,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #edci  ,,in ,,the ,,house ,,of  
,,representatives  ,september #ag1      
#bjbe,mr4 ,mc,govern 7for himself1 ,ms4 
,malliotakis1 ,ms4 ,pingree1 ,mr4       
,fitzpatrick1 and ,mr4 ,evans of        
,pennsylvania7 introduced the following 
bill2 which was referred to the         
,committee on ,ways and ,means  ,a      
,,bill  ,to amend title ,,xviii of the  
,social ,security ,act to establish a   
,medically ,tailored ,home-,delivered   
,meals ,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 ,program ,pilot 
,act4  #b4 ,medically tailored          
home-delivered meals 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 program  7a7       
,establishment ,for the #f-year period  
beginning not later than #cj months     
after the date of the enactment of this 
section1 subject to subsection 7f71 the 
,secretary shall conduct1 in accordance 
with the provisions of this section1 a  
,medically ,tailored ,home-,delivered   
,meals ,program 7in this section        
referred to as the ,program7 under which
 selected hospitals provide medically   
tailored home-delivered meals under part
 ,a of this title to qualified          
individuals 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 ,june #cj1 #bjbg1 
select to participate in the ,program at
 least1 subject to subsection 7f71 #dj  
eligible hospitals that attest to the   

,secretary that they 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 or a critical access
 hospital 7as described in section      
#ahbj7;c77#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 has an arrangement with     
providers of services or suppliers or   
other entities that have the ability1 to
 furnish the services described in      
subsection 7c72 and  7ii7 such other    
information as the ,secretary may       
require2  7,b7 in the case of a         

subsection 7d7 hospital1 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    
posted on the internet website of the   
,centers for ,medicare  ,medicaid       
,services 7including ,care ,compare or a
 successor website72 and  7,c7 meets1 as
 of the date of selection by the        
,secretary under paragraph 7#a71 program
 integrity requirements1 as determined  
by the ,secretary4  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    
,advanced ,practice ,nursing            

,professional1 or clinical social worker
 to carry out the screening and         
re-screening pursuant to paragraph 7#b71
 medical nutrition therapy pursuant to  
paragraph 7#c77;,b74  7#b7 ,screening   
and re-screening ,the selected hospital 
7including through arrangements         
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 approved 
or deemed to be approved by the         
,secretary to determine whether such    
individuals are qualified individuals   
pursuant to subsection 7h77#c72 and     
7,b7 in the case of an individual that  
was an inpatient of such selected       
hospital and was screened pursuant to   
subparagraph 7,a7 and determined 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 subsection
 7h77#c7 to be a qualified individual1  
the selected hospital 7including through
 arrangements described in subsection   
7b77#b77;,a77i77 shall1 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 weeks following the screen
 pursuant to paragraph 7#b77;,a7 and for
 each subsequent #ab-week period after  
the rescreen pursuant to paragraph      
7#b77;,b71 for the duration of the      
,program1 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      
individual and are responsive to the    
individual's medical and cultural needs 
7such as an allergy or dietary          
restrictions or other religious or      
cultural dietary needs72 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 effect 
of the ,program with respect to the     
factors described in subsection         
7e77#b77;,b74  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 ,program1 taking into consideration 

payment amounts from other payers for   
similar food-related services4  7#b7    
,cost-sharing  ,items and services for  
which payment may be made under the     
,program shall be provided without      
application of deductibles1 copayments1 
coinsurance1 or other cost-sharing under
 this title4  7e7 ,monitoring and       
evaluations  7#a7 ,program monitoring   
,the ,secretary shall monitor claims and
 other data submitted to the ,secretary 
of each qualified individual receiving  
food under the ,program for the purpose 
of determining whether the ,program     
improves health outcomes for qualified  
individuals4  7#b7 ,intermediate and    
final evaluations and reports ,the      
,secretary shall conduct an intermediate
 and final evaluation of the ,program4  
,each such evaluation shall--  7,a7 with
 respect to individuals determined to be
 qualified individuals and receiving    
food and for the relevant periods1      
determine-- 7i7 an analysis of inpatient
 admissions of such individuals after   

the initial inpatient admission1 and the
 diagnosis-related groups for such      
admissions2  7ii7 the number of         
admissions to other post-acute care     
services of such individuals1 and the   
reasons for such admissions2 and  7iii7 
the total expenditures under part ,a    
with respect to such individuals2  7,b7 
report the following1 with a comparison 
to comparable beneficiaries not         
participating in the ,program-- 7i7 an  
assessment of clinical health outcomes1 
as defined by the ,secretary2  7ii7     
changes in the total cost of care under 
part ,a 7including costs associated with
 readmission as defined in section      
#ahff7q77#e77;,e772 and  7iii7 patient  
and caregiving experience1 including    
whether such individuals would have     
continued to receive the food if they   
were required to pay for it2  7,c7      
obtain information from hospitals about 
payments made under the ,program1       
including whether such payments met or  
exceeded such hospitals' cost incurred  

in providing services under the         
,program2 and  7,d7 an analysis of      
health outcomes of individuals receiving
 items and services under the ,program  
compared to health outcomes of          
individuals not receiving items and     
services in the ,program4  7#c7 ,reports
 ,the ,secretary shall submit to the    
,committee on ,ways and ,means of the   
,house of ,representatives and the      
,committee on ,finance of the ,senate-- 
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 #h years 
after such date of implementation1 a    
report with respect to the final        
evaluation under such paragraph4  7f7   
,funding  7#a7 ,in general ,payments for
 items and services furnished under the 
,program and funds necessary for the    
costs of carrying out the ,program shall
 be made from the ,hospital ,insurance  
,trust ,fund under section #ahag4  7#b7 

,budget neutrality ,the ,secretary shall
 reduce payments made to subsection 7d7 
hospitals under section #ahhf7;d7 in a  
manner such that the total amount of    
such reductions for a year are estimated
 to be equal to the total amount of     
payments made under the ,program during 
such year4  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 who-- 7,a7 is entitled to   
benefits under part ,a and is not       
receiving similar benefits from other   
state or ,federal programs1 as reported 

by the individual2  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     
7,c7 at the time of discharge from a    
selected hospital or rescreening--  7i7 
lives at home2  7ii7 is not eligible for
 or admitted to extended care services  
7as defined in section #ahfa7;h772      
7iii7 has not made an election under    
section #ahab7;d77#a7 to receive hospice
 care2  7iv7 is 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