H.R. 10020 — Medicare at Home Act

This section finds that more than 10,000,000 Medicare beneficiaries need assistance with activities of daily living, that current law provides no coverage for long-term personal home care, and that out-of-pocket costs exceed $60,000 annually. It further finds that 94 percent of older adults, 90 percent of people with disabilities, and 89 percent of adults overall prefer to age at home, that 93 percent of adults support adding Medicare home care coverage, and that unpaid family caregivers provide over $1,000,000,000,000 in annual care.

This section establishes a new Medicare home care benefit under Part B. It covers up to 20 hours per week of assistance with activities of daily living (bathing, dressing, toileting, transferring, eating) and instrumental activities of daily living (meal preparation, medication reminders, light housekeeping) furnished in an individual's home by a home care worker, pursuant to a plan of care that certifies the individual requires help with at least two such activities (or one of each). The benefit is separate from existing home health services, and the Secretary must establish a payment methodology that includes a reasonable wage floor for home care workers.

This section establishes eligibility for home care services for individuals entitled to Medicare Part A or enrolled in Part B who have been certified as requiring assistance with at least two activities of daily living, two instrumental activities of daily living, or one of each, and who are not receiving duplicative long-term services and supports through Medicaid.

This section requires the Secretary to adjust the monthly Medicare Part B premium to reflect the additional actuarial cost of the benefit established under this Act, subject to the standard subsidy schedule. It directs the Chief Actuary of the Centers for Medicare & Medicaid Services to submit to Congress, within 180 days of enactment, an estimate of the per-beneficiary premium impact of the benefit.

This section directs the Secretary of Health and Human Services to promulgate regulations within one year of enactment, including standards for home care worker qualifications and agency enrollment. It applies the amendments to home care services furnished on or after the first day of the first plan year beginning more than two years after enactment.