[Congressional Record Volume 148, Number 146 (Wednesday, November 13, 2002)]
[Senate]
[Pages S10884-S10885]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             BENEFICIARY ACCESS AND MEDICARE PAYMENT EQUITY

 Mr. NELSON of Nebraska. Madam President, today I urge the 
Senate to act on the Beneficiary Access and Medicare Payment Equity 
package before the end of the session. Nebraska's health care providers 
are hurting financially. They need help from Congress to stop these 
Medicare reimbursement cuts or many will not be able to provide 
treatment to Medicare patients. Our 40 million seniors who depend on 
the Medicare system for their

[[Page S10885]]

health care coverage need to know they have access to quality, 
affordable care. The bill addresses a number of Medicare inequities 
including cuts to hospitals, home health care providers, physical 
therapists, physicians, and skilled nursing facilities.
  The Nebraska Hospital Association estimates that in this bill 
Nebraska hospitals would receive approximately $56 million in 
additional revenue for one year and $120 million over three years. the 
hospitals in my State need this funding to survive financially.
  This legislation would have a tremendous impact on Nebraska's 
teaching hospitals. Teaching hospitals receive indirect medical 
education (IME) payments because they have higher patient care costs 
than non-teaching hospitals due to the extra costs incurred for 
teaching. The Balanced Budget Act, BBA, of 1997 cut these payments, and 
a provision in this bill would provide for additional relief. Nebraska 
has two academic medical centers--the University of Nebraska Medical 
Center and Creighton University Medical Center--and both would benefit 
from this legislation. Other hospitals in my State would also benefit 
including: Alegent Bergan Mercy in Omaha, Alegent Immanuel in Omaha, 
Nebraska Methodist in Omaha, BryanLGH Medical Center in Lincoln, St. 
Elizabeth Regional Medical Center in Lincoln, Good Samaritan in 
Kearney, and St. Francis in Grand Island.
  The legislation also increases the Federal Medicaid disproportionate 
share hospital, DSH, allotment in extremely low-DSH States, such as 
Nebraska, from 1 percent to 3 percent of program costs. Even though the 
allotment percentage would be tripled, it is still far less than the 
national average. The DSH program provides relief to safety net 
hospitals that provide critical health care access to 42 million 
uninsured people in our country. Nebraska and 14 other States receive 
far less funding through the Medicaid DSH program per Medicaid and 
uninsured resident than the rest of the Nation and this lack of funding 
threatens the viability of many safety net hospitals.
  A number of other important provisions are included that would help 
Nebraska's hospitals including: equalizing the standardized amount for 
rural and other urban hospitals; adjusting the wage index rate; 
increasing Medicare DSH payments to rural hospitals; extending the hold 
harmless provision for rural hospitals for outpatient services for an 
other year; and improving the Critical Access Hospital program by 
allowing more flexibility in allocating swing and inpatient acute care 
beds.
  In addition to providing much-needed relief to hospitals, the bill 
also eliminates the 15 percent reduction in home health payments. This 
cut would reduce payments to home health care providers in my State by 
nearly $2 million per year. Nebraska providers cannot afford this cut. 
The legislation also recognizes the additional costs incurred by rural 
home health care providers and give them an addition 10 percent in 
payments.
  I am also pleased that the bill eliminates the $1500 outpatient 
therapy cap for two years. This arbitrary limit discriminates against 
Medicare beneficiaries who desperately need outpatient therapy to help 
them recuperate from surgery, a stroke, or other medical condition.
  As I mentioned last month, we also need to rectify the physician 
payment cut. Under current law, Medicare's physician payment rates are 
projected to fall by 12 percent over the next three years. Nebraska 
physicians' losses due to the 2003-2005 cuts will total about $63 
million or $17,230 per physician. This comes on top of a 5.4 percent 
payment cut which cost Nebraska doctors a total of $12.9 million or 
about $3,875 per physician in 2002.
  I also spoke of the need to help skilled nursing facilities which are 
experiencing severe financial difficulty. If action isn't taken, 
Nebraska's facilities will lose $28..48 per patient per day next year 
for a total of $10 million.
  Finally, I have spoken many times about providing fiscal relief to 
our States. This legislation also includes $5 billion in fiscal relief 
to States by increasing the Federal Medicaid matching rate and by 
providing a temporary social services block grant. This provision, that 
I helped author, would give Governors some needed flexibility in 
assessing the needs of their States. States would be eligible for the 
Medicaid funding increase as long as the eligibility levels they had in 
place on January 2, 2002 are maintained. Unfortunately, the Nebraska 
Legislature made Medicaid eligibility cuts in the recent special 
session, and these cuts would prevent our State from receiving the full 
funding available. However, I crafted a provision that would allow 
Nebraska to receive the funding if they reinstate these Medicaid cuts 
in the future.
  We need to pass this legislation before the session ends. Our 
Nation's seniors need to know that they can depend on the Medicare 
system for their health care needs. I look forward to working with my 
colleagues in addressing these important issues.

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