[Congressional Record Volume 161, Number 33 (Thursday, February 26, 2015)]
[Senate]
[Pages S1163-S1170]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Ms. COLLINS (for herself and Mr. Schumer):
S. 578. A bill to amend title XVIII of the Social Security Act to
ensure more timely access to home health services for Medicare
beneficiaries under the Medicare program; to the Committee on Finance.
Ms. COLLINS. Mr. President, I rise today on behalf of myself and
Senator Schumer to introduce legislation to ensure that our seniors and
disabled citizens have timely access to home health services under the
Medicare program.
Nurse practitioners, physician assistants, certified nurse midwives
and clinical nurse specialists are all playing increasingly important
roles in the delivery of health care services, particularly in rural
and medically underserved areas of our country where physicians may be
in scarce supply. In recognition of their growing role, Congress, in
1997, authorized Medicare to begin paying for physician services
provided by these health professionals as long as those services are
within their scope of practice under State law.
Despite their expanded role, these advanced practice registered
nurses and physician assistants are currently unable to order home
health services for their Medicare patients. Under current law, only
physicians are allowed to certify or initiate home health care for
Medicare patients, even though they may not be as familiar with the
patient's case as the non-physician provider. In fact, in many cases,
the certifying physician may not even have a relationship with the
patient and must rely upon the input of the nurse practitioner,
physician assistant, clinical nurse specialist or certified nurse
midwife to order the medically necessary home health care. At best,
this requirement adds more paperwork and a number of unnecessary steps
to the process before home health care can be provided. At worst, it
can lead to needless delays in getting Medicare patients the home
health care they need simply because a physician is not readily
available to sign the form.
The inability of advanced practice registered nurses and physician
assistants to order home health care is particularly burdensome for
Medicare beneficiaries in medically underserved areas, where these
providers may be the only health care professionals available. For
example, needed home health care was delayed by more than a week for a
Medicare patient in Nevada because the physician assistant was the only
health care professional serving the patient's small town, and the
supervising physician was located 60 miles away.
A nurse practitioner told me about another case in which her
collaborating physician had just lost her father and was not available.
As a consequence, the patient experienced a 2 day delay in getting
needed care while they waited to get the paperwork signed by another
physician.
Another nurse practitioner pointed out that it is ridiculous that she
can order physical and occupational therapy in a subacute facility but
cannot order home health care. One of her patients had to wait eleven
days after being discharged before his physical and occupational
therapy could continue simply because the home health agency had
difficulty finding a physician to certify the continuation of the same
therapy that the nurse practitioner had been able to authorize when the
patient was in the facility.
The Home Health Care Planning Improvement Act will help to ensure
that our Medicare beneficiaries get the home health care that they need
when they need it by allowing physician assistants, nurse
practitioners, clinical nurse specialists and certified nurse midwives
to order home health services. Our legislation is supported by a broad
coalition of organizations, including the AARP, the National Council on
Aging, the American Geriatrics Society, the National Association for
Home Care and Hospice, the American Nurses Association, the American
Association of Nurse Practitioners, the American Academy of Physician
Assistants, the American College of Nurse Midwives, and the Visiting
Nurse Associations of America. I urge my colleagues to join us as
cosponsors of this important legislation.
Mr. President, I ask unanimous consent that a letter of support be
printed in the Record.
There being no objection, the text of the material was ordered to be
printed in the Record, as follows:
February 25, 2015.
Hon. Susan Collins,
U.S. Senate, Washington, DC.
Hon. Chuck Schumer,
U.S. Senate, Washington, DC.
Dear Senator Collins and Senator Schumer: Thank you for
introducing the bipartisan Home Health Care Planning
Improvement Act of 2015. We, the undersigned groups, pledge
our continued support of your efforts to obtain passage of
this important legislation in the 114th Congress. As you
know, the bill authorizes nurse practitioners, clinical nurse
specialists, certified nurse-midwives and physician
assistants as eligible health care professionals who can
certify patient eligibility for home health care services
under Medicare. This critical
[[Page S1164]]
change would improve access to important home health care
services, and potentially prevent additional hospital, sub-
acute care facility and nursing home admissions--all of which
are costly to the consumer, the taxpayer and Medicare.
The undersigned organizations are committed to ensuring
that consumers have access to health care providers who are
qualified, educated, and certified to provide high quality
primary care, chronic care management, and other services
that keep them living a high quality life, with dignity, in
locations of their choice.
Although current law has long recognized advanced practice
registered nurses and physician assistants as authorized
Medicare providers, and allows these clinicians to certify
eligibility for nursing home care for their patients, it
precludes these same practitioners from certifying patient
eligibility for home health care services. This is an
unnecessary barrier to care and adds at least one more step
in the process of accessing home health care services by
requiring the provider to find a physician to certify
eligibility. In addition, time delays to locate a physician
to certify eligibility, particularly in rural and underserved
areas, can result in an extended hospital stay or nursing
home admission because the beneficiary could not be moved
back to or remain at home without home health care services.
There are decades of data supporting the ability of these
providers to deliver high quality care to people of all ages,
including Medicare recipients with multiple chronic
conditions. Advanced practice registered nurses are often the
only care providers available in health professional shortage
areas such as urban, rural, and frontier regions. Given the
existing and future projected primary care physician
shortages, and the coming of increased numbers of Medicare
eligible patients, the need will be even greater for all
qualified providers to be allowed to certify home health care
eligibility.
The Home Health Care Planning Improvement Act would help to
ensure that Medicare beneficiaries in need of home health
care services whose providers are nurse practitioners,
clinical nurse specialists, certified nurse midwives, and
physician assistants would be able to directly access home
health care by referral from their providers. This bill would
provide beneficiaries continued access to care and increase
the likelihood that they would experience better health and a
higher quality of life. Additionally, outside experts
assessed the impact of the bill earlier last year and
projected a Medicare savings of $7.1 million in 2015 and up
to a ten-year savings of $252.6 million. This analysis also
notes the potential to reduce beneficiary admissions to and
lengths of stay in institutional settings under the policy
change.
We appreciate your continued leadership and are committed
to working with you to ensure that this bipartisan
legislation is passed and placed on the President's desk for
signature at the first opportunity. The time is now to ensure
that patients have timely access to the quality, cost
effective care they need. For any questions, please contact
[email protected] or 703-740-2529.
Thank you for your help.
Sincerely,
AARP, AFT Nurses and Health Professionals, AMDA-The Society
for Post-Acute and Long-Term Care Medicine, Alzheimer's
Foundation of America, American Academy of Nursing, American
Academy of Physician Assistants, American Association of
Colleges of Nursing, American Association of Heart Failure
Nurses, American Association of Nurse Practitioners, American
Association of Occupational Health Nurses, American College
of Nurse-Midwives, American Geriatrics Society, American
Nephrology Nurses' Association, American Nurses Association,
American Organization of Nurse Executives.
