Medicare Catastrophic Coverage Act of 1988

(Conference report filed in House, H. Rept. 100-661) Medicare Catastrophic Coverage Act of 1988 - Title I: Provisions Relating to Part A of Medicare Program and Supplemental Medicare Premium - Subtitle A: Expansion of Medicare Part A Benefits - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to require that an inpatient hospital deductible be paid only for the first period of continuous hospitalization in a calendar year. (Currently, such deductible must be paid for each "spell of illness" requiring inpatient hospital services.) Removes durational limitations on the coverage of inpatient hospital services, except with respect to inpatient psychiatric hospital services. Eliminates the coinsurance requirement for inpatient hospital services. Establishes the monthly part A premium, required of individuals who wish to buy into the Hospital Insurance program, at the monthly actuarial value of part A services provided to beneficiaries age 65 and over. Imposes a coinsurance rate, equal to 20 percent of the average per diem reasonable cost of post-hospital extended care services, for the first eight days of an individual's receipt of such services in a calendar year. Provides coverage for post-hospital extended care services for 150 days in each calendar year. (Currently, such coverage is limited to 100 days for each "spell of illness.") Drops restrictions on the coverage of extended care services which are not post-hospital extended care services. Creates an extension period of hospice care for terminally ill beneficiaries which is to follow the two 90-day periods and the subsequent 30-day period of hospice care coverage currently provided in an individual's lifetime. Reduces the deductible imposed under part A on the first three pints of blood furnished to an individual during a calendar year to the extent such blood is replaced or a blood deductible has been imposed on the individual under part B (Supplementary Medical Insurance) of the Medicare program within such year. Subtitle B: Supplemental Medicare Premium - Amends the Internal Revenue Code to impose an annual supplemental Medicare premium on individuals who are eligible for benefits under part A of the Medicare program for more than six full months in a taxable year and whose tax liability equals or exceeds $150. Specifies premium rates through 1993, with rate adjustments thereafter reflecting program costs and revenues. Multiplies the premium rates by each $150 of tax liability an individual incurs to determine the premium due. Sets an annual cap on such premium. Makes special premium calculation rules applicable to couples filing joint returns and government retirees. Establishes the Federal Hospital Insurance Catastrophic Coverage Reserve Fund into which shall be transferred amounts equivalent to outlays for part A catastrophic coverage, excluding outpatient drug benefits. Directs the Secretary of the Treasury to conduct a study and report to the Congress by November 30, 1988, on Federal tax policies to promote private financing of long-term care. Title II: Provisions Relating to Part B of the Medicare Program and to Medicare Supplemental Health Insurance - Subtitle A: Expansion of Medicare Part B Benefits - Amends part B (Supplementary Medical Insurance) of the Medicare program to cover all of the reasonable out-of-pocket part B expenses a beneficiary incurs in excess of $1,370 in 1990, adjusting such ceiling annually thereafter so as to maintain the percentage of Medicare enrollees exceeding such cap at seven percent per year. Requires Medicare carriers to provide individuals who have reached the out-of-pocket expense limit with notice that they have reached such limit. Provides coverage, beginning in 1991, of the catastrophic expenses for outpatient prescription drugs and insulin (outpatient drugs) and beginning in 1990, for immunosuppressive drugs furnished for the second year and beyond after organ transplant surgery. Sets the annual deductible for such coverage at: (1) $550 in 1990, with Medicare paying 50 percent of the costs in excess of such amount; (2) $600 in 1991, with Medicare paying 50 percent of the costs in excess of such amount; (3) $652 in 1992, with Medicare paying 60 percent of the costs in excess of such amount; and (4) an amount set thereafter so that 16.8 percent of Medicare beneficiaries will exceed such amount, with Medicare paying 80 percent of the costs in excess of such amount. Sets payment limits for outpatient drugs, differentiating drugs for which generics are available from those for which they are not available. Continues current Medicare payments for 80 percent of the costs of immunosuppressive drugs used during the first year after a Medicare covered transplant. Pays, beginning in 1990, 80 percent of the costs of intravenous drugs provided in the home as well as all of the costs for home health aides and equipment to administer the drugs. Excludes beneficiary cost-sharing for intravenous drugs which are provided as part of a continuous therapy initiated at a hospital and first year immunosuppressive drugs from the calculation of the deductibles listed above. Directs the Secretary to establish a program to identify and to educate physicians and pharmacies concerning: (1) instances and patterns of unnecessary or inappropriate prescribing or dispensing practices; (2) instances or patterns of substandard care; and (3) potential adverse drug reactions. Requires the Secretary to develop, and update annually, an information guide concerning the comparative average wholesale prices of at least 500 of the most commonly prescribed outpatient drugs and mail such guide to Medicare hospitals, physicians, social security offices, senior citizen centers, and other appropriate places by January of each year. Sets forth outpatient drug cost reporting and control provisions. Authorizes a pharmacy to enter into an agreement with the Secretary to accept payment under part B of the Medicare program on an assigned basis for outpatient drugs furnished to part B enrollees. Sets forth the obligations of participating pharmacies, including the requirements that they: (1) charge Medicare beneficiaries no more for drugs than they charge the general public; (2) keep patient records for all outpatient drugs dispensed to such beneficiaries; and (3) offer to counsel each of their beneficiaries on the appropriate use of such drugs and the availability of therapeutically equivalent outpatient drugs. Requires the Secretary to provide each participating pharmacy with: (1) a distinctive emblem indicating its status as such; and (2) the equipment and assistance necessary for it to submit claims electronically. Requires the Secretary to establish, by January 1, 1991, a point-of-sale electronics system for use by carriers and participating pharmacies in submitting information respecting outpatient drugs dispensed to Medicare beneficiaries. Prohibits part B coverage of an outpatient drug which is dispensed in a quantity exceeding a 30-day supply or such longer supply, not exceeding 90 days, as the Secretary authorizes. Waives the requirement that a Medicare carrier be an insurer of health care services, authorizing the Secretary to contract with other entities for implementation and operation of the electronic point-of-sale claims processing system and for related functions. Requires Medicare carriers which make determinations or payments with respect to outpatient drugs to offer to receive requests from participating pharmacies for payments for such drugs through electronic communications and respond to requests by such pharmacies as to whether or not an individual has paid the deductible for such drugs. Requires the Director of the Office of Technology Assessment to appoint individuals with expertise in the provision and financing of covered outpatient drugs to a Prescription Drug Payment Review Commission which shall make recommendations to the Congress by May 1 of each year concerning methods of paying for covered outpatient drugs under part B of the Medicare program. Sets forth miscellaneous outpatient drug study and reporting requirements. Provides Medicare coverage for a mammogram: (1) every other year for women aged 65 or older and for women aged 40 to 49 who are not at a high risk of developing breast cancer; (2) once a year for women aged 50 to 64 or women aged 40 to 49 who are at a high risk of developing breast cancer; and (3) once between a women's 35th and 40th birthdays. Authorizes the Secretary to revise such frequencies after 1991. Sets forth study and reporting requirements. Covers in-home care furnished, under the supervision of a registered professional nurse, by a home health agency or by others under arrangements with such agency to an individual who has incurred expenses equal to the part B cost-sharing limit or the outpatient drug deductible for the year and, for the preceding three months, has been unable to perform at least two specified daily living activities without the assistance of an uncompensated primary caregiver with whom he or she resides. Limits such coverage to 80 hours per year. Directs the Secretary to report to the Congress, within 18 months of this Act's enactment, on the advisability of providing out-of-home services as alternative services to in-home care. Covers nursing care and home health aide services as home health services if such services are needed less than seven days each week or are needed for an initial period of up to 38 consecutive days and for a subsequent period on a