[Congressional Record Volume 140, Number 146 (Saturday, October 8, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: October 8, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                        TECHNICAL CORRECTION ACT

  Mr. ROCKEFELLER. Mr. President, I am extremely pleased that after 
several years of hard work, we are finally able to enact a number of 
Medicare provisions, mostly of a technical and clarifying nature. But 
many of these provisions are of great importance to my home State, 
especially in the case of the Essential Access Community Hospital and 
Rural Primary Care Hospital Program.
  West Virginia is one of seven States that is participating in the so-
called EACH/RPCH Program. West Virginia is serving as a national model 
of how to maintain essential and emergency health care services in 
rural and remote areas. This legislation contains a number of 
provisions to give hospitals additional flexibility to help them make 
the transition from a full service acute care hospital to a health care 
facility that provides emergency services, limited inpatient care, and 
other health services identified as vital to a particular community.
  Two hospitals in West Virginia, Broaddus Hospital in Phillipi and 
Webster County Memorial Hospital, have already been federally 
designated as rural primary care hospitals. They are two of only a 
handful of hospitals officially designated as RPCH's nationwide since 
the program was enacted in 1989. Part of the delay has been due to the 
inability of Congress to enact these technical amendments which have 
been stalled in the legislative process for the past few years. For 
example, this legislation clarifies that ``rural primary care 
hospitals'' may keep patients hospitalized for an average of 72 hours, 
rather than no longer than 72 hours. Without the EACH/RPCH Program, the 
only other option for many small, rural hospitals is to shut their 
doors.
  This legislation also includes a key extension for the authorization 
for the Rural Health Transition Grant Program. This grant program has 
benefited many hospitals in West Virginia since its enactment in the 
mid-1980's. Many West Virginia hospitals have already received funding 
to develop rural health care networks, for management improvements, 
recruitment and retention of health care providers, and to enhance 
outpatient services.
  I am particularly pleased that this legislation includes a provision 
that clarifies legislation I authored, which was successfully enacted 
in 1989, that expanded Medicare reimbursement to include coverage for 
mental health services provided by psychologists. Previously, millions 
of Medicare beneficiaries, particularly residents of rural areas, were 
unable to have access to mental health services because psychiatrists 
were the only recognized mental health providers under Medicare. In 
West Virginia, almost 40 percent of the rural elderly live in areas 
without a psychiatrist. That's why I felt it was so important for the 
Medicare Program to catch up with other health insurance programs and 
State laws.

  This legislation also completes action on a piece of legislation 
which I introduced in 1991, the Medicare Cancer Coverage Improvement 
Act. The sole provision of this legislation that has yet to be enacted 
is included in this technical bill as well. It instructs the Secretary 
of Health and Human Services to study the costs of patient care for 
Medicare beneficiaries enrolled in clinical trials of new cancer 
therapies. This will allow patients to participate in clinical trials 
which may save their lives, instead of forcing them to back into 
therapies already deemed useless by their doctors. It is time to 
develop a rational policy to make sure Medicare beneficiaries are not 
unfairly denied access to the best available care. As that National 
Cancer Institute has frequently noted, treatment provided under a 
clinical protocol is state-of-the-art cancer therapy.
  Mr. President, I am also pleased that this legislation contains a 
provision to extend the Medicare Select Program for another 6 months. 
While currently limited to 15 States, this Medigap insurance policy 
option has resulted in lower premiums for many Medicare beneficiaries. 
A recent Consumer Reports included 8 Medicare Select policies in the 
top 15 rated Medigap products nationwide.
  Last year, I introduced the Family Preservation and Child Protection 
Reform Act with Senator Bond which called for new Federal funding for 
child welfare services, with an emphasis on preventive service to 
children. Thanks to the leadership of our President, we made a 
downpayment on child welfare reform with almost $1 billion in new 
flexible funding in the budget bill signed into law last year. This 
bill helps to fill in the gaps by moving forward on provisions that 
could not be in the reconciliation bill because of procedural rules of 
the Senate. This package includes basic action for child welfare 
traineeships, and other necessary enhancements.
