REPEAL OF EXPANSION OF MEDICARE PART A BENEFITS.

SEC. 101. REPEAL OF EXPANSION OF MEDICARE PART A BENEFITS. (a) In General.— (1) General rule.—Except as provided in paragraph (2), sections 101, 102, and 104(d) (other than paragraph (7)) of the Medicare Catastrophic Coverage Act of 1988 (Public Law 100–360) (in this Act referred to as “MCCA”) are repealed, and the provisions of law amended or repealed by such sections are restored or revived as if such section had not been enacted. (2) Exception for blood deduction.—The repeal of section 102(1) of MCCA (relating to deductibles and coinsurance under part A) shall not apply, but only insofar as such section amended paragraph (2) of section 1813(a) of the Social Security Act (relating to a deduction for blood). (b) Transition Provisions for Medicare Beneficiaries.— (1) Inpatient hospital services and post-hospital extended care services.—In applying sections 1812 and 1813 of the Social Security Act, as restored by subsection (a)(1), with respect to inpatient hospital services and extended care services provided on or after January 1, 1990— (A) no day before January 1, 1990, shall be counted in determining the beginning (or period) of a spell of illness; (B) with respect to the limitation on such services provided in a spell of illness, days of such services before January 1, 1990, shall not be counted, except that days of inpatient hospital services before January 1, 1989, which were applied with respect to an individual after receiving 90 days of services in a spell of illness (commonly known as “lifetime reserve days”) shall be counted; (C) the limitation of coverage of extended care services to post-hospital extended care services shall not apply to an individual receiving such services from a skilled nursing facility during a continuous period beginning before (and including) January 1, 1990, until the end of the period of 30 103 STAT. 1980consecutive days in which the individual is not provided inpatient hospital services or extended care services; and (D) the inpatient hospital deductible under section 18I3(aXl) of such Act shall not apply— (i) in the case of an individual who is receiving inpatient hospital services during a continuous period beginning before (and including) January 1, 1990, with respect to the spell of illness beginning on such date, if such a deductible was imposed on the individual for a period of hospitalization during 1989; (ii) for a spell of illness beginning during January 1990, if such a deductible was imposed on the individual for a period of hospitalization that began in December 1989; and (iii) in the case of a spell of illness of an individual that began before January 1, 1990. (2) Hospice care.—The restoration of section 1812(a)(4) of the Social Security Act, effected by subsection (a)(1), shall not apply to hospice care provided during the subsequent period (described in such section as in effect on December 31, 1989) with respect to which an election has been made before January 1, 1990. (3) Termination of hold harmless provisions.—Section 104(b) of MCCA is amended by striking “or 1990” each place it appears. (c) Termination of Transitional Adjustments in Payments for Inpatient Hospital Services.— (1) PPS hospital.—Section 104(c)(l) of MCCA is amended by inserting “; and before January 1, 1990,” after “October 1, 1988,”. (2) PPS–EXEMPT HOSPITALS.— (A) In general.—Section 104(c)(2) of MCCA is amended— (i) by inserting “and before January 1, 1990,” after “January 1, 1989,”; and (ii) by striking the period at the end and inserting the following: “, without regard to whether any of such beneficiaries exhausted medicare inpatient hospital insurance benefits before January 1, 1989.”. (B) Transition.—The Secretary of Health and Human Services shall make an appropriate adjustment to the target amount established under section 1886(b)(3XA) of the Social Security Act in the case of inpatient hospital services provided to an inpatient whose stay began before January 1, 1990, in order to take into account the target amount that would have applied but for the amendments made by this title. (d) Effective Date.—The provisions of this section shall take effect January 1, 1990, except that the amendments made by subsection (c) shall be effective as if included in the enactment of MCCA.