To amend title XVIII of the Social Security Act to provide for the use of qualified family caregivers in the provision of home health aide services under the Medicare Program, to amend the Family and Medical Leave Act of 1993, and for other purposes.

Summary: Family Caregiver Security Act of 2004 - Amends title XVIII (Medicare) of the Social Security Act to provide for the use of qualified family caregivers in the provision of home health aide services under Medicare.

Amends the Family and Medical Leave Act of 1993 to: (1) include nurse practitioners as health care providers; (2) extend benefits to domestic or civil partners; and (3) extend from 12 to 24 workweeks the period of family or medical leave for spouses employed by the same employer.

SECTION 1. SHORT TITLE.

    This Act may be cited as ``Family Caregiver Security Act of 2004''.

SEC. 2. PROVISION OF QUALIFIED FAMILY CAREGIVER SERVICES UNDER THE 
              MEDICARE PROGRAM.

    (a) In General.--Section 1891(a) of the Social Security Act (42 
U.S.C. 1395bbb(a)) is amended by adding at the end the following new 
paragraph:
            ``(7)(A) The agency permits an individual who is under its 
        care to have home health aide services or personal care 
        assistant services provided by a qualified family caregiver (as 
        defined in subparagraph (B)) under an approved plan of care and 
        provides for payment for the services of the caregiver, 
        regardless of whether the caregiver is an employee of the 
        agency, at a rate comparable to the rate otherwise paid for 
        such services provided by other qualified personnel. In 
        addition, in the case of such a caregiver the agency shall 
        provide for appropriate training and oversight of such services 
        by a registered nurse in the same or similar manner to that 
        provided in the case of such services furnished by another 
        qualified individual and shall provide the caregiver, as part 
        of the plan of care, with educational information and resources 
        related to family caregiver health and wellness.
            ``(B) For purposes of this paragraph, the term `qualified 
        family caregiver' means, with respect to the provision of home 
        health aide services or personal care assistant services to an 
        individual, an individual who is a family caregiver (as defined 
        in section 372(2) of the National Family Caregiver Support Act) 
        of the individual and who demonstrates proficiency in the 
        provision of the home health aide services or personal care 
        assistant services involved to the satisfaction of the 
        supervising registered professional nurse.
            ``(C) This paragraph shall supersede any other restriction 
        of this title (including section 1862(a)(11)) on the provision 
        of home health aide services or personal care assistant 
        services by a qualified family caregiver described in 
        subparagraph (B) on the basis of the caregiver's relationship 
        to the recipient of such services. This subparagraph shall not 
        affect any disqualification of an individual from providing 
        services on the basis of the individual's lack of qualification 
        to provide the services or on the basis of an exclusion of 
        participation of the individual under part B of title XI.
            ``(D) The Secretary, in consultation with the Secretary of 
        Labor, shall provide guidance to home health agencies on 
        payment administration and management methodologies to 
        facilitate the provision of home health aide services and 
        personal assistant care services by qualified family caregivers 
        under this paragraph.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on January 1, 2005, and shall apply to services furnished 
on or after such date.
    (c) Construction.--Nothing in this section shall be construed as 
preventing the application of fraud and abuse sanctions (including 
those under sections 1128, 1128A, and 1128B of the Social Security Act) 
with respect to family caregivers under section 1891(a)(7) of the 
Social Security Act, as added by subsection (a), in the same manner as 
such sanctions may be applied to other individuals who provide home 
health aide services or personal assistant care services.
    (d) Prohibition of Denial of Services Because of Refusal of 
Physical Therapy Services During Rehabilitation.--Nothing in title 
XVIII of the Social Security Act shall be construed as authorizing the 
exclusion of coverage of skilled nursing services for an individual who 
is 75 years of age or older as part of home health services solely on 
the basis of the individual's refusal of physical therapy services 
during rehabilitation, regardless of whether such physical therapy 
services are part of the plan of care for the individual.

SEC. 3. AMENDMENTS TO FAMILY AND MEDICAL LEAVE ACT OF 1993.

    (a) Inclusion of Nurse Practitioners as Health Care.--Section 
101(6)(C) of the Family and Medical Leave Act of 1993 (29 U.S.C. 
2611(6)(C)) is amended--
            (1) by striking ``or'' at the end of subparagraph (A);
            (2) by redesignating subparagraph (B) as subparagraph (C); 
        and
            (3) by inserting after subparagraph (A) the following new 
        subparagraph:
                    ``(B) a nurse practitioner; or''.
    (b) Extension to Domestic Partners.--Section 101(13) of such Act 
(29 U.S.C. 2611(13)) is amended by inserting before the period at the 
end the following: ``, and includes a domestic or civil partner 
registered or recognized under the applicable domestic or civil 
partnership of State or local law''.
    (c) Extension of Period of Family or Medical Leave for Spouses 
Employed by Same Employer.--Section 102(f) of such Act (29 U.S.C. 
2612(f)) is amended ``12 workweeks'' and inserting ``24 workweeks''.
    (d) Clarification of Coverage of Outpatient Hospice Care.--Section 
101(11) of such Act (29 U.S.C. 2611(11)) is amended--
            (1) by striking ``or'' at the end of subparagraph (A);
            (2) by redesignating subparagraph (B) as subparagraph (C); 
        and
            (3) by inserting after subparagraph (A) the following new 
        subparagraph:
                    ``(B) hospice care; or''.