Kay Hagan

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak for up to 10 minutes each.

Mrs. HAGAN

Mrs. HAGAN. I yield the floor.

Mrs. HAGAN. Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that it adjourn under the previous order, following the remarks of Senator Specter.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, tonight cloture was filed on the small business jobs bill. As a result, the filing deadline for first-degree amendments is 1 p.m. tomorrow. Senators should expect rollcall votes to occur throughout the day in relation to amendments to the bill, if an agreement can be reached to consider amendments.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I understand that S. 3657, introduced earlier today by Senator Wyden, is at the desk, and I ask for its first reading.

Mrs. HAGAN. Mr. President, I now ask for its second reading and object to my own request.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 9:30 a.m. on Wednesday, July 28; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day; that following any leader remarks, the Senate proceed to a period of morning business for 1 hour, with Senators permitted to speak therein for up to 10 minutes each, with the time equally divided and controlled between the two leaders or their designees, with the Republicans controlling the first half and the majority controlling the final half; that following morning business, the Senate resume consideration of H.R. 5297, the small business jobs bill.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I applaud the Senator from Louisiana for putting forward this amendment with the Senator from Florida. I think banks would be interested in lending this money. I think small local, community banks know their client base, know their customers. They are the ones to which these funds are going to be made available. It is not going to be the big banks. This is going to go to banks with $10 billion assets or less. There is nothing forcing these banks to take this money. I highly recommend we move forward with this bill. I echo so much what Senator Landrieu has been talking about on the floor today. The small business lending fund is an absolutely critical component of the small business package we are moving through the Senate. Small businesses are the backbone of our economy and, in particular, in the State of North Carolina. In fact, small businesses represent over 98 percent of the State's employers in North Carolina and close to 50 percent of the private sector jobs. Having spent the last year and a half meeting with small business owners all across North Carolina, I have seen firsthand the power of their determination and innovation. I know that the small businesses will be the catalyst that we need right now for our economic recovery. In North Carolina, we have over 455,000 people unemployed--455,000. We need to be doing all we can in Congress to help this recovery. Small businesses cannot begin to grow and expand and hire until they have access to credit and capital to invest. The small business lending fund does a lot to address that problem by giving banks a powerful incentive to increase lending to small businesses. I have heard my colleagues in South Dakota and Alabama speak today about this bill, comparing it to TARP, implying that banks will not participate because the fund too closely resembles TARP. Nobody is making a bank participate. This is totally voluntary. The small business lending fund is not another TARP. It is not another bailout. This fund goes to Main Street banks, our local community banks, not the big ones, not the ones with $10 billion assets or larger. These are provisions targeted at providing money to the banks that are the healthiest and most capable of increasing lending. In fact, the measure contains provisions to ensure that the funds only go to the banks that are healthy and viable. In North Carolina, which is one of the biggest banking States in the country, our bankers have offered their endorsement of this proposal. I am focused on creating a better climate for businesses to add jobs in North Carolina and across the country. I think this is a sensible proposal that will help small businesses to hire and grow. I thank the Senator from Louisiana, as well as the Senator from Florida, for putting forth this amendment.

Mrs. HAGAN

Mrs. HAGAN. Madam President, I rise today to discuss the conference agreement on financial services regulatory reform and specifically an issue in section 619 of title VI, known as the Volcker rule. The section's limitations on financial organizations that own a depository institution from investing or sponsoring in hedge funds or investments in private equity to 3 percent of an organization's assets, in the aggregate, references ``tier 1 capital.'' The term ``tier 1 capital'' is a concept currently applied strictly to banks and bank holding companies and consists of core capital, which includes equity capital and disclosed reserves. However, there are financial organizations subject to the Volcker rule's investment constraints that do not have a principal regulator that utilizes tier 1 capital measurements to determine an entity's financial strength. In order to ensure a level playing field with traditional banks, I would hope the appropriate regulators would determine a suitable equivalent of tier 1 capital to determine the investment limit, while still satisfying the intent of the Volcker rule. I ask the regulators to make certain that these types of financial organizations will be subject to the Volcker rule in a manner that takes into account their unique structure. In addition, I am pleased that as part of the conference report that the Volcker language was modified to permit a banking entity to engage in a certain level of traditional asset management business, including the ability to sponsor and offer hedge and private equity funds. With that in mind, I wanted to clarify certain details around this authority. First, I was pleased