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bradley #4
AMENDMENT STRIKING 10% FEE ON CHILD SUPPORT COLLECTIONS
INTRODUCED BY SENATOR BRADLEY
Proposal Strike the provision requiring states to impose a 10%
fee on all child support payments collected through the Child
Support Enforcement program.
Rationale The provision in the Chairman's mark takes money away
from single parents payments in order to meet federal budget
deficit goals. The money would be taken from the amount which
the court has determined that the parent requires to meet their
child-raising responsibilities. In addition, this provision
charges single parents a high price for having a court order
enforced.
Nursing Home Quality of Care
Amendment to Medigrant Bill
Offered by Sen. David Pryor / Kackefeller
Proposal: Maintain current federal standards, survey and certification process, and
enforcement mechanism to ensure quality of care in nursing homes.
The amendment would reinstate the nursing home reform provisions enacted as part of the
Omnibus Budget Reconciliation Acts of 1987, 1989, and 1990, appearing at 42 USCS @ 1396Γ,
"Requirements for nursing facilities." All current provisions would be retained.
Cost Impact: No expected cost impact. The aggregate cap in the Medigrant bill would
not be revised as a result of this amendment.
HCFA Approval of State
Nursing Home Standards
Amendment to Medigrant Bill
Offered by Sen. David Pryor
Proposal: To provide for Federal approval of State nursing home quality standards.
The amendment would require all States to submit their proposed nursing home quality
standards as part of their state plan to the Health Care Financing Administration for approval
before being approved to participate in the Medigrant program. This is to ensure that States
adequately provide for protection of frail nursing home residents.
Cost Impact: No expected cost impact. The aggregate cap in the Medigrant bill would
not be revised as a result of this amendment.
Medicaid Drug Rebate Program
Amendment to MediGrant bill
Offered by Sen. David Pryor
Proposal: Retain the Medicaid drug rebate program as an option for state Medicaid
programs. The amendment would strike bill language repealing the Medicaid drug rebate
program, effective October 1, 1998. States may elect to participate im the existing rebate
program or to negotiate and implement rebates independently.
Cost Impact: Continuation of a voluntary Medicaid drug rebate program would
generate additional Federal and state savings after October 1, 1998. The aggregate cap in the
MediGrant bill would not be revised as a result of this amendment.
Medicaid Drug Rebate Program
Amendment to MediGrant bill
Offered by Sen. David Pryor
Proposal: Maintain current inclusion of nursing facilities in the Medicaid drug rebate
program. The amendment would strike bill language excluding nursing facilities from the
rebate program. States may elect to exclude nursing facilities, if their unit drug acquisition
costs are shown to be equal or lower than historic unit costs under existing rebate agreements.
Cost Impact: Continued inclusion of nursing facilities would generate additional
Federal and state savings. The aggregate cap in the MediGrant bill would not be revised as a
result of this amendment.
Medicaid Drug Rebate Program
Amendment to MediGrant bill
Offered by Sen. David Pryor
Proposal: The Secretary of HHS shall convene a task force for the purpose of
determining whether the Medicaid drug rebate program should be retained or repealed. The
task force shall be convened no later than June 1, 1998, and shall report its findings to the
Secretary by October 1, 1998.
The report shall assess the extent to which state Medicaid programs rely on the drug
rebate program to manage prescription drug expenditures; the impact of repeal of the drug
rebate program on recipient access to prescription drugs and pharmacy services; and the likely
actions states would take to manage prescription drug expenditures in the absence of drug
rebate revenue.
The task force shall consist of volunteer representatives appointed by: the chair and
vice chair of the National Governors Association (NGA); the State Medicaid Directors
Association; associations representing the prescription and generic drug industries; an
association representing pharmacies; and an associa: on representing the in. rests of Medicaid
recipients.
The report shall be transmitted to the Senate Committee on Finance, House Committee
on Commerce and the Senate Special Committee on Aging.
Cost Impact: No expected cost impact. The aggregate cap in the MediGrant bill
would not be revised as a result of this amendment.
Medicaid Drug Rebate Program
Amendment to MediGrant bill
Offered by Sen. David Pryor
Proposal: Provide for rebate master agreements and statutory definitions necessary to
the implementation of the Veterans Health Care Act of 1992 (P.L. 102-585).
The amendment reinstates the requirement that drug manufacturers sign rebate master
agreements with the Secretary of Veterans Affairs. The Department of Veterans Affairs and
the Veterans Health Administration manage a prescription drug rebate program wholly
independent of the Medicaid rebate program. The Veterans Health Care Act refers to specific
provisions in the Medicaid statute (section 1927 of the Social Security Act), including key
definitions. The amendment would provide such definitions, solely for the purposes of the
rebate agreements reached under the Veterans Health Care Act.
Cost Impact: No expected cost impact. The aggregate cap in the MediGrant bill
would not be revised as a result of this amendment.
PRyor 7
FINAL VERSION
QUALITY STANDARDS FOR COORDINATED CARE PLANS
Amendment to the Chairman's Mark (Medicare Choice)
Offered by Senator David Pryor
PROPOSAL: The amendment would restore existing regulations and laws
pertaining to quality standards that apply to Medicare risk plans (Social Security Act,
Section 1876), repealed or altered under the Mark. In addition, new provisions described
here would supplement these current regulations and laws.
These new enrollee-protection provisions - as would existing laws and regulations
- would apply to all coordinated care organizations that accept Medicare beneficiaries.
including HMOs, preferred provider organizations, and "provider service networks" (all
referred to in this document as "plans").
The following are the new quality assurance standards that would be added to
those already in place in Section 1876.
1. Access To Services/Appeals Process
The Secretary shall:
Provide information to enrollees concerning their rights to appeal plans'
decisions not to provide covered services and their rights to address
grievances with their health plans to HCFA and the Peer Review
Organizations, at time of enrollment and on an annual basis (insert p. 13).
Ensure that participating plans respond to the request for health services of
enrollees in a reasonable amount of time after the request is made. The
Secretary would also ensure that plans respond to enrollees' appeals in a
reasonable amount of time. The Secretary shall define "reasonable" and
may establish different timetables for different types of medical conditions
and services (insert page 15).
Review in an expedited manner plan denials for cases in which denial of
care could result in significant harm (insert page 15).
2. Data Collection, Analysis, and Dissemination
The Secretary shall:
Establish and integrate into ongoing external quality assurance activities a
September 26, 1995
FINAL VERSION
new set of quality indicators, developed specifically for the Medicare
population, that would be used to determine whether a plan is providing
quality care and appropriate continuity and coordination of care (insert p.
15).
