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May 24, 2024 Contents Introduction Descriptions of Medicaid, CHIP, and Medicare Medicaid CHIP Medicare Summaries of Provisions Subtitle B--Medicaid Section 201: Requirement for State Medicaid Plans to Provide Coverage for [...]

October 24, 2023 Contents Introduction Descriptions of Medicaid and CHIP Medicaid CHIP Summaries of Provisions Territories Provisions Section 5101(a): Revising Allotments for Puerto Rico 5101(b). Extension of Increased Federal Medical [...]

Contents Tables Table 1. Provisions Expired or Expiring in the 118th Congress, First Session Table 2. Provisions That Expired in the 117th Congress Table A-1. Demonstration Projects and Pilot Programs [...]

Updated February 8, 2023 Contents Introduction Eligibility Categorical Eligibility Financial Eligibility Additional Eligibility Requirements for LTSS Coverage Medicaid Enrollment Share of Enrollment Versus Expenditures, by Population Benefits Primary Benefit Packages [...]

January 24, 2023 Contents Introduction Budget Reconciliation Process Abbreviated Summary of Provisions Detailed Summary of Provisions Medicare Prescription Drug Price Negotiation Section 11001: Providing for Lower Prices for Certain High-Priced [...]

June 14, 2021 This report describes selected health care-related provisions that are scheduled to expire during the first session of the 117th Congress (i.e., during calendar year [CY] 2021). For [...]

April 27, 2021 Contents Introduction Budget Reconciliation Process High-Level Summary Private Health Insurance Medicaid and CHIP Provisions Medicare Provisions Medicare and Medicaid Provisions Abbreviated Summary of Provisions Detailed Summaries of [...]

Updated February 22, 2021 Contents Introduction Eligibility Categorical Eligibility Financial Eligibility Additional Eligibility Requirements for LTSS Coverage Medicaid Enrollment Share of Enrollment Versus Expenditures, by Population Benefits Traditional Medicaid Benefits [...]

Updated June 4, 2020 Medicare covers certain reasonable and necessary services provided by Medicare-enrolled health care practitioners for treating substance abuse disorders, such as alcoholism and opioid and other drug [...]

May 21, 2020 Contents Introduction Medicare History Eligibility and Enrollment Benefits and Payments Part A Inpatient Hospital Services Skilled Nursing Facility Services Hospice Care Parts A and B Home Health [...]

April 29, 2020 Contents Introduction A Snapshot of CARES Act Health Provisions Report Contents Definitions, Abbreviations, and Acronyms 'Section 319' Public Health Emergency Additional Definitions and Acronyms CARES Act Health [...]

Updated January 2, 2019 Contents Introduction Budgetary Impact Related Prior Laws SUPPORT ACT Provisions Medicare Coverage of Opioids and OUD Treatment Medicare Provisions of the SUPPORT Act Title II: Medicare [...]

Updated March 20, 2018 Contents Introduction High-Level Summary CHIP Public Health Maternal, Infant, and Early Childhood Home Visiting Program Medicaid Abbreviated Summary of Provisions Detailed Summaries of Provisions CHIP Provisions [...]

Updated March 9, 2018 Contents Introduction Abbreviated Summary of Provisions Tables Table 1. Title 1 (CHIP): Description and CRS Contact Information, by Section Table 2. Title II (Medicare Extenders): Description [...]

Updated February 22, 2017 Contents Social Security Act (SSA) CY2017 Expiring Provisions Title V: Maternal and Child Health Services Block Grant Family-to-Family Health Information Centers (SSA [section] 501(c); 42 U.S.C. [...]

Updated January 6, 2017 Summary This report summarizes the Increasing Choice, Access, and Quality in Health Care for Americans Act, enacted December 13, 2016, as Division C of the 21st [...]

Updated December 23, 2016 Contents Introduction Title I-Innovation Projects and State Responses to Opioid Abuse. Section 1001. NIH Innovation Projects Section 1002. FDA Innovation Projects Section 1003. Account for the [...]

