January 6, 2009 CONGRESSIONAL RECORD — SENATE S61 

penalty of more than $10,000 for each such 

violation in the case of a participating hospital that the Secretary determines has a 

pattern or practice of such violations (with 

the amount of such additional penalties 

being determined in accordance with a 

schedule or methodology specified in regulations). 

‘‘(B) PROCEDURES.—The provisions of section 1128A (other than subsections (a) and 

(b)) shall apply to a civil money penalty 

under this paragraph in the same manner as 

such provisions apply to a penalty or proceeding under section 1128A. 

‘‘(C) PUBLIC NOTICE OF VIOLATIONS.— 

‘‘(i) INTERNET WEBSITE.—The Secretary 

shall publish on the Internet website of the 

Department of Health and Human Services 

the names of participating hospitals on 

which civil money penalties have been imposed under this section, the violation for 

which the penalty was imposed, and such additional information as the Secretary determines appropriate. 

‘‘(ii) CHANGE OF OWNERSHIP.—With respect 

to a participating hospital that had a change 

in ownership, as determined by the Secretary, penalties imposed on the hospital 

while under previous ownership shall no 

longer be published by the Secretary of such 

Internet website after the 1-year period beginning on the date of change in ownership. 

‘‘(e) WHISTLEBLOWER PROTECTIONS.— 

‘‘(1) PROHIBITION OF DISCRIMINATION AND RETALIATION.—A participating hospital shall 

not discriminate or retaliate in any manner 

against any patient or employee of the hospital because that patient or employee, or 

any other person, has presented a grievance 

or complaint, or has initiated or cooperated 

in any investigation or proceeding of any 

kind, relating to the staffing system or other 

requirements and prohibitions of this section. 

‘‘(2) RELIEF FOR PREVAILING EMPLOYEES.— 

An employee of a participating hospital who 

has been discriminated or retaliated against 

in employment in violation of this subsection may initiate judicial action in a 

United States district court and shall be entitled to reinstatement, reimbursement for 

lost wages, and work benefits caused by the 

unlawful acts of the employing hospital. Prevailing employees are entitled to reasonable 

attorney’s fees and costs associated with 

pursuing the case. 

‘‘(3) RELIEF FOR PREVAILING PATIENTS.—A 

patient who has been discriminated or retaliated against in violation of this subsection 

may initiate judicial action in a United 

States district court. A prevailing patient 

shall be entitled to liquidated damages of 

$5,000 for a violation of this statute in addition to any other damages under other applicable statutes, regulations, or common law. 

Prevailing patients are entitled to reasonable attorney’s fees and costs associated 

with pursuing the case. 

‘‘(4) LIMITATION ON ACTIONS.—No action 

may be brought under paragraph (2) or (3) 

more than 2 years after the discrimination 

or retaliation with respect to which the action is brought. 

‘‘(5) TREATMENT OF ADVERSE EMPLOYMENT

ACTIONS.—For purposes of this subsection— 

‘‘(A) an adverse employment action shall 

be treated as retaliation or discrimination; 

and 

‘‘(B) the term ‘adverse employment action’ 

includes— 

‘‘(i) the failure to promote an individual or 

provide any other employment-related benefit for which the individual would otherwise 

be eligible; 

‘‘(ii) an adverse evaluation or decision 

made in relation to accreditation, certification, credentialing, or licensing of the individual; and 

‘‘(iii) a personnel action that is adverse to 

the individual concerned. 

‘‘(f) RELATIONSHIP TO STATE LAWS.—Nothing in this section shall be construed as exempting or relieving any person from any liability, duty, penalty, or punishment provided by any present or future law of any 

State or political subdivision of a State, 

other than any such law which purports to 

require or permit the doing of any act which 

would be an unlawful practice under this 

title. 

‘‘(g) RELATIONSHIP TO CONDUCT PROHIBITED

UNDER THE NATIONAL LABOR RELATIONS ACT

OR OTHER COLLECTIVE BARGAINING LAWS.— 

Nothing in this section shall be construed as 

permitting conduct prohibited under the National Labor Relations Act or under any 

other Federal, State, or local collective bargaining law. 

