Expanding Care in the Home Act

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2853 Introduced in House (IH)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                H. R. 2853

  To amend title XVIII of the Social Security Act to expand access to 
           clinical care in the home, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 25, 2023

  Mr. Smith of Nebraska (for himself and Mrs. Dingell) 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 expand access to 
           clinical care in the home, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Expanding Care in 
the Home Act''.
    (b) Table of Contents.--the table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Enhancing primary care in the home.
Sec. 3. Improving coverage for Medicare home infusion.
Sec. 4. Establishing payment for staff-assisted home dialysis.
Sec. 5. Ensuring Medicare beneficiaries have access to in-home labs.
Sec. 6. Expanding advanced diagnostic imaging in the home.
Sec. 7. Delivering personal care services to Medicare beneficiaries.
Sec. 8. Building the future of the home-based care workforce.

SEC. 2. ENHANCING PRIMARY CARE IN THE HOME.

    (a) In General.--The Secretary of Health and Human Services (HHS 
Secretary) shall allow primary care providers (PCPs) enrolled in 
Medicare Part B to elect to receive a monthly capitated payment for 
Primary Care Qualified Evaluation and Management Services (PQEM) as an 
alternative to fee-for-service reimbursement. Providers shall be 
allowed to elect to receive a monthly capitated payment for a period of 
time ranging from one to five years.
    (b) Covered Services.--The HHS Secretary shall annually identify 
PQEM services no later than October 1 each year. At a minimum, these 
services shall include the following services when billed by a primary 
care provider or a nonprimary care specialist (as outlined by the 
Secretary):
            (1) Office or Other Outpatient Services (99201-99205, 
        99211-99215).
            (2) Domiciliary, Rest Home or Custodial Care Services 
        (99324-99328, 99334-99337).
            (3) Domiciliary, Rest Home or Home Care Plan Oversight 
        Services 99339-99340).
            (4) Home Services (99341-99345, 99347-99350).
            (5) Transitional Care Management Services (99495-99496).
            (6) Care Coordination Management Services (99490).
            (7) Wellness Visits (G0402, G0438, G0439).
    (c) Payment.--The capitated payment system designed by the HHS 
Secretary shall have the following:
            (1) Base capitated payments should reflect the previous 3 
        years excluding the period during which there was an active 
        public health emergency for COVID-19.
            (2) There should be an increase in payments to reflect the 
        need for PCPs to invest in changing their office practice 
        workflow.
            (3) Higher PCP payment could be possible through greater 
        bonuses related to improving value through total cost of care 
        and quality.
            (4) PCPs electing capitated payments should be permitted to 
        offer incentives to engage patients to be assigned to their 
        patient care panels.
    (d) Attribution.--The HHS Secretary shall ensure that PCPs electing 
to receive a capitated payment have visibility and input into the 
attribution model used to attribute patients to them. At a minimum, the 
attribution methodology should--
            (1) patient attribution to panels should be prospective;
            (2) panels should be updated monthly or quarterly; and
            (3) PCPs should have a mechanism and incentives to enroll 
        patients so they can influence who is attributed to their 
        panel.

SEC. 3. IMPROVING COVERAGE FOR MEDICARE HOME INFUSION.