Updated December 22, 2016 Contents Introduction Summary of Provisions Title VI--Strengthening Leadership and Accountability Subtitle A--Leadership Assistant Secretary for Mental Health and Substance Use Chief Medical Officer Authorizations for SAMHSA's [...]

Contents Expiring Provision Defined Exclusions That Do Not Meet the Definition Expiring Provisions in the 114th Congress SSA Title XVIII: Medicare Community-Based Care Transitions Program (42 U.S.C. 1395b-1) Bonus Payment [...]

Updated November 10, 2015 Contents Overview Summary of Provisions Title I--SGR Repeal and Medicare Provider Payment Modernization Section 101: Repealing the Sustainable Growth Rate and Improving Medicare Payment for Physicians' [...]

Updated August 10, 2015 Contents Overview Summary of Provisions Section 2. NIH and Cures Innovation Fund Title I--Discovery Subtitle A--National Institutes of Health Funding Section 1001. National Institutes of Health [...]

March 9, 2015 Contents Introduction Budget Summary Medicare Medicaid Program Integrity CHIP State Grants and Demonstrations Private Health Insurance Protections and Programs Center for Medicare & Medicaid Innovation Program Management [...]

The article presents a report by the U.S. Congressional Research Service which describes elected health care-related provisions that are scheduled to expire during the first session of the 117th Congress. It mentions about Medicaid, the State Children's Health Insurance Program, Patient Protection and Affordable Care Act, and Pregnancy Assistance Fund.

The article presents a report of the U.S. Congressional Research Service (CRS), that talks about the Medicaid, a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term services. It mentions that Medicaid represents national health care spending, private health insurance and Medicare accounted for national health care spending.

Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, or have end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services. In FY2019, the program is expected to cover approximately 61 million persons (52 million aged and 9 million disabled) at a total cost of about $772 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the annual appropriations process. Services provided under Parts A and B (also referred to as "original" or "traditional" Medicare) are generally paid directly by the government on a "fee-forservice" basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly "capitated" amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. Since 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111- 152) made numerous changes to the Medicare program that modified provider reimbursements, provided incentives to increase the quality and efficiency of care, and enhanced certain Medicare benefits. In the 114th Congress, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. Projections of future Medicare expenditures and funding indicate that the program will place increasing financial demands on the federal budget and on beneficiaries. For example, the Hospital Insurance (Part A) trust fund is projected to become insolvent in 2026. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country's competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program. This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes. [ABSTRACT FROM AUTHOR]

The article provides an overview of Medicaid in the U.S. which finances the delivery of primary and acute medical services as well as long-term services Topics discussed include Medicaid expansion under the Patient Protection and Affordable Care Act; alternative benefit plans under state Medicaid programs; and information on beneficiary cost sharing.

The article discusses the Medicare program. Topics mention including covering health care services to the qualified beneficiaries, payment systems and several changes in the program which include the reimbursement, enhancing Medicare benefits and providing incentives to increase the efficiency and quality.

The article presents a summary of the Increasing Choice, Access, and Quality in Health Care for Americans Act, enacted December 13, 2016, as Division C of the 21st Century Cures Act (P.L. 114-255). Topics include Title XV through Title XVII, which include provisions primarily relating to Medicare, Title XVIII, which includes a provision relating to the small-group health insurance market.

The article presents a summary of provisions of the Increasing Choice, Access, and Quality in Health Care for Americans Act, enacted December 13, 2016 as Division C of the 21st Century Cures Act. Topics include establishing beneficiary equity in the Medicare hospital readmission program, five-year extension of the rural community hospital demonstration program, and regulatory relief for long-term care hospitals.

The article discusses the sections of the Centers for Medicare & Medicaid Services' (CMS) budget. Topics discussed include comparison of budget allocated to Medicare, Medicaid and the State Children's Health Insurance Program (CHIP) for fiscal years 2014, 2015 and 2016, budget allocated to state grants and demonstrations, and budget proposal for private health insurance protections and programs.

