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Senate Proceeding on Dec 4th, 2009 :: 8:13:05 to 8:27:50
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Max Baucus

8:13:01 to 8:13:22( Edit History Discussion )

Max Baucus: senate to support senator johanns when we come to a vote on this thank you, mr. president. i yield the floor. mr. baucus: mr. president? the presiding officer: t senator from mr. baucus: i heard that this is

Max Baucus

8:13:05 to 8:27:50( Edit History Discussion )
Speech By: Max Baucus

Max Baucus

8:13:23 to 8:13:43( Edit History Discussion )

Max Baucus: going to hear from senators that this will hurt seniors, words like smoke screen and all of that. this is a well thoughtout considered policy that i think strikes a very good balance between getting care to -- especially to seniors at home, which is so important, on the one hand and making sure that

Max Baucus

8:13:44 to 8:14:04( Edit History Discussion )

Max Baucus: there's not waste on the other hand. i mean, that is our responsibility here is to make sure that the program works an works well. i have sort after special interest in this. my mother's in the hospital, about two weeksgo, and she fortunately is doing much better. she's in the hospital. i spent some time with home

Max Baucus

8:14:05 to 8:14:26( Edit History Discussion )

Max Baucus: health caregiver, who is doing -- with whom i was very, impressed. thisome health person was just doing a great job with my mother and -- and i've seen other instances too. but, personally, i was very happy to see my mother in very, very good care from a home health care nurse. i think it is also important to just remind my colleagues that

Max Baucus

8:14:27 to 8:14:48( Edit History Discussion )

Max Baucus: this amendment is really a retread on the mccain amendment that we debated over the last few days, generally. that is, once again the opponents of this bill are endorsing the status quo of medicare going on the brink of going bankrupt and seniors facing i remind my colleagues again

Max Baucus

8:14:49 to 8:15:10( Edit History Discussion )

Max Baucus: what will happen if we stick to the status quo, that is no bill which the other side is advocating. it means medicare will go broke in eight years. that's the stus quo. in our legislation that is postponed for at least five more years. the status quo, with no bill with the other sides advocating, means seniors will continue paying higher and higher premiums and cost sharing due to

Max Baucus

8:15:11 to 8:15:32( Edit History Discussion )

Max Baucus: wasteful overpayments to a good newsroom of -- number of health care providers. there is so much waste in our syst know there is a lot of waste in our system, and frankly i'm quite surprised that not all of our colleagues want to cut out the waste. in effect, they want to keep the waste. that's unfortunately in our system. the status quo also means tt

Max Baucus

8:15:33 to 8:15:54( Edit History Discussion )

Max Baucus: each year billions of medicare dollars will continue to be wasted on lining the pockets of private insurance companies, and that might be a bit statement, but the fact is that that -- is that some chief executives of private insurance companies are paid millions -- tens of millions of dollars to

Max Baucus

8:15:55 to 8:16:17( Edit History Discussion )

Max Baucus: manage medicare programs, especially medicare advantage, and that the status quo means that will continue. the status quo also means that seniors will continue struggling to pay for prescription drugs. mr. president, the stakes of seniors in the medicare program have never been higher. we have a choice here, mr. president. it's a very simple choice.

Max Baucus

8:16:18 to 8:16:38( Edit History Discussion )

Max Baucus: either endorse the status quo or strengthen medicare. let's talk a little bit about home health care. regarding medicare changes for home health providers let me describe what is in the senate bill. i don't think our colleagues really know specifically what's in the senate bill. that may be a strong statement to make, but i think if they knew what was in the bill, that

Max Baucus

8:16:39 to 8:17:00( Edit History Discussion )

Max Baucus: some of the statements made tonight might be a little bit different. as most of my colleagues would agree, home health care is extremely important. it's a vy important benefit in the medicare program. we are all very strong advocates of home health. across the country, there are more than 9,800 home health

Max Baucus

8:17:01 to 8:17:21( Edit History Discussion )

Max Baucus: agencies that provide care seniors in their homes. this care helps seniors get better, it helps them avoid expensive rehospitalizations. we're all champions of home health. we like peopleot to b institutionalized. it's much better where appropriate to have care in the home and home health care

Max Baucus

8:17:22 to 8:17:43( Edit History Discussion )

Max Baucus: agencies have provided that. it's so, so important. in my state of montana, home health care providers go the extra mile, literally, to provide care to patients across vast distances. in some cases,ome health providers in rural areas have to drive 100 miles just to see one patient. they're dedicated people. they go great distances and

Max Baucus

8:17:44 to 8:18:05( Edit History Discussion )

Max Baucus: travel a long way to see very few patients. home health providers make a real difference in improving seniors' health and we should support their efforts, and we all do. we all very much support their efrts. we'll have great respect for the services of home health -- that home health providers give. we also have the responsibility to protect the medicare program.

