Medicare Catastrophic Coverage Act of 1988

Summary

Medicare Catastrophic Protection Act of 1987 - Title I: Provisions Relating to Part A of Medicare Program - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to require that an inpatient hospital deductible be paid only for the first period of continuous hospitalization in a calendar year. (Currently, such deductible must be paid for each "spell of illness" requiring inpatient hospital services.) Removes durational limitations on the coverage of inpatient hospital services, except with respect to inpatient psychiatric hospital services. Eliminates the coinsurance requirement for inpatient hospital services. Sets the inpatient hospital deductible for 1987 at $520, requiring cost-of-living adjustments to such deductible for succeeding years. Establishes the monthly part A premium, required of individuals who wish to buy into the Hospital Insurance program, at the monthly actuarial value of part A services provided to beneficiaries age 65 and over. Imposes a coinsurance rate, equal to 20 percent of the average per diem cost of post-hospital extended care services, for the first seven days of an individual's receipt of such services in a calendar year. Provides coverage for post-hospital extended care services for 150 days in each calendar year. (Currently, such coverage is limited to 100 days for each "spell of illness.") Drops restrictions on the coverage of extended care services which are not post-hospital extended care services. 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. Reduces the deductible imposed under part A on the first three pints of blood furnished to an individual during a calendar year to the extent such blood is replaced or a blood deductible has been imposed on the individual under part B (Supplementary Medical Insurance) of the Medicare program within such year. Provides part A coverage for home health services only when an individual is not entitled to part B benefits. Amends the Internal Revenue Code to impose an annual supplemental Medicare premium on part A Medicare beneficiaries pursuant to a table which bases the amount of such premium due on the size of a beneficiary's gross income. Requires the Secretary of Health and Human Services to make returns setting forth certain information regarding part A Medicare beneficiaries. Title II: Provisions Relating to Part B of the Medicare Program - Amends part B (Supplementary Medical Insurance) of the Medicare program to cover all of the out-of-pocket part B expenses a beneficiary incurs in excess of $1,043 in 1989, adjusting such ceiling annually thereafter to reflect cost-of-living increases. 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. Covers nursing care and home health aide services as home health services if such services are needed less than seven days each week or are needed for an initial period of up to 35 consecutive days and for a subsequent period on a physician's certification of exceptional circumstances. Increases the maximum Medicare payment allowed for outpatient mental health services. Directs the Secretary to: (1) mail a notice annually to Medicare beneficiaries of the extent to which Medicare coverage is provided for health care services and Medicare and Medicaid (title XIX of the Act) coverage is provided for long-term care services; and (2) send participating physician directories to part B enrollees. Amends title XVI (Supplemental Security Income) of the Act to provide Medicaid coverage to part A Medicare beneficiaries whose income does not exceed the Federal poverty level applicable to a family of one or two individuals which includes an individual age 65 or older. Amends the Medicare program to make permanent the provisions authorizing a State to arrange for Medicare coverage of individuals covered by certain other titles of the Act. Provides for the adjustment of Medicare part B premiums to take into account the costs of additional benefits provided by this Act's catastrophic coverage. Directs the Secretary to report to the Congress within 150 days of this Act's enactment on recommended changes in the certification requirements for Medicare supplemental policies. Requires a Medicare supplemental policy to: (1) mail notice to beneficiaries before 1989 of improved Medicare benefits contained in legislation of the 100th Congress and the effect such legislation will have on such policy; and (2) submit a copy of each of its advertisements to the State Commissioner of Insurance for his or her review. Extends, through September 30, 1992, certain projects demonstrating the concept of a social health maintenance organization. Directs the Comptroller General to report to the Congress within six months of this Act's enactment on the need for, and cost of, including within the Medicare program: (1) annual preventive care visits; (2) routine eye care; (3) dental services; (4) hearing aids for those with a significant hearing loss and biannual hearing testing; (5) comprehensive long-term care services; and (6) prescription drugs and biologicals. Requires the Secretary to provide for research on issues relating to the delivery and financing of Medicare long-term care services. Authorizes appropriations for FY 1988 through 1992 for such research.

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Documents

6 official files

• Public Law (PDF)

  Public Law · EN · 2 July 1988

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• Conference report filed in House

  summary · EN · 31 May 1988

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• Passed Senate amended

  summary · EN · 27 October 1987

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• Passed House amended

  summary · EN · 22 July 1987

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• Reported to House amended, Part II

  summary · EN · 1 July 1987

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• Introduced in House

  summary · EN · 19 May 1987

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