1.This Act may be cited as the
Medicare Adult Day Care Services Act
of 2009
.
2.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.
3.Medicare coverage
of substitute adult day care services
(a)Substitute adult
day care services benefit
(1)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 definedSection 1861 of the
Social Security Act (42 U.S.C. 1395x)
is amended by adding at the end the following new subsection:
(hhh)Substitute adult day care services; adult day care
facility(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)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
systemSection 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)
(A)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 amountThe 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)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)
(A)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 billingA 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)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)The amendments made by this section shall apply to items and
services furnished on or after January 1, 2010.