To provide reimbursement for Federally qualified health centers participating in medicare manged care.

TEXT OF AMENDMENTS

SA 951. Mr. ALEXANDER proposed an amendment to the bill S. 504, to
establish academies for teachers and students of American history and
civics and a national alliance of teachers of American history and
civics, and for other purposes; as follows:

Strike all after the enacting clause and insert the
following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ``American History and Civics
Education Act of 2003''.

SEC. 2. DEFINITIONS.

In this Act:
(1) American history and civics.--The term ``American
history and civics'' means the key events, key persons, key
ideas, and key documents that shaped the institutions and
democratic heritage of the United States of America.
(2) Chairman.--The term ``Chairman'' means the Chairman of
the National Endowment for the Humanities.
(3) Educational institution.--The term ``educational
institution''--
(A) means--
(i) an institution of higher education;
(ii) an educational institution created by a legislative
act of a State for the express purpose of teaching American
history and civics to elementary school and secondary school
students; or
(iii) a nonprofit educational institution, library, or
research center; and
(B) includes a consortium of entities described in
subparagraph (A).
(4) Institution of higher education.--The term
``institution of higher education'' has the meaning given the
term in section 101(a) of the Higher Education Act of 1965
(20 U.S.C. 1001(a)).
(5) Key documents.--The term ``key documents'' means the
documents that established or explained the foundational
principles of democracy in the United States, including the
United States Constitution and the amendments to the
Constitution (particularly the Bill of Rights), the
Declaration of Independence, the Federalist Papers, and the
Emancipation Proclamation.
(6) Key events.--The term ``key events'' means the critical
turning points in the history of the United States (including
the encounter of Native Americans with European settlers, the
American Revolution, the Civil War, the world wars of the
twentieth century, the civil rights movement, and the major
court decisions, legislation, literature, and the arts) that
established democracy and extended its promise in American
life.
(7) Key ideas.--The term ``key ideas'' means the ideas that
shaped the democratic institutions and heritage of the United
States, including the notions of liberty, equal opportunity,
individualism, laissez faire, the rule of law, federalism and
e pluribus unum, the free exercise of religion, the
separation of church and state, and a belief in progress.
(8) Key persons.--The term ``key persons'' means the men
and women who led the United States as Founding Fathers,
Native American leaders, elected officials, scientists,
inventors, pioneers, advocates of equal rights,
entrepreneurs, and artists.
(9) State.--The term ``State'' means each of the 50 States
and the District of Columbia.
(10) Teachers of american history and civics.--The term
``teachers of American history and civics'' means
kindergarten through grade 12 teachers who teach American
history, government, or civics, or who incorporate such
subjects into their teaching.

SEC. 3. PRESIDENTIAL ACADEMIES FOR TEACHING OF AMERICAN
HISTORY AND CIVICS.

(a) Establishment.--From amounts appropriated under
subsection (j), the National Endowment for the Humanities
shall award grants, on a competitive basis, to educational
institutions to establish Presidential Academies for Teaching
of American History and Civics (in this section referred to
as ``Academies'') that shall offer workshops for teachers of
American history and civics--
(1) to strengthen such teachers' knowledge of the subjects
of American history and civics; and
(2) to learn how better to teach such subjects.
(b) Application.--
(1) In general.--An educational institution that desires to
receive a grant under this section shall submit an
application to the National Endowment for the Humanities at
such time, in such manner, and containing such information as
the National Endowment for the Humanities may require.
(2) Contents.--An application submitted under paragraph (1)
shall--
(A) include the criteria that will be used to determine
which teachers will be selected to attend workshops offered
by the Academy;
(B) identify the individual the educational institution
intends to appoint to be the primary scholar at the Academy;
(C) include a description of the curriculum to be used at
workshops offered by the Academy; and
(D) provide an assurance that the recruitment plan for
which teachers will be selected to attend workshops offered
by the Academy will include teachers from schools receiving
assistance under part A of title I of the Elementary and
Secondary Education Act of 1965 (20 U.S.C. 6311 et seq.),
particularly those schools with high concentrations of
students described in section 1124(c) of such Act.
(c) Number of Grants.--The National Endowment for the
Humanities shall award not more than 12 grants to different
educational institutions under this section.
(d) Distribution.--The Chairman shall encourage equitable
distribution of grants under this section among the
geographical regions of the United States.
(e) Grant Terms.--Grants awarded under this section shall
be for a term of 2 years.
(f) Use of Funds.--
(1) Workshops.--
(A) In general.--An educational institution that receives a
grant under this section shall establish an Academy that
shall offer a workshop during the summer, or during another
appropriate time, for teachers of American history and
civics--
(i) to strengthen such teachers' knowledge of the subjects
of American history and civics; and
(ii) to learn how better to teach such subjects.
(B) Duration of workshop.--A workshop offered pursuant to
this section shall be approximately 2 weeks in duration.
(2) Academy staff.--
(A) Primary scholar.--Each Academy shall be headed by a
primary scholar identified in the application submitted under
subsection (b) who shall--
(i) be accomplished in the field of American history and
civics; and
(ii) design the curriculum for and lead the workshop.
(B) Core teachers.--Each primary scholar shall appoint an
appropriate number of core teachers. At the direction of the
primary scholar, the core teachers shall teach and train the
workshop attendees.
(3) Selection of teachers.--
(A) In general.--
(i) Number of teachers.--Each year, each Academy shall
select kindergarten through grade 12 teachers of American
history and civics to attend the workshop offered by the
Academy.
(ii) Flexibility in number of teachers.--Each Academy shall
select not more than 300 and not less than 50 teachers under
clause (i).
(B) Teachers from public and private schools.--An Academy
may select teachers from public schools and private schools
to attend the workshop offered by the Academy.
(g) Costs.--
(1) In general.--Except as provided in paragraph (2), a
teacher who attends a workshop offered pursuant to this
section shall not incur costs associated with attending the
workshop, including costs for meals, lodging, and materials
while attending the workshop, and may receive a stipend to
cover such costs.
(2) Travel costs.--A teacher who attends a workshop offered
pursuant to this section shall use non-Federal funds to pay
for such teacher's costs of transit to and from the Academy.
(h) Evaluation.--
(1) In general.--At the completion of all of the workshops
assisted in the third year grants are awarded under this
section, the National Endowment for the Humanities shall
conduct an evaluation and submit a report on its findings to
the relevant committees of Congress.
(2) Content of evaluation.--The evaluation conducted
pursuant to paragraph (1) shall--
(A) determine the overall success of the grant program
authorized under this section; and
(B) highlight the best grantees' practices in order to
become models for future grantees.
(i) Non-Federal Funds.--An educational institution
receiving Federal assistance under this section may
contribute non-Federal funds toward the costs of operating
the Academy.
(j) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $7,000,000 for
each of fiscal years 2004 through 2007.

SEC. 4. CONGRESSIONAL ACADEMIES FOR STUDENTS OF AMERICAN
HISTORY AND CIVICS.

(a) Establishment.--From amounts appropriated under
subsection (j), the National Endowment for the Humanities
shall award grants, on a competitive basis, to educational
institutions to establish Congressional Academies for
Students of American History and Civics (in this section
referred to as ``Academies'') that shall offer workshops for
outstanding students of American history and civics to
broaden and deepen such students' understanding of American
history and civics.
(b) Application.--
(1) In general.--An educational institution that desires to
receive a grant under this section shall submit an
application to the National Endowment for the Humanities at
such time, in such manner, and containing such information as
the National Endowment for the Humanities may require.
(2) Contents.--An application submitted under paragraph (1)
shall--
(A) include the criteria that will be used to determine
which students will be selected to attend workshops offered
by the Academy;

[[Page S8308]]