physician's certification of exceptional circumstances. Requires the Secretary to provide for research on issues relating to the delivery and financing of Medicare long-term care services. Authorizes appropriations for FY 1988 through 1993 for such research. Sets forth reporting requirements. Directs the Secretary to conduct a survey of adult day care services and report to the Congress within one year of this Act's enactment regarding such services, and standards which may be applied in providing Medicare coverage for such services. Subtitle B: Medicare Part B Monthly Premium Financing - Increases the part B premium by the sum of a catastrophic coverage monthly premium and a prescription drug monthly premium. Specifies the rates of the latter two premiums through 1993, with rate adjustments thereafter reflecting program costs and revenues. Establishes the Federal Catastrophic Drug Insurance Trust Fund into which part A and B premiums attributable to outpatient drug coverage are to be transferred. Creates the Medicare Catastrophic Coverage Account from which catastrophic (non-drug) outlays are to be debited and to which catastrophic coverage premiums are to be credited, though no funds are actually transferred into or paid out of the account. Subtitle C: Miscellaneous Provisions - Gives Medicare supplemental health insurance policy holders 30 days after being issued a policy to return such policy for a full refund of any premiums paid. Requires State Medicare supplemental health insurance policy certification programs to monitor the ratio of benefits provided to premiums collected under such policies. Directs the Secretary to: (1) inform Medicare beneficiaries about supplemental health insurance marketing and sales abuses which warrant criminal penalties and the manner in which they may report such abuses to appropriate officials; (2) publish a toll-free number for beneficiaries to report such abuses; and (3) inform Medicare beneficiaries of the addresses and telephone numbers of State and Federal agencies and offices that provide information and assistance regarding the selection of Medicare supplemental policies. Requires that State regulatory standards for Medicare supplemental health insurance policies be at least as stringent as the National Association of Insurance Commissioners (NAIC) Model Standards, amended within 90 days of this Act's enactment to reflect changes made by this Act. Provides that if the NAIC Model Standards are not amended, Federal model standards shall be established and serve as the standards for evaluating State regulatory standards for Medicare supplemental health insurance policies. Directs the Secretary to report to the Congress in March 1989 and July 1990 on actions States have taken in adopting standards at least as stringent as the NAIC Model Standards. Requires a Medicare supplemental policy to submit a copy of each of its advertisements to the State Commissioner of Insurance for his or her review or approval to the extent it may be required under State law. Provides that the Secretary, rather than the President, shall appoint Supplemental Health Insurance Panel members. Directs the Secretary to: (1) take this Act's amendments into account in determining the payments to be made to health maintenance organizations; and (2) require such organizations to adjust their agreements with Medicare beneficiaries in consideration of such amendments. Requires the Secretary to mail a notice annually to Medicare beneficiaries, and upon their entitlement or enrollment, of the extent to which Medicare coverage and payment is provided for health care services and Medicare and Medicaid (title XIX of the Act) coverage is provided for long-term care services. Requires that a notice be mailed annually to beneficiaries which contains: (1) a description of Medicare's participating physician program; (2) explanations of the advantages of obtaining services from participating physicians or suppliers and the assistance offered by carriers in obtaining their names; and (3) the local carrier's toll-free number for program inquiries and requests for free copies of appropriate directories. Revises the notice provided to beneficiaries in conjunction with the payment of non-assigned claims to require the inclusion of: (1) a clear statement of amounts charged in excess of Medicare-recognized amounts; and (2) an offer of assistance in obtaining the names of participating physicians and suppliers. Revises the penalties applicable against health maintenance organizations which charge enrollees excess premiums, or expel or refuse to reenroll a beneficiary on the basis of his or her health status. Title III: Provisions Relating to the Medicaid Program - Amends the Medicaid program to phase-in, by 1992, the requirement that States provide Medicaid coverage of Medicare premiums, deductibles, and coinsurance payments for which Medicare-eligible individuals whose income does not exceed the Federal poverty level would otherwise be accountable. Prohibits States from setting the resource eligibility limit for such coverage at more than twice the resource limit for eligibility under the Supplemental Security Income Program (title XVI of the Act). Gives U.S. Commonwealths and Territories the option of providing such coverage. Phases-in, by July 1, 1990, the requirement that States extend Medicaid coverage to pregnant women and infants up to age one with incomes below the Federal poverty level but too high, under current requirements, to qualify for Medicaid. Gives U.S. Commonwealths and territories the option of providing such coverage. Sets forth rules regarding the attribution of income and resources to institutionalized and community spouses. Provides that for the initial determination of an institutionalized spouse's medicaid eligibility all the resources held by either the institutionalized or community spouse shall be considered available to the institutionalized spouse except for an amount which equals the community spouse resource allowance determined without subtracting from such allowance resources otherwise available to the community spouse. Sets forth the formula for determining the community spouse resource allowance which provides the community spouse with at least $12,000 annually, with annual adjustments to such formula reflecting changes in the cost-of-living. Excludes, from the determination of the institutionalized spouse's eligibility, support which the community spouse owes to the institutionalized spouse if the latter assigns his or her support rights to the State. Provides that after the initial eligibility determination: (1) no resources of the community spouse will be considered available to the institutionalized spouse; and (2) the income of the institutionalized spouse will not be considered to include a specified personal needs allowance, community spouse monthly income allowance, family allowance, and incurred expenses for medical or remedial care for the institutionalized spouse that are not covered by a legally liable third party. Sets forth the formulas for determining such allowances. Provides the community spouse with a minimum monthly maintenance needs allowance determined pursuant to a specified formula and capped at $1,500, with subsequent adjustments for inflation. Gives the institutionalized and the community spouse the right to a hearing to establish that: (1) the minimum monthly maintenance needs allowance is inadequate, due to exceptional circumstances, to protect the community spouse from significant financial duress; or (2) the resource allowance, when combined with the income allowance, is not adequate to raise the community spouse's income to the minimum monthly maintenance needs allowance. Requires the substitution of an adequate allowance for an allowance found to be inadequate. Prohibits the income allowance from being less than court-ordered support payments. Delays the Medicaid eligibility of institutionalized individuals who disposed of their resources at less than fair market value within 30 months prior to applying for Medicaid benefits. Sets forth situations in which a delay shall not be applied. Prohibits Missouri from including any aged, blind, or disabled individual's home as a resource in determining his or her Medicaid eligibility. Title IV: United States Bipartisan Commission on Comprehensive Health Care, OBRA Technical Corrections, and Miscellaneous Provisions - Subtitle A: United States Bipartisan Commission on Comprehensive Health Care - Establishes the United States Bipartisan Commission on Comprehensive Health Care which shall: (1) examine shortcomings in the current health care delivery and financial mechanisms that limit or prevent access of individuals to comprehensive health care; and (2) make recommendations to the Congress respecting Federal programs, policies, and financing needed to assure the availability of comprehensive long-term care for everyone. Directs the Commission to report to the Congress on its findings and recommendations regarding comprehensive long-term care for: (1) the elderly and disabled, within six months of this Act's enactment; and (2) everyone, within one year of this Act's enactment. Terminates the Commission 30 days after submission of the latter report. Authorizes appropriations for the implementation of this title. Subtitle B: OBRA Technical Corrections - Makes technical corrections to certain health care provisions in the Omnibus Budget Reconciliation Act of 1987. Subtitle C: Miscellaneous Provisions - Requires employers which provide