‘‘(h) REGULATIONS.—The Secretary shall 

promulgate such regulations as are appropriate and necessary to implement this section. 

‘‘(i) DEFINITIONS.—In this section: 

‘‘(1) PARTICIPATING HOSPITAL.—The term 

‘participating hospital’ means a hospital 

that has entered into a provider agreement 

under section 1866. 

‘‘(2) REGISTERED NURSE.—The term ‘registered nurse’ means an individual who has 

been granted a license to practice as a registered nurse in at least 1 State. 

‘‘(3) UNIT.—The term ‘unit’ of a hospital is 

an organizational department or separate geographic area of a hospital, such as a burn 

unit, a labor and delivery room, a post-anesthesia service area, an emergency department, an operating room, a pediatric unit, a 

stepdown or intermediate care unit, a specialty care unit, a telemetry unit, a general 

medical care unit, a subacute care unit, and 

a transitional inpatient care unit. 

‘‘(4) SHIFT.—The term ‘shift’ means a 

scheduled set of hours or duty period to be 

worked at a participating hospital. 

‘‘(5) PERSON.—The term ‘person’ means 1 or 

more individuals, associations, corporations, 

unincorporated organizations, or labor 

unions.’’. 

(c) EFFECTIVE DATE.—The amendments 

made by this section shall take effect on 

January 1, 2010. 

By Mr. INOUYE: 

S. 55. A bill to amend the XVIII of 

the Social Security Act to provide improved reimbursement for clinical social worker services under the Medicare program; to the Committee on Finance. 

Mr. INOUYE. Mr. President, today I 

am, again, introducing legislation to 

amend title XVIII of the Social Security Act to correct discrepancies in the 

reimbursement of clinical social workers covered through Medicare, Part B. 

These three proposed changes contained in this legislation clarify the 

current payment process for clinical 

social workers and establish a reimbursement methodology for the profession that is similar to other health 

care professionals reimbursed through 

the Medicare program. 

First, this legislation sets payment 

for clinical social worker services according to a fee schedule established by 

the Secretary. Second, it explicitly 

states that services and supplies furnished by a clinical social worker are a 

covered Medicare expense, just as these 

services are covered for other mental 

health professionals in Medicare. 

Third, the bill allows clinical social 

workers to be reimbursed for services 

provided to a client who is hospitalized. 

Clinical social workers are valued 

members of our health care provider 

network. They are legally regulated in 

every state of the nation and are recognized as independent providers of mental health care throughout the health 

care system. It is time to correct the 

disparate reimbursement treatment of 

this profession under Medicare. 

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

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 55 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Equity for 

Clinical Social Workers Act of 2009’’. 

SEC. 2. IMPROVED REIMBURSEMENT FOR CLINICAL SOCIAL WORKER SERVICES 

UNDER MEDICARE. 

(a) IN GENERAL.—Section 1833(a)(1)(F)(ii) of 

the Social Security Act (42 U.S.C. 

1395l(a)(1)(F)(ii)) is amended to read as follows: ‘‘(ii) the amount determined by a fee 

schedule established by the Secretary,’’. 

(b) DEFINITION OF CLINICAL SOCIAL WORKER

SERVICES EXPANDED.—Section 1861(hh)(2) of 

the Social Security Act (42 U.S.C. 

1395x(hh)(2)) is amended by striking ‘‘services performed by a clinical social worker (as 

defined in paragraph (1))’’ and inserting 

‘‘such services and such services and supplies 

furnished as an incident to such services performed by a clinical social worker (as defined in paragraph (1))’’. 

(c) CLINICAL SOCIAL WORKER SERVICES NOT

TO BE INCLUDED IN INPATIENT HOSPITAL

SERVICES.—Section 1861(b)(4) of the Social 

Security Act (42 U.S.C. 1395x(b)(4)) is amended by striking ‘‘and services’’ and inserting 

‘‘clinical social worker services, and services’’. 

(d) TREATMENT OF SERVICES FURNISHED IN

INPATIENT SETTING.—Section 1832(a)(2)(B)(iii) 

of the Social Security Act (42 U.S.C. 

