Long-Term Care Reform and Deficit Reduction Act of 1997

TABLE OF CONTENTS:

Title I: Home and Community-Based Services for Individuals

with Disabilities

Title II: Prospective Payment System for Nursing Facilities

Title III: Additional Medicare Provisions

Long-Term Care Reform and Deficit Reduction Act of 1997 - Title I:

Home and Community-Based Services for Individuals with Disabilities - Authorizes specified payments to each State with an approved plan for specified home- and community-based services (including certain Medicaid services under SSA title XIX of the Social Security Act) (SSA) for individuals with disabilities.

(Sec. 105) Prohibits such plans from requiring cost sharing for low-income individuals. Requires plans to: (1) ensure the quality of services; (2) adhere to Federal quality standards; (3) provide for a client advocacy office; (4) provide safeguards on confidentiality and against abuse; and (5) protect individual rights.

(Sec. 107) Establishes an advisory group to advise the Secretary of Health and Human Services and the States on all aspects of such State programs. Requires each State plan to provide for a State advisory group.

(Sec. 109) Authorizes appropriations and provides for allotments to States.

(Sec. 110) Requires the Secretary to report to the Congress on evaluations of services to individuals with low-incomes and disabilities.

(Sec. 111) Amends the Public Health Service Act to direct the Secretary to disseminate information and materials to assist specified entities in replicating successful programs aimed at offering care management to hospitalized individuals in need of long-term care so that services to meet individual needs and preferences can be arranged in home- and community-based settings as an alternative to long-term nursing home placement.

Directs the Secretary to establish a program under which incentive grants may be awarded to assist agencies and organizations in developing and expanding programs and projects that facilitate the discharge of individuals in hospitals or other acute care facilities who need long-term care services, and their placement into home- and community-based settings.

Authorizes appropriations.

Title II: Prospective Payment System for Nursing Facilities - Mandates that payment rates under the Prospective Payment System for nursing facilities reflect enumerated objectives. Declares that this Act does not affect the skilled nursing facility benefit under SSA title XVIII (Medicare).

(Sec. 205) Instructs the Secretary of Health and Human Services to:

(1) establish a resident classification system which groups residents into classes according to similarity of their assessed condition and required services; and (2) determine payment rates for nursing facilities according to prescribed guidelines.

(Sec. 207) Prescribes guidelines for: (1) resident assessment; (2) per diem rates for nursing service, administrative and general, and property costs; (3) payment for fee-for-service ancillary services; (4) reimbursement of selected ancillary services; (5) mid-year rate adjustments; and (6) payment methods for new and low-volume nursing facilities.

(Sec. 215) Details appeal procedures for any person or legal entity aggrieved by a decision of the Secretary under this title.

(Sec. 216) Requires this Prospective Payment System to be phased in over a three year period using a specified blended rate.

Title III: Additional Medicare Provisions - Amends SSA title XVIII to provide for: (1) elimination of formula-driven overpayments for certain outpatient hospital services; and (2) permanent extension of certain secondary payer provisions, including those for the working disabled and individuals with end stage renal disease.

(Sec. 303) Revises the formulae for payments to health maintenance organizations and competitive medical plans (eligible organizations).

Requires the Secretary to determine the annual per capita rate of payment for each Medicare payment area (which has been set at 95 percent of the adjusted average per capita cost) by adjusting such cost for: (1) individuals who are enrolled under Medicare part B (Supplementary Medical Insurance) only with an eligible organization that has entered into a risk-sharing contract; and (2) such risk factors as age, disability status, gender, institutional status, and such other factors as the Secretary determines to be appropriate so as to ensure actuarial equivalence.

Requires the Secretary to establish a separate rate of payment to an eligible organization with respect to any enrolled individual with end-stage renal disease.

Prescribes a general formula for the adjusted average per capita cost of a Medicare payment area based on an area-specific adjusted average per capita cost and an input-price-adjusted national adjusted average per capita cost. Specifies area-specific and national percentages for contract years 1998 through 2002 and after.