IN-HOME CARE FOR CERTAIN CHRONICALLY DEPENDENT INDIVIDUALS.

SEC. 205. IN-HOME CARE FOR CERTAIN CHRONICALLY DEPENDENT INDIVIDUALS. (a) In General.—Section 1832(a) (42 U.S.C. 1395k(a)) is amended— (1) in paragraph (2)(A)— (A) by inserting “(i)” after “(A)”, and (B) by inserting before the semicolon at the end the following: “, and (ii) in-home care for a chronically dependent individual for up to 80 hours in any 12-month period described in section 1861(11)(4), but not to exceed 80 hours in any calendar year;”; and (2) by adding at the end the following new sentence: “In the case of in-home care (described in paragraph (2)(A)(ii)) provided to a chronically dependent individual on any day, such care provided for 3 hours or less on the day shall be counted (for purposes of the limitation in such paragraph) as 3 hours of such care.”. 102 STAT. 730 (b) In-Home Care for Chronically Dependent Individual Defined.—Section 1861 (42 U.S.C. 1395x), as amended by section 204(a)(2) of this Act, is amended by adding at the end the following new subsection: “In-Home Care; Chronically Dependent Individual “(ll) (1) The term ‘in-home care’ means the following items and services furnished, under the supervision of a registered professional nurse, to a chronically dependent individual (as defined in paragraph (2)) during the period described in paragraph (4) by a home health agency or by others under arrangements with them made by such agency in a place of residence used as such individual’s home: “(A) Services of a homemaker/home health aide (who has successfully completed a training program approved by the Secretary). “(B) Personal care services. “(C) Nursing care provided by a licensed professional nurse. “(2) The term ‘chronically dependent individual’ means an individual who— “(A) is dependent on a daily basis on a primary caregiver who is living with the individual and is assisting the individual without monetary compensation in the performance of at least 2 of the activities of daily living (described in paragraph (3)), and “(B) without such assistance could not perform such activities of daily living. “(3) The ‘activities of daily living’, referred to in paragraph (2), are as follows: “(i) Eating. “(ii) Bathing. “(iii) Dressing. “(iv) Toileting. “(v) Transferring in and out of a bed or in and out of a chair. “(4) The 12-month period described in this paragraph is the 1-year period beginning on the date that the Secretary determines that a chronically dependent individual either— “(A) has become entitled to benefits under section 1833(c) (relating to having incurred out-of-pocket part B cost sharing equal to the part B catastrophic limit), or “(B) has become entitled to have payments made for covered outpatient drugs under section 1834(c). In the case of an individual who qualifies under subparagraph (A) or (B) within 12 months after previously qualifying, the subsequent qualification shall begin a new 12-month period under this paragraph. In the case of an individual enrolled in a buy-out plan (as defined in section 1833(c)(5)(D)) or a drug buy-out plan (as defined in section 1834(c)(6)(D)), the Secretary shall establish such procedures as may be appropriate to identify individuals who are deemed to be described in subparagraph (A) or (B), respectively, for purposes of the provision of in-home care under the plan.”. (c) Payment.— Section 1833(a) (42 U.S.C. 13951(a)) is amended— (1) in paragraph (2), by inserting “(A)(ii),” after “subparagraphs” the first place it appears, (2) in paragraph (3), by striking “(D)” and inserting “(A)(ii), (D), ”, and (3) by adding at the end the following: 102 STAT. 731 “Payment for in-home care for chronically dependent individuals shall be paid on the basis of an hour of such care provided. In applying paragraph (2) in the case of an organization receiving payment under clause (A) of paragraph (1) or under a reasonable cost reimbursement contract under section 1876 and providing coverage of in-home care, the Secretary shall provide for an appropriate adjustment in the payment amounts otherwise made to reflect the aggregate increase in payments that would otherwise be made with respect to enrollees in the organization if payments were made other than under such clause or such a contract if payments were to be made on an individual-by-individual basis.”. (d) Certification.— Section 1835(a)(2) (42 U.S.C. 1395n(a)(2)), as amended by section 203(d) of this Act, is amended— (1) by striking “and” at the end of subparagraph (F); (2) by striking the period at the end of subparagraph (G) and inserting in lieu thereof “; and”; and (3) by inserting after subparagraph (G) the following new subparagraph: “(H) in the case of in-home care provided to a chronically dependent individual during a 12-month period, the individual was a chronically dependent individual during the 3-month period immediately preceding the beginning of the 12-month period.”. (e) Standards for Utilization.— (1) Section 1862(a) (42 U.S.C. 1395y(a)), as amended by section 204(d)(2) of this Act, is amended— (A) in paragraph (1)— (i) by striking “and” at the end of subparagraph (E), (ii) by adding “and” at the end of subparagraph (F), and (iv) by adding at the end the following new subparagraph: “(G) in the case of in-home care for chronically dependent individuals, which is not reasonable and necessary to assure the health and condition of the individual is maintained in the individual’s noninstitutional residence;”; and (B) in paragraph (6), by inserting “and except, in the case of in-home care, as is otherwise permitted under paragraph (1)(G)” after “paragraph (1)(C)”. (2) The Secretary of Health and Human Services shall take appropriate efforts to assure the quality, and provide for appropriate utilization of, in-home care for chronically dependent individuals under the amendments made by this section. (f) Effective Date.—The amendments made by this section shall apply to items and services furnished on or after January 1, 1990. (g) Study of Alternative Out-of-Home Services.—The Secretary of Health and Human Services shall study, and report to Congress, not later than 18 months after the date of the enactment of this Act, on the advisability of providing, to chronically dependent individuals eligible for in-home care under the amendments made by this section, out-of-home services (such as adult day care services or nursing facility services) as alternative services to in-home care.