Statements on Introduced Bills and Joint Resolutions

Floor Speech

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Ms. COLLINS. Mr. President, I rise today with my colleague from
Washington to introduce the Preserve Access to Rural Home Health
Services Act of 2015 to extend the modest increase in payments for home
health services in rural areas that otherwise will expire on January 1
of next year.

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 caregivers provide have
enabled millions of our most frail and vulnerable older and disabled
citizens to avoid hospitals and nursing homes and stay just where they
want to be--in the comfort, privacy, and security of their own homes. I
have accompanied several of Maine's caring home health nurses on their
visits to patients and have seen first hand the difference that they
are making for patients and their families.

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. Because of the
longer travel times, rural caregivers are unable to make as many visits
in a day as their urban counterparts. For example, home health care
agencies in Aroostook County in Northern Maine, where I am from, cover
almost 6,700 square miles, with an average population of less than 11
persons per square mile. These agencies' costs are understandably much
higher than other agencies located in more urban areas due to the long
distances the staff must drive to see clients. Moreover, the staff is
not able to see as many patients due to time on the road.

Agencies serving rural areas are also frequently smaller than their
urban counterparts, which means that their relative costs are higher.
Smaller agencies with fewer patients and fewer visits mean that fixed
costs, particularly those associated with meeting regulatory
requirements, are spread over a much smaller number of patients and
visits, increasing overall per-patient and per-visit costs.

Moreover, in many rural areas, home health agencies are the primary
caregivers for homebound beneficiaries with limited access to
transportation. These rural patients often require more time and care
than their urban counterparts and are understandably more expensive for
agencies to serve. If the extra three per cent rural payment is not
extended, agencies may be forced to make decisions not to accept rural
patients with greater care needs. That could translate into less access
to health care for ill, homebound seniors. The result would likely be
that these seniors would be hospitalized more frequently and would have
to seek care in nursing homes, adding considerable cost to the system.

Failure to extend the rural add-on payment would only put more
pressure on rural home health agencies that are already operating on
very narrow margins and could force some of the agencies to close their
doors altogether. If any of these agencies were forced to close, the
Medicare patients in that region could lose all of their access to home
care.

The legislation we are introducing today will extend the rural add-on
for 5 years and help to ensure that Medicare patients in rural areas
continue to have access to the home health services they need.
Moreover, we would offset costs of the bill by reducing the home health
outlier fund by .25 percent over the same 5 years. I urge our
colleagues to join us as cosponsors.

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