Summary: H.R.5394 — 98th Congress (1983-1984)All Information (Except Text)

There is one summary for H.R.5394. Bill summaries are authored by CRS.

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Introduced in House (04/09/1984)

Omnibus Budget Reconciliation Act of 1984 - Title I: Agricultural Programs - Incorporates by reference the conference report on H.R. 4072, the Wheat Improvement Act of 1983 (H. Report 98-646) dealing with: (1) price supports for wheat, feed grains, upland cotton, and rice; (2) export assistance; and (3) agricultural credit.

Title II: Civil Service and Military Retirement Programs - Limits the cost of living increase in the annuity or retired or retainer pay of a Government retiree for FY 1986 and 1987 to one-half of the increase that would otherwise be effective if: (1) the retiree is under 62 years of age as of the effective date of the increase; and (2) the annuity or retired or retainer pay is based on the retiree's Government service (but is not computed on the basis of a disability).

Requires any survivor annuity which is based on the service of any such retiree to be computed as if this title had not been enacted.

Title III: Health Programs - Medicare and Medicaid Budget Reconciliation Amendments of 1984 - Part A: Medicare Reconciliation Amendments - Directs the Secretary of Health and Human Services to establish a national fee schedule for diagnostic laboratory tests for which payment is made under part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act. Directs the Secretary to set the fee schedule at 60 percent of the prevailing charges paid under part B for similar diagnostic laboratory tests during the 12-month period beginning July 1, 1984. Directs the Secretary, in addition to the amounts provided under the fee schedule, to provide for and establish a nominal fee payable to cover the costs of collecting the sample in a diagnostic laboratory test. Provides for Medicare payment of the lesser of 80 percent (or 100 percent in the case of tests for which payment is made on the basis of an assignment or in the situation of the death of a beneficiary) of the amount determined by the Secretary or the amount of billed charges. Eliminates the part B deductible for laboratory tests paid on the basis of an assignment and in the case of payment on behalf of a deceased beneficiary. Amends title XIX (Medicaid) to provide for Medicaid coverage of laboratory tests to the extent such coverage is provided under Medicare.

Provides for Medicare coverage of hepatitis B vaccine and its administration in a hospital or renal dialysis facility.

Revises provisions under part B of title XVIII relating to payment for the services of a teaching physician to limit, for the purposes of determining the customary charge, the consideration of charges made by a physician outside of teaching to charges made by nonteaching physicians. Provides that if all the teaching physicians in the hospital agree to have payment made for all physicians' services under part B furnished patients in the hospital on the basis of an assignment, the carrier shall take into account the amounts otherwise payable under part B with respect to similar services in the same locality.

Directs the Secretary to compile annually a list of physicians serving individuals enrolled under part B indicating the share of claims which each physician has accepted on an assignment basis in the preceding year. Directs the Secretary to: (1) publish annually a list of all physicians who have agreed to accept payment on the basis of an assignment; and (2) annually provide enrollees with a list of physicians in their area who accept assignments.

Directs the Secretary to study and report to Congress on methods by which payment amounts and other program policies under part B may be modified to: (1) eliminate inequities in the relative amounts paid to physicians by type of service, locality, and specialty; (2) increase incentives for physicians and other suppliers to accept assignments; and (3) provide incentives for physicians and other providers not to provide increased or otherwise excessive amounts of hospital, physician, and other health care services. Directs the Secretary, in order to carry out the study and facilitate congressional review, to compile a centralized Medicare part B charge data base utilizing information gathered by Medicare carriers and used by the carriers in making the 1984 reasonable charge updates.

Directs the Secretary to issue revisions to the current guidelines for payment under part B for physicians' services for the transtelephonic monitoring of cardiac pacemakers. Requires such guidelines to include provisions regarding the specifications for and frequency of transtelephonic monitoring procedures which will be found reasonable and necessary. Directs the Secretary to: (1) review, and report to the appropriate congressional committees, regarding the appropriateness of the current rate of part B reimbursement for physicians' services associated with the implantation or replacement of pacemaker devices and pacemaker leads; and (2) consider reducing the recognized rates for such services by 20 percent.

Directs the Secretary, through the Administrator of the Food and Drug Administration, to provide for a registry of all cardiac pacemaker devices and pacemaker leads for which payment was made under title XVIII. Directs the Secretary, in any case where the Secretary has reason to believe that replacement of a cardiac pacemaker device or lead for which Medicare payment is or may be requested is related to the malfunction of a device or lead, to require the testing of the device.

Directs the Secretary to provide that payment will not be made under part B for a physician's debridement of mycotic toenails to the extent such debridement is performed more than once every 60 days, unless the medical necessity for more frequent treatment is documented by the physician.

