National and state-level healthcare reform provisions are outlined and categorized.
Created by CBHC303 on Jun 3, 2010
Last updated: 06/08/10 at 03:56 PM
Allows all young adults who previously participated in foster care to qualify for Medicaid and all associated benefits, such as the Early Periodic Screening, Diagnosis, and Treatment Program, until age 25.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Imposes an excise tax of 40% on health insurers and health plan administrators for any plan with a premium that exceeds $10,200 for individual coverage and $27,500 for family coverage, with the tax applied to the amount of the premium in excess of the threshold
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Allows states to apply for a waiver for as many as five years of requirements related to Exchanges, qualified health plans, and cost-sharing, provided that states can prove the waivers would provide comprehensive and affordable health insurance to at least a comparable number of residents as Exchanges
Allows Health Care Choice Compacts to begin operations
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires individuals to maintain minimum essential health insurance for themselves and applicable dependents in each month or pay a penalty, with exemptions for individuals who cannot afford health insurance, those who have incomes less than the federal tax filing threshold, members of Indian tribes, and those who lack coverage for less than three months in a year.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Establishes premium assistance credits for individuals and families that have incomes at or less than 400% of the federal poverty level and enroll in health plans in Exchanges
Caps standard out-of-pocket costs for health plans in Exchanges at $5,950 for individuals and $11,900 for families, with lower caps for individuals and families that receive premium assistance credits
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Prohibits discrimination by group or individual health plans against all individuals who have pre-existing medical conditions
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires each state to establish an American Health Benefit Exchange and a Small Business Health Options Program Exchange for individuals and small businesses that have 50 to 100 employees (allows expansion to larger employers after 2016)
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Prohibits the establishment of annual limits on benefits by group and individual health plans
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires state Medicaid programs to cover all individuals who are younger than age 65 and have incomes at or less than 133% of the federal poverty level and provides these programs with increased match rates for coverage of newly eligible individuals
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires the HHS secretary to award grants to states to establish American Health Benefit Exchanges, as well as establish standards for Exchanges, qualified health plans, reinsurance, and risk adjustment.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Provides states with a 23 percentage point increase in their federal CHIP match rates, with a cap at 100%
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires the HHS secretary to issue regulations for interstate Health Care Choice Compacts, which can offer qualified health plans in all associated states, provided that these plans adhere to the consumer protection and other laws of each of the states
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
In the event that the HHS secretary determines a state will not have an operational Exchange by 2014, allows the secretary to operate an Exchange in that state.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires HHS to transition Medicare beneficiaries enrolled in SNPs that do not meet statutory target definitions.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Establishes a demonstration project that will allow qualified pediatric providers to receive recognition and payments under Medicaid as accountable care organizations, as well as permit ACOs that meet quality of care standards and reduce costs to share in a portion of their savings to the program
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Establishes a program to create and fund the development of community health teams to support the creation of medical homes through increased access to comprehensive, community-based, and coordinated care
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Allows accountable care organizations that meet quality of care standards and reduce costs to share in a portion of their savings to Medicare.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires SNPs to obtain approval from the National Committee for Quality Assurance.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires HHS to establish a three-year Medicaid demonstration project to reimburse certain institutions for mental disease for services provided to beneficiaries who are between ages 21 and 65 and require medical assistance to stabilize an emergency psychiatric condition.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Create a new Medicaid state plan option to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a health home. Provide states taking up the option with 90% FMAP for two years for health home related services including care management, care coordination and health promotion.
http://www.kff.org/healthreform/8060.cfm
Allows states to enroll Medicaid beneficiaries with chronic conditions, which include serious and persistent mental illness, into medical homes as part of pilot projects.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Requires an evaluation of Medicare Advantage risk adjustment for chronically ill beneficiaries.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Allows HHS to apply a frailty payment adjustment to fully integrated, dual-eligible SNPs that enroll frail Medicare beneficiaries.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Establishes a voluntary, public long-term care insurance program for the purchase of community living assistance services and supports by individuals who have functional limitations.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Creates a new center, the CMS Center for Medicare and Medicaid Innovation, to test innovative payment and service delivery models (no later than January 1, 2011).
http://www.kff.org/healthreform/upload/8060.pdf
Requires pharmaceutical companies to provide a 50% discount to Medicare Part D beneficiaries for brand-name medications and biologics purchased in the “donut hole” coverage gap
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Prohibits discrimination by group or individual health plans against children who have pre-existing medical conditions
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Provide dependent coverage for adult children up to age 26 for all individual and group policies.
http://www.kff.org/healthreform/8060.cfm
Prohibits the establishment of lifetime limits on benefits by group and individual health plans.
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Establishes a Community First Choice Option through which state Medicaid programs can offer community-based attendant services and supports to beneficiaries who otherwise would require the level of care offered in a hospital, nursing home, or intermediate care facility for the mentally retarded
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
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.
http://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdfhttp://www.kff.org/healthreform/upload/8060.pdf
Creates a state option to provide Medicaid coverage for family planning services to certain low-income individuals through a Medicaid State Plan
Amendment up to the highest level of eligibility for pregnant women.
http://www.kff.org/healthreform/upload/8060.pdf
Provide a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 and gradually eliminate the Medicare Part D coverage gap by 2020.
http://www.kff.org/healthreform/8060.cfm
Improve care coordination for dual eligibles by creating a new office within the Centers for Medicare and Medicaid services, the Federal Coordinated
Health Care Office.
http://www.kff.org/healthreform/upload/8060.pdf
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)
http://www.kff.org/healthreform/upload/8060.pdf
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)
http://www.kff.org/healthreform/8060.cfm
Provide tax credits to small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance for
employees.
http://www.kff.org/healthreform/upload/8060.pdf
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 plans should be excluded from the Exchange based on unjustified premium increases.
http://www.kff.org/healthreform/upload/8060.pdf
Maintenance of effort: requires states to maintain current income eligibility levels for CHIP through September 2019
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Extends the Special Needs Plan program through 2013
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
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 ServicesTask Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women. (required within six months of enactment)
http://www.kff.org/healthreform/upload/8060.pdf
Maintenance of effort: requires states to maintain current Medicaid income eligibility levels for children
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
Creates a state option to cover childless adults though a Medicaid State Plan Amendment.
Allows state Medicaid programs to cover parents and childless adults who have incomes at or less than 133% of the federal poverty level at their current federal match rates
http://www.thenationalcouncil.org/galleries/policy-file/HC%20Reform%20Law%20Timeline.pdf
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