Technical and Miscellaneous Social Security Act Amendments of 1990

Title I: Human Resource Amendments - Human Resource Amendments of 1990 - Subtitle A: Child Support Enforcement - Amends part D (Child Support and Establishment of Paternity) of title IV of the Social Security Act to extend provisions that allow States to ask the Internal Revenue Service to withhold Federal tax refunds otherwise due to families not receiving benefits under the Aid to Families with Dependent Children program (AFDC) (Part A of title IV of the Social Security Act) in order to collect past due child support payments. Makes such a collection applicable to past-due support owed to anyone who was determined to be disabled under title II (Old Age, Survivors and Disability Insurance) (OASDI) or title XVI (Supplemental Security Income) (SSI) of the Social Security Act as a minor.

Amends the Family Support Act of 1988 to reauthorize the Commission on Interstate Child Support.

Directs the Secretary of Health and Human Services (HHS) to enter into an agreement with the State of Texas to grant that State a waiver to continue the project in Bexar County on delinquency monitoring for child support without requiring a written application and payment of an application fee. Requires the appropriate State agency to perform a study and report to the Congress on the cost-effectiveness of monitoring delinquent child support payments in order for the waiver to be granted.

Subtitle B: Unemployment Compensation - Amends title IX (Employment Security) of the Social Security Act to make permanent a limitation on State use of Unemployment Trust Fund amounts for administrative purposes. Modifies the distribution formula so that any excess amounts would be distributed to State accounts in the Unemployment Trust Fund in proportion to each State's share of wages subject to Federal unemployment taxes paid in the prior calendar year. Requires States to account for such amounts in accordance with standards established by the Secretary of Labor.

Amends the Internal Revenue Code to require State unemployment compensation laws to prohibit courts from stopping law suits on related employment issues based on a decision in an unemployment compensation hearing.

Subtitle C: Supplemental Security Income - Amends the SSI program to exclude amounts received from a State fund to aid victims of crime from an individual's income and resources. Prohibits the denial of SSI benefits to individuals by reason of their rejection of amounts offered as compensation for a crime. Eliminates the age requirement that blind and disabled individuals receiving SSI benefits must meet in order to be eligible for Medicaid (title XIX of the Social Security Act) benefits under the work incentive program. Excludes impairment-related work expenses from income in determining State supplementary payments and initial eligibility and reeligibility for SSI benefits. Treats any royalty which is earned in connection with the publication of an individual's work and any honorarium which is received for services rendered as earned income for purposes of SSI eligibility and benefit determinations. Excludes certain State relocation assistance from income and resources under the SSI program. Directs the Secretary of HHS to make reasonable efforts to ensure that a qualified pediatrician or other specialist in a field of child medicine evaluates child disabilities for purposes of determining eligibility for SSI benefits. Authorizes reimbursement to State agencies for the costs of vocational rehabilitation services provided to certain individuals who are not currently receiving Federal SSI benefits.

Extends the period of presumptive eligibility for benefits.

Permits continuing disability and blindness reviews no more than once every 12 months.

Subtitle D: Aid to Families with Dependent Children - Amends the AFDC program to give States the option of specifying from which categories of families monthly reports will be required. Requires States which exercise such option to describe the categories subject to such reporting requirement in their State plans. Gives States the option of choosing to apply the retrospective budgeting technique to any one or more of the categories to which such reporting requirement applies. Disallows the treatment of a child receiving State or local foster care maintenance payments as a member of a family unit for purposes of determining eligibility for, or the amount of, AFDC benefits. Excludes the income and resources of such a child from the income and resources of the family. Disallows the treatment of a child receiving Federal adoption assistance payments under part E (Foster Care and Adoption Assistance) of title IV of the Social Security Act, or adoption assistance payments under State or local law, as a member of a family unit for purposes of determining eligibility for, or the amount of, AFDC benefits. Excludes the income and resources of such a child from the income and resources of the family, except where such exclusion would reduce the amount of benefits to the family. Revises provisions governing the determination of AFDC benefits for a dependent child whose parent or legal guardian is under the age of 18 to delete all references to legal guardians. Amends AFDC and foster care and adoption assistance State plan requirements to require that each State agency report to an appropriate agency or official known or suspected instances of child abuse and neglect of a child receiving program aid.

