I 
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 fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee 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 Representa-
tives 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. 
VerDate Sep 11 2014 
01:31 May 03, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6211
E:\BILLS\H2853.IH
H2853
SSpencer on DSK30NT082PROD with BILLS
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. Pro-
viders 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 Sec-
retary): 
(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). 
VerDate Sep 11 2014 
01:31 May 03, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2853.IH
H2853
SSpencer on DSK30NT082PROD with BILLS
(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 de-
signed 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 at-
VerDate Sep 11 2014 
01:31 May 03, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2853.IH
H2853
SSpencer on DSK30NT082PROD with BILLS
tribute patients to them. At a minimum, the attribution 
methodology should— 
(1) patient attribution to panels should be pro-
spective; 
(2) panels should be updated monthly or quar-
terly; and 
(3) PCPs should have a mechanism and incen-
tives to enroll patients so they can influence who is 
attributed to their panel. 
SEC. 3. IMPROVING COVERAGE FOR MEDICARE HOME IN-
FUSION. 
(a) IN GENERAL.—The HHS Secretary shall estab-
lish reimbursement for home infusion services and associ-
ated equipment and items under part B. 
(b) COVERED SERVICES AND SUPPLIES.—Home In-
fusion Therapy (HIT) and associated equipment are de-
fined 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 Infu-
sion Drugs such as disposable supplies for the drug 
administration (e.g., tubing, elastomeric pumps) and 
for the routine maintenance of the infusion access 
device; 
VerDate Sep 11 2014 
01:31 May 03, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2853.IH
H2853
SSpencer on DSK30NT082PROD with BILLS