		IV
		112th CONGRESS
		1st Session
		H. RES. 225
		IN THE HOUSE OF REPRESENTATIVES

			April 14, 2011
			Ms. Richardson (for
			 herself, Ms. Bordallo,
			 Mr. Faleomavaega, and
			 Mr. Al Green of Texas) submitted the
			 following resolution; which was referred to the
			 Committee on Foreign
			 Affairs

		RESOLUTION
		Honoring the victims of the Cambodian
		  genocide that took place from April 1975 to January 1979.

		Whereas, beginning in April 1975 and ending in January
			 1979, at least 1,700,000 to 3,000,000 people were deliberately and
			 systematically killed in Cambodia in one of the worst human tragedies of the
			 modern era;
		Whereas in 1975, Pol Pot led the Communist guerilla group,
			 the Khmer Rouge, in a large-scale insurgency in Cambodia that resulted in the
			 removal of Cambodians from their homes and into labor camps in an attempt to
			 restructure Khmer society;
		Whereas traditional Khmer culture and society were
			 systematically destroyed, including the destruction of temples, schools,
			 hospitals, and other buildings;
		Whereas families were separated in an attempt by the Khmer
			 Rouge to prevent family formation, many individuals were punished or killed for
			 education, wealth, or sophistication, and doctors, nurses, clergy, teachers,
			 business owners, artisans, city dwellers, and even those individuals who wore
			 glasses were singled out for execution since they were seen as bourgeois or
			 contaminated with Western influence;
		Whereas the Khmer Rouge maintained control by mass public
			 torture, executions, and dismantling of the social order;
		Whereas men, women, and children were sent to labor camps
			 and forced to do strenuous farm work and famine and disease became epidemic
			 while medicine and medical care were non-existent;
		Whereas after the Khmer Rouge regime was overthrown in
			 1979, thousands of Cambodians fled on foot to refugee camps in Thailand and
			 many refugees were processed again in other camps in the Philippines and
			 Indonesia;
		Whereas from these refugee camps approximately 145,149
			 Cambodians made their way to the United States between 1975 and 1999, with the
			 majority of Cambodians arriving in the early 1980s;
		Whereas these Cambodians were subsequently resettled in
			 communities across the United States;
		Whereas according to the United States Bureau of the
			 Census figures from the 2009 American Community Survey, there are approximately
			 241,520 Cambodians currently living in the United States;
		Whereas despite their tremendous loss, Cambodians and
			 Cambodian Americans have shown courage and resiliency;
		Whereas the memory of those Cambodians who were killed
			 during the Cambodian genocide must never be forgotten and the survivors of the
			 Cambodian genocide should be honored;
		Whereas the resettlement of Cambodians reflected the hard
			 work of voluntary agencies through funding by the Federal Government,
			 individual citizens, and Federal, State, and local governmental agencies, all
			 working together to assist the new arrivals in adjusting to society in the
			 United States;
		Whereas Cambodian refugees have done much to further
			 successful resettlement in the United States, including through mutual
			 assistance associations organized by previously resettled Southeast Asian
			 refugees to help new refugees through the provision of essential social,
			 psychological, cultural, educational, and economic services; and
		Whereas while remembering and honoring both their
			 traditional culture and their traumatic past, the new generation of Cambodian
			 Americans is contributing to United States society in meaningful ways: Now,
			 therefore, be it

		That the House of
			 Representatives—
			(1)honors the victims of the genocide in
			 Cambodia that took place beginning in April 1975 and ending in January 1979;
			 and
			(2)continues to support efforts to pursue
			 justice for the victims of the Cambodian genocide.


		I
		111th CONGRESS
		1st Session
		H. R. 2560
		IN THE HOUSE OF REPRESENTATIVES

			May 21, 2009
			Mr. Markey of
			 Massachusetts (for himself and Mr. Smith
			 of New Jersey) introduced the following bill; which was referred to
			 the Committee on Ways and
			 Means, and in addition to the Committee on
			 Energy and Commerce, for
			 a period to be subsequently 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 XVIII of the Social Security Act to
		  provide certain high cost Medicare beneficiaries suffering from multiple
		  chronic conditions with access to coordinated, primary care medical services in
		  lower cost treatment settings, such as their residences, under a plan of care
		  developed by a team of qualified and experienced health care
		  professionals.

		1.Short titleThis Act may be cited as the
			 Independence at Home Act of
			 2009.
		2.FindingsCongress makes the following
			 findings:
			(1)According to the November 2007
			 Congressional Budget Office Long Term Outlook for Health Care Spending, unless
			 changes are made to the way health care is delivered, growing demand for
			 resources caused by rising health care costs and to a lesser extent the
			 Nation’s expanding elderly population will confront Americans with increasingly
			 difficult choices between health care and other priorities. However,
			 opportunities exist to constrain health care costs without adverse health care
			 consequences.
			(2)Medicare beneficiaries with multiple
			 chronic conditions account for a disproportionate share of Medicare spending
			 compared to their representation in the overall Medicare population, and
			 evidence suggests that such patients often receive poorly coordinated care,
			 including conflicting information from health providers and different diagnoses
			 of the same symptoms.
			(3)People with
			 chronic conditions account for 76 percent of all hospital admissions, 88
			 percent of all prescriptions filled, and 72 percent of physician visits.
			(4)Studies show that hospital utilization and
			 emergency room visits for patients with multiple chronic conditions can be
			 reduced and significant savings can be achieved through the use of
			 interdisciplinary teams of health care professionals caring for patients in
			 their places of residence.
			(5)The Independence at Home Act creates a
			 chronic care coordination pilot project to bring primary care medical services
			 to the highest cost Medicare beneficiaries with multiple chronic conditions in
			 their home or place of residence so that they may be as independent as possible
			 for as long as possible in a comfortable setting.
			(6)The Independence
			 at Home Act generates savings by providing better, more coordinated care across
			 all treatment settings to the highest cost Medicare beneficiaries with multiple
			 chronic conditions, reducing duplicative and unnecessary services, and avoiding
			 unnecessary hospitalizations, nursing home admissions, and emergency room
			 visits.
			(7)The Independence
			 at Home Act holds providers accountable for improving beneficiary outcomes,
			 ensuring patient and caregiver satisfaction, and achieving cost savings to
			 Medicare on an annual basis.
			(8)The Independence
			 at Home Act creates incentives for practitioners and providers to develop
			 methods and technologies for providing better and lower cost health care to the
			 highest cost Medicare beneficiaries with the greatest incentives provided in
			 the case of highest cost beneficiaries.
			(9)The Independence
			 at Home Act contains the central elements of proven home-based primary care
			 delivery models that have been utilized for years by the Department of Veterans
			 Affairs and house calls programs across the country to deliver
			 coordinated care for chronic conditions in the comfort of a patient’s home or
			 place of residence.
			3.Establishment of
			 voluntary Independence at Home chronic care coordination pilot project under
			 traditional Medicare fee-for-service program
			(a)In
			 generalTitle XVIII of the
			 Social Security Act is amended—
				(1)by amending subsection (c) of section 1807
			 (42 U.S.C. 1395b–8) to read as follows:

						(c)Independence at
				Home chronic care coordination pilot projectA pilot project for Independence at Home
				chronic care coordination programs for high cost Medicare beneficiaries with
				multiple chronic conditions is set forth in section
				1807A.
						;
				and
				(2)by inserting after
			 section 1807 the following new section:

