Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Ms. COLLINS

Ms. COLLINS. Mr. President, tomorrow, following the morning business period, the Senate will resume consideration of the IRS reform bill. It is hoped that the managers' amendment will be offered during Tuesday's session. In addition, Members who desire to debate this legislation are encouraged to do so tomorrow so that the Senate can complete action on the IRS reform bill as early as possible this week. As a reminder, there will be a rollcall vote tomorrow at 5:30 p.m. on passage of the workforce development legislation, H.R. 1385. Any votes ordered with respect to the IRS reform bill will be stacked to occur following that 5:30 vote.

Ms. COLLINS

Ms. COLLINS. The Workforce Investment Partnership Act restates the Senate's long commitment to vocational education, adult education, job training, and vocational rehabilitation. Yet it does more than just continue this tradition; it builds upon our experiences and moves us forward--improving our education and training programs. S. 1186 will provide better opportunities for America's citizens to get the skills they, as individuals, need to obtain work and that America's businesses need to retain their competitive edge in the global economy. S. 1186 is a commitment to meeting the challenges faced by America to produce the workforce that we need for the 21st century. It incorporates almost seventy categorical programs and builds an integrated workforce system as a replacement for the current group of fragmented or duplicative programs. The vocational education section is particularly significant in its emphasis on the inclusion of a strong academic component in vocational education assuring that students in vocational programs receive the strongest possible education and the broadest possible base on which to build careers. It requires the states to explain how duplication will be avoided, and how the activities of related programs will be coordinated. Finally it requires the establishment of rigorous performance measures of both state and local progress toward concrete goals. The job training components will lead to more comprehensive and efficient state systems for workforce development with linkages to strengthen welfare to work activities. It gives greater authority and flexibility to the states in the way each responds to the education and training needs of its citizens and its business community. For example, under S. 1186, a governor in a state with a ``Work-Flex'' program can waive requirements that prevent a local workforce area from responding efficiently to local needs. It allows governors to consolidate administrative funds and state reserve funds from different funding streams to coordinate and manage the use of these funds for a state's priorities. The Workforce Investment Partnership Act will also encourage efforts by the states to improve the integration of previously separate programs, a change that is especially welcome in Maine where extensive efforts are already underway to coordinate the efforts of the vocational high schools, the technical colleges, adult education and job training programs and vocational rehabilitation. This streamlining and integration of federal programs will support Maine's priorities in this area. I am especially pleased that the bill includes incentive grants that will reward states that exceed their goals and will support states in the development of innovative programs tailored to their own needs. This will result in new models and methods for vocational education and job training. The incentive grants should encourage the states to move toward the important goal of improved integration of vocational education, adult education and job training. This bill also incorporates the Rehabilitation Act, which I cosponsored. In doing so it provides important links between vocational rehabilitation and a state's workforce system. It simplifies the access of persons with disabilities to vocational rehabilitation services and streamlines the administration of these services. The Workforce Investment Partnership Act challenges each state to improve the vocational education and vocational rehabilitation that it provides to its citizens, to be sure that its vocational and job training programs respond to and anticipate the changing demands of the economy, and that it fosters programs helping those on welfare move to work. This bill will help the states turn these challenges into opportunities.

