[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 796 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 796

To amend title XVIII of the Social Security Act to provide for coverage 
    of expanded nursing facility and in-home services for dependent 
                individuals under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 13, 2003

  Mr. Engel introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, 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 provide for coverage 
    of expanded nursing facility and in-home services for dependent 
                individuals under the Medicare Program.

    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 ``Comprehensive Long-Term Care Act of 
2003''.

SEC. 2. EXPANDED LONG-TERM CARE SERVICES UNDER MEDICARE PROGRAM FOR 
              DEPENDENT INDIVIDUALS.

    (a) In General.--
            (1) Part a.--Section 1812 of the Social Security Act (42 
        U.S.C. 1395d) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (2)(B), by striking 
                        ``subsection (f),'' and inserting ``subsection 
                        (f) and section 1889,'',
                            (ii) by striking ``and'' at the end of 
                        paragraph (3),
                            (iii) by striking the period at the end of 
                        paragraph (4) and inserting ``; and'', and
                            (iv) by adding at the end the following new 
                        paragraph:
            ``(5) long-term care services consisting of extended care 
        services (in accordance with section 1889).''; and
                    (B) in subsection (b)(2), by striking ``post-
                hospital'' and inserting ``except as provided in 
                section 1889, post-hospital''.
            (2) Part b.--Section 1861(s)(2) of the Social Security Act 
        (42 U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (U);
            (2) by inserting ``and'' at the end of subparagraph (V); 
        and
            (3) by adding at the end the following new subparagraph:
            ``(W) long-term care services consisting of in-home care 
        (in accordance with section 1889);''.
    (b) Description of Services; Eligibility.--Title XVIII of such Act 
is amended by inserting after section 1888 the following new section:

