[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Extensions of Remarks]
[Pages E1988-E1989]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       THE MEDICARE NURSING AND PARAMEDICAL EDUCATION ACT OF 1998

                                 ______
                                 

                            HON. KEN BENTSEN

                                of texas

                    in the house of representatives

                       Thursday, October 8, 1998

  Mr. BENTSEN. Mr. Speaker, I rise today to introduce legislation, the 
Medicare Nursing and Paramedical Education Act of 1998, to ensure that 
our nation continues to invest in the training of nurses and allied 
health professionals even as our health care system makes its 
transition to the increased use of managed care. I am pleased that 
several colleagues are joining me as original co-sponsors to this 
initiative, including Reps. Crane, Ganske, Cardin, Rangel, Stark, and 
Jefferson.
  This legislation would provide guaranteed federal funding for nursing 
and paramedical education and help ensure that our nation continues to 
train enough nurses and other health care providers during this 
transition to managed care. Without such a guarantee, I am concerned 
that the availability and quality of medical care in our country would 
be at risk.
  Teaching hospitals have a different mission and caseload than other 
hospitals. These hospitals are teaching centers where reimbursements 
for treating patients must pay for the cost not only of patient care, 
but also for medical education including nursing and paramedical 
education. In the past, teaching hospitals were able to subsidize the 
cost of medical education through higher reimbursements from private 
and public health insurance programs. With the introduction of managed 
care, these subsidies are being reduced and eliminated.
  Under current law, the Medicare program provides payments to teaching 
hospitals for nursing and paramedical education. These Medicare 
payments pay a portion of the costs associated with the required 
classroom and clinical training.
  As more Medicare beneficiaries enroll in managed care plans, payments 
for nursing and paramedical education are reduced in two ways. First, 
many managed care patients no longer seek services from teaching 
hospitals because their plans do not allow it. Second, payments are cut 
because the formula for these payments is based on the number of 
traditional, fee-for-service Medicare patients served at these 
hospitals. When fewer patients visit hospitals, these pass-through 
payments are reduced.
  In 1995, Medicare provided $253 million for a portion of the costs 
associated with the allied health and nursing education. This payment 
represents 37 percent of the total costs of operating these programs at 
731 hospitals nationwide. According to a recent Lewin Group estimate, 
allied health and nursing education pass-through programs would be 
reduced by $80 million in 2002 from current levels because of fewer 
Medicare beneficiaries utilizing teaching institutions. This year, for 
example, Methodist Hospital in Houston estimates that it would lose 
$71,871 because Medicare managed care patients are not seeking services 
from them. Clearly, we need to correct this inequity.
  As the representative for the Texas Medical Center, home of two 
medical schools, three nursing programs, and several paramedical 
programs, I have seen firsthand the invaluable role of medical 
education in our health care system and the stresses being placed on it 
today. For instance, Methodist Hospital provides training for 825 
students in its nursing, allied health, physical and occupational 
therapy, respiratory therapy, laboratory technology, and pharmacy 
programs. I am concerned that without sufficient Medicare support that 
these programs would be jeopardized.
  The Balanced Budget Act of 1997 included a provision, similar to 
legislation I introduced,

[[Page E1989]]

to ensure that Medicare managed care health plans contribute to the 
cost of graduate medical education at teaching and research hospitals. 
This law carves out a portion of the Adjusted Average Per Capita Cost 
(AAPCC) payment to Medicare managed care plans and transfers this 
funding directly to teaching hospitals to help pay the costs of 
graduate medical education. This law provides $5 billion for physician 
medical education over five years. However, the law did not require 
Medicare managed care health plans to provide similar funding for 
nursing and allied health professional programs. My legislation would 
correct this omission by extending the provisions of the Balanced 
Budget Act to require Medicare managed care plans to contribute a 
portion of their AAPCC payment to teaching institutions which provide 
nursing and allied health professional education. All health care 
consumers, including those in Medicare managed care plans, benefit from 
this training and should contribute equally towards this goal.
  Our nation's medical education programs are the best in the world. 
Maintaining this excellence requires continued investment by the 
federal government. Our teaching hospitals need and deserve the 
resources to meet the challenge of our aging population and our 
changing health care marketplace. This legislation would ensure that 
our nation continues to have the health care professionals we need to 
provide quality health care services in the future.
  I also believe that this legislation is fiscally responsible. This 
legislation has no budgetary impact, because a portion of the payment 
to managed care plans would simply be shifted to these teaching 
institutions.
  I urge my colleagues to support this effort to provide guaranteed 
funding for nursing and allied health professional education.

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