,,ii  #aag? ,,congress  #a/ ,session    
,s4 #befb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #bi1 #bjba,ms4   
,/ab5[ 7= h]self1 ,mr4 ,"y1 ,ms4        
,hassan1 ,ms4 ,coll9s1 ,mr4 ,casey1 ,mr4
 ,lank=d1 ,mr4 ,c>d91 & ,ms4 ,lummis7   
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve ext5d$ c>e s]vices by provid+   
,m$ic>e b5efici>ies ) an option = co/   
effective home-bas$ ext5d$ c>e "u !     
,m$ic>e program1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,*oose ,home ,c>e ,act ( #bjba4  #b4    
,e/abli%m5t ( a home-bas$ ext5d$ c>e    
s]vices b5efit z "p ( ,m$ic>e  7a7      
,improv$ support = heal? c>e at home    
7#a7 ,9 g5]al ,section #ahab ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acie;d7 
is am5d$-- 7,a7 9 subsection 7a7-- 7i7 9
 p>agraph 7#b77;,a71 by ins]t+ 7r$uc$ by
 ! numb] ( days ( home-bas$ ext5d$ c>e  
s]vices furni%$ "u p>agraph 7#f7 dur+   

su* spell ( illness7 aft] spell (       
illness2  7ii7 9 p>agraph 7#d71 by /rik+
 & at ! end2  7iii7 9 p>agraph 7#e71 by 
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7iv7 by add+ at ! end ! foll[+ new      
p>agraph3  7#f7 7,a7 home-bas$ ext5d$   
c>e s]vices = a #cj-;day episode =      
individuals :o o!rwise qualify =        
po/-hospital ext5d$ c>e s]vices "u      
p>agraph 7#b77;,a72  7,b7 to ! ext5t    
provid$ 9 subsection 7f71 home-bas$     
ext5d$ c>e s]vices t are n po/-hospital 
home-bas$ ext5d$ c>e s]vices2 &  7,c7 9 
su* circum/ances z ! ,secret>y may      
specify1 home-bas$ ext5d$ c>e s]vices = 
"o or m subsequ5t #cj-;day episode or   
episodes up to a maximum ( #ajj days (  
home-bas$ ext5d$ c>e s]vices 9 a spell (
 illness4  2  7,b7 9 subsection 7b7--   
7i7 9 p>agraph 7#b71 by /rik+ or at !   
end2  7ii7 9 p>agraph 7#c71 by /rik+ !  
p]iod at ! end & ins]t+ 2 or2 &  7iii7  
by ins]t+ aft] p>agraph 7#c7 ! foll[+   
new p>agraph3  7#d7 home-bas$ ext5d$ c>e
 s]vices furni%$ to an individual aft]  

su* s]vices h be5 furni%$ to !          
individual = a #cj-;day episode dur+ su*
 spell1 except z provid$ by ! ,secret>y 
pursuant to subp>agraph 7,b7 or 7,c7 (  
subsection 7a77#f74  2 &  7,c7 9        
subsection 7f7-- 7i7 9 p>agraph 7#a7--  
7,i7 by ins]t+ &1 "u subsection         
7a77#f77;,b71 ( home-bas$ ext5d$ c>e    
s]vices1 z applicable1 aft] ext5d$ c>e  
s]vices ! fir/ place x appe>s2  7,,ii7  
by ins]t+ or po/-hospital home-bas$     
ext5d$ c>e s]vices aft] po/-hospital    
ext5d$ c>e s]vices2 &  7,,iii7 by ins]t+
 or subsection 7a77#f71 z applicable    
be=e ! p]iod2 &  7ii7 9 p>agraph 7#b7-- 
7,i7 9 subp>agraph 7,a71 by ins]t+ or   
subsection 7a77#f77;,b71 z applicable   
aft] subsection 7a77#b77;,b72 &  7,,ii7 
9 subp>agraph 7,b71 by /rik+ subsection 
& ins]t+ subsections4  7#b7 ,co9surance 
& d$uctible ,section #ahac7;a77#c7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;e7a77#c77 is am5d$ by ins]t+ !    
foll[+ be=e ! p]iod3 7or1 9 ! case :]e  
an individual is furni%$ po/-hospital   