American Pediatric Surgical Nurses Association, American
Psychiatric Nurses Association, Association of Community
Health Nursing Educators, Association of Public Health
Nurses, Association of Rehabilitation Nurses, Center for
Medicare Advocacy, Gerontological Advance Practice Nurses
Association, International Society of Psychiatric-Mental
Health Nurses, The Jewish Federations of North America,
Justice in Aging, Leading Age, Medicare Rights Center,
National Academy of Elder Law Attorneys, National Association
for Home Care & Hospice.
National Association of Clinical Nurse Specialists,
National Association of Neonatal Nurses, National Association
of Neonatal Nurse Practitioners, National Association of
Pediatric Nurse Practitioners, National Association of
Professional Geriatric Care Managers, National Black Nurses
Association, National Committee to Preserve Social Security
and Medicare, National Consumer Voice for Quality Long-Term
Care, National Council on Aging, National Organization of
Nurse Practitioner Faculties, Organization for Associate
Degree Nursing, OWL--The Voice of Women 40+, Public Health
Nursing Section, American Public Health Association, VNAA--
The Visiting Nurse Associations of America, Women's Institute
for a Secure Retirement.
______
By Mr. DURBIN (for himself, Mr. Nelson, Mr. Blumenthal, Mr.
Markey, and Ms. Klobuchar):
S. 588. A bill to require the Consumer Product Safety Commission to
establish a consumer product safety standard for liquid detergent
packets to protect children under the age of five from injury or
illness, and for other purposes; to the Committee on Commerce, Science,
and Transportation.
Mr. DURBIN. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 588
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 ``Detergent Poisoning And
Child Safety Act of 2015'' or the ``Detergent PACS Act of
2015''.
SEC. 2. SPECIAL PACKAGING AND OTHER REQUIREMENTS FOR LIQUID
DETERGENT PACKETS.
(a) Definitions.--In this Act:
(1) Commission.--The term ``Commission'' means the Consumer
Product Safety Commission.
(2) Consumer product.--The term ``consumer product'' has
the meaning given such term in section 3(a) of the Consumer
Product Safety Act (15 U.S.C. 2052(a)).
(3) Detergent packet.--The term ``detergent packet'' means
a consumer product that consists of a detergent enclosed in a
water soluble outer layer.
(4) Liquid detergent packet.--The term ``liquid detergent
packet'' means a consumer product that consists of a
substantially liquid or gel detergent enclosed in a water
soluble outer layer.
(5) Special packaging.--The term ``special packaging'' has
the meaning given that term in section 2 of the Poison
Prevention Packaging Act of 1970 (15 U.S.C. 1471).
(b) Safety Standards Required.--
(1) In general.--Except as provided in subsection (c)(1),
not later than 540 days after the date of the enactment of
this Act, the Commission shall promulgate a final rule that
establishes safety standards for liquid detergent packets to
protect children who are younger than 5 years of age from
injury or illness caused by exposure to such packets.
(2) Elements.--The final rule promulgated under paragraph
(1) shall--
(A) require special packaging for liquid detergent packets;
(B) include standards to address the design and color of
liquid detergent packets to--
(i) make them less attractive to children;
(ii) reduce the likelihood of exposure to detergent; and
(iii) otherwise reduce risks related to the ingestion or
aspiration of, or ocular contact with, detergent and other
potential injury risks of liquid detergent packets;
(C) include standards to address the composition of liquid
detergent packets to make the consequences of exposure less
severe; and
(D) prescribe warning labels that--
(i) adequately inform consumers of the potential risks of
injury and death caused by liquid detergent packets;
(ii) are conspicuous and visible at the point of sale;
(iii) clarify hazard patterns, including known consequences
of such hazards; and
(iv) identify actions needed to avoid injury.
(3) Treatment as consumer product safety standard.--A rule
promulgated under paragraph (1) shall be treated as a
consumer product safety standard described in section 7(a) of
the Consumer Product Safety Act (15 U.S.C. 2056(a)).
(4) Rulemaking.--
(A) In general.--A rule under paragraph (1) shall be
promulgated in accordance with section 553 of title 5, United
States Code.
(B) Inapplicability of certain requirements.--Section 9 of
the Consumer Product Safety Act (15 U.S.C. 2058) shall not
apply to a rulemaking under paragraph (1).
(c) Adoption of Voluntary Standard.--
(1) In general.--Subsection (b)(1) shall not apply if the
Commission determines that--
(A) a voluntary standard pertaining to liquid detergent
packets manufactured or imported for use in the United States
protects children as described in subsection (b)(1);
(B) such voluntary standard is or will be in effect not
later than 1 year after the date of the enactment of this
Act; and
(C) such voluntary standard is developed by ASTM
International Subcommittee F15.71 on Liquid Laundry Packets,
or such other entity as the Commission considers a successor
to ASTM International Subcommittee F15.71.
(2) Publication of determination.--If the Commission makes
a determination under paragraph (1), the Commission shall
publish such determination in the Federal Register.
(3) Treatment of voluntary standard.--If the Commission
determines that a voluntary standard meets the conditions in
paragraph (1), such standard shall be treated as a consumer
product safety standard described in section 7(a) of the
Consumer Product Safety Act (15 U.S.C. 2056(a)) beginning on
the date that is the later of--
(A) the date that is 180 days after the date of the
publication under paragraph (2) of such determination; or
(B) the effective date specified in the voluntary standard.
(4) Revision of voluntary standard.--
(A) Notice of revision.--If a voluntary standard is treated
as a consumer product safety standard under paragraph (3) and
such standard is revised by ASTM International
[[Page S1165]]
after the Commission makes a determination under paragraph
(1), ASTM International shall notify the Commission of such
revision not later than 60 days after making such revision.
(B) Treatment of revisions.--A voluntary standard with
respect to which the Commission receives notice under
subparagraph (A) shall be treated as a consumer product
safety standard described in section 7(a) of the Consumer
Product Safety Act (15 U.S.C. 2056(a)), promulgated in lieu
of the prior version, effective 180 days after the date the
Commission is notified of the revision under subparagraph
(A), unless not later than 90 days after receiving that
notice the Commission determines that the revised voluntary
standard does not meet the requirements of paragraph (1)(A),
in which case the Commission shall continue to enforce the
prior version.
(d) Future Rulemaking.--
(1) In general.--The Commission may, at any time after
promulgating a final rule under subsection (b)(1) or making a
determination under subsection (c)(1), promulgate such rules
in accordance with section 553 of title 5, United States
Code, as the Commission considers appropriate to protect, to
the maximum degree practicable, children as described in
subsection (a)(1).
(2) Treatment as consumer product safety standard.--A rule
promulgated under paragraph (1) shall be treated as a
consumer product safety standard described in section 7(a) of
the Consumer Product Safety Act (15 U.S.C. 2056(a)).
(3) Inapplicability of certain requirements.--Section 9 of
the Consumer Product Safety Act (15 U.S.C. 2058) shall not
apply to a rulemaking under paragraph (1).