their employees or retired former employees with health care benefits that are duplicative of this Act's benefits to provide additional benefits that are at least equal in value to the duplicative benefits or refund the value of such benefits to employees or retired former employees. Directs the Office of Personnel Management to reduce the rates charged Medicare eligible individuals participating in the Federal Employees Health Benefits (FEHB) program to compensate for the cost of medical services and supplies which, but for this Act's catastrophic coverage benefits, would have been incurred by such program. Requires the Director of the Office of Personnel Management to submit reports to the Congress by April 1, 1989, regarding: (1) changes to the FEHB program that may be required to incorporate FEHB plans designed for Medicare eligible individuals and to improve the efficiency and effectiveness of the program; and (2) the feasibility of adopting NAIC Model Standards for Medicare supplemental policies when providing Medicare supplemental plans as a type of FEHB plan. Directs the Secretary to establish a demonstration project by entering into an agreement with a private or public nonprofit organization to: (1) provide training and technical assistance to prepare volunteers to counsel elderly Medicare or Medicaid beneficiaries regarding their eligibility for such benefits and assist such beneficiaries in applying for those benefits; and (2) reimburse volunteers for expenses incurred in receiving such training or providing such services. Authorizes appropriations from FY 1989 through 1991 for such projects. Requires the Secretary to establish, within one year of this Act's enactment, four two-year demonstration projects under which an entity agrees to provide case management services to Medicare beneficiaries with selected high cost catastrophic illnesses so that the Secretary and the Congress can evaluate the appropriateness and determine the most effective approach to providing case management services to such beneficiaries. Requires that one such project be conducted by a peer review organization. Authorizes appropriations for such projects. Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 and the Omnibus Budget Reconciliation Acts of 1986 and 1987 to extend: (1) certain waiver of liability provisions applicable to hospitals, skilled nursing facilities, and home health agencies; and (2) the prohibition on new Medicare cost-saving regulations. Directs the Administrator of the Health Care Financing Administration to establish, within 90 days of this Act's enactment, an Advisory Committee on Medicare Home Health Claims which shall conduct a study and report to the Congress, within one year of this Act's enactment, on the reasons for the increase in the denial of claims for home health services during 1986 and 1987, the ramifications of such increase, and the need to reform the process involved in such denials. Authorizes appropriations for such Committee. Amends part A (General Provisions) of title XI of the Social Security Act to prohibit the use of the words "Social Security," "Medicare," or other words, letters, symbols, or emblems, in a communication or production in a manner which the user knows or should know would convey a false impression of connection with, or authorization from, the Social Security Administration, the Health Care Financing Administration, or the Department of Health and Human Services. Authorizes the Secretary to impose civil monetary penalties for violations of such prohibition. Authorizes civil monetary penalties, where only criminal penalties currently apply, for deceptive selling practices relating to Medicare supplemental health insurance policies. Requires the Secretary to establish up to five demonstration projects, for up to three years each, to review the appropriateness of classifying chronic ventilator-dependent units in hospitals as rehabilitation units for Medicare reimbursement purposes.

(Measure passed Senate, amended, in lieu of S. 1127, roll call #353 (86-11)) Medicare Catastrophic Loss Prevention Act of 1987 - Amends part A (Hospital Insurance) of title XVIII (Medicare of the Social Security Act to remove durational limitations on Medicare coverage of inpatient hospital services, and cover 150 days of post-hospital extended care services per year, for an individual covered under parts A and B (Supplementary Medical Insurance) of the Medicare program. (Individuals covered only under part A would be subject to current durational limitations on such services.) Provides that an individual covered under parts A and B of the Medicare program shall not be required to pay more than one deductible for inpatient hospital services and one deductible for blood furnished in connection with such services per year. (Currently such deductibles are imposed for each "spell of illness.") Eliminates the coinsurance requirement imposed on such individuals for extended hospital stays. Imposes a coinsurance rate, equal to 15 percent of the average per diem cost of post-hospital extended care services, for the first ten days of a part A and B beneficiary's receipt of such services per year. (Currently, the coinsurance requirement applies to days 21 through 100 of a "spell of illness" requiring such services.) Amends part B of the Medicare program to cover all of the out-of-pocket Medicare expenses which a part B beneficiary incurs in excess of $1,850 in 1988, and $2,030 in 1989, adjusted annually thereafter to reflect changes in the cost-of-living. Provides for the adjustment of Medicare payments to organizations providing health care on a prepaid basis so as to reimburse them for such excess out-of-pocket costs incurred on behalf of enrollees. Includes as out-of-pocket costs: (1) beneficiary cost sharing expenses; and (2) amounts expended for specified preventive health services. Imposes a monthly catastrophic coverage premium of $4.00 for 1988 on an individual covered under parts A and B of the Medicare program, with annual adjustments to such premium thereafter reflecting changes in the amount of catastrophic benefits paid and the need to establish and maintain a contingency or reserve Fund. Imposes a smaller monthly catastrophic coverage premium on individuals who are only covered under part B of the Medicare program. Establishes a monthly catastrophic drug benefit premium for part B beneficiaries. Imposes a supplemental part B premium of $13.08 per year, adjusted annually to reflect changes in the cost of catastrophic benefits, for each $150 of income tax due in excess of $150. Sets an annual cap on the supplemental premium. Establishes the Federal Catastrophic Drug Insurance Trust Fund into which catastrophic drug benefit premiums shall be paid and the Federal Catastrophic Health Insurance Trust Fund into which the other catastrophic benefit premiums shall be paid. Covers, as home health services, daily nursing care and home health aide services furnished for up to 21 days with a physician's certification of the need for such daily care. Covers such services on a daily basis for 45 days when provided to a part B beneficiary within 30 days of his or her hospital discharge. (Currently such care must be provided on a part-time or intermittent basis.) Covers home intravenous drug therapy furnished by or under arrangements with a qualified provider in accordance with a plan established and periodically reviewed by a physician. Defines as "homebound" (a prerequisite of eligibility for Medicare home health services) any person who has a condition which restricts his or her ability to leave the home without support or for whom leaving the home is medically contraindicated. Directs the Secretary of Health and Human Services to notify Medicare beneficiaries, when they apply for benefits under part A or enroll under part B, and in November 1987 and annually thereafter, regarding the extent of and limitations on Medicare coverage, including the ways in which coverage differs between those who are and those who are not covered under part B. Authorizes the Secretary to: (1) enter into agreements with private or public nonprofit organizations to provide training and technical assistance to prepare volunteers to counsel elderly Medicare or Medicaid beneficiaries regarding their eligibility for such benefits and assist such beneficiaries in applying for those benefits; and (2) reimburse volunteers for expenses incurred in receiving such training or providing such services. Requires the Secretary to take into account the costs incurred by organizations providing health care on a prepaid basis as a result of this Act's amendments in modifying contracts with such organizations. Requires such organizations to adjust their agreements with Medicare beneficiaries in consideration of such amendments. Requires a health maintenance organization (HMO) to notify individuals who are enrolled or eligible to enroll with such organization that the organization can terminate or refuse to renew its contract with the Secretary and that this may result in the termination of an individual's enrollment with the organization. Imposes civil monetary penalties and intermediate sanctions on HMOs which willfully: (1) fail substantially to provide medically necessary items and services if the failure adversely affects the enrollee; (2) charge an individual a greater premium than is permitted; (3) act to expel or refuse to re-enroll an individual for medical reasons; (4) engage in any practice that denies or discourages enrollment by individuals whose medical condition or history indicates a need for substantial future medical services; or (5) misrepresent or falsify enrollment information, or enroll an individual without the individual's knowledge or consent or after making a material inducement to the individual. Provides coverage of the catastrophic expenses for outpatient prescription drugs (outpatient drugs) under part B of the Medicare program. Includes immunosuppressive drugs within such coverage if furnished to individuals within one year after their receipt of a covered organ transplant. Sets the annual deductible for such coverage at $600 for 1990, with subsequent annual adjustments of such deductible reflecting changes in the cost of outpatient drugs. Covers 80 percent of the costs in excess of such deductible provided the cost for each drug does not exceed payment limits based on the average cost for each drug. Authorizes the Secretary to deny payment for outpatient drugs which are prescribed or dispensed with excessive frequency or in excessive quantities. Directs the Secretary to: (1) establish a utilization review program for outpatient drugs to identify instances of unnecessary or inappropriate prescribing or dispensing practices and identify patterns of substandard care; and (2) develop, and update annually, an information guide concerning the comparative average wholesale prices of at least 500 of the most commonly prescribed outpatient drugs and mail such guide to Medicare hospitals and physicians by January 1 of each year. Authorizes a pharmacy to enter into an agreement with the Secretary to accept payment under part B of the Medicare program on an assigned basis for outpatient drugs furnished to part B enrollees. Sets forth the obligations of participating pharmacies, including the requirements that they: (1) charge Medicare beneficiaries no more for drugs than they charge the general public; (2) keep patient records for all outpatient drugs dispensed to such beneficiaries; (3) assist beneficiaries in determining whether or not their expenses have exceeded the annual deductible; and (4) offer to counsel each of their beneficiaries on the appropriate use of such drugs and the availability of therapeutically equivalent outpatient drugs; and (5) submit requests for payment to carriers electronically by 1991, except where such requirement would impose undue hardship on a pharmacy. Requires the Secretary to provide each participating pharmacy with: (1) a distinctive emblem indicating its status as such; and (2) information on the payment limits established for outpatient drugs. Prohibits part B coverage of an outpatient drug which is dispensed in a quantity exceeding a 90-day supply for an individual receiving chronic maintenance drug therapy, or a 60-day supply for any other individual. Requires Medicare carriers which make determinations or payments with respect to outpatient drugs to: (1) offer to receive requests for payments for such drugs through electronic communications; (2) respond to requests by participating pharmacies as to whether or not an individual has paid the deductible for such drugs; and (3) make payments for an outpatient drug claim from within 30 to 45 days of the receipt of such claim. Directs the Secretary to: (1) conduct a survey of expenses for covered outpatient drugs to provide information on the distribution of such expenses among Medicare beneficiaries; and (2) report to the Congress regarding such survey by January 19, 1989. Requires that, within two months of the Secretary's survey report: (1) the Congressional Budget Office transmit its estimate of future Medicare expenditures for outpatient drugs to the Congress; and (2) the General Accounting Office report to the Congress on the validity of the Secretary's survey, the extent to which pharmacies accept assignment, and the barriers to such acceptance. Requires the Office of Technology Assessment and the Institute of Medicine to report to the Congress and the Secretary within one year of this Act's enactment regarding the inclusion of additional or alternative drugs as covered outpatient drugs. Directs the Secretary to conduct additional studies regarding outpatient drug coverage and submit a final report to the Congress regarding such studies by January 1, 1991. Requires the Secretary and the General Accounting Office to each: (1) conduct and periodically update a study comparing published average wholesale prices and actual pharmacy acquisition costs by pharmacy type; and (2) submit reports to the Congress on the results of each such study and update. Directs the Secretary to: (1) enter into an agreement with two or more private entities to conduct demonstration projects testing the use of magnetic cards, electronic billing, and other technological devices in the administration of benefits with respect to covered outpatient drugs; and (2) report to the Congress on the results of a project within six months of such project's completion. Requires the Secretary to develop a standard receipt to be used by Medicare beneficiaries in making purchases from participating pharmacies and distribute copies of such receipt to participating pharmacies by January 1, 1990. Creates an extension period of hospice care for terminally ill beneficiaries which is to follow the two 90-day periods and the subsequent 30-day period of hospice care coverage currently provided in an individual's lifetime. Gives Medicare supplemental health insurance policy holders 30 days after being issued a policy to return such policy for a full refund of any premiums paid. Requires State Medicare supplemental health insurance policy certification programs to monitor the ratio of benefits provided to premiums collected under such policies. Directs the Secretary to: (1) inform Medicare beneficiaries about supplemental health insurance marketing and sales abuses which warrant criminal penalties and the manner in which they may report such abuses to appropriate officials; (2) establish a toll-free number for beneficiaries to report such abuses; and (3) inform Medicare beneficiaries of the addresses and telephone numbers of State and Federal agencies and offices that provide information and assistance regarding the selection of Medicare supplemental policies. Requires that State regulatory standards for Medicare supplemental health insurance policies be at least as stringent as the National Association of Insurance Commissioners (NAIC) Model Standards, amended within 90 days of this Act's enactment to reflect changes made by this Act. Provides that if the NAIC Model Standards are not amended, Federal model standards shall be established and serve as the standards for evaluating State regulatory standards for Medicare supplemental health insurance policies. Requires that States use savings accrued under Medicaid from catastrophic Medicare coverage to expand Medicaid (title XIX of the Act) coverage of the low-income elderly and community spouses of institutionalized individuals. Requires States which provide Medicaid coverage to all qualified Medicare beneficiaries whose income does not exceed the Federal poverty level and which provide a monthly Medicaid maintenance needs allowance for community spouses of institutionalized individuals of at least $550 to increase opportunities for the elderly to participate in adult day health care and other community-based services. Requires that States use savings accrued under Medicaid from Medicare coverage of home intravenous drug therapy and catastrophic expenses for outpatient drugs to provide Medicaid coverage of the costs the low-income elderly incur for Medicare coverage of outpatient drugs. Amends the Medicaid program to authorize States to provide Medicaid coverage of a qualified Medicare beneficiary's prescribed drugs to the same extent that coverage is provided to the categorically needy instead of providing Medicaid coverage of the deductible for Medicare covered outpatient drugs. Authorizes States which provide Medicaid coverage of Medicare beneficiary expenses for Medicare outpatient drug coverage to include beneficiaries whose income exceeds the Federal poverty level if such beneficiaries contribute to the cost of such coverage. Sets forth rules regarding the attribution of income and resources to institutionalized and community spouses. Provides that for the initial determination of an institutionalized spouse's medicaid eligibility all the resources held by either the institutionalized or community spouse shall be considered available to the institutionalized spouse except for an amount which equals the community spouse resource allowance determined without subtracting from such allowance resources otherwise available to the community spouse. Sets forth the formula for determining the community spouse resource allowance which provides the community spouse with at least $12,000 annually, with annual adustments to such formula reflecting changes in the cost-of-living. Excludes, from the determination of the institutionalized spouse's eligibility, support which the community spouse owes to the institutionalized spouse if the latter assigns his or her support rights to the State. Provides that after the initial eligibility determination: (1) no resources of the community spouse will be considered available to the institutionalized spouse; and (2) the income of the institutionalized spouse will not be considered to include a specified personal needs allowance, community spouse monthly income allowance, family allowance, and incurred expenses for medical or