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21–308 2016

LEGISLATION TO IMPROVE AND SUSTAIN THE 

MEDICARE PROGRAM 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

JUNE 8, 2016

Serial 114–HL09 

Printed for the use of the Committee on Ways and Means 

( 


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COMMITTEE ON WAYS AND MEANS 

KEVIN BRADY, Texas, Chairman 

KEVIN BRADY, Texas 

SAM JOHNSON, Texas 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

DAVID G. REICHERT, Washington 

CHARLES W. BOUSTANY, JR., Louisiana 

PETER J. ROSKAM, Illinois 

TOM PRICE, Georgia 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

DIANE BLACK, Tennessee 

TOM REED, New York 

TODD YOUNG, Indiana 

MIKE KELLY, Pennsylvania 

JIM RENACCI, Ohio 

PAT MEEHAN, Pennsylvania 

KRISTI NOEM, South Dakota 

GEORGE HOLDING, North Carolina 

JASON SMITH, Missouri 

ROBERT J. DOLD, Illinois 

TOM RICE, South Carolina 

SANDER M. LEVIN, Michigan 

CHARLES B. RANGEL, New York 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

RICHARD E. NEAL, Massachusetts 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

MIKE THOMPSON, California 

JOHN B. LARSON, Connecticut 

EARL BLUMENAUER, Oregon 

RON KIND, Wisconsin 

BILL PASCRELL, JR., New Jersey 

JOSEPH CROWLEY, New York 

DANNY DAVIS, Illinois 

LINDA SA ́ NCHEZ, California 

DAVID STEWART, Staff Director 

NICK GWYN, Minority Chief of Staff 

SUBCOMMITTEE ON HEALTH 

PATRICK J. TIBERI, Ohio, Chairman 

SAM JOHNSON, Texas 

DEVIN NUNES, California 

PETER J. ROSKAM, Illinois 

TOM PRICE, Georgia 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

LYNN JENKINS, Kansas 

KENNY MARCHANT, Texas 

DIANE BLACK, Tennessee 

ERIK PAULSEN, Minnesota 

JIM MCDERMOTT, Washington 

MIKE THOMPSON, California 

RON KIND, Wisconsin 

EARL BLUMENAUER, Oregon 

BILL PASCRELL, JR., New Jersey 

DANNY DAVIS, Illinois 

JOHN LEWIS, Georgia 


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C O N T E N T S 

Page 

Advisory of June 8, 2016, announcing the hearing ............................................... 2 

WITNESSES 

PANEL ONE 

The Honorable Charles W. Boustany, Member of Congress, Washington, 

D.C. ........................................................................................................................ 22

The Honorable Robert J. Dold, Member of Congress, Washington, D.C. ..... 16 

The Honorable Kristi L. Noem, Member of Congress, Washington, D.C. ..... 20 

The Honorable David G. Reichert, Member of Congress, Washington, 

D.C. ........................................................................................................................ 18

PANEL TWO 

The Honorable Joseph Crowley, Member of Congress, Washington, D.C. ... 30 

The Honorable John B. Larson, Member of Congress, Washington, D.C. .... 28 

The Honorable Patrick Meehan, Member of Congress, Washington, D.C. ... 25 

The Honorable James B. Renacci, Member of Congress, Washington, D.C. 21 

PANEL THREE 

The Honorable Alexander X. Mooney, Member of Congress, Washington, 

D.C. ........................................................................................................................ 26

The Honorable Christopher H. Smith, Member of Congress, Washington, 

D.C. ........................................................................................................................ 33

The Honorable Lee M. Zeldin, Member of Congress, Washington, D.C. ....... 31 

SUBMISSIONS FOR THE RECORD 

The Honorable Diane Black, statement ................................................................. 48 

The American College of Clinical Pharmacy, and The College of Psychiatric 

and Neurologic Pharmacists, statement ............................................................ 50 

Lymphedema Advocacy Group, statement ............................................................ 53 

Medicare Rights, statement .................................................................................... 59 

Property Casualty Insurers Association of America, statement .......................... 61 


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LEGISLATION TO IMPROVE AND SUSTAIN 

THE MEDICARE PROGRAM 

WEDNESDAY, JUNE 8, 2016 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON WAYS AND MEANS, 

SUBCOMMITTEE ON HEALTH, 

Washington, DC. 

The subcommittee met, pursuant to notice, at 2:20 p.m. in Room 

1100 Longworth House Office Building, the Honorable Pat Tiberi 

[chairman of the subcommittee] presiding. 

[The advisory announcing the hearing follows:] 


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Chairman TIBERI. The subcommittee will come to order. Welcome to the Ways and Means Health Subcommittee Member Day 

hearing entitled, ‘‘Legislation to Improve and Sustain the Medicare 

Program.’’ Today, similar to our last Member Day hearing on taxrelated proposals to improve health care, this Subcommittee is providing a public platform for any and all Members of Congress interested to discuss bills that they have introduced that modify the 

way health care is assessed and delivered to more than 55 million 

seniors who rely on the Medicare program. 

Members have put a lot of work into developing and drafting 

these pieces of legislation, and this Member Day hearing is their 

opportunity to share with their colleagues and the American people 

why these bills are important, and why this Committee should take 

them up. 

In addition to my colleagues from Ways and Means, I am excited 

to hear from Members who serve on other committees who have 

worked equally hard on legislation to transform and improve our 

Medicare program. 

We remain committed to working through regular order. That includes hearings like the one today from those on and off the committee. 

So how is it going to work? Members will have five minutes to 

discuss their Medicare legislative priorities. I would remind those 

Members that they are also able to submit written testimony in 

support of their legislation. 


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We thank you all, witnesses and members of this Subcommittee, 

for taking the time out of your busy schedules to be with us today. 

And I hope, Dr. McDermott, we can build on the kind words you 

said about us yesterday. I knew it might take a little while for you 

to say kind words about us, and we accomplished that. So let’s 

build on that, sir. 

I yield to the ranking member. 

Mr. MCDERMOTT. Thank you, Mr. Chairman. We might as well 

start out on a good note. And I think that I want to thank you for 

holding this Member Day hearing to improve and sustain Medicare. I welcome this opportunity to learn more about the ideas that 

my colleagues may have, and they will discuss today. 

When it comes to Medicare, the policies which were put in place 

in 1965, those policies we have made a wide range of interests— 

physicians, insurers, hospitals, and many others. And the most important people affected, however, by Medicare are the beneficiaries, 

the 55 million seniors and Americans with disabilities who depend 

on Medicare for their health care. 

At its core, Medicare is a fulfillment of a commitment to the 

health security of the American people. Individuals who have contributed to the system deserve the peace of mind of knowing that 

Medicare’s benefits will be there when they need them. That means 

that Congress must work to ensure that Medicare truly strengthens the quality and accessibility of beneficiaries’ health care. 

A strong Medicare doesn’t mean we turn the program over to the 

insurance industry, and it doesn’t mean we shift more costs on to 

the beneficiaries. A stronger Medicare is a program that provides 

comprehensive coverage to beneficiaries at affordable cost. To make 

that a reality we have to move the conversation in Congress away 

from harmful ideas like privatizing the program and cutting seniors’ benefits toward a more productive discussion of how to make 

Medicare work better for beneficiaries. 

To that end, I intend to discuss legislation I have recently introduced which will provide beneficiaries with access to comprehensive dental, vision, and hearing services. This is a popular, longoverdue reform that will improve the health security of millions of 

Americans. And I look forward to talking further about the importance of this during the hearing. 

I also hope to hear from my colleagues about other ideas that 

will continue to build upon and expand Medicare. I intend to carefully scrutinize ideas that may not be in the best interests of the 

program or the beneficiaries. Today’s hearing is a part of what 

must be an ongoing process of careful debate that will show the 

American people what Congress is doing or not doing to improve 

health security. 

When Medicare was put in place, the life expectancy in this 

country was about 10 years lower than it is today. So we had such 

success in Medicare that we have got a whole lot of new problems 

that we didn’t have before. It must be followed by substantive legislative hearings and markups and amendments, so that we could 

weed out bad ideas and make sure the ones that are good can have 

the passage of this Congress. 

Thank you again, Mr. Chairman, for bringing this day together, 

and I look forward to hearing the witnesses. 


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Chairman TIBERI. Thank you, Dr. McDermott. Without objection, other Members’ opening statements will be made part of the 

record. 

Now we will hear from Members of the Subcommittee on their 

priorities to improve Medicare. I am the lead Republican on the 

Medicare Home Infusion Site of CARE Act, which we are working 

with the Senate and CMS to ensure it will work for all stakeholders. It is truly an important piece of legislation that will expand beneficiary access to infusion treatments in their homes, if 

that is where they choose to receive their care, something that private providers already cover. 

I look forward to continuing to work on this legislation that will 

increase beneficiary access to appropriate and cost-effective care, 

and advancing it when it is ready. 

Chairman TIBERI. With that, I turn to my left, literally, to Dr. 

McDermott once more for the purposes of discussing his legislation. 

Dr. McDermott, you are recognized for five minutes. 

Mr. MCDERMOTT. We welcome you on the left. I would like to 

ask unanimous consent to enter into the record a letter from the 

Medicare Rights organization dated 8 June 2016. 

Chairman TIBERI. Without objection. Without objection. 

[The information follows: The Honorable Jim McDermott] 


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Mr. MCDERMOTT. Mr. Chairman, I have sat here on this Committee for 25 years and watched lots of things happen. And I am 

really glad that we are having a hearing today when we could put 

some ideas up on the table that we haven’t had before. 

I am introducing today a bill called the Medicare Dental, Vision, 

and Hearing Act, a bill I introduced, I guess, yesterday, actually. 

The creation of Medicare in 1965 was one of the great policy 

achievements in the history of this country. The benefits that Medicare provided ensured that 55 million citizens and people with disabilities would enjoy the peace of mind and the security that comes 

with having quality health coverage. The best way to improve and 

sustain Medicare is by expanding it and strengthening it because, 

unfortunately, there are holes in the program that weaken health 

security of our beneficiaries. 

