```

[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1874 Introduced in House (IH)]

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.

    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 ``David Jayne Homebound Reform Act of 
2003''.

SEC. 2. DEMONSTRATION PROJECT TO CLARIFY THE DEFINITION OF HOMEBOUND.

    (a) Demonstration Project.--Not later than January 1, 2004, the 
Secretary shall conduct a demonstration project under which medicare 
beneficiaries with chronic conditions described in subsection (b) are 
deemed to be homebound for purposes of receiving home health services 
under the medicare program.
    (b) Medicare Beneficiary Described.--For purposes of subsection 
(a), a medicare beneficiary is eligible to be deemed to be homebound, 
without regard to the purpose, frequency, or duration of absences from 
the home, if the beneficiary--
            (1) has been certified by a physician as an individual who 
        has a permanent and severe condition that will not improve;
            (2) requires the individual to receive assistance from 
        another individual with at least 3 out of the 5 activities of 
        daily living for the rest of the individual's life;
            (3) requires 1 or more home health services to achieve a 
        functional condition that gives the individual the ability to 
        leave home; and
            (4) requires technological assistance or the assistance of 
        another person to leave the home.
    (c) Data.--The Secretary shall collect such data on the 
demonstration project with respect to the provision of home health 
services to medicare beneficiaries that relates to quality of care, 
patient outcomes, and additional costs, if any, to the medicare 
program.
    (d) Reports to Congress.--(1) Not later than 1 year after the date 
of the implementation of the demonstration project under this section, 
the Secretary shall submit to Congress an initial report on the project 
using the data collected under subsection (c).
    (2) Not later than 1 year after the date of submittal of the report 
under paragraph (1), the Secretary shall submit to Congress an 
additional report on the project using the data collected under 
subsection (c).
    (e) Waiver Authority.--The Secretary shall waive compliance with 
the requirements of title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) to such extent and for such period as the Secretary 
determines is necessary to conduct demonstration projects.
    (f) Construction.--Nothing in this section shall be construed as 
waiving any applicable civil monetary penalty, criminal penalty, or 
other remedy available to the Secretary under title XI or title XVIII 
of the Social Security Act for acts prohibited under such titles, 
including penalties for false certifications for purposes of receipt of 
items or services under the medicare program.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated from the Federal Hospital Insurance Trust Fund and the 
Federal Supplementary Insurance Trust Fund under title XVIII of the 
Social Security Act (42 U.S.C. 1395i, 1395t), in such proportions as 
the Secretary determines to be appropriate, such funds as are necessary 
for the costs of carrying out the demonstration project under this 
section.
    (h) Definitions.--In this section:
            (1) Medicare beneficiary.--The term ``medicare 
        beneficiary'' means an individual entitled to benefits under 
        part A of this title, enrolled under part B of this title, or 
        both.
            (2) Home health services.--The term ``home health 
        services'' has the meaning given such term in section 1861(m) 
        of the Social Security Act (42 U.S.C. 1395x(m)).
            (3) Activities of daily living defined.--The term 
        ``activities of daily living'' means eating, toileting, 
        transferring, bathing, and dressing.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 3. CLARIFICATION OF THE DEFINITION OF HOMEBOUND FOR PURPOSES OF 
              DETERMINING ELIGIBILITY FOR HOME HEALTH SERVICES UNDER 
              THE MEDICARE PROGRAM.

    (a) Clarification.--Sections 1814(a) and 1835(a) of the Social 
Security Act (42 U.S.C. 1395f(a); 1395n(a)) are each amended by adding 
at the end the following: ``Notwithstanding the preceding sentences, in 
the case of an individual who has been certified by a physician as an 
individual who has a permanent and severe condition that will not 
improve and requires the individual to receive assistance from another 
individual with at least 3 out of the 5 activities of daily living for 
the rest of the individual's life, who requires 1 or more home health 
services described in section 1861(m) to achieve a functional condition 
that gives the individual the ability to leave home, and who requires 
technological assistance or the assistance of another person to leave 
the home, the Secretary may not disqualify such individual from being 
considered to be `confined to his home' based on the purpose, 
frequency, or duration of the absences from the home. For purposes of 
the preceding sentence, the term `activities of daily living' means 
eating, toileting, transferring, bathing, and dressing.''.
    (b) Contingent Effective Date.--(1) The amendments made by 
subsection (a) shall become effective (if at all) in accordance with 
paragraph (2).
    (2)(A) Not later than December 1, 2006, the Secretary of Health and 
Human Services (in this paragraph referred to as the ``Secretary'') 
shall submit to Congress a report on the results of the demonstration 
project established under section 2 that analyzes the effect of the 
demonstration project on the provision of home health services under 
the medicare program.
    (B) Such project shall be discontinued, and the amendments made by 
subsection (a) shall become effective, on January 1, 2007, unless the 
Secretary includes in that report a finding, on the basis of data 
collected under section 2(c) that the clarification of the definition 
of homebound under the demonstration project--
            (i) adversely effects the provision of home health services 
        under the medicare program; or
            (ii) directly causes an unreasonable increase of 
        expenditures under the medicare program for the provision of 
        such services that is directly attributable to such 
        clarification.
    (C) If the Secretary includes in the report under subparagraph (B) 
a finding referred to in subparagraph (B)(ii), the Secretary shall 
include in such report--
            (i) the specific data evidencing the amount of the increase 
        in expenditures that is a directly attributable to the 
        clarification (expressed both in absolute dollar terms and as a 
        percentage) above expenditures incurred for home health 
        services under the medicare program made for home health 
        services that are covered under the program without regard to 
        this Act; and
            (ii) specific recommendations to exempt permanently and 
        severely disabled homebound beneficiaries from restrictions on 
        the length, frequency and purpose of their absences from the 
        home to qualify for home health services without incurring 
        additional unreasonable costs to the medicare program.
    (c) Technical Amendments.--(1) Sections 1814(a) and 1835(a) of the 
Social Security Act (42 U.S.C. 1395f(a); 1395n(a)) are each amended in 
the sixth sentence by striking ``leave home,'' and inserting ``leave 
home and''.
    (2) Section 1814(a) of the Social Security Act (42 U.S.C. 
1395f(a)), as amended by subsection (a), is amended by moving the 
seventh sentence, as added by section 322(a)(1) of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 
(appendix F, 114 Stat. 2763A-501), as enacted into law by section 
1(a)(6) of Public Law 106-554, to the end of that section.
                                 <all>
```