[Congressional Record Volume 147, Number 112 (Friday, August 3, 2001)]
[Extensions of Remarks]
[Pages E1533-E1534]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         MEDICARE REGULATORY AND CONTRACTING REFORM ACT OF 2001

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, August 2, 2001

  Mr. STARK. Mr. Speaker, today I am pleased to join Chairman Nancy 
Johnson (R-CT) in introducing legislation that will improve Medicare's 
administrative functions. Our bill addresses two very important 
problems in Medicare. First, it takes important steps to improve 
outreach and assistance to beneficiaries and providers, and to respond 
to certain other legitimate concerns raised by physicians and other 
providers. And second, it includes long overdue contracting reforms 
that will improve beneficiary and provider services and permit the 
consolidation of Medicare claims processing. Importantly, however, our 
legislation does not compromise the government's ability to protect 
taxpayer dollars from being inappropriately spent under Medicare.
  Mr. Speaker, no public program can continue without strong public 
support, and I suggest that Medicare needs both public support and 
provider support. The Centers for Medicare and Medicaid Services (CMS), 
formerly the Health Care Financing Administration (HCFA), is constantly 
criticized for burdensome regulations and paperwork. Yet polls of 
physicians and other providers have shown that providers prefer 
Medicare over other payers because Medicare pays faster and does less 
second-guessing than other payers.
  We need to improve the education and information processes for 
providers. It is hard for even the most seasoned Medicare analyst to 
keep track of all the payment and policy changes that have occurred in 
Medicare in the last few years. How can we expect providers to keep 
track of all of these changes while continuing to provide services? We 
need to do a much better job of educating and assisting physicians and 
other providers about these changes, and this legislation will help the 
CMS/HCFA do so.
  Mr. Speaker, throughout the history of Medicare, we have relied on 
Medicare contractors--carriers and fiscal intermediaries--to provide 
information to beneficiaries and providers, but that process is 
outdated in the face of all of the changes. Although that approach 
worked well for many years, I think most stakeholders would agree that 
we need major improvements in the Medicare contracting processes. Every 
President since President Carter has proposed reforms to the 
administrative contracting provisions in Medicare, yet they have never 
been enacted. I hope we succeed this time.
  Mr. Speaker, our legislation takes important steps to improve 
outreach and assistance to

[[Page E1534]]

providers. It would also create a Medicare Provider Ombudsman to help 
physicians and other providers to address confusion, lack of 
coordination, and other problems or concerns they may have with 
Medicare policies.
  Our bill reforms the Medicare contracting processes by consolidating 
the contracting functions for Part A and Part B of Medicare, permitting 
the Secretary to contract with separate Medicare Administrative 
Contractors to perform discrete functions, making use of the Federal 
Acquisition Rules in contracting, eliminating the requirements for cost 
contracting, and expanding the kinds of entities eligible for 
contracting. Our bill would permit consolidation of claims processing 
with fewer contractors, and it would permit separate contracting along 
functional lines--for beneficiary services, provider services, and 
claims processing.
  Mr. Speaker, my support for combining the administrative contracting 
functions of Part A and Part B in no way implies my support for 
combining the Part A and Part B trust funds or otherwise combining the 
financing or benefits. I strongly oppose such a consolidation.
  Mr. Speaker, I have tried for years to get CMS/HCFA to institute a 
single toll-free phone number for Medicare beneficiaries like the 
single toll-free phone number that Social Security has operated for 
years. Finally, in the BBA, the Congress mandated the establishment of 
a toll-free number, 1-800-MEDICARE. By all accounts, it has been a 
great success, and even CMS/HCFA now touts its success. However, CMS/
HCFA has still been unwilling to permit Medicare beneficiaries to use 
this number as a single entry point to Medicare. The latest national 
Medicare handbook includes 14 pages of telephone numbers for 
beneficiaries to call with specific questions! Surely, if a beneficiary 
calls the 1-800-MEDICARE number, their call could be transferred to the 
appropriate number, rather than asking them to try to locate the 
correct number themselves from among 14 pages of numbers!
  In addition to not having a single place to call for Medicare 
problems, beneficiaries also have no casework office whose 
responsibility is to help them with their Medicare problems. In the 
past, CMS/HCFA has relied on the contractors, but many of the problems 
beneficiaries face are with the contractors themselves. In addition, 
CMS/HCFA now relies on State Health Insurance Counseling and Assistance 
Programs (HICAP) organizations to help beneficiaries. I am a strong 
supporter of these organizations; however, these agencies are staffed 
with volunteers. It is absurd for a huge public program the size of 
Medicare to rely on volunteers to be the main source of assistance for 
its beneficiaries.
  We should look to the Social Security Administration to identify ways 
to provide assistance for Medicare beneficiaries. For example, Social 
Security not only has regional teleservice centers to staff their 
national toll-free line and help beneficiaries with their questions, 
SSA also has Program Service Centers to perform casework for Social 
Security beneficiaries with specific problems. We need similar offices 
for Medicare beneficiaries to perform casework for them. Currently, 
Medicare casework is handled primarily by Congressional offices, since 
no casework office exists in Medicare.
  I have proposed that Medicare staff be stationed in Social Security 
field offices to help answer questions and provide assistance for 
Medicare beneficiaries. There are 1291 SSA field offices around the 
world, and I would like to see Medicare staff in many, if not all of 
them in the near future. I am pleased that the legislation we are 
introducing today authorizes a demonstration program to examine the 
value of placing Medicare staff in SSA field offices, and I hope it 
will be expanded if it is found to aid beneficiaries.
  Finally, Mr. Speaker, let me address Medicare administrative 
resources. Two years ago, in the January/February 1999 issue of Health 
Affairs, fourteen of our nation's leading Medicare policy analysts--
ranging from conservative to liberal--published an open letter titled, 
``Crisis Facing HCFA & Millions of Americans.'' The crisis they spoke 
about was the lack of resources to administer Medicare. Their letter is 
even more relevant today. As its administrative workload has increased, 
CMS/HCFA resources have not kept pace. The changes that we propose in 
our legislation today are important, but by themselves, they are not 
sufficient. We simply must get more resources into Medicare 
administration.

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