Choose Home Care Act of 2021
This bill provides for coverage of home-based extended care services under Medicare.
Specifically, the bill provides for coverage of services that are furnished to Medicare beneficiaries in their homes by home health agencies, including nursing care, meals and nutritional support, home medical supplies, nonemergency medical transportation, and care coordination. Coverage includes 30 days of post-hospital care and other periods of extended illness, as determined by the Centers for Medicare & Medicaid Services (CMS). Home health agencies that provide such services may receive additional payments in accordance with a specified methodology.
The CMS may make payments for covered services furnished before 2022 during any period in which there is a public health emergency.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5514 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 5514
To amend title XVIII of the Social Security Act to improve extended
care services by providing Medicare beneficiaries with an option for
cost effective home-based extended care under the Medicare program, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 8, 2021
Mr. Cuellar (for himself, Mr. Comer, Mr. Suozzi, Mr. Evans, Mr. Higgins
of Louisiana, Mr. Bishop of Georgia, Mr. Higgins of New York, Mr.
Vicente Gonzalez of Texas, Mr. Tonko, Mr. Carter of Georgia, Mr.
O'Halleran, Mr. Brendan F. Boyle of Pennsylvania, Ms. Norton, and Mr.
Johnson of Louisiana) introduced the following bill; which was referred
to the Committee on Ways and Means, and in addition to the Committee on
Energy and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve extended
care services by providing Medicare beneficiaries with an option for
cost effective home-based extended care under the Medicare program, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Choose Home Care Act of 2021''.
SEC. 2. ESTABLISHMENT OF A HOME-BASED EXTENDED CARE SERVICES BENEFIT AS
PART OF MEDICARE.
(a) Improved Support for Health Care at Home.--
(1) In general.--Section 1812 of the Social Security Act
(42 U.S.C. 1395d) is amended--
(A) in subsection (a)--
(i) in paragraph (2)(A), by inserting
``(reduced by the number of days of home-based
extended care services furnished under
paragraph (6) during such spell of illness)''
after ``spell of illness'';
(ii) in paragraph (4), by striking ``and''
at the end;
(iii) in paragraph (5), by striking the
period at the end and inserting ``; and''; and
(iv) by adding at the end the following new
paragraph:
``(6)(A) home-based extended care services for a 30-day
episode for individuals who otherwise qualify for post-hospital
extended care services under paragraph (2)(A);
``(B) to the extent provided in subsection (f), home-based
extended care services that are not post-hospital home-based
extended care services; and
``(C) in such circumstances as the Secretary may specify,
home-based extended care services for one or more subsequent
30-day episode or episodes up to a maximum of 100 days of home-
based extended care services in a spell of illness.'';
(B) in subsection (b)--
(i) in paragraph (2), by striking ``or'' at
the end;
(ii) in paragraph (3), by striking the
period at the end and inserting ``; or''; and
(iii) by inserting after paragraph (3) the
following new paragraph:
``(4) home-based extended care services furnished to an
individual after such services have been furnished to the
individual for a 30-day episode during such spell, except as
provided by the Secretary pursuant to subparagraph (B) or (C)
of subsection (a)(6).''; and
(C) in subsection (f)--
(i) in paragraph (1)--
(I) by inserting ``and, under
subsection (a)(6)(B), of home-based
extended care services, as
applicable,'' after ``extended care
services'' the first place it appears;
(II) by inserting ``or post-
hospital home-based extended care
services'' after ``post-hospital
extended care services''; and
(III) by inserting ``or subsection
(a)(6), as applicable'' before the
period; and
(ii) in paragraph (2)--
(I) in subparagraph (A), by
inserting ``or subsection (a)(6)(B), as
applicable,'' after ``subsection
(a)(2)(B)''; and
(II) in subparagraph (B), by
striking ``subsection'' and inserting
``subsections''.
(2) Coinsurance and deductible.--Section 1813(a)(3) of the
Social Security Act (42 U.S.C. 1395e(a)(3)) is amended by
striking the period and inserting the following: ``(or, in the
case where an individual is furnished post-hospital home-based
extended care services, after such services (or a combination
of such services and post-hospital extended care services) have
been furnished to him for 20 days during such spell).''.
