I 

108TH CONGRESS 

1ST SESSION H. R. 2453

To amend title XVIII of the Social Security Act to provide for coverage 

under the Medicare Program of substitute adult day care services. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 12, 2003

Mr. KLECZKA (for himself and Mr. STARK) introduced the following bill; 

which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of 

such provisions as fall within the jurisdiction of the committee concerned 

A BILL

To amend title XVIII of the Social Security Act to provide 

for coverage under the Medicare Program of substitute 

adult day care services.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Substitute 

5 Adult Day Care Services Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 
2

•HR 2453 IH 

1 (1) Adult day care offers services, including 

2 medical care, rehabilitation therapies, dignified as3 sistance with activities of daily living, nutrition ther4 apy, health monitoring, social interaction, stimu5 lating activities, and transportation, to seniors who 

6 are frail, physically challenged, or cognitively im7 paired at no extra cost to the medicare program. 

8 (2) The care given at adult day care centers 

9 provides seniors and their familial caregivers support 

10 that is critical to keeping the senior in the family 

11 home. 

12 (3) More than 22,000,000 families in the 

13 United States serve as caregivers for aging or ailing 

14 seniors, and nearly 1 in 4 American families provide 

15 close to 80 percent of the care to individuals requir16 ing long-term care. 

17 (4) Nearly 75 percent of those actively pro18 viding such care are women who also maintain other 

19 responsibilities, such as working outside of the home 

20 and raising young children. 

21 (5) The average loss of income to these care22 givers has been shown to be $659,130 in wages, pen23 sion, and Social Security benefits. 

24 (6) The loss in productivity in United States 

25 businesses attributable to caregivers for aging or ail-
3

•HR 2453 IH 

1 ing seniors ranges from $11,000,000,000 to 

2 $29,000,000,000 annually. 

3 (7) Adult day care centers, located in every 

4 State in the United States and the District of Co5 lumbia, serve as quality health options to treat our 

6 Nation’s elderly population, which is about to dra7 matically increase with the aging of the baby boomer 

8 generation. 

9 SEC. 3. MEDICARE COVERAGE OF SUBSTITUTE ADULT DAY 

10 CARE SERVICES. 

11 (a) SUBSTITUTE ADULT DAY CARE SERVICES BEN12 EFIT.—

13 (1) IN GENERAL.—Section 1861(m) of the So14 cial Security Act (42 U.S.C. 1395x(m)) is amend15 ed—

16 (A) in the matter preceding paragraph (1), 

17 by inserting ‘‘or paragraph (8)’’ after ‘‘para18 graph (7)’’; 

19 (B) in paragraph (6), by striking ‘‘and’’ at 

20 the end; 

21 (C) in paragraph (7), by adding ‘‘and’’ at 

22 the end; and 

23 (D) by inserting after paragraph (7), the 

24 following new paragraph: 
4

•HR 2453 IH 

1 ‘‘(8) substitute adult day care services (as de2 fined in subsection (ww));’’. 

3 (2) SUBSTITUTE ADULT DAY CARE SERVICES

4 DEFINED.—Section 1861 of the Social Security Act 

5 (42 U.S.C. 1395x) is amended by adding at the end 

6 the following new subsection: 

7 ‘‘Substitute Adult Day Care Services; Adult Day Care 

8 Facility 

9 ‘‘(ww)(1)(A) The term ‘substitute adult day care 

10 services’ means the items and services described in sub11 paragraph (B) that are furnished to an individual by an 

12 adult day care facility as a part of a plan under subsection 

13 (m) that substitutes such services for a portion of the 

14 items and services described in subparagraph (B)(i) fur15 nished by a home health agency under the plan, as deter16 mined by the physician establishing the plan. 

17 ‘‘(B) The items and services described in this sub18 paragraph are the following items and services: 

19 ‘‘(i) Items and services described in paragraphs 

20 (1) through (7) of subsection (m). 

21 ‘‘(ii) Transportation of the individual to and 

22 from the adult day care facility in connection with 

23 any such item or service. 

24 ‘‘(iii) Meals. 
5

•HR 2453 IH 

1 ‘‘(iv) A program of supervised activities (that 

2 meets such criteria as the Secretary determines ap3 propriate) designed to promote physical and mental 

4 health that are furnished to the individual by the 

5 adult day care facility in a group setting for a period 

6 of not fewer than 4 and not greater than 12 hours 

7 per day. 

8 ‘‘(v) A medication management program (as de9 fined in subparagraph (C)). 

10 ‘‘(C) For purposes of subparagraph (B)(v), the term 

11 ‘medication management program’ means a program of 

12 education and services (that meets such criteria as the 

13 Secretary determines appropriate) to minimize—

14 ‘‘(i) unnecessary or inappropriate use of pre15 scription drugs; and 

16 ‘‘(ii) adverse events due to unintended prescrip17 tion drug-to-drug interactions. 

