Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I commend my good friend on the committee for the work he has done in this area. This is an area where we have joined together. It will ensure that we have a change, a positive change in the clinical trial aspect. I want to work together with the Senator in that regard. I also want to say this bill is not finished yet. We have places to go and time to spend to bring it to a better form than it is now. I look forward to continuing to work to improve the bill. I reserve the remainder of my time.

Mr. JEFFORDS. Yes.

Mr. JEFFORDS. We will have an amendment which will deal with that problem.

Mr. JEFFORDS. I am happy to yield.

Mr. JEFFORDS. I tell you, we have a better health care bill. That is all I am telling you. It will protect more people at less cost. Your bill is so expensive that you are going to affect a million people, and those people are the ones we want most to protect. Those are the people who are working low-income jobs and who will be torn off and removed from health care protection by your bill. We will not do that. We are going to protect those people who need the protection the most from being denied health insurance. I take back the remainder of my time. It would be inappropriate to set Federal health insurance standards that duplicate the responsibility of the 50 State insurance departments. As the National Association of Insurance Commissioners put it: We do not want States to be preempted by Congressional or administrative actions. . .Congress should focus attention on those consumers who have no protections in the self-funded ERISA plans. Senator Kennedy's approach would set health insurance standards that duplicate the responsibility of the 50 State insurance departments. Worse yet, it would mandate that the Health Care Financing Administration, HCFA, enforce them, if the State decides otherwise. It would be a disaster--HCFA can't even handle the small things they have with HIPAA, the Medicare and Medicaid problems--to get involved in the demands that would be placed upon them by the Democratic bill. This past recess, Senator Leahy and I held a meeting in Vermont to let New England home health providers meet with HCFA. It was a packed and angry house, with providers traveling from New Hampshire, Massachusetts, and Connecticut. That is who the Democrats would have enforce their bill. It is in no one's best interests to build a dual system of overlapping State and Federal health insurance regulation. Increasing health insurance premiums causes significant losses in coverage. The Congressional Budget Office, CBO, pegged the cost of the Democratic bill at six times higher than S. 326. Based on our best estimates, passage of the Democratic bill would result in the loss of coverage for over 1.5 million working Americans and their families. Now, why do you want to charge forward with that plan? To put this in perspective, this would mean they would have their family's coverage canceled under the Democratic bill--canceled. Let me repeat that. Adoption of the Democratic approach would cancel the insurance policies of almost 1.5 million Americans, CBO estimates. I cannot support legislation that would result in the loss of health insurance coverage for the combined population of the States of Virginia, Delaware, South Dakota, and Wyoming--no coverage.

Mr. JEFFORDS. How much time do we have?

Mr. JEFFORDS. Mr. President, I know that my worthy opponents have made note of our absence. We are not ignoring this issue. We have a better answer. There will be a Snowe-Abraham amendment presented, probably tomorrow, that will handle this issue. I think the Members will agree that the approach we take will be preferable to the one being taken right now. I would like to address my colleagues generally on the situation at this time. The Patients' Bill of Rights Act addresses those areas of health quality on which there is broad consensus. It is solid legislation that will result in a greatly improved health care system for all Americans. The Committee on Health, Education, Labor, and Pensions, the HELP Committee, has been long dedicated to action in order to improve the quality of health care. Our commitment to developing appropriate managed care standards has been demonstrated by the 17 additional hearings related to health care quality. Senator Frist's Public Health and Safety Subcommittee held three hearings on the work of the Agency for Health Care Policy and Research, sometimes referred to as AHCPR. Each of these hearings helped us to develop the separate pieces of legislation that are reflected in S. 326, the Patients' Bill of Rights Act. People need to know what their plan will cover and how they will get their health care. The Patients' Bill of Rights requires full disclosure by an employer about health plans it offers to employees. Patients also need to know how adverse decisions by a plan can be appealed, both internally--that is, within the HMO--and externally, through an independent medical reviewer. Under our bill, the reviewer's decision will be binding on the health plan. We are talking about an external, outside reviewer, and it is binding. There is no appeal. It is binding. They have to do it. However, the patient will retain his or her current rights to go to court. Timely utilization decisions and a defined process for appealing such decisions are the keys to restoring trust in the health care system. Our legislation also provides Americans covered by health insurance with new rights to prevent discrimination based on predictive genetic information. This is a crucial provision. It ensures that medical decisions are made by physicians in consultation with their patients and are based on the best scientific evidence. That is the key phrase. We want to remember that one because you won't see it on the other side. It provides a stronger emphasis on quality improvement in our health care system with a refocused role for AHCPR, taking advantage of all the abilities we have now to understand better what is going on with respect to health care in this country, to sift through the information that comes through AHCPR and make judgments on what the best medicine is. Some believe that the answer to improving our Nation's health care quality is to allow greater access to the tort system, maybe a better lawsuit. However, you simply cannot sue your way to better health. We believe that patients must get the care they need when they need it. They ought not to have to go to court with a lawsuit. They ought to get it when they need it. It is a question of whether you want good health or you want a good lawsuit. In the Patients' Bill of Rights, we make sure each patient is afforded every opportunity to have the right treatment decision made by health care professionals. In the event that does not occur, patients have the recourse of pursuing an outside appeal to get medical decisions by medical people to give them good medical treatment. Prevention, not litigation, is the best medicine. Our bill creates new, enforceable Federal health standards to cover those 48 million people of the 124 million Americans covered by employer-sponsored plans. These are the very same people that the States, through their regulation of private health insurance companies, cannot protect. We will protect them. What are these standards? They include, first, a prudent layperson standard for emergency care; second, a mandatory point of service option; direct access to OB/GYNs and pediatricians--that has not been recognized by the opposition--continuity of care; a prohibition on gag rules; access to medication; access to specialists; and self-pay for behavioral health. It would be inappropriate to set Federal health insurance standards that duplicate the responsibility of the 50 State insurance departments.

