,i #aah? ,,congress #a/ ,session ,h4 ,r4 #bhec ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #be1 #bjbc,mr4 ,smi? ( ,nebraska 7= himself & ,mrs4 ,d+ell7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to exp& access to cl9ical c>e 9 ! home1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,exp&+ ,c>e 9 ! ,home ,act4 7b7 ,table ( cont5ts ! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4,sec4 #b4 ,enhanc+ prim>y c>e 9 ! home4,sec4 #c4 ,improv+ cov]age = ,m$ic>e home infusion4,sec4 #d4 ,e/abli%+ paym5t = /aff-assi/$ home dialysis4,sec4 #e4 ,ensur+ ,m$ic>e b5efici>ies h access to 9-home labs4,sec4 #f4 ,exp&+ advanc$ diagno/ic imag+ 9 ! home4,sec4 #g4 ,deliv]+ p]sonal c>e s]vices to ,m$ic>e b5efici>ies4,sec4 #h4 ,build+ ! future ( ! home-bas$ c>e work=ce4 #b4 ,enhanc+ prim>y c>e 9 ! home 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 7,,hhs ,secret>y7 %all all[ prim>y c>e provid]s 7,p,c,ps7 enroll$ 9 ,m$ic>e ,"p ,b to elect to receive a mon?ly capitat$ paym5t = ,prim>y ,c>e ,qualifi$ ,evaluation & ,managem5t ,s]vices 7,,pqem7 z an alt]native to fee-=-s]vice reimbursem5t4 ,provid]s %all be all[$ to elect to receive a mon?ly capitat$ paym5t = a p]iod ( "t rang+ f "o to five ye>s4 7b7 ,cov]$ s]vices ,! ,,hhs ,secret>y %all annually id5tify ,,pqem s]vices no lat] ?an ,octob] #a ea* ye>4 ,at a m9imum1 ^! s]vices %all include ! foll[+ s]vices :5 bill$ by a prim>y c>e provid] or a nonprim>y c>e speciali/ 7z outl9$ by ! ,secret>y73 7#a7 ,(fice or ,o!r ,outpati5t ,s]vices 7#iibja-iibje1 #iibaa-iibae74 7#b7 ,domicili>y1 ,re/ ,home or ,cu/odial ,c>e ,s]vices 7#iicbd-iicbh1 #iiccd-iiccg74 7#c7 ,domicili>y1 ,re/ ,home or ,home ,c>e ,plan ,ov]sight ,s]vices #iicci-iicdj74 7#d7 ,home ,s]vices 7#iicda-iicde1 #iicdg-iicej74 7#e7 ,transitional ,c>e ,managem5t ,s]vices 7#iidie-iidif74 7#f7 ,c>e ,coord9ation ,managem5t ,s]vices 7#iidij74 7#g7 ,wellness ,visits 7,g#jdjb1 ,g#jdch1 ,g#jdci74 7c7 ,paym5t ,! capitat$ paym5t sy/em design$ by ! ,,hhs ,secret>y %all h ! foll[+3 7#a7 ,base capitat$ paym5ts %\ld reflect ! previ\s #c ye>s exclud+ ! p]iod dur+ :i* !re 0 an active public heal? em]g5cy = ,,covid-#ai4 7#b7 ,!re %\ld be an increase 9 paym5ts to reflect ! ne$ = ,p,c,ps to inve/ 9 *ang+ _! (fice practice workfl[4 7#c7 ,high] ,,pcp paym5t c\ld be possible ?r\gh great] bonuses relat$ to improv+ value ?r\gh total co/ ( c>e & quality4 7#d7 ,p,c,ps elect+ capitat$ paym5ts %\ld be p]mitt$ to (f] inc5tives to engage pati5ts to be assign$ to _! pati5t c>e panels4 7d7 ,attribution ,! ,,hhs ,secret>y %all ensure t ,p,c,ps elect+ to receive a capitat$ paym5t h visibility & input into ! attribution model us$ to attribute pati5ts to !m4 ,at a m9imum1 ! attribution me?odology %\ld-- 7#a7 pati5t attribution to panels %\ld be prospective2 7#b7 panels %\ld be updat$ mon?ly or qu>t]ly2 & 7#c7 ,p,c,ps %\ld h a me*anism & inc5tives to enroll pati5ts s !y c influ5ce :o is attribut$ to _! panel4 #c4 ,improv+ cov]age = ,m$ic>e home infusion 7a7 ,9 g5]al ,! ,,hhs ,secret>y %all e/abli% reimbursem5t = home infusion s]vices & associat$ equipm5t & items "u "p ,b4 7b7 ,cov]$ s]vices & supplies ,home ,infusion ,!rapy 7,,hit7 & associat$ equipm5t are def9$ to include-- 7#a7 equipm5t 7e4g41 me*anical pumps7 = drug adm9i/ration ( ,eligible ,infusion ,drugs2 7#b7 items 7o!r ?an drugs & equipm5t7 us$ 9 connection ) ! deliv]y ( ,eligible ,infusion ,drugs su* z disposable supplies = ! drug adm9i/ration 7e4g41 tub+1 ela/om]ic pumps7 & = ! r\t9e ma9t5ance ( ! infusion access device2 7#c7 #bd_/g availability ( ph>maci/ pr(essional s]vices su* z assessm5ts1 drug prep>ation & comp\nd+1 disp5s+1 cl9ical monitor+1 adm9i/rative1 & education2 & 7#d7 #bd_/g availability ( nurs+ s]vices 7:5 n provid$ z "p ( a home heal? episode74 7c7 ,qualifi$ provid]s ,provid$ by a qualifi$ home infusion !rapy s]vices suppli] z def9$ 9 section #ahfa7;iii77#c77;,c7 ( ?is ,act4 7d7 ,eligible infusion drugs ,eligible "p ,b & "p ,d ,infusion ,drugs are def9$ z p>5t]al drugs or biologics adm9i/]$ ?r\gh intrav5\s1 intra!cal1 intra-art]ial1 or subcutane\s access device1 except-- 7#a7 drugs & biologics on ! self-adm9i/]$ drug li/2 & 7#b7 drugs & biologics cov]$ "u ,"p ,b ,durable ,m$ical ,equipm5t1 ,pro/hetics1 ,or?otics & ,supplies 7,,dmepos74 7e7 ,curr5t or future infusion drugs ,provid$1 no?+ 9 ?is section %all be con/ru$ to *ange ! cov]age /atus ( any curr5t or future infusion drugs t meet ! def9ition ( a cov]$ "p ,d drug z def9$ at section #ahfj;,d-#b7;e7 & :i* are paid "u ,m$ic>e "p ,d4 7f7 ,ref]r+ provid]s ,pati5ts mu/ be "u ! c>e ( a physician1 nurse practition]1 or physician assi/ant4 7g7 ,safety & quality ,consi/5t ) /&>ds ( c>e f\nd )9 comm]cial1 ,m$ic>e ,advantage1 & ,/ate ,m$icaid programs ) reg>d to /]ile prep>ation ( ! drug to a f9al1 useable =m2 timel9ess ( initiation ( c>e2 bill+ ( drugs1 items1 & ph>macy s]vices by a s+le entity2 p]=m+ p]iodic assessm5ts ( pati5t satisfaction & collection & evaluation ( quality outcome data2 & ma9ta9+ a consolidat$ pati5t record ( s]vices provid$ 9 accordance ) ! plan ( c>e4 7h7 7#a7 ,reimbursem5t ,a p] infusion day paym5t is e/abli%$ & def9$ z a paym5t = ! date on :i* a drug 0 adm9i/]$ to ! individual at home 7reg>dless ( :e!r a skill$ pr(essional 0 physically pres5t 9 ! home ( su* individual on su* date74 7#b7 ,m>ket rates ,su* paym5t may be bas$ on a m>ket analysis ( rates paid = home infusion supplies & s]vices by ! comm]cial sector & ,m$ic>e ,advantage programs4 7#c7 ,paym5t eligibility ,no?+ %all prev5t a home infusion suppli] f be+ paid a p] infusion day paym5t :5 a qualifi$ home heal? ag5cy provides ! nurs+ s]vices = ! infusion !rapy "u ! "p ,a home heal? b5efit4 #d4 ,e/abli%+ paym5t = /aff-assi/$ home dialysis 7a7 ,9 g5]al ,section #ahha7;b77#ad7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,j7 7i7 ,= s]vices furni%$ on or aft] ! date :i* is #a ye> aft] ! date ( ! enactm5t ( ?is subp>agraph :i* are /aff-assi/$ home dialysis 7z def9$ 9 clause 7iv77,,iii771 ! ,secret>y %all increase ! s+le paym5t t w\ld o!rwise apply "u ?is p>agraph = r5al dialysis s]vices furni%$ to new & respite individuals 9 accordance ) ! paym5t sy/em e/abli%$ "u clause 7iii7 by qualifi$ provid]s4 7ii7 7,i7 ,subject to subclause 7,,ii71 /aff-assi/$ home dialysis may only be furni%$ dur+-- 7aa7 ) respect to an individual describ$ 9 subclause 7iv77,i77aa71 "o #ij-;day p]iod :i* may be r5ew$ up to two #cj-;day p]iods2 & 7bb7 ) respect to an individual describ$ 9 subclause 7iv77,i77bb7 & not)/&+ :e!r su* an individual receives any respite c>e "u "p ,a1 any #cj-;day p]iod4 