remedial care for the institutionalized spouse that are not covered by a legally liable third party. Sets forth the formulas for determining such allowances. Gives the institutionalized and the community spouse the right to a hearing to establish that the community spouse monthly income allowance or resource allowance is not adequate to support the community spouse without financial duress so that an adequate amount of support will be substituted for the allowance. Prohibits such income allowance from being less than court-ordered support payments. Delays the Medicaid eligibility of institutionalized individuals who disposed of their resources at less than fair market value within 26 months prior to applying for Medicaid benefits. Sets forth situations in which a delay shall not be applied. Directs the Secretary to report to the Congress by December 31, 1988, regarding means for recovering amounts from deceased Medicaid beneficiaries' estates to pay for Medicaid skilled nursing facility or intermediate care facility services furnished to such beneficiaries. Directs the Secretary to report to the Congress by October 1, 1989, on a study to be conducted by the Institute of Medicine into private and public funding options for long-term care. Directs the Secretary of the Treasury to conduct a study and report to the Congress by April 1, 1988, on Federal tax policies to promote private financing of long-term care. Requires the Secretary to establish, within one year of this Act's enactment, no less than six one-year projects evaluating the feasibility of providing case management services to Medicare beneficiaries with catastrophic illnesses. Requires that project services be provided through peer review organizations. Sets forth reporting requirements. Amends part A (General Provisions) of title XI of the Act to repeal the Secretary's authority to conduct a specified program testing the proficiency of health care personnel. Amends the Medicare program to require the Trustees of the Hospital Insurance and Supplementary Medical Insurance trust funds to comment in their annual report to the Congress on the extent to which the catastrophic coverage premium and the supplemental part B premium cover the cost of catastrophic coverage benefits and related administrative expenses. Sets forth technical amendments relating to waivers for home and community-based services and a New Jersey respite care pilot project. Requires employers which provide their employees or retired former employees with health care benefits that are duplicative of this Act's benefits to provide additional benefits that are at least equal in value to the duplicative benefits or refund the value of such benefits to employees or retired former employees. Directs the Office of Personnel Management to reduce the rates charged Medicare eligible individuals participating in the Federal Employees Health Benefits (FEHB) program to compensate for the cost of medical services and supplies which, but for this Act's catastrophic coverage benefits, would have been incurred by such program. Requires the Director of the Office of Personnel Management to submit reports to the Congress by April 1, 1989, regarding: (1) changes to the FEHB program that may be required to incorporate FEHB plans designed for Medicare eligible individuals and to improve the efficiency and effectiveness of the program; and (2) the feasibility of adopting NAIC Model Standards for Medicare supplemental policies when providing Medicare supplemental plans as a type of FEHB plan. Directs the Secretary to conduct a survey and report to the Congress within one year of this Act's enactment on adult day care services. Amends the Medicaid program to authorize a State agency of New Jersey to operate a health maintenance organization. Amends the Omnibus Budget Reconciliation Act of 1986 to delay, from November 21, 1987, to December 31, 1988, the application of certain standards for organ procurement agencies. Amends part B of the Medicare program to set forth transitional provisions regarding the monthly catastrophic drug benefit premium. Authorizes the Secretary to reduce the deductible for covered outpatient drugs in 1991, 1992, and 1993 when sufficient revenue exists to pay for such coverage and provide an adequate contingency margin. Expresses the sense of the Senate regarding the need for effective cost controls on, and the minimization of beneficiary costs for, new catastrophic benefits. Establishes the United States Bipartisan Commission on Comprehensive Health Care which shall: (1) examine shortcomings in the current health care delivery and financing mechanisms that limit or prevent access of individuals to comprehensive health care; and (2) make recommendations to the Congress respecting Federal programs, policies, and financing needed to assure the availability of comprehensive long-term care for everyone. Directs the Commission to report to the Congress on its findings and recommendations regarding comprehensive long-term care for: (1) the elderly and disabled, within six months of this Act's enactment; and (2) everyone, within one year of this Act's enactment. Terminates the Commission 30 days after submission of the latter report. Authorizes appropriations for the Commission.

(Measure passed House, amended (Inserted text of H.R. 2941), roll call #281 (302-127)) Medicare Catastrophic Protection Act of 1987 - Title I: Provisions Relating to Part A of Medicare Program and Supplemental Medicare Premium - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to require that an inpatient hospital deductible be paid only for the first period of continuous hospitalization in a calendar year. (Currently, such deductible must be paid for each "spell of illness" requiring inpatient hospital services.) Removes durational limitations on the coverage of inpatient hospital services, except with respect to inpatient psychiatric hospital services. Eliminates the coinsurance requirement for inpatient hospital services. Establishes the monthly part A premium, required of individuals who wish to buy into the Hospital Insurance program, at the monthly actuarial value of part A services provided to beneficiaries age 65 and over. Imposes a coinsurance rate, equal to 20 percent of the average per diem cost of post-hospital extended care services, for the first seven days of an individual's receipt of such services in a calendar year. Provides coverage for post-hospital extended care services for 150 days in each calendar year. (Currently, such coverage is limited to 100 days for each "spell of illness.") Drops restrictions on the coverage of extended care services which are not post-hospital extended care services. Creates an extension period of hospice care for terminally ill beneficiaries which is to follow the two 90-day periods and the subsequent 30-day period of hospice care coverage currently provided in an individual's lifetime. Reduces the deductible imposed under part A on the first three pints of blood furnished to an individual during a calendar year to the extent such blood is replaced or a blood deductible has been imposed on the individual under part B (Supplementary Medical Insurance) of the Medicare program within such year. Provides part A coverage for home health services only when an individual is not entitled to part B benefits. Amends the Internal Revenue Code to impose an annual supplemental Medicare premium on part A Medicare beneficiaries pursuant to a table which bases the amount of such premium due on the size of a beneficiary's gross income. Requires adjustments to such premium so that it covers 25 percent of the costs of covered outpatient drugs and related administrative costs. Directs the Secretary of Health and Human Services to make returns setting forth certain information regarding part A Medicare beneficiaries. Title II: Provisions Relating to Part B of the Medicare Program and to Medicare Supplemental Health Insurance - Amends part B (Supplementary Medical Insurance) of the Medicare program to cover all of the out-of-pocket part B expenses a beneficiary incurs in excess of $1,043 in 1989, adjusting such ceiling annually thereafter to reflect cost-of-living increases. Requires Medicare carriers to provide individuals who have reached the out-of-pocket expense limit with a notice which may be presented to a physician that: (1) states that the individual has reached such limit; and (2) encourages the physician not to charge the individual in excess of the reasonable charge and to accept payment on an assigned basis for services furnished to the individual during the remainder of the year. Provides coverage of the catastrophic expenses for outpatient prescription drugs and insulin (outpatient drugs) under part B of the Medicare program. Includes immunosuppressive drugs within such coverage if furnished to individuals within one year after their receipt of a covered organ transplant. Sets the annual deductible for such coverage at $500 for 1989, with adjustments of such deductible in 1990 and 1991 reflecting changes in the cost of medical care, and subsequent annual adjustments reflecting changes in the cost of outpatient drugs. Covers all costs in excess of such deductible provided the cost for each drug does not exceed payment limits based on the average cost for each drug. Authorizes the Secretary to deny payment for outpatient drugs which are prescribed or dispensed with excessive frequency or in excessive quantities. Directs the Secretary to: (1) establish a utilization review program for