Medicare Access to Rehabilitation Services Act of 2015

Mr. President, I rise today to address what I believe is a national security and public safety weakness.

The United States currently has a system in place to keep known or suspected terrorists off of airplanes. But even though they can't fly, these very same terrorists can walk into any gun store anywhere in the country and purchase a firearm.

If a terrorist is too dangerous to board an airplane, that same individual is too dangerous to possess a gun.

That's why we are introducing the Denying Firearms and Explosives to Dangerous Terrorists Act, a bill to fix this glaring loophole in our background check system.

This is not a hypothetical issue.

Individuals with links to terrorism regularly purchase guns in the United States.

According to data just received from the Government Accountability Office, between February 2004 and December 2014, there were at least 2,233 cases in which a known or suspected terrorist--individuals who at the time were on federal terrorist watch lists--tried to buy a firearm or obtain a firearm or explosives license or permit.

In 91 percent of these cases, a total of 2,043 separate occasions, those known or suspected terrorists successfully passed a background check.

The Kouachi brothers, the terrorists who killed 12 people at Charlie Hebdo in Paris, are reportedly on the U.S. no fly list.

However, if they had made it to the United States, the fact that they were on terrorist watch lists would have done nothing to prevent them from legally buying firearms or explosives.

One of the alleged Boston Marathon bombers, Tamerlan Tsarnaev, was reportedly placed on two terrorist watch lists in 2011.

He later killed three and injured 170 with homemade explosives and killed a police officer with a handgun.

In 2009, Abdulhakim Mujahid Muhammad opened fire at a military recruiting station in Little Rock, Arkansas. He killed one and critically injured another.

According to press reports, Muhammad had been under investigation by the FBI for suspected links to terrorism after traveling to Yemen, where he was arrested for using a Somali passport. Those actions certainly would have placed him on terrorist watch lists, but would not have kept him from buying firearms.

The bill that we are introducing today is very simple.

It would close this dangerous loophole by giving the Attorney General discretion to prevent someone from buying explosives or a gun if that individual is a known or suspected terrorist and may use the firearm in connection with terrorism.

It would also give the Attorney General discretion to prevent someone from obtaining a license to sell guns or explosives if that individual is a known or suspected terrorist and may use the firearm in connection with terrorism.

The Attorney General could use a range of tools to make this decision, most notable terrorist watch lists and the no fly list.

In addition to making the decision at the discretion of the Attorney General, the bill includes other safeguards to make sure innocent individuals are not denied the ability to buy firearms or explosives.

The first safeguard is that very high standards already exist for an individual to be designated as a known or suspected terrorist.

The FBI or the National Counterterrorism Center must nominate the individual to be included in the Terrorist Screening Database.

There must be sufficient identifying data about the person to ensure they can be accurately matched with the terrorist on the watch list.

The circumstances must meet the ``reasonable suspicion'' standard. This means the facts of the case must be strong enough to reasonably determine the person is known or suspected to be engaged in terrorism.

The second safeguard is that every provision in current law allowing individuals to appeal the denial of a firearm or explosive purchase will also apply to this bill.

The office within the FBI that handles the background check system, known as the NICS Section, or the National Instant Criminal Background Check System Section, must provide the reason for denial upon request.

Individuals then have the right to correct any inaccurate records in the background check system. If a purchase is still denied, individuals can take the Justice Department to court to overturn the decision.

Gun safety safety bills are often labeled as Democratic bills. That is not the case here.

This bill was first proposed by the Justice Department under President George W. Bush, who recognized that keeping guns away from terrorists is good policy.

Attorney General Holder has also testified that the Justice Department under President Obama continues to support this proposal.

The bill has also been endorsed by Everytown for Gun Safety. This group represents more than 1,000 current and former mayors, both Republican and Democrat.

The legislation has also been endorsed by the Brady Campaign to Prevent Gun Violence, the Violence Policy Center, Americans for Responsible Solutions, and the Coalition to Stop Gun Violence.

I would also like to thank the bill's cosponsors: Senators Whitehouse, Schumer, Durbin, Blumenthal, Boxer, Reed, Menendez, Gillibrand, Murphy, Warren, and Markey. All of you are champions for stronger gun safety laws.

The terrorist attack in Paris should be a wake-up call for everyone.

This sort of terrorist attack is very possible here in the United States, and the ability for known and suspected terrorists to buy guns and explosives makes it even more likely.

Congress should close this loophole in our background check system and ensure that known and suspected terrorists can't easily gain access to these weapons.

I urge my colleagues to support this bill.

Mr. President, I rise in support of the Medicare Access to Rehabilitation Services Act, which I am introducing today with my colleague Senator Collins. This important bill repeals the monetary caps that limit Medicare beneficiaries' access to medically necessary outpatient physical therapy, occupational therapy, and speech-language pathology services.

