[Congressional Record (Bound Edition), Volume 154 (2008), Part 5] [House] [Pages 6523-6532] [From the U.S. Government Publishing Office, www.gpo.gov]PROTECTING THE MEDICAID SAFETY NET ACT OF 2008 Mr. DINGELL. Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5613) to extend certain moratoria and impose additional moratoria on certain Medicaid regulations through April 1, 2009, as amended. The Clerk read the title of the bill. The text of the bill is as follows: H.R. 5613 Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Protecting the Medicaid Safety Net Act of 2008''. SEC. 2. MORATORIA ON CERTAIN MEDICAID REGULATIONS. (a) Extension of Certain Moratoria in Public Law 110-28.-- Section 7002(a)(1) of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, 2007 (Public Law 110-28) is amended-- (1) by striking ``prior to the date that is 1 year after the date of enactment of this Act'' and inserting ``prior to April 1, 2009''; (2) in subparagraph (A), by inserting after ``Federal Regulations)'' the following: ``or in the final regulation, relating to such parts, published on May 29, 2007 (72 Federal Register 29748)''; and (3) in subparagraph (C), by inserting before the period at the end the following: ``, including the proposed regulation published on May 23, 2007 (72 Federal Register 28930)''. (b) Extension of Certain Moratoria in Public Law 110-173.-- Section 206 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) is amended-- (1) by striking ``June 30, 2008'' and inserting ``April 1, 2009''; (2) by inserting ``, including the proposed regulation published on August 13, 2007 (72 Federal Register 45201),'' after ``rehabilitation services''; and (3) by inserting ``, including the final regulation published on December 28, 2007 (72 Federal Register 73635),'' after ``school-based transportation''. (c) Additional Moratoria.-- (1) In general.--Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, prior to April 1, 2009, take any action (through promulgation of regulation, issuance of regulatory guidance, use of Federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to impose any restrictions relating to a provision described in subparagraph (A), (B), or (C) of paragraph (2) if such restrictions are more restrictive in any aspect than those applied to the respective provision as of the date specified in paragraph (3) for such provision. (2) Provisions described.-- (A) Portion of interim final regulation relating to medicaid treatment of optional case management services.-- (i) In general.--Subject to clause (ii), the provision described in this subparagraph is the interim final regulation relating to optional State plan case management services under the Medicaid program published on December 4, 2007 (72 Federal Register 68077) in its entirety. (ii) Exception.--The provision described in this subparagraph does not include the portion of such regulation as relates directly to implementing section 1915(g)(2)(A)(ii) of the Social Security Act, as amended by section 6052 of the Deficit Reduction Act of 2005 (Public Law 109-171), through the definition of case management services and targeted case management services contained in proposed section 440.169 of title 42, Code of Federal Regulations, but only to the extent that such portion is not more restrictive than the policies set forth in the Dear State Medicaid Director letter on case management issued on January 19, 2001 (SMDL #01-013), and with respect to community transition case management, the Dear State Medicaid Director letter issued on July 25, 2000 (Olmstead Update 3). (B) Proposed regulation relating to redefinition of medicaid outpatient hospital services.--The provision described in this subparagraph is the proposed regulation relating to clarification of outpatient clinic and hospital facility services definition and upper payment limit under the Medicaid program published on September 28, 2007 (72 Federal Register 55158) in its entirety. (C) Portion of proposed regulation relating to medicaid allowable provider taxes.-- (i) In general.--Subject to clause (ii), the provision described in this subparagraph is the final regulation relating to health-care-related taxes under the Medicaid program published on February 22, 2008 (73 Federal Register 9685) in its entirety. (ii) Exception.--The provision described in this subparagraph does not include the portions of such regulation as relate to the following: (I) Reduction in threshold.--The reduction from 6 percent to 5.5 percent in the threshold applied under section 433.68(f)(3)(i) of title 42, Code of Federal Regulations, for determining whether or not there is an indirect guarantee to hold a taxpayer harmless, as required to carry out section 1903(w)(4)(C)(ii) of the Social Security Act, as added by section 403 of the Medicare Improvement and Extension Act of 2006 (division B of Public Law 109-432). (II) Change in definition of managed care.--The change in the definition of managed care as proposed in the revision of section 433.56(a)(8) of title 42, Code of Federal Regulations, as required to carry out section 1903(w)(7)(A)(viii) of the Social Security Act, as amended by section 6051 of the Deficit Reduction Act of 2005 (Public Law 109-171). (3) Date specified.--The date specified in this paragraph for the provision described in-- (A) subparagraph (A) of paragraph (2) is December 3, 2007; (B) subparagraph (B) of such paragraph is September 27, 2007; or (C) subparagraph (C) of such paragraph is February 21, 2008. SEC. 3. FUNDS TO REDUCE MEDICAID FRAUD AND ABUSE. (a) In General.--For purposes of reducing fraud and abuse in the Medicaid program under title XIX of the Social Security Act, there is appropriated to the Secretary of Health and Human Services, out of any money in the Treasury not otherwise appropriated, $25,000,000, for each fiscal year (beginning with fiscal year 2009). Amounts appropriated under this section shall remain available for expenditure until expended and shall be in addition to any other amounts appropriated or made available to the Secretary for such purposes with respect to the Medicaid program. (b) Annual Report.--Not later than September 30 of 2009 and of each subsequent year, the Secretary of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report on the activities (and the results of such activities) funded under subsection (a) to reduce [[Page 6524]] waste, fraud, and abuse in the Medicaid program under title XIX of the Social Security Act during the previous 12 month period, including the amount of funds appropriated under such subsection (a) for each such activity and an estimate of the savings to the Medicaid program resulting from each such activity. SEC. 4. STUDY AND REPORTS TO CONGRESS. (a) Secretarial Report Identifying Problems.--Not later than July 1, 2008, the Secretary of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report that-- (1) outlines the specific problems the Medicaid regulations referred to in the amendments made by subsections (a) and (b) of section 2 and in the provisions described in subsection (c)(2) of such section were intended to address; (2) detailing how these regulations were designed to address these specific problems; and (3) cites the legal authority for such regulations. (b) Independent Comprehensive Study and Report.-- (1) In general.--Not later than July 1, 2008, the Secretary of Health and Human Services shall enter into a contract with an independent organization for the purpose of-- (A) producing a comprehensive report on the prevalence of the problems outlined in the report submitted under subsection (a); (B) identifying strategies in existence to address these problems; and (C) assessing the impact of each regulation referred to in such subsection on each State and the District of Columbia. (2) Additional matter.--The report under paragraph (1) shall also include-- (A) an identification of which claims for items and services (including administrative activities) under title XIX of the Social Security Act are not processed through systems described in section 1903(r) of such Act; (B) an examination of the reasons why these claims for such items and services are not processed through such systems; and (C) recommendations on actions by the Federal government and the States that can make claims for such items and services more accurate and complete consistent with such title. (3) Deadline.--The report under paragraph (1) shall be submitted to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate not later than March 1, 2009. (4) Cooperation of states.--If the Secretary of Health and Human Services determines that a State or the District of Columbia has not cooperated with the independent organization for purposes of the report under this subsection, the Secretary shall reduce the amount paid to the State or District under section 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) by $25,000 for each day on which the Secretary determines such State or District has not so cooperated. Such reduction shall be made through a process that permits the State or District to challenge the Secretary's determination. (c) Funding.-- (1) In general.--Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Secretary without further appropriation, $5,000,000 to carry out this section. (2) Availability; amounts in addition to other amounts appropriated for such activities.--Amounts appropriated pursuant to paragraph (1) shall-- (A) remain available until expended; and (B) be in addition to any other amounts appropriated or made available to the Secretary of Health and Human Services with respect to the Medicaid program. SEC. 5. ASSET VERIFICATION THROUGH ACCESS TO INFORMATION HELD BY FINANCIAL INSTITUTIONS. (a) Addition of Authority.--Title XIX of the Social Security Act is amended by inserting after section 1939 the following new section: ``asset verification through access to information held by financial institutions ``Sec. 1940. (a) Implementation.