outpatient drugs to identify instances of unnecessary or inappropriate prescribing or dispensing practices and identify quality of care problems; and (2) develop, and update annually, an information guide concerning the comparative average wholesale prices of at least 500 of the most commonly prescribed outpatient drugs and mail such guide to Medicare hospitals and physicians by March 1 of each year. Authorizes a pharmacy to enter into an agreement with the Secretary to accept payment under part B of the Medicare program on an assigned basis for outpatient drugs furnished to part B enrollees. Sets forth the obligations of participating pharmacies, including the requirements that they: (1) charge Medicare beneficiaries no more for drugs than they charge the general public; (2) keep patient records for all outpatient drugs dispensed to such beneficiaries; (3) assist beneficiaries in determining whether or not their expenses have exceeded the annual deductible; and (4) offer to counsel each of their beneficiaries on the appropriate use of such drugs and the availability of therapeutically equivalent outpatient drugs; and (5) submit requests for payment to carriers electronically by 1992, except where such requirement would impose undue hardship on a pharmacy. Requires the Secretary to provide each participating pharmacy with: (1) a distinctive emblem indicating its status as such; and (2) information on the payment limits established for outpatient drugs. Prohibits part B coverage of an outpatient drug which is dispensed in a quantity exceeding a 60-day supply. Requires Medicare carriers which make determinations or payments with respect to outpatient drugs to offer to receive requests from participating pharmacies for payments for such drugs through electronic communications and respond to requests by such pharmacies as to whether or not an individual has paid the deductible for such drugs. Directs the Secretary to: (1) conduct a survey of expenses for covered outpatient drugs to provide information on the distribution of such expenses among Medicare beneficiaries; and (2) report to the Congress regarding such survey by March 1, 1989. Requires the Congressional Budget Office to transmit its estimate of future Medicare expenditures for outpatient drugs to the Congress within two months of the Secretary's survey report. Requires the Director of the Office of Technology Assessment to appoint individuals with expertise in the provision and financing of covered outpatient drugs to a Prescription Drug Payment Review Commission which shall make recommendations to the Congress by March 1 of each year concerning methods of paying for covered outpatient drugs under part B of the Medicare program. Directs the Secretary to conduct additional studies regarding outpatient drug coverage and report to the Congress regarding such studies by 1991. Covers in-home care furnished, under the supervision of a registered professional nurse, by a home health agency or by others under arrangements with such agency to an individual who, for the preceding three months, has been unable to perform at least two specified daily living activities without the assistance of an uncompensated primary caregiver with whom he or she resides. Limits such coverage to 80 hours per year. Directs the Secretary to report to the Congress: (1) within 18 months of this Act's enactment, on the advisability of providing out-of-home services as alternative services to in-home care; and (2) by January 1, 1991, on the extent of the use, cost, and effectiveness of in-home care. Covers nursing care and home health aide services as home health services if such services are needed less than seven days each week or are needed for an initial period of up to 35 consecutive days and for a subsequent period on a physician's certification of exceptional circumstances. Increases the maximum Medicare payment allowed for outpatient mental health services. Amends the Medicare program to adjust part B premiums to take into account the costs of additional benefits provided by this Act's catastrophic coverage. Directs the Secretary to: (1) take this Act's amendments into account in determining the payments to be made to health maintenance organizations; and (2) require such organizations to adjust their agreements with Medicare beneficiaries in consideration of such amendments. Directs the Secretary to: (1) mail a notice annually to Medicare beneficiaries of the extent to which Medicare coverage is provided for health care services and Medicare and Medicaid (title XIX of the Act) coverage is provided for long-term care services; and (2) send participating physician directories to part B enrollees. Directs the Secretary to report to the Congress within 150 days of this Act's enactment on recommended changes in the certification requirements for Medicare supplemental policies. Requires a Medicare supplemental policy to: (1) mail notice to beneficiaries before 1989 of improved Medicare benefits contained in legislation of the 100th Congress and the effect such legislation will have on such policy; and (2) submit a copy of each of its advertisements to the State Commissioner of Insurance for his or her review. Extends, through September 30, 1992, certain projects demonstrating the concept of a social health maintenance organization. Requires the Secretary to provide for research on issues relating to the delivery and financing of Medicare long-term care services. Authorizes appropriations for FY 1988 through 1992 for such research. Directs the Secretary to conduct a survey of adult day care services and report to the Congress within one year of this Act's enactment regarding such services, and standards which may be applied in providing Medicare coverage for such services. Title III: Provisions Relating to the Medicaid Program - Amends the Medicaid program to require States to provide Medicaid coverage of Medicare premiums, deductibles, and coinsurance payments for which Medicare-eligible individuals whose income does not exceed the Federal poverty level would otherwise be accountable. Prohibits States from setting the resource eligibility limit for such coverage at more than twice the resource limit for eligibility under the Supplemental Security Income program (title XVI of the Act). Gives U.S. Commonwealths and Territories the option of providing such coverage. Provides that for the initial determination of an institutionalized spouse's Medicaid eligibility the institutionalized spouse may transfer his or her resources to the community spouse to the extent the spousal share (computed by dividing the sum of the spouse's resources in half) is less than $12,000 (adjusted annually to reflect changes in the cost-of-living), but attributes any resources not solely in the ownership of the community spouse to the institutionalized spouse if such transfer is not made. Considers resources held in the name of the community spouse to be available to the institutionalized spouse to the extent their value exceeds $48,000 (adjusted annually to reflect changes in the cost-of-living), or, if greater, the amount a court has ordered to be retained by the community spouse for support. Provides that after the initial eligibility determination: (1) no resources of the community spouse will be considered available to the institutionalized spouse; and (2) the income of the institutionalized spouse will not be considered to include a specified personal needs allowance, community spouse monthly income allowance, family allowance, and incurred expenses for medical or remedial care for the institutionalized spouse that are not covered by a legally liable third party. Sets forth the formulas for determining such allowances. Gives the institutionalized spouse the right to a hearing to establish that the community spouse monthly income allowance is not adequate to support the community spouse without financial duress so that an adequate amount of support will be substituted for the allowance. Prohibits such allowance from being less than court-ordered support payments. Delays the Medicaid eligibility of institutionalized individuals who disposed of their resources at less than fair market value within two years prior to applying for Medicaid benefits. Sets forth situations in which a delay shall not be applied. Allows the institutionalized spouse to elect to be governed by State rules in effect as of March 1, 1987, regarding treatment of income and transfers of resources for Medicaid eligibility purposes, but permits neither spouse to opt out of this Act's rules regarding the treatment of resources at the initial eligibility determination. Title IV: United States Bipartisan Commission on Comprehensive Health Care - Establishes the United States Bipartisan Commission on Comprehensive Health Care which shall: (1) examine shortcomings in the current health care delivery and financing mechanisms that limit or prevent access of individuals to comprehensive health care; and (2) make recommendations to the Congress respecting Federal programs, policies, and financing needed to assure the availability of comprehensive long-term care for everyone. Directs the Commission to report to the Congress on its findings and recommendations regarding comprehensive long-term care for: (1) the elderly and disabled, within six months of this Act's enactment; and (2) everyone, within one year of this Act's enactment. Terminates the Commission 30 days after submission of the latter report. Authorizes appropriations for the implementation of this title.

