[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2133 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 2133
To amend title XVIII of the Social Security Act to establish a
Medically Tailored Home-Delivered Meals Demonstration 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
individuals.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 22, 2023
Ms. Stabenow (for herself, Mr. Marshall, Mr. Booker, and Mr. Cassidy)
introduced the following bill; 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
Medically Tailored Home-Delivered Meals Demonstration 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
individuals.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medically Tailored Home-Delivered
Meals Demonstration Act''.
SEC. 2. MEDICALLY TAILORED HOME-DELIVERED MEALS DEMONSTRATION PROGRAM.
Part E of title XVIII of the Social Security Act is amended by
inserting after section 1866G (42 U.S.C. 1395cc-7) the following new
section:
``SEC. 1866H. MEDICALLY TAILORED HOME-DELIVERED MEALS DEMONSTRATION
PROGRAM.
``(a) Establishment.--For the 4-year period beginning not later
than 30 months after the date of the enactment of this section, the
Secretary shall conduct, in accordance with the provisions of this
section, a Medically Tailored Home-Delivered Meals Demonstration
Program (in this section referred to as the `Program') to test a
payment and service delivery model under which selected hospitals
provide medically tailored home-delivered meals under part A of this
title to qualified individuals, with respect to such hospitals, to
improve clinical health outcomes and reduce the rate of readmissions of
such individuals.
``(b) Selection of Hospitals To Participate in Program.--
``(1) Selected hospitals.--Under the Program, the Secretary
shall, not later than January 1, 2024, select to participate in
the Program at least 20 eligible hospitals across all
geographic regions, with consideration given to eligible
hospitals located in rural areas and other underserved
communities, that the Secretary determines have the capacity to
satisfy the requirements described in subsection (c). In this
section, each such eligible hospital so selected shall be
referred to as a `selected hospital'.
``(2) Eligible hospitals.--For purposes of this section,
the term `eligible hospital' means a subsection (d) hospital
(as defined in section 1886(d)(1)(B)) that--
``(A) submits to the Secretary an application, at
such time and in such form and manner as specified by
the Secretary, that contains--
``(i) an attestation (in such form and
manner as specified by the Secretary) that such
hospital has the ability, or is under an
arrangement with a provider of services,
supplier, or other entity that has the ability,
to comply with the requirements described in
subsection (c); and
``(ii) such other information as the
Secretary may require;
``(B) has, for the 2 most recent fiscal years
ending prior to the date of selection by the Secretary
under paragraph (1), averaged at least 3 stars for the
overall hospital quality star rating on the internet
website of the Centers for Medicare & Medicaid Services
(including Care Compare or a successor website); and
``(C) is not, as of the date of selection by the
Secretary under paragraph (1), subject to--
``(i) the requirement to return any
overpayment pursuant to section 1128J(d); or
``(ii) any activity described in section
1893(b) (relating to Medicare integrity program
actions).
``(c) Minimum Program Requirements.--Under the Program, a selected
hospital shall comply with each of the following requirements:
``(1) Staffing.--The selected hospital shall provide
(including through an arrangement described in subsection
(b)(2)(A)(i)), for the duration of the participation of the
hospital under the Program, a physician, registered dietitian
or nutrition professional, or clinical social worker to carry
out the screening and re-screening pursuant to paragraph (2),
and medical nutrition therapy pursuant to paragraph (3)(B).
``(2) Screening and re-screening.--The selected hospital
(including through an arrangement described in subsection
(b)(2)(A)(i)) shall--
``(A) as part of the discharge planning process
described in section 1861(ee), screen individuals that
are inpatients of such selected hospital with validated
screening tools (as developed by the Secretary) to
determine whether such individuals are qualified
individuals; and
``(B) in the case of an individual determined
pursuant to subparagraph (A) or this subparagraph to be
a qualified individual, re-screen such individual with
validated screening tools (as determined by the
Secretary) every 12 weeks after such determination
occurring during the participation of the hospital
under the Program to determine whether such individual
continues to be a qualified individual.