						1807A.Independence at Home chronic care coordination pilot
		  project(a)Implementation
								(1)In
				generalThe Secretary shall
				provide for the phased in development, implementation, and evaluation of
				Independence at Home programs described in this section to meet the following
				objectives:
									(A)To improve patient outcomes, compared to
				comparable beneficiaries who do not participate in such a program, through
				reduced hospitalizations, nursing home admissions, or emergency room visits,
				increased symptom self-management, and similar results.
									(B)To improve satisfaction of patients and
				caregivers, as demonstrated through a quantitative pre-test and post-test
				survey developed by the Secretary that measures patient and caregiver
				satisfaction of care coordination, educational information, timeliness of
				response, and similar care features.
									(C)To achieve a
				minimum of 5 percent cost savings in the care of beneficiaries under this title
				suffering from multiple high cost chronic diseases.
									(2)Initial
				implementation (phase I)
									(A)In
				generalIn carrying out this
				section and to the extent possible, the Secretary shall enter into agreements
				with at least two unaffiliated Independence at Home organizations in each of
				the 13 highest cost States (based on average per capita expenditures per State
				under this title), in the District of Columbia, and in 13 additional States
				that are representative of other regions of the United States and include
				medically underserved rural and urban areas, to provide chronic care
				coordination services for a period of three years or until those agreements are
				terminated by the Secretary. Such agreements under this paragraph shall
				continue in effect until the Secretary makes the determination described in
				paragraph (3) or until those agreements are supplanted by new agreements under
				such paragraph. The phase of implementation under this paragraph is referred to
				in this section as the initial implementation phase or
				phase I.
									(B)PreferenceIn
				selecting Independence at Home organizations under this paragraph, the
				Secretary shall give a preference, to the extent practicable, to organizations
				that—
										(i)have documented experience in furnishing
				the types of services covered by this section to eligible beneficiaries in the
				home or place of residence using qualified teams of health care professionals
				that are directed by individuals who have the qualifications of Independence at
				Home physicians, or in cases when such direction is provided by an Independence
				at Home physician to a physician assistant who has at least one year of
				experience providing gerontological medical and related services for
				chronically ill individuals in their homes, or other similar qualification as
				determined by the Secretary to be appropriate for the Independence at Home
				program, by the physician assistant acting under the supervision of an
				Independence at Home physician and as permitted under State law, or
				Independence at Home nurse practitioners;
										(ii)have the capacity
				to provide services covered by this section to at least 150 eligible
				beneficiaries; and
										(iii)use electronic
				medical records, health information technology, and individualized plans of
				care.
										(3)Expanded
				implementation phase (Phase II)
									(A)In
				generalFor periods beginning
				after the end of the 3-year initial implementation period under paragraph (2),
				subject to subparagraph (B), the Secretary shall renew agreements described in
				paragraph (2) with Independence at Home organization that have met all 3
				objectives specified in paragraph (1) and enter into agreements described in
				paragraph (2) with any other organization that is located in any State or the
				District of Columbia, that was not an Independence at Home organization during
				the initial implementation period, and that meets the qualifications of an
				Independence at Home organization under this section. The Secretary may
				terminate and not renew such an agreement with an organization that has not met
				such objectives during the initial implementation period. The phase of
				implementation under this paragraph is referred to in this section as the
				expanded implementation phase or phase II.
									(B)ContingencyThe expanded implementation under
				subparagraph (A) shall not occur if the Secretary finds, not later than 60 days
				after the date of issuance of the independent evaluation under paragraph (5),
				that continuation of the Independence at Home project is not in the best
				interest of beneficiaries under this title or in the best interest of Federal
				health care programs.
									(4)EligibilityNo organization shall be prohibited from
				participating under this section during expanded implementation phase under
				paragraph (3) (and, to the extent practicable, during initial implementation
				phase under paragraph (2)) because of its small size as long as it meets the
				eligibility requirements of this section.
								(5)Independent
				evaluations
									(A)In
				generalThe Secretary shall contract for an independent
				evaluation of the initial implementation phase under paragraph (2) with an
				interim report to Congress to be provided on such evaluation as soon as
				practicable after the first year of such phase and a final report to be
				provided to Congress as soon as practicable following the conclusion of the
				initial implementation phase, but not later than 6 months following the end of
				such phase. Such an evaluation shall be conducted by individuals with knowledge
				of chronic care coordination programs for the targeted patient population and
				demonstrated experience in the evaluation of such programs.
									(B)Information to
				be includedEach such report shall include an assessment of the
				following factors and shall identify the characteristics of individual
				Independence at Home programs that are the most effective in producing
				improvements in—
										(i)beneficiary,
				caregiver, and provider satisfaction;
										(ii)health outcomes
				appropriate for patients with multiple chronic diseases; and
										(iii)cost savings to
				the program under this title, such as in reducing—
											(I)hospital and
				skilled nursing facility admission rates and lengths of stay;
											(II)hospital readmission rates; and
											(III)emergency
				department visits.
											(C)Breakdown by
				conditionEach such report
				shall include data on performance of Independence at Home organizations in
				responding to the needs of eligible beneficiaries with specific chronic
				conditions and combinations of conditions, as well as the overall eligible
				beneficiary population.
									(6)Agreements
									(A)In
				generalThe Secretary shall enter into agreements, beginning not
				later than one year after the date of the enactment of this section, with
				Independence at Home organizations that meet the participation requirements of
				this section, including minimum performance standards developed under
				subsection (e)(3), in order to provide access by eligible beneficiaries to
				Independence at Home programs under this section.
									(B)AuthorityIf the Secretary deems it necessary to
				serve the best interest of the beneficiaries under this title or the best
				interest of Federal health care programs, the Secretary may—
										(i)require screening
				of all potential Independence at Home organizations, including owners, (such as
				through fingerprinting, licensure checks, site-visits, and other database
				checks) before entering into an agreement;
										(ii)require a
				provisional period during which a new Independence at Home organization would
				be subject to enhanced oversight (such as prepayment review, unannounced site
				visits, and payment caps); and
										(iii)require
				applicants to disclose previous affiliation with entities that have uncollected
				Medicare or Medicaid debt, and authorize the denial of enrollment if the
				Secretary determines that these affiliations pose undue risk to the
				program.
										(7)RegulationsAt least three months before entering into
				the first agreement under this section, the Secretary shall publish in the
				Federal Register the specifications for implementing this section. Such
				specifications shall describe the implementation process from initial to final
				implementation phases, including how the Secretary will identify and notify
				potential enrollees and how and when beneficiaries may enroll and disenroll
				from Independence at Home programs and change the programs in which they are
				enrolled.
								(8)Periodic
				progress reportsSemi-annually during the first year in which
				this section is implemented and annually thereafter during the period of
				implementation of this section, the Secretary shall submit to the Committees on
				Ways and Means and Energy and Commerce of the House of Representatives and the
				Committee on Finance of the Senate a report that describes the progress of
				implementation of this section and explaining any variation from the
				Independence at Home program as described in this section.
								(9)Annual best
				practices conferenceDuring
				the initial implementation phase and to the extent practicable at intervals
				thereafter, the Secretary shall provide for an annual Independence at Home
				teleconference for Independence at Home organizations to share best practices
				and review treatment interventions and protocols that were successful in
				meeting all 3 objectives specified in paragraph (1).
								(b)DefinitionsFor
				purposes of this section:
								(1)Activities of
				daily livingThe term activities of daily living
				means bathing, dressing, grooming, transferring, feeding, or toileting.
								(2)CaregiverThe
				term caregiver means, with respect to an individual with a
				qualifying functional impairment, a family member, friend, or neighbor who
				provides assistance to the individual.
								(3)Eligible
				beneficiary
									(A)In
				generalThe term eligible beneficiary means, with
				respect to an Independence at Home program, an individual who—
										(i)is
				entitled to benefits under part A and enrolled under part B, but not enrolled
				in a plan under part C;
										(ii)has a qualifying
				functional impairment and has been diagnosed with two or more of the chronic
				conditions described in subparagraph (C); and
										(iii)within the 12
				months prior to the individual first enrolling with an Independence at Home
				program under this section, has received benefits under part A for the
				following services:
											(I)Non-elective
				inpatient hospital services.
											(II)Services in the
				emergency department of a hospital.
											(III)Any one of the
				following:
												(aa)Skilled nursing
