[Congressional Record (Bound Edition), Volume 145 (1999), Part 18]
[Senate]
[Pages 25541-25545]
[From the U.S. Government Publishing Office, www.gpo.gov]



                          HOME HEALTH SERVICES

  Ms. COLLINS. Mr. President, Senate Republicans are committed to 
enacting legislation to preserve, strengthen, and save Medicare for 
current and future generations. In addition to addressing the long-term 
issues facing Medicare, it is absolutely critical that this Congress 
also take action this year to remedy some of the unintended 
consequences of the Balanced Budget Act of 1997, which have been 
exacerbated by a host of ill-conceived new regulatory requirements 
imposed by the Clinton administration.
  These problems are the subject of the issue my colleague from Kansas 
and I wish to address today, for these problems are jeopardizing access 
to critical home health services for millions of our Nation's most 
vulnerable and frail senior citizens.
  America's home health agencies provide invaluable services that have 
enabled a growing number of our vulnerable senior citizens to avoid 
hospitals, to avoid nursing homes, and receive the care they need and 
want in the security and privacy of their own homes--right where they 
want to be.
  In 1996, however, home health was the fastest growing component of 
the Medicare budget, which understandably prompted Congress and the 
Clinton administration to initiate changes that were intended to make 
the program more cost effective and efficient. There was strong 
bipartisan support for the provisions that called for the 
implementation of a prospective payment system for home care. 
Unfortunately, until this system is implemented, home health care 
agencies are being paid under a critically flawed interim payment 
system known as IPS, that penalizes those home health agencies that 
historically have been the most cost effective.
  Mr. ROBERTS. Mr. President, will the Senator from Maine yield to me 
for a question?
  Ms. COLLINS. I am happy to yield to my colleague.
  Mr. ROBERTS. For all of those who are listening and watching this 
debate, I thank the distinguished Senator from Maine for her--I wrote 
it down--untiring, persevering, never-give-up leadership with regard to 
this effort to resolve our problems with HCFA. What an acronym. We have 
all heard of Peter and the dike. This is Susan at the dam, the HCFA 
dam. In fact, we could probably turn that around in regard to what is 
happening.
  I want to ask a question. Do you mean this new interim payment 
system--and we will go through this in some detail. I want folks to 
remember interim payment system, IPS. That is the acronym. Everything 
has to be an acronym in Washington. I don't call it IPS. I call it the 
``IPS mess''. It not only rewards but actually penalizes the home 
health care agencies for their past, not bad behavior but good 
behavior; is that right?
  Ms. COLLINS. Unfortunately, that is exactly right. Unbelievable 
though it may seem, the formula that is being used actually penalizes 
those agencies in our two States that have done a good job of holding 
down costs. It rewards those home health agencies that have provided 
the most visits, that have spent the most Medicare dollars. It is 
totally backwards. In fact, home health agencies in our two regions of 
the country, the Northeast and the Midwest, are among those that have 
been particularly hard hit by this inexplicable formula, the IPS, that 
the Senator just mentioned.
  The Wall Street Journal observed last year--this could be said of 
agencies in the Midwest as well--that if New England had just been a 
little greedier, its home health agencies would be a whole lot better 
off now. Ironically, the regions, yours and mine, are getting clobbered 
by the system because they have had a tradition of nonprofit community 
service and efficiency.
  Even more troubling--and I commend the Senator from Kansas for his 
leadership on this issue; I know this troubles him as well--is the fact 
the flawed system is restricting access to care for the

[[Page 25542]]

