Health Security Act. Subtitle B. Long Term Care
Overview
Type of Reform: Transforming Healthcare Structures (Medicare Expansion, New Program, and Private Market Incentives)
Description: Expands Medicare by (1) extending Medicare Part A coverage to extended care services to chronically dependent individuals; and (2) providing coverage of home care services under Medicare Part B.
- Requires states to establish and support state plans to provide home and community-based care to individuals with disabilities without regard to age or income.
- Clarifies favorable tax treatment of private LTC insurance premiums and benefits.
- Provides a tax credit to working individuals with disabilities, for up to 50% of their care costs, up to a maximum of $15,000 per year.
- Provides federal grants for consumer education and counseling on LTC insurance.
Sponsor/Cosponsors:
- Introduced by Sen. Mitchell (D-ME) on November 23, 1993.
- 23 co-sponsors, including 15 Democrats and eight Republicans.
Impact and Action:
- Major health care reform legislation including new benefits within Medicare to cover LTC (Title II; Subtitle B).
- Called for tax advantaged treatment for premiums and benefits from LTC insurance (Title VI; Subtitle G).
- Laid the groundwork for other Medicare expansion bills, e.g., The Health Security Act of 1994 (S. 2357).
Program Details
(Medicare Expansion Only)
Participation Criteria
Individuals meeting one of the following criteria:
- Older adults with Medicare.
- Chronically ill individuals as defined in the Conditions for Receiving Benefits (below).
Conditions for Receiving Benefits Scope of Services
Specific criteria determined by each state, but generally individuals meeting one of the following criteria:
- Requiring help with three or more ADLs expected to last at least 180 days.
- Having severe cognitive impairment or mental impairment.
- Having profound or severe mental retardation.
- Being a child under six years old with a severe disability or chronic medical condition that would otherwise require facility-based care.
Scope of Services
Including, but not limited to, care management, homemaker and chore help, home modification, respite, assistive technology, adult day care, and home health services. Room and board are excluded.
Amount of Services
Amount and limits of services determined by each state.
Participant Financial Responsibility
Co-insurance amounts based on income:
- Incomes below 150% FPL: 0%
- Incomes of 150% to 200% FPL: Up to 10%
- Incomes of 200% to 250% FPL: Up to 25%
- Incomes more than 250% FPL: 25%
Elimination Period
Not specified.
Provider Requirements
Determined by each state.
Provider Payment Levels
Determined by each state.
Inflation Adjustments
- Program budget increases annually, keeping with the increase for the national health care budget and the growth in the number of persons with severe disabilities.
- Provider payment methodology, including inflation adjustments, determined by each state.
Financing & Implementation
(Medicare Expansion Only)
Revenue Source(s)
Not specified.
Total Program Costs
For FY 1996, the initial budget estimate was $4.5 billion, increasing annually up to $38.3 billion in 2003.
Program Administration
- Department of Health and Human Services establishes the program structure and allocates funding to states (based on a formula with a federal share of program costs ranging from 78% to 95%).
- States fund the non-federal share of costs and administer the program including specifying covered services, creating protocols for determining need, certifying provider eligibility, overseeing program quality, and more.
Subtitle B. Long Term Care (S.1757)
Category: