I 
108TH CONGRESS 
1ST SESSION 
H. R. 796
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 
FEBRUARY 13, 2003
Mr. ENGEL introduced the following bill; which was referred to the Committee 
on Energy and 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 juris-
diction of the committee 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 2003’’.
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)) 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.—Benefits are payable 
under this title for long-term care services under this sec-
tion only 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 (as defined in subsection 
(d)(2)). 
‘‘(c) PAYMENT FOR SERVICES.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
Notwithstanding any other provision of law, the 
amount payable under this title for long-term care 
services under this section shall be determined in ac-
cordance with a fee schedule for such services estab-
lished by the Secretary. 
‘‘(2) 
IMPOSITION
OF
DEDUCTIBLE.—The 
amount otherwise payable under this title for long-
term care services under this section furnished dur-
ing a calendar year shall be reduced by an amount 
equal to the deductible imposed for inpatient hos-
pital 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 activities of daily living (as defined in 
paragraph (3)); or
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘in-home care’ means the items and 
services described in paragraph (2) furnished to an 
individual by a home care agency (as defined in sec-
tion 1861(ww)) or by others under arrangements 
with them made by the agency provided in a place 
of residence used as such individual’s home (other 
than services described in paragraph (2)(H)). 
‘‘(2) SERVICES
DESCRIBED.—The items and 
services described in this paragraph are as follows: 
‘‘(A) Nursing care provided by or under 
the supervision of a registered professional 
nurse. 
‘‘(B) Services of a homemaker/home health 
aide who has successfully completed a training 
and competency evaluation program approved 
by the Secretary. 
‘‘(C) Personal care services. 
‘‘(D) Medical social services. 
‘‘(E) Physical, occupational, or respiratory 
therapy or speech-language pathology services. 
‘‘(F) Medical supplies (other than drugs 
and biologicals) and durable medical equipment, 
while under such a plan.
‘‘(G) Patient and caregiver (including fam-
ily caregiver) education and training to develop 
skills necessary to permit the individual to re-
main in the home setting. 
‘‘(H) Community care services furnished 
outside of the place of residence. 
‘‘(I) Such other home-based items and 
services (other than room and board) as the 
Secretary may approve. 
‘‘(f) CASE MANAGEMENT REQUIREMENTS.—
‘‘(1) REQUESTS FOR ASSESSMENT.—Each indi-
vidual entitled to benefits under part A or part B 
(or another person on such individual’s behalf) may 
request a case management agency to conduct an as-
sessment under this subsection to determine whether 
the individual is a dependent individual or a chron-
ically dependent individual and to assess the individ-
ual’s needs for long-term care services under this 
section. 
‘‘(2) DESCRIPTION OF PLANS.—For purposes of 
this section, a ‘case management plan’ means, with 
respect to an individual, a written plan of care 
which—
‘‘(A) is established and periodically re-
viewed and revised by a case management agen-
cy; and 
‘‘(B) reflects the individual’s needs identi-
fied in the assessment under paragraph (1). 
‘‘(3) CASE MANAGEMENT AGENCY DEFINED.—
In this section, the term ‘case management agency’ 
means a nonprofit or public agency or organization 
(or a nonprofit or public subdivision of such an 
agency or organization) certified by the Secretary to 
conduct assessments and establish case management 
plans under this subsection which—
‘‘(A) is experienced in conducting assess-
ments, in establishing and periodically reviewing 
and revising case management plans for nurs-
ing facility services and in-home care, and in 
coordinating and reviewing the quality of the 
provision of such services and care; 
‘‘(B) is capable of efficiently and effectively 
performing directly or through contracts under 
paragraph (4) such duties; and 
‘‘(C) does not provide long-term care serv-
ices or nursing facility services and does not 
have a direct or indirect ownership or control 
interest in, or direct or indirect affiliation or re-
lationship with, an entity that provides, such 
services. 
‘‘(4) 
CONTRACTING
OUT
CERTAIN
FUNC-
TIONS.—The Secretary shall permit a case manage-
ment agency, to the extent necessary to carry out 
functions under this section, to provide for assess-
ments and case management plans through con-
tracts with nonprofit or public organizations which 
do not provide long-term care services or nursing fa-
cility services and do not have a direct or indirect 
ownership or control interest in, or direct or indirect 
affiliation or relationship with, an entity that pro-
vides, such services.’’. 
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1833(a)(1) of the Social Security Act (42 U.S.C. 
1395l(a)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(U)’’; and 
(B) by inserting before the semicolon at the end 
the following: ‘‘, and (V) with respect to expenses in-
curred 
for 
services 
described 
in 
section 
1861(s)(2)(W), the amounts paid shall be the 
amounts determined under section 1889(c);’’. 
(2) Section 1861 of the Social Security Act (42 
U.S.C. 1395x) is amended by adding at the end the fol-
lowing new subsection:
‘‘HOME CARE AGENCY 
‘‘(ww) The term ‘home care agency’ means a public 
agency or private organization, or a subdivision of such 
an agency or organization, which is a home health agency 
(as defined in subsection (o)) or—
‘‘(1) is primarily engaged in providing services 
of homemaker/home health aides and personal care 
aides; 
‘‘(2) maintains clinical records on all patients; 
‘‘(3) in the case of an agency or organization in 
any State in which State or applicable local law pro-
vides for the licensing of agencies or organizations of 
this nature—
‘‘(A) is licensed pursuant to such law, or 
‘‘(B) is approved, by the agency of such 
State or locality, responsible for licensing agen-
cies or organizations of this nature, as meeting 
the standards established for such licensing; 
and 
‘‘(4) meets such other requirements as the Sec-
retary may find necessary in the interest of the 
health and safety of individuals who are furnished 
services by such agency or organization and for the 
effective and efficient operation of the program.’’.
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2004.
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