[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
[[Page S7634]]
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
[[Page S7635]]
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.
______