Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as chairman of the committee on Veterans' Affairs, I am tremendously pleased to urge prompt, favorable Senate action on the pending measure, legislation that will provide a cost-of-living adjustment to veterans' compensation for next year. This measure includes the actual adjusted amounts as calculated, based on the increase in the Consumer Price Index. I thank my colleague on the Veterans' Affairs Committee, Ranking Minority Member Senator Arlen Specter, for his diligence and commitment to providing this important increase to well deserving veterans. The Veterans' Compensation Cost-of-Living Adjustment Act of 2001 directs the Secretary of Veterans Affairs to increase, as of December 1, 2001, the rates of veterans' disability compensation, as well as compensation for eligible dependents and surviving spouses. The legislation raises compensation by 2.6 percent, the same percentage as the increase provided to Social Security recipients. It is particularly timely that we move this legislation during the week of Veterans Day. Veterans and their families depend on the cost- of-living increase to ensure that their well-deserved benefits not be eroded by inflation. Veterans' disability compensation rates must keep pace with the increasing cost of living. I urge all of my colleagues to support passage of this bill. Mr. President, I ask unanimous consent that a summary of the legislation be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as chairman of the Committee on Veterans' Affairs, I urge the Senate to pass S. 739, the proposed ``Heather French Henry Homeless Veterans Assistance Act of 2001,'' a bill that enhances VA's efforts to combat homelessness among our Nation's veterans. On July 19, 2001, the Committee on Veterans' Affairs held a hearing on S. 739 as originally introduced by my good friend and colleague on the Committee, Senate Paul Wellstone. The Department of Veterans Affairs and homeless advocate shared their views on what could be done to help VA treat the unique problems faced by homeless veterans. Witnesses testified that homelessness remains a prevalent problem among veterans, with roughly one-third of the total homeless population consisting of veterans. Members of the Committee were told that more needs to be done to help these men and women get back on their feet. I will highlight a couple of the provisions included in the bill and refer my colleagues to the report accompanying this legislation for more detail. The pending measure contains many provisions seek to enhance programs that VA currently administers to homeless veterans, most notably the Grant and Per Diem Program. This program offers grants to nonprofit community-based organizations that serve homeless veterans. Specifically, the bill authorizes up to $55 million a year in funding for the program. In addition, the bill would link the daily per diem rates provided to these community-based organizations for the care of homeless veterans to the rate already provided to state veterans homes for domiciliary care. This would increase the daily rate from $19 to $24, giving those who are truly combating homelessness the appropriate resources with which to work. Another important aspect of this legislation is the establishment of an Advisory Committee on Homeless Veterans within VA. This 12-15 member committee would evaluate and report directly to the Secretary of Veterans Affairs on all matters related to homeless veterans. This ensures that there is always a voice for this segment of the veteran population at the highest level within VA. With regard to the overall evaluation of homeless programs--often cited as one of the biggest impediments to properly serving the homeless--the pending legislation would encourage the continued support of at least one evaluation center within VA. Currently, VA's Northeast Program Evaluation Center in Connecticut conducts such research, and it's important to ensure that all research efforts receive needed resources to pursue valuable work. Evaluation needs to be conducted so that VA policy makers and Members of Congress know what works and what does not. Therefore, the pending measure would require two annual reports to Congress from VA on the activities of both the health care and benefits-related aspects of their treatment of homeless veterans. Yet another key aspect of the pending measure is the required establishment of at least five new Comprehensive Service Centers. These centers would be located in the metropolitan areas found by VA to have the greatest demand for homeless services. Existing centers, such as ones located in Brooklyn, NY, and Dallas, TX, provide the full spectrum of care for homeless veterans, including transitional housing and substance abuse treatment. In closing, I would like to acknowledge the hard work and dedication of the namesake of this bill, Miss America 2000, Heather French Henry. Her focus on homeless veterans during her reign and subsequent to the end of her tenure as miss America brought significant attention to this important issue. Ms. Henry's advocacy for homeless veterans is truly admirable. It is my sincere hope this bill will give VA greater ability to treat homeless veterans, and thereby contribute toward eradicating this national share. I urge my colleagues on the House Veterans's Affairs Committee, who have also been active on this issue, to work with Senator Wellstone, the other members of our Committee, and me, to help those who have sacrificed for our country and now need our help. I ask unanimous consent that a summary of S. 739 be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Madam President, I was proud to support the entire VA-HUD Appropriations conference report yesterday, including its vital investments for our Nation's veterans. Chairperson Mikulski and Ranking Member Bond work hard each and every year to provide investment in a wide range of important agencies and programs, ranging from veterans, to housing, to the National Science Foundation. This year I am particularly proud of a new investment within the National Science Foundation, NSF, to promote math and science education. Two new programs have been funded: the Mathematics and Science Partnerships program and the Noyce Scholarships worth $165 million. Our elementary and secondary students are currently sadly lacking in their mastery of technical subjects. Although our 4th