[Congressional Record Volume 146, Number 86 (Friday, June 30, 2000)]
[Senate]
[Pages S6257-S6259]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. KYL:
S. 2834. A bill to authorize the Secretary of the Interior, acting
through the Bureau of Reclamation, to convey property to the Greater
Yuma Port Authority of Yuma County, Arizona, for use as an
international port of entry; to the Committee on Energy and Natural
Resources.
Legislation to Convey Land to the Greater Yuma Port Authority for
Construction of a Second Commercial Port of Entry for the Yuma Area
Mr. KYL. Mr. President, I introduce a bill today to facilitate the
construction of a secondary port of entry in Yuma County. I introduce
this measure in collaboration with Representative Ed Pastor, who has
taken the lead on this issue in the House of Representatives and has
seen his bill H.R. 3023, through to passage just this week by a vote of
404 to 1.
The identical bill I introduce today will convey to the Greater Yuma
Port Authority an area of land currently controlled by the Bureau of
Reclamation for the purpose of constructing a commercial port of entry
on approximately 330 acres of land just east of the city of San Luis.
Anyone who has ever been to the U.S. port of entry in San Luis,
Arizona, knows that traffic congestion there causes such bad delays
that oftentimes individuals attempting to conduct cross-border trade
there, bring goods across the border, or simply visit relatives and
friends, are discouraged from crossing the border or are faced with
spending two to four hours to cross. The port of entry at San Luis has
become one of the busiest ports-of-crossing in the nation.
After months of negotiation, all of the local principals involved in
this effort, from the city of Yuma to Yuma County, the city of San Luis
and Somerton and the Cocopah Indian Nation, and the Bureau of
Reclamation, now fully support this effort. The bill will facilitate
the construction of an additional commercial port of entry just east of
San Luis, to be conveyed to the Greater Yuma Port Authority (YMPO) for
fair market value.
Mr. President, this legislation will make a difference to the people
of Arizona, particularly to the people of Yuma and surrounding areas.
It will help increase cross-border trade in the area, and will help to
spur economic development for an Arizona region in need. I urge
expeditious consideration of this legislation.
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By Mr. GRASSLEY (for himself and Mr. Feingold):
S. 2835. A bill to provide an appropriate transition from the interim
payment system for home health services to the prospective payment
system for such services under the medicare program; to the Committee
on Finance.
medicare home health refinement act of 2000
Mr. GRASSLEY. Mr. President, today I am joining Senator Feingold of
Wisconsin in introducing the Medicare Home Health Refinement Act of
2000. I want to thank my colleague for inviting me to join him in this
effort to preserve our nation's home health providers.
In my work as Chairman of the Senate Special Committee on Aging, of
which Senator Feingold is a member, I have been monitoring our nation's
critical home health care system closely. In 1997, we investigated
distressing examples of fraud and abuse among a few home health
agencies (HHAs). In 1998, I chaired a hearing on the devastating
effects of the Interim Payment System (IPS) for home health.
Unfortunately, my legislative efforts to improve the payment system
that year were blocked. Last year, the Aging Committee held a hearing
on the new OASIS information collection instrument, and on the burden
it imposed on home care providers.
At this point in 2000, the main challenge facing our system of home
care is the new Prospective Payment System (PPS), which will take
effect on October 1 of this year. We've been working
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toward this for many years, and I am gratified that it will finally
happen. The Health Care Financing Administration (HCFA) published the
final PPS rule on June 28, and I was pleased to hear that many home
health providers consider it an improvement over the proposed rule.
After the trauma of the Interim Payment System, I have high hopes that
the PPS will be great news for our Medicare beneficiaries who need home
care.
Even so, the new PPS will pose major transitional challenges for home
health agencies, and this bill seeks to ease that transition so that
the PPS will succeed. The bill does the following:
1. Emergency cash flow assistance. The bill provides one-time advance
payments to home health agencies during transition from IPS to PPS.
