[Congressional Record Volume 146, Number 112 (Wednesday, September 20, 2000)]
[Senate]
[Pages S8807-S8809]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MEDICARE HOME HEALTH

  Ms. COLLINS. Mr. President, it is absolutely critical that Congress 
take action this year to address some of the unintended consequences of 
the Balanced Budget Act of 1997, which has been exacerbated by a host 
of ill-conceived new regulatory requirements imposed by the Clinton 
administration.
  The combination of regulatory overkill and budget cutbacks is 
jeopardizing access to critical home health services for millions of 
our Nation's most frail and vulnerable senior citizens.
  Tonight, the Senator from Wisconsin and I are taking the opportunity 
to talk about this very important issue. The Senator from Wisconsin has 
been a real leader in helping to restore the cuts and to fight the 
onerous regulatory requirements imposed by the administration which 
have affected home health care services across the Nation.
  I also want to recognize that there have been many other Senators who 
have been involved in this fight. I am going to put a list of the 
cosponsors to the legislation that I have introduced into the Record.
  I ask unanimous consent a list of cosponsors, which exceeds 50 
Senators, be printed in the Record, reflecting the contributions many 
of our colleagues have made to this fight.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                         Cosponsors of S. 2365

       Spencer Abraham, Wayne Allard, John Ashcroft, Max Baucus, 
     Robert F. Bennett, Jeff Bingaman, Christopher S. Bond, 
     Barbara Boxer, Sam Brownback, Conrad R. Burns.
       Lincoln D. Chafee, Max Cleland, Thad Cochran, Kent Conrad, 
     Michael DeWine,

[[Page S8808]]

     Christopher J. Dodd, John Edwards, Michael B. Enzi, Dianne 
     Feinstein, Bill Frist.
       Slade Gorton, Rod Grams, Judd Gregg, Chuck Hagel, Orrin G. 
     Hatch, Jesse Helms, Ernest F. Hollings, Y. Tim Hutchinson, 
     Kay Bailey Hutchison, James M. Inhofe.
       James M. Jeffords, John F. Kerry, Frank R. Lautenberg, 
     Patrick J. Leahy, Carl Levin, Joseph I. Lieberman, Blanche 
     Lincoln, Richard G. Lugar, Barbara A. Mikulski, Frank H. 
     Murkowski.
       Patty Murray, Jack Reed, Pat Roberts, John D. Rockefeller 
     IV, Rick Santorum, Charles E. Schumer, Bob Smith, Gordon 
     Smith, Olympia J. Snowe, Arlen Specter.
       Robert G. Torricelli, George V. Voinovich, John W. Warner, 
     Paul D. Wellstone.

