[Congressional Record Volume 144, Number 57 (Friday, May 8, 1998)]
[Senate]
[Pages S4558-S4560]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. JEFFORDS (for himself, Mr. Rockefeller, Mr. Specter, Mr.
Hollings, Mr. Murkowski, Mr. Leahy, and Mr. Hagel):
S. 2054. A bill to amend title XVIII of the Social Security Act to
require the Secretary of Veterans Affairs and the Secretary of Health
and Human Services to carry out a model project to provide the
Department of Veterans Affairs with medicare reimbursement for medicare
health-care services provided to certain medicare-eligible veterans; to
the Committee on Finance.
the veterans' equality for treatment and services act of 1998
Mr. JEFFORDS. Mr. President, I am proud to rise with my colleagues,
Senator Rockefeller, Senator Specter, Senator Hollings, Senator
Murkowski, and my friend from Vermont, Senator Leahy, to introduce the
Veterans' Equality for Treatment and Services Act, or VETS Act, of
1998. This bill will give our Nation's veterans greater freedom to
choose where they receive their medical care.
Also known as ``Medicare Subvention,'' the VETS Act will authorize
the Department of Veterans Affairs to set up 12 pilot sites around the
country for Medicare-eligible veterans who are either barred from
getting care at VA facilities, or cannot afford costly VA copayments.
As members of the Senate Finance Committee, Senator Rockefeller and I
worked successfully last summer to pass this exact piece of legislation
through the Senate Finance Committee. We were disappointed that before
final passage of the 1997 Balanced Budget Act our legislation was
replaced with a requirement to simply study the matter and issue a
report.
Well, we have studied the issue and it is now time to act. The
Veterans Health Administration under the able leadership of Ken Kizer
has devised Medicare Subvention payment methods and I have recently
spoken with Secretary Togo West about our mutual commitment to the
passage of Medicare Subvention in this Congress.
Under current law, the VA will not generally treat a non-service
connected Medicare-eligible veteran because they have no way to recover
the full cost of doing so. Under the VETS Act, this same veteran could
go to their VA for care and Medicare would reimbursement the VA at the
normal Medicare rate. Total Medicare reimbursements
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would be limited to $50 million annually. The reimbursement level would
be reduced if the VA treats fewer Medicare eligible veterans than in
the prior fiscal year. The General Accounting Office would also monitor
the operation of the sites and report on any increase in costs to
Medicare. If the Demonstration Project increases Medicare's costs, the
Veterans Affairs would reimburse Medicare for any increased costs and
take action to suspend or terminate the program. Therefore, numerous
safeguards and limitations in the bill ensure that Medicare Subvention
does not drain the Medicare Trust Fund.
Mr. President, we should give our veterans the ability to make the
choice of where they will receive their medical care. Although last
year's enactment of the Department of Defense Medicare Subvention
program alleviated what veterans call a ``lockout'' from the military
health care system, we need to finish the job by allowing all veterans
access to the VA health care facility of their choice.
In closing, the Veterans' Service Organizations strongly support the
VETS Act. I look forward to working with them, Secretary West and the
administration, and my colleagues here in the Senate and in the House
to get this legislation signed into law this year.
Mr. ROCKEFELLER. Mr. President, I am pleased to offer my
support to the Veterans' Equality for Treatment and Services Act of
1998. This bill will authorize a demonstration project to allow VA to
bill Medicare for health care services provided to certain dual
beneficiaries. The legislation is known as VA subvention, which is a
concept that has been discussed over the years by those of us in
Congress, by veterans service organizations, and by advisory bodies
studying the VA health care system. I join my colleagues Senators
Jeffords, Hollings, and Specter in this initiative.
Due to budget constraints, many VA hospitals and clinics have been
forced to turn away middle income, Medicare-eligible veterans who seek
VA care. To truly understand the need for VA subvention, I ask my
colleagues to couple these difficulties in accessing the system, with
VA's frozen FY 99 budget. The frozen medical care budget obviously
cannot cover even salary adjustments required by law, let alone allow
for any growth and expansion within the VA health care system.
For veterans, enactment of the Veterans Equality for Treatment and
Services Act of 1998 would mean the infusion of new revenue and thus,
improved access to care. For the Health Care Financing Administration
(HCFA), a VA subvention demonstration project will provide the
opportunity to assess the effects of coordination on improving
efficiency, access, and quality of care for dual-eligible beneficiaries
in a selected number of sites. Finally, Congress would receive the
results of this feasibility study, which, once and for all, would give
us the necessary data to make rational policy decisions in the future
about Medicare and VA's involvement.
The four VA medical centers in my own State of West Virginia spent
$4.2 million caring for nearly a thousand Medicare-eligible veterans
with middle incomes in 1995. Though this is telling information, I
cannot provide my colleagues with the truly crucial piece of the story,
that is, the number of these Medicare-eligible veterans who were turned
away from the facilities created to serve them because of lack of
resources. This demonstration project would encourage these eligible
veterans who have not previously received care from the Huntington,
Beckley, Martinsburg, and Clarksburg VAMCs to do so.
