[Congressional Record (Bound Edition), Volume 147 (2001), Part 14]
[Extensions of Remarks]
[Page 20003]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 20003]]

              THE MENTAL HEALTH COMMUNITY PARTNERSHIP ACT

                                 ______
                                 

                          HON. LYNN C. WOOLSEY

                             of california

                    in the house of representatives

                       Tuesday, October 16, 2001

  Ms. WOOLSEY. Mr. Speaker, Sonoma County, which I represent, as well 
as Stanislaus County in California, currently face a potential crisis 
in their mental health communities. In order for these County staffed 
inpatient psychiatric units to keep their Medicare provider status, 
under last year's HCFA rule, the hospitals would have to take over 
employment of County health care workers who currently provide the 
psychiatric care. Today I am introducing legislation that will enable 
the hospitals to keep their Medicare provider status while allowing the 
health care workers to remain County employees. This is an avenue the 
counties and hospitals currently don't have under the HCFA rules. Under 
my bill, everyone wins: County employees keep their job status, the 
hospitals retain their Medicare provider status, and Medicare patients 
will continue to receive the high quality treatment that they deserve.
  This predicament began when the agency formerly known as the Health 
Care Financing Administration (HCFA) issued the Provider-Based Rules 
(PBR) as part of the ``Outpatient Prospective Payment System'' final 
rule last year. The regulations were issued in an attempt to curb 
abuses and manipulation in the Medicare reimbursement system. However, 
it created an unintended consequence for my constituents.
  The concept behind the PBR was to regulate hospital acquisitions of 
off-site physicians' offices to ensure these outpatient sites were 
sufficiently integrated with a hospital in order to receive the higher 
cost-based reimbursement available only to hospitals. HCFA's rule also 
stated that this applied to inpatient services. In effect, the PBR 
prohibits management companies from employing the health care workers 
who provide the care at its inpatient hospital units. While this may 
seem reasonable on the surface, this employment requirement presents a 
serious problem that HCFA did not intend when it issued the PBR. In the 
case of Sonoma and Stanislaus counties, the counties employ both the 
management staff and the health care workers at local Sutter hospitals' 
inpatient psychiatric units. In my district, Sonoma County currently 
manages and employs the staff at the former Oakerest psychiatric unit 
(now the ``Norton Center'') through a contract with Sutter Medical 
Center of Santa Rosa. Preserving this management contract arrangement 
between Sutter and the County is critical because current County health 
care workers have the necessary expertise to deliver this specialized 
type of care to patients. My bill will allow this type of public-
private management contract arrangement to continue without threatening 
a hospital's Medicare provider status.
  In accordance with the PBR, the Norton Center can meet the seven 
requirements that demonstrate it is an integrated part of the Hospital. 
However, it cannot meet HCFA's additional requirements for entities 
operating through management contracts. Unless it can comply with all 
the regulations, the Norton Center will not receive any reimbursement 
under the Medicare and Medicaid programs. If the Norton Center has to 
forfeit its role as a Medicare and Medicaid provider, it may have to 
stop providing services altogether since it serves a high percentage of 
Medicare and Medicaid beneficiaries. HCFA's recommendation is that 
entities in violation of the management contract requirements just 
employ the County health care workers directly. This is not a realistic 
remedy for Sonoma County because it would result in the termination of 
approximately 60 County employees. That's why I am pleased to offer the 
``Mental Health Community Partnership Act,'' because I agree that the 
regulations were never intended to eliminate this form of public-
private management contract arrangements or threaten access to 
essential health care services. Specifically, this bill allows a 
hospital to contract with a public entity to provide inpatient 
psychiatric services, if the health facility is operated or managed by 
a state or local government. It's a win-win for everyone because it 
preserves the rule's original goal to curb Medicare abuse, the Norton 
Center will keep its Medicare provider status, County workers will keep 
their job status, and Medicare and Medicaid patients will continue to 
enjoy access to inpatient psychiatric services. Congress should take 
this opportunity to protect quality jobs and provide access to 
comprehensive health care for our most needy.

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