[Congressional Record Volume 144, Number 140 (Thursday, October 8, 1998)]
[Extensions of Remarks]
[Pages E1956-E1957]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       HOME HEALTH CARE PAYMENTS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Wednesday, October 7, 1998

  Mr. STARK. Mr. Speaker, on behalf of myself, Mr. Dingell, Mr. Matsui, 
Mr. Brown of Ohio, Mr. Coyne, Mr. Levin, Mr. Cardin, Mr. McDermott, and 
Mr. McGovern of Massachusetts, I am today introducing a bill to help 
ameliorate the impact of the home health agency interim payment system 
and to delay the scheduled 15% cut in home health agency payments 
scheduled for next fall.
  Our bill is revenue neutral.
  It is different from the bill being developed by some of the 
Republicans on the Ways and

[[Page E1957]]

Means and Commerce Committees. It does not create huge new tax breaks 
which will cost far more in out-years than they raise in the near term. 
It concentrates its relief on those who have been careful, cost-
conscious providers and does not throw out money at the agencies which 
have been abusing Medicare by providing excessive and often 
questionable visits.
  Our bill is identical (except for the pay-for) to the bipartisan bill 
which has been developed by the Senate Finance Committee, and which may 
pass the Senate at any moment. Our pay-for simply changes the limits on 
the Medicare Medical Savings Account demonstration project, lowering 
the number of participants in the early start-up years and raising them 
in the out-years and extending the life of the demo. Very few people 
are likely to participate in this program in the early years, yet CBO 
charges us for the cost of a full-blown program. By starting more 
realistically, we will not hurt the program, but can be scored for 
budget savings.
  Attached is a description of the formula changes our bill makes.
  This is a small, do-able bill in the last hours of the 105th 
Congress. It does not waste money on the agencies who have created so 
much of the fraud, waste, and abuse problem in the home health sector. 
It is a reponsible pay-for. It is a bill that can quickly and easily be 
conferenced with the Senate.
  We urge other Members to join us in supporting this approach.

                       Summary of Formula Changes

       Reduces state and regional differences for ``old'' agency 
     payments; brings down the per beneficiary limits for the 
     highest cost ``old'' agencies; raises the per beneficiary 
     limits for the lower cost ``old'' agencies and eliminates 
     current 2% discount on per beneficiary limits applicable to 
     new agencies. Raises the separate average cost per visit 
     limits for all agencies.
       CBO: budget neutral (through FY 2008).
     Per Beneficiary Limits
       1. ``Old'' agencies: payment is 50% BBA policy +50% (50% 
     national mean +50% regional mean);
       2. ``New'' agencies: payments are increased by 2% to equal 
     100% of the national median (about $3,450), (which continues 
     to be regionally adjusted for wages); and
     Per Visit Limits
       3. Increase the per visit limits from 105% to 110%.
       4. Delays for 1 year the 15% across-the-board cuts 
     currently scheduled to go into effect on October 1, 1999.
       CBO: Cost is $1 billion over 5 years.

       

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