[Congressional Record Volume 144, Number 102 (Monday, July 27, 1998)]
[Extensions of Remarks]
[Pages E1446-E1447]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




INTRODUCTION OF THE MEDICARE HOME HEALTH BENEFICIARY PROTECTION ACT OF 
                                  1998

                                 ______
                                 

                            HON. NICK RAHALL

                            of west virginia

                    in the house of representatives

                         Monday, July 27, 1998

  Mr. RAHALL. Mr. Speaker, I rise today to introduce the Medicare Home 
Health Beneficiary Protection Act of 1998, on behalf of myself, and Mr. 
Merrill Cook of Utah, Mr. Bob Wise of West Virginia, and Mr. J.C. Watts 
of Oklahoma.
  Last November I introduced another bill linked to changes made in the 
way home health agencies would be reimbursed for services they provide 
to homebound seniors and other frail and disabled persons, in their 
homes, by the Medicare program.
  The bill I introduced late last year is called the Medicare 
Venipuncture Fairness Act, H.R. 2912, and it seeks to restore a home 
health benefit known as venipuncuture--the drawing of blood samples--to 
Medicare enrollees who were receiving this care provided by home health 
providers, in consultation with the patient's own physicians. This home 
benefit, so important to the stability of homebound patients, was 
terminated by the Balanced Budget Act of 1997. As a result, many former 
venipuncture patients have entered nursing homes, and hospitals, and 
some have died from having their health and well-being compromised 
because of the loss of this vital service.
  Today, I find myself again trying to assist the home health agencies 
and their needy patients, by introducing a three year moratorium on the 
Interim Payment System--or IPS--also imposed on the industry under the 
BBA of 1997.
  Under the BBA, the Health Care Financing Administration, or HCFA, was 
directed by Congress to replace cost-based reimbursement for home 
health services with Prospective Payment System (PPS), to become 
effective in October, 1999. This Interim Payment System (IPS) was 
imposed while HCFA prepares to implement the PPS late next year, 
imposing new per beneficiary caps on home health agencies. HCFA 
Administrator Nancy-Ann Min DeParle has recently stated that her agency 
cannot meet the PPS deadline of October 1999.
  While there is no question of the importance of providing a 
transitioning procedure for home health benefits into a PPS, to ensure 
that all such agencies are cost-effective as they deliver services to 
the homebound, usually elderly, frail patients, it is our solemn duty 
to also protect eligible, elderly Medicare beneficiaries.
  It is quite evident to me that the current IPS, coupled with HCFAs 
interpretation of the surety bond status, is gravely threatening access 
to these invaluable services throughout our nation. Quite simply, the 
IPS is fatally flawed.
  While we all seek to drive out those who would deceive and defraud 
the elderly and the Medicare Program, by devious, fly-by-night home 
health providers, I am deeply concerned about a punitive IPS, which is 
now in effect, which is driving good, caring, quality providers out of 
business. Nationwide, over 1000 home health providers have closed or 
stopped accepting Medicare patients. There are few resources available 
to former patients except nursing facilities, which are much more 
expensive but which Medicare does not have to pay for, or emergency 
rooms at local hospitals if a beneficiary's health destabilizes--
another expense that must be borne by Medicare.
  Since last November I have sought intervention from the Secretary of 
Health and Human Services, the President, and among my colleagues, 
urging them to take action to stop the demonizing of home health 
providers by allowing HCFA to continue to misinterpret the intent of 
Congress, and to continue to impose more and more punitive measures 
upon the home health care industry.
  Since last November I have sought to impress upon my colleagues, HHS 
and the White House, that HCFA is over-regulating these industries a 
majority of which are caring providers. Yet HCFA continues its arrogant 
disregard for Congressional intent, and our constituents--the elderly, 
the frail, the disabled--leaving them to find other sources of care as 
agency after agency is forced out of business.
  Today, let me say again that fraud and abuse in the Medicare system 
must be ended--but it is also noteworthy that in its zeal to find 
criminals, HCFA appears to have written and enforced regulations that 
treat all providers as criminals or potential criminals.
  It is time for Congress to now impose a moratorium on the IPS. My 
bill not only accomplishes this equitable goal, but it also puts

[[Page E1447]]

pressure on HCFA to move expeditiously toward the establishment of PPS 
for home care.
  A study conducted by the George Washington University Medical Center, 
Center for Health Policy Research, entitled ``Medicare Home Health 
Services; An Analysis of the Implications of the BBA of 1997 for Access 
and Quality,'' confirms why Congress must take expedited action in 
removing the IPS.
  Just briefly, the Study concluded that (1) the BBA's reductions in 
Medicare's Home Health coverage and financing can be expected to impact 
the sickest and highest cost patients, and punish the very agencies 
that specialize in the provision of care to this population; (2) the 
most severe effects of the IPS falls on the sickest patients living in 
states with the lowest utilization patterns (as is true in my State of 
West Virginia); and (3) the BBA's interim payment system will shift 
costs to other payers (notably Medicaid) while rewarding inefficient 
agencies who care for relatively healthier patients.
  So it is not only beneficiaries and providers who are alerting a 
sleeping Congress to the devastation of this IPS system, but outside 
experts are also telling us that we must revisit this issue.
  While the IPS approach is a short-term solution, it has serious 
consequences for many vulnerable patients and honest providers.
  For that reason, last Friday, June 24, 1998, Senator Christopher Bond 
introduced an identical bill to the one I and my colleagues introduce 
today. I salute him for quickly recognizing that the IPS is a serious--
very serious--problem and for acting at once.
  Mr. Speaker, ensuring that home health care agencies, both profit and 
not-for-profit, can continue operating as the high quality health care 
providers they are, will require the cooperation of Congress, the 
agencies themselves, HCFA, HHS and the White House.
  But Congress has the power to fix the IPS problem, and it must take 
expedited action to do so. We truly must not stand by while thousands 
of home health agencies shut down. It seems to me to be in our best 
interest to maintain and support those who are not only specialist in 
caring for the aged, the infirm, the severely disabled, but to heap 
upon them the high praise they deserve and have earned for the work 
they do, both in the name of compassion and out of a sense of 
responsibility toward the home health care needs of senior citizens.

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