Medicare Home Health Flexibility Act of 2017

Mr. President, today I rise to address the important urgency of addressing climate change. Across the country, we are seeing the impacts of the warmer climate, and it is having devastating consequences on our forests, on our farming, on our fishing, and on our urban populations.

Years ago, people talked about what we might see if we continued to burn fossil fuels and continued to put carbon dioxide into the air, but no longer do we have to talk about what we might see, because it is here. The facts are on the ground right now.

We can look at my home State of Oregon. In Oregon, we have the challenge of forest fire seasons that are longer by several months than they were just decades ago. We have the challenge of warmer winters, resulting in pine beetles doing more damage to our trees. The fact that we have lower snowpacks in the Cascade Mountains means warmer trout streams and less water for irrigation. We have had the worst-ever droughts in the Klamath Basin in the past 15 years. Over on the coast, we have a big impact on oysters. Because we have burned so much in fossil fuels to create so much carbon dioxide that has been absorbed by the oceans and turned into carbonic acid, the oceans have acidified. They are 30 percent more acidic than they were 150 years ago, meaning our oysters are having trouble reaching out and pulling the molecules out of the water to form a shell. In fact, it takes so much energy to do so that they are dying.

That is what is happening. That is just in Oregon. We can look across the United States and see impact after impact.

If we were in Minnesota, we could talk about the tick populations that are killing the moose because it is not cold enough in the winter to kill the ticks. If we are in Maine, we can talk about the fact that the lobsters are migrating to Canada because that is where the colder waters can be found. If we are in Florida, we can talk about sunny day floods, because the ocean levels have risen and the ocean water--the saltwater--is contaminating the freshwater that cities depend on. If we are up the Atlantic coast, we can talk about Hurricane Sandy and how its devastating power was enhanced by an ocean that is much warmer than it was decades ago. If we are in Texas, we can talk about the spread of mosquitoes that carry the Zika virus affecting folks. So the list goes on and on. But it is not just in the United States of America. It is on the entire planet.

As we are talking about oysters on the west coast of the United States, across the globe folks are talking about coral reefs. The Great Barrier Reef has virtually died over the last few years. Scientists say 80 percent of the Great Barrier Reef off Australia has died in the last 3 years. If we are looking at the mountainous regions of the world, you can trace the flow of glaciers and find that across the globe glaciers have diminished by an enormous amount. Some say that if you

want to see a glacier in Glacier National Park, you better get there soon. That is just in the United States.

If we turn north to the upper reaches of Canada and the permafrost, you can visit what are called the drunken forests, because the permafrost is melting and the trees are starting to lean in every which direction. If you turn to Alaska, you are finding that Native populations are having to relocate because of changing circumstances of a warmer Alaska.

Go to the Arctic Ocean and what you see is a massive amount of missing ice, and, because that ice is missing, the ocean is absorbing more energy from the sun, and it is creating a feedback loop that is having further devastating consequences. And so the list goes on and on.

It is not just time to address climate change boldly. It is time to address it aggressively. It is time for 100 by 50. What that means is 100 percent clean and renewable energy to power the economy by the year 2050 and the steps to get there in between and to have 50 percent of our energy clean and renewable by the year 2030. That is not far away. That is just 13 years away, and for 2050, add another 20 years.

We have to act quickly because right now human civilization is failing the test. Our responsibility is to stop burning fossil fuels and to stop putting carbon dioxide into the atmosphere. That is why we have to rapidly transition from an energy economy based on fossil fuels to one based on clean and renewable energy.

Why do I say we are failing the test at the moment? We are failing the test because if you look at the flow of carbon dioxide into the atmosphere from human civilization, the rate of carbon dioxide pollution has not leveled out. In fact, the speed of pollution and the amount of pollution per year is increasing. So we have a tremendous challenge ahead of us. We have to take and not only reduce the amount but reduce it enormously in a short period of time.

Now some say this vision is too bold. Some say this vision is too difficult, that it is too hard. It makes me think of President Kennedy's call. He said decades ago:

We choose to go to the moon in this decade and do other

things, not because they are easy, but because they are hard.

