,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #djfc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #be1 #bjai,ms4  
,sn*ez 7= h]self1 ,mr4 ,coh51 ,ms4 ,m5g1
 & ,ms4 ,roybal-,all>d7 introduc$ !     
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,ways & ,means1 & 9       
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to provide =     
cov]age ( c]tifi$ adult day s]vices "u !
 ,m$ic>e program1 & = o!r purposes4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,m$ic>e ,adult ,day ,s]vices ,act (     
#bjai4  #b4 ,f9d+s ,congress makes !    
foll[+ f9d+s3  7#a7 ,adult day c>e c (f]
 s]vices1 includ+ m$ical c>e1           
rehabilitation !rapies1 dignifi$        
assi/ance ) activities ( daily liv+1    
nutrition !rapy1 heal? monitor+1 social 
int]action1 /imulat+ activities1 &      

transportation1 to s5iors & p )         
disabilities at no extra co/ to !       
,m$ic>e program4  7#b7 ,! c>e giv5 at   
adult day s]vices c5t]s "u an           
int]discipl9>y team provides s5iors1 p )
 disabilities1 & _! familial c>egiv]s ) 
m c>e h\rs & additional s]vices t are   
critical to keep+ pati5ts heal?i] & 9 ! 
homes ( ! pati5ts in/ead ( 9 a nurs+    
home1 & r$uces ! risk ( hospital        
admission or readmission4  #c4 ,m$ic>e  
cov]age ( c]tifi$ adult day s]vices  7a7
 ,m$ic>e c]tifi$ adult day s]vices      
b5efit  7#a7 ,def9ition ,section #ahfa (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciex7 is am5d$ by add+ at ! end !    
foll[+ new subsection3  7kkk7 ,c]tifi$  
adult day s]vices2 adult day s]vices    
provid]2 c]tifi$ adult day s]vices c5t]2
 po/-,in/itutional c]tifi$ adult day    
s]vices2 c]tifi$ adult day s]vices spell
 ( illness  7#a7  7,a7 ,! t]m c]tifi$   
adult day s]vices means1 subject to     
p>agraph 7#d71 ! items & s]vices        
describ$ 9 subp>agraph 7,b7 t are       

furni%$ to an individual :o is "u ! c>e 
( a physician--  7i7 by an adult day    
s]vices provid] 7z def9$ 9 p>agraph     
7#b77 or by ano!r entity "u an          
arrangem5t ) su* an adult day s]vices   
provid] to provide su* s]vices2  7ii7 9 
accordance ) a plan 7= furni%+ su* items
 & s]vices to su* individual7 approv$ & 
p]iodically review$ by su* physician2 & 
7iii7 9 a c]tifi$ adult day s]vices c5t]
 7z def9$ 9 p>agraph 7#c774  7,b7 ,=    
purposes ( subp>agraph 7,a71 ! items &  
s]vices describ$ 9 ?is subp>agraph are !
 foll[+3  7i7 ,"p-"t or int]mitt5t      
s]vices 7z def9$ 9 subp>agraph 7,c77i77 
provid$ by or "u ! sup]vision ( a       
regi/]$ pr(essional nurse4  7ii7        
,physical or occupational !rapy or      
spee*-language pa?ology s]vices1 or any 
comb9ation ( su* s]vices4  7iii7 ,m$ical
 social s]vices "u ! direction ( a      
physician4  7iv7 ,nutritional meals1    
includ+ special diets1 z ord]$ by a     
physician4  7v7 ,a program ( sup]vis$   
activities 7t meets su* crit]ia z !     