One of the largest holes in the Medicare system is that it does 

not currently cover most dental, vision, or hearing expenses. In 

fact, not only does it not pay for these crucial health services, they 

are specifically excluded from coverage by the statute that was 

passed in 1965. This is a misguided policy that, for decades, has 

had harmful consequences on beneficiaries. 

Doing without dental coverage frequently leads to preventable 

health problems. Patients who have poor or no dental care often 

find themselves suffering from costly and potentially fatal conditions such as cardio-vascular disease and oral cancers. We had recently here in Washington, D.C. a young kid who didn’t have dental care and got encephalitis of the brain from an infected tooth. 

Now, similar untreated vision disorders substantially increase 

the risk of falls among senior citizens. One of the biggest problems 

for senior citizens is falling. And if they have bad vision and don’t 

have glasses, or they got cataracts or whatever, they are having 

trouble. These falls can result in serious injuries and expensive 

hospitalizations. 

Hearing loss, for those of us who grew up in the age of rock 

music, and used to stand next to the woofers and the tweeters at 

full volume, today have hearing aids because we did things with 

our ears that we didn’t understand then. There are lots and lots 

of seniors who have hearing loss and that is an isolating event. 

When you have no ability to hear, you are cut out of everything. 

And that is why it is—if we are having seniors live longer and 

longer and longer, into their eighties and nineties, we are going to 

see more of the hearing and the vision loss that we have not dealt 

with in the past. It is a widespread—the hearing loss is as widespread among Medicare beneficiaries, often leading to social isolation, depression, and cognitive impairments. We wind up treating 

them for depression, we treat them for all kinds of other things, basically, because they can’t hear. 

Yet research shows that a majority of the elderly who need hearing aids do not have them, in large part due to cost. That is why 

the reforms made by the Medicare Dental, Vision, and Hearing 

Benefit Act are so important. This bill modernizes and strengthens 

Medicare’s benefit package to address the full spectrum of beneficiaries’ health needs. It amends Part B to provide coverage of important health services, including routine and major dental care, 

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portant supplies including dentures, glasses, and hearing aids. It 

repeals the harmful statutory exclusions that prevent Medicare 

from paying for these costs. 

And to control costs and ease the burden as we implement these 

major reforms, it places reasonable limitations on coverage and 

provides that new benefits will be phased in gradually. All too 

often at this Committee our policy discussions focus on how much 

we can cut from Medicare and how to further shift the costs onto 

beneficiaries. In the process we fail to recognize the possibilities before us and the enormous power we wield. 

The truth is that Medicare must be strengthened, not cut, and 

benefits must be expanded, not scaled back. As the Ways and 

Means Committee, we owe a duty to the American people to discuss how we can make that happen. 

And I yield back the balance of my time. I thank the chairman. 

Chairman TIBERI. Thank you. Thank you, Dr. McDermott. My 

phone was ringing and I was thinking it was my mom and dad calling me about your legislation there. 

[Laughter.] 

Chairman TIBERI. Very well done. Mr. Roskam is recognized for 

five minutes. 

Mr. ROSKAM. Thank you, Mr. Chairman and Ranking Member 

McDermott. Five minutes, three bills, let me do this quickly. Buckle up, I think I can do it. 

So H.R. 512 is the Disarm Act, and it is designed to incentivize 

the development of new antibiotic drugs. The Administration recognizes that we have an incredible problem here. The CDC recognizes 

that we have an incredible problem here. And the incredible problem is that we have got infections that are unwilling to yield to 

some of the antibiotics, and we don’t have enough incentive out 

there in the private sector to invest, essentially. And this is a 

plague. 

Let me just give you one quick example. In March and April in 

the Midwest 18 people died from 57 inspections in 3 states. And 

this is here, it is upon us, and we need to deal with it. H.R. 512 

would address this by reimbursing hospitals for the cost of acquired 

new certain agents. 

It passed in Chairman Upton’s Cures Act. We will see where that 

is in the Senate, Mr. Chairman, but in my view, we would be wise 

to reclaim jurisdiction here and move it again. 

Bill number two, H.R. 3220, the Common Access Card. This is 

a bill that I have introduced with Mr. Blumenauer. Some of the 

work of the Oversight Subcommittee has shown that the fraud and 

erroneous payments rate at Medicare is 12.7 percent. I mean this 

is a shocking figure. And, you know, you begin to ask yourself, 

‘‘How is this possible?’’ Well, it is possible in part because you got 

these flimsy old Medicare cards, and it is a bunch of nonsense. 

And what we are proposing is this, to take the technology that 

the Department of Defense uses currently, try a pilot program, and 

create a common access card. 

Ready for a statistic? February 2016, a few months ago, GAO revealed that 22 percent of health care fraud cases ultimately prosecuted by the Federal Government could have been prevented by 

use of a smart card—22 percent. Marinate in that for a second. 


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When we are running around here, grubbing around, looking for 

nickels and dimes, thinking about 22 percent, thinking about 12.7 

percent—you take my point. 

So here is what we need to do. We need to pass this bill, number 

one. But you need to give us good feedback. 

I spoke with Secretary Burwell this week. She is committed to 

expediting a meeting to get stakeholders together. And I think we 

can do a lot of good work here. And, Dr. McDermott, I am looking 

to you to get on this bill. 

And then finally, the H.R. 4853 is the SAFE Act. And in a nutshell, this legislation provides CMS with additional flexibility to 

permit approved private-sector accreditors to use their own updated standards and survey processes for hospital accreditation. So, 

in other words, we have got the private sector that is doing a fabulous job, we have got a statute that basically tethers us to an old 

system. So let’s dump the loser stuff, pick up the things that work, 

and let’s adopt it so that these hospitals can move forward on that 

basis, to allow accrediting bodies to use assessment methods that 

incorporated the latest, best practices in health care delivery to ensure hospitals adhere to high-quality standards and patient safety. 

And Mr. Chairman, who doesn’t love that? And I yield back. 

Chairman TIBERI. Well done, Mr. Roskam, thank you very 

much. 

Before I yield to Mr. Davis for five minutes, I just want to thank 

him for coming down to the floor yesterday and his kind words on 

the bill that originated in this Subcommittee, and thank all the 

Members for their input on a bill that passed the floor unanimously yesterday. 

So with that, Mr. Davis, you are recognized for five minutes. 

Mr. DAVIS. Thank you, Mr. Chairman. And I shall discuss H.R. 

2124, the Resident Physician Shortage Reduction Act, introduced 

by Representatives Crowley and Boustany. 

Mr. Chairman and Ranking Member, the Illinois 7th Congressional District, which I represent, contains the most hospital beds 

of any congressional district in the nation, and is also home to four 

major academic medical centers. Given our nation’s growing and 

aging population, coupled with the coverage expansion contained in 

the Affordable Care Act, the demand for health care continues to 

increase, especially for those with complex health care needs, such 

as the fastest-growing population in the nation of those aged 75 

and older. 

Recent studies show that our nation will need as many as 90,000 

new physicians over the next decade, and as many as 63,000 of 

which will need to be specialists. 

Clearly, today more than ever, Congress should maintain and enhance our nation’s investment in training tomorrow’s physician 

workforce. Given that it takes anywhere from 5 to 10 years to train 

a physician, the question facing Congress is what are we doing to 

ensure that our nation is physician workforce ready to meet our 

nation’s health care needs both today and in the future? 

The teaching hospitals in my district are incurring the costs of 

these programs significantly greater than the direct and indirect 

graduate medical education payments they received. In fact, most 

of the major teaching hospitals in Chicago are training in excess 


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of 100 doctors over the residency cap, which costs tens of millions 

of dollars that will never be reimbursed to those institutions for 

training more physicians to address the growing shortages in primary care and acute surgical specialties. 

Medical schools and teaching hospitals are also working to ensure that new doctors coming into the system are trained to serve 

in new delivery models that focus on care coordination and quality 

improvement. According to the latest physician workforce projections, roughly two-thirds of the shortage in coming years will be in 

specialty practice areas such as neurology, pediatrics, subspecialties, geriatrics, and oncology. 

We need more doctors and allied health professionals to assist a 

health care system that for decades was not adequately addressed 

in health disparities among millions of racial and ethnic minority 

Americans. Many of our minorities are disproportionately more 

likely to suffer deleterious health just because they are low-income 

wage owners, poor in health, and suffer worse health outcomes, 

and are more likely to die prematurely and often from preventable 

causes compared to other members of the population. 

This bill provides a greatly needed opportunity to train the physicians that we need throughout our country. I am delighted that 

Representative Crowley and Representative Boustany have collaborated to pass it. And I would urge all of my colleagues, certainly, 

to be in support of it. 

And Mr. Chairman, I thank you and yield back the balance of 

my time. 

Chairman TIBERI. Thank you, Mr. Davis. 

Dr. Price, you are recognized for five minutes. 

Mr. PRICE. Thank you, Mr. Chairman, and I appreciate the opportunity to discuss bills relating to a very important subject, and 

that is the issue of saving and strengthening and securing Medicare. The demographic challenges that we have in this country are 

huge, and Medicare is running out of resources, as you well know. 

That is according to their own trustees. 

The challenge that we have right now is that CMS is saving 

money, according to them, by decreasing services and limiting access to care. And it is happening right now, it is not happening just 

in a fictitious way potentially in the future. 

I want to talk about three pieces of legislation. The first is H.R. 

5210, which deals with durable medical equipment, patient access 

to durable medical equipment. CMS instituted what is called a 

competitive bidding program for suppliers of durable medical 

equipment that is not either competitive and isn’t bidding, and it 

isn’t because it doesn’t hold bidders accountable, it doesn’t ensure 

that bidders are qualified to provide the products in the bid markets, and it produces bid rates that are financially unsustainable. 

Mr. Chairman, this literally is harming lives, as we speak. Essential services, including oxygen, are being denied to patients because of difficulty gaining those services. In rural areas it is a 

huge, huge problem. Many areas, many rural areas of the country, 

the amount paid for these services doesn’t even cover the costs. So 

you get decreased availability. 

In Georgia, for example, 20 percent decrease in the number of 

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duction in medical equipment supply stores in our state, just in the 

last 3 years. Patients’ lives are literally at risk. 