Max Baucus

8:18:06 to 8:18:27( Edit History Discussion )

Max Baucus: we have to root out waste. and unfortunately, there is almost always some waste somewhere. it's a matter of judgment as to how much is waste and how much is not. we must make sure medicare is paying appropriately. that is, medicare is not over paying for medicare services. we also must take action to root

Max Baucus

8:18:28 to 8:18:50( Edit History Discussion )

Max Baucus: out fraud and abuse generally where it may occur in the home health industry as well. the policies in this senate bill i think achieve both goals. so what do we do in the bill? first, the senate bill would rebase home health payments to ensure payments reflect actual costs of providing care. these changes are based on recommendations by medpac, the

Max Baucus

8:18:51 to 8:19:11( Edit History Discussion )

Max Baucus: independent advisory commission which advises congress on medicare reimbursement. it's a nonpartisan group. medpac advises rebase home health payments. what do we mean by that? when the current home health payments were set, seniors received an average of 31 visits per episode.

Max Baucus

8:19:12 to 8:19:33( Edit History Discussion )

Max Baucus: today they receive 21, 22 visits as they get paid for frankly -- actually get paid about the same for doing less. we're trying to make sure the payment reflects the actual services provided. so the senate bill directs the c.m.s. to rebase payments to reflect this change. it's common sense.

Max Baucus

8:19:34 to 8:19:56( Edit History Discussion )

Max Baucus: medpac recommended medpac thinks it's got to keep up with the times because times have changed over the years and that the payment systems reflect that change. something else i think is very important as mos of my colleagues agree with. that is the senate bill roots out fraud that unfortunately exists in home health care as

Max Baucus

8:19:57 to 8:20:17( Edit History Discussion )

Max Baucus: well as some areas of medicare spending. it roots out the tries to root out the fraud and medicare payments for outli cases. medicare provides an extra payment today to health folks who treat sicker

Max Baucus

8:20:18 to 8:20:38( Edit History Discussion )

Max Baucus: people or otherwise known as outlier patients, really sick. fortunately, the -- unfortunately, the general accounting office found that some providers were gaming the system and getting much more outlier payments than they deserved. for example, the general accounting office found in one florida county alone, home health providers were receiving

Max Baucus

8:20:39 to 8:20:59( Edit History Discussion )

Max Baucus: 60% of all total outlier payments. that's nationwide, one county getting 60%, even though the county had less than 1% of a total medicare population. i don't want to just single florida, but there are some other counties, they tend to be in the southern part of the country which clearly have grossly, grossly disproportionate amount of

Max Baucus

8:21:00 to 8:21:21( Edit History Discussion )

Max Baucus: outlier payments, they are gaming t system. we addressed thi problem placing a cap on the amount provided by the payments. the senate bill also makes changes in 2007 and 2012 recommended by medpac. why is that important? medpac was actually much tougher.

Max Baucus

8:21:22 to 8:21:43( Edit History Discussion )

Max Baucus: they wanted to start right away in 2010. no, we'll hold off a little bit. we wanted to be fair to the home health providers. in addition, the bill establishes a productivity adjustment for home health providers beginning not right away, not next year, not the following year. it doesn't begin until the year 2015. these changes as home health

Max Baucus

8:21:44 to 8:22:04( Edit History Discussion )

Max Baucus: more efficient and higher quality care over time. being very fair about it. very importantly, in ming these changes, we worked very closely with the home health industry changes were reasonable and they were fair. let's take each of the policies and what they do with respect to the agencies to make sure we're

Max Baucus

8:22:05 to 8:22:27( Edit History Discussion )

Max Baucus: fair. rebasing, medpac recommended we fully implement these changes in the year 2011. to ensure that providers could adapt to the new payment rates, we in the senate decided we would phase in these changes over four years. ho health providers support this phase-in. they think it's a good idea.

Max Baucus

8:22:28 to 8:22:49( Edit History Discussion )

Max Baucus: on the outlier policy and the fraud changes, these policies were actually suggested to us by guess who? by the home health industry. they came to us and said we suggest that you make some changes in the outliers because too many agencies and home health providers are gaming the system. make some stop that gaming.