				or sub-acute rehabilitation services in a Medicare-certified nursing
				facility.
												(bb)Comprehensive
				acute rehabilitation facility or Comprehensive outpatient rehabilitation
				facility services.
												(cc)Skilled nursing
				or rehabilitation services through a Medicare-certified home health
				agency.
												(B)DisqualificationsSuch
				term does not include an individual—
										(i)who is receiving
				benefits under section 1881;
										(ii)who is enrolled
				in a PACE program under section 1894;
										(iii)who is enrolled in (and is not disenrolled
				from) a chronic care improvement program under section 1807;
										(iv)who within a 12-month period has been a
				resident for more than 90 days in a skilled nursing facility, a nursing
				facility (as defined in section 1919), or any other facility identified by the
				Secretary;
										(v)who
				resides in a setting that presents a danger to the safety of in-home health
				care providers and primary caregivers; or
										(vi)whose enrollment
				in an Independence at Home program the Secretary determines would be
				inappropriate.
										(C)Chronic
				conditions describedThe chronic conditions described in this
				subparagraph are the following:
										(i)Congestive heart
				failure.
										(ii)Diabetes.
										(iii)Chronic
				obstructive pulmonary disease.
										(iv)Ischemic heart
				disease.
										(v)Peripheral
				arterial disease.
										(vi)Stroke.
										(vii)Alzheimer’s
				Disease and other dementias designated by the Secretary.
										(viii)Pressure
				ulcers.
										(ix)Hypertension.
										(x)Neurodegenerative diseases designated by
				the Secretary which result in high costs under this title, including amyotropic
				lateral sclerosis (ALS), multiple sclerosis, and Parkinson’s disease.
										(xi)Any other chronic condition that the
				Secretary identifies as likely to result in high costs to the program under
				this title when such condition is present in combination with one or more of
				the chronic conditions specified in the preceding clauses.
										(4)Independence at
				home assessmentThe term
				Independence at Home assessment means a determination of
				eligibility of an individual for an Independence at Home program as an eligible
				beneficiary (as defined in paragraph (3)), a comprehensive medical history,
				physical examination, and assessment of the beneficiary’s clinical and
				functional status that—
									(A)is conducted in
				person by an individual—
										(i)who—
											(I)is an Independence
				at Home physician or an Independence at Home nurse practitioner; or
											(II)a physician
				assistant, nurse practitioner, or clinical nurse specialist, as defined in
				section 1861(aa)(5), who is employed by an Independence at Home organization
				and is supervised by an Independence at Home physician or Independence at Home
				nurse practitioner; and
											(ii)does not have an ownership interest in the
				Independence at Home organization unless the Secretary determines that it is
				impracticable to preclude such individual’s involvement; and
										(B)includes an
				assessment of—
										(i)activities of
				daily living and other co-morbidities;
										(ii)medications and
				medication adherence;
										(iii)affect,
				cognition, executive function, and presence of mental disorders;
										(iv)functional status,
				including mobility, balance, gait, risk of falling, and sensory
				function;
										(v)social functioning
				and social integration;
										(vi)environmental
				needs and a safety assessment;
										(vii)the ability of
				the beneficiary’s primary caregiver to assist with the beneficiary’s care as
				well as the caregiver’s own physical and emotional capacity, education, and
				training;
										(viii)whether, in the professional judgment of
				the individual conducting the assessment, the beneficiary is likely to benefit
				from an Independence at Home program;
										(ix)whether the
				conditions in the beneficiary’s home or place of residence would permit the
				safe provision of services in the home or residence, respectively, under an
				Independence at Home program;
										(x)whether the beneficiary has a designated
				primary care physician whom the beneficiary has seen in an office-based setting
				within the previous 12 months; and
										(xi)other factors
				determined appropriate by the Secretary.
										(5)Independence at
				Home care teamThe term Independence at Home care
				team—
									(A)means, with respect to a participant, a
				team of qualified individuals that provides services to the participant as part
				of an Independence at Home program; and
									(B)includes an
				Independence at Home physician or an Independence at Home nurse practitioner
				and an Independence at Home coordinator (who may also be an Independence at
				Home physician or an Independence at Home nurse practitioner).
									(6)Independence at
				Home coordinatorThe term Independence at Home
				coordinator means, with respect to a participant, an individual
				who—
									(A)is employed by an
				Independence at Home organization and is responsible for coordinating all of
				the services of the participant’s Independence at Home plan;
									(B)is a licensed health professional, such as
				a physician, registered nurse, nurse practitioner, clinical nurse specialist,
				physician assistant, or other health care professional as the Secretary
				determines appropriate, who has at least one year of experience providing and
				coordinating medical and related services for individuals in their homes;
				and
									(C)serves as the
				primary point of contact responsible for communications with the participant
				and for facilitating communications with other health care providers under the
				plan.
									(7)Independence at
				home organizationThe term
				Independence at Home organization means a provider of services, a
				physician or physician group practice, a nurse practitioner or nurse
				practitioner group practice which receives payment for services furnished under
				this title (other than only under this section) and which—
									(A)has entered into
				an agreement under subsection (a)(2) to provide an Independence at Home program
				under this section;
									(B)(i)provides all of the
				services of the Independence at Home plan in a participant’s home or place of
				residence, or
										(ii)if the organization is not able to
				provide all such services in such home or residence, has adequate mechanisms
				for ensuring the provision of such services by one or more qualified
				entities;
										(C)has Independence at Home physicians,
				clinical nurse specialists, nurse practitioners, or physician assistants
				available to respond to patient emergencies 24 hours a day, seven days a
				week;
									(D)accepts all eligible beneficiaries from the
				organization’s service area, as determined under the agreement with the
				Secretary under this section, except to the extent that qualified staff are not
				available; and
									(E)meets other
				requirements for such an organization under this section.
									(8)Independence at
				Home physicianThe term Independence at Home
				physician means a physician who—
									(A)is employed by or affiliated with an
				Independence at Home organization, as required under paragraph (7)(C), or has
				another contractual relationship with the Independence at Home organization
				that requires the physician to make in-home visits and to be responsible for
				the plans of care for the physician’s patients;
									(B)is
				certified—
										(i)by
				the American Board of Family Physicians, the American Board of Internal
				Medicine, the American Osteopathic Board of Family Physicians, the American
				Osteopathic Board of Internal Medicine, the American Board of Emergency
				Medicine, or the American Board of Physical Medicine and Rehabilitation;
				or
										(ii)by a Board
				recognized by the American Board of Medical Specialties and determined by the
				Secretary to be appropriate for the Independence at Home program;
										(C)has—
										(i)a certification in geriatric medicine as
				provided by American Board of Medical Specialties; or
										(ii)passed the clinical competency examination
				of the American Academy of Home Care Physicians and has substantial experience
				in the delivery of medical care in the home, including at least two years of
				experience in the management of Medicare patients and one year of experience in
				home-based medical care including at least 200 house calls; and
										(D)has furnished
				services during the previous 12 months for which payment is made under this
				title.
									(9)Independence at
				Home nurse practitionerThe
				term Independence at Home nurse practitioner means a nurse
				practitioner who—
									(A)is employed by or affiliated with an
				Independence at Home organization, as required under paragraph (7)(C), or has
				another contractual relationship with the Independence at Home organization
				that requires the nurse practitioner to make in-home visits and to be
				responsible for the plans of care for the nurse practitioner’s patients;
									(B)practices in
				accordance with State law regarding scope of practice for nurse
				practitioners;
									(C)is
				certified—
										(i)as a Gerontologic Nurse Practitioner by the
				American Academy of Nurse Practitioners Certification Program or the American
				Nurses Credentialing Center; or
										(ii)as a family nurse
				practitioner or adult nurse practitioner by the American Academy of Nurse
				Practitioners Certification Board or the American Nurses Credentialing Center
				and holds a certificate of Added Qualification in gerontology, elder care or
				care of the older adult provided by the American Academy of Nurse
				Practitioners, the American Nurses Credentialing Center or a national nurse
				practitioner certification board deemed by the Secretary to be appropriate for
				an Independence at Home program; and
										(D)has furnished services during the previous
				12 months for which payment is made under this title.
									(10)Independence at
				Home planThe term Independence at Home plan means a
				plan established under subsection (d)(2) for a specific participant in an
				Independence at Home program.
								(11)Independence at
				Home programThe term Independence at Home program
				means a program described in subsection (d) that is operated by an Independence
				at Home organization.
								(12)ParticipantThe
				term participant means an eligible beneficiary who has voluntarily
				enrolled in an Independence at Home program.
								(13)Qualified
				entityThe term qualified entity means a person or
				organization that is licensed or otherwise legally permitted to provide the
				specific service (or services) provided under an Independence at Home plan that
