Spending Reduction Provisions
Amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to extend for one year provisions which provide for financing 25 percent of part B costs from enrollee premiums.
Revises part B provisions determining the prevailing level of physician charges.
Provides Medicare coverage for hepatitis B vaccine administered to end-stage renal disease hemodialysis patients.
Directs the Secretary of Health and Human Services, by regulation, to prohibit payment for a physician's debridement of mycotic toenails if performed more than once every 60 days, unless the physician documents the necessity for such treatment.
Provides Medicare coverage for the supplies necessary for the self-administration of blood clotting factors for hemophilia patients.
Directs the Secretary to establish, on an area-wide basis, fee schedules for diagnostic laboratory tests for which payment is made under part B, other than such tests performed by a provider of services.
Directs the Secretary to set the fee schedule at 65 percent of the prevailing charges paid under part B for similar diagnostic laboratory tests during the fee screen year beginning July 1, 1983.
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) of the amount determined by the Secretary or the amount of billed charges.
Provides that the provisions of this paragraph shall be effective until March 1, 1986.
Directs the Secretary to report to Congress concerning payments for such tests.
Provides for the indexing of the part B deductible.
Sets reimbursement to a home health agency, for durable medical equipment, at a maximum of 80 percent of reasonable cost.
Increases the Medicaid (title XIX of the Act) ceiling amount for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. Amends title V (Maternal and Child Health Services Block Grant) of the Act to increase the authorization of appropriations.
Requires a State to provide Medicaid coverage to pregnant women who would be eligible under part A (Aid to Families With Dependent Children) of the Act if the child were born.
Postpones until April 1, 1984, the implementation of the single payment limit for skilled nursing facilities.
Revises the recertification schedule for skilled nursing facilities and intermediate care facilities.
Directs the Director of the Office of Technology Assessment to:
(1) conduct a study of physician reimbursement under Medicare with respect to any inequities that may exist between reimbursement levels for medical procedures and cognitive services; and
(2) make any appropriate recommendations for changes in such reimbursement system.
Eliminates the part B deductible with respect to diagnostic tests performed in a laboratory which has a negotiated rate agreement with the laboratory.
Provides that coverage for the services of a home health agency or hospice shall end 30 days following the termination of a home health agency's or hospice's Medicare participation agreement.
Repeals specified requirements relating to coverage of tuberculosis treatments under Medicare and Medicaid (title XIX of the Act). Authorizes the United States to bring an action directly against third party insurance programs for Medicare costs.
Permits part B payments to be made to an entity:
(1) which provides coverage of the service under a health benefits plan;
(2) which has paid the person who provided the service the amount which that person has accepted as payment in full for the service; and
(3) to which the individual has agreed in writing that payment may be made.
Eliminates the Health Insurance Benefits Advisory Council. Prohibits the Secretary from disclosing any accreditation survey made and released to the Secretary by the Joint Commission on Accreditation of Hospitals, the American Osteopathic Association, or any other national accreditation body, of any entity accredited by such body.
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.
Authorizes the Secretary to use accrediting organizations to determine whether rural health clinics, laboratories, clinics, rehabilitation agencies, and public health agencies meet Medicare requirements.
Amends part A (General Provisions) of title XI of the Social Security Act to remove the exclusion on making research and demonstration grants to for-profit organizations.
Revises requirements for medical review and independent medical review under Medicaid. Eliminates the special payment rate provisions for hospitals furnishing skilled nursing or intermediate care facility services.
Grants the Secretary the authority to issue and enforce subpenas under Medicaid. Repeals provisions under titles XVIII and XIX of the Act which authorized payments to promote the closing and conversion of underutilized hospital facilities.
Provides that the Administrator of the Health Care Financing Administration shall be appointed by the President by and with the advice and consent of the Senate. Authorizes the Secretary to bar from participation in Medicare or Medicaid any provider of which five percent or more is owned by an individual convicted of Medicare or Medicaid related crimes.
Permits a physician with a significant interest in a home health agency to perform patient certifications for the agency if the agency is the only agency in the community.
Directs the Secretary to:
(1) annually prepare a list containing the name, address, volume of services, and percent of bills submitted for payment by each physician during the preceding year that were paid on the basis of an assignment; and
(2) make the list available to each district office of the Social Security Administration and other appropriate locations.
