Pat Roberts

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask unanimous consent that when the Senate completes its business today, it recess until the hour of 9:30 in the morning on Tuesday, September 26. I further ask unanimous consent that on Tuesday, immediately following the prayer, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate then begin consideration of the H-1B visa bill as under the previous order.

Mr. ROBERTS. Further, I ask unanimous consent that the Senate stand in recess from the hours of 12:30 p.m. to 2:15 p.m. for the weekly policy conferences to meet.

Mr. ROBERTS. Mr. President, I ask unanimous consent that the scheduled cloture vote occur at 10:15 on Tuesday morning with the time prior to the vote divided as ordered previously.

Mr. ROBERTS. I ask unanimous consent that second-degree amendments may be filed at the desk up to 10:15 in the morning under the terms of rule XXII.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, for the information of all Senators, the Senate will begin 45 minutes of debate on the H-1B visa bill at 9:30 tomorrow morning. Following that debate, at 10:15 a.m., the Senate will proceed to a cloture vote on the pending amendment to the H-1B legislation. If cloture is invoked, the Senate will continue debate on the amendment. If cloture is not invoked, the Senate is expected to resume debate on the motion to proceed to S. 2557, the National Energy Security Act of 2000. Also this week, the Senate is expected to take up any appropriations conference reports available for action. Mr. SESSIONS addressed the Chair.

Mr. ROBERTS. Mr. President, I yield the floor.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed, the amendment to the title be agreed, the motion to reconsider be laid upon the table, and any statement relating to this resolution be printed in the Record.

