[Congressional Record Volume 144, Number 10 (Wednesday, February 11, 1998)]
[House]
[Pages H409-H410]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               HR 2912 MEDICARE VENIPUNCTURE FAIRNESS ACT

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from West Virginia (Mr. Rahall) is recognized for 5 minutes.

[[Page H410]]

  Mr. RAHALL. Mr. Speaker, I feel like the old farmer who was being 
severely chastised by his fellow farmers for beating his mule over the 
head because he wouldn't respond to a simple ``gitty-up.'' The farmer 
gave the stubborn old mule one final whap, and the beast of burden 
began moving swiftly ahead, pulling his load. The old farmer looked at 
his fellow farmers, as he tossed the two-by-four on the back of the 
wagon for future use and said:
  First, you have to get their attention.
  Last week I sent out a Dear Colleague about the termination of the 
Venipuncture home health benefit to get everyone's attention by asking: 
Have we No Shame?
  While it may have felt like a two-by-four to many, hopefully it went 
to the heart of this body so that it can move toward doing something 
about the fact that the wildly applauded, history-making Balanced 
Budget Act contained language did, on February 5, 1998, terminate the 
13-year old Venipuncture or blood drawing procedure as a skilled home 
health benefit under Medicare.
  I hoped a two-by-four would alert them that this lost benefit is 
having a severe, life-threatening impact on seniors, and that we need 
to fix it.
  We can and have spent hours on this floor renaming our National 
airport, but we have not spent any time on this floor talking about the 
gross and severe hardships caused by the loss of venipuncture as a home 
health benefit. I happen to think Venipuncture is more important.
  My colleagues, we have a dire situation here.
  We have HCFA promising that venipuncture can still be allowed, but we 
don't have HCFA explaining how difficult that could be.
  We don't have HCFA spelling out that patients need to get to their 
doctors and ask for a reevaluation leading to a new authorization for 
them to receive a NEW skilled care so that venipuncture can continue.
  And we don't have a lot of doctors out there willing to take a chance 
on being audited themselves if they actually do re-qualify a former 
venipuncture patient for a new skilled care.
  We don't have HCFA spelling out that while most areas, and assuredly 
not rural areas, don't have laboratory technicians that make house 
calls--HCFA still insists that these elderly, frail disabled patients 
contact a lab technician and ask them to make house calls in order to 
draw blood--for which HCFA will pay the princely sum of $3.
  And it is a little known fact--but some States have laws AGAINST lab 
technicians leaving their labs for any reason to perform blood work in 
a patient's home.
  Now if venipuncture patients CAN'T requalify through their doctors 
for a NEW skilled care benefit, and if the patients CAN'T find a local 
lab technician willing to travel 50 to 100 miles in rural America to 
make a house call for a paltry $3, then venipuncture ISN'T available--
is it?
  So, while it is technically correct for HCFA to day that patients can 
still get venipuncture, they don't spell out the two big ``IF's''--and 
so the REALITY is that for the most part, Venipuncture patients are out 
in the cold and without services and unlikely to obtain them ever 
again.
  And my colleagues, if you think doctors are afraid of the wrath of 
HCFA's auditors, listen to what Medicare's Fiscal intermediaries are 
saying.
  Fiscal intermediaries are saying: venipuncture better not show up on 
ANY new claims received after February 5, 1998, even in conjunction 
with another new SKILLED benefit, because they will be denied. Fiscal 
intermediaries are afraid of audits too.
  But the most offensive thing I've heard yet is that one fiscal 
intermediary official stated that in fact he believed that without 
venipuncture services, some of the patients could end up in the 
MORTUARY--his word--not mine--end up in the mortuary.
  And this same official also stated it was ``too bad, so sad . . .'' 
about patients ending up in mortuaries.
  No wonder you need a two by four to get folks' attention--when those 
in charge of processing home health benefit claims for the homebound, 
elderly, sick and terminally ill can state publicly that it's ``too 
bad, so sad . . .'' about former patients ending up at the local 
morgue--AND NO ONE RAISES AN EYEBROW?
  I wish we could get a hearing on this matter. I wish we could get a 
hearing and bring in this intermediary to the witness table and ask him 
to repeat his offensive statements for the public record. I wish we 
could get the intermediary to tell us why he thinks people might die 
without venipuncture.
  I believe it is true that patients might die without this benefit--
but I guess as long as they don't die in epidemic proportions--no one 
will care.
  Well, I care.
  I know of 71 Members of this House that care because they cosponsor 
H.R. 2912.
  My colleagues who are speaking during this special order tonight--
they care, and I thank them for caring.
  There are alternatives to terminating the benefit. Congress could 
grandfather in those patients now receiving venipuncture, but not allow 
any new patients to be covered by the benefit except as described in 
the BBA.
  Or, Venipuncture could be retained as a skilled care, but placed 
under the requirement, also in the BBA, that it be administered by HCFA 
using normative standards as is required for other home health benefits 
under Medicare.
  I am listening and I am ready to work with the committees of 
jurisdiction, or with the Administration including the President, 
should he wish to use his executive order powers to remedy this gross 
injustice against the frail elderly, disabled and terminally ill 
Medicare enrolled patients throughout this entire country.
  And while we are waiting to see how many patients end up in the 
mortuary for a lack of venipuncture benefits I ask you:
  ARE WE ASHAMED YET?
  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from California (Mr. Riggs) is recognized for 5 minutes.
  (Mr. RIGGS addressed the House. His remarks will appear hereafter in 
the Extensions of Remarks.)

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