Health Care Financing Amendments of 1981

Health Care Financing Amendments of 1981 - Title I: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to set a limit on the authorization of appropriations for Medicaid for fiscal year 1981 and succeeding fiscal years (presently, a sum sufficient to carry out the program is authorized), except for funding to eliminate fraud and funding to pay States' claims for Medicaid expenditures prior to October 1, 1981. Apportions funds to States according to the ratio of each State's estimated Medicaid expenditures compared to the estimated expenditures of all States for fiscal year 1981. Authorizes separate funding for mechanized claims processing and information retrieval systems. Prohibits payment for any fiscal year 1980 State expenditure unless a claim is filed by October 1, 1981, except in exceptional circumstances.

Makes various waivers and modifications of Medicaid program requirements. Eliminates all requirements with respect to eligibility and benefits of the medically needy, and all requirements (other than mandatory services for the categorically needy) to provide equal benefits to all medically needy and categorically needy (mainly individuals receiving cash assistance under the Social Security Act). Maintains the requirement of a State to provide all mandatory services to the categorically needy, but permits a State to use reasonable criteria in determining benefits and eligibility for other needy individuals. Replaces the present requirement that Medicaid beneficiaries be afforded the freedom to choose a provider with a requirement to provide standards reasonably expected to give recipients adequate quality care. Repeals certain requirements with respect to: (1) utilization review and control; and (2) the amount and method of provider reimbursement. Revises requirements for Medicaid management information systems. Permits the waiver of certain State plan requirements if a State demonstrates that it has established alternative methods which can be expected to achieve the same goal. Provides personal care services to individuals who, without them, would require institutionalization.

Increases Federal funding for automated eligibility assessment systems.

Provides that disputed overpayments to a State which were disallowed by the Secretary of Health and Human Services will be recovered by the Secretary rather than retained by the State pending final determination.

Permits a State to attribute to an alien the income and resources of the alien's sponsor for purposes of determining the alien's eligibility for Medicaid, if such alien seeks Medicaid within three years of entry into the United States.

Title II: Medicare - Amends title XVIII (Medicare) of the Act to provide that contracts for the administration of benefits could be entered into with any public or private entity.

Permits payments to providers on other than a reasonable cost or reasonable charge basis.

Permits competitive bidding on contracts for the administration of benefits.

Eliminates the requirement for a Railroad Retirement Board carrier contract.

Repeals the 12-month statutory limitation on agreements with skilled nursing facilities.

Prohibits payment for general routine care, including nursing care, of inpatients in hospitals and skilled nursing facilities above a certain amount (determined according to formula) unless it is demonstrated that the cost of caring for Medicare patients is more costly than caring for other patients.

Permits the Secretary to withhold payments under Medicare to any Medicaid provider from which Medicaid overpayments cannot be recovered or from which information necessary to determine overpayments cannot be collected.

Limits home health services to 100 visits annually under part A (Hospital Insurance) and 100 visits annually under part B (Supplementary Medical Insurance) of title XVIII. Eliminates the need for occupational therapy as a basis for entitlement to home health services.

Eliminates part A coverage of alcohol detoxification facility services.

Eliminates part B coverage of comprehensive outpatient rehabilitation services.

Reduces from $500 to $100 the annual limit for outpatient physical therapy services.

Eliminates coverage for hospitalization required solely because of the severity of a dental procedure.

Restricts enrollment under part B to the first quarter of each calendar year.

Provides, under part B, that with respect to State agreements for coverage of eligible individuals who are receiving money payments under a public assistance program, coverage extended to additional groups of individuals under an agreement requested by a State during 1981 shall not extend to items and services furnished under part B after the second month of enactment.

Repeals the requirement for end-stage renal disease networks.

Eliminates the temporary delay for the last 21 days of fiscal year 1981 in periodic interim payments to hospitals.

Repeals utilization review requirements.

Eliminates Medicare coverage for pneumococcal vaccine.

Title III: Other Provisions - Amends part A (General Provisions) of title XI of the Act to set forth civil penalties for Medicare and Medicaid fraud. Sets forth the procedures for appealing the Secretary's determination of fraud. Permits the Secretary to deny further participation in Medicare or Medicaid to any individual against whom a final determination of fraud has been reached.

Repeals the requirement under part A (Aid to Families with Dependent Children) of title IV of the Act that a State notify AFDC families of the availability of child health screening and treatment services under Medicaid.

Amends part B (Professional Standards Review) of title XI of the Act to permit the Secretary to enter into an agreement with a Professional Standards Review Organization (PSRO) for less than 12 months. Prohibits judicial review of the termination of an agreement by the Secretary. Eliminates the requirement that the Secretary provide a formal hearing to terminate a PSRO agreement. Permits the Secretary to terminate an agreement upon giving 90 days notice.

Abolishes the Statewide Professional Standards Review Councils.

Changes the authority of the Secretary with respect to funding PSRO's from mandatory to discretionary.

Permits a State to withdraw its Medicaid program from participation in the professional standards review program.

Repeals requirements that the Secretary carry out specified studies and demonstration projects.

Amends titles I (Old Age Assistance), IV (Part A), X (Aid to Blind), XIV (Aid to the Permanently and Totally Disabled), and XVI (Supplemental Security Income) of the Act to repeal obsolete authority to provide medical assistance, such authority having been replaced by Medicaid.