[Congressional Record Volume 165, Number 26 (Monday, February 11, 2019)]
[Senate]
[Page S1167]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Ms. Stabenow, Mr. Kennedy, Mr. 
        Jones, Mr. Cassidy, Mr. Paul, and Mrs. Shaheen):
  S. 433. 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 two bills that I have introduced that will help to preserve and 
to expand access to home healthcare.
  I have been a strong supporter of home care since my very first home 
visit early in my Senate service. This experience gave me the 
opportunity to meet and to visit with home healthcare patients, where I 
saw firsthand what a difference highly skilled, caring visiting nurses 
and other healthcare professionals make in the lives of patients and 
their families. I have been a passionate advocate of home healthcare 
ever since.
  The highly skilled and compassionate care that home health agencies 
provide in the State of Maine and across the country have enabled 
millions of our most frail and vulnerable individuals to avoid 
hospitals and nursing homes and to stay just where they want to be--in 
the comfort, privacy, and security of their own homes.
  As we look to the future, home health services will continue to be in 
high demand. The Census projects that by the year 2030, the proportion 
of U.S. residents older than age 65 will have nearly doubled from 2010.
  The Home Health Payment Innovation Act, which I have introduced with 
Senator Stabenow, Senator Kennedy, Senator Jones, Senator Cassidy, and 
Senator Paul, preserves access to existing home health services under 
the Medicare Program, while also providing a pathway for innovative 
approaches to using these vital services. This bipartisan legislation 
is endorsed by the National Association of Home Care and Hospice, as 
well as by the Partnership for Quality Home Healthcare.
  Our bill would make two key adjustments in home health payment reform 
provisions that were passed last year. First, it would prevent 
unwarranted payment rate cuts by basing any behavioral adjustments on 
actual evidence. Second, it would limit the risk of disruption in care 
by providing a phase-in for any necessary rate increases or decreases. 
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.
  Our bill also provides the pathway to expanded use of home healthcare 
in the Medicare Program without increasing program spending
  It provides flexibility on waiving what is called the ``homebound 
requirement'' for home health services when a plan or innovative care 
delivery model, such as an accountable care organization, determines 
that providing care to the patient in the home would improve outcomes 
and reduce spending on patient care.
  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--the homebound limitation--will 
help to advance the goals of ensuring that care is delivered at the 
right time, in the right place, and at the right cost.

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