Allows payments to hospitals under part A (Hospital Insurance) of Medicare for the operation of mobile intensive care units if certain conditions are met.

Provides for the appointment by the President (rather than by the Secretary of Health and Human Services) of the Administrator of the Health Care Financing Administration. Sets forth the pay level for the Administrator.

Permits limited provider representation on peer review organizations (PRO's). Permits a physician who has a financial interest in an agency which is a sole community home health agency to carry out the certification and plan-of-care functions for patients who will receive services from the agency. Repeals certain special tuberculosis treatment requirements.

Allows part B payments to be made to a health benefits plan, if the beneficiary agrees, and if the physician or supplier accepts the plan's payment as payment in full.

Includes podiatrists in the definition of "physician" for outpatient physical therapy services. Includes podiatrists and dentists in the definition of "physician" for outpatient ambulatory surgery. Allows physical therapists to establish medicare qualified plans for physical therapy.

Increases from $10,000 to $50,000 the minimum amount of any agreement between a medicare provider and a subcontractor before the Secretary or Comptroller General must have access to the subcontractor's records.

Establishes the statutory right of Medicare to recover directly from a liable third party, if the beneficiary himself does not do so, and to pay a beneficiary, or on the beneficiary's behalf, pending recovery where such third party is not expected to pay promptly.

Extends the Secretary's authority to rely on accrediting organizations in determining whether rural health clinics, laboratories, clinics, rehabilitation agencies, including outpatient rehabilitation facilities, and public health agencies meet Medicare requirements. Sets forth rules for the confidentiality of accreditation surveys. Limits coverage to 30 days for services furnished by a home health agency whose agreement has been terminated.

Extends the Secretary's authority to exclude from Medicare participation (and to direct State agencies to exclude from Medicaid participation) any entity in which ownership or controlling interest is held by a person convicted of program-related criminal offenses, or in which an officer, director, agent, or managing employee was convicted of such criminal offense.

Eliminates the Health Insurance Benefits Advisory Council. Requires the Secretary to designate one 30-day period in which all health maintenance organizations (HMO's) and competitive medical plans (CMP's) in an area participating in Medicare must have an open enrollment period.

Specifies a deadline of July 1, 1985, for a report to Congress on including payment for physicians' services to hospital inpatients in DRG payment amounts.

Authorizes the Secretary, if patient health and safety is not jeopardized, to apply less severe sanctions than are presently available for dealing with an end-stage renal disease facility which is not in compliance with applicable regulations.

Makes the national end-stage renal disease medical information system discretionary with the Secretary.

Removes the costs of nurse anesthetists from DRG-based payments.

Sets forth rules for the determination of hospital area wage indexes. Revises the definition of bona fide emergency services for purposes of the limitations on payment for hospital outpatient services. Delays from October 1, 1983, to April 1, 1984, the effective date for single-rate for skilled nursing facilities.

Part B: Medicaid Reconciliation Amendments - Provides that the Federal medical assistance percentage, under title XIX of the Social Security Act, shall be 100 percent with respect to amounts expended as medical assistance for services furnished to a "qualified pregnant woman or child." Defines a qualified pregnant woman or child as an individual who was not eligible for categorically needy coverage under Medicaid as of June 30, 1983, and who is: (1) under five years of age and who meets Aid to Families with Dependent Children (part A of title IV of the Social Security Act) requirements but does not receive cash payments and is a categorically needy individual; or (2) a pregnant woman who, at the State's option, may be deemed an AFDC recipient for Medicaid purposes or who is a member of a family which would be eligible for AFDC if the State's AFDC plan required payment of aid with respect to dependent children deprived of parental support by reason of the unemployment of a parent who is the principal earner.

Authorizes a State's Medicaid plan to not take into account the financial responsibility of any individual for an applicant or recipient who is a pregnant woman under 21 who does not have legal custody over other children, unless the applicant or recipient is the individual's spouse, except that a State may limit the applicability of this provision to applicants and recipients living in such an individual's household or in a custodial institution for pregnant women.

Provides that a child born to a woman eligible for and receiving Medicaid as of the child's birth shall be deemed to have applied for medical assistance and been found eligible for assistance on the child's birth date and shall remain eligible for assistance for one year so long as the child is a member of the women's household and the woman remains eligible for assistance.

Revises Medicaid provisions relating to medically needy income levels. Provides that in the case of a family consisting of only two individuals both of whom are adults and at least one of whom is aged, blind, or disabled, the term "highest amount which would ordinarily be paid to a family of the same size" under the State's plan approved under part A of title IV of the Social Security Act shall, at the State's option, be the amount determined by the State to be the amount of aid which would ordinarily be payable under such plan to a family which consists of one adult and two children and which is without any income or resources.

