[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[House]
[Pages H10243-H10259]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 MEDICARE HOME HEALTH AND VETERANS HEALTH CARE IMPROVEMENT ACT OF 1998

  Mr. THOMAS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 4567) to amend title XVIII of the Social Security Act to 
make revisions in the per beneficiary and per visit payment limits on 
payment for health services under the Medicare Program, as amended.
  The Clerk read as follows:

                               H.R. 4567

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Home Health and Veterans Health Care Improvement Act of 
     1998''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:


Sec. 1. Short title; table of contents.

  TITLE I--MEDICARE HOME HEALTH CARE INTERIM PAYMENT SYSTEM REFINEMENT

Sec. 101. Increase in per beneficiary limits and per visit payment 
              limits for payment for home health services.

             TITLE II--VETERANS MEDICARE ACCESS IMPROVEMENT

Sec. 201. Improvement in veterans' access to services.

  TITLE III--AUTHORIZATION OF ADDITIONAL EXCEPTIONS TO IMPOSITION OF 
                   PENALTIES FOR CERTAIN INDUCEMENTS

Sec. 301. Authorization of additional exceptions to imposition of 
              penalties for providing inducements to beneficiaries.

  TITLE IV--EXPANSION OF MEMBERSHIP OF THE MEDICARE PAYMENT ADVISORY 
                               COMMISSION

Sec. 401. Expansion of membership of MedPAC to 17.

                        TITLE V--REVENUE OFFSET

Sec. 501. Revenue offset.
  TITLE I--MEDICARE HOME HEALTH CARE INTERIM PAYMENT SYSTEM REFINEMENT

     SEC. 101. INCREASE IN PER BENEFICIARY LIMITS AND PER VISIT 
                   PAYMENT LIMITS FOR PAYMENT FOR HOME HEALTH 
                   SERVICES.

       (a) Increase in Per Beneficiary Limits.--Section 
     1861(v)(1)(L) of the Social Security Act (42 U.S.C. 
     1395x(v)(1)(L)) is amended--
       (1) in the first sentence of clause (v), by inserting 
     ``subject to clause (viii)(I),'' before ``the Secretary'';
       (2) in clause (vi)(I), by inserting ``subject to clauses 
     (viii)(II) and (viii)(III)'' after ``fiscal year 1994''; and
       (3) by adding at the end the following new clause:
       ``(viii)(I) In the case of a provider with a 12-month cost 
     reporting period ending in fiscal year 1994, if the limit 
     imposed under clause (v) (determined without regard to this 
     subclause) for a cost reporting period beginning during or 
     after fiscal year 1999 is less than the median described in 
     clause (vi)(I) (but determined as if any reference in clause 
     (v) to `98 percent' were a reference to `100 percent'), the 
     limit otherwise imposed under clause (v) for such provider 
     and period shall be increased by \1/2\ of such difference.
       ``(II) Subject to subclause (IV), for new providers and 
     those providers without a 12-month cost reporting period 
     ending in fiscal year 1994, but for which the first cost 
     reporting period begins before fiscal year 1999, for cost 
     reporting periods beginning during or after fiscal year 1999, 
     the per beneficiary limitation described in clause (vi)(I) 
     shall be equal to 50 percent of the median described in such 
     clause plus 50 percent of the sum of 75 percent of such 
     median and 25 percent of 98 percent of the standardized 
     regional average of such costs for the agency's census 
     division, described in clause (v)(I). However, in no case 
     shall the limitation under this subclause be less than the 
     median described in clause (vi)(I) (determined as if any 
     reference in clause (v) to `98 percent' were a reference to 
     `100 percent').
       ``(III) Subject to subclause (IV), in the case of a new 
     home health agency for which the first cost reporting period 
     begins during or after fiscal year 1999, the limitation 
     applied under clause (vi)(I) (but only with respect to such 
     provider) shall be equal to 75 percent of the median 
     described in clause (vi)(I).

[[Page H10244]]

       ``(IV) In the case of a new provider or a provider without 
     a 12-month cost reporting period ending in fiscal year 1994, 
     subclause (II) shall apply, instead of subclause (III), to a 
     home health agency which filed an application for home health 
     agency provider status under this title before September 15, 
     1998, or which was approved as a branch of its parent agency 
     before such date and becomes a subunit of the parent agency 
     or a separate agency on or after such date.
       ``(V) Each of the amounts specified in subclauses (I) 
     through (III) are such amounts as adjusted under clause (iii) 
     to reflect variations in wages among different areas.''.
       (b) Revision of Per Visit Limits.--Section 1861(v)(1)(L)(i) 
     of such Act (42 U.S.C. 1395x(v)(1)(L)(i)) is amended--
       (1) in subclause (III), by striking ``or'';
       (2) in subclause (IV)--
       (A) by inserting ``and before October 1, 1998,'' after 
     ``October 1, 1997,''; and
       (B) by striking the period at the end and inserting ``, 
     or''; and
       (3) by adding at the end the following new subclause:
       ``(V) October 1, 1998, 108 percent of such median.''.
       (c) Exclusion of Additional Part B Costs From Determination 
     of Part B Monthly Premium.--Section 1839 of such Act (42 
     U.S.C. 1395r) is amended--
       (1) in subsection (a)(3), by inserting ``(except as 
     provided in subsection (g))'' after ``year that''; and
       (2) by adding at the end the following new subsection:
       ``(g) In estimating the benefits and administrative costs 
     which will be payable from the Federal Supplementary Medical 
     Insurance Trust Fund for a year for purposes of determining 
     the monthly premium rate under subsection (a)(3), the 
     Secretary shall exclude an estimate of any benefits and 
     administrative costs attributable to the application of 
     section 1861(v)(1)(L)(viii) or to the establishment under 
     section 1861(v)(1)(L)(i)(V) of a per visit limit at 108 
     percent of the median (instead of 105 percent of the median), 
     but only to the extent payment for home health services under 
     this title is not being made under section 1895 (relating to 
     prospective payment for home health services).''.
       (d) Reports on Summary of Research Conducted by the 
     Secretary on the Prospective Payment System.--By not later 
     than January 1, 1999, the Secretary of Health and Human 
     Services shall submit to Congress a report on the following 
     matters:
       (1) Research.--A description of any research paid for by 
     the Secretary on the development of a prospective payment 
     system for home health services furnished under the medicare 
     care program under title XVIII of the Social Security Act, 
     and a summary of the results of such research.
       (2) Schedule for implementation of system.--The Secretary's 
     schedule for the implementation of the prospective payment 
     system for home health services under section 1895 of the 
     Social Security Act (42 U.S.C. 1395fff).
       (3) Alternative to 15 percent reduction in limits.--The 
     Secretary's recommendations for one or more alternative means 
     to provide for savings equivalent to the savings estimated to 
     be made by the mandatory 15 percent reduction in payment 
     limits for such home health services for fiscal year 2000 
     under section 1895(b)(3)(A) of the Social Security Act (42 
     U.S.C. 1395fff(b)(3)(A)), or, in the case the Secretary does 
     not establish and implement such prospective payment system, 
     under section 4603(e) of the Balanced Budget Act of 1997.
       (e) MedPAC Reports.--
       (1) Review of secretary's report.--Not later than 60 days 
     after the date the Secretary of Health and Human Services 
     submits to Congress the report under subsection (d), the 
     Medicare Payment Advisory Commission (established under 
     section 1805 of the Social Security Act (42 U.S.C. 1395b-6)) 
     shall submit to Congress a report describing the Commission's 
     analysis of the Secretary's report, and shall include the 
     Commission's recommendations with respect to the matters 
     contained in such report.
       (2) Annual report.--The Commission shall include in its 
     annual report to Congress for June 1999 an analysis of 
     whether changes in law made by the Balanced Budget Act of 
     1997, as modified by the amendments made by this section, 
     with respect to payments for home health services furnished 
     under the medicare program under title XVIII of the Social 
     Security Act impede access to such services by individuals 
     entitled to benefits under such program.
       (f) GAO Audit of Research Expenditures.--The Comptroller 
     General of the United States shall conduct an audit of sums 
     obligated or expended by the Health Care Financing 
     Administration for the research described in subsection 
     (d)(1), and of the data, reports, proposals, or other 
     information provided by such research.
       (g) Prompt Implementation.--The Secretary of Health and 
     Human Services shall promptly issue (without regard to 
     chapter 8 of title 5, United States Code) such regulations or 
     program memoranda as may be necessary to effect the 
     amendments made by this section for cost reporting periods 
     beginning on or after October 1, 1998. In effecting the 
     amendments made by subsection (a) for cost reporting periods 
     beginning in fiscal year 1999, the ``median'' referred to in 
     section 1861(v)(1)(L)(vi)(I) of the Social Security Act for 
     such periods shall be the national standardized per 
     beneficiary limitation specified in Table 3C published in the 
     Federal Register on August 11, 1998, (63 FR 42926) and the 
     ``standardized regional average of such costs'' referred to 
     in section 1861(v)(1)(L)(v)(I) of such Act for a census 
     division shall be the sum of the labor and nonlabor 
     components of the standardized per-beneficiary limitation for 
     that census division specified in Table 3B published in the 
     Federal Register on that date (63 FR 42926) (or in Table 3D 
     as so published with respect to Puerto Rico and Guam).
             TITLE II--VETERANS MEDICARE ACCESS IMPROVEMENT

     SEC. 201. IMPROVEMENT IN VETERANS' ACCESS TO SERVICES.

       (a) In General.--Title XVIII of the Social Security Act, as 
     amended by sections 4603, 4801, and 4015(a) of the Balanced 
     Budget Act of 1997, is amended by adding at the end the 
     following:


                ``improving veterans' access to services

       ``Sec. 1897. (a) Definitions.--In this section:
       ``(1) Administering secretaries.--The term `administering 
     Secretaries' means the Secretary of Health and Human Services 
     and the Secretary of Veterans Affairs acting jointly.
       ``(2) Program.--The term `program' means the program 
     established under this section with respect to category A 
     medicare-eligible veterans.
       ``(3) Demonstration project; project.--The terms 
     `demonstration project' and `project' mean the demonstration 
     project carried out under this section with respect to 
     category C medicare-eligible veterans.
       ``(4) Medicare-eligible veterans.--
       ``(A) Category a medicare-eligible veteran.--The term 
     `category A medicare-eligible veteran' means an individual--
       ``(i) who is a veteran (as defined in section 101(2) of 
     title 38, United States Code) and is described in paragraph 
     (1) or (2) of section 1710(a) of title 38, United States 
     Code;
       ``(ii) who is entitled to hospital insurance benefits under 
     part A of the medicare program and is enrolled in the 
     supplementary medical insurance program under part B of the 
     medicare program; and
       ``(iii) for whom the medical center of the Department of 
     Veterans Affairs that is closest to the individual's place of 
     residence is geographically remote or inaccessible from such 
     place.
       ``(B) Category c medicare-eligible veteran.--The term 
     `category C medicare-eligible veteran' means an individual 
     who--
       ``(i) is a veteran (as defined in section 101(2) of title 
     38, United States Code) and is described in section 
     1710(a)(3) of title 38, United States Code; and
       ``(ii) is entitled to hospital insurance benefits under 
     part A of the medicare program and is enrolled in the 
     supplementary medical insurance program under part B of the 
     medicare program.
       ``(5) Medicare health care services.--The term `medicare 
     health care services' means items or services covered under 
     part A or B of this title.
       ``(6) Trust funds.--The term `trust funds' means the 
     Federal Hospital Insurance Trust Fund established in section 
     1817 and the Federal Supplementary Medical Insurance Trust 
     Fund established in section 1841.
       ``(b) Program and Demonstration Project.--
       ``(1) In general.--
       ``(A) Establishment.--The administering Secretaries are 
     authorized to establish--
       ``(i) a program (under an agreement entered into by the 
     administering Secretaries) under which the Secretary of 
     Health and Human Services shall reimburse the Secretary of 
     Veterans Affairs, from the trust funds, for medicare health 
     care services furnished to category A medicare-eligible 
     veterans; and
       ``(ii) a demonstration project (under such an agreement) 
     under which the Secretary of Health and Human Services shall 
     reimburse the Secretary of Veterans Affairs, from the trust 
     funds, for medicare health care services furnished to 
     category C medicare-eligible veterans.
       ``(B) Agreement.--The agreement entered into under 
     subparagraph (A) shall include at a minimum--
       ``(i) a description of the benefits to be provided to the 
     participants of the program and the demonstration project 
     established under this section;
       ``(ii) a description of the eligibility rules for 
     participation in the program and demonstration project, 
     including any cost sharing requirements;
       ``(iii) a description of the process for enrolling veterans 
     for participation in the program, which process may, to the 
     extent practicable, be administered in the same or similar 
     manner to the registration process established to implement 
     section 1705 of title 38, United States Code;
       ``(iv) a description of how the program and the 
     demonstration project will satisfy the requirements under 
     this title;
       ``(v) a description of the sites selected under paragraph 
     (2);
       ``(vi) a description of how reimbursement requirements 
     under subsection (g) and maintenance of effort requirements 
     under subsection (h) will be implemented in the program and 
     in the demonstration project;
       ``(vii) a statement that all data of the Department of 
     Veterans Affairs and of the Department of Health and Human 
     Services that the administering Secretaries determine is 
     necessary to conduct independent estimates

[[Page H10245]]

     and audits of the maintenance of effort requirement, the 
     annual reconciliation, and related matters required under the 
     program and the demonstration project shall be available to 
     the administering Secretaries;
       ``(viii) a description of any requirement that the 
     Secretary of Health and Human Services waives pursuant to 
     subsection (d);
       ``(ix) a requirement that the Secretary of Veterans Affairs 
     undertake and maintain outreach and marketing activities, 
     consistent with capacity limits under the program, for 
     category A medicare-eligible veterans;
       ``(x) a description of how the administering Secretaries 
     shall conduct the data matching program under subparagraph 
     (F), including the frequency of updates to the comparisons 
     performed under subparagraph (F)(ii); and
       ``(xi) a statement by the Secretary of Veterans Affairs 
     that the type or amount of health care services furnished 
     under chapter 17 of title 38, United States Code, to veterans 
     who are entitled to benefits under part A or enrolled under 
     part B, or both, shall not be reduced by reason of the 
     program or project.
       ``(C) Cost-sharing under demonstration project.--
     Notwithstanding any provision of title 38, United States 
     Code, in order--
       ``(i) to maintain and broaden access to services,
       ``(ii) to encourage appropriate use of services, and
       ``(iii) to control costs,

     the Secretary of Veterans Affairs may establish enrollment 
     fees and copayment requirements under the demonstration 
     project under this section consistent with subsection (d)(1). 
     Such fees and requirements may vary based on income.
       ``(D) Health care benefits.--The administering Secretaries 
     shall prescribe the minimum health care benefits to be 
     provided under the program and demonstration project to 
     medicare-eligible veterans enrolled in the program or 
     project. Those benefits shall include at least all medicare 
     health care services covered under this title.
       ``(E) Establishment of service networks.--
       ``(i) Use of va outpatient clinics.--The Secretary of 
     Veterans Affairs, to the extent practicable, shall use 
     outpatient clinics of the Department of Veterans Affairs in 
     providing services under the program.
       ``(ii) Authority to contract for services.--The Secretary 
     of Veterans Affairs may enter into contracts and arrangements 
     with entities (such as private practitioners, providers of 
     services, preferred provider organizations, and health care 
     plans) for the provision of services for which the Secretary 
     of Health and Human Services is responsible under the program 
     or project under this section and shall take into account the 
     existence of qualified practitioners and providers in the 
     areas in which the program or project is being conducted. 
     Under such contracts and arrangements, such Secretary of 
     Health and Human Services may require the entities to furnish 
     such information as such Secretary may require to carry out 
     this section.
       ``(F) Data match.--
       ``(i) Establishment of data matching program.--The 
     administering Secretaries shall establish a data matching 
     program under which there is an exchange of information of 
     the Department of Veterans Affairs and of the Department of 
     Health and Human Services as is necessary to identify 
     veterans who are entitled to benefits under part A or 
     enrolled under part B, or both, in order to carry out this 
     section. The provisions of section 552a of title 5, United 
     States Code, shall apply with respect to such matching 
     program only to the extent the administering Secretaries find 
     it feasible and appropriate in carrying out this section in a 
     timely and efficient manner.
       ``(ii) Performance of data match.--The administering 
     Secretaries, using the data matching program established 
     under clause (i), shall perform a comparison in order to 
     identify veterans who are entitled to benefits under part A 
     or enrolled under part B, or both. To the extent such 
     Secretaries deem appropriate to carry out this section, the 
     comparison and identification may distinguish among such 
     veterans by category of veterans, by entitlement to benefits 
     under this title, or by other characteristics.
       ``(iii) Deadline for first data match.--The administering 
     Secretaries shall first perform a comparison under clause 
     (ii) by not later than October 31, 1998.
       ``(iv) Certification by inspector general.--

       ``(I) In general.--The administering Secretaries may not 
     conduct the program unless the Inspector General of the 
     Department of Health and Human Services certifies to Congress 
     that the administering Secretaries have established the data 
     matching program under clause (i) and have performed a 
     comparison under clause (ii).
       ``(II) Deadline for certification.--Not later than December 
     15, 1998, the Inspector General of the Department of Health 
     and Human Services shall submit a report to Congress 
     containing the certification under subclause (I) or the 
     denial of such certification.

