[Congressional Record Volume 144, Number 109 (Wednesday, August 5, 1998)]
[Extensions of Remarks]
[Page E1550]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           THE MEDICARE SUBSTITUTE ADULT DAY CARE SERVICE ACT

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Wednesday, August 5, 1998

  Mr. STARK. Mr. Speaker, I am pleased to rise with my colleagues 
Representatives Cardin, Kleczka, and Lewis with whom I serve on the 
Ways and Means Health Subcommittee, to introduce The Medicare 
Substitute Adult Day Care Services Act.
  This bill would update the Medicare home health benefit to 
incorporate modern setting for rehabilitation. While the home had been 
the only setting in which a homebound person could reasonably be 
expected to receive therapy, that is no longer always the case. This 
legislation would allow patients and their families to choose the best 
setting for their individual needs. This new choice would be provided 
at no additional cost to the Medicare program.
  Adult day care centers (ADCs) are proving to be effective--often 
preferable--alternatives to complete confinement in the home. Homebound 
people can utilize these centers because they provide door-to-door 
services for their patients. ADCs send special vehicles and trained 
personnel to a patient's home and will go so far as to get the patient 
out of bed and transport them to the ADC site in specially-equipped 
vehicles. Without this transportation component, homebound patients 
would be not able to utilize such a service.
  For certain patients, the ADC setting is far preferable to 
traditional home health care. The ADC can provide skilled therapy like 
the home health provider, but also provide therapeutic activities and 
meals for the patients. These centers provide a social setting within a 
therapeutic environment to serve patients with a variety of needs. 
Thus, patients have the opportunity to interact with a broad array of 
people and to participate in organized group activities that promote 
better physical and mental health. Rehabilitation can be enhanced in 
such a setting.
  It is also important to note that ADC care provides an added benefit 
to the caregivers for frail seniors. When a Medicare beneficiary 
receives home health services in the home, these providers are not in 
the home all day. They provide the service they are paid for and then 
leave. Many frail seniors cannot be left alone for long periods of time 
and this restriction prevents their caregivers from being able to 
maintain employment outside of the home. If the senior were receiving 
ADC services, they would receive supervised care for the whole day and 
the primary care giver would be able to maintain a job and/or be able 
to leave the home for longer periods of time.

  From a cost perspective, an ADC setting can provide savings as well. 
In the home care arena, a skilled nurse, a physical therapist, or any 
home health provider must travel from home to home providing services 
to one patient per site. There are significant transportation costs and 
time costs associated with that method of care. In an ADC, the patients 
are brought to the providers so that a provider can see a larger number 
of patients in a shorter period of time. That means that payments per 
patient for skilled therapies can be reduced in the ADC setting 
compared to the home health setting.
  The Medicare Substitute Adult Day Care Services Act would incorporate 
the adult day care setting into the current Medicare home health 
benefit. It would do so by allowing beneficiaries to substitute some, 
or all, of their Medicare home health services in the home for care in 
an adult day care center (ADC).
  To achieve cost-savings, the ADC would be paid a flat rate of 95% of 
the rate that would have been paid for the service had it been 
delivered in the patient's home. The ADC would be required, with that 
one payment, to provide a full day of care to the patient. That care 
would include the home health benefit and transportation, meals and 
therapeutic activities.
  It is especially important to note that this bill is not an expansion 
of the home health benefit. It would not make any new people eligible 
for the Medicare home health benefit. Nor would it expand the 
definition of what qualifies for reimbursement by Medicare for home 
health services.
  In order to qualify for the ADC option, a patient would still need to 
qualify for Medicare home health benefits just like they do today. They 
would need to be homebound and they would need to have a certification 
from a doctor for skilled therapy in the home.
  All the bill would do is recognize that ADCs can provide the same 
services, at lower costs, and include the benefits of social 
interaction, activities, meals, and a therapeutic environment in which 
trained professionals can treat, monitor and support Medicare 
beneficiaries who would otherwise be at home without professional help. 
All of these things aid the rehabilitation process of patients.
  In order to participate in the Medicare home care program, adult day 
care centers would need to meet the same standards that are required of 
home health agencies. The only exception to this rule is that the ADCs 
would not be required to be ``primarily'' involved in the provision 
skilled nursing services and therapy services. They would be required 
to provide those services, but because ADCs provide services to an 
array of patients, skilled nursing services and therapy services may 
not always be their primary activity. Otherwise, all the home health 
requirements would apply to ADCs.
  Here is an example of how the system would work if this bill were 
law. A patient is prescribed home care by his or her doctor. At that 
time the patient and his or her family decide how to arrange for the 
services. They could choose to receive all services through the home, 
or could choose to substitute some adult day care services. So, if the 
patient had 3 physical therapy visits and 2 home health aide visits, 
they could decide to take the home health aide visits at home, but 
substitute three days of ADC services for the physical therapy visits. 
On those days, the patient would be picked up from home, taken to the 
ADC, receive the physical therapy, and receive the additional benefits 
of the ADC setting (group therapy, meals, socialization, and 
transportation). All of these services would be incorporated into the 
payment rate of 95% of the home setting rate for the physical therapy 
service. It is a savings for Medicare and an improved benefit to the 
patient--a winning solution for everyone.
  While we believe this bill would create savings for Medicare without 
any additional protections, to make sure that that is the case, we have 
included a budget neutrality provision in the bill. This provision 
would allow the Secretary of Health and Human Services to change the 
percentage of the payment rate for ADC services if growth in those 
services were to be greater than current projections under the 
traditional home health program.
  This is a small step forward for rehabilitation therapy for seniors. 
Eligibility for the home health benefit is not changed so it is not an 
expansion of the benefit. We believe that patients would greatly 
benefit from the option of an adult day care setting for the provision 
of home health services and look forward to working with our colleagues 
to enact this incremental, important Medicare improvement.

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