Limits on outpatient rehabilitation therapy services under Medicare were first imposed in 1997 as part of the Balanced Budget Act. The decision to impose limits on these services was not based on data, quality-of-care concerns, or clinical judgment--its sole purpose was to limit spending in order to balance the federal budget. Since 1997, Congress has acted over 12 times to prevent the implementation of the therapy caps through moratoriums and an exceptions process. While these short-term actions have provided necessary relief to our seniors, a long-term solution is essential to bring permanent relief and much- needed stability for both patients and providers.

We need a full repeal of the existing caps on physical therapy, occupational therapy, and speech-language pathology services. These annual financial caps limit services often needed after a stroke, traumatic brain injury, or spinal cord injury, or to effectively manage conditions such as Parkinson's disease, multiple sclerosis, and arthritis. Arbitrary caps on these vital Medicare outpatient therapy services are simply unacceptable. They also discriminate against the oldest and sickest Medicare beneficiaries, who typically require the most intensive therapy, and disadvantage Medicare beneficiaries who live in regions with higher health care costs.

In a 2009 report issued by the Medicare Payment Advisory Committee, MEDPAC, it was estimated that the

therapy cap, if enforced without an exceptions process, could negatively impact 931,000 Medicare beneficiaries. Arbitrarily capping outpatient rehabilitation therapy services would likely cause some beneficiaries to delay necessary care, force others to assume higher out-of pocket costs, and disrupt the continuum of care for many seniors and individuals with disabilities.

I urge my colleagues to join me and Senator Collins in supporting the Medicare Access to Rehabilitation Services Act to ensure that our seniors have access to the outpatient rehabilitation therapy services that they need.

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

Mr. President, I am pleased join my colleague, Senator Risch, in introducing the Small Business Investment Company Capital, SBIC, Act of 2015. And I am pleased that Congressman Chabot, Chairman of the House Small Business Committee, is introducing the same bill on the House side today.

This bipartisan legislation makes a common-sense change to the Small Business Investment Company, SBIC, program run by the Small Business Administration, SBA. This change will provide increased support to some of the program's most successful participants, SBICs that run multiple funds at a time. At no additional cost to the taxpayer, the SBIC Act will raise the limit that a ``family of funds'' can borrow with an SBA guarantee from $225 million to $350 million

The SBIC program guarantees loans to qualified investment funds, or SBICs. In turn, these SBICs invest in promising small businesses by combining the SBA loan with privately raised capital, often at a 2:1 ratio. It is important to note that while these SBICs are licensed and regulated by the SBA, they are privately owned and operated.

Since its inception, the SBIC Debenture program has been incredibly successful. SBICs have invested more than $70 billion in nearly 170,000 small businesses. Recently, the program has experienced rapid growth. In 2013, SBA guaranteed loans to SBICs equaling $3.5 billion, a 70 percent increase in financing dollars from three years ago and the highest amount of financings in the past decade.

This success is largely attributed to Congressional action that raised the ceiling for maximum investments for the SBIC program each year from $3 billion to $4 billion. Senator Landrieu, Senator Risch, and I worked with a bipartisan coalition to increase this ceiling and ensure SBIC funds have access to sufficient capital to invest in promising small businesses.

Nowhere is the success of this increase seen more than in Maryland. Since the start of fiscal year 2015, SBICs have already invested nearly $65 million in Maryland small businesses. Yet, this success could be enhanced even more if Congress increased the amount SBICs with a family of funds can borrow from the SBA.

SBICs that run multiple funds at a time are known as ``families of funds.'' While many of our Nation's most successful and reliable SBICs have a family of funds, their success is being restricted by the current lending limit. Simply raising the limit from $225 million to $350 million would provide these proven fund managers the additional capital needed to invest in small businesses and stimulate local economies.

Put simply, by increasing the ``family of funds'' lending limit to $350 million, proven investors can invest in more promising small businesses. The SBIC Act enhances the SBA's ability to support these successful investors as they finance small businesses that will continue to create jobs in this country.

Mr. President, I am pleased today to join my friend and colleague from North Dakota, Senator Heitkamp, in introducing the School Food Modernization Act to assist schools in providing healthier meals to students throughout the country.

School meals play a vital role in the lives of our young people. More than 30 million children participate in the National School Lunch Program every school day. In Maine, 40 percent of children qualify for free or reduced-price meals based on household income.

