[Congressional Record Volume 144, Number 137 (Monday, October 5, 1998)]
[House]
[Pages H9352-H9355]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
FEDERAL EMPLOYEES HEALTH CARE PROTECTION ACT OF 1997
Mrs. MORELLA. Mr. Speaker, I move to suspend the rules and concur in
the Senate amendments to the bill (H.R. 1836) to amend chapter 89 of
title 5, United States Code, to improve administration of sanctions
against unfit health care providers under the Federal Employees Health
Benefits Program, and for other purposes.
The Clerk read as follows:
Senate amendments:
Page 2, line 3, strike out ``1997'' and insert ``1998''.
Page 12, line 8, strike out ``January 3, 1998'' and insert
``or before January 2, 1999''.
Page 12, lines 13 and 14, strike out ``January 3, 1998''
and insert ``or before January 2, 1999''.
Page 12, line 18, strike out ``January 3, 1998'' and insert
``or before January 2, 1999''.
Page 13, line 13, strike out ``January 3, 1998'' and insert
``or before January 2, 1999''.
Page 13, line 19, strike out ``January 3, 1998'' and insert
``or before January 2, 1999''.
Page 14, lines 2 and 3, strike out ``January 3, 1998'' and
insert ``or before January 2, 1999''.
Page 14, line 10, strike out ``January 3, 1998'' and insert
``or before January 2, 1999''.
Page 14, line 16, strike out ``January 4, 1998'' and insert
``January 3, 1999 or such earlier date as established by the
Office of Personnel management after consultation with the
Federal Deposit Insurance Corporation or the Board of
Governors of the Federal Reserve System, as appropriate''.
Page 14, line 24, strike out ``January 3, 1998'' and insert
``or before January 2, 1999''.
Page 15, line 13 after ``Office'' insert ``of Personnel
Management''.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from
Maryland (Mrs. Morella) and the gentleman from Maryland (Mr. Cummings)
each will control 20 minutes.
The Chair recognizes the gentlewoman from Maryland (Mrs. Morella).
General Leave
Mrs. MORELLA. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks on the bill, H.R. 1836, as amended by the Senate.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Maryland?
There was no objection.
Mrs. MORELLA. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I want to thank the gentleman from Indiana (Mr. Burton),
the chairman of the Committee on Government Reform and Oversight, for
introducing this very important bill. I also want to thank the
gentleman from Florida (Mr. Mica), chairman of the Subcommittee on
Civil Service, for his
[[Page H9353]]
assistance in bringing this bill to the floor today; as well as the
committee's ranking minority member, the gentleman from California (Mr.
Waxman); and the subcommittee's ranking minority member, the gentleman
from Maryland (Mr. Cummings), who is going to be handling this bill
across the aisle, for their support.
FEHBP is an outstanding program, but even among the best programs,
there is always room for improvement. The FEHBP is critically important
to my constituents, and it is the country's largest employer-based
health insurance program, serving the health care needs of almost 10
million Federal employees, retirees and their families. It is critical
we continue its success. This legislation will attack fraud and abuse
in the FEHBP program.
Turning to section 5 of H.R. 1836, I want to make clear that my
endorsement of the bill is based upon my understanding that nothing in
the measure is designed to hinder the types of market forces which have
made the FEHBP a cost effective health insurance model for other public
agencies and private industry. This legislation is not intended to tilt
the competitive playing field in the health insurance marketplace in
one direction or another.
Section 5 suggests as its goal the disclosure of certain rate
agreements which might yield savings to plans and ultimately to
enrollees in the Federal Employees Health Benefits Program. I agree
that the FEHBP plan should be held to no less a standard than private
sector counterparts.
When H.R. 1836 was originally introduced, I opposed the draft of
section 5. As originally drafted, section 5 would have cost the FEHBP
savings and created an administrative burden that would have increased
administrative costs. These increased costs to FEHBP would have been
borne jointly by the Federal Government and Federal employees and
retirees. I appreciate the willingness of the gentleman from Indiana
(Mr. Burton) to listen to the many stakeholders involved in the issue
and consent to redrafting section 5, the new draft now part of this
legislation.
