b. C. Section XI: Reports A. B. Development and implementation of "social PRO" mechanism focusing on home help; Use of alternative mechanisms to perform quality assurance activities, including Area Agencies on Aging and public health and/or social service departments. The Secretary shall provide a report by January I of each year to Congress which addresses the performance and nature of the home care quality assurance system during the previous fiscal year. This report shall include the following. 1. 2. 3. 4. 5. 6. 7. 8. The number of individuals served by the home care agencies, programs and services outlined in this Act. The federal funds expended for home care services under Medicare, Noncompliance with the home health quality assurance provisions under Medicare and Medicaid and the sanctions imposed. The home help monitoring agents used in each state or jurisdiction, their findings of non-compliance with the quality assurance standards of this Act, and the availability and use of sanctions. The economic impact on home care agencies, programs and services of requiring them to comply with quality assurance standards. Impact of quality assurance standards on availability of home care services in rural areas. The concerns and recommendations of the CAB. The status of the home care training and certification grants under Section IX of this Act and the research and demonstration projects under Section X in progress or completed within the fiscal year. Medicare, Medicaid, the Social Services Block Grant and the Older Americans Act are be amended to require states with authority under these titles and acts to prepare and forward to the Secretary by October 1 of each year annual reports providing the following information and any other information the Secretary may require. 1. 2. 3. The number of individuals served by the home care agencies, programs and services outlined in this Act. The amount of state and federal funds expended for home care services under Medicare, Medicaid, the Social Services Block Grant Program and the Older Americans Act. 1 The home help monitoring agents used in each state or jurisdiction, their findings of non-compliance with the quality assurance standards of this Act, and the availability and use of sanctions. 4. The economic impact on home care agencies, programs and services of requiring them to comply with quality assurance standards. 5. Impact of quality assurance standards on availability of home care services in rural areas. The Secretary shall examine and report on January 1 of each year to the Congress on the availability, adequacy and use of sanctions to correct home care quality violations within the previous fiscal year. The Secretary shall evaluate and report on the effectiveness of research and demonstration projects under Section X of this Act within three years of enactment of this Act. Section XII: Minimization of Burden on States and Providers A. In implementing the provisions of this Act, the Secretary shall make every effort to minimize any additional, unnecessary administrative and related financial burden on states and providers. Section XIII: Long Term Care Facilities and Home Care Ombudsman Program A. B. The Older Americans Act shall be amended to include a home care ombudsman function. 1. 2. 3. 4. The existing provisions of the Long Term Care Facilities Ombudsman Program shall be continued and amended to include home care recipients. The Program shall be amended to require that policies and procedures be developed for coordinating ombudsman activities with those of PROs and home help monitoring agents. The Program shall be amended to required that an annual report of the ombudsman activities be provided to the chief executive officer of each state and the Secretary. The Program shall have a statewide toll free hot-line for receiving complaints by or on behalf of older individuals concerning nursing home and home care quality issues. The Secretary shall direct that a Nursing Home Facilities and Home Care Section XIV: Funding A. Funding for PRO review of home health agencies is drawn from the Federal 1. An additional 3% of hospital payment amounts (for PRO review) in the first fiscal year; B. The Secretary shall develop a formula for the distribution of funds to states for the monitoring of home help services based on the proportion of expenditures by each state on such services under Medicaid, the Social Services Block Grant and the Older Americans Act. The formula shall ensure that by the third year of enactment, no state shall have less than 1% of the total available funds. Funding is authorized as follows: 1. A total of five million in start-up costs is to appropriate to the states in the first year; 2. A total of ten million is to be distributed in the second year; and 3. C. D. E. A total of 20 million is to be distributed in subsequent years. Funding for the Nursing Home Facilities and Home Care Ombudsman program shall be made through the Older Americans Act as follows: 1. 