[Congressional Record Volume 161, Number 179 (Thursday, December 10, 2015)]
[Senate]
[Pages S8604-S8605]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Ms. Cantwell):
  S. 2389. A bill to amend title XVIII of the Social Security Act to 
extend the rural add-on payment in the Medicare home health benefit, 
and for other purposes; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today with my colleague from 
Washington, Senator Cantwell, to introduce the Preserve Access to 
Medicare Rural Home Health Services Act of 2015. This legislation would 
extend the modest increase in payments for home health services in 
rural areas that otherwise will expire on January 1 of 2018.
  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, privacy, and security of their own homes. I 
have accompanied several of Maine's caring home health nurses on their 
visits to patients and have seen first hand the difference that they 
are making for patients and their families.
  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

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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. For example, home health care agencies 
in Aroostook County in Northern Maine, where I am from, cover almost 
6,700 square miles, with an average population of fewer than 11 persons 
per square mile. These agencies' costs are understandably much higher 
than other agencies located in more urban areas 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 serving 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 three per cent rural payment is not 
extended, agencies may be forced to decide 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 would 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. 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. 
Moreover, we would offset costs of the bill by reducing the home health 
outlier fund by .25 percent over the same 5 years. I urge our 
colleagues to join us as cosponsors.
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