Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, the amendment before us on the Treasury- Postal appropriations bill concerns the provision of child care services located in federally-owned and -leased buildings. This amendment will go a long way towards ensuring that child care services located in federally-owned and leased buildings are safe, positive environments for the children of federal employees. I have been working closely with the Senate Committee on Government Affairs which has jurisdiction over this legislation. Chairman Thompson and his staff have been extremely helpful, as has the ranking member of that committee, Senator Glenn. The Senate Rules Committee was instrumental in crafting the language related to the Senate Employees' Child Care Center. I want to thank Chairman Warner, and Senator Ford and their staff for their assistance. This amendment was first introduced as a stand-alone bill on November 7, 1997. It was drafted because of several serious incidents which occurred in federal child care facilities. At that time, it came to my attention that child care centers located in federal facilities are not subject to even the most minimal health and safety standards. As my colleagues know, federal property is exempt from state and local laws, regulations, and oversight. What this means for child care centers on federal property is that state and local health safety standards do not and cannot apply. This might not be a problem if federally-owned or leased child care centers met enforceable health and safety standards. I think most parents who place their children in federal child care would assume that this would be the case. However, I think federal employees will find it very surprising to learn, as I did, that, at many centers, no such health and safety standards apply. I find this very troubling, and I think we should be embarassed that child care in federal facilities child care cannot guarantee that children are in safe environments. The federal government should set the example when it comes to providing safe child care. It should not turn an apathetic shoulder from meeting such standards simply because state and local regulations do not apply to them. My amendment will require child care services in federal buildings to meet a standard no less stringent than the requirements for the same type of child care offered in the community in which the federal child care center is located. The child care provider would not be required to obtain a state or local license, although that is an option open to them. The Government Services Administration would be responsible for establishing the rules and regulations necessary to ensure that each child care facility in a federal building meets the same level of standards applicable to other child care services in the community. In 1987, Congress passed the ``Trible amendment'' which permitted executive, legislative, and judicial branch agencies to utilize a portion of federally-owned or leased space for the provision of child care services for federal employees. The General Services Administration (GSA) was given the authority to provide guidance, assistance, and oversight to federal agencies for the development of child care centers. In the decade since the Trible amendment was passed, hundreds of federal facilities throughout the nation have established on-site child care centers which are a tremendous help to our employees. The General Services Administration has done an excellent job of helping agencies develop child care centers and have adopted strong standards for those centers located in GSA-leased or -owned space. However, there are over 100 child care centers located in federal facilities that are not subject to the GSA standards or any other laws, rules, or regulations to ensure that the facilities are safe places for our children. Most parents, placing their children in a federal child care center, assume that some standards are in place--assume that the centers must minimally meet state and local child care licensing rules and regulations. They assume that the centers are subject to independent oversight and monitoring to continually ensure the safety of the premises. Yet, that is not the case. In one case a federal employee had strong reason to suspect the sexual abuse of her child by an employee of child care center located in a federal facility. Local child protective services and law enforcement personnel were denied access to the premises and were prohibited from investigating the incident. Another employee's child was repeatedly injured because the child care providers under contract with a federal agency to provide on-site child care services failed to ensure that age-appropriate health and safety measures were taken--current law says they were not required to do so, even after the problems were identified and injuries had occurred. In addition, I believe that the federal government can and should lead by example. Federal facilities should always try to meet the highest possible standards. In fact, the GSA has required national accreditation in GSA-owned and leased facilities, and has stated that its centers are either in compliance or are strenuously working to get there. This is the kind of tough standard we should strive for in all of our federal child care facilities. For that reason, this amendment requires that within five years, all child care services located within federal facilities must become accredited by a professionally recognized child care accreditation entity. While state and local child care requirements generally ensure that those services meet the basic health and safety needs, child care credentialling entities go further. Accreditation also includes requirements that developmentally appropriate activities are an integral part of the program, that staff is trained, and that the program is a positive environment that contributes to the healthy development of children receiving child care services. There are several child care accreditation entities providing these services around the country. The National Council for Private School Accreditation is a coalition of 13 entities providing private school accreditation, many of which issue credentials to child care service providers. The Council on Accreditation of Services for Families and Children, Inc. has developed standards and guidelines that are used by several child care accreditation entities to ensure a high quality of care for children. The National Association for the Education of Young Children provides accreditation for child care centers throughout the country. The Lutheran Church-Missouri Synod has been accrediting child care services longer than any other entity. Child care providers in federally-owned and leased facilities will be able to choose which child care accreditation they will obtain. In addition, the General Services Administration is permitted to develop a child care accreditation process to add to the choices already available to programs in federal facilities. Federal child care should mean something more than simply a location in a federal facility. The federal government has an obligation to provide safe care for the children of its employees, and it has a responsibility for making sure that those standards are monitored and enforced. Some federal employees receive this guarantee. Many do not. We can and must do better. Senators Landrieu and Dodd are original co-sponsors of this amendment. I urge my colleagues to help ensure high quality child care in federally owned and leased facilities by supporting this amendment.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I join my colleague from Vermont in recognizing September 13th as the 150th Anniversary of Phineas Gage's accident in Cavendish, VT. Gage was clearing away boulders for a new rail line in the town of Cavendish, population 1300, when an explosion sent his tamping rod passing through his skull and landing 30 yards away. It initially appeared that Gage had survived the accident without long term effects. However, soon after the accident, it became apparent that his emotional stability and good attitude had changed forever offering insight into the effects of the frontal lobe brain damage on mental function. Earlier this year,Vermont Governor Howard Dean signed a proclamation declaring September 13, 1998 as Phineas Gage 150th Anniversary Commemoration Day. On this day, accompanying the historic festival, Cavendish will host the John Martyn Harlow Frontal Lobe Symposium. John Harlow, Gage's doctor, carefully documented Gage's accident and recovery, providing early insight into frontal lobe brain damage. The symposium will draw experts and scholars from around the globe to reexamine the Gage case, and apply modern technology to better understand the connection between brain damage and personality change. I join my colleague from Vermont in commending the residents of Cavendish for bringing together their town, the state of Vermont, and the international neurological community to celebrate this Vermont legend and the medical breakthrough surrounding his life. The story follows: The Story of Phineas Gage's Accident Phineas Gage is one of the most famous patients in medical history and probably the most famous patient to have survived severe damage to the brain. He is also the first patient from whom we have learned something about the relationship between personality and the function of the frontal lobe of the brain. Gage was the foreman in a railway construction gang working for the contractors preparing the bed for the Rutland and Burlington Railroad just outside of Cavendish (Vermont). On September 13, 1848, an accidental explosion of a charge he had set blew his tamping iron through the left side of his skull. The tamping iron, a crowbar-like tool, was 3 feet 7 inches long, weighed 13\1/2\ pounds, and was 1\1/4\ inches in diameter at one end, tapering over a distance of about 1 foot to a diameter of \1/4\ inch at the other end. The tamping iron went point first under his left cheek bone and out through the top of his head, landing about 25 to 30 yards behind him. Gage was knocked over but may not have lost consciousness according to historic accounts even though most of the left frontal lobe was destroyed. He was treated by Dr. John Harlow, the Cavendish physician, with such skill that Gage returned to his home in Lebanon, NH, 10 weeks later. Seven months later, Gage felt strong enough to resume work. But because his personality had changed so much, the contractors who had employed him would not return him to his former position. Before the accident, he had been their most capable and efficient foreman, one with a well-balanced mind and a shrewd business sense. He was not fitful, irreverent, and grossly profane, showing little deference for his men. He was impatient and obstinate, yet capricious and vacillating, unable to settle on any of the plans he devised for future action. His friends