-- ``(1) In general.--Subject to the provisions of this section, each State shall implement an asset verification program described in subsection (b), for purposes of determining or redetermining the eligibility of an individual for medical assistance under the State plan under this title. ``(2) Plan submittal.--In order to meet the requirement of paragraph (1), each State shall-- ``(A) submit not later than a deadline specified by the Secretary consistent with paragraph (3), a State plan amendment under this title that describes how the State intends to implement the asset verification program; and ``(B) provide for implementation of such program for eligibility determinations and redeterminations made on or after 6 months after the deadline established for submittal of such plan amendment. ``(3) Phase-in.-- ``(A) In general.-- ``(i) Implementation in current asset verification demo states.--The Secretary shall require those States specified in subparagraph (C) (to which an asset verification program has been applied before the date of the enactment of this section) to implement an asset verification program under this subsection by the end of fiscal year 2009. ``(ii) Implementation in other states.--The Secretary shall require other States to submit and implement an asset verification program under this subsection in such manner as is designed to result in the application of such programs, in the aggregate for all such other States, to enrollment of approximately, but not less than, the following percentage of enrollees, in the aggregate for all such other States, by the end of the fiscal year involved: ``(I) 12.5 percent by the end of fiscal year 2009. ``(II) 25 percent by the end of fiscal year 2010. ``(III) 50 percent by the end of fiscal year 2011. ``(IV) 75 percent by the end of fiscal year 2012. ``(V) 100 percent by the end of fiscal year 2013. ``(B) Consideration.--In selecting States under subparagraph (A)(ii), the Secretary shall consult with the States involved and take into account the feasibility of implementing asset verification programs in each such State. ``(C) States specified.--The States specified in this subparagraph are California, New York, and New Jersey. ``(D) Construction.--Nothing in subparagraph (A)(ii) shall be construed as preventing a State from requesting, and the Secretary approving, the implementation of an asset verification program in advance of the deadline otherwise established under such subparagraph. ``(4) Exemption of territories.--This section shall only apply to the 50 States and the District of Columbia. ``(b) Asset Verification Program.-- ``(1) In general.--For purposes of this section, an asset verification program means a program described in paragraph (2) under which a State-- ``(A) requires each applicant for, or recipient of, medical assistance under the State plan under this title on the basis of being aged, blind, or disabled to provide authorization by such applicant or recipient (and any other person whose resources are material to the determination of the eligibility of the applicant or recipient for such assistance) for the State to obtain (subject to the cost reimbursement requirements of section 1115(a) of the Right to Financial Privacy Act but at no cost to the applicant or recipient) from any financial institution (within the meaning of section 1101(1) of such Act) any financial record (within the meaning of section 1101(2) of such Act) held by the institution with respect to the applicant or recipient (and such other person, as applicable), whenever the State determines the record is needed in connection with a determination with respect to such eligibility for (or the amount or extent of) such medical assistance; and ``(B) uses the authorization provided under subparagraph (A) to verify the financial resources of such applicant or recipient (and such other person, as applicable), in order to determine or redetermine the eligibility of such applicant or recipient for medical assistance under the State plan. ``(2) Program described.--A program described in this paragraph is a program for verifying individual assets in a manner consistent with the approach used by the Commissioner of Social Security under section 1631(e)(1)(B)(ii). ``(c) Duration of Authorization.--Notwithstanding section 1104(a)(1) of the Right to Financial Privacy Act, an authorization provided to a State under subsection (b)(1) shall remain effective until the earliest of-- ``(1) the rendering of a final adverse decision on the applicant's application for medical assistance under the State's plan under this title; ``(2) the cessation of the recipient's eligibility for such medical assistance; or ``(3) the express revocation by the applicant or recipient (or such other person described in subsection (b)(1), as applicable) of the authorization, in a written notification to the State. ``(d) Treatment of Right to Financial Privacy Act Requirements.-- ``(1) An authorization obtained by the State under subsection (b)(1) shall be considered to meet the requirements of the Right to Financial Privacy Act for purposes of section 1103(a) of such Act, and need not be furnished to the financial institution, notwithstanding section 1104(a) of such Act. ``(2) The certification requirements of section 1103(b) of the Right to Financial Privacy Act shall not apply to requests by the State pursuant to an authorization provided under subsection (b)(1). ``(3) A request by the State pursuant to an authorization provided under subsection (b)(1) is deemed to meet the requirements of section 1104(a)(3) of the Right to Financial Privacy Act and of section 1102 of such Act, relating to a reasonable description of financial records. ``(e) Required Disclosure.--The State shall inform any person who provides authorization pursuant to subsection (b)(1)(A) of the duration and scope of the authorization. ``(f) Refusal or Revocation of Authorization.--If an applicant for, or recipient of, medical assistance under the State plan under this title (or such other person described in subsection (b)(1), as applicable) refuses to provide, or revokes, any authorization made by the applicant or recipient (or such other person, as applicable) under subsection (b)(1)(A) for the State to obtain from any financial institution any financial record, the State may, on that basis, determine that the applicant or recipient is ineligible for medical assistance. ``(g) Use of Contractor.--For purposes of implementing an asset verification program under this section, a State may select and enter into a contract with a public or private entity meeting such criteria and qualifications as the State determines appropriate, consistent with requirements in regulations relating to general contracting provisions and with section 1903(i)(2). In carrying out activities under such contract, such an entity shall be subject to the [[Page 6525]] same requirements and limitations on use and disclosure of information as would apply if the State were to carry out such activities directly. ``(h) Technical Assistance.--The Secretary shall provide States with technical assistance to aid in implementation of an asset verification program under this section. ``(i) Reports.--A State implementing an asset verification program under this section shall furnish to the Secretary such reports concerning the program, at such times, in such format, and containing such information as the Secretary determines appropriate. ``(j) Treatment of Program Expenses.--Notwithstanding any other provision of law, reasonable expenses of States in carrying out the program under this section shall be treated, for purposes of section 1903(a), in the same manner as State expenditures specified in paragraph (7) of such section.''. (b) State Plan Requirements.--Section 1902(a) of such Act (42 U.S.C. 1396a(a)) is amended-- (1) in paragraph (69) by striking ``and'' at the end; (2) in paragraph (70) by striking the period at the end and inserting ``; and''; and (3) by inserting after paragraph (70), as so amended, the following new paragraph: ``(71) provide that the State will implement an asset verification program as required under section 1940.''. (c) Withholding of Federal Matching Payments for Noncompliant States.--Section 1903(i) of such Act (42 U.S.C. 1396b(i)) is amended-- (1) in paragraph (22) by striking ``or'' at the end; (2) in paragraph (23) by striking the period at the end and inserting ``; or''; and (3) by adding after paragraph (23) the following new paragraph: ``(24) if a State is required to implement an asset verification program under section 1940 and fails to implement such program in accordance with such section, with respect to amounts expended by such State for medical assistance for individuals subject to asset verification under such section, unless-- ``(A) the State demonstrates to the Secretary's satisfaction that the State made a good faith effort to comply; ``(B) not later than 60 days after the date of a finding that the State is in noncompliance, the State submits to the Secretary (and the Secretary approves) a corrective action plan to remedy such noncompliance; and ``(C) not later than 12 months after the date of such submission (and approval), the State fulfills the terms of such corrective action plan.''. (d) Repeal.--Section 4 of Public Law 110-90 is repealed. SEC. 6. ADJUSTMENT TO PAQI FUND. Section 1848(l)(2) of the Social Security Act (42 U.S.C. 1395w-4(l)(2)), as amended by section 101(a)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is amended-- (1) in subparagraph (A)(i)-- (A) in subclause (III), by striking ``$4,960,000,000'' and inserting ``$3,790,000,000''; and (B) by adding at the end the following new subclause: ``(IV) For expenditures during 2014, an amount equal to $3,690,000,000.''; (2) in subparagraph (A)(ii), by adding at the end the following new subclause: ``(IV) 2014.