Require plans to report complete encounter data, including data on
physician visits, nursing home days, home health days, hospital inpatient
days, and rehabilitation services, using HCFA Form 1500; UB92, or any
other form selected by the Secretary (insert p. 15).
Require plans to provide information to prospective enrollees on the plans'
specialist referral process, and on request, the number of referrals to
specialists requested by the enrollee and the primary care provider that were
denied and reasons for these denials (insert p. 13).
Publish for use by beneficiaries (i) comparative data it collects on plans
such as complaint rates, disenrollment rates, and rates and outcomes of
appeals, and (ii) the results of its major investigations or any findings of
significant noncompliance by plans (insert p. 13).
3. Marketing Protections/Enrollment And Disenrollment Issues
The Secretary shall:
Require plans to provide standardized, easy-to-read, information at all
marketing presentations describing the rules of plan enrollment, including
"lock-in" and requirements for referrals to specialty care (insert p. 13).
Prohibit the payment of commissions to plan marketing agents if a new
enrollee disenrolls within three months of enrollment (insert p. 11).
Prohibit plans' sales agents from visiting the residence of eligible enrollees
for purposes of enrolling the individual or providing enrollment information
to the individual other than at the individual's request (insert p. 13).
COST IMPACT: No expected cost impact. Under current law, as explained in
Social Security 1876(i)(7)(B), the cost of managed care quality oversight activities are
born by the health plans.
September 26, 1995
Rockefeller Medicaid Amendment #1
As a condition of receipt of federal Medicaid funding, each state will cover all
children, under age 19 years of age, living under 100% of federal poverty and all
pregnant women living under 185% of federal poverty.
Rockefeller Medicaid Amendment #2
As a condition of receipt of federal Medicaid funding, each state will cover all
Qualified Medicare Beneficiaries, as defined in the Social Security Act, and all
individuals with a diagnosis of Alzheimer's disease living under 100% of federal
poverty.
Rockefeller Medicaid Amendment #3
Insert in the appropriate section referencing state payment rates to hospitals and
skilled nursing facilities the language from Title XIX of the Social Security Act,
Section 1902 (a)(13)(A):
"for payment, which the state finds, and makes satisfactory to the Secretary, are
reasonable and adequate to meet the costs which must be incurred by efficiently and
economically operated facilities in order to provide care and services in conformity
with applicable state and federal laws, regulations, quality and safety standards
"
insert due process protections for providers
Rockefeller Medicaid Amendment #4
The Congressional Budget Office shall prepare an analysis of the effects of the
changes in the Medicaid program on the health insurance status of each of the
following populations: 1) children, 2) the elderly, and 3) the disabled. This report
shall be made annually, and submitted to the Committees of jurisdiction of the
Medicaid program, the Senate Finance and House Commerce Committees, by May
15th.
Rockefeller Medicaid Amendment #5
As a condition of receipt of federal Medicaid funds, each state shall insure that
Medicaid beneficiaries have access to primary care services within 30 miles of their
residences.
FOSTER CARE AMENDMENT
#6
Senator Jay Rockefeller
The amendment would strike the provision that limits a
state's cost for administering the foster care program to 10
percent growth per year (on page 12 of the modifications to
the mark.)
Replace this proposal with a provision to reduce the
federal matching rate for foster care administrative costs
from 50% to 44.1%.
This option would exclude the expense of installing new
computer systems which are eligible for 75% federal funding
through September 30, 1996.
FOSTER CARE AMENDMENT
# 7
Senator Jay Rockefeller
The amendment would strike the provision that limits a
state's cost for administering the foster care program to 10
percent growth per year (on page 12 of the modifications to
the mark.)
Replace this proposal with a provision to reduce the
federal matching rate for foster care administrative costs
from 50% to 45%.
#17
96-12-60
08/21/25
08:02 PM
Poster Care budget splions for the Sende Finance Commissee
Assemes November 15, 1995 effective date.
D-R-A F-T
Compand to CBO benefine
By flacel USED cotizing millions of dollars)
1996
1997
1998
1999
2008
2002
Total
Total
POOL 03:50PM 04:18PM R OM FM FINANCE .C COMMITTEE
09-26-95
Fire-Year Seven-Year
2001
Direct Spending
Reduce growth of feater care
administrative costs
BA
-00
-190
-200
-220
-250
-270
-260
$
-1510
to 18% a your di
OT
-TO
-160
-200
-220
-260
270
-280
-020
-4470
Reduce federal match nie
for beter care adabititive
BA
-140
-105
-180
-190
-205
-220
-235
-$80
-1336
costs from 50% to 40%.
or
-115
-165
-876
-190
-200
-216
-230
-245
-t230
82853 01
This ba probibery activite.
as This assume that the 10% growth occisuld applyto such state.
ID-000 and BAR
100/1002
EDVd
CO/
Rockefeller/Grassley Amendment
Provider-Sponsored Network Option
Page 9 of the Chairman's mark:
Modify #2 under Medicare Choice Plan Options to read as
follows
"Coordinated care plans -- Health plans that provide
health care services through an integrated network of
providers, including health maintenance organizations (HMOs),
point-of-service (POS) plans, preferred provider organizations
(PPOs), and provider sponsored networks (PSNs).
On page 9 of the Chairman's mark:
Add the following after #1 under Organizations eligible to
contract with the Secretary of HHS as Medicare Choice plans
must:
"There would be a separate federal certification process
for provider-sponsored networks. They would not be subject to
state regulation but would be subject to federal Medicare
Choice standards and federally certified until at least
December 31, 2000. By no later than December 31, 1999, the
Secretary is required to report to Congress on an evaluation
of whether certification of PSNs should be transferred to
states with PSN regulatory processes that meet federal
criteria."
on page 10 of the Chairman's mark
Insert at the end of #3 under Organizations eligible to
contract with the Secretary of HHS as Medicare Choice plans
must:
"In developing solvency requirements, the Secretary shall
take into account a Medicare Choice plan's delivery system
assets and its ability to provide services directly to its
enrollees through its affiliated providers.
on page 15 of the Chairman's mark:
Insert at the end of #2, under Capacity and enrollment:
"Provider sponsored networks that have experience in
providing coordinated care under arrangements with other
health plans would not be subject to rules regarding minimum
levels of enrollees, commercial or otherwise."
Rockefeller/Grassley Amendment
Provider-Sponsored Network Option
on page 18 of the Chairman's mark:
Add item #6 under Medicare Payments
"6. The Secretary will conduct a partial capitation
demonstration and report to Congress no later than
December 31, 1998 on the administrative-feasibility of
partial capitation methods, and on empirical information
necessary for defining threshold levels and risk-share
percentages."
on page 21 under Transition Rules for 1996 add #3
The Secretary would be required to publish federal
Medicare Choice standards by April 1, 1996.