The article discusses legislative proposals in relation to the program management section of the U.S. Centers for Medicare and Medicaid Services' (CMS) budget. Topics discussed include the increase in mandatory funding for program management, funding for CMS quality measurement, and the authorization of CMS to assess a fee on Medicare providers to cover administrative costs for the Federal Payment Levy Program.

The article discusses legislative proposals in relation to the budget of Medicaid. Topics discussed include the expansion of state's option to change their benefit packages, the coverage of the screening, diagnosis and treatment of children in inpatient psychiatric facilities, and the coverage of preventive health and comprehensive tobacco-cessation services.

The article discusses legislative proposals in relation to the program integrity section of the U.S. Centers for Medicare and Medicaid Services' (CMS) budget. Topics discussed include the use of recovery audit contractors (RACs) to prevent Medicare abuse and fraud, the expansion of funding and authority for the integrity program for Medicaid, and the establishment of gifting authority for the public-private partnership Healthcare Fraud Prevention Partnership.

The article discusses U.S. President Barack Obama's budget proposal for the Centers for Medicare & Medicaid Services (CMS) for fiscal year 2016. Topics discussed include sections of the CMS budget including Medicare, Medicaid and State Children's Health Insurance Program (CHIP), the responsibilities of CMS, and the reputation of CMS as the country's biggest health care purchaser.

An appendix is presented of the Medicare beneficiary costs in 2017 which shows several tables on topics such as hospitalization insurance, supplementary medical insurance, and outpatient prescription drug benefit.

An appendix is presented of abbreviations related to Medicare including Patient Protection and Affordable Care Act (ACA), Accountable Care Organization (ACO), and Adjusted Gross Income (AGI).

The article offers information on the administration of the U.S. Centers for Medicare & Medicaid Services (CMS) for the Medicare program through contracts with private entities, like the Medicare Administrative Contractors (MACs). Topics discussed include the roles and functions of MACs, the implementation of the fee-for-service (FFS) contracting reform, and testing of recovery audit contractors (RACs) in FFS Medicare Pars A and B.

The article offers information on the Part D of the Medicare in the U.S. which provides coverage of outpatient prescription drugs to Medicare beneficiaries. Topics discussed include the use of the private prescription drug plans (PDPs) to provide prescription drug coverage, the requirement to qualify for the Part D prescription drug plans, and the payments of Medicare to plans.

The article reports on the eligibility and enrollment in the Medicare, a health insurance in the U.S. Topics mentioned include the finance and regulation for medical care, the cash disability benefits from Railroad Retirement and Social Security systems, and the benefits of Medicare. Also mentioned are the regulation for the beneficiaries of health insurance and the insurance premiums management.

The article provides information on the history of Medicare which was enacted in 1965 to provide health insurance for older people under the U.S. Social Security Act, consisted of four parts of coverage including Part A, Part B, and Part C. It mentions changes to Medicare including coverage expansion to include individuals under 65 years old with end-stage renal disease (ESRD) and discusses laws enacted with provisions to raise program spending such as the Balanced Budget Act of 1997 (BBA 97).

The article discusses the sources of additional coverage for Medicare beneficiaries in the U.S. Topics include the role of employer coverage in financing for prescription drug, the coverage that Medigap beneficiaries enjoy and the eligibility of low income Medicare beneficiaries to avail the coverage of the Medicaid.

The article discusses the administration of the Medicare program of the U.S. It explores the role of the Centers for Medicare and Medicaid Services (CMS) in collaborating with Medicare Administrative Contractors (MACs) in the daily operations of the program. Details on how Medicare extends its services to beneficiaries, the role of private entities and how CMS monitors auditing and quality assurance activities are explored.