--The amount available for expenditures during 2014 shall only be available for an adjustment to the update of the conversion factor under subsection (d) for that year.''; and (3) in subparagraph (B)-- (A) in clause (ii), by striking ``and'' at the end; (B) in clause (iii), by striking the period at the end and inserting ``; and''; and (C) by adding at the end the following new clause: ``(iv) 2014 for payment with respect to physicians' services furnished during 2014.''. The SPEAKER pro tempore. Pursuant to the rule, the gentleman from Michigan (Mr. Dingell) and the gentleman from Texas (Mr. Barton) each will control 20 minutes. The Chair recognizes the gentleman from Michigan. General Leave Mr. DINGELL. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days to revise and extend their remarks and to include extraneous material on the bill under consideration. The SPEAKER pro tempore. Is there objection to the request of the gentleman from Michigan? There was no objection. Mr. DINGELL. Mr. Speaker, I yield myself 3 minutes. Mr. Speaker, I rise today in support of H.R. 5613, the Protecting the Medicaid Safety Net Act of 2008. This is a bipartisan bill, critically important to our Nation's safety net. The Committee on Energy and Commerce reported it favorably with a strong bipartisan vote of 46-0. I want to commend and thank our subcommittee chairman, Mr. Pallone, and our distinguished colleague and cosponsor of the legislation, Mr. Murphy of Pennsylvania, for their leadership on this matter. And I want to express to my good friends and the ranking members on the committee and the subcommittee, Mr. Barton and Mr. Deal, for their superb cooperation. I also want to thank my colleagues on the Committees on Ways and Means and Financial Services for the splendid cooperation and help they gave us in moving this legislation to the floor expeditiously. The support of Chairmen Rangel and Stark were both necessary and very much appreciated. H.R. 5613 places a 1-year moratorium on seven regulations recently issued by the U.S. Department of Health and Human Services. The regulations would have restricted payments to critical safety net providers such as hospitals and nursing homes, as well as payments for graduate medical education training. The regulation would have reduced or eliminated payments that allow children with severe mental illness to remain in family settings, and payments to schools transporting poor children with disabilities. The Governors of all 50 States oppose these rules, as do the State Medicaid directors, State legislators, and the National Association of Counties. More than 2,000 national and local groups such as the American Hospital Association, the American Federation of Teachers and the March of Dimes support this legislation. They know of the devastating effect these rules would have upon local communities, upon the hospitals, and upon vulnerable beneficiaries. Without this moratorium, schools would be forced to lay off workers starting in June. Hospitals and nursing homes would be forced to cut off services and to lay off workers as well. In troublesome economic times, we cannot afford to lose good-paying jobs or to cut services that enable people with disabilities to be gainfully employed. H.R. 5613 will postpone the implementation of these seven rules for 1 year, giving Congress time to evaluate the effect they would have on States, providers and beneficiaries. I want to again commend my colleagues on both sides of the aisle, including my dear friend, Mr. Barton, and Mr. Deal for their leadership and hard work on this matter. I urge my colleagues to vote for H.R. 5613. Mr. Speaker, I reserve the balance of my time. Mr. BARTON of Texas. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise today to join my good friend, Chairman John Dingell of the Energy and Commerce Committee, in support of H.R. 5613, the Protecting the Medicaid Safety Net Act of 2008. Given the fact that Secretary Leavitt of Health and Human Services indicated that he would recommend to the President of the United States that he veto the bill before us in its current form, I do wish we could have brought the bill to the floor under a rule with several potential amendments and a motion to recommit so that we can have a little bit fuller debate rather than putting it on the suspension calendar. Having said that, I am very glad that it is coming to the floor as a stand- alone bill, and that Chairman Dingell and Chairman Pallone of the subcommittee have followed regular order in passing this legislation. I want to thank Chairman Dingell and Chairman Pallone for holding a legislative hearing as well as a subcommittee markup and a full committee markup on the bill that's now before us. I also want to thank them for having an open process, where staff on both sides of the aisle could work together, amendments could be shared, and some of those amendments could be agreed upon and incorporated into the bill that's before us today. I would not have been able to support H.R. 5613 as originally introduced, but I can support the bill that's before us this afternoon. I'm proud that, on occasion, we do put good public policy ahead of partisan politics, and the bill before us, again, is an example of what I believe to be better public policy. I do hope that we take this opportunity to take the issue before us, if [[Page 6526]] this bill becomes law, and actually work on it for the year that the moratorium is in place. The bill before us would place a year-long moratorium on seven Medicaid rules. It does not mean that the suspended rules themselves are all bad and don't address a problem that needs to be addressed. It does mean that many of the interest groups and many of the States had significant problems with those rules, and so it was felt prudent to have a moratorium where we could hopefully, in the interim, determine how to fine tune and maybe change some of those rules. We do need to save money in Medicaid. We do need to do something on this system of intergovernmental transfers. For those of you who don't understand what an intergovernmental transfer is, as used in Medicaid, a State will give money to the Federal Government that is then matched by the Federal Government and sent back to the State. The State will give some of that money to, in this case a hospital system, but then keep some of the money that it initially gave. So it's kind of a shell game where you put up some money to get it matched, and once you get the matched back, the money you put up you use for another purpose, not for a health purpose, but maybe for a different purpose, like building a highway or something like that. One of the suspended rules would have addressed this intergovernmental transfer, and I hope that in the next year, on a bipartisan basis, we can address the intergovernmental transfer issue itself. Mr. DINGELL. Will the gentleman from Texas yield? Mr. BARTON of Texas. I would be happy to yield. Mr. DINGELL. I want to again commend my friend from Texas for his superb performance on this legislation. And I want to assure him that I share his concerns on the intergovernmental transfer matter, and that we will be going into it. I thank my friend. Mr. BARTON of Texas. I thank the distinguished chairman. We simply cannot pretend on a day that we're suspending these rules that there are not fundamental financial difficulties facing Medicaid. So while we agree to suspend the rules for the next year, I hope we can also agree, as the chairman just indicated that he did, that we're going to continue to work on the problems these rules were designed to address so that over time we can reach agreement on how to save money under Medicaid. I do believe the bill before us is a good bill. It does have a pay- for. It is, on a net basis, a slight revenue increase to the Federal Treasury, so it is paid for. And if we spend the next year working together, if we implement some of the things in this bill, the bill gives $25 million a year to combat waste, fraud and abuse in Medicaid, if we use that money wisely, we will uncover some savings. And if we look at some of these suspended rules, we can perhaps work together to fine tune them so that a year from now, at the beginning of the next administration, we don't have to extend the moratorium. In short, Mr. Speaker, while this is not a perfect bill, it's a good bill. Don't let the pursuit of perfection prevent the accomplishment of what is something that is good and possible. I would urge a ``yes'' vote on H.R. 5613, especially on my side of the aisle, among the Republicans in the House of Representatives. With that, I reserve the balance of my time. Mr. DINGELL. Mr. Speaker, I yield 3 minutes to the distinguished gentleman from California (Mr. Waxman). Mr. WAXMAN. Mr. Speaker, I rise in strong support of the Dingell- Murphy bill, H.R. 5613, which would delay seven Medicaid regulations that would shift billions of dollars in costs from the Federal Government to States, counties, school districts, hospitals, and other medical providers. There is absolutely no justification for such a cost shift, especially at a time when many States are struggling to avoid budget cuts as their economies slow and revenues decline. The bill would delay the implementation of these regulations until April 1, 2009. The Oversight Committee held hearings on this matter. We heard testimony from public and teaching hospital administrators, an emergency room physician, a child welfare worker and a school nurse. They explained how the regulations would shift costs to States and localities and what that cost would mean for access to services for beneficiaries. We also heard from a representative from the Centers for Medicare and Medicaid Services, which issued these regulations. And since Medicaid is a Federal-State program, one would think that when the Federal Government changes the rules, as these regulations would do, it would first try to determine what the impact of these changes would be on the different