Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I yield the Senator from Tennessee 5 minutes.

Mr. JEFFORDS. Mr. President, I yield to the Senator from Tennessee as much time as he may desire.

Mr. JEFFORDS. Mr. President, I yield the Senator from Maine such time as she may take.

Mr. JEFFORDS. I yield 5 minutes to the Senator from Iowa.

Mr. JEFFORDS. Mr. President, I yield 5 minutes to the Senator from Minnesota.

Mr. JEFFORDS. I will defer to the distinguished Senator from Oklahoma. Mr. NICKLES addressed the Chair.

Mr. JEFFORDS. There are 48 million. It is higher. Somewhere in that area. From 20 to 48.

Mr. JEFFORDS. Somewhere around 20 million.

Mr. JEFFORDS. I can give you a number.

Mr. JEFFORDS. As we are going along here, we have two different approaches, and the approach we take is that we are trying to help those women who are primarily under ERISA prohibitions----

Mr. JEFFORDS. I yield 1 minute to the majority whip.

Mr. JEFFORDS. I yield 10 minutes to the Senator from Maine.

Mr. JEFFORDS. Mr. President, I want to continue this only if it is on the Senator's time. I don't have the ability----

Mr. JEFFORDS. They can do that, but it will not be legally binding. The patient will have an appeal because in the law it says it must be necessary and appropriate care that must be provided. They cannot define necessary. They cannot define appropriate. That is a standard which we established after evidence as to what the best care is that should be available to them. The provisions are in the bill.

Mr. JEFFORDS. Objection.

Mr. JEFFORDS. Mr. President, I yield 1 minute to the Senator from Texas.

Mr. JEFFORDS. I yield 7 minutes to the Senator from Michigan.

Mr. JEFFORDS

Mr. JEFFORDS. If there is no further business to come before the Senate, I now ask unanimous consent the Senate stand in adjournment under the previous order.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent that when the Senate complete its business today it stand in adjournment until the hour of 9:30 a.m. on Wednesday, July 14. Further, I ask unanimous consent that on Wednesday, immediately following the prayer, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate stand in a period of morning business until 10 a.m., with Senators speaking for up to 5 minutes each with the following exceptions: Senator Grams of Minnesota, 15 minutes; Senator Daschle, or his designee, for 15 minutes.