(B) identify the individual the educational institution
intends to appoint to be the primary scholar at the Academy;
(C) include a description of the curriculum to be used at
workshops offered by the Academy; and
(D) include a description of how the educational
institution will--
(i) inform students from schools receiving assistance under
part A of title I of the Elementary and Secondary Education
Act of 1965 (20 U.S.C. 6311 et seq.), particularly those
schools with high concentrations of students described in
section 1124(c) of such Act, of the Academy; and
(ii) provide such students with information on how to apply
to attend workshops offered by the Academy so that such
students may attend the workshops.
(c) Number of Grants.--The National Endowment for the
Humanities shall award not more than 12 grants to different
educational institutions under this section.
(d) Distribution.--The Chairman shall encourage equitable
distribution of grants under this section among the
geographical regions of the United States.
(e) Grant Terms.--Grants awarded under this section shall
be for a term of 2 years.
(f) Use of Funds.--
(1) Workshops.--
(A) In general.--An educational institution that receives a
grant under this section shall establish an Academy that
shall offer a workshop during the summer, or during another
appropriate time, for outstanding students of American
history, government, and civics to broaden and deepen such
students' understanding of American history and civics.
(B) Duration of workshop.--A workshop offered pursuant to
this section shall be approximately 4 weeks in duration.
(2) Academy staff.--
(A) Primary scholar.--Each Academy shall be headed by a
primary scholar identified in the application submitted under
subsection (b) who shall--
(i) be accomplished in the field of American history and
civics; and
(ii) design the curriculum for and lead the workshop.
(B) Core teachers.--Each primary scholar shall appoint an
appropriate number of core teachers. At the direction of the
primary scholar, the core teachers shall teach the workshop
attendees.
(3) Selection of students.--
(A) Number of students.--Each year, each Academy shall
select between 100 and 300 eligible students to attend the
workshop offered by the Academy.
(B) Eligible students.--A student shall be eligible to
attend a workshop offered by an Academy if the student--
(i) is recommended by the student's secondary school
principal (or other head of such student's academic program)
to attend the workshop; and
(ii) will be a junior or senior in the academic year
following attendance at the workshop.
(g) Costs.--
(1) In general.--Except as provided in paragraph (2), a
student who attends a workshop offered pursuant to this
section shall not incur costs associated with attending the
workshop, including costs for meals, lodging, and materials
while attending the workshop.
(2) Travel costs.--A student who attends a workshop offered
pursuant to this section shall use non-Federal funds to pay
for such student's costs of transit to and from the Academy.
(h) Evaluation.--
(1) In general.--At the completion of all of the workshops
assisted in the third year grants are awarded under this
section, the National Endowment for the Humanities shall
conduct an evaluation and submit a report on its findings to
the relevant committees of Congress.
(2) Content of evaluation.--The evaluation conducted
pursuant to paragraph (1) shall--
(A) determine the overall success of the grant program
authorized under this section; and
(B) highlight the best grantees' practices in order to
become models for future grantees.
(i) Non-Federal Funds.--An educational institution
receiving Federal assistance under this section may
contribute non-Federal funds toward the costs of operating
the Academy.
(j) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $14,000,000 for
each of fiscal years 2004 through 2007.

SEC. 5. NATIONAL ALLIANCE OF TEACHERS OF AMERICAN HISTORY AND
CIVICS.

(a) Establishment.--
(1) In general.--From amounts appropriated under subsection
(e), the National Endowment for the Humanities shall award 1
or more grants to organizations for the creation of a
national alliance of elementary school and secondary school
teachers of American history and civics.
(2) Purpose.--The purpose of the national alliance is--
(A) to facilitate the sharing of ideas among teachers of
American history and civics; and
(B) to encourage best practices in the teaching of American
history and civics.
(b) Application.--An organization that desires to receive a
grant under this section shall submit an application to the
National Endowment for the Humanities at such time, in such
manner, and containing such information as the National
Endowment for the Humanities may require.
(c) Grant Term.--A grant awarded under this section shall
be for a term of 2 years and may be reapplied after the
initial term expires.
(d) Use of Funds.--An organization that receives a grant
under this section may use the grant funds for any of the
following:
(1) Creation of a website on the Internet to facilitate
discussion of new ideas on improving American history and
civics education.
(2) Creation of in-State chapters of the national alliance,
to which individual teachers of American history and civics
may belong, that sponsors American history and civics
activities for such teachers in the State.
(3) Seminars, lectures, or other events focused on American
history and civics, which may be sponsored in cooperation
with, or through grants awarded to, libraries, States'
humanities councils, or other appropriate entities.
(4) Coordinate activities with other nonprofit educational
alliances that promote the teaching or study of subjects
related to American history and civics.
(e) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, and for any
administrative costs associated with carrying out sections 3
and 4, $4,000,000 for each of fiscal years 2004 through 2007.
SA 952. Mrs. CLINTON submitted an amendment intended to be proposed
by her to the bill S. 1 to amend title XVIII of the Social Security Act
to make improvements in the medicare program, to provide prescription
drug coverage under the medicare program, and for other purposes; which
was ordered to lie on the table; as follows:

On page 76, line 20, strike ``The'' and insert ``Except to
the extent necessary to provide eligible beneficiaries
already enrolled in a Medicare Prescription Drug plan with
the choice of avoiding disruption by remaining enrolled in
that plan, the''.
______

SA 953. Mrs. CLINTON submitted an amendment intended to be proposed
by her to the bill S. 1, to amend title XVIII of the Social Security
Act to make improvements in the medicare program, to provide
prescription drug coverage under the medicare program, and for other
purposes; which was ordered to lie on the table; as follows:

On page 608, between lines 10 and 11, insert the following:

SEC. ____. TRAINING FOR LONG-TERM CARE OMBUDSMAN.

(a) In General.--The Secretary of Health and Human
Services, acting through the Director of the Administration
on Aging and in consultation with the Director of the Agency
for Healthcare Research and Quality and the Administrator of
the Centers for Medicare & Medicaid Services, shall authorize
a program, to be developed and implemented by the National
Long-Term Care Ombudsman Resource Center, for the training of
long-term care ombudsmen in the use of quality of care
information.
(b) Training.--Under the program developed under subsection
(a), training shall be provided to long-term care ombudsman
to enable such ombudsman to educate consumers concerning--
(1) nursing home quality of care issues;
(2) available nursing home quality of care reports,
including existing quality data that the Administrator of the
Centers for Medicare & Medicaid Services has released for use
by the public in choosing long-term care facilities; and
(3) the manner in which an individual can successfully
integrate quality information into health care decision
making regarding nursing home decisions.
(c) Duties of Resource Center.--The National Long-Term Care
Ombudsman Resource Center shall--
(1) develop and maintain a curriculum for ombudsmen;
(2) develop, produce, and maintain training materials;
(3) conduct train-the-trainer programs at regional and
national levels; and
(4) act as a clearinghouse for best practices in
communicating the significance of nursing home quality
indicators to residents and their caregivers.
(d) Pilot Programs.--The Secretary of Health and Human
Services shall award grants for the establishment of 1-year
pilot demonstration programs in 10 States using long-term
care ombudsmen to educate consumers regarding home health
care quality. Such pilot demonstration programs shall test
the effectiveness of having a committed position within the
State dedicated to helping consumers use home health care
quality indicators.
(e) Report.--Not later than 18 months after the date of
enactment of this Act, and annually thereafter, the Secretary
of Health and Human Services shall submit to Congress a
report concerning the effectiveness of the program
established under this section, including the benefits of
providing for dedicated staff who are responsible for
educating consumers to use home health quality indicators in
their health care decision-making.
(f) Authorization.--In addition to any other amounts
authorized to be appropriate for long-term care ombudsman
programs, there are authorized to be appropriated to carry
out this section $4,000,000 for fiscal year 2004 (of which
$1,000,000 shall be used to

[[Page S8309]]

carry out subsection (d)), and $2,000,000 for each fiscal
year thereafter.
______

SA 954. Mrs. CLINTON submitted an amendment intended to be proposed
by her to the bill S. 1, to amend title XVIII of the Social Security
Act to make improvements in the medicare program, to provide
prescription drug coverage under the medicare program, and for other
purposes; which was ordered to lie on the table; as follows:

On page 46, between lines 13 and 14, insert the following:
``(i) Health Literacy Standards.--
``(1) In general.--For purposes of assisting eligible
entities in providing quality assurance measures as described
in subsection (c)(1)(B), the Secretary, acting through the
Director of the Agency for Healthcare Research and Quality,
the Administrator of Health Resources and Services
Administration, the Director of the National Library of
Medicine, and the Commissioner of Food and Drugs, shall
develop standardized materials that pharmacists may use to
assist non-English speaking or functionally illiterate
patients in the safe and appropriate use of prescription
drugs. Such materials may include the use of pictures and the
development of standardized translations in multiple
languages of prescription labels and bottle labels and other
patient safety initiative information. Such materials shall
be available electronically for direct access by pharmacists.
``(2) Authorization of appropriations.--There are
authorized to be appropriated to carry out this subsection,
such sums as may be necessary for each of fiscal years 2004
and 2005.
______

SA 955. Mr. CORZINE submitted an amendment intended to be proposed by
him to the bill S. 1, to amend title XVIII of the Social Security Act
to make improvements in the medicare program, to provide prescription
drug coverage under the medicare program, and for other purposes; which
was ordered to lie on the table; as follows:

At the end of subtitle A of title I, add the following:

SEC. ____. CONFORMING CHANGES REGARDING FEDERALLY QUALIFIED
HEALTH CENTERS.

