Medicare Catastrophic Protection Act of 1987

Medicare Catastrophic Protection Act of 1987 - Title I: Provisions Relating to Part A of Medicare Program and Supplemental Medicare Premium - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to require that an inpatient hospital deductible be paid only for the first period of continuous hospitalization in a calendar year. (Currently, such deductible must be paid for each "spell of illness" requiring inpatient hospital services.) Removes durational limitations on the coverage of inpatient hospital services, except with respect to inpatient psychiatric hospital services. Eliminates the coinsurance requirement for inpatient hospital services.

Establishes the monthly part A premium, required of individuals who wish to buy into the Hospital Insurance program, at the monthly actuarial value of part A services provided to beneficiaries age 65 and over. Imposes a coinsurance rate, equal to 20 percent of the average per diem cost of post-hospital extended care services, for the first seven days of an individual's receipt of such services in a calendar year.

Provides coverage for post-hospital extended care services for 150 days in each calendar year. (Currently, such coverage is limited to 100 days for each "spell of illness.") Drops restrictions on the coverage of extended care services which are not post-hospital extended care services. Creates an extension period of hospice care for terminally ill beneficiaries which is to follow the two 90-day periods and the subsequent 30-day period of hospice care coverage currently provided in an individual's lifetime. Reduces the deductible imposed under part A on the first three pints of blood furnished to an individual during a calendar year to the extent such blood is replaced or a blood deductible has been imposed on the individual under part B (Supplementary Medical Insurance) of the Medicare program within such year. Provides part A coverage for home health services only when an individual is not entitled to part B benefits.

Amends the Internal Revenue Code to impose an annual supplemental Medicare premium on part A Medicare beneficiaries pursuant to a table which bases the amount of such premium due on the size of a beneficiary's gross income. Requires adjustments to such premium so that it covers 25 percent of the costs of covered outpatient drugs and related administrative costs. Directs the Secretary of Health and Human Services to make returns setting forth certain information regarding part A Medicare beneficiaries.

Title II: Provisions Relating to Part B of the Medicare Program and to Medicare Supplemental Health Insurance - Amends part B (Supplementary Medical Insurance) of the Medicare program to cover all of the out-of-pocket part B expenses a beneficiary incurs in excess of $1,043 in 1989, adjusting such ceiling annually thereafter to reflect cost-of-living increases. Requires Medicare carriers to provide individuals who have reached the out-of-pocket expense limit with a notice which may be presented to a physician and: (1) states that the individual has reached such limit; and (2) encourages the physician not to charge the individual in excess of the reasonable charge and to accept payment on an assigned basis for services furnished to the individual during the remainder of the year.

Provides coverage of the catastrophic expenses for outpatient prescription drugs and insulin (outpatient drugs) under part B of the Medicare program. Includes immunosuppressive drugs within such coverage if furnished to individuals within one year after their receipt of a covered organ transplant. Sets the annual deductible for such coverage at $500 for 1989, with adjustments of such deductible in 1990 and 1991 reflecting changes in the cost of medical care, and subsequent annual adjustments reflecting changes in the cost of outpatient drugs. Covers 80 percent of the costs in excess of such deductible provided the cost for each drug does not exceed payment limits based on the average cost for each drug. Authorizes the Secretary to deny payment for outpatient drugs which are prescribed or dispensed with excessive frequency or in excessive quantities. Directs the Secretary to: (1) establish a utilization review program for outpatient drugs to identify instances of unnecessary or inappropriate prescribing or dispensing practices and identify quality of care problems; and (2) develop, and update annually, an information guide concerning the comparative average wholesale prices of at least 500 of the most commonly prescribed outpatient drugs and mail such guide to Medicare hospitals and physicians by March 1 of each year.

Authorizes a pharmacy to enter into an agreement with the Secretary to accept payment under part B of the Medicare program on an assigned basis for outpatient drugs furnished to part B enrollees. Sets forth the obligations of participating pharmacies, including the requirements that they: (1) charge Medicare beneficiaries no more for drugs than they charge the general public; (2) keep patient records for all outpatient drugs dispensed to such beneficiaries; (3) assist beneficiaries in determining whether or not their expenses have exceeded the annual deductible; (4) offer to counsel each of their beneficiaries on the appropriate use of such drugs and the availability of therapeutically equivalent outpatient drugs; and (5) submit requests for payment to carriers electronically by 1992, except where such requirement would impose undue hardship on a pharmacy. Requires the Secretary to provide each participating pharmacy with: (1) a distinctive emblem indicating its status as such; and (2) information on the payment limits established for outpatient drugs. Prohibits part B coverage of an outpatient drug which is dispensed in a quantity exceeding a 60-day supply.

Requires Medicare carriers which make determinations or payments with respect to outpatient drugs to offer to receive requests from participating pharmacies for payments for such drugs through electronic communications and respond to requests by such pharmacies as to whether or not an individual has paid the deductible for such drugs.

Directs the Secretary to: (1) conduct a survey of expenses for covered outpatient drugs to provide information on the distribution of such expenses among Medicare beneficiaries; and (2) report to the Congress regarding such survey by March 1, 1989. Requires the Congressional Budget Office to transmit its estimate of future Medicare expenditures for outpatient drugs to the Congress within two months of the Secretary's survey report. Requires the Director of the Office of Technology Assessment to appoint individuals with expertise in the provision and financing of covered outpatient drugs to a Prescription Drug Payment Review Commission which shall make recommendations to the Congress by March 1 of each year concerning methods of paying for covered outpatient drugs under part B of the Medicare program. Directs the Secretary to conduct additional studies regarding outpatient drug coverage and report to the Congress regarding such studies by 1991.