graders are on a par with the rest of the world, by the time they reach the 12th grade they are in the bottom half of countries of the world. This is an intolerable situation. Our United States students come to college ill equipped to study mathematics, science, and engineering. The partnerships and scholarships funded in this package offer the promise of substantial improvement in the performance of our students. Under the Mathematics and Science Partnerships programs, universities, businesses, and local educational institutions will form partnerships to develop new programs to teach these subjects. These programs will be watched and evaluated and those that are successful will be incorporated into the mainstream of K-12 education. The Noyce Scholarships will address a different problem. One of the best predictors of student performance is the quality of the teacher. Too many of our teachers of technical subjects are not well qualified. The scholarships will remedy this situation by supporting students of technical subjects who agree to teach two years for every year of support. This will ensure that many of our urban and rural schools that are particularly in need of good teachers will obtain relief. President Bush proposed the math and science partnerships in his budget. Working with Senators Kennedy and Roberts, I sponsored legislation in the Senate to authorize the Partnerships and the Noyce Scholarships. The House of Representatives has already passed a similar measure introduced by Congressman Boehlert. The VA-HUD appropriations package provide the first year of funding and the down payment to start these key programs to improve math and science education, and invest in our future. I appreciate the support of my colleagues for the entire package, and I am especially pleased about these new investments in math and science education which represent such promise for the future.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as we again approach Veterans Day, it is vital that we pause, more so than on any Veterans Day in recent memory, to give tribute to the more than 48 million heroic veterans who have served in our military since the start of the Republic and who have fought so that the freedom and safety of this great Nation would not be compromised. We owe our veterans our heartfelt gratitude for answering the call and serving us all in the United States Armed Forces. Today, as it should be, military service is being held in high esteem. The events of September 11 have renewed America's sense of gratitude toward the men and women of the Armed Forces for the great sacrifices they make everyday on behalf of our Nation. America has been steadfast in its commitment to the world to be a beacon for freedom. Our military personnel have honored our commitment to the world, time after time, in every part of the globe. At present, the members of our Armed Forces are fighting the terrorist regime responsible for the deaths of thousands of Americans on September 11th. We will win this fight. And once again, our men and women in uniform will honor our commitment to the world. What strikes me with enormous poignancy is the age of those who have answered the call to duty throughout our history. In this war, as in those of our past, we send our young to honor our commitments abroad and to protect our great Nation. They are the best of the best. Their motto might well be, in the words of Alexander Pope, ``Act well your part, therein all honor lies.'' As we observe Veterans Day, let us remember that we owe our veterans our gratitude and appreciation year round, and not merely on the day set aside for the commemoration of their service and sacrifice. It would be truly disgraceful if veterans were made to feel forgotten except for this one day per year. Indeed, our gratitude should be as steadfast as the great monuments that Americans have built in commemoration of the very service and sacrifices our veterans made. There should be no ambivalence in our attitude toward those who serve in the United States Armed Forces. I am proud to represent the State of West Virginia in the Senate. West Virginia has one of the highest veteran populations per capita of any State. The deep patriotism and loyalty to our country of the people of my State of West Virginia fills me with gratitude, and inspires me in my role as Chairman of the Senate Committee on Veterans' Affairs. In that position, I am fortunate to represent not only the veterans of West Virginia, but veterans all over our country. As Chairman, I have fought very hard for improvements in benefits and services to veterans. We have made significant strides this year in fulfilling the pledge of Abraham Lincoln, ``to care for him who shall have borne the battle, and for his widow and his orphans.'' A critical need for veterans is long-term care. Our veteran population is aging rapidly and it is our responsibility to care for them. I am dedicated to this need, and in groundbreaking legislation, I was able to secure a significant expansion in the eligibility for and types of treatment that will soon be available to veterans. It is my belief that the Montgomery GI Bill must be sufficient to recognize the commitment and sacrifices that individuals make to serve in the military. In keeping with that belief, the Committee has endorsed legislation under which the basic rate of the MGIB benefit will be raised over the next 3 years. In addition, accelerated payments of MGIB benefits will be authorized to accommodate the compressed schedule of courses that leads to employment in a high technology industry. We should make every effort to accommodate the educational needs of our veterans, and this change is an important step in doing so. Additionally, the Committee endorsed legislation under which the maximum amount for the popular VA home loan guaranty will be increased. It will now be within the reach of veterans to buy homes in major metropolitan areas where home prices have skyrocketed. Many years have passed since a VA home loan guaranty increase, and high housing costs in certain areas had put homeownership beyond the reach of our veterans who live in those areas. This increase will add value to the existing benefit. Today, and everyday, we should honor those who have worn the uniforms of our Nation. All those who served deserve our appreciation, our respect, and our compassion. They are indeed, the best of the best.

