I
106TH CONGRESS
2D SESSION
H. R. 5162
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 HOUSE OF REPRESENTATIVES
SEPTEMBER 12, 2000
Mrs. MCCARTHY of New York (for herself and Mrs. MORELLA) introduced the
following bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Commerce, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Health Care Safety
Net Oversight Act of 2000’’.
SEC. 2. FINDINGS AND PURPOSE.
(a) FINDINGS.—Congress makes the following find-
ings:
(1) America’s core health care safety net is
made up of providers that deliver a significant level
of health care and other related services to unin-
sured individuals, to beneficiaries under the med-
icaid program under title XIX of the Social Security
Act, and to other vulnerable populations.
(2) Thousands of providers render uncompen-
sated care to uninsured and underinsured individ-
uals.
(3) There are currently 44,000,000 uninsured
individuals in the Nation, and an equal number of
low-income underinsured individuals (including med-
icaid beneficiaries) who depend on the core health
care safety net.
(b) PURPOSE.—The purpose of this Act is to create
an independent and nonpartisan commission to assess the
health care needs of the uninsured and to monitor the in-
frastructure, effectiveness, and financial stability of the
Nation’s core health care safety net.
SEC. 3. SAFETY NET ORGANIZATIONS AND PATIENT ADVI-
SORY COMMISSION.
(a) IN GENERAL.—Title XI of the Social Security Act
(42 U.S.C. 1320 et seq.) is amended by adding at the end
the following new part:
‘‘PART D—SAFETY NET ORGANIZATIONS AND PATIENT
ADVISORY COMMISSION
‘‘SAFETY NET ORGANIZATIONS AND PATIENT ADVISORY
COMMISSION
‘‘SEC. 1181. (a) ESTABLISHMENT.—There is estab-
lished the Safety Net Organizations and Patient Advisory
Commission (in this section referred to as the ‘Commis-
sion’).
‘‘(b) STUDY OF HEALTH CARE SAFETY NET PRO-
GRAMS AND REPORTING REQUIREMENTS.—
‘‘(1) STUDY.—The Commission shall study the
health care safety net programs by—
‘‘(A) monitoring each health care safety
net program to document and analyze the ef-
fects of changes in these programs on the core
health care safety net;
‘‘(B) evaluating the impact of the Emer-
gency Medical Treatment and Labor Act, the
Balanced Budget Act of 1997, the Medicare,
Medicaid, and SCHIP Balanced Budget Refine-
ment Act of 1999, and other forces on the ca-
pacity of the core health care safety net to con-
tinue their roles in the core health care safety
net system to care for uninsured individuals,
medicaid beneficiaries, and other vulnerable
populations;
‘‘(C) monitoring existing data sets to as-
sess the status of the core health care safety
net and health outcomes for vulnerable popu-
lations;
‘‘(D) wherever possible, linking and inte-
grating existing data systems to enhance the
ability of the core health care safety net to
track changes in the status of the core health
care safety net and health outcomes for vulner-
able populations;
‘‘(E) supporting the development of new
data systems where existing data are insuffi-
cient or inadequate;
‘‘(F) developing criteria and indicators of
impending core health care safety net failure;
‘‘(G) establishing an early-warning system
to identify impending failures of core health
care safety net systems and providers;
‘‘(H) providing accurate and timely infor-
mation to Federal, State, and local policy mak-
ers on the indicators that may lead to the fail-
ure of the core health care safety net and an es-
timate of the projected consequences of such
failures and the impact of such a failure on the
community;
‘‘(I) monitoring and providing oversight for
the transition of individuals receiving supple-
mental security income, medicaid, or SCHIP
benefits who enroll with a managed care entity
(as defined in section 1932(a)(1)(B)), including
the review of—
‘‘(i) the degree to which health plans
have the capacity (including case manage-
ment and management information system
infrastructure) to provide quality managed
care services to such an individual;
‘‘(ii) the degree to which these plans
may be overburdened by adverse selection;
and
‘‘(iii) the degree to which emergency
departments are used by enrollees of these
plans; and
‘‘(J) identifying and disseminating the best
practices for more effective application of the
lessons that have been learned.
‘‘(2) REPORTS.—
‘‘(A) ANNUAL REPORTS.—Not later than
June 1 of each year (beginning with 2002), the
Commission shall submit to the appropriate
committees of Congress a report on the health
care needs of the uninsured and the financial
and infrastructure stability of the Nation’s core
health care safety net based on the review con-
ducted under paragraph (1).
‘‘(B) 
AGENDA
AND
ADDITIONAL
RE-
VIEWS.—
‘‘(i) AGENDA.—The Chair of the
Commission shall consult periodically with
the Chairpersons and Ranking Minority
Members of the appropriate committees of
Congress 
regarding 
the 
Commission’s
agenda and progress toward achieving the
agenda.
