[Congressional Record Volume 146, Number 81 (Friday, June 23, 2000)]
[Extensions of Remarks]
[Page E1093]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCTION OF THE EQUAL ACCESS TO MEDICARE HOME HEALTH CARE ACT OF 
                                  2000

                                 ______
                                 

                         HON. JAMES P. McGOVERN

                            of massachusetts

                    in the house of representatives

                        Thursday, June 22, 2000

  Mr. McGOVERN. Mr. Speaker, I rise today to join my colleagues--Van 
Hilleary, Robert A. Weygand, and John Peterson--in introducing the 
Equal Access to Medicare Home Health Care Act of 2000. This is an 
important piece of legislation that will extend the solvency of 
Medicare to home health care agencies across the country.
  Mr. Speaker, Medicare is one of the most important and most popular 
programs ever implemented in our history. President Lyndon Johnson 
enacted Medicare into law in 1965. His signature was a statement that 
older Americans will not go without healthcare once they retire. He 
told us: ``No longer will older Americans be denied the healing miracle 
of modern medicine. No longer will illness crush and destroy the 
savings that they have so carefully put away over a lifetime so that 
they might enjoy dignity in their later years. No longer will young 
families see their own incomes, and their own hopes, eaten away simply 
because they are carrying out their deep moral obligations to their 
parents, and to their uncles, and their aunts. And no longer will this 
Nation refuse the hand of justice to those who have given a lifetime of 
service and wisdom and labor to the progress of this progressive 
country.''
  President Johnson was right. Today, millions of seniors participate 
in Medicare and this Congress is engaged in a debate to expand the 
program. One of the most important benefits provided by Medicare to 
seniors is home health care. Today, over 30 million seniors take 
advantage of the Medicare home health benefit. This benefit is vital to 
these seniors because it gives them independence. They can receive 
treatment in the comfort of their own homes. It is also cost effective. 
Without home health care, seniors would have to receive their care in 
the more costly settings of nursing homes or hospitals.
  But patient care is in danger because of the actions of Congress. In 
1997, Congress passed--without my vote--the Balanced Budget Act (BBA). 
The net effect of this bill was to cut over $200 billion out of 
Medicare. Home health care was not spared from these vicious cuts. 
According to the Congressional Budget Office (CBO), Medicare spending 
on home health care dropped 45% 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.
  The provisions in the BBA hit my home state of Massachusetts 
particularly hard. The home health provisions in the BBA attempted to 
cut the fraud, waste and abuse in the home health care business. 
Massachusetts, among other Northeastern states, has a very efficient 
home health care system. Yet the BBA hurt Massachusetts very badly. To 
date, 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. In 1998, those agencies still able to serve 
Medicare patients had $164 million in net operating losses. Over 10,000 
patients have lost access to home health care service in Massachusetts 
because of the cuts in the BBA. As a result, many patients are relying 
on their family, most of them untrained to provide the care needed by 
their loved one, or are moving into more costly nursing homes and 
hospitals.
  This bill that I am introducing today with my colleagues will provide 
some relief for this ailing industry, thereby allowing these agencies 
to resume treating seniors in the best way possible. Specifically, this 
bill addresses four shortcomings. These shortcomings were either caused 
by the cuts in the BBA or were identified by agencies as reasons why 
they cannot continue to treat Medicare patients.
  First, our bill eliminates the 15% cut in Medicare home health 
payments. The BBA mandated that home health payments be cut by 15% on 
October 1, 2000. In 1999, Congress delayed implementation of that cut 
by one year. However, this cut will be implemented on October 1, 2001. 
This cut will further devastate this industry. The five national home 
health associations agree that this cut must be eliminated, and this 
bill ensures its elimination.
  Second, the Equal Access to Medicare Home Health Care Act of 2000 
provides relief for overpayments. The BBA mandated that the Health Care 
Financing Administration (HCFA) create a new payment structure, called 
the Perspective Payment System (PPS). While HCFA developed the PPS, the 
agency instituted an Interim Payment System (IPS). Thousands of 
agencies incurred overpayments during their first year of IPS 
implementation because they were not notified of their per beneficiary 
limits until long after these limits were imposed. With regard to IPS 
overpayments, HCFA does not dispute that beneficiaries were eligible 
for the services received and that the costs incurred were reasonable. 
Currently, agencies can opt into a 12-month extension with interest 
(approximately 13%). If an agency needs more than 12 months, it must 
request that extension from either the fiscal intermediary or the HCFA 
regional office. This bill gives agencies an automatic three-year, 
interest free extension, thereby allowing agencies to have the funds on 
hand to treat their patients.
  Third, our bill provides an extra payment to home health agencies for 
transportation in rural areas and for security in high crime areas. 
Thousands of seniors who receive home care services live in rural 
areas, and the costs to treat these people are high. Agencies incur the 
travel costs in order to reach these patients and they cannot treat as 
many people in a single day because of the physical distance between 
patients. Rural patients deserve the same access to home care as non-
rural areas, and this bill will allow agencies that serve rural areas 
to continue providing service to these areas. Specifically, this bill 
adds 10% to the base payment for patients in rural areas. Studies show 
that delivery of home health services in rural areas is 12 to 15% more 
costly than average. This 10% add-on to the base payment for rural 
agencies will help insure care for needy beneficiaries in rural areas 
by easing the fiscal burden of agencies to treat these patients. 
Additionally, many agencies operate in high-risk areas and must provide 
security services to ensure the safety of their home care workers. This 
provision would reimburse these agencies for the costs of providing 
such services. The costs eligible for reimbursement would be determined 
by the Secretary of Health and Human Services, implemented nine months 
after the date of enactment of the bill.
  Fourth, the Equal Access to Medicare Home Health Care Act of 2000 
provides access to telemedicine for home health agencies. Technology is 
improving by leaps and bounds. Telemedicine allows doctors and other 
health care professionals to examine and sometimes treat a patient 
through an interactive terminal, like a television. Some home health 
agencies are already examining patients using telemedicine. Medicare, 
however, does not reimburse for home health care telemedicine visits, 
primarily because it is unclear how and to what extent these visits 
should be reimbursed. For this reason, this bill requires HCFA to study 
these visits and to report their findings to Congress. This bill also 
allows home health agencies to list on their cost reports any 
telemedicine services provided. Cost reporting will provide the data 
necessary to develop a fair and reasonable Medicare reimbursement 
policy for home health telemedicine and bring the benefits of modern 
science and technology to our nation's seniors.
  This bill is an important step in continuing the vital home health 
services provided by Medicare. The BBA hurt home health services, yet, 
today, Medicare is the most solvent it has ever been. Our nation is 
experiencing the biggest economic expansion in the history of the 
world. We must have the political will to improve the systems that 
provide the necessary services to everyone in this great country. The 
Equal Access to Medicare Home Health Care Act of 2000 will do just 
that.

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