       ``(2) Number of sites.--The program and demonstration 
     project shall be conducted in geographic service areas of the 
     Department of Veterans Affairs, designated jointly by the 
     administering Secretaries after review of all such areas, as 
     follows:
       ``(A) Program sites.--
       ``(i) In general.--Except as provided in clause (ii), the 
     program shall be conducted in not more than 3 such areas with 
     respect to category A medicare-eligible veterans.
       ``(ii) Additional program sites.--Subject to the 
     certification required under subsection (h)(1)(B)(iii), for a 
     year beginning on or after January 1, 2003, the program shall 
     be conducted in such areas as are designated jointly by the 
     administering Secretaries after review of all such areas.
       ``(B) Project sites.--
       ``(i) In general.--The demonstration project shall be 
     conducted in not more than 3 such areas with respect to 
     category C medicare-eligible veterans.
       ``(ii) Mandatory site.--At least one of the areas 
     designated under clause (i) shall encompass the catchment 
     area of a military medical facility which was closed pursuant 
     to either the Defense Base Closure and Realignment Act of 
     1990 (part A of title XXIX of Public Law 101-510; 10 U.S.C. 
     2687 note) or title II of the Defense Authorization 
     Amendments and Base Closure and Realignment Act (Public Law 
     100-526; 10 U.S.C. 2687 note).
       ``(3) Restriction.--Funds from the program or demonstration 
     project shall not be used for--
       ``(A) the construction of any treatment facility of the 
     Department of Veterans Affairs; or
       ``(B) the renovation, expansion, or other construction at 
     such a facility.
       ``(4) Duration.--The administering Secretaries shall 
     conduct and implement the program and the demonstration 
     project as follows:
       ``(A) Program.--
       ``(i) In general.--The program shall begin on January 1, 
     2000, in the sites designated under paragraph (2)(A)(i) and, 
     subject to subsection (h)(1)(B)(iii)(II), for a year 
     beginning on or after January 1, 2003, the program may be 
     conducted in such additional sites designated under paragraph 
     (2)(A)(ii).
       ``(ii) Limitation on number of veterans covered under 
     certain circumstances.--If for a year beginning on or after 
     January 1, 2003, the program is conducted only in the sites 
     designated under paragraph (2)(A)(i), medicare health care 
     services may not be provided under the program to a number of 
     category-A medicare-eligible veterans that exceeds the 
     aggregate number of such veterans covered under the program 
     as of December 31, 2002.
       ``(B) Project.--The demonstration project shall begin on 
     January 1, 1999, and end on December 31, 2001.
       ``(C) Implementation.--The administering Secretaries may 
     implement the program and demonstration project through the 
     publication of regulations that take effect on an interim 
     basis, after notice and pending opportunity for public 
     comment.
       ``(5) Reports.--
       ``(A) Program.--By not later than September 1, 1999, the 
     administering Secretaries shall submit a copy of the 
     agreement entered into under paragraph (1) with respect to 
     the program to Congress.
       ``(B) Project.--By not later than November 1, 1998, the 
     administering Secretaries shall submit a copy of the 
     agreement entered into under paragraph (1) with respect to 
     the project to Congress.
       ``(6) Report on maintenance of level of health care 
     services.--
       ``(A) In general.--The Secretary of Veterans Affairs may 
     not implement the program at a site designated under 
     paragraph (2)(A) unless, by not later than 90 days before the 
     date of the implementation, the Secretary of Veterans Affairs 
     submits to Congress and to the Comptroller General of the 
     United States a report that contains the information 
     described in subparagraph (B). The Secretary of Veterans 
     Affairs shall periodically update the report under this 
     paragraph as appropriate.
       ``(B) Information described.--For purposes of subparagraph 
     (A), the information described in this subparagraph is a 
     description of the operation of the program at the site and 
     of the steps to be taken by the Secretary of Veterans Affairs 
     to prevent the reduction of the type or amount of health care 
     services furnished under chapter 17 of title 38, United 
     States Code, to veterans who are entitled to benefits under 
     part A or enrolled under part B, or both, within the 
     geographic service area of the Department of Veterans Affairs 
     in which the site is located by reason of the program or 
     project.
       ``(c) Crediting of Payments.--A payment received by the 
     Secretary of Veterans Affairs under the program or 
     demonstration project shall be credited to the applicable 
     Department of Veterans Affairs medical care appropriation 
     (and within that appropriation). Any such payment received 
     during a fiscal year for services provided during a prior 
     fiscal year may be obligated by the Secretary of Veterans 
     Affairs during the fiscal year during which the payment is 
     received.
       ``(d) Application of Certain Medicare Requirements.--
       ``(1) Authority.--
       ``(A) In general.--Except as provided under subparagraph 
     (B), the program and the demonstration project shall meet all 
     requirements of Medicare+Choice plans under part C and 
     regulations pertaining thereto, and other requirements for 
     receiving medicare payments, except that the prohibition of 
     payments to Federal providers of services under sections 
     1814(c) and 1835(d), and paragraphs (2) and (3) of section 
     1862(a) shall not apply.
       ``(B) Waiver.--Except as provided in paragraph (2), the 
     Secretary of Health and Human Services is authorized to waive 
     any requirement described under subparagraph (A), or approve 
     equivalent or alternative

[[Page H10246]]

     ways of meeting such a requirement, but only if such waiver 
     or approval--
       ``(i) reflects the unique status of the Department of 
     Veterans Affairs as an agency of the Federal Government; and
       ``(ii) is necessary to carry out the program or 
     demonstration project.
       ``(2) Beneficiary protections and other matters.--The 
     program and the demonstration project shall comply with the 
     requirements of part C of this title that relate to 
     beneficiary protections and other matters, including such 
     requirements relating to the following areas, to the extent 
     not inconsistent with subsection (b)(1)(B)(iii):
       ``(A) Enrollment and disenrollment.
       ``(B) Nondiscrimination.
       ``(C) Information provided to beneficiaries.
       ``(D) Cost-sharing limitations.
       ``(E) Appeal and grievance procedures.
       ``(F) Provider participation.
       ``(G) Access to services.
       ``(H) Quality assurance and external review.
       ``(I) Advance directives.
       ``(J) Other areas of beneficiary protections that the 
     administering Secretaries determine are applicable to such 
     program or project.
       ``(e) Inspector General.--Nothing in the agreement entered 
     into under subsection (b) shall limit the Inspector General 
     of the Department of Health and Human Services from 
     investigating any matters regarding the expenditure of funds 
     under this title for the program and demonstration project, 
     including compliance with the provisions of this title and 
     all other relevant laws.
       ``(f) Voluntary Participation.--Participation of a category 
     A medicare-eligible veteran in the program or category C 
     medicare-eligible veteran in the demonstration project shall 
     be voluntary.
       ``(g) Payments Based on Regular Medicare Payment Rates.--
       ``(1) In general.--Subject to the succeeding provisions of 
     this subsection, the Secretary of Health and Human Services 
     shall reimburse the Secretary of Veterans Affairs for 
     services provided under the program or demonstration project 
     at a rate equal to 95 percent of the amount paid to a 
     Medicare+Choice organization under part C of this title with 
     respect to such an enrollee. In cases in which a payment 
     amount may not otherwise be readily computed, the Secretary 
     of Health and Human Services shall establish rules for 
     computing equivalent or comparable payment amounts.
       ``(2) Exclusion of certain amounts.--In computing the 
     amount of payment under paragraph (1), the following shall be 
     excluded:
       ``(A) Special payments.--Any amount attributable to an 
     adjustment under subparagraphs (B) and (F) of section 
     1886(d)(5) and subsection (h) of such section.
       ``(B) Percentage of capital payments.--An amount determined 
     by the administering Secretaries for amounts attributable to 
     payments for capital-related costs under subsection (g) of 
     such section.
       ``(3) Periodic payments from medicare trust funds.--
     Payments under this subsection shall be made--
       ``(A) on a periodic basis consistent with the periodicity 
     of payments under this title; and
       ``(B) in appropriate part, as determined by the Secretary 
     of Health and Human Services, from the trust funds.
       ``(4) Cap on reimbursement amounts.--The aggregate amount 
     to be reimbursed under this subsection pursuant to the 
     agreement entered into between the administering Secretaries 
     under subsection (b) is as follows:
       ``(A) Program.--With respect to category A medicare-
     eligible veterans, such aggregate amount shall not exceed--
       ``(i) for 2000, a total of $50,000,000;
       ``(ii) for 2001, a total of $75,000,000; and
       ``(iii) subject to subparagraph (B), for 2002 and each 
     succeeding year, a total of $100,000,000.
       ``(B) Expansion of program.--If for a year beginning on or 
     after January 1, 2003, the program is conducted in sites 
     designated under subsection (b)(2)(A)(ii), the limitation 
     under subparagraph (A)(iii) shall not apply to the program 
     for such a year.
       ``(C) Project.--With respect to category C medicare-
     eligible veterans, such aggregate amount shall not exceed a 
     total of $50,000,000 for each of calendar years 1999 through 
     2001.
       ``(h) Maintenance of Effort.--
       ``(1) Monitoring effect of program and demonstration 
     project on costs to medicare program.--
       ``(A) In general.--The administering Secretaries, in 
     consultation with the Comptroller General of the United 
     States, shall closely monitor the expenditures made under 
     this title for category A and C medicare-eligible veterans 
     compared to the expenditures that would have been made for 
     such veterans if the program and demonstration project had 
     not been conducted. The agreement entered into by the 
     administering Secretaries under subsection (b) shall require 
     the Department of Veterans Affairs to maintain overall the 
     level of effort for services covered under this title to such 
     categories of veterans by reference to a base year as 
     determined by the administering Secretaries.
       ``(B) Determination of measure of costs of medicare health 
     care services.--
       ``(i) Improvement of information management system.--Not 
     later than October 1, 2001, the Secretary of Veterans Affairs 
     shall improve its information management system such that, 
     for a year beginning on or after January 1, 2002, the 
     Secretary of Veterans Affairs is able to identify costs 
     incurred by the Department of Veterans Affairs in providing 
     medicare health care services to medicare-eligible veterans 
     for purposes of meeting the requirements with respect to 
     maintenance of effort under an agreement under subsection 
     (b)(1)(A).
       ``(ii) Identification of medicare health care services.--
     The Secretary of Health and Human Services shall provide such 
     assistance as is necessary for the Secretary of Veterans 
     Affairs to determine which health care services furnished by 
     the Secretary of Veterans Affairs qualify as medicare health 
     care services.
       ``(iii) Certification by hhs inspector general.--

       ``(I) Request for certification.--The Secretary of Veterans 
     Affairs may request the Inspector General of the Department 
     of Health and Human Services to make a certification to 
     Congress that the Secretary of Veterans Affairs has improved 
     its management system under clause (i) such that the 
     Secretary of Veterans Affairs is able to identify the costs 
     described in such clause in a reasonably reliable and 
     accurate manner.
       ``(II) Requirement for expansion of program.--The program 
     may be conducted in the additional sites under paragraph 
     (2)(A)(ii) and cover such additional category A medicare 
     eligible veterans in such additional sites only if the 
     Inspector General of the Department of Health and Human 
     Services has made the certification described in subclause 
     (I).
       ``(III) Deadline for certification.--Not later than the 
     date that is the earlier of the date that is 60 days after 
     the Secretary of Veterans Affairs requests a certification 
     under subclause (I) or June 1, 2002, the Inspector General of 
     the Department of Health and Human Services shall submit a 
     report to Congress containing the certification under 
     subclause (I) or the denial of such certification.

       ``(C) Maintenance of level of effort.--
       ``(i) Report by secretary of veterans affairs on basis for 
     calculation.--Not later than the date that is 60 days after 
     the date on which the administering Secretaries enter into an 
     agreement under subsection (b)(1)(A), the Secretary of 
     Veterans Affairs shall submit a report to Congress and the 
     Comptroller General of the United States explaining the 
     methodology used and basis for calculating the level of 
     effort of the Department of Veterans Affairs under the 
     program and project.
       ``(ii) Report by comptroller general.--Not later than the 
     date that is 180 days after the date described in clause (i), 
     the Comptroller General of the United States shall submit to 
     Congress and the administering Secretaries a report setting 
     forth the Comptroller General's findings, conclusion, and 
     recommendations with respect to the report submitted by the 
     Secretary of Veterans Affairs under clause (i).
       ``(iii) Response by secretary of veterans affairs.--The 
     Secretary of Veterans Affairs shall submit to Congress not 
     later than 60 days after the date described in clause (ii) a 
     report setting forth such Secretary's response to the report 
     submitted by the Comptroller General under clause (ii).
       ``(D) Annual report by the comptroller general.--Not later 
     than December 31 of each year during which the program and 
     demonstration project is conducted, the Comptroller General 
     of the United States shall submit to the administering 
     Secretaries and to Congress a report on the extent, if any, 
     to which the costs of the Secretary of Health and Human 
     Services under the medicare program under this title 
     increased during the preceding fiscal year as a result of the 
     program or demonstration project.
       ``(2) Required response in case of increase in costs.--
       ``(A) In general.--If the administering Secretaries find, 
     based on paragraph (1), that the expenditures under the 
     medicare program under this title increased (or are expected 
     to increase) during a fiscal year because of the program or 
     demonstration project, the administering Secretaries shall 
     take such steps as may be needed--
       ``(i) to recoup for the medicare program the amount of such 
     increase in expenditures; and
       ``(ii) to prevent any such increase in the future.
       ``(B) Steps.--Such steps--
       ``(i) under subparagraph (A)(i) shall include payment of 
     the amount of such increased expenditures by the Secretary of 
     Veterans Affairs from the current medical care appropriation 
     for the Department of Veterans Affairs to the trust funds; 
     and
       ``(ii) under subparagraph (A)(ii) shall include lowering 
     the amount of payment under the program or project under 
     subsection (g)(1), and may include, in the case of the 
     demonstration project, suspending or terminating the project 
     (in whole or in part).
       ``(i) Evaluation and Reports.--
       ``(1) Independent evaluation by gao.--
       ``(A) In general.--The Comptroller General of the United 
     States shall conduct an evaluation of the program and an 
     evaluation of the demonstration project, and shall submit 
     annual reports on the program and demonstration project to 
     the administering Secretaries and to Congress.
       ``(B) First report.--The first report for the program or 
     demonstration project under subparagraph (A) shall be 
     submitted not later than 12 months after the date on which 
     the Secretary of Veterans Affairs first provides services 
     under the program or project, respectively.