Mr. ROCKEFELLER

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

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise to support S. 1428, which is the intelligence authorization bill, and to congratulate particularly Senator Bob Graham from the State of Florida for his excellent leadership on this whole matter. We all know the work of the Intelligence Committee and the work of the intelligence community, more particularly, is incredibly important at all times and, obviously, after September 11, it has become a matter of national survival in many respects. So this is an extremely important bill and a very good one. We rely on the people in the intelligence community in every way. We often do not think about it, although we have thought about it more in the last couple of months. They support the U.S. military actions in Afghanistan; they work with other countries to track down and arrest terrorists and disrupt all kinds of attacks which we may not hear about because they did not occur; they assist law enforcement agencies with the anthrax investigation; they follow the finances of terrorist organizations allowing the Department of the Treasury to freeze assets with accurate and proper information, and they are leading the hunt for the leaders of al-Qaida. The intelligence community has surged its efforts to support this war, but it is also now obviously been called on for enormous amounts of new resources just to meet the day-to-day requirements they had before September 11. We continue to collect and analyze counterproliferation, counternarcotics and international organized crime. We collect intelligence regarding our traditional state adversaries, such as North Korea and Cuba, and we keep a very close eye on hot spots around the world, obviously including places such as the Middle East. There are four priorities in the bill. They should remain our priorities. The first is we revitalize the National Security Agency. That was done. We correct deficiencies in human intelligence. That is being addressed. We address the imbalance between collection and analysis. We have talked about that for a long time. We provide sufficient funding for research and development. All of those are addressed. As I indicated, we need the resources not just now, but there will be probably more needs in the future. That is being done through the supplemental appropriations process, as it should be, but I just put our colleagues on notice this is going to be a continuing situation. This is my first year on the Intelligence Committee. I have to say I am extraordinarily impressed by the diligence of the committee, by the people who are on it, including the Presiding Officer, and the vigor and emphasis which they bring to their work. It is a committee that not a lot of people know a great deal about, but it does very important work. I urge my colleagues to support this bill. I thank the Presiding Officer, and I yield the floor.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, for many years, Senator Mike DeWine and I have worked with a bipartisan coalition to promote adoptions and to strengthen Federal funding to help abused and neglected children, especially through the Safe and Stable Families program. Senator DeWine has been a real leader especially in the key area of defining reasonable effort to protect children. We are joined in our effort by Senators Landrieu and Craig, both well-known advocates for adoption and leaders of the Adoption Caucus. President Bush called for an increase of $200 million for this program in his State of the Union address and his budget. In OMB's mid- session review, the administration changed its request from $200 million in mandatory money to discretionary funding. Since then, the House of Representatives added $70 million in new funding in their Labor-HHS-appropriations bill. Children suffering from abuse and neglect are among our most vulnerable children. In 1997, Congress enacted new legislation to make the health and safety of a child paramount, and to stress the importance of providing every child a permanent home. The act imposed new time frames for States to consider adoption. Since then, adoptions from foster care have almost doubled. But these families need support to address the special needs of these children. Currently, there are over 800,000 children in foster care. About 1 million cases of abuse and neglect are substantiated each year. In my State of West Virginia, the number of adoptions are increasing, but the statistics on abuse and neglect of children remain stubbornly high. New funding will enable my State and every State to expand their programs for adoption, family support, family preservation, and help to families in foster care. Our goal is to secure new investments in the Safe and Stable Families Program to help these vulnerable children. I truly appreciate the cooperation and support of Senators Harkin and Specter in accepting our amendment to provide new funding for this worthy cause. Chairman Harkin and Ranking Member Specter have a very hard task in overseeing the Labor-HHS-Education appropriations bill. Balancing all the needs within their jurisdiction, including health care, education, worker safety, and other issues is a very difficult task, but a task they manage each year with skill and fairness. Their deep concern and compassion for children is well-known, and their willingness to work with Senator DeWine and me further highlights their commitment to some of the most vulnerable children, those suffering from abuse and neglect. I am truly grateful for their leadership and support. Things have changed dramatically in our country and in the Congress. We need to respond to the new challenges and the new fiscal issues. But the needs of abused and neglected children remain, and we also need to be sensitive to their problems and their needs. I appreciate the support from my colleagues.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am delighted to join my good friend from Pennsylvania as an original cosponsor of the ``Medicare Adult Day Services Alternative Act.'' Adult day health care is a vital component of good long-term care, for patients and for their caregivers. I am hopeful that as a result of this bill, adult day health care will play an increasingly larger role in how we care for the elderly in this country. To be clear, this bill would simply give beneficiaries of the Medicare home health benefit the option of choosing to receive their care partially in an adult day care setting. This bill would not expand the list of who is eligible for home care, it simply changes the location where services may be provided. The benefits of this legislation, are that beneficiaries gain increased social interaction with peers, while simultaneously giving caregivers a measure of respite. I am a strong supporter of adult day health care, because I've seen the tremendous benefits of it in the VA health care system. The federally funded VA health care system, because of the very substantial World War II veteran population, has developed some of the most innovative ways to care for older people especially in non- institutional settings. As a result of this demand, VA has led the Nation in developing adult day health care programs. The Adult Day Health Care Program at VA was established in the late 1970s at five facilities. At this time, there are 15 in-house VA Adult Day Health Care programs. All other VA medical centers provide this program to veterans through a contractual basis with community-based programs. In 1999, I introduced legislation to further expand on VA adult day by making adult day health care, and other non-institutional long-term care services, part of the standard benefits package in the VA. I am thrilled that my legislation was passed later that year and that all veterans who enroll for VA care will have access to these services. I look forward to working with members of the Senate Finance Committee to advance the cause of long-term care. It is my view that providing long-term care to all Americans is a priority. Let us delay no longer.