  I would especially like to commend Chairman Moynihan and the ranking 
member, Senator Packwood, for their leadership on the Suter issue, 
which covers the enforcement of State plans of child welfare, welfare 
and other provisions of the Social Security Act. A sweeping Supreme 
Court decision eliminated an individual's right to sue to enforce 
provisions of State plans under the Social Security Act. This caused 
real concern, and I joined with several of my Senate colleagues in 
petitioning the finance committee to review this court decision and its 
impact on States and children in 1992. Senators Moynihan and packwood 
held a hearing which helped to forge a compromise on this issue. That 
compromise is part of this legislation.
  Also, I would like to mention that this legislation makes 
improvements in child support enforcement. It includes a provision, 
similar to a bill I sponsored in the past, to require States to provide 
information to credit bureaus about overdue child support. If an 
individual places their credit rating at risk by missing a car payment, 
shouldn't the same thing happen if they are at least 2 months 
delinquent on their child support payments.
  Mr. President, I have only listed a few of the provisions that 
illustrate the scope and importance of this legislation, even though it 
is called a ``technical corrections'' bill. Again, despite its 
technical nature, this bill will provide important assistance to rural 
areas and other health care providers, and help children and families 
get the services they need.
  Mr. MOYNIHAN. Mr. President, I urge Senators to support enactment of 
H.R. 5252, the Social Security Act Amendments of 1994, which was 
reported by the Finance Committee on November 17 of last year, and was 
passed by the House just yesterday.
  The bill contains a number of important technical corrections and 
miscellaneous Social Security Act provisions that enjoy bipartisan 
support in both the Senate and the House. These provisions could not be 
included in the Omnibus Reconciliation Act of 1993 because they had no 
budgetary impact. Under the strict rules of budget reconciliation in 
the Senate, any provision that has no impact on Federal spending is 
subject to a point of order.
  While the Finance Committee excluded these provisions from its budget 
package, the House of Representatives passed many of these provisions 
as part of its 1993 budget package. In conference last year, the 
chairman of the Committee on Ways and Means and I agreed to develop a 
separate bill to include all the budget-neutral, noncontroversial 
provisions that could not be included in the 1993 budget reconciliation 
legislation. The result is the bill before us today.
  H.R. 5252 includes provisions that will make substantial improvements 
in Social Security Act programs. It will improve the enforcement of 
child support, assure better protection of abused and neglected 
children, extend the Medicare select demonstration programs which allow 
Medicare beneficiaries to participate in managed health care plans, and 
make other improvements in the Medicare Program.
  The bill also includes the Welfare Indicators Act, a bill which I 
sponsored, and which will begin to generate the information needed to 
understand the problem of welfare dependency. It requires the Secretary 
of Health and Human Services, in consultation with the Secretary of 
Agriculture, to develop, first, indicators of the rate at which, and 
the degree to which, families depend on income from welfare programs, 
and the duration of welfare participation; and second, predictors of 
welfare receipt. The Secretary will be required to prepare an annual 
report on welfare receipt that provides information on trends, 
predictors, and causes of welfare receipt, including recommendations 
for legislation to reduce welfare recipiency.
  Mr. DODD. Mr. President, I rise to address an issue of concern to me 
and many others in this Chamber. I am referring to the Medigap 
amendments contained in the Social Security Amendments Act of 1993. I 
am concerned about the potential negative impact of a certain provision 
on the innovative public/private long-term care insurance partnership 
programs now underway in my State of Connecticut, in Indiana, 
California, and New York, and in projects being developed in the States 
of Maryland, Illinois, and Iowa. These programs are designed to provide 
cost-effective long-term care coverage to middle income people.
  It is my understanding that while the Medigap amendments legislation 
is not intended to put a halt to these programs or to have a negative 
impact on such programs, this may be the unintended result of the 
legislation before us.
  The Partnership Program involves long-term care policies which 
coordinate benefits with the Medicare Program. This means that such 
policies will combine with Medicare to pay maximum benefits but not 
more than 100 percent of the cost, as this would be against good public 
policy. This coordination feature reduces cost and therefore helps 
produce more affordable coverage.
  However, I further understand that because the majority of long-term 
care policies sold to seniors do not so coordinate with Medicare, the 
legislation might be read by some in a way that assumes that 
coordination is not the norm. Since coordination is a critical issue 
for Connecticut and other partnership States and because I believe 
there is no intent on the part of the Senate Finance Committee to ban 
coordination of benefits, I would hope that the committee chairman 
might clarify this point.