    (a) In General.--The HHS Secretary shall establish reimbursement 
for home infusion services and associated equipment and items under 
part B.
    (b) Covered Services and Supplies.--Home Infusion Therapy (HIT) and 
associated equipment are defined to include--
            (1) equipment (e.g., mechanical pumps) for drug 
        administration of Eligible Infusion Drugs;
            (2) items (other than drugs and equipment) used in 
        connection with the delivery of Eligible Infusion Drugs such as 
        disposable supplies for the drug administration (e.g., tubing, 
        elastomeric pumps) and for the routine maintenance of the 
        infusion access device;
            (3) 24/7 availability of pharmacist professional services 
        such as assessments, drug preparation and compounding, 
        dispensing, clinical monitoring, administrative, and education; 
        and
            (4) 24/7 availability of nursing services (when not 
        provided as part of a home health episode).
    (c) Qualified Providers.--Provided by a qualified home infusion 
therapy services supplier as defined in section 1861(iii)(3)(C) of this 
Act.
    (d) Eligible Infusion Drugs.--Eligible part B and part D Infusion 
Drugs are defined as parenteral drugs or biologics administered through 
intravenous, intrathecal, intra-arterial, or subcutaneous access 
device, except--
            (1) drugs and biologics on the self-administered drug list; 
        and
            (2) drugs and biologics covered under Part B Durable 
        Medical Equipment, Prosthetics, Orthotics and Supplies 
        (DMEPOS).
    (e) Current or Future Infusion Drugs.--Provided, nothing in this 
section shall be construed to change the coverage status of any current 
or future infusion drugs that meet the definition of a covered part D 
drug as defined at section 1860D-2(e) and which are paid under Medicare 
part D.
    (f) Referring Providers.--Patients must be under the care of a 
physician, nurse practitioner, or physician assistant.
    (g) Safety and Quality.--Consistent with standards of care found 
within commercial, Medicare Advantage, and State Medicaid programs with 
regard to sterile preparation of the drug to a final, useable form; 
timeliness of initiation of care; billing of drugs, items, and pharmacy 
services by a single entity; performing periodic assessments of patient 
satisfaction and collection and evaluation of quality outcome data; and 
maintaining a consolidated patient record of services provided in 
accordance with the plan of care.
    (h)(1) Reimbursement.--A per infusion day payment is established 
and defined as ``a payment for the date on which a drug was 
administered to the individual at home (regardless of whether a skilled 
professional was physically present in the home of such individual on 
such date)''.
    (2) Market Rates.--Such payment may be based on a market analysis 
of rates paid for home infusion supplies and services by the commercial 
sector and Medicare Advantage programs.
    (3) Payment Eligibility.--Nothing shall prevent a home infusion 
supplier from being paid a per infusion day payment when a qualified 
home health agency provides the nursing services for the infusion 
therapy under the part A home health benefit.

SEC. 4. ESTABLISHING PAYMENT FOR STAFF-ASSISTED HOME DIALYSIS.