‘‘(ii) 
ADDITIONAL
REVIEWS.—The
Commission may conduct additional re-
views, and submit additional reports to the
appropriate committees of Congress, from
time to time on such topics relating to the
health care safety net programs as may be
requested the Commission.
‘‘(C) AVAILABILITY
OF
REPORTS.—The
Commission shall transmit to the Comptroller
General and the Secretary a copy of each report
submitted under this subsection and shall make
such reports available to the public.
‘‘(3) DEFINITIONS.—In this section:
‘‘(A) APPROPRIATE COMMITTEES OF CON-
GRESS.—The term ‘appropriate committees of
Congress’ means the Committees on Ways and
Means and Commerce of the House of Rep-
resentatives and the Committee on Finance of
the Senate.
‘‘(B) CORE HEALTH CARE SAFETY NET.—
The term ‘core health care safety net’ means
any health care provider that—
‘‘(i) by legal mandate or explicitly
adopted mission, offers access to health
care services to patients, regardless of the
ability of such patient to pay for such serv-
ices; and
‘‘(ii) has a case mix that is substan-
tially comprised of patients who are unin-
sured, covered under the medicaid pro-
gram, covered under any other public
health care program, or are otherwise vul-
nerable populations.
Such term includes each disproportionate share
hospital, federally qualified health centers, other
Federal, State, and locally supported clinic,
rural health clinic, local health department, and
provider covered under the Emergency Medical
Treatment and Labor Act.
‘‘(C) HEALTH
CARE
SAFETY
NET
PRO-
GRAMS.—The term ‘health care safety net pro-
grams’ includes the following:
‘‘(i) MEDICAID.—The medicaid pro-
gram under title XIX.
‘‘(ii) SCHIP.—The State children’s
health insurance program under title XXI.
‘‘(iii) MATERNAL AND CHILD HEALTH
SERVICES BLOCK GRANT PROGRAM.—The
maternal and child health services block
grant program under title V.
‘‘(iv) FQHC PROGRAMS.—Each feder-
ally funded program under which a health
center (as defined in section 330(1) of the
Public Health Service Act), a Federally
qualified health center (as defined in sec-
tion 1861(aa)(4)), or a Federally-qualified
health center (as defined in section
1905(l)(2)(B)) receives funds.
‘‘(v) RHC PROGRAMS.—Each feder-
ally funded program under which a rural
health 
clinic 
(as 
defined 
in 
section
1861(aa)(4) or 1905(l)(1)) receives funds.
‘‘(vi) DSH PAYMENT
PLANS.—Each
federally funded program under which a
disproportionate share hospital receives
funds.
‘‘(vii) EMERGENCY
MEDICAL
TREAT-
MENT AND LABOR ACT.—All care provided
under section 1867 for the uninsured,
underinsured, 
beneficiaries 
under 
title
XIX, and other vulnerable individuals.
‘‘(viii) OTHER HEALTH CARE SAFETY
NET PROGRAMS.—Such term also includes
any other health care program that the
Commission determines to be appropriate.
‘‘(D) VULNERABLE
POPULATIONS.—The
term ‘vulnerable populations’ includes unin-
sured individuals, low-income individuals, farm
workers, homeless individuals, individuals with
disabilities, individuals with HIV or AIDS, and
such other individuals as the Commission may
designate.
‘‘(c) MEMBERSHIP.—
‘‘(1) NUMBER AND APPOINTMENT.—The Com-
mission shall be composed of 17 members appointed
by the Comptroller General of the United States (in
this section referred to as the ‘Comptroller Gen-
eral’), in consultation with the committees of juris-
diction in the House of Representatives and the Sen-
ate.
‘‘(2) QUALIFICATIONS.—
‘‘(A) IN
GENERAL.—The membership of
the Commission shall include individuals with
national recognition for their expertise in health
finance and economics, health care safety net
research and program management, actuarial
science, health facility management, health
plans and integrated delivery systems, reim-
bursement of health facilities, allopathic and os-
teopathic medicine (including emergency medi-
cine), and other providers of health services,
and other related fields, who provide a mix of
different professionals, broad geographic rep-
resentation, and a balance between urban and
rural representatives.
‘‘(B) INCLUSION.—The membership of the
Commission shall include health professionals,
employers, 
third-party 
payers, 
individuals
skilled in the conduct and interpretation of bio-
medical, health services, and health economics
research and expertise in outcomes and effec-
tiveness research and technology assessment.
Such membership shall also include recipients
of care from core health care safety net and in-
dividuals who provide and manage the delivery
of care by the core health care safety net.
