[Congressional Record Volume 145, Number 104 (Wednesday, July 21, 1999)]
[Senate]
[Pages S8958-S8960]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   SENATE CONCURRENT RESOLUTION 47--EXPRESSING THE SENSE OF CONGRESS 
        REGARDING THE REGULATORY BURDENS ON HOME HEALTH AGENCIES

  Mrs. HUTCHISON (for herself, Mr. Bond, Ms. Collins, Mr. Frist, Mr. 
Allard, Mr. Edwards, Mr. Cochran, Mr. Cleland, Mr. Roberts, and Mr. 
Torricelli) submitted the following concurrent resolution; which was 
referred to the Committee on Finance:

                            S. Con. Res. 47

       Whereas 3,900,000 elderly persons currently use health care 
     services provided under the medicare home health program;
       Whereas the Balanced Budget Act of 1997 made a number of 
     changes to the administration of the medicare home health 
     program;
       Whereas many such changes imposed by such Act were required 
     to be implemented by the Health Care Financing Administration 
     (referred to in this resolution as ``HCFA'') of the 
     Department of Health and Human Services;
       Whereas many of such regulations promulgated by HCFA in 
     order to implement such changes have proven to be 
     administratively burdensome, have diverted funds away from 
     needed beneficiary care, and were promulgated as final rules 
     without prior opportunity for comment by the home health 
     industry and home health patients;
       Whereas HCFA has implemented a branch office policy that 
     imposes arbitrary distance and suspension requirements that 
     are administratively burdensome and threaten access to home 
     health services, particularly in rural areas;
       Whereas, in order to implement the shift of medicare 
     payment for home health services from part A to part B, HCFA 
     imposed a sequential billing policy that prohibited home

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     health agencies from submitting bills for patient services if 
     a previous bill was submitted for that patient who was 
     undergoing medical review;
       Whereas HCFA has expanded medical reviews of home health 
     claims so that the processing of such claims has slowed down 
     significantly nationwide;
       Whereas HCFA is requiring home health agencies to submit 
     patient data using the Outcomes and Assessment Information 
     Set (referred to in this resolution as ``OASIS'') in 
     anticipation of and to assist the development of a 
     prospective payment system (PPS) for home health services;
       Whereas, HCFA plans to implement an overly burdensome 
     requirement that agencies report visit times in 15-minute 
     increments that fails to account for the entire time spent in 
     the home and on activities such as care planning, 
     coordination, documentation, and travel that are essential 
     for a home health visit;
       Whereas most home health agencies will not be reimbursed 
     for any of the costs or the increase in administrative 
     requirements associated with OASIS;
       Whereas the slowdown in claims processing, coupled with 
     sequential billing and implementation of OASIS, has 
     substantially increased home health agency cash flow problems 
     because payments are often delayed by 3 months or more;
       Whereas the vast majority of home health agencies are small 
     businesses that cannot operate with such significant cash 
     flow problems; and
       Whereas there are many other elements of the medicare home 
     health program, such as the interim payment system, which 
     have created financial problems for home health agencies, 
     such that more than 2,200 agencies nationwide have already 
     closed: Now, therefore, be it
       Resolved by the Senate (the House of Representatives 
     concurring), That it is the sense of Congress that--
       (1) Congress should actively oversee the administration by 
     the Health Care Financing Administration (referred to in this 
     resolution as ``HCFA'') of the medicare home health program;
       (2) in overseeing such administration, Congress should pay 
     particular attention to HCFA's compliance with the public 
     notice and comment requirements of the Administrative 
     Procedures Act (5 U.S.C. 551 et seq.), HCFA's consideration 
     of input from the home health community, and HCFA's 
     coordination and consistent application of policies among 
     HCFA's central and regional offices; and
       (3) Congress should monitor HCFA's adherence to and 
     implementation of Congressional intent when executing changes 
     during such administration.

