Advanced Nuclear Fuel Availability Act

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 7217) to amend title XIX of the Social Security Act to provide States with the option of providing coordinated care for children with complex medical conditions through a health home, and for other purposes.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and insert extraneous materials in the Record on the bill.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, we are here today, the culmination of a 6-year journey. The IMPROVE Act is a combination of three bills. One bill is a bill that allows Medicare to follow the patient; another bill is a bill for spousal impoverishment, to prevent that; and the third bill, and the primary bill in this package, is a bill that we call the ACE Kids Act.

Mr. Speaker, there are, luckily, not a large number, about 2 million children in this country, who have multiple complex medical conditions that are life-threatening. These are the sickest of the sick of our young population. About 500,000 of these children are Medicaid eligible. In other words, their families qualify for low-income health insurance called Medicaid.

Mr. Speaker, under current law, the parents of these children have to create the healthcare network on a case-by-case basis for their child. They also cannot seek healthcare across State lines that is covered by Medicaid. So current law makes it very difficult on these sickest-of- the-sick children.

The ACE Kids Act changes that, Mr. Speaker. It allows the creation of a medical home that can cross State lines, that can coordinate care.

It is optional. The States do not have to participate in this program. The parents of the child do not have to participate in this program. But if they do wish to participate, you create a health home for the child wherein everything is coordinated.

In the pilot programs that have been run using this model, you get better quality healthcare at lower cost. We think the pilot programs show that, over time, if we adopt this model and if the States adopt it and the families adopt it, we get a lot better healthcare at a lower cost. So this is a win-win, Mr. Speaker.

As I said, we have worked on this for 6 years. It is a bipartisan bill. In the last Congress, we had a majority of the Congress that sponsored the bill. In this Congress, we have more than 130 cosponsors on a bipartisan basis.

We have had a hearing in the committee of jurisdiction, the Committee on Energy and Commerce. We have had a markup in subcommittee. We have had a markup in full committee. Now, Mr. Speaker, we are bringing it to the floor.

We hope the House, later today, will vote affirmatively to pass this on suspension and send it to the Senate. We have preconferenced it with the Senate, and we have every reason to believe, if the House passes it today, the Senate will take it up expeditiously and pass it, and this is a bill that will become law.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from Oregon (Mr. Walden), who is the current chairman of the Energy and Commerce Committee.

Mr. Speaker, before I yield to Dr. Burgess, I echo what Congresswoman Castor just said about the staffs that have worked so hard. We couldn't have done this bill without all the individuals she just named.

I also thank her. When she said I have been tireless, she makes me look like a snail, and she is the rabbit working every day to make this possible.

Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. Burgess), the distinguished subcommittee chairman of the Health Subcommittee, my good friend.

Mr. Speaker, I yield an additional 30 seconds to the gentleman from Texas.

Mr. Speaker, I thank the gentlewoman from Michigan for her kind words. I appreciate the nice gift I got yesterday from her and her husband, his new book, ``The Dean.'' I look forward to reading it over Christmas.

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Kentucky (Mr. Guthrie).

Mr. Speaker, I yield 1 minute to the gentleman from Michigan (Mr. Upton), the former full committee chairman and the current subcommittee chairman of the Energy Subcommittee.

Mr. Speaker, I yield 1 minute to the gentleman from Florida (Mr. Bilirakis).

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Georgia (Mr. Carter), a strong supporter.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Washington (Ms. Herrera Beutler), one of the tireless supporters of this bill from day one, who herself has a medically complex special needs child, who went through the nightmare of having to create her own network for her child, and who has been a cosponsor since day one.

Mr. Speaker, I yield 1 minute to the gentleman from New York (Mr. Zeldin).

Mr. Speaker, may I inquire how much time I have remaining?

Mr. Speaker, I yield myself the balance of my time.

Mr. Speaker, before I close, I want to set the record straight on one thing. There has been a report that this bill, the ACE Kids Act, expands Medicaid. That is factually incorrect.

The children that qualify for the ACE Kids Act are already covered by Medicaid.

There is no expansion. We do not create a new program. We do not expand an existing program. We do not change the definitions.

