[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2133 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 2133

    To amend title XVIII of the Social Security Act to establish a 
Medically Tailored Home-Delivered Meals Demonstration Program to test a 
payment and service delivery model under part A of Medicare to improve 
clinical health outcomes and reduce the rate of readmissions of certain 
                              individuals.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 22, 2023

 Ms. Stabenow (for herself, Mr. Marshall, Mr. Booker, and Mr. Cassidy) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to establish a 
Medically Tailored Home-Delivered Meals Demonstration Program to test a 
payment and service delivery model under part A of Medicare to improve 
clinical health outcomes and reduce the rate of readmissions of certain 
                              individuals.

    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 ``Medically Tailored Home-Delivered 
Meals Demonstration Act''.

SEC. 2. MEDICALLY TAILORED HOME-DELIVERED MEALS DEMONSTRATION PROGRAM.

    Part E of title XVIII of the Social Security Act is amended by 
inserting after section 1866G (42 U.S.C. 1395cc-7) the following new 
section:

``SEC. 1866H. MEDICALLY TAILORED HOME-DELIVERED MEALS DEMONSTRATION 
              PROGRAM.

    ``(a) Establishment.--For the 4-year period beginning not later 
than 30 months after the date of the enactment of this section, the 
Secretary shall conduct, in accordance with the provisions of this 
section, a Medically Tailored Home-Delivered Meals Demonstration 
Program (in this section referred to as the `Program') to test a 
payment and service delivery model under which selected hospitals 
provide medically tailored home-delivered meals under part A of this 
title to qualified individuals, with respect to such hospitals, to 
improve clinical health outcomes and reduce the rate of readmissions of 
such individuals.
    ``(b) Selection of Hospitals To Participate in Program.--
            ``(1) Selected hospitals.--Under the Program, the Secretary 
        shall, not later than January 1, 2024, select to participate in 
        the Program at least 20 eligible hospitals across all 
        geographic regions, with consideration given to eligible 
        hospitals located in rural areas and other underserved 
        communities, that the Secretary determines have the capacity to 
        satisfy the requirements described in subsection (c). In this 
        section, each such eligible hospital so selected shall be 
        referred to as a `selected hospital'.
            ``(2) Eligible hospitals.--For purposes of this section, 
        the term `eligible hospital' means a subsection (d) hospital 
        (as defined in section 1886(d)(1)(B)) that--
                    ``(A) submits to the Secretary an application, at 
                such time and in such form and manner as specified by 
                the Secretary, that contains--
                            ``(i) an attestation (in such form and 
                        manner as specified by the Secretary) that such 
                        hospital has the ability, or is under an 
                        arrangement with a provider of services, 
                        supplier, or other entity that has the ability, 
                        to comply with the requirements described in 
                        subsection (c); and
                            ``(ii) such other information as the 
                        Secretary may require;
                    ``(B) has, for the 2 most recent fiscal years 
                ending prior to the date of selection by the Secretary 
                under paragraph (1), averaged at least 3 stars for the 
                overall hospital quality star rating on the internet 
                website of the Centers for Medicare & Medicaid Services 
                (including Care Compare or a successor website); and
                    ``(C) is not, as of the date of selection by the 
                Secretary under paragraph (1), subject to--
                            ``(i) the requirement to return any 
                        overpayment pursuant to section 1128J(d); or
                            ``(ii) any activity described in section 
                        1893(b) (relating to Medicare integrity program 
                        actions).
    ``(c) Minimum Program Requirements.--Under the Program, a selected 
hospital shall comply with each of the following requirements:
            ``(1) Staffing.--The selected hospital shall provide 
        (including through an arrangement described in subsection 
        (b)(2)(A)(i)), for the duration of the participation of the 
        hospital under the Program, a physician, registered dietitian 
        or nutrition professional, or clinical social worker to carry 
        out the screening and re-screening pursuant to paragraph (2), 
        and medical nutrition therapy pursuant to paragraph (3)(B).
            ``(2) Screening and re-screening.--The selected hospital 
        (including through an arrangement described in subsection 
        (b)(2)(A)(i)) shall--
                    ``(A) as part of the discharge planning process 
                described in section 1861(ee), screen individuals that 
                are inpatients of such selected hospital with validated 
                screening tools (as developed by the Secretary) to 
                determine whether such individuals are qualified 
                individuals; and
                    ``(B) in the case of an individual determined 
                pursuant to subparagraph (A) or this subparagraph to be 
                a qualified individual, re-screen such individual with 
                validated screening tools (as determined by the 
                Secretary) every 12 weeks after such determination 
                occurring during the participation of the hospital 
                under the Program to determine whether such individual 
                continues to be a qualified individual.
            ``(3) Providing medically tailored home-delivered meals and 
        medical nutrition therapy.--In the case of an individual that 
        is determined by the selected hospital pursuant to paragraph 
        (2) to be a qualified individual, the selected hospital 
        (including through an arrangement described in subsection 
        (b)(2)(A)(i)) shall with respect to the period during which 
        such hospital is participating in the Program--
                    ``(A) provide, for each day during a period of at 
                least 12 weeks, for the preparation and delivery to 
