[Congressional Record Volume 146, Number 3 (Wednesday, January 26, 2000)]
[Senate]
[Pages S77-S78]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   HEALTH ACCOMPLISHMENTS FOR THE FIRST SESSION OF THE 106th CONGRESS

  Mr. HATCH. Mr. President, I will take just a few minutes at the 
beginning of the second session of the 106th Congress to comment on 
several legislative initiatives I authored in the first session, and 
which I am pleased to say either passed or were substantially 
incorporated into other bills that were approved and signed into law by 
the President last year.
  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 last year. I am delighted that the Senate passed 
this important legislation in November.
  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 Peter 
Domenici all joined me in introducing this legislation.
  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 extremely pleased that the House and Senate approved the 
Medicare, Medicaid, and CHIP Adjustment Act of 1999 and that President 
Clinton signed the measure into law.
  This important bill 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 immunosuppressive drugs.
  Over $17 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 that 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 refinement 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 
refinement 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 help restore needed Medicare funding 
to providers.
  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.
  Overall, $2.7 billion is restored to SNFs under this legislation.
  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.

[[Page S78]]

  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 
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.
  Indepednet 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 legislation to provide greater GME funding for 
children's hospitals. The bill passed the Senate and House, and was 
signed into law by the President.
  Moreover, $40 million is contained in the omnibus FY 2000 
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 refinement bill.
  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 conference report change this by allowing more 
reasonable Medicare reimbursements for these therapies.
  Take John Rapp, my constituent from Salt Lake City.
  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 $10,000 to 
$1,500, and, therefore, it would not be cost-effective for hospitals to 
offer this service. Fortunately, the provisions included in the 
conference report 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 of the conference report.
  Mr. President, there are numerous other provisions in this BBA 
refinement package that I will not take the time to comment on now, but 
they are equally important and 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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