The National Minority Quality Forum has data that demonstrates it is driving up costs by avoidable hospital bills and increasing out-of-pocket payments by patients. It has led to increased 

mortality—that means death and hospitalizations and a higher cost 

for Medicare beneficiaries. The OIG for Medicare itself said that 

CMS paid over $1 million to 63 suppliers for product categories 

they weren’t even licensed to provide in their state, over $1 million. 

So, H.R. 5210 would simply delay the onset of this competitive 

bidding program and expanding the onset of the program, and that 

is a bipartisan-supported bill. 

Second is H.R. 4848, the Healthy Inpatient Procedures Act, 

called the HIP Act. As an orthopedic surgeon, I bear some familiarity with this area. This is talking about the comprehensive care 

joint replacement, or CJR, model. This is something that CMS put 

in place to try to decrease amount of resources spent on lower-extremity joint replacements. The problem is they have gotten it all 

wrong. It is what they call a demonstration product, but it is the 

first mandatory demonstration product. 

So, how it could be a demonstration product and be mandatory 

is beyond me. Sixty percent of the hospitals, as estimated, will be 

penalized because of this. Decreasing resources available for patients to utilize for lower-extremity joint replacement. So what happens? Medicare CMS limits access, limits choice, increases consolidation of services, and therefore, increases prices. 

What does this mean to patients? As a formerly practicing orthopedic surgeon, I would talk to patients about what kind of replacement they ought to have. And Medicare may or may not agree with 

that. The problem with this is that, if Medicare doesn’t agree with 

it, then guess who doesn’t get the joint replacement that they need? 

It is the patient. 

So the H.R. 4848 would delay onset of this program until January 2018. Again, it is a bipartisan support, it would simply give 

docs time to get ready for it and give us an opportunity to modify 

this program. 

And then, finally, H.R. 5001. Everybody has heard from their 

docs about the issue of electronic medical records. It is a disaster 

for physicians back home. The amount of time that they are having 

to spend on this to simply comply with regulations that don’t increase the quality of care to patients is astounding. 

What Medicare did this year is to change the meaningful use reporting period from a 90-day period, rolling 90-day period where 

docs would have to comply, to 365 days, which means the entire 

year, which means you can’t have your server go down, you can’t 

have any problem at all throughout the course of the year, or you 

get dinged by Medicare for not having what they believe is the appropriate electronic medical record. This bill would simply return 

it to the 90-day reporting period that we have had in the past. 

Again, common sense, bipartisan. 

I appreciate the opportunity to present these, and look forward 

to them passing. 

Chairman TIBERI. Thank you, Doc. With that, Representative 

Buchanan of Florida is recognized for five minutes. 


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Mr. BUCHANAN. Thank you, Mr. Chairman, for holding this important hearing. Before discussing my legislation I would like to 

mention the importance of examining medical competitive bidding 

also, as Dr. Price has clearly taken the lead on this, but has a huge 

impact on my region in Florida, especially Sarasota, but all 

through Florida. A lot of diabetics are very concerned about the impact it is going to have on them going forward. 

So I appreciate, Dr. Price, your leadership. And hopefully this is 

something we can get done quickly. 

Now, as for my legislation, along with my good friend, Congressman Pascrell, I introduced the Preserving Patient Act [sic] to PostAcute Hospital Care, H.R. 4650. 

Right now, tens of thousands of Medicare patients rely on access 

to highly specialized care facilities known as long-term acute care 

hospitals, or LTACs after they are released from intensive care 

units. These facilities are uniquely equipped to care for chronically 

ill patients over an extended period of time. And unless Congress 

acts, the allowable caseload for these facilities will be cut in half 

January 1, 2017. 

So in six months it would be cut in half. This means people will 

either remain stuck in the hospital ICU longer than they want to, 

or be forced to move to another place, away from their homes and 

families, to find care that they need. 

My bill prevents this cut from taking place, and Congress has approved similar measures several times over the last decade. We 

need to act soon. The cut takes effect at the end of the year, but 

these facilities need time to plan for their patients’ care. If we fail 

to pass this bill, more than 100,000 seniors could be denied vital 

care at their local ATAC hospital. 

With that, I yield back. 

Chairman TIBERI. Thank you, Mr. Buchanan, and thank you for 

bringing up Dr. Price’s bill. I too share that concern with respect 

to the durable medical goods issue, and have had constituents in 

my region of Ohio express concern. So I look forward to working 

with you on that, Dr. Price. 

Ms. Jenkins, CPA Jenkins, you are recognized for five minutes. 

Ms. JENKINS. Thank you, Mr. Chairman, and thank you for 

holding this important hearing and allowing me an opportunity to 

speak on bipartisan legislation that I am proud to advocate for that 

will allow more beneficiaries to access vital care in rural areas, 

save Medicare patients in the system money, and ensure its stability for generations to come. 

H.R. 1202, the Medicare Patient Access to Hospice Act, which I 

introduced with Congressman Thompson, will allow physician assistants to receive reimbursement from Medicare as the attending 

physician in a hospice setting. Hospice care is incredibly important 

in my district because of the lack of hospitals and doctors’ offices 

that urban districts have with large health systems. 

Along with allowing physician assistants the ability to perform 

cost-saving medical care in hospice setting, H.R. 1784, the MEND 

Act, which I introduced with Congressman Tonka, will bring about 

an out-of-date CMS regulation in line with the accreditation body 

that allows hospital-based nursing programs to produce nurses and 

shore up critical shortage in the Medicare system. 


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A third bill, H.R. 2138, the Medicare Access To Rural Anesthesia 

Act, which I introduced with Congressman Cleaver, will pay anesthesiologists in certain rural hospitals under Medicare Part A for 

their services at the rate paid to a certified registered nurse anesthetist in those hospitals for the same services. 

As I pointed out with H.R. 1202, Medicare beneficiaries in Kansas must use entire days sometimes to travel to certain hospitals 

to get care. Many of those hospitals can’t afford a full-time anesthesiologist, so those folks are then forced to travel somewhere else to 

get care. H.R. 2138 will help eliminate that burden and allow more 

rural hospitals to hire and keep anesthesiologists on staff. 

Similarly to that bill, H.R. 3355, which I introduced with Congressman Lewis, will allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac intensive 

care and pulmonary rehabilitation programs. Again, this will allow 

critical access and rural hospitals to hire and keep these vital staff 

members and provide needed care to rural parts of Kansas and the 

United States. Americans living on farms and ranches and those 

rural areas have the same need for medical services as those living 

in urban areas. And this legislation will give them more adequate 

service and keep costs down for the patients and the whole system. 

I will continue to work to give rural Medicare beneficiaries better 

access to care and save the entire Medicare system precious dollars 

so they can stay solvent and effective for generations to come. 

These four bills will make it much easier for Medicare beneficiaries 

to access and afford the care that they need, especially in rural 

parts of the states. 

I strongly encourage my colleagues to support these pieces of legislation and help me bring them to the House floor. 

I thank you, Mr. Chairman, and I will yield back. 

Chairman TIBERI. Thank you, Ms. Jenkins. Representative 

Marchant is recognized for five minutes. 

Mr. MARCHANT. Thank you, Mr. Chairman. Thanks for having 

this hearing and allowing us to put forward our ideas. 

I introduced H.R. 3288 with my friend and colleague, Dr. Boustany, last year. This legislation amends Title XVIII of the Social 

Security Act to change the method of determining disproportionate 

share hospital payments under the Medicare program. As the 

members of this Committee are aware, DSH payments compensate 

hospitals for the above-average operating costs they incur in treating a large share of low-income patients. 

Mr. Chairman, 19 states have decided not to adopt Medicaid expansion. DSH hospitals in each of these states such as Texas, Florida, Tennessee, Kansas, and Georgia, are financially disadvantaged 

by this. Though it is not our job to make state-level decisions, it 

is our job to ensure our hospitals have the resources necessary to 

care for our constituents. 

My bill would help ease the burden these hospitals are facing. 

Patient care is not a partisan issue, and I urge all of my colleagues 

on this Committee to cosponsor this non-partisan, no-cost policy. 

Mr. Chairman, once again I appreciate the effort being made 

here today and for the forum to speak on ideas to sustain Medicare, and look forward to continuing to work with you and the committee to advance the policy and strengthen the DSH program. 


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Thank you, and I yield back. 

Chairman TIBERI. Thank you, Mr. Marchant. 

Representative Paulsen from Minnesota, you are recognized for 

five minutes. 

Mr. PAULSEN. Thank you, Mr. Chairman also for holding this 

hearing. I have two bills that I have introduced that I would like 

to touch on today that have bipartisan support and would benefit 

seniors on Medicare. 

The first is H.R. 5075, the Accelerating Innovation in Medicine 

Act, also known as the AIM Act, which I introduced with Representative Ron Kind. Currently, patients and providers are having 

trouble accessing the newest, most innovative medical technologies 

and more and more barriers and coming from CMS, rather than 

from the FDA. And we, as a committee, need to take a serious look 

at the CMS coding, coverage, and reimbursement process to examine how the agency is functioning, its impact on the biomedical ecosystem, and its effect on ensuring that patients will have access to 

the next generations of advanced therapies. 

Currently, the process of receiving a CMS code alone can take as 

long as three years. National coverage decisions are typically time 

consuming and cumbersome, and some new therapies must go 

through a process of convincing each local carrier to provide coverage before a patient or a senior can get access. This process 

delays patient access to ground-breaking treatments. 

My bill, the AIM Act, would focus on the front end of this process 

by increasing patient access to the new—to new FDA-approved 

medical devices and procedures, and speeding up the collection of 

data needed for Medicare coverage decisions. The AIM Act does 

this by allowing a manufacturer to place FDA-approved devices 

and treatments on a list, where they are available for Medicare 

beneficiaries that self-pay. 

By agreeing to not seek Medicare reimbursement for three years, 

the devices then will be available without government red tape, paperwork, and administrative costs. And during that three-year period the manufacturer could collect patient data that will help 

streamline a future Medicare coverage decision. 

The current system is expensive, it is inefficient, and it gives providers, patients, and manufacturers uncertainty. And we need legislation like the AIM Act so that we can ensure the continued development of new treatments to improve Medicare outcomes, efficiencies, and lower costs. 

