[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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