[Congressional Record Volume 143, Number 17 (Tuesday, February 11, 1997)]
[Extensions of Remarks]
[Pages E213-E214]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     LEGISLATION TO EXTEND COMMUNITY NURSING CENTER DEMONSTRATIONS 
                               INTRODUCED

                                 ______
                                 

                            HON. JIM RAMSTAD

                              of minnesota

                    in the house of representatives

                       Tuesday, February 11, 1997

  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 I sponsored in the 104th 
Congress to extend the demonstration authority under the Medicare 
program for Community Nursing Organization [CNO] projects.
  CNO projects 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.
  The current CNO demonstration program, which was authorized by 
Congress in 1987, involves more than 6,000 Medicare beneficiaries in 
Arizona, Illinois, Minnesota, and New York. It is designed to determine 
the practicality of prepaid community nursing as a means to improve 
home health care and reduce the need for costly institutional care for 
Medicare beneficiaries.
  To date, the projects have been effective in collecting valuable data 
to determine whether the combination of capitated payments and nurse-
case management will promote timely and appropriate use of community 
nursing and ambulatory care services and reduce the use of costly acute 
care services.
  Authority for these effective programs was set to expire December 31, 
1996. Mr. Speaker, while I was glad to Health Care Financing 
Administration [HCFA] extended the demonstration authority for the CNO 
projects using administrative means, I was disappointed this extension 
was only for 1 year. HCFA stated that the authority was extended to 
allow them to better evaluate the costs or savings of the services 
available under the program, learn more about the benefits or barriers 
of a partially capitated program for post-acute care, review Medicare 
payments for out-of-plan services covered in a capitation rate, and 
provide greater opportunity for beneficiaries to participate in these 
programs.
  Frankly, in order to do all this analysis of the program, we need 
more than one year. 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.

[[Page E214]]

  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 CNOs 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. CNOs 
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, CNOs 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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