I 

118TH CONGRESS 

1ST SESSION H. R. 6780 

To amend title XVIII of the Social Security Act to establish a Medically 

Tailored Home-Delivered Meals Demonstration Program to test a payment and service delivery model under part A of Medicare to improve 

clinical health outcomes and reduce the rate of readmissions of certain 

individuals. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 14, 2023 

Mr. MCGOVERN (for himself, Ms. MALLIOTAKIS, Ms. PINGREE, Mr. EVANS, 

and Mr. FITZPATRICK) introduced the following bill; which was referred 

to the Committee on Ways and Means 

A BILL 

To amend title XVIII of the Social Security Act to establish 

a Medically Tailored Home-Delivered Meals Demonstration Program to test a payment and service delivery 

model under part A of Medicare to improve clinical 

health outcomes and reduce the rate of readmissions 

of certain individuals. 

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 ‘‘Medically Tailored 

5 Home-Delivered Meals Demonstration Pilot Act’’. 

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1 SEC. 2. MEDICALLY TAILORED HOME-DELIVERED MEALS 

2 DEMONSTRATION PROGRAM. 

3 Part E of title XVIII of the Social Security Act is 

4 amended by inserting after section 1866G (42 U.S.C. 

5 1395cc–7) the following new section: 

6 ‘‘SEC. 1866H. MEDICALLY TAILORED HOME-DELIVERED 

7 MEALS DEMONSTRATION PROGRAM. 

8 ‘‘(a) ESTABLISHMENT.—For the 4-year period begin9 ning not later than 30 months after the date of the enact10 ment of this section, the Secretary shall conduct, in ac11 cordance with the provisions of this section, a Medically 

12 Tailored Home-Delivered Meals Demonstration Program 

13 (in this section referred to as the ‘Program’) to test a pay14 ment and service delivery model under which selected hos15 pitals provide medically tailored home-delivered meals 

16 under part A of this title to qualified individuals, with re17 spect to such hospitals, to improve clinical health outcomes 

18 and reduce the rate of readmissions of such individuals. 

19 ‘‘(b) SELECTION OF HOSPITALS TO PARTICIPATE IN

20 PROGRAM.— 

21 ‘‘(1) SELECTED HOSPITALS.—Under the Pro22 gram, the Secretary shall, not later than January 1, 

23 2024, select to participate in the Program at least 

24 20 eligible hospitals across all geographic regions, 

25 with consideration given to eligible hospitals located 

26 in rural areas and other underserved communities, 

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1 that the Secretary determines have the capacity to 

2 satisfy the requirements described in subsection (c). 

3 In this section, each such eligible hospital so selected 

4 shall be referred to as a ‘selected hospital’. 

5 ‘‘(2) ELIGIBLE HOSPITALS.—For purposes of 

6 this section, the term ‘eligible hospital’ means a sub7 section (d) hospital (as defined in section 

8 1886(d)(1)(B)) that— 

9 ‘‘(A) submits to the Secretary an applica10 tion, at such time and in such form and manner 

11 as specified by the Secretary, that contains— 

12 ‘‘(i) an attestation (in such form and 

13 manner as specified by the Secretary) that 

14 such hospital has the ability, or has in ef15 fect an arrangement with a provider of 

16 services, supplier, or other entity with at 

17 least 1 year of experience in furnishing 

18 medically tailored home-delivered meals 

19 that has the ability, to comply with the re20 quirements described in subsection (c); and 

21 ‘‘(ii) such other information as the 

22 Secretary may require; 

23 ‘‘(B) has, for the 2 most recent fiscal years 

24 ending prior to the date of selection by the Sec25 retary under paragraph (1), averaged at least 3 

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1 stars for the overall hospital quality star rating 

2 on the Internet website of the Centers for Medi3 care & Medicaid Services (including Care Com4 pare or a successor website); and 

5 ‘‘(C) is not, as of the date of selection by 

6 the Secretary under paragraph (1), subject to— 

7 ‘‘(i) the requirement to return any 

8 overpayment pursuant to section 1128J(d); 

9 or 

10 ‘‘(ii) any activity described in section 

11 1893(b) (relating to Medicare integrity 

12 program actions). 