7,,ii7 ,not)/&+ ! limits describ$ 9 subclause 7,i71 /aff-assi/$ home dialysis may be furni%$ = z long z ! ,secret>y det]m9es appropriate to an individual :o-- 7aa7 is bl9d2 7bb7 has a cognitive or neurological impairm5t 7includ+ a /roke1 ,alzheim]'s1 dem5tia amyotrophic lat]al scl]osis1 or any o!r impairm5t det]m9$ by ! ,secret>y72 or 7cc7 has any o!r illness or injury t r$uces mobility 7includ+ c]ebral palsy1 sp9al cord injuries1 or any o!r illness or injury det]m9$ by ! ,secret>y74 7iii7 ,! ,secret>y %all e/abli% a prospective paym5t sy/em ?r\gh regulations to det]m9e ! am\nts payable to qualifi$ provid]s = /aff-assi/$ home dialysis4 ,9 e/abli%+ su* sy/em1 ! ,secret>y may consid]-- 7,i7 ! co/s ( furni%+ /aff-assi/$ home dialysis2 7,,ii7 consultations ) dialysis provid]s1 dialysis pati5ts1 private pay]s1 & ,,ma plans2 7,,iii7 paym5t am\nts = simil> items & s]vices "u p>ts ,a & ,b2 & 7,,iv7 paym5t am\nts e/abli%$ by ,,ma plans "u "p ,c1 gr\p heal? plans1 & heal? insurance cov]age (f]$ by heal? insurance issu]s4 7iv7 ,9 ?is subp>agraph3 7,i7 ,! t]m new & respite individual means an individual describ$ 9 subsection 7a7 :o is ei!r-- 7aa7 initiat+ ei!r p]itoneal or home hemodialysis2 or 7bb7 receiv+ home dialysis & is unable to self-dialyze due to illness1 injury1 c>egiv] issues1 or o!r tempor>y circum/ances4 7,,ii7 ,! t]m qualifi$ provid] means a tra9$ pr(essional 7z det]m9$ by ! ,secret>y1 includ+ nurses & c]tifi$ pati5t te*nicians7 :o furni%es r5al dialysis s]vices &-- 7aa7 meets requirem5ts 7z det]m9$ by ! ,secret>y7 t ensures compet5cy 9 pati5t c>e & modality usage2 & 7bb7 provides 9-p]son assi/ance to a pati5t = at lea/ #ge p]c5t ( /aff-assi/$ home dialysis sessions dur+ a p]iod describ$ 9 clause 7ii77i74 7,,iii7 7aa7 ,! t]m /aff-assi/$ home dialysis means home dialysis us+ tra9$ pr(essionals to assi/ individuals :o h be5 det]m9$ to h end /age r5al disease1 & ! frequ5cy ( su* home dialysis is det]m9$ by su* pr(essionals 9 coord9ation ) ! pati5t & 8 or h] c>e p>tn]1 & outl9$ 9 a pati5t plan ( c>e4 7bb7 ,9 ?is subclause1 ! t]m c>e p>tn] means anyone :o is designat$ by ! pati5t :o assi/s ! individual ) ! furni%+ ( home dialysis4 7cc7 ,9 ?is subclause1 ! t]m pati5t plan ( c>e has ! mean+ giv5 su* t]m 9 section #did4ij ( title #db1 ,code ( ,f$]al ,regulations4 4 7b7 ,pati5t education & tra9+ relat+ to /aff-,assi/$ home dialysis ,section #ahha7;b77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#e77 is am5d$-- 7#a7 9 subp>agraph 7,c71 by /rik+ at ! end &2 7#b7 9 subp>agraph 7,d71 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraphs3 7,d7 educate pati5ts ( ! opportunity to receive /aff-assi/$ home dialysis 7z def9$ 9 p>agraph 7#ad77;,j77iv77,,iii77 dur+ ! p]iod beg9n+ #cj days aft] ! fir/ day su* facility furni%es r5al dialysis s]vices to an individual & end+ #fj days aft] su* day2 & 7,e7 provide = nurses1 c]tifi$ pati5t te*nicians1 or o!r pr(essionals to tra9 pati5ts & _! c>e p>tn]s 9 skills & proc$ures ne$$ to p]=m home dialysis 7z def9$ 9 p>agraph 7#ad77;,j77iv77,,iii77 treatm5t-- 7i7 regul>ly & indep5d5tly2 7ii7 ?r\gh teleheal? s]vices or ?r\gh gr\p tra9+ 7z describ$ 9 ! int]pretive guidance relat+ to tag numb] ,v#eij ( ,advance ,copy--,end ,/age ,r5al ,disease 7,,esrd7 ,program ,int]pretive ,guidance ,v]sion #a4a 