[Congressional Record Volume 149, Number 84 (Tuesday, June 10, 2003)]
[Senate]
[Pages S7633-S7635]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SANTORIUM (for himself and Mrs. Lincoln):
  S. 1227. A bill to amend title XVIII of the Social Security Act to 
provide for coverage of substitute adult day services under the 
medicare program; to the Committee on Finance.

  Mr. SANTORUM. Mr. President, I rise to join my colleague Mrs. Lincoln 
of Arkansas to reintroduce 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 the 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, 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.
  Congress' attention in this area is critical, given the expected 
growing costs of long-term care services, and the fact that so many 
American families are already serving as caregivers for aging or ailing 
seniors and providing 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. This legislation would 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

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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 facets 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 has been 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 
Senator Lincoln 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. 1227

       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 2003''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) adult day services 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 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 services facilities 
     provide continuity of care and an important sense of 
     community for both the senior and the caregiver;
       (8) there are adult day services facilities 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. MEDICARE COVERAGE OF SUBSTITUTE ADULT DAY SERVICES.

       (a) Substitute Adult Day 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 services (as defined in 
     subsection (ww));''.
       (2) Substitute adult day 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 Services; Adult Day Services Facility

       ``(ww)(1)(A) The term `substitute adult day services' means 
     the items and services described in subparagraph (B) that are 
     furnished to an individual by an adult day services facility 
     as a part of a plan under subsection (m) that substitutes 
     such services for some or all 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 services 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 services 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) provides the items and services described in 
     paragraph (1)(B); and
       ``(iii) meets the requirements of paragraphs (2) through 
     (8) of subsection (o).
       ``(B) Notwithstanding subparagraph (A), the term `adult day 
     services 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 services 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.''.
       (b) Payment for Substitute Adult Day 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 Services.--
       ``(1) Payment rate.--For purposes of making payments to an 
     adult day services facility for substitute adult day services 
     (as defined in section 1861(ww)), the following rules shall 
     apply:
       ``(A) Estimation of payment amount.--The Secretary shall 
     estimate the amount that would otherwise be payable to a home 
     health agency under this section for all home health services 
     described in paragraph (1)(B)(i) of such section under the 
     plan of care.
       ``(B) Amount of payment.--Subject to paragraph (3)(B), the 
     total amount payable for substitute adult day services under 
     the plan of care is equal to 95 percent of the amount 
     estimated to be payable under subparagraph (A).
       ``(2) Limitation on balance billing.--An adult day services 
     facility shall accept as payment in full for substitute adult 
     day services (including those services described in clauses 
     (ii) through (iv) of section 1861(ww)(1)(B)) furnished by the 
     facility to an individual entitled to benefits under this 
     title the amount of payment provided under this subsection 
     for home health services consisting of substitute adult day 
     services.
       ``(3) Adjustment in case of overutilization of substitute 
     adult day services.--
       ``(A) Monitoring expenditures.--Beginning with fiscal year 
     2005, the Secretary shall monitor the expenditures made under 
     this title for home health services, including such services 
     consisting of substitute adult day services, for the fiscal 
     year and shall compare such expenditures to expenditures that 
     the Secretary estimates would have been made under this title 
     for home health services for the fiscal year if the Medicare 
     Adult Day Services Alternative Act of 2003 had not been 
     enacted.
       ``(B) Required reduction in payment rate.--If the Secretary 
     determines, after making the comparison under subparagraph 
     (A) 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 this title, including such services 
     consisting of substitute adult day services, for the fiscal 
     year exceed expenditures that would have been made under this 
     title for home health

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     services for the fiscal year if the Medicare Adult Day 
     Services Alternative Act of 2003 not been enacted, then the 
     Secretary shall adjust the rate of payment to adult day 
     services facilities under paragraph (1)(B) for home health 
     services consisting of substitute adult day services 
     furnished in the fiscal year in order to eliminate such 
     excess.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished on or after 
     January 1, 2004.
                                 ______