‘‘(C) MAJORITY NONPROVIDERS.—Individ-
uals who are directly involved in the provision,
or management of the delivery, of items and
services covered under the health care safety
net programs shall not constitute a majority of
the membership of the Commission.
‘‘(D) ETHICAL DISCLOSURE.—The Comp-
troller General shall establish a system for pub-
lic disclosure by members of the Commission of
financial and other potential conflicts of interest
relating to such members.
‘‘(3) TERMS.—
‘‘(A) IN GENERAL.—The terms of mem-
bers of the Commission shall be for 3 years ex-
cept that the Comptroller General shall des-
ignate staggered terms for the members first
appointed.
‘‘(B) VACANCIES.—
‘‘(i) IN GENERAL.—A vacancy in the
Commission shall be filled in the same
manner in which the original appointment
was made.
‘‘(ii) APPOINTMENT.—Any member
appointed to fill a vacancy occurring before
the expiration of the term for which the
member’s predecessor was appointed shall
be appointed only for the remainder of that
term.
‘‘(iii) TERM.—A member may serve
after the expiration of that member’s term
until a successor has taken office.
‘‘(4) COMPENSATION.—
‘‘(A) IN GENERAL.—While serving on the
business of the Commission (including travel
time), a member of the Commission—
‘‘(i) shall be entitled to compensation
at the per diem equivalent of the rate pro-
vided for level IV of the Executive Sched-
ule under section 5315 of title 5, United
States Code; and
‘‘(ii) while so serving away from home
and the member’s regular place of busi-
ness, a member may be allowed travel ex-
penses, as authorized by the Commission.
‘‘(B) OTHER PERSONNEL.—For purposes
of pay (other than pay of members of the Com-
mission) and employment benefits, rights, and
privileges, all personnel of the Commission shall
be treated as if they were employees of the
United States Senate.
‘‘(5) CHAIR; VICE
CHAIR.—The Comptroller
General shall designate a member of the Commis-
sion, at the time of appointment of the member as
Chair and a member as Vice Chair for that term of
appointment, except that in the case of vacancy of
the Chair or Vice Chair, the Comptroller General
may designate another member for the remainder of
that member’s term.
‘‘(6) MEETINGS.—The Commission shall meet
at the call of the Chair or upon the written request
of a majority of its members.
‘‘(d) DIRECTOR AND STAFF; EXPERTS AND CON-
SULTANTS.—Subject to such review as the Comptroller
General deems necessary to ensure the efficient adminis-
tration of the Commission, the Commission may—
‘‘(1) employ and fix the compensation of an Ex-
ecutive Director (subject to the approval of the
Comptroller General) and such other personnel as
may be necessary to carry out its review of health
care safety net programs and reporting requirements
(without regard to the provisions of title 5, United
States Code, governing appointments in the competi-
tive service);
‘‘(2) seek such assistance and support as may
be required in the performance of its review of
health care safety net programs and reporting re-
quirements from appropriate Federal departments
and agencies;
‘‘(3) enter into contracts or make other ar-
rangements, as may be necessary for the conduct of
the work of the Commission (without regard to sec-
tion 3709 of the Revised Statutes (41 U.S.C. 5));
‘‘(4) make advance, progress, and other pay-
ments which relate to the work of the Commission;
‘‘(5) provide transportation and subsistence for
persons serving without compensation; and
‘‘(6) prescribe such rules and regulations as it
deems necessary with respect to the internal organi-
zation and operation of the Commission.
‘‘(e) POWERS.—
‘‘(1) OBTAINING OFFICIAL DATA.—
‘‘(A) IN GENERAL.—The Commission may
secure directly from any department or agency
of the United States information necessary to
enable it to carry out this section.
‘‘(B) REQUEST OF CHAIR.—Upon request
of the Chair, the head of that department or
agency shall furnish that information to the
Commission on an agreed upon schedule.
‘‘(2) DATA COLLECTION.—In order to carry out
its functions, the Commission shall—
‘‘(A) use existing information, both pub-
lished and unpublished, where possible, collected
and assessed either by its own staff or under
other arrangements made in accordance with
this section;
‘‘(B) carry out, or award grants or con-
tracts for, original research and experimen-
tation, where existing information is inad-
equate; and
Federal Hospital Insurance Trust Fund under
section 1817 such sums as may be necessary to
carry out the provisions of this section.
‘‘(B) LIMITATION.—For any fiscal year,
the sums appropriated under subparagraph (A)
may not exceed $7,000,000.’’.
(b) EFFECTIVE DATE.—The Comptroller General of
the United States shall appoint the initial members of the
Safety Net Organizations and Patient Advisory Commis-
sion established under subsection (a) not later than June
1, 2001.
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