Medicare Telehealth Improvement Act of 2008

Mr. President, Americans are facing economic challenges at every turn. They see jobs disappearing, homes being foreclosed, debts soaring, and benefits worth less and less. Now families are finding that the loans they rely on to afford the high cost of college may also be at risk.

Some lenders have stopped making private student loans, and others have even temporarily stopped making loans under the Federal program. We can't allow problems in the credit market to prevent students from going to college.

We have been working with the Secretary of Education to take steps to see that all Federal backstops are in place and operational in order to protect students from these problems.

Today, I am introducing legislation for additional steps to protect students by reducing their reliance on loans, and by improving the existing Federal student loan programs to give them better terms and conditions.

The legislation does three things. It increases grant aid for the neediest students. It expands options for students and parents under the Federal loan programs so that fewer of them will have to turn to higher cost private loans. It takes steps to shore up the reliability of the current Federal loan programs so that families will have timely and reliable access to Federal loans.

Over 6 million students relied on Federal loans last year. It is essential to make sure this support is there for them when they need it. In the past 20 years, the cost of college has tripled, and more and more students are relying on student loans to afford a college education. In 1993, less than half of all graduates took out loans, but in 2004, nearly \2/3\ did so.

The average U.S. student now graduates with more than $19,000 of student loan debt. As a result, they are under increasing pressure to give up lower-paying jobs and careers they may prefer, due to the burden of repaying their loan debts.

Legislation was enacted last year that increased grant aid and made Federal loans cheaper for students by reducing interest rates. We also provided that no graduates should have to pay more than 15 percent of their income in monthly loan payments, and that those who enter public service will have their loans completely forgiven. But these benefits will be meaningless if students cannot obtain the loans needed to gain a degree.

In recent weeks, the credit market crisis has made it more difficult for lenders to obtain capital for student loans. As a result, some lenders are leaving the student loan market and those operating outside the Federal loan program are cutting back on loans to high risk borrowers.

So far, because of the attractiveness of the Federal guarantee in the Federal loan program, other lenders are stepping in to fill the gaps in that program.

Since the interest rates in that program are capped, students are protected from inflated interest costs.

But students who need to go beyond the Federal loan program will have a more difficult time finding lenders, and their rates will go up.

Also, parents who traditionally had various options for borrowing to finance college for their children are seeing those options disappear. Some no longer have access to low-cost home equity lines of credit. Others are being turned down for additional loans as they struggle to pay their own mortgages.

As I mentioned, we are already taking action to ensure that programs already in place to protect students and families from credit market disruptions are fully operational.

I have urged Secretary Spellings to make it as easy as possible for colleges and families to participate in the existing loan program that allows students and parents to borrow directly from the Federal Government, without going through a bank. This Direct Loan program uses Treasury funds. It does not rely on capital from the private financial markets, so it's insulated from the market disruptions now taking place.

I have also urged the Secretary to put in place a plan to activate the ``Lender-of-Last-Resort'' program, which enables the Secretary to advance capital to designated lenders and guaranty agencies, so they can help students who are having trouble finding loans through other banks.

These programs are now in the law, and nearly 2,000 colleges are already signed up to use the Direct Loan Program.

We're also taking steps to help students and parents who must borrow outside the Federal loan program, since they are the ones most likely to be affected by the credit market decline.

Currently, however, many students and parents don't know about their Federal options. According to Department of Education estimates, between 40 and 60 percent of students who turn to high-cost private loans are not actually taking full advantage of Federal grants and loans first.

We're taking steps to correct that problem in the Higher Education Reauthorization bill that's in conference now.

But there is much more we can do to reduce families' reliance on high-cost private loans. The legislation I am offering today will increase access for students and families to low-cost Federal loans. It will also strengthen the backstops in the Federal program, to ensure students and families will continue to have access to Federal loans.

The legislation cuts back in several ways on the number of private loans that families have to take out:

It increases Pell Grant aid for the lowest income students.

It increases the amount that students can borrow under the Federal loan program.

It makes Federal loans for parents more attractive by enabling parents to defer payments on the loans while students are in college just as students can defer payments on their own loans.

It also takes steps to shore up the Federal loan program to ensure there are no disruptions in access for students.

It makes it easier for schools to use the ``Lender-of-Last-Resort'' program when students or schools have problems finding lenders.

It provides an additional backstop to give lenders access to the capital they need for new loans, if the situation worsens.