home-bas$ ext5d$ c>e s]vices1 aft] su*  
s]vices 7or a comb9ation ( su* s]vices &
 po/-hospital ext5d$ c>e s]vices7 h be5 
furni%$ to him = #bj days dur+ su*      
spell74  7#c7 ,c]tification requirem5t  
,section #ahad7;a77#b7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#b77 is am5d$-- 7,a7 9 !     
matt] prec$+ subp>agraph 7,a71 by ins]t+
 or 7,e7 aft] subp>agraph 7,c72  7,b7 9 
subp>agraph 7,c71 by /rik+ or at ! end2 
7,c7 9 subp>agraph 7,d71 by ins]t+ or   
aft] ! semicolon2 &  7,d7 by add+ at !  
end ! foll[+ new subp>agraph3  7,e7 9 ! 
case ( po/-hospital home-bas$ ext5d$ c>e
 s]vices1 su* s]vices are or 7 requir$  
to be furni%$ because ! individual      
o!rwise ne$s or ne$$ & qualifies =      
ext5d$ c>e s]vices 9 a skill$ nurs+     
facility payable "u ?is "p "u           
subp>agraph 7,b71 & su* individual does 
n qualify = s]vices 9 an inpati5t       
rehabilitation facility or long-t]m c>e 
hospital payable "u ?is "p2  4  7#d7    
,po/-hospital ext5d$ c>e s]vices        

,section #ahfa7;i7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciex7i77 is      
am5d$1 9 ! second s5t5ce-- 7,a7 by /rik+
 or 7,b7 & ins]t+ 7,b72 &  7,b7 by      
ins]t+ ! foll[+ be=e ! p]iod 1 or 7,c7 9
 ! case ( an individual receiv+         
po/-hospital home-bas$ ext5d$ c>e       
s]vices1 )9 #cj days aft] dis*>ge f a   
hospital4  7#e7 ,def9ition ( home-bas$  
ext5d$ c>e s]vices ,section #ahfa ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7lll7           
,home-,bas$ ,ext5d$ ,c>e ,s]vices  7#a7 
,! t]m home-bas$ ext5d$ c>e s]vices     
means ! foll[+ items & s]vices furni%$  
to an individual 9 ! individual's home  
by a home heal? ag5cy 7z def9$ 9        
subsection 7o7 includ+ ! additional     
requirem5ts "u p>agraph 7#i7 ( su*      
subsection71 or by o!rs "u arrangem5ts )
 su* ag5cy3 7,a7 ,nurs+ c>e1 o!r ?an z  
describ$ 9 subsection 7m71 includ+ :5   
provid$ us+ telecommunications te*nology
 z a supplem5t to daily 9-p]son c>e4    

7,b7 ,physical or occupational !rapy or 
spee*-language pa?ology s]vices1 o!r ?an
 z describ$ 9 subsection 7m71 includ+ :5
 provid$ us+ telecommunications z a     
supplem5t to daily 9-p]son c>e4  7,c7   
,meals & nutritional support4  7,d7     
,remote pati5t monitor+ z a supplem5t to
 9-p]son c>e o!r ?an z describ$ 9       
subsection 7m74  7,e7 ,m$ical social    
s]vices o!r ?an z describ$ 9 subsection 
7m74  7,f7 ,s]vices ( a home heal? aide 
o!r ?an z describ$ 9 subsection 7m7 &   
p]sonal c>e s]vices4  7,g7 ,respite c>e1
 family c>egiv] & o!r unpaid c>egiv]    
supports1 education1 & tra9+ res\rces4  
7,h7 ,assi/ance ) adh]5ce to drugs      
prescrib$ = ! individual4  7,i7 ,m$ical 
supplies1 appliances1 & equipm5t1 o!r   
?an ^? describ$ 9 subsection 7m71 = use 
9 ! home1 includ+ relat$ to ba?+1       
dress+1 toilet+1 walk+1 or fe$+4  7,j7  
,nonem]g5cy m$ical transportation o!r   
?an ambulance s]vices4  7,k7 ,c>e       
coord9ation & integration1 includ+      
provid+ dis*>ge plann+ & c>e transitions

