Grassley Works for Rural Health Care, Older Iowans


Senator Wins Chairman's Endorsement for Important Initiatives


Jill Kozeny

202/224-1308


Sen. Chuck Grassley today announced that the comprehensive bill to fund Medicare and Medicaid which the Senate Finance Committee began considering formally today contains many provisions he authored to help meet the challenges of rural health care delivery in Iowa and improve the quality of life of older Americans.

"Access to primary and even emergency care in rural America is a constant challenge. Since 1980, 420 rural hospitals across the country have closed their doors. Many of these hospitals were the victims of one-size-fits-all Medicare regulations designed for larger, full-service hospitals. That's why I have developed legislation to better tailor federal programs so that smaller community hospitals can fulfill their critical mission for rural residents. By including these provisions in the reform package unveiled today, Congress is taking action to help keep open the doors of rural hospitals," Grassley said.

The Iowa senator also expressed his commitment to improving health care for older Americans, especially those who are dually eligible for both Medicare and Medicaid. "Under the current system, these people are treated like ping-pong balls being bounced back and forth between providers and programs. So it's very good news that the Finance Committee will endorse my bill to expand unique systems of care that are designed specifically for the needs of frail elderly. These are coordinated-care programs that enable the frail elderly to remain as healthy as possible, at home in their communities. Under the Grassley PACE bill, nursing homes will no longer be the only option for seniors who require daily care," Grassley said.

In addition, Grassley stated he will continue his effort to fix the grossly unfair Medicare reimbursement rates in rural counties across the country upon which meeting the challenge of access to rural health care is heavily contingent. The bill presented today by Finance Committee Chairman William Roth of Delaware adopted Grassley's proposal to establish a 50/50 national/local blended payment rate for managed care entities. This blending of rates is a key tool in improving payment to areas where medical services are less costly, such as Iowa. Grassley said he will continue to fight for additional provisions which would make the payment system fairer to all areas of the country, including rural areas.

"The time to bring equity to the Medicare managed care payments system is now. Older Americans should have access to the same options within Medicare regardless of where they live. Today, Iowans have no other choice than the standard fee-for-service option. An unfair payment system leaves older Iowans without benefits available to others, including free eyeglasses, prescription drugs, wellness programs, and hearing aids. I want to bring equity to the system so that those who want the managed care option have access to it," Grassley said.

Specifically, items from the rural health care "first aid kit" and other legislative initiatives proposed by Grassley and included in the proposal put forward by Roth on Tuesday include the following:

  • The Primary Care Health Practitioner Incentive Act of 1997. This legislation would increase the availability of quality health care in America by requiring Medicare to reimburse nurse practitioners and clinical nurse specialist for services they are licensed to perform. The legislation would establish direct reimbursement in all settings at 85 percent of the physician reimbursement schedule. Under current law, only a supervising physician may be reimbursed. This limits the ability of nurses to serve in rural areas;
  • The Physician Assistant Incentive Act of 1997. This provides the same reimbursement protection described in the previous item to physician assistants under Medicare. By allowing these qualified health care professionals to operate independently, they may be able to establish a practice in a small town otherwise unable to support a full-time physician;
  • The Medicare Dependent Hospital Act (MDH) of 1997. This legislation would reinstate the MDH program which lapsed in 1994. It would allow small hospitals with 60 percent of inpatient days or discharges attributed to Medicare to select a more beneficial reimbursement arrangement with Medicare;
  • The Rural Health Improvement Act of 1997. Based on two successful pilot programs, this legislation would allow hospitals with 15 or fewer beds to apply for waivers from certain Medicare regulations designed for larger, full-service hospitals. Grassley said the added flexibility will help keep open the smaller hospitals, which often are the only source of emergency care within 30 miles;
  • The Medicare Patient Choice and Access Act of 1997. Grassley introduced this legislation to establish consumer protection standards for those enrolled in Medicare managed care plans. He has said that while managed care may be a useful cost-containment tool, it should always provide quality health care. Major provisions of Grassley's bill were included in the Finance Committee proposal including a requirement that the Secretary of Health and Human Services (HHS) provide beneficiaries information about how doctors are compensated, an expedited appeals process for urgent cases and a 30-day review for all grievances and appeals, and a requirement that the Secretary contract with an independent entity to review all appeals for urgent cases;
  • The Medicare Beneficiary Information Act of 1997. This legislation will enable Medicare beneficiaries to make an informed choice about whether to enter a Medicare managed care plan and, if so, which plan best meets their personal health care needs. "Having the choice of managed care means nothing without having the knowledge to make an informed choice," Grassley said. The provision will require that beneficiaries be provided with a user-friendly comparative chart with which to compare the various options available within their area;
  • The Rural Health Care Protection Act of 1997. This legislation aims to protect access to acute care for rural Americans. It would help Sole Community Hospitals remain viable. It also enhances Medicare payments to Rural Referral Centers, which provide sophisticated care to patients referred from community hospitals within their regions; and,
  • The PACE Provider Act of 1997. This legislation was written to improve health care for our nation's most vulnerable elderly. It is designed to provide coordinated care for frail seniors who are eligible for both Medicare and Medicaid. By coordinating both Medicare and Medicaid benefits for frail seniors, quality of life is improved and money is saved. Grassley held an Aging Committee hearing that examined this topic.

During negotiations on the Chairman's proposal, Grassley also won added protection for Medicare beneficiaries who rely upon home oxygen equipment with approval of language which directs the Secretary of HHS to employ Peer Review Organizations to evaluate access to and the quality of this durable medical equipment program.

In addition, Grassley responded to concerns of Iowans on home health care. Many had expressed concern that a proposed redefinition of the "home bound" criterion for home health services would deny access to needed services. Roth accepted Grassley's proposal that further study be devoted to the effect on beneficiaries of such a change, rather than immediately making the change without a full understanding of its impact on seniors.

Beginning Tuesday morning, the Finance Committee is scheduled to meet throughout the week to amend and approve the Chairman's proposal. The legislation then must be considered by the full Senate and ultimately reconciled with the version advanced by the House of Representatives before it can be sent to the White House for the President's signature.

Grassley for many years has been a leader in Congress for improving rural health care. In January, he was elected Chairman of the Senate Special Committee on Aging.