II

106TH CONGRESS

2D SESSION S. 2826

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

of substitute adult day care services under the medicare program.

IN THE SENATE OF THE UNITED STATES

JUNE 29, 2000

Mr. SANTORUM (for himself and Mr. ROCKEFELLER) introduced the following

bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide

for coverage of substitute adult day care 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 Alternative Act of 2000’’.

6 SEC. 2. FINDINGS.

7 Congress finds that—

8 (1) adult day care offers services, including

9 medical care, rehabilitation therapies, dignified as10 sistance with activities of daily living, social inter-
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1 action, and stimulating activities, to seniors who are

2 frail, physically challenged, or cognitively impaired;

3 (2) access to adult day care services provides

4 seniors and their familial caregivers support that is

5 critical to keeping the senior in the family home;

6 (3) more than 22,000,000 families in the

7 United States serve as caregivers for aging or ailing

8 seniors, nearly 1 in 4 American families, providing

9 close to 80 percent of the care to individuals requir10 ing long-term care;

11 (4) nearly 75 percent of those actively providing

12 such care are women who also maintain other re13 sponsibilities, such as working outside of the home

14 and raising young children;

15 (5) the average loss of income to these care16 givers has been shown to be $659,130 in wages, pen17 sion, and Social Security benefits;

18 (6) the loss in productivity in United States

19 businesses ranges from $11,000,000,000 to

20 $29,000,000,000 annually;

21 (7) the services offered in adult day care facili22 ties provide continuity of care and an important

23 sense of community for both the senior and the care24 giver;
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1 (8) there are adult day care centers in every

2 State in the United States and the District of Co3 lumbia;

4 (9) these centers generally offer transportation,

5 meals, personal care, and counseling in addition to

6 the medical services and socialization benefits of7 fered; and

8 (10) with the need for quality options in how to

9 best care for our senior population about to dramati10 cally increase with the aging of the baby boomer

11 generation, the time to address these issues is now.

12 SEC. 3. COVERAGE OF SUBSTITUTE ADULT DAY CARE SERV13 ICES UNDER MEDICARE.

14 (a) SUBSTITUTE ADULT DAY CARE SERVICES BEN15 EFIT.—

16 (1) IN GENERAL.—Section 1861(m) of the So17 cial Security Act (42 U.S.C. 1395x(m)) is

18 amended—

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

20 by inserting ‘‘or (8)’’ after ‘‘paragraph (7)’’;

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

22 the end;

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

24 the end; and
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1 (D) by inserting after paragraph (7), the

2 following new paragraph:

3 ‘‘(8) substitute adult day care services (as de4 fined in subsection (uu));’’.

5 (2) SUBSTITUTE ADULT DAY CARE SERVICES

6 DEFINED.—Section 1861 of the Social Security Act

7 (42 U.S.C. 1395x) is amended by adding at the end

8 the following new subsection:

9 ‘‘Substitute Adult Day Care Services; Adult Day Care

10 Facility

11 ‘‘(uu)(1)(A) The term ‘substitute adult day care serv12 ices’ means the items and services described in subpara13 graph (B) that are furnished to an individual by an adult

14 day care facility as a part of a plan under subsection (m)

15 that substitutes such services for a portion of the items

16 and services described in subparagraph (B)(i) furnished

17 by a home health agency under the plan, as determined

18 by the physician establishing the plan.

19 ‘‘(B) The items and services described in this sub20 paragraph are the following items and services:

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

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

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

24 from the adult day care facility in connection with

25 any such item or service.
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1 ‘‘(iii) Meals.

2 ‘‘(iv) A program of supervised activities de3 signed to promote physical and mental health and

4 furnished to the individual by the adult day care fa5 cility in a group setting for a period of not fewer

6 than 4 and not greater than 12 hours per day.

7 ‘‘(v) A medication management program (as de8 fined in subparagraph (C)).

