TESTIMONY OF NANCY ANN MIN DEPARLE, ADMINISTRATOR YEAR 2000 CONVERSION EFFORTS AND IMPLICATIONS FOR BENEFICIARIES AND TAXPAYERS BEFORE THE HOUSE WAYS AND MEANS COMMITTEE
Chairman Archer, Congressman Rangel, distinguished committee members, thank you for inviting me here today to discuss my highest priority -- the Year 2000 computer challenge.I am happy to report today that, despite serious concerns about the Health Care Financing Administration's (HCFA) ability to meet this challenge, we are making remarkable progress.In fact, I am confident that HCFA's own Year 2000 systems issues will be resolved well before January 1, 2000.
Our foremost concern has been and continues to be that our more than 70 million Medicare, Medicaid and Children's Health Insurance Program (CHIP) beneficiaries continue to receive the health care services they need.That is why we are not only addressing the Year 2000 issues in those systems over which we have responsibility, but are also engaging in an unprecedented outreach effort to raise awareness and provide information to those other parts of the health care system where we have little authority and control.
HCFA is responsible for the financing of health care for our beneficiaries.We can assure that HCFA's claims processing and payment systems will work, that doctors and hospital bills will get paid.Continuity of care, however, depends on far more than payment systems.It depends upon doctors, hospitals and other service providers ensuring that their equipment will work and their offices will remain open.It depends upon pharmaceutical and medical supply chains, which rely heavily on information technology, continuing to operate normally.And all of this, of course, requires the continued functioning of basic utility and telecommunication services.
We have aggressively attacked our part of the problem.While our job is not yet done, and we will continue to work hard for the next year on testing and retesting our systems, as well as developing our contingency plans, we have already accomplished a great deal.
All 25 of our internal mission-critical systems are now certified as Year 2000 compliant, three months ahead of the government-wide deadline of March 31, 1999.
All 78 of our external mission-critical claim processing systems that our claims processing contractors use to pay bills are renovated.Of these, 54 have been self-certified as compliant.Our independent verification and validation (IV&V) expert contractor has rated 17 systems as highly compliant and will require only a minimal effort to resolve any remaining issues; another 39 systems will require a moderate level of effort.Our IV&V contractor has assured us that these systems will be compliant on time and that there is no evidence to suggest they will not.We will continue to have our own experts and staff on-site, monitoring and assisting contractors with remaining Year 2000 work, and we will recertify all mission-critical systems before October 1999.
And 27 of our 55 non-mission critical internal systems are certified as compliant.
We readily acknowledge that we got a late start with our Year 2000 problem, and that this has caused considerable concern and criticism.We recognize the importance of our programs to our beneficiaries and have thus set very aggressive goals and put together a vigorous Year 2000 program, with extensive testing and independent review.We have asked our IV&V contractor to set rigorous performance measures and be hard in their judgment of our contractors' progress.
For the remainder of 1999, we will continue to renovate, test, and retest our systems.We are ahead of schedule on our internal mission-critical systems, and we are well on our way to meeting the Federal government's March 31, 1999 deadline for our external systems.We will certainly be ready well before January 1, 2000.
I must be clear, however, about what HCFA can and cannot do.HCFA pays bills.Providers provide service and send claims to our claims processing contractors once services are delivered. We are responsible for all our own systems, our claims processing contractors' systems, and data exchange interfaces between all of these systems and the systems of States, providers, banks, phone companies, and other partners.We do not have the authority, ability, or resources to step in and fix systems for others, such as States or providers.And that leads to a rather substantial concern for which we need the assistance of Congress and others to address.
Concern for States and Providers
It is not enough for HCFA alone to be ready for the Year 2000.Health care provider computers and systems must be Year 2000 compliant in order for providers to be able to generate and submit bills to us.State computers and systems also must be Year 2000 compliant for Medicaid and CHIP to continue uninterrupted payment for beneficiary service.Many States and providers will meet the Year 2000 challenge on time.However, monitoring by us and the General Accounting Office (GAO) indicates that some States and providers could well fail.This is the first time any of us have had to deal with such a problem, and we at HCFA are eager to share the lessons we have learned along the way.We are providing assistance to the extent that we are able.But that likely will not be enough.This matter is of urgent concern, and literally grows in importance with each passing day.
