March 6', 1986 EXTENSIONS OF REMARKS 3989 EXTENSIONS OF REMARKS MEDICARE CONTINUING CARE health benefits more equitable and cost effec­ aries continue to be protected until an alterna­ EQUITY AND QUALITY ASSUR­ tive and by protecting the beneficiary's rightful tive system, such as that offered by CCEQA, ANCE ACT OF 1986 access to quality medical, hospital, post-hospi­ can be put in place. tal and restorative care. Among the other prominent changes HON. EDWARD R. ROYBAL The legislation I am introducing today is the CCEQA makes in Medicare's continuing care OF CALIFORNIA most recent of three companion bills that ad­ benefit and quality assurance system are the IN THE HOUSE OF REPRESENTATIVES dress the problems of access and quality following: which elderly patients are now facing. CONTINUING CARE PROVISIONS Thursday, March 6, 1986 The first of these companion bills, the The current waiver of liability for nursing Mr. ROYBAL. Mr. Speaker, today I rise to "Quality Assurance Act of 1985" [QUARA]­ home and home health care is replaced by a introduce the "Medicare Continuing Care (H.R. 1970) was introduced April 3, 1985. This system of prior authorization. Where the ad­ Equity and Quality Assurance Act of 1986" legislation builds upon the current quality as­ ministration stops at dropping the waiver, [CCEQA]. CCEQA is a comprehensive reform surance system by requiring that the Depart­ CCEQA replaces it with a more equitable al­ package that addresses serious problems of ment of Human Services [DHHS] and its con­ ternative; access and quality which beneficiaries now tract Peer Review Organizations [PRO] Current restrictions on beneficiary appeals face under Medicare's continuing, long-term expend at least as much effort and resources are lifted to make all Medicare claims appeal­ care and acute care benefits. It substantially for quality as for cost containment; by extend­ changes the way continuing care benefits are ing quality assurance activities to all providers; able and to permit providers to represent managed and upgrades the quality assurance by involving patients, local consumer boards beneficiaries in all cases of appeal; system for the entire Medicare Program. and States in the quality review process; and Independent PRO review of medical neces­ The House Select Committee on Aging, by developing improved methods for measur­ sity and practical considerations is built into which I chair, has taken a hard look at prob­ ing and assuring quality across service set­ the current appeals process for continuing lems of access and quality resulting from tings. care claims; health care cost containment over the past The second bill, the "Medicare Beneficiary Uniform criteria and protocols are estab­ year. In 1985, two major hearings were held Protection Act of 1986" (H.R. 4065), was in­ lished to make claim determinations more that showed that: First, elderly patients are troduced January 29, 1986, to prevent the ad­ equitable and predictable within and across in­ being discharged sooner and sicker due to ministration from dropping the Medicare termediaries and over time; pressures on hospitals to shorten lengths of waiver of liability that helps to protect benefici­ The performance criteria for fiscal interme­ stay under prospective reimbursement; and ary access to needed home health and skilled diaries, now heavily weighted toward cost-sav­ second, actions by the administration are se­ nursing services. The Medicare waiver gives ings, are changed to give equal weight to ac­ verely limiting beneficiary access to essential limited financial protection to health providers curacy as to savings; and nursing home and home health care. who accept patients they have good reason to A vehicle is created to directly involve con­ These hearings confirmed that health care believe are eligible for Medicare coverage, but sumers, providers and intermediaries in the cost containment is putting America's elderly whose claims are subsequently denied. If this development and implementation of CCEQA in a classic catch-22 bind. While, on the one provision is eliminated without reforms to pro­ provisions and other continuing care policies hand, we are seeing older patients being dis­ tect beneficiary access, providers will have at the national level. charged sooner and sicker from our hospitals, every reason to limit their participation in Med­ QUALITY ASSURANCE PROVISIONS this is only half the story. Efforts by the ad­ icare, to pull out of the program altogether or PRO's are required to expend at least as ministration to contain the cost of continuing to turn patients away whenever there is any much effort and resources for quality as for long-term care are also limiting the elderly's question of Medicare coverage. cost containment; access to the home health and post-hospital H.R. 4065 reflects congressional opposition PRO's are required to extend quality assur­ skilled nursing home services-care they need to dropping the