very senior citizens who need the care the most. Those are our seniors 
who are the sicker patients, who have complex chronic care needs, such 
as diabetic wound care patients whom I visited in northern Maine during 
a home health care visit, or IV therapy patients who require multiple 
visits. Indeed, according to a recent survey by the Medicare Payment 
Advisory Commission, almost 40 percent of home health agencies have 
said there are patients who they no longer serve due to the flawed 
interim payment system and the regulatory overkill on the part of the 
Clinton administration.
  I show the distinguished Senator from Kansas and the distinguished 
Presiding Officer, who is also committed to this issue, and my other 
colleagues, a chart that demonstrates the dramatic impact the IPS, this 
flawed payment system, has had in my own State of Maine.
  As you can see, the number of Medicare beneficiaries who have been 
served by home health care agencies has dropped dramatically. It has 
dropped by 13 percent, from 49,458 to 42,858; 6,600 senior and disabled 
citizens in my State have lost their access to home health care 
services in 1 year. This is so troubling to me. The number of visits 
has plummeted by more than 420,000, and reimbursements to our home 
health agencies have dropped by an astounding $20 million in a year. 
Keep in mind that Maine has some of the least costly home health care 
agencies in the country. They have been very prudent in their use of 
resources. They were low cost to begin with. So when this formula went 
into effect, it put such a squeeze on them, they had no choice but to 
close offices, lay off staff, and stop serving some of the most 
vulnerable, ill senior citizens in my State.
  The point is, cuts of this magnitude, that we have seen in the State 
of Maine and throughout the country, cannot be sustained without 
hurting senior citizens.
  Mr. ROBERTS. Mr. President, I will ask the Senator from Maine, if she 
will yield, another question.
  Ms. COLLINS. I am happy to yield.
  Mr. ROBERTS. I heard similar complaints--I have them written down--on 
the interim payment system, the IPS system, from the same agencies in 
my State. In fact, since January of 1998, 56 Medicare-certified 
agencies in Kansas have closed their doors, largely as a result of the 
changes in the IPS. These are not the fly-by-night home health care 
agencies we hear about that sometimes are in the press. Many of these 
agencies have been in existence for 20 years. I have visited these 
agencies. There was a survey conducted by the Kansas Home Care 
Association that shows agencies have laid off an average of 42 percent 
of their staff. They are subsidizing their Medicare payments to the 
tune of $213,000. In 1997, many agencies decreased the Medicare patient 
visits by 63 percent. Your chart shows 6,600 people. I have asked 
Kansas to come up with the numbers of people who are affected. They are 
trying to do that. It could be in the hundreds; it could be in the 
thousands.
  But one person, just one person is a valued individual. That is 
everybody's mom, dad, grandmother, or granddad. So from the standpoint 
of numbers, it is astounding what the distinguished Senator has put up 
on the chart with regard to this so-called IPS system. We are going 
through the same kind of problem. I am going to ask you, how much 
longer is this IPS mess going to be in effect? It was supposed to be a 
transition program to the prospective payment system, but they said, 
well, we can't do it that fast. I understand that because it does take 
a lot of work, but how much longer will we have to put up with this?
  Ms. COLLINS. Unfortunately, I say to my friend, the Senator from 
Kansas, the answer is far longer than any of us in Congress ever 
anticipated. The problems with the IPS system, which the Senator has 
described so eloquently for his State, and we have seen in my State, 
are all the more pressing because the Clinton administration has missed 
the deadline for implementing the prospective payment system. As a 
consequence, home health care agencies throughout our Nation are going 
to be struggling under this unfair and flawed payment system far longer 
than Congress ever envisioned or intended when it passed the Balanced 
Budget Act.
  Mr. ROBERTS. Mr. President, I ask the Senator to yield for another 
question, if she will.
  Ms. COLLINS. I am happy to.
  Mr. ROBERTS. The home health care agencies are worried about IPS in 
Kansas. I know the same is true of all around the country. They also 
complain that their financial problems have been exacerbated--that is a 
fancy word that means a whole lot worse--by a host of new regulatory 
requirements imposed by HCFA--my favorite agency in Washington--
including the implementation of something called OASIS--I have the 
report--that they are requiring nurses to fill out. Oasis, if you look 
in the dictionary, is a desert island somewhere or in the middle of the 
desert; you come to an oasis and you get relief. Oasis is not relief. 
You don't spell relief by spelling oasis: a new outcome and assessment 
information data set; new requirements for surety bonds, sequential 
billing, overpayment recoupment, and a new 15-minute increment 
reporting requirement that is a doozy. What about all these reporting 
requirements in addition to the IPS problem? What about OASIS?
  Ms. COLLINS. The Senator is absolutely correct. We not only have a 
flawed payment system, but home health agencies are struggling under a 
mountain of burden of unnecessary and onerous regulations imposed by 
HCFA, imposed by the Clinton administration. In fact, my colleague may 
be interested to know that earlier this year I chaired a hearing of the 
Permanent Subcommittee on Investigations on home health care. We heard 
firsthand about the financial distress and cash-flow problems that home 
health agencies across the country are experiencing. In fact, the 
Senator has talked about the number that have closed in Kansas.
  The Senator may already know, but for the benefit of my colleagues 
who may not be as well informed as the Senator from Kansas, more than 
2,300 home health agencies across the country have been forced to close 
their doors as a result of the regulatory burden and the flawed payment 
system.
  We heard witnesses talk about their frustrations. In fact, the CEO of 
the Visiting Nurses Service in Saco, ME, termed the Clinton 
administration's regulatory policy as being one of ``implement and 
suspend.'' She and others pointed to numerous examples of hastily 
enacted, ill-conceived requirements along the lines of what the Senator 
pointed out--surety bonds, sequential billing, the OASIS system, a host 
of unnecessary regulatory requirements. What has happened is, no sooner 
does HCFA impose this burden on these home health agencies and they 
invest the costs necessary to comply, then HCFA changes its mind and 
suspends the regulatory requirements and says never mind.
  Mr. ROBERTS. Will the Senator yield for another question or just an 
observation?
  Ms. COLLINS. Yes.
  Mr. ROBERTS. Now, wait a minute, HCFA imposed the cost burden of this 
mandate on home health care agencies. Then they had seconds thoughts. 
Why?
  Ms. COLLINS. I think the Senator will allow me to respond. This is a 
typical example of the administration rushing in without thinking 
through the regulatory burden that is imposed and, in response to an 
outcry from Members of Congress, such as ourselves, and from senior 
citizens and home health agencies, it then decided maybe it made a 
mistake. But, in the meantime, our home health agencies have gone 
through the time, trouble and expense of implementing these 
requirements.
  Mr. ROBERTS. But they suspended them?
  Ms. COLLINS. That's correct.
  Mr. ROBERTS. They didn't say you have no requirement to keep up the 
reporting paperwork; they just suspended them. So that shoe will drop 
again.
  Ms. COLLINS. The Senator makes a good point. In some cases, they may 
suspend it and then they may turn around and impose the burden again. 
It

