News from Capitol Hill
New Leadership Reflects Conservative Sweep
With the national elections a part of history now, our attention focuses on the conservative themes of the winners. The promises of the 96th Congress convened two years ago. of national health insurance and hospital cost containment, have passed into oblivion. The Reagan Presidency and Republican Senate reveal a marked change in popular sentiment for leaders emphasizing inflation control, increases in productivity, and a strong national defense.
Concern for social programs with the elderly as beneficiaries has been evident throughout post-election hearings, testimonies, and reports. Health and Human Services (HHS) Secretary Schweiker stated in his confirmation hearings that he wants to be "remembered for putting preventive health care, preventive medicine into the mainstream of department programs." Cost-effectiveness and program review will be examined critically by this administration. In response to a question from Senator Bentsen (D, TX), Schweiker commented that "a lot can be done when considering costeffectiveness," in terms of promoting "home health delivery" over institutionalization. The former Senator assured the Senate Finance Committee that he will give "immediate, high priority" to eliminating waste, fraud, and abuse in Medicare and Medicaid programs.
Health Agenda of the New Congress
Although Congress has not yet developed a formal agenda, reviews of some 35 Public Health Service Act programs scheduled to expire in calendar year 1981 will dominate.
The following is the status of recent legislative activities affecting the elderly.
Continuing Resolution-P.L. 96536
The second continuing resolution was signed into law on December 16 by President Carter. The law establishes fiscal year 1981 funding levels for a number of federal agencies, including those prov iding services to the elderlv. The resolution authorizes those agencies to spend at these levels through June 5, 1981.
An additional $41.736 million for community programs under the Older Americans Act was included in the funding levels. Title III-C (Nutrition Services) received the largest increase, $30 million above the fiscal 1980 level. A portion of this increase reflects the impact of inflation and attempts to sustain these programs fiscally, rather than an increase in services
Other items in the second continuing resolution include:
White House Conference on Aging: An additional $3 million was approved for the 1981 White House Conference.
National Institute on Aging: As the focal point for aging research, NIA will be funded at $76.091 million, a figure representing an increase of $6.091 million over the 1980 funding level.
Home Health Demonstration: The home health demonstration program within the Public Health Service is to be funded $1 million below the FY 1980 level. The continuing resolution provides for the House-approved $4 million level of funding.
Congress approves Medicare and Medicaid Amendments-P.L. 96499.
Perhaps the most substantive health legislation to emerge from the 96th Congress were the Medicare-Medicaid portions of the Omnibus Budget Reconciliation Act of 1980 (P.L. 96-499) and several separate Medicare-Medicaid amendments passed before the Congress adjourned sine die in December, 1980.
The most significant of these amendments (P.L. 96-499) to the Social Security Act include:
Medicare Home Health Benefits: P.L. 96-499 removes the 100-visit limitations for home health visits under Medicare Parts A and B, thus providing coverage for an unlimited number of visits; removes the requirements for a three-day prior hospitalization stay under Part A; eliminates the $60 deductible for home health care under Part B; and makes occupational therapy a primary home health benefit. The new law allows participation in the Medicare program by proprietary home health agencies in states without licensure laws.
Hospital Transfers to Nursing Homes: The new law extends from 14 days to 30 days the .period for transfer from hospital to skilled nursing facility in order to qualify for extended care benefits. The 30day period also applies to cases of readmission to a skilled nursing facility without meeting the additional three-day hospital stay rule.
Pneumococcal Vaccine:President Carter signed P.L. 96-611, which will authorize Medicare coverage for pneumococcal vaccine without copayment or deductible charges. There was speculation that the bill would be vetoed because of a transfer of assets measure added to the bill by Senator Russell Long (D, LA). The added provision gives additional authority to states to limit Medicaid eligibility for individuals who dispose of resources in order to meet SSI eligibility requirements.
Medicare Part C Proposed
A recent report of the House Select Committee on Aging proposes to expand Medicare to include optional coverage of eye and hearing prescriptions and aids, dental care, prescription drugs, and physical examinations. The proposed Part C would be optional, like Part B, and would require a similar premium.
The report also suggests a tax credit incentive to encourage doctors to accept assignment of Medicare repayment. The proposal suggests giving up to $25,000 in direct deduction from their taxes for physicians who accept assignments.
ANA Task Force on WHCOA Publication
The ANA task force on the White House Conference on Aging has published the first of several background papers for the delegates to the 1981 conference. Gerontological Nursing: The Positive Difference is recommended for all nurses involved in activities preparing for the conference.
Conditions of Participation
At the time of this writing, Secretary Patricia Harris was deciding whether to publish separately the conditions of participation section on patients' rights for Medicare and Medicaid nursing homes. With little time left, the Secretary's office probably will hand over the rest of the regulations to the incoming Reagan Administration. The new rules, which have been two years in the making, place more emphasis on the quality of care actually received. The old regulations stress institutional framework. The campaign rhetoric of President Reagan and the transition team tend to make the future bleak for any new regulations.
In a related decision, Senator Lawton Chiles (D, FL), chairman of the Senate Special Committee on Aging (of the 16th Congress), has requested the General Accounting Office (GAO) report to Congress in January on the conditions.
New Premiums Announced
The December 24 issue of the Federal Register announced that effective July I, 1981, the monthly Medicare hospital insurance premium for the uninsured aged will be $89. In the same issue, it was announced that the premium rates for the aged (65 and older) and disabled enrolled in Medicare Supplementary Medical Insurance (SMI) will be $11 per month