Revises Medicaid provisions relating to the recertification of need for stays in skilled nursing and intermediate care facilities. Requires recertifications for intermediate care facility patients to occur on or before 60 days of admission, six, 12, 18, and 24 months afterwards, and annually thereafter. Requires recertifications for skilled nursing facility patients to occur on or before 30, 60, and 90 days of admission, and every 60 days thereafter. Revises the penalty formula for noncompliance with the recertification requirements.

Authorizes the Secretary to modify or waive the requirement which limits the total combined Medicare and Medicaid membership to 75 percent for a health maintenance organization if the organization: (1) is a nonprofit organization with at least 25,000 members; (2) is and has been a qualified health maintenance organization for at least four years; (3) provides basic health services through members of the staff of the organization; (4) is located in a medically underserved area; and (5) previously received a membership requirement waiver.

Prohibits Medicaid copayments for prescribed drugs.

Increases the maximum amount of Medicaid payments available to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

Provides that Medicaid provisions requiring a reduction of the amount of payment otherwise to be made to a public psychiatric hospital due to the level of care received in such hospital shall not apply to payments to hospitals before July 1, 1985. Provides that such a reduction made for payments during the 12-month period ending June 30, 1986, and during the 12-month period ending June 30, 1987, shall be one-third and two-thirds, respectively, of the amount of the reduction which would otherwise be required.

Makes technical amendments to titles V (Maternal and Child Health Services) and XIX of the Social Security Act.

Amends the Public Health Service Act to revise provisions relating to the recovery of Federal expenditures from a hospital or other medical facility under certain conditions. Provides that the United States shall be entitled to recover a certain amount, from either the transferor or transferee, if any such facility which received Federal funds for construction or modernization, under the Public Health Service Act, at any time within 20 years after the completion of construction or modernization: (1) is sold or transferred to any entity which is not qualified to file an application under such Act for a construction or modernization project or which is not approved as a transferee by a State; or (2) ceases to be a public health center or a public or other nonprofit hospital, outpatient facility, facility for long-term care, or rehabilitation facility. Provides that the amount the United States is entitled to recover, subject to certain exceptions, shall bear the same ratio to the then value of so much of the facility as constituted an approved project as the amount of the Federal financial participation bore to the cost of the construction or modernization of such project.

Title IV: Small Business Programs - Amends the Small Business Act to extend through October 1, 1987, the requirement that agricultural producers seek disaster loan assistance from the Farmers Home Administration before applying for a Small Business Administration disaster loan.

Title V: Veterans' Programs - Makes the effective date for the award of a military pension to the survivor of a veteran with a non-service connected disability the first day of the month in which the death occurred if the application is received within 60 days of the date of death. Increases from one-half to one percent the loan fee payable by a veteran receiving a Veterans Administration (VA) home loan. Extends from FY 1985 through FY 1987 the fee collection program. Directs that such fees be deposited in the VA Loan Guaranty Revolving Fund.

Requires that the Administrator be notified by the holder of a guaranteed loan which is in default of any proposed public sale of the property securing the loan. Limits the liability of the United States under the guaranty to the difference between the amount of total indebtedness under the loan and the net value of the property where the Administrator determines that the net value of the property exceeds the amount of unguaranteed debt. Sets forth conditions under which the Administrator may or may not receive conveyance of the property depending upon whether the holder of the defaulted loan is the successful bidder and whether or not the bidding price meets, exceeds or is less than the net value of the property or the total indebtedness under the loan. Establishes the liability of the United States under the guaranty in each case.

Directs the Administrator to reduce the number of vendee loans (loans made to purchasers of real property acquired by the VA because of the default of a guaranteed loan) to 75 percent of the number of sales of such property.

Title VI: Savings in AFDC, SSI, and Other Programs - Subtitle A: Accelerated Collection and Deposit of Payments to Executive Agencies - Requires the head of each executive agency, under such regulations as the Secretary of the Treasury shall prescribe, to provide for the collection and timely deposit of money owed to such agency by the use of such procedures as withdrawals and deposits by electronic transfer of funds, automatic withdrawals from accounts of financial institutions, and a system under which financial institutions receive and deposit, on behalf of the agency, payments transmitted to post office lockboxes. Establishes in the Treasury a revolving fund to be known as the Cash Management Improvements Fund to be used for developing and implementing such collections and deposits. Provides that noncomplying agencies shall be assessed a charge which will be deposited in such Fund. Requires an agency to deposit in the Treasury money collected within three days of receipt.

