[Congressional Record Volume 148, Number 119 (Thursday, September 19, 2002)]
[Senate]
[Page S8927]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FEINGOLD:
  S. 2970. A bill to amend the XVIII of the Social Security act to 
assure fair and adequate payment for high-risk medicare beneficiaries 
and to establish payment incentives and to evaluate clinical methods 
for assuring quality services to people with serious and disabling 
chronic conditions; to the Committee on Finance.
  Mr. FEINGOLD. Madam President, I rise today to introduce the 
Promoting Care for the Frail Elderly Act of 2002, which is of critical 
importance to the most vulnerable Medicare beneficiaries, disabled 
seniors and those with complex medical conditions.
  A number of States have successfully chosen to serve seniors and the 
disabled by combining Medicare and Medicaid services through a waiver 
approved by the Department of Health and Human Services that integrates 
services under Medicare and Medicaid capitated financing arrangements. 
These programs provide beneficiaries with a comprehensive benefit 
package that combines the services traditionally provided by Medicare, 
Medicaid, and home and community based wavier programs.
  In my home State of Wisconsin, the Wisconsin Partnership Program, 
WPP, is one such success, a community-based program that has improved 
the quality, access, and cost-effectiveness of the care delivered to 
its beneficiaries. Perhaps most important to the beneficiaries, these 
programs help the disabled and the frail elderly remain in their own 
community, and avoid institutionalized care. Wisconsin is lucky to have 
four such programs across our State: Elder Care and Community Living 
Alliance of Dane County, Community Care for the Elderly of Milwaukee 
County, and Community Health Partnership of Eau Claire, Dunn, and 
Chippewa Counties.
  In order to qualify for these programs, a person must be Medicaid-
eligible, have physical disabilities or frailties of aging, and require 
a level of care provided by nursing homes. Through programs such as the 
Wisconsin Partnership Program, these frail elderly and disabled 
beneficiaries are able to receive quality preventive care up front, 
which allows more beneficiaries to stay in their communities and 
reduces the rate of hospitalization.
  In Wisconsin, about 26 percent of all Medicaid recipients age 65 or 
older are in nursing homes. This rate drops dramatically for those 
enrolled in the Wisconsin Partnership Program, where only 5.9 percent 
of recipients age 65 or older are in nursing homes.
  While the Wisconsin Partnership Program is a success, we must ensure 
that the Federal Government continues to support these State-based 
solutions to our long-term care needs and other specialty managed care 
programs that focus on frail, chronically-ill seniors. The current 
formula used to cover those enrolled in Medicare managed care programs 
overpays for healthy beneficiaries and underpays for the frail elderly 
and disabled. This payment method creates a backwards incentive for 
plans to avoid serving the most vulnerable segment of the Medicare 
population, the very seniors who could benefit most from program such 
as the Wisconsin Partnership Program.
  While a number of steps have been taken to improve these payment 
methods over the past four years, we must ensure that they meet the 
needs of Medicare beneficiaries with complex care needs.
  This legislation will help develop an appropriate incentive for 
specialty managed care programs serving a disproportionate number of 
frail, medically complex beneficiaries. My legislation will take 
several steps toward meeting this goal. First it will require the 
Center for Medicare and Medicaid Services to evaluate alternative risk 
adjustment methods that account for the higher costs borne by plans 
with a disproportionate number of high cost beneficiaries.
  During this study, it will also implement the recommendations of the 
Medicare Payment Advisory Commission by permitting these plans that 
currently operate under demonstration authority to maintain existing 
payment formulas until the Secretary devises a risk adjustment method 
that pays adequately for high risk enrollees. At the same time, it 
would also direct MedPAC to evaluate appropriate methods to adjust 
payment rates based on the makeup of the beneficiaries.
  Finally, my legislation would also authorize the Secretary to conduct 
a demonstration to enhance care and improve outcomes for frail, 
vulnerable Medicare beneficiaries.
  I would also like to make clear that this legislation uses existing 
funds to pay for these initiatives, and is thus budget neutral. It 
authorizes the demonstration program within existing dollars and would 
also provide additional funding for the frailty adjustment with 
existing Medicare+Choice dollars.
  Fundamental long-term care reform is vital to any health care reform 
that Congress may consider. As part of these reforms, we must support 
state and local efforts to encourage care for the most vulnerable 
populations. We must provide our seniors and disabled with real 
choices. They are entitled to the opportunity to continue to live in 
the homes and communities that they helped build and sustain. I urge my 
colleagues to support this measure that will help provide a measure of 
support for the most frail elderly and disabled to allow them to stay 
in their own homes.
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