In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

SECTION 1. ESTABLISHMENT OF NEW FASHION MODEL NONIMMIGRANT 
              CLASSIFICATION.

    (a) In General.--
            (1) New classification.--Section 101(a)(15)(P) of the 
        Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(P)) is 
        amended--
                    (A) in clause (iii), by striking ``or'' at the end;
                    (B) in clause (iv), by striking ``clause (i), (ii), 
                or (iii)'' and inserting ``clause (i), (ii), (iii), or 
                (iv)'';
                    (C) by redesignating clause (iv) as clause (v); and
                    (D) by inserting after clause (iii) the following:
                    ``(iv) is a fashion model who is of distinguished 
                merit and ability and who is seeking to enter the 
                United States temporarily to perform fashion modeling 
                services that involve events or productions which have 
                a distinguished reputation or that are performed for an 
                organization or establishment that has a distinguished 
                reputation for, or a record of, utilizing prominent 
                modeling talent; or''.
            (2) Authorized period of stay.--Section 214(a)(2)(B) of the 
        Immigration and Nationality Act (8 U.S.C. 1184(a)(2)(B)) is 
        amended in the second sentence--
                    (A) by inserting ``or fashion models'' after 
                ``athletes''; and
                    (B) by inserting ``or fashion model'' after 
                ``athlete''.
            (3) Numerical limitation.--Section 214(c)(4) of the 
        Immigration and Nationality Act (8 U.S.C. 1184(c)(4)) is 
        amended by adding at the end the following:
    ``(I)(i) The total number of aliens who may be issued visas or 
otherwise provided nonimmigrant status during any fiscal year under 
section 101(a)(15)(P)(iv) may not exceed 1,000.
    ``(ii) The numerical limitation established by clause (i) shall 
only apply to principal aliens and not to the spouses or children of 
such aliens.
    ``(iii) An alien who has already been counted toward the limitation 
established by clause (i) shall not be counted again during the same 
period of stay or authorized extension under subsection (a)(2)(B), 
irrespective of whether there is a change in petitioner under 
subparagraph (C).''.
            (4) Consultation.--
                    (A) In general.--Section 214(c)(4)(D) of the 
                Immigration and Nationality Act (8 U.S.C. 
                1184(c)(4)(D)) is amended by striking ``clause (i) or 
                (iii)'' and inserting ``clause (i), (iii), or (iv)''.
                    (B) Advisory opinion.--Section 214(c)(6)(A)(iii) of 
                the Immigration and Nationality Act (8 U.S.C. 
                1184(c)(6)(A)(iii)) is amended--
                            (i) by striking ``section 101(a)(15)(P)(i) 
                        or 101(a)(15)(P)(iii),'' and inserting ``clause 
                        (i), (iii), or (iv) of section 
                        101(a)(15)(P),''; and
                            (ii) by striking ``of athletics or 
                        entertainment''.
                    (C) Expedited procedures.--Section 214(c)(6)(E)(i) 
                of the Immigration and Nationality Act (8 U.S.C. 
                1184(c)(6)(E)(i)) is amended by striking ``artists or 
                entertainers'' and inserting ``artists, entertainers, 
                or fashion models''.
    (b) Elimination of H-1B Classification for Fashion Models.--Section 
101(a)(15)(H)(i)(b) of the Immigration and Nationality Act (8 U.S.C. 
1101(a)(15)(H)(i)(b)) is amended--
            (1) by striking ``or as a fashion model''; and
            (2) by striking ``or, in the case of a fashion model, is of 
        distinguished merit and ability''.
    (c) Effective Date and Implementation.--
            (1) In general.--The amendments made by this section shall 
        take effect on the date of the enactment of this Act.
            (2) Regulations, guidelines, and precedents.--The 
        regulations, guidelines and precedents in effect on the date of 
        the enactment of this Act for the adjudication of petitions for 
        fashion models under section 101(a)(15)(H)(i)(b) of the 
        Immigration and Nationality Act (8 U.S.C. 
        1101(a)(15)(H)(i)(b)), shall be applied to petitions for 
        fashion models under section 101(a)(15)(P)(iv) of the 
        Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(P)(iv)), 
        as added by this Act, except to the extent modified by the 
        Secretary of Homeland Security through final regulations (not 
        through interim regulations) promulgated in accordance with 
        subchapter II of chapter 5, and chapter 7, of title 5, United 
        States Code (commonly known as the ``Administrative Procedure 
        Act'').
            (3) Construction.--Nothing in this section shall be 
        construed as preventing an alien who is a fashion model from 
        obtaining nonimmigrant status under section 101(a)(15)(O)(i) of 
        the Immigration and Nationality Act (8 U.S.C. 
        1101(a)(15)(O)(i)) if such alien is otherwise qualified for 
        such status.
            (4) Treatment of pending petitions.--Petitions filed on 
        behalf of fashion models under section 101(a)(15)(H)(i)(b) of 
        the Immigration and Nationality Act (8 U.S.C. 
        1101(a)(15)(H)(i)(b)) that are pending on the date of the 
        enactment of this Act shall be treated as if they had been 
        filed under section 101(a)(15)(P)(iv) of the Immigration and 
        Nationality Act (8 U.S.C. 1101(a)(15)(P)(iv)), as added by this 
        Act.
Amends the Immigration and Nationality Act to replace the current nonimmigrant (H-1B) visa category for fashion models with a new (P-4) visa category.

