II 

117TH CONGRESS 

1ST SESSION S. 2562 

To amend title XVIII of the Social Security Act to improve extended care 

services by providing Medicare beneficiaries with an option for cost effective home-based extended care under the Medicare program, and for 

other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 29, 2021 

Ms. STABENOW (for herself, Mr. YOUNG, Ms. HASSAN, Ms. COLLINS, Mr. 

CASEY, Mr. LANKFORD, Mr. CARDIN, and Ms. LUMMIS) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to improve 

extended care services by providing Medicare beneficiaries with an option for cost effective home-based 

extended care under the Medicare program, and for other 

purposes. 

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 ‘‘Choose Home Care 

5 Act of 2021’’. 


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1 SEC. 2. ESTABLISHMENT OF A HOME-BASED EXTENDED 

2 CARE SERVICES BENEFIT AS PART OF MEDI3 CARE. 

4 (a) IMPROVED SUPPORT FOR HEALTH CARE AT

5 HOME.— 

6 (1) IN GENERAL.—Section 1812 of the Social 

7 Security Act (42 U.S.C. 1395d) is amended— 

8 (A) in subsection (a)— 

9 (i) in paragraph (2)(A), by inserting 

10 ‘‘(reduced by the number of days of home11 based extended care services furnished 

12 under paragraph (6) during such spell of 

13 illness)’’ after ‘‘spell of illness’’; 

14 (ii) in paragraph (4), by striking 

15 ‘‘and’’ at the end; 

16 (iii) in paragraph (5), by striking the 

17 period at the end and inserting ‘‘; and’’; 

18 and 

19 (iv) by adding at the end the following 

20 new paragraph: 

21 ‘‘(6)(A) home-based extended care services for a 

22 30-day episode for individuals who otherwise qualify 

23 for post-hospital extended care services under para24 graph (2)(A); 


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1 ‘‘(B) to the extent provided in subsection (f), 

2 home-based extended care services that are not post3 hospital home-based extended care services; and 

4 ‘‘(C) in such circumstances as the Secretary 

5 may specify, home-based extended care services for 

6 one or more subsequent 30-day episode or episodes 

7 up to a maximum of 100 days of home-based ex8 tended care services in a spell of illness.’’; 

9 (B) in subsection (b)— 

10 (i) in paragraph (2), by striking ‘‘or’’ 

11 at the end; 

12 (ii) in paragraph (3), by striking the 

13 period at the end and inserting ‘‘; or’’; and 

14 (iii) by inserting after paragraph (3) 

15 the following new paragraph: 

16 ‘‘(4) home-based extended care services fur17 nished to an individual after such services have been 

18 furnished to the individual for a 30-day episode dur19 ing such spell, except as provided by the Secretary 

20 pursuant to subparagraph (B) or (C) of subsection 

21 (a)(6).’’; and 

22 (C) in subsection (f)— 

23 (i) in paragraph (1)— 

24 (I) by inserting ‘‘and, under sub25 section (a)(6)(B), of home-based exVerDate Sep 11 2014 19:22 Aug 05, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2562.IS S2562

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1 tended care services, as applicable,’’ 

2 after ‘‘extended care services’’ the 

3 first place it appears; 

4 (II) by inserting ‘‘or post-hospital 

5 home-based extended care services’’ 

6 after ‘‘post-hospital extended care 

7 services’’; and 

8 (III) by inserting ‘‘or subsection 

9 (a)(6), as applicable’’ before the pe10 riod; and 

11 (ii) in paragraph (2)— 

12 (I) in subparagraph (A), by in13 serting ‘‘or subsection (a)(6)(B), as 

14 applicable’’ after ‘‘subsection 

15 (a)(2)(B)’’; and 

16 (II) in subparagraph (B), by 

17 striking ‘‘subsection’’ and inserting 

18 ‘‘subsections’’. 

19 (2) COINSURANCE AND DEDUCTIBLE.—Section 

20 1813(a)(3) of the Social Security Act (42 U.S.C. 

21 1395e(a)(3)) is amended by inserting the following 

22 before the period: ‘‘(or, in the case where an indi23 vidual is furnished post-hospital home-based ex24 tended care services, after such services (or a com25 bination of such services and post-hospital extended 


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1 care services) have been furnished to him for 20 

2 days during such spell)’’. 

3 (3) CERTIFICATION REQUIREMENT.—Section 

4 1814(a)(2) of the Social Security Act (42 U.S.C. 

