Home Health Care Access Protection Act of 2010

Mr. President, I rise today to join with my colleague from Wisconsin in introducing legislation, the Home Health Care Access Protection Act of 2010, to prevent future unfair administrative cuts in Medicare home health payment rates.

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 helped to keep families together and enabled millions of our most frail and vulnerable older and disabled persons to avoid hospitals and nursing homes and stay just where they want to be--in the comfort and security of their own homes. Moreover, by helping these individuals to avoid more costly institutional care, they are saving Medicare millions of dollars each year.

That is why I find it so ironic--and troubling--that the Medicare home health benefit continually comes under attack.

The health care reform bill that was recently signed into law by the President includes $40 billion in cuts to home care over the next ten years. Moreover, these cuts are a ``double-whammy'' because they come on top of $25 billion in additional cuts to home health over the next ten years imposed by the Centers for Medicare and Medicaid Services through regulation.

These cuts are particularly disproportionate for a program that costs Medicare less than $18 billion a year. This simply is not right, and it certainly is not in the best interest of our Nation's seniors who rely on home care to keep them out of hospitals, nursing homes, and other institutions.

The payment rate cuts implemented and proposed by CMS are based on the assertion that home health agencies have intentionally ``gamed the system'' by claiming that their patients have conditions of higher clinical severity than they actually have in order to receive higher Medicare payments. This unfounded allegation of ``case mix creep'' is based on what CMS contends to be an increase in the average clinical assessment ``score'' of home health patients over the last few years.

In fact, there are very real clinical and policy explanations for why the average clinical severity of home care patients' health conditions may have increased over the years. For example, the incentives built into the hospital diagnosis-related group--or DRG--reimbursement system have led to the faster discharge of sicker patients. Advances in technology and changes in medical practice have also enabled home health agencies to treat more complicated medical conditions that previously could only be treated in hospitals, nursing homes, or inpatient rehabilitation facilities.

Moreover, this unfair payment rate cut is being assessed across the board, even for home health agencies that showed a decrease in their clinical assessment scores. If an individual home health agency is truly gaming the system, CMS should target that one agency, not penalize everyone.

The research method, data and findings that CMS has used to justify the administrative cuts also raise serious concerns about the validity of the payment rate cuts. For example, while changes in the need for therapy services significantly affect the case mix ``score,'' the CMS research methodology disregards those changes in evaluating whether the patient population has changed. Moreover, the method by which CMS evaluates changes in case mix coding is not transparent, does not allow for true public participation, and is not performed in a manner that ensures accountability to Medicare patients and providers in terms of its validity and accuracy of outcomes.

The legislation we are introducing today will establish a reliable and transparent process for determining whether payment rate cuts are needed to account for improper changes in ``case mix scoring'' that are not related to changes in the nature of the patients served in home health care or the nature of the care they received. This process will still enable the Secretary of Health and Human Services to enact rate adjustments provided there is reliable evidence that higher case mix scores are resulting from factors other than changes in patient conditions. The legislation will also prevent the implementation of future Medicare payment rate cuts in home health until the Secretary is able to justify the payment cuts through the improved process set forth in the bill.

Home health care has consistently proven to be a compassionate and cost-effective alternative to institutional care. Additional deep cuts will be completely counterproductive to our efforts to control overall health care costs. The Home Health Care Access Protection Act of 2010 will help to ensure that our seniors and disabled Americans continue to have access to the quality home health services they deserve, and I encourage all of my colleagues to sign on as cosponsors.

Mr. President, I rise today to introduce the No Child Left Behind Flexibility and Improvements Act. I am pleased to be joined in this effort by my colleague from Maine, Senator Snowe. Our legislation would give greater local control and flexibility to Maine and other states in their efforts to implement the No Child Left Behind Act, NCLB, and provides common sense reforms in the statute.

Since NCLB was enacted in 2002, I have had the opportunity to meet with numerous Maine educators to discuss their concerns with the law. In response to their concerns, in March 2004, Senator Snowe and I commissioned the Maine NCLB Task Force to examine the implementation issues facing Maine under both NCLB and the Maine Learning Results. Our task force included members from every county in the State and had superintendents, teachers, principals, school board members, parents, business leaders, former state legislators, special education experts, assessment specialists, officials from the Maine Department of Education, a former Maine Commissioner of Education, and the Dean from the University of Maine's College of Education and Human Development.