Makes March 31, 1991, the final reporting date for the National Commission on Children.

Adds the Foster Care and Adoption Assistance program to the list of programs for which information about AFDC applicants and recipients may be made available.

Amends part A (General Provisions) of title XI of the Social Security Act to repeal the spending cap on temporary assistance provided under the repatriation program until FY 1992. Permits HHS to receive gifts to assist program participants.

Amends the Omnibus Budget Reconciliation Act of 1989 to extend the prohibitions with respect to the use of emergency assistance funds for the homeless.

Makes technical amendments necessary for the State of Minnesota to implement its Family Investment Plan demonstration project.

Subtitle E: Child Welfare and Foster Care - Amends the Foster Care and Adoption Assistance program to add child placement services as activities for which States are entitled to receive Federal reimbursement. Allows States to include youths up to age 21 who have been discharged from the foster care system in services provided under the independent living program.

Amends the Omnibus Budget Reconciliation Act of 1989 to extend the current prohibition on reducing payments to, seeking repayment from, or withholding payments from any State as a result of a disallowance determination made in connection with a triennial review of State compliance with certain foster care protections.

Title II: Amendments Relating to Old-Age, Survivors, and Disability Insurance - Amends the OASDI program to permanently provide for the continuation of disability and Medicare (title XVIII of the Social Security Act) benefits during appeal. Repeals the separate definition of disability applicable to widows and widowers. Requires a child adopted by the surviving spouse of a deceased worker to have either lived with the worker or received at least one-half of his or her support from the worker at the time of the worker's death in order to receive survivor's benefits. Provides benefits to a widow or widower who in good faith married unaware that his or her marriage was invalid and who lost entitlement to benefits because another entitled spouse claimed those benefits.

Amends the OASDI and SSI programs to require that the Secretary conduct criminal background checks of representative payee applicants (excluding parents and spouses) and verify their identities. Prohibits the certification of a representative payee without adequate evidence that such certification is in the interest of the OASDI or SSI beneficiary. Requires the Secretary to establish and maintain two centralized, current files, accessible to local offices of the Social Security Administration (SSA), identifying persons who have previously misused social security benefits.

Prohibits a beneficiary's creditor from serving as his or her representative payee, unless such creditor: (1) is a relative residing with such beneficiary; (2) is the beneficiary's legal guardian; (3) is a licensed or certified care facility; (4) is the owner or an employee of such a facility; or (5) poses no risk to the beneficiary and no other suitable representative payee is available.

Provides for the payment of benefits directly to a beneficiary, except in certain situations where the beneficiary's condition makes direct payments harmful, until a representative payee has been chosen.

Directs the Secretary to provide an OASDI or SSI beneficiary with notice of a determination that he or she needs a representative payee, including an explanation of his or her right to appeal such determination and the designation of a particular person as representative payee.

Directs the Secretary to terminate payment of benefits to a representative payee who misuses such benefits and to certify payment to an alternative representative payee or to the individual.

Provides that in cases where the negligent failure of the Secretary to investigate or monitor a representative payee results in the misuse of benefits by the representative payee, the Secretary shall certify for payment to the beneficiary or his alternative representative payee an amount equal to such misused benefits. Directs the Secretary to make a good faith effort to obtain restitution from terminated representative payees.

Requires the Secretary to conduct a feasibility study and report to the Congress on: (1) obtaining for social security field offices ready access to records of individuals convicted of fraud involving social security checks; (2) determining the type of representative payee applicant most likely to have a felony or misdemeanor conviction; (3) the suitability of individuals with prior convictions to serve as representative payees; and (4) the circumstances under which such applicants could be allowed to serve as representative payees.

Provides compensation to social service agencies which serve as representative payees. Limits the amount of fees such agencies may collect.

