[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.

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