Defines such category as a fashion model who is of distinguished merit and ability and who is seeking to enter the United States temporarily to perform fashion modeling services that involve events or productions which have a distinguished reputation or that are performed for an organization or establishment that has a distinguished reputation for, or a record of, utilizing prominent modeling talent.

Provides that such entrants may not: (1) exceed 1,000 in any fiscal year, not including accompanying spouses or children; and (2) stay in the United States for more than 10 years (initial five-year period with one five-year extension).

Makes an employer petition for such alien models eligible for expedited consultation procedures.

States that applicable H-1B regulations, guidelines, and precedents in effect on the date of the enactment of this Act for the adjudication of fashion model petitions shall be applied to P-4 petitions, except to the extent modified by the Secretary of Homeland Security.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Shareholder Empowerment Act of 
2009''.

SEC. 2. MAJORITY VOTING FOR DIRECTORS.

    The Securities Exchange Act of 1934 is amended by adding after 
section 16 the following new section:

``SEC. 16A. ELECTION OF DIRECTORS.

    ``(a) Standards Relating to Election of Directors.--
            ``(1) Commission rules.--Not later than 270 days after the 
        date of enactment of this section, the Commission shall, by 
        rule, direct the national securities exchanges and national 
        securities associations to prohibit the listing of any security 
        of an issuer that is not in compliance with the requirements of 
        any portion of paragraph (2). Such rules shall provide for 
        appropriate procedures for an issuer to have an opportunity to 
        cure any defects that would be the basis for such a prohibition 
        before the imposition of such prohibition.
            ``(2) Standards for election of directors.--
                    ``(A) Majority voting.--Each issuer shall, to the 
                extent permitted under State law, provide in its 
                governing documents that--
                            ``(i) directors in uncontested elections 
                        shall be elected by a majority of the votes 
                        cast as to each nominee; and
                            ``(ii) in contested elections where the 
                        number of nominees exceeds the number of 
                        directors to be elected, directors shall be 
                        elected by the vote of a plurality of the 
                        shares represented at any meeting and entitled 
                        to vote on the election of directors.
                    ``(B) Resignation policy.--Each issuer shall also, 
                to the extent permitted under State law, adopt 
                procedures under which any director who is not elected 
                to a new term shall offer to tender his or her 
                resignation to the board of directors. The board of 
                directors, with the advice of a committee of the board 
                if such a committee has been established for that 
                purpose, shall determine what action should be taken as 
                to that resignation and shall publicly disclose its 
                decision and the rationale for that decision within a 
                reasonable period after certification of the election 
                results.
    ``(b) Shareholder Access to the Proxy in Director Elections.--
            ``(1) Rule.--Not later than 270 days after the date of 
        enactment of this section, the Commission shall, by rule, 
        require that in proxy statements and proxies, authorizations or 
        consents prepared by an issuer pursuant to section 14, the 
        issuer shall identify and provide security holders with an 
        opportunity to vote on candidates for the board of directors 
        who have been nominated by holders in the aggregate at least 1 
        percent of the issuer's voting securities for at least 2 years 
        prior to a record date established by the issuer for a meeting 
        of security holders.
            ``(2) Application.--This rule shall specify the information 
        to be provided to an issuer by security holders who nominate 
        candidates for inclusion in an issuer's proxy materials under 
        this section and shall require the issuer to disclose 
