I 

113TH CONGRESS 

1ST SESSION H. R. 3334 

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

of certified adult day services under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 23, 2013 

Ms. LINDA T. SA ́NCHEZ of California (for herself, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. BLUMENAUER, Ms. BORDALLO, Mr. CARSON of Indiana, Mr. CARTWRIGHT, Ms. CLARKE, Mr. CONYERS, Mr. DANNY K. 

DAVIS of Illinois, Ms. FRANKEL of Florida, Ms. NORTON, Ms. JACKSON

LEE, Mr. LANGEVIN, Mr. LOEBSACK, Mr. LOWENTHAL, Ms. MICHELLE

LUJAN GRISHAM of New Mexico, Mr. MICHAUD, Mrs. NAPOLITANO, Mr. 

RANGEL, Ms. ROYBAL-ALLARD, Ms. SCHAKOWSKY, Ms. SCHWARTZ, and 

Ms. WATERS) 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 of certified adult day services under the 

Medicare program. 

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 Adult Day 

5 Services Act of 2013’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Adult day care can offer services, including 

4 medical care, rehabilitation therapies, dignified as5 sistance with activities of daily living, nutrition ther6 apy, health monitoring, social interaction, stimu7 lating activities, and transportation, to seniors and 

8 people with disabilities at no extra cost to the Medi9 care program. 

10 (2) The care given at adult day services centers 

11 under an interdisciplinary team provides seniors, 

12 people with disabilities, and their familial caregivers 

13 with more care hours and additional services that 

14 are critical to keeping patients healthier and in the 

15 homes of the patients instead of in a nursing home, 

16 and reduces the risk of hospital admission or read17 mission. 

18 SEC. 3. MEDICARE COVERAGE OF CERTIFIED ADULT DAY 

19 SERVICES. 

20 (a) MEDICARE CERTIFIED ADULT DAY SERVICES

21 BENEFIT.— 

22 (1) DEFINITION.—Section 1861 of the Social 

23 Security Act (42 U.S.C. 1395x) is amended by add24 ing at the end the following new subsection: 

25 ‘‘(iii) CERTIFIED ADULT DAY SERVICES; ADULT DAY

26 SERVICES PROVIDER; CERTIFIED ADULT DAY SERVICES


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1 CENTER; POST-INSTITUTIONAL CERTIFIED ADULT DAY

2 SERVICES; CERTIFIED ADULT DAY SERVICES SPELL OF

3 ILLNESS.—(1)(A) The term ‘certified adult day services’ 

4 means, subject to paragraph (4), the items and services 

5 described in subparagraph (B) that are furnished to an 

6 individual who is under the care of a physician— 

7 ‘‘(i) by an adult day services provider (as 

8 defined in paragraph (2)) or by another entity 

9 under an arrangement with such an adult day 

10 services provider to provide such services; 

11 ‘‘(ii) in accordance with a plan (for fur12 nishing such items and services to such indi13 vidual) approved and periodically reviewed by 

14 such physician; and 

15 ‘‘(iii) in a certified adult day services cen16 ter (as defined in paragraph (3)). 

17 ‘‘(B) For purposes of subparagraph (A), the items 

18 and services described in this subparagraph are the fol19 lowing: 

20 ‘‘(i) Part-time or intermittent services (as de21 fined in subparagraph (C)(i)) provided by or under 

22 the supervision of a registered professional nurse. 

23 ‘‘(ii) Physical or occupational therapy or 

24 speech-language pathology services, or any combina25 tion of such services. 


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1 ‘‘(iii) Medical social services under the direction 

2 of a physician. 

3 ‘‘(iv) Nutritional meals, including special diets, 

4 as ordered by a physician. 

5 ‘‘(v) A program of supervised activities (that 

6 meets such criteria as the Secretary determines ap7 propriate) designed to promote physical and mental 

8 health that are furnished in a group setting for a pe9 riod of not fewer than 4 and not greater than 8 

10 hours per day. 

11 ‘‘(vi) A medication management program (as 

12 defined in subparagraph (C)(ii)). 

13 ‘‘(vii) Medical supplies (including catheters, 

14 catheter supplies, ostomy bags, and supplies related 

15 to ostomy care, and a covered osteoporosis drug (as 

16 defined in subsection (kk)), but excluding other 

17 drugs and biologicals) and durable medical equip18 ment. 