Eligible agencies either have low cash reserves, have negative cash
flow under PPS as defined by the Secretary of HHS, or were eligible to
receive funds from the Periodic Interim Payment (PIP) system on
September 30, 2000. Payments equal the average total Medicare costs
incurred by the agency in a three-month period as reported on the
agency's most recently settled cost report. Payments would be available
for six months and repaid within twelve months.
Agencies would also receive 80 percent of the 60-day episode payment
rate after notifying HCFA of admission, with the remaining 20 percent
coming after submission of final episode claim, instead of 60/40 under
the rule published on June 28, 2000. HCFA would also be prohibited from
imposing conditions on a claim based on the status of an earlier claim
for the same beneficiary.
The rationale for this is that PIP, which largely serves nonprofit,
community-based agencies with minimal cash reserve, will be
discontinued as of October 1. If PPS delays a substantial portion of
payment until after termination of patient episode, providers will have
significant cash flow problems. Many agencies are unable to secure
lines of credit or other loans because of the effect of IPS on cash
reserves.
2. Reimbursement for unfunded PPS-related costs. The bill reimburses
agencies for technology costs required for PPS compliance, up to $10
per beneficiary. Payments would be authorized for Fiscal Years 2001
through 2003.
The rationale for this item: agencies have had to purchase new
hardware, software, and other technology to comply with new rules.
These costs are not reimbursed by Medicare.
3. Reimbursement for OASIS labor costs. It reimburses agencies for
labor costs associated with OASIS assessments, up to $30 per
beneficiary annually. Payments are authorized for FY 2001-2003.
This is needed because the final rule provides for only a modest
payment per episode, despite an estimated hour of time needed for a
skilled clinician to collect information at admission, plus time for
data quality review and follow-up.
4. Creation of a fee schedule for non-routine medical supplies. The
bill develops a separate fee schedule for medical supplies under
prospective payment.
This is essential because PPS rates include the average medical
supply cost, but some agencies' patient populations have greater or
lesser medical supply needs. The original rates would underpay agencies
that treat these vulnerable populations and overpay agencies that treat
patients with low medical supply needs. This provision has no budget
impact.
Mr. President, I recognize that there are other issues that pose a
major threat to our home care system, including the 15 percent cut
scheduled for October 2001. This bill does not address that issue,
though it is obvious that Congress will have to do so. But this bill
will help make the new PPS a success, so home care providers can use
their resources to see patients, which is what they do best. I will
seek the inclusion of this bill in any Finance Committee Medicare
provider package we put together this year.
Mr. FEINGOLD. Mr. President, I am pleased to join Senator Grassley in
introducing the Medicare Home Health Refinement Act of 2000. This
legislation will provide a measure of financial relief for cost
efficient home health agencies that are making the transition from the
Interim Payment System to the soon to be implemented Prospective
Payment System.
Since the enactment of the Balanced Budget Act of 1997, many cost-
effective home health agencies have experienced financial hardship,
which has forced agencies to divert funds away from patient care.
We must ensure that home health care agencies can continue to provide
their invaluable service to the elderly and the disabled.
As I travel to each of Wisconsin's 72 counties each year, I have
heard countless stories from home health agencies that a number of
burdensome new regulations imposed by the Health Care Financing
Administration have hindered their ability to do what they do best--
provide quality care.
Our legislation addresses many of these concerns. In fact, a number
of the provisions come directly from the providers in Wisconsin.
Our bill offers a combination of emergency cash flow assistance,
reimbursement for transition costs, and a system to separate medical
supply costs from other home health expenses as home health agencies
switch to a new payment system.
Home health care provides compassionate, at-home care to seniors and
people with disabilities in cities and towns throughout Wisconsin.
Without it, many patients have no choice but to go to a nursing home,
or even an emergency room, to get the care they need. For too many home
health patients in Wisconsin, that day has arrived.
Home health agencies around my state have closed their doors due to
massive changes in Medicare, and seniors and the disabled have been
forced to go elsewhere for care.
The Balanced Budget Act
As my colleagues know, the Balanced Budget Act of 1997 contained a
number of measures that were intended to slow home health care
spending. Congress targeted home health spending due to the fact that
prior to the Balanced Budget Act, home health care had become the
fastest growing component of Medicare spending.