to see that the Volcker Rule, as modified, will permit banking entities several years to bring their full range of activities into conformance with the new rule. In particular, section 619(c)(2) ensures that the new investment restrictions under section 619(d)(1)(G)(iii) and section 619(d)(4)--including the numerical limitations under section 619(d)(4)(B)(ii)--will only apply to a banking entity at the end of the period that is 2 years after the section's effective date. This date for the regulators to begin applying the new rules can also be extended into the future for up to three 1-year periods under section 619(c)(2) and can also separately be extended for illiquid funds with contractual commitments as of May 1, 2010, under section 619(c)(3), on a one-time basis for up to 5 years. Only after all of these time periods and extensions have run will any of the limitations under section 619(d)(1)(G) and section 619(d)(4) be applied by regulators. Second, as an added protection, section 619(f) applies sections 23A and 23B of the Federal Reserve Act to transactions between all of a banking entity's affiliates and hedge or private equity funds where the banking entity organizes, offers, serves as an investment manager, investment adviser, or sponsor of such funds under section 619(d). These restrictions are also applied to transactions between a banking entity's affiliates and other funds that are ``controlled'' by a hedge or private equity fund permitted for the banking entity under 619(d). Importantly, these 23A and 23B restrictions do not apply to funds not ``controlled'' by funds permitted for the banking entity under section 619(d), and it should also be clear that under section 619 there are no new restrictions or limitations of any type placed on the portfolio investments of any hedge or private equity fund permitted for a banking entity under section 619. Third, as a condition of sponsorship, section 619(d)(1)(G)(v) requires that a banking entity does not, directly or indirectly, guarantee or assume or otherwise insure the obligations or performance of any sponsored hedge or private equity fund or of any other hedge or private equity fund in which the sponsored fund invests. While this restricts guarantees by the banking entity as well as the insuring of obligation or performance, it does not limit other normal banking relations with funds merely due to a noncontrol investment by a fund sponsored by the banking entity. As described above, section 619(f) limits transactions under 23A and 23B of the Federal Reserve Act with a fund ``controlled'' by the banking entity or a fund sponsored by the banking entity. However, 619(f) does not limit in any manner transactions and normal banking relationships with a fund not ``controlled'' by the banking entity or a fund sponsored by the banking entity. Finally, section 619(d)(4)(I) permits certain banking entities to operate hedge and private equity funds outside of the United States provided that no ownership interest in any hedge or private equity fund is offered for sale or sold to a U.S. resident. For consistency's sake, I would expect that, apart from the U.S. marketing restrictions, these provisions will be applied by the regulators in conformity with and incorporating the Federal Reserve's current precedents, rulings, positions, and practices under sections 4(c)(9) and 4(c)(13) of the Bank Holding Company Act so as to provide greater certainty and utilize the established legal framework for funds operated by bank holding companies outside of the United States.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I would like to engage Senator Lincoln, chairman of the Agriculture, Nutrition and Forestry Committee, in a colloquy. Title VII of the Dodd-Frank Wall Street Reform and Consumer Protection Act, which Chairman Lincoln was the primary architect of, creates a new regulatory framework for the over-the-counter derivatives market. It will require a significant portion of derivatives trades to be cleared through a centralized clearinghouse and traded on an exchange, and it will also increase reporting and capital and margin requirements on significant players in the market. The new regulatory framework will help improve transparency and disclosure within the derivatives market for the benefit of all investors. Under the bill, the Commodity Futures Trading Commission, CFTC, and the Securities and Exchange Commission, SEC, are instructed to further define the terms ``major swap participant'' and ``major security-based swap participant.'' The definitions of major swap participant and major security-based swap participant included in the bill require the CFTC and the SEC to determine whether a person dealing in swaps maintains a ``substantial position'' in swaps, as well as whether such outstanding swaps create ``substantial counterparty exposure'' that could have ``serious adverse effects on the financial stability of the United States banking system or financial markets.'' The definition also encompasses ``financial entities'' that are highly leveraged relative to the amount of capital it holds, are not already subject to capital requirements set by a Federal banking regulator, and maintain a substantial position in outstanding swaps. I understand when the CFTC and SEC are making the determination as to whether a person dealing in swaps is a major swap participant or major security-based swap participant, it is the intent of the conference committee that both the CFTC and the SEC focus on risk factors that contributed to the recent financial crisis, such as excessive leverage, under-collateralization of swap positions, and a lack of information about the aggregate size of positions. Is this correct?

Mrs. HAGAN. I thank the Senator. If I may, I have one additional question. When considering whether an entity maintains a substantial position in swaps, should the CFTC and the SEC look at the aggregate positions of funds managed by asset managers or at the individual fund level?

