors and to serve so many of our nation's indigent.

   Last year, in the BBRA, we mitigated the scheduled reduction in FY 2000--freezing the IME adjustment at 6.5 percent; and the IME adjustment was set at 6.25 percent for FY 2001, and 5.5 percent thereafter. The package we are introducing today, would restore $600 million in funds for FY 2001 and FY 2002 by setting the IME adjustment at 6.5 percent in both years. The IME adjustment would then fall to 5.5 percent thereafter--a reduction which I had hoped to cancel this year, and sincerely hope the congress will cancel in future legislation.

   I have stood before my colleagues on countless occasions to bring attention to the financial plight of medical scho ols and teaching hospitals. Yet, I regret that the fate of the 144 accredited medical scho ols and 1416 graduate medi cal educ ation teac hing institutions still remains uncertain. The proposals in this bill will provide critically needed financing--at least in the short-run.

   In the long-run, however, we need to restructure the financing of graduate medi cal educ ation alon g the lines I have proposed in the Graduate Medi cal Educ ation Trus t 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 disc overy. The Graduate Medi cal Educ ation Trus t 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 medi cal educ ation. S. 210 would roughly double current funding levels for Graduate Medi cal Educ ation and would establish a Medical Educ ation Advi sory Commission to make recommendations on the operation of the Medical Educ ation Trus t Fund, on alternative payment sources for funding graduate medi cal educ ation 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 for the next two years, this bill 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; target additional relief to rural hospitals; reduce cuts in payments to hospitals for handling large numbers of low-income patients (referred to as ``disproportionate share (DSH) hospital payments''); delay the scheduled 15 percent cut in payments to home health agencies; improve funding for skilled nursing facilities; and assist beneficiaries through preventive benefits and smaller coinsurance payments.

   Let me close by again complimenting Senator ROTH on developing this bill on a bipartisan basis and expressing my hope that the forthcoming information negotiations with committees of the House will be similarly conducted on a bipartisan basis.

   By Mr. BINGAMAN:

   S. 3166. A bill to amend the Clinger-Cohen Act of 1996 to provide individual federal agencies and the executive branch as a whole with increased incentives to use the share-in-savings program under that Act, to ease the use of such program, and for other purposes; to the Committee on Governmental Affairs.

   INFORMATION TECHNOLOGY SHARE-IN-SAVINGS PROGRAM IMPROVEMENT ACT OF 2000

   Mr. BINGAMAN. Mr. President, today I'm introducing a bill designed to lower the cost of the government's information technology systems and improve how those systems serve our citizens by encouraging greater use of a ``share-in-savings'' approach to contracting for information technology (IT).

   Under a share-in-savings approach, the government contracts with a company to provide an improved, lower cost IT service and the company pays the up-front costs of the project, which is not the usual practice. In return, the contractor gets paid a portion of the money saved by the government under the new arrangement. Essentially, the contractor bears the capital costs needed for the government to save some money and has a strong incentive to decrease the government's costs because they get paid a portion of any savings.

   Although this approach to IT contracting is authorized as a pilot program under the Clinger-Cohen Act, I understand the executive branch has not made much use of this approach to date. Hence, I believe there are opportunities for greater creativity in this area if we give the agencies greater incentives.

   Basically, my bill does three things. First, and most importantly, it gives agencies an incentive to try a share-in-savings approach by letting them keep up to half the government's net savings to use for additional IT projects, rather than having all the net savings going back to the Treasury. It's just human nature that if you ask someone to do something risky--like a new IT system--but all the benefits go elsewhere, they're not going to be very inclined to do it. That is, unless they get to

   keep some of the benefits to improve their own operations--which is what this bill let's them do. The point here is that the more agency managers actually are willing to use this approach, the more money the taxpayer will save in the long run.

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