2. The amount of Title Illb funds allotted for the Ombudsman Program is increased from one percent to two percent or $20,000, whichever is greater. The total authorization level for Title Illb funds in FY1987 is An additional $500,000 are provided to the Secretary for Training and An additional three million are provided to the Secretary for Research and Demonstrations in the first year, two million in the second year, and three million in subsequent years. The CHAIRMAN. I wish to thank the witnesses for appearing before the committee today. Let me add that I find it unfortunate and disappointing that the administration chose not to send a representative to this hearing. However, I appreciate the time of those present and look forward to their testimony. [EDITOR'S NOTE.-The written statement of the administration appears in appendix A.] The Chair now recognizes Mr. Rinaldo STATEMENT OF REPRESENTATIVE MATTHEW J. RINALDO Mr. RINALDO. Thank you very much, Mr. Chairman. Mr. Chairman, the issue we are discussing this afternoon, quality in home care, deserves a high national profile, as well as careful attention by Congress. We are all well aware of the revolution in health care especially for the elderly in the past 3 years. We in Congress are especially aware of the charges by Medicare beneficiaries of premature discharges sooner and sicker as a result of the prospective payment method of reimbursement. Shorter hospital stays however are not necessarily bad and do not always reflect poor quality care if there is a continuum of posthospital services available to insure a successful recuperation from an illness. Home care is essential to this process. I am proud to say that my home State, New Jersey, has been a leader on the issue of quality in home care. For some time now the New Jersey Department of Health has licensed and regulated all Medicare certified home health agencies which now number approximately 60. Until recently, however, most of the State's 300 home care providers have not been subjected to any concerted, coordinated quality assurance efforts because they did not participate in Medicare. Fortunately, this is changing, because the New Jersey Department of Human Services has recognized the increasing reliance on homemaker and home health aid services, especially for the elderly. New Jersey, has been very vigilant in its response to the clear need for greater control over the quality of care. New Jersey is the first State to institute a commission on accreditation of home care which is based on the Joint Commission on Accreditation of Hospitals. Now all Medicaid personal care and homemaker providers must either be accredited or licensed by the State department of health. This is an important step in my view in the march to ensure quality home care. I would like our witnesses, and I certainly want to thank them for their participation in this hearing, to reflect on two questions. Can New Jersey's initiative be used as a model for all States? And, second, and the question I think is very important: What national standards can Congress implement to guarantee effective high quality home care. Thank you again for calling this hearing, Mr. Chairman, and I look forward to the testimony of our witnesses. The CHAIRMAN. Thank you, Mr. Rinaldo. The Chair recognizes Mr. Synar. STATEMENT OF REPRESENTATIVE MIKE SYNAR Mr. SYNAR. Thank you, Mr. Chairman. An increasing number of senior citizens are turning to home health care agencies to help them make a safe and comfortable transition from hospital bed to home. The home health care agencies are a viable solution to the problems resulting from shorter hospital stays under PPS. They are particularly important in rural areas such as Oklahoma where distance and lack of transportation can isolate senior citizens. Congress has a responsibility to insure that taxpayer's dollars, in this case Medicare reimbursements to home health care agencies, are being spent wisely. It is our duty to determine whether or not the home health care services Medicare pays for are dispensing quality care. Although these agencies must be certified by HCFA, it is possible that reduced reimbursement levels are severely restricting the ability of these agencies to maintain their very best care. I don't mean to suggest that home health care agencies should be excused from providing poor care, but we should be mindful of the role cost containment plays in quality assurance. Congress also has a responsibility to those individuals who receive home health care services from noncertified agencies to make sure that this care is adequate and administered in a compassionate manner. There is no question that the current lack of oversight could cause potential problems. Home health care is too important to risk the damage which will occur if we lose the confidence of our home health care agencies, and that's why I'm glad we are having the hearing today and commend the chairman for calling it. The CHAIRMAN. The chair now recognizes Mr. McCain. STATEMENT OF REPRESENTATIVE JOHN MCCAIN Mr. MCCAIN. Thank you, Mr. Chairman, I would like to summarize my statement and request that my statement be included in the record in full. The CHAIRMAN. Without objection, so ordered. [The prepared statement of Mr. McCain follows:] ། |