vision of an item or service described in a previous 
provision of this subparagraph. 
‘‘(C)(i) For purposes of subparagraph (B)(i), the 
term ‘part-time or intermittent services’ means certified 
adult day services furnished any number of days per week 
as long as such services are furnished fewer than 8 hours 
each day. For purposes of sections 1814(a)(2)(C) and 
1835(a)(2)(A), insofar as such respective section relates 
to certified adult day services, ‘intermittent’ means cer-
tified adult day services that are either provided or needed 
on fewer than 7 days each week, or less than 8 hours of 
each day for periods of 21 days or less (with extensions 
in exceptional circumstances when the need for additional 
care is finite and predictable). 
‘‘(ii) For purposes of subparagraph (B)(vi), 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) The term ‘adult day services provider’ means a 
provider of home and community-based services that is ap-
proved in the applicable State to provide long-term serv-
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ices and supports, which may include nursing care, phys-
ical therapy, occupational therapy, social work services, 
transportation, and personal care services. 
‘‘(3) The term ‘certified adult day services center’ 
means a facility— 
‘‘(A) of a public agency or private organization, 
or a subdivision of such an agency or organization, 
that— 
‘‘(i) is primarily engaged in providing an 
interdisciplinary approach that includes skilled 
nursing services and other therapeutic services 
directly; 
‘‘(ii) has policies, established by a group of 
professional personnel (associated with the 
agency or organization), including one or more 
physicians and one or more registered profes-
sional nurses, to govern the services (referred to 
in subparagraph (A)) which it provides, and 
provides for supervision of such services; 
‘‘(iii) maintains clinical records on all pa-
tients; 
‘‘(iv) in the case of an agency or organiza-
tion in any State in which State or applicable 
local law provides for the licensing or certifi-
cation of agencies or organizations of this na-
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ture, (i) is licensed or certified pursuant to such 
law, or (ii) is approved, by the agency of such 
State or locality responsible for licensing or cer-
tifying agencies or organizations of this nature, 
as meeting the standards established for such 
licensing or certification; 
‘‘(v) is licensed or certified by the State in-
volved or accredited as meeting requirements, 
including under section 1865, through a nation-
ally recognized accrediting agency that is recog-
nized by the Secretary; 
‘‘(vi) has in effect an overall plan and 
budget that meets the requirements of sub-
section (z); 
‘‘(vii) meets applicable conditions of par-
ticipation under section 1891(a) (or similar 
conditions specified by the Secretary as applica-
ble to such an agency or organization) and such 
other conditions of participation as the Sec-
retary may find necessary in the interest of the 
health and safety of individuals who are fur-
nished services by such agency or organization; 
and 
‘‘(viii) meets such additional requirements 
(including conditions relating to bonding or es-
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tablishing of escrow accounts as the Secretary 
finds necessary for the financial security of the 
program) as the Secretary finds necessary for 
the effective and efficient operation of the pro-
gram; 
‘‘(B) at which such agency or organization pro-
vides for items and services described in paragraph 
(1)(B); and 
‘‘(C) that complies with all applicable State and 
local building codes, fire codes, zoning laws, and 
State licensing building standards that apply to a 
State licensed or certified or nationally accredited 
adult day center, and in States where there are no 
State licensing building standards for adult day cen-
ters, building standards based on the standards 
adopted by a nationally recognized accrediting agen-
cy that is recognized by the Secretary and applies to 
such a center standards that are comparable to the 
requirements applied to a skilled nursing facility 
pursuant to section 1819(d)(2)(B). 
‘‘(4) For purposes of paragraph (1)(A), an item or 
service furnished to an individual, with respect to a period, 
shall not be considered an adult day service if— 
‘‘(A) the individual is— 
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‘‘(i) concurrently receiving similar skilled 
services under a State plan under section 
1905(a) or under a home and community-based 
waiver authorized for a State under section 
1115, under subsection (c) or (d) of section 
1915, under a State plan amendment under 
subsection (i) of section 1915, or under section 
1902(a)(10)(D); and 
‘‘(ii) receiving such item or service during 
such period under such State plan, waiver, 
amendment, or respective section; or 
‘‘(B) the individual is receiving such item or 
service during such period pursuant to a plan of 
care from a home health agency under section 
1861(m). 
