[Congressional Record Volume 149, Number 15 (Tuesday, January 28, 2003)]
[Senate]
[Page S1662]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         EXTENSION OF THE RURAL ADD-ON PAYMENT FOR HOME HEALTH

  Ms. COLLINS. Mr. President, on behalf of myself and Senator Bond, I 
want to thank the chairman of the Finance Committee and the chairman of 
the Appropriations Committee for agreeing to include a 6 month 
extension of the add-on payment for rural home health services in the 
omnibus appropriations bill. Extension of this add-on payment, which 
currently is scheduled to sunset on April 1 will help to ensure that 
Medicare patients in rural areas continue to have access to the home 
health services that they need.
  Home health has become an increasingly important part of our health 
care system. The kinds of highly skilled, and often technically 
complex, services that our Nation's home health agencies provide have 
enabled millions of our most frail and vulnerable older persons to 
avoid hospitals and nursing homes and stay just where they want to be, 
in the comfort and security of their own homes.
  Surveys have shown that the delivery of home health services in rural 
areas can be as much as 12 to 15 percent more costly because of the 
extra travel time required to cover long distances between patients, 
higher transportation expenses, and other factors.
  Rural agencies also experience higher costs relative to productivity. 
Because of the longer travel times and distances between patients, 
rural caregivers are unable to perform as many visits in a day as their 
urban counterparts. Saundra Scott-Adams, the executive director of the 
Visiting Nurses of Aroostook in Aroostook County, ME, where I am from, 
tells me her agency covers 6,600 square miles with a population of only 
72,000. Her costs are understandably much higher and her staff 
productivity much lower than the average due to the long distances her 
staff must cover to see patients.
  Moreover, agencies in rural areas are frequently smaller than their 
urban counterparts, which means their relative costs are higher due to 
smaller scale operations. Smaller agencies with fewer patients and 
fewer visits means that fixed costs, particularly those associated with 
meeting regulatory requirements, are spread over a smaller number of 
patients and visits, increasing overall per-patient and per-visit 
costs.
  If the rural add-on payment is eliminated on April 1, it will only 
put more pressure on rural home health agencies that are already 
struggling and could force more of these agencies to close. Many 
agencies operating in rural areas are the only home health providers in 
a vast geographic area. If any of these agencies are forced to close, 
the Medicare patients in that region will lose complete access to home 
health care.
  The Medicare Payment Advisory Commission, MedPAC, met earlier this 
week and voted unanimously to extend for 1 year the add-on payments for 
rural home health services at 5 percent. Our provision is consistent 
with the MedPAC's recommendation and will extend the expiring provision 
through September 30. This will give the Finance Committee time to 
consider whether this add-on payment should be extended further.
  Once again, I thank my colleagues for their assistance, and I look 
forward to working with them on this and other issues of importance to 
the health of rural Americans.

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