18 ‘‘(2)(A) Except as provided in subparagraph (B), the 

19 term ‘adult day care facility’ means a public agency or 

20 private organization, or a subdivision of such an agency 

21 or organization, that—

22 ‘‘(i) is engaged in providing skilled nursing 

23 services and other therapeutic services directly or 

24 under arrangement with a home health agency;
6

•HR 2453 IH 

1 ‘‘(ii) meets such standards established by the 

2 Secretary to assure quality of care and such other 

3 requirements as the Secretary finds necessary in the 

4 interest of the health and safety of individuals who 

5 are furnished services in the facility; 

6 ‘‘(iii) provides the items and services described 

7 in paragraph (1)(B); and 

8 ‘‘(iv) meets the requirements of paragraphs (2) 

9 through (8) of subsection (o). 

10 ‘‘(B) The Secretary may waive the requirement of a 

11 surety bond under paragraph (7) of subsection (o) in the 

12 case of an agency or organization that provides a com13 parable surety bond under State law. 

14 ‘‘(C) For purposes of payment for home health serv15 ices consisting of substitute adult day care services fur16 nished under this title, any reference to a home health 

17 agency is deemed to be a reference to an adult day care 

18 facility. 

19 ‘‘(D) Nothing in this paragraph shall be construed 

20 as prohibiting a home health agency from—

21 ‘‘(i) establishing a substitute adult day care fa22 cility; or 

23 ‘‘(ii) providing services under arrangements 

24 with a substitute adult day care facility.’’. 
7

•HR 2453 IH 

1 (3) CONFORMING AMENDMENTS.—Sections 

2 1814(a)(2)(C) and 1835(a)(2)(A)(i) of the Social 

3 Security Act (42 U.S.C.1395f(a)(2)(C) and 

4 1395n(a)(2)(A)(i)) are each amended by striking 

5 ‘‘section 1861(m)(7)’’ and inserting ‘‘paragraph (7) 

6 or (8) of section 1861(m)’’. 

7 (b) PAYMENT FOR SUBSTITUTE ADULT DAY CARE

8 SERVICES UNDER THE HOME HEALTH PROSPECTIVE

9 PAYMENT SYSTEM.—Section 1895 of the Social Security 

10 Act (42 U.S.C. 1395fff) is amended—

11 (1) in the first sentence of paragraph (b)(1), by 

12 inserting after ‘‘home health services’’ the following: 

13 ‘‘or home health services consisting of substitute 

14 adult day care services.’’; and 

15 (2) by adding at the end the following new sub16 section: 

17 ‘‘(f) PAYMENT RATE AND LIMITATION ON PAYMENT

18 FOR SUBSTITUTE ADULT DAY CARE SERVICES.—

19 ‘‘(1) PAYMENT RATE.—

20 ‘‘(A) IN GENERAL.—The Secretary shall 

21 determine each component (as defined by the 

22 Secretary) of substitute adult day care services 

23 (under section 1861(ww)(1)(B)(i)) furnished to 

24 an individual under the plan of care established 
8

•HR 2453 IH 

1 under section 1861(m) with respect to such 

2 services. 

3 ‘‘(B) ESTIMATION OF PAYMENT

4 AMOUNT.—The Secretary shall estimate the 

5 amount that would otherwise be payable under 

6 this section for all home health services under 

7 that plan of care other than substitute adult 

8 day care services for a week or other period 

9 specified by the Secretary. 

10 ‘‘(C) AMOUNT OF PAYMENT.—The total 

11 amount payable for home health services con12 sisting of substitute adult day care services 

13 under such plan of care is equal to the amount 

14 estimated to be payable under subparagraph 

15 (B) furnished under the plan by a home health 

16 agency. 

17 ‘‘(2) LIMITATIONS.—

18 ‘‘(A) IN GENERAL.—With respect to home 

19 health services consisting of substitute adult 

20 day care services, no payment may be made 

21 under this section for home health services con22 sisting of substitute adult day care services de23 scribed in clauses (ii) through (v) of section 

24 1861(ww)(1)(B). 
9

•HR 2453 IH 

1 ‘‘(B) LIMITATION ON BALANCE BILLING.—

2 An adult day care facility shall accept as pay3 ment in full for substitute adult day care serv4 ices (including those services described in 

5 clauses (ii) through (v) of section 

6 1861(ww)(1)(B)) furnished by the facility to an 

7 individual entitled to benefits under this title 

8 the amount of payment provided under this sec9 tion for home health services consisting of sub10 stitute adult day care services.’’. 

11 (c) CONSOLIDATED BILLING.—Section 1862(a) of 

12 such Act (42 U.S.C. 1395y(a)), is amended—

13 (1) by striking ‘‘or’’ at the end of paragraph 

14 (20), 

15 (2) by striking the period at the end of para16 graph (21) and inserting ‘‘; or’’, and 

17 (3) by inserting after paragraph (21) the fol18 lowing new paragraph: 

19 ‘‘(22) which are substitute adult day care serv20 ices for which payment may be made under section 

21 1895(f) and which are furnished to an individual by 

22 a substitute adult day care facility pursuant to a 

23 plan of care established under section 1861(m) with 

24 respect to such services, by an entity other than the 

25 substitute adult day care facility, unless the services 
10

•HR 2453 IH 

1 are furnished under arrangements (as defined in sec2 tion 1861(w)(1)) with the entity made by the sub3 stitute adult day care facility.’’. 

4 (d) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to items and services furnished on 

6 or after January 1, 2004.

Æ