I will take a moment to describe each of these provisions.

The best way to help students and families afford college is to increase grant aid. More aid up front means fewer loans and less debt on graduation day. That is why the Democratic Congress delivered on our promise last year to raise the Pell Grant. The maximum grant will increase to $5,400 by 2012--an increase of $1,350 over the level at which it had stagnated under the current administration.

This increase in up-front aid means that students eligible for the maximum Pell grant will have to borrow $6,000 less in loans over the course of their college career.

The legislation I am introducing builds on that progress, and focuses on students who need it most. Currently, over 2.6 million students-- half of all Pell Grant recipients--come from families whose income, under the Federal formula, makes them eligible for the maximum amount of Federal assistance because they are determined to be unable to contribute to their children's college bills. Still, after all grant aid, these families face an average unmet need of $5,600, which they are forced to borrow in order to pay for college. This bill brings additional assistance to these students, by increasing the maximum Pell Grant for these students by up to $750.

Because Federal grant aid has not kept pace with the rising cost of college in recent decades, many students have been forced to turn to loans. The bill helps students who still need to borrow for college by guaranteeing their access to additional low-cost federal loans, rather than forcing them to turn to the more expensive private loan market.

Currently, undergraduate students who are dependents of their parents can take out loans of between $3,500 and $5,500 annually, depending what year of college they're in. The total amount they can borrow is $23,000. Independent students can borrow about double that amount.

Consider what this means for a middle-class family in Massachusetts struggling to send a child to college.

Here is a family that makes $68,700--the median income in our State. On average, these families will spend $17,424 a year for college. Based on the federal formula, the parents are expected to contribute between $8,000 and $10,000 a year from their earnings with the rest to be obtained through grants and loans. After accounting for all federal, state, and institutional aid, this family still faces over $2,600 in unmet costs each year--on top of their expected family contribution. The estimate is conservative, because many parents don't have the $8,000-10,000 they're expected to contribute.

To make up the difference, many families can take out federal parent ``PLUS'' loans at a 7.9 percent interest rate. If they don't qualify for such loans because of poor credit, their children may have to turn to higher cost private loans.

The bill increases eligibility for Federal student loans in order to give students a better, lower-cost option than relying on private lenders.

It allows undergraduates dependent on their parents to borrow up to $1,000 more a year. It tracks current law by allowing independent students to borrow twice that amount. It also allows students whose parents are not able to borrow under the Federal parent loan program because of poor credit to borrow an additional $2,000 per year.

In addition, the bill increases the total amount that students can borrow over the course of their college career. Dependent students will be able to borrow up to $29,500. Independent students, and students whose parents don't have access to PLUS parent loans, can borrow up to $57,500.

Further, the legislation makes federal parent loans more attractive. Currently, most parents have the option of borrowing low-cost federal loans--up to the cost of attendance--for their children. In the 2006- 2007 school year, 600,000 parents borrowed approximately $8 billion in PLUS loans, and the average loan was $13,600.

Many parents in recent years have not taken advantage of PLUS loans, because they had other options, such as home equity lines of credit, or private loans with good terms and conditions. This year, for the first time in a decade, the number of PLUS loan borrowers declined--by about 160,000. At the same time, student and parent dependence on private loans has increased. In the 2006-2007 school year, over $17 billion in private student loans were used to finance higher education.

With the credit crunch making it harder and more expensive for parents to borrow from private sources, this legislation will make it easier for parents to obtain Federal loans. Specifically, it allows parents to defer payment on those loans until their children graduate from school--just as students are able to do under their own Federal loans.

This provision protects parents from having to make any payments over the next few years, and allows them to use that time to meet other financial obligations, such as getting their mortgages back on track.

In addition to these provisions that significantly reduce families' need to turn to the private loan market, the legislation also takes two important steps to strengthen the backstops in the Federal loan program, to ensure that students and parents can continue to have timely, uninterrupted access to Federal loans.

First, it makes it easier for students and schools to participate in the ``Lender-of-Last-Resort'' program. Current law requires designated lenders to make loans to students who are having trouble finding a Federal student loan elsewhere. But the program requires individual students to demonstrate that they can't find a loan before they can turn to a ``lender of last resort.''

If the current market worsens, more lenders may stop making Federal student loans, and this ``lender-of-last-resort'' process will become untenable. Nationally, 18 million students are enrolled in colleges and universities. We can't require each of them to demonstrate they can't find another lender before using this safety net.