``(3) 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 paragraph
(2) to be a qualified individual, the selected hospital
(including through an arrangement described in subsection
(b)(2)(A)(i)) shall with respect to the period during which
such hospital is participating in the Program--
``(A) provide, for each day during a period of at
least 12 weeks, for the preparation and delivery to
such individual of at least 2 medically tailored home-
delivered meals (or a portioned equivalent) that meet
at least two-thirds of the daily nutritional needs of
the qualified individual; and
``(B) provide to such qualified individual, in
connection with delivering such meals and for a period
of at least 12 weeks and not more than 1 year, medical
nutrition therapy.
``(4) Data submission.--The selected hospital shall submit
to the Secretary data, in such form, manner, and frequency as
designated by the Secretary, so that the Secretary may
determine the affect of the Program with respect to the factors
described in subsection (e)(2)(B).
``(5) Additional requirements.--The selected hospital shall
satisfy such additional requirements as may be specified by the
Secretary.
``(d) Payment; Cost-Sharing.--
``(1) Payment.--The Secretary shall determine the form,
manner, and amount of payment to be provided to a selected
hospital under the Program.
``(2) Cost-sharing.--Items and services for which payment
may be made under the Program shall be provided without
application of any deductible, copayment, coinsurance, or other
cost-sharing under this title.
``(e) Evaluations.--
``(1) Assessing clinical health outcomes.--The Secretary
shall assess the clinical health outcomes of each individual
who is determined by a selected hospital pursuant to subsection
(c)(2) to be a qualified individual for a period of at least 12
weeks and not more than 1 year after the date on which such
individual is so determined under subparagraph (A) of such
subsection.
``(2) Intermediate and final evaluations.--The Secretary
shall conduct an intermediate and final evaluation of the
Program. Each such evaluation shall--
``(A) based on the assessments conducted under
paragraph (1), with respect to individuals determined
to be qualified individuals and the periods for which
such assessments are so conducted, determine--
``(i) the number of inpatient admissions of
such individuals;
``(ii) the number of admissions to skilled
nursing facilities of such individuals; and
``(iii) the total expenditures under part A
with respect to such individuals;
``(B) determine the extent to which the Program
has--
``(i) improved clinical health outcomes, as
defined by the Secretary;
``(ii) reduced the cost of care under part
A (including costs associated with readmission
as defined in section 1886(q)(5)(E)); and
``(iii) increased patient satisfaction, as
defined by the Secretary; and
``(C) specify the form, manner, and amounts of
payments made under the Program pursuant to subsection
(d)(1) and the effectiveness of such payment form,
manner, and amounts.
``(3) Reports.--The Secretary shall submit to Congress--
``(A) not later than 3 years after the date of
implementation of the Program, a report with respect to
the intermediate evaluation under paragraph (2); and
``(B) not later than 6 years after such date of
implementation, a report with respect to the final
evaluation under such paragraph.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section.
``(g) Definitions.--In this section:
``(1) Medical nutrition therapy.--The term `medical
nutrition therapy' has the meaning given such term in section
1861(vv)(1).
``(2) Medically tailored home-delivered meal.--The term
`medically tailored home-delivered meal' means, with respect to
a qualified individual, a meal that is designed by a registered
dietitian or nutrition professional for the treatment plan of
the qualified individual.
``(3) Qualified individual.--The term `qualified
individual' means an individual, with respect to a selected
hospital, who--
``(A) is entitled to benefits under part A;
``(B) has a diet-impacted disease (such as kidney
disease, congestive heart failure, diabetes, chronic
obstructive pulmonary disease, or any other disease the
Secretary determines appropriate); and
``(C) at the time of discharge from such hospital--
``(i) lives at home;
``(ii) is not eligible for--
``(I) extended care services (as
defined in section 1861(h));
``(II) post-hospital extended care
services (as defined in section
1861(i));
``(III) home health services (as
defined in section 1861(m)); or
``(IV) post-institutional home
health services (as defined in section
1861(tt));
``(iii) has not made an election under
section 1812(d)(1) to receive hospice care;
``(iv) is certified by a physician at the
time of discharge to be limited with respect to
at least 2 of the activities of daily living
(as described in section 7702B(c)(2)(B) of the
Internal Revenue Code of 1986); and
``(v) meets any other criteria for high-
risk of readmission (as determined by the
Secretary).
``(4) Registered dietitian or nutrition professional.--The
term `registered dietitian or nutrition professional' has the
meaning given such term in section 1861(vv)(2).''.
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