(a) Permitting FQHCs to Fill Prescriptions.--Section
1861(aa)(3) (42 U.S.C. 1395x(aa)(3)) is amended--
(1) in subparagraph (A), by striking ``and'' after the
comma at the end;
(2) in subparagraph (B), by inserting ``and'' after the
comma at the end; and
(3) by adding at the end the following new subparagraph:
``(C) drugs and biologicals for which payment may otherwise
be made under this title,''.
(b) Elimination of Per Visit Limit.--Section 1833(a)(3) (42
U.S.C. 1395l(a)(3)) is amended by inserting ``, except that
such regulations may not limit the per visit payment amount
with regard to drugs and biologicals described in section
1861(aa)(3)(C) and purchased under section 340B of the Public
Health Service Act'' after ``the Secretary may prescribe in
regulations''.
______

SA 956. Mr. GRAHAM of Florida proposed an amendment to the bill S. 1,
to amend title XVIII of the Social Security Act to make improvements in
the medicare program, to provide prescription drug coverage under the
medicare program, and for other purposes; as follows:

On page 107, between lines 19 and 20, insert the following:
``(d) Beneficiary Not Responsible for Paying Applicable
Percent of the Monthly National Average Premium While the
Beneficiary is in the Coverage Gap.--
``(1) In general.--Notwithstanding subsection (c), if an
individual, with respect to any period of a year, has reached
the initial coverage limit under paragraph (3) of section
1860D-6(c) for the year but has not reached the annual out-
of-pocket limit under paragraph (4) of such section for the
year, the applicable percent under subsection (c) during such
period shall be zero.
``(2) Process.--The Administrator shall establish a process
for carrying out paragraph (1). Under such process, the
Administrator shall--
``(A) require eligible entities offering Medicare
Prescription Drug plans, MedicareAdvantage organizations
offering MedicareAdvantage plans that provide qualified
prescription drug coverage, and entities with a contract
under section 1860D-13(e) to furnish the Administrator with
such information as the Administrator determines necessary to
carry out paragraph (1); and
``(B) furnish the Commissioner of Social Security with such
information as the Administrator determines necessary to
collect the appropriate monthly beneficiary obligation
pursuant to section 1860D-18.

At the end of subtitle C of title IV, insert the following:

SEC. ____. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.

(a) Technical Amendment Concerning Secretary's Authority to
Make Conditional Payment When Certain Primary Plans Do Not
Pay Promptly.--
(1) In general.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2))
is amended--
(A) in subparagraph (A)(ii), by striking ``promptly (as
determined in accordance with regulations)'';
(B) in subparagraph (B)--
(i) by redesignating clauses (i) through (iii) as clauses
(ii) through (iv), respectively; and
(ii) by inserting before clause (ii), as so redesignated,
the following new clause:
``(i) Authority to make conditional payment.--The Secretary
may make payment under this title with respect to an item or
service if a primary plan described in subparagraph (A)(ii)
has not made or cannot reasonably be expected to make payment
with respect to such item or service promptly (as determined
in accordance with regulations). Any such payment by the
Secretary shall be conditioned on reimbursement to the
appropriate Trust Fund in accordance with the succeeding
provisions of this subsection.''.
(2) Effective date.--The amendments made by paragraph (1)
shall be effective as if included in the enactment of title
III of the Medicare and Medicaid Budget Reconciliation
Amendments of 1984 (Public Law 98-369).
(b) Clarifying Amendments to Conditional Payment
Provisions.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is
further amended--
(1) in subparagraph (A), in the matter following clause
(ii), by inserting the following sentence at the end: ``An
entity that engages in a business, trade, or profession shall
be deemed to have a self-insured plan if it carries its own
risk (whether by a failure to obtain insurance, or otherwise)
in whole or in part.'';
(2) in subparagraph (B)(ii), as redesignated by subsection
(a)(2)(B)--
(A) by striking the first sentence and inserting the
following: ``A primary plan, and an entity that receives
payment from a primary plan, shall reimburse the appropriate
Trust Fund for any payment made by the Secretary under this
title with respect to an item or service if it is
demonstrated that such primary plan has or had a
responsibility to make payment with respect to such item or
service. A primary plan's responsibility for such payment may
be demonstrated by a judgment, a payment conditioned upon the
recipient's compromise, waiver, or release (whether or not
there is a determination or admission of liability) of
payment for items or services included in a claim against the
primary plan or the primary plan's insured, or by other
means.''; and
(B) in the final sentence, by striking ``on the date such
notice or other information is received'' and inserting ``on
the date notice of, or information related to, a primary
plan's responsibility for such payment or other information
is received''; and
(3) in subparagraph (B)(iii), as redesignated by subsection
(a)(2)(B), by striking the first sentence and inserting the
following: ``In order to recover payment made under this
title for an item or service, the United States may bring an
action against any or all entities that are or were required
or responsible (directly, as an insurer or self-insurer, as a
third-party administrator, as an employer that sponsors or
contributes to a group health plan, or large group health
plan, or otherwise) to make payment with respect to the same
item or service (or any portion thereof) under a primary
plan. The United States may, in accordance with paragraph
(3)(A) collect double damages against any such entity. In
addition, the United States may recover under this clause
from any entity that has received payment from a primary plan
or from the proceeds of a primary plan's payment to any
entity.''.
(c) Clerical Amendments.--Section 1862(b) (42 U.S.C.
1395y(b)) is amended--
(1) in paragraph (1)(A), by moving the indentation of
clauses (ii) through (v) 2 ems to the left; and
(2) in paragraph (3)(A), by striking ``such'' before
``paragraphs''.
______

SA 957. Mr. DAYTON submitted an amendment intended to be proposed by
him to the bill S. 1, to amend title XVIII of the Social Security Act
to make improvements in the medicare program, to provide prescription
drug coverage under the medicare program, and for other purposes; which
was ordered to lie on the table; as follows:

At the appropriate place insert the following:

SEC. ____. LIMITATION ON PRESCRIPTION DRUG BENEFITS OF
MEMBERS OF CONGRESS.

(a) Limitation on Benefits.--Notwithstanding any other
provision of law, during calendar year 2004, the actuarial
value of the prescription drug benefit of any Member of
Congress enrolled in a health benefits plan under chapter 89
of title 5, United States Code, may not exceed the actuarial
value of any prescription drug benefit under title XVIII of
the Social Security Act passed by the 1st session of the
108th Congress and enacted in law.
(b) Regulations.--The Office of Personnel Management shall
promulgate regulations to carry out this section.
______

SA 958. Mr. KERRY proposed an amendment to the bill S. 1, to amend
title XVIII of the Social Security Act to make improvements in the
medicare program, to provide prescription drug

[[Page S8310]]

coverage under the medicare program, and for other purposes; as
follows:

On page 204, after line 22, insert the following:

SEC. ____. ACCESS TO DISCOUNTED PRESCRIPTION DRUGS.

(a) In General.--From amounts made available under
subsection (c), the Secretary of Health and Human Services
shall award grants to covered entities described in section
340B(a)(4) of the Public Health Service Act (42 U.S.C.
256b(a)(4)) to enable such entities to pay the start-up costs
associated with the establishment of pharmacies to provide
covered drugs under such section 340B.
(b) Application.--To be eligible to receive a grant under
subsection (a), a covered entity shall prepare and submit to
the Secretary of Health and Human Services an application at
such time, in such manner, and containing such information as
the Secretary may require.
(c) Funding.--The following sums are appropriated, out of
any money in the Treasury not otherwise appropriated to the
Prescription Drug Account established under section 1860DD-25
of the Social Security Act, $300,000,000 to carry out this
section. Amounts made available under this subsection shall
become available October 1, 2004, and shall remain available
until expended.
______

SA 959. Mrs. LINCOLN submitted an amendment intended to be proposed
by her to the bill S. 1, to amend title XVIII of the Social Security
Act to make improvements in the medicare program, to provide
prescription drug coverage under the medicare program, and for other
purposes; as follows:

At the end of subtitle B of title IV, add the following:

SEC. ____. MEDICARE DEMONSTRATION PROJECT FOR DIRECT ACCESS
TO PHYSICAL THERAPY SERVICES.

(a) In General.--The Secretary shall conduct a
demonstration project under this section (in this section
referred to as the ``project'') to demonstrate the impact of
allowing medicare fee-for-service beneficiaries direct access
to outpatient physical therapy services and physical therapy
services furnished as comprehensive rehabilitation facility
services on--
(1) costs under the medicare program under title XVIII of
the Social Security Act; and
(2) the satisfaction of beneficiaries receiving such
services.
(b) Deadline for Establishment; Duration; Sites.--
(1) Deadline.--The Secretary shall establish the project
not later than 1 year after the date of enactment of this
Act.
(2) Duration; sites.-- The project shall--
(A) be conducted for a period of 3 years;
(B) include sites in at least 5 States; and
(C) to the extent feasible, be conducted on a statewide
basis in each State included under subparagraph (B).
(3) Early termination.--Notwithstanding paragraph (2)(A),
the Secretary may terminate the operation of the project at a
site before the end of the 3-year period specified in such
paragraph if the Secretary determines, based on actual data,
that the total amount expended for all services under this
title for individuals at such site for a 12-month period are
greater than the total amount that would have been expended
for such services for such individuals for such period but
for the operation of the project at such site.
(c) Waiver of Medicare Requirements.--The Secretary shall
waive compliance with such requirements of the medicare
program under title XVIII of the Social Security Act to the
extent and for the period the Secretary finds necessary to
conduct the demonstration project.
(d) Evaluations and Reports.--
(1) Evaluations.--
(A) In general.--The Secretary shall conduct interim and
final evaluations of the project.
(B) Focus.--The evaluations conducted under paragraph (1)
shall--
(i) focus on the impact of the project on program costs
under title XVIII of the Social Security Act and patient
satisfaction with health care items and services for which
payment is made under such title; and
(ii) include comparisons, with respect to episodes of care
involving direct access to physical therapy services and
episodes of care involving a physician referral for such
services, of--

(I) the average number of claims paid per episode for
outpatient physical therapy services and physical therapy
services furnished as comprehensive outpatient rehabilitation
facility services;
(II) the average number of physician office visits per
episode; and
(III) the average expenditures under such title per
episode.