 Mrs. HUTCHISON. Mr. President, I rise today to submit a Senate 
concurrent resolution intended to focus the attention of Congress on 
the current plight of Medicare beneficiaries who receive home health 
care. Specifically, the resolution calls for increased Congressional 
oversight with regard to home health care of the Health Care Financing 
Administration (HCFA), which has responsibility of implementing the 
federal Medicare program.
  Home health providers, or ``agencies'' as they are called, are being 
decimated by overly burdensome and complex regulations issued by HCFA. 
Ostensibly issued to implement the Medicare preservation provisions of 
the 1997 Balanced Budget Act, these regulations instead have ignored or 
conjured Congressional intent and in the process have driven thousands 
of home health agencies out of business and left tens of thousands of 
homebound seniors scrambling to find care.
  Mr. President, my home state of Texas is very rural. Despite the fact 
that there are now almost 20 million people living in Texas, most areas 
of the state remain rural, even isolated from major population centers. 
Many of these areas are medically very underserved. There are counties 
in Texas without a single hospital, and several without so much as a 
clinic for people to go to find basic health services. It's not unusual 
for a Texan in some parts of the state to have to drive 100 miles or 
more just to see a doctor.
  When Congress created the home health benefit within the Medicare 
program, it dramatically extended Medicare's reach to senior citizens 
and disabled persons living in these rural areas. Home health also 
offered to bring much needed health services to many who, although they 
may reside in a city, nevertheless may live an isolated existence 
because they are homebound.
  Because of the tremendous need and demand for home health care, the 
program began to grow rapidly. This growth began to alarm some who felt 
that the cost of the program would soon outstrip the Medicare system's 
ability to pay for it. There were also a growing number of reports of 
abuse and fraud within Medicare generally, and specifically within the 
home health program.
  So in 1997, as part of a broader Medicare package, Congress acted to 
make the home health program more efficient and to crack-down on fraud 
and abuse. While these reforms were intended as a wake-up call to 
inefficient and fraudulent home health providers, they were not 
intended to pull the rug out from under the entire home health 
industry, and the 4 million patients nationwide who depend on the 
services home care provides. Unfortunately, that is exactly what has 
happened.
  Home health agencies have been besieged on all sides. Implementation 
of the Interim Payment System (IPS) has caused immediate cuts in 
payments to agencies by upwards of 60 percent. In many cases, these 
cuts are being implemented retroactively, resulting in many agencies 
being slapped with ``overpayment'' demand notices for hundreds of 
thousands of dollars. In some cases, these payment demands exceed the 
agency's annual payroll. Moreover, the manner in which HCFA has chosen 
to implement the IPS has caused the most efficient agencies to suffer 
the most severe cuts. Agencies that were less efficient, and thus were 
paid more in the past, are ironically given higher reimbursements under 
the IPS.
  At the same time, home health agencies have been hit with many new, 
complex, and burdensome regulations, some of which seem to have no real 
purpose other than to generate more paperwork and administrative costs 
by home care agencies.
  For example, home health providers are now required to keep track of 
and report their time in 15 minute increments. Many visiting nurses and 
other home health providers report having to use a stopwatch while they 
administer care to their patients in order to comply with this new 
requirement. Another example is HCFA's implementation of a sequential 
billing policy, wherein an agency cannot bill Medicare for services 
provided to a patient until all previous claims for that patient are 
resolved, even if those earlier claims are held-up by the Medicare 
bureaucracy.
  Across the nation, and particularly in my home state of Texas, the 
combined results of these payment cuts and new regulations have been 
nothing short of catastrophic. In Texas alone, an estimated 700 home 
care agencies have already gone out of business since 1997, and many 
more are on the verge of collapse. Nationwide, upwards of 2200 agencies 
have reportedly shut their doors, representing about a third of the 
total number of home care agencies.
  Mr. President, it seems that everywhere I travel in Texas, and I 
travel to some very rural areas, the one health complaint I hear 
consistently from my constituents concerns changes in the Medicare home 
health benefit. I have heard numerous instances of home health 
beneficiaries, particularly those with complex illnesses and demanding 
health needs, who have been left high and dry by the closure of their 
home care agency. Many of these individuals have been forced into 
hospitals or nursing homes. Others simply get no care, or must rely to 
the extent they can upon what care family or neighbors can provide.
  I and many of my colleagues have communicated with HCFA in an attempt 
to soften the blow of their regulations, with only very limited 
success. And while HCFA has been largely unresponsive to Congress, it 
has been even more insulated from the comments, suggestions, and 
complaints from the home health community. In many cases, payment 
system changes have been enacted with virtually no public participation 
or comment.
  Mr. President, our nation's homebound senior citizens deserve more.
  This resolution seeks to bring attention to the plight of home health 
beneficiaries under HCFA's cumbersome implementation of the reforms 
Congress enacted. It calls upon Congress to take a more active role in 
overseeing the Health Care Financing Administration with regard to home 
health care and HCFA's implementation of its home care regulations. 
Most importantly, the resolution calls upon HCFA to adhere more closely 
to Congressional intent in administering the Medicare home health 
benefit to ensure that the program is not further eviscerated.

[[Page S8960]]

  This resolution is certainly not the only solution to the current 
home health crisis. Just this month I joined with Senators Collins, 
Bond, and others, many of whom are original cosponsors of this 
resolution, in introducing substantive legislation that will repeal 
some of the most severe applications of the 1997 Balanced Budget Act. 
While these changes cannot turn back time to restore the agencies and 
services that have been lost, it can help prevent even more providers 
from going out of business and even more homebound patients from being 
medically stranded.
  Mr. President, I call upon my colleagues to support this resolution, 
as well as the substantive legislation just introduced by my colleague, 
Senator Collins. But most importantly, I call upon my colleagues to 
recognize the real and ongoing health care crisis facing America's 
homebound seniors and disabled individuals.

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