5 1395f(a)(2)) is amended— 

6 (A) in the matter preceding subparagraph 

7 (A), by inserting ‘‘or (E)’’ after ‘‘subparagraph 

8 (C)’’; 

9 (B) in subparagraph (C), by striking ‘‘or’’ 

10 at the end; 

11 (C) in subparagraph (D), by inserting ‘‘or’’ 

12 after the semicolon; and 

13 (D) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(E) in the case of post-hospital home16 based extended care services, such services are 

17 or were required to be furnished because the in18 dividual otherwise needs or needed and qualifies 

19 for extended care services in a skilled nursing 

20 facility payable under this part under subpara21 graph (B), and such individual does not qualify 

22 for services in an inpatient rehabilitation facil23 ity or long-term care hospital payable under 

24 this part;’’. 


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1 (4) POST-HOSPITAL EXTENDED CARE SERV2 ICES.—Section 1861(i) of the Social Security Act 

3 (42 U.S.C. 1395x(i)) is amended, in the second sen4 tence— 

5 (A) by striking ‘‘or (B)’’ and inserting 

6 ‘‘(B)’’; and 

7 (B) by inserting the following before the 

8 period ‘‘, or (C) in the case of an individual re9 ceiving post-hospital home-based extended care 

10 services, within 30 days after discharge from a 

11 hospital’’. 

12 (5) DEFINITION OF HOME-BASED EXTENDED

13 CARE SERVICES.—Section 1861 of the Social Secu14 rity Act (42 U.S.C. 1395x) is amended by adding at 

15 the end the following new subsection: 

16 ‘‘Home-Based Extended Care Services 

17 ‘‘(lll)(1) The term ‘home-based extended care serv18 ices’ means the following items and services furnished to 

19 an individual in the individual’s home by a home health 

20 agency (as defined in subsection (o) including the addi21 tional requirements under paragraph (9) of such sub22 section), or by others under arrangements with such agen23 cy: 

24 ‘‘(A) Nursing care, other than as described in 

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1 communications technology as a supplement to daily 

2 in-person care. 

3 ‘‘(B) Physical or occupational therapy or 

4 speech-language pathology services, other than as 

5 described in subsection (m), including when provided 

6 using telecommunications as a supplement to daily 

7 in-person care. 

8 ‘‘(C) Meals and nutritional support. 

9 ‘‘(D) Remote patient monitoring as a supple10 ment to in-person care other than as described in 

11 subsection (m). 

12 ‘‘(E) Medical social services other than as de13 scribed in subsection (m). 

14 ‘‘(F) Services of a home health aide other than 

15 as described in subsection (m) and personal care 

16 services. 

17 ‘‘(G) Respite care, family caregiver and other 

18 unpaid caregiver supports, education, and training 

19 resources. 

20 ‘‘(H) Assistance with adherence to drugs pre21 scribed for the individual. 

22 ‘‘(I) Medical supplies, appliances, and equip23 ment, other than those described in subsection (m), 

24 for use in the home, including related to bathing, 

25 dressing, toileting, walking, or feeding. 


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1 ‘‘(J) Nonemergency medical transportation 

2 other than ambulance services. 

3 ‘‘(K) Care coordination and integration, includ4 ing providing discharge planning and care transi5 tions support to the individual and family and other 

6 unpaid caregivers, including referral for person-cen7 tered counseling or options counseling from their 

8 State’s Aging and Disability Resource Center/No 

9 Wrong Door System, upon completion of a 30-day 

10 episode or one or more subsequent 30-day episode or 

11 episodes, if applicable, under section 1812(a)(6)(C). 

12 To the greatest extent possible, care transitions sup13 port services provided as part of home-based ex14 tended care services should use evidence-based mod15 els and practices, particularly those that employ 

16 face-to-face visits. 

17 ‘‘(L) Such other items and services as the home 

18 health agency determines are necessary for the care 

19 of the individual in the home. 

20 ‘‘(2) Nothing in this subsection shall be construed as 

21 impacting an individual’s eligibility for transition of care 

22 services under any other provision of this title or otherwise 

23 for which the individual is eligible.’’. 


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1 (6) DISCHARGE PLANNING.—Section 

2 1861(ee)(2) of the Social Security Act (42 U.S.C. 