          ``long-term care services for dependent individuals

    ``Sec. 1889. (a) In General.--Benefits are payable under this title 
for long-term care services under this section only if--
            ``(1) the individual is a dependent individual; and
            ``(2) such services are provided in accordance with a case 
        management plan developed by a case management agency.
    ``(b) Services Provided.--In this section, the term `long-term care 
services' means--
            ``(1) in-home care (as defined in subsection (e)); and
            ``(2) extended care services (as defined in section 
        1861(h)), but only with respect to a chronically dependent 
        individual (as defined in subsection (d)(2)).
    ``(c) Payment for Services.--
            ``(1) In general.--Subject to paragraph (2), 
        Notwithstanding any other provision of law, the amount payable 
        under this title for long-term care services under this section 
        shall be determined in accordance with a fee schedule for such 
        services established by the Secretary.
            ``(2) Imposition of deductible.--The amount otherwise 
        payable under this title for long-term care services under this 
        section furnished during a calendar year shall be reduced by an 
        amount equal to the deductible imposed for inpatient hospital 
        services for the year under section 1813(a)(1).
    ``(d) Dependent Individual Defined.--
            ``(1) In general.--In this section, the term `dependent 
        individual' means an individual who--
                    ``(A) is unable to perform (without substantial 
                assistance from another individual) because of physical 
                or cognitive impairment at least 2 activities of daily 
                living (as defined in paragraph (3)); or
                    ``(B) has a similar level of disability due to 
                cognitive impairment that requires substantial 
                direction, instruction, or supervision of another 
                individual in order--
                            ``(i) to perform at least 2 activities of 
                        daily living; or
                            ``(ii) to remain in the community without 
                        causing harm to self or others because of 
                        inappropriate behavioral patterns.
            ``(2) Chronically dependent individual.--In this section, 
        the term `chronically dependent individual' means a dependent 
        individual who would meet the requirements of paragraph (1) if 
        `3 activities of daily living' were substituted for `2 
        activities of daily living'.
            ``(3) Activities of daily living defined.--The `activities 
        of daily living' referred to in this subsection are as follows:
                    ``(A) Eating.
                    ``(B) Bathing.
                    ``(C) Dressing.
                    ``(D) Toileting.
                    ``(E) Transferring in and out of a bed or in and 
                out of a chair.
    ``(e) In-Home Care.--
            ``(1) In general.--For purposes of this section, the term 
        `in-home care' means the items and services described in 
        paragraph (2) furnished to an individual by a home care agency 
        (as defined in section 1861(ww)) or by others under 
        arrangements with them made by the agency provided in a place 
        of residence used as such individual's home (other than 
        services described in paragraph (2)(H)).
            ``(2) Services described.--The items and services described 
        in this paragraph are as follows:
                    ``(A) Nursing care provided by or under the 
                supervision of a registered professional nurse.
                    ``(B) Services of a homemaker/home health aide who 
                has successfully completed a training and competency 
                evaluation program approved by the Secretary.
                    ``(C) Personal care services.
                    ``(D) Medical social services.
                    ``(E) Physical, occupational, or respiratory 
                therapy or speech-language pathology services.
                    ``(F) Medical supplies (other than drugs and 
                biologicals) and durable medical equipment, while under 
                such a plan.
                    ``(G) Patient and caregiver (including family 
                caregiver) education and training to develop skills 
                necessary to permit the individual to remain in the 
                home setting.
                    ``(H) Community care services furnished outside of 
                the place of residence.
                    ``(I) Such other home-based items and services 
                (other than room and board) as the Secretary may 
                approve.
    ``(f) Case Management Requirements.--
            ``(1) Requests for assessment.--Each individual entitled to 
        benefits under part A or part B (or another person on such 
        individual's behalf) may request a case management agency to 
        conduct an assessment under this subsection to determine 
        whether the individual is a dependent individual or a 
        chronically dependent individual and to assess the individual's 
        needs for long-term care services under this section.
            ``(2) Description of plans.--For purposes of this section, 
        a `case management plan' means, with respect to an individual, 
        a written plan of care which--
                    ``(A) is established and periodically reviewed and 
                revised by a case management agency; and
                    ``(B) reflects the individual's needs identified in 
                the assessment under paragraph (1).
            ``(3) Case management agency defined.--In this section, the 
        term `case management agency' means a nonprofit or public 
        agency or organization (or a nonprofit or public subdivision of 
        such an agency or organization) certified by the Secretary to 
        conduct assessments and establish case management plans under 
        this subsection which--
                    ``(A) is experienced in conducting assessments, in 
                establishing and periodically reviewing and revising 
                case management plans for nursing facility services and 
                in-home care, and in coordinating and reviewing the 
                quality of the provision of such services and care;
                    ``(B) is capable of efficiently and effectively 
                performing directly or through contracts under 
                paragraph (4) such duties; and
                    ``(C) does not provide long-term care services or 
                nursing facility services and does not have a direct or 
                indirect ownership or control interest in, or direct or 
                indirect affiliation or relationship with, an entity 
                that provides, such services.
            ``(4) Contracting out certain functions.--The Secretary 
        shall permit a case management agency, to the extent necessary 
        to carry out functions under this section, to provide for 
        assessments and case management plans through contracts with 
        nonprofit or public organizations which do not provide long-
        term care services or nursing facility services and do not have 
        a direct or indirect ownership or control interest in, or 
        direct or indirect affiliation or relationship with, an entity 
        that provides, such services.''.
    (c) Conforming Amendments.--(1) Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
            (A) by striking ``and'' before ``(U)''; and
            (B) by inserting before the semicolon at the end the 
        following: ``, and (V) with respect to expenses incurred for 
        services described in section 1861(s)(2)(W), the amounts paid 
        shall be the amounts determined under section 1889(c);''.
    (2) Section 1861 of the Social Security Act (42 U.S.C. 1395x) is 
amended by adding at the end the following new subsection:

                           ``home care agency

    ``(ww) The term `home care agency' means a public agency or private 
organization, or a subdivision of such an agency or organization, which 
is a home health agency (as defined in subsection (o)) or--
            ``(1) is primarily engaged in providing services of 
        homemaker/home health aides and personal care aides;
            ``(2) maintains clinical records on all patients;
            ``(3) in the case of an agency or organization in any State 
        in which State or applicable local law provides for the 
        licensing of agencies or organizations of this nature--
                    ``(A) is licensed pursuant to such law, or
                    ``(B) is approved, by the agency of such State or 
                locality, responsible for licensing agencies or 
                organizations of this nature, as meeting the standards 
                established for such licensing; and
            ``(4) meets such other requirements as the Secretary may 
        find necessary in the interest of the health and safety of 
        individuals who are furnished services by such agency or 
        organization and for the effective and efficient operation of 
        the program.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2004.
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