        information about such candidates in the issuer's proxy 
        materials to the same extent that information must be disclosed 
        about candidates nominated by the issuer. This rule shall apply 
        only when eligible security holders have nominated fewer than a 
        majority of the number of directors then authorized to serve on 
        the board of directors, and the rule shall specify procedures 
        to be followed if different security holders nominate 
        candidates sufficient to constitute a majority of the board of 
        directors.
            ``(3) Effective date.--The rule shall apply to proxy voting 
        for meetings of security holders held on or after January 1, 
        2010, except to the extent that a meeting was originally 
        scheduled to be held in 2009, but was adjourned to 2010.
    ``(c) Broker Discretionary Voting in Uncontested Director 
Elections.--Not later than 270 days after the date of enactment of this 
section, the Commission shall by, rule, require that a broker shall not 
be allowed to vote securities on an uncontested election to the board 
of directors of an issuer to the extent that the beneficial owner of 
those securities has not provided specific instructions to the broker. 
The rule shall apply to proxy voting for meetings of security holders 
held on or after January 1, 2010, except to the extent that a meeting 
was originally scheduled to be held in 2009, but was adjourned to 2010.
    ``(d) Independent Chairman of the Board of Directors.--
            ``(1) Commission rules.--Not later than 270 days after the 
        date of enactment of this section, the Commission shall, by 
        rule, direct the national securities exchanges and national 
        securities associations to prohibit the listing of any security 
        of an issuer that is not in compliance with the requirements of 
        any portion of paragraph (2). Such rules shall provide for 
        appropriate procedures for an issuer to have an opportunity to 
        cure any defects that would be the basis for such a prohibition 
        before the imposition of such prohibition.
            ``(2) Independent chairman of the board of directors.--Each 
        issuer shall provide in its governing documents or a public 
        statement of corporate policy that, to the extent possible and 
        consistent with the issuer's status as a publicly traded 
        company, the chairman of the board of directors shall be an 
        independent director who has not previously served as an 
        executive officer of the issuer. Such rule shall be implemented 
        with due regard for contracts in existence on the date of 
        enactment of this section. For purposes of this subsection, an 
        `independent director' shall be one who during the preceding 5 
        years has not been--
                    ``(A) employed by the issuer in an executive 
                capacity;
                    ``(B) an employee, director or owner greater than 
                20 percent of the beneficial shares of a firm that is a 
                paid adviser or consultant to the issuer;
                    ``(C) employed by a significant customer or 
                supplier of the issuer;
                    ``(D) a party to a personal services contract with 
                the issuer, as well as with the issuer's Chair, chief 
                executive officer, or other senior executive officer;
                    ``(E) an employee, officer or director of a 
                foundation, university or other non-profit organization 
                that receives the greater of $100,000 or 1 percent of 
                total annual donations from the issuer;
                    ``(F) a relative of an executive of the issuer;
                    ``(G) part of an interlocking directorate in which 
                the issuer's chief executive officer or another 
                executive serves on the board of another issuer 
                employing that director; and
                    ``(H) engaged in any other relationship with the 
                issuer or senior executives that the Commission 
                determines would not render that director an 
                independent director.''.

SEC. 3. EXECUTIVE COMPENSATION REQUIREMENTS.

    The Securities Exchange Act of 1934 is further amended by adding 
after the section 16A, as added by section 2, the following new section

``SEC. 16B. EXECUTIVE COMPENSATION REQUIREMENTS.

