Health Reform Implementation

The following information is from the Kaiser Family Foundation.  I am posting this for information.  Please no politics.  Here is the link.  http://www.kff.org/healthreform/8060.cfm

2010

Insurance Reforms:

Establish a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions. (Effective 90 days following enactment until January 1, 2014) -----Provide dependent coverage for adult children up to age 26 for all individual and group policies. -----Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage and prior to 2014, plans may only impose annual limits on coverage as determined by the Secretary. Prohibit insurers from rescinding coverage except in cases of fraud and prohibit pre-existing condition exclusions for children. -----Require qualified health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women. -----Provide tax credits to small employers with no more than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees. -----Create a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. (Effective 90 days following enactment until January 1, 2014)-----Require health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers for the amount of the premium spent on clinical services and quality that is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets. (Requirement to report medical loss ratio effective plan year 2010; requirement to provide rebates effective January 1, 2011) -----Establish a process for reviewing increases in health plan premiums and require plans to justify increases. Require states to report on trends in premium increases and recommend whether certain plan should be excluded from the Exchange based on unjustified premium increases.

2010

Medicaid:

Create a state option to cover childless adults though a Medicaid state plan amendment.-----
Create a state option to provide Medicaid coverage for family planning services up to the highest level of eligibility for pregnant women to certain low-income individuals through a Medicaid state plan amendment. -----
Create a new option for states to provide Children's Health Insurance Program (CHIP) coverage to children of state employees eligible for health benefits if certain conditions are met. -----
Increase the Medicaid drug rebate percentage for brand name drugs to 23.1% (except the rebate for clotting factors and drugs approved exclusively for pediatric use increases to 17.1%); increase the Medicaid rebate for non-innovator, multiple source drugs to 13% of average manufacturer price; and extend the drug rebate to Medicaid managed care plans. -----

Provide funding for and expand the role of the Medicaid and CHIP Payment and Access Commission to include assessments of adult services (including those dually eligible for Medicare and Medicaid). -----
Require the Secretary of HHS to issue regulations to establish a process for public notice and comment for section 1115 waivers in Medicaid and CHIP.-----

2010

Tax Changes:

Impose additional requirements on non-profit hospitals. Impose a tax of $50,000 per year for failure to meet these requirements. Limit the deductibility of executive and employee compensation to $500,000 per applicable individual for health insurance providers. Impose a tax of 10% on the amount paid for indoor tanning services. Exclude unprocessed fuels from the definition of cellulosic biofuel for purposes of applying the cellulosic biofuel producer credit. Clarify application of the economic substance doctrine and increase penalties for underpayments attributable to a transaction lacking economic substance.

2011

Medicare:

Require pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begin phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.
Provide a 10% Medicare bonus payment to primary care physicians, and to general surgeons practicing in health professional shortage areas. (Effective 2011 through 2015)
Restructure payments to Medicare Advantage plans by setting payments to different percentages of Medicare fee-for-service rates.
Prohibit Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.
Provide Medicare payments to qualifying hospitals in counties with the lowest quartile Medicare spending for 2011 and 2012.
Freeze the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels, and reduce the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple. 

Create an Innovation Center within the Centers for Medicare and Medicaid Services.

I think I will stop here.  The site continues with implementation by category by year.  Here is the link again.

http://www.kff.org/healthreform/8060.cfm

The most substantial changes occur in the later years with full implementation in 2015.

If anyone would like me to continue the copying by category and year, I will.

Health Care 2012:

• Accountable Care Organizations in Medicare

Allows providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.

Implementation: January 1, 2012

• Medicare Advantage Plan Payments

Reduces rebates paid to Medicare Advantage plans and provides bonus payments to high-quality plans.

Implementation: January 1, 2012

• Medicare Independence at Home Demonstration

Creates the Independence at Home demonstration program to provide high-need Medicare beneficiaries with primary care services in their home.

Implementation: January 1, 2012

• Medicare Provider Payment Changes

Adds a productivity adjustment to the market basket update for certain providers, resulting in lower rates than otherwise would have been paid.

Implementation: Begins calendar, fiscal, or rate year 2012, as appropriate

• Fraud and Abuse Prevention

Establishes procedures for screening, oversight, and reporting for providers and suppliers that participate in Medicare, Medicaid, and CHIP; requires additional entities to register under Medicare.

Implementation: January 1, 2012

• Annual Fees on the Pharmaceutical Industry

Imposes new annual fees on the pharmaceutical manufacturing sector.

Implementation: January 1, 2012

• Medicaid Payment Demonstration Projects

Creates new demonstration projects in Medicaid for up to eight states to pay bundled payments for episodes of care that include hospitalizations and to allow pediatric medical providers organized as accountable care organizations to share in cost-savings.

Implementation: January 1, 2012 through December 31, 2016

• Data Collection to Reduce Health Care Disparities

Requires enhanced collection and reporting of data on race, ethnicity, sex, primary language, disability status, and for underserved rural and frontier populations.

Implementation: March 23, 2012

• Medicare Value-Based Purchasing

Establishes a hospital value-based purchasing program in Medicare to pay hospitals based on performance on quality measures and requires plans to be developed to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.

Implementation: October 1, 2012

• Reduced Medicare Payments for Hospital Readmissions

Reduces Medicare payments that would otherwise be made to hospitals to account for excess (preventable) hospital readmissions.

Implementation: October 1, 2012

Bump

Bump

You're welcome.

According to a recent poll over half of Americans think the Health Care Bill was repealed.  This is not the case.  The bill was repealed in the House but was not repealed in the Senate.  It is still in affect.  This schedule of implementation is still valid.

Bump.

Bump