‘‘(II) The term ‘qualified provider’ 
means a trained professional (as deter-
mined by the Secretary, including nurses 
and certified patient technicians) who fur-
nishes renal dialysis services and— 
‘‘(aa) meets requirements (as de-
termined by the Secretary) that en-
sures competency in patient care and 
modality usage; and 
‘‘(bb) provides in-person assist-
ance to a patient for at least 75 per-
cent 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 pa-
tient and his or her care partner, and out-
lined in a patient plan of care. 
‘‘(bb) In this subclause, the term ‘care 
partner’ means anyone who is designated 
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by the patient who assists the individual 
with the furnishing of home dialysis. 
‘‘(cc) In this subclause, the term ‘pa-
tient 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 sub-
paragraphs: 
‘‘(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 facil-
ity furnishes renal dialysis services to an indi-
vidual and ending 60 days after such day; and 
‘‘(E) provide for nurses, certified patient 
technicians, or other professionals to train pa-
tients and their care partners in skills and pro-
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cedures needed to perform home dialysis (as de-
fined in paragraph (14)(J)(iv)(III)) treat-
ment— 
‘‘(i) regularly and independently; 
‘‘(ii) through telehealth services or 
through group training (as described in the 
interpretive guidance relating to tag num-
ber V590 of ‘Advance Copy—End Stage 
Renal Disease (ESRD) Program Interpre-
tive Guidance Version 1.1’ (published on 
October 3, 2008)) in accordance with the 
Federal regulations (concerning the privacy 
of individually identifiable health informa-
tion) promulgated under section 264(c) of 
the Health Insurance Portability and Ac-
countability Act of 1996; and 
‘‘(iii) in the home or resident of a pa-
tient, 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— 
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(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 re-
ceives staff-assisted home dialysis (as de-
fined in section 1881(b)(14)(J)(iv)(III)) 
and otherwise meets the requirements (as 
determined by the Secretary), notwith-
standing whether an individual is a quali-
fied 
provider 
(as 
defined 
in 
section 
1881(b)(14)(J)(iv)(II)) or otherwise eligi-
ble for reimbursement under title XVIII.’’. 
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(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 sec-
tion 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 acknowledg-
ment that they are capable of home dialysis and 
want home dialysis, if that is the modality they 
choose. 
(5) PATIENT QUALITY OF LIFE METRIC.—Sec-
tion 1115A(b)(2)(B) of the Social Security Act (42 
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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 dialy-
sis.’’. 
SEC. 5. ENSURING MEDICARE BENEFICIARIES HAVE AC-
CESS TO IN-HOME LABS. 
(a) IN GENERAL.—The Secretary shall establish re-
imbursements 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 clin-
ical laboratory tests. Eligibility shall be more comprehen-
sive 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 
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conditions, social needs, barriers to accessing care, income 
level, or dual eligible status. 
(d) ELIGIBLE SUPPLIERS.—The Secretary shall de-
termine eligible suppliers for specimen collection of at- 
home clinical lab tests. 
(e) PAYMENT FOR TRAVEL ALLOWANCE.—The Sec-
retary 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 sensi-
tively, and other infectious disease protocols. 
(g) BENEFICIARY COSTS.—No provision in this sec-
tion 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 eval-
uation of Medicare reimbursable advanced diagnostic im-
aging as defined in subsection (e)(1)(B) of section 1834 
of the Social Security Act. The purpose of the evaluation 
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shall be to consider expansions to reimbursable at-home 
advanced diagnostic imaging services, including costs of 
transportation. 
(b) MINIMUM ACTION.—At a minimum, the Sec-
retary 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 trig-
ger 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, so-
cial needs, barriers to accessing care, income level, or dual 
eligible status. 
(d) AUTHORITY.—The Secretary shall have the au-
thority to expand the types of at-home advanced diag-
nostic imaging services reimbursable under Medicare, if 
medically appropriate and safe. 
(e) PAYMENT.—No provision in this section shall im-
pact the payment rates set annually through the physician 
fee schedule. 
(f) REPORT TO CONGRESS.—The Secretary shall sub-
mit the findings from the evaluation in section (a) in a 
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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 MEDI-
CARE 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 bene-
ficiaries (‘‘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 enti-
tled 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; 
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(3) must have an income at or below 400 per-
cent 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 hos-
pitalization stay, as defined by the Secretary, in the 
last 30 days. 
(e) OTHER ELIGIBILITY REQUIREMENTS.—The Sec-
retary 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 bene-
ficiary 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 Sec-
retary shall establish a process to validate beneficiary eli-
gibility 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 re-
maining Benefit period. 
(h) REIMBURSEMENT.—The Secretary will establish 
an hourly rate for personal care services through the an-
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nual 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-serv-
ice 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 re-
quirements for Federal background checks, and other ap-
propriate 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 Condi-
tions of Participation (CoPs). 
(k) OVERLAP.—The Secretary shall develop criteria 
describing how model overlap will be addressed when pa-
tients are eligible for the Benefit and are otherwise partici-
pating in a payment and delivery reform model under sec-
tion 1899 or through the Center for Medicare and Med-
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icaid Innovation. The Secretary shall exclude costs of the 
Benefit from reconciliation in these payment and delivery 
reform models as appropriate to limit unintended con-
sequences. 
(l) DEFINITIONS.— 
(1) FUNCTIONALLY DISABLED.—An individual 
is ‘‘functionally disabled’’ if the individual— 
(A) is unable to perform without substan-
tial 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 substan-
tial human assistance (including verbal re-
minding 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 re-
quire substantial supervision from another 
individual because he or she engages in in-
appropriate behaviors that pose serious 
health or safety hazards to himself or her-
self or others. 
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(2) PERSONAL CARE ASSISTANCE SERVICES.— 
Assistance with activities of daily living, as defined 
at subsection III of this section, which do not re-
quire the skills of qualified technical or professional 
personnel. 
(3) ACTIVITIES OF DAILY LIVING.—As defined 
in 42 CFR § 441.505, activities of daily living 
(ADLs) means basic personal everyday activities in-
cluding, but not limited to, tasks such as eating, 
toileting, grooming, dressing, bathing, and transfer-
ring. 
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 Serv-
ices 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 sys-
tems, community-based organizations, non-profit 
home health agencies or personal care organizations, 
State and local health agencies, and other entities 
identified by the Secretary. 
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(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 fo-
cused on delivering care in the home. 
(B) Establish career advancement training 
to improve the unique needs of medical per-
sonnel entering the home, for example training 
for cultural sensitivity, use of digital tech-
nologies, 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 con-
taining such information as the Secretary may re-
quire. 
(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 com-
munity or a health professional shortage area, or are 
heavily community-focused. 
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(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 Sec-
retary 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 rec-
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ommendations and strategies for the Department of 
Health and Human Services for the following: 
(A) Identify key considerations and oppor-
tunities for a potential registered nurse board 
certification in home-based care. 
(B) Develop the specifications and eligi-
bility 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 estab-
lishing a nursing board certification in home- 
based care. 
(3) 
CONSIDERATIONS.—In 
developing 
rec-
ommendations 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 pur-
sue careers in home-based care nursing. 
(C) Access and barriers to in-home nursing 
career opportunities for vulnerable or underrep-
resented populations into nursing. 
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