And then, Mr. Chairman, the second bill is H.R. 2404, the Treat 

and Reduce Obesity Act that I have also introduced with Representative Ron Kind. Obesity is now an epidemic and a public 

health crisis that needs to be addressed. Over 40 percent of seniors 

are obese. This disease takes both a physical and an emotional toll 

on an individual, and often is the cause of many other chronic conditions like diabetes, heart disease, stroke, and others. 

Nearly 20 percent of the increase in our health care spending 

over the last 2 decades was caused by obesity. And this disease directly costs Medicare more than $50 billion a year, and that number will continue to increase over the coming years. This is bad for 

our seniors and it is bad for Medicare. 


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Unfortunately, there are limitations in place preventing patients 

from accessing important treatments and providers that can help 

them combat obesity. The Treat and Reduce Obesity Act would remove these barriers by giving patients access to FDA-approved obesity drugs under Medicare Part D, and allowing additional qualified health care practitioners to provide intensive behavioral therapy services. Patients and clinicians require access to the full range 

of proven, safe, and effective therapies for the treatment of obesity. 

We have the ability to save the health care system billions of dollars and, at the same time, make the lives of patients significantly 

better. And that is why this bill has nearly 150 bipartisan cosponsors. We can’t solve this problem overnight. But by taking action 

now we will help us solve our obesity crisis over the long term. 

And finally, Mr. Chairman, I just want to touch on another issue 

that I am working on. I recently held a roundtable in Minnesota 

with some hospitals, and they are concerned about the direction 

that Medicare is going in terms of too much regulation, too many 

requirements, and the reimbursement system being very unpredictable. Hospitals, providers, and patients all recognize that we need 

fundamental reforms to the system. Otherwise, the system will collapse and seniors will suffer. 

Thankfully, there are providers, health plans, and states out 

there that are now trying to find ways to make our health care system more efficient and effective. They are not trying to tie the 

health care system up in knots with duplicative process measures 

that may or not yield the best results [sic]. But they are focusing 

on outcomes, high impact, clinically credible outcomes that we can 

focus providers around to achieve substantive and sustainable improvements for patients. And we can learn a lot from these state 

and local initiatives to strengthen Medicare. 

I look forward to working with you, Mr. Chairman, and my colleagues on those efforts to do just that. Those are just several of 

the ideas that I have for reforming Medicare, and I look forward 

to working with the chairman in the future on these bipartisan 

ideas. I yield back. 

Chairman TIBERI. Thank you, Mr. Paulsen. We are now to be 

joined by members of the full committee who have some ideas of 

their own on health care. 

Welcome, everybody. How is it down there? Not bad? 

Well, let’s start with the gentleman to my far left, Mr. Dold. 

You are recognized for five minutes to share your ideas with us. 

STATEMENT OF THE HONORABLE ROBERT DOLD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Mr. DOLD. Thank you, Mr. Chairman. I appreciate the comments from my colleagues down here—your comments. 

[Laughter.] 

Mr. DOLD. But anyway, Mr. Chairman, I thank you for the opportunity to testify before you today on two bills that I think will 

make some critically necessary reforms to Medicare. 

The first I would like to speak about is H.R. 5122, a bill that I 

helped introduce alongside my colleagues, Dr. Bucshon, Dr. Boustany, Dr. Price, and Representative Shimkus. This legislation 

would prevent CMS from finalizing, implementing, or enforcing the 


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demonstration program they proposed on March 8th of 2016. The 

proposal will dramatically alter the way Medicare Part B reimburses physicians for medications they administer to seniors in outpatient settings. The resulting cuts could disrupt access to medications for our most vulnerable seniors, including those with cancer, 

arthritis, and other very serious diseases. 

As you are all aware, this proposed demonstration was developed 

by the Center for Medicare and Medicaid Innovation with very little transparency and limited input from patients and physicians. 

Unlike previous CMMI demonstrations, all Part B providers are required to participate. As a direct result of the demonstration, by 

phase two, 75 percent of all providers will see drastic cuts to their 

reimbursements when providing Part B-covered medicines to patients. 

It also appears that CMS has failed to fully model how this demonstration will interact with other programs, especially the implementation of macro-legislation passed to repeal the SGR. 

Thanks to the ingenuity and perseverance of incredible researchers, our modern medical system has moved away from a one-sizefits-all treatment and has progressed into an era of precision medicine where treatments are highly personalized for each individual 

patient. 

The proposed demo, or demonstration project, directly contradicts 

this progress by incentivizing doctors to provide older, less advanced treatments, rather than newer, more innovative options. By 

allowing this demonstration to proceed, we are putting physicians 

in a very difficult position that not only is unfair, but detrimental 

to patient care. This will be especially true for providers working 

in small clinics serving rural areas. 

When the Federal Government created Medicare 50 years ago, 

Congress made a commitment to America’s seniors, and the cuts 

embedded in this demonstration project are a betrayal of that commitment. We must stop this ill-conceived proposal, and uphold our 

commitment to protect health care for seniors. 

I would also like to speak with you today about another bill that 

will ensure seniors receive the best care possible. It is H.R. 1178, 

the Ensuring Equal Access to Treatments Act, sponsored by my 

friends, Representative Reed and Representative Kind. It improves 

the way that CMS pays for certain diagnostic procedures that have 

a discretionary drug component by altering the current one-sizefits-all approach which does not allow seniors to receive the personalized care that best meets their needs. 

In 2014 outpatient prospective payment system had a rule that 

CMS redefined in terms of packaged payments for certain drugs 

administered with corresponding procedure. Rather than reimbursing for the drugs and the procedure separately, CMS now uses one 

package payment, which includes the drugs and all other services 

and supplies associated with the procedure. 

Unfortunately, since the package payment is the same whether 

or not the drug is used, the new payment structure has the effect 

of encouraging health care providers to choose treatments which 

may not result in the best long-term outcome for the patient. H.R. 

1178 corrects the problem by requiring CMS to create two separate 


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payment codes, one for when the diagnostic procedure is performed 

with drugs, and another when it is performed without drugs. 

We have already seen cases where 2014 packaged payments is 

negatively impacting vulnerable seniors. One example concerns the 

diagnostic of coronary heart disease. Providers have two options to 

raise a patient’s heart rate to a specific target: a stress test on a 

treadmill or a stress test by an induced drug, which may be needed 

for those that are unable to get on a treadmill to raise their heart 

rate. 

The current package payment system provides an incentive for 

providers to choose the free treadmill test over the drug, even if the 

drug may be more appropriate. I believe we have an obligation to 

correct this misaligned incentive, so that patients receive the most 

appropriate care necessary. We have seen a similar problem when 

physicians choose whether to diagnose bladder cancer with the 

new, innovative procedure known as a blue light cystostopy, or an 

older, less advanced white light test. 

We made a commitment to provide America’s seniors with highquality health care through Medicare programs. I look forward to 

working with all of you on H.R. 5122 and H.R. 1178, and the other 

bills that have been presented here today, in order to ensure that 

we maintain our commitment to our seniors. 

I thank you. 

Chairman TIBERI. Thank you, Mr. Dold. Thank you for your 

leadership in trying to stop that Part B demonstration program 

being proposed. It is important for us to try to do that. Look forward to working with you in that attempt. 

With that, Sheriff Reichert, you are recognized for five minutes. 

STATEMENT OF THE HONORABLE DAVID G. REICHERT, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON 

Mr. REICHERT. Thank you, Mr. Chairman. And I want to thank 

Chairman Tiberi and Ranking Member McDermott for being here 

today and holding this hearing and listening to our initiatives that 

we have been working on. I would like to talk about a couple of 

bills. 

First I would like to talk about H.R. 2649. And this bill was introduced with Representative Mike Thompson, and it is assisting 

Medicare beneficiaries who have been injured on the job, filed a 

claim for workers compensation, and settled their claims. In these 

settlements an amount must be set aside to cover Medicare’s share 

of future medical expenses related to the injury. 

The problem is that there are no statutory or regulatory provisions defining how these set-aside amounts should be determined. 

And the current procedure used by CMS has been subject to 

change without reasonable notice to the parties involved. This broken process results in delays and hardships for injured workers. 

My bill establishes a clear, predictable process. A few ways it accomplishes this is by setting up timeframes for CMS to review setasides, providing an appeals process and also offering individuals 

the option to pay the total set-aside amount directly to CMS. 


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So I look forward to working with you on this bill in advance. It 

is one of the priorities that we have been discussing, both on the 

D and the R side. 

The next bill is one that, Mr. Chairman, you and I have talked 

about. It is the Lymphedema Treatment Act. This is 1608. I introduced this bill with Mr. Blumenauer. Lymphedema causes painful 

swelling in parts of the body where the lymph nodes or vessels 

have been damaged. While there are many causes, damage from 

cancer treatment is probably the most common. While there is no 

known cure for lymphedema, it is treatable. 

But sadly, Mr. Chairman, current Medicare law leaves patients 

without access to treatment items they need to manage the swelling and prevent further health complication. My bill will fix this 

by providing coverage of doctor-prescribed compression supplies. 

This will not only save lives, but improve patients’ health. But it 

also will strengthen Medicare program by reducing costly hospital 

stays. 

For example, Sarah from Ohio. When she was diagnosed with 

lymphedema she was on the verge of losing her mobility and suffered frequent episodes of cellulitis. Between 2002 and 2004 she 

was hospitalized more than 10 times. In 2005 she was prescribed 

her first pair of compression garments. And by wearing these garments on a daily basis, she was able to maintain the progress she 

has made through treatment, manage her lymphedema so well that 

she has not been to the hospital in over a decade. In over a decade. 

Bob, from New York. In 2000 he was hospitalized twice with potentially fatal cellulitis infections. Later that year he was diagnosed with lymphedema. He received treatment and was prescribed 

the compression garments. In the 16 years since he has not had another cellulitis attack and has not been to the hospital. 

Now, we can talk about whether or not this is expensive, because 

that is what, of course, the Administration’s argument is, and 

Medicare’s argument is. But we are saving a lot of money by providing these garments to these patients who have suffered through 

and survived cancer, saving money at the back end on other treatments and hospital stays. And not only that, it is the right thing 

to do for these patients. 