,secret>y det]m9es appropriate7 design$ 
to promote physical & m5tal heal? t are 
furni%$ 9 a gr\p sett+ = a p]iod ( n    
few] ?an #d & n great] ?an #h h\rs p]   
day4  7vi7 ,a m$ication managem5t       
program 7z def9$ 9 subp>agraph          
7,c77ii774  7vii7 ,m$ical supplies      
7includ+ ca!t]s1 ca!t] supplies1 o/omy  
bags1 & supplies relat$ to o/omy c>e1 & 
a cov]$ o/eoporosis drug 7z def9$ 9     
subsection 7kk771 b exclud+ o!r drugs & 
biologicals7 & durable m$ical equipm5t4 
7viii7 ,transportation ( ! individual   
describ$ 9 subp>agraph 7,a7 to & f a    
c]tifi$ adult day s]vices c5t] 9        
connection ) ! provision ( an item or   
s]vice describ$ 9 a previ\s provision ( 
?is subp>agraph4  7,c7  7i7 ,= purposes 
( subp>agraph 7,b77i71 ! t]m "p-"t or   
int]mitt5t s]vices means c]tifi$ adult  
day s]vices furni%$ any numb] ( days p] 
week z long z su* s]vices are furni%$   
few] ?an #h h\rs ea* day4 ,= purposes ( 
sections #ahad7;a77#b77;,c7 &           
#ahce7;a77#b77;,a71 ins(> z su*         

respective section relates to c]tifi$   
adult day s]vices1 int]mitt5t means     
c]tifi$ adult day s]vices t are ei!r    
provid$ or ne$$ on few] ?an #g days ea* 
week1 or less ?an #h h\rs ( ea* day =   
p]iods ( #ba days or less 7) ext5sions 9
 exceptional circum/ances :5 ! ne$ =    
additional c>e is f9ite & pr$ictable74  
7ii7 ,= purposes ( subp>agraph 7,b77vi71
 ! t]m m$ication managem5t program means
 a program ( education & s]vices 7t     
meets su* crit]ia z ! ,secret>y det]m9es
 appropriate7 to m9imize--  7,i7        
unnecess>y or inappropriate use (       
prescription drugs2 &  7,,ii7 adv]se    
ev5ts due to un9t5d$ prescription       
drug-to-drug int]actions4  7#b7 ,! t]m  
adult day s]vices provid] means a       
provid] ( home & community-bas$ s]vices 
t is approv$ 9 ! applicable ,/ate to    
provide long-t]m s]vices & supports1 :i*
 may include nurs+ c>e1 physical !rapy1 
occupational !rapy1 social "w s]vices1  
transportation1 & p]sonal c>e s]vices4  
7#c7 ,! t]m c]tifi$ adult day s]vices   

c5t] means a facility-- 7,a7 ( a public 
ag5cy or private organization1 or a     
subdivision ( su* an ag5cy or           
organization1 t--  7i7 is prim>ily      
engag$ 9 provid+ an int]discipl9>y      
approa* t includes skill$ nurs+ s]vices 
& o!r !rapeutic s]vices directly2  7ii7 
has policies1 e/abli%$ by a gr\p (      
pr(essional p]sonnel 7associat$ ) !     
ag5cy or organization71 includ+ "o or m 
physicians & "o or m regi/]$ pr(essional
 nurses1 to gov]n ! s]vices 7ref]r$ to 9
 subp>agraph 7,a77 :i* x provides1 &    
provides = sup]vision ( su* s]vices2    
7iii7 ma9ta9s cl9ical records on all    
pati5ts2  7iv7 9 ! case ( an ag5cy or   
organization 9 any ,/ate 9 :i* ,/ate or 
applicable local law provides = ! lic5s+
 or c]tification ( ag5cies or           
organizations ( ?is nature1 7i7 is      
lic5s$ or c]tifi$ pursuant to su* law1  
or 7ii7 is approv$1 by ! ag5cy ( su*    
,/ate or locality responsible = lic5s+  
or c]tify+ ag5cies or organizations (   
?is nature1 z meet+ ! /&>ds e/abli%$ =  

