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 Com-
mittee 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 Pro-
gram, to amend the Family and Medical Leave Act of 
1993, 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. 
This Act may be cited as ‘‘Family Caregiver Security 
Act of 2004’’.
SEC. 2. PROVISION OF QUALIFIED FAMILY CAREGIVER 
SERVICES UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1891(a) of the Social Se-
curity Act (42 U.S.C. 1395bbb(a)) is amended by adding 
at the end the following new paragraph: 
‘‘(7)(A) The agency permits an individual who 
is under its care to have home health aide services 
or personal care assistant services provided by a 
qualified family caregiver (as defined in subpara-
graph (B)) under an approved plan of care and pro-
vides for payment for the services of the caregiver, 
regardless of whether the caregiver is an employee of 
the agency, at a rate comparable to the rate other-
wise paid for such services provided by other quali-
fied personnel. In addition, in the case of such a 
caregiver the agency shall provide for appropriate 
training and oversight of such services by a reg-
istered nurse in the same or similar manner to that 
provided in the case of such services furnished by 
another qualified individual and shall provide the 
caregiver, as part of the plan of care, with edu-
cational information and resources related to family 
caregiver health and wellness. 
‘‘(B) For purposes of this paragraph, the term 
‘qualified family caregiver’ means, with respect to 
the provision of home health aide services or per-
sonal care assistant services to an individual, an in-
dividual who is a family caregiver (as defined in sec-
tion 372(2) of the National Family Caregiver Sup-
port Act) of the individual and who demonstrates 
proficiency in the provision of the home health aide 
services or personal care assistant services involved 
to the satisfaction of the supervising registered pro-
fessional nurse. 
‘‘(C) This paragraph shall supersede any other 
restriction 
of 
this 
title 
(including 
section 
1862(a)(11)) on the provision of home health aide 
services or personal care assistant services by a 
qualified family caregiver described in subparagraph 
(B) on the basis of the caregiver’s relationship to the 
recipient of such services. This subparagraph shall 
not affect any disqualification of an individual from 
providing services on the basis of the individual’s 
lack of qualification to provide the services or on the 
basis of an exclusion of participation of the indi-
vidual under part B of title XI. 
‘‘(D) The Secretary, in consultation with the 
Secretary of Labor, shall provide guidance to home 
health agencies on payment administration and man-
agement methodologies to facilitate the provision of 
home health aide services and personal assistant