(Reported to House from the Committee on Energy and Commerce with amendment, H. Rept. 100-105 (Part II)) Medicare Catastrophic Protection Act of 1987 - Title I: Provisions Relating to Part A of Medicare Program - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to require that an inpatient hospital deductible be paid only for the first period of continuous hospitalization in a calendar year. (Currently, such deductible must be paid for each "spell of illness" requiring inpatient hospital services.) Removes durational limitations on the coverage of inpatient hospital services, except with respect to inpatient psychiatric hospital services. Eliminates the coinsurance requirement for inpatient hospital services. Sets the inpatient hospital deductible for 1987 at $520, requiring cost-of-living adjustments to such deductible for succeeding years. Establishes the monthly part A premium, required of individuals who wish to buy into the Hospital Insurance program, at the monthly actuarial value of part A services provided to beneficiaries age 65 and over. Imposes a coinsurance rate, equal to 20 percent of the average per diem cost of post-hospital extended care services, for the first seven days of an individual's receipt of such services in a calendar year. Provides coverage for post-hospital extended care services for 150 days in each calendar year. (Currently, such coverage is limited to 100 days for each "spell of illness.") Drops restrictions on the coverage of extended care services which are not post-hospital extended care services. Creates an extension period of hospice care for terminally ill beneficiaries which is to follow the two 90-day periods and the subsequent 30-day period of hospice care coverage currently provided in an individual's lifetime. Reduces the deductible imposed under part A on the first three pints of blood furnished to an individual during a calendar year to the extent such blood is replaced or a blood deductible has been imposed on the individual under part B (Supplementary Medical Insurance) of the Medicare program within such year. Provides part A coverage for home health services only when an individual is not entitled to part B benefits. Amends the Internal Revenue Code to impose an annual supplemental Medicare premium on part A Medicare beneficiaries pursuant to a table which bases the amount of such premium due on the size of a beneficiary's gross income. Requires the Secretary of Health and Human Services to make returns setting forth certain information regarding part A Medicare beneficiaries. Title II: Provisions Relating to Part B of the Medicare Program and to the Medicaid Program - Amends part B (Supplementary Medical Insurance) of the Medicare program to cover all of the out-of-pocket part B expenses a beneficiary incurs in excess of $1,043 in 1989, adjusting such ceiling annually thereafter to reflect cost-of-living increases. Includes the reasonable expenses incurred for an annual colorectal examination for cancer and for a mammogram, once every third year, for detection of breast cancer as covered out-of-pocket expenses. Provides for the adjustment of Medicare payments to organizations providing health care on a prepaid basis so as to reimburse them for such excess out-of-pocket costs incurred on behalf of enrollees. Requires Medicare carriers to provide a physician who does not accept payment on an assigned basis with notice that: (1) an individual has reached the out-of-pocket expense limit; and (2) encourages the physician not to charge the individual in excess of the reasonable charge and to accept payment on an assigned basis for services furnished to the individual during the remainder of the year. Provides coverage of the catastrophic expenses for outpatient prescription drugs and insulin (outpatient drugs) under part B of the Medicare program. Sets the annual deductible for such coverage at $500 for 1989, with subsequent adjustments of such deductible reflecting changes in the cost of medical care. Covers all costs in excess of such deductible provided the cost for each drug does not exceed payment limits based on the average cost for each drug. Authorizes the Secretary to deny payment for outpatient drugs which are prescribed or dispensed with excessive frequency or in excessive quantities. Authorizes a pharmacy to enter into an agreement with the Secretary to accept payment under part B of the Medicare program on an assigned basis for outpatient drugs furnished to part B enrollees. Sets forth the obligations of participating pharmacies, including the requirements that they: (1) charge Medicare beneficiaries no more for drugs than they charge the general public; (2) keep patient records for all outpatient drugs dispensed to such beneficiaries; (3) assist beneficiaries in determining whether or not their expenses have exceeded the annual deductible; and (4) offer to counsel each of their beneficiaries on the appropriate use of such drugs and the availability of therapeutically equivalent outpatient drugs. Requires the Secretary to provide each participating pharmacy with: (1) a distinctive emblem indicating its status as such; and (2) information on the payment limits established for outpatient drugs. Increases the monthly Medicare part B premium to cover Medicare payments for outpatient drugs. Requires Medicare carriers which make determinations or payments with respect to outpatient drugs to offer to receive requests from participating pharmacies for payments for such drugs through electronic communications and respond to requests by such pharmacies as to whether or not an individual has paid the deductible for such drugs. Directs the Secretary to: (1) take this Act's amendments into account in estimating the adjusted average per capita cost used in computing payments to be made to health maintenance organizations; and (2) require such organizations to adjust their agreements with Medicare beneficiaries in consideration of such amendments. Covers in-home care furnished, under the supervision of a registered professional nurse, by a home health agency or by others under arrangements with such agency to an individual who, for the preceding three months, has been unable to perform at least two specified daily living activities without the assistance of an uncompensated primary caregiver with whom he or she resides. Limits such coverage to 120 hours per year. Provides for increases in the Medicare part B premium to meet the costs of such in-home care. Directs the Secretary to report to the Congress: (1) within 18 months of this Act's enactment, on the advisability of providing out-of-home services as alternative services to in-home care; and (2) by January 1991, on the extent of use, cost, and effectiveness of in-home care. Covers nursing care and home health aide services as home health services if such services are needed less than seven days each week or are needed for an initial period of up to 35 consecutive days and for a subsequent period on a physician's certification of exceptional circumstances. Increases the maximum Medicare payment allowed for outpatient mental health services. Covers influenza vaccines and their administration. Increases the Medicare part B premium to meet the costs of such coverage. Directs the Secretary to: (1) mail a notice annually to Medicare beneficiaries of the extent to which Medicare coverage is provided for health care services and Medicare and Medicaid (title XIX of the Act) coverage is provided for long-term care services; and (2) send participating physician directories to part B enrollees. Amends the Medicaid program to require States to provide Medicaid coverage of Medicare premiums, deductibles, and coinsurance payments for which Medicare-eligible individuals whose income does not exceed the Federal poverty level would otherwise be accountable. Prohibits States from setting the resource eligibility limit for such coverage at more than twice the resource limit for eligibility under the Supplemental Security Income program (title XVI of the Act). Gives U.S. Commonwealths and Territories the option of providing such coverage. Amends the Medicare Program to adjust part B premiums to take into account the costs of additional benefits provided by this Act's catastrophic coverage. Directs the Secretary to report to the Congress within 150 days of this Act's enactment on recommended changes in the certification requirements for Medicare supplemental policies. Requires a Medicare supplemental policy to: (1) mail notice to beneficiaries before 1989 of improved Medicare benefits contained in legislation of the 100th Congress and the effect such legislation will have on such policy; and (2) submit a copy of each of its advertisements to the State Commissioner of Insurance for his or her review. Extends, through September 30, 1992, certain projects demonstrating the concept of a social health maintenance organization. Directs the Comptroller General to report to the Congress within six months of this Act's enactment on the need for, and cost of, including within the Medicare program: (1) annual preventive care visits; (2) routine eye care; (3) dental services; (4) hearing aids for those with a significant hearing loss and biannual hearing