[[Page H10247]]

       ``(C) Final report on demonstration project.--A final 
     report shall be submitted with respect to the demonstration 
     project not later than 3\1/2\ years after the date of the 
     first report on the project under subparagraph (B).
       ``(D) Contents.--The evaluation and reports under this 
     paragraph for the program or demonstration project shall 
     include an assessment, based on the agreement entered into 
     under subsection (b), of the following:
       ``(i) Any savings or costs to the medicare program under 
     this title resulting from the program or project.
       ``(ii) The cost to the Department of Veterans Affairs of 
     providing care to category A medicare-eligible veterans under 
     the program or to category C medicare-eligible veterans under 
     the demonstration project, respectively.
       ``(iii) An analysis of how such program or project affects 
     the overall accessibility of medical care through the 
     Department of Veterans Affairs, and a description of the 
     unintended effects (if any) upon the patient enrollment 
     system under section 1705 of title 38, United States Code.
       ``(iv) Compliance by the Department of Veterans Affairs 
     with the requirements under this title.
       ``(v) The number of category A medicare-eligible veterans 
     or category C medicare-eligible veterans, respectively, 
     opting to participate in the program or project instead of 
     receiving health benefits through another health insurance 
     plan (including benefits under this title).
       ``(vi) A list of the health insurance plans and programs 
     that were the primary payers for medicare-eligible veterans 
     during the year prior to their participation in the program 
     or project, respectively, and the distribution of their 
     previous enrollment in such plans and programs.
       ``(vii) Any impact of the program or project, respectively, 
     on private health care providers and beneficiaries under this 
     title that are not enrolled in the program or project.
       ``(viii) An assessment of the access to care and quality of 
     care for medicare-eligible veterans under the program or 
     project, respectively.
       ``(ix) An analysis of whether, and in what manner, easier 
     access to medical centers of the Department of Veterans 
     Affairs affects the number of category A medicare-eligible 
     veterans or C medicare-eligible veterans, respectively, 
     receiving medicare health care services.
       ``(x) Any impact of the program or project, respectively, 
     on the access to care for category A medicare-eligible 
     veterans or C medicare-eligible veterans, respectively, who 
     did not enroll in the program or project and for other 
     individuals entitled to benefits under this title.
       ``(xi) A description of the difficulties (if any) 
     experienced by the Department of Veterans Affairs in managing 
     the program or project, respectively.
       ``(xii) Any additional elements specified in the agreement 
     entered into under subsection (b).
       ``(xiii) Any additional elements that the Comptroller 
     General of the United States determines is appropriate to 
     assess regarding the program or project, respectively.
       ``(2) Reports by secretaries on program and demonstration 
     project with respect to medicare-eligible veterans.--
       ``(A) Demonstration project.--Not later than 6 months after 
     the date of the submission of the final report by the 
     Comptroller General of the United States on the demonstration 
     project under paragraph (1)(C), the administering Secretaries 
     shall submit to Congress a report containing their 
     recommendation as to--
       ``(i) whether there is a cost to the health care program 
     under this title in conducting the demonstration project;
       ``(ii) whether to extend the demonstration project or make 
     the project permanent; and
       ``(iii) whether the terms and conditions of the project 
     should otherwise be continued (or modified) with respect to 
     medicare-eligible veterans.
       ``(B) Program.--Not later than 6 months after the date of 
     the submission of the report by the Comptroller General of 
     the United States on the third year of the operation of the 
     program, the administering Secretaries shall submit to 
     Congress a report containing their recommendation as to--
       ``(i) whether there is a cost to the health care program 
     under this title in conducting the program under this 
     section;
       ``(ii) whether to discontinue the program with respect to 
     category A medicare-eligible veterans; and
       ``(iii) whether the terms and conditions of the program 
     should otherwise be continued (or modified) with respect to 
     medicare-eligible veterans.
       ``(j) Application of Medigap Protections to Demonstration 
     Project Enrollees.--(1) Subject to paragraph (2), the 
     provisions of section 1882(s)(3) (other than clauses (i) 
     through (iv) of subparagraph (B)) and 1882(s)(4) shall apply 
     to enrollment (and termination of enrollment) in the 
     demonstration project, in the same manner as they apply to 
     enrollment (and termination of enrollment) with a 
     Medicare+Choice organization in a Medicare+Choice plan.
       ``(2) In applying paragraph (1)--
       ``(A) any reference in clause (v) or (vi) of section 
     1882(s)(3)(B) to 12 months is deemed a reference to 36 
     months; and
       ``(B) the notification required under section 1882(s)(3)(D) 
     shall be provided in a manner specified by the Secretary of 
     Veterans Affairs.''.
       (b) Repeal of Plan Requirement.--Subsection (b) of section 
     4015 of the Balanced Budget Act of 1997 (relating to an 
     implementation plan for Veterans subvention) is repealed.
       (c) Report to Congress on a Method to Include the Costs of 
     Veterans Affairs and Military Facility Services to Medicare-
     eligible Beneficiaries in the Calculation of Medicare+Choice 
     Payment Rates.--The Secretary of Health and Human Services 
     shall report to the Congress by not later than January 1, 
     2001, on a method to phase-in the costs of military facility 
     services furnished by the Department of Veterans Affairs or 
     the Department of Defense to medicare-eligible beneficiaries 
     in the calculation of an area's Medicare+Choice capitation 
     payment. Such report shall include on a county-by- county 
     basis--
       (1) the actual or estimated cost of such services to 
     medicare-eligible beneficiaries;
       (2) the change in Medicare+Choice capitation payment rates 
     if such costs are included in the calculation of payment 
     rates;
       (3) one or more proposals for the implementation of payment 
     adjustments to Medicare+Choice plans in counties where the 
     payment rate has been affected due to the failure to 
     calculate the cost of such services to medicare-eligible 
     beneficiaries; and
       (4) a system to ensure that when a Medicare+Choice enrollee 
     receives covered services through a facility of the 
     Department of Veterans Affairs or the Department of Defense 
     there is an appropriate payment recovery to the medicare 
     program.
  TITLE III--AUTHORIZATION OF ADDITIONAL EXCEPTIONS TO IMPOSITION OF 
                   PENALTIES FOR CERTAIN INDUCEMENTS

     SEC. 301. AUTHORIZATION OF ADDITIONAL EXCEPTIONS TO 
                   IMPOSITION OF PENALTIES FOR PROVIDING 
                   INDUCEMENTS TO BENEFICIARIES.

       (a) In General.--Subparagraph (B) of section 1128A(i)(6) of 
     the Social Security Act (42 U.S.C. 1320a-7a(i)(6)) is amended 
     to read as follows:
       ``(B) any permissible practice described in any 
     subparagraph of section 1128B(b)(3) or in regulations issued 
     by the Secretary;''.
       (b) Extension of Advisory Opinion Authority.--Section 
     1128D(b)(2)(A) of such Act (42 U.S.C. 1320a-7d(b)(2)(A)) is 
     amended by inserting ``or section 1128A(i)(6)'' after 
     ``1128B(b)''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on the date of the enactment of this Act.
       (d) Interim Final Rulemaking Authority.--The Secretary of 
     Health and Human Services may promulgate regulations that 
     take effect on an interim basis, after notice and pending 
     opportunity for public comment, in order to implement the 
     amendments made by this section in a timely manner.
  TITLE IV--EXPANSION OF MEMBERSHIP OF THE MEDICARE PAYMENT ADVISORY 
                               COMMISSION

     SEC. 401. EXPANSION OF MEMBERSHIP OF MEDPAC TO 17.

       (a) In General.--Section 1805(c)(1) of the Social Security 
     Act (42 U.S.C. 1395b-6(c)(1)), as added by section 4022 of 
     the Balanced Budget Act of 1997, is amended by striking 
     ``15'' and inserting ``17''.
       (b) Initial Terms of Additional Members.--
       (1) In general.--For purposes of staggering the initial 
     terms of members of the Medicare Payment Advisory Commission 
     (under section 1805(c)(3) of such Act (42 U.S.C. 1395b-
     6(c)(3)), the initial terms of the two additional members of 
     the Commission provided for by the amendment under subsection 
     (a) are as follows:
       (A) One member shall be appointed for one year.
       (B) One member shall be appointed for two years.
       (2) Commencement of terms.--Such terms shall begin on May 
     1, 1999.
                        TITLE V--REVENUE OFFSET

     SEC. 501. REVENUE OFFSET.

       (a) In General.--Subparagraph (B) of section 408A(c)(3) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``relates'' and all that follows and inserting ``relates, the 
     taxpayer's adjusted gross income exceeds $145,000 ($290,000 
     in the case of a joint return).''
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to distributions after December 31, 1998.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Thomas) and the gentleman from California (Mr. Stark) 
each will control 20 minutes.
  The Chair recognizes the gentleman from California (Mr. Thomas).
  Mr. THOMAS. Mr. Speaker, I ask unanimous consent that 8 of those 20 
minutes in the affirmative be controlled by the gentleman from Florida 
(Mr. Bilirakis), chairman of the Subcommittee on Health of the 
Committee on Commerce.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?

[[Page H10248]]

  There was no objection.


                             General Leave

  Mr. THOMAS. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and include extraneous material on H.R. 4567.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this bill, H.R. 4567, is one that is needed for a number 
of reasons. Most people will probably focus on what they consider to be 
the major provision, and that is a modification in the home health care 
payment structure.
  In the Balanced Budget Act of 1997, after extensive negotiations with 
the administration, we were able to get the administration to change 
their 100 percent structure to a blended arrangement which we thought 
would at least modify the perniciousness of the administration's 
approach. We could not get them to go farther. That position became the 
interim payment structure that we are operating under now. Once we were 
able to examine what the administration really wanted, we discovered 
that it was lacking in a number of provisions in assisting on a broad 
base home health care agencies previously established, newly 
established and between States.
  Not only was it not adequate in its interim payment structure form, 
but we were told in August by the Health Care Financing Administration 
that, because of their computers' difficulties with the year 2000 
problem, they would not be able to honor the date that they said the 
prospective payment system replacing the interim payment system would 
go into effect. What ensued was a series of negotiations among all of 
those parties affected, and a bill was passed through the Committee on 
Ways and Means, modified by the Committee on Commerce's concerns and 
with the administration as a full partner to make sure that anything 
that we proposed could actually be carried out by the administration 
because of the year 2000 computer problems.
  We have in front of us, I believe, a solution in which there are no 
losers. One of the difficulties is that many of the proposals basically 
robbed Peter to pay Paul, revenue neutral. Even if they added money to 
the pot, it was clear that it was only perpetuating an unfair system. 
Although we perhaps add more money than I would have liked to have 
added to the overall pot to solve the problem, the most important 
provision is that it treats those who are most in need fairly, and that 
is essential, I think, if in these latter days we are able to move this 
legislation.
  A second provision of this bill is a veterans' subvention program. 
The Department of Defense has a Medicare subvention demonstration 
program. We were anxious to involve the veterans. This is a perfected 
veterans' subvention program.
  There are basically two categories of veterans. The category C are 
those who are relatively well off, vis-a-vis the category A veterans, 
and who do not have service-related disabilities. The primary focus is 
on the category A veterans. There is a real problem in this area. We 
believe that this provision is a worthwhile one. It is a demonstration 
for both of us, and the chairman of the Committee on Veterans' Affairs 
will speak to that very shortly.
  There are two other minor provisions. One is to allow for the 
reinstitution of a long-standing practice in which those patients who 
are end-stage renal disease patients and unable to provide for 
insurance coverage are assisted in that insurance coverage. Through a 
technical failure in our fraud and abuse program, that technically 
would not be allowed. This creates an opportunity for the Inspector 
General at HHS to make sure there is a safe harbor to protect those 
individuals.
  The last item is an expansion of the MedPAC board, which would 
provide for a broadening of the representational interests on that 
board, be they professional, general public or geographic, based upon 
who those additional members would be.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I ask unanimous consent that 6 minutes of 
debate time be allocated to the gentleman from Pennsylvania (Mr. 
Klink).
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. STARK. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the bill that the gentleman from California (Mr. Thomas) 
and the Republican leadership have crafted does some good things: The 
subvention. There are some issues dealing with Medicare payments to 
people with end-stage renal disease that are helpful. There is an 
attempt to fix or assist the problems that are being caused in the home 
health delivery system by the administration's inability to get their 
act together.
  Having said that, they have snatched victory from the jaws of defeat 
and pounded it to death. The bill is now a tax loophole and a stealth 
pay raise for Members of Congress and it has combined a series of 
measures and almost assured its defeat in the Senate because it 
violates the Senate rules and costs $10 billion over the next 10 years. 
Admittedly we only work in a 5-year time frame. They would raise a 
point of order in the Senate and need 60 votes and it is unlikely that 
it would pass there.

                              {time}  1215

  It extends a tax break to the very wealthy and now includes Members 
of Congress. Previously we were unable, as Members of Congress, to take 
advantage of Roth IRAs, and we now will be able to so that we have, and 
I am sure people will soon discover, we are about to vote ourselves a 
pay raise. I vote for pay raises, but I like to do it up front so that 
my constituents know that. I think it is too bad that we are doing it. 
It violates the budget, the IRA tax breaks have been dropped in 
conference or must be dropped or the bill is doomed.
  We had suggested in the Committee on Ways and Means the postponement 
and reduction of medical savings accounts for seniors, and, 
interestingly enough, there are not any. There is no company offering 
medical savings accounts to seniors, and we could have saved a billion 
dollars and postponed the 15 percent tax cut which the home health 
industry is staring in the face next year. That was defeated by the 
Republicans in the Committee on Ways and Means, and I hope that if this 
bill goes to conference we could reestablish that. It hurts no one, 
there is no insurance company selling it, no seniors can buy it, we 
have already lost 300 million in savings which has evaporated. Through 
the inactivity or ignorance of the Republican bill we are going to let 
more of that savings disappear which could be used to help home health 
agencies who need it.
  Again, this bill gives up, loses, $10.7 billion, does precious little 
except for the most egregious home health providers and mostly in 
southern States who have taken most advantage of this payment, and we 
could have done a better job, Mr. Speaker, we could have not dipped 
into the surplus so egregiously, and I hope that when this bill comes 
to conference, if in fact it ever does, that we can correct it at that 
point.
  Mr. Speaker, I reserve the balance of my time.
  Mr. THOMAS. Mr. Speaker, I yield myself 30 seconds.
  Notwithstanding the gentleman's description of the bill, the paid-for 
provision which increases the individual retirement accounts on Roth 
IRAs from 100,000 to 145,000 does comport with the budget rules on the 
House side, and in looking for areas to pay for a change in Medicare 
and related medical costs, we thought it most prudent not to dip into 
Medicare or other health care provisions to rob Peter to pay Paul, and 
it seems to me that this is a particularly appropriate way within the 
House budget rules.
  Mr. Speaker, I yield 2 minutes to the gentleman from Arizona (Mr. 
Stump), the distinguished Chairman of the Committee on Veterans' 
Affairs.
  Mr. STUMP. Mr. Speaker, I thank the gentleman for yielding this time 
to me.
  I rise in strong support of this measure and am pleased to be an 
original cosponsor. This legislation would realize one of the top 
priorities of our national veterans organizations, enabling

[[Page H10249]]

