|
Grant Community.com Catalog of Federal Domestic Assistance Program Descriptions |
CATALOG OF FEDERAL DOMESTIC
ASSISTANCE
93.773: Medicare: Hospital Insurance
|
| PROGRAM AND AWARD | FINANCIAL AND INFORMATION CONTACTS |
| ELIGIBILITY REQUIREMENTS | FINANCIAL AND ADMINISTRATIVE INFO. |
| APPLICATION AND AWARD PROCESS | INFORMATION CONTACTS |
| RELATED PROGRAMS | ASSISTANCE CONSIDERATIONS |
| PROGRAM ACCOMPLISHMENTS | POST ASSISTANCE REQUIREMENTS |
Applicant Eligibility: Persons age 65 or over and certain disabled persons are eligible for hospital insurance protection. Nearly everyone who reached 65 before 1968 is eligible for hospital insurance, including people not eligible for cash Social Security benefits. A person reaching age 65 in 1968 or after, who is not eligible for cash benefits, needs some work credit to qualify for hospital insurance benefits. The amount of work credit needed depends on age. Hospital insurance (Medicare Part A) is also available to persons, age 65 or over, not otherwise eligible through payment of a monthly premium which is currently $301. A reduced Part A premium of $166 per month in 2000 is available to persons with 30 or more quarters paid into the social security system, as well as to their spouse, surviving spouse or divorced spouse. The reduction in Part A premium payments would also apply to the surviving spouse, or divorced spouse of an individual who had at least 30 quarters of coverage under the social security system. Federal employees began contributing toward Medicare hospital insurance coverage beginning January 1983. Employees who worked prior to 1983 and who were employed during January 1983, can receive credit toward establishing Medicare eligibility, if necessary, for prior non-contributory quarters of Federal employment. State and local government employees not already in Social Security-covered positions and hired on or after April 1, 1986 also contribute toward Medicare hospital insurance coverage. Although States may request agreements to cover individuals employed prior to April 1, 1986, no credit is given toward establishing Medicare entitlement for prior employment. Persons under age 65 who have been entitled for at least 24 months to Social Security disability benefits, or for 29 consecutive months to railroad retirement benefits based on disability, are eligible for hospital insurance benefits.
Beneficiary Eligibility: Persons age 65 or over and qualified disabled persons.
Credentials/Documentation: Proof of age or disability. This program is excluded from coverage under OMB Circular No. A-87.
Preapplication Coordination: None. This program is excluded from coverage under E.O. 12372.
Application Procedure: Phone or visit the local Social Security Office. Individuals entitled to Social Security or railroad retirement are enrolled without application. This program is excluded from coverage under OMB Circular Nos. A-102 and A-110.
Award Procedure: The individual will be notified by mail of enrollment, whether automatic or applied for.
Deadlines: None.
Range of Approval/Disapproval Time: Not applicable.
Appeals: Phone or visit the local Social Security Office or Medicare payment organization responsible for the initial determination. The appeal process ranges from reviews of the initial determinations to formal hearings and, in cases meeting certain criteria, reviews by Federal Courts.
Renewals: Not applicable.
Criteria for Selecting Proposals: Not applicable.
Examples of Funded Projects: Not applicable.
Range and Average of Financial Assistance: Benefits may be paid based on the prospective payment amount or the reasonable costs of covered inpatient hospital services and based on the reasonable costs of covered post-hospital extended care services which are incurred during a benefit period. For benefit periods beginning in calendar year 2000, the beneficiary is responsible for a $776 inpatient hospital deductible, a $194 per day coinsurance amount for the 60 through ninetieth day of inpatient hospital care, a $388 per day coinsurance amount for inpatient hospital care during the 60 lifetime reserve days, and a $97.00 per day coinsurance amount for days 21 through 100 of care in a skilled nursing facility. Home health services are paid in full.
In fiscal year 1999, 38,844,000 persons were protected. In fiscal year 2000, we estimate that the number of persons protected will be 39,261,000. In fiscal year 2001 the number of persons protected is estimated to be 39,702,000.
Federal Agency: HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Type of Assistance: Direct Payments for Specified Use.
Obligations: (Benefit Outlays) FY 99 $129,107,320; FY 00 est $129,216,000; and FY 01 est $139,869,000.
Budget Account Number: 20-8005-0-7-571.
Authorization: Social Security Act Amendments of 1965, Title XVIII, Part A, Public Law 89-97, as amended, Public Laws 90-248, 92-603, 93-233, 94-182, 94-437 and 95-292, 42 U.S.C. 1395 et seq.; Social Security Disability Amendments of 1980, Public Law 96-265; Public Law 97-248; Section 1, Public Law 98-21; Subtitle A, Public Law 98-369; Public Law 98-460, 99-177, 99-272, 99-509, and 100-203, 42 U.S.C. 1305 Note; Medicare Catastrophic Coverage Repeal Act of 1988, Title I, Subtitles A and B, and Title IV, Subtitle B and C, Public Law 100-360; Catastrophic Coverage Repeal Act of 1989, Public Law 101-234; Omnibus Budget Reconciliation Act of 1989, Title VI, Subtitle A, Public Law 101-239; Omnibus Budget Reconciliation Act of 1990, Public Law 101-508; Omnibus Budget Reconciliation Act of 1993, Public Law 103-66; Social Security Act Amendments of 1994, Public Law 103-432; Contract with America Advancement Act of 1996, Public Law 104-121; Health Insurance Portability and Accountability Act of 1996, Public Law 104-191; Balanced Budget Act of 1997, Public Law 105-33. Balanced Budget and Refinement Act of 1999, Public Law 106-113.
Regulations, Guidelines, and Literature: Code of Federal Regulations, Title 20, Parts 401, 405 and 422; Title 42, Parts 400, 401, 405, 406, 409, 412, 417, and 418. "Your Medicare Handbook," SSA-79-10050, and other publications are available from any Social Security Office without charge.
Regional or Local Office: Consult Appendix IV of the Catalog for a listing of Regional Offices.
Headquarters Office: Mrs. Carol Cronin, Director, Center for Beneficiary Services, Health Care Financing Administration, Room C5-19-07, 7500 Security Blvd., Baltimore, MD 21244. Phone: (410) 786-2744. Use the same number for FTS.
(See Appendix IV for more contact info.)
Formula and Matching Requirements: This program has no statutory formula or matching requirements.
Length and Time Phasing of Assistance: Not applicable.
Uses and Use Restrictions: Hospital insurance benefits are paid to participating and emergency hospitals, skilled nursing facilities, home health agencies, and hospice agencies to cover the prospective payment amount or reasonable cost of medically necessary services furnished to individuals entitled under this program.
Reports: None.
Audits: None.
Records: None.
About
News Grant
Management Software Federal
Grant Programs Audits
Studies Expenditures
Links
Last Updated, November, 2000
Comments or Questions? ©Grant
Community.com 2000, All Rights Reserved