7publi%$ on ,octob] #c1 #bjjh77 9 accordance ) ! ,f$]al regulations 7conc]n+ ! privacy ( individually id5tifiable heal? in=mation7 promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif2 & 7iii7 9 ! home or resid5t ( a pati5t1 9 a dialysis facility1 or ! place 9 :i* ! pati5t int5ds to receive /aff-assi/$ home dialysis4 4 7c7 ,o!r provisions 7#a7 ,anti-kickback /atute ,section #aabh;,b7b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77 is am5d$-- 7,a7 9 subp>agraph 7,j71 by /rik+ at ! end &2 7,b7 9 subp>agraph 7,k71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,l7 any remun]ation relat+ to ! furni%+ ( /aff-assi/$ home dialysis 7z def9$ 9 section #ahha7;b77#ad77;,j77iv77,,iii774 4 7#b7 ,,cmi model ,section #aaae;,a7b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-7b77#b77;,b77 is am5d$ by add+ at ! end ! foll[+ new clause3 7xxviii7 ,mak+ paym5t to anyone :o is designat$ by a pati5t :o receives /aff-assi/$ home dialysis 7z def9$ 9 section #ahha7;b77#ad77;,j77iv77,,iii77 & o!rwise meets ! requirem5ts 7z det]m9$ by ! ,secret>y71 not)/&+ :e!r an individual is a qualifi$ provid] 7z def9$ 9 section #ahha7;b77#ad77;,j77iv77,,ii77 or o!rwise eligible = reimbursem5t "u title ,,xviii4 4 7#c7 ,/udy ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report t exam9es racial disp>ities 9 ! utilization ( ! home dialysis def9$ 9 section #ahha7;b77#ad77;,j77iv77,,iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77;,j77iv77,,iii77 & make recomm5dations on h[ to improve access to su* dialysis = communities ( color4 7#d7 ,pati5t decision tool ,n lat] ?an ,decemb] #ca1 #bjbc1 = ! purpose ( section #ahha7;b77#ad77;,j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77;,j771 ! ,secret>y ( ,heal? & ,human ,s]vices %all conv5e a pati5t panel to create a pati5t-c5t]$ decision tool = dialysis pati5ts to evaluate _! life/yle & goals & be assi/$ 9 *oos+ ! dialysis modality t be/ suits !m4 ,?is tool %\ld include an ackn[l$gm5t t !y are capable ( home dialysis & want home dialysis1 if t is ! modality !y *oose4 7#e7 ,pati5t quality ( life metric ,section #aaae;,a7b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7i7 ,a pati5t quality ( life metric = all pati5ts utiliz+ dialysis reg>dless ( modality ) ! int5t ( measur+ & improv+ pati5t quality ( life on dialysis4 4 #e4 ,ensur+ m$ic>e b5efici>ies h access to 9-home labs 7a7 ,9 g5]al ,! ,secret>y %all e/abli% reimbursem5ts = an add-on paym5t to cov] travel co/s & mail+ co/s associat$ ) specim5 collection ( at-home cl9ical laboratory te/s = eligible ,m$ic>e b5efici>ies4 7b7 ,cov]age ,! add-on paym5t %all apply to all at-home cl9ical laboratory te/s curr5tly reimburs$ "u ,"p ,b z ord]$ by an eligible ,m$ic>e provid]4 7c7 ,eligible b5efici>ies ,! ,secret>y %all det]m9e ! scre5+ tool or utilization managem5t t w\ld trigg] b5efici>y eligibility = at-home cl9ical laboratory te/s4 ,eligibility %all be m compreh5sive ?an ! homeb\nd /atus z def9$ 9 sections #ahce7;a7 & #ahad7;a7 ( ! ,social ,security ,act4 ,! scre5+ tool %all consid] o!r crit]ia su* z *ronic conditions1 social ne$s1 b>ri]s to access+ c>e1 income level1 or dual eligible /atus4 7d7 ,eligible suppli]s ,! ,secret>y %all det]m9e eligible suppli]s = specim5 collection ( at-home cl9ical lab te/s4 7e7 ,paym5t = travel