Mr. ROBERTS. Mr. President, I ask unanimous consent that the Senate now proceed to the immediate consideration of S. Res. 304, which was reported by the Judiciary Committee.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask to reconsider the vote, and on behalf of the Senator from New Hampshire, Mr. Smith, I move to table my own motion.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, late in the afternoon of this coming Thursday, the U.S. Marine Corps will conduct a retirement ceremony at the Marine Corps War Memorial in Arlington, VA. It would not be too surprising for all who know the honoree, if those legendary marines raising the flag atop Mt. Suribachi at the Iwo Jima Memorial and ensconced in statuary history might actually plant the flag, come to attention and give a proud salute to Gen. Charles E. Wilhelm. Now retired after 35 years of service and the former commander of the U.S. Southern Command, Charles Wilhelm has been the epitome of dedication, professionalism, and pride. Simply put, he has been a marine's marine. In paying tribute to General Wilhelm, my remarks are in keeping with the appreciation, admiration, and thanks of my colleagues in the Senate, more especially the chairman and members of the Armed Services Committee, all those privileged to serve on committees of jurisdiction dealing with our national defense and foreign policy and former marines who serve in the Congress. I think Charles Wilhelm was destined to serve in our Nation's sea service and become an outstanding marine in that he was born of the shores of Albemarle Sound in historic Edenton, NC. He graduated from Florida State University and later earned a master of science degree from Salve Regina College in Newport, RI. He was commissioned a second lieutenant in 1964 and saw two tours of service in Vietnam where in the full component of command positions, he served with distinction: as a rifle platoon commander; company commander; and senior advisor to a Vietnamese Army battalion. For his heroism under fire, he was awarded the Silver Star Medal, Bronze Star Medal with Combat V, Navy Commendation Medal with Combat V, and the Army Commendation Medal with Combat V. General Wilhelm's other personal decorations include the Defense Service Medal with Oak Leaf Cluster, the Distinguished Service Medal, Defense Meritorious Service Medal, the Navy Commendation Medal, and Combat Action Ribbon. The last thing that Charley Wilhelm would want or stand for would be for some Senator like myself to stand on the Senate floor and list the rest of all of the assignments and tours and accomplishments that make up his outstanding career. But, since I am on the Senate floor and relatively safe, I hope, from the well known and respected iron will of the general, a marine, who with respect and admiration and a great deal of circumspect care--certainly not in his presence--was called ``Kaiser Wilhelm,'' I'm going to give it a try. I do so because of the immense respect this man has within the ranks of all the services, U.S. and international, whohave served under his command. General Wilhelm's service was universal in scope and outstanding in performance: inspector-instructor to the 4th Reconnaissance Battalion, a Reserve unit in Gulfport, Mississippi; Deputy Provost Marshal, U.S. Naval Forces Philippines; operations officer and executive officer, 1st Battalion, 1st Marines, Camp Pendleton, California; staff officer for Logistics, Plans and Policy Branch, Installations and Logistics Department, Headquarters Marine Corps; J-3, Headquarters, U.S. European Command. Then in August of 1998, while assigned as the Assistant Chief of Staff for Operations of the Second Marine Expeditionary Force, Charles Wilhelm was promoted to brigadier general and assigned as the Director of Operations, Headquarters Marine Corps. Two years later, he was chosen to serve as Deputy Assistant to the Secretary of Defense for Policy and Missions within the Office of the Assistant Secretary of Defense for Special Operations and Low Intensity Conflict. This experience served him well, when, as commanding general of the 1st Marine Division, General Wilhelm served as Commander, Marine Forces Somalia as part of Operation Restore Hope. I might add a personal observation at this point in stating with Charles Wilhelm, the United States has a respected resource with regard to the difficult but necessary challenge our military has in meeting vital national security interests and balancing those interests with the many, if not overwhelming, peacekeeping and humanitarian missions we find ourselves involved in today. It goes without saying that in the past members of our military have been sent into peacekeeping missions where there was no peace to be kept. When that happens, why peacekeepers become targets and tragedy results. Gen. Charles Wilhelm knows the difference and we should take heed. He went on to serve in a series of command positions to include: Commanding General, Marine Corps Combat Development Command; Commander, U.S. Marine Corps Forces, Atlantic; Commander, U.S. Marine Corps Forces, South; Commanding General, Second Marine Expeditionary Force; Commanding General, Marine Strike Force Atlantic. General Wilhelm assumed duties at U.S. Southern Command in September, in 1997 where he served until his retirement just a few weeks ago. As commander of the U.S. Southern Command, General Wilhelm devoted his enormous personal energy--and boy does he have that--his visionary leadership and his remarkable diplomatic skills to achieving vital national security objectives and strengthening democratic institutions and governance--and thereby individual freedom and economic opportunity--throughout the Southern Hemisphere. General Wilhelm's personal decorations are testimony to his valor and bravery. He is indeed recognized within the U.S. Marine Corps as a warrior among warriors. But, he is also part military and political theorist, diplomat, and humanitarian. He enhanced civilian control of military institutions throughout Latin America; he improved multilateral relations among the 32 nations--that is 32 nations and 12.5 million square miles stretching from Antarctica to the Florida Keys. Concurrently, General Wilhelm oversaw the integration of the Caribbean into the command's theater, supervised the implementation of the 1977 Panama Canal treaties--no small feat--he energized United States Interagency efforts to counter the flow of illegal narcotics into the United States and finally, sought and obtained congressional support for the U.S. assistance plan for Colombia's counter drug program. While doing all of this in his 3 year stint, he restructured his command's architecture and theater engagement strategy to position the command to meet the challenges of the 21st century. I am tempted to say that in the midst of all this he rested on the 7th day but in fact he did not. As chairman of the Emerging Threats Subcommittee of the Senate Armed Services Committee--that is the subcommittee of jurisdiction over virtually all of the missions within the Southern Command--I want the record to show that the general accomplished his goals at precisely the same time the Southern Command suffered tremendous budget and infrastructure challenges. That is the nicest way I can put it. He always said he did not have problems; he had challenges. That was due to U.S. involvement in the Balkans and the drawdown of the tremendous budget and essential infrastructure support to the general's mission and the mission of the Southern Command. I do not know how, quite frankly, he accomplished his tasks. I might add, from my personal standpoint, in terms of our immediate and pressing challenges with regard to refugees, more than in the Balkans, the problems and challenges of immigration, drugs, terrorism, trade, the commonality of interests within our own hemisphere, and our domestic energy supply--we now get roughly 17 to 18 percent of our energy supply from Venezuela; there are real problems in Venezuela--our vital national interests, General Wilhelm has tried his very best to alert the Pentagon, the administration, and the Congress to these concerns and suggest rational and reasonable policy options. His advice is sound, based upon years of experience and hard, hard work. The value and worth of his policy recommendations, I will predict, and his cornerstone efforts to build on that success will be proven correct. Carol Rosenberg of the Miami Herald newspaper recently captured what I am trying to say in an article that accurately describes the successes General Wilhelm has achieved and the character of the man as well. Ms. Rosenberg simply put it this way: A Black Hawk helicopter landed in the center of a crude baseball diamond on a recent morning, delivering a four-star U.S. Marine general bearing baseballs and money. Chopper blades were still kicking dust when hundreds of residents crowded around, some sporting American League style uniforms donated by a California bike shop owner-- At the request of the general. Then a nine-man Nicaraguan band pulled out sheet music and played The Star Spangled Banner for the general. According to the article, he said: This is why I love this job. I've never heard it played any better. His career stretches back to Vietnam, as noted by Ms. Rosenberg. She went on to point out in her article the general has been part military strategist and diplomat. She outlined his leadership, as I said before, in the tremendous U.S. humanitarian efforts after Hurricane Mitch and other medical and disaster recovery missions demonstrating the United States bid to be a good neighbor and an ally in the Americas and the example of a civilian-controlled military to the emerging democracies. In the article, Ms. Rosenberg also pointed out that last month General Wilhelm paid a last visit to Managua, Nicaragua, and stood proudly as the Nicaragua Army chief, General Javier Carrion, draped him with a blue and white sash, the army's highest honor in Nicaragua, for ``building respectful relations'' between the two countries. For a decade, our Nation was allied with the Nicaraguan Army's adversary, i.e. the Contras, in a 10-year-old civil war. According to veteran observers, only 2 years ago, the tension and suspicion was still so thick between the two countries that you could cut it. Last month, through the efforts of one man, General Wilhelm received a medal for building respect between the two nations. I ask unanimous consent that the article by Carol Rosenberg in the Miami Herald be printed in the Record.