(3) Certification requirement.--Section 1814(a)(2) of the
Social Security Act (42 U.S.C. 1395f(a)(2)) is amended--
(A) in the matter preceding subparagraph (A), by
inserting ``or (E)'' after ``subparagraph (C)'';
(B) in subparagraph (C), by striking ``or'' at the
end;
(C) in subparagraph (D), by inserting ``or'' after
the semicolon; and
(D) by adding at the end the following new
subparagraph:
``(E) in the case of post-hospital home-based
extended care services, such services are or were
required to be furnished because the individual
otherwise needs or needed and qualifies for extended
care services in a skilled nursing facility payable
under this part under subparagraph (B), and such
individual does not qualify for services in an
inpatient rehabilitation facility or long-term care
hospital payable under this part;''.
(4) Post-hospital extended care services.--Section 1861(i)
of the Social Security Act (42 U.S.C. 1395x(i)) is amended, in
the second sentence--
(A) by striking ``or (B)'' and inserting ``(B)'';
and
(B) by striking the period and inserting the
following: ``, or (C) in the case of an individual
receiving post-hospital home-based extended care
services, within 30 days after discharge from a
hospital.''.
(5) Definition of home-based extended care services.--
Section 1861 of the Social Security Act (42 U.S.C. 1395x) is
amended by adding at the end the following new subsection:
``Home-Based Extended Care Services
``(lll)(1) The term `home-based extended care services' means the
following items and services furnished to an individual in the
individual's home by a home health agency (as defined in subsection (o)
including the additional requirements under paragraph (9) of such
subsection), or by others under arrangements with such agency:
``(A) Nursing care, other than as described in subsection
(m), including when provided using telecommunications
technology as a supplement to daily in-person care.
``(B) Physical or occupational therapy or speech-language
pathology services, other than as described in subsection (m),
including when provided using telecommunications as a
supplement to daily in-person care.
``(C) Meals and nutritional support.
``(D) Remote patient monitoring as a supplement to in-
person care other than as described in subsection (m).
``(E) Medical social services other than as described in
subsection (m).
``(F) Services of a home health aide other than as
described in subsection (m) and personal care services.
``(G) Respite care, family caregiver and other unpaid
caregiver supports, education, and training resources.
``(H) Assistance with adherence to drugs prescribed for the
individual.
``(I) Medical supplies, appliances, and equipment, other
than those described in subsection (m), for use in the home,
including related to bathing, dressing, toileting, walking, or
feeding.
``(J) Nonemergency medical transportation other than
ambulance services.
``(K) Care coordination and integration, including
providing discharge planning and care transitions support to
the individual and family and other unpaid caregivers,
including referral for person-centered counseling or options
counseling from their State's Aging and Disability Resource
Center/No Wrong Door System, upon completion of a 30-day
episode or one or more subsequent 30-day episode or episodes,
if applicable, under section 1812(a)(6)(C). To the greatest
extent possible, care transitions support services provided as
part of home-based extended care services should use evidence-
based models and practices, particularly those that employ
face-to-face visits.
``(L) Such other items and services as the home health
agency determines are necessary for the care of the individual
in the home.
``(2) Nothing in this subsection shall be construed as impacting an
individual's eligibility for transition of care services under any
other provision of this title or otherwise for which the individual is
eligible.''.
(6) Discharge planning.--Section 1861(ee)(2) of the Social
Security Act (42 U.S.C. 1395x(ee)(2)) is amended--
(A) in subparagraph (D)--
(i) by striking ``hospice care and post-
hospital extended care services'' and inserting
``hospice care, post-hospital extended care
services, post-hospital home-based extended
care services, and services furnished by
inpatient rehabilitation facilities and units
and long-term care hospitals''; and
(ii) by inserting ``and home-based extended
care services'' after ``home health services'';
and
(B) by adding at the end the following new
subparagraph:
``(I) The discharge planning evaluation and discharge plan
for an individual who meets applicable standards and criteria
for extended care services under section 1812, and who does not
need services provided by an inpatient rehabilitation facility
or unit or a long-term care hospital, shall include, in
addition to the items described in subparagraph (D)--
``(i) an evaluation, in coordination with a
qualified home health agency, of the appropriateness of
home-based extended care services, including
consideration of patient characteristics, including but
not limited to functional, cognitive, and behavioral
competencies and deficits and primary and secondary
diagnoses, the availability of able and willing
caregivers, the scope of home-based extended care
services needed and other services (if applicable), the
length of time such services would be needed, the
availability of the level of services needed, and the
need for and availability of health care services
following completion of home-based extended care
services, the individual's place of care preferences,
and the integration of and consideration of social
determinants, inclusive of race and ethnicity and the
availability of and access to quality services, into
measures used to determine eligibility of a beneficiary
to receive home-based extended care services;
``(ii) a consultation with the individual as to the
findings of such evaluation, including consideration of
the individual's place of care preferences, goals
regarding care, family caregiver concerns, and the
ability of the individual to safely and effectively
receive care in the home;
``(iii) the provision of caregiver training
resources to family and other unpaid caregivers
including guidance on medical, nursing, and personal
care tasks; and
``(iv) obtaining verbal consent from the individual
that is recorded in the individual's inpatient care
record if the individual chooses to receive home-based
extended care services.