Because that challenge is one that we are willing to accept,

one we are unwilling to postpone, and one which we intend to

win.

I tell you today that we must, as a Nation, be willing to accept the challenge of transforming our energy economy. We must be unwilling to postpone tackling this challenge of transforming our energy economy, and this challenge is one where we must be committed to winning. It is not just time. It is way past time.

I came to the Senate floor last September to lay out the concept of 100 by 50--100 percent clean, renewable energy by 2050. I come today to the Senate floor to say that today a group of Senators are introducing a bill to lay out a roadmap to get there.

Just as President Kennedy laid out the vision of putting an American on the moon, NASA went to work and laid out a plan on how we would get there. They didn't know at first how it would be done. They hadn't proceeded to invent the staged rocket that would enable someone to escape the gravity of Earth in a fashion to get us to the moon. They didn't know how to create a lunar landing operation to put people safely on the planet surface. They weren't even sure of the composition of the surface of the moon, but they figured it out. They put forward a draft. They reworked that draft.

Today we are putting forth a roadmap. I thank my colleagues who are standing with me today to be the original cosponsors: Senator Bernie Sanders of Vermont, Senator Ed Markey of Massachusetts, and Senator Cory Booker of New Jersey. I know other colleagues will join us as time progresses, but it is important not to wait until we have, if you will, a large population to begin the conversation--a large set of sponsors to begin the conversation of laying out a roadmap. It is important to lay it out now. It is important to lay it out now because it is a statement of values. It is important to lay it out now so that there is a vision that can be discussed--a detailed vision of how to take on different sectors of the energy economy that can be discussed and debated.

So we are focused not on whether to get to 100 by 50, but on how we are going to get to 100 by 50. I invite and encourage that debate because each of us can envision a roadmap that is slightly different. So let's have that conversation, but let's not forget the importance of getting to this destination--100 percent clean, renewable energy--and getting thereby the year 2050.

Yes, it is audacious when you think about how we use energy today, to think about how we can transform it in just a few decades, but we have many of the tools we need right now. With focused research and development, we can add the other tools that we need.

Let us not fail to accept this challenge, because our planet is crying out in anguish. In addition to the facts on the ground that I have been mentioning, we can simply take the temperature of the planet. Month after month after month, year after year, in the past 2 years we have been setting new records for having the hottest month--not the hottest month in Washington, DC, not the hottest month in the United States of America but the hottest March in the history of the planet, the hottest April since we have been measuring the temperature of the planet--May, June, and so on and so forth.

So the time for conversing about whether we have a problem is over. Now is the time to say how we will achieve this vision.

One important element of achieving this vision is greening the grid. That means that we need to phase out electricity that is generated by fossil fuels. We need to invest in clean and renewable energy that puts green electrons in the grid instead, and we need to advance and develop the deployment of technologies that contribute to this, including high- voltage transmission lines that will move energy between different parts of the United States. We certainly need to develop the ability to store electricity and to use automated demand management and automated supply management so we can match the supply of green energy to the demand at different times of the day or just the demand of different times of the day to make renewable energy fit to the operation of the economy.

Now, we have some specific powerful gifts in this effort. One is that we have a dramatically declining cost of solar energy. A second is that we have a dramatically declining cost in wind energy. A third is that we have a dramatically declining cost of battery storage. This isn't an accident. This has happened because of the innovation economy where these ideas were developed and promoted and researched and advanced right here in the United States of America. But it really helps change the conversation. There have been many who are deeply invested in the fossil fuel world who would like to say that advancing to a clean and renewable energy economy will hurt the economy. But now we are coming to the point that it is less expensive to generate renewable energy than to generate fossil fuel energy. The fact is that we can create a tremendous number of jobs as we rebuild this energy economy.

If we turn specifically to the issue of a Federal emissions vehicle standard--because that is one of the pieces of this puzzle--it means that we have to make national investments in electrical recharging stations along our roads and highways to support these vehicles. There are already half a million plug-in electric vehicles on our roads today, and these vehicles--these cars--are becoming cheaper as the numbers continue to grow.