The Veterans Equality for Treatment and Services Act is designed to
be budget neutral. To that end, the VA would be required to maintain
its current level of services to Medicare-eligible veterans already
being served and would be effectively limited to reimbursement for
additional care provided to new users. Payments from Medicare would be
at a reduced rate and would exclude Disproportionate Share Hospital
adjustments, Graduate Medical Education payments, and a large
percentage of capital-related costs. In effect, the VA would be
providing health care to Medicare-eligible veterans at a deeply
discounted rate. HHS and VA would have the ability to adjust payment
rates, or to shrink or terminate the program if Medicare's costs
increase. In the event that these safeguards included in the proposal
fail--an event which the VA has declared unlikely--this proposal caps
all Medicare payments to the VA at $50 million.
A HCFA representative testified before Congress and stated that this
proposal will provide quality service to certain dual-eligible
beneficiaries and, ``at the same time, preserve and protect the
Medicare Trust Fund for all Americans.'' Although the VA subvention
proposal is a small effort compared to the other recent changes made to
the Medicare program and the changes to come, it is enormously
important to our veterans and the health care system they depend upon.
Last year, Senator Jeffords and I successfully offered a similar VA/
Medicare proposal at a Finance Committee markup because we saw it as a
way to provide quality health care to veterans who are also eligible
for Medicare, while at the same time preserving and protecting the
Medicare Trust Fund. The Senate later passed the provision, which was
included in the Balanced Budget Act of 1997. However, rather than
enacting a modest VA demonstration project which would yield the
information we need to make rational decisions in the future, budget
conferees only approved a Department of Defense subvention plan. To put
it bluntly, veterans got shortchanged.
Since that time, VA and HCFA have entered into a Memorandum of
Agreement which closely outlines the terms by which Medicare will pay
for certain veterans receiving care at participating sites in the same
manner as other fee-for-service providers and health maintenance
organizations.
I had hoped that the House of Representatives would have acted by now
to approve a VA subvention proposal. Unfortunately, this has not
occurred. Mr. President, veterans deserve the opportunity to come to VA
facilities for their care and bring their Medicare coverage with them.
I look forward to working with my colleagues on the Committees on
Finance and Veterans' Affairs to make this long sought-after proposal a
reality.
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By Mr. REID:
S. 2055. A bill to require Medicare providers to disclose publicly
staffing and performance data in order to promote improved consumer
information and choice, to protect employees of Medicare providers who
report concerns about the safety and quality of services provided by
Medicare providers or who report violations of Federal or State law by
those providers, and to require review of the impact on public health
and safety of proposed mergers and acquisitions of Medicare providers;
to the Committee on Finance.
the patient safety act of 1998
Mr. REID. Mr. President, today I am introducing the Patient Safety
Act of 1998. This legislation focuses on the major safety, quality, and
workforce issues for nurses employed by health care institutions and
the patients who receive care in these facilities. The Patient Safety
Act establishes guidelines for hospital participation in Medicare in
order to protect both health care consumers and workers.
Health care consumers need access to information about health care
institutions in order to make informed decisions about where they
receive care. This legislation would require health care institutions
to publicly disclose specified information on staffing levels, mix and
patient outcomes. At minimum, health care institutions would have to
make public: the number of registered nurses providing direct care;
numbers of unlicensed personnel utilized to provide direct patient
care; average number of patients per registered nurse providing direct
patient care; patient mortality rate; incidence of adverse patient care
incidents; and methods used for determining and adjusting staffing
levels and patient care needs.
Nurses should be able to voice their concerns about dangerous patient
care conditions without the fear of retribution from their employers.
The Patient Safety Act of 1998 would add whistleblower protections to
Medicare law. A violation of this provision would make an institution
ineligible for Medicare participation.
Finally, the Patient Safety Act of 1998 would direct the Department
of Health and Human Services to review mergers and acquisitions of
hospitals
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to determine their long-term effects on the well-being of patients, the
community and employees.
The Patient Safety Act of 1998 is a valuable information resource for
consumers. This legislation will ensure that the public has the data
necessary to make informed decisions about their health care providers.
______
By Mr. REID:
S. 2056. A bill to amend title XVIII of the Social Security Act and
title 38, United States Code, to require hospitals to use only hollow-
bore needle devices that minimize the risk of needlestick injury to
health care workers; to the Committee on Finance.
the health care worker protection act of 1998
Mr. REID. Mr. President, today I am introducing the Health Care
Worker Protection Act of 1998. This legislation would reduce the number
of health care workers who are accidentally exposed to potentially
contaminated, infectious blood via a needle stick injury.
The Health Care Worker Protection Act of 1998 would make the use of
safe needle devices, as determined by the Food and Drug Administration
(FDA), a condition of participation for Medicare. The bill would call
for the FDA to create an Advisory Council to establish safety standards
for hollow bore devices. The Advisory Council would be composed of
consumers, health care providers and technical experts. Finally, the
Department of Health and Human Services would be authorized $5 million
to establish education and training programs for the use of the safe
devices identified by the FDA.
Approximately eighty percent of all reported occupational exposures
result from needle stick injuries, making this the most common cause of
health care worker-related exposure to blood borne pathogens. More than
twenty pathogens can be transmitted through small amounts of blood
including HIV, syphilis, Rocky Mountain spotted fever, varicella-
zoster, malaria, Hepatitis B and C, along with other forms of
hepatitis. According to the Centers for Disease Control and Prevention,
American health care workers report more than 800,000 needle sticks and
sharps injuries each year.
The Health Worker Protection Act of 1998 is designed to reduce the
risks to health care workers from these accidents. This legislation
will ensure that the necessary tools--better information and better
medical devices--are made available to front-line health care workers
in order to reduce the injury and death that have resulted from needle
sticks.
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