Extension of the Rural Add-On Payment for Home Health

EXTENSION OF THE RURAL ADD-ON PAYMENT FOR HOME HEALTH

Ms. COLLINS. Mr. President, on behalf of myself and Senator BOND, I want to thank the chairman of the Finance Committee and the chairman of the Appropriations Committee for agreeing to include a 6 month extension of the add-on payment for rural home health services in the omnibus appropriations bill. Extension of this add-on payment, which currently is scheduled to sunset on April 1 will help to ensure that Medicare patients in rural areas continue to have access to the home health services that they need.

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 enabled millions of our most frail and vulnerable older persons to avoid hospitals and nursing homes and stay just where they want to be, in the comfort and security of their own homes.

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 required to cover long distances between patients, higher transportation expenses, and other factors.

Rural agencies also experience higher costs relative to productivity. Because of the longer travel times and distances between patients, rural caregivers are unable to perform as many visits in a day as their urban counterparts. Saundra Scott-Adams, the executive director of the Visiting Nurses of Aroostook in Aroostook County, ME, where I am from, tells me her agency covers 6,600 square miles with a population of only 72,000. Her costs are understandably much higher and her staff productivity much lower than the average due to the long distances her staff must cover to see patients.

Moreover, agencies in rural areas are frequently smaller than their urban counterparts, which means their relative costs are higher due to smaller scale operations. Smaller agencies with fewer patients and fewer visits means that fixed costs, particularly those associated with meeting regulatory requirements, are spread over a smaller number of patients and visits, increasing overall per-patient and per-visit costs.

If the rural add-on payment is eliminated on April 1, it will only put more pressure on rural home health agencies that are already struggling and could force more of these agencies to close. Many agencies operating in rural areas are the only home health providers in a vast geographic area. If any of these agencies are forced to close, the Medicare patients in that region will lose complete access to home health care.

The Medicare Payment Advisory Commission, MedPAC, met earlier this week and voted unanimously to extend for 1 year the add-on payments for rural home health services at 5 percent. Our provision is consistent with the MedPAC's recommendation and will extend the expiring provision through September 30. This will give the Finance Committee time to consider whether this add-on payment should be extended further.

Once again, I thank my colleagues for their assistance, and I look forward to working with them on this and other issues of importance to the health of rural Americans.