Max Baucus

8:22:50 to 8:23:10( Edit History Discussion )

Max Baucus: make some changes to stop the fraud, so they came to us and they gave us some obviously, the home health industry fully supports the changes thathey recommended to us. and they're in this bill. on the market basket and productivity changes, the senate bill reductions as we delay these reductions while the rebasing policy is taking effect.

Max Baucus

8:23:11 to 8:23:31( Edit History Discussion )

Max Baucus: again, we want to be fair. this bill gives home health agencies extra time, much more time than is recommended by very aggressive proposed changes, proposed by medpac, very aggressive changes proposed in the house bill and by the administration. he is saying no, those are too

Max Baucus

8:23:32 to 8:23:53( Edit History Discussion )

Max Baucus: aggressive, so we in the senate decide to give agencies extra time to adapt these payment changes and this -- rather than having all these implemented at the same time as medpac and the house and administration all would -- would recommend. and finally, with respect to rural home health providers, we're all very sensitive to the rural -- the special needs of rural america.

Max Baucus

8:23:54 to 8:24:15( Edit History Discussion )

Max Baucus: so what do we do about that? well, from the rural providers receive 3% extra payment each year. this is a payment that will ensure that rural providers are protected as we reform the broader home health system. so an extra 3% from the period

Max Baucus

8:24:16 to 8:24:36( Edit History Discussion )

Max Baucus: 2010-2015 for rural providers. so in total, the home heah believe, strike a fair balance between ensuring seniors have access to home care and also rootingut inappropriate payments from this system. now, i previously heard my good friend say, well, gee, these changes are really going to hurt seniors. they're not going to hurt seniors.

Max Baucus

8:24:37 to 8:24:58( Edit History Discussion )

Max Baucus: in fact, most of these changes are changes suggested by the home health care industry. i think that all of us want to root out fraud and waste. opponents also sometimes claim that the medicare beneficiaries will be harmed in lots of ways by this bill. that's a scare tactic, mr. president. let me say what the american association of retired persons

Max Baucus

8:24:59 to 8:25:20( Edit History Discussion )

Max Baucus: says about these kind of claims, that is the claim that these changes in medicare reimbursement are going to harm seniors. the aarp says, and i quote -- "opponents of health reform won't rest. they are using myths and misinformation to distruth the truth that medicare will be harmed. after a lifetime of hard work, don't senio

Max Baucus

8:25:21 to 8:25:41( Edit History Discussion )

Max Baucus: that's a statement by the aarp. i don't suggest here tonight that any of our colleagues are using myths and misinformation to distort the truth, but main point here is aarp when it hears claims that seniors are ing to be hurt says that's not true, and they support this bill, they strongly support this ll, i might add. so let me remind my colleagues of some of the positive changes in this legislation.

Max Baucus

8:25:42 to 8:26:02( Edit History Discussion )

Max Baucus: this legislation approves the solvency of the medicare program by five years. it puts $30 billion back into the pockets of seniors in the form of lower medicare premiums. it makes prescription drugs more affordable. that's an added bill that would not be available if this legislation was not passed. the bill guarantees seniors can continue to see the doctor of

Max Baucus

8:26:03 to 8:26:24( Edit History Discussion )

Max Baucus: their choosing. the bill provides free wellness and prevention those are new benefits that don't currently exist. it also includes fair to appropriate changes to home health as i suggested protect access to care. i don't question the motives of my colleagues. they believe they are standing up for seniors in opposing home health changes, butn truth they are really going to harm seniors because they are

Max Baucus

8:26:25 to 8:26:47( Edit History Discussion )

Max Baucus: hurting the medicare program, and i don't think we want to hurt the medicare program. rather, we're medicare proam by making these changes. one other point i want to make that's just kind of interesting, i thought, when i still have it.

Max Baucus

8:26:48 to 8:27:08( Edit History Discussion )

Max Baucus: it's kind of interesting, the growth rate in home health care spending will continue to be very high after this legislation passed. it will

Max Baucus

8:27:09 to 8:27:30( Edit History Discussion )

Max Baucus: the growth rate per year under this bill currently, excuse me, currently the growth rate of home health care industries is almost 11% per year. after this legislation, it will be almost 8%. 8% annual growth in the home health care industry, and that's much faster than national health expenditures.

Max Baucus

8:27:31 to 8:27:50( Edit History Discussion )

Max Baucus: so i think -- most things in life are a judgment call. i think we will fairly decide the changes we make in this bill are good for seniors, they are good for home health, because they are sensitive to the needs of the industry, sensitive to patients, frankly, but also

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