Requires the Secretary to maintain a centralized, current file, accessible to local SSA offices, identifying all representative payees and the beneficiaries utilizing their services. Requires local offices to maintain a current list of the public agencies and community-based nonprofit social service agencies which are qualified to serve as representative payees and which are located in the office's service area.

Requires the Secretary to conduct a study and report to the Congress on the needs for an accounting system for high-risk representative payees which is more stringent than is otherwise required under the Social Security Act.

Requires the Secretary to: (1) implement a demonstration project to make available to State protective service agencies a list of all addresses where OASDI and SSI benefit payments are received by five or more individuals; and (2) conduct a feasibility study and report to the Congress on designating the Department of Veterans Affairs as the lead agency for purposes of selecting, appointing, and monitoring representative payees for individuals who receive OASDI or SSI benefits and benefits from the Department of Veterans Affairs. Sets forth reporting requirements.

Revises the procedures governing payment of fees for representation of claimants in SSA administrative proceedings. Requires SSA to approve any fee agreement submitted in writing by the representative and the claimant if the Secretary's determination with respect to the claim for benefits was favorable and if the agreed-upon fee did not exceed 25 percent of the claimant's past-due benefits, up to $4,000.

Establishes additional requirements for notices concerning OASDI and SSI benefits.

Restores direct telephone access to local SSA offices.

Directs the Secretary to develop and carry out demonstration projects to assess the advantages and disadvantages of permitting disabled individuals to select a qualified vocational rehabilitation provider for services to enable them to engage in substantial gainful activity and leave the disability rolls.

Amends the Social Security Disability Amendments of 1980 to extend the authority of the Secretary to conduct demonstration projects.

Amends the OASDI program to exempt certain aliens, including aliens who received legal status under the Immigration and Nationality Act, from prosecution for misreporting of earnings or misuse of social security cards or account numbers.

Reduces the amount of wages required to earn a year of coverage for determining a special minimum amount of OASDI benefits.

Eliminates eligibility for retroactive OASDI benefits for certain categories of individuals eligible for reduced benefits.

Treats the earnings of corporate directors as received in the year that the relevant services are performed only for purposes of the social security retirement test.

Amends the Internal Revenue Code to set forth special rules for the collection of employee social security and railroad retirement taxes on taxable group-term life insurance provided to retirees.

Amends the OASDI program to make technical amendments to provisions regarding old-age benefit computation methods and dependent benefits when a disabled worker is in an extended period of eligibility.

Amends the Internal Revenue Code to make technical amendments with respect to the cross-referencing of the railroad retirement Tier 1 tax rate to the Federal Insurance Contributions Act.

Amends the Railroad Retirement Solvency Act of 1983 to extend the transfer of proceeds from the taxation of certain railroad retirement Tier 2 benefits from the General Fund into the Railroad Retirement Account.

Amends the Social Security Act and the Internal Revenue Code to make miscellaneous technical corrections.

Waives the two-year waiting period for independent entitlement to a divorced spouse's benefits if the worker was entitled to benefits prior to the divorce.

Reduces the percentage of favorable OASDI decisions made by State agencies with respect to disability insurance cases that the Secretary must review prior to their effectuation. Applies such reduction to favorable decisions on both initial allowances and allowances upon reconsideration. Requires the Secretary to review decisions regarding continuances to the extent necessary to assure a high level of accuracy in such decisions.

Increases the exempt amount in 1993 and 1994 for purposes of the retirement test applied to individuals who have attained retirement age.

Eliminates recomputations of benefits for beneficiaries with earnings in the year they reach age 70 or in later years, except for beneficiaries with one or more zero years averaged into their average lifetime earnings.

Title III: Miscellaneous and Technical Amendments Relating to the Medicare Program - Subtitle A: No-Cost Provisions - Amends the Medicare program to require certain providers of medical care to provide adult patients with information on their rights under State law to make decisions concerning their medical care, including rights concerning living wills and power of attorney directives. Prescribes penalties for providers who fail to give patients such information. Directs the Secretary to assist in the development and distribution to such providers of a document that describes such rights. Provides for the inclusion in annual Medicare beneficiary mailings of a general description of: (1) patient's rights regarding living wills and power of attorney directives; and (2) where information on such rights may be obtained in each State.

