[Congressional Record Volume 144, Number 77 (Monday, June 15, 1998)]
[Senate]
[Pages S6342-S6343]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    MEDICARE HOME HEALTH EQUITY ACT

 Mr. KOHL. Mr. President, I rise today to join 16 of my 
colleagues in cosponsoring S. 1993, the Medicare Home Health Equity 
Act. I want to commend my colleague from Maine, Senator Collins, for 
taking the lead on this extremely important issue. This legislation 
will go a long way toward ensuring that seniors in Wisconsin continue 
to have access to the quality home health services they need, and that 
home health providers in low-cost States like Wisconsin receive fair 
and equitable reimbursement for the valuable services they provide.
  Mr. President, I have long supported efforts to expand access to home 
health care. This important long-term care option allows people to stay 
in their homes longer, where they are often most comfortable, while 
they receive the skilled medical care they need. Home care empowers 
people to continue to live independently among their families and 
friends. It is of added value that in many cases, home care is also 
more cost-effective than institutional-based care. For those seniors 
whose medical needs can be met with home-based care in a cost-effective 
way, we should do everything we can to make sure that they have the 
choice to continue to stay in their homes and received care through the 
Medicare home health benefit.
  I realize that the Medicare changes Congress made last year in the 
Balanced Budget Act were necessary in order to help prevent Medicare 
from going bankrupt. Home health is the fastest growing component of 
Medicare and it was imperative that we bring costs under control. 
However, I am deeply concerned that the Interim Payment System created 
in the BBA will inadvertently penalize those States, like Wisconsin, 
that have historically done a good job in keeping costs low.
  The IPS established in the BBA is based on a technical formula which 
pays home health agencies the lowest of three measures: (1) actual 
costs; (2) a per visit limit of 105% of the national median; or (3) a 
per beneficiary annual limit, derived from a blend of 75% of an 
agency's costs and 25% regional costs. Without going into the details 
of this complicated formula, this in effect means that agencies that 
have done a good job keeping costs and utilization low will be 
penalized under the IPS. At the same time, those agencies that provided 
the most visits and spent the most per patient will be rewarded by 
continuing to receive higher reimbursement levels that the agencies 
that were more efficient. Although the IPS would reduce reimbursement 
for everyone, Wisconsin agencies have already been successful in 
keeping costs low, and there is no fat to trim from their 
reimbursement.
  The proposed IPS would be devastating for home care in Wisconsin and 
would likely drive many good providers from the Medicare program. 
Already, I

[[Page S6343]]

have heard from Wisconsin agencies who have had to let staff go, limit 
new patients, and who honestly don't know how they will be able to 
afford to operate under the IPS. This will severely hurt Wisconsin's 
seniors, many of whom will now have to enter nursing facilities because 
far fewer home health services will be available for them.
  Mr. President, this was not my intention when I voted for the 
Balanced Budget Act last year, and I believe that we must now work to 
make the IPS more equitable for seniors and providers. The Medicare 
Home Health Equity Act will accomplish this by changing the formula on 
which IPS is based. The new formula would be based 75 percent on the 
national average cost per patient in calendar year 1994 ($3,987) and 25 
percent on the regional average cost per patient in calendar year 1995. 
This change would bring more equity between States and would ensure 
that low cost States like Wisconsin are not penalized for being 
efficient. Most importantly, this change will ensure that seniors in 
Wisconsin continue to have access to the quality home health care 
services they need and deserve.
  Mr. President, I understand that several more of my colleagues are 
also working on legislation that would bring greater equity to the 
Interim Payment System. I am cosponsoring this legislation not only 
because it is good for Wisconsin and other low cost States, but also 
because it is my hope that by bringing attention to this issue, we can 
all work together to find a fair solution for all States. I look 
forward to working with my colleagues on this important issue during 
the remaining months of the 105th Congress.

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