Our own progress in meeting the Year 2000 challenge is due in large part to the outstanding effort and commitment of staff throughout HCFA and at our Medicare contractors.We have been greatly aided by wise counsel from the GAO, and especially by the expert IV&V contractors we hired, based on the GAO's recommendations, to ensure that our Year 2000 work is done correctly. And, importantly, we could not have come so far so quickly without the timely support and funding that Congress has provided.
HCFA's Year 2000 Efforts
There is no question that we have faced an uphill battle in achieving Year 2000 compliance.A number of key steps are getting us where we need to be.They include:
Scope of HCFA's Year 2000 Workload
The Year 2000 especially affects the programs HCFA administers because of our extensive reliance on multiple computer systems.More than 150 different systems are used by HCFA in administering the Medicare program.About 100 of these systems are considered "mission-critical."These systems are both internal and external and are responsible for establishing beneficiary eligibility and making payments to providers, plans, and States.Medicare is the most automated health care payer in the country.We process nearly one billion claims annually, most electronically.
In fact, 97 percent of inpatient hospital and other Medicare Part A claims, and 81 percent of physician and other Medicare Part B claims are submitted electronically to the Medicare claims processing contractors.All claims undergo substantial electronic processing at the contractors and many claims are processed to payment with no manual intervention whatsoever.This high level of electronic billing has allowed us to achieve significant operating efficiency and cost savings.However, this reliance on automated systems also has made the Year 2000 computer fix a major challenge.Critical dates in computerized claims processing include the date a beneficiary became eligible, the date a patient was admitted or discharged from a hospital, the date a wheelchair rental began, or the date an enrollee entered a managed care plan.
Renovating all these systems has been complicated.Each system used by our programs and our 60-plus claims processing contractors, as well as interfaces with State Medicaid programs, banking institutions and some 1.3 million providers has to be thoroughly reviewed and renovated by those responsible for each particular system.We are requiring that systems be tested individually, as well as with the exchanges they perform with other partners.
To fix the Medicare systems alone, we have had to renovate some 49 million lines of internal and external systems code to find date-sensitive processes.We have had to repair all of our Medicare-specific software so it will work with new versions of vendor-supplied software.We have had to update the operating systems that drive the hardware we use with millennium compliant versions.We also have had to test and upgrade deficient operational hardware, including our telecommunications equipment and software.And we must assure that all data exchanges with thousands of our partners will function properly.
Providers must ready their own systems for the Year 2000 in a timely manner if the health care system is to meet the millennium challenge completely and successfully.One of the first steps, and perhaps the easiest, is changing the formats of claims to allow for 8-digit date fields.Our electronic media claims monitoring indicates that over 98 percent of Part B claims submitters (either physicians/suppliers or their billing agents) are submitting the 8-digit date fields. Fifty-eight percent of Part A submitters (hospitals and other institutions or their billing agents) that submit claims electronically are also using the 8-digit fields.
It is essential that all providers address the Year 2000 issue.Thus, we recently announced that we would require all submitters to start using the 8-digit date formats by April 5, 1999.Claims received on or after that date without the new formats will not be accepted.That does not mean that providers need to be fully compliant by April 5, but it does mean that we want to be assured that they have begun working on their systems by, at least, having taken this first step.
As mentioned earlier, we will be ready to process claims, but providers need to be able to submit correct claims.And, we are concerned that providers address other Year 2000 issues as well, not just their billing system issues.Providers must take appropriate Year 2000 remediation steps with other systems, such as clinical systems, and their biomedical devices to ensure continued high quality patient care.
