[Congressional Record (Bound Edition), Volume 145 (1999), Part 7]
[EX]
[Pages 10021-10022]
[From the U.S. Government Publishing Office, www.gpo.gov]



        MEDICARE REHABILITATION BENEFIT IMPROVEMENT ACT OF 1999

                                 ______
                                 

                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                         Tuesday, May 18, 1999

  Mr. CARDIN. Mr. Speaker, I rise along with my colleagues Frank 
Pallone, Jim McCrery, and Richard Burr, to introduce the Medicare 
Rehabilitation Benefit Improvement Act of 1999. This legislation is an 
urgently needed, common sense approach that will help repair a damaging 
provision passed by Congress nearly two years ago.
  In recent years, cost pressures on the Medicare program have resulted 
in Congress imposing $115 billion in cuts on the Medicare program 
through the Balanced Budget Act of 1997. As a result, we have seen 
sharp reductions in payments for the elderly's care. Some of these cuts 
can be absorbed by our health care system. Others, however, cannot, and 
are having a devastating impact on the quality of patient care being 
delivered to the most frail, sickest Medicare beneficiaries. The 
Congressional Budget Office has just reported that actual BBA cuts to 
Medicare will exceed by billions of dollars what Congress intended for 
the five years from 1998 through 2002. It is time to look at what 
Congress actually did, and where appropriate, make necessary changes.
  BBA imposed annual $1,500 caps on Part B outpatient rehabilitative 
services--one for physical therapy and speech-language pathology, and 
one for occupational therapy--provided outside the hospital setting. In 
practice, these limits ignore a patient's clinical requirements and 
restrict care for those who suffer from the most debilitating diseases, 
such as stroke, hip fracture, or ALS, and those who incur multiple 
injuries in a given year. And because the caps are not adjusted for 
cost variations across the nation, they disproportionately harm 
beneficiaries in high cost areas. Finally, because the new consolidated 
billing rules imposed by BBA require all filing for patients in skilled 
nursing facilities to be done by the facility itself, those facilities 
that provide adequate therapy services to their sickest patients feel 
the brunt of the payment limits.
  When BBA was being written and debated, Congress held no hearings to 
examine what the impact of these arbitrary limits might be on patient 
care. The caps were a crude budget cutting measure designed to deliver 
savings--$1.7 billion over five years. And in that regard, they were 
successful. The therapy caps were implemented on January 1, 1999. Since 
that time, I have heard that in my district, some Medicare 
beneficiaries in SNFs have already exceeded their limit. Some estimates 
indicate that one of every six beneficiaries who receive rehabilitative 
care outside a hospital setting will need in excess of $1,500 in 
services in a given year. The Health Care Financing Administration's 
own words in the regulation implementing the cap, from the Federal 
Register of November 2, 1998, illustrate the problem:

       The $1,500 limits will reduce the amount of therapy 
     services paid for by Medicare. The patients most affected are 
     likely to be those with diagnoses such as stroke, certain 
     fractures, and amputation, where the number of therapy visits 
     needed by a patient may exceed those that can be reimbursed 
     by Medicare under the statutory limits. Services not paid for 
     by Medicare, however may be paid for by other payers.

  But what about Medicare enrollees who cannot afford high-priced 
supplemental insurance policies to cover the balances? Clearly, some 
relief is necessary so that all patients with serious conditions have 
access to adequate therapy services and the opportunity to resume 
normal activities of daily living.
  In the last Congress, I introduced bipartisan legislation that would 
eliminate the arbitrary therapy cap and instead pay for outpatient 
rehabilitative services based on the patient's diagnosis. But Congress 
adjourned without holding hearings on that bill. This year, we are 
beginning to witness the consequences of our failure to act. So today, 
I am pleased to join my colleagues in sponsoring the ``Medicare 
Rehabilitation Benefit Improvement Act,'' which is specifically 
designed to provide relief to beneficiaries who need greater levels of 
care. This bill creates limited exceptions to the $1,500 cap so that 
those patients who need additional care the most will be able to 
continue to receive it. The bill also requires the Secretary of HHS to 
study the impact of this legislation on beneficiaries and to develop 
alternatives to the $1,500 limits. This will help Congress determine if 
the caps for rehabilitative therapy services should continue.
  This legislation is a common sense approach that will permit Medicare 
patients who need intensive therapy services to secure the

[[Page 10022]]

appropriate level of care for their conditions. It has the strong 
endorsement of several organizations, including the American Health 
Care Association, the American Occupational Therapy Association the 
American Speech-Language-Hearing Association, the National Association 
of Rehabilitation Agencies, and the Private Practice Section of the 
American Physical Therapy Association. I urge my colleagues to join me 
in support of this essential measure to restore adequate therapy 
outpatient rehabilitative coverage to those beneficiaries most in need.

                          ____________________