Clauses (i), (ii), and (iii) shall not preempt any applicable
State law requirements. Clause (iv) shall preempt any State law
requirements relating to consent for home-based extended care
services. The Secretary shall establish, through notice and
comment rulemaking, the right to an expedited appeal of any
adverse determination regarding the determination to provide
the individual with the option of home-based extended care
services and the scope of home-based extended care services
needed by the individual.''.
(7) Additional requirements.--Section 1861(o) of the Social
Security Act (42 U.S.C. 1395x(o)) is amended--
(A) in paragraph (7)(B), by striking ``and'' at the
end;
(B) in paragraph (8), by inserting ``and'' at the
end; and
(C) by inserting after paragraph (8) the following
new paragraph:
``(9) for purposes of furnishing post-hospital home-based
extended care services under section 1812(a)(6), meets such
additional requirements and conditions as the Secretary finds
necessary, including--
``(A) the provision of care on a 24-hour basis;
``(B) the ability to provide all items and services
described in subsection (lll);
``(C) the provision of necessary and covered
services;
``(D) education, training, and supervision
requirements for those providing home-based extended
care services; and
``(E) compliance with all requirements and
conditions when such services are provided under
arrangement as described in subsection (m) to ensure
that others providing care under such arrangement with
such agency are held to the same standards
(requirements and conditions) as the agency;''.
(8) Home-based extended care services add-on.--Section 1895
of the Social Security Act (42 U.S.C. 1395fff) is amended by
adding at the end the following new subsection:
``(f) Home-Based Extended Care Services Add-On.--
``(1) In general.--An add-on payment in addition to the
amount otherwise payable under this section for home health
services shall be made to a home health agency that meets the
additional requirements of section 1861(o)(9) and provides
home-based extended care services under section 1812(a)(6).
``(2) Payment amount.--Subject to paragraphs (3) and (4),
the amount of such add-on payment for home-based extended care
services provided to an individual shall be determined as
follows:
``(A) Determination.--Such amount shall be
determined based on the following:
``(i) The following four case-mix
classifications, determined by the number of
hours of personal care services provided to an
individual, as follows:
``(I) Up to 60 hours, including an
initial assessment.
``(II) Sixty-one to 120 hours.
``(III) One hundred twenty-one to
240 hours.
``(IV) Two hundred forty-one to 360
hours of personal care services.
``(ii) In calculating the number of hours
of personal care services under clause (i),
part-time or intermittent services provided by
home health aides under sections 1812(a)(2) and
1835(a)(2)(A) shall not be included.
``(iii) Such other factors as the Secretary
determines appropriate.
``(B) Fixed base amount.--The Secretary shall
provide a fixed base amount for each of the 4 case-mix
classifications described in subclauses (I) through
(IV) of subparagraph (A)(i) as follows:
``(i) 2022.--For services furnished during
2022, a fixed base amount of--
``(I) in the case of the case-mix
classification described in subclause
(I) of subparagraph (A)(i), $2,010;
``(II) in the case of the case-mix
classification described in subclause
(II) of such subparagraph, $4,020;
``(III) in the case of the case-mix
classification described in subclause
(III) of such subparagraph, $7,360; and
``(IV) in the case of the case-mix
classification described in subclause
(IV) of such subparagraph, $10,720,
respectively.
``(ii) 2023 and subsequent years.--For
services furnished during 2023, or a subsequent
year, a fixed base amount equal to the amount
determined under this subparagraph for the
preceding year for the applicable case-mix
classification, updated by the home health
applicable increase percentage under subsection
(b)(3)(B) applicable to the year involved.
``(C) Area wage index adjustment.--The fixed base
amount determined under subparagraph (B) shall be
subject to the applicable area wage index under
subsection (b)(4)(C).
``(3) Alternative add-on payment model.--For services
furnished in 2023, or in a subsequent year, the Secretary may
apply an alternative model of payment that shall be based on
relevant and reliable data on patient characteristics that
reflect the variations in resource use and intensity within a
patient case mix.
