[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7742 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 7742

 To amend title XVIII of the Social Security Act to establish a 2-year 
 demonstration program for hospitals to provide outpatient observation 
              services to Medicare beneficiaries at home.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 20, 2024

  Ms. Castor of Florida (for herself and Mr. Buchanan) 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 establish a 2-year 
 demonstration program for hospitals to provide outpatient observation 
              services to Medicare beneficiaries at home.

    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 ``At Home Observation and Medical 
Evaluation Services Act of 2024'' or the ``At HOME Services Act''.

SEC. 2. DEMONSTRATION PROGRAM FOR HOSPITALS TO PROVIDE OUTPATIENT 
              OBSERVATION SERVICES TO MEDICARE BENEFICIARIES AT HOME.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1866G the following new section:

``SEC. 1866H. DEMONSTRATION PROGRAM FOR HOSPITALS TO PROVIDE OUTPATIENT 
              OBSERVATION SERVICES AT HOME.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this section, the Secretary shall implement a 2-year 
demonstration program (in this section referred to as the `Program') 
for hospitals to provide outpatient observation services to eligible 
beneficiaries in the homes of such beneficiaries. In implementing such 
Program, the Secretary shall grant waivers and flexibilities (as 
described in subsection (b)) to an individual hospital that submits a 
request for such waivers and flexibilities and meets specified criteria 
(as described in subsection (c)) in order to participate in the 
Program.
    ``(b) Waivers and Flexibilities.--For the purposes of subsection 
(a), the waivers and flexibilities described in this paragraph are the 
following waivers and flexibilities that were made available to 
individual hospitals under the Acute Hospital Care at Home initiative 
of the Secretary during the emergency period described in section 
1135(g)(1)(B):
            ``(1) Subject to subsection (c)(2), waiver of the 
        requirements to provide 24-hour nursing services on premises 
        and for the immediate availability of a registered nurse under 
        section 482.23(b) of title 42, Code of Federal Regulations (or 
        any successor regulation), and the waivers of the physical 
        environment and Life Safety Code requirements under section 
        482.41 of title 42, Code of Federal Regulations (or any 
        successor regulation).
            ``(2) Waiver of the telehealth requirements under clause 
        (i) of section 1834(m)(4)(C), as amended by section 4113(a) of 
        the Health Extenders, Improving Access to Medicare, Medicaid, 
        and CHIP, and Strengthening Public Health Act of 2022, such 
        that the originating sites described in clause (ii) of such 
        section shall include the home or temporary residence of the 
        individual.
            ``(3) Other waivers and flexibilities that, as of the date 
        of enactment of this section, were in place for such initiative 
        during such emergency period.
    ``(c) Specified Criteria.--For purposes of subsection (a), the 
specified criteria for granting such waivers and flexibilities to 
individual hospitals are:
            ``(1) The hospital and any other entities providing 
        services under arrangements with the hospital shall ensure that 
        the standard of care to treat an eligible beneficiary at home 
        is the same as the standard of care to treat such beneficiary 
        as an inpatient of the hospital.
            ``(2) The hospital shall meet all patient safety standards 
        determined appropriate by the Secretary, in addition to those 
        that otherwise apply to the hospital, except those for which 
        the waivers and flexibilities under this subsection apply.
            ``(3) The hospital shall provide to the Secretary, at a 
        time, form and manner determined by the Secretary, any data and 
        information the Secretary determines necessary to do the 
        following:
                    ``(A) Monitor the quality of care furnished, and to 
                the extent practicable ensure the safety of, eligible 
                beneficiaries and analyze costs of such care.
                    ``(B) Undertake the study described in subsection 
                (e).
            ``(4) The hospital meets such other requirements and 
        conditions as the Secretary determines appropriate.
    ``(d) Termination.--The Secretary may terminate a hospital from 
participation in the Program (and the waivers and flexibilities 
applicable to such hospital) if the Secretary determines that the 
hospital no longer meets the criteria described in subsection (c).
    ``(e) Study and Report.--
            ``(1) In general.--The Secretary shall conduct a study to--
                    ``(A) analyze, to the extent practicable, the 
                criteria established by hospitals to determine which 
                beneficiaries may be furnished services under the 
                Program; and
                    ``(B) analyze and compare, to the extent 
                practicable--
                            ``(i) the quality of care furnished to 
                        beneficiaries with similar conditions and 
                        characteristics in the hospital setting and 
                        through the Program, including health outcomes, 
                        hospital readmission rates, hospital mortality 
                        rates, length of stay, infection rates, and 
                        patient experience of care;
                            ``(ii) clinical conditions treated and 
                        diagnosis-related groups of discharges from the 
                        hospital setting and under the Program;
                            ``(iii) costs incurred by furnishing care 
                        in the hospital setting and through the 
                        Program;
                            ``(iv) the quantity, mix and intensity of 
                        such services (such as in-person visits and 
                        virtual contacts with patients) furnished under 
                        the Program and furnished in the hospital 
                        setting; and
                            ``(v) socioeconomic information on 
                        beneficiaries treated under the Program, 
                        including racial and ethnic data, income, and 
                        whether such beneficiaries are dually eligible 
                        for benefits under this title and title XIX.
            ``(2) Report.--Not later than 1 year after the completion 
        of the Program, the Secretary shall post on a website of the 
        Centers for Medicare & Medicaid Services a report on the study 
        conducted under paragraph (1).
    ``(f) Implementation.--Notwithstanding any other provision of law, 
the Secretary may implement this section by program instruction or 
otherwise.
    ``(g) Publicly Available Information.--The Secretary shall, as 
feasible, make the information collected under subsections (c)(3) and 
(e)(1) available on the Medicare.gov Internet website (or a successor 
website).''.
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