Rockefeller Amendment
Strike Budget-Driven Caps on Managed Care Payments
Finance Mark: indexes Medicare base payment amount for
Medicare Choice plans to the "per capita growth in the gross
domestic product (GDP) "
Amendment: strike "per capita growth in the gross
domestic product" and insert "and indexed each year to the
growth of private health insurance premiums" -
Rockefeller Amendment
Out-of-Pocket Protection for Beneficiaries from BELT
Page 54, line 12, in lieu of following sentence
"The payment reductions would not affect the coinsurance,
deductible, or premium amounts payable by Medicare
beneficiaries.
insert the following sentence:
The payment reductions would reduce the coinsurance,
deductible, and premium amounts payable by Medicare
beneficiaries by the same percentage reduction that applies to
provider payments.
Rockefeller Amendment
Preserving Current Law Balance Billing Protection
for all Medicare Beneficiaries
Current Law HMOs are protected from paying the full
charges of providers when beneficiaries obtain out-of-plan
care services. Hospitals and skilled nursing facilities,
under section 1866 (a) (1) (0), are required to accept Medicare
amounts as payment in full for inpatient hospital and extended
care services. Medicare participating physicians, under
section 1876 (j), must accept the fee schedule amounts as
payment in full, and nonparticipating physicians must comply
with the limiting charge amount. In this current structure,
the beneficiary is not vulnerable to extra billing, the HMO is
responsible for guaranteeing payment in full for all plan
services provided to Medicare enrollees.
Chairman's Mark All Medicare providers, physicians, and
suppliers could require payment of full charges. This
situation will, undoubtedly, ensure that the real costs to
plans and beneficiaries will be higher than today.
Traditional Medicare may cease to exist is some geographic
areas if, for example, physicians decide to accept payment
only from private fee-for-service plans that allow them to
collect full charges. To avoid this and to protect Medicare
beneficiaries from extra billing charges, it is necessary to
extend protections in current law to all Medicare Choice
plans.
Amendment
Add to section 4.) Consumer Protections (page 16) g.
g. For services provided by Medicare Choice plans,
beneficiary liability would be limited to the cost sharing
amounts specified in the plan's marketing materials. For all
non-network services (e.g. medical savings account enrollees,
private fee for service plan enrollees, network plan enrollees
seeking out-of-plan services), apply the payment principles in
sections 1866 and 1876 to all items and services covered by
Medicare. Thus, participating physicians and suppliers paid
under a fee schedule would accept the fee schedule amounts as
payments in full. Nonparticipating physicians would be
prohibited from billing beyond the limiting charge for their
services. All other providers would accept Medicare's payment
as payment in full, e.g. DRG and pass-through amounts for
hospitals. In fee-for-service plans, beneficiary liability,
i.e. deductibles and coinsurance amounts, would be computed
using the lesser of the actual charge or the Medicare payment
amount.
Breaux # 1
EITC Amendment
(Sen. Breaux)
The amendment will require a doubling of taxpayer penalties in areas where
fraud, tax underpayment and the like are of similar magnitude to those which have
plagued the EITC in the past.
VACCINE AMENDMENT
(Sen. Breaux)
This amendment would clarify that states would have the option of using Medicaid
or other state funds to purchase vaccines at a discounted rate for children the state deems
eligible for Medicaid. It would thus ensure that states, which under the chairman's mark
would be required to offer vaccines to children on Medicaid, could purchase them at a
reduced rate as they now do.
It would allow the Secretary of HHS, where appropriate, to contract with multiple
vaccine manufacturers.
It would provide the Sense of the Committee that states adhere to the Advisory
Committee on Immunization Policies guidelines.
CONRAD AMENDMENT ON MENTAL HEALTH SERVICES
AMENDMENT:
On page 61. after "department of health", insert the following:
1. States also have the flexibility to provide the following options:
Outpatient and intensive community-based mental health services. including psychiatric
rehabilitation. day treatment, intensive in-home services for children, and partial
hospitalization.
(i) Acute inpatient mental health services, including services furnished in a State operated
mental hospital and. (ii) residential treatment center services for children
2. States have complete authority to elect the scope of assistance available to Medicaid recipients. but
they may not impose treatment limits or financial requirements on mental illness services which are
not imposed on services for other conditions. States shall not be prevented from requiring pre-
admission screening. prior authorization or services or other mechanisms limiting coverage of mental
illness services to those that are medically necessary.
EXPLANATION:
Current Medicaid law permits states great flexibility in defining a range of community-based services
for adults and children who have serious mental disorders. Virtually all mental health services
provided by state Medicaid programs are optional. This amendment retains the optional nature of
mental health coverage. while ensuring that the new program does not unintentionally preclude states
that wish to do so from providing a full array of services.
The provisions of this amendment on outpatient community-based services are intended to guarantee
state flexibility. There is concern that any legislative language that only refers to "outpatient"
services without including options like rehabilitation. day treatment, etc., could be perceived by states
as limiting their authority to fund such options.
The inpatient services language is intended to ensure states will not substitute federal dollars for state
funds that have historically been spent on the residents of state operated mental hospitals. The
Chairman's Mark completely repeals the so-called "IMD" exclusion. under which the Federal
government has historically refused to pay the costs of individuals between ages 21 and 65 in
Institutions for Mental Disease. Like the Chairman's Mark, the Conrad Amendment permits
Medicaid reimbursement for acute care coverage in state-operated facilities and private psychiatric
hospitals. However, unlike the Chairman's Mark, the amendment ensures that states will continue to
pay the cost of long term services that have been a state responsibility since the 1870s.
The non-discrimination language merely prohibits states from applying arbitrary blanket limits to
mental health services that are not applied to other services. The provision does nothing to preclude
states from conducting pre-admission screening. prior authorization, etc. Nor does it require that
particular groups of people with mental disorders be covered. or that any specific range of mental
health services be covered States would be free to set any amount. duration and scope limits.
Conrad # 2
CONRAD SENSE OF THE COMMITTEE AMENDMENT
It is the Sense of the Finance Committee that in the event the Congressional Budget Office
declares that a fiscal dividend exists in accordance with the Budget Resolution. that such a
dividend should be used for further deficit reduction so that Social Security surpluses are not
used to balance the budget, and to reduce savings from:
federal health programs for the elderly, children, disabled and poor;
programs that benefit working and middle class Americans, and;
programs that invest in education. infrastructure and research.