[[Page 25543]]

is hard to know. The agency seems to be in so much turmoil and so 
insensitive to the home health care agencies.
  Mr. ROBERTS. If there is a home health care agency and they go 
through the requirements and get, hopefully, up to speed--although you 
don't know how with the lack of personnel and you are not being paid 
for it, et cetera--they could then be suspended, but they have already 
gone through those costs to comply. But then you don't know. Aren't 
they sort of in a ``HCFA purgatory'' here?
  Ms. COLLINS. The Senator is exactly correct. Let me give you a 
specific example. In 1998, HCFA instituted a new policy for sequential 
billing. Under this policy, home health agencies are required to submit 
claims in a sequential order to Medicare. Now, this required a 
substantial investment in computer software, a lot of process changes 
on behalf of the home health agencies and the fiscal intermediaries. 
Moreover, the way the system was set up, if there were subsequent 
claims for a particular patient, they could not be paid until all 
previous claims relating to this patient were settled. This caused 
enormous cash flow problems for home health agencies. They experienced 
delays as long as 120 days before they could get the payment they were 
due.
  One witness at my hearing testified that her agency was still owed 
about $20,000 for fiscal '98, and other agencies reported they had to 
obtain bridge loans, or tap into their credit lines, solely because of 
this ill-conceived policy.
  Now, due to the objections raised by the Senator from Kansas, myself, 
other Members, and the home health care industry, HCFA finally decided 
to suspend the policy this past July. But, in the meantime, we have had 
over a year of turmoil because of this policy, and home health agencies 
had already spent time, energy, training, and effort to comply with a 
misguided policy that now is, as you put it, in ``HCFA purgatory.''
  Mr. ROBERTS. Mr. President, I ask the Senator if she will yield for 
another question?
  Ms. COLLINS. I am happy to yield.
  Mr. ROBERTS. We have also heard a number of complaints from my 
constituents about this business called OASIS. For those who don't 
know, again, OASIS is a system of records containing all this data on 
the physical, mental, and functional status of Medicare and Medicaid 
patients receiving care from home health care agencies. So HCFA then 
implemented OASIS, as I understand it, as a tool to help the agency 
improve the quality of care and form the basis for a new home health 
prospective payment system. There is certainly nothing wrong with that. 
But the problem, as the Senator has pointed out, is that the collection 
of data is burdensome and expensive for agencies; it invades the 
personal privacy of patients, and it must be collected for non-Medicare 
patients--that is the part I don't understand--as well as those served 
by Medicare.
  Why on earth would they require that? I don't understand this. You 
talk about an unfunded mandate. This has to be at least in the top 10.
  The Kansas House of Representatives actually passed a resolution 
earlier this year that asked Congress to rescind HCFA rules requiring 
OASIS. I have it right here. It is not often that an entire legislature 
of a State passes a resolution telling some alphabet soup agency back 
here, wait a minute, this doesn't make any sense; you are causing an 
awful lot of regulatory overkill and causing home health care agencies 
to go out of business. Let's see. The State of Kansas is very concerned 
about the health and well-being of the senior and disabled citizens. We 
have 1, 2, 3, 4, 5, 6 ``whereases,'' translated: Whoa, HCFA, don't do 
this. It is an unfunded mandate.
  This was passed by the House of Representatives of the State of 
Kansas and it was resolved ``that the Secretary of State be directed to 
provide an enrolled copy of this resolution to the President of the 
United States, Secretary of Health and Human Services, President of the 
United States Senate, Speaker of the House of Representatives, Minority 
leaders of the United States Senate and the United States House of 
Representatives,'' saying please don't enforce these OASIS regs the way 
they are being enforced. It is signed by the distinguished speaker of 
the House in Kansas and the President of the Senate.
  I ask unanimous consent that the resolution be printed in the Record.
  There being no objection, the material resolution was ordered to be 
printed in the Record, as follows:

                  House Concurrent Resolution No. 5041

       Whereas, New rules made by HCFA require OASIS assessment 
     and follow-up reports for all patients of Medicare-certified 
     home health agencies and health departments whether or not 
     the personal or attendant care for such patients is paid from 
     Medicare; and
       Whereas, The new HCFA report requires an 18-page initial 
     assessment, which must be completed by a registered nurse, 
     with a 13 page follow-up assessment being required every 60 
     days; and
       Whereas, The requirement for computer software for the 
     preparation and transmission of such assessments and follow-
     up reports is another unfunded mandate of the federal 
     government; and
       Whereas, The HCFA requirement requires costly unfunded 
     reporting of those who receive services which are not paid by 
     Medicare--which reporting duplicates existing assessment and 
     reporting requirements of the Kansas Department on Aging; and
       Whereas, In the environment of the small, home health care 
     services existing in Kansas, it is not feasible to create 
     separate organizations to provide services for non-Medicare 
     customers. The end result of the HCFA rules is that Medicare-
     certified agencies will no longer be able to provide in-home 
     services to non-Medicare customers. Consequently, with lower 
     levels of preventive home services being available to older 
     Kansans there will be an increase in hospital admissions, 
     thus increasing Medicare costs, and an increase in nursing 
     home admissions, thus increasing Medicaid costs; and
       Whereas, OASIS appears to be solely a research project of 
     HCFA, totally unfunded by federal sources, and accomplished 
     with loss of funds by reporting agencies and loss of services 
     for Kansas seniors: Now, therefore,
       Be it resolved by the House of Representatives of the State 
     of Kansas, the Senate concurring therein: That we memorialize 
     the Congress of the United States to require the Health Care 
     Financing Administration OASIS reporting and data reporting 
     requirements to apply only to Medicare patients and not to 
     all patients of Medicare-certified home health agencies; and
       Be it further resolved: That the Secretary of State be 
     directed to provide an enrolled copy of this resolution to 
     the President of the United States, Secretary of Health and 
     Human Services, President of the United States Senate, 
     Speaker of the United States House of Representatives, 
     minority leaders of the United States Senate and the United 
     States House of Representatives, and to each member of the 
     Kansas Congressional delegation.

