CONGRESSIONAL RECORD — Extensions of Remarks E1943 the wrong way to approach a short term eco- health the devastated arts community of New family. Mrs. O’Connor has been a familiar nomic stimulus bill. It is not temporary, and in- York in the wake of the September 11th at- sight on the playing fields of Shrewsbury. She stead of addressing the needs of laid off work- tacks. Broadway may be rebounding, but the and her husband John have three sons, John, ers, the Republican bill is a give away to the performance artists and the small art galleries, Kevin, and Brian. wealthiest Americans and corporations. Even who have no marketing campaign behind It is a pleasure to present the 2001 Eleanor Treasury Secretary O’Neill has said the bill is them, are suffering. A fully funded NEA could Roosevelt Humanitarian Award to a woman misguided. The country would be much better be the key to restoring this once thriving arts whose devotion to community and family ex- served by considering the comprehensive community and drive the economic recovery of emplifies the values of Eleanor Roosevelt. aviation security bill I introduced with other New York. But unless we make a commitment f Democrats on the Transportation and Infra- to dramatically increase its budget, it will not structure Committee. This should have been have the ability to lead these efforts. INTRODUCING MEDICARE CHRONIC one of our top priorities in the days after Sep- However, the arts are not just an economic CARE IMPROVEMENT ACT OF 2001 tember 11, but six weeks later we have not engine. They also provide the emotional and seen floor action. spiritual lift that we have all needed this past HON. FORTNEY PETE STARK There are numerous problems with the Re- month. In the wake of the attacks, music halls OF CALIFORNIA publican bill, but I am particularly troubled by around the country were packed. A crying na- IN THE HOUSE OF REPRESENTATIVES a provision that will allow multi-national cor- tion flocked to the theater to laugh again. Peo- Tuesday, October 30, 2001 porations to avoid paying U.S. taxes by taking ple went to dance concerts and museums for profits out of this country. How does this stim- a sense of community and emotional release. Mr. STARK. Mr. Speaker, today I join with ulate our economy? Some of the business In times of crisis, the arts can provide comfort several colleagues to introduce the Medicare provisions in this bill are retroactive all the way in a frightening world. Chronic Care Improvement Act of 2001. This back to 1986. In addition, the Republicans I salute the appropriators for supporting comprehensive piece of legislation would up- provide no immediate federal support for un- Challenge America. But I caution, if we do not date and improve the Medicare healthcare de- employment insurance or health care benefits support the other vital elements of the NEA, livery system to better meet the needs of peo- for laid off workers, but instead make benefits the flourishing arts communities we have ple with serious and disabling chronic health dependent on later actions by the states. We turned to in recent weeks will surely whither conditions. need to get money directly to middle and low- away. Individuals with chronic illnesses represent income workers to get that money back into f the highest-cost, fastest-growing sector in the economy. healthcare, accounting for 90% of morbidity, Mr. Speaker, I urge my colleagues to reject TRIBUTE TO DONNA LARGESS 80% of deaths, and over 75% of national di- this outrageous Republican bill, and then let O’CONNOR rect medical expenditures. For a person who us move quickly to consider aviation security is seriously disabled by their chronic condition, legislation. We have already waited far too HON. JAMES P. McGOVERN annual medical expenditures can be nearly 15 long. OF MASSACHUSETTS times that of a healthy person. Furthermore f IN THE HOUSE OF REPRESENTATIVES approximately 100 million Americans have Tuesday, October 30, 2001 chronic conditions and this number is ex- CONFERENCE REPORT ON H.R. 2217, pected to increase to 157 million—or half the DEPARTMENT OF THE INTERIOR Mr. MCGOVERN. Mr. Speaker, I rise today to honor Donna Largess O’Connor. Her polit- population—by 2020. AND RELATED AGENCIES APPRO- Although chronic conditions are America’s PRIATIONS ACT, 2001 ical commitment to the ideals of the Demo- cratic Party, as well as her contributions to number one healthcare problem, we have a SPEECH OF civic and charitable causes deserves com- healthcare system that is designed around mendation and respect. acute care needs. A recent IOM report, Cross- HON. JERROLD NADLER A life long resident of Shrewsbury, Mrs. ing