[Congressional Record Volume 145, Number 165 (Friday, November 19, 1999)]
[Senate]
[Pages S15082-S15084]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           BIENNIAL BUDGETING

  Mr. DOMENICI. Yesterday (November 18), House Rules Committee Chairman 
David Dreier introduced H. Res. 396, a resolution expressing the sense 
of the House that biennial budgeting legislation should be enacted in 
the second session of the 106th Congress.
  Notably, this resolution has 245 cosponsors, significantly more than 
a majority of that body. Those sponsors include the entire House 
Republican leadership, 25 members of the House Appropriations 
Committee, including the Chairman, and 45 Democrats.
  Critics of biennial budgeting often point to lack of support in the 
House as a reason why the proposal will never be adopted. That hurdle 
seems now to have been swept away, as significantly more than a 
majority of the House has been convinced by the inescapable logic and 
numerous advantages of a biennial budget process.
  This year, we have yet again been faced with a numbing repetition of 
the all-too-familiar appropriations end game. Annual appropriations 
have been stalled because of a handful of controversial policy and 
funding issues.
  While the vast bulk of appropriations are routine and are funded from 
year to year with only incremental change, they nonetheless are held 
hostage to these controversial and often unrelated budget and policy 
debates. This is unnecessary and counterproductive.
  A biennial budget process would restore the integrity and 
effectiveness of the appropriations process, would reinvigorate the 
tradition of separate Congressional authorization and oversight, and 
would give Federal departments and agencies badly needed time to carry 
out and evaluate Federal programs more effectively.
  Many Senators of both parties have long acknowledged the need for a 
biennial budget process. A majority of House members now concurs. Both 
President Clinton and Vice-President Gore support biennial budgeting, 
and recently Governor George W. Bush voice strong support for the idea.
  All sides now agree that biennial budgeting is the right thing to do. 
Now is time to go forward. We have studied, talked, and debated enough. 
Let's now resolve to act on this important bill as soon as possible 
when we return from the congressional adjournment.
  Mr. HATCH. Mr. President, I would like to take just a few minutes in 
these final hours of the First Session of the 106th Congress to comment 
on several legislative initiatives I authored this year, and which I am 
pleased to say have either passed or were substantially incorporated 
into other bills that were approved and will be sent to the President.
  One of the most important issues for my state of Utah is the 
Radiation Exposure Compensation Act (RECA) Amendments of 1999, S. 1515, 
which I introduced earlier. I am delighted that the Senate passed this 
important legislation earlier today.
  This bill will guarantee that our government provides fair 
compensation to the thousands of individuals adversely affected by the 
mining of uranium and from fallout during the testing of nuclear 
weapons in the early post-war years.
  Senator Ben Nighthorse Campbell; the distinguished Senate Minority 
Leader, Senator Tom Daschle; Senator Jeff Bingaman; and Senator Pete

[[Page S15083]]