    ``(a) Shareholder Approval of Executive Compensation.--
            ``(1) Annual shareholder vote on executive compensation.--
        Any proxy or consent or authorization for an annual or other 
        meeting of an issuer shall permit a separate vote by 
        shareholders to approve the compensation of senior executive 
        officers, as disclosed pursuant to the compensation disclosure 
        rules of the Commission (which disclosure shall include the 
        compensation discussion and analysis, the compensation tables, 
        and any related material).
            ``(2) Non-binding nature of vote.--A shareholder vote 
        described in paragraph (1) shall not be binding on the board of 
        directors of an issuer and may not be construed as overruling a 
        decision by such board, nor to create or imply any additional 
        fiduciary duty by such board, nor shall such vote be construed 
        to restrict or limit the ability of security holders to make 
        proposals for inclusion in proxy materials related to executive 
        compensation.
            ``(3) Deadline for rules.--Not later than 1 year after the 
        date of enactment of this section, the Commission shall issue 
        any final rules and regulations required by this section.
            ``(4) Exception.--This provision shall not apply to any 
        issuer who is subject to a similar recoupment requirement under 
        another provision of Federal law.
    ``(b) Independent Compensation Advisers.--
            ``(1) Requirement.--Not later than 1 year after the date of 
        enactment of this section, the Commission shall, by rule, 
        require that if an issuer's board of directors or a committee 
        thereof retains an individual adviser or advisory firm in 
        conjunction with negotiating employment contracts or 
        compensation agreements with the issuer's executives, the 
        individual adviser and his or her firm shall be independent of 
        the issuer, its executives and directors, and shall report 
        solely to the board of directors or the committee thereof 
        responsible for executive compensation. The rule shall further 
        require that issuers shall not agree to indemnify or limit the 
        liability of compensation advisers or advisory firms.
            ``(2) Determination.--In determining the extent to which an 
        adviser or advisory firm is independent of an issuer within the 
        meaning of this section, the Commission shall consider such 
        matters as--
                    ``(A) the extent (as measured by annual fees and 
                other relevant metrics) to which an individual adviser 
                or advisory firm provides services in conjunction with 
                negotiating employment contracts or compensation 
                agreements with the issuer's executives, as compared to 
                other services that the adviser or advisory firm 
                provides to the issuer or executives;
                    ``(B) whether individual advisers are permitted to 
                hold equity and do hold equity in the issuer; and
                    ``(C) whether an advisory firm's incentive 
                compensation plan links the compensation of individual 
                advisers to the advisory firm's provision of other 
                services to the issuer.
    ``(c) Clawbacks of Unearned Performance-Based Pay.--
            ``(1) Commission rules.--Not later than 270 days after the 
        date of enactment of this section, the Commission shall, by 
        rule, direct the national securities exchanges and national 
        securities associations to prohibit the listing of any security 
        of an issuer that is not in compliance with the requirements of 
        any portion of paragraph (2). Such rules shall provide for 
        appropriate procedures for an issuer to have an opportunity to 
        cure any defects that would be the basis for such a prohibition 
        before the imposition of such prohibition.
            ``(2) Recoupment of unearned compensation.--An issuer's 
        board of directors or a committee thereof shall develop and 
        disclose a policy for reviewing unearned bonus payments, 
        incentive payments, or equity payments that were awarded to 
        executive officers owing to fraud, financial results that 
        require restatement, or some other cause. The policy should 
        require recovery or cancellation of any unearned payments to 
        the extent that it is feasible and practical to do so.
            ``(3) Exception.--This provision shall not apply to any 
        issuer who is subject to a similar recoupment requirement under 
        another provision of Federal law.
    ``(d) Severance Agreements Tied to Performance.--
            ``(1) Commission rules.--Not later than 270 days after the 
        date of enactment of this section, the Commission shall, by 
        rule, direct the national securities exchanges and national 
        securities associations to prohibit the listing of any security 
        of an issuer that is not in compliance with the requirements of 
        any portion of paragraph (2). Such rules shall provide for 
        appropriate procedures for an issuer to have an opportunity to 
        cure any defects that would be the basis for such a prohibition 
        before the imposition of such prohibition.
            ``(2) Severance agreements tied to performance.--An 
        issuer's board of directors or a committee thereof shall not 
        enter into agreements providing for severance payments to a 
        senior executive officer who is terminated because of poor 
        performance as an executive, as determined by the board of 
        directors. To the extent that an issuer is able to terminate a 
        senior executive officer for cause, poor performance by the 
        executive, as determined by the board of directors, shall be 
        considered as one such cause. The rule shall be implemented 
        with due regard for contracts in existence on the date of 
        enactment of this section.
    ``(e) Improved Disclosure of Compensation Targets.--Not later than 
1 year after the date of enactment of this section, the Commission 
shall, by rule, require additional disclosure of specific performance 
targets that are used by issuers to determine a senior executive 
officer's eligibility for bonuses, equity and incentive compensation. 
The Commission shall consider methods to improve disclosure in 
situations when it is claimed that disclosure would result in 
competitive harm to the issuer, including, requirements that the issuer 
describe its past experience with similar target levels, disclose any 
inconsistencies between compensation targets and targets set in other 
contexts, submit a request for confidential treatment of the 
performance targets under Commission rules, or disclose the data after 
disclosure would no longer be considered competitively harmful.''.
Shareholder Empowerment Act of 2009 - Amends the Securities Exchange Act of 1934 to direct the Securities and Exchange Commission (SEC) to prohibit national securities exchanges and associations from listing the securities of any issuer unless, to the extent permitted by state law, such issuer requires: (1) the election of directors who receive the majority of votes in uncontested elections or a plurality of votes in contested elections; and (2) directors who are not reelected to offer to tender their resignations.