  Ms. COLLINS. Mr. President, health care has come full circle. 
Patients are spending less time in the hospital. More and more 
procedures are being done on an outpatient basis, and recovery and care 
for patients with chronic diseases and conditions has increasingly been 
taking place in the home. Moreover, the number of older Americans who 
are chronically ill or disabled in some way continues to grow each 
year. Concerns about how to care for these individuals will only 
multiply as our population ages and is at greater risk of chronic 
disease and disability.
  As a consequence, home health has become an increasingly important 
part of our health care system. The kinds of highly skilled--and often 
technically complex--services that our nation's home health agencies 
provide have enabled millions of our most frail and vulnerable older 
persons to avoid hospitals and nursing homes and stay just where they 
want to be--in the comfort and security of their own homes.
  By the late 1990s, home health was the fastest growing component of 
Medicare spending. The program grew at an average annual rate of more 
than 25 percent from 1990 to 1997. The number of home health 
beneficiaries more than doubled, and Medicare home health spending 
soared from $2.5 billion in 1989 to $17.8 billion in 1997.
  This rapid growth in home health spending understandably prompted the 
Congress and the Administration, as part of the Balanced Budget Act of 
1997, to initiate changes that were intended to slow this growth in 
spending and make the program more cost-effective and efficient. These 
measures, however, have unfortunately produced cuts in home health 
spending far beyond what Congress intended. Home health spending 
dropped to $9.7 billion in FY 1999--just about half the 1997 amount. 
And on the horizon is an additional 15 percent cut that would put our 
already struggling home health agencies at risk and would seriously 
jeopardize access to critical home health services for millions of our 
nation's seniors.
  Last year, I chaired a hearing of the Permanent Subcommittee on 
Investigations where we heard about the financial distress and cash-
flow problems that home health agencies across the country are 
experiencing. Indeed, over 2,500 agencies, about one-quarter of all 
home health agencies nationwide, have either closed or stopped serving 
Medicare patients. Others have laid off staff or declined to accept new 
patients with more serious health problems. Moreover, the financial 
problems of home health agencies have been exacerbated by a number of 
burdensome new regulatory requirements imposed by the Health Care 
Financing Administration.
  One witness, who is a CEO of a visiting nurse service in Saco, ME, 
termed HCFA's regulatory policy as that of being ``implement and 
suspend.'' No longer had the agency spent all this money and time and 
effort in complying with a new regulatory requirement, then the Federal 
Government decided: never mind; we really didn't mean it; we weren't 
ready to implement this.
  We also heard numerous complaints about OASIS, a system of data 
collection containing data on the physical, mental, and functional 
status of patients receiving care from home health agencies. Not only 
has this been a very expensive and burdensome paperwork process, but 
the process of collecting information invades the personal privacy of 
many patients, which they understandably are concerned about.
  I recently met with home health nurses in southern Maine and I heard 
complaints about the administrative burdens and paperwork requirements 
associated with OASIS and its effect on patient care. I also heard what 
the real impact of the budget cutbacks has meant for many of the people 
in the State of Maine.
  I call attention to a chart that shows the impact that we are already 
experiencing in the State of Maine. As shown in the chart, nearly 7,500 
Maine citizens have lost access to home health services altogether. 
What has happened to those 7,500 senior citizens? Believe me, I know 
from my discussions with dedicated nurses who were providing home 
health services to them, it is not that they have recovered; it is not 
that they have gotten well. Rather, the loss of home health services 
has forced many of them into nursing homes prematurely or has put them 
at risk of increased hospitalization.
  Ironically, the Medicare trust fund pays far more for nursing home 
care or for hospitalization than it would continuing to provide home 
health care services to these individuals. The chart shows the 
financial burden in Maine in a year's time has suffered a 26-percent 
decrease in reimbursements for a 30-percent cut in visits. Again, it is 
our most vulnerable, frail, ill, elderly citizens who are bearing the 
brunt of these cutbacks.
  I heard very sad stories about the impact. Consider the case of one 
elderly woman who suffered from advanced Alzheimer's disease, 
pneumonia, and hypertension, among other illnesses. She was bed bound, 
verbally nonresponsive, and had a number of other serious health 
issues, including infections and weight loss. This woman had been 
receiving home health services for 2 years. That allowed her to 
continue to stabilize through the care and the coordination of a 
compassionate and skilled home health nurse. Unfortunately, the agency 
received a denial notice, terminating home health care for this woman.
  A true tragedy happened in this case. Less than 3 months later, after 
her home health care had been terminated, this woman died as a result 
of a wound on her foot that went untreated, a serious wound that 
undoubtedly her home health nurse would have recognized.

  This is only one of the heart-wrenching stories that I heard during 
that visit. It is only one of the countless testimonials that I have 
heard from both patients and home health providers across the State.
  It is now clear that the savings goals set forth for home health in 
the Balanced Budget Act of 1997 have not only been met but far 
surpassed. According to a recent study by the Congressional Budget 
Office, spending for home health care has fallen by more than 35 
percent in the last year. In fact, CBO cites this larger than 
anticipated reduction in home health care spending as the reason why 
overall Medicare spending fell last year for the first time.
  The CBO now projects that the post-Balanced Budget Act reductions in 
home health will be about $69 billion between fiscal years 1998 and 
2002. This is over four times the $16 billion that Congress expected to 
save as a result of the 1997 act. It is a clear indication, 
particularly when combined with the regulatory overkill of this 
administration, that the Medicare home health cutbacks have been far 
deeper and far wider reaching than Congress ever intended.
  I have introduced legislation which is cosponsored by the Senator 
from Wisconsin who, as I said, has been a leader in this area, with my 
colleague from Missouri, Senator Bond. In fact, both Senator Bond and 
Senator Ashcroft, as well as many of my other colleagues, are 
cosponsors of legislation that eliminates the further 15-percent 
reduction in Medicare payments to home health agencies that is 
currently scheduled to go into effect on October 1 of next year. If we 
do not act to eliminate this 15-percent cut that is looming on the 
horizon, it will sound the death knell for thousands of home health 
agencies. And ultimately the people, the true victims, will be those 
senior citizens who will no longer receive the care they need. I know 
the Presiding Officer has also been very concerned about the impact in 
his State; all Members who have rural States know the importance of 
home health care.
  As Congress prepares for action on Medicare, we should give top 
priority to providing much needed relief to our Nation's beleaguered 
home health agencies. The legislation I have introduced currently has 
55 Senate cosponsors--32 Republicans and 23 Democrats.

