I 

109TH CONGRESS 

1ST SESSION H. R. 175 

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

of qualified family caregivers in the provision of home health aide services 

under the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 4, 2005 

Ms. MILLENDER-MCDONALD 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 provide 

for the use of qualified family caregivers in the provision 

of home health aide services 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 ‘‘Family Caregiver Se5 curity Act of 2005’’. 
2 

•HR 175 IH 

1 SEC. 2. PROVISION OF QUALIFIED FAMILY CAREGIVER 

2 SERVICES UNDER THE MEDICARE PROGRAM. 

3 (a) IN GENERAL.—Section 1891(a) of the Social Se4 curity Act (42 U.S.C. 1395bbb(a)) is amended by adding 

5 at the end the following new paragraph: 

6 ‘‘(7)(A) The agency permits an individual who is 

7 under its care to have home health aide services or per8 sonal care assistant services provided by a qualified family 

9 caregiver (as defined in subparagraph (B)) under an ap10 proved plan of care and provides for payment for the serv11 ices of the caregiver, regardless of whether the caregiver 

12 is an employee of the agency, at a rate comparable to the 

13 rate otherwise paid for such services provided by other 

14 qualified personnel. In addition, in the case of such a care15 giver the agency shall provide for appropriate training and 

16 oversight of such services by a registered nurse in the 

17 same or similar manner to that provided in the case of 

18 such services furnished by another qualified individual and 

19 shall provide the caregiver, as part of the plan of care, 

20 with educational information and resources related to fam21 ily caregiver health and wellness. 

22 ‘‘(B) For purposes of this paragraph, the term ‘quali23 fied family caregiver’ means, with respect to the provision 

24 of home health aide services or personal care assistant 

25 services to an individual, an individual who is a family 

26 caregiver (as defined in section 372(2) of the National 
3 

•HR 175 IH 

1 Family Caregiver Support Act) of the individual and who 

2 demonstrates proficiency in the provision of the home 

3 health aide services or personal care assistant services in4 volved to the satisfaction of the supervising registered pro5 fessional nurse. 

6 ‘‘(C) This paragraph shall supersede any other re7 striction of this title (including section 1862(a)(11)) on 

8 the provision of home health aide services or personal care 

9 assistant services by a qualified family caregiver described 

10 in subparagraph (B) on the basis of the caregiver’s rela11 tionship to the recipient of such services. This subpara12 graph shall not affect any disqualification of an individual 

13 from providing services on the basis of the individual’s 

14 lack of qualification to provide the services or on the basis 

15 of an exclusion of participation of the individual under 

16 part B of title XI. 

17 ‘‘(D) The Secretary, in consultation with the Sec18 retary of Labor, shall provide guidance to home health 

19 agencies on payment administration and management 

20 methodologies to facilitate the provision of home health 

21 aide services and personal assistant care services by quali22 fied family caregivers under this paragraph.’’. 

23 (b) EFFECTIVE DATE.—The amendment made by 

24 subsection (a) shall take effect on January 1, 2006, and 

25 shall apply to services furnished on or after such date. 
4 

•HR 175 IH 

1 (c) CONSTRUCTION.—Nothing in this section shall be 

2 construed as preventing the application of fraud and abuse 

3 sanctions (including those under sections 1128, 1128A, 

4 and 1128B of the Social Security Act) with respect to 

5 family caregivers under section 1891(a)(7) of the Social 

6 Security Act, as added by subsection (a), in the same man7 ner as such sanctions may be applied to other individuals 

8 who provide home health aide services or personal assist9 ant care services. 

10 (d) PROHIBITION OF DENIAL OF SERVICES BECAUSE

11 OF REFUSAL OF PHYSICAL THERAPY SERVICES DURING

12 REHABILITATION.—Nothing in title XVIII of the Social 

13 Security Act shall be construed as authorizing the exclu14 sion of coverage of skilled nursing services for an indi15 vidual who is 75 years of age or older as part of home 

16 health services solely on the basis of the individual’s re17 fusal of physical therapy services during rehabilitation, re18 gardless of whether such physical therapy services are part 

19 of the plan of care for the individual. 

Æ