[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2453 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 2453
To amend title XVIII of the Social Security Act to provide for coverage
under the Medicare Program of substitute adult day care services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 12, 2003
Mr. Kleczka (for himself and Mr. Stark) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addition
to the Committee on Energy and Commerce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for coverage
under the Medicare Program of substitute adult day care services.
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 Substitute Adult Day Care
Services Act of 2003''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Adult day care offers services, including medical care,
rehabilitation therapies, dignified assistance with activities
of daily living, nutrition therapy, health monitoring, social
interaction, stimulating activities, and transportation, to
seniors who are frail, physically challenged, or cognitively
impaired at no extra cost to the medicare program.
(2) The care given at adult day care centers 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, and nearly 1
in 4 American families provide 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
attributable to caregivers for aging or ailing seniors ranges
from $11,000,000,000 to $29,000,000,000 annually.
(7) Adult day care centers, located in every State in the
United States and the District of Columbia, serve as quality
health options to treat our Nation's elderly population, which
is about to dramatically increase with the aging of the baby
boomer generation.
SEC. 3. MEDICARE COVERAGE OF SUBSTITUTE ADULT DAY CARE SERVICES.
(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 paragraph (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) Transportation of the individual to and from the
adult day care facility in connection with any such item or
service.
``(iii) Meals.
``(iv) A program of supervised activities (that meets such
criteria as the Secretary determines appropriate) designed to
promote physical and mental health that are 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.
``(v) A medication management program (as defined in
subparagraph (C)).
``(C) For purposes of subparagraph (B)(v), the term `medication
management program' means a program of education and services (that
meets such criteria as the Secretary determines appropriate) 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 subparagraph (B), 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
assure 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) 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.
``(C) 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.
``(D) Nothing in this paragraph shall be construed as prohibiting a
home health agency from--
``(i) establishing a substitute adult day care facility; or
``(ii) providing services under arrangements with a
substitute adult day care facility.''.
(3) Conforming amendments.--Sections 1814(a)(2)(C) and
1835(a)(2)(A)(i) of the Social Security Act (42
U.S.C.1395f(a)(2)(C) and 1395n(a)(2)(A)(i)) are each amended by
striking ``section 1861(m)(7)'' and inserting ``paragraph (7)
or (8) of section 1861(m)''.
(b) Payment for Substitute Adult Day Care Services Under the Home
Health Prospective Payment System.--Section 1895 of the Social Security
Act (42 U.S.C. 1395fff) is amended--
(1) in the first sentence of paragraph (b)(1), by inserting
after ``home health services'' the following: ``or home health
services consisting of substitute adult day care services.'';
and
(2) by adding at the end the following new subsection:
``(f) Payment Rate and Limitation on Payment for Substitute Adult
Day Care Services.--
``(1) Payment rate.--
``(A) In general.--The Secretary shall determine
each component (as defined by the Secretary) of
substitute adult day care services (under section
1861(ww)(1)(B)(i)) furnished to an individual under the
plan of care established under section 1861(m) with
respect to such services.
``(B) Estimation of payment amount.--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 week or other period specified by
the Secretary.
``(C) Amount of payment.--The total amount payable
for home health services consisting of substitute adult
day care services under such plan of care is equal to
the amount estimated to be payable under subparagraph
(B) furnished under the plan by a home health agency.
``(2) Limitations.--
``(A) In general.--With respect to home health
services consisting of substitute adult day care
services, no payment may be made under this section for
home health services consisting of substitute adult day
care services described in clauses (ii) through (v) of
section 1861(ww)(1)(B).
``(B) Limitation on balance billing.--An adult day
care facility shall accept as payment in full for
substitute adult day care services (including those
services described in clauses (ii) through (v) 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 section for home
health services consisting of substitute adult day care
services.''.
(c) Consolidated Billing.--Section 1862(a) of such Act (42 U.S.C.
1395y(a)), is amended--
(1) by striking ``or'' at the end of paragraph (20),
(2) by striking the period at the end of paragraph (21) and
inserting ``; or'', and
(3) by inserting after paragraph (21) the following new
paragraph:
``(22) which are substitute adult day care services for
which payment may be made under section 1895(f) and which are
furnished to an individual by a substitute adult day care
facility pursuant to a plan of care established under section
1861(m) with respect to such services, by an entity other than
the substitute adult day care facility, unless the services are
furnished under arrangements (as defined in section 1861(w)(1))
with the entity made by the substitute adult day care
facility.''.
(d) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2004.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsor introductory remarks on measure. (CR E1239)
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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