I 
109TH CONGRESS 
1ST SESSION H. R. 1981
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 
APRIL 28, 2005
Mr. DOGGETT (for himself, Mr. ANDREWS, Mr. BACA, Mr. BECERRA, Mr. 
BROWN of Ohio, Mr. CARDIN, Mr. CARDOZA, Mr. CONYERS, Mr. 
CUELLAR, Mr. DELAHUNT, Ms. DELAURO, Mr. EVANS, Mr. FILNER, Mr. 
FRANK of Massachusetts, Mr. GONZALEZ, Mr. AL GREEN of Texas, Mr. 
GENE GREEN of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Mr. HINCHEY, 
Mr. HINOJOSA, Mr. HONDA, Mr. INSLEE, Ms. JACKSON-LEE of Texas, 
Mr. JEFFERSON, Ms. EDDIE BERNICE JOHNSON of Texas, Ms. KIL-
PATRICK
of Michigan, Mr. LEWIS
of Georgia, Mr. LYNCH, Mr. 
MCDERMOTT, Mr. MCGOVERN, Mr. GEORGE MILLER of California, Ms. 
MOORE of Wisconsin, Mr. MORAN of Virginia, Mrs. NAPOLITANO, Mr. 
OLVER, Mr. ORTIZ, Mr. PASTOR, Mr. RANGEL, Mr. REYES, Ms. ROYBAL-
ALLARD, Mr. RUSH, Ms. LINDA T. SA´NCHEZ of California, Ms. LORETTA 
SANCHEZ of California, Mr. SANDERS, Ms. SOLIS, Mr. STARK, Mr. 
THOMPSON of Mississippi, Mr. TIERNEY, Mrs. JONES of Ohio, Ms. WAT-
SON, and Mr. WAXMAN) 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 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 Adult Day 
Care Services Act of 2005’’. 
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) One quarter of all workers provide some 
form of elder care for those age 65 and older, and 
by 2007, the number of households involved in 
caregiving to persons age 50 or older could reach 39 
million. 
(4) The pool of potential family caregivers, who 
are primarily women and who provide an estimated
$257,000,000,000 in ‘‘free’’ services annually, is 
dwindling, from 11 potential caregivers for each per-
son 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 
caregiver loses $659,139 in wages, pension benefits, 
and Social Security benefits over a lifetime. 
(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 (bbb));’’. 
(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 
‘‘(bbb)(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(bbb)(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(bbb)(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(bbb)(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 
the Social Security Act (42 U.S.C. 1395y(a)), is amend-
ed—
(1) by striking ‘‘or’’ at the end of paragraph 
(21); 
(2) by striking the period at the end of para-
graph (22) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (22) the fol-
lowing new paragraph: 
‘‘(23) 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, 2006. 
(e) RELATIONSHIP TO DEMONSTRATION PROJECT.—
(1) Notwithstanding subsection (d) of section 703 of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 
2336), the Secretary may terminate the demonstration 
project for medical adult day care services established 
under such section 703, but in no case earlier than the 
date on which the Secretary has fully implemented the 
preceding provisions of this section. The Secretary shall 
ensure that individuals receiving medical adult day care 
services under such demonstration program do not experi-
ence any interruption in the receipt of such services by 
reason of the termination of the demonstration program.
(2) Section 703 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2336) is amended by striking sub-
section (h).
Æ