II

106TH CONGRESS

2D SESSION S. 3035

To amend title XI of the Social Security Act to create an independent

and nonpartisan commission to assess the health care needs of the

uninsured and to monitor the financial stability of the Nation’s health

care safety net.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 12, 2000

Mr. BAUCUS (for himself, Mr. GRASSLEY, Mr. JEFFORDS, Mr. ROCKEFELLER,

and Mr. HATCH) introduced the following bill; which was read twice and

referred to the Committee on Finance

A BILL

To amend title XI of the Social Security Act to create

an independent and nonpartisan commission to assess

the health care needs of the uninsured and to monitor

the financial stability of the Nation’s health care safety

net.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Health Care Safety

5 Net Oversight Act of 2000’’.
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1 SEC. 2. FINDINGS AND PURPOSE.

2 (a) FINDINGS.—Congress makes the following find3 ings:

4 (1) America’s core health care safety net is

5 made up of providers that deliver a significant level

6 of health care and other related services to unin7 sured individuals, to beneficiaries under the med8 icaid program under title XIX of the Social Security

9 Act, and to other vulnerable populations.

10 (2) Thousands of providers render uncompen11 sated care to uninsured and underinsured individ12 uals.

13 (3) There are currently 44,000,000 uninsured

14 individuals in the Nation, and an equal number of

15 low-income underinsured individuals (including med16 icaid beneficiaries) who depend on the core health

17 care safety net.

18 (b) PURPOSE.—The purpose of this Act is to create

19 an independent and nonpartisan commission to assess the

20 health care needs of the uninsured and to monitor the in21 frastructure, effectiveness, and financial stability of the

22 Nation’s core health care safety net.
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1 SEC. 3. SAFETY NET ORGANIZATIONS AND PATIENT ADVI2 SORY COMMISSION.

3 (a) IN GENERAL.—Title XI of the Social Security Act

4 (42 U.S.C. 1320 et seq.) is amended by adding at the end

5 the following new part:

6 ‘‘PART D—SAFETY NET ORGANIZATIONS AND PATIENT

7 ADVISORY COMMISSION

8 ‘‘SAFETY NET ORGANIZATIONS AND PATIENT ADVISORY

9 COMMISSION

10 ‘‘SEC. 1181. (a) ESTABLISHMENT.—There is estab11 lished the Safety Net Organizations and Patient Advisory

12 Commission (in this section referred to as the ‘Commis13 sion’).

14 ‘‘(b) STUDY OF HEALTH CARE SAFETY NET PRO15 GRAMS AND REPORTING REQUIREMENTS.—

16 ‘‘(1) STUDY.—The Commission shall study the

17 health care safety net programs by—

18 ‘‘(A) monitoring each health care safety

19 net program to document and analyze the ef20 fects of changes in these programs on the core

21 health care safety net;

22 ‘‘(B) evaluating the impact of the Emer23 gency Medical Treatment and Labor Act, the

24 Balanced Budget Act of 1997, the Medicare,

25 Medicaid, and SCHIP Balanced Budget Refine26 ment Act of 1999, and other forces on the ca-
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1 pacity of the core health care safety net to con2 tinue their roles in the core health care safety

3 net system to care for uninsured individuals,

4 medicaid beneficiaries, and other vulnerable

5 populations;

6 ‘‘(C) monitoring existing data sets to as7 sess the status of the core health care safety

8 net and health outcomes for vulnerable popu9 lations;

10 ‘‘(D) wherever possible, linking and inte11 grating existing data systems to enhance the

12 ability of the core health care safety net to

13 track changes in the status of the core health

14 care safety net and health outcomes for vulner15 able populations;

16 ‘‘(E) supporting the development of new

17 data systems where existing data are insuffi18 cient or inadequate;

19 ‘‘(F) developing criteria and indicators of

20 impending core health care safety net failure;

21 ‘‘(G) establishing an early-warning system

22 to identify impending failures of core health

23 care safety net systems and providers;

24 ‘‘(H) providing accurate and timely infor25 mation to Federal, State, and local policy mak-
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1 ers on the indicators that may lead to the fail2 ure of the core health care safety net and an es3 timate of the projected consequences of such

4 failures and the impact of such a failure on the

5 community;

6 ‘‘(I) monitoring and providing oversight for

7 the transition of individuals receiving supple8 mental security income, medicaid, or SCHIP

9 benefits who enroll with a managed care entity

10 (as defined in section 1932(a)(1)(B)), including

11 the review of—

12 ‘‘(i) the degree to which health plans

13 have the capacity (including case manage14 ment and management information system

15 infrastructure) to provide quality managed

16 care services to such an individual;

17 ‘‘(ii) the degree to which these plans

18 may be overburdened by adverse selection;

19 and

20 ‘‘(iii) the degree to which emergency

21 departments are used by enrollees of these

22 plans; and

23 ‘‘(J) identifying and disseminating the best

24 practices for more effective application of the

25 lessons that have been learned.
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1 ‘‘(2) REPORTS.—

2 ‘‘(A) ANNUAL REPORTS.—Not later than

3 June 1 of each year (beginning with 2002), the

4 Commission shall submit to the appropriate

5 committees of Congress a report on the health

6 care needs of the uninsured and the financial

7 and infrastructure stability of the Nation’s core

8 health care safety net based on the review con9 ducted under paragraph (1).

10 ‘‘(B) AGENDA AND ADDITIONAL RE11 VIEWS.—

12 ‘‘(i) AGENDA.—The Chair of the

13 Commission shall consult periodically with

14 the Chairpersons and Ranking Minority

15 Members of the appropriate committees of

16 Congress regarding the Commission’s

17 agenda and progress toward achieving the

18 agenda.

19 ‘‘(ii) ADDITIONAL REVIEWS.—The

20 Commission may conduct additional re21 views, and submit additional reports to the

22 appropriate committees of Congress, from

23 time to time on such topics relating to the

24 health care safety net programs as may be

25 requested the Commission.
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1 ‘‘(C) AVAILABILITY OF REPORTS.—The

2 Commission shall transmit to the Comptroller

3 General and the Secretary a copy of each report

4 submitted under this subsection and shall make

5 such reports available to the public.

6 ‘‘(3) DEFINITIONS.—In this section:

7 ‘‘(A) APPROPRIATE COMMITTEES OF CON8 GRESS.—The term ‘appropriate committees of

9 Congress’ means the Committees on Ways and

10 Means and Commerce of the House of Rep11 resentatives and the Committee on Finance of

12 the Senate.

13 ‘‘(B) CORE HEALTH CARE SAFETY NET.—

14 The term ‘core health care safety net’ means

15 any health care provider that—

16 ‘‘(i) by legal mandate or explicitly

17 adopted mission, offers access to health

18 care services to patients, regardless of the

19 ability of such patient to pay for such serv20 ices; and

21 ‘‘(ii) has a case mix that is substan22 tially comprised of patients who are unin23 sured, covered under the medicaid pro24 gram, covered under any other public
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1 health care program, or are otherwise vul2 nerable populations.

3 Such term includes each disproportionate share

4 hospital, federally qualified health centers, other

5 Federal, State, and locally supported clinic,

6 rural health clinic, local health department, and

7 provider covered under the Emergency Medical

8 Treatment and Labor Act.

9 ‘‘(C) HEALTH CARE SAFETY NET PRO10 GRAMS.—The term ‘health care safety net pro11 grams’ includes the following:

12 ‘‘(i) MEDICAID.—The medicaid pro13 gram under title XIX.

14 ‘‘(ii) SCHIP.—The State children’s

15 health insurance program under title XXI.

16 ‘‘(iii) MATERNAL AND CHILD HEALTH

17 SERVICES BLOCK GRANT PROGRAM.—The

18 maternal and child health services block

19 grant program under title V.

20 ‘‘(iv) FQHC PROGRAMS.—Each feder21 ally funded program under which a health

22 center (as defined in section 330(1) of the

23 Public Health Service Act), a Federally

24 qualified health center (as defined in sec25 tion 1861(aa)(4)), or a Federally-qualified
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1 health center (as defined in section

2 1905(l)(2)(B)) receives funds.

3 ‘‘(v) RHC PROGRAMS.—Each feder4 ally funded program under which a rural

5 health clinic (as defined in section

6 1861(aa)(4) or 1905(l)(1)) receives funds.

