[Congressional Record Volume 148, Number 68 (Thursday, May 23, 2002)]
[Senate]
[Pages S4844-S4845]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HATCH (for himself, Mr. Graham, Mr. Allard, Mr. Kennedy, 
        and Ms. Mikulski):
  S. 2557. A bill to amend title XVIII of the Social Security Act to 
improve access to Medicare+Choice plans for special needs medicare 
beneficiaries, and for other purposes; to the Committee on Finance.
  Mr. HATCH. Mr. President, I rise today to introduce legislation that 
will help one of the most vulnerable segments of the Medicare 
population; the Medicare Improvements for Special Needs Beneficiaries 
Act of 2002 will improve access to quality health care for frail, 
elderly Medicare beneficiaries living in nursing homes or the 
community.
  Approximately six million of these individuals are eligible for both 
Medicare and Medicaid coverage. These ``dual eligibles,'' as they are 
called, are the most vulnerable group of Medicare beneficiaries. They 
are elderly or disabled and poor, and many have serious health risks 
and complex medical, social, and long-term care needs. Care for these 
beneficiaries is fragmented, and many face barriers to needed services. 
Dual eligibles represent a disproportionate share of Medicare spending.
  A small number of health plans specialized in providing quality 
coordinated care to frail elderly Medicare beneficiaries through 
demonstrations and the Medicare+Choice program. These specialized plans 
are a Medicare+Choice success story, fulfilling the program's original 
goals by employing innovative clinical models of care that improve care 
and health outcomes while reducing medical costs. These plans currently 
serve approximately 25,000 Medicare beneficiaries, most of whom reside 
in nursing homes.
  The model is simple: teams of physicians and nurse practitioners work 
together to provide as much primary, preventive, and acute care as 
possible on site, in a nursing home facility or in the patient's home. 
For institutionalized enrollees, this means fewer trips to the 
emergency room; for community-based enrollees, it means avoiding 
nursing home placement. If enrollees can be treated successfully 
without a trip to the hospital or placement in a nursing home, they 
remain healthier and costs to the Medicare program are reduced.
  These specialized plans are currently facing regulatory barriers that 
prevent them from becoming permanent Medicare+Choice program options 
and expanding service to frail and elderly beneficiaries in the 
community. The Medicare Improvements for Special Needs Beneficaries Act 
of 2002 provides improved beneficiary access to Medicare+Choice plans 
by removing these barriers and allowing plans to specialize in serving 
dual eligible, institutionalized, and other frail beneficiaries.
  Specially, the bill would allow a special Medicare+Choice program 
designation in order to allow these plans to target enrollment to the 
frail elderly and concentrate care on this vulnerable population. As a 
safeguard, our bill also includes several quality assurance and 
reporting requirements which these plans must adhere to in order to 
remain in the program.
  The Congress is continually trying to improve our nation's health 
care system and improve service for Medicare beneficiaries. I believe 
this legislation takes a small step toward this goal. These programs 
are fulfilling the original promise of the Medicare+Choice program to 
improve quality and lower costs, and this legislation is a no-cost way 
to continue this effort. These plans serve a unique and valuable 
purpose for a very vulnerable segment of our society. I hope my 
colleagues will join me in supporting this important legislation.
  Mr. GRAHAM. Mr. President, I rise today to introduce legislation to 
improve the health and healthcare of one of the most fragile groups 
within our Medicare population. The Medicare Improvements for Special 
Needs Beneficiaries Act of 2002 would improve access to quality 
healthcare for frail, elderly Medicare beneficiaries living in nursing 
homes or the community. Approximately 6 million of these individuals 
are eligible for both Medicare and Medicaid coverage, so-called ``dual 
eligibles.''
  These ``dual eligibles'' deserve our greatest attention. They are 
vulnerable financially as well as medically. Typically, these older 
Americans suffer from the chronic health conditions compounded by 
complex social and acute care needs. Further, even with the best of 
intentions, their healthcare delivery is often limited by a health 
system that is fragmented and poorly coordinated. Despite 28 percent of 
Medicare spending going toward their care, the system fails at 
delivering optimal coordinated health services.
  While we have looked for success in our current Medicare+Choice 
plans, we find a system that is in need of serious restructuring and 
development. On the other hand, a small number of health plans already 
specialize in providing the quality coordinated care that this 
vulnerable group needs. These plans are truly a Medicare+Choice success 
story, however, limited through their demonstration status and relative 
small number. They have documented an improvement in care delivery as 
well as health outcomes while actually reducing overall medical costs! 
These plans currently serve 25,000 Medicare beneficiaries, most of whom 
are institutionalized.
  How does this work? Through facilitating the physicians, nurses, and 
other health professionals to work together toward a common goal: 
better quality of life and health. By emphasizing preventive and 
primary care as much as acute and tertiary care, these care-givers look 
as much at getting through a crisis as they do at preventing the next 
adverse health event. This leads to fewer urgent and emergent 
healthcare visits, decreased need for skilled nursing facility 
placements, and shorter and fewer hospitalizations. Anyone who has 
visited an elder in the hospital knows that the cost of this care, 
however great, is small compared

[[Page S4845]]

to the unsettling nature of the event itself. Avoiding both is a win!
  While the improvement in healthcare delivery and costs are important, 
these plans can point to genuine improvements in health and quality of 
life. The quality of life toward the end of the lifespan should be no 
less important than it is when we are younger. Communication and 
involvement of the beneficiary's family, when possible, also leads to 
greater peace of mind and less anxiety for all.
  Evercare, an affiliate of the United Health Group, has participated 
in the demonstration project since 1995. In that time they have 
developed considerable experience and great success. They have reduced 
inpatient hospitalizations, patient mortality and improved clinical 
indicators of quality. All the while, they have also consistently 
achieved a 95% satisfaction rate among family members.
  In this demonstration project, Evercare has increased the vaccination 
rate for pneumonia to \2/3\ from less than half for most nursing home 
residents. Flu vaccine is delivered to 20 percent more patients than in 
the standard care system, and over 90 percent of the residents have had 
documented discussions around their future care, compared with less 
than 40 percent among general nursing home residents.
  The time and effort spent on this demonstration project by Evercare 
and others has given us the necessary information to move forward and 
offer such care to the much larger group of seniors that might benefit. 
However, these plans are continuing to face substantial hurdles to 
becoming permanent M+C options and expanding services to more 
beneficiaries. The Medicare Improvements for Special Needs 
Beneficiaries Act of 2002 provides improved access to these plans by 
removing the barriers and allowing plans to specialize in serving dual 
eligible, institutionalized, and other frail beneficiaries.
  This bill will allow a special ``Medicare+Choice'' program 
designation in order to allow plans to target enrollment to the frail 
elderly and concentrate care on this vulnerable population. The bill 
includes specific quality assurance and reporting requirements to 
ensure that these programs continue their success in improving health 
and healthcare.
  While we seek more and better means of improving service for our 
Medicare beneficiaries, we should not lose sight of some of the small 
success. Leveraging the success of the demonstration group. This piece 
of legislation will enable these programs to grow and mature, without 
additional cost. I hope my colleagues will join me in supporting this 
piece of legislation.
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