(e) Report to Congress.--
(1) In general.--Not later than 4 years after the date of
the enactment of this Act, the Commission shall submit to the
Committee on Commerce, Science, and Transportation of the
Senate and the Committee on Energy and Commerce of the House
of Representatives a report on risks posed by detergent
packets to young children and how the Commission is working
to protect such children from such risks.
(2) Matters covered.--The report required by paragraph (1)
shall include the following:
(A) A quantitative assessment of annual national pediatric
exposure to detergent packets, including the number of
exposure incidents, the means of exposure (whether by
ingestion, aspiration, or ocular contact), the clinical
effects of the exposures, and medical outcomes.
(B) An assessment as to whether the rule promulgated under
subsection (b)(1) or the voluntary standard adopted under
subsection (c), as the case may be, has been effective in
protecting young children from injury or illness caused by
exposure to detergent packets.
(C) Such recommendations for legislative or administrative
action as the Commission may have to protect young children
as described in subparagraph (B).
(3) Publication.--The Commission shall make the report
required by paragraph (1) available to the public on Internet
website of the Commission.
______
By Mrs. FEINSTEIN (for herself and Mrs. Boxer):
S. 596. A bill to amend the Federal Water Pollution Control Act to
establish a grant program to support the restoration of San Francisco
Bay; to the Committee on Environment and Public Works.
Mrs. FEINSTEIN. Mr. President, I rise on behalf of myself and Senator
Boxer to introduce legislation to further the restoration of the San
Francisco Bay.
San Francisco Bay is truly a national treasure. Encompassing
approximately 550 square miles, it is the largest estuary on the west
coast, and is vital to the Nation for both ecological and economic
reasons. It is home to more than 1,000 plant and wildlife species,
roughly 77 percent of California's remaining perennial estuarine
wetlands, and an important stopover for birds along the Pacific Flyway.
Marshes around the bay help prevent flooding, protecting more than 40
cities in nine counties, one of the Nation's busiest seaports, and two
international airports. The bay is critical to the region's economy,
which if it were its own nation, would be the world's 19th largest
economy.
Over the last 150 years, the water quality and health of the San
Francisco Bay Estuary have been diminished by pollution, invasive
species, loss of wetland habitat and other factors. The degradation has
not only impacted fish and wildlife, but has also reduced the estuary's
ability to support important economic activities such as commercial and
sport fishing, shipping, agriculture, recreation, and tourism.
Federal funding in recent years has started the Bay's recovery
process by investing in projects that improve water quality and restore
critical habitat. These investments, $43 million between 2008 and 2015,
were critical to leveraging $145 million from other partners. But much
work remains.
That is why I am pleased to introduce the San Francisco Bay
Restoration Act with Senator Boxer, Ranking Member of the Senate
Environment and Public Works Committee. Companion legislation has also
been introduced in the U.S. House of Representatives by Congresswoman
Jackie Speier.
This bill was first introduced in the 112th Congress. The Senate
Committee on Environment and Public Works reported favorably on the
bill in both the 112th and 113th Congresses and recommended its
passage.
This bill recognizes the important restoration work that must be done
to restore and protect the iconic San Francisco Bay. It authorizes $5
million a year for restoration work between 2015 and 2019, prioritizing
funding for projects that will protect and restore vital estuarine
habitat for migratory waterfowl, shorebirds, and wildlife; improve and
restore water quality and rearing habitat for fish; and in turn
reinvigorate recreation, tourism, and agricultural activities in and
around the bay.
I urge my colleagues to join me in their support for this measure.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection the text of the bill was ordered to be
printed in the Record, as follows:
S. 596
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 ``San Francisco Bay
Restoration Act''.
SEC. 2. SAN FRANCISCO BAY RESTORATION GRANT PROGRAM.
Title I of the Federal Water Pollution Control Act (33
U.S.C. 1251 et seq.) is amended by adding at the end the
following:
``SEC. 123. SAN FRANCISCO BAY RESTORATION GRANT PROGRAM.
``(a) Definitions.--In this section:
``(1) Annual priority list.--The term `annual priority
list' means the annual priority list compiled under
subsection (b).
``(2) Comprehensive plan.--The term `comprehensive plan'
means--
``(A) the comprehensive conservation and management plan
approved under section 320 for the San Francisco Bay estuary;
and
``(B) any amendments to that plan.
``(3) Estuary partnership.--The term `Estuary Partnership'
means the San Francisco Estuary Partnership, the entity that
is designated as the management conference under section 320.
``(b) Annual Priority List.--
``(1) In general.--After providing public notice, the
Administrator shall annually compile a priority list
identifying and prioritizing the activities, projects, and
studies intended to be funded with the amounts made available
under subsection (c).
``(2) Inclusions.--The annual priority list compiled under
paragraph (1) shall include--
``(A) activities, projects, or studies, including
restoration projects and habitat improvement for fish,
waterfowl, and wildlife, that advance the goals and
objectives of the approved comprehensive plan;
``(B) information on the activities, projects, programs, or
studies specified under subparagraph (A), including a
description of--
``(i) the identities of the financial assistance
recipients; and
``(ii) the communities to be served; and
``(C) the criteria and methods established by the
Administrator for selection of activities, projects, and
studies.
``(3) Consultation.--In developing the priority list under
paragraph (1), the Administrator shall consult with and
consider the recommendations of--
``(A) the Estuary Partnership;
``(B) the State of California and affected local
governments in the San Francisco Bay estuary watershed; and
``(C) any other relevant stakeholder involved with the
protection and restoration of the San Francisco Bay estuary
that the Administrator determines to be appropriate.
``(c) Grant Program.--
``(1) In general.--Pursuant to section 320, the
Administrator may provide funding through cooperative
agreements, grants, or other means to State and local
agencies, special districts, and public or nonprofit
agencies, institutions, and organizations, including the
Estuary Partnership, for activities, studies, or projects
identified on the annual priority list.
``(2) Maximum amount of grants; non-federal share.--
``(A) Maximum amount of grants.--Amounts provided to any
individual or entity under this section for a fiscal year
shall not exceed an amount equal to 75 percent of the total
cost of any eligible activities that are to be carried out
using those amounts.
``(B) Non-federal share.--The non-Federal share of the
total cost of any eligible activities that are carried out
using amounts provided under this section shall be--
[[Page S1166]]
``(i) not less than 25 percent; and
``(ii) provided from non-Federal sources.
``(d) Funding.--
``(1) Authorization of appropriations.--There is authorized
to be appropriated to the Administrator to carry out this
section $5,000,000 for each of fiscal years 2015 through
2019.
``(2) Administrative expenses.--Of the amount made
available to carry out this section for a fiscal year, the
Administrator shall use not more than 5 percent to pay
administrative expenses incurred in carrying out this
section.
``(3) Relationship to other funding.--Nothing in this
section limits the eligibility of the Estuary Partnership to
receive funding under section 320(g).
``(4) Prohibition.--No amounts made available under
subsection (c) may be used for the administration of a
management conference under section 320.''.
