,i #aacth ,,congress #ast ,session ,h4 ,r4 #cccd ,,in ,,the ,,house ,,of ,,representatives ,october #bc1 #bjac,ms4 ,linda ,t4 ,snchez of ,california 7for herself1 ,ms4 ,eddie ,bernice ,johnson of ,texas1 ,mr4 ,blumenauer1 ,ms4 ,bordallo1 ,mr4 ,carson of ,indiana1 ,mr4 ,cartwright1 ,ms4 ,clarke1 ,mr4 ,conyers1 ,mr4 ,danny ,k4 ,davis of ,illinois1 ,ms4 ,frankel of ,florida1 ,ms4 ,norton1 ,ms4 ,jackson ,lee1 ,mr4 ,langevin1 ,mr4 ,loebsack1 ,mr4 ,lowenthal1 ,ms4 ,michelle ,lujan ,grisham of ,new ,mexico1 ,mr4 ,michaud1 ,mrs4 ,napolitano1 ,mr4 ,rangel1 ,ms4 ,roybal-,allard1 ,ms4 ,schakowsky1 ,ms4 ,schwartz1 and ,ms4 ,waters7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 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 of certified adult day services under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,medicare ,adult ,day ,services ,act of #bjac4 #b4 ,findings ,congress makes the following findings3 7#a7 ,adult day care can offer services1 including medical care1 rehabilitation therapies1 dignified assistance with activities of daily living1 nutrition therapy1 health monitoring1 social interaction1 stimulating activities1 and transportation1 to seniors and people with disabilities at no extra cost to the ,medicare program4 7#b7 ,the care given at adult day services centers under an interdisciplinary team provides seniors1 people with disabilities1 and their familial caregivers with more care hours and additional services that are critical to keeping patients healthier and in the homes of the patients instead of in a nursing home1 and reduces the risk of hospital admission or readmission4 #c4 ,medicare coverage of certified adult day services 7a7 ,medicare certified adult day services benefit 7#a7 ,definition ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7iii7 ,certified adult day services2 adult day services provider2 certified adult day services center2 post-,institutional certified adult day services2 certified adult day services spell of illness 7#a7 7,a7 ,the term certified adult day services means1 subject to paragraph 7#d71 the items and services described in subparagraph 7,b7 that are furnished to an individual who is under the care of a physician-- 7i7 by an adult day services provider 7as defined in paragraph 7#b77 or by another entity under an arrangement with such an adult day services provider to provide such services2 7ii7 in accordance with a plan 7for furnishing such items and services to such individual7 approved and periodically reviewed by such physician2 and 7iii7 in a certified adult day services center 7as defined in paragraph 7#c774 7,b7 ,for purposes of subparagraph 7,a71 the items and services described in this subparagraph are the following3 7i7 ,part-time or intermittent services 7as defined in subparagraph 7,c77i77 provided by or under the supervision of a registered professional nurse4 7ii7 ,physical or occupational therapy or speech-language pathology services1 or any combination of such services4 7iii7 ,medical social services under the direction of a physician4 7iv7 ,nutritional meals1 including special diets1 as ordered by a physician4 7v7 ,a program of supervised activities 7that meets such criteria as the ,secretary determines appropriate7 designed to promote physical and mental health that are furnished in a group setting for a period of not fewer than #d and not greater than #h hours per day4 7vi7 ,a medication management program 7as defined in subparagraph 7,c77ii774 7vii7 ,medical supplies 7including catheters1 catheter supplies1 ostomy bags1 and supplies related to ostomy care1 and a covered osteoporosis drug 7as defined in subsection 7kk771 but excluding other drugs and biologicals7 and durable medical equipment4 7viii7 ,transportation of the individual described in subparagraph 7,a7 to and from a certified adult day services center in connection with the provision of an item or service described in a previous provision of this subparagraph4 7,c7 7i7 ,for purposes of subparagraph 7,b77i71 the term part-time or intermittent services means certified adult day services furnished any number of days per week as long as such services are furnished fewer than #h hours each day4 ,for purposes of sections #ahad7;a77#b77;,c7 and #ahce7;a77#b77;,a71 insofar as such respective section relates to certified adult day services1 intermittent means certified adult day services that are either provided or needed on fewer than #g days each week1 or less than #h hours of each day for periods of #ba days or less 7with extensions in exceptional circumstances when the need for additional care is finite and predictable74 7ii7 ,for purposes of subparagraph 7,b77vi71 the term medication management program means a program of education