(2) Interim and final reports.--The Secretary shall submit
to the Committee on Finance of the Senate and the Committees
on Ways and Means and Energy and Commerce of the House of
Representatives reports on the evaluations conducted under
paragraph (1) by--
(A) in the case of the report on the interim evaluation,
not later than the end of the second year the project has
been in operation; and
(B) in the case of the report on the final evaluation, not
later than 180 days after the closing date of the project.
(3) Funding for evaluation.--There are authorized to be
appropriated such sums as may be necessary to provide for the
evaluations and reports required by this subsection.
(e) Definitions.--In this section:
(1) Comprehensive outpatient rehabilitation services.--
Subject to paragraph (2), the term ``comprehensive outpatient
rehabilitation services'' has the meaning given to such term
in section 1861(cc) of the Social Security Act (42 U.S.C.
1395x(cc)).
(2) Direct access.--The term ``direct access'' means, with
respect to outpatient physical therapy services and physical
therapy services furnished as comprehensive outpatient
rehabilitation facility services, coverage of and payment for
such services in accordance with the provisions of title
XVIII of the Social Security Act, except that sections
1835(a)(2), 1861(p), and 1861(cc) of such Act (42 U.S.C.
1395n(a)(2), 1395x(p), and 1395x(cc), respectively) shall be
applied--
(A) without regard to any requirement that--
(i) an individual be under the care of (or referred by) a
physician; or
(ii) services be provided under the supervision of a
physician; and
(B) by allowing a physician or a qualified physical
therapist to satisfy any requirement for--
(i) certification and recertification; and
(ii) establishment and periodic review of a plan of care.
(3) Fee-for-service medicare beneficiary.--The term ``fee-
for-service medicare beneficiary'' means an individual who--
(A) is enrolled under part B of title XVIII of the Social
Security Act (42 U.S.C. 1395j et seq.); and
(B) is not enrolled in--
(i) a Medicare+Choice plan under part C of such title (42
U.S.C. 1395w-21 et seq.);
(ii) a plan offered by an eligible organization under
section 1876 of such Act (42 U.S.C. 1395mm);
(iii) a program of all-inclusive care for the elderly
(PACE) under section 1894 of such Act (42 U.S.C. 1395eee); or
(iv) a social health maintenance organization (SHMO)
demonstration project established under section 4018(b) of
the Omnibus Budget Reconciliation Act of 1987 (Public Law
100-203).
(4) Outpatient physical therapy services.--Subject to
paragraph (2), the term ``outpatient physical therapy
services'' has the meaning given to such term in section
1861(p) of the Social Security Act (42 U.S.C. 1395x(p)),
except that such term shall not include the speech-language
pathology services described in the fourth sentence of such
section.
(5) Physician.--The term ``physician'' has the meaning
given to such term in section 1861(r)(1) of such Act (42
U.S.C. 1395x(r)(1)).
(6) Qualified physical therapist.--The term ``qualified
physical therapist'' has the meaning given to such term for
purposes of section 1861(p) of such Act (42 U.S.C. 1395x(p)),
as in effect on the date of enactment of this Act.
______

SA 960. Mr. DAYTON submitted an amendment intended to be proposed by
him to the bill S. 1, to amend title XVIII of the Social Security Act
to make improvements in the medicare program, to provide prescription
drug coverage under the medicare program, and for other purposes; which
was ordered to lie on the table; as follows:

At the end of subtitle A of title V, add the following:

SEC. ____. STREAMLINING AND SIMPLIFICATION OF MEDICARE
REGULATIONS.

(a) In General.--The Secretary of Health and Human Services
shall conduct an analysis of the regulations issued under
title XVIII of the Social Security Act and related laws in
order to determine how such regulations may be streamlined
and simplified to increase the efficiency and effectiveness
of the medicare program without harming beneficiaries or
providers and to decrease the burdens the medicare payment
systems impose on both beneficiaries and providers.
(b) Reduction in Regulations.--The Secretary, after
completion of the analysis under subsection (a), shall direct
the rewriting of the regulations described in subsection (a)
in such a manner as to--
(1) reduce the number of words comprising all regulations
by at least two-thirds by October 1, 2004, and
(2) ensure the simple, effective, and efficient operation
of the medicare program.
(c) Application of the Paperwork Reduction Act.--The
Secretary shall apply the provisions of chapter 35 of title
44, United States Code (commonly known as the ``Paperwork
Reduction Act'') to the provisions of this Act to ensure that
any regulations issued to implement this Act are written in
plain language, are streamlined, promote the maximum
efficiency and effectiveness of the medicare and medicaid
programs without harming beneficiaries or providers, and
minimize the burdens the payment systems affected by this Act
impose on both beneficiaries and providers.
______

SA 961. Mrs. MURRAY submitted an amendment intended to be proposed by
her to the bill S. 1, to amend title XVIII of the Social Security Act
to make improvements in the medicare program, to provide prescription
drug coverage under the medicare program,

[[Page S8311]]

and for other purposes; which was ordered to lie on the table; as
follows:

At the end of subtitle A of title II, add the following:

SEC. ____. IMPROVEMENTS IN MEDICAREADVANTAGE BENCHMARK
DETERMINATIONS.

(a) Revision of National Average Used in Calculation of
Blend.--Section 1853(c)(4)(B)(i)(II) (42 U.S.C. 1395w-
23(c)(4)(B)(i)(II)), as amended by section 203, is amended by
inserting ``who are enrolled in a MedicareAdvantage plan''
after ``the average number of medicare beneficiaries''.
(b) Change in Budget Neutrality.--Section 1853(c) (42
U.S.C. 1395w-23(c)), as amended by section 203, is amended--
(1) in paragraph (1)(A)--
(A) in clause (ii), by striking the comma at the end and
inserting a period; and
(B) by striking the flush matter following clause (ii); and
(2) by striking paragraph (5).
(c) Inclusion of Costs of DOD and VA Military Facility
Services to Medicare-eligible Beneficiaries in Calculation of
Medicare+Choice Payment Rates.--
(1) For purposes of calculating medicare+choice payment
rates.--Section 1853(c)(3) (42 U.S.C. 1395w-23(c)(3)), as
amended by section 203, is amended--
(A) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (E)''; and
(B) by adding at the end the following new subparagraph:
``(E) Inclusion of costs of dod and va military facility
services to medicare-eligible beneficiaries.--In determining
the area-specific Medicare+Choice capitation rate under
subparagraph (A) for a year (beginning with 2006), the annual
per capita rate of payment for 1997 determined under section
1876(a)(1)(C) shall be adjusted to include in the rate the
Secretary's estimate, on a per capita basis, of the amount of
additional payments that would have been made in the area
involved under this title if individuals entitled to benefits
under this title had not received services from facilities of
the Department of Defense or the Department of Veterans
Affairs.''.
(2) For purposes of calculating local fee-for-service
rates.--Section 1853(d)(5) (42 U.S.C. 1395w-23(d)(5)), as
amended by section 203, is amended--
(A) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (C)''; and
(B) by adding at the end the following new subparagraph:
``(C) Inclusion of costs of dod and va military facility
services to medicare-eligible beneficiaries.--In determining
the local fee-for-service rate under subparagraph (A) for a
year (beginning with 2006), the annual per capita rate of
payment for 1997 determined under section 1876(a)(1)(C) shall
be adjusted to include in the rate the Secretary's estimate,
on a per capita basis, of the amount of additional payments
that would have been made in the area involved under this
title if individuals entitled to benefits under this title
had not received services from facilities of the Department
of Defense or the Department of Veterans Affairs.''.
(d) Effective Date.--The amendments made by this section
shall apply with respect to plan years beginning on and after
January 1, 2006.
______

SA 962. Mr. SMITH (for himself and Mr. Bingaman) submitted an
amendment intended to be proposed by him to the bill S. 1, to amend
title XVIII of the Social Security Act to make improvements in the
medicare program, to provide prescription drug coverage under the
medicare program, and for other purposes; which was ordered to lie on
the table; as follows:

At the end of title VI, insert the following:

SEC. ____. REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH
CENTERS PARTICIPATING IN MEDICARE MANAGED CARE.

