Senator Carper Offers Proposals to Address Vulnerabilities in Medicare and Medicaid Programs

WASHINGTON – During today’s Senate Finance Committee business meeting today, Sen. Tom Carper (D-Del.), a member of the Finance committee and ranking member of the Homeland Security and Governmental Affairs Committee, set forth two common-sense legislative proposals to address critical issues within our health care system. The first amendment would require the Department of Health and Human Services (HHS) to issue guidance to states clarifying coverage of important behavioral health care interventions for children in foster care under Medicaid. The second would establish a series of requirements to strengthen Medicare and Medicaid program integrity efforts, in order to curb waste and fraud. 

“As we come together to build the Committee’s agenda for this Congress, I want to shine some much-needed light on two areas where my colleagues in Congress and I can work together in the spirit of bipartisanship, and make positive change in the lives of thousands of our nation’s most vulnerable citizens,” Sen. Carper said.

“My first proposal addresses a mostly unseen vulnerability in Medicaid and the foster care system. Many foster children show symptoms of emotional trauma, abuse, or neglect. Our past work with the Government Accountability Office found that many times, those foster children were prescribed improper levels of mind-altering medications, at too young an age, often contrary to established medical best practices. Not only are these drugs very expensive to the taxpayers, but they can have serious side effects and often are unable to fully resolve the mental health trauma facing these children, particularly when prescribed inappropriately. It is critical that we understand and treat these underlying problems affecting these children first, through qualitative care, and not simply through medication. My proposal today would require the Department of Health and Human Services to issue guidance to the states and clarify the kinds of alternative treatments available through Medicaid. It would also encourage states to offer coverage for qualitative treatments that evidence has shown are effective in treating the emotional needs of children in the foster care system.

“My second proposal represents a bipartisan set of initiatives that would bolster the integrity of our Medicare and Medicaid programs by taking commonsense steps to prevent improper payments and fraud. The amendment is based on the bipartisan Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act. By cracking down on vulnerabilities that put tax dollars at risk to waste, fraud and abuse, this measure would ensure that Medicare and Medicaid remain sustainable for years to come, and continue to provide quality care and services on which so many Americans depend.”

For years, Sen. Carper has provided critical oversight on the improper prescribing of mind-altering medications, also known as psychotropic drugs, for children in the American foster care system. In December 2011, as chairman of the Federal Financial Management Subcommittee, he held a hearing on the mental health care provided to foster children by Medicaid, following a Government Accountability Office (GAO) report on the issue. The report found that thousands of foster children, including infants, are prescribed alarmingly heavy doses of psychotropic medications in excess of the maximum doses for the child’s age as recommended by U.S. Food and Drug Administration (FDA). The report also found that some children were prescribed many psychotropic medications at the same time. During his tenure as chairman of the Homeland Security and Governmental Affairs Committee, he continued leading efforts to conduct oversight in this area. In April 2014, GAO released a follow-up report that highlights individual children’s medical and psychological treatment while in foster care. The report concluded that additional efforts may be needed to address the problem that psychotropic drugs are overly prescribed to our nation’s foster youth.

The PRIME Act was originally introduced as a bill by Sens. Carper and Coburn (R-Okla.) and Reps. Roskam (R-IL) and Carney (D-Del.) in June 2013. On December 12, 2013, the Senate Finance Committee included portions of the PRIME Act as an amendment to their version of the SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013, which did not see enactment.