Ms. COLLINS

Ms. COLLINS. Mr. President, America's home health agencies provide invaluable services that have enabled a growing number of our most frail and vulnerable senior citizens to avoid hospitals and nursing homes and stay just where they want to be--in their own homes. Today, home health is the fastest growing component of Medicare spending, and the program grew at an astounding average annual rate of more than 25 percent from 1990 to 1997. As a consequence, the number of Medicare home health beneficiaries has more than doubled, and Medicare home health spending has soared from $2.7 billion in 1989 to $17.1 billion in 1996. This rapid growth in home health spending understandably prompted Congress and the Health Care Financing Administration, as part of the Balanced Budget Act of 1997, to initiate changes that were intended to make the program more cost-effective and efficient and protect it from fraud and abuse. However, in trying to get a handle on costs, we in Congress and the administration have unintentionally created problems that may restrict some elderly citizens' access to vitally needed home health care. Critics have long pointed out that Medicare's cost-based payment method for home health care has inherent incentives for home care agencies to provide more services, which has driven up costs. Therefore, the Balanced Budget Act called for the implementation of a prospective payment system for home care by October 1, 1999. Until then, home health agencies will be paid according to what is known as an Interim Payment System. Under the new IPS, home health agencies will be paid the lesser of: their actual costs; a per-visit cost limit; or a new blended agency- specific per beneficiary annual limit based 75 percent on an agency's own costs per beneficiary and 25 percent on the average cost per beneficiary for agencies in the same region. These costs are to be calculated from cost reports for reporting periods ending in 1994. I spent some time going over the formula because it is important to understand what the importance of that very complicated formula is for many of our home health agencies. At a recent hearing of the Senate Special Committee on Aging, on which I serve, we heard testimony from a number of witnesses who expressed concern that the new Interim Payment System inadvertently penalizes cost-efficient home health agencies by basing 75 percent of the agencies' per patient payment limits on their FY 1994 average cost per patient. This system effectively rewards agencies that provided the most visits and spent the most Medicare dollars in 1994, while it penalizes low-cost, more efficient providers. Let me repeat that point, Mr. President. The agencies, usually the non-profits, that have provided services at the lowest cost, are penalized by the new payment system. Home health agencies in the Northeast are among those that have been particularly hard-hit by the formula change. As the Wall Street Journal recently observed, If New England had been just a little greedier, its home- health industry would be a lot better off now . . . Ironically, . . . [the region] is getting clobbered by the system because of its tradition of non-profit community service and efficiency. Moreover, there is no logic to the variance in payment levels. As the same article goes on to point out, the average patient cap in Tennessee is expected to be $2,200 higher than Connecticut's, and the cap for Mississippi is expected to be $2,000 more than Maine's, without any evidence that patients in the Southern states are sicker or that nurses and other home health personnel in this region cost more. Mr. President, I ask unanimous consent that the entire text of this article be printed in the Record.

Ms. COLLINS. Mr. President, this system also gives a competitive advantage to high-cost agencies over their lower cost neighbors, since agencies in a particular region may have dramatically different reimbursement levels regardless of any differences among their patient populations. And finally, this system may force low-cost agencies to stop accepting patients with more serious health care needs. That is exactly the opposite of what we should want. I simply do not think that this is what Congress intended. To rectify this problem, today I am pleased to introduce legislation along with Senators Chafee, Jeffords, Leahy, Feingold, Snowe, Durbin, Harkin, Reed and Santorum. The Medicare Home Health Equity Act will level the playing field and make certain that home health agencies that have been prudent in their use of Medicare resources are not unfairly penalized. The legislation will also ensure that home health agencies in the same region are reimbursed similarly for treating similar patients. Instead of allowing the experience of high-cost agencies to serve as the basis for the new cost limits, the bill we are introducing today sets a new per beneficiary cost limit based on a blend of national and regional average costs per patient. This new formula will be based 75 percent on the national average cost per patient and 25 percent on the regional average cost per patient. Moreover, by eliminating the agency- specific data from the formula, the Medicare Home Health Equity Act will move us more quickly to the national and regional rates which will be the cornerstones of the future prospective payment system, and it will do so in a way that is budget neutral. This is a matter of common sense and fairness. It is also a matter of ensuring that there is a fair system for reimbursing these vitally needed home health agencies that are providing services that are so important to so many of our senior citizens. I urge all of my colleagues to join as cosponsors of the Medicare Home Health Equity Act, and I ask unanimous consent that the text of the bill as well as a section by section summary be printed in the Record.

Ms. COLLINS. Mr. President, I thank the Senator from Wisconsin for his cosponsorship of this important legislation and for his leadership in this issue.

Ms. COLLINS

Ms. COLLINS. If there is no other Senator seeking recognition, I suggest the absence of a quorum.

