[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
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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
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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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