H.R. 3607 (101st): Medicare Catastrophic Coverage Repeal Act of 1989

101st Congress, 1989–1990. Text as of Dec 13, 1989 (Passed Congress/Enrolled Bill).

Status & Summary | PDF | Source: GPOStatutes at Large

PUBLIC LAW 101-234—DEC. 13, 1989                               103 STAT. 1979

Public Law 101-284
101st Congress
                                  An Act
                                                                                    Dec. 13, 1989
To repeal medicare provisions in the Medicare Catastrophic Coverage Act of 1988.     [H R 36071

 Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,                                    Medicare
                                                                                   Catastrophic
SECTION 1. SHORT TITLE.                                                            Coverage Repeal
                                                                                   Act of 1989.
  This Act may be cited as the "Medicare Catastrophic Coverage                     42 u s e 1305
Repeal Act of 1989".                                                               note.


TITLE I—PROVISIONS RELATING TO PART
  A OF MEDICARE PROGRAM AND SUP-
  PLEMENTAL MEDICARE PREMIUM
SEC. 101. REPEAL OF EXPANSION OF MEDICARE PART A BENEFITS.
  (a) IN GENERAL.—                                                                 42 u s e 1395e
       (1) GENERAL RULE.—Except as provided in paragraph (2), sec-                 note.
     tions 101, 102, and 104(d) (other than paragraph (7)) of the
     Medicare Catastrophic Coverage Act of 1988 (Public Law 100-
     360) (in this Act referred to as "MCCA") are repealed, and the                42 u s e 1395c-
     provisions of law amended or repealed by such sections are                    1395f, 1395k,
                                                                                   1395x, 1395CC,
     restored or revived as if such section had not been enacted.                  1395tt.
        (2) EXCEPTION FOR BLOOD DEDUCTION.—The repeal of section
     102(1) of MCCA (relating to deductibles and coinsurance under
     part A) shall not apply, but only insofar as such section
     amended paragraph (2) of section 1813(a) of the Social Security
     Act (relating to a deduction for blood).
  (b) TRANSITION PROVISIONS FOR MEDICARE BENEFICIARIES.—          42 u s e 1395e
                                                                  note.
       (1) INPATIENT HOSPITAL SERVICES AND POST-HOSPITAL EXTENDED
     CARE SERVICES.—In applying sections 1812 and 1813 of the Social
     Security Act, as restored by subsection (a)(1), with respect to
     inpatient hospital services and extended care services provided
     on or after January 1, 1990—
            (A) no day before January 1, 1990, shall be counted in
         determining the beginning (or period) of a spell of illness;
            (B) with respect to the limitation on such services pro-
         vided in a spell of illness, days of such services before
         January 1, 1990, shall not be counted, except that days of
         inpatient hospital services before January 1, 1989, which
         were applied with respect to an individual after receiving
         90 days of services in a spell of illness (commonly known as
         "lifetime reserve days") shall be counted;
            (C) the limitation of coverage of extended care services to
         post-hospital extended care services shall not apply to an
         individual receiving such services from a skilled nursing
         facility during a continuous period beginning before (and
         including) January 1, 1990, until the end of the period of 30