Conrad #3
CONRAD/PRESSLER MEDICARE ANESTHESIA SERVICES AMENDMENT
AMENDMENT:
On page 48, at the end of the section entitled "Improving Access to Health Services and
Improving Medicare in Rural Areas," insert the text of S.1263, the Medicare Anesthesia
Services Reform Act.
EXPLANATION:
This proposal consists of two provisions. The first provision requires the Health Care
Financing Administration to defer to state law when determining whether to condition
Medicare reimbursement to Certified Registered Nurse Anesthetists (CRNA's) on physician
supervision. Current Medicare regulations require physician supervision of CRNA's as a
condition for hospitals and ambulatory surgical centers to receive Medicare reimbursement.
This federal requirement is in direct conflict with numerous state laws that allow nurse
anesthetists to practice without such supervision.
The second provision ensures payment equity between CRNA's and anesthesiologists. Under
current Medicare regulations. if an anesthesiologist and a CRNA work together on one case
and Medicare later decides that the use of two anesthesia providers was not "medically
necessary." neither the hospital nor the CRNA receives payment. This provision does not
require Medicare to pay additional funds. Rather. it requires that the fee be split evenly
between the two practitioners who jointly worked on the case.
O:\SIM\SIM95.734
S.L.C.
Conrad
cont.
104TH CONGRESS
1ST SESSION
S. 1263
IN THE SENATE OF THE UNITED STATES
Mr. CONRAD (for himself. Mr. PRESSLER. Mr. THURMOND. and Mr. INOUYE
introduced the following bill: which was read twice and referred to the
Committee on
A BILL
To direct the Secretary of Health and E iman Services to
revise existing regulations concerning the conditions of
payment under part B of the medicare program relating
to anesthesia services furnished by certified registered
nurse anesthetists. and for other purposes.
1
Be it enacted by the Senate and House of Representa-
2 tives of the United States of America in Congress assembled,
3 SECTION 1. SHORT TITLE.
4
This Act may be cited as the "Medicare Anesthesia
5 Services Reform Act".
O:\SIM\SIM95.734
S.L.C.
2
1 SEC. 2. REVISION OF CONDITIONS OF PAYMENT TO FOSTER
2
CONSISTENCY WITH STATE SUPERVISION
3
STANDARDS.
4
(a) PROMULGATION OF REVISED REGULATIONS.-
5 The Secretary of Health and Human Services shall revise
6 any regulations describing the conditions under which pay-
7 ment may be made for anesthesia services under the medi-
8 care program under title XVIII of the Social Security Act
9 (42 U.S.C. 1395 et seq.) to provide that payment may
10 be made under the medicare program for anesthesia serv-
11 ices furnished in a hospital or an ambulatory surgical cen-
12 ter by a certified registered nurse anesthetist who. under
13 the law of the State in which the service is furnished. is
14 permitted to administer anesthesia services without super-
15 vision by the physician performing the operation or the
16 anesthesiologist.
17
(b) EFFECTIVE DATE.-The revisions to the regula-
18 tions referred to in subsection (a) shall apply with respect
19 to anesthesia services furnished on or after January 1,
20 1996.
21 SEC. 3. ENSURING PAYMENT FOR PHYSICIAN AND CER-
22
TIFIED REGISTERED NURSE ANESTHETIST
23
FOR JOINTLY FURNISHED SINGLE CASE AN-
24
ESTHESIA SERVICES.
25
(a) PAYMENT TO PHYSICIAN.-Section 1848(a)(4) of
26 the Social Security Act (42 U.S.C. 1395w-4(a)(4)) is
O:\SIM\SIM95.734
S.L.C.
3
1 amended by adding at the end the following new subpara-
2 graph:
3
"(C) PAYMENT FOR SINGLE CASE.-Not-
4
withstanding section 1862(a)(1)(A), with re-
5
spect to physicians' services consisting of the
6
furnishing of anesthesia services for a single
7
case that are furnished jointly with a certified
8
registered nurse anesthetist, if the carrier de-
9
termines that the use of both the physician and
10
the nurse anesthetist to furnish the anesthesia
11
service was not medically necessary. the fee
12
schedule amount to be applied shall be equal to
13
50 percent of the fee schedule amount otherwise
14
applicable under this section if the anesthesi
15
service were personally performed by the physi-
16
cian alone.".
17
(b) PAYMENT TO CRNA.-Section 1833(l)(4)(B) of
18 such Act (42 U.S.C. 13951(i)(4)(B)) is amended by adding
19 at the end the following new clause:
20
"(iv) Notwithstanding section 1862(a)(1)(A), in the
21 case of services of a certified registered nurse anesthetist
22 consisting of the furnishing of anesthesia services for a
23 single case that are furnished jointly with a physician. if
24 the carrier determines that the use of both the physician
25 and the nurse anesthetist to furnish the anesthesia service
S.L.C.
4
1 was not medically necessary, the fee schedule amount shall
2 be equal to 50 percent of the fee schedule amount other-
3 wise applicable under this section if the anesthesia service
4 were personally performed by the physician alone.".
5
(c) EFFECTIVE DATE.-The amendments made by
6 subsections (a) and (b) shall apply with respect to services
7 furnished on or after January 1, 1996.
Conrad #4
CONRAD MEDICARE INTEGRITY AMENDMENT
AMENDMENT:
On pages 52 through 54 of the chairman's mark, strike the Budget Expenditure Limit Tool.
EXPLANATION:
The Chairman's mark allows seniors to choose coverage options other than traditional
Medicare fee-for-service. The Congressional Budget Office scores the savings of this
provision at $47.5 billion. However, if those savings are not realized, the BELT provision
will cut fee-for-service Medicare spending. Repeated additional cuts in Medicare fee-for-
service could erode the integrity of the program and force seniors into health care plans that
they do not wish to join.
#5
CONRAD/BAUCUS SPOUSAL IMPOVERISHMENT AMENDMENT
AMENDMENT:
Current law protections that guarantee that spouses of nursing home residents will be able to
retain enough monthly income to remain in the community are reinstated.
EXPLANATION:
Since 1988, states have been required to allow spouses of institutionalized Medicaid
beneficiaries to keep a specified amount of the couple's total income and assets. Without
these protections. spouses could be forced to sell their home, sue each other for support. or
even divorce in order to avoid destitution. The Chairman's mark repeals this protection.
Conrad #6
CONRAD AMENDMENT ON DURABLE MEDICAL EQUIPMENT
On page 41. at the end of the section entitled "Payments for Durable Medical Equipment."
insert the following:
Any individual purchasing or renting customized or upgraded durable medical
equipment may do so by paying the difference between such customized or upgraded
equipment at the point of sale or rental from a supplier; such supplier shall bill and
receive the amount equivalent to such covered durable medical equipment.