13 ‘‘(c) MINIMUM PROGRAM REQUIREMENTS.—Under 

14 the Program, a selected hospital shall comply with each 

15 of the following requirements: 

16 ‘‘(1) STAFFING.—The selected hospital shall 

17 provide (including through an arrangement de18 scribed in subsection (b)(2)(A)(i)), for the duration 

19 of the participation of the hospital under the Pro20 gram, a physician, registered dietitian or nutrition 

21 professional, or clinical social worker to carry out 

22 the screening and re-screening pursuant to para23 graph (2), and medical nutrition therapy pursuant 

24 to paragraph (3)(B). 

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1 ‘‘(2) SCREENING AND RE-SCREENING.—The se2 lected hospital (including through an arrangement 

3 described in subsection (b)(2)(A)(i)) shall— 

4 ‘‘(A) as part of the discharge planning 

5 process described in section 1861(ee), screen in6 dividuals that are inpatients of such selected 

7 hospital with validated screening tools (as devel8 oped by the Secretary) to determine whether 

9 such individuals are qualified individuals; and 

10 ‘‘(B) in the case of an individual deter11 mined pursuant to subparagraph (A) or this 

12 subparagraph to be a qualified individual, re13 screen such individual with validated screening 

14 tools (as determined by the Secretary) every 12 

15 weeks after such determination occurring dur16 ing the participation of the hospital under the 

17 Program to determine whether such individual 

18 continues to be a qualified individual. 

19 ‘‘(3) PROVIDING MEDICALLY TAILORED HOME20 DELIVERED MEALS AND MEDICAL NUTRITION THER21 APY.—In the case of an individual that is deter22 mined by the selected hospital pursuant to para23 graph (2) to be a qualified individual, the selected 

24 hospital (including through an arrangement de25 scribed in subsection (b)(2)(A)(i)) shall with respect 

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1 to the period during which such hospital is partici2 pating in the Program— 

3 ‘‘(A) provide, for each day during a period 

4 of at least 12 weeks, for the preparation and 

5 delivery to such individual of at least 2 medi6 cally tailored home-delivered meals (or a 

7 portioned equivalent) that meet at least two8 thirds of the daily nutritional needs of the 

9 qualified individual; and 

10 ‘‘(B) provide to such qualified individual, 

11 in connection with delivering such meals and 

12 for a period of at least 12 weeks and not more 

13 than 1 year, medical nutrition therapy. 

14 ‘‘(4) DATA SUBMISSION.—The selected hospital 

15 shall submit to the Secretary data, in such form, 

16 manner, and frequency as designated by the Sec17 retary, so that the Secretary may determine the af18 fect of the Program with respect to the factors de19 scribed in subsection (e)(2)(B). 

20 ‘‘(5) ADDITIONAL REQUIREMENTS.—The se21 lected hospital shall satisfy such additional require22 ments as may be specified by the Secretary. 

23 ‘‘(d) PAYMENT; COST-SHARING.— 

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1 ‘‘(1) PAYMENT.—The Secretary shall determine 

2 the form, manner, and amount of payment to be 

3 provided to a selected hospital under the Program. 

4 ‘‘(2) COST-SHARING.—Items and services for 

5 which payment may be made under the Program 

6 shall be provided without application of any deduct7 ible, copayment, coinsurance, or other cost-sharing 

8 under this title. 

9 ‘‘(e) EVALUATIONS.— 

10 ‘‘(1) ASSESSING CLINICAL HEALTH OUT11 COMES.—The Secretary shall assess the clinical 

12 health outcomes of each individual who is deter13 mined by a selected hospital pursuant to subsection 

14 (c)(2) to be a qualified individual for a period of at 

15 least 12 weeks and not more than 1 year after the 

16 date on which such individual is so determined 

17 under subparagraph (A) of such subsection. 

