(1) Adult day care offers 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 who 
are frail, physically challenged, or cognitively im-
paired at no extra cost to the medicare program. 
(2) The care given at adult day care centers 
provides seniors and their familial caregivers support 
that is critical to keeping the senior in the family 
home. 
(3) More than 22,000,000 families in the 
United States serve as caregivers for aging or ailing 
seniors, and nearly 1 in 4 American families provide 
close to 80 percent of the care to individuals requir-
ing long-term care. 
(4) Nearly 75 percent of those actively pro-
viding such care are women who also maintain other 
responsibilities, such as working outside of the home 
and raising young children. 
(5) The average loss of income to these care-
givers has been shown to be $659,130 in wages, pen-
sion, and Social Security benefits. 
(6) The loss in productivity in United States 
businesses attributable to caregivers for aging or ail-
ing 
seniors 
ranges 
from 
$11,000,000,000 
to 
$29,000,000,000 annually. 
(7) Adult day care centers, located in every 
State in the United States and the District of Co-
lumbia, serve as quality health options to treat our 
Nation’s elderly population, which is about to dra-
matically 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.—
(1) IN GENERAL.—Section 1861(m) of the So-
cial Security Act (42 U.S.C. 1395x(m)) is amend-
ed—
(A) in the matter preceding paragraph (1), 
by inserting ‘‘or paragraph (8)’’ after ‘‘para-
graph (7)’’; 
(B) in paragraph (6), by striking ‘‘and’’ at 
the end; 
(C) in paragraph (7), by adding ‘‘and’’ at 
the end; and 
(D) by inserting after paragraph (7), the 
following new paragraph:
‘‘(8) substitute adult day care services (as de-
fined in subsection (ww));’’. 
(2) SUBSTITUTE ADULT DAY CARE SERVICES 
DEFINED.—Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
‘‘Substitute Adult Day Care Services; Adult Day Care 
Facility 
‘‘(ww)(1)(A) The term ‘substitute adult day care 
services’ means the items and services described in sub-
paragraph (B) that are furnished to an individual by an 
adult day care facility as a part of a plan under subsection 
(m) that substitutes such services for a portion of the 
items and services described in subparagraph (B)(i) fur-
nished by a home health agency under the plan, as deter-
mined by the physician establishing the plan. 
‘‘(B) The items and services described in this sub-
paragraph are the following items and services: 
‘‘(i) Items and services described in paragraphs 
(1) through (7) of subsection (m). 
‘‘(ii) Transportation of the individual to and 
from the adult day care facility in connection with 
any such item or service. 
‘‘(iii) Meals.
‘‘(iv) A program of supervised activities (that 
meets such criteria as the Secretary determines ap-
propriate) designed to promote physical and mental 
health that are furnished to the individual by the 
adult day care facility in a group setting for a period 
of not fewer than 4 and not greater than 12 hours 
per day. 
‘‘(v) A medication management program (as de-
fined in subparagraph (C)). 
‘‘(C) For purposes of subparagraph (B)(v), the term 
‘medication management program’ means a program of 
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 ‘adult day care facility’ means a public agency or 
private organization, or a subdivision of such an agency 
or organization, 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); and 
‘‘(iv) meets the requirements of paragraphs (2) 
through (8) of subsection (o). 
‘‘(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 an adult day care 
facility. 
‘‘(D) Nothing in this paragraph shall be construed 
as prohibiting a home health agency from—
‘‘(i) establishing a substitute adult day care fa-
cility; or 
‘‘(ii) providing services under arrangements 
with a substitute adult day care 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)’’. 
(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—
(1) in the first sentence of paragraph (b)(1), by 
inserting after ‘‘home health services’’ the following: 
‘‘or home health services consisting of substitute 
adult day care services.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(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(ww)(1)(B)(i)) furnished to 
an individual under the plan of care established