and services 7that meets such criteria as the ,secretary determines appropriate7 to minimize-- 7,i7 unnecessary or inappropriate use of prescription drugs2 and 7,,ii7 adverse events due to unintended prescription drug-to-drug interactions4 7#b7 ,the term adult day services provider means a provider of home and community-based services that is approved in the applicable ,state to provide long-term services and supports1 which may include nursing care1 physical therapy1 occupational therapy1 social work services1 transportation1 and personal care services4 7#c7 ,the term certified adult day services center means a facility-- 7,a7 of a public agency or private organization1 or a subdivision of such an agency or organization1 that-- 7i7 is primarily engaged in providing an interdisciplinary approach that includes skilled nursing services and other therapeutic services directly2 7ii7 has policies1 established by a group of professional personnel 7associated with the agency or organization71 including one or more physicians and one or more registered professional nurses1 to govern the services 7referred to in subparagraph 7,a77 which it provides1 and provides for supervision of such services2 7iii7 maintains clinical records on all patients2 7iv7 in the case of an agency or organization in any ,state in which ,state or applicable local law provides for the licensing or certification of agencies or organizations of this nature1 7i7 is licensed or certified pursuant to such law1 or 7ii7 is approved1 by the agency of such ,state or locality responsible for licensing or certifying agencies or organizations of this nature1 as meeting the standards established for such licensing or certification2 7v7 is licensed or certified by the ,state involved or accredited as meeting requirements1 including under section #ahfe1 through a nationally recognized accrediting agency that is recognized by the ,secretary2 7vi7 has in effect an overall plan and budget that meets the requirements of subsection 7z72 7vii7 meets applicable conditions of participation under section #ahia7;a7 7or similar conditions specified by the ,secretary as applicable to such an agency or organization7 and such other conditions of participation as the ,secretary may find necessary in the interest of the health and safety of individuals who are furnished services by such agency or organization2 and 7viii7 meets such additional requirements 7including conditions relating to bonding or establishing of escrow accounts as the ,secretary finds necessary for the financial security of the program7 as the ,secretary finds necessary for the effective and efficient operation of the program2 7,b7 at which such agency or organization provides for items and services described in paragraph 7#a77;,b72 and 7,c7 that complies with all applicable ,state and local building codes1 fire codes1 zoning laws1 and ,state licensing building standards that apply to a ,state licensed or certified or nationally accredited adult day center1 and in ,states where there are no ,state licensing building standards for adult day centers1 building standards based on the standards adopted by a nationally recognized accrediting agency that is recognized by the ,secretary and applies to such a center standards that are comparable to the requirements applied to a skilled nursing facility pursuant to section #ahai7;d77#b77;,b74 7#d7 ,for purposes of paragraph 7#a77;,a71 an item or service furnished to an individual1 with respect to a period1 shall not be considered an adult day service if-- 7,a7 the individual is-- 7i7 concurrently receiving similar skilled services under a ,state plan under section #aije7;a7 or under a home and community-based waiver authorized for a ,state under section #aaae1 under subsection 7c7 or 7d7 of section #aiae1 under a ,state plan amendment under subsection 7i7 of section #aiae1 or under section #aijb7;a77#aj77;,d72 and 7ii7 receiving such item or service during such period under such ,state plan1 waiver1 amendment1 or respective section2 or 7,b7 the individual is receiving such item or service during such period pursuant to a plan of care from a home health agency under section #ahfa7m74 7#e7 ,nothing in this subsection shall be construed as prohibiting a home health agency from-- 7,a7 establishing a ,state licensed or certified or nationally accredited certified adult day services center and furnishing certified adult day services2 or 7,b7 providing services under arrangements with such a center4 7#f7 ,the term post-institutional certified adult day services means certified adult day services furnished to an individual-- 7,a7 after discharge from a hospital or critical access hospital in which the individual was an inpatient