testing; (5) comprehensive long-term care services; and (6) prescription drugs and biologicals. Requires the Secretary to provide for research on issues relating to the delivery and financing of Medicare long-term care services. Authorizes appropriations for FY 1988 through 1992 for such research. Provides that for the initial determination of an institutionalized spouse's Medicaid eligibility the institutionalized spouse may transfer his or her resources to the community spouse to the extent the spousal share (computed by dividing the sum of the spouse's resources in half) is less than $12,000 (adjusted annually to reflect changes in the cost-of-living), but attributes any resources not solely in the ownership of the community spouse to the institutionalized spouse if such transfer is not made. Considers resources held in the name of the community spouse to be available to the institutionalized spouse to the extent their value exceeds $48,000 (adjusted annually to reflect changes in the cost-of-living), or, if greater, the amount a court has ordered to be retained by the community spouse for support. Provides that after the initial eligibility determination: (1) no resources of the community spouse will be considered available to the institutionalized spouse; and (2) the income of the institutionalized spouse will not be considered to include a specified personal needs allowance, community spouse monthly income allowance, family allowance, and incurred expenses for medical or remedial care for the institutionalized spouse that are not covered by a legally liable third party. Sets forth the formulas for determining such allowances. Gives the institutionalized spouse the right to a hearing to establish that the community spouse monthly income allowance is not adequate to support the community spouse without financial duress so that an adequate amount of support will be substituted for the allowance. Prohibits such allowance from being less than court-ordered support payments. Delays the Medicaid eligibility of institutionalized individuals who disposed of their resources at less than fair market value within two years prior to applying for Medicaid benefits. Sets forth situations in which a delay shall not be applied. Allows the institutionalized spouse to elect to be governed by State rules in effect as of March 1, 1987, regarding treatment of income and transfers of resources for Medicaid eligibility purposes, but permits neither spouse to opt out of this Act's rules regarding the treatment of resources at the initial eligibility determination. Directs the Secretary to conduct a survey of adult day care services and report to the Congress within one year of this Act's enactment regarding such services, and standards which may be applied in providing Medicare coverage for such services. Title III: United States Bipartisan Commission on Comprehensive Health Care - Establishes the United States Bipartisan Commission on Comprehensive Health Care which shall: (1) examine shortcomings in the current health care delivery and financing mechanisms that limit or prevent access of individuals to comprehensive health care; and (2) make recommendations to the Congress respecting Federal programs, policies, and financing needed to assure the availability of comprehensive long-term care for everyone. Directs the Commission to report to the Congress on its findings and recommendations regarding comprehensive long-term care for: (1) the elderly and disabled, within six months of this Act's enactment; and (2) everyone, within one year of this Act's enactment. Terminates the Commission 30 days after submission of the latter report. Authorizes appropriations for the implementation of this title.

Medicare Catastrophic Protection Act of 1987 - Title I: Provisions Relating to Part A of Medicare Program - Amends part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act to require that an inpatient hospital deductible be paid only for the first period of continuous hospitalization in a calendar year. (Currently, such deductible must be paid for each "spell of illness" requiring inpatient hospital services.) Removes durational limitations on the coverage of inpatient hospital services, except with respect to inpatient psychiatric hospital services. Eliminates the coinsurance requirement for inpatient hospital services. Sets the inpatient hospital deductible for 1987 at $520, requiring cost-of-living adjustments to such deductible for succeeding years. Establishes the monthly part A premium, required of individuals who wish to buy into the Hospital Insurance program, at the monthly actuarial value of part A services provided to beneficiaries age 65 and over. Imposes a coinsurance rate, equal to 20 percent of the average per diem cost of post-hospital extended care services, for the first seven days of an individual's receipt of such services in a calendar year. Provides coverage for post-hospital extended care services for 150 days in each calendar year. (Currently, such coverage is limited to 100 days for each "spell of illness.") Drops restrictions on the coverage of extended care services which are not post-hospital extended care services. Creates an extension period of hospice care for terminally ill beneficiaries which is to follow the two 90-day periods and the subsequent 30-day period of hospice care coverage currently provided in an individual's lifetime. Reduces the deductible imposed under part A on the first three pints of blood furnished to an individual during a calendar year to the extent such blood is replaced or a blood deductible has been imposed on the individual under part B (Supplementary Medical Insurance) of the Medicare program within such year. Provides part A coverage for home health services only when an individual is not entitled to part B benefits. Amends the Internal Revenue Code to impose an annual supplemental Medicare premium on part A Medicare beneficiaries pursuant to a table which bases the amount of such premium due on the size of a beneficiary's gross income. Requires the Secretary of Health and Human Services to make returns setting forth certain information regarding part A Medicare beneficiaries. Title II: Provisions Relating to Part B of the Medicare Program - Amends part B (Supplementary Medical Insurance) of the Medicare program to cover all of the out-of-pocket part B expenses a beneficiary incurs in excess of $1,043 in 1989, adjusting such ceiling annually thereafter to reflect cost-of-living increases. Provides for the adjustment of Medicare payments to organizations providing health care on a prepaid basis so as to reimburse them for such excess out-of-pocket costs incurred on behalf of enrollees. Covers nursing care and home health aide services as home health services if such services are needed less than seven days each week or are needed for an initial period of up to 35 consecutive days and for a subsequent period on a physician's certification of exceptional circumstances. Increases the maximum Medicare payment allowed for outpatient mental health services. Directs the Secretary to: (1) mail a notice annually to Medicare beneficiaries of the extent to which Medicare coverage is provided for health care services and Medicare and Medicaid (title XIX of the Act) coverage is provided for long-term care services; and (2) send participating physician directories to part B enrollees. Amends title XVI (Supplemental Security Income) of the Act to provide Medicaid coverage to part A Medicare beneficiaries whose income does not exceed the Federal poverty level applicable to a family of one or two individuals which includes an individual age 65 or older. Amends the Medicare program to make permanent the provisions authorizing a State to arrange for Medicare coverage of individuals covered by certain other titles of the Act. Provides for the adjustment of Medicare part B premiums to take into account the costs of additional benefits provided by this Act's catastrophic coverage. Directs the Secretary to report to the Congress within 150 days of this Act's enactment on recommended changes in the certification requirements for Medicare supplemental policies. Requires a Medicare supplemental policy to: (1) mail notice to beneficiaries before 1989 of improved Medicare benefits contained in legislation of the 100th Congress and the effect such legislation will have on such policy; and (2) submit a copy of each of its advertisements to the State Commissioner of Insurance for his or her review. Extends, through September 30, 1992, certain projects demonstrating the concept of a social health maintenance organization. Directs the Comptroller General to report to the Congress within six months of this Act's enactment on the need for, and cost of, including within the Medicare program: (1) annual preventive care visits; (2) routine eye care; (3) dental services; (4) hearing aids for those with a significant hearing loss and biannual hearing testing; (5) comprehensive long-term care services; and (6) prescription drugs and biologicals. Requires the Secretary to provide for research on issues relating to the delivery and financing of Medicare long-term care services. Authorizes appropriations for FY 1988 through 1992 for such research.