[Congressional Record Volume 146, Number 112 (Wednesday, September 20, 2000)]
[Extensions of Remarks]
[Pages E1540-E1541]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               DIGNITY FOR THE TERMINALLY ILL ACT OF 2000

                                 ______
                                 

                            HON. MATT SALMON

                               of arizona

                    in the house of representatives

                     Wednesday, September 20, 2000

  Mr. SALMON. Mr. Speaker, I rise to introduce the Dignity for the 
Terminally Ill Act of 2000. The bill clarifies an ambiguity in Federal 
law which allows the Health Care Financing Administration [HCFA] to cut 
off Medicare funding to hospice patients after 6 months of treatment. 
The scope of this problem was detailed in a recent Wall Street Journal 
report which revealed that in early February 1997, several Hospice 
patients received letters from HCFA saying they were under 
investigation for Medicare fraud simply because they had lived longer 
than current Federal guidelines allow for reimbursement. In other 
words, HCFA officials were more concerned about being reimbursed than 
they were about caring for these dying patients.
  It seems strange that HCFA would begin cracking down on its 6-month 
rule given the fact that, for years, Medicare officials have encouraged 
the hospice industry to grow, primarily because it is less costly to 
care for the terminally ill at home than it is to treat these patients 
in a nursing home or hospital.
  Unfortunately, it seems the rise in hospice care during the 1990s 
brought about an increase in fraud and abuse of the Medicare system, 
which in turn sparked a misguided crackdown on terminally ill patients.
  HCFA officials discovered roughly $83 million in such abuse and began 
pushing their intermediaries to crack down on the problem. In 1997, the 
Inspector General of the Department of Health and Human Services warned 
HCFA officials to do a better job enforcing their 6-month reimbursement 
guideline. While HCFA's plans may have been well-intentioned, its 
intermediaries' attempt to enforce the rule was disastrous. For 
example, the Wall Street Journal reported that UGS, a subsidiary of 
Blue Cross Blue Shield in Wisconsin and a Medicare intermediary, sent 
letters to five terminally ill patients which declared that they were 
not eligible for Medicare hospice and, adding insult to injury, 
requested these patients to pay $450,000 for the care they received.
  Outrage from several hospices and Federal legislators has led to a 
small change in HCFA's aggressive crackdown on its 6-month rule. Last 
week, HCFA's administrator, Nancy-Ann Min DeParle, wrote to thousands 
of hospices to explain that there has been a ``disturbing 
misperception'' about HCFA's efforts to enforce its 6-month regulation. 
However, she never specifically declared that reimbursement for care of 
hospice patients will continue for as long as they receive treatment. 
She only offered to create a ``voluntary'' case-by-case review of 
patients who remain in hospice care longer than 6 months.

[[Page E1541]]

  Regardless of Administrator DeParle's change in position, we must 
clarify the law so that there is no question about HCFA's 
responsibility to provide care for the terminally ill. It is the right 
and moral thing to do. More importantly, it will let hospice patients 
live out their final days in dignity. I urge my colleagues to cosponsor 
my bill and I submit the Wall Street Journal article of June 5th to be 
printed in the Record.

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