______
By Mr. TILLIS:
S. 597. A bill to amend section 706 of the Telecommunications Act of
1996 to provide that such section does not authorize the Federal
Communications Commission to preempt the laws of certain States
relating to the regulation of municipal broadband, and for other
purposes; to the Committee on Commerce, Science, and Transportation.
Mr. TILLIS. Mr. President, I rise today to announce that along with
my colleague in the House of Representatives, Representative Marsha
Blackburn, have introduced legislation that prohibits the Federal
Communications Commission from pre-empting States with municipal
broadband laws already on the books, or any other States that
subsequently adopt such municipal broadband laws. The bill also
includes a Sense of Congress stating that the FCC should not impose
municipal broadband regulations on any state.
Earlier today, the FCC took an unprecedented and legally questionable
step to allow Wilson, North Carolina, to ignore North Carolina law when
expanding its municipal broadband network.
The North Carolina law the FCC preempted is intended to protect
taxpayers and consumers from the financial risks we have seen many
municipalities, including Wilson, face when venturing into broadband
ventures that are best left to the private market to provide.
After witnessing how some local governments wasted taxpayer dollars
and accumulated millions in debt through poor decision making, the
legislatures of states like North Carolina and Tennessee passed
commonsense, bipartisan laws that protect hardworking taxpayers and
maintain the fairness of free-market competition. Representative
Blackburn and I recognize the need for Congress to step in and take
action to keep unelected bureaucrats from acting contrary to the
expressed will of the American people through their State legislatures.
______
By Mr. CARDIN (for himself, Mr. Crapo, and Mr. Nelson):
S. 598. A bill to improve the understanding of, and promote access to
treatment for, chronic kidney disease, and for other purposes; to the
Committee on Finance.
Mr. CARDIN. Mr. President, I rise in support of the bipartisan
Chronic Kidney Disease Improvement in Research and Treatment Act of
2015, which I am introducing with Senators Crapo and Nelson today. This
legislation seeks to make a real difference in the lives of Americans
suffering from kidney disease and end-stage renal disease.
Kidney disease is the 9th leading cause of death in the United
States, and unfortunately, more than one in ten Americans today suffer
from some form of kidney disease. More than 615,000 Americans are
living with kidney failure or end-stage renal disease, which is an
irreversible condition that can be fatal without a kidney transplant or
life-sustaining dialysis. 430,000 patients in our country rely on life-
sustaining dialysis care to survive.
This legislation seeks to promote research, expand patient choice,
and improve care coordination for these hundreds of thousands of
patients. Specifically, it would identify the gaps in research and
improve the coordination of Federal research efforts. The bill would
require the Government Accountability Office to submit a comprehensive
report analyzing current federally funded research projects regarding
chronic kidney disease and identifying knowledge gaps that are not
being addressed through those research efforts. It would also direct
the Department of Health and Human Services to evaluate and report on
the biological, social, and behavioral factors related to kidney
disease and efforts to slow the progression of disease in minority
populations disproportionately affected by this disease.
This legislation would improve access to pre-dialysis kidney
education programs to better manage patients' kidney disease and even
prevent kidney failure in some cases. Nephrologists and other health
professionals would be incentivized to work in underserved rural and
urban areas, and current payment policies would be modified to
encourage home dialysis, which is not incentivized under the current
Medicare payment structure. Patients with acute kidney injury would
also be allowed to receive treatments through dialysis providers,
therefore reducing costs associated with care provided in the more
expensive hospital outpatient setting. Perhaps most importantly, our
legislation would establish a voluntary coordinated care program that
would incentivize doctors and dialysis facilities to work together to
improve the coordination of care and reduce costly hospitalization.
Lastly, the bill would expand the options for patients by allowing
individuals diagnosed with kidney failure to enroll in the Medicare
Advantage program and reauthorizing on a permanent basis the Medicare
Advantage Special Needs Plan for patients with kidney failure.
I urge my colleagues to join me, Senator Crapo and Senator Nelson in
supporting the Chronic Kidney Disease Improvement in Research and
Treatment Act of 2015, which will improve the care of patients who
suffer from kidney disease and end-stage renal disease.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection the text of the bill was ordered to be
printed in the Record, as follows:
S. 598
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 ``Chronic Kidney Disease
Improvement in Research and Treatment Act of 2015''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--IMPROVING UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH
EXPANDED RESEARCH AND COORDINATION
Sec. 101. Identifying gaps in chronic kidney disease research.
Sec. 102. Coordinating research on chronic kidney disease.
Sec. 103. Understanding the progression of kidney disease and treatment
of kidney failure in minority populations.
Sec. 104. Identifying Medicare payment disincentives for transplant and
post-transplant care.
TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS
Sec. 201. Increasing access to Medicare kidney disease education
benefit.
Sec. 202. Improving access to chronic kidney disease treatment in
underserved rural and urban areas.
Sec. 203. Promoting access to home dialysis treatments.
Sec. 204. Expanding access for patients with acute kidney injury.
TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR
INDIVIDUALS WITH CHRONIC KIDNEY DISEASE
Sec. 301. Stabilizing Medicare payments for services provided to
beneficiaries with stage V chronic kidney disease
receiving dialysis services.
Sec. 302. Providing individuals with kidney failure access to managed
care and coordinated care programs.
TITLE I--IMPROVING UNDERSTANDING OF CHRONIC KIDNEY DISEASE THROUGH
EXPANDED RESEARCH AND COORDINATION
SEC. 101. IDENTIFYING GAPS IN CHRONIC KIDNEY DISEASE
RESEARCH.
(a) Report.--Not later than one year after the date of
enactment of this Act, the Comptroller General of the United
States shall develop and submit to Congress a comprehensive
report assessing the adequacy of Federal expenditures in
chronic kidney disease research relative to Federal
expenditures for chronic kidney disease care.
(b) Contents.--The report required by this section shall--
(1) analyze the current chronic kidney disease research
projects being funded by Federal agencies;
[[Page S1167]]
(2) identify, including by surveying the kidney care
community, areas of chronic kidney disease knowledge gaps
that are not part of current Federal research efforts;
(3) report on the level of Federal expenditures on kidney
research as compared to the amount of Federal expenditures on
treating individuals with chronic kidney disease; and
(4) identify areas of kidney failure knowledge gaps in
research to assess treatment patterns associated with
providing care to minority populations that are
disproportionately affected by kidney failure.
SEC. 102. COORDINATING RESEARCH ON CHRONIC KIDNEY DISEASE.
(a) Interagency Committee.--The Secretary of Health and
Human Services shall establish and maintain an interagency
committee for the purpose of improving the coordination of
chronic kidney disease research.
(b) Reports.--For the purpose described in subsection (a),
the interagency committee established under such subsection
shall issue public reports that--
(1) include a strategic plan, including recommendations
for--
(A) improving communication and coordination among Federal
agencies;
(B) procedures for monitoring Federal chronic kidney
disease research activities; and
(C) ways to maximize the efficiency of the Federal chronic
kidney disease research investment and minimize the potential
for unnecessary duplication;
(2) include a portfolio analysis that provides information
on chronic kidney disease research projects, organized by the
strategic plan objectives; and
(3) address such other topics as the interagency committee
determines appropriate.
