I
107TH CONGRESS
1ST SESSION
H. R. 3585
To amend title XVIII of the Social Security Act to provide for coverage
under the Medicare Program of substitute adult day care services.
IN THE HOUSE OF REPRESENTATIVES
DECEMBER 20, 2001
Mr. KLECZKA (for himself and Mr. STARK) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 under the Medicare Program of substitute
adult day care services.
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 Substitute
Adult Day Care Services Act of 2001’’.
SEC. 2. FINDINGS.
Congress makes the following findings:
(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
amended—
(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
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
under such plan of care is equal to the amount
estimated to be payable under subparagraph
(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(ww)(1)(B).
‘‘(B) LIMITATION ON BALANCE BILLING.—
An adult day care facility shall accept as pay-
ment in full for substitute adult day care serv-
ices (including those services described in
clauses 
(ii) 
through 
(v) 
of 
section
1861(ww)(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.’’.
(c) CONSOLIDATED BILLING.—Section 1862(a) of
such Act (42 U.S.C. 1395y(a)), is amended—
(1) by striking ‘‘or’’ at the end of paragraph
(20),
(2) by striking the period at the end of para-
graph (21) and inserting ‘‘; or’’, and
(3) by inserting after paragraph (21) the fol-
lowing new paragraph:
‘‘(22) 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 substitute adult day care facility pursuant to a
plan of care established under section 1861(m) with
respect to such services, by an entity other than the
substitute adult day care facility, unless the services
are furnished under arrangements (as defined in sec-
tion 1861(w)(1)) with the entity made by the sub-
stitute adult day care facility.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 2002.
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