William Roth

Mr. ROTH

Mr. ROTH. Mr. President, I ask that the Senate now resume consideration of amendment No. 520, the committee amendment.

Mr. ROTH. I yield 2 minutes off the bill.

Mr. ROTH. I yield the remaining time I have to the distinguished Senator from North Carolina.

Mr. ROTH. Madam President, I ask unanimous consent that the next two first-degree amendments in order to S. 949 first be an amendment by Senator Domenici regarding budget enforcement, to be followed by an amendment by Senator Byrd regarding the budget.

Mr. ROTH. Yes. There will be time to debate it this evening. That is correct.

Mr. ROTH. Mr. President, how much time do I have?

Mr. ROTH. Mr. President, I yield 5 minutes to the distinguished Senator from Indiana.

Mr. ROTH. I yield 5 minutes to the Senator from Pennsylvania.

Mr. ROTH. Mr. President, I yield 5 minutes to the Senator from New Hampshire.

Mr. ROTH. Mr. President, I yield the distinguished Senator from Missouri 7 minutes.

Mr. ROTH. That is correct. Mr. President, I yield 7 minutes to the distinguished Senator from Montana.

Mr. ROTH. Mr. President--

Mr. ROTH

Mr. ROTH. Mr. President, pursuant to section 313(b)(1)(c) of the Congressional Budget Act, I submit a list on behalf of the Committee on the Budget of the extraneous material in S. 947 the, Balanced Budget Act of 1997, as reported. I ask unanimous consent that the list be printed in the Record.

Mr. ROTH

Mr. ROTH. That is correct.

Mr. ROTH. Mr. President, I oppose the Kennedy amendment. As we have just been discussing, we have carefully crafted and negotiated the issue of the benefits package for the new children's health initiative. This amendment would break that agreement by requiring additional benefits. It does the very opposite of what we want to do. We want to provide flexibility to the States, and this would be a major step in the wrong direction. Mr. DOMENICI addressed the Chair.

Mr. ROTH. That is correct.

Mr. ROTH. No; the choice is not limited to that. Under the option, the States must provide benefits that are the equivalent of a Blue Cross standard plan. But I emphasize the word ``equivalent,'' because it means considerable flexibility. I should point out, it also includes vision and hearing services.

Mr. ROTH. Mr. President, section 2102 allows for the use of existing State funds to provide additional health care coverage for children over 200 percent of poverty.

Mr. ROTH. Mr. President, I say to the Senator from Vermont, he has my assurance that we will discuss this concern in the conference committee. It is not my intent to penalize those States that have done a good job in covering their low-income children or to exclude needy children from coverage.

Mr. ROTH. Mr. President, I object to the amendment. We are transferring, over 7 years, home health care to part B, but we want to do it in seven segments because it is agreed that the beneficiaries should continue to pay 25 percent of the cost of the part B services. We do not want to put it all over the first year because we do not want to raise the premiums that rapidly. So in order to be consistent, what we provide in the legislation is that the home health care will be transferred over 7 years. Each year an additional seventh will be included in the cost of the premium, so that will make the phasein much lower.

Mr. ROTH. So I don't have any disagreement with our distinguished friend and leader as to the whole process, but we have in good faith tried to deal with the process and meet the time schedules that everybody has wanted us to achieve. I could go on and read all of these, if you like, sir. But I will say they are highly technical. The first one, I might point out, included two Medicare hospital- related provisions. As I said, the first is a modification as to how we reimburse what are called Medicare PPS-exempt hospitals. A PPS hospital is paid on a prospective payment basis. That was a means that was adopted many years ago to try to gain better control of expenditures than you have when you have cost reimbursements. The hospital knows that for a certain kind of function, they will be able to receive so much money--say, $1,000. And they know they have to live within that. So they have an incentive to try to keep those costs down. But now we are cutting because we have to make greater savings. The hospitals, according to our independent panel, are doing relatively well, and we are trying to cut it more. The second is a hospital wage index classification and reimbursement. We deal or address the wage index, and a highly technical modification takes place there. So, as I say, they are this kind of technical change basically in an effort to make legislative language accurate and achieve the goals that were intended by the policy.

Mr. ROTH. Mr. President, if I may say so, I am encouraged very greatly by the news that the Senator from New Mexico will stay as long as possible, as does our distinguished friend and leader from West Virginia. I say to my good friend from West Virginia, as he well knows, in every major piece of legislation there are a lot of technicalities and complexities involved in the legislation. In the efforts to draft them and put them in final shape, it becomes necessary to have a number of technical modifications at the end. I would also say that in developing this legislation, it has been my intention to work with everyone, both in committee and on the floor. We have tried to include everybody--Republican, Democrats, senior Members, and junior Members. So I think the process has been all-inclusive. Basically, what we have here in the so-called managers' amendment is sort of a cleanup of a number of matters that had to be modified to make them technically correct to take care in some cases of some of the concerns of individual Members. Each of these have been reviewed very carefully by the technicians who understand it. I think part of the problem is that these are very complex matters that aren't easy to explain or even to understand. But let me point out, for example, that in the managers' amendment, the first section that deals with what is known as ``PPS-exempt'' hospital changes, it deals with technical changes as to how they are reimbursed. For example, the first says strike the update formula and substitute with a zero; update for fiscal years 1998, 2001, and market basket, minus 3 percent in 2002. In trying to reach the $115 billion savings that we are supposed to make in Medicare, we reduce payments to the providers. Normally the reimbursement each year reflects the cost-of-living or inflation. But in this particular case, in order to make savings and because the hospitals are doing reasonably well, we are reducing the reimbursement. It is that kind of technical change that much of this deals with. In another situation, we are--again in efforts to save money-- reducing what is known as disproportion payment and we have based the recommendations on what an independent commission has recommended, and I might say that is what the administration has recommended as well. These, again, are all basically very technical. But going back to the reduction of the disproportion, because both Democrat and Republican Members were concerned about reducing as much as was recommended by this independent board, we have slowed that phase-in a little bit to make it easier for those organizations to adjust. So essentially I would say it is this kind of technical change that we are trying to deal with here rather than major policy. I assure you that we have dealt with both managers--the Republican manager, the Democrat, and, of course, I might say that we have been working very closely with my good friend and colleague, Pat Moynihan.

Mr. ROTH. Yes, I am happy to explain to my distinguished friend from West Virginia. It includes two Medicare hospital-related provisions. The first is a modification to the Medicare PPS, exempt hospital payments, and the second is a hospital wage index classification. The second makes three additions to the Medicaid provisions. These include a Grassley amendment that was adopted in committee on the effect of managed care on individuals with special needs, a clarification on the definition of provider taxes, and continuation of certain 1115 waivers. There are four provisions on welfare, clarification of the language on SSI, and Medicaid benefits of certain Indians. It makes a conforming amendment on work activities, and it confirms the maintenance-of-effort requirement to the existing welfare block grant. It also requires that half of the payments for job placement be provided after an individual has been placed in the work force for at least 6 months. Finally, the modification to the managers' amendment also modifies the formula for achieving savings in the Disproportionate Share Hospital Program. The amendment provides a smoother transition for the States and delays the restrictions on payment to mental health facilities. As I said, Mr. President, all these amendments have been cleared by both sides of the aisle. I urge their adoption.

Mr. ROTH. Mr. President, the managers' amendment with the modification has been approved on both sides of the aisle. I urge its adoption.

Mr. ROTH. Mr. President, I ask unanimous consent that amendment No. 506, the managers' amendment, be called up, and I send a modification to the desk.