(a) Reimbursement.--
(1) In general.--Section 1833(a)(3) (42 U.S.C. 1395l(a)(3))
is amended to read as follows:
``(3) in the case of services described in section
1832(a)(2)(D)--
``(A) except as provided in subparagraph (B), the costs
which are reasonable and related to the cost of furnishing
such services or which are based on such other tests of
reasonableness as the Secretary may prescribe in regulations,
including those authorized under section 1861(v)(1)(A), less
the amount a provider may charge as described in clause (ii)
of section 1866(a)(2)(A), but in no case may the payment for
such services (other than for items and services described in
section 1861(s)(10)(A)) exceed 80 percent of such costs; or
``(B) with respect to the services described in clause (ii)
of section 1832(a)(2)(D) that are furnished to an individual
enrolled with a MedicareAdvantage plan under part C pursuant
to a written agreement described in section 1853(j), the
amount by which--
``(i) the amount of payment that would have otherwise been
provided under subparagraph (A) (calculated as if `100
percent' were substituted for `80 percent' in such
subparagraph) for such services if the individual had not
been so enrolled; exceeds
``(ii) the amount of the payments received under such
written agreement for such services (not including any
financial incentives provided for in such agreement such as
risk pool payments, bonuses, or withholds),

less the amount the Federally qualified health center may
charge as described in section 1857(e)(3)(C);''.
(b) Continuation of MedicareAdvantage Monthly Payments.--
(1) In general.--Section 1853 (42 U.S.C. 1395w-23), as
amended by this Act, is amended by adding at the end the
following new subsection:
``(j) Payment Rule for Federally Qualified Health Center
Services.--If an individual who is enrolled with a
MedicareAdvantage plan under this part receives a service
from a Federally qualified health center that has a written
agreement with such plan for providing such a service
(including any agreement required under section 1857(e)(3))--
``(1) the Secretary shall pay the amount determined under
section 1833(a)(3)(B) directly to the Federally qualified
health center not less frequently than quarterly; and
``(2) the Secretary shall not reduce the amount of the
monthly payments to the MedicareAdvantage plan made under
section 1853(a) as a result of the application of paragraph
(1).''.
(2) Conforming amendments.--
(A) Paragraphs (1) and (2) of section 1851(i) (42 U.S.C.
1395w-21(i)(1)), as amended by this Act, are each amended by
inserting ``1853(j),'' after ``1853(i),''.
(B) Section 1853(c)(5) is amended by striking ``subsections
(a)(3)(C)(iii) and (i)'' and inserting ``subsections
(a)(3)(C)(iii), (i), and (j)(1)''.
(c) Additional MedicareAdvantage Contract Requirements.--
Section 1857(e) (42 U.S.C. 1395w-27(e)) is amended by adding
at the end the following new paragraph:
``(3) Agreements with federally qualified health centers.--
``(A) Payment levels and amounts.--A contract under this
part shall require the MedicareAdvantage plan to provide, in
any contract between the plan and a Federally qualified
health center, for a level and amount of payment to the
Federally qualified health center for services provided by
such health center that is not less than the level and amount
of payment that the plan would make for such services if the
services had been furnished by a provider of services that
was not a Federally qualified health center.
``(B) Cost-sharing.--Under the written agreement described
in subparagraph (A), a Federally qualified health center must
accept the MedicareAdvantage contract price plus the Federal
payment provided for in section 1833(a)(3)(B) as payment in
full for services covered by the contract, except that such a
health center may collect any amount of cost-sharing
permitted under the contract under this part, so long as the
amounts of any deductible, coinsurance, or copayment comply
with the requirements under section 1854(e).''.
(d) Safe Harbor From Antikickback Prohibition.--Section
1128B(b)(3) (42 U.S.C. 1320a-7b(b)(3)) is amended--
(1) in subparagraph (E), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (F), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(G) any remuneration between a Federally qualified health
center (or an entity controlled by such a health center) and
a MedicareAdvantage plan pursuant to the written agreement
described in section 1853(j).''.
(e) Effective Date.--The amendments made by this section
shall apply to services provided on or after January 1, 2006,
and contract years beginning on or after such date.
______

SA 963. Mrs. LINCOLN (for herself, Mr. Conrad, Mr. Miller, and Mr.
Carper) proposed an amendment to the bill S. 1, to amend title XVIII of
the Social Security Act to make improvements in the medicare program,
to provide prescription drug coverage under the medicare program, and
for other purposes; as follows:
On page 83, strike lines 1 through 7, and insert the
following:
``(5) Contract to be available in designated area for 2
years.--Notwithstanding paragraph (1), if the Administrator
enters into a contract with an entity with respect to an area
designated under subparagraph (B) of such paragraph for a
year, the following rules shall apply:
``(A) The contract shall be for a 2-year period.
``(B) The Secretary is not required to make the
determination under paragraph (1)(A) with respect to the
second year of the contract for the area.
``(C) During the second year of the contract, an eligible
beneficiary residing in the area may continue to receive
standard prescription drug coverage (including access to
negotiated prices for such beneficiaries pursuant to section
1860D-6(e)) under such contract or through any Medicare
Prescription Drug plan that is available in the area.

At the end of title VI, add the following:

SEC. ____. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.

(a) Technical Amendment Concerning Secretary's Authority to
Make Conditional Payment When Certain Primary Plans Do Not
Pay Promptly.--
(1) In general.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2))
is amended--

[[Page S8312]]

(A) in subparagraph (A)(ii), by striking ``promptly (as
determined in accordance with regulations)'';
(B) in subparagraph (B)--
(i) by redesignating clauses (i) through (iii) as clauses
(ii) through (iv), respectively; and
(ii) by inserting before clause (ii), as so redesignated,
the following new clause:
``(i) Authority to make conditional payment.--The Secretary
may make payment under this title with respect to an item or
service if a primary plan described in subparagraph (A)(ii)
has not made or cannot reasonably be expected to make payment
with respect to such item or service promptly (as determined
in accordance with regulations). Any such payment by the
Secretary shall be conditioned on reimbursement to the
appropriate Trust Fund in accordance with the succeeding
provisions of this subsection.''.
(2) Effective date.--The amendments made by paragraph (1)
shall be effective as if included in the enactment of title
III of the Medicare and Medicaid Budget Reconciliation
Amendments of 1984 (Public Law 98-369).
(b) Clarifying Amendments to Conditional Payment
Provisions.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is
further amended--
(1) in subparagraph (A), in the matter following clause
(ii), by inserting the following sentence at the end: ``An
entity that engages in a business, trade, or profession shall
be deemed to have a self-insured plan if it carries its own
risk (whether by a failure to obtain insurance, or otherwise)
in whole or in part.'';
(2) in subparagraph (B)(ii), as redesignated by subsection
(a)(2)(B)--
(A) by striking the first sentence and inserting the
following: ``A primary plan, and an entity that receives
payment from a primary plan, shall reimburse the appropriate
Trust Fund for any payment made by the Secretary under this
title with respect to an item or service if it is
demonstrated that such primary plan has or had a
responsibility to make payment with respect to such item or
service. A primary plan's responsibility for such payment may
be demonstrated by a judgment, a payment conditioned upon the
recipient's compromise, waiver, or release (whether or not
there is a determination or admission of liability) of
payment for items or services included in a claim against the
primary plan or the primary plan's insured, or by other
means.''; and
(B) in the final sentence, by striking ``on the date such
notice or other information is received'' and inserting ``on
the date notice of, or information related to, a primary
plan's responsibility for such payment or other information
is received''; and
(3) in subparagraph (B)(iii), , as redesignated by
subsection (a)(2)(B), by striking the first sentence and
inserting the following: ``In order to recover payment made
under this title for an item or service, the United States
may bring an action against any or all entities that are or
were required or responsible (directly, as an insurer or
self-insurer, as a third-party administrator, as an employer
that sponsors or contributes to a group health plan, or large
group health plan, or otherwise) to make payment with respect
to the same item or service (or any portion thereof) under a
primary plan. The United States may, in accordance with
paragraph (3)(A) collect double damages against any such
entity. In addition, the United States may recover under this
clause from any entity that has received payment from a
primary plan or from the proceeds of a primary plan's payment
to any entity.''.
(c) Clerical Amendments.--Section 1862(b) (42 U.S.C.
1395y(b)) is amended--
(1) in paragraph (1)(A), by moving the indentation of
clauses (ii) through (v) 2 ems to the left; and
(2) in paragraph (3)(A), by striking ``such'' before
``paragraphs''.
______

SA 964. Mr. BAUCUS (for Mr. Jeffords) proposed an amendment to the
bill S. 1, to amend title XVIII of the Social Security Act to make
improvements in the medicare program, to provide prescription drug
coverage under the medicare program, and for other purposes; as
follows:
Beginning on page 8, strike line 1 and all that follows
through page 9, line 2, and insert the following:
``(A) In general.--Except as provided in subparagraphs (B),
(C), and (D), the term `covered drug' means--
``(i) a drug that may be dispensed only upon a prescription
and that is described in clause (i) or (ii) of subparagraph
(A) of section 1927(k)(2);
``(ii) a smoking cessation agent that is approved under
section 505 of the Federal Food, Drug, and Cosmetic Act as a
non-prescription drug and is dispensed upon a prescription;
``(iii) a biological product described in clauses (i)
through (iii) of subparagraph (B) of section 1927(k)(2); or
``(iv) insulin described in subparagraph (C) of such
section;
and such term includes a vaccine licensed under section 351
of the Public Health Service Act and any use of a covered
drug for a medically accepted indication (as defined in
section 1927(k)(6)).
``(B) Exclusions.--
``(i) In general.--The term `covered drug' does not include
drugs or classes of drugs, or their medical uses, which may
be excluded from coverage or otherwise restricted under
section 1927(d)(2), other than subparagraphs (E) and (G)
thereof insofar as they relate to smoking cessation agents,
or under section 1927(d)(3).
______

SA 965. Mr. BAUCUS (for Mr. Jeffords) proposed an amendment to the
bill S. 1, to amend title XVIII of the Social Security Act to make
improvements in the medicare program, to provide prescription drug
coverage under the medicare program, and for other purposes; as
follows:

At the end of subtitle B of title IV, add the following:

SEC. ____. COUNCIL FOR TECHNOLOGY AND INNOVATION.

