Summary: H.R.2691 — 106th Congress (1999-2000)All Information (Except Text)

There is one summary for H.R.2691. Bill summaries are authored by CRS.

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Introduced in House (08/03/1999)

Omnibus Long-Term Care Improvement Act of 1999 - Title I: Refundable Credit For Long-Term Care - Amends the Internal Revenue Code to allow as a credit against income tax an amount equal to the sum of $1,000 multiplied by the number of applicable individuals with respect to whom the taxpayer is an eligible caregiver for the taxable year.

Title II: Medicare Long-Term Care Improvements - Subtitle A: Medicare SNF, HHA, and Other Improvements - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for expanded long-term in-home, community-based, and respite care services under the Medicare program for dependent individuals.

(Sec. 202) Provides for coverage of substitute adult day care services as home health services under Medicare.

(Sec. 203) Provides for coverage of Medicare home health case management plans established by home health case managers for long-term home health spells of illness.

Directs the Secretary of Health and Human Services (Secretary) to establish a fee schedule for payment for home health case manager services.

Requires the Secretary to study and report to Congress on the types of Medicare post-acute hospital care services to determine whether use of case managers and case management plans similar to home health case managers and home health case management plans is feasible and appropriate for each such type of service.

(Sec. 204) Requires the Secretary to identify at least ten medical conditions, classified by diagnosis-related groups (DRGs), which consistently require an intense level of post-acute care, either by health care providers or by private caregivers.

Requires disproportionate share (DSH) hospitals to provide, in the case of an inpatient classified a voluntary discharge classified within a certain medical condition before the date of the discharge, a comprehensive case management plan of care that includes a program of education, training, and assistance to the private caregiver, designed to stabilize or to improve the individual's health and to reduce the likelihood of hospital readmission. Requires a reduction in payment for failure to establish such plan of care.

(Sec. 205) Directs the Secretary to pay an additional amount to home health agencies furnishing qualified Medicare home health services during a cost reporting period beginning on or after October 1, 1997, for treatment of conditions within any one of the specified diagnoses classified in St. Anthony's ICD-9-CM Code Book for Physician Payment. Places a limitation of payments. Authorizes appropriations. Bars judicial review.

(Sec. 206) Amends SSA title XVIII with respect to the post-hospital referral process and the definition of homebound.

Subtitle B: Encouraging Provision of Hospice Care - Amends SSA title XVIII to: (1) provide for hospice information for certain Medicare beneficiaries at time of hospital discharge; and (2) permit payment to hospice programs for costs of medical education.

(Sec. 212) Amends the Balanced Budget Act of 1997 (BBA '97) to include hospice programs among qualified consortia for certain demonstration projects.

(Sec. 213) Amends Federal civil service law to provide for the inclusion of hospice care under the Federal Employees Health Benefits Program.

Subtitle C: QMB Improvements - Amends part A (General Provisions) of SSA title XI to establish a mechanism for promoting Medicare cost-sharing assistance to eligible low-income Medicare beneficiaries.

(Sec. 221) Amends the Internal Revenue Code to direct the Secretary of the Treasury, upon written request from the Commissioner of Social Security, to disclose to the Secretary whether with respect to an identified Medicare beneficiary: (1) there has not been filed an income tax return for the most recent period for which the Secretary has information; or (2) such a return has been filed, and the amount of the gross income is below the level (or levels) the Secretary may specify to carry out the Ticket to Work and Self-Sufficiency Program, treating the number of dependents as the size of the family involved; and (3) whether, if the individual qualified for Medicare cost-sharing assistance at any time in the previous year, the individual's gross income is still within the eligibility level for the TWSS Program.

Title III: Nursing Home Quality Protections - Amends SSA titles XVIII and XIX (Medicaid) to: (1) require a skilled nursing facility (SNF) or, respectively, a nursing facility, to post for each wing or floor of the facility the names of the licensed and unlicensed nursing staff on duty at any time, and the number of residents on such wing or floor for whom they are responsible; and (2) require each State to assess against a SNF or nursing facility a fee to recover the State's actual costs and expenses in conducting any resurveys or reinspections in addition to the annual standard survey in those cases in which violations are found and deficiencies are cited in the initial survey, and the resurvey or reinspection is required to determine whether the facility has achieved compliance.