1395k(a)(2)(B)(iii)) is amended— 

(1) by striking ‘‘and services’’ and inserting 

‘‘clinical social worker services, and services’’; and 

(2) by adding ‘‘and’’ at the end. 

(e) EFFECTIVE DATE.—The amendments 

made by this section shall apply to payments 

made for clinical social worker services furnished on or after January 1, 2010. 

By Mr. INOUYE: 

S. 56. A bill to amend the XVIII of 

the Social Security Act to remove the 

restriction that a clinical psychologist 

or clinical social worker provide services in a comprehensive outpatient rehabilitation facility to a patient only 

under the care of a physician; to the 

Committee on Finance. 

Mr. INOUYE. Mr. President, today I 

again introduce legislation to authorize the autonomous functioning of clinical psychologists and clinical social 

workers within the Medicare comprehensive outpatient rehabilitation 

facility program. 

In my judgment, it is unfortunate 

that Medicare requires clinical supervision of the services provided by certain health professionals and does not 


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S62 CONGRESSIONAL RECORD — SENATE January 6, 2009 

allow them to function to the full extent of their State practice licenses. 

Those who need the services of outpatient rehabilitation facilities should 

have access to a wide range of social 

and behavioral science expertise. Clinical psychologists and clinical social 

workers are recognized as independent 

providers of mental health care services under the Federal Employee 

Health Benefits Program, the 

TRICARE Military Health Program of 

the Uniformed Services, the Medicare 

(Part B) Program, and numerous private insurance plans. This legislation 

will ensure that these qualified professionals achieve the same recognition 

under the Medicare comprehensive outpatient rehabilitation facility program. 

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

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 56 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Autonomy 

for Psychologists and Social Workers Act of 

2009’’. 

SEC. 2. REMOVAL OF RESTRICTION THAT A CLINICAL PSYCHOLOGIST OR CLINICAL 

SOCIAL WORKER PROVIDE SERVICES IN A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY 

TO A PATIENT ONLY UNDER THE 

CARE OF A PHYSICIAN. 

(a) IN GENERAL.—Section 1861(cc)(2)(E) of 

the Social Security Act (42 U.S.C. 

1395x(cc)(2)(E)) is amended by striking ‘‘physician’’ and inserting ‘‘physician, except that 

a patient receiving qualified psychologist 

services (as defined in subsection (ii)) may be 

under the care of a clinical psychologist with 

respect to such services to the extent permitted under State law and except that a patient receiving clinical social worker services (as defined in subsection (hh)(2)) may be 

under the care of a clinical social worker 

with respect to such services to the extent 

permitted under State law’’. 

(b) EFFECTIVE DATE.—The amendment 

made by subsection (a) shall apply to services provided on or after January 1, 2010. 

By Mr. INOUYE: 

S. 57. A bill to amend title VII of the 

Public Health Service Act to establish 

a psychology post-doctoral fellowship 

program, and for other purposes; to the 

Committee on Health, Education, 

Labor, and Pensions. 

Mr. INOUYE. Mr. President, today, I 

am reintroducing legislation to amend 

Title VII of the Public Health Service 

Act to establish a psychology post-doctoral program. Psychologists have 

made a unique contribution in reaching 

out to the Nation’s medically underserved populations. Expertise in behavioral science is useful in addressing 

grave concerns such as violence, addiction, mental illness, adolescent and 

child behavioral disorders, and family 

disruption. Establishment of a psychology post-doctoral program could 

be an effective way to find solutions to 

these issues. 

Similar programs supporting additional, specialized training in traditionally underserved settings have 

been successful in retaining participants to serve the same populations. 

For example, mental health professionals who have participated in these 

specialized federally funded programs 

have tended not only to meet their repayment obligations, but have continued to work in the public sector or 

with the underserved. 

While a doctorate in psychology provides broad-based knowledge and mastery in a wide variety of clinical skills, 

specialized post-doctoral fellowship 

programs help to develop particular diagnostic and treatment skills required 

to respond effectively to underserved 

populations. For example, what appears to be poor academic motivation 

in a child recently relocated from 

Southeast Asia might actually reflect 

a cultural value of reserve rather than 

a disinterest in academic learning. 

Specialized assessment skills enable 

the clinician to initiate effective treatment. 