So I want to thank Members here today who have already cosponsored this bill. I would like to recognize the patient advocates 

who have taken the time to meet with their Members and share 

their stories. Thanks to their tireless efforts, the bill now enjoys, 

Mr. Chairman, over 230 bipartisan cosponsors. And now we are 

working to even get more. 

And I ask, Mr. Chairman, unanimous consent to enter into the 

record a statement from the lymphedema advocacy group. 

Chairman TIBERI. Without objection. 

Mr. REICHERT. The bottom line here is these are not defined 

by Medicare as medical devices because they don’t fall within the 

definition of long-term, durable devices, which is three years, because in most cases the patients have to have new garments every 

six months. They are not disposable medical devices because they 

keep them six months and not a few weeks or a few days. This is 

ridiculous, a ridiculous rule, Mr. Chairman, and this bipartisan 


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piece of legislation changes this rule and helps these patients get 

the treatment they so desperately need. 

Thank you, I yield back. 

Chairman TIBERI. Thank you, Sheriff. Now, representing the 

entire South Dakota delegation in the House, Representative Kristi 

Noem. 

Mrs. NOEM. That is a big job. 

Chairman TIBERI. Thank you for being here. 

STATEMENT OF THE HONORABLE KRISTI NOEM, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF SOUTH 

DAKOTA 

Mrs. NOEM. Thank you, Mr. Chairman. And thank you Ranking 

Member McDermott and Members of the Subcommittee, for holding 

this hearing and allowing me to talk about a Medicare bill that I 

am promoting. 

I am here to discuss H.R. 4277, the Medicare Mental Health Access Act. I introduced this bipartisan bill with my Democratic representative, Jan Schakowsky, who has been a leader on mental 

health care policy. She is a member of the E&C committee. And I 

want to thank her and her staff for all of their hard work on this 

issue, as well. 

As you know, millions of Americans lack adequate access to mental heath services. And it is especially true for thousands of seniors 

who age into Medicare every day. The Federal Government should 

be working to improve access for these individuals. But sadly, current law does exactly the opposite. In fact, it presents significant 

barriers to American seniors who seek mental health services. 

The problem is that seniors have to go through a middle-man to 

get care, and that is because Medicare requires that many services 

provided by clinical psychologists must be prescribed and monitored by a medical doctor, a doctor who may or may not have any 

experience or training in mental health care. This supervision requirement is outdated and it stands in stark contrast to the private 

sector, in which clinical psychologists are largely allowed to provide 

treatment independently. 

That requirement also fails to respect clinical psychologists’ rigorous training and licensure requirements, which includes years of 

study in obtaining a Ph.D. This requirement is especially harmful 

for rural and under-served areas like South Dakota. When a physician is not available to oversee a clinical psychologists’s treatment 

program, the services are simply not offered. 

My bill, H.R. 4277, makes it easier for seniors to obtain mental 

health care services that they need, and it puts clinical psychologists on equal footing with other non-physician providers like chiropractors and optometrists. They are easily accessible by Medicare 

beneficiaries. 

In short, the Medicare Mental Health Access Act amends Medicare’s definition of ‘‘physician.’’ It includes clinical psychologists. 

This would have the effect of removing the middle-man from the 

process of seeking mental health services and allowing seniors to 

go directly to clinical psychologists. 

It is also important to note that, while this adds clinical psychologists to the physician definition, it would not allow clinical 


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psychologists to become medical doctors. Rather, it would simply 

allow them to practice in a more independent way by removing 

that physician supervision requirement. 

I would like to thank Mr. Nunes, Mr. Kind, Mr. Blumenauer, the 

subcommittee members who have already cosponsored this important bill. I urge the rest of you to join them because the Medical 

Mental Health Access Act represents a huge opportunity for us. It 

will tear down barriers for mental health care access for our seniors where, in states like South Dakota, we see it being a real issue 

for them getting the kind of care that they need. 

I sincerely hope the committee will take up this bill as soon as 

possible. And again, Mr. Chairman, I thank you for the opportunity 

to testify today. 

Chairman TIBERI. Thank you for your leadership on these important issues. 

Mr. Renacci, thank you for your leadership on the readmissions 

issue that became part of a bill that we passed unanimously on the 

floor last night. And we recognize you for five minutes. 

STATEMENT OF THE HONORABLE JIM RENACCI, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO 

Mr. RENACCI. Thank you, Mr. Chairman, for holding this hearing. I am grateful for the many bills that my colleagues have and 

will present today. Indeed, I am a proud cosponsor of many of 

them. I also think it is important we are here today presenting proposals, and continuing the conversation on how we can improve the 

delivery of services through Medicare and health care systems in 

general. 

When it comes to seniors, for instance, too often they decide not 

to seek the care they need because of the price, the inconvenience, 

or the bureaucratic red tape which gets in the way. There are so 

many burdensome and confusing regulations which many times 

leave Medicare beneficiaries waiting for a level of care they need 

or potentially facing extremely large bills they thought Medicare 

was covering. 

For example, under current Medicare payment policy, even if a 

physician knows the proper care setting for a beneficiary is a 

skilled nursing facility, beneficiary must be admitted to a hospital, 

stay at least three days as an inpatient, in order for Medicare to 

cover the cost of the beneficiary’s stay in a skilled nursing facility. 

Many times the beneficiary’s personal doctor is also on staff at that 

same hospital, and certainly knows the level of care needed before 

they are admitted. 

Even more concerning is that often times patients are not actually admitted as an inpatient, and are only admitted under observation stay. Despite most not knowing their status, most beneficiaries actually see no difference in care while at the hospital, but 

are penalized for non-payment if later admitted to a skilled facility. 

Unlike other post-acute care settings, Medicare requires a threeday inpatient hospital stay to qualify for skilled care, causing confusion for beneficiaries. According to an OIG report in 2012, beneficiaries had over 600,000 hospital stays that lasted 3 nights or 

more, but did not qualify them for skilled nursing facilities, meaning these individuals were either outpatient or observation status 


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during the hospital stay. Because they did not have the three days 

of inpatient care, as confusing as it sounds, they did not qualify for 

skilled nursing care, due to the inpatient requirement, and they 

are left incurring tens of thousands of dollars of costs that are not 

reimbursed by Medicare if they end up going to a skilled facility. 

In order to protect access to rehabilitation services, I have introduced a bipartisan bill, H.R. 290, the Creating Access to Rehabilitation for Every Senior. It is called the CARES Act. It waives the 

three-day inpatient stay requirement for skilled nursing facilities 

that meet certain quality measures. 

Here is an interesting fact. The average three-day inpatient hospital stay in many cases is equal to or sometimes more costly than 

the average 27-day stay in a skilled nursing facility. And we burden our Medicare system with both levels of cost. Even private insurance companies have already eliminated this unnecessary and 

duplicative expense, the three-day requirement. 

Therefore, by eliminating the three-day inpatient requirement, 

Congress can save both the beneficiary and the Medicare system 

money by reducing unnecessary hospitalizations. 

I understand this issue. I operated skilled nursing facilities for 

over 28 years. Just like many of the bills that passed the full 

House yesterday, I believe this is one more common-sense reform 

which will minimize hospital over-utilization, cut down on unnecessary red tape, eliminate unnecessary costs to Medicare program, 

and focus on what is best for the patient. 

Why should a beneficiary have to go to a hospital, have a doctor 

diagnose the need for nursing home care, all while remaining in 

the hospital, costing the system thousands of dollars? The CARES 

Act fixes this one step, let’s doctors decide the best care delivery 

system without burdening the cost of a three-day hospital stay, and 

helps protect the solvency of Medicare. 

And I look forward to working with my colleagues on both sides 

of the aisle to try and move this legislation. Thank you, Mr. Chairman, and I yield back. 

Chairman TIBERI. Thank you, Mr. Renacci. 

Dr. Boustany, you are recognized for five minutes. Thanks for 

your leadership in health care. 

STATEMENT OF THE HONORABLE CHARLES BOUSTANY, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF LOUISIANA 

Mr. BOUSTANY. Thank you, Mr. Chairman. I want to thank you 

and fellow members of the Ways and Means Committee, the Health 

Subcommittee, for holding this hearing and for hearing our priorities through a regular legislative order. I think this is really important, and especially with an emphasis now on strengthening the 

Medicare program, which is a vital program. 

As you all know, the Medicare program was established in 1965 

to provide reliable health coverage for America’s seniors, and we all 

know there are significant challenges ahead to preserve and 

strengthen this program. And I am convinced that we cannot really 

truthfully and effectively solve the problems with Medicare unless 

we fully embrace innovation and the latest technology that comes 


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online to improve the health and the lifespan and the quality of life 

for our seniors. 

I could tell you, as a long-time practicing cardio-vascular surgeon, I saw an explosion of new technology, just in the time I was 

in practice, that made major differences, huge differences in the 

lives of seniors, and that continues today. 

I am proud to join my Ways and Means colleague, Richie Neal, 

as well as colleagues on the Energy and Commerce Committee, Gus 

Bilirakis and Tony Cardenas, to introduce H.R. 5009, called the 

Ensuring Patient Access to Critical Breakthrough Products Act. 

This legislation provides an accelerated route to FDA approval and 

subsequent limited coverage under Medicare in order to stimulate 

the development of important new diagnostics and treatments that 

address currently unmet medical needs. 

For instance, following FDA approval it can take upwards of 

three years to receive a reimbursement code under Medicare, delaying patient access to groundbreaking technology. This is just unacceptable. We can do better. And while this legislation continues 

to allow CMS to remain the final arbiter for extending permanent 

coverage of this limited universal medical device technology, this 

legislation is a very important step to enhancing access on the 

front end to this cutting edge diagnostic and treatment technology 

for America’s seniors. 

Many examples exist. I have talked to a number of our companies, particularly the heart valve technology arena, where they 

move to advance technology now—for instance, instead of having to 

cut open the chest and spread the ribs and the sternum, they can 

do this through percutaneous technology to save lives and morbidity, and truly help people who might not have even been candidates for open heart surgery because of other existing comorbidities. That is just one example of the many advances. 