Ms. COLLINS. I thank the Chair. (The remarks of Ms. Collins and Mr. Feingold pertaining to the introduction of S. 1993 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Ms. COLLINS

Ms. COLLINS. Mr. President, America's home health agencies provide invaluable services that have enabled a growing number of our most frail and vulnerable senior citizens to avoid hospitals and nursing homes and stay just where they want to be--in their own homes. Today, home health is the fastest growing component of Medicare spending, and the program grew at an astounding average annual rate of more than 25 percent from 1990 to 1997. As a consequence, the number of Medicare home health beneficiaries has more than doubled, and Medicare home health spending has soared from $2.7 billion in 1989 to $17.1 billion in 1996. This rapid growth in home health spending understandably prompted Congress and the Health Care Financing Administration, as part of the Balanced Budget Act of 1997, to initiate changes that were intended to make the program more cost-effective and efficient and protect it from fraud and abuse. However, in trying to get a handle on costs, we in Congress and the administration have unintentionally created problems that may restrict some elderly citizens' access to vitally needed home health care. Critics have long pointed out that Medicare's cost-based payment method for home health care has inherent incentives for home care agencies to provide more services, which has driven up costs. Therefore, the Balanced Budget Act called for the implementation of a prospective payment system for home care by October 1, 1999. Until then, home health agencies will be paid according to what is known as an Interim Payment System. Under the new IPS, home health agencies will be paid the lesser of: their actual costs; a per-visit cost limit; or a new blended agency- specific per beneficiary annual limit based 75 percent on an agency's own costs per beneficiary and 25 percent on the average cost per beneficiary for agencies in the same region. These costs are to be calculated from cost reports for reporting periods ending in 1994. I spent some time going over the formula because it is important to understand what the importance of that very complicated formula is for many of our home health agencies. At a recent hearing of the Senate Special Committee on Aging, on which I serve, we heard testimony from a number of witnesses who expressed concern that the new Interim Payment System inadvertently penalizes cost-efficient home health agencies by basing 75 percent of the agencies' per patient payment limits on their FY 1994 average cost per patient. This system effectively rewards agencies that provided the most visits and spent the most Medicare dollars in 1994, while it penalizes low-cost, more efficient providers. Let me repeat that point, Mr. President. The agencies, usually the non-profits, that have provided services at the lowest cost, are penalized by the new payment system. Home health agencies in the Northeast are among those that have been particularly hard-hit by the formula change. As the Wall Street Journal recently observed, If New England had been just a little greedier, its home- health industry would be a lot better off now . . . Ironically, . . . [the region] is getting clobbered by the system because of its tradition of non-profit community service and efficiency. Moreover, there is no logic to the variance in payment levels. As the same article goes on to point out, the average patient cap in Tennessee is expected to be $2,200 higher than Connecticut's, and the cap for Mississippi is expected to be $2,000 more than Maine's, without any evidence that patients in the Southern states are sicker or that nurses and other home health personnel in this region cost more. Mr. President, I ask unanimous consent that the entire text of this article be printed in the Record.

Ms. COLLINS. Mr. President, this system also gives a competitive advantage to high-cost agencies over their lower cost neighbors, since agencies in a particular region may have dramatically different reimbursement levels regardless of any differences among their patient populations. And finally, this system may force low-cost agencies to stop accepting patients with more serious health care needs. That is exactly the opposite of what we should want. I simply do not think that this is what Congress intended. To rectify this problem, today I am pleased to introduce legislation along with Senators Chafee, Jeffords, Leahy, Feingold, Snowe, Durbin, Harkin, Reed and Santorum. The Medicare Home Health Equity Act will level the playing field and make certain that home health agencies that have been prudent in their use of Medicare resources are not unfairly penalized. The legislation will also ensure that home health agencies in the same region are reimbursed similarly for treating similar patients. Instead of allowing the experience of high-cost agencies to serve as the basis for the new cost limits, the bill we are introducing today sets a new per beneficiary cost limit based on a blend of national and regional average costs per patient. This new formula will be based 75 percent on the national average cost per patient and 25 percent on the regional average cost per patient. Moreover, by eliminating the agency- specific data from the formula, the Medicare Home Health Equity Act will move us more quickly to the national and regional rates which will be the cornerstones of the future prospective payment system, and it will do so in a way that is budget neutral. This is a matter of common sense and fairness. It is also a matter of ensuring that there is a fair system for reimbursing these vitally needed home health agencies that are providing services that are so important to so many of our senior citizens. I urge all of my colleagues to join as cosponsors of the Medicare Home Health Equity Act, and I ask unanimous consent that the text of the bill as well as a section by section summary be printed in the Record.

