Dr. Takamura: The Balanced Budget Refinement Act of 1999 enacted late last year included amendments to the BBA of 1997 to remedy adverse impacts upon beneficiaries. The amendments were sought by both the Administration and members of Congress from both sides of the aisle. For example, the BBRA imposed a moratorium on BBA therapy caps that adversely affected beneficiaries. Under the BBRA, payments were also adjusted for very sick patients in nursing homes. Funding was restored for teaching hospitals, and the transition to the new prospective payment system for outpatient care was eased for hospitals.

As have many other public and private sector organizations, we are "reinventing" ourselves to increase our efficiency. We are using teams and other management approaches to enable AoA to:

1) ready an increasingly diverse America for the dramatic growth of its aging population and
2) better serve at-risk older persons.

AoA works with other-U.S. D.H.H.S. and federal agencies to ensure that quality, cost-effective services and programs are available and used appropriately. To give all Americans the best opportunity to live out long lives characterized by independence and dignity, we have proposed a National Life Course Planning initiative. Through this, AoA proposes to help educate mid-life and older persons about how they can be better prepared for their older years.

Dr. Takamura: A standard requirement of many laws is that they be re-authorized every several years. This is also the case with the Older Americans Act, which has been re-authorized 13 times. Congress has indicated that it will continue their efforts to reauthorize the Act during the 2nd session of the 106th Congress. Issues which have arisen around the re-authorization proposals advanced by the House, Senate, and the Administration in the past include those related to cost sharing, the intrastate funding formula, minority targeting and issues pertinent to Title V, the Senior Community Service Employment Program, which is administered by the Department of Labor.

Dr. Takamura: As sister agencies in the Department of Health, and Human Services, the Administration on Aging and the Health Care Financing Administration have distinctly different roles and responsibilities. HCFA oversees the massive Medicare program which provides most older Americans with access to and coverage for the cost primarily of medical care delivered through hospitals, clinics, private physician offices, and to a limited degree, in the home. HCFA also funds the state-administered Medicaid program which covers the cost of institutional long term care and limited home and community based care for nursing home eligible persons with limited incomes and assets. Both Medicare and Medicaid are entitlement programs. The Administration on Aging's responsibility is to administer the programs and services of the Older Americans Act. Since the 1970's, the OAA programs and services have enabled older persons to live independently in their homes and communities among their families and friends. OAA services and programs include community-based and in-home meals programs, respite, transportation, and information and referral services. AoA and its Aging Network and HCFA work closely at the federal, state, and local levels. My counterpart, Nancy Ann DeParle, Administrator of HCFA, and I are active participants in Departmental and Administration initiatives that impact our constituencies. Recently, the Administration on Aging and the Health Care Financing Administration released $450,000 in grants to four national aging organizations to improve the quality of care in nursing homes. The awards, part of the Clinton Administration's initiative on nursing homes, will support the demonstration of approaches to educate and empower communities and families to improve nutrition and hydreition, and prevent abuse of nursing home residents.

Dr.Takamura: My visits to various parts of the country over the past two years have demonstrated the tremendous love, strength, and will of family members who are caring for their older loved ones. From Florida to Alaska, my staff and I have met hundreds of family caregivers who have shared their most challenging and emotional experiences in providing care to their mothers, fathers, spouses, sisters and friends. What has been pointed out in news, in professional journals, and other articles in the popular press is that these family members give so much of themselves to care for their loved one and that they wouldn't have it any other way. But it is also clear that they very much need basic information, assistance and respite in their communities. That is what the Clinton administration's FY 2001 proposal, which calls upon Congress to providing funding for supportive services for caregivers, is all about. If enacted by Congress, approximately 250,000 families would receive assistance in coping with their caregiving responsibilities. Additionally, the Clinton Administration is proposing a $3,000 tax credit for caregivers. We are very hopeful that there will be strong bipartisan support for both proposals and that they will receive final approval this year.