I
106TH CONGRESS
1ST SESSION
H. R. 3041
To provide for a demonstration project to allow certain organizations that
provide care under Medicare to purchase home-care services from self-
employed caregivers through home-care referral agencies.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 7, 1999
Mr. DEUTSCH introduced the following bill; which was referred to the Com-
mittee on 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 jurisdic-
tion of the committee concerned
A BILL
To provide for a demonstration project to allow certain orga-
nizations that provide care under Medicare to purchase
home-care services from self-employed caregivers through
home-care referral agencies.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Home Health Avail-
ability Act of 1999’’.
SEC. 2. MEDICARE DEMONSTRATION PROJECT FOR HOME
HEALTH.
(a) DEFINITIONS.—In this section:
(1) CAREGIVER.—The term ‘‘caregiver’’ means
a self-employed individual who is a registered nurse,
licensed practical nurse, certified nursing assistant,
home health aide, homemaker, companion, or sitter
who is engaged in providing services for patients in
their homes or places of residence.
(2) CLIENT.—The term ‘‘client’’ means an indi-
vidual eligible to receive home health services under
title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
(3) DEMONSTRATION PROJECT; PROJECT.—The
terms ‘‘demonstration project’’ and ‘‘project’’ mean
the demonstration project carried out under this sec-
tion.
(4) DEMONSTRATION
PROJECT
STATE.—The
term ‘‘demonstrate project state’’ means the State of
Florida.
(5) HOME-CARE REFERRAL AGENCY; REFERRAL
AGENCY.—The term ‘‘home-care referral agency’’ or
‘‘referral agency’’ means a public agency or private
entity or a subdivision of one of the foregoing that
meets applicable State licensing requirements and is
lawfully engaged in the business of procuring, offer-
ing, promising, or attempting to secure health care
or home health related contracts (including, but not
limited to, contracts for the provision of services to
patients in their homes or places of residence and
contracts for the provision of services including pri-
vate duty or supplemental staffing at health-care fa-
cilities) for caregivers.
(6) PARTICIPATING ORGANIZATION.—The term
‘‘participating 
organization’’ 
means 
a
Medicare+Choice organization (as defined in section
1859(a)(1) of the Social Security Act, 42 U.S.C.
1395w–29(a)(1)), that elects to participate in the
demonstration project.
(7) SELF-EMPLOYED
INDIVIDUAL.—The term
‘‘self-employed individual’’ means an individual who
contracts with a referral agency for providing serv-
ices if any payment made to the individual under
such contract constitutes self-employment income
(as defined in section 1402(b) of the Internal Rev-
enue Code of 1986).
(b) DEMONSTRATION PROJECT.—
(1) IN GENERAL.—
(A) ESTABLISHMENT.—The Secretary of
Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’) shall establish a
demonstration project under which a partici-
pating organization will be authorized to pur-
chase home health services, as defined in sec-
tion 1861(m) of the Social Security Act (42
U.S.C. 1395x(m)), from a caregiver through a
home-care referral agency and, solely for pur-
poses of this section and only when home health
services are being purchased under the dem-
onstration project, the term ‘‘home health serv-
ices’’, as so defined, shall be modified by sub-
stituting in lieu of the term ‘‘home health agen-
cy’’ wherever it appears therein, the term
‘‘home-care referral agency’’.
(B) NO EFFECT ON HOME HEALTH AGEN-
CIES.—The demonstration project shall not in
any way affect a home health agency, as de-
fined in section 1861(o) of the Social Security
Act (42 U.S.C. 1395x(o)). The project’s sole
purpose is to provide participating organiza-
tions with the option of purchasing home health
services from an additional source.
(C) VOLUNTARY PARTICIPATION.—Partici-
pation organizations that elect to participate in
the demonstration project are under no obliga-
tion to purchase all, or any specified minimum
percentage of, home health services under the
demonstration project, and shall have the right
to cease participating in the demonstration
project at any time.
(D) ELECTION
TO
PARTICIPATE
IN
THE
DEMONSTRATION PROJECT.—In order to par-
ticipate in the demonstration project, a partici-
pating organization must provide the Secretary
with a written notice of election to participate,
which notice shall state—
(i) the name and address of the orga-
nization;
(ii) the effective date of the organiza-
tion’s election to participate; and
(iii) the cities within the demonstra-
tion project State in which the organiza-
tion has operations and elects to partici-
pate.
(2) DURATION.—The Secretary shall conduct
the demonstration project during the 3-year period
beginning on September 1, 2000.
(c) AUTHORITY TO WAIVE CERTAIN MEDICARE RE-
QUIREMENTS.—The Secretary may, to the extent nec-
essary to carry out the demonstration project, waive any
requirements under title XVIII of the Social Security Act.
(d) EVALUATION AND REPORTS.—
(1) INDEPENDENT EVALUATION.—
(A) GENERAL.—The Secretary shall ar-
range for an independent entity with expertise
in the evaluation of health care services to con-
duct an evaluation of the demonstration project.
(B) 
CONTENTS.—The 
evaluation 
con-
ducted under subparagraph (A) shall include an
assessment of the following:
(i) A comparison of the quality of care
provided by caregivers under the dem-
onstration project relative to the quality of
care provided by a home health agency.
(ii) A comparison of the cost of care
provided by caregivers under the dem-
onstration project relative to the cost of
care provided by a home health agency.
(iii) A comparison of the level of satis-
faction with the care received by individ-
uals who have received home care under
the demonstration project relative to the
level of satisfaction by such individuals
with the home care they received from a
home health agency.
(C) ANNUAL REPORTS.—The independent
entity conducting the evaluation under subpara-
graph (A) shall submit reports on such evalua-
tions to the Secretary and to the committees of
jurisdiction in the Congress as follows:
(i) INITIAL REPORT.—The entity shall
submit an initial report not later than 12
months after the date on which the dem-
onstration project begins operation.
(ii) SECOND
ANNUAL
REPORT.—The
entity shall submit a second annual report
not later than 24 months after the date on
which the demonstration project begins op-
eration.
(iii) FINAL REPORT.—The entity shall
submit a final report not later than 30
months after the date on which the dem-
onstration project begins operation.
(2) REPORT ON EXTENSION AND EXPANSION
OF DEMONSTRATION PROJECT.—Not later than 30
months after the date on which the demonstration
project begins operation, the Secretary shall submit
to Congress a report containing—
(A) a recommendation as to—
(i) whether to extend the demonstra-
tion project or make the project perma-
nent;
(ii) whether to expand the project to
cover additional States; and
(iii) whether the terms and conditions
of the project should be continued (or
modified) if the project is extended or ex-
panded; and
(B) a detailed description of any costs as-
sociated with their recommendation made pur-
suant to clauses (i) and (ii) of subparagraph
(A).
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