103 STAT. 1980 PUBLIC LAW 101-234—DEC. 13,1989 consecutive days in which the individual is not provided inpatient hospital services or extended care services; and (D) the inpatient hospital deductible under section 1813(a)(1) of such Act shall not apply— (i) in the case of an individual who is receiving inpatient hospital services during a continuous period beginning before (and including) January 1, 1990, with respect to the spell of illness beginning on such date, if such a deductible was imposed on the individual for a period of hospitalization during 1989; (ii) for a spell of illness beginning during January 1990, if such a deductible was imposed on the individ- ual for a period of hospitalization that began in Decem- ber 1989; and (iii) in the case of a spell of illness of an individual that began before January 1,1990. (2) HOSPICE CARE.—The restoration of section 1812(a)(4) of the Social Security Act, effected by subsection (a)(1), shall not apply to hospice care provided during the subsequent period (de- scribed in such section as in effect on December 31, 1989) with respect to which an election has been made before January 1, 1990. (3) TERMINATION OF HOLD HARMLESS PROVISIONS.—Section 42 use I395e 104(b) of MCCA is amended by striking "or 1990" each place it ^°^- appears. (c) TERMINATION OF TRANSITIONAL ADJUSTMENTS IN PAYMENTS FOR INPATIENT HOSPITAL SERVICES.— 42 use 1395WW (1) PPS HOSPITALS.—Section 104(c)(1) of MCCA is amended by °o^- inserting "and before January 1,1990," after "October 1,1988,". (2) P P S - E X E M P T HOSPITALS.— (A) IN GENERAL.—Section 104(c)(2) of MCCA is amended— (i) by inserting "and before January 1, 1990," after "January 1, 1989,"; and (ii) by striking the period at the end and inserting the following: ", without regard to whether any of such beneficiaries exhausted medicare inpatient hospital insurance benefits before January 1,1989.". 42 use 1395WW (B) TRANSITION.—The Secretary of Health and Human note. Services shall make an appropriate adjustment to the target amount established under section 1886(b)(3)(A) of the Social Security Act in the case of inpatient hospital services provided to an inpatient whose stay began before Janu- ary 1, 1990, in order to take into account the target amount that would have applied but for the amendments made by this title. 42 use 1395c (d) EFFECTIVE DATE.—The provisions of this section shall take *^°*®- effect January 1, 1990, except that the amendments made by subsec- tion (c) shall be effective as if included in the enactment of MCCA. SEC. 102. REPEAL OF SUPPLEMENTAL MEDICARE PREMIUM AND FED- ERAL HOSPITAL INSURANCE CATASTROPHIC COVERAGE RESERVE FUND. 26 use 59B and (a) IN GENERAL.—Sections 111 and 112 of MCCA are repealed and notes, 6050F and ^^j^e provisions of law amended by such sections are restored or 1395'i-la and revived as if such sections had not been enacted, note.
*--,*^-'^,^^\%^^fei^''.s»; r#*r<»* PUBLIC LAW 101-234—DEC. 13, 1989 103 STAT. 1981 (b) DELAY IN STUDY DEADLINE.—Section 113(c) of MCCA is amended by striking "November 30, 1988" and inserting "May 31, 1990". (c) DISPOSAL OF FUNDS IN FEDERAL HOSPITAL INSURANCE CATA- 42 u s e 1395t STROPHIC COVERAGE RESERVE FUND.—Any balance in the Federal note. Hospital Insurance Catastrophic Coverage Reserve Fund (created under section 1817A(a) of the Social Security Act, as inserted by section 112(a) of MCCA) as of January 1, 1990, shall be transferred into the Federal Supplementary Medical Insurance Trust Fund and any amounts payable due to overpayments into such Trust Fund shall be payable from the Federal Supplementary Medical Insur- ance Trust Fund. (d) EFFECTIVE DATES.— 26 u s e 59B (1) IN GENERAL.—Except as provided in this subsection, the note. provisions of this section shall take effect January 1, 1990. (2) REPEAL OF SUPPLEMENTAL MEDICARE PREMIUM.—The repeal of section 111 of MCCA shall apply to taxable years beginning after December 31, 1988. TITLE II~PROVISIONS RELATING TO PART B OF THE MEDICARE PROGRAM SEC. 201. REPEAL OF EXPANSION OF MEDICARE PART B BENEFITS. (a) IN GENERAL.— 42 u s e 1320a-7a (1) GENERAL RULE.—Except as provided in paragraph (2), sec- note. tions 201 through 208 of MCCA are repealed and the provisions 42 use of law amended or repealed by such sections are restored or 1320a-7a, 1320C-3 and revived as if such sections had not been enacted. note, 1395b-l (2) EXCEPTION.—Paragraph (1) shall not apply to subsections note, 1395h, (g) and (m)(4) of section 202 of MCCA. 1395k and notes, 1395/, 1395m (b) CONFORMING AMENDMENTS.