				the entity has agreed to provide.
								(14)Qualifying
				functional impairmentThe term qualifying functional
				impairment means an inability to perform, without the assistance of
				another person, two or more activities of daily living.
								(15)Qualified
				individualThe term
				qualified individual means a individual that is licensed or
				otherwise legally permitted to provide the specific service (or services) under
				an Independence at Home plan that the individual has agreed to provide.
								(c)Identification
				and enrollment of prospective program participants
								(1)Notice to
				eligible independence at home beneficiariesThe Secretary shall
				develop a model notice to be made available to Medicare beneficiaries (and to
				their caregivers) who are potentially eligible for an Independence at Home
				program by participating providers and by Independence at Home programs. Such
				notice shall include the following information:
									(A)A description of
				the potential advantages to the beneficiary participating in an Independence at
				Home program.
									(B)A description of
				the eligibility requirements to participate.
									(C)Notice that
				participation is voluntary.
									(D)A statement that
				all other Medicare benefits remain available to beneficiaries who enroll in an
				Independence at Home program.
									(E)Notice that those who enroll in an
				Independence at Home program will be responsible for copayments for house calls
				made by Independence at Home physicians, physician assistants, or by
				Independence at Home nurse practitioners, except that such copayments may be
				reduced or eliminated at the discretion of the Independence at Home physician,
				physician assistant, or Independence at Home nurse practitioner involved in
				accordance with subsection (f).
									(F)A description of
				the services that could be provided.
									(G)A description of
				the method for participating, or withdrawing from participation, in an
				Independence at Home program or becoming no longer eligible to so
				participate.
									(2)Voluntary
				participation and choiceAn eligible beneficiary may participate
				in an Independence at Home program through enrollment in such program on a
				voluntary basis and may terminate such participation at any time. Such a
				beneficiary may also receive Independence at Home services from the
				Independence at Home organization of the beneficiary’s choice but may not
				receive Independence at Home services from more than one Independence at Home
				organization at a time.
								(d)Independence at
				Home program requirements
								(1)In
				generalEach Independence at Home program shall, for each
				participant enrolled in the program—
									(A)designate—
										(i)an Independence at Home physician or an
				Independence at Home nurse practitioner; and
										(ii)an Independence
				at Home coordinator;
										(B)have a process to
				ensure that the participant received an Independence at Home assessment before
				enrollment in the program;
									(C)with the
				participation of the participant (or the participant’s representative or
				caregiver), an Independence at Home physician, a physician assistant under the
				supervision of an Independence at Home physician and as permitted under State
				law, or an Independence at Home nurse practitioner, and the Independence at
				Home coordinator, develop an Independence at Home plan for the participant in
				accordance with paragraph (2);
									(D)ensure that the
				participant receives an Independence at Home assessment at least every 6 months
				after the original assessment to ensure that the Independence at Home plan for
				the participant remains current and appropriate;
									(E)implement all of
				the services under the participant’s Independence at Home plan and in instances
				in which the Independence at Home organization does not provide specific
				services within the Independence at Home plan, ensure that qualified entities
				successfully provide those specific services; and
									(F)provide for an electronic medical record
				and electronic health information technology to coordinate the participant’s
				care and to exchange information with the Medicare program and electronic
				monitoring and communication technologies and mobile diagnostic and therapeutic
				technologies as appropriate and accepted by the participant.
									(2)Independence at
				home plan
									(A)In
				generalAn Independence at
				Home plan for a participant shall be developed with the participant, an
				Independence at Home physician, a physician assistant under the supervision of
				an Independence at Home physician and as permitted under State law, an
				Independence at Home nurse practitioner, or an Independence at Home
				coordinator, and, if appropriate, one or more of the participant’s caregivers
				and shall—
										(i)document the
				chronic conditions, co-morbidities, and other health needs identified in the
				participant’s Independence at Home assessment;
										(ii)determine which services under an
				Independence at Home plan described in subparagraph (C) are appropriate for the
				participant; and
										(iii)identify the
				qualified entity responsible for providing each service under such plan.
										(B)Communication of
				individualized independence at home plan to the independence at home
				coordinatorIf the individual responsible for conducting the
				participant’s Independence at Home assessment and developing the Independence
				at Home plan is not the participant’s Independence at Home coordinator, the
				Independence at Home physician or Independence at Home nurse practitioner is
				responsible for ensuring that the participant’s Independence at Home
				coordinator has such plan and is familiar with the requirements of the plan and
				has the appropriate contact information for all of the members of the
				Independence at Home care team.
									(C)Services
				provided under an independence at home planAn Independence at Home organization shall
				coordinate and make available through referral to a qualified entity the
				services described in the following clauses (i) through (iii) to the extent
				they are needed and covered by under this title and shall provide the care
				coordination services described in the following clause (iv) to the extent they
				are appropriate and accepted by a participant:
										(i)Primary care services, such as physician
				visits, diagnosis, treatment, and preventive services.
										(ii)Home health
				services, such as skilled nursing care and physical and occupational
				therapy.
										(iii)Phlebotomy and ancillary laboratory and
				imaging services, including point of care laboratory and imaging
				diagnostics.
										(iv)Care coordination services, consisting
				of—
											(I)Monitoring and
				management of medications by a pharmacist who is certified in geriatric
				pharmacy by the Commission for Certification in Geriatric Pharmacy or possesses
				other comparable certification demonstrating knowledge and expertise in
				geriatric pharmacotherapy, as well as assistance to participants and their
				caregivers with respect to selection of a prescription drug plan under part D
				that best meets the needs of the participant’s chronic conditions.
											(II)Coordination of
				all medical treatment furnished to the participant, regardless of whether such
				treatment is covered and available to the participant under this title.
											(III)Self-care education and preventive care
				consistent with the participant’s condition.
											(IV)Education for
				primary caregivers and family members.
											(V)Caregiver
				counseling services and information about, and referral to, other caregiver
				support and health care services in the community.
											(VI)Referral to
				social services, such as personal care, meals, volunteers, and individual and
				family therapy.
											(VII)Information
				about, and access to, hospice care.
											(VIII)Pain and palliative care and end-of-life
				care, including information about developing advanced directives and physicians
				orders for life sustaining treatment.
											(3)Primary
				treatment role within an Independence at Home care teamAn
				Independence at Home physician, a physician assistant under the supervision of
				an Independence at Home physician and as permitted under State law, or an
				Independence at Home nurse practitioner may assume the primary treatment role
				as permitted under State law.
								(4)Additional
				responsibilities
									(A)Outcomes
				reportEach Independence at
				Home organization offering an Independence at Home program shall monitor and
				report to the Secretary, in a manner specified by the Secretary, on—
										(i)patient
				outcomes;
										(ii)beneficiary,
				caregiver, and provider satisfaction with respect to coordination of the
				participant’s care; and
										(iii)the achievement
				of mandatory minimum savings described in subsection (e)(6).
										(B)Additional
				requirementsEach such
				organization and program shall provide the Secretary with listings of
				individuals employed by the organization, including contract employees, and
				individuals with an ownership interest in the organization and comply with such
				additional requirements as the Secretary may specify.
									(e)Terms and
				conditions
								(1)In
				generalAn agreement under this section with an Independence at
				Home organization shall contain such terms and conditions as the Secretary may
				specify consistent with this section.
								(2)Clinical, quality
				improvement, and financial requirementsThe Secretary may not
				enter into an agreement with such an organization under this section for the
				operation of an Independence at Home program unless—
									(A)the program and organization meet the
				requirements of subsection (d), minimum quality and performance standards
				developed under paragraph (3), and such clinical, quality improvement,
				financial, program integrity, and other requirements as the Secretary deems to
				be appropriate for participants to be served; and
									(B)the organization
				demonstrates to the satisfaction of the Secretary that the organization is able
				to assume financial risk for performance under the agreement with respect to
				payments made to the organization under such agreement through available
				reserves, reinsurance, or withholding of funding provided under this title, or
				such other means as the Secretary determines appropriate.
									(3)Minimum quality
				and performance standards
									(A)In
				generalThe Secretary shall develop mandatory minimum quality and
				performance standards for Independence at Home organizations and
				programs.
									(B)Standards to be
				includedSuch standards shall include measures of—
										(i)improvement in
				participant outcomes;
