Senator Collins Introduces Rural Home Health Payment Fairness Act

S. 636. A bill to amend title XVIII of the Social Security Act to provide for a permanent increase in medicare payments for home health services that are furnished in rural areas; to the Committee on Finance.

Ms. COLLINS. Mr. President, I rise today to introduce the Rural Home Health Payment Fairness Act, which would extend the 10 percent add-on payment under Medicare for home health care services in rural areas that is currently scheduled to sunset on April 1. This legislation would help to ensure seniors and disabled citizens living in rural America continue to receive the home health care benefits and services they depend on and deserve.

Health care in this country has gone full circle. Patients are spending less time in the hospital. More and more procedures are being done on an outpatient basis and recovery and care for patients with chronic diseases and conditions have increasingly been taking place in the home. As a consequence, home health care has become an increasingly important part of our health care. The kinds of highly skilled and often technically complex services our Nation's home health nurses provide have enabled millions of our most frail and vulnerable senior citizens to avoid hospitals and nursing homes and stay where they want to be, in the security, privacy, and comfort of their very own homes.

I have visited home health patients throughout my State in northern, central, and southern Maine. Regardless of where they live, the impact of home health care on their lives has been the same. It has made the difference between couples staying together in their own home for their golden years, despite the ill health of one of the spouses, or being forced prematurely into a nursing home or into repeated hospitalizations.

One elderly gentleman told me all he wanted was to live out the remaining days of his life with his wife, whom he had been married to for decades, and that home health care allowed them to be together in the home where they had always lived, as he completes his final years.

Home health care is also a bargain. It makes a great deal of sense to care for people in their own homes and avoid the extra costs of nursing homes and hospitalization. Our home health care system is fragile. Extension of the 10 percent add-on payment for rural home health care agencies will help to ensure that patients living in rural communities continue to have access to vital home health services. Surveys have shown 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 cost factors.

Rural agencies also experience higher costs relative to productivity. Because of the longer travel distances, rural caregivers are unable to perform as many visits in a single day as their urban counterparts. Saundra Scott-Adams, the Executive Director of Visiting Nurses of Aroostook in northern Maine, tells me her agency covers 6,600 square miles to serve a population of only 73,000. Her costs are understandably much higher and her hard-working nurses are not able to see as many patients in a day as their urban counterparts. The long distances they must drive mean they are able to see fewer patients each day.

Moreover, agencies in rural areas are frequently smaller than their big city counterparts, which means their relative costs are higher due to smaller scale operations and an ability to take advantage of economies of scale. Smaller agencies with fewer patients and fewer visits mean 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 our rural home health agencies that are already operating on a very narrow margin, and it could, in fact, force some of these agencies to close.

Some agencies operating in rural areas are the only home health providers for a vast geographic area. If any of these agencies are forced to close, the Medicare patients in that region will completely lose their access to home health care.

Earlier this year, the Medicare Payment Advisory Commission voted unanimously to extend the rural add-on payment for home health services for one year. I urge all of my colleagues to join me in cosponsoring this important legislation to ensure that all of our seniors, no matter where they live, whether they live in big cities, in suburbs, or the smallest communities, continue to have access to quality home health services.