[Congressional Record Volume 145, Number 98 (Tuesday, July 13, 1999)]
[Senate]
[Pages S8382-S8383]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. JEFFORDS (for himself, Mr. Reed, Mr. Enzi, and Mr. Leahy):
  S. 1358. A bill to amend title XVIII of the Social Security Act to 
provide more equitable payments to home health agencies under the 
Medicare Program; to the Committee on Finance.


         THE PRESERVING ACCESS TO CARE IN THE HOME ACT OF 1999

  Mr. JEFFORDS. Mr. President, I rise today to introduce the Preserving 
Access to Care in the Home Act of 1999, also known as the PATCH Act. 
This important bill has been crafted to protect access to care for 
those most in need, relieve the cash flow problems faced by agencies, 
and improve the interaction between home health agencies and HCFA. I 
want to recognize Senator Reed, Senator Enzi, and Senator Leahy. These 
cosponsors have shown tremendous effort and dedication in dealing with 
the crisis in home health care.
  Abraham Lincoln said ``The legitimate object of government is to do 
for a community of people, whatever they need to have done, but cannot 
do at all, or cannot so well do for themselves, in their separate and 
individual capacities.'' This is the essence of home health care.
  Home health care means so much to so many people: it means that 
people recovering from surgery can go home sooner--it means that 
someone recovering from an accident can get physical therapy in their 
home, it means our seniors can stay at home, and out of nursing homes. 
It is smart policy from human and financial standpoints.
  My own State of Vermont is a model for providing high-quality, 
comprehensive care with a low price tag. For the past eight years, the 
average Medicare expenditure for home health care in Vermont has been 
the lowest in the nation. Vermont's home care system was designed to 
efficiently meet the needs of frail and elderly citizens in our largely 
rural State, but the Health Care Financing Administration's (HCFA) 
reimbursement system was not. HCFA's interim payment system (IPS) has 
been implemented in a manner that inadequately reimburses agencies for 
the care that they provide.
  The Balanced Budget Act (BBA) did a lot of good, providing health 
care coverage for millions of low income children, providing targeted 
tax relief for families and students, tax incentives to encourage 
pensions savings, and extending the life of Medicare. However, as with 
most things in life, it was not perfect.
  The BBA failed to recognize how the new home health reimbursement 
would affect small rural home health care providers. The IPS has caused 
such significant cash flow problems, that many agencies are struggling 
to meet their payroll needs. Home health care agencies are now facing 
the prospect of 15 percent budget cut next year. This budget cut, on 
top of already stretched budgets, would be disastrous for providers and 
patients alike.
  The PATCH Act will rectify these problems.

[[Page S8383]]

  First, the PATCH Act eliminates the 15-percent cut scheduled for next 
year. The actual savings under IPS have exceeded initial expectations, 
so the 15-percent cut is unnecessary to achieve the savings originally 
projected as needed.
  Second, the PATCH Act clarifies the definition of ``homebound'' so 
that coverage decisions are based on the condition of the individual 
and not on an arbitrary number of absences from the home. Many seniors 
have found themselves virtual prisoners in their homes, threatened with 
loss of coverage if they attend adult day care, weekly religious 
services, or even visit family members in the hospital. This makes no 
sense because all of these activities are steps on the road to 
successful and healthy recovery. Often, home care professionals want 
patients to get outside a little bit, as part of their care plan. This 
helps fight off depression. Eligibility for home care should depend on 
the health of the patient.
  Third, the PATCH Act creates an ``outlier'' provision so that 
medically complex patients suffering from multiple ailments are not 
excluded by the Medicare program. Agencies will receive reimbursements 
for reasonable costs so that they can continue to provide care for 
these complex patients without going bankrupt. Home health agencies can 
provide care to long-term chronic care patients at a lower cost than 
nursing homes, or hospitals.
  Next, the PATCH Act also matches the rate of review to the rate of 
denial and provides a reward to agencies for ``good behavior'' and 
incentive to submit ``good claims.'' Conducting high cost, intense 
audits on all agencies, regardless of the past efficiency of the 
agency, is expensive and unproductive. Many agencies are finding 
themselves swamped by pre-payment reviews for claims that they submit. 
These reviews require that health professionals spend a substantial 
amount of their time filling out forms instead of providing urgently 
needed care to the elderly. Matching the rate of review to the rate of 
denial adds to the efficiency of home health agencies, and the 
efficiency of the regulatory. If the finalized denial rate of claims 
for a home health agency is less than 5 percent then (a) there will be 
no prepayment reviews, and (b) the post-payment review shall not exceed 
10 percent of the claims.
  Finally, the bill restores the periodic interim payment system (PIP) 
and provides guidelines to HCFA on the development of a prospective 
payment system (PPS) that will be fair to Vermont's low-cost, rural 
providers.
  The sooner you can return patients to their homes, the sooner they 
can recover. The familiar environment of the home, family, and friends 
is more nurturing to recovering patients than the often stressful and 
unfamiliar surroundings of a hospital. Home health allows them to 
receive treatment for their medical conditions while being integrated 
back into independence. Home health is also a great avenue for 
education. It empowers families to assist in the care of their loved 
ones. This, too, results in lower costs because family members, in 
addition to health professionals, provide some of the care. Access to 
care in the home must be saved.
  I look forward to turning this legislation into law. The women and 
men who provide home care are on the front line every day and deserve 
nothing but our best efforts.
                                 ______