One of the factors that is enabling the car to become cheaper is the dropping cost of lithium in the batteries that power them. They are getting smaller, lighter, and cheaper. So in the same space you can put more energy with less weight to drive cars further. Since 2008, the cost of these batteries per kilowatt hour has fallen fourfold. They will continuously grow. Having more of these cars on our roads and our highways as the costs keep falling, it is vital that we have an infrastructure in place to support them.

We need to ensure that everyone is part of this clean and renewable energy resolution, including low-income and disadvantaged communities. We addressed that in the 100 by 50 legislation. To do this, we established grants

to bring affordable clean energy and energy efficiency to individuals' homes and communities. We invest in zero emission public transportation that is affordable and accessible. We also want to ensure that no workers are left behind in this transformation, especially the workers in the fossil fuel industry. That is why we need to provide a just transition for those workers and job training programs. We need to have a strategy to ensure that there are opportunities to move from jobs in the fossil fuel world to positions in the clean and renewable energy industry. Those industries are, in fact, booming, with jobs in solar and wind growing 12 times faster than the rest of the U.S. economy. Already, the number of clean and renewable industry jobs has surpassed those in the fossil fuel industry by a margin of 5 to 1.

We want to enable everyone to have the skills they need to succeed in these emerging industries, but to move to this future, we must come to a point at which we stop investing in new fossil fuel infrastructure. We cannot proceed to make this pivot quickly to a cleaner, brighter, renewable future if we continue to tie ourselves and our government to a fossil fuel-powered past. To achieve this clean break, the 100 by 50 Act ends future fossil fuel investments at the Federal level. That would affect projects similar to the Keystone XL Pipeline and the Dakota Access Pipeline, and we would end the tax subsidies for the fossil fuel industry.

This burning of fossil fuels is destroying our planet. We must stop subsidizing the destruction of our planet. This burning of fossil fuels is destroying our forests, which our rural communities depend on. We must stop subsidizing the destruction of our forests. The burning of these fossil fuels is driving droughts, reducing irrigation water, and hurting our farmers. We must quit subsidizing the destruction of agriculture in America. The burning of fossil fuels is also impacting our fishing--from warmer, smaller trout streams to a fishing industry that depends on the critical ecosystem in the ocean. We must stop subsidizing the destruction of our fishing industry.

It is also important to make sure that America remains a leader in the energy economy and leads in the effort to make sure that we do not have a disadvantage with regard to manufacturing in other countries. What that means is that, with regard to countries that are not pursuing this on the same aggressive level, we need to have an effort to drive this transaction. We need to make sure that if there are additional costs, those are offset with a border tax so that we do not encourage the movement of production out of our economy here at home. We have done so with trade policy--in a massively destructive way--to the middle class of America. If we do not make things in America, we will not have a middle class in America, and we need to make sure that we do not do that in the transition of our energy economy.

To fund this plan, we propose a new source of revenue. When I say a ``new source of revenue,'' that is a little misleading because we are taking a cue from history, specifically World War II, and modeling bonds--climate bonds--on the war bonds that helped fund our fight against totalitarianism--to fund our fight against Germany and the Soviet Union. Auctioning off climate bonds is a way to raise the funds to drive the grants to power this transformation--to accelerate this transformation--and make sure that we do not leave out disadvantaged communities but, rather, bring them fully into this transition. The 100 by 50 Act is ambitious, but the circumstances require no less.

Furthermore, we cannot, simply, propose a Federal Government strategy because we live in the United States of America, where important things are done at many different levels. Here in this Chamber--right now in the U.S. Senate--we do not have a committee chair who is going to say that we need to have committee hearings in order to take on this issue. We do not have a committee chair on the House side who is going to drive this conversation. We do not have a President who understands the damage that is being done to our forests and our fishing and our farming and to our planet and who is going to lead the battle.

We have to turn to the wisdom of the American people. We have to turn to the wisdom of the States and the wisdom of the counties and the wisdom of the cities and the wisdom of individuals across America who are willing to go to the leadership of their mosques or the leadership of their temples or the leadership of their churches, who are willing to go to the leadership of nonprofits that they are a part of, who are willing to go to their city councils or their county commissions, who are willing to go to their State legislators.

