[Congressional Record Volume 145, Number 117 (Friday, September 10, 1999)]
[Senate]
[Pages S10729-S10733]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Feingold, and Mr. Chafee):
  S. 1574. A bill to amend title XVIII of the Social Security Act to 
improve the interim payment system for home health services, and for 
other purposes; to the Committee on Finance.


        the fairness in medicare home health access act of 1999

  Mr. CONRAD. Mr. President, today I am pleased to be joined by 
Senators Feingold and Chafee in introducing the Fairness in Medicare 
Home Health Access Act of 1999. I am proud to say that the Governing 
Board of the North Dakota Home Care Association, as well as the 
Visiting Nurse Association of America, have endorsed this legislation 
as a crucial step toward ensuring beneficiaries retain access to vital 
home care services.
  As you know, home health care has proven to be an important component 
of the Medicare package because it allows beneficiaries with acute 
needs to receive care in their home rather than in other settings, such 
as a hospital or nursing home. In my state of North Dakota, home health 
care has been particularly important because it has allowed seniors 
living in remote, frontier areas to receive consistent, quality health 
care without having to travel long distances to the nearest health care 
facility.
  Over the last three decades, we have witnessed significant increases 
in home health utilization as medical practices have shifted care from 
an inpatient to outpatient setting. To help address rising health care 
spending, the Congress included targeted measures in the Balanced 
Budget Act of 1997 (BBA) to reduce costs and give providers incentives 
to become more efficient. In particular, the BBA directed the Health 
Care Financing Administration to implement an interim payment system 
for home health care until which time a prospective payment system 
could be instituted. While the interim payment system has allowed 
agencies to become more cost-effective, there are also concerns that it 
may be having some unintended consequences on agencies' ability to 
deliver quality, appropriate home care services to Medicare 
beneficiaries.
  Mr. President, this legislation takes definitive steps to address 
various unintended consequences of the interim payment system and of 
the BBA in general.
  Home health providers serving rural beneficiaries have been 
particularly affected by the interim payment system. As you know, home 
health care delivery is unique because unlike most other services, the 
health care provider must travel to the patient. Compared to urban 
agencies, rural home care providers must travel longer distances to 
serve beneficiaries and they often face poor weather and road 
conditions. Due to these constraints, agencies serving rural 
beneficiaries must visit patients less frequently; but during an 
isolated visit aides tend to spend more time with beneficiaries to 
ensure that they are receiving appropriate levels of care. 
Unfortunately, the per visit limits included in the interim payment 
system do not adequately account for the unique challenges of serving 
rural beneficiaries. This legislation revises the per visit cost limit 
to ensure agencies have the resources to deliver care to beneficiaries 
living in rural and underserved areas.
  It also appears that the interim payment system does not adequately 
account for the needs of medically-complex beneficiaries. Various 
reports have

[[Page S10730]]

suggested that the interim payment system has resulted in restricted 
access to home health services for high-acuity, high-cost patients. In 
a recent survey conducted by the Medicare Payment Advisory Commission, 
nearly 40 percent of agencies reported that they are less likely to 
admit patients identified as those with long-term or chronic needs. In 
addition, many beneficiary advocates have raised concerns that home 
health agencies are denying access to care because they believe 
Medicare will no longer cover the high costs of providing services to 
medically complex individuals. When it is implemented, the prospective 
payment system will include a measure to account for the treatment of 
medically-complex beneficiaries. In the interim, this legislation will 
allow agencies to receive more appropriate payments for treating high-
acuity, high-cost beneficiaries.