Section 1868 (42 U.S.C. 1395ee), as amended by section 534,
is amended--
(1) by adding at the end of the heading the following: ``;
council for technology and innovation''; and
(2) by adding at the end the following new subsection:
``(c) Council for Technology and Innovation.--
``(1) Establishment.--The Secretary shall establish a
Council for Technology and Innovation within the Centers for
Medicare & Medicaid Services (in this section referred to as
`CMS').
``(2) Composition.--The Council shall be composed of senior
CMS staff and clinicians and shall be chaired by the
Executive Coordinator for Technology and Innovation (as
appointed or designated under paragraph (4)).
``(3) Duties.--The Council shall coordinate the activities
of coverage, coding, and payment processes with respect to
new technologies and procedures, including new drug
therapies, under this title in order to expedite patient
access to new technologies and therapies.
``(4) Executive Coordinator for technology and
innovation.--The Secretary shall appoint (or designate) a
noncareer appointee (as defined in section 3132(a)(7) of
title 5, United States Code) who shall serve as the Executive
Coordinator for Technology and Innovation. Such executive
coordinator shall report to the Administrator of CMS, shall
chair the Council, shall oversee the execution of its duties,
shall serve as a single point of contact for outside groups
and entities regarding the coverage, coding, and payment
processes under this title, and shall prepare reports to
Congress required under section 1869(f)(7).''.
______

SA 966. Mr. CRAIG submitted an amendment intended to be proposed by
him to the bill S. 1, to amend title XVIII of the Social Security Act
to make improvements in the medicare program, to provide prescription
drug coverage under the medicare program, and for other purposes; as
follows:

At the appropriate place in title VI, insert the following:

SEC. ____. RESTORATION OF FEDERAL HOSPITAL INSURANCE TRUST
FUND.

(a) Definitions.--In this section:
(1) Clerical error.--The term ``clerical error'' means the
failure that occurred on April 15, 2001, to have transferred
the correct amount from the general fund of the Treasury to
the Trust Fund.
(2) Trust fund.--The term ``Trust Fund'' means the Federal
Hospital Insurance Trust Fund established under section 1817
of the Social Security Act (42 U.S.C. 1395i).
(b) Correction of Trust Fund Holdings.--
(1) In general.--Not later than 120 days after the date of
enactment of this Act, the Secretary of the Treasury shall
take the actions described in paragraph (2) with respect to
the Trust Fund with the goal being that, after such actions
are taken, the holdings of the Trust Fund will replicate, to
the extent practicable in the judgment of the Secretary of
the Treasury, in consultation with the Secretary of Health
and Human Services, the holdings that would have been held by
the Trust Fund if the clerical error had not occurred.
(2) Obligations issued and remedied.--The Secretary of the
Treasury shall--
(A) issue to the Trust Fund obligations under chapter 31 of
title 31, United States Code, that bear issue dates, interest
rates, and maturity dates that are the same as those for the
obligations that--
(i) would have been issued to the Trust Fund if the
clerical error had not occurred; or
(ii) were issued to the Trust Fund and were redeemed by
reason of the clerical error; and
(B) redeem from the Trust Fund obligations that would have
been redeemed from the Trust Fund if the clerical error had
not occurred.
(c) Appropriation.--Not later than 120 days after the date
of enactment of this Act, there is appropriated to the Trust
Fund, out of any money in the Treasury not otherwise
appropriated, an amount determined by the Secretary of the
Treasury, in consultation with the Secretary of Health and
Human Services, to be equal to the interest income lost by
the Trust Fund through the date on which the appropriation is
being made as a result of the clerical error.
______

SA 967. Mr. BAUCUS (for Mr. Harkin) proposed an amendment to the bill
S. 1, to amend title XVIII of the Social Security Act to make
improvements in

[[Page S8313]]

the medicare program, to provide prescription drug coverage under the
medicare program, and for other purposes; as follows:

At the end of subtitle B of title IV, add the following:

SEC. ____. IMPROVED PAYMENT FOR CERTAIN MAMMOGRAPHY SERVICES.

(a) Exclusion From OPD Fee Schedule.--Section
1833(t)(1)(B)(iv) (42 U.S.C. 13951(t)(1)(B)(iv)) is amended
by inserting before the period at the end the following:
``and does not include screening mammography (as defined in
section 1861(jj)) and unilateral and bilateral diagnostic
mammography''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to mammography performed on or after January 1,
2004.
______

SA 968. Mr. BAUCUS (for Mr. Harkin) proposed an amendment to the bill
S. 1, to amend title XVIII of the Social Security Act to make
improvements in the medicare program, to provide prescription drug
coverage under the medicare program, and for other purposes; as
follows:

At the end of subtitle B of title IV, add the following:

SEC. ____. REIMBURSEMENT FOR TOTAL BODY ORTHOTIC MANAGEMENT
FOR CERTAIN NURSING HOME PATIENTS.

(a) In General.--Not later than 60 days after the date of
the enactment of this Act, the Secretary shall issue product
codes that qualified practioners and suppliers may use to
receive reimbursement under section 1834(h) of the Social
Security Act (42 U.S.C. 1395m(h)) for qualified total body
orthotic management devices used for the treatment of
nonambulatory individuals with severe musculoskeletal
conditions who are in the full-time care of skilled nursing
facilities (as defined in section 1861(j) of such Act (42
U.S.C. 1395x(j))). In issuing such codes, the Secretary shall
take all steps necessary to prevent fraud and abuse.
(b) Qualified Total Body Orthotic Management Device.--For
purposes of this section, the term ``qualified total body
orthotic management device'' means a medically-prescribed
device which--
(1) consists of custom fitted individual braces with
adjustable points at the hips, knee, ankle, elbow, and wrist,
but only if--
(A) the individually adjustable braces are attached to a
frame which is an integral component of the device and cannot
function or be used apart from the frame; and
(B) the frame is designed such that it serves no purpose
without the braces; and
(2) is designed to--
(A) improve function;
(B) retard progression of musculoskeletal deformity; or
(C) restrict, eliminate, or assist in the functioning of
lower and upper extremities and pelvic, spinal, and cervical
regions of the body affected by injury, weakness, or
deformity,

of an individual for whom stabilization of affected areas of
the body, or relief of pressure points, is required for
medical reasons.
______

SA 969. Mr. BAUCUS (for Mr. Dodd) proposed an amendment to the bill
S. 1, to amend title XVIII of the Social Security Act to make
improvements in the medicare program, to provide prescription drug
coverage under the medicare program, and for other purposes; as
follows:

At the end of subtitle C of title II, add the following:

SEC. ____. PERMITTING CONTINUOUS OPEN ENROLLMENT AND
DISENROLLMENT UNDER MEDICARE PARTS C AND D
UNTIL 2008.

(a) Under Medicare Prescription Drug Plans.--Subclause (II)
of section 1860D-3(a)(1)(A)(i), as added by section 101, is
amended to read as follows:

``(II)(aa) during 2006 and 2007, may change an election
under this clause at any time; and
``(bb) during 2008 or a subsequent year, may make an annual
election to change the election under this clause.''.

