This timeline highlights those provisions that physicians need to know, but that don't require specific action.
Created by TNMED on Mar 30, 2011
Last updated: 05/31/11 at 12:29 PM
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What It Is: The Department of Health and Human Services will have, not later than July 1, 2013, issued regulations for the creation of health care choice compacts under which two or more states would be allowed to enter into an agreement under which one or more qualified health plans could be offered in the individual markets in all states but, with some exceptions, only be subject to the laws and regulations of the state in which the plan was issued. Where It Is: §1333 of the PPACA
What It Is: Certain hospitals will see a 1% reduction in Medicare payments for hospital-acquired conditions. Where It Is: § 3008 of the PPACA Applies Fiscal Year 2015.
What It Is: Medicaid disproportionate share payments to hospitals will be reduced by $18 billion between this date at 2020. Where It Is: §§2551 and 10201 of the PPACA; Amended by §1203 of the Reconciliation Act
1. Expanded Medicaid Coverage
2. Presumptive Eligibility for Medicaid
3. First Recommendations Due from Medicare Independent Payment Advisory Board
4. Creation of State-Based Health Benefit Exchanges
5. Prohibition on Annual Coverage Limits
6. Allowance for Wellness Programs in Insurance
Please click on the link below for more information.
What It Is: The Consumer Operated and Orient Plan (CO-OP) will be created to foster the creation of non-profit, member-run health insurance companies. Where It Is: §1322 of the PPACA
Ends January 1, 2015. What It Is: Increases Medicaid payments for primary care services provided by primary care physicians to 100% of the Medicare payment rate for 2013 and 2014. States will receive 100% federal funding to cover the costs. Where It Is: §1202 of the Reconciliation Act
What It Is: Federal subsidies for brand-name prescriptions filled in the Medicare Part D prescription coverage gap begin, and increase annually until 2020, when the discount will be 75%. Where It Is: §3301 of the PPACA; Amended by §1101 of the Reconciliation Act
What It Is: The tax deduction for Medicare-eligible retiree pharmaceutical plans will be eliminated on this date. Where It Is: §9012 of the PPACA; Amended by §1407 of the Reconciliation Act
What It Is: Imposition of a 2.3% on all medical devices sold. Exempts eyeglasses, hearing aids, and other items to be determined by rule. Where It Is: §1405 of the PPACA
What It Is: Medicare Advantage plan rebates will decrease beginning in 2012. Further, Medicare Advantage plans will be rated on a five-star basis for “quality,” with beneficiaries being eligible for greater rebates if they participate in a higher-rated plan. Where It Is: §1102 of the Reconciliation Bill
What It Is: Establishment of increased compliance, screening and oversight procedures and enhanced disclosure requirements, as well as a potential temporary moratorium on enrollment for new providers. Where It Is: §6401 of the PPACA
What It Is: Revision of market basket updates, incorporating a full productivity adjustment into any updates that do not already incorporate such adjustments. Where It Is: §3401 of the PPACA
What It Is: The Medicare Independent Payment Advisory Board’s purpose will be to reduce the per capita rate of growth in Medicare spending. Proposals will be submitted to Congress beginning January of 2014. Where It Is: §3403 of the PPACA
What It Is: The Secretary of Health and Human Services will be required to identify state-based initiatives to deny payments for hospital-acquired infections and incorporate the best practices applicable to Medicaid into federal regulations prohibiting federal payments to states for Medicaid services related to certain such conditions. Where It Is: §2702 of the PPACA
What It Is: Planning and establishment grants will begin to be awarded to states to begin planning American Health Benefit Exchanges and Small Business Health Options Program Exchanges. Where It Is: §1311 of the PPACA
1. Additional Medicare Incentive Payments for Primary Care Providers
2. Additional Medicare Incentive Payments for General Surgeons Practicing in Health Professional Shortage Areas
3. Removal of Barriers to Preventive Services in Medicare
4. Closing the Medicare Prescription Drug "Donut Hole"
5. Changes to Medicare Advantage Plan Payments
6. Changes to Tax-Free Savings Accounts
Please see the link below for more information.
For Plan or Policy Years Beginning On or After September 23, 2010 What It Is: A group and individual health benefit plan that provides coverage must continue to make coverage available for adult children until the individual turns 26. Where It Is: §2714 of the PPACA
For Plan or Policy Years Beginning On or After September 23, 2010 What It Is: Group health plans and health insurance issuers offering group or individual health insurance coverage must provide coverage, without cost share requirements, for: (1) preventive services that have an A or B rating by the USPSTF; (2) recommended immunizations; and (3) preventive care for women and children. Where It Is: §2713 of the PPACA
For Plan or Policy Years Beginnings On or After September 23, 2010 What It Is: Group health plans and health insurance issuer offering group or individual health insurance coverage shall implement an effective appeals process for appeals of coverage determinations and claims, under which the plan or issuer shall, at a minimum: (1) have an internal appeals process; (2) provide effective notice of the process to enrollees; (3) allow enrollees to review their files and present evidence and testimony as part of the appeal process; and (4) be subject to an authorized external review process. Where It Is: §2719 of the PPACA
What It Is: Eligibility for the 340(B) drug discount program will be expanded to certain children’s hospitals, certain free-standing cancer hospitals, critical access hospitals, rural referral centers, and other entities. Where It Is: §§7101-7103 of the PPACA
What It Is: The Department of Health and Human Services has established a high-risk pool program to provide health coverage for previously uninsured people with a pre-existing condition. The program will last until January 1, 2014. Where It Is: §1101 of the PPACA
What It Is:
The Department of Health and Human Services has created a website for consumers designed to inform consumers as to new information and resources regarding health coverage options.
Where It Is:
§4004 of the PPACA
Ends January 1, 2014 What It Is: A temporary reinsurance program to provide partial reimbursement to participating employment-based plans for the cost of providing health insurance coverage to early retirees and their dependents during this period. Where It Is: §1102 of the PPACA, amended by §10102 of the PPACA
What It Is: Extends the Medicaid drug rebate to Medicaid Managed Care plans. Where It Is: §2501 of the PPACA
What It Is: The Coordinated Health Care Office is within CMS, and exists to improve coordination of care for patients with dual eligibility (eligibility for both Medicare and Medicaid). Where It Is: §2602 of the PPACA
Funding Begins Fiscal Year 2010 What It Is: The Patient-Centered Outcomes Research Institute (PCORI) is a non-profit corporation that is not an agency or establishment of the US government. The goal of the PCORI is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which various health conditions can be effectively and appropriately prevented, treated, monitored and managed. Where It Is: §6301 of the PPACA
What It Is: Medicare beneficiaries who reached the Part D coverage gap in 2010 received a $250 rebate. Where It Is: §3301 of the PPACA; Amended by §1101 of the Reconciliation Act
Begins Fiscal Year 2010. What It Is: Reduction in market basket updates for hospital services, long-term care facilities, inpatient rehabilitation facilities, and psychiatric hospitals. Adjustments to payments will be made based on productivity beginning in 2012. Where It Is: §3401 of the PPACA
What It Is: Increases the Medicaid matching rate for most brand-name prescription drugs by 23.1%, except for clotting factors and drugs approved by the FDA exclusively for pediatric use, which will increase by 17.1%. The Medicaid matching rate for generic, non-innovator drugs is increased by 13%. Where It Is: §2501 of the PPACA