,,ii #aahth ,,congress #ast ,session ,s4 #bacc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bb1 #bjbc ,ms4 ,stabenow 7for herself1 ,mr4 ,marshall1 ,mr4 ,booker1 and ,mr4 ,cassidy7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish a ,medically ,tailored ,home-,delivered ,meals ,demonstration ,program to test a payment and service delivery model under part ,a of ,medicare to improve clinical health outcomes and reduce the rate of readmissions of certain individuals4 #a4 ,short title ,this ,act may be cited as the ,medically ,tailored ,home-,delivered ,meals ,demonstration ,act4 #b4 ,medically ,tailored ,home-,delivered ,meals ,demonstration ,program ,part ,e of title ,,xviii of the ,social ,security ,act is amended by inserting after section #ahff;,g 7#db ,u4,s4,c4 #acie;cc-#g7 the following new section3 #ahff;,h4 ,medically ,tailored ,home-,delivered ,meals ,demonstration ,program 7a7 ,establishment ,for the #d-year period beginning not later than #cj months after the date of the enactment of this section1 the ,secretary shall conduct1 in accordance with the provisions of this section1 a ,medically ,tailored ,home-,delivered ,meals ,demonstration ,program 7in this section referred to as the ,program7 to test a payment and service delivery model under which selected hospitals provide medically tailored home-delivered meals under part ,a of this title to qualified individuals1 with respect to such hospitals1 to improve clinical health outcomes and reduce the rate of readmissions of such individuals4 7b7 ,selection of hospitals ,to participate in ,program 7#a7 ,selected hospitals ,under the ,program1 the ,secretary shall1 not later than ,january #a1 #bjbd1 select to participate in the ,program at least #bj eligible hospitals across all geographic regions1 with consideration given to eligible hospitals located in rural areas and other underserved communities1 that the ,secretary determines have the capacity to satisfy the requirements described in subsection 7c74 ,in this section1 each such eligible hospital so selected shall be referred to as a selected hospital4 7#b7 ,eligible hospitals ,for purposes of this section1 the term eligible hospital means a subsection 7d7 hospital 7as defined in section #ahhf7;d77#a77;,b77 that-- 7,a7 submits to the ,secretary an application1 at such time and in such form and manner as specified by the ,secretary1 that contains-- 7i7 an attestation 7in such form and manner as specified by the ,secretary7 that such hospital has the ability1 or is under an arrangement with a provider of services1 supplier1 or other entity that has the ability1 to comply with the requirements described in subsection 7c72 and 7ii7 such other information as the ,secretary may require2 7,b7 has1 for the #b most recent fiscal years ending prior to the date of selection by the ,secretary under paragraph 7#a71 averaged at least #c stars for the overall hospital quality star rating on the internet website of the ,centers for ,medicare ,medicaid ,services 7including ,care ,compare or a successor website72 and 7,c7 is not1 as of the date of selection by the ,secretary under paragraph 7#a71 subject to-- 7i7 the requirement to return any overpayment pursuant to section #aabh;,j7d72 or 7ii7 any activity described in section #ahic7;b7 7relating to ,medicare integrity program actions74 7c7 ,minimum ,program requirements ,under the ,program1 a selected hospital shall comply with each of the following requirements3 7#a7 ,staffing ,the selected hospital shall provide 7including through an arrangement described in subsection 7b77#b77;,a77i771 for the duration of the participation of the hospital under the ,program1 a physician1 registered dietitian or nutrition professional1 or clinical social worker to carry out the screening and re-screening pursuant to paragraph 7#b71 and medical nutrition therapy pursuant to paragraph 7#c77;,b74 7#b7 ,screening and re-screening ,the selected hospital 7including through an arrangement described in subsection 7b77#b77;,a77i77 shall-- 7,a7 as part of the discharge planning process described in section #ahfa7;ee71 screen individuals that are inpatients of such selected hospital with validated screening tools 7as developed by the ,secretary7 to determine whether such individuals are qualified individuals2 and 7,b7 in the case of an individual determined pursuant to subparagraph 7,a7 or this subparagraph to be a qualified individual1 re-screen such individual with validated screening tools 7as determined by the ,secretary7 every #ab weeks after such determination occurring during the participation of the hospital under the ,program to determine whether such individual continues to be a qualified individual4 7#c7 ,providing medically tailored home-delivered meals and medical nutrition therapy ,in the case of an individual that is determined by the selected hospital pursuant to paragraph 7#b7 to be a qualified individual1 the selected hospital 7including through an arrangement described in subsection 