[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5439 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 5439
To amend title XVIII of the Social Security Act to establish a
Medically Tailored Home-Delivered Meals 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 HOUSE OF REPRESENTATIVES
September 17, 2025
Mr. McGovern (for himself, Ms. Malliotakis, Ms. Pingree, Mr.
Fitzpatrick, and Mr. Evans of Pennsylvania) introduced the following
bill; which was referred to the Committee on Ways and Means
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a
Medically Tailored Home-Delivered Meals 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 Program Pilot Act''.
SEC. 2. MEDICALLY TAILORED HOME-DELIVERED MEALS 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 PROGRAM.
``(a) Establishment.--For the 6-year period beginning not later
than 30 months after the date of the enactment of this section, subject
to subsection (f), the Secretary shall conduct, in accordance with the
provisions of this section, a Medically Tailored Home-Delivered Meals
Program (in this section referred to as the `Program') under which
selected hospitals provide medically tailored home-delivered meals
under part A of this title to qualified individuals 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 June 30, 2027, select to participate in
the Program at least, subject to subsection (f), 40 eligible
hospitals that attest to the Secretary that they 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)) or a critical access
hospital (as described in section 1820(c)(2)) 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 has an arrangement
with providers of services or suppliers or
other entities that have the ability, to
furnish the services described in subsection
(c); and
``(ii) such other information as the
Secretary may require;
``(B) in the case of a subsection (d) hospital,
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 posted on the internet website of
the Centers for Medicare & Medicaid Services (including
Care Compare or a successor website); and
``(C) meets, as of the date of selection by the
Secretary under paragraph (1), program integrity
requirements, as determined by the Secretary.
``(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, Advanced Practice Nursing
Professional, or clinical social worker to carry out the
screening and re-screening pursuant to paragraph (2), medical
nutrition therapy pursuant to paragraph (3)(B).
``(2) Screening and re-screening.--The selected hospital
(including through arrangements 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 approved or deemed to be approved by
the Secretary to determine whether such individuals are
qualified individuals pursuant to subsection (h)(3);
and
``(B) in the case of an individual that was an
inpatient of such selected hospital and was screened
pursuant to subparagraph (A) and determined 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 subsection
(h)(3) to be a qualified individual, the selected hospital
(including through arrangements 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 following the screen pursuant to
paragraph (2)(A) and for each subsequent 12-week period
after the rescreen pursuant to paragraph (2)(B), for
the duration of the Program, 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 are
responsive to the individual's medical and cultural
needs (such as an allergy or dietary restrictions or
other religious or cultural dietary needs); 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 effect of the Program with respect to the factors
described in subsection (e)(2)(B).
``(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, taking into consideration payment
amounts from other payers for similar food-related services.
``(2) Cost-sharing.--Items and services for which payment
may be made under the Program shall be provided without
application of deductibles, copayments, coinsurance, or other
cost-sharing under this title.
``(e) Monitoring and Evaluations.--
``(1) Program monitoring.--The Secretary shall monitor
claims and other data submitted to the Secretary of each
qualified individual receiving food under the Program for the
purpose of determining whether the Program improves health
outcomes for qualified individuals.
``(2) Intermediate and final evaluations and reports.--The
Secretary shall conduct an intermediate and final evaluation of
the Program. Each such evaluation shall--
``(A) with respect to individuals determined to be
qualified individuals and receiving food and for the
relevant periods, determine--
``(i) an analysis of inpatient admissions
of such individuals after the initial inpatient
admission, and the diagnosis-related groups for
such admissions;
``(ii) the number of admissions to other
post-acute care services of such individuals,
and the reasons for such admissions; and
``(iii) the total expenditures under part A
with respect to such individuals;
``(B) report the following, with a comparison to
comparable beneficiaries not participating in the
Program--
``(i) an assessment of clinical health
outcomes, as defined by the Secretary;
``(ii) changes in the total cost of care
under part A (including costs associated with
readmission as defined in section
1866(q)(5)(E)); and
``(iii) patient and caregiving experience,
including whether such individuals would have
continued to receive the food if they were
required to pay for it;
``(C) obtain information from hospitals about
payments made under the Program, including whether such
payments met or exceeded such hospitals' cost incurred
in providing services under the Program; and
``(D) an analysis of health outcomes of individuals
receiving items and services under the Program compared
to health outcomes of individuals not receiving items
and services in the Program.
``(3) Reports.--The Secretary shall submit to the Committee
on Ways and Means of the House of Representatives and the
Committee on Finance of the Senate--
``(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 8 years after such date of
implementation, a report with respect to the final
evaluation under such paragraph.
``(f) Funding.--
``(1) In general.--Payments for items and services
furnished under the Program and funds necessary for the costs
of carrying out the Program shall be made from the Hospital
Insurance Trust Fund under section 1817.
``(2) Budget neutrality.--The Secretary shall reduce
payments made to subsection (d) hospitals under section 1886(d)
in a manner such that the total amount of such reductions for a
year are estimated to be equal to the total amount of payments
made under the Program during such year.
``(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, who--
``(A) is entitled to benefits under part A and is
not receiving similar benefits from other state or
Federal programs, as reported by the individual;
``(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);
``(C) at the time of discharge from a selected
hospital or rescreening--
``(i) lives at home;
``(ii) is not eligible for or admitted to
extended care services (as defined in section
1861(h));
``(iii) has not made an election under
section 1812(d)(1) to receive hospice care;
``(iv) is 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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