But if we are caught whereby, after going through a lengthy FDA 

process CMS delays the implementation and the use of this technology because there is no reimbursement code, then, I mean, this 

technology sits there and it is not accessible for seniors. 

This legislation is a modest approach to addressing this logjam 

and helping to move this technology forward, and so I look forward 

to working with the committee, and hope we can mark up this bill. 

Thank you, Mr. Chairman, I yield back. 

Chairman TIBERI. Thank you, Dr. Boustany, for your leadership. With that, the gentleman from New Jersey, my friend, Mr. 

Pascrell, a member of the subcommittee, is recognized for five minutes. 

STATEMENT OF THE HONORABLE BILL PASCRELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PASCRELL. Thanks, Mr. Chairman, and thanks for putting 

this together. There are some things we disagree with, there are 

a lot of things we do have in common, though. So today I want to 

touch three subjects, if I may. 

Huntington’s Disease Parity Act, H.R. 842, the Huntington’s Disease Parity Act, with my friend, Congressman Adam Kinzinger 

from Illinois. Today the bill has 253 bipartisan cosponsors, 15 from 


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our committee alone, and of itself, makes this bill, I think, worthy 

of consideration. 

Huntington’s Disease, or HD, is a genetic neuro-degenerative disease that causes total physical and mental deterioration over a 10 

to 25-year period. Because it is a genetic disorder, HD profoundly 

affects the lives of entire families emotionally, socially, financially, 

like a lot of other diseases, too. This devastating disease has no 

treatment or cure, and slowly diminishes an individual’s ability to 

walk, to talk, to reason. 

Today I will focus on the one provision of the bill which would 

waive the two-year Medicare waiting period for individuals with 

HD. Under current law, once a person with HD is deemed eligible 

for disability benefits—which is a challenge in itself—they are then 

forced to wait two more years before they can receive Medicare 

benefits. This means that while people are in the grips of a terrible, 

all-consuming, degenerative disease they can often not access the 

range of health care services they desperately need. This is simply 

unacceptable, Mr. Chairman. 

I thank all of my colleagues on the Ways and Means who joined 

with me on this legislation. 

Second thing is Reserving Patient Access to Post-Acute Hospital 

Care Act. I would like to highlight H.R. 4650, the Preserving Patient Access to Close Acute Hospital Care Act, which I introduced 

with my friend, Congressman Vern Buchanan. As the co-founder 

and co-chair of the Congressional Brain Injury Task Force, I understand the important role that long-term care hospitals play in the 

recovery of many individuals who suffer moderate to severe traumatic brain injuries, or TBIs. 

If there is one thing that I have learned about TBI in the 16 

years I have been working on this issue, it is that recovery looks 

different for everyone. That is why we must preserve access to all 

post-acute care options, so patients can receive the individualized 

care that they need. 

H.R. 4650 would provide an additional 2 years of relief from the 

full implementation of the 25 percent rule for long-term care hospitals. I would also note that the industry has offered to extend the 

current moratorium for a long-term care hospital to help offset the 

cost of the bill, which is something that I hope the committee 

would consider. 

And my final point is this, Mr. Chairman, something you have 

heard me speak about too many times, probably, and that is the 

UDI and claims. More than a few times. I just want to touch briefly 

on it being included in the unique device identifiers, the UDIs, in 

health insurance claims. 

This is an important patient safety measure that would improve 

post-market surveillance of medical devices to help identify problems with devices more quickly and help improve Medicare program integrity. I was very pleased last month when CMS Acting 

Administrator Andy Slavitt expressed support for the important 

policy. 

I look forward to working with you, Mr. Chairman, Mr. Ranking 

Member, to get this done. And I thank you, and I yield back, Mr. 

Chairman. Thank you. 


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Chairman TIBERI. Thank you, Mr. Pascrell. We will go from Jersey to Philly. 

Representative Meehan, you are recognized for five minutes. 

Mr. MEEHAN. It is a great route, isn’t it, Mr. Pascrell? 

STATEMENT OF THE HONORABLE PATRICK MEEHAN, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH 

OF PENNSYLVANIA 

Mr. MEEHAN. Thank you, Mr. Chairman and the full committee, for your participation and allowing us to take this opportunity. And I appreciate the opportunity to speak about H.R. 4212, 

which is the Community-Based Independence for Seniors Act of 

2015, which I introduced with our colleague, Representative Linda 

Sa ́nchez. 

The bill would authorize community-based institutional special 

needs plan demonstration program to provide home and community-based long-term services and supports to low-income Medicare 

beneficiaries who need assistance with at least two activities of 

daily living. 

Under current law, Medicare does not typically provide coverage 

for community-based, long-term care services and supports, which 

include medical and personal care, such as assistance with bathing 

or managing medications. And one study found that 13 percent of 

seniors spent down their savings in order to qualify for Medicaid. 

The demonstration program is designed to eliminate the need for 

Medicare beneficiaries who receive a low-income subsidy to spend 

their savings and become dependent on Medicaid. Many seniors 

prefer to remain in their homes—in fact, they are more healthy as 

a result of it—to receive the care that they need. And home and 

community-based care holds the promise of keeping seniors healthy 

and avoiding costly care. 

The demonstration offers up to five Medicare Advantage plans to 

provide coverage for long-term care services. The plans will receive 

a per-month payment not to exceed $400 for providing these services, and eligible Medicare beneficiaries with CBI in their area 

have the option to enroll in the plan. 

HHS will evaluate whether providing home and communitybased services to Medicare beneficiaries reduces state and Federal 

Government health care spending through delaying Medicaid eligibility for low-income seniors and reducing the need for acute care. 

The demand for long-term care services and supports continue to 

increase. The population of seniors 85 years and older is estimated 

to more than triple by 2050, and this group is 4 times more likely 

to use long-term services and supports compared to seniors age 65 

to 84. 

This program is one step towards reforming long-term service 

and supports that can generate savings while allowing seniors to 

remain healthy at home. A similar version of my legislation was reported out of the Senate Finance Committee last year, and I ask 

for the Chairman’s support in advance of H.R. 4212. 

I also want to highlight the arbitrary and capricious manner in 

which CMS is making decisions regarding eligibility to participate 

in Medicare programs as a hospital. CMS must not establish or 

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ganizations to furnish services or benefits, unless the agency uses 

notice and comment rulemaking. However, CMS has done just that 

in a ruling that will make a determination that Wills Eye Hospital 

is not eligible to participate in Medicare as a hospital. 

In contrast, the Pennsylvania Department of Health in the state 

of Pennsylvania, the survey agency determined that the hospital 

satisfied the Medicare conditions of participation and should be licensed under Pennsylvania laws an inpatient hospital. And I ask 

the chairman to work with me to ensure that CMS is using known 

standards in making determinations regarding hospital status for 

purposes of the Medicare reimbursement. 

And lastly, I want to note that I am working with Ranking Member McDermott on the Beneficiary Enrollment Notification and Eligibility Simplification Act, also known as the BENES Act. And as 

many of you know, Medicare enrollment rules are complex, and 

seniors do not receive notice from CMS regarding their responsibility to enroll. And because of these confusing rules, seniors may 

find themselves subject to a late enrollment penalty. 

The Part B late enrollment penalty permanently increases a 

beneficiary’s premium by 10 percent for every 12-month period the 

beneficiary could have had Part B coverage but did not. Others are 

paying for private coverage that is a secondary coverage to Medicare. But without enrolling in Medicare, these seniors will find 

themselves responsible for significant out-of-pocket costs. Part of 

the solution is to require CMS, in cooperation with the Social Security Administration and the IRS, to issue notifications to individuals approaching eligibility about the enrollment rules and the coordination of Medicare coverage with other health insurance coverage. 

I appreciate the consideration of my colleagues, and I thank you, 

Mr. Chairman. 

Chairman TIBERI. Thank you, Mr. Meehan. 

Welcome to the Ways and Means Committee room, Mr. Mooney 

from West Virginia. You are recognized for five minutes. 

Turn on your—thank you. 

STATEMENT OF THE HONORABLE ALEX MOONEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WEST 

VIRGINIA 

Mr. MOONEY. All right. There you go. Thank you, Mr. Chairman. I do appreciate the opportunity to testify about my bipartisan 

bill, the Promoting Responsible Opioid Prescribing Act, or the 

PROP Act. 

My home state of West Virginia has the highest rate of opioid 

overdose deaths in the country, more than double the national average. This drug abuse epidemic is a tragedy crying out for action. 

Addictions ravage our communities, rips families apart, stunts the 

development of our youth, and harms our economy. 

The House has already taken some important steps to address 

this epidemic, but much more remains to be done. One solution is 

my bipartisan bill, the PROP Act, H.R. 4499. This bipartisan bill 

removes a harmful provision of the Affordable Care Act that places 

unnecessary pressure on doctors and hospitals to prescribe narcotic 


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pain medication, regardless of whether the patient actually needs 

it. 

This problem was first brought to my attention by a group of doctors in Charleston, West Virginia, and I thank them for that. These 

doctors, many of whom serve Medicare patients, describe the dilemma they face when treating pain: either prescribe narcotic pain 

medicine to patients who do not need it, or risk receiving a low patient satisfaction score and a subsequent cut to the reimbursement 

rates. This dilemma is a result of a well-intentioned policy that is 

having unintended negative consequences. 

In 2006 the Center for Medicare and Medicaid Services, CMS, 

and the Department of Health and Human Services, HHS, developed a survey called the ‘‘Hospital Consumer Survey of Health 

Care Providers and Systems.’’ We know it as HCAPS. HCAPS is a 

standardized survey used to measure patient perspectives and satisfaction on the care they receive in hospital settings. At first hospitals used this survey on an optional basis. However, when the Affordable Care Act became law in 2010, it put in place ‘‘paid performance provisions’’ that use these survey results as a factor in 

calculating Medicare reimbursement rates for physicians and hospitals on ‘‘quality measures.’’ 

The survey includes three questions related to pain management, 

including one that asks whether patients feel that their caretakers 

did ‘‘everything they could to help’’ with pain. While these questions are clearly intended to help patients, doctors tell me that 

these questions pressure the doctors to over-use prescription pain 

narcotics when treating patients. 

