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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Medicare Adult Day Services
Alternative Act of 2001''.

SEC. 2. FINDINGS.

Congress finds that--
(1) adult day care offers services, including medical care,
rehabilitation therapies, dignified assistance with activities
of daily living, social interaction, and stimulating
activities, to seniors who are frail, physically challenged, or
cognitively impaired;
(2) access to adult day care services 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, nearly 1 in 4
American families, providing close to 80 percent of the care to
individuals requiring long-term care;
(4) nearly 75 percent of those actively providing 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 caregivers has been
shown to be $659,130 in wages, pension, and Social Security
benefits;
(6) the loss in productivity in United States businesses
ranges from $11,000,000,000 to $29,000,000,000 annually;
(7) the services offered in adult day care facilities
provide continuity of care and an important sense of community
for both the senior and the caregiver;
(8) there are adult day care centers in every State in the
United States and the District of Columbia;
(9) these centers generally offer transportation, meals,
personal care, and counseling in addition to the medical
services and socialization benefits offered; and
(10) with the need for quality options in how to best care
for our senior population about to dramatically increase with
the aging of the baby boomer generation, the time to address
these issues is now.

SEC. 3. 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 (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 (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 subparagraph (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) 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) Meals.
''(iii) 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 4 and not greater than 12 hours per day.
''(iv) A medication management program (as defined in
subparagraph (C)).
''(C) For purposes of subparagraph (B)(iv), the term 'medication
management program' means a program of services, including medicine
screening and patient and health care provider education programs, that
provides services to minimize--
''(i) unnecessary or inappropriate use of prescription
drugs; and
''(ii) adverse events due to unintended prescription drug-
to-drug interactions.
''(2)(A) Except as provided in subparagraphs (B) and (C), 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
ensure 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) Notwithstanding subparagraph (A), the term 'adult day care
facility' shall include a home health agency in which the items and
services described in clauses (ii) through (iv) of paragraph (1)(B) are
provided--
''(i) by an adult day-care program that is licensed or
certified by a State, or accredited, to furnish such items and
services in the State; and
''(ii) under arrangements with that program made by such
agency.
''(C) 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.
''(D) 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.''.
(b) Payment for Substitute Adult Day Care Services.--Section 1895
of the Social Security Act (42 U.S.C. 1395fff) is amended by adding at
the end the following new subsection:
''(f) Payment Rate for Substitute Adult Day Care Services.--In the
case of home health services consisting of substitute adult day care
services (as defined in section 1861(ww)), the following rules apply:
''(1) 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 period specified by the Secretary.
''(2) The total amount payable for home health services
consisting of substitute adult day care services under such
plan may not exceed 95 percent of the amount estimated to be
payable under paragraph (1) furnished under the plan by a home
health agency.''.
(c) Adjustment in Case of Overutilization of Substitute Adult Day
Care Services.--
(1) Monitoring expenditures.--Beginning with fiscal year
2003, the Secretary of Health and Human Services shall monitor
the expenditures made under the Medicare Program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for
home health services (as defined in section 1861(m) of such Act
(42 U.S.C. 1395x(m))) for the fiscal year, including substitute
adult day care services under paragraph (8) of such section (as
added by subsection (a)), and shall 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 under
the Medicare Program, including such substitute adult day care
services, exceed expenditures that would have been made under
such program for home health services for a year if subsection
(a) had not been enacted, then the Secretary shall adjust the
rate of payment to adult day care facilities so that total
expenditures for home health services under such program 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, 2002.
Output:
Medicare Adult Day Services Alternative Act of 2001 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for Medicare coverage of substitute adult day care services.