(c) Meetings.--The interagency committee established under
subsection (a) shall meet not less frequently than semi-
annually.
SEC. 103. UNDERSTANDING THE PROGRESSION OF KIDNEY DISEASE AND
TREATMENT OF KIDNEY FAILURE IN MINORITY
POPULATIONS.
Not later than one year after the date of enactment of this
Act, the Secretary of Health and Human Services shall--
(1) complete a study on--
(A) the social, behavioral, and biological factors leading
to kidney disease;
(B) efforts to slow the progression of kidney disease in
minority populations that are disproportionately affected by
such disease; and
(C) treatment patterns associated with providing care,
under the Medicare program under title XVIII of the Social
Security Act, the Medicaid program under title XIX of such
Act, and through private health insurance, to minority
populations that are disproportionately affected by kidney
failure; and
(2) submit to Congress a report on the results of such
study.
SEC. 104. IDENTIFYING MEDICARE PAYMENT DISINCENTIVES FOR
TRANSPLANT AND POST-TRANSPLANT CARE.
Not later than 2 years after the date of enactment of this
Act, the Secretary of Health and Human Services shall submit
to Congress a report on any disincentives in the payment
systems under the Medicare program under title XVIII of the
Social Security Act that create barriers to kidney
transplants and post-transplant care for beneficiaries with
end-stage renal disease.
TITLE II--PROMOTING ACCESS TO CHRONIC KIDNEY DISEASE TREATMENTS
SEC. 201. INCREASING ACCESS TO MEDICARE KIDNEY DISEASE
EDUCATION BENEFIT.
(a) In General.--Section 1861(ggg) of the Social Security
Act (42 U.S.C. 1395x(ggg)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by inserting `` or stage V'' after
``stage IV'';
(B) in subparagraph (B), by inserting ``or of a physician
assistant, nurse practitioner, or clinical nurse specialist
(as defined in section 1861(aa)(5)) assisting in the
treatment of the individual's kidney condition'' after
``kidney condition''; and
(2) in paragraph (2)--
(A) by striking subparagraph (B); and
(B) in subparagraph (A)--
(i) by striking ``(A)'' after ``(2)'';
(ii) by striking ``and'' at the end of clause (i);
(iii) by striking the period at the end of clause (ii) and
inserting ``; and'';
(iv) by redesignating clauses (i) and (ii) as subparagraphs
(A) and (B), respectively; and
(v) by adding at the end the following:
``(C) a renal dialysis facility subject to the requirements
of section 1881(b)(1) with personnel who--
``(i) provide the services described in paragraph (1); and
``(ii) is a physician (as defined in subsection (r)(1)) or
a physician assistant, nurse practitioner, or clinical nurse
specialist (as defined in subsection (aa)(5)).''.
(b) Payment to Renal Dialysis Facilities.--Section 1881(b)
of such Act (42 U.S.C. 1395rr(b)) is amended by adding at the
end the following new paragraph:
``(15) For purposes of paragraph (14), the single payment
for renal dialysis services under such paragraph shall not
take into account the amount of payment for kidney disease
education services (as defined in section 1861(ggg)).
Instead, payment for such services shall be made to the renal
dialysis facility on an assignment-related basis under
section 1848.''.
(c) Effective Date.--The amendments made by this section
apply to kidney disease education services furnished on or
after January 1, 2016.
SEC. 202. IMPROVING ACCESS TO CHRONIC KIDNEY DISEASE
TREATMENT IN UNDERSERVED RURAL AND URBAN AREAS.
(a) Definition of Primary Care Services.--Section
331(a)(3)(D) of the Public Health Service Act (42 U.S.C.
254d(a)(3)(D)) is amended by inserting ``and includes renal
dialysis services'' before the period at the end.
(b) National Health Service Corps Scholarship Program.--
Section 338A(a)(2) of the Public Health Service Act (42
U.S.C. 254l(a)(2)) is amended by inserting ``, including
nephrologists and non-physician practitioners providing renal
dialysis services'' before the period at the end.
(c) National Health Service Corps Loan Repayment Program.--
Section 338B(a)(2) of the Public Health Service Act (42
U.S.C. 254l-1(a)(2)) is amended by inserting ``, including
nephrologists and non-physician practitioners providing renal
dialysis services'' before the period at the end.
SEC. 203. PROMOTING ACCESS TO HOME DIALYSIS TREATMENTS.
Section 1834(m)(4)(C)(ii) of the Social Security Act (42
U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end
the following new subclause:
``(IX) A renal dialysis facility (as defined in section
1881).''.
SEC. 204. EXPANDING ACCESS FOR PATIENTS WITH ACUTE KIDNEY
INJURY.
Section 1881(b) of the Social Security Act (42 U.S.C.
1395rr(b)) is amended--
(1) in paragraph (1), by inserting ``or acute kidney
injury'' after ``individuals who have been determined to have
end stage renal disease'';
(2) in paragraph (2)(A), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(3) in paragraph (2)(B), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(4) in paragraph (3), in the matter preceding subparagraph
(A), by inserting ``or acute kidney injury'' after ``end
stage renal disease'';
(5) in paragraph (11)(A), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(6) in paragraph (11)(B), by inserting ``or acute kidney
injury'' after ``end stage renal disease'';
(7) in paragraph (14)(B)--
(A) in clause (ii), by inserting ``or acute kidney injury''
after ``end stage renal disease'';
(B) in clause (iii), by inserting ``or acute kidney
injury'' after ``end stage renal disease''; and
(C) in clause (iv), by inserting ``or acute kidney injury''
after ``end stage renal disease''; and
(8) in paragraph (14)(H)(i), by inserting ``or acute kidney
injury'' after ``end stage renal disease''.
TITLE III--CREATING ECONOMIC STABILITY FOR PROVIDERS CARING FOR
INDIVIDUALS WITH CHRONIC KIDNEY DISEASE
SEC. 301. STABILIZING MEDICARE PAYMENTS FOR SERVICES PROVIDED
TO BENEFICIARIES WITH STAGE V CHRONIC KIDNEY
DISEASE RECEIVING DIALYSIS SERVICES.
Section 1881(b)(14) of the Social Security Act (42 U.S.C.
1395rr(b)(14)) is amended--
(1) in subparagraph (D), in the matter preceding clause
(i), by striking ``Such system'' and inserting ``Subject to
subparagraph (J), such system''; and
(2) by adding at the end the following new subparagraph:
``(J)(i) For payment for renal dialysis services furnished
on or after January 1, 2016, under the system under this
paragraph--
``(I) the payment adjustment described in clause (i) of
subparagraph (D) shall not take into account comorbidities;
``(II) the payment adjustment described in clause (ii) of
such subparagraph shall not be included;
``(III) the standardization factor described in the final
rule published in the Federal Register on November 8, 2012
(77 Fed. Reg. 67470), shall be established using the most
currently available data (and not historical data) and
adjusted on an annual basis, based on such available data, to
account for any change in utilization of drugs and any
modification in adjustors applied under this paragraph; and
``(IV) the Secretary shall take into account reasonable
costs consistent with paragraph (2)(B) when calculating such
payments.