Ms. COLLINS. Mr. President, I thank the Senator from Wisconsin for his cosponsorship of this important legislation and for his leadership in this issue.

Ms. COLLINS

Ms. COLLINS. Mr. President, this morning the Senate will be in a period of morning business until 10:45 a.m. Following morning business, the Senate will proceed to executive session to resume consideration of the treaty on NATO enlargement. Senator Harkin will then be recognized to offer an amendment regarding U.S. costs. Under the previous order, there will be 2 hours equally divided for debate on the amendment. At 12:45 p.m., the Senate will recess until 2:15 p.m., to allow the weekly party caucuses to meet. When the Senate reconvenes at 2:15, there will be 10 minutes of debate equally divided for closing remarks on the State Department Reauthorization Conference Report. Following that debate, at 2:25 p.m., the Senate will proceed to the first of two stacked rollcall votes. The first vote will be on the adoption of the State Department Conference Report, to be immediately followed by a vote on or in relation to the Harkin amendment. Members should expect further rollcall votes throughout Tuesday's session on amendments to NATO enlargement, or any other legislative or executive items cleared for action. I thank my colleagues for their attention.

Ms. COLLINS

Ms. COLLINS. Mr. President, the matter of NATO expansion is perhaps the single most important foreign policy or defense issue to come before Congress this year. Because of the complexity of the issues involved, the importance of this decision, and its implications for our relationship with Russia, I have not rushed to judgment on this subject. Today, however, I would like to explain why after careful consideration, I have decided to support NATO expansion. The past half-century has shown the cardinal importance of American engagement in European affairs. Throughout the Cold War, our involvement in Europe, principally through NATO, helped provide a crucial framework of peace and stability in which the countries of Europe have been able to develop--giving them breathing room in which to leave behind wartime devastation and grow into prosperous trading partners and allies. Today, of course, the Cold War has ended. The importance of U.S. involvement in Europe, however, has not. With the end of the continent's artificial division along the inter- German frontier into hostile ideological blocks, the meaning of ``Europe'' has changed and its role in the world has evolved. If they are to have relevance in this new post-Cold War era, institutions built around Europe's previous divisions must also evolve, or else face creeping irrelevance. NATO may not be important to the world in precisely the way it used to be--as a breakwater against Soviet expansionism--but the cooperative security arrangements it embodies remain vital to European stability and to world peace. Mr. President, NATO stands without peer in modern times as an institution capable of effective, coordinated international action in times of crisis. More important still, however, is the Alliance's much more quiet, everyday role as the ultimate underwriter of European peace, providing a supportive framework within which allied democracies can successfully consolidate themselves after difficult periods of transition and become valuable friends and partners in the best sense of these words. NATO expansion to incorporate the newly-liberated countries of Poland, Hungary, and the Czech Republic will help ensure that the Alliance remains an important guarantor of continental peace and stability in the years to come--and that America continues to play an engaged and productive role in European security. I do not mean to suggest that NATO expansion has no costs, or that I am entirely sanguine about its potential implications. I have been extremely concerned both about the anticipated financial costs of NATO expansion and about its potential impact upon U.S.- Russian relations. With regard to the costs of NATO to the American taxpayer, I have discussed my concerns with both Secretary of Defense Bill Cohen and Secretary of State Madeleine Albright. In particular, I have been very concerned about the great variation in cost estimates given during the last year or so, estimates that have ranged from a total of $35 billion, or even more, over the next 10 years to a total cost of a relatively small $1.5 billion, with the United States share of that $1.5 billion being approximately $400 million. As both Secretary Cohen and Secretary Albright have pointed out to me, the highest estimates anticipated expanding NATO to four countries, rather than three, and were not based on information