said he was, ``No longer Gage.'' Phineas Gage never worked at the level of a foreman again. He held a number of odd jobs according to Dr. Harlow's 1868 account. He appeared at Barnum's Museum in New York, worked in the livery stable of the Darmouth Inn (Hanover, NH) and drove coaches and cared for horses in Chile. In about 1859, after his health began to fail, he went to San Francisco to live with his mother. He began to have epileptic seizures in February 1860 and died on May 21, 1860. No studies of Phineas Gage's brain were made post mortem. Late in 1867, his body was exhumed from its grave in San Francisco's Lone Mountain Cemetery. Phineas' skull and the famous tamping iron were delivered by his brother-in-law to Dr. Harlow (who was at that time, living in Woburn, MA). Harlow reported his findings, including his estimate of the brain damage, in 1868. He donated the skull and tamping iron for preservation to the Warren Museum in the Harvard University School of Medicine where they are still on display, and still studied. The case created a good deal of interest in both medical and lay circles at the time (which continues to this day). Phineas survived a horrendous injury. His case began to have a profound influence on the science of localization of brain function. For nearly 20 years knowledge of the profound change that occurred to Gage's personality was not widely disseminated. It was true that he was physically unchanged except for the obvious scars and that his mental capacity was also unchanged. Without knowing about the personality difference, most people thought he had survived totally intact. His case was therefore used as evidence against the doctrine that any functions were localized in the brain, especially against the phrenological version of it. Later it was also used as negative evidence in the medical debates regarding aphasia and frontal lobe function. The real story was publicized after 1868 by David Ferrier, the notable English doctor and physiological research worker. Even now, 150 years after the fateful accident, the case continues to generate controversy.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to argue in support of an amendment sponsored by myself and Senator Baucus that would require the U.S. Postal Service to let communities know when they are planning to shut down, relocate, or consolidate a community's post office. This amendment aims to preserve the fabric of downtowns and prevent sprawl by giving citizens a say in Postal Service decisions to close, relocate, or consolidate their local post office. This amendment is supported by the National Governors Association, the National League of Cities, the National Trust for Historic Preservation, the National Association of Postmasters of the United States, the National Conference of State Historic Preservation Officers, the American Planning Association, the Association of United States Postal Lessors, and the International Downtown Association. Coming from a small town in Vermont, I understand the importance downtowns or village centers play in the identity and longevity of a community. Downtowns are where people go to socialize, shop, learn what their elected representatives are doing, and gather to celebrate holidays with their neighbors. One of the focal points of any downtown area is the community's post office. Post offices have been part of downtowns and village centers as long as most cities and towns have existed. These post offices are often located in historic buildings and have provided towns with a sense of continuity as their communities have changed over time. The removal of this focal point can quickly lead to the disappearance of continuity and spirit of a community and then the community itself. Mr. President, this amendment will enable the inhabitants of small villages and large towns to have a say when the Postal Service decides that their local post office will be closed, relocated, or consolidated. Some of my colleagues may ask why this legislation is necessary. A few stories from my home state of Vermont will answer this question. A few years ago the general store on the green in Perkinsville, Vermont went bankrupt and the adjacent post office wanted to leave the small village center for a new building outside of town. By the time the community was aware of the project, plans were so far along--the new building had actually been constructed based on the promise of the post office as the anchor tenant--that there was no time to fully investigate in-town alternatives. One elderly resident wrote that in contrast to families now being able to walk to the post office, ``we certainly won't be walking along the busy Route 106 two miles or more to get our mail.'' The State Historic Preservation Officer commented that as people meet neighbors at the post office, the threads of community are woven and reinforced. ``It may be intangible, but its real, and such interaction is critically important to the preservation of the spirit and physical fabric of small village centers like Perkinsville.'' In 1988, the post office in the Stockbridge, Vermont, General Store needed to expand. The store owner tried to find money to rehabilitate an 1811 barn next to the store to provide the needed space, but was not successful. In 1990, the post office moved into a new facility located on the outskirts of Stockbridge on a previously undeveloped section of land at the intersection of two highways. People can no longer walk to the post office as they once were able to do when it was located in the village center. The relocation of the Stockbridge post office unfortunately removed one of the anchors of the community. These are not isolated examples. Mr. President, post office relocations are not only occurring in Vermont, but all across the country. My colleagues will quickly discover similar examples in their own states where the removal of the post office has harmed the economic vitality of the downtown area, deprived access to citizens without cars, and contributed to urban sprawl. The basic premise for this legislation is to give the individuals in a community a voice in the process of a proposed relocation, closing or consolidation of a post office. This community voice has been lacking in the current process. This bill does not give the citizenry the ultimate veto power over a relocation, closing or consolidation. Instead, the bill sets up a process that makes sure community voices and concerns are heard and taken into account by the Postal Service. Additionally, this act will require the Postal Service to abide by local zoning laws and the historic preservation rules regarding federal buildings. Because it is a federal entity, the Postal Service has the ability to override local zoning requirements. In some cases this has lead to disruption of traffic patterns, a rejection of local safety standards, and concerns about environmental damage from problems such as storm water management. Mr. President, post offices in Vermont and across the nation are centers of social and business interaction. In communities where post offices are located on village greens or in downtowns, they become integral to these communities' identities. I believe that this legislation will strengthen the federal-local ties of the Postal Service, help preserve our downtowns, and combat the problem of sprawl. I urge my colleagues to join Senator Baucus and me in support of this important amendment. This is a simple amendment. I can't believe it can't be accepted. Vermonters are tired of waking up in the morning and finding out their post office will be somewhere else. Under the proposed rule, all they get is a notice in the mail. There is no public hearing required. There is no way to appeal. It is just given carte blanche as to what they want to do. In one little town in Vermont, they found out their post office moved 2 miles outside of town, and the people who had gathered in the village, a lot of the reason they gathered in the village was to be able to walk to the post office. They have to go 2 miles to get their mail. No notice, no ability to participate at all. Blanket exemption for many zoning rules. They don't have to even take care of what the planning for the town has been. There is an exemption from the historic preservation rule. It says they can exempt projects from the new standards if the project is to meet an emergency requirement or is for temporary use, with no definition of what they are. You are at the complete mercy of the post office to stick it anywhere they want. I tell you, our post offices are up in arms over this. All we want is a simple logical way where people are notified, they get a chance to be heard, they find out where the locations are going to be, they have an opportunity to make suggestions, and then they get on with life. But right now the way it is, it has my people in Vermont in the small town areas deeply upset. They have got postmasters who are ready to march on Washington. Why? Because we want some simple, commonsense rules to be abided by so that there is local input as to where your next post office is going to be. I yield the floor. Mr. COCHRAN addressed the Chair.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today, I am releasing a new U.S. General Accounting Office (GAO) report entitled, ``Private Health Insurance: HCFA Cautious in Enforcing Federal HIPAA Standards in States Lacking Comparable Laws'' (GAO/HEHS-98-217R). The GAO report warns that Federal involvement in the role traditionally reserved for the States may complicate oversight of private health insurance. In 1945, Congress passed the McCarran-Ferguson Act, thereby endorsing the arrangement where States are responsible for the regulation of insurance. Federal regulation of health insurance in States establishes a new precedent. In light of current proposals that would establish additional Federal standards of health insurance, I believe we must carefully consider the appropriate role for Federal and State regulatory agencies in monitoring and enforcing compliance with insurance standards. As the Chairman of the Committee on Labor and Human Resources, I have closely monitored the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) since its enactment in the last Congress. HIPAA set new Federal standards for access, portability, and renewability for group health plans under the Employee Retirement Income Security Act of 1974 (ERISA) and for health insurance issuers which have traditionally been regulated by the States. Under the HIPAA framework, in the event that a State does not enact the new Federal standards for health insurance issuers, the Health Care Financing Administration (HCFA) is required to enforce the provisions. As of June 30, 1998, officials in California, Rhode Island, and Missouri have voluntarily notified HCFA that they have failed to enact HIPAA standards in legislation. Two other States, Massachusetts and Michigan, are widely known to have not