I 
108TH CONGRESS 
1ST SESSION H. R. 1874
To establish a demonstration project to clarify the definition of homebound 
for purposes of determining eligibility for home health services under 
the Medicare Program, and to conditionally authorize that clarification. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 30, 2003
Mr. MARKEY (for himself and Mr. SMITH of New Jersey) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To establish a demonstration project to clarify the definition 
of homebound for purposes of determining eligibility for 
home health services under the Medicare Program, and 
to conditionally authorize that clarification.
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 ‘‘David Jayne Home-
bound Reform Act of 2003’’.
SEC. 2. DEMONSTRATION PROJECT TO CLARIFY THE DEFI-
NITION OF HOMEBOUND. 
(a) DEMONSTRATION PROJECT.—Not later than Jan-
uary 1, 2004, the Secretary shall conduct a demonstration 
project under which medicare beneficiaries with chronic 
conditions described in subsection (b) are deemed to be 
homebound for purposes of receiving home health services 
under the medicare program. 
(b) MEDICARE BENEFICIARY DESCRIBED.—For pur-
poses of subsection (a), a medicare beneficiary is eligible 
to be deemed to be homebound, without regard to the pur-
pose, frequency, or duration of absences from the home, 
if the beneficiary—
(1) has been certified by a physician as an indi-
vidual who has a permanent and severe condition 
that will not improve; 
(2) requires the individual to receive assistance 
from another individual with at least 3 out of the 5 
activities of daily living for the rest of the individ-
ual’s life; 
(3) requires 1 or more home health services to 
achieve a functional condition that gives the indi-
vidual the ability to leave home; and 
(4) requires technological assistance or the as-
sistance of another person to leave the home.
(c) DATA.—The Secretary shall collect such data on 
the demonstration project with respect to the provision of 
home health services to medicare beneficiaries that relates 
to quality of care, patient outcomes, and additional costs, 
if any, to the medicare program. 
(d) REPORTS TO CONGRESS.—(1) Not later than 1 
year after the date of the implementation of the dem-
onstration project under this section, the Secretary shall 
submit to Congress an initial report on the project using 
the data collected under subsection (c). 
(2) Not later than 1 year after the date of submittal 
of the report under paragraph (1), the Secretary shall sub-
mit to Congress an additional report on the project using 
the data collected under subsection (c). 
(e) WAIVER AUTHORITY.—The Secretary shall waive 
compliance with the requirements of title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) to such extent 
and for such period as the Secretary determines is nec-
essary to conduct demonstration projects. 
(f) CONSTRUCTION.—Nothing in this section shall be 
construed as waiving any applicable civil monetary pen-
alty, criminal penalty, or other remedy available to the 
Secretary under title XI or title XVIII of the Social Secu-
rity Act for acts prohibited under such titles, including
penalties for false certifications for purposes of receipt of 
items or services under the medicare program. 
(g) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated from the Federal Hospital 
Insurance Trust Fund and the Federal Supplementary In-
surance Trust Fund under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395i, 1395t), in such proportions as 
the Secretary determines to be appropriate, such funds as 
are necessary for the costs of carrying out the demonstra-
tion project under this section. 
(h) DEFINITIONS.—In this section: 
(1) 
MEDICARE
BENEFICIARY.—The 
term 
‘‘medicare beneficiary’’ means an individual entitled 
to benefits under part A of this title, enrolled under 
part B of this title, or both. 
(2) HOME
HEALTH
SERVICES.—The term 
‘‘home health services’’ has the meaning given such 
term in section 1861(m) of the Social Security Act 
(42 U.S.C. 1395x(m)). 
(3) ACTIVITIES OF DAILY LIVING DEFINED.—
The term ‘‘activities of daily living’’ means eating, 
toileting, transferring, bathing, and dressing. 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services.
SEC. 3. CLARIFICATION OF THE DEFINITION OF HOME-
BOUND FOR PURPOSES OF DETERMINING 
ELIGIBILITY FOR HOME HEALTH SERVICES 
UNDER THE MEDICARE PROGRAM. 
(a) CLARIFICATION.—Sections 1814(a) and 1835(a) 
of the Social Security Act (42 U.S.C. 1395f(a); 1395n(a)) 
are each amended by adding at the end the following: 
‘‘Notwithstanding the preceding sentences, in the case of 
an individual who has been certified by a physician as an 
individual who has a permanent and severe condition that 
will not improve and requires the individual to receive as-
sistance from another individual with at least 3 out of the 
5 activities of daily living for the rest of the individual’s 
life, who requires 1 or more home health services described 
in section 1861(m) to achieve a functional condition that 
gives the individual the ability to leave home, and who re-
quires technological assistance or the assistance of another 
person to leave the home, the Secretary may not disqualify 
such individual from being considered to be ‘confined to 
his home’ based on the purpose, frequency, or duration 
of the absences from the home. For purposes of the pre-
ceding sentence, the term ‘activities of daily living’ means 
eating, toileting, transferring, bathing, and dressing.’’. 
(b) CONTINGENT
EFFECTIVE
DATE.—(1) The 
amendments made by subsection (a) shall become effective 
(if at all) in accordance with paragraph (2).
(2)(A) Not later than December 1, 2006, the Sec-
retary of Health and Human Services (in this paragraph 
referred to as the ‘‘Secretary’’) shall submit to Congress 
a report on the results of the demonstration project estab-
lished under section 2 that analyzes the effect of the dem-
onstration project on the provision of home health services 
under the medicare program. 
(B) Such project shall be discontinued, and the 
amendments made by subsection (a) shall become effec-
tive, on January 1, 2007, unless the Secretary includes 
in that report a finding, on the basis of data collected 
under section 2(c) that the clarification of the definition 
of homebound under the demonstration project—
(i) adversely effects the provision of home 
health services under the medicare program; or 
(ii) directly causes an unreasonable increase of 
expenditures under the medicare program for the 
provision of such services that is directly attributable 
to such clarification. 
(C) If the Secretary includes in the report under sub-
paragraph (B) a finding referred to in subparagraph 
(B)(ii), the Secretary shall include in such report—
(i) the specific data evidencing the amount of 
the increase in expenditures that is a directly attrib-
utable to the clarification (expressed both in absolute
dollar terms and as a percentage) above expendi-
tures incurred for home health services under the 
medicare program made for home health services 
that are covered under the program without regard 
to this Act; and 
(ii) specific recommendations to exempt perma-
nently and severely disabled homebound beneficiaries 
from restrictions on the length, frequency and pur-
pose of their absences from the home to qualify for 
home health services without incurring additional 
unreasonable costs to the medicare program. 
(c) 
TECHNICAL
AMENDMENTS.—(1) 
Sections 
1814(a) and 1835(a) of the Social Security Act (42 U.S.C. 
1395f(a); 1395n(a)) are each amended in the sixth sen-
tence by striking ‘‘leave home,’’ and inserting ‘‘leave home 
and’’. 
(2) Section 1814(a) of the Social Security Act (42 
U.S.C. 1395f(a)), as amended by subsection (a), is amend-
ed by moving the seventh sentence, as added by section 
322(a)(1) of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (appendix F, 
114 Stat. 2763A–501), as enacted into law by section 
1(a)(6) of Public Law 106–554, to the end of that section.
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