After a year of study, the Task Force presented us with its final report outlining recommendations for possible statutory and regulatory changes to the act. These recommendations form the basis of the legislation that we are introducing today.

First, our legislation would provide greater flexibility to states in the ways that they demonstrate student progress in meeting state education standards. Specifically, it would permit states to use a cohort growth model, which tracks the progress of the same group of students over time. It would also permit the use of an ``indexing'' model, where progress is measured based on the number of students whose scores improve form, for example, a ``below-basic'' to a ``basic'' level, and not simply on the number of students who cross the ``proficient'' line.

Second, our legislation would provide schools with better notice regarding possible performance issues, allowing schools a chance to identify and work with a particular group of students before being identified. It would expand the existing ``safe-harbor'' provisions to allow more schools to qualify for this important protection. The changes made in our bill are in keeping with what assessment experts and teachers know--that significant gains in academic achievement tend to occur gradually and over time.

Third, our legislation would allow the members of a special education student's IEP team to determine the best assessment for that individual student, and would permit the student's performance on that assessment to count for all NCLB purposes.

One reason this change is so important for Maine is that we have small student populations and Maine has chosen a very small subgroup size--only 20 students. I was concerned to hear reports that in some schools, special education students fear that they are being blamed for their school not making adequate yearly progress. While the statute explicitly prohibits the disaggregation of student data if it would jeopardize student privacy, I am concerned to hear that this is not working out in practice.

This legislative change is also based on principles of fairness and common sense. Many times, it simply does not make sense to require a special needs student to take a grade-level assessment that everyone knows he or she is not ready to take. Many special education students are referred for special education services precisely because they cannot meet grade-level expectations. Allowing the IEP team to determine the best test for each special student will bring an important improvement to the Act while still ensuring accountability.

Fourth, the legislation addresses my concern about the statute's current requirement that all schools reach 100 percent proficiency by 2013-2014. Our bill would require the Secretary of Education to review progress by the states toward meeting this goal every three years, and would allow him to modify the time-line as necessary.

Fifth, our legislation would provide new flexibility for teachers of multiple subjects at the secondary school level to help them meet the ``highly qualified teacher'' requirements. Unfortunately, the current regulations place undue burdens on teachers at small and rural schools who often teach multiple subjects due to staffing needs, and on special education teachers who work with students on a variety of subjects throughout the day. Under the bill, provided these teachers are highly qualified for one subject they teach, they will be provided additional time and less burdensome avenues to satisfy the remaining requirements.

Our legislation is a comprehensive effort to provide greater flexibility and common sense modifications to address the key NCLB challenges facing Maine. Our goals remain the same as those in NCLB: a good education for each and every child; well-qualified, committed teachers in every classroom; and increased transparency and accountability for every school. I look forward to working with my colleagues on these issues during the upcoming NCLB reauthorization process.

Mr. President, today I rise to introduce a joint resolution that would renew sanctions against the Burmese junta. As in years past, I am joined in this effort by my good friend Senator Feinstein. Senators McCain, Durbin, Gregg, and Lieberman are original cosponsors of this bipartisan legislation and continue to be leaders on the issue.

Renewing sanctions against the military regime in Burma is as timely and as important as ever. Over the past year, the regime has not only made clear that it has no intention of reforming, it is also trying to stand up a new sham constitution and to legitimize itself in the eyes of the world through a sham election. In my view, the United States must deny the regime that legitimacy.

By way of background, a little history is in order. For nearly half a century, Burma has been under some kind of military rule, and every popular effort to reverse that situation has failed. In 1988, military authorities violently put down a popular uprising. Two years later, the Burmese people went to the polls and handed an overwhelming victory to the prodemocracy opposition, and the junta ignored the results. It never seated these popularly elected candidates. It jailed prodemocracy leaders, such as Aung San Suu Kyi, and it has maintained its brutal rule ever since.

In response to these events, the United States established on a bipartisan basis various sanctions against the Burmese regime. These include a 1997 Executive order; the annual import ban, which has been renewed annually since 2003; and restrictions on Burmese jade, which were enacted in 2008.

On a number of occasions since 1990, the United States and the U.N. have attempted to engage Burma diplomatically. These include, during the Clinton administration, a delegation led by Deputy Assistant Secretary of State Thomas Hubbard; various efforts by former U.S. Ambassador to the U.N. Madeleine Albright; and two trips to Burma by then-Congressman Bill Richardson in the mid-1990s.