the Quality Chasm, appropriately con- OF NEW YORK O’Connor graduated from Shrewsbury High cludes, ‘‘chronic conditions should serve as a IN THE HOUSE OF REPRESENTATIVES School, Memorial Hospital School of Nursing, starting point for the restructuring of health Wednesday, October 17, 2001 and Worcester State College. She has been care delivery because chronic conditions are Mr. NADLER. Mr. Speaker, I rise in support employed since 1973 at the Memorial Campus now the leading cause of illness, disability, of the Interior Appropriations bill. It is far from of UMass Memorial Medical Center, currently and death in the United States, affecting al- perfect, but it is thankfully free of the most ob- as Unit Manager of the Neonatal Intensive most half of the population and accounting for jectionable provisions we have seen the last Care Unit. the majority of health care resources used.’’ several years. While contributing to the care of newborns, This statement is particularly true with re- I want to take special note of the modest in- Mrs. O’Connor also played a special role in spect to Medicare beneficiaries—about 80% of crease once again granted to the National En- the town. She was elected to the board of se- those aged 65 and older have one chronic dowment for the Arts, Challenge America lectmen, serving as Chair, Vice Chair and condition and two thirds have two or more. For Grant. This is a very important program that Clerk during her twelve-year tenure. She was women, the numbers are even higher—90% helps bring the arts to areas of this country a Board member of the Massachusetts Munic- have one or more chronic diseases. that have traditionally been under-served. I’m ipal Association; the Massachusetts Select- Chronic illnesses are physical and mental happy to see this vital program continuing to man’s Association, Women Elected to Munic- conditions that are persistent, recurring, and be supported. ipal Office, and the Worcester County Select- can range from mild to severely disabling. At the same time, however, I can’t help but man’s Association. Additionally, she served as Some have acute periods that require hos- be disappointed that the other activities of the Chair of the Coolidge School Renovation pitalization, while others can be successfully NEA will continue to receive flat funding. After Project, the Town of Shrewsbury Growth managed to prevent costly hospitalizations. years of contentious debate, I suppose we Study Committee, and the Worcester County Conditions like arthritis, depression, and hy- could be thankful that at least it’s not a cut. Advisory Board. Currently, she is a member of pertension are particularly common among But in reality, it is a cut. Level funding means the Town of Shrewsbury Finance Committee, older Americans. Others, such as schizo- that the resources that the NEA needs to do Town Meeting Member, and a member of the phrenia and multiple sclerosis, can lead to its job get stretched thinner year after year. National Association of Neonatal Nurses. profound impairment and disability in Ameri- I appreciate the hard work of the appropri- Somehow, Mrs. O’Connor found time for po- cans under 65. ators, but I hope that in the future we can litical volunteering as well. She served as the We cannot deliver 21st century healthcare work to increase the NEA’s budget to a level Co-Chair with her cousin Linda Parmakian for with a system that was designed a half-cen- that would enable it to fulfill its core mission of the Committee to Elect Congressman Jim tury ago, before angioplasty or bypass surgery nurturing work that would not, on its own, re- McGovern, member of the Shrewsbury Demo- for heart disease and before L-dopa for Par- ceive popular support. At times, this may cratic Town Committee, and delegate to many kinson’s disease. Medical discoveries like mean supporting forms of expression that we Democratic State Conventions. A tireless cam- these have transformed many illnesses from ourselves may not agree with. But that is one paigner, Mrs. O’Connor works hard to secure rapidly disabling conditions to chronic condi- way we promote a free society. an election. tions that people live with for a long time. But A true National Endowment for the Arts However, despite her involvement with her the healthcare system that works for dev- would play a vital role in nursing back to community, her priority has always been her astating heart attack does not work for chronic E1944 CONGRESSIONAL RECORD — Extensions of Remarks October 30, 2001 illnesses, which benefit from a completely dif- conditions. I urge my colleagues to join me in tion, cumulative costs, and quality indica- ferent group of