Domestic violence poses a significant 

public health problem and is not just a 

problem for the criminal justice system. Violence against women results in 

thousands of hospitalizations a year. 

Rates of child and spouse abuse in 

rural areas are particularly high, as 

are the rates of alcohol abuse and depression in adolescents. A post-doctoral fellowship program in the psychology of the rural populations could 

be of special benefit in addressing these 

problems. 

Given the demonstrated success and 

effectiveness of specialized training 

programs, it is incumbent upon us to 

encourage participation in post-doctoral fellowships that respond to the 

needs of the Nation’s underserved. 

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

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 57 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Psychologists in the Service of the Public Act of 

2009’’. 

SEC. 2. GRANTS FOR FELLOWSHIPS IN PSYCHOLOGY. 

Part C of title VII of the Public Health 

Service Act (42 U.S.C. 293k et seq.) is amended by adding at the end the following: 

‘‘SEC. 749. GRANTS FOR FELLOWSHIPS IN PSYCHOLOGY. 

‘‘(a) IN GENERAL.—The Secretary shall establish a psychology post-doctoral fellowship 

program to make grants to and enter into 

contracts with eligible entities to encourage 

the provision of psychological training and 

services in underserved treatment areas. 

‘‘(b) ELIGIBLE ENTITIES.— 

‘‘(1) INDIVIDUALS.—In order to receive a 

grant under this section an individual shall 

submit an application to the Secretary at 

such time, in such form, and containing such 

information as the Secretary shall require, 

including a certification that such individual— 

‘‘(A) has received a doctoral degree 

through a graduate program in psychology 

provided by an accredited institution at the 

time such grant is awarded; 

‘‘(B) will provide services to a medically 

underserved population during the period of 

such grant; 

‘‘(C) will comply with the provisions of 

subsection (c); and 

‘‘(D) will provide any other information or 

assurances as the Secretary determines appropriate. 

‘‘(2) INSTITUTIONS.—In order to receive a 

grant or contract under this section, an institution shall submit an application to the 

Secretary at such time, in such form, and 

containing such information as the Secretary shall require, including a certification 

that such institution— 

‘‘(A) is an entity, approved by the State, 

that provides psychological services in medically underserved areas or to medically underserved populations (including entities 

that care for the mentally retarded, mental 

health institutions, and prisons); 

‘‘(B) will use amounts provided to such institution under this section to provide financial assistance in the form of fellowships to 

qualified individuals who meet the requirements of subparagraphs (A) through (C) of 

paragraph (1); 

‘‘(C) will not use more than 10 percent of 

amounts provided under this section to pay 

for the administrative costs of any fellowship programs established with such funds; 

and 

‘‘(D) will provide any other information or 

assurances as the Secretary determines appropriate. 

‘‘(c) CONTINUED PROVISION OF SERVICES.— 

Any individual who receives a grant or fellowship under this section shall certify to 

the Secretary that such individual will continue to provide the type of services for 

which such grant or fellowship is awarded for 

not less than 1 year after the term of the 

grant or fellowship has expired. 

‘‘(d) REGULATIONS.—Not later than 180 days 

after the date of enactment of this section, 

the Secretary shall promulgate regulations 

necessary to carry out this section, including regulations that define the terms ‘medically underserved areas’ and ‘medically underserved populations’. 

‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

There are authorized to be appropriated to 

carry out this section $5,000,000 for each of 

the fiscal years 2010 through 2012.’’. 

By Mr. INOUYE: 

S. 58. A bill to amend the Internal 

Revenue Code of 1986 to modify the application of the tonnage tax on vessels 

operating in the dual United States domestic and foreign trades, and for 

other purposes; to the Committee on 

Finance. 

Mr. INOUYE. Mr. Presdient, foreign 

registered ships now carry 97 percent of 

the imports and exports moving in 

United States international trade. 

These foreign vessels are held to lower 

standards than United States registered ships, and are virtually 

untaxed. Their costs of operation are, 

therefore, lower than United States 

ship operating costs, which explains 

their 97 percent market share. 

Three years ago, in order to help 

level the playing field for United 

States-flag ships that compete in international trade, Congress enacted, 

under the American Jobs Creation Act 


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