OTHER MEDICAID PROVISIONS.

SEC. 6468. OTHER MEDICAID PROVISIONS. (a) Institutions fob Mental Diseases.— (1) Study.—The Secretary of Health and Human Services shall conduct a study of— (A) the implementation, under current provisions, regulations, guidelines, and regulatory practices under title XIX of the Social Security Act, of the exclusion of coverage of services to certain individuals residing in institutions for mental diseases, and (B) the costs and benefits of providing services under title XIX of the Social Security Act in public subacute psychiatric facilities which provide services to psychiatric patients who would otherwise require acute hospitalization. (2) Report.—By not later than October 1, 1990, the Secretary shall submit a report to Congress on the study and shall include in the report recommendations respecting— (A) modifications in such provisions, regulations, guidelines, and practices, if any, that may be appropriate to accommodate changes that may have occurred since 1972 in the delivery of psychiatric and other mental health services on an inpatient basis to such individuals, and (B) the continued coverage of services provided in subacute psychiatric facilities under title XIX of the Social Security Act. (3) Moratorium on treatment of certain facilities.—Any determination by the Secretary that Kent Community Hospital Complex in Michigan or Saginaw Community Hospital in Michigan is an institution for mental diseases, for purposes of title XIX of the Social Security Act shall not take effect until 180 days after the date the Congress receives the report required under paragraph (2). (b) Extension of Texas Personal Care Services Waiver.—Section 9523(a) of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended by section 4115(d) of the Omnibus Budget 103 STAT. 2268Reconciliation Act of 1987 (added by section 411(k)(9)(C) of the Medicare Catastrophic Coverage Act of 1988), is amended by striking “January 1, 1990” and inserting “July 1, 1990”. (c) Hospice Payment for Room and Board.— (1) In general.—Section 1902(a)(13)(D) of the Social Security Act (42 U.S.C. 1396a(a)(13)(D)) is amended— (A) by striking “in the same amounts, and using the same methodology, as used” and inserting “in amounts no lower than the amounts, using the same methodology, used”, and (B) by striking “a separate rate may be paid for” and inserting “in the case of”, and (C) by striking “to take into account the room and board furnished by such facility” and inserting “there shall be paid an additional amount, to take into account the room and board furnished by the facility, equal to at least 95 percent of the rate that would have been paid by the State under the plan for facility services in that facility for that individual”. (2) Effective date.—The amendments made by paragraph (1) shall apply to services furnished on or after April 1, 1990, without regard to whether or not final regulations have been promulgated by such date to implement such amendments. (d) Medicare Buy-in for Premiums of Certain Working Disabled.— (1) In general.—Section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended— (A) by inserting “(i)” after “(E)”, (B) by striking the semicolon at the end and inserting “, and”, and (C) by adding at the end the following new clause: “(ii) for making medical assistance available for payment of medicare cost-sharing described in section 1905(p)(3)(A)(i) for qualified disabled and working individuals described in section 1905(s);”. (2) Eligibility.—Section 1905 of such Act (42 U.S.C. 1396d), as amended by section 6403(a) of this subtitle, is amended by adding at the end the following new subsection: “(s) The term ‘qualified disabled and working individual’ means an individual— “(1) who is entitled to enroll for hospital insurance benefits under part A of title XVIII under section 1818A (as added by 6012 of the Omnibus Budget Reconciliation Act of 1989); “(2) whose income (as determined under section 1612 for purposes of the supplemental security income program) does not exceed 200 percent of the official poverty line (as defined by the Office of Management and Budget and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved; “(3) whose resources (as determined under section 1613 for purposes of the supplemental security income program) do not exceed twice the maximum amount of resources that an individual or a couple (in the case of an individual with a spouse) may have and obtain benefits for supplemental security income benefits under title XVI; and “(4) who is not otherwise eligible for medical assistance under this title.”. 103 STAT. 2269 (3) Premium payments required for certain individuals.—Section 1916 of such Act (42 U.S.C. 1396o) is amended— (A) in subsection (a), by striking “(E)” and inserting “(E)(i)”, (B) by redesignating subsections (d) and (e) as subsections (e) and (f), respectively, and (C) by inserting after subsection (c) the following new subsection: “(d) With respect to a qualified disabled and working individual described in section 1905(s) whose income (as determined under paragraph (3) of that section) exceeds 150 percent of the official poverty line referred to in that paragraph, the State plan of a State may provide for the charging of a premium (expressed as a percentage of the medicare cost-sharing described in section 1905(p)(3)(A)(i) provided with respect to the individual) according to a sliding scale under which such percentage increases from 0 percent to 100 percent, in reasonable increments (as determined by the Secretary), as the individual’s income increases from 150 percent of such poverty line to 200 percent of such poverty line.”. (4) Conforming amendments.— (A) Section 1905(p)(3) of such Act (42 U.S.C. 1396d(p)(3)) is amended— (i) by amending subparagraph (A) to read as follows: “(A)(i) premiums under section 1818, and “(ii) premiums under section 1839,”, and (ii) in subparagraph (A) as so amended, by striking “section 1818” and inserting “section 1818 or 1818A”. (B) Section 1905(p)(1)(A) of such Act is amended by inserting “, but not including an individual entitled to such benefits only pursuant to an enrollment under section 1818A” after “1818”. (C) Section 1902(f) of such Act (42 U.S.C. 1396a(f) is amended by inserting “, except with respect to qualified disabled and working individuals (described in section 1905(s)),” after “1619(b)(3)”. (5) Effective date.— (A) The amendments made by this subsection apply (except as provided under subparagraph (B)) to payments under title XIX of the Social Security Act for calendar quarters beginning on or after July 1, 1990, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date. (B) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act, For purposes of the previous sentence, in the case 103 STAT. 2270of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.