[Congressional Record (Bound Edition), Volume 147 (2001), Part 20]
[Extensions of Remarks]
[Page 28011]
[From the U.S. Government Publishing Office, www.gpo.gov]



  INTRODUCTION OF THE MEDICARE SUBSTITUTE ADULT DAY CARE SERVICES ACT

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                         HON. GERALD D. KLECZKA

                              of wisconsin

                    in the house of representatives

                      Thursday, December 20, 2001

  Mr. KLECZKA. Mr. Speaker, today Mr. Stark from California and I are 
introducing the Medicare Substitute Adult Day Care Services Act. This 
critical legislation would expand home health rehabilitation options 
for Medicare beneficiaries while simultaneously assisting family 
caregivers with the very real difficulties in caring for a homebound 
family member.
  Specifically, this bill would update the Medicare home health benefit 
by allowing beneficiaries the option of substituting some, or all, of 
their Medicare home health services for care in an adult day care 
center (ADC).
  The ADC would be paid the same rate that would have been paid for the 
service had it been delivered in the patient's home. In addition, the 
ADC would be required, with that one payment, to provide a full day of 
care to the patient at no additional cost to the Medicare program. That 
care would include the home health benefit as well as transportation, 
meals, medication management, and a program of supervised activities.
  The ADC is capable of providing these additional services at the same 
payment rate as home health care because 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.
  It is important to note that 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.
  To be eligible for this new 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.
  This legislation simply recognizes that adult day care facilities can 
provide the same health services with the added benefits of social 
interaction, activities, meals, and a therapeutic environment, in which 
a group of trained professionals can treat, monitor and support 
Medicare beneficiaries who would otherwise be monitored at home by a 
single caregiver. Rehabilitation is enhanced by such comprehensive 
care.
  Not only does ADC aid in the rehabilitation of the patient, it 
provides an added benefit to the family caregiver. When a beneficiary 
receives the Medicare home health benefit in the home, the provider 
does not remain there all day. They provide the service they are paid 
for and leave to treat their next patient.
  Because many frail seniors cannot be left alone for long periods of 
time, this prevents the caregiver from having a respite or being able 
to maintain employment outside of the home. If the senior could utilize 
ADC services, they would receive supervised care for the whole day and 
the caregiver would have the flexibility to maintain a job and/or be 
able to leave the home for longer periods of time.
  Adult day care centers are proving to be effective, and often 
preferable, altematives to complete confinement in the home. I urge my 
colleagues to cosponsor and support this important legislation.

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