MediPlan Long-Term Care Act (H.R. 651)
Overview
Type of Reform: Expanding Medicare Coverage
Description:
- Creates a “MediPlan” universal social insurance program within Medicare to provide coverage of LTSS for all U.S. citizens.
- Removes Medicare’s existing post-hospitalization requirement and extends nursing home coverage beyond the existing 100-day limit.
Sponsoring Organization and Key Author(s):
Sponsoring Organization:
- Introduced by Rep. Pete Stark (D-CA).
- Three Democratic co-sponsors.
Impact and Action:
- Introduced in the House.
- House Committee Referrals: Energy and Commerce, Ways and Means, Subcommittee on Health, Subcommittee on Health and the Environment.
- Subcommittee Hearings Held March 1991.
Program Details
Participation Criteria
All U.S. citizens.
Conditions for Receiving Benefits Scope of Services
Nursing Facility: Ages 65+ years and unable to perform three or more ADLs (or having a similar level of disability due to cognitive impairment).
HCBS: Unable to perform two or more ADLs (or having a similar level of disability due to cognitive impairment).
Scope of Services
Nursing facility services and HCBS
Amount of Services
HCBS: Up to three years.
Nursing Facility Care: Up to six months, with an extension for individuals who have not been an inpatient for at least six consecutive months, have a different diagnosis, or where there has been a substantial worsening of their condition since the last discharge.
Participant Financial Responsibility
20% copay for nursing facility costs, after two-month deductible; 20% copay for home care. Deductibles and copayments are waived for persons with incomes below 200% of FPL. Balance billing is prohibited.
Elimination Period
Not applicable.
Provider Requirements
Contract with fiscal intermediaries based on rules established by the Department of Health and Human Services.
Provider Payment Levels
- Payment amounts based on a prospective payment methodology.
- Coordination of benefits with Medicare so that the LTC MediPlan Trust Fund is the secondary payer.
Inflation Adjustments
Provider payments inflated based on an index of increased costs specific to LTSS.
Financing & Implementation
Revenue Source(s)
- Income tax. Annual premium paid of 2% of the excess (if any) of the modified gross income of the taxpayer over $16,000 ($32,000 in the case of a joint return).
- Also funded by Medicaid savings.
Total Program Costs
Brookings/ICF LTC Financing Model estimated $47 billion in additional public spending, with a reduction in out-of-pocket spending of $12.6 billion (in 1992 dollars).
Program Administration
The Department of Health and Human Services will be responsible for program administration and monitoring. No additional details specified.
MediPlan Long-Term Care Act, 1991 (H.R. 651)
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