``(ii) Not later than January 1, 2016, the Secretary shall
amend the ESRD facility cost report to--
``(I) include the per treatment network fee (as described
in paragraph (7)) as an allowable cost; and
``(II) eliminate the limitation for reporting medical
director fees on such reports in order to take into account
the wages of a board-certified nephrologist.''.
SEC. 302. PROVIDING INDIVIDUALS WITH KIDNEY FAILURE ACCESS TO
MANAGED CARE AND COORDINATED CARE PROGRAMS.
(a) Expanding Access to Medicare Advantage.--
(1) Eligibility under medicare advantage.--
(A) In general.--Section 1851(a)(3) of the Social Security
Act (42 U.S.C. 1395w-21(a)(3)) is amended--
(i) by striking subparagraph (B); and
(ii) by striking ``eligible individual.--'' and all that
follows through ``In this title''
[[Page S1168]]
and inserting ``eligible individual.--In this title''.
(B) Conforming amendment.--Section 1852(b)(1) of the Social
Security Act (42 U.S.C. 1395w-22(b)(1)) is amended--
(i) by striking subparagraph (B); and
(ii) by striking ``Beneficiaries.--'' and all that follows
through ``A Medicare+Choice organization'' and inserting
``Beneficiaries.--A Medicare Advantage organization''.
(C) Effective date.--The amendments made by this paragraph
shall apply with respect to plan years beginning on or after
January 1, 2016.
(2) Education.--Section 1851(d)(2)(A)(iii) of the Social
Security Act (42 U.S.C. 1395w-21(d)(2)(A)(iii)) is amended by
inserting before the period at the end the following ``,
including any additional information that individuals
determined to have end stage renal disease may need to make
informed decisions with respect to such an election''.
(3) Quality metrics.--Section 1852(e)(3)(A) of the Social
Security Act (42 U.S.C. 1395w-22(e)(3)(A)) is amended by
adding at the end the following new clause:
``(v) Requirements with respect to individuals with esrd.--
In addition to the data required to be collected, analyzed,
and reported under clause (i) and notwithstanding the
limitations under subparagraph (B), as part of the quality
improvement program under paragraph (1), each MA organization
shall provide for the collection, analysis, and reporting of
data, determined in consultation with the kidney care
community, that permits the measurement of health outcomes
and other indices of quality with respect to individuals
determined to have end stage renal disease.''.
(b) Permanent Extension of Medicare Advantage ESRD Special
Needs Plans Authority.--Section 1859(f)(1) of the Social
Security Act (42 U.S.C. 1395w-28(f)(1)) is amended by
inserting ``, in the case of a specialized MA plan for
special needs individuals who have not been determined to
have end stage renal disease,'' before ``for periods before
January 1, 2017''.
(c) Voluntary ESRD Coordinated Care Gainsharing Program.--
(1) In general.--Section 1881(b) of the Social Security Act
(42 U.S.C. 1395rr(b)) is amended by adding at the end the
following new paragraph:
``(15)(A) Not later than January 1, 2017, the Secretary
shall, in accordance with this paragraph, establish an ESRD
Care Coordination gainsharing program for nephrologists,
renal dialysis facilities, and providers of services that
develop coordinated care organizations to provide a full
range of clinical and supportive services (as described in
subparagraph (D)) to individuals determined to have end stage
renal disease.
``(B) Under such program, subject to subparagraph (C), the
payment amounts renal dialysis facilities and providers of
services described in subparagraph (A) would otherwise
receive under paragraph (14) and nephrologists described in
subparagraph (A) would otherwise receive under section 1848
with respect to dialysis services furnished by such a
facility, provider, or nephrologist during a year, shall be
increased by a portion of the amount (as determined by the
Secretary) of actual reductions in expenditures under this
title attributable to the coordinated care organization
developed by such facility, provider, or nephrologist
involved, taking into account non-dialysis expenditures under
parts A and B, during the preceding calendar year. The
payment amount under this subparagraph shall be provided to a
nephrologist, renal dialysis facility, and provider of
services that developed the coordinated care organization not
later than March 31 of the year after the year during which
such services are provided by such nephrologist, facility, or
provider.
``(C) The aggregate incentive payment amounts provided
under such program for a year may not exceed the amount equal
to 2 percent less than the estimated total amount of non-
dialysis expenditures under parts A and B for 2017 for items
and services that are not related to dialysis or transplant
services.
``(D) For purposes of subparagraph (A), the full range of
clinical and supportive services includes at least the
following:
``(i) Primary care and other preventative services.
``(ii) Specialty care for co-morbidities or non-renal acute
conditions, including at least podiatry, cardiology, and
orthopedics.
``(iii) Vascular access.
``(iv) Laboratory testing and diagnostic imaging.
``(v) Pharmacy care management.
``(vi) Patient, family, and caregiver education.
``(vii) Psychiatric, behavioral therapy, and counseling
services.
``(E) In providing payment incentive amounts under such
program, the Secretary shall apply a risk adjustment
methodology that--
``(i) uses risk adjuster factors applied under part C; and
``(ii) adjusts such payments to exclude the top 2 percent
of outliers.
``(F) In establishing such program, the Secretary shall
ensure that each of the following is satisfied:
``(i) The program allows for all types and sizes of renal
dialysis facilities and providers of services described in
subparagraph (A), including profit and not-for-profit, urban
and rural, as well as all other types and sizes of such
facilities and providers, to participate.
``(ii) The program rewards high quality, efficient
facilities and providers through gain-sharing.
``(iii) For purposes of determining the actual reductions
in expenditures under this title attributable to a
coordinated care organization described in subparagraph (A),
the program includes a market-based benchmark system that
will not be rebased against which such expenditures shall be
compared.
``(iv) The program results in reductions of expenditures
under parts A and B for services that are not dialysis-
related services.
``(v) The program allows new applicants to participate in
the program after the initial implementation period.
``(vi) The program establishes clear quality metrics in
consultation with the kidney care community.
``(vii) The program provides for waivers of Federal laws or
requirements, in consultation with interested stakeholders.
``(viii) Under such program the Secretary attributes
individuals described in subparagraph (A) who receive
treatment through a care coordination organization described
in such subparagraph to such organization rather than to any
other payment model that requires beneficiary attribution.
``(ix) Under such program the Secretary provides quarterly
Medicare parts A and B claims data to facilities and
providers described in subparagraph (A) participating in such
program.
``(G) Not later than 3 years after the date of the
implementation of the ESRD Care Coordination gainsharing
program, the Secretary shall submit to Congress a report on
the waivers granted under subparagraph (F)(vii) and the
effectiveness of such waivers in allowing the coordination of
care.''.
