San Juan Islands National Conservation Area Act

Mr. President, I rise today to introduce the Nursing Home Resident Pain Relief Act of 2011. This legislation will help ensure that nursing home residents have timely access to pain medication as needed in emergency situations. By streamlining processes that can now cause delays in administering these vital drugs, the bill will also allow designated health care professionals to administer controlled substances to residents whose medical conditions warrant quick pain relief.

To accomplish these ends, the legislation amends the Controlled Substances Act, CSA, in several ways. First, it allows nurses and other appropriately licensed health professionals, designated by the nursing home and with approval from the physician, to order and administer pain medication to residents upon a physician's oral prescription. The bill also establishes a clear chain of accountability for these licensed health professionals, physicians, as well as for nursing homes and long-term care pharmacies.

Last year, the Special Committee on Aging, which I Chair, held a listening session where we heard about a recent Drug Enforcement Agency, DEA, enforcement initiative that has kept nursing home residents from receiving much-needed medication to manage their pain. For many years, nurses had been able to call urgently-needed prescriptions into pharmacies upon a physician's order over the phone. Pharmacies would fill the order, residents would get their pain medication, and physicians would follow up with written confirmation of the prescription. Now, DEA requires physicians to directly issue prescriptions in writing for Schedule II pain medications before they can be dispensed, including in emergency circumstances. This poses a problem for nursing home residents because facilities often do not have physicians on site to fill out the necessary paper work in time to provide critically needed pain medicine. The DEA's enforcement initiative has created an unintended consequence where nursing home residents often have to suffer for several hours or even days before they receive pain medication.

These delays have serious consequences. Here is an all-too-common scenario: an elderly resident that returns to a nursing home after surgery may be in more pain than his physician anticipated and need more medication than the physician prescribed to manage the pain. In order to access the medication he needs, the nursing home employees must first have his physician send a written prescription to a pharmacy. If the physician is difficult to locate or slow to respond, this can take hours or even days. The resident's

pain may become so unmanageable while he waits that he must be transported by ambulance to a hospital emergency room. The ambulance ride and emergency room admission are not only expensive; they can set back the fragile resident's recovery from surgery. Our legislation would make these situations entirely avoidable.

DEA's enforcement initiative effectively put nursing home providers in a difficult position: If they follow the letter of the law, they are in danger of violating Health and Human Services regulations requiring them to administer medications in a timely manner. Failure to do so can result in monetary penalties. In addition, pharmacies could face fines under the CSA if they respond to the nursing home's order--which is almost always transmitted by a nurse--if they fill the order. As a result, a number of pharmacies, including several in the Midwest, are facing tens of millions of dollars in fines imposed by DEA.

Last year DEA issued a policy statement to provide a way for nursing home residents to access some kinds of medication more quickly. Under this new policy, a nursing home's licensed health care professionals may, on a physician's behalf, transcribe the physician's oral prescription for Schedule III, IV or V medications to a pharmacy to be filled. While we appreciated DEA's efforts, without amending the CSA the agency does not have the statutory authority to allow licensed health care professionals to transmit prescriptions for Schedule II controlled substances, the category under which nearly all pain medications fall. Legislation is required in order to provide nursing home residents prompt, reliable pain relief when they are suffering from severe injury or illness.

Our bill would provide a remedy by modifying the CSA to permit pain medication to be dispensed in emergency situations by nursing home professionals without a direct written order by a physician prior to its dispensing. Let me explain how this would work. A physician, if he or she chooses, would be able to authorize the administrator of a long- term care facility to designate one or more licensed health care professionals employed by the facility to act as a ``facility designee.'' In emergency situations only, and upon receiving an oral prescription from the physician, a facility designee would be permitted to contact a pharmacy to have the prescription filled and then dispense Schedule II medications to long-term care facility residents.