The legislation instead allows financial aid officers and colleges to make this determination on behalf of all their students, so that students can easily obtain a loan through a ``lender of last resort.'' Consider the difference this would make at state universities, some of which enroll more than 50,000 college and graduate students and generally rely on one or two primary lenders.

The Clinton Administration enacted such a policy in 1998--the last time lenders threatened to leave the program. The legislation requires the Secretary to make clear that colleges have this option should they need it.

Finally, many lenders who have announced they will not be able to make loans for this college year have had to make that decision because they cannot obtain capital for those loans through their traditional sources in the private financial markets.

Many of these lenders sell the loans they originate in order to replenish their capital and make new loans. But these so-called ``secondary markets'' have begun to close because of the credit crunch.

Some lenders can't find a buyer for their loans. They are stuck with the loans now on their books, and have no capital for new loans in the fall. Over the past month, this has caused some lenders to announce that they will stop making new Federal loans.

This legislation provides a back-up plan for lenders who need it, in case the private credit markets are unavailable to lenders. It allows the Secretary of Education to act as a ``secondary market of last resort,'' by buying the loans that lenders are currently holding on their books and cannot sell.

This will not cause students any greater complexity--under the program established by this legislation, student loans will continue to be serviced under the same terms and conditions that the borrower signed up for. The Department can contract with the same loan servicers that private banks use, and the transition will be seamless for borrowers.

We hope that these additional protections for students and families will not be needed. But given the uncertainties in the overall economy and the credit markets, Congress has an obligation to shore up programs on which millions of students heavily depend. Few things are more important than ensuring that families can afford a college degree for their children, and the goal of this legislation is to make that possible. I urge my colleagues to support it.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I rise today with my esteemed colleagues--Senator Olympia Snowe of Maine and Senator Edward Kennedy of Massachusetts--to introduce a timely and vital piece of legislation, the Economic Recovery in Health Care Act of 2008. This bill will preserve access to health care for our most vulnerable citizens during this time of economic uncertainty.

Earlier this week, Federal Reserve Chairman Ben Bernanke confirmed what we have all long-suspected--that the U.S. economy could be headed for a protracted recession. The tell-tale warning signs of recession have been visible in the states for at least a full quarter now. According to the National Governors Association, the recent economic downturn has left 18 States with budget shortfalls totaling $14 million in 2008, and 21 States project shortfalls totaling more than $32 million in 2009. If the current downturn follows the path of most recessions, between 35 and 40 States will face severe budget shortfalls in 2009.

As a former Governor, who survived the tough times of the 1980s, I can attest to the enormous budget pressures States face when the economy slows. State revenues often evaporate rapidly during an economic downturn. Unlike the Federal Government, States cannot borrow infinite amounts of debt from China and other countries. By law, 49 States--including West Virginia--are required to balance their budgets and, in times of economic downturn, this task becomes significantly more difficult.

Some of my colleagues may be wondering why health care is such a big deal when we have all these other problems to worry about--the mortgage crisis, the credit crunch, and a weak dollar. Well, I would say to my colleagues that we don't have to look very far for an answer to this very question. As we saw during the economic downturn of 2001-2003, decreased access to health care coverage was a huge crisis for working families.

There was a huge loss in private health care coverage. Data from the Center for Studying Health System Change indicates that the proportion of the under-65 population with employer-sponsored coverage fell from 67 percent in 2001 to 63.4 percent in 2003. After adjusting for population growth, this means that nearly 9 million fewer people were covered by employer-sponsored health insurance during the recession than would have been the case if coverage rates remained unchanged.

Medicaid also didn't fare very well during the last recession. It is consistently the first program slated for cuts during a state budget squeeze. According to the Kaiser Commission on Medicaid and the Uninsured, between fiscal years 2002 and 2005, the loss of revenue led all 50 States to reduce Medicaid provider payment rates and implement prescription drug cost controls, 38 States to reduce Medicaid eligibility and 34 States to reduce benefits.

These cuts placed a huge burden on Medicaid providers and the working families who depend on Medicaid to meet their health care needs. While Congress did ultimately respond to the last economic downturn by providing $20 billion in State fiscal relief in 2003, and this relief went a long way to preserve health care coverage for millions of working families, we cannot discount the fact that one million low- income people had already lost Medicaid coverage because we waited two years into the recession to act.