Medicare-eligible veterans for the first time to get Medicare coverage 
through the VA. This legislation would expand veterans' options and 
their access to care while still offering the promise of reducing 
Medicare costs.
  While the Committee on Veterans' Affairs took the lead in reporting 
out this legislation, I am indeed indebted to my friend, the gentleman 
from California (Mr. Thomas), the primary architect of the broader VA 
Medicare provisions being taken up today. Bill Thomas' highly acclaimed 
expertise on the Medicare program and his willingness to become 
knowledgeable on VA health care with key to moving this legislation, 
and I would also like to thank the gentleman from Florida (Mr. 
Bilirakis) who is an original cosponsor and has been a tireless 
champion for veterans.
  Veterans' legislation is truly nonpartisan, and I want to salute our 
colleagues on the other side of the aisle on the Committee on Ways and 
Means, the Committee on Commerce and the Committee on Veterans Affairs 
who helped advance this legislation.
  Mr. Speaker, this is a good bill for veterans, and I urge the Members 
to adopt it.
  Mr. BILBRAY. Mr. Speaker, I yield myself such time as I might 
consume.
  Mr. Speaker, our bill is the result of hard work between the 
Committee on Commerce and Committee on Ways and Means. Many of us have 
heard from constituents, principally veterans and senior citizens who 
are or may be effected by current health policy which we address and 
improve in the bill before us today.
  H.R. 4567 proves, I think, that Members of Congress do listen to the 
concerns of their constituents and, when appropriate, work to find 
viable solutions. Several issues are addressed in this legislation.
  Long ago our Nation made a commitment to care for the brave men and 
women who fought the battles to keep America free, and these are our 
Nation's veterans. As a veteran myself and a representative of a 
congressional district with a large veterans population, I am pleased 
that we have incorporated a Veterans Medicare Access Improvement Act 
into H.R. 4567. The Veterans Medicare Access Improvement Act will 
permit the Medicare program to reimburse the VA for care given to 
Medicare eligible veterans. The bill provides new health care options 
to veterans who have previously been shut out of the VA health care 
system, and it allows the VA to reach out to thousands of underserved 
veterans.
  The home health issue is also addressed. Currently one out of every 
ten Medicare beneficiaries receives close to 80 home health visits per 
year. BBA 97 sought to address the over utilization of home health 
services by directing HCFA to create a prospective payment system for 
the home health industry by October of 1999. Initially HCVA was told to 
implement an interim payment system which would allow home health 
agencies to make the transition to the new prospective payment system. 
HCFA recently informed Congress, unfortunately, that it could not make 
the October 1, 1999, deadline, thus forcing home health agencies to 
live with the reimbursement policy which many believe is unfair and 
will cause numerous facilities to shut down. Through this bill we make 
the payments to both old and new home health facilities more equitable, 
thus creating a more even playing field for home health agencies across 
the country, and most important, we restore assurance to Medicare 
beneficiaries that they will continue to have home health care 
services.
  Our home health reforms build on three simple and yet crucial 
principles: equity, resolving the arbitrary differences inadvertently 
created by BBA 97; transitional sensitivity helping home health 
agencies not only survive the interim payment system, but also place 
them squarely on the track for the impending prospective payment system 
and implementability guaranteeing that HCFA can immediately put into 
effect the reforms we authorize.
  In closing, Mr. Speaker, I urge my colleagues to support the Medicare 
and Veterans Health Improvement Act.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from 
Maryland (Mr. Cardin).
  Mr. CARDIN. Mr. Speaker, let me thank my friend for yielding me this 
time, and let me thank also the Chairman of our Subcommittee on Health 
for bringing forward this legislation. This is important legislation to 
deal with the home health care services in our community.
  Mr. Speaker, last year we made a mistake, and now we need to correct 
it. We are moving towards implementing a prospective payment system for 
home health care providers, and that will reward efficiency and cost 
effective programs. We had anticipated that that new system would be in 
effect on October 1, 1999. We are not going to make that date. HCFA has 
made that clear. In the interim we have developed an interim payment 
system, and we tried to hold each provider somewhat harmless. But what 
we did was penalize cost-efficient programs by tying the interim 
payment system to historical costs. A program that already has a low 
number of per-patient visits and has got its cost down is discriminated 
against. We need to take steps to correct it. The legislation before us 
will correct that circumstance by allowing those programs that are 
below the national average cost to get a bonus payment by mixing the 
costs with their historical cost and what the average cost is in the 
Nation.
  That makes sense. That will help many health care providers in our 
Nation.
  In my own State of Maryland, where our costs are well below the 
national average because our number of patient visits on home health 
care services is below the national average we would be adversely 
impacted unless this legislation is enacted. We have far fewer number 
of providers per our population than most States, and yet if we do not 
enact legislation, Maryland, a cost effective state that is doing the 
right thing, we are in jeopardy, we are told, of losing 13 of our 
providers in our State that will not be able to make it unless we 
provide some relief.
  So this legislation makes sense. We should take steps in order to 
deal with the interim situation until we can implement the perspective 
payment system, and I thank the gentleman for yielding me this time.
  Mr. THOMAS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Connecticut (Mrs. Johnson) a member of the Committee on Ways and Means 
without whose full participation, ideas and creative approaches to 
solutions we would not be here with this bill.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman for 
those kind remarks and thank the gentleman from California (Mr. 
Thomas), the gentleman from Florida (Mr. Bilirakis), the gentleman from 
Texas (Mr. Archer) and the gentleman from Florida (Mr. Bliley) for 
their hard work to bring this bill to the floor. Indeed the need is 
urgent.
  I would remind Members that when we passed the Balanced Budget 
Amendment we anticipated slowing growth in the cost of home health 
services by $16 billion because of the law we wrote. But equally 
important, because of the administrative changes HCFA made on its own 
or failed to make to comply with the budget document and because the 
work of the work of the Inspector General's office, there has been an 
interaction on this critical service sector that CBO estimates now will 
take 26 billion out of these services. That is 10 billion more than we 
anticipated. Believe me, this is a critical industry under terrible 
distress, and it is our job to fix it.
  So I strongly support this bill that does bring much needed relief to 
specifically low cost, high quality home health providers nationwide, 
and I want to state for the record that some home health agencies in my 
State of Connecticut are not only low cost, but according to a 
government conducted audit they are also virtually free of fraud and 
abuse. We have legitimate concerns about fraud and abuse in the home 
health industry. But the Yankee spirit that has kept home health costs 
low in Connecticut has also kept home health spending honest and home 
health services high quality.
  Ultimately the interim payment system we passed last year penalizes 
efficient home health providers that have served the Medicare program 
by keeping their costs down. These are the very providers that we need 
to preserve in the system if we expect to keep

[[Page H10250]]

Medicare spending affordable and Medicare operating well in the next 
century. This legislation will preserve our low cost providers, correct 
the problems of the past and enable us to establish a strong Medicare 
system that serves our seniors in the future.
  Mr. Speaker, I want to thank Chairmen Thomas, Bilirakis, Archer and 
Bliley and their staff for their hard work on bringing this important 
bill to the floor today.
  I support this bill because it brings much-needed relief to low-cost, 
high-quality home health providers nationwide. And I want to state for 
the record, that home health agencies in my home state of Connecticut 
are not only low-cost, but--according to a government-conducted audit--
they are also virtually free of fraud and abuse. We have heard 
legitimate concerns about fraud and abuse nationwide in the home health 
industry, but the Yankee spirit that has kept home health costs low in 
Connecticut has also kept home health spending honest and home health 
services high quality.
  Unfortunately, the interim payment system we passed last year 
penalizes efficient home health providers who have served the Medicare 
program by keeping their costs down. These are the very providers that 
we need to preserve in the system if we expect to keep Medicare 
operating in the next century. This legislation will preserve low-cost 
providers by increasing their rates during the transition to the new 
payment system.
  The best solution for the long-term is to move home health care into 
a prospective payment system (PPS), where payments will based on the 
health needs of the patient and recognize those who need more intense 
services. The real tragedy of the current system is that we don't have 
the data necessary to build a system based on patient need. And the 
agency administering Medicare cannot accomplish this goal by the 
statutory date of October 1, 1999.
  To prevent IPS, which is not adjusted for the severity of illness, 
from compromising the ability of important community providers to care 
for seniors and to ensure that the PPS will go into effect in a timely 
and accurate manner, this bill will reform IPS and require reports to 
Congress that will demonstrate progress on PPS development and account 
for all the resources used.
  This bill also includes an important provision that will enable our 
veterans to seek Medicare-reimbursed services in veterans hospitals. 
This will strengthen our VA hospitals and open up accessible care for 
low income veterans.
  I urge my colleagues to support this important bill and work to 
ensure that it passes before we adjourn.
  Mr. KLINK. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, we are here today to fix some of the problems caused by 
the deep cuts in the Balanced Budget Amendment made in the Medicare 
home health care benefits. This is not a perfect bill. It is, first of 
all, not retroactive, it does not address the 15 percent cut scheduled 
for next year like the Democrat bill would have, and I really do not 
like the way it is paid for, but I support this bill today because I 
have heard from too many people in my district who are worried about 
the drastic impacts the interim payment system is having on the home 
health care providers and on the patients they serve.
  I am going to support this bill because somewhere in this debate over 
how we should pay for home health care we are losing the focus on the 
seniors who need that home health care and who without it are going to 
end up back in the hospital or back in nursing homes. But for the life 
of me I do not understand why the costs of Medicare home health 
benefits vary so much from State to State and region to region; why, 
for example in my district, people who are treated by Nancy Dlusky in 
Greensburg, Pennsylvania, or Carol Rimer in Delmont, Pennsylvania, get 
on average only $2,300 a year while in other parts of the country for 
the same services people are being reimbursed 8, 10, 12 thousand 
dollars a year.
  This is not a perfect bill, but it is a step in the right direction, 
and I hope that in conference we can perfect it even further.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from 
Michigan (Mr. Levin).
  (Mr. LEVIN asked and was given permission to revise and extend his 
remarks.)

                              {time}  1230

  Mr. LEVIN. Mr. Speaker, I thank the distinguished gentleman for 
yielding me this time.
  The IPS, Interim Payment System, has been grossly unfair, grossly 
unfair to low-cost, cost-effective providers in States, especially 
States like Michigan. This is a step in the right direction.
  But I want to express two hopes. Number one, this is not retroactive. 
A lot of very good, healthy, once healthy, home health agencies have 
been terribly hurt. I think our system should protect the cost 
effective and not assist those that are cost ineffective. So I hope if 
this bill gets to conference that we can look at that issue.
  Also, the chairman of the subcommittee and I have talked about the 
entire bill. I hope we can take another look in the way we pay for 
this. I do not think we should mortgage the future to correct the past 
or the present. So I rise in support of this bill. It is urgently 
needed.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Speaker, first of all, let me thank the gentleman 
from California (Mr. Thomas) and the gentleman from Florida (Mr. 
Bilirakis) for addressing this issue.
  There is no question, many things needed to be done to straighten out 
the problems in home health care. There are still problems with this 
bill. I am going to support this bill, and it is my hope that this will 
come through.
  With the interim payment system, there is no recognition of the need 
for the chronically ill, dependent senior for home health. We need 
outlier protection for those firms who really take care of our seniors, 
who have proven that they will not dump a senior just because the money 
wears out.
  Unfortunately, with HCFA and their administration of the Balanced 
Budget Act, not the amendment, but the act, the administration of that 
act has, in my State, penalized the best and helped the worst. This 
will go a long way towards changing that.
  It, however, does not do anything with the 15 percent cut that is to 
go into effect October 1 of 1999, which has to be addressed if we are 
going to keep these firms viable and care for our seniors.
  In closing, I have two people in my district that I would like to 
thank who have worked tirelessly, without ceasing, to try to solve some 
of these problems with great new ideas. Their names are Mark Lemmons 
and Steve Money. One is a former bank examiner, and the other is a 
former businessman. They are not home health care people, but they know 
costs, and they care for seniors. We have to make sure something 
happens on this before we leave this town.
  Mr. KLINK. Mr. Speaker, I yield 1 minute to the gentleman from New 
Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, I am pleased to see that we are at least 
moving forward in an attempt to do something to correct the home health 
crisis.
  New Jersey's home health providers are among the most efficient in 
the Nation; and, in my view, it is unfair to penalize those agencies 
for their efficiency.
  I also want to address this 15 percent cut. As we know, the Balanced 
Budget Act, as everyone who has been affected by this problem knows, 
mandates a 15 percent across-the-board reduction to the per beneficiary 
caps in fiscal year 2000 if the prospective payment system is not ready 
by that time. We already know that it will not be. I would like to have 
a provision postponing that cut included in this legislation.
  Mr. Speaker, 2 days ago, the gentleman from Michigan (Mr. Dingell) 
and a number of my Democratic colleagues in the House introduced a bill 
that would reach the goal by reducing the enrollment cap on Medical 
Savings Accounts demonstration projects in the short term.
  Reducing the enrollment cap on MSAs, moreover, makes even more sense 
when we consider that nobody has signed up for an MSA yet. It is my 
understanding the other body was working on a proposal that would 
include this reduction, and I hope we are successful on getting that 
postponement included. I think that is very important.
  Mr. THOMAS. Mr. Speaker, it is my privilege to yield 2 minutes to the 
gentleman from Arizona (Mr. Hayworth),

[[Page H10251]]

