[Congressional Record Volume 153, Number 10 (Thursday, January 18, 2007)]
[Senate]
[Pages S765-S766]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Hatch, Mr. Wyden, Mr. Vitter, Mr. 
        Dorgan, and Mrs. Lincoln):
  S. 338. A bill to amend title XVIII of the Social Security Act to 
ensure and foster continued patient quality of care by establishing 
facility and patient criteria for long-term care hospitals and related 
improvements under the Medicare program; to the Committee on Finance.
  Mr. CONRAD. Mr. President, today I am introducing legislation that 
would take steps to protect access to long-term care hospitals while 
ensuring that these institutions are admitting the appropriate type of 
patients. I am pleased to be introducing the bill along with my 
colleague, Senator Hatch, and I urge my colleagues to consider 
cosponsoring this cost-saving proposal.
  Long Term Acute Care hospitals, or LTAC hospitals, serve a vital role 
in the Medicare program by providing care to beneficiaries with 
clinically complex conditions that need hospital care for extended 
periods of time. These are patients who are too sick to go home or even 
to a skilled nursing facility, but are stable enough to be released 
from an intensive care unit. I am happy to have two of these hospitals 
in North Dakota, one in Fargo and one in Mandan. Together, these two 
hospitals employ several hundred people and provide care to thousands 
of North Dakotans. They are a vital part of the North Dakota continuum 
of care.
  While these hospitals provide important health services to very frail 
individuals, the Centers for Medicare and Medicaid Services (CMS) has 
become concerned with the growth in these facilities. In 2006, there 
were 400 LTAC hospitals, compared to 100 in 1996. In addition, the 
agency has also expressed concern that some LTAC hospitals are 
admitting patients that may be better served by nursing homes or 
another level of care. As a result, CMS has begun to arbitrarily cut 
LTAC hospital payments across-the-board.
  As Chairman of the Budget Committee, I have a unique appreciation for 
the enormous fiscal challenges that face our country and respect CMS's 
efforts to reduce growth in Medicare. However, any cuts in spending 
should be targeted at waste and abuse. We should address the growth in 
LTAC hospitals, but we also want to ensure that there is a place for 
patients who truly need long-term hospital stays.
  The legislation I'm introducing today is a first step in clarifying 
Congressional intent and giving CMS clearer definitions of what is and 
is not a LTAC hospital and what type of patient should be admitted to 
these facilities. At the heart of this bill is a provision that limits 
the types of patients who can be admitted to LTAC hospitals to those 
who truly need the specialized care these facilities provide. LTAC 
hospitals like those in my state that admit only very sick patients 
will not be significantly affected. But, by eliminating abuses by those 
facilities that have been receiving generous payments for patients who 
do not require this sort of specialized care, this provision of the 
bill would significantly reduce Medicare spending on LTAC hospitals.
  It was not easy for the LTAC hospitals in North Dakota and across the 
country to support legislation that restricts their payments, but I 
compliment them for working with me to put forward a constructive 
public policy proposal. In particular, I want to recognize Custer 
Huseby, Chief Executive Officer of SCCI Hospital in Fargo. He 
understands that the status quo is no longer defensible and has fought 
to put forward a workable solution that maintains access to these vital 
facilities, where they are appropriate. I also want to thank Chip 
Thomas and Karen Haskins of the North Dakota Healthcare Association, 
who have partnered with Mr. Huseby to support this legislation.
  Long-term care hospitals serve a vital role in our health care 
system, and we must protect access to these facilities for those who 
truly need it. But, we can also take responsible steps to ensure that 
our federal tax dollars are well spent and directed to the most 
appropriate level of care. I believe my legislation achieves this 
balance and urge my colleagues to support this measure.
  Mr. HATCH. Mr. President, I am happy to join my colleagues, Senators 
Conrad, Wyden, Vitter, Dorgan and Lincoln in introducing legislation to 
create standards for long-term, acute-care (LTAC) hospitals. My home 
State of Utah has LTAC hospitals located in Salt Lake City, West Valley 
City and Bountiful.
  Let me explain what LTAC hospitals are to my colleagues, and discuss 
the need for this legislation. A general hospital stay in the United 
States is about 6 days. In contrast, the average patient stay in an 
LTAC hospital is 25 days. LTAC hospitals represent one of four post-
acute care facilities. Of the four types of post-acute care, LTAC 
hospitals are the most expensive. And, the number of LTAC hospitals has 
grown rapidly from 100 to 400 over a 10-year period. These dynamics 
have led the Centers for Medicare & Medicaid Services (CMS) to push for 
having certain LTAC patients treated in less costly facilities such as 
nursing homes or rehabilitation clinics.
