[Congressional Record Volume 143, Number 95 (Tuesday, July 8, 1997)]
[House]
[Pages H4873-H4874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 WAIVING MEDICAID ENROLLMENT RULE FOR BETTER HEALTH PLAN OF AMHERST, NY

  Mr. PAXON. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 2018) to waive temporarily the Medicaid enrollment composition 
rule for the Better Health Plan of Amherst, NY, as amended.
  The Clerk read as follows:

                               H.R. 2018

       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 
                   BETTER HEALTH PLAN, INC.

       Effective July 1, 1997, the requirement of section 
     1903(m)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
     1396b(m)(2)(A)(ii)) is waived, for contract periods through 
     December 31, 1998, with respect to the Better Health Plan, 
     Inc. operating in New York.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
York [Mr. Paxon] and the gentleman from New York [Mr. Engel] each will 
control 20 minutes.
  The Chair recognizes the gentleman from New York [Mr. Paxon].
  Mr. PAXON. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. PAXON asked and was given permission to revise and extend his 
remarks.)
  Mr. PAXON. Mr. Speaker, I rise today in support of H.R. 2018, 
legislation I offered along with my colleagues from New York on the 
Committee on Commerce. Our legislation is but a small piece of 
legislation but it is absolutely vital to many Medicaid recipients in 
the State of New York.
  Better Health Plan, based in my district in Amherst, New York, needs 
an extension of their 75/25 waiver which expired on June 30, 1997. The 
75/25 rule requires that any Medicaid managed care plan enroll at least 
25 percent of their patients from the private sector. Without this 
legislation, Better Health Plan would be forced to disenroll thousands 
of Medicaid recipients. These recipients would face a disruption of 
their health care, and Mr. Speaker, we cannot allow this to happen. The 
75/25 rule would be eliminated under the President's proposed budget as 
well as the congressional budget plan. Unfortunately the budget bill 
was not signed into law by June 30 of this year. Therefore, we need to 
take quick and decisive action on H.R. 2018.
  I must also point out that the New York State Department of Health 
and Better Health Plan were hoping the State's 1115 Medicaid waiver 
would be approved by this time. Approval of the 1115 waiver would have 
provided relief without the need for congressional action. 
Unfortunately, we were told by HCFA that a decision on the 1115 rule 
waiver would not come before June 30, 1997.
  It is because of this that I offer H.R. 2018 today and ask that my 
colleagues quickly approve this legislation so that Better Health Plan 
may continue to provide quality health care to Medicaid beneficiaries, 
as they have since 1994. Better Health Plan is a Medicaid prepaid 
health services plan approved by the New York State Department of 
Health. At present, Better Health Plan operates in New York City and 11 
counties across the State of New York. Better Health serves over 41,500 
individuals of which 36,700 are Medicaid recipients.
  I received a letter from the New York State Department of Health 
verifying that mandated surveys have been conducted by the State and 
there have been no quality-of-care deficiencies with Better Health 
Plan.
  Therefore, before I close, I would like to thank my colleagues, the 
gentlemen from New York, particularly Mr. Engel, Mr. Towns, Mr. Manton, 
and Mr. Lazio who have all been helpful in bringing this legislation to 
the floor. I would also like to thank the gentleman from Virginia [Mr. 
Bliley] and his staff for their prompt attention to this situation. It 
is because of this bipartisan effort that we will ensure that Medicaid 
patients in New York City/State will continue to receive quality health 
care.
  Mr. Speaker, I reserve the balance of my time.

                              {time}  1630

  Mr. ENGEL. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I join with my friend and colleague, the gentleman from 
New York [Mr. Paxon], in strong support of H.R. 2108.
  Let me say, as he has said, the five members of the Committee on 
Commerce from New York all strongly support the bill. Indeed, the 
Committee on Commerce passed the bill unanimously by voice vote. This, 
as the gentleman from New York said, would grant a waiver for the 
Better Health Plan from the 75-25 rule.
  The Better Health Plan covers people throughout New York State, 
mostly northern New York, but also in the city of New York as well, and 
the 75-25 rule states that any Medicaid HMO plan must have a minimum of 
25 percent participation from non-Medicaid enrollees. This rule has 
been eliminated in the Medicaid portion of the budget reconciliation 
measure.
  However, as was pointed out, the budget plan has yet to be enacted 
and, because of that, Better Health must now begin disenrolling 
patients unless the bill before us is enacted. Better

[[Page H4874]]