—Section 1905(p) of the Social and notes, Security Act (42 U.S.C 1396d(p)) is amended— 1395n, 1395u (1) in paragraph (3)(C)— and notes, 1395W-2, (A) by striking "Subject to paragraph (4), deductibles" 1395W-3,1395x and inserting "Deductibles", and and notes, 1395y, (B) by striking "1813, section 1833(b)" and all that follows 1395z, and inserting "1813 and section 1833(b))."; and 1395aa-1395bb, 1395CC, 1395mm, (2) by striking paragraph (4) and redesignating paragraph (5) 1395ZZ note, as paragraph (4). 1395ww note, (c) EFFECTIVE DATE.—The provisions of this section shall take 1396a, 1396b, effect January 1, 1990. 1396n. 42 u s e 1320a-7a SEC. 202. REPEAL OF CHANGES IN MEDICARE PART B MONTHLY note. PREMIUM AND FINANCING. 42 u s e 401 note. 42 u s e 401, (a) IN GENERAL.—Sections 211 through 213 (other than sections 13951, 1395/, 211(b) and 211(c)(3)(B)) of MCCA are repealed and the provisions of 1395r and note, 1395s, 1395t, law amended or repealed by such sections are restored or revised as 1395t-l, 1395t-2, if such sections had not been enacted. 1395w, 1395mm. (b) EFFECTIVE DATE.—The provisions of subsection (a) shall take effect January 1, 1990, and the repeal of section 211 of MCCA shall apply to premiums for months beginning after December 31, 1989. SEC. 20;{. A M E N D M E N T O F C E R T A I N MISCELLANEOUS PROVISIONS. (a) R E V I S I O N O F M E D I G A P R E G U L A T I O N S . —
103 STAT. 1982 PUBLIC LAW 101-234—DEC. 13, 1989 (1) IN GENERAL.—Section 1882 of the Social Security Act (42 U.S.C. 1395ss), as amended by section 221(d) of MCCA, is amended— (A) in the third sentence of subsection (a) and in subsec- tion (b)(1), by striking "subsection (k)(3)" and inserting "subsections (k)(3), (k)(4), (m), and (n)"; (B) in subsection (k)— (i) in paragraph (1)(A), by inserting "except as pro- vided in subsection (m)," before "subsection (g)(2)(A)", and (ii) in paragraph (3), by striking "subsection (1)" and inserting "subsections (1), (m), and (n)"; and (C) by adding at the end the following new subsections: State and local "(m)(l)(A) If, within the 90-day period beginning on the date of the governments. enactment of this subsection, the National Association of Insurance Commissioners (in this subsection and subsection (n) referred to as the 'Association') revises the amended NAIC Model Regulation (re- ferred to in subsection (k)(l)(A) and adopted on September 20, 1988) to improve such regulation and otherwise to reflect the changes in law made by the Medicare Catastrophic Coverage Repeal Act of 1989, subsection (g)(2)(A) shall be applied in a State, effective on and after the date specified in subparagraph (B), as if the reference to the Model Regulation adopted on June 6, 1979, were a reference to the amended NAIC Model Regulation (referred to in subsection (k)(l)(A)) as revised by the Association in accordance with this paragraph (in this subsection and subsection (n) referred to as the 'revised NAIC Model Regulation'). "(B) The date specified in this subparagraph for a State is the earlier of the date the State adopts standards equal to or more stringent than the revised NAIC Model Regulation or 1 year after the date the Association first adopts such revised Regulation. "(2)(A) If the Association does not revise the amended NAIC Model Regulation, within the 90-day period specified in paragraph (1)(A), the Secretary shall promulgate, not later than 60 days after the end of such period, revised Federal model standards (in this subsection and subsection (n) referred to as 'revised Federal model standards') for medicare supplemental policies to improve such standards and otherwise to reflect the changes in law made by the Medicare Catastrophic Coverage Repeal Act of 1989, subsection (g)(2)(A) shall be applied in a State, effective on and after the date specified in subparagraph (B), as if the reference to the Model Regulation adopted on June 6, 1979, were a reference to the revised Federal model standards. "(B) The date specified in this subparagraph for a State is the earher of the date the State adopts standards equal to or more stringent than the revised Federal model standards or 1 year after the date the Secretary first promulgates such standards. "(3) Notwithstanding any other provision of this section (except as provided in subsection (n))— "(A) no medicare supplemental policy may be certified by the Secretary pursuant to subsection (a), "(B) no certification made pursuant to subsection (a) shall remain in effect, and "(C) no State regulatory program shall be found to meet (or to continue to meet) the requirements of subsection (b)(1)(A), unless such policy meets (or such program provides for the applica- tion of standards equal to or more stringent than) the standards set