Mr. ROBERTS

Mr. ROBERTS. My colleague referred to--and I referred to it in my opening comments--the additional 15-percent cut across the board in these payments to go into effect on October 1, 2001. With regard to what she has just related to the Senate, given the savings that have already been achieved, the question is obvious, is this additional cut necessary? I tell my colleagues and all those interested in this particular issue that last year we had to come up with an emergency bill. Nobody likes to do that. We would prefer it to go through authorization and appropriations. Nobody likes to be faced with an emergency bill. This year is the same way. We are wrestling with that in terms of the budget caps we should live with. We are trying to figure that out. Here we are willing to provide more emergency money and we turn around and go through another 15-percent cut. It seems to me that is not conducive to what we are about with regard to consistency. What effect would that have with regard to home health care agencies?

Mr. ROBERTS. I have one final question. First, I thank the Senator from Maine for all her leadership and her hard work in this effort, for tapping not so gently on the shoulders of the leadership and, in a bipartisan way, attracting all sorts of support for this bill. I believe it is possible for Congress to bring this much needed relief to the home health care industry, as well as to the small rural hospitals and the teaching hospitals that are feeling the pinch of all these regulatory and legislative changes made in the last few years--with every good intent. But this is the law of unintended consequences personified. We must work quickly. Time is of the essence for many of our home health agencies and hospitals, especially the small rural providers. I don't want to have to go out again on a 105-county listening tour in Kansas and have people come and say; Senator Roberts, thank you so much for your past help on a whole litany of things we have gone through regarding the home health care delivery system, only to find out that their doors may close. I will continue to work with my colleague from Maine to pass legislation before Congress adjourns this year. We have a good team and we have good support. We cannot go home without providing help. I thank the distinguished Senator for her leadership in heading up a home health care posse for fairness and justice.

Mr. ROBERTS. If I may ask one additional question, what kind of support do we have in the Senate? I think the magic number is 55. I would like for the Senator to tell our colleagues.

Mr. ROBERTS. If the Senator will yield for an additional question, what are we going to do to help remedy this serious problem? I know the Senator has legislation, but would she summarize what she thinks is the answer to that.

Mr. ROBERTS. Will my distinguished colleague yield for another question?