Mr. JEFFORDS

Mr. JEFFORDS. For the information of all Senators, the Senate will convene at 9:30 and be in a period of morning business until 10 a.m. Following morning business, the Senate will immediately resume consideration of S. 1344, the Patients' Bill of Rights legislation. Debate will continue on the pending amendment until all time has expired. Additional amendments are expected to be offered and debated throughout tomorrow's session of the Senate. Therefore, Senators should anticipate votes throughout the day on Wednesday. As always, Senators will be notified as votes are scheduled.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I send to the desk an amendment to Calendar No. 169, previously passed by the Senate. I ask unanimous consent it be immediately adopted and the motion to reconsider be laid upon the table.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to introduce the Preserving Access to Care in the Home Act of 1999, also known as the PATCH Act. This important bill has been crafted to protect access to care for those most in need, relieve the cash flow problems faced by agencies, and improve the interaction between home health agencies and HCFA. I want to recognize Senator Reed, Senator Enzi, and Senator Leahy. These cosponsors have shown tremendous effort and dedication in dealing with the crisis in home health care. Abraham Lincoln said ``The legitimate object of government is to do for a community of people, whatever they need to have done, but cannot do at all, or cannot so well do for themselves, in their separate and individual capacities.'' This is the essence of home health care. Home health care means so much to so many people: it means that people recovering from surgery can go home sooner--it means that someone recovering from an accident can get physical therapy in their home, it means our seniors can stay at home, and out of nursing homes. It is smart policy from human and financial standpoints. My own State of Vermont is a model for providing high-quality, comprehensive care with a low price tag. For the past eight years, the average Medicare expenditure for home health care in Vermont has been the lowest in the nation. Vermont's home care system was designed to efficiently meet the needs of frail and elderly citizens in our largely rural State, but the Health Care Financing Administration's (HCFA) reimbursement system was not. HCFA's interim payment system (IPS) has been implemented in a manner that inadequately reimburses agencies for the care that they provide. The Balanced Budget Act (BBA) did a lot of good, providing health care coverage for millions of low income children, providing targeted tax relief for families and students, tax incentives to encourage pensions savings, and extending the life of Medicare. However, as with most things in life, it was not perfect. The BBA failed to recognize how the new home health reimbursement would affect small rural home health care providers. The IPS has caused such significant cash flow problems, that many agencies are struggling to meet their payroll needs. Home health care agencies are now facing the prospect of 15 percent budget cut next year. This budget cut, on top of already stretched budgets, would be disastrous for providers and patients alike. The PATCH Act will rectify these problems. First, the PATCH Act eliminates the 15-percent cut scheduled for next year. The actual savings under IPS have exceeded initial expectations, so the 15-percent cut is unnecessary to achieve the savings originally projected as needed. Second, the PATCH Act clarifies the definition of ``homebound'' so that coverage decisions are based on the condition of the individual and not on an arbitrary number of absences from the home. Many seniors have found themselves virtual prisoners in their homes, threatened with loss of coverage if they attend adult day care, weekly religious services, or even visit family members in the hospital. This makes no sense because all of these activities are steps on the road to successful and healthy recovery. Often, home care professionals want patients to get outside a little bit, as part of their care plan. This helps fight off depression. Eligibility for home care should depend on the health of the patient. Third, the PATCH Act creates an ``outlier'' provision so that medically complex patients suffering from multiple ailments are not excluded by the Medicare program. Agencies will receive reimbursements for reasonable costs so that they can continue to provide care for these complex patients without going bankrupt. Home health agencies can provide care to long-term chronic care patients at a lower cost than nursing homes, or hospitals. Next, the PATCH Act also matches the rate of review to the rate of denial and provides a reward to agencies for ``good behavior'' and incentive to submit ``good claims.'' Conducting high cost, intense audits on all agencies, regardless of the past efficiency of the agency, is expensive and unproductive. Many agencies are finding themselves swamped by pre-payment reviews for claims that they submit. These reviews require that health professionals spend a substantial amount of their time filling out forms instead of providing urgently needed care to the elderly. Matching the rate of review to the rate of denial adds to the efficiency of home health agencies, and the efficiency of the regulatory. If the finalized denial rate of claims for a home health agency is less than 5 percent then (a) there will be no prepayment reviews, and (b) the post-payment review shall not exceed 10 percent of the claims. Finally, the bill restores the periodic interim payment system (PIP) and provides guidelines to HCFA on the development of a prospective payment system (PPS) that will be fair to Vermont's low-cost, rural providers. The sooner you can return patients to their homes, the sooner they can recover. The familiar environment of the home, family, and friends is more nurturing to recovering patients than the often stressful and unfamiliar surroundings of a hospital. Home health allows them to receive treatment for their medical conditions while being integrated back into independence. Home health is also a great avenue for education. It empowers families to assist in the care of their loved ones. This, too, results in lower costs because family members, in addition to health professionals, provide some of the care. Access to care in the home must be saved. I look forward to turning this legislation into law. The women and men who provide home care are on the front line every day and deserve nothing but our best efforts.