waiver by containing language ance activities to all providers, including nurs­ now more than ever. Follow-up studies by the identical to that agreed to by Senate and ing home and home health providers; committee also revealed problems inherent in House conferees in the "Consolidated Omni­ Patients, local consumer boards and States how Medicare's acute and continuing care bus Reconciliation Act of 1985"-an act are involved in the quality review process benefits are administered. As a result, I have passed by the House just minutes ago. through local consumer advisory boards; called through CCEQA for a major restructur­ Since H.R. 4065 was introduced, the admin­ Improved methods are to be developed for ing of the Medicare Program. istration has issued a final rule to drop the measuring and assuring quality across service What has become clear is that efforts to Medicare waiver of liability, effective March settings through a new national council on contain provider costs are, instead, taking a 24, 1986. Also since this time, a companion quality assurance; and direct toll on the Medicare beneficiary's bill to H.R. 4065 has been introduced by the For the,first time, standards are set for dis­ access to quality physician, hospital, nursing Honorable Senator GLENN in the Senate (S. charge planning that must be met by all Medi­ home and home health care. The alarming re­ 2122). One of the primary provisions of the care hospitals and that will protect against ality is that for the first time in the history of legislation I am introducing today is to pre­ premature discharge and promote the pa­ public health policy, concerns for quality and serve the Medicare waiver of liability in the tient's smooth transition into post-hospital access to care have become secondary to short term and, over a 30-month period, re­ care. concerns for cost. place it with a system of prior and concurrent Only through changes such as these can Where Congress and the administration in authorization for skilled nursing home and we adequately protect Medicare beneficiaries particular have moved quickly to contain home health claims. Where the administration from the adverse effects of cost-driven public health care costs, there has not been a corre­ stops at dropping the Medicare waiver, policy. Only through such changes can we sponding push for a solid system of quality as­ CCEQA goes further to replace it with a more build an equitable and high quality system of surance to monitor cost containment and pro­ equitable alternative that protects benefici­ acute and chronic care. Only through such ac­ tect beneficiaries from the adverse effects of aries while also maintaining cost-controls. tions can we move beyond the notion of cost­ a system that has been squeezed too hard. With the date on which the Medicare waiver efficient to cost-beneficial health care. And, The continuing long-term care and quality will expire just days away, the House has only with these reforms in mind can we assurance reforms in CCEQA take a major acted well to pass a reconciliation bill with the begin-as I have begun-to finish the unfin­ step forward to correct these deficiencies by waiver of liability provision intact. If passed by ished agenda of Medicare and Medicaid by making Medicare's nursing home and home the Congress, this will ensure that benefici- making comprehensive health care coverage e This "bullet" symbol identifies statements or insertions which are not spoken by the Member on the floor. 3990 EXTENSIONS OF REMARKS March 6, 1986 available to Americans of all ages. I refer here boards and creates "hot-lines" for Medicare Secretary of DHHS on the design, imple­ to my plans to introduce, in the next several providers and consumers. mentation and evaluation of the continuing days, the "USHealth Act" which provides cat­ Promotes the development of improved care provisions of this Act; on the develop­ astrophic and basic health protection for all methods for measuring and assuring quality ment and interpretation of definitions, poli­ through a new national council on quality cies and regulations under Medicare's con­ Americans regardless of age or income. assurance. tinuing care benefit; on the allocation of re­ The reforms in CCEQA are not minor-but Establishes guidelines and standards for sources for the administration of these ben­ neither are the health care needs and related hospital discharge planning to prevent pre­ efits; and on the management of other Med­ financial risks of older and younger Ameri­ mature discharge and ensure a smooth tran­ icare and Medicaid continuing <long term> cans. In this spirit, the Congress cannot move sition to post-hospital care. care benefits. quickly enough to correct the deficiencies of THE ISSUE Council members include persons with ex­ our current health care system that have put During 1985, the House Select Committee pertise in geriatrics and rehabilitative prac­ the nation's elderly in a catch 22 bind.