Health Plan is a Medicaid prepaid health services plan approved by the 
New York State Department of Health to operate in the State since March 
30, 1994. At present, as I mentioned, the plan operates in the five 
boroughs of New York City, as well as Westchester County, which I also 
represent, and in 11 other counties, and serves over 41,000 enrollees, 
including 37,000 Medicaid recipients.
  Surveys conducted by the State of New York have not reported any 
quality of care deficiencies with Better Health. For the last 3 years, 
Better Health has operated under an exemption to the 75-25 rule that 
was granted by HCFA in June 1994. The waiver period ended last week on 
June 30 and Better Health will be required to send out notices of 
disenrollment to its enrollees unless this legislation is enacted. That 
is why it is so important we enact this legislation today. We must pass 
the measure before us today in order to ensure that the patients 
continue to receive the care they need.
  I also want to mention, Mr. Speaker, that in addition, there are two 
other plans in New York that are also requesting waivers and find 
themselves in the same predicament that Better Health has found itself, 
and these two other plans are Health First and Genesis, the latter of 
which is in my district to a very large degree.
  While both plans will not have to disenroll patients until later this 
year, because their waiver lasts a little longer, I would have 
preferred to see waivers granted for these plans also. I would have 
preferred to have seen it all in one bill. But should there be delays 
or problems arising in the future on the budget plan, I plan to work 
with my friend from New York, Mr. Paxon, and the Committee on Commerce 
should we need to address the situation later on in the year with 
regard to the other plans that I mentioned. So, Mr. Speaker, I strongly 
urge my colleagues to support this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PAXON. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  Mr. ENGEL. Mr. Speaker, I yield such time as he may consume to the 
gentleman from New York [Mr. Towns].
  Mr. TOWNS. Mr. Speaker, I thank my colleague for yielding me this 
time, and I want to begin by saying that I want to thank Members on 
both sides of the aisle and the leadership for moving this bill very 
quickly. Also I want to thank the staff on both sides of the aisle who 
have done a superb job. I could call the names, but I will not get into 
that because I might just leave a name out.
  The Better Health Plan serves over 40,000 Medicaid recipients in the 
New York area. This plan provides services all over the five boroughs 
of New York City, including my district, which has close to 2,000 
beneficiaries. Better Health Plan offers many innovative health care 
programs for its Medicaid members and helps them become better 
consumers of health care, which is very, very important.
  The plan also offers a wide variety of preventive services, including 
vision, hearing, lead screening tests and also provides counseling 
services for alcohol and tobacco and drug habits as well. The 
legislation waives the Medicaid 75-25 rule and will continue to make 
this plan available to New York residents.
  My colleague mentioned earlier that there were some other New York 
plans that were also concerned about the fact that they were not 
included in this legislation. It is my hope that the waiver will come 
about and that we will not have to do that, but in the event it does 
not occur, I would like to assure him that I will join him in doing 
everything that I can to make certain that they are included because we 
need to make certain that people do not need to have frustration and 
tension because of the fact the 75-25 rule is in effect.
  Again, Mr. Speaker, I want to thank my colleagues, the gentlemen from 
New York, Messrs. Paxon, Engel, Manton and Lazio, and also thank my 
staff person, Brenda Pillors, who worked very hard on this.
  Mr. MANTON. Mr. Speaker, as an original cosponsor of this 
legislation, I rise in strong support of H.R. 2018, a bill to extend 
the 75-25 Medicaid waiver for Better Health Plan of Amherst. I want to 
thank my colleagues on the Commerce Committee, particularly 
Representatives Paxon, Towns, Engel, and Lazio for their efforts in 
bringing this legislation to the floor in such a swift manner.
  Better Health Plan of Amherst provides essential services to its 
beneficiaries in the five Boroughs of New York City and eleven counties 
throughout New York State. Of the 40,000 individuals Better Health Plan 
serves, 36,700 are Medicaid recipients. H.R. 2018 would ensure 
uninterrupted delivery of quality health care for those who rely on the 
services provided by Better Health Plan. The quality services provided 
by Better Health Plan range from increased access to health care to 
intensive health education for its members.
  Mr. Speaker, I urge my colleagues to support this legislation which 
would guarantee that Better Health Plan of Amherst can continue to 
provide quality, low-cost health care to its numerous beneficiaries.
  Mr. QUINN. Mr. Speaker, I rise today in support of H.R. 2018, a bill 
that provides a temporary Medicaid waiver for the Better Health Plan in 
New York. This is a bill that I strongly support, Mr. Speaker, and I 
urge all of my colleagues to do the same.
  Thousands of Medicaid patients in New York are anxiously waiting to 
see if the doors to their health care office will remain open tomorrow 
morning, due to the 75/25 Medicaid enrollment provision. According to 
this provision, 25 percent of a health plan's patients must be enrolled 
from the private sector. If a health plan cannot meet this goal, they 
must start disenrolling patients. The Better Health Plan, in Amherst, 
NY is in danger of having to disenroll more than 36,000 Medicaid 
recipients, since their 75/25 waiver expired on June 30 of this year.
  This bill will grant the Better Health Plan an extended waiver of the 
75/25 provision until December 31, 1998, thereby aiding low income New 
York residents. I remain committed to ensuring quality care for New 
York Medicaid patients, which can be done by other means than a 75/25 
provision. However, we cannot and should not sit here and order health 
care providers to close their doors on more than 40,000 patients. Quick 
action is needed to ensure that the quality care that Medicaid patients 
are now receiving from health plans will continue. The future of 
Medicaid recipients hangs in the balance at this time while the very 
real threat of termination of care and services to these lower income 
residents is dependent upon this vote. Please don't let these people 
down, support H.R. 2018.
  Mr. ENGEL. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Goodling). The question is on the motion 
offered by the gentleman from New York [Mr. Paxon] that the House 
suspend the rules and pass the bill, H.R. 2018, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________