Other diplomatic efforts included Assistant Secretary of State Christopher Hill's ``roadmap'' in 2006, and overtures made by the United States through China in 2007. In 2008, ADM Timothy Keating met with Burmese officials as part of United States efforts to provide humanitarian assistance in the wake of Cyclone Nargis.

The U.N., for its part, has dispatched a human rights envoy to Burma 15 times and special envoys 26 times over the past two decades. U.N. Secretary General Ban Ki-Moon has visited Burma on two occasions.

None of these efforts has yielded anything in the way of reform. Indeed, when Burmese citizens, led by Buddhist monks, took to the streets in peaceful protest against the government and its policies in the fall of 2007, these prodemocracy protesters, much like their predecessors, were brutally suppressed.

Nonetheless, the regime has sought at various times to save face internationally. In response to this last major challenge to its authority in the fall of 2007, for example, the regime unveiled a proposed constitution. But a quick look at the document shows that it could scarcely have been less democratic. It precluded Suu Kyi from participating in the electoral process and ensured that the charter may not be amended without the military's blessing. The noted constitutional law professor, David Williams, of Indiana University, told the Senate Foreign Relations Committee last year it was ``one of the worst constitutions [he had] ever seen.''

What is more, the vote to adopt this constitution took place 2 years ago in the immediate aftermath of Cyclone Nargis, the worst natural disaster in modern Burmese history, and international election observers were not permitted access to the country during the vote. If the regime was interested in legitimacy, holding a vote such as this in the middle of a natural disaster without election observers is not exactly the way to do it.

The results of this vote were roundly condemned, and for good reason. Still, despite widespread condemnation of this constitution and the circumstances surrounding its adoption, some held out hope that a subsequent election law might lead to democratic reform. But those hopes were dashed earlier this year when the regime actually issued the long-awaited election law. Among other things, the law would force the democratic opposition, the National League for Democracy, to expel Suu Kyi if the party chose to enter any of its candidates in the upcoming national election and it forbids political prisoners and Buddhist monks from political participation.

The deadline for registering candidates and political parties under the new law is later this week, and parties that fail to register before then will be deemed illegal. In other words, the law's practical effect would be to sideline Burma's most prominent democratic reformer and force its leading opposition party out of business.

We also get periodic press reports of ties between Burma and North Korea, including a particularly alarming report in recent days about an alleged weapons transfer from Pyongyang.

Last year, the Obama administration initiated a review of United States policy with respect to Burma. As a result of that review, the administration decided it is time for the United States to take another run at engaging the regime. That is why last summer Secretary Clinton reportedly proposed to

her Burmese counterpart at an international conference in Southeast Asia that the United States remove its investment ban on Burma in exchange for the unconditional release of Suu Kyi. Whatever the merits of this overture, this was a serious offer from a high ranking U.S. official aimed at improving bilateral relations.

Yet not only was Secretary Clinton's offer ignored and Suu Kyi not freed, the regime actually extended Suu Kyi's detention for another year and a half, and several months later, the junta denied her appeal. It was shortly after that that the regime released the antidemocratic election law I just referred to. So however well intentioned, the administration's policy of engagement has, unfortunately, met with the same fate as earlier engagement efforts, notwithstanding the fig leaves the regime occasionally holds out as supposed proof of its willingness to reform.

Clearly, the regime craves legitimization of its rule. Why else would it suddenly move to finalize the constitution it had been working on intermittently for 14 years after its rule was challenged by the nonviolent Saffron Revolution in the fall of 2007? They did it for the same reason they trotted out a transparently flawed election law earlier this year: They wanted to provide the appearance of reform where there was none. But they cannot have it both ways. If the regime wants legitimization, it must show real progress.

Secretary Clinton's policy review toward Burma concluded

that engagement along with sanctions might produce results

where sanctions alone had failed. Although we have yet to see

any positive results from engagement, the administration

itself concedes that sanctions should remain in place. But

the administration, to its credit, has been quite candid

about the lack of tangible progress by the regime.

Assistant Secretary of State Kurt Campbell acknowledged as much after the release of the Burmese election law. He said:

[T]he U.S. approach was to try to encourage domestic

dialogue between the key stakeholders . . . and the recent

promulgation of the election criteria doesn't leave much room

for such a dialog.

It should be noted parenthetically the absence of any tangible result from engagement has nothing to do with the work of American diplomats. It has everything to do with the type of regime we are dealing with in Burma. But, again, the fact remains that no progress--none--has been made.

