[Congressional Record Volume 144, Number 151 (Wednesday, October 21, 1998)]
[Senate]
[Page S12896]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        VERMONT HOME HEALTH CARE

 Mr. LEAHY. Mr. President, it has been a long road to get us 
where we are today to a modification of the unfair Medicare home health 
interim payment system (IPS) reimbursement that passed last year as 
part of the Balanced Budget Act (BBA). Making sure that this change was 
passed this year was not about politics but about helping those with 
the most to lose, the seniors and disabled Americans who rely on home 
health care.
  At the beginning of this year, when I discussed with my colleagues a 
problem with the ``Medicare Home Health IPS,'' I received a lot of 
blank stares. The rising level of understanding about this problem--and 
the rising level of support to fix it--was a commendable and effective 
team effort on the part of home health beneficiaries and their care 
givers. They were able to explain to their representatives in Congress 
why the short-term tinkering in health policy that created the IPS was 
unfair and was done with too little thought for the consequences.
  The IPS passed last year sought to reduce overall spending on home 
health care by eliminating fraud, waste and abuse to preserve the 
benefit for those who truly need it. But as Vermont providers know all 
too well, there were unintended consequences of this proposal that 
severely harmed their ability to provide care to the most vulnerable 
populations.
  Under this faulty system, Vermont's 13 non-profit home health 
agencies predicted millions of dollars in reduced payments this year 
while already boasting the lowest average Medicare costs in the 
country. The skewed thinking behind the IPS created a system under 
which Vermont was punished for its low-cost, efficient provision of 
home health care while high-cost, inefficient providers were rewarded.
  A year ago this month, my office began to receive phone calls and 
letters from Vermont home health beneficiaries and their care givers 
who were beginning to understand what the overwhelming impact of the 
new IPS would be. In an effort to raise this issue to the level of 
where we are today, concerned senators and representatives began the 
drum beat of highlighting this as a critical issue that must have 
relief this year.
  From the beginning there was a lot of reluctance by the congressional 
leadership to take up any Medicare legislation this year.
  The home health agencies in my state were relentless in their efforts 
to continue to call attention to the fundamental unfairness of the 
Medicare IPS that punished their prudent and efficient provision of 
service to Vermonters.
  My staff and I met with home health officials, and we agreed early on 
that any and all pressure that we could put on the Administration and 
other members of Congress would be critical to ensuring the ability of 
home health care providers to meet the needs of Vermonters.
  Several bipartisan Senate bills were introduced over the past year, 
the first being one sponsored by Senators Kennedy, Kerry, Jeffords and 
myself. We knew at the time that this was not the perfect answer but 
that we needed to start a process to get the ball rolling.
  Subsequently, several other bills were introduced which I also 
cosponsored, most notably by Senator Collins and another by Senator 
Grassley. I also joined Senator Bond in offering an amendment in the 
Appropriations Committee which we withdrew once we were assured that 
the Republican leadership was taking this issue seriously and would 
deal with it separately. My colleague from Vermont, Senator Jeffords, 
has pushed hard for this solution as a member of the Finance Committee.
  I applaud the bipartisan nature of the work to get this situation 
turned around. The beneficiaries, the agencies which serve them, and 
Members of Congress continued to press until we found some relief from 
the fundamental unfairness in the payment system for home health care.
  The Omnibus Appropriations Act conference agreement passed today 
makes necessary changes to the IPS payment system for the Medicare's 
home health care benefit. In short, the agreement is expected to 
provide some equity to agencies which have low-cost, low-utilization 
practices relative to other agencies by increasing the per beneficiary 
limits. Agencies below the national median per beneficiary limit will 
have their limit increased by one-third of the difference between their 
limit and the national median. The agreement also delays the 
implementation of the prospective payment system (PPS) until October 1, 
2000, and delays an across-the-board 15 percent reduction in payments 
to home health agencies until that date.
  Like most contentious issues, this fix does not go as far as I would 
have liked and as far as I believe efficient providers like those in 
Vermont deserve. I support it however because it is better than the 
status quo.
  In the longer term, we need to stop ignoring a more fundamental 
problem. Congress needs to address the long-term health care needs of 
the American people.
  Stepping back to understanding why the IPS was passed last year, we 
can see that it was in recognition of the difficulty of designing a 
more permanent PPS for Medicare home health reimbursement, coupled with 
the need to immediately control spending.
  In the long term, a well-designed PPS will provide the Medicare 
program with the best means to control home health spending and address 
the problems Vermont home care agencies, and other agencies around the 
country that are able to provide quality, low-cost care.
  The BBA requires implementation of a PPS by agencies in FY 2000. The 
PPS would establish a fixed, predetermined payment per unit of service, 
adjusted for patient characteristics that affect the cost of care. 
Under a well-designed PPS system, efficient providers would be 
financially rewarded. Conversely, inefficient ones would need to better 
control their costs to remain viable. If a PPS is not properly 
implemented, Medicare will not save money, cost-control incentives will 
at best be weak, and access to and quality of care could suffer.
  I am committed to working with my colleagues to make sure that we 
work steadfastly in overcoming any hurdles in developing a well-
designed PPS so that we do not find ourselves in the same situation 
that we found ourselves with the IPS.

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