We simply make it possible, if this bill becomes law, for parents of children that qualify and that are already covered under Medicaid, they can choose a healthcare home for their child, and that healthcare home can cross State lines. But as Dr. Burgess pointed out, it is not coercive. The States don't have to participate in the program, the families don't have to participate in the program. It is all voluntary. But the pilot programs that have been done on this model, they save money and they give better care. It has been proven.

CBO has scored this over time that it saves money, but we put pay- fors in the bill. If it did cost some extra money, it would be paid for. There is a 2-quarter, 6-month increase in the FMAP, the Federal matching that the Federal Government gives to States that choose to participate. I think it is about 15 percent extra money for 6 months. That is the only cost.

Now, to close, I am going to read a list, and Congresswoman Castor read a lot of these, but these are the national groups that support our bill: the Adult Congenital Heart Association, America's Essential Hospitals, American Academy of Pediatrics, American Association of Child & Adolescent Psychiatry, American Board of Pediatrics, American College of Cardiology, American College of Surgeons, American Heart Association, American Psychological Association, American Society of Echocardiography, American Thoracic Society, Amicus Therapeutics, Association of American Medical Colleges, Association of Medical School Pediatric Department Chairs, Autism Society, Autism Speaks, ChildServe, Children's Cause for Cancer Advocacy, Children's Hospital Association, Epilepsy Foundation, Family Voices, Foundation to Eradicate Duchenne, International Pediatric Rehabilitation Collaborative, March of Dimes, Mended Little Hearts, MomsRising, National Association for Children's Behavioral Health. There are about seven or ten more.

Mr. Speaker, I want to thank the staff, especially Krista Rosenthall, Jeannine Bender, committee staff Caleb Graff, Josh Trent, and Ryan Long. And, again, I thank Kathy Castor and Gene Green.

Mr. Speaker, this has been a bipartisan effort. I ask for a strong ``yea'' vote.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, on that I demand the yeas and nays.

Mr. Speaker, I rise in support of H.R. 7217. This is a bipartisan Medicaid package that moves forward House priorities with responsible offsets. The Energy and Commerce Committee has been working to draft and perfect the legislation before us, and it is encouraging to see this reach the House floor.

Not only does this package include a new program to improve access to care, it reauthorizes important and effective programs from which Americans benefit each and every day. Title I of this package is based upon Representative Joe Barton and Representative Kathy Castor's ACE Kids Act.

But I do want to assure families that have children with chronic illnesses that this legislation is intended to help them, if they want help, to obtain care coordination services. However, I also want to clarify that this legislation is not intended to limit families or their physicians from selecting their provider of medical services.

There is nothing in this legislation that restricts the child's family and their physician from deciding who is the best provider amongst those accepting Medicaid and qualified to offer the medical services. The Center for Medicare and Medicaid Services has provided assurances that current freedom-of-choice rules will apply to new care coordination activity.

As a doctor, I know that many children with chronic illnesses have a strong relationship with their doctors and with other members of their healthcare team. I want to make certain that this new law will help families coordinate their care without affecting the relationship that families have with their current medical care providers or with other providers in their communities from whom they may wish to receive their care.

This package also extends funding for the Money Follows the Person Demonstration, an effort that was led by my Energy and Commerce Subcommittee on Health Vice Chair Brett Guthrie and Representative Debbie Dingell from Michigan.

This Medicaid demonstration was established in 2005 for individuals in States across our Nation, including Texas, to receive long-term care services in their homes or other community settings rather than institutions such as nursing homes. The funding for this program has already expired, and a funding extension is already overdue. While it would have been nice to extend this for longer, it was essential to get this extension across the floor.

A 3-month extension for the protection for Medicaid recipients of home and community-based services against spousal impoverishment was also included. This effort was championed by Representatives Fred Upton and Debbie Dingell.

Mr. Speaker, in an effort to be fiscally responsible, this legislation includes several offsets to make this package, on net, a saver.

While it is largely a Medicaid package, there is one small but important Medicare provision. This provision excludes complex medical rehabilitative wheelchairs from Medicare's Competitive Acquisition Program. Currently, these chairs are not included, but because the statute did not provide the same clear exemption that power wheelchairs received, there is fear that this unintended omission can lead to them being included.

