I

107TH CONGRESS

1ST SESSION H. R. 913

To amend title XVIII of the Social Security Act to provide for coverage

of expanded nursing facility and in-home services for dependent individuals under the Medicare Program.

IN THE HOUSE OF REPRESENTATIVES

MARCH 7, 2001

Mr. ENGEL (for himself and Mr. BRADY of Pennsylvania) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 provide

for coverage of expanded nursing facility and in-home

services for dependent individuals under the Medicare

Program.

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 ‘‘Comprehensive Long5 Term Care Act of 2001’’.
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1 SEC. 2. EXPANDED LONG-TERM CARE SERVICES UNDER

2 MEDICARE PROGRAM FOR DEPENDENT INDI3 VIDUALS.

4 (a) IN GENERAL.—

5 (1) PART A.—Section 1812 of the Social Secu6 rity Act (42 U.S.C. 1395d) is amended—

7 (A) in subsection (a)—

8 (i) in paragraph (2)(B), by striking

9 ‘‘subsection (f),’’ and inserting ‘‘subsection

10 (f) and section 1889,’’,

11 (ii) by striking ‘‘and’’ at the end of

12 paragraph (3),

13 (iii) by striking the period at the end

14 of paragraph (4) and inserting ‘‘; and’’,

15 and

16 (iv) by adding at the end the following

17 new paragraph:

18 ‘‘(5) long-term care services consisting of ex19 tended care services (in accordance with section

20 1889).’’; and

21 (B) in subsection (b)(2), by striking ‘‘post22 hospital’’ and inserting ‘‘except as provided in

23 section 1889, post-hospital’’.

24 (2) PART B.—Section 1861(s)(2) of the Social

25 Security Act (42 U.S.C. 1395x(s)(2)), as amended

26 by sections 102(a) and 105(a) of the Medicare, Med-
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1 icaid, and SCHIP Benefits Improvement and Pro2 tection Act of 2000, as enacted into law by section

3 1(a)(6) of Public Law 106–554, is amended—

4 (1) by striking ‘‘and’’ at the end of subpara5 graph (U);

6 (2) by inserting ‘‘and’’ at the end of subpara7 graph (V); and

8 (3) by adding at the end the following new sub9 paragraph:

10 ‘‘(W) long-term care services consisting of in11 home care (in accordance with section 1889);’’.

12 (b) DESCRIPTION OF SERVICES; ELIGIBILITY.—Title

13 XVIII of such Act is amended by inserting after section

14 1888 the following new section:

15 ‘‘LONG-TERM CARE SERVICES FOR DEPENDENT

16 INDIVIDUALS

17 ‘‘SEC. 1889. (a) IN GENERAL.—An individual enti18 tled to benefits under this part shall be entitled to have

19 payments made on the individual’s behalf for long-term

20 care services if—

21 ‘‘(1) the individual is a dependent individual;

22 and

23 ‘‘(2) such services are provided in accordance

24 with a case management plan developed by a case

25 management agency.
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1 ‘‘(b) SERVICES PROVIDED.—In this section, the term

2 ‘long-term care services’ means—

3 ‘‘(1) in-home care (as defined in subsection (e));

4 and

5 ‘‘(2) extended care services (as defined in sec6 tion 1861(h)), but only with respect to a chronically

7 dependent individual.

8 ‘‘(c) PAYMENT FOR SERVICES.—

9 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

10 the amount payable for long-term care services

11 under this section shall be determined in accordance

12 with a fee schedule for such services established by

13 the Secretary.

14 ‘‘(2) IMPOSITION OF DEDUCTIBLE.—The

15 amount otherwise payable for long-term care services

16 under this section furnished during a calendar year

17 shall be reduced by an amount equal to the deduct18 ible imposed for inpatient hospital services for the

19 year under section 1813(a)(1).

20 ‘‘(d) DEPENDENT INDIVIDUAL DEFINED.—

21 ‘‘(1) IN GENERAL.—In this section, the term

22 ‘dependent individual’ means an individual who—

23 ‘‘(A) is unable to perform (without sub24 stantial assistance from another individual) be25 cause of physical or cognitive impairment at
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1 least 2 of the following activities of daily living:

2 bathing, dressing, toileting, transferring, and

3 eating; or

4 ‘‘(B) has a similar level of disability due to

5 cognitive impairment that requires substantial

6 direction, instruction, or supervision of another

7 individual in order—

8 ‘‘(i) to perform 2 or more of the ac9 tivities of daily living described in subpara10 graph (A), or

11 ‘‘(ii) to remain in the community

12 without causing harm to self or others be13 cause of inappropriate behavioral patterns.

14 ‘‘(2) CHRONICALLY DEPENDENT INDIVIDUAL.—

15 In this section, the term ‘chronically dependent indi16 vidual’ means an individual described in paragraph

17 (1) who—

18 ‘‘(A) for purposes of subparagraph (A) of

19 such paragraph, is unable to perform at least 3

20 of the activities of daily living described in such

21 subparagraph; or

22 ‘‘(B) for purposes of subparagraph (B)(i)

23 of such paragraph, has a level of disability that

24 requires direction, instruction, or supervision of
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1 another individual to perform 3 or more of such

2 activities of daily living.

3 ‘‘(3) ACTIVITIES OF DAILY LIVING DEFINED.—

4 The ‘activities of daily living’ referred to in this sub5 section are as follows:

6 ‘‘(A) Eating.

7 ‘‘(B) Bathing.

8 ‘‘(C) Dressing.

9 ‘‘(D) Toileting.

10 ‘‘(E) Transferring in and out of a bed or

11 in and out of a chair.