States. Well, we followed up with the head of the CMS for Medicaid, and he told us that he had not done a State-by-State specific analysis of the impact and he had no plans to do such an analysis. So our committee made our own analysis. We did a survey of Medicaid directors for 43 States and the District of Columbia, and they told us that if CMS were allowed to implement all seven Medicaid regulations, their States would lose nearly $50 billion in Federal funds over the next 5 years. The result of these cost shifts would not be greater efficiency, it would not be a savings of money, it would simply come out of the reimbursements, and fewer eligible populations. They would disrupt the existing systems for care of fragile populations, such as adults with severe mental illness or children with special health care needs. They would undercut the financial stability of hospitals and emergency rooms that treat Americans without health insurance. They would impose large, new administrative burdens and costs on State Medicaid programs without any offsetting policy benefit. In short, the best professional judgment was that the regulations would have harmful fiscal and programmatic consequences for their States and the people that look to the Medicaid program as the safety net for health care. {time} 1500 The bill before us gives the department and the Congress the time to look into these issues in the detail they deserve without making fundamental changes in Federal Medicaid policy. I urge support for this bipartisan legislation. Mr. BARTON of Texas. Mr. Speaker, I reserve the balance of my time. Mr. DINGELL. Mr. Speaker, I yield 3 minutes to the distinguished gentlewoman from California (Ms. Harman). Ms. HARMAN. Mr. Speaker, it's an honor to serve under Chairman Dingell on the Energy and Commerce Committee and to support this effort to keep the Medicaid safety net intact. That our chairman shepherded this must-pass bill through our committee with unanimous support is testament to his enormous legislative skill and bipartisanship. Unless we pass this bill, Mr. Speaker, public hospitals and the essential services they provide will be at grave risk. A major public hospital in my district, Harbor-UCLA Medical Center, is among them. It is the only level 1 trauma center near top terror targets like LAX and the ports of Long Beach and L.A. In the event of an attack, Harbor would be on the front lines. As a teaching hospital, it helps train the next generation of doctors. Mr. Speaker, if all seven Medicaid regulations are implemented, Los Angeles County will lose $240 million in annual funding, the equivalent of closing a public hospital like Harbor. Harbor is already overcrowded. It needs more help, not less. It needs to offer more services, not to close. H.R. 5613 will stop these catastrophic cuts, and it deserves our full support. I urge our colleagues to vote ``aye'' and to join in overriding a White House veto should one occur. Mr. BARTON of Texas. Mr. Speaker, I reserve the balance of my time. Mr. DINGELL. Mr. Speaker, I yield myself such time as I may consume. The distinguished gentleman from Pennsylvania (Mr. Tim Murphy) worked very hard on this important legislation and is a cosponsor of it. Regrettably, he is detained, unfortunately, on an aircraft and is not able to [[Page 6527]] be with us today to speak in favor of this bill on which he worked so hard. And I want the Record to show that the House owes the distinguished gentleman from Pennsylvania (Mr. Tim Murphy) a real debt of thanks for his hard work here and for his remarkable leadership. Mr. Speaker, I now yield 2 minutes to my dear friend the gentleman from New York (Mr. Towns). Mr. TOWNS. Mr. Speaker, I rise to commend Chairman Dingell and, of course, Congressman Murphy and Congressman Barton for placing this 1- year moratorium on the CMS Medicaid rules that would devastate patients, persons with disabilities, hospitals, States, and our entire safety net. Instead, these are the very entities and people that we should be helping, not hurting. CMS went well beyond the authority Congress allowed in enacting these rules. Therefore, as a cosponsor, I urge my colleagues to vote in favor of this measure and support our Nation's Governors who have called for this moratorium and rightfully so. So I urge my colleagues to support this legislation. Mr. BARTON of Texas. Mr. Speaker, I simply want to reiterate that as the ranking member on the Energy and Commerce Committee, I strongly support this piece of legislation. It did receive the votes of every Republican on the committee. It passed 46-0. I had wished it would not have been a suspension calendar bill, but I am happy it is a stand- alone bill, and I would encourage my colleagues to vote for this bill. Mr. Speaker, I yield back the balance of my time. Mr. DINGELL. Mr. Speaker, I want to thank again my colleague from Texas. He is always a gentleman. I want to note that last night the Commerce Committee dedicated a picture hung in the committee in honor of our good friend Mr. Barton. It is a fine-looking picture of a distinguished former chairman of the committee, and I would urge my colleagues, if they want to look at a distinguished Member of this body hanging on the wall in the committee and to look at a very fine piece of art, they should come over and see the excellent picture of our good friend Mr. Barton hanging there in the committee. Mr. BACA. Mr. Speaker, I rise in support of H.R. 5613, the Protecting the Medicaid Safety Net Act of 2008. After unsuccessful attempts at S- CHIP over the last several months, over 33,000 children in my district are still uninsured. Now the most vulnerable of beneficiaries of Medicaid, children and the disabled, are faced with a major crisis. This bill has bipartisan support, this is not about politics. It's about helping hardworking families and the poorest among us. This bill includes a moratorium of 7 CMS regulations, preventing the stripping of over $20 billion in Federal Medicaid funding over the next 5 years to States for vital programs and services. These programs and services will only shrink and shrivel if they are put against the wall to eat up these costs. Even school districts, like Rialto Unified School District from my district, will face difficult challenges in providing direct health services to the 30,000 students it currently serves. Cutting these valuable services at a time when many States, including California are facing record budget deficits is not an option. The poorest amongst us on Medicaid are most affected. We cannot turn our backs during these troubling times of increasing foreclosures and rising gas prices. Cancer does not distinguish between incomes, why should health care coverage? I support H.R. 5613, and urge my colleagues to do the honorable thing and vote for this bill. Mr. STARK. Mr. Speaker, I rise to express my strong support for H.R. 5613, the ``Protecting the Medicaid Safety Net Act of 2008.'' This bill stops George Bush's draconian attempt to gut the Medicaid program, which provides medical care to millions of low-income children and families. If we fail to enact this bill, more than $20 billion in vital Federal funding for States will disappear. This is $20 billion that helps schools provide transportation for physically disabled children, allows local governments to contribute to the State Medicaid share, and trains physicians. This President has presided over the greatest transition from boom to bust since the 1920s. As families face foreclosure and rising food and gas costs, States see declining sales tax receipts and greater numbers in need of assistance. Our President would add insult to injury for working families by dismantling their safety net. The seven regulations proposed by the Bush administration would undermine longstanding practices upon which States have built their Medicaid programs. The regulations are opposed by a bipartisan coalition of lawmakers; all the Nation's Governors from both sides of the aisle; and a host of public health, physician, and patient advocates. The bill passed unanimously out of the Energy and Commerce Committee. In this day and age, that is a remarkable phenomenon. I am proud to join colleagues from both sides of the aisle to vote in favor of this moratorium and to protect the health care safety net for America's working families. Ms. MOORE of Wisconsin. Mr. Speaker, today I join a bipartisan House to stand up to the Bush administration to prevent it from irresponsibly slashing the Medicaid budget. States that work with the Federal government to run and fund Medicaid programs are already facing budgetary restraints, flat funding, and shortfalls. The administration's proposed cuts to Medicaid would exacerbate their budgetary crunch, and would directly affect the quality of care given to low-income kids, seniors, families and people living with disabilities. The bill before us today, H.R. 5613, would place a 1-year moratorium on seven Medicaid regulations proposed by the administration. This 1- year moratorium would give Congress more time to evaluate the potential effects of his proposed cuts on State Medicaid programs and the individuals that they serve. Several groups have warned that the unexpected slashes in Federal Medicaid dollars could force States to shift their Medicaid costs to patients, who would be hard pressed to make up the differences in health care costs. At present, some 30 million low-income children depend on the Medicaid program. The Government Accountability Office testified that it had not recommended the specific changes proposed by the administration, nor had officials there had time to adequately study the potential effects of these changes for 6 of the 7 regulations. Before the President starts tinkering with domestic programs upon which millions of our most vulnerable citizens rely, he owes it to them to do his homework. If he won't, then Congress owes it to the American