In response to this current downturn, state legislatures are already beginning to limit access to Medicaid and CHIP in preparation for the harsh economic times ahead. According to the Center on Budget and Policy Priorities, at least 10 states have implemented or are considering budget cuts that will reduce access to Medicaid or CHIP for working families. For example, Nevada has capped the State's CHIP program

at its approximate current number of enrollees. As a result, hundreds of children will be denied coverage. California has proposed increasing co-payments and premiums for children enrolled in CHIP and reducing CHIP dental services. I want to remind my colleagues that it was only 1 year ago that millions across the country mourned the death of 12-year- old Deamonte Driver, whose lack of dental care led to fatal brain infection.

At least four States are cutting or proposing to cut Medicaid services for the elderly or disabled, or significantly increasing the cost of these services. For example, Maine has proposed cuts that will remove 7,000 mentally ill and poor adults from Medicaid; and Rhode Island is requiring low-income elderly people to pay more for adult daycare.

Several States have proposed reductions in or delayed payments to providers. For example, New Jersey has proposed a reduction in funding for hospital charity of 15 percent, which will impact hospitals' ability to care for some of the State's most vulnerable residents.

There is no question that our States are in economic peril. However, children don't stop getting sick just because the economy slows. Seniors don't suddenly stop needing long-term care services simply because the economy slows. Instead, the need for access to Medicaid and CHIP grows during times of economic uncertainty, and we must act to ensure that Medicaid and CHIP coverage is available when families need it the most.

The Economic Recovery in Health Care Act provides the timely, targeted, and temporary Federal response necessary to avoid a health care crisis during this current economic slowdown. Our legislation accomplishes this objective in two ways.

First, our bill responds to the Medicaid administrative regulations recently proposed by the administration, which, if allowed to go into effect, would further aggravate the impact of the economic downturn on States and working families. The Congressional Budget Office estimates that these regulations would reduce Federal Medicaid matching payments by approximately $18 billion over 5 years and $42 billion over 10 years. However, State reports to the House Oversight Committee indicate that the cost shift to States could be far greater.

Now is a time when States need greater financial support from the Federal Government, not less financial support and more restrictions that make providing quality care to those most in need nearly impossible.

Our bill will preserve access to Medicaid for seniors, pregnant women, individuals with disabilities, and children during the economic downturn by temporarily extending--through April 1, 2009--the Medicaid moratoria on payments to public providers, graduate medical education, school-based services, and rehabilitative services that Congress has already enacted. The Economic Recovery in Health Care Act would also preserve access to Medicaid by delaying--through April 1, 2009-- implementation of the following additional Medicaid regulations, which are already in effect or scheduled to go into effect in the near future: targeted case management, allowable provider taxes, outpatient clinic and hospital services, and the Departmental Appeals Board rule. Our bill would also preserve access to CHIP for low-income children by implementing a 1-year moratorium on the August 17 CHIP guidance.

The second major component of our legislation is targeted State fiscal relief. Leading economists have found that targeted State aid would generate increased economic activity of $1.36 for each dollar of cost. Our legislation provides approximately $12 billion in targeted State fiscal relief, equally divided between an increase in Federal Medicaid matching payments and targeted grants to States.

Unlike the State fiscal relief provided in 2003 and previous fiscal relief proposals offered this year, each State must meet certain criteria in order to qualify for an increase in federal matching payments and the targeted grants. The criteria would be based on the average of State ranks in unemployment, food stamp participation, and foreclosures. These three economic indicators closely align with State budget deficits and would allow us to more appropriately target State fiscal relief to the States with the most need.

I urge my colleagues to strongly support this important legislation. Medicaid is a Federal-State partnership, and the Federal Government bears the primary responsibility for ensuring that the Federal guarantee of health benefits is not denied to eligible working families, particularly during an economic downturn. With all the worries that working American families are currently facing, they should not have to add health care to their growing list of concerns.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I rise today to introduce the bipartisan reauthorization and expansion for the Temporary Assistance for Needy Families, TANF, Supplemental Grants with my colleague, Senator Lindsey Graham of South Carolina.

The TANF Supplemental Grants will expire this year without action. Currently 17 States depend on these grants, but our legislation would expand and improve on the grants. Welfare reform was passed in 1996, and since then neither the basic TANF Block Grant nor the TANF Supplemental Grant has been increased. This means that the value of the TANF funding in constant dollars has declined by almost 20 percent.