now available about the condition of Eastern Europe's military infrastructure. I am thus greatly encouraged by NATO's most up-to-date financial estimates which were based upon an intensive country-by-country survey of the Polish, Czech and Hungarian defense establishments. This latest study, the methodology of which has been endorsed by the General Accounting Office as well as by the Department of Defense, indicates that the likely costs of NATO expansion are much lower than had been previously estimated. Mr. President, this study does not pull the wool over anyone's eyes. The shrinkage of the official cost estimates since early 1997, in fact, represents movement along a learning curve, and the pleasant surprise of discovering, after much analysis, that Eastern European militaries are in much better shape than previously thought is largely responsible for much of the change in the estimate. There will certainly be costs to military modernization in Poland, Hungary and the Czech Republic, but most of these expenses will be borne by the new member countries themselves. Of the remainder, we will share the burden with our present NATO allies through our proportional contributions to the NATO common fund. All told, these expenses will not be significant compared to the benefits we will all reap from ensuring NATO's continuing role in securing European peace and security and stability. With respect to U.S.-Russian relations, I have also been encouraged by the progress of our extensive Partnership for Peace Program with Moscow and of our mutual efforts to ensure that Russia's decaying strategic nuclear infrastructure remains secure against terrorism, theft and accident. Today, Russian and NATO diplomats sit together to discuss mutual concerns on a permanent joint council convened for this purpose. U.S. nuclear experts work very closely with Russian authorities in protecting the security of Russia's nuclear establishment. Significantly, these crucial cooperative efforts with Russia have continued and even accelerated as NATO expansion has become more imminent. Most recently, the Russian Government announced in mid-April that it will push very hard to persuade the Duma to ratify START II strategic arms reduction agreement with the United States. These are not the hallmarks of a government preparing for a ``new cold war'' if Poland, Hungary and the Czech Republic join our alliance. To the contrary, U.S.-Russian relations have been growing warmer, even as NATO has been preparing to expand. I look forward, in fact, to seeing Eastern Europe develop a whole new continuum of productive relationships with the United States and the West, links that range from formal NATO military ties to expanded Partnership for Peace relations, to ever more important economic and cultural ties. The Europe of the 21st century will not be one of haves and have-nots when it comes to transnational ties. Rather, it will be a Europe bound together in a mutually reinforcing web of different but complementary relationships stretching across the entire spectrum of public affairs. This is a Europe to which we should look forward with eager anticipation, and it is one in the creation of which NATO expansion to Poland, Hungary and the Czech Republic can play an important role. It is for these reasons, Mr. President, that after careful consideration and much deliberation I shall cast my vote in favor of NATO expansion. Thank you, Mr. President. I yield the floor. Mr. BINGAMAN addressed the Chair.

Ms. COLLINS

Ms. COLLINS. I thank the Chair. (The remarks of Ms. Collins pertaining to the introduction of S. 1988 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Ms. COLLINS. Mr. President, I suggest the absence of a quorum.

Ms. COLLINS. Mr. President, I ask unanimous consent that I be recognized for 10 minutes to speak as in morning business for a period not to exceed 15 minutes.

Ms. COLLINS. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Ms. COLLINS

Ms. COLLINS. Mr. President, for the information of all Senators, the Senate will begin debate on the NATO treaty at 12 noon on Monday. At 6 p.m., the Senate will conduct a rollcall vote on the confirmation of Scott Fleming to be an Assistant Secretary at the Department of Education. It is the leader's hope that before and after that vote the Senate can conduct a vigorous debate on the NATO treaty and possibly have amendments offered during Monday's session of the Senate. As previously ordered, the vote on the conference report to accompany the State Department reorganization legislation will occur on Tuesday at 2:25 p.m. And I announce to the membership that the vote scheduled for Monday, April 27, will occur at 6 p.m.