(2) Conforming amendments.--
(A) Section 1881.--Section 1881(b) of the Social Security
Act (42 U.S.C. 1395rr(b)) is amended--
(i) in each of paragraphs (12)(A) and (13)(A), by striking
``paragraph (14)'' and inserting ``paragraphs (14) and
(15)''; and
(ii) in paragraph (14)(A)(i), by inserting ``and paragraph
(15)'' after ``Subject to subparagraph (E)''.
(B) Section 1848.--Section 1848 of the Social Security Act
(42 U.S.C. 1395w-4) is amended by adding at the end the
following new subsection:
``(q) Voluntary ESRD Coordinated Care Program.--For
provisions related to incentive payment amounts to
nephrologists under the ESRD Care Coordination gainsharing
program, see section 1881(b)(15).''.
(d) Patient Information Requirement.--The Secretary of
Health and Human Services shall require hospitals that
furnish items and services to individuals entitled to
benefits under part A of title XVIII of the Social Security
Act or eligible for benefits under part B of such title and
who subsequently receive dialysis services at a renal
dialysis facility (as defined in section 1881 of such Act (42
U.S.C. 1395rr)) to provide to such facility health
information with respect to such individual, including a
discharge summary and co-morbidity information, upon request
of the facility, not later than 7 days after notification by
the hospital of the provision of such services to such
individual or of the determination that such individual has
end stage renal disease, as applicable.
Mr. CRAPO. Mr. President, I rise to speak on the importance of the
Chronic Kidney Disease Improvement in Research and Treatment Act being
introduced today. This legislation will not only pave the way for
enhanced research opportunities and allow physicians greater
flexibility in how and where they treat patients, but, importantly,
will provide increased access to care for those with chronic and end-
stage kidney disease, particularly in rural and underserved areas. As
our Nation continues to face dangerously high levels of debt, it is
imperative we prioritize initiatives such as this while simultaneously
ensuring we do not worsen our already fragile fiscal picture. Prior to
passage, as with any piece of legislation, a responsible offset that is
budget neutral must be included.
______
By Mr. CARDIN (for himself, Mr. Toomey, and Ms. Collins):
S. 599. A bill to extend and expand the Medicaid emergency
psychiatric demonstration project; to the Committee on Finance.
Mr. CARDIN. Mr. President, today Senators Toomey and Collins and I
are introducing the Improving Access to Emergency Psychiatric Care Act
of 2015, which will build on the current 3-year Medicaid Emergency
Psychiatric Demonstration Project to provide timely and cost-effective
treatment to people who are experiencing an emergency psychiatric
crisis.
We know that emergency psychiatric care delivered in general
hospitals and freestanding psychiatric hospitals is a life-saving
service for individuals with severe mental illnesses. In addition, a
Government Accountability Office report, GAO-09-347, on hospital
emergency departments concluded the difficulties in transferring,
admitting, or
[[Page S1169]]
discharging psychiatric patients from the emergency department
contribute to overcrowding in our Nation's emergency rooms.
Community-based psychiatric hospitals, like Sheppard Pratt Health
System in my home State of Maryland, could help relieve these back-ups
in emergency departments; however, due to a longstanding Medicaid
statutory provision called the Institution for Mental Disease, IMD,
exclusion, patients receiving care in these freestanding psychiatric
hospitals are not covered if the patients are between the ages of 21
and 64, and the hospitals cannot get Medicaid Federal matching payments
for these services.
In response to this problem, bipartisan legislation was first
introduced in the Senate in 2003 by Senators Olympia Snowe and Kent
Conrad, who were joined by Senators Susan Collins and Ron Wyden, to
address this problem by allowing Federal Medicaid matching payments to
freestanding psychiatric hospitals for emergency psychiatric cases. In
2010, based on this legislation, Congress authorized a three-year
demonstration that was intended to expand the number of emergency
inpatient psychiatric beds available in communities. Currently, 11
States, including my State of Maryland, and the District of Columbia
are participating in this demonstration.
The purpose of the demonstration is to determine whether allowing
Federal Medicaid matching payments to freestanding psychiatric
hospitals for emergency psychiatric cases improves access to and
quality of medically necessary care, improves discharge planning for
demonstration beneficiaries, and has a positive impact on Medicaid cost
and utilization. The preliminary data shows that, of the total number
of Medicaid beneficiaries admitted to these freestanding psychiatric
hospitals, 84 percent had just one admission during the entire first
year of the demonstration. The average length of stay was a short 8.2
days and, in 88 percent of the admissions, the patients were discharged
home.
The current demonstration project would end no later than December
31, 2015; however, the final evaluation of this project by CMS is not
expected to be completed until 1 year later, in the fall of 2016.
The purpose of the bipartisan legislation we are introducing today is
to allow the Secretary of Health and Human Services to continue the
current demonstration project until the Secretary submits a report to
Congress with her recommendations, based on the final evaluation,
regarding whether the current demonstration should be extended for an
additional 3 years and whether additional States should be allowed to
participate in the demonstration, or September 30, 2016, whichever
occurs first.
Importantly, in order to extend the current demonstration project
until the report is submitted, the Secretary must determine that
overall Medicaid spending in the participating state is not expected to
increase during the extension of the demonstration project for a
maximum of nine months, and the Chief Actuary of CMS must also certify
that the extension is not projected to result in an increase in net
Medicaid program spending. If, in her report, the Secretary recommends
extending the demonstration project for an additional three years and/
or expanding it to include other States, the same requirements
regarding Medicaid spending would need to be met, ensuring budget
neutrality. At the completion of those additional 3 years, the
demonstration project would come to a close unless Congress passes
authorizing legislation to continue and/or expand the demonstration
project.
We have a real crisis in this country for millions of Americans who
cannot get timely access to life-saving emergency inpatient psychiatric
treatment. The Medicaid program is a vital source of support for people
with mental disorders, funding more than 50 percent of state and local
spending on mental health services. This outdated IMD policy is
penalizing the disabled and poor. It is also contributing to
inefficiencies in our health care system and likely adding to the cost
of care. The legislation introducing today would help ensure that the
neediest have access to hospital care when they need it and strengthen
our Nation's health care system. It is an incremental, targeted
approach with built-in cost safeguards, so I hope my colleagues will
join with me to support this legislation.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 599
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 ``Improving Access to
Emergency Psychiatric Care Act''.
SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMERGENCY
PSYCHIATRIC DEMONSTRATION PROJECT.
(a) In General.--Subsection (d) of section 2707 of Public
Law 111-148 (42 U.S.C. 1396a note) is amended to read as
follows:
``(d) Length of Demonstration Project.--
``(1) In general.--Except as provided in paragraphs (2) and
(3), the demonstration project established under this section
shall be conducted for a period of 3 consecutive years.