  In addition, this legislation includes provisions to further ensure 
home care agencies have the appropriate resources to serve Medicare 
beneficiaries. To help slow the growth of home health expenditures, the 
BBA includes a provision to reduce home health cost limits by 15 
percent, beginning October 1, 2000. There is significant concern that 
the timing and level of the scheduled 15 percent reduction will result 
in reduced beneficiary access to health care. To address this concern, 
various industry representatives have requested a complete elimination 
of the scheduled reduction; however the cost of this reduction is 
estimated to be nearly $17 billion over ten years. Against the backdrop 
of impending insolvency of the Medicare program and the overall needs 
of the health care community as a whole regarding BBA-related relief, 
it will not be possible to completely eliminate this scheduled 
reduction. For this reason, this legislation suggests a middle-ground 
approach to this issue to ensure the scheduled reduction does not 
result in a reduction in beneficiary access.
  Primarily, this legislation would ensure that agencies receive 
adequate reimbursement by delaying the scheduled 15 percent reduction 
until the prospective payment system is fully implemented. This means 
that if implementation of the prospective payment system is delayed, 
the scheduled reduction would be delayed accordingly. In addition, to 
allow agencies to transition to the prospective payment system, and 
ensure they retain the necessary resources to serve beneficiaries, this 
legislation would reduce the scheduled reduction to 10 percent and 
would phase-in a further 5 percent reduction three years after the 
prospective payment system is implemented. These responsible measures 
will provide home health agencies additional resources to continue 
serving Medicare beneficiaries.
  In addition, this legislation would offer home health agencies relief 
from a particularly burdensome regulatory requirement. The BBA requires 
home health agencies to record the length of time of home health visits 
in 15-minute increments. This requirement is burdensome for agencies 
because time for travel and administrative duties related to this 
requirement are not compensated. Also, it is not clear that the 
collection of this data has a defined use. This provision eliminates 
the 15-minute reporting requirement and directs that any data 
collection regarding direct patient care have a defined purpose and not 
be unnecessary labor-intensive for home care providers.
  This bill would also take steps to address concerns regarding the 
provision of durable medical supplies to Medicare beneficiaries. The 
BBA requires implementation of consolidated billing for home health 
services. As part of consolidated billing, the BBA requires home care 
providers (rather than durable medical equipment suppliers) to provide 
durable medical equipment (DME) to Medicare beneficiaries during any 
episode of care by the home health provider. When a beneficiary seeks 
home health care, there is concern that they may experience a break in 
the continuum of care as they shift between receiving medical equipment 
from a DME supplier to receiving these supplies from a home health 
agency. In addition, many home health agencies are not currently 
equipped to provide and be reimbursed for the provision of durable 
medical equipment. This provision would ensure beneficiaries do not 
experience a break in serve with regard to durable medical equipment by 
allowing DME providers to continue delivering services to beneficiaries 
regardless of their home health status.
  Lastly, this legislation includes a provision that directs the 
establishment of a nationally uniform process to ensure that fiscal 
intermediaries have the training and ability to provide timely and 
accurate coverage and payment information to home health agencies and 
beneficiaries. This provision will be particularly important to home 
health reimbursement transitions to a new prospective payment system.
  I am confident that this legislation will ensure home health agencies 
can continue providing critical health care services to Medicare 
beneficiaries. I urge my colleagues to support this important 
legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follow:

                                S. 1574

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``The Fairness in Medicare 
     Home Health Access Act of 1999''.

     SEC. 2. FINDINGS AND PURPOSES.

       (a) Findings.--Congress finds the following:
       (1) Home health care is a vital component of the medicare 
     program under title XVIII of the Social Security Act.
       (2) Home health services provided under the medicare 
     program enable medicare beneficiaries who are homebound and 
     greatly risk costly institutionalized care to continue to 
     live in their own homes and communities.
       (3) Implementation of the interim payment system for home 
     health services has inadvertently exacerbated payment 
     disparities for home health services among regions, 
     penalizing efficient, low-cost providers in rural areas and 
     providing insufficient compensation for the care of medicare 
     beneficiaries with acute, medically complex conditions.
       (4) The combination of insufficient payments and new 
     administrative changes has reduced the access of medicare 
     beneficiaries to home health services in many areas by 
     forcing home health agencies to provide fewer services, to 
     shrink their service areas, or to limit the types of 
     conditions for which they provide treatment.
       (b) Purposes.--The purposes of this Act are as follows:
       (1) To improve access to care for medicare beneficiaries 
     with high medical needs by establishing a process for home 
     health agencies to exclude services provided to medicare 
     beneficiaries with acute, medically complex conditions from 
     payment limits and to receive payment based on the reasonable 
     costs of providing such services through a process that is 
     feasible for the Health Care Financing Administration to 
     administer.
       (2) To ensure that the 15 percent contingency reduction in 
     medicare payments for home health services established under 
     the Balanced Budget Act of 1997 does not occur under the 
     interim payment system for home health services.
       (3) To reduce the scheduled 15 percent reduction in the 
     cost limits and per beneficiary limits to 10 percent and to 
     phase-in the additional 5 percent reduction in such limits 
     after the initial 3 years of the prospective payment system 
     for home health services.
       (4) To address the unique challenges of serving medicare 
     beneficiaries in rural and underserved areas by increasing 
     the per visit cost limit under the interim payment system for 
     home health services.
       (5) To refine the home health consolidated billing 
     provision to ensure that medicare beneficiaries requiring 
     durable medical equipment services do not experience a break 
     in the continuum of care during episodes of home health care.
       (6) To eliminate the requirement that home health agencies 
     identify the length of time of a service visit in 15 minute 
     increments.
       (7) To express the sense of the Senate that the Secretary 
     of Health and Human Services should establish a uniform 
     process for disseminating information to fiscal 
     intermediaries to ensure timely and accurate information to 
     home health agencies and beneficiaries.

