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Extensions of Remarks 7727 Extensions of Remarks April 16, 1996 EXTENSIONS OF REMARKS 7727 EXTENSIONS OF REMARKS MEDICARE BENEFICIARY PROTEC­ Differences in plan benefits and costs would Recognizing the special needs of individuals TION AMENDMENTS-H.R. 1707 be presented in easy, comparative formats. A with disabilities and chronic-illness, the criticism of managed care plans has been the amendments guarantee enrollees access to HON: FORTNEY PETE STARK lack of readily available, understandable and designated centers of excellence. The stand­ OF CALIFORNIA comparable information of plans. This legisla­ ard for the designation of a center of excel­ IN THE HOUSE OF REPRESENTATIVES tion works to correct this by requiring Medi­ lence will be established by the Secretary. care-contracting plans to provide descriptive Factors that would be included in the Sec­ Tuesday, April 16, 1996 information on plan utilization review require­ retary's designation would include specialized Mr. STARK. Mr. Speaker, last May, I intro­ ments, plan standards for contracting with pro­ education and training, participation in peer-re­ duced legislation designed to ensure that viders, provider credentials, and plan physi­ viewed research, and treatment of patients Medicare beneficiaries have access to quality cian payment arrangements. This bill would from outside the facility's geographic area. care and fair treatment by their HMO's and standardize the basic benefit package for To improve due process for providers in net­ managed care plans. Today, I reiterate the Medicare HMO's. Plans could not impose cost works, public notices would be required as to need for Medicare beneficiary protection and sharing other than nominal copayments for when applications by participating providers urge passage of the needed safeguards that Medicare-covered services. Also, limits on ad­ are to be accepted. Notification of a decision H.R. 1707 provides. ditional benefits must be fully explained and to terminate or not renew a contract would be An important issue addressed by this meas­ enrollees given reasonable notice that benefits required not later than 45 days before it is to ure is the serious abuse of marketing prac­ are expiring. take effect. tices by HMO's. Abuses by sales agents are Managed care is a system that provides fi­ In order to ensure access to enrollees especially prevalent in geographic areas nancial incentives to provide less care. A 1989 throughout a plan's service area, the Sec­ where people have little experience with man­ GAO report concluded that this system that retary may require plans to contract with cer­ aged care. The commission system in which puts providers at financial risk for expensive tain clinics and other essential community pro­ many HMO agents work is an inappropriate fi­ medical treatment inherently contains incen­ viders in the service area. In general, the serv­ nancial incentive which leads to pressure tives to deny or delay needed care. The prob­ ice area of a Medicare-contracting plan would sales to vulnerable beneficiaries. For example, lem of inconsistent and delayed utilization re­ be an entire metropolitan statistical area. when Geraldine Dallek of the Center for view practices of managed care plans would To comply with this plan, Federal regulators Health Care Rights provided testimony last be remedied i.n several ways by H.R. 1707. would be given authority to impose intermedi­ year to the Senate Special Committee on First, financial compensation could not be ate sanctions. Currently, the Secretary has the Aging, she reported a story of a woman from given to individuals performing the UR based authority to bar participation in Medicare. Los Angeles who was a victim of these prac­ upon the number of denials. Second, negative Under this plan, the Secretary could prohibit tices. The woman, Mrs. B, who has a fifth determinations about medical necessity or ar:r plans from enrolling beneficiaries until it meets grade education, received an unsolicited visit propriateness will be required to be made by all Federal requirements. A new review proc­ from an HMO marketing agent. When Mrs. B clinically qualified personnel. Also, final deter­ ess would allow HMO's to submit a corrective refused to sign up for the plan, the representa­ mination of coverage must be made within 24 action plan for violations. A civil money pen­ tive persuaded her to sign an enrollment form hours. alty up to $25,000 for each violation that ad­ by telling her that it would only be used to ver­ The amendments would also update HMO versely affects an individual enrolled in the ify his visit. plans in the area of access to emergency plan would be authorized. To remedy abusive HMO marketing prac­ medical services. Specifically, plans could not The Medicare beneficiary protection amend­ tices, H.R. 