During a House Ways and Means Committee hearing held before the congressional recess, Rep. Linda Sanchez (D-CA) questioned healthcare witnesses about healthcare spending cuts.
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NewsTranscript
00:00Ms. Sanchez, you're recognized.
00:05Thank you, Mr. Chairman, for holding this hearing, and I want to thank our witnesses
00:08for being here today.
00:10Post-acute care is a critical part of the care continuum, but it's often fragmented
00:15in its delivery, so I'm encouraged to hear the witnesses' ideas to help address some
00:20of these issues.
00:22Something that I personally care deeply about is long-term care.
00:25More often than not, caregiving is unpaid, and it's provided by loved ones.
00:30Two-thirds of caregivers in the United States are women, and I've worked for over 10 years
00:35to pass a caregiving tax credit, and today my colleague, Mr. Kerry, and I reintroduced
00:41the Bipartisan Credit for Caring Act.
00:43I hope that we can pass this on a bipartisan basis to provide much-needed relief for working
00:48families, because the only other way working families can afford long-term care is through
00:53Medicaid, and Republicans are hell-bent on pursuing an $880 billion cut in Medicaid to
01:01pay for the tax cuts for the largest corporations and highest income earners in the United States.
01:09The fact is that three out of every five nursing home residents rely on Medicaid.
01:16Mr. Carlson, I want to thank you for your testimony on long-term care and your notes
01:20on staffing standards in skilled nursing facilities.
01:24I want to ask you, and if you could answer briefly, because we've got a lot of territory
01:26to cover, what kind of impact would Medicaid cuts have on access to nursing facility care?
01:35Thank you for the question that has been mentioned.
01:41Nursing facility residents, you're talking about close to two-thirds of residents who
01:45are reimbursed by Medicaid, and so that's just obviously a tremendously big piece of
01:52reimbursement for nursing facilities.
01:55So any dramatic cuts to Medicaid funding, as I mentioned earlier, the consequences fall
02:01to the states.
02:02They don't have enough money to do what they want to do.
02:04What needs to be done to cover the health care needs of older —
02:08So the individuals would be responsible.
02:10Can many of them afford that on their own?
02:12Right.
02:13Then it falls on — the facilities aren't adequately reimbursed, or the eligibility
02:18standards are changed.
02:21One way or another, it becomes untenable for everyone.
02:26The providers, it's likely to become untenable.
02:28But I'm focused on the patient.
02:30What happens to the patient?
02:31Yeah, for the beneficiaries, you know, they either don't have coverage or the financial
02:35standards would be such that they couldn't afford the care that they needed.
02:42They wouldn't get the care.
02:43Yeah.
02:44You get squeezed out.
02:45Be brief.
02:46They wouldn't get the care.
02:47They'd be squeezed out.
02:49And what would that do to the nursing home industry in states like Alaska, Georgia, Louisiana,
02:54or West Virginia?
02:57Those are states which is an even higher percentage of Medicaid benefit, I think north of 70 percent.
03:03So $880 billion cut in Medicaid would mean that those facilities and their patients who
03:10are no longer receiving the subsidies, what happens to those facilities?
03:16The impact is even bigger in those states because the percentage hit on nursing facilities
03:21is that much higher.
03:23There's not enough money for individuals.
03:25There's not enough money for providers.
03:27Okay.
03:29I want everyone to recall when my Republican colleagues on this committee voted to rescind
03:33the minimum staffing rule for nursing facilities last year.
03:37Our own chairman said in his opening statement during our markup last year, quote, without
03:42access to more staff, nursing homes, particularly those in rural areas, will have no choice
03:49but to reduce the number of residents they admit or shut down altogether.
03:54Let me repeat that.
03:55Without access to more staff, nursing homes will shut down.
03:59So let me ask, are Republicans still outraged about rural nursing facility closures?
04:05Because that $880 billion cut in Medicaid will close many of those rural facilities.
04:12So I urge you to stand up to oppose those cuts, which will devastate those rural facilities
04:19and the patients that they serve.
04:21I also want to talk about access to issues in post-acute care.
04:25This is an issue that I've worked on on a bipartisan basis with Ms. Van Dyne of this
04:29committee.
04:30And I would like to submit for the record our letter on MA network adequacy standards,
04:36which still do not include IRFs.
04:39So ordered.
04:40Thank you, Mr. Chairman.
04:41I also consistently hear that patients experience long delays in post-acute care due to Medicare
04:47Advantage's plan's prior authorization practices.
04:51Mr. Tongeli, in your testimony, you cite improper denials in coverage for more intensive post-acute
04:57care.
04:58That causes delays in care when a patient transitions to the post-acute setting at an
05:06IRF.
05:11Thank you for the question.
05:13The delays result from the process that has been set up by the Medicare Advantage plan.
05:20Like I said previously, fee-for-service Medicare patients, we can assess that patient and bring
05:24them in within one day.
05:27If it's a patient who has Medicare Advantage, we have to take that clinical information.
05:33We have to provide it to the Medicare Advantage plan for approval to bring the patient in.
05:39Often what we see is an immediate denial.
05:43And how often are those prior authorization claims denials appealed and overturned?
05:49They're over – oh, appealed and overturned?
05:52Yes.
05:53Overturned.
05:54And what we find in our experience is that roughly maybe 40% of the ones that are initially
06:04denied can be overturned during appeal.
06:07Thank you, and I yield back.