Mr. Speaker, I thank the gentleman for the additional time, and I include my full statement in the Record.

Mr. Speaker, I rise today in support of H.R. 7217, a bipartisan Medicaid package that propels forward House priorities with responsible offsets. The Energy and Commerce Committee has been working diligently to draft and perfect the legislation before us, and it is encouraging to see this package reach the House floor. Not only does this package include an exciting new program to improve access to care, it reauthorizes important and effective programs from which Americans benefit each and every day.

Title I of this package is based upon Rep. Joe Barton and Rep. Cathy Castor's ACE Kids Act. I want to ensure families who have children with chronic illnesses that this legislation is intended to help them, if they want help, to obtain care coordination services. However, I want to clarify that this legislation is not intended to limit families and their physicians from selecting the provider of medical services. There is nothing in this legislation that restricts the child's family, and their physician, from deciding who is the best provider among those accepting Medicaid and qualified to offer the medical services. CMS has provided assurances that current ``freedom of choice'' rules will apply to new care coordination activity. As a physician, I know that many children with chronic illnesses have a strong relationship with their physician and with other providers. I want to make sure that this new law will help families coordinate their care without affecting the relationship that families have with their current medical care providers or with other providers in their communities from whom they may want to receive such care from.''

This package also extends funding for the Money Follows the Person demonstration, an effort led by my E&C Subcommittee on Health Vice Chair, Brett Guthrie, and Rep. Debbie Dingell. This Medicaid demonstration, which was established in 2005, has enabled eligible individuals in states across our nation, including Texas, to receive long-term care services in their homes or other community settings, rather than in institutions such as nursing homes. The funding for this program has already expired, and a funding extension is already long overdue. While we would have like to extend the funding for longer, it was essential that we get an extension across the floor, even if a small one.

A 3-month extension for the Protection for Medicaid Recipients of Home and Community-Based Services Against Spousal Impoverishment program is also included. This effort was championed by Representatives Fred Upton and Debbie Dingell. Our seniors are among our most vulnerable citizens, and it is programs like this one that help to protect them from financial ruin.

In an effort to be fiscally responsible, this legislation includes several offsets that make this package on net a saver, which is something that Energy & Commerce insists upon and is critically important.

While this is largely a Medicaid Package, there is one small but important Medicare provision. This provision excludes manual Complex Rehabilitative wheelchairs from Medicare's Competitive Acquisition Program. Currently, these chairs are not included but because statute did not provide the same clear exemption that power wheelchairs received, there is fear this unintended omission could lead them to being included. This provision also delays the application of competitive bid pricing with CRT accessories used with a CRT manual chair for 18 months. This mirrors a similar protection last provided by Congress for power wheelchairs in the 21st Century Cures Act.

This package contains must-pass provisions that the Energy and Commerce Committee have long fought to pass. The provisions included in this legislation will improve access to care for Medicaid and Medicare beneficiaries, which is a laudable and important goal. Not only are these provisions imperative, but they are responsibly offset. I would particularly like to thank Energy and Commerce Committee staffer Caleb Graff, who has spent countless hours negotiating to get this package to the floor. I support this legislation, and I urge my fellow members and our friends in the Senate to do so as well.

Mr. Speaker, I thank Congressman Green for being an outspoken advocate for his constituents, but especially for affordable healthcare for all Americans, especially children. It has been a privilege serving with him.

Mr. Speaker, on behalf of the families with children with complex medical needs all across America, I rise to urge approval of the IMPROVE Act, which includes a bill that I have been working on for a number of years with Representative Joe Barton called the ACE Kids Act.

We drafted the Advancing Care for Exceptional Kids Act a few years ago with the simple but important goal of putting families and children first. The bill authorizes the creation of cost-saving and time-saving health homes where specialized care is coordinated in a high-quality setting.

Mr. Speaker, the children with complex medical conditions and their families are heroic.

Caroline West in Tampa, Florida, has a rare genetic condition, also cerebral palsy and a seizure disorder. She can't walk. It is very difficult for her to speak, but she is able to attend school part-time and enjoys the life of a typical teenager, in many respects.

