[Congressional Record (Bound Edition), Volume 145 (1999), Part 20]
[Extensions of Remarks]
[Page 29622]
[From the U.S. Government Publishing Office, www.gpo.gov]



  MEDICARE, MEDICAID AND SCHIP BALANCED BUDGET REFINEMENT ACT OF 1999

                                 ______
                                 

                               speech of

                             HON. JIM RYUN

                               of kansas

                    in the house of representatives

                        Friday, November 5, 1999

  Mr. RYUN of Kansas. Mr. Speaker, I have heard over and over from the 
health care professionals and the Medicare patients in the 2nd District 
of Kansas about how devastating the unintended consequences of the 
Balanced Budget Act have been on the Medicare system.
  The BBA's attempt to reduce waste and fraud and prolong the life of 
Medicare by reducing reimbursements has unfortunately resulted in less 
care per patient, especially in rural Kansas. From 1997 to 1998 the 
average reimbursement per patient in Kansas dropped from $4,060 to 
$2,642 and the average number of visits per patient dropped from 65 to 
42. We can be certain that these figures do not reflect a sudden 
dramatic increase in healthy seniors.
  Too many seniors have watched their rural hospital or home health 
clinic close or are denied care as a result of the budget cuts. In 
Kansas alone, 60 Home Health Agencies have closed their doors over the 
last two years. It's time for us to reverse the Balanced Budget Act's 
death sentence on Medicare and the Health Care Financing 
Administration's poor interpretation of the Act.
  I was particularly pleased when Chairman Thomas, the author of this 
bill, came to Kansas to hear first hand the concerns of health care 
providers in my district. I know the Chairman took these concerns and 
so many others from around the country into consideration when he 
drafted this legislation.
  The Medicare Balanced Budget Refinement Act is a positive step toward 
halting the closing of home health agencies and rural hospitals and 
will ensure greater patient access to quality care. Particularly 
significant to keeping the doors of home health agencies open is the 
delay of the 15% payment reduction until a year after implementation of 
the prospective payment system. The Act also recognizes the paperwork 
burden the OASIS questionnaire places on nurses and agency staff and 
provides a $10 payment for each patient requiring this paperwork. The 
Medicare cuts for home health agencies were deep, and we cannot 
continue to expect agencies to do more with less. More importantly, 
many seniors will be able to remain in their homes rather than checking 
into hospitals and nursing homes.
  Small rural hospitals have also suffered from the BBA as their 
limited budgets have been stretched thin. The Medicare Balanced Budget 
Refinement Act assists small rural hospitals with the cost of 
transition to the new prospective payment system through the 
availability of up to $50,000 in grants to purchase computers, train 
staff and cover other cost associated with the transition. The Act 
eliminates the requirement for states to review the need for swing beds 
through the Certificate of Need (CON) process. It also eliminates the 5 
constraints on length of stay providing flexibility for hospitals with 
under 100 beds to participate more extensively in the Medicare swing 
bed program.
  Mr. Speaker, I voted against the Balanced Budget Act in 1997 largely 
because of the negative impact it would have on rural health care. I 
support H.R. 3075 because it goes a long way to correct the problems 
with the current system.

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