a member of the Committee on Ways and Means.
  Mr. HAYWORTH. Mr. Speaker, I thank the Speaker and my colleague from 
California for the time and having the privilege to serve on two of the 
three committees with jurisdiction, both the Committee on Ways and 
Means and the Committee on Veterans' Affairs.
  I am pleased to rise with the dean of our Arizona delegation and the 
chairman of the Committee on Veterans' Affairs, the gentleman from 
Arizona (Mr. Stump), in strong support of this legislation.
  As has been chronicled by people from both sides of the aisle with 
disparate views of the role of government in health care, we all agree 
today, Mr. Speaker, that this is an idea whose time has come, not only 
for the challenges confronting home health care, challenges that in and 
of themselves tend to make HCFA truly a four-letter word, if not an 
acronym, in terms of the administration and practical applicability of 
ideas, but also for those Americans who have worn the uniform of our 
Armed Services and served with distinction both in wartime or in 
peacetime, especially in a place like the Sixth Congressional District 
of Arizona, a district in square mileage almost the size of the 
Commonwealth of Pennsylvania.
  This is historic legislation because it would permit the VA to 
establish service networks to provide Medicare-reimbursed care to 
service-connected or financially needy Medicare-eligible veterans for 
whom VA medical centers are geographically remote or inaccessible. 
While we are working to establish these service centers for these 
veterans, this is another tool that can be utilized to give these 
veterans flexibility and access to health care in their senior years.
  For these reasons and many more too numerous to mention, Mr. Speaker, 
I would ask all of my colleagues on both sides of the aisle to join in 
strong support of this legislation.
  Mr. STARK. Mr. Speaker, I am honored to yield 1 minute to the 
gentleman from South Carolina (Mr. Spratt), the distinguished ranking 
member of the Committee on the Budget.
  (Mr. SPRATT asked and was given permission to revise and extend his 
remarks.)
  Mr. SPRATT. Mr. Speaker, I have long supported VA subvention, and I 
want to fix the home health care payment formula as much as anybody on 
the floor, although I am not sure this bill does much for home health 
care in my State.
  I am sure of this, it deals a body blow to the deficit. This bill 
adds $6.9 billion in new spending over the next 10 years, $6.9 billion. 
It cuts revenues, reduces tax revenues by $4.9 billion. So it takes a 
whack of nearly $12 billion out of the budget, out of the surplus over 
the next 12 years.
  Ironically, that is because the Roth IRA provision put in here as a 
``pay for'' does save money over the first 5 years, $2.4 billion. But 
over the second 5 years, over the 10-year course of this bill, it loses 
nearly $5 billion, $4.9 billion. This is a shortsighted way to pay for 
the bill.
  We would be better off to drop the Roth provisions altogether. It 
would save us a $5 billion hit on the surplus, and we would only have a 
$7 billion reduction. It is not the way to go if we want to save the 
surplus for Social Security or protect the fiscal situation that we 
have worked so hard to get ourselves into.
  Mr. BILIRAKIS. Mr. Speaker, I yield 1 minute to the gentleman from 
New York (Mr. Lazio), another member of the subcommittee.
  Mr. LAZIO of New York. Mr. Speaker, I want to begin by thanking the 
three chairmen of the subcommittees, the gentleman from Florida (Mr. 
Bilirakis), the gentleman from California (Mr. Thompson), and the full 
panel chairman, the gentleman from Arizona (Mr. Stump), for their work 
on this and both sides on the aisle, quite frankly, for this critical 
piece of health care that helps Americans stay in their own home, 
protects families, keeps them together, builds stronger communities, 
gives seniors and those who are disabled, who are facing critical life 
choices the peace of mind of knowing that, if they are afflicted with a 
life-threatening disease, that the system will back them up.
  This current reimbursement system clearly undermines, I think, the 
best of what home health care has provided. The current system reduces 
payments to New York home health agencies by nearly $130 million, 
including some of the most efficient and cost-effective home health 
care agencies.
  The ultimate result is that New York seniors are threatened with 
losing their home health care. At a time when moms and dads are trying 
to live their retirement years in comfort, the current system 
undermines their peace of mind. With hard work and leadership from the 
Committee on Commerce, the Committee on Ways and Means and the 
Committee on Veterans' Affairs, I am pleased that this bill provides 
the peace of mind that our seniors need.
  During the past year, I have worked with home health care providers 
in New York to save them and the care that they provide to our seniors. 
The new reimbursement system for home health care agencies which was 
developed in the Balanced Budget Act of 1997, the interim payment 
system, has unintentionally and negatively affected New York residents.
  For example, in my district, Southside Hospital's Home Care Agency is 
expecting a loss of 31 percent this year. That means Southside will 
lose $1.2 million! The personal security of hundreds of seniors, my 
friends and neighbors, is threatened.
  The New York home health care system is one of the most efficient 
home care industries in the nation. We are one of the best. 
Nevertheless, the current reimbursement system reduces payments to New 
York home health agencies by nearly $130 million in 1998!
  The unintended result of this new system is that New York seniors are 
theatened with losing their health care. At a time when moms and dads 
are trying to live their retirement years in comfort, the current IPS 
system pulls the rug out from them. This is the reason why I have 
worked so hard to address this system and make changes to it to ensure 
that our seniors--our family, friends, and neighbors--can receive the 
care they deserve.
  With hard work and leadership from both sides of the aisle, I am 
pleased that the legislation offered on the floor today provides about 
1.5 billion dollars to home health care throughout the nation. Only 
with this money can seniors recover the quality health care they have 
earned.
  The home health provisions before us are supported by the Health Care 
Association of New York State, the Home Care Association of New York 
State, and the esteemed Governor from New York.
  The bill raises the per beneficiary cap for agencies that have 
maintained low costs. We should reward the efficient New York 
providers, not punish them. The bill does not pit agencies against one 
another. It does not pit one region of the country against another.
  Now, Long Island providers will not have to shut down and force our 
seniors into institutionalized care.
  This bill meets two of the loftiest standards of a civilized 
society--maintaining a senior's dignity--and keeping them active in 
their communitry during their golden years. The alternative is to 
penalize the most vulnerable in our society simply for growing old.
  I urge my colleagues to vote for the Medicare and Veterans Health 
Improvement Act of 1998.
  Mr. KLINK. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Texas (Ms. Eddie Bernice Johnson) who is a nurse, is well respected on 
matters not only on health care but a great many issues.
  (Ms. EDDIE BERNICE JOHNSON of Texas asked and was given permission to 
revise and extend her remarks.)
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise in support of 
this bill and want to thank the leadership on both sides of the aisle 
for bringing it. I cannot support it wholeheartedly, however, without 
bringing a few things to my colleague's attention.
  I am from a big State with lots of miles, and the new agencies that 
cover many of those remote-located patients will not be helped by this 
bill.
  We also need to do something about the 15 percent slash that is due 
next year before that time. I want to associate myself with the remarks 
of the ranking member of the Committee on Banking and Financial 
Services, because that is the concern that I have.
  While we are creating a tax loophole for the highest earners, which 
raises money in the short run, it will cost us billions and billions of 
dollars in the long run.
  I do have some concerns. I know that we have an emergency and we do 
need this coverage, but we cannot let it go

[[Page H10252]]

without making sure that there is time for correction.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from 
Massachusetts (Mr. McGovern).
  Mr. McGOVERN. Mr. Speaker, for over a year now, there has been a 
small group of us who have been fighting to change the home health care 
provisions in the Balanced Budget Act; and I want to thank my 
colleague, the gentleman from Rhode Island (Mr. Weygand), the 
gentlewoman from Michigan (Ms. Stabenow), the gentleman from New Jersey 
(Mr. Pappas), and the gentleman from Oklahoma (Mr. Coburn) for their 
diligence and their determination to try to help fix this problem.
  What we have today on the floor amounts, in my opinion, to a very 
important achievement. I want to publicly thank the gentleman from 
California (Chairman Thomas) for bringing this bill to the floor.
  This bill could most certainly be improved, but I commend my 
colleagues for bringing us this far in the process. I hope that we can 
work quickly with the Senate in these last few days and pass this bill 
out of Congress in a form that the President can sign.
  I urge all my colleagues to support this legislation.
  While there are many people that I would like to thank and recognize, 
I want to thank the people of Massachusetts who have educated me on 
this issue, the nurses, the doctors, the home health care agency owners 
and, most important, our Nation's seniors and the critically ill. I was 
invited into their homes and their workplaces and shown how important 
this Medicare benefit is in the lives of everyday people.
  This Congress made a grave mistake in the Balanced Budget Act with 
regard to home health care, and this bill will help correct that 
mistake. I urge my colleagues to support it.
  Mr. THOMAS. Mr. Speaker, it is my pleasure to yield such time as he 
may consume to the gentleman from New Jersey (Mr. Saxton).
  (Mr. SAXTON asked and was given permission to revise and extend his 
remarks.)
  Mr. SAXTON. Mr. Speaker, I rise in strong support of the Medicare 
Home Health Care and Veterans Health Care Improvement Act.
  Mr. Speaker, I am pleased to come here today to vote for the Medicare 
Home Health Care and Veterans Health Care Improvement Act.
  This bill takes a step in assisting efficient home health agencies 
around the country that were hit so hard by the Medicare Interim 
Payment System. The home health agencies of New Jersey have provided 
exemplary care to the seniors of our State while keeping their costs 
very low and should not have been unfairly penalized by IPS.
  As always, I continue to support efforts to rid the Medicare system 
of waste, fraud, and abuse. IPS did not fairly address these problems. 
I do hope that at some time in the very near future, we can revisit 
this issue and identify and rid Medicare of such fraudulent practices 
which only hurt our seniors and the quality of care they receive.
  Also, Mr. Speaker, while H.R. 4567 does offer much needed relief to 
the home health providers in my State, the effects of the IPS during 
FY98 have been extremely detrimental to them. I must request that 
retroactivity be implemented for low cost agencies as we continue this 
process.
  Mr. Speaker, the 60,000 seniors who live in my district in New Jersey 
are united behind us and our efforts to fix the IPS.
  Thank you Mr. Thomas and Mr. Bilirakis for realizing the needs of 
cost-effective agencies.
  Mr. KLINK. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Texas (Mr. Green) of the Committee on Commerce.
  (Mr. GREEN asked and was given permission to revise and extend his 
remarks.)
  Mr. GREEN. Mr. Speaker, I rise in reluctant support of this 
legislation, although the veterans' benefit is the definite plus in the 
bill and makes it worthy in its own right. It is a shame that, after 
literally months of discussions and hours of meetings, this is the best 
we could do on home health care.
  The best part of the bill is it will not hurt any home health care 
agency. Every agency that is affected by this bill will be helped; but 
in my State of Texas, very few of them will.
  However, this bill does not address the looming 15 percent cut in 
payments to agencies that is right around the corner. It does not 
address the problems most agencies will face when they receive their 
demand letters from HCFA. So, despite our efforts today, many home 
health care agencies could be forced to close, only because HCFA did 
not notify of them of their IPS rate until as late as July.
  Mr. Speaker, H.R. 4567 is not the home health care fix most of us had 
hoped for. But it is a start in the right direction, and I look forward 
to properly addressing all of the other problems the IPS has caused at 
the start of the next session of Congress.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Vermont (Mr. Sanders).
  Mr. SANDERS. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Mr. Speaker, home health care agencies that do a terrific job in 
serving some of the most vulnerable and frail people in the State of 
Vermont have lost substantial funding because of an absurd formula that 
was put in place last year.
  This bill begins to address the inequities of that unfair formula and 
would increase funding for home care, home health care agencies in 
Vermont and throughout this country that are cost effective and 
efficient.
  Unfortunately, the funding approach for improving this formula is not 
adequate; and my hope is that, in conference committee, it can be 
changed. But, most importantly, this is a step forward to addressing a 
real crisis in home health care funding that exists in Vermont and 
other States where agencies have been cost effective and efficient. I 
urge support for this legislation.
  Mr. KLINK. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Massachusetts (Mr. Markey), a member of the Committee on 
Commerce.

                              {time}  1245

  Mr. MARKEY. Mr. Speaker, this is a good bill; not perfect, but it is 
good.
  My mother passed away in July afflicted by Alzheimer's for 10 years. 
We kept her in our home. My father, who is 87, tended to her every 
single day all day long for 10 years.
  The only way that that was possible was for the home health care aide 
to give him some help in the course of each day. It is very difficult 
for people who want to tend to this population, which will number in 
the millions as each year goes by, as the baby boomers get old, for us 
to allow people who want to avoid the indignities of nursing homes, 
which my father wanted to do for my mother, because he wanted to honor 
her by keeping her in the house, in our house that she never left, 
except when she was hospitalized for diseases unrelated to Alzheimer's.
  This bill is critically important for millions of families who want 
to offer the same kind of protections for their loved ones. I hope that 
it passes unanimously.
  Mr. BILIRAKIS. Mr. Speaker, I yield 1 minute to the gentleman from 
Florida (Mr. Stearns), a member of the subcommittee.
  (Mr. STEARNS asked and was given permission to revise and extend his 
remarks.)
  Mr. STEARNS. Mr. Speaker, this is very important legislation. We just 
have to hope and pray that it actually gets through the Congress this 
year.
  Medicare-eligible veterans are too often shut out of the VA health 
care system, particularly if they are low-income and services-connected 
in the rural parts of this country.
  This bill would, for the first time, enable Medicare-eligible 
veterans to bring their Medicare benefits to the VA. It is an important 
step to provide improved access and equity. Importantly, this bill can 
also reduce Medicare costs for the care of these beneficiaries.
  Dealing with the home health care side of it, I share with the 
gentleman from Massachusetts (Mr. Markey) the same sentiments, because 
we cared for my mother in our home for over 10 years, too.
  I support implementing the new IPS blend that is more equitable than 
the present system. Furthermore, new agencies must not be penalized and 
should receive treatment similar to other existing agencies. I note, of 
course, for my colleagues from Florida, it increases the home health 
care payment by at least 5 percent.
  Medicare is a vast complicated program to begin with and the changes 
that will occur

[[Page H10253]]

over the next few years are bound to compound the frustration and fear 
seniors already feel about this program.
  I think we all recognize that home health care is vital to many of 
our Medicare recipients and nobody wants to see our seniors suffer 
needlessly. We all remember the many witnesses who testified about home 
health care organizations that had bilked the Medicare program out of 
billions of dollars. Our intention was to reduce unnecessary and 
fraudulent spending in home health. I believe we were right in setting 
out to rid the medicare program of fly-by-night organizations that cost 
the program money that could have been spent on taking care of the 
needs of seniors.
  However, the Interim Payment System now in place is a disaster for 
rural areas and must be corrected. I support implementing a new IPS 
blend that is more equitable than the present system. Furthermore, new 
agencies must not be penalized and should receive treatment similar to 
that of existing agencies.
  This bill addresses these problems by requiring the Secretary to 
report back to Congress by January 1, 1999 with a time line for 
implementation of the new system so that Congress will have an 
opportunity to weigh in and closely monitor its progression. 
Furthermore, the Administration is charged with making an alternative 
to the 15-percent reductions that will occur on October 1, 1999. 
Hopefully, we can alleviate some of the difficulties Medicare home 
health care beneficiaries have been experiencing for the past few 
months.
  Finally, I would like to indicate my support for the portion of this 
legislation that was initially introduced as H.R. 3511. The bill will 
give HHS the discretion to determine, for example, whether allowing 
physicians to waive the Medicare copayment and deductible requirements 
for Medicare recipients who participate in particular health care 
program would open the door to fraud or abuse in the Medicare program. 
If not, HHS is authorized to issue an advisory opinion permitting the 
waiver of these requirements with regard to those services.
  These provisions of the legislation are critically important to 
programs such as the National Eye Care Project (NECP), which provide 
critical health care services to American senior citizens. The National 
Eye Care Program is the largest and most sustained public service 
project in American medicine, and is currently sponsored by the 
Foundation of the American Academy of Ophthalmology and the Knights 
Templar Eye Foundation, Inc. The program currently has 7,500 
participating volunteer ophthalmologists, who examined over 110,000 
seniors since 1986. Of those examined, over 70% were diagnosed with an 
eye disease requiring follow-up care. The program has been recognized 
by the White House, multiple U.S. Senators and Congressman, the 
American Medical Association, and the American College of Surgeons.
  The program works by matching callers to a toll-free Help line with 
one of the 7,500 volunteer ophthalmologists nationwide. The physician 
then provides a comprehensive medical eye examination and treatment for 
conditions diagnosed at the initial visit. Any financially 
disadvantaged senior who is a U.S. citizen or legal resident and has no 
access to an ophthalmologist is eligible to participate.
  From the program's inception in 1986 until the passage of the Health 
Insurance Portability and Accountability Act of 1996 (HIPAA), 
participating doctors could waive copayment charges and accept 
insurance reimbursement as payment in full. However, unfortunate 
technical language found in HIPAA restricted the NECP's participating 
doctors to waiving fees only for those in financial need. This has 
forced the NECP to add a means test to their Help line. This test asks 
questions that financially needy seniors may find embarrassing, such as 
`does your financial situation prevent you from seeking eye care?' This 
means test has unfortunately led to a decrease in the number of seniors 
seeking care, and has turned away seniors that otherwise would have 
received treatment.
  That's why the pending legislation is so important--it does nothing 
to dilute the tough anti-fraud and abuse provisions found in HIPAA, 
while giving the Secretary of Health and Human Services the authority 
to provide a common sense exemption from payment requirements for the 
NECP, or for other programs that benefit the public welfare.
  Congress needs to allow doctors participating in the NECP to continue 
their work unhindered and to encourage seniors to utilize the program. 
More than 50% of all new cases of blindness each year occur in the 
elderly, at least half of which are preventable. Eye diseases are among 
the most debilitating and prevalent problems facing the elderly, many 
of which display no outward symptoms until irreparable damage to their 
eye sight is imminent.
  Mr. Speaker, I urge my colleagues to support this important 
legislation.
  This is important legislation for America's veterans. Medicare-
eligible veterans are too often shut out of the VA health care system.
  This bill for the first time would enable Medicare-eligible veterans 
to bring their Medicare benefits to VA. It is an important step to 
provide improved access and equity.
  Importantly, this bill can also reduce Medicare costs for the care of 
these beneficiaries.-
  Mr. KLINK. Mr. Speaker, I yield the remainder of the time to the 
gentleman from New York (Mr. Engel).
  (Mr. ENGEL asked and was given permission to revise and extend his 
remarks.)
  Mr. ENGEL. Mr. Speaker, I want to express my strong support for this 
home health care bill.
  In April I introduced the Medicare Home Health Agency Efficiency Act, 
and I am pleased that H.R. 4567 addresses many of my concerns and, in 
the end, creates greater equity for all home health care agencies. I 
hope that we can in the next Congress and in conference continue to 
work on the problems that still face home health care agencies and my 
constituents. The current reimbursement system in New York penalizes 
the most efficient home care agencies and without this legislation, 
home care agencies in New York would have to close and deprive people 
of vitally-needed services.
  I strongly support the concept of home health care. I have a story 
also. My father, before he passed away, we kept him in our home, and 
without home health care services, we could not have done this.
  So I think this is a good first step, it is a good step in the right 
direction, and we need to keep on working on this problem. I commend my 
colleagues for doing this.
  Mr. Speaker, I yield the remainder of my time to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I think it is a good bill, 
too, and I think we need to work on the IPS, and I would hope that we 
would be able to continue to work on the interim payments and work with 
the gentleman as well on his legislation.
  Mr. STARK. Mr. Speaker, I am happy to yield 1 minute to the 
distinguished gentleman from Rhode Island (Mr. Weygand).
  (Mr. WEYGAND asked and was given permission to revise and extend his 
remarks.)
  Mr. WEYGAND. Mr. Speaker, I want to thank the gentleman from 
California (Mr. Stark) for yielding me this time.
  I also would like to take a moment to thank some of my colleagues who 
have been very helpful in putting this bill together and working 
together, and that is particularly the gentleman from Massachusetts 
(Mr. McGovern), the gentleman from Oklahoma (Mr. Coburn), and, in 
particular, the gentleman from Maryland (Mr. Cardin), and the 
gentlewoman from Michigan (Ms. Stabenow). We have all worked over the 
last year and a half to try to bring this bill to fruition.
  Last year we made a horrible mistake in passing a budget that 
included an interim payment system that was intended to take away fraud 
and abuse from wasteful agencies, but it also did a terrible thing. It 
took the most efficient and effective agencies and cut them as well.
  In my State I have seen VNAs go out of business. A VNA that was in 
business for 87 years serving the needy had to close its doors, others 
have laid off people, because of this interim payment system.
  This past spring we were lucky to get an amendment through in the 
budget that put us in this direction. This is a good first step, and I 
compliment the gentleman from California (Mr. Thomas) for bringing it 
before us today. But there are other parts of this that have not been 
addressed that we must address in the near future.
  Retroactivity. The 1999 interim payment assistance was supposed to go 
into a PPS. I hope that we will address those; I hope that we will have 
a future for our needy people in the home health care system, and I ask 
my colleagues to support this.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Michigan (Ms. Stabenow).
  (Ms. STABENOW asked and was given permission to revise and extend her 
remarks.)
  Ms. STABENOW. Mr. Speaker, I would join with my friend from Rhode 
Island in thanking everyone who has been involved in this issue. But I 
also would join today with those who express great concern about the 
bill that is in front of us.