Covers in-home care furnished, under the supervision of a registered professional nurse, by a home health agency or by others under arrangements with such agency to an individual who, for the preceding three months, has been unable to perform at least two specified daily living activities without the assistance of an uncompensated primary caregiver with whom he or she resides. Limits such coverage to 80 hours per year. Directs the Secretary to report to the Congress: (1) within 18 months of this Act's enactment, on the advisability of providing out-of-home services as alternative services to in-home care; and (2) by January 1, 1991, on the extent of the use, cost, and effectiveness of in-home care.

Covers nursing care and home health aide services as home health services if such services are needed less than seven days each week or are needed for an initial period of up to 35 consecutive days and for a subsequent period on a physician's certification of exceptional circumstances. Increases the maximum Medicare payment allowed for outpatient mental health services.

Amends the Medicare program to adjust part B premiums to take into account the costs of additional benefits provided by this Act's catastrophic coverage.

Directs the Secretary to: (1) take this Act's amendments into account in determining the payments to be made to health maintenance organizations; and (2) require such organizations to adjust their agreements with Medicare beneficiaries in consideration of such amendments.

Directs the Secretary to: (1) mail a notice annually to Medicare beneficiaries of the extent to which Medicare coverage is provided for health care services and Medicare and Medicaid (title XIX of the Act) coverage is provided for long-term care services; and (2) send participating physician directories to part B enrollees.

Directs the Secretary to report to the Congress within 150 days of this Act's enactment on recommended changes in the certification requirements for Medicare supplemental policies. Requires a Medicare supplemental policy to: (1) mail notice to beneficiaries before 1989 of improved Medicare benefits contained in legislation of the 100th Congress and the effect such legislation will have on such policy; and (2) submit a copy of each of its advertisements to the State Commissioner of Insurance for his or her review.

Extends, through September 30, 1992, certain projects demonstrating the concept of a social health maintenance organization.

Requires the Secretary to provide for research on issues relating to the delivery and financing of Medicare long-term care services. Authorizes appropriations for FY 1988 through 1992 for such research.

Directs the Secretary to conduct a survey of adult day care services and report to the Congress within one year of this Act's enactment regarding such services, and standards which may be applied in providing Medicare coverage for such services.

Title III: Provisions Relating to the Medicaid Program - Amends the Medicaid program to require States to provide Medicaid coverage of Medicare premiums, deductibles, and coinsurance payments for which Medicare-eligible individuals whose income does not exceed the Federal poverty level would otherwise be accountable. Prohibits States from setting the resource eligibility limit for such coverage at more than twice the resource limit for eligibility under the Supplemental Security Income program (title XVI of the Act). Gives U.S. Commonwealths and Territories the option of providing such coverage.

Provides that for the initial determination of an institutionalized spouse's Medicaid eligibility the institutionalized spouse may transfer his or her resources to the community spouse to the extent the spousal share (computed by dividing the sum of the spouse's resources in half) is less than $12,000 (adjusted annually to reflect changes in the cost-of-living), but attributes any resources not solely in the ownership of the community spouse to the institutionalized spouse if such transfer is not made. Considers resources held in the name of the community spouse to be available to the institutionalized spouse to the extent their value exceeds $48,000 (adjusted annually to reflect changes in the cost-of-living), or, if greater, the amount a court has ordered to be retained by the community spouse for support.

Provides that after the initial eligibility determination: (1) no resources of the community spouse will be considered available to the institutionalized spouse; and (2) the income of the institutionalized spouse will not be considered to include a specified personal needs allowance, community spouse monthly income allowance, family allowance, and incurred expenses for medical or remedial care for the institutionalized spouse that are not covered by a legally liable third party. Sets forth the formulas for determining such allowances. Gives the institutionalized spouse the right to a hearing to establish that the community spouse monthly income allowance is not adequate to support the community spouse without financial duress so that an adequate amount of support will be substituted for the allowance. Prohibits such allowance from being less than court-ordered support payments.

Delays the Medicaid eligibility of institutionalized individuals who disposed of their resources at less than fair market value within two years prior to applying for Medicaid benefits. Sets forth situations in which a delay shall not be applied. Allows the institutionalized spouse to elect to be governed by State rules in effect as of March 1, 1987, regarding treatment of income and transfers of resources for Medicaid eligibility purposes, but permits neither spouse to opt out of this Act's rules regarding the treatment of resources at the initial eligibility determination.

Title IV: United States Bipartisan Commission on Comprehensive Health Care - Establishes the United States Bipartisan Commission on Comprehensive Health Care which shall: (1) examine shortcomings in the current health care delivery and financing mechanisms that limit or prevent access of individuals to comprehensive health care; and (2) make recommendations to the Congress respecting Federal programs, policies, and financing needed to assure the availability of comprehensive long-term care for everyone. Directs the Commission to report to the Congress on its findings and recommendations regarding comprehensive long-term care for: (1) the elderly and disabled, within six months of this Act's enactment; and (2) everyone, within one year of this Act's enactment. Terminates the Commission 30 days after submission of the latter report. Authorizes appropriations for the implementation of this title.