Medicare at Home Act
Sponsored By: Senator Kim, Andy [D-NJ]
Introduced
Summary
This bill would create a new Medicare benefit for home care services that would pay for in-home help with daily tasks under a physician-reviewed plan of care. It would cap services at 20 hours per week and phase in rules and payment changes over time.
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- Medicare beneficiaries who need help with daily living would become eligible if a clinician certifies they need assistance with at least two activities of daily living (ADLs), two instrumental activities of daily living (IADLs), or one ADL and one IADL. The benefit would not duplicate similar state plan or waiver long-term services.
- Home care workers and agencies would be paid under a Part B enrollment and payment system that requires the Secretary to set a payment methodology reflecting a reasonable wage floor and to issue worker qualification and agency enrollment standards.
- Administration and financing steps would include a Chief Actuary estimate of per-beneficiary premium impact within 180 days, regulations within one year, and an effective date for services starting more than two years after enactment.
*Financing would come through Part B premium adjustments to reflect the benefit's actuarial cost.*
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 0 benefits, 0 costs, 3 mixed.
Medicare home care coverage expansion
If enacted, Medicare would cover a new "home care services" benefit for help in your home. You must be entitled to Part A or enrolled in Part B. A physician or authorized practitioner would have to create and review a plan of care that certifies you need help with at least 2 ADLs, or 2 IADLs, or 1 ADL and 1 IADL. You could not get these services if Medicaid already pays for the same help. Services would be limited to 20 hours per week. Coverage would start for services furnished on or after the first day of the first plan year beginning more than two years after enactment.
Medicare home care pay and premiums
If enacted, HHS would have to set Medicare payment rules for the new home care benefit that include a reasonable wage floor for home care workers. The Secretary would also adjust the Medicare Part B monthly premium to reflect the added actuarial cost, using the usual premium subsidy rules. The Chief Actuary would prepare an estimate of the per-beneficiary premium impact within 180 days after enactment.
Rules for Medicare home care workers
If enacted, HHS would have to write rules to implement the new home care benefit within one year of enactment. The rules would include standards for who can work as a Medicare home care worker and standards for how agencies enroll to bill Medicare. These rules would guide how the benefit works but do not themselves set pay rates.
Sponsors & CoSponsors
Sponsor
Kim, Andy [D-NJ]
NJ • D
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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