  Our legislation is premised on the belief that only truly sick 
patients should go to LTAC hospitals. Less medically-complex patients 
should be seen at less intensive facilities. S. 338 limits the type of 
patients who may be treated in LTAC hospitals and, by doing so, it will 
generate at least $1 billion in savings over the next 5 years.
  LTAC hospitals have a role to play in the American continuum of 
health care. We all agree that there should be a place for patients who 
truly need long-term hospital stays. In that sense, LTAC hospitals 
serve an important role. Today, Medicare spending on LTAC hospitals is 
little more than one percent of total Medicare spending.
  Let me conclude by saying that this bill is just one component of a 
larger debate that we need to have about Medicare post-acute care. LTAC 
hospitals are one component. Nursing homes and rehabilitation clinics 
are other components. All long-term care providers need to do a better 
job in convincing the Congress and Federal regulators why our health 
care system needs four different types of post-acute facilities.
  I urge my colleagues to cosponsor the Conrad-Hatch legislation--it is 
a good bill and it addresses an important aspect of the long-term 
health care debate. As baby boomers continue to retire, long-term care 
will become more and more important to all Americans.
  Mr. LEAHY. Mr. President, today I join, again, with a bipartisan 
group of Senators to introduce a bill to reform our immigration laws 
concerning foreign agricultural workers. America's farmers are calling 
for a greater number of legal foreign workers, and an improved system 
for obtaining those workers. We need to likewise ensure meaningful 
benefits and protections to the workers who will fill these jobs.
  I am especially pleased that measures are included to help dairy 
farmers, who in my home State of Vermont are an integral part of our 
economy, our history, and our culture. Indeed, it is difficult to think 
of the Green Mountain State without conjuring up the image of verdant 
rolling hills dotted with Holstein cows. The provisions in this bill 
make the H-2A program more workable for dairy farmers by lengthening 
the time period a foreign worker may remain in the country, providing a 
process by which an employer can extend the stay of a worker, and by 
ensuring that workers may ultimately apply for an adjustment to 
permanent legal resident status.
  The bill we introduce today goes a long way toward reforming our H-2A 
visa program. Along with measures to help streamline procedures for 
labor certification by employers, the bill will make it easier for 
employers to meet their responsibilities to ensure that available 
agricultural jobs are offered first to domestic workers. The bill also 
makes the process easier for an employer to apply for an extension to a 
worker's stay, and makes it easier for a foreign worker to switch jobs 
during their stay.
  The bill includes greater protections for workers, including the 
requirement that employers meet the same motor vehicle safety standards 
for H-2A workers that are required for domestic workers. A limited 
Federal right of action is provided for H-2A workers to enforce the 
economic benefits provided under the H-2A program, or those provided in 
writing by their employers.

[[Page S766]]

More flexibility is provided for workers and employers by permitting 
employers to elect to provide a housing allowance, instead of housing. 
These are but a few of the positive reforms contained in the bill.
  The bill also contains a procedure by which undocumented workers who 
have been working in agriculture can apply for a ``blue card,'' a 
system where through consistent employment, a fine, proof of the 
payment of taxes, and proof of no serious criminal history, an 
undocumented worker can continue his or her contribution legally, and 
eventually adjust his or her status. The ``blue card'' program 
encourages family unification by making special provisions for spouses 
and children of the card holder. The program also has a numerical cap 
and the built-in safeguard of a sunset provision.
  These reforms are a commonsense response that should help meet the 
needs of our farmers without burdening them with an unduly, time-
consuming procedure for securing legal workers. The bill represents an 
effort to meet both the needs of agricultural employers while 
respecting the rights and interests of agricultural workers, and is an 
example of a bipartisan group of legislators listening and responding 
to the interests of all parties affected.
  I join with other Senators in recognizing the needs of our modern 
economy, and the needs of the American farmer as well as the rights of 
the individuals who make up the backbone of many farming operations. 
Working together we can ensure that no American farmer is put in the 
position of having to choose between obeying the law and making a 
living, and that no willing worker is denied a chance to work.
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