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today I am proud to introduce the Culture of Safety Hospital Accountability Act. This bill will test alternatives to the current, inflexible system to ensure that hospitals are meeting the highest health and safety standards for their patients. Under the current system, the Centers for Medicare and Medicaid, or CMS, requires hospitals participating in Medicare and Medicaid to comply with Conditions of Participation--health and safety standards established by CMS for the protection of Medicare and Medicaid beneficiaries. CMS contracts with State agencies to perform inspections of hospitals, nursing homes, and other health care facilities to ensure compliance. However, there are significant deficiencies in the current system. A major concern among hospitals is CMS' assignment of Immediate Jeopardy, which puts hospitals on a 23-day fast-track to losing their Medicare and Medicaid funding. Right now, the only remedy that CMS has when a hospital receives a citation is termination. There is no flexibility to consider the incident on a case-by-case basis--or even to consider whether the hospital self-reported and immediately corrected the incident. Moreover, current procedures fail to consider the substantial resources and efforts that hospitals are already investing in quality improvement and patient safety. Take, for example, a hospital in my State, which last year got a 23- day termination notice after they self-reported that one of their nurses had H1N1. The hospital immediately sent the nurse home and, as I mentioned, immediately reported the incident to CMS. Nevertheless, the hospital was required to undergo an inspection and submit the requisite plan of correction to CMS. The agency was not able to process the paperwork until day 22 of the 23-day notice, causing undue stress for the community as they wondered whether the hospital was going to be forced to close its doors. In addition to the uncertainty for the hospital, the human resources required and costs incurred to implement this inflexible system are enormous. Once a hospital is cited as out of compliance with their Condition of Participation, the State CMS inspectors are required to survey the entire hospital and any other hospitals under the same CMS provider number. In the case of the hospital I just mentioned, it took State inspectors an entire week with 17 staff to survey their hospital system. To address this inflexibility in the current system, I am introducing the Culture of Safety Hospital Accountability Act. This bill would do three things: First, it would require the Secretary of Health and Human Services to study existing quality assurance and patient safety activities within hospitals and identify best practices that should be replicated. Second, it would create a demonstration program among hospitals, State health care agencies, and HHS to promote and implement best practices for improving patient safety and quality of care. HHS would identify up to 6 States and not more than 24 hospitals to participate in a 3-year demonstration program. Finally, the bill would authorize the Secretary of HHS to promulgate regulations modifying termination agreements regarding health and safety requirements with hospitals and critical access hospitals to better ensure compliance, prevent recurrence of violations, and improve internal structures and processes that address patient quality and safety. Patient safety must be first and foremost, and it is not the intent of the demonstration project to keep CMS or State inspectors out of hospitals, nor to impair the remedies CMS needs to address quality issues. Instead, the bill will help to explore how CMS, State regulatory authorities, and hospitals can work collaboratively to address quality and safety issues in ways that will ensure the best quality of care for patients.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today I am proud to introduce the Culture of Safety Hospital Accountability Act. This bill will test alternatives to the current, inflexible system to ensure that hospitals are meeting the highest health and safety standards for their patients. Under the current system, the Centers for Medicare and Medicaid, or CMS, requires hospitals participating in Medicare and Medicaid to comply with Conditions of Participation--health and safety standards established by CMS for the protection of Medicare and Medicaid beneficiaries. CMS contracts with State agencies to perform inspections of hospitals, nursing homes, and other health care facilities to ensure compliance. However, there are significant deficiencies in the current system. A major concern among hospitals is CMS' assignment of Immediate Jeopardy, which puts hospitals on a 23-day fast-track to losing their Medicare and Medicaid funding. Right now, the only remedy that CMS has when a hospital receives a citation is termination. There is no flexibility to consider the incident on a case-by-case basis--or even to consider whether the hospital self-reported and immediately corrected the incident. Moreover, current procedures fail to consider the substantial resources and efforts that hospitals are already investing in quality improvement and patient safety. Take, for example, a hospital in my State, which last year got a 23- day termination notice after they self-reported that one of their nurses had H1N1. The hospital immediately sent the nurse home and, as I mentioned, immediately reported the incident to CMS. Nevertheless, the hospital was required to undergo an inspection and submit the requisite plan of correction to CMS. The agency was not able to process the paperwork until day 22 of the 23-day notice, causing undue stress for the community as they wondered whether the hospital was going to be forced to close its doors. In addition to the uncertainty for the hospital, the human resources required and costs incurred to implement this inflexible system are enormous. Once a hospital is cited as out of compliance with their Condition of Participation, the State CMS inspectors are required to survey the entire hospital and any other hospitals under the same CMS provider number. In the case of the