[Congressional Record Volume 155, Number 79 (Thursday, May 21, 2009)]
[Senate]
[Page S5824]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mrs. Lincoln, and Mr. Bond):
  S. 1123. A bill to provide for a five-year payment increase under the 
Medicare program for home health services furnished in a rural area; to 
the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today with my colleagues from 
Arkansas and Missouri to introduce the Medicare Rural Home Health 
Payment Fairness Act to reinstate the 5 percent add-on payment for home 
health services in rural areas that expired on January 1, 2007.
  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 caregivers provide have 
enabled millions of our most frail and vulnerable older and disabled 
citizens to avoid hospitals and nursing homes and stay just where they 
want to be--in the comfort and security of their own homes. I have 
accompanied several of Maine's caring home health nurses on their 
visits to some of their patients. I have seen first hand the difference 
that they are making for Maine's elderly.
  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. 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 the 
Visiting Nurses of Aroostook in Northern Maine, where I am from, tells 
me her agency covers 6,600 square miles with a total population of only 
73,000. This agency's costs are understandably much higher than other 
agencies due to the long distances the staff must drive to see clients. 
Moreover, the staff is not able to see as many patients due to time on 
the road.
  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, increasing 
overall 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 their urban counterparts, and are understandably more expensive 
for agencies to serve. If the extra rural payment is not extended, 
agencies may be forced to make decisions not to accept rural patients 
with greater care needs. That could translate into less access to 
health care for ill, homebound seniors. The result would likely be that 
these seniors would be hospitalized more frequently and would have to 
seek care in nursing homes, adding considerable cost to the system.
  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 and could force some of the 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 were forced to close, the Medicare patients in that 
region could lose all of their access to home care.
  The legislation we are introducing today will extend the rural add-on 
for 5 years and help to ensure that Medicare patients in rural areas 
continue to have access to the home health services they need. I urge 
all of our colleagues to join us as cosponsors.
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