[Congressional Record Volume 144, Number 124 (Thursday, September 17, 1998)]
[Extensions of Remarks]
[Page E1751]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


       INTRODUCTION OF THE MEDICARE HOME HEALTH CASE MANAGER ACT

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Thursday, September 17, 1998

  Mr. STARK. Mr. Speaker, I rise today with Representative Ben Cardin 
(D-MD) to introduce the Medicare Home Health Case Manager Act of 1998. 
The Medicare home health benefit has received much attention this year. 
The reason for that attention has been the dramatic growth of home 
health services over the past decade.
  The Balanced Budget Act of 1997 (BBA) made a number of changes to the 
home health benefit to help stem that growth. However, much more needs 
to be done.
  The Medicare Home Health Case Manager Act is a double winner. It 
would simultaneously reduce Medicare spending on home health while 
improving the quality of the benefit. It does this by introducing a new 
component to the benefit: an independent case manager.
  Today, home health care is prescribed by a patient's physician, but 
then the actual plan of care is executed by the home health agency 
treating the patient. This creates incentives that have nothing to do 
with quality or appropriateness of care. Under the cost-based 
reimbursement system that existed before passage of BBA, the incentive 
to home health agencies was to over-utilize services for patients 
because that is how the agency made more money. In the BBA's 
prospective payment system (PPS) of the future, the incentive will be 
the opposite and there are real concerns about potential under-
utilization of services.
  The Medicare Home Health Case Manager Act would ensure that home 
health care decisions for long-stay patients were being made by an 
independent case manager who in no way financially benefited by the 
length or type of home care provided to a patient. They would be paid 
by a Medicare fee-schedule that would in no way be influenced by the 
amount or type of care they recommend.
  This idea is endorsed by the Medicare Payment Advisory Commission 
(MEDPAC), a Commission appointed by Congress to provide expert advice 
on Medicare and Medicaid policy. In their March 1998 report to Congress 
they recommended that such a case manager be adopted for the home 
health benefit.
  Their report states:


       Such an assessment would help to minimize the provision of 
     services of marginal clinical value, while ensuring that 
     patients receive appropriate care. Requiring case management 
     of long-term home health users could improve outcomes for 
     individuals with long-term home health needs and at the same 
     time slow the growth of Medicare home health expenditures. 
     (emphasis added)


  There are also real-life examples of case management systems saving 
money and improving care. For example, Maryland's Medicaid program has 
a high cost user initiative which in FY 96 saved the state $3.30 for 
each $1 spent--a savings of 230%. The Health Insurance Association of 
America also commissioned a study of its member plans and found that 
rehabiltation/case management programs return an investment of $30 for 
every $1 spent.
  History has shown us that simply throwing more money into home health 
is not the answer for assuring that patients receive appropriate care. 
Let's use this opportunity to make a real, tangible improvement in the 
quality of care obtained by Medicare patients and simultaneously save 
Medicare spending by reducing inappropriate visits. I look forward to 
working with my colleagues for passage of this important legislation.

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