hospital I just mentioned, it took State inspectors an entire week with 17 staff to survey their hospital system. To address this inflexibility in the current system, I am introducing the Culture of Safety Hospital Accountability Act. This bill would do three things: First, it would require the Secretary of Health and Human Services to study existing quality assurance and patient safety activities within hospitals and identify best practices that should be replicated. Second, it would create a demonstration program among hospitals, State health care agencies, and HHS to promote and implement best practices for improving patient safety and quality of care. HHS would identify up to 6 States and not more than 24 hospitals to participate in a 3-year demonstration program. Finally, the bill would authorize the Secretary of HHS to promulgate regulations modifying termination agreements regarding health and safety requirements with hospitals and critical access hospitals to better ensure compliance, prevent recurrence of violations, and improve internal structures and processes that address patient quality and safety. Patient safety must be first and foremost, and it is not the intent of the demonstration project to keep CMS or State inspectors out of hospitals, nor to impair the remedies CMS needs to address quality issues. Instead, the bill will help to explore how CMS, State regulatory authorities, and hospitals can work collaboratively to address quality and safety issues in ways that will ensure the best quality of care for patients.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, before I begin, I congratulate Senator Dodd for all of the extremely hard work he has done on Wall Street reform. We are certainly pleased that we are at this point in time.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I come to the Senate floor this afternoon to discuss two nominees for the Fourth Circuit Court of Appeals--Judges Jim Wynn and Albert Diaz. When I came to the Senate, I had high hopes of increasing the number of North Carolinians on the court. North Carolina is the fastest growing and largest State served by the Fourth Circuit. Yet only 1 of the 15 seats is filled by the abundant talent from our State, and over the past century North Carolina has had fewer total judges on the court than any other State. Furthermore, there have been inexcusable vacancies on this court throughout history. Given that the U.S. Supreme Court only reviews 1 percent of the cases it receives, the Fourth Circuit is the last stop for almost all Federal cases in the region. We must bring this court back to its full strength. Since 1990, when this court was granted 15 seats, it has never had 15 active judges. Judge Wynn brings decades of judicial experience to the bench. He has served on the North Carolina Court of Appeals since 1990 and had a brief tenure on the State supreme court. He has been the chair of the bar association's Judges Advisory Committee on Ethics. Additionally, Judge Wynn has served on Active and Reserve Duty in the Navy for 30 years and was a certified military trial judge. He has been honored for his extraordinary service several times, including three Meritorious Service Medals. Judge Diaz has served since 2005 as one of North Carolina's three business court judges. Prior to that, Judge Diaz was a judge on the State superior court for nearly 4 years. As a business court judge, Judge Diaz has handled complex business cases. He started as a lawyer in the U.S. Marine Corps, was an appellate counsel in the Navy's Office of the Judge Advocate General and has been a judge in the Marine Corps Reserves. Judge Diaz also has extensive experience in business litigation and has served on the State Judicial Council which advises the State supreme court's chief justice on ways to improve the courts. He is a graduate of New York University Law School, with a graduate degree in business from Boston University and undergraduate degree in business from the University of Pennsylvania. I note that both judges have received unanimous ratings of well qualified from the American Bar Association. Additionally, both men's confirmation to this Federal bench will be historically significant, as Judge Diaz will be the first Latin American on the Fourth Circuit and Judge Wynn will be the fourth African American to ever serve on this bench. These fine men have the support of both myself and my colleague from North Carolina, Senator Burr. Editorials and newspapers throughout North Carolina have praised these nominations and have urged their swift confirmation. The Charlotte Observer said Judges Wynn and Diaz are ``widely regarded as intelligent, ethical judges who have won respect for their judicial and military careers. They are the kind of judges the federal bench needs . . . Their quality is so unquestioned that only partisanship could stall their nominations.'' Unfortunately, I worry that is what is happening. Both Judge Wynn and Judge Diaz were approved by the Senate Judiciary Committee on January 28--Judge Diaz unanimously and Judge Wynn with only one dissenting vote. But for over 5 months now, the nominations have languished on the calendar. It is past time that these two fine judges be confirmed to the Fourth Circuit. Mr. President, as in executive session, I ask unanimous consent that at a time to be determined by the majority leader, following consultation with the Republican leader, the Senate proceed to executive session and consider en bloc the following nominations on the Executive Calendar: Calendar No. 656, Albert Diaz, to be a U.S. Circuit Judge for the Fourth Circuit, and Calendar No. 657, James Wynn, to be a U.S. Circuit Judge for the Fourth Circuit; that the nominations be debated concurrently for up to 3 hours, with the time equally divided and controlled between Senators Leahy and Sessions or their designees; that upon the use or yielding back of time, the Senate proceed to vote on confirmation of the nominations in the order listed; that upon confirmation, the motions to reconsider be considered made and laid upon the table en bloc, the President be immediately notified of the Senate's action, and the Senate resume legislative session.

