I 

108TH CONGRESS 

1ST SESSION H. R. 1874

To establish a demonstration project to clarify the definition of homebound 

for purposes of determining eligibility for home health services under 

the Medicare Program, and to conditionally authorize that clarification. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 30, 2003

Mr. MARKEY (for himself and Mr. SMITH of New Jersey) 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 establish a demonstration project to clarify the definition 

of homebound for purposes of determining eligibility for 

home health services under the Medicare Program, and 

to conditionally authorize that clarification.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘David Jayne Home5 bound Reform Act of 2003’’. 
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1 SEC. 2. DEMONSTRATION PROJECT TO CLARIFY THE DEFI2 NITION OF HOMEBOUND. 

3 (a) DEMONSTRATION PROJECT.—Not later than Jan4 uary 1, 2004, the Secretary shall conduct a demonstration 

5 project under which medicare beneficiaries with chronic 

6 conditions described in subsection (b) are deemed to be 

7 homebound for purposes of receiving home health services 

8 under the medicare program. 

9 (b) MEDICARE BENEFICIARY DESCRIBED.—For pur10 poses of subsection (a), a medicare beneficiary is eligible 

11 to be deemed to be homebound, without regard to the pur12 pose, frequency, or duration of absences from the home, 

13 if the beneficiary—

14 (1) has been certified by a physician as an indi15 vidual who has a permanent and severe condition 

16 that will not improve; 

17 (2) requires the individual to receive assistance 

18 from another individual with at least 3 out of the 5 

19 activities of daily living for the rest of the individ20 ual’s life; 

21 (3) requires 1 or more home health services to 

22 achieve a functional condition that gives the indi23 vidual the ability to leave home; and 

24 (4) requires technological assistance or the as25 sistance of another person to leave the home. 
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1 (c) DATA.—The Secretary shall collect such data on 

2 the demonstration project with respect to the provision of 

3 home health services to medicare beneficiaries that relates 

4 to quality of care, patient outcomes, and additional costs, 

5 if any, to the medicare program. 

6 (d) REPORTS TO CONGRESS.—(1) Not later than 1 

7 year after the date of the implementation of the dem8 onstration project under this section, the Secretary shall 

9 submit to Congress an initial report on the project using 

10 the data collected under subsection (c). 

11 (2) Not later than 1 year after the date of submittal 

12 of the report under paragraph (1), the Secretary shall sub13 mit to Congress an additional report on the project using 

14 the data collected under subsection (c). 

15 (e) WAIVER AUTHORITY.—The Secretary shall waive 

16 compliance with the requirements of title XVIII of the So17 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

18 and for such period as the Secretary determines is nec19 essary to conduct demonstration projects. 

20 (f) CONSTRUCTION.—Nothing in this section shall be 

21 construed as waiving any applicable civil monetary pen22 alty, criminal penalty, or other remedy available to the 

23 Secretary under title XI or title XVIII of the Social Secu24 rity Act for acts prohibited under such titles, including 
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1 penalties for false certifications for purposes of receipt of 

2 items or services under the medicare program. 

3 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated from the Federal Hospital 

5 Insurance Trust Fund and the Federal Supplementary In6 surance Trust Fund under title XVIII of the Social Secu7 rity Act (42 U.S.C. 1395i, 1395t), in such proportions as 

8 the Secretary determines to be appropriate, such funds as 

9 are necessary for the costs of carrying out the demonstra10 tion project under this section. 

11 (h) DEFINITIONS.—In this section: 

12 (1) MEDICARE BENEFICIARY.—The term 

13 ‘‘medicare beneficiary’’ means an individual entitled 

14 to benefits under part A of this title, enrolled under 

15 part B of this title, or both. 

16 (2) HOME HEALTH SERVICES.—The term 

17 ‘‘home health services’’ has the meaning given such 

18 term in section 1861(m) of the Social Security Act 

19 (42 U.S.C. 1395x(m)). 

20 (3) ACTIVITIES OF DAILY LIVING DEFINED.—

21 The term ‘‘activities of daily living’’ means eating, 

22 toileting, transferring, bathing, and dressing. 

