Medicaid Federalization Act of 1991

Medicaid Federalization Act of 1991 - Amends title XIX (Medicaid) of the Social Security Act to: (1) convert the Medicaid program to a federally administered program of medical assistance that requires contributions by a State in order for individuals in the State to receive current Medicaid core services; (2) provides for the reversion of Medicaid administrative authority to a State upon the State's request; (3) require the Secretary of Health and Human Services to publish an alternative version of Medicare (title XVIII of the Social Security Act) fee schedule amounts for physicians' services and Medicare payment amounts for the operating costs of inpatient hospital services for use in determining payment amounts for such services under Medicaid that takes into account differences in the individuals covered and such services provided under Medicare and Medicaid; (4) provide that if a physician knowingly and willfully and on a repeated basis refuses to furnish services to individuals eligible for Medicaid, the Secretary may exclude such physician from participating in Medicare for a limited period; and (5) direct the Secretary of the Treasury to increase excise taxes on alcohol, tobacco products, and gasoline and other specified fuels in order to finance a federally administered Medicaid program.

 
HR 3974 IH
102d CONGRESS
1st Session
 H. R. 3974
To amend title XIX of the Social Security Act to convert the medicaid
program to a Federally-administered program of medical assistance, and for
other purposes.
IN THE HOUSE OF REPRESENTATIVES
November 26, 1991
Mr. KENNEDY introduced the following bill; which was referred jointly to
the Committees on Energy and Commerce and Ways and Means
A BILL
To amend title XIX of the Social Security Act to convert the medicaid
program to a Federally-administered program of medical assistance, and for
other purposes.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. SHORT TITLE.
  This Act may be cited as the `Medicaid Federalization Act of 1991'.
SEC. 2. FEDERALIZATION OF MEDICAID PROGRAM.
  (a) IN GENERAL- Title XIX of the Social Security Act (42 U.S.C. 1396 et
  seq.) is amended to read as follows:
`TITLE XIX--FEDERAL MEDICAL ASSISTANCE PROGRAM
`ESTABLISHMENT
  `SEC. 1901. For the purpose of furnishing medical assistance on behalf of
  families with dependent children and of aged, blind, or disabled individuals,
  whose income and resources are insufficient to meet the costs of necessary
  medical services, and rehabilitation and other services to help such families
  and individuals attain or retain capability for independence or self-care,
  there is hereby established a program to be administered by the Secretary
  of Health and Human Services for providing medical assistance (as defined
  in section 1903) to eligible individuals (as defined in section 1902).
`ELIGIBILITY
  `SEC. 1902. (a) IN GENERAL- Subject to section 1905(a) and section 1906,
  an individual shall be eligible to receive medical assistance during
  quarters occurring in a year under the program established by this title
  if the individual--
  `(1) is an individual described in section 1902(a)(10)(A)(i) of this Act
  (as in effect on the date of the enactment of the Medicaid Federalization
  Act of 1991);
  `(2) is an individual whose income does not exceed 100 percent of the
  official poverty line (as defined by the Office of Management and Budget,
  and revised annually in accordance with section 673(2) of the Omnibus Budget
  Reconciliation Act of 1981) applicable to a family of the size involved; or
  `(3) in the case of an individual not described in paragraph (1) or paragraph
  (2) who--
  `(A) is a resident of a State that has made a contribution for quarters
  occurring during the year in accordance with section 1905(b), and
  `(B) is an individual who is described in subparagraph (A)(ii), (C), or
  (E) of section 1902(a)(10) of this Act (as in effect on the date referred
  to in paragraph (1)) or who meets the eligibility standards for receiving
  assistance under the State's plan for medical assistance under this title
  as such standards were in effect on the date referred to in paragraph (1)
  (or who would meet such standards if amounts equal to the costs incurred
  by the individual for medical care or for any other type of remedial care
  were not taken into account in determining the individual's income for
  purposes of such standards).
  `(b) ENROLLMENT- An individual eligible under subsection (a) shall be
  enrolled in the program established under this title in accordance with an
  enrollment process established by the Secretary that provides for enrollment
  under terms at least as flexible and inclusive as the terms provided under
  this title as in effect on the date referred to in subsection (a)(1).
`MEDICAL ASSISTANCE
  `SEC. 1903. (a) IN GENERAL- For purposes of this title, the term `medical
  assistance' means payment of part or all of the cost of the following care
  and services (if provided in or after the third month before the month in
  which the recipient makes application for assistance):
  `(1) The care and services listed in paragraphs (1) through (5) (other
  than paragraph (4)(A)), (17), and (21) of section 1905(a) of this Act
  (as in effect on the date of the enactment of the Medicaid Federalization
  Act of 1991).