Mrs. HAGAN. Mr. President, it is disappointing that we cannot get consent for these judges. Senator Richard Burr and I together introduced these two individuals at the Judiciary Committee hearing. I will say that I remain committed to working with my colleagues on both sides of the aisle, as well as any Senator who has concerns over either judge, to working toward a reasonable solution that would allow an up- or-down vote on Judges Wynn and Diaz. Mr. President, I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today, I am proud to introduce the Medication Therapy Management, MTM, Expanded Benefits Act of 2010, with my colleague from Minnesota, Senator Franken. A recent analysis conducted by the New England Healthcare Institute estimates that the overall cost of medication nonadherence is as much as $290 billion per year. According to a recent article published in the New England Journal of Medicine, over $100 billion is spent annually on avoidable hospitalizations because patients do not take their medications correctly. Not only does nonadherence cost our system billions of dollars, nonadherence to medication regimens also affects the quality of life for seniors and may lead to early death. The elderly typically take many more prescription medicines than the general population and therefore are at greater risk for problems associated with improper use of medications. For example, the same New England Journal of Medicine article I just reference found that better adherence to antihypertensive treatment alone could prevent 89,000 premature deaths in the U.S. annually. With as much as one half of all patients in the U.S. not following their doctors' orders regarding their medications, medication therapy management could help reduce some of the wasted health care costs in our system. North Carolina has implemented some very successful MTM programs. The Asheville Project, which focuses on diabetes, asthma, and cardiovascular disease, has seen improved health outcomes and significant savings among city employees since it began in 1997. For example, in the Asheville Project's diabetes MTM Project, they have seen a decrease in medical costs of between $1,622 to $3,356 per patient per year; a decrease in insurance claims of $2,704 per patient in year 1 and a $6,502 decrease in year 5; a 50 percent decrease in use of sick days; and increased productivity gains estimated at $18,000 annually. In 2007, the North Carolina Health and Wellness Trust Fund Commission launched an innovative statewide program, Checkmeds NC, to provide MTM services to North Carolina seniors. During the program's first year, more than 15,000 North Carolina seniors and 285 pharmacists participated. The seniors bring all of their prescriptions, over-the- counter medicines, vitamins and supplements to the pharmacy to be thoroughly reviewed in a one-on-one session. The pharmacist follows up and educates the patient about his or her medication regimen. The program saved an estimated $10 million, and countless health problems were avoided. During consideration of health care reform, I was pleased to have successfully secured language in the bill that built off these North Carolina models and implemented MTM nationally for seniors suffering from two or more chronic conditions. The bill I am introducing today takes MTM one step further. Specifically, this bill would expand MTM eligibility to seniors with any chronic condition that accounts for high spending in our health care system, such as heart failure and diabetes. Currently, only 12.9 percent of Part D beneficiaries are eligible under the MTM criteria for multiple chronic conditions. However, of those, more than 85 percent have chosen to participate in the benefit. Clearly this program is very popular and widely utilized by those who are already eligible. By expanding eligibility to more seniors, MTM will certainly result in Medicare savings. The bill also ensures access to MTM for seniors at a pharmacy or with a qualified health care provider of their choice. To ensure pharmacists and health care providers are able to provide MTM to seniors, this bill ensures they are appropriately reimbursed for their time and service. This provision will permit pharmacies and other health care providers to spend considerable time and resources evaluating a person's drug routine and educating them on proper usage-- all critical components of a successful MTM program. Finally, this bill would establish standards for data collection to evaluate and improve the Part D MTM benefit. The value of MTM is widely known and discussed. I am proud that North Carolina is a leader in this arena. Expansion of MTM to more seniors will no doubt improve their overall health, while at the same time reducing waste in our health care system. I urge my colleagues to support this bill.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today, I am proud to introduce the Medication Therapy Management, MTM, Expanded Benefits Act of 2010, with my colleague from Minnesota, Senator Franken. A recent analysis conducted by the New England Healthcare Institute estimates that the overall cost of medication nonadherence is as much as $290 billion per year. According to a recent article published in the New England Journal of Medicine, over $100 billion is spent annually on avoidable hospitalizations because patients do not take their medications correctly. Not only does nonadherence cost our system billions of dollars, nonadherence to medication regimens also affects the quality of life for seniors and may lead to early death. The elderly typically take many more prescription medicines than the general population and therefore are at greater risk for problems associated with improper use of medications. For example, the same New England Journal of Medicine article I just reference found that better adherence to antihypertensive treatment alone could prevent 89,000 premature deaths in the U.S. annually. With as much as one half of all patients in the U.S. not following their doctors' orders regarding their medications, medication therapy management could help reduce some of the wasted health care costs in our system. North Carolina has implemented some very successful MTM programs. The Asheville Project, which focuses on diabetes, asthma, and cardiovascular disease, has seen improved health outcomes and significant savings among city employees since it began in 1997. For example, in the Asheville Project's diabetes MTM Project, they have seen a decrease in medical costs of between $1,622 to $3,356 per patient per year; a decrease in insurance claims of $2,704 per patient in year 1 and a $6,502 decrease in year 5; a 50 percent decrease in use of sick days; and increased productivity gains estimated at $18,000 annually. In 2007, the North Carolina Health and Wellness Trust Fund Commission launched an innovative statewide program, Checkmeds NC, to provide MTM services to North Carolina seniors. During the program's first year, more than 15,000 North Carolina seniors and 285 pharmacists participated. The seniors bring all of their prescriptions, over-the- counter medicines, vitamins and supplements to the pharmacy to be thoroughly