Health Security Act (S.2357)
Overview
Type of Reform: Transforming Healthcare Structures (Medicaid Reform and Private Market Incentives) solutions.
Description:
- Creates a state-based HCBS program for hospitalized individuals who need LTSS as an alternative to nursing facility placement.
- Clarifies favorable tax treatment of private LTC insurance and LTC expenses by treating policies as accident or health insurance contracts and assuring that payments are not taxable because they are treated as reimbursement for expenses actually incurred for medical care.
Sponsor/Cosponsors:
Sponsoring Organization:
- Introduced by Sen. Mitchell (D-ME) on August 3, 1994.
- No cosponsors.
Impact and Action:
- One title within major senate leadership legislation to reform the health care system.
- Built on the Health Security Act of 1993 (S. 1757).
Program Details
Participation Criteria
Each state that has a plan for HCBS for individuals with disabilities submitted to and approved by the Secretary under section 2102(b) is entitled to payment in accordance with section 2108 under the program.
Conditions for Receiving Benefits Scope of Services
Demonstrated need for LTSS by meeting one of the following criteria:
- Needing help with three or more ADLs expected to last >90 days.
- Having severe cognitive or mental impairment.
- Having a symptom of one or more serious behavioral problems.
- Having severe or profound mental retardation.
- Being under age six and having a severe or chronic medical problem.
Scope of Services
Home care, homemaker, personal care, home modification, adult day care, respite care, care management, rehabilitation, transportation, person-centered care.
Amount of Services
Amounts and maximums at the discretion of each state in accordance with their approved state plans.
Participant Financial Responsibility
Copayments on a sliding-scale based on income:
- No copayment for incomes <150% of FPL.
- Up to 40% copayment for incomes of 400% FPL or more.
Annual deductibles on a sliding-scale based on income:
- $100 for incomes <175% of FPL.
- Up to $600 for incomes at 150% FPL or more.
Elimination Period
None specified.
Provider Requirements
Criteria determined by state; state plans cannot limit provider participation to only licensed/certified providers.
Provider Payment Levels
Payment methodologies to be determined by the state.
Inflation Adjustments
Not specified.
Financing & Implementation
Revenue Source(s)
Not specified.
Total Program Costs
- ASPE estimates $4.5 billion in 1996 to $18.7 billion in 2000 for the HCBS new program component only.
- CBO estimates $5 billion to $20 billion over the same time period.
Program Administration
- Secretary of HHS will designate the agency responsible for program administration and funding.
- States will develop HCBS state plans and administer programs in accordance with federal requirements (including providing assessment services, benefit determinations, provider payments, and more).
- Federal funding allotments to states for HCBS State Programs are based on estimates of the population with disabilities, costs of care, and percent of low-income individuals in the state.
Health Security Act, 1994 (S. 2357)
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