Health Care Financing Amendments of 1983

Health Care Financing Amendments of 1983 - Title I: Medicare - Subtitle A: Changes in Eligibility, Benefits, and Cost Sharing - Amends title XVIII (Medicare) of the Social Security Act to increase the Supplementary Medical Insurance (SMI), (part B of title XVIII) deductible by the percentage increase in the Medicare Physicians' services economic index.

Amends titles II (Old Age, Survivors and Disability Insurance) and XVIII of the Act to provide that Medicare eligibility shall not begin until the first full month in which an individual becomes age 65.

Revises provisions relating to SMI premiums. Directs the Secretary of Health and Human Services during September 1983 and annually thereafter to determine the monthly actuarial rate for enrollees age 65 and over which shall be applicable for the succeeding year. Provides that the actuarial rate shall be the amount the Secretary estimates to be necessary so that the aggregate amount for that succeeding year with respect to those enrollees age 65 and over will equal one-half of the total benefits and administrative costs estimated to be payable from the Federal Supplementary Medical Insurance Trust Fund for services performed and related administrative costs incurred in that year. Directs the Secretary during September 1983 and annually thereafter to determine a monthly premium amount applicable for the succeeding year. Provides that amount (except in certain instances) shall be equal to: (1) for 1984, 50 percent of the 1984 monthly actuarial rate for enrollees age 65 and over; (2) for 1985, 55 percent of the 1985 monthly actuarial rate; (3) for 1986, 60 percent of the 1986 monthly actuarial rate; (4) for 1987, 65 percent of the 1987 monthly actuarial rate; and (5) for 1988 and each succeeding year, 70 percent of the monthly actuarial rate for that year.

Provides that payments to home health agencies for durable medical equipment shall be the lesser of: (1) the reasonable cost of the equipment and the customary charges for such equipment less an amount equal to 20 percent of the reasonable charge, but in no case may the payment for the equipment exceed 80 percent of the reasonable cost; or (2) if the equipment is furnished by a public home health agency free of charge or at a nominal charge, an amount which provides fair compensation to the agency.

Eliminates the SMI deductible for diagnostic tests performed in a laboratory which has entered into a negotiated rate agreement with the Secretary.

Provides for a 30 day period of coverage for services furnished by a home health agency following the termination of the agency's agreement.

Subtitle B: Changes in Reimbursement - Reduces the "applicable percentage increase" used in computing hospital "target amounts."

Provides that in determining SMI reasonable charges for physicians' services, the prevailing and customary charge levels that apply to services furnished after June 1982 but before July 1983 shall also apply to services furnished after June 1983 but before July 1984.

Authorizes the Secretary to enter into an agreement with a public or private entity under which the entity accepts specified amounts as full payment for certain SMI items and services.

Subtitle C: Administrative Changes - Revises provisions relating to Medicare claims processing. Authorizes the Secretary to enter into agreements with intermediaries providing for their determination of the amount of the payments required under part A (Hospital Insurance) of title XVIII to be made to providers of services assigned by the Secretary to specific intermediaries, and for the making of such payments by intermediaries to those providers. Defines "intermediary" as: (1) a voluntary association, corporation, partnership, or other nongovernmental organization which is lawfully engaged in providing, paying for, or reimbursing the cost of, health services under group health insurance policies or contracts, medical or hospital service agreements, membership or subscription contracts, or similar group arrangements, in consideration of premiums or other periodic charges payable to the intermediary; or (2) an agency or organization with which an agreement was in effect on the date of enactment of the Health Care Financing Amendments of 1982.

Requires all items and services furnished by a hospital to inpatients to be furnished by or through the hospital, except for physicians' services.

Prohibits payment for inpatient hospital services furnished to an individual as an inpatient of a particular hospital during a spell of illness after such services have been furnished to the individual for 150 days as an inpatient of that hospital or of another hospital that has previously filed a request for payment for such services during such spell minus one day for each day of inpatient hospital services in excess of 90 received during any preceding spell of illness. Requires the first hospital filing after Medicare payment for inpatient hospital services to be responsible for collecting the deductible.

Repeals specified requirements relating to coverage of tuberculosis treatments.

Eliminates utilization review requirements.

Eliminates the requirement for a separate Railroad Retirement Board carrier contract.

Authorizes the United States to bring an action directly against a third party payer (workmen's compensation, automobile, or other insurance plan) for Medicare payments.

Prohibits a provider from receiving payment for custodial services or for services not reasonable and necessary.

Permits SMI payments to be made to an entity: (1) which provides coverage of the service under a health benefits plan; (2) which has paid the person who provided the service an amount which that person has accepted as payment in full for the service; and (3) to which the individual has agreed in writing that payment may be made.

Eliminates the Health Insurance Benefits Advisory Council.

Prohibits the Secretary from disclosing any accreditation survey made by the Joint Commission on Accreditation of Hospitals or the American Osteopathic Association of an institution accredited by either of those bodies as a hospital.

Eliminates the requirement that institutional providers include as a part of the required overall plan and budget the three year capital expenditures plan.

Eliminates the requirement that a psychiatric hospital must be accredited by the Joint Commission on Accreditation of Hospitals.

Eliminates the requirement that final cost reports of health maintenance organizations and competitive medical plans be independently certified.

Provides that only in contracts of above $50,000 (currently $10,000) between a Medicare provider and any of its subcontractors must there be a clause permitting access to the subcontractor's records before reimbursement will be made.

Makes the national end-stage renal disease medical information system discretionary with the Secretary (currently, the Secretary is required to establish the system).

Authorizes the Secretary, if patient health and safety is not jeopardized, to apply less severe sanctions than are presently available for dealing with an end-stage renal disease facility which is not in compliance with applicable regulations.

