[Congressional Record Volume 145, Number 143 (Wednesday, October 20, 1999)]
[Senate]
[Page S12946]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  MEDICARE BENEFICIARY ACCESS TO QUALITY NURSING HOME CARE ACT OF 1999

 Mr. ABRAHAM. Mr. President, on the 13th of October, I was 
proud to cosponsor S. 1500, the Medicare Beneficiary Access to Quality 
Nursing Home Care Act of 1999. When Congress worked with the President 
to craft and pass the Balanced Budget Act of 1997, it included a number 
of desperately needed cost-saving measures to ensure that Medicare did 
not go bankrupt. At the time, Medicare was projected to be bankrupt by 
2001 with annual costs rising at three times the rate of inflation.
  However, the Health Care Financing Administration, which oversees the 
administration of Medicare, has far exceeded the scope of the Balanced 
Budget Act of 1997, and gone beyond the intent of Congress in scaling 
back health care provider reimbursements. Driven by a philosophy that 
the Federal Government knows best how to handle your health care 
decisions, this administration has uniformly adopted policies that 
limit Medicare beneficiary choice, obstruct critically needed market-
based reforms, and relentlessly pursued a strategy of reducing payments 
to providers as the prime method to reduce outlays.
  Sometimes such a ``Washington-knows-best'' strategy just doesn't 
work. The fact of the matter is, health care providers will bear costs 
that cannot be overlooked or undervalued simply because HCFA wishes to 
declare it so. This has been especially prevalent in the area of 
Skilled Nursing Facility care. The recently implemented Prospective 
Payment System (PPS) fails to account for the full range of services 
required by most Medicare beneficiaries provided care in these 
facilities.
  Specifically, the PPS implemented by HCFA has a payment schedule 
called Resource Utilization Groups (RUGs) that are intended to account 
for the needs of individual beneficiaries. However, these RUGs have 
failed to account for the full range of needs of these beneficiaries, 
especially for the medically complex patient. While private market 
insurance is significantly better at recognizing the needs of the 
medically complex patient, the failure of this administration to allow 
for any type of market-based reform to move forward has forced us to 
rely upon the implementation of the PPS by HCFA, which, as I discussed 
before, seems to have a predisposition towards underpaying for 
necessary services.
  The result, Mr. President, is that beneficiaries are increasingly 
denied access to lower-cost Skilled Nursing Facilities and are forced 
to continue care in higher-cost hospitals where they also may not be 
able to get the most appropriate level of rehabilitative care. S. 1500, 
introduced by Senator Hatch, attempts to address the over-reaching of 
HCFA directly and swiftly. First, it would provide for payment ``add-
ons'' for the provision of additional treatment in the care of the 
medically complex patient. Second, it restores one percentage point of 
the reductions to the annual inflation adjustor mandated by BBA-97. 
Although the inflation adjustment reduction was directly written in the 
BBA-97 language, it's revision provides Congress the most direct and 
simplest way to counteract the excesses of HCFA.
  Mr. President, I am heartened that HCFA has recognized the flaws in 
the current PPS system and is undertaking a review of this system. 
However, that review will not be completed until next year. Our Skilled 
Nursing Facilities need these restorations now in order to continue to 
provide our Medicare beneficiaries continued and uninterrupted care. 
That is why I fully support this legislation, am cosponsoring it, and 
call on my colleagues to do the same as soon as possible.

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