``(2) Temporary extension of participation eligibility for
selected states.--
``(A) In general.--Subject to paragraph (3), a State
selected as an eligible State to participate in the
demonstration project on or prior to March 13, 2012, shall,
upon the request of the State, be permitted to continue to
participate in the demonstration project through the date
described in subparagraph (B) if--
``(i) the Secretary determines that the continued
participation of the State in the demonstration project is
not expected to increase spending under title XIX of the
Social Security Act; and
``(ii) the Chief Actuary of the Centers for Medicare &
Medicaid Services certifies that such extension for that
State is projected to reduce (or is projected not to result
in any increase in) net program spending under title XIX of
the Social Security Act.
``(B) Date described.--The date described in this
subparagraph is the earlier of--
``(i) the date on which Secretary submits the
recommendations required under subsection (f)(3); or
``(ii) September 30, 2016.
``(3) Extension and expansion of demonstration project.--
``(A) Additional extension.--Taking into account the
recommendations submitted to Congress pursuant to subsection
(f)(3), the Secretary may, if the Secretary determines that
extension and expansion of the demonstration project
satisfies the criteria for the temporary extension under
subparagraphs (A) and (B) of paragraph (2)--
``(i) extend the demonstration project through December 31,
2019; and
``(ii) permit any eligible State participating in the
demonstration project as of the date such recommendations are
submitted to continue to participate in the project.
``(B) Option for expansion to additional states.--Taking
into account the recommendations submitted to Congress
pursuant to subsection (f)(3), the Secretary may expand
(including on a nationwide basis) the number of eligible
States participating in the demonstration project during the
extension period established under subparagraph (A) if, with
respect to any new eligible State--
``(i) the Secretary determines that the participation of
the State in the demonstration project is not expected to
increase spending under title XIX of the Social Security Act;
and
``(ii) the Chief Actuary of the Centers for Medicare &
Medicaid Services certifies that the participation of the
State in the demonstration project is projected to reduce (or
is projected not to result in any increase in) net program
spending under title XIX of the Social Security Act.
``(4) Authority to ensure budget neutrality.--The Secretary
annually shall review each participating State's
demonstration project expenditures to ensure compliance with
the requirements of paragraphs (2)(A), (2)(B), (3)(B)(i), and
(3)(B)(ii) (as applicable). If the Secretary determines with
respect to a State's participation in the demonstration
project that the State's net program spending under title XIX
of the Social Security Act has increased as a result of the
State's participation in the project, the Secretary shall
treat the demonstration project excess expenditures of the
State as an overpayment under title XIX of the Social
Security Act.''.
(b) Funding.--Subsection (e) of section 2707 of such Act
(42 U.S.C. 1396a note) is amended--
(1) in the subsection heading, by striking ``Limitations on
Federal'';
(2) in paragraph (2)--
(A) in the paragraph heading, by striking ``5-year''; and
(B) by striking ``through December 31, 2015'' and inserting
``until expended'';
(3) by striking paragraph (3);
(4) by redesignating paragraphs (4) and (5) as paragraphs
(3) and (4), respectively;
(5) in paragraph (3) (as so redesignated), by striking
``and the availability of funds'' and inserting ``(other than
States deemed to be eligible States through the application
of subsection (c)(4))''; and
(6) in paragraph (4) (as so redesignated)--
(A) in the first sentence--
(i) by inserting ``(other than a State deemed to be an
eligible State through the
[[Page S1170]]
application of subsection (c)(4))'' after ``eligible State'';
and
(ii) by striking ``paragraph (4)'' and inserting
``paragraph (3)''; and
(B) by inserting after the first sentence the following
``In addition to any payments made to an eligible State under
the preceding sentence, the Secretary shall, during any
period in effect under paragraph (2) or (3) of subsection
(d), or during any period in which a law described in
subsection (f)(4)(C) is in effect, pay each eligible State
(including any State deemed to be an eligible State through
the application of subsection (c)(4)), an amount each quarter
equal to the Federal medical assistance percentage of
expenditures in the quarter during such period for medical
assistance described in subsection (a). Payments made to
States under this paragraph shall be considered to have been
made under, and are subject to, the requirements of section
1903 of the Social Security Act (42 U.S.C. 1396b).''.
(c) Recommendations to Congress.--Subsection (f) of section
2707 of such Act (42 U.S.C. 1396a note) is amended by adding
at the end the following:
``(3) Recommendation to congress regarding extension and
expansion of project.--Not later than September 30, 2016, the
Secretary shall submit to Congress and make available to the
public recommendations based on an evaluation of the
demonstration project, including the use of appropriate
quality measures, regarding--
``(A) whether the demonstration project should be continued
after December 31, 2016; and
``(B) whether the demonstration project should be expanded
(including on a nationwide basis).
``(4) Recommendation to congress regarding permanent
extension and nationwide expansion.--
``(A) In general.--Not later than April 1, 2019, the
Secretary shall submit to Congress and make available to the
public recommendations based on an evaluation of the
demonstration project, including the use of appropriate
quality measures, regarding--
``(i) whether the demonstration project should be
permanently continued after December 31, 2019, in 1 or more
States; and
``(ii) whether the demonstration project should be expanded
(including on a nationwide basis).
``(B) Requirements.--Any recommendation submitted under
subparagraph (A) to permanently continue the project in a
State, or to expand the project to 1 or more other States
(including on a nationwide basis) shall include a
certification from the Chief Actuary of the Centers for
Medicare & Medicaid Services that permanently continuing the
project in a particular State, or expanding the project to a
particular State (or all States) is projected to reduce (or
is projected not to result in any increase in) net program
spending under title XIX of the Social Security Act. If the
Secretary determines with respect to a State's participation
in the demonstration project that net program spending under
title XIX of such Act has increased as a result of the
project, the Secretary shall treat the demonstration project
excess expenditures of the State as an overpayment under
title XIX of the Social Security Act.
``(C) Congressional approval required.--The Secretary shall
not permanently continue the demonstration project in any
State after December 31, 2019, or expand the demonstration
project to any additional State after December 31, 2019,
unless Congress enacts a law approving either or both such
actions.
``(5) Funding.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the Centers
for Medicare & Medicaid Services Program Management Account
to carry out this subsection, $100,000 for fiscal year 2015,
to remain available until expended.''.
(d) Conforming Amendments.--Section 2707 of such Act (42
U.S.C. 1396a note) is amended--
(1) in subsection (c)--
(A) in paragraph (1), by striking ``An eligible State'' and
inserting ``Except as otherwise provided in paragraph (4), an
eligible State'';
(B) in paragraph (3), by striking ``A State shall'' and
inserting ``Except as otherwise provided in paragraph (4), a
State shall''; and
(C) by adding at the end the following:
``(4) Nationwide availability.--In the event that the
Secretary makes a recommendation pursuant to subsection
(f)(4) that the demonstration project be expanded on a
national basis, any State that has submitted or submits an
application pursuant to paragraph (2) shall be deemed to have
been selected to be an eligible State to participate in the
demonstration project.''; and
(2) in the heading for subsection (f), by striking ``and
Report'' and inserting ``, Report, and Recommendations''.
(e) Effective Date.--The amendments made by this section
shall take effect on the date of the enactment of this Act.
____________________