12 ‘‘(e) IN-HOME CARE.—

13 ‘‘(1) IN GENERAL.—For purposes of this sec14 tion, the term ‘in-home care’ means the items and

15 services described in paragraph (2) furnished to an

16 individual by a home care agency (as defined in sec17 tion 1861(ww)) or by others under arrangements

18 with them made by the agency provided in a place

19 of residence used as such individual’s home (other

20 than services described in paragraph (2)(H)).

21 ‘‘(2) SERVICES DESCRIBED.—The items and

22 services described in this paragraph are as follows:

23 ‘‘(A) Nursing care provided by or under

24 the supervision of a registered professional

25 nurse.
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1 ‘‘(B) Services of a homemaker/home health

2 aide who has successfully completed a training

3 and competency evaluation program approved

4 by the Secretary.

5 ‘‘(C) Personal care services.

6 ‘‘(D) Medical social services.

7 ‘‘(E) Physical, occupational, or respiratory

8 therapy or speech-language pathology.

9 ‘‘(F) Medical supplies (other than drugs

10 and biologicals) and durable medical equipment,

11 while under such a plan.

12 ‘‘(G) Patient and caregiver (including fam13 ily caregiver) education and training to develop

14 skills necessary to permit the individual to re15 main in the home setting.

16 ‘‘(H) Community care services furnished

17 outside of the place of residence.

18 ‘‘(I) Such other home-based items and

19 services (other than room and board) as the

20 Secretary may approve.

21 ‘‘(f) CASE MANAGEMENT REQUIREMENTS.—

22 ‘‘(1) REQUESTS FOR ASSESSMENT.—Each indi23 vidual entitled to benefits under this title (or an24 other person on such individual’s behalf) may re25 quest a case management agency to conduct an as-
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1 sessment under this section to determine whether

2 the individual is a dependent individual or a chron3 ically dependent individual.

4 ‘‘(2) DESCRIPTION OF PLANS.—For purposes of

5 this section, a ‘case management plan’ means, with

6 respect to an individual, a written plan of care

7 which—

8 ‘‘(A) is established and periodically re9 viewed and revised by a case management agen10 cy; and

11 ‘‘(B) reflects the individual’s needs identi12 fied in the assessment under paragraph (1).

13 ‘‘(3) CASE MANAGEMENT AGENCY DEFINED.—

14 In this section, the term ‘case management agency’

15 means a nonprofit or public agency or organization

16 (or a nonprofit or public subdivision of such an

17 agency or organization) certified by the Secretary to

18 conduct assessments and establish case management

19 plans under this subsection which—

20 ‘‘(A) is experienced in conducting assess21 ments, in establishing and periodically reviewing

22 and revising case management plans for nurs23 ing facility services and in-home care, and in

24 coordinating and reviewing the quality of the

25 provision of such services and care;
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1 ‘‘(B) is capable of efficiently and effectively

2 performing directly or through contracts under

3 paragraph (4) such duties; and

4 ‘‘(C) does not provide nursing facility serv5 ices or in-home care and does not have a direct

6 or indirect ownership or control interest in, or

7 direct or indirect affiliation or relationship with,

8 an entity that provides, such services or care.

9 ‘‘(4) CONTRACTING OUT CERTAIN FUNC10 TIONS.—The Secretary shall permit a case manage11 ment agency, to the extent necessary to carry out

12 functions under this section, to provide for assess13 ments and case management plans through con14 tracts with nonprofit or public organizations which

15 do not provide nursing facility services or in-home

16 care and do not have a direct or indirect ownership

17 or control interest in, or direct or indirect affiliation

18 or relationship with, an entity that provides, such

19 services or care.’’.

20 (c) CONFORMING AMENDMENTS.—(1) Section

21 1833(a)(1) of the Social Security Act (42 U.S.C.

22 1395l(a)(1)), as amended by sections 105(c) and 223(c)

23 of the Medicare, Medicaid, and SCHIP Benefits Improve24 ment and Protection Act of 2000, as enacted into law by

25 section 1(a)(6) of Public Law 106–554, is amended—
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1 (A) by striking ‘‘and’’ before ‘‘(U)’’; and

2 (B) by inserting before the semicolon at the end

3 the following: ‘‘, and (V) with respect to expenses in4 curred for services described in section

5 1861(s)(2)(W), the amounts paid shall be the

6 amounts determined under section 1889(c);’’.

7 (2) Section 1861 of the Social Security Act (42

8 U.S.C. 1395x), as amended by sections 102(b) and 105(b)

9 of the Medicare, Medicaid, and SCHIP Benefits Improve10 ment and Protection Act of 2000, as enacted into law by

11 section 1(a)(6) of Public Law 106–554, is amended by

12 adding at the end the following new subsection:

13 ‘‘HOME CARE AGENCY

14 ‘‘(ww) The term ‘home care agency’ means a public

15 agency or private organization, or a subdivision of such

16 an agency or organization, which is a home health agency

17 (as defined in subsection (o)) or—

18 ‘‘(1) is primarily engaged in providing services

19 of homemaker/home health aides and personal care

20 aides;

21 ‘‘(2) maintains clinical records on all patients;

22 ‘‘(3) in the case of an agency or organization in

23 any State in which State or applicable local law pro24 vides for the licensing of agencies or organizations of

25 this nature—

26 ‘‘(A) is licensed pursuant to such law, or
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1 ‘‘(B) is approved, by the agency of such

2 State or locality, responsible for licensing agen3 cies or organizations of this nature, as meeting

4 the standards established for such licensing;

5 and

6 ‘‘(4) meets such other requirements as the Sec7 retary may find necessary in the interest of the

8 health and safety of individuals who are furnished

9 services by such agency or organization and for the

10 effective and efficient operation of the program.’’.

11 (d) EFFECTIVE DATE.—The amendments made by

12 this section shall apply to items and services furnished on

13 or after January 1, 2002.

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