[Congressional Record Volume 164, Number 164 (Wednesday, October 3, 2018)]
[Senate]
[Pages S6496-S6497]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Ms. Stabenow, and Mr. Nelson):
  S. 3545. A bill to amend title XVIII of the Social Security Act to 
improve home health payment reforms under the Medicare program; to the 
Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today to urge my colleagues to 
support

[[Page S6497]]

the Home Health Payment Innovation Act, which I have introduced with 
Senator Stabenow and Senator Nelson. Our legislation would help 
preserve access to existing home health services under the Medicare 
program while also providing a pathway for innovative approaches to 
utilizing these services moving forward. This bipartisan legislation is 
endorsed by the National Association of Homecare and Hospice as well as 
the Partnership for Quality Home Healthcare.
  I have been a strong supporter of home care since my very first home 
visit during my second year of Senate service. This experience gave me 
the opportunity to meet and visit with home health patients, where I 
saw first-hand what a difference highly skilled and caring visiting 
nurses make to the lives of patients and their families. I have been a 
passionate advocate for home care ever since. Last year, I was 
delighted to be recognized with the Ruby Slipper award from the Maine 
Home Care and Hospice Alliance--appropriately named because as Dorothy 
said in The Wizard of Oz, ``There's no place like home.''
  The highly skilled and compassionate care that home health agencies 
provide in Maine and across the country has helped to keep families 
together and enabled millions of our most frail and vulnerable 
individuals to avoid hospitals and nursing homes and stay just where 
they want to be--in the comfort and security of their own homes. In 
fact, in 2014, AARP found that nearly 87 percent of of adults over 65 
years old want to stay in their current home and community as they age. 
Furthermore, 85 percent of home health patients live with three or more 
chronic conditions.
  The legislation I am introducing today ensures the viability of home 
health services now and in the future. First, the Home Health Care 
Payment Innovation Act provides two key adjustments to the Bipartisan 
Budget Act of 2018 home health payment reform provisions. These changes 
would prevent premature payment rate cuts by basing any behavioral 
adjustment on observed evidence. It also provides a phase-in for any 
necessary rate increases or decreases to limit the risk of disruption 
in care. This phase-in is critical for home health providers as CMS has 
already proposed cutting Medicare payment rates in 2020 by more than $1 
billion in the first year alone, based purely on assumptions of changes 
in behavior.
  Second, the legislation provides a pathway to expanded use of home 
health care in Medicare without increasing program spending by 
providing flexibility on waiving the ``homebound'' requirement for home 
health services when a plan or innovative care delivery models such as 
an ACO determines that providing care in the home would improve patient 
outcomes and reduce spending on patient care.
  By helping patients to avoid more costly hospital visits and nursing 
homes, we already know that home health saves Medicare, Medicaid and 
private insurers millions of dollars each year. Moving forward, as 
plans and providers continue to experiment with innovative ways to 
deliver care and improve value in Medicare spending, allowing them the 
flexibility to waive this limitation will help advance the goals of 
ensuring that care is delivered at the right time, at the right place, 
and at the right cost. The legislation I introduced today provides the 
pathway to do just that--promote innovation in home health. I urge my 
colleagues to support this legislation.

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