H.R. 10020: Medicare at Home Act

This bill would create a new Medicare home care benefit for certain beneficiaries who need help with everyday tasks but are not already getting similar long-term care through Medicaid.

What services would be covered

The bill defines “home care services” as help provided in a person’s home by a home care worker, under a care plan. Covered services would include:

• Help with activities of daily living, such as bathing, dressing, toileting, transferring, and eating.
• Help with instrumental activities of daily living, such as meal preparation, medication reminders, and light housekeeping tied directly to the person’s health and safety.

The benefit would be separate from Medicare’s existing home health services.

Limits on the benefit

The home care benefit would be capped at 20 hours per week per person. It would not cover unlimited care or full-time long-term custodial care.

To receive the benefit, a person would need a care plan established and periodically reviewed by a physician or other authorized practitioner, and they would have to be certified as needing help with:

• at least 2 activities of daily living, or
• at least 2 instrumental activities of daily living, or
• 1 activity of daily living and 1 instrumental activity of daily living.

Who could qualify

An individual would be eligible if they:

• are entitled to Medicare Part A or enrolled in Part B;
• meet the medical certification standard described above; and
• are not already receiving duplicative long-term services and supports through Medicaid or a Medicaid waiver.

How Medicare would pay for it

The bill would add home care services to the list of Medicare Part B-covered items and require the Secretary of Health and Human Services to set a payment system for these services. That payment system would need to include a reasonable wage floor for home care workers.

How it would be financed

The bill directs the government to adjust Medicare Part B premiums to cover the added cost of the new benefit, while following the usual subsidy rules for lower-income beneficiaries. It also requires the Medicare chief actuary to report to Congress within 180 days on the expected premium effect per beneficiary.

Implementation timeline

The Department of Health and Human Services would have to issue implementing regulations within 1 year of enactment, including rules on worker qualifications and agency enrollment. The benefit would begin for services furnished on or after the first day of the first plan year starting more than 2 years after enactment.

Relevant Companies

None found