 support to ! individual & family & o!r 
unpaid c>egiv]s1 includ+ ref]ral =      
p]son-c5t]$ c\nsel+ or options c\nsel+ f
 _! ,/ate's ,ag+ & ,disability ,res\rce 
,c5t]_/,no ,wrong ,door ,sy/em1 ^u      
completion ( a #cj-;day episode or "o or
 m subsequ5t #cj-;day episode or        
episodes1 if applicable1 "u section     
#ahab7;a77#f77;,c74 ,to ! greate/ ext5t 
possible1 c>e transitions support       
s]vices provid$ z "p ( home-bas$ ext5d$ 
c>e s]vices %\ld use evid5ce-bas$ models
 & practices1 p>ticul>ly ^? t employ    
face-to-face visits4  7,l7 ,su* o!r     
items & s]vices z ! home heal? ag5cy    
det]m9es are necess>y = ! c>e ( !       
individual 9 ! home4  7#b7 ,no?+ 9 ?is  
subsection %all be con/ru$ z impact+ an 
individual's eligibility = transition ( 
c>e s]vices "u any o!r provision ( ?is  
title or o!rwise = :i* ! individual is  
eligible4  4  7#f7 ,dis*>ge plann+      
,section #ahfa7;ee77#b7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciex7ee77#b77 is am5d$-- 7,a7 9       

subp>agraph 7,d7-- 7i7 by /rik+ hospice 
c>e & po/-hospital ext5d$ c>e s]vices & 
ins]t+ hospice c>e1 po/-hospital ext5d$ 
c>e s]vices1 po/-hospital home-bas$     
ext5d$ c>e s]vices1 & s]vices furni%$ by
 inpati5t rehabilitation facilities &   
units & long-t]m c>e hospitals2 &  7ii7 
by ins]t+ & home-bas$ ext5d$ c>e s]vices
 aft] home heal? s]vices2 &  7,b7 by    
add+ at ! end ! foll[+ new subp>agraph3 
7,i7 ,! dis*>ge plann+ evaluation &     
dis*>ge plan = an individual :o meets   
applicable /&>ds & crit]ia = ext5d$ c>e 
s]vices "u section #ahab1 & :o does n   
ne$ s]vices provid$ by an inpati5t      
rehabilitation facility or unit or a    
long-t]m c>e hospital1 %all include1 9  
addition to ! items describ$ 9          
subp>agraph 7,d7-- 7i7 an evaluation1 9 
coord9ation ) a qualifi$ home heal?     
ag5cy1 ( ! appropriat5ess ( home-bas$   
ext5d$ c>e s]vices1 includ+ consid]ation
 ( pati5t *>act]i/ics1 includ+ b n      
limit$ to functional1 cognitive1 &      
behavioral compet5cies & deficits &     

prim>y & second>y diagnoses1 !          
availability ( able & will+ c>egiv]s1 ! 
scope ( home-bas$ ext5d$ c>e s]vices    
ne$$ & o!r s]vices 7if applicable71 !   
l5g? ( "t su* s]vices w\ld be ne$$1 !   
availability ( ! level ( s]vices ne$$1 &
 ! ne$ = & availability ( heal? c>e     
s]vices foll[+ completion ( home-bas$   
ext5d$ c>e s]vices1 ! individual's place
 ( c>e pref]5ces1 & ! integration ( &   
consid]ation ( social det]m9ants1       
inclusive ( race & e?nicity & !         
availability ( & access to quality      
s]vices1 into measures us$ to det]m9e   
eligibility ( a b5efici>y to receive    
home-bas$ ext5d$ c>e s]vices2  7ii7 a   
consultation ) ! individual z to ! f9d+s
 ( su* evaluation1 includ+ consid]ation 
( ! individual's place ( c>e pref]5ces1 
goals reg>d+ c>e1 family c>egiv]        
conc]ns1 & ! ability ( ! individual to  
safely & effectively receive c>e 9 !    
home2  7iii7 ! provision ( c>egiv] tra9+
 res\rces to family & o!r unpaid        
c>egiv]s includ+ guidance on m$ical1    

nurs+1 & p]sonal c>e tasks2 &  7iv7     
obta9+ v]bal cons5t f ! individual t is 
record$ 9 ! individual's inpati5t c>e   
record if ! individual *ooses to receive
 home-bas$ ext5d$ c>e s]vices4  ,clauses
 7i71 7ii71 & 7iii7 %all n preempt any  
applicable ,/ate law requirem5ts4       
,clause 7iv7 %all preempt any ,/ate law 
requirem5ts relat+ to cons5t = home-bas$
 ext5d$ c>e s]vices4 ,! ,secret>y %all  
e/abli%1 ?r\gh notice & comm5t rulemak+1
 ! "r to an exp$it$ appeal ( any adv]se 
det]m9ation reg>d+ ! det]m9ation to     
provide ! individual ) ! option (       
home-bas$ ext5d$ c>e s]vices & ! scope (
 home-bas$ ext5d$ c>e s]vices ne$$ by ! 
individual4 4  7#g7 ,additional         
requirem5ts ,section #ahfa7o7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7o77 is am5d$-- 7,a7 9 p>agraph   
7#g77;,b71 by /rik+ & at ! end2  7,b7 9 
p>agraph 7#h71 by ins]t+ & at ! end2 &  
7,c7 by ins]t+ aft] p>agraph 7#h7 !     
foll[+ new p>agraph3  7#i7 = purposes ( 
furni%+ po/-hospital home-bas$ ext5d$   

