[Congressional Record Volume 147, Number 97 (Thursday, July 12, 2001)]
[Senate]
[Pages S7591-S7592]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FEINGOLD (for himself, Mr. Murkowski, Ms. Collins, and Mr. 
        Kerry):
  S. 1169. A bill to streamline the regulatory processes applicable to 
home health agencies under the medicare program under title XVIII of 
the social Security Act and the medicaid program under title XIX of 
such Act, and for other purposes; to the Committee on Finance.
  Mr. FEINGOLD. Mr. President, I rise today to introduce the Home 
Health Nurse and Patient Act of 2001. This legislation reduces 
administrative burdens, requires a focused analysis of crucial claims 
processing concerns, and provides the opportunity for constructive 
reforms of current inefficiencies.
  I am especially pleased to be joined by a number of my colleagues, 
including Senator Murkowski and Senator Kerry who have been leaders in 
the regulatory reform movement, and Senator Collins, who has truly been 
a champion for preserving access to home health care.
  Without Senator Collins' leadership on this issue, including the 1999 
hearing that she held on the issue of regulatory burdens facing the 
home health care industry, this legislation would not be where it is 
today.
  Senator Collins' legislation to repeal the 15 percent reduction in 
payments to home health care providers is also of the utmost 
importance, and is the other piece to the puzzle in terms of preserving 
access to home health care. It is my hope that the Senate Finance 
Committee will report out her legislation this year.
  Scope of the problem: As many of my colleagues know, home health care 
provides compassionate, at-home care to seniors and people with 
disabilities in cities and towns throughout America.
  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 my home state of Wisconsin, that day has arrived.
  Over the past few years, home health agencies around Wisconsin have 
closed their doors due to massive changes in Medicare, and seniors and 
the disabled have been forced to go elsewhere for care.
  In Wisconsin, over 40 Medicare home health providers have shut down 
since the implementation of the 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.
  Over the past 3 years, nearly 30 of Wisconsin's 72 counties have lost 
between one and fifteen home health care agencies.
  Quite frankly, in many parts of Wisconsin, beneficiaries in certain 
areas or with certain diagnoses simply don't have access to home health 
care.
  While we have thankfully moved beyond the interim payment system, 
many home health agencies are facing another cloud in the horizon--an 
impending nursing shortage and a regulatory system that causes nurses 
to fill out paperwork instead of caring for patients.
  Burdensome and excessive paperwork often causes nurses to leave the 
home health care profession, and that can mean that patients stay in 
the hospital longer than necessary.
  A 2000 national survey by the Hospital and Healthcare Compensation 
Service reported a 21-percent turnover rate for home health registered 
nurses, a 24-percent turnover rate for home health licensed practicing 
nurses, and a 28-percent turnover for home health aides.
  The actual amount of time that a nurse provides medical care during 
an average ``start of care'' home health visit is approximately 45 
minutes, only 30 percent of the average 2.5 hours of a nurse's time 
during the admission visit. According to Price Waterhouse Cooper, every 
hour of patient care time requires 48 minutes of paperwork time for 
hospital-owned home health agencies.
  I would like to share with my colleagues this advertisement from 
Nursing Spectrum magazine.
  Let me read this line here in bold print: ``No OASIS.''
  As you can see the main selling point in the advertisement is the 
fact that the job will not force nurses to collect OASIS data. This is 
just one simple example of how the administrative burden we have 
imposed on our nurses.
  Our legislation takes a common sense approach to developing Medicare 
home health regulatory policies that are pro-consumer, provider-
friendly, and efficient for the Center for Medicare and Medicaid 
Services, CMS, to administer.
  It would also help to ensure that the policies are successful, fair 
and effective because all parties would collaborate on recommendations 
to the Secretary of Health and Human Services, HHS, through joint task 
forces.
  This legislation would significantly alleviate the burdens that the 
Outcomes Assessment and Information Set (OASIS), the claims process for 
patients who are enrolled in both Medicare and Medicaid, and certain 
audit and medical review processes have had on home health providers.
  More importantly, the changes to the OASIS and the claims review 
process also would reduce the stress often experienced by home health 
patients due to the complexity of both regulations.
  It would also create a task force to analyze the appropriateness and 
efficacy of the OASIS patient assessment

[[Page S7592]]

instrument on Medicare, Medicaid and non-government financed patients.
  During the study, the OASIS process would be optional for the non-
Medicare and non-Medicaid patients and inapplicable to those patients 
receiving personal care services only.
  Many beneficiaries are also concerned about arbitrary coverage 
decisions, that leaves beneficiaries in the lurch. That is why this 
legislation requires the Secretary to form a task force to develop an 
efficient process for the handling of Medicare claims related to 
individuals also eligible for Medicaid coverage where the claim may not 
be covered under Medicare.
  Finally, the Home Health Nurse and Patient Act would create a task 
force that would engage in a wholesale evaluation of the process used 
by Medicare to select and review home health services' claims.
  The task force would consider such changes as establishing time 
limits for claim determinations, the use of alternative dispute 
resolution processes, the development of formal claims sampling 
protocols, allowing re-submission of corrected claims, and permitting 
physician assistants and nurse practitioners to establish care plans.
  I hope to continue to work with both providers and beneficiaries to 
take a serious look at what refinements need to occur to ensure the 
home bound elderly and disabled 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.
                                 ______