  Mr. MOYNIHAN. I understand the concern of the Senator from 
Connecticut and the issue he raises regarding how coordination is to be 
addressed. Because these amendments are not effective until after 
regulations have been published, there is ample time to work with the 
Senator and the administration to ensure an appropriate outcome to the 
regulatory process regarding this issue. It is my hope that the 
regulatory process will address the issue of coordination in a way that 
encourages cost-effective long-term care coverage, including the public 
private partnership programs in Connecticut, Indiana, California, New 
York, and other States. I do not intend that this legislation halt such 
cost-effective programs.
  It must also be stressed that it is important for these Medigap 
amendments to pass the Senate today because without these amendments 
which passed both the House and Senate already in 1992, the underlying 
statute makes it clearly illegal to sell health insurance policies that 
duplicate Medicare benefits. Therefore, even though there may be 
questions about the implications of some of these new provisions, it is 
of utmost importance that we clarify the underlying statute by passing 
this bill, so that people in need of insurance benefits can purchase 
them.
  Mr. DORGAN. Mr. President, I rise in support of H.R. 5252, the 
proposed extension of the Medicare select demonstration project.
  Medicare select is a 15-State demonstration project that allows 
Medicaid beneficiaries to buy their supplemental insurance, known as 
``Medigap'' policies, through managed care plans. This demonstration 
project has been very successful, in my State of North Dakota and the 
other 14 States, at keeping supplemental premiums low. In North Dakota, 
Medicare select policies are 16 percent less expensive than identical, 
supplemental policies.
  The Medicare select demonstration project expired a few days ago, at 
the end of the last fiscal year. The project would have been extended 
by any of the major health care reform bills considered this year. By 
extending the Medicare select program today, 400,000 Medicare 
beneficiaries nationwide, including 10,000 North Dakotans, will be able 
to keep their Medicare select policies, rather than be forced to buy 
more expensive supplemental insurance.
  If we had let this program expire, it would have cost each of these 
10,000 North Dakota senior citizens about $144 per year more than they 
are paying now. This is a total of $1.44 million right out of their 
pockets. They are not wealthy folks. These are primarily retired people 
who live on fixed incomes. They already are spending a substantial 
portion of their limited income on health care--including copayments, 
deductibles, prescription drugs.
  Medicare select helps these people make ends meet. It means they have 
a little extra money each month to pay for their medicine--to buy 
winter clothes--or maybe to have a holiday dinner.
  I am glad we did not penalize our senior citizens by failing to act. 
I thank my colleagues for joining me in supporting this legislation to 
extend the highly successful Medicare select demonstration project.
  Mr. FEINGOLD. Mr. President, I was pleased to see that H.R. 5252 has 
passed the Senate without a provision, included in earlier versions of 
the measure, intended to change current law with respect to so-called 
estate recoveries under medical assistance.
  Last year, we enacted a change to the estate recovery law as part of 
the Omnibus Budget Reconciliation Act of 1993 [OBRA 93]. OBRA 93 allows 
States to recover, from the estates of Medicaid beneficiaries over age 
55, either the cost of Medicaid nursing home services, home and 
community-based services, hospital services, and prescription drug 
services, or the cost of other services provided under the State 
Medicaid plan.
  An effort was made, in earlier versions of this legislation in the 
Senate, to change the law as it relates to this provision. In 
particular, the proposed change would have limited State options with 
respect to estate recoveries by mandating that States pursue recovery 
for certain specified services, including home and community-based 
services.
  As we saw in Wisconsin, requiring liens to be attached to the homes 
of elderly disabled individuals has a cruel, unintended result. When 
that policy was implemented briefly in Wisconsin in 1991 with respect 
to home and community-based services, scores of elderly disabled 
individuals in need of long-term care refused home and community-based 
services because of the estate recovery requirements, with the result 
that many of these people were at risk of imminent placement in 
institutional settings, settings that are often much more expensive to 
taxpayers.
  Fortunately, the Wisconsin Legislature repealed the measure, removing 
a significant barrier to the less expensive home and community-based 
long-term care alternative.
  Mr. President, we need comprehensive long-term care reform. 
Specifically, we need a home and community-based program of flexible, 
consumer-oriented and consumer-directed services. But until we pass 
that kind of reform, our home and community waiver programs will be the 
closest alternative that the disabled of all ages will have. It is 
vital that we make those services as accessible as possible for that 
population.
  

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