In 2010, Congress will need to review the entire TANF program, but between now and then our legislation seeks to provide modest help for States that are struggling to serve vulnerable children in needy families. Our legislation would provide a modest increase for any State which spends less than the national average per underprivileged child on TANF activities of Federal and State resources. This would help States that cannot meet the average ``catch up,'' and provide more services to underprivileged children. To be reasonable, the increase is capped at $10 million or 10 percent of their existing TANF grant for States that have never received a TANF Supplemental Grant. For States that are receiving a TANF Supplemental Grant, they could qualify for up to $2.5 million in additional funding or 2.5 percent of their existing TANF grant.

This is a modest but important effort to help every state provide for vulnerable children who are receiving less

than that national average for an underprivileged child. This proposal should help the most vulnerable at a time when the economic slowdown is creating more obstacles for families to make a successful transition from welfare to work.

In West Virginia, our neediest children are not even receiving the average amount spent on America's underprivileged children, and that is true in too many States. Our children and families are struggling to meet the bold goals of welfare reform with fewer resources and tougher standards. This reauthorization is a chance to help those States that are struggling to achieve the national average for funding. It would be base funding for underprivileged children rather than population growth. It will target resources to vulnerable children.

Mr. President, today I am proud to introduce the National Park Centennial Fund Act, a bill that will help restore the grandeur of our national parks in preparation for the 100th birthday of the National Park System in 2016. I am pleased to introduce this bill with Senator Collins, Senator Baucus, Senator Coleman, and Senator Tester. I want to thank them for their work and for their support of this bill, which I hope we can pass this year.

Nearly a century ago, following the extraordinary vision of leaders whose dreams were ahead of their time, we as Americans pledged to protect our Nation's most special lands and treasures. At places like Yellowstone, Yosemite, Mesa Verde, and Gettysburg we have set aside for permanent protection those landscapes that conjure the sublime, those historic treasures that tell the American story, and those cultural sites that help define us as a people.

In 2016, we will celebrate the 100th anniversary of the National Park System. The centennial celebration will be an opportunity to resurrect the spirit that drove people like Enos Mills, one of the founders of Rocky Mountain National Park, to work tirelessly to protect our Nation's crown jewels for future generations. ``In years to come when I am asleep beneath the pines,'' Mills proclaimed in 1909, ``thousands of families will find rest and hope in this park.'' He was right. Thanks to the excellent work of the Park Service and its employees over the past 90 years, the 3.2 million visitors that come to Rocky Mountain National Park each year experience the same wild lands and spectacular vistas that our ancestors enjoyed.

The coming of the 2016 centennial of the National Park System is an opportunity to restore the luster of our national parks and inspire future generations to protect these national treasures.

Secretary Kempthorne took an important step in this direction when, in August 2006, he announced that the National Park Service will undertake the Centennial Initiative to prepare for the 100th anniversary of the Park System in 2016. As part of the Centennial Initiative, Secretary Kempthorne proposed the creation of a partnership between: the federal government; the private, philanthropic sector; and other non-federal sources. The goal of this partnership would be to increase philanthropic contributions to the parks by providing Federal matching funds for donations made by Americans for projects that improve the parks and visitor experiences. This program is called the Centennial Challenge.

When Secretary Kempthorne presented this proposal to the Senate Energy and Natural Resources Committee last year, I offered my strong support for the concept. However, the legislation offered by the Administration to put the Centennial Challenge into action suffered from a number of deficiencies--namely, a lack of a spending offset and an unclear delineation of the public's and Congress' role in the program. There were also concerns about the bill's effect on other Park Service accounts, friends groups, and existing philanthropic initiatives.

The National Park Centennial Fund Act that we are introducing today answers many of these questions and, I believe, is a legislative package that is worthy of bipartisan support and passage.

This bill takes Secretary Kempthorne's Centennial Challenge proposal from vision to reality by establishing the Centennial Challenge Fund, a matching donation fund in the federal treasury that will provide up to $100 million a year to the national parks in support of signature ``Centennial projects and programs.'' This would allow supporters of the parks to match their contributions with federal dollars to carry out a program or a project at a national park unit, provided that the project or program is approved by the Park Service and Congress.

This bill provides $100 million in mandatory spending for each of the fiscal years from 2008 to 2017 to carry out special, select Centennial projects throughout the National Park System. Non-federal philanthropic participation is encouraged, but not required, for a project to be executed with Federal money from the Centennial Fund.

