[Congressional Record Volume 142, Number 125 (Thursday, September 12, 1996)]
[Senate]
[Pages S10426-S10427]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. D'AMATO (for himself, Mr. Moynihan, Mr. Grams, Mr. 
        Wellstone, Mr. Simon, and Ms. Moseley-Braun):
  S. 2067. A bill to extend certain Medicare community nursing 
organization demonstration projects; to the Committee on Finance.


              Community Nursing Organizations Legislation

  Mr. D'AMATO. Mr. President, I introduce legislation which will permit 
a three-year reauthorization of certain Medicare Community Nursing 
Organization [CNO] demonstration projects within the Health Care 
Financing Administration [HCFA].
  In 1987, in response to the Omnibus Budget Reconciliation Act of 
1987, Congress authorized the Community Nursing Organization 
demonstration projects to test capitated payment under the Medicare 
Program for community nursing and ambulatory care services furnished to 
beneficiaries. The demonstration projects are structured to answer two 
questions: First, is it feasible to have a capitated, case-managed, 
nurse service delivery model for home health and ambulatory care; and 
second, What is the impact on enrollees, providers, and the larger 
health care system?
  These CNO programs are intended to reduce the breakup in the delivery 
of health care services, to reduce the use of costly emergency care 
services, and to improve the continuity of home health and ambulatory 
care for Medicare beneficiaries. CNO's are responsible with providing 
home health care, case management, outpatient physical and speech 
therapy, ambulance services, prosthetic devices, durable medical 
equipment, and any optional, HCFA-approved services appropriate to 
prevent the need to institutionalize Medicare enrollees.
  HCFA awarded four CNO sites in September 1992 through the competitive 
procurement process: First, Visiting Nurse Service in New York, NY--a 
not-for-profit Medicare certified home health agency; second, Carle 
Clinic in Mahomet, IL--a multispecialty group practice; third, 
Carondelet Health Care in Tuscon, AZ--a hospital-based organization; 
and fourth, Living at Home/Block Nurse Program in St. Paul, MN--a not-
for-profit nursing organization replicating the Block Nurse Program 
model. These CNO's operate under full financial risk to themselves and 
are financially responsible for the provision of all mandatory 
community nursing and ambulatory care services available to Medicare 
enrollees.
  Mr. President, these CNO projects are consistent with congressional 
efforts to

[[Page S10427]]

introduce a wider range of managed care options to Medicare 
beneficiaries. Their authorization needs to be extended in order to 
ensure a fair testing of the CNO managed care concept. We need the 
extention of this demonstration authority to continue to provide an 
important example of how coordinated care can provide additional 
benefits without increasing Medicare costs. In addition, further time 
is necessary to evaluate the impact of the CNO contribution to Medicare 
patients and to assess their capacity for operating under a fixed 
budget.
  Most importantly, this demonstration extension will not increase 
Medicare expenditures. CNO's actually save Medicare dollars by 
providing better and more accessible health care in homes and in 
community settings, thereby allowing enrollees to avoid unnecessary 
hospitalizations and nursing home admissions. By demonstrating what a 
primary care-oriented nursing practice can accomplish with elderly or 
disabled patients, CNO's help illuminate methods for increasing 
benefits, saving funding dollars, and most importantly, improving the 
quality of life for patients.
  Mr. President, I urge my colleagues to consider this bill carefully 
and join me in seeking to extend these cost-savings and patient-
oriented CNO demonstrations for another 3 years.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2067

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. EXTENSION OF CERTAIN MEDICARE COMMUNITY NURSING 
                   ORGANIZATION DEMONSTRATION PROJECTS

       Notwithstanding any other provision of law, demonstration 
     projects conducted under section 4079 of the Omnibus Budget 
     Reconciliation Act of 1987 my be conducted for an additional 
     period of 3 years, and the deadline for any report required 
     relating to the results of such projects shall be not later 
     than 6 months after the end of such additional period.
                                 ______