reviewed in a one-on-one session. The pharmacist follows up and educates the patient about his or her medication regimen. The program saved an estimated $10 million, and countless health problems were avoided. During consideration of health care reform, I was pleased to have successfully secured language in the bill that built off these North Carolina models and implemented MTM nationally for seniors suffering from two or more chronic conditions. The bill I am introducing today takes MTM one step further. Specifically, this bill would expand MTM eligibility to seniors with any chronic condition that accounts for high spending in our health care system, such as heart failure and diabetes. Currently, only 12.9 percent of Part D beneficiaries are eligible under the MTM criteria for multiple chronic conditions. However, of those, more than 85 percent have chosen to participate in the benefit. Clearly this program is very popular and widely utilized by those who are already eligible. By expanding eligibility to more seniors, MTM will certainly result in Medicare savings. The bill also ensures access to MTM for seniors at a pharmacy or with a qualified health care provider of their choice. To ensure pharmacists and health care providers are able to provide MTM to seniors, this bill ensures they are appropriately reimbursed for their time and service. This provision will permit pharmacies and other health care providers to spend considerable time and resources evaluating a person's drug routine and educating them on proper usage-- all critical components of a successful MTM program. Finally, this bill would establish standards for data collection to evaluate and improve the Part D MTM benefit. The value of MTM is widely known and discussed. I am proud that North Carolina is a leader in this arena. Expansion of MTM to more seniors will no doubt improve their overall health, while at the same time reducing waste in our health care system. I urge my colleagues to support this bill.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today, I am proud to introduce an important piece of legislation to spur job growth across America. The American Manufacturing Efficiency and Retraining Investment Collaboration Achievement Works Act also known as the AMERICA Works Act is part of the solution to the Nation's unemployment problem. With the national unemployment rate at 9.7 percent, and at 10.8 percent in my home state of North Carolina, we need to do everything we can to reinvigorate the American workforce. The United States needs a strong technical workforce. Our country is facing a widening skills gap between older workers with advanced technical skills who will be retiring in the next few years, and the younger workers who have not yet received adequate training to replace them. The benefits of industry-recognized credentials are widely known, but too often those credentials do not count toward educational requirements, do not match the needs of local employers, or require too much time to earn just one credential. Ultimately, the system ends up breaking down, to the detriment of instructors, employers, and employees. The AMERICA Works Act would give priority to Federal job training programs that provide an industry-recognized and nationally-portable credential. The legislation encourages national industries to come together and agree upon common standards, defining the skill sets needed in employees. Once industries have agreed upon standards, they can work with educational institutions to turn the standards into workable curriculums with tiered or stackable credentials. Ultimately, local workforce boards can help workers seeking training and employment opportunity by directing them toward job training programs that have priority under existing Federal programs. The AMERICA Works Act would require certain Federal job training and career development education programs to give priority to programs that provide an industry-recognized and nationally-portable credential. This credentialing system starts out with basic competencies that prepare individuals for the workplace. Once basic competencies are completed, individuals can work toward high performance technical competencies and then progress further to highly skilled technical and management competencies. The credentialing levels are stackable, allowing workers flexibility along their career tracks. Stackable credentials provide straight forward paths, with clear entry and exit points, for workers to advance their careers and attain high quality jobs. In North Carolina, we have an advanced manufacturing skills program at Forsyth Technical Community College in Winston-Salem. Forsyth Technical Community College is participating in the National Association of Manufacturers Endorsed Skills Certification System, which offers credit programs toward nationally-recognized, stackable credentials. Currently, they have 207 students enrolled in their programs. Forsyth Technical has already collaborated with State and local businesses to begin the process of incorporating their credentials into job descriptions. They believe that introducing graduates with skill certifications into the local workforce will help improve the hiring process, and these nationally-recognized credentials will increase employment opportunities. The AMERICA Works Act will benefit business. When businesses clearly identify skills they need in their employees, educational institutions can tailor programs to teach those skills and workers will be better suited to meet their needs--starting on day one. This legislation will benefit workers. Stackable credentials benefit workers by offering several on-ramps and off-ramps to a two-year technical degree: workers in training can exit the system having earned a basic, industry-recognized credential that qualifies them for employment, but without having completed the full two-year technical degree, and they can easily re-enter the system later to move up within their field and work toward the more advanced degree. The AMERICA Works Act will benefit educational programs. Local educational institutes want to provide their students with the most useful skills possible. Open lines of communication between businesses, workforce boards and workers will better enable them to do just that. This legislation will benefit local economies. Local workforce boards will have the chance to determine which skills training programs are most valuable for their region, today and into the future. Local areas with well-trained workforces can more effectively lure new businesses. While this bill mentions manufacturing, it would benefit any industry that meets the criteria established in the legislation. I want to do everything I can to create jobs and make sure our workers have the skills needed to help our businesses grow and thrive. By incentivizing companies to work with educational institutes and develop industry-recognized, nationally-portable, and stackable credentialing curricula, we can ensure that we have the best businesses, with the best workers, trained at the best institutes. I urge my other colleagues to join me in supporting this important bill to enhance employment opportunity for hardworking Americans.