[Congressional Record Volume 147, Number 162 (Wednesday, November 28, 2001)]
[Senate]
[Pages S12106-S12107]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KERRY (for himself, Mr. Murkowski, Mr. Baucus, Mr. 
        Grassley, Mr. Jeffords, Mr. Thompson, Mr. Breaux, Mr. 
        Hutchinson, Mr. Daschle, Mr. Craig, Mr. Bingaman, Mr. Inhofe, 
        Mrs. Lincoln, Mr. Hollings, Mrs. Murray, Mr. Carper, Mr. 
        Johnson, and Mr. Hatch):
  S. 1738. A bill to amend title XVIII of the Social Security Act to 
provide regulatory relief appeals process reforms, contracting 
flexibility, and education improvements under the Medicare Program, and 
for other purposes; to the Committee on Finance.
  Mr. KERRY. Madam President, I am pleased to join my colleagues 
Senators Murkowski, Baucus and Grassley in introducing the Medicare 
Appeals, Regulatory and Contracting Improvement Act, MARCIA. This 
legislation will give health care providers relief from unnecessary and 
burdensome government regulations that threaten to interfere with the 
delivery of health care to our nation's Medicare beneficiaries.
  Medicare provides health care coverage for over 40 million senior and 
disabled Americans, relying on thousands of health care providers, 
including doctors, nurses, hospitals, nursing homes, home care 
agencies, and hospices, to deliver services, and more than fifty 
private health insurance companies to process millions of claims. While 
this public-private partnership forms the linchpin of the Medicare 
program, it is not as strong as it could be.
  Health care providers rightfully complain that Medicare has become 
too complex, with changes to claims payment systems made so frequently 
that they can not keep up. Today, Medicare providers are subjected to 
over 100,000 pages of regulations that are continuously being modified. 
Many providers complain that they have less time to spend on patient 
care because they are spending more time trying to understand how to 
comply with massive amounts of paperwork and constantly evolving 
regulatory requirements.
  The current Medicare appeals process is also problematic. It takes 
far too long to appeal an incorrect Medicare decision, often taking 
several years to complete. This system, coupled with some of the 
tactics used by the Federal Government and its contractors in 
collecting Medicare overpayments, leaves providers feeling frustrated, 
confused, and besieged. Regulations necessary to ensuring the integrity 
and efficiency of the Medicare program must be maintained and enforced, 
however, the occasionally aggressive means through which these 
regulations are administered has discouraged many providers from 
wanting to participate in the Medicare program.
  The Medicare Appeals, Regulatory and Contracting Improvement Act, 
MARCIA, will strengthen the Medicare public-private partnership. The 
bill has five primary components. First, it relieves burdens on 
beneficiaries and providers by requiring the Centers for Medicare and 
Medicaid Services, CMS, to issue new rules and policies in an orderly 
and reasonable manner. Second, it provides new appeals protections for 
all Medicare fee-for-service providers and beneficiaries. Third, it 
allows CMS to use competition to select the best available 
administrative contractors to serve beneficiaries and providers. 
Fourth, it requires Medicare contractors and CMS to place a greater 
emphasis on provider education and outreach. Finally, it makes the 
Medicare overpayment collection and extrapolation process more fair. 
The bill accomplishes all of these objectives without undermining the 
False Claims Act or other Medicare fraud recovery efforts, and I urge 
my colleagues to join with me to secure its passage.
  Mr. MURKOWSKI. Madam President, right now, all across America, 
Medicare beneficiaries are seeking medical care from a flawed health 
care system. Reduced benefit packages, ever escalating costs, and 
limited access in rural areas are just a few of the problems our system 
faces on a daily basis. For these reasons, Congress must continue to 
move towards the modernization of Medicare. But as we address the needs 
of beneficiaries, we must not turn our back upon the very providers 
that seniors rely upon for their care.
  Who are providers? They are the physicians, the hospitals, the 
nursing homes, and others who deliver quality care to our needy 
Medicare population. They are the backbone of our complex health care 
network. When our Nation's seniors need care, it is the provider who 
heals, not the health insurer--and certainly not the federal 
government.
  But more, and more often, seniors are being told by providers that 
they don't accept Medicare. This is becoming even more common in rural 
areas, where the number of physicians is limited and access to quality 
care is extremely restricted. Quite simply, beneficiaries are being 
told that their insurance is simply not wanted. Why? Well it's not as 
simple as low reimbursement rates. In fact it's much more complex.
  The infrastructure that manages the Medicare program, the Centers for 
Medicare and Medicaid Services, CMS, and its network of contractors, 
are working with a system that was designed to block care and micro-
manage independent practices. Providers simply cannot afford to keep up 
with the seemingly endless number of complex, redundant, and 
unnecessary regulations. And if providers do participate? Well, a 
simple administrative error in submitting a claim could subject them to 
heavy-handed audits and the financial devastation of their practice. 