										(ii)improvement in
				satisfaction of the beneficiary, caregiver, and provider involved; and
										(iii)cost savings
				consistent with paragraph (6).
										(C)Minimum
				participation standardSuch
				standards shall include a requirement that, for any year after the first year
				and except as the Secretary may provide for a program serving a rural area, an
				Independence at Home program had an average number of participants during the
				previous year of at least 100 participants.
									(4)Term of
				agreement and modificationThe agreement under this subsection shall
				be, subject to paragraphs (3)(C) and (5), for a period of three years, and the
				terms and conditions may be modified during the contract period by the
				Secretary as necessary to serve the best interest of the beneficiaries under
				this title or the best interest of Federal health care programs or upon the
				request of the Independence at Home organization.
								(5)Termination and
				non-renewal of agreement
									(A)In
				generalIf the Secretary
				determines that an Independence at Home organization has failed to meet the
				minimum performance standards under paragraph (3) or other requirements under
				this section, or if the Secretary deems it necessary to serve the best interest
				of the beneficiaries under this title or the best interest of Federal health
				care programs, the Secretary may terminate the agreement of the organization at
				the end of the contract year.
									(B)Required
				termination where risk to health or safety of a participantThe
				Secretary shall terminate an agreement with an Independence at Home
				organization at any time the Secretary determines that the care being provided
				by such organization poses a threat to the health and safety of a
				participant.
									(C)Termination by
				Independence at Home organizationsNotwithstanding any other provision of this
				subsection, an Independence at Home organization may terminate an agreement
				with the Secretary under this section to provide an Independence at Home
				program at the end of a contract year if the organization provides to the
				Secretary and to the beneficiaries participating in the program notification of
				such termination more than 90 days before the end of such year. Paragraphs (6),
				(8), and (9)(B) shall apply to the organization until the date of
				termination.
									(D)Notice of
				involuntary terminationThe
				Secretary shall notify the participants in an Independence at Home program as
				soon as practicable if a determination is made to terminate an agreement with
				the Independence at Home organization involuntarily as provided in
				subparagraphs (A) and (B). Such notice shall inform the beneficiary of any
				other Independence at Home organizations that might be available to the
				beneficiary.
									(6)Mandatory
				minimum savings
									(A)Required
										(i)In
				generalUnder an agreement under this subsection, each
				Independence at Home organization shall ensure that during any year of the
				agreement for its Independence at Home program, there is an aggregate savings
				in the cost to the program under this title for participating beneficiaries, as
				calculated under subparagraph (B), that is not less than 5 percent of the
				product described in clause (ii) for such participating beneficiaries and
				year.
										(ii)Product
				describedThe product
				described in this clause for participating beneficiaries in an Independence at
				Home program for a year is the product of—
											(I)the estimated
				average monthly costs that would have been incurred under parts A and B (and,
				to the extent cost information is available, part D) if those beneficiaries had
				not participated in the Independence at Home program; and
											(II)the number of
				participant-months for that year.
											(B)Computation of
				aggregate savings
										(i)Model for
				calculating savingsThe
				Secretary shall contract with a nongovernmental organization or academic
				institution to independently develop an analytical model for determining
				whether an Independence at Home program achieves at least savings required
				under subparagraph (A) relative to costs that would have been incurred by
				Medicare in the absence of Independence at Home programs. The analytical model
				developed by the independent research organization for making these
				determinations shall utilize state-of-the-art econometric techniques, such as
				Heckman’s selection correction methodologies, to account for sample selection
				bias, omitted variable bias, or problems with endogeneity.
										(ii)Application of
				the modelUsing the model developed under clause (i), the
				Secretary shall compare the actual costs to Medicare of beneficiaries
				participating in an Independence at Home program to the predicted costs to
				Medicare of such beneficiaries to determine whether an Independence at Home
				program achieves the savings required under subparagraph (A).
										(iii)Revisions of
				the modelThe Secretary shall require that the model developed
				under clause (i) for determining savings shall be designed according to
				instructions that will control, or adjust for, inflation as well as risk
				factors including, age, race, gender, disability status, socioeconomic status,
				region of country (such as State, county, metropolitan statistical area, or zip
				code), and such other factors as the Secretary determines to be appropriate,
				including adjustment for prior health care utilization. The Secretary may add
				to, modify, or substitute for such adjustment factors if such changes will
				improve the sensitivity or specificity of the calculation of costs
				savings.
										(iv)Participant-monthIn
				making the calculation described in subparagraph (A), each month or part of a
				month in a program year that a beneficiary participates in an Independence at
				Home program shall be counted as a participant-month.
										(C)Notice of savings
				calculationNo later than 30
				days before the beginning of the first year of the pilot project under this
				section and 120 days before the beginning of any Independence at Home program
				year after the first such year, the Secretary shall publish in the Federal
				Register a description of the model developed under subparagraph (B)(i) and
				information for calculating savings required under subparagraph (A), including
				any revisions, sufficient to permit Independence at Home organizations to
				determine the savings they will be required to achieve during the program year
				to meet the savings requirement under subparagraph (A). In order to facilitate
				this notice, the Secretary may designate a single annual date for the beginning
				of all Independence at Home program years that shall not be later than one year
				from the date of enactment of this section.
									(7)Manner of
				paymentSubject to paragraph (8), payments shall be made by the
				Secretary to an Independence at Home organization at a rate negotiated between
				the Secretary and the organization under the agreement for—
									(A)Independence at Home assessments;
				and
									(B)on a per-participant, per-month basis for
				the items and services required to be provided or made available under
				subsection (d)(2)(C)(iv).
									(8)Ensuring
				mandatory minimum savingsThe Secretary shall require any
				Independence at Home organization that fails in any year to achieve the
				mandatory minimum savings described in paragraph (6) to provide those savings
				by refunding payments made to the organization under paragraph (7) during such
				year.
								(9)Budget neutral
				payment condition
									(A)In
				generalUnder this section, the Secretary shall ensure that the
				cumulative, aggregate sum of Medicare program benefit expenditures under parts
				A, B, and D for participants in Independence at Home programs and funds paid to
				Independence at Home organizations under this section, shall not exceed the
				Medicare program benefit expenditures under such parts that the Secretary
				estimates would have been made for such participants in the absence of such
				programs.
									(B)Treatment of
				savings
										(i)Initial
				implementation phaseIf an Independence at Home organization
				achieves aggregate savings in a year in the initial implementation phase in
				excess of the mandatory minimum savings described in paragraph (6)(A)(ii), 80
				percent of such aggregate savings shall be paid to the organization and the
				remainder shall be retained by the programs under this title during the initial
				implementation phase.
										(ii)Expanded
				implementation phaseIf an
				Independence at Home organization achieves aggregate savings in a year in the
				expanded implementation phase in excess of 5 percent of the product described
				in paragraph (6)(A)(ii)—
											(I)insofar as such savings do not exceed 25
				percent of such product, 80 percent of such aggregate savings shall be paid to
				the organization and the remainder shall be retained by the programs under this
				title; and.
											(II)insofar as such savings exceed 25 percent
				of such product, in the Secretary’s discretion, 50 percent of such excess
				aggregate savings shall be paid to the organization and the remainder shall be
				retained by the programs under this title.
											(f)Waiver of
				coinsurance for house callsA
				physician, physician assistant, or nurse practitioner furnishing services
				related to the Independence at Home program in the home or residence of a
				participant in an Independence at Home program may waive collection of any
				coinsurance that might otherwise be payable under section 1833(a) with respect
				to such services but only if the conditions described in section 1128A(i)(6)(A)
				are met.
							(g)ReportNot later than three months after the date
				of receipt of the independent evaluation provided under subsection (a)(5) and
				each year thereafter during which this section is being implemented, the
				Secretary shall submit to the Committees of jurisdiction in Congress a report
				that shall include—
								(1)whether the Independence at Home programs
				under this section are meeting the minimum quality and performance standards in
				(e)(3);
								(2)a comparative evaluation of Independence at
				Home organizations in order to identify which programs, and characteristics of
				those programs, were the most effective in producing the best participant
				outcomes, patient and caregiver satisfaction, and cost savings; and
								(3)an evaluation of
				whether the participant eligibility criteria identified beneficiaries who were
				in the top ten percent of the highest cost Medicare
				beneficiaries.
								.
				(b)Conforming
			 amendmentSection 1833(a) of
			 such Act (42 U.S.C. 1395l(a)) is amended, in the matter before paragraph (1),
			 by inserting and section 1807A(f) after section
			 1876.