[[Page H10254]]

  It has been said that there are no losers as it relates to home 
health care in this bill. The difficulty is, for me in representing my 
constituency in Michigan, there are also no winners in this bill.
  It has been estimated that in Michigan almost half of our home health 
care agencies will no longer be able to serve Medicare patients by the 
end of this year, almost half of those who provide home health care 
now.
  In Michigan, unfortunately, on average, this bill provides only 
$58.00 in additional home health care services, $58.00 to agencies that 
are already tremendously efficient providing quality home health care. 
This is not enough of a fix. This does not, in fact, stop the 15 
percent cut for next year.
  I urge the conference committee create a better solution so we can 
provide quality home health care into the future.
  Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from West 
Virginia (Mr. Rahall).
  Mr. RAHALL. Mr. Speaker, I thank the gentleman from California for 
yielding.
  Mr. Speaker, I am not opposed to the improved payment system for 
kidney disease patients contained in this bill. Nor am I opposed to the 
commendable veteran benefits contained herein. I am, however, deeply 
concerned about the bill's home health provisions as many of my other 
colleagues have already expressed.
  This bill that is masquerading as an appropriate remedy for the 
devastating effects of last year's BBA, which imposed an interim 
payment system on our Nation's home health care agencies, the only 
specialists we have who serve homebound disabled seniors, and the 
effect has been to drive thousands out of business and deprive seniors 
of adequate access to care to which they are entitled.
  The home health care provisions of the BBA call for paying home 
health care agencies in 1994 dollars, and since January this year more 
than 1,100 have gone out of business or have been forced to stop 
serving Medicare patients because they cannot afford it.
  The problem, Mr. Speaker, is pure and simple, that the Thomas bill, 
however well intended, is not the proper response to the Nation's home 
health care problem. It does no harm and it does no good, as has 
already been stated. It is paying mere lip service to the problem of 
the interim payment system, and I do hope we can address this in the 
next session of Congress.
  Mr. BILIRAKIS. Mr. Speaker, I yield the balance of my time to the 
gentleman from New Jersey (Mr. Pappas), who has been a stalwart on this 
issue.
  (Mr. PAPPAS asked and was given permission to revise and extend his 
remarks.)
  Mr. PAPPAS. Mr. Speaker, Judy Stanley and Steve Snyder approached me 
last December about an issue which prompted my introducing of H.R. 
3567, gained 106 cosponsors and I have worked hard to find a solution 
to the problems the home health IPSs cause New Jersey and other states.
  Let me thank the gentleman from Arizona (Mr. Stump), the gentleman 
from Florida (Mr. Bilirakis) and the gentleman from California (Mr. 
Thomas) and their staffs for all their hard work. I will support the 
compromise as a needed step to move forward but I am disappointed that 
the bill does not do more to improve the viability of low cost 
agencies.
  This bill does not curb the spending patterns of older agencies that 
have had high costs. Addressing that issue is an important part of 
preparing the home health industry for perspective payment. It also 
does not address the automatic 15 percent reduction in reimbursement.
  Finally, I am hopeful that the final product will contain 
retroactivity, which CBO has already scored as costing $200 million. 
Narrowly tailoring retroactive relief to low cost States or regions 
would reduce this cost even more. I encourage my colleagues to see if 
these remaining issues can be addressed in the final package and I urge 
my colleagues to support it.
  Mr. STARK. Mr. Speaker, I yield myself the remainder of the time.
  Mr. Speaker, I again join with many of my colleagues who support the 
tenor of the bill but have serious reservations about its budget 
implications. I would hope that if there is a chance to revisit this 
bill we can find a more sensible way to pay for it.
  Further, I would like to, in the spirit of bipartisan suggestion, 
urge the distinguished chairman of the subcommittee, the gentleman from 
California (Mr. Thomas), to hark back to the eighties when we tried in 
the Pepper Commission to develop a long-term care proposal.
  Let no one make any mistakes. This growth in home health care has 
been generated by the lack of any ability to pay for long-term care in 
the Medicare system.
  Rather than see the industry sneak a long-term care policy into the 
back door of acute care Medicare, we should honestly propose and debate 
a long-term care social insurance program. If it were fairly presented, 
with the problems in long-term care discussed, I think we could find a 
way to include it in the Medicare system rather than tinkering with 
ways to squeeze down the cost of home health.
  Mr. Speaker, I yield back the balance of my time.
  Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I include at this point in the Record a detailed 
explanation of the bill.

Explanation of H.R. 4567--Medicare Home Health and Veterans Health Care 
                        Improvement Act of 1998


  title i. medicare home health care interim payment system refinement

                              Current Law

       Section 4602 of the Balanced Budget Act established interim 
     payments for Medicare home health care agencies until 
     implementation of the Prospective Payment System on October 
     1, 1999. Agencies are currently paid their costs up to two 
     limits. The limits are applied when an agency settles its 
     cost report with Medicare. The first limit--the per visit 
     limit--is based on the mix of visits the agency provided to 
     Medicare patients during the year. The per visit limits are 
     based on 105 percent of the median costs by category of 
     services. The second limit--the per beneficiary limit--is 
     based 75 percent on an agency's historical cost per 
     beneficiary and 25 percent on the average per beneficiary 
     historical costs for the region in which the agency is 
     located (both are reduced by 2 percent and are adjusted by 
     the home health market basket). Agencies whose first full 
     year cost report began after October 1, 1993 receive the 
     national median of the per beneficiary limits.

                        Explanation of Provision

       The bill contains a modified version of H.R. 4567. The 
     amendment would increase the per visit limits to 108 percent 
     of the national median costs. In addition, the amendment 
     would increase the per beneficiary limit for many agencies. 
     For those agencies whose per beneficiary limit is below the 
     input price adjusted national median limit, the beneficiary 
     limit would be increased by one half of the difference 
     between the agency's per beneficiary limit and the input 
     price adjusted national median limit (without the two percent 
     reduction). Home health agencies whose first full cost report 
     began on or after October 1, 1993 and before October 1, 1998 
     would receive a new beneficiary cap. The cap would be equal 
     the greater of (1) the national median limit, without the 2 
     percent adjustment, and (2) a new blended payment equal to 50 
     percent of the payment established under the Balanced Budget 
     Act and 50 percent based on a new blend. The new blend would 
     be equal to 75 percent of the national median and 25 percent 
     of the regional mean--both decreased by two percent.
       Home health agencies which began treating Medicare patients 
     on or after October 1, 1998 would have per beneficiary limits 
     equaling 75 percent of the input price adjusted national 
     median limit, minus two percent. In the case of a home health 
     care agency or home health care branch which existed as of 
     September 15, 1998, the 75 percent of the national median 
     rule would not apply if that branch subsequently becomes a 
     subunit of its parent or a separate agency. Rather, the 
     parent agency's limit at the time the branch becomes a 
     subunit or a separate agency would be used. These changes 
     would have no impact on the Medicare part B monthly premium.
       The bill also would require the Secretary of Health and 
     Human Services to submit to Congress a report describing (1) 
     all of the research to date on the development of a 
     prospective payment system for Medicare home health services, 
     (2) a schedule for implementation of the BBA mandated 
     prospective payment system, and (3) the Secretary's 
     recommendations for one or more alternatives to provide 
     savings equal to the estimated savings from the 15 percent 
     reduction in payment limits scheduled for fiscal year 2000. 
     The Medicare Payment Advisory Commission (MedPAC) would be 
     required to submit a report to Congress no later than 60 days 
     after the date that the Secretary submits her report. In 
     addition, MedPAC would have to include in its June 1999 
     report an analysis of whether changes in law made by the 
     Balanced Budget Act and amended by this section, impede 
     access to home health services. The General Accounting Office 
     would be required to conduct an audit of the Health Care 
     Financing Administration's expenditures for research related 
     to the development

[[Page H10255]]

     of a prospective payment system for Medicare home health care 
     services.

                           Reason for Change

       The Medicare home health care interim payment system per 
     beneficiary limits are based on one year of historical cost 
     data (from cost reporting period ending in fiscal year 1994). 
     The rates are based on a blend of agency-specific data and 
     regional data. While this blending reduces some of the 
     variation among agencies, there still exists a more than ten-
     fold difference between the per beneficiary limits across 
     agencies. Some agencies with very lost historical costs have 
     difficulty responding to changes in the mix of patients. This 
     bill would assist the lowest cost agencies by increasing the 
     per beneficiary limits for the agencies below the national 
     median limit. In addition, the amendment would help decrease 
     some of the differences between old and new agencies within a 
     region.
       Because of the Administration's recent announcement of a 
     delay in implementing the prospective payment system on 
     October 1, 1999, as required in the Balanced Budget Act, 
     there is considerable concern about the impact of this delay 
     on agencies and beneficiaries receiving home health care 
     services. In order to ensure accountability, the Secretary 
     would be required to report back to Congress by January 1, 
     1999 with a detailed time line for implementation of the new 
     system so that the progress may be carefully monitored by the 
     Congress. The Administration would also be required to 
     propose recommended alternatives to the 15 percent across-
     the-board reduction in rates that will occur on October 1, 
     1999 because of the PPS implementation delay.

                             Effective Date

       Medicare home health agency cost reporting periods 
     beginning on or after October 1, 1998.


  title ii. veterans medicare access improvement medicare home health 
                 care interim payment system refinement

                              Current Law

       Current law generally prohibits other government agencies 
     from receiving reimbursements for providing Medicare-covered 
     services to Medicare-eligible veterans. In general, Medicare 
     does not pay for services furnished by a federal provider of 
     services or other federal agency. The law has thus generally 
     barred payments for services provided to military retirees at 
     Department of Defense (DoD) facilities and for services 
     provided at VA hospitals and clinics. Subvention is the term 
     given to proposals which would permit the U.S. Department of 
     Veterans Affairs to receive reimbursement from the Medicare 
     trust funds for care provided to Medicare-eligible 
     beneficiaries at VA medical facilities.
       The Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) 
     authorized a 3-year demonstration project at six sites under 
     which the Secretary of HHS will reimburse the Secretary of 
     DoD from the Medicare trust funds for services furnished to 
     certain Medicare-eligible military retirees and dependents. 
     The demonstration project is to be established through an 
     agreement entered into by the Secretaries. The Balanced 
     Budget Act of 1997 required the Secretary of HHS and VA to 
     jointly submit to Congress a detailed implementation plan for 
     a subvention demonstration project for veterans.

                        Explanation of Provision

       The bill contains the text of H.R. 3828. The amendment 
     would amend Medicare law by adding a new Section 1897 to the 
     Social Security Act--``Improving Veterans' Access to 
     Services.'' The bill would establish a subvention program for 
     low-income veterans and a demonstration project for other 
     veterans so that the Department of Veterans Affairs may offer 
     certain veterans comprehensive Medicare health care services. 
     Section 1897 would authorize VA subvention in certain 
     circumstances. Subvention is the term given to proposals 
     which would permit the Department of Veterans Affairs to 
     receive reimbursement from the Medicare trust funds for care 
     provided to Medicare-eligible beneficiaries at VA medical 
     facilities. The bill specifically aims at helping vulnerable 
     veterans--known in veterans parlance as ``Category A'' 
     veterans--who have either low income or a service-connected 
     disability. The bill also creates a three-year demonstration 
     project to test subvention for other veterans--known as 
     ``Category C'' veterans--who are not low-income or service-
     disabled.
       The bill would create a Medicare subvention program for 
     Category A veterans but limits Category A subvention to three 
     sites for the three years. If the Category A subvention meets 
     certain criteria, then the subvention program may be offered 
     on a national basis. The amendment provides that Medicare 
     payments for the Category A be capped at $50 million in the 
     first year, $75 million in the second year and $100 million 
     in the third. The amendment would also create a Medicare 
     subvention program for Category C veterans (all other 
     veterans) but limits Category C subvention to three sites for 
     three years. The amendment provides that Medicare payments 
     for Category C will be capped at $50 million per year for 
     three years.
       The bill would require the VA to maintain its current level 
     of services to Medicare-eligible veterans and provides that 
     the Secretary of Health & Human Services and the Secretary of 
     Veterans Affairs must monitor expenditure levels during the 
     project in relation to expenditures that would have been made 
     but for subvention.
       The bill has provisions which are designed to hold harmless 
     the Medicare Trust Fund, including: (1.) The VA would be paid 
     a discounted rate from the customary Medicare managed care 
     payments (to make up for VA's lower administrative costs); 
     (2.) The VA would be required to institute modern data 
     systems to track the costs and services provided to Medicare-
     eligible veterans; (3.) The VA would be required to maintain 
     the same level-of-effort that it now provides to Medicare-
     eligible veterans; (4.) The VA's subvention services would be 
     audited by the Comptroller General and the Inspector General.

                             Effective Date

       The Category C demonstration project could begin as early 
     as January 1, 1999 and end on three years after the 
     commencement. The Category A program would begin on January 
     1, 2000 at the designated sites.


  title iii. authorization of additional exceptions to imposition of 
                   penalties for certain inducements

                              Current Law

       Current law prohibits medical facilities from making 
     improper inducements in order to attract patients. Because of 
     this, medical facilities have scaled back financial 
     assistance programs which help patients, (e.g., programs to 
     pay patient Medicare Part B and Medigap premiums) lest these 
     programs be construed as improper inducements.
       The Health Insurance Portability and Accountability Act of 
     1996 (HIPAA) contained a number of provisions designed to 
     toughen fraud and abuse enforcement. One provision--Section 
     231(h)(1)(C)(5) of HIPAA--prohibited medical facilities from 
     offering patients any kind of inducement to receive services 
     from any particular medical provider. This provision was 
     designed to prevent kickbacks which the Inspector General 
     reported was occurring in some circumstances.