all[ance ,! ,secret>y %all e/abli% paym5t me?odology = ! travel all[ance reimbursem5t4 ,! me?odology %all acc\nt = geographic v>iation 9 co/s ( transportation4 7f7 ,paym5t = mail+ co/s ,! ,secret>y %all e/abli% paym5t me?odology = reimbursem5t ( ! co/ = mail+ complet$ at-home cl9ical lab te/s4 ,! reimbursem5t /ructure %all be ti]$ on %ipp+ bas$ ^u ! nature ( ! collection & process+ ne$s1 = example cold *a9 requirem5ts1 "t s5sitively1 & o!r infecti\s disease protocols4 7g7 ,b5efici>y co/s ,no provision 9 ?is section %all impact ! co9surance appli$ to b5efici>ies z curr5tly reimburs$ = cl9ical laboratory te/s4 #f4 ,exp&+ advanc$ diagno/ic imag+ 9 ! home 7a7 ,g5]al ,! ,secret>y %all conduct an evaluation ( ,m$ic>e reimbursable advanc$ diagno/ic imag+ z def9$ 9 subsection 7e77#a77;,b7 ( section #ahcd ( ! ,social ,security ,act4 ,! purpose ( ! evaluation %all be to consid] expansions to reimbursable at-home advanc$ diagno/ic imag+ s]vices1 includ+ co/s ( transportation4 7b7 ,m9imum action ,at a m9imum1 ! ,secret>y %all p]mit ! deliv]y & reimbursem5t ( ultras\nd imag+ 9 ! home1 includ+ ! co/ ( transportation4 7c7 ,eligibility ,! ,secret>y %all det]m9e ! scre5+ tool or utilization managem5t t w\ld trigg] b5efici>y eligibility = at-home advanc$ diagno/ic s]vices4 ,eligibility %all be m compreh5sive ?an ! homeb\nd /atus z def9$ 9 sections #ahce7;a7 & #ahad7;a7 ( ! ,social ,security ,act4 ,! scre5+ tool %all consid] o!r crit]ia su* z *ronic conditions1 social ne$s1 b>ri]s to access+ c>e1 income level1 or dual eligible /atus4 7d7 ,au?ority ,! ,secret>y %all h ! au?ority to exp& ! types ( at-home advanc$ diagno/ic imag+ s]vices reimbursable "u ,m$ic>e1 if m$ically appropriate & safe4 7e7 ,paym5t ,no provision 9 ?is section %all impact ! paym5t rates set annually ?r\gh ! physician fee s*$ule4 7f7 ,report to congress ,! ,secret>y %all submit ! f9d+s f ! evaluation 9 section 7a7 9 a report to ,congress n lat] ?an #ij days aft] enact$4 ,! report %\ld provide ju/ification = ! ,secret>y's decision n to exp& p>ticul> diagno/ic s]vices 9 ! home & recomm5dations to fur!r exp& advanc$ diagno/ic imag+ 9 ! home4 #g4 ,deliv]+ p]sonal c>e s]vices to ,m$ic>e b5efici>ies 7a7 ,g5]al ,! ,social ,security ,act is am5d$ to e/abli% cov]age = p]sonal c>e assi/ance s]vices z def9$ 9 subsection 7k7 to eligible ,m$ic>e b5efici>ies 7,b5efit h]eaft]74 7b7 ,s]vices ,up to #ab h\rs p] week ( p]sonal c>e assi/ance s]vices 9 increm5ts ( no less ?an f\r h\rs4 7c7 ,"t limit$ b5efit ,if prescrib$ by a qualifi$ ,m$ic>e provid]1 ! eligible b5efici>y is entitl$ to #cj days ( p]sonal c>e s]vices & eligible = two additional #cj-;day p]iods if ! provid] deems x is appropriate4 ,! ,b5efit %all be capp$ at #ij days p] cal5d> ye>4 7d7 ,eligibility ,to be consid]$ eligible = ! ,b5efit1 ! b5efici>y-- 7#a7 mu/ be ,m$ic>e eligible2 7#b7 mu/ n be ,m$icaid-eligible2 7#c7 mu/ h an income at or bel[ #djj p]c5t ( ! ,f$]al ,pov]ty ,level 7,,fpl72 7#d7 mu/ be functionally disabl$ z def9$ 9 subsection 7l72 & 7#e7 mu/ h f\r or m *ronic conditions z def9$ by ! ,secret>y or _h a qualifi$ hospitalization /ay1 z def9$ by ! ,secret>y1 9 ! la/ #cj days4 7e7 ,o!r eligibility requirem5ts ,! ,secret>y may consid] o!r eligibility requirem5ts t are kn[n to1 bas$ on evaluation & rese>*1 improve value ( c>e & coord9ation ( c>e4 ,= example1 ! b5efici>y c\ld be requir$ to att5d an annual wellness visit or be align$ ) a prim>y c>e provid] or speciali/ :o functions z a prim>y c>e provid]4 7f7 ,b5efit det]m9ation process ,! ,secret>y %all e/abli% a process to validate b5efici>y eligibility = ! ,b5efit ?r\gh a det]m9ation process4 ,additionally1 ! ,secret>y %all put 9 place an appeals process to review possible wrongful det]m9ations4 7g7 ,co9surance ,aft] #cj days ( p]sonal c>e s]vices1 a #bj p]c5t co9surance %all apply = ! rema9+ ,b5efit p]iod4 7h7 ,reimbursem5t ,! ,secret>y w e/abli% an h\rly rate = p]sonal c>e s]vices ?r\gh ! annual physician fee s*$ule4 ,! h\rly rate %\ld be bas$ on a bl5d ( ! ,dep>tm5t ( ,vet]ans ,affairs fee s*$ule = ! homemak]_/home heal? aide s]vice 7,g#jaef7 & av]ages = private sector home c>e4 7i7 ,value-,bas$ c>e reimbursem5t ,! ,secret>y %\ld e/abli% a value-bas$ compon5t to ! reimbursem5t ( ! ,b5efit t focuses on r$uc+ m$ical ne$s4 ,= example1 a portion ( ! fee-=-s]vice reimbursem5t c\ld be )held & if c]ta9 quality measures 7e4g41 avoid+ unnecess>y hospitalizations7 are a*iev$1 ! rema9+ portion ( ! reimbursem5t w\ld be paid4 7j7 ,ov]sight ,! ,secret>y %all e/abli% a process to c]tify p]sonal c>e ag5cies1 = example requirem5ts = ,f$]al backgr\nd *ecks1 & o!r appropriate ov]sight4 ,p]sonal c>e aides %all be employ$ by an ag5cy4 ,to ensure suffici5t numb] ( provid]s1 ,ag5cies provid+ solely p]sonal c>e s]vices z def9$ 9 ?is section %all n be requir$ to comply ) ,conditions ( ,p>ticipation 7,co,ps74 7k7 ,ov]lap ,! ,secret>y %all develop crit]ia describ+ h[ model ov]lap w be address$ :5 pati5ts are eligible = ! ,b5efit & are o!rwise p>ticipat+ 9 a paym5t & deliv]y re=m model "u section #ahii or ?r\gh ! ,c5t] = ,m$ic>e & ,m$icaid ,innovation4 ,! ,secret>y %all exclude co/s ( ! ,b5efit f reconciliation 9 ^! paym5t & deliv]y re=m models z appropriate to limit un9t5d$ consequ5ces4 7l7 ,def9itions 7#a7 ,functionally disabl$ ,an individual is functionally disabl$ if ! individual-- 7,a7 is unable to p]=m )\t sub/antial assi/ance f ano!r individual at lea/ #b ( ! foll[+ #c activities ( daily liv+3 toilet+1 transf]r+1 & eat+2 or 7,b7 has a prim>y or second>y diagnosis ( ,alzheim]'s disease & is-- 7i7 unable to p]=m )\t sub/antial human assi/ance 7includ+ v]bal rem9d+ or physical cue+7 or sup]vision at lea/ #b ( ! foll[+ #e activities ( daily liv+3 ba?+1 dress+1 toilet+1 transf]r+1 & eat+2 or 7ii7 cognitively impair$ s z to require sub/antial sup]vision f ano!r individual because he or %e engages 9 inappropriate behaviors t pose s]i\s heal? or safety haz>ds to himself or h]self or o!rs4 7#b7 ,p]sonal c>e assi/ance s]vices ,assi/ance ) activities ( daily liv+1 z def9$ at subsection ,,iii ( ?is section1 :i* d n require ! skills ( qualifi$ te*nical or pr(essional p]sonnel4 7#c7 ,activities ( daily liv+ ,z def9$ 9 #db ,,cfr #dda4eje1 activities ( daily liv+ 7,a,d,ls7 means basic p]sonal ev]yday activities includ+1 b n limit$ to1 tasks su* z eat+1 toilet+1 groom+1 dress+1 ba?