Legitimacy is the one thing the regime cannot impose by force. But if legitimacy is what it wants, a first step would be credible elections. At this point there is no reason to believe that is even possible under the current constitution, under the current election law, and in the current political climate in Burma.

Renewing sanctions is important because it denies the junta the legitimacy it so craves. A sanctions regime says to the junta and the world, in no uncertain terms, the United States does not view this government as having the support of its citizens. It says the United States will not be a party to recognizing the junta's attempts to overturn the democratic elections of 1990, the last true expression of the Burmese voters.

Sanctions should remain in place against the junta for the same reason the term ``Burma'' is used by friends of democracy instead of the junta's chosen name of ``Myanmar''--because Myanmar is the name of a government that has not been chosen by its people.

In short, sanctions should remain in place because lifting sanctions would give the regime precisely what it wants; namely, legitimacy.

I strongly urge my colleagues to support sanctions renewal against the Burmese regime.

I thank my friend from Connecticut.

Mr. President, I ask unanimous consent that the text of the joint resolution be printed in the Record.

Mr. President, I rise today once again with Senator McConnell to introduce a joint resolution renewing the ban on all imports from Burma for another year.

We are proud to be joined by Senators McCain, Durbin, Gregg, and Lieberman and we look forward to swift action by the Senate, House, and the President on this important matter.

Now, more than ever, the people of Burma need to know that we stand by them and support their vision of a free and democratic Burma.

On May 6th, the National League for Democracy, NLD, led by Nobel Peace Prize Laureate and political prisoner Aung San Suu Kyi, will cease to exist.

Let me be clear: the NLD is not shutting down out of its own free will.

It is being forced to disband by an unjust and undemocratic constitution and election law, both drafted in secret and behind closed doors by the ruling military junta, the State Peace and Development Council, SPDC, to solidify its grip on power.

Let me explain.

Under the terms of the new constitution, 25 percent of the seats must be set aside for the military.

Think about that: before any vote has been cast, the military is guaranteed a quarter of the seats in the new 440 member House of Representatives.

How will this new institution be any different from the current military regime?

If that is not enough to raise doubts about the military's commitment to a truly representative government, it should also be pointed out that last week the regime's Prime Minister, Thein Sein, and 22 cabinet ministers resigned from the army to form a new ``civilian'' political party, the Union Solidarity and Development Party.

Any seats won by this new ``party'' in the upcoming elections will be in addition to the 25 percent set aside for active military members.

Does anyone really believe the regime has embraced democracy and the concept of civilian rule? Unfortunately, it will be business as usual for the people of Burma and the democratic opposition.

What about Suu Kyi and her National League of Democracy, winners of the last free parliamentary elections in 1990?

First, last month, the regime, which never allowed the NLD to assume power, officially annulled its 1990 victory.

Second, under the new constitution, as a convicted ``criminal'' Suu Kyi is barred from running in the elections.

Finally, under the terms of the election law, in order to participate in the upcoming parliamentary elections and remain legally active, a political party has to cut ties with any members who are convicted criminals.

Thus, the NLD had to either kick Suu Kyi out of the party and participate in the elections or face extinction.

It should come as no surprise that the NLD refused to turn its back on Suu Kyi and give its stamp of approval to the regime's sham constitution and electoral law.

I applaud their courage and their devotion to democracy, human rights, and the rule of law.

While I am saddened to see the regime close its doors, the spirit and the principles of the NLD will live on in the hearts and minds of the people.

I know they will one day be able to elect a truly representative government.

As Tin Oo, the NLD's deputy leader and former political prisoner said: ``We do not feel sad. We have honor. One day we will come back; we will be reincarnated by the will of the people.''

This is a clear message to the regime that an illegitimate constitution and election law cannot suppress the unyielding democratic aspirations of the people of Burma.

Now, we must send our own signal to the regime that its quest for legitimacy has failed.

We must send our own signal to the democratic opposition that we stand in solidarity with them and we will not abandon them.

Now is the time to renew the import ban on all products from Burma for another year.

Let me be clear--I am disappointed that the ban has not moved Burma any closer to national reconciliation and a democratic government.

Indeed, as I have noted, the regime has taken several steps in the wrong direction.

But we have the opportunity to review these sanctions every year.

Last year we passed legislation allowing the sanctions to be renewed, once a year, for up to three more years until 2012.

