Medicare-Medicaid Administrative and Reimbursement Reform Act

Medicare-Medicaid Administrative and Reimbursement Reform Act - Establishes additional requirements applicable to the determination of the reasonable costs of services provided by hospitals under titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act. Directs the Secretary of Health, Education, and Welfare to establish a system by which hospitals will be classified by: (1) size; (2) type of hospital; (3) location (rural or urban); and (4) other criteria determined by the Secretary to be appropriate. Defines the term "routine operating cost" as used in this Act. Stipulates that such term does not include: (1) capital costs; (2) direct personnel and supply costs of hospital education and training programs; (3) costs of interns, residents, and non-administrative physicians; (4) energy costs associated with heating and cooling the hospital plant; and (5) malpractice insurance expenses; or (6) ancillary service costs. Directs the Secretary to determine for the hospitals in each category an average per diem routine operating cost amount, based upon the amount of the hospitals' routine operating costs, to be used in making payments to such hospitals. Establishes a Health Facilities Costs Commission to conduct a continuing study, investigation, and review of the reimbursement provided to hospitals under the Medicare or Medicaid programs. Directs the Secretary to establish a Hospital Transitional Allowance Board to act on the applications of hospitals for reimbursement of expenses incurred in the retirement or conversion of under-utilized facilities. Redefines the term "capital expenditure" as used in this Act in relation to expenditures made by or on behalf of health care facilities or health maintenance organizations to raise the limit on such expenditures from $100,000 to $150,000. Establishes a plan for the reimbursement of physicians under which participating doctors of medicine or osteopathy would accept the assignment of patients' claims for reimbursement under the Medicare program. Requires the Secretary to establish procedures for expediting the payment of such assigned claims to physicians. Promulgates an incentive payment to encourage physicians to participate in the program of assignment of claims. Directs the Secretary to specify those surgical procedures which can be safely and appropriately performed either in a hospital or on an inpatient ambulatory basis: (1) in a physician's office; or (2) in an ambulatory surgical center or hospital. Authorizes payment under the Medicare program for those ambulatory procedures not performed in a hospital. Directs the Secretary to establish with respect to each such surgical procedure an amount which is payable either to: (1) the physician for the excess costs in outfitting the physician's office to perform such procedures; or (2) the ambulatory surgical center for its services furnished in connection with such procedures. Stipulates that such amounts will be payable only upon assurances that the performance of such procedures will cost substantially less than the cost of performing such procedures on an inpatient basis in a hospital. Sets forth criteria for determining the reasonable charge which may be made for physicians' services, and medical services, supplies and equipment under the Medicare and Medicaid programs. Authorizes payment, under the Supplementary Medical Insurance Benefits program of Medicare, for antigens prepared by an allergist for a particular patient. Authorizes payment of physician's fees for a deceased Medicare recipient to the spouse or legally designated representative of the recipient under specified circumstances. Authorizes rural hospitals of less than 50 beds which have been granted a certificate of need for the provision of long-term care services to enter into agreements with the Secretary under the Medicare and Medicaid programs, providing that their inpatient hospital facilities may be used to furnish services which if furnished by a skilled nursing facility would constitute post hospital extended care services. Authorizes, pursuant to such agreements, for payments to be made for skilled nursing services and intermediate care services furnished by a hospital. Directs the Secretary to make agreements with the States under which the services of a State health agency will be utilized for the purpose of determining whether an institution in such State qualifies as a skilled nursing facility for purposes of the Medicaid program. Terminates the Health Insurance Benefits Advisory Council. Authorizes the Secretary to make grants to public or nonprofit private regional pediatric respiratory centers affiliated with institutions in the prevention, diagnosis, and treatment of respiratory diseases in children and young adults and in providing health care services to children and young adults suffering from such diseases. Authorizes the appropriation of such sums as may be necessary for the making of such grants for fiscal year 1979 and the succeeding four fiscal years. Amends title XI (General Provisions and Professional Standards Review) of the Social Security Act to stipulate that no Professional Standards Review Organization and no Statewide Professional Standards Review Council shall be considered to be or have been an agency or authority of the United States Government for the purpose of disclosure of information developed or collected under the Act. Removes the 100 visit limitation presently applicable to home health services under the Medicare program. Eliminates prior hospitalization as a condition of eligibility for home health care services under such program. Directs the Secretary to develop uniform claims forms to be utilized in making payments for health services under the Medicare and Medicaid program. Amends title XI to require, as a condition for payment to any State under title V (Maternal and Child Health and Crippled Children's Services) or title XIX for costs incurred in the performance of audits of certain entities which also provide services under title XVIII, that the conduct of such audits be coordinated with audits performed with respect to the entity for purposes of title XVIII. Requires, under titles V and XIX, that a State plan for medical assistance provide that the records of any entity participating in the plan and providing services reimbursable on a cost-related basis will be audited to insure that proper payments are made under the plan. Requires the Secretary to report to Congress concerning such audits. Requires skilled nursing facilities to provide services under both Medicare and Medicaid on a non-discriminatory basis, in order to be reimbursed under either plan. Provides coverage under the Medicare program for optometrists' services with respect to aphakia. Directs the Secretary to conduct a special study of the criteria presently used in determining whether a facility is a "skilled nursing facility" as that term is used in title XVIII. Authorizes States which have not yet entered into an agreement with the Secretary to provide coverage for certain individuals under part B (Supplementary Medical Insurance for the Aged and Disabled) of title XVIII to enter into such an agreement.

Written by analysts at the Congressional Research Service and published on Congress.gov, not by Civibrief. Summarized at the "Introduced in House" stage on February 15, 1979. It describes the bill, it is not the legal text.

Every answer above is assembled from this measure's own record on Congress.gov and from published counts of what Congress has passed before. Civibrief does not predict outcomes and takes no position on any measure.