At a time when prescription pain abuse is rampant, this is deeply concerning. Doctors, not the Federal Government, know best how 

to treat patients. And that includes the question of how best to use 

narcotic pain medicine. The PROP Act would remove the three pain 

management questions from consideration only when CMS is conducting reimbursement analysis. However, the patient will still answer the pain management questions in the HCAPS survey, so hospitals can monitor how they are doing. 

By severing the relationship between HCAPS question on the 

pain management and reimbursement, we can remove undue pressure on doctors to prescribe unnecessary opioid medications. This 

simple change will reduce access to narcotic pain medication for patients who do not need it, thereby reducing the risk of addiction. 

According to the National Institute on Drug Abuse, people who 

abuse opioid pain killers are 19 times more likely to start using 

heroine than people who do not abuse those painkillers. 

In addition, CMS is fully able to implement the PROP Act. The 

agency has already provided my staff and this Committee with 

technical assistance on the bill. If the bill passes, CMS will simply 

remove the questions from reimbursement calculations during the 

next rulemaking session. I would like to thank the staff from this 

Committee for their help with that. 

The PROP Act is also broadly supported by groups active in this 

field, including the American Hospital Association, the American 

Medical Association, Physicians for Responsible Opioid Prescribing, 

Association of American Medical Colleges, and America’s Essentials 

Hospitals. It has also been introduced in the Senate by Senators 


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Johnson, Manchin, Capito, Barrasso, Blumenthal, Markey, Toomey, 

Ayotte, and King. 

Finally, I want to thank many members of the Ways and Means 

Committee who are already cosponsoring the PROP Act: Tom Price, 

Diane Black, Tom Rice, Pat Meehan, Earl Blumenauer, and Bill 

Pascrell. 

Thank you, Mr. Chairman, for your consideration. 

Chairman TIBERI. Thank you, Mr. Mooney, for your leadership 

on the PROP Act. It is one that I have heard about, too, back in 

my district in Ohio, as we have talked about. So I look forward to 

working with you. 

Mr. MOONEY. Thank you. 

Chairman TIBERI. Thanks for being here. 

Mr. MOONEY. Sure. 

Chairman TIBERI. Before I turn to Mr. Larson for five minutes, 

I wish to inform him that a member of this Subcommittee was 

going to object to you being here, but I don’t see him right now. 

So be prepared if he comes back in the room. 

Mr. CROWLEY. Mr. Chairman? Mr. Chairman? 

Chairman TIBERI. Mr. Crowley? 

Mr. CROWLEY. On behalf of Mr. Pascrell, I would like to object. 

[Laughter.] 

Chairman TIBERI. Mr. Larson, you are recognized for five minutes. Can you turn on your microphone? Thank you. 

Mr. LARSON. I thank the chairman for interceding on my behalf. We were just on one of Mr. Pascrell’s shows. 

Chairman TIBERI. I heard. 

Mr. LARSON. He is perplexed after that show. 

STATEMENT OF THE HONORABLE JOHN LARSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CONNECTICUT 

Mr. LARSON. So, in keeping with the spirit of the meeting, let 

me first start by thanking Cathy McMorris Rodgers, as well as our 

colleagues, Tom Reed and Kurt Schrader, on introducing H.R. 

3244, which is Providing Innovative Care for Complex Cases Demonstration Act of 2016. 

Mr. Chairman, this bill would create a demonstration program in 

Medicare that would allow for contracts in several different parts 

of our country to be awarded with either a high-quality Medicare 

Advantage plan or physician organization ACO to provide an innovative care plan for the highest cost Medicare beneficiaries in this 

area. 

As the chairman knows more keenly than most, that the hardestto-serve population at the end of stages in their life is the most 

costly that we face, in terms of the Medicare programs that serve 

this nation so well. What this bill does, in short, is to provide more 

benefits, lower out-of-pocket costs, provide an integrated care 

model, and set high-quality standards. 

What it does, in short, too, Mr. Chairman, is something I believe 

this Committee should always subscribe to, and that is combining 

the very best that public health and the government side of the 

ledger can bring to bear, along with the innovation and technology 

of the private sector and academic research organizations that we 


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have to lower the cost of health care in a way that is most efficient 

and productive. 

It is no mistake that when we were looking at the Affordable Care Act that there is somewhere between 700 and $800 billion annually in fraud, abuse, and overlap of responsibilities that take 

place within the health care system. This can be eliminated. 

We know this can happen, in large part, because of, well, 

innovators like the Aetna in my district, in Hartford, Connecticut, 

where we are fortunate to have an individual who is the CEO who 

is a visionary and way ahead of his time, a person who recognizes 

that what we want to do is make sure that we are able to keep 

people in their own homes, that they are able to stay there and 

provide for the needs. It is a place that they all want to be. 

And in the process, if we can keep them out of the hospital, nobody wants their loved one to acquire a staff infection while in the 

hospital. Nobody wants to have to be readmitted after a hospital 

stay because of a lack of follow-up care. No one who has a loved 

one with a chronic health condition like heart disease or diabetes 

wants their health to be compromised because of a lack of coordination amongst health care providers. 

What this bill will do is provide innovations. What it will provide 

is an opportunity for us to keep people in their homes in an integrated fashion by coordinating their care in a systemic manner 

that will allow us to impact the cost and also provide the patient 

with the best possible outcomes, Mr. Chairman. 

I am proud to be a sponsor of this, and I think this is a prime 

example of how we can work together across the aisle by sharing 

the vitality of ideas in everything that technology and innovation 

and, frankly, that the public health system can bring to bear. And 

then, from a human standpoint, recognizing what the citizen and 

what the people want. In the final stages of life they want to be 

in their homes. And we ought to be able to come up with the innovation and way to do it. 

Mark Bertolini, the CEO of the Aetna, recognizes this and is one 

of the leading thought thinkers with respect to innovative health 

care designed to reduce these costs so we get away from the near 

20 percent of our gross domestic product that health care ends up 

costing. 

So, Mr. Chairman, I again want to congratulate my cosponsors, 

especially Cathy McMorris Rodgers, our colleague, Tom Reed, and 

also Mr. Schrader for their support of this bill, and I thank you for 

the opportunity to testify before your committee, and hope it will 

be taken up during this brief session. 

Chairman TIBERI. Thank you. I thank the gentleman from Connecticut. I have heard a little about that. Aetna has a large presence in Ohio. And I am kind of surprised that you promoted a gentleman with an Italian last name as being intelligent and 

thoughtworthy. 

Mr. LARSON. Well, unlike Mr. Pascrell, he has a vowel at the 

end of his name. 

[Laughter.] 

Mr. LARSON. But thank you, Mr. Chairman. 

Chairman TIBERI. I thank the gentleman. The gentleman from 

New York is recognized for five minutes. 


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STATEMENT OF THE HONORABLE JOSEPH CROWLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW 

YORK 

Mr. CROWLEY. I believe Mr. Pascrell also objected to my testimony today, as well. So on his behalf I would like to object to my 

testimony. But thank you, Mr. Chairman and Mr. McDermott, for 

this opportunity to join you today as we hear proposals to strengthen the Medicare program. 

I am glad to have the opportunity to talk about legislation I put 

forward to address what must be a priority within the Medicare 

program: training the doctors we need to meet the health care 

needs for tomorrow. And I thank Mr. Davis, who I believe spoke 

earlier about this particular bill. 

This is not something we could take lightly. Estimates indicate 

that by 2025 we will have a shortage of up to 95,000 doctors, both 

primary care doctors and specialists in the United States. Our 

health care needs are only growing, with a greater importance on 

preventative care and comprehensive health in an aging population. Ten thousand Americans turn 65 every day, so it is clear we 

need to have doctors available to treat them and Americans of all 

ages. 

Important steps have been taken. Medical schools have worked 

to increase their enrollment and their graduating classes. But what 

a lot of people don’t realize is that once those students graduate, 

they need to complete another stage of training by doing a residency program at one of the nation’s teaching hospitals. Without 

completing their residency, they cannot become licensed to practice 

medicine. 

Unfortunately, growing numbers of smart, well-prepared medical 

school graduates are fighting for a stagnant number of residency 

slots. We are not just facing a physician shortage, we are facing a 

physician bottleneck. 

But there is a clear path forward. For generations, training doctors has been a shared responsibility of the Federal Government 

and teaching hospitals, and that is because it is a shared benefit. 

The whole country benefits from more well-trained doctors. Congress has long recognized the value of investing in doctor training. 

And as a result, the Medicare program helps to support doctor 

training programs by funding residency slots around the country. 

However, there was an arbitrary cap on the number of residency 

slots that Medicare will support. And this cap hasn’t been raised 

in nearly two decades. Teaching hospitals have done their part in 

stretching their funds as far as they can go to help fund additional 

residency positions, even beyond that which Medicare covers. But 

they cannot do this alone. We must act and act soon to raise the 

Medicare cap on residency slots. 

There is no way to create more doctors overnight, but we can 

make the changes now that will open up the doctor training pipeline. I have put forward bipartisan, common-sense legislation, the 

Resident Physician Shortage Reduction Act, to increase the number 

of Medicare-supported residency slots by 15,000 over 5 years. And 

I am pleased to have been joined in this effort by Dr. Charles Boustany, a member of this Committee, and someone who I think all 


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of us respect for his experience. After all, who better to stress the 

importance of medical training than a cardio-vascular surgeon? 

Over 125 Members of the House, including many members of 

this Committee, have joined us as cosponsors of this bill. This bill 

would further address our doctor shortage issues by directing half 

of the new slots to go to specialists that are determined to be running a shortage. And it makes a decisive statement that we need 

to make a strong investment in our doctor training program. That 

is particularly important if we should seek continued proposals to 

cut or weaken the impact of graduate medical education funding. 

Far from being a luxury, teaching hospitals depend on this funding to fulfill their mission. It is an investment, not just in dollars 

and cents of running a teaching hospital, but in the highly complex 

and costly patient care missions that teaching hospitals undertake. 

They run advanced trauma centers and burn units. They see more 

complex patient cases. They treat patients with rare and difficult 

disease, like Ebola. And that helps train future doctors in all those 

areas. 