7 ‘‘(vi) DSH PAYMENT PLANS.—Each

8 federally funded program under which a

9 disproportionate share hospital receives

10 funds.

11 ‘‘(vii) EMERGENCY MEDICAL TREAT12 MENT AND LABOR ACT.—All care provided

13 under section 1867 for the uninsured,

14 underinsured, beneficiaries under title

15 XIX, and other vulnerable individuals.

16 ‘‘(viii) OTHER HEALTH CARE SAFETY

17 NET PROGRAMS.—Such term also includes

18 any other health care program that the

19 Commission determines to be appropriate.

20 ‘‘(D) VULNERABLE POPULATIONS.—The

21 term ‘vulnerable populations’ includes unin22 sured individuals, low-income individuals, farm

23 workers, homeless individuals, individuals with

24 disabilities, individuals with HIV or AIDS, and
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1 such other individuals as the Commission may

2 designate.

3 ‘‘(c) MEMBERSHIP.—

4 ‘‘(1) NUMBER AND APPOINTMENT.—The Com5 mission shall be composed of 17 members appointed

6 by the Comptroller General of the United States (in

7 this section referred to as the ‘Comptroller Gen8 eral’), in consultation with the committees of juris9 diction in the House of Representatives and the Sen10 ate.

11 ‘‘(2) QUALIFICATIONS.—

12 ‘‘(A) IN GENERAL.—The membership of

13 the Commission shall include individuals with

14 national recognition for their expertise in health

15 finance and economics, health care safety net

16 research and program management, actuarial

17 science, health facility management, health

18 plans and integrated delivery systems, reim19 bursement of health facilities, allopathic and os20 teopathic medicine (including emergency medi21 cine), and other providers of health services,

22 and other related fields, who provide a mix of

23 different professionals, broad geographic rep24 resentation, and a balance between urban and

25 rural representatives.
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1 ‘‘(B) INCLUSION.—The membership of the

2 Commission shall include health professionals,

3 employers, third-party payers, individuals

4 skilled in the conduct and interpretation of bio5 medical, health services, and health economics

6 research and expertise in outcomes and effec7 tiveness research and technology assessment.

8 Such membership shall also include recipients

9 of care from core health care safety net and in10 dividuals who provide and manage the delivery

11 of care by the core health care safety net.

12 ‘‘(C) MAJORITY NONPROVIDERS.—Individ13 uals who are directly involved in the provision,

14 or management of the delivery, of items and

15 services covered under the health care safety

16 net programs shall not constitute a majority of

17 the membership of the Commission.

18 ‘‘(D) ETHICAL DISCLOSURE.—The Comp19 troller General shall establish a system for pub20 lic disclosure by members of the Commission of

21 financial and other potential conflicts of interest

22 relating to such members.

23 ‘‘(3) TERMS.—

24 ‘‘(A) IN GENERAL.—The terms of mem25 bers of the Commission shall be for 3 years ex-
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1 cept that the Comptroller General shall des2 ignate staggered terms for the members first

3 appointed.

4 ‘‘(B) VACANCIES.—

5 ‘‘(i) IN GENERAL.—A vacancy in the

6 Commission shall be filled in the same

7 manner in which the original appointment

8 was made.

9 ‘‘(ii) APPOINTMENT.—Any member

10 appointed to fill a vacancy occurring before

11 the expiration of the term for which the

12 member’s predecessor was appointed shall

13 be appointed only for the remainder of that

14 term.

15 ‘‘(iii) TERM.—A member may serve

16 after the expiration of that member’s term

17 until a successor has taken office.

18 ‘‘(4) COMPENSATION.—

19 ‘‘(A) IN GENERAL.—While serving on the

20 business of the Commission (including travel

21 time), a member of the Commission—

22 ‘‘(i) shall be entitled to compensation

23 at the per diem equivalent of the rate pro24 vided for level IV of the Executive Sched-
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1 ule under section 5315 of title 5, United

2 States Code; and

3 ‘‘(ii) while so serving away from home

4 and the member’s regular place of busi5 ness, a member may be allowed travel ex6 penses, as authorized by the Commission.