This would allow a physician to provide the prescription information to the facility designee via phone when a resident urgently needs pain medication and the physician is unavailable to transmit a written prescription to a pharmacy for a Schedule II controlled substance. The facility designee must document the physician's prescription in writing and transmit the written document to a pharmacy so that the prescription can be filled. After the pharmacy fills the prescription, it must send a copy of the written document memorializing the prescription to the physician for his or her endorsement. The physician must then send the endorsed document, confirming the oral prescription, to the pharmacy within five business days.

Diversion of controlled substances for illicit purposes is of great concern to me. That is why we have included numerous provisions to protect against diversion in nursing homes. For example, the bill requires careful recordkeeping by facilities and pharmacies, which can then be reviewed by DEA as necessary. It requires each actor--the physician, facility designee, and pharmacist--to make a record of his or her role in the process. Long-term care facilities are asked to maintain a written or electronic logbook that memorializes prescriptions and their administration.

Additionally, the legislation enhances criminal and civil penalties for long-term care facility administrators and facility designees who divert drugs, or who violate recordkeeping requirements. These steps will help to ensure that pain medications get to those nursing home residents who need them.

I appreciate the great interest of the stakeholders, including long- term care facility, physician and pharmacy organizations, in solving this problem and I look forward to working with them to finally end the needless delay in pain relief. I would like to thank Attorney General Holder, DEA Administrator Michelle Leonhardt, and their staff for working with me on this legislation, and I look forward to continuing our work together to assure rapid approval by Congress.

Nursing home residents cannot wait for pain medication when they are in debilitating pain and our straightforward bill can help provide some needed relief. I urge my colleagues to support this important legislation.

Mr. President, I rise today to introduce the Automatic IRA Act of 2011. When fully phased in, this bill will give nearly 42 million Americans nationwide an easy, effective way to take responsibility for their financial futures and plan for a secure retirement. The Act incorporates the President's call, in his Proposed fiscal year 2010, 2011, and 2012 Budgets, for Congress to enact Automatic IRA legislation.

Currently, about half of American workers have no opportunity to save for retirement at work. In my home State of New Mexico, that share is nearly 60 percent. Among those lacking coverage at work, only one in ten contributes annually to an individual retirement account, IRA; the rest generally make no dedicated savings for retirement. The result? An alarming number of American workers are woefully unprepared for a financially secure retirement. According to Boston College's Center for Retirement Research, ``in 2009 half of today's households will not have enough retirement income to maintain their pre-retirement standard of living, even if they work to age 65, which is above the current average retirement age.'' Especially in this period of economic uncertainty, it is imperative that Congress focus on this retirement savings crisis. My bill takes a common-sense approach to doing so.

Under this bill, most private-sector employees working in establishments of 10 or more employees who are not currently covered by a workplace retirement plan would be given the opportunity to save through regular payroll deposits that continue automatically, unless they elect out. The savings will be deposited into the worker's own IRA, which will be subject to the laws already in place governing IRA accounts. Employers' administrative functions will be minimal. And the arrangement is market-oriented; other than the smallest of accounts, automatic IRAs will be provided by the same banks, mutual funds, insurance carriers, and other institutions that currently provide them.

The automatic IRA approach is intended to help these households overcome the barrier of inertia. It builds on the successful use-- encouraged by reforms I strongly supported the Pension Protection Act of 2006--of automatic features in 401(k) plans that encourage employees toward sensible decisions, while allowing them to make alternative choices. We have already seen evidence that automatic 401(k) enrollment can dramatically boost employee participation rates, from seven in ten eligible workers to 9 in 10. In the 401(k) context, the gains are even more striking for population groups least likely to save, including women, Latino, and low-income workers.

Of the 75 million American workers who now are not covered by employment-based retirement plans, an estimated 42 million would be eligible to save and enroll under Automatic IRA legislation. This includes more than 250,000 in my home state of New Mexico. Many of these individuals are familiar with IRAs. But when asked why they haven't used the existing program, about half point to issues relating to setup and decision-making as the key barriers. The automatic IRA would eliminate these barriers, and the Retirement Security Project estimates that automatic IRA legislation could increase net national saving by nearly $15 billion annually.