enacted conforming legislation, but the States have not notified HCFA, nor has HCFA initiated the formal process to determine if Federal regulation is necessary. In the case of the five States where HIPAA standards have not been adopted, HCFA must assume several functions normally reserved for State insurance regulators. These duties include (1) responding to consumer inquiries and complaints; (2) providing guidance to carriers about HIPAA requirements; (3) obtaining and reviewing carriers' product literature and policies for compliance with HIPAA standards; (4) monitoring carrier marketing practices for compliance; and (5) imposing civil monetary penalties on carriers who fail to comply with HIPAA requirements. HCFA officials have acknowledged that their agency has thus far taken a minimalist approach to regulating HIPAA, and they attribute the agency's limited involvement to a lack of experienced staff, as well as uncertainty about its actual regulatory authority. Originally assuming that States would adopt HIPAA legislation, HCFA reassigned only a small number of staff members to address enforcement issues. The reassigned staff generally came from other divisions and had no previous experience in private health insurance. As of July, 1998, HCFA has authorized 40 full-time staff members to work on all HIPAA-related issues. HCFA officials acknowledge that these new staffers will likely focus on responding to consumer inquiries and complaints. Officials also have said that they will need additional staff to conduct any further enforcement activities. They are unable to state their precise staff needs, because they are inexperienced in the regulation of private health insurance and are uncertain of their long- term responsibility. At a Labor Committee oversight hearing in March, HCFA Commissioner Nancy-Ann Min DeParle testified that HCFA may require an additional range of enforcement tools, beyond the already- established civil monetary penalties. Without formal notification of noncompliance from Massachusetts and Michigan, HCFA must undertake a determination process to establish the States' nonconformance, officially providing the authority for HCFA to become involved. HCFA officials have not yet undertaken this effort, which they characterize as cumbersome. The GAO has found that HCFA's review of carriers' product literature and policy compliance would be restricted by the Paperwork Reduction Act. The Act establishes a process for approval of any collection information, defined as collecting information from 10 or more persons. HCFA would need to obtain approval from the Office of Management and Budget for anything other than obtaining information in response to specific consumer complaints. To fulfill its regulatory duties, HCFA would need OMB approval to collect information from all carriers on a regular basis, which most State insurance commissioners already do. In California, Missouri, and Rhode Island, oversight of health benefits is divided between State insurance regulators and the Department of Labor. The addition of HCFA to the array of regulatory bodies may further fragment and complicate the regulation of private health insurance. This framework may lead to duplication, yet none of these agencies will have complete authority for regulating health insurance products. Ms. DeParle herself has stated that this would be a challenging ``patchwork quilt of Federal and State enforcement.'' One example is in Missouri, where the State's present small-group, guaranteed-issue requirement is applicable to groups of 3 to 25 individuals. HIPAA's small-group guaranteed-issue standard applies to policies sold to groups of 2 to 50 individuals. Therefore, in Missouri, HCFA has the responsibility for ensuring that carriers guarantee products to groups the size of 2 individuals, and groups the size of 26 to 50 individuals. The legislative history of HIPAA makes clear that the Congress intended that the effect of this legislation would be that all States would come quickly into compliance with the stated Federal standards, eliminating the need for active regulation by HCFA. We are now confronted by the fact that in at least five States HCFA must initiate enforcement with respect to group to individual market coverage. At a March 19, 1998, Labor Committee HIPAA oversight hearing, Don Moran of the Lewin Group testified: ``The lesson I take from HIPAA is that, in the complex world of health benefits regulation, the Federal government cannot tidily insert itself as a policy-setter in a predominantly State-administered regulatory regime.'' In establishing minimum Federal standards for health insurance, we may have to develop alternative approaches to the HIPAA framework so as to encourage States to meet Federal standards and retain enforcement responsibilities. Mr. President, the GAO report concludes that HCFA's regulatory role is likely to expand as it assumes enforcement responsibilities to ensure States' compliance with HIPAA. It is clear that HCFA's new regulatory responsibilities will increase the burden faced by health carriers and regulators, and will add to the confusion faced by consumers, who try to navigate through the intricate system of overlapping and duplicative regulatory jurisdiction.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am pleased the Senate has turned to consideration of the Community Opportunities, Accountability, Education and Training Services Act of 1998--the COATS Act--which reauthorizes the Human Services Act. This legislation, sponsored by Senator Coats, Senator Dodd, myself, and Senator Kennedy, was voted unanimously out of the Senate Labor and Human Resources Committee on June 24, 1998, and continues to have broad bipartisan support. This bill includes the reauthorization of three of our most important programs providing services and assistance to the neediest of Americans: the Head Start program, the Community Services Block Grant, and the Low Income Home Energy Assistance Program. It also includes a new program, the Assets for Independence Act, to empower these citizens into achieving economic independence. This legislation draws upon over thirty years of experience with these programs. While each of these programs is working--and working well--there are clearly some things that we can be doing better. So while this bill leaves present law largely intact, it does include some important changes to make these programs more accountable and more effective in carrying out the specific tasks that we have asked of them. The Head Start Program has been instrumental in helping many children enter school ready to learn. It goes beyond child care, by providing medical, dental, and other services to children enrolled in the program. However, I believe that its major contribution has been to support parents in their role as the primary teacher for their children. Head Start is a comprehensive service program that has made a difference in the lives of so many children and their parents. While most of us know the difference that Head Start has made in the lives of millions of children and their parents, it is important that we continue to ensure that the program is the very best it can be. This reauthorization includes a major evaluation and research initiative. I believe this research will help demonstrate the positive impact of high quality, comprehensive services for children and families. More importantly, this initiative can provide the American people with more information about how best to help prepare all of our children for the challenges that lie ahead in the next century. We also have increased funding for the Infant and Toddler Head Start program. Although this program is relatively new, the emerging research on early brain development clearly indicates that tremendous benefits can be gained by supporting parents in their efforts to be good parents for their children. Few young parents have the family and community support networks that were once such an integral part of raising children. The Infant and Toddler program strives to re-create those networks in order to help mothers and fathers better meet the challenges of parenthood. One of the more controversial changes in this year's reauthorization is the inclusion of for-profit providers as eligible grantees for Head Start. Yet, working with Senators Kennedy and Dodd, we were able to reach an acceptable compromise that makes clear exactly what is and is not allowed. Briefly, the legislation opens up the competitive process to another segment of child care and human service provider . However, it does not require the Secretary to award a grant to a non-profit entity. It does not lessen the requirements and standards that any Head Start program must meet. I do not believe that, by virtue of an organization's tax status, it is either more or less capable of providing the high quality of services which we require of all Head Start grantees. I am pleased that an agreement on this issue has been reached. The second major program authorized under this legislation is the Community Services Block Grant. This program provides funding which enables States to work with their communities to reduce poverty. That's an easily defined goal, but getting there takes lots of work. Because it is locally-driven and community-based, the CSBG is used differently in every community--drawing upon available strengths and resources to meet the unique needs of each. In Vermont, the CSBG serves communities all across our state, from Brattleboro to the Northeast Kingdom. Under the current formula, Vermont receives a little more than $2.6 million in CSBG funds. Whether it's using CSBG dollars to help the underprivileged learn new job skills or go back to school, or helping families become self-sufficient by teaching them how to search for affordable housing or simply work within a budget, I think countless families and communities in our State would agree that the initial investment has earned priceless returns. Communities are using those dollars to make a difference. For this reason, I am pleased that we have made only minor adjustments in these programs, and that most of these changes make some necessary improvements that will allow us to better determine the effectiveness of CSBG programs. For example, this bill requires states to monitor their grantees to determine whether they are meeting performance goals, administrative standards, and financial management requirements. The bill also establishes state and federal accountability and reporting provisions, and requires grantees to participate in a performance measurement system. Presently, grantees may participate in this system, but are not required to do so. The changes in this bill mean that we will be able to better monitor the progress of programs and measure the effectiveness of the delivery of programs. I want to point out, however, that I am aware that through a technical change that we were unable to remove at the last