PUBLIC LAW 101-234—DEC. 13, 1989 103 STAT. 1983 forth in the revised NAIC Model Regulation or the revised Federal model standards (as the case may be) by the date specified in paragraph (1)(B) or (2)(B) (as the case may be). "(n)(l) Until the date specified in paragraph (4), in the case of a qualifying medicare supplemental policy described in paragraph (3) issued in a State— "(A) before the transition deadline, the policy is deemed to remain in compliance with the standards described in subsec- tion (b)(1)(A) only if the insurer issuing the policy complies with the transition provision described in paragraph (2), or "(B) on or after the transition deadline, the policy is deemed to be in compliance with the standards described in subsection (b)(1)(A) only if the insurer issuing the policy complies with the revised NAIC Model Regulation or the revised Federal model standards (as the case may be) before the date of the sale of the policy. In this paragraph, the term 'transition deadline' means 1 year after the date the Association adopts the revised NAIC Model Regulation or 1 year after the date the Secretary promulgates revised Federal model standards (as the case may be). "(2) The transition provision described in this paragraph is— "(A) such transition provision as the Association provides, by not later than December 15, 1989, so as to provide for an appropriate transition (i) to restore benefit provisions which are no longer duplicative as a result of the changes in benefits under this title made by the Medicare Catastrophic Coverage Repeal Act of 1989 and (ii) to eliminate the requirement of payment for the first 8 days of coinsurance for extended care services, or "(B) if the Association does not provide for a transition provi- sion by the date described in subparagraph (A), such transition provision as the Secretary shall provide, by January 1, 1990, so as to provide for an appropriate transition described in subpara- graph (A). "(3) In paragraph (1), the term 'qualifying medicare supplemental policy' means a medicare supplemental policy which has been issued in compliance with this section as in effect on the date before the date of the enactment of this subsection. "(4)(A) The date specified in this paragraph for a policy issued in a State is— "(i) the first date a State adopts, after the date of the enact- ment of this subsection, standards equal to or more stringent than the revised NAIC Model Regulation (or revised Federal < model standards), as the case may be, or "(ii) the date specified in subparagraph (B), whichever is earlier. "(B) In the case of a State which the Secretary identifies, in consultation with the Association, as— "(i) requiring State legislation (other than legislation appro- priating funds) in order for medicare supplemental policies to meet standards described in subparagraph (A)(i), but "(ii) having a legislature which is not scheduled to meet in 1990 in a legislative session in which such legislation may be considered, the date specified in this subparagraph is the first day of the first o calendar quarter beginning after the close of the first legislative session of the State legislature that begins on or after January 1,
