I 118th CONGRESS 2d Session H. R. 7742 IN THE HOUSE OF REPRESENTATIVES March 20, 2024 Ms. Castor of Florida (for herself and Mr. Buchanan ) introduced the following 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 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 establish a 2-year demonstration program for hospitals to provide outpatient observation services to Medicare beneficiaries at home.

1. Short title This Act may be cited as the At Home Observation and Medical Evaluation Services Act of 2024 or the At HOME Services Act . 2. Demonstration program for hospitals to provide outpatient observation services to Medicare beneficiaries at home Title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) is amended by inserting after section 1866G the following new section: 1866H. Demonstration program for hospitals to provide outpatient observation services at home (a) In general Not later than 1 year after the date of enactment of this section, the Secretary shall implement a 2-year demonstration program (in this section referred to as the Program ) for hospitals to provide outpatient observation services to eligible beneficiaries in the homes of such beneficiaries. In implementing such Program, the Secretary shall grant waivers and flexibilities (as described in subsection (b)) to an individual hospital that submits a request for such waivers and flexibilities and meets specified criteria (as described in subsection (c)) in order to participate in the Program. (b) Waivers and flexibilities For the purposes of subsection (a), the waivers and flexibilities described in this paragraph are the following waivers and flexibilities that were made available to individual hospitals under the Acute Hospital Care at Home initiative of the Secretary during the emergency period described in section 1135(g)(1)(B): (1) Subject to subsection (c)(2), waiver of the requirements to provide 24-hour nursing services on premises and for the immediate availability of a registered nurse under section 482.23(b) of title 42, Code of Federal Regulations (or any successor regulation), and the waivers of the physical environment and Life Safety Code requirements under section 482.41 of title 42, Code of Federal Regulations (or any successor regulation). (2) Waiver of the telehealth requirements under clause (i) of section 1834(m)(4)(C), as amended by section 4113(a) of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022, such that the originating sites described in clause (ii) of such section shall include the home or temporary residence of the individual. (3) Other waivers and flexibilities that, as of the date of enactment of this section, were in place for such initiative during such emergency period. (c) Specified criteria For purposes of subsection (a), the specified criteria for granting such waivers and flexibilities to individual hospitals are: (1) The hospital and any other entities providing services under arrangements with the hospital shall ensure that the standard of care to treat an eligible beneficiary at home is the same as the standard of care to treat such beneficiary as an inpatient of the hospital. (2) The hospital shall meet all patient safety standards determined appropriate by the Secretary, in addition to those that otherwise apply to the hospital, except those for which the waivers and flexibilities under this subsection apply. (3) The hospital shall provide to the Secretary, at a time, form and manner determined by the Secretary, any data and information the Secretary determines necessary to do the following: (A) Monitor the quality of care furnished, and to the extent practicable ensure the safety of, eligible beneficiaries and analyze costs of such care. (B) Undertake the study described in subsection (e). (4) The hospital meets such other requirements and conditions as the Secretary determines appropriate. (d) Termination The Secretary may terminate a hospital from participation in the Program (and the waivers and flexibilities applicable to such hospital) if the Secretary determines that the hospital no longer meets the criteria described in subsection (c). (e) Study and report (1) In general The Secretary shall conduct a study to— (A) analyze, to the extent practicable, the criteria established by hospitals to determine which beneficiaries may be furnished services under the Program; and (B) analyze and compare, to the extent practicable— (i) the quality of care furnished to beneficiaries with similar conditions and characteristics in the hospital setting and through the Program, including health outcomes, hospital readmission rates, hospital mortality rates, length of stay, infection rates, and patient experience of care; (ii) clinical conditions treated and diagnosis-related groups of discharges from the hospital setting and under the Program; (iii) costs incurred by furnishing care in the hospital setting and through the Program; (iv) the quantity, mix and intensity of such services (such as in-person visits and virtual contacts with patients) furnished under the Program and furnished in the hospital setting; and (v) socioeconomic information on beneficiaries treated under the Program, including racial and ethnic data, income, and whether such beneficiaries are dually eligible for benefits under this title and title XIX. (2) Report Not later than 1 year after the completion of the Program, the Secretary shall post on a website of the Centers for Medicare & Medicaid Services a report on the study conducted under paragraph (1). (f) Implementation Notwithstanding any other provision of law, the Secretary may implement this section by program instruction or otherwise. (g) Publicly available information The Secretary shall, as feasible, make the information collected under subsections (c)(3) and (e)(1) available on the Medicare.gov Internet website (or a successor website). .