su* lic5s+ or c]tification2  7v7 is     
lic5s$ or c]tifi$ by ! ,/ate involv$ or 
accr$it$ z meet+ requirem5ts1 includ+ "u
 section #ahfe1 ?r\gh a nationally      
recogniz$ accr$it+ ag5cy t is recogniz$ 
by ! ,secret>y2  7vi7 has 9 effect an   
ov]all plan & budget t meets !          
requirem5ts ( subsection 7z72  7vii7    
meets applicable conditions (           
p>ticipation "u section #ahia7;a7 7or   
simil> conditions specifi$ by !         
,secret>y z applicable to su* an ag5cy  
or organization7 & su* o!r conditions ( 
p>ticipation z ! ,secret>y may f9d      
necess>y 9 ! int]e/ ( ! heal? & safety (
 individuals :o are furni%$ s]vices by  
su* ag5cy or organization2 &  7viii7    
meets su* additional requirem5ts        
7includ+ conditions relat+ to bond+ or  
e/abli%+ ( escr[ acc\nts z ! ,secret>y  
f9ds necess>y = ! f9ancial security ( ! 
program7 z ! ,secret>y f9ds necess>y = !
 effective & effici5t op]ation ( !      
program2  7,b7 at :i* su* ag5cy or      
organization provides = items & s]vices 

describ$ 9 p>agraph 7#a77;,b72 &  7,c7 t
 complies ) all applicable ,/ate & local
 build+ codes1 fire codes1 zon+ laws1 & 
,/ate lic5s+ build+ /&>ds t apply to a  
,/ate lic5s$ or c]tifi$ or nationally   
accr$it$ adult day c5t]1 & 9 ,/ates :]e 
!re are no ,/ate lic5s+ build+ /&>ds =  
adult day c5t]s1 build+ /&>ds bas$ on ! 
/&>ds adopt$ by a nationally recogniz$  
accr$it+ ag5cy t is recogniz$ by !      
,secret>y & applies to su* a c5t] /&>ds 
t are comp>able to ! requirem5ts appli$ 
to a skill$ nurs+ facility pursuant to  
section #ahai7;d77#b77;,b74  7#d7 ,=    
purposes ( p>agraph 7#a77;,a71 an item  
or s]vice furni%$ to an individual1 )   
respect to a p]iod1 %all n be consid]$  
an adult day s]vice if--  7,a7 !        
individual is-- 7i7 concurr5tly receiv+ 
simil> skill$ s]vices "u a ,/ate plan "u
 section #aije7;a7 or "u a home &       
community-bas$ waiv] au?oriz$ = a ,/ate 
"u section #aaae1 "u subsection 7c7 or  
7d7 ( section #aiae1 "u a ,/ate plan    
am5dm5t "u subsection 7i7 ( section     

#aiae1 or "u section                    
#aijb7;a77#aj77;,d72 &  7ii7 receiv+ su*
 item or s]vice dur+ su* p]iod "u su*   
,/ate plan1 waiv]1 am5dm5t1 or          
respective section2 or  7,b7 !          
individual is receiv+ su* item or s]vice
 dur+ su* p]iod pursuant to a plan ( c>e
 f a home heal? ag5cy "u section        
#ahfa7m74  7#e7 ,no?+ 9 ?is subsection  
%all be con/ru$ z prohibit+ a home heal?
 ag5cy f-- 7,a7 e/abli%+ a ,/ate lic5s$ 
or c]tifi$ or nationally accr$it$       
c]tifi$ adult day s]vices c5t] & furni%+
 c]tifi$ adult day s]vices2 or  7,b7    
provid+ s]vices "u arrangem5ts ) su* a  
c5t]4  7#f7 ,! t]m po/-in/itutional     
c]tifi$ adult day s]vices means c]tifi$ 
adult day s]vices furni%$ to an         
individual--  7,a7 aft] dis*>ge f a     
hospital or critical access hospital 9  
:i* ! individual 0 an inpati5t = n less 
?an #c consecutive days be=e su* dis*>ge
 if su* c]tifi$ adult day s]vices 7     
initiat$ )9 #ad days aft] ! date ( su*  
dis*>ge2 or  7,b7 aft] dis*>ge f a      