3 1395x(ee)(2)) is amended— 

4 (A) in subparagraph (D)— 

5 (i) by striking ‘‘hospice care and post6 hospital extended care services’’ and insert7 ing ‘‘hospice care, post-hospital extended 

8 care services, post-hospital home-based ex9 tended care services, and services furnished 

10 by inpatient rehabilitation facilities and 

11 units and long-term care hospitals’’; and 

12 (ii) by inserting ‘‘and home-based ex13 tended care services’’ after ‘‘home health 

14 services’’; and 

15 (B) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(I) The discharge planning evaluation and dis18 charge plan for an individual who meets applicable 

19 standards and criteria for extended care services 

20 under section 1812, and who does not need services 

21 provided by an inpatient rehabilitation facility or 

22 unit or a long-term care hospital, shall include, in 

23 addition to the items described in subparagraph 

24 (D)— 


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1 ‘‘(i) an evaluation, in coordination with a 

2 qualified home health agency, of the appro3 priateness of home-based extended care serv4 ices, including consideration of patient charac5 teristics, including but not limited to functional, 

6 cognitive, and behavioral competencies and defi7 cits and primary and secondary diagnoses, the 

8 availability of able and willing caregivers, the 

9 scope of home-based extended care services 

10 needed and other services (if applicable), the 

11 length of time such services would be needed, 

12 the availability of the level of services needed, 

13 and the need for and availability of health care 

14 services following completion of home-based ex15 tended care services, the individual’s place of 

16 care preferences, and the integration of and 

17 consideration of social determinants, inclusive 

18 of race and ethnicity and the availability of and 

19 access to quality services, into measures used to 

20 determine eligibility of a beneficiary to receive 

21 home-based extended care services; 

22 ‘‘(ii) a consultation with the individual as 

23 to the findings of such evaluation, including 

24 consideration of the individual’s place of care 

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1 giver concerns, and the ability of the individual 

2 to safely and effectively receive care in the 

3 home; 

4 ‘‘(iii) the provision of caregiver training re5 sources to family and other unpaid caregivers 

6 including guidance on medical, nursing, and 

7 personal care tasks; and 

8 ‘‘(iv) obtaining verbal consent from the in9 dividual that is recorded in the individual’s in10 patient care record if the individual chooses to 

11 receive home-based extended care services. 

12 Clauses (i), (ii), and (iii) shall not preempt any ap13 plicable State law requirements. Clause (iv) shall 

14 preempt any State law requirements relating to con15 sent for home-based extended care services. The Sec16 retary shall establish, through notice and comment 

17 rulemaking, the right to an expedited appeal of any 

18 adverse determination regarding the determination 

19 to provide the individual with the option of home20 based extended care services and the scope of home21 based extended care services needed by the indi22 vidual.’’. 

23 (7) ADDITIONAL REQUIREMENTS.—Section 

24 1861(o) of the Social Security Act (42 U.S.C. 

25 1395x(o)) is amended— 


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1 (A) in paragraph (7)(B), by striking ‘‘and’’ 

2 at the end; 

3 (B) in paragraph (8), by inserting ‘‘and’’ 

4 at the end; and 

5 (C) by inserting after paragraph (8) the 

6 following new paragraph: 

7 ‘‘(9) for purposes of furnishing post-hospital 

8 home-based extended care services under section 

9 1812(a)(6), meets such additional requirements and 

10 conditions as the Secretary finds necessary, includ11 ing— 

12 ‘‘(A) the provision of care on a 24-hour 

13 basis; 

14 ‘‘(B) the ability to provide all items and 

15 services described in subsection (lll); 

16 ‘‘(C) the provision of necessary and cov17 ered services; 

18 ‘‘(D) education, training, and supervision 

19 requirements for those providing home-based 

20 extended care services; and 

21 ‘‘(E) compliance with all requirements and 

22 conditions when such services are provided 

23 under arrangement as described in subsection 

24 (m) to ensure that others providing care under 

25 such arrangement with such agency are held to 


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1 the same standards (requirements and condi2 tions) as the agency;’’. 

3 (8) HOME-BASED EXTENDED CARE SERVICES

4 ADD-ON.—Section 1895 of the Social Security Act 

5 (42 U.S.C. 1395fff) is amended by adding at the 

6 end the following new subsection: 

7 ‘‘(f) HOME-BASED EXTENDED CARE SERVICES ADD8 ON.— 

9 ‘‘(1) IN GENERAL.—An add-on payment in ad10 dition to the amount otherwise payable under this 

11 section for home health services shall be made to a 

12 home health agency that meets the additional re13 quirements of section 1861(o)(9) and provides home14 based extended care services under section 

15 1812(a)(6). 