114 HR 4767 IH: State Secrets Protection Act
U.S. House of Representatives
2016-03-16
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		I
		114th CONGRESS
		2d Session
		H. R. 4767
		IN THE HOUSE OF REPRESENTATIVES

			March 16, 2016
			Mr. Nadler (for himself, Mr. McClintock, and Mr. Conyers) introduced the following bill; which was referred to the Committee on the Judiciary

		A BILL
		To provide safe, fair, and responsible procedures and standards for resolving claims of state
			 secret privilege.

 1.Short titleThis Act may be cited as the State Secrets Protection Act. 2.State secret privilegeIn any civil action brought in Federal or State court, the Government has a privilege to refuse to give information and to prevent any person from giving information only if the Government shows that public disclosure of the information that the Government seeks to protect would be reasonably likely to cause significant harm to the national defense or the diplomatic relations of the United States.
		3.Protection of secrets
 (a)In generalThe court shall take steps to protect sensitive information that comes before the court in connection with proceedings under this Act. These steps may include reviewing evidence or pleadings and hearing arguments ex parte, issuing protective orders, placing material under seal, and applying security procedures established under the Classified Information Procedures Act for classified information to protect the sensitive information.
 (b)In camera proceedingsAll hearings and other proceedings under this Act may be conducted in camera, as needed to protect information that may be subject to the privilege.
 (c)Participation of counselParticipation of counsel in proceedings under this Act may be limited if the court determines that the limitation is a necessary step to protect information the Government asserts is protected by the privilege or that supports the claim of privilege.
 (d)Guardian ad litemWhere counsel is excluded from a proceeding, the court shall have discretion to appoint a guardian ad litem to represent the absent litigant’s interests, drawing, in consultation with the excluded nongovernmental party, from a previously generated list of attorneys who have been granted required security clearances in the past and have agreed to serve in this capacity. The guardian ad litem shall not discuss the information claimed as privileged or its content with any nongovernmental party or nongovernmental party’s counsel.
 (e)Production of adequate substitute pending resolution of the claim of privilegeIf, at any point during its consideration of the Government’s claim, the court determines that disclosure of information to a party or counsel, or disclosure of information by a party that already possesses it, presents a risk of a harm described in subsection (a) that cannot be addressed through less restrictive means provided in this subsection, the court may require the Government to produce an adequate substitute, such as a redacted version, summary of the information, or stipulation regarding the relevant facts, if the court deems such a substitute feasible. The substitute must be reviewed and approved by the court and must provide counsel with a substantially equivalent opportunity to assess and challenge the Government’s claim of privilege as would the protected information.
			4.Assertion of the privilege
 (a)In generalThe Government may assert the privilege in connection with any claim in a civil action to which it is a party or may intervene in a civil action to which it is not a party to do so.
 (b)Supporting affidavitsIf the Government asserts the privilege, the Government shall provide the court with an affidavit signed by the head of the executive branch agency with responsibility for, and control over, the information asserted to be subject to the privilege. In the affidavit, the head of the agency shall explain the factual basis for the claim of privilege. The Government shall make public an unclassified version of the affidavit.
			5.Preliminary proceedings
 (a)Preliminary review by courtOnce the Government has asserted the privilege, and before the court makes any determinations under section 6, the court shall undertake a preliminary review of the information the Government asserts is protected by the privilege and provide the Government an opportunity to seek protective measures under this Act. After any initial protective measures are in place, the court shall proceed to the consideration of additional preliminary matters under this section.
 (b)Consideration of whether To appoint special master or expert witnessThe court shall consider whether the appointment of a special master with appropriate expertise or an expert witness, or both, would facilitate the court’s duties under this Act.
 (c)Index of materialsThe court may order the Government to provide a manageable index of the information that the Government asserts is subject to the privilege. The index must correlate statements made in the affidavit required under this Act with portions of the information the Government asserts is subject to the privilege. The index shall be specific enough to afford the court an adequate foundation to review the basis of the assertion of the privilege by the Government.
 (d)Prehearing conferencesAfter the preliminary review, the court shall hold one or more conferences with the parties to— (1)determine any steps needed to protect sensitive information;
 (2)define the issues presented by the Government’s claim of privilege, including whether it is possible to allow the parties to complete nonprivileged discovery before determining whether the claim of privilege is valid;
 (3)order disclosure to the court of anything needed to assess the claim, including all information the Government asserts is protected by the privilege and other material related to the Government’s claim;
 (4)resolve any disputes regarding participation of counsel or parties in proceedings relating to the claim, including access to the Government’s evidence and arguments;
 (5)set a schedule for completion of discovery related to the Government’s claim; and (6)take other steps as needed, such as ordering counsel or parties to obtain security clearances.
				6.Procedures and standard for assessing the privilege claim
 (a)HearingThe court shall conduct a hearing to determine whether the privilege claim is valid. (b)Basis for ruling (1)GenerallyThe court may not determine that the privilege is valid until the court has reviewed—
 (A)except as provided in paragraph (2), all of the information that the Government asserts is privileged;
 (B)the affidavits, evidence, memoranda and other filings submitted by the parties related to the privilege claim; and
 (C)any other evidence that the court determines it needs to rule on the privilege. (2)Sampling in certain casesWhere the volume of information the Government asserts is privileged precludes a timely review, or the court otherwise determines a review of all of that information is not feasible, the court may substitute a sufficient sampling of the information if the court determines that there is no reasonable possibility that review of the additional information would change the court’s determination on the privilege claim and the information reviewed is sufficient to enable the court to make the independent assessment required by this section.
 (c)StandardIn ruling on the validity of the privilege, the court shall make an independent assessment of whether the harm identified by the Government, as required by section 2, is reasonably likely to occur should the privilege not be upheld. The court shall weigh testimony from Government experts in the same manner as it does, and along with, any other expert testimony.
 (d)Burden of proofThe Government shall have the burden of proof as to the nature of the harm and as to the likelihood of its occurrence.
			7.Effect of court determination
 (a)In generalIf the court determines that the privilege is not validly asserted, the court shall issue appropriate orders regarding the disclosure of the information to a nongovernmental party and its admission at trial, subject to the other rules of evidence, with the right to interlocutory appeal as provided in section 8 for any such orders. If the court determines that the privilege is validly asserted, that information shall not be disclosed to a nongovernmental party or the public.
			(b)Nonprivileged substitute
 (1)Court consideration of substituteIf the court finds that the privilege is validly asserted and it is possible to craft a nonprivileged substitute, such as those described in section 3(e), for the privileged information that would provide the parties a substantially equivalent opportunity to litigate the case, the court shall order the Government to produce the substitute to the satisfaction of the court.
 (2)Refusal to provideIn a civil action brought against the Government, if the court orders the Government to provide a nonprivileged substitute for information and the Government fails to comply, in addition to any other appropriate sanctions, the court shall find against the Government on the factual or legal issue to which the privileged information is relevant. If the action is not brought against the Government, the court shall weigh the equities and make appropriate orders as provided in subsection (d).
 (c)Opportunity To complete discoveryThe court shall not resolve any issue or claim and shall not grant a motion to dismiss or motion for summary judgment based on the state secrets privilege and adversely to any party against whom the Government’s privilege claim has been upheld until that party has had a full opportunity to complete nonprivileged discovery and to litigate the issue or claim to which the privileged information is relevant without regard to that privileged information.
 (d)Appropriate orders in the interest of justiceAfter reviewing all available evidence, and only after determining that privileged information, for which it is impossible to create a nonprivileged substitute, is necessary to decide a factual or legal issue or claim, the court shall weigh the equities and make appropriate orders in the interest of justice, such as striking the testimony of a witness, finding in favor of or against a party on a factual or legal issue to which the information is relevant, or dismissing a claim or counterclaim. This paragraph does not permit an award of money damages against a party based in whole or in part on privileged information that was not disclosed to that party.
			8.Interlocutory appeal
 (a)In generalThe courts of appeal shall have jurisdiction of an appeal from a decision or order of a district court determining that the state secrets privilege is not validly asserted, sanctioning a refusal to provide an adequate or nonprivileged substitute required under this Act, or refusing protective steps sought by the Government under this Act pending the resolution of the claim of state secrets privilege.
			(b)Appeal
 (1)In generalAn appeal taken under this section either before or during trial shall be expedited by the court of appeals.
 (2)During trialIf an appeal is taken during trial, the district court shall adjourn the trial until the appeal is resolved and the court of appeals—
 (A)shall hear argument on appeal as expeditiously as possible after adjournment of the trial by the district court;
 (B)may dispense with written briefs other than the supporting materials previously submitted to the trial court;
 (C)shall render its decision as expeditiously as possible after argument on appeal; and (D)may dispense with the issuance of a written opinion in rendering its decision.
					9.Reporting
 (a)In generalConsistent with applicable authorities and duties, including those conferred by the Constitution of the United States upon the executive and legislative branches, the Attorney General shall report in writing to the Permanent Select Committee on Intelligence of the House of Representatives, the Select Committee on Intelligence of the Senate, and the chairmen and ranking minority members of the Committees on the Judiciary of the House of Representatives and the Senate on any case in which the Government invokes a state secrets privilege, not later than 30 calendar days after the date of such assertion. Each report submitted under this subsection shall include all affidavits filed under this Act by the Government.
			(b)Operation and effectiveness
 (1)In generalThe Attorney General shall deliver to the committees of Congress described in subsection (a) a report concerning the operation and effectiveness of this Act and including suggested amendments to the Act.
 (2)DeadlineThe Attorney General shall submit this report not later than 1 year after the date of enactment of this Act, and every year thereafter until the date that is 3 years after that date of enactment. After the date that is 3 years after that date of enactment, the Attorney General shall submit a report under paragraph (1) as necessary.
 10.Rule of constructionThis Act provides the only privilege that may be asserted in civil cases based on state secrets and the standards and procedures set forth in this Act apply to any assertion of the privilege.
 11.ApplicationThis Act applies to claims pending on or after the date of enactment of this Act. A court also may relieve a party or its legal representative from a final judgment, order, or proceeding that was based, in whole or in part, on the state secrets privilege if—
 (1)the motion for relief is filed with the rendering court within one year of the date of enactment of this Act;
 (2)the underlying judgment, order, or proceeding from which the party seeks relief was entered after January 1, 2002; and
 (3)the claim on which the judgment, order, or proceeding is based is— (A)against the Government; or
 (B)arises out of conduct by persons acting in the capacity of a Government officer, employee, or agent.


