Quality Care for Life Act of 1994

TABLE OF CONTENTS:

Title I: Prospective Payment System for Nursing Facilities

Title II: Subacute Care Continuum Amendments of 1994

Title III: Long-Term Care Tax Clarification

Title IV: Long-Term Care Insurance Standards

Title V: Financial Eligibility Standards

Title VI: Establishment of Program for Home and

Community-Based Services for Certain Individuals with

Disabilities

Title VII: Asset Transfers

Quality Care for Life Act of 1994 - Title I: Prospective Payment System for Nursing Facilities - Prospective Payment System for Nursing Facilities Amendments of 1994 - Mandates that payment rates under the Prospective Payment System for Nursing Facilities reflect enumerated objectives. Declares that this Act does not affect the skilled nursing facility benefit under title XVIII (Medicare) of the Social Security Act (SSA).

(Sec. 105) Instructs the Secretary of Health and Human Services to: (1) establish a resident classification system which groups residents into classes according to similarity of their assessed condition and required services; and (2) determine payment rates for nursing facilities according to prescribed guidelines.

(Sec. 107) Prescribes guidelines for: (1) resident assessment; (2) per diem rate for nursing service costs, administrative and general costs; (3) payment for fee-for-service ancillary services; (4) reimbursement of selected ancillary services including drugs and medical supplies; (5) the per diem rate for property costs; (6) mid-year adjustments; and (7) payment methods for new and low-volume nursing facilities.

Title II: Subacute Care Continuum Amendments of 1994 - Subacute Care Continuum Act of 1994 - Provides that SSA shall not be construed as limiting a skilled nursing facility (SNF) from offering subacute care services. Prohibits the Secretary or the States from imposing conditions for such services which restrict SNFs from qualifying based upon their status.

(Sec. 203) Instructs the Secretary, regardless of the issuance of final regulations, to: (1) grant an interim exception within 90 days of submission of a request by a SNF providing subacute care services; and (2) establish identical fee schedules for physician visits to a subacute care patient in a SNF or in a hospital.

(Sec. 205) Provides coverage under the Medicare program for respiratory therapy services in a SNF. Requires the Secretary to determine and subsequently publish a list of hospital DRGs appropriate for SNFs and the appropriate hospitalizations and copayments and rebase Medicare payments which reflect the lower cost of such care provided in SNFs.

(Sec. 207) Expresses the sense of the Congress that: (1) the States are encouraged to develop payment methodologies for nursing facilities which provide subacute care for medicaid patients; and (2) Federal funding should be available for nursing facilities which provide subacute care to medicaid patients.

Title III: Long-Term Care Tax Clarification - Private Long-Term Care Insurance Incentive Amendments of 1994 - Amends the Internal Revenue Code to: (1) set forth definitions concerning the treatment of long-term care insurance or plans; (2) treat qualified long-term services as deductible medical care; (3) permit the offer of certain long-term care insurance contracts in certain employer (cafeteria) plans; (4) include in gross income excessive long-term care benefits; and (5) mandate that qualified long-term care insurance tax reserves be determined according to the reserve method prescribed by the National Association of Insurance Commissioners.

Title IV: Long-Term Care Insurance Standards - Long-Term Care Insurance Standards Amendments of 1994 - Directs the Congress to appoint the National Long-Term Care Insurance Advisory Council to advise it and monitor development of the long-term care insurance market. Authorizes appropriations.

(Sec. 402) Amends the Internal Revenue Code to set forth consumer protection provisions regarding long-term care insurance policies. Sets forth tax penalties for non-complying issuers of such policies.

(Sec. 404) Declares that insurance policies deemed by a State Insurance Commissioner to be in compliance with this Act and the Internal Revenue Code shall be deemed approved for sale in any other State.

Title V: Financial Eligibility Standards - Amends title XIX (Medicaid) of the Social Security Act to delineate the criteria for financial eligibility for nursing facility services. Directs the Secretary to provide grants for State demonstration projects to investigate the coordination of private long-term care insurance benefits and financial eligibility requirements.

Title VI: Establishment of Program for Home and Community-Based Services for Certain Individuals with Disabilities - Home and Community-Based Services for Individuals with Disabilities Program Amendments of 1994 - Establishes a program which mandates that States having an approved State plan provide for home and community-based services for eligible individuals with disabilities.

(Sec. 602) Increases the amount of an individual's resources which shall be disregarded when determining eligibility for inpatient nursing or intermediate care facilities for the mentally retarded.

Title VII: Asset Transfers - Extends from 36 to 60 months the look-back period for asset transfers. Modifies the guidelines for such transfers with respect to the treatment of certain trusts.