Directs the Secretary to: (1) arrange with the Institute of Medicine of the National Academy of Sciences for a study on the implementation of directed health care decisions; and (2) develop and implement a demonstration project in selected States to inform the public of the option to execute living wills and power of attorney directives and a patient's right to participate in and direct health care decisions.

Makes miscellaneous and technical amendments to provisions relating to: (1) part A (Hospital Insurance), particularly with respect to hospital obligations concerning treatment of emergency medical conditions, designation of rural primary care hospitals, skilled nursing facility routine cost limits, enrollment for health maintenance organization (HMO) members, nursing home reform amendments, and State waiver authority; and (2) part B (Supplementary Medical Insurance), particularly with respect to claims form reporting, physician payments, and immediate enrollment by individuals covered by an employment-based plan.

Corrects various drafting errors.

Amends provisions relating to the Hospital Insurance program to: (1) extend the protection afforded skilled nursing facilities and hospices against being held liable for payment of denied claims; and (2) provide for the designation of pediatric liver transplant facilities.

Directs the Secretary to conduct a study and report to the Congress on the effect of State law prohibiting the employment of physicians by hospitals on the availability and accessibility of trauma and emergency care services.

Directs the Secretary to develop a proposal to: (1) modify the current payment system for skilled nursing facilities with respect to extended care under the Medicare program; or (2) replace such system with one under which payment would be made on the basis of prospectively determined rates. Sets forth reporting requirements.

Amends provisions relating to the Supplementary Medical Insurance program to: (1) revise claims form information; (2) prohibit the Secretary from conducting demonstration projects of competitive bidding for cataract surgery which rely on physician marketing; (3) extend the preventive health services demonstration program for Medicare beneficiaries; (4) set limits on extra billing for durable medical equipment; (5) provide for area adjustment for durable medical equipment; (6) require providers to disclose individuals with ownership interests; (7) reauthorize Alzheimer's disease demonstration projects; and (8) grant patients the option of purchasing a power-driven wheel chair on a lump-sum basis on initial use.

Amends the Medicare program to prohibit the Secretary from entering into a contract with an HMO unless certain conditions regarding the HMO's physician incentive payment plan are met. Directs the Secretary to revise the methodology used to establish the adjusted average per capita cost for determining the payments to HMOs. Prohibits changes in Medicare benefits which significantly change the cost of providing benefits from applying to risk contracts with HMOs in any contract year unless the costs of the change in coverage were included in the Secretary's annual notice of per capita rates of payment for beneficiaries enrolled in HMOs. Extends payment under the Supplementary Medical Insurance program to all emergency services under the program provided to beneficiaries enrolled in an HMO. Requires HMOs which are owned and operated by a government entity to have an enrolled membership at least one-half of which consists of individuals who are not entitled to Medicare benefits in order to enter into a contract with the Secretary.

Amends the Medicare program to require that Medicare supplemental policy issuers: (1) establish four types of benefit packages, ranging from standard to comprehensive; and (2) provide prospective purchasers with a description of policy benefits that uses uniform language specified by the Secretary and a uniform format to help consumers compare benefits among policies. Prohibits an issuer from selling a Medicare supplemental (Medigap) policy unless it offers a policy that only includes the standard benefit package. Allows additional benefits to be offered if: (1) they are not generally available in any of the four types of benefit packages; and (2) the insurer specifies the additional premium for each benefit. Permits each State to design its own four-benefit package, provided the standard benefit package is one of the packages offered either alone or along with additional comprehensive benefits in other packages. Directs the Secretary to specify the benefits for each type of package provided under a Medigap policy in the absence of a State-specific approach to the four-benefit package. Defines the standard benefit package to be used in both State and federally designed benefit packages.