They are going to say that we need to have a 100 by 50 resolution for our nonprofits, for our religious organizations, for our cities, for our counties, for our States because we need to own this issue. We Americans at every level need to own this issue. This is an issue that depends upon citizens across the globe taking hold of this in a powerful way that cannot be blocked by the dark money of the fossil fuel industry.

In so doing, by passing that 100 by 50 resolution for the city or the nonprofit or the church or the mosque or the synagogue or the temple, we will also adopt an action plan that involves the specific steps that local organizations are going to take over the next 2 to 3 years. This year, maybe they are going to convert their hot water heaters to electrons rather than burning natural gas. Maybe they are going to sign up for green electrons from their local utilities, which is an option that is offered in many places across America. The following year, maybe they are going to invest in energy-saving retrofits of their buildings. The year after that, maybe they are going to say that we have to revamp our fleet of vehicles and start using rechargeable vehicles, like the Volt or the Bolt or the LEAF or a whole set of cars that has been appearing in the economy over the last few years. One can charge them up and, thereby, run them off green electrons rather than off fossil fuels.

These are things that can be owned and done. In fact, it is already happening. It is happening with local organizations across this country that are committing themselves to 100 percent clean and renewable energy. More than 25 cities across the country have already adopted this vision--from Madison, WI, to Abita Springs, LA; from San Diego, CA, to Salt Lake City, UT; from Georgetown, TX, to Greensburg, KS-- cities that are working toward a 100 percent clean and renewable future. There are 88 major businesses that are getting in on the action as well--Walmart, Johnson & Johnson, Procter & Gamble, Nike, Coca-Cola, General Motors, and Apple. These are only a few of the major companies that have committed to powering themselves with 100 percent clean and renewable energy.

What is driving this move toward clean and renewable energy? It is that Americans everywhere are seeing the effects on the ground. They are calling for action, and community leaders and business leaders are responding. We need to respond here in the U.S. Senate. We should be holding hearings on how to put this plan into action. We should be taking the best ideas from the city actions and the business actions and the nonprofit actions from across the country and from the ideas generated on the right side of the aisle and the left side of the aisle because the destruction we face--the threat we face--is not a blue issue or a red issue; it is a human civilization issue.

America has been a driver of the technology that can transform our economy and also the technology that we can sell to the world. In adopting this vision and in fighting for this vision, America can be a leader with other nations around the world. It has been beyond strange to have other countries lecture us over the last few months to maintain our commitment as a Federal Government to this vision. Other countries are saying: America, you have to be part of the solution. You have benefited enormously from the burning of fossil fuels, perhaps more than any other economy in the world. You have one of the highest per capita footprints for carbon. You must be part of this effort because every country in the world is affected.

More than 40 countries have now adopted the vision of clean and renewable energy, so there is no time for America to step out and not be part of the solution, not be part of the leadership, not be part of the driving force, not benefit from being on the cutting edge of this transformation of the energy economy.

Just as President Kennedy laid out the vision for going to the Moon, Americans from every walk are coming together to lay out the vision for a 100 percent clean and renewable energy economy. They are adopting a framework--a time, a goal--as to where we are going and when we are getting there; 100 by 50 sums it up.

After President Kennedy laid out the vision, America went to work to make it happen, and we landed American citizens on the Moon. Now it is time for all of America to get to work and implement this vision and ensure that we succeed in transforming our energy economy within the next few decades by taking important steps every single year--driving ourselves forward, understanding the urgency, applying the technology, accelerating the implementation--to achieve 100 percent clean and renewable energy by 2050.

If there were an asteroid coming toward the Earth, we would not be talking politics or political advantage. We would all be working together to take it on--destroy it before it destroyed us. We have the equivalent of an asteroid that is coming at the Earth in global warming. The time to play politics has passed. The time to play partisanship has passed. It is time for every citizen and every organization at every level--every chair representing every Senator from every State in the Union--to come together to take on this challenge together.

I call upon my fellow Senators to be part of, perhaps, the most important effort we have to solve the biggest challenge to the health of America and the health of the planet--global warming. Step forward and be part of the effort.

Thank you, Mr. President.

