[Congressional Record Volume 146, Number 117 (Wednesday, September 27, 2000)]
[Extensions of Remarks]
[Pages E1615-E1616]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




THE INTRODUCTION OF ``THE MEDICARE, MEDICAID AND SCHIP BALANCED BUDGET 
                        REFINEMENT ACT OF 2000''

                                 ______
                                 

                         HON. EDWARD J. MARKEY

                            of massachusetts

                    in the house of representatives

                     Wednesday, September 27, 2000

  Mr. MARKEY. Mr. Speaker, I am pleased to join with my friend and 
colleague, the Gentleman from Massachusetts, Mr. Frank, the entire 
Massachusetts delegation in the House, and many of my other colleagues 
in the House in introducing the ``Medicare, Medicaid, SCHIP Balanced 
Budget Refinement Act of 2000.''
  Mr. Speaker, in this era of unprecedented surplus, we must ask the 
question, ``Who's surplus is it?'' The answer is, ``it's the seniors' 
surplus.'' The legislation we are introducing today is closely modeled 
after legislation (S. 3077) recently introduced in the Senate, and will 
provide $40 to $50 billion over five years in additional Medicare and 
Medicaid payments to health care providers adversely affected by the 
cuts in the 1997 law, including hospitals, home health agencies, 
managed care plans, and nursing homes.
  In 1997, seniors in our country were told that the price tag for 
Balanced Budget Act was going to be $115 billion. Even then, the 
Gentleman from Massachusetts (Mr. Frank) and I thought that price was 
too high, and that was one of the principal reasons we voted against 
the bill. But today, we find ourselves in a situation where the actual 
cost of the BBA is turning out to be over $200 billion. In addition to 
the cost of the BBA doubling, Medicare spending is down sharply, 
increasing by just 1.5 percent in FY98, decreasing by 1.0 percent in 
FY99, and increasing just 1.5 percent in FY2000--well below the 
predicted growth rates for the program.
  Mr. Speaker, we owe our seniors a refund. That's not too much to ask 
for the men and women who built this country. The 1997 Medicare cuts 
have harmed seniors, and I believe we should give this senior surplus 
back to the seniors to pay for their health care programs.
  Congress is working on a package of Medicare givebacks this year to 
deal with the most critical aspects of the BBA cuts, a package that 
will cost about $21 billion. However, I am hopeful that as we move 
forward in the few remaining weeks of this session, that we will 
increase the price tag for this package. $21 billion is not going to be 
enough to get the job done.
  Mr. Speaker, the following is a summary of the legislation, outlining 
specific areas of relief, such as community and teaching hospitals, 
skilled nursing facilities, home health care facilities, and Medicare 
HMOs, which I submit into the Record.

The Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of 2000

       We believe strong that Congress, in light of the projected 
     budget surplus for the next five years, should provide 
     substantial relief to health care providers hurt by the 1997 
     Balanced Budget Act. Today, we are introducing the House 
     companion bill to S. 3077, the Balanced Budget Refinement Act 
     of 2000.


  The following is a summary of the key provisions of the legislation:

       Hospitals: Significant portions of the BBA spending 
     reductions have impacted hospitals. According to the Medicare 
     Payment Advisory Commission (MedPAC), ``Hospitals' financial 
     status deteriorated significantly in 1998 and 1999,'' the 
     years following enactment of BBA. BBRA-2000 would address the 
     most pressing problems facing hospitals by:
       Fully restoring, for fiscal years '01 and '02, inpatient 
     market basket payments to keep up with increases in hospital 
     costs, an improvement that will help all hospitals.
       Preventing implementation of further reductions in (IME) 
     payment rates for vital teaching hospitals--which are on the 
     cutting edge of medical research and provide essential care 
     to a large proportion of indigent patients. Support for 
     medical training and research at independent children's 
     hospitals is also included in the Democratic proposal.
       Targeting additional relief to rural hospitals (Critical 
     Access Hospitals, Medicare Dependent Hospitals, and Sole 
     Community Hospitals) and making it easier for them to qualify 
     for disproportionate share payments under Medicare.
       Providing additional support for hospitals with a 
     disproportionate share of indigent patients, including 
     elimination of scheduled reductions in Medicare and Medicaid 
     disproportionate share (DSH) payments, and extending Medicaid 
     to legal immigrant children and pregnant women, as well as 
     providing State Children's health Insurance Program (SCHIP) 
     coverage to these children.
       Establishing a grant program to assist hospitals in their 
     transition to a more data intensive care-delivery model.
       Providing Puerto Rico hospitals with a more favorable 
     payment rate (specifically, the inpatient operating blend 
     rate) as MedPAC data suggests is warranted.
       Home Health. The BBA hit home health agencies particularly 
     hard. Home health spending dropped 45 percent between 1997 
     and 1999, while the number of home health agencies declined 
     by more than 2000 over that period. MedPAC has cautioned 
     against implementing next year the scheduled 15 percent 
     reduction in payments. BBRA-2000 would:
       Repeal the scheduled 15 percent cut in the home health 
     payments, remove medical supplies in the home health 
     prospective payment system (PPS), provide a 10-percent upward 
     adjustment in rural home health payments to address the 
     special needs of rural home health agencies in the transition 
     to PPS. Security costs for high crime areas are also covered 
     in this legislation.
       Provides $500 million to care for ``outlier'', or the 
     sickest and most costly, patients.
       Clarifies the ``homebound'' definition allowing Medicare 
     beneficiaries to attend adult day care, religious services or 
     important family events while continuing to receive home 
     health benefits.
       Allows home health agencies to list telemedical services on 
     their cost reports and orders HCFA to study whether these 
     services should be reimbursable under Medicare.
       Provide full update payments (inflation) for medical 
     equipment, oxygen, and other suppliers.
       Skilled Nursing Facilities (SNFs). The BBA was expected to 
     reduce payments to skilled nursing facilities by about $9.5 
     billion. The actual reduction in payments to SNFs over the 
     period is estimated to be significantly larger. BBRA-2000 
     would:
       Allow nursing home payments to keep up with increases in 
     costs through a full market basket update for SNFs for FY 
     2001 and FY 2002, and market basket plus two percent for 
     additional payments.
       Further delay caps on the amount of physical/speech therapy 
     and occupational therapy a patient can receive while the 
     Secretary completes a scheduled study on this issue.
       Rural. Rural providers typically serve a larger proportion 
     of Medicare beneficiaries and are more adversely affected by 
     reductions in Medicare payments. In addition to the rural 
     relief measures noted above (under ``hospitals''), BBRA-2000 
     addresses the unique situation faced in rural areas through a 
     number of measures, including: a permanent ``hold-harmless'' 
     exemption for small rural hospitals from the Medicare 
     Outpatient PPS; assistance for rural home health agencies; a 
     capital loan fund to improve infrastructure of small rural 
     facilities; assistance to develop technology related to new 
     prospective
       Hospice. Payments to hospices have not kept up with the 
     cost of providing care because of the cost of prescription 
     drugs, the therapies now in end-of-life care, as well as 
     decreasing lengths of stay. Hospice base rates have not been 
     increased since 1989. BBRA-2000 would provide significant 
     additional funding for hospice services to account for their 
     increasing costs, including full market basket updates for 
     fiscal years '01 and '02 and a 10-percent upward adjustment 
     in the underlying hospice rates.
       Medicare+Choice. This legislation would ensure that 
     appropriate payments are made

