[Congressional Record Volume 146, Number 142 (Wednesday, November 1, 2000)]
[Senate]
[Pages S11472-S11473]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            SMALL BUSINESS REAUTHORIZATION CONFERENCE REPORT

  Mr. GRASSLEY. Mr. President, I would like to take a moment to discuss 
some of the health care provisions in the tax bill. It's not a perfect 
bill, but it contains a lot of items that will improve health care in 
this country.
  Let me touch on the issue of Medicare equity. We in Iowa have been 
frustrated by the inequitable payment formulas that hurt cost-efficient 
states like ours. These disparities exist in both traditional Medicare 
and in the Medicare+Choice program. Well, this bill takes a major step 
toward correcting this injustice. I'd like to walk through some of the 
reasons why this bill is good for health care in Iowa.
  This bill corrects the Medicare Disproportionate Share program, known 
as ``DISH,'' as proposed in a bill I sponsored with Senator Roberts and 
others. This program helps hospitals that treat large numbers of 
uninsured patients. It's obvious that many rural Americans are 
uninsured, and that rural hospitals meet their duty to treat these 
people. But from its inception, this program has discriminated against 
rural hospitals. They have had to meet a much higher threshold than 
large urban hospitals have. Well, this bill finally equalizes the 
thresholds for all hospitals. There's still more work to do on this 
program, but this is a major step forward for equity in Medicare.
  The bill also reforms the Medicare Dependent Hospital program, as 
proposed in legislation I co-sponsored with Senator Conrad and many 
others. Many rural areas have aged populations, and this is especially 
true in Iowa. So this designation benefits small rural facilities that 
have more than 60% Medicare patients. But incredibly, hospitals only 
receive this benefit if they met that level way back in 1988! 
Unfortunately, the Medicare program is full of this kind of outdated, 
unreasonable rules. That's why we need Medicare reform. But in the 
meantime, I'm glad to report that this bill would correct this 
particular problem: if a rural hospital has been over that 60% level in 
recent years, it qualifies. That's great news for rural hospitals.
  Other key provisions of the bill strengthen our Sole Community 
Hospitals, knock down obstacles to the success of the Critical Access 
Hospital program for rural areas, and enhance rural patients' access to 
emergency and ambulance services.
  The bill also helps hospitals--including all Iowa hospitals, both 
urban and rural--by providing a full Medicare payment increase to 
offset inflation in 2001.
  Low payment rates for Iowa and other efficient states have prevented 
the Medicare+Choice program from taking root in Iowa and offering 
seniors the full range of health care options available elsewhere. I am 
pleased that the bill provides a major boost to entice plans to enter 
such regions, raising the minimum monthly payments for plans in rural 
areas from $415 to $475 per month, and for urban areas from $415 to 
$525 per month. These increases were proposed in a bill I co-sponsored 
with Senator Domenici and others, and I am hopeful that they will soon 
provide Iowans with the same range of choices available to seniors in 
other areas.
  The bill gives rural seniors access to the best medical care through 
telemedicine, as I have worked with Senator Jeffords and many others to 
do. In rural areas, medical specialists are not readily available. For 
many seniors, traveling long distances is simply not feasible. But 
technology now makes it possible for patients to go to their local 
hospital or clinic and be seen by a specialist hundreds of miles away. 
We in Iowa have tremendous capacity to take advantage of this. Yet for 
too long, the Medicare bureaucracy has put up every barrier it could 
think of to telemedicine. But this bill changes that, greatly expanding 
the availability of Medicare payment for services provided by 
telemedicine, Medicare patients will now have access to the world's 
best doctors and medical care regardless of where they live.
  The bill protects funding for home health services by delaying a 
scheduled 15% cut in payments, as well as providing a full medical 
inflation update. It's not secret that I, like many of my colleagues, 
would have preferred to see that 15% cut canceled permanently rather 
than simply delayed for another year. I hope that we will accomplish 
that next year.
  The bill also protects the access of our neediest beneficiaries to 
home health services when they use adult day care services. Patients 
can only receive home care under Medicare if they are ``homebound,'' 
and the bureaucracy has said that patients who leave their home for 
health care at an adult day care facility--such as many Alzheimer's 
patients--are no longer homebound. This has forced patients who are 
capable of living in their homes to move into institutions, just to get 
health care. I am very pleased that this bill includes the common-sense 
legislation I co-sponsored with Senator Jeffords to correct this Catch-
22.