The article provides information about the health insurance coverage provided under the Part D insurance plan of Medicare beneficiaries in the U.S. Topics include the coverage for outpatient prescription drugs, Medicare payment to plans and the coverage for low-income beneficiaries. Details on the standard coverage for 2016 is also offered.

The article provides details on the eligibility and enrollment in Medicare in the U.S. Topics discussed include the age of persons who are automatically entitled to premium-free Part A, payment for Medicare payroll taxes on earnings covered by either the Social Security or the Railroad Retirement systems, and information on the enrollment in Medicare Part B which is said to be voluntary.

The article discusses the historical and political background of the U.S. Medicare. Topics include a number of laws being enacted in 1980s and 1990s that included provisions designed to further stem the rapid increase in program spending, the impact of the Balanced Budget Act of 1997 on the rate of growth in payments to providers, and the expansion of program coverage to certain individuals under 65 years of age.

The 111th Congress has devoted considerable effort to health reform that seeks to increase health insurance coverage for more Americans and help to control costs, while improving quality and patient outcomes. The Affordable Health Choices for America Act (H.R. 3962) was introduced in the House of Representatives on October 29, 2009. H.R. 3962 is based on H.R. 3200, America's Affordable Health Choices Act of 2009, originally introduced on July 14, 2009, and reported separately on October 14, 2009, by three House Committees-Education and Labor, Energy and Commerce, and Ways and Means. H.R. 3962 was further modified by the manager's amendment posted on November 3, 2009. H.R. 3962, as passed by the House on November 7, 2009, proposes sweeping reforms of the health care delivery system, described in the three divisions. Division A, "Affordable Health Care Choices," focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and small employers. Division B, "Medicare and Medicaid Improvements," proposes modifications to the largest two public health insurance programs to make them consistent with provisions in Division A and to amend other provisions in existing federal statute. Division C, "Public Health and Workforce Development," would amend and expand existing health professions and nursing workforce programs. A Republican alternative amendment in the nature of a substitute, dated November 3, 2009, is addressed in a separate CRS report. This report summarizes the major provisions affecting Medicaid and CHIP in H.R. 3962 (as passed), including modifications made by the manager's amendment. The report focuses primarily on provisions in Division B, Title VII-Medicaid and CHIP, plus selected provisions in Title IX-Miscellaneous Provisions. It also describes selected sections of Titles I and II of Division D, the Indian Health Care Improvement Act Amendments of 2009, related to improving access to Medicaid and CHIP for American Indians and Alaskan Natives. Due to the breadth of the changes proposed in H.R. 3962, some provisions of Divisions A and C also could affect Medicaid, but these are not Medicaid-specific. The Division B provisions would modify existing law and add new provisions affecting Medicaid eligibility; benefits; financing; waste, fraud, and abuse; payments to territories; demonstrations and pilot programs; and other miscellaneous Medicaid components. A major provision in Division B would expand Medicaid eligibility for traditional and non-traditional beneficiary categories up to 150% of the federal poverty level. The federal government would fully finance the costs for certain of these expanded beneficiary categories for periods before 2015, decreasing to 91% beginning in 2015. With respect to benefits, Medicaid programs would be required to cover preventive services, and would be allowed to cover nurse home visitation and birthing center services. There are a number of financing changes that would affect Medicaid under H.R. 3962, including reducing Medicaid disproportionate share hospital (DSH) payments by $10 billion by FY2019, increasing prescription drug rebates, and raising provider payments for certain primary care services. Additional waste, fraud, and abuse provisions affecting Medicaid and the Children's Health Insurance Program (CHIP) include requirements to deny payment for health care acquired conditions, require new Medicaid Integrity Program evaluations and reports, and require states to implement a national correct coding initiative, similar to the Medicare program. Under H.R. 3962, spending caps for the territories would be increased, and a series of demonstrations would be approved, including a medical home program, an accountable care organization program, and a program for stabilization of emergency medical conditions by mental disease institutions. [ABSTRACT FROM AUTHOR]