minute, this legislation contains language repealing the Community Economic Development program. This was brought to my attention, and to the attention of the Ranking Member, last Friday, and we have taken steps to remedy the situation. Our House colleagues have indicated their bill will not repeal this provision, and Senator Coats and I have pledged that we will remove the language repealing this program in conference. This is a matter that was due to a technical oversight only; it is certainly not the intention of the committee to end this program, and I am grateful for the assistance of Congressman Bill Goodling and his staff in helping us resolve this matter satisfactorily. I also want to mention that I know there was some concern about allowing faith-based organizations to participate as direct grantees in CSBG programs. I want to be clear that this bill does not allow faith- based organizations any priority in becoming grantees. It simply says that they may participate. If a faith-based organization receives a grant, it will still be expected to run quality programs and operate in the same way any other grantee would, including establishing a tri- partite board to administer the programs. Further, there is language in this bill essentially grandfathering in existing community action agencies as eligible grantees, so there should not be a concern that current grantees will suddenly find themselves jockeying for funding. If they are delivering good services, they may continue to do so. There was also some concern over including a new program, the Neighborhood Innovation Project, as an allowable activity under the discretionary account because it would mean less funds for the other programs authorized in the account. Let me explain why this is not the case--and, in fact, if Congressional appropriators follow the authorization carefully, there should be more funding for programs within this account. Under current law, the discretionary account receives a set-aside of nine percent of the CSBG funds. Presently, the discretionary account only contains the community economic development programs and the rural community development programs as allowable expenditures. However, at appropriations time, the appropriators have been folding the National Youth Sports program (NYSP) and the Community Food and Nutrition Act (CFNP) into the nine percent set-aside. What the law actually says--and what this bill reinforces--is that the NYSP and the CFNP program are both worthwhile programs that should receive separately appropriated line-items; they should not be competing with the community economic development and rural community development initiatives to receive a part of that nine-percent set-aside. I hope the appropriators will follow the authorization and limit the programs funded through the nine-percent set-aside. Under the new bill, we maintain the NYSP and CFNP as separate accounts that do not compete with programs in the discretionary account. I know this all sounds like maudlin bookkeeping, but what it means is that, even with the new Neighborhood Innovation Project included in the discretionary account, there are now only three programs among which the discretionary account can be divided, not four. That should mean funding can go a little bit further for these programs. Meanwhile, the NYSP and CNFP can receive their own separate streams of funding. That is clearly our intent. While on the subject of the NYSP, let me just mention one change we made in the current program to ensure a more comprehensive delivery of services. What this legislation would do is link youth who participate in this five week summer program to community-based youth services that can serve their needs all year long. The third major program reauthorized in this legislation is the Low Income Home Energy Assistance Program (LIHEAP), which, due to the forward-funded nature of the program, is authorized through 2004. The program provides assistance to 4.3 million low-income households to help families pay their heating and cooling bills. LIHEAP is a state block grant program that has faced more than its fair share of budget cuts. In fact, I am very dismayed that appropriators on the House side have voted to slash funding for the program. Our bill reauthorizes the program at the $2 billion level and continues to authorize funds to be released on an emergency basis by the President. On that subject, we have included language that clarifies the criteria under which LIHEAP funds can be released during an emergency or natural disaster. Last winter, when much of Northern New England was devastated by a 100-year ice storm, 53 Senators unsuccessfully wrote to the President asking him to release LIHEAP emergency funds. Our bill includes language that will help states obtain funds when they face similar natural or economic disasters. Finally, this bill authorizes a new, $25 million program known as the Assets for Independence Act. This new program builds upon the Individual Development Accounts that we allowed under welfare reform. The Assets for Independence Act would help qualified, poor individuals establish individual savings accounts that they can later use for post- secondary education, purchase of a first home, or business capitalization. In Vermont, we are already operating a program very much like this under our welfare waiver. However, Vermont's program does not look exactly like what is in this bill, and I want to make it clear that Vermont, and any other state, may continue to operate existing IDA programs as they deem fit, using their existing resources. States do not have to make their program look like those established in this bill unless they specifically apply for the funding made available under this section. What is in this bill does not override any existing IDA program. Knowing this, I am pleased we were able to include this new section in the bill, as I know it has been a priority for Senator Coats, and I commend him for working with me to ensure that Vermont can continue to run its existing programs. This legislation is the result of months of hard work, negotiation, and compromise. This is a very good bill that deserves the support of the Senate. It reinforces what works in these programs, and discards what does not. It continues the mission that we began many years ago of empowering communities to help their most vulnerable populations, and it does this in a responsible manner. I am pleased with the bipartisan atmosphere that has surrounded this bill so far, and I look forward to finishing the reauthorization in the same manner. I want to thank Senator Coats for his excellent work on this important legislation. As always, it is a pleasure working with him, and I want to commend him for his hard work in crafting this compromise. Senator Kennedy and Senator Dodd were instrumental in drafting this bill and moving it through the committee, and each has left a definite mark on this legislation. I also appreciate the valuable input from Senators DeWine and Ashcroft in drafting some key provisions of the bill. There are a number of staff who have worked very hard on this legislation who deserve recognition for their efforts. In particular, I want to thank Stephanie Monroe with Senator Coats--her effort was extraordinary; Suzanne Day, Jeanne Ireland and Jim Fenton with Senator Dodd; Stephanie Robinson with Senator Kennedy; and Geoff Brown, Kimberly Barnes-O'Connor and Brian Jones of my staff. In addition, I want to note the contributions of Vince Ventimiglia with Senator Coats on the IDA section; Aaron Grau with Senator DeWine for his help with migrant and seasonal Head Start; Robin Bowen with Senator McConnell for her assistance on the CED correction; and Denzel McGuire with Chairman Goodling for her help in assuring a smooth debate with the House. Again, Mr. President, I am proud of this legislation and of all the work that has gone into it. I look forward to working with our House colleagues to approve final legislation, with broad bipartisan support, before the 105th Congress adjourns for the year. I yield the floor.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Senate Committee on Labor and Human Resources will be held on Tuesday, July 28, 1998, 10 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is Substance Abuse: The Science of Addiction and Options for Treatment. For further information, please call the committee, 202/224- 5375. committee on labor and human resources

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that an executive session of the Senate Committee on Labor and Human Resources will be held on Wednesday, July 29, 1998, 9:30 a.m., in SD-430 of the Senate Dirksen Building. The committee will consider S. 1380, Charter Schools Expansion Act and S. 2213, the Education Flexibility Amendments of 1998. For further information please call the committee, 202/224-5375.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I want to thank Senator Shelby and the entire Senate Transportation Appropriations Committee for their work putting together this legislation. I would like to briefly engage my colleagues in a colloquy on an issue important to me and my constituents in Vermont; preservation of our nation's historic covered bridges. The recently passed federal transportation legislation, ISTEA- 2, contains language authorizing funding to protect historic wooden covered bridges. The National Historic Covered Bridge Preservation Act asks the Secretary of Transportation to study the appropriate techniques to protect and preserve covered bridges, distribute this information to states and towns across the country and grant funds to fully repair and protect these beautiful old historic structures. The bill, that is now law, authorizes $10 million for these activities. I understand the difficulty my colleagues had in distributing funds in this legislation. Although no funds were directly appropriated for these activities, I would ask the Chairman of the Senate Transportation Appropriations Subcommittee if he would agree that preservation of historic covered bridges should be a priority?

Mr. JEFFORDS. Would the Senator agree that from available funds included in this legislation for the Federal Highway Administration that priority should be given to funding the collection and dissemination of information concerning historic covered bridges, conduct research on the history of historic covered bridges, and study the techniques for protecting historic covered bridges from rot, fire, natural disasters or weight related damage? Would the Senator agree that the Federal Highway Administration should use available funds to develop and publish guidance for implementation of the National Historic Covered Bridge Preservation Act?

Mr. JEFFORDS. Would the Chairman of the Senate Transportation Appropriations Committee agree that funding for the repair and reconstruction of covered bridges should be given priority within the Bridge Discretionary Program?