services. taking a major step forward in improving the tors in Medicare. For example, Medicare data show that peo- quality of care for Medicare beneficiaries with Direct the Secretary to report the study results to Congress every 3 years. The report ple with chronic conditions see eight different chronic health conditions. must include recommendations on improving physicians on average. Yet Medicare does not MEDICARE CHRONIC CARE IMPROVEMENT ACT care for Medicare beneficiaries with chronic compensate physicians for time spent commu- OF 2001 conditions, reducing chronic conditions, and nicating with each other around complex pa- TITLE I—EXPANSION OF BENEFITS TO PREVENT, reducing related medical expenses. tient needs, monitoring for harmful drug inter- DELAY, AND MINIMIZE THE PROGRESSSION OF Identify improvements in Medicare to ensure ef- actions, or teaching patients and caregivers CHRONIC CONDITIONS fective chronic condition care how to better manage their conditions. As a Improve access to preventive services Direct the Secretary to contract with the result, these crucial care coordination services Eliminate deductibles and co-insurance for IOM to investigate and identify barriers and are rarely provided. Medicare covered preventive services. facilitators to effective care for Medicare To effectively meet the needs of individuals Streamline process of approving preventive beneficiaries with chronic conditions, includ- with chronic conditions, our healthcare system benefits by directing the Secretary of Health ing inconsistent clinical, financial, or ad- and Human Services to contract with the In- ministrative requirements across care set- must reward care coordination as well as pre- stitute of Medicine (IOM) to investigate and tings. The IOM’s report must include rec- vention and health promotion. We must pro- recommend new preventive benefits every 3 ommendations to improve access to effective mote early diagnosis, interdisciplinary care, years. Grant the Secretary the authority to care. and counseling and education for patients and implement these recommendations, and fast- Definitions track the recommendations through Con- their caregivers. Furthermore, we must de- ‘‘Chronic condition’’ means one or more gress if the Secretary chooses not to act velop more effective national policies on physical or mental conditions which are upon this authority. chronic condition care by studying chronic likely to last for an unspecified period of condition trends, including utilization, quality, Expand access to health promotion services time, or for the duration of an individual’s and costs of services for patients with chronic Establish demonstration projects to pro- life, for which there is no known cure, and mote disease self-management. which may affect an individual’s ability to conditions. Implement a Medicare health education The medical discoveries of the 20th century carry out basic activities of daily living and risk appraisal program no later than 18 (ADLs), instrumental activities of daily liv- have dramatically prolonged the life expect- months after a series of demonstration ing (IADLs), or both. ancy of persons with all types of chronic con- projects conclude. ‘‘Serious and disabling chronic condi- ditions. In the 21st century, our challenge is to Expand coverage for care coordination and as- tion(s)’’ means the individual has one or reduce the progression of disability and im- sessment services more physical or mental conditions and has prove the functional status and quality of life of Create a new benefit that covers assess- been certified by a licensed health care prac- persons with chronic illness. ment, care coordination, counseling, and titioner within the preceding 12 months as The Medicare Chronic Care Improvement education assistance for individuals with se- having a level of disability such that the in- Act of 2001 strives to achieve these goals by: rious and disabling chronic conditions. Serv- dividual for at least 90 days, is unable to per- form at least 2 ADLs or a number of IADLs Improving access to preventive and ices could be provided by health care profes- sionals, including physicians, social workers, or other measure indicating an equivalent wellness services for Medicare beneficiaries; and nurses. Examples of items and services level of disability or requiring substantial Covering assessment and care coordination to be covered include: initial and periodic supervision due to severe cognitive impair- services for Medicare beneficiaries with seri- health screening and assessments; manage- ment. ous and disabling chronic conditions; ment and referral for medical and other f Refining