[Congressional Record Volume 160, Number 59 (Thursday, April 10, 2014)]
[Extensions of Remarks]
[Page E571]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  INTRODUCTION OF THE STRENGTHENING HEALTHCARE OPTIONS FOR VULNERABLE 
                            POPULATIONS ACT

                                 ______
                                 

                          HON. KYRSTEN SINEMA

                               of arizona

                    in the house of representatives

                        Thursday, April 10, 2014

  Ms. SINEMA. Mr. Speaker, I rise today to ask my colleagues to join me 
in supporting the bipartisan Strengthening Healthcare Options for 
Vulnerable Populations Act.
  This legislation, which I will introduce today, extends the 
authorization of Medicare Advantage Dual Special Needs Plans, D-SNPs, 
and makes necessary improvements to this valuable program for 
vulnerable seniors.
  Special Needs Plans, or SNPs, are a type of Medicare Advantage Plan 
with membership limited to a specific population with specific diseases 
or characteristics, and tailored benefits, provider choices, and drug 
formularies developed to best meet the needs of the group they serve.
  Dual Special Needs Plans, or D-SNPs, are plans developed for 
individuals who are both Medicare and Medicaid eligible. The Medicare 
dual eligible population is low-income and more likely to have complex 
and costly healthcare needs. Nationally, it costs $300 billion to care 
for this population. D-SNPs are driving improved care outcomes and 
greater efficiency eliminating redundancies between the two programs.
  There are 125,000 dual eligible individuals in Arizona and nine 
million nationally. More than half of the dual eligibles in my state 
are enrolled in a D-SNP.
  D-SNPs in Arizona are well-run and have demonstrated success: 31 
percent lower rate of hospitalization; 43 percent lower rate of days in 
hospital; 9 percent lower emergency use; 21 percent lower readmission 
rate; 3 percent higher preventive care services.
  But D-SNPs are not just about controlling cost and improving 
healthcare delivery for a vulnerable population. D-SNPs, because of 
their innovative and targeted services, are a valuable option for 
seniors trying to live with dignity or people with disabilities trying 
to live fuller lives.
  Bonnie Grant is in her 60s and lives in south Phoenix. Through her D-
SNP, she has access to a transportation called Van Go. Bonnie uses the 
service to go shopping and other places ``instead of being stuck at 
home.'' She said that it helps because ``instead of being holed up in 
your home,'' she can be engaged in the community and enjoy her life.
  The Van Go benefit is the type of creative service offered by D-SNPs 
that improve the wellbeing of enrollees.
  Joseph Ford lives in suburban Phoenix. He was disabled in a car 
accident. The hands-on managed care he receives through his D-SNPs, 
including in-home visits, allows Mr. Ford to stay in his home and live 
a fuller life. Keeping individuals like Mr. Ford in their homes instead 
of institutional care facilities is better for the beneficiary and a 
significant cost savings to the Medicaid and Medicare programs.
  We need creative and commonsense solutions to control the cost and 
improve the quality of services provided to this vulnerable population, 
which includes seniors and single working mothers. That is what D-SNPs 
are doing and that is why we introduce this bill today.
  The Strengthening Healthcare Options for Vulnerable Populations Act 
will allow seniors to have greater choice, help drive down cost and 
improve outcomes.
  First, this bill extends authorization for D-SNPs and requires that 
plans fully integrate Medicare and Medicaid services, while providing 
states with flexibility to make the plans work for their citizens. This 
long term authorization will create stability in the SNP program, 
thereby allowing states, the federal government and the private sector 
to begin to develop consistent strategies for addressing care for dual 
eligibles. Beneficiaries will also know that the plan they have chosen 
will not be taken away.
  Second, the bill directs CMS in coordination with State Medicaid 
Directors to develop a clearly defined role for state Medicaid agencies 
in contracting and oversight of integrated D-SNPs.
  Third, the legislation follows the recommendation of National 
Association of Medicaid Directors (NAMD) to designate the Medicare-
Medicaid Coordinating Office within CMS as the dedicated point of 
contact to assist states with ongoing D-SNP administration issues, 
including eliminating redundancies and improving coordination of 
Medicare and Medicaid services and streamlining the flow of information 
to beneficiaries. The bill would also allow HHS to adjust Medicare's 
processes, timelines and requirements to improve the seamless delivery 
of patient-centered services across the care continuum.
  Fourth, the bill provides additional protections to beneficiaries by 
requiring CMS, in coordination with states, to establish a streamlined 
dispute resolution process and by requiring Medicare to continue to 
provide coverage during the dispute process.
  Lastly, our legislation improves the Medicare Advantage star ratings 
program to better evaluate and incentivize D-SNP performance. The bill 
directs CMS to take the necessary steps to recognize and incentivize 
performance by plans who serve more difficult or complex populations 
like the dual population.
  Ensuring that vulnerable seniors continue to have access to these 
valuable plans is an important part of ensuring that they can live out 
their golden years with dignity.
  The Strengthening Healthcare Options for Vulnerable Populations Act 
extends an important program for one of Arizona's most vulnerable 
populations. This bill ensures that seniors and others in these plans 
will be able to keep the managed care services they have selected. This 
bill provides states with greater flexibility to control cost and 
provide improved services. Finally, this bill can help control cost for 
a very expensive population nationally while at the same time improving 
healthcare outcomes.
  I urge my colleagues to join me in cosponsoring this important 
legislation.

                          ____________________