Mr. JEFFORDS. I would like to thank both Chairman Chafee and Chairman Shelby for their commitment to covered bridges and for working with me to ensure that the program is fully funded within available funds at the U.S. Department of Transportation.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, July 25, 1998, is a great day for Vermont as we celebrate the sesquicentennial anniversary of the Blodgett Oven Company. On behalf of all Vermonters, I want to wish the company a very happy anniversary. For one hundred and fifty years, the Blodgett Oven Company has been a commercial cooking products manufacturer in Burlington, Vermont. Their products are renowned for their reliability and quality. Throughout the world, Blodgett ovens, broilers, steamers, and fryers are depended upon by the food service industry. Chefs know that they can trust the Blodgett name to deliver efficient, technologically advanced machinery. Within Chittenden County, the Blodgett Oven Company plays an important role, stimulating the local economy by providing hundreds of jobs to area residents. Mr. President, the Blodgett Oven Company is one of the most successful businesses in the state of Vermont. Their innovative products are well-known and, among their clientele, the company is regarded very highly. This tribute recognizes the achievements of the Blodgett Oven Company and, equally as important, the workers who contribute to the company's success.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to share some great news and to give thanks to the Members who helped me with respect to this very emotional situation that we have dealt with. I want to share the great news that three young Vermont girls who were abducted to Egypt are now back. I want to thank 56 of my colleagues for their support in this case for signing a letter to urge their return to Vermont. I also want to thank the Egyptian and American Governments for their invaluable assistance. Last October, anticipating a Vermont court order giving his wife sole custody of their three girls, Michael Zaazhoa took Sarah, Maryam and Leila under falsified passports and fled to Egypt. Lamis Zaazhoa began the frantic search for her girls, ages 3, 5 and 6, which took 9 months, and culminated in a joyful reunion at the U.S. Embassy in Cairo this past Friday. Lamis listened to the wise counsel of her family and decided to go the long, anxious route of petitioning the Egyptian courts for sole custody of her children under Egyptian law and getting an Egyptian court order for the return of her girls. The Vermont delegation quickly swung into action in support of her efforts, enlisting the help of the U.S. Embassy in Cairo and the Egyptian Embassy in Washington. After the Egyptian courts ruled squarely in Lamis's favor, I walked around the Senate floor with a letter from Senator Leahy and me to President Mubarak of Egypt, asking for his support. Fifty-five of my Colleagues signed this letter. I am deeply appreciative of my Colleagues help, which I consider pivotal to the success of our efforts. And I am very grateful to the Egyptian Embassy and Egyptian Government for its help in ensuring that Egyptian law was enforced and the girls were returned to their mother. The staff of the American Embassy was there for us all along, and arranged the swift return to the United States of Lamis and her girls once they were reunited. I wish I could have invited all of my colleagues to the wonderful meeting Senator Leahy and I had with these three sweet girls yesterday! Their beautiful smiles and the joy on Lamis's face deeply touched the hearts of all those present. In difficult situations like these, we rely on the good offices of our Government, and the cooperation of our friends in foreign governments. And yesterday we saw with our own eyes the beautiful fruits of those efforts! This is an unusual result. Many of these cases occur, but very, very few are reconciled the way this was. I thank Jeff Munger of my staff in Vermont, whose sister brought to his attention the plight of the children and spearheaded the results that we got. So, again, I thank all the Members for their helpfulness in getting the three little girls back to Vermont. I thank the Chair.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent to speak for 3 minutes as in morning business.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am glad to cosponsor the Pension Coverage and Portability Act of 1998, (PCPA). I cosponsored the predecessor bill, S. 889 with senators Graham, Hatch, and others, and PCPA is a natural follow-on to S. 889. This bill will encourage pension plan sponsorship among small businesses and make it easier for the small business man or woman to have greater confidence in government oversight of their plan and that they will not have to constantly hire services of actuaries, accountants and tax attorneys and investment advisers once they establish it. The bill makes it easier to implement a payroll deduction IRA, it provides for a simplified defined benefit pension plan, it allows a payroll deduction SIMPLE plan with limits twice as high as those currently available to IRAs, it eliminates IRS registration fees for new plans and provides a tax credit for plan start up, as well as many other things. The bill also eases the top-heavy rules. In the days when the only small pension plans belonged to doctor's and lawyer's offices, the top heavy rules were needed to assure non-discrimination in provision of benefits. But instead of expanding coverage, the top heavy rules now tend to impose harsh requirements on the small business owner which deters him or her from even offering a plan. This bill makes changes to the top heavy rules in constructive and thoughtful ways, such as by changing the family aggregation rules, taking employee elective contributions into account for purposes of meeting the standards and simplifying the definition of `key employee'. The bill makes pension plans more portable, a feature that is desperately needed in today's highly mobile workforce. Senator Graham has incorporated the body of S. 2329, the bill that he, Senator Bingaman and I introduced recently, as Title III of PCPA. Our bill eases rollovers, allows rollovers of after-tax contributions, waives the 60-day rule under certain circumstances, modifies the ``same-desk'' rule, rationalizes distribution rules and allows governmental workers to purchase service credit with defined contribution plan money to increase their benefits in their defined benefit plans. This bill makes essentially the same changes. In addition to encouraging plan sponsorship among small businesses and facilitating pension portability, the bill encourages retirement savings education. It also reduces the regulatory burdens associated with maintaining a plan, such as providing coverage test flexibility and freedom from the requirement to use mechanical nondiscrimination testing rules. Although I believe the vast majority of this measure takes positive steps forward, I do have some misgivings about the staffing firms provision included in section 108. I am cosponsoring PCPA despite the inclusion of section 108 in the bill, but I hope that Senator Graham and the other cosponsors will work with me to air the issues and try to address the concerns of those who oppose this provision in as constructive a manner as is appropriate.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Senate Committee on Labor and Human Resources will be held on Thursday, July 23, 1998, 10:00 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is Presidential Nominees Ida Castro and Paul Igasaki to be Members of the Equal Employment Opportunity Commission. For further information, please call the committee, 202/224-5375. subcommittee on water and power

Mr. JEFFORDS

Mr. JEFFORDS. This has been, to me, one of the more important days of this session. I believe that is true because of the introduction earlier by Senator Lott of the Republican health care bill. First, I commend the majority leader for the dexterous way in which he handled both allowing the members of a committee, a standing committee, to work, and then to join them with a leadership task force, formed by the majority leader, to put together a bill which could be backed by all Members of the Republican side. That was no easy task, but I am happy to say that by working together I think we have provided, for the Senate's review, an outstanding piece of legislation. I also want to begin by commending Senator Nickles and all the Members who participated in putting this legislation together on the task force, and in my committee. I think it is solid legislation that will result in a greatly improved health care system for Americans. I am proud to be a cosponsor of the Patients' Bill of Rights. As always, there has been a flurry of work over the past few weeks as we have put this legislation together. But this last-minute work is only possible because we laid a sound foundation throughout the entire 105th Congress through many hearings. In particular, there are members on my committee, who also served on the task force, who I think were key in bringing about a consensus. First, Senator Frist, who, obviously, from his valuable expertise as a physician, as well as a masterful legislator, has assisted in helping us provide a bill which we can be proud of and which we can be assured will be in the best interest of all patients as well as the health care system. Senator Collins, who came here after being a State regulator in the health care area, provided tremendous knowledge and insight into how we could weave in and out the very complicated aspects of what should the Federal Government do and what should the States do, with leaving an emphasis primarily on allowing the States--which I will talk about later. Over the past 14 months, the Labor and Human Resources Committee has held 11 hearings related