  Mr. ROBERTS. I am sure that this burden is being felt by agencies 
nationwide, not only in Kansas. I am not sure the legislatures of each 
State have been passing resolutions to say we need relief from OASIS, 
but I ask the Senator if she has any idea how long it takes for nurses 
to collect this information?
  Ms. COLLINS. Most agencies are reporting that it takes a nurse 
between 1 and a half and 2 hours per patient. Now, I point out, that is 
2 hours that could be used on direct patient care, on tending to the 
problems that caused the home health visits to be necessary in the 
first place. Instead, as the Senator has so ably described, it is being 
spent on unnecessary paperwork.
  Mr. ROBERTS. Mr. President, I have 2 or 3 more questions. I have a 
copy of OASIS. This is not relief. I understand the time requirements. 
I want you to look at this. This OASIS document includes an 18-page 
initial assessment that must be completed by a registered nurse, and a 
13-page follow-up assessment that is required every 60 days. This is 
perpetual reporting, a perpetual reporting machine, well-boiled by 
HCFA. And this is on top of assessments already required by States. The 
paperwork burden is immense. I am curious about what is included in 
this assessment. Is the Senator aware of the nature of the questions in 
this assessment?
  I think I know the answer. I have read through this OASIS--the third 
degree, or whatever you want to call it. Will the Senator speak to the 
nature of the questions in the assessment?
  Ms. COLLINS. Well, the Senator has put his finger on yet another 
problem. As I understand it--and the Senator is

[[Page 25544]]