The Secretary of Health and Human Services shall promulgate appropriate beneficiary
protection safeguards.
Conrad #7
CONRAD AMENDMENT ON ACCESS TO PSYCHOLOGICAL SERVICES
AMENDMENT:
Section 1861 (ff)(1) of the Social Security Act is amended by inserting at the end thereof the
following:
Notwithstanding the previous sentence, to the extent permitted under the law of the State in
which the services are provided, a clinical psychologist may prescribe and supervise partial
hospitalization services. and establish and periodically review an individualized plan of
treatment for such services.
Conrad # 8
CONRAD AMENDMENT TO PROTECT ALL INDIVIDUALS WITH DISABILITIES
AMENDMENT:
On page 61. amend the paragraph that reads, "For each group. the minimum percentage to
be spent would be equal to 85 percent of the average percentage of the state's Medicaid
spending during FY1992 through FY1994 devoted to mandatory services for members of that
group who were required to be covered under current Medicaid law", shall be amended by
replacing the portion of the sentence between "FY1994" and the period with the following:
"all state Medicaid expenditures for members of that group."
RATIONALE:
The Chairman's mark only guarantees that states will spend 85 percent of funds currently
spent on "mandatory" Medicaid services. Such a requirement provides virtually no
protection for non-elderly people with disabilities who require long term services. For
example, federal -state Medicaid expenditures for long term developmental disabilities
services currently total about $13.5 billion (of which about $8 billion represents the federal
share). Because intermediate care facilities for the mentally retarded and home and
community-based waiver services are both "optional" state plan coverages exercised by every
state. none of the expenditures for their services are included in the Chairman's 85% figure.
Any definition or description of home and community-based services and related supportive
services should include habilitation services, non-medical transportation services. assistive
devices and minor modifications in a person's home or personal vehicle. as options for
states.
Graham + 1
AMENDMENT BY SENATOR GRAHAM
"Medicaid Access and Quality Protection Act of 1995" -- Per Capita Cap Alternative
pp. 56-77: Strike the "Medicaid Reform Proposal" and replace with the "Medicaid Access
and Quality Protection Act of 1995". This alternative to Medicaid block grants seeks to
reduce funding by $60 billion over seven years as opposed to $182 billion in the Republican
block grant.
Per Capita Cap: Maintains the individual entitlement to Medicaid coverage but
controls spending by restraining the inflationary growth per person covered.
Demographic and economic changes would be automatically adjusted for, but
spending per person would be restrained. The federal government would make
payments to each state based on the statutory federal matching rate or the per capita
cap, whichever is lower.
Stated in Inflation-Adjusted Terms: Protects states from potential increases in
inflation.
Separate Caps by Category: Caps would be applied separately to the (1) elderly, (2)
the disabled, (3) children and (4) adults.
Non-Discrimination: Prohibits de jure or de facto enrollment discrimination on the
basis on age, health and other risk factors. Further prohibits de jure or de facto
discrimination in the access to or delivery of services within a category of enrollees.
State Flexibility: Provides for greater state flexibility and innovation in the Medicaid
program by repealing the 1115 waiver process (language from Sen. Chafee's
Medicaid Managed Care Act of 1995 or S. 839).
Phase-Out of Boren Amendment and Cost Reimbursement for Federally Qualified
Health Centers and Rural Health Centers.
Eliminate the 1915(c) waivers for home and community based care and make it a state
option.
Permit nominal copayments for Medicaid services other than prenatal care, well-child
exams and immunizations for those above 100% of poverty.
*
State Accountability/Performance Measures and State Rankings: States would be held
accountable for performance measures they develop in conjunction with the Health
Care Financing Administration with respect to quality and access to care.
*
Maintenance of Effort: Maintains state effort.
Disproportionate Share: Retargets disproportionate share funding, as outlined in the
"Medicaid Reform Proposal". However, creates a set-aside for community health
centers and rural health centers.
Health Access and Quality Fund: Sets aside $10 billion over the next seven years for
the expansion of access and the improvement of quality for states to access. This
fund would be over and above the allocations under the per capita cap.
Freezes Administrative Costs: In exchange for greater flexibility, saves additional
funding by freezing administrative costs over the seven year period.
Caps Payments to Institutions for Mentally Retarded Persons: Average Medicaid
reimbursement in 1991 for large ICF/MRs ranged among states, according to the
HHS Inspector General, from $27,000 to $158,000 per resident. This proposal
establishes a national ceiling of reimbursement at the present average cost of
payments by states to institutions for the care of mentally retarded persons.
Savings is obtained by implementing a per capita cap, retargeting disproportionate share
funding, freezing administrative costs and capping payments to institutions for mentally
retarded persons.
Cost Estimate: $60 billion could be saved over seven years.
Graham #2
AMENDMENT BY SENATOR GRAHAM AND MOSELEY-BRAUN
Uninsured Rate -- Sunset Trigger
On page 77, at the end of the "Medicaid Reform Proposal" section, add a sunset provision to
the Medicaid provisions of this Act. The sunset provision would apply and revert back to
Medicaid law prior to enactment of this Act if the uninsured rate for the general population,
according to Current Population Survey estimates, exceed 45 million for any year or 10
million for children.
AMENDMENT BY SENATOR GRAHAM AND MOSELEY-BRAUN
Infant Mortality Rate -- Sunset Trigger
On page 77, at the end of the "Medicaid Reform Proposal" section, add a sunset provision to
the Medicaid provisions of this Act. The sunset provision would apply and revert back to
Medicaid law prior to enactment of this Act if the infant mortality rate increases nationwide.
However, if the infant mortality rate increases for an individual state but not for the entire
nation, the state must cover up to 133% for all prenatal and pregnancy-related services to
pregnant women and infants to age one.
Graham #4
AMENDMENT BY SENATOR GRAHAM
Pre-Existing Conditions
At the appropriate place, "prohibit Medicaid plans from instituting preexisting condition
exclusions for coverage of any item or service for an eligible individual."
Graham #5
AMENDMENT BY SENATOR GRAHAM
Medicaid Formula Proposal
On page 71, strike the Medicaid formula proposal and insert an alternative funding formula.
It would include --
Each state's Medicaid program would be allowed to grow at a rate of 3 percent per
year.
The amount above the 3 percent growth allowed under the federal budget would be
allocated through an equity index which would work as follows:
*
Growth Factor: One-fourth would be allocated to the 25 states with the highest
rate of growth with each state receiving a pro-rata share based on the FY 1995
base.
