[Congressional Record Volume 144, Number 127 (Tuesday, September 22, 1998)]
[Senate]
[Page S10724]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. COCHRAN:
  S. 2508. A bill to amend title XVIII of the Social Security Act to 
impose conditions on the implementation of the interim payment system 
for home health services furnished by home health agencies under the 
Medicare Program and to modify the standards for calculating the per 
beneficiary payment limits under such payment system, and for other 
purposes; to the Committee on Finance.


            homebound elderly relief opportunity act of 1998

  Mr. COCHRAN. Mr. President, today I am introducing the ``Homebound 
Elderly Relief Opportunity Act of 1998'' (HERO). This measure addresses 
a very serious concern: the future of home care within the Medicare 
system.
  For Mississippians, home health has had a two-fold benefit: Home care 
serves to reduce costly hospitalization stays while enhancing the 
patient's quality of life through continued stay in the familiar home 
setting.
  Additionally, in a rural state like Mississippi, home health has 
enabled health care to be delivered to the immobile and elderly who are 
often miles and hours from the nearest hospital or clinic.
  Despite these obvious benefits, home health is very expensive, 
however. With Medicare and government expenditures, it is not always a 
question of ``What we should afford?'' but ``What we can afford?''
  Congress answered these questions with the Balanced Budget Act of 
1997, which has brought fiscal responsibility back to government. BBA 
97 dealt with among other issues, Medicare, and in turn home health, 
probably the fastest growing expenditure within the program. The work 
of Senator Roth and the Finance Committee has helped insure some 
stability in home health expenditures, so that a good thing does not 
quickly become a bad thing and bankrupt the trust fund. However, 
instead of saving this vital Medicare benefit, HCFA's application of 
the Balanced Budget Act to home health--through the use of the Interim 
Payment System--has threatened its very existence. In so doing, HCFA 
has ignored both equity and the elderly, particularly in rural America.
  The Senate has not completely ignored the home health crisis: Sixty-
eight of my colleagues have made statements which appear with their 
photographs on a recent industry poster proclaiming the ills of HCFA's 
interim payment system and its threat to the continuation of home 
health services.
  Five of my colleagues--Senators Grassley and Breaux; Senator Bond; 
Senator Collins; and Senator Kennedy have each introduced bills to 
adjust or eliminate IPS. Senator Bond has been the Senate champion of 
saving home health. His Senate Bill 2354, of which I am cosponsor, 
provides a direct, honest response to the HCFA-created nightmare. His 
bill would impose a moratorium on IPS from fiscal year 1998 forward 
until HCFA develops the prospective payment system, the only sure way 
to solve the home health expenditure issue in a fair manner. However, 
the Moratorium Bill's cost has been scored by CBO to be in the many 
many billions. While we must save home health, we cannot do so in a way 
that jeopardizes all of Medicare. We must find a compromise. That is 
the purpose of introducing HERO today.
  The HERO Bill is an effort to correct the essential problems with the 
interim payment system and to create a better bridge to the prospective 
payment system which we all hope will be developed and implemented 
soon. I believe it provides the best opportunity for success with 
respect to Government spending, Medicare reimbursement, and protecting 
beneficiaries.
  It establishes budget limits for Medicare home health expenditures 
for 1999-2002 with the same savings levels currently projected by the 
Congressional Budget Office under the Balanced Budget Act of 1997 
provisions. If expenditure estimates exceed the budget limits, payments 
to providers will be limited to regional levels on an equitable basis. 
Finally, it insures access to home care for all qualified Medicare 
beneficiaries.
  Overall, this bill provides one last opportunity in this session for 
all home health beneficiaries to receive the Medicare benefit to which 
they are entitled and for the providers of those services to be fairly 
reimbursed. It corrects the essential flaw in the original payment 
reform which rewarded the inefficient and punished the efficient 
providers and failed to account for the variation in the types of 
patients served by home health agencies. However, this bill operates 
with budgetary and operational safeguards to insure that the home 
health benefit stays on its steady course.
  Mr. President, Congress must reform IPS immediately before even more 
reputable home health agencies are forced out of business and more 
seniors are forced to go without care or leave their homes for more 
expensive hospital or nursing home care. I urge Senators to support 
this bill.

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