Summary: S.350 — 96th Congress (1979-1980)All Information (Except Text)

There is one summary for S.350. Bill summaries are authored by CRS.

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Introduced in Senate (02/06/1979)

Catastrophic Health Insurance and Medical Assistance Reform Act - Title I: Catastrophic Illness Insurance - Establishes a Catastrophic Health Insurance program under the Social Security Act. Sets forth the eligibility criteria for individuals. Entitles every individual who: (1) is a resident of the United States; and (2) is a citizen of, or a lawfully admitted alien in, the United States to catastrophic health insurance benefits provided by this Act in cases where the individual is not covered by an employer plan.

Delimits the scope of benefits, including hospital and related insurance benefits (hospital, post-hospital and home health services) and medical and other health services.

Provides for a general deductible from: (1) the reasonable costs of inpatient hospital services past 60 days; and (2) inpatient hospital benefits of the higher of the following: (A) $2,000; or (B) $2,000 adjusted by the Consumer Price Index to reflect changes in fees for physician services (in $100 increments).

Permits payments for specified mental health care services. Requires the Secretary of Health, Education, and Welfare to promulgate regulations prescribing standards designed to assure that services consisting of the furnishing of blood or blood products, or the application of procedures or courses of treatment which are experimental or extraordinarily complex, will be provided only when such services are appropriate to the health care needs of the patient.

Creates, in the United States Treasury, a Federal Catastrophic Health Insurance Trust Fund to provide a reserve for payment of benefits authorized by this Act.

States that individuals covered under approved employer or self-employed plans shall be entitled to those benefits rather than the benefits provided by the catastrophic health insurance plan. Defines the term "employer plan" as meaning an insurance policy, contract, or other arrangement entered into between an employer and a carrier, in consideration of premiums or other periodic payments, undertaken to pay for the costs of health services received by the employer's employees. Requires that the coverage provided under such plans must include a package of benefits which is the same as that provided by the Federal catastrophic health insurance benefits plan established under this Act. Sets forth additional requirements governing employer health plans.

Establishes an Actuarial Committee to prepare and recommend annually to the Secretary a Table of Values of Catastrophic Health Insurance Coverage, which shall establish the actuarial value of one year's catastrophic health insurance coverage for employers, carriers, and others involved in the programs.

Creates a tax on self- employment income and an excise tax on employers. Allows a tax credit up to the entire amount of such taxes for the actuarial value of catastrophic health insurance coverage for the self-employed and for the employees covered under approved employer plans.

Title II: Medical Assistance Plan for Low-Income People - Replaces the Medicaid program with a plan of medical assistance for low-income people. Requires assistance for low-income individuals and families, for the costs of necessary hospital, skilled nursing facility, medical, and other health care services.

Guarantees free choice by patients of health services from any person, institution, or agency qualified under this act. Permits individuals the option of obtaining other health insurance protection.

Describes the medical assistance plan, what individuals are eligible to receive its health benefits, and the application procedure. Enumerates the scope of benefits under the plan, including: (1) 60 days of inpatient hospital services; (2) medical and other health services; (3) skilled nursing facility services; (4) home health services; (5) intermediate care services; (6) mental health services; (7) pre-natal and well-baby care; (8) family planning assistance; (9) early and periodic screening diagnosis, and treatment for eligible children under age 18; and (10) payment for Medicare Supplementary Medical Insurance Benefits for recipients of aid under this title. Prescribes the co-payment requirements and procedures of persons eligible for benefits.

Creates the Medical Coverage Trust Fund within the Treasury. Makes provisions for State contributions to the Fund.

Prohibits exclusion by employers of specified employees from coverage under group health insurance plans.

Title III: Private Basic Health Insurance Certification Program - Establishes a program, under the Social Security Act, under which any insurer may submit any health insurance policy to the Secretary for examination and certification. Sets forth the standards under which the Secretary shall deny certification of any such insurance policy. Requires the Secretary to offer basic Federal health insurance to individuals residing in States in which no private health insurance program has been certified.

Title IV: Other Amendments - Authorizes payments for immunizations which the Secretary determines are appropriate under title XVIII (Medicare) of the Social Security Act, but only if provided on a scheduled allowable basis, as determined under regulations promulgated by the Secretary. Increases the amount of reimbursement under Medicare for outpatient mental health care. Reduces the monthly premium for optional coverage under the Medicare hospital insurance programs. Extends coverage of the renal disease program authorized under such Act to specified individuals not previously covered.

Expresses the policy of Congress to encourage and expand philanthropic support for health care.