The food served at schools to these children affects their health and well-being. Many children consume up to half their daily caloric intake at school. In fact, children often get their most nutritious meal of the day at school instead of at home. At the same time, too many of our children are at risk of serious disease. One-third of the children in this country are overweight or obese, which increases their risk for heart disease, high blood pressure, Type 2 Diabetes and other chronic diseases. These conditions may have a lifelong effect on their health as they grow to adulthood.

In response to concerns about the health of our children, our schools have stepped up to the plate. Nationwide, schools are working diligently to meet the new U.S. Department of Agriculture standards and serve healthier meals. For example, in the New Sweden Consolidated School in Aroostook County, ME, food service manager Melanie Lagasse prepares meals from scratch instead of opening cans or pushing a defrost button. The school's 64 students, ranging from preschool to eighth grade, have grown to relish the chicken stew, baked fish, and meatloaf that she makes fresh.

Many schools, however, lack the right tools for preparing meals rich in fresh ingredients and must rely on workarounds that are expensive, inefficient, and unsustainable. Schools built decades ago lack the tools and the infrastructure necessary beyond reheating and holding food for meal service.

To serve healthier meals to their students, 99 percent of Maine school districts need at least one piece of equipment and almost half, 48 percent, of districts need kitchen infrastructure upgrades. The median equipment need per school is $45,000.

Even more costly would be making the required changes to infrastructure. Forty-eight percent of Maine schools need some kind of infrastructure change to serve healthy meals. For example, 41 percent of schools need more physical space, 22 percent need more electrical capacity, 21 percent need more plumbing capacity, and 19 percent need more ventilation.

Add the equipment costs together with the infrastructure costs and it is estimated that overall, $58.8 million would be needed just in Maine to serve healthy meals to all of our students. That far exceeds the $111,000 in grants that the USDA awarded Maine during the last two fiscal years for new equipment.

Our bill authorizes loan guarantee assistance and grants for school equipment and infrastructure improvements, thereby helping food service personnel meet nutrition standards. First, it would establish a loan guarantee assistance program within USDA to help schools acquire new equipment to prepare and serve healthier, more nutritious meals to students. School administrators and other eligible borrowers could obtain Federal guarantees for 80 percent of the loan value needed to construct, remodel, or expand their kitchens, dining, or food storage infrastructure.

Second, the bill would provide targeted grant assistance to give school administrators and food service directors the seed funding needed to upgrade kitchen infrastructure or to purchase high-quality, durable kitchen equipment such as commercial ovens, steamers, and stoves.

Finally, to aid school food service personnel in meeting the nutrition guidelines, the legislation would strengthen training and provide technical assistance by authorizing USDA to provide support on a competitive basis to highly qualified third-party trainers to develop and administer training and technical assistance, including online programs.

We need to start our school children off on the right food every day. If they are going to be able to learn and compete, they need to be healthy and their minds and bodies fully nourished. This bill will help us achieve that goal.

Mr. President, I rise in support of the Medicare Access to Rehabilitation Services Act, which I am introducing today with my colleague Senator Collins. This important bill repeals the monetary caps that limit Medicare beneficiaries' access to medically necessary outpatient physical therapy, occupational therapy, and speech-language pathology services.

Limits on outpatient rehabilitation therapy services under Medicare were first imposed in 1997 as part of the Balanced Budget Act. The decision to impose limits on these services was not based on data, quality-of-care concerns, or clinical judgment--its sole purpose was to limit spending in order to balance the federal budget. Since 1997, Congress has acted over 12 times to prevent the implementation of the therapy caps through moratoriums and an exceptions process. While these short-term actions have provided necessary relief to our seniors, a long-term solution is essential to bring permanent relief and much- needed stability for both patients and providers.

We need a full repeal of the existing caps on physical therapy, occupational therapy, and speech-language pathology services. These annual financial caps limit services often needed after a stroke, traumatic brain injury, or spinal cord injury, or to effectively manage conditions such as Parkinson's disease, multiple sclerosis, and arthritis. Arbitrary caps on these vital Medicare outpatient therapy services are simply unacceptable. They also discriminate against the oldest and sickest Medicare beneficiaries, who typically require the most intensive therapy, and disadvantage Medicare beneficiaries who live in regions with higher health care costs.

In a 2009 report issued by the Medicare Payment Advisory Committee, MEDPAC, it was estimated that the

therapy cap, if enforced without an exceptions process, could negatively impact 931,000 Medicare beneficiaries. Arbitrarily capping outpatient rehabilitation therapy services would likely cause some beneficiaries to delay necessary care, force others to assume higher out-of pocket costs, and disrupt the continuum of care for many seniors and individuals with disabilities.

I urge my colleagues to join me and Senator Collins in supporting the Medicare Access to Rehabilitation Services Act to ensure that our seniors have access to the outpatient rehabilitation therapy services that they need.

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