[Congressional Record Volume 153, Number 157 (Wednesday, October 17, 2007)]
[Senate]
[Pages S12992-S12993]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Casey, Mr. Bond, Ms. Cantwell, 
        Mr. Roberts, and Mr. Reed):
  S. 2181, A bill to amend title XVIII of the Social Security Act to 
protect Medicare beneficiaries' access to home health services under 
the Medicare program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I am pleased to join Senators Casey, 
Bond, Cantwell, Roberts and Reed in introducing legislation, the Home 
Health Care Access Protection Act, to prevent the devastating 11.75 
percent cut that the Centers for Medicare and Medicaid Services, CMS, 
is planning to make in Medicare home health payment rates over the next 
4 years.
  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 helped to 
keep families together and enabled millions of our most frail and 
vulnerable older and disabled persons to avoid hospitals and nursing 
homes and stay just where they want to be--in the comfort and security 
of their own homes. Moreover, by helping these individuals to avoid 
more costly institutional care, they are saving Medicare millions of 
dollars each year.
  That is why I find it so ironic that the Medicare home health benefit 
is once again under attack.
  The House version of the SCHIP reauthorization bill proposed cutting 
Medicare home health spending by $2.6 billion over 5 years, and the 
Senate may soon be considering similar cuts.
  To make matters worse, CMS has proposed additional administrative 
cuts that are estimated to total more than $6 billion over the next 5 
years. If allowed to go forward, this ``double whammy'' for home care 
will result in

[[Page S12993]]

cuts in excess of $8.6 billion over 5 years from a program that costs 
less than $15 billion a year. This simply is not right, and it 
certainly is not in the best interest of our Nation's seniors who rely 
on home care to keep them out of hospitals, nursing homes and other 
institutions.
  The administrative cuts proposed by CMS are based on the assertion 
that home health agencies have intentionally ``gamed the system'' by 
claiming that their patients have conditions of higher clinical 
severity than they actually have in order to receive higher Medicare 
payments. This unfounded allegation of ``case mix creep'' is based on 
what CMS contends to be an increase in the average clinical assessment 
``score'' of home health patients over the last few years.
  In fact, there are very real clinical and policy explanations for why 
the average clinical severity of home care patients' health conditions 
may have increased over the years. For example, the incentives built 
into the hospital DRG reimbursement system have led to the faster 
discharge of sicker patients. Advances in technology and changes in 
medical practice have also enabled home health agencies to treat more 
complicated medical conditions that earlier could only be treated in 
hospitals, nursing homes, or inpatient rehabilitation facilities.
  These administrative cuts are proposed to go into effect on January 
l. This would be devastating to home health agencies in Maine and 
across the Nation, particularly given that there is no evidence of 
intentional ``gaming'' on the part of home health agencies to warrant 
such a severe financial penalty.
  Moreover, CMS has not made public any of the details of the research 
method, data and findings they used to justify the planned cuts, making 
it impossible for Congress or the public to evaluate the reliability or 
the validity of its actions.
  What is of most concern to me, however, is that this unfair penalty 
is being assessed across the board, even for home health agencies that 
showed a decrease in their clinical assessment scores. If an individual 
home health agency is truly gaming the system, CMS should target that 
one agency, not penalize everyone.

  The fact is that the Medicare home health benefit has already taken a 
larger hit in spending cuts over the past 10 years than any other 
Medicare benefit. In fact, home health as a share of Medicare spending 
has dropped from 8.7 percent in 1997 to 3.2 percent today, and is 
projected to decline to 2.6 percent of Medicare spending in 2015.
  This downward spiral in home health spending began with provisions in 
the Balanced Budget Act of 1997, which resulted in a 50 percent cut in 
Medicare home health spending by 2001--far more than the Congress 
intended or the Congressional Budget Office projected.
  And home health spending continues to be much lower than CBO 
projections. In 2000, the CBO projected that home health spending in 
2006 would total $21.1 billion under the new home health prospective 
payment system. The actual total expenditures for home health last year 
were $13.2 billion. If home health agencies were engaging in the kind 
of widespread ``upcoding'' that CMS has alleged, home health spending 
would be exceeding CBO's projections. In fact, home health spending has 
been far less than expected.
  Home health care has consistently proven to be a compassionate and 
cost-effective alternative to institutional care. Additional deep cuts 
will be completely counterproductive to our efforts to control overall 
health care costs. They will also place the quality of home health 
services at risk, particularly given ever-rising transportation, 
staffing, and technology costs. Cuts of this magnitude could leave some 
providers with no alternative but to reduce the number of home health 
visits or patient admissions, which would ultimately threaten seniors' 
access to care and clinical outcomes. Or they could cause them to close 
their doors altogether.
  The legislation that we are introducing today will block the ``case 
mix creep'' cuts that were proposed by CMS as part of the final home 
health prospective payment system regulation in August. It will also 
establish a reliable and transparent process that the Department of 
Health and Human Services must use to justify that payment rate cuts 
are needed to account for improper changes in ``case mix scoring.'' A 
companion bill to our legislation is being introduced in the House by 
Representative Jim McGovern. 
  The Home Health Care Access Protection Act of 2007 will help to 
ensure that our seniors and disabled Americans continue to have access 
to the quality home health services they deserve, and I encourage all 
of my colleagues to sign on as cosponsors.
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