[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[Extensions of Remarks]
[Page 26917]
[From the U.S. Government Publishing Office, www.gpo.gov]



 INTRODUCTION OF THE HEALTH CARE PRESERVATION AND ACCESSIBILITY ACT OF 
                                  1999

                                 ______
                                 

                           HON. BOBBY L. RUSH

                              of illinois

                    in the house of representatives

                       Tuesday, October 26, 1999

  Mr. RUSH. Mr. Speaker, State hospitals all over the country are 
experiencing severe financial crisis due to the Balanced Budget Act of 
1997 (BBA 97, P.L. 105-33), which reduced Medicare reimbursements to 
hospitals and health service providers over a 5-year period. The BBA 
cuts ordered in 1999 were supposed to slow the growth of Medicare and 
save $112 billion over 5 years, including $4 billion from Medicare 
payments to hospitals. However, the BBA, which I opposed, has imposed 
severe financial burdens on teaching hospitals, rural hospitals, 
skilled nursing facilities, and home health providers. In my State 
alone, hospitals are estimated to lose $2.8 billion in Medicare 
payments over a 5-year period.
  The financial burden of the BBA cuts is causing severe pain for the 
teaching hospitals in my State. Because Illinois ranks fifth in the 
Nation in the number of teaching hospitals, and these facilities are 
expected to lose more than $1.6 billion over the 5-year period, of the 
BBA's life. These cuts have a devastating effect on the communities 
that they serve.
  In order to provide relief for these hospitals, I am introducing the 
Health Care Preservation and Accessibility Act of 1999, which will 
restore one-third of the difference between the projected and actual 
savings from hospitals. The legislation will accomplish this by 
freezing the cuts on teaching hospitals, rural hospitals, children's 
hospitals that operate graduate medical education programs, skilled 
nursing facilities and home health care. Specifically, my legislation 
will restore cuts in the following manner:
  Teaching Hospitals: Freezes the cuts in indirect medical payments 
(IME) to 1999 levels. It also freezes cuts in the disproportionate 
share payments (DSH payments) at 2% and provides payments directly to 
those serving a large share of low-income patients.
  Children's Hospitals--GME: Directs the Secretary of Health and Human 
Services to make payments as specified to each children's hospital for 
the cost reporting period under Medicare for FY 2000 and 2001 for the 
direct and indirect expenses associated with operating approved medical 
residency training programs.
  Rural Hospitals: Sets a floor on outpatient hospital payments so that 
rural hospitals do not fall below 1999 levels and establishes a new 
payment system for rural health centers.
  Safety Net Providers: Revises the payment system for community health 
centers so that it more adequately covers the costs and allows those 
providers that furnish service to low-income Americans to be directly 
compensated for their services.
  Rehabilitation Therapy Caps: Eliminates the $1,500 per beneficiary 
cap imposed by the BBA and replaces it with a payment system that is 
based on the severity of illness.
  Skilled Nursing Facilities: Revises the BBA's new prospective payment 
system for skilled nursing facilities. My bill will increase 
reimbursements for patients needing a high level of service to more 
accurately reflect the cost of their care. It will establish a 
demonstration program where the rule requiring a 3-day hospital stay 
for skilled nursing services can be waived for certain illnesses.
  Home Health Providers: Delays a 15% reduction in the interim payment 
system if the Secretary of Health and Human services misses the 
deadline for instituting the new prospective system. It also allows for 
interest free recoupment of overpayments due to HCFA's underestimation 
of the interim payment rates for certain agencies.
  My legislation also provides additional protections for senior 
citizens and persons with disabilities and strengthens protections and 
sanctions for Medicare fraud and abuse.
  I hope that my legislation, the Health Care Preservation and 
Accessibility Act of 1999 will provide the much-needed relief to the 
Illinois Hospitals that have been harmed by the 1997 BBA-imposed 
reductions.

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