A bill to amend the Social Security Act to improve the survey and certification process, rate-setting and fiscal audit methods, and general regulation of nursing homes and intermediate care facilities under the medicaid program, and to provide for medical, psychological, and social assessment of long-term care patients under both the medicare and medicaid programs.

Summary

Title I: Survey and Certification, Ratesetting and Audit, and General Regulation of Long-Term Care Facilities Under Medicaid Programs - Requires that a State plan for medical assistance must provide that no skilled nursing facility may receive payments under such plan unless and until it is approved to receive payments under title XVIII (Medicare) of the Social Security Act. Provides that such State plan require that the State agency shall have the power to terminate reimbursement to a skilled nursing or intermediate care facility which violates its provider agreement. Requires such State plan to include that the inspection and medical review shall serve as the basis for determining the overpayment to such facility, and the amount such agency must refund. Requires such State plan to provide that any skilled nursing facility receiving payments under the plan be required to maintain with the State agency a bond to anitcipate any and all claims for overpayment. Title II: Medical, Psychological, and Social Assessment of Patients in Need of Long-Term Care Under Medicare And Medicaid Programs - Requires that for payment of services furnished an individual under the Medicare and Medicaid programs physician's certification be based on such patient assessment criteria as the Secretary of Health, Education, and Welfare may require. Provides that a State plan must include a regular program of medical review utilizing such criteria as are required by the Secretary, and a plan for periodic inspections of all nursing homes to find the feasibilities, determined by reference to the criteria and methods required by the Secretary of meeting their health care needs through alternative institutional or noninstitutional services.

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1 official file

• Introduced in Senate

  summary · EN · 29 April 1975

  Open at official source

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