    (a) In General.--Section 1881(b)(14) of the Social Security Act (42 
U.S.C. 1395rr(b)(14)) is amended by adding at the end the following new 
subparagraph:
                    ``(J)(i) For services furnished on or after the 
                date which is 1 year after the date of the enactment of 
                this subparagraph which are staff-assisted home 
                dialysis (as defined in clause (iv)(III)), the 
                Secretary shall increase the single payment that would 
                otherwise apply under this paragraph for renal dialysis 
                services furnished to new and respite individuals in 
                accordance with the payment system established under 
                clause (iii) by qualified providers.
                    ``(ii)(I) Subject to subclause (II), staff-assisted 
                home dialysis may only be furnished during--
                            ``(aa) with respect to an individual 
                        described in subclause (iv)(I)(aa), one 90-day 
                        period which may be renewed up to two 30-day 
                        periods; and
                            ``(bb) with respect to an individual 
                        described in subclause (iv)(I)(bb) and 
                        notwithstanding whether such an individual 
                        receives any respite care under part A, any 30-
                        day period.
                    ``(II) Notwithstanding the limits described in 
                subclause (I), staff-assisted home dialysis may be 
                furnished for as long as the Secretary determines 
                appropriate to an individual who--
                            ``(aa) is blind;
                            ``(bb) has a cognitive or neurological 
                        impairment (including a stroke, Alzheimer's, 
                        dementia amyotrophic lateral sclerosis, or any 
                        other impairment determined by the Secretary); 
                        or
                            ``(cc) has any other illness or injury that 
                        reduces mobility (including cerebral palsy, 
                        spinal cord injuries, or any other illness or 
                        injury determined by the Secretary).
                    ``(iii) The Secretary shall establish a prospective 
                payment system through regulations to determine the 
                amounts payable to qualified providers for staff-
                assisted home dialysis. In establishing such system, 
                the Secretary may consider--
                            ``(I) the costs of furnishing staff-
                        assisted home dialysis;
                            ``(II) consultations with dialysis 
                        providers, dialysis patients, private payers, 
                        and MA plans;
                            ``(III) payment amounts for similar items 
                        and services under parts A and B; and
                            ``(IV) payment amounts established by MA 
                        plans under part C, group health plans, and 
                        health insurance coverage offered by health 
                        insurance issuers.
                    ``(iv) In this subparagraph:
                            ``(I) The term `new and respite individual' 
                        means an individual described in subsection (a) 
                        who is either--
                                    ``(aa) initiating either peritoneal 
                                or home hemodialysis; or
                                    ``(bb) receiving home dialysis and 
                                is unable to self-dialyze due to 
                                illness, injury, caregiver issues, or 
                                other temporary circumstances.
                            ``(II) The term `qualified provider' means 
                        a trained professional (as determined by the 
                        Secretary, including nurses and certified 
                        patient technicians) who furnishes renal 
                        dialysis services and--
                                    ``(aa) meets requirements (as 
                                determined by the Secretary) that 
                                ensures competency in patient care and 
                                modality usage; and
                                    ``(bb) provides in-person 
                                assistance to a patient for at least 75 
                                percent of staff-assisted home dialysis 
                                sessions during a period described in 
                                clause (ii)(i).
                            ``(III)(aa) The term `staff-assisted home 
                        dialysis' means home dialysis using trained 
                        professionals to assist individuals who have 
                        been determined to have end stage renal 
                        disease, and the frequency of such home 
                        dialysis is determined by such professionals in 
                        coordination with the patient and his or her 
                        care partner, and outlined in a patient plan of 
                        care.
                            ``(bb) In this subclause, the term `care 
                        partner' means anyone who is designated by the 
                        patient who assists the individual with the 