c>e s]vices "u section #ahab7;a77#f71   
meets su* additional requirem5ts &      
conditions z ! ,secret>y f9ds necess>y1 
includ+-- 7,a7 ! provision ( c>e on a   
#bd-;h\r basis2  7,b7 ! ability to      
provide all items & s]vices describ$ 9  
subsection 7lll72  7,c7 ! provision (   
necess>y & cov]$ s]vices2  7,d7         
education1 tra9+1 & sup]vision          
requirem5ts = ^? provid+ home-bas$      
ext5d$ c>e s]vices2 &  7,e7 compliance )
 all requirem5ts & conditions :5 su*    
s]vices are provid$ "u arrangem5t z     
describ$ 9 subsection 7m7 to ensure t   
o!rs provid+ c>e "u su* arrangem5t ) su*
 ag5cy are held to ! same /&>ds         
7requirem5ts & conditions7 z ! ag5cy2  4
  7#h7 ,home-bas$ ext5d$ c>e s]vices    
add-on ,section #ahie ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acie;fff7
 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7f7 ,home-,bas$ ext5d$ c>e 
s]vices add-,on  7#a7 ,9 g5]al ,an      
add-on paym5t 9 addition to ! am\nt     
o!rwise payable "u ?is section = home   

heal? s]vices %all be made to a home    
heal? ag5cy t meets ! additional        
requirem5ts ( section #ahfa7o77#i7 &    
provides home-bas$ ext5d$ c>e s]vices "u
 section #ahab7;a77#f74  7#b7 ,paym5t   
am\nt ,subject to p>agraphs 7#c7 & 7#d71
 ! am\nt ( su* add-on paym5t = home-bas$
 ext5d$ c>e s]vices provid$ to an       
individual %all be det]m9$ z foll[s3    
7,a7 ,det]m9ation ,su* am\nt %all be    
det]m9$ bas$ on ! foll[+3 7i7 ,! foll[+ 
f\r case-mix classifications1 det]m9$ by
 ! numb] ( h\rs ( p]sonal c>e s]vices   
provid$ to an individual1 z foll[s3 7,i7
 ,up to #fj h\rs1 includ+ an initial    
assessm5t4  7,,ii7 #fa to #abj h\rs4    
7,,iii7 #aba to #bdj h\rs4  7,,iv7 #bda 
to #cfj h\rs ( p]sonal c>e s]vices4     
7ii7 ,9 calculat+ ! numb] ( h\rs (      
p]sonal c>e s]vices "u clause 7i71 "p-"t
 or int]mitt5t s]vices provid$ by home  
heal? aides "u sections #ahab7;a77#b7 & 
#ahce7;a77#b77;,a7 %all n be includ$4   
7iii7 ,su* o!r factors z ! ,secret>y    
det]m9es appropriate4  7,b7 ,fix$ base  

am\nt ,! ,secret>y %all provide a fix$  
base am\nt = ea* ( ! #d case-mix        
classifications describ$ 9 subclauses   
7,i7 ?r\gh 7,,iv7 ( subp>agraph 7,a77i7 
z foll[s3 7i7 #bjbb ,= s]vices furni%$  
dur+ #bjbb1 a fix$ base am\nt (-- 7,i7 9
 ! case ( ! case-mix classification     
describ$ 9 subclause 7,i7 ( subp>agraph 
7,a77i71 #b1jaj2  7,,ii7 9 ! case ( !   
case-mix classification describ$ 9      
subclause 7,,ii7 ( su* subp>agraph1     
#d1jbj2  7,,iii7 9 ! case ( ! case-mix  
classification describ$ 9 subclause     
7,,iii7 ( su* subp>agraph1 #g1cfj2 &    
7,,iv7 9 ! case ( ! case-mix            
classification describ$ 9 subclause     
7,,iv7 ( su* subp>agraph1 #aj1gbj1      
respectively4  7ii7 #bjbc & subsequ5t   
ye>s ,= s]vices furni%$ dur+ #bjbc1 or a
 subsequ5t ye>1 a fix$ base am\nt equal 
to ! am\nt det]m9$ "u ?is subp>agraph = 
! prec$+ ye> = ! applicable case-mix    
classification1 updat$ by ! home heal?  
applicable increase p]c5tage "u         
subsection 7b77#c77;,b7 applicable to ! 