people to investigate his proposed changes so we can fully understand their effect on poor and working families. Nearly 2,000 groups from across the country, including school districts, hospitals, case management providers, and organizations serving people with disabilities and mental illnesses have joined us in support of the Protecting the Medicaid Safety Net Act. I am proud to be a cosponsor of this bill and urge my colleagues to cast their votes in favor of it. Mr. UPTON. Mr. Speaker, I rise today in support of H.R. 5613 the Protecting the Medicaid Safety Net Act, and urge my colleagues to join me in voting for it. Last week, my colleagues and I on the Energy and Commerce Committee unanimously approved H.R. 5613, the Protecting the Medicaid Safety Net Act. This bill places moratoria on seven regulations issued by the Center for Medicare and Medicaid Services, CMS. If allowed to go into effect as currently written, these regulations would seriously erode federal funding to the states for a range of Medicaid services, including rehabilitation and medical services for schoolchildren with disabilities, and would totally eliminate federal Medicaid matching funds for Graduate Medical Education at a time when my state is already in the grip of a growing physician shortage. I am particularly concerned about the detrimental effect that these regulations would have on students and schools in my district and districts across the country. Under the Individuals with Disabilities Education Act, schools are required to provide medical and rehabilitation services that are necessary for children to enter and continue to attend school. If federal matching funds are reduced or eliminated, our schools will still be required pay for these services, meaning other vital services and programs would have to be significantly cut back or eliminated. Another major concern of mine is the extent to which these regulations would reduce or eliminate federal matching payments for many of our community hospitals, seriously undermining access to care for poor and disabled women, children, and persons with disabilities. Our hospitals are already struggling under low Medicaid reimbursement rates and higher rates of uncompensated care as my State's economy has worsened. Like schools, hospitals are under a federal mandate--this one to examine and stabilize every patient who [[Page 6528]] walks through their emergency room doors. These regulations could significantly increase hospitals' burden of uncompensated care. I am also concerned about provisions in several of the regulations that could well undo the progress we have made over many years in enabling persons with mental and physical disabilities to live independently and participate as fully as they are able in the workforce and the life of their communities rather than being confined to institutional settings. Because of all these factors, I again encourage my colleagues to join me in voting for this bill. Mr. GENE GREEN of Texas. Mr. Speaker, I rise in strong support of H.R. 5613, the Protecting Medicaid Safety Net Act. The rules issued by CMS in August were said to be cost saving measures and a way to reduce waste, fraud, and abuse. If these 7 regulations go into effect Texas would lose $3.4 billion in Federal Medicaid funding over the next 5 years and nationwide cuts to Medicaid funding could total around $50 billion. These regulations attack the core mission of Medicaid by eliminating much needed services for children, the elderly, and the poor. These cuts will also have a devastating impact on state's Medicaid funds; consequently hurting the most vulnerable populations who are helped by the Medicaid safety net. This population accesses services and support care from Medicaid because they cannot access services elsewhere due to costs or restrictions on benefits. If these regulations go into effect, I don't know where the states will find the funds to continue operating programs such as school administrative and transportation services, coverage for rehabilitative services, and outpatient hospital services. Especially since the lack of Medicaid funding will create budget crises in most states as they scramble to pay for services or eliminate them altogether. This bill gives Congress enough time to understand the consequences of these regulations and come up with a solution we all can agree on rather than cutting these necessary services. I am disappointed that the Administration has threatened to veto this bill. This piece of legislation is the result of a lot of hard work on both sides of the aisle. I am particularly upset that the Administration seems to have forgotten once again about its Texas roots. Texas, along with California and New York stand to lose the largest amount of funding from these Medicaid cuts and this is money our states cannot afford to lose. This bill has the support of 2,000 organizations and the National Governors Association. I urge my colleagues to support this bill and stop these cuts. Mr. GRIJALVA. Mr. Speaker, over the past year, the Centers for Medicare and Medicaid Services, CMS, have introduced a series of Medicaid regulations that have caused grave concern to our States and beneficiaries. States are struggling as the economy sinks into recession, and these proposed regulations, if not suspended, will add billions in Medicaid costs to our States at a time when their tax revenues are falling and Medicaid caseloads are growing. The seven regulations issued by CMS erode the foundation of the Medicaid system by preventing beneficiaries from accessing the care they need. These proposed regulations would endanger access to care by severely limiting payments to public hospitals, eliminate coverage for outpatient services that keep beneficiaries from unnecessary emergency room use, and by restricting support for transportation services for children with disabilities. I would like to take this opportunity to thank Chairman Dingell for his superb leadership on this issue and for introducing and garnering bipartisan support for this unfortunate but very necessary moratorium. This important legislation will help protect beneficiaries from harmful cuts and alleviate the immediate concerns that the Medicaid regulations cause for long term care patients, residents and providers alike. The bill also establishes an independent review of these regulations prior to the expiration of the moratorium next year. In addition, it provides $25 million to HHS each year, beginning in FY 2009, to fight fraud and abuse in the Medicaid program. This moratorium is a temporary fix, allowing Congress an opportunity to review these regulations as thoroughly as possible before they are implemented and the burden is borne by our constituents. While CMS argues that these changes will create efficiencies in the program, there is no evidence to support this claim. What is known is that these changes will cause extreme harm to our most vulnerable citizens--low-income children, the disabled, and the elderly. By utterly disregarding the immense public outcry surrounding the enactment of these rules, this administration is placing desperately needed services in jeopardy without thoroughly weighing the effects these regulations will have on States. Now more than ever, in the face of major State budget deficits, we cannot allow the Federal Government to make major regulatory changes to Medicaid that will result in billions of additional costs to states. I am a proud, original cosponsor of Chairman Dingell's H.R. 5613, the Protecting the Medicaid Safety Net Act of 2008 and urge all my colleagues in this 110th Congress to stand with me and stop this Administration from implementing these foolish and potentially devastating regulations. Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support of the Protecting the Medicaid Safety Net Act of 2008. Since its inception, Medicaid has been a joint State and Federal partnership to provide health care to the country's neediest and most vulnerable populations. Unfortunately, the Centers for Medicare and Medicaid Services, CMS, recently issued a series of Medicaid regulations that will significantly shift costs to States and restrict services to needy individuals. These regulations will force States to stop providing beneficiaries access to certain Medicaid services. Among the damaging Medicaid regulations issued by CMS, I am especially concerned about the restrictive rules on targeted case management services that help people with disabilities remain in their community. Nearly 200,000 people in Maryland receive some type of Medicaid case management services, and these new rules will put more than $60 million in Federal funds for Maryland at risk. CMS also proposes to eliminate or severely restrict Federal Medicaid funding for rehabilitation services, graduate medical education, hospital outpatient services, safety net institutions, and school-based transportation and outreach programs. While CMS claims that the elimination of $20 billion in Federal Medicaid funding will create efficiencies in the program, it did not consult with Congress on these far reaching regulations. With so many States, including Maryland, facing huge budget shortfalls and trying to figure out how to provide Medicaid services to their populations, now is not the time for the Federal Government to cut back on its share of funding. The legislation before us today would delay implementation of the regulations put forth by CMS so that Congress can examine their full impact. Mr. Speaker, we have a responsibility and an obligation to our vulnerable citizens--low-income children, the disabled, and the elderly--to effectively provide access to adequate and quality health care services. I urge my colleagues to support this bipartisan bill. Mrs. CHRISTENSEN. Mr. Speaker, I rise today in full support of H.R. 5613--the Medicaid Safety Net Act of 2008. The millions of people who depend on this critical