Subtitle B: Improvements in Administration of Social Security Earnings Test - Amends title II (Old Age, Survivors and Disability Insurance) of the Social Security Act to require the Secretary of Health and Human Services to establish procedures to avoid paying more than the correct amount of title II benefits to any individual as a result of such individual's failure to file a correct report or estimate of earnings or wages.

Subtitle C: Improvements in SSI, AFDC, and Related Programs - Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon written request, to disclose return information with respect to unearned income to any officer or employee of any Federal, State, or local agency administering any of the following programs: (1) the Aid to Families with Dependent Children program (part A of title IV of the Social Security Act); (2) Medicaid (title XIX of the Social Security Act); (3) Supplemental Security Income program (title XVI of the Social Security Act); (4) as applicable to Puerto Rico, Guam, and the Virgin Islands any benefits provided under titles I (Old Age Assistance and Medical Assistance for the Aged), X (Aid to the Blind), XIV (Aid to the Permanently and Totally Disabled), and XVI of the Social Security Act; and (5) the Food Stamp program. Amends Part A (General Provisions) of title XI of the Social Security Act to require any Federal, State, or local agency receiving such information to independently verify such information before making any benefit adjustments. Directs each State agency charged with the administration of a State plan approved under part A of title IV, title X, title XIV, or title XVI of the Act, and the Secretary of Health and Human Services with respect to the SSI program, to request and use any such information obtained from the Secretary of the Treasury for purposes of income and eligibility verification. Requires such information to be used to identify and prevent ineligibility and incorrect payments.

Amends title XVI of the Act to increase, by $100.00 per year over the next five years for single individuals and by $150.00 per year for the next five years for married individuals, the resources limit for single individuals from $1,500 to $2,000, and for married couples from $2,250 to $3000.

Provides, under title XVI, that in situations where there has not been fraud in connection with an SSI overpayment, such overpayment shall be recovered through adjustments in future benefits in amounts not exceeding the lesser of: (1) the monthly benefit; or (2) an amount equal to ten percent of a beneficiary's monthly income.

Provides that to the extent that an overpayment results because a recipient's resources exceed the applicable limit, such overpayment shall be determined to be the lesser of: (1) the benefits received; or (2) the greatest amount by which the total value of the recipient's resources exceeded the applicable limit.

Excludes from resources, for 12-months from the date of receipt, any underpayment amount received in the form of a retroactive check.

Amends part A of title IV of the Act to revise the gross income limitation. Provides that no family shall be eligible if its income exceeds 130 percent of the poverty line as defined in the Community Services Block Grant Act. (Current law prohibits eligibility if family income exceeds 150 percent the State's standard of need.)

Provides that the $75 monthly work expense deduction shall be applicable to both full and part-time workers.

Repeals the four-month limit on the $30 disregard from earned income.

Requires a State plan to provide that, in any case where a family has ceased to receive aid because of certain increases in income, a monthly transition allowance of $10.00 shall be paid for at least nine months. Permits former AFDC recipients to reapply for such allowance in certain cases.

States that, for purposes of earned income disregards, an individual's earned income shall be the gross amount of earnings.

Permits the exclusion from resources of burial plots, funeral agreements, and real property which a family is making a good faith effort to sell.

Provides that where a State is unable to provide day care and transportation for community work experience program participants, the State shall directly reimburse participants for such costs.

Permits, rather than requires, States to use a monthly reporting and retrospective budgeting system. Provides Federal matching for State supplementary payments made under a retrospective budgeting system.

Provides for the exclusion from income, for AFDC purposes, of amounts received as an earned income tax credit.

Amends part A (General Provisions) of title XI of the Act to permit any State with an approved AFDC plan to establish and conduct one or more pilot projects to demonstrate the use of integrated service delivery systems for human services programs in that State or in one or more political subdivisions of such State. Requires a pilot project to involve or include: (1) the development of a common set of terms; (2) the development for each applicant of a single comprehensive family profile; (3) the establishment and maintenance of a single resources directory; (4) the development of a unified budget and budgeting process, and a unified accounting system; (5) the implementation of unified planning, needs assessment, and evaluation; (6) the consolidation of agency locations and related transportation services; (7) the standardization of procedures for purchasing services from nongovernmental sources; (8) the creation of communications linkages among agencies; (9) the development of uniform application and eligibility determination procedures; and (10) any other methods, arrangements, and procedures consistent with the establishment of an integrated service delivery system. Requires any State desiring to establish and conduct a pilot project to apply to the Secretary. Directs the Secretary to approve a project only if the project will not lower or restrict the levels of aid, assistance, benefits, or services, or the income or resource standards, deductions, or exclusions of any of the human services programs involved. Permits a State with an approved application to request the Secretary to waive any requirement which would otherwise apply with respect to the proposed project under any of the laws governing the human services programs to be included in the project. Sets forth guidelines for approving or disapproving such waiver request. Sets forth guidelines relating to information disclosure. Provides that Federal funding for an approved pilot project shall be: (1) 90 percent for the first 18 months; (2) 80 percent for the following 12-months; and (3) 70 percent for the next 12-month period. Directs the Secretary to report to Congress concerning approved projects. Directs the Comptroller General, through the personnel and facilities of the General Accounting Office, to conduct a study concerning such projects. Authorizes funds to be appropriated for such projects for FY 1985 through 1988.