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am delighted to join my good friend from Pennsylvania as an original cosponsor of the ``Medicare Adult Day Services Alternative Act.'' Adult day health care is a vital component of good long-term care, for patients and for their caregivers. I am hopeful that as a result of this bill, adult day health care will play an increasingly larger role in how we care for the elderly in this country. To be clear, this bill would simply give beneficiaries of the Medicare home health benefit the option of choosing to receive their care partially in an adult day care setting. This bill would not expand the list of who is eligible for home care, it simply changes the location where services may be provided. The benefits of this legislation, are that beneficiaries gain increased social interaction with peers, while simultaneously giving caregivers a measure of respite. I am a strong supporter of adult day health care, because I've seen the tremendous benefits of it in the VA health care system. The federally funded VA health care system, because of the very substantial World War II veteran population, has developed some of the most innovative ways to care for older people especially in non- institutional settings. As a result of this demand, VA has led the Nation in developing adult day health care programs. The Adult Day Health Care Program at VA was established in the late 1970s at five facilities. At this time, there are 15 in-house VA Adult Day Health Care programs. All other VA medical centers provide this program to veterans through a contractual basis with community-based programs. In 1999, I introduced legislation to further expand on VA adult day by making adult day health care, and other non-institutional long-term care services, part of the standard benefits package in the VA. I am thrilled that my legislation was passed later that year and that all veterans who enroll for VA care will have access to these services. I look forward to working with members of the Senate Finance Committee to advance the cause of long-term care. It is my view that providing long-term care to all Americans is a priority. Let us delay no longer.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Madam President, I am proud today to introduce legislation that would improve upon the current requirement that the Department of Veterans Affairs maintain specialized health care services. It is my hope that the ``Veterans Specialized Treatment Act'' will finally settle the issue and that high quality, specialized health care services will be readily available to our veterans at each and every VA hospital. From its inception, the Department of Veterans' Affairs' health care system has been challenged to meet the special needs of its veteran patients, such as spinal cord injuries, amputations, blindness, post- traumatic stress disorder, substance abuse, and homelessness. Over the years, VA has developed widely recognized expertise in providing specialized services to meet these needs. We have all been proud of VA's expertise, some of which is unparalleled in the larger health care community. Unfortunately, in recent years, VA's specialized programs have come under stress due to budget constraints, reorganizational changes, and the introduction of a new resource allocation system. Budgetary pressures, in particular, raised concerns back in 1996 that VA's costly specialized programs may be particularly vulnerable and disproportionately subject to reductions. As a result, Congress recognized the need to include protections for the specialized services programs. Public Law 104-262 specifically required the Secretary of Veterans Affairs to maintain capacity to provide for the specialized treatment needs of disabled veterans at the level in existence at the time the bill was passed, October 9, 1996 and to report annually to Congress on the status of its efforts. While each of the VA's required reports have proclaimed success in maintaining capacity, some remain skeptical. The General Accounting Office found that ``much more information and analyses are needed to support VA's, 1998, conclusion, that capacity was up to par.'' The VA Federal Advisory Committee on Prosthetics and Special Disability Programs has in the past called VA's data ``flawed'' and has not endorsed all of VA's report. In 1999, my own staff on the Committee on Veterans' Affairs also examined VA's implementation of the law and found that certain key programs, such as Post-Traumatic Stress Disorder and substance abuse disorder programs, were not meeting the mandated capacity levels. The most recent report shows, again, that there is concern about whether VA is adhering to the law. The VA Federal Committee on Care of Severely Chronically Mentally Ill Veterans stated in an official response that the 2000 report on capacity ``once again, documents the Department's decline in maintaining specialized services for . . . high priority patients, without explicitly acknowledging it.'' Committee members also emphasized that based on the results of the report, it did not appear that high-quality, system-wide access to specialized services is being provided by VA. I am disappointed that VA has still been unable to properly demonstrate that adequate levels of care for those veterans with specialized health care needs are being maintained. The legislation I introduce today seeks to remedy this problem by closing loopholes in the original law to ensure VA's compliance. Congress has spoken quite clearly in the past: VA does not have the discretion about whether or not to maintain capacity for specialized services. My proposed legislation would modify the existing report and require that VA submit information on the number of full-time staff providing treatment and the number of dedicated staffed beds; the number of veterans served by each such distinct program and facility; the number of units of service provided to veterans by such program, including the number of inpatient and residential days of care as well as the number of outpatient visits; and the amount of money spent for the care of veterans using these specialized services. Having this information for each of the distinct specialized services will allow Congress to fully understand how the specialized services are fairing. While I applaud VA's use of outcome measures, I believe it is imperative that the report contain hard data on the number of staffed beds and other information. VA would also be required to maintain capacity of the Department at each and every medical center. Current law only requires that ``overall'' capacity be maintained. Another key element of the legislation is that the Inspector General of VA would conduct an annual audit to ensure that the requirements of the capacity law are carried out every year. The IG would also be required to review the VA's yearly report and provide their assessment, on that report, to Congress. Finally, in an effort to encourage VA managers to comply with the legislation, VA would be required to look at the status of the specialized services programs whenever job performance is reviewed. My colleagues, I ask for your support of this bill, as it would help ensure that specialized services, a crucial segment of the health care VA provides to veterans, are maintained at the necessary level.