18 ‘‘(2) INTERMEDIATE AND FINAL EVALUA19 TIONS.—The Secretary shall conduct an inter20 mediate and final evaluation of the Program. Each 

21 such evaluation shall— 

22 ‘‘(A) based on the assessments conducted 

23 under paragraph (1), with respect to individuals 

24 determined to be qualified individuals and the 

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1 periods for which such assessments are so con2 ducted, determine— 

3 ‘‘(i) the number of inpatient admis4 sions of such individuals; 

5 ‘‘(ii) the number of admissions to 

6 skilled nursing facilities of such individ7 uals; and 

8 ‘‘(iii) the total expenditures under 

9 part A with respect to such individuals; 

10 ‘‘(B) determine the extent to which the 

11 Program has— 

12 ‘‘(i) improved clinical health outcomes, 

13 as defined by the Secretary; 

14 ‘‘(ii) reduced the cost of care under 

15 part A (including costs associated with re16 admission as defined in section 

17 1886(q)(5)(E)); and 

18 ‘‘(iii) increased patient satisfaction, as 

19 defined by the Secretary; and 

20 ‘‘(C) specify the form, manner, and 

21 amounts of payments made under the Program 

22 pursuant to subsection (d)(1) and the effective23 ness of such payment form, manner, and 

24 amounts. 

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1 ‘‘(3) REPORTS.—The Secretary shall submit to 

2 Congress— 

3 ‘‘(A) not later than 3 years after the date 

4 of implementation of the Program, a report 

5 with respect to the intermediate evaluation 

6 under paragraph (2); and 

7 ‘‘(B) not later than 6 years after such date 

8 of implementation, a report with respect to the 

9 final evaluation under such paragraph. 

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated such sums as are nec12 essary to carry out this section. 

13 ‘‘(g) DEFINITIONS.—In this section: 

14 ‘‘(1) MEDICAL NUTRITION THERAPY.—The 

15 term ‘medical nutrition therapy’ has the meaning 

16 given such term in section 1861(vv)(1). 

17 ‘‘(2) MEDICALLY TAILORED HOME-DELIVERED

18 MEAL.—The term ‘medically tailored home-delivered 

19 meal’ means, with respect to a qualified individual, 

20 a meal that is designed by a registered dietitian or 

21 nutritional professional for the treatment plan of the 

22 qualified individual. 

23 ‘‘(3) QUALIFIED INDIVIDUAL.—The term ‘quali24 fied individual’ means an individual, with respect to 

25 a selected hospital, who— 

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1 ‘‘(A) is entitled to benefits under part A; 

2 ‘‘(B) has a diet-impacted disease (such as 

3 kidney disease, congestive heart failure, diabe4 tes, chronic obstructive pulmonary disease, or 

5 any other disease the Secretary determines ap6 propriate); and 

7 ‘‘(C) at the time of discharge from such 

8 hospital— 

9 ‘‘(i) lives at home; 

10 ‘‘(ii) is not eligible for— 

11 ‘‘(I) extended care services (as 

12 defined in section 1861(h)); 

13 ‘‘(II) post-hospital extended care 

14 services (as defined in section 

15 1861(i)); or 

16 ‘‘(III) post-institutional home 

17 health services (as defined in section 

18 1861(tt)); 

19 ‘‘(iii) has not made an election under 

20 section 1812(d)(1) to receive hospice care; 

21 ‘‘(iv) is certified by a physician at the 

22 time of discharge to be limited with respect 

23 to at least 2 of the activities of daily living 

24 (as described in section 7702B(c)(2)(B) of 

25 the Internal Revenue Code of 1986); and 

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1 ‘‘(v) meets any other criteria for high2 risk of readmission (as determined by the 

3 Secretary). 

4 ‘‘(4) REGISTERED DIETITIAN OR NUTRITION

5 PROFESSIONAL.—The term ‘registered dietitian or 

6 nutrition professional’ has the meaning given such 

7 term in section 1861(vv)(2).’’. 

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