110 HR 3208 IH: To amend the U.S. Troop Readiness, Veterans’ Care,

U.S. House of Representatives
2007-07-27
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		I
		110th CONGRESS
		1st Session
		H. R. 3208
		IN THE HOUSE OF REPRESENTATIVES

			July 27, 2007
			Mr. Cannon (for
			 himself, Mr. Matheson, and
			 Mr. Bishop of Utah) introduced the
			 following bill; which was referred to the Committee on Agriculture

		A BILL
		To amend the U.S. Troop Readiness, Veterans’ Care,
		  Katrina Recovery, and Iraq Accountability Appropriations Act, 2007, to extend
		  the date for which livestock assistance is available for losses due to a
		  disaster.

		1.Short titleThis Act may be cited as the
			 Fire Disaster Assistance Act of 2007.
		2.Extending assistance
			 datesSection 9002 of the U.S.
			 Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability
			 Appropriations Act, 2007 (Public Law 110–28; 121 Stat. 214) is amended by
			 striking February 28, 2007 each place it occurs and inserting
			 August 31, 2007.


109 HR 3291 IH: To suspend temporarily the duty on pro-jet fast black 286 stage.
U.S. House of Representatives
2005-07-14
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
109th CONGRESS
1st Session
H. R. 3291
IN THE HOUSE OF REPRESENTATIVES

July 14, 2005
Mr. Castle introduced the following bill; which was referred to the Committee on Ways and Means

A BILL
To suspend temporarily the duty on pro-jet fast black 286 stage.

1.Pro-Jet Fast Black 286 Stage
(a)In generalSubchapter II of chapter 99 of the Harmonized Tariff Schedule of the United States is amended by inserting in numerical sequence the following new heading:

9902.13.11 Pro-jet fast black 286 stage [(substituted naphthalenylazo) substituted naphthalenyl azo] carboxyphenylene, sodium salt (PMN No. P–90–394) (provided for in subheading 3204.14.30)FreeNo changeNo changeOn or before 12/31/2008.
(b)Effective dateThe amendment made by subsection (a) applies to goods entered, or withdrawn from warehouse for consumption, on or after the 15th day after the date of the enactment of this Act.


117 HR 5415 IH: Debt Ceiling Reform Act
U.S. House of Representatives
2021-09-29
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I117th CONGRESS1st SessionH. R. 5415IN THE HOUSE OF REPRESENTATIVESSeptember 29, 2021Mr. Brendan F. Boyle of Pennsylvania (for himself, Mr. Yarmuth, Mr. Lieu, Mrs. Watson Coleman, Mr. Espaillat, Ms. Lofgren, Ms. Wild, Mr. Cohen, and Mr. Evans) introduced the following bill; which was referred to the Committee on Ways and MeansA BILLTo provide the Secretary of the Treasury authority to increase the public debt limit.1.Short titleThis Act may be cited as the Debt Ceiling Reform Act. 2. Secretary of Treasury authorized to increase public debt limitThe dollar amount contained in section 3101(b) of title 31, United States Code, shall be treated as being equal to such greater dollar amount as the Secretary of the Treasury may periodically determine. The preceding sentence shall not apply to the extent provided in any subsequently enacted provision of law.


		I
		111th CONGRESS
		2d Session
		H. R. 5485
		IN THE HOUSE OF REPRESENTATIVES

			June 8, 2010
			Mr. Tonko introduced
			 the following bill; which was referred to the
			 Committee on Homeland
			 Security, and in addition to the Committee on
			 Transportation and
			 Infrastructure, for a period to be subsequently determined by
			 the Speaker, in each case for consideration of such provisions as fall within
			 the jurisdiction of the committee concerned

		A BILL
		To expand the National Domestic Preparedness Consortium
		  to include the SUNY National Center for Security and
		  Preparedness.

		1.Short titleThis Act may be cited as the
			 National Domestic Preparedness
			 Consortium Enhancement Act of 2010.
		2.FindingsCongress finds that—
			(1)the State
			 University of New York (SUNY) is the Nation’s largest comprehensive system of
			 public higher education, comprising 64 campuses across the State of New
			 York;
			(2)the SUNY National
			 Center for Security and Preparedness oversees a coordinated strategy to
			 leverage the resources of all 64 SUNY campuses to develop homeland security
			 training programs and to apply SUNY’s homeland security research
			 expertise;
			(3)the SUNY National Center for Security and
			 Preparedness and the SUNY campuses provide extraordinary capabilities to help
			 the Nation in the areas of intelligence, preparedness, protection analysis,
			 information sharing, and critical decisionmaking;
			(4)the SUNY National Center for Security and
			 Preparedness is poised to create a program in the areas of intelligence,
			 preparedness, protection analysis, information sharing, and critical
			 decisionmaking;
			(5)the management
			 team of the SUNY National Center for Security and Preparedness has many years
			 of experience with working with the National Domestic Preparedness
			 Consortium;
			(6)the SUNY National
			 Center for Security and Preparedness has established partnerships that will
			 allow the SUNY National Center for Security and Preparedness immediately to
			 identify and certify instructors, pilot and certify courses, and set up an
			 infrastructure that is compatible with the reporting requirements of the
			 Department of Homeland Security; and
			(7)none of the member institutions of the
			 National Domestic Preparedness Consortium of the Department of Homeland
			 Security are currently focusing on providing training in the areas of
			 intelligence, protection analysis, information sharing, and critical
			 decisionmaking.
			3.Enhancement of
			 National Domestic Preparedness ConsortiumThe National Domestic Preparedness
			 Consortium of the Department of Homeland Security shall include the SUNY
			 National Center for Security and Preparedness in order to train State, local,
			 and tribal emergency response providers to prepare for and respond to acts of
			 terrorism, including weapons of mass destruction.


		II

		109th CONGRESS

		2d Session

		S. 2232

		IN THE SENATE OF THE UNITED STATES

			February 1, 2006

			Mr. Vitter introduced

			 the following bill; which was read twice and referred to the

			 Committee on Environment and Public

			 Works

		A BILL

		To require the Secretary of the Army to submit to

		  Congress a report identifying activities for hurricane and flood protection in

		  Lake Pontchartrain, Louisiana, and for other purposes.

		1.Short titleThis Act may be cited as the

			 Louisiana Emergency Needs Corps of

			 Engineers Authorization Act of 2006.