+1 & transf]r+4 #h4 ,build+ ! future ( ! home-bas$ c>e work=ce 7a7 ,creation ( grants to communities ,to fo/] home-,bas$ c>e pr(essionals 7#a7 ,g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 may aw>d grants to entities to inve/ 9 develop+ ! home-bas$ c>e work=ce4 7#b7 ,eligible grantees ,! ,secret>y may aw>d grants to nonpr(it hospital or heal? sy/ems1 community-bas$ organizations1 non-pr(it home heal? ag5cies or p]sonal c>e organizations1 ,/ate & local heal? ag5cies1 & o!r entities id5tifi$ by ! ,secret>y4 7#c7 ,use ( funds ,! grantee may use funds = ! foll[+3 7,a7 ,inve/ 9 transition+ facility-bas$ m$ical p]sonnel to c>e models t are focus$ on deliv]+ c>e 9 ! home4 7,b7 ,e/abli% c>e] advancem5t tra9+ to improve ! unique ne$s ( m$ical p]sonnel ent]+ ! home1 = example tra9+ = cultural s5sitivity1 use ( digital te*nologies1 & be/ practices4 7,c7 ,recruit new m$ical p]sonnel t w be responsible = deliv]+ c>e or support s]vices = c>e models 9 ! home4 7#d7 ,application ,to be eligible to receive a grant1 an entity %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#e7 ,priority ,9 select+ grant recipi5ts1 ! ,secret>y %all prioritize entities t are able to provide evid5ce t !y prim>ily s]ve m9ority populations1 op]ate 9 a m$ically und]s]v$ community or a heal? pr(essional %ortage area1 or are heavily community-focus$4 7#f7 ,grantee report+ requirem5ts ,ea* entity aw>d$ a grant %all submit an annual report to ! ,secret>y on ! activities conduct$ "u su* grant1 & o!r in=mation z ! ,secret>y may require4 7#g7 ,report to congress ,n lat] ?an #e ye>s aft] ! date ( enactm5t ( ?is section & e #e ye>s !reaft]1 ! ,secret>y %all submit a report to ,congress t provides a summ>y ( ! activities & outcomes associat$ ) grants made "u ?is section4 7#h7 ,appropriation ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #ej1jjj1jjj to rema9 available until exp5d$4 7b7 ,e/abli%m5t ( home-,bas$ nurs+ task =ce 7#a7 ,g5]al ,n lat] ?an #ij days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all e/abli% a task =ce on develop+ /&>ds = a home-bas$ nurs+ bo>d c]tification 79 ?is section ref]r$ to z ! ,task ,=ce74 7#b7 ,duties ,n lat] ?an #ab mon?s aft] ! e/abli%m5t ( ! ,task ,=ce1 ! ,task ,=ce %all develop & submit to ! ,secret>y recomm5dations & /rategies = ! ,dep>tm5t ( ,heal? & ,human ,s]vices = ! foll[+3 7,a7 ,id5tify key consid]ations & opportunities = a pot5tial regi/]$ nurse bo>d c]tification 9 home-bas$ c>e4 7,b7 ,develop ! specifications & eligibility requirem5ts t w\ld ne$ to be met = a nurs+ bo>d c]tification 9 home-bas$ c>e4 7,c7 ,outl9e ! b5efits & pot5tial issues t w\ld be associat$ ) e/abli%+ a nurs+ bo>d c]tification 9 home-bas$ c>e4 7#c7 ,consid]ations ,9 develop+ recomm5dations & /rategies1 ! ,task ,=ce %all consid] ! foll[+3 7,a7 ,curr5t & future /ate ( ! 9-home regi/]$ nurs+ work=ce1 includ+ project$ job ne$s4 7,b7 ,factors influ5c+ individuals to pursue c>e]s 9 home-bas$ c>e nurs+4 7,c7 ,access & b>ri]s to 9-home nurs+ c>e] opportunities = vuln]able or und]repres5t$ populations into nurs+4 7,d7 ,unique role ! 