  `(2) In the case of an individual who is a resident of a State that has
  made a contribution for the year in accordance with section 1905--
  `(A) the care and services listed in section 1905(a) of this Act (as in
  effect on the date referred to in paragraph (1)) that are not described
  in paragraph (1); and
  `(B) any other care and services provided in the State under the State's
  plan for medical assistance under this title as of the date referred to
  in paragraph (1).
  `(b) SERVICES PROVIDED BY PREPAID HEALTH PLANS- As prescribed by
  the Secretary, the Secretary may enter into a contract with a health
  maintenance organization or other entity providing medical assistance on
  a prepaid basis for the provision of medical assistance under this title
  if the organization and contract meet such requirements as the Secretary
  may impose, taking into account requirements for such organizations and
  contracts under section 1903(m) (as in effect on the date referred to in
  subsection (a)(1)).
`AMOUNT OF PAYMENTS FOR SERVICES
  `SEC. 1904. (a) IN GENERAL- Except as provided in subsection (b), the
  amount of payment made for care and services under the program for medical
  assistance established under this title shall be equal to--
  `(1) for care and services provided during 1992, the amount of payment
  provided for such care and services under this title (as in effect on the
  date referred to in subsection (a)(1));
  `(2) for care and services provided during 1993, the sum of 67 percent of
  the amount of payment provided for such care and services under this title
  (as in effect on the date referred to in subsection (a)(1)) and 33 percent of
  the amount of payment provided for such care and services under title XVIII;
  `(3) for care and services provided during 1994, the sum of 33 percent of
  the amount of payment provided for such care and services under this title
  (as in effect on the date referred to in subsection (a)(1)) and 67 percent
  of the amount of payment provided for such care and services under title
  XVIII; and
  `(4) for care and services provided during 1994, the amount of payment
  provided for such care and services under title XVIII.
  `(b) NONAPPLICATION OF MEDICARE COST-SHARING- In determining the payment
  amounts under subsection (a)--
  `(1) there shall not be taken into account any deductibles or coinsurance
  imposed under title XVIII; and
  `(2) the Secretary may impose a nominal deduction, cost-sharing, or similar
  charge in accordance with section 1916 (as in effect on the date referred
  to in section 1902(a)(1)).
`CONTRIBUTIONS BY STATES
  `SEC. 1905. (a) STATE CONTRIBUTION FOR CORE SERVICES- In order to receive
  medical assistance during a year (beginning in 1992 and ending in 1999)
  under the program established under this title, an individual must reside
  in a State that makes a payment for quarters in the year to the Secretary
  (at such time and in such form as the Secretary may require) equal to a
  percentage of the costs incurred in providing such assistance under the
  program, except that the total of all payments made by the State under
  this subsection during a year may not exceed--
  `(1) in 1992, 1993, 1994, or 1995, the total amount paid by the State
  during 1991 in providing medical assistance (other than assistance provided
  to individuals described in paragraphs (1) or (2) of section 1902(a)
  or assistance for the care and services described in section 1903(a)(2)
  or section 1906) under the State plan under this title (as in effect on
  the date of the enactment of the Medicaid Federalization Act of 1991);
  `(2) in 1996, 80 percent of the amount described in paragraph (1);
  `(3) in 1997, 60 percent of the amount described in paragraph (1);
  `(4) in 1998, 40 percent of the amount described in paragraph (1); and
  `(5) in 1999, 20 percent of the amount described in paragraph (1).
  `(b) VOLUNTARY CONTRIBUTIONS FOR SUPPLEMENTAL SERVICES- In such form and
  in such terms as the Secretary may prescribe, a State may provide for
  coverage under the program for medical assistance established under this
  title during a year of the individuals described in section 1902(a)(3)
  or for the care and services described in section 1903(a)(2) by making a
  payment to the Secretary for quarters in the year in an amount equal to
  50 percent of the costs of such coverage (including administrative costs).
`STATE PROVISION OF LONG-TERM CARE SERVICES
  `SEC. 1906. In order to receive medical assistance during a year under
  the program established under this title, an individual must reside in a
  State that provides the services described in paragraphs (4)(A), (14), and
  (15) of section 1905(a) (as in effect on the date of the enactment of the
  Medicaid Federalization Act of 1991) during the year, under the terms and
  conditions applicable to the provision of such services under this title
  as of the date of the enactment of such Act.
