Health Care bill

Long-Term Care Family Security Act of 1992 - Title I: Community Care and Nursing Facility Care - Amends the Social Security Act (SSA) to add a new title XXI, Community Care and Nursing Facility Care.

Entitles U.S. citizens and resident aliens (eligible individuals) who are moderately or severely disabled to community and nursing facility care. Specifies the scope of community and nursing facility care coverage. Sets limits on the hours of community care on the basis of the level of impairment. Provides that additional hours of community care may be made available to individuals with greater needs from pooled benefit hours. Provides for adjustment in computation of hours of community care to account for variation in intensity of types of care. Sets limits on short-term nursing facility care.

Provides for assessment agency: (1) determination of the level of impairment of eligible individuals and financial eligibility for community and nursing facility care benefits; and (2) review of the quality of care provided under new title XXI.

Requires care managers to: (1) establish and periodically review and revise plans of care for community care; (2) arrange for and monitor the provision and quality of community care and authorize payment for care; and (3) allocate additional hours of community care among different individuals who have been certified moderately or severely disabled and whose plans of care are being monitored.

Provides for payment for community and nursing facility care. Requires that payment rates for home- and community-based services be based on a fee schedule or other prospective payment methodology established and annually adjusted by the Secretary of Health and Human Services. Subjects such services to specified coinsurance requirements. Requires that payment rates for nursing facilities be based on a specified prospective payment system. Provides that payment for care under new title XXI may be made only to providers and facilities that meet specified conditions.

Requires the Director of the Office of Technology Assessment to provide for appointment of a Long-Term Care Payment Assessment Commission to: (1) make annual recommendations to the Secretary and the Congress on appropriate payment rates for community and nursing facility care; and (2) provide for specified studies and reports to the Congress about them. Authorizes appropriations.

Provides for assistance to low-income individuals for coinsurance for community and short-term nursing facility care and charges for assessments.

Provides protected resource levels with respect to long-term nursing facility care.

Provides for determination of the amount of the resident-specific deductible for nursing facility care.

Creates in the Treasury the Federal Long-Term Care Trust Fund for financing the community and nursing facility care program established above. Authorizes appropriations.

Makes miscellaneous and technical amendments to Medicare and Medicaid (SSA titles XVIII and XIX) provisions, with changes including: (1) limits on Federal financial participation under Medicaid for services covered under new title XXI; (2) prohibitions on duplication of Medicaid benefits with benefits under such title; and (3) limits on skilled nursing facility care under Medicare.

Title II: Financing Provisions - Amends the Internal Revenue Code to: (1) increase payroll taxes on employees (including railroad employees), employers, the self-employed, and the tax on employee representatives in the form of a long-term care tax; and (2) impose a long-term care tax on the unearned income of individuals.

Reduces from $192,000 to $54,800 the unified credits against estate and gift taxes. Reduces the gross estate threshold for the imposition of the estate tax from $600,000 to $200,000 for U.S. citizens or permanent residents, and from $60,000 to $20,000 for nonresident non-citizens of the United States.

Requires States to maintain current levels of financial commitment under Medicaid for population groups and long-term care services covered under the public program.

Title III: Treatment of Long-Term Care Insurance - Subtitle A: Establishment of Standards for Long-Term Care Insurance Policies - Amends new title XXI to require the National Association of Insurance Commissioners or, in its absence, the Secretary, to promulgate standards for State programs to regulate long-term care insurance policies that incorporate specified requirements with respect to issuers and policy content and sales. Requires standards relating to issuers to provide for: (1) examination of policy and full refund; (2) explanation of claims denials; and (3) limitations on agent compensation. Requires standards relating to policy content to provide for: (1) use of standard definitions and terminology and uniform format; (2) minimum benefits; (3) limitations on use of preexisting condition limits; (4) protection against inflation; (5) limits on premium increases; (6) guarantees of renewability, continuation, and conversion; and (7) upgrade rights. Requires standards relating to policy sales to provide for: (1) agent certification; and (2) prohibitions against sales of duplicate policies and sales to Medicaid beneficiaries and certain unfair sales practices. Sets forth enforcement provisions.

Requires the Secretary, after the enactment of this Act, to report to the Congress on standards for insurer solvency protection.

Subtitle B: Clarification of Tax Treatment of Long-Term Care Services and Long-Term Care Insurance Policies - Amends the Internal Revenue Code to accord: (1) the community and nursing facility care provided under new SSA title XXI the same tax treatment (including expense deductions) as medical care; and (2) insurance policies for such community and nursing facility care the same tax treatment as accident and health insurance policies.

Provides for the tax treatment of certain pre-death benefits and benefit riders.

Amends SSA title XI to prohibit applicants or recipients under specified public assistance programs from being required to make an election respecting certain pre-death benefits under life insurance policies.

Title IV: Additional Grants and Demonstration Projects - Amends the Public Health Service Act to authorize the Secretary to make grants to community care agencies to assist them in providing community care to low-income individuals. Authorizes appropriations.

Requires the Secretary to make grants to public and private entities to develop programs to train individuals to provide home health, homemaker, and personal assistance services for which payment may be made under SSA new title XXI. Authorizes appropriations.

Amends the Older Americans Act of 1965 to authorize additional appropriations for long-term care ombudsman programs. Includes within the jurisdiction of the State Long-Term Care Ombudsman the investigation of complaints by recipients of community care under new SSA title XXI.

Amends the Developmental Disabilities Assistance and Bill of Rights Act to authorize additional appropriations for information and referral services for the community and nursing facility care program under new SSA title XXI.

Amends the Protection and Advocacy for Mentally Ill Individuals Act of 1986 to expand information and counseling services to include information and referral to such community and nursing facility care program.

Title V: Review of Pharmaceutical Benefits - Requires the Director of the Office of Technology Assessment to provide for the appointment of a Pharmaceutical Payment Assessment and Policy Review Commission. Requires the Commission to report annually to the Congress on prescription drug costs and on issues with respect to coverage of prescription drugs under Federal health care programs. Makes appropriations for the Commission.

Directs the Secretary to establish: (1) demonstration projects to assess the impact on cost, quality of care, and access to prescription drugs and pharmaceutical services of developing a prescription drug benefit for individuals that are receiving benefits for long-term care under new SSA title XXI; and (2) a Long-Term Care Prescription Drug Use Review Committee to advise about such demonstration projects. Authorizes appropriations.