I
107TH CONGRESS
1ST SESSION
H. R. 913
To amend title XVIII of the Social Security Act to provide for coverage
of expanded nursing facility and in-home services for dependent individ-
uals under the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 7, 2001
Mr. ENGEL (for himself and Mr. BRADY of Pennsylvania) 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 provide
for coverage of expanded nursing facility and in-home
services for dependent individuals under the Medicare
Program.
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 ‘‘Comprehensive Long-
Term Care Act of 2001’’.
SEC. 2. EXPANDED LONG-TERM CARE SERVICES UNDER
MEDICARE PROGRAM FOR DEPENDENT INDI-
VIDUALS.
(a) IN GENERAL.—
(1) PART A.—Section 1812 of the Social Secu-
rity Act (42 U.S.C. 1395d) is amended—
(A) in subsection (a)—
(i) in paragraph (2)(B), by striking
‘‘subsection (f),’’ and inserting ‘‘subsection
(f) and section 1889,’’,
(ii) by striking ‘‘and’’ at the end of
paragraph (3),
(iii) by striking the period at the end
of paragraph (4) and inserting ‘‘; and’’,
and
(iv) by adding at the end the following
new paragraph:
‘‘(5) long-term care services consisting of ex-
tended care services (in accordance with section
1889).’’; and
(B) in subsection (b)(2), by striking ‘‘post-
hospital’’ and inserting ‘‘except as provided in
section 1889, post-hospital’’.
(2) PART B.—Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)), as amended
by sections 102(a) and 105(a) of the Medicare, Med-
icaid, and SCHIP Benefits Improvement and Pro-
tection Act of 2000, as enacted into law by section
1(a)(6) of Public Law 106–554, is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (U);
(2) by inserting ‘‘and’’ at the end of subpara-
graph (V); and
(3) by adding at the end the following new sub-
paragraph:
‘‘(W) long-term care services consisting of in-
home care (in accordance with section 1889);’’.
(b) DESCRIPTION OF SERVICES; ELIGIBILITY.—Title
XVIII of such Act is amended by inserting after section
1888 the following new section:
‘‘LONG-TERM CARE SERVICES FOR DEPENDENT
INDIVIDUALS
‘‘SEC. 1889. (a) IN GENERAL.—An individual enti-
tled to benefits under this part shall be entitled to have
payments made on the individual’s behalf for long-term
care services if—
‘‘(1) the individual is a dependent individual;
and
‘‘(2) such services are provided in accordance
with a case management plan developed by a case
management agency.
‘‘(b) SERVICES PROVIDED.—In this section, the term
‘long-term care services’ means—
‘‘(1) in-home care (as defined in subsection (e));
and
‘‘(2) extended care services (as defined in sec-
tion 1861(h)), but only with respect to a chronically
dependent individual.
‘‘(c) PAYMENT FOR SERVICES.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the amount payable for long-term care services
under this section shall be determined in accordance
with a fee schedule for such services established by
the Secretary.
‘‘(2) 
IMPOSITION
OF
DEDUCTIBLE.—The
amount otherwise payable for long-term care services
under this section furnished during a calendar year
shall be reduced by an amount equal to the deduct-
ible imposed for inpatient hospital services for the
year under section 1813(a)(1).
‘‘(d) DEPENDENT INDIVIDUAL DEFINED.—
‘‘(1) IN GENERAL.—In this section, the term
‘dependent individual’ means an individual who—
‘‘(A) is unable to perform (without sub-
stantial assistance from another individual) be-
cause of physical or cognitive impairment at
least 2 of the following activities of daily living:
bathing, dressing, toileting, transferring, and
eating; or
‘‘(B) has a similar level of disability due to
cognitive impairment that requires substantial
direction, instruction, or supervision of another
individual in order—
‘‘(i) to perform 2 or more of the ac-
tivities of daily living described in subpara-
graph (A), or
‘‘(ii) to remain in the community
without causing harm to self or others be-
cause of inappropriate behavioral patterns.
‘‘(2) CHRONICALLY DEPENDENT INDIVIDUAL.—
In this section, the term ‘chronically dependent indi-
vidual’ means an individual described in paragraph
(1) who—
‘‘(A) for purposes of subparagraph (A) of
such paragraph, is unable to perform at least 3
of the activities of daily living described in such
subparagraph; or
‘‘(B) for purposes of subparagraph (B)(i)
of such paragraph, has a level of disability that
requires direction, instruction, or supervision of