skill$ nurs+ facility 9 :i* ! individual
 0 provid$ po/-hospital ext5d$ c>e      
s]vices if su* c]tifi$ adult day s]vices
 7 initiat$ )9 #ad days aft] ! date (   
su* dis*>ge4  7#g7 ,! t]m c]tifi$ adult 
day s]vices spell ( illness ) respect to
 any individual means a p]iod (         
consecutive days-- 7,a7 beg9n+ ) ! fir/ 
day 7n includ$ 9 a previ\s c]tifi$ adult
 day s]vices spell ( illness7--  7i7 on 
:i* su* individual is furni%$           
po/-in/itutional c]tifi$ adult day      
s]vices2 &  7ii7 :i* occurs 9 a mon? =  
:i* ! individual is entitl$ to b5efits  
"u "p ,a2 &  7,b7 end+ ) ! close ( !    
fir/ p]iod ( #fj consecutive days       
!reaft] on ea* ( :i* ! individual is    
nei!r an inpati5t ( a hospital or       
critical access hospital nor an inpati5t
 ( a facility describ$ 9 section        
#ahai7;a77#a7 or subsection 7y77#a7 nor 
provid$ home heal? s]vices or c]tifi$   
adult day s]vices4  4  7#b7 ,inclusion  
"u "p ,b b5efit ,section #ahcb7;a77#b7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4

 #aciek7a77#b77 is am5d$-- 7,a7 9       
subp>agraph 7,i71 by /rik+ at ! end &2  
7,b7 9 subp>agraph 7,j71 by /rik+ at !  
end ! p]iod & ins]t+ &2 &  7,c7 by add+ 
at ! end ! foll[+ new subp>agraph3  7,k7
 c]tifi$ adult day s]vices 7z def9$ 9   
section #ahfa7kkk77#a77;,a774  4  7#c7  
,inclusion "u "p ,a b5efit ,section     
#ahab7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;d7a77 is am5d$--   
7,a7 9 p>agraph 7#d71 by /rik+ at ! end 
&2  7,b7 9 p>agraph 7#e71 by /rik+ !    
p]iod at ! end & ins]t+ &2 &  7,c7 by   
add+ at ! end ! foll[+ new p>agraph3    
7#f7 9 ! case ( individuals n enroll$ 9 
"p ,b1 c]tifi$ adult day s]vices 7z     
def9$ 9 p>agraph 7#a77;,a7 ( section    
#ahfa7kkk771 & 9 ! case ( individuals s 
enroll$1 po/-in/itutional c]tifi$ adult 
day s]vices 7z def9$ 9 p>agraph 7#f7 (  
su* section7 furni%$ dur+ a c]tifi$     
adult day s]vices spell ( illness 7z    
def9$ 9 p>agraph 7#g7 ( su* section7 =  
up to #ajj visits dur+ su* spell (      
illness4  4  7b7 ,paym5t ( claims       

requirem5ts = home heal? s]vices appli$ 
to c]tifi$ adult day s]vices  7#a7 ,"p  
,a ,section #ahad7;a77#b77;,c7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;f7a77#b77;,c77 is am5d$ by ins]t+ 
or c]tifi$ adult day s]vices aft] ea*   
occurr5ce ( home heal? s]vices4  7#b7   
,"p ,b ,section #ahce7;a77#b77;,a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acien7a77#b77;,a77 is am5d$--  7,a7 9 !
 matt] prec$+ clause 7i71 by ins]t+ or  
c]tifi$ adult day s]vices 7z def9$ 9    
section #ahfa7kkk77#a77;,a77 aft] home  
heal? s]vices2 &  7,b7 9 clause 7i71 by 
ins]t+ or c]tifi$ adult day s]vices aft]
 home heal? s]vices4  7c7 ,con=m+       
am5dm5ts  7#a7 ,int]mitt5t s]vices      
,section #ahfa7m7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciex7m77 is am5d$ 
9 ! la/ s5t5ce by ins]t+ ins(> z su*    
respective section relates to home heal?
 s]vices1 aft] section                  
#ahce7;a77#b77;,a714  7#b7 ,int]action )
 cov]age ( home heal? s]vices ,section  
#ahfa7m7 ( ! ,social ,security ,act 7#db