  I am also very pleased that the bill addresses the Medicare hospice 
benefit, providing for a higher payment increase for inflation. The 
bill also deals with the ``six-month rule'' for hospice eligibility, 
clarifying that it is only a guideline, not an inflexible requirement. 
These provisions respond to concerns aired at my Aging Committee 
hearing on hospice in September, and I look forward to continued work 
in the 107th Congress to strengthen hospice care.
  The legislation extends the moratorium on therapy caps and provides 
Medicare beneficiaries in nursing homes with access to critical 
services. The Balanced Budget Act of 1997 included a $1,500 cap on 
occupational, physical and speech-language pathology therapy services 
received outside a hospital setting. Thirty-one days after the law was 
implemented, an estimated one in four beneficiaries had exhausted half 
of their yearly benefit. Furthermore, it was those beneficiaries in 
need of the most rehabilitative care that were penalized by being 
forced to pay the entire cost for these services outside of a hospital 
setting. I fought successfully during last year's Balanced Budget 
Refinement Act for a two-year moratorium on the therapy caps while the 
Health Care Financing Administration studies the issue; I am pleased to 
see this effort recognized and the moratorium extended for an 
additional year.
  The bill protects the right of patients in Medicare+Choice plans to 
return to their Medicare Skilled Nursing Facility of origin if they 
have to leave that facility for a brief hospitalization. Without this 
right, there have been instances in which patients in religiously 
affiliated nursing facilities have not been permitted to return to 
those facilities after hospitalization. I am gratified that the bill 
includes the legislation I co-sponsored with Senator Mack on this 
issue.
  The bill discontinues a policy to phase out Medicaid cost-based 
reimbursement to our nation's 3,000 Rural Health Clinics and 900 
Community Health Centers. In its place, it provides a reimbursement 
solution to ensure that these essential primary care providers can 
continue to serve millions of uninsured and under-insured Americans. 
The bill establishes a prospective payment system in Medicaid for 
federally certified Rural Health Centers and Community Health Centers. 
This provision creates an equitable payment system for these providers 
and ensures that the health care safety net remains strong and secure.
  As one example, the legislation also provides Medicare beneficiaries 
with greater access to the most thorough type of colon cancer 
screening--colonoscopy. As Chairman of the Senate Special Committee on 
Aging, I held

[[Page S11473]]

a hearing earlier this year to raise awareness about the far-reaching 
and devastating effects of colon cancer. This year 129,400 Americans 
will be diagnosed with this type of cancer and 56,000 Americans will 
die from it. However, if detected and treated early, colorectal cancer 
is curable in up to 90 percent of diagnosed cases. I fully support an 
expanded colon cancer screening benefit for Medicare beneficiaries and 
urge all older Americans to put the benefit to use.
  For the first time, medical nutrition therapy may be reimbursed by 
Medicare for patients with diabetes or renal disease. As part of the 
Balanced Budget Act of 1997, Congress instructed the Institute of 
Medicine (IOM) to conduct a study of the benefits of nutrition therapy. 
IOM reported that nutrition therapy would improve the quality of care 
and would be an efficient use of Medicare resources. I cosponsored 
legislation to expand Medicare coverage to include nutrition therapy; 
offering coverage for beneficiaries with diabetes or renal disease is a 
step in the right direction.
  In another first, this bill eliminates the arbitrary time limitation 
on Medicare coverage of immunosuppressive drugs following an organ 
transplant. Medicare covers expensive transplant operations but fails 
to follow through with coverage of the drugs necessary to preserve the 
transplanted organ; reimbursement is currently limited to the first 
three years following the procedure. While last year's BBRA extended 
coverage in some cases for an additional eight months, this legislation 
drops any time limitation for coverage of drugs critical to the health 
of transplant patients. This is common sense policy I am glad to 
support.
  I plan to come to the floor on other occasions to discuss other 
provisions of this bill. While I'm not completely satisfied, I think 
there is a lot that will help Americans get the health care they need 
and deserve.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. DODD. Mr. President, I am going to speak, if I may, over the next 
few minutes, on a couple of different, unrelated subject matters. The 
first I would like to spend a few minutes talking about is the 
situation in Colombia, South America, and, as we have watched events 
unfold over the last several days, the great concern I have about a 
deteriorating situation in that nation.
  Then, second, I will spend a couple of minutes talking about two of 
our colleagues who decided to retire from the Senate this year, Senator 
Connie Mack of Florida, my good friend, and Senator Pat Moynihan of New 
York. I will take a few minutes on these separate, distinct subject 
matters. I appreciate the indulgence of the Chair.

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