I
107TH CONGRESS
2D SESSION
H. R. 4153
To amend title XVIII of the Social Security Act to direct the Secretary
of Health and Human Services to carry out a demonstration program
under the Medicare Program to examine the clinical and cost effective-
ness of providing medical adult day care center services to Medicare
beneficiaries.
IN THE HOUSE OF REPRESENTATIVES
APRIL 10, 2002
Mr. LEWIS of Kentucky 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 with-
in the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to direct
the Secretary of Health and Human Services to carry
out a demonstration program under the Medicare Pro-
gram to examine the clinical and cost effectiveness of
providing medical adult day care center services to Medi-
care beneficiaries.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. MEDICARE MEDICAL ADULT DAY CARE SERV-
ICES DEMONSTRATION PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by inserting after section 1895
the following new section:
‘‘MEDICAL ADULT DAY CARE SERVICES DEMONSTRATION
PROGRAM
‘‘SEC. 1895A. (a) ESTABLISHMENT.—Subject to the
succeeding provisions of this section, the Secretary shall
establish a demonstration program under which the Sec-
retary shall reimburse a qualified provider of services for
medical adult day care services furnished as part of a plan
of care for home health services established for a medicare
beneficiary if elected by the beneficiary. Requirements ap-
plicable to eligibility for receipt of home health services
shall apply for medical adult day care services, including
requirements for the beneficiary to be homebound.
‘‘(b) DEMONSTRATION PROJECT SITES.—The pro-
gram established under this section shall be conducted in
States selected by the Secretary that license or certify pro-
viders of services that furnish medical adult day care serv-
ices, and shall be conducted in no more than 5 such
States. Of the States selected by the Secretary, one shall
include a State that has, as a percentage of its resident
population, the 1 of the 5 highest percentages of medicare
beneficiaries residing in the State.
‘‘(c) DURATION.—The Secretary shall conduct the
demonstration program for a period of 4 and one half
years.
‘‘(d) VOLUNTARY PARTICIPATION.—Participation of
medicare beneficiaries in the demonstration program shall
be voluntary. The total number of such beneficiaries that
may participate in the project at any given time may not
exceed 15,000. Medicare beneficiaries with a secondary di-
agnosis or comorbidity of Alzheimer’s or Parkinson’s dis-
ease shall be given preference in determining who may
participate in the demonstration project.
‘‘(e) PAYMENT.—Payment to qualified providers of
services for medical adult day care services furnished
under the demonstration project shall be equal to 95 per-
cent of the rate that would otherwise apply under section
1895 for home health services furnished.
‘‘(f) PROVISIONS RELATING TO PROVIDERS.—
‘‘(1) LIMITATION ON NUMBER OF PROVIDERS
AND SERVICE AREAS.—Not more than 25 qualified
providers of services may furnish medical adult day
care services under the demonstration project, and
not more than 17 such providers may have as its
primary service area an urban area. Qualified pro-
viders of services that are under common ownership
or control of an organization that furnish medical
adult day care services under the project shall all be
treated, for purposes of the limitation of this para-
graph, as a single qualified provider of services.
‘‘(2) PREFERENCE
TO
CERTAIN
CLASSES
OF
PROVIDERS.—In selecting qualified providers of serv-
ices to furnish medical adult day care services under
the demonstration program, the Secretary shall give
preference to those providers that are home health
agencies, as defined in section 1861(o), under com-
mon ownership or control of an organization that
proposes to furnish medical adult day care services
in a service area that encompasses more than one
State.
‘‘(g) EVALUATION
AND REPORT.—The Secretary
shall conduct an evaluation of the clinical and cost effec-
tiveness of the demonstration program under this section.
Not later 3 years after the commencement of the program,
the Secretary shall submit to Congress a report on the
evaluation, and shall include in the report the following:
‘‘(1) An analysis of the patient outcomes and
costs of furnishing care to the medicare beneficiaries
participating in the program as compared to such
outcomes and costs to beneficiaries receiving only
home health services for the same health conditions.
‘‘(2) Such recommendations regarding the ex-
tension, expansion, or termination of the program as
the Secretary determines appropriate.
In conducting the evaluation and analysis under this sub-
section, the Secretary shall utilize data collected through
the OASIS system referred to in subsection (e), and may
collect such supplemental data from qualified providers of
services participating in the demonstration program as the
Secretary determines appropriate.
‘‘(h) DEFINITIONS.—In this section:
‘‘(1) QUALIFIED PROVIDER OF SERVICES.—The
term ‘qualified provider of services’ means, with re-
spect to the furnishing of medical adult day care
services—
‘‘(A) a public agency or private organiza-
tion, or a subdivision of such an agency or or-
ganization, that—
‘‘(i) is engaged in providing skilled
nursing services and other therapeutic
services directly or under arrangement
with a home health agency;
‘‘(ii) meets such standards established
by the Secretary to assure quality of care
and such other requirements as the Sec-
retary finds necessary in the interest of the
health and safety of individuals who are
furnished services in the facility;
‘‘(iii) provides the medical adult day
care 
services 
described 
in 
paragraph
(2)(B);
‘‘(iv) meets the requirements of para-
graphs (2) through (8) of section 1861(o),
but the Secretary may waive the require-
ment for a surety bond under paragraph
(7) of such section in the same manner as
is provided under such section; and
‘‘(v) has been licensed or certified by
a State to furnish medical adult day care
services in the State for a continuous pe-
riod of not less than 24 months; or
‘‘(B) a home health agency (as defined in
section 1861(o)), either directly or under ar-
rangements with an agency or organization de-
scribed in subparagraph (A) that has been li-
censed or certified by a State to furnish home
health services in the State for a continuous pe-
riod of not less than 24 months.
‘‘(2) MEDICAL ADULT DAY CARE SERVICES.—
‘‘(A) IN
GENERAL.—The term ‘medical
adult day care services’ means the items and
services described in subparagraph (B) that are
furnished to a medicare beneficiary by a quali-
fied provider of services as a part of a plan
under section 1861(m) that describes the home
health service items and services that are to be
furnished in the individual’s residence and the
medical adult day care items and services de-
scribed in subparagraph (B) that are furnished
by the qualified provider of services in a med-
ical adult day care setting, as determined by
the physician establishing the plan pursuant to
a comprehensive patient assessment conducted
by the qualified provider of services and ap-
proved by the physician.
‘‘(B) ITEMS DESCRIBED.—The items and
services described in this subparagraph are the
following:
‘‘(i) Home health service items and
services 
described 
in 
paragraphs 
(1)
through (7) of section 1861(m).
‘‘(ii) Transportation of the individual
to and from the qualified provider of serv-
ices in connection with any such item or
service.
‘‘(iii) Meals.
‘‘(iv) A program of supervised activi-
ties (that meets such criteria as the Sec-
retary determines appropriate) designed to
promote physical and mental health that
are furnished to the individual by the
qualified provider of services in a group
setting.
‘‘(3) 
MEDICARE
BENEFICIARY.—The 
term
‘medicare beneficiary’ means an individual entitled
to benefits under part A of this title, enrolled under
part B of this title, or both.’’.
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