Should we force providers to choose between protecting their practice 
and caring for seniors?
  I believe the answer is no. For this reason, I am pleased to 
introduce the ``Medicare Appeals, Regulatory and Contracting 
Improvements Act of 2001.'' I am joined by my colleagues Senator Kerry, 
Senator Baucus, and Senator Grassley. This legislation is a bipartisan 
compromise, based upon legislation I offered earlier this year. It will 
allow providers to practice medicine without fearing the threats, 
intimidation, and aggressive tactics of a faceless bureaucratic 
machine.
  Most importantly, this bill will reform the flawed appeals process 
within CMS. Currently, a provider who allegedly has received an 
overpayment is forced to choose between three options: admit the 
overpayment, submit additional information to mitigate the charge, or 
appeal the decision. However, providers who choose to submit additional 
evidence must subject their entire practice to review and waive their 
appeal rights. That's right, to submit additional evidence you must 
waive your right to an appeal!
  And what is the result of this maddening system that runs contrary to 
our Nation's history of fair and just administrative decisions? Often, 
providers are intimidated into accepting the arbitrary decision of an 
auditor employed by a CMS contractor. Sometimes, they are even forced 
to pull out of the Medicare program. In the end, our senior population 
suffers.
  To bring additional fairness to the system, the bill provides new 
appeal protections for all Medicare fee-for-service providers and 
beneficiaries. It also requires the Medicare administrative contractors 
and CMS to place a greater emphasis on provider education and outreach. 
And most importantly, it reforms the Medicare overpayment collection 
and extrapolation process. All of this is accomplished without 
undermining the False Claims Act or current Medicare fraud enforcement 
efforts.
  It is with the goal of protecting our Medicare population, and the 
providers who tend care, that leads us to introduce this bipartisan 
compromise. This bill will ensure that providers are treated with the 
respect that they deserve, and that Medicare beneficiaries aren't told 
that their health insurance isn't wanted. We owe it to our nation's 
seniors. I urge immediate action on this worthy bill.
  Mr. BAUCUS. Madam President, I rise today as a cosponsor of the 
Medicare Appeals, Regulatory and Contracting Improvements Act of 2001.
  Medicare is one of the Federal Government's greatest successes. It 
provides health care for nearly 40 million seniors and disabled 
beneficiaries. Medicare is often considered the gold-standard of health 
insurance programs around the nation and the world. And it has lifted 
millions of individuals out of poverty since its enactment in 1965.
  Medicare's success is due to its public-private partnership, which is 
the

[[Page S12107]]

foundation of the program. While Medicare is almost entirely federally 
financed, it relies on thousands of private hospitals, private 
physicians, and other health care providers and suppliers to deliver 
health care services. Moreover, it relies on more than 50 private 
health insurance companies to process millions of claims every year.
  Every so often Congress needs to evaluate this public-private 
partnership to see how its working. And this past year, Senator Kerry, 
Senator Murkowski, Senator Grassley, and I have undertaken this 
evaluation.
  I have heard from hundreds of health care providers who have levied 
legitimate complaints about the operation of Medicare. They argue that 
Medicare has become too complex. Changes to the claims payment systems 
are made every day, and health care organization simply cannot keep up. 
This is especially true for small rural hospitals and other health care 
providers in my state of Montana. They do not have the staff to stay 
abreast of the constant changes to the Medicare payment systems.
  I have also heard from providers about the current Medicare appeals 
process. The Medicare appeals process is broken. It takes too long to 
appeal an incorrect Medicare decision. Providers often have to file 
lengthy and expensive appeals, sometimes taking several years to 
settle.
  And finally, I have heard from health care providers about the 
aggressive tactics that are sometimes used by Federal Government and 
its contractors in collecting Medicare overpayments. Medicare needs to 
realize that mistakes happen, especially with this very complex 
program. When providers make honest mistakes, they should be treated as 
mistakes, not criminal fraud.
  Earlier this year, my colleagues Senators Kerry and Murkowski 
introduced a version of this bill, the ``Medicare Education and 
Regulatory Fairness Act of 2001.'' I commend Senators Kerry and 
Murkowski for their hard work on this bill; it made a very important 
contribution to our understanding of this issue and the need for 
reform. However, I had some concerns with their original bill, namely 
that it unintentionally created some new loopholes for truly dishonest 
providers to commit fraud.
  Rather than oppose their bill, I asked my staff along with Senator 
Grassley's staff to work with Senator Kerry and Senator Murkowki's 
office to redraft their bill to address some of my concerns. And I am 
proud to say that we have developed a bill that everyone can support.
