Welfare and Medicaid Responsibility Exchange Act of 1995

TABLE OF CONTENTS:

Division A: Exchange of Responsibilities for Providing

Welfare Assistance and Medical Care

Title I: Federal and State Responsibilities During and

After the Transition Period

Subtitle A: Transition Period

Subtitle B: Post-Transition Period

Subtitle C: Legislative Proposals

Subtitle D: Health Benefits and Coverage

Commission

Title II: Acute Care Benefits Under the Medicare

Program for Elderly Low-Income and Nonelderly Low-

Income Disabled Individuals

Subtitle A: Eligibility Criteria and Acute Care

Benefits for Elderly Low-Income Individuals

Subtitle B: Eligibility and Acute Care Benefits

for Nonelderly Low-Income Disabled Individuals

Subtitle C: Premiums, Coinsurance, and Deductibles

Established Without Regard to Additional Costs

Title III: Establishment of the Long-Term Care Program

Subtitle A: Establishment

Subtitle B: Providing Long-Term Care

Subtitle C: Requirements for Long-Term Care

Contractors

Subtitle D: Establishing Long-Term Care Benefits

for Certain Individuals

Title IV: Ensuring Financing for Federal Health Care

for Certain Elderly Low-Income and Nonelderly Low-

Income Disabled Individuals

Title V: Miscellaneous Provisions

Division B: Tax Incentives and Standards for Long-Term Care

Insurance

Title I: Tax Treatment of Long-Term Care Insurance

Title II: Standards for Long-Term Care Insurance

Title III: Incentives to Encourage the Purchase of

Private Insurance

Welfare and Medicaid Responsibility Exchange Act of 1995 - Division A: Exchange of Responsibilities For Providing Welfare Assistance and Medical Care - Title I: Federal and State Responsibilities During and After the Transition Period - Subtitle A: Transition Period - Provides for the termination of AFDC (Aid to Families with Dependent Children), JOBS (Job Opportunities and Basic Skills Training Program), WIC (Special Supplemental Food Program for Women, Infants, and Children), and food stamp programs over a five- year transition period starting October 1, 1996, shifting financial responsibility to the States for providing similar assistance to low-income individuals, with such cash or non-cash assistance paid for, in part, out of equivalent to the Federal welfare savings. Requires States to provide Medicaid assistance, during such transition period, to certain otherwise eligible individuals who are not welfare- related.

Subtitle B: Post-Transition Period - Requires Federal assumption, during the transition period, of Medicaid acute care benefits and long-term care benefits. Authorizes each State, after the transition period, to provide medical care to welfare-related individuals.

(Sec. 121) Directs the Health Benefits and Coverage Commission (established under subtitle D of this title) to develop a legislative proposal recommending a certain grant program designed to award grant funds to those States: (1) that experience the greatest loss of Federal funds as a result of program terminations of this title; and (2) contain cities or counties among the least affluent in the United States, and have the greatest need for public services for low-income and disadvantaged individuals.

Subtitle C: Legislative Proposals - Specifies other legislative proposals for the Commission to develop. Provides for congressional consideration of implementing bills.

Subtitle D: Health Benefits and Coverage Commission - Establishes the Health Benefits and Coverage Commission. Authorizes appropriations.

Title II: Acute Care Benefits Under the Medicare Program for Elderly Low-Income and Nonelderly Low-Income Disabled Individuals - Subtitle A: Eligibility Criteria and Acute Care Benefits for Elderly Low-Income Individuals - Requires the legislative proposal developed by the Commission under title I to recommend a category of elderly low-income individuals eligible for benefits under the Medicare program (as amended by this Act), subject to the availability of appropriations. Limits such category to: (1) the elderly individuals eligible for Supplementary Security Income (SSI) under title XVI of the Social Security Act (SSA); (2) elderly individuals who meet a Federal medically needy standard (which may be based on specified factors); and (3) individuals who would have been eligible to receive medical assistance for Medicare cost-sharing as certain kinds of beneficiaries under SSA before enactment of this Act. Requires certain cost projections to accompany such proposal, together with prescribed cost controls.

(Sec. 202) Requires such proposal to include specified Medicare benefits for elderly low-income individuals.

Subtitle B: Eligibility and Acute Care Benefits for Nonelderly Low-Income Disabled Individuals - Requires such legislative proposal to establish a category of nonelderly low-income disabled individuals. Requires certain cost projections to accompany such proposal, together with prescribed cost controls.

(Sec. 212) Requires such proposal to include specified Medicare benefits for nonelderly low-income disabled individuals.