                        Explanation of Provision

       The bill contains the text of H.R. 3511. The amendment 
     would affect the HIPAA provision in several ways: First, the 
     Inspector General of the Health and Human Services Department 
     could create exceptions--known as ``safe harbors''--to the 
     fraud and abuse rules so as to exclude specific practices 
     from the HIPAA provisions. Second, the bill would allow 
     medical facilities to obtain advisory opinions from the 
     Inspector General. These opinions would provide legal and 
     regulatory guidance to medical facilities as to whether 
     payment of coinsurance or other premiums violates HIPAA's 
     fraud and abuse provisions. Finally, the bill would also give 
     the Secretary of HHS interim final rulemaking authority which 
     would speed up the process whereby these safe harbors and 
     advisory opinions become effective.

                           Reason for Change

       Prior to the enactment of HIPAA, specialized medical 
     facilities, such as dialysis centers, operated programs to 
     help their patients afford medical treatment. Examples of 
     these programs included paying patients' Medicare Part B 
     premiums; giving patients free eye-glasses and other services 
     designed to assist patients. The effect of the HIPAA fraud 
     and abuse provision was to discourage medical facilities from 
     offering programs to help patients lest these programs be 
     seen as inducements for patients to receive services from the 
     particular medical facility. This bill gives the Inspector 
     General the authority to make exceptions and to establish 
     safeguards which would permit an exception to the HIPAA 
     provision.

                             Effective Date

       Upon enactment.


  TITLE IV. EXPANSION OF MEMBERSHIP OF THE MEDICARE PAYMENT ADVISORY 
                               COMMISSION

                              Current Law

       The Balanced Budget Act of 1997, Public Law 105-33, 
     established the Medicare Payment Advisory Commission (MedPAC) 
     as a result of merging two commissions, the Prospective 
     Payment Advisory Commission and the Physician Payment Review 
     Commission. MedPAC, like its predecessors, is a nonpartisan 
     commission which advises Congress and makes recommendations 
     regarding Medicare payment policies.
       Section 4022 of the Balanced Budget Act detailed the 
     criteria for membership on the Commission: The membership of 
     the Commission shall include individuals with national 
     recognition for their expertise in health finance and 
     economics, actuarial science, health facility management, 
     health plans and integrated delivery systems, reimbursement 
     of health facilities, allopathic and osteopathic physicians, 
     and other providers of health services, and other related 
     fields, who provide a mix of different professionals, broad 
     geographic representation, and a balance between urban and 
     rural representatives.
       MedPAC commissioners are appointed by the Comptroller 
     General and serve terms of three years. The Balanced Budget 
     Act authorizes the Commission to have fifteen commissioners.

                        Explanation of Provision

       The bill contains the text of H.R. 4377. The amendment 
     would add two commissioners to MedPAC.

                           Reason for Change

       The addition of two commissioners would enable the 
     commission to reflect more fully

[[Page H10256]]

     the diversity of backgrounds and interests in the health 
     policy community. Expanding the number of commissioners would 
     not only allow for a greater range of professional expertise 
     but also a more diverse representation from various parts of 
     the country.

                             Effective Date

       May 1999.


                        TITLE V. REVENUE OFFSET

                              Current Law

       Taxpayers (single or married) may roll their ``traditional 
     IRA'' over into a ``Roth-IRA'' if their adjusted-gross-income 
     (AGI) does not exceed $100,000. Married taxpayers, filing 
     separately, cannot roll their traditional IRA into a Roth-
     IRA.

                        Explanation of Provision

       The bill would allow single taxpayers with adjusted gross 
     income of $145,000 and married taxpayers with AGI of $290,000 
     to roll their traditional IRA into a Roth-IRA. Married tax 
     payers, filing separately with adjusted gross income of 
     $145,000 could also do a Roth rollover.

                           Reason for Change

       The current rules impose unwarranted restrictions on 
     taxpayers based merely on their marital status and thus 
     prevent certain taxpayers from adequately providing for their 
     retirement years.

                             Effective Date

       Distributions after December 31, 1998.
  Mr. Speaker, I can assure the Members no one is more aware of the 
modest scope of this bill than I am. It is a very modest correction to 
the interim payment system. Included in the bill is a request that the 
secretary provide us with some offset proposals for the 15 percent 
reduction that I know concerns a number of individuals. It is clear it 
does not take care of the home health care problems. It does not 
address long-term care concerns.
  The Medicare Commission is currently examining those chronic concerns 
that face seniors today and all Americans tomorrow. Ongoing oversight 
of the Health Care Financing Administration is absolutely critical.
  This is a modest proposal on the interim payment system. We will 
continue to examine the changes that are occurring in the home health 
care industry, but for the veteran subvention, for the modest 
protection for the end-stage renal disease individuals, for the 
expansion of the MedPAC Advisory Board, I would ask for an aye vote.
  Mr. GUTIERREZ. Mr. Speaker, I rise today in support of the Veterans 
Programs Enhancement Act of 1998. I commend Chairman Stump and Ranking 
Member Evans for their tireless effort in producing this important 
legislation.
  I also compliment the staff of both the House and Senate Veterans' 
Affairs Committees. Their hard work and dedication to our veterans has 
made this legislation possible.
  People outside of this building are often unaware of the vital role 
staff play in the legislative process. They should not be. Our veterans 
should know how hard the veterans committee staff works for them each 
day. I hold this bill up as testament to their efforts.
  Mr. Speaker, for much of this year I was not sure what this Congress 
would be able to accomplish on behalf of our nation's veterans.
  I would venture to say that this Congress's record on veterans issues 
has been mediocre at best. Funding for veterans health care was cut 
again, medicare subvention was not achieved and veterans benefits were 
slashed to fund highway construction.
  But in the end, with the passage of this legislation, we will be able 
to point to some notable achievements on veterans issues this year.
  With this bill, we establish a precedent for the presumptive 
treatment and compensation of Persian Gulf War veterans.
  I have long felt that we must give our Gulf War veterans the benefit 
of the doubt when it comes to health care and service connection. This 
bill helps us reach this goal that I have long called for.
  In addition, this legislation helps prepare us to provide quality 
treatment for the veterans of future conflicts.
  We were unprepared for the aftermath of the Gulf War.
  However, by establishing a National Center for the Study of War-
Related Illnesses, this bill helps prepare our veterans health system 
for the aftermath of future conflicts.
  This bill also extends the VA's authority to treat the medical 
problems afflicting Gulf War veterans until 2001. We know we are not 
through dealing with the health problems confronting Gulf War veterans 
and I am pleased to see this fact recognized in this legislation.
  The VA's sexual trauma treatment program, a program that I have 
advocated for throughout this session, is also reauthorized by this 
bill. During the past two years, the reality of sexual abuse and 
harassment of women in the military has come to light. It is only right 
that we maintain the VA's capacity to offer the victims of these crimes 
the treatment they need and deserve.
  In addition, I am also pleased by this bill's provisions regarding 
educational opportunities, housing and medical construction at veterans 
hospitals. The reforms contained here are necessary and well-
intentioned and should contribute to the welfare of veterans throughout 
America.
  I am proud to support this bipartisan bill. And I urge my colleagues 
in the House to support this legislation as well.
  Mr. ADAM SMITH of Washington. Mr. Speaker, I would like to take this 
opportunity to express my strong support for making changes to the home 
health care interim payment system (IPS). As part of the $16.2 billion 
in savings from home health over five years, the Balanced Budget Act of 
1997 created an interim payment system to serve as a bridge until the 
prospective payment system could be implemented. While the interim 
payment system was designed to cut costs and reduce fraud, it has 
unfairly punished the efficient home health agencies throughout the 
country, including those of Washington state.
  In the 1980s, the federal government promoted home care as a way to 
improve the health care situation in the United States. Using home care 
services reduces hospitalization, cuts the demand for expensive nursing 
homes, eases the burden on family caregivers and is proven to help sick 
people get better faster. Increased use of these services has helped 
make the health care system more efficient and better for consumers. 
While home health services have improved health care for many 
individuals, Congress could not ignore the increased costs and fraud in 
the home health system in recent years, and we acknowledged changes 
need to be made. Unfortunately, Congress did not make the correct 
changes in the process.
  My primary concern with the changes in the Balanced Budget Act of 
1997 relating to home health care payments is that in interim payment 
system disproportionately punishes areas of the country where home 
health patients are served efficiently. Washington state has been 
especially effective in their use of home health care. The state's home 
health care systems is one of the most efficient in the country. The 
typical home health patient in Washington state uses only about 34 
visits per year, which is less than half of the national average. 
Efficient agencies should be rewarded, not punished, under the new 
system and I believe Congress must fix the changes they made as part of 
the BBA to assure we do not unfairly punish those who have done their 
job well.
  I strongly support this bill because I believe it is a good step in 
the right direction for addressing the problems in the home health 
interim payment system. I feet we must continue to address this issue 
in the future to assure we are not punishing the home health agencies 
that provide services efficiently.
  Mr. MORAN of Kansas. Mr. Speaker, I rise today in support of H.R. 
4567, the Medicare Home Health Care Improvement Act. Last year's 
changes to Medicare made across the board cuts to home health funding 
that have been devastating to many agencies and their patients, 
particularly in states with the lowest historical costs.
  Mr. Speaker, this legislation would provide critically needed relief 
for our seniors needing home health care. In my home state of Kansas, a 
number of agencies have already closed their doors. For the seniors 
that I represent in rural areas and smaller communities, the loss of 
their home health agency, too often means the loss of critical 
services.
  While this legislation is not a perfect solution, it represents an 
important step. We simply cannot afford to close this session of 
Congress without addressing the dire circumstances facing our seniors. 
I urge my colleagues to support this legislation.
  Mr. DUNCAN. Mr. Speaker, I feel that there are segments of the 
healthcare community that are under-represented on the Medicare Payment 
Advisory Commission (MedPAC).
  Specifically, there is a notable lack of input and expertise from the 
medical supply industry. These manufacturers must overcome 
technological and clinical challenges during the development, 
production, and distribution of medical supplies. I believe that the 
insight derived from this market experience supports the appointment of 
someone from the medical supply industry to the MedPAC.
  I am told that 25 to 30 percent of the current cost of Medicare 
involves medical supplies. Since MedPAC will review and make 
recommendations to the Congress concerning Medicare payment policies, I 
think it is clearly prudent to have this segment of the healthcare 
industry represented in any future appointments.
  Also, if MedPAC is to make recommendations on procurement issues, 
including the impact and cost of competitive-bidding for effective 
medical products, it is appropriate to ensure that someone from the 
medical supply industry serve as a MedPAC commissioner. Although I do 
not wish to amend the bill to require representation of any specific 
industry, I

[[Page H10257]]

do want to recommend that consideration be given to the appointment to 
MedPAC of a recognized professional from the medical supply industry.
  Mr. MENENDEZ. Mr. Speaker, the Balanced Budget Act of 1997 put the 
home health care industry on a prospective payment system, and set up 
an interim payment system for agencies until the prospective payment 
system could be fully implemented.
  Unfortunately, those home health agencies which have historically 
been fiscally responsible in their administration of federal dollars 
have been penalized for good program management.
  In my state of New Jersey, the home health industry has been 
aggressive in its management of resources. New Jersey's annual average 
for visits per beneficiary served is only 39.7. The national average is 
66 visits per year, and some states have numbers as high as 125 visits 
per beneficiary! So the message has been that it doesn't pay to be 
prudent with federal dollars.
  HCFA's regulations have not so much penalized those states which have 
had excessive costs as they have mandated that all states--including 
those states with the lowest number of beneficiary visits--bear the 
financial costs in an across-the-board distribution of the effort to 
rein in the costs for this industry.
  The bill we are adopting today, H.R. 4567, is a step in the right 
direction. However, there is a basic sense of fairness which is missed 
in the ``hold harmless'' provisions. It is my sincere hope that as this 
bill is conferenced some measure of equity is brought into the 
negotiations which will recognize the efforts of those states which 
have been in the lowest 20 percentile of costs in the home health care 
industry. If they are not rewarded for their prudent handling of this 
program, they should at the very least not be penalized.
  Mr. BLILEY. Mr. Speaker, I rise in support of the Medicare Home 
Health Care and Veterans Health Care Improvement Act, H.R. 4567. This 
measure is a monumental step forward in expanding quality health care 
coverage to millions of Americans.
  This legislation is the result of a true cooperative spirit between 
the Commerce and Ways and Means Committee, and would like to personally 
thank Chairman Archer and Congressmen Bilirakis and Thomas for all 
their hard work on this effort.
  While there are a number of important provisions in this bill, I 
would like to focus solely on two--home health care and VA subvention.
  First, nearly one out of every ten Medicare recipients receives home 
care, with an average of 80 home health visits each. In the Balanced 
Budget Agreement of 1997, Congress and the Administration sought to 
restrain the growth in these costs by going to a prospective payment 
system.
  However, before this plan could be implemented, HCFA had to implement 
a supposed ``short term'', or interim, payment system that would help 
the agency and the industry move to this new billing system. 
Unfortunately, HHS and HCFA have failed to implement a policy that is 
equitable to all home health agencies.
  Our bill recognizes the importance of this benefit to our nation's 
elderly, while reaffirming our commitment to the Balanced Budget 
Agreement.
  Our home health reforms build on three simple, yet crucial 
principles:
  (1) equity, resolving the arbitrary differences inadvertently created 
by the Balanced Budget Act of 1997;
  (2) transitional sensitivity, helping home health agencies not only 
survive the interim payment system but also place them squarely on the 
track for the impending prospective payment system; and
  (3) implementability, guaranteeing that HCFA can immediately put into 
effect the reforms we authorize.
  Secondly, all of us understand and appreciate the importance of 
maintaining our nation's commitments to our nation's servicemen and 
women, and there is no stronger commitment made to our veterans than 
the guarantee of quality health care.
  By allowing Medicare-eligible veterans to use their Medicare benefits 
in VA facilities, we are not only helping veterans get their care when 
and where they feel most comfortable, but we are also helping the VA 
reach out to those veterans who have fallen through the cracks or are 
under-served.
  In closing, the Medicare and Veterans Health Improvement Act is a 
major step forward for our nation's seniors and they deserve no less 
than the fullest measure of our support.
  Mr. Speaker, I ask my colleagues for their strong support of this 
legislation.
  Mrs. ROUKEMA. Mr. Speaker, I rise in support of this legislation 
which moves us in the right direction for saving home health care in 
New Jersey. Yet, I do wish we could do more.
  The proposed Medicare interim payment system would have the effect of 
punishing the efficient, low cost home health providers. This proposal 
before us today will help soften that blow by adjusting the per 
beneficiary limit.


                       the per-beneficiary limit

  One of the flaws with the proposed interim payment system policy was 
in the formula to calculate the per beneficiary limit. Because 
reductions are made based on agency specific data and regional average 
costs, expensive agencies who are driving the increase in growth and 
costs in this industry continue to function at a much higher rate than 
that of more efficient and less costly ones.
  In New Jersey this would mean that New Jersey would receive a 
reimbursement less than that of the national median.
  This bill before us today would bring up those states that are below 
the national median limit, closer to that national median.