While the intent of this legislation was in doubt after the report of
the Committee on Government Reform and Oversight was altered prior to
filing last year, I believe the Senate has clarified our intentions and
join my colleagues in recognizing the Senate's report, especially the
additional views filed by Subcommittee Chairman Cochran of the Senate
Committee on Governmental Affairs, and Senators Glenn and Levin, as the
proper memorialization of our congressional intent on section 5. We
thank them.
Section 5 of H.R. 1836 will tell the Office of Personnel Management
to encourage disclosure of certain arrangements in an effort to
maintain the integrity of FEHBP. I support this effort. At the same
time, I understand that section 5 would create no additional duties for
the Office of Personnel Management or have a chilling effect on current
negotiated arrangements which yield the program savings. I understand
that this fact is reinforced by the Congressional Budget Office in
estimating that the section would have no budgetary effect on the
program.
{time} 1415
I am including the Senate committee report's description at this
point in the Record to clarify our mutual intent.
Based upon concerns raised to the House Government Reform
and Oversight Committee by the American Medical Association
and the American Hospital Association that certain payers
were taking advantage of discounts to which they were not
entitled, the Office of Personnel Management Inspector
General was requested to conduct a review ``to determine
whether silent PPOs were used by FEHBP carriers to capture
discounts to which they were not entitled.''
The additional views of Senators Cochran, Glenn and Levin in the
Record further clarify our mutual intent:
In brief the Office of Personnel Management Inspector
General found no evidence that health care providers were
being victimized by FEHBP carriers, nor any evidence of
schemes allowing payers to capture discounts they are not
contractually entitled to receive. Although we support
inclusion in H.R. 1836 of section 5 bill language, we believe
Congress should be careful to avoid interjecting the Federal
Government into contractual issues between health care
providers and health plans.
A recent audit by the OPM IG defined ``Silent'' PPOs as a
health care provider discount taken by an FEHBP carrier
without a contract existing between the PPO and the health
care provider. This is the type of unethical practice that
the FEHBP carriers should avoid.
Further, PPOs, both directed and nondirected, provide
various incentives to health care providers which contract
with PPOs for the benefit of FEHBP; i.e, to reduce health
care costs. The FEHBP must continue to benefit from these
relationships, recognizing that the PPOs must always have a
contract with the health care provider.
During our committee deliberations, issues were raised with respect
to activities of ``silent PPOs'' and the potential adverse impact their
discounts could have on cost initiatives within the FEHBP.
PPOs play an important role in today's health care market. Both
directed and nondirected PPOs provide legitimate and valuable benefits
to health care providers, carriers, and patients. Nondirected discounts
are currently saving the government and FEHBP enrollees millions of
dollars a year through their legitimate utilization by a number of fee-
for-service carriers. Examples of nondirected discounts are those given
by participating providers in return for incentives other than
steerage, such as prompt payment, prepayment, claim audit assistance
and negotiated provider settlements.
Section 7 of H.R. 1836 resulted from an amendment I offered to the
bill in subcommittee to increase the Physicians Comparability
Allowance, a critically important tool to recruit and retain Federal
physicians. Last fall, I commissioned a GAO study to review the PCA and
its usefulness. The September 1997 GAO report confirms that the PCA is
critical. Since I requested the GAO study, I have heard from hundreds
of Federal physicians from across the country who stated very clearly
that without the PCA, they would have chosen a different career.
This section would increase the PCA from $20,000 to $30,000. The
Physicians Comparability Act has not been increased in 10 years. This
increase, however, would not result in an increase in appropriations;
it simply allows agencies to pay an additional PCA from their own
budgets based on their recruitment and retention needs.
According to the Office of Personnel Management, the ``PCA
constitutes a declining percentage of income.'' I had also hoped to
include a provision in legislation that I introduced, H.R. 2541, that
would include a physician's PCA in his or her average pay for purposes
of computing retirement.
I understood the cost concerns of the chairman, the gentleman from
Florida (Mr. Mica), and I requested a CBO score. Now that we have
received the CBO score demonstrating that this provision does not
impose any significant cost on the Federal Government, I am hopeful
that we can move this piece forward as well.