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today, I am proud to introduce an important piece of legislation to spur job growth across America. The American Manufacturing Efficiency and Retraining Investment Collaboration Achievement Works Act also known as the AMERICA Works Act is part of the solution to the Nation's unemployment problem. With the national unemployment rate at 9.7 percent, and at 10.8 percent in my home state of North Carolina, we need to do everything we can to reinvigorate the American workforce. The United States needs a strong technical workforce. Our country is facing a widening skills gap between older workers with advanced technical skills who will be retiring in the next few years, and the younger workers who have not yet received adequate training to replace them. The benefits of industry-recognized credentials are widely known, but too often those credentials do not count toward educational requirements, do not match the needs of local employers, or require too much time to earn just one credential. Ultimately, the system ends up breaking down, to the detriment of instructors, employers, and employees. The AMERICA Works Act would give priority to Federal job training programs that provide an industry-recognized and nationally-portable credential. The legislation encourages national industries to come together and agree upon common standards, defining the skill sets needed in employees. Once industries have agreed upon standards, they can work with educational institutions to turn the standards into workable curriculums with tiered or stackable credentials. Ultimately, local workforce boards can help workers seeking training and employment opportunity by directing them toward job training programs that have priority under existing Federal programs. The AMERICA Works Act would require certain Federal job training and career development education programs to give priority to programs that provide an industry-recognized and nationally-portable credential. This credentialing system starts out with basic competencies that prepare individuals for the workplace. Once basic competencies are completed, individuals can work toward high performance technical competencies and then progress further to highly skilled technical and management competencies. The credentialing levels are stackable, allowing workers flexibility along their career tracks. Stackable credentials provide straight forward paths, with clear entry and exit points, for workers to advance their careers and attain high quality jobs. In North Carolina, we have an advanced manufacturing skills program at Forsyth Technical Community College in Winston-Salem. Forsyth Technical Community College is participating in the National Association of Manufacturers Endorsed Skills Certification System, which offers credit programs toward nationally-recognized, stackable credentials. Currently, they have 207 students enrolled in their programs. Forsyth Technical has already collaborated with State and local businesses to begin the process of incorporating their credentials into job descriptions. They believe that introducing graduates with skill certifications into the local workforce will help improve the hiring process, and these nationally-recognized credentials will increase employment opportunities. The AMERICA Works Act will benefit business. When businesses clearly identify skills they need in their employees, educational institutions can tailor programs to teach those skills and workers will be better suited to meet their needs--starting on day one. This legislation will benefit workers. Stackable credentials benefit workers by offering several on-ramps and off-ramps to a two-year technical degree: workers in training can exit the system having earned a basic, industry-recognized credential that qualifies them for employment, but without having completed the full two-year technical degree, and they can easily re-enter the system later to move up within their field and work toward the more advanced degree. The AMERICA Works Act will benefit educational programs. Local educational institutes want to provide their students with the most useful skills possible. Open lines of communication between businesses, workforce boards and workers will better enable them to do just that. This legislation will benefit local economies. Local workforce boards will have the chance to determine which skills training programs are most valuable for their region, today and into the future. Local areas with well-trained workforces can more effectively lure new businesses. While this bill mentions manufacturing, it would benefit any industry that meets the criteria established in the legislation. I want to do everything I can to create jobs and make sure our workers have the skills needed to help our businesses grow and thrive. By incentivizing companies to work with educational institutes and develop industry-recognized, nationally-portable, and stackable credentialing curricula, we can ensure that we have the best businesses, with the best workers, trained at the best institutes. I urge my other colleagues to join me in supporting this important bill to enhance employment opportunity for hardworking Americans.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today I am proud to introduce the Birth Defects Prevention, Risk Reduction, and Awareness Act. This bill would ensure that women of childbearing age and health care professionals have access to clinical and evidence based information about the risks and benefits of drug, chemical, and nutritional exposures during pregnancy and while a woman is breastfeeding. Women who are pregnant or breastfeeding and taking medication for chronic diseases such as asthma, hypertension, and epilepsy often have questions about the risks and benefits. Most pregnant women, as we witnessed last year, really want to know what the science indicates on whether they should get vaccinated against H1N1 or the seasonal flu. Oftentimes, women will seek answers to these important questions from an established pregnancy and breastfeeding information service. In fact, each year over 70,000 women and health care providers contact these information services across the country. These information services provide valuable information that empowers women. In fact, one study indicated that 78 percent of women who were considering terminating otherwise wanted pregnancies due to fears about exposing their fetus to a medication changed their mind after receiving appropriate counseling from a teratology information service. It is not just women who use these services; health care providers, including physicians and pharmacists, also utilize these pregnancy and breastfeeding information services. A 2009 study found that over 90 percent of physicians who use these services indicated that the service provides high quality information that has a significant impact on clinical care. In North Carolina, we have the North Carolina Pregnancy Exposure Riskline, run out of Mission Health System in Asheville. The North Carolina Pregnancy Exposure Riskline fields calls from a variety