Long-Term Care Family Protection Act of 1991

Long-Term Care Family Protection Act of 1991 - Title I: Home And Community Care And Nursing Facility Care Under The Medicare Program - Amends title XVIII (Medicare) of the Social Security Act to establish an entitlement under a new part C for payment for home and community care and nursing facility care for individuals determined by a long-term care management agency to be eligible for such care.

Sets forth eligibility rules requiring individuals to receive an assessment and be certified as a chronically dependent individual in order to receive part C benefits.

Creates in the Treasury the Federal Long-Term Care Trust Fund (Fund) and appropriates to it amounts attributable to additional revenue resulting from this Act. Pays amounts from the Fund for the expenses of providing home and community care. Requires such amounts to be determined under a fee schedule or other prospectively determined reimbursement mechanism established and annually adjusted by the Secretary of Health and Human Services. Requires the fee schedule or reimbursement mechanism to provide for uniform national payment rates, adjusted for area differences in wage levels. Establishes monthly payment limitations with respect to long-term home and community care provided to chronically dependent individuals and dependent children and applies such limitations on an average basis with respect to such care furnished over any period of four consecutive months. Requires the Secretary, before the beginning of each calendar year, to estimate, for nursing facilities located in each State, the State average per diem payment rates that would apply for nursing facility care in the State on a full-time basis in the year if there were no reduction for coinsurance under new part C. Pays a specified amount from the Fund for the daily expenses of providing nursing facility care after applicable copayment requirements have been met. Makes available Fund amounts to carry out the functions of the Long-Term Advisory Council. Authorizes the appropriation of additional sums for the Fund for home and community care, nursing facility care, and long-term care advisory council expenditures.

Defines "home care agency."

Makes various conforming and miscellaneous amendments, including amendments with respect to entitlement to benefits of social security beneficiaries and dependent children under title II (Old Age, Survivors and Disability Insurance) (OASDI) of the Social Security Act, to include appropriate references to nursing facilities and home care agencies, the long-term care benefits under new part C, and the Fund.

Amends the Railroad Retirement Act of 1974 to include home and community care and nursing facility care.

Makes available the hearing and judicial review procedures for appeals of Medicare part A (Hospital Insurance) benefits to persons appealing a negative certification or any other determination with respect to a claim for part C benefits.

Title II: Assuring Self-Financing of Long-Term Care Benefits And Quality Assurance - Amends the Medicare program to direct the Secretary, in consultation with the Long-Term Care Advisory Council, to estimate the amounts transferable to the Fund and the amounts expected to be expended during the succeeding fiscal year for home and community care. Provides that if the Secretary estimates that a deficit exists, the amount payable for home and community care shall be reduced by a copayment amount (no more than five percent of the national average daily payment rate for home and community care) necessary to reduce the amount of the deficit by one-half.

Directs the Secretary to promulgate a long-term home and community care consumers' bill of rights that may be asserted by the consumer or the consumer's representative. Specifies the rights which such bill of rights must recognize as the rights of long-term home and community care consumers.

Directs the Secretary to promulgate regulations: (1) making payment for the provision of long-term home and community care services contingent upon the home health agency's compliance with the home and community care consumer's bill of rights and with other specified requirements; (2) making payment for the provision of case management services contingent upon the long-term care management agency's compliance with the home and community care consumer's bill of rights and with other specified requirements; (3) which establish procedures for surveying long-term care management agencies regarding compliance with conditions of participation; and (4) under which certain peer review organizations shall monitor the provision of home health services and long-term home and community care.

Directs the Secretary to establish a Consumer Board to monitor the review activities of peer review organizations.

Requires peer review organizations to establish and operate statewide toll-free hotlines for receiving questions and complaints from home and community care consumers, home and community care providers, and other interested persons concerning home and community care quality issues.

Requires the Secretary to require peer review organizations to assist home and community care consumers in the resolution of problems related to the quality of home and community care services and case management services.

Requires each State to establish and appoint members to a community advisory board for each long-term care management agency to monitor the activities of that agency.

Directs the Secretary to develop and implement: (1) methods for monitoring the continuity of care provided to long-term home and community care consumers throughout episodes of illness and across care settings; (2) outcome-oriented criteria for use in determining quality assurance in long-term home and community care services; (3) a range of intermediate sanctions and procedures implementing such sanctions to be applied to long-term care management agencies providing case management services for failing to comply with this Act.

Directs the Secretary to: (1) encourage States to develop policies and procedures for the licensing of home health agencies; (2) gather information relating to activities of States in implementing licensing policies and procedures; and (3) issue a biannual report which summarizes such information.

Establishes the Long-Term Care Advisory Council to: (1) assist the Secretary in assuring the prompt and efficient implementation of the new part C; (2) review regularly the implementation of such part; and (3) recommend to the Secretary and the Congress any needed changes or refinements to such part or regulations promulgated to implement such part.

Requires the Secretary to conduct studies on quality assurance measures for long-term home and community care services provided under new part C.

Directs the Secretary to prepare and file an annual report with the Congress regarding the nature and performance during the preceding fiscal year of the home and community care quality assurance system established above.

Authorizes appropriations.

Title III: Financing Of Long-Term Care - Amends the OASDI program to provide that, notwithstanding any provision of the Social Security Act or the Internal Revenue Code of 1986, there is no limit on the amount of an individual's net earnings from self-employment or remuneration for employment that is subject to the hospital insurance tax.

Amends the Internal Revenue Code to increase OASDI taxes beginning in 1993.

Title IV: Medicare Buy-In For Individuals With Disabilities - Amends the Medicare program to: (1) permit individuals with disabilities to purchase Medicare part A hospital insurance coverage during the 24-month waiting period for Medicare entitlement without being enrolled under Medicare part B (Supplementary Medical Insurance); (2) permit individuals with disabilities not entitled to long-term care benefits to buy into Medicare to obtain such benefits; and (3) set forth provisions for determining the premiums for such individuals.