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent the Senate immediately proceed to executive session to consider the following nominations en bloc on the Executive Calendar, Nos. 157, 158, 161, 162, and 163. I finally ask unanimous consent that the nominations be confirmed en bloc, the motion to reconsider be laid upon the table, and any statements related to the nominations appear in the Record, the President be immediately notified of the Senate's action, and the Senate then return to legislative business.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to introduce the Preserving Access to Care in the Home Act of 1999, also known as the PATCH Act. This important bill has been crafted to protect access to care for those most in need, relieve the cash flow problems faced by agencies, and improve the interaction between home health agencies and HCFA. I want to recognize Senator Reed, Senator Enzi, and Senator Leahy. These cosponsors have shown tremendous effort and dedication in dealing with the crisis in home health care. Abraham Lincoln said ``The legitimate object of government is to do for a community of people, whatever they need to have done, but cannot do at all, or cannot so well do for themselves, in their separate and individual capacities.'' This is the essence of home health care. Home health care means so much to so many people: it means that people recovering from surgery can go home sooner--it means that someone recovering from an accident can get physical therapy in their home, it means our seniors can stay at home, and out of nursing homes. It is smart policy from human and financial standpoints. My own State of Vermont is a model for providing high-quality, comprehensive care with a low price tag. For the past eight years, the average Medicare expenditure for home health care in Vermont has been the lowest in the nation. Vermont's home care system was designed to efficiently meet the needs of frail and elderly citizens in our largely rural State, but the Health Care Financing Administration's (HCFA) reimbursement system was not. HCFA's interim payment system (IPS) has been implemented in a manner that inadequately reimburses agencies for the care that they provide. The Balanced Budget Act (BBA) did a lot of good, providing health care coverage for millions of low income children, providing targeted tax relief for families and students, tax incentives to encourage pensions savings, and extending the life of Medicare. However, as with most things in life, it was not perfect. The BBA failed to recognize how the new home health reimbursement would affect small rural home health care providers. The IPS has caused such significant cash flow problems, that many agencies are struggling to meet their payroll needs. Home health care agencies are now facing the prospect of 15 percent budget cut next year. This budget cut, on top of already stretched budgets, would be disastrous for providers and patients alike. The PATCH Act will rectify these problems. First, the PATCH Act eliminates the 15-percent cut scheduled for next year. The actual savings under IPS have exceeded initial expectations, so the 15-percent cut is unnecessary to achieve the savings originally projected as needed. Second, the PATCH Act clarifies the definition of ``homebound'' so that coverage decisions are based on the condition of the individual and not on an arbitrary number of absences from the home. Many seniors have found themselves virtual prisoners in their homes, threatened with loss of coverage if they attend adult day care, weekly religious services, or even visit family members in the hospital. This makes no sense because all of these activities are steps on the road to successful and healthy recovery. Often, home care professionals want patients to get outside a little bit, as part of their care plan. This helps fight off depression. Eligibility for home care should depend on the health of the patient. Third, the PATCH Act creates an ``outlier'' provision so that medically complex patients suffering from multiple ailments are not excluded by the Medicare program. Agencies will receive reimbursements for reasonable costs so that they can continue to provide care for these complex patients without going bankrupt. Home health agencies can provide care to long-term chronic care patients at a lower cost than nursing homes, or hospitals. Next, the PATCH Act also matches the rate of review to the rate of denial and provides a reward to agencies for ``good behavior'' and incentive to submit ``good claims.'' Conducting high cost, intense audits on all agencies, regardless of the past efficiency of the agency, is expensive and unproductive. Many agencies are finding themselves swamped by pre-payment reviews for claims that they submit. These reviews require that health professionals spend a substantial amount of their time filling out forms instead of providing urgently needed care to the elderly. Matching the rate of review to the rate of denial adds to the efficiency of home health agencies, and the efficiency of the regulatory. If the finalized denial rate of claims for a home health agency is less than 5 percent then (a) there will be no prepayment reviews, and (b) the post-payment review shall not exceed 10 percent of the claims. Finally, the bill restores the periodic interim payment system (PIP) and provides guidelines to HCFA on the development of a prospective payment system (PPS) that will be fair to Vermont's low-cost, rural providers. The sooner you can return patients to their homes, the sooner they can recover. The familiar environment of the home, family, and friends is more nurturing to recovering patients than the often stressful and unfamiliar surroundings of a hospital. Home health allows them to receive treatment for their medical conditions while being integrated back into independence. Home health is also a great avenue for education. It empowers families to assist in the care of their loved ones. This, too, results in lower costs because family members, in addition to health professionals, provide some of the care. Access to care in the home must be saved. I look forward to turning this legislation into law. The women and men who provide home care are on the front line every day and deserve nothing but our best efforts.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, as in executive session, I ask unanimous consent that the injunction of secrecy be removed from the following treaty transmitted to the Senate on July 13, 1999, by the President of the United States: Extradition Treaty with Paraguay (Treaty Document No. 106-4). I further ask that the treaty be considered as having been read the first time; that it be referred, with accompanying papers, to the Committee on Foreign Relations and ordered to be printed; and that the President's message be printed in the Record.