19 ‘‘(viii) Transportation of the individual de20 scribed in subparagraph (A) to and from a certified 

21 adult day services center in connection with the pro22 vision of an item or service described in a previous 

23 provision of this subparagraph. 

24 ‘‘(C)(i) For purposes of subparagraph (B)(i), the 

25 term ‘part-time or intermittent services’ means certified 


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1 adult day services furnished any number of days per week 

2 as long as such services are furnished fewer than 8 hours 

3 each day. For purposes of sections 1814(a)(2)(C) and 

4 1835(a)(2)(A), insofar as such respective section relates 

5 to certified adult day services, ‘intermittent’ means cer6 tified adult day services that are either provided or needed 

7 on fewer than 7 days each week, or less than 8 hours of 

8 each day for periods of 21 days or less (with extensions 

9 in exceptional circumstances when the need for additional 

10 care is finite and predictable). 

11 ‘‘(ii) For purposes of subparagraph (B)(vi), the term 

12 ‘medication management program’ means a program of 

13 education and services (that meets such criteria as the 

14 Secretary determines appropriate) to minimize— 

15 ‘‘(I) unnecessary or inappropriate use of pre16 scription drugs; and 

17 ‘‘(II) adverse events due to unintended prescrip18 tion drug-to-drug interactions. 

19 ‘‘(2) The term ‘adult day services provider’ means a 

20 provider of home and community-based services that is ap21 proved in the applicable State to provide long-term serv22 ices and supports, which may include nursing care, phys23 ical therapy, occupational therapy, social work services, 

24 transportation, and personal care services. 


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1 ‘‘(3) The term ‘certified adult day services center’ 

2 means a facility— 

3 ‘‘(A) of a public agency or private organization, 

4 or a subdivision of such an agency or organization, 

5 that— 

6 ‘‘(i) is primarily engaged in providing an 

7 interdisciplinary approach that includes skilled 

8 nursing services and other therapeutic services 

9 directly; 

10 ‘‘(ii) has policies, established by a group of 

11 professional personnel (associated with the 

12 agency or organization), including one or more 

13 physicians and one or more registered profes14 sional nurses, to govern the services (referred to 

15 in subparagraph (A)) which it provides, and 

16 provides for supervision of such services; 

17 ‘‘(iii) maintains clinical records on all pa18 tients; 

19 ‘‘(iv) in the case of an agency or organiza20 tion in any State in which State or applicable 

21 local law provides for the licensing or certifi22 cation of agencies or organizations of this na23 ture, (i) is licensed or certified pursuant to such 

24 law, or (ii) is approved, by the agency of such 

25 State or locality responsible for licensing or cerVerDate Mar 15 2010 02:36 Oct 25, 2013 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3334.IH H3334

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1 tifying agencies or organizations of this nature, 

2 as meeting the standards established for such 

3 licensing or certification; 

4 ‘‘(v) is licensed or certified by the State in5 volved or accredited as meeting requirements, 

6 including under section 1865, through a nation7 ally recognized accrediting agency that is recog8 nized by the Secretary; 

9 ‘‘(vi) has in effect an overall plan and 

10 budget that meets the requirements of sub11 section (z); 

12 ‘‘(vii) meets applicable conditions of par13 ticipation under section 1891(a) (or similar 

14 conditions specified by the Secretary as applica15 ble to such an agency or organization) and such 

16 other conditions of participation as the Sec17 retary may find necessary in the interest of the 

18 health and safety of individuals who are fur19 nished services by such agency or organization; 

20 and 

21 ‘‘(viii) meets such additional requirements 

22 (including conditions relating to bonding or es23 tablishing of escrow accounts as the Secretary 

24 finds necessary for the financial security of the 

25 program) as the Secretary finds necessary for 


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1 the effective and efficient operation of the pro2 gram; 

3 ‘‘(B) at which such agency or organization pro4 vides for items and services described in paragraph 

5 (1)(B); and 

6 ‘‘(C) that complies with all applicable State and 

7 local building codes, fire codes, zoning laws, and 

8 State licensing building standards that apply to a 

9 State licensed or certified or nationally accredited 

10 adult day center, and in States where there are no 

11 State licensing building standards for adult day cen12 ters, building standards based on the standards 

13 adopted by a nationally recognized accrediting agen14 cy that is recognized by the Secretary and applies to 

15 such a center standards that are comparable to the 

16 requirements applied to a skilled nursing facility 

17 pursuant to section 1819(d)(2)(B). 

