indicates a current co-signer
Dear Colleague:
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.
We are therefore particularly concerned about the new copayments for home health services that are proposed in the House-passed Medicare bill. The average senior spends 22 percent of his or her income on health care. Those in poor health spend 44 percent and low-income women over 85 spend 52 percent. A home health copayment of $40 to $50 per episode would impose a significant additional burden on those Medicare beneficiaries who can least afford it and would create a slippery slope to even higher copayments in the future.
The House bill, H.R. 1, not only includes a new home health copayment, but it also cuts the home health market basket update by 0.4 percent and provides for just a 5 percent rural add-on. In contrast, the Senate bill, S. 1, includes no copayments, a full market-based update, and restoration of the full 10 percent add-on payment for home health services in rural areas. 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. Extension of this add-on payment will therefore help to ensure that Medicare patients in rural areas continue to have access to the home health services that they need.
Medicare home health expenditures have been cut by nearly 40 percent since the enactment of the Balanced Budget Act of 1997. This includes the 7 percent across-the-board cut in home health benefits that went into effect last October, and the loss of the 10 percent rural add-on payment in April of this year. The CBO now projects that Medicare home health expenditures for FY 2003 will be $9.8 billion, down from $10 billion in the previous year. This equates to a minus 2 percent rate of growth in home health this year.
We are concerned that any further cuts in the Medicare home health benefit simply cannot be sustained without affecting patient care, particularly for those Medicare beneficiaries with complex care needs. As we work to reach final agreement on a Medicare bill, we must ensure that the home health benefit remains a strong and viable option under the Medicare program. We therefore urge that you join us in cosigning the attached letter to the Medicare conferees urging that they adopt the home health provisions that were included in the Senate-passed bill.
Please call Priscilla Hanley in Senator Collins’ office (4-9223), Lisa German in Senator Reed’s office (4-4642), Kara Vlasaty in Senator Bond’s office (4-5721) or Shannon Lightner in Senator Feingold’s office (4-5323) if you have any questions or would like to cosign the letter.
Sincerely
Senator Susan Collins
United States Senate
Senator Jack Reed (D-RI)
United States Senate
Senator Kit Bond (R-MO)
United States Senate
Senator Russ Feingold (D-WI)
United States Senate
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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 where they want to be – in the comfort and security of their own homes.
We are concerned about the new copayments for home health services that are proposed in the House-passed Medicare bill. The average senior spends 22 percent of his or her income on health care. Those in poor health spend 44 percent and low-income women over 85 spend 52 percent. Patients using the Medicare home health benefit must already pay the Part B deductible; a 20 percent copayment for a physician to prescribe and oversee the home health plan of care; and, for those coming from a hospital or skilled nursing facility (SNF), the Part A deductible and SNF coinsurance. Many must also pay 20 percent coinsurance for home medical equipment. Others must pay for personal assistance with activities of daily living, respite care, and other non-covered services to remain independent. A home health copayment of $40 to $50 per episode would impose a significant additional burden on those beneficiaries who can least afford it and would create a slippery slope to even higher copayments in the future.
The House bill, H.R. 1, not only includes a new home health copayment, but it also cuts the home health market basket update by 0.4 percent and provides for just a 5 percent rural add-on. In contrast, the Senate bill, S. 1, includes no copayments, a full market-basket update, and restoration of the full 10 percent add-on payment for home health services in rural areas. 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. Extension of this add-on payment will therefore help to ensure that Medicare patients in rural areas continue to have access to the home health services they need.
Medicare home health expenditures have been cut by nearly 40 percent since the enactment of the Balanced Budget Act of 1997. This includes the 7 percent across-the-board cut in home health benefits that went into effect last October, and the loss of the 10 percent rural add-on payment in April of this year. The Congressional Budget Office now projects that Medicare home health expenditures for FY 2003 will be $9.8 billion, down from $10 billion in the previous year. This equates to a minus 2 percent rate of growth in home health this year.
As a consequence of the cutbacks in Medicare home health, over 3,400 home health agencies nationwide have either closed or stopped serving Medicare beneficiaries. Moreover, the number of Medicare patients receiving home health care nationwide has dropped by 1.3 million – more than one-third. Which points to the central and most critical issue – cuts of this magnitude simply cannot be sustained without ultimately affecting patient care.
We are concerned that any further cuts in the Medicare home health benefit simply cannot be sustained without affecting patient care, particularly for those Medicare beneficiaries with complex care needs. As we work to reach final agreement on a Medicare bill, we must ensure that the home health benefit remains a strong and viable option under the Medicare program. We therefore respectfully request that the Senate and House conferees adopt the home health provisions that were included in the Senate-passed bill.
Thank you for your consideration, and we look forward to working with you to ensure that elderly and disabled Americans continue to have access to quality home health services.