fee-for-service payments for physi- health services; medication management; cian and post-acute services and M+C risk ad- and patient and family caregiver education THE IMPORTANCE OF ROYAL- justment methodologies to more accurately ac- and counseling. TIES—A SONGWRITER’S PER- count for the costs of chronic illnesses and TITLE II—ESTABLISH PAYMENT INCENTIVES FOR SPECTIVE disabilities; FURNISHING QUALITY SERVICES TO INDIVID- Studying chronic condition trends and costs UALS WITH SERIOUS AND DISABLING CHRONIC CONDITIONS HON. JOHN CONYERS, JR. to serve as the basis for improved Medicare Improve Medicare financing methods OF MICHIGAN policies on chronic care; and Direct the Secretary to refine Medicare IN THE HOUSE OF REPRESENTATIVES Commissioning an Institute of Medicine prospective payment systems for skilled Tuesday, October 30, 2001 study to identify barriers and facilitators to ef- nursing facility (SNF), home health, ther- fective chronic illness care, with a report and apy, partial hospitalization, end stage renal Mr. CONYERS. Mr. Speaker, today I am in- recommendations to Congress. dialysis (ESRD), and outpatient hospital serting into the RECORD a letter to me from For more detail, I am also entering a sec- services and refine resource-based relative Mr. Lamont Dozier, a fellow Detroiter who rose tion-by-section bill summary into the CON- value scale (RBRVS) payment methods for to the top of his profession as an award-win- GRESSIONAL RECORD following this statement. physicians to ensure appropriate payment ning songwriter, artist, and producer. In fact, This legislation has been endorsed by a va- for serving individuals with serious and dis- Mr. Dozier has been so successful that his ca- abling chronic conditions. riety of health organizations representing con- Direct the Secretary to refine reer has lasted for more than four decades, in- sumers and providers: Medicare+Choice risk adjustment method- cluding a stint as a songwriter for Motown Chronic Care Coalition: American Associa- ology to provide adequate payment for plans Records with the team of Holland-Dozier-Hol- tion of Homes and Services for the Aging; with specialized programs for frail elderly land. American Geriatrics Society, Catholic Health and at-risk beneficiaries. That success, however, did not come easily. Association of the United States, Elderplan Until the refined risk adjustment method- Most people usually think of the singer or Social HMO, National Chronic Care Consor- ology is implemented, direct the Secretary group who performed the song, not the song- to continue current payment methodologies writer or composer who wrote it. We easily re- tium, National Council on the Aging, National for existing specialized programs for frail el- Family Caregivers Association. derly and at-risk beneficiaries. member the Supremes and Phil Collins when National Depressive and Manic-Depressive Create a demonstration program to provide we hear ‘‘Baby Love,’’ ‘‘Stop in the Name of Association. additional payments to Medicare+Choice Love,’’ or ‘‘Two Hearts.’’ But if we look closely Association for Ambulatory Behavioral plans that provide a specialized program of at the liner notes on the albums for those Healthcare. care for beneficiaries with serious and dis- songs, we see songwriting credits for none American Lung Association. abling chronic conditions. These plans must other than Lamont Dozier. The Supremes and American Academy of Neurology. exclusively serve such beneficiaries or serve Phil Collins could never have had those hits a disproportionate share of such bene- United Seniors Health Cooperative. ficiaries. The demonstration program would had it not been for Mr. Dozier and his cre- American Neurological Association. expire one year after the refined risk adjust- ativity. In fact, through his artistic genius, we Let us not forget—Medicare is the major ment methodology is implemented. can understand the notion (to use the words source of health coverage for seniors with TITLE III—STUDY AND REPORT ON EFFECTIVE of Frances W. Preston, President and CEO of chronic conditions. As Congress considers CHRONIC CONDITION CARE Broadcast Music, Inc.) that ‘‘it all starts with a modernization strategies, we must take action Evaluate Medicare policies regarding chronic song.’’ to protect Medicare and ensure that its benefit, condition care In his letter, Mr. Dozier explains the impor- financing and oversight structures are able to Direct the Secretary to study chronic con- tance of copyrights, royalties, and perform- better meet the needs of persons with chronic dition trends and associated service utiliza- ance rights organizations. The Copyright Act