Simply put, if we fail to renew the import ban, we will reward the military regime for its decades' long record of oppression.

We will reward them for keeping the true leader of Burma, Suu Kyi, behind bars and under house arrest for the better part of 20 years.

We will reward them for forcing the National League for Democracy to close its doors.

We will reward them for 2,100 political prisoners, the use of child soldiers, the persecution of ethnic minorities, the use of rape as an instrument of war, the use of torture, the use of forced labor, and the displacement of civilians.

Indeed, the standards for lifting the sanctions are clear. The regime must make ``substantial and measureable progress'' towards ending violations of internationally recognized human rights; releasing all political prisoners; allowing freedom of speech and press; allowing freedom of association; permitting the peaceful exercise of religion; and bringing to a conclusion an agreement between the SPDC and the National League for Democracy and Burma's ethnic nationalities on the restoration of a democratic government.

By every measure, the regime has failed to even come close to meeting these conditions. So we must act to renew the import ban.

But we cannot act alone.

I urge the United Nations and the international community to follow our lead and put pressure on the regime to abandon this process, release political prisoners, and draft a truly democratic and representative constitution.

I urge my colleagues to support this joint resolution.

Mr. President, I am deeply troubled by the increasing number of sexual assaults in the U.S. military. Not only is sexual assault a crime that is incompatible with military service, but it also undermines core values, degrades military readiness, subverts good will and forever changes the lives of victims and their families.

We know from the Defense Department's 2009 Report on Sexual Assault in the Military that the number of reported sexual assaults in the military

increased substantially last year--a trend that has continued for the last couple of years.

Unfortunately, according to the Pentagon, we also know that while improvements have been made, the number of sexual assaults in the military actually reported is far below the estimated number of assaults that have actually occurred in the military. It is estimated that only 10 to 20 percent of sexual assaults in the military are actually reported.

Obviously, more needs to be done. That is why I have introduced the Defense, Sexual Trauma Response and Good Governance, STRONG Act of 2010. This legislation builds on many of the common sense solutions that were included in the December 2009 Report on Sexual Assault in the Military, a report from the Defense Task Force on Sexual Assault in the Military Services.

The Defense STRONG Act of 2010 would guarantee legal counsel from a Judge Advocate General to all sexual assault victims, whether or not they file restricted or unrestricted reports. Currently, anyone who files a restricted report cannot seek legal counsel. Seeking legal counsel triggers an investigation, which, in turn, makes that report unrestricted--that is, it is no longer confidential and the chain of command is notified.

A directive issued by the Department of Defense in 2005 omitted Judge Advocate Generals and civilian lawyers trained in military law from the list of individuals that a victim can seek guidance and assistance from. The only individuals on the list are Sexual Assault Response Coordinator's, SARCs, Victim Advocates, VAs, health care personnel, and chaplains--none of whom are likely to have legal training. But it is my belief that the victim of a sexual assault should have the right to legal counsel no matter what.

In its report, the Defense Task Force on Sexual Assault in the Military Services also found that victims are not offered appropriate privileged communications. The report noted that there are 35 states that currently have a privilege for communications between Victim Advocates and victims of sexual assault. However, because no privilege exists in military proceedings, defense counsel are able to identify Victim Advocates as a potential defense witness in a court-martial. There have been multiple occasions in which information was obtained from Victim Advocates in court-martial proceedings and used to try to undermine the credibility of a victim with cross examinations highlighting inconsistencies in prior statements.

There are certain roles that I believe are inherently governmental and certainly one is the role of Sexual Assault Response Coordinator, which should be filled by either a uniformed servicemember or a DoD civilian employee, not a contractor. The Defense Task Force on Sexual Assault in the Military Services agreed. So this legislation would require one Sexual Assault Response Coordinator per brigade, filled by either a full-time military servicemember or a DoD civilian employee.

Moreover, this legislation also would require that Victim Advocates be either a uniformed servicemember or a DoD civilian employee. At the battalion level, there are usually two part time Victim Advocates. The Defense STRONG Act would require that there be at least one-full time Victim Advocate at each battalion, or battalion equivalent.

Another issue that has long plagued the DoD's ability to adequately respond to and prevent sexual assaults in the military is the lack of standardization amongst the services. The Defense STRONG Act would require the DoD to standardize much of their certification programs in a manner modeled after the Defense Equal Opportunity Management Institute, training Sexual Assault Response Coordinators as well as Victim Advocates. Standardization and professionalization would drastically impact readiness.