Requires applicants to sign a statement prior to sale which indicates current coverage, except in cases where the policy is purchased to replace existing coverage or where States pay Medigap premiums for Medicaid beneficiaries. Makes it a violation of this Act for a Medigap policy to be issued without the obtainment of such a statement or if the statement indicates that the applicant is currently covered under another Medigap policy. Provides for: (1) suspension of such a policy during the receipt of Medicaid benefits; (2) identification of duplicate coverage through the matching of information supplied by insurers and employers; and (3) reporting of duplicate coverage by the Secretary to States which have designated a four-benefit package.

Requires Medigap insurers to use a uniform methodology for calculating loss ratios. Requires States to report to the Secretary annually on loss-ratios under Medigap policies and the use of sanctions for policies that fail to use a uniform methodology for calculating loss-ratios.

Requires Medigap issuers of replacement policies to waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods for similar benefits contained in the new policy to the extent such time was spent under the original policy.

Requires Medigap insurers to issue policies without any conditions to an individual for six months after he or she first enrolls in the Supplementary Medical Insurance program.

Establishes minimum loss ratios for daily hospital indemnity and dread disease policies which are sold to or renewed by Medicare beneficiaries.

Directs the Secretary to make grants to States to assist Medicare beneficiaries in purchasing health insurance coverage. Authorizes appropriations.

Directs the Secretary to establish a national resource center to act as a clearinghouse for distribution of health insurance information to the States. Authorizes appropriations.

Directs the Secretary to promulgate regulations to implement such amendments to the Medicare program which include uniform enforcement provisions and reflect certain National Association of Insurance Commissioners' Medigap standards.

Provides for certification of State regulatory programs by the Secretary, rather than the Supplemental Insurance Panel.

Requires all Medigap policies to be approved by the State involved or by the Secretary prior to sale.

Directs the Comptroller General to conduct studies and report to the Congress with respect to State compliance with Medigap requirements.

Amends the Internal Revenue Code to subject an entity that issues a non-approved Medigap policy to an excise tax equal to 50 percent of its premium.

Amends the Hospital Insurance program to cut Medicare payments for inpatient hospital and extended care services provided in a State by one-half if the State does not implement a controlled substance accountable prescription system.

Requires that such system: (1) prohibit a health care practitioner from prescribing certain controlled substances without writing the prescription on a form, provided by the State, which identifies such practitioner; and (2) require such practitioner to maintain a readily retrievable record of such transactions. Requires every person who dispenses such controlled substances to maintain a two-year record of such transactions, including the information contained on prescription forms, and to periodically provide information in such record to the State.

Makes the system inapplicable to drugs dispensed directly by a practitioners to a user and drugs dispensed by oral prescription in emergency situations. Limits the use of system information to the enforcement of laws under the Medicare program, the Controlled Substances Act, or a State controlled substances Act. Requires States and the Secretary to maintain active programs to process system information and to investigation potential violations of law identified by such inforamtion.

Directs the Secretary to develop a brochure which describes the proper prescribing of controlled substances for cancer pain and mental illness and specifies where additional information may be obtained respecting proper prescribing practices.

Amends part A (General Provisions) of title XI of the Social Security Act to provide for the use of administrative law judges who are in positions within HHS in health-related cases if and when SSA becomes an independent agency.

Amends the Medicare program to: (1) revise provisions for enforcing the requirements imposed on hospitals and physicians when examining and treating emergency medical conditions and women in active labor; (2) require the Secretary to use the hospital wage index for home health agency cost limits; (3) make a certain exemption for physicians employed by a hospital inapplicable to a financial relationship unrelated to clinical laboratory services for which a referral would otherwise be prohibited; (4) exclude certain entities which infrequently bill Medicare and claims from foreign providers from reporting requirements relating to physician ownership and referral; (5) change the date for issuance of regulations relating to physician ownership of clinical laboratories; (6) revise anti-fraud and abuse amendments to provide for mandatory exclusion for inducements to beneficiaries or employees; and (7) prohibit the Secretary from imposing, or requiring States to impose, on certain facilities, a fee to offset the costs of surveys to certify compliance with conditions for participation under the Hospital Insurance or SSI program. Prohibits the Secretary from issuing any final regulation, instruction, or other policy change which is primarily intended to slow down or speed up claims processing or to delay payment of claims. Revises requirements with respect to the Social Health Maintenance Organizations (SHMOs) demonstration. Authorizes additional SHMO demonstration projects. Directs the Secretary to develop a proposal for a prospective payment system for home health services for submission to the Congress. Treats a hospital participating in the demonstration authorized by the Technical and Miscellaneous Revenue Act of 1988 as meeting certain requirements regarding hospital-based nursing schools. Reinstates certain demonstration projects involving case management which were established under the Medicare Catastrophic Coverage Act of 1988.

