| Home > 106th Congressional Bills > S. 2827 (is) To provide for the conveyance of the Department of Veterans Affairs Medical Center at Ft. Lyon, Colorado, to the State of Colorado, and for other purposes. [Introduced in Senate] ...
S. 2827 (is) To provide for the conveyance of the Department of Veterans Affairs Medical Center at Ft. Lyon, Colorado, to the State of Colorado, and for other purposes. [Introduced in Senate] ...
106th CONGRESS 2d Session S. 2826 To amend title XVIII of the Social Security Act to provide for coverage of substitute adult day care services under the medicare program. _______________________________________________________________________ IN THE SENATE OF THE UNITED STATES June 29, 2000 Mr. Santorum (for himself and Mr. Rockefeller) introduced the following bill; which was read twice and referred to the Committee on Finance _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to provide for coverage of substitute adult day care services under the medicare program. 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 2000''. SEC. 2. FINDINGS. Congress finds that-- (1) adult day care 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 care 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 care facilities provide continuity of care and an important sense of community for both the senior and the caregiver; (8) there are adult day care centers 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. COVERAGE OF SUBSTITUTE ADULT DAY CARE SERVICES UNDER MEDICARE. (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 (uu));''. (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 ``(uu)(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 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. ``(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 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 (v) of paragraph (1)(B) are provided by others under arrangements with them 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.''. (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); 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.--Section 1895 of the Social Security Act (42 U.S.C. 1395fff) is amended by adding at the end the following new subsection: ``(e) 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(uu)), the following rules apply: ``(1) The Secretary shall determine each component (as defined by the Secretary) of substitute adult day care services (under section 1861(uu)(1)(B)(i)) furnished to an individual under the plan of care established under section 1861(m) with respect to such services. ``(2) 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. ``(3) 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 (2) furnished under the plan by a home health agency. ``(4) No payment may be made under this title for home health services consisting of substitute adult day care services described in clauses (ii) through (v) of section 1861(uu)(1)(B).''. (c) Adjustment in Case of Overutilization of Substitute Adult Day Care Services.-- (1) Monitoring expenditures.--Beginning with fiscal year 2002, 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 the date on which the prospective payment system for home health services furnished under the medicare program under section 1895 of the Social Security Act (42 U.S.C. 1395fff) is established and implemented. <all>
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