‘‘(5) Nothing in this subsection shall be construed as 
prohibiting a home health agency from— 
‘‘(A) establishing a State licensed or certified or 
nationally accredited certified adult day services cen-
ter and furnishing certified adult day services; or 
‘‘(B) providing services under arrangements 
with such a center. 
‘‘(6) The term ‘post-institutional certified adult day 
services’ means certified adult day services furnished to 
an individual— 
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‘‘(A) after discharge from a hospital or critical 
access hospital in which the individual was an inpa-
tient for not less than 3 consecutive days before 
such discharge if such certified adult day services 
were initiated within 14 days after the date of such 
discharge; or 
‘‘(B) after discharge from a skilled nursing fa-
cility in which the individual was provided post-hos-
pital extended care services if such certified adult 
day services were initiated within 14 days after the 
date of such discharge. 
‘‘(7) The term ‘certified adult day services spell of 
illness’ with respect to any individual means a period of 
consecutive days— 
‘‘(A) beginning with the first day (not included 
in a previous certified adult day services spell of ill-
ness)— 
‘‘(i) on which such individual is furnished 
post-institutional certified adult day services; 
and 
‘‘(ii) which occurs in a month for which 
the individual is entitled to benefits under part 
A; and 
‘‘(B) ending with the close of the first period of 
60 consecutive days thereafter on each of which the 
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individual is neither an inpatient of a hospital or 
critical access hospital nor an inpatient of a facility 
described in section 1819(a)(1) or subsection (y)(1) 
nor provided home health services or certified adult 
day services.’’. 
(2) INCLUSION UNDER PART B BENEFIT.—Sec-
tion 1832(a)(2) of the Social Security Act (42 
U.S.C. 1395k(a)(2)) is amended— 
(A) in subparagraph (I), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (J), by striking at the 
end the period and inserting ‘‘and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(K) certified adult day services (as de-
fined in section 1861(kkk)(1)(A)).’’. 
(3) INCLUSION UNDER PART A BENEFIT.—Sec-
tion 1812(a) of the Social Security Act (42 U.S.C. 
1395d(a)) is amended— 
(A) in paragraph (4), by striking at the 
end ‘‘and’’; 
(B) in paragraph (5), by striking the pe-
riod at the end and inserting ‘‘and’’; and 
(C) by adding at the end the following new 
paragraph: 
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‘‘(6) in the case of individuals not enrolled in 
part B, certified adult day services (as defined in 
paragraph (1)(A) of section 1861(kkk)), and in the 
case of individuals so enrolled, post-institutional cer-
tified adult day services (as defined in paragraph (6) 
of such section) furnished during a certified adult 
day services spell of illness (as defined in paragraph 
(7) of such section) for up to 100 visits during such 
spell of illness.’’. 
(b) PAYMENT OF CLAIMS REQUIREMENTS FOR HOME 
HEALTH SERVICES APPLIED TO CERTIFIED ADULT DAY 
SERVICES.— 
(1) PART A.—Section 1814(a)(2)(C) of the So-
cial Security Act (42 U.S.C. 1395f(a)(2)(C)) is 
amended by inserting ‘‘or certified adult day serv-
ices’’ after each occurrence of ‘‘home health serv-
ices’’. 
(2) PART B.—Section 1835(a)(2)(A) of the So-
cial Security Act (42 U.S.C. 1395n(a)(2)(A)) is 
amended— 
(A) in the matter preceding clause (i), by 
inserting ‘‘or certified adult day services (as de-
fined in section 1861(kkk)(1)(A))’’ after ‘‘home 
health services’’; and 
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(B) in clause (i), by inserting ‘‘or certified 
adult day services’’ after ‘‘home health serv-
ices’’. 
(c) CONFORMING AMENDMENTS.— 
(1) 
INTERMITTENT
SERVICES.—Section 
1861(m) of the Social Security Act (42 U.S.C. 
1395x(m)) is amended in the last sentence by insert-
ing ‘‘insofar as such respective section relates to 
home 
health 
services,’’ 
after 
‘‘section 
1835(a)(2)(A),’’. 
(2) INTERACTION WITH COVERAGE OF HOME 
HEALTH SERVICES.—Section 1861(m) of the Social 
Security Act (42 U.S.C. 1395x(m)), as amended by 
paragraph (1), is amended by adding at the end the 
following new sentence: ‘‘An individual described in 
this subsection, with respect to home health services 
furnished during a period, shall not include an indi-
vidual who is receiving comparable certified adult 
day services (as defined in section 1861(kkk)(1)) 
during such period.’’. 