Mr. President, over the past few years, the national headlines have been dominated by stories about the high cost of pharmaceuticals. We have seen jaw-dropping examples, such as the unconscionable price increase overnight by Turing Pharmaceuticals of their drug for patients with HIV, from $13.50 to $750 per pill.

Pharmaceutical companies should be compensated for their important work developing lifesaving treatments. But when companies engage in predatory practices at the expense of consumers, we must act. That is why today I am reintroducing the Creating and Restoring Equal Access to Equivalent Samples, or CREATES, Act, bipartisan legislation to end inappropriate delay tactics that are used by some brand-name drug manufacturers to block competition from more affordable generic drugs. I am glad to be joined by Senators Grassley, Klobuchar, Lee, and Feinstein, and several other Senators of both parties in introducing this bill today.

The first delay tactic addressed by the CREATES Act involves the withholding of drug samples that generic manufacturers need to gain regulatory approval. Federal law requires generic competitors to prove that their low-cost alternative is as equally safe and effective as the brand-name drug with which they wish to compete. Unfortunately, some brand-name companies are preventing generic manufacturers from obtaining the samples they need to make the necessary comparison. This simple delay tactic uses regulatory safeguards as a weapon to block competition. The FDA has reported receiving more than 100 inquiries from generic product developers who were unable to access samples of a brand-name drug to compare their generic product.

The second delay tactic addressed by the CREATES Act involves the development of shared safety protocols. For some high-risk drugs, Federal law requires a generic drug manufacturer to join the brand-name drug manufacturer in a single, shared safety protocol for distribution of the drug. Despite this requirement, some brand-name companies are refusing to negotiate shared safety protocols with potential generic competitors, again undermining those competitors' ability to gain FDA approval for their generic versions of such drugs.

The revised version of the CREATES Act also allows the FDA more discretion to approve alternative safety protocols, rather than require parties to develop shared safety protocols. Any safety protocol approved by the FDA must meet the rigorous statutory standards already in place.

These exclusionary practices thwart competition and deny consumers the benefit of lower drug prices. I share the concerns of Vermonters and Americans across the country that many prescription drugs are simply too expensive. When brand companies can artificially raise the price of drugs by using predatory practices, patients suffer. Illnesses get worse. Families, government programs, and other payers in the healthcare system ultimately bear those added, unnecessary costs.

This legislation is not a silver bullet to address all of the complex problems driving the high costs of medications. In addition to the delayed entry of generic drugs, I am troubled by the rising cost of treatments for opioid overdoses, which remain expensive for local law enforcement agencies, even though there are generic competitors. In Vermont, many patients are grappling with the extremely high cost of a new drug for hepatitis C that will likely have years of market exclusivity before generic alternatives can be made. Last year we learned the price of EpiPen had increased by almost 500 percent since 2009, now costing roughly $600 for a two-pack. The sharp increase in price combined with the relatively short shelf life of the product--1 year to 18 months--has put this lifesaving drug out of reach for many.

Think for a moment about the impact of price hikes on the family of a patient facing a life-threatening illness. Across the country, hardworking Americans feel like the system is rigged against them by corporations that are looking to make a profit at any price. With examples like Turing and Mylan, it is no wonder they feel that way.

The CREATES Act is one piece of the puzzle, addressing anticompetitive behavior that delays the creation of affordable generic drugs. Drug affordability is a bipartisan issue that affects each and every American. These reforms will make a difference. I hope other Senators will join us in supporting these bipartisan reforms.

Mr. President. Every day, Social Security provides vital benefits to millions of Americans who worked and paid into the system. To ensure workers would receive full access to these fundamental lifeline benefits, for many years, the law protected these earned benefits from attempts to recover debts. However, 20 years ago, Congress suddenly reversed course, and made a change to the law that allowed the government to cut Social Security and other hard-earned benefit payments in order to collect student loan and other federal debts, like home loans owed to the Veterans Administration, and food stamp overpayments. Now, more and more seniors are finding themselves subject to government garnishment of their already modest Social Security benefits in order to recoup student loan debts. In fact, the New York Times published an editorial recently titled, ``Haunted by Student Debt Past Age 50'' that highlighted the worsening struggle that seniors face with student debt.