Directs the SEC to: (1) require issuers to identify and provide security holders with an opportunity to vote on director candidates who have been nominated by holders of at least 1% of the issuer's voting securities for at least two years, provided security holders have nominated fewer than a majority of the directors then authorized to serve; (2) prohibit brokers from voting securities on an uncontested election to the board of directors without having received specific instructions from the securities' beneficial owners; and (3) requires listed issuers, to the extent possible, to have an independent chairman of their board of directors who has not served as an executive of the issuer.

Requires any proxy or consent or authorization for an annual or other meeting of a securities issuer to permit a separate shareholder vote on executive compensation, though such vote shall not be binding on its board of directors.

Directs the SEC to direct the national securities exchanges and national securities associations to prohibit: (1) issuers from retaining advisors in negotiating executive employment or compensation agreements that are not independent or are protected from liability by such issuers; (2) the listing of issuers that do not have a (clawback) policy of recovering executive payments that were unearned due to fraud, faulty financial statements, or some other cause; and (3) the listing of issuers that provide severance payments to senior executives who are terminated for poor performance.

Directs the SEC to require additional disclosure of specific performance targets issuers use in determining a senior executive's eligibility for bonuses, equity, and incentive compensation.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Substitute Adult Day Care 
Services Act of 1998''.

SEC. 2. COVERAGE OF SUBSTITUTE ADULT DAY CARE SERVICES UNDER MEDICARE.

    (a) Substitute Adult Day Care Services Benefit.--
            (1) In general.--Section 1861(m) of the Social Security Act 
        (42 U.S.C. 1395x(m)) is amended--
                    (A) in the matter preceding paragraph (1), by 
                inserting ``or paragraph (8)'' after ``paragraph (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 defined in 
        subsection (uu));''.
            (2) Substitute adult day care services defined.--Section 
        1861 of such 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