of constituents, including health care providers, pregnant women, preconception women, potential adoptive parents, and others. Each year, trained genetic counselors answer questions from over 300 callers, who want information on the impact of maternal exposures during pregnancy and while breastfeeding. The North Carolina Pregnancy Exposure Riskline provides detailed, factual information to callers on the current available data, and makes referrals to pregnancy registries that are continuing to gather information so that researchers and health care providers can have the best information for future women. If needed and requested, counselors will refer women to pregnancy resources such as substances treatment facilities or the NC Family Health Resource line, which has led North Carolina in information campaigns on the benefits of folic acid and ``Back to Sleep.'' The North Carolina Pregnancy Exposure Riskline also supports the North Carolina Teratology Information Specialists program to provide outreach and education about fetal alcohol syndrome. Although this is an invaluable service for many women, physicians, and other health care providers, pregnancy and breastfeeding information services across the country have been forced to close due to insufficient funding. The bill I am introducing today would require the Secretary of Health and Human Services, through the Centers for Disease Control and Prevention, to implement a birth defects prevention and public awareness grant program. Specifically, CDC would initiate a national media campaign to increase awareness among health care providers and at risk populations about pregnancy and breast feeding information services. Experienced organizations would be eligible to apply for grants: to provide information; and to conduct surveillance and research of pregnancy exposures that may cause birth defects, prematurity or other adverse pregnancy outcomes, and maternal exposures that may cause harm to a breast-fed infant. I am so pleased that the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the March of Dimes, the Organization of Teratology Information Specialists, and the American Academy of Asthma & Immunology are in support of this worthwhile bill. I urge my other colleagues to join me in supporting this important bill to provide valuable information about maternal exposures during pregnancy and while breastfeeding.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise in support of the motion to instruct offered by my colleague from Texas, Senator Hutchison. I thank the Senator from Texas for her leadership on this issue of importance to members of the military in our States and across the country. Section 619 of the Restoring American Financial Stability Act of 2010 bans certain activities not only at depository institutions but also at bank affiliates, including insurance affiliates. In doing so, section 619 inadvertently jeopardizes access to the important financial resources offered by diversified financial institutions to service men and women and their families. Section 619 bans proprietary trading, but proprietary trading by insurance entities is significantly different than the risk that comes with banks' proprietary trading. Insurance companies use premiums to trade funds, not the consumer deposits that this provision targets. Insurance trades are generally low risk and focus on long-term payment of claims and are already heavily regulated by State insurance regulators. Servicemembers and their families rely on the ability of diversified financial service firms to provide both insurance and banking services under one roof. I am concerned that section 619 may force military members to change their current financial service providers and possibly subject the service men and women to unnecessary cost and burdens. That is why Senator Hutchison and I have worked for several weeks to correct this oversight, and why I introduced amendment 3799 with Senators Hutchison, Carper, Cornyn, Begich, Webb, Burr, and Isakson. Amendment 3799 was a narrow change that addressed the issue. To my knowledge, it was not opposed by anyone. While amendment 3799 was not voted on, Senator Hutchison's motion to instruct provides clear guidance to the conferees to ensure that proprietary trading restrictions do not prevent insurance company affiliates of depository institutions from engaging in such trading as part of the ordinary business of insurance. It is critical that we adopt this motion so that diversified financial institutions may continue to provide low-cost and convenient access to diversified financial services for those sacrificing in service to our country. I urge my colleagues to vote yes on this motion. I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise in support of the motion to instruct offered by my colleague from Texas, Senator Hutchison. I thank the Senator from Texas for her leadership on this issue of importance to members of the military in our States and across the country. Section 619 of the Restoring American Financial Stability Act of 2010 bans certain activities not only at depository institutions but also at bank affiliates, including insurance affiliates. In doing so, section 619 inadvertently jeopardizes access to the important financial resources offered by diversified financial institutions to service men and women and their families. Section 619 bans proprietary trading, but proprietary trading by insurance entities is significantly different than the risk that comes with banks' proprietary trading. Insurance companies use premiums to trade funds, not the consumer deposits that this provision targets. Insurance trades are generally low risk and focus on long-term payment of claims and are already heavily regulated by State insurance regulators. Servicemembers and their families rely on the ability of diversified financial service firms to provide both insurance and banking services under one roof. I am concerned that section 619 may force military members to change their current financial service providers and possibly subject the service men and women to unnecessary cost and burdens. That is why Senator Hutchison and I have worked for several weeks to correct this oversight, and why I introduced amendment 3799 with Senators Hutchison, Carper, Cornyn, Begich, Webb, Burr, and Isakson. Amendment 3799 was a narrow change that addressed the issue. To my knowledge, it was not opposed by anyone. While amendment 3799 was not voted on, Senator Hutchison's motion to instruct provides clear guidance to the conferees to ensure that proprietary trading restrictions do not prevent insurance company affiliates of depository institutions from engaging in such trading as part of the ordinary business of insurance. It is critical that we adopt this motion so that diversified financial institutions may continue to provide low-cost and convenient access to diversified financial services for those sacrificing in service to our country. I urge my colleagues to vote yes on this motion. I yield the floor.

Mrs. HAGAN

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

Mrs. HAGAN. I ask unanimous consent to speak on amendment No. 3744.