(3) 
INSTITUTIONAL
PLANNING
REQUIRE-
MENT.—Section 1861(z) of the Social Security Act 
(42 U.S.C. 1395x(z)) is amended in the matter pre-
ceding paragraph (1), by striking ‘‘or home health 
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agency’’ and inserting ‘‘home health agency, or cer-
tified adult day services center’’. 
(4) INCLUSION AS PROVIDER OF SERVICES.— 
Section 1861(u) of the Social Security Act (42 
U.S.C. 1395x(u)) is amended by inserting ‘‘certified 
adult day services center,’’ after ‘‘home health agen-
cy,’’. 
(d) PAYMENT FOR CERTIFIED ADULT DAY 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 fol-
lowing new subsection: 
‘‘(f) APPLICATION OF HOME HEALTH PROSPECTIVE 
PAYMENT SYSTEM
TO CERTIFIED ADULT DAY SERV-
ICES.— 
‘‘(1) IN GENERAL.—The Secretary shall, in ac-
cordance with this subsection, develop a methodology 
under which the fee schedule and provisions under 
this section shall apply to certified adult day services 
(as defined in section 1861(kkk)(1)) in a similar 
manner to which such schedule and provisions apply 
to home health services. 
‘‘(2) PAYMENT
RATE
DETERMINATION
AND 
LIMITATIONS.—Under such methodology, the fol-
lowing shall apply, with respect to certified adult day 
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services furnished to an individual during a period 
specified by the Secretary under a plan of care es-
tablished under section 1861(kkk) for which pay-
ment may be made under this title: 
‘‘(A) DETERMINATION OF COMPONENTS.— 
The Secretary shall determine each component 
(as defined by the Secretary) of such certified 
adult day services. 
‘‘(B) 
ESTIMATION
OF
PAYMENT 
AMOUNT.—The Secretary shall estimate the 
amount that would otherwise be payable under 
this section for the components of services de-
termined under subparagraph (A) if such serv-
ices were furnished by a home health agency 
(or, if such component or service would not oth-
erwise be so payable under this section if so 
furnished, the amount that would be payable 
under this section for a comparable home 
health service furnished by a home health agen-
cy) during such period. 
‘‘(C) AMOUNT
OF
PAYMENT.—The total 
amount payable under this section for such cer-
tified adult day services furnished to such indi-
vidual during such period shall be 98 percent of 
the amount estimated to be payable for such 
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services (or comparable services) under sub-
paragraph (B) for such period. 
‘‘(D) LIMITATION.—No payment may be 
made under this section for certified adult day 
services described in clauses (iv) through (vi) 
and (ix) of section 1861(kkk)(1)(A). 
‘‘(3) LIMITATION
ON
BALANCE
BILLING.—A 
certified adult day services center shall accept as 
payment in full for certified adult day services de-
scribed in clauses (i) through (iii), (vii) through 
(viii), 
and 
(x) 
through 
(xii) 
of 
section 
1861(kkk)(1)(A) furnished by the center to an indi-
vidual entitled to benefits under this title the 
amount of payment provided under this section for 
home health services consisting of items and services 
described in such respective clauses.’’. 
(e) 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 
(24); 
(2) by striking the period at the end of para-
graph (25) and inserting, ‘‘or’’; and 
(3) by inserting after paragraph (25) the fol-
lowing new paragraph: 
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‘‘(26) which are certified adult day services 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 certified 
adult day services center pursuant to a plan of care 
established under section 1861(kkk) 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.’’. 
(f) TEMPORARY INCREASE FOR CERTIFIED ADULT 
DAY SERVICES FURNISHED IN A RURAL AREA.— 
(1) IN GENERAL.—With respect to episodes and 
visits ending on or after January 1, 2018, and be-
fore January 1, 2020, in the case of certified adult 
day services (as defined in section 1861(kkk)(1)(A) 
of the Social Security Act, as added by subsection 
(a)), furnished in a rural area (as defined in section 
1886(d)(2)(D) 
of 
such 
Act 
(42 
U.S.C. 
1395ww(d)(2)(D))), the Secretary of Health and 
Human Services shall increase the payment amount 
otherwise made under section 1895 of such Act (42 
U.S.C. 1395fff) for such services by 3 percent. 
(2) WAIVING BUDGET NEUTRALITY.—The Sec-
retary shall not reduce the standard prospective pay-
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