Mr. ROCKEFELLER. Madam President, I rise today to introduce a small bill, but one with important consequences. My measure, the ``Medicare Remote Monitoring Services Act of 2001,'' seeks to increase access to remote management technologies by providing equal payment for these services under Medicare. I am pleased to be joined by Senator Snowe in introducing this measure. As my colleagues know, many new technologies that collect, analyze, and transmit clinical health information are in development or have recently been introduced to the market. These remote management technologies hold clear promise: Better information on the patient's condition, collected and stored electronically, analyzed for clinical value, and transmitted to the physician or the patient, should improve patient care and access. Instead of a time-consuming 20-mile trips to the doctor's office, it takes the patient 10 minutes to transmit the data by computer. This is not going to replace hands-on medicine, but when it's not possible for the physician to be there, this can be a tool. It's a more aggressive way to be with the patient and help avoid a crisis. Despite these innovations, many new clinical information and remote management technologies have failed to diffuse rapidly. A significant barrier to wider adoption and evolution of the technologies is the relative lack of payment mechanisms under Medicare for services provided by a physician related to these technologies. The June 2001 ``MedPAC report to Congress on Medicare in Rural America'' raises concerns about access to health care in rural areas. The report states that if policymakers are interested in expanding the use of telemedicine approaches to improve access to care, one avenue that could be explored is the coverage of technology that enables a diagnostic test to be performed on a patient remotely and then be sent electronically to the consulting physician for review at a later time. In addition, in its March 2001 report, ``Crossing the Quality Chasm,'' the Institute of Medicine stated that the automation of clinical and other health transactions was an essential factor for improving quality, preventing errors, enhancing consumer confidence, and improving efficiency, yet ``health care delivery has been relatively untouched by the revolution in information technology that has been transforming nearly every other aspect of society.'' Under this legislation remote monitoring services that are found to be comparable to face to face, encounter-based, monitoring services will be given the same coverage and level of Medicare payment as the comparable encounter-based physician service. The provision will be implemented in a budget-neutral manner. I urge my colleagues to cosponsor this legislation that will improve patient access, care, and management, as well as spur the development of new technologies that will improve services further.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Madam President, I join several colleagues today to introduce the Medicare Chronic Care Improvement Act of 2001. Although we in Congress are focused on helping the Nation recover from the horrific attacks of September 11, we must also stand tall against the terrorists who wish to sabotage our domestic policy agenda and continue to work on the issues that affect the everyday health and well being of American citizens. With this conviction, I believe it is time to address the leading health care problem of the 21st century, chronic conditions. Chronic conditions account for an astounding 90 percent of morbidity, 80 percent of deaths, and over 75 percent of direct medical expenditures in the United States. Nearly 125 million Americans have chronic conditions, and this number is expected to increase to 157 million, approximately half the population, by 2020. Chronic conditions encompass an array of health conditions that are persistent, recurring, and cannot be cured. They include severely impairing conditions like Alzheimer's disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, depression, hypertension, and arthritis. Certainly in West Virginia, many of our workers, especially coal miners and steelworkers, suffer from chronic conditions. Treating serious and disabling chronic conditions is the highest cost and fastest growing segment of health care. Direct medical costs for chronic conditions reached $510 billion in 2000 and are projected to reach $1.07 trillion by 2020. An estimated 80 percent of Medicare beneficiaries suffer from at least one chronic condition and those beneficiaries account for an astounding 95 percent of Medicare spending. But Medicare does not provide many of the health care services that people with chronic conditions need. For example, current Medicare data show that, on average, people with chronic conditions see eight different physicians. Medicare does not compensate these physicians for communicating with one another, nor are they paid for care coordination, monitoring medications, early detection, or for educating or counseling patients and caregivers. As a result, few of these services, which are critical to people with chronic conditions, are provided. To meet the needs of these individuals, our health care system must embrace a person-centered, system-oriented approach to care. Payers and providers who serve the same person must be empowered to work together to help people with chronic conditions prevent, delay, or minimize disease and disability progression and maximize their health and well being. Over 10 years ago, I served as Chairman of the Pepper Commission. Our final report recognized that people with chronic conditions have special needs requiring multidisciplinary health care or social services to compliment or augment their health care. The Commission further recognized that medical care cannot be fully accessible or effective for this segment of the population unless it is accompanied by education, outreach, and systems to coordinate a broad range of services. The Commission identified these needed changes over ten years ago. And, as I stand before you today, not a single one of these recommendations has been made. I am here to propose a long overdue and much needed solution, The Medicare Chronic Care Improvement Act of 2001. This bill establishes a comprehensive plan to update and streamline the Medicare healthcare delivery system to better meet the needs of people with chronic health conditions. First, the Medicare Chronic Care Improvement Act of 2001 helps prevent, delay, and minimize the progression of chronic conditions by authorizing the Secretary of Health and Human Services to expand coverage of preventive health benefits. The bill permits providers to waive deductibles and co-payments for preventive and wellness services and streamlines the process of approving preventive benefits. Second, this bill provides a person-centered, system-oriented approach to care for this extremely vulnerable segment of our population by expanding Medicare coverage to include assessment, care- coordination, self-management services, and patient and family caregiver education and counseling. Third, this legislation improves Medicare fee-for-service and managed care financing for plans that serve beneficiaries with multiple, complex chronic conditions. The Secretary is directed to develop a plan to refine payment incentives to ensure appropriate payment for serving these high-cost individuals. And finally, the Medicare Chronic Care Improvement Act of 2001 requires the Secretary of HHS to report to Congress on chronic