ye> involv$4  7,c7 ,area wage index     
adju/m5t ,! fix$ base am\nt det]m9$ "u  
subp>agraph 7,b7 %all be subject to !   
applicable area wage index "u subsection
 7b77#d77;,c74  7#c7 ,alt]native add-on 
paym5t model ,= s]vices furni%$ 9 #bjbc1
 or 9 a subsequ5t ye>1 ! ,secret>y may  
apply an alt]native model ( paym5t t    
%all be bas$ on relevant & reliable data
 on pati5t *>act]i/ics t reflect !      
v>iations 9 res\rce use & int5sity )9 a 
pati5t case mix4  7#d7 ,limitation      
,not)/&+ any o!r provision 9 ?is        
section1 ! am\nt ( ! additional paym5t  
"u ?is subsection to a home heal? ag5cy 
= home-bas$ ext5d$ c>e s]vices1 9       
comb9ation ) ! am\nt ( paym5t = home    
heal? s]vices "u ?is section = a unit ( 
s]vices furni%$ to an individual1 %all n
 result 9 a total am\nt ( paym5t "u ?is 
section = su* s]vices t exce$s an am\nt 
equal to #hj p]c5t ( ! national m$ian   
#cj-;day paym5t am\nt = ext5d$ c>e      
s]vices furni%$ 9 a skill$ nurs+        
facility "u section #ahab = ! mo/ rec5t 

fiscal ye> prior to ! paym5t ye> = :i*  
data is available1 updat$ bas$ on !     
skill$ nurs+ facility m>ket basket      
p]c5tage *ange "u section               
#ahhh7;e77#e77;,b74 ,! ,secret>y may    
adju/ ! am\nt ( ! additional paym5t =   
home-bas$ ext5d$ c>e s]vices "u ?is     
subsection 9 ord] to comply ) !         
limitation "u ! prec$+ s5t5ce4  4  7b7  
,transp>5cy 9 notice & comm5t rulemak+  
,9 e/abli%+ /&>ds & proc$ures "u !      
provisions (1 & am5dm5ts made by1 ?is   
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices 79 ?is section ref]r$ to z !   
,secret>y7 %all include full transp>5cy 
?r\gh notice & comm5t rulemak+ ( !      
me?odology1 assumptions1 evid5ce1 & all 
data us$ 9 support ( propos$ paym5t     
rates1 /&>ds = eligibility & paym5t =   
s]vices1 provid] conditions =           
p>ticipation1 & any o!r matt] relat$ to 
! implem5tation ( su* provisions &      
am5dm5ts4  7c7 ,/akehold] input ,9      
e/abli%+ any propos$ /&>ds & proc$ures  
"u ! provisions (1 & am5dm5ts made by1  

?is ,act1 ! ,secret>y %all solicit      
writt5 input on su* propos$ /&>ds &     
proc$ures f provid]s1 repres5tatives (  
provid]s1 ,m$ic>e b5efici>ies1 families1
 & relat$ /akehold] gr\ps & consid] su* 
input 9 ! developm5t ( su* /&>ds &      
proc$ures4  7d7 ,annual report to       
,congress ,= cal5d> ye> #bjbb1 & ea*    
cal5d> ye> !reaft]1 ! ,secret>y %all    
submit a report to ,congress on !       
cov]age ( home-bas$ ext5d$ c>e s]vices  
"u ! ,m$ic>e program 7#db ,u4,s4,c4     
#acie et seq47 pursuant to ! provisions 
(1 & am5dm5ts made by1 ?is ,act4 ,ea*   
report submitt$ "u ?is subsection %all  
include ! foll[+3 7#a7 ,! total numb] ( 
individuals receiv+ su* s]vices pursuant
 to su* provisions & am5dm5ts1 includ+  
:i* s]vices su* individuals receiv$1 h[ 
long su* individuals receiv$ su*        
s]vices1 & :at ! av]age h\rs 7 p]       
individual1 & ! total am\nt (           
exp5ditures = su* s]vices "u ! ,m$ic>e  
program1 includ+ an itemization (       
exp5ditures associat$ ) home heal? c>e &

