I 

108TH CONGRESS 

2D SESSION H. R. 4095 

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, to amend the Family and Medical Leave 

Act of 1993, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 31, 2004 

Ms. MILLENDER-MCDONALD (for herself, Mrs. CHRISTENSEN, and Mr. 

CUMMINGS) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy 

and Commerce, Education and the Workforce, Government Reform, and 

House Administration, 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, to amend the Family and Medical Leave Act of 

1993, 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 ‘‘Family Caregiver Security 

5 Act of 2004’’. 
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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 

7 is under its care to have home health aide services 

8 or personal care assistant services provided by a 

9 qualified family caregiver (as defined in subpara10 graph (B)) under an approved plan of care and pro11 vides for payment for the services of the caregiver, 

12 regardless of whether the caregiver is an employee of 

13 the agency, at a rate comparable to the rate other14 wise paid for such services provided by other quali15 fied personnel. In addition, in the case of such a 

16 caregiver the agency shall provide for appropriate 

17 training and oversight of such services by a reg18 istered nurse in the same or similar manner to that 

19 provided in the case of such services furnished by 

20 another qualified individual and shall provide the 

21 caregiver, as part of the plan of care, with edu22 cational information and resources related to family 

23 caregiver health and wellness. 

24 ‘‘(B) For purposes of this paragraph, the term 

25 ‘qualified family caregiver’ means, with respect to 

26 the provision of home health aide services or per-
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1 sonal care assistant services to an individual, an in2 dividual who is a family caregiver (as defined in sec3 tion 372(2) of the National Family Caregiver Sup4 port Act) of the individual and who demonstrates 

5 proficiency in the provision of the home health aide 

6 services or personal care assistant services involved 

7 to the satisfaction of the supervising registered pro8 fessional nurse. 

9 ‘‘(C) This paragraph shall supersede any other 

10 restriction of this title (including section 

11 1862(a)(11)) on the provision of home health aide 

12 services or personal care assistant services by a 

13 qualified family caregiver described in subparagraph 

14 (B) on the basis of the caregiver’s relationship to the 

15 recipient of such services. This subparagraph shall 

16 not affect any disqualification of an individual from 

17 providing services on the basis of the individual’s 

18 lack of qualification to provide the services or on the 

19 basis of an exclusion of participation of the indi20 vidual under part B of title XI. 

21 ‘‘(D) The Secretary, in consultation with the 

22 Secretary of Labor, shall provide guidance to home 

23 health agencies on payment administration and man24 agement methodologies to facilitate the provision of 

25 home health aide services and personal assistant 
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1 care services by qualified family caregivers under 

2 this paragraph.’’. 

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

4 subsection (a) shall take effect on January 1, 2005, and 

5 shall apply to services furnished on or after such date. 

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

7 construed as preventing the application of fraud and abuse 

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

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

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

11 Security Act, as added by subsection (a), in the same man12 ner as such sanctions may be applied to other individuals 

13 who provide home health aide services or personal assist14 ant care services. 

15 (d) PROHIBITION OF DENIAL OF SERVICES BECAUSE

16 OF REFUSAL OF PHYSICAL THERAPY SERVICES DURING

17 REHABILITATION.—Nothing in title XVIII of the Social 

18 Security Act shall be construed as authorizing the exclu19 sion of coverage of skilled nursing services for an indi20 vidual who is 75 years of age or older as part of home 

21 health services solely on the basis of the individual’s re22 fusal of physical therapy services during rehabilitation, re23 gardless of whether such physical therapy services are part 

24 of the plan of care for the individual. 
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1 SEC. 3. AMENDMENTS TO FAMILY AND MEDICAL LEAVE 

2 ACT OF 1993. 

3 (a) INCLUSION OF NURSE PRACTITIONERS AS

4 HEALTH CARE.—Section 101(6)(C) of the Family and 

5 Medical Leave Act of 1993 (29 U.S.C. 2611(6)(C)) is 

6 amended— 

7 (1) by striking ‘‘or’’ at the end of subparagraph 

8 (A); 

9 (2) by redesignating subparagraph (B) as sub10 paragraph (C); and 

11 (3) by inserting after subparagraph (A) the fol12 lowing new subparagraph: 

13 ‘‘(B) a nurse practitioner; or’’. 

14 (b) EXTENSION TO DOMESTIC PARTNERS.—Section 

15 101(13) of such Act (29 U.S.C. 2611(13)) is amended by 

16 inserting before the period at the end the following: ‘‘, and 

17 includes a domestic or civil partner registered or recog18 nized under the applicable domestic or civil partnership 

19 of State or local law’’. 

20 (c) EXTENSION OF PERIOD OF FAMILY OR MEDICAL

21 LEAVE FOR SPOUSES EMPLOYED BY SAME EMPLOYER.— 

22 Section 102(f) of such Act (29 U.S.C. 2612(f)) is amend23 ed ‘‘12 workweeks’’ and inserting ‘‘24 workweeks’’. 

24 (d) CLARIFICATION OF COVERAGE OF OUTPATIENT

25 HOSPICE CARE.—Section 101(11) of such Act (29 U.S.C. 

26 2611(11)) is amended— 
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1 (1) by striking ‘‘or’’ at the end of subparagraph 

2 (A); 

3 (2) by redesignating subparagraph (B) as sub4 paragraph (C); and 

5 (3) by inserting after subparagraph (A) the fol6 lowing new subparagraph: 

7 ‘‘(B) hospice care; or’’. 

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