     SEC. 3. ADEQUATELY ACCOUNTING FOR THE NEEDS OF MEDICARE 
                   BENEFICIARIES WITH ACUTE, MEDICALLY COMPLEX 
                   CONDITIONS.

       (a) Waiver of Per Beneficiary Limits for Outliers.--Section 
     1861(v)(1)(L) of the Social Security Act (42 U.S.C. 
     1395x(v)(1)(L)), as amended by section 5101 of the Tax and 
     Trade Relief Extension Act of 1998 (contained in Division J 
     of Public Law 105-277), is amended--
       (1) by redesignating clause (ix) as clause (x); and
       (2) by inserting after clause (viii) the following:
       ``(ix)(I) Notwithstanding the applicable per beneficiary 
     limit under clause (v), (vi), or (viii), but subject to the 
     applicable per visit

[[Page S10731]]

     limit under clause (i), in the case of a provider that 
     demonstrates to the Secretary that with respect to an 
     individual to whom the provider furnished home health 
     services appropriate to the individual's condition (as 
     determined by the Secretary) at a reasonable cost (as 
     determined by the Secretary), and that such reasonable cost 
     significantly exceeded such applicable per beneficiary limit 
     because of unusual variations in the type or amount of 
     medically necessary care required to treat the individual, 
     the Secretary, upon application by the provider, shall pay to 
     such provider for such individual such reasonable cost.
       ``(II) The total amount of the additional payments made to 
     home health agencies pursuant to subclause (I) in any fiscal 
     year shall not exceed an amount equal to 2 percent of the 
     amounts that would have been paid under this subparagraph in 
     such year if this clause had not been enacted.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the date of enactment of this Act, and 
     apply with respect to each application for payment of 
     reasonable costs for outliers submitted by any home health 
     agency for cost reporting periods ending on or after October 
     1, 1999.

     SEC. 4. PROTECTION OF THE ACCESS OF MEDICARE BENEFICIARIES TO 
                   HOME HEALTH SERVICES BY ADDRESSING THE 15 
                   PERCENT CONTINGENCY REDUCTION IN INTERIM 
                   PAYMENTS FOR HOME HEALTH SERVICES.

       (a) Elimination of Contingency Reduction.--Section 4603 of 
     the Balanced Budget Act of 1997 (42 U.S.C. 1395fff note), as 
     amended by section 5101(c)(3) of the Tax and Trade Relief 
     Extension Act of 1998 (contained in division J of Public Law 
     105-277), is amended by striking subsection (e).
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect as if included in the enactment of the 
     Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 
     251).

     SEC. 5. PROTECTION OF THE ACCESS OF MEDICARE BENEFICIARIES TO 
                   HOME HEALTH SERVICES THROUGH A PHASE-IN OF THE 
                   15 PERCENT REDUCTION IN PROSPECTIVE PAYMENTS 
                   FOR HOME HEALTH SERVICES.

       (a) Phase-In of 15 Percent Reduction.--Section 
     1895(b)(3)(A)(ii) (42 U.S.C. 1395fff(b)), as amended by 
     section 5101(c)(1)(B) of the Tax and Trade Relief Extension 
     Act of 1998 (contained in division J of Public Law 105-277), 
     is amended--
       (1) in paragraph (3)(A)(ii), by striking ``15'' and 
     inserting ``10''; and
       (2) by adding at the end the following:
       ``(7) Special rule for payments beginning with fiscal year 
     2004.--Beginning with fiscal year 2004, payment under this 
     section shall be made as if `15' had been substituted for 
     `10' in clause (ii) of paragraph (3)(A) when computing the 
     initial basis under such paragraph.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the date of enactment of this Act.

     SEC. 6. INCREASE IN PER VISIT COST LIMIT TO 112 PERCENT OF 
                   THE NATIONAL MEDIAN.