To ensure that Congress has the opportunity to review and approve the proposed project list, the bill requires the Secretary oflnterior to submit to Congress, as part of the President's annual budget submission, a list of proposed Centennial projects. The yearly project lists are to be developed by the Secretary with input from the public and National Park Service employees.

Projects must meet specific criteria set forth in the bill. All projects must be consistent with Park Service policies and adopted park planning documents and be representative of the breadth of the national park system. The bill also requires that project proposals fall into one of seven categories or ``initiatives'' defined in the bill: Education, Diversity, Supporting Park Professionals, Environmental Leadership, Natural Resource Protection, Cultural Resource Protection, and Visitor Enjoyment and Health, and Construction. No more than 30 percent of the amounts available in the fund in any fiscal year may be spent on construction activities.

The National Park Centennial Fund Act also specifies that the Federal dollars made available from the Centennial Fund shall supplement and not replace annual Park Service expenditures, and that adequate permanent staffing levels must be maintained. The Secretary is required to submit a report to Congress each year detailing Centennial Fund accounting, results, and Park Service staffing levels.

The National Park Centennial Fund Act bill proposes to pay for the Centennial Fund by establishing a new conservation royalty from unanticipated off-shore oil and gas revenues in the Gulf of Mexico that the Federal Government is now collecting. In 2008, off-shore oil and gas lease sales have already generated more than $4 billion in revenue above Department of Interior projections. Rather than returning all these revenues--which were generated from the depletion of a natural resource--to the Federal treasury, the National Park Centennial Fund Act reinvests up to $1 billion in the Centennial Fund and the permanent protection of our national treasures.

Moreover, the bill supplements the funding from this conservation royalty with revenues that would be generated through the sale of a new postage stamp celebrating the 100th anniversary of the National Park System.

I want to again thank my colleagues, Senator Collins, Senator Baucus, Senator Coleman, and Senator Tester, for their support and for their work on this

bill. This is an effort that is worthy of broad, bipartisan support, and it is a bill which I hope we will pass this year.

Finally, I would like to note that I see another bill that I have introduced, S. 2194, as complementary to this effort. The National Park Ranger School Partnership Act, which I introduced with Senator Conrad, would provide greater opportunities for our kids to experience and learn from the tremendous resources in our national parks by establishing partnerships between NPS and local schools under the No Child Left Behind Act. The bill would also create a pilot grant program aimed at getting more school children into the national parks.

I look forward to working with my colleagues to pass both of these bills.

Mr. President, today I rise with my colleague, Senator Stabenow, to introduce an important piece of legislation for Medicare beneficiaries living in rural areas. The Medicare Telehealth Improvement Act will ensure that rural beneficiaries have access to health care services by connecting remote areas to the services often only available in large urban centers.

Fifteen years ago, I cofounded the Congressional Steering Committee on Telemedicine and Health Care Informatics to bring more attention to this technology and its potential. I took an interest in this technology because in large, rural, medically underserved States like mine, telemedicine provides access to care that is simply unavailable otherwise. In many areas of North Dakota, routine check-ups with a specialist can require a 200 mile round trip journey. That's fine for a young person on a nice spring day. But it doesn't work for seniors in the middle of a North Dakota blizzard.

That's why in 1997, we fought to provide Medicare coverage of telemedicine services. But access to this benefit was strictly limited. For example, the telehealth service must be provided in a health professional shortage area or county not classified as a metropolitan statistical area. In addition, only consultations, office visits, individual psychotherapy and pharmacologic management are covered services. Moreover, reimbursement, which is the same as the current physician fee schedule amount, is limited to physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists, clinical psychologists, clinical social workers, and registered dieticians. Finally, only physician offices, hospitals, rural health

clinics, and Federally-qualified health centers are eligible to be originating sites and receive the ``facility fee.''

While this benefit has been helpful to seniors in rural areas, the adoption of telemedicine in the Medicare program has been slow. That is because we had to place too many restrictions on the benefit to control the estimated costs o covering these services. However, experience has shown that the use of telemedicine does not dramatically increase spending. In fact, it can actually save money.

That is why Senator Stabenow and I are introducing the Medicare Telehealth Improvement Act today. More seniors need to have access to this technology in all areas of health care, and our bill makes important changes in Medicare coverage.