18 ‘‘(4) For purposes of paragraph (1)(A), an item or 

19 service furnished to an individual, with respect to a period, 

20 shall not be considered an adult day service if— 

21 ‘‘(A) the individual is— 

22 ‘‘(i) concurrently receiving similar skilled 

23 services under a State plan under section 

24 1905(a) or under a home and community-based 

25 waiver authorized for a State under section 


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1 1115, under subsection (c) or (d) of section 

2 1915, under a State plan amendment under 

3 subsection (i) of section 1915, or under section 

4 1902(a)(10)(D); and 

5 ‘‘(ii) receiving such item or service during 

6 such period under such State plan, waiver, 

7 amendment, or respective section; or 

8 ‘‘(B) the individual is receiving such item or 

9 service during such period pursuant to a plan of 

10 care from a home health agency under section 

11 1861(m). 

12 ‘‘(5) Nothing in this subsection shall be construed as 

13 prohibiting a home health agency from— 

14 ‘‘(A) establishing a State licensed or certified or 

15 nationally accredited certified adult day services cen16 ter and furnishing certified adult day services; or 

17 ‘‘(B) providing services under arrangements 

18 with such a center. 

19 ‘‘(6) The term ‘post-institutional certified adult day 

20 services’ means certified adult day services furnished to 

21 an individual— 

22 ‘‘(A) after discharge from a hospital or critical 

23 access hospital in which the individual was an inpa24 tient for not less than 3 consecutive days before 

25 such discharge if such certified adult day services 


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1 were initiated within 14 days after the date of such 

2 discharge; or 

3 ‘‘(B) after discharge from a skilled nursing fa4 cility in which the individual was provided post-hos5 pital extended care services if such certified adult 

6 day services were initiated within 14 days after the 

7 date of such discharge. 

8 ‘‘(7) The term ‘certified adult day services spell of 

9 illness’ with respect to any individual means a period of 

10 consecutive days— 

11 ‘‘(A) beginning with the first day (not included 

12 in a previous certified adult day services spell of ill13 ness)— 

14 ‘‘(i) on which such individual is furnished 

15 post-institutional certified adult day services; 

16 and 

17 ‘‘(ii) which occurs in a month for which 

18 the individual is entitled to benefits under part 

19 A; and 

20 ‘‘(B) ending with the close of the first period of 

21 60 consecutive days thereafter on each of which the 

22 individual is neither an inpatient of a hospital or 

23 critical access hospital nor an inpatient of a facility 

24 described in section 1819(a)(1) or subsection (y)(1) 


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1 nor provided home health services or certified adult 

2 day services.’’. 

3 (2) INCLUSION UNDER PART B BENEFIT.—Sec4 tion 1832(a)(2) of the Social Security Act (42 

5 U.S.C. 1395k(a)(2)) is amended— 

6 (A) in subparagraph (I), by striking at the 

7 end ‘‘and’’; 

8 (B) in subparagraph (J), by striking at the 

9 end the period and inserting ‘‘; and’’; and 

10 (C) by adding at the end the following new 

11 subparagraph: 

12 ‘‘(K) certified adult day services (as de13 fined in section 1861(iii)(1)(A)).’’. 

14 (3) INCLUSION UNDER PART A BENEFIT.—Sec15 tion 1812(a) of the Social Security Act is amend16 ed— 

17 (A) in paragraph (4), by striking at the 

18 end ‘‘and’’; 

19 (B) in paragraph (5), by striking the pe20 riod at the end and inserting ‘‘; and’’; and 

21 (C) by adding at the end the following new 

22 paragraph: 

23 ‘‘(6) in the case of individuals not enrolled in 

24 part B, certified adult day services (as defined in 

25 paragraph (1)(A) of section 1861(iii)), and in the 


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1 case of individuals so enrolled, post-institutional cer2 tified adult day services (as defined in paragraph (6) 

3 of such section) furnished during a certified adult 

4 day services spell of illness (as defined in paragraph 

5 (7) of such section) for up to 100 visits during such 

6 spell of illness.’’. 