                        furnishing of home dialysis.
                            ``(cc) In this subclause, the term `patient 
                        plan of care' has the meaning given such term 
                        in section 494.90 of title 42, Code of Federal 
                        Regulations.''.
    (b) Patient Education and Training Relating to Staff-Assisted Home 
Dialysis.--Section 1881(b)(5) of the Social Security Act (42 U.S.C. 
1395rr(b)(5)) is amended--
            (1) in subparagraph (C), by striking at the end ``and'';
            (2) in subparagraph (D), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following new subparagraphs:
                    ``(D) educate patients of the opportunity to 
                receive staff-assisted home dialysis (as defined in 
                paragraph (14)(J)(iv)(III)) during the period beginning 
                30 days after the first day such facility furnishes 
                renal dialysis services to an individual and ending 60 
                days after such day; and
                    ``(E) provide for nurses, certified patient 
                technicians, or other professionals to train patients 
                and their care partners in skills and procedures needed 
                to perform home dialysis (as defined in paragraph 
                (14)(J)(iv)(III)) treatment--
                            ``(i) regularly and independently;
                            ``(ii) through telehealth services or 
                        through group training (as described in the 
                        interpretive guidance relating to tag number 
                        V590 of `Advance Copy--End Stage Renal Disease 
                        (ESRD) Program Interpretive Guidance Version 
                        1.1' (published on October 3, 2008)) in 
                        accordance with the Federal regulations 
                        (concerning the privacy of individually 
                        identifiable health information) promulgated 
                        under section 264(c) of the Health Insurance 
                        Portability and Accountability Act of 1996; and
                            ``(iii) in the home or resident of a 
                        patient, in a dialysis facility, or the place 
                        in which the patient intends to receive staff-
                        assisted home dialysis.''.
    (c) Other Provisions.--
            (1) Anti-kickback statute.--Section 1128B(b)(3) of the 
        Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
                    (A) in subparagraph (J), by striking at the end 
                ``and'';
                    (B) in subparagraph (K), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                                    ``(L) any remuneration relating to 
                                the furnishing of staff-assisted home 
                                dialysis (as defined in section 
                                1881(b)(14)(J)(iv)(III)).''.
            (2) CMI model.--Section 1115A(b)(2)(B) of the Social 
        Security Act (42 U.S.C. 1320b-(b)(2)(B)) is amended by adding 
        at the end the following new clause:
                            ``(xxviii) Making payment to anyone who is 
                        designated by a patient who receives staff-
                        assisted home dialysis (as defined in section 
                        1881(b)(14)(J)(iv)(III)) and otherwise meets 
                        the requirements (as determined by the 
                        Secretary), notwithstanding whether an 
                        individual is a qualified provider (as defined 
                        in section 1881(b)(14)(J)(iv)(II)) or otherwise 
                        eligible for reimbursement under title 
                        XVIII.''.
            (3) Study.--Not later than 2 years after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services shall submit to the Committee on Energy and Commerce 
        of the House of Representatives and the Committee on Finance of 
        the Senate a report that examines racial disparities in the 
        utilization of the home dialysis defined in section 
        1881(b)(14)(J)(iv)(III) of the Social Security Act (42 U.S.C. 
        1395rr(b)(14)(J)(iv)(III)) and make recommendations on how to 
        improve access to such dialysis for communities of color.
            (4) Patient decision tool.--Not later than December 31, 
        2023, for the purpose of section 1881(b)(14)(J) of the Social 
        Security Act (42 U.S.C. 1395rr(b)(14)(J)), the Secretary of 
        Health and Human Services shall convene a patient panel to 
        create a patient-centered decision tool for dialysis patients 
        to evaluate their lifestyle and goals and be assisted in 
        choosing the dialysis modality that best suits them. This tool 
        should include an acknowledgment that they are capable of home 
        dialysis and want home dialysis, if that is the modality they 
        choose.
            (5) Patient quality of life metric.--Section 1115A(b)(2)(B) 
        of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is 
        amended by adding at the end the following new subparagraph:
                            ``(i) A patient quality of life metric for 
                        all patients utilizing dialysis regardless of 
                        modality with the intent of measuring and 
                        improving patient quality of life on 
                        dialysis.''.

