[Congressional Record Volume 148, Number 83 (Thursday, June 20, 2002)]
[Senate]
[Pages S5856-S5857]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER:
  S. 2655. A bill to amend titles XVIII and XIX of the Social Security 
Act to improve access to long-term care services under the Medicare and 
Medicaid Programs; to the Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, I am pleased to introduce ``A First 
Step to Long-Term Care Act of 2002.'' This is a targeted long-term care 
package--a first step in the direction of long-term care reform. This 
legislation is about protecting assets, expanding home care, and 
modestly expanding Medicare to address the need for adult day health 
care.
  Government coverage for nursing home care operates primarily, and 
most substantially, through the Medicaid program the safety net for the 
poor. Despite what many Americans believe or hope, Medicare is not 
designed or financed to cover long-term care needs. Medicare is, in 
fact, the universal health care program for the elderly, which covers 
all health care needs, save prescription drugs and long-term care.
  Just this morning, I testified before the Senate Special Committee on 
Aging about the need to find real solutions to attack the issue of 
long-term care coverage. This legislation is a step in that direction.
  Today, the home care benefit under Medicare offers skilled care and 
possibly home health aides on a part-time or intermittent basis. 
Beneficiaries also must be confined to the home, despite the fact that 
many could leave the home with assistance. ``A First Step to Long-Term 
Care Reform'' retains the requirement that leaving the home requires a 
considerable and taxing effort, but it obviates the difficult choice 
that patients face: either be imprisoned in their home or risk losing 
Medicare coverage.
  We also need to begin to provide options to nursing home care under 
the Medicare benefit, such as the payment for adult day health care. 
This is something Senator Santorum has been working on as well. Doing 
so would provide a measure of respite and will reduce the bias towards 
institutionalizing those who can, with the right circumstances--stay at 
home.
  Giving states relief from the mandate that they must pursue and sell-
off the estates of Medicaid beneficiaries is another first step. In the 
short-term, we can provide states with the option of whether or not to 
do so. West Virginia is one State, in particular, which is seeking 
relief from this harsh and unnecessary mandate. I recognize Congressman 
Nick Rahall, my good friend and colleague from West Virginia, for his 
leadership on this issue.
  Mr. President, there are few issues that are as challenging as 
providing a solution for the long-term care problem, but we simply must 
have the courage to find solutions. I 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. 2655

       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 ``A First Step to Long-Term 
     Care Act of 2002''.

     SEC. 2. MAKING MEDICAID ESTATE RECOVERY OPTIONAL.

       (a) In General.--Section 1917(b)(1) of the Social Security 
     Act (42 U.S.C. 1396p(b)(1)) is amended by striking ``shall 
     seek'' each place it appears and inserting ``may seek''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on the date of enactment of this Act. A 
     State (as defined for purposes of title XIX of the Social 
     Security Act) may apply such amendments to estates and sales 
     occurring at such earlier date as the State may specify.

     SEC. 3. COVERAGE OF SUBSTITUTE ADULT DAY CARE SERVICES UNDER 
                   THE MEDICARE PROGRAM.

       (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:
       ``(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.--

[[Page S5857]]

       (1) Monitoring expenditures.--Beginning with fiscal year 
     2004, 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, 2003.

     SEC. 4. CLARIFICATION OF THE DEFINITION OF HOMEBOUND FOR 
                   PURPOSES OF DETERMINING ELIGIBILITY FOR HOME 
                   HEALTH SERVICES UNDER THE MEDICARE PROGRAM.

       (a) Clarification.--Sections 1814(a) and 1835(a) of the 
     Social Security Act (42 U.S.C. 1395f(a); 1395n(a)) are each 
     amended by adding at the end the following: ``Notwithstanding 
     the preceding sentences, in the case of an individual that 
     requires technological assistance or the assistance of 
     another individual to leave the home, the Secretary may not 
     disqualify such individual from being considered to be 
     `confined to his home' based on the frequency or duration of 
     the absences from the home.''.
       (b) Technical Amendments.--(1) Sections 1814(a) and 1835(a) 
     of the Social Security Act (42 U.S.C. 1395f(a); 1395n(a)) are 
     each amended in the sixth sentence by striking ``leave 
     home,'' and inserting ``leave home and''.
       (2) Section 1814(a) of the Social Security Act (42 U.S.C. 
     1395f(a)), as amended by subsection (a), is amended by moving 
     the seventh sentence, as added by section 322(a)(1) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (appendix F, 114 Stat. 2763A-501), as 
     enacted into law by section 1(a)(6) of Public Law 106-554, to 
     the end of that section.
       (c) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished on or after the 
     date of enactment of this Act.
                                 ______