Mr. JEFFORDS. Fortunately, we can provide the key protections that consumers want, at a minimal cost and without the disruption of coverage, if we apply these protections responsibly and where they are needed. In sharp contrast to the Democratic alternative, our bill would actually increase coverage. With the additional Tax Code provisions of S. 326, the Patients' Bill of Rights Act, our bill allows for full deduction of health insurance for the self-employed, the full availability of medical savings accounts, and the carryover of unused benefits from flexible spending accounts.

Mr. JEFFORDS. With the Patients' Bill of Rights Plus Act, we provide Americans with greater choice of more affordable health insurance.

Mr. JEFFORDS. First of all, we defer to the States in that regard.

Mr. JEFFORDS. That is my intention.

Mr. JEFFORDS. Yes.

Mr. JEFFORDS. I think the Senator has her own time.

Mr. JEFFORDS. Well, in some areas we go beyond that, as the Senator well knows.

Mr. JEFFORDS. We are going to provide them with better protections.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I send to the desk an amendment to Calendar No. 169, previously passed by the Senate. I ask unanimous consent it be immediately adopted and the motion to reconsider be laid upon the table.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent that when the Senate complete its business today it stand in adjournment until the hour of 9:30 a.m. on Wednesday, July 14. Further, I ask unanimous consent that on Wednesday, immediately following the prayer, 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, and the Senate stand in a period of morning business until 10 a.m., with Senators speaking for up to 5 minutes each with the following exceptions: Senator Grams of Minnesota, 15 minutes; Senator Daschle, or his designee, for 15 minutes.