7 (b) PAYMENT OF CLAIMS REQUIREMENTS FOR HOME

8 HEALTH SERVICES APPLIED TO CERTIFIED ADULT DAY

9 SERVICES.— 

10 (1) PART A.—Section 1814(a)(2)(C) of the So11 cial Security Act (42 U.S.C. 1395f(a)(2)(C)) is 

12 amended by inserting ‘‘or certified adult day serv13 ices’’ after each occurrence of ‘‘home health serv14 ices’’. 

15 (2) PART B.—Section 1835(a)(2)(A) of the So16 cial Security Act (42 U.S.C. 1395n(a)(2)(A)) is 

17 amended— 

18 (A) in the matter preceding clause (i), by 

19 inserting ‘‘or certified adult day services (as de20 fined in section 1861(iii)(1)(A))’’ after ‘‘home 

21 health services’’; and 

22 (B) in clause (i), by inserting ‘‘or certified 

23 adult day services’’ after ‘‘home health serv24 ices’’. 

25 (c) CONFORMING AMENDMENTS.— 


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1 (1) INTERACTION WITH COVERAGE OF HOME

2 HEALTH SERVICES.—Section 1861(m) of the Social 

3 Security Act (42 U.S.C. 1395x(m)) is amended by 

4 adding at the end the following new sentence: ‘‘An 

5 individual described in this subsection, with respect 

6 to home health services furnished during a period, 

7 shall not include an individual who is receiving com8 parable certified adult day services (as defined in 

9 section 1861(iii)(1)) during such period.’’. 

10 (2) INTERMITTENT SERVICES.—Section 

11 1861(m) of the Social Security Act (42 U.S.C. 

12 1395x(m)) is amended in the last sentence by insert13 ing ‘‘insofar as such respective section relates to 

14 home health services,’’ after ‘‘section 

15 1835(a)(2)(A),’’. 

16 (3) INSTITUTIONAL PLANNING REQUIRE17 MENT.—Section 1861(z) of the Social Security Act 

18 (42 U.S.C. 1395x(z)) is amended in the matter pre19 ceding paragraph (1), by striking ‘‘or home health 

20 agency’’ and inserting ‘‘home health agency, or cer21 tified adult day services center’’. 

22 (4) INCLUSION AS PROVIDER OF SERVICES.— 

23 Section 1861(u) of the Social Security Act (42 

24 U.S.C. 1395x(u)) is amended by inserting ‘‘certified 


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1 adult day services center,’’ after ‘‘home health agen2 cy,’’. 

3 (d) PAYMENT FOR CERTIFIED ADULT DAY SERVICES

4 UNDER THE HOME HEALTH PROSPECTIVE PAYMENT

5 SYSTEM.—Section 1895 of the Social Security Act (42 

6 U.S.C. 1395fff) is amended by adding at the end the fol7 lowing new subsection: 

8 ‘‘(f) APPLICATION OF HOME HEALTH PROSPECTIVE

9 PAYMENT SYSTEM TO CERTIFIED ADULT DAY SERV10 ICES.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall, in ac12 cordance with this subsection, develop a methodology 

13 under which the fee schedule and provisions under 

14 this section shall apply to certified adult day services 

15 (as defined in section 1861(iii)(1)) in a similar man16 ner to which such schedule and provisions apply to 

17 home health services. 

18 ‘‘(2) PAYMENT RATE DETERMINATION AND

19 LIMITATIONS.—Under such methodology, the fol20 lowing shall apply, with respect to certified adult day 

21 services furnished to an individual during a period 

22 specified by the Secretary under a plan of care es23 tablished under section 1861(iii) for which payment 

24 may be made under this title: 


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1 ‘‘(A) DETERMINATION OF COMPONENTS.— 

2 The Secretary shall determine each component 

3 (as defined by the Secretary) of such certified 

4 adult day services. 

