119-hr5439

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5439 Introduced in House

    (IH) ]

<DOC>

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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