I must stress our concern must always be focused first and foremost on protecting the beneficiaries and their continued access to care.Providers who fail to fix their own systems, and thus are unable to bill us for services, are strictly prohibited from billing beneficiaries. Beneficiaries are legally protected from liability for bills that Medicare would ordinarily pay, even if the provider is not Year 2000 compliant.To safeguard beneficiaries in the new millennium, we will provide them with a phone number to call to report any inappropriate billings they receive from providers or any difficulties they encounter in accessing care.Our beneficiaries are counting on us.Their health care needs will continue regardless of what day it is.
Due to the critical need for providers to become Year 2000 compliant, we have launched a broad outreach campaign.Last month, in an unprecedented step, we mailed a letter to all 1.3 million providers serving our beneficiaries explaining the gravity of the Year 2000 problem and providing a checklist for what must be done to achieve compliance.
Our provider outreach campaign features a special Year 2000 Internet site, www.hcfa.gov/Y2K, which includes some of the basic steps that can be taken by a Medicare provider or supplier, such as:
The Internet site also includes links to other essential sites for providers, such as the Food and Drug Administration's Internet site on medical device compliance.
We have developed a speakers' bureau with staff trained to make presentations and answer questions on Year 2000 issues all around the country.We are leading the Health Care Sector of the President's Council on Year 2000 Conversion, which includes working closely with provider trade associations and public sector health partners to raise awareness of the millennium issue and encourage all providers to become compliant.And our claims processing contractors are offering providers Year 2000 compliant electronic billing software for free or at minimal cost.
I was pleased that some provider associations have recently announced their intention to assess the Year 2000 readiness of their membership and to step up educational efforts on the critical nature of this problem.This is an essential undertaking.Quite simply, Year 2000 compliance cannot be a one-way street.Providers also must meet this challenge head on, or risk not being able to receive prompt payment from Medicare, Medicaid, or virtually any other insurer.
We welcome Congress' help in making providers aware of the Year 2000 and energizing them to address their part of the problem.I invite you to help us identify opportunities to get the Year 2000 message across and encourage you to stress the importance of this issue when you meet with providers.As I mentioned previously, we have established a special Year 2000 speakers' bureau with staff around the country prepared to speak and offer guidance.You may want to have them join you when you meet with providers, and let others know that they are available.
Our concern for States is as great as our concern for providers.For both, we do not have the authority, ability, or resources to step in and fix their systems for them.Our ten regional offices are monitoring the status of each State's remediation effort.We also have an expert IV&V contractor, TRW, to assist us in conducting on-site visits in every State to provide advice and validate assessments so that we can maintain an accurate picture of each State's progress.We have already done on-site visits in 13 States and the District of Columbia and expect to visit the remaining States by the end of April.The preliminary reports confirm earlier work by the GAO which strongly suggests that some States may not be ready on time.
We have asked all Medicaid and CHIP Directors to:
It is each State's responsibility to take the steps it believes are appropriate to meet the needs of its Medicaid and CHIP beneficiaries.Our primary role is to assess, as best we can, each State's progress and to provide guidance.While we do not have the authority, ability, or resources to fix State systems, we can and do want to help.Besides furnishing the services of TRW, we have developed technical assistance documents, and we have held regional meetings and workshops for States on how to develop contingency plans.We know that States and Congress share our goal of protecting all our beneficiaries throughout the millennium transition.
Although we fully intend to have our own systems ready long before January 1, 2000, we know we must be prepared in case any unanticipated problems arise.We are undertaking an extensive effort to develop contingency plans for all our mission-critical business processes.Our top priorities in developing these plans are to:
Contingency planning is an Agency-wide effort with active participation of all of our most senior executives.We are closely following the GAO's advice on contingency planning which they outlined in their August 1998 guidance, Year 2000 Business Continuity and Contingency Planning and in their September 1998 report, Medicare Computer Systems --Year 2000 Challenges Put Benefits and Services in Jeopardy .
We recently completed the second phase of the contingency planning process by reviewing 280 Medicare business processes, performing risk and impact analyses, and identifying the potential impact of mission-critical failures.We are now in the third phase wherein we will explicate and document our contingency plans and implementation modes, define events that will trigger use of the plans, as well as establish and train implementation teams should the need arise to execute the plans.