`ADMINISTRATION
  `SEC. 1907. (a) IN GENERAL- The Secretary shall provide for such methods
  of administration, beneficiary safeguards, freedom of choice of providers,
  and third-party liability for the program established under this title as
  the Secretary considers appropriate, based (to the maximum extent possible)
  upon the requirements imposed on States under this title as in effect on
  the date of the enactment of the Medicaid Federalization Act of 1991.
  `(b) DELEGATION TO STATES- Upon the request of a State, the Secretary may
  delegate to the State such responsibility for the administration of this
  title in that State as the Secretary determines to be appropriate.
`CONTINUATION OF CERTAIN POLICIES
  `SEC. 1908. As prescribed by the Secretary, the following provisions
  of this title as in effect on the date of the enactment of the Medicaid
  Federalization Act of 1991 shall apply under this title in the same manner
  as they applied under this title before such date:
  `(1) Section 1917 (relating to liens, adjustments and recoveries and
  transfers of assets).
  `(2) Section 1919 (relating to requirements for nursing facilities).
  `(3) Section 1924 (relating to treatment of income and resources for
  certain institutionalized spouses).
  `(4) Section 1925 (relating to extension of eligibility for medical
  assistance).
  `(5) Section 1927 (relating to payment for covered outpatient drugs).
`APPROPRIATION
  SEC. 1909. There are authorized to be appropriated for each fiscal year
  a sum sufficient to carry out the purposes of this title.'.
  (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
  quarters beginning on or after January 1, 1992, without regard to whether
  or not regulations have been promulgated to carry out such amendment by
  such date.
SEC. 3. REVISION OF PHYSICIAN RELATIVE VALUE SCALES AND INPATIENT HOSPITAL
DIAGNOSIS RELATED GROUPS.
  (a) PHYSICIAN SERVICES- Not later than July 1, 1992, the Secretary of
  Health and Human Services, in consultation with the Physician Payment
  Review Commission, shall publish an alternative version of the fee schedule
  amounts for physicians' services established under section 1848 of the
  Social Security Act for use in determining payment amounts for physicians'
  services under title XIX of such Act (as amended by section 2(a)) that takes
  into account differences in the individuals covered and the physicians'
  services provided under title XVIII and title XIX of such Act.
  `(b) INPATIENT HOSPITAL SERVICES- Not later than July 1, 1992, the Secretary,
  in consultation with the Prospective Payment Assessment Commission, shall
  publish an alternative version of the payment amounts for the operating
  costs of inpatient hospital services established under section 1886(d) of
  the Social Security Act for use in determining payment amounts for inpatient
  hospital services under title XIX of such Act (as amended by section 2(a))
  that takes into account differences in the individuals covered and the
  inpatient hospital services provided under title XVIII and title XIX of
  such Act.
SEC. 4. REQUIRING PARTICIPATING PHYSICIANS UNDER MEDICARE TO ACCEPT MEDICAID
PATIENTS.
  (a) IN GENERAL- Section 1848(i) of the Social Security Act (42
  U.S.C. 1395w-44(i)) is amended by adding at the end the following new
  paragraph:
  `(4) EXCLUSION OF PHYSICIANS REFUSING TO SERVE MEDICAID PATIENTS- If a
  physician knowingly and willfully and on a repeated basis refuses to furnish
  services to individuals eligible for medical assistance under title XIX,
  the Secretary may exclude the physician from participation in the programs
  under this Act for a period not to exceed 2 years, in accordance with the
  procedures of subsections (c), (f), and (g) of section 1128.'.
  (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
  services furnished on or after January 1, 1992.
SEC. 5. FINANCING THROUGH INCREASES IN CERTAIN EXCISE TAXES.
  (a) IN GENERAL- For each taxable year beginning after December 1991, the
  Secretary of the Treasury shall increase the excise taxes referred to in
  subsection (b) that are otherwise provided for the taxable year under the
  Internal Revenue Code of 1986 by amounts that will generate sufficient
  revenue to carry out title XIX of the Social Security Act (as amended by
  section 2) during the taxable year.
  (b) TAXES AFFECTED- The excise taxes referred to in subsection are as
  follows:
  (1) The excise taxes on alcohol, distilled spirits, wine, and beer provided
  under chapter 51 of the Internal Revenue Code of 1986.
  (2) The excise taxes on tobacco products provided under chapter 52 of the
  Internal Revenue Code of 1986.
  (3) The excise taxes on gasoline provided under section 4801 of the Internal
  Revenue Code of 1986.
  (4) The excise taxes on diesel and aviation fuel provided under section
  4091 of the Internal Revenue Code of 1986.