A bill to amend the Social Security Act to extend entitlement to health care benefits on the basis of age under the Federal medical insurance program (medicare) to all persons who are citizens or residents of the United States aged 65 or more; to add additional categories of benefits under the program (including health maintenance and preventive services, dental services, outpatient drugs, eyeglasses, hearing aids, and prosthetic devices) for all persons entitled (whether on the basis of age or disability) to the benefits of the program; to extend the duration of benefits under the program where now limited; to eliminate premiums now required under the supplementary medical insurance benefits part of the medicare program and merge that part with the hospital insurance part; to eliminate all deductibles; to eliminate copayments for low-income persons under the program, and to provide, for others, copayments for certain services or items but only up to a variable income-related out-of-pocket expense limit (catastrophic expense limit); to provide for prospective review and approval of the rates of charges of hospitals and other institutions under the program, and for prospective establishment (on a negotiated basis when feasible) of fee schedules for physicians and other practitioners; to revise the coverage of the tax provisions for financing the medicare program and increase the Government contribution to the program.
Comprehensive Medicare Reform Act - Title I: Revision of Medicare Entitlement and Benefits - Repeals Parts A (Hospital Insurance Benefits for the Aged) and Part B (Supplementary Medical Insurance Benefits for the Aged) of Title XVIII (Health Insurance for the Aged) of the Social Security Act and enacts in lieu of those parts the provisions of this title.
Lowers the age for participation in the Insurance Plan (Medicare) provided under title XVIII for specified classes of individuals. Makes the following classes of persons entitled to benefits under such title: (1) specified individuals receiving disability payments; and (2) specified individuals with chronic renal disease.
Specifies covered institutional services including, but not limited to: (1) inpatient and outpatient hospital services; (2) skilled-nursing home services; (3) intermediate-care facility services; and (4) home health services.
Lists the following covered services: (1) physicians' services (including psychiatric services if provided by a health maintenance organization); (2) dental services; (3) drugs; (4) devices, appliances, and equipment (if the item is prescribed or certified as medically necessary by an appropriate professional practitioner and if it appears on a current list of items established by the Secretary of Health, Education, and Welfare); and (5) other professional and supporting services, including, but not limited to (a) the professional services of optometrists, (b) the professional services of podiatrists, and (c) the diagnostic services of independent pathology laboratories, and diagnostic and therapeutic radiology furnished by independent radiology services.
Excludes services and items from coverage under this title, including but not limited to: (1) services furnished outside the United States, with an exception for specified hospital services and related professional services; (2) the furnishing of personal comfort items; (3) purely custodial care; (4) cosmetic services; and (5) services for which the individual has no legal obligation to pay.
Provides for the reduction in the amounts otherwise payable under this title from the Medicare Trust Fund with respect to a covered service based upon the applicable amount of coinsurance held by individuals entitled to benefits under this title.
Provides for exceptions to the above reductions in the cases of low-income persons, members of low-income families, and specified cases of payment of catastrophic expense benefits. Sets forth a schedule for the degree of payment reduction by type of service to be effectuated by the individual's coinsurance amount. Sets forth an initial table for the determination of income classes for individuals and members of families under this title. Provides for the periodic revision of income classes established under this title.
Provides for the periodic revision of the catastrophic expense benefit expenditure limitations set under this title.
Provides that payment of covered services provided to an individual by an institutional provider shall be made only to that provider. States that the amount payable to that provider with respect to such services shall be the reasonable cost of the services to the provider governed by the provisions of this title less the amount of any payment of coinsurance.
Provides that payment for covered services that were furnished to an individual by a noninstitutional provider shall be made only to: (1) the participating provider who furnished the services, or (2) in the case of emergency services furnished by a nonparticipating provider, either (a) to the individual on the basis of an itemized bill, or (b) to the provider on the basis of an assignment from the individual.
Authorizes the Secretary to enter into contracts with carriers under which the carrier, on behalf of the Secretary (and subject to review by the Secretary), will perform administrative functions, including the administration of benefits under this Act. Provides that no contract shall be entered into with a carrier unless the Secretary finds that the carrier will perform its obligations under the contract efficiently and effectively and will meet such requirements as to financial responsibility, legal authority, and other matters as he finds pertinent.
Creates the Medicare Trust Fund which shall consist of the assets and liabilities of the Federal Hospital Insurance Fund and the Federal Supplementary Medical Insurance Trust Fund. Authorizes to be appropriated to the Trust Fund a Government contribution in an amount, as estimated by the Board of Trustees, which when added to other income and assets of the Trust Fund will make the Trust Fund sufficient for the prompt payment of all amounts required or authorized by law to be paid therefrom. Authorizes the Board to borrow funds from the Treasury, pending the approval by Congress of the Government contribution, if the Board determines that the amount of the Trust Fund is insufficient to make all required payments in the next three calendar months.
Creates an Institutional Provider Reimbursement Review Board to hear disputes presented by any institutional provider of services which has filed a required cost report (for purposes of reimbursement) within the time specified in regulations if: (1) the provider is dissatisfied with a final determination of the organization serving as its fiscal intermediary as to the amount of total program reimbursement due the provider for the items and services furnished to individuals for which payment may be made under this title for the period covered by the report; (2) the amount in controversy is $10,000 or more; and (3) the provider files a request for a hearing within 180 days after notice of the intermediary's final determination.
Title II: Health Insurance Taxes - Defines the term "employment" for purposes of the health insurance tax provisions of the Internal Revenue Code of 1954. Provides for the exclusion of employer payment of employee taxes from employees' gross income as determined under such provisions of such Code.
Title III: Studies Related to Long-Term Care - Authorizes the Secretary of Health, Education, and Welfare, the Secretary of Housing and Urban Development, and the Secretary of Labor to conduct a joint study on the subject of health related and other long-term institutional care. Authorizes additional studies by the Secretary of Health, Education, and Welfare and the Secretary of Housing and Urban Development concerning the provision of social services to enable elderly persons to live in their own homes. Requires the Secretaries to submit reports to the President and the Congress not later than two years after the date of enactment of this Act.
Introduced in House
Introduced in House
Referred to House Committee on Ways and Means.
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