[Congressional Record Volume 146, Number 80 (Thursday, June 22, 2000)]
[Senate]
[Pages S5663-S5664]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KERRY (for himself and Ms. Collins):
  S. 2766. A bill to amend title XVIII of the Social Security Act with 
respect to payments made under the prospective payment system for home 
health services furnished under the Medicare program; to the Committee 
on Finance.


            THE EQUAL ACCESS TO HOME HEALTH CARE ACT OF 2000

 Mr. KERRY. Mr. President, I am pleased to join my colleague 
Senator Collins in introducing the Equal Access to Medicare Home Health 
Care Act. This legislation will protect patient access to home health 
care under Medicare, and ensure that providers are able to continue 
serving seniors who reside in medically underserved areas.
  Medicare was enacted in 1965, under the leadership of President 
Lyndon Johnson, as a promise to the American people that, in exchange 
for their years of hard work and service to our country, their health 
care would be protected in their golden years. Today, over 30 million 
seniors rely on the Medicare home health benefit to receive the care 
they need to maintain their independence and remain in their own homes, 
and to avoid the need for more costly hospital or nursing home care.
  Home health care is critical. It is a benefit to which all eligible 
Medicare beneficiaries, regardless of where they live, should be 
entitled. But, this benefit is being seriously undermined. Since 
enactment of the Balanced Budget Act, BBA, of 1997, federal funding for 
home health care has plummeted. According to the Congressional Budget 
Office, CBO, Medicare spending on home health care dropped 45 percent 
in the last two fiscal years--from $17.5 billion in 1998 to $9.7 
billion in 1999--far beyond the original amount of savings sought by 
the BBA. Across the country, these cuts have forced over 2,500 home 
health agencies to close and over 500,000 patients to lose their 
services.
  In my own State of Massachusetts--a state that, because of economic 
efficiency, sustained a disproportionate share of the BBA cuts in 
Medicare home health funding--28 home health agencies have closed, 6 
more have turned in their Medicare provider numbers and chosen to opt 
out of the Medicare program, and 12 more have been forced to merge in 
order to consolidate their limited resources. The home health agencies 
that have continued to serve patients despite the deep cuts in Medicare 
funding reported net operating losses of $164 million in 1998. The loss 
of home health care providers in Massachusetts has cost 10,000 patients 
access to home health services. Consequently, many of the most 
vulnerable residents in my state are being forced to enter hospitals 
and nursing homes, or going without any help at all.
  To compound the problem, without Congressional action, Medicare 
payments for home health care will be automatically cut by an 
additional 15 percent next year. It is critical that we defend 
America's seniors against future cuts in home health services, and this 
bill will eliminate the additional 15 percent cut in Medicare home 
health payments mandated by the BBA. However, we must do more than 
attempt to stop future cuts. Indeed, it is equally as important that we 
begin to provide relief to home health providers who are already 
struggling to care for patients.
  During the first year of implementation of the Interim Payment 
System, IPS, thousands of home health care agencies incurred 
overpayments because they were not notified of their per beneficiary 
limits until long after the limits were imposed. The provisions of this 
bill would extend the repayment period for IPS overpayments without 
interest for three years, and thereafter at an interest rate lower than 
currently mandated.
  Under IPS, even agencies which did not incur overpayments were placed 
on precarious financial footing because of insufficient payments, 
particularly for high-cost and long-term patients. Accordingly, it is 
critical that we bolster the efforts of all home health care providers 
to transcend their current operating deficits, especially as they 
transition from the Interim Payment System to the Prospective Payment 
System, PPS.
  The BBA specified that, in aggregate, PPS payments to home health 
providers must equal IPS payments. This adjustment--the budget 
neutrality factor--is expected to reduce PPS payments for home health 
services by 22 percent below the average Medicare costs prior to 
enactment of the BBA. In order to provide relief to home health 
providers in this budget neutral context, the Equal Access to Medicare 
Home Health Care Act would establish a 10 percent add-on to the 
episodic base payment for patients in rural areas, to reflect the 
increasing costs of travel, and a ``reasonable cost'' add-on for 
security services utilized by providers in our urban areas. These add-
ons ensure that patients in our medically underserved communities 
continue to receive the home care they need and deserve.
  Finally, this legislation would encourage the incorporation of 
telehealth technology in home care plans by allowing cost reporting of 
the telemedicine services utilized by agencies. Telemedicine has 
demonstrated tremendous potential in bringing modern health care 
services to patients who reside in areas where providers and technology 
are scarce. Cost reporting will provide the data necessary to develop a 
fair and reasonable Medicare reimbursement policy for telehomecare and

[[Page S5664]]

bring the benefits of modern science and technology to our nation's 
underserved.
  Unless we increase the federal commitment to the Medicare home health 
care benefit, we can only expect to continue to imperil the health of 
an entire generation. We must act to deliver on that promise that 
President Johnson made 25 years ago--our nation's seniors deserve no 
less.
                                 ______