16 ‘‘(2) PAYMENT AMOUNT.—Subject to para17 graphs (3) and (4), the amount of such add-on pay18 ment for home-based extended care services provided 

19 to an individual shall be determined as follows: 

20 ‘‘(A) DETERMINATION.—Such amount 

21 shall be determined based on the following: 

22 ‘‘(i) The following four case-mix clas23 sifications, determined by the number of 

24 hours of personal care services provided to 

25 an individual, as follows: 


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1 ‘‘(I) Up to 60 hours, including an 

2 initial assessment. 

3 ‘‘(II) 61 to 120 hours. 

4 ‘‘(III) 121 to 240 hours. 

5 ‘‘(IV) 241 to 360 hours of per6 sonal care services. 

7 ‘‘(ii) In calculating the number of 

8 hours of personal care services under 

9 clause (i), part-time or intermittent serv10 ices provided by home health aides under 

11 sections 1812(a)(2) and 1835(a)(2)(A) 

12 shall not be included. 

13 ‘‘(iii) Such other factors as the Sec14 retary determines appropriate. 

15 ‘‘(B) FIXED BASE AMOUNT.—The Sec16 retary shall provide a fixed base amount for 

17 each of the 4 case-mix classifications described 

18 in subclauses (I) through (IV) of subparagraph 

19 (A)(i) as follows: 

20 ‘‘(i) 2022.—For services furnished 

21 during 2022, a fixed base amount of— 

22 ‘‘(I) in the case of the case-mix 

23 classification described in subclause 

24 (I) of subparagraph (A)(i), $2,010; 


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1 ‘‘(II) in the case of the case-mix 

2 classification described in subclause 

3 (II) of such subparagraph, $4,020; 

4 ‘‘(III) in the case of the case-mix 

5 classification described in subclause 

6 (III) of such subparagraph, $7,360; 

7 and 

8 ‘‘(IV) in the case of the case-mix 

9 classification described in subclause 

10 (IV) of such subparagraph, $10,720, 

11 respectively. 

12 ‘‘(ii) 2023 AND SUBSEQUENT

13 YEARS.—For services furnished during 

14 2023, or a subsequent year, a fixed base 

15 amount equal to the amount determined 

16 under this subparagraph for the preceding 

17 year for the applicable case-mix classifica18 tion, updated by the home health applica19 ble increase percentage under subsection 

20 (b)(3)(B) applicable to the year involved. 

21 ‘‘(C) AREA WAGE INDEX ADJUSTMENT.— 

22 The fixed base amount determined under sub23 paragraph (B) shall be subject to the applicable 

24 area wage index under subsection (b)(4)(C). 


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1 ‘‘(3) ALTERNATIVE ADD-ON PAYMENT

2 MODEL.—For services furnished in 2023, or in a 

3 subsequent year, the Secretary may apply an alter4 native model of payment that shall be based on rel5 evant and reliable data on patient characteristics 

6 that reflect the variations in resource use and inten7 sity within a patient case mix. 

8 ‘‘(4) LIMITATION.—Notwithstanding any other 

9 provision in this section, the amount of the addi10 tional payment under this subsection to a home 

11 health agency for home-based extended care services, 

12 in combination with the amount of payment for 

13 home health services under this section for a unit of 

14 services furnished to an individual, shall not result 

15 in a total amount of payment under this section for 

16 such services that exceeds an amount equal to 80 

17 percent of the national median 30-day payment 

18 amount for extended care services furnished in a 

19 skilled nursing facility under section 1812 for the 

20 most recent fiscal year prior to the payment year for 

21 which data is available, updated based on the skilled 

22 nursing facility market basket percentage change 

23 under section 1888(e)(5)(B). The Secretary may ad24 just the amount of the additional payment for home25 based extended care services under this subsection in 


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1 order to comply with the limitation under the pre2 ceding sentence.’’. 

3 (b) TRANSPARENCY IN NOTICE AND COMMENT

4 RULEMAKING.—In establishing standards and procedures 

5 under the provisions of, and amendments made by, this 

6 Act, the Secretary of Health and Human Services (in this 

7 section referred to as the ‘‘Secretary’’) shall include full 

8 transparency through notice and comment rulemaking of 

9 the methodology, assumptions, evidence, and all data used 

10 in support of proposed payment rates, standards for eligi11 bility and payment for services, provider conditions for 

12 participation, and any other matter related to the imple13 mentation of such provisions and amendments. 

