Most seniors want to live in their own homes for as long as possible. While home care may not be the right for everyone, it certainly is an option for many older Americans. To remain at home and age in place, seniors must have access to the appropriate services and resources. Providing them with home health care makes sense and is often less expensive than nursing homes or assisted living facilities.

For many years, Medicare has provided a home health benefit. Unfortunately, as a cost-saving measure, the reimbursement rate for home care was dramatically reduced by the 1997 Balanced Budget Act. The across-the-board reductions forced many Maryland home care agencies to close, and reduced access to services for many of our seniors.

At the beginning of the 108^th Congress, I introduced the Medicare Payment Restoration and Benefits Improvement Act to increase payments to home care agencies and provide an additional 10% payment for services provided in rural areas. In the House, a bipartisan group of 290 members joined me in urging Speaker Dennis Hastert to improve reimbursement rates for home care. Although the recently enacted Medicare prescription drug bill (HR 1) increased payments for rural home care services, it reduced reimbursement for non-rural areas across the country over the next three years.

Also of concern is access to outpatient rehabilitative services, which is often key to remaining at home. Millions of seniors depend on outpatient rehabilitation therapy to restore mobility after an injury or illness. Unfortunately, as a cost-saving measure, the 1997 budget act also imposed an arbitrary $1,500 annual payment cap on the following services: physical therapy, speech-language therapy, and occupational therapy.

Studies show that one-in-10 Medicare patients who receive outpatient therapy exceed $1,500 in expenses each year. Many seniors with serious conditions must either pay out-of-pocket for their care, or return to more costly hospital treatment.

To permanently eliminate these caps, I have introduced the Medicare Access to Rehabilitation Services Act. It would require Medicare to pay for outpatient therapy based on the patient’s condition not on financial considerations. This bipartisan bill has been cosponsored by more than two-thirds of the House. In December, Congress imposed a two-year moratorium, through Dec. 31, 2005, on the implementation of these caps. I will continue my efforts to have these caps permanently eliminated.

In addition to access and affordability, quality is another important consideration for seniors who want to stay in their homes. The Center the Medicare and Medicaid Services (CMS) has introduced a new publication, Medicare and Home Health Care, to help seniors understand their benefits. It is available on-line at www.medicare.gov under "Publications," or by calling 1-800-633-4227. The Medicare web site also features a new resource called Home Health Compare, which includes specific measures of quality for Medicare-certified home care agencies. This comparison can help seniors make better informed decisions about providers in their area.

Many seniors will need careful coordination of resources and services in order to continue to live independently. This can be well worth the effort because home care can improve quality of life and save money. Congress’ role must be to encourage quality, reward efficiency, and reimburse appropriately so that access to home care services remains available to our seniors.

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