Lucy Ferlita is the only living person in the United States with early onset myopathy with areflexia, respiratory distress, and dysphagia. Very little is known about this disease, but what we know is that it is very difficult for her to eat. She has to have a feeding tube, a ventilator to breath, and nursing care 24 hours a day, and yet she is a bright and social 6-year-old.

Jaden Velasquez has a congenital heart defect. He was born with it. The left side of his heart is severely underdeveloped. He has undergone numerous surgeries, yet he is a loving and happy 10-year-old, loves swimming, and is enjoying life.

Lakota Lockhart, with congenital central hypoventilation syndrome, a central nervous system disorder, causes him to not be able to breathe every time he tries to sleep.

I met these children in Tampa, Florida, at St. Joseph's Children's Hospital. They have the world-renowned Chronic-Complex Clinic that was started 16 years ago by a passionate pediatric doctor named Dr. Daniel Plasencia. The ACE Kids Act is modeled after the work being done at St. Joe's by the professionals at the Chronic-Complex Clinic and the 700 kids and families they currently serve and other children's hospitals all across the country.

The families have shared with us how difficult it is to get quality healthcare. It is oftentimes so fragmented and uncoordinated that they have to go from one office to another, and maybe the specialist is in another State. That is why we put together the ACE Kids Act, to help coordinate care in a single setting to help give these kids a better quality of life, and the ACE Kids Act will do just that.

The bill provides an incentive to States to establish health homes to better coordinate care for kids with medical complexities. It also directs HHS to provide guidance to States on best practices relating to providing care across State lines.

As so many of these families know all too well, coordinating care across State lines can be burdensome, so that is the aim of the ACE Kids Act: to lift that burden.

In addition to Congressman Joe Barton, who has worked diligently for so many years to get this over the finish line, I thank all of the families with children with complex medical challenges. They deserve credit for moving this bill forward, coming to Congress, and helping to explain the importance of coordinating care.

I also thank Chairman Walden, Ranking Member Pallone, Chairman Burgess, and Ranking Member Green for their support, and our stalwart partners: Representatives Herrera Beutler, Eshoo, and Reichert.

Thank you to America's children's hospitals, the March of Dimes, the American Academy of Pediatrics, and thanks to the professional staff at the committee for your dedication to these families, especially Rachel Pryor, Samantha Satchell, Tiffany Guarascio, and Josh Trent and Caleb Graff on the Republican side.

Additionally, this bill would not be where it is without the stellar work of Representative Barton's staffers: Krista Rosenthall, Gable Brady, Sophie Trainor, and Jeannine Bender, and my LD, Elizabeth Brown.

Passage of this bill will be a gift to so many families during this holiday season and beyond, so I urge my colleagues here in the House and then over in the Senate to pass the ACE Kids Act contained within the IMPROVE Act.

Mr. Speaker, I thank Mr. Barton for his great leadership on the ACE Kids Act. I know this has been something he has been dedicated to for many years, and I am glad we could get this worked out and to the floor today. In fact, Mr. Speaker, these bills add to the 129 that the Energy and Commerce Committee has passed across this House floor.

Mr. Speaker, 92 percent of those bills have been bipartisan. I don't think the American people know that, because when we get along and do things, it doesn't get much coverage. But most of our work, 92 percent of our bills have been bipartisan, plus these today. 28 of those measures have become law.

I rise in strong support of this bipartisan H.R. 7217, which includes a number of different policies to improve and bolster the Medicaid and Medicare programs for vulnerable patients across our country, Mr. Speaker.

I recognize Joe Barton and our colleague, Kathy Castor from Florida, who I know is going to speak in a moment. They have just worked relentlessly on the ACE Kids Act. This is an important bill, and it is included in this package and one I am proud the House will advance forward today.

They both should be commended for their work because, you see, Mr. Speaker, the ACE Kids Act is bipartisan. It is cost-effective legislation. It provides children and their families the treatment and coordinated care they so desperately need and deserve.

Representative Barton, former chairman of the committee, has long been a champion on this issue, and, again, I thank him for his tireless efforts to advocate for improving care for our Nation's sickest children.

This bill also extends two key Medicaid programs: the Money Follows the Person Demonstration Program and the spousal impoverishment rules in Medicaid, both of which were due to expire or be out of money by the end of the year.