This is the fourth consecutive Congress in which I have introduced Automatic IRA legislation. The concept was initially developed by scholars at the Brookings Institution and Heritage Foundation. Indeed, the Automatic IRA concept has long enjoyed broad support across the political spectrum. For instance, Martin Feldstein, chief economic advisor to President Reagan, has described himself as ``a great enthusiast of automatic enrollment IRAs'' who thinks ``as a policy, it's a no-brainer'' and ``can't imagine why there would be any significant opposition from political players on either side of the aisle.''

Finally, this bill seeks to send a strong signal of preference for employers to offer qualified retirement plans,

like 401(k)s. Among other features, it doubles the credit for employers that newly establish qualified plans and it directs the Secretaries of the Treasury and Labor to implement final regulations and establish a model plan for Multiple Employer Plans.

I am grateful that my colleague on the Senate Finance Committee, Senator Kerry, is joining me in introducing this bill. I am also pleased to note the broad range of stakeholders supporting the Automatic IRA concept, including AARP; the American Society of Pension Professionals & Actuaries; Aspen Institute's Initiative on Financial Security; the Business and Professional Women's Foundation; CFED; Consumers Union; FINRA; the Minority Business Roundtable; New Economics for Women; the United States Black Chamber; the United States Women's Chamber of Commerce; Women Impacting Public Policy; and the Women's Institute for a Secure Retirement.

Ensuring easy access to a retirement account and the ability to have part of their wages go directly from their paycheck into this account are proven strategies to encourage retirement savings. I call on the Senate to take up this bill and give it full consideration.

Mr. President, I rise today to introduce the San Juan Islands National Conservation Area Act.

The San Juan Islands in northwest Washington host some of the most beautiful, serene spots in the world. The San Juans are made up of 172 islands with over 300 miles of shoreline, some little more than rocks, others home to towns, farms, and forests. The coastlines are a mix of sandy and rocky beaches, shallow and deep harbors, and placid and reef- studded bays. And between the many islands run channels of water that support many of Washington's most important marine species, including abundant salmon runs and our majestic regional icon, the orca whale.

Included in the San Juan Islands are nearly 1,000 acres of land owned by the Federal Government, spread out over 60 separate locations and managed by the U.S. Bureau of Land Management, BLM. These parcels, which range from pine forests to lighthouses, provide recreational, ecological, historical, cultural, and scientific benefits to island residents and around 70,000 tourists that visit each year.

Despite their value, no long-term comprehensive management plan exists for these Federal parcels, threatening continued preservation and public access to these sites. Many of these areas are fragile, increasing the challenge of accommodating increasing numbers of visitors.

In addition, San Juan Island residents have seen the possibility of public lands they treasure being transferred to private ownership. In 2005, the Washington State Department of Natural Resources made a unilateral decision to divest itself of all its properties in San Juan County, including Mitchell Hill, a popular and scenic hiking trail on San Juan Island. While these lands were actively pursued by a private, out-of-state, real-estate developer, I was proud to work with the San Juan Island community to help secure Federal funding to keep these lands in the public domain.

Unfortunately, the Bureau of Land Management lands in the San Juan Islands are not permanently protected or preserved in public ownership. Last July, Congressman Larsen, the Bureau of Land Management, and I visited with residents and businesses that have been working for years to permanently protect these special places.

The legislation I introduce today is a direct result of our efforts and represents a consensus between the San Juan Island community, Congressman Larsen, and the Department of the Interior. If enacted, the San Juan Islands National Conservation Area Act will designate all 1,000 acres of BLM lands in the San Juans as a National Conservation Area, ensuring that these natural treasures remain protected, accessible to the public, and better managed to accommodate visitor use.