Mr. JEFFORDS

Mr. JEFFORDS. For the information of all Senators, the Senate will convene at 9:30 and be in a period of morning business until 10 a.m. Following morning business, the Senate will immediately resume consideration of S. 1344, the Patients' Bill of Rights legislation. Debate will continue on the pending amendment until all time has expired. Additional amendments are expected to be offered and debated throughout tomorrow's session of the Senate. Therefore, Senators should anticipate votes throughout the day on Wednesday. As always, Senators will be notified as votes are scheduled.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, as in executive session, I ask unanimous consent that the injunction of secrecy be removed from the following treaty transmitted to the Senate on July 13, 1999, by the President of the United States: Extradition Treaty with Paraguay (Treaty Document No. 106-4). I further ask that the treaty be considered as having been read the first time; that it be referred, with accompanying papers, to the Committee on Foreign Relations and ordered to be printed; and that the President's message be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to introduce the Preserving Access to Care in the Home Act of 1999, also known as the PATCH Act. This important bill has been crafted to protect access to care for those most in need, relieve the cash flow problems faced by agencies, and improve the interaction between home health agencies and HCFA. I want to recognize Senator Reed, Senator Enzi, and Senator Leahy. These cosponsors have shown tremendous effort and dedication in dealing with the crisis in home health care. Abraham Lincoln said ``The legitimate object of government is to do for a community of people, whatever they need to have done, but cannot do at all, or cannot so well do for themselves, in their separate and individual capacities.'' This is the essence of home health care. Home health care means so much to so many people: it means that people recovering from surgery can go home sooner--it means that someone recovering from an accident can get physical therapy in their home, it means our seniors can stay at home, and out of nursing homes. It is smart policy from human and financial standpoints. My own State of Vermont is a model for providing high-quality, comprehensive care with a low price tag. For the past eight years, the average Medicare expenditure for home health care in Vermont has been the lowest in the nation. Vermont's home care system was designed to efficiently meet the needs of frail and elderly citizens in our largely rural State, but the Health Care Financing Administration's (HCFA) reimbursement system was not. HCFA's interim payment system (IPS) has been implemented in a manner that inadequately reimburses agencies for the care that they provide. The Balanced Budget Act (BBA) did a lot of good, providing health care coverage for millions of low income children, providing targeted tax relief for families and students, tax incentives to encourage pensions savings, and extending the life of Medicare. However, as with most things in life, it was not perfect. The BBA failed to recognize how the new home health reimbursement would affect small rural home health care providers. The IPS has caused such significant cash flow problems, that many agencies are struggling to meet their payroll needs. Home health care agencies are now facing the prospect of 15 percent budget cut next year. This budget cut, on top of already stretched budgets, would be disastrous for providers and patients alike. The PATCH Act will rectify these problems. First, the PATCH Act eliminates the 15-percent cut scheduled for next year. The actual savings under IPS have exceeded initial expectations, so the 15-percent cut is unnecessary to achieve the savings originally projected as needed. Second, the PATCH Act clarifies the definition of ``homebound'' so that coverage decisions are based on the condition of the individual and not on an arbitrary number of absences from the home. Many seniors have found themselves virtual prisoners in their homes, threatened with loss of coverage if they attend adult day care, weekly religious services, or even visit family members in the hospital. This makes no sense because all of these activities are steps on the road to successful and healthy recovery. Often, home care professionals want patients to get outside a little bit, as part of their care plan. This helps fight off depression. Eligibility for home care should depend on the health of the patient. Third, the PATCH Act creates an ``outlier'' provision so that medically complex patients suffering from multiple ailments are not excluded by the Medicare program. Agencies will receive reimbursements for reasonable costs so that they can continue to provide care for these complex patients without going bankrupt. Home health agencies can provide care to long-term chronic care patients at a lower cost than nursing homes, or hospitals. Next, the PATCH Act also matches the rate of review to the rate of denial and provides a reward to agencies for ``good behavior'' and incentive to submit ``good claims.'' Conducting high cost, intense audits on all agencies, regardless of the past efficiency of the agency, is expensive and unproductive. Many agencies are finding themselves swamped by pre-payment reviews for claims that they submit. These reviews require that health professionals spend a substantial amount of their time filling out forms instead of providing urgently needed care to the elderly. Matching the rate of review to the rate of denial adds to the efficiency of home health agencies, and the efficiency of the regulatory. If the finalized denial rate of claims for a home health agency is less than 5 percent then (a) there will be no prepayment reviews, and (b) the post-payment review shall not exceed 10 percent of the claims. Finally, the bill restores the periodic interim payment system (PIP) and provides guidelines to HCFA on the development of a prospective payment system (PPS) that will be fair to Vermont's low-cost, rural providers. The sooner you can return patients to their homes, the sooner they can recover. The familiar environment of the home, family, and friends is more nurturing to recovering patients than the often stressful and unfamiliar surroundings of a hospital. Home health allows them to receive treatment for their medical conditions while being integrated back into independence. Home health is also a great avenue for education. It empowers families to assist in the care of their loved ones. This, too, results in lower costs because family members, in addition to health professionals, provide some of the care. Access to care in the home must be saved. I look forward to turning this legislation into law. The women and men who provide home care are on the front line every day and deserve nothing but our best efforts.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent the Senate immediately proceed to executive session to consider the following nominations en bloc on the Executive Calendar, Nos. 157, 158, 161, 162, and 163. I finally ask unanimous consent that the nominations be confirmed en bloc, the motion to reconsider be laid upon the table, and any statements related to the nominations appear in the Record, the President be immediately notified of the Senate's action, and the Senate then return to legislative business.