the expert on the OASIS system--OASIS collects information on the 
patients' medical history. We can understand that part, but also on the 
patient's living arrangements, sensory status, medications, and 
emotional state.
  Mr. ROBERTS. Will the Senator yield for a question?
  Ms. COLLINS. I am glad to.
  Mr. ROBERTS. Emotional status?
  Ms. COLLINS. That is correct.
  Mr. ROBERTS. I see that page, as I have gone over this.
  I tell the distinguished Presiding Officer, nurses in Colorado must 
ask the questions of these patients about their feelings--it sounds 
like a Barbara Streisand song--such as if they have ever felt 
depressed, had trouble sleeping, or even if they have ever attempted 
suicide. The thought occurs to me that Members of this distinguished 
body from time to time feel depressed and have trouble sleeping. I hope 
that would not be the case with regard to suicide.
  I am being too sarcastic.
  Do we really think we need to ask a nurse to bother a physical 
therapy patient for this information so that he or she can send the 
answers over to some computer someplace in Baltimore that will then use 
this information to develop a prospective payment system, and we can't 
find out when it is going to be proposed? Who in Baltimore reads these? 
I asked that in regard to HCFA, in regard to all of their requirements 
back when it was Health, Education, and Welfare in regard to Kansas 
City. I wanted to go to Kansas City and say: Who reads this stuff? What 
do they do with it? Maybe the Senator and I could go to Baltimore and 
figure that out. Why on Earth would we ask a nurse to bother a physical 
therapy patient for this information so they can send the answers? It 
hasn't anything to do with physical therapy patients. Why is that?
  Ms. COLLINS. I completely agree with my colleague. These are the 
questions, when asked of the senior citizens whom I talked to, they 
find very intrusive. The nurses who are treating them are offended that 
they have to pry into matters that have no connection to the reason for 
the home health visit.
  Moreover, as I pointed out earlier to my friend and colleague, this 
is time that is being spent on unnecessary paperwork, on intrusive 
questions that alienate and destroy the relationship between the nurse 
and the patients that could better be used for actually caring for the 
patient.
  Agencies are not reimbursed for this time. Moreover, in a State such 
as Maine, which is very rural, our home health providers have to spend 
a lot of time traveling from patient to patient. This is time that is 
lost from the system.
  Another issue, which the Senator has also raised, which is 
inexplicable to me, is why is HCFA collecting this data for non-
Medicare patients? I don't understand that. Am I correct? The Senator 
from Kansas is much more knowledgeable about the OASIS system than I 
am. Am I correct that it actually applies to non-Medicare patients as 
well?
  Mr. ROBERTS. I would be happy to respond to the distinguished 
Senator.
  Unfortunately, she is correct. Any Medicare-approved health care 
agency must comply with all Medicare conditions of participation. That 
is MCP--probably another acronym, and I will not venture to say what 
that sounds like--including the collection of OASIS. This means 
patients who do not participate in Medicare are still subject to 
Medicare assessment.
  In June, HCFA amended this regulation to say that these agencies 
don't have to--here again, this is what we have a lot of trouble with--
transmit the data on non-Medicare patients for the time being, but they 
still must spend the time taking these assessments. Hello.
  Ms. COLLINS. Yet another sample of what the Senator has described as 
policies being implemented, then pulled back, agencies not knowing 
whether they are coming or going, and being subjected to the confusing 
and conflicting and extensive requirements that are detracting from the 
ability of these agencies to provide essential care to our seniors.
  I want to give the Senator from Kansas yet another example of this 
regulatory overkill by HCFA. I don't know whether the Senator from 
Kansas is familiar with this, but it is the new 15 -minute incremental 
reporting requirement. HCFA is requiring nurses to act more like 
accountants or lawyers billing for every 15 minutes of their time. They 
are going to have to carry stopwatches to comply with this. 
Implementation is not only going to be very difficult for the staff to 
administer, but also, once again, it changes the very relationship 
between the patient and the nurse. It is very disruptive to a patient's 
care.
  Mr. ROBERTS. Will the Senator yield for one additional observation 
and a question?
  Ms. COLLINS. I am glad to yield.
  Mr. ROBERTS. I want to go back to my statement earlier when I said in 
that June HCFA responded in regard to the outcry on the part of the 
home health care agencies in regards to the regulation on the 
conditions of participation with OASIS. As I indicated before, the 
agency still must spend the time taking the assessment. So I asked 
staff. I said: Wait a minute. Why is it, if they suspended it, you 
still have to take the assessment? I don't know where they are storing 
all of this paperwork. Maybe they burn it at Christmas time That may be 
a good idea. But, at any rate, write the mail; don't send it. And I 
asked staff: Why are we still doing this if, in fact, you don't send it 
in? It is a privacy issue. Look at the questions that are involved. 
These are privacy issues, and they haven't figured that out yet. So if, 
in fact, there are privacy issues, it would seem to me we had better 
settle those first or we are going to have lawsuits, big time. Why 
issue the regulation and then say to people: Well, we have a bunch of 
privacy issues that we haven't thought through, but keep on filling 
them out, and when we figure out the privacy issue, why, then we will 
get back to you.
  I am extremely sympathetic to the concerns raised by my constituents 
that these new policies will harm seniors.
  But let's give HCFA a break. I have been pretty critical and a little 
sarcastic, and I have to admit that I have a bias.
  I have been working on this ever since I have had the privilege of 
being in public service. Even back when I was an administrative 
assistant to Congressman Keith Sebelius, we used to have these HCFA 
directives coming out to the rural health care delivery system. I can 
remember one right off the bat on behalf of cost containment.
  Give HCFA a break. They are in charge of cost containment. We are all 
good at passing laws and then passing a lot of regulations, and saying, 
OK, you have to really put up with these, and it is up to HCFA to put 
out the regulations. And when we find they don't work, the people come 
to us and complain about it.
  I can remember one rather incredible thing when they said we are not 
going to pay anybody any Medicare reimbursement unless the patient 
admissions are reviewed by hospitals on a 24-hour basis by three 
doctors. We thought about that a little and said: We think we are for 
this--because we didn't have any doctors. I figured, well, what the 
heck. If we go ahead and accept this regulation, maybe they could 
provide the three.
  Then there was the other great example of the sole provider and 
community hospital--talking about Goodland, KS, America, out on the 
prairie at the top of the world, a great place to live, a great farming 
community miles from nowhere. We asked again--it was HHS at that 
particular time--can you give us this decree, or this ruling to make 
this hospital eligible for a little more in payments? They said: Well, 
no, because everybody out there--I am not making this up--has four-
wheel drives, and it is pretty flat in Kansas. What? As opposed to 
Colorado, I say to the distinguished Presiding Officer, who serves as 
an outstanding Senator. Four-wheel drive, and it is flat, and because 
they have lizards, windstorms. Our weather out there is a little tough 
for some bird in, like Virginia, down here to make that assessment.