The over 2,700 Federal physicians eligible for the PCA are working on
cures for AIDS, cancer, and heart disease; protecting the safety of
food and drugs; providing medical care to Defense and State Department
employees and dependents, airline pilots, astronauts, native Americans,
and Federal prisons.
The Government cannot pay physicians on the same scale as physicians
employed in hospitals, HMOs, and universities. Consequently, the PCA
provides some compensation to offset this loss of income for Federal
physicians to ensure that the Government can recruit and retain highly-
trained and well-qualified physicians.
I urge my colleagues, Mr. Speaker, to join me in supporting this
important measure.
Mr. Speaker, I reserve the balance of my time.
Mr. CUMMINGS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, H.R. 1836, the Federal Employees Health Care Protection
Act of 1998, is a good bill that has won strong bipartisan support. It
has at its core a provision that would enable the Office of Personnel
Management to effectively use administrative sanctions to protect our
health care program from fraud and abuse perpetuated by unscrupulous
health care providers.
By strengthening OPM's administrative powers and giving it the
authority to impose monetary sanctions on health care providers who
engage in professional and financial misconduct, OPM will be able to
assure Federal employees that they are being provided
[[Page H9354]]
with health care services free of mismanagement and abuse.
The enactment of this reform was requested by the Office of Personnel
Management last year because they found imposing administrative
sanctions under current law was time-consuming and expensive. The House
passed H.R. 1836 last November, and the Senate passed a bill last week
after making necessary technical changes to update the dates on which
certain sections of the bill are to be implemented.
H.R. 1836, however, contains some additional provisions that will
also improve the administration of the Federal Employees Health Benefit
Program. I would like to highlight just a few of them.
The bill contains a provision to strengthen the current preemption
statute in title 5 so as to ensure FEHBP's national plans can continue
to provide uniform benefits and rates to enrollees regardless of where
they live. Another provision would permit active and retired employees
of the Federal Deposit Insurance Corporation and the Federal Reserve
System to reenter FEHBP. This will save both agencies several millions
of dollars in future premium cost.
This bill also requires OPM to encourage participating health plans
that contract with third parties to obtain discounted rates from health
care providers to seek assurances that a condition surrounding those
discounts had been fully disclosed.
Finally, H.R. 1836 clarifies a provision of existing law concerning
direct access and reimbursement to health care providers in the
program.
Mr. Speaker, I believe that H.R. 1836 makes important and needed
improvements in the Federal Employees Health Benefits Program. I urge
all Members to give it their support.
Mr. Speaker, I reserve the balance of my time.
Mrs. MORELLA. Mr. Speaker, I yield such time as he may consume to the
distinguished gentleman from Virginia (Mr. Davis).
Mr. DAVIS of Virginia. Mr. Speaker, I thank my friend, the
gentlewoman from Maryland (Mrs. Morella) for yielding.
Mr. Speaker, I appreciate her work on the bill and the work of the
gentleman from Maryland (Mr. Cummings) on this bill as it moves forward
to what will hopefully be a successful passage today.
This bill, H.R. 1826, does amend the FEHBP to expand the power of the
Office of Personnel Management to sanction fraudulent health care
providers. The bill authorizes OPM to debar and fine fraudulent health
providers that are participating in the FEHBP, and I think my
colleagues have spoken about some of the specifics of this earlier.
One of the important things this does is it takes about 5,000
employees and annuitants from the Federal Deposit Insurance Corporation
and the Federal Reserve Board who are currently ineligible for the
FEHBP. Because of a change in their coverage, they can now be covered
by the Federal Employees Health Benefit Plan.
This is very, very helpful to them. This in no way, shape or form
reduces the rates that other Federal employees are paying for this. I
think it is a very critical point that needs to be made, and it will
give adequate protection and health care to people who are generally
under the Federal envelope in these two areas.