safety net and I thank and applaud Chairman Dingell for once again protecting our Nation's critically important Medicaid program. It is a shame that every year Democrats have to fight back at least one attempt to cut funding and provisions in this program that is so vital to the Nation's poor--the majority of which are people of color. The administration and the Secretary's policies are going in the absolute wrong direction. Rather Medicaid and Children's Health Insurance funding needs to be increased to meet the needs of the increasing numbers of un- and under-insured which includes 9 million children. This administration's failed economic policies have left more people vulnerable. Racial and ethnic minorities suffer worse morbidity and mortality because of lack of access. Caps on Medicaid in the territories don't even allow us to cover residents at 100 percent of poverty and per capita spending is a shamefully small fraction of that of our fellow Americans in the States. This Nation's healthcare system as we all know has become a sick-care system and not only is it not doing a good job at that, it is in crisis and on the verge of catastrophe. The proposed actions restricting payments for graduate medical education and blanket regulations against payment for certain services, threaten to not only make the healthcare situation in this country worse for the poor, but for everyone, and to threaten the competitiveness and security of our Nation. I look forward to the new Democratic administration, who will work with Chairman Dingell and others to transform health care in this country and reduce the skyrocketing costs through emphasis on prevention and equal access to quality, comprehensive culturally competent care for everyone who lives here. The foundation of this effort must be stronger Medicaid and SCHIP. [[Page 6529]] By stopping the assault on these two programs; by stopping payments to hard working providers and for the training of the healthcare workforce needed, we set the stage for that transformation to begin. Thank you Mr. Chairman, for your continued leadership. I urge passage of H.R. 5613 to protect this important safety net. Mr. PAYNE. Mr. Speaker, I rise to express my strong support for the passage of H.R. 5613, the Protecting the Medicaid Safety Net Act. I commend my colleagues Representative Dingell and Representative Murphy for introducing this bill, which would extend until March 31, 2009 the moratorium on several Medicaid regulations that would strip an estimated $20 billion over 5 years from the Medicaid program. Mr. Speaker, for more than 40 years, Medicaid has served as the Nation's health care safety net, providing access to health services for millions who cannot afford private insurance in a dynamic and changing economy. Today, more than 57 million children, poor, disabled and elderly individuals rely on Medicaid for care. The program now serves more people than Medicare, and with the ranks of the uninsured growing, and the threat of an economic recession, the Medicaid program is more important than ever. Mr. Speaker, hospitals are the backbone of America's health care safety net, providing care to all patients who come through their doors, regardless of their ability to pay. But, hospitals are experiencing severe payment shortfalls when treating Medicaid patients. Despite these financial pressures, the Administration continues to call for further cuts in federal funds for the Medicaid program that will affect hospitals and the patients they serve. Despite concerns raised by Congress, CMS continues to take steps to implement these regulations. These rules range from limiting payments for teaching hospitals, public hospitals and hospital outpatient services to reducing school-based services for children and case management for the disabled. Last year, Congress imposed a year-long moratorium (P.L. 110-28) on two regulations the proposed and final cost-limit rule and the proposed graduate medical education (GME) rule. The moratorium on implementation of these rules expires May 25, 2008. CMS's regulatory budget-cutting policies will have a devastating effect on my home State of New Jersey's Medicaid program, along with the hospitals and physicians serving our Nation's most vulnerable population--poor children and mothers, the disabled and elderly individuals. Much of Congress has expressed opposition to these rules. This bill would delay implementation of regulations affecting: CPEs; IGTs; GME; coverage of rehab services for people with disabilities; outreach and enrollment in schools, in addition to specialized medical transportation to school for children covered by Medicaid; coverage of hospital outpatient services; case management services that allow people with disabilities to remain in the community; and state provider tax laws. Mr. Speaker, there is no question that CMS's regulatory budget- cutting policies will have a devastating effect on my home State of New Jersey's Medicaid program, along with the hospitals and physicians serving our Nation's most vulnerable population--poor children and mothers, the disabled and elderly individuals. Mr. Speaker, we need to pass H.R. 5613 today. I urge my colleagues to vote for this bill legislation. Mr. ABERCROMBIE. Mr. Speaker, I rise today to support H.R. 5613, the ``Protecting the Medicaid Safety Net Act of 2008,'' a bill that I proudly cosponsored. The bill would place a 1-year moratorium on proposed Medicaid regulations by the Bush administration intended to save money. Unfortunately, these cuts would take Federal funds from States at a time that many are struggling to meet obligations within Medicaid and other programmatic areas. By limiting access to rehabilitation and targeted case management services, the administration cynically attacks the poorest and weakest members of our society. Eliminating the reimbursement for transportation services for certain special needs students would deny them the basic right to an education. The regulations halt important payments to hospitals at a time that many across the Nation and within my home State of Hawaii are actually losing money. Placing the 1-year moratorium would help us better asses the full impact of these disastrous cuts, and come up with a plan that controls the growing costs of Medicaid without harming quality, as these regulations seem to do. The extent of the unpopularity of these cuts is clearly shown by the expedited move by the Committee on Energy and Commerce to report the bill unanimously to the House floor, in contravention of the President's veto threat. Medicaid provides medical coverage for the poorest and neediest of our country. It is the insurer of last resort for many who have either lost jobs or are barely subsisting. To take away these funds at this time is cruel and undermines the intent of the very program. I urge my colleagues to support this important piece of legislation. Ms. ESHOO. Mr. Speaker, I'm proud to be a cosponsor of the Protecting the Medicaid Safety Net Act of 2008 and very pleased that a bipartisan agreement was reached to bring the bill up under suspension of the rules because it's essential for the House of Representatives to pass this legislation as soon as possible. Over 2,100 organizations across the country have told Congress that we have to stop the seven regulations issued by the Centers for Medicare and Medicaid Services, CMS, over the last year because they threaten the loss of $50 billion in Federal funding for key healthcare services. California's Governor Schwarzenegger has estimated that the regulatory changes will place an additional $12.5 billion burden on California alone. CMS has claimed these cuts are being imposed to eliminate waste from the Medicaid program. Far from addressing ``inappropriate'' payments, the seven regulations that CMS adopted will cut legitimate and necessary care for the most vulnerable in our society. Rather than using the power it already has to address waste, fraud, and abuse, CMS has taken the wrong turn by simply declaring that it will not pay for services. CMS is saying ``no'' to rehabilitation services to help people with profound disabilities and medical conditions maintain or gain function. CMS is saying ``no'' to case management services that help people get the medical care they need and are entitled to; this includes services for individuals with disabilities who are trying to move out of institutions and into the community. CMS is saying ``no'' to specialized transportation to help children with disabilities get to and from school. CMS is saying ``no'' to compensating safety-net hospitals for their critical services to the communities. By adopting this bill, we will stop the implementation of these draconian regulations. The bill will require an HHS study and report on the regulations and their impacts on states, something CMS failed to do. For those concerned about waste, the bill provides additional funding for the Secretary to root out true fraud within the system. Finally, the costs of the bill are fully paid for by requiring electronic verification of assets for individuals applying for Medicaid. With many of these regulations due to take effect very soon, it's critical that the House pass this bill today with a margin that will convince the President that a veto will not be sustained. I urge my colleagues to join me in voting for this important bill. Mrs. MALONEY of New York. Mr. Speaker, I would like to express my strong support of H.R. 5613, the Medicaid Safety Net Act of 2008. This important legislation will prevent the implementation of seven Medicaid regulations before April 2009. Passage of H.R. 5613 is vitally important to my home state of New York. These regulations are estimated to cut Medicaid funding by nearly $20 billion over five years and will impact payments for safety net providers, hospital clinic services, rehabilitation services, graduate medical education and case management services. In