Authorizes, under regulations prescribed by the Secretary of Health and Human Services, any State which is currently participating in the AFDC program, the Medicaid program, and the food stamp program to apply to the Secretary to establish and conduct a demonstration program which shall try to develop ways of improving the delivery of services to needy individuals and families under the three programs by eliminating at least some differences in program requirements and specifications.

Prohibits the approval of more than five applications. Directs the Secretary to approve an application only if the project will not lower or restrict the level of aid, assistance, benefits, services, or the applicable income or resource standards, deductions, or exclusions under the programs. Prohibits a project from lasting more than three years, except that an additional two years may be allowed upon the Secretary's approval. Authorizes each State conducting a demonstration project to adopt, for purposes of the AFDC program, any of the existing rules, procedures, and specifications currently in effect under either or both of the other two programs, with the objective of developing for the three programs: (1) a common set of terms and definitions; (2) uniform application and eligibility determination procedures; (3) a unified budgeting process; (4) a single-family case file; and (5) a common administrative structure that allows for unified planning and evaluation. Requires: (1) each participating State to report to the Secretary; and (2) the Secretary to report to Congress.

Exempts pregnant women in the third trimester of pregnancy from registering for the work incentive program.

Provides that when computing the maximum number of required hours of work under a community work experience program, child support payments received shall be subtracted from the AFDC payment.

Permits a State to recalculate the period of AFDC ineligibility which occurs when a family receives a nonrecurring lump sum, if the recalculation would promote the purposes and objectives of the AFDC program.

Provides that recovery of an AFDC overpayment need not be attempted if the cost of recovery would equal or exceed the amount of the overpayment.

Provides that when an overpayment occurs due to the ownership or possession of excess resources, the amount of overpayment to be recovered shall be the lesser of: (1) the total amount of benefits that the family received during the period in which resources exceeded the limit; or (2) the greatest amount by which the total value of the resources exceeded the limit at any time during the overpayment period.

Authorizes a State to make protective payments if the parent does not register for work as required, accept suitable employment, or cooperate with child support enforcement efforts.

Suspends sanctions on States based on AFDC error rates for the period beginning October 1, 1983, and ending September 30, 1985.

Provides that any individual who is an alien and whose sponsor was a public or private agency shall be ineligible for AFDC for the three year period following such alien's entry into the United States, unless the State agency administering the plan determines that the sponsor either no longer exists or has become unable to meet the individual's needs.

Permits the disclosure of certain information concerning an AFDC recipient who is a fugitive felon to a State or local law enforcement officer.

Establishes a payment schedule for the Federal reimbursement of States' back claims for public assistance programs under the Social Security Act.

Provides for an AFDC grant diversion program under which a State may make employment (including on-the-job training) available as an alternative to AFDC otherwise provided. Directs a State, in operating a grant diversion program, to: (1) enter into contracts with public or private employers under which such employers will provide employment for eligible individuals over a period of up to nine months; and (2) pay to each such employer with respect to each individual so employed an amount equal to the lesser of the maximum amount that could have been paid directly to such individual as AFDC at the time of the initial job placement or 50 percent of the individual's wages. States that: (1) wages paid shall be considered to be wages under any provision of law; and (2) any participant shall be considered to be receiving AFDC for purposes of Medicaid eligibility.

Makes permanent AFDC and SSI provisions which exempt in-kind home energy assistance provided by a private nonprofit organization.

Sets forth the effective date.

Amends the Trade Act of 1974 to begin the period for the 26-week additional trade readjustment allowances with the first week the worker is in training if that training has not been approved until after the last week of entitlement to basic benefits. Increases the maximum job search allowance from $600 to $800. Increases the maximum relocation allowance from $600 to $800.

Extends eligibility for industry-wide technical assistance to industries in which a substantial number of workers have been certified for trade adjustment assistance. Increases from $2,000,000 to $10,000,000 the amount of assistance that can be provided annually to a single industry.