Student loan debt is becoming an increasingly serious problem in Oregon and across the Nation, with students and their families burdened by crushing student loan debt. Even in the best circumstances, many families will struggle to pay off crippling loans for years to come. However, for people who rely on benefits like Social Security after retirement, disability, or the death of a family member, making payments on student loans or other Federal debts can become an insurmountable hardship.

Because of the lifeline nature of these earned benefits, for more than 40 years the law prevented all creditors from collecting hard- earned Social Security, railroad retirement, and black lung benefits to recoup debts. The only exceptions included unpaid Federal taxes, child support or alimony payments, and court-ordered victim restitution. These protections helped ensure that our social safety net programs were functioning as intended--something I think we can all agree is essential to preserving Social Security and other earned benefits.

Astonishingly, when the law changed as part of a 1996 omnibus budget bill, these changes were never fully debated in Congress. This means Members of Congress never had the chance to really explore how this policy would affect beneficiaries. The legislation ultimately included some protections for the most vulnerable, but even those protections have not been updated in 20 years.

We now realize what a profound effect the loss of these protections has had on retirees and individuals with disabilities, who often live on fixed incomes. More and more seniors and people with disabilities are having their Social Security and other lifeline benefits taken away to pay federal debts. For example, according to a GAO report, in 2004, about 8,000 seniors were living in poverty after having their benefits garnished to recover a student debt. In 2015, over 67,000 seniors were subject to garnishment for a student debt and living in poverty. Congress should restore sanity to the system, and reestablish the protections that these beneficiaries deserve.

That is why I, along with Senators Brown, Merkley, Feinstein, Hirono, Schatz, Leahy, Nelson, Whitehouse, Gillibrand, Sanders, and Warren are reintroducing the Protection of Social Security Benefits Restoration Act. The bill would restore the strong protections in the law that prevented the government from taking away earned benefits to pay federal debts, and guarantee beneficiaries will be able to maintain a basic standard of living by receiving the benefits they have earned. The bill is supported by Social Security Works, the Arc of the United States, Latinos for a Secure Retirement, Puget Sound Advocates for Retirement Action, PSARA, AFL-CIO, the Economic Opportunity Institute, the National Organization for Women, Justice in Aging, Gray Panthers NYC, Alliance for Retired Americans, the National Committee to Preserve Social Security and Medicare, Global Policy Solutions, AARP, the American Federation of Government Employees, and the International Union, United Automobile, Aerospace & Agricultural Implement Workers of America, UAW.

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

Mr. President, I wish to introduce the Medicare Home Health Flexibility Act of 2017. I am pleased that my colleague, the senior Senator from Nevada, Mr. Heller, has agreed to cosponsor this bipartisan, no-cost legislation that would allow occupational therapists to perform the initial home health assessment visit and comprehensive assessments in cases in

which occupational therapy is ordered by the physician, along with speech language pathology and/or physical therapy services, and skilled nursing care is not required. Our bill will help ensure that Medicare beneficiaries receive timely access to essential home health therapy care.

Occupational therapists have long been recognized as a valuable component of our Nation's healthcare workforce and a critical aspect of home healthcare because of their focus on patients' functional capabilities and their expertise in home safety. Physicians frequently order occupational therapy as part of an initial plan of care for patients requiring home health care, alongside the qualifying services of physical therapy, speech-language pathology, and skilled nursing. Under certain circumstances, an occupational therapist is allowed to perform the comprehensive assessment to determine a Medicare beneficiary's continuing need for home healthcare. However, under current Medicare law, occupational therapists are not permitted to conduct the initial assessment for home health cases, even when occupational therapy is included in the physician's order and when the case is exclusively related to rehabilitation therapy. Additionally, occupational therapists are not allowed to complete the comprehensive assessment unless occupational therapy is the qualifying service.

