[Congressional Record Volume 147, Number 149 (Thursday, November 1, 2001)]
[Senate]
[Pages S11374-S11376]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SANTORUM (for himself, Mr. Rockefeller, Mrs. Lincoln, and 
        Mr. McConnell):
  S. 1619. 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; to the Committee on Finance.
  Mr. SANTORUM. Mr. President, I rise to join my colleagues Mr. 
Rockefeller, Mrs. Lincoln, and Mr. McConnell to introduce bipartisan 
legislation aimed at improving long-term care health and rehabilitation 
options for Medicare beneficiaries, and also assisting family 
caregivers.
  We all recognize that our Nation needs to address sooner rather than 
later challenges of financing long-term care services for our growing 
aging population. The Congressional Budget Office has projected that 
national expenditures for long-term care services for the elderly will 
increase each year through 2040. But it is in just over a decade when 
we will see these challenges become even more pronounced

[[Page S11375]]

when the 76 million baby boomers begin to turn 65. Baby boomers are 
expected to live longer and greater numbers will reach 85 and older.
  Given the expected growing costs of long-term care services, and 
combined with the fact that today so many American families are already 
serving as caregivers for aging or ailing seniors and providing such a 
large portion of long-term care services, it is more important than 
ever that we have in place quality options in how to best care for our 
senior population about to dramatically increase.
  This is why we are introducing the Medicare Adult Day Services 
Alternative Act, legislation to offer home health beneficiaries more 
options for receiving care in a setting of their own choosing, rather 
than confining the provision of those benefits solely to the home.
  This legislation would give beneficiaries the option to receive some 
or all of their Medicare home health services in an adult day setting. 
This would be a substitution, not an expansion, of services. The bill 
would not make new people eligible for Medicare home health benefits or 
expand the list of services paid for. In fact, this legislation may be 
designed to produce net savings for the Medicare program.
  Permitting homebound patients to receive their home health care in a 
clinically-based senior day center, as an alternative to receiving it 
at home, could result in significant benefits to the Medicare program, 
such as reduced cost-per-episode, reduced numbers of episodes, as well 
as mental and physical stimulation for patients.
  Moreover, the Medicare Adult Day Services Alternative Act could well 
have a positive impact on our economy, as it would enable caregivers to 
attend to other things in today's fast-paced family life, such as 
working a full- or part-time job and caring for children, knowing their 
loved ones are well cared for. It is unfortunate that today many 
caregivers have to choose between working or caring for a family 
member. It is estimated that the average loss of income to these 
caregivers is more than $600,000 in wages, pension, and Social Security 
benefits. And by extension, the loss in productivity in United States 
businesses is pegged at more than $10 billion annually.
  But it does not have to be an either-or proposition. The Medicare 
Adult Day Services Alternative Act is a creative solution to health 
care delivery, which would adequately reimburse providers in a fiscally 
responsible way. Located in every state in the United States and the 
District of Columbia, adult day centers generally offer transportation, 
meals, personal care, and counseling in addition to the medical 
services and socialization benefits offered.
  We can and should offer both our Medicare beneficiaries and family 
caregivers more and better options for health care delivery, and that 
is exactly what the Medicare Adult Day Services Alternative Act is 
designed to do. This legislation is bipartisan, and is supported by 
more than 20 national non-profit organizations concerned with the well-
being of America's older population and committed to representing their 
interests.
  I hope our colleagues will join us in this cause. I again thank 
Senators Rockefeller, Lincoln and McConnell for working with me in this 
effort, and ask unanimous consent that the text of the bill be printed 
in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1619

       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 2001''.

     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 (ww));''.
       (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

       ``(ww)(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) Meals.
       ``(iii) 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.
       ``(iv) A medication management program (as defined in 
     subparagraph (C)).
       ``(C) For purposes of subparagraph (B)(iv), 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 (iv) 
     of paragraph (1)(B) are provided--
       ``(i) by an adult day-care program that is licensed or 
     certified by a State, or accredited, to furnish such items 
     and services in the State; and
       ``(ii) under arrangements with that program 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.''.
       (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:

[[Page S11376]]

       ``(f) 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(ww)), the following rules apply:
       ``(1) 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 period specified by the Secretary.
       ``(2) 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 (1) furnished under the plan by a 
     home health agency.''.
       (c) Adjustment in Case of Overutilization of Substitute 
     Adult Day Care Services.--
       (1) Monitoring expenditures.--Beginning with fiscal year 
     2003, 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 
     January 1, 2002.

  Mr. ROCKEFELLER. Mr. President, I am delighted to join my good friend 
from Pennsylvania as an original cosponsor of the ``Medicare Adult Day 
Services Alternative Act.''
  Adult day health care is a vital component of good long-term care, 
for patients and for their caregivers. I am hopeful that as a result of 
this bill, adult day health care will play an increasingly larger role 
in how we care for the elderly in this country.
  To be clear, this bill would simply give beneficiaries of the 
Medicare home health benefit the option of choosing to receive their 
care partially in an adult day care setting. This bill would not expand 
the list of who is eligible for home care, it simply changes the 
location where services may be provided. The benefits of this 
legislation, are that beneficiaries gain increased social interaction 
with peers, while simultaneously giving caregivers a measure of 
respite.
  I am a strong supporter of adult day health care, because I've seen 
the tremendous benefits of it in the VA health care system. The 
federally funded VA health care system, because of the very substantial 
World War II veteran population, has developed some of the most 
innovative ways to care for older people especially in non-
institutional settings. As a result of this demand, VA has led the 
Nation in developing adult day health care programs. The Adult Day 
Health Care Program at VA was established in the late 1970s at five 
facilities. At this time, there are 15 in-house VA Adult Day Health 
Care programs. All other VA medical centers provide this program to 
veterans through a contractual basis with community-based programs.
  In 1999, I introduced legislation to further expand on VA adult day 
by making adult day health care, and other non-institutional long-term 
care services, part of the standard benefits package in the VA. I am 
thrilled that my legislation was passed later that year and that all 
veterans who enroll for VA care will have access to these services.
  I look forward to working with members of the Senate Finance 
Committee to advance the cause of long-term care. It is my view that 
providing long-term care to all Americans is a priority. Let us delay 
no longer.
                                 ______