 ,u4,s4,c4 #aciex7m771 z am5d$ by       
p>agraph 7#a71 is am5d$ by add+ at ! end
 ! foll[+ new s5t5ce3 ,an individual    
describ$ 9 ?is subsection1 ) respect to 
home heal? s]vices furni%$ dur+ a p]iod1
 %all n include an individual :o is     
receiv+ comp>able c]tifi$ adult day     
s]vices 7z def9$ 9 section              
#ahfa7kkk77#a77 dur+ su* p]iod44  7#c7  
,in/itutional plann+ requirem5t ,section
 #ahfa7z7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciex7z77 is am5d$ 9 !  
matt] prec$+ p>agraph 7#a71 by /rik+ or 
home heal? ag5cy & ins]t+ home heal?    
ag5cy1 or c]tifi$ adult day s]vices     
c5t]4  7#d7 ,inclusion z provid] (      
s]vices ,section #ahfa7u7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #aciex7u77
 is am5d$ by ins]t+ c]tifi$ adult day   
s]vices c5t]1 aft] home heal? ag5cy14   
7d7 ,paym5t = c]tifi$ adult day s]vices 
"u ! home heal? prospective paym5t sy/em
 ,section #ahie ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acie;fff7 is am5d$ 
by add+ at ! end ! foll[+ new           

subsection3  7f7 ,application ( home    
heal? prospective paym5t sy/em to       
c]tifi$ adult day s]vices  7#a7 ,9 g5]al
 ,! ,secret>y %all1 9 accordance ) ?is  
subsection1 develop a me?odology "u :i* 
! fee s*$ule & provisions "u ?is section
 %all apply to c]tifi$ adult day s]vices
 7z def9$ 9 section #ahfa7kkk77#a77 9 a 
simil> mann] to :i* su* s*$ule &        
provisions apply to home heal? s]vices4 
7#b7 ,paym5t rate det]m9ation &         
limitations ,"u su* me?odology1 ! foll[+
 %all apply1 ) respect to c]tifi$ adult 
day s]vices furni%$ to an individual    
dur+ a p]iod specifi$ by ! ,secret>y "u 
a plan ( c>e e/abli%$ "u section        
#ahfa7kkk7 = :i* paym5t may be made "u  
?is title3  7,a7 ,det]m9ation (         
compon5ts ,! ,secret>y %all det]m9e ea* 
compon5t 7z def9$ by ! ,secret>y7 ( su* 
c]tifi$ adult day s]vices4  7,b7        
,e/imation ( paym5t am\nt ,! ,secret>y  
%all e/imate ! am\nt t w\ld o!rwise be  
payable "u ?is section = ! compon5ts (  
s]vices det]m9$ "u subp>agraph 7,a7 if  

su* s]vices 7 furni%$ by a home heal?   
ag5cy 7or1 if su* compon5t or s]vice    
w\ld n o!rwise be s payable "u ?is      
section if s furni%$1 ! am\nt t w\ld be 
payable "u ?is section = a comp>able    
home heal? s]vice furni%$ by a home     
heal? ag5cy7 dur+ su* p]iod4  7,c7      
,am\nt ( paym5t ,! total am\nt payable  
"u ?is section = su* c]tifi$ adult day  
s]vices furni%$ to su* individual dur+  
su* p]iod %all be #ih p]c5t ( ! am\nt   
e/imat$ to be payable = su* s]vices 7or 
comp>able s]vices7 "u subp>agraph 7,b7 =
 su* p]iod4  7,d7 ,limitation ,no paym5t
 may be made "u ?is section = c]tifi$   
adult day s]vices describ$ 9 clauses    
7iv7 ?r\gh 7vi7 & 7ix7 ( section        
#ahfa7kkk77#a77;,a74  7#c7 ,limitation  
on balance bill+ ,a c]tifi$ adult day   
s]vices c5t] %all accept z paym5t 9 full
 = c]tifi$ adult day s]vices describ$ 9 
clauses 7i7 ?r\gh 7iii71 7vii7 ?r\gh    
7viii71 & 7x7 ?r\gh 7xii7 ( section     
#ahfa7kkk77#a77;,a7 furni%$ by ! c5t] to
 an individual entitl$ to b5efits "u ?is