First, the Medicare Telehealth Improvement Act would increase the number of originating sites eligible to receive the facility fee to include nursing homes, dialysis facilities and community mental health centers. Moreover, it would allow any other site that has telecommunications systems to be an originating site, but these sites would not be eligible for the facility fee.

Second, the bill allows more providers to participate. For a number of years, we have advocated to include physical therapists, occupational therapists, audiologists, and speech-language pathologists. This bill would make that change.

Finally, we would improve the Medicare process for updating the list of eligible services. Despite widespread support for the inclusion of new codes, CMS has not sufficiently updated the list of covered services in recent years. In response, our bill creates an advisory panel that would give recommendations on the addition or deletion of services.

Senator Stabenow and I have worked to garner support from a variety of stakeholders. In fact, the bill we are introducing today has the support of the American Telemedicine Association, the National Council on Community Behavioral Healthcare, the American Health Care Association, the American Health Information Management Association, the Center for Aging Services Technologies, the National Association for the Support of Long Term Care, and the National Center for Assisted Living.

This bill is a meaningful step to further adoption of telehealth in the Medicare program. It will allow seniors to seek care in the comfort of their communities, instead of having to drive hundreds of miles. I urge my colleagues to support this initiative to ensure that every senior has access to the care they need.

Mr. President, I ask unanimous consent that letters of support be printed in the Record.

Mr. President, today I rise with my colleague, Senator Stabenow, to introduce an important piece of legislation for Medicare beneficiaries living in rural areas. The Medicare Telehealth Improvement Act will ensure that rural beneficiaries have access to health care services by connecting remote areas to the services often only available in large urban centers.

Fifteen years ago, I cofounded the Congressional Steering Committee on Telemedicine and Health Care Informatics to bring more attention to this technology and its potential. I took an interest in this technology because in large, rural, medically underserved States like mine, telemedicine provides access to care that is simply unavailable otherwise. In many areas of North Dakota, routine check-ups with a specialist can require a 200 mile round trip journey. That's fine for a young person on a nice spring day. But it doesn't work for seniors in the middle of a North Dakota blizzard.

That's why in 1997, we fought to provide Medicare coverage of telemedicine services. But access to this benefit was strictly limited. For example, the telehealth service must be provided in a health professional shortage area or county not classified as a metropolitan statistical area. In addition, only consultations, office visits, individual psychotherapy and pharmacologic management are covered services. Moreover, reimbursement, which is the same as the current physician fee schedule amount, is limited to physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists, clinical psychologists, clinical social workers, and registered dieticians. Finally, only physician offices, hospitals, rural health

clinics, and Federally-qualified health centers are eligible to be originating sites and receive the ``facility fee.''

While this benefit has been helpful to seniors in rural areas, the adoption of telemedicine in the Medicare program has been slow. That is because we had to place too many restrictions on the benefit to control the estimated costs o covering these services. However, experience has shown that the use of telemedicine does not dramatically increase spending. In fact, it can actually save money.

That is why Senator Stabenow and I are introducing the Medicare Telehealth Improvement Act today. More seniors need to have access to this technology in all areas of health care, and our bill makes important changes in Medicare coverage.

First, the Medicare Telehealth Improvement Act would increase the number of originating sites eligible to receive the facility fee to include nursing homes, dialysis facilities and community mental health centers. Moreover, it would allow any other site that has telecommunications systems to be an originating site, but these sites would not be eligible for the facility fee.

Second, the bill allows more providers to participate. For a number of years, we have advocated to include physical therapists, occupational therapists, audiologists, and speech-language pathologists. This bill would make that change.

Finally, we would improve the Medicare process for updating the list of eligible services. Despite widespread support for the inclusion of new codes, CMS has not sufficiently updated the list of covered services in recent years. In response, our bill creates an advisory panel that would give recommendations on the addition or deletion of services.

Senator Stabenow and I have worked to garner support from a variety of stakeholders. In fact, the bill we are introducing today has the support of the American Telemedicine Association, the National Council on Community Behavioral Healthcare, the American Health Care Association, the American Health Information Management Association, the Center for Aging Services Technologies, the National Association for the Support of Long Term Care, and the National Center for Assisted Living.

This bill is a meaningful step to further adoption of telehealth in the Medicare program. It will allow seniors to seek care in the comfort of their communities, instead of having to drive hundreds of miles. I urge my colleagues to support this initiative to ensure that every senior has access to the care they need.

Mr. President, I ask unanimous consent that letters of support be printed in the Record.