my home district, the New York City Health and Hospitals Corporation, HHC, the largest municipal hospital system in the country, would lose over $500 million a year, 10 percent of the HHC budget. To give perspective, HHC operates 11 acute care hospitals and more than 80 community clinics which serve 1.3 million patients, 400,000 of whom are uninsured. Another of the proposed regulations would eliminate Medicaid funding for graduate medical education, GME. My district is a center for graduate medical education. If the GME proposed regulation goes into effect, the impact would be devastating to New York teaching hospitals which educate a disproportionate number of our nations doctors. New York trains one of every seven doctors in the country. The loss of Medicaid funding for physician training would be $590 million a year for all of the hospitals in New York City and $675 million a year for all of the hospitals in New York State. Reducing the GME would not only dramatically impact New York, it would negatively impact the entire country which relies on New York trained doctors. [[Page 6530]] We must not rush to cut services to beneficiaries. Instead, Congress must have the opportunity to thoughtfully and deliberately evaluate what is happening in the States and address any concerns. Mr. PAUL. Mr. Speaker, I rise in reluctant opposition to H.R. 5613, legislation halting the implementation of a package of new Medicaid rules. The proponents of H.R. 5613 are correct that halting some of these rules will protect needed Medicaid reimbursements for health care providers. However, some of the rules that H.R. 5613 blocks address abuses of Federal Medicaid dollars that should be halted. Greater efforts to ensure Medicaid resources are properly spent will help those health care providers most in need of continued support from the Medicaid program, since a Medicaid dollar lost to fraud and abuse is a dollar that cannot be spent helping hospitals and physicians provide health care to the poor. Had members been given the opportunity to offer amendments, we could have fashioned a bill that would have protected needed reimbursements for legitimate health care expenditures while addressing legitimate concerns about misuse of Medicaid funds. Unfortunately, the House leadership chose to deny members the ability to improve this bill, and have a meaningful debate on how to ensure Medicaid's financial stability without denying care to those dependent on the program, by putting this bill on the suspension calendar. According to some estimates, failure to implement the proposed regulations could cost the already financially fragile Medicaid system as much as 10 billion over the next several years. Yet, the sponsors of this bill refuse to make a serious effort to address these costs. Mr. Speaker, instead of rushing H.R. 5613 into law, we should be looking for ways to shore up Medicaid by making cuts in other, lower priority programs, using those savings to ensure the short-term fiscal stability of federal entitlement programs while transitioning to a more stable means of providing health care for low-income Americans. I have been outspoken on the areas I believe should be subject to deep cuts in order to finance serious entitlement reform that protects those relying on these programs. I will not go into detail on these cuts, although I will observe that in recent weeks this Congress has authorized billions of new foreign aid spending, yet today we are told we cannot find the money to address Medicaid's long-term financial imbalances. Mr. Speaker, H.R. 5613 may provide some short-term benefit to Medicaid providers, however, it does so by further jeopardizing the long-term fiscal soundness of the Medicaid program. Thus, this passage of this bill will ultimately damage the very low-income Americans the bill aims to help. Mr. UDALL of Colorado. Mr. Speaker, I rise in support of H.R. 5613, the Protecting the Medicaid Safety Net Act of 2008. By passing this bipartisan bill, we can help ensure that our respective States can continue to provide needed health care to citizens who are eligible for Medicaid. I have heard from a number of health care providers, hospital administrators, public health officials, and constituents in my district in regards to seven Medicaid regulations issued by the Department of Health and Human Services. The message has been clear: these regulations have the potential to devastate the health care safety net in Colorado, pulling an extraordinary amount of funding away from the State's health care economy with the highest cost placed on the backs of the most vulnerable. Though I think that all seven regulations deserve a great deal more scrutiny and discussion, there are two regulations in particular that give me serious concern. The first, a regulation that would alter the definition of ``publicly-owned providers,'' would put 34 hospital providers in my State at risk of losing funding budgeted for serving low-income and indigent patients. The Colorado Department of Health Care Policy and Financing estimates that the State would lose $711 million over 5 years--a loss that the Department says would put ``the financial stability of the entire safety-net provider community in Colorado at risk.'' The second regulation with which I am concerned would completely eliminate Medicaid funding for the Graduate Medical Education program, pulling an estimated $60 million from Colorado's teaching hospitals over 5 years. Our teaching hospitals, which play a critical role in providing health care to underserved communities, cannot withstand this sort of hit to their budgets without severely curtailing important services. Broadly speaking, I think that these seven regulations ought to be much more carefully scrutinized. Where some were intended to change Medicaid policy without Congressional authorization, others responded to Congressional action by altering policy beyond what Congress intended. A 1-year moratorium will enable Congress to thoroughly examine these regulations to ensure that States like mine are not devastated by rules that, frankly speaking, appear to undermine the very purpose for which Medicaid was established. I am proud to support this bill, and I look forward to working with my colleagues to ensure that our State Medicaid safety-nets remain strong and viable. Mrs. MILLER of Michigan. Mr. Speaker, I rise in strong support of H.R. 5613, Protecting the Medicaid Safety Net Act of 2008. I believe that any society can be judged on how they treat the most vulnerable--namely seniors, children and the disabled. This measure places a 1-year moratorium on Medicaid regulations and cuts put forward unilaterally by the administration that could have a devastating effect on each of those groups. Some of these cuts would slash access to rehabilitation services, decrease services for foster care and abused children, limit services to the elderly, and persons with developmental disabilities. In fact, these cuts could have a disastrous impact in Michigan on the 21,000 developmentally disabled and 27,000 children with medical conditions--the very people who need our help the most. With Michigan's struggling economy, the high price of gas and home heating, and an overall increase in cost of living, many families need access to these services. The proposed cuts to the Medicaid program have the potential to cost the State of Michigan over 15,000 jobs and the loss of $732 million dollars in Federal funding in the first year alone. And it's set to get worse over the next 5 years resulting in an estimated $3.9 billion in Federal cuts. Delaying these draconian cuts for 1 year will give Congress the opportunity to work together on these issues so that we can better serve those in need across our Nation. I urge my colleagues to support this measure. Ms. WOOLSEY. Mr. Speaker, I rise today in support of H.R. 5613, the Protecting the Medicaid Safety Net Act. This important bill would place a moratorium on seven harmful medicaid regulations. Medicaid provides valuable services to some of our nation's neediest children and families and these regulations would severely impact state budgets and ability to continue to offer the same level of services. If these regulations are implemented, California could lose up to $12.5 billion in Federal Medicaid funds over the next 5 years. In a growing recession, this is the last thing we should be doing. Instead, we should be helping states help those who need access to the medicaid services. To succeed, every child needs access to the best opportunities. A quality education can help these children succeed, but too many children come to school with other issues that need to be addressed: They haven't had breakfast or a meal since the before the weekend, they have been sick and need medication but lack health insurance, or they need some kind of additional help and therapy because of disabilities. These children depend upon the coordination of the state and schools to connect children to these services. A school nurse can help connect a student and his or her family to Medicaid services and help him or her through the enrollment process to ensure that the student can receive asthma medication, eyeglasses, preventative care, or emergency healthcare to come to school and focus on learning. One of these regulations would cease the Federal Government's reimbursement to States for this service. Less outreach will mean fewer children will receive Medicaid services. As we move deeper into an economic recession, more families may lose jobs and health insurance. More children will need access to Medicaid, not less. Schools are a great place to find these children and walk their families through the process to enroll in Medicaid to ensure no child will go without important medical care. Under the Individuals With Disability Act (IDEA), schools are required to provide specialized services to students with disabilities, such