       Section 1861(v)(1)(L)(i) of the Social Security Act (42 
     U.S.C. 1395x(v)(1)(L)(i)), as amended by section 5101(b) of 
     the Tax and Trade Relief Extension Act of 1998 (contained in 
     division J of Public Law 105-277), is amended--
       (1) in subclause (IV), by striking ``or'';
       (2) in subclause (V)--
       (A) by inserting ``and before October 1, 1999,'' after 
     ``October 1, 1998,''; and
       (B) by striking the period and inserting ``, or''; and
       (3) by adding at the end the following:
       ``(VI) October 1, 1999, 112 percent of such median.''.

     SEC. 7. REFINEMENT OF HOME HEALTH AGENCY CONSOLIDATED 
                   BILLING.

       (a) In General.--Section 1842(b)(6)(F) of the Social 
     Security Act (42 U.S.C. 1395u(b)(6)(F)) is amended by 
     striking ``payment shall be made to the agency (without 
     regard to whether or not the item or service was furnished by 
     the agency, by others under arrangement with them made by the 
     agency, or when any other contracting or consulting 
     arrangement, or otherwise).'' and inserting ``(i) payment 
     shall be made to the agency (without regard to whether or not 
     the item or service was furnished by the agency, by others 
     under arrangement with them made by the agency, or when any 
     other contracting or consulting arrangement, or otherwise); 
     and (ii) in the case of an item of durable medical equipment 
     (as defined in section 1861(n)), payment for the item shall 
     be made to the agency separately from payment for other items 
     and services furnished to such an individual under such 
     plan.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to items of durable medical equipment furnished 
     on or after the date of enactment of this Act.

     SEC. 8. ELIMINATION OF TIMEKEEPING REQUIREMENTS UNDER THE 
                   PROSPECTIVE PAYMENT SYSTEM FOR HOME HEALTH 
                   AGENCIES.

       (a) In General.--Section 1895(c) of the Social Security Act 
     (42 U.S.C. 1395fff(c)) is amended--
       (1) by striking ``unless--'' and all that follows through 
     ``(1) the'' and inserting ``unless the''; and
       (2) by striking ``1835(a)(2)(A);'' and all that follows 
     through the period and inserting ``1835(a)(2)(A).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on the date of enactment of this Act.

     SEC. 9. SENSE OF THE SENATE REGARDING THE TIMELINESS AND 
                   ACCURACY OF INTERMEDIARY COMMUNICATIONS TO HOME 
                   HEALTH AGENCIES.

       It is the sense of the Senate that the Secretary of Health 
     and Human Services should establish a nationally uniform 
     process that ensures that each fiscal intermediary (as 
     defined in section 1816(a) of the Social Security Act (42 
     U.S.C. 1395h(a))) and each carrier (as defined in section 
     1842(f) of such Act (42 U.S.C. 1395u(f))) has the training 
     and ability necessary to provide timely, accurate, and 
     consistent coverage and payment information to each home 
     health agency and to each individual eligible to have payment 
     made under the medicare program under title XVIII of such Act 
     (42 U.S.C. 1395 et seq.).

  Mr. FEINGOLD. Mr. President, I rise today to join my colleagues 
Senator Conrad and Senator Chafee to introduce the Fairness in Medicare 
Home Health Access Act of 1999 to address some serious access problems 
in the Medicare home health care program. Our bill contains provisions 
to ensure that all Medicare beneficiaries who qualify for home health 
services have real access to those services.
  Mr. President, I have been working to promote the availability of 
home care and other long-term care options for my entire public life 
because I believe strongly in the importance of enabling people to stay 
in their own homes. For seniors who are homebound and have skilled 
nursing needs, having access to home health services through the 
Medicare program is the difference between staying in their own home 
and moving into a nursing home. The availability of home health 
services is integral to preserving independence, dignity and hope for 
many beneficiaries. I feel strongly that where there is a choice, we 
should do our best to allow patients to choose home health care. I 
think seniors need and deserve that choice.
  Mr. President, as you know, and as many of our colleagues know, the 
Balanced Budget Act of 1997 contained significant changes to the way 
that Medicare pays for home health services. Perhaps the most 
significant change was a switch from cost-based reimbursement to an 
Interim Payment System, or IPS. IPS was intended as a cost-saving 
transitional payment system to tide us over until the development and 
implementation of a Prospective Payment System or PPS, for home health 
payments under Medicare. Unfortunately, the cuts went deeper than 
anyone--including CBO forecasters--anticipated, leaving many Medicare 
beneficiaries without access to the services they need.
  The IPS is based on past spending: agencies are paid the lowest of 
three measures: (1) actual costs; (2) a per visit limit of 105% of the 
national median; or (3) a per beneficiary annual limit, derived from a 
blend of 75% of an agency's costs and 25% regional costs.
  These formulas get pretty technical, Mr. President, and I won't go 
into too much detail about them. What is important is that the net 
effect of the Interim Payment System is that since IPS pays agencies 
the lowest of the three measures, agencies in areas where costs are 
historically low will be disproportionately and unfairly affected. In 
effect, they are penalized for having kept their costs low in the past.
  And, Mr. President, Wisconsin's Medicare home health spending has 
been very, very low, even before the advent of IPS. The 1999 edition of 
the Dartmouth Atlas of Health Care described the variation in Medicare 
home health reimbursements as ``extreme'': in 1996, the national 
average Medicare home health expenditure per-enrollee was $532.00, but 
the maximum and minimum ranged from a high of $3,090 in McAllen, Texas, 
to an unbelievable $81 in Appleton, Wisconsin, in my home state. Even 
the area of Wisconsin with the highest reimbursements is only at $267 
per beneficiary, about half of the national average. When you consider 
that these figures are adjusted for age, sex, race, illness and price 
of services, the variation is truly astounding. Pegging reimbursement 
to past spending, as IPS does, simply magnifies the existing payment 
inequalities.