National Conservation Area designated lands are considered some of the most important Bureau of Land Management properties and are therefore a higher priority for management funding than non-designated lands they manage. Specifically, National Conservation Area status would ensure the San Juan Island properties are appropriately managed to protect their unique qualities and not grouped in with other BLM lands where activities such as mining, oil and gas exploration, off road vehicle use, and grazing are allowed. Importantly, my legislation requires that the management plan drafting process allows for local input into how these properties are to be managed for the long-term.

A National Conservation Area designation will also foster a stronger working relationship with other agency partners such as the U.S. Fish and Wildlife Service and provide increased opportunities for sharing resources.

I am looking forward to working to advance this legislation through the Senate Energy and Natural Resources Committee, and through the full Senate. Through our efforts we will work to ensure that future generations will be able to enjoy these special parts of the San Juan Islands.

I would also like to thank my colleague Senator Murray for agreeing to cosponsor this legislation, and Congressman Larsen for his leadership and introducing companion legislation today in the House of Representatives.

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 San Juan Islands National Conservation Area Act.

The San Juan Islands in northwest Washington host some of the most beautiful, serene spots in the world. The San Juans are made up of 172 islands with over 300 miles of shoreline, some little more than rocks, others home to towns, farms, and forests. The coastlines are a mix of sandy and rocky beaches, shallow and deep harbors, and placid and reef- studded bays. And between the many islands run channels of water that support many of Washington's most important marine species, including abundant salmon runs and our majestic regional icon, the orca whale.

Included in the San Juan Islands are nearly 1,000 acres of land owned by the Federal Government, spread out over 60 separate locations and managed by the U.S. Bureau of Land Management, BLM. These parcels, which range from pine forests to lighthouses, provide recreational, ecological, historical, cultural, and scientific benefits to island residents and around 70,000 tourists that visit each year.

Despite their value, no long-term comprehensive management plan exists for these Federal parcels, threatening continued preservation and public access to these sites. Many of these areas are fragile, increasing the challenge of accommodating increasing numbers of visitors.

In addition, San Juan Island residents have seen the possibility of public lands they treasure being transferred to private ownership. In 2005, the Washington State Department of Natural Resources made a unilateral decision to divest itself of all its properties in San Juan County, including Mitchell Hill, a popular and scenic hiking trail on San Juan Island. While these lands were actively pursued by a private, out-of-state, real-estate developer, I was proud to work with the San Juan Island community to help secure Federal funding to keep these lands in the public domain.

Unfortunately, the Bureau of Land Management lands in the San Juan Islands are not permanently protected or preserved in public ownership. Last July, Congressman Larsen, the Bureau of Land Management, and I visited with residents and businesses that have been working for years to permanently protect these special places.

The legislation I introduce today is a direct result of our efforts and represents a consensus between the San Juan Island community, Congressman Larsen, and the Department of the Interior. If enacted, the San Juan Islands National Conservation Area Act will designate all 1,000 acres of BLM lands in the San Juans as a National Conservation Area, ensuring that these natural treasures remain protected, accessible to the public, and better managed to accommodate visitor use.

National Conservation Area designated lands are considered some of the most important Bureau of Land Management properties and are therefore a higher priority for management funding than non-designated lands they manage. Specifically, National Conservation Area status would ensure the San Juan Island properties are appropriately managed to protect their unique qualities and not grouped in with other BLM lands where activities such as mining, oil and gas exploration, off road vehicle use, and grazing are allowed. Importantly, my legislation requires that the management plan drafting process allows for local input into how these properties are to be managed for the long-term.

A National Conservation Area designation will also foster a stronger working relationship with other agency partners such as the U.S. Fish and Wildlife Service and provide increased opportunities for sharing resources.

I am looking forward to working to advance this legislation through the Senate Energy and Natural Resources Committee, and through the full Senate. Through our efforts we will work to ensure that future generations will be able to enjoy these special parts of the San Juan Islands.

I would also like to thank my colleague Senator Murray for agreeing to cosponsor this legislation, and Congressman Larsen for his leadership and introducing companion legislation today in the House of Representatives.

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