Mr. ROBERTS. I tell my distinguished friend that unfortunately that is correct. Any Medicare-approved home health agency must comply with all Medicare conditions of participation, including the collection of OASIS. This means that patients who do not participate in Medicare are still subject to the Medicare assessment. That is exactly correct. Last year, HCFA amended this regulation to say that these agencies don't have to transmit the data on non-Medicare patients for the time being. However, the agency still must spend the time making the assessment. So it is sort of a Catch-22. I am certainly sympathetic to the concerns raised by my constituents that these new regulations and spending cuts will harm, again, the senior. But aren't these policy changes necessary to achieve the Medicare saving goals established by the Balanced Budget Act, I ask my colleague?

Mr. ROBERTS. Yes.

Mr. ROBERTS. I thank my colleague from Minnesota. I will try to keep my remarks certainly more brief and more pertinent. The point I was trying to make--I know that the same is true with regard to Texas--the Senator from Texas is here--and also Minnesota and Maine--is the time to travel great distances, many miles. Our health care providers spend an awful lot of time traveling from one patient's home to another. What happens is that the first patient may be located many miles away from the next patient. It requires the home health care nurse to work virtually nonstop to meet the deadlines required for the submission of the data to HCFA, which interferes with the personal care and the travel time. This is like 24-hour duty that is exacerbated by all of the data requirements.

Mr. ROBERTS. Mr. President, I ask unanimous consent for an additional 10 minutes.

Mr. ROBERTS. I agree with my colleague. That is too much to ask. That is ridiculous. I also point out that the time filling out the forms would be much better used actually caring for the patients. There is an hour and a half that the nurse could have been doing that.

Mr. ROBERTS. Will the Senator yield for another question?

Mr. ROBERTS. Emotional status? I see that patients must answer questions about their feelings. Have they ever been depressed? Have they ever had trouble sleeping? Have they ever attempted suicide? In some cases, that might be necessary, but do we really think we need a nurse to bother a physical therapy patient for this information so that he or she can send the answers over computer to someplace in Baltimore--hopefully Kansas City, but probably in Baltimore? Does the Senator from Maine have any idea how patients have reacted to this survey? Talk about emotional distress, if somebody were to ask me in a hospital what I felt or how would I feel, do I feel depressed, I think they would learn pretty doggone quick.

Mr. ROBERTS. The OASIS document includes an 18-page initial assessment that must be completed by a registered nurse and a 13-page followup assessment that is required every 60 days. This reminds me of a situation quite a few years ago, when the Department came out with a requirement that all Medicare patients would have to be reviewed by a doctor every 24 hours. At the time I said I was for that, stunning all of the health care folks in my district. I was in the House of Representatives then. I said: Surely, if they are going to require a 24-hour reporting requirement by a doctor, they will furnish us the doctor. There was sort of a method to the madness. At any rate, as I have indicated, there is an 18-page initial assessment that must be completed by a registered nurse. A 13-page followup assessment is required every 60 days. This is on top of assessments already required by the State. That is very important. It isn't as if there is no regulatory function to safeguard the interests of the patients and the taxpayer. The paperwork burden is immense. I am curious about what is included in this assessment. Is the Senator aware of the nature of the questions?

Mr. ROBERTS. I certainly agree with that. Will the Senator yield for another question?

Mr. ROBERTS. This OASIS business, in regard to all the complaints we have heard, as I have indicated--I think I ought to go into that a little bit more than explaining what the acronym is. OASIS is a system of records containing data on the physical, mental, and functional status of Medicare and Medicaid patients receiving care from home health agencies. HCFA tried to implement OASIS as a tool to help the agency improve the quality of care and form the basis for a new home health care prospective payment system. The problem is--and my colleague chaired the subcommittee and asked all the very pertinent questions--the collection of data is so burdensome and expensive for agencies, it invades the personal privacy of the patients. It must be collected for non-Medicare patients as well as those served by Medicare. Just yesterday, I learned that the whole OASIS information system in Kansas is not working; the computer system has failed. Agencies across the State are having a lot of difficulty in transmitting any kind of data. This burden is being felt by agencies all over the country. The question I have for the Senator is, Does she have any idea how long it takes? She has already spoken about this to some degree. Can we put a timeframe on it? Can we get more specific as to how long it takes for nurses to collect this information for HCFA? What does it cost in terms of nurse time?