for not less than #c consecutive days before such discharge if such certified adult day services were initiated within #ad days after the date of such discharge2 or 7,b7 after discharge from a skilled nursing facility in which the individual was provided post-hospital extended care services if such certified adult day services were initiated within #ad days after the date of such discharge4 7#g7 ,the term certified adult day services spell of illness with respect to any individual means a period of consecutive days-- 7,a7 beginning with the first day 7not included in a previous certified adult day services spell of illness7-- 7i7 on which such individual is furnished post-institutional certified adult day services2 and 7ii7 which occurs in a month for which the individual is entitled to benefits under part ,a2 and 7,b7 ending with the close of the first period of #fj consecutive days thereafter on each of which the individual is neither an inpatient of a hospital or critical access hospital nor an inpatient of a facility described in section #ahai7;a77#a7 or subsection 7y77#a7 nor provided home health services or certified adult day services4 4 7#b7 ,inclusion under part ,b benefit ,section #ahcb7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77 is amended-- 7,a7 in subparagraph 7,i71 by striking at the end and2 7,b7 in subparagraph 7,j71 by striking at the end the period and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,k7 certified adult day services 7as defined in section #ahfa7;iii77#a77;,a774 4 7#c7 ,inclusion under part ,a benefit ,section #ahab7;a7 of the ,social ,security ,act is amended-- 7,a7 in paragraph 7#d71 by striking at the end and2 7,b7 in paragraph 7#e71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new paragraph3 7#f7 in the case of individuals not enrolled in part ,b1 certified adult day services 7as defined in paragraph 7#a77;,a7 of section #ahfa7;iii771 and in the case of individuals so enrolled1 post-institutional certified adult day services 7as defined in paragraph 7#f7 of such section7 furnished during a certified adult day services spell of illness 7as defined in paragraph 7#g7 of such section7 for up to #ajj visits during such spell of illness4 4 7b7 ,payment of claims requirements for home health services applied to certified adult day services 7#a7 ,part ,a ,section #ahad7;a77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#b77;,c77 is amended by inserting or certified adult day services after each occurrence of home health services4 7#b7 ,part ,b ,section #ahce7;a77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acien7a77#b77;,a77 is amended-- 7,a7 in the matter preceding clause 7i71 by inserting or certified adult day services 7as defined in section #ahfa7;iii77#a77;,a77 after home health services2 and 7,b7 in clause 7i71 by inserting or certified adult day services after home health services4 7c7 ,conforming amendments 7#a7 ,interaction with coverage of home health services ,section #ahfa7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7m77 is amended by adding at the end the following new sentence3 ,an individual described in this subsection1 with respect to home health services furnished during a period1 shall not include an individual who is receiving comparable certified adult day services 7as defined in section #ahfa7;iii77#a77 during such period44 7#b7 ,intermittent services ,section #ahfa7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7m77 is amended in the last sentence by inserting insofar as such respective section relates to home health services1 after section #ahce7;a77#b77;,a714 7#c7 ,institutional planning requirement ,section #ahfa7z7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7z77 is amended in the matter preceding paragraph 7#a71 by striking or home health agency and inserting home health agency1 or certified adult day services center4 7#d7 ,inclusion as provider of services ,section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u77 is amended by inserting certified adult day services center1 after home health agency14 7d7 ,payment for certified adult day services under the home health prospective payment system ,section #ahie of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7 is amended by adding at the end the following new subsection3 7f7 ,application of home health prospective payment system to certified adult day services 7#a7 ,in general ,the ,secretary shall1 in accordance with this subsection1 develop a methodology under which the fee schedule and provisions under this section shall apply to certified adult day services 7as defined in section #ahfa7;iii77#a77 in a similar manner to which such schedule and provisions apply to home health services4 7#b7 ,payment rate determination and limitations ,under such methodology1 the following shall apply1 with respect to certified adult day services furnished to an individual during a period specified by the ,secretary under a plan of care established under section #ahfa7;iii7 for which payment may be made under this title3 7,a7 ,determination of components ,the ,secretary shall determine each component 7as defined by the ,secretary7 of such certified adult day services4 7,b7 ,estimation of payment amount ,the ,secretary shall estimate the amount that would otherwise be payable under this section for the components of services determined under subparagraph 7,a7 if such services were furnished by a home health agency 7or1 if such component or service would not otherwise be so payable under this section if so furnished1 the amount that would be payable under this section for a comparable home health service furnished by a home health agency7 during such period4 7,c7 ,amount of payment ,the total amount payable under this section for such certified adult day services furnished to such individual during such period shall be #ih percent of the amount estimated to be payable for such services 7or comparable services7 under subparagraph 7,b7 for such period4 7,d7 ,limitation ,no payment may be made under this section for certified adult day services described in clauses 7iv7 through 7vi7 and 7ix7 of section #ahfa7;iii77#a77;,a74 7#c7 ,limitation on balance billing ,a certified adult day services center shall accept as payment in full for certified adult day services described in clauses 7i7 through 7iii71 7vii7 through 7viii71 and 7x7 through 7xii7 of section #ahfa7;iii77#a77;,a7 furnished by the center to an individual entitled to benefits under this title the amount of payment provided under this section for home health services consisting of items and services described in such respective clauses4 4 7e7 ,consolidated billing ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is amended-- 7#a7 by striking or at the end of paragraph 7#bd72 7#b7 by striking the period at the end of paragraph 7#be7 and inserting1 or2 and 7#c7 by inserting after paragraph 7#be7 the following new paragraph3 7#bf7 which are certified adult day services for which payment may be made under section #ahie7;f7 and which are furnished to an individual by a ,state licensed or certified or nationally accredited certified adult day services center pursuant to a plan of care established under section #ahfa7;iii7 with respect to such services1 by an entity other than such facility1 unless the services are furnished under arrangements 7as defined in section #ahfa7w77#a77 with the entity made by such facility4 4 7f7 ,temporary increase for certified adult day services furnished in a rural area 7#a7 ,in general ,with respect to episodes and visits ending on or after ,january #a1 #bjad1 and before ,january #a1 #bjaf1 in the case of certified adult day services 7as defined in section #ahfa7;iii77#a77;,a7 of the ,social ,security ,act1 as added by subsection 7a771 furnished in a rural area 7as defined in section #ahhf7;d77#b77;,d7 of such ,act 7#db ,u4,s4,c4 #acieww7d77#b77;,d7771 the ,secretary of ,health and ,human ,services shall increase the payment amount otherwise made under section #ahie of such ,act 7#db ,u4,s4,c4 #acie;fff7 for such services by #c percent4 7#b7 ,waiving budget neutrality ,the ,secretary shall not reduce the standard prospective payment amount 7or amounts7 under section #ahie of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7 applicable to such certified adult day services furnished during a period to offset the increase in payments resulting from the application of paragraph 7#a74 7#c7 ,no effect on subsequent periods ,the payment increase provided under paragraph 7#a7 for a period under such paragraph-- 7,a7 shall not apply to episodes and visits ending after such period2 and 7,b7 shall not be taken into account in calculating the payment amounts applicable for episodes and visits occurring after such period4 7g7 ,adult day services provider technical assistance ,in order to facilitate the development of certified adult day services under title ,,xviii of the ,social ,security ,act1 the ,secretary of ,health and ,human ,services shall1 as deemed necessary by the ,secretary1 provide adult day services providers 7as defined in section #ahfa7;iii77#b7 of such ,act7 with technical assistance1 consultation1 tools1 and other resources to assist them with the application process and implementation of certified adult day services 7as defined in such section74 7h7 ,effective date ,the amendments made by this section shall apply to items and services furnished on or after ,january #a1 #bjad4