Ms. COLLINS

Ms. COLLINS. Mr. President, if there is no further business to come before the Senate, I now ask unanimous consent that the Senate stand in adjournment under the previous order. Thereupon, the Senate, at 3:23 p.m., adjourned until Monday, April 27, 1998, at 11 a.m.

Ms. COLLINS

Ms. COLLINS. Thank you, Mr. President. Mr. President, I am very pleased to join the senior Senator from Maine and our distinguished colleague from Rhode Island in paying tribute to the extraordinary accomplishments of a former Maine Senator, George Mitchell, in bringing a new sense of hope, peace, and security to Northern Ireland. Mr. President, it was Samuel Johnson who said in 1777 that knowledge that you will be hanged in a fortnight does wonders to concentrate your mind. In 1998, former Senate majority leader, George Mitchell, proved the truth of this aphorism by giving the Northern Ireland peace talks a Good Friday deadline, placing upon these negotiations the equivalent, if you will, of a sunset provision that left the parties with no alternative but finally to come up with a real solution. This deadline accomplished its purpose wonderfully. It concentrated their minds wonderfully and led directly to the historic agreement. Some years ago, it scarcely seemed possible to imagine a Northern Ireland in which children could grow up without fear of violence and bloodshed. Today, however, due to the extraordinary efforts of former Senator George Mitchell, this brighter future is not only imaginable-- it is very nearly here. That Senator Mitchell should possess such statesmanship and skill is, of course, no surprise to the people in my home State of Maine. Senator Mitchell is greatly admired in this country for his work on behalf of the citizens of Maine and indeed of all Americans. Today, however, the people of Northern Ireland and the Republic of Ireland--and peace- loving people everywhere--also owe Senator Mitchell a great debt for helping to steer these talks to their successful conclusion. I do not believe that we would be celebrating this agreement without his heroic efforts. It is my great hope that with his statesmanship and steady hand, Senator Mitchell has now made it possible to achieve a real reconciliation in Northern Ireland--and for the Irish people to go about building their future together, in cooperation rather than in conflict. I am very pleased that the Senate has passed overwhelmingly a resolution expressing our support for the Irish peace process and the brighter future represented by this truly historic agreement. Thank you, Mr. President. I yield the floor. Mr. CHAFEE addressed the Chair.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in adjournment until 11 a.m., on Monday, April 27. I further ask unanimous consent that on Monday, immediately following the prayer, the routine requests through the morning hour be granted, and the Senate then proceed to 1 hour of morning business with Senators permitted to speak for up to 10 minutes each, with the following exceptions: Senator Thomas, 15 minutes; Senator Feinstein, 20 minutes. I further ask unanimous consent that following morning business, at 12 noon the Senate proceed to executive session and begin debate on the NATO treaty.

Ms. COLLINS

Ms. COLLINS. I further ask unanimous consent that immediately following the confirmation, the Senate proceed to the following additional nominations, that they be confirmed, that the motions to reconsider be laid upon the table, and that the President be immediately notified of the Senate's action, and that the Senate resume consideration of the NATO treaty. Those nominations are: Garr King, of Oregon, to be a district judge in Oregon; Gregory Sleet, of Delaware, to be a district judge for Delaware; and Cherryl Thomas to be a member of the Railroad Retirement Board.

Ms. COLLINS. Mr. President, I ask for the yeas and nays.

Ms. COLLINS. Mr. President, as in executive session, I ask unanimous consent that on Monday, April 27, at 6 p.m., the Senate turn to the nomination of Scott Fleming, to be Assistant Secretary for Legislation at the Department of Education, and that the Senate proceed to an immediate vote on the confirmation of the nomination without intervening action or debate and that it be in order now to order the yeas and nays on the nomination.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that two bills that are at the desk, H.R. 3565 and S. 1985, be placed on the calendar.