7 ‘‘(B) OTHER PERSONNEL.—For purposes

8 of pay (other than pay of members of the Com9 mission) and employment benefits, rights, and

10 privileges, all personnel of the Commission shall

11 be treated as if they were employees of the

12 United States Senate.

13 ‘‘(5) CHAIR; VICE CHAIR.—The Comptroller

14 General shall designate a member of the Commis15 sion, at the time of appointment of the member as

16 Chair and a member as Vice Chair for that term of

17 appointment, except that in the case of vacancy of

18 the Chair or Vice Chair, the Comptroller General

19 may designate another member for the remainder of

20 that member’s term.

21 ‘‘(6) MEETINGS.—The Commission shall meet

22 at the call of the Chair or upon the written request

23 of a majority of its members.

24 ‘‘(d) DIRECTOR AND STAFF; EXPERTS AND CON25 SULTANTS.—Subject to such review as the Comptroller
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1 General deems necessary to ensure the efficient adminis2 tration of the Commission, the Commission may—

3 ‘‘(1) employ and fix the compensation of an Ex4 ecutive Director (subject to the approval of the

5 Comptroller General) and such other personnel as

6 may be necessary to carry out its review of health

7 care safety net programs and reporting requirements

8 (without regard to the provisions of title 5, United

9 States Code, governing appointments in the competi10 tive service);

11 ‘‘(2) seek such assistance and support as may

12 be required in the performance of its review of

13 health care safety net programs and reporting re14 quirements from appropriate Federal departments

15 and agencies;

16 ‘‘(3) enter into contracts or make other ar17 rangements, as may be necessary for the conduct of

18 the work of the Commission (without regard to sec19 tion 3709 of the Revised Statutes (41 U.S.C. 5));

20 ‘‘(4) make advance, progress, and other pay21 ments which relate to the work of the Commission;

22 ‘‘(5) provide transportation and subsistence for

23 persons serving without compensation; and
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1 ‘‘(6) prescribe such rules and regulations as it

2 deems necessary with respect to the internal organi3 zation and operation of the Commission.

4 ‘‘(e) POWERS.—

5 ‘‘(1) OBTAINING OFFICIAL DATA.—

6 ‘‘(A) IN GENERAL.—The Commission may

7 secure directly from any department or agency

8 of the United States information necessary to

9 enable it to carry out this section.

10 ‘‘(B) REQUEST OF CHAIR.—Upon request

11 of the Chair, the head of that department or

12 agency shall furnish that information to the

13 Commission on an agreed upon schedule.

14 ‘‘(2) DATA COLLECTION.—In order to carry out

15 its functions, the Commission shall—

16 ‘‘(A) use existing information, both pub17 lished and unpublished, where possible, collected

18 and assessed either by its own staff or under

19 other arrangements made in accordance with

20 this section;

21 ‘‘(B) carry out, or award grants or con22 tracts for, original research and experimen23 tation, where existing information is inad24 equate; and
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1 ‘‘(C) adopt procedures allowing any inter2 ested party to submit information for the Com3 mission’s use in making reports and rec4 ommendations.

5 ‘‘(3) ACCESS OF GAO TO INFORMATION.—The

6 Comptroller General shall have unrestricted access

7 to all deliberations, records, and nonproprietary data

8 of the Commission, immediately upon request.

9 ‘‘(4) PERIODIC AUDIT.—The Commission shall

10 be subject to periodic audit by the Comptroller Gen11 eral.

12 ‘‘(f) APPLICATION OF FACA.—Section 14 of the

13 Federal Advisory Committee Act does not apply to the

14 Commission.

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

16 ‘‘(1) REQUEST FOR APPROPRIATIONS.—The

17 Commission shall submit requests for appropriations

18 in the same manner as the Comptroller General sub19 mits requests for appropriations, but amounts ap20 propriated for the Commission shall be separate

21 from amounts appropriated for the Comptroller Gen22 eral.

23 ‘‘(2) AUTHORIZATION.—There are authorized to

24 be appropriated such sums as may be necessary to

25 carry out the provisions of this section.’’.
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1 (b) EFFECTIVE DATE.—The Comptroller General of

2 the United States shall appoint the initial members of the

3 Safety Net Organizations and Patient Advisory Commis4 sion established under subsection (a) not later than June

5 1, 2001.

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