,,ii #aaith ,,congress #b;d ,session ,s4 #ebgj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #e1 #bjbf,mr4 ,kim 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 ,medicare home care benefit1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare at ,home ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,more than #aj1jjj1jjj ,medicare beneficiaries need assistance with one or more activities of daily living1 and current ,medicare law does not cover long-term1 personal care in the home4 7#b7 ,the absence of a home care benefit forces beneficiaries and families to pay out of pocket1 spend down into ,medicaid1 or forgo needed care1 often at greater cost to the health care system through avoidable hospitalizations and institutionalization4 ,paying out of pocket for home care costs more than #fj1jjj annually4 7#c7 ,the vast majority of people want to live and age with dignity in their homes when they need care1 including #id percent of older adults1 #ij percent of people with disabilities1 and #hi percent of adults overall4 7#d7 ,americans overwhelmingly and strongly believe ,medicare should cover home care services1 with #ic percent of adults agreeing4 ,the majority of current ,medicare beneficiaries either believe it already does or do not know if it does or not4 7#e7 ,a modest1 capped home care benefit under ,medicare would allow older adults and people with disabilities to remain safely in their homes and communities4 ,it would also take the pressure off of unpaid family caregivers who now provide over #a1jjj1jjj1jjj1jjj in unpaid care to the economy filling in gaps in the systems4 #c4 ,establishment of ,medicare home care benefit 7a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7ooo7 ,home care services 7#a7 ,in general ,the term home care services means the following services furnished to an individual in the individual's home by a home care worker under a plan established under paragraph 7#c73 7,a7 ,assistance with activities of daily living1 including bathing1 dressing1 toileting1 transferring1 and eating4 7,b7 ,assistance with instrumental activities of daily living1 including meal preparation1 medication reminders1 and light housekeeping directly related to the health and safety of the individual4 7#b7 ,limitations ,home care services furnished under this subsection-- 7,a7 shall not exceed #bj hours per week per individual2 and 7,b7 do not include1 and are separate from1 home health services described in subsection 7m74 7#c7 ,plan of care ,home care services shall be furnished pursuant to a plan of care established and periodically reviewed by a physician 7or other practitioner authorized under this title to establish a plan of care71 which shall certify that the individual requires assistance with not fewer than #b activities of daily living1 #b instrumental activities of daily living1 or #a activity of daily living and #a instrumental activity of daily living described in paragraph 7#a77;,a74 4 7b7 ,coverage under part ,b ,section #ahcb7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77 is amended-- 7#a7 in subparagraph 7,i71 by striking and at the end2 7#b7 in subparagraph 7,j71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,k7 home care services 7as defined in section #ahfa7ooo774 4 7c7 ,payment ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended by adding at the end the following new subsection3 7ee7 ,payment for home care services ,the ,secretary shall establish a payment methodology for home care services 7as defined in section #ahfa7ooo77 furnished by agencies or individuals enrolled under this title1 which shall reflect a reasonable wage floor for home care workers furnishing such services4 4 #d4 ,eligibility ,an individual is eligible for home care services under this ,act if the individual-- 7#a7 is entitled to benefits under part ,a1 or enrolled under part ,b1 of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 7#b7 has been certified1 in accordance with section #ahfa7ooo77#c7 of such ,act 7as added by section #c71 as requiring assistance with not fewer than #b activities of daily living1 #b instrumental activities of daily living1 or #a activity of daily living and #a instrumental activity of daily living2 and 7#c7 is not1 at the time ,medicare home care services are furnished1 receiving long-term services and supports through a ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 that duplicate the services described in section #ahfa7ooo74 #e4 ,benefit amount ,home care services furnished under this ,act may not exceed #bj hours per week per eligible individual1 as set forth in section #ahfa7ooo77#b77;,a7 of the ,social ,security ,act 7as added by section #c74 #f4 ,financing 7a7 ,part ,b premium ,the ,secretary shall adjust the monthly premium under section #ahci of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7 to reflect the additional actuarial cost of the benefit established under this ,act1 subject to the standard subsidy schedule under such section4 7b7 ,actuarial report ,not later than #ahj days after the date of enactment of this ,act1 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services shall submit to ,congress an estimate of the per-beneficiary premium impact of the benefit established under this ,act4 #g4 ,administration 7a7 ,regulations ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall promulgate regulations necessary to carry out this ,act and the amendments made by this ,act1 including standards for home care worker qualifications and agency enrollment4 7b7 ,effective date ,the amendments made by this ,act shall apply to home care services furnished on or after the first day of the first plan year beginning more than #b years after the date of enactment of this ,act4