                             Retroactivity

  But I do wish that we could make this legislation retroactive. By not 
making this legislation retroactive we have left agencies to work under 
the great financial burdens caused by the interim payment system.
  I do hope that we can move this bill forward, but we do still have 
some work to do.
  Mr. BEREUTER. Mr. Speaker, this Member rises today as a co-sponsor 
and strong supporter or H.R. 4567. When Congress passed the Balanced 
Budget Act last year, we made some very important changes to Medicare 
that will insure its availability for seniors well into the next 
century. However, Congress went a little too far in the area of home 
health. In an attempt to eliminate the waste, fraud and abuse that did 
exist in the home health care industry, the Medicare interim payment 
system, which was created last year, instead hurt some of the most 
cost-conscious agencies that have worked hard over the years to keep 
costs low.
  For example, one of the home health agencies in this Member's 
district in Beatrice, NE, was told earlier this year by their 
intermediary that under IPS they would receive a Medicare reimbursement 
limit of about $1,600 per beneficiary. That's over $700 less than the 
regional average of $2,341 per beneficiary, and $2,200 less than the 
national average reimbursement per beneficiary of $3,862. A 
reimbursement limit of $1,600 a year is simply not enough money in many 
cases where a home health agency needs to treat a disabled, elderly 
individual. To make matters worse, the only other home health agency in 
the town of Beatrice went out of business this summer, mostly due to 
its low Medicare home health reimbursement rate.
  Even worse, HCFA has announced that they cannot implement a 
permanent, perspective payment system by their October 1, 1999, 
deadline because of their Y2K problems. Therefore, under current law, 
home health agencies will not face an additional reduction of 15 
percent in their per-beneficiary reimbursement. Under this system, home 
health agencies, especially those in rural areas, will go out of 
business--this unfortunate situation will occur in areas of many 
States, including Nebraska, with the end result being that these areas 
will have no home health services available. Under this system, 
Medicare beneficiaries will suffer.
  H.R. 4567 begins to correct the problem with the interim payment 
system and will allow these agencies to stay in business until a 
prospective payment system is implemented. It increases the per 
beneficiary reimbursement to those agencies whose limit is below the 
national median limit--which will help almost every agency in this 
Member's district. It also directs HCFA to send Congress a report on 
its progress, if any, on implementing a prospective payment system. 
Finally, H.R. 4567 asks the Secretary of Health and Human Services to 
help Congress find a way to prevent the 15 percent reduction in payment 
limits scheduled for October 1, 1999.
  Mr. Speaker, this Member cannot emphasize enough the importance of 
passing legislation that will correct the flaws of the IPS. Congress 
must pass legislation before the end of this session in order to save 
the hundreds of home health agencies all over the country that will no 
longer be able to provide care next year if the current payment system 
is allowed to remain in place. This Member asks all of his colleagues 
to support this critical measure for all of the elderly constituents 
receiving home health in their district.
  Mr. RODRIGUEZ. Mr. Speaker, I would like to support H.R. 4567 with 
enthusiasm. This bill on its surface aims to improve veterans heatlh 
and correct serious deficiencies in our home health reimbursement 
system. Unfortunately, at least in the home health area, the bill falls 
woefully short of its stated goal.
  For veterans this is the first effort to implement VA-Medicare 
subvention, which has been sought by veteran's service organizations 
for years. This legislation would allow veterans who are covered by 
Medicare to receive treatment at VA facilities. I support subvention 
and am a co-sponsor of legislation to bring this overdue option to 
veterans. We own our veterans quality health--for this reason I will 
vote for this bill today.
  However, this bill falls FAR short of addressing the real need of our 
communities that

[[Page H10258]]

rely so heavily on the home health care industry. Home health fills a 
much needed void for my for my community where very few hospitals exist 
and nursing home have been closed. How can we expect our elderly 
Medicare beneficiaries in rural communities to survive when a handful 
of home health agencies are closing everyday? I have no idea how my 
constituents are expected to survive. Many of the Medicare 
beneficiaries that utilize home health have already been told they will 
not longer receive care and have been left to the hands to fate.
  This bill fails to address the pressing problems created by the 
faulty interim payment system (IPS) and further address the failure of 
the Health Care Financing Administration to recognize the need in rural 
communities for such care. HR 4567 fails to recognize two key 
provisions: the need for retroactivity, and the automatic 15 percent 
reduction scheduled for this year.
  It is a shame that we are not able to bring a bill to the floor that 
addresses the heart of the home health crisis--access to health care 
for our elderly. The Republican leadership has failed our elderly by 
not recognizing that more needs to be done and that it needs to be done 
now. Our only hope is that REAL changes will be made in the conference 
version of this bill. If not, we will all surely go home from this 
session hanging our heads low, knowing that we have not really solved 
the matter. Instead we have pretended to acknowledge it and then walked 
away.
  Mr. ROTHMAN. Mr. Speaker, I rise today in support of H.R. 4567. I am 
pleased that this bill includes the text of H.R. 3511, and urge my 
colleagues to vote in favor of this important legislation. H.R. 3511 is 
one of those bills that, though technical in nature, can be critically 
important for those that it may affect.
  In fact, for some older Americans, this legislation will mean the 
difference between spending the remaining years of their lives 
struggling to overcome the handicap of blindness and having the 
benefits and opportunities of sight.
  H.R. 3511 can make a difference in the lives of our senior citizens 
because it grants to the Secretary of Health and Human Service (HHS) 
the discretion needed to allow programs such as the National Eye Care 
Project (NECP) to provide eye care to all elderly Americans at no out-
of-pocket cost to those that it serves. Under current law, 
ophthalmologists who participate in the National Eye Care Project are 
required to charge each patient all of the copayments and deductible 
specified by Medicare--unless, of course, that patient is determined to 
be finally disadvantaged and lacking the means to pay for medical eye 
care.
  The problem is that many senior citizens will decide not to see an 
eye doctor if they must answer such intrusive questions as whether 
making the Medicare copayment would mean they are ``unable to afford 
food'' or ``be forced to put off paying for such expenses as food, 
housing, transportation and prescription medication.'' Others who are 
not ``financially disabled,'' as defined by Medicare, do not believe 
they can afford the copayments and deductibles, and therefore decide to 
defer a visit to the eye doctor for another day. Unfortunately, with 
some eye diseases, a delay of even a few weeks can lead to irreparable 
damage, and even blindness, which could have been avoided with timely 
care.
  The National Eye Care Project was established by the Foundation of 
the American Academy of Ophthalmology in 1986 to address this problem. 
Through a toll-free Helpline, seniors can receive information about 
common eye diseases and, if eligible, get a referral to one of the 
approximately 7,500 volunteer ophthalmologists across the country who 
provides eye care to those in need.
  Prior to enactment of the Health Insurance Portability and 
Accountability Act of 1996 (HIPAA), and the NECP could advertise that 
it would provide this care ``at no out-of-pocket cost'' to those who 
need it, and seniors seeking care were not required to answer intrusive 
questions about whethr they could afford to make Medicare copayments. 
However, HIPAA made this approach illegal by prohibiting the waiver of 
Medicare copayments without a case-by-case determination of financial 
need. H.R. 3511 will remedy this situation by giving the Secretry of 
Health and Human Services the discretion to allow a program such as the 
NECP to waive Medicare co-payments for all participants. HHS would not, 
of course, make such a determination for the NECP of other programs if 
it could not establish that granting a waiver would not create a 
loophole for fraud and abuse in the Medicare program. Combating fraud 
and abuse was the original objective behind HIPAA restrictions.
  In conclusion, Mr. Speaker, H.R. 3511 is important legislation that 
can lead to significant benefits for our senior citizens. I urge my 
colleagues to vote for this legislation.
  Mr. PORTMAN. Mr. Speaker, I rise in support of H.R. 4567, the 
Medicare Home Health Care and Veterans Health Care Improvement Act. 
Home health care is a vital service for Medicare beneficiaries that 
provides patients with peace of mind by allowing them to stay in their 
homes during their golden years. Without this service, many individuals 
would be forced into more expensive assisted living facilities or 
nursing homes.
  The bill is necessary because HCFA has told us that, as a result of 
the Y2K computer problem, it cannot implement the prospective payment 
system for home healthcare by October 1, 1999 as required by the 
Balanced Budget Act. This means home health agencies, through no fault 
of their own, will be hurt by the interim payment system and will 
continue to be paid under it longer than Congress intended. This 
unfortunate situation threatens the very existence of many agencies, 
including some from my Congressional district that have been 
responsible and have operated efficiently to keep their costs down.
  H.R. 4567 is designed to provide needed relief to such agencies under 
the interim payment system while HCFA sorts out its computer problems. 
I agree with those agencies that feel additional measures are needed, 
but that just isn't possible under our current budget constraints. The 
real solution is for HCFA to redouble its efforts to implement the PPS 
without further delay. In the meantime, H.R. 4567 will help agencies 
get through this difficult period.
  I urge passage of this bill to ensure that agencies can continue to 
offer essential health care services to seniors in southwest Ohio and 
around the nation, and I call on HCFA to do whatever it takes to see 
that agencies can get out of the interim payment system as soon as 
possible.
  Mr. STARK. Mr. Speaker, this bill is nothing more than a tax break 
for the wealthy disguised as a Medicare bill. It's a perk for Members 
of Congress who, along with their spouses, will not be eligible for new 
tax shelter--Roth IRAs.
  We have had no chance to study the home health proposal. Relative to 
the bill reported out of Ways and Means, it moves money toward new, 
for-profit agencies, who have been the cause of the home health funding 
crisis. Many of these agencies have been the very definition of fraud, 
waste, and abuse.
  The health policy in this bill is not as good as the policy in the 
bill reported from Ways and Means--but it is not bad.
  What is horrendous, what is totally unacceptable is the pay for and 
the budget implications! This bill loses $10.7 billion over 10 years. 
It is absurd, but true that the Treasury would be better off if the 
Majority did not try to pay for the bill! With this bill, you are 
spending the surplus. You are creating a tax loophole for the very 
upper income, that will cost billions and billions in the out-years--
just when we will need the money to save Medicare and extend its life. 
This proposal is poor tax policy and poor budget policy. We should be 
saving the surplus for Medicare--not spending it to please some for-
profit home health agencies that have been abusing the program. Between 
now and 2008 when the Medicare Trust Fund will be exhausted, we will 
need about $325 billion--yet this bill gives away billions and adds to 
that pending crisis.
  Over the next 5 years, Medicare will spend about $1.1 trillion. You 
would think that we could find zero-point-two (0.2) percent out of 
current Medicare spending. There is a National Bipartisan Commission on 
the Future of Medicare that is trying to save Medicare for future 
generations, but if we can't find 0.2%, and give away billions of 
dollars that could be saved for Medicare, what does that say about the 
worth of that Commission? The Majority's pay for will undoubtedly run 
into budget rules in the Senate, and will be opposed by the 
Administration. To offer such a pay for smells like a poison pill.
  Mr. BONILLA. Mr. Speaker, I rise today in support of H.R. 4567, the 
Medicare Home Health Care and Veterans Health Care Improvement Act of 
1998. This bill provides additional resources for health care for the 
heroic men and women who are our nation's veterans. However, this bill 
falls far short of improving the situation that home health care 
agencies are facing.
  The Balanced Budget Act of 1997 directed the Health Care Financing 
Administration (HCFA) to develop a prospective payment system of 
reimbursement for home health care agencies by 1999. In the meantime, 
HCFA developed an interim payment system designed to help health care 
agencies' transition to a prospective payment system. Unfortunately, 
this system has jeopardized the health care for many of our most 
vulnerable citizens and has put many hard-working agencies out of 
business. In August, the HCFA told Congress that it will not follow the 
law and develop the prospective payment system. Due to HCFA's inaction, 
Congress was forced to quickly develop an interim payment system to 
keep home health care afloat until HCFA can get its act together.
  While the bill we are voting on today takes one step forward in that 
fix, we still have a

[[Page H10259]]

long way to go. As we face the last days of this congressional session, 
I am disappointed that we are faced with a ``take it or leave it'' 
situation. However, I am supporting today's measure because a little 
help is better than no help. I am confident that this Congress will 
continue to have home health reform as its top priority when it returns 
next year.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today to 
express my support for H.R. 4567, the Medicare Home Health Care and 
Veterans Health Care Improvement Act of 1998 and to congratulate the 
bill's sponsors for moving this important legislation forward before 
Congress adjourns this year.
  While the bill is not perfect, it does promise to help the 
historically low-cost agencies that have been penalized by the interim 
payment system (IMPS) implemented in the Balanced Budget Act of 1997 
for their past efficiencies in delivering high quality home care. I 
also applaud the sponsors of the bill for increasing the per visit 
reimbursement limit.
  While I support the bill, I have some reservations. Texas is a big 
State with large rural areas. I am concerned that reimbursement to new 
health agencies in rural areas that must travel long distances to serve 
their patients is too low under the Interim Payment System. H.R. 4567 
does little to help these new agencies.
  Furthermore, the bill does nothing to postpone the 15% cut scheduled 
for next fall when HCFA fails to implement the Prospective Payment 
System by the October 1, 1999 deadline.
  I hope to see these issues addressed during conference with the 
Senate. In addition, I can only hope that a more appropriate funding 
mechanism can be found in conference that does not create a tax 
loophole for the highest earners which raises money in the short run 
and costs us billions in the long run.
  Mr. HILLEARY. Mr. Speaker, I would like to give my support, though 
reluctantly, to H.R. 4567, the Medicare Home Health Care and Veteran 
Health Care Improvement Act.
  First, I would like to extend thanks to Chairman Thomas, Bliley, 
Stump, Archer and Bilirakis for their hard work and countless hours 
spent crafting this legislation. I would also like to thank members 
from both sides of the aisle who have worked tirelessly on this 
subject, especially Congressmen Rahall, Aderholt, Coburn, Pappas, 
Stabenow, and Weygand. If not for their hard work and perseverance, we 
would not even have this bill before us today.
  This bill does wonderful things for both our veterans and those in 
need of kidney dialysis treatment. However, it is woefully inadequate 
in terms of its aid to home health.
  For our veterans, it gives those who have served our country so 
proudly the right to receive Medicare benefits at VA facilities. This 
bill will open up access and help ease the financial burden that many 
of our veterans would otherwise face and create more flexibility on 
their medical care through a process known as ``subvention.'' Under 
subvention VA facilities would be able to provide efficient and 
affordable ``one-stop'' shopping for veteran medical services. I am 
proud to support this initiative.
  This bill also does a tremendous job for those kidney patients who 
need better access to dialysis machines. Under this bill ``safe 
harbors'' would be created to allow those in need to have a specialized 
dialysis help subsidize their payments. This would give greater access 
and make more affordable dialysis machines to the many people who 
suffer from kidney failure.
  However, I must stress my emphatic displeasure with the home health 
portions of this bill. I do not believe that the home health sections 
of this bill are bad ideas as written in the bill. Instead, I oppose 
the glaring omission of several essential elements that must be 
addressed in order to save this industry that provides health service 
to so many of our elderly. Among the major deficiencies in the bill are 
failures to address the agency retroactivity, regional equity, and the 
impending industry wide 15% cut set to occur next October 1.
  I especially find it disheartening that this bill does not even 
attempt to help every region. In my state of Tennessee, most agencies 
will not even see a drop of this increase, yet we have already seen 24 
closures this year. A regional solution is an incomplete solution.
  I do not want to see us simply put a Band-Aid on the problem and 
pretend that we have done adequate work. By only going halfway on this 
issue, we have done the home health industry a disservice. For I fear 
that if we do not address these issues in the next few days, then we 
will be unable to solve the problems that these issues will create next 
year.
  In particular, I feel that if the 15% cut goes into effect, the 
entire industry, and the seniors they serve, will be severely impacted. 
By putting off the problem until next year, the bill merely gives a 
wink and a nod without offering a solution. I know that if this problem 
is not addressed, either by establishing a permanent case-mix adjuster 
or a delay of the 15%, the industry will fail, and we will have this 
wasted opportunity to blame.
  I am completely dumbfounded to why we give a halfhearted solution 
when we have the opportunity to do so much more. I hope that the issues 
in this bill are not closed. I hope that we still can address important 
issues like the impending 15% cut set for next year. If we do not come 
back next Congress and act quickly, I fear that the sick and elderly 
will never forgive us for our inaction.
  I reluctantly urge my colleagues to support this bill and strongly 
urge my colleagues and the chairmen overseeing home health care to 
continue working and address the remaining critical problems facing 
this industry.
  The SPEAKER pro tempore (Mr. LaHood). The question is on the motion 
offered by the gentleman from California (Mr. Thomas) that the House 
suspend the rules and pass the bill, H.R. 4567, as amended.
  The question was taken.
  Mr. THOMAS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 5 of rule I and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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