    ``(uu)(1)(A) The term `substitute adult day care services' means 
the items and services described in subparagraph (B) furnished to an 
individual by an adult day care facility as a part of a plan under 
subsection (m) substituting such services for a portion of the items 
and services described in subparagraph (B)(i) furnished by a home 
health agency under the plan, as determined by the physician 
establishing the plan.
    ``(B) The items and services described in this subparagraph 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 designed to 
        promote physical and mental health and furnished to the 
        individual by the adult day care facility in a group setting 
        for a period of not fewer than four and not greater than twelve 
        hours per day.
    ``(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; and
            ``(ii) 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 comparable surety bond under State law.
    ``(C) For purposes of payment for home health services consisting 
of substitute adult day care services furnished under this title, any 
reference to a home health agency is deemed to be a reference to an 
adult day care facility.''.
            (3) Conforming amendments.--Sections 1814(a)(2)(C) and 
        1835(a)(2)(A)(i) of such Act (42 U.S.C. 1395f(a)(2)(C) and 42 
        U.S.C. 1395f(a)(2)(C)) 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.--
            (1) Reasonable cost.--Section 1861(v)(1)(L) of such Act (42 
        U.S.C. 1395x(v)(1)(L)) is amended by adding at the end the 
        following new clause:
    ``(viii) In the case home health services consisting of substitute 
adult day care services, the following rules apply:
            ``(I) The Secretary shall determine each component (as 
        defined by the Secretary) of substitute adult day care services 
        (under subsection (uu)(1)(B)(i)) furnished to an individual 
        under the plan of care established under subsection (m) with 
        respect to such services.
            ``(II) The Secretary shall estimate the amount that would 
        otherwise be payable under this subparagraph 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.
            ``(III) The total amount payable for home health services 
        consisting of substitute adult day care services may not exceed 
        95 percent of the amount estimated to be payable under 
        subclause (II) furnished under the plan by a home health 
        agency.
            ``(IV) No payment may be made under this title for home 
        health services consisting of substitute adult day care 
        services described in clauses (ii), (iii), and (iv) of 
        subsection (uu)(1)(B).''.
            (2) Prospective payment system.--Section 1895 of such Act 
        (42 U.S.C. 1395fff) is amended by adding at the end the 
        following new subsection:
    ``(e) Payment Rate for Substitue Adult Day Care Services.--In the 
case home health services consisting of substitute adult day care 
services, the following rules apply:
            ``(1) The Secretary shall determine each component (as 
        defined by the Secretary) of substitute adult day care services 
        (under section 1861(uu)(1)(B)(i)) furnished to an individual 
        under the plan of care established under section 1861(m) with 
        respect to such services.
            ``(2) 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.
            ``(3) The total amount payable for home health services 
        consisting of substitute adult day care services may not exceed 
        95 percent of the amount estimated to be payable under 
        paragraph (2) furnished under the plan by a home health agency.
            ``(4) No payment may be made under this title for home 
        health services consisting of substitute adult day care 
        services described in clauses (ii), (iii), and (iv) of section 
        1861(uu)(1)(B).''.
    (c) Adjustment in Case of Overutilization of Substitute Adult Day 
Care Services.--
            (1) Monitoring expenditures.--The Secretary of Health and 
        Human Services shall monitor the expenditures made under the 
        Medicare Program under title XVIII of the Social Security Act 
        for home health services furnished under section 1861(m) of 
        such Act for a fiscal year beginning with fiscal year 2000, 
        including substitute adult day care services under paragraph 
        (8) of such section (as added by subsection (a)), and compare 
        such expenditures to expenditures that the Secretary estimates 
        would have been made for home health services for that fiscal 
        year if subsection (a) had not been enacted.
            (2) Required reduction in payment rate.--If the Secretary 
        determines, after making the comparison under paragraph (1) and 
        making such adjustments for changes in demographics and age of 
        the Medicare beneficiary population as the Secretary determines 
        appropriate, that expenditures for home health services 
        including such substitute adult day care services exceed 
        expenditures that would have been made for home health services 
        furnished under section 1861(m) of such Act for a year if 
        subsection (a) had not been enacted, then the Secretary shall 
        adjust the rate of payment so that total expenditures for home 
        health services furnished under such section in a fiscal year 
        does not exceed the Secretary's estimate of such expenditures 
        if subsection (a) had not been enacted.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 1999.

Medicare Substitute Adult Day Care Services Act of 1998 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of substitute adult day care services. 
Directs the Secretary of Health and Human Services to monitor Medicare expenditures for home health services for a fiscal year, including substitute adult day care services, and compare them to expenditures that the Secretary estimates would have been made for home health services for that fiscal year if there had been no coverage of substitute adult day care services.  Requires the Secretary, if home health service expenditures exceed such estimates, to adjust the rate of payment for home health services so that total expenditures do not exceed such estimates.