9-home regi/]$ nurs+ work=ce plays 9 engag+ ) c>egiv]s4 7,e7 ,diff]5ces 9 facility-bas$ c>e v]ses home-bas$ c>e f ! p]spective ( ! nurse1 su* z cl9ical compet5cy1 burn\t1 level ( exp]i5ce requir$1 cultural s5sitivities requir$1 /ressors1 & m4 7#d7 ,public report ,n lat] ?an #fj days aft] ! submission ( ! recomm5dations & /rategies1 ! ,secret>y %all submit to ! ,congress a report conta9+ su* recomm5dations & /rategies4 7#e7 ,p]iod ( appo9tm5t ,memb]s %all be appo9t$ to ! ,task ,=ce ! duration ( ! exi/5ce ( ! ,task ,=ce4 7#f7 ,comp5sation ,task ,=ce memb]s %all s]ve )\t comp5sation4 7#g7 ,sunset ,! ,task ,=ce %all t]m9ate ^u ! submission ( ! report requir$4 7c7 ,exp&+ em]g5cy m$ical s]vices work=ce /udy 7#a7 ,g5]al ,n lat] ?an #ij days aft] ! date ( enactm5t ( ,exp&+ ,em]g5cy ,m$ical ,s]vices 7,,ems7 ,work=ce ,program1 ! ,secret>y %all e/abli% a c\ncil to /udy ! impacts ( exp&+ ! role ( em]g5cy m$ical s]vice 7,,ems7 provid]s 9 ! triage1 treatm5t1 & transf] ( pati5ts 9 bo? em]g5cy & non-em]g5cy enc\nt]s & associat$ impacts on ! ,,ems work=ce 79 ?is section ref]r$ to z ! ,c\ncil74 7#b7 ,duties ,n lat] ?an #ab mon?s aft] ! e/abli%m5t ( ! ,c\ncil1 ! ,c\ncil %all develop & submit a /udy to ! ,secret>y ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices t-- 7,a7 details b>ri]s to ,,ems provid]s to treat+ 9-place2 7,b7 outl9es ! b5efits & o!r consid]ations associat$ ) exp&+ ! scope ( s]vices deliv]$ by ,,ems provid]s2 7,c7 exam9es ! curr5t ,,ems provid] work=ce's ability to exp& _! role 9 heal?c>e enc\nt]s2 7,d7 evaluates be/ practices = nurse navigation programs t assi/ 9 triage & dispat* ( appropriate level ( ,,ems provid]s2 7,e7 evaluates be/ practices = community p>am$ic9e programs2 & 7,f7 assesses ! impacts ( ! ,exp&+ ,em]g5cy ,m$ical ,s]vices 7,,ems7 ,work=ce ,program on m$ically & socially und]s]v$ communities' access to c>e & em]g5cy dep>tm5t utilization4 7#c7 ,consid]ations ,9 develop+ ! /udy1 ! ,c\ncil %all consid] ! foll[+3 7,a7 ,previ\s & exi/+ community p>am$ic9e programs4 7,b7 ,previ\s & exi/+ nurse navigation programs4 7,c7 ,access to ,,ems s]vices 9 rural communities4 7,d7 ,curr5t & future /ate ( ! ,,ems provid] work=ce1 includ+ project$ job ne$s4 7,e7 ,unique role ! ,,ems work=ce plays 9 engag+ ) ! community4 7,f7 ,tra9+ ( ,,ems provid]s4 7,g7 ,v>y+ roles & capabilities ( diff]5t levels ( ,,ems pr(essionals1 includ+ ,em]g5cy ,m$ical ,respond]1 ,em]g5cy ,m$ical ,te*nician1 ,advanc$--,,emt1 ,p>am$ic1 ,community ,p>am$ic4 7#d7 ,public report ,n lat] ?an #fj days aft] ! submission ( ! /udy1 ! ,secret>y %all submit to ! ,congress a report conta9+ recomm5dations & /rategies = utiliz+ ! ,,ems work=ce beyond ! scope ( _! curr5t role 9 heal?c>e enc\nt]s4 7#e7 ,p]iod ( appo9tm5t ,memb]s %all be appo9t$ to ! ,c\ncil ! duration ( ! exi/5ce ( ! ,c\ncil4 7#f7 ,comp5sation ,c\ncil memb]s %all s]ve )\t comp5sation4 7#g7 ,sunset ,! ,c\ncil %all t]m9ate ^u ! submission ( ! report requir$4 7#h7 ,,faca applicability ,! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all n apply to ! ,c\ncil4 7#i7 ,c\ncil proc$ures ,! ,secret>y1 9 consultation ) ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates & ! ,director ( ! ,(fice ( ,managem5t & ,budget1 %all e/abli% proc$ures = ! ,c\ncil to-- 7,a7 ensure t adequate res\rces are available to effectively execute ! responsibilities ( ! ,c\ncil2 7,b7 effectively coord9ate ) o!r relevant advisory bodies & work+ gr\ps to avoid unnecess>y duplication2 7,c7 create transp>5cy to ! public & ,congress ) reg>d to ,c\ncil memb]%ip1 co/s1 & activities1 includ+ ?r\gh use ( mod]n te*nology & social m$ia to dissem9ate in=mation2 & 7,d7 avoid conflicts ( int]e/ t w\ld jeop>dize ! ability ( ! ,c\ncil to make decisions & provide recomm5dations4