This legislation would also require the Department of Defense to develop modules specific to each level of Professional Military Education. By doing so, we could ensure that military leadership is aware of all available resources. This provision would also encourage the Department of Defense to craft each level of Professional Military Education to the level of responsibility as military leadership get promoted.

Elevating the Director of the Sexual Assault Prevention and Response Office to the Senior Executive Service level was another recommendation put forth by the Defense Task Force Report. A senior leader in this office is necessary in order to obtain resources and provide the attention this issue requires, much like the Defense Military Equal Opportunity Office and the Office of Military and Community Family Policy. Leadership at the senior level has already proven instrumental in helping advance the DoD's efforts in overcoming domestic violence and discrimination and could be just as helpful in combating sexual assaults.

While there is no magic formula for solving a problem that has long plagued the Department of Defense, I believe these provisions will strengthen the DoD's ability to respond to cases of sexual assault and prevent future cases from occurring.

Mr. President, I rise today to join with my colleague from Wisconsin in introducing legislation, the Home Health Care Access Protection Act of 2010, to prevent future unfair administrative cuts in Medicare home health payment rates.

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 helped to keep families together and enabled millions of our most frail and vulnerable older and disabled persons to avoid hospitals and nursing homes and stay just where they want to be--in the comfort and security of their own homes. Moreover, by helping these individuals to avoid more costly institutional care, they are saving Medicare millions of dollars each year.

That is why I find it so ironic--and troubling--that the Medicare home health benefit continually comes under attack.

The health care reform bill that was recently signed into law by the President includes $40 billion in cuts to home care over the next ten years. Moreover, these cuts are a ``double-whammy'' because they come on top of $25 billion in additional cuts to home health over the next ten years imposed by the Centers for Medicare and Medicaid Services through regulation.

These cuts are particularly disproportionate for a program that costs Medicare less than $18 billion a year. This simply is not right, and it certainly is not in the best interest of our Nation's seniors who rely on home care to keep them out of hospitals, nursing homes, and other institutions.

The payment rate cuts implemented and proposed by CMS are based on the assertion that home health agencies have intentionally ``gamed the system'' by claiming that their patients have conditions of higher clinical severity than they actually have in order to receive higher Medicare payments. This unfounded allegation of ``case mix creep'' is based on what CMS contends to be an increase in the average clinical assessment ``score'' of home health patients over the last few years.

In fact, there are very real clinical and policy explanations for why the average clinical severity of home care patients' health conditions may have increased over the years. For example, the incentives built into the hospital diagnosis-related group--or DRG--reimbursement system have led to the faster discharge of sicker patients. Advances in technology and changes in medical practice have also enabled home health agencies to treat more complicated medical conditions that previously could only be treated in hospitals, nursing homes, or inpatient rehabilitation facilities.

Moreover, this unfair payment rate cut is being assessed across the board, even for home health agencies that showed a decrease in their clinical assessment scores. If an individual home health agency is truly gaming the system, CMS should target that one agency, not penalize everyone.

The research method, data and findings that CMS has used to justify the administrative cuts also raise serious concerns about the validity of the payment rate cuts. For example, while changes in the need for therapy services significantly affect the case mix ``score,'' the CMS research methodology disregards those changes in evaluating whether the patient population has changed. Moreover, the method by which CMS evaluates changes in case mix coding is not transparent, does not allow for true public participation, and is not performed in a manner that ensures accountability to Medicare patients and providers in terms of its validity and accuracy of outcomes.

The legislation we are introducing today will establish a reliable and transparent process for determining whether payment rate cuts are needed to account for improper changes in ``case mix scoring'' that are not related to changes in the nature of the patients served in home health care or the nature of the care they received. This process will still enable the Secretary of Health and Human Services to enact rate adjustments provided there is reliable evidence that higher case mix scores are resulting from factors other than changes in patient conditions. The legislation will also prevent the implementation of future Medicare payment rate cuts in home health until the Secretary is able to justify the payment cuts through the improved process set forth in the bill.

Home health care has consistently proven to be a compassionate and cost-effective alternative to institutional care. Additional deep cuts will be completely counterproductive to our efforts to control overall health care costs. The Home Health Care Access Protection Act of 2010 will help to ensure that our seniors and disabled Americans continue to have access to the quality home health services they deserve, and I encourage all of my colleagues to sign on as cosponsors.