[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.
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