*
Efficiency Factor: One-fourth would be allocated to the 25 states with the least
cost per person with each state receiving a pro-rate share based on the FY
1995 base.
*
Elder and Disabled Factor: One-fourth would be allocated to the states above
the mean plus one standard deviation of the SSI population with each state
receiving a pro-rata share based on FY 1995 base.
*
Poverty Factor: One-fourth would be allocated to the states above the mean
plus one standard deviation of the poverty population with each state receiving
a pro-rata share based on FY 1995 base.
Rationale
The principle is rather simple: any restructured Medicaid program should distribute federal
funds on the basis on need. It is a compromise between two other major proposals -- a flat
growth cap and a total redistribution of federal funds based on need.
Cost Estimate
None. A redistribution of funding among the states.
Graham # E
AMENDMENT BY SENATOR GRAHAM
Improved Medicaid Funding Distribution Proposal
On p. 70, add the following program efficiency measures:
Freezes Administrative Costs: In exchange for greater flexibility, save additional
funding by limiting a state's administrative expenditures to 4% and by freezing
administrative costs for all states over the seven year period.
Caps Payments to Institutions for Mentally Retarded Persons: Average Medicaid
reimbursement in 1991 for large ICF/MRs ranged among states, according to the
HHS Inspector General, from $27,000 to $158,000 per resident. This proposal
establishes a national ceiling of reimbursement at the present average cost of
payments by states to institutions for the care of mentally retarded persons.
With the scorable savings by the Congressional Budget Office, raise the funding formula cap
on P. 71 from "no more than 133 percent above the national growth rate" to a higher
allowable figure that more quickly moves states to equity.
Rationale
Rather than moving all states to a common payment per person in poverty, the present
proposal expands the inequity.
Cost Estimate
None. A redistribution of savings from present program inefficiencies.
MOSELEY-BRAUN AMENDMENT
DISABLED CHILDREN AMENDMENT
On page 73, after the sentence, "Goals and objectives related to rates of childhood
immunizations will be developed," insert the following:
Goals and objectives related to standards of care and access to services for children with
special health care needs, as defined by the state, will also be included.
On page 62 the Secretary of HHS would be required to:
(1) Fund the refinement and validation of a national, quantifiable classification system for the
purposes of defining children with special health care needs. Such children would be those
with conditions that are, or can be anticipated to be, of at least a year's duration and service
needs significantly greater than well children. The classification system should be based on
commonly recognized diagnostic codes, be compatible with state and health plan data systems,
and be capable of serving as a basis for identifying these children and their medical
expenditures and monitoring the quality of care they receive. The system should be further
expanded to incorporate the consideration of the child's (1) severity status, (2) prognosis, and
(3) desired outcome, including tertiary prevention, maintenance of function, or improvement
of function.
(2) Fund state or regional demonstration projects which would:
develop methods of providing and assuring the quality of managed care for children
with special health care needs. This would include the development of adequate
capitation rates specific to this population and quality indicators such as system
performance standards, care guidelines for specific populations, outcomes measures
and patient/parent satisfaction;
provide for initial methods for identifying children with special health care needs based
on the diagnoses accounting for the majority of the chronic conditions affecting
children in the state or region which are likely to require significant medical
interventions whether in number o interventions or costs;
include appropriate representatives of providers of services to children with special
health care needs and representatives of appropriate state agencies and programs in the
development of initial methods of identifying children with special health care needs
and in the design and implementation of the demonstration projects; and
test the reliability and validity of the national classification system for children with
special health care needs described in paragraph (1).
Graham
*
AMENDMENT BY SENATOR GRAHAM
Maintenance of Effort - Real State Dollars
At the appropriate place, insert language that clarifies that states may only use provider
donations and taxes to match federal funds if such donations and taxes would quality for
federal matching funds under present law.
Rationale
Current limits on provider donations and taxes were enacted in response to state abuses. A
few states have used "creative financing" methods to increase their receipt of federal funds
without spending additional state resources. In effect, these states avoided their state match
responsibilities. These abuses creates significant interstate inequities, as a few states evaded
their obligations.
The proposed amendment would clarify that states cannot use these "creative financing"
techniques to avoid their state match responsibilities under the bill. For example, without the
amendment, a state could meet its matching obligations with supposed "provider tax
revenues" that are returned automatically to the taxpaying providers through Medicaid
payments. This amendment is needed for the bill's state match requirement to have any
meaning.
Graham 8
AMENDMENT BY SENATOR GRAHAM AND BRADLEY
Maintenance of Effort -- No Cost Shifting to Local Governments
At the appropriate place, insert language that clarifies that states may not shift the burden on
their matching rate requirements to local units of government without their expressed
consent.
Rationale
This amendment would seek to clarify that states cannot shift their federal matching rate
requirements on to local units of government.
Graham #9
AMENDMENT BY SENATOR GRAHAM
Maintenance of Effort -- Disallow Supplanting of Funds
At the appropriate place, insert language that clarifies that states cannot supplant present state
health funding for activities such as the provision of health care services, including public
health activities, with Medicaid block grant funding.
Rationale
This would ensure that states do not supplant their present in-state health spending with
federal Medicaid block grant dollars.
E ordham
AMENDMENT BY SENATOR GRAHAM
Coverage Standards if Performance Goals are Not Met
In order to assure that the Medigrant program does not cause
severe deterioration in the health status of children or pregnant
women in any state because that state's choices cause a significant
increase in the number of uninsured children or pregnant women not
getting timely prenatal care:
if the Secretary of HHS makes two successive annual
findings that the uninsured rate, as defined by the
Secretary consistent with Bureau of the Census Current
Population Survey Data, among children in a state is
higher than that state's average rate of uninsured
children under age 18 over the three most recent years
for which Current Population Survey Data is available,
then the state shall provide coverage for all children
with family incomes below the federal poverty level until
such time as the uninsured rate falls below the average
in the base years.
if the Secretary of HHS makes two successive annual
findings that a state's rate of women receiving prenatal
care in the first trimester of pregnancy, as defined by
the Secretary consistent with official National Center
for Health Statistics data, is lower than the state's
rates available for the most recent year prior to
enactment of this legislation, then the state shall
provide coverage for all pregnant women and infants with
family incomes below 133½% of the federal poverty level
until such time as the early prenatal care rate rises
above the average in the base years.