Domenici all joined me in introducing this legislation, and I 
appreciate their support.
  In 1990, the Radiation Exposure Compensation Act (42 U.S.C. 2210) was 
enacted in law. RECA, which I was proud to sponsor, required the 
federal government to compensate those who were harmed by the 
radioactive fallout from atomic testing. Administered through the 
Department of Justice, RECA has been responsible for compensating 
approximately 6,000 individuals for their injuries. Since the passage 
of the 1990 law, I have been continuously monitoring the implementation 
of the RECA program.
  Quite candidly, I have been disturbed over numerous reports from my 
Utah constituents about the difficulty they have encountered when they 
have attempted to file claims with the Department of Justice. I 
introduced S. 1515 in response to their concerns.
  This bill honors our nation's commitment to the thousands of 
individuals who were victims of radiation exposure while supporting our 
country's national defense. I believe we have an obligation to care for 
those who were injured, especially since, at the time, they were not 
adequately warned about the potential health hazards involved with 
their work.
  Another issue which many of my constituents contacted me about over 
the past year was the Medicare provisions contained in the 1997 
Balanced Budget Act (BBA) and the impact of these provisions on health 
care providers and Medicare beneficiaries.
  I am pleased that the House has given its approval to the Medicare, 
Medicaid, and CHIP Adjustment Act of 1999 which is now ready for Senate 
consideration and passage today.
  This important measure will help to ensure that Medicare 
beneficiaries can continue to receive high-quality, accessible health 
care.
  Overall, the bill increases payments for nursing homes, hospitals, 
home health agencies, managed care plans, and other Medicare providers. 
It will also increase payments for rehabilitative therapy services, and 
longer coverage of immunosuppresive drugs.
  Over $27 billion in legislative restorations are contained in this 
package for the next 10 years.
  Clearly we now know that there were unintended consequences as a 
result of the reimbursement provisions contained in the BBA. Many of 
the changes provided for in the BBA resulted in far more severe 
reductions in spending tham we projected in 1997. As a result, skilled 
nursing facilities, home health agencies and hospitals have been 
particularly hard hit from these changes in the Medicare law.
  In 1997, Medicare was in a serious financial condition and was 
projected to go bankrupt in the year 2001. The changes we made in 1997 
saved Medicare from financial insolvency and have resulted in extending 
the program's solvency until 2015.
  Nevertheless, the reductions we enacted in 1997 created a serious 
situation for many health care providers who simply are not being 
adequately reimbursed for the level and quality of care they were 
providing.
  This situation is particularly evident in the nursing home industry. 
Many skilled nursing facilities, or SNFs, are now facing bankruptcy 
because the current prospective payment system, which was enacted as 
part of the BBA, does not adequately compensate for the costs of care 
to medically complex patients.
  As a result, I introduced the Medicare Beneficiary Access to Quality 
Nursing Home Care Act of 1999, S. 1500, which was designed to provide 
immediate financial relief to nursing homes who care for medically 
complex patients.
  The Chairman of the Budget Committee, Senator Domenici, was the 
principal cosponsor of this important legislation. And I would like to 
take this opportunity now to thank him for the extraordinary effort he 
made in helping to have major provisions of our bill incorporated into 
the final conference agreement on the BBA Restorations bill.
  Moreover, I want to thank the other 44 Senators who cosponsored S. 
1500 and who lent their support in helping to move this issue to 
conference.
  This is an important victory for Medicare beneficiaries who depend on 
nursing home care. As we have seen over the past several years, those 
beneficiaries with medically complex conditions were having difficulty 
in gaining access to nursing home facilities, or SNFs, because many 
SNFs simply did not want to accept these patients due to the low 
reimbursement levels paid by Medicare.
  The current prospective payment system is flawed. It does not 
accurately account for the costs of these patients with complex 
conditions. The Health Care Financing Administration (HCFA) has 
acknowledged that the system needs to be corrected.
  Under the provisions of the BBA Restoration bill we are passing 
today, reimbursement rates are increased by 20% for 15 payment 
categories, or the Resource Utilization Groups--RUGs--beginning in 
April 2000. These increases are temporary until HCFA has fine-tuned the 
PPS and made adjustments to reflect a more accurate cost for these 
payment categories.
  Moreover, after the temporary increases have expired, all payment 
categories will be increased by 4% in fiscal year 2001 and 2002.
  These provisions will provide immediate increases of $1.4 billion to 
nursing home facilities to care for these high-cost patients.
  In addition, the bill also gives nursing homes the option to elect to 
be paid at the full federal rate for SNF PPS which will provide an 
additional $700 million to the nursing community.
  I would also add that I am pleased the conference report includes a 
provision to provide a two-year moratorium on the physical/speech 
therapy and occupational therapy caps that were enacted as part of the 
BBA. As we all well know, these arbitrary caps have resulted in 
considerable pain and difficulty for thousands of Medicare 
beneficiaries who have met and exceeded the therapy caps.
  I joined my colleague and good friend, Senator Grassley, as a 
cosponsor of this important legislation, and I want to commend him for 
his leadership in getting this bill incorporated into the final BBA 
Restoration conference report.
  There are many other important features of this bill that are 
included in the conference report agreement and, clearly, these 
provisions will do a great deal to health restore needed Medicare 
funding to providers. Overall, $2.7 billion is restored to SNFs under 
this legislation.
  The bottomline is all of this is ensuring that Medicare beneficiaries 
have access to quality health care. We need to keep that promise and I 
believe we have done that through the passage of this legislation 
today.
  With respect to other providers, I would briefly add that the bill 
contains funding for home health agencies as well. The bill will ease 
the administrative requirements on home health agencies as well as 
delay the 15 percent reduction in reimbursement rate for one year. This 
reduction was to have taken effect on October 2000 but will now be 
delayed for one year until October 1, 2001.
  I have worked very closely with my home health agencies in my state 
who were extremely concerned over the impact of the 15% reduction next 
year. I am pleased to tell them that we have addressed their concerns 
by delaying this reduction for another year. I think this time will 
give us an opportunity to focus on this provision to determine what 
other adjustments, if any, may be required in the future.
  Overall, the bill adds $1.3 billion back into the home health care 
component of Medicare.
  So I believe we have taken some significant steps to ensure that home 
health care agencies will be able to operate without the threat of 
increased Medicare reductions on their bottomline.
  We have also taken steps to help hospitals and teaching hospitals 
with over $7 billion in Medicare restorations. These increases will 
help to smooth the transition to the PPS for outpatient services--an 
issue that was brought to my attention by practically every hospital 
administrator in my state.
  On the separate, but equally important issue of children's graduate 
medical education funding, I am especially pleased that the House has 
passed legislation that will authorize, for the first time, a new 
program to provide children's hospitals with direct and indirect 
graduate medical education funding.

