[Congressional Record Volume 142, Number 55 (Thursday, April 25, 1996)]
[Extensions of Remarks]
[Page E645]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      INTRODUCTION OF H.R.--, TO EXTEND COMMUNITY NURSING CENTER 
                             DEMONSTRATIONS

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                            HON. JIM RAMSTAD

                              of minnesota

                    in the house of representatives

                        Thursday, April 25, 1996

  Mr. RAMSTAD. Mr. Speaker, as a strong supporter of home- and 
community-based services for the elderly and individuals with 
disabilities, I rise to introduce legislation to extend the 
demonstration authority under the Medicare Program for community 
nursing organizations [CNO].
  In 1987, Congress authorized the CNO demonstrations to test the 
efficacy of capitated nursing delivery organizations at providing 
quality services outside the nursing home setting, without requiring 
beneficiaries to join HMO's. CNO programs serve Medicare beneficiaries 
in home and community-based settings under contracts that provide a 
fixed, monthly capitation payment for each beneficiary who elects to 
enroll.
  The benefits include not only Medicare-covered home care and medical 
equipment and supplies, but other services not presently covered by 
traditional Medicare, including patient education, case management and 
health assessments. CNO's are able to offer extra benefits without 
increasing Medicare costs because of their emphasis on primary and 
preventative care and their coordinated management of the patient's 
care.
  At the end of this year, current authority will expire for these 
effective and growing programs, which currently serve approximately 
6,000 Medicare patients in four States.
  Mr. Speaker, we need to act now to extend this demonstration 
authority for another 3 years. This experiment provides an important 
example of how coordinated care can provide additional benefits without 
increasing Medicare costs. For Medicare enrollees, extra benefits 
include expanded coverage for physical and occupational therapy, health 
education, routine assessments, and case management services--all for 
an average monthly capitation rate of about $21. In my home State of 
Minnesota, the Health Seniors Project is a CNO serving over 1,500 
patients in four sites, two of which are urban and two rural.
  These demonstrations should also be extended in order to ensure a 
full and fair test of the CNO managed care concept. These 
demonstrations are consistent with our efforts to introduce a wider 
range of managed care options for Medicare beneficiaries. I believe we 
need more time to evaluate the impact of CNO's on patient outcomes and 
to assess their capacity for operating under fixed budgets.
  Mr. Speaker, it is important to recognize that the extension of this 
demonstration will not increase Medicare expenditures for care. CNO's 
actually save Medicare dollars by providing better and more accessible 
care in home and community settings, allowing beneficiaries to avoid 
unnecessary hospitalizations and nursing home admissions. By 
demonstrating what a primary care oriented nursing practice can 
accomplish with patients who are elderly or disabled, CNO's are helping 
show us how to increase benefits, save scarce dollars, and improve the 
quality of life for patients.
  Mr. Speaker, I urge my colleagues to consider this bill carefully and 
join me in seeking to extend these cost-savings and patient-enhancing 
CNO demonstrations for another 3 years.

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