condition trends and costs as a foundation for establishing national chronic care policies. For more detail, I am also entering a section-by-section bill summary into the Congressional Record following this statement. This legislation has been endorsed by a variety of health organizations representing consumers and providers including: Chronic Care Coalition, comprising the American Association of Homes and Services for the Aging, American Geriatrics Society, Catholic Health Association of the United States, Elderplan Social HMO, National Chronic Care Consortium, National Council on the Aging, and National Family Caregivers Association; National Depressive and Manic-Depressive Association; Association for Ambulatory Behavioral Healthcare; American Lung Association; American Academy of Neurology; American Neurological Association; and United Seniors Health Cooperative. The Medicare Chronic Care Improvement Act of 2001 provides a comprehensive solution to improving the quality of life and health for millions of Americans who are struggling with serious and disabling chronic conditions. It improves benefits for people with chronic conditions, it empowers providers to better care for these people, and it provides us with the research we need to better address chronic conditions in the future. And last, but not least, this legislation has the potential to save the Medicare program money, by better managing and treating chronic conditions before costly complications result. That is good for seniors and good for Medicare, a win-win situation. It is time to step up to the plate and fulfill our obligation to our Nation's most vulnerable citizens. This bill should stimulate the debate, and when Congress returns to business not related to the September 11th attacks, I intend to advance this legislation in the Finance Committee. I ask unanimous consent that the text of the bill and the summary be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Madam President, I join several colleagues today to introduce the Medicare Chronic Care Improvement Act of 2001. Although we in Congress are focused on helping the Nation recover from the horrific attacks of September 11, we must also stand tall against the terrorists who wish to sabotage our domestic policy agenda and continue to work on the issues that affect the everyday health and well being of American citizens. With this conviction, I believe it is time to address the leading health care problem of the 21st century, chronic conditions. Chronic conditions account for an astounding 90 percent of morbidity, 80 percent of deaths, and over 75 percent of direct medical expenditures in the United States. Nearly 125 million Americans have chronic conditions, and this number is expected to increase to 157 million, approximately half the population, by 2020. Chronic conditions encompass an array of health conditions that are persistent, recurring, and cannot be cured. They include severely impairing conditions like Alzheimer's disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, depression, hypertension, and arthritis. Certainly in West Virginia, many of our workers, especially coal miners and steelworkers, suffer from chronic conditions. Treating serious and disabling chronic conditions is the highest cost and fastest growing segment of health care. Direct medical costs for chronic conditions reached $510 billion in 2000 and are projected to reach $1.07 trillion by 2020. An estimated 80 percent of Medicare beneficiaries suffer from at least one chronic condition and those beneficiaries account for an astounding 95 percent of Medicare spending. But Medicare does not provide many of the health care services that people with chronic conditions need. For example, current Medicare data show that, on average, people with chronic conditions see eight different physicians. Medicare does not compensate these physicians for communicating with one another, nor are they paid for care coordination, monitoring medications, early detection, or for educating or counseling patients and caregivers. As a result, few of these services, which are critical to people with chronic conditions, are provided. To meet the needs of these individuals, our health care system must embrace a person-centered, system-oriented approach to care. Payers and providers who serve the same person must be empowered to work together to help people with chronic conditions prevent, delay, or minimize disease and disability progression and maximize their health and well being. Over 10 years ago, I served as Chairman of the Pepper Commission. Our final report recognized that people with chronic conditions have special needs requiring multidisciplinary health care or social services to compliment or augment their health care. The Commission further recognized that medical care cannot be fully accessible or effective for this segment of the population unless it is accompanied by education, outreach, and systems to coordinate a broad range of services. The Commission identified these needed changes over ten years ago. And, as I stand before you today, not a single one of these recommendations has been made. I am here to propose a long overdue and much needed solution, The Medicare Chronic Care Improvement Act of 2001. This bill establishes a comprehensive plan to update and streamline the Medicare healthcare delivery system to better meet the needs of people with chronic health conditions. First, the Medicare Chronic Care Improvement Act of 2001 helps prevent, delay, and minimize the progression of chronic conditions by authorizing the Secretary of Health and Human Services to expand coverage of preventive health benefits. The bill permits providers to waive deductibles and co-payments for preventive and wellness services and streamlines the process of approving preventive benefits. Second, this bill provides a person-centered, system-oriented approach to care for this extremely vulnerable segment of our population by expanding Medicare coverage to include assessment, care- coordination, self-management services, and patient and family caregiver education and counseling. Third, this legislation improves Medicare fee-for-service and managed care financing for plans that serve beneficiaries with multiple, complex chronic conditions. The Secretary is directed to develop a plan to refine payment incentives to ensure appropriate payment for serving these high-cost individuals. And finally, the Medicare Chronic Care Improvement Act of 2001 requires the Secretary of HHS to report to Congress on chronic condition trends and costs as a foundation for establishing national chronic care policies. For more detail, I am also entering a section-by-section bill summary into the Congressional Record following this statement. This legislation has been endorsed by a variety of health organizations representing consumers and providers including: Chronic Care Coalition, comprising the American Association of Homes and Services for the Aging, American Geriatrics Society, Catholic Health Association of the United States, Elderplan Social HMO, National Chronic Care Consortium, National Council on the Aging, and National Family Caregivers Association; National Depressive and Manic-Depressive Association; Association for Ambulatory Behavioral Healthcare; American Lung Association; American Academy of Neurology; American Neurological Association; and United Seniors Health Cooperative. The Medicare Chronic Care Improvement Act of 2001 provides a comprehensive solution to improving the quality of life