[[Page S15084]]

  Independent children's hospitals, including Primary Children's 
Hospital in Salt Lake City, receive very little Medicare graduate 
medical education funding (GME). This is because they treat very few 
Medicare patients, only children with end stage renal disease, and thus 
do not benefit from federal GME support through Medicare.
  I cosponsored this legislation in the Senate which passed earlier 
this year. The measure has now cleared the House and will soon be sent 
to the President who is expected to sign the measure into law very 
soon.
  Moreover, $40 million is contained in the appropriation's bill that 
will serve as an excellent foundation on which to provide assistance to 
children's hospitals.
  I am also pleased that provisions from S. 1626, the Medicare Patient 
Access to Technology Act, were included in the BBA Restoration measure.
  These important provisions guarantee senior citizens access to the 
best medical technology and pharmaceuticals. Currently, Medicare 
beneficiaries do not always have access to the most innovative 
treatments because Medicare reimbursement rates are inadequate. And I 
just don't think that it's fair to older Americans. My provisions 
contained in the restoration bill change this by allowing more 
reasonable Medicare reimbursements for these therapies.
  Take, John Rapp, my constituent from Salt Lake City, Utah. Mr. Rapp, 
who is 71 years old, was diagnosed with prostate cancer last May. He 
was presented with a series of treatment options and decided to have 
BRACHY therapy because it was minimally invasive, he could receive it 
as an outpatient and it had fewer complications than radical surgery.
  This new innovative therapy implants radioactive seeds in the 
prostate gland in order to kill cancer cells. The success rate of this 
therapy has been overwhelming.
  So, what's the problem? Without my legislation, services such as 
BRACHY therapy would not be available in the hospital outpatient 
setting to future Medicare patients due to the way the outpatient 
prospective payment system is being designed. Life saving services such 
as BRACHY therapy would be reimbursed at significantly lower-
reimbursement rates, from approximately about $10,000 to $1500, and, 
therefore, it would not be cost-effective for hospitals to offer this 
service. Fortunately, the provisions included in the omnibus spending 
bill change all of that--innovative treatments, such as BRACHY therapy, 
will now be available to future prostate cancer patients.
  We must get the newest technology, to seniors as quickly as possible. 
Government bureaucracy should not stand in the way of seniors receiving 
the best care available. We must put Medicare patients first, not 
government bureaucracy. That is why my legislation is necessary and I 
am so pleased that it was included in the Medicare package.
  Finally, I am pleased that this package also addressed the serious 
concerns of the community health centers. The community health centers 
community came to us because there were concerns about the financial 
hardship that the Balanced Budget Act would have imposed on these 
health centers and their patients. I worked hard with Finance Committee 
Chairman Roth, Senator Grassley, and Senator Baucus to resolve this 
important issue. I believe that the conference committee came up with a 
good solution, however, I intend to monitor this situation closely over 
the next couple of years.
  Mr. President, there are numerous other provisions in this 
restoration package that I will not take the time to comment on now, 
but they are equally important. I want to commend the leadership in the 
Senate and House for working to put together this important measure 
that will clearly help millions of Medicare beneficiaries throughout 
the country.

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