By permitting occupational therapists to perform initial home health assessment visits and comprehensive assessments in limited circumstances, the Medicare Home Health Flexibility Act can help prevent delays in the time it takes for Medicare beneficiaries to receive essential home healthcare, especially in underserved areas where access to physical therapists and speech language pathologists may be limited. On January 13, 2017, the Centers for Medicare & Medicaid Services, or CMS, released the final conditions of participation, or COPs, for home health agencies participating in Medicare and Medicaid. These new COPs expand the content of the home health comprehensive assessment to include the patient's functional, psychosocial, and cognitive status, all of which are areas of expertise for occupational therapists. The new COPs also require the creation of a patient-centered plan of care that is informed by the comprehensive assessment. As a result of their comprehensive education and unique training, occupational therapists are qualified to perform the necessary assessments to adhere to these new CMS home health guidelines.

It is important to note that the Medicare Home Health Flexibility Act would apply only to rehabilitation therapy cases in which skilled nursing care is not required. Nurses would still be required to conduct the initial assessment for all home health cases in which skilled nursing care is ordered by the physician. Also, although the legislation would allow occupational therapists to conduct the initial home health assessment visit and comprehensive assessments, it would not alter the existing criteria for establishing eligibility for the Medicare home health benefit.

I urge my colleagues to join me and Senator Heller and to support the Medicare Home Health Flexibility Act to correct the discrepancy in Medicare regulations between therapy providers and to help ensure timely access to essential, high-quality home health therapy care for Medicare beneficiaries.

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

Mr. President, I wish to introduce the Medicare Home Health Flexibility Act of 2017. I am pleased that my colleague, the senior Senator from Nevada, Mr. Heller, has agreed to cosponsor this bipartisan, no-cost legislation that would allow occupational therapists to perform the initial home health assessment visit and comprehensive assessments in cases in

which occupational therapy is ordered by the physician, along with speech language pathology and/or physical therapy services, and skilled nursing care is not required. Our bill will help ensure that Medicare beneficiaries receive timely access to essential home health therapy care.

Occupational therapists have long been recognized as a valuable component of our Nation's healthcare workforce and a critical aspect of home healthcare because of their focus on patients' functional capabilities and their expertise in home safety. Physicians frequently order occupational therapy as part of an initial plan of care for patients requiring home health care, alongside the qualifying services of physical therapy, speech-language pathology, and skilled nursing. Under certain circumstances, an occupational therapist is allowed to perform the comprehensive assessment to determine a Medicare beneficiary's continuing need for home healthcare. However, under current Medicare law, occupational therapists are not permitted to conduct the initial assessment for home health cases, even when occupational therapy is included in the physician's order and when the case is exclusively related to rehabilitation therapy. Additionally, occupational therapists are not allowed to complete the comprehensive assessment unless occupational therapy is the qualifying service.

By permitting occupational therapists to perform initial home health assessment visits and comprehensive assessments in limited circumstances, the Medicare Home Health Flexibility Act can help prevent delays in the time it takes for Medicare beneficiaries to receive essential home healthcare, especially in underserved areas where access to physical therapists and speech language pathologists may be limited. On January 13, 2017, the Centers for Medicare & Medicaid Services, or CMS, released the final conditions of participation, or COPs, for home health agencies participating in Medicare and Medicaid. These new COPs expand the content of the home health comprehensive assessment to include the patient's functional, psychosocial, and cognitive status, all of which are areas of expertise for occupational therapists. The new COPs also require the creation of a patient-centered plan of care that is informed by the comprehensive assessment. As a result of their comprehensive education and unique training, occupational therapists are qualified to perform the necessary assessments to adhere to these new CMS home health guidelines.

It is important to note that the Medicare Home Health Flexibility Act would apply only to rehabilitation therapy cases in which skilled nursing care is not required. Nurses would still be required to conduct the initial assessment for all home health cases in which skilled nursing care is ordered by the physician. Also, although the legislation would allow occupational therapists to conduct the initial home health assessment visit and comprehensive assessments, it would not alter the existing criteria for establishing eligibility for the Medicare home health benefit.

I urge my colleagues to join me and Senator Heller and to support the Medicare Home Health Flexibility Act to correct the discrepancy in Medicare regulations between therapy providers and to help ensure timely access to essential, high-quality home health therapy care for Medicare beneficiaries.

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