[Congressional Record (Bound Edition), Volume 147 (2001), Part 11]
[Extensions of Remarks]
[Page 16236]
[From the U.S. Government Publishing Office, www.gpo.gov]



 INTRODUCTION OF MEDICARE REGULATORY AND CONTRACTING REFORM ACT OF 2001

                                 ______
                                 

                         HON. NANCY L. JOHNSON

                             of connecticut

                    in the house of representatives

                        Thursday, August 2, 2001

  Mrs. JOHNSON of Connecticut. Mr. Speaker, today I rise to introduce 
the bipartisan Medicare Regulatory and Contracting Reform Act of 2001. 
Over the past several months, I have been working closely with Pete 
Stark, Ranking Member of the Ways and Means Health Subcommittee, to 
assemble this much needed package. This legislation is the product of 
months of bipartisan consultation with health care providers and with 
the Department of Health and Human Services. Our bill will go a long 
way toward alleviating the burden of unreasonable and unnecessary 
regulatory paperwork from the nation's doctors and other health care 
providers.
  I am pleased that every member of the Health Subcommittee has decided 
to join me and Congressman Stark in introducing this important 
legislation, along with several of our colleagues from the full 
committee. This interest tells us that Members of Congress are hearing 
from doctors, from home health workers, from hospital administrators, 
from nursing home aides that change is needed. Good health care is 
about patients, not paperwork. America's health care providers must be 
freed from the flood of forms.
  My Subcommittee has been taking a serious and honest look at the 
problems of providers throughout the year. And I have to tell you--the 
problems are real. At a hearing in March, Susan Wilson of the Visiting 
Nurses' Association of Central Connecticut testified about how 
difficult it is for a provider to respond to a technical denial of a 
claim. For example, a patient must be homebound in order to be entitled 
to benefits. A physician must certify, in writing, that the patient 
meets the homebound requirement. However, if the certification is not 
signed and dated prior to billing for coverage, a claim denial is 
issued. At this point, a provider has to pursue a formal appeal. Our 
bill requires the development of a system to allow easy corrections of 
technical problems with claims without having to go through the appeals 
process--saving time for providers and for the appeals system.
  At a recent meeting of my Subcommittee, Congressman Camp told us that 
he spent an afternoon working in one of his local doctors' offices, 
filling out the forms that need to be completed before Medicare can be 
billed for a health care service. He was confronted with several books, 
each as large as a phone book, that needed to be consulted in order to 
properly code the claim. It just should not be that difficult.
  I have visited a wide cross section of Connecticut's health care 
providers--and they raise a common theme with me. They are frustrated. 
These are good people who want to take care of the patients they see. 
And yet they are inundated by forms, requirements, second-guessing, and 
heavy handed oversight. We have to take action, or we run the risk of 
driving from the Medicare program the very providers we need to ensure 
that seniors have access to high quality care.
  An eye physician from Torrington Connecticut contacted me earlier 
this year to express his frustration with a system that subjected him, 
in his words, ``to a star-chamber proceeding . . . for the crime of 
serving the elderly.'' This is unacceptable. We must act.
  My bill will diminish the paperwork load required to meet complex and 
technical regulatory requirements and immediately free up for patient 
care time that providers now spend completing and filing federal forms. 
Specifically, my bill streamlines the regulatory process, enhances 
education and technical assistance for doctors and other health care 
providers, and protects the rights of providers in the audit and 
recovery process to ensure that the repayment process is fair and open. 
At the same time, the bill has been carefully designed to protect 
ongoing and necessary efforts to reduce waste, fraud and abuse from the 
Medicare program.
  In addition, under this bill, the Secretary is given the tools to 
manage Medicare program operations competitively and efficiently. For 
the first time, the new Centers for Medicare and Medicaid Services will 
be able to contract with the best entities available to process claims, 
make payments and answer questions. And the Secretary will be free to 
promote quality through incentives for the Medicare Administrative 
Contractors to provide outstanding service to seniors and health care 
providers.
  The bill includes a section I am particularly excited about that will 
create a demonstration program designed to make intense and targeted 
technical assistance available to small health care providers. This 
demonstration will offer technical experts to work with small providers 
on a voluntary basis to evaluate systems for compliance and suggest 
more efficient or more effective means of operating their documentation 
and billing systems. This demonstration is modeled on successful work 
undertaken by the Occupational Safety and Health Administration to 
promote compliance with complicated requirements. Through this 
demonstration, we are going to help small providers overwhelmed by the 
complexity of Medicare's rules by showing them what they need to do to 
comply.
  We also create an ombudsman to help providers solve problems they 
encounter with the Medicare program. Too many doctors tell us that they 
operate in fear of making an innocent error and ending up with the very 
viability of their practice in jeopardy. We need to change that mind 
set--Medicare should help providers comply with rules--it shouldn't 
drive them away from the system.
  Passage of the Johnson-Stark bill will take a long step toward making 
that goal a reality. I look forward to working with my colleagues and 
with the Administration to see our bill become law this year.

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