Each year the Secretary shall develop a report to Congress
based upon data for children's insurance coverage, low birth
weight, early prenatal càre, infant mortality and immunization
rates with respect to each state participating in the
program. The Secretary shall provide the report to all states
and shall provide each state the opportunity to respond to
such determinations made in the Secretary's report. If the
response by a State does not result in the Secretary reversing
a determination that the state's rates fail to meet the
targets for children's insurance coverage or early pre-natal
care, then the Secretary shall notify the state of the
coverage required under this section.
Graham:
AMENDMENT BY SENATOR GRAHAM
Continuation of Treatment
This amendment would require a State plan to provide, once an
eligible individual received services for a condition, illness or
injury under the plan, that ongoing treatment necessary for that
same condition, illness or injury would continue so long as the
individual's or family's income or resources did not change in a
way to create ineligibility under the plan. Such an amendment
would prevent states from making arbitrary decisions to terminate
necessary medical care in situations such as "Baby Doe" cases.
This would especially protect seriously ill or injured persons, or
persons who have received partial treatment or are in the middle of
an ongoing treatment plan and acting in reliance on it.
Rockefeller Amendment
Primary Care Access Amendment
Add new item under section 3.) Access, Health Plan
Standards, (pages 15,16)
d.) A Medicare Choice plans must make primary care
services available within 30 minutes or 30 miles from a
beneficiary's place of residence in rural areas.
Graham
12
AMENDMENT BY SENATORS GRAHAM, PRYOR AND BAUCUS
Medicare Anti-Fraud and Abuse Program (MAAP) -- Program Integrity
On p. 49, add a provision that would assure a dependable mandatory source of funds for all
Office of Inspector General (OIG) and Department of Health and Human Services (HHS)
Medicare anti-fraud and abuse activities by supporting them through the Medicare HI Trust
Fund. Program integrity activities will be better able to protect the Trust Funds as their
growth will be able to keep pace with the increase in Medicare claims.
Funding would include $200 million in FY 1996, $225 million in FY 1997, $250 million in
FY 1998, and for each succeeding fiscal year, an amount equal to the greater of --
*
$250 million increased by a percentage equal to the percentage increase in
expenditures under Title XVIII for the preceding fiscal year over fiscal year 1997; or
*
an amount equal to the aggregate amount expended for anti-fraud activities in fiscal
year 1998, increased, as determined by the Secretary, to reflect inflation and any
costs attributable to oversight responsibilities added with respect to periods after fiscal
year 1998.
Scorable savings will be used expressly to restore funding to hospitals in Part A and to
reduce the deductible increase to Medicare beneficiary in Part B.
Rationale
The Office of Inspector General estimates this would save the Medicare Trust Funds at least
$8 billion over 7 years by ensuring a stable source of funding for OIG and HHS activities,
removing them from discretionary budget limits. For example, this would support a
dramatic expansion of OIG's anti-fraud activities to protect Medicare and its investigative
capacity from 24 states to all 50 states and Puerto Rico.
ACEP WASH. D.C. OFFIC TEL 202-728-0617
Sep 24 95 16:31 No. 001 P.03
Graham#1
Amendment by Senator Graham
Purpose
To assure equitable coverage and treatment of emergency services under managed
care plans which contract to provide health care services for Medicare beneficiaries.
The amendment would require such health care plans to cover and pay for their fare
share of emergency services for Medicare beneficiaries that hospital emergency
departments and emergency physicians are required to provide. In addition, the
amendment would do the following:
(1) it would protect Medicare beneficiaries by establishing a "prudent layperson"
definition of emergency;
(2) it would prohibit managed care plans from requiring prior authorization for
emergency medical services;
(3) it would require managed care plans to provide emergency services without
regard to contractual arrangment;
(4) it would require managed care plans to instruct Medicare beneficiaries that it
is appropriate to use 911 in the event of an emergency.
Rationale
Federal law requires emergency physicians, emergency nurses, and other health care
providers to evaluate, treat and stabilize any individual seeking treatment in a hospital
emergency department. This law specifically prohibits emergency physicians from
delaying treatment needed to evaluate or stabilize an individual in order to determine
the health insurance status of the individual.
Today, managed care plans participating in the Medicare program routinely deny
payment for emergency services provided to Medicare beneficiaries, basing such
denials on (a) failure to obtain prior approval of such services from the plan, or (b) an
"after-the-fact" determination that the medical condition identified through the federally
required evaluation was not an emergency medical condition.
In 1892, a study conducted for the Health Care Financing Administration of disputed
claims by Medicare beneficiaries participating in the HMOs found that 60 percent of
disputed claims involved disputes over emergency care. The study's authors described
these cases as "dispute prone" and recommended that HCFA's definition of emergency
be amended to take into account the actions of a reasonable or prudent layperson
when confronted with a potential medical emergency.
202 728 0617
09-24-95 04 39PM P003 #05
Sep 24 95
16:31 No.001 P.04
These denials by managed care plans impose significant financial burdens on Medicare
beneficiaries who based upon symptoms that reasonably suggest a medical
emergency, prudently seek care in the a hospital emergency department. These
burdens discourage Medicare beneficiaries from seeking emergency care in cases
where it is appropriate and, ultimately, threaten the financial livelihood of hospital
including the Medicare population.
emergency departments in providing emergency services to the entire population,
-96%
202 728 0617
09-24-95 04:39PM F004 #05
202-728-0017
Sep 24 95
16:30 No.001 P.02
ORGANIZATIONS THAT SUPPORT THE GRAHAM AMENDMENT
American College of Emergency Physicians
National Association of EMS Physicians
Coalition for American Trauma Care
American Ambulance Association
Emergency Medical Services Section of the International Association of Fire Chiefs
International Association of Firefighters
Emergency Nurses Association
National Association of Emergency Medical Technicians
Association of Air Medical Services
National Association of State EMS Directors
American College of Cardiology
American College of Surgcons
Congress of Neurological Surgeons
American Association of Neurological Surgeons
American Association for the Surgery of Trauma
Consumer's Union
Citizen Action
Public Citizen
National Committee to Preserve Social Security and Medicare
American Heart Association
American Academy of Pediatrics
96%
202 728 0617
09-24-95 04:39PM P002 #05
Grahem
AMENDMENT BY SENATORS GRAHAM AND BRADLEY
Medicare Dependent Hospitals
On p. 47, add the requirement that the Prospective Payment Advisory Commission
(ProPAC), in addition to its recommendations on payment rate updates for all hospitals,
make a separate recommendation on updates for urban Medicare dependent hospitals.
In addition, the bill would require ProPAC's Annual Report to Congress to include
recommendations to ensure that beneficiaries served by the nation's 1400 Medicare dependent
hospitals would retain the same access and quality of care as Medicare beneficiaries
nationwide.
