I 
111TH CONGRESS 
1ST SESSION H. R. 3043 
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 HOUSE OF REPRESENTATIVES 
JUNE 25, 2009 
Ms. LINDA T. SA´NCHEZ of California 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 de-
termined 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 substitute adult day care services under 
the Medicare Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Adult Day 
Care Services Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
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(1) Adult day care can offer services, including 
medical care, rehabilitation therapies, dignified as-
sistance with activities of daily living, nutrition ther-
apy, health monitoring, social interaction, stimu-
lating activities, and transportation, to seniors and 
people with disabilities at no extra cost to the Medi-
care Program. 
(2) The care given at adult day care facilities 
provides seniors, people with disabilities, and their 
familial caregivers with more care hours and addi-
tional services that are critical to keeping patients 
healthier and in the home. 
(3) More than 50,000,000 people provide care 
for a chronically ill, disabled or aged family member 
or friend during any given year. In 2002, almost 
half of workers in the United States provided some 
form of caregiving. 
(4) Caregivers, the majority of whom are 
women, provide an estimated $306,000,000,000 in 
‘‘free’’ services annually. The pool of potential family 
caregivers is dwindling, from 11 potential caregivers 
for each person needing care today to a projected 4 
to 1 ratio in 2050. 
(5) Caregiving families tend to have lower in-
comes than non-caregiving families, and the average 
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intensive caregiver loses $659,139 in wages, pension 
benefits, and Social Security benefits over a lifetime. 
At least 6 out of 10 employed caregivers reported 
that they had made some work-related adjustments 
as a result of their caregiving responsibilities, and 
an estimated 9 percent of caregivers left the work-
place altogether as a result of their caregiving re-
sponsibilities. 
(6) The total estimated cost to employers for 
full-time employees with intense caregiving respon-
sibilities is $17,100,000,000. The total estimated 
cost to employers for all full-time, employed care-
givers is $33,600,000,000 annually. 
(7) Adult day care centers, which are located in 
every State in the United States and the District of 
Columbia, serve as an effective source of relief to fa-
milial caregivers and provide quality health options 
to treat our Nation’s elderly population, which is 
about to dramatically increase with the aging of the 
baby boomer generation. 
SEC. 3. MEDICARE COVERAGE OF SUBSTITUTE ADULT DAY 
CARE SERVICES. 
(a) SUBSTITUTE ADULT DAY CARE SERVICES BEN-
EFIT.— 
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education and services (that meets such criteria as the 
Secretary determines appropriate) to minimize— 
‘‘(i) unnecessary or inappropriate use of pre-
scription drugs; and 
‘‘(ii) adverse events due to unintended prescrip-
tion drug-to-drug interactions. 
‘‘(2)(A) Except as provided in subparagraph (B), the 
term ‘State licensed or certified or nationally accredited 
adult day care facility’ means a public agency or private 
organization, or a subdivision of such an agency or organi-
zation, 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 Secretary finds necessary in the 
interest of the health and safety of individuals who 
are furnished services in the facility; 
‘‘(iii) provides the items and services described 
in paragraph (1)(B); 
‘‘(iv) subject to subparagraph (B), meets the 
requirements of paragraphs (2) through (8) of sub-
section (o); and 
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‘‘(v) if the agency, organization, or subdivision 
is in a State not described in subsection (o)(4), is 
accredited through a nationally recognized accred-
iting agency. 
‘‘(B) The Secretary may waive the requirement of a 
surety bond under paragraph (7) of subsection (o) in the 
case of an agency or organization that provides a com-
parable surety bond under State law. 
‘‘(C) For purposes of payment for home health serv-
ices consisting of substitute adult day care services fur-
nished under this title, any reference to a home health 
agency is deemed to be a reference to a State licensed or 
certified or nationally accredited adult day care facility. 
‘‘(D) Nothing in this paragraph shall be construed 
as prohibiting a home health agency from— 
‘‘(i) establishing a State licensed or certified or 
nationally accredited adult day care facility; or 
‘‘(ii) providing services under arrangements 
with such a facility.’’. 
(3) 
CONFORMING
AMENDMENTS.—Sections 
1814(a)(2)(C) and 1835(a)(2)(A)(i) of the Social 
Security 
Act 
(42 
U.S.C. 
1395f(a)(2)(C) 
and 
1395n(a)(2)(A)(i)) are each amended by striking 
‘‘section 1861(m)(7)’’ and inserting ‘‘paragraph (7) 
or (8) of section 1861(m)’’. 
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(b) PAYMENT FOR SUBSTITUTE ADULT DAY CARE 
SERVICES UNDER
THE HOME HEALTH PROSPECTIVE 
PAYMENT SYSTEM.—Section 1895 of the Social Security 
Act (42 U.S.C. 1395fff) is amended by adding at the end 
the following new subsection: 
‘‘(f) PAYMENT RATE AND LIMITATION ON PAYMENT 
FOR SUBSTITUTE ADULT DAY CARE SERVICES.— 
‘‘(1) PAYMENT RATE.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
determine each component (as defined by the 
Secretary) of substitute adult day care services 
(under section 1861(hhh)(1)(B)(i)) furnished to 
an individual under the plan of care established 
under section 1861(m) with respect to such 
services. 
‘‘(B) 
ESTIMATION
OF
PAYMENT 
AMOUNT.—The Secretary shall estimate the 
amount that would otherwise be payable under 
this section for all home health services under 
that plan of care other than substitute adult 
day care services for a week or other period 
specified by the Secretary. 
‘‘(C) AMOUNT
OF
PAYMENT.—The total 
amount payable for home health services con-
sisting of substitute adult day care services 
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under such plan of care is 98 percent of the 
amount estimated to be payable under subpara-
graph (B) furnished under the plan by a home 
health agency. 
‘‘(2) LIMITATIONS.— 
‘‘(A) IN GENERAL.—With respect to home 
health services consisting of substitute adult 
day care services, no payment may be made 
under this section for home health services con-
sisting of substitute adult day care services de-
scribed in clauses (ii) through (v) of section 
1861(hhh)(1)(B). 
‘‘(B) LIMITATION ON BALANCE BILLING.— 
A State licensed or certified or nationally ac-
credited adult day care facility shall accept as 
payment in full for substitute adult day care 
services (including those services described in 
clauses 
(ii) 
through 
(v) 
of 
section 
1861(hhh)(1)(B)) furnished by the facility to 
an individual entitled to benefits under this title 
the amount of payment provided under this sec-
tion for home health services consisting of sub-
stitute adult day care services.’’. 
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(c) CONSOLIDATED BILLING.—Section 1862(a) of 
the Social Security Act (42 U.S.C. 1395y(a)) is amend-
ed— 
(1) by striking ‘‘or’’ at the end of paragraph 
(23); 
(2) by striking the period at the end of para-
graph (24) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (24) the fol-
lowing new paragraph: 
‘‘(25) which are substitute adult day care serv-
ices for which payment may be made under section 
1895(f) and which are furnished to an individual by 
a State licensed or certified or nationally accredited 
adult day care facility pursuant to a plan of care es-
tablished under section 1861(m) with respect to 
such services, by an entity other than such facility, 
unless the services are furnished under arrange-
ments (as defined in section 1861(w)(1)) with the 
entity made by such facility.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2010. 
Æ 
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