(b) Under MedicareAdvantage Plans.--Section 1851(e) (42
U.S.C. 1395w-21(e)), as amended by section 201, is amended--
(1) in paragraph (2)(A), by striking ``through 2005'' and
``December 31, 2005'' and inserting ``through 2007'' and
``December 31, 2007'', respectively;
(2) in the heading of paragraph (2)(B), by striking
``during 2006'' and inserting ``during 2008'';
(3) in paragraph (2)(B)(i), by striking ``2006'' and
inserting ``2008'' each place it appears;
(4) in paragraph (2)(C)(i), by striking ``2007'' and
inserting ``2009'' each place it appears;
(5) in paragraph (2)(D), by striking ``2006'' and inserting
``2008''; and
(6) in paragraph (4), by striking ``2006'' and inserting
``2008'' each place it appears.
______

SA 970. Mr. BAUCUS (for Mr. Dodd) proposed an amendment to the bill
S. 1, to amend title XVIII of the Social Security Act to make
improvements in the medicare program, to provide prescription drug
coverage under the medicare program, and for other purposes; as
follows:

Section 1860D-19(a) of the Social Security Act, as added by
section 101, is amended by adding at the end the following
new paragraph:
``(5) Reduction of cost-sharing for additional low-income
beneficiaries.--
``(A) In general.--In the case of an additional low-income
beneficiary (as defined in subparagraph (B)), such individual
shall be responsible for cost-sharing for the cost of any
covered drug provided in the year (after the individual has
reached the initial coverage limit described in section
1860D-6(c)(3) and before the individual has reached the
annual out-of-pocket limit under section 1860D-6(c)(4)(A)),
that is equal to 50.0 percent.
``(B) Additional low-income beneficiary.--Subject to
subparagraph (H), the term `additional low-income
beneficiary' means an individual--
``(i) who is enrolled under this part, including an
individual who is enrolled under a MedicareAdvantage plan;
``(ii) whose income is at least 160 percent, but not more
than 250 percent, of the poverty line; and
``(iii) who is not--

``(I) a qualified medicare beneficiary;
``(II) a specified low-income medicare beneficiary;
``(III) a qualifying individual;
``(IV) a subsidy-eligible individual; or
``(V) a dual eligible individual.

______

SA 971. Mr. BINGAMAN submitted an amendment intended to be proposed
by him to the bill S. 1, to amend title XVIII of the Social Security
Act to make improvements in the medicare program, to provide
prescription drug coverage under the medicare program, and for other
purposes; which was ordered to lie on the table; as follows:

At the end of subtitle C of title II, add the following:

SEC. ____. CARVING OUT DSH PAYMENTS FROM PAYMENTS TO
MEDICARE+CHOICE AND MEDICAREADVANTAGE
ORGANIZATIONS AND PAYING THE AMOUNTS DIRECTLY
TO DSH HOSPITALS ENROLLING MEDICARE+CHOICE AND
MEDICAREADVANTAGE ENROLLEES.

(a) Removal of DSH Payments From Calculation of Adjusted
Average Per Capita Cost.--
(1) Under medicare+choice.--Section 1853(c)(3) (42 U.S.C.
1395w-23(c)(3) and as amended by section 203) is amended--
(A) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (E)'',
(B) by adding at the end the following new subparagraph:
``(E) Removal of payments attributable to disproportionate
share payments from calculation of adjusted average per
capita cost.--For each year (beginning with 2004), the area-
specific Medicare+Choice capitation rate under subparagraph
(A)(ii) shall be adjusted to exclude from such rate the
portion of such rate that the Secretary estimates is
attributable to additional payment amounts described in
section 1886(d)(5)(F) (treating hospitals reimbursed under
section 1814(b)(3) as if such hospitals were reimbursed under
section 1886).''.
(2) Under medicareadvantage.--Section 1853(a)(5) (as
amended by section 203) is amended by adding at the end the
following new subparagraph:
``(C) Removal of payments attributable to disproportionate
share payments from calculation of adjusted average per
capita cost.--For each year (beginning with 2004), the area-
specific Medicare+Choice capitation rate under subparagraph
(A)(ii) shall be adjusted to exclude from such rate the
portion of such rate that the Secretary estimates is
attributable to additional payment amounts described in
section 1886(d)(5)(F) (treating hospitals reimbursed under
section 1814(b)(3) as if such hospitals were reimbursed under
section 1886).''.
(3) Effective dates.--The amendments made--
(A) by paragraph (1) shall apply to plan years beginning on
and after January 1, 2004 and shall continue to apply to plan
years beginning on and after January 1, 2006; and
(B) by paragraph (2) shall apply to plan years beginning on
and after January 1, 2006.
(b) Additional DSH Payments for Managed Care Enrollees.--
Section 1886(d)(5)(F) ((42 U.S.C. 1395ww(d)(5)(F)) is
amended--
(1) in clause (ii), by striking ``clause (ix)'' and
inserting ``clauses (ix) and (xvi)''; and
(2) by adding at the end the following new clause:
``(xvi)(I) For portions of cost reporting periods occurring
on or after January 1, 2004, the Secretary shall provide for
an additional payment amount for each applicable discharge of
any subsection (d) hospital that is a disproportionate share
hospital (as described in clause (i)).
``(II) For purposes of this clause the term `applicable
discharge' means the discharge of any individual who is
enrolled under a risk-sharing contract with a eligible
organization under section 1876 and who is entitled to
benefits under part A and any individual who is enrolled with
a Medicare+Choice organization or a MedicareAdvantage
organization under part C.
``(III) The amount of the payment under this clause with
respect to any applicable discharge shall be equal to the
estimated average per discharge amount that would otherwise
have been paid under this subparagraph if the individuals had
not been enrolled as described in subclause (II).

[[Page S8314]]

``(IV) The Secretary shall establish rules for paying an
additional amount for any hospital reimbursed under a
reimbursement system authorized under 1814(b)(3) if such
hospital would qualify as a disproportionate share hospital
under clause (i) were it not so reimbursed. Such payment
shall be determined in the same manner as the amount of
payment is determined under this clause for disproportionate
share hospitals.''.
______

SA 972. Mr. BINGAMAN submitted an amendment intended to be proposed
by him to the bill S. 1, to amend title XVIII of the Social Security
Act to make improvements in the medicare program, to provide
prescription drug coverage under the medicare program, and for other
purposes; which was ordered to lie on the table; as follows:

At the end of title VI, insert the following:

SEC. ____. REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH
CENTERS PARTICIPATING IN MEDICARE MANAGED CARE.

(a) Reimbursement.--
(1) In general.--Section 1833(a)(3) (42 U.S.C. 1395l(a)(3))
is amended to read as follows:
``(3) in the case of services described in section
1832(a)(2)(D)--
``(A) except as provided in subparagraph (B), the costs
which are reasonable and related to the cost of furnishing
such services or which are based on such other tests of
reasonableness as the Secretary may prescribe in regulations,
including those authorized under section 1861(v)(1)(A), less
the amount a provider may charge as described in clause (ii)
of section 1866(a)(2)(A), but in no case may the payment for
such services (other than for items and services described in
section 1861(s)(10)(A)) exceed 80 percent of such costs; or
``(B) with respect to the services described in clause (ii)
of section 1832(a)(2)(D) that are furnished to an individual
enrolled with a MedicareAdvantage plan under part C pursuant
to a written agreement described in section 1853(j), the
amount by which--
``(i) the amount of payment that would have otherwise been
provided under subparagraph (A) (calculated as if `100
percent' were substituted for `80 percent' in such
subparagraph) for such services if the individual had not
been so enrolled; exceeds
``(ii) the amount of the payments received under such
written agreement for such services (not including any
financial incentives provided for in such agreement such as
risk pool payments, bonuses, or withholds),
less the amount the Federally qualified health center may
charge as described in section 1857(e)(3)(C);''.
(b) Continuation of MedicareAdvantage Monthly Payments.--
(1) In general.--Section 1853 (42 U.S.C. 1395w-23), as
amended by this Act, is amended by adding at the end the
following new subsection:
``(j) Payment Rule for Federally Qualified Health Center
Services.--If an individual who is enrolled with a
MedicareAdvantage plan under this part receives a service
from a Federally qualified health center that has a written
agreement with such plan for providing such a service
(including any agreement required under section 1857(e)(3))--
``(1) the Secretary shall pay the amount determined under
section 1833(a)(3)(B) directly to the Federally qualified
health center not less frequently than quarterly; and
``(2) the Secretary shall not reduce the amount of the
monthly payments to the MedicareAdvantage plan made under
section 1853(a) as a result of the application of paragraph
(1).''.
(2) Conforming amendments.--
(A) Paragraphs (1) and (2) of section 1851(i) (42 U.S.C.
1395w-21(i)(1)), as amended by this Act, are each amended by
inserting ``1853(j),'' after ``1853(i),''.
(B) Section 1853(c)(5) is amended by striking ``subsections
(a)(3)(C)(iii) and (i)'' and inserting ``subsections
(a)(3)(C)(iii), (i), and (j)(1)''.
(c) Additional MedicareAdvantage Contract Requirements.--
Section 1857(e) (42 U.S.C. 1395w-27(e)) is amended by adding
at the end the following new paragraph:
``(3) Agreements with federally qualified health centers.--
``(A) Payment levels and amounts.--A contract under this
part shall require the MedicareAdvantage plan to provide, in
any contract between the plan and a Federally qualified
health center, for a level and amount of payment to the
Federally qualified health center for services provided by
such health center that is not less than the level and amount
of payment that the plan would make for such services if the
services had been furnished by a provider of services that
was not a Federally qualified health center.
``(B) Cost-sharing.--Under the written agreement described
in subparagraph (A), a Federally qualified health center must
accept the MedicareAdvantage contract price plus the Federal
payment provided for in section 1833(a)(3)(B) as payment in
full for services covered by the contract, except that such a
health center may collect any amount of cost-sharing
permitted under the contract under this part, so long as the
amounts of any deductible, coinsurance, or copayment comply
with the requirements under section 1854(e).''.
(d) Safe Harbor From Antikickback Prohibition.--Section
1128B(b)(3) (42 U.S.C. 1320a-7b(b)(3)) is amended--
(1) in subparagraph (E), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (F), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(G) any remuneration between a Federally qualified health
center (or an entity controlled by such a health center) and
a MedicareAdvantage plan pursuant to the written agreement
described in section 1853(j).''.
(e) Effective Date.--The amendments made by this section
shall apply to services provided on or after January 1, 2006,
and contract years beginning on or after such date.
______

SA 973. Mr. BINGAMAN submitted an amendment to be proposed by him to
the bill S. 1, to amend title XVIII of the Social Security Act to make
improvements in the medicare program, to provide prescription drug
coverage under the medicare program, and for other purposes; which was
ordered to lie on the table; as follows:

At the end of subtitle B of title IV, insert the following:

SEC. ____. AUTHORIZATION OF REIMBURSEMENT FOR ALL MEDICARE
PART B SERVICES FURNISHED BY CERTAIN INDIAN
HOSPITALS AND CLINICS.

