WEEK OF AUGUST 9, 1999
U.S. Rep. Phil English Washington Hotline
1410 Longworth
House Office Building
Washington, DC 20515
Things in DC have slowed down somewhat as the Summer District
Work Period began. Since no new legislation will be introduced, no
votes will be taken and no discussions will be held until September,
I thought I would take this opportunity to update you on some of the
legislation that I have introduced this year. Each week during the
recess I hope to give you a more in-depth look at what is going on
in the House.
Federal agencies effecting affordability and quality of health
care
The last few years have been especially difficult for
Pennsylvania hospitals as many of you are well aware of from local
news media reports. In 1997, the Health Care Financing
Administration (HCFA) and Pennsylvania's fiscal intermediary
reversed a long-standing interpretation of federal law regarding the
inclusion of General Assistance (GA) days in Medicare
Disproportionate Share (DSH) calculations. As a result, safety-net
hospitals are being forced to repay millions of dollars which have
been received during the last 12 years. Reversing this unfair
decision is a top priority of mine. Together with every Congressman
in Pennsylvania (from both parties), I’ve introduced legislation to
reverse this decision which would devastate our hospitals.
As we approach the second year of the 1997 Balanced Budget Act
(BBA), it appears that it may be having unintended consequences for
the availability and quality of health care. Recent reports from the
Congressional Budget Office indicate that HCFA (yes, them again) has
interprted the law in such a way as to reduce Medicare spending by
tens of billions of dollars below what Congress intended. Those of
you who live in Erie, Crawford and Mercer counties are seeing the
effects of these decisions in the Medicare +Choice program.
The Pennsylvania delegation has proposed legislation that would
"fine-tune" the BBA and correct some of its unintended consequences.
I believe that additional funding from the budget surplus earmarked
for BBA "fixes" is appropriate and would like to work in a
bipartisan fashion to craft such a bill.
As the Pennsylvania representatives develop relief proposals, our
concerns center on patient care issues and the fragile fiscal
environment that determines how well health care providers can meet
community health needs. We must consider the effects the BBA has had
on hospitals' ability to provide outpatient services and charity
care, as well as important elements such as rehabilitation therapy,
skilled nursing care and home health care.
At the same time, Congress must look at the educational aspects
of health care -- the programs that produce the doctors, nurses and
researchers who will treat us in the next century. We must maintain
the integrity of graduate medical education and our nursing and
allied health professional education programs to ensure that the
best and brightest will indeed have the opportunity to treat and
heal those who need help.
These are important issues, which affect Medicare beneficiaries
in Pennsylvania and across the country. I believe these problems can
be resolved by making BBA adjustments which do not compromise the
act's original goals.
Explaining Medicare Disproportionate Share...
The
Medicare Disproportionate Share (DSH) adjustment program was
implemented in 1986. Congress started the program because it
recognized that poor and elderly patients – especially in urban
areas – typically have multiple health problems of greater severity.
DSH was intended to buffer hospitals with substantial numbers of
low-income patients from the added costs of providing treatment to
this population.
But during the last 10 years, DSH has increasingly been viewed as
serving a broader purpose of protecting access to care for Medicare
and lower-income populations and lower-income populations by
assisting the hospitals they use.
Hospitals qualify for Medicare DSH after Medicare counts days of
care provided to SSI recipients who also receive Medicare, and days
for patients who were eligible for Medical Assistance. Historically,
in Pennsylvania, when Medicare officials counted medical assistance
days being reviewed for DSH eligibility, they included days for
patients who were in state-funded programs like General Assistance
(GA). But federal officials have told Pennsylvania hospitals that
they can no longer count GA days. HCFA also has implemented this
policy. For any open (ongoing) cost reports, hospitals are now being
required to identify and exclude GA days from their Medical
Assistance days count to determine eligibility for Medicare DSH.
It is expected that 21st district hospitals will lose about $5
million per year. Hospitals in our district that are effected
include: Butler Memorial Hospital; Hamet Medical Center, Erie; UPMC
Horizon, Farrell and Greenville; Metro Health Center, Erie;
Millcreek Community Hospital and St. Vincent Hospital, Erie.
Statewide the losses are anticipated to be in the tens of millions
each year.
HCFA and Medicare officials are basing their new interpretation
on the statute which states that inpatient days may be counted for
“... patients who for such days were eligible for medical assistance
under a State plan approved under subchapter XIX of this chapter.”
Under that interpretation, HCFA is disallowing GA days to as
“medical assistance days.” This is contrary to their interpretation
of the law since 1986.
On August 8, 1998, the entire Pennsylvania Congressional
delegation sent a letter to HCFA requesting that it revise its
decision to disallow inclusion of GA days. On October 1, 1998, HCFA
responded that their decision to disallow inclusion of GA days was
established by statute. HCFA acknowledged that Pennsylvania has been
including these days in the calculation since 1986. Also Medicare
officials would proceed with recouping what they now consider to be
overpayments under Medicare DSH, something I have tried to stop
through legislation. Under this legislation, HCFA would cease
collecting payments from these hospitals retroactively. The recouped
amounts that have been collected would be returned to the hospitals
As you can see health care is becoming more and more a complex
issue that must be resolved so that all Americans have affordable,
quality health care. Thanks for logging into the Washington Hotline.
If you would like to offer suggestions for topics of discussion or
to be taken off this list please contact Jennifer Hall at
Jennifer.Hall@mail.house.gov
Anyone interested in being added to the mailing list should
contact Jennifer in my office via email. When you are adding your
name, please be sure to include your town or city. And if you ever
need to contact me feel free to do so through the “Write your Rep”
link. Making email contacts to my office through the “Write your
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Stay cool during the dog days of August,
Phil | 