1707 would prohibit door-to-door require preauthorization for true emergency ments are a powerful step toward safeguard­ marketing and allow beneficiaries to enroll via medical care and could not deny a claim for ing the health of Medicare beneficiaries. Last mail. Also, it would limit the percentage of a beneficiary who uses the "911 " system to year, an inspector general's survey found that compensation received through commissions access services. Also, plans must define 16 percent of enrollees planned to leave their and require plans to recover commissions if "emergency medical care" in terms easily un­ HMO, but felt they could not. Even worse, 66 the beneficiary disenrolled within 90 days. derstood by the average person. An example percent of disabled/ERSD enrollees wanted to Most HMO enrollees give up their supple­ of why this is needed is given by the Center leave their HMO's. These statistics and others mental or MediGap coverage when they enroll for Health Care Rights which reports a case of indicate that HMO's are often failing to pror:r in an HMO. Many fear that if they disenroll a San Diego woman who went to her HMO's erly serve many Medicare beneficiaries. The from an HMO, no insurance company will sell urgent care center for treatment of an injury. remedies I propose will move us toward better them a supplemental policy. This is a very se­ She was told that the center had many people quality and a fairer managed care system. rious issue for those who leave their HMO be­ waiting and only one doctor on duty. The ben­ cause they are ill and believe the HMO is not eficiary was instructed to go to the nearest providing them adequate care. Under my bill, emergency room. The HMO later denied her CELEBRATING TUFTONIA'S WEEK beneficiaries will be able to secure a supple­ claim because the emergency room treatment mental plan after moving out of an HMO. H.R. was not authorized. HON. Bill RICHARDSON 1707 requires Medicare-contracting plans and These requirements will also benefit physi­ OF NEW MEXICO MediGap plans to participate in an open en­ cians by mandating reimbursement by the IN THE HOUSE OF REPRESENTATIVES rollment process. This provision allows for a plan to those physicians who provide emer­ beneficiary to enroll, disenroll, or change plans gency services in nonplan hospitals in order to Tuesday, April 16, 1996 during this period without being subject to fulfill the Federal antidumping law. Mr. RICHARDSON. Mr. Speaker, in just a medical underwriting or preexisting exclusions. An important protection standard in this leg­ few short weeks, many of us will be attending Also, the difficulty beneficiaries have making islation would benefit those who seek out-of­ college graduations watching as countless comparisons among Medicare coverage or:r plan treatment: Providers plans would be pro­ numbers of our constituents finish their college tions would be dealt with by having the Sec­ hibited from charging more than Medicare education, graduate, and become alumni. retary conduct annual open enrollment peri­ would have paid under fee-for-service rules. As seasoned alumni know, you always ods. During this period, Medicare beneficiaries Also, plans would be required to make ar­ maintain a special tie to your college. At my could enroll in traditional Medicare coverage rangements for beneficiaries to have occa­ alma mater, Tufts University actively encour­ or any additional HMO-managed care options. sional dialysis service outside the plans area. aged alumni to celebrate their college days by e This "bullet" symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor. 7728 EXTENSIONS OF REMARKS April 16, 1996 participating in annual "Tuftonia's Week" cele­ morgue for years. I'm not trying to be mor­ effect. It's true that satirical columns picked brations. It is a special time for more than bid in the Edgar Allan Poe mode. "Morgue" up a prize from time to time, as long as they 88,000 alumni of Tufts to tum their thoughts to is what old newshounds call their paper's li­ weren't too funny. I will not deny that al­ brary, and it's somebody's job to keep the though I am not often funny, I am definitely Tufts and to get together with fellow obits up to date. "Pulitzer Prizewinning col­ silly and that seemed to me the kiss of Tuttonians, to reminisce with old friends. umnist" will also juice up the resume if I death. Tuftonia Week also allows the university to ever have to start jobhunting again. Don't What I received yesterday, said the AP, focus attention on its enormously successful laugh. Downsizing is the order of the day. I was "a special award for what the Pulitzer alumni program called, "TuftServe." Last year, command a large salary, several dollars a board described as 'his extraordinary and Tufts alumni contributed more than 19,000 vol­ week over scale.
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