We expect to complete this third phase of contingency planning in March 1999.By the end of June 1999, our draft contingency plans will be validated, reviewed, and finalized.We anticipate completing our agency-wide plan by July 1999, three months ahead of the date recently recommended by GAO.
The Year 2000 problem is not static.We are obligated to perform rigorous testing because of the extent of our reliance on information systems.Efforts to solve one element of the problem often uncover other problems.This makes it challenging to determine our budgetary requirements.As you know, we previously have had to request additional funding and redirect existing funding to meet these changing demands.
In fiscal year 1998, we received $107.1 million in funding for millennium activities.This funding included a $15 million appropriation; an additional $30 million that was transferred from other agency projects; $20 million in redesignated funds originally appropriated for systems transitions; and $42.1 million made available by the Department of Health and Human Services (HHS) through the Secretary's one percent transfer authority.Through very careful financial management and a keen recognition of the importance of the Year 2000 effort, we actually obligated approximately $148 million in fiscal year 1998 on Year 2000 activities: $130 million on external systems and $18 million on internal systems.
Thanks to your support in the fiscal year 1999 appropriations process we are making significant progress toward obtaining the funding needed to support all of our Year 2000 efforts.We received $82.5 million in our appropriation for this year.The Office of Management and Budget (OMB), with Congressional concurrence, transferred an additional $205.1 million from the Year 2000 emergency fund.This funding provides a total of $287.6 million to support our Year 2000 efforts in fiscal year 1999.We plan to use FY 1999 as well as FY 2000 funding to increase our contingency planning efforts by developing, testing and rehearsing contingency plans.
The President's Budget request for FY 2000 includes an additional $150 million for our Year 2000 effort.In addition to funding our contingency planning efforts, a large portion of this funding will support outreach, continuing external systems remediation, and increases in billing and communications activities at our contractors.Increased public awareness of the Year 2000 and concern about potential problems, coupled with possible disruptions in claims processing, may increase the number and cost of paper and duplicate claims, the level of inquiries from beneficiaries and providers, as well as related printing and postage costs.This funding will help us and our contractors meet these anticipated challenges.
It is important to note that because our systems are highly automated and the majority of our processes are completed electronically, we are performing far more rigorous Year 2000 testing than many businesses.Many businesses are not testing their systems for future dates and they will not know with certainty if their systems will operate in the Year 2000.HCFA will.Our testing regimen is far more rigorous than the industry standard, with multiple layers of testing, including regression testing, testing in a simulated Year 2000 environment, and testing our entire systems in an actual Year 2000 environment.
In addition to the extensive tests performed by those who actually maintain the system, we also are requiring independent testing of our most critical systems and additional oversight by an IV&V contractor.This coming year we expect to perform extensive validation and recertification of these critical systems to ensure that changes made during 1999 do not affect our Year 2000 renovations.Although this additional testing and validation significantly increases the time required for and the cost of certifying the Medicare systems, we know that we simply cannot afford to fail and are doing everything within our power to ensure that we do not.
Our systems are not only complex in their own right, they also require extensive data exchanges with more than one million partners, such as providers, banks, and vendors.We must guarantee that all of our renovated systems work with all of these partners.And so we must conduct data exchange tests with the provider community to ensure that we can exchange the transactions required for electronic commerce.
We have made remarkable progress in our Year 2000 compliance effort and have taken critical steps to ensure that all of our systems will be ready for the new millennium.There is still a great deal of work to be done, but we now feel that we are making significant progress.We will continue in 1999 to work, test and retest our systems.But I must reiterate our concern with the progress of some States and providers in meeting their own Year 2000 challenges.We are committed to providing all the assistance we can, but in some cases that may not be enough.We all share a common goal of guaranteeing that our systems and programs function in the new millennium.I thank you for your attention to this essential issue, and I am happy to answer any questions you may have.