Mr. JEFFORDS

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

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to introduce the Preserving Access to Care in the Home Act of 1999, also known as the PATCH Act. This important bill has been crafted to protect access to care for those most in need, relieve the cash flow problems faced by agencies, and improve the interaction between home health agencies and HCFA. I want to recognize Senator Reed, Senator Enzi, and Senator Leahy. These cosponsors have shown tremendous effort and dedication in dealing with the crisis in home health care. Abraham Lincoln said ``The legitimate object of government is to do for a community of people, whatever they need to have done, but cannot do at all, or cannot so well do for themselves, in their separate and individual capacities.'' This is the essence of home health care. Home health care means so much to so many people: it means that people recovering from surgery can go home sooner--it means that someone recovering from an accident can get physical therapy in their home, it means our seniors can stay at home, and out of nursing homes. It is smart policy from human and financial standpoints. My own State of Vermont is a model for providing high-quality, comprehensive care with a low price tag. For the past eight years, the average Medicare expenditure for home health care in Vermont has been the lowest in the nation. Vermont's home care system was designed to efficiently meet the needs of frail and elderly citizens in our largely rural State, but the Health Care Financing Administration's (HCFA) reimbursement system was not. HCFA's interim payment system (IPS) has been implemented in a manner that inadequately reimburses agencies for the care that they provide. The Balanced Budget Act (BBA) did a lot of good, providing health care coverage for millions of low income children, providing targeted tax relief for families and students, tax incentives to encourage pensions savings, and extending the life of Medicare. However, as with most things in life, it was not perfect. The BBA failed to recognize how the new home health reimbursement would affect small rural home health care providers. The IPS has caused such significant cash flow problems, that many agencies are struggling to meet their payroll needs. Home health care agencies are now facing the prospect of 15 percent budget cut next year. This budget cut, on top of already stretched budgets, would be disastrous for providers and patients alike. The PATCH Act will rectify these problems. First, the PATCH Act eliminates the 15-percent cut scheduled for next year. The actual savings under IPS have exceeded initial expectations, so the 15-percent cut is unnecessary to achieve the savings originally projected as needed. Second, the PATCH Act clarifies the definition of ``homebound'' so that coverage decisions are based on the condition of the individual and not on an arbitrary number of absences from the home. Many seniors have found themselves virtual prisoners in their homes, threatened with loss of coverage if they attend adult day care, weekly religious services, or even visit family members in the hospital. This makes no sense because all of these activities are steps on the road to successful and healthy recovery. Often, home care professionals want patients to get outside a little bit, as part of their care plan. This helps fight off depression. Eligibility for home care should depend on the health of the patient. Third, the PATCH Act creates an ``outlier'' provision so that medically complex patients suffering from multiple ailments are not excluded by the Medicare program. Agencies will receive reimbursements for reasonable costs so that they can continue to provide care for these complex patients without going bankrupt. Home health agencies can provide care to long-term chronic care patients at a lower cost than nursing homes, or hospitals. Next, the PATCH Act also matches the rate of review to the rate of denial and provides a reward to agencies for ``good behavior'' and incentive to submit ``good claims.'' Conducting high cost, intense audits on all agencies, regardless of the past efficiency of the agency, is expensive and unproductive. Many agencies are finding themselves swamped by pre-payment reviews for claims that they submit. These reviews require that health professionals spend a substantial amount of their time filling out forms instead of providing urgently needed care to the elderly. Matching the rate of review to the rate of denial adds to the efficiency of home health agencies, and the efficiency of the regulatory. If the finalized denial rate of claims for a home health agency is less than 5 percent then (a) there will be no prepayment reviews, and (b) the post-payment review shall not exceed 10 percent of the claims. Finally, the bill restores the periodic interim payment system (PIP) and provides guidelines to HCFA on the development of a prospective payment system (PPS) that will be fair to Vermont's low-cost, rural providers. The sooner you can return patients to their homes, the sooner they can recover. The familiar environment of the home, family, and friends is more nurturing to recovering patients than the often stressful and unfamiliar surroundings of a hospital. Home health allows them to receive treatment for their medical conditions while being integrated back into independence. Home health is also a great avenue for education. It empowers families to assist in the care of their loved ones. This, too, results in lower costs because family members, in addition to health professionals, provide some of the care. Access to care in the home must be saved. I look forward to turning this legislation into law. The women and men who provide home care are on the front line every day and deserve nothing but our best efforts.