Prohibits Medicare payment to any physician convicted of Medicare or Medicaid (title XIX of the Act) related crimes.

Authorizes the Secretary to deny participation in the Medicare program to any provider: (1) convicted of Medicare or Medicaid related crimes; (2) against whom a Medicare or Medical related civil penalty has been assessed; or (3) to whom Medicare payments have been denied due to knowingly and willfully making a false statement or representation related to Medicare participation.

Authorizes the Secretary to terminate a agreement with a provider if any individual who directly or indirectly owns or controls five percent or more of the provider's business has been convicted of certain Medicare or Medicaid related offenses.

Authorizes the Secretary to use accrediting organizations to determine whether rural health clinics, laboratories, clinics, rehabilitation agencies, and public health agencies meet Medicare requirements.

Eliminates certain reporting requirements of the Secretary.

Title II: Medicaid - Subtitle A: Changes in Payments to States - Amends title XIX (Medicaid) of the Social Security Act to provide 100 percent Federal payment of the administrative costs of processing combined Medicare and Medicaid claims.

Provides that Federal Medicaid payments to States for FY 1985 and each succeeding year shall be reduced by three percent.

Prohibits payment with respect to any amount spent for an item or service furnished by or through a physician who has been convicted of a Medicare or Medicaid related crime or who knowingly and willfully made false representations related to Medicare or Medicaid.

Authorizes the Secretary to reduce the amount which would otherwise be considered as expenditures under a State plan by an amount equal to payments made by the State to any individual or institution that has failed to furnish requested information regarding payment claimed.

Subtitle B: Changes in Eligibility, Benefits, and Cost Sharing - Requires (currently, permits) a State to provide for the assignment of rights of payment.

Prohibits copayments on services furnished by health maintenance organizations (HMO's) to the categorically needy and to certain long-term care inpatients. Authorizes a State to exempt children and pregnant women from copayments. Authorizes a State to exempt emergency services from copayments. Requires the categorically needy to pay a copayment of one dollar per day for inpatient hospital services and one dollar per visit for outpatient hospital services, rural health clinic services, physician services, and clinic services. Requires copayments two dollars per day and $1.50 per visit by the medically needy for the same services.

Subtitle C: Administrative Changes - Repeals provisions prohibiting grants to profit making organizations for research or demonstration projects.

Revises provisions under title XIX relating to medical review and independent professional review.

Repeals special requirements relating to coverage of tuberculosis treatments.

Repeals the requirement that a State plan must have in effect: (1) a program of control over utilization of inpatient hospital services, skilled nursing facility services, or intermediate care facility services exceeding 60 days (or inpatient mental care services exceeding 90 days); and (2) a utilization review plan with respect to any amount spent for care or services in the above institutions.

Requires a State to obtain from each Medicaid applicant or recipient his or her taxpayer identification number.

Repeals the requirement that Medicaid management information systems provide written notice to each Medicaid recipient of the services furnished. Requires instead, that each State provide for an effective method of verifying whether services billed by all participating providers were furnished as claimed.

Authorizes the Secretary to waive or modify any Medicaid requirement with respect to Puerto Rico, the Virgin Islands, Guam, or the Northern Mariana Islands (currently, the Secretary has this authority only with respect to American Samoa), other than a waiver of the Federal medical assistance percentage, the ceiling on total Federal payments, or services for which medical assistance may be provided.

Authorizes a State to terminate an agreement with a provider if any owner of the institution has been convicted of certain offenses.

Eliminates the requirement that a psychiatric hospital must be accredited by the Joint Commission on Accreditation of Hospitals and requires instead that it meet specified standards under the Medicare program.

Modifies the type of hearing required before the Secretary may cancel approval of a skilled nursing facility or intermediate care facility.

Modifies payment rates for a hospital furnishing skilled nursing or intermediate care facility services. Provides those hospitals with the same payment rate as for other hospital services.

Revises the Secretary's authority to provide, by waiver, that a State plan may include as medical assistance approved home or community based services in the situation where an individual otherwise would have to be placed in nursing care facility. Provides that the waiver shall be for an initial term of one, two, or three years and, upon the request of a State, shall be extended for an additional periods of one, two, or three years, if appropriate.

Provides the Secretary with the same authority to issue and enforce subpoenas under Medicaid as the Secretary has under title II (Old age, Survivors and Disability Insurance) of the Act.

Revises provisions relating to disputed claims on which States are required to pay interest on Federal matching claims. Makes the requirement effective with respect to amounts claimed by the State (currently, expenditures for services furnished) on or after October 1, 1980.

Title III: Other Health Care Financing Provisions - Repeals provisions under titles XVIII and XIX of the Act which authorized payments to promote the closing and conversion of underutilized hospital facilities.

Amends part A (General Provisions) of title XI of the Act to provide that the Administrator of the Health Care Financing Administration shall be appointed by the President with the advice and consent of the Senate.

Revises provisions relating to the capital expenditures review program. Directs the Secretary, after consultation with the Governor and with appropriate local public officials, to make an agreement with any State which is able and willing to do so under which a designated planning agency (which shall be a State governmental agency) may make, and submit to the Secretary, findings and recommendations with respect to capital expenditures proposed by or on behalf of any health care facility in the State that the agency chooses to review. Eliminates the national advisory council, which was established to assist the Secretary with respect to the program.

Repeals provisions providing for Federal funding of State programs that review health facility capital expenditures.

Revises requirements relating to ownership of providers. Eliminates an individual owner's reporting requirements if such owner owns less than five percent (even though the amount of ownership is $25,000 or more).

Authorizes the Secretary to bar from participation in Medicare or Medicaid any provider in which five percent or more is owned by an individual convicted of Medicare or Medicaid related crimes.

Repeals part B (Peer Review of the Utilization and Quality of Health Care Services) of title XI of the Act.