I 

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. 

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 ‘‘At Home Observation 

5 and Medical Evaluation Services Act of 2024’’ or the ‘‘At 

6 HOME Services Act’’. 


ssavage on LAPJG3WLY3PROD with BILLS
2 

•HR 7742 IH

1 SEC. 2. DEMONSTRATION PROGRAM FOR HOSPITALS TO 

2 PROVIDE OUTPATIENT OBSERVATION SERV3 ICES TO MEDICARE BENEFICIARIES AT 

4 HOME. 

5 Title XVIII of the Social Security Act (42 U.S.C. 

6 1395 et seq.) is amended by inserting after section 1866G 

7 the following new section: 

8 ‘‘SEC. 1866H. DEMONSTRATION PROGRAM FOR HOSPITALS 

9 TO PROVIDE OUTPATIENT OBSERVATION 

10 SERVICES AT HOME. 

11 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

12 date of enactment of this section, the Secretary shall im13 plement a 2-year demonstration program (in this section 

14 referred to as the ‘Program’) for hospitals to provide out15 patient observation services to eligible beneficiaries in the 

16 homes of such beneficiaries. In implementing such Pro17 gram, the Secretary shall grant waivers and flexibilities 

18 (as described in subsection (b)) to an individual hospital 

19 that submits a request for such waivers and flexibilities 

20 and meets specified criteria (as described in subsection 

21 (c)) in order to participate in the Program. 

22 ‘‘(b) WAIVERS AND FLEXIBILITIES.—For the pur23 poses of subsection (a), the waivers and flexibilities de24 scribed in this paragraph are the following waivers and 

25 flexibilities that were made available to individual hos26 pitals under the Acute Hospital Care at Home initiative 


ssavage on LAPJG3WLY3PROD with BILLS
3 

•HR 7742 IH

1 of the Secretary during the emergency period described 

2 in section 1135(g)(1)(B): 

3 ‘‘(1) Subject to subsection (c)(2), waiver of the 

4 requirements to provide 24-hour nursing services on 

5 premises and for the immediate availability of a reg6 istered nurse under section 482.23(b) of title 42, 

7 Code of Federal Regulations (or any successor regu8 lation), and the waivers of the physical environment 

9 and Life Safety Code requirements under section 

10 482.41 of title 42, Code of Federal Regulations (or 

11 any successor regulation). 

12 ‘‘(2) Waiver of the telehealth requirements 

13 under clause (i) of section 1834(m)(4)(C), as 

14 amended by section 4113(a) of the Health Extend15 ers, Improving Access to Medicare, Medicaid, and 

16 CHIP, and Strengthening Public Health Act of 

17 2022, such that the originating sites described in 

18 clause (ii) of such section shall include the home or 

19 temporary residence of the individual. 

20 ‘‘(3) Other waivers and flexibilities that, as of 

21 the date of enactment of this section, were in place 

22 for such initiative during such emergency period. 

23 ‘‘(c) SPECIFIED CRITERIA.—For purposes of sub24 section (a), the specified criteria for granting such waivers 

25 and flexibilities to individual hospitals are: 


ssavage on LAPJG3WLY3PROD with BILLS
4 

•HR 7742 IH

1 ‘‘(1) The hospital and any other entities pro2 viding services under arrangements with the hospital 

3 shall ensure that the standard of care to treat an eli4 gible beneficiary at home is the same as the stand5 ard of care to treat such beneficiary as an inpatient 

6 of the hospital. 

7 ‘‘(2) The hospital shall meet all patient safety 

8 standards determined appropriate by the Secretary, 

9 in addition to those that otherwise apply to the hos10 pital, except those for which the waivers and flexi11 bilities under this subsection apply. 

12 ‘‘(3) The hospital shall provide to the Secretary, 

13 at a time, form and manner determined by the Sec14 retary, any data and information the Secretary de15 termines necessary to do the following: 

16 ‘‘(A) Monitor the quality of care furnished, 

17 and to the extent practicable ensure the safety 

18 of, eligible beneficiaries and analyze costs of 

19 such care. 

20 ‘‘(B) Undertake the study described in 

21 subsection (e). 

22 ‘‘(4) The hospital meets such other require23 ments and conditions as the Secretary determines 

24 appropriate. 


ssavage on LAPJG3WLY3PROD with BILLS
5 

•HR 7742 IH

1 ‘‘(d) TERMINATION.—The Secretary may terminate a 

2 hospital from participation in the Program (and the waiv3 ers and flexibilities applicable to such hospital) if the Sec4 retary determines that the hospital no longer meets the 

5 criteria described in subsection (c). 

6 ‘‘(e) STUDY AND REPORT.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall con8 duct a study to— 

9 ‘‘(A) analyze, to the extent practicable, the 

10 criteria established by hospitals to determine 

11 which beneficiaries may be furnished services 

12 under the Program; and 

13 ‘‘(B) analyze and compare, to the extent 

14 practicable— 

15 ‘‘(i) the quality of care furnished to 

16 beneficiaries with similar conditions and 

17 characteristics in the hospital setting and 

18 through the Program, including health out19 comes, hospital readmission rates, hospital 

20 mortality rates, length of stay, infection 

21 rates, and patient experience of care; 

22 ‘‘(ii) clinical conditions treated and di23 agnosis-related groups of discharges from 

24 the hospital setting and under the Pro25 gram; 


ssavage on LAPJG3WLY3PROD with BILLS
6 

•HR 7742 IH

1 ‘‘(iii) costs incurred by furnishing care 

2 in the hospital setting and through the 

3 Program; 

4 ‘‘(iv) the quantity, mix and intensity 

5 of such services (such as in-person visits 

6 and virtual contacts with patients) fur7 nished under the Program and furnished 

8 in the hospital setting; and 

9 ‘‘(v) socioeconomic information on 

10 beneficiaries treated under the Program, 

11 including racial and ethnic data, income, 

12 and whether such beneficiaries are dually 

13 eligible for benefits under this title and 

14 title XIX. 

15 ‘‘(2) REPORT.—Not later than 1 year after the 

16 completion of the Program, the Secretary shall post 

17 on a website of the Centers for Medicare & Medicaid 

18 Services a report on the study conducted under 

19 paragraph (1). 

20 ‘‘(f) IMPLEMENTATION.—Notwithstanding any other 

21 provision of law, the Secretary may implement this section 

22 by program instruction or otherwise. 

23 ‘‘(g) PUBLICLY AVAILABLE INFORMATION.—The 

24 Secretary shall, as feasible, make the information collected 


ssavage on LAPJG3WLY3PROD with BILLS
7 

•HR 7742 IH

1 under subsections (c)(3) and (e)(1) available on the Medi2 care.gov Internet website (or a successor website).’’. 

Æ 


ssavage on LAPJG3WLY3PROD with BILLS