[Congressional Record Volume 156, Number 66 (Wednesday, May 5, 2010)]
[Senate]
[Page S3168]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Mr. Feingold):
  S. 3315. 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 rise today to join with my colleague 
from Wisconsin in introducing legislation, the Home Health Care Access 
Protection Act of 2010, to prevent future unfair administrative cuts in 
Medicare home health payment rates.
  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--and troubling--that the Medicare 
home health benefit continually comes under attack.
  The health care reform bill that was recently signed into law by the 
President includes $40 billion in cuts to home care over the next ten 
years. Moreover, these cuts are a ``double-whammy'' because they come 
on top of $25 billion in additional cuts to home health over the next 
ten years imposed by the Centers for Medicare and Medicaid Services 
through regulation.
  These cuts are particularly disproportionate for a program that costs 
Medicare less than $18 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 payment rate cuts implemented and 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 diagnosis-related group--or 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 
previously could only be treated in hospitals, nursing homes, or 
inpatient rehabilitation facilities.
  Moreover, this unfair payment rate cut 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 research method, data and findings that CMS has used to justify 
the administrative cuts also raise serious concerns about the validity 
of the payment rate cuts. For example, while changes in the need for 
therapy services significantly affect the case mix ``score,'' the CMS 
research methodology disregards those changes in evaluating whether the 
patient population has changed. Moreover, the method by which CMS 
evaluates changes in case mix coding is not transparent, does not allow 
for true public participation, and is not performed in a manner that 
ensures accountability to Medicare patients and providers in terms of 
its validity and accuracy of outcomes.
  The legislation we are introducing today will establish a reliable 
and transparent process for determining whether payment rate cuts are 
needed to account for improper changes in ``case mix scoring'' that are 
not related to changes in the nature of the patients served in home 
health care or the nature of the care they received. This process will 
still enable the Secretary of Health and Human Services to enact rate 
adjustments provided there is reliable evidence that higher case mix 
scores are resulting from factors other than changes in patient 
conditions. The legislation will also prevent the implementation of 
future Medicare payment rate cuts in home health until the Secretary is 
able to justify the payment cuts through the improved process set forth 
in the bill.
  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. The Home Health Care Access Protection Act of 2010 
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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