[[Page S8809]]

 It has the strong backing of patient and consumer groups, ranging from 
the American Diabetes Association, the National Council on Aging, 
Easter Seals, the American Nurses Association, and the National Family 
Caregivers Association, as well as the two major industry groups 
representing home health care agencies with whom we have worked very 
closely.
  It is imperative we solve this problem before we adjourn this year. I 
appreciate the opportunity to address this issue.
  The remainder of the time will be reserved for the Senator from 
Wisconsin, with whom it has been a real pleasure to work on this issue.
  The PRESIDING OFFICER (Mr. Voinovich). The Senator from Wisconsin.
  Mr. FEINGOLD. Mr. President, I am very pleased to join the Senator 
from Maine in talking about the importance of eliminating the automatic 
15-percent reduction in Medicare payments to home health agencies. It 
is currently scheduled for October 1, 2001. I am very pleased to be 
working with her on this because she is a tremendous leader on this 
issue. It is a very good example of the kind of bipartisanship that is 
essential for this body to function well. I am most pleased to be 
working with the Senator on this because it is so obvious she has taken 
a great deal of time to listen to her constituents about this very 
important issue.
  I have heard the same sad story in Wisconsin, and we hear a lot of 
very compelling human stories in this job. But I find this one 
impossible to ignore. I know the Senator from Maine feels the same way. 
The fact is, this system of home health care--at least in the State of 
the Senator from Maine and my State--was working. It is not as if it is 
something we are trying to create. It was working. Because of some 
poorly constructed policies, it is being harmed in a way that is truly 
harming older people in our country.
  The story the Senator from Maine gave is a very compelling example of 
a broader series of tragedies that are occurring, I think, on an almost 
daily basis in my State of Wisconsin, and in many other States.
  So, I thank her. I believe strongly that Congress must act to 
preserve access to home health care for seniors and others. That is why 
I have made the preservation of access to home health services one of 
my top priorities in the U.S. Senate.
  For seniors who are homebound and have skilled nursing needs, having 
access to home health services through the Medicare Program is the 
difference between staying in their own home and moving into a nursing 
home.
  The availability of home health services is integral to preserving 
independence, dignity, and hope for many beneficiaries. I feel strongly 
that where there is a choice, we should do our best to allow patients 
to choose home health care. I think seniors need and deserve that 
choice.
  Mr. President, as you know, and as many of our colleagues know, the 
Balanced Budget Act of 1997 contained significant changes to the way 
that Medicare pays for home health services. Perhaps the most 
significant change was a switch from cost-based reimbursement to an 
interim payment system, or IPS.
  IPS was intended as a cost-saving transitional payment system to tide 
us over until the development and implementation of a prospective 
payment system or PPS, for home health payments under Medicare. 
Unfortunately, the cuts went deeper than anyone--including CBO 
forecasters--anticipated, leaving 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 5-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 2 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 2 years.
  So, what do these changes mean for Medicare beneficiaries?
  Frankly, in many parts of Wisconsin, these changes mean that 
beneficiaries in certain areas or with certain diagnoses simply do not 
have access to home health care.
  I am concerned that a further 15-percent cut in home health care 
reimbursements will further jeopardize care and leave some of our 
frailest Medicare beneficiaries without the choice to receive care at 
home. Last year, I was proud to work with Senator Collins and others to 
delay the automatic 15-percent reduction in Medicare home health 
payments for one year. However, I believe this reduction must be 
eliminated in order to preserve access to home health care.
  I think seniors need and deserve the choice to stay in their homes, 
and I hope my colleagues will follow the leadership of Senator Collins 
and others by supporting the elimination of the 15-percent cut.
  Mr. President, how much time do we have remaining?
  The PRESIDING OFFICER. The Senator has 8 minutes.
  Mr. FEINGOLD. Mr. President, I believe that will be sufficient. I 
will just proceed, if I may.

                          ____________________