5 ‘‘(B) ESTIMATION OF PAYMENT

6 AMOUNT.—The Secretary shall estimate the 

7 amount that would otherwise be payable under 

8 this section for the components of services de9 termined under subparagraph (A) if such serv10 ices were furnished by a home health agency 

11 (or, if such component or service would not oth12 erwise be so payable under this section if so 

13 furnished, the amount that would be payable 

14 under this section for a comparable home 

15 health service furnished by a home health agen16 cy) during such period. 

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

18 amount payable under this section for such cer19 tified adult day services furnished to such indi20 vidual during such period shall be 98 percent of 

21 the amount estimated to be payable for such 

22 services (or comparable services) under sub23 paragraph (B) for such period. 

24 ‘‘(D) LIMITATION.—No payment may be 

25 made under this section for certified adult day 


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1 services described in clauses (iv) through (vi) 

2 and (ix) of section 1861(iii)(1)(A). 

3 ‘‘(3) LIMITATION ON BALANCE BILLING.—A 

4 certified adult day services center shall accept as 

5 payment in full for certified adult day services de6 scribed in clauses (i) through (iii), (vii) through 

7 (viii), and (x) through (xii) of section 1861(iii)(1)(A) 

8 furnished by the center to an individual entitled to 

9 benefits under this title the amount of payment pro10 vided under this section for home health services 

11 consisting of items and services described in such re12 spective clauses.’’. 

13 (e) CONSOLIDATED BILLING.—Section 1862(a) of 

14 the Social Security Act (42 U.S.C. 1395y(a)) is amend15 ed— 

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

17 (24); 

18 (2) by striking the period at the end of para19 graph (25) and inserting, ‘‘or’’; and 

20 (3) by inserting after paragraph (25) the fol21 lowing new paragraph: 

22 ‘‘(26) which are certified adult day services for 

23 which payment may be made under section 1895(f) 

24 and which are furnished to an individual by a State 

25 licensed or certified or nationally accredited certified 


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1 adult day services center pursuant to a plan of care 

2 established under section 1861(iii) with respect to 

3 such services, by an entity other than such facility, 

4 unless the services are furnished under arrange5 ments (as defined in section 1861(w)(1)) with the 

6 entity made by such facility.’’. 

7 (f) TEMPORARY INCREASE FOR CERTIFIED ADULT

8 DAY SERVICES FURNISHED IN A RURAL AREA.— 

9 (1) IN GENERAL.—With respect to episodes and 

10 visits ending on or after January 1, 2014, and be11 fore January 1, 2016, in the case of certified adult 

12 day services (as defined in section 1861(iii)(1)(A) of 

13 the Social Security Act, as added by subsection (a)), 

14 furnished in a rural area (as defined in section 

15 1886(d)(2)(D) of such Act (42 U.S.C. 

16 1395ww(d)(2)(D))), the Secretary of Health and 

17 Human Services shall increase the payment amount 

18 otherwise made under section 1895 of such Act (42 

19 U.S.C. 1395fff) for such services by 3 percent. 

20 (2) WAIVING BUDGET NEUTRALITY.—The Sec21 retary shall not reduce the standard prospective pay22 ment amount (or amounts) under section 1895 of 

23 the Social Security Act (42 U.S.C. 1395fff) applica24 ble to such certified adult day services furnished 


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1 during a period to offset the increase in payments 

2 resulting from the application of paragraph (1). 

3 (3) NO EFFECT ON SUBSEQUENT PERIODS.— 

4 The payment increase provided under paragraph (1) 

5 for a period under such paragraph— 

6 (A) shall not apply to episodes and visits 

7 ending after such period; and 

8 (B) shall not be taken into account in cal9 culating the payment amounts applicable for 

10 episodes and visits occurring after such period. 

11 (g) ADULT DAY SERVICES PROVIDER TECHNICAL

12 ASSISTANCE.—In order to facilitate the development of 

13 certified adult day services under title XVIII of the Social 

14 Security Act, the Secretary of Health and Human Services 

15 shall, as deemed necessary by the Secretary, provide adult 

16 day services providers (as defined in section 1861(iii)(2) 

17 of such Act) with technical assistance, consultation, tools, 

18 and other resources to assist them with the application 

19 process and implementation of certified adult day services 

20 (as defined in such section). 

21 (h) EFFECTIVE DATE.—The amendments made by 

22 this section shall apply to items and services furnished on 

23 or after January 1, 2014. 

Æ 


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