		2.Hurricane and flood

			 protection, Lake Pontchartrain, Louisiana

			(a)ReportNot later than 20 days after the date of

			 enactment of this Act, the Secretary of the Army, acting through the Chief of

			 Engineers (referred to in this Act as the Secretary), shall submit

			 to the Committee on Environment and Public Works of the Senate and the

			 Committee on Transportation and Infrastructure of the House of Representatives

			 a report that—

				(1)with respect to

			 the project for hurricane-flood protection on Lake Pontchartrain, Louisiana,

			 under section 204 of the Flood Control Act of 1965 (79 Stat. 1077), identifies

			 activities to reconstruct hurricane and flood protection measures relating to

			 the outfall canals adjacent to Lake Pontchartrain in the Jefferson and Orleans

			 parishes of the State of Louisiana that are substantially in accordance with

			 levels of hurricane and flood protection authorized under Federal law

			 to—

					(A)reconstruct and

			 fortify floodwalls adjacent to the canals;

					(B)construct at the

			 heads of the canals pumping stations with adequate pumping capacity, as

			 determined by the Secretary;

					(C)install gate-like

			 structures at the heads of the canals; and

					(D)prevent—

						(i)seepage from the

			 canals into adjacent property; and

						(ii)the undermining

			 of floodwalls improved or reconstructed under subparagraph (A);

						(2)identifies

			 activities to protect, restore, and reduce the risk of storm damage in coastal

			 areas of the State of Louisiana in which a major disaster relating to Hurricane

			 Katrina or Hurricane Rita was declared by the President to exist on or after

			 August 29, 2005, in accordance with section 401 of the Robert T. Stafford

			 Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170), in accordance

			 with the report transmitted by the President to the House of Representatives

			 and dated October 28, 2005;

				(3)identifies

			 activities to fortify, strengthen, and improve hurricane protection and flood

			 control infrastructure (including pumping stations) in existence on or before

			 August 28, 2005, to ensure sustainability and prevent the failure of the

			 infrastructure under hurricane conditions, in accordance with predicted area

			 conditions for standard project hurricanes and located in an area designed to

			 be protected by a hurricane or flood control project authorized under Federal

			 law; and

				(4)identifies any

			 activity included in the report of the Chief of Engineers dated August 23, 2002

			 (including supplemental reports), that the Secretary determines to be integral

			 to the protection of life and property in the disaster area described in

			 paragraph (2).

				(b)Implementation

				(1)In

			 generalAbsent a resolution of Congress disapproving an activity

			 identified in the report under subsection (a), the Secretary may implement the

			 activity beginning on the date that is 30 days after the date on which the

			 report is submitted.

				(2)Federal

			 shareThe Federal share of the cost of an activity carried out

			 under paragraph (1) shall be 100 percent.

				(c)Authorization

			 of appropriationsThere are authorized to be appropriated to the

			 Secretary for each of fiscal years 2006 through 2010—

				(1)$1,400,000,000 to

			 carry out activities identified under paragraphs (1) through (3) of subsection

			 (a); and

				(2)$788,000,000 to

			 carry out activities identified under subsection (a)(4).

				3.Compensation

			(a)In

			 generalNotwithstanding any other provision of law, in acquiring

			 property or an interest in property to improve, reconstruct, or develop

			 hurricane and flood protection measures relating to Hurricane Katrina or Rita,

			 the Secretary shall compensate the owner of the property or interest without

			 taking into consideration any damage to the property or interest caused by

			 Hurricane Katrina or Rita.

			(b)Adjustment for

			 payments madeNotwithstanding subsection (a), the Secretary may

			 reduce the amount of compensation paid under that subsection for property or an

			 interest in property by the amount of any other payment received by the owner

			 of the property or interest for damages to that property or interest as a

			 result of Hurricane Katrina or Rita, including a payment received from—

				(1)an insurance

			 claim; or

				(2)the Federal

			 Emergency Management Agency.

				4.Effect of

			 ActNothing in this Act

			 affects any authority of the Secretary under any other Federal law.


		III
		112th CONGRESS
		1st Session
		S. RES. 298
		IN THE SENATE OF THE UNITED STATES

			October 18, 2011
			Mr. Casey (for himself,
			 Mr. Roberts, Mr. Sanders, Mr.
			 Levin, Mr. Akaka, and
			 Mr. Brown of Ohio) submitted the
			 following resolution; which was considered and agreed to

		RESOLUTION
		Expressing support for the designation of
		  October 20, 2011, as the National Day on
		  Writing.

		Whereas people in the
			 21st century are writing more
			 than ever before for personal, professional, and civic purposes;
		Whereas the social nature of writing invites people of
			 every age, profession, and walk of life to create meaning through
			 composing;
		Whereas more and more people in every occupation deem
			 writing as essential and influential in their work;
		Whereas writers continue to learn how to write for
			 different purposes, audiences, and occasions throughout their lifetimes;
		Whereas developing digital technologies expand the
			 possibilities for composing in multiple media at a faster pace than ever
			 before;
		Whereas young people are leading the way in developing new
			 forms of composing by using different forms of digital media;
		Whereas effective communication contributes to building a
			 global economy and a global community;
		Whereas the National Council of Teachers of English, in
			 conjunction with its many national and local partners, honors and celebrates
			 the importance of writing through the National Day on Writing;
		Whereas the National Day on Writing celebrates the
			 foundational place of writing in the personal, professional, and civic lives of
			 the people of the United States;
		Whereas the National Day on Writing provides an
			 opportunity for individuals across the United States to share and exhibit their
			 written works through the National Gallery of Writing;
		Whereas the National Day on Writing highlights the
			 importance of writing instruction and practice at every educational level and
			 in every subject area;
		Whereas the National Day on Writing emphasizes the
			 lifelong process of learning to write and compose for different audiences,
			 purposes, and occasions;
		Whereas the National Day on Writing honors the use of the
			 full range of media for composing, from traditional tools like print, audio,
			 and video, to Web 2.0 tools like blogs, wikis, and podcasts; and
		Whereas the National Day on Writing encourages all people
			 of the United States to write, as well as to enjoy and learn from the writing
			 of others: Now, therefore, be it

		That the Senate—
			(1)supports the
			 designation of October 20, 2011, as the National Day on
			 Writing;
			(2)strongly affirms
			 the purposes of the National Day on Writing;
			(3)encourages
			 participation in the National Galley of Writing, which serves as an exemplary
			 living archive of the centrality of writing in the lives of the people of the
			 United States; and
			(4)encourages
			 educational institutions, businesses, community and civic associations, and
			 other organizations to promote awareness of the National Day on Writing and
			 celebrate the writing of the members those organizations through individual
			 submissions to the National Gallery of Writing.


113 S292 IS: Dairy and Sheep H–2A Act
U.S. Senate
2013-02-13
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		II
		113th CONGRESS
		1st Session
		S. 292
		IN THE SENATE OF THE UNITED STATES

			February 13, 2013
			Mr. Lee introduced the
			 following bill; which was read twice and referred to the
			 Committee on the
			 Judiciary

		A BILL
		To amend the Immigration and Nationality Act to provide a
		  special rule for the period of admission of H–2A nonimmigrants employed as
		  sheepherders, goat herders, or dairy farmers, and for other
		  purposes.

		1.Short
			 titlesThis Act may be cited
			 as the Dairy and Sheep H–2A
			 Act or the DASH
			 Act.
		2.Nonimmigrant
			 status for dairy workers, sheepherders, and goat herdersSection 101(a)(15)(H)(ii)(a) of the
			 Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(H)(ii)(a)) is amended by
			 inserting or who is coming temporarily to the United States to perform
			 agricultural labor or services as a sheepherder, goat herder, or dairy
			 worker, after of a temporary or seasonal nature,.
		3.Special rule for
			 period of admission of H–2A nonimmigrants employed as sheepherders, goat
			 herders, or dairy workersSection 218(h) of the Immigration and
			 Nationality Act (8 U.S.C. 1188(h)) is amended by adding at the end of the
			 following:

				(3)In the case of an
				alien admitted as an H–2A worker for employment as a sheepherder, goat herder,
				or dairy worker—
					(A)the initial
				period of admission shall be for a period of 3 years;
					(B)the period of
				admission may be extended for additional periods of 3 years; and
					(C)no period of
				absence from the United States may be required as a condition of approval of an
				extension under subparagraph
				(B).
					.
		4.Provisions by
			 the Secretary of LaborThe
			 Secretary of Labor shall issue regulations that address the specific
			 requirements for the provision of housing to sheepherders, goat herders, and
			 dairy workers.
		5.Savings
			 provisionNothing in section
			 218 of the Immigration and Nationality Act (8 U.S.C. 1188), as amended by this
			 Act, may be construed to preclude the Secretary of Labor or the Secretary of
			 Homeland Security from continuing to apply special procedures and requirements
			 to the admission and employment of aliens in occupations involving the range
			 production of livestock.