SEC. 5. ENSURING MEDICARE BENEFICIARIES HAVE ACCESS TO IN-HOME LABS.

    (a) In General.--The Secretary shall establish reimbursements for 
an add-on payment to cover travel costs and mailing costs associated 
with specimen collection of at-home clinical laboratory tests for 
eligible Medicare beneficiaries.
    (b) Coverage.--The add-on payment shall apply to all at-home 
clinical laboratory tests currently reimbursed under Part B as ordered 
by an eligible Medicare provider.
    (c) Eligible Beneficiaries.--The Secretary shall determine the 
screening tool or utilization management that would trigger beneficiary 
eligibility for at-home clinical laboratory tests. Eligibility shall be 
more comprehensive than the homebound status as defined in sections 
1835(a) and 1814(a) of the Social Security Act. The screening tool 
shall consider other criteria such as chronic conditions, social needs, 
barriers to accessing care, income level, or dual eligible status.
    (d) Eligible Suppliers.--The Secretary shall determine eligible 
suppliers for specimen collection of at-home clinical lab tests.
    (e) Payment for Travel Allowance.--The Secretary shall establish 
payment methodology for the travel allowance reimbursement. The 
methodology shall account for geographic variation in costs of 
transportation.
    (f) Payment for Mailing Costs.--The Secretary shall establish 
payment methodology for reimbursement of the cost for mailing completed 
at-home clinical lab tests. The reimbursement structure shall be tiered 
on shipping based upon the nature of the collection and processing 
needs, for example cold chain requirements, time sensitively, and other 
infectious disease protocols.
    (g) Beneficiary Costs.--No provision in this section shall impact 
the coinsurance applied to beneficiaries as currently reimbursed for 
clinical laboratory tests.

SEC. 6. EXPANDING ADVANCED DIAGNOSTIC IMAGING IN THE HOME.

    (a) General.--The Secretary shall conduct an evaluation of Medicare 
reimbursable advanced diagnostic imaging as defined in subsection 
(e)(1)(B) of section 1834 of the Social Security Act. The purpose of 
the evaluation shall be to consider expansions to reimbursable at-home 
advanced diagnostic imaging services, including costs of 
transportation.
    (b) Minimum Action.--At a minimum, the Secretary shall permit the 
delivery and reimbursement of ultrasound imaging in the home, including 
the cost of transportation.
    (c) Eligibility.--The Secretary shall determine the screening tool 
or utilization management that would trigger beneficiary eligibility 
for at-home advanced diagnostic services. Eligibility shall be more 
comprehensive than the homebound status as defined in sections 1835(a) 
and 1814(a) of the Social Security Act. The screening tool shall 
consider other criteria such as chronic conditions, social needs, 
barriers to accessing care, income level, or dual eligible status.
    (d) Authority.--The Secretary shall have the authority to expand 
the types of at-home advanced diagnostic imaging services reimbursable 
under Medicare, if medically appropriate and safe.
    (e) Payment.--No provision in this section shall impact the payment 
rates set annually through the physician fee schedule.
    (f) Report to Congress.--The Secretary shall submit the findings 
from the evaluation in section (a) in a report to Congress not later 
than 90 days after enacted. The report should provide justification for 
the Secretary's decision not to expand particular diagnostic services 
in the home and recommendations to further expand advanced diagnostic 
imaging in the home.

SEC. 7. DELIVERING PERSONAL CARE SERVICES TO MEDICARE BENEFICIARIES.

    (a) General.--The Social Security Act is amended to establish 
coverage for personal care assistance services as defined in subsection 
(k) to eligible Medicare beneficiaries (``Benefit'' hereafter).
    (b) Services.--Up to 12 hours per week of personal care assistance 
services in increments of no less than four hours.
    (c) Time Limited Benefit.--If prescribed by a qualified Medicare 
provider, the eligible beneficiary is entitled to 30 days of personal 
care services and eligible for two additional 30-day periods if the 
provider deems it is appropriate. The Benefit shall be capped at 90 
days per calendar year.
    (d) Eligibility.--To be considered eligible for the Benefit, the 
beneficiary--
            (1) must be Medicare eligible;
            (2) must not be Medicaid-eligible;
            (3) must have an income at or below 400 percent of the 
        Federal Poverty Level (FPL);
            (4) must be functionally disabled as defined in subsection 
        (l); and
            (5) must have four or more chronic conditions as defined by 
        the Secretary or had a qualified hospitalization stay, as 
        defined by the Secretary, in the last 30 days.
    (e) Other Eligibility Requirements.--The Secretary may consider 
other eligibility requirements that are known to, based on evaluation 
and research, improve value of care and coordination of care. For 
example, the beneficiary could be required to attend an annual wellness 
visit or be aligned with a primary care provider or specialist who 
functions as a primary care provider.
    (f) Benefit Determination Process.--The Secretary shall establish a 
process to validate beneficiary eligibility for the Benefit through a 
determination process. Additionally, the Secretary shall put in place 
an appeals process to review possible wrongful determinations.
    (g) Coinsurance.--After 30 days of personal care services, a 20 
percent coinsurance shall apply for the remaining Benefit period.
    (h) Reimbursement.--The Secretary will establish an hourly rate for 
personal care services through the annual physician fee schedule. The 
hourly rate should be based on a blend of the Department of Veterans 
Affairs fee schedule for the homemaker/home health aide service (G0156) 
and averages for private sector home care.
    (i) Value-Based Care Reimbursement.--The Secretary should establish 
a value-based component to the reimbursement of the Benefit that 
focuses on reducing medical needs. For example, a portion of the fee-
for-service reimbursement could be withheld and if certain quality 
measures (e.g., avoiding unnecessary hospitalizations) are achieved, 
the remaining portion of the reimbursement would be paid.
    (j) Oversight.--The Secretary shall establish a process to certify 
personal care agencies, for example requirements for Federal background 
checks, and other appropriate oversight. Personal care aides shall be 
employed by an agency. To ensure sufficient number of providers, 
Agencies providing solely personal care services as defined in this 
section shall not be required to comply with Conditions of 
Participation (CoPs).
    (k) Overlap.--The Secretary shall develop criteria describing how 
model overlap will be addressed when patients are eligible for the 
Benefit and are otherwise participating in a payment and delivery 
reform model under section 1899 or through the Center for Medicare and 
Medicaid Innovation. The Secretary shall exclude costs of the Benefit 
from reconciliation in these payment and delivery reform models as 
appropriate to limit unintended consequences.
    (l) Definitions.--
            (1) Functionally disabled.--An individual is ``functionally 
        disabled'' if the individual--
                    (A) is unable to perform without substantial 
                assistance from another individual at least 2 of the 
                following 3 activities of daily living: toileting, 
                transferring, and eating; or
                    (B) has a primary or secondary diagnosis of 
                Alzheimer's disease and is--
                            (i) unable to perform without substantial 
                        human assistance (including verbal reminding or 
                        physical cueing) or supervision at least 2 of 
                        the following 5 activities of daily living: 
                        bathing, dressing, toileting, transferring, and 
                        eating; or
                            (ii) cognitively impaired so as to require 
                        substantial supervision from another individual 
                        because he or she engages in inappropriate 
                        behaviors that pose serious health or safety 
                        hazards to himself or herself or others.
            (2) Personal care assistance services.--Assistance with 
        activities of daily living, as defined at subsection III of 
        this section, which do not require the skills of qualified 
        technical or professional personnel.
            (3) Activities of daily living.--As defined in 42 CFR Sec.  
        441.505, activities of daily living (ADLs) means basic personal 
        everyday activities including, but not limited to, tasks such 
        as eating, toileting, grooming, dressing, bathing, and 
        transferring.

SEC. 8. BUILDING THE FUTURE OF THE HOME-BASED CARE WORKFORCE.

    (a) Creation of Grants to Communities To Foster Home-Based Care 
Professionals.--
            (1) General.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may award grants to entities to invest in 
        developing the home-based care workforce.
            (2) Eligible grantees.--The Secretary may award grants to 
        nonprofit hospital or health systems, community-based 
        organizations, non-profit home health agencies or personal care 
        organizations, State and local health agencies, and other 
        entities identified by the Secretary.
            (3) Use of funds.--The grantee may use funds for the 
        following:
                    (A) Invest in transitioning facility-based medical 
                personnel to care models that are focused on delivering 
                care in the home.
                    (B) Establish career advancement training to 
                improve the unique needs of medical personnel entering 
                the home, for example training for cultural 
                sensitivity, use of digital technologies, and best 
                practices.
                    (C) Recruit new medical personnel that will be 
                responsible for delivering care or support services for 
                care models in the home.
            (4) Application.--To be eligible to receive a grant, an 
        entity shall submit an application to the Secretary at such 
        time, in such manner, and containing such information as the 
        Secretary may require.
            (5) Priority.--In selecting grant recipients, the Secretary 
        shall prioritize entities that are able to provide evidence 
        that they primarily serve minority populations, operate in a 
        medically underserved community or a health professional 
        shortage area, or are heavily community-focused.
            (6) Grantee reporting requirements.--Each entity awarded a 
        grant shall submit an annual report to the Secretary on the 
        activities conducted under such grant, and other information as 
        the Secretary may require.
            (7) Report to congress.--Not later than 5 years after the 
        date of enactment of this section and every 5 years thereafter, 
        the Secretary shall submit a report to Congress that provides a 
        summary of the activities and outcomes associated with grants 
        made under this section.
            (8) Appropriation.--To carry out this section, there is 
        authorized to be appropriated $50,000,000 to remain available 
        until expended.
    (b) Establishment of Home-Based Nursing Task Force.--
            (1) General.--Not later than 90 days after the date of 
        enactment of this Act, the Secretary shall establish a task 
        force on developing standards for a home-based nursing board 
        certification (in this section referred to as the ``Task 
        Force'').
            (2) Duties.--Not later than 12 months after the 
        establishment of the Task Force, the Task Force shall develop 
        and submit to the Secretary recommendations and strategies for 
        the Department of Health and Human Services for the following:
                    (A) Identify key considerations and opportunities 
                for a potential registered nurse board certification in 
                home-based care.
                    (B) Develop the specifications and eligibility 
                requirements that would need to be met for a nursing 
                board certification in home-based care.
                    (C) Outline the benefits and potential issues that 
                would be associated with establishing a nursing board 
                certification in home-based care.
            (3) Considerations.--In developing recommendations and 
        strategies, the Task Force shall consider the following:
                    (A) Current and future state of the in-home 
                registered nursing workforce, including projected job 
                needs.
                    (B) Factors influencing individuals to pursue 
                careers in home-based care nursing.
                    (C) Access and barriers to in-home nursing career 
                opportunities for vulnerable or underrepresented 
                populations into nursing.
                    (D) Unique role the in-home registered nursing 
                workforce plays in engaging with caregivers.
                    (E) Differences in facility-based care verses home-
                based care from the perspective of the nurse, such as 
                clinical competency, burnout, level of experience 
                required, cultural sensitivities required, stressors, 
                and more.
            (4) Public report.--Not later than 60 days after the 
        submission of the recommendations and strategies, the Secretary 
        shall submit to the Congress a report containing such 
        recommendations and strategies.
            (5) Period of appointment.--Members shall be appointed to 
        the Task Force the duration of the existence of the Task Force.
            (6) Compensation.--Task Force members shall serve without 
        compensation.
            (7) Sunset.--The Task Force shall terminate upon the 
        submission of the report required.
    (c) Expanding Emergency Medical Services Workforce Study.--
            (1) General.--Not later than 90 days after the date of 
        enactment of Expanding Emergency Medical Services (EMS) 
        Workforce Program, the Secretary shall establish a council to 
        study the impacts of expanding the role of emergency medical 
        service (EMS) providers in the triage, treatment, and transfer 
        of patients in both emergency and non-emergency encounters and 
        associated impacts on the EMS workforce (in this section 
        referred to as the ``Council'').
            (2) Duties.--Not later than 12 months after the 
        establishment of the Council, the Council shall develop and 
        submit a study to the Secretary of the Department of Health and 
        Human Services that--
                    (A) details barriers to EMS providers to treating 
                in-place;
                    (B) outlines the benefits and other considerations 
                associated with expanding the scope of services 
                delivered by EMS providers;
                    (C) examines the current EMS provider workforce's 
                ability to expand their role in healthcare encounters;
                    (D) evaluates best practices for nurse navigation 
                programs that assist in triage and dispatch of 
                appropriate level of EMS providers;
                    (E) evaluates best practices for community 
                paramedicine programs; and
                    (F) assesses the impacts of the Expanding Emergency 
                Medical Services (EMS) Workforce Program on medically 
                and socially underserved communities' access to care 
                and emergency department utilization.
            (3) Considerations.--In developing the study, the Council 
        shall consider the following:
                    (A) Previous and existing community paramedicine 
                programs.
                    (B) Previous and existing nurse navigation 
                programs.
                    (C) Access to EMS services in rural communities.
                    (D) Current and future state of the EMS provider 
                workforce, including projected job needs.
                    (E) Unique role the EMS workforce plays in engaging 
                with the community.
                    (F) Training of EMS providers.
                    (G) Varying roles and capabilities of different 
                levels of EMS professionals, including Emergency 
                Medical Responder, Emergency Medical Technician, 
                Advanced--EMT, Paramedic, Community Paramedic.
            (4) Public report.--Not later than 60 days after the 
        submission of the study, the Secretary shall submit to the 
        Congress a report containing recommendations and strategies for 
        utilizing the EMS workforce beyond the scope of their current 
        role in healthcare encounters.
            (5) Period of appointment.--Members shall be appointed to 
        the Council the duration of the existence of the Council.
            (6) Compensation.--Council members shall serve without 
        compensation.
            (7) Sunset.--The Council shall terminate upon the 
        submission of the report required.
            (8) FACA applicability.--The Federal Advisory Committee Act 
        (5 U.S.C. App.) shall not apply to the Council.
            (9) Council procedures.--The Secretary, in consultation 
        with the Comptroller General of the United States and the 
        Director of the Office of Management and Budget, shall 
        establish procedures for the Council to--
                    (A) ensure that adequate resources are available to 
                effectively execute the responsibilities of the 
                Council;
                    (B) effectively coordinate with other relevant 
                advisory bodies and working groups to avoid unnecessary 
                duplication;
                    (C) create transparency to the public and Congress 
                with regard to Council membership, costs, and 
                activities, including through use of modern technology 
                and social media to disseminate information; and
                    (D) avoid conflicts of interest that would 
                jeopardize the ability of the Council to make decisions 
                and provide recommendations.
                                 &lt;all&gt;
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