[Congressional Record Volume 150, Number 98 (Thursday, July 15, 2004)]
[Senate]
[Pages S8230-S8231]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mrs. Lincoln, Mr. Bond, Mr. 
        Feingold, Mr. Thomas, Mr. Conrad, and Mr. Burns):
  S. 2659. A bill to extend the temporary increase in payments under 
the medicare program for home health services furnished in a rural 
area; to the Committee on Finance.
  Ms. COLLINS. Madam President, I rise today to introduce the Medicare 
Rural Home Health Payment Fairness Act. This legislation would extend 
the additional payment for home health services delivered in rural 
areas. This additional 5 percent reimbursement is currently scheduled 
to sunset on April 1, 2005. This legislation would make the additional 
reimbursement permanent.
  I note the presence of one of the strongest advocates of home health 
care, and that is my colleague from Missouri, Senator Bond. He has 
worked tirelessly to make certain that our seniors and disabled 
citizens are able to receive the home health care they need. I am very 
pleased to have him as one of the key supporters of this legislation.
  Home health care has become an increasingly important part of our 
health care system. The kinds of highly skilled and often technically 
complex services that our home health caregivers provide have enabled 
millions of our most frail and vulnerable older and disabled citizens 
to avoid hospitals and nursing homes and to receive health care just 
where they want to be--in the comfort, privacy, and security of their 
own homes.
  I have had the great honor of accompanying several of Maine's caring 
home health nurses on their visits to serve their patients. I have seen 
firsthand the difference that they are making for Maine's elderly. I 
remember visiting one elderly couple who told me that it was home 
health care that allowed them to stay together in their very own home, 
rather than being separated with one of them being forced to go into a 
nursing home in the remaining years of their life. Another woman told 
me that her late husband received home health care in the months 
leading up to his death. That had allowed him to be treated at home and 
to be with his family, which is where he very much wanted to be.

  Nevertheless, 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, the higher transportation expenses, and other 
factors. Because of the longer travel times, rural caregivers are 
unable to make as many visits in a day as their urban counterparts. The 
executive director of Visiting Nurses of Aroostook in northern Maine 
where I am from tells me that her agency covers 6,600 square miles with 
a population of only 73,000 people. Her costs are understandably much 
higher than other agencies due to the long distances her staff must 
drive to see their clients. Moreover, her staff is obviously not able 
to see as many patients in a day.
  Agencies in rural areas are also frequently smaller than their urban 
counterparts, which means that their relative costs are higher. Smaller 
agencies with fewer patients and fewer visits mean that fixed costs, 
particularly those associated with meeting regulatory requirements, are 
spread over a much smaller number of patients and visits, thus 
increasing overall the per-patient and per-visit costs. Moreover, in 
many rural areas, home health agencies are the primary caregivers for 
homebound beneficiaries with limited access to transportation. These 
rural patients often require more time and care than urban patients and 
are understandably more expensive for home health agencies to serve. If 
the rural extra payment is not extended, agencies may be forced to make 
decisions

[[Page S8231]]

not to accept patients living in remote areas who have greater care 
needs. That would translate into less access to health care for ill 
homebound seniors.
  Failure to extend the rural add-on payment will only put more 
pressure on rural home health agencies that are already operating on 
very narrow margins. It could force some of these agencies to close 
their doors altogether. Many home health agencies operating in rural 
areas are the only home health providers in large geographic areas. If 
any of these agencies is forced to close, the Medicare patients in that 
region could lose all their access to home health care.
  The bipartisan legislation I am introducing today, with Senators 
Lincoln, Bond, Feingold, Thomas, Conrad, and Burns, will help to ensure 
that Medicare patients in rural areas continue to have access to the 
home health services they very much need. I urge all of our colleagues 
to join us as cosponsors. We must act to ensure that this extra payment 
does not expire next April 1.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BOND. Madam President, I compliment my colleague from Maine for 
being a true champion and leader for assuring good home health care 
access to our seniors, disabled, and others who need specialized care. 
As she has done in Maine, I have done in Missouri and found that access 
to home health care is critically important. It is, No. 1, convenient, 
easier, more friendly, and more compassionate for the patients. No. 2, 
all of the statistics we have seen show home health care is more 
effective to treat people. They get well better.
  Finally, it makes sense economically. When cuts in Medicare shut down 
a home health care agency in one rural county in northwest Missouri, 40 
patients who had been treated for an average of $400,000 a year were 
forced to go to institutionalized care. Only 30 of them showed up. I 
hate to guess what happened to the other 10. Their cost for 1 year--it 
was $400,000--became $1.4 million. It was a terrible tragedy in human. 
terms, in health terms, and in economic terms.
  I am proud to join my colleague from Maine.
                                 ______