[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3043 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3043

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 HOUSE OF REPRESENTATIVES

                             June 25, 2009

Ms. Linda T. Sanchez of California 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 within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 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 Care Services Act 
of 2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Adult day care can offer services, including medical 
        care, rehabilitation therapies, dignified assistance with 
        activities of daily living, nutrition therapy, health 
        monitoring, social interaction, stimulating activities, and 
        transportation, to seniors and people with disabilities at no 
        extra cost to the Medicare Program.
            (2) The care given at adult day care facilities provides 
        seniors, people with disabilities, and their familial 
        caregivers with more care hours and additional services that 
        are critical to keeping patients healthier and in the home.
            (3) More than 50,000,000 people provide care for a 
        chronically ill, disabled or aged family member or friend 
        during any given year. In 2002, almost half of workers in the 
        United States provided some form of caregiving.
            (4) Caregivers, the majority of whom are women, provide an 
        estimated $306,000,000,000 in ``free'' services annually. The 
        pool of potential family caregivers is dwindling, from 11 
        potential caregivers for each person needing care today to a 
        projected 4 to 1 ratio in 2050.
            (5) Caregiving families tend to have lower incomes than 
        non-caregiving families, and the average intensive caregiver 
        loses $659,139 in wages, pension benefits, and Social Security 
        benefits over a lifetime. At least 6 out of 10 employed 
        caregivers reported that they had made some work-related 
        adjustments as a result of their caregiving responsibilities, 
        and an estimated 9 percent of caregivers left the workplace 
        altogether as a result of their caregiving responsibilities.
            (6) The total estimated cost to employers for full-time 
        employees with intense caregiving responsibilities is 
        $17,100,000,000. The total estimated cost to employers for all 
        full-time, employed caregivers is $33,600,000,000 annually.
            (7) Adult day care centers, which are located in every 
        State in the United States and the District of Columbia, serve 
        as an effective source of relief to familial caregivers and 
        provide quality health options to treat our Nation's elderly 
        population, which is about to dramatically 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 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 (hhh)(1)) furnished by a State licensed or certified 
        or nationally accredited adult day dare facility (as defined in 
        subsection (hhh)(2));''.
            (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

    ``(hhh)(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 a State licensed or certified or nationally 
accredited 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 such 
        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 appropriate) designed to 
        promote physical and mental health that are furnished to the 
        individual by such a 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 education and services (that 
meets such criteria as the Secretary determines appropriate) 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 subparagraph (B), the term `State 
licensed or certified or nationally accredited 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);
            ``(iv) subject to subparagraph (B), meets the requirements 
        of paragraphs (2) through (8) of subsection (o); and
            ``(v) if the agency, organization, or subdivision is in a 
        State not described in subsection (o)(4), is accredited through 
        a nationally recognized accrediting agency.
    ``(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 a 
State licensed or certified or nationally accredited adult day care 
facility.
    ``(D) Nothing in this paragraph shall be construed as prohibiting a 
home health agency from--
            ``(i) establishing a State licensed or certified or 
        nationally accredited adult day care facility; or
            ``(ii) providing services under arrangements with such a 
        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 by adding at the end the following 
new subsection:
    ``(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(hhh)(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 consisting of substitute adult 
                day care services under such plan of care is 98 percent 
                of 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 consisting of substitute adult day 
                care services described in clauses (ii) through (v) of 
                section 1861(hhh)(1)(B).
                    ``(B) Limitation on balance billing.--A State 
                licensed or certified or nationally accredited adult 
                day care facility shall accept as payment in full for 
                substitute adult day care services (including those 
                services described in clauses (ii) through (v) of 
                section 1861(hhh)(1)(B)) furnished by the facility to 
                an individual entitled to benefits under this title the 
                amount of payment provided under this section for home 
                health services consisting of substitute adult day care 
                services.''.
    (c) Consolidated Billing.--Section 1862(a) of the Social Security 
Act (42 U.S.C. 1395y(a)) is amended--
            (1) by striking ``or'' at the end of paragraph (23);
            (2) by striking the period at the end of paragraph (24) and 
        inserting ``; or''; and
            (3) by inserting after paragraph (24) the following new 
        paragraph:
            ``(25) which are substitute adult day care 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 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 such facility, unless 
        the services are furnished under arrangements (as defined in 
        section 1861(w)(1)) with the entity made by such facility.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2010.
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