7b77#b77;,a77i77 shall with respect to the period during which such hospital is participating in the ,program-- 7,a7 provide1 for each day during a period of at least #ab weeks1 for the preparation and delivery to such individual of at least #b medically tailored home-delivered meals 7or a portioned equivalent7 that meet at least two-thirds of the daily nutritional needs of the qualified individual2 and 7,b7 provide to such qualified individual1 in connection with delivering such meals and for a period of at least #ab weeks and not more than #a year1 medical nutrition therapy4 7#d7 ,data submission ,the selected hospital shall submit to the ,secretary data1 in such form1 manner1 and frequency as designated by the ,secretary1 so that the ,secretary may determine the affect of the ,program with respect to the factors described in subsection 7e77#b77;,b74 7#e7 ,additional requirements ,the selected hospital shall satisfy such additional requirements as may be specified by the ,secretary4 7d7 ,payment2 cost-,sharing 7#a7 ,payment ,the ,secretary shall determine the form1 manner1 and amount of payment to be provided to a selected hospital under the ,program4 7#b7 ,cost-sharing ,items and services for which payment may be made under the ,program shall be provided without application of any deductible1 copayment1 coinsurance1 or other cost-sharing under this title4 7e7 ,evaluations 7#a7 ,assessing clinical health outcomes ,the ,secretary shall assess the clinical health outcomes of each individual who is determined by a selected hospital pursuant to subsection 7c77#b7 to be a qualified individual for a period of at least #ab weeks and not more than #a year after the date on which such individual is so determined under subparagraph 7,a7 of such subsection4 7#b7 ,intermediate and final evaluations ,the ,secretary shall conduct an intermediate and final evaluation of the ,program4 ,each such evaluation shall-- 7,a7 based on the assessments conducted under paragraph 7#a71 with respect to individuals determined to be qualified individuals and the periods for which such assessments are so conducted1 determine-- 7i7 the number of inpatient admissions of such individuals2 7ii7 the number of admissions to skilled nursing facilities of such individuals2 and 7iii7 the total expenditures under part ,a with respect to such individuals2 7,b7 determine the extent to which the ,program has-- 7i7 improved clinical health outcomes1 as defined by the ,secretary2 7ii7 reduced the cost of care under part ,a 7including costs associated with readmission as defined in section #ahhf7q77#e77;,e772 and 7iii7 increased patient satisfaction1 as defined by the ,secretary2 and 7,c7 specify the form1 manner1 and amounts of payments made under the ,program pursuant to subsection 7d77#a7 and the effectiveness of such payment form1 manner1 and amounts4 7#c7 ,reports ,the ,secretary shall submit to ,congress-- 7,a7 not later than #c years after the date of implementation of the ,program1 a report with respect to the intermediate evaluation under paragraph 7#b72 and 7,b7 not later than #f years after such date of implementation1 a report with respect to the final evaluation under such paragraph4 7f7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out this section4 7g7 ,definitions ,in this section3 7#a7 ,medical nutrition therapy ,the term medical nutrition therapy has the meaning given such term in section #ahfa7vv77#a74 7#b7 ,medically tailored home-delivered meal ,the term medically tailored home-delivered meal means1 with respect to a qualified individual1 a meal that is designed by a registered dietitian or nutrition professional for the treatment plan of the qualified individual4 7#c7 ,qualified individual ,the term qualified individual means an individual1 with respect to a selected hospital1 who-- 7,a7 is entitled to benefits under part ,a2 7,b7 has a diet-impacted disease 7such as kidney disease1 congestive heart failure1 diabetes1 chronic obstructive pulmonary disease1 or any other disease the ,secretary determines appropriate72 and 7,c7 at the time of discharge from such hospital-- 7i7 lives at home2 7ii7 is not eligible for-- 7,i7 extended care services 7as defined in section #ahfa7;h772 7,,ii7 post-hospital extended care services 7as defined in section #ahfa7;i772 7,,iii7 home health services 7as defined in section #ahfa7m772 or 7,,iv7 post-institutional home health services 7as defined in section #ahfa7tt772 7iii7 has not made an election under section #ahab7;d77#a7 to receive hospice care2 7iv7 is certified by a physician at the time of discharge to be limited with respect to at least #b of the activities of daily living 7as described in section #ggjb;,b7c77#b77;,b7 of the ,internal ,revenue ,code of #aihf72 and 7v7 meets any other criteria for high-risk of readmission 7as determined by the ,secretary74 7#d7 ,registered dietitian or nutrition professional ,the term registered dietitian or nutrition professional has the meaning given such term in section #ahfa7vv77#b74 4