and health for millions of Americans who are struggling with serious and disabling chronic conditions. It improves benefits for people with chronic conditions, it empowers providers to better care for these people, and it provides us with the research we need to better address chronic conditions in the future. And last, but not least, this legislation has the potential to save the Medicare program money, by better managing and treating chronic conditions before costly complications result. That is good for seniors and good for Medicare, a win-win situation. It is time to step up to the plate and fulfill our obligation to our Nation's most vulnerable citizens. This bill should stimulate the debate, and when Congress returns to business not related to the September 11th attacks, I intend to advance this legislation in the Finance Committee. I ask unanimous consent that the text of the bill and the summary be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I do not have to tell my colleagues here in the Senate that bioterrorism has become a reality. Here, and throughout the Nation, we are frightened and frustrated by the lack of clear information on what the threats are, and how we are to find the resources to protect ourselves. With this need in mind, I proudly offer the ``Public Health Emergency Planning and Information Act of 2001,'' a bill which would provide grants to hospitals to prepare for public health emergencies, and that would fund programs to provide the public and medical providers with accurate information about potential biological attacks. As we have seen in the past few weeks, the first line of defense against the threat of bioterrorism relies upon swift action by local health care providers and public health officials. The quick response of doctors in Florida to that first case of anthrax on October 4th gave the medical community and the public a warning of what was to come. Despite this recognition, and despite a small number of additional actual anthrax cases, we are currently struggling with how to respond, who to treat, what to expect next, and what information we can trust. We cannot simply wait to see what happens next, we must face this new and terrifying threat immediately. Epidemics, whether natural or the result of deliberate attacks, unfold in communities, and may happen without warning. Our hospitals, and our physicians and nurses, must be prepared to detect outbreaks, diagnose diseases, treat patients, and activate state and federal response systems. They must be able to care for the public without becoming ill themselves. These tasks will be made more challenging by the sadly diminished public health care infrastructure. The legacy of this chronic underfunding of state and local health departments has become all too obvious in the past few days. Last year, Congress passed legislation authored by my colleagues, Senators Kennedy and Frist, to begin supplying the Centers for Disease Control and Prevention and our State and local health departments with the funding that they so desperately need. I applaud this goal, and trust that we can continue to build on those efforts. I remain concerned, however, about the resources available to local hospitals. Under pressures to contain the costs of health care, providers have shifted emphasis from hospital-based care to outpatient treatment over the last decade. This change, accompanied by ever shrinking staffing levels, has eroded our ability to care for a large number of patients at once. Annual epidemics of influenza already overwhelm the capacity of local health care systems, and now hospitals struggle to care for the ill while preparing for the unthinkable. Providers in small communities, particularly, have been less involved in Federal disaster training, and are most likely to lack the resources to accommodate a surge of patients during a deliberate or natural epidemic. Many caregivers from my own State of West Virginia have contacted me in recent weeks, desperate for resources to aid their preparations. Current standards established by accrediting organizations and the Centers for Disease Control and Prevention outline basic steps in emergency preparedness that should, or must, for accreditation purposes, be undertaken by all hospitals and health care facilities. However, almost all Federal funding for medical disasters has been released in response to emergencies, rather than to prepare for them. Hospitals have seen little financial incentive for purchasing equipment or supplies that might never be used, especially in the climate of managed care. The legislation that I introduce today would provide funding to aid these hospitals in preparing for emergencies, and to equip and train medical professionals to protect themselves and their patients during a public health crisis. My bill allows the Secretary of Health and Human Services to award grants directly to Medicare-eligible hospitals to meet emergency preparedness standards. These funds could be used to train personnel, increase communications between hospitals and local emergency response systems, and purchase necessary supplies or equipment. This bill would also protect hospitals that meet the public's need in a designated disaster area by covering the costs of replacing safety equipment and caring for the uninsured, so hospitals are not bankrupted by supporting public health. In addition to preparing our medical professionals for the possibility of an epidemic, we must prepare ourselves. The past week has revealed a glaring flaw in our public health response: the failure to provide essential facts about the symptoms and best responses to suspected bioterrorist attacks. Even here, in the United States Senate, staff who might have been exposed to a biological threat have wrestled with a lack of information and with misinformation. Poor information about basic personal safety, and about symptoms and risk, has made a bad situation worse, and the panic has spread from the Capitol throughout the Nation. During a public health crisis, such as a deliberate act of bioterrorism or a natural epidemic, qualified professionals should be able to deliver accurate and timely information to the public. We cannot ask individuals to make good decisions about protecting themselves and their families without helping them to understand the risks and the realities of potential outbreaks. We must act to ensure that American citizens can turn to a reliable, understandable source of information on agents such as anthrax. My legislation would provide funding for public health crisis education and information, and would require publication of educational materials for use by medical professionals and the general public. These materials would be designed to prepare the public for the most likely foreseeable events in order to avert panic, and to promote good public health. These programs will help hospitals and the public prepare not only for the threat of bioterrorism, but for the equally demanding tasks of controlling now-familiar epidemics of influenza and food-borne illnesses. We have been forced to confront our vulnerability to attacks that were until recently unthinkable, and to seek new ways to prepare and to protect ourselves, not only for the anthrax attack unfolding before us, but for the possible threats of the future. We must act now to prepare for whatever challenges lie ahead, as well as react to the fear at hand. I ask my colleagues to support this legislation, so that we may begin the steps necessary to protect the health of our Nation.