 title ! am\nt ( paym5t provid$ "u ?is  
section = home heal? s]vices consi/+ (  
items & s]vices describ$ 9 su*          
respective clauses4  4  7e7 ,consolidat$
 bill+ ,section #ahfb7;a7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #aciey7a77
 is am5d$-- 7#a7 by /rik+ or at ! end ( 
p>agraph 7#bd72  7#b7 by /rik+ ! p]iod  
at ! end ( p>agraph 7#be7 & ins]t+1 or2 
&  7#c7 by ins]t+ aft] p>agraph 7#be7 ! 
foll[+ new p>agraph3  7#bf7 :i* are     
c]tifi$ adult day s]vices = :i* paym5t  
may be made "u section #ahie7;f7 & :i*  
are furni%$ to an individual by a ,/ate 
lic5s$ or c]tifi$ or nationally accr$it$
 c]tifi$ adult day s]vices c5t] pursuant
 to a plan ( c>e e/abli%$ "u section    
#ahfa7kkk7 ) respect to su* s]vices1 by 
an entity o!r ?an su* facility1 unless !
 s]vices are furni%$ "u arrangem5ts 7z  
def9$ 9 section #ahfa7w77#a77 ) ! entity
 made by su* facility4  4  7f7 ,tempor>y
 increase = c]tifi$ adult day s]vices   
furni%$ 9 a rural area  7#a7 ,9 g5]al ,)
 respect to episodes & visits end+ on or

 aft] ,janu>y #a1 #bjah1 & be=e ,janu>y 
#a1 #bjbj1 9 ! case ( c]tifi$ adult day 
s]vices 7z def9$ 9 section              
#ahfa7kkk77#a77;,a7 ( ! ,social         
,security ,act1 z add$ by subsection    
7a771 furni%$ 9 a rural area 7z def9$ 9 
section #ahhf7;d77#b77;,d7 ( su* ,act   
7#db ,u4,s4,c4 #acieww7d77#b77;,d7771 ! 
,secret>y ( ,heal? & ,human ,s]vices    
%all increase ! paym5t am\nt o!rwise    
made "u section #ahie ( su* ,act 7#db   
,u4,s4,c4 #acie;fff7 = su* s]vices by #c
 p]c5t4  7#b7 ,waiv+ budget neutrality  
,! ,secret>y %all n r$uce ! /&>d        
prospective paym5t am\nt 7or am\nts7 "u 
section #ahie ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;fff7 applicable to
 su* c]tifi$ adult day s]vices furni%$  
dur+ a p]iod to (fset ! increase 9      
paym5ts result+ f ! application (       
p>agraph 7#a74  7#c7 ,no effect on      
subsequ5t p]iods ,! paym5t increase     
provid$ "u p>agraph 7#a7 = a p]iod "u   
su* p>agraph-- 7,a7 %all n apply to     
episodes & visits end+ aft] su* p]iod2 &

  7,b7 %all n be tak5 into acc\nt 9     
calculat+ ! paym5t am\nts applicable =  
episodes & visits occurr+ aft] su*      
p]iod4  7g7 ,adult day s]vices provid]  
te*nical assi/ance ,9 ord] to facilitate
 ! developm5t ( c]tifi$ adult day       
s]vices "u title ,,xviii ( ! ,social    
,security ,act1 ! ,secret>y ( ,heal? &  
,human ,s]vices %all1 z deem$ necess>y  
by ! ,secret>y1 provide adult day       
s]vices provid]s 7z def9$ 9 section     
#ahfa7kkk77#b7 ( su* ,act7 ) te*nical   
assi/ance1 consultation1 tools1 & o!r   
res\rces to assi/ !m ) ! application    
process & implem5tation ( c]tifi$ adult 
day s]vices 7z def9$ 9 su* section74    
7h7 ,effective date ,! am5dm5ts made by 
?is section %all apply to items &       
s]vices furni%$ on or aft] ,janu>y #a1  
#bjbj4