I want to thank the gentlewoman from Maryland (Mrs. Morella) for her
assistance in increasing from $20,000 to $30,000 the maximum amount
that Federal agencies can pay for the physicians' comparability
allowance. The comparability allowance was created in 1978 by the
Physicians' Comparability Act to ease the burden of a critical shortage
of doctors and vast salary differences between military doctors and
other Federal doctors, as well as the overall differences between
Federal and private sector doctors.
I think both of these provisions are well worth while, I think are
going to be advantageous to all concerned, and I just want to
congratulate my colleagues in bringing this to a vote today.
Mr. CUMMINGS. Mr. Speaker, I yield 3 minutes to the gentlewoman from
the District of Columbia (Ms. Norton), a distinguished Member who has
consistently fought hard for Federal employees and been at the
forefront of just about every battle that I have seen with regard to
this House and Federal employees.
Ms. NORTON. Mr. Speaker, I very much thank the gentleman from
Maryland (Mr. Cummings) for yielding and for his kind words, and I want
to thank the gentlewoman from Maryland (Mrs. Morella) and the gentleman
from Maryland (Mr. Cummings) for their leadership on this very
important issue.
Mr. Speaker, I also want to congratulate the Office of Personnel
Management for bringing this matter to the attention of the Congress so
that we could take action that is corrective of this problem. Delay in
correcting fraud and abuse at a time when premiums for Federal
employees are on the rise should not be tolerated, and I am very
appreciative that this bill has come to the floor before we adjourn.
By moving to allow the OPM to sanction providers who engage in
misconduct, we are sending a strong message that being a provider of
health care for Federal employees is not a right but a privilege. Those
who abuse that privilege will lose that privilege or be sanctioned for
their abuse of that privilege.
Over and over again, Mr. Speaker, the FEHBP is cited as a model for
health care in the country, and in a number of important ways it has
proved to be that over time. It will lose its place in that regard
unless we are willing to step up and do what this bill does, and that
essentially is to wipe away some of the causes of administrative delay
which have been responsible for the fact that OPM has not been able to
move promptly in some instances where misconduct was brought to its
attention.
Mr. Speaker, may I also speak in favor of the increase in the
physicians' comparability allowance. This is a period in which vast
disparities are found in the location and the willingness of physicians
to serve. When those disparities can be traced back to income, we must
look closely at the effect. Here we are not talking about an increase
in budget. We are talking about allowing an increase in comparability
pay where that is necessary. This provision attends to a real shortage
of physicians willing to serve as we need them.
For these two provisions and for the others in this bill, I am
personally grateful to the gentlewoman from Maryland (Mrs. Morella) and
the gentleman from Maryland (Mr. Cummings), and I once again thank them
for their very diligent and excellent work on this bill.
Mrs. MORELLA. Mr. Speaker, I have no further speakers on this side.
Perhaps the gentleman from Maryland (Mr. Cummings) has further
speakers.
Mr. CUMMINGS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I just wanted to add on to something that the
distinguished lady from the District of Columbia (Ms. Norton) was just
speaking about. Back in 1998, the FEHBP amendment has not been an
effective tool because it mandates exhaustive due process in every
case, requiring a hearing on the record to be offered before any
adverse determination takes effect.
{time} 1430
This precludes OPM's use of less formal administrative procedures to
deny health care providers access to the FEHB program, even where a
court or State licensing authority previously has found a provider
guilty of misconduct.
I just want to say that this law that we are passing today makes that
process much more practical. I think it is good government. I take a
moment to thank the other side, particularly my colleague from Maryland
for all her work that she has done with regard to this legislation and
other pieces of legislation which we will be considering today. It is
truly a bipartisan effort and is about lifting up the people of our
great Nation, those people day in and day out, hour after hour who work
to make this Nation the best that it can be. Mr. Speaker, I urge my
colleagues to support this legislation.
Mr. Speaker, I yield back the balance of my time.
Mrs. MORELLA. Mr. Speaker, I include for the Record a letter from
Chairman Mica and myself to Chairman Cochran.
The text of the letter is as follows:
[[Page H9355]]
House of Representatives
Washington, DC, July 29, 1998.
Senator Thad Cochran,
Chairman, Subcommittee on International Security,
Proliferation and Federal Services, Washington, DC.