Provides for provider representation in peer review organizations.
Makes certain changes affecting the Prospective Payment Assessment Commission. Provides, for purposes of Medicaid coverage, that the administrator of a clinic need not be a physician.
Waives the Medicare part B delayed enrollment penalty and provides a special enrollment period for working individuals aged 65 to 69 who were enrolled in private health plans.
Defines the term "bona fide emergency services" as used in title XVIII. Provides for the reimbursement of a hospital on a reasonable cost basis for the services of a certified registered nurse anesthetist.
Directs the Secretary to conduct a study and report to Congress on possible methods of reimbursement under title XVIII which would not discourage the use of certified registered nurse anesthetists.
Directs the Secretary to:
(1) conduct a study to develop an appropriate wage index for hospital workers;
(2) report the results to Congress; and
(3) adjust hospital payments under Medicare as necessary.
Authorizes the Secretary to waive certain nursing care requirements for hospices located in rural areas which were in operation on or before January 1, 1983, and have demonstrated a good faith effort to hire enough nurses.
Directs the Secretary to study and report to Congress on the necessity and appropriateness of the requirements that certain care services be furnished directly by a hospice.
Delays, until July 1, 1985, certain payment reductions under Medicaid scheduled to be made to public psychiatric hospitals due to the level of care received in such hospitals.
Revises provisions relating to:
(1) the accreditation of psychiatric hospitals for participation in Medicare and Medicaid; and
(2) Medicare reimbursement for a physician's service furnished in a teaching hospital.
Directs the Secretary:
(1) by February 1, 1984, to issue revisions to the current payment guidelines under Medicare part B for the transtelephonic monitoring of cardiac pacemakers;
(2) to review and report to specified congressional committees regarding the appropriateness of the current rate of reimbursement under part B for physicians' services associated with the implantation or replacement of pacemaker devices and pacemaker leads; and
(3) through the Administrator of the Food and Drug Administration, to provide for the establishment and maintenance by each manufacturer of cardiac pacemaker leads and devices of a registry of all cardiac pacemaker devices and pacemaker leads produced by such manufacturer for which Medicare payment was made.
Authorizes the Secretary to:
(1) as condition for payment being made for the implant or replacement of a cardiac pacemaker device or lead, require a provider to furnish the manufacturer certain information with respect to all patients bearing a device or lead produced by such manufacturer; and
(2) require a manufacturer to analyze each returned device or lead for which Medicare payment was made.
Requires a manufacturer of pacemaker devices and leads to post a bond or provide assurances to the Secretary that it will comply with the requirements of this paragraph.
Directs the Secretary to establish a single 30-day period each year in which all of the competitive medical plans and health maintenance organizations in an area participating in Medicare must have an open enrollment period.
Authorizes the Secretary to phase in the provision of the previous sentence over a three year period.
Amends part A (Aid to Families With Dependent Children) of the Act to require a State in determining the need of a dependent child to include the child's parent and dependent minor siblings who meet the definition of "dependent child" under part A, if the parent or sibling lives in the same home as the dependent child.
Includes any income of or available for such parent or sibling in determining such need.
Requires a State plan in determining need with respect to a dependent child whose parent is a minor to include any income of such minor's own parent if living in the same household.
Requires a minor parent applying for AFDC to live with such minor parent's parent unless:
(1) the parent cannot be located;
(2) it would jeopardize the dependent child's health or safety; or
(3) the minor parent has not lived at home for at least one year prior to the child's birth or one year prior to applying for AFDC. Specifies that the term "earned income" means, for AFDC purposes, gross income, prior to any deductions for taxes or other purposes.
Permits participants in community work experience programs to perform work in the public interest for a Federal agency.
Prohibits considering participants as Federal employees.
Authorizes a State to exclude for up to six months, for purposes of the AFDC gross income limitation, the earned income of a dependent child who is a full-time student.
Amends part A (General Provisions) of title XI of the Act to provide for adjustments in certain Supplemental Security Income (title XVI of the Act) benefits made because of retroactive Old Age, Survivors and Disability Insurance (title II of the Act) benefits received.
Directs the Secretary to issue regulations to require that State agencies administering the child support enforcement program under part D (Child Support and Establishment of Paternity) of title IV of the Act petition courts to include medical support as part of any child support order whenever health care coverage is available to the absent parent at a reasonable cost.