Congresswoman Linda Sánchez

The Medicare Adult Day Care Services Act of 2009 (pdf), a bill that would expand options for home and community-based services, has been introduced into the U.S. House by Rep. Linda Sánchez (D-CA).

The bill would amend the Social Security Act to cover adult day care services under Medicare. Seniors and people with disabilities would then be able to choose whether to receive care at home or at an adult day care center.

Sánchez Spokeswoman Marsha Catron said the bill would give Medicare beneficiaries more services and care hours at an all-inclusive rate that’s lower than many providers currently offer. These services would include not only nursing but various therapies (physical, occupational, speech), social services and personal care, and meals, transportation and recreational activities.

“Adult day care is a family-friendly option for seniors who require rehabilitation and other assistance with daily life tasks, but don’t require 24-hour care,” Sánchez said in a press release. “The Medicare Adult Day Care Services Act is a cost-effective way to add more choice to Medicare because it would pay adult day care providers 98% of the home health rate and give our seniors the option to choose adult day care.”

Sánchez said the bill would also help family caregivers, the majority of whom are women from low-income families, by reducing the amount of wages, pension benefits, and Social Security benefits lost due to caregiving responsibilities. And it would do this without adding to the cost of Medicare.

For information about other recent HCBS-friendly legislation, see PHI’s stories on Project 2020 and the Home and Community Balancing Incentives Act.

“Project 2020: Building on the Promise of Home and Community-Based Services” was introduced on the Senate side as S. 1257 by Sens. Maria Cantwell (D-WA) and Debbie Stabenow (D-MI), both key members of the Senate Finance Committee. On the House side, Reps. Bruce L. Braley (D-IA) and John Sarbanes (D-MD), both members of the House Energy and Commerce Subcommittee on Health, introduced the companion bill H.R. 2852.

The bill’s stated purpose is “To amend the Social Security Act to build on the aging network to establish long-term services and supports through single-entry point systems, evidence-based disease prevention and health promotion programs, and enhanced nursing home diversion programs.”

Cantwell explained its intent in more detail in a June 12 press release:

This legislation is designed to fix a deficiency in current law that prevents people from accessing long-term care information or services until they have become poor enough to qualify for Medicaid.  By this time, it is often too late to provide cost-effective home care and people end up in nursing homes, where they frequently spend the rest of their lives. This bill would provide people with the resources they need to pay for the services and support they need to stay in their own homes and communities, while also avoiding Medicaid eligibility. This will save money and improve access to care.

These resources and services would include:

• Access for older adults to services that provide counseling and assistance regarding long-term care services and supports
• Wellness programs provided by Area Agencies on Aging for seniors
• Specific care plans intended to allow lower-income individuals to stay in the community and off Medicaid.

The legislation comes in the wake of an advocacy campaign by the Aging Services Network, and especially by the National Association of State Units on Aging (NASUA) and the National Association of Area Agencies on Aging (n4a). It has been the top legislative priority this year for both organizations, and was described by n4a in their 2009 statement of policy priorities (pdf) as “not a comprehensive long-term services and supports solution, but rather an obvious next step forward and a perfect complement to current health care reform efforts.”

Rep. Braley claimed the bill might save the federal government $1.2 billion over 10 years. He also stressed its importance to America’s senior population.

“Our seniors’ health and happiness is such an important issue,” he said in a prepared statement. “Nursing home care is often a necessary part of growing older, but if we can keep seniors and persons with disabilities healthier and in their homes longer, we can both improve their quality of life and save money. Project 2020 will make seniors’ golden years better.”

The bill was introduced on the same day that Sens. Cantwell and Herb Kohl (D-WI) introduced the “Home and Community Balancing Incentives Act,” which would offer enhanced federal Medicaid matching rates to states for home and community-based health care programs.

“PHI is pleased to see efforts in Congress to improve access to home and community-based services,” said PHI National Policy Director Steve Edelstein. “Providing these services, however, will require a commensurate workforce policy that can ensure a stable, well-trained direct-care workforce to meet the needs of growing numbers of older Americans and people with disabilities.”