to issues of health care quality, confidentiality, genetic discrimination, privacy, and HCFA's implementation of its new health insurance responsibilities. Senator Bill Frist's Public Health and Safety Subcommittee has also held three hearings on the work of AHCPR. That has to do with trying to ensure that we have adequate information about outcomes and to try to utilize that information to better equip our professional people to be the best in the world in health care. Each of these hearings helped us in developing the separate pieces of legislation that are reflected in the Patients' Bill of Rights. Other colleagues here and on the House side have worked on this subject for an extended period of time, as well. Many of the protections that are included in the Patients' Bill of Rights are similar to those fashioned by Senator Roth in the Finance Committee last year when we provided many of these same protections to plans that serve Medicare patients. As we prepared this legislation, we had three goals in mind: first, give families the protections they want and need; second, ensure that medical decisions are made by physicians in consultation with their patients; and, finally, keep the cost of this legislation low so it does not displace anyone from being able to get health care coverage. As we all know, the number of people who participate is extremely sensitive to the cost of health care. Information about products or services is the keystone to any well-functioning market. The bill requires full information disclosure by an employer about the health plans that he or she offers employees. People need to know what the plan will cover and what their out-of-pocket expenses will be. And this should be in clear and obvious language which is readily available for the patient or the prospective purchaser of the insurance to review so they do not suddenly realize they have run out of money as far as the plan is concerned or they find that many aspects are not covered. They need to know where and how they will get their health care, and who will be providing these services. They also need to know how adverse decisions by the plan can be appealed, both internally and externally, to an independent reviewer. This is an extremely important part of this bill. This aspect of the bill which gives employees a brand new ERISA remedy of an external grievance and appeals process is one of which I am particularly proud since it is the cornerstone of S. 1712, my Health Care QUEST Act, which, incidentally, was a bipartisan bill. Under our bill, patients will get timely decisions about what will be covered. Further, if an individual disagrees with the plan's decision about coverage, that individual may ultimately appeal the decision to an independent, external reviewer after an internal review decision. And this can be done in an expedited situation, if it is necessary. The reviewer's decision will be binding on the part of the health plan, and the patients maintain their rights under ERISA to go to court. This is extremely important. This will be binding on the plan. So there will be no appeal by the plan through the courts or elsewhere from the decision by the reviewer. It is infinitely better to be able to get the care needed than to sue to recover damages because he or she could not get the care they needed, and the fact that that care was not being granted resulted in grievous situations for them. The medical records provision, which my committee also worked on for the past year, will give people the right to inspect and copy their personal medical information, and it will also allow them to append the record if there is inaccurate information. The bill will ensure that the holders of the information safeguard the medical records and requires them to share, in writing, their confidentiality policies and procedures with individuals. This is part of what was called the PIN Act, the Privacy Act, which also was a bipartisan bill. I want to again mention the task force. Senator Nickles started out some months ago desiring to provide the Republicans with a bill with which they could be pleased. A lot of work went into that. Many, many meetings were held. Many hours were spent trying to decide and make final decisions. I was a member of that task force, as was Senator Frist and Senator Collins from our committee. We had the ability to be able to utilize the expertise of the committee and the professional staff involved with them. I would like to mention Paul Harrington, in particular, and Karen Guice, of my staff, who is also a pediatrician and a fellow, for their incredibly good determinations on what the bill should have and their assistance in putting it together. I praise Senators Snowe and Domenici, who worked together to give us a portion of the bill which has to do with genetics and the protections that a patient should have, or an enrollee in a plan should have, to ensure that the genetic information--that genetic information--is not used against them to screen them. What I want to get to now, and I know there will be a lot more discussion next week, is the question of whether or not it is better to hand over much of the regulation to the Federal Government or whether it is better to leave it with the States. The 104th Congress enacted the Kassebaum-Kennedy legislation known as the Health Insurance Portability and Accountability Act in 1996, fondly referred to as HIPAA. Many consider this legislation to be the most significant Federal health insurance reform of the past decade. During this Congress, I have tried to closely monitor the impact of HIPAA over the past year to ensure its successful implementation consistent with legislative intent. The Federal regulators at HCFA have faced an overwhelming new set of health insurance duties under HCFA. What we said was that if the States wanted to--and almost all of them did--they could take control and implement the provisions of HIPAA. But five decided not to--California, Massachusetts, Michigan, Rhode Island, and Missouri. So what happened is that enforcement was handed over to the Federal Government. That is the point I want to make as to what has happened because of that. The Department of Health and Human Resources is now required to act as the insurance regulator for the State HIPAA provisions. Based on the findings of the GAO report that will be released next week, HCFA is ill equipped to carry out the role of insurance regulator. Building a dual system of overlapping State and Federal health insurance regulation is in no one's best interest, and the principle that States should regulate private health insurance guided the design of our legislation to get out of the problems created by HIPAA. Our legislation creates new Federal managed care standards to cover those 48 million Americans covered by ERISA plans that the States cannot protect. That is the second point. There are areas that the State is preempted from by ERISA which was passed in 1976. Under ERISA, it stated that those plans for self-insured or those that are multistate situations are under Federal order to provide uniformity in the regulation. We feel it would be irresponsible to set health insurance standards that duplicate their responsibility to the 50 State insurance departments and have HCFA enforce them. In a July 16 House Ways and Means committee hearing, HCFA's administrator stated she intended to postpone, among other things, prospective payment systems for home health services. To Members who will note this, this is a real blow to many States, Vermont in particular, who are being damaged severely by the present situation with respect to the home health care services and payments. The balanced budget amendment of 1997 establishes a prospective payment system, or PPS, for home health care in fiscal year 2000. The payment system designed for the interim period is proving to be an intolerable burden for the home health agencies that service Vermont's Medicare beneficiaries. They have already written to urge HCFA to urge a PPS by the October 1999 deadline set by Congress, thus minimizing the time an interim payment system will be in place. Her statement that she has delayed will result in many home health providers not receiving the reimbursement that they deserve. Given HCFA's inability to carry out its current responsibilities, I believe it would be irresponsible to promise the American people that it will be able to guarantee other rights by regulating the private health insurance industry. I will not offer Americans a promise that experience tells us will be broken, a hope that I believe won't be met. Our proposal, by keeping the regulation of health insurance where it belongs--at the State level--provides the American people with a real Patients' Bill of Rights that they can have the confidence in knowing that they will be there when they need it. I am afraid that the political battle over this legislation will be the subject that dominates the headlines. But the real issue here is to give Americans the protections they want and need in the package that they can afford and that we can enact, and also that they will have a remedy which will allow them to expeditiously get the care they need by having outside professionals give them that opportunity. That is why I and others have been working on this legislation since the beginning of Congress and why I hope it will be adopted before the end of Congress and signed into law by the President. This is too important of an issue for us to get bogged down in partisanship. I know the Democrats, and many of them on my committee, too, have worked very hard on their own bills. But let us not try to find out whose bill is better. Let us join together and make sure we can put together in the final analysis, through the legislative process, a bill which we all can be proud of and which the American people will be pleased with.

