Comprehensive Long-Term Care Reform Act of 1995

TABLE OF CONTENTS:

Title I: State Programs for Long-Term Care Services for

Needy Individuals with Disabilities

Subtitle A: State Long-Term Care Programs

Subtitle B: Increase in SSI Personal Needs Allowance

Subtitle C: Repeal of Coverage Under the Medicaid

Program of Long-Term Care Services

Title II: Tax Treatment of Long-Term Care Insurance and

Services

Title III: Long-Term Care Insurance Reform

Subtitle A: General Provisions

Subtitle B: Federal Standards and Requirements

Subtitle C: Enforcement

Subtitle D: Recommendations for Consumer Education

Program

Title IV: Financing

Comprehensive Long-Term Care Reform Act of 1995 - Title I: State Programs for Long-Term Care Services for Needy Individuals with Disabilities - Subtitle A: State Long-Term Care Programs - Entitles each State with a plan, approved under section 102, for long-term care services furnished to needy individuals with disabilities to payment in accordance with provisions of this title.

(Sec. 102) Sets forth requirements a State plan for long-term care services for needy individuals with disabilities must meet in order to be approved, including: (1) eligibility requirements which will provide for the initial screening of individuals who appear to have a reasonable likelihood of being individuals with disabilities; (2) services requirements; (3) cost sharing requirements; (4) provider requirements; (5) budget requirements; and (6) quality assurance requirements. Permits provider reimbursement methods to include retrospective reimbursement on a fee-for-service basis, prepayment on a capitation basis, payment by cash or vouchers to individuals with disabilities, or any combination of these methods.

Restricts payment to providers agreeing to accept plan payment as payment in full. Requires the plan to assure that, in the case of an individual receiving medical assistance for home and community-based services under Medicaid, a State will continue to make available an appropriate level of assistance for home and community-based services. Requires each State plan to provide for the establishment and maintenance of an advisory group to advise the State on all aspects of the plan. Requires coordination of the plan with other Federal and State plans assisting individuals with disabilities.

(Sec. 103) Defines the term individual with disabilities to mean: (1) individuals requiring help with activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; or (4) severely disabled children. Defines a needy individual as an individual whose income is less than 100 percent of the official poverty line and whose resources are less than a specified amount.

(Sec. 104) Requires a State plan to provide for long-term care services if provided pursuant to a comprehensive assessment of an individual's need has been made and an individual plan of care is developed by a care manager. Defines long-term care services, institutional services, home and community services, and personal assistance services.

(Sec. 105) Directs that under a State plan nominal cost-sharing may be imposed with respect to home and community-based services.

(Sec. 107) Provides for the establishment of a Federal advisory group.

(Sec. 108) Sets forth a formula for determining payments to States.

(Sec. 109) Requires the Comptroller General to submit a report to the Congress on a study of the estimated need for Federal payments to the States under this title for FY 1998, by no later than February 1997. Establishes the total Federal budget level for State plans in FY 1998 as the amount authorized and appropriated by the Congress.

Sets forth a formula for determining allotments to States.

Subtitle B: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) of the Social Security Act to increase the personal needs allowance.

Subtitle C: Repeal of Coverage Under the Medicaid Program of Long-Term Care Services - Amends title XIX (Medicaid) of the Social Security Act to exempt a State from providing long-term care services to needy individuals with disabilities under Medicaid when coverage is provided under provisions of this Act.

Title II: Tax Treatment of Long-Term Care Insurance and Services - Amends the Internal Revenue Code to treat qualified long-term care services as medical care for purposes of the medical expense deduction. Provides that the adjusted gross income threshold does not apply to amounts paid for qualified long-term care insurance and services.

(Sec. 203) Provides for the treatment of long-term care insurance as accident and health insurance.

(Sec. 204) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals.

(Sec. 206) Excludes from gross income amounts withdrawn from individual retirement plans or certain pension plans to pay qualified long-term care insurance premiums.

(Sec. 207) Provides for the nonrecognition of gain from the sale of a principal residence if the new residence is a qualified continuing care retirement community and the taxpayer has attained the age 55.

Title III: Long-Term Care Insurance Reform - Subtitle A: General Provisions - Directs the Secretary of Health and Human Services to promulgate regulations to implement this title in accordance with a specified timetable.

Subtitle B: Federal Standards and Requirements - Directs the Secretary to promulgate regulations: (1) designed to standardize formats and terminology used in long-term care insurance policies, to require insurers to provide to customers and beneficiaries information on the range of public and private long-term care coverage available, and to establish such other requirements as are appropriate to promote consumer understanding and comparison of benefits; (2) establishing requirements with respect to the terms of and benefits under long-term care insurance policies; (3) establishing requirements applicable to premiums for long-term care policies; (4) establishing requirements applicable to the sale or offering for sale of long-term care insurance policies; (5) establishing requirements applicable to the renewal, replacement, conversion, and cancellation of long-term care insurance policies; and (6) establishing requirements with respect to claims for and payment of benefits under long-term care insurance policies.

Subtitle C: Enforcement - Authorizes appropriations for grants to States which have an approved program to: (1) monitor insurers and policies; (2) investigate and resolve consumer complaints, which will include procedures for dispute resolution; and (3) provide technical assistance to insurers to help them understand and comply with the requirements of this subtitle, and other State laws, concerning long- term care policies and business practices.

Subtitle D: Recommendations for Consumer Education Program - Directs the Secretary to design programs for educating consumers concerning long-term care and long-term care insurance.

Title IV: Financing - Increases the excise taxes on cigarettes. Imposes floor stocks taxes on cigarettes removed before the tax increase and held on such date for sale, subject to exceptions.