[Congressional Record (Bound Edition), Volume 145 (1999), Part 9]
[Extensions of Remarks]
[Page 13229]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 13229]]

INTRODUCTION OF THE MEDICARE HOME HEALTH ACCESS RESTORATION ACT OF 1999

                                 ______
                                 

                         HON. WILLIAM J. COYNE

                            of pennsylvania

                    in the house of representatives

                        Wednesday, June 16, 1999

  Mr. COYNE. Mr. Speaker, today I am introductory the Medicare Home 
Health Access Restoration Act of 1999. I am introducing this 
legislation because of the dramatic changes the Interim Payment System 
(IPS) has made in the way home health care is provided in my home state 
of Pennsylvania and elsewhere. I am concerned that those changes are 
making it more difficult for the sickest and most vulnerable Medicare 
recipients to get the home health services to which they are entitled.
  Medicare provides home health services to homebound patients who need 
skilled nursing care. Many of these patients are recovering from 
surgery or receiving therapy after a serious illness like a stroke. 
Home care recipients often suffer from chronic illnesses that require 
monitoring, like severe diabetes and some mental illnesses. Home health 
care recipients tend to be the oldest, sickest, and poorest of Medicare 
beneficiaries. They are disproportionately low-income and over 85. They 
report being in fair or poor health. Three-fourths of them cannot 
perform at least one basic activity of daily living, like bathing, 
cooking, or getting out of bed. Almost half of home care recipients 
cannot perform 3 or more activities of daily living.
  In Pennsylvania, where home care costs and visit frequency have 
always been lower than the national average, home care visits have 
declined by over 25 percent since IPS became effective. That means the 
average home care recipient sees a nurse 11 times less under IPS than 
she did before, perhaps getting one visit a week instead of two. Over 
90 percent of my state's home health agencies reported that they will 
lose money in the first year of IPS and 6,100 home care workers have 
been laid off. These changes are causing agencies to provide less care, 
spend less time caring for patients, and avoid the patients who most 
need help.
  Like most other people who are concerned about the home care benefit, 
I support the shift to the prospective payment system, which will allow 
us to pay more accurately for the services beneficiaries receive. But 
it could be quite a while before PPS is implemented, particularly since 
the Health Care Financing Administration has temporarily suspended 
collection of the necessary data. The Interim Payment System is what we 
have now, and we could have it for a long time. It is affecting patient 
care now, and I do not believe we can just live with it'' for the 
months or years until the PPS is ready.
  The low IPS caps on payments for home health services mean that 
agencies often can't afford to provide Medicare beneficiaries with the 
services they need and to which they are entitled. Because the caps are 
based on individual agency 1994 spending, the problem is particularly 
serious for historically low-cost agencies. The low-cost agencies were 
given the lowest caps. Since they have already trimmed the fat from 
their operations, they are being forced to lay off nurses and cut 
services. The caps also create wide regional variation, and Medicare 
beneficiaries in historically efficient areas receiving much smaller 
benefits.
  Because the caps are based on an ``average'' patient, it is 
particularly difficult for the sickest patients to access care. The IPS 
does not acknowledge that some agencies specialize in very sick 
patients and that some individual patients require so much care that 
few agencies can afford to serve them. The current system creates an 
incentive for agencies to avoid admitting the sickest patients or to 
discharge them early.
  The legislation I am introducing today would make several important 
changes in the IPS. (1) It would gradually move toward a more equitable 
and reasonable payment level by increasing the payments for efficient 
agencies, increasing the number of times a home care nurse is allowed 
to visit a sick patient, and repealing the scheduled 15% cut in 
payments. (2) It would provide exceptions to the caps for the costliest 
patients and agencies that specialize in treating them. (3) It would 
protect beneficiaries from being inappropriately discharged because of 
the caps.
  Medicare's sickest and most vulnerable patients cannot wait much 
longer for Congress to act. Each day that the current system is in 
effect, home care agencies close or lay off workers, beneficiaries in 
states with low caps receive less service than they need, and high-
needs patients struggle to find agencies that will serve them. These 
reductions in the quality and quantity of home care services put 
patients right back where no one wants them to be--in expensive 
hospital and nursing home beds.

         Summary of Medicare Home Health Access Restoration Act

       Purpose: To restore access to home health services for 
     Medicare recipients whose necessary care has been curtailed 
     or eliminated due to provisions in the 1997 Balanced Budget 
     Act.


                            MAJOR PROVISIONS

       Adjusts per-beneficiary limits to provide fair 
     reimbursement to efficient agencies. The bill would increase 
     the per beneficiary limit for agencies with limits under the 
     national average to 90% of the national average in 1999, 95% 
     in 2000, and 100% in 2001. The bill would also cap payments 
     to providers at 250% of the national average in 1999, 225% in 
     2000, and 200% in 2001.
       Provides exceptions to caps for agencies that specialize in 
     a particular type of hard-to-serve patients AND for 
     individual ``outlier'' patients. Agencies that can 
     demonstrate to the Secretary that they specialize in treating 
     a much more expensive population will be exempted from the 
     250% payment cap. All agencies could apply for quarterly 
     ``outlier'' payments if they treated more costly than average 
     patients. HCFA will also be required to report back to 
     Congress regarding their implementation of the exceptions 
     policy, to ensure that the provisions are implemented in a 
     timely manner and that the relief is reaching agencies.
       Increases the per-visit limit to 110% of the median.
       Permanently repeals the 15% cut in IPS home health 
     payments. The bill eliminates the 15% cut from the Interim 
     Payment System.
       Protects beneficiaries from inappropriate discharge. The 
     bill provides Medicare beneficiaries with a notice of 
     discharge similar to the one provided to Medicare+Choice 
     hospital patients. It requires HCFA to provide information to 
     physicians about how the IPS affects their patients.
       Requires a GAO study on the value of home care to the 
     Medicare program. The bill asks the Comptroller General to 
     document the impact that providing home care (or not 
     providing home care) has on other government spending, 
     including Medicare inpatient services and Medicaid nursing 
     home reimbursement.

     

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