[Congressional Record Volume 142, Number 119 (Wednesday, September 4, 1996)]
[House]
[Pages H9936-H9938]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                WAIVING MEDICAID ENROLLMENT COMPOSITION

  Mr. TAUZIN. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3871) to waive temporarily the Medicaid enrollment 
composition rule for certain health maintenance organizations.
  The Clerk read as follows:

                               H.R. 3871

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

     SECTION 1. WAIVER OF 75/25 MEDICAID ENROLLMENT RULE FOR 
                   CERTAIN MANAGED CARE ORGANIZATIONS.

       The requirement of section 1903(m)(2)(A)(ii) of the Social 
     Security Act is waived--
       (1) with respect to Catholic Health Services Plan of 
     Brooklyn and Queens, Inc. (doing business as Fidelis Health 
     Plan) and Managed Healthcare Systems of New York, Inc., for 
     contract periods through January 1, 1999, and
       (2) with respect to Health Partners of Philadelphia, Inc., 
     for contract periods through December 31, 1999.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Louisiana [Mr. Tauzin] and the gentleman from New Jersey [Mr. Pallone] 
each will control 20 minutes.
  The Chair recognizes the gentleman from Louisiana [Mr. Tauzin].
  Mr. TAUZIN. Mr. Chairman, I yield myself such time as I may consume.
  (Mr. TAUZIN asked and was given permission to revise and extend his 
remarks.)
  Mr. TAUZIN. Mr. Speaker, on behalf of Chairman Bliley and Chairman 
Bilirakis, I bring to the floor H.R. 3871 and urge support of the 
measure.
  H.R. 3871 amends title 19 of the Social Security Act to extend 3 
existing 75-25 percent waivers of section 1903. Section 1903 is the 
section of the current Medicaid law that requires that Medicaid 
beneficiaries constitute less than 75 percent of the membership of any 
prepaid health maintenance organization.
  A present, a number of States and health plans are operating under 
federally approved waivers of this section. The bill we are considering 
today extends those 75-25 waivers held by 3 of these plans: Health 
Partners of Philadelphia, Fidelis Health Plan of New York, and Managed 
Healthcare Systems of New York.
  Health Partners of Philadelphia is a not-for-profit voluntary health 
maintenance organization comprised of local teaching hospitals. It is 
independently licensed by the Commonwealth of Pennsylvania and fully 
accredited by the National Committee for Quality Assurance. It serves 
approximately 87,000 Medicaid recipients and 250 commercially enrolled 
individuals in Philadelphia and the surrounding area.
  While Health Partners' chief focus is on primary care, health 
education and prevention, it also provides transportation services, 
expanded vision and dental benefits, multilingual capability, 24-hour 
access to mental health and substance abuse treatment, as well as home 
visits for new and expectant mothers and fathers.
  Fidelis Health Plan, operated by the Catholic Health Services Plan of 
Brooklyn and Queens, was established by the Catholic medical center 
which serves those two areas. The principal focus of the care provided 
by Fidelis to its 19,960 Medicaid recipients is primarily in preventive 
care as well as health education. Enrollees elect their own primary 
care practitioner who serves as personal provider and coordinates the 
primary and specialty care they receive through the plan.
  Finally, Managed Healthcare Systems of New York, a minority-
controlled managed care company founded

[[Page H9937]]

in 1994, serves nearly 39,000 enrollees in Brooklyn and Queens. MHS' 
primary and preventive care and health education services are conducted 
with the use of mobile health vans, a school-based health center, an 
after-school learning center, newly established primary care clinics, 
as well as community outreach efforts for pregnancy, asthma, diabetes, 
sickle cell anemia, tuberculosis, and HIV/AIDS.
  I urge my colleagues to support this noncontroversial measure so that 
we can continue to improve the services that Medicaid beneficiaries 
receive.
  Mr. Speaker, I would like to thank the gentleman from New Jersey [Mr. 
Pallone] for his efforts and those of the minority in bringing this 
bill forward.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  We have no objection to passage of H.R. 3871 before us today on the 
Suspension Calendar. As was mentioned by the gentleman from Louisiana 
[Mr. Tauzin], the bill amends the section of current Medicaid law which 
requires that Medicaid beneficiaries cannot constitute more than 75 
percent of the membership of any prepaid health maintenance 
organization.
  Basically 3 plans, Health Partners of Philadelphia, Fidelis Health 
Plan of New York, and Managed Healthcare Systems of New York, would 
continue operating under their federally approved waiver of this 
provision for an additional 2 years, and under the conditions of the 
waiver the Health Care Financing Administration will continue to 
monitor these plans to ensure that these Medicaid beneficiaries are 
receiving appropriate quality care.
  Mr. Speaker, I yield 2 minutes to the gentleman from New York [Mr. 
Manton].
  Mr. MANTON. Mr. Speaker, I rise to express my strong support for H.R. 
3871. Under this legislation, the Catholic Health Services Plan of 
Brooklyn and Queens, also known as Fidelis Care, and the Managed 
Healthcare Systems of New York would have their current waiver of the 
75-25 Medicaid requirements extended through January 1, 1999.
  Fidelis Care began enrolling members in Queens in November 1994 by 
providing a prepaid health services plan.
  With a current enrollment of 18,960, the plan provides a 
comprehensive package of benefits available to all its members. The 
Catholic Medical Center of Brooklyn and Queens, which sponsors Fidelis 
Care, provides excellent health care services to my constituents. This 
legislation would allow them to continue to deliver their quality 
health services to the communities of Queens and Brooklyn.
  This legislation also addresses the Managed Healthcare System of New 
York which has been a true community organization by serving Brooklyn 
since January 1994.
  Currently serving 39,000 enrollees in Brooklyn and Queens, MHS brings 
high quality managed care to inner-city communities. Many programs 
provided by MHS are available to all residents of the community, 
regardless if they are members of MHS.
  I commend my colleagues, Mr. Towns, Franks, and Greenwood, for their 
efforts in crafting H.R. 3871 and I look forward to the passage of this 
simple, yet important legislation.
  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
the District of Columbia [Ms. Norton].
  Ms. NORTON. I thank the gentleman for yielding me this time, and I 
thank the chairman and the ranking member for this legislation.
  Mr. Speaker, this legislation does not directly affect the District 
of Columbia but rather 3 plans in Philadelphia and New York. Yet I feel 
compelled to come to the floor to rise in strong support of H.R. 3871, 
in a real sense, as they say ``in the street,'' because we have been 
there and done that.
  For a number of years we have had a similar plan in the District 
which, at low cost, rendered exceptional care to Medicaid recipients. 
It took an enormous amount of work to get a waiver. I am particularly 
grateful to the committee for its help in obtaining that waiver for 
Chartered Health Care that goes until October 1, 1999.
  I simply would like to bring out the larger issue involved in what 
may look like a private bill. It is not that at all. These plans have 
to come here because of the way the statute is structured.
  The notion that at least 25 percent in a plan have to come from the 
commercial sector, from private parties, like us, and not only from 
welfare recipients, is very well-intentioned, particularly if you 
recall Medicaid mills, some of which perhaps still exist today. The 
problem, of course, which this proxy for quality is that these plans 
serve largely inner city residents. They are not a part of larger 
organizations like Blue Cross and Blue Shield, and so they encounter 
great difficulty when they try to recruit 25 percent of their clientele 
from people who are already attached to Blue Cross and Blue Shield or 
larger operations or HMO's near their own workplaces.
  The disabilities that come with not getting this waiver are great and 
are passed onto cities and ultimately to us and to the Federal 
Government. They cannot borrow as easily, they pay higher interest 
pending a waiver, but they are doing a remarkable service. They behave 
like managed care organizations but they have to be paid on a fee-for-
service model without these waivers.
  Health Care Financing Administration of course, monitors these 
organizations, and so this legislation carried no risk, but what it 
does do is free these organizations to do the job that must be done in 
the inner cities to keep people from going to emergency rooms and going 
to doctors who charge too much. I commend both sides for the work they 
have done on this bill.