  Mr. President, in Wisconsin, 29 Medicare home health providers have 
shut down since the implementation of IPS. Still more have shrunken 
their service areas, stopped accepting Medicare, or cannot accept 
assignment for high cost patients because the payments are simply too 
low.
  So, what do these changes mean for Medicare beneficiaries? Well, 
quite

[[Page S10732]]

frankly, in many parts of Wisconsin, the changes mean the beneficiaries 
in certain areas or with certain diagnoses simply don't have access to 
home health care. The IPS has created disincentives to treat patients 
with expensive medical diagnoses. Few agencies, if any, can afford to 
care for them.
  Mr. President, I think that a letter I received from my constituents 
at the Douglas County Health Department does a great job of 
illustrating just how bad the access problem is, particularly in rural 
areas. The Douglas County Health Department operates a home health 
program in Superior, Wisconsin, in the northwestern corner of my state. 
According to their letter, as a result of IPS, the program will lose 
approximately $590,000. Let me read my colleagues a passage from their 
letter: ``The Douglas County Home Care [program] serves . . . about 400 
residents a year, [of which] 82% [are] Medicare covered . . . 33% of 
our patients live in rural areas not covered by other home care 
providers. There are four other providers in our area. All have 
discontinued taking Medicare patients and/or have stopped serving rural 
patients due to the high cost and low reimbursement.''
  The legislation we are introducing today contains several important 
provisions to enable elderly and disabled homebound individuals to 
remain in their homes. The bill ensures by statute that by 15% across-
the-board cut for all home health providers cannot happen during the 
Interim Payment System and that it will only be 10% for the first three 
years of PPS. The bill also makes special provisions for medically 
complex patients who have more expensive health care needs, and raises 
the per visit limits to enable home care agencies to continue serving 
patients in rural areas, where travel times are longer. I think these 
two provisions are particularly significant because the present IPS 
does not adequately account for the care needs of homebound individuals 
in rural areas, and the absence of home care options essentially forces 
these individuals into nursing homes or hospitals.
  The bill provides some administrative relief from the 15 minute 
increment reporting rule and asks HCFA to reexamine whether the cost 
associated with the collection of data is worthwhile in terms of what 
those data may yield. Finally, the bill expresses the sense of the 
Senate that HCFA should ensure that fiscal intermediaries receive and 
convey accurate and consistent information to agencies.
  These provisions all need to be in place in order to ensure that we 
do not punish the most efficient and well-performing agencies as we 
seek to streamline and modernize the program.
  Like many of my colleagues, I voted in favor of BBA '97 because I 
believed it contained meaningful provisions to balance the budget. I 
want to emphasize that the goal was to balance the budget--it was not 
to punish home health agencies, and certainly not to deny Medicare 
beneficiaries access to the home health services they need.