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

10 ‘medication management program’ means a program of

11 services, including medicine screening and patient and

12 health care provider education programs, that provides

13 services 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 subparagraphs (B)

19 and (C), the term ‘adult day care facility’ means a public

20 agency or private organization, or a subdivision of such

21 an agency 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;
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1 ‘‘(ii) meets such standards established by the

2 Secretary to ensure 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) Notwithstanding subparagraph (A), the term

11 ‘adult day care facility’ shall include a home health agency

12 in which the items and services described in clauses (ii)

13 through (v) of paragraph (1)(B) are provided by others

14 under arrangements with them made by such agency.

15 ‘‘(C) The Secretary may waive the requirement of a

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

17 case of an agency or organization that provides a com18 parable surety bond under State law.

19 ‘‘(D) For purposes of payment for home health serv20 ices consisting of substitute adult day care services fur21 nished under this title, any reference to a home health

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

23 facility.’’.

24 (3) CONFORMING AMENDMENTS.—Sections

25 1814(a)(2)(C) and 1835(a)(2)(A)(i) of the Social
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1 Security Act (42 U.S.C. 1395f(a)(2)(C);

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

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

4 or (8) of section 1861(m)’’.

5 (b) PAYMENT FOR SUBSTITUTE ADULT DAY CARE

6 SERVICES.—Section 1895 of the Social Security Act (42

7 U.S.C. 1395fff) is amended by adding at the end the fol8 lowing new subsection:

9 ‘‘(e) PAYMENT RATE FOR SUBSTITUTE ADULT DAY

10 CARE SERVICES.—In the case of home health services con11 sisting of substitute adult day care services (as defined

12 in section 1861(uu)), the following rules apply:

13 ‘‘(1) The Secretary shall determine each compo14 nent (as defined by the Secretary) of substitute

15 adult day care services (under section

16 1861(uu)(1)(B)(i)) furnished to an individual under

17 the plan of care established under section 1861(m)

18 with respect to such services.

19 ‘‘(2) The Secretary shall estimate the amount

20 that would otherwise be payable under this section

21 for all home health services under that plan of care

22 other than substitute adult day care services for a

23 week or other period specified by the Secretary.

24 ‘‘(3) The total amount payable for home health

25 services consisting of substitute adult day care serv-
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1 ices under such plan may not exceed 95 percent of

2 the amount estimated to be payable under para3 graph (2) furnished under the plan by a home health

4 agency.

5 ‘‘(4) No payment may be made under this title

6 for home health services consisting of substitute

7 adult day care services described in clauses (ii)

8 through (v) of section 1861(uu)(1)(B).’’.

9 (c) ADJUSTMENT IN CASE OF OVERUTILIZATION OF

10 SUBSTITUTE ADULT DAY CARE SERVICES.—

11 (1) MONITORING EXPENDITURES.—Beginning

12 with fiscal year 2002, the Secretary of Health and

13 Human Services shall monitor the expenditures

14 made under the medicare program under title XVIII

15 of the Social Security Act (42 U.S.C. 1395 et seq.)

16 for home health services (as defined in section

17 1861(m) of such Act (42 U.S.C. 1395x(m))) for the

18 fiscal year, including substitute adult day care serv19 ices under paragraph (8) of such section (as added

20 by subsection (a)), and shall compare such expendi21 tures to expenditures that the Secretary estimates

22 would have been made for home health services for

23 that fiscal year if subsection (a) had not been en24 acted.
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1 (2) REQUIRED REDUCTION IN PAYMENT

2 RATE.—If the Secretary determines, after making

3 the comparison under paragraph (1) and making

4 such adjustments for changes in demographics and

5 age of the medicare beneficiary population as the

6 Secretary determines appropriate, that expenditures

7 for home health services under the medicare pro8 gram, including such substitute adult day care serv9 ices, exceed expenditures that would have been made

10 under such program for home health services for a

11 year if subsection (a) had not been enacted, then the

12 Secretary shall adjust the rate of payment to adult

13 day care facilities so that total expenditures for

14 home health services under such program in a fiscal

15 year does not exceed the Secretary’s estimate of

16 such expenditures if subsection (a) had not been en17 acted.

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

19 this section shall apply to items and services furnished on

20 or after the date on which the prospective payment system

21 for home health services furnished under the medicare

22 program under section 1895 of the Social Security Act (42

23 U.S.C. 1395fff) is established and implemented.

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