Unfortunately, the cuts went deeper than anyone anticipated, and have
left many Medicare beneficiaries without access to the services they
need.
These unintended consequences of the Balanced Budget Act of 1997 have
been severe indeed. Instead of the $100 billion in five-year savings
that we targeted, present projections indicate that actual Medicare
reductions have been in the area of $200 billion. Home health care
spending, which the Congressional Budget Office expected to rise by $2
billion in the last two years even after factoring in the Balanced
Budget Act cuts, has instead fallen by nearly 8 billion, or 45 percent.
These painful cuts have forced more than 40 home health care agencies
in 22 Wisconsin counties to close their doors, in just two years.
Mr. President, I stand by my vote in favor of the Balanced Budget
Act. And, like many of my colleagues, I believe that it contained
meaningful provisions to balance the budget. I want to emphasize that
the goal was to balance the budget--it was not to punish home health
agencies, and certainly not to deny Medicare beneficiaries access to
the home health services they need.
The Balanced Budget Act also included a number of burdensome
administration changes, and a new reimbursement system for home health
care agencies. It required the creation of a Prospective Payment
System, and, until that system was developed an interim payment system.
These new rules are forcing agencies to overhaul their computer
systems, purchase new software, and fill out more and more forms. Many
of these agencies already face major cash-flow problems, and are
rightly concerned that any delays in payments could hurt their ability
to properly care for beneficiaries.
With all of the changes, Congress must ensure that these home health
agencies, which have already been hit hard by payment cuts, have the
resources they need to provide quality home care to the American public
in a cost-effective manner.
rdf's home health care legislation
My legislation provides for some common sense provisions to ease the
transition to the new PPS system.
Under the first provision, the Health Care Financing Administration
would
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be able to provide one-time advance payments to home health agencies
which have been experiencing cash-flow problems. These payments are
temporary: agencies would be required to repay them within twelve
months.
It also provides some relief to agencies for their compliance with
the new regulations and rules. Across the country, home health agencies
have had to spend millions of dollars buying new computers and software
which can handle the new PPS. This provision also targets those small
agencies with a lesser cash flow and are relatively more affected by
the burdensome regulations.
My bill also includes compensation for agencies who must perform
patient outcome assessments under the new rules. We should recognize
that physicians' time is precious, and that we cannot expect them to
provide accurate, helpful data if every hour they spend filling out
forms is an hour less treatment that the agency can afford to provide.
Finally, the bill carves out funding for non-routine medical supplies
from the PPS, so that agencies who treat patients with complex medical
needs are not punished with low payments. We must ensure that all
beneficiaries have the choice to receive care at home, and not be
turned down or shut out of the market because agencies are afraid that
they'll be too costly to assist.
These are sensible changes which go a long way to alleviate the
burden that the change to the Prospective Payment System has imposed on
the agencies. These changes will allow agencies to focus their care on
Medicare beneficiaries, and reduce their burden as they transition to
PPS.
access to care
In Wisconsin, over 46 Medicare home health providers have shut down
since the implementation of Interim Payment System. Still more have
shrunken their service areas, stopped accepting Medicare patients, or
refused assignment for high cost patients because the payments are
simply too low.
So, what do these changes mean for Medicare beneficiaries? Well,
quite frankly, in many parts of Wisconsin, beneficiaries in certain
areas or with certain diagnoses simply don't have access to home health
care. The Interim Payment System has created disincentives to treat
patients with expensive medical diagnoses. Few agencies, if any, can
afford to care for patients with expensive medical diagnosis.
conclusion
I believe that Congress must take a serious look at what refinements
need to occur to ensure that our home bound elderly and disabled
constituents--among the frailest and most vulnerable people we serve--
can receive the services they need.
Without that fine-tuning, I am quite certain that more home health
agencies in Wisconsin and across our country will close, leaving some
of our frailest Medicare beneficiaries without the choice to receive
care at home. Again, I think Seniors need and deserve that choice, and
I hope my colleagues will join us in supporting this legislation.
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