  I believe we ought to take a serious look at what refinements and 
fine tuning need to occur to ensure that our homebound elderly and 
disabled constituents--among the frailest and most vulnerable of our 
people we serve--can receive the services they need.
  Without that fine-tuning, I am quite certain that more home health 
agencies in Wisconsin and in other areas across our country will close, 
leaving some of our frailest Medicare beneficiaries without the choice 
to receive care at home. Again, I think Seniors need and deserve that 
choice, and I hope my colleagues will join us in supporting this 
legislation.
  Mr. CHAFEE. Mr. President. I am pleased to join my colleagues, 
Senators Conrad and Feingold, in introducing the Fairness in Medicare 
Home Health Access Act of 1999. This legislation is an important step 
towards ensuring that our seniors retain access to medically necessary 
home health care services.
  The Fairness in Medicare Home Health Access Act contains several 
critical provisions, carefully designed to achieve the twin goals of 
controlling Medicare spending (thereby preserving and protecting the 
program for future beneficiaries), and ensuring that current 
beneficiaries continue to have access to crucial home health services.
  These provisions will allow the home health agencies in my state of 
Rhode Island, as well as agencies across the country, to continue 
delivering high quality, cost-effective care to our most frail seniors.
  Why are these provisions necessary? The Balanced Budget Act of 1997 
(BBA) included many important reforms to the Medicare program. As a 
result of these provisions, the program has been strengthened, and 
solvency of the trust fund extended. However, it now appears that the 
reductions in home health payments may be limiting access to our 
Medicare beneficiaries.
  In Rhode Island the number of beneficiaries served by Medicare home 
health providers has decreased by 22 percent, services provided to 
beneficiaries have decreased by 49 percent, and total payments to home 
health agencies have decreased by 47 percent. Agencies have had to lay 
off workers and some have even been forced to close.
  On October 1st, 2000, an additional 15 percent reduction in Medicare 
reimbursements is scheduled to take effect. I am concerned that a cut 
of that level could jeopardize or restrict access to care. At the same 
time, we must be mindful of the precarious financial situation of the 
Medicare program, and the limited resources available. The President 
has proposed restoring $7.5 billion over the next decade to those 
programs under Medicare which have been especially hard hit by the cost 
control measures included in the BBA. In his proposal, these funds 
would be available for changes to home health policies, as well as 
other components of the Medicare program which have been adversely 
impacted by those new policies.

  Therefore, while some of my colleagues have called for a repeal of 
the scheduled 15 percent reduction, given resource constraints, I 
simply do not believe that will be possible. To repeal that provision 
outright would cost $17.5 billion over the 10-year budget period. This 
restoration alone would greatly exceed the $7.5 billion the President 
has recommended to soften the impact of the BBA. Even in Congress, the 
most I've heard discussed in the way of ``BBA add-backs'' is in the 
range of $15 billion. Thus, while in an ideal world some may wish to 
spend $17.5 billion on this provision, it is clearly not possible.
  I believe it is critical to address the very real problems facing 
home health beneficiaries and agencies, but I also believe we must be 
realistic in our goals and expectations, and make carefully targeted 
adjustments to the BBA policies. For that reason I am pleased to join 
with Senators Conrad and Feingold in calling for a scaling-back of the 
scheduled reduction in home health reimbursements. Our bill would 
provide much-needed relief by gradually phasing-in the 15 percent 
reduction; for the first three years, the reduction would be limited to 
10 percent. Furthermore, beneficiary access will be protected by tying 
the reduction to implementation of the prospective payment system 
(PPS). Although I am confident the prospective payment system will be 
implemented by October 1, 2000 as required under the BBA, in the event 
the deadline is not met, our provision would ensure that no further 
reductions occur until the PPS is fully implemented.
  In addition, the Conrad-Feingold-Chafee bill includes several other 
important provisions:
  An ``outlier policy'' to ensure that patients with higher than 
average medical costs do not face access barriers as a result of their 
intensive medical needs;
  An increase in the interim payment system per visit cost limit to 112 
percent of the national median;
  A refinement to the consolidated billing policy by allowing durable 
medical equipment suppliers to continue delivering services to 
beneficiaries regardless of their home health status; and
  Elimination of the 15-minute incremental reporting requirement.
  The Medicare home health benefit provides vital services to our most 
vulnerable citizens. Patients receiving these services have lower 
incomes, are older, and have more serious functional impairments than 
the general Medicare population. The availability of home health 
services averts the need for even more costly institutional living 
arrangements for the elderly and

[[Page S10733]]

disabled who rely upon these services. It is these patients who are 
harmed when home health agencies are forced to close their doors or cut 
back on services.
  It is my hope that we will pass this legislation and therefore 
protect the beneficiaries who need our help the most. In that regard, I 
will work for its incorporation into any Medicare legislation the 
Senate Finance Committee, of which I am a member, may consider in the 
future. I urge my colleagues to support this measure.
                                 ______