                such individual of at least 2 medically tailored home-
                delivered meals (or a portioned equivalent) that meet 
                at least two-thirds of the daily nutritional needs of 
                the qualified individual; and
                    ``(B) provide to such qualified individual, in 
                connection with delivering such meals and for a period 
                of at least 12 weeks and not more than 1 year, medical 
                nutrition therapy.
            ``(4) Data submission.--The selected hospital shall submit 
        to the Secretary data, in such form, manner, and frequency as 
        designated by the Secretary, so that the Secretary may 
        determine the affect of the Program with respect to the factors 
        described in subsection (e)(2)(B).
            ``(5) Additional requirements.--The selected hospital shall 
        satisfy such additional requirements as may be specified by the 
        Secretary.
    ``(d) Payment; Cost-Sharing.--
            ``(1) Payment.--The Secretary shall determine the form, 
        manner, and amount of payment to be provided to a selected 
        hospital under the Program.
            ``(2) Cost-sharing.--Items and services for which payment 
        may be made under the Program shall be provided without 
        application of any deductible, copayment, coinsurance, or other 
        cost-sharing under this title.
    ``(e) Evaluations.--
            ``(1) Assessing clinical health outcomes.--The Secretary 
        shall assess the clinical health outcomes of each individual 
        who is determined by a selected hospital pursuant to subsection 
        (c)(2) to be a qualified individual for a period of at least 12 
        weeks and not more than 1 year after the date on which such 
        individual is so determined under subparagraph (A) of such 
        subsection.
            ``(2) Intermediate and final evaluations.--The Secretary 
        shall conduct an intermediate and final evaluation of the 
        Program. Each such evaluation shall--
                    ``(A) based on the assessments conducted under 
                paragraph (1), with respect to individuals determined 
                to be qualified individuals and the periods for which 
                such assessments are so conducted, determine--
                            ``(i) the number of inpatient admissions of 
                        such individuals;
                            ``(ii) the number of admissions to skilled 
                        nursing facilities of such individuals; and
                            ``(iii) the total expenditures under part A 
                        with respect to such individuals;
                    ``(B) determine the extent to which the Program 
                has--
                            ``(i) improved clinical health outcomes, as 
                        defined by the Secretary;
                            ``(ii) reduced the cost of care under part 
                        A (including costs associated with readmission 
                        as defined in section 1886(q)(5)(E)); and
                            ``(iii) increased patient satisfaction, as 
                        defined by the Secretary; and
                    ``(C) specify the form, manner, and amounts of 
                payments made under the Program pursuant to subsection 
                (d)(1) and the effectiveness of such payment form, 
                manner, and amounts.
            ``(3) Reports.--The Secretary shall submit to Congress--
                    ``(A) not later than 3 years after the date of 
                implementation of the Program, a report with respect to 
                the intermediate evaluation under paragraph (2); and
                    ``(B) not later than 6 years after such date of 
                implementation, a report with respect to the final 
                evaluation under such paragraph.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out this section.
    ``(g) Definitions.--In this section:
            ``(1) Medical nutrition therapy.--The term `medical 
        nutrition therapy' has the meaning given such term in section 
        1861(vv)(1).
            ``(2) Medically tailored home-delivered meal.--The term 
        `medically tailored home-delivered meal' means, with respect to 
        a qualified individual, a meal that is designed by a registered 
        dietitian or nutrition professional for the treatment plan of 
        the qualified individual.
            ``(3) Qualified individual.--The term `qualified 
        individual' means an individual, with respect to a selected 
        hospital, who--
                    ``(A) is entitled to benefits under part A;
                    ``(B) has a diet-impacted disease (such as kidney 
                disease, congestive heart failure, diabetes, chronic 
                obstructive pulmonary disease, or any other disease the 
                Secretary determines appropriate); and
                    ``(C) at the time of discharge from such hospital--
                            ``(i) lives at home;
                            ``(ii) is not eligible for--
                                    ``(I) extended care services (as 
                                defined in section 1861(h));
                                    ``(II) post-hospital extended care 
                                services (as defined in section 
                                1861(i));
                                    ``(III) home health services (as 
                                defined in section 1861(m)); or
                                    ``(IV) post-institutional home 
                                health services (as defined in section 
                                1861(tt));
                            ``(iii) has not made an election under 
                        section 1812(d)(1) to receive hospice care;
                            ``(iv) is certified by a physician at the 
                        time of discharge to be limited with respect to 
                        at least 2 of the activities of daily living 
                        (as described in section 7702B(c)(2)(B) of the 
                        Internal Revenue Code of 1986); and
                            ``(v) meets any other criteria for high-
                        risk of readmission (as determined by the 
                        Secretary).
            ``(4) Registered dietitian or nutrition professional.--The 
        term `registered dietitian or nutrition professional' has the 
        meaning given such term in section 1861(vv)(2).''.
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