(Sec. 302) Disallows Medicaid payments to SNFs or nursing facilities to cover fees assessed or any civil money penalty.

(Sec. 303) Amends SSA titles XVIII and XIX to provide for a program to prevent abuse of nursing facility and SNF residents, using background checks on employment applicants, and prohibiting the hiring of abusive workers. Prescribes civil penalties for violation of program requirements, and criminal penalties for knowing unauthorized use of worker information.

Expands State nurse aid registry requirements under Medicaid and Medicare to include collecting information about nursing facility employees other than nurse aides. Adds Federal and State requirements concerning criminal background checks on nursing facility employees.

Applies to other entities providing long-term care services under Medicaid and Medicare the screening and background checks applicable to skilled nursing facilities.

(Sec. 304) Amends SSA title XI to provide for inclusion of abusive nursing facility workers in the database established as part of national health care fraud and abuse data collection program. Authorizes appropriations.

(Sec. 305) Directs the Secretary to establish a demonstration program to provide grants to develop information on best practices in patient abuse prevention training (including behavior training and interventions) for managers and staff of hospital and health care facilities.

Authorizes appropriations.

Title IV: Access to Long-Term Care Insurance - Subtitle A: Group Long-Term Care Insurance - Amends Federal civil service law to provide for group long-term care insurance for Federal employees and related eligible individuals. Authorizes appropriations.

(Sec. 402) Directs the President to submit to Congress a plan under which employees who are not entitled to purchase long-term care benefits insurance may purchase insurance of the type offered under this subtitle.

Subtitle B: Extension of Consumer Protection Standards to All Long-Term Care Insurance Policies - Subjects to a specified civil monetary penalty any issuer of a long-term care insurance contract (other than a qualified long-term care insurance contract) that fails to comply with certain consumer protection standards of the Internal Revenue Code that apply to a qualified long-term care insurance contract, as adjusted to conform with the most recent version available of the long-term care insurance model regulation and the long-term care insurance model Act promulgated by the National Association of Insurance Commissioners.

Title V: Addition of National Family Caregiver Program to the Older Americans Act of 1965 - Amends the Older Americans Act of 1965 (OAA) to modify the program for in-home supportive services for older individuals who are victims of Alzheimer's disease and related disorders with neurological and organic brain dysfunction, and to the families of such victims. Provides for supportive activities to meet the special needs of caregivers, including caretakers who provide in-home services to frail older individuals as well as for a National Family Caregiver Support Program. Authorizes appropriations.

(Sec. 502) Revises OAA allotments to States with regard to the formula for computation of amount and unused funds.

Title VI: Medicare For Caregivers - Subtitle A: Access to Medicare Benefits for Caregivers - Amends SSA title XVIII to add a new part D (Medicare Benefits for Caregivers). Creates for use in such program the Medicare Caregiver Trust Fund, funded by transfers from the Federal Hospital Insurance Trust Fund and from the Federal Supplementary Medical Insurance Trust Fund of amounts equivalent to reductions in expenditures under the respective trust fund attributable to the enactment of the Medicare Fraud and Overpayment Act of 1999.

Subtitle B: COBRA Protection for Caregivers - Chapter 1: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide for COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) continuation benefits for certain caregivers whose group health plan coverage had been terminated.

Chapter 2: Amendments to the Public Health Service Act - Amends the Public Health Service Act to provide for COBRA continuation benefits for certain caregivers whose group health plan coverage had been terminated.

Chapter 3: Amendments to the Internal Revenue Code of 1986 - Amends the Internal Revenue Code to provide for COBRA continuation benefits for certain caregivers whose group health plan coverage had been terminated.

Subtitle C: Financing - Provides that any increase in Medicare payments that results from enactment of this title shall be offset by reductions in payments under such program pursuant to the anti-fraud and -abuse provisions of the Medicare Fraud and Overpayment Act of 1999.

Title VII: Social Security Benefit For Long-Term Caregivers - Amends SSA title II (Old Age, Survivors, and Disability Insurance) to provide for Social Security credit for certain long-term caregivers. Prescribes a formula for the deeming of caregiver wages for entitlement purposes. Authorizes appropriations.