[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2826 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 2826

To amend title XVIII of the Social Security Act to provide for coverage 
   of substitute adult day care services under the medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 29, 2000

Mr. Santorum (for himself and Mr. Rockefeller) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for coverage 
   of substitute adult day care services under the medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Adult Day Services 
Alternative Act of 2000''.

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 (uu));''.
            (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

    ``(uu)(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) 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 4 and not greater than 12 hours 
        per day.
            ``(v) A medication management program (as defined in 
        subparagraph (C)).
    ``(C) For purposes of subparagraph (B)(v), 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 (v) of paragraph (1)(B) are 
provided by others under arrangements with them 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.''.
            (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); 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.--Section 1895 
of the Social Security Act (42 U.S.C. 1395fff) is amended by adding at 
the end the following new subsection:
    ``(e) 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(uu)), 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 under such 
        plan 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) through (v) of section 
        1861(uu)(1)(B).''.
    (c) Adjustment in Case of Overutilization of Substitute Adult Day 
Care Services.--
            (1) Monitoring expenditures.--Beginning with fiscal year 
        2002, 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 the date on which the 
prospective payment system for home health services furnished under the 
medicare program under section 1895 of the Social Security Act (42 
U.S.C. 1395fff) is established and implemented.
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