as speech and physical therapy. The schools have been allowed to be reimbursed by Medicaid for the cost in transporting the students to these various services. One of the new regulations would eliminate this reimbursement. This would be a terrible burden upon these schools that are already short on funds. We need to help schools get students the education and services they need, not make it more difficult for schools to help these students. These are just two of the seven Medicaid regulations that will do more harm than good and two examples of why we need to pass H.R. 5613 and place a moratorium on these [[Page 6531]] regulations for the time being. I urge my colleagues to support H.R. 5613. Mr. CONYERS. Mr. Speaker, I rise to voice my strong support for H.R. 5613, the Protecting the Medicaid Safety Net Act. This important bipartisan bill extends a moratorium until April 1, 2009 on seven Administration-imposed Medicaid regulations that if implemented, would severely reduce Federal Medicaid funding. Without the moratorium, Medicaid funding to States for vital programs and services would be cut by $18 billion over the next 5 years. These cuts include restrictions on Medicaid payments for graduate medical education (GME), rehabilitation services, and outpatient hospital services, among other services. It would be irresponsible to think about cutting funding to academic medical centers and residency training programs when we currently face a shortage of physicians. If these cuts were allowed to go into effect, we would be unable to provide necessary medical services to many people who depend upon Medicaid. Constantly cutting funds to the very services which keep our fragmented, non-system of health care afloat is inhumane and nonsensical. The tactic of underfunding Federal programs in an attempt to undermine their effectiveness demonstrates the Administration's lack of commitment to the programs that faithfully and effectively serve the American people. Mr. Speaker, passage of H.R. 5613 is simply a necessity. We must halt the underfunding of important Medicaid programs. I wholeheartedly support the passage of H.R. 5613, the Protecting the Medicaid Safety Net Act. Mrs. BACHMANN. Mr. Speaker, today, the House is considering H.R. 5613, Protecting the Medicaid Safety Net Act of 2008. This legislation would place a moratorium on certain rules promulgated by the Centers for Medicare and Medicaid Services, CMS. While I applaud CMS for looking for ways to reduce the burden on taxpayers and to root out fraud which is regrettably rampant in the Medicaid program, some of these proposed rules simply go too far. They shift too great a cost to the States and leave many vulnerable Americans more vulnerable still. And so I will support this temporary stay to give the administration time to consider ways to meet its goals in a less draconian manner. To be sure, the Medicaid program has been abused. For instance, a CMS Inspector General report found $3.8 million in undocumented services in the targeted case management program, one which is impacted by these very rules. And CMS's regulations would certainly combat instances of waste and fraud. However, implementing a 1-year moratorium will give CMS an opportunity to review the regulations and give States and local providers an opportunity to prepare for pending implementation, each knowing that real reform is on the horizon. While I believe it is important to rein in entitlement spending, these rules, as currently formulated and immediately imposed, would jeopardize needed care for some of the most vulnerable populations of Americans. That being said, I am pleased that to address abuses of the Medicaid program, H.R. 5613 provides for anti-fraud enforcement activity in the interim. The bill also provides for the Department of Health and Human Services to hire an independent contractor to produce a report by March 1, 2009, on the proposed regulations and their impact on States. Moreover, all of these costs, as well as the foregone savings resulting from this moratorium are fully offset, meaning H.R. 5613 will not increase the national debt. The Medicaid program has helped millions of America's neediest individuals, including seniors, foster kids and the disabled, gain access to quality care, and while there have indeed been instances of misallocated funds, H.R. 5613 finds balance between regulatory restraint and financial flexibility, and it maintains a strong partnership with the States. Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today in strong support of H.R. 5613, the ``Protecting the Medicaid Safety Net Act of 2008.'' I would like to thank my colleagues Congressman John D. Dingell and Congressman Tim Murphy for introducing this important legislation. Mr. Speaker, this legislation will make vital strides toward expanding and improving access to healthcare to people in our communities who need it most. The Protecting the Medicaid Safety Net Act of 2008 is critical to keeping the doors open for the patients who use the public hospital systems throughout the country. In my home State of Texas, there was statewide and national support from various stakeholders, the Physicians, Governors, County Judges, Mayors, and many others all encouraging passage of H.R. 5613. Section 2 of H.R. 5613 amends the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, 2007 to extend until April 1, 2009, the moratorium on implementation of a proposed rule, ``Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions to ensure the integrity of the Federal-State financial partnerships under Medicaid and State Children's Health Insurance Program, SCHIP, of the Social Security Act, SSA. This Act will extend the moratorium until April 1, 2009, on any action by the Secretary of Health and Human Services, to restrict Medicaid payments for graduate medical education. It also, amends the Medicare, Medicaid, and SCHIP Extension Act of 2007 to extend until April 1, 2009, the moratorium on certain restrictions relating to Medicaid coverage or payment for rehabilitation services or school- based administration and school-based transportation. This moratorium establishes additional moratoria until April 1, 2009, on specified regulatory actions concerning Medicaid: (1) treatment of optional case management services; (2) outpatient hospital services; and (3) allowable provider taxes. Section 3 allows appropriated funds to go to the Secretary for the purpose of reducing fraud and abuse in the Medicaid program. It requires annual reports to specified congressional committees on activities funded by such appropriations, allowing for greater accountability to the people. More importantly, this Act will direct the Secretary to contract with an independent organization to produce a comprehensive report for Congress on the prevalence of such problems: (1) identifying which claims for items and services under Medicaid are not processed through automated data systems; (2) examining the reasons why they are not so processed; and (3) recommending Federal and State actions that can make claims for such items and services more accurate and completely consistent with Medicaid requirements. The administration has propagated Medicaid rules which would limit children's access to health care. According to the Congressional Budget Office, CBO, President Bush and the Centers for Medicare and Medicaid Services, CMS, intend to implement seven separate Medicaid rules which would reduce Federal Medicaid spending by $20 billion over the next 5 years. Specifically, the regulations would be: 1. Narrowing the range of rehabilitation services covered. 2. Narrowing the range of targeted case management services covered. 3. Limiting the outreach services provided by schools and ending reimbursement for transportation to and from school for children with disabilities. 4. Narrowing the range of allowable provider taxes. 5. Limiting the definition of outpatient hospital services provided. 6. Eliminating Federal Medicaid graduate medical education support 7. Limiting State funding mechanisms, including intergovernmental transfers, and capping public provider reimbursement. The combined effect of these actions would be disastrous to the health of all children and children's hospitals. 1. Many of these regulations threaten the most vulnerable children-- children who require the specialty services that Medicaid provides. 2. Children's hospitals care for the sickest and neediest children in our Nation. On average, half of the care children's hospitals provide is to children covered by Medicaid. 3. Because children's hospitals are so dependent on Medicaid funding, any decrease in Medicaid reimbursement would have a profound impact on children's hospitals' abilities to fulfill their core missions of clinical care, training, and research. By undermining the Medicaid safety net, these rules could threaten the ability of all children to access needed health care services. H.R. 5613, the Protecting the Medicaid Safety Net Act of 2008, would place a moratorium until April 1, 2009 on all of these Medicaid regulations. I am proud to cosponsor legislation that will add service before self to our leaders of tomorrow. I urge my colleagues to join me in supporting this legislation. Mr. DINGELL. Mr. Speaker, I have no further requests for time, and I yield back the balance of my time. The SPEAKER pro tempore. The question is on the motion offered by the gentleman from Michigan (Mr. Dingell) that the House suspend the rules and pass the bill, H.R. 5613, as amended. The question was taken. [[Page 6532]] The SPEAKER pro tempore. In the opinion of the Chair, two-thirds being in the affirmative, the ayes have it. Mr. BROUN of Georgia. Mr. Speaker, on that I demand the yeas and nays. The yeas and nays were ordered. The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the Chair's prior announcement, further proceedings on this motion will be postponed. ____________________