Mr. ROCKEFELLER. Mr. President, I am pleased today to introduce legislation that would ensure that Gulf War veterans suffering from unexplained illnesses continue to get the care that they need. If we do not act quickly, these veterans will soon lose their priority eligibility for health care through the Department of Veterans Affairs, despite the sad fact that we still do not understand the causes of their symptoms. As many of my colleagues know, servicemembers returning from the Gulf War in 1991 began to report a range of unexplained illnesses that many believed might have resulted from their service. Investigations by Congress, the Departments of Defense and Veterans Affairs, and the Institute of Medicine showed that the men and women who served in Operation Desert Storm might have been exposed to many battlefield hazards, including smoke from oil-well fires, pesticides, organic solvents, the drug pyridostigmine bromide, numerous vaccinations, and sarin nerve gas. Unfortunately, our efforts to determine whether any or all of these hazards might be linked to specific symptoms have been limited by poor data, a lack of research into the long-term effects of low-dose exposures, and incomplete military recordkeeping. In response to concerns about the health of Gulf War veterans, Congress passed Public Law 102-585, authorizing health examinations, tasking the National Academy of Sciences to evaluate scientific evidence regarding potential Gulf War exposures, and establishing the Gulf War Veterans Health Registry, and Public Law 102-310, authorizing VA to provide health care services on a priority basis to Gulf War veterans through December 31, 2001. Now, more than a decade after the war, scientific research has determined neither the causes of veterans' symptoms, nor the long-term health consequences of Gulf War-era exposures. In addition, the Department of Defense recently released new estimates of the number and locations of service personnel exposed to nerve agents. To meet the medical needs of these Gulf War veterans, now and as they continue to unfold, we must extend this period for providing health care services on a priority basis. The legislation that I have introduced would extend this period for 10 more years. I ask my colleagues in joining me to extend this critical service for the men and women who served this Nation.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the Subcommittee on Science, Technology and Space of the Committee on Commerce, Science, and Transportation be authorized to meet on Thursday, October 11, 2001, at 2:30 pm, on needs of fire services in responding to terrorism.

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the Subcommittee on Oceans, Atmosphere, and Fisheries of the Committee on Commerce, Science, and Transportation be authorized to meet on Thursday, October 11, 2001, at 9:30 am, on role of the Coast Guard and NOAA in strengthening security against maritime threats.

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the Committee on Governmental Affairs be authorized to meet on Thursday, October 11, 2001 at 9:30 am to consider the nomination of Mark W. Everson to be Controller, Office of Federal Financial Management, Office of Management and Budget.

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the Committee on Finance be authorized to meet during the session of the Senate on Thursday, October 11, 2001 at 2:30 pm to hear testimony on S. 685, ``Strengthening Working Families Act of 2001.''

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the committee on Armed Services be authorized to meet during the session of the Senate on Thursday, October 11, 2001, at 2:30 P.M., in open session to consider the nominations of Linton F. Brooks to be Deputy Administrator for Defense Nuclear Nonproliferation, National Nuclear Security Administration; Marvin R. Sambur to be Assistant Secretary of the Air Force for Acquisition; William Winkenwerder, Jr. to be Assistant Secretary of Defense for Health Affairs; Everett Beckner to be Deputy Administrator for Defense Programs, National Nuclear Security Administration; and Mary L. Walker to be General Counsel of the Air Force.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I say to the Senator from California, there are at least one, perhaps two Senators on this side of the aisle who wish to speak.

Mr. ROCKEFELLER. Mr. President, I yield 5 minutes to the Senator from Minnesota.

Mr. ROCKEFELLER. Mr. President, I yield 10 minutes to the Senator from Illinois.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Reserving the right to object, this amendment, as I understand it, is the first amendment that will be unrelated to the bill. I don't want to comment further on that. We are going to have our cloture vote at 1:35. I object, at least for this period of time.

Mr. ROCKEFELLER. I suggest the absence of a quorum.