Amends part B (Peer Review) of title XI of the Social Security Act to: (1) give practitioners the opportunity to enter into, and complete, a corrective action plan before the peer review organization submits its report and recommendations to the Secretary; (2) allow peer review organizations to use podiatrists and optometrists in making final denial determinations; (3) direct the Secretary to conduct a study to develop a plan to improve the coordination of peer and carrier review of physician services; and (4) direct the Secretary to provide for the exchange of information between peer review organizations and State licensing boards.

Subtitle B: Medicare Initiatives - Amends the Medicare program to provide that hospitals which are exempt from the prospective payment system with costs in excess of the target amount limit will receive 50 percent of the costs in excess of the limit, up to 120 percent of the limit.

Prohibits the Secretary from making any recoupments in FY 1991 relating to overpayments to hospitals for the costs of physician education. Limits the annual amount of recoupment to 25 percent of the amount of such overpayments beginning in FY 1992.

Allows a hospital to be reimbursed for the costs incurred in conducting clinical training on its premises under an approved nursing education program which is not operated by the hospital, under certain conditions.

Prohibits the Secretary from recouping any alleged overpayments relating to costs which were otherwise allowable. Requires the Secretary, to the extent such recoupments have already occurred, to refund the money to the hospitals involved. Directs the Secretary to conduct a special audit to ensure the accuracy of such costs.

Increases the types of centers that provide primary care and other services to low-income individuals in inner-city and rural areas under the Medicare program.

Directs the Comptroller General to study and report to the Congress on whether physicians practicing in community and migrant health centers are able to obtain admitting privileges at local hospitals.

Changes the method of determining payments for certified registered nurse anesthetists.

Provides for coverage under the Medicare program of partial hospitalization services provided in community mental health centers which meet applicable State licensing or certification requirements.

Authorizes payment for trip fees for qualifying laboratories to cover the cost of transportation and personnel expenses for trained personnel to make a second daily trip to a nursing home of a homebound individual to collect a sample for testing which is ordered by a physician on an emergency basis.

Exempts portable radiology services from the reduction in the conversion factor for all other radiological services. Extends the split billing rule for interventional radiologists.

Extends coverage for hospice care beyond the current limit if the beneficiary is recertified as terminally ill by certain medical officials.

Provides separate coverage under the Medicare program for the services of psychologists provided to individuals who are inpatients in hospitals.

Authorizes Medicare coverage for erythropoietin and related items for home renal dialysis patients who are competent to use such drug without medical or other supervision, subject to methods and standards established by the Secretary for its use.

Establishes specified monthly Hospital Insurance premiums for 1992 through 1995. Provides that premiums after 1995 shall be the premium for the previous year adjusted by the percentage change in the inpatient hospital deductible.

Amends the Omnibus Budget Reconciliation Act of 1986 to increase the composite rates paid to free-standing and hospital-based facilities for treatment of dialysis patients.

Subtitle C: Medicare Program Cost Reductions - Amends the Medicare program to preclude outpatient care received on Saturdays and Sundays from being billed as inpatient hospital care. Makes technical amendments with respect to payments for: (1) hospital outpatient department services; (2) EKG interpretation; (3) items and services provided to end stage renal disease beneficiaries; and (4) ambulatory surgery and radiology. Limits Medicare coverage for seatlifts to include only the seat-lift mechanism. Increases the reduction in payments for: (1) transcutaneous electrical nerve stimulation devices; and (2) overpriced physician services. Reduces the annual Consumer Price Index update for clinical laboratory services.