I am disappointed we weren't able to secure a longer term extension of these programs. I know many of my colleagues share that disappointment. Both sides negotiated in good faith, though, on how to pay for an extension, and I hope that the bipartisan work on the long- term bill will continue early in the new Congress. Today, we are moving forward with a 3-month extension to prevent these programs from expiring.

Finally, this package includes a small but critically important Medicare fix to ensure disabled seniors have access to necessary mobility devices, and that is fully offset and paid for.

Further boosting our efforts to advance public health, we have four other bills before us today. Collectively, these bills reauthorize several important programs, promote safe motherhood, and improve patient care.

Lastly, we will consider H.R. 6140. That is the Advanced Nuclear Fuel Availability Act. This bill, as you already know, Mr. Speaker, directs the Secretary of Energy to establish a program to make high-assay, low- enriched uranium available for use in the first-of-a-kind advanced nuclear reactor designs. This fuel will enable the development and deployment of a new generation of innovative nuclear technologies.

Nuclear energy is the largest source of emissions-free electricity in the United States, so a strong U.S. nuclear energy policy can ensure a reliable, clean U.S. energy sector for years to come and provide American families and businesses with affordable energy.

In closing, Mr. Speaker, I thank Ranking Member Pallone, Mr. Green, and the other members of the Energy and Commerce Committee. I urge my colleagues to support passage of all of these bills, especially H.R. 7217, on behalf of patients in Oregon and all across our country.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in support of H.R. 7217, the IMPROVE Act. This legislation contains several important policies related to Medicaid and Medicare.

First, I am a proud original cosponsor of the ACE Kids Act, and I am happy to see it included in H.R. 7217. The ACE Kids Act aims to improve care coordination for children with complex medical conditions served by Medicaid.

The legislation creates a Medicaid health home, State optional, specifically targeted for this population of children. It also requires the Secretary to issue best practices on coordinating out-of-State care for children with complex medical conditions.

Mr. Speaker, I thank the sponsors of the ACE Kids Act, Representative Castor and Congressman Barton, both members of the Energy and Commerce Committee, for championing this issue for so many years.

The IMPROVE Act also provides new funding for the Money Follows the Person, the MFP, program. The MFP program helps individuals transition from institutional care to care in their community, where they can live more independent lives.

MFP also helps support States' home and community-based services infrastructure. Without this extension funding, we would start to see many of these MFP programs end in short order.

Mr. Speaker, I urge support for the program, which provides thousands of Americans with the choice to receive services in their home or community rather than in an institution.

The committee will continue to work on providing long-term funding to the MFP program in the next Congress.

I also voice my support for the extension of spousal impoverishment protections until April 2019. These protections will help ensure that a person can maintain enough income and assets to meet their basic living expenses while still allowing for their spouse to receive long-term care in their home or community under Medicaid.

The expiration of this policy would lead to people losing their long- term care services and the unnecessary institutionalization of people currently

receiving services in their homes or communities. The committee will continue to work on a long-term solution in the next Congress.

Mr. Speaker, I urge my colleagues to support passage of H.R. 7217, the IMPROVE Act, and I reserve the balance of my time.

Mr. Speaker, I yield 5 minutes to the gentlewoman from Florida (Ms. Castor), a cosponsor of the ACE Kids Act and a great member of our Energy and Commerce Committee.

Mr. Speaker, I yield 3 minutes to the gentlewoman from Michigan (Mrs. Dingell), another member of the Energy and Commerce Committee.

Mr. Speaker, I yield 3 minutes to the gentleman from Vermont (Mr. Welch), another good member of our Energy and Commerce Committee.

Mr. Speaker, I yield 3 minutes to the gentleman from Oregon (Mr. Schrader), a colleague from our committee.

Mr. Speaker, how much time do I have left?

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I think this is how we need to work together, and this is a good example of not only inter-State but also inter-party, to be able to solve these three problems that this bill corrects. I hope the next Congress will continue that effort of Republicans and Democrats talking to each other, Texans talking to Oklahomans, which is sometimes tough, to work together for the people we represent.

Mr. Speaker, I yield back the balance of my time.