  The Medicare Appeals, Regulatory and Contracting Improvements Act of 
2001 will make necessary and overdue improvements to the Medicare 
public-private partnership. The bill does five things. First, it 
improves the CMS rule-making process, for example, by requiring CMS to 
publish its regulations on one business day of each month. Second, It 
provides new appeal protections for all Medicare fee-for-service 
providers and beneficiaries. Third, it grants new competitive 
administrative contracting authority to CMS. Fourth, it requires the 
Medicare administrative contractors and CMS to place a greater emphasis 
on provider education and outreach. And fifth, it reforms the Medicare 
overpayment collection and extrapolation process.
  The bill accomplishes all five of these important objectives without 
undermining the False Claims Act of current Medicare fraud enforcement 
efforts. We have received assurances from the Department of Justice, 
the HHS Office of Inspector General, and the CMS that this is so.
  This is a good bill, a bill that will receive the support of provider 
groups and the support of the Federal agencies that oversee the 
Medicare program.
  While this bill is primarily focused on health care provider issues, 
I agree with my colleagues in the Senate and House that Congress also 
needs to ensure that beneficiaries are able to navigate and understand 
Medicare. I commend current efforts in the House to include provisions 
that would guarantee that beneficiaries have the right to find out 
whether Medicare services are covered before they become financially 
liable for them. Currently, when a doctor informs a patient that a 
service may not be covered by Medicare, the patient has no way to 
verify if this is the case. I will work to include these provisions in 
any enacted legislation.
  I commend my colleagues Senator Kerry, Senator Murkowski, and Senator 
Grassley for their commitment and their hard work on this bill. As 
chairman of the Finance Committee, I remain committed to quick 
consideration of this bill in my committee. I urge all of my colleagues 
to support it.
  Mr. CRAIG. Madam President, I am pleased to join today as an original 
cosponsor of the Medicare Appeals, Regulatory and Contracting 
Improvements Act, MARCIA. This legislation represents a clear and 
useful first step toward serious reform of the way Medicare does 
business with America's health care professionals and Medicare 
beneficiaries.
  I have heard from literally hundreds of doctors, hospitals, and other 
health care professionals in Idaho about the truly appalling paperwork 
and regulatory burdens imposed by the Medicare program, and even more 
troubling, about how these mounting regulatory burdens are causing many 
doctors to limit their participation in Medicare or to leave the 
program altogether.
  Also, as ranking member on the Senate's Special Committee on Aging, I 
have made examination of Medicare's paperwork and provider enforcement 
systems a key priority. In July, our committee held the first of what I 
hope may be a series of hearings looking into these problems, and this 
fall, members of my Aging Committee staff traveled across Idaho, 
talking with more than 60 Idaho providers about their concerns with 
Medicare.
  Most recently, I was pleased to have Tom Scully, the energetic and 
thoughtful new administrator of the Centers for Medicare and Medicaid 
Services, CMS, join me in Boise to talk about Medicare with Idaho 
health professionals and senior citizens. We heard a great deal of 
frustration, and not a little anger.
  At the same time, it was very clear to me that Tom Scully and the 
Bush administration are serious about tackling Medicare's many 
shortcomings. Indeed, Tom Scully and the administration have worked 
closely with Congress to help develop the legislation we are 
introducing today.
  Today, the number of pages of Medicare rules and regulations is 
now more than 110,000, approximately three times that of Federal tax 
laws and regulations. Moreover, for every hour spent on Medicare 
patient care in outpatient settings, doctors and their staffs now spend 
approximately 36 minutes on Medicare-related paperwork. And in hospital 
emergency care settings, that ratio is now 1 hour of paperwork for 
every 1 hour of patient care.

  These problems are genuinely daunting, and today's legislation is not 
a panacea. Rather, it is a promising beginning in what I hope will be 
an ongoing cooperative effort to make Medicare more responsive, more 
rational, and more efficient.
  Finally, let me be crystal clear: We must continue to devote 
significant resources to combating fraud and abuse in the Medicare 
program. Those who violate the public trust must be punished to the 
fullest extent of the law, and this legislation would in no way 
undercut these critical efforts.
  Rather, this bill would relieve complex and unreasonable burdens on 
providers and beneficiaries by requiring CMS to issue new rules in an 
orderly and reasonable manner, and would provide new appeal protections 
for many Medicare providers and beneficiaries. Further, this 
legislation would require CMS to use competition to select the best 
administrative contractors, and it would require CMS and its 
contractors to place greater emphasis on provider education and 
outreach. In addition, the bill would implement needed improvements in 
the way Medicare oversees alleged provider overpayments, principally by 
reforming current Medicare overpayment collection and extrapolation 
processes.
  I am pleased to join my colleagues in sponsoring this much needed 
legislation, and I look forward to continuing progress on these 
important issues in the coming year.
                                 ______