Summary: H.R.2762 — 100th Congress (1987-1988)All Information (Except Text)

There is one summary for H.R.2762. Bill summaries are authored by CRS.

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Introduced in House (06/24/1987)

Medicare Long-Term Home Care Catastrophic Protection Act of 1987 - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to provide part A coverage of long-term home care furnished through home health agencies to chronically ill individuals who are under a physician's care. Requires physicians to establish and periodically review a written plan of long-term home care for each of their patients who receive such coverage. Lists the services which comprise long-term home care. Defines a "chronically ill individual" as an individual who requires assistance with at least two daily living activities or has a similar level of dependency due to cognitive impairment. Holds monthly payments for long-term home care to 75 percent of the average monthly payment under the Medicaid program (title XIX of the Act) for skilled nursing facility services.

Amends title II (Old Age, Survivors and Disability Insurance) of such Act to cover, under part A of the Medicare program, long-term home care provided to children who: (1) are chronically ill and require assistance with at least two daily living activities; or (2) require a medical device to compensate for the loss of a vital body function and substantial and ongoing nursing care to avert death or further disability. Holds monthly payments for the latter category of children to the amount which would be payable under the Medicaid program if such children were institutionalized.

Adds a new title XXI to the Social Security Act entitled "Home Care Quality Assurance." Requires the Secretary of Health and Human Services to promulgate a home care consumers' bill of rights which includes rights: (1) facilitating consumer participation in the planning and delivery of services; (2) requiring consumer notification regarding services, charges for services, and the termination or reduction of services; (3) protecting consumer dignity, privacy, and property; and (4) ensuring service from properly trained and competent individuals.

Requires home health agencies to: (1) satisfy Medicare home care agency requirements; (2) provide consumers with copies of the home care bill of rights; (3) implement grievance review procedures and provide copies of such procedures to consumers; (4) provide consumers with schedules of the services to be provided; (5) have methods for identifying and reviewing a home care consumer's needs and coordinating the provision of services with other home health agencies; (6) ensure that each home care provider whom they employ or have under contract receives training; and (7) evaluate annually and supervise each home care provider whom they employ or have under contract. Conditions coverage of durable medical equipment services on providers: (1) issuing written instructions to and training the home care consumer and staff in the operation of such equipment; and (2) formulating an emergency plan for providing services to the consumer.

Directs the Secretary to establish procedures for conducting an equal number of announced and unannounced surveys of a home health agency's compliance with title XXI participation conditions, with more frequent surveys required for agencies with poor compliance records. Authorizes the Secretary to contract with States having survey procedures equivalent to those the Secretary would otherwise apply to conduct such compliance surveys and transmit their results to the Secretary annually. Directs the Secretary to develop procedures for reviewing State surveys, with more frequent review required if peer review organizations (PROs) find at least ten percent of State-surveyed agencies to have serious or chronic quality of care problems.

Directs the Secretary to promulgate regulations, within one year of this Act's enactment, pursuant to which PROs shall monitor the provision of home health services, devoting at least 75 percent of their efforts to quality assurance. Requires the inclusion of: (1) both documentary review and personal interviews of home care consumers and providers in the PRO review process; and (2) representatives of home care providers and consumers in PRO membership.

Requires the Secretary to establish a Consumer Board to oversee the review activities of PROs. Directs the Board to report to the Secretary and the State's chief executive on October 1 of each year regarding such review activities.

Requires the Secretary to develop methods for monitoring continuity in the provision of health care and outcome-orientated criteria for monitoring the quality of home care. Requires that PROs: (1) establish and operate statewide toll-free hotlines for receiving home care questions and complaints; and (2) assist consumers in resolving home care quality problems. Directs Consumer Boards and PROs to cooperate with State and local officials in educating consumers regarding quality assurance programs and the assistance available for consumers with quality assurance problems.

Requires the Secretary to issue regulations which impose sanctions against agencies and providers failing to comply with this Act. Requires the Secretary to report to the Congress on January 1 of each year regarding the availability, adequacy, and use of sanctions. Requires the Secretary to develop incentives to contractor compliance with title XXI participation conditions, including an annual directory of home care agencies having a consistent record of compliance with such conditions. Directs the Secretary to: (1) encourage States to develop home care provider licensing and certification policies; and (2) issue a biennial report on State implementation of such policies.

Establishes a Home Care Quality Assurance Council with which the Secretary must consult in implementing and administering title XXI of the Social Security Act.

Directs the Secretary to award grants for home care agency and provider training programs and to furnish States and home health agencies and providers with training materials.

Directs the Secretary to: (1) conduct, and issue a report regarding, studies on home care quality assurance measures; and (2) report to the Congress on January 1 of each year regarding the nature and performance during the preceding fiscal year of the home care quality assurance system.

Authorizes appropriations from the Federal Hospital Insurance Trust Fund to carry out title XXI. Directs the Secretary to issue regulations by 1988 for implementing title XXI.

Permits disabled individuals to purchase part A (Hospital Insurance) Medicare coverage during the 24-month waiting period preceding their entitlement to such coverage.

Amends the Internal Revenue Code to subject all of an individual's wages and self-employment income to the Hospital Insurance tax.