Mr. JEFFORDS

Mr. JEFFORDS. Madam President, in January of this year I addressed the Senate along with my colleagues from New York and Maine about the awesome ice storm that struck our area. Thanks to the help of Chairman Bond and others, our region received much needed assistance and relief. Today, I rise to inform my colleagues that Vermont has experienced yet another series of natural disasters. During the past few weeks the state of Vermont has received tremendous amounts of rain, causing severe flooding throughout the state. In fact, eleven of our fourteen counties were declared disaster areas after several days of heavy rain flooded streams and rivers. Hardest hit was the pristine Mad River in central Vermont. The river's stream banks were overwhelmed. Heavy sediment washed down the river depleting water quality. However, in sections of the river where methods to protect the stream banks through bioengineering and vegetation planting were established, the banks held steady during the floods preventing soils and sediments from entering the water system. Assistance is needed in the Mad River Valley of Vermont. The quality of the water in the Mad River is of great importance to the communities in the valley. Because of the recent flooding there is a need for the Environmental Protection Agency to provide assistance for maintaining that water quality. I am aware of the devastation that occurs during a long period of heavy rain and understand the impact it can have on a river's health and appearance. Protecting the water quality is important. EPA should provide assistance to the Mad River Valley Union Municipal District to assist them in water quality improvements. Experimenting with new methods to protect our river banks will help find solutions to maintain water quality and the health of our rivers, as well as safeguard the property and lives that inhabit the river valleys. Madam President, with help from the EPA, more creative methods could be established and tested along the Mad River helping maintain water quality and the beauty of the river. metered-dose inhalers

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I want to begin by commending Senator Nickles and all of the Members who participated in putting the ``Patients' Bill of Rights'' legislation together. I think it is solid legislation that will result in a greatly improved health care system for Americans and I am proud to be a co-sponsor of the ``Patients' Bill of Rights.'' As always, there has been a flurry of work over the past few weeks as we have put this legislation together. But this last minute work is only possible because we have laid a solid foundation throughout the entire 105th Congress. Over the past 14 months, the Labor and Human Resources Committee has held 11 hearings related to the issues of health care quality, confidentiality, genetic discrimination and the Health Care Financing Administration's (HCFA) implementation of its new health insurance responsibilties. Senator Bill Frist's Public Health and Safety Subcommittee has also held three hearings on the work of the Agency of Health Care Policy and Research (AHCPR). Each of these hearings helped us in developing the separate pieces of legislation that are reflected in our ``Patients'' Bill of Rights.'' Other colleagues here and on the House side, have worked ont this subject for an extended period of time. Many of the protections that are included in the ``Patients' Bill of Rights'' are similar to those fashioned by Senator Roth and the Finance Committee last year when we provided many of these same protections to plans that serve Medicare patients. As we prepared this legislation we had three goals in mind. First, give families the protections they want and need. Second, ensure that medical decisions are made by physicians in consultation with their patients. And finally, keep the cost of this legislation low so it does not displace anyone from being able to get health-care coverage. Information about products or services is the keystone to any well functioning market. This bill requires full information disclosure by an employer about the health plans he or she offers to employees. People need to know what the plan will cover and what their out-of- pocket expenses will be. They need to know where and how they will get their health care and who will be providing those services. They also need to know how adverse decisions by the plan can be appealed, both internally and externally to an independent reviewer. This aspect of our bill, that gives enrollees a new ERISA remedy of an external grievance and appeals process, is one of which I am particularly proud since it is the cornerstone of S 1712, the Health Care QUEST Act, that I introduced with Senator Lieberman. Under the ``Patients' Bill of Rights,'' enrollees will get timely decisions about what will be covered. Furthermore, if an individual disagrees with the plan's decision, that individual may ultimately appeal the decision to an independent external reviewer. The reviewer's decision will be binding on the part of the health plan. But, the patient maintains his or her current rights under ERISA to go to court. The medical records provisions, which my committee has also worked on for the past year and are contained in S. 1921, the Health Care PIN Act, which I introduced with Senator Dodd, will give people the right to inspect and copy their personal medical information and it will allow them to amend the record if there is inaccurate information. The bill will ensure that the holders of the information safeguard the medical records. It requires them to share, in writing, their confidentiality policies and procedures with individuals. The 104th Congress enacted the Kassebaum/Kennedy legislation, also known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Many consider this legislation to be the most significant federal health insurance reform of the past decade. During this Congress, I have tried to closely monitor the impact of HIPAA over the past year to ensure its successful implementation and consistency with legislative intent. The federal regulators at HCFA have faced an overwhelming new set of health insurance duties under HIPAA. In the five states that have failed to or chosen not to pass the legislation required by HIPAA (California, Massachusetts, Michigan, Rhode Island, and Missouri), the Department of Health and Human Services is now required to act as insurance regulator for the state HIPAA provisions. Based on the findings of a GAO report that I will be releasing next week, our experience under HIPAA demonstrates that HCFA is ill equipped to carry out the role of insurance regulator. Building a dual system of overlapping state and federal health insurance regulation is in no one's best interest. The principle that the states should continue to regulate the private health insurance market guided the design of our ``Patients' Bill of Rights'' legislation. Our legislation creates new federal managed care standards to cover those 48 million Americans covered by ERISA plans that the states cannot protect. We feel that it would be inappropriate to set federal health insurance standards that duplicate the responsibility of the 50 state insurance departments and have HCFA enforce them. A recent example demonstrates why this is such a concern. The Balanced Budget Act of 1997 establishes a prospective payment system (PPS) for home health care in fiscal year 2000. The payment system designed for the interim period is proving to be an intolerable burden for the home health agencies that serve Vermont's Medicare beneficiaries. At a July 16th House Ways and Means hearing, HCFA's administrator stated that she intended to postpone the development of a Medicare prospective payment systems for home health services. Her statement that she is delaying this mandate will result in many home health providers not receiving the reimbursement that they deserve and puts many of those providers at risk. Given HCFA's inability to carry out its current responsibilities, I believe it would be irresponsible to promise the American people that they will be able to receive new federal guarantees in the private health insurance system if we are relying on HCFA to enforce these rights. Our proposal, by keeping the regulation of health insurance where it belongs--at the state level--provides the American people with a real Patients' Bill of Rights that they can have the confidence in knowing will be enforced. I am afraid that the political battle over this legislation will be the subject that dominates the headlines. But the real issue here is to give Americans the protections they want and need in a package that they can afford and that we can enact. That is why I and others here have been working on this legislation since the beginning of this Congress, and why I hope the ``Patients' Bill of Rights'' we have introduced today will be adopted before the end of the Congress and signed into law by the President.

Mr. JEFFORDS. Mr. President, today I am introducing S. 2329, the Retirement Portability Account (RAP) Act. This bill is a close companion to H.R. 3503 introduced by our colleagues Earl Pomeroy of North Dakota and Jim Kolbe of Arizona earlier this year. In addition, it contains certain elements of H.R. 3788, the Portman-Cardin bill, which relate to increased pension portability. Generally this bill is intended to be a further iteration of the concepts embodied in both of those bills. It 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. Consistent with ``greatly improving the status quo'', this bill contains no mandates. No employer will be ``required'' to accept rollovers from other plans. 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) 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 uses 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. 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- Kolbe 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 change proposed by the Portman- Cardin bill, 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 this deadline, as well. The Retirement Account Portability bill 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 due 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. 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 plan in which they are currently participating, and thus obtain greater pension benefits in the plan in which they conclude their career. However, the bill does not allow the use of a lump sum cash-out from a defined benefit plan to be rolled over to a section 403(b) or section 457 plan. 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. I am not necessarily against the shorter vesting schedules, but I feel that this abbreviated vesting 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. Mr. President, I ask unanimous consent that a summary of the bill be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today I am introducing S. 2329, the Retirement Portability Account (RAP) Act. This bill is a close companion to H.R. 3503 introduced by our colleagues Earl Pomeroy of North Dakota and Jim Kolbe of Arizona earlier this year. In addition, it contains certain elements of H.R. 3788, the Portman-Cardin bill, which relate to increased pension portability. Generally this bill is intended to be a further iteration of the concepts embodied in both of those bills. It 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. Consistent with ``greatly improving the status quo'', this bill contains no mandates. No employer will be ``required'' to accept rollovers from other plans. 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) 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 uses 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. 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- Kolbe 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 change proposed by the Portman- Cardin bill, 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 this deadline, as well. The Retirement Account Portability bill 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 due 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. 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 plan in which they are currently participating, and thus obtain greater pension benefits in the plan in which they conclude their career. However, the bill does not allow the use of a lump sum cash-out from a defined benefit plan to be rolled over to a section 403(b) or section 457 plan. 