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Home Health & Hospice Week

Day Care:

KNOW YOUR FACTS-ADULT DAY CARE DEMONSTRATION

Published on Tue Jun 21, 2005

The ball is rolling on Medicare's medical adult day care demonstration project. Here are the project vitals: 

  • What: A three-year demonstration project, mandated by the Medicare Modernization Act, allowing up to 15,000 home health patients to receive a portion of their plan-of-care services in an adult day care facility.
     
  • Who: Medicare-certified home health agencies and medical adult day care facilities that have been certified or licensed by their states for at least two years are eligible to participate. In choosing the participants, the Centers for Medicare & Medicaid Services will give preference to HHAs and day care facilities that are under common ownership and control. If common ownership doesn't exist, HHAs and facilities must at least have a contractual arrangement. CMS plans to choose a variety of providers of different sizes, areas and types.
     
  • Where: Thirty-six states license their day care facilities. CMS will choose five sites to participate, and one site can include multiple states covered by the company.
     
  • When: Applications are due Sept. 22, and CMS plans to start the demo next February.
     
  • How: HHAs will receive 95 percent of a patient's usual prospective payment system episode amount if the patient participates in the project. HHAs must pay the day care facility for the entire day of day care services. HHAs must perform the OASIS assessment in the patient's home, but they may furnish any portion of the rest of the services in the adult day care facility.
     
  • Why: The project will study a number of factors, including patients' outcomes, Medicare cost and utilization, and whether the services delay patient placement in institutions.

    CMS will score the applicants based on scope and delivery of services under the demonstration, soundness of the marketing plan, organizational capabilities, ability to implement the demonstration and quality assurance.

    Source: CMS demonstration documents at     www.cms.hhs.gov/researchers/demos/MADCS/default.asp and CMS special Open Door Forum, July 18.

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