[Congressional Record Volume 144, Number 59 (Tuesday, May 12, 1998)]
[Extensions of Remarks]
[Page E831]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                 REHABILITATION BENEFITS REINSTATEMENT

                                 ______
                                 

                          HON. JOHN E. ENSIGN

                               of nevada

                    in the house of representatives

                         Tuesday, May 12, 1998

  Mr. ENSIGN. Mr. Speaker, today I rise to introduce the 
``Reinstatement of the Medicare Rehabilitation Act (RMRA) of 1998.'' 
RMRA repeals the $1,500 annual limits on physical and occupational 
rehabilitation services established by the Balanced Budget Act of 1997 
(BBA) which are set to go into effect on January 1, 1999 and requires 
the Health Care Financing Administration to implement a budget neutral 
alternative payment system no later than January 1, 2000.
  In a rush to find savings in the Medicare program last year, Congress 
imposed an arbitrary $1,500 annual limitation on most outpatient 
rehabilitation services. Unlike other BBA provisions, the $1,500 limits 
were adopted without the benefit of committee hearings or a detailed 
analysis by HCFA of their likely effects on beneficiaries' ability to 
obtain medically necessary services.
  In fact, analyses undertaken since the enactment of the BBA indicate 
that implementation of the limits will have a disproportionate effect 
on the most vulnerable Medicare beneficiaries, including victims of 
stroke and other debilitating conditions which require concentrated 
therapy services. A $1,500 annual payment may be sufficient to address 
the ``average'' case, but it will not be adequate for beneficiaries who 
require more intensive services. The option of transporting non-
ambulatory resident of a skilled nursing facility or other 
rehabilitation setting to an outpatient hospital department will be 
disruptive to patients and ultimately more costly to the Medicare 
program. Savings will be achieved only if this inconvenience and 
disruption cause patients to forgo medically necessary services to 
which they are entitled under the Medicare program.
  More importantly, American seniors have been encouraged to expect 
Medicare to cover the cost of medically necessary treatment, subject to 
reasonable copayments and deductibles. The existence of an arbitrary 
coverage limitation on otherwise medically necessary services will 
likely come as a shock to affected beneficiaries and their relatives, 
often at a time of great stress. Surely, a less disruptive approach can 
be found to achieve program savings.
  VSPA will prevent the $1,500 annual limitations from taking effect on 
January 1, 1999 and will require HCFA to develop and implement an 
alternative payment system for outpatient physical therapy, 
occupational therapy, and speech-language pathology services. Rather 
than limiting the availability of medically necessary services by 
imposing an arbitrary annual dollar limitation, the new system would be 
based on patient need. Payments would be based on patient 
classification by diagnostic category and would take into account prior 
use of services in both inpatient and outpatient setting. Payment rates 
would be established in a budget neutral manner. Mr. Speaker, I 
acknowledge that I did not oppose the inclusion of this provision in 
the Balanced Budget Act. Frankly, we did not understand how unfairly it 
could affect the most vulnerable of Medicare beneficiaries. Now that we 
have that information, we should not be reluctant to correct a policy 
which we now know will cause great hardship and unfairness.
  For these reasons, I urge my colleagues to join me in support of the 
Reinstatement of the Medicare Rehabilitation Benefit Act of 1998.

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