Dear Chairman Cochran: In response to the Senate's
anticipated action in favorably considering H.R. 1836, the
Federal Employees Health Benefits Protection Act, and in
anticipation of having the measure cleared for the President
without need of a conference, we write to clarify the purpose
of one element of the bill: Section 5 dealing with preferred
provider organizations.
As your additional views accurately represent, recent audit
activity by the OPM Inspector General in response to
complaints from provider associations (AMA and AHA) found no
evidence that health care providers were being victimized by
FEHBP carriers, nor evidence of schemes allowing payers to
capture discounts to which they were not contractually
entitled.
Both directed and non-directed PPOs provide various
incentives to health care providers which contract with PPOs
for the benefit of FEHBP--reducing health care costs. The
FEHBP must continue to benefit from these relationships,
recognizing that the PPOs must always have a contract with
the health care provider. Silent PPO activity, as described
by the OPM Inspector General, represents the type of
unethical practices that FEHBP carriers should avoid.
Further, we understand that the IG found no evidence of
``silent PPO'' activity within the FEHBP.
We look forward to continuing our close work in sustaining
the Federal Employees Health Benefits Program as a model for
others to follow.
Sincerely,
John Mica,
Chairman, Subcommittee on Civil Service.
Connie Morella.
Mrs. MORELLA. Mr. Speaker, I yield myself such time as I may consume.
I want to thank my colleagues for their support of this important
legislation. I would pick up and echo the comments of my colleague from
Maryland. Indeed this is a bipartisan piece of legislation that will
help all Federal employees and help us to recruit and retain physicians
and others into public service which is so very, very important.
I want to again reiterate my thanks to the gentleman from Indiana
(Mr. Burton), the gentleman from California (Mr. Waxman), the gentleman
from Florida (Mr. Mica) chairman of the Subcommittee on Civil Service;
and the gentleman from Maryland (Mr. Cummings). He is right. We work in
a very nonpartisan way on the Subcommittee on Civil Service. This
legislation is evidence of that. I thank him also for his leadership. I
ask my colleagues to support this legislation.
Mr. PAPPAS. Mr. Speaker, I rise in support of H.R. 1836, the
``Federal Employees Health Care Protection Act.''
While the legislation sets out laudable goals, I want to make clear
that my endorsement of the bill is based upon my understanding that
nothing in the measure is designed to hinder the types of market forces
which have made the FEHBP a cost-effective health insurance model for
the public agencies and private industry. This legislation is not
intended to tilt the competitiveness in the health insurance
marketplace in one direction or another.
One element of the legislation, Section 5, suggests as its goal the
disclosure of certain rate agreements which might yield savings to
plans and enrollees in the Federal Health benefits Program. I agree
that FEHBP plans should be held to no lesser standard than their
private sector counterparts and I agree with the clarification of
Congressional intent in the drafting of Section 5 as set forth in the
Senate Report's additional views filed by Senate Subcommittee chairman,
Senator Cochran.
During our committee deliberations, issues were raised concerning the
activities of ``silent PPO's'' and the potential of adverse impact
their discounts could have on cost saving initiatives within the FEHBP.
Some even speculated that a variety of unethical and perhaps fraudulent
activities related to ``silent PPOs'' were rampant in the federal
health program.
The Inspector General of the Office of Personnel Management dispelled
these allegations in a report issued on February 26, 1998. The
Inspector General audit found that the practices alleged are not
currently prevalent in the FEHBP. The Inspector General further
asserted that networks of non-directed PPOs operate within a
contractually authorized environment.
PPO's play an important role in today's health care market. Both
directed and non-directed PPO's provide legitimate and valuable
benefits to health care providers.
I remain committed to improving the quality of health care offered to
our federal employees as well as committed to ensuring a diverse and
competitive environment for health plans and providers.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Barrett of Nebraska). The question is on
the motion offered by the gentlewoman from Maryland (Mrs. Morella) that
the House suspend the rules and concur in the Senate amendments to the
bill, H.R. 1836.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the Senate amendments were
concurred in.
A motion to reconsider was laid on the table.
____________________