(a) In General.--Section 1880(e) (42 U.S.C. 1395qq(e)) is
amended--
(1) in paragraph (1)(A), by striking ``for services
described in paragraph (2)'' and inserting ``for all items
and services for which payment may be made under such part'';
(2) by striking paragraph (2); and
(3) by redesignating paragraph (3) as paragraph (2).
(b) Effective Date.--The amendments made by this section
shall apply to items and services furnished on or after
October 1, 2004.
______

SA 974. Mr. GRASSLEY (for himself, Mr. Leahy, Ms. Cantwell, Mr.
Durbin, and Mr. Kohl) submitted an amendment to be proposed by him to
the bill S. 1, to amend title XVIII of the Social Security Act to make
improvements in the medicare program, to provide prescription drug
coverage under the medicare program, and for other purposes; which was
ordered to lie on the table; as follows:
At the end of the amendment, insert the following:

TITLE ____--DRUG COMPETITION ACT OF 2003

SEC. ____01. SHORT TITLE.

This title may be cited as the ``Drug Competition Act of
2003''.

SEC. ____02. FINDINGS.

Congress finds that--
(1) prescription drug prices are increasing at an alarming
rate and are a major worry of many senior citizens and
American families;
(2) there is a potential for companies with patent rights
regarding brand name drugs and companies which could
manufacture generic versions of such drugs to enter into
financial deals that could tend to restrain trade and greatly
reduce competition and increase prescription drug
expenditures for American citizens; and
(3) enhancing competition among these companies can
significantly reduce prescription drug expenditures for
Americans.

SEC. ____03. PURPOSES.

The purposes of this title are--
(1) to provide timely notice to the Department of Justice
and the Federal Trade Commission regarding agreements between
companies with patent rights regarding brand name drugs and
companies which could manufacture generic versions of such
drugs; and
(2) by providing timely notice, to enhance the
effectiveness and efficiency of the enforcement of the
antitrust and competition laws of the United States.

SEC. ____04. DEFINITIONS.

In this title:
(1) ANDA.--The term ``ANDA'' means an Abbreviated New Drug
Application, as defined under section 201(aa) of the Federal
Food, Drug, and Cosmetic Act (21 U.S.C. 321(aa)).
(2) Assistant attorney general.--The term ``Assistant
Attorney General'' means the Assistant Attorney General in
charge of the Antitrust Division of the Department of
Justice.
(3) Brand name drug.--The term ``brand name drug'' means a
drug approved under section 505(c) of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 355(c)).
(4) Brand name drug company.--The term ``brand name drug
company'' means the party that received Food and Drug
Administration approval to market a brand name drug pursuant
to an NDA, where that drug is the subject of an ANDA, or a
party owning or controlling enforcement of any patent listed
in the Approved Drug Products With Therapeutic Equivalence
Evaluations of the Food and Drug Administration for that
drug, under section 505(b) of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 355(b)).
(5) Commission.--The term ``Commission'' means the Federal
Trade Commission.
(6) Generic drug.--The term ``generic drug'' means a
product that the Food and Drug Administration has approved
under section 505(j) of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 355(j)).
(7) Generic drug applicant.--The term ``generic drug
applicant'' means a person

[[Page S8315]]

who has filed or received approval for an ANDA under section
505(j) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
355(j)).
(8) NDA.--The term ``NDA'' means a New Drug Application, as
defined under section 505(b) et seq. of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 355(b) et seq.)

SEC. ____05. NOTIFICATION OF AGREEMENTS.

(a) In General.--
(1) Requirement.--A generic drug applicant that has
submitted an ANDA containing a certification under section
505(j)(2)(vii)(IV) of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 355(j)(2)(vii)(IV)) and a brand name drug
company that enter into an agreement described in paragraph
(2), prior to the generic drug that is the subject of the
application entering the market, shall each file the
agreement as required by subsection (b).
(2) Definition.--An agreement described in this paragraph
is an agreement regarding--
(A) the manufacture, marketing or sale of the brand name
drug that is the subject of the generic drug applicant's
ANDA;
(B) the manufacture, marketing or sale of the generic drug
that is the subject of the generic drug applicant's ANDA; or
(C) the 180-day period referred to in section
505(j)(5)(B)(iv) of the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 355(j)(5)(B)(iv)) as it applies to such ANDA or to
any other ANDA based on the same brand name drug.
(b) Filing.--
(1) Agreement.--The generic drug applicant and the brand
name drug company entering into an agreement described in
subsection (a)(2) shall file with the Assistant Attorney
General and the Commission the text of any such agreement,
except that the generic drug applicant and the brand-name
drug company shall not be required to file an agreement that
solely concerns--
(A) purchase orders for raw material supplies;
(B) equipment and facility contracts;
(C) employment or consulting contracts; or
(D) packaging and labeling contracts.
(2) Other agreements.--The generic drug applicant and the
brand name drug company entering into an agreement described
in subsection (a)(2) shall file with the Assistant Attorney
General and the Commission the text of any other agreements
not described in subsection (a)(2) between the generic drug
applicant and the brand name drug company which are
contingent upon, provide a contingent condition for, or are
otherwise related to an agreement which must be filed under
this title.
(3) Description.--In the event that any agreement required
to be filed by paragraph (1) or (2) has not been reduced to
text, both the generic drug applicant and the brand name drug
company shall file written descriptions of the non-textual
agreement or agreements that must be filed sufficient to
reveal all of the terms of the agreement or agreements.

SEC. ____06. FILING DEADLINES.

Any filing required under section 5 shall be filed with the
Assistant Attorney General and the Commission not later than
10 business days after the date the agreements are executed.

SEC. ____07. DISCLOSURE EXEMPTION.

Any information or documentary material filed with the
Assistant Attorney General or the Commission pursuant to this
title shall be exempt from disclosure under section 552 of
title 5, and no such information or documentary material may
be made public, except as may be relevant to any
administrative or judicial action or proceeding. Nothing in
this section is intended to prevent disclosure to either body
of Congress or to any duly authorized committee or
subcommittee of the Congress.

SEC. ____08. ENFORCEMENT.

(a) Civil Penalty.--Any brand name drug company or generic
drug applicant which fails to comply with any provision of
this title shall be liable for a civil penalty of not more
than $11,000, for each day during which such entity is in
violation of this title. Such penalty may be recovered in a
civil action brought by the United States, or brought by the
Commission in accordance with the procedures established in
section 16(a)(1) of the Federal Trade Commission Act (15
U.S.C. 56(a)).
(b) Compliance and Equitable Relief.--If any brand name
drug company or generic drug applicant fails to comply with
any provision of this title, the United States district court
may order compliance, and may grant such other equitable
relief as the court in its discretion determines necessary or
appropriate, upon application of the Assistant Attorney
General or the Commission.

SEC. ____09. RULEMAKING.

The Commission, with the concurrence of the Assistant
Attorney General and by rule in accordance with section 553
of title 5 United States Code, consistent with the purposes
of this title--
(1) may define the terms used in this title;
(2) may exempt classes of persons or agreements from the
requirements of this title; and
(3) may prescribe such other rules as may be necessary and
appropriate to carry out the purposes of this title.

SEC. ____10. SAVINGS CLAUSE.

Any action taken by the Assistant Attorney General or the
Commission, or any failure of the Assistant Attorney General
or the Commission to take action, under this title shall not
bar any proceeding or any action with respect to any
agreement between a brand name drug company and a generic
drug applicant at any time under any other provision of law,
nor shall any filing under this title constitute or create a
presumption of any violation of any antitrust or competition
laws.

SEC. ____11. EFFECTIVE DATE.

This title shall--
(1) take effect 30 days after the date of enactment of this
title; and
(2) shall apply to agreements described in section ____05
that are entered into 30 days after the date of enactment of
this title.

____________________