Medicare Catastrophic Loss Prevention Act of 1987

Summary

Medicare Catastrophic Loss Prevention Act of 1987 - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to remove durational limitations on Medicare coverage of inpatient hospital services, and cover 150 days of post-hospital extended care services per year, for an individual covered under parts A and B (Supplementary Medical Insurance) of the Medicare program. (Individuals covered only under part A would be subject to current durational limitations on such services.) Provides that an individual covered under parts A and B of the Medicare program shall not be required to pay more than one deductible for inpatient hospital services and one deductible for blood furnished in connection with such services per year. (Currently such deductibles are imposed for each "spell of illness.") Eliminates the coinsurance requirement imposed on such individuals for extended hospital stays. Imposes a coinsurance rate, equal to 15 percent of the average per diem cost of post-hospital extended care services, for the first ten days of a part A and B beneficiary's receipt of such services per year. (Currently, the coinsurance requirement applys to days 21 through 100 of a "spell of illness" requiring such services.) Amends part B of the Medicare program to cover all of the out-of-pocket Medicare expenses which a part B beneficiary incurs in excess of $1,700 in 1988, adjusted annually thereafter to reflect changes in the cost-of-living. Provides for the adjustment of Medicare payments to organizations providing health care on a prepaid basis so as to reimburse them for such excess out-of-pocket costs incurred on behalf of enrollees. Counts amounts an organ transplant patient spends on immunosuppressive drugs toward the out-of-pocket expense limit. Imposes a monthly catastrophic coverage premium of $4 for 1988 on an individual covered under parts A and B of the Medicare program, with annual adjustments to such premium thereafter reflecting changes in the amount of catastrophic benefits paid. Imposes a smaller monthly catastrophic coverage premium on individuals who are only covered under part B of the Medicare program. Imposes a supplemental part B premium of $12 per year, adjusted annually to reflect increases in the cost of catastrophic benefits, for each $150 of income tax due in excess of $150. Sets an annual cap on the supplemental premium. Covers, as home health services, daily nursing care and home health aide services furnished for up to 21 days with a physician's certification of the need for such daily care. Covers such services on a daily basis for 45 days when provided to a part B beneficiary within 30 days of his or her hospital discharge. (Currently such care must be provided on a part-time or intermittent basis.) Defines as "homebound" (a prerequisite of eligibility for Medicare home health services) any person who has a condition which restricts his or her ability to leave the home without support or for whom leaving the home is medically contraindicated. Directs the Secretary to notify Medicare beneficiaries, when they apply for benefits under part A or enroll under part B, and annually thereafter, regarding the extent of and limitations on Medicare coverage, including the ways in which coverage differs between those who are and those who are not covered under part B. Requires the Secretary to take into account the costs incurred by organizations providing health care on a prepaid basis as a result of this Act's amendments in modifying contracts with such organizations. Requires such organizations to adjust their agreements with Medicare beneficiaries in consideration of such amendments. Directs the Secretary to request the Institute of Medicine to perform a study to determine which prescription drugs should have their costs covered by the Medicare program or counted toward the part B beneficiary's out-of-pocket expense limit. Requires the Institute to submit an interim report within six months and a final report within one year of this Act's enactment to the Secretary and the Congress regarding such study. Creates an extension period of hospice care for terminally ill beneficiaries which is to follow the two 90-day periods and the subsequent 30-day period of hospice care coverage currently provided in an individual's lifetime. Requires that State regulatory standards for Medicare supplemental health insurance policies be at least as stringent as the National Association of Insurance Commissioners (NAIC) Model Standards, amended within 90 days of this Act's enactment to reflect changes made by this Act. Provides that if the NAIC Model Standards are not amended, Federal model standards shall be established and serve as the basis for evaluating State regulatory standards for Medicare supplemental health insurance policies. Requires that States use savings accrued under Medicare from catastrophic Medicare coverage to expand Medicaid (title XIX of the Act) coverage of the low-income elderly and community spouses of institutionalized individuals. Directs the Secretary to report to the Congress by October 1, 1989, on a study to be conducted by the Institute of Medicine into private and public funding options for long-term care. Requires the Secretary to report to the Congress within 180 days of this Act's enactment on steps taken to eliminate the three-day prior hospitalization requirement for extended care services.

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Documents

3 official files

• Indefinitely postponed in Senate

  summary · EN · 27 October 1987

  Open at official source

• Reported to Senate with amendment(s)

  summary · EN · 27 July 1987

  Open at official source

• Introduced in Senate

  summary · EN · 5 May 1987

  Open at official source

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