Medicare at Home Act

The Medicare at Home Act (H.R. 10020) amends Title XVIII of the Social Security Act to create a new home care benefit under Medicare Part B. Under the bill, Medicare Part B will pay for personal home care services delivered in an eligible individual's home. These services include: * **Activities of Daily Living (ADLs):** Bathing, dressing, toileting, transferring (moving from one position to another), and eating. * **Instrumental Activities of Daily Living (IADLs):** Meal preparation, medication reminders, and light housekeeping directly related to health and safety. The bill requires the Department of Health and Human Services (HHS) to issue implementation regulations within one year of enactment. The benefit will become available starting on the first day of the first plan year that begins more than two years after the bill is passed into law.

* **Medicare beneficiaries:** Individuals enrolled in Medicare Part B or entitled to Medicare Part A who meet specific physical or daily-living assistance criteria. * **Home care agencies and workers:** Providers delivering non-medical daily living care who must enroll with Medicare, meet HHS qualification standards, and receive at least a minimum wage floor set by HHS. * **Federal agencies:** HHS and the Centers for Medicare & Medicaid Services (CMS), which are responsible for establishing regulations, provider standards, wage rules, and actuarial reporting.

* **New Medicare Coverage:** Eligible beneficiaries can receive up to 20 hours per week of personal care and daily living assistance at home. * **Medical Certification and Care Plan:** To receive benefits, a physician or authorized practitioner must establish and periodically review a plan of care. The practitioner must certify that the beneficiary needs help with at least: * Two ADLs, * Two IADLs, or * One ADL and one IADL. * **Worker and Agency Standards:** HHS must create qualification rules for direct care workers and enrollment procedures for home care provider agencies. * **Worker Pay Requirements:** HHS must establish a provider payment system that incorporates a "reasonable wage floor" for home care workers.

* **Part B Premium Adjustments:** The Secretary of HHS is required to adjust monthly Medicare Part B premiums to cover the calculated cost of the new benefit, following existing standard subsidy schedules. * **Actuarial Impact Report:** The Chief Actuary of CMS must submit a report to Congress within 180 days of enactment detailing the estimated impact of the new benefit on individual beneficiary premiums.

* **Weekly Cap:** Coverage is limited to a maximum of 20 hours per week per beneficiary. * **Medicaid Non-Duplication:** Beneficiaries cannot receive this Medicare benefit if they are simultaneously receiving duplicative long-term services and supports through a Medicaid state plan or waiver. * **Separation from Home Health:** These personal home care services are defined as separate from traditional Medicare home health services and do not replace or include skilled home health care under section 1861(m) of the Social Security Act.

This bill establishes a new Medicare Part B benefit providing up to 20 hours a week of non-medical home assistance—such as help with bathing, eating, and light housekeeping—for qualifying beneficiaries who need help with daily tasks, funded by adjustments to monthly Part B premiums.