Rationale
According to the most recent report by the ProPAC, "The ability to use cost shifting to fill
the revenue gap where Medicare cost increases exceed payment increases varies across
hospitals. Facilities that treat larger shares of Medicare, Medicaid and the uninsured patients
have a lesser ability to cost shift to the private sector. In view of growing price competition
in the marketplace, these facilities will face a greater risk of declining margins, which
eventually could threaten their financial viability and their ability to care for Medicare
beneficiaries."
Graham
AMENDMENT BY SENATORS GRAHAM
Nondischargeability of Certain Medicare Debts
On p. 49, add a provision that would prevent providers and suppliers from using the
Bankruptcy Code as a vehicle to defeat the Secretary's effort to recoup overpayments from
the Medicare Trust Funds.
This provision would further prevent an excluded individual or entity from attempting to halt
exclusions imposed by the Office of Inspector General (OIG) by filing a bankruptcy petition
immediately prior to the effective date of the exclusion, asserting that the automatic stay
precludes the OIG from imposing an exclusion.
Rationale
Providers and suppliers, who owe financing obligations to Medicare, are seeking relief from
bankruptcy courts to have their outstanding overpayments, which are unsecured, discharged
or greatly reduced. The Medicare program has been unsuccessful in efforts to halt such
actions. A 1992 report issued by the Office of Inspector General entitled Federal Recovery
of Overpayments from Bankrupt Providers found that as of March 1991, the Medicare Trust
Funds lost $109 million due to the ability of providers and suppliers to discharge their
outstanding overpayments. Therefore, this provision would amend the Social Security Act to
state that providers and suppliers cannot use the bankruptcy forum to avoid these outstanding
obligations. 1 ote that education loans already have this status.
Graham # 16
AMENDMENT BY SENATORS GRAHAM
Improved Prevention in Issuance of Medicare Provider Numbers
On p. 49, add a provision that allows the Secretary of Health and Human Services to impose
fees to providers for the expressed purpose of upfront investigation and recertification of
providers prior to the issuance of Medicare provider numbers.
GRAMAM
EITC AMENDMENT
SENATOR CAROL MOSELEY-BRAUN
STRIKE CHILD SUPPORT AS PART OF THE DEFINITION OF ADJUSTED GROSS
INCOME USED FOR PHASING OUT THE CREDIT AND OFFSET THE SPENDING CUT
BY DECREASING THE INVESTMENT INCOME CAP FROM $2,350 TO AN AMOUNT
SUFFICIENT TO REPLACE THE CHILD SUPPORT OUTLAY AMOUNT.
Cmassley Smin#2
EITC AMENDMENT
SENATOR CAROL MOSELEY-BRAUN
STRIKE THE REPEAL OF THE EITC FOR INDIVIDUALS WITHOUT
QUALIF YING CHILDREN AND OFFSET THE SPENDING OUTLAYS BY LOWERING
THE INVESTMENT INCOME CAP FROM $2,350 TO AN AMOUNT NECESSARY TO CUT
SPENDING OUTLAYS BY $4.2 BILLION.
CENTER ON BUDGE
AND POLICY PRIORITIES
September 13, 1995
THE CONSEQUENCES OF ELIMINATING THE EITC
FOR CHILDLESS WORKERS
Legislation is moving forward in Congress that would repeal the small EITC for
poor workers without children. While those leading efforts to reduce the EITC often
describe their proposals as necessary steps to reduce errors and slow the growth of the
program, this proposal would do little to accomplish either objective. Indeed, the EITC
for workers without children provides needed tax relief for a group of poor workers
who generally receive little aid from other government assistance programs, who
experienced an exceptionally sharp increase in their tax burdens from 1980 to 1993, and
who frequently pay a substantial percentage of their very small incomes in federal
taxes.
If the childless workers credit is ended, poor workers without children would
face a large increase in their federal tax burdens; the payroll taxes they pay on their first
$4,230 of earnings would no longer be offset. Moreover, their federal tax burdens
would rise to still higher levels than these tax burdens had reached before the childless
workers credit was established in 1993. These workers would be affected by the
gasoline tax increase enacted in 1993 while losin~ the EITC they received that year
designed, in part, to offset the effects of the gas tax hike on them.
The Treasury Department estimates that 4.4 million workers would face an
average tax increase of $173 if the credit for workers without children is repealed, with
households who would have qualified for the maximum credit experiencing a tax
increase exceeding $300. Every dollar reduction in the childless workers tax credit
translates to an effective increase of a dollar in taxes since the value of the credit is
never greater than the amount of employee payroll taxes owed.
As a consequence, single workers with incomes at the poverty line would see
their already-high federal tax liability climb still higher. Under current law, a single
worker at the poverty line - projected to be $8,200 in 1996 - would owe nearly $1,400
in income and payroll tax in 1996. If the EITC for these workers is eliminated, this
worker's tax liability will rise by $100 to $1,500.¹
1
In accordance with standard economic analysis, these figures include the employer's and the
employee's share of the payroll tax. The Congressional Budget Office data used for Figure 1 also include
both the employer's and the employee's share of the payroll tax.
3023002
Tel:
202-408-1080
Fax:
202-408-1055
Robert Circenstein. Executive Director
still in poverty. They should not be taxed further by the elimination of their small EITC.
Table 1
Changes in Federal Tax Burdens, 1980-1993
Change in the Percentage
of Income Consumed
Household Category
by Federal Taxes
Non-elderly households without children
poorest fifth
+38%
middle fifth
5
top fifth
-3
Families with children
poorest fifth
-19%
middle fifth
1
top fifth
1
Aged
poorest fifth
-22%
middle fifth
-14
top fifth
-11
All households
poorest fifth
4%
middle fifth
-2
top fifth
-3
Source: Congressional Budget Office data published in House Committee on Ways and Means, 1992
Green Book, PP. 1526-7.
3
MOSELEY-BRAUN AMENDMENT
COST-SHARING AMENDMENT
On page 62, insert language that would prohibit states from denying Medicaid services to
individuals who are unable to meet cost-sharing obligations required by the state.
MOSELEY-BRAUN AMENDMENT
4
TRANSITIONAL MEDICAID
On page 61, insert language that would require states to provide Medicaid coverage to
persons who are transitioning off of either AFDC or Temporary Employment Assistance (TEA).
States would be required to extend Medicaid coverage to these persons for twelve months from
the time the person stopped receiving AFDC or TEA benefits.
MOSELEY-BRAUN AMENDMENT #5
CIVIL RIGHTS AMENDMENT
Strike from the bill any provision that bars any cause of action against states in relation to
the modified Medicaid program.