14 (c) STAKEHOLDER INPUT.—In establishing any pro15 posed standards and procedures under the provisions of, 

16 and amendments made by, this Act, the Secretary shall 

17 solicit written input on such proposed standards and pro18 cedures from providers, representatives of providers, Medi19 care beneficiaries, families, and related stakeholder groups 

20 and consider such input in the development of such stand21 ards and procedures. 

22 (d) ANNUAL REPORT TO CONGRESS.—For calendar 

23 year 2022, and each calendar year thereafter, the Sec24 retary shall submit a report to Congress on the coverage 

25 of home-based extended care services under the Medicare 


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1 program (42 U.S.C. 1395 et seq.) pursuant to the provi2 sions of, and amendments made by, this Act. Each report 

3 submitted under this subsection shall include the fol4 lowing: 

5 (1) The total number of individuals receiving 

6 such services pursuant to such provisions and 

7 amendments, including which services such individ8 uals received, how long such individuals received 

9 such services, and what the average hours were per 

10 individual, and the total amount of expenditures for 

11 such services under the Medicare program, including 

12 an itemization of expenditures associated with home 

13 health care and in-home support services. 

14 (2) An analysis of the efficiency and effective15 ness of the processes for discharge planning evalua16 tion and discharge planning under section 

17 1861(ee)(2)(I) of the Social Security Act, as added 

18 by subsection (a)(6), an itemization of the diagnoses, 

19 treatment protocols, and outcomes of individuals re20 ceiving benefits (including family or other unpaid 

21 caregivers, as applicable), an evaluation comparing 

22 clinical outcomes and patient experience for similar 

23 patients receiving home-based extended care services 

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1 based extended care services are being appropriately 

2 targeted to individuals who need and would benefit 

3 from the scope, level, and duration of such home4 based extended care services and whether individuals 

5 receiving such services are receiving the appropriate 

6 scope, level and duration of care, and the cost effec7 tiveness of furnishing home-based extended care 

8 services in relation to alternative skilled nursing fa9 cility costs. 

10 (3) Data by race and ethnicity as it applies to 

11 eligibility, decision on participation of the bene12 ficiary, utilization rates, and availability of quality 

13 home health services in defined locales, as well as 

14 any protocol or changes in practice that were insti15 tuted to address existing inequities. 

16 (4) Recommendations for such administrative 

17 or legislative action as the Secretary determines nec18 essary to improve the furnishing of such services. 

19 (e) PROGRAM INTEGRITY.—The Secretary shall take 

20 such actions and establish safeguards as are reasonable 

21 and necessary under existing law to ensure the program 

22 integrity of the provision of home-based extended care 

23 services pursuant to the provisions of, and amendments 

24 made by, this Act. 

25 (f) IMPLEMENTATION.— 


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1 (1) ESTABLISHMENT OF STANDARDS AND PRO2 CEDURES.—Not later than July 1, 2021, or as soon 

3 as practical after enactment of this Act during a 

4 public health emergency period described in section 

5 1135(g) of the Social Security Act (42 U.S.C. 

6 1320b–5(g)), the Secretary shall establish standards 

7 and procedures related to furnishing home-based ex8 tended care services pursuant to the provisions of, 

9 and amendments made by, this Act. 

10 (2) PROVISION OF INFORMATION REGARDING

11 THE HOME-BASED EXTENDED CARE SERVICES BEN12 EFIT.—The Secretary shall provide comprehensive 

13 information to Medicare beneficiaries and other 

14 stakeholders regarding the establishment and avail15 ability of the home-based extended care services ben16 efit under the Medicare program under title XVIII 

17 of the Social Security Act (42 U.S.C. 1395 et seq.) 

18 pursuant to the provisions of, and amendments 

19 made by, this Act. Such information shall be in ad20 dition to any publication of standards and proce21 dures with respect to such services in the Federal 

22 Register and Code of Federal Regulations. 

23 (3) AUTHORIZATION OF PAYMENTS DURING

24 PUBLIC HEALTH EMERGENCY PERIOD.—Notwith25 standing any other provision of law, the Secretary is 


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1 authorized to make payments for home-based ex2 tended care services as described in section 1895(f) 

3 of the Social Security Act, as added by subsection 

4 (a)(8), for such services furnished prior to 2022 dur5 ing any period in which there exists such a public 

6 health emergency period. 

Æ 


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