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. I am not necessarily against the shorter vesting schedules, but I feel that this abbreviated vesting 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. Mr. President, I ask unanimous consent that a summary of the bill be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I want to begin by commending Senator Nickles and all of the Members who participated in putting the ``Patients' Bill of Rights'' legislation together. I think it is solid legislation that will result in a greatly improved health care system for Americans and I am proud to be a co-sponsor of the ``Patients' Bill of Rights.'' As always, there has been a flurry of work over the past few weeks as we have put this legislation together. But this last minute work is only possible because we have laid a solid foundation throughout the entire 105th Congress. Over the past 14 months, the Labor and Human Resources Committee has held 11 hearings related to the issues of health care quality, confidentiality, genetic discrimination and the Health Care Financing Administration's (HCFA) implementation of its new health insurance responsibilties. Senator Bill Frist's Public Health and Safety Subcommittee has also held three hearings on the work of the Agency of Health Care Policy and Research (AHCPR). Each of these hearings helped us in developing the separate pieces of legislation that are reflected in our ``Patients'' Bill of Rights.'' Other colleagues here and on the House side, have worked ont this subject for an extended period of time. Many of the protections that are included in the ``Patients' Bill of Rights'' are similar to those fashioned by Senator Roth and the Finance Committee last year when we provided many of these same protections to plans that serve Medicare patients. As we prepared this legislation we had three goals in mind. First, give families the protections they want and need. Second, ensure that medical decisions are made by physicians in consultation with their patients. And finally, keep the cost of this legislation low so it does not displace anyone from being able to get health-care coverage. Information about products or services is the keystone to any well functioning market. This bill requires full information disclosure by an employer about the health plans he or she offers to employees. People need to know what the plan will cover and what their out-of- pocket expenses will be. They need to know where and how they will get their health care and who will be providing those services. They also need to know how adverse decisions by the plan can be appealed, both internally and externally to an independent reviewer. This aspect of our bill, that gives enrollees a new ERISA remedy of an external grievance and appeals process, is one of which I am particularly proud since it is the cornerstone of S 1712, the Health Care QUEST Act, that I introduced with Senator Lieberman. Under the ``Patients' Bill of Rights,'' enrollees will get timely decisions about what will be covered. Furthermore, if an individual disagrees with the plan's decision, that individual may ultimately appeal the decision to an independent external reviewer. The reviewer's decision will be binding on the part of the health plan. But, the patient maintains his or her current rights under ERISA to go to court. The medical records provisions, which my committee has also worked on for the past year and are contained in S. 1921, the Health Care PIN Act, which I introduced with Senator Dodd, will give people the right to inspect and copy their personal medical information and it will allow them to amend the record if there is inaccurate information. The bill will ensure that the holders of the information safeguard the medical records. It requires them to share, in writing, their confidentiality policies and procedures with individuals. The 104th Congress enacted the Kassebaum/Kennedy legislation, also known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Many consider this legislation to be the most significant federal health insurance reform of the past decade. During this Congress, I have tried to closely monitor the impact of HIPAA over the past year to ensure its successful implementation and consistency with legislative intent. The federal regulators at HCFA have faced an overwhelming new set of health insurance duties under HIPAA. In the five states that have failed to or chosen not to pass the legislation required by HIPAA (California, Massachusetts, Michigan, Rhode Island, and Missouri), the Department of Health and Human Services is now required to act as insurance regulator for the state HIPAA provisions. Based on the findings of a GAO report that I will be releasing next week, our experience under HIPAA demonstrates that HCFA is ill equipped to carry out the role of insurance regulator. Building a dual system of overlapping state and federal health insurance regulation is in no one's best interest. The principle that the states should continue to regulate the private health insurance market guided the design of our ``Patients' Bill of Rights'' legislation. Our legislation creates new federal managed care standards to cover those 48 million Americans covered by ERISA plans that the states cannot protect. We feel that it would be inappropriate to set federal health insurance standards that duplicate the responsibility of the 50 state insurance departments and have HCFA enforce them. A recent example demonstrates why this is such a concern. The Balanced Budget Act of 1997 establishes a prospective payment system (PPS) for home health care in fiscal year 2000. The payment system designed for the interim period is proving to be an intolerable burden for the home health agencies that serve Vermont's Medicare beneficiaries. At a July 16th House Ways and Means hearing, HCFA's administrator stated that she intended to postpone the development of a Medicare prospective payment systems for home health services. Her statement that she is delaying this mandate will result in many home health providers not receiving the reimbursement that they deserve and puts many of those providers at risk. Given HCFA's inability to carry out its current responsibilities, I believe it would be irresponsible to promise the American people that they will be able to receive new federal guarantees in the private health insurance system if we are relying on HCFA to enforce these rights. Our proposal, by keeping the regulation of health insurance where it belongs--at the state level--provides the American people with a real Patients' Bill of Rights that they can have the confidence in knowing will be enforced. I am afraid that the political battle over this legislation will be the subject that dominates the headlines. But the real issue here is to give Americans the protections they want and need in a package that they can afford and that we can enact. That is why I and others here have been working on this legislation since the beginning of this Congress, and why I hope the ``Patients' Bill of Rights'' we have introduced today will be adopted before the end of the Congress and signed into law by the President.

Mr. JEFFORDS

Mr. JEFFORDS. I would like to join Senator Leahy in expressing my hope that we can revisit the issue of disaster assistance funding in conference. Senator Leahy and I toured the damage in Vermont following the flooding there earlier this month, and the damage for farmers in affected areas was indeed severe. Those farmers are going to need assistance and I hope that we will be able to provide it in this bill.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, on June 23, 1998, I filed Report 105-220 to accompany S. 1754, the Health Professions Education Partnerships Act of 1998, a bill to consolidate and reauthorize health professions and minority and disadvantaged health education programs, and for other purposes. At the time the report was filed, an incorrect estimate was filed by the Congressional Budget Office. Since that time, the CBO has corrected its estimate. I ask that a complete copy of the revised CBO estimate be printed in the Record. The estimate follows: U.S. Congress, Congressional Budget Office, Washington, DC, June 24, 1998. Hon. James M. Jeffords, Chairman, Committee on Labor and Human Resources, U.S. Senate, Washington, DC. Dear Mr. Chairman: The Congressional Budget Office has prepared the enclosed revised cost estimate for S. 1754, Health Professions Education Partnerships Act of 1998. This revised estimate supersedes CBO's estimate of May 28, 1998, and corrects an error in the assumed subsidy rate for Health Education Assistance Loans. If you wish further details on this estimate, we will be pleased to provide them. The CBO staff contact is Cyndi Dudzinski, who can be reached at 226-9010. Sincerely, June E. O'Neill, Director. Enclosure.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise to once again express my concern over the plight of Medicare beneficiaries who are in need of home health care services. I am pleased to cosponsor the Home Health Access Preservation Act of 1998, with my colleagues on the Senate Finance Committee, as an attempt to address these concerns. The Interim Payment System which was enacted by this Congress for the reimbursement of home health care services is not achieving the policy goals that Congress wants nor is it not serving the best interest of American citizens. The act is appropriately titled because, without a correction, access to home health services for Medicare's most vulnerable beneficiaries will be seriously damaged. Since the new reimbursement system has been implemented, no fewer than 1,200 agencies have left Medicare program and most of these 1,200 have been forced to cease operations. Although many of our health policy actions are based upon allowing the market to determine the optimum efficiency of our health care system, we must recognize that not all areas and all sectors are prepared for a rapid change in how these forces operate. The problem of access to home care is particularly troublesome in rural areas and inner cities where these services are sorely needed. My home State of Vermont is a case in point. Home health agencies and their patients are facing a true crisis. There are only 13 agencies in the State, all not-for-profit, each serving a distinct and separate area. The system was developed to meet the needs of our largely rural State, and all of these agencies have a long tradition of providing quality care to our citizens. We cannot accept the loss of a single agency without serious consequences for patients and other sectors of care. I want to emphasize that today we are proposing a revision to the home health reimbursement system because of our deep concern for the welfare of those frail elders and disabled individuals who have come to depend upon home care for their very existence. Yes, we are concerned about fiscal responsibility. We remain determined to eliminate fraud and abuse within the Medicare program. Of course, we must find a way to preserve the Medicare Trust Fund for future generations. But it is not acceptable to seek these goals by any mechanism that will impose an even greater burden on those who are most in need of our help. The Home Health Access Preservation Act of 1998 is budget neutral. It does not change the fact that home health agencies will have to work hard to remain financially viable and allocate their resources carefully. The Act does, however, level the playing field for home health agencies. Under the present IPS system, agencies in close proximity to one another are expected to operate competitively under highly divergent payment limits. Furthermore, under the current IPS system, the most efficient agencies and those that care for the most difficult cases, are hit hardest by the reduction in reimbursement. Thus the Act does provide some relief for agencies in the worst predicament. Finally, it is important to recognize that the Home Health Access Preservation Act represents an interim resolution to our most pressing concerns. The implementation of a prospective payment system as directed by Congress represents the preferred solution. Thus, the bill requires the Secretary to provide regular quarterly updates to Congress on progress toward the development of the prospective payment system for home health care. But for now, Congress must pass legislation to ensure that home care remains an option for Medicare beneficiaries. We also must pledge to work with the Health Care Financing Administration and the home health industry to replace the interim payment system with a permanent system which better meets the needs of patients and is fair to health care providers. This Congress struggles with many challenges, but I doubt that there are many that are of greater significance than home health care. Access to home care affects a significant number of persons, has a serious influence on their mental and physical health, and its financial impact is measured in billions of dollars. We must act. We must act quickly to curtail the negative consequences of the payment system as it exists today.