Graduate medical education payments were designed by Congress to reflect and encourage and reward all those efforts. And in 

a time of changing health care, teaching hospitals are doing more 

to train residents in community care settings and to give residents 

the skills for exactly the kind of coordinated care that our system 

is moving toward. So I urge all my colleagues on the committee to 

allow our teaching hospitals to continue to thrive in the mission of 

training the next generation of physicians. That means maintaining our investment in graduate medical education funding. 

And in what I hope will be a priority for this Committee, it 

means lifting the outdated cap on residency slots, Mr. Chairman. 

It is not exaggerating to say the future of our health care system 

depends on just that. 

And with that I yield back. 

Chairman TIBERI. Thank you, Mr. Crowley. I appreciate your 

testimony today and bringing the matter to our attention. 

We will stay in the State of New York and recognize and welcome to the committee room, the Ways and Means Committee 

room, Mr. Zeldin for five minutes. 

STATEMENT OF THE HONORABLE LEE ZELDIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK 

Mr. ZELDIN. Thank you, Mr. Chairman. And thank you for the 

opportunity to present my bill, H.R. 3229, to provide for the nonapplication of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories, an important piece of legislation which would have a significant impact on individuals with 

severe disabilities. 

Complex power and manual rehabilitative wheelchairs and related accessories are mostly utilized by a small percentage of individuals who suffer from significant disabilities such as ALS, cerebral palsy, multiple sclerosis, muscular dystrophy, spinal cord injury, traumatic brain injury, and many more. Within the Medicare 

program these individuals represent less than 10 percent of all 

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tremely vulnerable group of people suffering from significant disabilities. 

The specialized equipment these individuals rely upon for daily 

life is provided through a clinical team model and requires evaluation, configuration, fitting, adjustment, or programming before it 

can be properly used. This small population of individuals has the 

highest level of disabilities and requires these individually-configured wheelchairs and critical related accessories to meet their medical needs and maximize their function in independence. 

In 2008 Congress passed and the President signed into law the 

Medicare Improvements for Patients and Providers Act, MIPPA, 

which established a fixed price schedule for complex rehab technology, CRT, and related accessories. Under MIPPA, CRT devices 

would be excluded from CMS’s competitive bidding program to ensure consistent and fair prices for consumers. Excluded devices include power wheelchairs and related accessories, which are the fundamental parts of the products that make them useful and beneficial to people with progressed disabilities such as recline tilt systems, specialty controls, and seatback cushions. 

In November 2014, however, CMS issued a ruling contrary to 

MIPPA which stated that, beginning in January of 2016, accessories that are used on complex rehabilitative wheelchairs will no 

longer be a part of the fixed-fee schedule, but will now be subject 

to competitive bidding prices, which will decrease access to the individually-configured wheelchairs and accessories relied on by 

adults and children with disabilities. 

While Congress acted to temporarily delay this measure until 

2017, further action is needed to permanently address this issue. 

My legislation, H.R. 3229, seeks to codify the 2008 MIPPA regulations, and excludes power and manual wheelchairs and their related accessories from the competitive bidding process. 

In addition to the significant support from groups such as the 

ALS Association, Muscular Dystrophy Association, National Multiple Sclerosis Society, Paralyzed Veterans of America, Vets First, 

the United Spinal Association, and the Christopher Reeve Foundation, just this past week the Government Accountability Office 

issued a report to Congress regarding the benefits of this legislation. This GAO report focused on utilization expenditures for Medicare wheelchairs and accessories, and how the 2016 competitive 

bidding program adjusted payment rates for accessories, and how 

those rates compared to the 2016 unadjusted fee schedule payment 

rates for the same items. 

In addition to recognizing that CRT wheelchairs and accessories 

are required by individuals with high levels of disabilities, the report also details that these wheelchairs and accessories are not 

standard wheelchairs, and they are individually configured to each 

person utilizing this technology to meet their specific needs. 

The report further states that the information CMS is relying 

upon to shift these wheelchairs and accessories from a fixed price 

schedule to the competitive bidding process is based on limited information from only 9 of 109 total bidding areas, which is clearly 

insufficient, in order to nationally shift policy. In fact, the report 

shows that this shift will bring about significant payment cuts, 


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ranging from 10 to 34 percent, which will only result in increased 

costs which are passed along to the consumer. 

My legislation is a common-sense approach to addressing one of 

the significant issues currently affecting the Medicare system. This 

broadly bipartisan legislation is supported by well over 100 Members in the House and its companion bill, Senate Bill 2196, also enjoys significant bipartisan support in the Senate. 

This legislation ensures that those who are in need of the most 

assistance are not unfairly impacted by this new policy shift. 

Mr. Chairman, thank you again for the opportunity to testify on 

behalf of this essential piece of legislation. And I yield back the balance of my time. 

Chairman TIBERI. Thank you, Representative Zeldin. Glad you 

have you here. 

And last, but not least, welcome to the Ways and Means Committee Room—I think the dean of the New Jersey delegation—Representative Chris Smith. 

STATEMENT OF THE HONORABLE CHRIS SMITH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. SMITH of New Jersey. Mr. Chairman—— 

Chairman TIBERI. You are recognized for five minutes. 

Mr. SMITH of New Jersey [continuing]. Thank you very much. 

Thank you, Ranking Member. As co-founder with Ed Markey some 

16 years ago of the Congressional Alzheimer’s Task Force, and as 

co-chair for the past 16 years, I am very grateful to you for providing me with the opportunity to speak about my bill, H.R. 1559, 

the Health Outcomes Planning and Education for Alzheimer’s Act, 

which now has 286 cosponsors, including many members of this 

Subcommittee. 

It is very appropriate that we are discussing hope today, as June 

is Alzheimer’s and Brain Awareness Month. As I am sure you are 

aware, well over five million Americans suffer from Alzheimer’s or 

related dementia. And as the Baby Boom population ages, that 

number is expected to skyrocket unless we find a cure or at least 

delay onset. 

This disease is devastating. We all know people who have had 

it—and friends and family members—to both the patient and family, alike. Shockingly, many Alzheimer’s patients do not receive an 

accurate diagnosis, especially in the early years. And, according to 

the Alzheimer’s Association, fewer than half of individuals with 

Alzheimer’s are even told of their diagnosis. The 200,000 Americans now affected with early onset Alzheimer’s are especially likely 

to get an inaccurate diagnosis. 

Alzheimer’s is also the most expensive disease in America. It incurs catastrophic cost to Medicaid and to Medicare: approximately 

$236 billion in 2016, alone. On average, Medicare spends three 

times more on seniors with Alzheimer’s than those without. That 

is to say about $22,000 for seniors with Alzheimer’s per year. To 

ensure that optimum care to every Alzheimer’s patient is provided, 

we need to find innovative ways to improve the quality of care. Occasionally, such initiatives will actually reduce—I say again, reduce—Medicare spending. 


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The HOPE Act would amend the Social Security Act to add an 

additional one-time benefit for care planning services for Medicare 

beneficiaries newly diagnosed with Alzheimer’s disease and related 

dementia. This one-time comprehensive care planning session will 

arm patients and caregivers alike with the facts, prognosis, and options for the most efficacious treatment plan that they might pursue. Comprehensive care planning will mitigate huge, unnecessary 

costs associated with preventable trips to the hospital and the 

emergency rooms. 

As far back as 10 years ago an article in the Journal of American 

Medical Association entitled, ‘‘Effectiveness of Collaborative Care 

for Older Adults with Alzheimer’s Disease in Primary Care,’’ Christopher Callahan wrote that there was a savings in a healthy aging 

brain center study that found a $3,500 net Medicare savings when 

it included such a care planning session. So if people know the 

facts, they are more likely to get the care they need earlier, rather 

than later, again averting hospital stays and also taking drugs that 

might have adverse impacts because of drug interaction. 

I would just give you one example that many people are not 

aware of. Aricept, which is prescribed to treat symptoms of Alzheimer’s, can be rendered ineffective when used with over-thecounter medicines such as Sudafed. Very often that is not known. 

And again, the drug is not having its positive impact that we would 

hope that it would have. 

Chairman TIBERI. Without objection. 

[The information follows: The Honorable Chris Smith] 


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Mr. SMITH of New Jersey. SPIREN, a Washington, D.C.-based 

health care consulting firm, conducted a cost estimate for HOPE. 

They did it at the behest of the Alzheimer’s Association. And they 

found that a result of this legislation net federal health spending 

would decrease by $692 million over a 10-year period. And again, 

most of those savings to Medicare would be the result of reduced 

hospitalizations and emergency room visits, as well as better medication management and better management of comorbidity, which 

of course is a major problem with people suffering with Alzheimer’s. 

I do hope the committee will consider the bill. It already has a 

huge majority of the House supporting it. And I yield back the balance of my time, and I thank you. 

Chairman TIBERI. Thank you, Congressman Smith, for your 

leadership not only on this bill, but for your leadership on the issue 

over the years, over the last 16 years. 

Mr. SMITH of New Jersey. Thank you, Mr. Chairman. 

Chairman TIBERI. There is hope out there. 

So, what a great day, Dr. McDermott. Some great ideas, some 

fascinating testimony. And I would like to get back to you on that. 

I would like to thank all the colleagues who came before us today, 

both from the committee and outside the committee. 

I appreciate all the time and work that they have done, that 

their staffs have done, that our staffs have done, as we have started this robust conversation about how we can modernize our health 

care system, including reforms to improve and to strengthen our 

Medicare system. 

And I am happy we have had the time, once again, to pursue regular order and make the public record—make a public record of the 

efforts that can help us achieve that goal. 

So please be advised that Members will have two weeks to submit written questions that can be answered later in writing. These 

questions and answers will be made part of the formal record. 

With that, the subcommittee stands adjourned. 

[Whereupon, at 3:55 p.m., the subcommittee was adjourned.] 

[Submissions for the record follow:] 


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The Honorable Diane Black, Statement 


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The American College of Clinical Pharmacy, and the College of Psychiatric 

and Neurologic Pharmacists, Statement 


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Lymphedema Advocacy Group, Statement 


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Medicare Rights, Statement 


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Property Casualty Insurers Association of America, Statement 


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Æ 


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