                             General Leave

  Mr. TAUZIN. Mr. Speaker, I ask unanimous consent all Members may have 
5 legislative days within which to revise and extend their remarks on 
H.R. 3871.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Louisiana?
  There was no objection.
  Mr. BILIRAKIS. Mr. Speaker, I would like to join my colleagues in 
supporting H.R. 3871. This measure amends section 1903 of the Social 
Security Act to extend the ``75-25'' waivers of three worthy health 
plans. As such, it represents a positive step in our efforts to build a 
better Medicaid Program.
  In the past, the Federal Medicaid statute has been amended to address 
needs and concerns specific to the role of health maintenance 
organizations [HMO's] in the Medicaid Program. As in the commercial 
sector, HMO's increasingly play a valued role in providing high-
quality, efficient health care services. Nevertheless, there have been 
instances where intervention has been necessary.
  Early State experimentation with managed care resulted in occasional 
reports of inaccurate information dissemination to enrollees, 
restricted access to nonparticipating providers, inconsistent provision 
of benefits, and, in certain cases, financial instability of the 
enrolling plan.
  In response, Congress has undertaken various actions over the last 20 
years to ensure that all managed care enrollees receive the quality 
care for which the industry is known. Unfortunately, certain unintended 
consequences resulted.
  For example, the Health Maintenance Organization Amendments of 1976, 
which limited the percentage of Medicaid and Medicare beneficiaries 
enrolled in risk contracts to 50 percent, had the unintended effect of 
sharply limiting managed care enrollment by Medicaid beneficiaries. In 
fact, by 1981 little more than 1 percent of the Medicaid population 
were enrolled in HMO's. Just as startling, 85 percent of those 
beneficiaries were located in just four States.
  Congress sought to correct this problem in the Omnibus Budget 
Reconciliation Act of 1981 which, among other changes, increased the 
allowable percentage of Medicaid beneficiaries that could be enrolled 
in HMO's from 50 percent to 75 percent.
  But as we have seen in far too many instances, current Medicaid law 
still creates significant obstacles for plans that focus on the needs 
of low-income communities. Although these plans have achieved notable 
success in enhancing the quality of care received by area Medicaid 
beneficiaries, they have been less successful in attracting commercial 
clients from outlying areas.
  The current law requirement that one-quarter of their enrolled 
population consist of such customers, therefore, often places them in 
the difficult position of having to choose between devoting resources 
to their Medicaid-funded enrollees or to the expense of competing 
against broader-based firms for commercial clients.
  Clearly, fundamental reform of the Medicaid Program is needed. Until 
such time as a more favorable climate for such reform exists, however, 
measures like H.R. 3871 are necessary

[[Page H9938]]

to relieve well-performing health plans of the unreasonable and often 
counterproductive requirements of title XIX.
  In this case, I am glad to say, we will remove the obstacles that 
threaten three noteworthy plans: Health Partners of Philadelphia, 
Fidelis Health Plan--operated by the Catholic Health Services Plan of 
Brooklyn and Queens--and Managed Healthcare Systems of New York.
  I commend my colleagues on both sides of the aisle for supporting 
this measure. With it, the Medicaid recipients of the Philadelphia and 
New York City regions will continue to receive high-quality, efficient, 
and responsive health care services.
  I thank you.
  Mr. PALLONE. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  Mr. TAUZIN. 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 Louisiana [Mr. Tauzin] that the House suspend the rules 
and pass the bill, H.R. 3871.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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