[[Page E1616]]

     to Medicare+Choice (M+C) plans. Expenditures by Medicare for 
     its fee-for-service providers included in BBRA-2000 
     indirectly benefit M+C plans to a significant extent. 
     Moreover, the legislation includes an increase in the M+C 
     growth percentage for fiscal years '01 and '02, permitting 
     plans to move to the 50:50 blended payment one year earlier, 
     and allowing plans which have decided to withdraw to 
     reconsider by November 2000.
       Physicians. Congress understands the pressures that 
     physicians face to deliver high-quality care while still 
     complying with payment and other regulatory obligations. 
     BBRA-2000 provides for comprehensive studies of issues 
     important to physicians, including: the practice expense 
     component of the Resource-Based Relative Value Scale (RBRVS) 
     physician payment system, post-payment audits, and regulatory 
     burdens. BBRA-2000 would provide relief to physicians in 
     training, whose debt can often be crushing, by lowering the 
     threshold for loan deferment from $72,000 to $48,000.
       Beneficiary Improvements. House Democrats continue to 
     believe that passage of a universal, affordable, voluntary, 
     and meaningful Medicare prescription drug benefit is the 
     highest priority for beneficiaries. In addition, BBRA-2000 
     would directly assist beneficiaries in the following ways:
       Coinsurance: BBRA-2000 would lower beneficiary coinsurance 
     to achieve a true 20 percent beneficiary copayment for all 
     hospital outpatient services within 20 years.
       Preventive Benefits: The bill would provide for significant 
     advances in preventive medicine for Medicare beneficiaries, 
     including waiver of deductibles and cost-sharing, glaucoma 
     screening, counseling for smoking cessation, and nutrition 
     therapy.
       Immunosuppressive Drugs: The bill would remove current 
     restrictions on payment for immunosuppressive drugs for organ 
     transplant patients.
       ALS: The bill would waive the 24-month waiting period for 
     Medicare disability coverage for individuals diagnosed with 
     amyotrophic lateral sclerosis (ALS).
       M+C Transition: For beneficiaries who have lost 
     Medicare+Choice plans in their area, BBRA-2000 includes 
     provisions that would strengthen fee-for-service Medicare and 
     assist beneficiaries in the period immediately following loss 
     of service.
       Return-to-home: The bill would allow beneficiaries to 
     return to the same nursing home or other appropriate site-of-
     care after a hospital stay.
       Part B penalty: The bill would limit the penalty for late 
     enrollment in Medicare Part B.
       Vision Services: The bill would allow beneficiaries to 
     access vision rehabilitation services provided by Orientation 
     and Mobility Specialists, Low Vision Therapists, and 
     Rehabilitation Teachers.
       Other Provisions. BBRA-2000 would address other high 
     priority issues, including: improved payment for dialysis in 
     fee-for-service and M+C to assure access to quality care for 
     end stage renal disease (ESRD) patients; increased market 
     basket updates for ambulance providers in fiscal years '01 
     and '02; an immediate opt-in to the new ambulance fee 
     schedule for affected providers; and enhanced training 
     opportunities for geriatricians and clinical psychologists. 
     BBRA-2000 also The Act in addition includes important 
     modifications to the Community Nursing Organization (CNO) 
     demonstration project, and additional funding for the Ricky 
     Ray Hemophilia program.
       Medicaid and SCHIP. The growing number of uninsured 
     individuals and declining enrollment in the Medicaid program 
     are issues that also must be addressed. To improve access to 
     health care for the uninsured and ensure that services 
     available through the Medicaid and SCHIP programs are 
     reaching those eligible for assistance, BBRA-2000 includes 
     the following provisions:
       Improve eligibility and enrollment processes in SCHIP and 
     Medicaid.
       Extend and improve the Transitional Medical Assistance 
     program for people who leave welfare for work.
       Improve access to Medicare cost-sharing assistance for low-
     income beneficiaries.
       Give states grants to develop home and community based 
     services for beneficiaries who would otherwise be in nursing 
     homes.
       Create a new prospective payment system (PPS) for Community 
     Health Centers to ensure they remain a strong, viable 
     component of our health care safety net.
       Extend Medicaid coverage of breast and cervical cancer 
     treatment to women diagnosed through the federally-funded 
     early detection program.
       Permit nurse practitioners and clinical nurse specialists 
     to bill independently under State Medicaid plans, regardless 
     of whether or not a physician or other health care provider 
     is supervising.

                          ____________________