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today I am introducing S. 1357, the Retirement Account Portability (RAP) Act. This bill is a close companion to H.R. 738, the bill introduced by Congressman Earl Pomeroy of North Dakota. It was also included as title III of the Pension Coverage and Portability Act, S. 741, introduced earlier this year by myself and Senators Graham and Grassley. Generally this bill is intended to be a further iteration of the concepts embodied in both of those bills. The RAP Act standardizes the rules in the Internal Revenue Code (IRC) which regulate how portable a worker's retirement savings account is, and while it does not make portability of pension benefits perfect, it greatly improves the status quo. No employer will be ``required'' to accept rollovers from other plans, however. A rollover will occur when the employee offers, and the employer agrees to accept, a rollover from another plan. Under current law, it is not possible for an individual to move an accumulated retirement savings account from a section 401(k) (for- profit) plan to a section 457 (state and local government) deferred compensation plan, to an Individual Retirement Account (IRA), then to a section 403(b) (non-profit organization or public school) deferred annuity plan and ultimately back into a section 401(k) plan, without violating various restrictions on the movement of their money. The RAP Act will make it possible for workers to take their retirement savings with them when they change jobs regardless of the type of employer for which they work. This bill will also help make IRAs more portable and will improve the use of conduit IRAs. Conduit IRAs are individual retirement accounts to which certain distributions from a qualified retirement plan or from another individual retirement account have been transferred. RAP changes the rules regulating these IRAs so that workers leaving the for-profit, non-profit or governmental field can use a conduit IRA as a parking spot for a pre-retirement distribution. These special accounts are needed by many workers until they have another employer-sponsored plan in which to rollover their savings. In many instances, this bill will allow an individual to rollover an IRA consisting exclusively of tax-deductible contributions into a retirement plan at his or her new place of employment, thus helping the individual consolidate retirement savings in a single account. Under certain circumstances, the RAP Act will also allow workers to rollover any after-tax contributions made at his or her previous workplace, into a new retirement plan. Under the provisions of the bill as drafted, after-tax contributions will be rollable from a plan to an IRA and from an IRA to an IRA, but not from a IRA to a plan, nor on a direct plan to plan basis. I am open to recommendations on how we can improve the treatment of after-tax rollovers and I look forward to hearing from my colleagues and the public on that topic. Current law requires a worker who changes jobs to face a deadline of 60 days within which to roll over any retirement savings benefits either into an Individual Retirement Account, or into the retirement plan of his or her new employer. Failure to meet the deadline can result in both income and excise taxes being imposed on the account. We believe that this deadline should be waived under certain circumstances and we have outlined them in the bill. Consistent with the Pomeroy bill, in case of a Presidentially-declared natural disaster or military service in a combat zone, the Treasury Department will have the authority to disallow imposition of any tax penalty for the account holder. Consistent with the additional changes incorporated by Congressman Pomeroy this year, however, we have included a waiver of tax penalties in the case of undue hardship, such as a serious personal injury or illness and we have given the Department of the Treasury the authority to waive the deadline. The Retirement Account Portability Act will also change two complicated rules which harm both plan sponsors and plan participants; one dealing with certain business sales (the so-called ``same desk'' rule) and the other dealing with retirement plan distribution options. Each of these rules has impeded true portability of pensions and we believe they ought to be changed. In addition, this bill will extend the Pension Benefit Guaranty Corporation's (PBGC) Missing Participant program to defined benefit multiemployer pension plans. Under current law, the PBGC has jurisdiction over both single-employer and multiemployer defined benefit pension plans. A few years ago, the agency initiated a program to locate missing participants from terminated, single-employer plans. The program attempts to locate individuals who are due a benefit, but who have not filed for benefits owed to them, or who have attempted to find their former employer but failed to receive their benefits. This bill expands the missing participant program to multiemployer pension plans. I know of no reason why individuals covered by a multiemployer pension plans should not have the same protections as participants of single-employer pension plans and this change will help more former employees receive all the benefits to which they are entitled. This bill does not expand the missing participants program to defined contribution plans. Supervision of defined contribution plans is outside the statutory jurisdiction of the PBGC and I have not heard strong arguments for including those plans within the jurisdiction of the agency. I would be pleased to hear the recommendations of any of my colleagues on this matter. In a particularly important provision, the Retirement Account Portability bill will allow public school teachers and other state and local employees who move between different states and localities to use their savings in their section 403(b) plan or section 457 deferred compensation arrangement to purchase ``service credit'' in the defined benefit plan in which they are currently participating, and thus obtain greater pension benefits in the plan in which they conclude their career. As a final note, this bill, this bill does not reduce the vesting schedule from the current five year cliff vesting (or seven year graded) to a three year cliff or six year graded vesting schedule that has been contained in other bills. I support the shorter vesting schedules, but I feel that the abbreviated schedule makes a dramatic change to tax law without removing some of the disincentives to maintaining a pension plan that businesses--especially small businesses--desperately need. More discussion of this matter is needed. Mr. President, I ask unanimous consent that a copy of the bill be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. If there is no further business to come before the Senate, I now ask unanimous consent the Senate stand in adjournment under the previous order.