 9-home support s]vices4  7#b7 ,an      
analysis ( ! effici5cy & effectiv5ess ( 
! processes = dis*>ge plann+ evaluation 
& dis*>ge plann+ "u section             
#ahfa7;ee77#b77;,i7 ( ! ,social         
,security ,act1 z add$ by subsection    
7a77#f71 an itemization ( ! diagnoses1  
treatm5t protocols1 & outcomes (        
individuals receiv+ b5efits 7includ+    
family or o!r unpaid c>egiv]s1 z        
applicable71 an evaluation comp>+       
cl9ical outcomes & pati5t exp]i5ce =    
simil> pati5ts receiv+ home-bas$ ext5d$ 
c>e s]vices & s]vices 9 skill$ nurs+    
facilities1 an evaluation 7:i* %all     
include audits7 ( :e!r home-bas$ ext5d$ 
c>e s]vices are be+ appropriately t>get$
 to individuals :o ne$ & w\ld b5efit f !
 scope1 level1 & duration ( su*         
home-bas$ ext5d$ c>e s]vices & :e!r     
individuals receiv+ su* s]vices are     
receiv+ ! appropriate scope1 level &    
duration ( c>e1 & ! co/ effectiv5ess (  
furni%+ home-bas$ ext5d$ c>e s]vices 9  
relation to alt]native skill$ nurs+     

facility co/s4  7#c7 ,data by race &    
e?nicity z x applies to eligibility1    
decision on p>ticipation ( ! b5efici>y1 
utilization rates1 & availability (     
quality home heal? s]vices 9 def9$      
locales1 z well z any protocol or *anges
 9 practice t 7 in/itut$ to address     
exi/+ inequities4  7#d7 ,recomm5dations 
= su* adm9i/rative or legislative action
 z ! ,secret>y det]m9es necess>y to     
improve ! furni%+ ( su* s]vices4  7e7   
,program integrity ,! ,secret>y %all    
take su* actions & e/abli% safegu>ds z  
are reasonable & necess>y "u exi/+ law  
to ensure ! program integrity ( !       
provision ( home-bas$ ext5d$ c>e s]vices
 pursuant to ! provisions (1 & am5dm5ts 
made by1 ?is ,act4  7f7 ,implem5tation  
7#a7 ,e/abli%m5t ( /&>ds & proc$ures ,n 
lat] ?an ,july #a1 #bjba1 or z soon z   
practical aft] enactm5t ( ?is ,act dur+ 
a public heal? em]g5cy p]iod describ$ 9 
section #aace7;g7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acbj;b-#e7;g771 !  
,secret>y %all e/abli% /&>ds & proc$ures

 relat$ to furni%+ home-bas$ ext5d$ c>e 
s]vices pursuant to ! provisions (1 &   
am5dm5ts made by1 ?is ,act4  7#b7       
,provision ( in=mation reg>d+ !         
home-bas$ ext5d$ c>e s]vices b5efit ,!  
,secret>y %all provide compreh5sive     
in=mation to ,m$ic>e b5efici>ies & o!r  
/akehold]s reg>d+ ! e/abli%m5t &        
availability ( ! home-bas$ ext5d$ c>e   
s]vices b5efit "u ! ,m$ic>e program "u  
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq47 pursuant 
to ! provisions (1 & am5dm5ts made by1  
?is ,act4 ,su* in=mation %all be 9      
addition to any publication ( /&>ds &   
proc$ures ) respect to su* s]vices 9 !  
,f$]al ,regi/] & ,code ( ,f$]al         
,regulations4  7#c7 ,au?orization (     
paym5ts dur+ public heal? em]g5cy p]iod 
,not)/&+ any o!r provision ( law1 !     
,secret>y is au?oriz$ to make paym5ts = 
home-bas$ ext5d$ c>e s]vices z describ$ 
9 section #ahie7;f7 ( ! ,social         
,security ,act1 z add$ by subsection    
7a77#h71 = su* s]vices furni%$ prior to 

#bjbb dur+ any p]iod 9 :i* !re exi/s su*
 a public heal? em]g5cy p]iod4