Subtitle C: Premiums, Coinsurance, and Deductibles Established Without Regard to Additional Costs - Directs the Secretary of Health and Human Services to establish premiums, coinsurance, and deductibles for the Medicare program after the transition period without regard to the amount of additional Federal expenditures incurred for providing acute care benefits to elderly low-income and nonelderly low-income disabled individuals.

Title III: Establishment of the Long-Term Care Program - Subtitle A: Establishment - Directs the Secretary to establish a long-term care program.

Subtitle B: Providing Long-Term Care - Directs the Secretary to establish a procedure for making eligibility determinations under the long-term care program and for periodic reassessment (at least annually, with certain exceptions) of an individual's financial and physical condition.

(Sec. 312) Authorizes the Secretary to contract on a statewide, marketwide, or regional basis with any State, local government, community or civic organization, private entity, joint public and private partnership, or fiscal intermediary meeting certain requirements to provide or deliver benefits under the long-term care program. Prescribes requirements for such contracts and contractors.

(Sec. 313) Requires the Secretary to provide individuals meeting eligibility criteria with long-term care benefits through any other means if at least one long-term care contractor in their area does not enter into a program contract.

(Sec. 314) Sets forth contract terms and the Secretary's powers and duties.

Subtitle C: Requirements for Long-Term Care Contractors - Prescribes other general requirements for long-term care contractors, along with needs assessment and individualized plan of care requirements for beneficiaries.

(Sec. 323) Requires long-term care contractors to establish: (1) procedures that assure reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice; and (2) meaningful procedures for hearing and resolving grievances with eligible individuals. Sets forth appeal procedures for such grievances.

(Sec. 325) Requires the Secretary to have access to any contractor or subcontractor records.

Subtitle D: Establishing Long-Term Care Benefits for Certain Individuals - Requires the Commission's legislative proposal to recommend national eligibility criteria for elderly or disabled individuals to receive long-term bare benefits, developed according to specified guidelines, and including repeal and replacement of the current Medicaid program with a program established according to this title.

Title IV: Ensuring Financing for Federal Health Care for Certain Elderly Low-Income and Nonelderly Low-Income Disabled Individuals - Requires the Secretary to report to the Congress the actual or estimated shortfall, along with a legislative proposal, if the funds appropriated for any fiscal year for acute care benefits and long-term care benefits are, or are estimated to be, insufficient to pay the total Federal expenditures for such purposes. Requires such legislative proposal to include a request for supplemental appropriations together with proposed modifications to eligibility requirements and benefits. Requires the Secretary to modify such benefits, according to specified priorities, if the Congress fails to enact legislation in response to the proposal with 45 days.

Title V: Miscellaneous Provisions - Requires an individual to satisfy separately the eligibility requirements for acute care benefits under Medicare and long-term care benefits under the long- term care program. Permits such individual to use the same assets or income to meet the separate eligibility criteria.

(Sec. 502) Requires the Secretary, after the transition period, to take all necessary and appropriate steps in administering the Medicare program and the long-term care program to facilitate and encourage opportunities for enrollment in private health care plans and integrated systems of managed care plans by individuals eligible for benefits under this Act.

(Sec. 503) Requires the Commission's legislative proposal to recommend modifications to SSI eligibility requirements for children, alcoholics, and drug addicts so that only the most severely disabled among them are eligible for SSI benefits.

(Sec. 504) Prescribes information requirements for an annual report to the Congress on implementation of this Act.

(Sec. 505) Directs the Commission to study and report to Congress on what legislative and regulatory measures can be taken to integrate acute and long-term care benefits for all elderly and disabled individuals.

Division B: Tax Incentives and Standards for Long-Term Care Insurance - Title I: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to make qualified long-term care expenses deductible medical care expenses.

(Sec. 1003) Treats a qualified long-term care insurance policy as an accident and health insurance contract.

(Sec. 1004) Excludes qualified long-term care plans from COBRA continuation requirements.

(Sec. 1005) Treats any amount distributed to an individual under a life insurance contract (including accelerated death benefits) on the life of a terminally ill individual as an amount paid by reason of the insured's death. Prescribes the tax treatment of companies issuing qualified accelerated death benefit riders.

Title II: Standards for Long-Term Care Insurance - Sets forth additional requirements for issuers of long-term care insurance policies. Imposes an excise tax on such issuers who fail to meet such requirements.

Title III: Incentives to Encourage the Purchase of Private Insurance - Directs the Secretary to provide for a public information and education program on the benefits of securing long-term care insurance coverage and the risks of not doing so. Authorizes appropriations.