Summary: S.1244 — 98th Congress (1983-1984)All Information (Except Text)

There is one summary for S.1244. Bill summaries are authored by CRS.

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Introduced in Senate (05/10/1983)

Senior Citizens Independent Community Care Act - Amends title XVIII (Medicare) of the Social Security Act to authorize any State to establish a statewide prepaid capitation program for providing acute and long-term care services for individuals aged 65 or older who require long-term care by reason of impairments which restrict daily living activities. Limits to four the number of States which may establish such a program during the four years following enactment. Authorizes the Secretary of Health and Human Services in subsequent years to limit the number of additional States which may establish such a program in order to insure that additional programs will not require payments from the Federal Hospital Insurance Trust Fund in excess of the amounts available in the Trust Fund.

Provides that each eligible individual shall be entitled to the following benefits: (1) all services to which such individual would be entitled under title XVIII; (2) homemaker-home health aide services; (3) adult day services; (4) respite care services for up to 14 days or 336 hours annually; (5) service coordination; (6) preadmission screening and assessment; (7) intermediate care facility services for up to 20 days annually; and (8) such other services as the Secretary may determine. States that services provided under the program shall be in lieu of any payments or services to which an individual would otherwise be entitled under title XVIII or under any other Federally funded program.

Makes any individual eligible who: (1) is entitled to benefits under part A(Hospital Insurance) of title XVIII and enrolled under part B (Supplementary Medical Insurance) of title XVIII; (2) has attained age 65; (3) resides in a State with a program; (4) agrees to participate in the program; (5) is not in an institution; (6) is certified by a preadmission assessment and screening team (PAT) to have an unmet need for certain services; and (7) has certain physical or mental impairments which interfere with the activities of daily living.

Requires a PAT to evaluate each eligible individual's health status, functional capabilities, and home and environment in order to assess and develop a plan of care for the individual before the individual can receive any benefits under the program. Requires an individual's status to be assessed on an ongoing basis, and the plan of care to be appropriately updated.

Directs the Governor of each State having a program to designate the State agency or agencies which shall administer the program. Directs such agency or agencies to coordinate the designation of entities which shall provide services under the program. Directs such entities to be responsible for establishing PATs and providing services under the program. Requires each PAT to consist of at least one physician and one social worker.

Directs the Secretary to pay a fixed per capita fee to each designated entity for which payment may be made under the program. Prohibits such fee from exceeding an amount equal to 60 percent of the average monthly rate in such State for services provided in free-standing skilled nursing facilities.

Requires an individual receiving services under the program which are otherwise covered services under parts A or B of title XVIII to pay the entity providing the services a copayment equal to the amount which such individual would be required to pay under parts A or B for the same services. Requires an individual receiving homemaker-home health aide services, adult day services, respite care services, or a preadmission screening and assessment to pay a copayment equal to 20 percent of the reasonable charge for such services. Prohibits an eligible individual from being required to make yearly copayments which exceed a specified percent of the individual's income for the preceding year.

Provides any individual the right to reasonable notice and opportunity for a hearing with respect to determinations made by the Secretary under the program in the same manner as under part A of title XVIII.

Sets forth the effective date.

Directs the Secretary to monitor the effect of the program and submit reports to Congress. Requires the reports to include a recommended strategy for implementing the program on a national basis. Directs the Office of Management and Budget to prepare an analysis of the budgetary impact of the implementation of the program on a national basis and to report to Congress with respect to such report.

Requires payments under this program to be made from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Requires payments related to services provided under this program which are not covered services under part A or B to be made from the Federal Hospital Insurance Trust Fund.

Directs the Secretary to conduct a study of the feasibility and desirability of establishing a program under which State Medicaid programs would provide prepaid capitation plans for providing Medicare and Medicaid (title XIX of the Act) services to those individuals eligible for both and to report the results of the study to Congress.