103 STAT. 1984 PUBLIC LAW 101-234—DEC. 13, 1989 1990. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature. "(5) In the case of a medicare supplemental policy in effect on January 1, 1990, the policy shall not be deemed to meet the stand- ards in subsection (c) unless each individual who is entitled to benefits under this title and is a policyholder or certificate holder under such policy on such date is sent a notice in an appropriate form by not later than January 31, 1990, that explains— "(A) the changes in benefits under this title effected by the Medicare Catastrophic Coverage Repeal Act of 1989, and "(B) how these changes may affect the benefits contained in such policy and the premium for the policy. "(6)(A) Except as provided in subparagraph (B), in the case of an individual who had in effect, as of December 31, 1988, a medicare supplemental policy with an insurer (as a policyholder or, in the case of a group policy, as a certificate holder) and the individual terminated coverage under such policy before the date of the enact- ment of this subsection, no medicare supplemental policy of the insurer shall be deemed to meet the standards in subsection (c) unless the insurer— "(i) provides written notice, no earlier than December 15, 1989, and no later than January 30, 1990, to the policyholder or certificate holder (at the most recent available address) of the offer described in clause (ii), and "(ii) offers the individual, during a period of at least 60 days beginning not later than February 1, 1990, reinstitution of coverage (with coverage effective as of January 1, 1990), under the terms which (I) do not provide for any waiting period with respect to treatment of pre-existing conditions, (II) provides for coverage which is substantially equivalent to coverage in effect before the date of such termination, and (III) provides for classification of premiums on which terms are at least as favor- able to the policyholder or certificate holder as the premium classification terms that would have applied to the policyholder or certificate holder had the coverage never terminated. "(B) An insurer is not required to make the offer under subpara- graph (A)(ii) in the case of an individual who is a policyholder or certificate holder in another medicare supplemental policy as of the date of the enactment of this subsection, if (as of January 1, 1990) the individual is not subject to a waiting period with respect to treatment of a pre-existing condition under such other policy.". 42 u s e 1395mm (b) ADJUSTMENT OF CONTRACTS WITH PREPAID HEALTH PLANS.— note. Notwithstanding any other provision of this Act, the amendments made by this Act (other than the repeal of sections 1833(c)(5) and 1834(c)(6) of the Social Security Act) shall not apply to risk-sharing contracts, for contract year 1990— (1) with eligible organizations under section 1876 of the Social Security Act, or (2) with health maintenance organizations under section 1876(i)(2)(A) of such Act (as in effect before February 1, 1985), under section 402(a) of the Social Security Amendments of 1967, or under section 222(a) of the Social Security Amendments of 1972. 42 u s e 1395b-2 (c) NOTICE OF CHANGES.—The Secretary of Health and Human note. Services shall provide, in the notice of medicare benefits provided under section 1804 of the Social Security Act for 1990, for a descrip-
PUBLIC LAW 101-234—DEC. 13, 1989 103 STAT. 1985 tion of t h e changes in benefits u n d e r title XVIII of such Act m a d e by t h e a m e n d m e n t s m a d e by t h i s Act. (d) MISCELLANEOUS T E C H N I C A L CORRECTION.—Section 221(g)(3) of MCCA is amended by striking "subsection (f)" a n d inserting 42 u s e 1395S8 "subsection (e)". note. (e) EFFECTIVE D A T E . — T h e provisions of this section shall t a k e 42 u s e 1395SS effect J a n u a r y 1, 1990, except t h a t t h e a m e n d m e n t m a d e by subsec- note. tion (d) shall be effective a s if included in t h e e n a c t m e n t of MCCA. TITLE III—MISCELLANEOUS AMENDMENTS SEC. 301. MISCELLANEOUS MCCA AMENDMENTS. (a) I N GENERAL.—Sections 421 t h r o u g h 425 a n d 427 of MCCA a r e 5 u s e 902 note; repealed a n d a n y provision of law a m e n d e d or repealed by such 42 u s e 1395b note, 1395b-l sections is restored or revived a s if such sections h a d n o t been note, 1395b-2 enacted. note, 1395h note. (b) MISCELLANEOUS T E C H N I C A L CORRECTIONS.