23 (4) SECRETARY.—The term ‘‘Secretary’’ means 

24 the Secretary of Health and Human Services. 
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1 SEC. 3. CLARIFICATION OF THE DEFINITION OF HOME2 BOUND FOR PURPOSES OF DETERMINING 

3 ELIGIBILITY FOR HOME HEALTH SERVICES 

4 UNDER THE MEDICARE PROGRAM. 

5 (a) CLARIFICATION.—Sections 1814(a) and 1835(a) 

6 of the Social Security Act (42 U.S.C. 1395f(a); 1395n(a)) 

7 are each amended by adding at the end the following: 

8 ‘‘Notwithstanding the preceding sentences, in the case of 

9 an individual who has been certified by a physician as an 

10 individual who has a permanent and severe condition that 

11 will not improve and requires the individual to receive as12 sistance from another individual with at least 3 out of the 

13 5 activities of daily living for the rest of the individual’s 

14 life, who requires 1 or more home health services described 

15 in section 1861(m) to achieve a functional condition that 

16 gives the individual the ability to leave home, and who re17 quires technological assistance or the assistance of another 

18 person to leave the home, the Secretary may not disqualify 

19 such individual from being considered to be ‘confined to 

20 his home’ based on the purpose, frequency, or duration 

21 of the absences from the home. For purposes of the pre22 ceding sentence, the term ‘activities of daily living’ means 

23 eating, toileting, transferring, bathing, and dressing.’’. 

24 (b) CONTINGENT EFFECTIVE DATE.—(1) The 

25 amendments made by subsection (a) shall become effective 

26 (if at all) in accordance with paragraph (2). 
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1 (2)(A) Not later than December 1, 2006, the Sec2 retary of Health and Human Services (in this paragraph 

3 referred to as the ‘‘Secretary’’) shall submit to Congress 

4 a report on the results of the demonstration project estab5 lished under section 2 that analyzes the effect of the dem6 onstration project on the provision of home health services 

7 under the medicare program. 

8 (B) Such project shall be discontinued, and the 

9 amendments made by subsection (a) shall become effec10 tive, on January 1, 2007, unless the Secretary includes 

11 in that report a finding, on the basis of data collected 

12 under section 2(c) that the clarification of the definition 

13 of homebound under the demonstration project—

14 (i) adversely effects the provision of home 

15 health services under the medicare program; or 

16 (ii) directly causes an unreasonable increase of 

17 expenditures under the medicare program for the 

18 provision of such services that is directly attributable 

19 to such clarification. 

20 (C) If the Secretary includes in the report under sub21 paragraph (B) a finding referred to in subparagraph 

22 (B)(ii), the Secretary shall include in such report—

23 (i) the specific data evidencing the amount of 

24 the increase in expenditures that is a directly attrib25 utable to the clarification (expressed both in absolute 
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1 dollar terms and as a percentage) above expendi2 tures incurred for home health services under the 

3 medicare program made for home health services 

4 that are covered under the program without regard 

5 to this Act; and 

6 (ii) specific recommendations to exempt perma7 nently and severely disabled homebound beneficiaries 

8 from restrictions on the length, frequency and pur9 pose of their absences from the home to qualify for 

10 home health services without incurring additional 

11 unreasonable costs to the medicare program. 

12 (c) TECHNICAL AMENDMENTS.—(1) Sections 

13 1814(a) and 1835(a) of the Social Security Act (42 U.S.C. 

14 1395f(a); 1395n(a)) are each amended in the sixth sen15 tence by striking ‘‘leave home,’’ and inserting ‘‘leave home 

16 and’’. 

17 (2) Section 1814(a) of the Social Security Act (42 

18 U.S.C. 1395f(a)), as amended by subsection (a), is amend19 ed by moving the seventh sentence, as added by section 

20 322(a)(1) of the Medicare, Medicaid, and SCHIP Benefits 

21 Improvement and Protection Act of 2000 (appendix F, 

22 114 Stat. 2763A–501), as enacted into law by section 

23 1(a)(6) of Public Law 106–554, to the end of that section.

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