[Congressional Record Volume 145, Number 96 (Thursday, July 1, 1999)]
[Senate]
[Pages S8079-S8080]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE HOME HEALTH EQUITY ACT OF 1999
Mr. LEVIN. Mr. President, on June 10th we held a hearing on home
health care in the Permanent Subcommittee on Investigations
Subcommittee where we examined how the so called ``reforms'' of the
Balanced Budget Act of 1997 were holding up. I continue to believe that
the answer to that question is, ``not well.'' That is why I am joining
with my colleague from Maine, Senator Collins, the Chairman of the PSI
Subcommittee, in introducing an important bill, the Medicare Home
Health Equity Act of 1999.
Home health care agencies provide a vital service to many elderly
Americans. In my own state of Michigan there are over 1.3 million
Medicare beneficiaries. Over 100,000 of these beneficiaries use the
services of Michigan's 223 home health agencies. People prefer to
recuperate in their own homes, and it is also less costly for the
government since the alternative is nursing home care which is
extraordinarily expensive for the Medicare program.
I am concerned about potential access problems. Although HCFA and the
GAO have reported that they have not seen a decline in access for
beneficiaries, the home health care witnesses that spoke before the PSI
Subcommittee all stated that they believed there was an access problem.
In fact, Barbara Markham Smith, from the George Washington University
Medical Center, testified that ``many seriously ill patients,
especially diabetics, appear to have been displaced from Medicare home
care.'' Sometimes it takes a while for the people in the field to
actually get the numbers back to the people in Washington, and I think
this is one of those instances.
We all know that during the early 90's home health care expenditures
grew at a rapid pace. According to the GAO, Medicare spent $3.7 billion
to pay for home health visits in 1990 compared to $17.8 billion in
1997. This growth led to changes, like the interim payment system,
(IPS) that were implemented
[[Page S8080]]
under the Balanced Budget Act. While some of the changes under the
Balanced Budget Act were good, some of the changes are now negatively
impacting Medicare beneficiaries.
I have heard from many constituents regarding home health care
changes under the Balanced Budget Act and the various regulations that
HCFA has imposed. In fact, last year, I received some 1500 letters from
both home health care providers and beneficiaries. I echo their
concerns when I say that the interim payment system penalizes cost
efficient home health providers, like those in Michigan, while
rewarding higher cost agencies.
Not only does the IPS penalize agencies that attempted to keep their
costs down in 1994, but the new regulations which HCFA has imposed on
the agencies are quite burdensome. There is no more poignant story to
demonstrate the undue burdens being placed on home health care
providers than that of Linda Stock, a Michigan home health care
provider. This month Ms. Stock testified before the PSI Subcommittee
about the problems that home care providers were having, particularly
cost efficient home care providers like her own. Last week Ms. Stock
called to let me know that she has resigned from her job because she
did not feel that she could ask her staff to implement regulations such
as OASIS (Outcome and Assessment Information Set) and the 15 minute
increment home health reporting requirement. It is tragic that a
committed health care provider such as Linda Stock would feel the need
to resign from her job rather than implement regulations which she
believed were unfair to both beneficiaries and providers.
So what can be done in the face of these problems? I believe that the
bill we are introducing today, if enacted, could go a long way towards
helping Ms. Stock and others like her.
Last year I worked on a bill with Senator Collins to revise the
payment formula used to calculate the per beneficiary limit. That bill
would have created new winners and losers under the IPS. This year's
bill does not attempt to revise the formula, and therefore avoids the
formula fight which made action on this issue so difficult last year.
Our new bill makes needed adjustments to the Balanced Budget Act of
1997 and related federal regulations.
Though technical in nature, I would like to read the major provisions
found in the bill:
(1) The bill will eliminate the automatic 15 per cent reduction in
Medicare home health payments now scheduled for October 1, 2000.
(2) The bill will provide supplemental payments to home health
agencies on a patient by patient basis if the cost of care for an
individual is considered by the Secretary to be significantly higher
than average due to the patient's particular health and functional
condition.
(3) The bill will increase the per beneficiary cost limit for
agencies with limits below the national average to the national average
cost per patient over a three year period or until the Medicare home
health prospective payment system is implemented.
(4) The bill will revise the surety bond requirement for home health
agencies to more appropriately target fraud
(5) The bill will extend the IPS overpayment recoupment period to
three years without interest
(6) The bill will eliminate the 15 minute incremental reporting
period
(7) The bill temporarily maintains the Periodic Interim Payment (PIP)
program, a program that permits HCFA to make payments to agencies-based
on historical payment levels--prior to the final settlement of claims
and cost reports.
I believe that this bill provides an opportunity for us to move
forward in solving some of the problems caused by the Balanced Budget
Act. We should pass this common sense bill that will ensure that home
care is accessible to those seniors who so desperately need it.
____________________