— (1) Effective a s if included in t h e e n a c t m e n t of t h e O m n i b u s Budget Reconciliation Act of 1987, section 1834(b)(4)(A) of t h e Social Security Act, a s added by section 4049(a)(2) of t h e Omni- bus Budget Reconciliation Act of 1987, is a m e n d e d by striking 42 u s e 1395m. " i n s u r a n c e a n d deductibles u n d e r section 1835(a)(l)(l)" a n d inserting "coinsurance a n d deductibles u n d e r sections 1833(a)(l)(J)". (2) Section 1842(j)(l)(C)(vii) of t h e Social Security Act, as added by section 4085(i)(7)(C) of t h e O m n i b u s Budget Reconciliation Act of 1!)87, is a m e n d e d by striking "accordingly" a n d inserting 42 u s e 1395u. "according". (8) Section 1886(g)(3)(A)(iv) of t h e Social Security Act, a s added by section 4006(a)(2) of t h e O m n i b u s Budget Reconciliation Act of 1987, is a m e n d e d by s t r i k i n g " m a y ) b e " a n d inserting " m a y 42 u s e 1395WW. be)" (4) Section 1866(a)(l)(F)(i)(III) of t h e Social Security Act is 42 u s e 1395CC. a m e n d e d by striking "fiscal year))" a n d inserting "fiscal year)". (5) Section 1875(c)(7) of t h e Social Security Act, a s added by section 9316(a) of t h e O m n i b u s Budget Reconciliation Act of 1986, is a m e n d e d by striking " d a t e of t h e e n a c t m e n t of this A c t " 42 u s e 1395Z/. a n d inserting " d a t e of t h e e n a c t m e n t of this section". (6) Section 1842(j)(2)(B) of t h e Social Security Act, a s a m e n d e d by section 8(c)(2)(A) of t h e Medicare a n d Medicaid F r a u d a n d Abuse P a t i e n t Protection Act of 1987, is a m e n d e d by striking " p a r a g r a p h s " a n d inserting "subsections". (c) MISCELLANEOUS CORRECTIONS R E L A T I N G TO THE O M N I B U S B U D G E T RECONCILIATION A C T OF 1987.— (1) Effective a s if included in t h e e n a c t m e n t of t h e O m n i b u s Budget Reconciliation Act of 1987, section 1834(b)(4)(A) of t h e Social Security Act (42 U.S.C. 1395m(b)(4)(A)), a s added by sec- tion 4049(a)(2) of t h e O m n i b u s Budget Reconciliation Act of 1987, is a m e n d e d by striking " i n s u r a n c e a n d deductibles u n d e r section 1835(a)(l)(I)" a n d inserting "coinsurance a n d deductibles u n d e r sections 1833(a)(l)(J)". (2) Section 1842(j)(l)(C)(vii) of t h e Social Security Act (42 U.S.C. 1395u(j)(l)(C)(viii)), a s added by section 4085(i)(7)(C) of t h e
103 STAT. 1986 PUBLIC LAW 101-234—DEC. 13, 1989 Omnibus Budget Reconciliation Act of 1987, is amended by striking "accordingly" and inserting "according". (3) Section 1886(g)(3)(A)(iv) of the Social Security Act (42 U.S.C. 1395ww(g)(3)(A)(iv)), as added by section 4006(a)(2) of the Omnibus Budget Reconciliation Act of 1987, is amended by striking "may) be" and inserting "may be)". (1) Section 1866(a)(l)(F)(i)(III) of the Social Security Act (42 U.S.C.^ 1395cc(a)(l)(F)(i)(III)) is amended by striking "fiscal year))" and inserting "fiscal year)". (2) Section 1875(c)(7) of the Social Security Act (42 U.S.C. 139511(c)(7)), as added by section 9316(a) of the Omnibus Budget Reconciliation Act of 1986, is amended by striking "date of the enactment of this Act" and inserting "date of the enactment of this section". (3) Section 1842(j)(2)(B) of the Social Security Act (42 U.S.C. 1395u(j)(2)(B)), as amended by section 8(c)(2)(A) of the Medicare and Medicaid Fraud and Abuse Patient Protection Act of 1987, is amended by striking "paragraphs" and inserting "sub- sections". 42 use 1395u (e) EFFECTIVE DATE.—The provisions of this section (other than "°*®- subsections (c) and (d)) shall t a k e effect J a n u a r y 1, 1990, except that— (1) the repeal of section 421 of MCCA shall not apply to duplicative part A benefits for periods before January 1, 1990, and (2) the amendments made by subsection (b) shall take effect on the date of the enactment of this Act. Approved December 13, 1989. LEGISLATIVE HISTORY—H.R. 3607: HOUSE REPORTS: No. 101-378 (Comm. of Conference). CONGRESSIONAL RECORD, Vol. 135 (1989): Nov. 8, considered and passed House; considered and passed Senate, amended. Nov. 19, House agreed to conference report. Senate rejected conference report. Nov. 21, Senate receded from its amendment; reconsidered and passed Senate, amended. House disagreed to Senate amendment. Senate receeded from its amendment.