[[Page 25545]]

  So I have a little bias here, but I want to give HCFA a break.
  I want to ask the Senator, are these policy changes necessary to 
achieve the Medicare savings goals? Medicare is a top concern; 
strengthen and preserve it. We have all worked very hard to do that. 
Are these policies necessary to achieve the savings that we want to 
achieve to strengthen and preserve Medicare?
  Ms. COLLINS. The Senator has raised an excellent question. There is a 
very good answer. That is no. In fact, the regulatory overkill of the 
Clinton administration has already exceeded the savings projected by 
the balanced budget amendment. Medicare for home health fell nearly 15 
percent last year, and CBO now projects the reductions in home health 
care will exceed $46 billion over the next 5 years. That is almost 
three times greater than the $16 billion estimate that the 
Congressional Budget Office originally estimated.
  It is yet another indication that these cuts are far too deep, and 
that they are hurting far too many people completely unnecessarily. 
They have been far too severe and much more far reaching than Congress 
ever intended when it was trying to bring a measure of fiscal restraint 
to the Medicare Program.
  Mr. ROBERTS. I ask the distinguished Senator from Maine, didn't we 
fix the problems last year when we passed the omnibus appropriations 
bill? I think we both made speeches at that particular time. What is 
the status?
  Ms. COLLINS. The Senator worked closely with me and others last year 
in providing a small measure of relief in the omnibus appropriations 
bill. I am pleased that together we were able to take some initial 
steps to remedy this issue. However, I think it is evident from the 
overwhelming evidence that the proposal did not go nearly far enough in 
relieving the financial distress of these home health agencies. The 
ones that are paying the price are the good agencies, the cost-
effective agencies that are serving our seniors. That is the tragedy.
  Mr. ROBERTS. If I could ask the Senator one final question, I know I 
have been hard on HCFA. Each Member has some very special experiences, 
and these are experiences that come to our attention when a constituent 
is having a big-time problem or a hospital or home health care agency. 
All of the folks that work down at HHS certainly don't fall under the 
category that I have been talking about. So what about our 
responsibility? What about our leadership? What should we do to fix the 
problem? How can we provide more relief to the beleaguered home health 
care agency?
  Ms. COLLINS. I know the Senator from Kansas has been such a leader 
and cares so much about this issue and has joined with me in 
introducing legislation, along with our colleague from Missouri, 
Senator Bond, and 31 of our colleagues. Both sides of the aisle have 
joined in legislation that we have introduced called the Medicare Home 
Health Equity Act.
  This solves the problem. For one thing, it eliminates another 15-
percent cut that is scheduled to go into effect in October of next 
year. I am sure my friend, the Senator from Kansas, agrees with me if 
that goes into effect, it will sound the death knell for the remaining 
home health agencies. That means the ones that have been struggling to 
hang on will be forced to close their doors or refuse even more 
services to our senior citizens. This is totally unnecessary because we 
have already achieved the savings, the targets set by the Balanced 
Budget Act.
  The legislation includes a number of other provisions that affect a 
lot of the regulatory issues we have discussed today. I think it is 
absolutely critical we pass this legislation or similar provisions 
before we go home. I have visited senior citizens in my State who, if 
they lose their home health services, are going to be forced into 
nursing homes or hospitals. The irony is that is going to be at far 
greater cost.
  Mr. ROBB. It will increase the costs.
  Ms. COLLINS. The Senator is right. This is penny wise and pound 
foolish--not to mention the human toll that is being taken on our 
vulnerable senior citizens and our disabled citizens.
  I know the Senator shares my commitment. This is of highest priority. 
We must solve this problem before we adjourn.
  Mr. ROBERTS. If the Senator will yield one more time, I thank the 
Senator for all of her leadership and all of her hard work in this 
effort. I believe it is absolutely mandatory for Congress to bring much 
needed relief to the home health care industry in the timeframe she has 
emphasized, as well as to the small rural hospitals and teaching 
hospitals that also are feeling the pinch of all the legislative and 
regulatory changes made in the last few years.
  The Senator is exactly right. We will have to move quickly. We must 
do it this year. There has been talk if we can't agree on a single 
proposal, we might have to put it off until next year. Time is of the 
essence in regard to our hospitals, especially the small rural 
providers. They operate on a shoestring budget. The same is true for 
the home health care agencies.
  I will continue to work with the distinguished Senator to pass 
legislation before Congress adjourns for the year. We cannot go home 
before we straighten this out and provide some help.
  I thank the Senator for her leadership. I think we have had a very 
good colloquy.
  Ms. COLLINS. I thank the Senator from Kansas. I appreciate his 
support and his compassion in making sure we are keeping our promise to 
our senior citizens. With his help and with our continuing partnership, 
I am convinced we can do the job and solve this problem before we 
adjourn.
  I yield the floor.

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