[Congressional Record Volume 145, Number 25 (Thursday, February 11, 1999)]
[Extensions of Remarks]
[Pages E222-E223]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  INTRODUCTION OF THE MEDICARE SUBSTITUTE ADULT DAY CARE SERVICES ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Thursday, February 11, 1999

  Mr. STARK. Mr. Speaker, I am pleased to rise with a number of my 
colleagues to introduce The Medicare Substitute Adult Day Care Services 
Act. This bill would improve home health rehabilitation options for 
Medicare beneficiaries and simultaneously assist family caregivers with 
the very real difficulties in caring for a homebound family member.
  As Congress turns needed attention to modernizing the Medicare 
program, this bill is an important step in that direction. It would 
update the Medicare home health benefit by allowing beneficiaries the 
option of choosing an adult day care setting for the provision of home 
health benefits rather than confining the provision of those benefits 
solely to the home.
  More specifically, 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 
percent 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 care to the patient. That care 
would include the home health benefit AND transportation, meals and 
supervised activities.
  Above the 95 percent reimbursement limitation there are additional 
inherent cost savings in the ADC setting. 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.
  As an added budget neutrality measure, the bill includes a provision 
that 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 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 ADC's 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.
  The bill includes important quality and anti-fraud protections. In 
order to participate in the Medicare home care program, adult day care 
centers would be required to meet the same standards that are required 
of home health agencies. The only exception to this rule is

[[Page E223]]

that the ADC's would not be required to be ``primarily'' involved in 
the provision skilled nursing services and therapy services. They would 
have to provide those services, but because ADC's 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 ADC's.
  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 3 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 percent 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.
  Adult day care centers (ADC's) are proving to be effective, and often 
preferable, alternatives to complete confinement in the home. States 
are taking advantage of their services for Medicaid patients today. 
Homebound people can utilize these centers because they provide door-
to-door services for their patients. ADC's 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 not be 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.
  Again, it is important to note that ADC care provides an added 
benefit to the caregivers for frail seniors or disabled individuals. 
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 caregiver would be 
able to maintain a job and/or be able to leave the home for longer 
periods of time.
  This is a small step forward for rehabilitation therapy for seniors 
and disabled individuals. Eligibility for the home health benefit is 
not changed so it is not an expansion of the benefit. Patients would 
greatly benefit from the option of an adult daycare setting for the 
provision of home health services. I look forward to working with my 
colleagues to enact this incremental, important Medicare improvement.

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