``(4) Limitation.--Notwithstanding any other provision in
this section, the amount of the additional payment under this
subsection to a home health agency for home-based extended care
services, in combination with the amount of payment for home
health services under this section for a unit of services
furnished to an individual, shall not result in a total amount
of payment under this section for such services that exceeds an
amount equal to 80 percent of the national median 30-day
payment amount for extended care services furnished in a
skilled nursing facility under section 1812 for the most recent
fiscal year prior to the payment year for which data is
available, updated based on the skilled nursing facility market
basket percentage change under section 1888(e)(5)(B). The
Secretary may adjust the amount of the additional payment for
home-based extended care services under this subsection in
order to comply with the limitation under the preceding
sentence.''.
(b) Transparency in Notice and Comment Rulemaking.--In establishing
standards and procedures under the provisions of, and amendments made
by, this Act, the Secretary of Health and Human Services (in this
section referred to as the ``Secretary'') shall include full
transparency through notice and comment rulemaking of the methodology,
assumptions, evidence, and all data used in support of proposed payment
rates, standards for eligibility and payment for services, provider
conditions for participation, and any other matter related to the
implementation of such provisions and amendments.
(c) Stakeholder Input.--In establishing any proposed standards and
procedures under the provisions of, and amendments made by, this Act,
the Secretary shall solicit written input on such proposed standards
and procedures from providers, representatives of providers, Medicare
beneficiaries, families, and related stakeholder groups and consider
such input in the development of such standards and procedures.
(d) Annual Report to Congress.--For calendar year 2022, and each
calendar year thereafter, the Secretary shall submit a report to
Congress on the coverage of home-based extended care services under the
Medicare program (42 U.S.C. 1395 et seq.) pursuant to the provisions
of, and amendments made by, this Act. Each report submitted under this
subsection shall include the following:
(1) The total number of individuals receiving such services
pursuant to such provisions and amendments, including which
services such individuals received, how long such individuals
received such services, and what the average hours were per
individual, and the total amount of expenditures for such
services under the Medicare program, including an itemization
of expenditures associated with home health care and in-home
support services.
(2) An analysis of the efficiency and effectiveness of the
processes for discharge planning evaluation and discharge
planning under section 1861(ee)(2)(I) of the Social Security
Act, as added by subsection (a)(6), an itemization of the
diagnoses, treatment protocols, and outcomes of individuals
receiving benefits (including family or other unpaid
caregivers, as applicable), an evaluation comparing clinical
outcomes and patient experience for similar patients receiving
home-based extended care services and services in skilled
nursing facilities, an evaluation (which shall include audits)
of whether home-based extended care services are being
appropriately targeted to individuals who need and would
benefit from the scope, level, and duration of such home-based
extended care services and whether individuals receiving such
services are receiving the appropriate scope, level and
duration of care, and the cost effectiveness of furnishing
home-based extended care services in relation to alternative
skilled nursing facility costs.
(3) Data by race and ethnicity as it applies to
eligibility, decision on participation of the beneficiary,
utilization rates, and availability of quality home health
services in defined locales, as well as any protocol or changes
in practice that were instituted to address existing
inequities.
(4) Recommendations for such administrative or legislative
action as the Secretary determines necessary to improve the
furnishing of such services.
(e) Program Integrity.--The Secretary shall take such actions and
establish safeguards as are reasonable and necessary under existing law
to ensure the program integrity of the provision of home-based extended
care services pursuant to the provisions of, and amendments made by,
this Act.
(f) Implementation.--
(1) Establishment of standards and procedures.--Not later
than July 1, 2021, or as soon as practical after enactment of
this Act during a public health emergency period described in
section 1135(g) of the Social Security Act (42 U.S.C. 1320b-
5(g)), the Secretary shall establish standards and procedures
related to furnishing home-based extended care services
pursuant to the provisions of, and amendments made by, this
Act.
(2) Provision of information regarding the home-based
extended care services benefit.--The Secretary shall provide
comprehensive information to Medicare beneficiaries and other
stakeholders regarding the establishment and availability of
the home-based extended care services benefit under the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) pursuant to the provisions of, and
amendments made by, this Act. Such information shall be in
addition to any publication of standards and procedures with
respect to such services in the Federal Register and Code of
Federal Regulations.
(3) Authorization of payments during public health
emergency period.--Notwithstanding any other provision of law,
the Secretary is authorized to make payments for home-based
extended care services as described in section 1895(f) of the
Social Security Act, as added by subsection (a)(8), for such
services furnished prior to 2022 during any period in which
there exists such a public health emergency period.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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